kallend 1,620 #1 October 22, 2012 www.pbs.org/newshour/rundown/2012/10/health-costs-how-the-us-compares-with-other-countries.html And it's not even partisan.... The only sure way to survive a canopy collision is not to have one. Quote Share this post Link to post Share on other sites
airdvr 197 #2 October 22, 2012 Quotewww.pbs.org/newshour/rundown/2012/10/health-costs-how-the-us-compares-with-other-countries.html And it's not even partisan. Your hero has pushed through ACA. It will correct these problems right?Please don't dent the planet. Destinations by Roxanne Quote Share this post Link to post Share on other sites
kallend 1,620 #3 October 22, 2012 QuoteQuotewww.pbs.org/newshour/rundown/2012/10/health-costs-how-the-us-compares-with-other-countries.html And it's not even partisan. Your hero has pushed through ACA. It will correct these problems right? That remains to be seen, but we know they'll only get worse if ACA is repealed.... The only sure way to survive a canopy collision is not to have one. Quote Share this post Link to post Share on other sites
lawrocket 3 #4 October 22, 2012 Here are some thoughts from portions of the article: Quote one hospital system's unusual approach to improving performance while reducing costs -- one based on Toyota's assembly line model for manufacturing cars. The concept is pretty simple: If waste is rooted out of the "assembly line process," the result will be better cars (or health outcomes, in this case) and lowered costs. Assembly line processes take out discretion. In health care, that’s called “nursing.” Our health care is based on two things: (1) patient choice; and (2) physician medical judgment. And – health care is an exception to normal economic rules. It does not get less expensive the higher-quality and more available it is. QuoteThe U.S. spent $8,233 on health per person in 2010. More than half of that spending was by federal, state and local governments. Our government already spends more per person that OECD countries. Ours is high quality medicine that is available on demand. It’ll be expensive. QuoteNorway, the Netherlands and Switzerland are the next highest spenders, but in the same year, they all spent at least $3,000 less per person. The average spending on health care among the other 33 developed OECD countries was $3,268 per person. Take a good look at the demographics. Like it or not, racial background – and cultural background – play a significant role in the diseases suffered. 80% are ethnic Dutch. Ethnic Dutch get the same diseases. Florida has a larger population than the Netherlands. Guess how much easier it is to have less expensive healthcare in that situation? QuoteIn the U.S., how much a health care service gets paid depends on the kind of insurance a patient has. This means that health care services can choose patients who have an insurance policy that pays them more generously than other patients who have lower-paying insurers, such as Medicaid. Hmmm. So the US government pays less and doctors don’t want to take it. QuoteThey are flexible in responding if they think certain costs are exceeding what they budgeted for. In Japan, if spending in a specific area seems to be growing faster than projected, they lower fees for that area How about that? “We’re spending a little too much money on dialysis. Cut the payments.” QuoteThey are often statutory and Medicare cannot change the rates without approval by Congress. This makes the system very inflexible for cost containment. Anyone else picking up on this? When a public health crisis occurs, cut the payments to the health care providers. This makes health care more affordable – by lowering access to it. QuoteThere are few methods for controlling rising costs in private insurance in the U.S. Private health insurance – and to an even greater extent PUBLIC health insurance – institutionalizes moral hazard. Of COURSE the price goes up when the cost of unhealthy actions is spread to others. Quote$900 per person per year goes on administrative costs. Yep. Say hello to “Medicare” Quote OECD countries use strong regulation to set prices that hospitals can charge for different services The same is done here by regulating what will be paid. It’s why Medicare will pay an OB/GYN $80 to do a hysterectomy – a procedure that takes more than 3 hours. Quoteand some of them even set budgets for how much hospitals can spend. That’s called “rationing.” QuoteThe quality of care delivered in hospitals in these countries are comparable to that in the U.S. So it’s high quality and inexpensive. It will therefore be rationed. Which is what has always been acknowledged. It’s why Canadian governors come here for treatment. QuoteSuch an approach still leaves room for differences in prices across regions and states Comparing the US to Switzerland in terms of demographics and even geography is ridiculous. Quote]A coronary bypasses costs between nearly 50 percent more than in Canada, Australia and France, and are double the price in Germany. There are a half a million CABG operations performed in the US each year. I don’t know the stats for Germany, or the wait time for it. Quotewith so many different kinds of insurance, no one organization has a strong incentive to cut out wasteful practices and ensure that all Americans get value for the very high levels of expenditure incurred when they are sick. THE KEY IS THE DAMNED INSUREDS! GO TO AN ER AND SEE THE PEOPLE THERE WITH NON-EMERGENCY CONDITIONS SEEKING TREATMENT BECAUSE THEY DON’T HAVE TO PAY FOR IT. The easiest way to cut costs is for the people to incur the costs themselves. QuoteThe U.S. did 100 MRI tests and 265 CT tests for every 1000 people in 2010 -- more than twice the average in other OECD countries. It does more tonsillectomies and more knee replacements than any other OECD country. It also has more Caesarean sections and coronary bypass procedures than in most other countries. Because Medicare will pay decent money for procedures. It’s that simple. It’s how they get paid – and the government encourages procedures by: (1) paying more for them; and (2) making sure that the patient doesn’t pay for them. QuotePayments that mean that physicians get paid more if they do more interventions, regardless of medical necessity. They agree with me. QuoteBecause patients ask for more tests and services. Yeppers. Why? Because they aren’t PAYING for the tests. Everybody else is. QuoteMedicare in the U.S. has long pioneered how hospitals are paid, by providing a fixed amount for a patient with a particular condition. This means that hospitals have an incentive to treat patients as quickly as possible and it also demonstrates how broader reform in the U.S. could potentially have large effects on costs. As well as incentive to discharge patients when money cannot be made. Hello, Medicare! QuoteThe size and diversity of the U.S. system has also provided room for more experimentation to try and find better ways to deliver health care. Wait – weren’t you talking about “assembly line” earlier on? This is anathema to assembly line. Quoteholding them accountable for costs and outcomes and the Medical Home model, which seeks to coordinate care and better engage patients and families, using health coaches, care transition pathways and other interventions to reduce expensive re-hospitalizations. Once again, hold everyone accountable but the patient. Obesity is health cost numero uno, but if doctors don’t’ prevent it then they are held accountable? What the? Quote Unfortunately, while the U.S. is better at trying out such innovations on a relatively small scale, it then struggles to roll out successful innovations nationally. Right. Because El Paso, Texas and Minneapolis, Minnesota have plenty of geographic, climactic and demographic differences. See “snowmobile crossing” signs. QuoteOverall, the life expectancy of a U.S. citizen, at 78.2 years, is shorter than the average among OECD countries of 79.5 years and there are a number of specific areas where U.S. health care is weak when compared with other countries. Why is this called a “health care” problem? I don’t’ see the problem as “health care” so much as “self-care.” Did Breitbart die because he received bad health care? Or did he die because of a genetic condition that was amplified by obesity and a generally unhealthy lifestyle? QuoteThe U.S. needs stronger policies in tackling lifestyles that lead to poor health. While many states are making efforts to reduce smoking, there are fewer policies to tackle the harmful use of alcohol in the U.S. than you would find in other OECD countries, such as higher taxes on alcohol or minimum prices. Or, perhaps, quitting with the ag subsidies that make it cheaper and easier to get a Big Mac than an apple. We’re suffering from diseases of affluence. Or how about we decline to cover the obese? I’m sure we’d find the obesity epidemic to be cured quite nicely if there was a disincentive to being obese, rather than incentives given for it. QuoteThe slides below show that the U.S. does poorly both in terms of diet and physical activity, even in comparison with other high-obesity countries, across all age groups. Interestingly, the poverty stricken have the worst problem with this. They used to be hungry. Now they are obese and malnourished. Thanks, government! Well done! QuoteSupport for physician counseling Take a poll of physicians about what percentage of patients actually comply with medical advice. Quoteprograms to help encourage healthier lifestyles vary widely with different insurance arrangements. Here’s one – penalize the unhealthy. Hey, they cost society. So penalize them into good health. Having them work on a vegetable farm is cheaper than lifelong diabetes treatments. QuoteThe U.S. has a national program to cover breast and cervical cancer screening for low-income women, why not have one to cover lifestyle counseling for low-income people? Because the former is a free service wherein the work and costs are borne by others. The latter is a free service that requires work and costs performed by the patient. That’s why it won’t work. Poor health is now a pre-existing condition that is covered, thus making it less expensive to be unhealthy. QuoteA similar picture emerges for chronic obstructive pulmonary disease (230 admissions per 100,000 population compared to an OECD average of 198, 2009). Note: COPD used to be called “emphysema.” But everyone knows “emphysema” is, the vast majority of times, caused by smoking. People gave themselves emphysema. Now “COPD” has come along, and those poor souls unfortunate enough to get it need help. A lifetime of cancer sticks and you get emphysema? Screw you. Pay for it yourself. But that’s just not right, is it? It’s a pre-existing condition that needs to be covered by all of us to control the costs of healthcare by increasing costs of treating it. My wife is hotter than your wife. Quote Share this post Link to post Share on other sites
kallend 1,620 #5 October 23, 2012 Nice conflation of your opinions with the article's facts. Nevertheless, based on outcomes the US spends more (a lot more) than anywhere else yet has a life expectancy lower than average.... The only sure way to survive a canopy collision is not to have one. Quote Share this post Link to post Share on other sites
lawrocket 3 #6 October 23, 2012 Quotebased on outcomes the US spends more (a lot more) than anywhere else yet has a life expectancy lower than average. And gee, one would think that sicker populations would have higher healthcare costs. They gave the solutions - quit paying doctors to take care of them and the costs go down. It's an interesting thought. But how do you think it will go over?' AND - tell me how to have unrationed, high quality and inexpensive healthcare. Note - every time the cost goes up they just cut funding. My wife is hotter than your wife. Quote Share this post Link to post Share on other sites
kallend 1,620 #7 October 23, 2012 QuoteQuotebased on outcomes the US spends more (a lot more) than anywhere else yet has a life expectancy lower than average. And gee, one would think that sicker populations would have higher healthcare costs. . So why is the population sicker if the healthcare is so good?... The only sure way to survive a canopy collision is not to have one. Quote Share this post Link to post Share on other sites
Icon134 0 #8 October 23, 2012 QuoteQuoteQuotebased on outcomes the US spends more (a lot more) than anywhere else yet has a life expectancy lower than average. And gee, one would think that sicker populations would have higher healthcare costs. . So why is the population sicker if the healthcare is so good? I'm going to go out on a limb and say that health "care" doesn't equate to less "sick" people. educating people and having those people actually follow the recommendations is the only thing that will help reduce the number of "sick" people... and that is difficult to impossible to do.Livin' on the Edge... sleeping with my rigger's wife... Quote Share this post Link to post Share on other sites
airdvr 197 #9 October 23, 2012 Spent some time this morning at a Home Health supplier...walkers, canes, crutches, nebulizers, and CPAPs. Basically stuff that is mostly paid for by Medicare and Medicaid. My take is you will lose the customer service aspect of health care when we eventually switch to a single payer system. It was like being at the post office. Everyone stuck in first gear, phones ringing and no one answering them. It might be less expensive but the old adage about getting what you pay for is in play here. Some competition is a good thing.Please don't dent the planet. Destinations by Roxanne Quote Share this post Link to post Share on other sites
lawrocket 3 #10 October 23, 2012 QuoteSo why is the population sicker if the healthcare is so good? Post hoc ergo procter hoc. These people would be dead but/for healthcare. Take a look at the 30 year old, obese diabetic with congestive heart failure and say it's the doctor's fault. That it's the health care system's fault. It's bullshit. My wife is hotter than your wife. Quote Share this post Link to post Share on other sites
lawrocket 3 #11 October 23, 2012 Quoteeducating people and having those people actually follow the recommendations Primarily the latter. My wife is hotter than your wife. Quote Share this post Link to post Share on other sites
SkyDekker 1,120 #12 October 23, 2012 QuoteAND - tell me how to have unrationed, high quality and inexpensive healthcare. Note - every time the cost goes up they just cut funding. The question becomes what you want your healthcare to do. Do you want very high quality healthcare available to some, or do you want lesser quality available to many? I like a hybrid system that combines both. A base system of public health care with an option for private health care. Say a Canadian health care system with a private health care system laid on top. Quote Share this post Link to post Share on other sites
rehmwa 2 #13 October 23, 2012 QuoteTake a look at the 30 year old, obese diabetic with congestive heart failure and say it's the doctor's fault. That it's the health care system's fault. It's bullshit. via the government, other taxpayers pay for his medical treatment - he chooses to take medication to make the symptoms tolerable so he can continue to make horrible and unhealthy choices he pays for his own medical treatment - he eats better tries not to be grossly obese and takes care of himself better It's not the doctor's fault, it's the economic support structure's fault. Good intentions with crappy results - it's a theme. (unless the 'results' have nothing to do with health and only about 'buying' votes from the greedy and ignorant - then the 'results' are great) ... Driving is a one dimensional activity - a monkey can do it - being proud of your driving abilities is like being proud of being able to put on pants Quote Share this post Link to post Share on other sites
SkyDekker 1,120 #14 October 23, 2012 QuoteTake a look at the 30 year old, obese diabetic with congestive heart failure and say it's the doctor's fault. That it's the health care system's fault. It's bullshit. That depends on how you define health care. If you include preventative care, then there is a certainly an argument to be made that the health care systems carries some of the blame. It appears to me that your system really doesn't focus on the preventative side of health care. That seems to be left to TV programming. Quote Share this post Link to post Share on other sites
SkyDekker 1,120 #15 October 23, 2012 QuoteIt's not the doctor's fault, Really, then who is prescribing the medication? Somewhere a doctor is aiding this process. Quote Share this post Link to post Share on other sites
airdvr 197 #16 October 23, 2012 QuoteQuoteIt's not the doctor's fault, Really, then who is prescribing the medication? Somewhere a doctor is aiding this process. Please enlighten us with what you think the alternative would be.Please don't dent the planet. Destinations by Roxanne Quote Share this post Link to post Share on other sites
SkyDekker 1,120 #17 October 23, 2012 Stop prescribing the quick fix and take away the benefits doctors get for prescribing medication. Specially benefits linked to number of prescriptions written. Quote Share this post Link to post Share on other sites
rehmwa 2 #18 October 23, 2012 QuoteStop prescribing the quick fix and take away the benefits doctors get for prescribing medication. Specially benefits linked to number of prescriptions written. Every decent doctor I know has a #1 complaint - the patient DEMANDS the quick fix and refuses to listen to discussions about nutrition and exercise and it's even easier to take a pass on the real fix when the 'quick fix' is paid for by someone else ... Driving is a one dimensional activity - a monkey can do it - being proud of your driving abilities is like being proud of being able to put on pants Quote Share this post Link to post Share on other sites
lawrocket 3 #19 October 23, 2012 QuoteIt appears to me that your system really doesn't focus on the preventative side of health care Our system focuses plenty on preventative care. There's education. Everybody knows about healthy choices versus unhealthy choices. Additionally, check out the fat payoffs to Pharma. A healthy lifestyle is bad for Pharma. Take a look at this: http://www.opensecrets.org/industries/indus.php?ind=H04 Note that the lobbying totals decreased dramatically in 2012. No need - they got the fat payoff with ACA. What's the problem? As Rehmwa stated, it's far easier to have somebody else pay for a pill to control blood pressure and continue with the present lifestyle than it is to change the lifestyle and lower your own blood pressure through a decent diet. We've got here the entitlement society being perfected. A healthy person is now required to pay more in order to "control the costs" paid by the unhealthy. Kallend frequently mentions that this same system mitigates freeloading. I respond that getting rid of the system that encouraged freeloading would be cheaper AND it does not end freeloading at all. We know it because the system will fail if the healthy are not required to pay more. The ACA itself simply provides alternative funding for the freeloaders. My wife is hotter than your wife. Quote Share this post Link to post Share on other sites
lawrocket 3 #20 October 23, 2012 QuoteStop prescribing the quick fix and take away the benefits doctors get for prescribing medication. Specially benefits linked to number of prescriptions written. Blaming the doctors for prescribing is like blaming the firefighters for water damage. The fire was there and they're trying to put it out. When people have to pay for their own medications, they'll figure out that spending $150 per month on blood pressure pills is not easy and perhaps they'll want to try to change something. My wife is hotter than your wife. Quote Share this post Link to post Share on other sites
SkyDekker 1,120 #21 October 23, 2012 Quote Every decent doctor I know has a #1 complaint - the patient DEMANDS the quick fix and refuses to listen to discussions about nutrition and exercise and it's even easier to take a pass on the real fix when the 'quick fix' is paid for by someone else So it is easier for the Doc to prescribe and they get benefits in return. Indeed, the doctor plays no role in this at all. Quote Share this post Link to post Share on other sites
SkyDekker 1,120 #22 October 23, 2012 QuoteBlaming the doctors for prescribing is like blaming the firefighters for water damage. The fire was there and they're trying to put it out. In Canada we have to conform to the fire code and any building permits have to be approved through the fire department. You are comparing preventative measures with acute emergency measures. Quote Share this post Link to post Share on other sites
kallend 1,620 #23 October 23, 2012 QuoteQuoteSo why is the population sicker if the healthcare is so good? Post hoc ergo procter hoc. These people would be dead but/for healthcare. Take a look at the 30 year old, obese diabetic with congestive heart failure and say it's the doctor's fault. That it's the health care system's fault. It's bullshit. What part of the concept of HEALTH is it that you don't comprehend?... The only sure way to survive a canopy collision is not to have one. Quote Share this post Link to post Share on other sites
kallend 1,620 #24 October 23, 2012 QuoteQuoteeducating people and having those people actually follow the recommendations Primarily the latter. Remember the original meaning of the word "DOCTOR".... The only sure way to survive a canopy collision is not to have one. Quote Share this post Link to post Share on other sites
kallend 1,620 #25 October 23, 2012 QuoteQuoteStop prescribing the quick fix and take away the benefits doctors get for prescribing medication. Specially benefits linked to number of prescriptions written. Every decent doctor I know has a #1 complaint - the patient DEMANDS the quick fix and refuses to listen to discussions about nutrition and exercise and it's even easier to take a pass on the real fix when the 'quick fix' is paid for by someone else See previous post about the original meaning of "DOCTOR". Healthcare <> medicine. The US HEALTHcare system sucks, as is clearly seen in comparing cost vs outcomes.... The only sure way to survive a canopy collision is not to have one. Quote Share this post Link to post Share on other sites
