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Old 06-19-2009, 12:30 PM   #41
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Anyone interested in reading what is actually being considered should read this Ezra Klein - The Finance Committee's "Comprehensive Incrementalism"

which links to this http://www.washingtonpost.com/wp-srv...sal_061809.pdf
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Old 06-19-2009, 01:43 PM   #42
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Indeed, among developed countries, the United States is the biggest spender. It spends 52% more on heath per person than the country ranked second, which is Switzerland. Despite that, the United States does not necessarily do better in terms of health care access, quality or outcomes.

To Holtz-Eakin, who advised John McCain in last year's presidential race,failed health reform wouldmean that "everyone gets coverage but we don't change the underlying cost dynamics. Health care spending goes up and we haven't solved our deficit problem."
These are the two thoughts (from the OP link) that keep coming back to me. The United States spends much more than any other country, developed or not, and is "less healthy" by most measures. And our costs are rising much faster than we can sustain. I watched a good PBS special (you still can here FRONTLINE: sick around the world | PBS) a while ago, they look at the United Kingdom, Japan, Germany, Taiwan and Switzerland and they all spend considerably less and get more without much rationing. We can't simply nationalize the current system, that will only add more bureaucracy cost. I would love the see the system from Japan, Germany, Taiwan, the UK or Switzerland implemented here. But special interests (health care, pharma, insurers, attorneys, etc.), and fear of the unknown (voting population & consequently politicians) keep us frozen with the status quo that we all know can't continue. We can keep talking about all the reasons we can't do anything, or wait until we have no choice...
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Old 06-19-2009, 01:52 PM   #43
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These are the two thoughts (from the OP link) that keep coming back to me. The United States spends much more than any other country, developed or not, and is "less healthy" by most measures. And our costs are rising much faster than we can sustain. I watched a good PBS special (you still can here FRONTLINE: sick around the world | PBS) a while ago, they look at the United Kingdom, Japan, Germany, Taiwan and Switzerland and they all spend considerably less and get more without much rationing. We can't simply nationalize the current system, that will only add more bureaucracy cost. I would love the see the system from Japan, Germany, Taiwan, the UK or Switzerland implemented here. But special interests (health care, pharma, insurers, attorneys, etc.), and fear of the unknown (voting population & consequently politicians) keep us frozen with the status quo that we all know can't continue. We can keep talking about all the reasons we can't do anything, or wait until we have no choice...
Perhaps our lifestyle is so much worse we simply are unable to spend ourselves into comparable health - even though we try so very hard on both aspects.
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Old 06-19-2009, 02:01 PM   #44
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Perhaps our lifestyle is so much worse we simply are unable to spend ourselves into comparable health - even though we try so very hard on both aspects.
I am sure lifestyle exacerbates our costsand I wonder why - and what can be done about it, but that's not the only difference. Our "unit cost" of health care is demonstrably higher as well and there are models all around us that are better.
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Old 06-19-2009, 02:06 PM   #45
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Fat chance.
Is that the same meaning as "slim chance"?
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Old 06-19-2009, 02:41 PM   #46
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I have trouble believing that the US has dramatically poorer lifestyles than other rich countries - certainly not enough to justify the difference in medical spending. For example, this is what I could find on per capita cigarette consumption:

4,313 Greece
3,023 Japan
2,779 Spain
2,428 Belgium
2,323 Netherlands
2,236 Ireland
2,079 Portugal
2,073 Austria
2,058 France
1,976 Canada
1,919 Denmark
1,907 Australia
1,901 Italy
1,702 Germany
1,691 US
1,351 Finland
1,202 Sweden
725 Norway

(Unfortunately, I got most of the data from NationMaster, but had to use InfoPlease for the US number. UK appears to be about 1,060.)
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Old 06-19-2009, 02:43 PM   #47
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I have trouble believing that the US has dramatically poorer lifestyles than other rich countries - certainly not enough to justify the difference in medical spending. For example, this is what I could find on per capita cigarette consumption:

4,313 Greece
3,023 Japan
2,779 Spain
2,428 Belgium
2,323 Netherlands
2,236 Ireland
2,079 Portugal
2,073 Austria
2,058 France
1,976 Canada
1,919 Denmark
1,907 Australia
1,901 Italy
1,702 Germany
1,691 US
1,351 Finland
1,202 Sweden
725 Norway

(Unfortunately, I got most of the data from NationMaster, but had to use InfoPlease for the US number. UK appears to be about 1,060.)
I used the same site as you for obesity.

Obesity statistics - countries compared - NationMaster

Guess where the US ranks?
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Old 06-19-2009, 02:51 PM   #48
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I used the same site as you for obesity.

Obesity statistics - countries compared - NationMaster

Guess where the US ranks?
We're number 1! We're number 1! Oh wait, crap...
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Old 06-19-2009, 03:13 PM   #49
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I used the same site as you for obesity.

Obesity statistics - countries compared - NationMaster

Guess where the US ranks?
Yep:

30.6% United States:
23.0% United Kingdom:
21.9% Greece:
21.7% Australia:
20.9% New Zealand:
14.3% Canada:
13.1% Spain:
13.0% Ireland:
12.9% Germany:
12.8% Portugal:
12.8% Finland:
11.7% Belgium:
10.0% Netherlands:
9.7% Sweden:
9.5% Denmark:
9.4% France:
9.1% Austria:
8.5% Italy:
8.3% Norway:
7.7% Switzerland:
3.2% Japan:
3.2% Korea, South:

Putting the smoking and obesity together, does it really make sense that "lifestyle" forces the US to spend 50% more than anybody else?

This is the first thing I could find on the extra expenses associated with obesity:
Quote:
The excess medical expenditures that result from treating these obesity-related diseases are significant. Roland Sturm used regression analysis to show that obese adults incur annual medical expenditures that are $395 (36 percent) higher than those of normal weight incur.

Now if the excess obesity rate in the US is 20% of the population, and they incur 36% more expense, I get an overall increase of 7.2%. That's meaningful, but I'm trying to explain 50%.

National Medical Spending Attributable To Overweight And Obesity: How Much, And Who's Paying? -- Finkelstein et al., 10.1377/hlthaff.w3.219 -- Health Affairs
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Old 06-19-2009, 03:17 PM   #50
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I think if we studied the reasons why people don't have health ins. we would find a whole range of answers.
anybody see this Video - CNBC.com

maybe we dont really have a problem with people being uninsured
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Old 06-19-2009, 03:20 PM   #51
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That's meaningful, but I'm trying to explain 50%.
Have you compared prescription drug prices? The U.S. is, to some degree, subsidizing the rest of the world for the R&D for new drugs.
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Old 06-19-2009, 03:52 PM   #52
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but I'm trying to explain 50%.
do other contries spend as much on "heroic/end of life" medical proceedures as we do? i read somewhere that the majority of medical costs for the average american happens in their last years of life. also do LTC costs count as medical in the stats quoted here?
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Old 06-19-2009, 03:55 PM   #53
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A personal trainer told me that with losing weight, it's 20% exercise and 80% diet (good food choices, so called "clean eating"). Just throwing that out there because I always believed you could exercise yourself to sleek and slim, but evidently not; you'll just have gorgeous muscles under that fat layer.....

Also, strictly antecdotal but my sister is a nurse in a dialysis center, and if I remember correctly, they treat around 40 patients per day in her center. Many, many, many of their patients suffering from kidney failure have uncontrolled high bp, uncontrolled diabetes and extreme overweight. Lots of their patients are Medicare or Medicaid, so it's not like treatment isn't available. But all the pills in the world don't help with a medical condition if you aren't compliant with treatment.

My own mother is probably close to 100 lbs overweight and takes 3 kinds of bp pills. Her doctor raises 40 kinds of hell every time he sees her, but she refuses to work on the weight. She is 82, so while the excess weight didn't cause an early death, it's certainly affected the quality of her life.

I wonder how the U.S. costs would stack up to other countries if you could somehow remove the obesity factor. If the U.S. had the same obesity rate as say Switzerland from the above referenced chart, how would $ spent on health care change?
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Old 06-19-2009, 04:07 PM   #54
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It's pretty clear there's increasingly a "war" on fat people going on today, and increased public funding exposure to health issues will only make that worse. I think fat people and smokers are the only two classes of people against whom bigotry and discrimination are still socially acceptable.
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Old 06-19-2009, 04:15 PM   #55
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Things that make our US healthcare so expensive

lifestyle (obesity, smoking, drugs)
high cost and profit for intermediaries (insurance)
excessive profit for some product and service providers
administrative burden (millions of microplans)
high charges for specialized services
forced use of expensive specialized facilities for routine medical needs (emergency room)
multiple regulations around the country
punitive legal awards
diagnostic overuse (expensive tests even for routine matters)
treatment overuse (especially end of life)
excessive unproductive labor vs technology

Our current dysfunctional approach to healthcare has evolved over decades, driven by a unique combination of medical and financial motivations. It is both quite good and quite bad.

“Comprehensive healthcare reform” is going to take a long time. The ideological and financial interests today are well entrenched. Starting with high upfront costs in the midst of a recession – well, it’s a hard sell. The version they’re considering now makes more sense.
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Old 06-19-2009, 04:25 PM   #56
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(Qualifing Dr. Frist is ex-senate majority leader Repblican, and a heart surgeon.)


Not to mention a pioneer in video diagnostics.
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Old 06-19-2009, 04:30 PM   #57
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Given that we eat too much, and don't exercise enough, are we going to see a system that forces diet and exercise?

While this may seem far fetched to some, I don't think it is. We already have laws on the books that are justified by 'We all may have to pay if you are in an accident and don't have a seat belt on'. The same logic is used to support helmet laws and a slew of OSHA regulations. So it does not seem too far fetched that we will see lawmakers crafting some form of tax or law for the good of us all.

After all if you are over weight 'We all have to pay your bill'.

I'd bet untold sums we'll see this within 10 years. Probably in the form of a 'sin tax', for example on refined sugars (or something like that).

Even without any change to the status quo in health care, much of the obesity problem already hits the public purse through medicare and medicaid. I suppose many would consider our obesity epidemic an externality of the processed food industry.
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Old 06-19-2009, 04:40 PM   #58
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It's pretty clear there's increasingly a "war" on fat people going on today, and increased public funding exposure to health issues will only make that worse. I think fat people and smokers are the only two classes of people against whom bigotry and discrimination are still socially acceptable.
I'm sorry you feel like a war has been declared on "fat" people and smokers. Truly I am. But I have to wonder why do you think pointing out the health risks of obesity and smoking is bigotry and discrimination? Those behaviors are risky to one's health.

Not exactly the same thing (but close), but as a woman who is 6' tall, I've never met anyone who didn't have something to say about my height, and have heard "wow, you're tall" (like I didn't know that.....) or "how's the weather up there" more times than I can count. It's amazing to me that people look you straight in the face and say these things. Maybe I'm a victim of some kind of discrimination, seriously. But I've made up my mind that the next time some old fat dude looks at me and says "wow, you're tall", I'm going to look right at his big gut and say "wow, you're fat". Wonder how that will go over?
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Old 06-19-2009, 04:59 PM   #59
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But I've made up my mind that the next time some old fat dude looks at me and says "wow, you're tall", I'm going to look right at his big gut and say "wow, you're fat". Wonder how that will go over?

That's awesome, bubba. Please tell us about it when you do.
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Old 06-19-2009, 05:08 PM   #60
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I'm sorry you feel like a war has been declared on "fat" people and smokers. Truly I am. But I have to wonder why do you think pointing out the health risks of obesity and smoking is bigotry and discrimination? Those behaviors are risky to one's health.
Sure, they are. No quarrel at all with that. But in my experience, usually in terms of discussing public policy it's less about genuine concern about health and more about "you're costing me money" or "I'm subsidizing you." (I'm not saying that's you, but it's common in discourse about public health. The post you replied to was directly after yours but it wasn't yours in particular I was aiming at. Hope that's clear.)

The thing is, the bean counters who rip into smokers and the overweight for "costing them more" in health care almost never account for the fact that on average, they live several years less -- and therefore collect several years less from Social Security and Medicare. So from a pure bean-counter standpoint, it would be intellectually dishonest to only look at the added public health care costs of smoking and obesity while ignoring the cost savings in Social Security (and perhaps Medicare in the long run).

Smokers and the obese could just as easily say they are subsidizing Social Security for the physically fit.

And as far as your being a tall woman, I think a short guy like me can relate. At least people don't say you have a "Napoleon complex" or "short man's syndrome." For what it's worth, my wife is 5' 9" and more than an inch taller than me.

I'm neither obese nor a smoker, but that's beside the point.
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RIP to Reemy, my avatar dog (2003 - 9/16/2017)
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