<p>BedHead - Did the McKinsey Institute study take into account the tremendous ethnic diversity within our nation. Sorry but I don’t know exactly what OCED means, but if it refers to northern European countries than the study is comparing apples to oranges. America has enormous numbers of immigrants, many ill when they come, many undocumented and thus receiving haphazard care, but all of whom are included in studies looking at our health care systems. In contrast, European nations – like France – have an amazingly homogeneous population in which those from divere ethnic backgrounds are most often “contract” “temporary” workers, and not included in these wonderful studies. That’s just one problem with many of them that continually make the US sound like the dark ages in term of health care.</p>
<p>FWIW, Ameria has been footing the bill for virtually all medical technological advances in the world for quite a while. The socialist countries - and yeah - I do mean socialist – of course, adopted universal health care a while ago, regulate costs, and dispense the vast preponderance of care. Do you see big medical breakthroughs coming from England? France? Sweden? No.</p>
<p>It’s quite a pickle we’re in. Everyone wants premium health care and is just convinced that they deserve it and that it should be provided to them with no administrative headaches and absolutely free of any cost. As it happens, good health care and improving health care is the product of very talented minds and quite a lot of risk and work. As it happens, this means it’s an expensive commodity. Most of Europe and Cananda and Australia have said they won’t pay for it - they will let America foot the bill for all the innovation and then ration out health care in amounts and at quality levels that govt bureacrats approve. If we go this way, too, the innovation will simply stop, among other unfortunate consequences. And now I’m tired. No one will argue a die-hard liberal into changing sides. I was one once, too. It takes life experiences to do that.</p>
<p>“I don’t think these anecdotes prove anything.”</p>
<p>BedHead, what are you talking about? I think it’s perfectly clear that if the health care system is working for me and my family, then it doesn’t need to be changed.</p>
<p>I feel the same way about the way college costs are covered in this country. I had seven years of university education at some of the best private schools in the country, and my out-of-pocket tuition cost was zero! My father just wrote the checks; it was as simple as 1, 2, 3. I don’t know why some people think there’s an access problem.</p>
<p>BedHead, perhaps you could enlighten us to some of the scientific advances made by Brazillian pediatricians. Please, let’s all remember that “health care” is not “oil” or “corn.” It’s a knowledge product that we need to keep continually evolving and we need to invest in if that’s to happen. I seriously doubt that Brazil is at the forefront of medical breakthroughs.</p>
<p>Excellent points mammall. If we move to a LCD system we will be frozen having the best 2008 medical care–in 2028. The rest of the world rides on our research for free. Also I have no idea how they would get around the need for rationing care in any single pay system. Unlimited care to all will drive the costs well past what we spend now–without the development of better care.</p>
<p>Have you ever heard of McKinsey & Co? Do you think they were so stupid as to specify a study that didn’t take into account those things – or generally that studies of medical outcomes don’t take these things into account? You haven’t heard of the OECD so I imagine you’re not familiar with McKinsey. Look them both up. No, the OECD doesn’t just include Europe.</p>
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<p>Firstly, one can marshall any anecdote to suggest anything, and the point is there are plenty of anecdotes to suggest health care is just fine even in a developing country like Brazil. Barrons nice story about his eye is worthless as an indicator of anything systematic, in other words. </p>
<p>Americans have just enough pride in our science to think that good healthcare equates to medical breakthroughs. Our science is first-rate; there’s no question and I am proud of that. Medical breakthroughs abound. This condition co-exists with a condition highlighted by the McKinsey study and many others that we pay more, get worse, and get less medical care and coverage. I guess that’s too complicated a set of issues for a lot of people to see. What good are medical breakthroughs for the population overall that never gets access to them? </p>
<p>I don’t know what the state of science is in Brazil, and it’s an irrelevancy. What I do know anecdotally so take it for what that’s worth is that general pediatric care in Brazil is better than general pediatric care here, at least in the practices I’ve encountered. Now, if my baby needed a heart transplant, I’d want the best US doctor. Though I probably would never have access to him/her.</p>
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<p>Thank you, Hanna. I find your sarcasm refreshing.</p>
<p>I am glad for Barrons’ eye, but I think I’d give the word of the CEO of Aetna a bit more weight.</p>
<p>I’m also glad that our government - i.e. ME - has invested so much in first-rate research through our institutions of higher education and through the National Institutes of Health - and am looking forward to doing more of it. </p>
<p>I am also sorry that the thousands of people now going to India, Brazil, Thailand, Argentina, and Mexico for quality health care - often with the blessing and financial support of insurance companies - can’t find as much value for their health care dollars here. But that’s globalization for you.</p>
<p>I read the study and it concludes nothing of the sort that you stated. It says on the whole we spend more and do not get significantly better care on the whole (not worse care)( but some get much better care). The whys are pretty simple–doctors and nurses here make more, drugs cost more, and the players need to make a profit. The other KEY finding was that patients demand the best without concern for cost. So the solutions they propose are simple and inpossible–pay people less (see Canadian doctors flee to US), have people opt for lower cost care (right), and remove profits for drugs and hospitals and insurance companies (longterm result–fewer new drugs and the MV dept ( or maybe Washington “Crash” Ferries) will be running your insurance plan).</p>
<p>uh, BedHead, a very good friend’s daughter was hired by McKinsey out of undergrad and is now getting her MBA at harvard on their tab. And I’ve actually worked in the field of health outcomes research at universities. So although I’m not an expert, I’m also not completely stupid and most in the outcomes area are well aware how crude statistics can indeed be used to make the point that universal health care = fabulous, US health care = Sucks! It is in fact enormously difficult to conduct a study that controls for demographics, income, race, education levels and immigration status . . . just to name a few. Look at our infant mortality. Low birth weight babies are almost entirely clustered among teenage unmarried black and hispanic women. Now that isn’t a consequence of bad health care. That’s a consequence of bad socialization either in our education system or social welfare systems. That’s just one example. If we’re going to compare to Brazil, we’re talking about a smaller, more ethnically uniform, younger, and more educationally uniform population with scarce immigration. The challenges for dispensing government health care to such a population is light years simpler than in the US. And that doesn’t even take on the question of innovation.</p>
<p>What exactly was the shockingly superious pediatric care in Brazil? Just curious what the metric might be to support this claim.</p>
<p>mini - do you have any notion of how much research money the drug and device industries pour into our universities? Do you have any sense of how much money the drug and device industries pour into the FDA? Do you have any sense of the tax revenues that drug and device industries - not to mention their millions of well-paid and highly taxed employees - pay into the IRS and thus the NIH each year.</p>
<p>Yeah. Get rid of the drug and device industries and that will really solve the health care cost problem.</p>
<p>Go overseas for your health care where it will simply be dispensed more cheaply than here. What is being dispensed is not a product of those systems.</p>
<p>And finally, did anyone catch the rather interesting piece in the venerable NY Times last week - can’t remember the author, it wasn’t on the op-ed page - that pointed out that rising health care costs are in fact mostly a function of two things: (1) there is more health care technology available each year and (2) these new therapies actually work quite well, keep us alive longer and have us coming back for more, resulting in the average American consuming vastly more health care than a generation ago.</p>
<p>“The challenges for dispensing government health care to such a population is light years simpler than in the US.”</p>
<p>What this says more simply as that we’ve rationed care for years to ensure that a much larger proportion of non-white populations either don’t get it at all, or get poorer quality care. JAMA has published studies for years on African-American populations with the same insurance, with the same income, and with THE SAME DOCTORS receiving poorer quality care - I’ve got such studies on my shelf related to heart disease, COPD, diabetes, and referral to drug treatment. But rationing has pretty much assured that they don’t have the same insurance, or the same doctors. </p>
<p>Smaller? Brazil has a population of 200 million so yes it is technically smaller, but it’s no country of 10 million. More ethnically uniform? Are you serious? Do you have the slightest inkling of how many Africans, Europeans, Asians (esp. Japanese), native Americans, etc. make up the Brazilian populace? There is so much miscegenation in Brazil that there was a famous TRUE story that a white couple took home a black baby from the maternity ward while a black couple took home a white baby, neither of them thought anything strange had occurred, and there was only a fight after several months when the hospital itself realized the babies had been switched. Ethnically uniform? </p>
<p>Look, don’t wade in too deeply here. It’s obvious you don’t have a clue about Brazil. Really. If you could claim Brazil is more ethnically uniform than the US or just about anywhere, you don’t have the slightest idea of that country, so let’s end the discussion on that front.</p>
<p>I wasn’t claiming to have done a systematic overview of Brazilian medicine. I was merely countering Barrons anecdote with one of my own. </p>
<p>Our Brazilian pediatricians spent vastly more time with our child than our American ones, noticed several things that the Americans hadn’t noticed (including damage to our baby’s right shoulder socket and limited arm movement that my wife had noticed and I hadn’t – and that my wife didn’t mention to the doctors in Brazil).</p>
<p>Was this shockingly superious care? No, and it wasn’t shockingly superior care either – those were your words – but I’ll tell you if I could choose a general pediatrician for my daughter to see, it would be a Brazilian one.</p>
<p>Most Americans read about medical breakthroughs – of which we are a leading provider as a nation – and somehow conclude this translates to overall better care. They can’t imagine a developing country like Brazil could actually provide better general care in many cases. Even you said sneeringly “shocking superious care” as if Brazil couldn’t possibly do this – or as if Brazilians are a bunch of illiterates.</p>
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<p>You didn’t read the whole thing and understand it, then.</p>
<p>Here’s the intro summary. Also the full study states that the insured in the uS receive top quality care on the whole. The problem is then the uninsured. Also the study discusses demographis briefly but does not attempt tp adjust for them.
–who is being more accurate?</p>
<p>"The United States spends more of its income on health care than other developed countries and that share is rising. It is an arresting statistic that the U.S. now spends more on health care than it does on food.</p>
<p>In this new report MGI finds that the United States spends approximately $480 billion ($1,600 per capita) more on health care than other OECD countries and that additional spending is not explained by a higher disease burden; the research shows that the U.S. population is not significantly sicker than the other countries studied. </p>
<p>Instead, MGI found that the overriding cause of high U.S. health care costs is the failure of the intermediation system — payors, employers, and government — to provide sufficient incentives to patients and consumers to be value–conscious in their demand decisions, and to regulate the necessary incentives to promote rational use by providers and suppliers. </p>
<p>Given the less than optimal access for all U.S. citizens (relative to peer countries), MGI concludes that major opportunities for cost improvement —even if not the full $480 billion—are as possible as they are necessary although no single reform is likely to succeed in achieving the needed rebalancing. To be effective, reform in health care will need to apply sound principles on both the demand and supply side of the system.</p>
<p>You just gave yourself away. You quoted the intro summary. You actually have to read the whole report. Don’t read the synthesis. Go and read the whole report.</p>
<p>It says essentially that we pay a lot more and our health outcomes are not proportionately better, but are in fact in many cases worse, even accounting for differences in population and coverage and all that. </p>
<p>Read the whole report. If you are saying that the report doesn’t say essentially what I said, again, you didn’t read it all or what you read you didn’t understand. We pay way more and we don’t get value for it. And access is poor, and even in the intro. McKinsey puts this fact in “gentlemanly” words that may have escaped you
<p>I rerad the whole report but you can’t copy sections of it so I posted the summary which one would think contaions the key findings. Yes, and I noted the REASONS for the higher costs. Which are you prepared to slash? The outcomes are fine for the people with coverage. You were implying we get worse care and pay more which is false.</p>
<p>As a country, we get worse care and pay more. I know all you appear to care about is your family and your detached retina repair (for which I am truly glad for you) and I am glad your family is covered by a plan that seems to actually be willing to pay for your needed medical interventions – a lot of people don’t get such coverage, by the way, even when they think they are covered. </p>
<p>McKinsey, though, didn’t study health care outcomes for your family. They were a little bit more expansive and decided to compare our nation to other nations.</p>
<p>They concluded we pay, PER CAPITA, $1,600 more per person for health care in our country.
And that the higher spending wasn’t explained by worse intrinsic health and didn’t result in better outcomes for us (pay more, dollar-for-dollar less quality). Again, they looked at this on the national level. They didn’t choose your family which has coverage and compare it to a family that lives in Lapland. They compared national performance and payments.</p>
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<p>I’d slash eye coverage. People can learn to live with one eye, IMO. What’s the big deal about a detached retina?</p>
<p>Seriously, I’d pick the German model. Private health care companies are allowed to exist and compete and thrive, but on the pricing side, the government sets all the prices as well as minimum treatment standards. This gets the companies competing – and focusing a lot of their effort on cost management. Everyone would be covered. None of the cherry-picking healthy individuals and culling out the less healthy ones, as happens in our system. A person pays solid premiums for several years and then when they encounter a problem for which they’ve insured themselves all these years, the insurance companies try to cut costs by dumping them or denying them their coverage in many cases.</p>
<p>For those who’d say this would create a massive unwanted bureaucracy, what the heck do you think we have right now? Where do you think a lot of the money we spend goes? That’s right: into bureaucracies that figure out how to avoid covering unhealthy people.</p>
<p>Private insurance profits and underwriting - 19%-33%. My single-payor plan has already done it (with the benefit package, by law, EXACTLY the same as the private insurers), with my premiums one-third that of the next lowest option; I get to choose ANY licensed health care providers on the basis of quality, waiting time (or their first names, if I choose), and a board of consumers and practitioners – rather than underwriting pencil-pushers – dealing with any appeals that might come up in the process. No massive bureaucracy, unlike in the private sector. Health care that works. No advertising expenses either.</p>
<p>So are you telling them to cut doctor and nurses pay? That is the big ticket item in costs. Setting prices means a cut in pay for doctors–it’s that simple if you are to save money you pay them less per procedure. Every system requires an oversight system and I doubt the Dept of Motor Vehicles can do it for much less than Cigna, etc. To say the government can run it cheaper is usually wishful thinking. And somebody has to run it. So maybe you can save a small portion of the ins comp overhead but it will be chump change. The main thing you have to do–acording to the M study–is make everyone happy with less. Less pay for providors, fewer scans for tumors etc, fewer new drugs, etc etc. Go sell that. Good luck.</p>
<p>Barrons, you are completely incorrect. The government-run medical system we currently have–Medicare–delivers the goods for lower administrative costs than for-profit insurance companies. Not wishful thinking. Current reality.</p>
<p>Also, it is well documented that the US pays a higher proportion of GDP for medical care than other industrialized nations and gets worse results in terms of infant mortality, life expectancy, and all of the usual markers.</p>
<p>“So are you telling them to cut doctor and nurses pay?”</p>
<p>Not in the least. I’d raise it - for doctors simply by allowing them to compete on the basis of quality. Why is it that, when it comes to competition, the corporate socialists don’t want any part of it? (Oh, I’m sorry, my bad, the question has the answer contained within. ;))</p>
<p>“To say the government can run it cheaper is usually wishful thinking.”</p>
<p>Not only can, but does. And in your own state. Premiums, by law, are set for state employees as a percentage of plan outlays. I can show you the rates.</p>
<p>The study does not conclude that we get worse results in those terms. It mentions the indicators in passing but does not attempt to fully analyze the outcomes and possible other variables that might explain the variances so to say that is a conclusion is false. We work harder and longer in the US for example–we have shorter vacations. We have more murders and probably more serious car accidents that can shorten life. </p>
<p>And if indeed Medicare is run cheaply it may be lacking the controls that prevent false and overbilling. I know there have been huge problems exposed with fraud in Medicaid and that something approaching 20% of spending goes to fraudulent claims. So maybe it’s not really as cheap as it appears. It’s easy to just shovel $$$ out the door without checks for fraud, quality etc.
Maybe Washington state employees are an easy to manage and compliant group. I’ll see what my wife says about their payments and processes.</p>
<p>I love watching mini in action on this one. No one will ever engage him on the issue of the current single-payer experiments already in place in America. It’s amusing to watch people dance around the issue.</p>
<p>I’m a big fan of mini’s idea: get the government into the industry, and make them the low cost alternative; tie their providing healthcare to recommendations by actual practitioners; and then allow private firms to compete as well.</p>
<p>I’m a little confused: all kinds of free-market people seem to think that the government will be worse at its job than private providers. If you really think that, shouldn’t you be prepared to let the government into the market and check if that’s really the case? </p>
<p>Because it seems from mini’s state that the government actually does a better job - and, despite mammall’s incredulity, it appears that single payer systems in other OECD countries also do a better job [and by the way, mammall, Canada’s aggregate healthcare outcomes in terms of dollars spent per capita follows this pattern, with a population in many respects similar to America].</p>
<p>But if you’re all so convinced that the government will be worse, why not let them try their hand at it? If they are indeed worse, private insurers will not have any market share taken away from them; if they are better, private insurers will be forced to improve. I see a win-win.</p>
<p>By the way, mammall: Just because one creates a single-payer system for distributing the actual healthcare, does not mean that the pharmaceutical or device companies are going to somehow go out of business. They provide a service to whoever is providing the healthcare - whether that is the government or private companies.</p>