Does Higher Health Care Spending Lead To Better Patient Outcomes? 504
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.? "
We all know why (Score:5, Insightful)
Re:We all know why (Score:5, Insightful)
Re:We all know why (Score:5, Interesting)
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)
Re:We all know why (Score:5, Insightful)
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.
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>>>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
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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)
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)
...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)
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.
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Re:We all know why (Score:5, Insightful)
Re:We all know why (Score:5, Interesting)
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)
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!
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No. What's laughable is that you only get a "modest difference" from taking care of yourself. There are any number of expensive to treat conditions that are the direct result of poor eating and exercise habits.
This is a complex situation. It's scientifically dishonest to try to fixate on one or two variables while not trying to control all of the others.
Beyond cultural habits, genetics also plays a significant role in longevity.
Conspicuously absent from that list of countries that "are doing it right" is th
Re:We all know why (Score:5, Informative)
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)
Just because the US healthcare system can offer a very high quality of care doesn't mean that it's any use to its citizens when the vast majority of them can't afford it.
If you're fabulously wealthy then the US offers some of the best healthcare in the world, but if you're not, it's a disaster area.
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That is just not true.
I was riding my Goldwing back from a day at work where I got called in on a Sunday to get things running again.
I was out riding in the morning so I came to work on my bike.
On the way home a guy turned left in front of me. Hit him doing about 40. he took off. Wrecked the bike but I got out of it with a decent chunk of skin missing and massive bruising on my right side. Nothing broken. Got taken to a trauma center and got the full work up to make sure I was not going to die of internal i
Re:We all know why (Score:5, Insightful)
why is it that those that can afford the very best fly across the world to get their care in the U.S.
People from all over the world who can afford the very best order their high end sports cars from Italy. Therefore, all Italians must drive the best, fastest cars in the world.
Re:We all know why (Score:5, Interesting)
As a Canadian, I can answer why Canadians would do this.
Firstly, there's a chance that the Canadian government will pay for your treatment anyway. These cases aren't super common, but they (actually, the provincial governments) will cover procedures that are hard to get or experimental in Canada under certain restrictions.
Secondly, if you have the money, everything is possible, no matter where you live. The reason why America is so enticing is precisely why it fails its own citizens (IMO): there is excess capacity. If you have money, there are doctors and hospitals that have a lot of extra room for you because they're not concerned with serving people without money or insurance (until it's an emergency). In Canada, the queues are full. The people have been triaged, and rich or poor, they've got to wait. Someone that makes a million dollars a year doesn't get to jump the line because of their income, and someone that barely scrapes by can be assured that they'll get their care. So if you're rich in Canada and you can afford not to wait, you may skip out of the country to get an operation somewhere else. (Frankly, this is something I encourage. It makes the lines shorter for everyone else.)
Care at the very high level in the US is extremely good; nobody in their right mind argues with that. American researchers and surgeons are often also the ones performing new and different techniques, so your system is on the leading edge.
So, yeah. The American system works for people that don't live in America precisely because it ISN'T fair, and the system inside my country is a level playing field that the rich don't want to wait on. (This is not a criticism of the wealthy in Canada, per se. As far as I know, they think our system is as great as the rest of us do. But they have the money, and they can decide how to spend it.)
Re:We all know why (Score:5, Informative)
The question here is whether those two things are mutually exclusive. Frankly, we can see from the example of our two countries that they're not. Rich people in Canada live with a de facto two-tier system. They have most of their care paid for through their taxes. Effective primary care means that they--and everyone else--prevent a substantial amount of sickness. This is good for society on the whole. While I don't have hard data to back that up exactly, it seems to follow: a society where people are sick is going to have a reduced capacity to work.
One of the biggest problem in the US is the money spent on paperwork. Study after study has shown that having the insurance middleman screwing things up is no small part of the additional costs. That's how the US can spend more money per capita by almost a factor of two and still get no better outcomes. Canada's single-payer system reduces the drag inherent in providers fighting with insurers over how much to pay.
Canada's health system, it should be noted, only covers a list of 'essential' services, so we also live in a mildly two-tier system. Laser eye surgery isn't covered by the state, and only partially covered by insurance (yes, you can buy private insurance here, too!) Unsurprisingly, the price of lasik continues to go down. But again, it's deemed non-essential, and that's probably true.
Moreover, you CAN, if you like, open a private, for-profit heart surgery clinic in Canada. You just can't bill the Canadian government for it. Private citizens would have to field the full cost of the surgery, with no medicare payments to defray the cost. But nobody does that here because the market simply doesn't have enough people in it to support that. Hence the tourist surgery.
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A friend from Britian developed a cold that refused to go away, but the "free" health system made him wait 3 weeks just to see a general practitioner.
No they didn't. The problem with your imaginary friend story is that you can't make an appointment to see an NHS GP three weeks in advance. Nearly all practises now only allow you to make an appointment up to 2 days in advance, though you can get same day for urgent cases. Your friend could also have changed practise if he wasn't happy with the one he was with.
Once he got there they said, "Oh allergies," without any kind of tests, and handed him some pills. So he asked to get a second opinion from a private physician, in hopes of finding-out what was really wrong. The UK Government's hospital said "no". The end.
Nope, this didn't happen either. Why would he need a referral? If he wanted to go see a private doctor, there's nothing stopping him. They're not eve
Re:We all know why (Score:5, Insightful)
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?
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Re:We all know why (Score:5, Insightful)
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?
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Hold on a second (Score:4, Insightful)
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.
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That is when Medicare and Medicaid went into effect. The way to solve the problem with health care costs is to eliminate the tax break for employer provided health insurance and to simplify the way that Health Savings Accounts work. This would cause people to gradually shift from the current he
Re:Hold on a second (Score:4, Interesting)
Yeah, I'm sorry, but health care is price-controlled in major ways, particularly Medicare and Medicaid, and that is a de facto subsidization.
Furthermore, it is an Economic principle that anything that is price-controlled causes a shortage of the good controlled and causes higher prices. This may be the one thing that almost all Economists actually agree on, and it is based on 4500 years of historical records.
I was just reading an article about a doctor who had a 12-person office until last December. In January he quit taking Medicare and Medicaid patients, and quit taking insurance. He was able to lower his prices 14% and improve his revenues by 22%. He now runs his office with 4 people. (Let's not forget that filling out insurance forms and so forth are still services, but now they are in shorter supply.) The motive for declining insurance and MM? MM did not pay the expenses and were costing him a great deal of money and aggravation. Statistics vary according to specialty, location and survey source, but the number of doctors not taking new medicare patients seems to be somewhere between 12% and 19%. .This range is up about 4% from 2009.
Higher cost in the US... (Score:3, Insightful)
all goes to someone's profit, not someone's care.
Re:Higher cost in the US... (Score:5, Insightful)
Yes, but if there is a profit, it's not going to care for someone, it's lining someone's pocket.
Plus the mechanism you use to gather the profit is horrendously inefficient - for that 15% margin you are essentially doubling your costs by paying for all the insurance bureaucracy on one side and the bureaucracy on the healthcare side designed to interface with it.
The USA pays double per capita what it's next nearest neighbour among the G8 nations spends on healthcare, for comparable outcomes.
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blame the patients (Score:2)
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
Re:blame the patients (Score:4, Informative)
Food-safe plastics do exist. I cannot say whether this particular plastic used was food-safe or not, but its at least possible.
Re:blame the patients (Score:4, Insightful)
No one that has any training in chemistry will seriously suggest that you actually heat plastic together with your food.
Had that fight with the spouse for years before the whole BPA thing hit the news.
The risks are far too great if your wrong and the benefits are far too trivial even if you're right.
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Depends on the plastic. Some are tested pretty carefully and have various certifications.
Of course you could take the word of internet chain letters over the Harvard Medical School.
http://www.health.harvard.edu/healthbeat/HEALTHbeat_081606.htm [harvard.edu]
It's your choice as to whether or not you want to behave rationally.
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this was raw pork covered with what looked like saran wrap and tied with kitchen string outside the plastic and the instructions were to cook it in the oven with the plastic on
Obesity (Score:3)
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)
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....
Re:Obesity (Score:4, Insightful)
What if spending money isn't the answer? What if the answer deals more with a change in social values?
Do you know how you change social values, especially regarding health? You spend money on health programs and preventative care. If people only go to the doctor when they have a serious illness, then only serious illness will be treated and preventative care will be ignored. Make care free or close to it then spend on getting people to care about health. It will save money in the long run.
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"Hidden" Medicare Costs (Score:2)
http://www.insurancefraud.org/medicarefraud.htm [insurancefraud.org]
http://medicarefraudcenter.org/medicare-fraud-information/9-medicare-fraud-statistics.html [medicarefraudcenter.org]
http://www.discriminationattorney.com/medicare-fraud-1854607.html [discrimina...torney.com]
No (Score:5, Insightful)
Re:I think the world can be grateful... (Score:5, Interesting)
... for the US having a government not basing its policies on adages, witticisms and one-liners.
You sure about that bro?
Are you now, or have you ever been, a member of the Communist Party?
The spending is very concentrated (Score:5, Insightful)
5% of the population (15 million people) account for 50% ($1 trillion) in spending.
http://www.ahrq.gov/research/ria19/expendria.htm [ahrq.gov]
Re:The spending is very concentrated (Score:5, Interesting)
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.
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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.
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This is not sickness. This is the consequence of eating too much food and not exercising. It would be entirely reasonable to ask if healthcare dollars should go to treating people for eating too many twinkies.
Depression is horribly overreported. Being bummed out because your life is not going as you wish is not depression. It's just being sad.
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Perhaps we're spending at least half our health care dollars on people who are seriously sick or injured. The horror!
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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
Re:The spending is very concentrated (Score:5, Insightful)
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.
Already Well Studied in the US (Score:4, Interesting)
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.
Non-Americans? (Score:2)
Or perhaps you aren't an American.
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Or British, though for virtually the opposite reasons.
Why Doctors Die Differntly (Score:5, Interesting)
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.
Re:Why Doctors Die Differntly (Score:5, Interesting)
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.
Re:Why Old People Die Differntly (Score:3)
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.
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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.
Re:Why Old People Die Differntly (Score:5, Interesting)
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.
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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
And dementia is a big problem (Score:5, Informative)
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."
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Lessons of a $618,616 Death (Score:4, Informative)
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.
Stop the hate (Score:5, Funny)
There's nothing wrong with living under a rock. It's energy efficient, quiet and affordable. And, no unwanted guests.
Break it down to the basics (Score:5, Insightful)
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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
Re:Break it down to the basics (Score:5, Insightful)
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.
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That's right.
Caduceus (Hermes, god of thieves)=2 snakes.
Rod of Aesculapius (Apollo, god of medicine)=1 snake.
Re:Break it down to the basics (Score:5, Insightful)
Americanitis (Score:4, Insightful)
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.
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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.
Not News (Score:2)
Top to Bottom Re-evaluation (Score:2, Informative)
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.
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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
Wrong Question (Score:3)
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.
No reliable statistics found. (Score:3)
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.
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Where is your data? This is not what the data I have seen shows.
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That doesn't sound like a problem. If I need healthcare, I don't want to be sold on more expensive procedures or extra procedures. I want what is necessary.
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You think all the pharma companies do it because they care, deep down?
That statement is silly. Whatever motivates people to provide good health care of another is fact.
It doesn't matter if you don't like why. When you dive in the psyche for a lot of people, regardless if they're doing something nice or not, often when you find their reasons for doing so, you won't like it.
Ideally, sure it would be nice if people's motivation was simply 'to be better and care for others as a human being'. Wake up, we're not in a fantasy world.
What makes you think greedy doctors provide good health care? I can't speak for every field, but as a software developer I can tell you that 95% of the devs I worked with that didn't like coding were also not good at coding. I have to imagine it's the same way with every profession, including medicine.
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Just who are you to determine how much someone should get paid for whatever job they take? I'd like to know what job you have and how much you get paid and let me see what you own, I'll also decide what you do and do not need to live a life of such means to match your skills.
Well, I'm a federal employee, FV-I, making the minimum for my pay band ($68k/year), working as a lead developer and project manager. Go look it up if you care, since my income is a matter of public record. I work to support myself and my family, but I could make a *lot* more at one of the local oil companies, assuming I was willing to vote how I'm told, participate in employee prayer sessions, and never, ever say anything disparaging about the state of our energy system in this country.
If you want to k
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Actually - making money should be your ONLY motivator in being a doctor.
If you want to save people, go be a minister.
I'm really glad you're not my doctor. Who knows what kind of ineffective, overly expensive treatment you'd recommend just to line your pockets.
Re:"health care" = "disease management" (Score:5, Insightful)
Hi grub! You're back! We missed you!
Unfortunately, this time you're more correct than insane. (We won't talk about the adjustments - those should be done with a framing hammer for most people).
The little article quoted to support the argument that 'more spending is better healthcare' is illustrative.
mortality rate was 12.7% vs 12.8% for AMI, 10.2% vs 12.4% for CHF, 7.7% vs 9.7% for hip fracture, and 3.3% vs 3.9% for CHF
Note those big differences folks. Right down there in the noise floor.
In the US we spend WAY too much doing things to people that gives very little benefit to them. The major culprit is the 'free market' system where profit (at multiple levels) is considered the appropriate metric. Although everyone and their little sister will go on about how 'patient care is first', everyone in the system realizes that this is just a sop to the weak of mind.
It's been an interesting experiment, but the results are all too clear. Going to be a bit longer before the folks who stand to benefit from this mess get forced to clean it up (just like a couple of other industries, isn't it?).
Re:"health care" = "disease management" (Score:4, Insightful)
1) Mortality rate != quality of life. My "health care" is about the latter, while the former also plays a role.
2) Insurance Scheme != Free Market. If you went to an old lady and said you can either have the $90,000 that a hip replacement costs, or you can get the replacement, THAT is free market. People would be more diligent about the VALUE of their treatment. Can $90K buy more quality of life than the replacement? I suppose that depends on the situation, but at least the person getting the treatment could actually have "informed consent"!
Illustrative Example (Score:4, Insightful)
Exactly. Insurance disconnects market forces that would otherwise put downward pressure on price and consumption of services.
Here's a personal example:
During a recent visit to the dermatologist, he casually says he's sending me down to get some blood drawn to run some tests. The nurse takes my blood, and I go home. Three weeks later, I get the bill, for over $1,670 for the "labs." If I had known, that was how much they were going to charge, I would have never allowed them to draw my blood. And this is the problem.
They compel you to consume a service, without ever knowing the price before you as a consumer are allowed to make the purchasing decision. No ability to shop around, or incentive for competition on price. And you are legally obligated to owe the debt, before even knowing what it will cost you. They just send you the bill for whatever amount they want weeks later. Talk about a business model.
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Three weeks later, I get the bill, for over $1,670 for the "labs." If I had known, that was how much they were going to charge, I would have never allowed them to draw my blood.
That depends on what the test is for. If he says, "You might have X. This blood test can tell. If you do, and we catch it in time, it can save your life." (Or, "Then you can put your affairs in order.")
$1,670 is much higher than the standard panel of automated blood tests, the SMA-20, which I'd guess is $100, so it must have been some specialized test.
I agree that he should have explained to you what it was for, and how much it was going to cost. But if he did that for every patient, he'd have to raise his
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Still want to put that $90k under her nose and offer to have her sign her death certificate to get it? No, I didn't think so.
While I don't think that's the best solution, I think it's much more equitable than what we have today. As long as she is informed of all the ramifications.
Re:"health care" = "disease management" (Score:5, Insightful)
> In the US we spend WAY too much doing things to people that gives very little benefit to them. The major
> culprit is the 'free market' system where profit (at multiple levels) is considered the appropriate metric.
How exactly is our healthcare anything like free market? Do you get any real choice in provider? Do you know the prices? Do you evaluate cost vs. benefit before buying the service? Does anyone even perceive healthcare as buying a service?
The reason we have this problem is precisely because healthcare isn't a free market. People see things as being "free" (and will complain bitterly if they're not), and never bother to ask whether or not dropping $10+k on a pointless treatment really matters. (Hell, half the time it's difficult to impossible to figure out what the cost is anyway. Good luck getting a straight answer on that, when the quoted "price" is 4x what would be normally be paid by a healthcare provider.) If there's no cost, there's no competition and no cost-benefit analysis.
When it comes down to it, even thought the service is technically provided by the private sector, the only choice you have in it is, essentially, who your employer is (to the extent you can call that a choice). Even in an illegal conspiratorial oligopoly you can at least pick your poison. As it is you pretty much get what get and nothing if you don't want it (but you'll still be paying for it anyways). If that's a free market then so was communist Russia.
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The reason we have this problem is precisely because healthcare isn't a free market
OK. You seem convinced of this position, and I'm genuinely curious. Can you give an example of a country where there exists a genuine free market in health care, that achieves better health results than the USA does? There are roughtly 200 countries to pick from, and I know some have neither socialized medicine nor insurance systems, so throw me an example please.
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The closest thing you will get to a free market in health care was the in the U.S...a long time ago. Don't confuse old technology with old policy when comparing the two by saying "we'll go back to using leaches". I believe the first major change to this was in 1973. The GP is completely correct in that the major problem in health care today is that people don't pay directly. There are proxies and no one knows the price.
If gas prices were hidden and the government (or insurance company) paid for them, pe
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But if that's the case, then one of the many many countries with no socilization of their health care system at all ought to have better outcomes than the US. So show me one.
Here, I'll even do a little of the legwork. The World Health Organization ranked countries by healthcare efficency here [who.int]. The USA ranked 37th (of about 190). So if the real culprit, as you folks are claiming, is how "free market" the system is, then which of those 36 more efficient countries has a free-er healthcare market than us?
Re:"health care" = "disease management" (Score:5, Insightful)
That's a rather accurate and complete description.
I only have a couple things to add.
The quoted price is what you risk paying if you don't have insurance. So a high quoted price is something good for the insurer as it will scare you into buying their overpriced services.
Some insurers might pay more than others for the same service, so one could think they would want to reduce the "quoted price" so they all benefit by paying less. But I am more and more convinced they actually benefit too much from the absence of reasonable public prices and therefore are trying to keep the non-transparent pricing in place.
I am not familiar with many drugs, but the few I know make it clear that your insurer doesn't care about getting you a good price for drugs. The copay of drugs can be 2 to 3 times more than the list price or quoted price of the same drug in France (whereas food, clothing, gas and many other commodities are rather cheaper in the US). This is a clear indication that the insurance company acts like a broker that helps you buy services but it actually doesn't care if you get ripped off. The only meaningful difference is that in France, the insurance company negotiates the list price down. So everybody, even those who don't have insurance benefit from the negotiation.
If we were able to switch insurance providers easily, we would be able to choose the best brokers and also the best coverage. The only issue is that you don't want freeloaders in the system, so you need a minimum level of coverage that people must get. Otherwise they can just go with a dummy insurance for 2$ and then when they are sick they can just benefit from our humanity (i.e. we are human so we won't let them without care when they show up at the emergency room).
Overall, healthcare is an issue that is both social and individual. Therefore it can't be simply handled by pure market or pure governmental solutions. But at least we should make sure we have working market components in the solution and working governmental components too.
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Dude,
Everybody benefits from ridiculous quoted prices. The hospital increases prices 10%. The insurance company negotiator negotiates some of that price increase away. Because the discount for his company is now 55% of list price, rather then 50%, he gets a bonus. The hospital gets a) 5% more profits for no extra work, or b) 5% more to waste on sexy prestige-bringing, low-revenue crap like brain surgeons; so their executives get a bonus. The insurer can jack up premiums and 'prove' they're justified to the
Re:"health care" = "disease management" (Score:5, Insightful)
The reason we have this problem is precisely because healthcare isn't a free market.
I'm not a total free-marketer, but I have to agree at least this far: the problem is that we have built a system that is neither a free market nor a socialist system, but instead borrows from the worst qualities of both.
Most people don't have a choice in healthcare nor do they have a clear idea of what costs they're paying, or what costs they would be expected to pay if they faced an emergency. Health insurance has been heavily subsidized by the federal government for decades. On the other hand, it isn't regulated very well, the costs aren't made transparent, and it's run as a for-profit venture. You basically have a subsidized government monopoly without serious regulation or even the supposed motive of helping people.
In my view, we should basically pick one road or the other. The way we have things set up right now is just corporate welfare, but nobody really wants to end it. Conservatives like corporate welfare because their economic theory boils down to "give rich people more money, and they'll fix everything." Liberals want the socialized system but want to hide behind some free-market trappings.
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The purpose of the US health care system is to provide return on capital, it does that very well, what's the problem ?
That IS the problem.
Someone has to be severely messed up in the wetware to think that a "moral society" and a capitalist approach to the easing and comfort of human suffering are compatible concepts.
Re:No, it does not (Score:5, Interesting)
Living in Canada, I can tell you - our healthcare system SUCKS. Have a broken arm? Go to the emergency room and sit there for 4 to 6 hours for someone to attend to you...
The exact same thing happens in the US (triage is triage, after all), and then you get a $3000 bill in the mail.
Sounds great, right?
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Living in Canada, I can tell that you have zero experience with a health care system outside of our own.
Yeah, it's crummy. I've been hit by two cars in my life, and I've spent my time in my share of emergency rooms while bleeding and hurt. But once I left the emergency room, I didn't pay for any of the care I received. And, on the grand scale, it wasn't so bad.
I remember sitting in the waiting area, and one of the hospital volunteers came around to talk to me. He asked if he could get me anything, and apolo
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