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Old 04-10-2011, 11:34 PM   #41
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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.
It may that America is the world's best example of why "diversity" is a losing idea. Cohesiveness helps social programs to be accepted and to function smoothy. And homogeneity contributes mightily to cohesiveness.

Other than that, you tell me. Is it as some have said that we Americans are all fat? But we took a poll, and this group at least is far from fat. I am not so sure that Americans are fatter than any other industrial populations. Where are all these fat people? How do the experts know that Americans are all fat? I have never seen anyone come around with the census takers and a scale. My doctor does not send my height and weight to the fat police in Olympia, or in Washington DC.

Others have said that we smoke and drink too much. But this crap too, as many nations healthier and more frugal with their healthcare systems than we smoke and/or drink quite a bit more.

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Old 04-10-2011, 11:49 PM   #42
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I am not so sure that Americans are fatter than any other industrial populations.
Oh, but yes, we are!

I still remember the time we were in Sorrento, Italy, walking up a long sloped street leading from the pier back into town. In front of us was a group of children in elementary school. They were on a school outing, and all of them had walked briskly up the steep street, except for just one girl. She could not keep up, and one look would tell you why. She was a bit pudgy, not fat at all by American standard, but that was enough for her to be left behind. She was crying, and two school teachers were with her, trying to console her. I remember telling my wife that I felt for that poor girl.

Later on the same trip, we were huffing when climbing up and down the stairs that were between the cliff-hugging road on the Amalfi coast down to the beach of Positano, an old little Italian woman of 70+ watched us and was smiling at our effort.

My BMI has always been 25 and that of my wife less than 24. However, we did not exercise much and were a bit out-of-shape. We have been trying to do better.

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Others have said that we smoke and drink too much. But this crap too, as many nations healthier and more frugal with their healthcare systems than we smoke and/or drink quite a bit more.
Yes, up until recently, they smoke and drink more than we do. I am envious. How do they do that?
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Old 04-10-2011, 11:56 PM   #43
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Oh, but yes, we are!

I still remember the time we were in Sorrento, Italy, walking up a long sloped street leading from the pier back into town. In front of us was a group of children in elementary schools. They were on a school outing, and all of them had walked briskly up the steep street, except for just one girl. She could not keep up, and one look would tell you why. She was a bit pudgy, not fat at all by American standard, but that was enough for her to be left behind. She was crying, and two school teachers were with her, trying to console her. I remember telling my wife that I felt for that poor girl.

Later on the same trip, we were huffing when climbing the stairs up and down that were between the cliff-hugging road on the Amalfi coast down to the beach of Positano, an old little Italian woman of 70+ watched us and was smiling at our effort.


Yes, up until recently, they smoke and drink more than we do. I am envious. How do they do that?
Stunningly cogent train of thought!

Ha
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Old 04-11-2011, 12:12 AM   #44
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By the way, my theory is that it is not really obesity or high BMI that does us in. It's the lack of physical exercise, the driving everywhere instead of walking, the couch potato lifestyle that shortens our lives.

A neighbor of mine is a short and slightly heavy woman, also in her 50s. However, it is just her built and I will readily concede that she has more physical exercise than I have, is more fit in the cardiovascular sense, can outrun me, and outwork me in physical labor. But generally speaking, if one has to walk a few miles to catch a bus, or walk those stairs through the London Underground, plus as expensive as their food is, one has no choice but to have a low BMI and be fairly fit. It's by necessity more than personal resolute, I firmly believe.
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Old 04-11-2011, 04:11 AM   #45
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By the way, my theory is that it is not really obesity or high BMI that does us in. It's the lack of physical exercise, the driving everywhere instead of walking, the couch potato lifestyle that shortens our lives.

A neighbor of mine is a short and slightly heavy woman, also in her 50s. However, it is just her built and I will readily concede that she has more physical exercise than I have, is more fit in the cardiovascular sense, can outrun me, and outwork me in physical labor. But generally speaking, if one has to walk a few miles to catch a bus, or walk those stairs through the London Underground, plus as expensive as their food is, one has no choice but to have a low BMI and be fairly fit. It's by necessity more than personal resolute, I firmly believe.
I've been living in the UK for 5 weeks now, feeding ourselves, no car, hills everywhere, lots of hikes as well as having to walk everywhere and I'm putting on weight

While food, I'm sure, is more expensive than in the USA it is not overly so. Quality cheeses and "artisan" breads that we love and eat in USA are actually much cheaper here. e.g. a large whole grain extremely tasty fresh baked, still warm loaf from our local supermarkets costs 1 ($1.60) and we pay well over $3 for that in the USA.

We usually put down our incresed weight when we visit here to eating out, drinking beer and using a car. But we are having difficulty controlling our weight even when fully in control. It is quite frustrating, but still have a few more months to change things.

btw, my brother and 2 sisters are obese, as are DW's younger sister and brother. Both our mothers were obese, and my parents never had a car so being forced to walk and catch the bus certainly didn't help.

The local gym we attend here has a time every day where the NHS sponsored obese members come to work out on the treadmills and bikes etc. I've seen this before with one of my sisters and also with her neighbor where NHS prevention programs worked well. With my sister it was was to quit smoking, about 7 years ago. To ensure she was sticking to the program she had to go in each week and have a CO test to be sure she wasn't cheating, and they provided the nicotine patches she needed to kick the habit.

I commented on how much weight her long time neigbor had lost and how great she looked. Sis told me that the NHS paid her Weight Watcher fees as long as she continued to lose weight. She lost a LOT of weight, and kept it off for 12 months and was provided a free tummy tuck paid for by the NHS.

Not saying that prevention programs are the answer to lower long term costs but it must help. Many companies in the USA have fitness programs and incentives to keep their health costs down, and I assume they continue to do so because they believe it works somewhat. (could just be a gimmick of course).
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Old 04-11-2011, 04:37 AM   #46
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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
Something you didn't include on that list (unless you meant it as part of "service providers") is the income earned by medical practitioners. A colleague's husband is an anaesthetist with 15 years experience, and he makes a bit less than $100,000 a year (this is in a large city in France).
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Old 04-11-2011, 07:02 AM   #47
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I'm not so sure about this skin-in-the-game argument. Maybe with elective surgery - cosmetic, hip replacement and the like. And maybe if the copay is substantial enough to make you really think twice about it. But do we really want to encourage people to hobble around all their life rather than get a knee replaced? And does any system under consideration pay for elective cosmetic surgery anyway? The idea that no copays for routine stuff would have average people running into the doctor all the time doesn't ring true to me at all. Until I was 50 or so, almost nothing would get me into the doctor. If I was sick I stayed home - cost wasn't keeping me from running in. I often skipped my annual physical and only DW's hectoring got me in on off years. As I got older I began self starting to the annual physicals but only because I need my Allopurinol prescription renewed (gout is a much better motivator than a copay). The bottom line is that it is a PITA to go to the doctor's office and a bigger PITA to go to an emergency room. I just don't buy that the problem is out of control demand for procedures we don't need. I know, anecdotes are not evidence but still....
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Old 04-11-2011, 07:13 AM   #48
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I'm not so sure about this skin-in-the-game argument. Maybe with elective surgery - cosmetic, hip replacement and the like. And maybe if the copay is substantial enough to make you really think twice about it. But do we really want to encourage people to hobble around all their life rather than get a knee replaced? And does any system under consideration pay for elective cosmetic surgery anyway? The idea that no copays for routine stuff would have average people running into the doctor all the time doesn't ring true to me at all. Until I was 50 or so, almost nothing would get me into the doctor. If I was sick I stayed home - cost wasn't keeping me from running in. I often skipped my annual physical and only DW's hectoring got me in on off years. As I got older I began self starting to the annual physicals but only because I need my Allopurinol prescription renewed (gout is a much better motivator than a copay). The bottom line is that it is a PITA to go to the doctor's office and a bigger PITA to go to an emergency room. I just don't buy that the problem is out of control demand for procedures we don't need. I know, anecdotes are not evidence but still....
+1

I see it all the time in the UK where you can't persuade friends and family to visit a Doc when they are feeling ill. Just yesterday we were out for the day with some good friends and they are concerned about their SIL who is 53, feeling tired a lot, urinates very often but refuses to go to the doctor despite his wife's efforts to persuade him, including her telling him, "If you die I'll be left by myself with 3 boys under age 12".

The frequent urination is almost certainly BPH but he won't know unless he makes an appointment.

PS - there are no co-pays in the UK
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Old 04-11-2011, 07:17 AM   #49
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Not saying that prevention programs are the answer to lower long term costs but it must help. Many companies in the USA have fitness programs and incentives to keep their health costs down, and I assume they continue to do so because they believe it works somewhat. (could just be a gimmick of course).
Ease of access to healthcare, early diagnosis and preventative care are big factors in the better cost and outcome performance of the NHS vs US healthcare. The UK population has just as bad a lifestyle as the US, heavy alcohol consumption and lots of bad food. But nobody in the UK ever has to worry about paying for a visit to the doctor so if they feel ill they go to see their GP and may conditions are caught early when treatment is easier and inexpensive.

My mother is a good example, she's 87. About 5 years ago she had a small stroke. Since then she goes to a clinic for high blood pressure where she does some exercise and gets lifestyle advice and they monitor her BP and cholesterol. She also visits the doctor for regular checkups and he caught that her glucose levels were starting to jump up and down so she's now on a drug for early diabeties. After that diagnosis she had eye tests and those showed some bad vessels in her retina, due to the diabeties, which have been treated by laser oblation and a small cataract that has been removed. All these are small outpatient and management procedures because the conditions were all caught early.

Doctors decide on how to treat patients, but here is a national panel that decides on whether the NHS will pay for a treatment. Recently there have been some cases where an experimental cancer drug was not available on the NHS and this gets headlines. That's the deal you make for overall care for everyone. The UK populace likes that deal and the NHS is UK's political "third rail". I don't think such as system would be appropriate for the US because of it's emphasis on individualism rather than the collective good.
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Old 04-11-2011, 07:27 AM   #50
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Ease of access to healthcare, early diagnosis and preventative care are big factors in the better cost and outcome performance of the NHS vs US healthcare.
An interesting fact in Japan, which has universal private healthcare regulated by the government, is that the average person in Japan visits a doctor 4 times more often than someone in the US and has 5 times more MRI's. Most of the doctor visits are routine, and preventative, so that could also be a factor in their longer livespans.
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Old 04-11-2011, 07:35 AM   #51
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That's the deal you make for overall care for everyone. The UK populace likes that deal and the NHS is UK's political "third rail". I don't think such as system would be appropriate for the US because of it's emphasis on individualism rather than the collective good.
One of the things which the UK politicians have tried to introduce is "patient choice". Perhaps they got it from the US, if this earlier post by samclem is typical:
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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've never understood what "patient choice" was about. OK, if I'm diagnosed with X, I want to know what my treatment choices are (for example: "operation / pain control / nothing"), but any doctor can give me all that, regardless of the system I'm in. I just want the best chance of getting better. It's not like buying a car and deciding if I want to trade off the sliding roof in the Toyota for the parking camera in the Honda. Even if I were to "shop around", whatever that would mean, I have no way to know which doctor is offering me the "better deal", whatever that would mean.
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Old 04-11-2011, 10:02 AM   #52
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My understanding is that they are using an older MRI technology that is much cheaper than the cutting edge stuff we are now using in the US.

There may be an advantage in not always having to have the shiniest new toy.

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An interesting fact in Japan, which has universal private healthcare regulated by the government, is that the average person in Japan visits a doctor 4 times more often than someone in the US and has 5 times more MRI's. Most of the doctor visits are routine, and preventative, so that could also be a factor in their longer livespans.
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Old 04-11-2011, 10:15 AM   #53
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My understanding is that they are using an older MRI technology that is much cheaper than the cutting edge stuff we are now using in the US.

There may be an advantage in not always having to have the shiniest new toy.
Utilization is also a big cost saving. My BIL in the UK has regular MRI's monitoring his brain tumor. His appointments are always in the evenings, after 7 or 8pm, which suits my sister as she doesn't have to take time off work to take him.
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Old 04-11-2011, 10:40 AM   #54
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One of the things which the UK politicians have tried to introduce is "patient choice". Perhaps they got it from the US, if this earlier post by samclem is typical:

I've never understood what "patient choice" was about. OK, if I'm diagnosed with X, I want to know what my treatment choices are (for example: "operation / pain control / nothing"), but any doctor can give me all that, regardless of the system I'm in. I just want the best chance of getting better. It's not like buying a car and deciding if I want to trade off the sliding roof in the Toyota for the parking camera in the Honda. Even if I were to "shop around", whatever that would mean, I have no way to know which doctor is offering me the "better deal", whatever that would mean.
I agree. This doesn't make sense to me at the medical level. At the insurance level one can make choices but these usual are a trade you can understand since they involve costs and coverage.

But suppose you go to the doctor because of very acute indigestion that is keeping you up at night. The doctor asks for a description of a particularly bad episode you recently experienced. After listening to your story, the doctor decides you didn't experience indigestion but you had a heart attack and are on the verge of a massive heart attack. So he looks around and orders every lab test, x-ray, etc. in his own office. Even the X-Ray technician admits mystification when you inquire why all the mobilization. Finally, when you challenge the doctor he says he is calling the ambulance to transport you to the hospital. You go to leave and he calls your husband in and tells him to take you to the hospital. You and your husband get in the car and go home. You go back to work the next day BUT now any time you get burppy you wonder.

It would be a strawman had it not recently happened to me. Until recently I was what I would call over-insured. I needed to hang on to my federal government insurance (FEHB) but there was no reason to drop the BCBS my husband had which was free to us and had better drug coverage. But I am certain that my FFS is a problem with me getting good medical care. It seems to me that I can't get attention paid to a small but debilitating problem for all the incentives the medical experts have to spread the wealth. How is this a shopping problem when it is your guess verses the doctor? And if I have a "shopped-for" doctor who doesn't do this, is he honest or a bad doctor? Beats me.

But, note, if I self-diagnosed wrong and the doctor was sincere, I will leave you forum friends earlier than I expected.

So we have choices? I changed doctors. I chose a doctor that either is not doing this or, with his high throughput of patients just doesn't care much past pushing pills at everything and getting to the next appointment room. He also pushes business card for specialists but never gives an actual referral. This feels like - "don't bother me with your problems; take them somewhere else". He never asks if I followed up and doesn't seem to even record the things I tell him in my alloted <2 minutes appointment.

Shopping? I have moved across country but next time something like this happens I am going to cooperate with the doctor. The psychological lingering affect of what you think is a hyped diagnosis is just too intrusive.

Anyone who has not read this article from the New Yorker really should because too little of the conversation goes down to the health care delivery area:
McAllen, Texas and the high cost of health care : The New Yorker
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Old 04-11-2011, 11:06 AM   #55
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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.
I don't know why their outcomes are better than ours but I do know european and canadian smoke more than in the US. Maybe the diet is the problem but putting the blame on a particular segment of society is not the solution. We have the most expensive healthcare system in the world and yet so many americans are without med insurance and this has nothing to do with life style choices. The fact that we have this conversation shows that our health care system is in trouble. I can't seem to find such passionate exchanges in any other developed countries about their health care systems. Maybe the solution is right in front of our noses.
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Old 04-11-2011, 11:09 AM   #56
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Its the insurance company profits that make up a large part of the difference....all that $$ isn't going to patient care.
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Old 04-11-2011, 11:24 AM   #57
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From Tadpole:
"Anyone who has not read this article from the New Yorker really should because too little of the conversation goes down to the health care delivery area:
McAllen, Texas and the high cost of health care : The New Yorker"


I've been a registered nurse working in health care for over 35 years. This article reminds me of something a colleague said many, many years ago...which was
"The most expensive thing in health care is the ball point pen in a physicians hand."

I can't even begin to describe the thousands of useless tests, procedures, consults and therapies I have seen prescribed. But....health care is a product, and if you go to where they sell it....they will try and force you to buy top-of-the-line, even when there is no clear advantage to your health.
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Old 04-11-2011, 11:26 AM   #58
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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
UK doctors do not get paid anywhere near as much as ours.....


At least back when I lived there in 2000... I worked with a guy whose wife was one of those docs and he made almost twice as much as she did as an accountant....
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Old 04-11-2011, 11:30 AM   #59
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Agree that physicians have lots of power.......and I've seen first hand sitting in physician's offices how much power the drug companies have too.....wooing those physicians....not hard to see who has influence when the drug rep walks right in when there's a waiting room full of patients...and you often can hear scrapes of conversations while waiting...about lunches, dinners, etc. Somehow this plays a role too into the formula of why things cost so much here while not giving us the benefit compared to the cost.
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Old 04-11-2011, 11:36 AM   #60
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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.


Ha
Oh come on.... arguing can be fun



As to a universal system.... I just do not trust our government to get it right.. and if they do not, then I have no choice after it happens... I have to live with it....

Right now, in our expensive and flawed system, I still have choices... if I do not like the docs I go to, or the group they are in.... I can choose another doc or another group of docs...

Now, the Swiss system is intriguing... a single payor system with options etc. etc... but I still do not think it addresses the high costs we have...
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