Health Care

[dteowner]

And here PJ's been telling us that state-run healthcare is wonderfully efficient and lagtime and long lines are just right-wing propaganda... Perhaps the empty Koolaid glass isn't on my table after all.

[Eliaures]

And here PJ's been telling us that state-run healthcare is wonderfully efficient and lagtime and long lines are just right-wing propaganda... Perhaps the empty Koolaid glass isn't on my table after all.

We're back to that old talking point. I'm sure all health care systems, and all bureaucracies whether public or private, have their frustrations and drawbacks. Just because "socialized" medicine has these conservative mythologized problems does not mean that the alternative is better. There are millions in this country that don't get the health care they need because the HMO system is more concerned with profit than they are with the health of their "customers".

[Zaleukos]

And here PJ's been telling us that state-run healthcare is wonderfully efficient and lagtime and long lines are just right-wing propaganda... Perhaps the empty Koolaid glass isn't on my table after all.

In PJs defence Finland might do better.:p Sweden doesnt have the shortest queues nor the most cost efficient system in Europe by a long shot.

The queues are mainly for non-critical specialist healthcare and vary across the country (my old province which has more private subcontractors and allows more patient choice for instance has way higher patient satisfaction, lower taxes, and a better economy, than the dump where I live now). To be fair I think the difference between western countries in term of patient utility is fairly small with respect to quality of treatment for urgent conditions. The differences mainly seem to be:

An American with a good health insurance wont have to wait for as long for non-critical treatment, while here everyone has to wait.
The uninsured take a greater financial hit in the US (as everyone is insured by definition here) and wont be prioritised for non-critical treatments.
Your system is somewhat more expensive relative to GDP.

Clear but IMHO not crucial differences. Personally I lean towards private providers and public funding through some sort of voucher system, which we already have for schools.

[dteowner]

We're seriously derailling the thread (perhaps a split-out would be wise, Corwin?), but I'm curious about this whole "private subcontractor" thing that's been mentioned a couple times. How does that work? Do you pay 100% of their fee or a surcharge over and above their regular government billing?

[Prime Junta]

And here PJ's been telling us that state-run healthcare is wonderfully efficient and lagtime and long lines are just right-wing propaganda... Perhaps the empty Koolaid glass isn't on my table after all.

Where, exactly, have I been telling you that?

To set the record straight, I've been pointing out that there are both really well-run and comparatively poorly-run public health systems (e.g. France for the former and the UK for the latter), and that the non-government-run health care system in the USA is the most expensive in the world per capita while only delivering a middle-of-the-road standard of care.

My point being that the conservative case that government-run health care is *inevitably* inefficient, wasteful, and costly, or even *more* inefficient, wasteful, and costly than privately-run health care, doesn't stand up in face of the evidence.

[Prime Junta]

In PJs defence Finland might do better.:p Sweden doesnt have the shortest queues nor the most cost efficient system in Europe by a long shot.

Finland's health care system isn't all that great, actually. Pre- and postnatal health care is world-class, but the rest of it is at best average for an industrialized country -- better than the UK but nowhere near France, for example. It's hard to make a direct head-to-head comparison with the US; it's better in some respects and significantly worse in others. Not unlike Sweden's, as a matter of fact.

We do have a parallel private health care system, with the government reimbursing a part of the cost, though, so people with extra health insurance or enough money to pay for it can get elective surgery etc. immediately. I would much prefer to have the standard of care in the public health system raised to the point where this would become unnecessary.

[txa1265]

I would much prefer to have the standard of care in the public health system raised to the point where this would become unnecessary.

There was a post last week somewhere (can't find it now) about an article from 1968 that looked at 'the world in 2008' ... and I bet that if they were to look out on health care and compare it to the sorry state of things pretty much everywhere they would be appalled.

[dteowner]

So the system is sufficiently broken that only people with health insurance or huge bank accounts can get timely and/or higher quality care? I thought that was the whole indictment of the US privatized system.

For the record, I think the US system is broken, too, but don't see where getting Uncle Sam involved is going to help much. Our pediatrician (we're not talking a heart surgeon here) up in Indy shared with me several years ago that his malpratice insurance was $14,000 a month and he had a clean history. (I have no way verify that, but I have no reason to doubt his word) Doing a little math, that means that roughly $35 of every office visit goes toward his insurance. That's before you pay for the building, the support staff, the equipment, and (last but not least) yourself. Kinda puts that ridiculous bill in a different light, eh?

[Prime Junta]

So the system is sufficiently broken that only people with health insurance or huge bank accounts can get timely and/or higher quality care? I thought that was the whole indictment of the US privatized system.

Um, no. Not that broken. Just broken enough that, for example, should you fall ill on a Friday evening when the drunk idiots are overloading the system, you might end up waiting ten hours to be served, if the triage nurse determines you're not about to croak during it. Or that you might be waiting for months rather than weeks let alone days to get a hip replacement. Or that hospital food tastes like boiled diapers. Or that the hospital might be crowded enough that you get stuck in a room with someone of the opposite sex. That sort of thing.

FWIW, my sister's husband is permanently wheelchair-bound, after an unfortunate incident involving a beautiful summer night, an empty highway, and big motorcycle. He has a lot of experience with the public health system. About 90% of it is positive. The last 10% is highly annoying -- annoying enough that people who can afford the (fairly reasonable) extra cost often take their business to private practices.

For the record, I think the US system is broken, too, but don't see where getting Uncle Sam involved is going to help much. Our pediatrician (we're not talking a heart surgeon here) up in Indy shared with me several years ago that his malpratice insurance was $14,000 a month and he had a clean history. (I have no way verify that, but I have no reason to doubt his word) Doing a little math, that means that roughly $35 of every office visit goes toward his insurance. That's before you pay for the building, the support staff, the equipment, and (last but not least) yourself. Kinda puts that ridiculous bill in a different light, eh?

Yes, it most certainly does (if you weren't aware of it beforehand, that is).

[Corwin]

Moved/Split as requested!!

[Zaleukos]

We're seriously derailling the thread (perhaps a split-out would be wise, Corwin?), but I'm curious about this whole "private subcontractor" thing that's been mentioned a couple times. How does that work? Do you pay 100% of their fee or a surcharge over and above their regular government billing?

I lived in a small town of 55000, so the private clinics that I have experience of are mainly general practicioners (plus a few nose/ear, urology). For the GPs everyone register with a clinic and doctor of their choice (if there is space) and the clinic is reimbursed at a rate depending on the age and estimated general health status of the patient, as well as with a fixed sum per visit (or treatment for specialists, I am not sure how this is calculated). The patients always pay a small fee when seeing any doctor (about USD 30) to discourage overuse, the rest is covered by the regional (a political body between town and national level mainly responsible for healthcare) budget.

Certain treatments are outside the system, such as cosmetic surgery.

[txa1265]

I lived in a small town of 55000

55,000 is not really a 'small town' ... ;)

[Corwin]

For awhile, I lived in the largest town in western Queensland; it had a population of 1000!! Brisbane, the capital city of Queensland only has a population of nearly 1 million!!

[magerette]

My husband and I caught this show (http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/?campaign=pbshomefeatures_2_frontlinebrsickaroundt heworld_2008-04-16) called Sick Around the World last night on PBS(US non-network publicly funded television). It's a very interesting examination of the health care systems in Britain, Japan, Taiwan, Germany and Switzerland. (http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/) Frankly, it gave me a completely different perspective on so-called socialized medicine.

The commentator who traveled to these countries interviewed (http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/interviews/) doctors, politicians and the man in the street. One of the questions he asked in each country was "And how many people last year had to declare bankruptcy here because of medical bills?"(In the US the figure is high)

Every single representative of their country said zero. That it couldn't even happen there. Plus lots of other interesting facts and figures. Well worth a watch if it comes your way.

[JemyM]

When it comes to treatment that is not urgent and requires a specialist the queues might indeed be long in Sweden.

But we also have stories like Kalle Dejemyr (http://www.svd.se/nyheter/inrikes/artikel_20046.svd). He is 20 years old and have the deadly disease Hunters Disease. There is a medicine though, but the problem is that it costs 10 million swedish krona per year. But the government pays the treatment. Due to his medication he can now work parttime as a carpenter and basicly he can live a normal life.

[GothicGothicness]

Sweden used to have a great health care system, but now it is becoming a very segmented country. For example in China, YES CHINA we are talking about a none wellfare country here! I can go to the doctor the same day I get sick!! My mom has to wait for 3 weeks before she can get a doctor! But on the other hand me who have a high class job will get treatment within the hour from a specialist for free! IT is becoming really unfair! a larger and larger gap :(

[KazikluBey]

Sweden used to have a great health care system, but now it is becoming a very segmented country. For example in China, YES CHINA we are talking about a none wellfare country here! I can go to the doctor the same day I get sick!! My mom has to wait for 3 weeks before she can get a doctor! But on the other hand me who have a high class job will get treatment within the hour from a specialist for free! IT is becoming really unfair! a larger and larger gap :(
That specialist is provided as a benefit from your high-class-job company, no?

[GothicGothicness]

That specialist is provided as a benefit from your high-class-job company, no?

Yeah, but they can deduct it from the tax, so technically it means the gouverment is still paying most of it.

[zakhal]

The bad part with the finnish system is that you might i.e loose functionality of your limbs or fingers (strings are cut and need to be reattached asap) because of the waiting lines.

Also elderly people mgiht get ignored i.e if they have broken arms that need operation. They simply reserve the operating places for younger people.

So its always good to have somkind of insurance just incase you need quick operation. But in most cases the national health care is sufficient. In example when my arm broke and was unhealable they operated it (I carry small metal plate now inside the arm) and now its back to 100% functionality. The total cost was perhaps 50 euros.

[magerette]

This is one of the most disgusting stories I've ever seen--and points out how bad it is to be poor/minority and needing health care in America:
Mental Patient Dies in Waiting Room while Staff Does Nothing (http://www.msnbc.msn.com/id/25475759/)

[blatantninja]

That is a horrible story, and I hope several licenses are lost and criminal charges levied if justified. However, don't act like that is the normal way poor/minotrities are dealt with in the medical community here. It's not even close.

[magerette]

That is a horrible story, and I hope several licenses are lost and criminal charges levied if justified. However, don't act like that is the normal way poor/minotrities are dealt with in the medical community here. It's not even close.

Yes, I thought you and/or dte would call me on that one. I won't even go there with you. And I really don't know the woman is poor--that's an assumption--an assumption based on the fact that if she could afford better care, she would have been somewhere else. Maybe we can agree that's she's black, and she's dead?

bn--I don't want to be offensive, but please don't tell me how to "act." I'm not "acting"--I have strong feelings about how the disadvantaged are treated and I also have personal experience of it. Yes, this is an extreme example, but it also points to a larger issue, which of course, you can choose to avoid and ignore if you so desire by saying "most health care is better than this." Things like this should NEVER happen to anyone, and that they can and do says more than I ever will be able to.

[blatantninja]

Yes, I thought you and/or dte would call me on that one. I won't even go there with you. And I really don't know the woman is poor--that's an assumption--an assumption based on the fact that if she could afford better care, she would have been somewhere else. Maybe we can agree that's she's black, and she's dead?

She probably is poor. Sadly, many people that are mentally handicapped end up that way.

bn--I don't want to be offensive, but please don't tell me how to "act." I'm not "acting"--I have strong feelings about how the disadvantaged are treated and I also have personal experience of it. Yes, this is an extreme example, but it also points to a larger issue, which of course, you can choose to avoid and ignore if you so desire by saying "most health care is better than this." Things like this should NEVER happen to anyone, and that they can and do says more than I ever will be able to.

I don't avoid it, I understand the reality of it. And yes, while this should never happen to anyone, it is still sensationalistic to showcase it as a prime example of what is wrong with our healthcare system. There are far less sensationalistic things that are still very widespread and very disturbing.

[dteowner]

Clearly not a representative sample, but clearly reprehensible. Looks like the legal system is gearing up, which is appropriate in this case.

You're highlighting a single datapoint to support your position, which is problematic, as you've already noted.

Now, the interesting question here is whether a "beyond the pale" situation like this is more likely in a market-driven system like ours (designed to give only such care as money will buy) or a public-driven system like Europe's (well documented for ridiculous waits for often sub-standard care). Obviously, this situation happened on our watch, but I'm wondering what the broader picture truly is.

[magerette]

bn wrote:
I don't avoid it, I understand the reality of it. And yes, while this should never happen to anyone, it is still sensationalistic to showcase it as a prime example of what is wrong with our healthcare system. There are far less sensationalistic things that are still very widespread and very disturbing.


I'll agree to being "sensationalistic"--even though all I said was that this case "points out how bad it is to be poor/minority and needing health care in America." But then you have to agree to being defensive and jumping all over the point to imply it's not valid. I don't see how "more widespread and disturbing things" being out there in any way makes this example less heinous, or less indicative of the flaws in our healthcare system.

I agree, though, I do tend to be melodramatic and emotional in my assessments, which tends to make for a less even playing field when talking with those who don't look at issues from the emotional end of the spectrum. If you're reacting to my over-emotional approach and trying to tone it down a bit, I understand that. But don't overlook what's really happening here. No fines or criminal charges are going to bring back this woman's life, which was lost because it had no value to the system designated to preserve it. Why exactly do you think that was?

[dteowner]

which tends to make for a less even playing field when talking with those who don't look at issues from the emotional end of the spectrum.I think I just got called a cold-hearted bastard...

( ;) )

[magerette]

Naah--just a guy. :) The republican part is just icing on the cake, though.

[blatantninja]

I'll agree to being "sensationalistic"--even though all I said was that this case "points out how bad it is to be poor/minority and needing health care in America." But then you have to agree to being defensive and jumping all over the point to imply it's not valid.

I'm as guilty of being emotional on these issues as well. I'm in the )maybe upper) middle class that is feeling squeezed as it is and then people want to suck even more money out to pay for things like universal healthcare. I get very defensive about my taxes going up!

No fines or criminal charges are going to bring back this woman's life, which was lost because it had no value to the system designated to preserve it. Why exactly do you think that was?

It was because someone failed in their job. This is what bothers me about argument for universal healthcare. This woman (and I am making assumptions here) most likely already qualified for medicaid. Maybe she was taking advantage of it, maybe not (unfortunately in the case of the mentally ill, it is usually the latter), but she had access to a government plan. I'm not going to pretend that medicaid buys the best care out there, it doesn't. But she had access.

The problem was the staff were she was behaved in at best a negligent and at worst a criminal manner. And the other patients, that could have at least tried to call another doctor (since the one that showed up didn't seem to care), did nothing either. How is universal healthcare going to fix that? Especially if we end up with a hybrid system? If I understand them correctly, in a hybrid system, doctors can still choose whether or not to accept universal plan members, so the best are still going to be in a private practice, and we're going to be left with the lower end of the medical profession handling the masses. How is that any different or better?

[magerette]

I'm as guilty of being emotional on these issues as well. I'm in the )maybe upper) middle class that is feeling squeezed as it is and then people want to suck even more money out to pay for things like universal healthcare. I get very defensive about my taxes going up!

You know what they say about death and taxes. :) I'm willing to guarantee that your/my taxes will go up regardless of whether universal health care comes to pass, or who is elected the next president. At least if they went up in the interests of health care you might be able to afford to get sick, whereas paying for more military bases in Iraq won't be much help to anyone but the military contractors.

It was because someone failed in their job. *snip*

Agreed, but it is also because the system sets that person up to fail--it's overloaded, underfunded, and poorly managed. In a word, broken. That was really all I was intending to point out with my OP.

How is universal healthcare going to fix that?...How is that any different or better?

Obviously it *may* not be any better. Can you agree with me that it also *might* not be any worse? I understand, and have even argued, that with our government's track record government regulated healthcare seems doomed to be boondoggled in a quagmire of bureaucracy. Nonetheless, like the energy crisis, something has got to be done. I don't know if universal healthcare is the last best answer, but it seems to be working well in other countries when it's done right--why shouldn't it be possible to have it work here, to overhaul and fix the system we have now so that it works for everyone paying into it?-(and most people receiving medicaid pay into it at some point in their lives.)

The problem is that most people have lost all expectations of our government actually doing its job. We just sit back and complain, and expect that nothing will ever change for the better.

In short, I'd like to believe that it's possible for our government to be competent, and to run efficiently if the citizens pay attention and demand that it do so instead of expecting that any change will be for the worse.

[dteowner]

The problem is that most people have lost all expectations of our government actually doing its job. We just sit back and complain, and expect that nothing will ever change for the better.

In short, I'd like to believe that it's possible for our government to be competent, and to run efficiently if the citizens pay attention and demand that it do so instead of expecting that any change will be for the worse.Tru dat!

The problem is that, given the breadth of opinions among our citizenry, no organization is capable of meeting even a majority of the requirements, particularly given that those requirements will constantly change on the chaotic waves of self-interest.

And that's assuming that said organization actually attempted to focus on the citizenry rather than its own perpetuation... (it just wouldn't be the same if I didn't throw in a pinch of cynicism)

[Prime Junta]

And that's assuming that said organization actually attempted to focus on the citizenry rather than its own perpetuation... (it just wouldn't be the same if I didn't throw in a pinch of cynicism)

The two aren't necessarily at odds, you know.

I really don't know how I'd fix American healthcare, but I can identify a few big, structural inefficiencies that need solving:

(1) Insurance companies spend enormous amounts of resources finding ways *not* to pay for healthcare, by carefully vetting applicants, wording contracts, and disputing them. If these resources were spent on treating people, they would buy a quite a lot of it.

(2) Medical professionals spend enormous amounts of money on malpractice insurance. If these resources were spent on treating people, they would buy a quite a lot of that too.

(3) Limited medical coverage, which a great many of you guys have, will generally pay for treatment of existing medical conditions, but not of preventative care. So, for example, if a diabetic's toe goes gangrenous, insurance will cover the cost of the amputation. However, most insurance *won't* cover the much, much lower cost of physical therapy that would have stopped the toe from going gangrenous in the first place. This is much more expensive *and* much harder on the patient; it's also a drag on the national economy as someone recovering from an amputation won't be able to work, whereas someone getting physical therapy once a week is. "An ounce of prevention is worth a pound of cure" and all that.

(4) Conversely, people with (virtually) unlimited medical coverage get prescribed a lot of completely unnecessary and often expensive tests and treatments. Under this system, the doctor has the incentive to prescribe everything possible, "just in case," since that's where the money comes from, and the patient has no incentive to refuse them, since he isn't paying for them. Again, massive resources get used with no tangible result.

IOW, your current system has perverse incentives, which lead to enormous waste of resources at all levels -- insurance companies working hard not to pay or not to insure those people who most need the insurance, patients ending up in expensive treatments because they put off cheap preventative care because their insurance wouldn't cover it, doctors prescribing expensive but unnecessary tests and treatments to patients who don't need them and don't pay for them, and *everybody* employing an army of lawyers to sort out the mess when something goes wrong, or to prevent it from going wrong (in the legal sense).

Now, I'm not saying that a universal health care system, or single-payer medical insurance with identical conditions for all, would be the *only* solution to these structural problems, but it is certainly *a* solution to them (other than the malpractice stuff, which would require changes to tort law). If you can figure out a way to solve these problems some other way, while keeping the things that do work well in your system, more power to you. I'll be watching with keen interest.

[blatantninja]

(1) Insurance companies spend enormous amounts of resources finding ways *not* to pay for healthcare, by carefully vetting applicants, wording contracts, and disputing them. If these resources were spent on treating people, they would buy a quite a lot of it.

This is certainly true to some extent. I'm not sure just opening the floodgates would fix it, but I think it could be streamlined to a much better extent. A great example is the over-charged bill--> insurance kicks it back at a lower cost --> then you get billed for the deductible scheme, which is primarily caused by Medicare's reimbursement policies. Lots of waste there.

(2) Medical professionals spend enormous amounts of money on malpractice insurance. If these resources were spent on treating people, they would buy a quite a lot of that too.

They passed tort reform in Texas a few years back, and it's a mixed bag of returns. On the one hand, as malpractice insurance rates have declined, the number of doctors moving to Texas has increased significantly, giving us a better pool. On the other hand, when you legislate something like tort reform, you end up with some cases that actually DO deserve larger amounts in a settlement getting artificially capped. Personally, I blame the legal community. They simply don't police themselves and are far too interested in getting the biggest judgment and not the right judgment. Also, you get doctors that may have really high rates elsewhere because they make a lot of mistakes now coming to Texas.

(3) Limited medical coverage, which a great many of you guys have, will generally pay for treatment of existing medical conditions, but not of preventative care. So, for example, if a diabetic's toe goes gangrenous, insurance will cover the cost of the amputation. However, most insurance *won't* cover the much, much lower cost of physical therapy that would have stopped the toe from going gangrenous in the first place. This is much more expensive *and* much harder on the patient; it's also a drag on the national economy as someone recovering from an amputation won't be able to work, whereas someone getting physical therapy once a week is. "An ounce of prevention is worth a pound of cure" and all that.

I have no idea what the statistics are on limited medical coverage, but my impression has been that it isn't that high. Every employer I've worked for has had full coverage, and even when I was unemployed I had a full coverage individual package (which interestingly, at least in Texas, if you have been covered by a group plan for at least 3 yrs prior to getting an individual plan, the individual plan can't exclude anything for pre-existing conditions).

But yes, I think we really need to push preventative medicine. In fact, that is one of the problems with the uninsured. If they have something that finally gets bad enough that they HAVE to see a doctor, it's more expensive to treat since it wasn't caught early and they will likely go to the emergency room, which is the most expensive place to treat something.

(4) Conversely, people with (virtually) unlimited medical coverage get prescribed a lot of completely unnecessary and often expensive tests and treatments. Under this system, the doctor has the incentive to prescribe everything possible, "just in case," since that's where the money comes from, and the patient has no incentive to refuse them, since he isn't paying for them. Again, massive resources get used with no tangible result.

They've tried various ways to control this (the HMO being the most notable), but it never seems to work. I'm not sure how much doctors benefit from extra tests (just don't know how much, if anything, they get paid for these things since the doctor prescribing usually isn't the one doing them). Regardless, I haven't yet seen an effective way to eliminate unnecessary tests and treatments. If you have too many approval levels (like an HMO), you waste as much in bureaucracy.

How do they do it in a universal plan? Does the doctor have to get the procedure's approved at a higher level? Or since I assume they are just paid a salary, the thought is they have less incentive to order extra tests (assuming they benefit from them)?

[Prime Junta]

How do they do it in a universal plan? Does the doctor have to get the procedure's approved at a higher level? Or since I assume they are just paid a salary, the thought is they have less incentive to order extra tests (assuming they benefit from them)?

There isn't any single way of doing it, just like there isn't any single model for a universal plan. At least in Finland, individual physicians have a great deal of discretion over what they prescribe. A patient will have to go through the system "bottom up" -- first talk to a nurse, who will make an appointment with a GP; the GP will then authorize tests or refer the patient to a specialist. Emergency rooms work much as they do in your neck of the woods, of course. In this system, there are no financial incentives for physicians to prescribe unnecessary tests or procedures "just in case," so generally speaking they don't.

(The Finnish system isn't terrible, but it's far from the best out there either, except in pediatrics where it really is rather good; if you want an example of a really well-run public health care system, you should look at France.)

[Dyne]

This (http://news.bbc.co.uk/1/hi/world/americas/7420744.stm) BBC news article surprised the heck out of me. No dentistry, spectacles, not even a GP consultation for the poor? Amazing for the richest country in the world.

[magerette]

Excellent article, Dyne, and rather ironic that a charity originated to help third world countries is doing 60% of it's work here in America. Yes, many insurance programs have separate plans for vision and dental, but if you have no employer-based insurance, then you have no plan except buying private policies(expensive) or state aid, which is spotty. As a little girl, my single mom took us to the U. of Chicago dental school for free dental care from the students. I still have the hole where one of them pulled my permanent molar thinking it was a baby tooth. :)

[Alrik Fassbauer]

This is one of the most disgusting stories I've ever seen--and points out how bad it is to be poor/minority and needing health care in America:
Mental Patient Dies in Waiting Room while Staff Does Nothing (http://www.msnbc.msn.com/id/25475759/)

It's in the press today, even here !

It's horrible. "Disgusting" is still an understatement for me.

Plus it's said to be the second case of that that comes to public attention - although in the article someone is cited who says that it occurs much more often without being noticed.