Interesting overview of American health care: present status, history and causes

[reallife]

Re: Interesting overview of American health care: present status, history and causes

We have a program locally that supports medical doctors. No debt for anyone who will practice in NM for 10 years after achieving a degree.

When I was stationed in El Paso, TX I looked into moving over to NM when I got out of the Army. This was in mid-90s. Medical practice conditions in NM were (and still are) onerous. The population as a whole is very poor and physician incomes reflect that. I decided I couldn't make a living there even though I had already paid off all my student loans. I doubt if much has changed since then. I love NM; the mountains, deserts, etc. It is just an awful place to practice medicine.

[Thailandnotes]

Re: Interesting overview of American health care: present status, history and causes

Good article in the Post. But this information will never get through to the general public.

"5 Myths About Health Care Around the World"


http://www.washingtonpost.com/wp-dyn...101778_pf.html

"Overseas, strict cost controls actually drive innovation. In the United States, an MRI scan of the neck region costs about $1,500. In Japan, the identical scan costs $98. Under the pressure of cost controls, Japanese researchers found ways to perform the same diagnostic technique for one-fifteenth the American price. (And Japanese labs still make a profit.)"

[flintlock]

Re: Interesting overview of American health care: present status, history and causes

My point about technology was merely where do you draw the line between an expensive experimental treatment and one that becomes everyone's "right" to demand? They can do face transplants now. Will that mean anyone who is disfigured can "demand" that procedure? I saw a guy limping down the road today with a old fashioned and misfitted artificial leg. It looked like a giant spring and was too short for him. Will he be "entitled" to the latest Bionic leg, even if on Medicaid? Our technological capacity is outrunning our ability to pay for it. At least if we offer it as part of an insurance plan. If people want to pay for it out of pocket then I have no problem with it. But in a lot of cases, this cutting edge stuff relies on government money infusions, otherwise they'd never make it. This when you can't even find a place to park at our local VA hospital. Cutting edge stuff is great, but not if it means failing to honor previous commitments to the larger segment of the population. It's called, "living within your means" and it's apparently become out of fashion.

[flintlock]

Re: Interesting overview of American health care: present status, history and causes

Good article in the Post. But this information will never get through to the general public.

"5 Myths About Health Care Around the World"


http://www.washingtonpost.com/wp-dyn...101778_pf.html

"Overseas, strict cost controls actually drive innovation. In the United States, an MRI scan of the neck region costs about $1,500. In Japan, the identical scan costs $98. Under the pressure of cost controls, Japanese researchers found ways to perform the same diagnostic technique for one-fifteenth the American price. (And Japanese labs still make a profit.)"

I have a feeling there are a lot more myths out there when you get down to it. How much is spread by insurance companies and how much is just fear of the unknown?

[MulaMan]

Re: Interesting overview of American health care: present status, history and causes

I have a feeling there are a lot more myths out there when you get down to it. How much is spread by insurance companies and how much is just fear of the unknown?

Well I do "know" that most of the myths are spread by insurance companies just as I "know" that most of the town hall anti-Obama freaks are spread by insurance companies.

It is called common sense or the obvious or if it walks like a duck...seems many Americans no longer have the ability to filter out obvious corruption in exchange for simple common sense and that is scary.

[Jim Nickerson]

Re: Interesting overview of American health care: present status, history and causes

Good article in the Post. But this information will never get through to the general public.

"5 Myths About Health Care Around the World"


http://www.washingtonpost.com/wp-dyn...101778_pf.html

"Overseas, strict cost controls actually drive innovation. In the United States, an MRI scan of the neck region costs about $1,500. In Japan, the identical scan costs $98. Under the pressure of cost controls, Japanese researchers found ways to perform the same diagnostic technique for one-fifteenth the American price. (And Japanese labs still make a profit.)"

Will Rogers supposedly said "Everybody is ignorant, only on different subjects." And, "There is nothing so stupid as the educated man if you get him off the thing he was educated in."

I put those quotes up because in my opinion all of us are ignorant about something and certainly about the particularly the issue at hand, and so far I've not encountered any one who is really intelligent about dealing with the US health care dilemma--either here or in day to day life.

The article above brought into the discussion by Thailandnotes, assuming it is largely valid, is one that will wisen most of us here a bit further, and if one wishes to argue or discuss the dilemma, doing so with at least a little decent information should help. That article puts to shame a lot that is thought to be good about US health care.

Anyone following this thread that did not read the intial reference by c1ue, should really take the time to do so if you are interested in the problem and wish to have a better informed opinion.

[Jim Nickerson]

Re: Interesting overview of American health care: present status, history and causes

If you think you as a voter in the US have something to say about the modification of the present health care system such that it would focus primarily on providing healthcare that serves people while not further driving the country into financial oblivion vs. providing profits to vested interest groups, I submit you are an IDIOT.

http://www.latimes.com/news/nationwo...,6925890.story

Healthcare insurers get upper hand

Obama's overhaul fight is being won by the industry, experts say. The end result may be a financial 'bonanza.'

[Thailandnotes]

Re: Interesting overview of American health care: present status, history and causes

"The health insurance industry, in particular, saw its premiums go from 1.5 percent of G.D.P. in 1970 to 5.5 percent in 2007, so that a once minor player has become a political behemoth, one that is currently spending $1.4 million a day lobbying Congress.

http://www.nytimes.com/2009/08/31/op...gman.html?_r=1

[Jay]

Re: Interesting overview of American health care: present status, history and causes

I have practiced in an environment with no litigation fears and in an environment fraught with them, and have practiced in different countries. The specter of a huge lawsuit absolutely changes the way any doc practices and makes one do more tests and makes patient care flow much more inefficient. You might even think, "well, why change the way you practice if you are giving everyone the best care you can, the venue shouldn't change your approach", which is an idealistic thought of course, but beyond that, and more importantly, the standard of care to which you are measured in court changes depending on the current practice environment. That fact alone practically forces you to do more tests in a high test country or environment.

I agree that not everyone can have a baboon bone marrow transplant. American's need to learn that health care is a finite resource and stop being so narrow minded. All it takes is practicing medicine outside of the first world and it becomes clear what is really important and what isn't. American's waste tons of cash and man hours on unnecessary (and sometimes dangerous) tests and drugs in a million ways. People come to the Emergency Department all the time demanding certain studies. That is ridiculous. I see people all the time that call an ambulance to take them across town to the hospital because of a cold. Why are they able to get away with it? Because all it takes is one patient who has a bad outcome because they are refused a trip and a subsequent large lawsuit and you are back to free $5000 rides across town to anyone who wants one. I actually knew a drunk who would call the ambulance when he wanted to go across town. He would stop off in the Emergency Department and then leave AWOL to pick up a 6 pack of beer. The hospital was closer to his liquor store than his tent. That $5000 charge for the 6 pack is picked up by you and me all day long. Again, all it takes is one missed major illness and he or family own the ambulance service. Tort reform is needed.

[Jay]

Re: Interesting overview of American health care: present status, history and causes

As far as med mal lawsuits go, in most states in the last 10 years, a plaintiff or lawyer really cant make money suing doctors, except very rare cases, most of which certainly justify large awards.

Why are there so many then? :rolleyes:

[Jay]

Re: Interesting overview of American health care: present status, history and causes

I work at a large, well-known academic medical center. Our infection control group has been monitoring compliance with basic hand hygiene practices for about two years. Even with a well-publicized campaign that all the big wigs embraced and took part in, we're still below 75% compliance, and that's probably an overestimate. Compliance among doctors is the worst, below 50%.

Not surprised at all.

[lakedaemonian]

Re: Interesting overview of American health care: present status, history and causes

I am not a medical professional or a lawyer, although I am a keen amateur learning about first responder/primary care as my "hobby" wearing a hat as a patrol medic in the Army.

But I can add my experience from being a healthcare customer in the US and New Zealand.

I strongly prefer the NZ system.

While I've be reading this thread I received a phonecall from a surgeon operating on my wife, as she developed a small hernia by her bellybutton from working out at the gym a month ago.

In one month, the NZ universal health care system cycled her through from start to finish.

It's clearly a low priority operation, but we quickly gained an appointment with her GP, who gave us a fast referral to a well regarded surgeon, the surgery was quickly scheduled, and completed within the past hour......finishing with a phone call from the surgeon himself with a followup and discharge tomorrow.....and a private room with Sat TV and ensuite in a facility that appears to focus on the lighter end surgical procedures.

Cost.....$0 in fees direct to us...but we pay 12.5% GST sales tax and 38% income tax on all income over $70k.

Our income is mid-to-high six figures, so we pay a fair bit of tax, but I cannot help but be impressed...enough to not bother with private insurance for now.

We had several other run-ins over the past decade:

Emergency room visit from being hit by a truck from behind on motorbike...concussion.....above average level of care from what I recall, and good followup. Bill = 0$

Emergency room visit for eye laceration...excellent level of care(coincidentally shadowed by some of my Army peers) and followup. Bill = 0$

1st child emergency C-Section. I had the opportunity to enter the surgical suite and was very impressed with the level of care provided for my wife and son in a very difficult birth, all except for the midwife. My son is alive as a result of an excellent surgical team. bill = 0$

2nd child scheduled C-Section. In the surgical suite again.....WAY better atmosphere, much more comfortable. Textbook perfect. bill = 1500$ for the OB/GYN, we were his last baby, he's moved fully into fertility treatment due to the Mid Wife Mafia..see below.

A couple dozen GP visits for the kids in the last few years. Bill = Very affordable co-payments. Very good data sharing.....swapping doctors and patient files is instantaneous...excellent use of IT.

Overall.....anecdotally, we've been provided with an excellent level of care in our experience.

Some of the reasons I see why it works "better" for us here:

ACC....Accident Compensation Corp...government run insurer who makes folks physically whole.

Torts....specifically intentional negligence/medical misadventure exist here and allow for exemplary damages...but it's fairly rare.

Mistakes happen, and I hope my family doesn't suffer from unintentional medical mistakes, but I think that is the thin line of government backed accident insurance that stops NZ from going down the path of lawsuit lottery.

As an insurance company I sincerely hope the ACC is able to continue funding needs going forward.....there are some big physio/rehab cuts happening, requiring copays to reduce an area known or abuse.

The biggest issue I have seen is the almost complete domination of "the birthing business" by midwives in NZ.

We had midwives for both our children.......I sacked the midwife for our first child, replaced by a far more competent one, only to see the original sacked midwife appear in the birthing unit while my wife was in labour(the replacement was attending another birth), who was incapable of asking for help when in over her head, necessitating the need for ME to escalate it and leading to Emergency C-Sec.

As mentioned by Jim, with specialist nurses capable of handling some anesthesia cases to keep per procedure costs lower, the same is occurring in NZ with maternity care......but here they have dominated the sector in every respect....a couple of recent high profile and completely unacceptable brain farts by midwives received a bit of attention, but $$$ talks..in this case.....cost savings I suppose.

In the end, while I continue to be impressed with the level of care we receive as just another NZ family......I wonder if we will be able to say the same in 10,20 years...or are we just enjoying the sweet spot in the benefit curve and likely to see healthcare inflation hidden with reduced qualitym of care?

[Jim Nickerson]

Re: Interesting overview of American health care: present status, history and causes

Yes, We Can Afford Health-Care Reform




By Simon Johnson and James Kwak
Tuesday, September 1, 2009; 8:29 AM

http://www.washingtonpost.com/wp-dyn...s=rss_business

A QUOTE:

• Put another way, if you are for fiscal discipline, you should be for health-care reform. If our government cannot produce some kind of reform, that will only reinforce the perception that our political system is incapable of resolving our largest, most difficult problem -- and that is what will make investors think twice about investing in America.

[ThePythonicCow]

Re: Interesting overview of American health care: present status, history and causes

• Put another way, if you are for fiscal discipline, you should be for health-care reform. If our government cannot produce some kind of reform, that will only reinforce the perception that our political system is incapable of resolving our largest, most difficult problem -- and that is what will make investors think twice about investing in America.

Unfortunately, given the degree to which financial, insurance, pharaceutical and legal interests control Washington, any "reform" we can produce will likely and properly reinforce the awareness that our political system is capable only of deeper corruption.

[hayekvindicated]

Re: Interesting overview of American health care: present status, history and causes

I agree with your sentiment about bankers and lawyers.

On the other hand, the average income in the US is around $32,000 year (last time I checked). Your gross income is $200K to $240K. That's about 7 times the average salary. Not too bad . . . .

Luckily, in America those salaries can still buy a comfortable life in most states. In London, you can barely manage a middle class existence on that kind of money - without spending everything you earn and racking up enormous debts.