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Hospitals are the villains in the health care debacle
I have been pushing this message on this board for some time. The Docs are not the problem. Hospitals (and their corporations) big pharma, and the insurance companies are responsible for the insane cost of medicine in this country.
My assessment is based on watching over years that legislation coming out of Washington seeemd always to favor the hospitals. Often at the expense of physicians and patients.
The evidence keeps coming in. Here is the latest:
[link=http://www.realclearinvestigations.com/links/2017/07/18/hospitals_profit_at_community_expense_103950.html]http://www.realclearinves…ty_expense_103950.html[/link]
The nation’s top hospitals advertised and lobbied mightily to keep their tax-exempt status under Obamacare, citing the charitable care they provide their communities. But a decade later they’ve cut back on such givebacks even as their revenue has soared due to the tax break and the millions of additional paying customers provided by the health-insurance overhaul, a Politico investigation finds.
Here is the truth:
Hospitals are the robber barons of the 21st century.
They are evil.
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177 Replies
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Yes, and the sky is blue. And sex can lead to pregnancy. And bears defecate in the woods. And u know that and so do I. And hospitals have a powerful lobby and we have none. And politicians kiss the assets of the powerful. And that’s that.
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Big business benefits from big government, something which the big blue never admits, yet the people they support know it full well.
Obamacare was the biggest corporate welfare program (for insurance companies) of the last 30 years, maybe ever in America — yet it was some weird triumph for all those who claimed to be against “big business” for their whole lives . It’s weird that tribalism stunts honest thought and dialogue.-
Spot on, dr fagler
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Quote from InNyc
Spot on, dr ****ler
Check out the Frumi response above, it’s precisely the reason why so many lefties are worthless to even discuss topcis with — they hold to absolutely no principles or intellectual honesty. You can have honest debate and dialogue with people who actually have ideas and principles they adhere to. But when it’s just some color or animal, and the positions flap with the politicans tongues in the breeze, it’s like having a discussion with a 4 year old with a lollipop: “No, or give me more.”-
If we are being intellectually honest, the corporate welfare part of Obamacare was adopted from the GOP/Heritage Foundation. If someone desires a fully insured populace, malpractice reform and half-baked tax incentives or whatever other nonsense the modern GOP farts out are intellectually dishonest of course.
There’s a reason D.C. currently can’t pass a bill.
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And the solution is….?
Big bad Pharma, Big bad Hospitals, Big bad Corporations, Big bad Insurance. Let’s not forget Big bad Government. We spend so much on these bad players and the doctors are getting shafted.
All these things with the exception of the big bad Government are called the Healthcare market. All those players are all just making profits from the Healthcare market.
Yes, hospitals got richer, yes hospitals bought up smaller hospitals and practices. But many patients did get insurance and care when before they could not except through ERs & then got a whopping bill. Revenue is up because of the ACA & charity is down because many people are now covered under insurance or Medicare/Medicaid.
Healthcare is always a work in progress. Things have improved since before the ACA for a lot of patients but the system shows that we are still the most expensive system in the world but showing not quite stellar results compared to other countries who do better for less. How do they do that? -
Here’s another article to consider.
[link=https://www.nytimes.com/2017/07/20/health/affordable-care-act-repeal-popularity-doylestown-pennsylvania.html]https://www.nytimes.com/2…town-pennsylvania.html[/link]
Jennifer Bell, sitting outside Mr. Murphys bagel shop with a friend, was raised a Democrat and always supported the [link=http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/health_insurance_and_managed_care/health_care_reform/index.html?inline=nyt-classifier]health care law[/link]. But it was only after she was injured in a serious car accident in 2013 that she thought to advocate for it. She used to get health insurance through her job as a teacher. Now disabled with extensive neurological damage, and working part-time in a record store, she qualifies for Medicaid, and without it, she said, could not afford her ongoing treatment.
Its very, very scary to think about not having health insurance, she said.
If the condition doesnt kill you, the stress of having it does, in this country, she added. The fact that people do without health insurance is a sin, in my opinion.
If you only just focus on the imperfect you’ll never see the good.
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[i]big pharma, and the insurance companies are responsible for the insane cost of medicine in this country. [/i]
We just experienced this waste. Son needed albuterol because the supply we had expired. Maybe once a year he needs it, usually when he gets a winter cold. My wife noticed our current supply expired. Call MD for an order because we were going away and we take it with us just in case. Called pharmacy later to verify they received it. Pharmacist tells my wife they did and she needs to check to make sure she has enough doses. My wife explains to pharmacist he does not use a lot of it, two boxes are enough and if he had a an issue where he needed more (he never has) he would have been seen. Pharmacist tells my wife this is a maintenance drug and by our plan she has to give us a 90 day supply. The MD order reads “as needed”. It does not read every four hours or 6 times a day.
I went to pick the meds up. Twelve boxes of albuterol. They had to give me a cardboard box to take it home. This supply will expire and be discarded just like the last supply. Called insurance company to express concern about the waste they refer me to CVS Caremark which oversees the plan. Why would CVS help me they are getting the money and their automated system did not give me much of a choice to talk to someone about the waste.-
90 day supply has become a standard but I’ve never seen getting 12 inhalers of albuterol however especially as albuterol is taken “as needed.” Did you call the insurance company for clarification?
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I think the idea is lumping three fills together prevents the insurance company from paying three separate times, which is presumably more expensive than paying once three times.
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The med was for his nebulizer and yes I called the insurance company. I get the 90 days for maintenance meds when the MD order reads take once a day etc. This order was as needed and we told the pharmacist he will never use it.
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Quote from deadwing
If we are being intellectually honest, the corporate welfare part of Obamacare was adopted from the GOP/Heritage Foundation. If someone desires a fully insured populace, malpractice reform and half-baked tax incentives or whatever other nonsense the modern GOP farts out are intellectually dishonest of course.
There’s a reason D.C. currently can’t pass a bill.
I don’t doubt that it was, in part, an idea from some thinktank like Heritage or Heritage (haven’t looked up the history but will take your word for it). Here’s the difference: I post on here and adhere to ideas not party lines and loyalties that as I said above, are dishonest time and time again. So you’re proving my point again by trying to rope-a-dope me into supporting something about the GOP or Heritage just because, but that’s precisely my point! I don’t.
Do you see the weird reasoning? Because some supposedly conservative group previously mentioned a model that may or may not have had nefarious means, but was certainly problematic (corporate welfare), now we can use double speak and employ that same model because someone else did something at some point. Again, it’s an admission of dishonesty to show that you aren’t against corporate welfare when it comes down to it, you are always doing something in a deceptive way.
Why can’t you people just admit that the DC cartel has historically involved (D) and (R). That’s been my point for over a year here and why I could sense that Donald Trump would become president. That (R) has had disingenuous (won’t carry out their) stated platforms, which we are finding out for certain right now, proves the point even futher: Mr. Trump is working against two parties in major ways. What does that make him?
THE ONLY REAL OUTSIDER everyone was always seeking. And it’s why he’s president. Whether you like it or not.
I’m not sure why there is denial of this reality.-
You’re charging at wind mills my man. You’ll find I’m no fan of Obamacare by any means. But conflating democrat incompetence and deceptive corporatism with whatever it is the current GOP cult is is disingenuous at best.
Anyway this isn’t the political forum. It’s too bad our careers are so dependent on whatever it is politicians find they can get away with.
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K, we can move it to over there, or not at all. My points stand.
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And this “Adam ruins everything- why hospitals are so expensive” seems interesting:
[link]https://www.youtube.com/watch?v=CeDOQpfaUc8[/link]
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WOW! That is so spot on.
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Cute video. Several points…Like PACS, the people putting up the money are not the end-users/consumers. This is a situation ripe for abuse. Second, the overcharges aren’t all profit…some goes to cover self-pay/no pay.
There needs to be a fundamental revamping of the entire system. Pull the plug. But Single Payer is NOT the answer. It will only make things worse.-
As the video shows, we ALL put up the money for healthcare, one way or another. As for “overcharges,” self-pay doesn’t come into play except they are often charges full faux prices unless there is a cash-only price list; no pay is addressed by the ACA by providing insurance or Medicaid.
GOP tried 100% of nothing to give and got nothing. Fine to say start over from nothing but 2 questions, with what and how to transition with an industry that is 20% of the economy. Pulling the rug out is a guaranteed economic and healthcare disaster.
As always, the question is what is the replacement plan?-
I gave you mine. You didn’t like it. Let’s hear yours.
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Everyone in America should watch that video.
It should be shown in prime time.
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Hold on! After declaring that the health care industry spends more on lobbying than oil and defense combined, they show Uncle Sam taking a bag of money, and saying “Thanks Doc, I’ll take care of you real well!”
It is NOT the docs spending all that lobbying cash. Pharma, AHA, Insurance, device manufacturers, those are the massive lobbyists. He’s using docs as an intellectually lazy, disingenuous and damaging shorthand for the whole industry.
We all know the chargemaster flim flam, and more education about it is good, but I’m not sure this is the representation you want.
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good point, I didn’t pay that close of attention ….
A *similar*, slightly edited version of that video should be seen by every american …
But basically, the typical American does still seem to think that doctors are making out like bandits and are the root of the problem. Reading the comments sections of articles on health care costs will drive you nuts …-
Physician pay accounts for something like 7% of the healthcare bill. But as we are the “face” of medical care, we get blamed, and we are targeted for cuts. We could work for free and it wouldn’t make much difference in the bottom line at all.
To many out there, single payer translates to “I get Cadillac care for FREE, and the RICH people pay for it!” Buried somewhere in there is the thought that doctors are at the top of the list of RICH people, they make too much, and they can afford to give free care. Ironically, we do just that for those who cannot pay, but the media NEVER reports that.
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You argue as if physicians will be billed for the majority of the cost of healthcare while giving everyone else a Cadillac.
The argument is false just on the face of it. Hyperbole isnt facts. & no one with any sort of knowledge thinks physicianss income is solely or even a majority of the reason America has the highest healthcare costs in the world.
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Mds can not survive in a payment model of Medicaid and Medicare. F that. I did not spend 15 years in schooling and training to have a salary on par with travel nurses , low level financial industry people and sales people (while also covering 24/7 procedural and diagnostic call )
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“Hospitals are the robber barons of the 21st century.
They are evil.”I think one of the fundamental problems of medicine today is the lack of interest alignment between hospitals and doctors. When doctors ran the hospitals, they were at least decent places to work for the doctors, and what was good for the doctors was also good for the hospital. Now with MBAs grinding out every last cent to goose the bottom line – often at the expense of the physician staff, of course many hospitals are lousy places to work. We need to get back to a place of aligned interests for doctors and hospitals – part of that is a stable base of people that can afford care. No point selling yachts in a desert, or to people on the verge of bankruptcy from your services. Right or left, it’s just bad for business.
Also – to the guy who got the windfall of inhalers from CVS. Thank them for the box, take what you need, and bring the rest to your local safety net family practice office – those docs will be grateful for the free inhalers for their patients.
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Quote from wisdom
Mds can not survive in a payment model of Medicaid and Medicare. F that. I did not spend 15 years in schooling and training to have a salary on par with travel nurses , low level financial industry people and sales people (while also covering 24/7 procedural and diagnostic call )
So which is it? Physicians aren’t paid enough or contribute to the high cost of healthcare? It can’t be both. And no one is compensated for procedural and diagnostic call? They are provided freely?
Physicians need to decide which side of the fence they want to straddle. Andy why do so many physicians have to justify their income by dissing other professions and healthcare roles? What nurse normally earns what a physician normally earns, whether GP or specialist?
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Quote from Frumious
You argue as if physicians will be billed for the majority of the cost of healthcare while giving everyone else a Cadillac.
The argument is false just on the face of it. Hyperbole isnt facts. & no one with any sort of knowledge thinks physicianss income is solely or even a majority of the reason America has the highest healthcare costs in the world.
That is not what I said. Go back and read it again. You are lusting so after single payer you cannot seem to tolerate any criticism of it. So I’ll say it again….It WILL NOT WORK HERE.-
Quote from DoctorDalai
Quote from Frumious
You argue as if physicians will be billed for the majority of the cost of healthcare while giving everyone else a Cadillac.
The argument is false just on the face of it. Hyperbole isnt facts. & no one with any sort of knowledge thinks physicianss income is solely or even a majority of the reason America has the highest healthcare costs in the world.
That is not what I said. Go back and read it again. You are lusting so after single payer you cannot seem to tolerate any criticism of it. So I’ll say it again….It WILL NOT WORK HERE.
Lust. You are thinking of pornography, not single payer.
It is what you said.
Why would it not work here? What is unique about American healthcare vs the World’s healthcare? Is it only about physician income? Then how to complain that income ONLY makes up a fraction of healthcare expense? So far the only arguments I’m seen advanced has to do with physician income and the concurrent argument that affordable healthcare for all must mean an income cut for physicians. Ergo, not acceptable.
Am I missing something? Isn’t there more to it?
What happened to profiteering, the Chargemaster & invented costs for tissues, insurance company stock profits, hospital and vendor profits?-
The issue is that in the US, the MD will get f ed disproportionately
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I’m saying that a salary of 200k w weekends holidays busting your butt all the time , in the US is inadequate for level of training and intelligence. There are a lot of people out there pulling similar money with far less training , stress or training , not to mention advancement opportunities. Good friend is in consulting. Salary below mine at similar age lady 2 yrs. . Became CEO of a smaller co w salary on par. His next step up in 2 years is going to be double my take home and from there on …. sky is limit if he does well and executes.
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The devil’s advocate position is that in Canadian or Australian single payer, doctors do decently (mid 3-400k), decent lifestyle (from what I’ve read but not first hand info). UK docs don’t do as well.
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Quote from Frumious
no one with any sort of knowledge thinks physicianss income is solely or even a majority of the reason America has the highest healthcare costs in the world.
Interesting.
Here’s a challenge then: Ask people how much they think health care costs would be reduced if every doctor in America worked for free. Now, of course their front desk staff, nurses, etc don’t work for free, and someone has to pay for office space, supplies, and so on, but if all doctors worked for exactly $zero, how much would we save?
I will tell you from my conversations with non-physicians, including people who are highly educated, etc, not a single one has ever gotten it right (somewhere between 5% and 10%).
So, what you say may be true, but your pool of “people with any sort of knowledge” is, in my experience, a tiny minority of the American people.
Would love to see a poll on this, and what the range of responses are. My guess is the average would be at least a 50% decrease in costs if you polled a broad range of the general public.
Care to give it a try with people you know?-
isn’t there a thread recently on Gen Rad or Off Topics about Rad pay in Canada? Apprehensions about how low it was but it didn’t seem that low to me. Yet Canada has Universal Health.
Or perhaps my beliefs about what a good income for rads is vs what American rads think is a good income is way off and Canada’s income for a rad is poverty?
What is the expectation for a rad income anyway then? American that is vs Canadian as an example. Or pick a European country’s income for a rad in equivalent value. -
Quote from BHE
Quote from Frumious
no one with any sort of knowledge thinks physicianss income is solely or even a majority of the reason America has the highest healthcare costs in the world.
Interesting.
Here’s a challenge then: Ask people how much they think health care costs would be reduced if every doctor in America worked for free. Now, of course their front desk staff, nurses, etc don’t work for free, and someone has to pay for office space, supplies, and so on, but if all doctors worked for exactly $zero, how much would we save?
I will tell you from my conversations with non-physicians, including people who are highly educated, etc, not a single one has ever gotten it right (somewhere between 5% and 10%).So, what you say may be true, but your pool of “people with any sort of knowledge” is, in my experience, a tiny minority of the American people.
Would love to see a poll on this, and what the range of responses are. My guess is the average would be at least a 50% decrease in costs if you polled a broad range of the general public.
Care to give it a try with people you know?
FREE?
Is that a serious question? Is that a serious proposal?
That is not how economies work in any example. It is a nonsensical proposal/question. It’s the equivalent nonsense answer typical of the WSJ Opinion page that if every billionaire gave all their fortune away, how long would it last? The answer is always not long. But the real question is if that money were invested in something that returned income or something equivalent, it would last a very long time.
The question is deliberately loaded to fail. It’s a fake question that has no basis in reality. It is the fairy tale of the Goose that Laid the Golden Eggs.-
Read what BHE said, and try not to alter it with your own spin.
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I don’t think you understood what I said.
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I admire the few physicians that have gone out on their own and only take cash, don’t accept insurance, Medicare or Medicaid and charge very reasonable prices.
Unfortunately they are very few and you still need insurance for hospitals and surgeries. However if larger groups of cash only physicians form, I wonder if they could treat most conditions or even form their own cash only hospitals or at least outpatient centers that are not required to treat patients for free.
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In my opinion, there are only two ways you effect change in modern America. You either lobby to pay off government, or you appeal directly to the public.
Not just physicians but healthcare workers in general get completely shafted in our current market, and the only option for cutting costs from the perspective of those who write our laws is screwing over healthcare workers, because all other players in the equation are immune via their lobbying power.
I do not understand why health care workers try to lobby to government at all. The ACR going to DC is a bit like sending a 5 year old to play in the Super Bowl. Any group representing health care professionals is a joke to politicians given our limited resources, and these groups are stuck trying to convince us of their victories in which they take what could have been a 50% cut, and limit it to a 40% cut. It is like if I bragged about getting a $500 discount by going to the local car dealership and buying a Toyota Camry for $35,000.
We would be much better off spending the limited resources we have appealing directly to the American public. Hammer the message home to them over and over that it is not health care workers driving up the cost of care–rather it is the leeches sucking at every level of the health care teat.
I have very little faith in the intelligence of the American public, but I have far more faith in the public than our government. If health care workers win over the general public, then the government will be forced to stop victimizing those who deliver care, and to actually address the real issues that make our system so expensive and inefficient. -
Quote from Frumious
Quote from BHE
That is not how economies work in any example. It is a nonsensical proposal/question. It’s the equivalent nonsense answer typical of the WSJ Opinion page that if every billionaire gave all their fortune away, how long would it last? The answer is always not long. But the real question is if that money were invested in something that returned income or something equivalent, it would last a very long time.The question is deliberately loaded to fail. It’s a fake question that has no basis in reality. It is the fairy tale of the Goose that Laid the Golden Eggs.
The problem with your suggestion that every billionaire isn’t being asked to give away their fortunes to be invested in anything that had a return on the investment. The wealth would be confiscated by the federal government and squandered on some social service give away. The feds don’t invest money in stocks and bonds. They can print money, but that cannot create wealth.
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One asks how other countries with government health insurance can have similar mortality rates and spend less money per capita than the United States does. There is a reason for why the UK has a shortage of radiologists and why the numbers of doctors in Ireland are dwindling as they all flee to the US where they can still earn a decent living.
As for mortality, no one is adjusting for obesity. We are so much better off that even our poorest citizens are not wanting for food and obesity is epidemic. That leads to diabetes, heart disease etc and all those costs that show up later. We may not live as long, but we die fatter and happier.
No one adjusts for high suicide rates, and the ultra-high mortality of black men between 18-24 due to gang related shooting either.
Here is the dirty little secret no one wants to talk about:
We are all mortal. We currently spend about 18% of GDP on health care. Actually, that isn’t really a correct description. Health care IS 18% of GDP. A lot of people are gainfully employed in medicine, and related industries. A lot of public sector union pensions are invested in those same companies. But, we could spend 100% of GDP on health care, and borrow another 100% of GDP and within a decade, the death rates in the country would be back to what they are now after a short temporary dip.
You can have universal healthcare, You can have affordable healthcare. You can have high quality health care. But, you can NEVER have more than two of the three at any one time.
If we spent more effort worrying about the health of our immortal souls, and less about our mortal shells, it would do more to improve overall health of the nation than any money spend on treating illnesses. Lets see, thou shalt not murder. Thou shalt not commit adultery. Thou shalt not steal. Honor they mother and father. Thou shalt not covet…. Thou shalt not bear false witness. Life is worth living, but it isn’t healthy to invest in immortality.
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Single payer barely works in nations with small, fairly homogeneous populations that follow orders. Japan, Canada, Sweden, etc. It will not work here. Americans WILL NOT TOLERATE the sacrifices inherent in a system wherein they have to wait. Why do you think we have patient portals for reports? Because Americans WILL NOT WAIT for anything.
Your little tantrum about physician income is quite revealing. You DO indeed want all the RICH folks to pay for your free healthcare, and frankly, I DO find wealth redistribution, which is a nicer name for STEALING, pornographic, and not in a good way. And of course, nothing better get in the way of the FREE CARE juggernaut, especially those darn doctors. Just whom did you expect would take care of you, anyway??? I mentioned physician income solely to make the readers understand that it does not rise to a significant percentage of the healthcare dollar. But as we are the face of medicine, we stand to get “f ed” as Wisdom put it.
As an aside… [link=https://www.youtube.com/watch?v=l3GfCmbPDN0&feature=youtu.be]https://www.youtube.com/w…0&feature=youtu.be[/link]-
Oh, by the way, NHS, Britain’s single payer, doesn’t work, either:
[link=https://www.forbes.com/sites/theapothecary/2016/09/04/british-government-hospitals-to-ban-smokers-the-obese-from-surgery-due-to-budget-constraints/#691856943b99]https://www.forbes.com/si…straints/#691856943b99[/link]
[blockquote] The NHS longstanding problems
The NHS has, for decades, [link=http://www.nationalreview.com/critical-condition/231045/why-americans-dislike-britains-nhs-avik-roy]endured problems[/link] that will remind many of the VAs [link=http://www.forbes.com/sites/theapothecary/2014/05/23/no-the-va-isnt-a-preview-of-obamacare-its-much-worse/#58b979423156]waiting list scandal[/link]:
[ul][*]NHS doctors [link=http://www.telegraph.co.uk/news/uknews/3322438/Patients-left-in-the-dark-about-life-saving-drugs.html]routinely conceal[/link] from patients information about innovative new therapies that the NHS doesnt pay for, so as to not [link=http://news.bbc.co.uk/2/hi/health/7581705.stm]distress, upset or confuse[/link] them.[*]Terminally ill patients are [link=http://www.telegraph.co.uk/health/healthnews/6127514/Sentenced-to-death-on-the-NHS.html]incorrectly classified as close to death[/link] so as to allow the withdrawal of expensive life support.[*]NHS expert guidelines on the management of high cholesterol are [link=http://www.dailymail.co.uk/health/article-419083/Sentenced-death-NICE.html]intentionally out of date[/link], putting patients at serious risk, in order to save money.[*]When the government approved an innovative new treatment for elderly blindness, the NHS initially decided to reimburse for the treatment only after patients were [link=http://news.bbc.co.uk/2/hi/health/7582740.stm]already blind in one eye[/link] using the logic that a person blind in one eye can still see, and is therefore not that badly off.[*]While most NHS patients expect to wait five months for a hip operation or knee surgery, leaving them immobile and disabled in the meantime, the [link=http://news.bbc.co.uk/2/hi/3749801.stm]actual waiting times[/link] are even worse: 11 months for hips and 12 months for knees. (This compares to a wait of 3 to 4 weeks for such procedures in the United States.)[*][link=http://www.timesonline.co.uk/tol/news/uk/health/article4499847.ece]One in four Britons[/link] with cancer is denied treatment with the latest drugs proven to extend life.[*]Those who seek to pay for such drugs on their own are [link=http://www.timesonline.co.uk/tol/life_and_style/health/article4040146.ece]expelled from the NHS system[/link], for making the government look bad, and are forced to pay for the entirety of their own care for the rest of their lives.[*]Britons diagnosed with cancer or heart attacks are [link=http://www.dailymail.co.uk/news/article-1234276/Britain-sick-man-Europe-Heart-cancer-survival-rates-worst-developed-world.html]more likely to die[/link], and more quickly, than those of most other developed nations. Britains survival rates for these diseases are little better than [those] of former Communist countries. [/ul] [/blockquote]
But the rush to “single payer” goes on. Like all Socialist fantasies, the US supporters are quite convinced they will “do it better”. Ha.
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NO, he was not “serious”.
It is a thought experiment, one which I have often used.
If you paid doctors nothing, then you would save 7% (or so). Meanwhile medical inflation will continue and you will eat up that 7% in roughly a year. Then, the following years, you still have inflation, and you have saved what little you could.
And – to address the question of whether doctors continue to drive up medical costs – it is NOT what they are paid, it is what they order. In our area, if in one day you suggest getting 3 follow up CT scans, you have exceeded your salary in generated costs. Imagine how much cost a busy internist can generate in a day of ordering tests, or an intensivist.
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As another thought experiment, let’s imagine the ideal situation for a patient. The patient would be assigned a “champion” – someone who has the patient’s best interests as their own best interests. Someone who also knows all about medical testing, and all descriptions of diseases.
How to keep the patient’s interest as their focus: They are paid not by a hospital or the government, who have their own agendas, but by the patient, or by some source under the complete control of the patient. The PATIENT is their “client”. They get no reimbursement for any testing they order. When a patient needs a procedure, they are referred to the physician who the “champion” knows well to have the best outcomes in the area. Remember, if the patient does well, the champion does well also, since presumably, he/she will get more patients.
I am describing what medical care was like, in some regards, prior to government interference in medical payments. “In some regards”, because there were still some questions about overutilization. But, if your doctor told you you needed procedure X and referred you to a surgeon, you didn’t question whether they were sending you based on their own financial concerns. And, if they said you didn’t need procedure X, you didn’t worry that maybe they were trying to improve their utilization scores at your expense.
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Quote from Dr.Sardonicus
As another thought experiment, let’s imagine the ideal situation for a patient. The patient would be assigned a “champion” – someone who has the patient’s best interests as their own best interests. Someone who also knows all about medical testing, and all descriptions of diseases.
How to keep the patient’s interest as their focus: They are paid not by a hospital or the government, who have their own agendas, but by the patient, or by some source under the complete control of the patient. The PATIENT is their “client”. They get no reimbursement for any testing they order. When a patient needs a procedure, they are referred to the physician who the “champion” knows well to have the best outcomes in the area. Remember, if the patient does well, the champion does well also, since presumably, he/she will get more patients.I am describing what medical care was like, in some regards, prior to government interference in medical payments. “In some regards”, because there were still some questions about overutilization. But, if your doctor told you you needed procedure X and referred you to a surgeon, you didn’t question whether they were sending you based on their own financial concerns. And, if they said you didn’t need procedure X, you didn’t worry that maybe they were trying to improve their utilization scores at your expense.
That’s not real either. First extremely few people know healthcare sufficiently to be a champion. I have been for family members & have found their wishes subverted in spite of my being a champion for 1 thing. 2nd, many people still had no or still restricted access to good healthcare especially if they were not affluent. One of the goals of Johnson’s War on Poverty program in the 1st place that included Medicare. And my mother complained of paternalistic and male bias in her healthcare when she needed it. That was in the 1950’s. She depended on my father’s championship but he didn’t have a clue about medicine and shared some negative attitudes about “entitled” women who did not want to work forgetting my mother worked all her life, even after marriage.
The past was never as idealistic as some dream it was.
2nd, medical care was anything but perfectly wonderful before government got involved. How long ago are you talking? Before Medicare? How many people on this board practiced medicine before Medicare?
There was never any such world as your thought experiment thinks there was. Times were even harder than today’s world in many ways. Our memories are primarily those of children then. What the hell did we know of the real problems of the world until we grew up enough to see and experience or lived in difficult households where we had to grow up early.
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As I follow this discussion, I am puzzled and skeptical. Admittedly, without knowing the fine details of the excessively long ACA, I think some of the “good” is very clear.
1. More people get covered (though clearly not all as some would still rather pay a penalty)
2. Insurance can be carried for longer, to age 26 on parents
3. Pre-existing conditions not an exclusion anymore
4. Family coverages more complete (yet some view this as a failure and govt intrusion)
Failures are:
1. Increases in insurance rates (though I have no idea if the ACA rates have gone up higher than other rates)
2. Forced coverages people don’t want or need
3. Tax consequences for the upper income levels
4. “Govt interference” to the nth degree (though some people view that as a positive, to protect the vulnerable)
Can we conceive of change that forces the bad items to be moderated without screwing up the good reasons?
Is opposition to ACA strictly because President Obama was in office at time of its adoption (and chief champion, along with Rep. Pelosi and Sen. Reid)? What could have been done in retrospect to get any cooperation of the GOP, if anything? Is that even possible? Now, what could be done to get cooperation of the Dems?
Throwing out the typical political terms does nothing for me–i.e. calling out “lefties” or what not. It makes people feel defensive, and I think having sane discussion is better without making assumptions or names.-
Quote from Midwest Eastern Rad
As I follow this discussion, I am puzzled and skeptical. Admittedly, without knowing the fine details of the excessively long ACA, I think some of the “good” is very clear.
1. More people get covered (though clearly not all as some would still rather pay a penalty)
2. Insurance can be carried for longer, to age 26 on parents
3. Pre-existing conditions not an exclusion anymore
4. Family coverages more complete (yet some view this as a failure and govt intrusion)Failures are:
1. Increases in insurance rates (though I have no idea if the ACA rates have gone up higher than other rates)
2. Forced coverages people don’t want or need
3. Tax consequences for the upper income levels
4. “Govt interference” to the nth degree (though some people view that as a positive, to protect the vulnerable)Can we conceive of change that forces the bad items to be moderated without screwing up the good reasons?
Is opposition to ACA strictly because President Obama was in office at time of its adoption (and chief champion, along with Rep. Pelosi and Sen. Reid)? What could have been done in retrospect to get any cooperation of the GOP, if anything? Is that even possible? Now, what could be done to get cooperation of the Dems?
Throwing out the typical political terms does nothing for me–i.e. calling out “lefties” or what not. It makes people feel defensive, and I think having sane discussion is better without making assumptions or names.
Agree with the good things.
But the “bad” things – these were necessary if there were to be anywhere close to financial viability for the plan. You have to pay to get some thing. i.e. no free lunch. And this was all predicted before the enactment of the bill (yes – a few did read it). I thought it was ridiculous to say he was going to give all this “free stuff”, and decrease premiums to middle class families by $2400 a year. But, people just wanted to believe.
As to what could have been done to get the GOP on board. Well….. I remember pretty clearly that Obama convened a meeting that included the Republicans in Feb 2008. I thought: “Interesting, he DID say he was going to be more inclusive during the campaign. Maybe this will work”
What happened was the Republicans indicated they wanted to be part of the group drafting the legislation, and Obama said “Elections have consequences. I won”.
THE END of any sort of bipartisanship not only on this issue, but many others.
What could have happened instead? He could have followed through on his campaign rhetoric and actually included a wide range of people on the drafting committees, or he could have told us straight out on the campaign he had no intention of being bipartisan and then….. we could have elected McCain.-
Quote from Dr.Sardonicus
As to what could have been done to get the GOP on board. Well….. I remember pretty clearly that Obama convened a meeting that included the Republicans in Feb 2008. I thought: “Interesting, he DID say he was going to be more inclusive during the campaign. Maybe this will work”
What happened was the Republicans indicated they wanted to be part of the group drafting the legislation, and Obama said “Elections have consequences. I won”.
THE END of any sort of bipartisanship not only on this issue, but many others.
What could have happened instead? He could have followed through on his campaign rhetoric and actually included a wide range of people on the drafting committees, or he could have told us straight out on the campaign he had no intention of being bipartisan and then….. we could have elected McCain.
I’m with wisdom here, the discussions about healthcare were very open and there were very many meetings. IT was the GOP who refused to go to meetings. There were a couple Republicans who did go & their concerns were addressed in very many cases but when it came to vote on the healthcare bill, they marched lockstep according to Boehner’s & McConnell’s strategy & tactic of 100% opposition they agreed to in December 2008. No cooperation so that no GOP fingerprints would be on anything, total opposition so that Obama could claim no successes. As McConnell stated, their goal was to make Obama a 1 term President. Even remember Ryan agreeing to financial terms during the financial meltdown & then walking out of the committee when it came to voting for things he had agreed to.
No, it was the Republicans who did their best to gum up everything & then lied about being locked out of discussions. -
Thanks for replying. Your insight is always interesting to me and teaches me
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Quote from Midwest Eastern Rad
1. More people get covered (though clearly not all as some would still rather pay a penalty)
Most of that increase is the result of Medicaid expansion. The fundamental flaws of Medicaid were not addressed.
On the private side, many Americans lost employer and individual plans and saw them replaced with ‘bronze’ level garbage plans. A net loss.2. Insurance can be carried for longer, to age 26 on parents
Terrible idea. Low cost plans were readily available for that group prior to O-care. They didnt buy insurance because they are stupid, not because it wasn’t available. Now the young are getting fleeced to pay for the care of the fat aging boomers and insurance for those entering the workforce has been priced out of reach.
3. Pre-existing conditions not an exclusion anymore
Which created an incentive to buy no insurance or bronze insurance while you are healthy and only to buy insurance that covers illness (gold or plat) once you develop a chronic health problem.
4. Family coverages more complete (yet some view this as a failure and govt intrusion)
If ‘complete’ means that I have to buy maternity coverage after my family is complete or mental health when I am not interested in it, then yes it’s more ‘complete’. And ‘complete’ doesn’t mean a thing if you can’t afford the out of pocket cost of your garbage ‘bronze’ plan or if United was your insurer and just denied everything your physician recommended.
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Quote from Dr.Sardonicus
NO, he was not “serious”.
It is a thought experiment, one which I have often used.If you paid doctors nothing, then you would save 7% (or so). Meanwhile medical inflation will continue and you will eat up that 7% in roughly a year. Then, the following years, you still have inflation, and you have saved what little you could.
And – to address the question of whether doctors continue to drive up medical costs – it is NOT what they are paid, it is what they order. In our area, if in one day you suggest getting 3 follow up CT scans, you have exceeded your salary in generated costs. Imagine how much cost a busy internist can generate in a day of ordering tests, or an intensivist.
IMO, that “thought experiment” is on par with, “if i had wings” or “if I could be invisible…” I am not being insulting to either you or BHE but the experiment is meaningless. Why would that be an effective plan in the 1st place as it addresses what exactly in the long term? It is an empty argument. What if hospitals charged nothing or vendors or insurance companies. What if all surgeries were free? Or MRI and PET scanners and the isotopes? All dentistry. What if healthcare was provided absolutely 100% free? What is everything was 100% free to everyone?
And you are where exactly and have proven what exactly? That not only physicians could not work but no one else could either there’d be no economy to speak of also. We’d be in the collapsed economies of the areas in the world where war existed, like Syria and Iraq, where physicians and nurses and construction workers work “for free” because they are doing something instead of standing around being useless. Not exactly a working economy for anyone. Therefore a useless experiment. We aren’t at any point where AI and robots can make us look like the inhabitants of “Wall-E” where nothing has progressed in the time in space.
The thought experiment answers nothing except to kill a straw horse of the angry imagination.
For clarification, I have never criticized physician pay or ever said it was a major cause of the high cost of healthcare in the USA. I would be contradicting myself if I did since I have relatives in the Old Country who are physicians and mentioned the topic of rad pay in Canada, countries with universal healthcare who live quality lives under their income in countries where healthcare costs are a fraction of ours.
So stop raising straw show horses is my thought experiment & discuss the real issues of why costs are so high & yet we can’t seem to provide universal healthcare at a higher quality at the same level at the same lower cost.
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Quote from Frumious
Quote from Dr.Sardonicus
NO, he was not “serious”.
It is a thought experiment, one which I have often used.If you paid doctors nothing, then you would save 7% (or so). Meanwhile medical inflation will continue and you will eat up that 7% in roughly a year. Then, the following years, you still have inflation, and you have saved what little you could.
And – to address the question of whether doctors continue to drive up medical costs – it is NOT what they are paid, it is what they order. In our area, if in one day you suggest getting 3 follow up CT scans, you have exceeded your salary in generated costs. Imagine how much cost a busy internist can generate in a day of ordering tests, or an intensivist.
IMO, that “thought experiment” is on par with, “if i had wings” or “if I could be invisible…” I am not being insulting to either you or BHE but the experiment is meaningless. Why would that be an effective plan in the 1st place as it addresses what exactly in the long term? It is an empty argument. What if hospitals charged nothing or vendors or insurance companies. What if all surgeries were free? Or MRI and PET scanners and the isotopes? All dentistry. What if healthcare was provided absolutely 100% free? What is everything was 100% free to everyone?
And you are where exactly and have proven what exactly? That not only physicians could not work but no one else could either there’d be no economy to speak of also. We’d be in the collapsed economies of the areas in the world where war existed, like Syria and Iraq, where physicians and nurses and construction workers work “for free” because they are doing something instead of standing around being useless. Not exactly a working economy for anyone. Therefore a useless experiment. We aren’t at any point where AI and robots can make us look like the inhabitants of “Wall-E” where nothing has progressed in the time in space.
The thought experiment answers nothing except to kill a straw horse of the angry imagination.
For clarification, I have never criticized physician pay or ever said it was a major cause of the high cost of healthcare in the USA. I would be contradicting myself if I did since I have relatives in the Old Country who are physicians and mentioned the topic of rad pay in Canada, countries with universal healthcare who live quality lives under their income in countries where healthcare costs are a fraction of ours.
So stop raising straw show horses is my thought experiment & discuss the real issues of why costs are so high & yet we can’t seem to provide universal healthcare at a higher quality at the same level at the same lower cost.
Frumious – you missed the point. The point is this:
Many people think doctors are paid too much. Many think that all the ills of the health care system would be cured by reducing pay to doctors. The thought experiment is used to point out to people that reducing pay to doctors – even to nothing -will not fix this system.
(AND – as we all know – physician reimbursement has been steadily going down for the past 20 years and the cost has gone through the roof. Still more evidence…)-
Yes you are right D.
Unfortunately Frumi is a radical leftist that believes doctors are the root cause of the ills of our healthcare system. If doctors could just be compensated like kindergarten teachers our healthcare system would be great…..Not possible to even have an intelligent conversation with Frumi. Don’t waste your time…..-
“radical leftist”
Why do we call people names or group them? Why not just deal with issues and respect? We get nowhere
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Quote from Dr.Sardonicus
Frumious – you missed the point. The point is this:
Many people think doctors are paid too much. Many think that all the ills of the health care system would be cured by reducing pay to doctors. The thought experiment is used to point out to people that reducing pay to doctors – even to nothing -will not fix this system.
(AND – as we all know – physician reimbursement has been steadily going down for the past 20 years and the cost has gone through the roof. Still more evidence…)
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thank you
it’s a pretty simple point actually. not political at all, if you bother to think about it. -
Quote from Dr.Sardonicus
Frumious – you missed the point. The point is this:
Many people think doctors are paid too much. Many think that all the ills of the health care system would be cured by reducing pay to doctors. The thought experiment is used to point out to people that reducing pay to doctors – even to nothing -will not fix this system.
(AND – as we all know – physician reimbursement has been steadily going down for the past 20 years and the cost has gone through the roof. Still more evidence…)
I understand completely. Physicians are what lay people see and most people see physicians as affluent. And many physicians are very visible about their affluence, sometimes deliberately. And people hear the high cost of medicine & their immediate picture is affluent physicians. That’s a given.
But much of it is ignorance about what healthcare costs & often it is manipulation by those with an agenda to prey on the ignorance. Many of these same lay people say the Affordable Care Act is a good thing but hate Obamacare. Very few people have a clue about the cost of healthcare and why. Before “shared costs” such as co-pay started very many people just assumed healthcare was free. They paid little to nothing from employer provided insurance. Talk to a patient about why they are getting a procedure when it was useless of duplicated & their answer was they didn’t worry because it was free.
And the fact is that many physicians themselves don’t really understand costs & make assumptions that would seem logical in any other application except it’s healthcare and there is little that is logical or transparent about costs.
Of all the people in the system, it should be physicians in the forefront clamoring for an open affordable system but too many physicians leave it up to politicians or administrators who have less influence than assumed or just make do with the system we have or create a system for the lobbies who support them. The agenda from the lobbies is not to make the system more transparent or affordable. There’s money to be made in healthcare. Any attempts to make things open and affordable will be attacked and are and ignorance just seems to spread.-
Quote from Frumious
And the fact is that many physicians themselves don’t really understand costs & make assumptions that would seem logical in any other application except it’s healthcare and there is little that is logical or transparent about costs.
Good point. I don’t recall ever having a single lecture on HC costs/insurance etc in medical school or residency. Would have been nice to have an objective course on this topic.-
my mistake, it was about the stimulus package. Nevertheless, his attitude was basically, I’m not listening to you, because I won
[link=http://www.politico.com/story/2009/01/obama-to-gop-i-won-017862]http://www.politico.com/s…ma-to-gop-i-won-017862[/link]-
Yes, a flat-footed snub but at the same time this was after Boehner & McConnell already agreed to the tactic of total opposition. So whose is the greater offense?
[link=http://swampland.time.com/2012/08/23/the-party-of-no-new-details-on-the-gop-plot-to-obstruct-obama/]http://swampland.time.com…lot-to-obstruct-obama/[/link]
[link=http://www.nytimes.com/2010/03/17/us/politics/17mcconnell.html]http://www.nytimes.com/20…itics/17mcconnell.html[/link]
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Quote from Frumious
Yes, a flat-footed snub but at the same time this was after Boehner & McConnell already agreed to the tactic of total opposition. So whose is the greater offense?
[link=http://swampland.time.com/2012/08/23/the-party-of-no-new-details-on-the-gop-plot-to-obstruct-obama/]http://swampland.time.com…lot-to-obstruct-obama/[/link]
[link=http://www.nytimes.com/2010/03/17/us/politics/17mcconnell.html]http://www.nytimes.com/20…itics/17mcconnell.html[/link]
You are right, McConnell’s resistance pre-dated the “I won” statement. Perhaps Obama was expressing his rage at the attitude of McConnell. However, I might argue a deft politician would try to pick off McConnell’s votes one at a time with incentives that they could not ignore. He didn’t.
And, at any rate, this had been building on both sides for some time. Perhaps it started with Robert Bork’s confirmation hearings. The Dems did that. And planted the seeds for the Reps to stonewall Obama’s last nominee.
But, really, isn’t this a reflection of the society in general? The electronic communication we all have grown addicted to almost demands simplification of complex ideas to the point they are not recognizable. Then it encourages one to express opposition to another idea as loudly and forcefully as possible.
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No arguments about Obama’s not handling many things better.
That said, I still think healthcare is affordable and can be universally provided as it is around the world while reducing costs & keeping healthcare workers, including physicians well paid. But it requires government intervention and regulation, whether in a single payer system or a private market system albeit highly regulated like a utility so as to provide openness about costs and pricing. A minor thing like a box of tissues, to be facetious, should not be priced in the tens-of-dollars; if it is give the patient’s family an itemized price list so they can elect to bring in their tissues or maybe hospitals can bundle their packages much like cable does with different bundles, one bundle with a single box of tissues, another with unlimited tissues.. That requirement alone would bring righteous outrage about costs and pricing.
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Quote from Frumious
So stop raising straw show horses is my thought experiment & discuss the real issues of why costs are so high & yet we can’t seem to provide universal healthcare at a higher quality at the same level at the same lower cost.
have you read ANYTHING AT ALL of the preceding thread. It started as a discussion of costs of medicine – focusing on hospital corporations. So the discussion of why the cost is so high is actually there – you just didn’t see it.
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I think obama did attempt to be bipartisan. That being said , saying you are and being it behind doors are different things.
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As single-payer advocates often angrily complain, the US spends a LOT on healthcare, supposedly the most in the world. Please explain how spending EVEN MORE on single payer will save us money.
We all have heard stories about $5 tissue boxes and $10 aspirin tablets. Those charges are padded to pay for those who cannot, so the reduction of these charges does not suffice as an explanation.-
And just to make my own personal opinion crystal clear, let me quote from my favorite Conservative website, [link=http://www.americanthinker.com/articles/2017/08/hysterical_at_writers_caused_charlie_gard_to_suffer.html]American Thinker[/link]:
[blockquote]Socialized medicine changes a society completely, by fundamentally altering the relationship between the individual and the government. When everyone’s physical survival, everyone’s hope for necessary medical care in a crisis, depends not on a relationship between patients and doctors — private citizens seeking or offering a vital service — but rather between patients and government — the ruled and the rulers — the premises of collectivist submission and State omnipotence are deeply insinuated into everyone’s soul.[/blockquote] [blockquote]That is why progressives have always regarded socialized health care as one of the crown jewels of authoritarian control. Once a society has been palliated — pun intended — with such a system for a few generations, even nominal conservatives like Ms. Phillips find themselves genuinely mystified how anyone could imagine that a State-run hospital outright denying parents any authority over their child’s care, and being supported in this baby-theft by court decisions coercively barring the parents from taking their own child out of the State’s death chamber, has anything at all to do with government. I mean, that’s just honorable health care workers doing the Lord’s work, right?[/blockquote] [blockquote]Socialized medicine kills many things, including rational thought.[/blockquote]
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It’s going to happen eventually. Might as well figure out a way for a hybrid private model to prevail rather than “Medicaid for all” which would just destroy everything.
Currently the Medicaid expansion is the much stronger half of Obamacare.
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Quote from DoctorDalai
As single-payer advocates often angrily complain, the US spends a LOT on healthcare, supposedly the most in the world. Please explain how spending EVEN MORE on single payer will save us money.
We all have heard stories about $5 tissue boxes and $10 aspirin tablets. Those charges are padded to pay for those who cannot, so the reduction of these charges does not suffice as an explanation.
Explain how costs will increase please. As I recall, while costs did increase at the implementation of the ACA, the cost curve did follow a shallower slope than prior to the ACA. And the ACA was never designed by Heritage to provide cheaper healthcare only universal. And that is while adding millions of additional people to healthcare insurance and Medicare/Medicaid.
How did that happen mathematically?
Explain how all the other industrialized countries of the world are able to provide better healthcare to all their population at a fraction of our costs? Their R&D is not demonstrably worse than ours, their physicians are not paupers, they have modern equipment, facilities, schools. They do NOT have $10 aspirin or tissues. There are many different flavors of universal healthcare, but all are cheaper & on many measurements, demonstrably better than what we provide for our population. They even provide for their immigrants, we want to run a background check before treatment.
How do they do it? America, the “Can’t Do!” country? How do they spend less for better healthcare for more of their population? Why aren’t Canada, Britain, Germany, France, The Lowlands, Sweden, Norway, Switzerland, Singapore, Japan, etc, all bankrupt by having universal healthcare? But we will go bankrupt if we provide affordable healthcare?
What is the evidence of that claim in the face of actual real evidence proving the opposite of that prediction?
Here’s an example of where we fall short.
[link=https://www.nytimes.com/2017/07/29/opinion/sunday/texas-childbirth-maternal-mortality.html]https://www.nytimes.com/2…aternal-mortality.html[/link]weve structured health care so that [link=https://www.propublica.org/article/lost-mothers-maternal-health-died-childbirth-pregnancy]motherhood is far more deadly[/link] in the United States than in other advanced countries. An American woman is about five times as likely to die in pregnancy or childbirth as [link=http://stats.oecd.org/index.aspx?queryid=30116]a British woman[/link] partly because Britain makes a determined effort to save mothers lives, and we dont.
Here in Texas, women die from pregnancy at a rate almost unrivaled in the industrialized world. A woman in Texas is about 10 times as likely to die from pregnancy as one in Spain or Sweden, and by all accounts, the health care plans proposed so far by Republicans would make maternal mortality even worse in Texas and across America.
Women die unnecessarily in Texas for many reasons, but it doesnt help that some womens health clinics have closed and that access to Medicaid is difficult.
Amy, 23, had arrived at the hospital with a headache near the end of an uncomplicated pregnancy, her first. Her husband was there, and everything seemed normal and then Amy collapsed and lost consciousness.
Doctors performed an emergency C-section and saved the baby, a daughter, and Dr. Hollier struggled to keep Amy alive. She failed. Amy had suffered a preventable massive stroke, related to severe high blood pressure.
Within the U.S., California has done [link=https://www.vox.com/science-and-health/2017/6/29/15830970/women-health-care-maternal-mortality-rate]an outstanding job[/link] cutting maternal deaths and showing what is possible. A crucial step is careful counting of maternal deaths and investigation of each one to learn what could have been done differently.
[link=http://journals.lww.com/greenjournal/Fulltext/2016/09000/Recent_Increases_in_the_U_S__Maternal_Mortality.6.aspx]Obstetrics & Gynecology[/link], a medical journal, says that the U.S. ranks below every member of the Organization for Economic Cooperation and Development industrialized club in maternal mortality, except for Mexico.
A timeline of healthcare in US.
[link=http://www.pbs.org/healthcarecrisis/history.htm]http://www.pbs.org/healthcarecrisis/history.htm[/link]
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The historical basis for Heritage’s original healthcare plan, from [i][u]1989[/u][/i]!
[link=http://www.heritage.org/social-security/report/assuring-affordable-health-care-all-americans]http://www.heritage.org/s…lth-care-all-americans[/link]The United States spends over 11 percent of its gross national product on health care. 1″hat translates into more than $2,000 per person each year – more than the per capita GN P of many countries. Yet although the U.S. spends far more than any other country on health care, there are gaping holes in the system’s coverage, and health care services are gripped by runaway inflation. As many as 37 million Americans lack adequate ins u rance against health care cost, and many others who have insurance still dr6ad the financial impact of a serious disease.
There are three serious underlying problems with the current health care system. First, it actually invites runaway costs. For historical and tax rea sons, health care benefits are provided to most Americans through their employerk.’Mese benefits are tax-free income, and most employees pay little or none of the premium costs out of pocket, and they have little knowledge of the actual costs of the servi c es they use. For the worker, these services are essentially “free,” and so he or she has little reluctance to demand them…This tax dynamic within the insured health care market also pushes up costs for all Americans, insured or uninsured, rich or poor. Ile second problem is that the direct and indirect assistance provided by government does not channel the greatest help to those who need it most. The tax code, as mentioned, favors company-based health plans. Thus individuals purchasing their own insurance for health care needs and employees and dependents not covered under company plans face higher costs for obtaining protection. This cost differential tends to make insurance comparatively more expensive for lower skilled workers and th ‘e ir dependents. Thus we find many individuals and families, particularly among the young, w ‘ho decide to use their income for other objectives than health care insurance, even though they have the means to obtain in s urance withoutcutting back on other necessities. Often these are individuals who are healthy. They are playing Russian roulette with their continued good health. The result of these problems is the system we have today, in which many Americans find it fin a ncially difficult to obtain the protection they need against the financial impact of illness. The very rich and the very poor, who are insulated by income and tax breaks on the one hand and welfare-based government assistance on the other, generally have adequate protection.
Many ideas have been put forward to address this problem. Increasingly, pressure is building for some kind of national health insurance system in America. I believe that eventually the U.S. will have a “national health system,” in the sense of a system that assures-each citizen of access to affordable health care. At issue is the kind of national system we should have.-
Because you are a groupthink junkie, Frumi, doesn’t mean anyone else is. Rather, we actually consider all ideas and accept them or reject them on their merits. You try to act like conservatives would or should just accept some thinktank’s plan … just because they might agree with them somewhere else or in some other case.
That actually exposes you as an unprincipled, groupthink, identity politics participant. Thank you once again for showing us the difference between honest thinkers, and leftist ideologues, such as yourself.
It is very informative in its own right.-
And your idea is? You never really explain or reason anything out.
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F*ger is actually partially right here. All ideas are on the table. Even bad ones. Even good ones.
I have said about a dozen times that I think the present system needs to be scrapped. You would think there would be trumpets and fanfare over such an admission, but all we got was hand-wringing…[i]”You CAN’T just take away our pacifier and not have a temporary pacifier while you’re preparing the new pacifier!”[/i]
The Heritage conclusion is hard to dispute. When people perceive things as “free” they will consume as much of them as they can get. And assurance of access to affordable health care does NOT automatically imply single-payer. Let’s make sure we understand this.
As far as metrics, try to find some stats from true sources, not from the utterly and completely biased Socialist outlets you prefer. They have an agenda to push socialized medicine and so they will spread lies, half-truths, and other propaganda in that vein. While things are nowhere near as bad as these doomsayers would have you think, our system is not perfect, but you must keep in mind that we have a larger population that IS NOT REGIMENTED in the way of most European nations. We don’t do what we are told, we don’t seek care until something falls off, and we simply are rebellious to the point of hurting ourselves. That explains much of the “bad” metrics out there. And this includes pregnant women as well as everyone else.
The bottom line is this…we need an overhaul. We do NOT need government running our healthcare. Regulating it yes, running it no. Look at it this way…you don’t want Trump in charge of your care, and I don’t want Shrillary (or Frumious for that matter) in charge of mine. Capisce?-
So why don’t you provide these non-biased stats that counter my arguments or “Socialist sources.”
As for the government “running” healthcare, that is only your argument, not anyone else. There are many examples of government regulating market-based universal healthcare, almost no one is Britain & the British system was never the argument except yours. Your argument is always, “It can’t be done here.” And my question is what can’t be done & why not? What makes America unique in not being able to provide affordable healthcare to everyone that is equal or better than what is provided in many other industrialized countries?
They do it but we can’t? If “they” are all Socialist countries, maybe they do have something to show us about doing things better. And doesn’t Israel have something of Socialist healthcare too? Participation is compulsory, no?
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I’ve worked in the UK’s NHS. The U.K. Is universal coverage, not single-payer, btw. There are many ways that they reduce costs which would not be tolerated in the US, including rationing and seriously delayed care. There are also ways to reduce costs that might be tolerated here, like a much leaner, less lavishly paid layer of administrators in the hospital and insurance systems. Overall it can be very, very similar to the VA. To correct a misstatement above, the NHS does check immigration status and does not just hand out care to anyone that flies in (although that happened in decades past).
If one does not wish to receive all their care via the NHS, there is a robust private system. You’ll still pay tax to fund the NHS, of course, but you can use it if you wish.
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Quote from Frumious
So why don’t you provide these non-biased stats that counter my arguments or “Socialist sources.”
As for the government “running” healthcare, that is only your argument, not anyone else. There are many examples of government regulating market-based universal healthcare, almost no one is Britain & the British system was never the argument except yours. Your argument is always, “It can’t be done here.” And my question is what can’t be done & why not? What makes America unique in not being able to provide affordable healthcare to everyone that is equal or better than what is provided in many other industrialized countries?
They do it but we can’t? If “they” are all Socialist countries, maybe they do have something to show us about doing things better. And doesn’t Israel have something of Socialist healthcare too? Participation is compulsory, no?
And as usual you ignore 95% of what I wrote so you can have your tantrum favoring governmental control. Look at what Sandeep wrote above. Those reasons, and many more explain why socialized medicine/single payer won’t work here. Start with our dislike of queues that the Europeans love, or at least tolerate, and go from there. But you really don’t want to hear it.
Our infant mortality rate is higher because we count premies etc who have little chance of survival in the denominator; your European idols don’t. Now later on, approaching one year, there certainly is a discrepancy in infant mortality which is related to socioeconomics. The infants of the poor don’t do well. But we don’t know WHY. It could be we aren’t throwing enough money at them. It could be the poor have bad habits that affect their children, smoking, drugs, etc. It could be a lot of things. We have room to improve. But I have yet to understand the math. We spend more than anyone else, our system, at least according to you and yours, isn’t as good, so we are supposed to spend MORE to get there. Of course, YOU aren’t planning to spend a dime…
Having the government run things is NOT THE ANSWER. But that is the only answer you will accept. Because deep down, you want the RICH to pay for everything, and having the government play Robin Hood on your behalf is the only way to (legally) accomplish it. Socialized/single payer works in VERY SMALL nations with relatively homogeneous populations that are used to being regimented and following orders. IT WILL NOT WORK WITH AMERICANS. Unless your dreams come true and we eventually end up a Eurosocialist nation, wherein conformity rules. Until then, not happening. And QUIT saying it’s “my” argument and mine alone. YOU are so immersed in your desire for government control of everything you are no longer rational. I guess you somehow think the government scr3wing the RICH will fix everything that went wrong in your life. It won’t.
This is why I quit the political Off-Topic board, and you are about to get rid of me here. Enjoy.
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Well said Dr. D. Don’t expect Frumi to understand your argument. He wants the government to control every aspect of his life. His solution to every problem is to increase taxes and let the government take over or control every industry.
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Arguing over definitions.
Sandeep, most all the countries have “universal healthcare,” including Britain which has single payer but everything is under & provided by the government, a slightly different flavor than most all other countries. Canada contracts with private services, Germany has universal healthcare but private insurance can be purchased instead but funds go into a “sickness fund.” Many countries use a combination of compulsory public and private funding. No one particular type is the “correct” one that would be proposed for the US, but they all are “universal” providing healthcare for everyone.
No one is proposing the British NHS model for the US that I know. Not even Bernie.
And for the misinformed, whether ignorant or deliberately misleading, nothing is “free.” As I noted if patients think anything is free it is employer provided insurance where there is/was no co-pay, etc. Any of you speak to your patients? Never heard a patient with employer=-provided insurance claim their healthcare was “free?” That is pre-ACA, not post. I heard patients claim just that for decades, since the 1970’s.
Sardonicus, no one claimed Kristof is medical but he writes on women’s issues, whether female genital cutting/mutilation or slavery or keeping women out of schools or even women dying of pre-eclampsia. And if the majority of woman are not seeking medical care because they are seeking “holistic” medicine instead, you have to show me stats because I doubt alternative medicine is the cause of higher death rates. Please show me I’m wrong, that the majority of deaths are caused by patients choosing alternative care over regular medical care. The article states that women in Texas for example have a higher mortality rate than women in some European countries. Are Texas women suddenly eating granola & adopting holistic medicine over regular medicine?
Dalia, you need to read, no one is calling for the British system, certainly not me. I just say we can have a universal system, whether that is a Canadian, French, German, Swiss. Swedish, Japanese, Singaporean, etc model.
And the Heritage lecture should be interesting for a primary reason alone, it was given in 1989, long before the ACA and it specifically states concerns about patients’ beliefs that they have “free” insurance. This was NOT government provided or single-payer insurance. Everyone missing that?
And regardless of everything, we still have the most expensive system in the whole world and produce results that are not superior to everyone else’s systems. And we were not covering everyone at that & still we were more expensive than everyone else. Everyone missing that too? Why is that? So you can’t say we can’t afford universal care when no one seems capable of addressing why we have the most expensive system that does not provide the best care in the world while it left out a significant fraction of the population from healthcare.
As conservatives, and the majority of physicians are, I agree, throwing more $ at the problem isn’t the solution BUT why aren’t you concerned that we already have a sub-par system compared to countries who provide better care in general to all of their population, not just a fraction?
No one seems to ever answer those obvious questions.-
And why so cranky Dalai & Ben? I’m just discussing the viability and cost of universal healthcare in the USA compared to the world, not taking babies away from parents to be raised in a government commune.
Is there some difficulty in discussing a subject you obviously don’t agree? Without the insults?
No one has explained to me your belief why universal healthcare is impossible in the USA when it seems to work so well in very many other countries. And more cheaply. It’s all because of Socialism? Is that is your argument, you are making an argument for Socialism as the better system. -
We have tried to explain. You don’t accept the explanation.
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Quote from DoctorDalai
Our infant mortality rate is higher because we count premies etc who have little chance of survival in the denominator; your European idols don’t. Now later on, approaching one year, there certainly is a discrepancy in infant mortality which is related to socioeconomics. The infants of the poor don’t do well. But we don’t know WHY. It could be we aren’t throwing enough money at them. It could be the poor have bad habits that affect their children, smoking, drugs, etc.
From 2010, but still relevant.
[link=https://www.cdc.gov/nchs/data/nvsr/nvsr63/nvsr63_05.pdf]https://www.cdc.gov/nchs/…r/nvsr63/nvsr63_05.pdf[/link]
MethodsInfant mortality and preterm birth data are compared between the United States and European countries. The percent contribution of the two factors to infant mortality differences is computed using the Kitagawa method, with Sweden as the reference country.
ResultsIn 2010, the U.S. infant mortality rate was 6.1 infant deaths per 1,000 live births, and the United States ranked 26th in infant mortality among Organisation for Economic Co-operation and Devel opment countries. After excluding births at less than 24 weeks of gestation to ensure international comparability, the U.S. infant mortality rate was 4.2, still higher than for most European countries and about twice the rates for Finland, Sweden, and Denmark. U.S. infant mortality rates for very preterm infants (2431 weeks of gestation) compared favorably with most European rates. However, the U.S. mortality rate for infants at 3236 weeks was second-highest, and the rate for infants at 37 weeks of gestation or more was highest, among the countries studied. About 39% of the United States higher infant mortality rate when compared with that of Sweden was due to a higher percentage of preterm births, while 47% was due to a higher infant mortality rate at 37 weeks of gestation or more. If the United States could reduce these two factors to Swedens levels, the U.S. infant mortality rate would fall by 43%, with nearly 7,300 infant deaths averted annually.The reasons can’t be unknown since so many other countries seem to know how to reduce their infant deaths.
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You refuse to grasp this, but THE POPULATIONS ARE DIFFERENT. These studies (which do NOT come to any real conclusion as to why the discrepancies exist) are the equivalent of saying cats and dogs have different mortality rates.
This particular study only controlled for gestational age, and then that was only the second part of the study. No controls for race, socioeconomic status, intelligence, drug use, and a host of other things that will affect infant (and maternal) mortality.
Much as you can’t bring yourself to admit it, America is different. The population is much larger, much more heterogeneous, and much less likely to listen to “experts”. Therein lies the problem.
We would all like to have a 0% infant mortality. I’m afraid that isn’t something the government can simply enforce.-
America isn’t different & the population of the USA to all of Europe is comparable. Massachusetts successfully ran Romneycare & it has a population similar to many European states. As for population mix, I’d say it can be argued that Europe has more of a mix, not to mention languages and cultures, more than the USA.
And if universal healthcare were so culturally incompatible to the USA, then the VA would be a total failure not to mention Medicare/Medicaid and Social Security. And yet they are not failures.
Infant mortality is illustrative, it is not the whole story. Going through the weeds will prove nothing about universal healthcare. The fact remains the US system is still the most expensive & other countries do have measurably better results and at an absolutely lesser cost than the US does.
[link=http://sm.stanford.edu/archive/stanmed/2013fall/article2.html]http://sm.stanford.edu/ar…2013fall/article2.html[/link]compared with most of the developed world, the statistics arent something to brag about. [b]According to a 2011 World Bank report, the United States ranks 46th when it comes to infant mortality, coming in behind the vast majority of Europe, behind Australia, New Zealand and Canada, behind Korea and Cuba.[/b] Every year twice the number of U.S. babies die on their first day alive than in all 27 European Union nations combined, although 1 million more are born there (4.3 million versus 5.3 million respectively). This is one of many disconcerting statistics in Save the Childrens [i]State of the Worlds Mothers[/i] report published this year.
[b]It would be comforting to attribute the poor ranking to a quirk in how the deaths are calculated.[/b] After all, not all countries define birth the same way. For example, in the United States, arrivals of all living infants are counted as births, but a few European countries (the Czech Republic, France, Ireland, the Netherlands, Norway and Poland) have more restrictive definitions. For example, France and the Netherlands report live births only if the infant weighs at least 500 grams a little more than a pound or were born at 22 weeks gestation or later.
[b]But these reporting differences cannot account for the full extent of the gap between countries, says Paul Wise, MD, a pediatrician at Packard Childrens and a health policy analyst at Stanford. The reporting differences are a minor part of the story but not an excuse for why the U.S has such a high mortality rate. [/b]
Because even when researchers look only at births that meet the criteria for all European countries 500-gram babies born at 22 weeks and later the United States doesnt fare any better. In 2009, Marian MacDorman, PhD, a statistician at the Centers for Disease Control and Preventions National Center for Health Statistics drew up a new ranking list, comparing the United States with 20 European countries and excluding the deaths of all babies born before 22 weeks gestation. The United States still ranked below most European countries.
So the problem is real, which begs the questions: Whats going on? And whats to be done about it?
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US population is the same as Europe? You’re kidding right? You must be.
So what’s going on? The experts don’t know. I have a theory that it is due to the demographic and behavioral differences. Your theory is that the Socialists throw more of the RICH people’s money at it. But since we already spend more than anyone else, why haven’t we fixed this?
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And, BTW, your bringing forth a NYT article is not at all convincing. They have proven themselves over and over in the past 5 years to be blinded by ideology. Not to be trusted. And the article is by Nicholas Kristof – a political writer, with no expertise at all in medicine. The article he cites indicates an increase in maternal mortality. And says nothing about the cause. But Kristof’s unfounded implication is that it is a failure of the medical system. And people will simply accept that assumption without questioning. Without really even noticing that it is an assumption.
However, my first hypothesis would be that it would have something to do with “holistic” medicine – young women running away from scientifically based care to have babies at home, well away from emergency care. This sort of thinking is epidemic in the US. Just as childhood viral diseases are coming back in the US because of the insane anti-vax campaigns. Thus, such an increase in maternal mortality may have nothing at all to do with quality of US medical care – but be related to lack of intelligent thought by the patients themselves.
The referenced article indicates an approximate 80% rise in maternal mortailty between 2000 to about 2008 – from 10/100,000 to 18/100,000
Meanwhile, the average number of measles cases between 2000 and 2012 was about 60/year. In 2015 it was 667
This increase in measles is not a failure of the medical system, so why should we assume that increase in maternal mortality is?
This sort of critical analysis is beyond the capabilities of this NYT writer.
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That is the most asinine argument I have ever heard.
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Look up the populations Dalai & the land area “Europe” encompasses. US is a bit over 300 million & it depends on what is accepted by “Europe” which population can be measured over 700+ million Even if limited to Western Europe, depending on the countries included can be 200-400 million.
All I am asking you is why you think America can’t do universal healthcare. I assume you mean culturally since that is what I gather from your remarks. What culturally prevents Americans from universal healthcare when we already have “socialist” benefits that we seem to love, including Medicare & Social Security?
And why do you think we spend more $ on healthcare than anyone else int eh world with universal healthcare?
These are simple straightforward questions even if the answers aren’t easy.-
Those 700 million Europeans are not governed by one entity. Even in the decaying EU. That is a false tautology.
Americans are good at taking benefits, but they are not good at doing what they are told. Medicare and SS are given to the beneficiary, and he may more or less do what he wants with them. People are very happy to take “free” stuff. But when the costs become apparent…when the lines get long, for example, Americans will start to whine. LOUDLY.
You still aren’t helping me with the math problem. Since we spend more than everyone else, how does spending even more work?-
We already spend more, 2x as much in some cases. Where does spending even more come in? Unless you mean restoring everything as it was before the ACA so that we spend even more for even less?
Your math is not my math.
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Quote from Frumious
Your math is not my math.
Something we can definitely agree upon.
The ACA vastly increased costs, revealing the propensity of the previous occupant to lie through his teeth. Keeping your doctor and $2500 reduction in annual premiums? It would be funny if it wasn’t such a horrific falsehood.
So we can provide [i]better [/i]coverage UNIVERSALLY for less money? PLEASE tell me how that works. And don’t simply say, “Sweden does it so we can too!!!”-
The cost is already built in & is a fraction of what we pay per year anyway.
[link=http://www.factcheck.org/2015/02/conflating-costs-of-the-aca/]http://www.factcheck.org/…ting-costs-of-the-aca/[/link]Kominski stressed to us that while the costs associated with the ACA are not insignificant, they are a small portion of total national health expenditures in the United States. In 2013 alone, national health spending totaled [link=http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/downloads/highlights.pdf]$2.9 trillion[/link], more than double the 10-year net cost of the ACA. The nations total spending for that year amounted to $9,255 per person.
[link=https://www.thebalance.com/cost-of-obamacare-3306050]https://www.thebalance.co..st-of-obamacare-3306050[/link]
The non-partisan [link=https://www.thebalance.com/congressional-budget-office-what-it-does-and-its-impact-3305977]Congressional Budget Office[/link] said that the ACA would reduce the debt by $143 billion.
It added up the costs of both of the laws that implemented Obamacare. The Patient Protection and Affordable Care Act (Public Law 111-148) detailed the plan. The [link=https://www.thebalance.com/obama-s-health-care-reform-plan-3305753]Health Care[/link] and Education Reconciliation Act (Public Law 111-152) passed [link=https://www.thebalance.com/what-is-tax-freedom-day-3306327]new taxes[/link] and budget reductions in other areas, which offset the cost of the plan. Here’s how the [link=https://www.thebalance.com/obamacare-taxes-penalties-and-credits-3306061]Obamacare taxes[/link] affected you.
Here’s a summary of the five new taxes imposed by Obamacare, which would bring in an additional $567 billion in revenue:
[ol][*]Hospital insurance tax – $212 billion.[*]Non-compliance tax – $64 billion.[*]Cadillac health insurance tax – $32 billion.[*]Medical device and insurers tax – $107 billion.[*]Raising medical deduction limit to 10 percent – $104 billion. [/ol] Also, there were five areas where cost savings of $477 billion were implemented:
[ol][*]Reduce drug subsidies to the wealthy – $87 billion.[*]Reduce hospital DSH payments – $37 billion.[*]Reduce Medicare payments – $197 billion. [/ol][*]Reduce Medicare Advantage payments – $135 billion.[*]Service education loans directly. That eliminated the cost of the private loan servicer, Sallie Mae – $20 billion. [/ol] When the costs of $940 billion were deducted, the deficit would have been reduced by $104 billion. This would have been added back to the deficit if [link=https://www.thebalance.com/how-could-trump-change-health-care-in-america-4111422]Trump had repealed and replaced Obamacare[/link].
And yes, other countries do actually provide cheaper healthcare. So please answer how they can do it but we can’t? It’s obviously not impossible since we are the only ones who would not be able to do it.
America, the “Can’t Do” nation? Whatever happened to exceptionalism? Kennedy’s moonshot? Suddenly we are gelded? -
Frumi will not answer your question because it’s obvious. The lefts solution for everything. Raise taxes. First raise taxes on the wealthy so all leftys are happy. Then when they realize that’s not enough they will increase taxes on the middle class. Problem solved.
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Indeed. Taxes, taxes, taxes, and MORE taxes. That’s always the answer, isn’t it? Let RICH can pay for socialized medicine, that’ll work! The costs are built in? What tripe.
My taxes are up big time…You even post yourself that taxes and otherwise screwing the “wealthy” is how Obamacare got funded, and it doesn’t even begin to create a Universal/National/Socialist single payer system. That’s gonna cost a LOT more. But we can afford another $10K/person, can’t we? As long as the RICH pay it. I have yet to hear how WE can pay half of what we now pay per capita and achieve a better system. All I hear is “gimme, gimme, Gimme, GIMME, [size=”4″][i][b]GIMME[/b][/i][/size]!!!!!!”
In the meantime, MY health insurance premium is now $25,000/year with $6000 deductible. And I have to continuously fight with the company to get my kid’s Remicaid infusion that keeps him healthy.
As an aside, the blatantly partisan (or incompetent) CBO couldn’t calculate change from a burger and fries at McDonalds. They declared that the fractured Republican plan would cause millions to be dropped from the insurance rolls….when they MEANT that millions would CHOOSE not to have insurance if they weren’t FORCED to do. FORCED.
Sandeep Panga told us about Britain’s NHS. Here’s a little tidbit that will make IT folks, who don’t get the mission criticality of anything in healthcare, quake in their boots ([link]http://www.nejm.org/doi/pdf/10.1056/NEJMp1706754):[/link]
[blockquote] Superficially, the NHS cyberattack appeared to expose the pitfalls specific to underresourced socialized medicine. The British press discovered that the NHS IT system was particularly vulnerable to the WannaCry infection since, despite cybersecurity warnings, former Prime Minister David Cameron had elected to cut costs by scrapping a £5.5 million ($7.07 million) annual deal with Microsoft to provide ongoing security support for the 14-year-old Windows XP system thats still running on several hundred thousand NHS hospital computers. Worse, in March, Microsoft had issued a patch specifically to prevent this kind of malware attack, but many NHS computers were running software that was too old to benefit from it or that hadnt been patched in time.
Certainly, for frontline doctors like us who are used to wrestling with clunky NHS IT systems, the biggest surprise of the malware attack was not that it happened but why it had taken so long. It is an irony lost on no NHS doctor that though we can transplant faces, build bionic limbs, even operate on fetuses still in the womb, a working, functional NHS computer can seem rarer and more precious than gold dust.
But the NHSs cyberattack ex- perience has more nuanced and generalizable implications. First, it exposed the fact that although much has been written about cyberattacks potentially breaching confidential patient information, health care providers have not truly considered the physical harm that could befall our patients should an external party with malicious intent take over health service computers.4 This realization raises urgent questions about the necessity of equipping hospitals with fit-for-purpose IT. Digital security simply hadnt been an NHS priority until WannaCrys infection became the biggest cyberattack on critical infrastructure in U.K. history.
For NHS staff, the attack was stressful, grueling, and exhausting not least for the legions of NHS IT workers who toiled all night to update and then patch thousands of health service sys- tems. For doctors, it was a wake- up call. Underfunding ultimately left us horribly exposed to a predictable attack that threatened not just privacy but patient safety. If the WannaCry saga appears depressing, however a realization of the perils of poorly funded health care that was not the lesson we ultimately took from the experience. Facing adversity, with their backs against the wall, NHS staff quietly and resolutely got on with the job at hand.But although through our resilience our most vulnerable patients were able to pull through the crisis this time, we cannot be complacent and wait for a next time. All health care workers now have a responsibility to educate ourselves about this emerging threat and demand that funds be made available to ensure that the software we use is as up to date as the medicines we prescribe. We wouldnt accept being told to use outdated equipment on our patients, and our now-critical IT should be no different.
[/blockquote] THIS is what we want? Oh, I forgot. The RICH people will pay enough to keep that nightmare from happening here. Somehow there don’t seem to be enough RICH people in England to upgrade the NHS to something beyond WinXP.
Let’s talk about Sweden, the example Marxists often use as the epitome of socialized medicine. Not even considering the huge burden placed upon this once prosperous nation by their blind admittance of “refugees” (many of whom bilk the system and rape the women), the shining light of Socialism is fading fast:
[link=http://www.nationalcenter.org/NPA555_Sweden_Health_Care.html]http://www.nationalcenter…weden_Health_Care.html[/link]
[blockquote] [align=left][font=”verdana, arial, helvetica, sans-serif”][size=”-1″]While Sweden is a first world country, its health care system – at least in regards to access – is closer to the third world. Because the health care system is heavily-funded and operated by the government, the system is plagued with waiting lists for surgery. Those waiting lists increase patients’ anxiety, pain and risk of death.[/size][/font][/align] [align=left][font=”verdana, arial, helvetica, sans-serif”][size=”-1″]Sweden’s health care system offers two lessons for the policymakers of the United States. The first is that a single-payer system is not the answer to the problems faced as Americans. Sweden’s system does not hold down costs and results in rationing of care. The second lesson is that market-oriented reforms must permit the market to work. Specifically, government should not protect health care providers that fail to provide patients with a quality service from going out of business.[/size][/font][/align] [align=left][font=”verdana, arial, helvetica, sans-serif”][size=”-1″]When the United States chooses to reform its health care system, reform should lead to improvement. Reforming along the lines of Sweden would only make our system worse. [/size][/font][/align]
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[link=https://www.thelocal.se/20150127/swedens-health-care-is-a-shame-to-the-country]https://www.thelocal.se/2…a-shame-to-the-country[/link]
[blockquote]Swedish patients have reacted to the poor availability of medical care by highly justified dissatisfaction. The official national guideline for the maximum waiting time to see a doctor in primary care in Sweden is seven days (ridiculously long compared to many other countries). Only Portugal has longer expected waiting times.
Current surveys suggest that the waiting time for family physicians and specialists in the Greater Stockholm area currently appears to be up to one month.
The county councils and the Swedish Association of Local Authorities and Regions’ (SKL) excuses are well known: shortage of doctors, large migration to urban areas, nurses fleeing the profession, and so on.
But in reality, Sweden has no fewer doctors and other health professionals than most other countries in the study.
There is no relationship between money supply and availability. Albania, one of Europe’s poorest countries, has no waiting time at all. And population movements and demographic changes are taking place all across Europe, not just in Sweden.
No, it seems that waiting times are a mental disorder inherent in the Swedish health care administration, rather than a resource issue. It would be interesting for behavioural researchers to perhaps study how within an empathetic profession such as child psychiatry, doctors can become accustomed to announcing to their young patients and relatives that the waiting time for an appointment is 18 months – a common timeframe in Sweden.
The question remains: What is preventing Sweden from taking a firm grip on its exuberant waiting times and making radical improvements? It hardly needs more investigation or more money – health care is not more expensive in countries with good accessibility. How long will queuing patients have to live with anxiety, pain and incapacity before Sweden’s counties are able to honour their duties?
[/blockquote] Sweden spends roughly half of what we do on healthcare per capita. SOME of their metrics are better than ours, but…Sweden has a small population, they are healthier genetically, there is far less obesity, etc. To say they do a better job ignores all of this. And it turns out they might not be doing a better job.
As usual, this is but an academic exercise. As with globalconfusionclimatewarmingchange, those who believe, BELIEVE. Frumious is OK with reducing everyone to waiting days, months, years, whatever, for their care, as long as everyone is treated equally. And if that ends up with everyone equally [i]miserable[/i] that’s OK. There is no single nation with the heterogeneity of population we have here, with the spirit of independence, with the genetic variability.
Again…. I want to hear how we can spend half of what we do and get a better system, and if that is possible, why are my taxes and premiums skyrocketing? I haven’t heard anything to dissuade me from my opinion that this is all about wealth-redistribution far more than making anyone the slightest bit healthier.
As an aside, I’m wondering what PACS Frumious manages. It must have incredibly minimal requirements for supervision.-
I believe our country could sort of achieve universal care. It would require a two tiered system where everybody receives basic care. For those who want 10 spine mri’s per year, they would have to pay for it unlike in our current open bar health care system.
The main problem with universal care in America at present is that you would be taxing the rich to give to the super rich–not the poor. What I mean is our government has to grow a sack and negotiate with pharmaceutical companies and the like. Otherwise when taxpayers spend a dollar on care for the poor and middle class the bulk of that money is going to rich corporate executives. Fix the system first so the money is spent productively.
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I have been fortunate enough to travel around the world a bit. Americans lack of personal responsibility has led to rampant health problems. Adult and childhood obesity has led to diabetes, htn, etc….was in Amsterdam and you have to search for overweight people. In US you have to search for thin people. i wonder if this has anything to do with our expensive, subpar healthcare?
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Quote from Dr Spaceman
I believe our country could sort of achieve universal care. It would require a two tiered system where everybody receives basic care. For those who want 10 spine mri’s per year, they would have to pay for it unlike in our current open bar health care system.
The main problem with universal care in America at present is that you would be taxing the rich to give to the super rich–not the poor. What I mean is our government has to grow a sack and negotiate with pharmaceutical companies and the like. Otherwise when taxpayers spend a dollar on care for the poor and middle class the bulk of that money is going to rich corporate executives. Fix the system first so the money is spent productively.
Which part(s) get fixed first to spend productively? First the voters need to recognize the necessity of creating a good affordable healthcare system & then what that means. Politicians need to then do the work for this. Right now we see all Republicans opposed to this although that might be changing with the threat to Medicare/Medicaid and those who have gained insurance due to the ACA by more conservative members of Congress.Medicare negotiating drug pricing is forbidden by Congress at the present time. Otherwise, yes, negotiating is an absolute necessity for any sort of affordable system.
[link=http://www.nytimes.com/2007/04/18/washington/18cnd-medicare.html]http://www.nytimes.com/20…on/18cnd-medicare.html[/link]
A pillar of the Democratic political program tumbled today when Republicans in the Senate blocked a proposal to allow Medicare to negotiate lower drug prices for millions of older Americans, a practice now forbidden by law.
Democrats could not muster the 60 votes needed to take up the legislation in the face of staunch opposition from Republicans, who said that private insurers and their agents, known as pharmacy benefit managers, were already negotiating large discounts for Medicare beneficiaries.[link=http://www.pbs.org/newshour/making-sense/medicare-allow-price-gouging-prescription-drugs/]http://www.pbs.org/newsho…ng-prescription-drugs/[/link]
Your government is allowing this, because the pharmaceutical industry convinced enough legislators in 2003 to forbid Medicare from negotiating drug prices when Congress enacted the law creating Part D drug plans.
But it does require other changes:
[link=https://www.nytimes.com/2016/02/02/upshot/the-real-reason-medicare-is-a-lousy-drug-negotiator-it-cant-say-no.html]https://www.nytimes.com/2…or-it-cant-say-no.html[/link]
A good negotiator needs to be able to walk away.
The current system has private insurance companies each negotiating separate deals on behalf of large groups of Medicare patients. Right now, the program is O.K. at negotiating, saving as much as 30 percent off the list price of drugs, according to government reports. But Medicare still pays much, much more than government health systems in other countries.
The real problem is that Medicare can very rarely say No way to a drug company. Medicare beneficiaries wanted the program to cover most drugs that older people would want to use. So Congress put in place rules that strengthen the hand of the drug companies in negotiations.
Medicare is required to cover [link=https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/downloads/chapter6.pdf#page=23]almost every cancer treatment that is approved[/link] by the Food and Drug Administration, for example, one of six categories where the drug plans can almost never say no to the drug companies. If a drug maker comes out with a new cancer medicine with a sky-high price, theres not much a Medicare plan can do to talk it down.
To negotiate prices any further, the government would need to impose access or coverage restrictions on medicines, said Doug Elmendorf, testifying before Congress in 2009. Elmendorf was the director of the budget office then; he is now the dean of Harvards John F. Kennedy School of Government.
The government does have one program that can say no to drug companies, and it gets much better deals than Medicare. The Department of Veterans Affairs negotiates hard with drugmakers. But it is also bound by fewer rules than Medicare, and one result is that it covers far fewer drugs.
Other countries act more like the V.A. than Medicare. In Britain, drug makers that wont negotiate wont be able to sell any drugs at all. Thats real leverage, but it also means that patients in England dont have access to all the drugs that older people in the United States might want to take.
But one of the criticisms for conservatives would be that government is price setting by this negotiating or otherwise interfering & skewing the market since Medicare is such a large customer. But then drug companies are not exactly tiny either.
It does require stronger regulating from the government. Again something conservatives are opposed to.
There are many examples of other countries doing what is necessary to grate an affordable universal healthcare system; private insurance can be supplemental or be available instead. My opinion is that reducing administrative costs as well as openness of charges would also make a significant impact on cost as a start along with drug choices and prices. -
Quote from Dr Spaceman
I believe our country could sort of achieve universal care. It would require a two tiered system where everybody receives basic care. For those who want 10 spine mri’s per year, they would have to pay for it unlike in our current open bar health care system.
The main problem with universal care in America at present is that you would be taxing the rich to give to the super rich–not the poor. What I mean is our government has to grow a sack and negotiate with pharmaceutical companies and the like. Otherwise when taxpayers spend a dollar on care for the poor and middle class the bulk of that money is going to rich corporate executives. Fix the system first so the money is spent productively.
I believe Dr Spaceman is on the right track. It remains to be seen if big pharma and device companies can be reigned in. Also medical needs are almost infinite- especially when all that is required for medicare reimbursement is a study with a p value less than .05.
The American public are continually robbed and physically harmed by worthless care-
Spine fusion surgery and most spine surgery for that matter
epidural or almost and other joint injection.
Coronary stenting
Overpriced chronic opioid treatment
Most psychiatric medications
the list is endless….-
Quote from bcov
The American public are continually robbed and physically harmed by worthless care-
Spine fusion surgery and most spine surgery for that matter
epidural or almost and other joint injection.
Coronary stenting
Overpriced chronic opioid treatment
Most psychiatric medications
the list is endless….
Is your beloved IA planning to spread the predatory model to cardiology and surgery? Otherwise, you’re speaking out of school about things you are not qualified to denigrate. As with certain people chasing med students away from radiology with their dire, baseless predictions, your hubris might be harming someone in need of one of those medications or procedures. I’ve had epidurals, for example, and I have absolutely no doubt I avoided spine surgery. But several partners have had spine procedures when necessary and they have done very well. I know people whose lives have been saved by antidepressants. [i]MY[/i] list is endless.
Apparently you believe the former Occupant who accused physicians of removing tonsils and limbs to pad their bills. Guess that’s business as usual at IA, but not for the rest of us.
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Quote from Dr Spaceman
I believe our country could sort of achieve universal care. It would require a two tiered system where everybody receives basic care. [b]For those who want 10 spine mri’s per year, they would have to pay for it unlike in our current open bar health care system. [/b]
[b]The main problem with universal care in America at present is that you would be taxing the rich to give to the super rich–not the poor. [/b]What I mean is our government has to grow a sack and negotiate with pharmaceutical companies and the like. Otherwise when taxpayers spend a dollar on care for the poor and middle class the bulk of that money is going to rich corporate executives. Fix the system first so the money is spent productively.
Absolutely
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Sardonicus, no one claimed Kristof is medical but he writes on women’s issues, whether female genital cutting/mutilation or slavery or keeping women out of schools or even women dying of pre-eclampsia. And if the majority of woman are not seeking medical care because they are seeking “holistic” medicine instead, you have to show me stats because I doubt alternative medicine is the cause of higher death rates. Please show me I’m wrong, that the majority of deaths are caused by patients choosing alternative care over regular medical care. The article states that women in Texas for example have a higher mortality rate than women in some European countries. Are Texas women suddenly eating granola & adopting holistic medicine over regular medicine?
Frumi
Once again, I urge you to read what I wrote before responding.
In the article cited, the authors said they had no indication of what the reason for the increase was.
I said ONE HYPOTHESIS to be tested was that many women are spurning actual medical care.
You mention a majority of women. I said nothing about the numbers.
In fact, it does not take a majority.
The increase in Measles is a result of only 8-9% of children not being vaccinated
I would be very sure that a Majority of women are not ignoring medical care. But it does not take a majority to impact the overall mortality rate. If 1% of women opt out of medical care (certainly a possibility), and the mortality rate among that cohort is 0.8% (certainly a possibility), then you have the increase of 8/100,000 live births. So this is a hypothesis worthy of consideration.
I mention this idea primarily to point out that Kristof says or implies poor medical care is to blame for the increase in mortality rate when the authors he quotes states straight out that they have no idea why this has occurred, and there are other potential reasons for it to have occurred. Yet another example of NYT letting their ideology get in the way of actual, factual journalism.
I have now spent 15 minutes responding to your misrepresentation of my post. I am actually angry about that. Responding to your straw men and misrepresentations is a time consuming, unending task, and I am done with it. Others should consider this and decide perhaps to do the same.
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Quote from Dr.Sardonicus
Frumi
Once again, I urge you to read what I wrote before responding.
In the article cited, the authors said they had no indication of what the reason for the increase was.
I said ONE HYPOTHESIS to be tested was that many women are spurning actual medical care.
You mention a majority of women. I said nothing about the numbers.
In fact, it does not take a majority.
The increase in Measles is a result of only 8-9% of children not being vaccinated
I would be very sure that a Majority of women are not ignoring medical care. But it does not take a majority to impact the overall mortality rate. If 1% of women opt out of medical care (certainly a possibility), and the mortality rate among that cohort is 0.8% (certainly a possibility), then you have the increase of 8/100,000 live births. So this is a hypothesis worthy of consideration.
I mention this idea primarily to point out that Kristof says or implies poor medical care is to blame for the increase in mortality rate when the authors he quotes states straight out that they have no idea why this has occurred, and there are other potential reasons for it to have occurred. Yet another example of NYT letting their ideology get in the way of actual, factual journalism.
I have now spent 15 minutes responding to your misrepresentation of my post. I am actually angry about that. Responding to your straw men and misrepresentations is a time consuming, unending task, and I am done with it. Others should consider this and decide perhaps to do the same.
OK, remove “majority.” But from your statement I gathered you were saying that holistic alternative medicine play a significant part in the numbers.
However, my first hypothesis would be that it would have something to do with “holistic” medicine – young women running away from scientifically based care to have babies at home, well away from emergency care. This sort of thinking is epidemic in the US. Just as childhood viral diseases are coming back in the US because of the insane anti-vax campaigns. Thus, such an increase in maternal mortality may have nothing at all to do with quality of US medical care – but be related to lack of intelligent thought by the patients themselves.
As for the anti-vax idiots, they are idiots & their beliefs are a result of ignorance, distrust in medical care & government an industry – the fear of deliberate mercury poisoning, autism or something related to the Red scare of the past with fluoride in public water systems. It also is related to so-called “freedom” claims of rejecting government requirements. There is a rad on AM with whom I had disagreements about his apparent support of the anti-vaxers in the name of resisting government requirements, something rather astounding to me.
As for Kristof, I think his arguments using pre-eclampsia as an example, is that the symptoms can be better recognized and therefore deaths reduced. Not an altogether unreasonable thing in itself. And the NYTimes is not The Lancet either; but even The Lancet has published articles that have proven false such as the origin of the anti-vaxers conspiracy, the MMR vaccine as published in The Lancet. Is that a fault of medicine? But the paper was debunked by another newspaper, the Sunday Times & reporter Brian Deer.
But my point from the beginning was always that our numbers regardless of whomever points out examples, Kristof or someone else, our numbers are higher than other developed countries. No one has stated definitive reasons except suggesting poverty and access to healthcare as large factors, regardless of the anti-vaxers and “holistic medicine” seekers being exceptions. Poor people aren’t making this choice and yes, Kristof has an agenda. I have an agenda writing this, I am for universal healthcare & think we can do better providing healthcare.
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Quote from Dr.Sardonicus
I have now spent 15 minutes responding to your misrepresentation of my post. I am actually angry about that. Responding to your straw men and misrepresentations is a time consuming, unending task, and I am done with it. Others should consider this and decide perhaps to do the same.
That’s all she does. Make up stuff you said and then argue against what she claimed you said. This trolling has been going on for years.
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The “single payer” discussion is incredibly important and polarizing. Some are incredibly invested in the idea and refuse to see any other possible approach. The near-mania exhibited rivals the rabidity about global climatewarmingchaoschange. It becomes a near-religious quest, very difficult to discuss in any semblance of a rational manner.
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fw, why are you a self-hating woman?
Ah, now it’s my turn to whinge & whine for 5 min or 15 min that people aren’t reading what I said and are inventing things I did not say. What is good for the goose is good for the gander as my grandmother told me.
What I did say is that I am in favor of universal healthcare. Period.
Whether it is single payer or say Germany’s flavor is fine if not irrelevant to th importance of keeping a universal healthcare system. Keeping down costs is the 2nd part, whether that is through single payer or not matters not. The single glaring factor is that we in our system have the most expensive system of all with benefits that aren’t as good as many industrialized countries while not covering as many as those other countries do. What has been said for GE medical products can be said about our system of healthcare, “You will find better systems but you won’t find a more expensive system.”
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“Is your beloved IA planning to spread the predatory model to cardiology and surgery?”
IA no longer exists- it has been subsumed into Envision Healthcare Holdings, Inc. Otherwise known as EVHC traded on the New York stock exchange, which will likely be subsumed by a larger company in the near future…
I do not love the corporate practice of medicine, I fear it.
“Otherwise, you’re speaking out of school about things you are not qualified to denigrate.”
Envision’s scope of business has no bearing on my scope of knowledge. My reading, training, and experience do.
“As with certain people chasing med students away from radiology with their dire, baseless predictions, your hubris might be harming someone in need of one of those medications or procedures.”
How can someone be harmed by not having a placebo or harmful procedure?
“I’ve had epidurals, for example, and I have absolutely no doubt I avoided spine surgery. But several partners have had spine procedures when necessary and they have done very well. I know people whose lives have been saved by antidepressants. [i]MY[/i] list is endless.”
Anecdotal “evidence” is not evidence at all. Placebo response must be separated from specific therapeutic effect by means of double blind randomized controlled trials or sham RCTs for procedures.
As I have said before I question if DoctorDalia is indeed a doctor at all. He or she sounds more like a technologist or corporate healthcare’s most recent invention, the “Noctor.” DoctorDalia is an expert and quite adept at the non sequitur.“Apparently you believe the former Occupant who accused physicians of removing tonsils and limbs to pad their bills. Guess that’s business as usual at IA, but not for the rest of us.”
Envision, or any radiology group, has no impact on what business a hospital or referring doctor chooses to engage in.-
Wanna see my medical licenses from four states? And my diploma from a pretty good medical School? At least copy and paste my nickname correctly if you feel the intense need to act like a bloody jerk.
So you are now a toady for Envision instead of IA. Whoopie. How do you sleep at night? Does Hashim or his successor tuck you in?
Your OPINION as a radiologist, who by the way works for [i]traitors[/i] to the entire field, is that some of these procedures are placebos. There is a host of literature out there that disagrees. Including my own personal experience. Your declaring this as FACT could dissuade someone who lands here via google or whatever to avoid a necessary procedure. But since you can sleep at night anyway, that might not bother you at all.
Typical mentality of a corporate flunky. Bad case of LDS. -
Quote from bcov
“Is your beloved IA planning to spread the predatory model to cardiology and surgery?”
IA no longer exists- it has been subsumed into Envision Healthcare Holdings, Inc. Otherwise known as EVHC traded on the New York stock exchange, which will likely be subsumed by a larger company in the near future…I do not love the corporate practice of medicine, I fear it.
“Otherwise, you’re speaking out of school about things you are not qualified to denigrate.”
Envision’s scope of business has no bearing on my scope of knowledge. My reading, training, and experience do.“As with certain people chasing med students away from radiology with their dire, baseless predictions, your hubris might be harming someone in need of one of those medications or procedures.”
How can someone be harmed by not having a placebo or harmful procedure?“I’ve had epidurals, for example, and I have absolutely no doubt I avoided spine surgery. But several partners have had spine procedures when necessary and they have done very well. I know people whose lives have been saved by antidepressants. [i]MY[/i] list is endless.”
Anecdotal “evidence” is not evidence at all. Placebo response must be separated from specific therapeutic effect by means of double blind randomized controlled trials or sham RCTs for procedures.
As I have said before I question if DoctorDalia is indeed a doctor at all. He or she sounds more like a technologist or corporate healthcare’s most recent invention, the “Noctor.” DoctorDalia is an expert and quite adept at the non sequitur.
“Apparently you believe the former Occupant who accused physicians of removing tonsils and limbs to pad their bills. Guess that’s business as usual at IA, but not for the rest of us.”
Envision, or any radiology group, has no impact on what business a hospital or referring doctor chooses to engage in.
Let’s just stop this.
Dalai is a radiologist. A fine one. Who is very concerned with the quality of medicine and how it is going to hell. His concern shows in the intensity of his arguments.
I know because I am a personal friend and we have had many discussions on this and other subjects online and over dinner.
So – just stop with the personal stuff – the slinging of suspicions, etc. Confine the arguments to substantive contributions, preferably referenced.
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Thanks, Dr. S, but might as well let him bleat. It just erodes away at what little credibility he has left.
But back to single payer, which itself is a hijack of your original thread.
The [link=https://www.fraserinstitute.org/studies/health-care]Fraser Institute[/link] is a non-partisan think tank in Canada. Their reports on Canada’s idolized system are eye-opening:
[blockquote]Canadians often misunderstand the true cost of our public health care system. This occurs partly because Canadians do not incur direct expenses for their use of health care, and partly because Canadians cannot readily determine the value of their contribution to public health care insurance.
In 2017, the estimated average payment for public health care insurance ranges from $3,994 to $12,410 for six common Canadian family types, depending on the type of family.
For the average Canadian family, between 1997 and 2017, the cost of public health care insurance increased 3.2 times as fast as the cost of food, 2.7 times as fast as the cost of clothing, 1.9 times as fast as the cost of shelter, and 1.8 times faster than average income.
The 10% of Canadian families with the lowest incomes will pay an average of about $471 for public health care insurance in 2017. The 10% of Canadian families who earn an average income of $63,163 will pay an average of $5,789 for public health care insurance, and the families among the top 10% of income earners in Canada will pay $39,123.[/blockquote] [blockquote]In 2016, an estimated 63,459 Canadians received non-emergency medical treatment outside Canada.
Physicians in British Columbia reported the highest proportion of patients (in a province) receiving treatment abroad (2.4%). The larg- est number of patients estimated to have left the country for treatment was from Ontario (26,513).
Across Canada, otolaryngologists reported the highest proportion of patients (in a specialty) travelling abroad for treatment (2.1%). The largest number of patients (in a specialty) travelled abroad for general surgeries (9,454).One explanation for patients travelling abroad to receive medical treatment may relate to the long waiting times they are forced endure in Canadas health care system. In 2016, patients could expect to wait 10.6 weeks for medically necessary treatment after seeing a specialistalmost 4 weeks longer than the time physicians consider to be clinically reasonable (7.0 weeks). One measure of the privately borne cost of wait times is the value of time that is lost while waiting for treatment. [/blockquote] [blockquote]Valuing only hours lost during the aver-
age work week, the estimated cost of waiting for care in Canada for patients who were in
the queue in 2016 was more than $1.7 billion. This works out to an average of about $1,759 for each of the estimated 973,505 Canadians wait- ing for treatment in 2016.
This is a conservative estimate that places no intrinsic value on the time individuals spend waiting in a reduced capacity outside of the work week. Valuing all hours of the week, in-cluding evenings and weekends but excluding eight hours of sleep per night, would increase the estimated cost of waiting to $5.2 billion, or about $5,360 per person.
This estimate only counts costs that are borne by the individual waiting for treatment. The costs of care provided by family members (the time spent caring for the individual waiting for treatment) and their lost productivity due
to dif culty or mental anguish are not valued in this estimate. Moreover, non-monetary medical costs, such as increased risk of mortality or ad- verse events that result directly from long delays for treatment, are not included in this estimate. [/blockquote] And so on.
Single Payer doesn’t work [i]well[/i] anywhere, and it won’t work HERE at all.
But we cannot progress, we cannot create something better because our promise-breaking, power-hungry Congress won’t take the chance on losing a vote from some entitled ObamaScare lover who will have a tantrum if anyone even suggests that his pacifier might be taken away, even temporarily. So we’re stuck.
Here, I agree with President Trump…The huge premium increases and higher and higher deductibles will soon make people realize just how bad ObamaScare really is. And then I HOPE the GOP has something decent to replace it with. Or we’ll be scr3wed even worse.
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Canada and Britain are programs that are the poster children for bad nationalized health care.
But – it must be said that our system doesn’t work well now either.
I am curious about Germany and Switzerland. I have heard rumors that they do well, but don’t know details. In particular I have heard that the Swiss require every insurance company that wants to sell any insurance at all (auto, life) to sell health insurance with a profit margin of 1%. Interesting thought.-
Oh, I agree. I’ve said about five dozen times that our whole mess needs to be scrapped and redone. But since I didn’t declare fealty for Socialism, I mean Single Payer, this statement was not felt acceptable or adequate.
But we need something new. What works in places with relatively small, homogeneous populations will not work for 300 million cranky, cantankerous Americans. It just will not work.-
reminds me –
During the HilaryCare debacle, I heard a physician in Boston interviewed – because he was Canadian and had experience in both systems.
What he said was this (paraphrased): “The Canadian system would work in the US except for one problem – the US is populated with Americans, not Canadians”
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[link=http://www.swisshealth.ch/en/ueber-die-schweiz/gesundheitswesen.php]http://www.swisshealth.ch…z/gesundheitswesen.php[/link]
Health insurance is compulsory for all Swiss residents. International civil servants, members of permanent missions and their family members are exempted from compulsory health insurance. However, they can apply to join the Swiss health insurance system within six months of taking up residence in the country.
Swiss are required to purchase basic health insurance, which covers a range of treatments detailed in the Federal Act. Therefore, double standards in healthcare can be avoided as the rules are the same throughout the country. Insurers are required to offer this basic insurance to everyone, regardless of age or medical condition. They are not allowed to make a profit off this basic insurance; they can, however, have varying prices on supplemental plans.
Overall, the Swiss health system is a variant of the highly government-regulated social insurance systems of Europe: Ostensibly private, nonprofit health insurers that also are subject to uniform fee schedules and myriad government regulations.
The insured person pays the insurance premium for the basic plan up to 8% of their personal income. If a premium is higher than this, the government gives the insured person a cash subsidy to pay for any additional premium.
The Swiss Health care system is according the WHO one of the worldwide most advanced health care systems that guarantees outstanding medical result all over the country and therefore is often taken as an antetype to build up adequate health care systems in other countries.
[link=https://www.expatica.com/ch/healthcare/Getting-healthcare-in-Switzerland_103130.html]https://www.expatica.com/…witzerland_103130.html[/link]
[ul][*]Switzerland spends the highest percentage of GDP on healthcare (around 11.4 percent) compared to all EU countries.[*]Basic health insurance is compulsory in Switzerland, although you are free to choose your own Swiss health insurance company.[*]In the EU’s latest statistics, Switzerland was the only country compared to the EU to total more than EUR 4,500 per inhabitant on healthcare expenditure. [/ul]
[link=https://www.expatica.com/de/healthcare/Your-guide-to-the-German-healthcare-system_103359.html]https://www.expatica.com/…are-system_103359.html[/link]
The German healthcare system dates to the 1880s, making it the oldest in Europe, while today its doctors, specialists and facilities make it of one the very best healthcare systems in the world. Today it operates under a dual public-private system.
The healthcare system in Germany is funded by statutory contributions ensuring free healthcare for all. You can also take out [link=https://www.expatica.com/de/healthcare/German-health-insurance_693463.html]private health insurance[/link] (Private Krankenversicherung or PKV) to replace or top up GKV cover. There are strict conditions, however, about who must register for mandatory state health insurance, and who can opt out in favour of private health insurance.
Germanys healthcare system sits between the British state-run and the American market-led model, relying on a dual public-private system. Before you consider the positives and negatives of the German healthcare system, expats need to consider whether public insurance or private health insurance is required.
In particular, self-employed, eldery residents, long-term students and high-earners will have to weigh up the positives and negatives of public and private healthcare in Germany, as they are eligible to opt out of Germany’s mandatory public health insurance.
[h4]German healthcare system pros[/h4] [ul][*]Under the German healthcare system, you are not restricted to the nearest GP in your postcode. Patients in Germany are able to choose from a wide range of doctors, hospitals and remedies.[*]Patients are not expected to first see their doctor in Germany before being referred to an alternative healthcare professional. If you wish to see a chiropractor you can do so without a doctor’s referral.[*]Germany’s private health insurance sector is well developed with plenty of choice. Private health insurance is available from more than two dozen German health insurance companies, including charity and church-run hospitals, as well as private centres. [/ul]
[link=https://www.theatlantic.com/health/archive/2014/04/what-american-healthcare-can-learn-from-germany/360133/]https://www.theatlantic.c…n-from-germany/360133/[/link]
All things considered, its good to be a sick German. There are no network limitations, so people can see any doctor they want. There are no deductibles, so Germans have no fear of spending hundreds before their insurance ever kicks in.
Theres also no money that changes hands during a medical appointment. Patients show their insurance card at the doctors office, and the doctors’ association pays the doctor using money from the sickness funds. “You dont have to sit at home and sort through invoices or wonder if you overlooked fine print, Sophia Schlette, a public health expert and a former senior advisor at Berlins National Statutory Health Insurance Physicians Association, told me. That insurance card, by the way, is good for hospital visits anywhere in Europe.
Germany is in the middle of the pack among developed countries when it comes to healthcare spending per capita, according to a report [link=http://www.commonwealthfund.org/~/media/Files/Publications/In%20the%20Literature/2013/Nov/PDF_Schoen_2013_IHP_survey_chartpack_final.pdf]released[/link] by the Commonwealth Fund last fall.
But of all of the countries studied, Germans were the most likely to be able to get a same-day or next-day appointment and to hear back from a doctor quickly if they had a question. They rarely use emergency rooms, and they can access doctors after-hours with ease.
Perhaps the biggest difference between our two approaches is the extent to which Germany has managed to rein in the cost of healthcare for consumers. Prices for procedures there are lower and more uniform because doctors associations negotiate their fees directly with all of the sickness funds in each state. That’s part of the reason why [link=http://www.washingtonpost.com/wp-srv/special/business/high-cost-of-medical-procedures-in-the-us/]an appendectomy costs[/link] $3,093 in Germany, but $13,000 in the U.S.
In Germany, there is a uniform fee schedule for all physicians that work under the social code, Schlette said. Theres a huge catalogue where they determine meticulously how much is billed for each procedure. Thats like the Bible.
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From 2004 but still applicable. By Uwe Reinhardt
[link=http://jamanetwork.com/journals/jama/fullarticle/199371]http://jamanetwork.com/jo…ama/fullarticle/199371[/link]Americans who are not in favor of government-run health insurance may find the German, Dutch, and Swiss health systems of special interest. None of these nations relies on government-run health insurance as in the model of the Canadian provincial health insurance plans or the US Medicare and Medicaid/State Children’s Health Insurance Program programs. All 3 have flirted in recent years with elements of price-based consumer choice, albeit within a framework of strictly regulated competition.
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The Swiss system is very similar to the us under the ACA ( we’re it to be strengthened)
Private insurance strongly regulated.
Individual mandate.
Coverage guarantees with individual copays.
Limits of 8% of income for total cost of a plan.
They also have the second most expensive system in the world.
Living with the politics realities of the US, getting to the Swiss system is about as good as be expected .
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Let’s just stop this.
Dalai is a radiologist. A fine one. Who is very concerned with the quality of medicine and how it is going to hell. His concern shows in the intensity of his arguments.
I know because I am a personal friend and we have had many discussions on this and other subjects online and over dinner.
So – just stop with the personal stuff – the slinging of suspicions, etc. Confine the arguments to substantive contributions, preferably referenced.
Dr Sardonicus- Only one out of 7 of my rebuttals was an ad hominem fallacious attack- I agree it was unprofessional, irrational, and ineffective but pleasing to my irrational side. Also, Dr Dalai seems to respond only to ad hominem attacks while disregarding true substance- it’s easier I guess.
There rest were sound arguments.
Dr Dalai may be a fine radiologist. I cannot comment on his expertise and haven’t.
His reasoning however, I have questioned.
I cannot agree that he is concerned with the quality of medicine since he supports ineffective and harmful procedures, medications, and the US rigged healthcare system operating under the false pretense of laissez faire capitalism.
I do think he is concerned with maintaining his socioeconomic status through low taxation and exploitation of those of lower socioeconomic status- nothing wrong with self interest per se but don’t wave that flag under the guise of justice or the general good.
“Justice is fairness.” -John Rawls
Dr Dalai’s atavistic regression to juvenile genitalia comments exposes him for the Trumper he is.
Trump was taunting rival Marco Rubio by calling him “Little Marco.” The Florida senator struck back at a rally. “I’ll admit it, he’s taller than me,” he told a crowd of supporters in Virginia. “He’s like 6’2″, which is why I don’t understand why his hands are the size of someone who is 5’2″. And you know what they say about men with small hands? You can’t trust them.” Trump responded a few days later, at the Republican debate in Detroit. “Look at those hands, are they small hands?” he said, raising them for all to see. “And [Rubio] referred to my hands ‘If they’re small, something else must be small.’ I guarantee you, there’s no problem. I guarantee.”
For the first time in American history, penis size became an issue in a presidential campaign.
[link=http://www.hollywoodreporter.com/news/how-small-are-trumps-hands-916593]http://www.hollywoodrepor…re-trumps-hands-916593[/link]
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And some elements of the German, and Swiss, and Australian, and Japanese system might be helpful here.
We should have the opportunity to build upon the best [i]medical care[/i] in the world to create the best [i]insurance [/i]in the world. But we cannot progress when politicians are too scared to do anything.-
Politicians are not the sole problem, they are going where they are being pushed for the most part as well as ideology.
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Not really. The majority of the GOP members of Congress are in their seats because they promised to repeal ObamaScare. Now, they are paralyzed by their fear of [i]losing [/i]their seats if they vote away the pacifier. One wonders how much overlap there is in the electorate that voted for the repealers and those who whine about having entitlements taken away. I would bet there isn’t much.
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I disagree. There must be considerable overlap or the GOP wouldn’t be scared. I also do recall at least some of them promising they had a better plan, not just a repeal.
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You might well be right, although the entitled tend to make themselves heard to a greater degree than the disgusted.
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Quote from Frumious
Politicians are not the sole problem, they are going where they are being pushed for the most part as well as ideology.
This cynic disagrees.
Politicians gain power by promising stuff. Free stuff. So they promise free – or greatly reduced price (below the value delivered) medical care. People like that. a lot.
Trump offered to do things he can’t do. People loved it and voted for him simply because he promised.
Now, to be fair, Obama and Hilary also promised things they knew they couldn’t do.
So it is a competition – who can promise the most without really being concerned with whether they can deliver. After all, you have to get into office to do anything.
Does that make it politicians’ fault for promising what people want, or the people’s fault for 1) demanding irrational, economically impossible benefits and 2) not scrutinizing the promises to understand they are impossible.? Take your choice. Either is correct.-
and – we DO have to ask.
Precisely what is the malpractice situation in those countries.
We all see useless over-testing rampant through our practices.
here is a partial list I have written in two minutes:
mammograms for breast pain
F/u ultrasounds for breast cysts
CT for head bumps
follow up CT’s for lung densities.
We all know that this is partially a result of fee for service – both on the part of physicians and facilities, but also due to the need for the physician to purchase the very cheapest form of malpractice insurance by being sure you did EVERYTHING possible for the patient – the pan-scan.
And – also – it is no secret that a very large portion of our total national medical bill is incurred in the patients last days on the planet. Other countries actually let people go without running up bills of 100s of thousands of dollars before they do.
30 percent of all expenses of decedents occurred in the last 30 days of life, 46 percent in the last 60 days, and 77 percent in the last six months of life;
[link=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690284/ ]https://www.ncbi.nlm.nih….cles/PMC2690284/ [/link]
(this from 2005)-
Quote from Dr.Sardonicus
And – also – it is no secret that a very large portion of our total national medical bill is incurred in the patients last days on the planet. Other countries actually let people go without running up bills of 100s of thousands of dollars before they do.
30 percent of all expenses of decedents occurred in the last 30 days of life, 46 percent in the last 60 days, and 77 percent in the last six months of life;
[link=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690284/]https://www.ncbi.nlm.nih….cles/PMC2690284/ [/link]
(this from 2005)
That is actually not what the data says. The data says that for a particular subgroup of people who actually died, the expenses were distributed in that manner. The data does not show that those percentages of our global healthcare expenses are spent within the stated timing. One of the more recent studies using the medicare claims file and data from private insurers puts the total expenses in the last year of life across the board at somewhere around 15%.
Yes, we all know the COPDers that spend 99 days in the ICU before they died hand had several stroke evaluations with MRI/CTA/US and repeat CTPAs along the way. We all know this is an absurd waste of money and I wish there was a way to fix it. But as absurdly expensive as those cases are, as a proportion of all healthcare expenses they are not as big of slice of the pie as we tend to think.
Some of the best money we can spend in medicine is to train more palliative care specialists and geriatricians. It’ll save us some of those last year expenses but more importantly it improves the comfort of those who don’t benefit from aggressive medical intervention.
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And this cynic disagrees. As Dalai pointed out, all the Republicans promised to REMOVE something, specifically the ACA.
Politicians are elected because they are giving the voters what they want, whether “free stuff” or not. Even attitude.
And as for “free stuff,” you make it sound like it’s all the people holding pencil cups voting when they are the ones who vote the least. Many affluent people vote and a lot more than poor(er) people do. So what’s their “free stuff?” Tax breaks, laws that benefit them financially, etc.
An example is Medicare. You will think that is a “free stuff” government handout but many in the medical field made out very well by getting a trade off to not oppose Medicaid. Things are never as black and white and simple as they seem at first glance, especially if you have only partial information, especially if that partial information might be filtered by an agenda. And let’s remember that “free stuff” for poor people can be for a very good reason.
[link=https://economix.blogs.nytimes.com/2014/02/28/how-the-medical-establishment-got-the-treasurys-keys/#more-172616]https://economix.blogs.ny…urys-keys/#more-172616[/link]
About half a century ago, organized medicine and the hospital industry in this country struck a deal with Congress that in retrospect seems as audacious as it seems incredible: Congress was asked to surrender to these industries the keys to the United States Treasury.
As [link=http://www.ssa.gov/history/wilburc.html]Wilbur Cohen[/link], a chief architect of the law and subsequently secretary of health, education and welfare, [link=https://facultystaff.richmond.edu/~bmayes/pdf/JHMAS_Jan2006_RMayes.pdf]later described the deal[/link] (Page 25):
[blockquote]The sponsors of Medicare, myself included, had to concede in 1965 that there would be no real controls over hospitals and physicians. I was required to promise before the final vote in the executive session of the House Ways and Means Committee that the federal agency [to be in charge of administering Medicare] would exercise no control.
[/blockquote] Medicare was not to interfere in any way in the physicians treatment of Medicare patients through what we now know in private health insurance as [link=http://dictionary.reference.com/browse/managed+care]managed care[/link]. Nor was Medicare allowed to influence the way hospitals were constructed and operated. Finally, the deal called for a completely one-sided payment system.
As Rick Mayes reports in his [link=https://facultystaff.richmond.edu/~bmayes/pdf/JHMAS_Jan2006_RMayes.pdf]wonderful essay[/link] The Origins, Development, and Passage of Medicares Revolutionary Prospective Payment System, a prominent leader of a hospital association later acknowledged that the retrospective full-cost reimbursement feature established under this deal was just stupid. It is hard to disagree with that assessment.
So how could the policy analysis and politicians pushing for Medicares passage be so stupid as to agree to such a deal?
In the early 1960, more than a third of Americas elderly lived in poverty. Hospitals in many states were strictly segregated by race, with predictable differences in the quality of care. At the same time, modern medicine was progressing in terms of effectiveness, but also in cost. In the absence of Medicare, the blessings of modern medicine would have been out of reach for millions of older Americans.
Medicares sponsors dreamed of a health system in which these blessings would be shared on roughly equal terms by all elderly Americans, regardless of their own ability to pay for needed health care or their race.
To help implement that vision, these proponents reluctantly paid the price the providers of health care extracted in return for accepting the legislation: Congress surrendered to the providers the keys to the United States Treasury, full well knowing that this social contract could have only a short shelf life. One would assume that physicians and hospital leaders knew that as well.
In other words, the proponents of Medicare who signed on to the deal were anything but stupid. When confronted by the health care sector with a harsh trade-off between their cherished vision for health care, on the one hand, and a sensible payment policy, on the other, they let their vision override economically sound payment policy. Millions upon millions of Americas senior citizens are indebted to them for a program that remains [link=http://economix.blogs.nytimes.com/2011/02/11/keep-your-government-hands-off-my-government-programs/]highly popular[/link] to this day.
Younger leaders of medicine and the hospital industry would do well to recall this dubious social contract struck by their predecessors to appreciate that the countless amendments to Medicare and the ever-new regulations emanating from the program are just the byproduct of many skirmishes in a protracted and tenacious war over possession of the keys to the Treasury.
So if “free stuff” is the concern, most “free stuff” is going up to the more affluent people, it’s just that this stuff doesn’t have convenient accounting lines to follow while the “free stuff” set up for the poorer people does require strict accounting. So as a result since Reagan, income and wealth inequality has broadened with the middle class being poorer or at least running in place while the vast majority of wealth generated has gone to the upper income groups. Reverse Robin Hood. Free stuff flows up from down, not down from up.
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This board has become infested victims of paranoid schizophrenia, borderline personality disorder, and belief in Socialism.
And some are afflicted by all three.
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