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Old 02-15-2012, 09:25 PM   #141
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Viewed an interview with this gentleman this morning (Dan Rather's program on HDNet). For those of you who contend we can't reduce health care costs while increasing quality of health care. The details are readily available...
I have met Dr. Berwick and seen him present many times, because I have been involved in healthcare quality improvement for years. There is an enormous amount of waste in healthcare in every country in which I have worked, and there are many opportunities to improve it. There are many examples of specific examples of outstanding improvement across the globe and the NHS in Britain has some of the best. (See NICE, the National Centre of Clinical Excellence). If you are interested in learning more, take a look at the website of the organization Dr. Berwick founded, the Institute of Healthcare Improvement (IHI Home Page). There are many barriers to spreading improvement across broad health systems, including complexity, change management, lack of leadership, politics and special interests.
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Old 02-15-2012, 09:56 PM   #142
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I wonder how much the increased ease and availability in joint replacements will effect health care costs down the road. I read this week that one out of 20 people over the age of 50 now has had some joint replaced already. The article said that older people used to just adjust their lifestyle to fit their pain cmfort level. Now people want it fixed and return as quickly to their previous lifestyle. The article questioned that this might in turn require more replacements down the road since they are occuring at younger ages and in turn these replaced joints will in turn need repaired or replaced.
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Old 02-15-2012, 10:08 PM   #143
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I wonder how much the increased ease and availability in joint replacements will effect health care costs down the road. I read this week that one out of 20 people over the age of 50 now has had some joint replaced already. The article said that older people used to just adjust their lifestyle to fit their pain cmfort level. Now people want it fixed and return as quickly to their previous lifestyle. The article questioned that this might in turn require more replacements down the road since they are occuring at younger ages and in turn these replaced joints will in turn need repaired or replaced.
I expect it is quite a complex calculation when looking at the cost. MIL had both knee joints replaced and it certainly kept her mobile and moving. I'd like to think that the extra exercise she got being mobile contributed not only to a healthier life, but lower costs in LTC as she she could well have ended up in a nursing home otherwise. Since it was done under the NHS I have no idea about the relative costs of the surgery and nursing home care.
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Old 02-15-2012, 10:27 PM   #144
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I expect it is quite a complex calculation when looking at the cost. MIL had both knee joints replaced and it certainly kept her mobile and moving. I'd like to think that the extra exercise she got being mobile contributed not only to a healthier life, but lower costs in LTC as she she could well have ended up in a nursing home otherwise. Since it was done under the NHS I have no idea about the relative costs of the surgery and nursing home care.
That is a very good point. I was just thinking in the narrow sense of health care cost and its effect on premiums for just the surgery. There are other varibles to consider in measuring the total cost in relation to health care.
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Old 02-15-2012, 10:37 PM   #145
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Over 140 posts and the thread's not closed yet. I'm darn surprised impressed.

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I wonder how much the increased ease and availability in joint replacements will effect health care costs down the road. I read this week that one out of 20 people over the age of 50 now has had some joint replaced already. The article said that older people used to just adjust their lifestyle to fit their pain cmfort level. Now people want it fixed and return as quickly to their previous lifestyle. The article questioned that this might in turn require more replacements down the road since they are occuring at younger ages and in turn these replaced joints will in turn need repaired or replaced.
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That is a very good point. I was just thinking in the narrow sense of health care cost and its effect on premiums for just the surgery. There are other varibles to consider in measuring the total cost in relation to health care.
I saw a business analysis of a surgeon's innovative new hip joint. (It's still in the lab. Let's not get our hopes up.) He went through all the problems with current hip-replacement surgery, a survey of all the models, and a forecast of the market.

From a business perspective of the current state-of-the-art surgery, you need a factory assembly line of hip surgeons. It doesn't have to be quite like Foxconn but it helps to have something like a rotating eight-table layout similar to LASIK clinics. Then you need to keep churning out those hip replacements as fast as you can file the Medicare & health insurance claims.

But everyone perked up when the surgeon pointed out that his device will be tested in dogs before it goes to humans. It turns out that veterinarians do more hip surgery per capita than surgeons, and they get a lot more money for it... One potential investor actually said "Forget the Boomers, let's fix golden retrievers!"

Based on what I learned from that discussion, the future of controlling surgical expenses lies in minimally-invasive techniques that augment existing systems (like cartilage) rather than replacing infrastructure (like bones). In other words, the cost-cutting only comes from less cutting.
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Old 02-15-2012, 10:53 PM   #146
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In other words, the cost-cutting only comes from less cutting.
another version of "a stich in time saves 9"

I love it, and it makes so much sense. It has been over 7 years since I had carpentry work done on both shoulders. In each case DW dropped me at the surgery at 6am and picked me up before 9am. Within a couple weeks I was pain free with full mobility. Quite incredible, as simple tasks such as shaving had either become really difficult and painful, or impossible to achieve.
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Old 02-16-2012, 07:00 AM   #147
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Technological advances that reduce hospital stay times can greatly reduce costs, but good public health, preventative care and early and easy access to health care are vital in controlling overall costs.

I firmly believe that the 50 million uninsured in the US don't go to the doctor often enough, if at all, and chronic conditions that could be easily treated develop into acute illness requiring expensive treatment.
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Old 02-16-2012, 08:46 AM   #148
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Technological advances that reduce hospital stay times can greatly reduce costs, but good public health, preventative care and early and easy access to health care are vital in controlling overall costs.

I firmly believe that the 50 million uninsured in the US don't go to the doctor often enough, if at all, and chronic conditions that could be easily treated develop into acute illness requiring expensive treatment.
+1

Even just the simplest thing as identifying and controlling high blood pressure. Huge future costs involved if not controlled with a very inexpensive medication.
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Old 02-16-2012, 08:55 AM   #149
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Over 140 posts and the thread's not closed yet. I'm darn surprised impressed.
I'm impressed with the members too, though we've had lengthy non-political discussions re: health care here before. It is a crucial retirement topic of course, glad we can exchange views (for the most part) without resorting to the political scare tactic sound bites and out of date "facts" that prevents progress. There is no way we can just accept the health care status quo, I wish we'd get on with it, and maybe we are.
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Old 02-17-2012, 08:22 PM   #150
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I admire the way the UK has tackled health care. They are VERY proactive in preventative treatment, to the point of advertising on transit systems, TV, people out in the street directing people inside a little temporary vaccination clinic to get their flu shots.

Doctors receive a base salary of say around $80,000 to $100,000 and then get bonuses for achieving success with their patients. If they are successful in getting people to stop smoking, they get so many points, lose weight, more points, bring cholesterol down, more points, diabetes under control more points, etc. etc. This translates into yearly bonuses for the doctors, and can easily double their annual salary. It's payment for success. Sounds to me like they really got a system that rewards results, and strives to keep people healthy.
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Old 02-17-2012, 08:28 PM   #151
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I admire the way the UK has tackled health care. They are VERY proactive in preventative treatment, to the point of advertising on transit systems, TV, people out in the street directing people inside a little temporary vaccination clinic to get their flu shots.

Doctors receive a base salary of say around $80,000 to $100,000 and then get bonuses for achieving success with their patients. If they are successful in getting people to stop smoking, they get so many points, lose weight, more points, bring cholesterol down, more points, diabetes under control more points, etc. etc. This translates into yearly bonuses for the doctors, and can easily double their annual salary. It's payment for success. Sounds to me like they really got a system that rewards results, and strives to keep people healthy.
Wonder how long it will take to repay that US med-school student loan making $80K a year. You can make $160K being a salesman without all the responsibility.
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Old 02-17-2012, 09:04 PM   #152
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Didn't the Michael Moore movie show some Brit or French doctor who said they made $180k and they did house calls?
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Old 02-17-2012, 09:16 PM   #153
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I admire the way the UK has tackled health care. They are VERY proactive in preventative treatment, to the point of advertising on transit systems, TV, people out in the street directing people inside a little temporary vaccination clinic to get their flu shots.

Doctors receive a base salary of say around $80,000 to $100,000 and then get bonuses for achieving success with their patients. If they are successful in getting people to stop smoking, they get so many points, lose weight, more points, bring cholesterol down, more points, diabetes under control more points, etc. etc. This translates into yearly bonuses for the doctors, and can easily double their annual salary. It's payment for success. Sounds to me like they really got a system that rewards results, and strives to keep people healthy.
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Wonder how long it will take to repay that US med-school student loan making $80K a year. You can make $160K being a salesman without all the responsibility.
It's all relative.

In the UK, university education is a fraction of the cost that it is here.

I don't think Dr salaries are the reason healthcare is so expensive in the USA. Engineers in the USA are paid a similar multipier higher than engineers in the UK, but US manufacturing/engineering companies more than match their UK counterparts.

PS

I do agree that a system of compensation that pays on long term results, and doesn't have doctors as share holders in the clinics and labs they use, is a better model for lower costs.
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Old 02-17-2012, 09:24 PM   #154
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I've scanned this thread and have not seen comments regarding the difference between health care, health care costs, and health care insurance. These issues are related but they are not the same, even though many people think they are synonymous.

Health care in my mind is the doctor, nurse, hospital, procedure - the actual care provided - IMHO the quality of health care in the U.S. is very good.

The cost of health care is very complex. Employers are typically involved, if not employers, then the government (Medicare/Medicaid) is involved. There are tax incentives and the cost portion becomes complex very quickly. I feel strongly that spending Other People's Money (OPM) contributes to higher costs. If your doctor suggests several alternatives and you have no incentive to understand the costs involved, you'll likely opt for the most expensive/complex offering and disregard the cost factor.

Health care insurance is commonly thought of as the "coverage" we receive. For example, what we pay for the care. As I said previously, cost and insurance are not the same although they are intertwined. I think we should all pay for our care and insurance should be just that - insurance for unexpected events. Peridic office visits for colds, flu, and other relatively routine procedures should not be expected to be "free." There is no free - somebody (you and me) are paying the cost.

HSAs have lots of good features. For those of us that can self-fund an HSA we should do so. For those of welfare I suppose tax money can be used to fund the HSA. When we go to the doctor for relatively routine procedures we pay for the care from our HSA. This will drive us to be more involved in inderstanding the costs. When we're involved in the cost we will make better decisions. So, self-funded or tax payer funded (for those on welfare/Medicaid/Medicare) HSAs make lots of sense in my mind. But don't confuse this with single-payer.

I'll be the first to say our U.S. system needs to be changed. It needs a dramatic overhaul. I'd prefer to have employers removed from the equation - that only came about during WWII and it's been a problem ever since.

I am not in favor of a single-payer (i.e. government) system. I personally know people in Canada and in the U.K. Yes, they like the system in general but they also think there are significant problems that need to be addressed. Most of the people I know in Canada and the U.K. have supplemental insurance to get them to the front of the line. One person I know did not have supplemental insurance and she had to avoid leaving the country for a planned vacation so she could be "on call" for her so-called elective surgery. It was considered elective since she had already had the initial surgery that addressed her broken leg. The follow-up surgery would not have been considered elective in my mind but the single-payer system in Canada said she had to wait for surgery and they would not assure her of a hospital date. I don't want that system. I'll gladly deal with some paperwork and added premiums for more input in the system.
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Old 02-17-2012, 09:32 PM   #155
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nvestystyl,

It sounds like your friend in Canada chose to have money to spend on vacations rather than have supplemental health insurance. Is that not what insurance is for? To cover unexpected events. I don't see why that example makes it worse than in the USA.
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Old 02-18-2012, 02:34 AM   #156
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If I was to go only on personal experience I would say US healthcare is the best in the world. I have an MA state health plan that costs me $100 a month with no- deductible and very low co-pays. I recently had out patient surgery and the total cost was $250 and including the ultrasound, blood tests and follow up visits and I only had to wait 2 days after getting a referral form my primary care doctor. If I was in the UK I would have had the same level of care for no out of pocket cost, but I might have waited a couple of months.

So US healthcare is great for me and UK almost as good. I have access to two systems that deliver excellent care. Of course YMMV, and for many in American their milage is long and hard particularly if they have any history of illness and try to buy insurance on the private market. Sure US healthcare works for me, but it fails or is non-existant for a large percentage of Americans. When that gets above 50% we might see change
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Old 02-18-2012, 05:24 AM   #157
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My husband plays tennis a couple times a week with international snowbirds from Germany, France, Canada and the Netherlands. Politics, including healthcare, come up in their Friday coffee klatch. They consider our lack of available healthcare for those who can least afford it barbaric.
While we Canadians have a health care system that is far from perfect we do not lose any sleep worrying that the economically unfortunate among us and their children will also have to suffer illness and death without proper care.
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Old 02-18-2012, 05:38 AM   #158
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Health care is a big factor in the ability to RE, at least from my POV. I think I can do it now if it were not concerns about a catastrophic illness blowing up my savings.

I'd have to get coverage for over 10 years until Medicare, assuming they don't change the rules of the game for those under 55 like they've been talking about (the Ryan plan, for instance).
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Old 02-18-2012, 06:00 AM   #159
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I am not in favor of a single-payer (i.e. government) system. I personally know people in Canada and in the U.K. Yes, they like the system in general but they also think there are significant problems that need to be addressed. Most of the people I know in Canada and the U.K. have supplemental insurance to get them to the front of the line. One person I know did not have supplemental insurance and she had to avoid leaving the country for a planned vacation so she could be "on call" for her so-called elective surgery. It was considered elective since she had already had the initial surgery that addressed her broken leg. The follow-up surgery would not have been considered elective in my mind but the single-payer system in Canada said she had to wait for surgery and they would not assure her of a hospital date. I don't want that system. I'll gladly deal with some paperwork and added premiums for more input in the system.

In Canada, there is no such thing as supplemental insurance that will get you to the front of the line. The system is based on the principle of universal access. Some provinces have been pushing the envelope by allowing some private, for profit services such as MRi scans but even this is limited.

Orthopaedic surgery is one of the worst areas in the system. Wait times can be very long. It's not clear to me why this is other than the fact that generally, no one will die waiting for a knee operation. If your friend was "on call" it was because she was wait listed for her surgery, meaning that they wanted to get her in ASAP and so she had to be available in the event of a spot opening up in the surgical schedule. This was not a result of her not having bought some sort of insurance.
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Old 02-18-2012, 08:00 AM   #160
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If I was to go only on personal experience I would say US healthcare is the best in the world. I have an MA state health plan that costs me $100 a month with no- deductible and very low co-pays. I recently had out patient surgery and the total cost was $250 and including the ultrasound, blood tests and follow up visits and I only had to wait 2 days after getting a referral form my primary care doctor. If I was in the UK I would have had the same level of care for no out of pocket cost, but I might have waited a couple of months.
But if you live in the US, that's not what it costs you, you pay considerably more. Much more than any other country on the world. And that POV is one of the reasons the public isn't really pushing for change, most have no idea how much it's really costing them...even though it's spelled out for us repeatedly. We get what we deserve.
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