The good old USA and medical costs

[getoutearly]

Why are Americans not demanding that they be provided with Health Care along the lines of every other civilized nation in the world??

Should this not be a basic right

Yeah, Canada, France, Italy, UK, etc those are great examples of what socialized medicine can do. That's why they all head over here if they really get sick. I guess you could say the same thing about our health care as you could about our judicial system; It's the worst in the world, except for all the others...

Besides, what's wrong with our health care system has nothing to do with our health care (THE best in the world); it has everything to do with the ambulance chasing lawyers...

Ok, enough of the soap box; coudn't help myself.

I feel your pain sewinglady, I hate to think of hanging around for another 4+ yrs just for the insurance, but unfortunatley, that's the way it's looking...

 

[Martha]

Re: Deer in the headlights

Besides, what's wrong with our health care system has nothing to do with our health care (THE best in the world); it has everything to do with the ambulance chasing lawyers...

Huh? What facts do you base that statement on?

Or are you just picking on me.

 

[MasterBlaster]

Re: Deer in the headlights

Ambulance Chasing Lawyers, is Getoutearlys way of saying that the costs of big medical judgements and the costs of malpractice insurance is a large number. Add in all the malpractice driven CYA medicine and the costs really go up.

Still that's not the big driver in costs.

Right now we have great medical care and can get it on demand but at very high prices and without access for everyone in the country.

My take on government run medical care is that there will be high medical access for everyone but at a cost of quality and on demand service.

So those other countries trade quality and timeliness for widespread access. Maybe that's a choice we should make. But at least let everyone know the trade-offs we will be making and have an even-handed debate.

Think US Post Office like service when you think of government run medical care. It gets the job done but you may wish the service and the timeliness was better.

 

[cute fuzzy bunny]

Re: Deer in the headlights

Huh? What facts do you base that statement on?

Or are you just picking on me.

Here we go again...

Statistically speaking, from broad swaths of government and health care generated reports with excellent grounding in actual facts, common whipping boys like malpractice and illegal immigrants barely register against the trillions spent on healthcare annually.

For the cause, look in the mirror and at your fellow people. Most health care costs are spent because people (doctors included) cant let a lost cause go. Up to 80% of health care costs are spent in the last year of a patients life, which means by definition, that the efforts didnt work. Secondarily, we're in poor health: overweight, under exercised and with poor life habits.

If we as a people ate a little less, exercised a little more, actively reduced our unnecessary stresses, and learned to let our loved ones go when its their time...health care costs would more than halve, if not drop 75%.

 

[SteveR]

Re: Deer in the headlights

Here we go again...

Statistically speaking, from broad swaths of government and health care generated reports with excellent grounding in actual facts, common whipping boys like malpractice and illegal immigrants barely register against the trillions spent on healthcare annually.

For the cause, look in the mirror and at your fellow people.  Most health care costs are spent because people (doctors included) cant let a lost cause go.  Up to 80% of health care costs are spent in the last year of a patients life, which means by definition, that the efforts didnt work.  Secondarily, we're in poor health: overweight, under exercised and with poor life habits.

If we as a people ate a little less, exercised a little more, actively reduced our unnecessary stresses, and learned to let our loved ones go when its their time...health care costs would more than halve, if not drop 75%.

Care to post your source for these "facts?"

 

[Martha]

Re: Deer in the headlights

Most health care costs are spent because people (doctors included) cant let a lost cause go. Up to 80% of health care costs are spent in the last year of a patients life, which means by definition, that the efforts didnt work.

That is consistent with what I have read. What is truly daunting is the difficulty in letting someone go and determining if it is the right decision.

Personal experience is my grandneice who has been mostly in a hospital for the 8 months of her life, awaiting first an intestine transplant and now both an intestine and a liver transplant. The difficulties:

---too many doctors and other professionals, with no one in charge of oversight over them all. No one to take all the complicated information and help you determine if the suffering is worth while.

---doctors disagree with each other. No surprise in complicated situations such as her situation. No one to truly give you the odds of survival. You can only read research but each individual is different, with different factors in play.

---it is damn hard to hold a baby and see her smile and learn, and then decide maybe it is time to stop the tests, stop replacing stomach tubes, stop treating neverending infections. But you see she is bright yellow from jaundice, her body covered with buises from needle pokes, surgeries, and tubes. I just saw her shaking from the morphine after the latest surgery, unable to get enough energy to open her eyes wide and cry.

--- you really don't think about the fact that she is a two million dollar baby.

---it is all just too damn sad.

edited for my lousey spelling.

 

[cute fuzzy bunny]

Re: Deer in the headlights

Done it about 5 times now for the semi annual tirade against lawyers and immigrants, unfortunately several of the threads were overly consumed by idiots.

I took the time to find the thread with the detailed run down on illegal immigrants. You can look for the thread with the info on malpractice, its even smaller as an impact. My claim of ~80% of health care costs spent in the last year of life has been oft challenged, and just as oft supported by not only globs of reports from medical and insurance organizations, many doctors who use this site have supported the claim.

From an old thread, my post, on illegal immigrant health care costs, just so you know I dont make stuff up and throw it out there because it feels "right":

1. SG points out with good sources that the approximate number of undocumented illegal aliens is ~5M.
2. There are approximately 45M americans without health care (DeNavas-Walt, C., B. Proctor, and R. J. Mills. Income, Poverty, and Health Insurance Coverage in the United States: 2003. U.S. Census Bureau., August 2004.)
3. The US spends approximately $100B in care for the uninsured. (Institute of Medicine. Hidden Costs, Values Lost: Uninsurance in America. The National Academies Press. 17 June 2003 .)
4. About $34B of that $100B per year is uncompensated/unpaid (same source as above)
5. Another $37B of that $100B is paid by private and public payers of health care for the uninsured. For those who havent ever heard this, an enormous amount of money is available in grants and other programs for the uninsured. My mother in law, a charge nurse, made us all aware of this when she found grants to cover a car accident for my uninsured brother in law...paid all of his bills for free. ($37B number from same source as above)
6. Another $26B is paid out of pocket by the uninsured.

So if we make several presumptions:
- Citizens and documented aliens dont go to the hospital more often than undocumented aliens, and vice versa; I think this is generous since I think undocumented aliens are far less likely to go to a hospital.
- A hospital stay and/or emergency room treatment for a documented alien or citizen is no more or less costly than for an undocumented alien, which I think is also reasonable.

That makes uninsured, uncompensated losses at $34B, spread across the 45 million uninsured and the 5 million illegal aliens. Simple math given the above constraints says 1/10th of the cost is borne by illegal aliens, making this a $3.4B problem.

That makes the unreimbursed illegal alien healthcare problem 3.4% of the total uninsured healthcare "problem". Which is in the vicinity of statistical drift, lost in the noise.

If you care to argue that illegal aliens visit hospitals more often and/or cost more per visit than US citizens, please factor in that as many as 82 million...as much as 1/3 of the US population...spent at least part of 2002 or 2003 without health insurance for some period. See the same US census report above as source for this data.

As overall healthcare in the US reached 1.7 trillion and is estimated at 1.8 trillion in 2004 (3. Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group; and U.S. Department of Commerce, Bureau of Economic Analysis and Bureau of the Census) the uninsured costs are a notable problem, but unreimbursed illegal alien healthcare costs become reduced in stature to incredibly irrelevant.

 

[cute fuzzy bunny]

Re: Deer in the headlights

That is consistent with what I have read. What is truly daunting is the difficulty in letting someone go and determining if it is the right decision.

Personal experience is my grandneice who has been mostly in a hospital for the 8 months of her life, awaiting first an intestine transplant and now both an intestine and a liver transplant. The difficulties:

---too many doctors and other professionals, with no one in charge of oversight over them all. No one to take all the complicated information and help you determine if the suffering is worth while.

---doctors disagree with each other. No surprise in complicated situations such as her situation. No one to truly give you the odds of survival. You can only read research but each individual is different, with different factors in play.

---it is damn hard to hold a baby and see her smile and learn, and then decide maybe it is time to stop the tests, stop replacing stomach tubes, stop treating neverending infections. But you see she is bright yellow from jaundice, her body covered with buises from needle pokes, surgeries, and tubes. I just saw her shaking from the morphine after the latest surgery, unable to get enough energy to open her eyes wide and cry.

--- you really don't think about the fact that she is a two million dollar baby.

---it is all just too damn sad.

edited for my lousey spelling.

Unbelievably sad Martha, and the subject in this case being a baby makes it all the harder.

I had to console before pointing out you misspelled "lousey"

Since my wife works in the emergency room, I get all the stories. Guy hit by a train, completely ripped to shreds, family still wants "everything done". Guy has absolutely no chance and died a few days later after racking up huge costs. Young guy tries to hang himself, he's brain dead with no reasonable chance of recovery, kept alive for a long time on machines, huge bills.

There are plenty of ambiguous cases, replete with indecision and disagreeing doctors. Most are pretty clear cut though.

But yeah, its easy for someone to sit back in the easy chair and finger ambulance chasers and filthy immigrants as the cause, rather than looking for the real reasons and finding the Pogo effect...

 

[Martha]

Re: Deer in the headlights

Yeah, I saw my "lousy" spelling but you caught me before I could change it. Too late.

I am wasting time here googling cost of end of life care because I can't seem to find what I have read in the past. We might have to retrack our figures on end of life care.

I have spent a lot of time in the University of Minnesota Children's hospital and have seen no end of sad cases. Most are situations where there is no clear cut answer whatsoever. Most involve very expensive medical care. One thing we don't do is ration medical care on the basis of it being simply too expensive for the potential return. All my grandneice's medical care is paid for by medicaid as she is on SSI. They never say no. Should they? I don't know.

Met an extended family at the hospital last week. A young child got an infection that spread to her heart. They had to decide whether to remove life support. They bravely did so.

I have never met so many brave children, parents, grandparents, uncles, aunts, and friends as I have at Children's Hospital.

 

[Martha]

BTW, I split off this discussion from the original post as it is a new topic.

 

[Marshac]

We should make a sticky full of medical facts and stats. Constantly arguing about medical costs, whose to blame, why "oUr sYst3m rul3z", etc is getting old.

 

[cute fuzzy bunny]

Sorry about the spelling thing...I was hoping for a "screw you" as its been a long time. I guess I'll have to work harder to earn it.

I've found and posted sources before on the high cost of end of life medical care. It doesnt matter if you or I find it again and post it. This is like mortgages and social security, people already have their minds made up and no amount of proof will be satisfactory to change most minds. The issue is actually irrelevant to the cost. If I obtained and added up everyones medical bills to show conclusively that the costs were there, religious, moral and social beliefs would quickly dismiss the cost and find another easier target to complain about.

And there are plenty of "sources" that show with incomplete or nonexistent data that there is no such "end of life cost problem". I imagine when 80% of the work and income may 'go away', plenty of interested parties will come to the table with their arguments...

Anything involving a child is ambiguous. You heart has to go out to them and their families. They have the potential for an entire life ahead of them. Less ambiguous are accident victims that have lived their lives and have little, if any chance to survive, or serious illness victims who will go to any length for that 5-10% chance of survival.

Socialized medicine looks at the 70 year old former alcoholic that needs a liver transplant and tells them to open their own wallet, and in many cases, go to another country to avoid the common mans complaint that the wealthy are getting better care than they are. In the US, our morals are decidedly deeper, as long as someone else is paying...

Edited for grammar before I got caught

 

[Outtahere]

Martha that is truely a sad story and not a decision I would want to make.

So they tell you your child is brain dead but a few months later (after you refuse to take her off LS) she wakes up.  That happened here in NE, a man beat his stepchild and put her into a coma, for months they have been fighting over who has the right to pull the plug.  Of course he (stepdad) wants to keep her alive because once they pull the plug he's on the hook for murder.  The court finally decides that the state has the right, they go to evaluate the condition of the child again, lo and behold she's improving, so much so that she's breathing on her own and is now awake and responding.  Lucky for the stepfather and lucky for the little girl, who is now in rehab and making great progress.

It's true stories like this that make people want the extra effort made to save their loved ones reguardless of the cost.

 

[Martha]

We should make a sticky full of medical facts and stats. Constantly arguing about medical costs, whose to blame, why "oUr sYst3m rul3z", etc is getting old.

I am thinking of writing a book. No one good place for consumers on all the information out there concerning healthcare.

I'm probably too lazy and there is that spelling problem . . .

 

[cute fuzzy bunny]

Outahere, the case you mention creates room for thought, however, that happens about .02% of the time.

By the way, I'm not condoning or suggesting we unhook people from their machines or let a child die because we want to save money. I'm pointing out that it costs a lot and we cant spend that money and reasonably point fingers at lawyers and illegal immigrants...because they arent the problem.

While I have spoken to few doctors who dont agree with the high cost of end of life care postulation, doctors are also sometimes part of the problem. For example, I went to the doctors office for an appointment last year and the admin had forgotten to put the appointment in, so the doctor wasnt there. I spent an hour waiting while they tried to call him on the cell phone he had left on his desk in the other room. I ended up going back the next day. When the insurance paperwork came in the next month, two doctor visits recorded and paid for by blue cross. I called the doctors office and they said that since they took my blood pressure and weighed me, that constituted an office visit. I could have called blue cross and tipped them off, but I had the feeling the doctors office had done their homework and in fact the insurance company would still pay the claim. However the doctor made no attempt to collect the $20 co-pay, which is smart of them.

In some cases the insurance companies are the problem. I had two lab tests done last year where the paperwork to pay the claims was obviously onerous. I saw five forms in my file the doctor had to fill out for each one. I had to pay a co-pay. And at the end of it, Blue Cross decided to not pay five bucks of each one, while the doctor and lab billed me for it.

How much does it cost to fill out five forms, take a set of forms back, figure out that I owe five bucks, bill me for it, have me write a check, stamp an envelope and mail it, then process the five dollar payment?

Ridiculous.

In some cases the legal system is part of the problem. People do stupid things to themselves and want someone else to pay them for it, and our system allows that in some situations.

All that having been said, I dont think you have to walk far with an open mind to conclude that our own poor overall health and the tax our demands for complete and endless care at someone elses expense is the root cause of our health care costs.

 

[F-One]

I hate to be callous but the NE child will still cost a small fortune for someone. They don't say it now and it is too early to determine the extent but the child certainly has brain damage. It may not show up until 5 or 6, may not show until 9 or 10, but it will show up. I know, my son suffered anoxia in hospital after being born with cleft palate - brain damage wasn't diagnosed until he was 14 before that he "had" ADD, then Obsessive Compulsive, then behavior disability, the autism (asbergers), then mental problem not otherwise diagnosed (can't remember the term now).

 

[cute fuzzy bunny]

Ayuh, you caught it. I predicted a quick and easy lateral from the cost issue to the moral issue, and there it is.

 

[dylar]

We spend more and get less. Have a look at any of this information and tell me our system is the best. OECD 2005 Health Care Data

 

[Martha]

I hate to be callous but the NE child will still cost a small fortune for someone. They don't say it now and it is too early to determine the extent but the child certainly has brain damage. It may not show up until 5 or 6, may not show until 9 or 10, but it will show up. I know, my son suffered anoxia in hospital after being born with cleft palate - brain damage wasn't diagnosed until he was 14 before that he "had" ADD, then Obsessive Compulsive, then behavior disability, the autism (asbergers), then mental problem not otherwise diagnosed (can't remember the term now).

Maybe yes, maybe no. From what I have discussed with medical professionals involved in my grandneices care, they are getting far better at diagnosing developmental problems and preventing them. My grandneice is developmentally on track. Along with the surgeons, GI guys, the liver guys, the transplant guys, the skin guys, the infectious disease guys, there are the occupational and physical therapists. Saving babies' lives also advances research, which make it easier to save another baby's life and more likely that child will have less problems as he or she gets older.

But yes, a lot of babies that have been saved suffer from many many medical problems throughout their life. Adding to all the other ethical issues.

My BIL's sister has a son that was born way too premature. He ended up being autistic. Many many problems and he is unlikely ever to be able to care for himself. He is now 10 years old. He calls me "Auntie Same" because I look just like my sister, his aunt.

 

[Nords]

I'm probably too lazy and there is that spelling problem . . .

Don't let that hold you back-- editors can solve both of those problems!

 

[Martha]

WSJ has an article today on medicaid and the struggles states are having with Medicaid cuts. Many states are cutting a number of people off of their medicaid rolls, even if they are disabled. In Missouri a family of three can earn no more than $3504 a year to qualify for Medicaid. Families with a disabled family member are also facing increased barriers to getting Medicaid for the disabled family member.

The WSJ says the biggest driver of Medicaid costs is the "long-term care for a relatively small number of elderly and disabled beneficiaries. About 4% of Medicaid recipients account for half the program's expenditures." This is according to the Kaiser Family Foundation.

So, my grandneice incurs 2 million of medical expenses and others get cut off and get nothing.

This is a big freaking problem.

 

[Martha]

Oh, one more thing. In Missouri the Legislature has decided to end Medicaid in 2008 and has established a commision to come up with a replacement. The commission has proposed tax credits to small employers who offer health insurance, and incentives for people to buy nursing home insurance. Won't help people like my grandniece and her mother, who is having to care for her full time and as a result lost her job. She would have used up her lifetime healthcare limits anyway.

I think we need to separate health insurance from employment.

 

[farmerEd]

We spend more and get less. Have a look at any of this information and tell me our system is the best. OECD 2005 Health Care Data

Yep...all you need to do is look at the mortality tables in the first-world countries that have "socialized" health care and compare it to the USA...if I remember correctly, despite spending more than other other country per capita, we still come in something like 10th or 11th in longevity...if we truly had the "best health care in the world", we also have the longest average lifespans...and we don't.

 

[haha]

We spend more and get less. Have a look at any of this information and tell me our system is the best. OECD 2005 Health Care Data

I have posted these stats over and over. Most forum members go blind when they see it, deaf when they hear it. Miust be part of the "America- Love it or leave it" syndrome.

Ha

 

[getoutearly]

Wow, had no idea I would touch such a nerve!!  Sorry about that. 

CFB, I agree that the end o f life costs are a big factor , and we don't exactly take good care of ourselves (I can't throw any stones there). 

I do think (and, I don't have any "statistics" to quote to back this up - unfortunatley, I've got a damn job that takes up too much of my time - trying to remedy that though....) that it is the lawyers that are driving a lot of the end of life costs and the doctor's need to CYA on every issue.  The docs can't pull the plug for fear of lawsuits. 

Also, I think we are our own worst enemy,  in that we have gotten so complacent, with health insurance picking up the lions share of our health care costs.  If we had to pay for more of it out of our own pocket, we would not go to the doctor every time johnny had a sniffle, and would not demand antibiotics on every other visit to the clinic. 

(It's kind of like the (one possible) solution to rising taxes:  do away with paycheck withholding, and make people write that check to Uncle Sam every month or two weeks.  See how long it would take to have a tax revolt on our hands...)

Anyway, sorry about starting this thread.  Although I didn't really.  I just couldn't let the comment slide...

disclaimer: I haven't run this through the spell check, and am typing with the keyboard on my lap, so no telling what the spellchecker police will say!