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Interesting Article on Massachusetts Experiment
Old 10-24-2007, 09:16 AM   #1
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Interesting Article on Massachusetts Experiment

This article by Maggie Mahar, who wrote an excellent book called Money Driven Medicine, discusses some of the reasons why the US spends more on healthcare per capita than anywhere else and why the Massachusetts plan isn't doing as well as they hoped.

This quote, from the beginning of the article, is especially relevant.

Quote:
“If your personal doctor told you that you had an incurable and fatal disease, would you accept that diagnosis or seek a second opinion?
  • In the U.S. 91 percent of patients said they would seek a second opinion.
  • In Canada 80 percent “ “ “ “ “ “ “
  • In Australia 71 percent “ “
  • In New Zealand 51 percent
  • In the U.K. 28 percent
“You have to love the British. You can just hear an Englishman saying ‘Well, Luv, it’s been a good life, hasn’t it? Now let’s make a pot of tea and discuss the funeral arrangements.”
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Old 10-24-2007, 09:43 AM   #2
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Interesting article. It only hints at health care rationing for a difference between us and Europe. I wonder how much we spend needlessly in those last days of life for those that will die anyway?
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Old 10-24-2007, 10:42 AM   #3
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This article is consistent with what I read in a Dartmouth article not long ago. If you are paid by the procedure it is not a surprise that the more specialists in an area, the more procedures.
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Old 10-24-2007, 02:30 PM   #4
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There are definite allusions to rationing, which (whether its PC to say so or not) seems to be part and parcel of many non-US healthcare systems. Of course we have some rationing here too, but its done by insurance companies.

Its too bad that the MA experiment isn't going well, since that is probably the best prototype of the national plan being touted by Hillary and others. Interesting that people will choose to pay the fine rather than buy insurance because it costs less to do so. Suspect a nationally based system would have similar unintended consequences.

One thing MA doesn't have to deal with (at least as much) which a national plan would, is the whole uninsurable underwriting issue. Even before Romney's plan MA required health insurers to underwrite all applicants. That is not true nationally, and will lead to big changes due to the dramatically higher utilization that will quickly result from many with chronic conditioning suddenly having insurance.
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Old 10-24-2007, 04:49 PM   #5
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What I found interesting is that it sounds like many of the younger, healthier people -- the ones who are needed in order to make this all work -- have decided it's cheaper to defy the law and pay the fine than to comply with it. And, of course, that those who receive massive subsidies by the plan are signing up for it in greater than expected numbers.

No shockers here, given human nature.
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Old 10-24-2007, 11:13 PM   #6
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"Look at a graph of average healthcare expenditures per person in Massachusetts compared to average healthcare expenditures in the rest of the U.S., and you find that in Massachusetts, individuals receive an average of nearly $10,000 worth of care each year—compared to just a little over $7,000 per capita nationwide."

I'm not sure who they are including in their population.

Does this include ONLY Massachusetts residents? Having some of the best hospitals in the world, Massachusetts attracts a lot of non-Mass citizens to this state for healthcare, some famous but the majority being average folks from all over the world. If they are counting money spent on these people, of course the cost of providing healthcare is huge in this state. But that's like saying people in Iowa eat the most corn per capita because Iowa is the biggest corn producer in the USA.
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Old 10-25-2007, 12:10 AM   #7
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Quote:
“If your personal doctor told you that you had an incurable and fatal disease, would you accept that diagnosis or seek a second opinion?
  • In the U.S. 91 percent of patients said they would seek a second opinion.
  • In Canada 80 percent “ “ “ “ “ “ “
  • In Australia 71 percent “ “
  • In New Zealand 51 percent
  • In the U.K. 28 percent
“You have to love the British. You can just hear an Englishman saying ‘Well, Luv, it’s been a good life, hasn’t it? Now let’s make a pot of tea and discuss the funeral arrangements.”
IMHO Americans want to control their own destiny. For some screwball reason, we think we can. We also don't trust our government.
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Old 10-25-2007, 01:20 AM   #8
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Quote:
Originally Posted by retire@40 View Post
I'm not sure who they are including in their population.

Does this include ONLY Massachusetts residents? Having some of the best hospitals in the world, Massachusetts attracts a lot of non-Mass citizens to this state for healthcare, some famous but the majority being average folks from all over the world. If they are counting money spent on these people, of course the cost of providing healthcare is huge in this state. But that's like saying people in Iowa eat the most corn per capita because Iowa is the biggest corn producer in the USA.
A very important question. The Dartmouth researchers on this are very sophisticated people, I imagine if someone from New Hampshire is referred to the Mass General Hospital, his New Hampshire Medicare spending would be affected, rather than being added to Massachusetts'. It would be interesting to know though.

I have wondered the same about per capita crime rates in Las Vegas. Maybe a million people live there, but way more than that are there every day of the year. These people fall victim to crimes too- so they are in the crime rate numerator. Are they also in the denominator?

Ha
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Old 10-25-2007, 08:39 AM   #9
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There was a guy talking on NPR a few months back talking about the U.S. having a much different view on death and live saving procedures...similar to this...I also saw some interviews of younger MA residents on the income border that still viewed health insurance as a unnecessary expense....kinda hard to stop that belief when the young are subsidizing the older and sicker....hmmm...I never need to see the doctor vs. that big screen tv sure would nice
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Old 10-25-2007, 09:21 AM   #10
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Quote:
Originally Posted by maddythebeagle View Post
There was a guy talking on NPR a few months back talking about the U.S. having a much different view on death and live saving procedures...similar to this...I also saw some interviews of younger MA residents on the income border that still viewed health insurance as a unnecessary expense....kinda hard to stop that belief when the young are subsidizing the older and sicker....hmmm...I never need to see the doctor vs. that big screen tv sure would nice
Well, it does seem like U.S. health care doesn't know when to say enough is enough and switch from restorative/curative care to palliative care for the terminally ill.

And as for the subsidies, in the future as the problems mount with Social Security, Medicare, health care, pensions, national debt, et cetera, if anything there would seem to be more and more resentment toward all the wealth transfers from young to old which just become a worse deal with each generation. And to add insult to injury, younger workers are seeing their parents' and grandparents' generation live it up on the national credit card which they may get stuck for paying back decades down the road after those who ran up the tab are long gone.

A 25-year-old worker may see their 55-year-old colleague covered by a pension when he/she will get none. And Social Security is sure to be there for the older one, even as the younger one pays higher and higher taxes for it (and may or may no see it). The older one might still get some early retiree health benefits, unlike the younger. And if they are asked to pay "group rates" on mandatory health insurance to subsidize the older and sicker, well, one wonders what it will take to start getting the younger people to start voting...

The nation is aging. The elderly vote and the younger folks do not (comparatively as a group). Demographics are shifting such that the ratio of benefit recipients to taxpayers is rising steadily and making entitlement programs as we know them very precarious.

Frankly, in some ways the nation is lucky that youth are more apathetic than their elderly counterparts or we may have had a revolution by now.
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