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Old 02-13-2012, 04:41 PM   #101
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Ok folks, I did some research and here is more information:

A July 14, 2011 article from Yahoo News about how the world's first synthetically grown organ was sucessfully transplanted in Sweden.
http://voices.yahoo.com/synthetic-organ-transplants-possible-first-time-done-8767819.html

A July 13, 2011 article from the London, UK Telegraph about a team of doctors in Gothenberg, Sweden who will perform only the second womb transplant in the world on a UK businesswoman donating her womb to her daughter.
http://www.telegraph.co.uk/health/8571487/Worlds-first-womb-transplant-planned.html

An August 3, 2011 article from a newspaper in Vermont about a Burlington, VT woman who will get lifesaving surgery at Karolinska in Stockholm.
http://www.7dvt.com/2011fletcher-allen-has-candidate-groundbreaking-windpipe-transplant

A November 30, 2011 article from the website www.transplantcafe.com about a Maryland man going to Sweden for a lifesaving transplant.
http://transplantcafe.com/profiles/blogs/helphopelive-patient-spotlight-groundbreaking-use-of-stem-cells

Who paid for these procedures or how this affected Sweden's free for all medical care I could not tell you. There is plenty more, but it is time for me to have a beer and go to sleep. Happy reading!!
Thanks for the effort James7, but you may have misunderstood my question. I'm well aware that the Swedish medical system has plenty of advanced medical technology. The articles you posted are further examples of this. But I'm struggling to understand how outside "private pay" patients fit into socialized systems, such as Sweden's. The answer seems to be, as others have mentioned above, the socialized systems have a private component to them operating in parallel with the socialized component.

EDIT:

In looking through the articles james7 kindly provided, there was a mention of how an "outsider" is given access to care in the Swedish socialized system. The article was about a Vermont woman who required a windpipe transplant and the Italian doctor (in Switzerland) who provided it. From that article:

Quote:
While in Burlington last week, Macchiarini, 53, explained why he agreed to treat Phillips — free of charge. “She’s a young and beautiful girl who had a beautiful past,” he explains, in a thick Italian accent. “She deserves to live.”
That makes it clear why the Swedish system is so appealing to young, beautiful girls who have had a beautiful past.
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Old 02-13-2012, 04:43 PM   #102
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On the topic of the availability of insurance in Mass. Can anyone list places to move to in Mass. that have a lower cost of living than the big cities? A town of 50,000 to 100,000 would be a nice starting point. IF you have any cost data points like housing to add that would be great. I am not familiar at all with that state but will probably need to be. I am only 47 and I see a move there in the future as the most likely way to stay in the States going forward.
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Old 02-13-2012, 04:49 PM   #103
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On the topic of the availability of insurance in Mass. Can anyone list places to move to in Mass. that have a lower cost of living than the big cities? A town of 50,000 to 100,000 would be a nice starting point. IF you have any cost data points like housing to add that would be great. I am not familiar at all with that state but will probably need to be. I am only 47 and I see a move there in the future as the most likely way to stay in the States going forward.
Lots of info including cost of living Massachusetts Bigger Cities (over 6000 residents) - Real Estate, Housing, Schools, Residents, Crime, Pollution, Demographics and More, and a forum where you can ask residents questions after you're narrowed your list some.
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Old 02-13-2012, 04:54 PM   #104
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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...
It sounds like what you're saying is that until we improve the USA health care system so it provides better results at lower costs, you're not willing to absorb higher costs (pay higher taxes) to ensure everyone is covered? Is that correct?

If so, I think you're proposing a chicken - egg scenario. People can't all be guaranteed coverage until costs go down. But costs can't go down while so many people lack preventive care and use emergency rooms for routine sicknesses. And around and around.......

Perhaps I'm misunderstanding what you're saying.
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Old 02-13-2012, 05:15 PM   #105
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It sounds like what you're saying is that until we improve the USA health care system so it provides better results at lower costs, you're not willing to absorb higher costs (pay higher taxes) to ensure everyone is covered? Is that correct?

If so, I think you're proposing a chicken - egg scenario. People can't all be guaranteed coverage until costs go down. But costs can't go down while so many people lack preventive care and use emergency rooms for routine sicknesses. And around and around.......

Perhaps I'm misunderstanding what you're saying.
Not exactly. I'm repeating myself but we already pay more per capita than any other country by a wide margin. Collectively we can't afford to just increase taxes to include all the uninsured while maintaining the US health care status quo. So we have to reduce costs and maybe increase taxes concurrently. Like I said in my last post, we spend 50-100% more than other developed countries, our uninsured are 17% of the population - so it's not obvious taxes must be increased. We have more than 30 countries with mature health care systems we can benchmark. Even then it will be an iterative process, but I can't believe we can't reduce health care costs - any more than I believe we can't reduce other federal spending (vs just increasing taxes to cover our huge deficit spending).
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Old 02-13-2012, 05:22 PM   #106
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Do systems in other countries incentivise participants to stay healthy?

It will be hard to see my neighbor paying the same premium if he/she is 100 pounds overweight, smokes like a chimney, drinks like a fish, and a long walk is the daily trip to the mailbox!
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Old 02-13-2012, 05:24 PM   #107
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Not exactly. I'm repeating myself but we already pay more per capita than any other country by a wide margin. Collectively we can't afford to just increase taxes to include all the uninsured while maintaining the US health care status quo. So we have to reduce costs and maybe increase taxes concurrently. Like I said in my last post, we spend 50-100% more than other developed countries, our uninsured are 17% of the population - so it's not obvious taxes must be increased. We have more than 30 countries with mature health care systems we can benchmark. Even then it will be an iterative process, but I can't believe we can't reduce health care costs any more than I believe we can't reduce other federal spending (vs just increasing taxes to cover our huge deficit spending).
OK, thanks.

We need to provide access to health care for all. And our current system seems too expensive vs. the results. No argument from me.

I do wonder however if waiting until we define a plan which improves both issues concurrently before implementing anything might lead us to never implementing anything.

Not arguing that either issue isn't important. Rather, just wondering if we can link them so tightly and ever get anything started.
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Old 02-13-2012, 05:30 PM   #108
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Do systems in other countries incentivise participants to stay healthy?

It will be hard to see my neighbor paying the same premium if he/she is 100 pounds overweight, smokes like a chimney, drinks like a fish, and a long walk is the daily trip to the mailbox!
I only know of isolated examples where USA group plans punish folks with non-optimum life styles by charging higher premiums. In the individual policy world, however, it's more common to pay more or be denied coverage altogether for being obese, smoking, etc., or some combination.

Perhaps some of our board participants with knowledge of the UK or Canadian systems can comment on how poor life style issues are handled there. Alan? nun?
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Old 02-13-2012, 07:14 PM   #109
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I only know of isolated examples where USA group plans punish folks with non-optimum life styles by charging higher premiums. In the individual policy world, however, it's more common to pay more or be denied coverage altogether for being obese, smoking, etc., or some combination.

Perhaps some of our board participants with knowledge of the UK or Canadian systems can comment on how poor life style issues are handled there. Alan? nun?
A few personal examples. I'd heard news aricles on NHS sponsored health improvement programs and we witnessed a little of one last year. We joined our local gym and were warned about the busy period 9am to 10am Tuesdays and Thursdays. Of course we forgot and saw first hand the NHS sponsored overweight members being put through their paces on the machines (mostly aerobics) by a trainer.

About 8 years ago my sister decided that she really did want to give up smoking so she signed onto the NHS program. She chose the nicotine patch approach and they were provided at no cost to her. She had to attend the clinic every week and have a blood gases test done to check the CO level and talk to the Doc. You can't smoke and not have increased CO levels, so no cheating. For her the program worked great and she hasn't smoked since - she'd been a smoker from being 11 years old.

Earlier than that I was visiting and asked her about her next door neighbor who I had known for many years. She had lost loads of weight and was looking absolutely great. My sister said she had gone through the NHS sponsored weight loss program. Again, you get one shot at it, the NHS pays the costs of a program, Weight Watchers in the case of this person, and you have to go to the doctors each week to weigh in and talk to the Doc. Not only did she lose loads of weight but she kept it off for a year which entitled her to a free tummy-tuck, which she chose to take.
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Old 02-13-2012, 07:24 PM   #110
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Ban health insurance. We know it is just more of that "From each according to his ability (to pay), to each according to their need (the sickos!)" nonsense.

Make everyone pay for everything out of their own pocket, ensuring a real free market with free market mechanisms to match service costs to demand. Eliminate the AMA bottlenecks and guild structure to limit the supply of doctors. Allow barbers to provide basic medical service and alternative care. Leeches, get your fresh leeches!

Can't afford the care? Sell a kidney or a chunk of your liver! Out of spare parts? Perhaps you can get a loan (check with Midas Mulligan) or an advance on indentured servitude, with your new master leveraging against the risk you might not survive.


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Old 02-13-2012, 07:24 PM   #111
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Said Midpack: reduce health care by 17%, cover all Americans, No income tax increase, and we still spend more per capita than other countries!

I just can't see that happening, and few comments.
1. Where does she propose the reduction in health care will come from-medicare?
2.When you cover more people, you need more revenue, thus taxes increases. Private corporation? I read GE did not pay any taxes ExxonMobil? C mon! Romney pays only 14.9%
3. American medicine is different compared to other countries. It is very procedure oriented. This is very expensive and lobby always find a way to have it approved for billing. There is little money to be made for prevention.
4. We Americans are also so egocentric and selfish. We are for reforms but when we get sick- we'll all want to go to the Mayo clinic for the latest
and most expensive procedures even if it works well close by.
5. It does not matter what reform we do, if we supersize our food, not exercise, smoke, use illicit drugs, drink too much alcohol, drive fast, health care is going to get expensive. Without cooperation of people result is nil.
6.If you look closely at other socialized medicine, they have a tendency to
exaggerate their results, but there is no way out for some. People are stucked with the socialized system, and there is little option if they are
unhappy with the system. (Sweden, Norway, England).
7. BTW, I just read there was just a nationwide strike of doctors in Germany, doctors abusing their patients in Sweden, etc. So nobody is perfect.
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Old 02-13-2012, 09:23 PM   #112
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On the topic of the availability of insurance in Mass. Can anyone list places to move to in Mass. that have a lower cost of living than the big cities? A town of 50,000 to 100,000 would be a nice starting point. IF you have any cost data points like housing to add that would be great. I am not familiar at all with that state but will probably need to be. I am only 47 and I see a move there in the future as the most likely way to stay in the States going forward.
Inexpensive places include Lowell, Fall River, Bridgewater, Fitchburg and the are plenty of places West of Worcester, but the Berkshires and parts of the Pioneer Valley can get expensive again.
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Old 02-13-2012, 09:44 PM   #113
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I just realized that my question in an earlier post about the income levels of the medical profession in the US vs. those in other developed countries was not fair.

It might be true that a US doctor deserves to make more than his French counterpart for many reasons. The former might have a large debt to get his degree, and then when he has his practice, might face more litigious risks, etc... As a layman, I do not know about all the issues.

Being a believer in the free-market system, I wonder how other systems provide incentives for a health care provider to be more efficient. We all work for a profit, and expect to get paid more if we are better than our peers. If health care providers are to be non-profit, would they become more like government agencies? Apologies to government workers here on this forum, but I have seen a lot of inefficiencies in the government functions that I interface with in my work. They have no skin in the game, and do not care as much as people in the private world.

I have always thought that there are many facets to the issue of high health care costs in the US. Here's another example. In both my family doctor and my dentist offices, I saw about the same number of clerical workers as the number of health care professionals, i.e. nurses or PA and the doctor himself. Obviously, they need many paper pushers to deal with Medicare and the private insurance companies. And then, on the other end, who knows how many are employed by the government and the insurance companies to haggle back and forth with the health care providers. Meanwhile, do the patients know if the charges are correct, or do they even care how much certain procedures cost?

I also have this observation. Back when I was covered by my megacorp's insurance, I never cared that much about what something cost. Now that I have a $10K annual deduction policy, I have been paying out of my own pocket for everything, and my insurer's role is simply to get the doctors to agree to a reasonable charge. Once the fees are set, it appears that the offices are so happy to get paid immediately by me instead of having to wait to be paid by the insurers.

Having an insurer as a middle man adds to the healthcare cost. The private insurers do provide a service, but how much of the nation healthcare cost do they account for? Now, with the government as the middle man, can we expect it to be better than the current insurers?
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Old 02-13-2012, 10:08 PM   #114
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Being a believer in the free-market, I wonder how other systems provide incentives for a health care provider to be more efficient.
If you are a believer in the free market, are you aware that HI companies are exempt from the anti-trust regulations that govern the rest of business in the USA. This means there are no rules outlawing bid rigging, price fixing, and other insurance company practices that drive up health care costs, and often drive up their own profits as well.

Non-profit HI companies compete against other on service and efficiency. Just because a business is non-profit doesn't mean people who work and manage the business don't earn lots of money. Many hospitals in the US are non-profit (and I'm not talking about charity hospitals).
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Old 02-13-2012, 10:13 PM   #115
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It is not really a free-market system!

Yes, I do know that administrators of US non-profit hospitals make a lot of money. Again, patients do not care to ask about mischarges or overcharges because they have no skin in the game. I was thinking that the same things could happen with other countries' systems. How do they deal with that?
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Old 02-13-2012, 10:23 PM   #116
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It is not really a free-market system!

Yes, I do know that administrators of US non-profit hospitals make a lot of money. Again, patients do not care to ask about mischarges or overcharges because they have no skin in the game. I was thinking that the same things could happen with other countries' systems. How do they deal with that?
I don't know about other countries but the UK has a number of NHS Trusts that manage the services in different regions. The Trusts get money from Central Government and are given financial and medical targets they have to meet.

NHS trust - Wikipedia, the free encyclopedia

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The trusts are not trusts in the legal sense but are in effect public sector corporations. Each trust is headed by a board consisting of executive and non-executive directors, and is chaired by a non-executive director. Non-executive directors are recruited by open advertisement.

All trust boards are required to have an audit committee consisting only of non-executive directors, on which the chair may not sit. This committee is entrusted not only with supervision of financial audit, but of systems of corporate governance within the trust.
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Old 02-13-2012, 11:12 PM   #117
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I have lived in US for 30 years and I have recently started re-joining my Asian home country's NHI. It is universal and the premium for my wife and I are very low. Many of my countrymen are doing the same thing and returning home for RE. I am still working in US and get health insurance through work, but I worry about the years after I RE and before I reach 65.

The country has implemented their NHI for 20 years. During the 80s, there were many sad stories where the families had to choose between letting grandpa die without surgery, or sell their house to pay for the surgery. Many hospitals turned away patients because they could not pay.

Now, it has all changed. During the presidential debate last month, none of the 3 candidates ever mentioned health care issues, because, well, it is now a non-issue. Everyone is covered by NHI. Premium is paid according to the income bracket and investment. The rich therefore pay more. There is still supplemental insurance market. People can purchase cancer coverage, for example, when NHI covers with limitation.

I know it is not perfect, nor is their care better than money can buy in US, but it is a safety net that I can have so I won't go bankrupt, when it is a ral possibility in US if I somehow fall into that black hole.
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Old 02-14-2012, 06:23 AM   #118
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I know it is not perfect, nor is their care better than money can buy in US, but it is a safety net that I can have so I won't go bankrupt, when it is a ral possibility in US if I somehow fall into that black hole.
That's why I am retiring overseas (probably to the same country you are talking about). Through my wife's citizenship there, we'll both be covered by NHI. Our system needs fixed - my older brother is deep, deep in the hole now due to his wife's cancer (they work for a small family business and have no insurance). People should not be ruined financially for the rest of their lives due to illness.
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Old 02-14-2012, 06:45 AM   #119
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That's why I am retiring overseas (probably to the same country you are talking about). Through my wife's citizenship there, we'll both be covered by NHI. Our system needs fixed - my older brother is deep, deep in the hole now due to his wife's cancer (they work for a small family business and have no insurance). People should not be ruined financially for the rest of their lives due to illness.
If Massachusetts manages to control insurance costs I will consider staying here when I ER, but I will more than likely return to the UK where I can use the NHS. The NHS will be a factor in my decision, but family and wanting to live back where I was born would the the main reasons.
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Old 02-14-2012, 07:13 AM   #120
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Said Midpack: reduce health care by 17%, cover all Americans, No income tax increase, and we still spend more per capita than other countries!

I just can't see that happening, and few comments.
1. Where does she propose the reduction in health care will come from-medicare?
Most likely by less coverage for everyone. A large size pizza previously consumed by 4 people has to be shared by 40 people now. What can we expect? Rationing is such a dirty and radioactive word. No one wants to deal with it. But it's the common sense, and already in place at different degrees in different forms.

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2.When you cover more people, you need more revenue, thus taxes increases. Private corporation? I read GE did not pay any taxes ExxonMobil? C mon! Romney pays only 14.9%
There's a lot of waste in the current health care system already, and it's not totally impossible to cover more people without more revenue. However, this is a double edge sword. If I remember correctly, in US about 1-1.5 out of 10 jobs are health care related. Where should the excess labor go if the current health care system is leaned out?

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3. American medicine is different compared to other countries. It is very procedure oriented. This is very expensive and lobby always find a way to have it approved for billing. There is little money to be made for prevention.
Our current system has strong tendency of over diagnosis, over prescription, over treatment, and over billing. Sometimes, if not mostly, some tests/procedures and their associated cost could have been totally avoided. But again, this is a double edge sword.

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4. We Americans are also so egocentric and selfish. We are for reforms but when we get sick- we'll all want to go to the Mayo clinic for the latest and most expensive procedures even if it works well close by.
Human beings are irrational animals. We tend to be in a self-denial that all medical care resources are unlimited, especially when our own well beings are directly affected. It's a human nature and totally understandable.

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5. It does not matter what reform we do, if we supersize our food, not exercise, smoke, use illicit drugs, drink too much alcohol, drive fast, health care is going to get expensive. Without cooperation of people result is nil.
Absolutely. Everyone should have access to health care. However, instead of treating this as a right, in return everyone should also treat this as a privilege which carries certain individual obligation to be fulfilled for oneself and other fellow citizens. The system itself should also encourage or even reward healthy and less risky life style. Individual behavior determines the final health care cost; health care cost/pricing strategy also influences individual behavior.

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6.If you look closely at other socialized medicine, they have a tendency to exaggerate their results, but there is no way out for some. People are stucked with the socialized system, and there is little option if they are unhappy with the system. (Sweden, Norway, England).
Life gives, life takes. It's unreasonable that everyone wants to go to heaven, but no one wants to die at first.

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7. BTW, I just read there was just a nationwide strike of doctors in Germany, doctors abusing their patients in Sweden, etc. So nobody is perfect.
Agree. It's just a matter of different degree of imperfection.

The bottom line is nothing is for free and no resource is unlimited. As long as people are more rational about this bottom line, more cynical about politicians' Gulliver travel, and more responsible for themselves and other fellow insurers insurees, then there's still some hope for a meaningful reform and sustainable health care system.
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