Is the U.S. Healthcare System Overpriced and Underperforming?

[Schrodinger's Dog]

If you've been following the presidential campaign recently, chances are you heard Vice President Dick Cheney claim that the U.S. has "the best healthcare system in the world". According to the World Health Organization's (WHO) last World Health Report though, the U.S. system ranks only 37th in the world, far behind other OECD countries and just slightly ahead of Cuba. While the WHO's study has some flaws, it does offer a balanced evaluation of healthcare systems' overall output (life expectancy, infant mortality, etc...) and costs ($ spent per person, % of GDP dedicated to healthcare). As such, it is extremely hard to believe that Mr. Cheney's declarations are grounded in reality rather than in shameless political exploitation of the population's ignorance about foreign healthcare systems. More importantly, the U.S.' poor showing in the WHO ranking raises some fundamental questions about a healthcare system that is costly, unfair, and of inconsistent quality despite its dynamic innovation.

To start, U.S. healthcare coverage is one of the most incomplete and unequal in the developed world. Forty-five million people, (i.e., one in six Americans) are not covered by any health insurance. The richest 5% of the population account for 55% of total healthcare spending while the bottom 50% of the population account for only 3% of total spending. Furthermore, standard health insurance plans typically cover a lot less services than the most basic European health insurance schemes. Falling sick can quickly turn into a horrendous financial nightmare for most Americans and their families. For some people, taking care of one's health is simply not in the cards. As a result, life expectancy at birth is about a year shorter in the U.S. as compared to the OECD average, U.S. immunization rates against viral diseases are lower than average, and infant mortality is significantly higher than in other developed countries.

Further, the U.S. healthcare system is the most expensive in the world, both in absolute and in relative terms. Costs have steadily risen quicker than in any other developed country since the early 1980's and worryingly spiraled out of control over the past few years. While U.S. healthcare spending per capita was in line with other OECD countries in the 1980's, it has now surpassed $5,000/person in 2003, (i.e., more than twice the OECD average). Healthcare costs have risen at a 7% annual rate during President Bush's presidency, or twice as fast as GDP. Healthcare spending now represents more than 14% of the U.S. GDP, far ahead of second and third-highest ranked Switzerland (11% of GDP) and Germany (10-11% of GDP). Despite Mr. Cheney and Mr. Bush's optimistic beat, the U.S. healthcare system's high costs are particularly troubling considering that the U.S. population is significantly younger than the European population, a place where healthcare is comparatively cheaper.

http://www.huppi.com/kangaroo/L-healthcare.htm

In particular myths about welfare.

http://www.huppi.com/kangaroo/LiberalFAQ.htm#Backhealthcare

Little bit biased but apparently they've become worse, without going into the WHO's pdf's that are very long winded, but if you want to. And if anyone has a concise breakdown, I couldn't find it but apparently Canada and the US are 30th and 37th, ranked by bang for buck, or what you get for your dollar based on mortality, infant mortality, people without adequate healthcare etc,etc.

http://www.usatoday.com/money/industries/health/2006-10-15-health-concern-usat_x.htm

With this in mind do you think North America's healthcare systems are overpriced don't perform well, and in the case of the US don't tally well with Europe. Why do you think this is or don't you?

13.4% GDP compared to Englands 6.6% GDP? It's not any better now, what are the reasons for the cost? And do you think you need to improve, get up the table to the best European healthcare systems? Or do you think that to do so is socialism and therefore to be fought against at every turn. In a nutshell why does your system proclaimed the best in the world, actually in reality not rank very highly?

http://www.who.int/whosis/en/index.html

If you want to wade through this.

 

[denverdoc]

SD,
wow, those are mindbending stats. I had approximate knowledge of some of the data, but was shocked by others.

Its the best healthcare money can buy. I mean if I had unlimited resources and in need of a heart transplant, I'd sure as hell have it done here. But getting an ingrown nail fixed, would likely cost a helluva lot more here than anywhere else in the world, with I daresay comparable results, or worse on acct of some infection that practically kills you in the process.

It would be easy to blame lawyers. And fun. So let's! The cost of the malpractice insurance and law suits is only a nickel on the health care buck, IIRC. But it has led to a defensive style/CYA style of practice that eats bucks like nobodys business. Take your average panic attack. 32yo female in good health presents to an ER complaining of tachycardia, shortness of breath and weird tingling sensations in her nands. No prior cardiac history. Rather than an EKG and a minor tranquilizer, good chance she will end up in a semi-intensive cardiac unit under telemetry. No one seriously believes this is a life threatening condition, EKG is normal and 30 minutes after getting some Valium like drug, looks fine, feels fine, and is ready to roll. In the mind of the average US physician, there is every reason to believe the case is closed, but then the nagging doubt problem rears it's ugly head. There's a 1/100000 chance that this might be a zebra, and not a horse. Safe thing to do, observe overnight, get a panel of cardiac enzymes, whatever. So this intervention which might have cost a couple hundred--we have EKG machines that cost a bundle more than the average bear so as to have AI interpretations, but any doc worth his/her salt reads them personally, what if the machine missed something? --now is 2000 or more. I'm not making this up.

This is the so called standard of care issue--if you offer less than what other ass covering docs in the community would do as prudent and reasonable practitioners, you have nothing to gain except the satisfaction of having saved Mrs Jones 1800 bucks, and everything to lose even if its 1/100000. To practice sanely is not for the faint of heart, esp with a fat mortgage and two kids in college.

This doesn't begin to address the issue in its entirety, but health care has become really irrational in my opinion, which is likely I seek refuge at the PF!

 

[Schrodinger's Dog]

What makes me laugh is I pay personally, perhaps about $3000 or so dollars per year the average employer probably a little more, I think the average is probably around the $3500 mark (taking median pay into account) in combined taxes and NI national insurance is about $1600 per year with those earning above $64,000 per year only paying 1% instead of 11.1% to keep up a free healthcare service; you pay on average $3226 not including taxes of the $11765, not including the cost 14.1% or so cost to GDP and thus to your tax bill, 14.1% of whatever tax covers this, and we're ranked 8th in the world and your in 37th?

Does this make any sense? What we pay in insurance doesn't usually cover our health bill in fact in about 99% of people it's not even close, and even with the taxes this is seldom covered, but since the governments only paying 6.6% GDP, it's actually costing us less in taxes and NI than in the US to subsidise healthcare? In other words our bang for buck is why we're in 8th place.

The only objection I can see to national or perhaps state by state healthcare, is it's socialism=communism=evil? And the beureacracy(it's centralised thus there is less) But you also have to remember a health service doesn't work like a business, if you fail in business you go bankrupt, if you fail in the health service, people die.

And what also hikes up your cost, law suits, try seeing how much people will sue when ultimately there paying for it out of their taxes, ie the more you sue the more you pay in taxes, and suing the government has always been an absolute nightmare anyway.

Well sign me up to this particular form of socialism, when 46 million of your people have no adequate health care in the US you know something is rotten in the state of Denmark.

Arnold Schwarzenegger recently announced he was thinking of bringing in a more "European" system into California, I hope it works, because it might just might persuade people that a health care system has nothing to do with socialism, it's just a practical business/ethical essential.

http://www.washingtonpost.com/wp-dyn/content/article/2007/01/08/AR2007010800865.html?nav=hcmodule

Schwarzenegger Proposes Universal Health Coverage
California Plan Could Cost State $12 Billion

By Sonya Geis and Christopher Lee
Washington Post Staff Writers
Tuesday, January 9, 2007

LOS ANGELES, Jan. 8 -- Gov. Arnold Schwarzenegger (R) on Monday proposed a system of universal health insurance for Californians that would make the nation's most populous state the third to guarantee medical coverage for all its residents.

"Prices for health care and insurance are rising twice as fast as inflation, twice as fast as wages. That is a terrible drain on everyone, and it is a drain on our economy," Schwarzenegger said. "My solution is that everyone in California must have insurance. If you can't afford it, the state will help you buy it, but you must be insured."

Much of the opposition to Schwarzenegger's program, which requires legislative approval, is expected to come from his fellow Republicans, who object that the plan will be costly for small businesses. But the governor said California cannot afford not to do it. Nearly one in five California residents does not have health insurance -- a total of 6.5 million people, many of whom seek expensive care in emergency rooms.

Nationwide, the ranks of the uninsured are growing. Census figures show that a record 46.6 million Americans, including 8.3 million children, had no health insurance in 2005, up from 45.3 million in 2004. Among those who did have coverage, fewer were receiving it through their jobs as employers scaled back their health plans.

Analysts say the California proposal is illustrative of the resurgence of interest among politicians at all levels in expanding health coverage to the uninsured and that it provides fresh evidence that, with Congress stalled on enacting comprehensive health-care reform, the states are beginning to take matters into their own hands.

In the past year, Massachusetts and Vermont have passed laws requiring all their residents to obtain health insurance, with help from the state if necessary. Other states considering expanding coverage to reduce the number of uninsured include Washington, Montana, Rhode Island, Wisconsin and Illinois.

"Health care for the uninsured is back on the agenda," said Diane Rowland, executive vice president of the Kaiser Family Foundation, a nonprofit, nonpartisan organization that researches health-care issues. "The governors are trying to lead the way, but it's also going to take national action to try to address this problem."

Schwarzenegger's plan would require everyone living in California -- even illegal immigrants -- to have health insurance, at an estimated cost of $12 billion. Individuals who refuse to carry insurance could face reductions in their state income tax refunds or the garnishment of their wages. All businesses with 10 or more employees would have to offer coverage or pay a fee of 4 percent of their payroll into a fund to help the uninsured buy health insurance.

Schwarzenegger also recommended expanding the state's existing program for children's health insurance to families that earn less than three times the poverty level, or about $60,000 for a family of four.

The governor also wants to force insurers to offer coverage to people with existing medical conditions. Currently many insurers will not cover older people, those with major illnesses or even people with relatively minor complaints such as asthma or varicose veins.

Schwarzenegger also would require insurance providers to use 85 percent of their premium proceeds on patient care.

The state would increase reimbursements to doctors and hospitals by a total of $4 billion. Money for the program would come from new taxes on doctors (2 percent of their revenue) and hospitals (4 percent), federal funds, and county funds that now pay for emergency care for the uninsured.

In addition to objections from small business, Schwarzenegger is sure to face opposition to taxes on doctors and hospitals, additional regulation of insurance providers and the extension of coverage to illegal immigrants.

"Imposing a new jobs tax on employers of any size and expanding costly government mandates is the wrong approach, one which will devastate our economy," the Assembly's Republican leader, Mike Villines, said in a statement Monday.

But Schwarzenegger said that while the plan will cost money, it will pump funds back into the health system because of the expanded coverage. "Everyone ends up with a better deal," he said.

Lee reported from Washington.

 

[russ_watters]

wow, those are mindbending stats. I had approximate knowledge of some of the data, but was shocked by others.

We discussed these numbers about 2 days ago -- most are wrong, out of date, misleading, etc., and he already knows it. For example, the first link say the following:

All statistics here are for the year 1991; they have generally become worse for the U.S. since then.

Life Expectancy: United States 71.6 78.6

But 15 years later...

male: 75.02 years
female: 80.82 years (2006 est.)

http://indexmundi.com/united_states/life_expectancy_at_birth.html

Here's a ranking of 2005 life expectancies (not separated by sex): http://www.airninja.com/worldfacts/LifeExpectancyOfNations.htm

Assuming the data is even accurate (a cursory look shows the positions of the US and UK are switched, so that is a clear error in the ranking if not the data), the US's life expectancy has gone up by about 2.7 years in the past 15 while Japan's (I picked one of the higher ones on both charts) has gone up by about 1.8. Germany (sligtly above us in both) has gone up by about 2.8. So the upper end of the chart is compressing.

Going deeper, our life expectancy is still lower than average for developed nations (though by nowhere near as much as the OP suggested). The reason is because infant mortality is higher than average. And infant mortality is high because the US does have about the best healthcare in the the developed world. Confused? The reason is simple:

The primary reason Cuba has a lower infant mortality rate than the United States is that the United States is a world leader in an odd category -- the percentage of infants who die on their birthday. In any given year in the United States anywhere from 30-40 percent of infants die before they are even a day old. [that's a typo - it is 30-40% of infants who die die before they are a day old]

Why? Because the United States also easily has the most intensive system of emergency intervention to keep low birth weight and premature infants alive in the world. The United States is, for example, one of only a handful countries that keeps detailed statistics on early fetal mortality -- the survival rate of infants who are born as early as the 20th week of gestation.

http://www.skepticism.net/articles/2002/000022.html

Whether you have health insurance or not the US puts much more effort into saving low-birth weight babies than most other countries in the world. And that, btw, is kind of a hidden health insurance: if you're in a car wreck, the hospital will save your life before finding out if you have health insurance.

And money stats are, of course, indirect so they don't necessarily paint an accurate picture of what level of care people are actually getting.

 

[Evo]

What makes me laugh is I pay personally, perhaps about $3000 or so dollars per year the average employer probably a little more

YIKES! $3,000.00 annually? I pay $324.00 a year for both my daughter and I for our insurance. Then if we need to go to the doctor, the visit and any associated tests costs a total of $15.00, most prescription medicine costs $5.00. My total annual medical expenses for the TWO of us is less than $500.00 annually. And I have a pre-tax spending account for medical expenses, so I don't pay taxes on the money.

 

[russ_watters]

YIKES! $3,000.00 annually? I pay $324.00 a year for both my daughter and I for our insurance. Then if we need to go to the doctor, the visit and any associated tests costs a total of $15.00, most prescription medicine costs $5.00. My total annual medical expenses for the TWO of us is less than $500.00 annually.

I pay $129 a month for myself. I don't get health insurance from work, so that is the total cost of my insurance.

 

[russ_watters]

More on this:

And money stats are, of course, indirect so they don't necessarily paint an accurate picture of what level of care people are actually getting.

Here's info on cancer surviorship:

The largest international cancer survival study to date, it found the chances of surviving for at least five years after being diagnosed with cancer ranged from a low of 25.2 percent for men in Poland to 57.9 percent for women in France. Regionally, Scandinavia came out best and Eastern Europe worst.

That compares with a survival rate of 62 percent for men and 63.5 percent for women in the United States. Comparable statistics for other areas of the world were not immediately available.

For a more detailed breakdown of the European results see this chart. Unfortunately, that chart does not include the United States. For data on how far ahead the US is of Canada for cancer survival rates (hint: half the US states are ahead of Canada's best province BC) see here for a comparison of American states and Canadian provinces.

The sheer amount of money spent makes a difference.

http://www.parapundit.com/archives/001666.html

So what is more important, the fraction who have insurance (which is misleading anyway since it doesn't include coverage the uninsured still get) or how people actually fare with diseases? Evo touched on another actual quality of care issue in the other thread: how long you have to wait to get treatment.

 

[denverdoc]

I pay $129 a month for myself. I don't get health insurance from work, so that is the total cost of my insurance.

I was last quoted about $680/month as a self-employed male for what I considered so-so coverage. As of now, I am among the 50 million w/o health insurance. I seriously doubt, Russ, the safety net is as wide as you imply. There is some truth that if you're in an accident, you'll get taken care of. Otherwise its treat em and street em.

And its not like even then the debt goes away--you'll be hounded to death by bill collectors from the hospital until bankruptcy becomes the best option.

So you end up in a paradoxical situation:unless very rich or very poor and on disability/medicaid, a serious illness will for most result in a complete divestiture of assets. Or you don't get care. This can happen with insurance or without, depending on the terms. But its not pretty. I get bankruptcy notices all the time. Just eat the bills.

Notice when you call or walk into a doc's office, ER, etc what is the first thing asked for? Tell me about the net then.

 

[Evo]

My daughter's boyfriend had to go to the emergency room and he doesn't have insurance. When they discharged him, he was given forms to apply for financial aid that will pay most, if not all, of the bill.

What kind of insurance company are you going through? I know a lot of people that are self-employed and their insurance costs are pretty close to what Russ pays.

My employer pays most of my insurance premium, but the full premium is only $226.75 per month and that covers two people.

 

[denverdoc]

My daughter's boyfriend had to go to the emergency room and he doesn't have insurance. When they discharged him, he was given forms to apply for financial aid that will pay most, if not all, of the bill.

What kind of insurance company are you going through? I know a lot of people that are self-employed and their insurance costs are pretty close to what Russ pays.

My employer pays most of my insurance premium, but the full premium is only $226.75 per month and that covers two people.

Evo, keep us posted on the outcome of that one. Forgive my skepticism, but I'll bet this financial aid is about as substantial as a desert mirage. And without getting into the details of your coverage, I'm also betting you get what you pay for: high deductibles, crummy pharm benefits, a plethora of exclusions, retricted provider choices, etc. If not the insurer is losing $$. What looks pretty good on paper ends up being a basic catastrophic coverage in many cases with fairly low caps at that.

 

[russ_watters]

Actually, we didn't include what we pay toward medicare in our personal numbers for healthcare costs. That's 2.9%, or for a middle-income person who makes $50,000 a year, $1,450. Car insurance coveres injuries in car accidents, too.

 

[Schrodinger's Dog]

YIKES! $3,000.00 annually? I pay $324.00 a year for both my daughter and I for our insurance. Then if we need to go to the doctor, the visit and any associated tests costs a total of $15.00, most prescription medicine costs $5.00. My total annual medical expenses for the TWO of us is less than $500.00 annually. And I have a pre-tax spending account for medical expenses, so I don't pay taxes on the money.

Well according to you averages, the average person pays $3000 dollars. And I assume yor're not including taxes you pay to support the 14.1% GDP. I'd imagine this takes into account the average persons costs on top of their insurance which probably doesn't cover a lot of stuff. Dr's visits, dentists, some are NHS so much cheaper. Medication etc.

All Dr visits are free all prescriptions are $12 even if they cost $4000 a pill. So all my medication total value about $1500 is about $144 which means we visit the Dr far more frequently than probably you do.

You have to take into account it's nearly $2 to the pound atm as well. plus usually your place of work pays half of that. So in reality you should half my personal figure and then add about $400

We discussed these numbers about 2 days ago -- most are wrong, out of date, misleading, etc., and he already knows it. For example, the first link say the following: But 15 years later...
http://indexmundi.com/united_states/life_expectancy_at_birth.html

Here's a ranking of 2005 life expectancies (not separated by sex): http://www.airninja.com/worldfacts/LifeExpectancyOfNations.htm

Assuming the data is even accurate (a cursory look shows the positions of the US and UK are switched, so that is a clear error in the ranking if not the data), the US's life expectancy has gone up by about 2.7 years in the past 15 while Japan's (I picked one of the higher ones on both charts) has gone up by about 1.8. Germany (sligtly above us in both) has gone up by about 2.8. So the upper end of the chart is compressing.

Going deeper, our life expectancy is still lower than average for developed nations (though by nowhere near as much as the OP suggested). The reason is because infant mortality is higher than average. And infant mortality is high because the US does have about the best healthcare in the the developed world. Confused? The reason is simple: http://www.skepticism.net/articles/2002/000022.html

Whether you have health insurance or not the US puts much more effort into saving low-birth weight babies than most other countries in the world. And that, btw, is kind of a hidden health insurance: if you're in a car wreck, the hospital will save your life before finding out if you have health insurance.

And money stats are, of course, indirect so they don't necessarily paint an accurate picture of what level of care people are actually getting.

Do you not think the fact that 46.6 million people plays a part in your mortality figures and infant mortality too?

If your not happy with the figures check out the WHO statisitics I can assure you they are as accurate as they can be.

However you want to spin it your still ranked far below many healthcare systems in Europe.

 

[russ_watters]

I'm also betting you get what you pay for: high deductibles, crummy pharm benefits, a plethora of exclusions, retricted provider choices, etc. If not the insurer is losing $$. What looks pretty good on paper ends up being a basic catastrophic coverage in many cases with fairly low caps at that.

Actually, no, you don't get what you pay for it with insurance, you get much, much less...unless you get very sick, or very old, in which case you get much, much more. For the first 50 years or so of your life, unless you are very unlucky, most people pay small premiums, but they also don't get sick. The deal is so good for the insurance company that they can provide good coverage and still make enough money to cover the losing proposition that is insuring the elderly.

Take me, for example: I've been under my current deal for about 4 years. I've paid more than $6,000 and in all that time I haven't seen a doctor once. Since I don't smoke, don't drink on a daily basis, and do exercise, I don't have a lot of risk. By far the biggest risk for a person like me is a car accident, but that's covered by car insurance. The next is probably a fall or other home improvement injury, but I could have one of those a year and the insurance company would still make money on me. After that is sports injuries and if I ever need to 'scope out a knee (I wrestled in high school...), that'll cost a lot, but it likely won't equal the money I've put in. And after that is one of the many random diseases I could get - the bank-breakers, like cancer. But for someone like me, that's probably a one in a thousand proposition, which means that the insurance company has several million dollars available for each of those.

 

[Schrodinger's Dog]

http://www3.who.int/whosis/mort/table1.cfm?path=whosis,mort,mort_table1&language=english

US population about 300 million

UK figures population about 60 million.

Bear in mind we also have a very sophisticated program of keeping babies alive to their first year, which is probably comparable with the US.

The figures do speak for themselves.

 

[sara_87]

In America does each and every individual have to have health insurance (or pay some other kind of tax) to get treatment when they need it?

 

[Evo]

Evo, keep us posted on the outcome of that one. Forgive my skepticism, but I'll bet this financial aid is about as substantial as a desert mirage.

Already approved. It paid most of his bill, and now the hospital is helping him apply for charity which will probably pay the balance. The catch is you have to be under a certain income level.

And without getting into the details of your coverage, I'm also betting you get what you pay for: high deductibles,

ZERO deductibles

crummy pharm benefits

All generics are 5.00, no deductible, on non-generics, I pay 20% of cost capped at a maximum of $49, no prescription can cost me more than that. If I buy a 90 day prescription by mail the last month's pills are free.

a plethora of exclusions

Nope.

I also have a list of primary care providers to choose from and all my existing physicians were members. Also, I don't need a referal to go to a specialist. I work for a very large company, I get phenomenal benefits.

You should be able to buy insurance under some kind of association. For example the American Bar Association has a group plan that attorneys can get group rates under.

 

[russ_watters]

http://www3.who.int/whosis/mort/table1.cfm?path=whosis,mort,mort_table1&language=english

US population about 300 million

UK figures population about 60 million.

The figures do speak for themselves.

What numbers are we supposed to be collecting from that link? Sorry, no, you'll have to speak for them...

Bear in mind we also have a very sophisticated program of keeping babies alive to their first year, which is probably comparable with the US.

Certainly, but the difference is in what is done on the first day, not in the first year.

 

[russ_watters]

Do you not think the fact that 46.6 million people [what?] plays a part in your mortality figures and infant mortality too?

That isn't a complete sentence. What is missing?

If your not happy with the figures check out the WHO statisitics I can assure you they are as accurate as they can be.

I already showed you that many of the numbers are wrong/out of date! Care to defend any of your claims? You are flat-out ignoring information that you don't like.

 

[russ_watters]

In America does each and every individual have to have health insurance (or pay some other kind of tax) to get treatment when they need it?

No. We discussed it a little above, but doctors are required by ethics and law to treat sick people even if they don't have insurance. Obviously, the amount and quality of care can be lower, though, if you don't have insurance.

 

[edward]

No. We discussed it a little above, but doctors are required by ethics and law to treat sick people even if they don't have insurance. Obviously, the amount and quality of care can be lower, though, if you don't have insurance.

As far as I know only emergency care is mandatory. A person seeking non emergency care must apply for some type of aid, usually at the state level.

Walking into a medical facility other than an emergency room is futile. Local facilities such as labs in my area require an insurance card and a picture I.D.

 

[denverdoc]

As far as I know only emergency care is mandatory. A person seeking non emergency care must apply for some type of aid, usually at the state level.

Walking into a medical facility other than an emergency room is futile. Local facilities such as labs in my area require an insurance card and a picture I.D.

This is true, and there are laws that prevent dumping of indigents until some minimal amt of stabilization has occurred. It leads to some terrific gamesmanship and outright BS--well he was stable when the ambulance departed. As a result of this law ER costs have become astronomical in the states--darn near anything can rack up a 500 to 1000 dollar bill in nothing flat, this after a 4 hr wait and maybe 3 minutes aith an MD.

I think we need a single payer system with rationed care for everyone. Rephrase that: there is a compelling ehtical and moral need to bring the US up to the standards of the civilized world. Beyond that, people can do as they like for additional services. Maybe that means we can't afford to fix every 70 year olds leaky heart valve, but every kid under 18 ahould have access to a high standard of care w/o having to beg or having to be the dole.
J

 

[Evo]

There are free clinics all throughout the US. We have one of the top free clinics in the US here. These are for every day, non-emergency use.

Helping out my daughter's friend, although his hospital bill was taken care of, his prescriptions weren't. The prescriptions for antibiotics and other urgent needs were almost nothing, like $20, while medicines for non-critical meds like tranquilizers (he was diagnosed with diverticulitis) were over $100.

Oh, did I mention that I have pet medical insurance through my employer? My pets also have medical insurance.

Seriously, although only 15 and 1/3 % of Americans don't have insurance, I would like to see more medical coverage for the small percentage that aren't insured and don't have the incomes to afford it. Medicare and Medicaid can be very difficult to deal with due to the fraud.

this after a 4 hr wait and maybe 3 minutes aith an MD.

Only if you are in an inner city high crime area. The ER at the hospital 5 minutes from me has no waiting. The place is always empty. I'm a klutz and have had the opportunity to experience the ER several times.

 

[edward]

Evo, you are experiencing a very ideal situation.

That is not the average situation however. Emergency rooms in most metropolitan areas are in a crisis. Even those not in high crime areas are experiencing overcrowding. When my father-in-law broke his hip several years ago he had to be diverted from an overcrowded hospital ER that was only 2 miles away, to one that was 12 miles away.

After he was seen by a doctor and X rayed, he was left in a bed in the ER hallway for 4 hrs because there were no hospital rooms available.

One of the big problems is that people with no insurance use the ER as a first resort for care. Many of these people could be treated in urgent care centers, but urgent care facilities require insurance.

Emergency room crisis:

http://www.google.com/search?hl=en&q=emergency+room+crisis&btnG=Google+Search

The average emergency room wait at Anne Arundel Medical Center in Parole is one hour and 15 minutes, said Dr. Joseph Moser, vice president of medical affairs for AAMC.

The average wait at Baltimore Washington Medical Center in Glen Burnie is 15 minutes for people brought in by ambulance, according to Mary Lanham, director of marketing and public relations for BWMC. For less serious conditions, patients are typically treated within 21/2 hours, she said.

Dr. Larry Linder, chief medical officer and Emergency Department director for BWMC, said the problem is caused less by the influx of patients than by the inability to find enough beds and personnel to care for them after they're admitted.

http://www.hometownannapolis.com/cgi-bin/read/2007/02_06-29/GOV

 

[denverdoc]

Right, I'm not talking the knife and gun club, where much of the resources get diverted into serious trauma, just your average suburban ER. Also what they mention as "wait" is usually one of many. And precisely right, urgent care could like take care of most things, but w/o insurance or a wad of cash, its hasta la vista, baby.

Evo, There are three free care clinics in the Denver-Boulder area, all do great work, but treat an infinitesimally small fraction of the problem. It almost seems as if you're suggesting a 1000 points of light approach to this problem is going to somehow solve it.

I do see that we are finally taking some lessons from the Chinese and now have a wide variety of health care providers--PA's, nurse practitioners, and various nursing specialists including nurse anesthetists who have various skill sets and levels of training. This is a good move, and medical school/post grad training needs a serious overhaul, too.

End the end, the problem is largely one of expectations. We all want to live to be 120 wrinkle and fat free, but expect a pill or surgical procedure to accomplish it, sue whenever there's a bad outcome, and have this absolute faith that ever increasing levels of technical sophistication will be the ultimate fix. Theres a lot more to health than the absence of disease, and I wish more of our MD's took the approach of a gardener vs that of a mechanic
(borrowed from a book title: The Mechanic and the Gardener).

 

[edward]

Theres a lot more to health than the absence of disease, and I wish more of our MD's took the approach of a gardener vs that of a mechanic
(borrowed from a book title: The Mechanic and the Gardener).

That is a great perception Doc. The increasing pressure on doctors to cut the cost of treatment down to somewhere near the low reimbursement figure that is allowed by Medicare and insurance companies has brought about an assembly line concept to medical care.

Last summer my cardiologist sent me to an imaging center for a work up. He previously had performed the procedures in his office. It took three weeks to get scheduled into the center. When I got there the place was like a cattle round up. During the various elements of the testing I spent 6 hours going in and out of a small windowless waiting area where there were 15 patients and only 12 chairs.

On the other hand they were efficient and I still have heart of a healthy chimpanzee.

 

[Schrodinger's Dog]

That isn't a complete sentence. What is missing? I already showed you that many of the numbers are wrong/out of date! Care to defend any of your claims? You are flat-out ignoring information that you don't like.

Out of date but then I give you links to all the figures and I made it clear that these were old, and you say?

If you want to know what todays figures are look them up , and you'll note you still come off remarkably badly on expenditure, life expectancy and infant mortality?If you Can't be bothered to work it out yourself that's not my problem, if you look at the infant mortality figures it's plain to see per capita they are much worse than in the UK, and 46.6 million people are without health insurance(as I mentioned before)
That's 1 in 6 people.

Saying your doing better now, when you still only rank 37th in the world is hardly that comforting is it? The best healthcare in the world, to the people that can afford it and the very poor, but the in betweens get nothing, 1 in 6 without health insurance, is appaling n'est pas?

Stop ducking the issue(frankly I don't really care about the exact statistics, only that yours suck in terms of your outlay) You can carry on picking and chosing statistics to highlight which are wrong or outdated even though I already said this; fact is your system is too expensive and doesn't deliver anywhere near the service for cost of the top performers of which I'm glad to say the UK is one, for my $1600 per year and 7% GDP against 14.1% - I get the same statistics or in the case of infant mortality- better statistics, I know what I'd rather chose.

You can either accept you have a problem or you can say but the figures aren't accurate, even though I've already pointed this out? Frankly I suspect you'll prefer to bury your head in the sand, but that's your look out. Everythings fine, nothing to see here.

 

[denverdoc]

Out of date but then I give you links to all the figures and I made it clear that these were old, and you say?

If you want to know what todays figures are look them up , and you'll note you still come off remarkably badly on expenditure, life expectancy and infant mortality?If you Can't be bothered to work it out yourself that's not my problem, if you look at the infant mortality figures it's plain to see per capita they are much worse than in the UK, and 46.6 million people are without health insurance(as I mentioned before)
That's 1 in 6 people.

Saying your doing better now, when you still only rank 37th in the world is hardly that comforting is it? The best healthcare in the world, to the people that can afford it and the very poor, but the in betweens get nothing, 1 in 6 without health insurance, is appaling n'est pas?

Stop ducking the issue(frankly I don't really care about the exact statistics, only that yours suck in terms of your outlay) You can carry on picking and chosing statistics to highlight which are wrong or outdated even though I already said this; fact is your system is too expensive and doesn't deliver anywhere near the service for cost of the top performers of which I'm glad to say the UK is one, for my $1600 per year and 7% GDP against 14.1% - I get the same statistics or in the case of infant mortality- better statistics, I know what I'd rather chose.

You can either accept you have a problem or you can say but the figures aren't accurate, even though I've already pointed this out? Frankly I suspect you'll prefer to bury your head in the sand, but that's your look out. Everythings fine, nothing to see here.

Well, if recent trends are true, healthcare is only going to get more inefficient here in the US. I will make some general observations first. The hospital game is becoming increasingly corporate owned. I believe with the exception of Denver Health (a "county" hospital), the VA, and the University Hospital, every other major hospital in the area is now part of a chain. All are for profit of course. I am not a big believer in the notion that privatizing services necessarily leads to greater efficiency. What you do see is investment in increasingly specialized hospitals that attempt to grab the most profitable areas of medicine while ignoring the others. For me that's a problem. There are fewer and fewer psychiatric beds, so two patients recently had to be taken by ambulance to cities 50 and 70 mi away. The ambulance bills alone were likely well over a thousand dollars each.

Meanwhile the titans of the corporate chains and HMO's are battling it out:
http://www.rockymountainnews.com/drmn/health_care/article/0,2808,DRMN_25396_4960717,00.html

It is sheer folly IMO to assume that an increasingly for profit system of health care delivery is in our collective best interests. While cardiac care may get a smidgeon better, the losses elsewhere will more than offset the advantage. A lot of docs are finding the business increasingly distasteful and opting to bail altogether. I no longer do inpatient care on account of not wanting to set aside an hour or more a day to argue with some HMO doc sitting 1500 miles away as to why Mrs Jones needs to be in the hospital another day. Again if I chose to ignore the HMO, we eat the bill. But here's the other horn of the dilemma: if I choose to follow their "mandate," only I and the hospital are liable in the event of a bad outcome. Does this make sense to anyone other than the people running or profiting from the HMO?

 

[russ_watters]

Out of date but then I give you links to all the figures and I made it clear that these were old, and you say?

Actually, no, you never did acknowledge until just now that the numbers are out of date, and you still haven't provided an argument for why out of date numbers are valid, when I have shown that there is quite a bit of difference over 15 years.

Ie, while we may be 28th (in the link I provided), but the difference between us and the top (I took Andorra off, though...I think you would agree that it is out of line with the others and not really relevant anyway) is only 4.8%. Would you seriously consider that to be a major problem? How about in light of the improvement over the past 100 years? (life expectancies are roughly double what they were 100 years ago)

If you want to know what todays figures are look them up , and you'll note you still come off remarkably badly on expenditure, life expectancy and infant mortality? If you Can't be bothered to work it out yourself that's not my problem,

I gave you the new numbers and you have not commented on them.

...if you look at the infant mortality figures it's plain to see per capita they are much worse than in the UK. That difference is not very significant.

And I gave you the explanation for it, and for which you responded with a non-factual conjecture.

Also of note is the way the statistics are read. When you deal in single-digit fractions of 1000, differences are amplified over, say, using the survival rate. Ie, an infant's odds of surviving their first year in the US are about 99.3%, while they are, 99.5% in the UK. That doesn't look like a real problem to me.

and 46.6 million people are without health insurance(as I mentioned before)
That's 1 in 6 people.

That is meaningless for telling us what the quality of care is.

Saying your doing better now, when you still only rank 37th in the world is hardly that comforting is it? The best healthcare in the world, to the people that can afford it and the very poor, but the in betweens get nothing, 1 in 6 without health insurance, is appaling n'est pas?

None of that is meaningful, for reasons already stated and not addressed by you.

Stop ducking the issue

Start defending your point or withdraw it (or we will do it for you again).

fact is your system is too expensive and doesn't deliver anywhere near the service for cost of the top performers

And as already shown, that is just plain wrong.

of which I'm glad to say the UK is one, for my $1600 per year and 7% GDP against 14.1% - I get the same statistics or in the case of infant mortality- better statistics, I know what I'd rather chose.

Well, ok, if that's what you want. If you get cancer or heart disease, you may change your mind, since the actual quality of care (measured by survival rate) is better in the US.

You can either accept you have a problem or you can say but the figures aren't accurate, even though I've already pointed this out?

The US is certainly not perfect - no country is. But both your figures and logic are inaccurate/misleading/outdated as already shown. There are quite a lot of things about the US system that are the best in the world and quite a lot of others that are comparable to other countries. The primary shortcoming of the US system is in the healthcare for the number that are uninsured, but that problem is not the disaster that some people imply. The tendancy, though, is for people such as yourself to argue a point that implies a rich-poor disparity that has the rich being the few percent at the top and the poor being everyone else and implying that healthcare is only good for that few percent while it is dismal for everyone else. The reality, however, is that while it is certainly true that the healthcare for our poor is worse than the healthcare for a similar fraction of the people in Europe, it is also true that healthcare for the other ~85% of the population is better in the US than in Europe. So if you want to use that as a stick to beat the US with, ok, but watch out for the other end of the stick!: we need to improve healthcare for 15% of our population and you need to improve it for 85% of yours!

 

[russ_watters]

If you actually do care about the issue of infant mortality, SD, here is a report that will help you understand it better: http://www.cbo.gov/ftpdocs/62xx/doc6219/doc05b.pdf

It was written in 1992, so while it can't tell you how things are now, it does explain a lot about where the differences come from. A few interesting points in it:

-The rate tracks with birthweight, ie, the US has a higher incidence of low birth weight than in other western countries.
-The rate for blacks has consistently been twice the rate for whites in the US. (race and poverty generally track, so it isn't really a race issue)
-The US is unusual in that the infant mortality stats are reported by doctors, not families.
-The US is probably (their word) the world leader in efforts to resuscitate newborns. That pushes up the number of recorded live births, virtually all of which are low birth weight births. Ie, a baby who is classified as stillborn (and therefore not recorded as infant mortality) in other countries may be classified as a live birth in the US, pushing up our infant mortality stats.
-Drug use (it is higher in the US) is likely a factor.

 

[denverdoc]

If you actually do care about the issue of infant mortality, SD, here is a report that will help you understand it better: http://www.cbo.gov/ftpdocs/62xx/doc6219/doc05b.pdf

It was written in 1992, so while it can't tell you how things are now, it does explain a lot about where the differences come from. A few interesting points in it:

-The rate tracks with birthweight, ie, the US has a higher incidence of low birth weight than in other western countries.
-The rate for blacks has consistently been twice the rate for whites in the US. (race and poverty generally track, so it isn't really a race issue)
-The US is unusual in that the infant mortality stats are reported by doctors, not families.
-The US is probably (their word) the world leader in efforts to resuscitate newborns. That pushes up the number of recorded live births, virtually all of which are low birth weight births. Ie, a baby who is classified as stillborn (and therefore not recorded as infant mortality) in other countries may be classified as a live birth in the US, pushing up our infant mortality stats.
-Drug use (it is higher in the US) is likely a factor.

This may sound odd or even blasphemous, coming from a doctor, but I wonder whether this effort to keep many of the premies alive is worth it. I'm not talking about abandoning care for any kid in trouble, but being selective in our efforts. The life at all costs is part of the problem, IMO. This applies to all parts of the age spectrum, and no I'm not some heartless beancounter. But clearly we cannot afford to provide the state of the art care available to every US citizen. The $$ it costs to die is staggering, even when all are agreement that it is essentially futile care.

 

[russ_watters]

This may sound odd or even blasphemous, coming from a doctor, but I wonder whether this effort to keep many of the premies alive is worth it. I'm not talking about abandoning care for any kid in trouble, but being selective in our efforts. The life at all costs is part of the problem, IMO. This applies to all parts of the age spectrum, and no I'm not some heartless beancounter. But clearly we cannot afford to provide the state of the art care available to every US citizen. The $$ it costs to die is staggering, even when all are agreement that it is essentially futile care.

No, I'm totally with you on that. It is largely a western (and even more American) ethics/morality thing, but in a lot of cases it means prolonging pain or spending time/money/effort futiliy on a tiny chance of making a difference.

Simple example: the more time you spend trying to resuscite a not-breathing newborn (which, from above, Americans do more than most), the higher the likelyhood that newborn will suffer irreversible brain damage even if "successfully" revived.

 

[denverdoc]

No they don't. In fact SD's estimates are reasonable figures, about 1/6 don't have any form of insurance. Many are denied treatment. Others end up bankrupt after a serious illness. Hospitals are becoming ever more aggressive about collecting debts: generally within 90 days, debtors are turned over to collection agencies, who will soon make their lives hell. Many drugs are excluded from various insurance plans, even when they are by far the best or only available treastment. The only "right to health care" exists transiently when one is in need of immediate live saving measures. Beyond that, its good luck or bring cash. Now there are some exceptions, some of the childrens hospitals will turn no one away, and as Evo mentioned a few threads ago, there are "free clinics" which are not exactly free, but usually based on ability to pay. Collectively they serve less than 5 percent of the population and survive on the shoulders of benefactors and medical personnel willing to work for little or nothing. Because of the cost of extending free care which all facilities are requires to do, the costs of treatment/reimbursement rates depend to a large extent on whether one belongs to a large HMO/PPO. For instance a cash paying customer will generally pay at least twice for the same services as one belonging to a group which has has pre-negotiated rates for particular services. The only citizens with any built in services from tax dollars are those with Medicare, generally available to those over 65, and Medicaid, which is for those who are usually permanantly disabled. Some states have tried to augment services for the youth, which is partially federally funded.
J

PS: Mr Bush recently tried to steal these latter funds, meager as they are, to help pay for the war in Iraq.

 

[denverdoc]

No, I'm totally with you on that. It is largely a western (and even more American) ethics/morality thing, but in a lot of cases it means prolonging pain or spending time/money/effort futiliy on a tiny chance of making a difference.

Simple example: the more time you spend trying to resuscite a not-breathing newborn (which, from above, Americans do more than most), the higher the likelyhood that newborn will suffer irreversible brain damage even if "successfully" revived.

Not only brain damaged, which arguably is the worst kind of damaged, but these kids often have a plethora of problems affecting many organ systems. I hate those argumnts, if man was meant to..., but in this case I can't resist, if 5 month infants were meant to survive, women would have marsupial pouches.

 

[Schrodinger's Dog]

Not only brain damaged, which arguably is the worst kind of damaged, but these kids often have a plethora of problems affecting many organ systems. I hate those argumnts, if man was meant to..., but in this case I can't resist, if 5 month infants were meant to survive, women would have marsupial pouches.

Not to mention that we too also have an extremely sophisticated post natal healthcare system, if you want to know how I know I see it almost every day at work, the PICU has babies which weigh extraordinary small amounts in incubators and hooked up to a bewildering array of drugs.

We do the same things the US does, so this is not an argument it's another pointless obfuscation attempting to devoid itself of the real reason for poor infant mortality: 46.6 million people without health care. And those aren't my figures there yours and there not under negotiation. It works out at 1 in 6. The fact that you have the best healthcare in the world and not the best life expectancy - in fact your way down the list - is another telling statistic which also has a lot to do with the 46.6 million, and a lot to do with your extremely inefficient use of money, 14.1%GDP nigh on 4 times the size of your military expenditure and your at war?

 

[denverdoc]

Instead of looking simply at the number of Canadians pouring across the border in desperate need of proper medical care, break it down for us, how many want cosmetic or other procedures uncovered, or because they are nxious, don't want to wait. Or how about how many Canadians die whiole waiting for life saving surgery? Compare that to the US system, and yes it happens all the time if you're in need of a heart or a liver. Seems to me a lot of US citizens were flocking to Mexico for Laetrille at one time, and still go far and wide for healers of any stripe.

Cubans are very spoiled re health care in some respects, why there athletes seek out more during olympics has little bearing on the larger question.

Re the Brain drain? Maybe they want more $$, and see an opportunity to amass wealth beyond what they deserve?

IIRC, and correct me if I'm wrong, what the soviets attempted to do was to overcome a 150 year industrial head start, in a far flung land with multiple obstacles re languages and customs, and still beat us to space, despite our having grabbed the best and brightest german scientists and most of the V2 parts. Its not a system I agree with. Its too centralized, and when big corporations here in the US fail, often for the same reason. Its why the skunk works succeeded in so many feats of derrring-do, when the mother corp couldn't. Instead of focusing on recompensation, look more closely at communication and flexibility. The US health care system fails miserably on both accts, and is why it drains more dollars than any other. Its all about promises, most of which remain unfulfilled, but to a dieing man, any straw will do.