US Healthcare Expensive and Inefficient

[tomz]

New study comparing health costs and outcomes

"Americans get the poorest health care and yet pay the most compared to five other rich countries, according to a report released on Tuesday.

Germany, Britain, Australia and Canada all provide better care for less money, the Commonwealth Fund report found."

Sorry to keep bringing this up like a broken record, but it is what it is.

Then there's this regarding the Chrysler buyout:

"By unwinding a nine-year-old merger between Chrysler and Daimler-Benz of Germany, Cerberus is also taking on Chrysler’s $18 billion obligation for health care and pensions for employees and retirees.

Any efforts to sharply reduce those perks — which Chrysler can afford but says represent a cost burden of $1,500 a vehicle — will probably put it at odds with the U.A.W."

 

[lets-retire]

Here we go again. :

 

[Rich_by_the_Bay]

Here we go again. :

Just a matter of time...

15...14...13...12...11...10...9...

 

[MasterBlaster]

So US healthcare is expensive and inefficient. Thanks for pointing that out to me otherwise I wouldn't have ever known. It's good that our government is looking after our interests and is willing to spend $800k to get to that conclusion.

Expensive and inefficient indeed !

 

[unclemick]

Boy oh boy oh boy - you KNOW I have to leap into this one:

Deming: The Red Bead Experiment.

So there!

heh heh heh heh - and like the little kid in the ad says: Don't even mention Taguchi - or er something like that. Of course I went the first 12 years of ER without health insurance so don't listen to me - I'm radical.

 

[tomz]

So US healthcare is expensive and inefficient. Thanks for pointing that out to me otherwise I wouldn't have ever known. It's good that our government is looking after our interests and is willing to spend $800k to get to that conclusion.

Expensive and inefficient indeed !

You're welcome.

What is the $800K you are referring to? This study was done by a private foundation.

 

[mykidslovedogs]

Here are a couple of quotes from the article:

“We focus primarily on measures that are sensitive to medical care making a difference — infant mortality and healthy lives at age 60,” Davis said. “Those are pretty key measures, like how long you live and whether you are going to die before age 75.”

- We discussed these statistics in great detail the other day - socioeconomic factors between
countries are largely ignored when comparing infant mortality and longevity statistics. Until
it can be found with 100% certainty that socioeconomics do not play a role in infant mortality
and longevity, then I don't think these stats should even be used to compare healthcare systems
between/among countries.

The article also states:

“The area where the U.S. health care system performs best is preventive care, an area that has been monitored closely for over a decade by managed care plans,” the report reads.

and

“We include measures such as waiting more than four months for elective, non-emergency surgery. The United States doesn’t do as well as Germany but it does a lot better than the other countries on waiting time for surgery,” Davis said.

When comparing health system, I guess it all depends on what you value most. The Commonwealth admitted that the factors they value most are infant mortality rates and longetivity, neither of which have been proven with 100% certaintly as having a direct cause and effect relationship with the healthcare system. Remember....as all of you like to pound down the throat....coorelation does not prove causality. You have to remove the effects of socioeconomics and lifestyle choices from the equasion in order to get a better "apples to apples" comparison, and that would be almost impossible!

 

[Rich_by_the_Bay]

Lift off

 

[lets-retire]

Lift off

 

[mykidslovedogs]

Ka-Boom!

 

[tomz]

I just like to stir the pot every once in a while.

 

[Mwsinron]

I just like to stir the pot every once in a while.

 

[farmerEd]

When comparing health system, I guess it all depends on what you value most. The Commonwealth admitted that the factors they value most are infant mortality rates and longetivity, neither of which have been proven with 100% certaintly as having a direct cause and effect relationship with the healthcare system. Remember....as all of you like to pound down the throat....coorelation does not prove causality. You have to remove the effects of socioeconomics and lifestyle choices from the equasion in order to get a better "apples to apples" comparison, and that would be almost impossible!

I can't think of anything better to measure the overall success of a health care sytem than infant mortality and longevity. Do you have a better metric? or is it just that because the results don't support your view that you are against that particular metric?

 

[mykidslovedogs]

I can't think of anything better to measure the overall success of a health care sytem than infant mortality and longevity. Do you have a better metric? or is it just that because the results don't support your view that you are against that particular metric?

It's not that it's a bad metric, I just don't think it's a good metric to use to judge a healthcare system, because infant mortality and longevity rates are also heavily coorelated to socioeconomic issues such as level of education, teenage pregnancy rates, divorce rates, crime, alcohol and drug abuse, etc.. Due to the larger numbers of minority and poverty stricken groups we have in the USA as compared to other countries, we have to find a way to factor out the socio-economic influences on mortality rates before we try to make an apples to apples comparison, and I don't see that being done.

In the USA, we also tend to have much higher rates of obesity, which heavily influences longevity. Other countries don't seem to be in as much of a bind with obesity problems as we do. You can't blame obesity on the healthcare system, so until you can factor out lifestyle choices, I don't think you can make an apples to apples comparison on longevity with other countries and fairly say that our higher numbers are soley due to the failing healthcare system here. I've read before that approximately 50% of our healthcare spending can be attributed to complications stemming from obesity, smoking, alcohol and drug abuse. You simply have to factor out that data in order to make a good apples to apples comparison of mortality rates with other countries.

 

[farmerEd]

SO the answer than is NO...you have no better way of measuring the success or failure of the healthcare system....and yet you think the US has the best health care system around?

If you have no idea how to measure if something is better or worse, how can you repeatedly claim we have the best there is?

 

[unclemick]

'Soylent Green is people. You've got to tell everyone. Soylent Green is made from people.' Charlton Heston got all the good lines.

heh heh heh - Louisiana I had 0 health insurance. 10k deductible BCBS in Kansas. If necessary for the tail to wag the dog - a valid Passport and Thailand. You gotta love the the Bear - 'Agile, Mobile, and Hosile.' Who me stir the pot?

 

[mykidslovedogs]

SO the answer than is NO...you have no better way of measuring the success or failure of the healthcare system....and yet you think the US has the best health care system around?

If you have no idea how to measure if something is better or worse, how can you repeatedly claim we have the best there is?

Actually, I have never said our healthcare system is perfect. In fact, I have many times made suggestions on how it might be improved.

I think for a healthcare system to be the "best", it has to serve the largest number of people, with the best possible quality of service, readily available, at the fairest possible price. IMO, capitalistic solutions are the better way to get there. That's just my opinion.

Yes, we have a LOT of uninsured people, but remember, too, that approx 1/3 are uninsured by CHOICE (can afford and qualify for it, but choose not to buy it), and another 1/3 would qualify for child programs or Medicaid, yet they have not been signed up for it yet. That leaves about 15 million people uninsured against their will. Still, a HUGE number of those folks are only temporarily uninsured (in-between jobs, etc.) I would be very curious to see how that total stacks up against people in nationalized systems that are on a waiting list against their will. Once I see those statistics, then I'll be able to make a better decision as to which system is the Best

Again, IMO, I just think if you nationalize the whole thing you will eventually (not immediately) alienate a larger number of people than our current system does. Yes, our current system rations against some people by price, but IMO, worse, is a system that in the long run ends up having to ration care to everyone because of limited resources. IMO, inefficient is a system, that gives services to people in order of seniority instead of giving services to the people who most desire or need the service first. For example, Betty and Fred might both be in need of a knee surgery. Fred signs up for it first, but he would really rather put it off, if it weren't for the waiting list. He'd like to wait a couple of weeks, but since he knows he'll be waiting at least 20 weeks if he doesn't get on the list now, he signs up anyway. Meanwhile, Betty is in a lot of pain, and would really like to have the knee surgery and she is willing to pay more to get it done now, but she must wait 20 months before she can have it because of the waiting list. To me, THAT's the definition of inefficiency.

I really fear that the USA would not be apt to handle rationing of care very well, as we are extremely spoiled and used to being able to have what we want or need at our own convenience. Services in the USA are very readily availabe (particularly in the high-tech arena). Much of that freedom of choice goes away in a socialized model.

 

[califdreamer]

OK, just for fun, wouldn't the free market system itself be a source of the socioeconomic disadvantages many of our citizens face? All of these conversations seem to lead to "socioeconomic" differences as the problem rather than the healthcare system we have.

Please read that question carefully. It is not an argument for dismantling free market systems.

 

[mykidslovedogs]

OK, just for fun, wouldn't the free market system itself be a source of the socioeconomic disadvantages many of our citizens face? All of these conversations seem to lead to "socioeconomic" differences as the problem rather than the healthcare system we have.

Please read that question carefully. It is not an argument for dismantling free market systems.

You bet it would, but nationalizing healthcare isn't necessarily going to have any affect on fixing that part of the equasion.

 

[Freein05]

I will comment on the German health care system before this post gets locked. It is a form of National Health Care. There are a number of insurance companies that you can choose from that offer it. If you make over 3,800 Euros a month or are self employed you can opt out of the National Health Care and buy private insurance. Health insurance is required of everyone living in Germany for 6 months or more. The insurance even covers a stay at a health spa. That may change in the future. For employed people the cost is 13% of your gross salary. The employer pays half and the employees pay the other half. When an employee is off sick their pay comes from the health insurance plan so this saves the employer some money. Less than 1% of people living in Germany don’t have health insurance. The health insurance program is also subsidized by other taxes like the value added tax (sales tax).

How good or bad is it? I studied in Germany for a year my wife (she is a German national) and we were covered by the national insurance plan. We did not ever have to worry about health insurance. Our first child was borne in Germany. Our second was borne in the US. The care was the same in both countries. The only difference was in Germany the minimum stay after birth is 7 days the stay in the US was 2 or 3 days.

About 6 years ago we were visiting a cousin in Germany and her husband had came down with the flu. He called his doctor and told her what was going on. She said as he never gets sick she would come out to see him. She was at his home in about 2 hours. Now that is not a bad wait. Try to get a US doctor to come to your home. One of the reasons the doctor did this is she did not want him in the office infecting other people.

We were in Germany last year and the subject of health insurance never comes up because they do not have to worry about it. The only person who complained was one of our relatives that choose the private health care system and wished she had stayed with the National Health Care system.

This and other true stories will never change the minds of people who profit off of the US health care system. Those who have insurance through their employer also are for the most part happy with the system. But they are only the loss of a job away form being without health care insurance.

 

[califdreamer]

You bet it would, but nationalizing healthcare isn't necessarily going to have any affect on fixing that part of the equasion.

I really wasn't advocating nationalizing health care. I was afraid that was the response I would get.

I was just pointing out the irony that the chief defense of our system in many of these conversations is that there are these mysterious socioeconomic differences among our population.

FWIW, I think we need to get more creative and devise a third way to solve this thorny problem. First step is for everyone, left and right, to get off their ideology and do some real thinking.

 

[Martha]

Yes, we have a LOT of uninsured people, but remember, too, that approx 1/3 are uninsured by CHOICE (can afford and qualify for it, but choose not to buy it), and another 1/3 would qualify for child programs or Medicaid, yet they have not been signed up for it yet. That leaves about 15 million people uninsured against their will. Still, a HUGE number of those folks are only temporarily uninsured (in-between jobs, etc.)

I have questioned these numbers which you have posted before. I won't go through each one this time. For example, I agree that there are roughly 45 million uninsured, but a 2004 study from Families USA found that 81.8 million lacked health insurance at some point in 2002 and 2003 and most were uninsured for more than 9 months. These are the temporarily uninsured, a much bigger number than the uninsured number. Adding to these numbers, the Commonwealth Fund has found 16 million adults as under-insured in 2003.

Well, I gotta give this a rest.

As far as doing real thinking, I believe a number of proposals had been advanced that show real thinking. Some of these have been discussed here. One is Senator Wyden's plan. Do a search and you will find discussions about his plan. Many are working on the issues but get shouted down by the politics. Retired Senator Dave Durenberger, a moderate republican from Minnesota, has been working on health care system issues. Specifically issues as to why health care costs so much in the United States and what we can do to change it. So good ideas can come from republicans or democrats or whatever. Let us pick one and try it.

 

[califdreamer]

As far as doing real thinking, I believe a number of proposals had been advanced that show real thinking. Some of these have been discussed here. One is Senator Wyden's plan. Do a search and you will find discussions about his plan. Many are working on the issues but get shouted down by the politics. Retired Senator Dave Durenberger, a moderate republican from Minnesota, has been working on health care system issues. Specifically issues as to why health care costs so much in the United States and what we can do to change it. So good ideas can come from republicans or democrats or whatever. Let us pick one and try it.

I agree and I applaud politicians who are brave enough to come up with alternative ideas. We need to find a way to overcome the chief weakness of the free market model (IMO access is the biggie) and the weakness of the wholly socialized model (IMO efficiency).

Affordable access to efficient, high-quality care is the holy grail. Hopefully we can approach something reasonably close. It will take all of our creatvity and political will to do so.

 

[unclemick]

So good ideas can come from republicans or democrats or whatever. Let us pick one and try it.

I don't think so. I'll go back to my ancient theme (unclemick and webtv days). You get some good kids, 8th or 9th graders, some hand held calculators, population data and a copy of Deming's Red Bead Experiment.

Ask them to raise taxes and figure out how to reward people to be healthy.

Shot any adult who comes near them till they are finished.

heh heh heh - no cocktails but I am a lefthanded INTJ.

 

[mykidslovedogs]

Calif - I am totally in agreement with you....I just lean a little bit further to the right in the types of solutions I would offer. Here is one I posted a few days ago:

Gov't mandates all Americans must carry at least the most basic health insurance plan (kind of like liability car insurance). This plan design would be standardized and required that all insurance carriers must offer it in their mix of healthplans. The plan should be a high deductible (say maybe $2500 single/$5000 family deductible) HSA compatible plan. It would be the ONLY plan that insurance carriers would be required to offer on a guaranteed issue basis. The plan would have to cover preventive care (nationally recommended cancer screenings and immunizations) NOT subject to the deductible. The plan would offer a copay of around $15 or less for generic drugs, and brand prescription coverage AFTER the deductible is met and 100% coverage for all other services AFTER the deductible is met. It must cost no more than what the average working class American could afford to pay, and no less than the cost to administer the plan and pay claims. Premiums could perhaps be offered on a sliding scale based on income(The gov't will determine the maximum premium.) The insured would be required to use the private carrier of their choice's networks or be penalized with a higher deductible if they choose to go outside of the network. The standardized plan would be portable from state to state because it is a guaranteed issue plan.

Although it might be hard for some people to afford the deductible, at least the health care providers will still get reimbursed for balances above the deductible, so their write-offs won't be nearly as hefty, and there won't be as much of a need for health care providers to come after private insurance carriers for lost profits, like they do today when someone with a $100,000 claim or higher is uninsured. This will help bring down premiums for everyone, overall, over time.

Medicaid and Medicare remain in force as is, however, if someone over the age of 65 wants to buy the cheaper, basic plan, they would be allowed to do so, and NOT be required to go on the gov't Medicare plan if they don't want to.

Employers are prohibited from providing medical benefits, but they would be allowed to have flexible spending plans or health re-imbursement arrangements, whereby people could have tax-deductible income and/or employer contributions set aside for use to pay premiums for personal health insurance coverage or for deductible health insurance expenses, if the employer wants to offer such a benefit. Employers should not be forced, nor taxed to provide subsidies for the basic plan.

Whoever is not eligible for Medicare or Medicaid, and does not purchase this minimal level of coverage voluntarily must understand that they could be turned away for medical care with NO legal consequences to the physician for turning them away. Any physician who wants to treat the person on a pro-bono basis has the perogative to do so, provided they don't try to recapture the lost profits from the private sector.

In addition, insurance carriers will still be allowed to medically underwrite products that have more bells and whistles than the basic plan design. People who want to buy up have all the freedom in the world to do so, provided that they can medically qualify.