Why medical bills are killing us.

[Midpack]

The infant mortality statistics are >highly< suspect. The US gets "dinged" for the deaths of many infants that would never have been counted as live births in other countries.

Good point. Coincidentally I just watched a pretty good CNN "Escape Fire" special on health care, and it mentioned that the US infant mortality stats included homicides of 1-4 year olds, that has nothing whatsover to do with our health care system. And they also noted that our lower longevity stats than other countries were driven in significant part by lifestyle/obesity choices, I don't doubt that either.

Our health care system challenges are complex and not from any one cause, if it were only that simple. And with lots of monied interests involved (just another of many causes), solutions will not come easily. But they'll have to come if the graphic shown in Escape Fire is true - "if other prices had risen at the same rate as health care costs since 1945, a dozen eggs would cost $45 and a gallon of milk would be $48."

HOLY COW!!!

 

[bUU]

We should retain some of those risks to control costs.

Not in this case: You can live without a working car. You cannot live without health. The extent to which insurance is appropriate is related to how critical the aspect is. For example, for many things, there is no good justification for insurance. (This is often brought up in travel-related forums, where many folks contend that domestic trip interruption insurance falls into that category.) For other things, catastrophic insurance is what's best. For other things, comprehensive coverage, including preventive measures, is what's best.

 

[palomalou]

I agree with Gaterdoc50. I believe that our unhealthy lifestyle is the major force driving high healthcare costs. This might change if the healthcare system also emphasized preventation through lifestyle changes, instead of just treating disease.

I have a question regarding this: is there really someone who doesn't know that basically health is improved with the eating of more fruits and vegetables and less red meat, more exercise, avoiding smoking, etc.? Do we really need the "health care system" to tell us so? I'm unsure what is being proposed here. Please enlighten.

Second, I am unsure what "elective" surgery is, regarding the wait times in various developed nations. Certainly, cosmetic is elective, but the web says, "able to be scheduled in advance." Is cancer surgery considered elective? I really don't understand, quite.

 

[meierlde]

I agree with Gaterdoc50. I believe that our unhealthy lifestyle is the major force driving high healthcare costs. This might change if the healthcare system also emphasized preventation through lifestyle changes, instead of just treating disease.

It is interesting that many of the problems see in humans are also seen in cats, dogs and horses at least. Many pets will eat anything they can get access to and get obese also. This makes me suspect a large part of the problem is we have built and environment that we did not evolve to live in. By this I mean that until 140 or so years ago famine was a recurring problem. As a result the folks who ate when food was in good supply to overcome the short periods were better able to compete in the evolutionary cycle. Suddenly we find our selves in the inverse situation where there is more food (calories at least) than we need. The fact that this occurs in other mammals at least suggests a fundamental problem, and that obesity may also have genetic and epigenetic roots. some of us evolved to use scarce food more efficiently and store excess for the coming famine. Expecting a biological process to change over 3 generations is quite a stretch.

 

[samclem]

Suddenly we find our selves in the inverse situation where there is more food (calories at least) than we need.

And I think two other complementary factors are at work to make us fat:
1) What tastes good to us. We like to each rich, fatty foods. To be "programmed" to prefer the taste of fats and other calorie-dense foods makes perfect sense when historically, starvation has been a major threat to human survival.
2) Most of us have no "drive" to exercise that counterbalances the "drive" to eat. Hunger and the enjoyment of food for its own sake make us want to consume calories, but there's no similar force making us want to expend them. This was not a problem when people needed to be much more physically active just to survive (get food, gather fuel for fires, travel long distances by foot, etc). Even our home heating systems today reduce required metabolic caloric expenditure--it takes food to keep a body warm in cold environments.

 

[palomalou]

You have to worry about unintended consequences. We all know that one of the problems with the current fee for service system is that if providers are paid for each procedure they do then they have an incentive to do a lot of procedures. And that has some pretty negative results.

On the other hand, when you have someone getting a set fee for you each month - whether they do anything for you or not - then you have a systems where providers make the most money by doing fewer procedures. On the surface that may sound good -- avoid overtreatment for example. And, that is good. The problem is that sometimes people actually do need treatment and may need a lot of it and/or may need treatment that is expensive.

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The Mayo Clinic model of salaried physicians who have somewhat limited hours (that is, they cannot be abused by the organization demanding they work 19 hours a day for the same salary) seems to set such a great model. There is no motivation to under-treat nor to over-treat/do unnecessary procedures.
I also believe that at root most physicians went into to profession to care for people. When visiting one, it becomes pretty clear when s/he went into it for the money.