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Old 02-25-2013, 06:00 PM   #121
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Improving elective surgery wait times would NOT be a reason for us to change. I'm not saying there aren't other reasons, just that wait time for elective surgery isn't one of them.
+1. Seems to me wait times for elective procedures would be more flexible, and our wait times for sick people are already longer than many/most countries...that was my point.

I don't understand those who defend the status quo without offering anything to address US access, cost (and rate of increase) and middling outcomes...instead of throwing out Canadian elective procedure wait times.
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Old 02-25-2013, 06:03 PM   #122
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Originally Posted by eridanus

I don't doubt it but read the Bloomberg article above.

"Last year, a routine visit to a U.S. doctor cost commercial insurers $89 on average, compared with $64 in Switzerland, $40 in Germany and $23 in France."

That's per visit. American doctors simply make more. Period.

"No other developed country pays doctors this much. In 2004, general practitioners in the U.S. were estimated to earn double -- measured by purchasing power -- the median for 21 nations in the Organization for Economic Cooperation and Development; for specialists, the difference was almost threefold."

‚€œIt‚€™s the Prices Stupid‚€--Why Americans Pay More for Health Care - 2005 - Stories - News - Johns Hopkins Bloomberg School of Public Health

"OC&PA: What would it take to fix the problem?

GA: In the United States, every individual physician or hospital is negotiating the prices for health care services with insurance companies. In other countries, one agency, not necessarily a government agency, negotiates and sets the cost for all of the public and private health insurers. That gives them a much stronger negotiating entity to make deals with physicians and hospitals."

But maybe we should go after the Big Fish first.

Do American doctors get paid too much? - Slate Magazine

"But none of this really matters, because doctors' salaries aren't a large enough chunk of health care spending in the United States to make a difference. According to Reinhardt, doctors' net take-home pay (that is, income minus expenses) amounts to only about 10 percent of overall health care spending. * So if you cut that by 10 percent in the name of cost savings, you'd only save about $26 billion. That's a drop in the ocean compared with overhead for insurance companies, billing expenses for doctors' offices, and advertising for drug companies. The real savings in health care will come from these expenses."
A article I read reinforces your last paragraph. In fact, they have it at 8.6% lowest only to Sweden as percentage of cost, though in actual dollar terms of actual salary they compare favorably.

Total U.S. physicians’ salaries comprised 8.6 percent of the nation’s total healthcare costs. Of the western nations with modern healthcare systems, only Sweden devoted less money to physician salaries than the U.S, at a portion of 8.5 percent.

In contrast, Jackson researchers found physician compensation to represent about 15 percent of total healthcare expenditure in Germany, 11 percent in France and 11.6 percent in Australia. In the United Kingdom, physician payment constituted 9.7 percent of the total healthcare costs.

http://www.healthcarefinancenews.com...estern-nations

I personally would be very leery of wage controls on our medical providers. Providers sacrifice many years of their lives to pursue their careers and incur significant debt doing this. I would hate to put in a measure that is a disincentive for bright people to pursue this career.
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Old 02-25-2013, 06:07 PM   #123
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I have not read the entire thread nor seen that Harvard study but the 25% figure does not surprise me. In fact I think the number could be even higher.

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Harvard study estimated at least 1/4 of total spending on health care was for administration overhead, specifically dealing with insurance claims.

The coding system wasn't standardized so there had to be specialists and doctors had to employ people just to deal with the insurance. Or spend a lot of their own time handling it.
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Old 02-25-2013, 06:13 PM   #124
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When we apply market principles in this way to buy health care in advance (not, as I said earlier, comparison shopping for an MRI when you are bleeding), then the emphasis will be where it needs to be and costs will be bounded by supply and demand. No need for top down cost controls (which always result in artificial scarcity). No need for the very wasteful single-payer fee-for-service model (Medicare, etc).
I think one of the main points of the Brill article is that the free market is currently at work in the drug, medical device, and to a certain extent hospital/medical group sectors. Relatively unregulated, it has led to near-monopoly conditions and price fixing (okay, very uncompetitive pricing) so far. I agree with you that in principle that free market forces should theoretically make an economic system efficient. But free market forces also led to the Standard Oil monopoly, thalidimide babies, and Love Canal. Like eridanus says, the devil is in the details!
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Old 02-25-2013, 06:23 PM   #125
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You can't really get the same kind of market in health care that you can in other products and services.

It's difficult enough to evaluate other professional services like law or accounting. But you have the time to do it, whereas if you got a major condition for which you need to start receiving care right away, you're not going to shop around.

Certainly if you're taken to the hospital in an ambulance, you're not going to look up reviews and tell the ambulance driver to take you to so and so hospital and call a certain doctor.

Or for that matter, shop for a provider based on price if your life or health is at stake. So the demand for health care is not driven by the same set of concerns that demand for say cars is driven.

And without medical training, most people are not in a position to evaluate how good a given provider is. What are you going to do, Google for reviews of a doctor? There are some sites that have reviews but they're nothing like restaurant reviews.
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Old 02-25-2013, 06:26 PM   #126
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A article I read reinforces your last paragraph. In fact, they have it at 8.6% lowest only to Sweden as percentage of cost, though in actual dollar terms of actual salary they compare favorably.

Total U.S. physicians’ salaries comprised 8.6 percent of the nation’s total healthcare costs. Of the western nations with modern healthcare systems, only Sweden devoted less money to physician salaries than the U.S, at a portion of 8.5 percent.

In contrast, Jackson researchers found physician compensation to represent about 15 percent of total healthcare expenditure in Germany, 11 percent in France and 11.6 percent in Australia. In the United Kingdom, physician payment constituted 9.7 percent of the total healthcare costs.

Physician compensation in U.S. among lowest for western nations | Healthcare Finance News

I personally would be very leery of wage controls on our medical providers. Providers sacrifice many years of their lives to pursue their careers and incur significant debt doing this. I would hate to put in a measure that is a disincentive for bright people to pursue this career.
Funny thing is, other components also are small part of the total spending.

Malpractice awards is a small portion, insurance company profits are a small portion.

So where is the lion share of the costs going to? Hospitals?
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Old 02-25-2013, 06:26 PM   #127
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+1. Seems to me wait times for elective procedures would be more flexible,
Not following you. Wait times for elective procedures will be more flexible when?
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I don't understand those who defend the status quo without offering anything to address US access, cost (and rate of increase) and middling outcomes...instead of throwing out Canadian elective procedure wait times.
If you're addressing this at me, I'm NOT defending the status quo. OTOH, I have some concerns about Obamacare as it is written and don't mind freely pointing out those areas of concern.

I didn't throw out Canadian elective procedure wait times. I just provided a correct graph showing elective surgery wait times across countries instead of the graph showing percentage of people waiting six days or longer to see their doc when feeling ill.
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Old 02-25-2013, 06:39 PM   #128
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Not following you. Wait times for elective procedures will be more flexible when?

If you're addressing this at me, I'm NOT defending the status quo. OTOH, I have some concerns about Obamacare as it is written and don't mind freely pointing out those areas of concern.

I didn't throw out Canadian elective procedure wait times. I just provided a correct graph showing elective surgery wait times across countries instead of the graph showing percentage of people waiting six days or longer to see their doc when feeling ill.
Please note that I began my post quoting you with a +1, which means I wholeheartedly agree with your quoted POV. My comments were meant for others...
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Old 02-25-2013, 06:44 PM   #129
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Please note that I began my post quoting you with a +1, which means I wholeheartedly agree with your quoted POV. My comments were meant for others...

Oh...... Nevermind......
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Old 02-25-2013, 06:45 PM   #130
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+1. Seems to me wait times for elective procedures would be more flexible, and our wait times for sick people are already longer than many/most countries...that was my point.

I don't understand those who defend the status quo without offering anything to address US access, cost (and rate of increase) and middling outcomes...instead of throwing out Canadian elective procedure wait times.
I did offer something to address costs. I said we should take responsibility for ourselves and address our obesity epidemic. Eat more salad, take a run, put duct tape over our mouths, whatever it takes. We have to understand the problems of obesity. Diabetes, hypertension, heart disease, digestive disorders, joint problems, cancer, inflammatory diseases, depression, impotence, infertility.... You name it.
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Old 02-26-2013, 03:36 AM   #131
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Great sentiment, but it still doesn't actually provide a solution to the actual problem. You would have to go further - turning your great sentiment into something offensively inhumane - in order for it to constitute something that would make a palpable difference in the problems being experienced.
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Old 02-26-2013, 08:01 AM   #132
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Great sentiment, but it still doesn't actually provide a solution to the actual problem. You would have to go further - turning your great sentiment into something offensively inhumane - in order for it to constitute something that would make a palpable difference in the problems being experienced.
Sorry, but I firmly believe that our unhealthy lifestyle is a major driver of costs. Apparently, I'm the only one who thinks so. lol Unhealthy lifestyle choices begin to rise as GDP rises for a country. It's well documented. So, it's tough to compare ourselves with countries that have GDP's smaller than a handful of our larger metropolitan areas. We have concluded that doctors fees, while larger, have little impact on total costs. Drug costs are also high but we use most of the worlds supply. We eat 99% of the worlds hydrocodone, 80% of all opiods. Antidepressant use is astronomical. Why are we so sad? Why do we feel physical and emotional pain more than Canadians or Germans or...? By all means, let's make drugs more affordable. The prices are killing us.
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Old 02-26-2013, 09:44 AM   #133
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Great sentiment, but it still doesn't actually provide a solution to the actual problem. You would have to go further - turning your great sentiment into something offensively inhumane - in order for it to constitute something that would make a palpable difference in the problems being experienced.
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Sorry, but I firmly believe that our unhealthy lifestyle is a major driver of costs. Apparently, I'm the only one who thinks so. lol Unhealthy lifestyle choices begin to rise as GDP rises for a country. It's well documented. So, it's tough to compare ourselves with countries that have GDP's smaller than a handful of our larger metropolitan areas. We have concluded that doctors fees, while larger, have little impact on total costs. Drug costs are also high but we use most of the worlds supply. We eat 99% of the worlds hydrocodone, 80% of all opiods. Antidepressant use is astronomical. Why are we so sad? Why do we feel physical and emotional pain more than Canadians or Germans or...? By all means, let's make drugs more affordable. The prices are killing us.

I do agree that obesity is an issue, collectively the western diet and lack of activity are significant, but only one of many. Some reasons (all discussed here before), by no means complete, which all lead to more expensive health care for everyone:
  • We’re fat. Obesity adds $147 billion per year to our health care bills.
  • What do I owe? (one reason I've posted about ad nauseum)That’s what you ask. “How much does it cost?” is a different question, and one that the average health care consumer cares little about. Because most Americans use insurance to pay for even the most routine doctor’s visits, and because employers or the government pay for a large portion of those insurance premiums, we have no idea whatsoever what’s a good price for an MRI, or a cast for a broken wrist, or an annual checkup. And we don’t care either. All we care about is how much the premiums and co-pays cost us at the time we pay them. Yet, we collectively are paying for all of it!
  • Insurance companies are businesses. Their business mission is to make money, not to make people healthy. They make more money when they charge higher premiums and cover fewer health expenses—and over the years, they’ve regularly done both.
  • No electronic records.Without electronic records, doctors do not know exactly how a customer has been diagnosed and treated in the past, and they’re likely to order repeat tests and write prescriptions for medications that have already been proven ineffective. What we have is a system routinely filled with inefficiencies and duplication of efforts … which leads to more expensive health care for everyone.
  • Doctors and hospitals get paid not for keeping their patients healthy, but for the specific, expense-able services they provide. They earn more money for each test, office visit, and treatment that occurs. With such an incentive system, the rational capitalist approach is to have more tests, more office visits, and more treatments. The incentives encourage more services while not encouraging overall health … which leads to more expensive health care for everyone.
  • Malpractice madness. As much as 10% of your doctor’s bill goes to cover the doc’s malpractice insurance. There’s no ceiling on how much a doctor can be sued for, and the costs of rising malpractice rates are passed along to the patients … which leads to more expensive health care for everyone. Doctors, ever fearful of being sued for doing too little, tend to go the other way and do too much. Facing the possibility of multi-million dollar lawsuits, they instinctively play it safe and order the extra test and prescribe the extra drug, even if they believe there’s little point to do so.
  • What do statistics mean anyway? Studies demonstrating that expensive surgeries yield no benefits to patients are sometimes disregarded by doctors. There seems to be no other reason than those doctors are paid for doing the surgery, and they’re not paid when they don’t do the surgery. So, study or no study, they do the surgery.
  • Premium pricing in the ER. Out of fear or panic, or simply because they feel they have no other place to turn, many people go to the ER even when their symptoms suggest simple illnesses such as urinary tract infections or sore throats. And at the ER, their treatments cost as much as six times that of a perfectly capable urgent care facility.
  • We take more pills. Lots of marginally effective drugs are approved, and comparative effectiveness is often disregarded, even outlawed in the case of Medicare.
  • Antitrust exemption. A small pool of insurers have been able to dominate the market, and customers have few other places to turn. The scene is one of very limited competition … which leads to more expensive health care for everyone.
  • No shopping across state lines. Customers aren’t allowed to buy their insurance from a company outside their state. It’s another way that competition is limited … which leads to more expensive health care for everyone.
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Old 02-26-2013, 09:45 AM   #134
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Sorry, but I firmly believe that our unhealthy lifestyle is a major driver of costs. Apparently, I'm the only one who thinks so. lol Unhealthy lifestyle choices begin to rise as GDP rises for a country. It's well documented. So, it's tough to compare ourselves with countries that have GDP's smaller than a handful of our larger metropolitan areas. We have concluded that doctors fees, while larger, have little impact on total costs. Drug costs are also high but we use most of the worlds supply. We eat 99% of the worlds hydrocodone, 80% of all opiods. Antidepressant use is astronomical. Why are we so sad? Why do we feel physical and emotional pain more than Canadians or Germans or...? By all means, let's make drugs more affordable. The prices are killing us.
I was reading an article last night that was dealing with high costs of prescriptions, and how to lower them. The article stated 47% of US population is taking a prescription. I sure hope if that is accurate that half of those are only birth control pills, as it didn't specify what any of them are. I just can't even relate to that number. Outside of some ampicillin taking during my childhood years for sore throats, I think I have taken a Vicodin once for a tooth extraction, and then threw the bottle away as I didn't like it. I guess I am fortunate, but that sure is a lot of prescriptions to be filled.
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Old 02-26-2013, 10:04 AM   #135
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I was reading an article last night that was dealing with high costs of prescriptions, and how to lower them. The article stated 47% of US population is taking a prescription. I sure hope if that is accurate that half of those are only birth control pills, as it didn't specify what any of them are. I just can't even relate to that number. Outside of some ampicillin taking during my childhood years for sore throats, I think I have taken a Vicodin once for a tooth extraction, and then threw the bottle away as I didn't like it. I guess I am fortunate, but that sure is a lot of prescriptions to be filled.
If we want to hammer docs on over prescribing, I'm first in line. Especially in instances like yours. They overprescribe pain meds because they don't want to get postoperative phone calls. I almost never prescribed narcotics for tooth extractions. I instructed the patient in post op care, gave instructions for ibuprofen if they could take it, and gave them my personal phone number if they had a problem. Rarely did anyone need something more for a simple extraction. That protocol also reduced the number of drug seeking patients to my office because, believe me, they know which docs write for the "good stuff."
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Old 02-26-2013, 10:10 AM   #136
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Great sentiment, but it still doesn't actually provide a solution to the actual problem. You would have to go further - turning your great sentiment into something offensively inhumane - in order for it to constitute something that would make a palpable difference in the problems being experienced.
Kinda sharp elbows, there don't ya think?
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Old 02-26-2013, 10:26 AM   #137
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Great sentiment, but it still doesn't actually provide a solution to the actual problem. You would have to go further - turning your great sentiment into something offensively inhumane - in order for it to constitute something that would make a palpable difference in the problems being experienced.
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Kinda sharp elbows, there don't ya think?
+1 travelover

Offensively inhumane? I'd liken the potential/means to combat obesity with that of smoking or drunk driving...
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Old 02-26-2013, 11:08 AM   #138
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Great sentiment, but it still doesn't actually provide a solution to the actual problem. You would have to go further - turning your great sentiment into something offensively inhumane - in order for it to constitute something that would make a palpable difference in the problems being experienced.
Sorry, but I firmly believe that our unhealthy lifestyle is a major driver of costs.
How would you make that real? Who will it impact, in what way, to what end, and to what effect? Your comments can be interpreted to mean "triple-tax all fatty food". It could be interpreted to mean "summarily put obese people to death". I doubt it means either, but without you filling in the blanks, there is no way to know what what you're saying would mean in reality.

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Kinda sharp elbows, there don't ya think?
Well, no, not really. The issue is that we all probably agree about the causes, or at least easily could agree... the problem is with regard to the solutions.

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+1 travelover

Offensively inhumane? I'd liken the potential/means to combat obesity with that of smoking or drunk driving...
With smoking, we've operationalized the intention through advertising, warning labels, differential impact on insurance premiums, etc. With drunk driving, we've operationalized the intention through similar means, and punitive action in the courts, including loss of privileges in society, fines, and jail time. Can't anyone operationalize the intention vis a vis the issues raised in this thread?

The reality is that it is hard, because obesity is quite different from nicotine addition or alcohol addiction. It is treated differently because it is different in fundamental ways.
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Old 02-26-2013, 11:18 AM   #139
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With smoking, we've operationalized the intention through advertising, warning labels, differential impact on insurance premiums, etc. With drunk driving, we've operationalized the intention through similar means, and punitive action in the courts, including loss of privileges in society, fines, and jail time. Can't anyone operationalize the intention vis a vis the issues raised in this thread?
That was my point, why can't we use many of the same evidently successful approaches?
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The reality is that it is hard, because obesity is quite different from nicotine addition or alcohol addiction. It is treated differently because it is different in fundamental ways.
Different how? Overeating is not addictive behavior in many cases? When I Google, I get so many hits linking food addiction, self or product induced, and obesity I don't know which one to pick/link...

But again, obesity is only one of many significant issues re: health care. Maybe you should start another thread if you want to focus on obesity...
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Old 02-26-2013, 11:25 AM   #140
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I was simply following up on Gatordoc50's focused contention about unhealthy eating (which, yes, does go beyond obesity, so take my comments in the context of the broader issue Gatordoc50 raised, not just obesity).
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