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Old 02-12-2012, 11:07 PM   #81
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Wow! Such cheap hospital costs, compared to the cost of food in their restaurants. I wonder how the incomes of healthcare professionals in other countries compare to those of their US counterparts, and also hospital profits.

The above malady sounded scary, so I had to look it up. From Wikipedia, Pudendal nerve entrapment (PNE), also known as Alcock canal syndrome, is an uncommon source of chronic pain, in which the pudendal nerve (located in the pelvis) is entrapped or compressed... The typical symptoms of PNE or PN are seen, for example, in male competitive cyclists (it is often called "cyclist syndrome")...

I know there is something wrong about the shape of those bicycle seats. You will not see me sitting on one. Anyway, we were in Nantes once...
Maybe the food and service in their restaurants is taxed heavily to pay for the health care

Some years back I read an article comparing health care costs in different European countries. The article had a chart showing the cost of a simple hernia operation in various countries, and they also had the cost in the USA. The Euro countries were all within 10 - 20 % of one another but the US was ~5 times more expensive.

In the PBS documentary "Sick around the World", looking at different countries' health care systems I remember that in Japan the cost of an MRI was $100 compared to $1,000 in the USA. The average Japanese person had 5 times more scans and visited the Doctor 4 times more often than an average US person. (Japan has Universal HI, not single payer, but with strict price controls)

I'd never heard of PNE before our friend developed it, but a couple of years ago another person (a guy) we knew also got it. We've been wearing padded bike shorts and using padded bike seats ever since.
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Old 02-12-2012, 11:45 PM   #82
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In the PBS documentary "Sick around the World", looking at different countries' health care systems I remember that in Japan the cost of an MRI was $100 compared to $1,000 in the USA. The average Japanese person had 5 times more scans and visited the Doctor 4 times more often than an average US person. (Japan has Universal HI, not single payer, but with strict price controls)
Well, it's a good thing that Japan invented the MRI.

Oh, wait.

Gee, I wonder how the medtech inventors recover the cost of the R&D from their technological advances... and the expense of experimental & heroic medical care on what we would call "hopeless" patients (excepting of course the ones that are related to us). And all of the litigation expenses that have gone into developing "the patient's bill of rights".

I'm not trying to claim that American healthcare is perfect. But it's sure expensive out there on the bleeding-edge frontier of tech. And what happens if the surgeons or techs in those other countries screw up and cripple or kill you a little? How come we never read those anecdotal stories here?

Many Americans think military Tricare is such a great deal for active-duty servicemembers... until they realize they can't choose their doctor, they can't get appointments in a timely manner, they have little confidentiality and no privacy, and no litigation rights. But it's free!
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Old 02-13-2012, 12:01 AM   #83
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Well, it's a good thing that Japan invented the MRI.

Oh, wait.

Gee, I wonder how the medtech inventors recover the cost of the R&D from their technological advances... and the expense of experimental & heroic medical care on what we would call "hopeless" patients (excepting of course the ones that are related to us).
There is plenty of medical innovation outside of the US that is funded from public and private sources, but I certainly hope the US keeps spending all this money to develop technology that the rest of the world can use. It's very magnanimous of the US to spend twice as much on healthcare as the rest of the world and save them the effort and money of developing all that new technology.

So would you give up Tricare to buy private insurance, or use the universal coverage HI system?
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Old 02-13-2012, 12:18 AM   #84
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So would you give up Tricare to buy private insurance, or use the universal coverage HI system?
Already gave it up.

Because I'm retired from the military, I'm now on the equivalent of private insurance (Tricare Prime). It has a much lower annual premium than most other private insurance ($460/year, rising to $520/year in October). Legislation proposes that the annual rates will start rising with at least the same percentage increase in the military retiree COLA.

If Tricare says that it's OK for my colonoscopy to be done at Queens Hospital, and Queens messes it up, then Queens would be subject to malpractice litigation. But Tricare usually sends me to a military treatment facility for anything other than routine outpatient care, so I had mine at Tripler. If they messed it up, then the Feres Doctrine would mean that I couldn't sue. In reality there'd probably be some sort of settlement... for my survivors. Or after my disability screening I'd be eligible for VA benefits.

I'm much happier with Tricare Prime than when I was on active duty. I can choose my clinic (whether that's a military treatment facility or a "civilian" clinic), I can choose my doctor (with some limits), and it's much easier to get an appointment. My chosen clinic is filled with residents & interns who are inquisitive, polite, and ready to admit their ignorance. Of course on active duty I usually received the same from corpsmen, but they weren't as highly trained or as closely supervised as the residents & interns.

Keep in mind that the military is generally a healthier population, with certain medical issues prevented from joining in the first place, and subject to much more stringent restrictions on exercise, bodyfat, & lifestyle (smoking, alcohol, drugs). Oh, wait, civilians don't have any of those restrictions...
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Old 02-13-2012, 01:05 AM   #85
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Wow! Such cheap hospital costs, compared to the cost of food in their restaurants. I wonder how the incomes of healthcare professionals in other countries compare to those of their US counterparts, and also hospital profits.

I remember reading something about this a few years ago. On a purchasing power parity basis, a French doctor earns about half what an American doctor earns IIRC. Still, doctors remain some of the most highly-compensated (and respected) professionals in France.

Hospitals in France are public and non-profit. Clinics are private and for-profit.
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Old 02-13-2012, 03:39 AM   #86
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Hello ERD50 - It is interesting you make a parallel with Civil Rights. I believe history will judge us and today's times (and the way we treat the tens of millions of poor and those without adequate healthcare coverage) quite badly.

I know which side I am on - this is one of the reasons why I give a lot of my time volunteering in free clinics here and abroad.
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In this country, not so very long ago, slavery, and then Civil Rights was a very divisive question, w/o consensus.

I guess those people like Abraham Lincoln and other abolitionists and those that followed should have just kept quiet. Don't want to ruffle any feathers, no, just keep that head deep in the sand. Everything will be better that way.
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Old 02-13-2012, 07:42 AM   #87
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A healthy debate is good because it allows different voices and ideas to be heard and exchanged. If it can lead to any concrete action or not, that's another story. However sometimes no action at all is better than some actions, such as biting another person's ear or finger which would inflict extra cost on the health care system.
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Old 02-13-2012, 08:18 AM   #88
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A healthy discussion, even if it does not lead to agreement, is a good thing. As my old Grand Pappy used to say "If you and I agree on everything, at least one of us is not thinking."
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Old 02-13-2012, 08:23 AM   #89
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My opinion:
1. To cover everybody with single payer, all our taxes should increase to pay for it.

2. We have to change our attitude that health care is a right, not a commodity. like Canada.

3. To economize, more effort should be in Prevention with actual mandates and rules for people to follow. Can't abuse the system and expect no consequences.

4. It will be tough to decide which is standard care which is covered and which is not. OK no Viagra!

5. All new proceedures should pass thru a random study with standard treatments before it will be approved for use. There's a lot of loopholes here which lead to very expensive care.

6. Well, this will be controversial, but there should be a public option!
and let it compete with private insurance companies.

7. In the end there will be a main government single payer system for standard care and extra private insurance for those who want Cadillac care. Such exist in England, Sweden, Germany etc.

8. No matter what, there will always be complaints!!
I might modify a few of these, but no fundamental disagreements. However WRT #1, we must find substantial cost reductions/efficiencies vs our present systems before increasing taxes to cover costs (then I'm OK with paying more). To just institutionalize our current system at 50-100% higher cost than other countries isn't something we can or should afford.

Interesting that we have developed countries (many with mature systems & results) all over the world to benchmark, even some who started from private systems like ours (Switzerland the closest from what I've read). You would think we could look at all the others and model the best system possible, I believe that's exactly what Taiwan did. [Yes, I realize why it's not so easy...]

I've linked to it before and others reference it above, viewing Sick Around The World | FRONTLINE | PBS is 60 minutes very well spent for reference.

I still wish some of the posters here who claim the US has the best healthcare would provide something concrete to support the claim. I wish it was true, but I can't see the evidence to support it...
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Old 02-13-2012, 08:46 AM   #90
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Already gave it up.

Because I'm retired from the military, I'm now on the equivalent of private insurance (Tricare Prime). It has a much lower annual premium than most other private insurance ($460/year, rising to $520/year in October). Legislation proposes that the annual rates will start rising with at least the same percentage increase in the military retiree COLA.
That's a great option to have. However, if you didn't have it which would you choose; Tricare or private insurance of the sort available to most US individuals and small business with deductibles, co-pays and pre-existing conditions?
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Old 02-13-2012, 09:48 AM   #91
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I think the biggest challenge in the future of health care in the US is deciding what we want the group to pay for as opposed to what we feel the individual should pay for.

Right now we have it in our heads that if we get sick, our insurance/Medicare should cover any treatment imaginable, regardless of cost or effectiveness.

That can't continue. We are inventing new and extremely expensive treatments every day. That is a great thing, but these things can't be included in universal coverage until they are cost effective. There is no avoiding the fact that wealth will bring better care.

I would like to see a fairly basic single payer system implemented. I think its basic structure would look like Medicare, but it will need to have a more cost effective approach to deciding what gets covered.

Most people of means will probably choose to supplement this coverage with something more comprehensive, either with insurance or with services purchased as needed.

In order to go down this path, though, we will need to have a grown-up conversation about heatlh care in this country. So I don't think we'll be doing that until our current system completely collapses


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I might modify a few of these, but no fundamental disagreements. However WRT #1, we must find substantial cost reductions/efficiencies vs our present systems before increasing taxes to cover costs (then I'm OK with paying more). To just institutionalize our current system at 50-100% higher cost than other countries isn't something we can or should afford.

Interesting that we have developed countries (many with mature systems & results) all over the world to benchmark, even some who started from private systems like ours (Switzerland the closest from what I've read). You would think we could look at all the others and model the best system possible, I believe that's exactly what Taiwan did. [Yes, I realize why it's not so easy...]

I've linked to it before and others reference it above, viewing Sick Around The World | FRONTLINE | PBS is 60 minutes very well spent for reference.

I still wish some of the posters here who claim the US has the best healthcare would provide something concrete to support the claim. I wish it was true, but I can't see the evidence to support it...
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Old 02-13-2012, 10:42 AM   #92
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I remember reading something about this a few years ago. On a purchasing power parity basis, a French doctor earns about half what an American doctor earns IIRC. Still, doctors remain some of the most highly-compensated (and respected) professionals in France.

Hospitals in France are public and non-profit. Clinics are private and for-profit.
I remember something along those lines as well. However, IIRC again, the doctors also had fairly heavily subsidized education. And of course their malpractice insurance is presumably less costly. So maybe we're not quite apples to apples in comparing "medical expenses" if education is excluded and the malpractice environments are so different.
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Old 02-13-2012, 11:08 AM   #93
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I think the cost of training our medical professionals contributes to our cost of care. We need to re-think the whole process. One option would be that a remodeled health care system pays for medical training for those who participate.

My former SIL is a nurse practitioner. She once told me that her return on training is better than that of an internist, family practitioner or OBGYN.
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Old 02-13-2012, 11:44 AM   #94
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I remember something along those lines as well. However, IIRC again, the doctors also had fairly heavily subsidized education. And of course their malpractice insurance is presumably less costly. So maybe we're not quite apples to apples in comparing "medical expenses" if education is excluded and the malpractice environments are so different.
True enough, but our "malpractice environment" is necessarily different than other developed countries for what legitimate reason? And there's much more to it than malpractice alone...
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Old 02-13-2012, 12:38 PM   #95
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@midpack

If look at Canada and Sweden, their taxes are much higher than the USA.
They also have VATS. Still there are some private supplementary for those who like a better room or care. There is no going away from it--Higher taxes if we cover everybody..

England is the same. There is a good standard care, but anything more serious, people have to wait. I've read they are very good in preventive care.

The model that is most feasible is like "Medicare" for everybody, in which it pays for 70% of standard care, then the 30% is private suplementary
insurance we have to pay for. The extreme model is the VA system- which is free for all veterans. BTW, both Medicare and VA works for people covered under them. I'm not a fan of private insurance.
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Old 02-13-2012, 01:03 PM   #96
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A friend from Norway commented on how we Americans are so sensitive to taxes.

I pointed out that yes, he pays a LOT more in taxes but has something to show for it: very low cost university (almost free), lifetime pensions, FREE healthcare and a fantastic infrastructure (roads, bridges etc)

Over here, I'm not sure we always know where our money goes...and I suspect that if you added the above benefits to our current tax base that we would be the highest taxed by a wide margin. JMHO.

Today's headlines of Greece should give us all pause in what can happen when 'cradle to grave' benefits are viewed as 'rights' or matters of 'fairness'.

And yes, I've lived long term in France, Italy and (for a shorter while) Greece...great living...until the money runs out and the tear gas starts flying!
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Old 02-13-2012, 02:34 PM   #97
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If look at Canada and Sweden, their taxes are much higher than the USA. They also have VATS. Still there are some private supplementary for those who like a better room or care. There is no going away from it--Higher taxes if we cover everybody.
Personal income taxes are not a direct indicator for relative health care costs between countries to begin with, any more than income taxes are an indicator for relative defense spending between countries. Furthermore, the total health care expense includes public and private costs, personal income tax is but one of several public revenue sources used for all sorts of spending. Private spending is much higher in the US vs other developed countries (though much of that is via corporate taxes that go to health care premiums and guess who ultimately pays the corporate taxes - individuals as customers).

About 17% of Americans are uninsured. We spend 40-50% more per capita on health care than the second most expensive country, and almost DOUBLE the OECD average cost per capita - this is the meaningful metric for comparison. If we reduce health care costs by 17% and cover all Americans, no tax increase, and we'd still be spending far more per capita than any other country. There are about 30 countries, many with mature health care systems, we can study as to how - we spend 53% more as a % of GDP and 82% more per capita on health care than Canada for example.
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In 2006, per-capita spending for health care in Canada was US$3,678; in the U.S., US$6,714. The U.S. spent 15.3% of GDP on health care in that year; Canada spent 10.0%. In 2006, 70% of health care spending in Canada was financed by government, versus 46% in the United States. Total government spending per capita in the U.S. on health care was 23% higher than Canadian government spending, and U.S. government expenditure on health care was just under 83% of total Canadian spending (public and private) though these statistics don't take into account population differences.
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The current Census Bureau report states that the number of Americans living uninsured has climbed to 49.9 million in 2010. The number of persons insured in 2010 increased to 256.2 million.According to its most recent figures, in 2009 there were 50.7 million people in the US (16.7% of the population) who were without health insurance.
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Old 02-13-2012, 03:00 PM   #98
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@midpack

If look at Canada and Sweden, their taxes are much higher than the USA.
They also have VATS. Still there are some private supplementary for those who like a better room or care. There is no going away from it--Higher taxes if we cover everybody..

England is the same. There is a good standard care, but anything more serious, people have to wait. I've read they are very good in preventive care.
In England no one is supposed to wait longer than 18 weeks for surgery or other procedures. People are "triaged" so if you have a heart attack and need stents etc that gets done immediately, if you need a hip replacement but are coping reasonably well you might have to wait depending on how many others need a similar surgery. My mother was diagnosed with cataracts and wet macular degeneration recently. The cataracts were not too bad so she had to wait 3 months to get those done, but they did the laser oblation for the macular degeneration immediately to stop further damage of the retina. My mum is now amazed at her vision and it cost her not a penny out of pocket.

Also the tax burden in UK is very similar to that in the US when you factor everything in. UK looses when it comes to VAT and taxes high earners more than the US, but wins out with less expensive local and housing taxes and of course you don't have to pay medical insurance. Also the UK has no equivalent of state income tax.
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Old 02-13-2012, 03:19 PM   #99
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And yes, I've lived long term in France, Italy and (for a shorter while) Greece...great living...until the money runs out and the tear gas starts flying!
The US spends more on healthcare per capital and as a fraction of GDP than all those countries and is also running a big deficit. If US health care was as efficient as that of France, Italy and even Greece it would be a big improvement and your taxes and insurance costs would go down
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Old 02-13-2012, 03:49 PM   #100
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My grandfather immigrated from Norway when their economy was bad. Once oil was discovered in the North Sea their economic picture changed. I think they are the only country where oil wealth was put to good use for the citizenry. Norwegians don't complain about their taxes because they have honest government and feel that they are receiving value for taxes paid. Let me assure you that Norwegians have a thrifty culture, they watch every krone spent. They work hard and expect their fellow citizens to contribute full value.

Not the Greek culture by a long shot.
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