U.S. Health-Care System Gets a "D"

[farmerEd]

OK, so our health care system sucks but at least we get to pay more for it than any other country.

http://news.yahoo.com/s/bw/20060921/bs_bw/tc20060921053503

 

[d]

The Commonwealth Fund, which studies health-care issues, commissioned the report last year as part of an effort to come up with solutions to the nation's troubled health-care system.

i must have missed the part which discussed the "solutions" ( ... to what has yet to be indentified as anything but a largely insoluble problem).

 

[farmerEd]

First you must get enough people to acknowledge there is a problem...without that, no solutions will matter.

IMO, doing what most of the other industrialized countries do, where they spend less and get better care is a start, no?

 

[Nords]

First you must get enough people to acknowledge there is a problem...without that, no solutions will matter.

"Problem"?  This is a tribute to capitalism & American culture!!

IMO, doing what most of the other industrialized countries do, where they spend less and get better care is a start, no?

Well, let's see.  Let's be like other industrialized countries with a lower GDP, a lower per-capita consumption, and a generally lower quality of (consumerism) life.  We'll make fewer products that encourage a sedentary lifestyle, although I'm not sure how Richard Simmons will fit into this scheme.

Then we'll eat less, smoke less, imbibe fewer addictive drugs, and drink less.  We might even eat healthier & drink healthier too, let alone start exercising. I'm sure we could cancel a few episodes of MTV's TRL for one or two "Sweatin' To The Rolling Stones" videos.

Eventually our healthcare system will run out of challenges.  There won't be any more morbidly obese, COPD/lung-cancer suffering, cirrhosis-scarred iceheads to take care of.  We won't have as many crack addicts, either, and their premature underweight newborns won't have to spend months in neo-natal intensive care units.  People might live longer with healthier brains instead of sliding sideways into dementia or psychosis or other syndromes requiring expensive prescriptions and full-time care.  Ozzie Osborne & Keith Richards be forgotton relics of an extinct subculture.

We won't have to design operating rooms for 800-pound patients or develop heart-lung transplant technology for smokers.  Diabetes & dialysis treatments might be as outdated as leeches.  Millions of drug-rehab workers would be unemployed and we'd have to take over all their vacant buildings for AA, OA, & NA meeting spaces. 

Of course we might not be able to take care of babies who are born with severe birth defects.  We might not be able to handle people who are severely injured in accidents or assaults or ravaged by a genetic lottery of diseases or allergic reactions.  And we might lose the ability to design orphan drugs to combat all those niche illnesses or syndromes.  Heck, we might not even be able to get funding support to slow the inevitable march of dementia or Alzheimer's.  It won't really matter because we'll be able to beat back all the obstructive docs & ambulance-chasing lawyers who won't let us unplug the brain-dead coma patients.  We'll just abandon those hopeless cases so that they don't count against our success rates.  After all a DOA is better than a "died on my watch", and a quick death is much less expensive than a drawn-out, expensive, yet ultimately unsuccessful exercise in life prolongation.

But by golly we'll be cost-effective!

So, Ol' McD, who goes first on the new system?  You?  Your family?  Your friends?  Or the "hopeless cases" and "lifestyle disease" spoilers who are needlessly raising the cost of your health insurance?

Anyone else?

 

[Rich_by_the_Bay]

Hey, Nords - I think you forgot your sarcasm emoticon.

 

[Nords]

Hey, Nords - I think you forgot your sarcasm emoticon.

Damn, there I was all focused on the language again and forgetting the cute pictures. Maybe I need an illustrator.

Or maybe I was hoping that the sarcasm would eventually eat through the sugary coating...

 

[maddythebeagle]

So, Ol' McD, who goes first on the new system?  You?  Your family?  Your friends?  Or the "hopeless cases" and "lifestyle disease" spoilers who are needlessly raising the cost of your health insurance?

Anyone else?

Damn, there I was all focused on the language again and forgetting the cute pictures. Maybe I need an illustrator.

here you go 

 

[haha]

"Problem"?  This is a tribute to capitalism & American culture!!
Well, let's see. 

Nords, the problem with this analysis is that it is pure bunk. You spent your life in a sub; now surfing and throwing roundhouse kicks. Great and valuable things to do, but hardly creating qualifications for healthcare delivery research.

A competent researcher could start today, and in 10 years he likely could not substantiate anything of what you have said.

And of course you ignore the only hard data, which is very, very clear –our death rates at any age stink. 7 out of 1000 peri-natal infant deaths? That is getting frighteningly close to 1 out of 100.

And for this we pay 60% more than the next highest spender?

To me it sounds like you are saying "I like Tri-Care, and I don't care to have anything else looked at."

That might be rational from your POV, or not, but why not just say that instead of all this other stuff?

Ha

 

[Rich_by_the_Bay]

Nords, the problem with this analysis is that it is pure bunk.

Yeah it really wasn't up to Nords' usual standards. Kinda rabid, with a total lack of any supporting evidence. Til I hear more, the OP's article is much more convincing to me.

Then again, I know how broken the system is cause I work in it. Don't like it much on those occasions where I become a patient, either.

 

[Nords]

A competent researcher could start today, and in 10 years he likely could not substantiate anything of what you have said.
And of course you ignore the only hard data, which is very, very clear –our death rates at any age stink. 7 out of 1000 peri-natal infant deaths? That is getting frighteningly close to 1 out of 100.
And for this we pay 60% more than the next highest spender?
To me it sounds like you are saying "I like Tri-Care, and I don't care to have anything else looked at."
That might be rational from your POV, or not, but why not just say that instead of all this other stuff?
Ha

Yeah it really wasn't up to Nords' usual standards. Kinda rabid, with a total lack of any supporting evidence. Til I hear more, the OP's article is much more convincing to me.
Then again, I know how broken the system is cause I work in it. Don't like it much on those occasions where I become a patient, either.

Guys, you remember John Belushi's trademark "Excuuuuuuse me!" remark on Saturday Night Live's "Weekend Update"?

Shoot the message, not the messenger.

I thought a little humorous cynical sarcasm would make the point better than emoticons or text that reads like it was being delivered by the Muppets' "Sam The Eagle", but here goes:

Maybe the author is looking at the results instead of the methods of gathering & analyzing the data. In other words their analysis is not penalizing the healthcare systems that don't make an attempt.

The American healthcare system is punished for taking on hopeless cases like premature births, horribly difficult birth defects, orphan diseases for which there's hardly any treatments let alone medications, and life extensions. All of these impossible tasks are probably not worth the effort unless they happen to you or your loved ones. We've all seen the statistics that the majority of one's healthcare expenses are spent in the last months of life, especially if heroic measures are taken. And nowhere else in the world can you arrive at a trauma center and expect to have as much of a fighting chance as you can in a major American metropolitan area... or at the Green Zone in Iraq. Thousands of crippled soldiers are alive today because of lifesaving measures that are horribly expensive and probably not cost effective.

In addition, few other societies have as many "lifestyle diseases" as us overeating, overdrinking, and generally overindulgent sedentary Americans. We're one of the worst reasons for our need for such advanced medical lifesaving support in spite of our behavior choices.

So it's not surprising to me that the American healthcare system takes more chances, throws more money at the problems, and generally sees poorer results for the same expenditures. Meanwhile other countries count similar challenges as "stillborn" or "DOA". After all, if you don't try then you can't fail. They don't drag down their "success" ratios and they don't cost any money (except for the autopsy).

As soon as we find another country that supports such an over-the-top hedonistic lifestyle with an equally over-the-top healthcare system, then I'll be ready to compare apples to apples.

Here's an overworked analogy. Baseball shortstops make quite a few errors earlier in their careers because they chase after every hit. They don't know what they can't do so they try to stop everything that goes by, but if they touch the ball then it's their error. As they get older (and wiser and slower) their error rates go down because they're not diving after the "hopeless cases". Since no one counts the balls that get by them without tipping their gloves, they're not counted against them as "errors". However I'd opine that their performance has actually declined because more hits get by them. Yet no one penalizes them for not trying to stop them, so their records look better than the younger players. There's no penalty for not trying.

Nords, the problem with this analysis is that it is pure bunk. You spent your life in a sub; now surfing and throwing roundhouse kicks. Great and valuable things to do, but hardly creating qualifications for healthcare delivery research.
To me it sounds like you are saying "I like Tri-Care, and I don't care to have anything else looked at."

Shame on you. I don't salsa or party the night away either, but at least I pointed out what to me seem to be some very serious flaws in the author's ranking system. Neither one of us has the qualifications to analyze the author's conclusions, but at least I didn't base my analysis on a personal attack of one's background or experience.

I will point out that healthcare decisions are composed of two parts-- financial and emotional, just like the annuity & mortgage debates. Each basis is equally valid, and again an attempt to impugn a healthcare system based on only one of those criteria is eligible for challenge on the other.

I can't believe that after reading my previous posts on military healthcare you have me confused with anyone who supports the system. You're as fit as I am by choice, not by mandate. I prefer a civilian doctor every time and I'm certainly getting what I'm paying for. It'd be interesting to see what a major healthcare insurer would charge for a system where you essentially have no privacy, few tort litigation rights, few choices, a highly selective population screened for membership while still mostly teenagers, and regular inspection of your compliance. I bet it'd be darn close to $38.34/month. Would you turn up your nose for something "better" or would you take what's offered?

Only in my case the payment was collected over the preceeding 24 years and at the expense of a few shipmates who couldn't be with us survivors. If you'd come from a similar background then perhaps you'd feel that your current healthcare premiums are a hard-earned & well-deserved benefit.

 

[haha]

Well, I'm not sure what to say, so I won't say much. For sure I don't begrudge you your insurance. I have insurance too.

And I don't think that I have any special qualifications in the healthcare area. But like the OP said, a lot of places are doing much better than we are, and what excuse do we have for not giving them a good look?

You seem to have the idea that populations of the countries with more universal health systems are some type of super healthy super fit master class.  This is actually more like the US system! In Europe you are taken care of whether you are fit enough to work or not; not so here. As to lifestyle diseases, the French and Italians and Germans and Brits and Czechs and Poles drink much more than Americans! And smoke- almost all nations of the world have higher smoking rates, at least among men, than the US does.

Not going to attempt to address much of the rest as it is hard to think that you yourself give much credence to it. For example, if our costs are inflated because of end of life life-extension, why don't our people gain life expectancies closer to the developed world average? Is it some kind of US curse?

You also seem to be implying that our poor showing on infant mortality is due to trying to save babies that would be let go in Europe or Japan.

I am waiting for some evidence on that one. 

One short comment on trauma care. Ours is excellent, and our roads are for the most part safer than the rest of the world. But don't forget- it all gets caught in the mortality statistics. It doesn't matter how heroic or slackerish the shortstop/surgeon is, a dead body gets counted as a dead body. And, I really don't think all the heroic shortstops are in America anyway.

As I remember, the US ties with Cuba in life expectancy. As Dr. Phil might say, “How's that workin’ for us?”

With affection but also some bewilderment,

Ha

 

[Zathras]

Nords, thank you for clarifying. Your second post, for me, did a much better job of getting your point across.

Do you believe that the babies in other countries are not included in their statistics? If so, then your statement about the reason our infant mortality rate is higher does make sense. I too would be interested in seeing details about the study and what exactly is and is not counted.

 

[Rich_by_the_Bay]

I guess my major point is to counter the inference that the system is crumbling largely because of people who abuse themselves or are somehow taking advantage of things. Yes, they are out there - drug abuse, smoking, obesity, early pregnancy, alcoholism, etc. and we desperately need to work on that.

But we are well beyond those issues being the major or predominant problem. Literally every day I see people who play by the rules but whose financial futures are in shambles due to illness. You know that nagging pain in your belly? Not heartburn for them, but pancreatic cancer. Feeling tired again, but longer than usual? Acute leukemia. Reading glasses not working anymore? Diabetes, even though you are not overweight. That nasty skin cyst getting bigger? Lymphoma. And you didn't do anything to "deserve" it.

Point is that everyone has their day but not everyone has an opportunity to insure against that day. Maybe they're FIREd and are dropped by their individual carrier. Maybe they're laid off and past COBRA. Maybe they can't afford COBRA. Maybe they have hard-saved resources but face nursing home admission requiring them to sell their belongings in order to get to Medicaid. Maybe they spent down caring for a loved ones. The possibilities are endless - 40 million strong and rising.

I'm not a socialist idealogue but in matters of health care, the crisis is here and I favor universal coverage for at least catastrophic care (say after the first $10K of expenses per year per person). If that means higher taxes, so be it. And I have no problem with financial incentives to stop smoking, lose weight, etc. If you are currently in good shape with good insurance, be grateful and hope that it lasts. But for other 10s of millions, I don't think anyone benefits from a "let them eat cake" attitude - it's usually not their fault. Fortunately, nobody in this current topic has taken such a stance, but I've heard it many times, often between the lines.

I know it's hard to change peoples' minds on this topic, but I hope this at least presents a different viewpoint.

 

[Martha]

. Literally every day I see people who play by the rules but whose financial futures are in shambles due to illness. You know that nagging pain in your belly? Not heartburn for them, but pancreatic cancer. Feeling tired again, but longer than usual? Acute leukemia. Reading glasses not working anymore? Diabetes, even though you are not overweight. That nasty skin cyst getting bigger? Lymphoma.

Don't say these kind of things--I am too much the hypochondriac.  Suddenly I am tired and am having trouble reading my computer screen. 

I'm not a socialist idealogue but in matters of health care, the crisis is here and I favor universal coverage for at least catastrophic care (say after the first $10K of expenses per year per person). If that means higher taxes, so be it. And I have no problem with financial incentives to stop smoking, lose weight, etc.  If you are currently in good shape with good insurance, be grateful and hope that it lasts. But for other 10s of millions, I don't think anyone benefits from a "let them eat cake" attitude - it's usually not their fault. Fortunately, nobody in this current topic has taken such a stance, but I've heard it many times, often between the lines.

I know it's hard to change peoples' minds on this topic, but I hope this at least presents a different viewpoint.

I usually jump into these threads first thing, but eveyone knows my position by now so I thought I would give it a rest.  Well said Rich.

Sometimes  it feels like people forget that no matter how unhealthy or healthy we are, we all die and odds are we will use medical care along the way. 

 

[Sam]

I thought the "D" was pretty generous.  Given that we spent the most and got very little back, and "F" might be more appropriate.  I wonder what the root problem  is?  "Naive" consumers, out-of-control legal system, fear-mongering, greed?  But that's another thread.

 

[d]

without further comment: "The advocacy group Families USA, which promotes universal health coverage,  ... In a report being released Thursday, the group said about two-thirds of the families would qualify for government-sponsored coverage for their children if parents would apply." 

 

[eridanus]

They also released,

"In the following 35 states, according to the report, average premium costs for workers rose at least three times faster than average earnings from 2000 to 2004:...."

"A careful analysis of the new Medicare law and the Administration's proposed regulations shows that approximately half of the program's beneficiaries are at risk of being worse off than they are today, according to a special report released by Families USA, the voice for health care consumers."

There ain't no health care crisis! 8)