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Can Technology Fix the Health Care System?
I was surfing through my usual tech sites for the latest news when I came across an article on Wired News. It turns out Steve Case is not alone in the quest to fix the health care system. I guess I don't get what the big attraction for these guys are.... I know the US's health care system is messed up, but I'm not sure technology can fix all of the aches, pains and dysfunction in our current system. I don't get why they don't just join a major company's board or start a hip/trendy start-up....
The biggest impediment to a great health care system is, and will always be, regulation. Regulation comes from one monster: the State.
The US had the greatest healthcare system in the world. Then the U.S. Federal State decided to start destroying it, piece by piece, through regulation. After the HMO Act of 1973, healthcare quickly degraded. Instead of removing the regulations, the State decided to make new ones, creating more aggressive monopoly powers (see: AMA), making costs go up (by providing tax relief for corporations and not individuals), and then tossing new entitlements into the system (medicare, medicaid, VA, etc) that made everyone's prices go up.
What's the old adage about insurance? Invite all your friends to dinner, and most will have burgers instead of steak. Agree to split the bill equally, and a few will order steak, but pay less for their share. Eventually, everyone will want steak, and they'll wonder why no one can afford dinner. It is no different with State-forced health care, and State-regulated healthcare.
To fix healthcare, start by dumping your AMA doctors. Ask your doctor if they are affiliated with the AMA, and if they are, walk. Find a great AAPS doctor, and pay them cash (they are MUCH cheaper paying cash than most deductibles with insurance). Start saving a nice nest egg, and then start increasing your deductible as high as you can -- $10,000 or more once your nest egg gets there. Insurance is for detrimental emergencies, not to check out that cough or find out why your nose is running.
Then, lose weight. Watch your carbs (starches and sugars). You'll have little need likely for doctors once you are healthy.
Finally, go the self-employment route. It works, once you have a big savings account, a high deductible, and are truly healthy because you're not another fat American. By being self employed, you can walk away from the monstrosity that is called "employer-sponsored health care." What a farce.
It isn't the market that made healthcare bad, it isn't corruption or greed -- it is your very government, trying to fix mistakes that the State of past generations has slowly caused. Don't spew garbage about the U.K. either, I have a few ex-patriate friends living there who has mentioned how terrible it is.
Links to good info:
Lowering the Cost of Health Care, Dr. Ron Paul
Free Market Medicine, Dr. Ron Paul
Subsidizing Sickness, Llewellyn Rockwell
But I'd suggest that proper application of game theory is key. Making a system that is hard to manipulate (i.e."game") is a very challenging problem, and frankly, I find it a lot more interesting one than the submitter seems to.
If you took the current medical system and had the government spent 10x as much on it prices would rise around 10 times. That's because doctors who want to work are all working, getting paid very well, and more money will just make them have to raise their prices or, if their prices were fixed, result in a shortage of available time slots for patients. The fix is is to make health care more efficient by not requiring someone who had to go to 8 years of college to give you a refill on your antibiotics, etc. There are serious medical cases that need expert attention but the vast majority of health care problems suck up the efforts of lots of highly trained accountants, overseers, inspectors, lawyers, claims adjusters and health professionals when the transaction could be so much simpler if they'd just trust people to have a bit more personal responsibility over their own health and not try to make sure that every single step of their treatment is authorized and approved by a limited pool of highly skilled professionals who are much better employed elsewhere.
Don't be bitter, but what can we do about it? One set of legislators is just as likely to write the rules in their favor as the next set. How can we possibly opt to stop giving them money when tax collection is automated and we have no direct control over their spending?
the NPG electrode was replaced with carbon blac
... and a strong believe in suvival of the fittest. Look to Europe: Afordable, reasonable healthcare for everyone is not a dream. Many countries have it. For example in Swizerland everybody has health-insurance, you cannot be without it, whether you have money or not.
However it is not possible with a free market, since that will charge customers whatever they still can pay and will let those that cannot pay die or live with problems that could be fixed. At the same time, hugely expensive treatments will be available for those that have the money and single wealthy individuals will be saved instead of hundreds without money. Face it: Despite its lip service to christian values, the US is one of the coldest, inhumane countries on this planet, were cristian values are preached but not practised at all. Instead there is this believe that the market can fix anything. It cannot were infrastructure questions like education, public transportation, healthcare, etc. are concerned, since all of these need a really long-term perspective and the will to make thinks work well instead of turning a profit.
Most ACs are not even worth the keystrokes to insult them. Be generically insulted by this and ignored otherwise.
A collar that shocks it's wearer every time they try to stuff a Big Mac, Twinkee, Slurpee or Hoagie down their gullet.
I mean, come on. People just want a pill to fix their woes. How many times have you met someone that you know have a condition that can be easily fixed through diet and exercise alone?
Besides cancers and other similar conditions, most problems facing the health care industry are caused by lack of exercise and eating the wrong kinds of food, and its a hard thing for people to change. And generally health care professionals are afraid to give definitive health advice because of the opportunity of lawsuits. How many times have doctors told patients that they should "reduce" instead of "eliminate" or "substitute" some offending substance?
There tons of evidence that most medications (some help) have horrendous side effects and yet people continue taking them as if there's no tomorrow. I think that no matter what doctors, tech, or the government does, its gonna take a sea change for Americans to wake up and smell the coffee and start taking their own health in their hands.
Newsfollow.com
Huh? I don't get it. How is technology going to fix anything? Sure, it's true that there are inefficiencies in the system, like being asked for your health history over and over, as described in the article, but you're not going to wring any major change out of this dysfunctional system just by digitizing people's health histories.
Technology is part of the problem. Technology costs money, and part of the problem with the US system is that it encourages people to spend inappropriately large amounts of money.
The fundamental problem is that it's a positive feedback system that's doing what positive feedback systems always do: wig out exponentially. If you really want to see something scary, look at an itemized hospital bill that includes the costs of things like bandages. The bandages cost 10 or 100 times more than they would at the drugstore. The reason they cost so much is that insurance companies are willing to pay it. Why are insurance companies willing to pay it? Because everything else is ridiculously expensive too, and anyway the insurance companies can raise their rates to cover it. Once the insurance companies raise their rates, the health-industrial complex smells money, and raises their prices.
If you like government regulation, one very simple, sensible thing to do would be for the government to penalize people who are affluent, but have a low deductible compared to their income. If my annual income is $150,000, then they should use tax incentives to browbeat me into not buying insurance that has a deductible any lower than, say, $40,000/year. That would make me treat all these expenditures like real money, not like other people's money. All of a sudden I'd be complaining bitterly about the overpriced bandages. When a nurse pulled out one of the hospital's bandages, I'd say, "No no no-- wait, don't open that! My wife went and got some bandages from CVS. Here, use one of these."
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I was in the emergency room for a few hours because I got suddenly very sick after a tooth extraction to the point that I was going to die. They ran a bunch of tests and gave me a saline iv and then sent me home shivering with a 102 fever.
So I got the bill a few weeks later. It was astronomical. Luckily the insurance covered it but it was of course filled up with all kinds of obscure bizarre codes that only insurance billers know anything about. What I'd like to see is some auditor look very closely at how the money flows around the medical system and find the $3000 toilet seats that I'm sure are lurking somewhere in their. I wouldn't be surprised if there were a few dirty HMOs that were taking kickbacks from hospitals for over-billing. Hospital over-billing would also be a perfect way to launder money I'm sure because everybody expects the costs to be unreasonable.
I think the best course of action would be for hospitals to sell their own insurance. Having the HMO and the hospital separate creates all kinds of incentives for fraud and over-billing not to mention many different sets of books to take care of.
- Overhead. Doctors need to hire transcriptionists and billing clerks to do work that could be largely automated. (Our product addresses this).
- Ease-of-use. Most of the EHRs on the market require an office to switch to a very low patient load for a very long training period. This makes migration to a product intended to improve communications and efficiency into an extremely expensive and cumbersome proposition. (Our product addresses this).
- Lack of communications (or standardized records formats). There are *some* standards (HL7 is what we use for integration with 3rd-party scheduling and billing systems where possible), but nothing widely accepted and comprehensive enough to be able to give a patient a flash drive with their complete medical history in a format any doctor's EHR product will understand. Worse, a lot of systems won't integrate with anything else without requiring the customer to fork out serious $$$ for the add-on functionality. (As just one small vendor, there's not so much we can do about this right now)
There are a bunch of other benefits that EHR vendors try to sell folks on -- automatic warnings about allergies, ability to guide the physician towards checking for symptoms that could indicate a serious problem, etc etc etc; I'm coming at this from the back-office geek point of view, though, so I really have no idea how significant these are in the grander scheme of things.Is adding more expensive IT products magic fairy dust that'll make healthcare cheap? Of course not. But technology that's well-thought-out, well-implemented and sanely priced certainly can help to make healthcare less expensive -- and putting records in a portable format benefits everyone.
(That said, there's a lot of poorly-implemented technology in healthcare... but that's a topic for a different, much more anonymous forum).
My friend and I just had a conversation about this last night. The fundamental problem is that your health is my responsibility, no matter what.
Let's say we went to a world where only private doctors existed and no one accepted insurance. The rich will be able to afford most care (although they're pretty much dead if they need something big like an organ transplant). With insurance so expensive these days, this isn't too far off from reality today.
Now, pretend that you're poor, and you come down with melanoma, despite your best attempt to avoid the sun. You can't afford care, so you wait until the last minute to get care at the ER. By then, your disease is probably advanced and much more expensive to treat, and the ER can't turn your away legally.
The ER charges you some really high price that you can't pay. They repossesses your car and foreclose on your home so you can pay for it. Maybe you can find a lawyer to declare bankruptcy. Meanwhile, the ER is still waiting for their payment, and the doctors have to be paid to pay off their student loans. So what do they do? They charge the rich people more to offset the cost.
Now you're now homeless, without a car to get to work, unemployed, and you're still in debt. Where do you go? Perhaps you turn to a life of crime and end up in prison. You definitely end up on welfare and Medicaid, probably living in a homeless shelter that is likely funded by tax-payer money.
This isn't some theoretical story. It happens to people all the time.
So, all of you who are terrified of having your tax dollars pay for "socialized health care," you're really missing the point. You're paying for it already. You're paying it in your hospital bills as cost shifting. You're paying for it via Medicare and Medicaid. You're paying for it in the prison system (which is the new mental health system). You're paying for it in terms of treating STDs by county clinics and through federally-qualified health centers.
Socialized health care is inevitable because it's already here, albeit in a horribly disorganized and inefficient state. If we kept everyone healthy, the cost of health care would drop for everyone. The question is, how can we do that while balancing quality care?
The US medical system is definitely sick. US citizens spend drastically more on medical care than other countries. If you are poor you cannot get decent medical help. If you are a visiting tourist and you get sick then you are in for bills that will make your eyes water.
... The list is far too long, guys - you come below Ireland in the Human Development Index. It's about time to pull your socks up America.
If you are in a job it HAS to pay medical insurance. People are terrified, not so much of losing their jobs, but losing their medical cover. (Yes, I do know that ruling a frightened people is much, much easier).
Why?
It isn't true in the UK, or Australia, or Europe. So it doesn't HAVE to be so.
But then the USA is one of the most unbalanced countries on Earth. By unbalanced, I mean the rich-poor gap is horrendous. Here we have the richest country in the world, and yet it has large numbers of poor illiterates, sick and dying. It is very, very sad.
I think it is amazing how the USA has gone from being perhaps the most admired country on the planet - say after the 2nd world war, to one of the least admired - say now - in barely a single generation. Quite an achievement.
I think it's time the USA started doing things that the world could admire, instead of steadfastly serving its own interests. In the medium to long term, being greedy and acting like a spoilt, petulant child tends to result in nobody liking you.
What could they (you) do?
* clean up your own backyard
* Institute a decent national medical system. Increase taxes to pay for it. Kill off the medical insurance companies, push back the tide of wealth in the medical profession
* Fix the schools. Put money into the system (gosh, there's tax again) especially in the poor areas. You NEED those scientists and business folk who drive you economy - and if they don't get a decent education because they were born poor, black, Hispanic, Muslim, female (or any of the other sins of America), you won't get them
* stop messing up the world. Stop starting wars (USA has started more than any other country since the 2nd world war ended). Try to do some good - but not with soldiers
* start doing thing that need to be done. How about really, really investing in sensible power generation (and stop giving tax breaks to oil and coal companies - maybe that would save you some of the tax). Do some decent research. Put some people on the moon. Make the world proud! You've done it before - do it again
Mind you, a good start would be just stop driving those horrible little trucks (called truck so they can break their own rules on fuel consumption - I mean really, guys).
Sweden is a far easier country to admire. Finland
And getting a fair and equitable medical industry would be a good start.
"Cats like plain crisps"
The money doesn't go towards $3000 toilet seats. It goes towards $3000 worth of treatment given to an uninsured person, as the hospital is required by law to do. They make up for unfunded charity care by sticking it to anyone who has good insurance.
I worked in a hospital for 9 years in the IT department. Trust me when I say that technology was NOT the impediment, but nurses and doctors who refused to use the technology. Instead of thinking about the positive uses (checking drug interactions, streamlining data collection, improved imaging times), the mere idea of "technology" was shunned by these supposedly-educated professionals.
I will never work in a hospital ever again. It was too painful the first time around. I understand that not all users are going to be computer proficient, but to have a user BRAG how little they know about computers, and they will be retiring in a few years, so they will just drag their heals...
Guh!
If ever there was a time to justify beating something with an ethernet patch cord, that was the time.
Fix the people and you fix the single largest impediment in any system.
Bearded Dragon
libertarianism is nothing but a code word for selfishness, dressed up in political signals and philosphical portents. but if you dress up a cheap whore in a fine dress, she's still a cheap whore. so it is with libertarians and anyone who spouts that nonsense
i put it this way: human nature is both altruistic and selfish. any political philosophy you present to the world has to address both sides of this coin, or you have built a political philosophy which is a nonstarter in the real world, because it doesn't jive with the nature of the humans you are attempting to impose it on
we all understand why communism doesn't work: it depends upon altruism, and doesn't address human selfishness. in a communist system, selfishness still exists, in the human beings in the system, but unaddressed by the system imposed upon them, and so selfishness eats communism apart from the inside
if you will, if a whole country suddenly went libertarian, you'd have the exact same problems as a communist country, in reverse along the axis of human selfishness-altruism. it would fail. as miserably and as surely as communism did. for the same reasons, in mirror image reverse
libertarianism appeals to earnest but naive college students with too many philosophy books under their belt, but without any real life experience, who build castles in the sky in their minds about how the world should or would or could work if people just started behaving in ways people have never behaved in any culture or time period since the dawn of mankind
it also appeals to rural folk, who don't understand how they fit into the larger world, and firmly believe themselves to be islands completely owing nothing to anyone else. what they are of course is coccooned within a larger country and system upon which the relative peace and quiet of their worlds depend. but it is hard to see that from the hinterlands until madness marches across the countryside, which it does, unfortunately, in societies that have abandoned the simple common human responsibility we have to take care of each other
and it appeals to 40 something selfish assholes behind on their alimony payments, corrupt and personally bankrupt about any give and take in their lives. nothing more needs to be said of such people. we understand them, and we understand why libertarianism appeals to them on a deep level
libertarianism is a gem of modern foolishness, and you are a glorious fool if you swallow the pap called libertarianism
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
Seriously, if you were going to try to fix the health system, would you try to do it without use of technology?
Without I/T systems and infrastructure, obviously any new system you implement to replace the older, obviously inefficient systems would be paper based.
While paper based methods are necessary for some systems (see George W. Bush, US Elections for clarification), I cannot see that being applicable to health care.
I am government man, come from the government. The government has sent me. -- G.I.R.
You got it right. The doctors have established what amounts to a state-sponsored cartel that prevents anyone from practicing medicine who isn't a member of their cartel, even well-trained people like nurses or patients themselves who may be much better in tune with their health than they're given credit for.
Oddly enough, one part of the "health care" system that's ignored is the war on drugs. I include it since its ostensible mission is the public health goal of preventing addiction and substance abuse. The DEA alone spends $2.5 billion (up from $1 billion from 1995!); add in the total expenditures of all state and local drug enforcement efforts and you have probably something on the order of $40 billion spent on an effort that obviously doesn't work well if at all.
$40 billion in spending would go a long way towards dealing with some of the skyrocketing costs.
The solution is Canada, Europe and the rest of the world. The are used to living with what is available even though they know it might not be the best.
Try and get that across to the American people. Just try.
ah, the peachy kean usa of a hundred years past, where racism was considered common sense, monopolistic robber barons controlled industry with pinkerton's men and bully clubs, and a war was started with spain to grab territory
clearly, the founding father's dream, right?
ever hear of a fancy word called "progress"?
libertarianism has nothing to do with what the founding fathers were getting at. the founding fathers were getting at liberty and freedom... freedom from things like disease and lives shortened by infirmary. things a little socialized medicine will fix. what will you lose? some money from your paycheck? you'd prefer to have people die in the streets? if a guy falls down and breaks his arm, do you walk by him and ignore him? no, you take care of him. here's a fancy phrase for you from the founding fathers, who you obviouslly adore, and SHOULD adore: "life, liberty, and the pursuit of happiness." hey genius. what's that first word in there?
LIFE
the fact is, i am more in tune with what the founding fathers wanted than you are
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
Now many people reading what I just said are probably thinking, "That's inhuman." These are people's lives, not cars. Well, I'm sorry but this is exactly why health care costs are spiraling out of control. Just like the United States being a debtor nation because people cannot say, "No."
I worked in health care as an analyst and application developer for 3 years. For one: it's a nightmare to use technology to do anything because the systems are hugely complicated and entangled in an enormous amount of rules, regulations, qualifications, exceptions, and so on. For two: we have all the statistical information necessary to classify diseases and injuries by cost and come up with a budget that says, "We can treat that, but the cost is too great given the statistical occurrence of the problem, so we can not treat you."
The outcry against that would be tremendous. But I can tell you for a fact that this is exactly what happens on a battlefield. Any battlefield: a corporate takeover, war between nations, etc. People make brutal choices that have a huge negative impact on peoples' lives all the time. A company buys another because it is expedient and then they let go of 50% of the workers. We don't like that, but we accept it.
But if someone says to most people, "I'm sorry but we cannot treat 30% of these problems. We have the money on hand in the short-term, but in the long-term it will break the system for all of us." People are not altruistic. People will not accept the fact that they have cancer and are going to die because the treatment is available but too statistically expensive. People will not accept the fact that they need some expensive heart surgery because they have been pouring fat and sugar into their bodies for years and now it's time for someone to pay for that abuse.
Many people don't take responsibility for themselves, because we don't have a system that requires it. We put people in prison and relieve them of the responsibility of food and shelter and making adult ethical choices. We provide expensive treatments for people that need emergency treatment because an emergency has occurred as a result of years of abusing themselves. And so on.
We're not going to fix a damn thing until we get better at saying, "No" in the short-term when it is absolutely necessary for a sustainable long-term. And that's true in all aspects of society. Health care, the environment, economics, education, whatever. It's all the same single cause. Most people can't make personal short-term sacrifices for long-term gain. Debtor nation. The one's that can, don't spend much time talking about these things because it goes nowhere. They can't solve other people's problems. People need to take responsibility for themselves or the few that already do have to carry everyone else.
Umm, you're making it sound impossible to have decent health care that covers the basics. Most industrialized countries have done that, except the US, without resorting your "inhuman" suggestions.
t goes towards $3000 worth of treatment given to an uninsured person, as the hospital is required by law to do.
Amen! Amen! I was wondering when someone was going to get around to posting the truth about how the insured pay for the services that are rendered to the uninsured. Health care organizations "give away" a certain percentage of their services to uninsured or under-insured patients every year. The fancy hospitals in the suburbs that generate a healthy profit are being used to support the hospitals that serve the inner-city population.
but like most difficult problems in life, the choice is between two infringements on your liberty: taxes, or the infirmary of your community
the bite taxes take out is easy to see and quantify and immediate in effect
a community that doesn't take care of itself is more difficult to quantify, sparse and slow in effect
you are part of a community, you derive your riches from it. taxes are an investment you make to guarantee the health of your community, so that you derive more riches from it. do you think the money in your paycheck is yours by inception from god? no, you worked for it, you provided something to your commuity, and they paid you money
now, in a vacuum, taxes are obviously evil. but in the context of the reality you live in, taxes are a SMALLER imposition on your life than a sick community is
and in life, it is about difficult choices, not simple propagandistic choices presented in a vacuum without any context
do you understand?
there are plenty of things that infringe on liberty in life: sleep, eating. why do i have to sleep? seems like a horrible imposition on my freedoms. of course its a silly statement, because we understand why that imposition on my freeodm occurs
it is also equally silly to think you can live in a community without being taxed, and yet continue to think you can derive financial benefit from a community that you won't take care of
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
I got Lyme Disease again last summer. I received a bill for $700 for a doctor's visit and several lab tests; my HMO paid $220, and the doctor's office was trying to get me to pay the difference. Not being a moron, I called my HMO, and they got me on a conference call with the doctor's billing firm. As a participant in my HMO, he was not allowed to bill me the excess charges -- but if I didn't have insurance, that visit would have cost me $700.
The real reason those hospital visits cost so much is that people go to the ER when they have a dislocated finger or a bad sunburn, instead of seeing a GP the following day. Hospitals are overwhelmed by trivial medical problems, and all those doctors, nurses, PAs, and support staff cost a fortune, never mind the fact that we all have to pay for indigent care through increased regular charges to those who can pay.
"Trolls they were, but filled with the evil will of their master: a fell race..." -- J.R.R. Tolkien on Olog-hai
The problem isn't the technology. The US health care system has the best technology in the world. That's not what's broken. The dysfunction comes from removing the health care recipient (you and I) from the health care market.
We don't buy health care, we buy insurance. While insurance works great for catastrophic needs, it falls flat when it comes to ordinary day to day needs, regardless of domain. Automobile insurance works because automobile accidents are (relatively) rare. But our costs are skyrocketing because we are using the insurance mechanism for day to day healthcare. It's as silly as buying food insurance to provide our groceries. The problem is further exacerbated because insurance companies are disinterested agents. They want to keep their costs down, but as long as we pay them, they have no interest whatsoever in keeping *our* costs down. The market system is working, but it's not working for us because we are not a part of it.
This isn't about whether healthcare is funded by the government or not. We can have government funded healthcare in a market based system. We just need to get the patient back in the role of consumer. If you give the poor vouchers for healthcare, and then allow everyone to purchase their day to day health maintenance needs out of pocket, the system can get start getting back on track.
Don't blame me, I didn't vote for either of them!
The rest of the country is moving away from lawsuits, and moving towards binding arbitration? Create a legally mandated review and report system, and Doctors who are statistically out of whack get reviewed and if it keeps up, lose their license. Those hurt by incompetants should have a scientifically valid avenue for complaining and receiving restitution. However, the current system is busted.
Current system, we do not award damages based upon merit, but based upon jury awards. While jury awards are a reasonable way of dealing with many torts, they also introduct tremendous unfairness and confusion. If a medical treatment has an 80% success rate, and yours failed, you should not have a tort... sometimes there is bad luck. If you want to protect people from bad luck, then let's pool risk and do insurance. Create a mandatory "tax" on medical services, based upon percentage failure rates and damages for treatments (we already have the billing codes) and let those that lose life's lottery collect from the pool.
However, medicine by jury is HORRID. My wife's delivery was all messed up by overeager Doctors and our need to fight back to stop unnecessary interventions. Unfortunately, "high risk" in medicine is anything over 1%, and as a result the masses suffer to protect the outliers. So little of medicine is based upon statistical evidence, and more about what is the standard procedure so I can defend my actions in front of a jury.
Back to the cost issue, even trial lawyers defending the practice like Sen. Edwards (D - N.C., retired) claim that malpractice is only 1% of the costs, but that seems unusually low. My father who has a successful practice had several years where his malpractice insurance and his takehome were roughly equal, so that's a huge burden. However, defensive medicine, NOT malpractice is the problem.
For example, a pregnant woman can take OTC vitamins that are good enough, cost? $10/month. That same pregnant woman will likely get a perscription for vitamins (my wife did) for $55/month (co-pay, $15/mo.). It only cost us $5/month difference, but the "medical costs" increased over 5-fold.
Likewise, often the new drugs are only slightly better than the old drugs, where they are statistically similar for most cases but slightly better in some. in addition, the generic may cost $2 - $4/pill, while the new perscription pill may cost $200 - $800. Now, I would personally be happy to cough up some money to avoid the low-risk change of complications during surgery, but is that reasonable that you get those drugs for everyone? Would it be better that most people take the risk of complication (which is usually already under 1%) than run up costs?
The problem isn't the costs, but that is you go with the cheaper option, 99% of your patients saved money, but 1% now have a tort against you.
That's why pediatricians perscribe anti-biotics for ear infections, despite the OVERWHELMING majority of them being viral and the anti-biotics have no affect.
Defensive medicine combined with everyone being entitled to the newest, most expensive drugs results in the current out of control medical costs increases.
Something like 80% of medical costs are incurred in the last year of life. However, we can't necessarily make decisions based upon this, because that's a retroactive evaluation. Some 80-year olds with cancer will burn through $250,000 in treatment and die inside of the year, making that a huge amount of expenses for nothing. Others will pull-through, living another 5-10 years in good shape, then dying of something different and unrelated. For the latter, the $250,000 was no doubt reasonably spent, for the former, we wasted resources.
The fact is you can't separate when the treatment is extreme and unreasonable, and when it was reasonable until after they go.
That said about the longer lifespans, the modern entitlement complex is a disaster. Social security solved two problems, getting the elderly out of the workforce (lowering the unemployment rate, we creates a drag on the economy beyond the fact that those people aren't working), and preventing the sickly elderly from being indigent, something reasonable to avoid.
If the retirement age was raised to be the equivalent in terms of life expectancy as it was when social security was created it would be 89 today. That's right, MOST PEOPLE didn't live to collect it, it was to help the helpless elderly. We decided that we were entitled to stop working at 65, while others were responsible for it. I'm not sure why that's an entitlement (I don't begrudge anyone that lived below their means and saved up for retirement), but because we didn't raise it continuously, there is no clean solution now.
I'm not suggesting the people should HAVE to work until their death... but retirement, like vacations, is a luxury that is expensive, and it's not clear why one has a right to ask others to pay for it. The true tragedy is the mythical trust fund, an accounting shell game, has given people the mistaken impression that their have "paid into the system" and therefore are entitled to social security, which is why the system is collapsing on itself.
Note that it's called social security, not a national pension, it's not a reward for payment into the system, it's a safety blanket for the disabled, orpaned, and elderly that need it, and never should have become a way of life.
Why were there poor people in the US before the New Deal, then? That seems like a pretty glaring argument against that position.
Progress can be made and health care for everyone is not impossible. But abuses of that system must be curtailed. An example of abuse is one individual consuming enough health care resources to provide a basic level of health care to 20 others because they have some rare disease (congenital or otherwise) or they treated their body poorly (drug use, obesity, etc.). Another abuse is any individual that is sitting on billions of dollars in wealth or is making hundreds of millions of dollars a year. There's no justification for huge disparities like that.
Can we have fair health care for everyone? Of course. But people need to think long-term about costs and change needs to be made. Let me put this as simply as possible: socialized health care is based on the idea that it is our duty and it is right that we provide a basic equality of health care to all. But that is not how our society functions and it is not how people really function. For almost everyone, "Me" comes first, or more pointedly, "My child" comes first. I am not saying there's something wrong with prioritizing the life of your child, but it points to the fact that we want to say, "Everyone deserves decent health care," which is an equality statement.
But we don't really believe that and we don't act that way. We pay some people tons of money and we give some people great healthcare. We prioritize the lives of our loved ones as more important than others. We put some people in facilities and we put others on the street. The debate on this issue and lack of resolution is due to the fact that we're largely hypocritical in what we say is right as compared to what we act out as "right". We want to think we're good people, so if people say, "Should everyone have decent health care?" we say, "Oh, yes. Of course." And then we turn around and ask for a $400,000 transplant to prolong a loved one's life so that we can have 6 more months with them.
Balanced healthcare is certainly possible. But not when you have such a vastly imbalanced amount of wealth and privilege. What we currently have is the best that you can get without large social change. And what we have right now is 5% of the people have 95% of the high quality health care. The other 95% of the population gets the remaining 5%. The likely negative outcome of our current path is a small echelon of our population will become virtually immortal and with such vast resources that the remaining 5% care is enough to provide best of class care at today's level to everyone. That's the pattern that's repeated again and again in history with wealth and power, so I doubt it will be any different here. The more positive outcome would be that technology so thoroughly solves issues of comfort and mortality that cost goes to 0 and everyone has whatever they need. Which would make Earth Heaven and cause the vast majority of Christians no end of confusion!
People don't believe all men are equal and they don't act that way. Everyone tries to "get ahead". What does that mean? It means we are all acting out the belief that we can become better, more deserving, and more privileged than others. The fallacy here is the same thing as saying an adult is better than a child. Just because you gain knowledge and skill and wealth doesn't mean you're intrinsically better or more deserving than the person that hasn't gotten as far as you yet. In fact, when it comes to our children, we instinctively do the opposite. We put them, the child that has accomplished less in the world ahead of ourselves. But in "adult" society everyone has had their fair chance and if you're not as wealthy or privileged as the next guy, it's because he's intrinsically "better". That's what the distribution of wealth and privilege says in our society and it is no different in health care. The punch line for this is when I say "our society", I'm referring to the country that I know very well: mine--the U.S. You're totally right that other nations are a good deal more successful at this health care issue, and I think it is because they are not nearly as rabidly capitalist as the U.S.
You don't fix systems that large by throwing technology at it.
Unless you fix the setup structurally so it's managed in a decent way instead of by deadbeats and get a consistent strategy and approach in place you'll be throwing money away as you're not fixing the real problem.
The irony is that fixing the real problem would be a huge money saver as well - but that would stop several gravy trains at once, of course..
Insert
It's a nutshell of why health care isn't going to be solved anytime soon: too many factions have conflicting interests with effectiveness. Insurance, Legal, real estate, and Medical (in that order) industries graft money all over the place, supporting an unsustainable system. Socialists of all shades use the sorry state of affairs as a point of leverage to gain overall standing on the world stage, while providing disincentive for the U.S. to make change for fear of yielding to the threat. Politicians take bribes and other considerations from one or more factions, and keep the ball spinning enough to curry favor with the electorate while maintaining the stream of revenue for themselves and/or their parties.
To all of the above, fuck off.
Ah genius. People are selfish, so let's create this huge bureaucratic apparatus that wastes scandalous amounts of money in the name of 'public funding' (and often this money does not even reach the people who most needs it: see also, aid to Africa). In many, many cases, governments do not solve problems, governments ARE the problem.
Because obviously, enforced high levels of taxation is the best way. There could not be any other way to help poor people, such as extending microcredit, focusing on schooling, running soup kitchens, etc.
Sheesh. You don't even see that all you are creating is an underclass for whom handouts have become a habit they can't kick.
Go somewhere random
You may not have noticed, but hospitals make far more off of the uninsured than they do off those who are insured.
Look at an explanation of benefits for hospital treatment. If you have "good insurance", anywhere from 20-60% of the hospital bill is written off when insurance declares the amount charged to be higher than the industry established norm, then insurance pays their portion, and you pay whatever is left over. That "written off" portion neither you nor insurance pays for, the hospital just has to absorb the loss of income.
The uninsured can't look at their bill and declare a big portion of it as "too high", so they pay whatever rate the hospital wants to charge, or go bankrupt trying.
"Flame away, I wear asbestos underwear"