<p>Why should the US spend a lot more for health care as a percentage of gdp compared to other developed countries…more than twice as much in a couple of cases…and insure a smaller percentage of its population?</p>
<p>It’s insane…</p>
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I would imagine this has to do with the evolution of society. There may have been a time where there were no rights of any kind. As we became more prosperous, people decided that any individual’s well-being is to a large extent depended on the state of his neighbors, and avoiding starving, or homeless, or illiterate neighbors was worth denying someone the luxury of having golden toilets. </p>
<p>As healthcare became more of a science with definite cost/benefits it too is becoming a right because if you think a $5 meal is a right, why would you say a $50 vaccination isn’t?</p>
<p>Nice snapshots…</p>
<p>[Slideshow</a> | “International Comparisons” - Kaiser Slides](<a href=“http://facts.kff.org/results.aspx?view=slides&detail=43]Slideshow”>http://facts.kff.org/results.aspx?view=slides&detail=43)</p>
<p>^ kaiser is a nonprofit health insurer and very driven by a particular ideological perspective. I once worked for Kaiser. Kaiser would benefit (ie, “profit”) enormously if we socialized medicine. </p>
<p>If you actually want to drill down and begin to appreciate the complexities of healthcare economics then start with this one by David Cutler, a Harvard economist who is at least nuanced and non-polemical in his perspective:</p>
<p>[Amazon.com:</a> Your Money or Your Life: Strong Medicine for America’s Health Care System (9780195181326): David M. Cutler: Books](<a href=“http://www.amazon.com/Your-Money-Life-Medicine-Americas/dp/0195181328/ref=sr_1_1?s=books&ie=UTF8&qid=1323622363&sr=1-1]Amazon.com:”>http://www.amazon.com/Your-Money-Life-Medicine-Americas/dp/0195181328/ref=sr_1_1?s=books&ie=UTF8&qid=1323622363&sr=1-1)</p>
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<p>I think chart 4 from the earlier link I posted shows some problems with the cost structure of US health care.</p>
<p>I thought what makes the US great is we are very productive as a country.</p>
<p>I thought the US produces more at less cost…</p>
<p>With health care…we produce less at more cost…</p>
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<p>I think the reason this is being discussed now is that even basic health care is now beyond the reach of 50 million of your fellow citizens. </p>
<p>The ironic thing is that those of you who are lucky enough to have good insurance would pay lower premiums if we had universal insurance. Right now, when someone without insurance has an ear infection, they end up in the ER because doctors won’t see them. Guess who often ends up paying for that – you.</p>
<p>Plus, as the Blue Crosses of the world slap on double-digit premium increases year after year, they lose many of their subscribers. The people who tend to stay in, are the people who are sickest and need insurance the most. And that of course increases the premium as well.</p>
<p>Ahhh . . . can always count on Dstark to bring an open mind to the discussion.</p>
<p>^^ But he’s right, sewhappy. As a nation, we pay a lot more and get a lot less – by a very long shot.</p>
<p>I am not an expert on Cutler’s thinking…</p>
<p>So you tell me sewhappy…</p>
<p>Cutler says that the rate of return on some health care costs are 5 to 1…so we should spend more for health care not less…correct? If a person spends 1 buck for some areas of health care…there is a 5 to 1 return…correct?</p>
<p>This is from Amazon…</p>
<p>“spending without first measuring and comparing the benefits purchased. Chapters 3 through 5 methodically track the growth in spending to treat low-birth-weight infants, patients with depression, and those who have had heart attacks. These initial chapters contain compelling information and should be read by all who are interested in health care policy. Underlying the growth in spending is the persistent march of science. The introduction of new forms of technology allows us to treat more patients with particular medical conditions, though generally at a high price per case. The heart of the book examines these trends and, in the three case studies that it follows, compares the added spending to the change in health benefits. In each case, total spending per case has risen, driven largely by the introduction of new medical technology. In some cases, the medical returns have been impressive. In the treatment of low-birth-weight newborns, medical advances (e.g., incubator design, new drugs), although expensive, have produced a dramatic reduction in mortality rates. As discussed in chapter 3, each additional $1 spent on treating low-birth-weight babies has produced $5 of additional health benefits – an expensive, though worthwhile, investment. Chapters 4 and 5 present the same evidence for treatment, respectively, of depression (a seven-to-one return on investment) and heart attacks (a four-to-one return on each dollar spent). Chapter 6 attempts a broader extrapolation of the medical value of health care spending – a somewhat tougher sell. Some of the later chapters, such as chapter 8, which examines what went wrong with managed care, seem to wander slightly off target. If the health care we are purchasing is worth it, why the general malaise? Some of it is clearly traced to the perceptions of purchasers and consumers that we spend too much, that we could buy the same benefits for far less money, and that the system is hopelessly complicated. Along these lines, chapters 9 and 10 attempt to address the issue of providing better care more efficiently”</p>
<p>Very nice, Dstark. Selective cut and paste. Very impressive.</p>
<p>I’m out on here. The usual suspects are now going to talk to each other for awhile and then it will no doubt get shut down by a moderator.</p>
<p>Sewhappy…</p>
<p>Does this article reflect Cutler’s views?</p>
<p>[The</a> New York Times > Magazine > The Quality Cure?](<a href=“The Quality Cure? - The New York Times”>The Quality Cure? - The New York Times)</p>
<p>Cutler seems to want more government spending…</p>
<p>True?</p>
<p>Cutler seems to want universal health care… True?</p>
<p>“And as for all those Indian docs coming over here. They come here rather than stay home because they make a better living here. Is this a win for India?”</p>
<p>It’s not a win in that they subsidize the U.S. health care system. It is a win in that they have more doctors than they can use, and that they don’t mind unloading some of the excess, especially when they have so many first rate ones.</p>
<p>(As for U.S. health care: my “top-rated” health care HMO ended up giving my younger d. three surgeries when she only needed one by LYING about the qualifications of their sports med “specialist”, and then refusing a referral to one who was publicly listed on their panel. She’ fine, but it likely cost her a $200k scholarship. And cost the health care company $175k when it likely should only have cost $50k.)</p>
<p>The word rationing scares people and makes them angry. So perhaps another word should be used. But in a single payer world, decisions would have to made about which procedures would be paid for and which ones wouldn’t.</p>
<p>Insurance companies make these decisions for people now. Much of their rationing, however, is done by one or more of these practices: refusing to cover certain people, or charging astronomical premiums, by dropping sick people’s coverage, by excluding “pre-existing” conditions, etc. These are blunt mechanisms, not based on fairness, or any analysis of cost-effectiveness.</p>
<p>Yes, a huge percentage of expenditures occur in the last month of person’s life, particularly elderly people. Much of this is “wasted” health care, in terms of extending the person’s life or improving their last days. This should be looked at, but think of the howls that would ensue from the fear mongers.</p>
<p>IF Only we could install washlet bidets in every houshold, we could eliminate a lot of retention issues at both ends.</p>
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<p>I disagree. I live in Canada now. I’ve had manyyyy extensive years of both systems. In Canada one of my children has spent much of their childhood seeing about 10 specialists on a regular basis. Both myself and my other child have an ongoing medical condition. We’ve experienced about four operations. My spouse had an kidney stone last year; I had what we feared was a heart attack. My mom, who has now immigrated with us, has been hospitalized on numerous occasions and has dementia. NOT ONCE have we experienced anything but absolutely stellar care that is on par with what we had in the US eastcoast with private insurance.</p>
<p>I just picked up three prescriptions last night, I didn’t have to take out my wallet (the bill to me for those was zero). In fact, we have never seen a medical bill here.</p>
<p>My mom’s psychiatrist used to visit her house every month, along with his assistant. We can see any doctor we want. I’ve never met someone who was denied a treatment. </p>
<p>Now our system is not perfect, and it varies actually quite a lot from province to province. But it is very hard to listen to the fear mongering created by special interests and easy to sustain with the general fear of the unknown. There are so many myths that feed that fear: </p>
<p>No we do not lack great doctors- they are paid much much less but there is no shortage of our best and brightest competing to get into med school (and when they are doctors, it’s much easier because they aren’t haggling with paperwork and insurers all the time). </p>
<p>No we do not find people are clamouring to use up wasted medical resources just because its free. Do you see those with private insurance in the US spending their free time seeing doctors for fun? </p>
<p>No we don’t have a ‘death panel’ and no one is afraid of missing medical care. Oh sure there is sometimes that in the news and it makes the papers (e.g. people fighting for untested MS surgery right now for example and the govt wanting to do more clinical trials first, or someone wanting a special drug for some rare cancer), but we hear many more such horror stories from the US. </p>
<p>And if you look at the numbers, where we live, we have a very long lifespan (on par with Japan), and we have higher survival rates for a host of cancers that are above anything found in the US.</p>
<p>We don’t have to worry if our kids with have medical coverage when they leave ours. We don’t have to worry if our seniors’ care will be sufficient. People aren’t afraid in the same way to leave an employer or lose their job for fear of not having insurance. And we don’t have pay out of pocket for medical care (sure we pay higher taxes- total income tax is now at 35%- but in this country everyone thinks everyone should be entitled to medical care regardless of their station in life).</p>
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My family has had Kaiser health care forever - through primary care, emergency care, urgent care, lengthy hospitalizations, a variety of surgeries, you name it. The only “ideological perspective” that I’ve observed driving Kaiser is a focus on providing sensible, efficient, quality health care which is governed by medical priorities instead of financial ones. I can understand how some people would consider that to be suspicious, even dangerous, but as a long-time KP member I like it. </p>
<p>Kaiser’s prescription renewal is available on-line, with the medicine mailed to you if you don’t want to pick it up. You can review your test results on-line. You can e-mail your doctor and get a response. Common problems have specialized clinics set up to deal with them swiftly and efficiently. One complaint you might get from Kaiser members: if you demand antibiotics for the flu you’ll get resistance instead of a happy face and a scrip. That’s one of the risks of non-fee-for-service medical care - you may not get useless and community-harmful medication on demand.</p>
<p>Many years ago I spent a time in a non-Kaiser, private physician/reimbursement based HMO. The doc referred me for tests the only justification for which was to bill the insurer. He didn’t even bother to let me know the results. Seriously. Kaiser probably would “profit” if we “socialized” medicine - as would the rest of us.</p>
<p>Cutler wants society to pay more for great healthcare because he thinks – and I tend to agree – that good health is the most important thing we can have. He’s a smart guy and I’m not smart enough and don’t have enough time to read all his stuff and noodle over it but I basically think that his contribution to all the dialogue is to start understanding that by insisting that we pay less for healthcare we are gong to end up regretting it longterm.</p>
<p>We have iphones. And terrific cars. And certainly a heck of a lot of food, more than is good for us. Why is our healthcare suppose to be this free thing that costs us nothing? It represents pretty much the apex of our technological innovation. Why is great care suppose to be cheap?</p>
<p>As for Canada, it is a very great country. What Canadian biotechs, medical device companies or medical schools innovating cardiac therapies or cancer treatments can you quickly google and slap onto this thread? A fraction of what goes on here. And that’s what we need to realize. If we became Canada, if the whole world became like Canada you would not see the technology advance the way we have. </p>
<p>Canada can have pretty cheap care. So can UK. A big part of the reason is because the US healthcare consumer foots the innovation bill for the world. </p>
<p>You are not going to get the innovation unless there is some reward in innovating. At this point, the US is one of the few countries who ponies up and makes it worthwhile. Don’t count on China. They don’t give a hoot about intellectual property.</p>
<p>And, btw, I have recently endured a lot of lousy doctoring. Two physicians tried to railroad me into a hysterectomy I didn’t need. Thank goodness for third opinions.</p>
<p>The intent and much of the design of the healthcare reform is good. One of the very best aspects is the focus on evidence based measures of treatment outcomes. We also need good valid data on physician performance. Hospital performance. All of that is very exciting.</p>
<p>I’m not saying government shouldn’t orchestrate healthcare and be integral in how we fund it. I’m saying we should not keep insisting it be cheap. Nothing is more important. But let’s get the best we can for what we pay. And let’s make the rest of the world start contributing to the innovation costs.</p>
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<p>Well I’m not exactly “high income” and I don’t know the extent of my insurance because I haven’t actually used it. It is not a preferred insurance that we take at my work. I come to this discussion as a healthcare provider. I have seen patients several times who complain about having no money yet they have the latest and greatest cellphone. They complain about being unable to pay their co-pays as they come in with big sodas and fast food everyday and reaking of cigarette smoke. I’m sorry, but I struggle to feel sorry for many of these people.</p>
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<p>How much medical research is done here compared to other countries? I’ll bet A LOT more.</p>
<p>I think one problem in America is our continued “growth” of healthcare professions. What used to be an associates degree to be an RN they now want a BS. A physical therapist used to require only a Bachelor’s and now requires a Doctoral degree. A physician assistant used to require only an associates and now requires a masters. All of these professions demand greater salaries due to greater education. I’m not sold on the patient care having improved substantially as this education has increased…</p>
<p>This is so much a ‘let them eat cake’ argument…AS IF cutting out the $30/mth phone (that probably replaces a landline), or giving up the BigMac would mean they can afford their healthcare.</p>
<p>We are currently covering the medical expenses of our MIL who we had to insist retire at 69 (prior she was fearful because medicaid just won’t cover what she needs but her job was literally killing her because she has very spiking BP). We <em>finally!</em> convinced her to let us help. And we didn’t insist she give up her phone or her satellite dish or her cookies. When you live in poverty those little extras make up your entire world.</p>