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Old 07-24-2007, 04:01 PM   #41
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What Canada lacks is the extraordinary deep pockets of successful private investors. We don't have a Mayo Clinic for the same reasons that we don't have a Harvard, Yale or Stanford.
True, but you have a McGill, Royal Vic, McMaster, UBC, U. of Toronto and other world class places for health care and research.

Not bad.
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Old 07-24-2007, 04:03 PM   #42
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That's a very sad commentary, and I refuse to accept that the only way to get world class science (and medicine is science) in our great country is through obscene profits.
It's not the only way to get world class science/medicine, but, IMO, it is the only way to get world class science/medicine for the majority of people who WANT/NEED it in a timely manner - otherwise, there is not enough supply.
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Old 07-24-2007, 04:12 PM   #43
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What Canada lacks is the extraordinary deep pockets of successful private investors.
Why would that be? Could it be that the private investors don't see enough PROFIT in making the investment?....or are you just saying that the rich investors are being selfish for not freely giving their money away to a 'not so lucrative' cause.
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Old 07-24-2007, 05:01 PM   #44
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True, but you have a McGill, Royal Vic, McMaster, UBC, U. of Toronto and other world class places for health care and research.
Not bad.
I always see Canadians making comments that they will come to Mayo if they need to....why wouldn't they just use the above mentioned facilities instead?
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Old 07-24-2007, 05:01 PM   #45
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There has been a fair amount of talk on this thread about importance of specialists and cutting edge treatment. There is some evidence that the number of specialists in an area does not lead to better care or improved outcomes. It does lead to more treatment though. I have linked to this article before in Dartmouth Medicine. I recommend reading it: Dartmouth Medicine Magazine :: The State of the Nation's Health
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Old 07-24-2007, 05:11 PM   #46
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Another thought. I have a friend who got breast cancer 5 years ago. Her father was a retired Mayo surgeon. She discussed getting treated at Mayo and he saw no particularly strong reason for her to be treated there. The treatment protocols for her type of breast cancer are fairly standardized and the best treatment for her, and for most people, is treatment close to home.

I think we should be more worried about our primary care system in the United States than worried about keeping our specialists in the money.
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Old 07-24-2007, 05:11 PM   #47
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There has been a fair amount of talk on this thread about importance of specialists and cutting edge treatment. There is some evidence that the number of specialists in an area does not lead to better care or improved outcomes. It does lead to more treatment though. I have linked to this article before in Dartmouth Medicine. I recommend reading it: Dartmouth Medicine Magazine :: The State of the Nation's Health
I agree that cutting edge treatment doesn't always lead to better outcomes, but isn't it nice to know that it's there when it IS needed, and that you won't have to wait obscene amounts of time to get treatment? I mean, your everyday PCP isn't going to be able to diagnose and treat brain/breast/prostate cancer. Three months to get an MRI for diagnosing a brain tumor is a bit excessive (typical in Canada).
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Old 07-24-2007, 05:17 PM   #48
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I think we should be more worried about our primary care system in the United States than worried about keeping our specialists in the money.
Your point of view fascinates me. Primary care in our country is relatively cheap. In fact, in Denver, if you have a 5000 major medical plan, you are entitled to the network discounts for routine office visits, and the average discounted price is $40-$50 for a routine (PCP) office visit. School aged children can get $10-15 physicals at the local churches if their parents don't have health insurance.

It's interesting to me that you prefer free coverage for primary care vs. timely availability of treatment for serious illnesses.
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Old 07-24-2007, 05:18 PM   #49
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It's not the only way to get world class science/medicine, but, IMO, it is the only way to get world class science/medicine for the majority of people who WANT/NEED it in a timely manner - otherwise, there is not enough supply.
Well, now, you've introduced an interesting though, supply and demand. Why is our health care cost continuing to rise well above inflation, and above people's abilities to pay? Because demand increases while supply stays the same or even deceases. IMO, there's several factors for this: an aging population, increased stress, increases in treatment options (ironically -- there was no MRI waiting list before there were MRIs), and a limited supply of physicians. We can't control many of these factors, but we can take steps to increase the supply of hospitals, equipment, and physicians. Since the private sector doesn't seem able to do this, there will be increasing pressure for the public sector to do it.

How many hospitals could be built with the money saved from reducing admin overhead from 30% (the private HMO number) to 3-5% (the Medicare number)? As far as physicians, one problem in producing more is that average med school cost is well over $30,000 per year, and it's very difficult to get into med school. Not that it should be easy to get into med school, not everyone can be a physician, but surely we could take steps to increase the supply.

To return to the Apollo program, I don't know how old you are, but when the Soviets put up Sputnik we were caught with our pants down. Not only were we behind in astronautics, we didn't have the engineers and scientists we needed to catch up. The answer was not to increase salaries and profits, but to produce more engineers through the National Defense education program (I was a product of that). Science, math, and engineering educations were subsidized by the government in return for an agreement to serve so many years either in the government or the military. In a few years we turned the situation around and became the world leader in aerospace. Why can't we do the same with medical education? Some say the AMA is partly responsible for throttling the demand, I don't know.
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Old 07-24-2007, 05:28 PM   #50
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I agree that cutting edge treatment doesn't always lead to better outcomes, but isn't it nice to know that it's there when it IS needed, and that you won't have to wait obscene amounts of time to get treatment? I mean, your everyday PCP isn't going to be able to diagnose and treat brain/breast/prostate cancer. Three months to get an MRI for diagnosing a brain tumor is a bit excessive (typical in Canada).
If we were in a trial, I would have to object to most things you say as assuming facts not in evidence.

I move for a mistrial.
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Old 07-24-2007, 05:36 PM   #51
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Well, now, you've introduced an interesting though, supply and demand. Why is our health care cost continuing to rise well above inflation, and above people's abilities to pay? Because demand increases while supply stays the same or even deceases. IMO, there's several factors for this: an aging population, increased stress, increases in treatment options (ironically -- there was no MRI waiting list before there were MRIs), and a limited supply of physicians. We can't control many of these factors, but we can take steps to increase the supply of hospitals, equipment, and physicians. Since the private sector doesn't seem able to do this, there will be increasing pressure for the public sector to do it.

How many hospitals could be built with the money saved from reducing admin overhead from 30% (the private HMO number) to 3-5% (the Medicare number)?
Let me explain why we have a lack of supply of primary care physicians in our country. It's not because the private sector isn't cutting the mustard. It's BECAUSE the Medicare/Medicaid systems don't pay them enough, so they don't choose those kind of careers. Instead, they go for the specialist careers where they can make a lot more MONEY! Combine that with an aging population and rediculously expensive malpractice insurance and overhead costs of equipment, staff, etc...and what do you get? (a SHORTAGE of PCPs created by the PUBLIC health system).

To answer your second question. The administrative costs of Medicare/Medicaid are kept in check because the gov't caps the amount of money going towards service...try getting timely and efficient service from a Medicare Administrative representative. Additionally, the time/costs that Doctors and practioners incur filing paperwork, etc...are not included in the published numbers. Yes, the numbers may be lower than in the private sector, but not as much as they are made out to be. No-one is including the time/cost that brokers like me spend helping people figure out which Medicare Part D plan to buy. Sometimes, I'll spend hours sifting through all of the plan choices for my clients, filing the application, and following up on it...all for a measly $5/mo commission. (I guarantee you my time is worth more than that!) Right now, I offer assistance with Medicare Part D as a value added benefit to my clients, but, if it keeps going the way it's going, I may have to send people off on their own to do the research...
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Old 07-24-2007, 06:16 PM   #52
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If we were in a trial, I would have to object to most things you say as assuming facts not in evidence.

I move for a mistrial.
I am so sorry, judge! The last time I checked, my PCP would not give me an MRI on my brain. Is yours different? Take a look here:

Long Wait for MRIs in Canada

Did you watch the video?

On The Fence Films :: Movies (A Short Course in Brain Surgery).

Would you declare a mistrial on Michael Moore too? I'll bet not!
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Old 07-24-2007, 07:20 PM   #53
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Let me explain why we have a lack of supply of primary care physicians in our country... ? (a SHORTAGE of PCPs created by the PUBLIC health system).
OK, if a Martian were to land in the US and read your arguments, they would conclude that we have the leading health system in the world, but our gummint keeps trying to screw it up. And the rest of western democracies must have decaying health systems with patients dying while waiting for procedures. Why, we must be guarding our very borders to keep out foreigners fleeing their health systems in order to take advantage of ours. And their poor governments must be about to topple from their people demanding a US style health system. That's the case, right?

Funny thing, when I lived in Holland I was very happy with their national system, as well all of my Dutch friends. In fact, some of my expat friends were so happy with it they chose Dutch hospitals and doctors even though they had the choice to return to the states for treatment. We must have been hoodwinked. My only complaint was difficulty in getting a lot of drugs, they emphasize prevention over overdrugging. And you know what, they certainly looked fit in comparison with Americans.
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Old 07-24-2007, 07:30 PM   #54
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OK, if a Martian were to land in the US and read your arguments, they would conclude that we have the leading health system in the world, but our gummint keeps trying to screw it up. And the rest of western democracies must have decaying health systems with patients dying while waiting for procedures. Why, we must be guarding our very borders to keep out foreigners fleeing their health systems in order to take advantage of ours. And their poor governments must be about to topple from their people demanding a US style health system. That's the case, right?
Not exactly, I DON'T think our system is perfect, but I do think it alienates fewer people than other systems, ESPECIALLY when it comes to complicated health issues. I will always prefer capitalistic solutions and tax incentives over gov't mandates. Did you happen to watch a few of those videos I posted links to?

FYI - I just had a client call who raved about the wonderful service she received on her new HSA plan with UHC. She had to have a unique surgery, and she said it all went through without a hitch. NOT a single problem with the insurance. Her HSA payed 100% after deductible just as planned, and she had already saved her deductible.

I posted a success story of my own on Michal Moore's SICKO website, and guess what? He or his moderators decided NOT to post my story. (He's got a place on his site where people can comment on their opinions about their healthcare/health insurance.) This did not come as much of a surprise to me. He isn't going to post anything GOOD about our healthcare system on his site, even if visitors want to make some good comments.
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Old 07-24-2007, 07:43 PM   #55
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I posted a success story of my own on Michal Moore's SICKO website, and guess what? He or his moderators decided NOT to post my story. (He's got a place on his site where people can comment on their opinions about their healthcare/health insurance.) This did not come as much of a surprise to me. He isn't going to post anything GOOD about our healthcare system on his site, even if visitors want to make some good comments.
There's plenty good about our health system -- for those who are insured and whose insurance allows the procedures and have affordable deductibles. And I'm sure you have plenty of success stories. Whenever services are unequally distributed those who qualify for the services are treated very well. I'm sure there are excellent doctors in Zimbabwe who treat the people at the top. We're much better than Zimbabwe in treating the majority of Americans but we suck at treating the bottom 20-40M.

How many success stories do you have to share from those at the bottom? I saw the videos. Still didn't answer the question about medical care in the US for those at the bottom. Why are you so set against extending medical care to those who can't afford it?

By the way the link you have about MRI waiting times in Canada has false information. It starts with "In Canada there is a 7-9 month wait for MRI's." I posted a previous link with data on waiting times by province, you might want to look at it.
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Old 07-24-2007, 08:15 PM   #56
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If we were in a trial, I would have to object to most things you say as assuming facts not in evidence.

I move for a mistrial.
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Old 07-24-2007, 08:53 PM   #57
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How many success stories do you have to share from those at the bottom?
Oh, Lord! I've spent a meaningful chunk of my career caring for those at the bottom of society (probably numbering in the thousands), often due to mental illness, addictions, alcoholism plus the occasional freeloader.

Success stores? Give me some time...I may be able to come up with one or two. A few times I've been able to game the system creatively to benefit a patient here and there, but otherwise... naaah, sorry, can't come up with many succes stories.

Major university teaching hospitals have a proud heritage of caring for the poor because the faculty physicians were often on salary and had little directly at stake for non-payment. But that has been changing, and not for the better; there is more emphasis on "productivity" every year.
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Old 07-24-2007, 09:03 PM   #58
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What Canada lacks is the extraordinary deep pockets of successful private investors. We don't have a Mayo Clinic for the same reasons that we don't have a Harvard, Yale or Stanford. This has nothing to do with government. The US is way ahead of Canada in tapping private benefactors for their "public" institutions. We are starting to get some momentum from the founders of eBay, RIM, and Celestica (Onyx). But we are way behind.

In fact, a major reason that my hospital, Vancouver General, has only 2 month lead times for major surgery is that the Pattison and Diamond families among others have been very generous.
ding ding ding....I have been to the Mayo Clinic several times for treatment...private benefactors are a big part of it...Certainly, it is the way they do things and history that generates the interest in giving....although, I see a lot of Canadian lic. plates in the parking garages, but hey MN is close to Canada, right...


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Old 07-24-2007, 09:09 PM   #59
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Jeez louise, the insurance troll is on my ignore list and I *still* have to hit the page down key about 12 times between these galtian strings of posts.

Regarding supply and demand...hmm...we've apparently got way more supply than they have in canada, what with all these world class medical institutions, wading hip deep in MRI machines and so forth.

So our health care should cost less per capita than canada's, what with their long waiting lines and apparent dearth of quality optional and probably unnecessary care.

Hey...waitaminit...all this ridiculous supply and quality of supply in evidence at every turn, yet the costs keep rising?!?

Where is all the money going...

Oh yeah, I forgot. Canada doesnt have to pay insurance companies.
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Old 07-24-2007, 09:44 PM   #60
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Oh, Lord! I've spent a meaningful chunk of my career caring for those at the bottom of society (probably numbering in the thousands), often due to mental illness, addictions, alcoholism plus the occasional freeloader.
I know you didn't intend this meaning, but that really is a "meaning-full" part of a career. Not to get religious, but you may yet receive pretty good pay for treating those at the bottom of society.

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Success stores? Give me some time...I may be able to come up with one or two. A few times I've been able to game the system creatively to benefit a patient here and there, but otherwise... naaah, sorry, can't come up with many succes stories.

Major university teaching hospitals have a proud heritage of caring for the poor because the faculty physicians were often on salary and had little directly at stake for non-payment. But that has been changing, and not for the better; there is more emphasis on "productivity" every year.
So we have a microcosm of a universal health care system within teaching hospitals, because the physicians don't have to depend on the patient's financial means for their salaries. And they have a proud heritage of caring for the poor. Sounds like they can provide the medical service that attracted them to the profession in the first place. Service is a word that is not often used in these debates. I'm not a physician, but I always considered my military career as a service. Lord knows the pay alone didn't begin to make the family separations and frequent moves worthwhile. And even if a budding medical student is looking forward to a good salary, I have to believe that without the call of service they will either not make a good physician or decide there are easier ways to make a buck.

So, Rich, I'll tell you something I often hear around military people -- thanks for your service!
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