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Medicine Science

Does Higher Health Care Spending Lead To Better Patient Outcomes? 504

Posted by samzenpus
from the put-your-money-where-your-health-is dept.
First time accepted submitter ericjones12398 writes "If you haven't seen the words 'health care' in news headlines lately, you must be living under a rock. What seems most controversial among the latest research and news is a flawed payment scale that undervalues primary care and overvalues specialty care. There is evidence suggesting that publicly funded health care spending (i.e., Medicare) has not been based on primary health care needs. Rather, In the U.S. Medicare spending relies on a resource-based relative value scale (RBRVS) which seems to promote higher spending without evidence of better patient outcomes. A study comparing spending and mortality rates in Ontario had the opposite findings however, supporting a link between higher spending and better outcomes for patients. What are we doing different in the U.S.? "
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Does Higher Health Care Spending Lead To Better Patient Outcomes?

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  • We all know why (Score:5, Insightful)

    by oldhack (1037484) on Monday April 02, 2012 @12:37PM (#39550025)
    We have a medical-industrial complex. Money's gotta flow.
    • Re:We all know why (Score:5, Insightful)

      by englishknnigits (1568303) on Monday April 02, 2012 @12:58PM (#39550345)
      And when you don't directly have to pay for it (ie Medicare) then you don't care about the cost to benefit. This is why most people should really be on something along the lines of an HDHP and treat health insurance as insurance. When you spend your money on yourself you care about both the cost and the benefit. When you spend someone elses money on someone else (ie government spending) you have no incentive to care about cost or benefit.
      • Re:We all know why (Score:5, Interesting)

        by ColdWetDog (752185) on Monday April 02, 2012 @01:05PM (#39550455) Homepage

        Won't work until you have a much higher penetrance rate for HDHP (HIgh Deductible Health Plans). Right now, anyone with an HDHP gets royally screwed paying top dollar for the care they do get. It does tend to prevent people from using health care resources, but given the broad brush you're sweeping with, that's not necessarily a good thing.

        The idea that HDHPs will actually decrease billed costs to something more reasonable (no $60 aspirins) has yet to be shown. It puts the burden on the wrong person and typically will only be used by intelligent, reasonably well off, healthy people - a small subset of the total population.

        • Re:We all know why (Score:5, Interesting)

          by englishknnigits (1568303) on Monday April 02, 2012 @01:35PM (#39550875)
          I have an HDHP (shocker) and it saves me lots of money. My monthly premiums are much less plus I can pay for my expenses with a tax deductible account. Going to a specialist will cost me between $90 - $200 assuming I don't get any crazy tests/procedures which is what I save every month on the premium alone. When I'm really sick and need to see a doctor, I go. If I'm feeling so so I may wait and try to avoid the cost if it doesn't seem serious. When I go to a doctor sometimes I will opt not to get a test or take a medication because I don't think it's worth it. If you don't have to pay to get name brand, why bother getting generic. If you don't have to pay for meds, why not just get them? If you don't have to pay for an office visit, why not go "just in case"?
          • Re:We all know why (Score:5, Insightful)

            by nbauman (624611) on Monday April 02, 2012 @04:30PM (#39553015) Homepage Journal

            When I go to a doctor sometimes I will opt not to get a test or take a medication because I don't think it's worth it.

            I don't understand how that works. The doctor says, "You may have cancer, we have to do this test to rule it out." How do you say no?

            The reason we have overtesting in the U.S. is because doctors get paid by procedure, not because patients don't have to pay for it.

            If the test or medication is necessary, you have no choice. If it's not necessary, they shouldn't be giving it.

            In the UK, NICE decides what tests and medications are necessary under what circumstances. Doctors are government employees, so they're expected to follow guidelines unless they have a good reason for doing otherwise. They give a lot fewer PSA tests in the UK. The death rate for prostate cancer is about the same.

        • by cpu6502 (1960974)

          >>>anyone with an HDHP gets royally screwed paying top dollar for the care they do get

          I have HIgh Deductible Health Plan (insurance for expenses over $20,000/annum) and do not get screwed. I spend just $90/month for the insurance and ~$200 for the annual doctor visit. That's less money than what many people pay on Cable and cellphone service.

          As for medicare or government healthcare, it really should be like welfare and food stamps. Needs-based rather than something covering everyone. Those who

        • HDHPs are awesome if you don't have a chronic condition that requires regular medication or OT/PT/Testing. The key is that you're covered if you get hit by a bus or have a heart attack or get cancer (though they can still drop you at the end of your plan year, so make sure you go down shortly after you re-up for the year). BUT - when you pay out of pocket, you pay at the negotiated health insurers rate. At that point, healthcare is pretty reasonably priced. I got a thyroid ultrasound and thin needle biops

      • Re:We all know why (Score:5, Informative)

        by jjohnson (62583) on Monday April 02, 2012 @01:06PM (#39550467) Homepage

        And when you don't directly have to pay for it (ie Medicare) then you don't care about the cost to benefit.

        This isn't true in UHC countries like Canada or France or Sweden, so why would it be true in the U.S.? In UHC countries, annual per capita spending is around 55% of what it is in the U.S. (in 2010, $3,900 to $7,400), and they have better aggregate outcomes as measured by things like life expectancy (average 2+ years higher in UHC countries than in the U.S.). With UHC schemes, it looks pretty clearly like they pay less and get more effective medical treatment.

        • Re:We all know why (Score:5, Insightful)

          by superdave80 (1226592) on Monday April 02, 2012 @01:13PM (#39550563)

          ...as measured by things like life expectancy...

          I've never understood why this gets thrown around as a measure of the quality of health care received, when there are tons of other factors that have much more of an affect on this (exercise, smoking, eating right, etc.).

          • Re:We all know why (Score:5, Informative)

            by jjohnson (62583) on Monday April 02, 2012 @01:26PM (#39550765) Homepage

            Because across a whole population, you would expect that the sum total of benefits of things like exercise, good medical care, healthy lifestyle choices, etc. would show up in life expectancy. When you have two populations, like Canada and the U.S., who have pretty comparable lifestyles overall, it seems like a reasonable, if blunt, proxy for the overall quality of health care.

            In the case of Canada and the U.S. at least, more on-point aggregate measures show the same thing: Canadians as a whole get better health care than Americans, and seem to have less trouble making appropriate cost/benefit tradeoffs in their health care.

            • Except that Canada's population is much smaller than that of the U.S. and is not nearly as heterogeneous that of the U.S..
          • Re:We all know why (Score:5, Insightful)

            by dave420 (699308) on Monday April 02, 2012 @01:40PM (#39550945)
            Because those countries care about preventative medicine, where doctors can help people without ever seeing them by giving them lots and lots of good advice and support tools (helplines, advertising campaigns, even the lowly pamphlet), which clearly wouldn't work in a place where doctors depend on patients for their income. Surely they make more money healing someone than preventing them getting sick. In UHC countries, exercise, smoking, diet, etc. are all priorities for the healthcare industry, as it saves them (and the taxpayers) money if the public is advised efficiently about various dangers in their lives.
          • Re:We all know why (Score:5, Interesting)

            by Comboman (895500) on Monday April 02, 2012 @03:13PM (#39552049)

            I've never understood why this gets thrown around as a measure of the quality of health care received, when there are tons of other factors that have much more of an affect on this (exercise, smoking, eating right, etc.).

            But healthy living (exercise, smoking, eating right, etc.) is all a part of true health care, it's just not a part of critical health care. Health care dollars spent on prevention are far more effective than those spent on critical care.

          • Re:We all know why (Score:5, Informative)

            by Ihmhi (1206036) <i_have_mental_health_issues@yahoo.com> on Monday April 02, 2012 @04:45PM (#39553183)

            Yeah, let's use something a bit better like the Infant Mortality Rate: [wikipedia.org]

            4. Sweden 3.18/1000 births
            9. France 4.10/1000 births
            24. Canada 5.30/1000 births
            34. United States 7.07/1000 births
            Data is the average of the last 15 years. See the link above for more.

            But socialized medicine is bad and for commie Reds!

            • But infant mortality is also tied to healthy living (eat right during pregnancy, don't smoke, don't do drugs, etc.). This is nearly the same metric, just in a different age group.
        • Re:We all know why (Score:5, Informative)

          by CptPicard (680154) on Monday April 02, 2012 @02:14PM (#39551413)

          Well, I'm a Finn, so we count as a "Socialist medicine" country, and as a somewhat severely disabled person by birth who still has been patched up to be a happy taxpayer, I certainly count as a huge and probably never fully profitable beneficiary of our system, but anyway...

          I frankly do not believe in the "UHC people do not care about the cost to benefit" argument. At least in civilized countries, people will have some common sense that even when they might totally destroy their health, it's not going to be fun even though they might get healthcare in the end. You'll want to avoid getting an organ transplant in general even though it might be paid for. When there are obvious public health concerns, such as the generally excessive alcohol intake in Finland, educating the public is a relatively small "totalitarian" cost as the objective benefit is so easy to see. Pure Libertarians will of course always disagree, and I can appreciate that.

          The benefit of general social insurance not only in economic but ethical terms just outweighs any abuse concerns. Those who would, really deserve the pain that comes with the unfortunately necessary pain that comes with the condition they put themselves into, regardless of the healthcare they're getting.

          And when it comes to actually *how* to provide the healthcare, it's all actually mercifully objective -- it's not like buying a car. Medicine is a science. We know that certain treatments work, in a scientific sense, and others do not. Hospitals do not need to be hotels. During my lifetime, I've been treated by incredibly skilled and compassionate public-sector doctors and nurses who have done their best -- and yet I've always been glad to be out of the hospital, as that means I'm getting better. And the outcome has been pretty good so far, yet I'm not so sure after all the cuts that are being imposed at the moment. Even the public sector can't run on thin air :-)

      • Re:We all know why (Score:5, Insightful)

        by vlm (69642) on Monday April 02, 2012 @01:13PM (#39550555)

        When you spend someone elses money on someone else ... you have no incentive to care about cost or benefit.

        Ah but we're talking about medical care here, and only a microscopic minority of freaks enjoy pain.

        As a thought experiment, put out a sign offering "free" root canals. Yes, yes for about a week you'll get a huge backlog of uninsured people with horrific dental pain who could not get any care before and now will joyously sign up for your free root canal. Once you work thru the backlog, the only people voluntarily going to your free-root-canal office are the same tiny fraction of people who really need one, and a couple of freaks with whip lashes and rope burns all other their bodies who do it for the pain. The price of a root canal seems to have very little correlation with the desire of the population for a root canal.

        I'm thinking the market for prostate exams, mammograms, broken bone casts is kind of the same.

        It's a completely different market from offering, say, free "adult" non-therapeutic massages, or free pr0n pixs, or free movies/music/tv, or addictive drugs, where demand is basically infinite.

        Lets say you offered "free" atmospheric oxygen. Well, first I'd breathe deeply, for free, just because I can, but that would get boring real fast. Then I'd probably have a few bonfires in my backyard, since oxygen is free so why the heck not. Hell I'd probably get a pet cat that breathes "free" oxygen. But extremely rapidly the demand kinda levels off. I had "free" water and "free" heat at my bachelor pad apartment years ago, and there is no fundamental reason to waste it, so I didn't. How much water do you think I can drink per day, anyway?

        • I actually agree with most of what you said but you are arguing a different point. The point isn't that people will intentionally wasteful, the point is that people will not do ANY cost/benefit analysis if they don't have to pay for it. You could get name brand for $100 or generic for $10. If they do the same thing and you are paying, you will get the generic. If you are not paying, why not get the name brand because then you are 100% sure you are getting the real thing? If you have a non-serious injur
      • Re:We all know why (Score:5, Insightful)

        by DrgnDancer (137700) on Monday April 02, 2012 @01:19PM (#39550661) Homepage

        That doesn't track. As the article points out, places with true "socialized" medicine (Canada and Europe) typically don't have these problems or have them in lesser degrees. When there's no profit motive, there's less incentive to over-test, less incentive to push unnecessary pills or treatments, and less over specialization. The problem with Medicare isn't that it causes people to overspend because they don't see the pain of the spending (medicare still requires copays and such), it's the system into which it's been pushed.

        Doctors and insurance companies have an adversarial relationship that drives cost up so both of them can profit. Enter Medicare. It has to play the game by the rules established by private insurance and doctors. It inherits the waste in system and (being government) adds some of its own. The problem isn't that people are wasteful of things they don't pay for (some are or course, but the national health care systems of numerous countries attest that it's not all of them, nor even an unworkable number of them). It's that the profit motive of both doctors and insurers keeps driving up costs, and Medicare has to live in their world. If socialized medicine is inherently more expensive, why do we pay so much more per capita for health care than any other rich country, but achieve, at best, comparable results?

    • Hold on a second (Score:4, Insightful)

      by geoffrobinson (109879) on Monday April 02, 2012 @01:09PM (#39550503) Homepage

      What do health care costs, housing costs (pre-bubble bursting), and college tuition costs all have in common?

      1) They all have risen much faster than inflation.
      2) They are all subsidized by government.

      If you hide the cost of a good from people via the tax code and you subsidize the good, you will get no mechanism to control costs. The tax code hides the cost of insurance since employees don't see or feel the employer's payment.

      Oddly enough Lasik surgeries haven't gone up in price. It isn't covered by insurance.

      Granted, there's a lot more nuance and information to bear on this topic. But it is a dynamic that can't be ignored. If you hide the price from someone, costs will go up. Unless you want to ration. Which when the HMOs tried to do it in the 1990s was about as popular as a skunk crashing a party.

  • by Anonymous Coward on Monday April 02, 2012 @12:39PM (#39550051)

    all goes to someone's profit, not someone's care.

  • how many old people eat crappy salt/sugar/carb laden food just because their parents made it for them as kids.

    and my favorite. yesterday my mother in law brought some pork over. it was marinated and wrapped in plastic. the butcher told to cook it in the plastic and i had an argument with her how its bad for you. she does it all the time at home

  • by Bovius (1243040) on Monday April 02, 2012 @12:40PM (#39550063)

    75% of money spent on health care in the U.S. is for self-inflicted diseases or the consequences thereof. That might be a good place to start looking.

    I'm not saying that people that need dialysis or bypass surgery shouldn't be helped; I'm saying we should be spending money on ways to help them not get there in the first place.

    • Re:Obesity (Score:5, Insightful)

      by ColdWetDog (752185) on Monday April 02, 2012 @01:11PM (#39550529) Homepage

      75% of money spent on health care in the U.S. is for self-inflicted diseases or the consequences thereof. That might be a good place to start looking.

      I'm not saying that people that need dialysis or bypass surgery shouldn't be helped; I'm saying we should be spending money on ways to help them not get there in the first place.

      Citation please. Those are numbers pulled out of various nether regions. Yes, people can do much for themselves to decrease / delay morbidity (not mortality so much). And yes, we should encourage and teach people to watch their weight, not smoke, drink alcohol in vast moderation, do yoga, clean their rooms and brush their teeth twice daily (floss once) but health care still is going to cost quite a bit of money - maybe more as the number of frail elderly that need increasing care climbs dramatically.

      Remember, one entertaining factoid in all of this - with all the 'bad things' we're doing (pollution / plastics / obesity / diabetes / whatever disease is popular this month) the average longevity of the population is slowly and steadily INCREASING. Now most of us think that's a good thing. Not many want to go back to the pre medical days of a 35 year average longevity, but it does have it's consequences....

  • No (Score:5, Insightful)

    by Cigarra (652458) on Monday April 02, 2012 @12:41PM (#39550085)
    The answer is no [wikipedia.org]. Next question?
  • by repapetilto (1219852) on Monday April 02, 2012 @12:42PM (#39550095)

    5% of the population (15 million people) account for 50% ($1 trillion) in spending.

    http://www.ahrq.gov/research/ria19/expendria.htm [ahrq.gov]

    • by NeutronCowboy (896098) on Monday April 02, 2012 @12:51PM (#39550245)

      Not surprising. Sick people cost more than healthy people. At any given time, less people are sick than are healthy. Furthermore, there is a small segment of chronically ill people.

      Note: the reason why health care needs the biggest pool possible is because at any given time, you cannot tell who will need expensive health care. Our health care isn't good enough to predict who will get what disease and when, or who will get into an expensive accident. This means that unless you want to bankrupt 5% of the US population and keep them permanently in the poor house, you need a national health care system. Otherwise, the health care system will trend to cost+profit+cost to help uninsured people.

      • The point is when comparing cost vs outcome between countries, it is those of this 5% that should be focused on. Most "analysis" done in the news assumes the costs are normally distributed (by reporting cost per capita, etc), when they are not.

    • by dkleinsc (563838)

      Perhaps we're spending at least half our health care dollars on people who are seriously sick or injured. The horror!

    • You expect that. It's somebody-or-other's law. There is always going to be a distribution of disease / habit / whatever and thus money spent (or not spent).

      Now, those folks are often touted as the low hanging fruit for medical cost savings, but it rarely works out that way because those people are sick. They're the ones that got short changed in the luck of the draw - they've had horrible diseases that are often not the result of anything under their control. Or they've just had the bad luck to walk int

    • by UnknowingFool (672806) on Monday April 02, 2012 @01:07PM (#39550481)

      One of the areas where the US needs more focus is end-of-life care. More often than not, individuals and their families are opting for expensive treatments at the end that may cause suffering and not provide any benefits for a tiny chance at a cure. One of the twists of advances in medicine is that people can be kept alive despite major medical problems, but many would not consider being kept alive in that state as "living" especially when no cure is likely.

      This was the background of the infamous "death panels" fiasco at the beginning of the health care reform debate. Under Medicare rules, doctors can only bill for their time for certain things. Discussing end-of-life options was not eligible. So doctors had to (1) not bill, (2) lie about their time, or (3) not discuss the options at all. The proposed change was made so that it would encourage doctors to have these discussions with patients that would reduce costs and suffering. But the Republicans twisted it into some sort of tribunal where people would have to advocate for their lives.

      For a more reasoned look at the problem watch this Frontline [pbs.org] about end-of-life care today and the issues surrounding it. The one perspective from the doctors is complex as they all want to save their patients but they question whether some of their treatments cause their patients more suffering more than anything else.

    • by Kagato (116051) on Monday April 02, 2012 @01:33PM (#39550841)

      The states with some of the lowest Health Care spending (compared to other US states) have the best outcomes. You look at a state like Minnesota which is highly regulated, mandates Health Insurance Companies are not for profit and allows "never pay events" (medical mistakes neither the patient nor insurance company have to pay) and they have some of the best outcomes.

      I'd also point out that high medical costs are often attributed to lawsuits. I would point out that Texas passed Tort reform a long time ago and the highest cost counties in the US are in Texas.

      Bottom line, you want lower cost health care you restrict profiteering and you don't reward bad behaviors by doctors or insurance companies.

  • "If you haven't seen the words 'health care' in news headlines lately, you must be living under a rock."

    Or perhaps you aren't an American.

  • by haemish (28576) * on Monday April 02, 2012 @12:46PM (#39550159)

    The last months of a persons life are overwhelmingly the most expensive, but the outcomes are predicable. There was a great article in the WSJ on this called Why Doctors Die Differently - http://online.wsj.com/article/SB10001424052970203918304577243321242833962.html [wsj.com] . The basic point is that doctors understand death, and when their condition makes death inevitable. They almost always opt for more life in their years than more years in their life. From a healthcare point of view, doctors have much less expensive end-of-life care.

    • by garcia (6573) on Monday April 02, 2012 @12:56PM (#39550327) Homepage

      I read that article when it came out and agreed with all of it. However, in many cases it's just simply not as easy as the article makes it seem.

      My grandfather passed away several years ago after living for the better part of a decade mentally and physically incapacitated following a serious brain hemorrhage. My father, having power of attorney, noted that he was not to receive anything other than painkillers. He was simply supposed to be made comfortable but no effort was to be made to prolong his life. The cost of that nursing home was astronomical even for care which is basic.

      There is also my remaining living grandparent. At 86 she is able to walk by herself, communicate clearly, etc. She also has a ton of health issues including diabetes, pain management, etc. Her costs, mostly shouldered by the taxpayers due to very low available income, are also astronomical and she's living what many may consider an active and acceptable lifestyle for her age.

      So yeah. Doctor's (and many others) choose to die quickly and w/o medical intervention which is likely to fail anyway. However these astronomical costs aren't just for those who are likely terminal patients. They're for everyone--even the "healthy" ones.

      • It is really disturbing how ready today's generation is to ship grandpa to a nursing home. What happened to family taking care of their own? Dying in bed, surrounded by your loved ones? Or just plain not spending the last decade of your life abandoned in abject loneliness. If only you had enough compassion and gratitude to your parents to take care of them in their old age as they took care of you in your youth. You know it's the right thing to do. It's even in the ten commandments.

        • Re: (Score:3, Informative)

          by Anonymous Coward

          The difference these days is dementia. I can speak from experience that it is far easier to care for a terminally ill family member without any mental incapacity than with. With people living longer, there is far greater rate of dementia among our old and ill. And to watch someone you have known and loved fade away from you is heartbreaking.

          On a more selfish level, just having someone show appreciation for your care is also very important, and caring for someone that doesn't know you any more can be hard.

        • by vux984 (928602) on Monday April 02, 2012 @01:46PM (#39551033)

          What happened to family taking care of their own?

          You need a house with an extra bedroom.
          Someone at home around the clock.

          So...you need a single income family in a house with extra rooms... In an age of dual income families who both have to work just to afford living in a small condo.

        • by garcia (6573)

          In this particular case he needed round-the-clock care which could not be provided in our home. He had a serious brain injury which left him totally incapacitated (as I mentioned in my original post).

          He had to have a foley inserted for urine collection which he would routinely remove himself, he wore a diaper for feces, for a short while when he was first admitted he had a feeding tube. He needed to be moved frequently to avoid bedsores. He had to undergo physical therapy regularly.

          Yeah, my parents could ha

      • by Sycraft-fu (314770) on Monday April 02, 2012 @01:20PM (#39550683)

        That's what is happening with my grandma, unfortunately. Probably Alzheimer's in her case. Whatever the case, her mind is almost gone. She requires a full time care taker at home now, and before long will need to move to a complete managed care facility. Fortunately she's got the money, it is no problem. However it is going to cost a boatload of money, particularly since other than that she's in pretty good health for a 85 year old. She could live 5 more years (maybe more).

        So what do you do in cases like that? I mean the perfect answer is to find a cure for dementia but it isn't like we can just snap our fingers. For now we have to deal with it. The only cheap solution is basically to just ignore people with it and let them die a horrible death. If you want to be civilized about it you have to care for them and it is damn expensive.

        These are new problems on the scale we face now. People didn't used to live long enough on average for this to happen a lot. Now, instead of just dying fairly quick, many people have a downward slide that can last a long time. That is damn expensive and not a situation where yo can "Just pull the plug," unless by that you mean "Ignore the person and let them die of starvation."

    • by PPH (736903)
      Doctors all die when their private airplane craters in some mountainside.
    • by alexander_686 (957440) on Monday April 02, 2012 @01:19PM (#39550665)

      http://www.businessweek.com/magazine/content/10_11/b4170032321836.htm [businessweek.com]

      This is something of a counterpoint. Amanda Bennett wrote an article about her husband's death. He had cancer and was expected to live a year or 2 more. Aggressive, and expense, treatment, meant that he live for 7 more - some of them good - some of them bad. So he beat the odds and thus can be considered a success. On the other hand, Bennett tries to weigh the cost of treatment, quality of life, and how the health care system should be structured. She does not come to concise answer, but she writes very well about the struggle.

  • by concealment (2447304) on Monday April 02, 2012 @12:50PM (#39550223) Homepage Journal

    There's nothing wrong with living under a rock. It's energy efficient, quiet and affordable. And, no unwanted guests.

  • by thechemic (1329333) on Monday April 02, 2012 @12:50PM (#39550231)
    The United States runs a "for profit" model. Canada runs a "for better society" model. In one model the fundamental design of one system dictates that consumers spend as much as possible and receive as little as possible. The fundamentals of the other design dictate that consumers all receive adequate care, and the only reason to spend more is to get more.
    • by vlm (69642)

      Too simplistic. Force all hospitals and insurance companies into non-profit status and the execs will still demand claims be denied to maximize executive bonuses.

      What could work is just categorically eliminating waste by changing the system.

      Pass a law that no claims can be denied. Instant improvement in customer service. Probably more money is spent trying to catch fraud than is actually spent via fraud. In the adult sex services industry I could imagine high levels of fraud. I'm not seeing why it woul

    • by Anonymous Coward on Monday April 02, 2012 @01:17PM (#39550633)

      The biggest giveaway for me is that in most places in the US, medicine uses the Caduceus (commerce, trickery, and death) as its symbol; in the majority of the world, medicine uses the Rod of Aesculapius (healing and health) as its symbol.

      • by nbauman (624611)

        That's right.

        Caduceus (Hermes, god of thieves)=2 snakes.

        Rod of Aesculapius (Apollo, god of medicine)=1 snake.

    • by T.E.D. (34228) on Monday April 02, 2012 @03:00PM (#39551905)
      Well, actually the US has four different models that it uses simultaniously. I'll list them roughly in order of how "socalized" they are.
      1. Veteran's Aministration. This system is totally government-run. The hospitals and doctors are all on the government payroll.
      2. Medicare/Medicaid. The doctors and hospitals are paid based on services rendered, but the US Government is paying all (or nearly all) of the money. Essentially the US Government is acting like one really large insurance company, with your taxes being the premiums (even if you aren't covered). About 1/4th of US residents are under model 1 or 2.
      3. Private insurance. The doctors and hospitals are paid based on services rendered, but a private insurance company is paying a large portion (if you are lucky the lion's share) of the bill. They in turn get their money from whoever pays their premiums. If that is a company, they are passing the costs of this on to their customers, making them less competitive in a global marketplace that includes companies in other countries that don't have to do this. About 46% of US residents are under this model.
      4. "Free Market". This person has no coverage of any kind. They generally don't go to doctors, because almost none of them can afford it (if they could afford such things, they would have bought into option 3). If they get sick enough that it's obviously life-or-death, they go to the most expensive place in the system (an emergency room) where they have to be treated by law, and then generally don't pay because there's no way a typical person can pay a sudden ER bill in the 10's of thousands of dollars or more. So their treatment ends up being paid by users of option 2 or 3. More than a quarter of US residents are using this model, and the percentage is increasing [gallup.com] every year.
  • Americanitis (Score:4, Insightful)

    by girlintraining (1395911) on Monday April 02, 2012 @12:55PM (#39550299)

    What are we doing different in the U.S.?

    We're throwing our money at CEOs the same way school girls throw wet panties at Justin Bieber at concerts. Next question.

    • What are we doing different in the U.S.?

      We're throwing our money at CEOs the same way school girls throw wet panties at Justin Bieber at concerts. Next question.

      Man, am I ever glad I've never been to a Justin Bieber concert. What a lucky life I've lived.

  • If anyone in the U.S. doesn't already know this, they damn well should (especially if they are going to start spouting about health care policy). These kinds of conclusions about More Care != Better Care and More Cost != Better Health have been floating around for nearly two decades. Behold: http://www.dartmouthatlas.org/ [dartmouthatlas.org]
  • After the Supremes ditch that abortion of a Bill, Obamacare, there needs to be a top to bottom evaluation of the entire medical system.

    Fundamental assumptions about the value of a service and the person providing that service need to be challenged. The infrastructure of record keeping, ownership, and payment needs to be overhauled. Information about services and their costs need to be plain and transparent because if any market is to function correctly, all the players need to know all the facts up front.

    • there needs to be a top to bottom evaluation of the entire medical system.

      And, of course, that won't ever happen. This country can't even come to grips with simple things like Daylight Savings Time. Rejiggering a quarter of the economy at one time?

      Coding for diseases and symptoms in the US is done with a system called the ICD-9 (International Classification of Diseases, version 9). This was codified in the 1980s (the ICD has been going on since around 1900). This was superceeded by the ICD-10 in 1992 and is now used in every country except the US (and I think North Korea). I

  • by Charliemopps (1157495) on Monday April 02, 2012 @01:41PM (#39550967)
    This question is irrelevant. The real question is: should people be able to spend their money in any way they chose, even if what they spend it on is pointless. If you think that we should be living in a free society then yes, people should be able to spend their money on a $100k cancer treatment that only has a 5% chance of giving them another year to live. It's their money.

    Healthcare costs are skyrocketing for a few very simple reasons:
    1. a terrible patent system that gives companies exclusive rights to certain drugs, chemicals and procedures when often that company did little to develop what they patented.
    2. a terrible legal oversight system in which these same companies can hide flaws in their drug/device until the patent is about to expire, then leak the information, get the drug/device banned and immediately release an alternative under a new patent, there-by allowing them to extend their patents almost forever.
    3. The marriage of the insurance and medical industries via the HMO/PPO networks. Now the doctors basically work for the insurer. The insurer demands test after test, sending the patient back and forth between doctors and specialists so they can collect as many co-pays as possible before treating. Closed Pharmacy plans force patients to buy from the HMOs pharmacy which conveniently does not carry many alternative drugs, and the patients are forced into buying drugs with a high co-pay or buying outside the network which, again, comes with a high co-pay.
    4. Add all of the above to the simple fact that it's human nature to want to live forever. They have what you need to live, they are the only ones allowed to sell it to you by law. They control the means to get it, the amount you can get, when you can get it and the price. That right there is the ultimate situation to ensure price gouging.

    I've not seen a single point I've made above addressed by congress. The simple fact is they are in the pocket of the healthcare industry, any plan that our government has regarding healthcare you can be sure will do nothing but make it even more profitable for the industry.
  • by meburke (736645) on Monday April 02, 2012 @07:30PM (#39554975)

    Sorry, but I couldn't find any comprehensive statistics that made a valid comparison.

    First, the chunk is too big: There is no valid way to statistically say that money is evenly distributed among health providers and/or patients.

    Second, in order too be valid, we would need a large sample of all medical services and statistics comparing similar ailments, the cost of treating each ailment, and the outcome. As far as I can tell, vaccinations have the only well-defined statistical data, and even that is controversial in some areas.

    Ask a better question.

The person who's taking you to lunch has no intention of paying.

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