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Does Higher Health Care Spending Lead To Better Patient Outcomes?
First time accepted submitter ericjones12398 writes "If you haven't seen the words 'health care' in news headlines lately, you must be living under a rock. What seems most controversial among the latest research and news is a flawed payment scale that undervalues primary care and overvalues specialty care. There is evidence suggesting that publicly funded health care spending (i.e., Medicare) has not been based on primary health care needs. Rather, In the U.S. Medicare spending relies on a resource-based relative value scale (RBRVS) which seems to promote higher spending without evidence of better patient outcomes. A study comparing spending and mortality rates in Ontario had the opposite findings however, supporting a link between higher spending and better outcomes for patients. What are we doing different in the U.S.? "
We have a medical-industrial complex. Money's gotta flow.
Fuck systemd. Fuck Redhat. Fuck Soylent, too. Wait, scratch the last one.
all goes to someone's profit, not someone's care.
how many old people eat crappy salt/sugar/carb laden food just because their parents made it for them as kids.
and my favorite. yesterday my mother in law brought some pork over. it was marinated and wrapped in plastic. the butcher told to cook it in the plastic and i had an argument with her how its bad for you. she does it all the time at home
75% of money spent on health care in the U.S. is for self-inflicted diseases or the consequences thereof. That might be a good place to start looking.
I'm not saying that people that need dialysis or bypass surgery shouldn't be helped; I'm saying we should be spending money on ways to help them not get there in the first place.
Well, don't forget about fraud here in the US.
http://www.insurancefraud.org/medicarefraud.htm
http://medicarefraudcenter.org/medicare-fraud-information/9-medicare-fraud-statistics.html
http://www.discriminationattorney.com/medicare-fraud-1854607.html
The answer is no. Next question?
I don't have a sig.
5% of the population (15 million people) account for 50% ($1 trillion) in spending.
http://www.ahrq.gov/research/ria19/expendria.htm
Or perhaps you aren't an American.
Still #1 -- Lonely Gay Geek
Everywhere except the US, increasing money on health care increases health care. In the US, increased money to healthcare increases funding for insurance companies coming up with new ways to deny claims.
We spend and spend and spend and the quality of our education goes to crap. Why? Because money isn't the answer to a social problem. Just like in health: money isn't stopping people from filling their faces with chips and Ho Hos.
... for the US having a government not basing its policies on adages, witticisms and one-liners.
The last months of a persons life are overwhelmingly the most expensive, but the outcomes are predicable. There was a great article in the WSJ on this called Why Doctors Die Differently - http://online.wsj.com/article/SB10001424052970203918304577243321242833962.html . The basic point is that doctors understand death, and when their condition makes death inevitable. They almost always opt for more life in their years than more years in their life. From a healthcare point of view, doctors have much less expensive end-of-life care.
There's nothing wrong with living under a rock. It's energy efficient, quiet and affordable. And, no unwanted guests.
The United States runs a "for profit" model. Canada runs a "for better society" model. In one model the fundamental design of one system dictates that consumers spend as much as possible and receive as little as possible. The fundamentals of the other design dictate that consumers all receive adequate care, and the only reason to spend more is to get more.
Let's make like a bird... and get the flock outta here.
The purpose of the US health care system is to provide return on capital, it does that very well, what's the problem ?
Hi grub! You're back! We missed you!
Unfortunately, this time you're more correct than insane. (We won't talk about the adjustments - those should be done with a framing hammer for most people).
The little article quoted to support the argument that 'more spending is better healthcare' is illustrative.
mortality rate was 12.7% vs 12.8% for AMI, 10.2% vs 12.4% for CHF, 7.7% vs 9.7% for hip fracture, and 3.3% vs 3.9% for CHF
Note those big differences folks. Right down there in the noise floor.
In the US we spend WAY too much doing things to people that gives very little benefit to them. The major culprit is the 'free market' system where profit (at multiple levels) is considered the appropriate metric. Although everyone and their little sister will go on about how 'patient care is first', everyone in the system realizes that this is just a sop to the weak of mind.
It's been an interesting experiment, but the results are all too clear. Going to be a bit longer before the folks who stand to benefit from this mess get forced to clean it up (just like a couple of other industries, isn't it?).
Faster! Faster! Faster would be better!
This is neither about science, nor technology. It's not even a political article that at least has some tiny connection to one of them.
What are we doing different in the U.S.?
We're throwing our money at CEOs the same way school girls throw wet panties at Justin Bieber at concerts. Next question.
#fuckbeta #iamslashdot #dicemustdie
If anyone in the U.S. doesn't already know this, they damn well should (especially if they are going to start spouting about health care policy). These kinds of conclusions about More Care != Better Care and More Cost != Better Health have been floating around for nearly two decades. Behold: http://www.dartmouthatlas.org/
http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande
"McAllen, Texas, the most expensive town in the most expensive country for health care in the world, seemed a good place to look for some answers."
The answer, as usual, can't be simplified into a sound bite. What's broken is the way doctors are paid, and what they're paid to do, not how much they make. It's about how we measure success. Worth a read.
After the Supremes ditch that abortion of a Bill, Obamacare, there needs to be a top to bottom evaluation of the entire medical system.
Fundamental assumptions about the value of a service and the person providing that service need to be challenged. The infrastructure of record keeping, ownership, and payment needs to be overhauled. Information about services and their costs need to be plain and transparent because if any market is to function correctly, all the players need to know all the facts up front.
When Fascism comes to America, it will call itself Anti-Fascism, and tell you to give up your guns.
The Province of Ontario is rather large and mostly rural. I wouldn't be surprised if most of the higher spending hospitals are located on University Avenue aka Hospital Alley in the largest city in the country, Toronto. It also wouldn't surprise me if it's also the highest spending area in medical research for the country. Most hospitals in the area have also have affiliate ties with the University of Toronto (hence University Avenue) which brings in more research money.
All this debate in the USA about health care spending and delivery ignores the biggest factor in predicting lifespan: how much time is spent walking everyday.
Invest in safe, walkable cities today, and future generations will see an increase in lifespan.
$5,000 will buy a huge amount of manual activities in some countries. This includes surgury and high quality nursing.
Likewise, liability insurance is much lower since income is so low.
Manufactured goods like beds, sheets, etc. Also cheaper.
Only 1st world manufactured goods and drugs would expensive.
And since they ignore patents and don't pay royalties to help cover the costs of research (by very expensive researchers who are expensive for the same reason above) many drugs will be cheaper too.
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Healthcare overseas is 10% of the cost.
Healthcare in India is 5% of the cost.
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It's sort of a red queen's race. Things are expensive here because they are expensive. If we were to suddenly devalue our currency 95%, some products like oil would get more expensive but mostly- we would just suddenly be competative with the other countries.
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I think if you adjust for relative costs of living, you'll find healthcare in the U.S. is really only about 2x as expensive as in most of the world. Still high.
Sad thing is the top 1% can afford to fly to Guam and India and take advantage of the cheap healthcare.
She was like chocolate when she drank... semi-sweet at first and then increasingly bitter.
There is a correlation between health spending and outcomes. If you compare the third world with the first world, then, yes, there is a positive correlation. The first world spends much more on health and is rewarded with much better health. Death is obviously much more likely for those who can't afford any kind of treatment.
On the other hand, comparing within the first world, there is little correlation within the population at large. The question is more about how the health care is distributed. In societies with more equal distribution of health care, the statistical results will be better.
In the USofA, the health care results for those who can afford it are excellent; the best in the world. It's just that lots of people can't afford it and they skew the statistics.
What do health care costs, housing costs (pre-bubble bursting), and college tuition costs all have in common?
1) They all have risen much faster than inflation.
2) They are all subsidized by government.
If you hide the cost of a good from people via the tax code and you subsidize the good, you will get no mechanism to control costs. The tax code hides the cost of insurance since employees don't see or feel the employer's payment.
Oddly enough Lasik surgeries haven't gone up in price. It isn't covered by insurance.
Granted, there's a lot more nuance and information to bear on this topic. But it is a dynamic that can't be ignored. If you hide the price from someone, costs will go up. Unless you want to ration. Which when the HMOs tried to do it in the 1990s was about as popular as a skunk crashing a party.
Except for ending slavery, the Nazis, communism, & securing American independence, war has never solved anything.
I need ten young, healthy people to sign up with me for a health care pool. Of course, I will statistically receive the lion's share of the proceeds, but content yourselves with the fact that You Care. I'll even send you a certificate suitable for framing that shamelessly declares your uber-caringness.
What are we doing differently in the U.S.?
Increased healthcare spending leads to better outcomes for executives in several healthcare related industries.
If one of those executives happens to be a patient, then you could even say it leads to better patient outcomes.
I'll see your senator, and I'll raise you two judges.
It is really disturbing how ready today's generation is to ship grandpa to a nursing home. What happened to family taking care of their own? Dying in bed, surrounded by your loved ones? Or just plain not spending the last decade of your life abandoned in abject loneliness. If only you had enough compassion and gratitude to your parents to take care of them in their old age as they took care of you in your youth. You know it's the right thing to do. It's even in the ten commandments.
http://www.businessweek.com/magazine/content/10_11/b4170032321836.htm
This is something of a counterpoint. Amanda Bennett wrote an article about her husband's death. He had cancer and was expected to live a year or 2 more. Aggressive, and expense, treatment, meant that he live for 7 more - some of them good - some of them bad. So he beat the odds and thus can be considered a success. On the other hand, Bennett tries to weigh the cost of treatment, quality of life, and how the health care system should be structured. She does not come to concise answer, but she writes very well about the struggle.
That's what is happening with my grandma, unfortunately. Probably Alzheimer's in her case. Whatever the case, her mind is almost gone. She requires a full time care taker at home now, and before long will need to move to a complete managed care facility. Fortunately she's got the money, it is no problem. However it is going to cost a boatload of money, particularly since other than that she's in pretty good health for a 85 year old. She could live 5 more years (maybe more).
So what do you do in cases like that? I mean the perfect answer is to find a cure for dementia but it isn't like we can just snap our fingers. For now we have to deal with it. The only cheap solution is basically to just ignore people with it and let them die a horrible death. If you want to be civilized about it you have to care for them and it is damn expensive.
These are new problems on the scale we face now. People didn't used to live long enough on average for this to happen a lot. Now, instead of just dying fairly quick, many people have a downward slide that can last a long time. That is damn expensive and not a situation where yo can "Just pull the plug," unless by that you mean "Ignore the person and let them die of starvation."
Right after we agree on and solve global warming/climate-change/cooling.
Human nature. Learn it. Live it. Love it.
1) Mortality rate != quality of life. My "health care" is about the latter, while the former also plays a role.
2) Insurance Scheme != Free Market. If you went to an old lady and said you can either have the $90,000 that a hip replacement costs, or you can get the replacement, THAT is free market. People would be more diligent about the VALUE of their treatment. Can $90K buy more quality of life than the replacement? I suppose that depends on the situation, but at least the person getting the treatment could actually have "informed consent"!
You have to be real careful comparing anything with Medicare for several reasons:
A) To qualify for Medicare you have to be in your sixties (with some exceptions, but true for the vast majority of enrollees)
B) Medicare takes everyone, with a large percentage (aka not an insignificant percentage) of enrollees coming from being uninsured/self- insured - they likely come with Pre-existing and previously untreated problems
C) Medicare has a policy of pay any invoice submitted, which results in a staggering level of waste and fraud which leads to skewed costs for treatments, as compared with priivate healthcare coverage plans that aggressively investigate fraud and abuse
It's fine to compare other populations with Medicare, but keep those properties of Medicare in mind when you compare things with it.
Ken
You want to look at decreasing lifespan. The expensive years are he ones in the end. When someone doesn't die of anything specific, but rather just gets so old that everything starts breaking down. That gets real expensive. Worse yet, if the thing that breaks down is their mind they can spend many years needing fulltime care which is really expensive.
Now I'm not saying we should look at decreasing lifespans, however please don't have this confused idea that it would lead to lower health care costs, which is what the article is about. Some people seem to think you can out-healthy everything. Just be healthy enough and you'll never be afflicted. Nope, sorry, not the case.
In the university where I worked, I actually came across a bunch of Computer Science PhD students who thinks that the statement "Childhood and adult obesity leads to skyrocket medical cost" is A MYTH.
The only way to solve the financial trouble of the US government may well be using the "seigniorage hack".
New Economic Perspectives
Three points I'd like to make. The first one is based on my time spent working in Europe (UK, the Netherlands, France and Germany) and the U.S. In Europe, there is much more emphasis on preventative care compared to what I've seen in the U.S. Being a cynic, you could say that's there's more money to be made from letting people get sick and then treating them as opposed to stopping them getting sick in the first place. Secondly, is the insurance aspect. My wife and I both go to the same primary care clinic. I have insurance, she doesn't (her choice which I don't agree with but that's another story). Last bills for an office visit - $395 for me and $90 for her. Out of pocket I paid less ($20) but I'm always surprised at how much less the un-insured rate is at medical practices in my area. Then take the case of the facility I work at. Out of 60 or so people working here (it's an ambulatory surgery center), 6 spend most of the day arguing with insurance companies over billing and denials. Another 3 handle the actual billing. That's a big administrative overhead to have. Lastly, there seems to be a huge number of medical facilities in any town in the U.S. Back in Europe, most issues were either handled by my primary care doctor or referred to a specialist at a local hospital. For my last issue I ended up going to 5 different facilities around town, who all sent my insurance company their separate bills. How inefficient is that?
The states with some of the lowest Health Care spending (compared to other US states) have the best outcomes. You look at a state like Minnesota which is highly regulated, mandates Health Insurance Companies are not for profit and allows "never pay events" (medical mistakes neither the patient nor insurance company have to pay) and they have some of the best outcomes.
I'd also point out that high medical costs are often attributed to lawsuits. I would point out that Texas passed Tort reform a long time ago and the highest cost counties in the US are in Texas.
Bottom line, you want lower cost health care you restrict profiteering and you don't reward bad behaviors by doctors or insurance companies.
It's a basic civilised social service.
you had me at #!
> In the US we spend WAY too much doing things to people that gives very little benefit to them. The major
> culprit is the 'free market' system where profit (at multiple levels) is considered the appropriate metric.
How exactly is our healthcare anything like free market? Do you get any real choice in provider? Do you know the prices? Do you evaluate cost vs. benefit before buying the service? Does anyone even perceive healthcare as buying a service?
The reason we have this problem is precisely because healthcare isn't a free market. People see things as being "free" (and will complain bitterly if they're not), and never bother to ask whether or not dropping $10+k on a pointless treatment really matters. (Hell, half the time it's difficult to impossible to figure out what the cost is anyway. Good luck getting a straight answer on that, when the quoted "price" is 4x what would be normally be paid by a healthcare provider.) If there's no cost, there's no competition and no cost-benefit analysis.
When it comes down to it, even thought the service is technically provided by the private sector, the only choice you have in it is, essentially, who your employer is (to the extent you can call that a choice). Even in an illegal conspiratorial oligopoly you can at least pick your poison. As it is you pretty much get what get and nothing if you don't want it (but you'll still be paying for it anyways). If that's a free market then so was communist Russia.
Living in Canada, I can tell you - our healthcare system SUCKS. Have a broken arm? Go to the emergency room and sit there for 4 to 6 hours for someone to attend to you... What you need is better expense management not higher spending.
Bow before me, for I am root.
Maybe they should worry about literacy as well.
you had me at #!
1) Mortality rate != quality of life. My "health care" is about the latter, while the former also plays a role.
2) Insurance Scheme != Free Market. If you went to an old lady and said you can either have the $90,000 that a hip replacement costs, or you can get the replacement, THAT is free market. People would be more diligent about the VALUE of their treatment. Can $90K buy more quality of life than the replacement? I suppose that depends on the situation, but at least the person getting the treatment could actually have "informed consent"!
You forgot one part of point 2: It is only a free market if Old Lady is offered a check for $90,000 and a contract stating that any and all reciprocal/external costs of not having a new hip are hers to bear (including additional costs related to elder care, that will of course be deducted from that $90k.) However, this is highly unworkable because say it's a new heart instead of a new hip and without it she would die in a matter of days instead of a matter of years. Still want to put that $90k under her nose and offer to have her sign her death certificate to get it? No, I didn't think so. Actual health care is not "insurance" nor is it a "free market" so attempts to make it fit into either of those models is just plain naive. You can certainly break pieces of it up and offer those as market-based solutions to something like primary care, or something like "major disease" insurance, but to put all of these things into one bucket, put one price tag on it and call it "health care" the way that companies in the US currently do is just plain dumb.
The difference these days is dementia. I can speak from experience that it is far easier to care for a terminally ill family member without any mental incapacity than with. With people living longer, there is far greater rate of dementia among our old and ill. And to watch someone you have known and loved fade away from you is heartbreaking.
On a more selfish level, just having someone show appreciation for your care is also very important, and caring for someone that doesn't know you any more can be hard.
This question is irrelevant. The real question is: should people be able to spend their money in any way they chose, even if what they spend it on is pointless. If you think that we should be living in a free society then yes, people should be able to spend their money on a $100k cancer treatment that only has a 5% chance of giving them another year to live. It's their money.
Healthcare costs are skyrocketing for a few very simple reasons:
1. a terrible patent system that gives companies exclusive rights to certain drugs, chemicals and procedures when often that company did little to develop what they patented.
2. a terrible legal oversight system in which these same companies can hide flaws in their drug/device until the patent is about to expire, then leak the information, get the drug/device banned and immediately release an alternative under a new patent, there-by allowing them to extend their patents almost forever.
3. The marriage of the insurance and medical industries via the HMO/PPO networks. Now the doctors basically work for the insurer. The insurer demands test after test, sending the patient back and forth between doctors and specialists so they can collect as many co-pays as possible before treating. Closed Pharmacy plans force patients to buy from the HMOs pharmacy which conveniently does not carry many alternative drugs, and the patients are forced into buying drugs with a high co-pay or buying outside the network which, again, comes with a high co-pay.
4. Add all of the above to the simple fact that it's human nature to want to live forever. They have what you need to live, they are the only ones allowed to sell it to you by law. They control the means to get it, the amount you can get, when you can get it and the price. That right there is the ultimate situation to ensure price gouging.
I've not seen a single point I've made above addressed by congress. The simple fact is they are in the pocket of the healthcare industry, any plan that our government has regarding healthcare you can be sure will do nothing but make it even more profitable for the industry.
The system in the US is very different from Ontario's health insurance plan. Traditional fee-for-service Medicare is very different from private insurance. Both of these combine to give the results you see.
1. Doctors (usually) graduate with huge student loans and have to pay into malpractice insurance in our system, which means they need to charge a lot of overhead to make a profit that justifies the amount of effort they put in to their education.
2. Doctors in the US also need a huge office staff to keep up with billing insurance companies, fighting claim rejections, processing referrals and all the "stuff" that is needed to deal with the wide variety of insurance companies. A single payer system with flat fees for service and a single (hopefully electronic) way to submit claims reduces those staff requirements significantly.
3. Doctors may bill a large fee for services rendered, but they usually never see that -- they get the "negotiated rate" from an insurance carrier. So, that $250 for simple bloodwork that is billed to an uninsured person gets knocked down to the $10 or whatever the insurer feels it's worth. Go look carefully at those Explanation of Benefits statements you get if you're insured. They detail exactly what your insurer pays and what the doctor or hospital has to write off. (This is also why uninsured people have it much worse; they're paying bills at the full rates to make up for the money they aren't getting from insurance companies.)
4. Because healthcare is very expensive if you're uninsured, and can be expensive even if you are, people wait longer to see the doctor and usually only see them when something serious (read: expensive to treat) is happening.
5. Without sounding too political, Americans generally can't stand the idea of modifying their behavior for the benefit of society. Selfish and individualistic would be two adjectives I'd use to describe most people who live here. Governments who have a little more control over their population (or maybe just a more homogeneous one) have an easier time pushing fitness and smoking cessation programs.
6. On the whole, people with lower incomes and education end up with much worse health problems, meaning they're more expensive to treat than those who can afford to pay.
We can't really fix #5 and #6 (Canada and Europe can't fix #6 completely either.) The big contributor is all that overhead (office staff, paperwork, insurance companies who take their cut, etc.) I've talked to doctors who say that Medicare has its problems, but at least they usually get reimbursed without fighting and it's easier to submit all the billing paperwork.
If I were king, and could wave a magic wand and fix everything, my solution would be this. Extend Medicare coverage to everyone at the current benefit levels, and yes, increase taxes to cover it. Let the private insurers fight over the gaps in coverage (Ontario's plan doesn't cover dental care or prescriptions, that's a huge market right there.) It would put a lot of office staff out of work, but is shuffling paper in 2012 high-value work?
An alternative would be to morph the private insurers into claims processors, and use them to help detect fraud. Usually, we only hear of the really outlandish fraud cases, like doctors recruiting Medicaid patients into signing forms authorizing treatments they never get. Fraudulent claim detection would be an interesting use of Big Data(TM), especially when the data is all in one single payer system.
People like to bash single payer systems because they ration a scarce resource. I just don't see it. Go to Ontario's health insurance plan website, or the NHS website. The wait times aren't unreasonable -- they're longer than what we're used to, but we're used to healthcare being treated as an unlimited resource. In any of those systems, if you're truly dying, you go to the emergency department and you're going to get treated.
really? But it is universal and is paid for. And Canada spends was less than the US for health care and it is universal. No denial based on previous conditions, regardless of employment status, and with most medicines for seniors paid for,
What happened to family taking care of their own?
You need a house with an extra bedroom.
Someone at home around the clock.
So...you need a single income family in a house with extra rooms... In an age of dual income families who both have to work just to afford living in a small condo.
The articles concludes with "Among Ontario hospitals." The US is not mentioned. So why ask "What are we doing different in the U.S.?" in the story headline?
Still want to put that $90k under her nose and offer to have her sign her death certificate to get it? No, I didn't think so.
While I don't think that's the best solution, I think it's much more equitable than what we have today. As long as she is informed of all the ramifications.
Hell, yes.
Let's send everyone to Chiroquacktors. They require you to come in and fill their coffers twice a week for the rest of your life while they adjust your back to fix your enlarged prostate or ingrown toenails. I understand they have a special back popper to cure lung cancer. Quacks. They may be able to fix some back problems but other than that they are quacks.
Receive regular Chiropractic adjustments. This will help with
nervous system function, remove blockages/subluxations, and help with nerve
impulse distribution.
I used to see a chiropractor. He spent most of his time convincing me that I had to keep coming back for more (at over $100 per visit, I can understand why). First time I went he told me that I might feel "dizzy or tired" after my first adjustment (yeah right, nothing like the power of suggestion, what?). I never saw any benefit from his treatment that couldn't be explained by the placebo effect.
He also enrolled me in a little lecture that one of his colleagues delivered in which he claimed that chiropractic can cure absolutely any ailment you can think of, and that vaccines cause autism, which is a flat out fucking lie.
If chiropractic wants to lose the pseudoscience label it'll have to start producing some evidence that it actually works and distance itself from the Jenny McCarthy/Jim Carey/Oprah crowd.
Drill baby drill - on Mars
It's a basic civilised social service.
Well there's your problem, right there...
the preceding comment is my own and in no way reflects the opinion of the Joint Chiefs of Staff
Easy one sided conversation to have from the couch but things get a bit blurred the closer to actual care you find yourself. The other day I had a patient call and demand a treatment "he had heard of on the internet" (boy I love that one). Where two specific sensors were placed in the esophagus at variable heights to accurately diagnose reflux. I told him that I had not eard of placing two sensors and even the placement of one (~ $750 cost of each) was a last resort after several other, cheaper tests had failed to provide diagnostic value. The reply from the patient was "the article said Medicare would pay for it." When I told him that wasn't true the guy went off on me.
For another example take sedation for colonoscopy, which by the way is not the norm in most European countries. The national standard of care is conscious sedation (not fully asleep) but more and more patients are demanding deep sedation (Propofol) even though it increases the bill by $400 to $1,400 (x 9.2 million) simply for patient comfort.
Nothing else! Proven over and over and over and over and over...
If you haven't seen the words 'health care' in news headlines lately, you must be living under a rock.
Technically, I'm living on a rock. It lies about halfway around the globe from the U.S.
If chiropractic wants to lose the pseudoscience label it'll have to start producing some evidence that it actually works and distance itself from the Jenny McCarthy/Jim Carey/Oprah crowd.
More importantly, it will have to distance itself from the pseudoscience crowd who claim vaccines cause autism and similar disproven ideas that some quack made up.
Some chiropractors are cynical quacks who are out to take the ignorant public for an easy buck. Others are genuinely trying to help people with legitimate physical therapy techniques, but are frequently misguided by the anti-medical quackery that pervades the field.
The reason we have this problem is precisely because healthcare isn't a free market
OK. You seem convinced of this position, and I'm genuinely curious. Can you give an example of a country where there exists a genuine free market in health care, that achieves better health results than the USA does? There are roughtly 200 countries to pick from, and I know some have neither socialized medicine nor insurance systems, so throw me an example please.
Wow, way to look at it one-sided.
Other side of the coin: They're in a nursing home because then they can be surrounded by NURSES who have an ideas to what care they need, can administer painkillers as needed, and take care of all of those things that those in the medical industry know how to do, but is highly unlikely for anyone else to know. Unless you know how to correctly insert a needle into a vein, insert a catheter, obtain medicine and know the correct dosage to administer via IV, then it's probably for the best if she's around people who CAN do all of that.
Personal experience: My dad needed to be in a hospital for the last few months of his life because he was exactly all of the above. So unless we strapped him onto the toilet at home, we would have been incapable physically move him around (from bed to washroom, etc), nor had any idea what to do if he's in pain in X location. Long story short, he's sitting in the hospital because WE CANNOT PHYSICALLY DO WHAT IS REQUIRED TO HELP HIM.
I mean sure, if you want your loved one to die in agony because of a urinary tract infection, you can leave him in your place, and watch him howl in agony while deficating on the bed. Personally, I'd prefer if he wasn't in pain and surrounded by professionals that can ensure that.
In this particular case he needed round-the-clock care which could not be provided in our home. He had a serious brain injury which left him totally incapacitated (as I mentioned in my original post).
He had to have a foley inserted for urine collection which he would routinely remove himself, he wore a diaper for feces, for a short while when he was first admitted he had a feeding tube. He needed to be moved frequently to avoid bedsores. He had to undergo physical therapy regularly.
Yeah, my parents could have added an addition on to the house and made it handicapped accessible. They should have brought in a team of nurses to tend to him round-the-clock in our home. My father could have quit his head-of-household wage-earning job while I was in college (I was on an athletic scholarship but still had expenses) in order to help care for him.
Unfortunately, in this instance, the best option both for my grandfather's quality of life and my parents' was to keep him in a nursing home instead.
YMMV.
We won't talk about the adjustments - those should be done with a framing hammer for most people.
Why so gentle, sledgehammer in the shop?
I will go along with good diet and exercise, but he left out quality rest. For optimum sleep I recommend my Snooze 4 Sure line of mattresses and box springs. Only Snooze 4 Sure is made with the same material used to line caskets... so you know it's comfy!
You have the right to remain sentient. If you give up the right to remain sentient, you will be elected to public office
Watch this documentary and shake your head wondering why infant/mother mortality rates are so high in the US despite all the medicalization of the birth process.
That's a rather accurate and complete description.
I only have a couple things to add.
The quoted price is what you risk paying if you don't have insurance. So a high quoted price is something good for the insurer as it will scare you into buying their overpriced services.
Some insurers might pay more than others for the same service, so one could think they would want to reduce the "quoted price" so they all benefit by paying less. But I am more and more convinced they actually benefit too much from the absence of reasonable public prices and therefore are trying to keep the non-transparent pricing in place.
I am not familiar with many drugs, but the few I know make it clear that your insurer doesn't care about getting you a good price for drugs. The copay of drugs can be 2 to 3 times more than the list price or quoted price of the same drug in France (whereas food, clothing, gas and many other commodities are rather cheaper in the US). This is a clear indication that the insurance company acts like a broker that helps you buy services but it actually doesn't care if you get ripped off. The only meaningful difference is that in France, the insurance company negotiates the list price down. So everybody, even those who don't have insurance benefit from the negotiation.
If we were able to switch insurance providers easily, we would be able to choose the best brokers and also the best coverage. The only issue is that you don't want freeloaders in the system, so you need a minimum level of coverage that people must get. Otherwise they can just go with a dummy insurance for 2$ and then when they are sick they can just benefit from our humanity (i.e. we are human so we won't let them without care when they show up at the emergency room).
Overall, healthcare is an issue that is both social and individual. Therefore it can't be simply handled by pure market or pure governmental solutions. But at least we should make sure we have working market components in the solution and working governmental components too.
The closest thing you will get to a free market in health care was the in the U.S...a long time ago. Don't confuse old technology with old policy when comparing the two by saying "we'll go back to using leaches". I believe the first major change to this was in 1973. The GP is completely correct in that the major problem in health care today is that people don't pay directly. There are proxies and no one knows the price.
If gas prices were hidden and the government (or insurance company) paid for them, people would drive all over the place without care. Demand for gas would go up and prices would go up. No one would challenge the price change because they don't even realize it and accept it as "normal".
That public insurance plan your gov wants will not be free. No matter what the cost is in the first couple of years it will continue to go up year by year. Like it says in that page, in 2010 the cost of that insurance plan was around 191 billion. I don't know exactly what will the cost be in the USA but it will be higher that's for sure.
Right now the health sector is worth around 33.1% of our provincial budget. It started smaller of course but over time, the budget for the healthcare system grew bigger and bigger and there's still no limit today. In the last provincial budget, nothing is done to take care of our deficit. This also includes the health care system.
The reason this does not hold true is that a point is reached where increased spending does not increased quality just increased levels of care. America spends 17% of GDP on healthcare vs around 12% for nations with other levels of care. So where does the money go? One example is over spending on medical technology since our providers are competing for patients. For instance, I live in a community of under 200,000 residents and we have 3 MRI machines each requiring $1,000,000 of revenue in order to justify the costs. Three hours north is Winnipeg Canada where 1 machine serves 1,000,000 residents. This substantially more tests need to be ordered to keep the MRI machines feasible which is easily accomplished by the physicians in the organization recommending unnecessary tests. Also, it is impossible for government to impose restrictions on medical technology since people have been brainwashed into thinking that technology directly results in better outcomes when in fact a doctor might obviously know what is wrong with you and doesn't need a picture to prove it in many instances. Another major issue we face is that though the market demands 60% primary care and 40% specialty there are no restrictions placed on physicians from doing whatever they want so 60% work in specialty and demand specialty compensation. Direct advertisement of prescriptions to consumers and an insurance system where insurers often pay less than 60% of premiums on actual care all work together to inflate the price of our care. Since this is what I studied in undergraduate and graduate school I could go on for pages about all of our problems but this is a comment not an article so I'll rest my case.
The reason we have this problem is precisely because healthcare isn't a free market.
I'm not a total free-marketer, but I have to agree at least this far: the problem is that we have built a system that is neither a free market nor a socialist system, but instead borrows from the worst qualities of both.
Most people don't have a choice in healthcare nor do they have a clear idea of what costs they're paying, or what costs they would be expected to pay if they faced an emergency. Health insurance has been heavily subsidized by the federal government for decades. On the other hand, it isn't regulated very well, the costs aren't made transparent, and it's run as a for-profit venture. You basically have a subsidized government monopoly without serious regulation or even the supposed motive of helping people.
In my view, we should basically pick one road or the other. The way we have things set up right now is just corporate welfare, but nobody really wants to end it. Conservatives like corporate welfare because their economic theory boils down to "give rich people more money, and they'll fix everything." Liberals want the socialized system but want to hide behind some free-market trappings.
Exactly. Insurance disconnects market forces that would otherwise put downward pressure on price and consumption of services.
Here's a personal example:
During a recent visit to the dermatologist, he casually says he's sending me down to get some blood drawn to run some tests. The nurse takes my blood, and I go home. Three weeks later, I get the bill, for over $1,670 for the "labs." If I had known, that was how much they were going to charge, I would have never allowed them to draw my blood. And this is the problem.
They compel you to consume a service, without ever knowing the price before you as a consumer are allowed to make the purchasing decision. No ability to shop around, or incentive for competition on price. And you are legally obligated to owe the debt, before even knowing what it will cost you. They just send you the bill for whatever amount they want weeks later. Talk about a business model.
The US is close to the level cap, so it takes 10X more to level than Canada. Canada is more into the role playing aspects.
That and they need to stop with the magnets, and homeopathic crap. They are great for getting your back and joints opened up (which can get rid of certain types of pain), some also do a fairly decent job with physical therapy but some of the crap they push is pretty bad.
Time to offend someone
well...stop seing healthcare as a business. Its a right that everyone has a life to begin with right (first ammendment).
So what can u do? simple. Pay doctors a fixed salary. Force pharma companies to produce cheaper and make all hospitals free of charge for anyone. ....but yeah...doesnt work because you guys think that this is communism...well...then stop whining and swollow the Bitter expensive and mostly useless (and maybe even homeopathic) pill. Buy a few bibles and hope for the best...because u aint prepared for the worst.
(God im happy to not be a american!...scary place...for real.)
Instead of think think think do
Because that results in more billable events.
Dude,
Everybody benefits from ridiculous quoted prices. The hospital increases prices 10%. The insurance company negotiator negotiates some of that price increase away. Because the discount for his company is now 55% of list price, rather then 50%, he gets a bonus. The hospital gets a) 5% more profits for no extra work, or b) 5% more to waste on sexy prestige-bringing, low-revenue crap like brain surgeons; so their executives get a bonus. The insurer can jack up premiums and 'prove' they're justified to the Insurance Commissioner because they're paying more for the same medical care, so that guy gets a bonus...
And the people who end up paying for the jacked-up rices, and executive bonuses, don't notice because their health insurance is a "fringe benefit." The bad guy to them isn't the health system, it's their boss who had to gut the budget for raises this year to keep their health plan.
In general I agree.
But in many cases seeing a ridiculously misinformed chiropractor is helpful to stay healthy. The reason is simple:
The most stubborn diseases we face today are caused by people doing shit they know they shouldn't do. If you're pre-diabetic and you have to explain to your chiropractor that you pigged out on donuts you're a lot less likely to pig out on donuts. You're also less likely to be allowed to rationalize getting back into cigarettes or booze.
Yeah you could get the same from an MD, but who can afford a half-hour appointment with an MD every week? A chiropractor is a lot cheaper, which means he's a lot more likely to get results.
This is why a lot of modern docs are trying to usurp Chiropractors, Massage therapists, and other Alt-Med types. If they can be convinced to cut down on the woo, tell people to get their vaccinations, and the MDs simply tolerate their BS explanations of why their particular placeboes "work," we'll probably end up with better health.
Sorry, no on point "C". My wife works at a hospital in medical records and has noted how rare it is for medicare to pay the bills that are owed.
But if that's the case, then one of the many many countries with no socilization of their health care system at all ought to have better outcomes than the US. So show me one.
Here, I'll even do a little of the legwork. The World Health Organization ranked countries by healthcare efficency here. The USA ranked 37th (of about 190). So if the real culprit, as you folks are claiming, is how "free market" the system is, then which of those 36 more efficient countries has a free-er healthcare market than us?
Housing may be related to interest rates, which are somewhat controlled by the Fed, or to the guarantee / purchase program for banks, but it's not subsidezed by the feds. Up until 2008, they were making money hand over fist. Houses went up due to rampant speculation.
College tuition costs can be masked by government backed loan programs where you can sequester college loan debt, making the cost of tuition appear lower because the cost is deferred. That one...yeah, I think there's culpability there.
Health Care? Doctor bitch incessantly about the public program (medicaid/medicare) reimbursement rates because they're so much lower than private insurers pay, which is in turn a small fraction (often 10-15%) of what medical providers will charge if you come in with cash. Litigation and profiteering is at the heart of medical costs. More than half of ALL court cases in my region are filed by in-house lawyers from the largest local hospital suing for unpaid medical bills.
There's nothing that the government is doing in healthcare that hides costs from people who are paying for service. The whole system is fucked up because there is no good way to shop for pricing vs efficacy, and if a doctor chooses a cheaper way to cure you and you die from even a closely related cause it's their livelihood on the line. It's in their interest to get you every service just to cover their butts. It's closer to the reason why NASA's stuff is so expensive: if you can't afford to fail, you''re going to spend an inordinate amount to try and guarantee success, even ifyou know the money is probably wasted.
Is it just my observation, or are there way too many stupid people in the world?
The fact is that the arguments for and against nationalized healthcare, etc are all just canards for the real question that we (as far as I can tell) don't have the seeds to face: resources are finite - need is not.
Is it worth $250,000...$500,000....$1 million or more to prolong some 85-year old's life another 6 months or year? In the US, we have a schizoid system: if the 85yr-old has enough money and wants to spend it that way they can. If they have NO insurance, often they can get very expensive treatments for free. If they have "some" money and insurance, they can only get some of these treatments.
In countries with national health care programs, on the other hand, generally its the decision of a bureaucrat somewhere (granted, most systems leave the tactical decisions to the doctors - but somewhere further back, that doctor's choices have been somehow constrained strategically by a lawmaker, bureaucrat, or agency).
We have staggering technical capabilities, but they come with staggering costs in sophisticated capital, training, expertise, etc.
For that matter, what is the value of any human life, at any stage?
I'm reminded of one of the most difficult situations I ever witnessed. A cousin had a child that was severely allergic to most everything. She was a nurse, and since they had a very specially-designed home, she took in high-(medical)-maintenance foster children. She had one beautiful, sweet little girl who'd been born to a crack-mommy. This girl, aside from allergies to pretty much everything including gluten, had severe haemophilia. Even TOUCHING a countertop where a sandwich had sat (bread=gluten) could give her a severe nosebleed, which could easily kill her. This girl was 3, and had had more than 200 transfusions. She essentially lived in a hospital her whole life. My cousin said one of the aid workers said the state had spent nearly $350,000/year on her care.
On the other hand, my sister-in-law adopted several equally-adorable children from a Guatemalan orphanage, where they were told that their "thank you" gift of $500 would feed and clothe many of the kids for a year as well as provide basic medical care for the whole orphanage.
So you tell me: Is the life of one sweet little American crack-baby girl worth the care and health of more than 700 Guatemalan orphans?
That's a moral dilemma I've struggled with for more than a decade since, and I've seen that a variation on this theme seems to be the *real* root of the healthcare debate. One party sees the crazy costs the other is paying for not-significantly-better outcomes, the other is uncomfortable with external constraints (theoretically) limiting access to resources.
Both want to give people the best healthcare possible given limited resources; one sees an 'impartial 3rd party' (government) as the fairest way to divide things, while the other prefers a system that (theoretically) allows anyone to have anything, as long as work hard enough and think ahead.
-Styopa
Can you give an example of a country where there exists a genuine free market in health care, that achieves better health results than the USA does?
Mod parent up.
I've been asking that question for a long time and never got an answer.
The only free-market health care systems I know of are in third world countries that don't have much of a health care system at all.
I believe South Africa had a free-market system under apartheid, but I could be wrong.
The reality of some people's conditions means that this isn't possible for everyone. What if the children work full-time, and the parent is requiring full-care? This can mean two-handed care. They may also need to be available around-the-clock.
I'll die before getting stuck in a home. I don't understand the point of clinging to life when life no longer has anything left for you. Y'know what's much cheaper than spending a decade miserable in a nursing home? Skydiving. It's probably even cheaper if you opt out of the parachute.
"The same group of researchers conducted a similar study of the US health care system about 10 years ago, and the findings were quite the opposite of the 2012 Ontario-based study."
Using different studies that may have used different criteria and were 10 years apart is not a good way to compare health systems. Unless they were designed to compare the same metrics in the same period, this data should be taken with a grain of salt.
That said, i think it is good that this kind of comparative study is being discussed. Considering that a large part of our GDP is being spent on health care, either by insurance or taxes, we should definitely be looking at what works and what does not.
Unfortunately, in my opinion it is the national culture here in the US that drives the cost up. Examples:
Primary physicians in the US are underpaid only in comparison to specialty physicians. They are paid more than primary care physicians in other countires and much more than the average citizen with equivalent education.
Laws are structured to uphold patents and contracts that do not benefit the general populace.
A substantial portion of the populace is happily inflicting diabetes, heart disease, and drug addiction (alcohol and tobacco, etc) upon themselves and anyone that tells them different are tree-hugging hippies.
Doctors and executives are technophiles who will spend millions of dollars on the newest equipment.
oldhack: "Security is a waste of money until shit hits the fan. 5 minutes later, it becomes waste of money again. "
Long answer: Hell, no!
"You can have a hip replacement (that would cost us the insurance company 90,000) or we'll give you 45,000 in cash...take your pick."
It sucks to be poor.
blindly antisocialist = antisocial
The United States runs a "for profit" model. Canada runs a "for better society" model. In one model the fundamental design of one system dictates that consumers spend as much as possible and receive as little as possible. The fundamentals of the other design dictate that consumers all receive adequate care, and the only reason to spend more is to get more.
Some people live in the Federation; others in the Ferengi Alliance.
If gas prices were hidden and the government (or insurance company) paid for them, people would drive all over the place without care.
If a US health insurance company paid for fuel, they'd audit every trip you took, making sure that it was a life-or-death situation before you went.
If a non-US public insurer (say, Australian Medicare) paid for fuel, they'd set the price they paid for fuel, reviewed yearly. Petrol stations ("gas" means LPG since this is Australia) would charge what they want. Some petrol stations would provide a completely no-frills service so that they could charge exactly the government price, so you'd never be out of pocket. Most would only charge the government price for people who are disabled and so couldn't walk or bike around. But petrol stations would actually be allowed to charge whatever they want, and many would pay it if they provided, say, full driveway service.
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why should people in lockup get to see doctors with out the big bills or Pre-existing condition BS.
As I noted in another post, my grandma is going through this. She requires full time care. Not as in someone who lives with her and checks in on her, as in someone who is minding after her at all time. That person can't have another job, that person cannot go and do anything without her, or without finding someone to care for her while they do.
So what do we do? Should I quit my job and move to care for her? Never mind that I'd go broke in about a year (I have savings, but not an infinite amount) is it fair to me to sink my life and my career to care for her? Also please understand that outside of dementia, she is fairly healthy for her age. This is something that would have to be done for somewhere in the range of 2-10 years (5 being the most likely).
Oh, and then there's the fact that I'm not a medical professional.
Taking care of someone for a brief while before they die is fairly feasible, particularly if it is a case of them being bed ridden and mainly just needing a comfortable place to die, which is what you are talking about in the past. Whole different thing to provide full time supervised care.
So sorry if you think I'm callous in that I think my grandma should be sent to a nursing home (not my call, her kids will make the choice not the grandkids) but I think that is the option to give her the best care. I am unwilling to become her fulltime caretaker, as are all the other grandkids. We all have other obligations.
I am not familiar with many drugs, but the few I know make it clear that your insurer doesn't care about getting you a good price for drugs. The copay of drugs can be 2 to 3 times more than the list price or quoted price of the same drug in France (whereas food, clothing, gas and many other commodities are rather cheaper in the US). This is a clear indication that the insurance company acts like a broker that helps you buy services but it actually doesn't care if you get ripped off. The only meaningful difference is that in France, the insurance company negotiates the list price down. So everybody, even those who don't have insurance benefit from the negotiation.
I live in the US, and have been taking prescription drugs for most of my life, and this does not match my experience. When I get prescriptions, the price is the co-pay for that class of drug, or the actual price, which ever is less. I have a higher co-pay for "specialty" and brand name drugs for which there are generic equivilents. I have drugs that fall into each category, specialty, brand name, generic, and less-than-copay.
I am not qualified, nor is my home equipped, to provide the sort of care available in good facilities that specialize in the needs of older patients. By the way, there are a whole range of options, from "assisted living" which is pretty much an independent life with facilities available if and as needed, to facilities offering nearly ICU level care, and everything in between. Any of these, chosen appropriately, and with regular visits or outings with family and friends, is better than sitting in my empty house all day while I am away at work and unavailable to provide ANY care or assistance. Your "golden age of yesteryear" when happy smiling oldsters lived with their loving families and were healthy and happy until they passed away singing in their sleep is a crock.
WALSTIB!
Please research some of the doctors that do not accept insurance.
A couple articles from google:
http://www.healthbeatblog.org/2008/07/doctors-who-don.html
http://www.kevinmd.com/blog/2010/02/primary-care-doctors-practice-insurance-free-medicine.html
Aah, change is good. -- Rafiki
Yeah, but it ain't easy. -- Simba
Sorry, but I couldn't find any comprehensive statistics that made a valid comparison.
First, the chunk is too big: There is no valid way to statistically say that money is evenly distributed among health providers and/or patients.
Second, in order too be valid, we would need a large sample of all medical services and statistics comparing similar ailments, the cost of treating each ailment, and the outcome. As far as I can tell, vaccinations have the only well-defined statistical data, and even that is controversial in some areas.
Ask a better question.
"The mind works quicker than you think!"
How exactly is our healthcare anything like free market? Do you get any real choice in provider? Do you know the prices? Do you evaluate cost vs. benefit before buying the service? Does anyone even perceive healthcare as buying a service?
you are ignorant. you let somebody else answer all of these questions for you, and thus you assume that you are powerless to make your own choices. that's right: you let them. not caring about something doesn't make it less free.
Canada has an efficient and effective single-payer system. When you are already spending money well, spending more money might be better.
The US has a fragmented, inefficient, and often ineffective hodgepodge of systems. When you are already spending money poorly, spending more money might be worse.
Or, put another way, Canada is probably somewhere to the right-of-peak on the Laffer curve of health care spending vs outcomes. The US is far, far to the left.
Medicare also pays less per procedure than private insurance. Medicare has much lower administrative costs than private insurance. Medicare "fraud" is usually nothing of the kind, but rather failure to fill out paperwork to arbitrary and labyrinthine standards. Even failing to sufficiently screw indigent patients who aren't covered by government programs is considered "fraud". Since anyone can sue anyone for this "fraud" (qui tam bounties), there are many frivolous yet successful lawsuits, driving up costs.
Even so, the cost to benefit of Medicare is much higher than any US private insurance.
"Is life so dear, or peace so sweet, as to be purchased at the price of chains and slavery?" - Patrick Henry
Except that Canada's population is much smaller than that of the U.S. and is not nearly as heterogeneous that of the U.S..
I would argue that Canada's population is just as heterogeneous as the US, if not more so given that we have a higher rate of immigration per capita. According to this the US had 14 million immigrants from 2000 to 2010 where as this says that Canada had 250,640 immigrate in 2001 alone. If this were kept up for the same ten year period it would mean ~2.5 million immigrants but for a country with a tenth of the population of the US so to have the same rate per capita the US would need ~25 million immigrants. So, assuming the diversity of immigrants is comparable Canada should be more diverse than the US.
In terms of overall population size having a lower total population should not make a difference at the levels we are considering. However the Canadian population density is far less than the US. We have a larger area with a tenth of the population although the distribution is not even. This means that it should be more expensive for us to run a healthcare system since we will need to have more hospitals per capita to serve remote locations.
The main reason that we have a longer average life expectancy is because everyone has access to healthcare. This means that even those who, under a US system, could not afford a doctor can get treatment. What would be an interesting, but potentially controversial, comparison would be to comare the life expectancy of Americans with healthcare plans to Canadians with a similar demographic. I suspect, but do not know that with that comparison the US may fair better.
And to make matters more morally cumbersome, you need to address the law of diminishing returns. At some point, you have to say enough is enough or else we all go bankrupt. And then we have to ask "who makes that decision". The patent or a bunch of bureaucrats who live under a different health plan entirely from the rest of us.
One hella'va mess. I see this as an eternal struggle that's never going to go away.
Life is not for the lazy.
Is there anyone who hasn't realized the true nature of the US healthcare system? It is a money first, patients second system. The main purpose of the US healthcare system is profit, period.
So your saying i should have left my appendix in, and just run around more? You know I may just use a medical professionals advice over yours. And are you a Chiropractor by any chance... you got a reference for your claims on its benefits. Something with data in it preferably.
If information wants to be free, why does my internet connection cost so much?
After all, if the "zero profit" cost of that biopsy is $400 then you haven't made much of a saving, and the $2k was just pain profiteering, a made-up figure to make you "think" you paid less than 15% when you actually paid around 75%.
No, they're still getting the right to free healthcare, therefore they should pay like everyone else does.
Or in defending CEO compensation, are you not instead motivated primarily by greed?
The bottom line is that Americans spend more on health care and get less than people in other countries.
A point that is not new, and which has been screamed by many people over the past few years.
At some point, you have to say enough is enough or else we all go bankrupt. And then we have to ask "who makes that decision". The patent or a bunch of bureaucrats who live under a different health plan entirely from the rest of us.
Well unless the patient has the money to fund their own health care, at some point there will be a bunch of bureaucrats making those decisions. If it's not the government bureaucrats, it'll be insurance company bureaucrats. Or some other bureaucrats. Even if you let the doctors be those bureaucrats, they'll get mired in the bureaucracy of covering themselves from lawsuits.
At a certain level of running things, you need bureaucrats. You still have to evaluate what incentives you're giving those bureaucrats, and how competently they're executing their duties.
The primary goal of a health care system is to help people get and stay healthy. The primary goal of what we laughingly refer to as a health care system in this country, is to make a profit. Any one that says any different is either a liar or is seriously deluding themselves. As long as it's primary concern is to make a profit and benefit investors, caring for the sick will NEVER be a true priority. A true health care system cannot be concerned with making a profit. The only money concern should be to keep itself going, which of course we all call socialism, which is evil.
So what we have is a health care industry but even that isn't accurate. This industry does not profit from making people healthy, if everyone got healthy it would be out of business. It profits from people being sick so they can come back for more supposed health care. The only way to make more people healthy and keep them that way is through spending a lot of money on preventative measures, rather than costly, reactive measures when a patient's condition has reached a critical stage. We already know that it's less expensive to prevent sickness than to treat it, this is an established fact but again, there is no profit to be made there.
So what we have, if we want to be accurate with our naming here, is a sickness industry. That is what the US has and until we get over this ridiculous fear of socialized medicine, that's what we'll be stuck with. Yes, I too have heard the horror stories of people in countries with socialized medicine waiting for months or years for life saving procedures. I have two points for you there;
1) I have friends in several countries with socialized medicine and I've spent time in those countries myself. Neither myself, nor my friends, knows anyone that this has happened to and neither do the people that have shared these stories with me. It probably happens once in a while but certainly not to the extent that the right wants us to believe.
2) I already have to book my own medical procedures to keep skin cancer at bay, three months out or more. That's right here in our own glorious and righteous, US "health care system". I have gone without treatment several times because I couldn't afford my copay or my deductible or when, right after I lost my job due to recession, because I didn't have any insurance. I personally know MANY people that have had to do the exact same thing.
The US spends more money on health care than any other developed nation, yet we have the least healthy population of any developed nation.
This idea that more money equals better healthcare has been tried and tested and is an utter failure
Several decades ago there were no insurance companies in the US and many towns had their own doctor. The doctor generally worked alone, sometimes having a single assistant. He didn't have to worry about malpractice suits or piles of paperwork stacked from the floor to the ceiling. And anyone who worked any sort of job could readily afford to pay for the doctors services. Even if you couldn't pay, the doctor didn't hold it against you as he knew that by taking the Hippocratic oath his job was to work for the greater good of the community. Skip forward a few decades and we have introduced insurance companies in the mix. These companies were designed to reduce upfront health care costs by spreading them out over a long period of time (i.e. insurance premiums). The problem is that the amount of paperwork that insurance companies require to honor claims from doctors has become so overburdening that we now have offices with 5 doctors and 20-30 nurses where the nurses spend 90% of their day collecting data and submitting forms to the insurance companies. Of course the nurses can't work for free so once the doctors have paid them all a reasonable wage for their work they now have to recoup their expenses from either the insurance company or the patient. Obviously the insurance company is going to pay as little as they can legally get away with (and sometimes illegally as evidenced by the many laws we have in this regard) the patient gets shafted. Lets be realistic.. it wouldn't cost $1500 for 3 visits to an allergy specialist, including 1 allergy test and 1 rhinoscopy unless insurance companies were involved. It would likely be around 1/3 of that price. But that's what I ended up having to pay because of the bureaucratic atrocity that is the medical insurance industry.
The "solution" to our escalating health care costs of having an open "market," where "consumers" have a financial incentive to choose economically, and can select based on costs and benefits, fails to take into account the fact that choice has little opportunity to operate in the vast majority of such spending. When you're scheduling your colonoscopy or cataract surgery (or many other non-urgent and relatively inexpensive procedures), or even finding a primary care doctor, it would reduce costs and promote competition if patients were able select from a list that included charges and a rating of the providers. But when someone has a heart attack, or is severely injured in an MVA, s/he is not in a position either to negotiate a price or to select the place of treatment based on its costs. When you are told you have cancer, finding the least expensive treatment is not likely to be your major consideration. When your elderly mother is in the ICU on a ventilator recovering from pneumonia and other complications of gallbladder surgery, your decisions on her management will probably not revolve primarily on saving money. Until docs and hospitals are paid based on patient outcomes (or at least for providing optimal care), and not on how much is done (especially how many procedures are done, a particularly important consideration in my specialty, cardiology), the chances of significantly moderating health care costs are slim to none. Possible realistic potential solutions include paying for episodes of care (see http://en.wikipedia.org/wiki/Bundled_payment), and integrated systems of care, where the primary care docs, specialists, clinics, hospitals, convalescent facilities, etc, are all part of the same system, such as Group Health (Seattle) and Kaiser Permanente (primarily on the west coast). But both would require significant changes in the structure of health care in the US, something that does not appear about to happen. Robin M. Lake, MD, FACC, FCCP
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I'd like to see an example of a working free market healthcare system before we
pick one road or the other.
.
As far as I can tell, the only examples of cheaper more effective health care systems are from Western Europe, which are almost entirely made up of single payer systems. Slashdot in general is an audience that demands evidence. There is no evidence that free market forces would handle the delivery of health care better than socialized systems.
Personally, if you were to ask me, I would guess that the single-payer system would be better. I do think that free markets are appropriate for many things, but I'm not sure healthcare is one of them. I have too many reasons for thinking this and I won't go into them all, but to me, being able to see a doctor should be like being able to go to the police-- for reasons both pertaining to humanitarian concerns and preventing perverse incentives, money should not be the issue. However, it's very difficult to determine which would be better in a strictly scientific manner. Economics is a soft science.
However, I still believe that we do not now have a "free market" for healthcare, and our current system doesn't allow for even the theoretical benefits of a free market. You essentially have a bunch of government-funded monopolies, so you already have all the problems that come along with a socialized system, but also all of the dehumanizing cut-throat greed of a capitalistic venture. This is the worst of both worlds.
Yup, I agree with you that we have the worst of both systems now. I just find it odd that in conversations about health care, ~50% of slashdot thinks the free market is going to help, when there are no working examples.
I don't even think that those in the free market camp are aware of the consequences of a truly free market solution. It would allow, among other things, letting children who's parents do not have money, to die outside of emergency room doors. If those ~50% don't like that image, then the question goes right back to "what is the most cost effective way to provide for those with no money?" And the only answer with evidence to back it up, is a shared burden, non-profit, socialist style system.
Yes, essentially I agree. It's easy to imagine a situation where you have a 10 year-old die from an easily treatable condition due to lack of cheap antibiotics. It's easy to children not receiving inoculations, and having that turn into a public health crisis. Failing to provide that level of basic healthcare because the children's parents lack money seems crazy to me. It might not even save our society money in the end, because disease causes economic damage due to things as abstract as lost productivity.
So I've said this before (and it matches your sentiment): Once you admit that we, as a society, should make sure that poor children have access to that level of healthcare, we should stop asking, "Do we want to socialize healthcare costs?" and start asking, "How do we want to socialize healthcare costs?"