oh my-- serious autocorrect issues. I believe in #574 I was trying to say the risk of an antitrust violation , not the fish of an antitrust isolation!!!
" I would like the government to exert as much influence over healthcare as semiconductors."
I would, too, if the government exerted as much influence on healthcare as it did semiconductors medicine would be a heck of a lot more advanced these days then it is, across the board. You are aware that if it weren’t for the federal government sponsoring the research that we wouldn’t have had the advance in semiconductors we have? The transistor itself was funded by Uncle Sam, the LSI and VLSI semiconductor chips happened because of government funded research, the advances in solid state physics that have allowed us to stretch silicon to limits 10, 20 years ago they thought were the end of the game were funded by basic research the government paid for, the x ray lithography they use to produce control lines a fraction of a NM were the result of basic funding. Corporations with their hordes of finance types think basic research is a waste of time.
I only wish the government would do that with health care and medicine, because quite frankly the proposals on the table, ACA or the replacement or whatnot, is not the fundamental problem. People have touched on the issue peripherally, and that is that medicine as practiced is focused on curing the sick, rather than preventing it, and that is the problem. Here are the highlights:
-We have extended people’s lifespans, but we haven’t necessarily enhanced it, so in older age the medical costs are quite high, pure and simple.
-We have the technology to be able to treat people as individuals and come up with profiles for things like exercise and nutrition to prevent disease, but this is routinely excluded from health insurance as being ‘too expensive’. The current plan floating around congress would basically take away any hope of this, by excluding wellness care.
-One of the biggest impacts on our health is nutrition and diet, a staggeringly amount of diseases that cost a lot to treat. One of the problems is that the ‘science of nutrition’ has not been funded or attacked the way we did with other issues in health care, we spend billions on cancer research, heart disease research, basic science that underlies pharm, but nutrition is all over the place, in part because large scale studies are expensive and it is hard to get funding. Estimates are that 40-50% of health costs are based in diet and nutrition, yet very little is done.
And people on here have pointed out the rapid swings in ‘healthy eating’, the stuff that fat is evil and causes heart disease, salt being bad for you even in moderation, all have come under fire, and it seems like day to day we hear different things, and it needs to be cleaned up, rather than being a sea of claims and counterclaims.
-Medical training as far as I can tell is still focused on symptomology and ‘fixing’ problems, rather than preventing them. Last thing I read, for example, shows that most medical programs have very little on wellness training, nutrition at most might be a single course (Tufts had a pretty good program at one point). Someone once compared medicine to being an auto mechanic, but auto mechanics understand the cars well enough to know what kinds of preventative care work, like changing the oil, changing brake fluid, rotating tires, changing the transmission fluid and filter, etc…
-Then we have the politics of health. Many of those who are screaming about the cost of health care are often the same people that are helping to promote illness in a sense. The farm subsidies that are huge, like corn subsidies, create the cheap food you see at fast food restaurants, soda that is basically sugar water, rolls full of HFC/sugar, meat loaded with empty calories gorged on subsidized corn and loaded with hormones and antibiotics because the government allows that…and the same for packaged goods. It has made ‘bad’ foods artificially cheap while not promoting healthy foods…but try taking away the corn subsidies and see what corn farmers and ADM and Cargill do, try and ban hormones and antibiotics in the meat supply and watch what ranchers and Mickey Dickey say, change the government recommendations to make green vegetables the core of eating and watch what the grain farming industry do.
Likewise, in this day and age, why do they allow tobacco farming and tobacco products to be sold? While they supposedly have gotten rid of the farm subsidies for tobacco, they still get tax subsidies. Please don’t give me the prohibition argument, tobacco unlike alcohol has no benefits, and there is no safe level of usage. Arguing this generates billions of dollars in revenue and creates jobs might be all great and good, but how much does tobacco cost us in health insurance costs, especially to the government, since the effects of long term smoking and use likely will hit when the person is in the medicare generation.
Then, too, those who want to gut environmental regulations, how much will that cost us in health care down the road? That factory being allowed to dump carcinogens into the river, the fracking rig’s chemicals seeping into acquifiers, how much did a love canal cost?
Companies scream about the cost of health insurance, but take a look at the modern working environment, where employers expect long hours, work intrudes into our lives 24/7, we are working longer, harder than any time since the 1930’s, and we are paying the price.
The point being that price transparency, making people aware of the cost of medicine, getting the profit motive out of medical care all might be great and good, but no matter what system we go to, preventing disease is the only real way to cut health care costs. We have spent billions on developing vaccines against diseases that were killers that have eradicated horrible diseases, we need to spend the same kind of thing on keeping people health rather than treating the consequences…fat chance,but until we do that, until we know what it really means to be healthy rather than the 'if you are obese, you are morally impure" or doctors nagging us about BMI, until we actively support across the board people being healthy, those costs are going to continue to rise, likely until we know what we are supporting and use government resources to help it happen, it will fail, pure and simple.
I don’t agree that preventing disease is the only way to cut health care costs, although it certainly should be pursued. Two other ways to cut health care costs are to pay providers less, and to more effectively deliver the health care we deliver.
In the US, we pay more per procedure, much more, than people in other countries. We pay doctors more, we pay hospitals more, we pay out-of-hospital surgery centers more, we pay pharma companies more. We don’t have to do that.
Right now in the US, we pay providers per procedure, in the main. We have a fragmented system, where our health data is siloed; one doctor who treats us can’t easily see what other doctors have done. We repeat tests. People with complex medical needs, like older seniors, have to deal with many doctors, who seemingly don’t talk to each other. Better, more integrated management, especially of the care of people with complex needs, ought to save money, though it’s difficult to implement.
@cardinalfang:
I didn’t say it was the only way, all the things you list are true, what I was saying that unless we work on the stuff I am talking about the things you are talking about alone won’t solve the fundamental problem. A friend of mine is from Taiwan, and unless he was lying, they have universal health coverage that seems to work, and one of the reasons it does is because people in Taiwan are more healthy than here (note, I have not had time to look up statistics on it, if in fact things like heart disease, cancer, diabetes and so forth are less prevalent).
And take a look at what I am saying in another light, and that is that medicine is most lucrative when you do get sick, rather than you staying healthy. You go to a doctor for a procedure, and a whole raft of people get paid, you stay healthy, no one gets paid. You go in because you are experiencing type II diabetes, now there is blood work (done at a lab potentially owned by the doctor who ordered it), you have routine office visits with that, you have to buy supplies to check your blood sugar level, take insulin, etc…one of the fundamental problems is if we basically got people to be healthier (and remember, if even 40% of medical issues are caused by lifestyle, primarily nutrition, that is a lot), is that a whole raft of downstream medical providers would be seeing a lot less patients and making less money, so in a sense there is an inducement, at least for the medical profession, that people increase being sick and so forth.
I have had time to look up the statistics on it. We don’t have higher health costs in the US because we are less healthy. We are not less healthy. Americans are fatter, but we smoke less, and smoking is worse for health than obesity.
@musicparent When deductibles began creeping up and people were paying more and more out of pocket, two of the three hospitals here had huge layoffs of support staff because people weren’t going to the doctor anymore. You’re right to say there are lots of downstream people driving costs.
A new study came out yesterday that said that 29% of cancers are due to preventable causes - like smoking, not using sunscreen and obesity. (And yes, the study is not perfect).
So what is a doctor or nurse supposed to do? He/she can warn, can prescribe anti-smoking prescription meds, can advise at every visit. But when push comes to shove only the patient can apply the sunscreen, take the prescription, exercise, eat better and all the rest.
http://www.cnn.com/2017/03/23/health/cancer-mutations-bad-luck-study/
But of course the great majority of cancer cases are not preventable - particulary childhood cancers. They are just extremely bad luck having to do with random errors in cell division.
@“Cardinal Fang” :
I don’t doubt more people smoke in Taiwan, but overall what is the obesity rate in Taiwan? What are the rates of heart disease even with all the smoking? There was an article recently by someone who was travelling out west, and he was shocked by the levels of obesity, from kids to adults. And that is also leaving out even for people in shape, how unhealthy our diet is, you ever look at the ingredients for the food a lot of people eat, all the processed and packaged food, that is loaded, among other chemicals and crap, sugar, which may be the real evil in our diet,from heart disease to type II diabetes. The food supply in this country has been industrialized and that isn’t a good thing, not to mention many of us are sedentary, when we travel we take the car, etc. While making medicine more efficient and cut out the crap (like, for example, getting an MRI for a sprained ankle, or having a doctor treat someone with poison ivy or a strep throat when a NP or a RN could treat it), using automated health scanners and the like will help, it won’t cut the biggest reason for soaring health costs. We have for example extended the lives of people significantly, but rather than getting people to be able to age without getting sick, it is in very expensive medicine to keep them going, same with people who are younger. As they used to say on the Fram commercials, you either pay me now (ie preventative medicine) or you pay me later, you don’t spend 5 bucks on an oil filter every X thousands of miles, you face replacing an engine that costs 4,000 dollars.
^^^ Well, then…off to McD’s for lunch.
Not surprising that comes from McKimsey, who have openly supported the notion that the answer to health care is competition among insurers, among providers, that the magic bullet will lower the cost of health care to where it is like TV sets, market competition isn’t going to solve this.
One of the things to note (and it is interesting they didn’t include Canada in this, I wonder why, though I suspect it likely would hurt their conclusion) is that the other countries they mention have national health care in some ways or the other (France uses a hybrid system,. least did last time I checked, that might be a better one). So why would that make a difference? I would love someone to show the total cost for people not having insurance, not having access to health care in a preventative way, so when they do go see a doctor they mighbt be critically ill. How much extra does it cost when people go to an er for routine care, go to a doctor’s office or clinic for a strep throat it likely will cost zip, do it at an er it costs a lot. In a national health care system you don’t have, for example, the hospital with the MRI machine that tells it people they want it humming 24/7 to pay for it, you don’t have doctors sending you for an MRI because they are part owner of the clinic, or when you need outpatient surgery, to their facility or to their lab, it isn’t allowed, because the profit motive isn’t there. Those countries also all, because of their NHS system and their laws, has price controls on drugs, Mylen labs would not have gotten away with a 600% price increase or the Martin Shvili staggering price increases on a generic drug.
Like I said, I didn’t say our whole problem was diet and nutrition and i certainly didn’t say it was strictly obesity, either, we are talking health, not weight necessarily. What is the cost of the hormones in beef, what is the cost of all the crap they put in food (you think the FDA really regulates safety?). What will the cost be of plants they have made genetically resistant to RoundUp, so they can spray fields of corn and the like with roundup to kill the weeds…roundup cannot be washed off, the plants and vegetables absorb it, it doesn’t break down, and it is a known carcinogen. That skinny model type who smokes could eventually get cancer and heart disease, the problem with the Mckimsey piece is is focused on obese people only (and yes, there are healthy obese people , genetics is a funny thing), when it should be on health. There are people who guzzle sode who are rail thin, and get type II diabetes, there are perfectly in shape people who end up with various kinds of cancer, for example. The key is not about obesity alone, it is about health and measuring it, it is one of the reasons the whole BMI thing is problematic, it is a single dimensional measurement in a multi, multi variable world, but doctors love it because it is cheap and easy (am I saying BMI is totally useless? No, as a rough rule of thumb someone who is way, way out on the bmi scale is likely to have more problems then someone who is closer in), but like I said, having a BMI of 20 won’t necessarily mean you won’t get cancer, arthritis, degenerative nerve diseases, diabetes, etc.
In fact I am objecting to this very thing, that people look for that single scapegoat, the extreme conservatives who believe if you take away health insurance people won’t ‘abuse it’ (rather than as is more likely, not get treatment when they need it and making it worse) and that doctors will ‘compete down to the market’ (yah mean go back to taking chickens in payment, as we hear in stories from the good old days), others blame the health insurance companies for everything, doctors and insurers blame the government, etc, looking for the magic scapegoat. that one magic pill, and what I am saying is without attacking the health side of this, preventative health, wellness, whatever you want to call it, no other thing is going to fix this mess, it needs to be attacked from all sides, and hasn’t been.
Just to update: the AHCA legislation has been pulled after it became clear that there were not enough votes to pass it in the House. Since we’re not allowed to debate its politics, I will leave off the emoticons…
The AHCA died. No vote, because the sponsors didn’t have the votes. Bye bye.
Theyre saying, “Dead for this Congress.”
Could it be?
I think so… there’s no room for compromise on the GOP side because of the inherent conflict between the goals of hard-line conservatives & moderates. It’s not that they don’t agree on details, it’s that they disagree on outcomes.
Yes, consider the differences in goals between the donors and voters…
I haven’t read the study, but I think that’s an oversimplification. Those “bad choice” factors impact the risk of cancer, but the same cancers occur in people who don’t engage in risky behavior. For example, nonsmokers get lung cancer
Because these are statistical risk factors – rather than direct causes in individuals – as a society we are probably better off from approaching these problems population wide, rather than focusing on individuals. There is no way to predict which nonsmokers will get lung cancer, or which lifelong smokers will escape serious lung disease – but cutting down the overall rate of tobacco use population wide will also reduce the rate of cancer & emphysema. Hence the logic behind increased taxes on cigarettes, with revenues from the tax directed toward health care support, such as Prop 56 on California’s ballot last November (which passed overwhelmingly)
I’m paraphrasing here, but Paul Ryan just said that Obamacare is now the law of the land for the foreseeable future.
Not quite. The referenced CNN story says that environmental and lifestyle factors contribute 29% of mutations.
Well, I am relieved for the 42 million who can retain their insurance and as a taxpayer so that people can get care outside of ERs!