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Old 04-10-2011, 08:19 AM   #21
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The US system does poorly compared to other nations because it uses a free market model without a functioning market. ...

Good observation. It is a hodge-podge. The system is more of less inconsistent which opens it up to being gamed by certain participants (suppliers and consumers) as well at excluding some consumers.
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Old 04-10-2011, 08:30 AM   #22
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Not quite true. Waits in the US can be long if you need to see a specialist, need a non-emergency appointment with your primary care doctor or are sitting in an emergency room. I do not have the info at hand, but a number of other countries outshine us on wait times and have good care and are less expensive than us.
Believe me the DW has to see a specialized specialist. The initial wait was three months for the appointment, but that was because we requested a certain day of the week. Not bad in comparison to other countries, since the appointment is for a condition that isn't immediately life threatening. From diagnosis to brain surgery was less than two weeks, not too bad for an issue not immediately life threatening. Her diagnosis was on the 17th and she was home after the surgery on the 1st. I've never had to wait more than a day for an appointment with a primary care doctor, except when I was in the military. Those civilian doctors were in three different areas ranging from very rural to major metropolitan. Granted emergency rooms can be a bit of a wait for those not in immediately life threatening situations, but often they could and should be seen by a family doctor. Unfortunately, the media has people afraid to go to those doctors because they are "so expensive". Approximately $100 for an appointment in the places I've used civilian doctors. Heck I even had one doctor who would provide medicine samples for those who's insurance didn't provide a drug benefit.

When I tore the cartilage in my ankle my wait time for a specialist was less than a week. I received a call from my primary care doctor on Saturday asking about my issue. I tore it on Friday night and I think my first appointment was on Wednesday. I was in surgery two weeks later.
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Old 04-10-2011, 09:24 AM   #23
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One interesting observation... the public spending and the private spending look to be about the same (roughly). . . .

There are roughly 42M Medicare recipients and roughly 46M Medicaid Recipients.
I know you were just giving a rough estimate, but I think it may be a bit too rough. It overlooks all the privately-funded medical care received by those Medicare patients (Medigap policies, etc) and it overlooks cost shifting by medical providers when services are provided to public patients and the costs transferred to private ones.

I like donheff's outsourcing idea. Maybe Mexico? Right next door, low labor costs.
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Old 04-10-2011, 10:20 AM   #24
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I would think so. It leads to all kinds of serious problems and high cost for chronic treatments for diabetes, heart disease, etc. Along with constant medical monitoring

I have also noticed that most every person I know that is morbidly obese seems to have knee problems in their 50's or 60's.
As well as great many fit, active people. I don't know any obese people, but I know plenty fit people who have knee problems and/or artificial knees.

Obesity overall has to be a negative in health. But blaming everything on the sick people is just reaching to blame people, rather than look at a flawed system. But our medical system would bankrupt us even if every man in America weighed 140 and every woman 115.

Ha
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Old 04-10-2011, 10:39 AM   #25
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The vast differences in access and provision of health care in the US is a big problem. I've always had great experiences in the US system, but I have a good job with excellent benefits and I work in Boston so while the costs are high the standard of care is excellent. I pay $100 a month in premiums, $20 copayment and have other. Out of pocket costs for diagnostic tests. I had a small outpatient surgery recently. I had a cyst and my doctor got me an appointment the next week for minor surgery. However he wanted to put me on antibiotics just incase it was infected. I had no fever it wasn't hot and no discharge. So I refuse. The surgery took 10 mins and I paid $250 for lab tests etc and it was well done. However after the initial dressing there was no after care treatment and I had to care for a significant wound on my own. The US does the difficult stuff well but too often ignores basic care that ensures good outcomes.
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Old 04-10-2011, 10:44 AM   #26
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However after the initial dressing there was no after care treatment and I had to care for a significant wound on my own. The US does the difficult stuff well but too often ignores basic care that ensures good outcomes.
I had a similar situation recently. Cyst removed from the middle of my back, and one from my butt. Neither exactly easy for me to see. And if you are going to ask friends, have to have pretty good friends to change the dressings on your butt.

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Old 04-10-2011, 11:07 AM   #27
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Good observation. It is a hodge-podge. The system is more of less inconsistent which opens it up to being gamed by certain participants (suppliers and consumers) as well at excluding some consumers.
A close friend of mine recently told me a story about a cousin of his. This guy is in his early 50s, never could hold a job in his life, as he was and still is a drug addict. He lived with a relative. My friend said this guy often complained of chest pain, and got transported to the ER on an ambulance. The objective was to get some pain killers that he used as a narcotic.

Recently, he applied for SSI, claiming disability, got declined, kept applying until he got it. The monthly payment was higher than what I know some workers I know get for SS. How could that be true, that a drug addict non-worker get more than workers? Did my friend lie to me?

Anyway, when this guy was accepted, they made the payment retroactive back to when he first applied. So, he got a nice lump sum. And he got subsidized housing or whatever have you.

My friend said his cousin came to see him recently. The reason? To ask to "borrow" some money. I guess the only way to satisfy this guy is to give him all the drugs he needed. An overdose would be nice, I believe.

Anyway, my friend is an ardent libertarian. In the universal health care debate, I tried to tell him that not all people in the lower echelon are like that, and there are honest low-wage workers who deserve to get some health care. Still, there is no way he would soften his stance. From his experience, can you blame him?
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Old 04-10-2011, 11:37 AM   #28
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A close friend of mine recently told me a story about a cousin of his. This guy is in his early 50s, never could hold a job in his life, as he was and still is a drug addict. He lived with a relative. My friend said this guy often complained of chest pain, and got transported to the ER on an ambulance. The objective was to get some pain killers that he used as a narcotic.

Recently, he applied for SSI, claiming disability, got declined, kept applying until he got it. The monthly payment was higher than what I know some workers I know get for SS. How could that be true, that a drug addict non-worker get more than workers? Did my friend lie to me?

Anyway, when this guy was accepted, they made the payment retroactive back to when he first applied. So, he got a nice lump sum. And he got subsidized housing or whatever have you.

My friend said his cousin came to see him recently. The reason? To ask to "borrow" some money. I guess the only way to satisfy this guy is to give him all the drugs he needed. An overdose would be nice, I believe.

Anyway, my friend is an ardent libertarian. In the universal health care debate, I tried to tell him that not all people in the lower echelon are like that, and there are honest low-wage workers who deserve to get some health care. Still, there is no way he would soften his stance. From his experience, can you blame him?
The average SSI payment for February 2011 was $497.60. SSI Monthly Statistics, February 2011 - Table 1

If a person is eligible for SSI should government be rewarded for improper denials or delay in payment? Of course the recipient should get back pay. I helped someone with a SSI appeal. The hearing was September 12 of 2010. The judge said he would issue an order giving her SSI retroactive to her application date, two years before. The delays were all the government's fault. It took more than a year to even get a hearing date. The worst? No checks have come yet and no back pay. The SSA is way behind in processing. They should have to pay interest and a penalty for the delays that in her case are now approaching three years.
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Old 04-10-2011, 11:54 AM   #29
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They should have to pay interest and a penalty for the delays that in her case are now approaching three years.
Can't argue with this. If the people are doing everything they are supposed to do and the government for whatever reason drags it's feet or delays the process there should be some form of repayment for the people.
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Old 04-10-2011, 01:53 PM   #30
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Obesity overall has to be a negative in health. But blaming everything on the sick people is just reaching to blame people, rather than look at a flawed system.
Who did? It's simply being considered among several reasons costs are higher in the US. Would you not agree it may be a significant reason (not saying #1 by any means)?


IMO the reasons US costs are higher without providing better results, in no particular order are:
  • 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
  • plus significantly/ironically, excessive usage
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Old 04-10-2011, 02:18 PM   #31
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If I might: Comments in bold:
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IMO the reasons US costs are higher without providing better results, in no particular order are:
  • lifestyle (obesity, smoking, drugs): Yes, this is a reason.
  • high cost and profit for intermediaries (insurance) Symptom, not a reason. All others below are symptoms, not root causes.
  • 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
  • plus significantly/ironically, excessive usage
All but the lifestyle factors are symptoms of a bigger problem, and can best be addressed through systemic reform. Without at least a pseudo-market in health care (informed consumers making choices with assets they control, companies benefitting when they reduce costs and provide better service), it's unlikely things will improve.

We have single-payer now (Medicare) with all it's top-down driven controls and government oversight. That system is a mess. We can do better. And we can certainly do better than the "private but not a true market" system we have throughout the rest of our health economy.
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Old 04-10-2011, 02:43 PM   #32
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Without at least a pseudo-market in health care (informed consumers making choices with assets they control, companies benefitting when they reduce costs and provide better service), it's unlikely things will improve.
I would say that the entire rest of the western world is a counter argument to this. The whole UK runs on a system very similar to Medicare, except without Medicare's copays and patient cost sharing, and is the most cost effective of all the national systems including ours.

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Old 04-10-2011, 04:03 PM   #33
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I would say that the entire rest of the western world is a counter argument to this. The whole UK runs on a system very similar to Medicare, except without Medicare's copays and patient cost sharing, and is the most cost effective of all the national systems including ours.
Ha
If that is true, then either citizens of other developed countries are a lot more enlightened than US citizens, which I doubt, or they have developed a check-and-balance system that has been more effective than ours in controlling abuses and wastes.
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Old 04-10-2011, 04:21 PM   #34
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If that is true,
I do not understand this statement. The simplest, most straightforward data, including the charts that started this thread show this incontrovertibly.


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Old 04-10-2011, 05:14 PM   #35
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I do not understand this statement. The simplest, most straightforward data, including the charts that started this thread show this incontrovertibly.

Ha
No all the charts show is they spend less per capita. They do not, have not, and never will, get to the root cause of why. Which really is the more important answer. I can buy a top of the line Mercedes and you can buy an entry level Kia and both are cars. You can call me a fool because I spent so much more. Until you look at WHY I my car costs more all you would know is I spent more. They also never compare costs with average income or control for the many variables between countries. If they did then we would see that the costs are not that different from country to country. I did the research on health care costs in relation to average income and found the percentages were much closer than I was expecting. Canada's costs and our costs were only a few hundred dollars off per year.
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Old 04-10-2011, 05:56 PM   #36
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No all the charts show is they spend less per capita. They do not, have not, and never will, get to the root cause of why. Which really is the more important answer. I can buy a top of the line Mercedes and you can buy an entry level Kia and both are cars. You can call me a fool because I spent so much more. Until you look at WHY I my car costs more all you would know is I spent more. They also never compare costs with average income or control for the many variables between countries. If they did then we would see that the costs are not that different from country to country. I did the research on health care costs in relation to average income and found the percentages were much closer than I was expecting. Canada's costs and our costs were only a few hundred dollars off per year.
Actually, the outcome is better in the UK than the US and Canada has all of its citizen covered. The US has 45 millions uninsured.
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Old 04-10-2011, 07:02 PM   #37
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I do not understand this statement. The simplest, most straightforward data, including the charts that started this thread show this incontrovertibly.
It is well known that the US spends more on health care, yet our life expectancy is less. I was not questioning that fact, but was asking about the lack of copays or a similar mechanism to keep down abuses that would come with an "all you can eat" system.

Here in the US, it used to be that even insured people did not have to make any copay. The copay was said to be necessary for people to "have some skin in the game". Else, they would go to a doctor for any simple headache.

I was still thinking about the drug addict cousin of my friend who abused the ER to get some pain killers, and stories in the news of how some doctors overcharged Medicare for non-treatments, when I read samclem's post about our current Medicare not being able to control costs. If we could not afford Medicare as it is, then how are we going to pay when it is opened to more than the elderly people? I was wondering what they do differently in the UK vs our Medicare.
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Old 04-10-2011, 08:02 PM   #38
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Actually, the outcome is better in the UK than the US and Canada has all of its citizen covered. The US has 45 millions uninsured.
And why are the outcomes better? Could it be due to lifestyle choices? Could it be due to diet? Where is that in the charts? As for Canada we provide a lot of their emergency care on the border. So much it is included in the training for Immigrations.
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Old 04-10-2011, 09:21 PM   #39
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I give up. It's like one of the posters said on another thread, there is nothing that can be said that someone can't say something to counter it, and it would take a judge to ajudicate it all.

To me it is as clear as the nose on my face, and that is good enough for me.

I will only hassle like this for money, I got over the thrill of arguing for its own sake about 3 decades ago.


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Old 04-10-2011, 11:15 PM   #40
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I would say that the entire rest of the western world is a counter argument to this. The whole UK runs on a system very similar to Medicare, except without Medicare's copays and patient cost sharing, and is the most cost effective of all the national systems including ours.

Ha
A lot of us who oppose government run health care would probably welcome it with open arms if the US government proved capable of running Medicare (or if states could run Medicaid) in a way that produces happy, healthy patients at low cost. As long as these programs remain money-hemorrhaging examples of inefficiency (at least compared to the programs in other nations) I doubt Americans will want to turn more of their health care over to government control. Government healthcare--heal thyself.
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