Natural Limits to Healthcare Expense Growth?
- Thread starter haha
- Start date
Check this article out. It has pros and cons of national healthcare and compares U.S. and Britain's systems. I think it's a good article, since it discusses both sides of a complex issue.
http://www.opinionjournal.com/extra/?id=110006785
This guy's wife had a stroke in England. I quote just the concluding paragraphs:
---
Having praised the caregivers, I'm forced to return to the inefficiencies of a health system devoid of incentives. One can tell that the edge has disappeared in treatment in Britain. For example, when we returned to the U.S. we discovered that treatment exists for thwarting the effects of blood clots in the brain if administered shortly after a stroke. Such treatment was never mentioned, even after we were admitted to the neurology hospital. Indeed, the only medication my wife was given for a severe stroke was a daily dose of aspirin. Now, treating stroke victims is tricky business. My wife had a low hemoglobin count, so with all the medications in the world, she still might have been better off with just aspirin. But consultations with doctors never brought up the possibilities of alternative drug therapies. (Of course, U.S. doctors tend to be pill pushers, but that's a different discussion.)
Then there was the condition of Queen's Square compared with the physical plant of the New York hospitals. As I mentioned, the cleanliness of U.S. hospitals is immediately apparent to all the senses. But Cornell and New York University hospitals (both of which my wife has been using since we returned) have ready access to technical equipment that is either hard to find or nonexistent in Britain. This includes both diagnostic equipment and state-of-the-art equipment used for physical therapy.
We did have one brief encounter with a more comprehensive type of British medical treatment--a day trip to one of the few remaining private hospitals in London.
Before she could travel back home, my wife needed to have the weak wall in her heart fortified with a metal clamp. The procedure is minimally invasive (a catheter is passed up to the heart from a small incision made in the groin), but it requires enormous skill. The cardiologist responsible for the procedure, Seamus Cullen, worked in both the public system and as a private clinician. He informed us that the waiting line to perform the procedure in a public hospital would take days if not weeks, but we could have the procedure done in a private hospital almost immediately. Since we'd already been separated from our 12-year-old daughter for almost a month, we opted to have the procedure done (with enormous assistance from my employer) at a private hospital.
Checking into the private hospital was like going from a rickety Third World hovel into a five-star hotel. There was clean carpeting, more than enough help, a private room (and a private bath!) in which to recover from the procedure, even a choice of wines offered with a wide variety of entrees. As we were feasting on our fancy new digs, Dr. Cullen came by, took my wife's hand, and quietly told us in detail about the procedure. He actually paused to ask us whether we understood him completely and had any questions. Only one, we both thought to ask: Is this a dream?
It wasn't long before the dream was over and we were back at Queen's Square. But on our return, one of the ever-accommodating nurses had found us a single room in the back of the ward where they usually throw rowdy patients. For the last five days, my wife and I prayed for well-behaved patients, and we managed to last out our days at Queen's Square basking in a private room.
But what of the bottom line? When I received the bill for my wife's one-month stay at Queen's Square, I thought there was a mistake. The bill included all doctors' costs, two MRI scans, more than a dozen physical therapy sessions, numerous blood and pathology tests, and of course room and board in the hospital for a month. And perhaps most important, it included the loving care of the finest nurses we'd encountered anywhere. The total cost: $25,752. That ain't chump change. But to put this in context, the cost of just 10 physical therapy sessions at New York's Cornell University Hospital came to $27,000--greater than the entire bill from British Health Service!
There is something seriously out of whack about 10 therapy sessions that cost more than a month's worth of hospital bills in England. Still, while costs in U.S. hospitals might well have become exorbitant because of too few incentives to keep costs down, the British system has simply lost sight of costs and incentives altogether. (The exception would appear to be the few remaining private clinics in Britain. The heart procedure done in the private clinic in London cost about $20,000.)
"Free health care" is a mantra that one hears all the time from advocates of the British system. But British health care is not "free." I mentioned the cost of living in London, which is twice as high for almost any good or service as prices in Manhattan. Folks like to blame an overvalued pound (or undervalued dollar). But that only explains about 30% of the extra cost. A far larger part of those extra costs come in the hidden value-added taxes--which can add up to 40% when you combine costs to consumers and producers. And with salaries tending to be about 20% lower in England than they are here, the purchasing power of Brits must be close to what we would define as the poverty level. The enormous costs of socialized medicine explain at least some of this disparity in the standard of living.
As for the quality of British health care, advocates of socialized medicine point out that while the British system may not be as rich as U.S. heath care, no patient is turned away. To which I would respond that my wife's one roommate at Cornell University Hospital in New York was an uninsured homeless woman, who shared the same spectacular view of the East River and was receiving about the same quality of health care as my wife. Uninsured Americans are not left on the street to die.
Something is clearly wrong with medical pricing over here. Ten therapy sessions aren't worth $27,000, no matter how shiny the floors are. On the other hand my wife was wheeled into Cornell and managed to partially walk out after a relatively pleasant stay in a relatively clean environment. Can one really put a price on that?
http://www.opinionjournal.com/extra/?id=110006785
This guy's wife had a stroke in England. I quote just the concluding paragraphs:
---
Having praised the caregivers, I'm forced to return to the inefficiencies of a health system devoid of incentives. One can tell that the edge has disappeared in treatment in Britain. For example, when we returned to the U.S. we discovered that treatment exists for thwarting the effects of blood clots in the brain if administered shortly after a stroke. Such treatment was never mentioned, even after we were admitted to the neurology hospital. Indeed, the only medication my wife was given for a severe stroke was a daily dose of aspirin. Now, treating stroke victims is tricky business. My wife had a low hemoglobin count, so with all the medications in the world, she still might have been better off with just aspirin. But consultations with doctors never brought up the possibilities of alternative drug therapies. (Of course, U.S. doctors tend to be pill pushers, but that's a different discussion.)
Then there was the condition of Queen's Square compared with the physical plant of the New York hospitals. As I mentioned, the cleanliness of U.S. hospitals is immediately apparent to all the senses. But Cornell and New York University hospitals (both of which my wife has been using since we returned) have ready access to technical equipment that is either hard to find or nonexistent in Britain. This includes both diagnostic equipment and state-of-the-art equipment used for physical therapy.
We did have one brief encounter with a more comprehensive type of British medical treatment--a day trip to one of the few remaining private hospitals in London.
Before she could travel back home, my wife needed to have the weak wall in her heart fortified with a metal clamp. The procedure is minimally invasive (a catheter is passed up to the heart from a small incision made in the groin), but it requires enormous skill. The cardiologist responsible for the procedure, Seamus Cullen, worked in both the public system and as a private clinician. He informed us that the waiting line to perform the procedure in a public hospital would take days if not weeks, but we could have the procedure done in a private hospital almost immediately. Since we'd already been separated from our 12-year-old daughter for almost a month, we opted to have the procedure done (with enormous assistance from my employer) at a private hospital.
Checking into the private hospital was like going from a rickety Third World hovel into a five-star hotel. There was clean carpeting, more than enough help, a private room (and a private bath!) in which to recover from the procedure, even a choice of wines offered with a wide variety of entrees. As we were feasting on our fancy new digs, Dr. Cullen came by, took my wife's hand, and quietly told us in detail about the procedure. He actually paused to ask us whether we understood him completely and had any questions. Only one, we both thought to ask: Is this a dream?
It wasn't long before the dream was over and we were back at Queen's Square. But on our return, one of the ever-accommodating nurses had found us a single room in the back of the ward where they usually throw rowdy patients. For the last five days, my wife and I prayed for well-behaved patients, and we managed to last out our days at Queen's Square basking in a private room.
But what of the bottom line? When I received the bill for my wife's one-month stay at Queen's Square, I thought there was a mistake. The bill included all doctors' costs, two MRI scans, more than a dozen physical therapy sessions, numerous blood and pathology tests, and of course room and board in the hospital for a month. And perhaps most important, it included the loving care of the finest nurses we'd encountered anywhere. The total cost: $25,752. That ain't chump change. But to put this in context, the cost of just 10 physical therapy sessions at New York's Cornell University Hospital came to $27,000--greater than the entire bill from British Health Service!
There is something seriously out of whack about 10 therapy sessions that cost more than a month's worth of hospital bills in England. Still, while costs in U.S. hospitals might well have become exorbitant because of too few incentives to keep costs down, the British system has simply lost sight of costs and incentives altogether. (The exception would appear to be the few remaining private clinics in Britain. The heart procedure done in the private clinic in London cost about $20,000.)
"Free health care" is a mantra that one hears all the time from advocates of the British system. But British health care is not "free." I mentioned the cost of living in London, which is twice as high for almost any good or service as prices in Manhattan. Folks like to blame an overvalued pound (or undervalued dollar). But that only explains about 30% of the extra cost. A far larger part of those extra costs come in the hidden value-added taxes--which can add up to 40% when you combine costs to consumers and producers. And with salaries tending to be about 20% lower in England than they are here, the purchasing power of Brits must be close to what we would define as the poverty level. The enormous costs of socialized medicine explain at least some of this disparity in the standard of living.
As for the quality of British health care, advocates of socialized medicine point out that while the British system may not be as rich as U.S. heath care, no patient is turned away. To which I would respond that my wife's one roommate at Cornell University Hospital in New York was an uninsured homeless woman, who shared the same spectacular view of the East River and was receiving about the same quality of health care as my wife. Uninsured Americans are not left on the street to die.
Something is clearly wrong with medical pricing over here. Ten therapy sessions aren't worth $27,000, no matter how shiny the floors are. On the other hand my wife was wheeled into Cornell and managed to partially walk out after a relatively pleasant stay in a relatively clean environment. Can one really put a price on that?
Medicare is going to start losing money (spending more than it takes in) next year, right? It won't take many years beyond that for something to change. Big change will happen the day we can't buy another B2 bomber because were funding aging boomers' viagra prescription.
BTW Drug makers spend about $100 million a year in direct lobbying to Congress, that doesn't include media buys, mailers, campaign contributions etc.
BTW Drug makers spend about $100 million a year in direct lobbying to Congress, that doesn't include media buys, mailers, campaign contributions etc.
Mountain_Mike
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I think some answers are simple:
1. Work on the supply side. Create more doctors, nurses, and other heal care workers. (Each year, thousands of people qualified to enter these training programs are turned away).
2. Eliminate malpractice lawsuits except in cases of intentional negligence. (In any operation or procedure, things can go wrong even if the operation is done correctly--I propose that people not be allowed to sue in cases like these). The same for prescriptions. There are known side effects to all drugs--so, let the patients make the choice and take the risks.
3. Deport the ILLEGALS who are getting "free" coverage, paid for by you and I.
The bottom line is we need to lower the COST of providing health care service in this country.
Years ago, I don't think we even had health insurance, except for catestrophic coverage. I remember leaving the doctor's office, with my mom paying $10 or something, cash, for the visit. You can't tell me that a doctor can't make a decent living on, say $50 for a 15 minute visit.
1. Work on the supply side. Create more doctors, nurses, and other heal care workers. (Each year, thousands of people qualified to enter these training programs are turned away).
2. Eliminate malpractice lawsuits except in cases of intentional negligence. (In any operation or procedure, things can go wrong even if the operation is done correctly--I propose that people not be allowed to sue in cases like these). The same for prescriptions. There are known side effects to all drugs--so, let the patients make the choice and take the risks.
3. Deport the ILLEGALS who are getting "free" coverage, paid for by you and I.
The bottom line is we need to lower the COST of providing health care service in this country.
Years ago, I don't think we even had health insurance, except for catestrophic coverage. I remember leaving the doctor's office, with my mom paying $10 or something, cash, for the visit. You can't tell me that a doctor can't make a decent living on, say $50 for a 15 minute visit.
Mountain_Mike said:
I have wondered if increasing the supply of doctors and other medical professionals would help as well.
BTW, there is no such thing as "intentional negligence". If there is an intentional injury to another, this is a battery. The concept of negligence is that negligence occurs when there is a duty to another and that duty is breached, causing injury. For example, generally there is a duty to take ordinary and reasonable care. So if a procedure goes wrong, but the doctor took reasonable care in the procedure, there is no negligence.
So I think the law is fine. The problems are that people might sue or try to extract a settlement even if there is no negligence. An insurance company might chose to settle even if there is no negligence. This is a different type of problem. Hard to judge how pervasive a problem it is.
cute fuzzy bunny
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
Mountain_Mike said:
Sorry, but I'm going to have to pause you in the middle of that gross generalization. My wife works in healthcare.
Our area is predominately indian farmers and rather poor mexicans. Since this is the headquarters for sunsweet and where a huge portion of crops are grown I'd say the odds are that a lot of those mexicans are 'illegals' and are the folks who are doing daily crop work and picking your fruits and vegetables for next to nothing so you can buy them at your local supermarket at a decent price.
I just asked her about this and she says all they get in the emergency room are white welfare folks who give them fake names and addresses. She says the indian folks find a way to pay for their care, and the "illegals" are afraid to come into the hospital for treatment.
Further, she says many of the poor white folk who come in to the emergency room for their free care often have little more than a bad cold or flu severely exacerbated by a drug or alcohol problem. They do a fine job of wasting a few aggregate hours of time.
Now you know to add poor white people with substance problems as a primary cause of higher health care costs.
By the way, if we simply deported the 'illegals' then your food costs would rise and nobody in the southwestern states would be able to afford child care, landscaping or housekeeping. If they could even find someone to do the work they'd want 4x the pay.
cute fuzzy bunny
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
In fact, she just reminded me of something that happened last year. Poor white kid and his pregnant girlfriend came into the ER, he was sick. Flu bug. Made the mistake of giving them his real name and address, and made the further mistake of giving his age, which was under 18. Hospital staff called the parents. Parents came down and were informed that their son was a little under the weather but so hopped up on whatever that the staff hoped they could help calm the kid down as he freaked out in the treatment room when the staff mentioned that his parents were coming down. He apparently had bugged out on his parents a few months earlier.
While all this was going on, the kid hung himself in the treatment room. Did a bad job. He was only permanently brain damaged and in a coma. So the hospital had to hook him up to a machine to keep him alive as the horrified parents wouldnt make the decision to pull the plug. This went on for over a month. The bills ran into six figures.
Good news is they had insurance.
Now you've got another item to add to your list!
While all this was going on, the kid hung himself in the treatment room. Did a bad job. He was only permanently brain damaged and in a coma. So the hospital had to hook him up to a machine to keep him alive as the horrified parents wouldnt make the decision to pull the plug. This went on for over a month. The bills ran into six figures.
Good news is they had insurance.
Now you've got another item to add to your list!
OP
OP
haha
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
And an absolutely typical one at that.th said:Now you've got another item to add to your list!
H
Mountain_Mike
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I thought I'd shake things up a bit
Martha - how about "gross negligence?" An insurance company shouldn't even have settle or worry about lawsuits, as long as the proper procedures were followed.
th - As far as illegals using emergency rooms, while I don't dispute or discount your wife's experiences, but I think it is not always the case. Take a look at the ERs in the San Diego or other border areas; many are in dire straits due to this factor. How about the illegals in prision who use health care? I agree that poor whites misusing ERs compound the problem as well. I part company with you on NEEDING illegal workers in order to get cheap veggies and services. My solution there would be to eliminate welfare for able-bodied people. They could either work at wages similar to what we are paying the illegals, or starve. You think that's too harsh?
Martha - how about "gross negligence?" An insurance company shouldn't even have settle or worry about lawsuits, as long as the proper procedures were followed.
th - As far as illegals using emergency rooms, while I don't dispute or discount your wife's experiences, but I think it is not always the case. Take a look at the ERs in the San Diego or other border areas; many are in dire straits due to this factor. How about the illegals in prision who use health care? I agree that poor whites misusing ERs compound the problem as well. I part company with you on NEEDING illegal workers in order to get cheap veggies and services. My solution there would be to eliminate welfare for able-bodied people. They could either work at wages similar to what we are paying the illegals, or starve. You think that's too harsh?
Mr._johngalt
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Mountain_Mike said:I thought I'd shake things up a bit
Martha - how about "gross negligence?" An insurance company shouldn't even have settle or worry about lawsuits, as long as the proper procedures were followed.
th - As far as illegals using emergency rooms, while I don't dispute or discount your wife's experiences, but I think it is not always the case. Take a look at the ERs in the San Diego or other border areas; many are in dire straits due to this factor. How about the illegals in prision who use health care? I agree that poor whites misusing ERs compound the problem as well. I part company with you on NEEDING illegal workers in order to get cheap veggies and services. My solution there would be to eliminate welfare for able-bodied people. They could either work at wages similar to what we are paying the illegals, or starve. You think that's too harsh?
Harsh? I would just shoot 'em and be done with it. Illegals? We don't need no stiiiiiiiiiking illegals. OTOH, we don't need a lot of the people who are
here legally. They are just takin' up space. Dumb people got no reason to
live!
JG
JG
OP
OP
haha
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
Maybe you are running for Goodwill Ambassador?MRGALT2U said:
This reminds me of William Schokley. (He was one of the inventor's of the transistor and a Nobel Prize winner). After he had retired, he seemed to lose his mind (went johngalt) and started proposing that we should give IQ tests to everyone and sterilize those who scored below average. His motives seemed to be racist related. Kinda sad, really.MRGALT2U said:
cute fuzzy bunny
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
Mountain_Mike said:
Sorry, cant let you slip this noose either. Most 'illegals' who commit crimes are deported, not jailed. Most 'illegals' wont come near a hospital emergency room because they're afraid of being deported if discovered. If you want to stretch this thing out to the 9th inning, I'll get US wide stats on the percentage of white scumbags who take up uninsured hospital costs vs all other potential 'illegal' colors.
As far as the illegals and the jobs they work, I think they get something like 10-20 a day to pick fruit around here. How many poor white trash are going to turn their backs on that 12 pack of silver bullets and a regular welfare check to work all day in 100 degree heat for twenty bucks?
None.
How many people are going to hire the nanny, landscaper, housekeeper, ad nauseum for even twice the price they'd have to pay to a 'legal'?
None.
One layer thinking of 'remove those nasty mexicans and nice white people will be able to get off welfare and take all those jobs' is just that...one layer thinking.
Why do you think all the hullabaloo is about giving 'illegals' drivers licenses here in CA. We've already figured out that they serve a function, they're here to stay (well, sort of) and we cant stop them from coming in...not to mention we dont know who would do the work they do now at the rate they work for, or what the economic implications of paying higher wages to 'legals' is, even if the 'legals' would do the work at all.
Considering I live in a farm belt here and most of the local news, interviews and whatnot are about farming, I can tell you that if the 'illegal' labor dried up for any reason, more than half of them would plow the fields under and sell to housing developers. They just wouldnt be able to make a living selling their products vs cheaper central/south american imports. In short, the 'illegals' would stay home, grow the same crops, and send them here for 25% less than a US farmer could produce them for.
Hey, wouldnt THAT be great?
cute fuzzy bunny
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
And another thing! (I'm really enjoying this JG approach to posting!)
I already gave you the most of the answer.
Most healthcare costs are associated with the final year of someones life...in other words, whatever was done didnt work. The doctors probably knew that. The patient and their family probably knew it. But they had insurance and the insurance company was on the hook for it, so why not?
High liability suit payouts causing high malpractice insurance. Doctors working 12+ hour shifts leading to high incidence of screw ups. You know how you feel after you've been sitting at your desk for 10 hours straight? Try that on your feet with life and death situations flying at you all day, and then at that point be required to save some persons life. Lotsa luck.
And then theres that other couple of bits I threw out there about the BC/BS system floating on $30B and insurers raising rates because their investment returns havent been so good the last 5 years.
The problem aint anything other than money chasing other money, and people who dont know when to stop and say goodbye.
I already gave you the most of the answer.
Most healthcare costs are associated with the final year of someones life...in other words, whatever was done didnt work. The doctors probably knew that. The patient and their family probably knew it. But they had insurance and the insurance company was on the hook for it, so why not?
High liability suit payouts causing high malpractice insurance. Doctors working 12+ hour shifts leading to high incidence of screw ups. You know how you feel after you've been sitting at your desk for 10 hours straight? Try that on your feet with life and death situations flying at you all day, and then at that point be required to save some persons life. Lotsa luck.
And then theres that other couple of bits I threw out there about the BC/BS system floating on $30B and insurers raising rates because their investment returns havent been so good the last 5 years.
The problem aint anything other than money chasing other money, and people who dont know when to stop and say goodbye.
Mountain_Mike said:I thought I'd shake things up a bit
Martha - how about "gross negligence?" An insurance company shouldn't even have settle or worry about lawsuits, as long as the proper procedures were followed.
Gee, I want my doctor to use at least ordinary care in treating me. If she doesn't and I am injured as a result, I want compensation. Just because some people bring frivolous lawsuits shouldn't bar me from bring a claim that has merit. I don't know much about PI law, but I do know that in my state, to bring a malpractice claim against a doctor you must have an affidavit from another doctor saying that the standard of care was breached. This is not easy to get and does weed out frivolous suits.
Except maybe for foodstamps which I don't know much about any more, there is very little welfare for able bodied people. Certainly there is no welfare for the able bodied without children, and for those who are taking care of children, it is cut off pretty quickly. Remember welfare reform?
Nothing "natural" about these limits!
But Mike, your post really sparked my recognition reflex, which is unusual for this topic. I couldn't understand why it seemed so familiar... until I realized that you're describing the military's healthcare system! (Eagle, can you back me up here? GD-ER, where are you? Samclem? Tomcat? Otako? Bridget?)
Simple answers are for simple problems. But here's a comparison--
1. The military is recruiting tons of healthcare workers and paying them annual bonuses as high as 50% of salary. The biggest problems are finding the instructors (colleges, teaching hospitals, doctors/nurses who aren't too burned out to pass on their experience) and then finding people who actually want to tackle this avocation. The military even runs its own medical schools & teaching hospitals to try to "grow their own." (A little hint-- if the military will pay you $25K extra per year to take a job that's usually done by people with $50K salaries, it's not gonna be an easy job. But you're allowed to shoot back.)
2. It's darn near impossible to sue a military medical worker (I think it has to do with government liability). Essentially an incompetent surgeon can kill a lot of people before it's even noticed, let alone before it's an issue. We're not just talking negligence-- we're talking gross dereliction of duty. One local hospital had a physician's assistant who was molesting children for nearly five years, a final year of it under "evidence-collecting surveillance", before being arrested & convicted. The kids received "free" psychiatric care and the families received a promise that it wouldn't happen again. Can you see that happening in a civilian hospital? It's actually easier to rein in bad military medical workers with the UCMJ ("duty") than via the civilian penal or civil litigation systems.
3. If they can't get on the base, they can't get in the ER. If you need emergency treatment but can't produce a military ID for the gate security staff, then they'll try first aid and call 911 for you. They'll do that even if you're less than 100 feet from a military ER.
The military is arguably the Wal-Mart of medical care. It's one of the nation's biggest & most expensive healthcare bureaucracies systems with access to advanced equipment and a fairly skilled staff. Other retailers live in fear of Wal-Mart while civilian doctors live in fear of TRICARE. Not only that, but the military exerts a lot of control over its patient's lifestyles-- they're discouraged from smoking, they have to exercise (and be graded on their performance) and they're required to undergo periodic screenings. They're fed reasonably healthy food while living in a reasonably clean, comfortable environment (we're talking shore duty here) and discouraged from risky off-duty behavior (drugs, alcohol, unsafe sex). Military people on drugs/alcohol or diabetic treatment or chronic diseases are frequently discharged, so the patient population is freakishly healthy compared to civilian medical care.
Yet after 24 years in the system I won't use a military physician or dentist. (I have no dental insurance and I pay out of pocket instead of using my
"free" space-available dental care.) In fact on active duty I took darn good care of myself to avoid falling into the system. Even corpsmen still joke about "Military medicine-- where you really understand why an ounce of prevention is worth a pound of cure." Every military member will consider going to a civilian doctor-- if they can afford it-- for a second opinion. When given a choice, the vast majority of parents in the military will choose a civilian pediatrician for their kids instead of a military pediatrician. The military system is on par with civilian healthcare and the costs are certainly reasonable. Yet if the system is so good, then why are the inmates customers trying so hard to leave?
How many of you would submit to the following requirements for your low-cost (free!) no-deductible medical insurance for you and your family? Keep in mind that failure to comply means that you'll be "administratively discharged" (fired):
- If you have a workplace dispute then you have no doctor-patient confidentiality. Your department boss has complete access to your entire medical, dental, & psychiatric records.
- Your bosses can make you go get an exam anytime. They can even make you stay in a hospital for psychiatric observation.
- Annual smoking-cessation classes. You're not entitled to smoke breaks or office smoking areas, either.
- Annual "healthy lifestyle" classes, including anti-drug & -alcohol seminars. Incidents in these two categories may result in being fired, forced to undergo additional training, or take anti-alcohol medication.
- Annual dental screenings/cleanings.
- Annual HIV blood test.
- Extremely graphic annual training on sexual diseases.
- Extremely graphic annual training on workplace safety.
- Anthrax vaccinations. (Hey, our lawyers say it's OK!)
- Annual mental-health & stress-reduction training. (No matter how adversely it affects your morale or stress levels.)
- Annual flu shots. This is not optional but you can get time off for immediately coming down with a respiratory infection (it's not flu because you were just vaccinated against it!).
- Hepatitis A&B vaccinations. This is not optional for most.
- If you travel in your job, many additional exotic vaccinations. Most of them don't have side effects and our lawyers say that we're sure of that.
- Mandatory DNA sampling for a forensic-identification database. Honestly, this info will only be used for official purposes. We really mean that.
- Annual PAP smear. (Unless you're a male, although it's happened before.)
- Semi-annual bodyfat measurements. You must remain within height-weight tables and have a bodyfat lower than a limit deemed as "obese". This system has been validated by the judicial authorities as "legal".
- Semi-annual physical-fitness test. You're only allowed to participate if you're not measured as "obese" by a technician, but if you don't participate then you're fired. Test details differ but essentially you have to be able to run 1.5 miles or swim 500 yards for an aerobic time, do a few dozen pushups in two minutes, and do a few dozen situps in two minutes. Some jobs (USMC, Army infantry) have additional requirements. Criteria get a little easier with age. Extra employment-review points are awarded for extra performance. Marginal reviews will be documented for marginal performance.
- Biennial physicals until age 40. Semi-decennial physicals after age 40. This includes a full blood workup, a comprehensive screening questionnaire with possible additional consultations for problem areas, a physical exam by a technician with additional checks by a doctor, and a doctor's full gynecological exam or a digital rectal exam. It'll take at least two two-hour visits and a lot of paperwork. If you're going on a long trip then we may do everything all over again, especially the physically-invasive parts, just to make sure.
- If you're over 40, annual fecal-occult screenings. (If you don't know, then believe me you don't want to ask.)
- Free psychiatric counseling & assistance. But if you scare us we may have to tell your boss. Some counseling or medications might restrict your access to your career-required jobs, but it's for your own good. Really.
Any takers?
Let's look at the other side of the question. Is it possible that America already has the world's best available healthcare system-- at a price we'd better be willing to pay for it-- and that we're just kvetching around the edges of it trying to raise its efficiency from 85% to 95%? There's nothing wrong with that, but none of the media will publicize the success stories if they can find a scary medical fiasco for the 5 PM news (film at 11).
I think TH has pointed out the key issues-- the vast majority of the expensive care is at the end of life, and quality costs money.
Here's a couple more of my opinions-- the American pharma industry leads the world in R&D and drug advances. Medical tech leads in surgical equipment, methods, & treatments. American medical schools are besieged with foreign students who presumably could choose to attend one in their native countries. American doctors collaborate more effectively and share more information more widely in peer-reviewed journals/websites than the rest of the world. HMO's cost-control criteria have made life a living hell for most physicians in the name of cost efficiency.
Does the rest of the world do their own training, research, & initiatives-- or do they take advantage of the American advances? Which system has more imitators, the American one or the British/Canadian systems?
When you (or one of your loved ones) is sick, no one goes to Wal-Mart if you can find a way to shop at Nieman-Marcus on someone else's credit card...
I don't usually join these healthcare debates because I pay $460/YEAR for my family's TRICARE. Our copay is $12. All of this used to be free when I was working.Mountain_Mike said:
But Mike, your post really sparked my recognition reflex, which is unusual for this topic. I couldn't understand why it seemed so familiar... until I realized that you're describing the military's healthcare system! (Eagle, can you back me up here? GD-ER, where are you? Samclem? Tomcat? Otako? Bridget?)
Simple answers are for simple problems. But here's a comparison--
1. The military is recruiting tons of healthcare workers and paying them annual bonuses as high as 50% of salary. The biggest problems are finding the instructors (colleges, teaching hospitals, doctors/nurses who aren't too burned out to pass on their experience) and then finding people who actually want to tackle this avocation. The military even runs its own medical schools & teaching hospitals to try to "grow their own." (A little hint-- if the military will pay you $25K extra per year to take a job that's usually done by people with $50K salaries, it's not gonna be an easy job. But you're allowed to shoot back.)
2. It's darn near impossible to sue a military medical worker (I think it has to do with government liability). Essentially an incompetent surgeon can kill a lot of people before it's even noticed, let alone before it's an issue. We're not just talking negligence-- we're talking gross dereliction of duty. One local hospital had a physician's assistant who was molesting children for nearly five years, a final year of it under "evidence-collecting surveillance", before being arrested & convicted. The kids received "free" psychiatric care and the families received a promise that it wouldn't happen again. Can you see that happening in a civilian hospital? It's actually easier to rein in bad military medical workers with the UCMJ ("duty") than via the civilian penal or civil litigation systems.
3. If they can't get on the base, they can't get in the ER. If you need emergency treatment but can't produce a military ID for the gate security staff, then they'll try first aid and call 911 for you. They'll do that even if you're less than 100 feet from a military ER.
The military is arguably the Wal-Mart of medical care. It's one of the nation's biggest & most expensive healthcare bureaucracies systems with access to advanced equipment and a fairly skilled staff. Other retailers live in fear of Wal-Mart while civilian doctors live in fear of TRICARE. Not only that, but the military exerts a lot of control over its patient's lifestyles-- they're discouraged from smoking, they have to exercise (and be graded on their performance) and they're required to undergo periodic screenings. They're fed reasonably healthy food while living in a reasonably clean, comfortable environment (we're talking shore duty here) and discouraged from risky off-duty behavior (drugs, alcohol, unsafe sex). Military people on drugs/alcohol or diabetic treatment or chronic diseases are frequently discharged, so the patient population is freakishly healthy compared to civilian medical care.
Yet after 24 years in the system I won't use a military physician or dentist. (I have no dental insurance and I pay out of pocket instead of using my
"free" space-available dental care.) In fact on active duty I took darn good care of myself to avoid falling into the system. Even corpsmen still joke about "Military medicine-- where you really understand why an ounce of prevention is worth a pound of cure." Every military member will consider going to a civilian doctor-- if they can afford it-- for a second opinion. When given a choice, the vast majority of parents in the military will choose a civilian pediatrician for their kids instead of a military pediatrician. The military system is on par with civilian healthcare and the costs are certainly reasonable. Yet if the system is so good, then why are the inmates customers trying so hard to leave?
How many of you would submit to the following requirements for your low-cost (free!) no-deductible medical insurance for you and your family? Keep in mind that failure to comply means that you'll be "administratively discharged" (fired):
- If you have a workplace dispute then you have no doctor-patient confidentiality. Your department boss has complete access to your entire medical, dental, & psychiatric records.
- Your bosses can make you go get an exam anytime. They can even make you stay in a hospital for psychiatric observation.
- Annual smoking-cessation classes. You're not entitled to smoke breaks or office smoking areas, either.
- Annual "healthy lifestyle" classes, including anti-drug & -alcohol seminars. Incidents in these two categories may result in being fired, forced to undergo additional training, or take anti-alcohol medication.
- Annual dental screenings/cleanings.
- Annual HIV blood test.
- Extremely graphic annual training on sexual diseases.
- Extremely graphic annual training on workplace safety.
- Anthrax vaccinations. (Hey, our lawyers say it's OK!)
- Annual mental-health & stress-reduction training. (No matter how adversely it affects your morale or stress levels.)
- Annual flu shots. This is not optional but you can get time off for immediately coming down with a respiratory infection (it's not flu because you were just vaccinated against it!).
- Hepatitis A&B vaccinations. This is not optional for most.
- If you travel in your job, many additional exotic vaccinations. Most of them don't have side effects and our lawyers say that we're sure of that.
- Mandatory DNA sampling for a forensic-identification database. Honestly, this info will only be used for official purposes. We really mean that.
- Annual PAP smear. (Unless you're a male, although it's happened before.)
- Semi-annual bodyfat measurements. You must remain within height-weight tables and have a bodyfat lower than a limit deemed as "obese". This system has been validated by the judicial authorities as "legal".
- Semi-annual physical-fitness test. You're only allowed to participate if you're not measured as "obese" by a technician, but if you don't participate then you're fired. Test details differ but essentially you have to be able to run 1.5 miles or swim 500 yards for an aerobic time, do a few dozen pushups in two minutes, and do a few dozen situps in two minutes. Some jobs (USMC, Army infantry) have additional requirements. Criteria get a little easier with age. Extra employment-review points are awarded for extra performance. Marginal reviews will be documented for marginal performance.
- Biennial physicals until age 40. Semi-decennial physicals after age 40. This includes a full blood workup, a comprehensive screening questionnaire with possible additional consultations for problem areas, a physical exam by a technician with additional checks by a doctor, and a doctor's full gynecological exam or a digital rectal exam. It'll take at least two two-hour visits and a lot of paperwork. If you're going on a long trip then we may do everything all over again, especially the physically-invasive parts, just to make sure.
- If you're over 40, annual fecal-occult screenings. (If you don't know, then believe me you don't want to ask.)
- Free psychiatric counseling & assistance. But if you scare us we may have to tell your boss. Some counseling or medications might restrict your access to your career-required jobs, but it's for your own good. Really.
Any takers?
Let's look at the other side of the question. Is it possible that America already has the world's best available healthcare system-- at a price we'd better be willing to pay for it-- and that we're just kvetching around the edges of it trying to raise its efficiency from 85% to 95%? There's nothing wrong with that, but none of the media will publicize the success stories if they can find a scary medical fiasco for the 5 PM news (film at 11).
I think TH has pointed out the key issues-- the vast majority of the expensive care is at the end of life, and quality costs money.
Here's a couple more of my opinions-- the American pharma industry leads the world in R&D and drug advances. Medical tech leads in surgical equipment, methods, & treatments. American medical schools are besieged with foreign students who presumably could choose to attend one in their native countries. American doctors collaborate more effectively and share more information more widely in peer-reviewed journals/websites than the rest of the world. HMO's cost-control criteria have made life a living hell for most physicians in the name of cost efficiency.
Does the rest of the world do their own training, research, & initiatives-- or do they take advantage of the American advances? Which system has more imitators, the American one or the British/Canadian systems?
When you (or one of your loved ones) is sick, no one goes to Wal-Mart if you can find a way to shop at Nieman-Marcus on someone else's credit card...
Mountain_Mike
Recycles dryer sheets
- Joined
- Feb 16, 2005
- Messages
- 239
Nords! Wow, thanks for that long and thoughtful reply. I have not been in the military, and am not terribly familiar with the Tricare system, but you've given some excellent insights.
For the office of President of these great United States, I nominate, from Minnesota, the home of Hubert Humphrey, Martha!!!!! And for Vice President, from the Golden State, th!! It's a can't lose ticket.
I must say, that after working in direct patient care in healthcare for 25 years in the West and Southwest, th and his DW are spot on in their analysis. Another problem that's not often mentioned, is that physicians see very few acutely ill people in their offices. They are most often routed directly to the ER or Urgent Care. I work in an L&D Triage and see women every day who do not need hospital care but the docs schedules are too crammed to get them in. I know this also happens in the ER.
Judy
I must say, that after working in direct patient care in healthcare for 25 years in the West and Southwest, th and his DW are spot on in their analysis. Another problem that's not often mentioned, is that physicians see very few acutely ill people in their offices. They are most often routed directly to the ER or Urgent Care. I work in an L&D Triage and see women every day who do not need hospital care but the docs schedules are too crammed to get them in. I know this also happens in the ER.
Judy
greg
Thinks s/he gets paid by the post
- Joined
- Jun 1, 2005
- Messages
- 1,071
Hey Martha, I just found the old Kerry/Edwards sign in the garage. Should I cross out the names, putting substitutes in there, and hang it on the wall or just throw it away?
P.S. When you get home, please put the pharmacy tel# on my speed dial.
P.S. When you get home, please put the pharmacy tel# on my speed dial.
![:-\](https://www.early-retirement.org/sk/forums/images/smilies/undecided.gif "Undecided :-\")
cute fuzzy bunny
Give me a museum and I'll fill it. (Picasso) Give me a forum ...
I did worse than that on occasion...
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