I can reduce the above screed to 7 words:
"Ration medical care according to Bios_Hakr's priorities."
Proponents of a monolithic health care financing system think they are getting all impure motivations out of the system, but all they're doing is shifting them around.
If you replace our current system with a government-run single-payer system, the critical decisions about whether some service that an individual wants is worth having the entire society pay for don't go away--they merely get shifted to the government. We've already seen this with Medicare. Ultimately, high-stakes medical decisions, like coverage for expensive new technologies, become political questions, and get made by people like Ted Kennedy (Democratic senator from Massachusetts) and Ted Stevens (Republican senator from Alaska). And those decisions are going to be subject to the same conflicting interests every other decision made in Washington faces. It will actually introduce new conflicts and motives into the system--just like decisions about locating military bases and other government facilities depend on how many people and companies from which states will benefit. While you'd like for these decisions to be made purely on clinical evidence (my line of work), they really get made on the basis of a mixture of clinical evidence and lobbying power, even stuff like who was the college roommate of an inflluential senator.
There is no health care financing system in the world that does not ration care one way or another, not even ours. Some systems hide the rationing better than others. The American system has less rationing than other systems, but in exchange we have the problem of the uninsured. Most of the systems people hold up as models ration care either by restricting the diffusion of new technologies or by queuing
Canada has the purest system of keeping equal access to health care services, but that comes in exchange for some of the worst queuing problems and the greatest restrictions on people's freedom of choice.(*) People in Canada die as the result of having to wait for a necessary medical service like a diagnostic MRI, because the government wants to control health care costs. That's great if you want to punish rich people for wanting better health care than the rest of us, but that's a rather stiff price to pay. Most countries (such as the UK and those in Europe) don't want to create those conflicts, so they allow a two-tiered system with some private service for those willing to pay out of their own pocket. In Canada, you don't have that (#), so you get stories of people being able to schedule next-day cancer surgery for their dog while waiting months for their own surgery.
To borrow a phrase, the US health care financing system is the worst system in the world except for every other one.
If time permits, I'll follow up with some further takedown of the post.
Matt Mitchell
Diagnostic Research Design & Reporting
*--Any time you create an entitlement for one person to take another person's property, no matter how noble the cause, there's going to have to be some control on that entitlement, or else the entire concept of private property is worthless and the producers will stop producing.
#--Though a recent court case may overturn that ban.
>Yeah, why $200 for an xray, when its free at the airport?
I can understand the ignorance--most people have never seen what goes on in a hospital radiology department.
Let's look at the airport situation first: you've got an x-ray machine with a motorized conveyer belt. That probably does cost more than a basic flat film x-ray machine for medical use. Then you've got a TSA agent making a modest salary looking at the images on the screen. Little training, and no significant consequences to the agent if s/he makes a mistake (see previous media reports on failure rate in tests when officials tried sending weapons through the screening system, and the hue and cry when it was suggested some of the agents ought to be fired).
Now, in the hospital, you've got the x-ray machine, and a trained and certified RT to operate it. You think that job is just lining up the patient and pushing a button? Wrong--I used to teach them. They have to know anatomy well enough to properly position patients for each different exam that might be ordered (and there are thousands) so the important areas of the anatomy are most clearly depicted in the image. Then s/he has to select the image exposure parameters to deliver the best quality image while minimizing radiation dose to the patient. After the image is acquired s/he has to check to see if it's satisfactory. Not as much training as this as for the radiologist who actually makes the diagnostic interpretation, but the RT does have to know what's going on in the image.
Once the images are acquired, they have to be read by the radiologist (college loans, medical school loans, six years or so residency and fellowship before s/he is qualified to do the job). Look at the area in question, maybe ask for and get previous films, look at the patient's history to see if there may be another explanation for the presenting symptoms and imaging findings, report on the question being asked by the doctor ordering the exam, look at the rest of the images to make sure there's not some unexpected abnormality, dictate the report, and sign it.
But wait, there's more! That $200 has to pay for consumable supplies like film, contrast agent, and linens (you want to use the same table cover as was used by someone with active TB?). It has to pay for the people who order and stock those supplies, the person who answers the phone and schedules the exam (and reschedules it if necessary), the person in the file room who knows where the previous films are and pulls them for the radiologist, and the person who transcribes the report and sends it to the referring doc (making a phone call if the results are urgent). It also has to pay for offices and filerooms for them to work in (plus a person to keep it all clean) and computers and other equipment for them to use.
There's still more. It pays for the RT's time each morning doing quality assurance checks on the x-ray machine and processor (don't have to do that for the airport machine), and the time and equipment for the field service engineer to fix the x-ray system when something goes wrong. As mentioned above, there's malpractice and other insurance to pay for--radiology is one of the most-sued specialties thanks to suits alleging failure to diagnose diseases early enough. And there's gotta be a surplus to make up for the patients who can't or won't pay.
Matt Mitchell Diagnostic Research Design & Reporting
Slashdot Mirror
I can reduce the above screed to 7 words: "Ration medical care according to Bios_Hakr's priorities." Proponents of a monolithic health care financing system think they are getting all impure motivations out of the system, but all they're doing is shifting them around. If you replace our current system with a government-run single-payer system, the critical decisions about whether some service that an individual wants is worth having the entire society pay for don't go away--they merely get shifted to the government. We've already seen this with Medicare. Ultimately, high-stakes medical decisions, like coverage for expensive new technologies, become political questions, and get made by people like Ted Kennedy (Democratic senator from Massachusetts) and Ted Stevens (Republican senator from Alaska). And those decisions are going to be subject to the same conflicting interests every other decision made in Washington faces. It will actually introduce new conflicts and motives into the system--just like decisions about locating military bases and other government facilities depend on how many people and companies from which states will benefit. While you'd like for these decisions to be made purely on clinical evidence (my line of work), they really get made on the basis of a mixture of clinical evidence and lobbying power, even stuff like who was the college roommate of an inflluential senator. There is no health care financing system in the world that does not ration care one way or another, not even ours. Some systems hide the rationing better than others. The American system has less rationing than other systems, but in exchange we have the problem of the uninsured. Most of the systems people hold up as models ration care either by restricting the diffusion of new technologies or by queuing Canada has the purest system of keeping equal access to health care services, but that comes in exchange for some of the worst queuing problems and the greatest restrictions on people's freedom of choice.(*) People in Canada die as the result of having to wait for a necessary medical service like a diagnostic MRI, because the government wants to control health care costs. That's great if you want to punish rich people for wanting better health care than the rest of us, but that's a rather stiff price to pay. Most countries (such as the UK and those in Europe) don't want to create those conflicts, so they allow a two-tiered system with some private service for those willing to pay out of their own pocket. In Canada, you don't have that (#), so you get stories of people being able to schedule next-day cancer surgery for their dog while waiting months for their own surgery. To borrow a phrase, the US health care financing system is the worst system in the world except for every other one. If time permits, I'll follow up with some further takedown of the post. Matt Mitchell Diagnostic Research Design & Reporting *--Any time you create an entitlement for one person to take another person's property, no matter how noble the cause, there's going to have to be some control on that entitlement, or else the entire concept of private property is worthless and the producers will stop producing. #--Though a recent court case may overturn that ban.
>Yeah, why $200 for an xray, when its free at the airport?
I can understand the ignorance--most people have never seen what goes on in a hospital radiology department.
Let's look at the airport situation first: you've got an x-ray machine with a motorized conveyer belt. That probably does cost more than a basic flat film x-ray machine for medical use. Then you've got a TSA agent making a modest salary looking at the images on the screen. Little training, and no significant consequences to the agent if s/he makes a mistake (see previous media reports on failure rate in tests when officials tried sending weapons through the screening system, and the hue and cry when it was suggested some of the agents ought to be fired).
Now, in the hospital, you've got the x-ray machine, and a trained and certified RT to operate it. You think that job is just lining up the patient and pushing a button? Wrong--I used to teach them. They have to know anatomy well enough to properly position patients for each different exam that might be ordered (and there are thousands) so the important areas of the anatomy are most clearly depicted in the image. Then s/he has to select the image exposure parameters to deliver the best quality image while minimizing radiation dose to the patient. After the image is acquired s/he has to check to see if it's satisfactory. Not as much training as this as for the radiologist who actually makes the diagnostic interpretation, but the RT does have to know what's going on in the image.
Once the images are acquired, they have to be read by the radiologist (college loans, medical school loans, six years or so residency and fellowship before s/he is qualified to do the job). Look at the area in question, maybe ask for and get previous films, look at the patient's history to see if there may be another explanation for the presenting symptoms and imaging findings, report on the question being asked by the doctor ordering the exam, look at the rest of the images to make sure there's not some unexpected abnormality, dictate the report, and sign it.
But wait, there's more! That $200 has to pay for consumable supplies like film, contrast agent, and linens (you want to use the same table cover as was used by someone with active TB?). It has to pay for the people who order and stock those supplies, the person who answers the phone and schedules the exam (and reschedules it if necessary), the person in the file room who knows where the previous films are and pulls them for the radiologist, and the person who transcribes the report and sends it to the referring doc (making a phone call if the results are urgent). It also has to pay for offices and filerooms for them to work in (plus a person to keep it all clean) and computers and other equipment for them to use.
There's still more. It pays for the RT's time each morning doing quality assurance checks on the x-ray machine and processor (don't have to do that for the airport machine), and the time and equipment for the field service engineer to fix the x-ray system when something goes wrong. As mentioned above, there's malpractice and other insurance to pay for--radiology is one of the most-sued specialties thanks to suits alleging failure to diagnose diseases early enough. And there's gotta be a surplus to make up for the patients who can't or won't pay.
Matt Mitchell
Diagnostic Research Design & Reporting