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Old 02-20-2012, 02:31 PM   #241
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I'll take your comments out of order:

Quote:
Originally Posted by Snowbird100 View Post
I think there's a fundamental problem with the American health care system, frankly !
Agreed!


Quote:
But for argument sake, isn't somehow there's some kind of resistance to block the wealth distribution, and that's why 45 million Americans are under insured or have no insurance at all ?


I know they (no insurance) will get treatment in ER, but according what I learnt, only ER; And Americans could go bankrupt b/c of medical costs. How can you explain that ?
I'll lump these together - and my response will also explain why so many of us are afraid of the change that our government promotes:

Yes, someone with means, but unable to get HI could end up essentially bankrupt. That is bad. But how did it get this way..... (hint: 'I'm from the government and I'm here to help you'...).

Our govt decided to provide incentives for employers to provide health care to their employees (I think there might have been some wage freeze issues too, and HI was not considered 'wages', but again this was govt driven). It was cheaper for companies to provide HI than salary. In low unemployment times, 'better' HI was provided to attract talent. But in this light, 'better' means low/no deductible or co-pay, go to the doc for any little thing and don't worry about it because 'you are not paying for it'. That is not how smart people buy car insurance when it is their own money they are spending (they will get reasonably high deductibles). Anyhow, this whole system had a lot to do with how we got into this mess in the US. And now, the people who broke it are telling us they are the right ones to fix it (while never admitting fault in the first place, and not changing that part of the system).

The first quote/response bears repeating:

Quote:
Originally Posted by Snowbird100 View Post
I think there's a fundamental problem with the American health care system, frankly !
Agreed!

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Old 02-20-2012, 02:39 PM   #242
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ERD, I'm not sure our system was designed that way (employer based, etc). Perhaps it just evolved, and now is stumbling because there is no central structure.
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Old 02-20-2012, 02:41 PM   #243
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I forgot to mention one more thing: I think a huge population might be another problem to fix HI in the US on top of hospitals for profit and doctors get paid too much (more than double what Canadians doctors get paid).

9 times more people than Canada (32 millions total in Canada) !

Summary of problems/costs:
- 9 times more than Canada (population): $$$$$$
- Private hospitals for profit: $$$
- Doctors get paid more than double: $$
- Red tape (insurance companies): $$
- Unnecessary procedures (some might argue): $$

I am having a headache
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Old 02-20-2012, 02:41 PM   #244
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Originally Posted by Snowbird100 View Post
Ooppsss !
Snowbird, just to be clear, you are welcome to join us and also post here. I think Alan was suggesting you not focus on the wealth distribution issue, as that invites the type of political discussion we try to discourage.
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Old 02-20-2012, 02:48 PM   #245
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Snowbird, just to be clear, you are welcome to join us and also post here. I think Alan was suggesting you not focus on the wealth distribution issue, as that invites the type of political discussion we try to discourage.
Thank you !
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Old 02-20-2012, 02:49 PM   #246
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During the debate about Obamacare a couple of years back I decided to do my own research on health care systems around the world. Having lived in Europe I know for a fact, or at least to my own satisfaction that their quality of care is at least as good as ours.

Europe spends about 14% of GDP on health care

USA spends about 17%.

I believe the extra 3% here comes from inefficiencies and from poor health choices. If we cut out 90% of the paperwork and finger-pointing about what is covered, who pays, what is preexisting, etc. and if people ate better diets and exercised, we'd probably cover that 3% spread and then some.

But Americans would rather argue about their god-given right to sit on their butts, eat pork rinds, and pontificate about "them socialists" in France than actually try to address the root of the problem!
I think your numbers are off. We spend more than 51% more than the next highest country which is Norway, and about 90% more than Canada and nearly 100% more than France.

I agree, we as a population are over weight and that is definitely a factor.
I don't think anyone would argue that. The poorest population are generally the most obese, and the wealthier Americans are the most fit (as a rule - not always) I think there is a direct correlation to income and intellect and being fit or obese. If you have traveled to other countries, you will see some significant differences in their eating habits, and food available.

We are the Fast Food capital of the world, and the general accepted diet for Americans is not exactly healthy. But our government does not seem willing to promote better eating. Look at the problem they are having with the school lunches, and the critisism Michele Obama got when she planted her garden and advocated eating more vegetables. Yes, it is not our government's job to take care of our health, but it wouldn't hurt for them to participate in some education.

I don't know what percentage to allocate to this fact. I don't know where you came up with your 3%. I concur, it is a factor, but how much I don't know. Certainly not attributing to 50-100% increase.
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Old 02-20-2012, 02:55 PM   #247
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Wait, the govt. is the reason why health care costs are the biggest cause of personal bankruptcies?

The tie to employer-based health care started during WWII or out of the Depression, I believe, as companies weren't able to increase wages during dire times and offered health care coverage as a perk to compensate for lower cash compensation.
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Old 02-20-2012, 02:56 PM   #248
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Originally Posted by modhatter View Post
I think your numbers are off. We spend more than 51% more than the next highest country which is Norway, and about 90% more than Canada and nearly 100% more than France.

I agree, we as a population are over weight and that is definitely a factor.
I don't think anyone would argue that. The poorest population are generally the most obese, and the wealthier Americans are the most fit (as a rule - not always) I think there is a direct correlation to income and intellect and being fit or obese. If you have traveled to other countries, you will see some significant differences in their eating habits, and food available.

We are the Fast Food capital of the world, and the general accepted diet for Americans is not exactly healthy. But our government does not seem willing to promote better eating. Look at the problem they are having with the school lunches, and the critisism Michele Obama got when she planted her garden and advocated eating more vegetables. Yes, it is not our government's job to take care of our health, but it wouldn't hurt for them to participate in some education.
I don't have the stats on costs between Canada and the US, but that 90% more than Canada seems right to me !

If we look at the costs between Canada/US:
- Canadian doctors gets half of American doctors
- No private hospitals/Hospitals for profit in the US
- Less red tape / private insurance companies, more red tape
- Less procedures, no unnecessary procedures / Unnecessary procedures driven by for profit hospitals (top up insurance)

So I am not surprised it costs 90% more than what it costs in Canada !
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Old 02-20-2012, 03:00 PM   #249
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Here is an interesting article on the history of health care in the US. (Note: it is from Humana so I'm sure it probably has some sort of an agenda...)

U. S. Healthcare History
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Old 02-20-2012, 03:14 PM   #250
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This is not true. If someone needs treatment they get it. You don't see the gutters in front of hospitals and ERs lined with dead/dying. It's not just emergency services either, I know people who have received excellent treatment for things like tendinitis surgery, with no out-of-pocket cost.

That is not to defend our system. I am one of the many who feels we need change, big changes. The recent bill that was passed does not address many of the issues that people on both sides of the political spectrum agree with (cut the link between employment and health insurance being one important one).

I don't think it is so much that we are afraid of change, but many of us feel we have reason to be afraid of the kind of changes our political system comes up with (that is meant to be totally non-partisan).

I think a nationalized health care system would be an easier pill to swallow (pun intended!) if we had more faith in our governmental system. Polls consistently put Congress approval ratings in single or low double digits. I think people are being generous


edit: forgot to comment on the Wealth Redistribution hot button - Our current system involves wealth redistribution; people w/o means are treated for free, some people decide to 'go naked' and don't pay for insurance. Others end up paying their bill through higher charges. A well run nationalized system could actually reduce the wealth redistribution aspect by not allowing those who can afford to pay to opt out (but still be accepted at the ER when trouble comes their way)
I certainly think we need big changes. But I am not a fan of wealth redistribution and I think doctors deserve to be paid well. In my opinion, fundamental to any change is the need to give individuals a powerful economic incentive to being healthy and avoiding costly diseases.

Now, I don't think for a second that anyone wants to be sick. But the fact remains that people continue to do, eat, behave, etc in ways that are all but unarguably unhealthy. These people then require more care and we all pay for it. If we have a socialized system then all taxpayers pay. If we have a purely private system then all policy holders pay. Essentially, anyone who receives care pays for those requiring more care because of their habits. Since I think we all want to get care at some point, I really believe that the debate about "socializing" is a red herring.

I think what we need to do is modify the system so that there are powerful forces putting pressures to reduce costs. I'd do this by making people pay for at least 20% of their own care, reward people for healthy behavior with rate reductions, and so forth.

In my state, our governor is charging people on the state's medicaid plan extra if they smoke or if they are obese. Although I generally lean toward the liberal side when it comes to health care, I think what she is doing is a big positive step in giving people a direct, measurable incentive to improving their own health and reducing the costs for all of us.

I worked with a guy who ran the state division of a major health plan (HMO) about 15 years ago. He remarked once on how he had a program shot down by the national office because the payback would not be seen in the same fiscal year. He wanted to subsidize the cost of gym memberships for plan members so that they would be more healthy. The expected cost savings and impact on health were enormous over 5 years or so but the idea was shot down because he could not demonstrate a short term financial gain. Of course subsidies like that are more common now.

I just think that we should get past the politics because there really is a lot that can be done without ticking off either the liberals or the conservatives. But I'm not holding my breath.
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Old 02-20-2012, 03:33 PM   #251
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I think your numbers are off. We spend more than 51% more than the next highest country which is Norway, and about 90% more than Canada and nearly 100% more than France.

I agree, we as a population are over weight and that is definitely a factor.
I don't think anyone would argue that. The poorest population are generally the most obese, and the wealthier Americans are the most fit (as a rule - not always) I think there is a direct correlation to income and intellect and being fit or obese. If you have traveled to other countries, you will see some significant differences in their eating habits, and food available.

We are the Fast Food capital of the world, and the general accepted diet for Americans is not exactly healthy. But our government does not seem willing to promote better eating. Look at the problem they are having with the school lunches, and the critisism Michele Obama got when she planted her garden and advocated eating more vegetables. Yes, it is not our government's job to take care of our health, but it wouldn't hurt for them to participate in some education.

I don't know what percentage to allocate to this fact. I don't know where you came up with your 3%. I concur, it is a factor, but how much I don't know. Certainly not attributing to 50-100% increase.
My numbers might be off. They came from the Kaiser Family Foundation. I have no idea what, if any, bias they have. But numbers were % of GDP. I don't think it is even possible that we spend double what a European country does. So, I might have an error in numbers but I am confident that simply improving the efficiency a little bit could go a long way toward fixing the system.

I lived in a European country that was quite socialist, many Americans believed they were communist. This was about 30 years ago. They had great, free health care. I went to the doctor there and here in the US and I knew others that had more major problems. Their system was better than ours in almost any measurable way. I'm not sure if it still is but I do know, because I still go back and have some ties with that country, that anyone who says that our care is much better is mistaken. Developed countries everywhere have the most modern medical care. You have access to the technology, drugs, and care you need. I think our care is equal but not better.

But in the country I am familiar with, the cost has gone up. "Free" care now involves expensive copays, higher taxes, and other charges that rival or exceed what we pay here in the US if we have insurance. That's enough to make people get the routine care they need but avoid unnecessary tests and procedures. A friend had here wisdom teeth out a few years ago about the same time I did. We compared costs and out out-of-pocket was about the same even though hers was supposedly "free."

As for the fast food comment, I totally agree. When/where I lived in Europe it was unusual to see a fat person. When you did it was usually just a little overweight. And it was always middle-aged or older people. When I go back now I see a lot of obesity. And I see a lot of fat kids which was never seen 30 years ago. It is really sad.

When I talk with friends there about it they tend to blame the lifestyle changes rather than fast food. The "traditional" diet has been replaced with a lot of quick, packaged food, not necessarily fast food but unhealthy garbage of any type.
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Old 02-20-2012, 04:02 PM   #252
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ERD, I'm not sure our system was designed that way (employer based, etc). Perhaps it just evolved, and now is stumbling because there is no central structure.
It probably was not a conscious 'design', but the laws that were passed promoted employer based HI over other methods of obtaining HI, and put an artificial value on it (making it cheaper than salary in some ways). That has created many problems.

Designed or not, I've seen rational viewpoints expressed from all different sides that breaking the employer-healthcare connection would be a positive, and that was not done in this last go-around.

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Old 02-20-2012, 04:02 PM   #253
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Snowbird, you brought up a good point in the size of the US. We have so many hospitals and medical institutions in place, that any kind of conversion will be a very large undertaking. Also, you mention doctors. We also have a shortage of doctors here, or at least GP's, and the cost to go to medical school is very high, so doctors expect a good return for their education.

I wish we had more altruistic people entering the profession based on a desire to heal, as opposed to making big bucks. We of course have some, but I don't know if it is the main focus of those entering the profession. I suspect in some cases it may be both.

As you can tell from some of the responses you have gotten, there is a great deal of government apprehension and disdain from a certain percent of the population - to any kind of government involvement in health care.

We have medicare for the elderly which has been great for seniors, but costs are very high and not sustainable, as the government is not getting the benefit of collecting premiums (or taxes for) from the younger healthier population. The government gets the old, and consequently most expensive, and the insurance companies get the younger and healthier.
Not a good business plan.

I agree whole heartedly with your opinion as to some of the causes for our overpriced system. I do not feel there is any place for profit in health care.
It is a total waste of money, and not only is profit taken off the top, administrative costs are much higher because of all the different entities involved. But with such a divide in opinion on this with the US population, it is doubtful our government will do anything. They are very influenced by the large corporations, and concerned with not getting their political donations if the cross the money flow from the corporations. (both parties)

We got something past about two years ago, which made some improvements, but lacked any real cost saving measures. And that was a h-ll of a fight, and sqeked through by only one vote and not following the normal path of legislation. Twenty six states now have filed suit against the new health care act, stating it is unconstitutional to mandate that everyone carry insurance. (in order to lower the overall premiums for everyone) The divide amongst the population tends to follow a party line, so it has turned into a political divide as well as independent issue over health care, though this is not always the case. Just makes it more complicated and difficult to come together.

I don't agree when I hear people say "they know what Canada's or the UK's or Frances health care is like" I feel they may know about numbers, but what they can't say with certainty is the countries feelings and experiences with their health care. No one can actually speak for that except the person who lives the walk. And many people living in these countries don't understand Americans and are curious as to why. We are becoming a global society and are talking together now, and sharing our experiences and or differences. What's wrong with that?

Doinghomework. Here are the numbers. It is higher now. We are over 17%. This is from 2008.
http://www.kff.org/insurance/snapshot/oecd042111.cfm
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Old 02-20-2012, 04:11 PM   #254
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During the debate about Obamacare a couple of years back I decided to do my own research on health care systems around the world. Having lived in Europe I know for a fact, or at least to my own satisfaction that their quality of care is at least as good as ours.

Europe spends about 14% of GDP on health care

USA spends about 17%.

I believe the extra 3% here comes from inefficiencies and from poor health choices.
From what I've seen, the differential is about double that. Here's one source, another I posted earlier, post #97.
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Old 02-20-2012, 04:11 PM   #255
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Snowbird, you brought up a good point in the size of the US. We have so many hospitals and medical institutions in place, that any kind of conversion will be a very large undertaking. Also, you mention doctors. We also have a shortage of doctors here, or at least GP's, and the cost to go to medical school is very high, so doctors expect a good return for their education.
I always forgot about the huge population in the US when talking about health care but I said to myself I would have to mention it in the forum.

Once the institutions were established (so many hospitals, institutions ...) in that scale for so many people (US population), it's so difficult to make changes ...

Doctors/education: Yes, it is so expensive to go to medical school in the US compared to Canada, that's why Canadians' first choice is alwasy home universities first, if not then out of province universities, then finally universities in the US.
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Old 02-20-2012, 04:18 PM   #256
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Europe spends about 14% of GDP on health care

USA spends about 17%.
All the numbers I've seen put European countries in the 8% to 12% of GDP range. If you had other data please present it.
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Old 02-20-2012, 04:27 PM   #257
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I wish we had more altruistic people entering the profession based on a desire to heal, as opposed to making big bucks. We of course have some, but I don't know if it is the main focus of those entering the profession. I suspect in some cases it may be both.
Canadians doctors, in general, and when they entered medical schools in Canada, they didn't go into the professions to make big bucks ... Not at all !

I think it's sad that doctors in the US (I don't know how many) entered the profession to make big bucks ! There's one dentist in the US who used paper clip as post for root canal, yes PAPER CLIP instead of stainless steel post for root canal.

Paper clip is allowed for temporary measure, not permanent root canal. And he performed so many root canals using paper clips to save $ or make $.

What a shame !
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Old 02-20-2012, 04:29 PM   #258
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A McKinsey study comparing health care in the US with other major countries dated 2007, linked in previous discussions. Accounting for the Cost of Health Care in the United States | McKinsey Global Institute | Americas | McKinsey & Company

They find and quantify many reasons for the difference in costs.
Quote:
Instead, MGI found that the overriding cause of high US health care costs is the failure of the intermediation system—payors, employers, and government—to provide sufficient incentives to patients and consumers to be value–conscious in their demand decisions, and to regulate the necessary incentives to promote rational use by providers and suppliers.
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Old 02-20-2012, 04:37 PM   #259
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If we look at the costs between Canada/US:
- Canadian doctors gets half of American doctors
- No private hospitals/Hospitals for profit in the US
- Less red tape / private insurance companies, more red tape
- Less procedures, no unnecessary procedures / Unnecessary procedures driven by for profit hospitals (top up insurance)
While we appreciate your zeal, unfortunately it's even more complicated IMO. Here's my personal (unprofessional) list of reasons in no particular order:
  • lifestyle (obesity, smoking, drugs)
  • high cost and profit for intermediaries (insurance)
  • excessive profit for some product and service providers
  • administrative burden (millions of microplans)
  • high charges for specialized services
  • forced use of expensive specialized facilities for routine medical needs (emergency room)
  • multiple regulations around the country
  • punitive legal awards
  • diagnostic overuse (expensive tests even for routine matters)
  • treatment overuse (especially end of life)
  • excessive unproductive labor vs technology
And here's a better list from a TIME magazine author (full article http://moneyland.time.com/2010/02/25/why-is-health-care-so-expensive-let-us-count-the-conspirators/)
Quote:
Why Is Health Care So Expensive? Let Us Count the Conspirators
I wonder if anybody is talking about health care reform today. If they are, instead of grandstanding and bickering, perhaps it’s worthwhile to take a hard look at the factors leading to more expensive care for everyone, and to make a real effort at bringing those costs down to earth. Because while one of the noble goals to health care reform is providing insurance to more people, it’d be a whole lot easier to do that if health care didn’t cost so darn much to begin with.

Here are some of the reasons … which all lead to more expensive health care for everyone:
Insurance companies are businesses. Their business mission is to make money, not to make people healthy.
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.
“Perverse incentives.” 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.
Malpractice madness. As much as 10¢ of every dollar of your doctor’s bill goes to cover the doc’s malpractice insurance.
Malpractice madness #2. Doctors, ever fearful of being sued for doing too little, tend to go the other way and do too much.
What do statistics mean anyway? Studies demonstrating that expensive surgeries yield no benefits to patients are sometimes disregarded by doctors.
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.
We’re fat. Obesity adds $147 billion per year to our health care bills.
We take more pills, and the pills make us fatter.
Antitrust exemption. For some reason, way back when someone thought it was a good idea to give the health insurance industry exemption from federal antitrust laws. The result, as a recent NY Times op-ed says, is that a small pool of insurers have been able to dominate the market, and customers have few other places to turn.
No shopping across state lines.
What do I owe? 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.
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Old 02-20-2012, 04:37 PM   #260
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We have medicare for the elderly which has been great for seniors, but costs are very high and not sustainable, as the government is not getting the benefit of collecting premiums (or taxes for) from the younger healthier population. The government gets the old, and consequently most expensive, and the insurance companies get the younger and healthier.
Not a good business plan.
I think it is sad that a health care system (such as the one in the US) that doesn't look after the most vulnerable re: seniors

In a society, I think the younger and stronger should look after the older, I don't see anything wrong with that ?

Collect some kind of health taxes from young people who are employed and pay for the seniors. They are old, they can't work, and that's why the younger should look after the seniors. I am amazed it's not happening in the US !?
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