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Near-universal Mexican Healthcare Coverage Results From Science-informed Changes
ananyo writes about improvement to Mexico's healthcare system. From the article: "A revamp of Mexico's beleaguered health-care system is proving to be a runaway success and offers a model for other nations seeking to reform their own systems, according to a review published this week in The Lancet (abstract). The key to the scheme's success is the way in which it has modified its reforms in response to scientific assessments of their effectiveness, the authors say. Launched in a law in 2003, the Mexican scheme was designed to sort out widespread inefficiencies and inconsistencies in the country's health-care system. Some 50 million Mexicans — nearly half the country's population — who previously were not covered by health insurance are now enrolled, leading the scheme's architects to claim that the country has near-universal health-care coverage. As well as the increased coverage, the scheme has seen the number of conditions treated under Mexican public health insurance nearly quintuple. Admittedly, the former health minister Julio Frenk, now dean of the Harvard School of Public Health, is a co-author on the paper."
So will I have to go to Mexico for my low price drugs now? Sorry Canada
Admittedly, the former health minister Julio Frenk, now dean of the Harvard School of Public Health, is a co-author on the paper."
Will there be any death panels?
What is this "it" you're referring to here? There are plenty of non-tanking countries with very good healthcare coverage.
Translation: "We did some things we thought would work, and then later we stopped doing the things that weren't working and did more of the things that were."
In an ideal world, governments behaving sensibly wouldn't make headlines.
. . . about a year and a half ago, and while it's not all bad, it's not quite as glowing as TFA.
“You have people signed up on paper, but there are no doctors, no medicine, no hospital beds,” said Miguel Pulido, the executive director of Fundar, a Mexican watchdog group that has studied the poor southern states of Guerrero and Chiapas.
The result is that how Mexicans are treated is very much a function of where they live. Lucila Rivera Díaz, 36, comes from one of the poorest regions in Guerrero. She said doctors there told her to take her mother, who they suspected had liver cancer, for tests in the neighboring state of Morelos.
Sounds like the problems the opponents to universal health care in the States are always worried about.
My sister opened a computer store in Hawaii. She sells C shells by the seashore.
You mean, using someone who actually understands the field he's working in instead of a politician with little or no qualifications, actually gives better results? OMFG this is revolutionary!
Done: Australia (to name one, there are plenty of others)
You can learn a lot about a person if you just take the time to inject them with sodium pentathol
Australia, I've been thinking about moving there anyway.
Yes, the claim that Mexico has near universal coverage is accurate, but Mexico's health care is not a US or Canadian (-provincial) style. This Wikipedia article is pretty accurate: http://en.wikipedia.org/wiki/Health_care_in_Mexico about how it works.
Ex-President Fox's Seguro Popular is mostly what the article talks about, and that's what (properly) gives Mexico the right to say that it has nearly 100% coverage. And it's a good program -- my mother-in-law's maid's kid received a kidney transplant under the program.
It's important to distinguish, though, that you're not forced into this system. You can still buy private insurance, or pay cash. (Last time I had to go to a hospital in Mexico, they simply wanted my credit card).
tl;dr: the Mexican government hasn't taken away choice.
--Jim (me)
...let's watch the mexican economy tank in 3...2...1...
Whats been tried? Universal healthcare?
Hong Kong. Universal coverage for nominal charge. (Hospitals about $12/day for any kind of treatment, waived if you really can't afford that.)
Name one. Real economists make money off it.
Name one what? One country with universal healthcare, that has had a decent economy for at least the last few decades?
lol.. isn't Australia a duel health care country consisting of private and public system like England? I'm pretty sure I was going to have to buy insurance when I was thinking of moving there.
What metrics do you use to assess a country's economy?
Australia (where I am)
Canada
The United Kingdom
Most of Europe, for that matter
South Africa
New Zealand
Singapore
Japan
And that's just off the top of my head, with a bit of googling to back it up. You know, basically every single first world country except the United States, who recently were in a massive recession and are looking to head that way again.
Check out my sci-fi book "Lacuna" at http://goo.gl/MVxX8
Which means nothing on its own. How should we account for the quality of care, taxes paid by each person recieving care, etc?
The Nordic states are doing pretty well, and they all have universal socialised healthcare. The Netherlands claims it has privatised healthcare, and the best service in the world, but in fact 75%+ of the cost is transparently covered by the taxpayer, and poor people do get free healthcare.
What metrics do you use to assess a country's economy?
Which ever you like. I'd probably go for standard of living, life expectancy, poverty level, unemployment, number of people in higher education, literacy etc., as well as national parameters like deficit, debt.
I'd guess there is actually a strong correlation between public universal healthcare and healthy economies. But not because public universal healthcare gives a better or worse economy, but because public universal healthcare as a good economy as a prerequisite.
Julio Frenk dean of the Harvard School of Public Health, is a co-author on the paper.
He's an academic, not a medic.
Oddly enough there are people in the world who are not motivated solely by profit.
We were only discussing whether a public universal healthcare system automatically tanks the economy. Whether this system provides better or worse care, or does it for ore tax money than would otherwise be spent in private insurance is a completely separate discussion.
(but as a clue, I have seen lots of studies saying that for example the US healthcare system provides about half as much "care per dollar" than most single payer systems. A lot of this is of course due to legal and bureaucratic overhead).
You display the ignorance that indicates that you are a drone repeating the mantra instilled in you by propaganda. There are plenty of countries doing very well with universal healthcare. The majority of them also offer private health care for the rich who think they can buy their way to better health with additional insurance.
Facts are history now plebs have politics for religion on social media.
Interesting that they don't mention what this is costing the taxpayers. Maybe it's in the body of the paper which I can read for just $31.50.
Probably not.
In AU everybody is covered by public health care, if you earn more than $72K Aus (current ~$75k US) you pay an extra 1% tax.
This equates to about $700 a year which (I am sure not by coincidence) is about the starting point for a single non-smoker private health cover. If you do take out private cover and earn > $72k you don't pay the extra tax.
All up I feel its a fair system
lol.. isn't Australia a duel health care country consisting of private and public system like England? I'm pretty sure I was going to have to buy insurance when I was thinking of moving there.
Is the NHS in the UK inadequate these days? I don't live there but I'm quite sure I'd be happy with "just" the NHS if I lived there. Having other insurances to cover e.g. loss of income from illness is one thing. I wouldn't have to have private insurance to cover transplants or cancer treatment, nor would be in a better situation to get such treatment than my poorer neighbor, and thats the important bit.
A healthcare system coudln't tank an economy unless people were forced to pay into it. People wouldnt be forced to pay into it unless it had already gotten TBTF.
I don't know why people don't get it. The "free market" people out there love to say "government shouldn't mess with it" and usually, I agree except when government has no choice.
Any time there is an unlimited supply, the government needs to help. Such cases include matters like "copyright" and "patent protection." The supply is unlimited and therefore must be enforced by government to use other means to get people to pay for something with an unlimited supply.
Any time there is an unlimited demandm the government needs to help. Such cases include matters like healthcare, water and electrical service. People need what they need and it has little to do with market conditions. Often is is "use or die." Government needs to ensure that needs of the people are met before suppliers are allowed to exploit the need to gain unlimited profits.
It's interesting and amusing to me that many such free market proponents are great with government enforced or assisted items like copyright but not with health and power regulation. "Only when it serves their interests." So it's selfish humanity as usual... and in the end, that's why we have law in the first place -- to help us to act against our own nature.
Yes they say the words that make you happy... do they actually deliver?
Weak sauce dude, weak sauce.
When information is power, privacy is freedom.
Yes they say the words that make you happy... do they actually deliver?
Still trolling? Let me repeat his statements for you, in a new wording
- All of the "first world" economies, except the US, pretty much have universal socialized health care.
- The systems are popular in these countries (they are all democracies, so they would have to be quite popular to remain).
- All of these economies are of course facing more or less rough times at the moment, but their economies would still be regarded as "healthy" on a global scale or seen over a few decades.
Danmark, Sweden, Finland, Norway at least are non-tanking. Plenty more in the rest of Europe, I would reckon.
The US is unique in beeing a "western world" country without universal healthcare, btw, and while we do have a financial crisis in Europe right now, I am not sure there are any relations to the health sector.
I don't know where I said that paying for public healthcare leads to a collapse. The current method of providing healthcare is basically stealing from future generations (which will eventually lead to collapse), if you think about how it works (at least in the US) it is a big ponzi scheme. Every generation needs to convince the ones after them to buy in to the insurance/Social Security scam. Please explain how else it could work.
A healthcare system coudln't tank an economy unless people were forced to pay into it.
Single payer universal health care means healthcare is a figure in the budget, just like infrastructure, defense etc. If there is a budget deficit you have to cut down on something (infrastructure, defence, healthcare, whatever). People are "forced to pay into it" no more or less they are forced to pay into defense or infrastructure. Having too large expenses for healthcare is entirely possible, reasons can be for example if you have a shift in demographics where fewer young people pays for the healthcare of a large aging population (Japan has this problem whereas the US does not). This can cause economic issues, but the same can be true if you have an aging airforce.
no, healthcare tanks the economy when hospitals are forced to provide healthcare to the uninsured. if some freeloading hick with no healthcare gets hit by a bus the local hospital will be forced to treat him even though it will cost hundreds of thousands of dollars that he will obviously never pay. the only option is either force people to contribute to healthcare through taxes or let hospitals refuse treatments...forcing hospitals to treat people who are too irresponsible to get insurance is a moral hazard and raises the cost for everyone else.
Which means nothing on its own. How should we account for the quality of care, taxes paid by each person recieving care, etc? The question was "name one". That's what I did. You can look up the economic detail as easily as I can.
Anecdote: I know an American in Hong Kong getting treatment for cancer, treatment he would be denied back in his home country despite paying taxes for the last 40 years since he lost his job there and thus his insurance. His chance of survival is still low, in America it's zero.
Without universal healthcare people live in ghettos and a country is full of factions at war. Apparently Mexico is a more civilized country than the rich antisocial faction of Americans would like it to be.
Mexico is a country full of factions at war.
Sometimes you wonder if the rabid religious nut-jobs who declare America to be the great Satan might have a point.
They do, but not just because we don't have universal health. Mexico is a country which continues to exist as an independent entity in spite of our best efforts.
"You're right," Fisheye says. "I should have set it on 'whip' or 'chop.'"
I don't know where I said that paying for public healthcare leads to a collapse.
I was thinking of this: "Like everywhere else it's been tried...let's watch the mexican economy tank in 3...2...1..."
The current method of providing healthcare is basically stealing from future generations (which will eventually lead to collapse), if you think about how it works (at least in the US) it is a big ponzi scheme. Every generation needs to convince the ones after them to buy in to the insurance/Social Security scam. Please explain how else it could work.
I don't know what you mean by "stealing from future generations". If you have a budget neutral (i.e. not deficit spending) based, tax financed, public healthcare system, how will that be problematic? Look at Sweden for example. There is a single payer universal healthcare system paid for by taxes, at the same time there is a budget surplus and the national debt has been quite rapidly reduced in the last decade. Are the current generation of swedes "stealing" from the next generation of swedes?
In UK, NZ, and I presume Australia too, the reason people pay for private health insurance is to get a bed in a private room when/if they require hospitilization, and to get on a shorter waiting list for tests and treatments for non-life-threatening conditions. If you're prepared to slum it in a shared ward with other patients and wait a few months to get surgery on that low level knee pain that's been annoying you for years, then the NHS is perfectly adequate, and will kick into action quickly and efficiently when you really need it.
That's about how it was described to me when I was about to be going there. Job fell apart and didn't go though. Most people I spoke with about it like it too.
and to get on a shorter waiting list for tests and treatments for non-life-threatening conditions.
You don't even get that in Australia, unless we are talking fake breasts or something equally frivolous.
And did you exchange a walk on part in the war for a lead role in a cage? - Pink Floyd.
If the government promised to people they better pay it. That will come out of someones paycheck.
Still the same as defense. Also comes out of someones paycheck. And what the government promises, they better deliver if they want to be reelected. You are still not making a point I feel.
... nothing. President Lawnchair signed the massive bailout for the health insurance companies (which was conveniently disguised as "health care reform") which ultimately left us with the same broken system, but with people now forced to buy into it. We still have no standard of care, and nothing that actually resembled universal coverage.
And now to further accentuate how ridiculous that is, the Mexican government just beat us to health care reform as well. A significant portion of their country is embattled in violent conflict in the drug war, yet they can pass health care reform. Up here, we can't pass it because of a collection of idiots who are afraid of (their own lack of understanding of) "socialism".
Yeah, go ahead. Mod me down. I can take it. At least I said my piece.
Damn_registrars has no butt-hole. Damn_registrars has no use for a butt-hole.
defense.... you mean the war department?
Just forget it then.
When I select HEALTH index (only) the United States ranks #38. The United States is trailing the industrial powerhouses of Cuba and Costa Rica.
Build your own index using UN data:
http://hdr.undp.org/en/data/build/
You can't be ahead of the curve, if you're stuck in a loop.
The NHS probably isn't inadequate but you do hear horror stories about it from time to time. Medical tourism in former colony states seems to be a popular thing for people who have government insurance coverage that is supposed to cover everyone. The NHS has a rule or law that states they can avoid treating any illness if you attempt to get treatment outside their system and it isn't an emergency situation. So if there is rumor of some miracle treatment for your liver cancer or whatever and you fly to whatever country who is allowing it to be practiced and the treatment fails, you can be stuck flipping the bill yourself for the rest of your liver cancer treatment life.
I think there are problems with most health care systems and they all have horror stories.
The United States relies upon private health insurance to provide much of the financing for medical costs. This is unusual: in Britain, Canada, and Spain, for example, health-care costs are largely paid for by the government. In Austria, Belgium, France, Germany, and the Netherlands, medical costs are paid for by a system of "social insurance": it is compulsory for most people to buy insurance, but insurance premiums are tied by law to income rather than to the risk of a claim.
The United States system makes it voluntary to buy insurance, and premiums are linked to risk, not to income. But these market-based premiums, beloved of many Americans, do not seem to be delivering health care that makes them happy. A recent survey revealed that only 17 percent of respondents in the United States were content with the health-care system and thought no substantial reforms were necessary. Why the discontent?
The superficial reasons are simple enough to describe: the system is hugely expensive, very bureaucratic, and extremely patchy. The expense first: US health cares costs a third more, per person, than that of the closest rival, super-rich Switzerland, and twice what many European countries spend. The United States government alone spends more per person than the combination of public and private expenditure in Britain, despite the fact that the British government provides free health care for all residents, while the American government spending program covers only the elderly (Medicare) and some of the marginalized (Medicaid). Most Americans worry about health-care costs and would be stunned to discovered that the British government spends less per person than the American government but still manages to provide free health care for everyone. In fact, if you figure in the costs of providing health insurance to government employees and providing tax breaks to encourage private health care, the US government spending on health care, per person, is the highest in the world.
Bureaucracy next. Researchers at the Harvard Medical School found that the administrative costs of the US system, public and private, exceed $1,000 per persons. In other words, when you count all the taxes, premiums, and out-of-pocket expenses, the typical American spends as much on doctor's receptionists and the like as citizens of Singapore and the Czech Republic spend on their entire medical care. Both places are countries with health outcomes very similar to those in the United States: life expectancy and “healthy life” expectancy (a statistic that distinguishes a long healthy life and a long life plagued by years of severe disability) are a shade lower in the Czech Republic than in the United States; and in Singapore they are a little higher than in the United States. The costs of US bureaucracy is also more than three times the $307 cost per person for the administration of the Canadian health system, whic
By looking at basic economic figures, such as Gross National Product, National debt, poverty percentages, unemployment rates, education levels etc. And yes, get over it: almost all of the countries in question are doing much better in those areas than the USA.
Canada. None of our major banks failed (in large part because of mortgage regulations that prevented banks from doing insane things like selling no-interest, no-job, no-asset loans), our unemployment rate is currently lower than the US, and our dollar is currently worth more than $1 US and has been at about that level (close to parity) for quite a few years now.
Granted, a lot of that is more a commentary on just how much worse the US economy has been since 2008, but in an economic sense we're definitely better off at the moment. As for the healthcare system, it is of course not perfect. But I have no particular complaints when I've needed it for either emergency or regular medical attention.
The US is a great country, and it has a fine healthcare system, if you can afford it. And affording it is a problem for a lot of people, especially if it is something serious and chronic. I think half the problem with the US attitude towards taxpayer-funded healthcare is that you guys don't realize just how bad you've got it, or how much you're being ripped off for incomplete service. It's really good healthcare, but average costs are much higher for partial coverage.
Then there's the overall financial management. In Canada, there's a broad public understanding that regardless of what government is in power, balanced budgets are expected. While you guys talked for decades about balanced budgets and paying down debt, we were actually doing it, all through the 1990s. We were running a budget surplus in the 1990s like the US was. Every year when there was a surplus, some of the surplus funds were put to paying down debt, and some of it was put into reducing taxes. It wasn't all carved away as large tax cuts so that the government ran into the red again. It was a balanced, incremental approach. That's come in very handy as the 2008 financial crisis unfolded, and given a lot more room to maneuver. It's still going to be a few years until balanced budgets are back again, but if we do run a surplus, I'm sure the government of the day will follow a similar strategy: some debt payment, some tax cuts. It's a prudent way to do things. You guys got fleeced by a bunch of con men who told you "deficits don't matter" and whose stated goal was to remove regulations and starve the government of funds by giving a huge tax break, preferably to the very rich, because they are the major drivers of the economic system. An interesting economic experiment. How's that working out?
Yep, they do liver, kidneys and all other major organs :-)
But they dont have any doctors there. they all left because of the low wages.
What, you mean the Tea Party people are lying about that?
Do not look at laser with remaining good eye.
Just look at this pretty list of countries by health expenditure and note the percentage of GDP health care cost for countries that use universal health care.
For further shaming of the US system (and to the benefit of other systems) you can compare with the WHO ranking of health systems though that might be a less objective metric.
Which means nothing on its own. How should we account for the quality of care, taxes paid by each person recieving care, etc?
That's a different argument/question from the one you originally posted. As Voltaire used to say, define your terms in the discussion. Other countries whose economies are not tanking due to their health care systems: Singapore, Israel, Switzerland, Japan, Brazil, Rwanda, Chile to name a few.
These countries are either doing well as developed nations or on the verge of becoming ones. As for Japan's economic woes, they have everything to do with an aging population, lack of women's participation in the workforce, and little economic expansion due to the 90's economic crisis. But even with all that, the average Japanese's purchasing power and lifestyle have not deteriorated (compare that to us.)
So if you are going to argue that any significant woes (or even tanking) on any of these countries are predominantly a function of their health care systems, you better come up with some citations. Hand waving does not count.
Since you're the one making the argument publicly funded healthcare and a healthy economy are impossible, why don't you define "healthy" for us.
Mexican, and world health , would benefit immeasurably more from Mexico getting rid of its kleptocracy where government jobs are the place to be for kickback wealth.
Then their economy wouldn't be so bad and they could contribute better to worldwide invention rates, whch are what saves the most lives in the long run.
Government-provided health care relies on the idea of handing out what already exists. As such it is a static analysis that is pennywise, pound foolish in ignoring the real lifesaving force: new treatments.
It is the exact same power as continuously-compounded interest. Socialized medicine is giving a man a few thousand dollars.
Freeing business from predation is the millions you have in thebank by socking a little away every week. I'd rather have 2055-level medical tech in 2050 thanks to industrious, free Mexico, than 2050-level tech and not free, kleptocracy-wise, Mexico.
(-1: Post disagrees with my already-settled worldview) is not a valid mod option.
Because that's what it sounds like to me! Death Panels! Because I want the right to have a homeopathic doctor (Excuse me, I mean "doctor" -- you can call them that if you use the quotes!) to treat my prostate cancer and if you don't let me, it's because of Death Panels!
I'm trying to teach myself to set people on fire with my mind... Is it hot in here?
Seriously? You're seriously asking that question?
In the civilised world, we view people who refuse to help the sick and injured as evil scum. In your country you may be happy with people dying, untreated, on the streets. YMMV.
Because Reagan signed that law into being in the 80's.
If Mexico got rid of their kickback-oriented kleptocracy so the path to wealth was no longer being a government official, and their economy became closer to the US's, they would save a hell of a lot more lives and extend longevity a hell of a lot more than free health care in an ongoing broken, almost-failed state will.
Stated brutally, Mexico, as-is, plus UHC evil US in terms of actual saving of lives. They focus on a lifesaving triviality when the biggest factor by far remains unchanged -- third world kleptocracy.
(-1: Post disagrees with my already-settled worldview) is not a valid mod option.
Sounds like a better deal for them there than here.
I posted this elsewhere, but its entirely relevant to most discussions on here -
In 2010 (year picked because figures are unlikely to be revised), the UK spent £118.2Billion on the NHS, for a population of about 63Million persons.
Thats a per population head equivalent of £1906 or $2954.
In that same year, the US spent about $381Billion on Medicaid and about $509Billion on Medicare - both of which highly intersect with what the NHS provides, for a population of about 311.5Million persons.
Thats a per population head equivalent of $2858.
Except the US Medicare and Medicaid programmes don't cover 311.5Million persons - Medicaid covers roughly 50Million persons, and Medicare covers roughly the same number - theres about a 6Million person intersection between the two (persons that are enrolled in both), so, again roughly, the total number of beneficiaries for these federal and state programmes is around 94Million.
That makes it a per eligible head equivilent of $9469.
And you know which system I would rather have? The one I currently use - the NHS at $2954.
The US system is just very very badly run.
Sources:
http://www.gao.gov/highrisk/risks/insurance/medicaid_program.php
http://www.gao.gov/highrisk/agency/hhs/reforming-medicare-payments.php
http://www.kff.org/medicare/upload/7305-05.pdf
http://en.wikipedia.org/wiki/Medicaid
http://en.wikipedia.org/wiki/Medicare_(United_States)
Mexico + UHC (double-less than) evil US, tx Slashdot autoformatter.
I't put a smiley face but I'm afraid of crashing their servers.
(-1: Post disagrees with my already-settled worldview) is not a valid mod option.
It's like any place, some departments better than others. Country wide, some places better than others.
I've had great treatment each time. The NHS is worth it.
Germany.
Yep, they do liver, kidneys and all other major organs :-)
So once you have been de-livered they do bother to put in a new one?
Only an American could ask that with a straight face.
"It's just that today... where do you honestly want to be treated?"
Any country that won't bankrupt me to do so. Because there's no point in being treated if you then have nowhere to live, recuperate, no life to enjoy after and have to work (while in ill health) for the next 20 years to pay it off. I would love to be treated in a perfect hospital with every medicine and treatment available and have it all done while people bring me cocktails and rub my feet. Of course. But the truth is that it's a choice being PAYING LOTS OF MONEY and being treated okay, or PAYING NOTHING and being treated when necessary.
If I cut my finger, I'll do it myself.
If I sprain my leg, I'll do it myself or walk into a hospital if it really develops complications.
If I break my leg, I have to go to hospital.
If I break my spine, I have to go to hospital.
If I get cancer, I have to go to hospital.
At no point would I ever *PAY* for those services. Think about that. I get cancer, I probably have 10-20 years at most if it's serious and will never truly rid myself of it, and I get ALL my treatment paid for me. How much would that cost on insurance, and how much would that cost if you had no insurance and had to pay cash? Now what if I'm diagnosed with, say, cerebral palsy at birth? How much is my insurance going to be then? Have you even SEEN the cost of quite basic medical treatment?
My country, the UK, is shit and wonderful at the same time but wouldn't expect a dying man to pay for his own care (maybe his car parking at the hospital, but that's a minor issue in comparison). The hospital might be crap. It might have worse care rates than private wards. The staff might be belligerent. But I'm not running up debts that I will never be able to pay while I'm laying there unconscious and can't do anything about it.
In the UK, the healthy pay for the sick.
In the US, the healthy pay (next to) nothing and the sick are left to fend for themselves.
Nice attitude to humanity, there.
I never to sit there, adding to the stress of my illness, with what might happen to my insurance payments, or my house, or my family, or anything else.
Sorry, given the choice, I'd go to a hospital where the treatment is "free" and the only cost is the queue and the waiting time. Because the simple, economic fact is that *I* cannot afford to pay for anything serious (and wouldn't go to hospital for anything that wasn't) and I already pay as-much, if-not-more tax than the US and we do just fine on "free" healthcare.
Literally - if I went on holiday to the US I have to buy a travel medical insurance that I *NEVER* have to purchase in the EU. Because if I break my leg in Spain, the treatment will be paid for by the UK. If I break my leg in the US, they won't pay (because of your ridiculous healthcare arrangements) and I have to BUDGET THAT INTO MY HOLIDAY. If I fall into a coma in the US, whether my fault or not, that's me bankrupt back in my own country trying to pay off the US medical bills. Or I can pay a fortune for insurance that NOBODY in the EU requires me to have. (And, yes, US residents are charged for the cost of their healthcare in the EU but they are used to it!). I actually have to take it into account just holidaying in the US.
Either pay for everyone's healthcare out of my taxes, or ask me to pay towards everyone's healthcare as a separate payment. Don't pay for some of it out of my taxes, then make me pay for anything above a slight cold, and then make insurances compulsory, and then let insurers set the prices how they like (the point of insurance should be to cover EVERYONE for an equal price - i.e. if you all pay $100 a month, then the guy who needs a $10 operation gets it as does the guy who needs 100 $10,000 operations - otherwise you are just paying for your own healthcare).
And, in the UK, I have the option. I have complete, free, blanket NHS protection on anything I ever do. I can also pay fo
millions of Americans are not flocking to mexico for free medical care... rather millions of mexicans come north.
But many Americans do flock south to Mexico for reduced-cost medical care. For example, my dental work will be about 10% down there what it would be up here... or 20% of what it would be if I still had dental coverage.
"You're right," Fisheye says. "I should have set it on 'whip' or 'chop.'"
Why are hospitals forced to provide healthcare services to people that cannot pay - this is one of the main drivers behind escalating costs of healthcare, but why is this the case?
This is the biggest crock I've ever heard. The main driver behind escalating costs is a lack of regulation over pricing. If the government says to big pharma "provide us with pill X for $Y" then big pharma will find a way, or not make any money.
Let me ask you a question - since when did a Q tip cost $12 - like it does in American hospitals?
You Americans make me laugh with your joke of a health"care" sytem
theres nothing frivolous about bigger breasts! even if they are fake
Its the first time I have a "troll" score on a post I've made. Funny how it isn't even on a troll post.
The article discusses primarily the ways that coverage has gotten better/more complete since they instituted this program, but in my experience with the Mexican health care system in the early 90s, the biggest problem was the quality of the care. It was horrible. The doctors and nurses in the big public hospitals were overworked, underpaid, and by and large didn't care. Sanitary conditions weren't very good. As a result, the general populace viewed the public hospital not as a place you went to get better, but a place you went to die, and it was also generally expected that you had better take several family members with you to help keep you comfortable because the nursing staff, such as it was, would ignore you. Anyone who could afford it, or could get friends and family to help scrape up the cash, went to a private hospital.
I imagine the care has improved somewhat, along with the coverage, especially at the larger hospitals. But I'll bet it's still quite different from what many of us would consider the term "health care" to mean.
Note to ACs: I usually delete AC replies without reading them. If you want to talk to me, log in.
There are other reasons that health care is so much more expensive in the US, though... because they never instituted proper tort laws (in part because of the privatized medical system), doctors' malpractice and other insurance is a lot higher. This, in turn, gets passed on to the users of the system, and it becomes a vicious circle... people sue for larger and larger amounts of money because they won't be able to get insurance in the private system, and need to be able to pay the increased medical fees, but the stupidly large amounts of money they sue for (and their propensity to sue for things that they'd never get away with in the UK or Canada) are the reason that the medical fees are going up.
You are absolutely right that things are much cheaper per capita in the UK. They are in Canada and Australia, too, and pretty much everywhere else where universal health care exists, not to mention the other economic benefits of having a population with access to preventative health care. But in the absence of sane tort laws, introducing public health care in the US won't fix the problem, either.
Then their economy wouldn't be so bad and they could contribute better to worldwide invention rates, whch are what saves the most lives in the long run
Government-provided health care relies on the idea of handing out what already exists. As such it is a static analysis that is pennywise, pound foolish in ignoring the real lifesaving force: new treatments.
Would you say that the economy of Canada, with its lower unemployment rate and higher per-capita income than the US is doing badly?
Every generation needs to convince the ones after them to buy in to the insurance/Social Security scam. Please explain how else it could work.
Simple: the population of people requiring healthcare treatment at any given moment, even at 0 population growth, is always going to be much smaller then the population who are able-bodied and working. Across the volume of that total population, if everyone kicks in a small amount of money, then we can ensure that there's cash available for all of them when they themselves need medical treatment.
Also, since insurance gets more efficient as you dilute the risk pool, expanding it up to the size of the entire country's population has enormous benefits - as well we follow on ones such as providing for government collective bargaining on the cost and purchase volumes of pharmaceuticals (the government is the largest possible purchaser, ordering the largest possible volumes, which means it'll always be able to negotiate a good deal).
Social Security (in the US) is not a scam, incidentally. It only becomes a scam if the American populace let that happen, which will be if they allow the government (screw it - allow the current batch of GOP politicians) to reduce SS benefits to future generations. The scheme has been enormously well-funded, and is owed billions by the US government, which has avoided raising taxes by "borrowing" against SS savings. It's alleged bankruptcy is due to the fact that that money was never paid back, because it was never used for anything profit earning in the long-run: it was wasted away as tax cuts to the rich, and still is.
'rich' people in countries with 'universal healthcare coverage' who buy private insurance don't necessarily buy it because they think they will be healthier, they buy it to see better doctors, vist less crowded offices than public clinics, and to avoid the inevitable waiting list for 'their turn' when a procedure or test is needed.
In England, for example, I suspect the average income for someone with private health insurance is not really that high - private insurance isn't THAT uncommon that only millionaires have it.
Ken
The evidence is that the amount of money that can be saved by various tort reform laws is approximately 2%:
http://www.nber.org/bah/2009no3/w15371.html
Now, that's not nothing, but it's not even close to explaining why US health care costs 3.5 times that of the UK. Some things that are more likely to make a difference:
1. Most health care in the US is fee-for-service, so doctors get paid more if they do more procedures, no matter how useful those procedures are. Solution: put doctors on salary.
2. The US spends a lot of money keeping people alive as basically a vegetable in a hospital during the last year of their life. Solution: end-of-life counseling and legalizing euthanasia.
3. A significant portion of health care costs are insurance companies, hospitals, individuals, and government each haggling to try to make the other parties pay for the cost of care. Solution: Single payer and single provider, so there's nobody else to haggle with.
4. Another significant problem is that people without insurance and money to pay for care tend to seek care at emergency rooms, which both makes it harder for ERs to handle real emergencies and means we spend easily 5 times what we would have spent to treat the same condition in a doctor's office. Solution: Cover everybody.
In other words, you get pretty close to what every other country in the world is doing, and it gets a lot cheaper to provide health care.
I am officially gone from
Let me put it this way, 10 years ago a little over half of the costs in my dad's practice were billing insurance. Its now over 75%. That right there should tell you a lot about how a single payer system could save money.
The next largest cost is malpractice insurance; when about half the doctor's lost their malpractice insurance so they closed up shop, the state stepped in, but its still a big problem.
Finally a single payer system consolidates information about what a doctor does. In other systems, like the VA, they're using that to shape doctor's practices. Basically they get the leaders in the field together to try and figure out an ideal process (e.g. weighing the risks and costs of a test to see when you should jump to the most accurate test vs using less accurate but less costly or more safe screening). Any doctor can go outside the reccomendation; all they need to do is basically check a box. If more than a certain percent of a doctors patients go outside the expected range, they then review the cases. There may be other mitigating circumstances, so they are reviewed by doctors and that feedback is used to refine the reccomendations or to consult with the doctor about how to be more cost-effective. This system shapes doctors behaviors toward providing proper medical care at a minimal cost, without ever preventing a patient from receiving the care their doctors feels is appropriate.
Keep in mind, for many people the government already provides care. If you don't have insurance and its life-threatening, the poor, veterans, etc. Before we were married, my wife worked as a pharmacy teach and she would see all these people getting pills on the government's dime and then selling them in the parking lot, yet the government wouldn't cover her and private insurance was more than she made, so she couldn't afford her bi-polar medicine. If she quit, the government would cover her, but she's the type of person who likes to pull her own weight so she went without. How much sense does that make?
For the same reason the police investigate crimes for people who cannot pay private investigators.
I think that is the biggest difference between the US and the rest of the 1st / 2nd world: USians want an ironclad guarantee of a perfect health outcome or they will sue, sue, sue. OB-Gyns in the US have to pay an incredibly massive amount of malpractice insurance and many still end up quitting due to the helicopter parents in waiting. Nothing is guaranteed, but USians refuse to accept reality.
I prefer the idea of Medicare Buy in for all in the US. It's been proposed several times, and never passed. The fact is, that if Government health care is so incredibly awful, why are the for-profit insurance companies afraid of a system in which they would have to compete for it? This is the question that they avoid.
You're misreading the statement, which made no claim about the total enrollment, just that the 50 million Mexicans previously not covered, are now covered.
There is no implication in it that they have only 50% of the population covered, you're just reading something into it that wasn't intended. I suppose they should have stated their new total coverage amount in order to avoid confusion, perhaps they did in the actual article, but it was left out of the summary.
Well, I'm here in Edmonton, Canada and I just recently got back from visiting a dentist in Puerto Vallarta, Mexico. Sure glad I went! Gotta do your research though!
Alberta dentist's have raised their prices in many cases to more than triple what they were 6 years ago. I even would've saved money by going to the States!
I feel bad for families who can't fly to Mexico on short notice... or me if I get stuck timewise next incident.
and your definition of tanking is when the tv tells you they are?
What are you babbling about?
a new strategy is needed, now anon...
That has silence of the lambs written all over it.
I suppose you consider fertility treatments to be frivolous.
I have private health care to thank for my 6 week old baby. I'd still be on a waiting list in England. And probably elsewhere.
:wq
Lawsuits only make up about 1-2% of the health care costs. They have made a wonderful scapegoat but that is about all they are. They play well into the 'US is such a litigious' nation trip people have been fed.. which is little more then a recast of the old American 'victims should know their place' attitude... which is always amusing since our laws were specifically written so that many laws are not enforced by the DoJ and thus a lawsuit is the only way to activate them.. thus if someone tries to actually get protection under the law they can be branded 'sue happy' and slurred for it. The handicapped are a common victim of this.
The quest for universal health coverage: achieving social protection for all in Mexico
In the US, the federal medicare* programs are for the poor and old, who by nature require more elaborate services than the normal population. In the UK, 100,000 old per year are put on the "liverpool care pathway" (death panel), which saves even more.
From National Geographic Magazine:
http://blogs.ngm.com/.a/6a00e0098226918833012876a6070f970c-800wi
Guess who gets the least bang for their buck in Healthcare?
Even that article doesn't quantify the costs caused by what it calls "defensive medicine". These are tests and procedures done a doctor covering his ass rather than trying to diagnose and treat evident conditions.
Just one?
Sorry can't do that, but here are six: Denmark, Germany, Sweden, Norway, Switzerland and Netherlands.
The amount the US spends on health care in total, Medicare, Medicaid and all the private health insurance, is about twice, per capita, what Canada, the UK, or Australia spend on their public systems. And that STILL doesn't adequately cover everybody.
I suppose you consider fertility treatments to be frivolous.
I hate to say this, but they ARE frivolous, at least when compared to other things such as cancer treatment.
Not to mention, you COULD just adopt... or do as you did, and pay for private care.
-- Let us endeavor so to live that when we pass even the undertaker shall be sorry. -- M. Twain
Investors. The country with the highest tax burden in the world right now, Denmark, is at the moment loaning money at an interest of -0.25%..
YES, that means rich people, very rich people, and investors in general, believe the Danish economy is so healthy they are willing to loan them money at negative interest, just so that Denmark can protect they money for them.
With a three trillion dollar deficit and record personal debt, pretty much everything the US does is "stealing from future generations."
On the other hand, non-deficit funded public health care systems in other countries are not.
You have no right to food, housing, [...] or healthcare.
Most civilised societies disagree with you.
Congratulations. You have probably expressed a reasonable opinion on Slashdot. Reasonable opinions are almost guaranteed to annoy a slashtar... I mean, Slashdotter with mod points, and "troll" is how emotionally immature persons crouching in their parents' basement see people who disagree with them.
How about Norway or Sweden?
Popular? In Canada any hint of weakening the public health care system is met with outrage. It's one of the few things you can guarantee will upset Canadians, and get your government booted. I suspect the same is probably true in other countries that have them.
There is no such case where supply and demand do not apply. The only question is - is there enough supply available to meet your price point?
55% of health care in Mexico is done privately.
You can't handle the truth.
I thought that there were states in which various flavors of tort reform were instituted, and the reform was NOT followed by interesting savings. I think Texas is one example. (I'm doing this all from memory; yeah, Wikipedia says insurance companies saved money, not sure any else did, or that it was big money. Shaving 2% off costs and dumping it entirely into the lap of the insurance companies would be a big win for them, that's for sure. http://en.wikipedia.org/wiki/Tort_reform )
http://articles.cnn.com/2012-05-17/world/world_mexico-decapitated-bodies_1_drug-war-gulf-cartel-monterrey?_s=PM:WORLD
http://www.infowars.com/35-decapitations-in-past-six-weeks-near-us-mexico-border/
http://www.bestgore.com/beheading/chainsaw-beheading-video-sinaloa-cartel-members-decapitated-mexico/
http://www.bbc.co.uk/news/world-latin-america-18063328
--
And so on.
No brain, no pain.
That paper really only addresses "direct tort reform", or the limiting of malpractice liability suits. In practice, though, malpractice suits are an evil twin of the VAT - you sue the doctor, the hospital, the company that built the gurney, the company that built the IV titration machine, the company that manufactured the IV solution, the nurse(s) who started the IV, the mfgr of the lighting in the room, the ambulance service that got you there, the 2 medics on board, the manufacturer of the ambulance, the schools involved in educating all of the humans involved, and if you're in a particularly nasty mood, you also sue several visitors who pissed you off along the way. I wish that I was kidding, but that's a big reason for high medical costs. A Ferno-Washington ambulance litter will run you >$6000, even though it's effectively no more than an aluminum tube frame with a vinyl- wrapped foam mattress. They *know* that they *will* be sued. A lot.
Who's giving anything out for free? Public health care systems simply involve one not for profit entity, the government, paying.
Speaking as someone who actually does medical research, in Canada, drug companies do and fund plenty of research here. We have excellent, unified records for epidemiological studies and a comparatively simple, consistent system with little risk of frivolous lawsuits.
Almost all the other OECD states solve this problem, usually with taxes, so yes, I think the state will solve this problem. "Learn your history", my ass. Go look at stats on expected lifespan, infant mortality, and health care cost (either per capita or as percentage of GDP). I'm not asking for unicorns and fairies -- I'm asking for what other people in other countries already have. What's ignorant (implied by your "learn your history") is pretending that this is not the case.
I think we do have a right to healthcare, as well as food and housing, at least as long as the country can afford it. The wealthy already get to have luxuries because they're rich, why do they also get to have the necessities, like shelter, healthcare and food as well?
I also think we should cut our military budget by at least 90% before we start saying we can't afford to provide everyone with healthcare.
-- Let us endeavor so to live that when we pass even the undertaker shall be sorry. -- M. Twain
"if you have a shift in demographics where fewer young people pays for the healthcare of a large aging population" ... or if the tax base is just not large enough for the young folks to continue subsidizing health care for the old/sick. Remember, that's the only way government "insurance" works - by forcing one group to subsidize another.
Homework: Discuss how this contradicts your belief that the free market is always the best solution.
-- Let us endeavor so to live that when we pass even the undertaker shall be sorry. -- M. Twain
Leaving the United States as the largest third world country without universal health care.
We're getting beat by Mexico while Congress is fighting over funding for Planned Parenthood by people who want to turn Medicare into a discount coupon program.
That's our life, the big wheel of shit. - The Fat Man, Blue Tango Salvage
Direct costs of malpractice, which include premiums, damage awards in excess of premiums, and associated litigation costs, represent no more than two percent of health care costs. Thus, tort reforms can have a substantial effect on health care costs only if they affect the amount of healthcare services provided.
Sorry, you must not work in health care.
This is just the malpractice part. What's not in the "1-2%" is what I'll call defensive medicine.
I have a colleague who is an orthopedic surgeon. He will not perform surgery on you unless you had an MRI or CT performed the day before. Many, many surgeons do this. And blood work. Update a complete panel. CBC, SMA, drug panel--the whole smash.
It does not matter if you had an MRI last week or your blood tests are two days old.
Why?
He does not want to get sued. You are paying for his defensive medicine.
You might ask "what does having an MRI prevent being sued?" There is a type of patient and a type of lawyer who look for clerical errors and then sue over them--not a negligence outcome. Not having an MRI the day before could be argued as not being the best care.
So what does it really mean? My colleague makes good money being a surgeon and would make less if he had a mark on his insurance record--just or unjust. With the surge in amateur ranking systems this means a lot to a practice.
Do I have a solution? Yes. Make it easier to become a physician or primary provider in the US. An ortho makes between $320K and $550K. That's in large part because of the amount of schooling (4 + 4 years after high school) , residency (4-5 years), fellowship (2 years), working for nearly free (a couple of years).
Make the PA an attractive choice in patients seeking care. Make a Family practice hospitalist specialty that requires 2 years grad school and 2 of residency.
Here's the last one: Make a non-profit hospital standards higher to keep non profit. Non-profit does not mean minimal bureaucratic excess.
So, what are they going to do? Just ship everyone to el norte to sit in our ER's to get 'free healthcare' since they cannot be turned away or asked their immigration status like they've been doing for the past 20 years?
But making it legal for students (who are not employed- they are investing time in future employment) to remain on the insurance of their employed parents (who can actually pay for it) is a national disaster ?
If you get fired (seems to be happening to rather a lot of Americans lately) and it takes a few months to get a new job and your savings run out and your insurance gets cancelled, you should be allowed to die on a pavement if you have an accident instead of being treated, getting better, finding a job and once more being able to contribute to the economy ?
I daresay sir, that you are not only a heartless psychopath, but a headless idiot as well.
Unicode killed the ASCII-art *
You seem to be confusing taxes to fund universal health care with social security, which is a large confusion. Health care insurance is pretty much pay as you go, and though there is a skew in costs to the elderly, young people are somewhat aware of reasons they might need it (pregnancy and delivery, usually routine, sometimes not; random medical horribleness, that sort of thing).
Social security is mostly a young-to-old transfer, but it is hardly a Ponzi scheme; there are projections for costs and projections for benefits, and it does not have Ponzi characteristics; people get their money out regularly (unlike a Ponzi scheme). If we accept the usually conservative projections of future SS budgets, then the money set aside in the SSTF will not be adequate starting sometime around 2035 -- but that is not an inherent Ponzi problem, that is something instituted in the 80s to help manage the retirement of the baby boom. Benefits won't stop; they'll just be smaller. We can fix that with relatively minor tweaks to funding or retirement age, and these fixes do not have the "then-another-fix, and another, and another" nature, at least not according to the usually conservative projections; you have to bring the system into demographic balance, and then you're done. The baby boom is one heck of a pig in the snake, and that's what causes a lot of the "problems" of SS.
A second important part of SS that you are ignoring is Survivor's Disability Insurance. When we went out to buy healthy insurance on our own (one of the joys of working for a startup), the initial estimates of the policy size were enormous. The sales-ish person we talked to helpfully pointing out that SDI takes care of a huge chunk of that. If it were not for the SDI part of SS, I would have been sending larger checks to the life insurance company for the last 15 years.
Before we were married, my wife worked as a pharmacy teach and she would see all these people getting pills on the government's dime and then selling them in the parking lot, yet the government wouldn't cover her and private insurance was more than she made, so she couldn't afford her bi-polar medicine. If she quit, the government would cover her, but she's the type of person who likes to pull her own weight so she went without. How much sense does that make?
As someone in a similar situation to your wife's (other than not being married), I'd say that it makes a lot of sense. Her work ethic, I mean, not the fucked up system.
They deliver lower infant mortality and longer expected lifespan. Those are nice, hard-to-fudge metrics. There is some possibility of fudging "infant mortality" by classifying some "infants" as "miscarriages", but I looked there, and the corresponding stats don't show evidence of such fudging. There are other metrics (for example, hip replacement wait time) where we apparently do better, but I think you have a hard argument if you want to claim that wait time for a hip replacement is a better proxy for medical care overall than life expectancy or infant mortality.
One possibility that is consistent with both our reputation for having wonderful hi-tech interventions, and with the expectation that universal health care leads to less buck-passing, less fragmented information about a person's care, and improved standard practices, is that we excel at (expensive) firefighting, but that other countries excel at (cheap) fire prevention. If this is true, it means that a shift to universal care will take some time to save money, because the benefits kick in more slowly. To relate this to (repeat example) hip replacements, it's better if the hip never needs to be replaced (presumably because of a better job at managing some of the causes, e.g., arthritis, or obesity).
Hip replacement is also not the great example it used to be, not since we had that mess with the metal-on-metal implants going bad (I have a sig-O-in-law who is having her hips RE-done. Ouch, ouch, ouch, ouch.)
These are tests and procedures done a doctor covering his ass rather than trying to diagnose and treat evident conditions.
... and increase his income (see my first point). This is especially true for specialists.
I am officially gone from
forcing hospitals to treat people who are too irresponsible to get insurance is a moral hazard and raises the cost for everyone else.
I was going to mod you down, but I decided, instead to point out WHY you're a fucking idiot. As of today, Aug 21, 2012, health insurance companies can and do refuse coverage to anyone that they deem "not sufficiently profitable." To refer to those unprofitable people with the blanket statement of "irresponsible" is pretty irresponsible in itself.
And to say that they should die when hit by a bus because they weren't good for Aetna's bottom-line makes you an evil corporatist fuck.
You generalize Americans as though we don't see the problem ourselves. We damn well know what a lot of the problems are, we just aren't allowed to talk about them. Talking about *important* matters only makes those that are dumb-voted in the office angry. When they get angry, they start to make laws that are only in place to make feel like they have accomplished something. It is 100% rubbish, all around, left or right.
1. Solution: put doctors on salary. You seem to forget that doctors are Free people and are not serfs owned by the Crown.
2. Solution: end-of-life counseling and legalizing euthanasia Well, duh. Just how do you figure when a person is going to die? I've worked with hospice patient for the past 15 years and cannot tell you when a patient is going to die. A better option would be to add all the 3rd generation entitlement citizens and sterilize them after their first child. If you're going to go that road, might as well get some mileage out of it.
3. Solution: Single payer and single provider, so there's nobody else to haggle with. And you don't shop around for a better price on your commodity items and just go to the local monopoly store to buy your food? Haggling brings down prices. And you believe that some bureaucratic drone that cannot make it in real job can make better decisions than anyone else. Ahh.... The hubris of the socialists.
4. Solution: Cover everybody. They tend to seek care in ER's since they know that they cannot be turned away due to the laws. Change the laws back and make them goto a clinic for the sniffles. That way we don't have to cover their ER visits and don't have to pay for their healthcare.
I've taken care of foreigners that came to the US to get medical care here since they didn't want to be treated by the cattle call system in their homelands. I've been in the European hospitals and seen the 'ward' nurse system. Thank you very much but I'll keep what we got in the US. Warts and all, it is still the healthcare system in the world and only 0bama jizz drinkers like Michael Moore go offshore then that isn't for anything serious.
These neoliberal politicians seem to live in an entirely different country, and Frenk is no exception; no wonder he's now run as far away from Mexico as possible and is now teaching elsewhere, standing, no doubt, on his alleged achievements while being the secretary of public health in Mexico.
As any mexican will tell you, his boasting is far from the truth; while he may have instituted a program that supposedly provides coverage for people not otherwise under any sort of health care plan (i.e. those who are not, as workers, covered by the mexican institute of social security (IMSS), or as government workers, covered by ISSSTE), he did so without increasing health spending significantly (from 2003 to 2005 it only increased 0.2 percent and it has remained constant ever since: http://corta.me/7mz). So how can you cover 50 million more people without increasing spending? very poorly, that's how. Understaffed and underequipped hospitals, lack of medication, soul-sucking bureaucracy and hoops to jump through, I don't think that's anything to boast about; as befits his neoliberal lineage, Frenk instituted these policies for the macroeconomic "bottom line".
IMSS is supposed to provide coverage for workers and their families. However this entails people working on a stable, formally constituted company which has the obligation to cover fees for employee coverage. It's not a privilege, it's a right that companies must provide to their employees. However, since Mexico has had near zero growth in the past two decades or so (and more so since 2000, when the disastrous, conservative PAN party arrived in power), job creation has stagnated, and even receded in some cases. Millions of people have to resort to the "informal economy", since there's no company through which they can have access to IMSS, this popular insurance thing was created to give some semblance of health care coverage to the 50 million poor and underemployed in Mexico. But make no mistake; this is not the glowing achievement that Frenk would have the world believe. It's really the government hastily trying to fulfill, in a half-assed way, their constitutionally mandated obligation for health care (Mexican Constitution, 4th Article). This has been there since 1983, so actually Frenk's implementation means a 20-year lag for the government to fulfill its obligations.
If we're talking about health care, the longevity and infant mortalty are good metrics. They're not that bad as part of an overall metric for scoring a nature, either.
Socialism has been tried in many places, failed in some where it was tried to excess, but works fine in others where it has been used appropriately. The dose makes the poison. Socialized health care works well everywhere it has been tried. Most countries, including the US, have socialized transport systems (in our case, highways -- arguably, we have built too many and encourage their overuse, but they work, and are hardly bringing the country down). The trashing of various economies has not one damn thing to do with health care; we took a hit, too, with our more-private system, and some countries with UHC did quite well indeed. What did us in was excess risk-taking by under-regulated banks, combined with amnesia about what it took to get us out of the Great Depression (dropping the Gold Standard, and War-scale government spending).
Germany is an interesting example -- they've had a form of UHC pretty much like Obamacare, and they have managed to continue it through boom and bust, where "bust" includes the two World Wars that they lost.
I'd be curious to know how much of the prices are because of tort (wouldn't that just be a sum of the malpractice insurance fees) and how much is due to inability to collect. I'm sure someone who works in medical billing could give some figures on billed vs collected.
I think that a significant portion of the high fees are to cover the people who don't (won't) pay.
Lawsuits only make up about 1-2% of the health care costs.
It's not the lawsuits. It's the insurance doctors (and now some nurses and PAs) are required to get to insure you against those lawsuits. This can be north of $100k/yr and in some cases (depending on the state) close to a quarter million a year for a surgeon.
Quality of care has to figure into the discussion as it's directly related to the average cost per person.
In an ideal world, governments behaving sensibly wouldn't make headlines.
Universal healthcare is useless if you live in a country with absolutely no rule of law (they have a murder rate three times the US) and in the midst of a bloody civil war the government won't admit to that kills about 10,000 people a year.
Any time anyone says the words "civil war" they freak out, yet the cartels are blowing up police stations and military installations like it's going out of style. Judges, police, prosecutors live in constant fear of the kidnappings, bombings, beheadings the cartels are using to brutally suppress the justice system.
Please help metamoderate.
Yeah, that's not actually true. There is no such rule, there is no such law, and the NHS will continue to pay for your treatment in their system. (Although obviously not the specific treatment they didn't approve of.)
Now, if you do something unapproved and have complications from that, they might balk at solving that.
If corporations are people, aren't stockholders guilty of slavery?
Keep adding a million migrants or so each year that scrape bottom barrel to live but use the same exact healthcare system. What little money they "save" usually goes back to their home country for their even poorer families. The problem is compound in America as we want to help others out but many of those people can't come close to helping themselves out. They ignore the rules that we have to protect our nation from these sort of issues but we also have rules that say, "You're here, let us help you." It's good humanitarianly speaking but you can't have the huge disparity in what is being paid and how much they are paying into. Canada is very stable when it comes to this and the disparity between the rich and poor is much smaller. Canada will most like remain good in most aspects as they don't seem to have any real change in population growth. The U.S simply cannot handle the type influx it has been seeing over the past 15-20 years.
The hospital I work at would probably not charge for the Q-tip itself, but add the fully burdened cost to the service provided.
Follow through, though. I'll try to make it easy for you.
The Q-tip was purchased and probably has an acquisition cost of $.01.
It was stocked by a nurse who needed to track inventory to maintain a non-profit status ($35/hr). 30 seconds to place it in the correct position and check off that it is now in inventory. ($0.50)
It was housed in a rolling cabinet that cost $2K. (assume cost is amortized over several years) The cart is cleaned once a week. The Q-tip bucket's share of this cleaning is 30 seconds @ $20/hr. let's say it's $0.01
It was requested by a care provider and took 60 seconds to log the care request into the government mandated electronic medical records used for tracking and assuring proper follow up to care. Cost of 60 seconds of care from a family practice physician (assuming $120K/year) is $1.
The request was printed out at a nurse station and picked up by charge nurse. Evaluation: 15 seconds. Delegation of the service 10 second. For a nurse making $70K/year, that is approximately $0.24.
The CNA ($25/hr) will open up the cabinet, get the Q-tip, walk the Q-tip to the patient. (2 minutes) Cost: Approximately $0.25
CNA logs the patient ID band and confirms the service will be performed: 30 seconds. (approximately $.10)
Actual use of Q-tip by CNA: 1 minute, including disposal in approved container. (approximately $0.20)
Disposal of Q-tip by janatorial staff: $0.01.
If procedure is properly performed and there are no adverse issue, you have an OCOGS of over $2. And you think it should be free?
You never pay into SS or Medicare, because there is no fund with any assets there, it's all IOUs, gov't bonds.
Just so we're clear here, what you're arguing here is that a US Treasury bond is not an asset. This would come as a big surprise to anyone who's ever bought one, including everyone working in financial markets anywhere in the world. The only way those IOUs aren't assets is if the US Treasury decides to default on its loan obligations, which means that we've also just seriously pissed off the Chinese and everyone else who was holding them, triggered a global financial collapse and quite possibly a serious war.
I am officially gone from
It is tough to find a good response for this point of view on slashdot. Most of the brains appear to be stuck in the proverbial parent's basement even if the body isn't.
In other words: it is not adequate.
A lot of that "non life threatening" stuff will turn chronic or become untreatable if you ignore it. It sounds a bit like the US system really, where you are only guaranteed timely treatment if you are at death's door.
Otherwise, your condition is left to fester until it becomes more painful and more expensive to adequately deal with.
A Pirate and a Puritan look the same on a balance sheet.
I do not know about other hospital but I do know about my local hospital. It is now in the midst of a major construction program. They are spending around 10 million dollars so that they can move the entrance from the south side to the north side. Just a couple of years ago they had a major addition to it. So I can not see that it is anywhere close to being closed or broke.
A lot of medical bills are pretty bogus. So if you are going by what the "MSRP" of a treatment is you are going to get a grossly inflated number versus what's actually paid. It's not clear that the usual statistics actually reflect what is spent versus what is charged.
Also, all of this whining about how Medicare and Medicaid cost is interesting considering the fact that most doctors avoid it because the reimbursement rates for either quite frankly suck. It sounds like it sucks to be a doctor in the UK if you are effectively stuck doing nothing but "medicare/medicaid".
Perhaps the US needs to start with free med school so the doctors can afford to work for peanuts.
A Pirate and a Puritan look the same on a balance sheet.
So then sum that up.
It's not an unknown number. So don't treat it as such. Don't make believe it is some shadowy "bogey man" you can point to as scary but never really spell out.
It's a wonderful argument you've got there. You can basically make up any argument you like based on numbers that don't really exist.
A Pirate and a Puritan look the same on a balance sheet.
LCP is a codification of care practices from the hospice movement. A hospice is arguably one of the more dignified and comfortable places to die, but they are heavily oversubscribed (which puts the lie to the notion that they are something that people want to avoid). So LCP provides a training manual for normal hospital wards to attempt to approach this level of service.
Whereas in the States, the patient would approach the end of their life not because they or their relatives have accepted it, but because their insurance can't cover the heroic measures being deployed to prolong their suffering^W life any more. The minds of the patient and their families will not just be full of grief, but also the anxiety of how they are going to pay the hospital bills, and what kind of hardship that will mean going forward.
Would you rather that decisions about your healthcare were made by a single individual? Or didn't benefit from the advice of experts in the field? "Death Panel" is just trolling by the people who'd rather keep healthcare in private hands ; and as a multi-billion dollar industry with a 15% profit margin on peoples suffering, who can blame them?
I am highly suspicious of these ratings of health systems by country. I have lived in various states and been subjected to their healthcare systems and have had first hand experiences that directly contradict some of these published studies.
A Pirate and a Puritan look the same on a balance sheet.
Medicare and SS spend more money than they take in, so to finance these pyramid schemes the gov't sells bonds.
SS takes in more than they make, you fucking moron. Which is where as these IOUs come from...the rest of the government borrows from them.
Jesus Christ on pogo stick, it's completely astonishing how many people are complete and total idiots.
Here, let me explain to you: You know how you don't have a job because you're too goddamn stupid to work a cash register? (And I also think it's unfair they fired you! Does it really matter if customers pay you or you pay them? Isn't it enough that money moves?) You know how you have to keep borrowing from your parents to pay off your credit cards? You know how they don't charge you interest?
They are, this analogy, social security, and you are the rest of the budget. And you are standing there arguing that they are borrowing too much and spending too much and will collapse, because look at all those IOUs they have from you! (IOUs are bad, right? So having IOUs must be bad, right?)
Hey, dumbass, it's you who have the problem, they're the people fucking bailing you out. The government has borrowed 2.7 trillion dollars from social security.
You get rid of social security, (even if we _don't_ pay it back, aka, we steal the 2.7 trillion dollars we've already borrowed, aka we default on US government securities), and in the future the rest of the budget is in a lot more trouble and has to borrow more, resulting in more interest. We borrowed $805 billion in 2011, so basically you're saying 'I wish we had to pay interest on an extra $805 billion each year!'.
And having stole 2.7 trillion dollars from our security holders (Even if said holders were ourselves), I can only imagine at what interest rate we'd have to offer on those added bonds. And our existing ones.
TL;DR: Conservatives think a place the government can, and has, borrowed money without interest (Instead of issuing bonds which do cost interest), is somehow causing the budget issues, and the fact that it has so much money is obvious proof that it is bankrupt.
(Medicare, OTOH, hovers on the line of taking in too much and too little, but is not separated out like social security and doesn't have a trust fund, so extra money just disappears into the general budget, and comes out another year, so it's harder to see that it's revenue neutral in general. People gasp and point out that it costs X billion dollars one year, and don't notice it made X billion dollars another. Right now, in a recession, yes, it's costing us.)
If corporations are people, aren't stockholders guilty of slavery?
You fail to explain how this will reduce the cost of insurance.
If 75% of your costs are dicking around with the insurance company arguing about whether illness X or medication Y are covered on a particular plan, for a particular patient, during a particular phase of the moon, etc., then you could spend 3 times more on everything else, and still come out of it spending less, if you had a single payer system where you just send them the bill (the charges being determined by the payer), and they pay it.
Government healthcare is, economically speaking, only about killing people before they cost the system (starting with anyone over 60 years, continuing with long-term disability patients, ...). Do you really want your insurance provider to have that principle as it's sole guidance ? Do you really want an organization not bound by contracts and with it's sole incentive to kill you the moment you become unproductive be the sole administrator of your healthcare ?
HAHAHAHAHAHAHAHAHAHAHAHA.
Oh, wow, thanks I needed that laugh.
You should be comic or something: Hey, folks, would you rather have a private corporation run entirely for profit decide whether or not you get care, or would you rather have the government decide that, which has people in it who have to get elected to office?
If corporations are people, aren't stockholders guilty of slavery?
What does it mean "at least as long ast he country can afford it"? You do NOT have the right to the use of a multi-million dollar facility/equipment. I would love to know what part of someone paying for med school, paying for dr. salaries, etc...is YOUR right to make use of for free.
But how much of the insurance is to protect against tort, and how much is actual malpractice.
In the annals of data about tort reform you can find some specialties (e.g. anestheticians) who changed their operational practices. As a specialty, their insurance rates went from the highest to among the lowest by simply adding things like check lists and adopting better practices.
These types of studies among the specialists would likely make a larger impact than tort reform, which only really impacts the outcomes of patients with legitimate medical malpractice claims. It's difficult to win such cases, which require a lot of proof. Tort reform only caps the results of the winners (very few), not the losers (most).
I always get the shakes before a drop.
I think they are one of few treatments that actually have a negative cost in the system. You create a taxpayer for a few thousand bucks, remember?
Thanks. Very relevant and interesting information.
The REAL costs of government run healthcare in the USA are even higher. Medicare and Medicaid reimbursement rates are mandated by government. Everyone else then gets stuck paying higher prices so that the providers can make up for the losses they take by treating Medicare/Medicaid patients.
Then we have the ban on re-importation of drugs and medical devices so that US citizens are forced to subsidize the rest of the world's medication and medical device usage.
We've also got another wonderful Federal mandate called EMTALA so that hospitals are forced to treat everyone that shows up at the door, regardless of their willingness or ability to pay. Who eats that cost? Not the government.
IMO, our government has totally screwed up the healthcare system in the US, so there's no way I'm going to let them take over the whole thing.
Remember, that's the only way all insurance works - by forcing one group to subsidize another.
FTFY.
Also, with all for profit insurance, you're subsidizing the losses of the insurance company when they make bad investments with your premiums (i.e. American insurance companies after 1999). If they make good investments, they don't see a reason to lower the premiums and just keep the profits.
I think you can see that growth in health care costs to the the individual have direct relationships to the lack of profits to the insurance company. If they don't hit a target, they raise the premium ever higher or reduce the payout or reject more claims. There is not direct relationship between premiums and quality of service, especially if you live in a captive market like Alabama.
There's hope the Obamacare changes to cap profits at 18% of premiums received will remove some of these issues. Also the gradual change into a system that monitors the actual effectiveness of outcomes will increase the effectiveness of treatment for the same dollar.
I always get the shakes before a drop.
actually, I know lots and lots of people that go to Mexico to get their prescriptions filled. And Mexicans are coming to the US for work, not health care.
If you actually think 'letting people who cannot pay for health care die in the street' is the solution, you need to say so, loudly, so no one can accidentally elect you to office^W^W^W^W^Wmisunderstand you, because you're taking a position that is wildly at odds with the _entire_ US population. _No one_ wants sick people dying in the street.
What people (At least, the left) have done is now require everyone to have insurance, so no freeloaders like the one you describe exist. (And in case they do not have insurance, they are fined, and any collected fines are used as part of the money the government reimburses hospitals with for covering uninsured people.)
Actually, wait, no, that's not really the left's doing either. It's the right that has been talking about such freeloaders for years, and repeatedly proposed that people _should_ have to get insurance. The left wanted to do other things, taking the profit out of insurance entirely or even have the government run a competing plan or even all of it, or just have it run the hospitals. But, unable to get any traction with that, the left eventually said, 'Fine, the right's idea is better than nothing.'...at which point the right decided it was the worst idea they'd ever heard.
But, regardless, it's nice to see someone correctly say 'The solution is _either_ to let people die on the street _or_ to have more government regulation than we used to have. Not letting people not get insurance and freeload wasn't working. Either more government regulation, or dead poor people'. You keep repeating that. (I do not think it will have the result you intend, but don't let that stop you.)
If corporations are people, aren't stockholders guilty of slavery?
This is correct, however I ask a follow up. Why are hospitals forced to provide healthcare services to people that cannot pay - this is one of the main drivers behind escalating costs of healthcare, but why is this the case?
Because.
You can rationalize several reasons depending on your bent.
I always get the shakes before a drop.
REAL Solution: Get the damned government and their stupid laws and stupid mandates out of the system entirely.
1. Consumers aren't stupid. If the person buying medical services had a direct relationship with the provider and complete price transparency in a competitive market, they are capable of making their own decisions. Auto mechanics and many other service providers operate on a fee per service basis
2. Good idea.
3. Get the government out of the equation. Make prices transparent and use health insurance more like auto collision insurance. Get rid of government mandates on what MUST be covered by a policy so that people can negotiate contracts for their unique situation.
4. Repeal EMTALA. Negotiate payment terms with the provider or go to a charity hospital.
In other words **** the government!
Private, for-profit businesses deliver millions of goods and services to people with high quality and at affordable prices. Competition and innovation decrease costs and increase quality. Governments never do.
Wait it gets worse.
Since there is no cap on the profits of insurance companies, they are free to simply raise premiums to pass on the cost of bad investment of past premiums.
For instance, all their internet stocks become worthless, then raise premiums to meet profit expectations. Or deny more claims, or pay doctors less for procedures.
The $12 Q-tip (uncited) is just a symptom of the inequties in the system. Doctors and hospitals need to be paid (not always what they want, but fairly). When the payers (insurance companies) refuse to pay for some services, then others have to priced higher to recoup the costs. And on and on...
I always get the shakes before a drop.
You falsely assume that .gov regulation lowers pricing. If the .gov orders big pharma "provide us with pill X for $Y", you falsely assume that big pharma won't tell the .gov bureaucratic weasel to stuff it where the sun doesn't shine and stop making pill X at a loss. You're somehow blinded that the .gov can make an edict and majically all ills are corrected. It is hard for me to understand how you can believe that these bureaucrats are somehow gods are all knowing and wise.
Your rhetorical question about the 'Q tip' is a 'Michael Mooresque diversion' to accuse and isn't looking for a real answer so I won't take the bait to respond.
You and your country men are free to stay out of the US healthcare system. We see the financial crisis du jour that this 'free healthcare' has brought to the EU and want no part of that madness.
which will be if they allow the government (screw it - allow the current batch of GOP politicians) to reduce SS benefits to future generations
And even if we do not a thing to change the current issues, the most pessimistic projections by the SS Board suggests:
The less pessimistic projections, which followed America's growth until the current recession, showed the program remaining able to fund to 100% for at least 75 years (the outer horizon of projections).
Further, if we rebalance the growth in inequality our society has allowed to occur for the last 30 years, then everyone in those time horizons is better off financially.
I always get the shakes before a drop.
Sounds like you pay twice for HealthCare. First through high taxes for an inferior system. And again through supplemental insurance. Why not have a free market where you pay-out-of-pocket in the first place and perhaps buy insurance for catastrophic health only. How is a free-market less efficient?
The conservative argument against universal health care is pretty simple. If it's paid for by taxes, the middle to upper class pay significantly more than everyone else for the same service. And those people don't like doing that.
Personally, i'm on the fence about the issue. I definitely see the benefits of a simple, efficient, single payer system. And I also feel it's important that everyone has access to affordable health care. However, I do find it annoying that a huge percentage of the population pays little to no taxes but expect more and more free services from the government. I think health care is a personal responsibility that everyone needs to budget for. Similar to buying groceries or paying rent (extreme poverty cases aside), everyone has to pay. I see far too many poor people buying iPhones and $100 data plans, yet claim they cannot afford health insurance.
If we are going to compare the health care of other countries with the United States, we should also compare the lifestyle differences between the US and other countries that affect our health and, therefore, the health care that we require. Generally, people in the US eat more crap, get less exercise, indulge in more promiscuous sex, and use more dangerous drugs than people in most other countries. Those things all cause serious disease that takes a lot of expensive medical care to manage before the patient ultimately succumbs. If a hypothetical Joe Blow wants to use meth, inject himself with heroin, eat steak for dinner every night, sit on the couch playing xbox till 1am while drinking diet pop, and then go of to the bars to drink and pickup a new sex partner for the night, he's going to be a high-roller at the local hospital as well.
What "enormous benefits" are there to a 20-something with a healthy lifestyle that gets put into the same risk pool as a morbidly obese chain smoker?
If the US government would repeal the ban on re-importation of prescription drugs, they would already be much cheaper. Government doesn't need to "negotiate" they just need to stop artificially propping up prices.
Is 'SS' a retirement program or a welfare program for old people? If it's a "retirement program" (as it's often described) it's a total scam. I say that because if new contributions stopped, the SS fund would not have enough assets to pay off the liabilities. Classic Ponzi scheme. If we admit that it's just another welfare program, the comparison is meaningless.
I thought the Mexican healthcare system, was to come to the US illegally across the border, and get onto our welfare system...help drain Medicare, and clog up our Hospitals' Emergency Rooms....?
No, that's just a side result of the Mexican Jobs Program. The health care in Mexico is all covered, but they'd have to go home to use it.
You fail to explain how this will reduce the cost of insurance.
The poster didn't say it would reduce the cost of insurance. They said it would reduce the cost of billing insurance, which is a huge medical expense that people are unaware of.
75% of the costs are billing. I assume by 'costs' that doesn't include the doctors salary (Often that's structured as profit, not salary..the doctor owns the place, works 'for free', and just keeps any money left over), but still..that means filling out paperwork to get payment from insurance companies is three times more than the heating and air, the rent, the equipment, receptionist, etc. Three times all that put together.
Basically, imagine the hassles you went through when you returned something you bought online. Even if it went okay and you were only on the phone ten minutes, and the paperwork all worked out. Now imagine having to do one of those for every single patient...and the process blows up on one out of five of them, requiring waiting on hold for two hours.
You know that time that your insurance was supposed to cover something, but apparently didn't realize it, and billed you for it, and you had to call them up and straighten it out? That was because someone at the doctor's office fell down on their job....and the corollary to that is every time insurance was correctly billed, it took a significant amount of time from someone at that office.
In fact, there are almost no medical practices without a full-time employee solely to deal with getting money from insurance companies. (And the ones without are mostly the ones that don't take insurance at all.)
With a single insurance company and a single plan, the costs of billing them would be greatly reduced. Also, presumably, a government-run service would not be quite as weasely when to comes to payment. But even it was, a single set of rules and single contact point would greatly reduce costs.
If corporations are people, aren't stockholders guilty of slavery?
The US does have universal healthcare. If you walk into a hospital you get treated.
Health Insurance is like every other insurance. You only need it if you have assets you want protected. It is a financial product. I have car insurance in case I get into an accident. It will buy me a new car or keep my house from being taken in a lawsuit.
I have life insurance not to keep me alive but to protect my family from income they would lose if I died.
I have homeowners insurance because if my house burns down I'd like a new one.
A poor person doesn't need health insurance because they don't have assets that need protecting.
This whole universal health insurance debate is an attack on the poor. They already get healthcare. It's just the non-poor don't want to pay for them. Well too bad.
I love Jesus, except for his foreign policy.
That Mexico can figure out universal care but the U.S. is predominated by the insurance industry. That insurance industry is the one primarily responsible for the run up in health care costs in the U.S. And of course in the U.S. we have the billing companies too. We need to neutralize both.
Hospital bills for the uninsured are entirely made-up bullshit. They've got to be some kind of tax scam or similar asshattery.
My wife had a minor-ish surgery a couple months ago, and the amount insurance paid versus what they would have charged us without insurance was a bit under 25% (!!!!!!), and obviously the hospital's not losing money on that—in fact, judging from New Jersey's experience with simply saying "no" to annual insurance premium increases and all the magical savings that appeared out of nowhere at every level of their health care system, I'd guess even the 25% is an inflated, rents-seeking rate.
Let's do some basic math: Our military budget is about $800 billion so cutting 90% would leave us with $88.9 billion.
We have about 1.5 million active people on duty for a cost of $154.2 billion + $3.1 billion for family housing which leaves -$68.4 billion dollars.
Already in the hole with your plan and we can't afford to provide them with bullets, let alone transportation, armor, food, medical care, etc.!
If we reduce our force down to 100K then the other 1.4 million ex-military and their families would end up needing unemployment, medicaid, food stamps, etc. I don't think that is a very fair thing to to to people who have served our country so bravely.
Your plan also ignores the approx 2.5 million people (and their families) in defense related jobs that would become unemployed and end up needing unemployment, medicaid, food stamps, etc.
Would we be able to provide healthcare from the savings? Of the $2.2 Trillion spent on healthcare in the U.S. each year, $800 billion is from medicare/medicaid so that leaves $1.4 Trillion. If we subtract the $711.1 billion dollar savings from defense we still have to come up with $688.9 billion (almost as much as we saved on defense), so no we don't make it.
I don't think you will be getting my vote in November!
"FTFY".
Cute but wrong. Normal insurance policies cannot systematically force one group of clients to subsidize another, because the former would simply leave and get their insurance at a lower rate elsewhere.
Re-read that sentence - it sounds to me like the nearly half the population WERE NOT previously covered by health insurance, but NOW ARE. Add that to the number who were previously covered (probably most of the remaining half), and the number who still aren't covered to get the complete picture. Oh yeah, for completeness we should throw in those who were covered but no longer are, but that's probably a very tiny minority.
--- Most topics have many sides worth arguing, allow me to take one opposite you.
Right... Academics are angels who are immune to greed and other human cravings (fame, power, security). They join the small ranks of angels of politicians and government bureaucrats ;-)
I find it curious how you identify people's motives by their title. There are lots of people not motivated solely by pecuniary profits, from random joes to company owners.
These comments are mine; I do not speak for my employer.
Ah - maybe there's the next opportunity in the free education offerings. khanacademy, codeacademy, udacity, mitx,.... How about free med school? At least the lecture portion could be commoditized.
You are an incredibly stupid person. So many Americans live in a weird bubble of ignorance. It's just embarrassing.
Who said anything about not working?
-- Let us endeavor so to live that when we pass even the undertaker shall be sorry. -- M. Twain
Australia's economy is tanking, but more from the Voldermort Tax than from health care.
Apocalypse Cancelled, Sorry, No Ticket Refunds
Why is necessary that doctors, insurance companies, pharma companies, etc... make so much money?
Scientists don't get paid a whole lot, and yet they're still inventing things. Why couldn't doctors do the same thing?
-- Let us endeavor so to live that when we pass even the undertaker shall be sorry. -- M. Twain
How is anything I said Marxist?
-- Let us endeavor so to live that when we pass even the undertaker shall be sorry. -- M. Twain
The oil/mining economy in Canada is running well. The rest, benefiting from the oil economy, will continue run well as long as the oil/mining economy is running well.
Canada made some hard decisions in the 1980's and early 1990's. It was hard. Brutal, even. These are some of the same choices the US needs to make today.
Bill
The cost of health-care in the US is out of control. Reform needs to happen across the board, the price of medical school, the price of drugs, the cost of procedures. Just about everything is broken, and we need radical reform to fix it.
-- Let us endeavor so to live that when we pass even the undertaker shall be sorry. -- M. Twain
Agreed. Like we NEED more people....
If I need a surgery and have no money to pay for it, a macroeconomist will say that I'm out of the "supply and demand" cycle. However, I might just die. Is that fair?
I am a Mexican. I have treated almost all of my medical needs over the past many (10?) years. Many of my friends prefer private healthcare - just for the reasons you mention. Of course, I have not had to wait for months for an urgent surgery (that happens here, of course), and would most likely do it privately.
Thankfully, I am in the social strata where I can choose. Most of the time, I can perfectly live with some waiting and hurrying. Many people won't even consider it. Up to them. But I know many, many people that were it not for the socialized medicine would get no alternatives at all.
Of course... this does not sadly cover the whole country. The countryside lives in a dramatically different situation, and the supposed universal coverage... does not exist.
I just had some dental work done a few days ago, I had no dental insurance. I was able to negotiate a killer price for a cash deal. The office was extremely happy to provide me with deep discounts they said billing is generally a majority of the overhead. My actual cost was probably barely more than any deductable I would have paid.
Got Code?
It's an asset. But it is issued by a government that owns printing presses.
Thinking it's value is guaranteed is foolish. Granted paying off the bonds will reduce the value of all dollar denominated assets. Not just the bonds.
It is a Ponzi scheme. If Ponzi had left Ponzi bonds in the account it wouldn't have changed anything.
Finally. Only fools are buying T bonds these days. The fed is buying any leftovers at the end of the auctions. There is no market rate for bonds. There is no market for bonds. It's just left hand selling to the right hand, which prints the money.
That said it's better then the euro. At least the fed is only buying 0% bonds from _one_ insolvent government. Better then the ECB.
John McAfee 'It was like that time I hired that Bangkok prostitute; to do my taxes, while I fucked my accountant'
You start your rant with a false statement and call the GP a fucking moron?
SS used to take more in then it spent. That money was taken by the general fund and spent. It now spends more then it takes in. Have you heard of the baby boom?
The trust fund is a lie. Nobody would allow a company to maintain a trust full of its own bonds. It's an even worse idea to let the government do it. All that money will ether come out of the general fund or it will be printed.
There is no market rate to T-bonds. The leftovers at the end of each auction are bought by the fed. It's only slightly better then Europe, where the ECB is buying bonds from multiple insolvent governments.
John McAfee 'It was like that time I hired that Bangkok prostitute; to do my taxes, while I fucked my accountant'
Maybe medicare pays less than market rates and the doctors raise prices on other patients to make up the difference?
My reforms? All patients pay the same price, minus any amount payed by their insurance (no network discounts for insurance companies, etc). Instead of prices of 30,000 for an overnight stay and appendectomy (my real bill 8 years ago) which then gets reduced by the insurance company, partially paid with the rest passed on to me, the bill would have the real price paid by every customer. No reducing the bill for insured folks and passing the cost on to other people and hiding the real billed amount.
Add on getting rid of malpractice reform which can easily run to 20-30% of a doctor's income for the year. Replace it with doctors having to cover for free the fixing of errors by their peers will encourage them to weed out bad doctors.
Turn medicare over to the county government. The local government can raise taxes similar to medicare, hire doctors and run a clinics that will compete with free market doctors and provide inexpensive or free care to those who need it.
I want the one that is bound by its contract. So yes, I want the private corporation.
John McAfee 'It was like that time I hired that Bangkok prostitute; to do my taxes, while I fucked my accountant'
Point of reference - I have 2 uncles who are doctors in Hong Kong (and they work in a public hospital) and both drive E-class Mercedes (keep in mind cars cost 2x-3x in Hong Kong what they cost in the States).
There are a huge number of yeast infections in this county. Probably because we're downriver from the bread factory.
Most real conservatives know it's not Social Security that's the problem, but rather things like Medicaid, and similar programs, that're the source of the problem.
It doesn't take a financial genius or a rocket scientist to go look at the budget dashboard figures from the GAO, etc. and see that we're spending less on Social Security/Medicare and Defense (Which includes all the spending done on the recent wars we've been involved in...remind yourself of that...) than on other idiot social programs (that's where the bulk of the actual spending has been for a long while.)- and know where to contremplate cutting things. You have issues with it, though, because everyone doesn't want their freebies cut off- and the Liberals have been using them for buying votes for YEARS now.
Want to fix things? It sure as hell doesn't start with cutting Defense spending or Social Security. It begins with culling things like those bailouts and things like Solyndra. It begins with curtailing what gets spent on Medicaid (Those here illegally get better medical care than the REST of us, including those on Medicare... Meds, glasses, etc. All paid for off of each and everyone's backs...)- and cutting off those that are not really legally entitled to it.
Want to fix the healthcare "problem"?
Get Medicare to QUIT arbitrarily paying out only 30% max of the billed and Medicaid to QUIT paying out 80%.
Get the Insurance companies to QUIT paying out only 30% over Medicare's payouts.
Change the Insurance story to be more like the HSA/High-deductible story where you're saving up money for healthcare and they only insure against catastrophic incidents.
While that won't fix things, the first item addresses one of the major causes of the "problem". The second forces a re-assessment of things. Might raise your insurance rates, might not. Obamacare will. The third's based on the premise that the "insurance" scheme we're doing here in the country's more of a scam inflicted on the patients and the doctors. You don't typically get "insurance" on piddly things for your car, right? Why should you do the same thing with health or other insurance? If you're able to save up money against regular visits, preferably untaxed or deducted from tax profile, you're going to be inclined to do it. Right now, because of "pre-existing" conditions, I was forced to do that with my new employer. Upshot is that it's cheaper with the same ultimate result for the next year because if I had to get anything under most of the cases, it was going to be excluded from the picture, uncovered, for the next 12 months. So...if I'm "eating" that, I'd rather it be untaxed.
Reality is...you can typically get health insurance in most States at a higher rate through a "risk pool" the State insists upon. I know about it- checked into it because for a long time I was doing contract software engineering and I'm a Type II Diabetic... It's typically 2-3 times more expensive than the regular insurance. Want to have it cheaper? Fine... Problem is, they're going to raise everyone else's rates up and not proportionate to my risks. They have to make a profit you know. So...instead of spending 200-300 per month for insurance, you'll spend $500-700. Enjoy your "universal" healthcare.
I am not merely a "consumer" or a "taxpayer". I am a Citizen of the State of Texas
Aren't we messing with natural selection when we enable people who aren't fertile to reproduce? If their infertility is genetic, won't that mean we'll be carrying the infertility phenotype forward?
Anyway, I'd rather have a kid with "better" genotypes than my own. Also, a person is largely a product of their environment. Genetics only play so much of a role. Why not adopt a child?
I think having the taxpayer pay for expensive fertility treatments should be an option of last resort. It would make more sense to empty out all the orphanages first.
-- Let us endeavor so to live that when we pass even the undertaker shall be sorry. -- M. Twain
The difference is that the insurance companies are not allowed to make a profit.
Great Ideal, the Record and Movie companies don't make a profit either! Most insurance companies we deal with (volume-wise) are non-profit anyways. Being non-profit means your expenses has to match your revenues, it's non some flying unicorn, pink ponies with sparkles measure of social goodness.
Apocalypse Cancelled, Sorry, No Ticket Refunds
UK National Health Service pays for fertility treatment.
In the US, it's expensive, so they implant several ova at the time, to make sure at least one of them will be fertilized. Result: When they overshoot, many high-risk twins, and higher-risk triplets, higher infant mortality, higher hospital expenses, worse care.
In the UK they don't worry that much about costs, so they implant one ovum at a time.
Fertility treatments aren't frivolous, because they restore a natural function which most people consider to be important.
Breast implants aren't restoring a natural function.
I think everyone deserves clothing too. And a small entertainment budget. And a gym membership to stay healthy. And I will vote for whomever will ensure that the people of the country pay their fair share. And if they don't pay, we'll throw them in jail.
How about people not leaving it too late to see the doctor?
Having idle capacity is expensive. One way to cut down on costs is to have a waiting list. Then you can ensure all those doctors who are paid a fortune are always occupied. It's a trade off, like with most things in life.
And the doctors aren't incompetent. They know if a condition will get more serious and will bump you up the list if they determine that your need is more critical.
SS used to take more in then it spent. That money was taken by the general fund and spent. It now spends more then it takes in. Have you heard of the baby boom?
That wasn't because of the baby boom, you idiot. That's because we have a recession going on here and unemployed people don't pay payroll taxes, and people retired early. So, until the economy turns around, payouts will exceed revenue for about 5% each year. (And it's not helped by payroll tax holidays.)
Extrapolating revenues and payouts based on our current financial situation is idiotic.
The _actual_ baby-boomer problems hits in 2017, and over the next 20 years, will eventually run out the trust fund.
The trust fund is a lie. Nobody would allow a company to maintain a trust full of its own bonds. It's an even worse idea to let the government do it. All that money will ether come out of the general fund or it will be printed.
Companies maintain separate areas of money all the time, you idiot, and move money around between them all the time. One part of the company doesn't need some of its yearly budget yet, but another part needs it earlier.
And what the fuck does 'out of the general fund' mean? Yes, it's coming 'out of the general fund'. The goddamn general fund borrowed from social security, and social security is taking back the amount it loaned them. ('I can't can't pay back your loan, that money would come straight of out my bank account!' 'Uh, yeah, that's generally where money comes from.')
'The trust fund is a lie' is complete and utter nonsense, spewed by total buffoons who have no idea what words actually mean. The Federal government has two goddamn bank accounts, and has for years been moving stuff from the SS account to the general one, to keep from paying interest on loans to the general ones, and now, when SS runs low, is moving it back. Yes, _of course_ this is going to be a problem, because the government can't balance its budget and SS had been making things better for it, and will no longer do so.
While, indeed, you can choose to steal all the money that people have put in social security by changing the laws, you cannot also complain there is a problem with social security, which is 'People want to steal from it'.
You are people who are running around threatening to rob banks because, in your own words 'It's not safe to put money in banks, because people will steal it'. And hence you have to get all the money _out_ of the banks by stealing it. Problem solved!
If corporations are people, aren't stockholders guilty of slavery?
"would you rather have a private corporation run entirely for profit decide"
I have nothing against "profit" per se. If you do, you're not thinking hard enough about your own life and what it would be like without the profit motive of people around you.
Remember too, that these private corporations don't get to "decide" at their whims. There is an actual contract, actual consideration changing hands, and actual case law to help settle differences. With a government program, rules barely exist, and the policies change as your betters see fit.
Direct costs of malpractice, which include premiums, damage awards in excess of premiums, and associated litigation costs, represent no more than two percent of health care costs. Thus, tort reforms can have a substantial effect on health care costs only if they affect the amount of healthcare services provided.
Sorry, you must not work in health care.
This is just the malpractice part. What's not in the "1-2%" is what I'll call defensive medicine.
I have a colleague who is an orthopedic surgeon. He will not perform surgery on you unless you had an MRI or CT performed the day before. Many, many surgeons do this. And blood work. Update a complete panel. CBC, SMA, drug panel--the whole smash.
It does not matter if you had an MRI last week or your blood tests are two days old.
Why?
He does not want to get sued. You are paying for his defensive medicine.
You might ask "what does having an MRI prevent being sued?" There is a type of patient and a type of lawyer who look for clerical errors and then sue over them--not a negligence outcome. Not having an MRI the day before could be argued as not being the best care.
So what does it really mean? My colleague makes good money being a surgeon and would make less if he had a mark on his insurance record--just or unjust. With the surge in amateur ranking systems this means a lot to a practice.
I call bullshit on this. I just challenged a doctor friend of mine to give me an example of defensive medicine for malpractice purposes that wasn't also good medicine according to the guidelines. He said MRIs. Then he admitted that the hospital is also giving MRIs because they have an MRI machine sitting there that they want to get billing from.
I can't prove it now, but I think hospitals and radiology centers are giving needless MRIs in order to make money out of their MRI machines, and when somebody calls them on it, they say, "We have to do it or we're liable to get sued" as an excuse.
There are guidelines for MRIs. Doctors should follow the guidelines because that's the standard of medicine. If you follow the guidelines, you can go into court, and get a dozen prestigious experts testifying in your defense that you did the right thing, and if the jury believes them, you'll get off. (If you have a stupid jury, you can lose whatever the law says, but following the guidelines is the best you can do.)
If the guidelines say you should have an MRI the day before surgery, then you should have it. If the guidelines say it's not necessary, you shouldn't have it. Same thing with the blood tests, although automated tests are cheap and can pick trends a surgeon should know about.
There is one exception, the Daniel Merenstein PSA case (look it up), where the doctor lost a malpractice case for following the national standard rather than the local standard, but that was because of a law specific to just a few states, and that should be changed, if it hasn't been already.
Let me ask you a question - since when did a Q tip cost $12 - like it does in American hospitals? You Americans make me laugh with your joke of a health"care" sytem
That's not just a Q tip, it's a FDA regulated medical device, everything has to be documented down to how the janitor sweeps the floor in the factory. Lot number of all the materials used in manufacture, tracked from start, through distribution to the patient's final use. Besides "Cotton Swabs Sterile 6 Inch 100 Pkgs Of 2, 2382 Your Price: $4.04"
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How much money is "a whole lot"? How much is too much? So you think everyone should make the same amount of money?
No, but I have no problem with government regulating the salaries of doctors. That's not Marxist at all... the government already does it with the military, police/fire department, etc...
One doesn't have to be Marxist to believe that government regulation, oversight, and yes, even control, of something could be better than the free-market solution.
-- Let us endeavor so to live that when we pass even the undertaker shall be sorry. -- M. Twain
Why is paying for guns more acceptable than paying for health-care? We have a massive nuclear arsenal for deterrence, we don't need much of a regular military; no country is going to attack us.
-- Let us endeavor so to live that when we pass even the undertaker shall be sorry. -- M. Twain
Turn medicare over to the county government. The local government can raise taxes similar to medicare, hire doctors and run a clinics that will compete with free market doctors and provide inexpensive or free care to those who need it.
This wouldn't really work, it would just segregate the rich from the poor even more. The rich would all move to counties where they don't have to pay medical taxes, and the poor counties would be stuck trying to pay for their own medical services, which they simply can't afford.
The whole point of having the federal government do it is that it makes it so you can force the rich to help pay for the health-care of the poor. Once you get too local the rich can simply dodge their civic responsibilities by moving.
And yes, I said force the rich to help pay for the health-care of the poor. This is how it should be, the rich greatly benefit from the labor of the poor and middle-class. It's only logical that they should help keep them in good health.
-- Let us endeavor so to live that when we pass even the undertaker shall be sorry. -- M. Twain
Not sure about other countries, but there is no such thing as 'just adopting' in the united states. Demand for healthy babies far out-weighs availability, so there are huge waiting lists and difficult interviews that need to be passed. From what I've heard, it's somewhat comparable to going through the process of obtaining a US green card.
The situation is easier if you want to raise a special needs child or one that euphemistically 'doesn't look like mommy and daddy.' It's much harder to find parents willing to adopt a drug addicted baby or one that has been in foster care for a while, so the requirements for raising a special needs kid are much more relaxed. Unfortunately, raising such a special needs kid isn't really what parents hoping to have their own children want.
In an ideal world, there wouldn't be headlines. Good things wouldn't make headlines, because they'd be routine and expected. Bad things wouldn't make headlines, because they wouldn't happen.
However, we live in the real world, where positive progress -- such as governments behaving sensibly -- does make headlines, and rightly so.
I'm not saying that the workers should own the means of production, or that the proletariat should rise up and demand control of the government. That would be Marxism.
Anyway, Marxism and Socialism aren't dirty words or insults... so if you want to call modern liberal socialism "Marxism", be my guest.
-- Let us endeavor so to live that when we pass even the undertaker shall be sorry. -- M. Twain
Damn you're stupid.
John McAfee 'It was like that time I hired that Bangkok prostitute; to do my taxes, while I fucked my accountant'
Want to fix things? It sure as hell doesn't start with cutting Defense spending or Social Security. It begins with culling things like those bailouts and things like Solyndra.
You can't actually claim to be serious and then whine about Solyndra. Solyndra is a nonsensical issue brought up mainly in the attempt to make some sort of Obama scandal out of it, although that fell apart when it was pointed out that 99% of that happened under Bush and someone in the DOE authorizing the loan a few days after Obama got in office does not mean Obama had anything to do with it. That's the only reason anyone knows anything about it, the attempt to make it a scandal. That was a $26 billion dollar program to give out loans to energy companies, and a possible loss of $529 million dollars is not particularly important.
And while you can complain about the entire loan program, the fact is, the rest of them are on track to make their loan payments, and hence the program made money even with the Solyndra loss, so that's not a good example either.
And excluding defense spending is crazy. There is absolutely no reason we need to spend anywhere near as much as we spend on defense. We have no actual threats that could be deterred via most defense spending, and no reason to have military bases in 90% of the places we do.
It begins with curtailing what gets spent on Medicaid (Those here illegally get better medical care than the REST of us, including those on Medicare... Meds, glasses, etc. All paid for off of each and everyone's backs...)- and cutting off those that are not really legally entitled to it.
While we _are_ paying for the medical care of those here illegally (Because they go to hospitals and then do not pay, which means we do), I have no idea why you think they get meds and glasses for free.
While that won't fix things, the first item addresses one of the major causes of the "problem". The second forces a re-assessment of things. Might raise your insurance rates, might not. Obamacare will.
Obamacare's _already_ lowered insurance rates, because of the requirement that 80% of premiums go towards care.
The third's based on the premise that the "insurance" scheme we're doing here in the country's more of a scam inflicted on the patients and the doctors. You don't typically get "insurance" on piddly things for your car, right? Why should you do the same thing with health or other insurance?
Erm, while insurance _is_ a scam, it is not a scam for the reason you think it is.
Your health is not 'piddly', and _anyone_ can be hit, _at any time_, by health care costs they can never, in their entire life, pay off.
Treating it as 'insurance' is indeed stupid. But saying 'People could just pay for it themselves' is not very reasonable either, as people clearly _can't_.
This is why health insurance is a scam. Because things that everyone needs, and everyone (except the super-rich) have the possibility of not being able to pay for, is not something that should be left to the private sector at all. It should be right up there with 'police protection', as it's something that individuals who use it cannot actually afford., but something that, society-wide, is something we want.
Insurance is a reasonable idea when it's some sort of custom thing per person. It is entirely reasonable for a museum to insure against loses, and the insurance company comes out and says 'You have to do X, Y, and Z and we'll insure you for this much.'.
It is not any sort of reasonable model when there's an entire segment of society that needs it, and it's even less of a reasonable model everyone needs it, and it's even less of one when failure to have it means everyone else has to pay.If everyone needs it, and the lack of it hurts everyone, then the solution is to just tax people more and _provide_ it, not via any 'insurance' model.
I am suddenly reminded of the 'fire insurance' that some places have started offering, and how
If corporations are people, aren't stockholders guilty of slavery?
Explain this:
Barbara Ann Karmanos, Total Provider Charges $863.00,
(-) Less BCBSM Paid $0.00,
(-) Less Participating Provider Savings $703.30,
(-) Less Other Insurance Paid $0.00
(=) Equals Your Balance* $159.70;
Karmanos got paid 9 cents on the dollar charged. Now when people talk Expensive American Healthcare are they talking about the dollars they ask for or the 9 cents they'll settle for?
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If you do, you're not thinking hard enough about your own life and what it would be like without the profit motive of people around you.
Yes, I often wish that people have some sort of profit motive to deny me good and services.
Wait, no I don't.
You realize that the insurance industry has a backwards profit motive of other corporations, right? The _less_ health care I get, the _more_ money they keep.
I can imagine how this would work in a grocery store. Instead of shopping, I give a $200 a week to a third party, a 'food insurer', and in return he promises to feed me enough for a week. (In this universe, sometimes people get supernaturally hungry and start eating $200,000 a year, so this insurance makes sense.)
What sort of food do you think people would end up eating?
I love people who have become so attached to the free market they do not actually understand where different corporations profits comes from, which is a rather important part of actually having a free market. (As most of the problems that need regulation come from where companies start making money on the _wrong things_.)
Insurance companies make money by reducing claims. This is all well and good when they're an art insurance company and they reduce claims by security audits and theft recovery people. It's not good when they're a health insurance company and they reduce claims by...not providing health care and dropping sick people.
There is an actual contract, actual consideration changing hands, and actual case law to help settle differences.
Are you serious?
Have you actually ever used health insurance for anything outside of routine stuff?
You realize we just had to pass a law saying they couldn't drop people from insurance because they got sick, and couldn't make up bogus pre-existing conditions. You realize that, right? You're not just some alien who showed up yesterday on this planet and thinks that health insurance companies actually provide any sort of useful services to people who are seriously ill?
If corporations are people, aren't stockholders guilty of slavery?
In the civilised world, we view people who refuse to help the sick and injured as evil scum. In your country you may be happy with people dying, untreated, on the streets. YMMV.
The same civilized world which in many places don't have the right to free speech? You might not be aware of the fact that people here DO get treatment. If you look at any of the border states especially you'll see the Hospitals filled with people. At one point in Los Angeles 60% of the patients aren't even citizens. How about Hospitals faltering because of massive influx of non citizens.
Man blir trött av att gå och göra ingenting.
I'll make sure these people know that
http://www.dailymail.co.uk/health/article-1016262/Grandmother-dies-NHS-cancer-treatment-withdrawn-paid-privately-life-extending-drug.html
I'm sure they will be happy to know their grandmother didn't die, was able to get the drugs kept from her by the NHS and that the NHS is continuing to treat her.
Actually, she would have died by now anyways because the drug would have kept her alive about 6 months longer on average. But it is exactly what i said, they wanted a treatment not allowed, had to pay privately for it, and the NHS refused to continue covering that illness if they got the private treatment.
You understand you're talking into a mic conneted to the whole world, right? As in, the "World Wide Web"?
I call bull.
Many of the surveys of “outcomes” that show other countries spend less for similar or better healthcare than the United States are just intentionally disingenuous (i.e., they lie).
I've had babies delivered both in and out of the US, been treated for routine issues inside and outside the US, and right now I'd prefer treatment abroad.
Any of my non-citizen colleagues who have had experience both in and out of the US care to chime in about how wonderful our healthcare system is for people who make less than $170K/year, and where you're from?
He put his boots up on the table and made a face. "The sig," he smirked. "You can waste your life in search of the sig."
"Give me your tired, your poor,
Your huddled masses yearning to breathe free,
The wretched refuse of your teeming shore.
Send these, the homeless, tempest-tost to me,
I lift my lamp beside the golden door!"
Emma Lazarus, 1883
I feel sorry for the younger people growing now and to be born, they are getting saddled with a giant debt that will lower this countries standard of living for all but the very wealthy.
Hmm, either we can pay Halliburton and Blackwater (Xe) obscene abomination-before-God amounts of money to build us a fence, or we can return taxation levels to where Republican-War-Hero/Man-Who-Stopped-Hitler-and-Saved-the-World President Eisenhower set them and pay our debts and honor our "City on a Hill" principles at the same time.
He put his boots up on the table and made a face. "The sig," he smirked. "You can waste your life in search of the sig."
Simple: the population of people requiring healthcare treatment at any given moment, even at 0 population growth, is always going to be much smaller then the population who are able-bodied and working.
This is true until a historic population boom just happens to begin hitting retirement age.
Social Security (in the US) is not a scam, incidentally
When your population "pyramid" looks like a snake that swallowed a large animal recently, assumptions like yours become invalid. The oldest boomers are just now hitting retirement age. Thats assuming that you arent considering folks over the retirement age "able-bodied." If you decide that people must work until they die, well thats another matter entirely. Is that what you have decided?
In 20 years, there will be only 2 tax payers for every 1 social security recipient. If that were true with todays benefits ($1000+/mo for $50K/year wage earner retiring at 62) on todays dollars, it would require taking in $500+ per tax payer per month just to cover social security outlays.
Now you can say that there is money in the social security fund to offset this, but that money isnt actually there is it? That money was spent by the boomer generation, and in its place is an unpaid IOU, an IOU that will need to be repaid by those same 2 tax payers that are not of the boomer generation.
Thats $6000 per year per tax payer just to maintain social security. That doesnt even cover medicare, the education system, roads, military, etc.. etc.. We are talking about a serious burden here, but you seem to think that its not a problem.
"His name was James Damore."
Investors. The country with the highest tax burden in the world right now, Denmark, is at the moment loaning money at an interest of -0.25%..
YES, that means rich people, very rich people, and investors in general, believe the Danish economy is so healthy they are willing to loan them money at negative interest, just so that Denmark can protect they money for them.
Got a link to that? I would love to read it.
--- "When you gotta do something wrong. You gotta do it right. (Fighter)"
No silly you get treated, afterwards you send them what you can each month and if they get too pissy about it, you file for bankruptcy. Bankruptcy Lawyers are so busy they wear roller-skates to get to the different hearing rooms, so nobody even blinks at a medical bankruptcy.
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Let's take your numbers at face value: you've just made a very convincing case to NOT let the US government have anything to do with health care.
Except the EU healthcare system is cheaper because it's run by the governments - not the free market. You seem to think that the healthcare systems in the EU changed over three years ago. Canada started it's move in 1948. The UK around the same time. The financial crisis du jour is nothing to do with taxpayer funded healthcare and everything to do with greedy bankers - especially greedy American bankers.
I've never said such things are or should be free. I'm just questioning why there's a $10 profit.
You're also assuming that government regulations requires big pharma to produce things at a loss - which is obviously ridiculous. It merely makes making huge profits on such things impossible, but EU governments still recognise that private companies need to make money in order to survive.
My sources are in Danish, but just google negative interest, and you will find several sources. Note there is a small handful of countries that has this situation now, Switzerland, Denmark and Germany I know of, and some links mentions Finland and Netherlands.
It is already mentioned on Wikipedia http://en.wikipedia.org/wiki/Interest_rate#Negative_interest_rates,
Wall-Street Journal: http://blogs.wsj.com/eurocrisis/2012/07/06/the-dangers-of-negative-interest-rates/
The Telegraph: http://www.telegraph.co.uk/finance/comment/jeremy-warner/9456634/Negative-interest-rates-spell-final-defeat-for-beleaguered-savers.html
So you're not getting paid by some company to do that research? If not, great for you, that is your choice. You get to decide whether you require payment/trade for your work. Do you really think we'd have anywhere near the technology we have today to even be having this discussion how we're having it if only supposedly altruistic societal needs were the driver? Nope. You wouldn't see someone in frontier-land in the 1700s complaining that they don't have universal health care. "Scientists don't get paid a whole lot" is such a red herring. Scientists get paid what someone will pay them. If they feel that's worth their time, they'll do it. If the entity that is paying them feels they are worth that money, they'll pay them. What goes into a doctor's pay scale is based on many things. What goes into the bill that you get from the hospital includes at some level all the cost that went into building the facility and equipment in addition to the labor. Doctors COULD donate their time, but that would only be part of it. In fact, MANY doctors do donate their time. Some do that at the cost of worse living conditions than a minimum wage worker can afford. But that is just that person donating their time, not the medicine, not any other thing associated with that care. Why can't I pull up to a gas pump and fill up for free? Why can't I go the the premier of Anchorman 2 in Los Angelas by hopping on a free plane and going in the theather grab some free popcorn and soda and avoid the ticket line all together? Sure, you may argue that entertainment isn't a vital human need. But I sure as heck need gas to get to my job. Otherwise...what would I do????? Oh I would have to get a job within my means for doing that job? Maybe take a bus? Work closer to home at a job I don't like as much?
The evidence clearly shows that less government = higher prices and lower quality. Trying to negotiate with medical providers isn't an equal fight. If you don't have someone big in your corner you will always lose.
Just so we're clear here, what you're arguing here is that a US Treasury bond is not an asset.
Let's see, do you have a billion dollars in a bank account?
What changes in your financial situation if you write yourself a check for a billion dollars from a bank account where you do not have a billion dollars? It goes on both sides of your accounting statement, it's both an asset and a liability, it negates itself, it means nothing, it's 0 net.
Now put your thinking hat on (really, do), I am going to hit you with a little bit of thinking type of material.
When government taxes people and says those taxes are for SS or for Medicare but instead of using that money to make some type of an investment into a business or a property or even just into some commodity (maybe a few tons of gold, silver or platinum, whatever), then what happens is that the money that was taxed for is now gone.
So understand this: the money that was taxed is gone. What is in that so called 'fund' when the money is gone? It's that check that one would write to himself or herself saying: billion dollars. But they don't have a billion dollars in a bank, it goes on both sides of the accounting statement, it is both, a liability and an asset, it's 0.
It is 0.
What does government need to do to pay to people who THINK that they have an asset stored in some form by the government? The government must sell bonds or raise more taxes, which is the same thing.
Selling bonds is not a substitute for raising taxes, it's just a way to push raising of the taxes into the future, and then more taxes have to be raised to pay back the value of the bond but also the interest.
So understand what just happened. The money that is taken in taxes is spent. Now the government must either raise more taxes or sell some debt instruments.
In order to repay for the debt instrument, the government must raise taxes. Why? Because the government doesn't have anything, its only source of income (except for license and permit fees and such) is taxes.
Government raises taxes first, tells you that it is storing your money as SS or Medicare fund, supposedly so that you will have a better chance of having your future medical and retirement expenses financed, because supposedly you are an idiot, and you can't save for your own retirement with that same money and you can't for some reason save for your own medical expenses.
But that money is spent and then government MUST collect taxes AGAIN to pay for what is spent.
So how is that an asset? Did you put your thinking hat on? Understood?
--
Oh, and by the way, I made it clear in all my other comments that US debt cannot be repaid, it will be defaulted upon. US dollar was defaulted upon back in 1971, now it's the rest of it, the bonds, the paper dollar, all of it, it's coming to a head. The way it's going to be done will be by inflation most likely, because neither the politicians nor the voters are capable of understanding the truth.
Look at the moderation and replies I get for my comments? You think anybody wants to hear the truth? I haven't lied yet and all I get is ridicule. This will come to pass that US dollar and bonds will be defaulted upon and I consider money printing (inflation) to be a default, but a worse kind of default, the kind that destroys the economy with it, not just credit, the actual economy.
You can't handle the truth.
Also, you're right, someone working a minimum wage job does deserve health care just as much as a millionaire. However, that's because both of them deserve to pay for it just like any other service. You have a right to housing in just the same way. You get what you pay for. Food same thing. If you want free food and housing, there are some LIMITED options, but they're not going to be very nice. Likewise with free healthcare.
"You realize that the insurance industry has a backwards profit motive of other corporations, right?"
No, they don't. In the long term, insurance companies make money from the "float", or slight actuarial or timing differences between premiums and payments. An insurance company that fails to fulfill its contracts (fails to make payments) will chase away clients, if there is a healthy competitive market. To the extent that there is no competitive market, this might be one area for government intervention, perhaps. But to hold that insurance companies are by definition fraudulent is delusional.
Aren't we messing with natural selection when we enable people to beat cancer when their body cannot do so on their own? If their risk of cancer is genetic, won't that mean we'll be carrying that risk forward?
Anyway, I'd rather have people that don't get cancer. Also, cancer can be largely a product of the host body's environment. Genetics only play so much of a role. Why not kill the person?
I think having the taxpayer pay for expensive cancer treatments should be an option of last resort. It would make more sense to empty out all of the hospital beds first.
Funny how suddenly you will be against this idea.
More seriously, infertility may be the only genetic limitation in a couple, and you cannot pick "better" genotypes from the litter when adopting anyway. What if the two brilliant people, who happen to be Olympic athletes, decide to breed, but then they run into these issues?
In your world view, their "inferior" genes should be cut off before they can continue simply because they have a single, very obvious issue. In my world view, both the cancer plagued person, and the infertile person should be able to seek medical help. And, most importantly, it's this slanted view that is the basis for rejecting the notion that government's should decide what qualifies as acceptable treatment.
That does not mean that people like me believe that the status quo is acceptable, nor do we believe that the current system in the United States was acceptable. We believe that the the government should actually break the monopolistic holds that certain insurance agencies have on certain states, thus opening up the market to a significant level of competition. At the exact same time, tort reform needs to occur to limit the cost of litigation due to things that are not even remotely reasonable--the always-relevant Hot Coffee incident comes to mind. Unlike the measures that have currently been taken, those would actually cause an immediate decrease in the cost of health care, and doctors could work toward getting out of the CYA business and move toward total care, such as the care provided by DO's.
http://www.nber.org/bah/2009no3/w15371.html
The source of the problem has proclaimed that it is not a problem at all.
In a nation where lawyers advertise on television to increase the cost of such lawsuits while they regularly recoup hugely significant double digit percentages from such malpractice cases, as well as donate heavily to fund the politicians that refuse to pass, or even consider tort reform, I find it a bit unconvincing when they choose to fund anti-tort reform research.
Look at the moderation and replies I get for my comments?
You frequently get moderated up, in spite of the fact that you are an arrogant and misinformed twot.
You think anybody wants to hear the truth?
The frequency with which you are moderated up suggests that no, people here do not want to hear the truth. If they wanted to hear the truth they would moderate you down to encourage you to actually read into what you are saying here. Your strange insistence that somehow you are the sole arbiter of what is - or is not - true is amusing.
I haven't lied yet and all I get is ridicule.
You have lied repeatedly. Many people have shown where you have lied (I am one of those people). I could show you where you have lied but then you would just lie about lying or link back to yourself to try to support your argument in spite of being clearly demonstrated to be a liar.
More impressive than your campaign of trying to bludgeon truth to death with ron paul mantras though is your new task of trying to use your sock puppets to drown out anyone who disagrees with you. How many do you have now? Do they get moderator points too?
Damn_registrars has no butt-hole. Damn_registrars has no use for a butt-hole.
Certainly fertility treatment is an elective procedure. Nobody ever died of infertility.
I'm happy for you that you were able to get the treatment through private insurance (which you would still have been able to have in any existing universal health care system) but as for actual NEED, the guy having a heart attack has you beat by a mile.
It is a perfectly vicious circle. People also sue for big heaps of money because it's their one shot to pay for a lifetime of extra care and for a lifetime of inability to work. Food stamps and welfare are sufficiently bad ways to live that nobody wants to get stuck there, and of course with a 'pre-existing condition' they will be a health insurance pariah.
They don't actually take a loss, they just don't rake in a profit.
If the medicare/medicaid rate was THE rate, they might apply some downward pressure on their outrageously expensive suppliers and realize some efficiencies.
A lot of the crazy expensive things we do to the elderly and terminal ultimately reduce the quality of life and shorten that life. We do them because it's profitable.
The fact is, there comes a point where there's just not anything useful medicine can do for you at any cost. At that point palliative care is entirely appropriate.
Typical priviledge rich kid. You're a PAN voter, right?
No sig for the moment.
And as a result, today he's doing cartwheels around the house and...Oh, no, wait, he's still unconscious and not really expected to improve. It's only human to pull out all the stops against all logic and rationality when it's your own child, but sadly the result is almost universally bad when that happens.
Meanwhile, people in the U.K. outlive people in the U.S. how do you account for that with all the Kevorkian vans going around executing everyone over 60?
Speaking of the U.S. what ACTUALLY happens is that private insurance costs more for every year older you get until you are forced to let it lapse. At that point they don't really care if you live or die anymore, you're Medicare's problem.
That' a pretty silly example. If the bus company would man up and pay for their mistake, the 'freeloading hick' wouldn't have any hospital bills.
I hope you're kidding!
If the hospital is actually so chintzy that it's tracking Q-tips at the individual unit level, then it deserves to fail.
How about fill a bucket in each exam room with a thousand or so, cost $10. When the physician needs one, he takes one, cost: too small to count. When the bucket gets low, dump in another thousand or so: Let's be generous and say the getting and dumping costs $25/bucket (that is, if the CNA is so inefficient that the procedure takes an hour) or $0.025/q-tip.
Now, cost of Q-tip (rounding up): $0.04. Savings: 98% There would have to be a truly tremendous amount of waste to even begin to cost as much as preventing it does.
Holy shit, it's Michael Kristopeit! He's back!
As the poster below mentioned, Australia currently has one of the strongest economies in the world (in part due to having a lot of expensive dirt, and not letting our banks get away with US-style shenanigans).
Meanwhile the 'Voldemort Tax' you mention isn't to stop complaints about the Carbon Tax, but rather to stop business jacking up prices unfairly, and then falsely blaming it on the Carbon Tax. If their prices do need to increase due to the tax, then they are allowed to state this: http://www.accc.gov.au/content/index.phtml/itemId/1039037
You can learn a lot about a person if you just take the time to inject them with sodium pentathol
...about the Italians, and the Irish, and the Poles, and every other group that ever came here...
He put his boots up on the table and made a face. "The sig," he smirked. "You can waste your life in search of the sig."
Normally drugs are cheap here. But I would say that the report is extremely self serving by Julio Frenk, it is akin to a report by Dick Cheney saying that waterboarding works and WMD had been found in Iraq, or the large banks reporting that deregulation is good in 2008. The reality is that both programs, "Seguro Popular" and "Oportunidades" became the mexican conservative's party attempt at building a vote-buying scheme for their own in the same way that the old single party dictatorship of PRI used the "Desarrollo Integral de la Familia", "Integral Development for Families" DIF goverment program to buy votes from the poor and put a mask of democracy over their de facto dictatorship in the second half of XX century.
The "Seguro Popular" increased the coverage, mostly on paper only, since the sudden increase in demand was not matched by a increase in the availability of healthcare services. The already stretched public health system now have to deal with 2 times more customers than what it used to do, and the coverage of "Seguro Popular" only covered a handful of diseases initially versus full coverage from the normal social security services, just to not make a full lie their claims of increased coverage.
Mexico: 100% conservative's America now!
Australia's economy is tanking, but more from the Voldermort Tax than from health care.
Even ignoring that the current Government is the lowest taxing in a couple of decades, that entire blog post is simply a collection of lies.
So something like emigrating then ?
(Of course, people trying this would find that moving somewhere with cheaper healthcare that wasn't publicly funded rather difficult.)
Whereas in a country with a decent social security net and single-pay healthcare system, they don't need to worry about being denied for future insurance/coverage, nor living on food stamps (disability pay can be reasonably good depending on the career you're leaving... my work plan gives full pay for 20 weeks, and 2/3 pay until I reach retirement age and can start collecting pension, and I would be eligible to collect public money from the disability program as well, so I'd actually be getting a small pay raise).
Vicious circle indeed, but it'll take some *major* reform to get out from under it in the US. I don't think the political will is there right now but I do hope that by introducing a single-pay healthcare system, things will gradually start to improve.
This is due to cost, not the lack of quality care here in the US. In point of fact the quality here is still better
Citation needed.
But the underlying question is what has caused the cost of health care to increase so dramatically in the US?
The answer is mercantilism.
"You're right," Fisheye says. "I should have set it on 'whip' or 'chop.'"
It sounds like it sucks to be a doctor in the UK if you are effectively stuck doing nothing but "medicare/medicaid".
Doctors working on the NHS get paid the same - doesnt matter if the patient came in for a checkup or for a triple-bypass. If your doctor is driven by making money rather than healing people, get another doctor.
Hey, folks, would you rather have a private corporation run entirely for profit decide whether or not you get care, or would you rather have the government decide that, which has people in it who have to get elected to office?
Easy! Id rather have a private corporation. After all, if they do kill me off I can use the Free Market(TM) to get another provider, thus keeping the market competitive and free from corruption.
"So something like emigrating then ?"
With government medicine, that's basically the choice - no choice at all. OTOH, with a healthy market, there ought to exist local competitors.
With "government medicine" you generally have at least as much choice in who treats you and what treatments you get as you would with "private medicine".
"you generally have at least as much choice"
Seriously? With government medicine, you get what the bureaucrats allow. With private medicine, you can also get what you pay for.
Yes. Since you obviously have neither knowledge nor experience of publicly funded healthcare in the real world, only the paranoiac right-wing caricature of it, you're just going to have to trust me when I tell you how it actually works.
So just like only getting the care the bureaucrats in your insurance company allow, then ?
(That's assuming you have health insurance in the first place, of course, which in America is not a reasonable assumption.)
Ah, I see, you're talking about the rich. Well, since there's nothing stopping you going out and getting your own private care in countries with public care, when you're rich, your choice is identical in either location - whatever you can afford (which is usually going to be more in the publicly-funded country, anyway, since their healthcare systems are typically more efficient).
"Since you obviously have neither knowledge nor experience..."
If that is an obvious truth to you, how would you reevaluate your other obvious truths, considering the farcical falsity of this one?
"Ah, I see, you're talking about the rich." ... or those who decide to self-insure: i.e., the young and healthy, who may carry no or only catastrophic coverage.
"there's nothing stopping you going out and getting your own private care in countries with public care"
You obviously have neither knowledge nor experience of places where competing private care is outlawed.
In UK, NZ, and I presume Australia too, the reason people pay for private health insurance is to get a bed in a private room when/if they require hospitilization, and to get on a shorter waiting list for tests and treatments for non-life-threatening conditions. If you're prepared to slum it in a shared ward with other patients and wait a few months to get surgery on that low level knee pain that's been annoying you for years, then the NHS is perfectly adequate, and will kick into action quickly and efficiently when you really need it.
Same story for Quebec and most of Canada. By the way, our health insurance, via taxes, also includes some of not most ambulance services. That includes heliocopter rides from remote locations to local hospitals. (We have a few hospitals with landing pads). In other cases, if it is scheduled surgery, it may include return plane fare if the resident is living in a remote region.
Where we fail badly is in the far north with Aboriginal Indians who live on reserves. They often have no resident doctor.
Leslie Satenstein Montreal Quebec Canada
Someone else, probably many "someone else"s, have described it as a supply and demand problem. Providing reasonable quality health care across most of the country is going to actually reduce the demand to cross the border and thus reduce the number of maids, gardeners and prostitutes that you get to cheat, abuse and humiliate. It must suck to be you.
Birds are not dinosaur descendants;birds are dinosaurs, for all useful meanings of "birds", "are" and "dinosaurs"
YOU apparently live in a bubble where whenever you need more money you just stroll over to the wall safe and pull it out. I, on the other hand, live in reality where we're forced to prioritize
Oh, I'm quite certain I live in a vastly different reality than yours, and I have no doubt I've built up far more financial resources than you have. I believe this is because you and I have fundamentally different approaches to life.
I look at my responsibilities -- old people to care for, children to raise -- and where the resources don't meet the responsibilities, I INCREASE THE RESOURCES. This requires hard work, courage, investment and foresight.
You look at your responsibilities, and you feel afraid, You look at old people to care for and children to raise and immediately begin deciding where you can shirk your duties, claiming "we're forced to prioritize." "Gotta feed the baby, so Grandma's gotta go." People like you used to shove old people out into the woods to die. I believe we can both take care of the kids AND the old people.
Yeah, I do have a wall safe. I started out homeless at 17, and I have performed tasks to make Heracles wince to put that safe there. You're right, I'm not buying the nonsense that there's not enough to go around when we pay the CEO of United Healthcare 1.1 Billion just to QUIT THE COMPANY. At one point, one out of every 700 dollars spent on healthcare in this country was going directly into his pocket. One pocket of one CEO of one company. You want to recapture resources? How about we begin there? Maybe, just maybe, we can cover Grandma's pain meds for just a little longer if we quit giving billions to felons.
In the meantime, how about you reach down deep, find what little of your manhood is left, and find the courage to say "We can take care of the baby AND we can take care of grandma. We can provide compassion and care at both birth AND death." Let go of all that fear and man up, sack up and take care of business without whining about how it's all too much for you.
You must be young.
I've got some gray in my hair, and I'm just about old enough to join AARP but if I ever become such a sad, defeated broken-down old man such as yourself, please, just take me out in the woods and shoot me. I intend to leave it all on the field before I go, and if you ever hear me start to whine that the ball is too heavy to carry, please, just take me out of the game.
He put his boots up on the table and made a face. "The sig," he smirked. "You can waste your life in search of the sig."
In which case you're getting at least equivalent - better in the case of no insurance - coverage from a public system.
No, I'm not aware of any country that prevents its citizens from seeking private care.
A citation:
http://www.kevinmd.com/blog/2011/02/defensive-medicine-accounts-20-mri-scans-xrays.html
Interesting link. The AAOS study was a podium session, not a peer-reviewed study. They merely asked the physicians whether they were performing the procedure as defensive medicine, but didn't confirm it. I'd like to know why a procedure would be useful as defensive medicine if it isn't useful for clinical management.
Of course these doctors or their practices are also getting paid for these MRIs. My hypothesis is that they're actually giving unnecessary MRIs just to make money out of it, and when challenged, they justify it by saying it's defensive medicine.
When somebody challenges a doctor on a useless procedure, it sounds a lot better if he says, "defensive medicine," than it does if he says, "I just do a lot of useless procedures because I make a lot of money out of them."
I'd like to see a study designed to tell the difference -- perhaps including a hospital where orthopedists and radiologists are on salary, and not paid by the procedure.
As KevinMD himself said, the costs of defensive medicine are probably overstated http://www.kevinmd.com/blog/2010/09/defensive-medicine-saves-money-physicians.html
Especially the claims made by Newt Gingrich's organization.
SS takes in more than they make, you fucking moron. Which is where as these IOUs come from...the rest of the government borrows from them.
- hey, fucking moron, that's how it used to be, not anymore, dumb fucking piece of human excrement.
Jesus Christ on pogo stick, it's completely astonishing how many people are complete and total idiots.
- my thoughts exactly. That is YOU - total and unyielding idiot.
You can't handle the truth.
"In which case you're getting at least equivalent - better in the case of no insurance - coverage"
Not really, as such people would be paying more into the system than they should: they are subsidizing the old/sick.
"No, I'm not aware of any country that prevents its citizens from seeking private care."
That is the situation here in the great white up, a travesty, I tell you.
Individual contributions to public healthcare are proportionally quite low. It is highly unlikely someone would contribute more than their otherwise "private" healthcare costs (or insurance) would be, particularly when averaged over a reasonable timeframe (decades). However, I will concede it's probably possible to find a corner case or two where someone lives a charmed life from birth to death never suffering more than a cough, and thus paid more into the system than they derived in benefits.
A quick Google search suggests there are private providers in Canada (eg: TMA).
Even that aside, are you suggesting that if you were to travel to the US (or some other country) for medical treatment, you would be stripped of your citizenship or not allowed to re-enter the country ?
"It is highly unlikely someone would contribute more than their otherwise "private" healthcare costs ... averaged over a reasonable timeframe (decades)"
What makes you think so? Government health care systems have barely existed for longer than a lifetime, over which demographics and costs have been on a constantly worsening trend. Averaging doesn't make sense like that. With real insurance, one's not left dreaming about the cost/benefits of "decades" of coverage, only a few plausibly forseeable years at a time.
"there are private providers in Canada"
Not *competing* ones.
"if you were to travel"
Right, there's an endorsal of the system.
Uh, evidence ? Publicly funded healthcare systems _consistently_ have better outcomes at lower costs.
Publicly funded healthcare dates back to the late 1800s (in Germany).
You can foresee when you'll need expensive medical care a few years in advance ?
So... You can't get care from TMA ?
How is an "endorsal of the system" relevant ? Your assertion was that it was not possible to get care outside of "the system", not whether or not "the system" provided adequate care.
"Publicly funded healthcare systems _consistently_ have better outcomes at lower costs."
That's not responsive. You claimed "... highly unlikely someone would contribute more ....", as a comparison of someone being able to choose a public or a private system in situ. Whatever studies may show about differences between different places and times does not inform this, even if they were taken at face value.
"Publicly funded healthcare dates back to the late 1800s (in Germany)."
As they say, the exception that "proves" the rule. In reality, we're talking about the 1930s or later in the modern world.
"You can foresee when you'll need expensive medical care a few years in advance?"
You misunderstand "insurance": it is not necessary or useful if you can predict specific events a few years in advance. I was talking about the connection of premiums (costs to the insured) to the changes of insured risk, as a function of time. Actuaries can speculate plausibly over a few years of the status quo; over decades, too many confounding factors exist to write a contract.
"So... You can't get care from TMA ?"
Did you read their web site at all? It's mostly a lament about how the public system is rationed etc.. They are basically a broker to get most things done by traveling to the US.
"Your assertion was that it was not possible to get care outside of "the system""
No, it was that the system outlawed competition. Beyond national boundaries, those laws don't apply. This does not mean the system is fine.
1. Solution: put doctors on salary. You seem to forget that doctors are Free people and are not serfs owned by the Crown.
Actually, a lot of doctors would prefer salary. The Mayo Clinic has done this for a really long time, and still gets lots of applicants.
2. Solution: end-of-life counseling and legalizing euthanasia
The goal here is to prevent us from spending lots of money taking care of, say, Alzheimers patients who have deteriorated so much they can't remember that they have a son, much less what his name is or what he looks like. A sane health care policy would work with the patient, their family, any advisors they want involved (e.g. a pastor or trusted friend), decide when the patient's life is not worth living, get everyone together for one last goodbye, and then administer a lethal level of painkillers to minimize the suffering.
3. Solution: Single payer and single provider, so there's nobody else to haggle with. And you don't shop around for a better price on your commodity items and just go to the local monopoly store to buy your food?
If you're lying in a bed in an ER with a broken leg, you don't want to shop around for the cheapest and best deal, you want to get your leg set and get the heck out of there. If you're sitting in a doctors' office and the doc tells you you have a serious disease and will die unless you take this particular pill, you'll likely take the pill no matter how much it costs you. It's not like broccoli at all, where I can relatively easily tell what's good and what's not, and can decide to buy carrots or cauliflower instead, and can easily shop around if I want to do so.
4. Solution: Cover everybody. They tend to seek care in ER's since they know that they cannot be turned away due to the laws. Change the laws back and make them goto a clinic for the sniffles.
They can't afford the clinic, otherwise they would go there. What do you want them to do to get health care? Or would you rather they just lived with their illness?
I am officially gone from
Actually, they are not really getting paid for the MRI directly, they simply have an expectation of a certain level of testing to occur. An Ortho I know is supposed to bring in $8-10MM in revenue for the hospital.
But to "why is it defensive"
There are attorneys (I get them frequently asking me questions) asking if a read I was doing was clear, was it performed correctly, was there patient movement--all pretty boring questions. Patients hire these attorneys to look into their case--maybe because it was a slip and fall, a car accident, work-comp, etc. The bad side of that is *if* there was a problem, the attorney becomes aggressive and then insinuates that the best was not provided for a patient. Now I'm liable because I may have read an image series and not commented that the patient moved or one of a hundred other possible compromises.
So for the surgeon--if the outcome is not 100% (patients have a very high expectation of what their outcome will be) the attorney will not only dig into standard of care, but ultimate care. So if a knee is repaired and the surgeon did not have the latest MRI performed the same day (or day before), the attorney will start a suit that indicates his client did not receive the ultimate care.
Really. This happens all the time. I read 60 cases a day. I get standard letters on maybe 10% of them. So 6 cases per day are going to be analyzed. Which is fine and I'm confident of my work. But I do 5 days a week. That's 30 cases reviewed per week, with the review being performed by an attorney who only paid if he can find something wrong--usually in process--and the definition of "wrong" is subjective. That should answer your question on being defensive.
On guidelines--it would be wonderful if a judge would be able to say "the physician followed the guidelines and therefore a judgement cannot be made based on him not following procedure" but it does not happen. I can follow every rule, recommendation, paper, and I still get questioned for the process I follow (and not even the correctness of the case) and merely the suspicion of a poor outcome is enough to mark my public profile.
Gingrich has some very interesting ideas that might work (he was working with Hillary Clinton on the issue several years ago--quite a pair.) I saw him speak at a AAFP session in Washington DC a few years ago.
I used to write articles for trade magazines about medical malpractice and product liability. I used to go to legal conferences on medical malpractice and interview lawyers, although I don't have the latest information and I'm recalling some of this from memory. I followed malpractice in JAMA and NEJM. I read the Case Records of the Massachusetts General Hospital, which usually includes a radiology report. So I realize the ambiguity, difficulty and subjectivity of reading a radiology image.
But the malpractice standard isn't the ultimate care. It's a reasonable standard of care. The standard isn't a good outcome. A bad outcome isn't malpractice. If a procedure has a 5% mortality, and the patient knows it and the doctor documented that informed consent in the chart, then death by itself isn't malpractice.
Let's assume an MRI is the standard of care and gives a better outcome for knee surgery. I can understand that a surgeon may have an MRI that he's not satisfied with, and orders a second MRI. But if he has a good recent MRI, I can't understand why he would need a second MRI the day before surgery. You should be able to get lots of experts to testify that a second MRI doesn't improve outcomes, doesn't make the surgery any safer, and isn't necessary. The bad outcome would still have occurred with an MRI.
There were a few articles recently in the NEJM about the overuse of imaging in the context of cancer risk, and I got the impression that a lot of it was unnecessary.
On guidelines -- actually, the defense expert witness says, "the physician followed the guidelines and therefore he was not committing malpractice." The plaintiff expert witness says he was committing malpractice. The judge tells the jury to decide who's right.
Guidelines have many limitations. You don't have guidelines for every procedure. You don't have Grade A evidence for every gudieline. They don't reflect the latest procedure. But they cover the most common procedures.
The court system, and the jury system, is fairly inefficient. A study in the NEJM recently reviewed malpractice judgments and reported the "good news" that 60% of them were decided consistent with the medical record, favoring defense and plaintiff equally. Unfortunately, there were also studies in the NEJM that suggested that the fear of malpractice doesn't lead to better care, as the plaintiffs' lawyers claim.
OTOH, those are the same jurors who are deciding criminal cases, often on the basis of similar medical evidence. The Seventh Amendment guarantees a right to a jury trial, so we can't just take malpractice suits away from jurors.
I don't think there's much room for improvement. Most of the "tort reforms" are efforts to tilt the playing field in favor of the defendant. They want to lower lawyers' fees, eliminate contingency fees, cap pain and suffering, shorten statutes of limitations.
That's nice for doctors, but it's not fair for the patient. Some babies are born with cereberal palsy, and it's not far for an obstetrician to be held liable for his luck of the draw. OTOH, patients are killed or injured because of egregious mistakes or overtreatment, and the cost of compensation gets pretty high. If a doctor does do unnecessary spinal surgery on a 50-year-old man and leaves him paralyzed from the waste down, what's the appropriate compensation for that? 24-hour-a-day attendants for life are pretty expensive.
All developed countries have medical malpratice liability. They seem to spend 2-3% on the liability system, so that seems about right. Estimates of defensive medicine vary, but I think that if you put aside the politically-based estimates and look at the evidence-based estimates, it's under 10%. And I think a lot of that doesn't really protect against malpractice.
My thinking is that the only justified reforms are reforms that bring medical and legal practice into greater conformity with the scientific evidence. That means getting doctors to follow evidence-based medicine and guidelines, and making that a legal s
Interesting, but...
If a physician is in the hot seat being deposed, he's already lost. Period. Full stop. Perhaps not to the legal community, but to his ego, his confidence, and the confidence from others, he's lost. The proliferation of online grading systems (which I support) don't help the trap.
I'm not saying that a poor outcome should not be investigated and perhaps tried, but there is enormous profit in making the letter from an attorney to a physician and a quick settlement. Why do you think an attorney advertises on TV? "Get your money"
I'm cynical because I hate the bottom feeders. It's free to send a request for information. I'm relatively insulated from surgery or medicine poor outcomes, but let me tell you--when reading breast films we always err on the side of defense. If a tumor is found/palpated and a DX-mammo or MR was read in the last year, I'm getting hauled in whether or not there was a finding I missed. You can always find someone "an expert" who can find something that you missed, whether the image signature is really there or not.
So while I agree with you, and can still argue "Of course unnecessary medicine can be very profitable" so is unnecessary lawyer action.
That and the Medicare fraud.
No I didn't. I said over a reasonable timeframe publicly funded care is going to cost all but the most unusual corner cases, at worst, no more than private care would and _most_ will end up better off (ie: spending less overall) in a publicly funded system than they would with a private system.
So "only" 80-odd years (3-4 generations) then ? What was the life expectancy back in the 1930s, do you think ? Perhaps more importantly, what was it for the century before that ?
You misunderstand the point of (well run) healthcare, which is not to be reactive to emergencies and unpredictable events at an individual level, but to improve health and quality of life across an entire lifetime and society.
Which remains irrelevant. Your assertion was that it was not possible to get care outside the public system, which is false. You can get care outside of the public system, you just can't get it in exactly the form you want.
Further, your underlying implication is that most (or even a significant fraction of) people would be better off with for-profit private care, which is not supported by the evidence.
If you are an average[0] person in a publicly-funded system, your costs, options and outcomes in a typical situation are going to be basically identical to a private system: accept the care the public system/your insurer provides, or pay for it out of your own pocket.
The big advantage with a public system comes in worse-case scenarios - the poor and/or higher-cost care - and particularly preventative care. In a private system, significant proportions of society either aren't insured, or can't afford to address anything but serious problems even with insurance.
While I don't agree with Canada's rules about private care facilities on principle (though I can understand the rasoning behind them), I doubt the outcomes are any worse - outside of unusual corner cases - in practice. Certainly I've never seen any evidence to support a claim they are.
[0] I actually suspect you need to be above average - over 1.5x median income level at least - before private care becomes competitive.
Yet, you seem to think "1 billion" is inappropriate compensation for such a feat?
Doing the math, 1 Billion dollars is roughly the value of 13,000 life careers. We're literally saying this man did more -- and I'll be unbelievably generous and use your yardstick of 15 years -- that he did more in 15 years than 13,000 other men did in their entire lives.
OK, it's within the realm of theoretical possibility. Here is a list of feats -- performed single-handedly, mind you -- that might merit a One Billion Dollar payout:
1. Formulating the Grand Unification Theory.
2. Providing the root treatment to cure all forms of cancer.
3. Finding a way to keep telomeres from degrading during replication.
4. Inventing an efficient machine to keep the central nervous system oxygenated and provided with nutrients after a traumatic event.
5. A root treatment to keep viruses from replicating.
6. A solar cell with 99 percent efficiency.
7. The initiation of peaceful relations with a species from outside our solar system.
Feats in that range would be worth a billion dollars. What did your boy do?
Oh that's right. He committed multiple felonies. From your own cite:
Settlement
On December 6, 2007, the Securities and Exchange Commission announced a settlement, under which McGuire was to repay $468 million as a partial settlement of the backdating prosecution. McGuire agreed to not serve as an officer or director of a public company for ten years.
Again, how about we not give billions of dollars to thieves and find a way to keep giving grandma her meds? Why do you people always want to reward criminals?
He put his boots up on the table and made a face. "The sig," he smirked. "You can waste your life in search of the sig."
Perhaps we could compensate the doctor for that humiliation by having him make a lot of money.
There was a physicians' mutual insurance company several years ago that used a law firm made up of doctors with law degrees. They never settled. They reviewed the case. If the doctor was wrong, they pay up. If the doctor was right, they fight it all the way through a jury trial. That's the way it should be. I wonder if it's an economically viable strategy.
I would like to give one of those "experts" a set of 10 breast films, 5 of which went on to become cancer, 5 of which did not, and ask him to tell which is which. I don't know if you can do that in court, but if the expert witness screws up once, you can refer to it every time he testifies afterwards.
BTW...
Yup, run over to the wall-safe. Got it. Your money tree is a fantastic invention. You should patent that.
It's called work and sacrifice. You should try it some time. You'd be amazed what can happen when you're not afraid to get your hands a little dirty.
Sorry, I'm a realist facing real problems, not a bleeding heart ...
Stop it, you're embarrassing me. Do you have any idea who the original "bleeding heart" is? Do you imagine you're insulting me by grouping me together with Him?! When you and I stand on Judgement Day, whose ideas do you think He'll have more sympathy for? That we should just cut the old people loose, or that we should declare that we are our brother's keeper and follow the example of the Samaritan?
You call me a "Bleeding Heart" for declaring we can save them all. I find myself in ridiculously good company. Please, by all means, insult me some more. I don't think I blushed quite all the way out to my ears yet...
He put his boots up on the table and made a face. "The sig," he smirked. "You can waste your life in search of the sig."
Ask yourself why all this "dicking around with the insurance company arguing about whether illness X or medication Y are covered on a particular plan, for a particular patient, during a particular phase of the moon, etc." got there in the first place. Any answers?
TLDR : Nixon approves the creation of HMOs
Because insurance companies make more money when they fail to provide the service that they offer. Therefore they have an incentive to make it as hard as possible to make a successful claim. They employ personnel who are specifically tasked with denying claims, both before payout, and after. They make their systems as byzantine and difficult as possible to this end. They "dilute the risk pool" as much as possible by excluding people for pre-existing conditions.
Some might suspect that the incredible proliferation of codes in systems like ICD-10 is not to provide a more accurate way to classify illnesses, but instead to make it easier to misfile the paperwork. - "Oh, I'm sorry, you used the code for *burrito* induced flatulence when it was a chimichenga, your claim is denied".
All of this produces a system where a vast amount of effort is diverted into wrangling with insurance companies. Labour is one of the big two costs of healthcare (the other being drugs). Anything that introduces more labour makes things disproportionately more expensive.
Contrast this to the situation in the UK, where we have a National Health Service - because there is a single payer, practitioners all pretty much know what is and what is not "covered" in their field, rather than there being different rules for each patient depending on their policy. No-one has to contact the insurer to see whether a drug is covered - there is a single reference manual for drug prescription in the UK, which covers the availability, usage, dosage, and even lists the cost price for reference. Because everyone is covered, you don't have to check their policy. Instead of the payer having an incentive to deny people care for whatever reason they can think of, practitioners have incentives to improve their patients health - they get paid per vaccination, they get paid for lowering the blood pressure of their patients, getting them to give up smoking, etc.
And we all get taxed right up the ass for this, right? We spend less than half, per capita, what America does on publicly funded healthcare. We only pay for our "National Insurance" when we are working. And we have universal coverage, with very similar healthcare outcomes to the US. The US spending covers less than a third of your population.
Our current incumbent Conservative government are doing their best to destroy this state of affairs because their corporate cronies obviously weep into their pillows at night at the wasted profit opportunity. As a nation, most of us have forgotten what it was like to wonder whether you could afford the doctor this month. Concepts like being bankrupted and forced to live in your daughters basement eating Ramen because your husband died and the medical bills were really expensive, are alien to us.
Yes, as a "commons" there are tragedies in the NHS. There are waiting lists for non-essential care. A hospital stay in the UK is probably not the comfortable hotel experience it is in the US. But none of us (apart from very rich people distanced far from the madding crowd) would be without it.
The man created 69.5 billion in annual revenues. So if I divide that by 13,000...yup, I don't know many people that have generated 5.35 million in wealth over their lifetimes, certainly not in 15 years. Even without the options backdating (which is not illegal: https://en.wikipedia.org/wiki/Options_backdating), he's probably still worth a billion.
You seem to measure people by what they should have, based on terms of what you believe are "more than enough for any one person".. You don't use fair measurements -- in your world, a man could claw out of the gutter and build a trillion dollar empire singlehandedly, but personally he should only get maybe 300 or 400 thousand dollars out of it, because that's more than enough for any one man. Right?
The man created 69.5 billion in annual revenues.
Yeah, no, he didn't. Kids with a garage band create more than he did. Little old ladies with Victory Gardens produce more. Grad students in English departments contribute more to Man's knowledge.
He sat on a chokepoint between doctors and patients and exacted a rent on the healthcare industry. He denied care to patients who were in desperate need and pcoketed the money that should have went to alleviate suffering.
The BEST you can say he did was he caused more suffering to patients, killed some people who didn't need to die and contributed to the general misery in the world. He's a foul, filthy man and when he stands before God one day, I don't want to be anywhere near him and his Billions in blood money.
He put his boots up on the table and made a face. "The sig," he smirked. "You can waste your life in search of the sig."
Because people like you always seem more than willing to call for more work and sacrifice from other people. My and my kin are the ones that fight the wars you start, clean up the messes you and your little Wall Street buddies create and generally try to care for the victims your "Screw You, I Got Mine" mentality strews about the countryside.
Tell you what. You stay on your side of the fence with Carnegie, Rockefeller and Rand, and I'll stay on mine with all the other famous Lefties like Bishop Romero, William Faulkner, Mark Twain, Charles Dickens, Patrick Henry, Thomas Jefferson, William Wallace, Sir Thomas More and all the rest stretching all the way back to the original Bleeding Heart, whom, BTW, I would never dare to try to use as an epithet.
I'm very comfortable letting God and history judge between us.
He put his boots up on the table and made a face. "The sig," he smirked. "You can waste your life in search of the sig."
Finland.
In capitalist USA corporations control the government.
I'll lay off trying to get you and yours to pay your fair share of taxes if you'll do me one favor. Make good on the blood debt you owe me and mine. The next time the call goes out, how about you girls stop hiding behind your Mommy's skirts and your Daddy's money and actually enlist to fight the war you got us into? I'm pretty sure our disagreements will disappear with the first shot you hear.
Looking forward to having you on the team,
And I promise not to razz you about all this too much later...
He put his boots up on the table and made a face. "The sig," he smirked. "You can waste your life in search of the sig."
The doctors get paid for defensive medicine. They would do it regardless of the potential for lawsuits. They do unnecessary tests and procedures even if they open themselves up for a lawsuit.
Man, you really need that seminar!
You are wrong. SS still takes in more than it spends and is projected to do so for a while longer. It is projected to outlay more than it spends eventually, as would be expected given demographics.
Man, you really need that seminar!
Dental insurance is strange. Most of what is available lately has been very high premium, stingy coverage of routine procedures, and a brazen 50% copay on anything serious such as gum work, crowns or fillings. Braces etc. are often not covered whatsoever.
I guess it is an effective way to force people to ration their own care, but I know a lot of people who can't afford to fix their mouth, and likely never will.
Man, you really need that seminar!