## national education & health care

 Originally posted by phatmonky Why don't you take the time to go read my posts instread of putting words in my mouth?[zz)]
Why don't you answer the question?

 Originally posted by Zero Average wait time isn't the only measure, though...wasn't it you who claimed that American doctors also call for unneeded procedures on a regular basis?(if it wasn't, just ignore that part) Other measures would have to include infant mortality, missed work days, etc.

No, it was me who said that overly beauracratic hospitals tie the hands of the doctor by telling them they are ordering too many tests (for the budget). My point is that I want more doctor autonomy, and I don't see that happening with a fully socialized system in this very political country.

The reason I mentioned the wait times agian, was that your post came in response to mine(mentioning specific incendents). In that post, I first mentioned the research I had posted earlier concerning the topic.

 Originally posted by Zero Why don't you answer the question?
Because, as USUAL, you are unable to read the thread you wish to participate in. I'm tried of having to hold your hand, like a child, through all the big bad discussions......

 Originally posted by phatmonky I prefer a privatized healthcare system no matter what. When I say that, that doesn't mean I woudl be against looking at alternatives to the insurance setup. It means I am against having doctors and hospitals all put under government control,pay, etc. I believe that doctors need to be given the autonomy to do what is best for the patient. Ask a doc who has worked in a heavily beaurocratic hospital, and you will know that they are told to stop ordering so many CTscans and other tests. I also would like to see a revamp of our medicare/medicaid system. I believe that all children should have healthcare access,and I believe that for extremely high cost/income ratios there needs to be some sort of aide given. With that all said, I don't support any system that will limit the patients ability to pay for the most superior service available, if they are so inclined. I also don't like the idea of a socialized healtcare because of the lack of incentives to NOT go to the doctor. I have spoken with canadian doctors who tell me about abuse of the 'free' system. The nurses would chew people out because they come up there with mosquito bites wanting a benadryl shot to stop the itching. How can such a system work, when people are so obese and unhealthy here already? The answer is, that it can't. Not without raising costs evenmore. Cover children and extreme cases. Give selection, incentives to stay healthy, and doctor autonomy. Then you have the perfect system.

EDIT- HOw funny, it's even the thread you referenced concerning doctors ordering tests.

 Originally posted by phatmonky No, it was me who said that overly beauracratic hospitals tie the hands of the doctor by telling them they are ordering too many tests (for the budget). My point is that I want more doctor autonomy, and I don't see that happening with a fully socialized system in this very political country. The reason I mentioned the wait times agian, was that your post came in response to mine(mentioning specific incendents). In that post, I first mentioned the research I had posted earlier concerning the topic.
Ok, cool...carry on. Of course, I don't see the difference between insurance companies screwing us over and teh government screwing us over...with the possible exception that there should be more money for health care compared to private insurance, since a government program would be not-for-profit, and no CEO would be skimming off our premiums to but a home in Aspen.

(can anyone spell bureaucratic?!?)

 Originally posted by phatmonky Because, as USUAL, you are unable to read the thread you wish to participate in. I'm tried of having to hold your hand, like a child, through all the big bad discussions...... FROM THIS VERY SAME THREAD: EDIT- HOw funny, it's even the thread you referenced concerning doctors ordering tests.
Thanks for answering the question...[:D] You didn't have to be rude about it, though. You can stop being a poopyhead anytime you like.

 Originally posted by Zero (can anyone spell bureaucratic?!?)
I can now.

 Originally posted by phatmonky I can now.
So can I, now, thanks to dictionary.com...let's see how long it lasts, though.

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 Originally posted by Evo I would have gone ballistic if I had to deal with that.
I know, they run those places like it's a business and they don't need the customers.

 Nereid, yes, your friend should live here, I selected this area for these specific reasons.
See, this is a major difference between the US and (western) Europe. In the US it is all privately owned and people flock to the areas that are most profitable and comfortable to live in. About a year ago I read about a research which showed that certain areas in the US have a grave shortage of doctors, while other areas are completely overcrowded by them. Ofcourse Europe consists of all small countries, so coverage is much more uniform.

 Zero, you're absolutely right about insurance being the driving force behind many of the problems within the health care industry.
Oh, I agree here too, if doctors don't want to see you because the TYPE of insurance that you have, that is just rediculous and shouldn't even be on their mind.

 Originally posted by Monique Oh, I agree here too, if doctors don't want to see you because the TYPE of insurance that you have, that is just rediculous and shouldn't even be on their mind.
Unfortunately, the free market leads to consolidation, uniformity of service, and a health care field run by accountants.

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 Originally posted by Monique I know, they run those places like it's a business and they don't need the customers. See, this is a major difference between the US and (western) Europe. In the US it is all privately owned and people flock to the areas that are most profitable and comfortable to live in. About a year ago I read about a research which showed that certain areas in the US have a grave shortage of doctors, while other areas are completely overcrowded by them. Ofcourse Europe consists of all small countries, so coverage is much more uniform. Oh, I agree here too, if doctors don't want to see you because the TYPE of insurance that you have, that is just rediculous and shouldn't even be on their mind. [/B]

Unfortunately, many times a doctor can't see a patient with a particular insurance because they are not on the "plan". Not out of choice....for instance, United for Seniors HMO dropped eastern Georgia because they were losing money in that region. Doctors did not drop it. If a United for Seniors wanted to see a doctor, they could, but would have to pay a office visit (say $75) and if any tests had to be ordered, the ordering doctor, who is not part of United for Seniors ,cannot get the referral and precertification so that the insurance can pay for it. This is becoming more and more common. Instead, these poor folks have to drive 45 miles into Atlanta to see a doctor or hospital on their plan. As for medicine being a business, unfortunately, it has to be so..... in part. With one doctor requiring ancillary staff of at least 2 phone people, 2 nurses (one to take care of patients and one to take care of referrals), an insurance specialist, a check in person to verify and ask permission from the insurance each time, a person to pull files, an office manager, a computer specialist etc. (our practice of three docs have over 20 ancilllary staff..... they cannot be asked to work for free.) They want their raises, 401K, dental and medical and disability insurance, workman's comp, disability insurance, three weeks of paid vacation and paid continuing medical ed ,uniform allowance and this is in addition to malpractice premiums more than half a doc's salary, a rent of$25,000 a month, 18 phone lines (always busy) costing over three thousand a month etc. Docs are taking it out of their paychecks (as I stated, Georgia docs average less than plumbers and chiropractors) but still the overhead grows. If we don't keep ourselves in business, there is no service to the patients if we go out of business and move to another state...as it is already happening.

I don't like our system as it is. It is broken. We need to salvage it. We have alot to learn from socialized medicine...negatives and positives. The AMA, American Medical Association, favors a nationalised health insurance...just getting rid of the bureaucratic nonsense with all the different paperwork and rules will be more cost effective. Medicare is already a form of it, though wrought with bureaucracy, it is the same from patient to patient. The rules and regulations change from one private insurer to another.

Uninsured patients are bankrupting our local hospitals as insured patients don't necessarily pick up the difference anymore.

However, a socialized medical system won't work for the simple reason that americans will not give up the right to sue, so that's out. (Can't expect a doc to pay for huge malpractice premiums on a civil servant's salary. ) In addition, we are too big and inhomogenous.

The Canadian medical system is pretty good until you get very sick and the "limit" has been spent. They have a back door.... us, which is why they work. (For instance, a 8 year old with a leukemia that is 80% curable could not be treated in Canada until the new year came around due to the budget deficit in her area hospital. She was in a blast crisis and waiting 3 months was sure death. Her mother took her 3 hours south to Dartmouth Hithcock medical center in New Hampshire, and had her treated successfully with induction therapy within 2 weeks.) That is just one small sample.

However, socialized medicine has it right when it allocates care to children and infants, and denies protracted, futile care in those who are elderly. (50% of all medicare dollars are spent on the last year of a elderly person's life.) Right now, if you want your 99 year old mother to have full artificial resuscitation and life suuppport costing $10,000 a day in the ICU, you have every right to it...and trust me, this happens. Don't know what the answer is but just the acknowledgment that we are not the best system in the world will be a first step........In short, Canada's health care system achieves more for less than the U.S. system. But to be perfectly honest, neither country is close to the top of the heap when you look around the globe. Back in 2000, if memory serves, the World Health Organization ranked countries' medical systems on the basis of how much bang they got for their buck. The world leaders were the French and Spanish. Canada ranked 30th; the U.S., 37th.  Recognitions: Gold Member Science Advisor Staff Emeritus I was wondering how long it would be for adrenaline to post to this thread. Great post, as always ... too few of us know what it's like from the POV of a dedicated doctor. On another aspect, I realise (thanks to some PMs) that the gross economic inefficiency of the US health-care sector hasn't been well described. I ask Njorl, SelfAdjoint and others who understand these concepts well to please jump in and amplify/clarify/correct. In economics, the activity of an industry sector can be described in terms of the proportion of the national GDP which it accounts for. This activity encompasses all aspects of the sector, and all players. While there is always room for disagreement over definitions and accuracy of statistics, economists generally have a pretty good handle on both the data and concepts, at least in developed economies like the US, the countries of the EU, Japan, Australia, etc. When you examine the level of economic activity by industry sector, you find a most extraordinary result - the US spends* approx twice as much as other developed economies on health care. By itself this isn't particularly noteworthy; the theory of economic advantage says (for example, caveats apply) that global economic utility is maximised by each economy concentrating its economic activity in sectors where it has a comparative advantage (this does NOT mean where it is cheapest! note the word 'comparative'). However, when it comes to health-care, where almost all the economic activity is domestic (ie no significant imports or exports), the benefits are not purely economic - most of us don't seek good health in order to work harder! So, what are the (economic or other) returns on the disproportionately large 'investment' that the US economy (not people!) makes in health care? That's the paradox; apparently none (of any significance): - no increase in life expectancy - no decrease in infant mortality - no reduction in incidence of major cancers - no increase in 5-year survival rates from major cancers - no decrease in incidence of heart disease - no increase in 'quality of life' for seniors - etc, etc, etc. Note that we're not talking about a few % at the margin; the contrast with ALL other advanced economies is stark. Some links: Health spending (US$ PPP) by economy A major business opportunity *this is measured as % of GDP (a measure of total economic activity) per capita (a.k.a. population), expressed in $PPP (purchasing power parity; basically this metric removes distortions due to differences in exchange rates and the fact that the same basket of goods and services cost very different amounts in each economy, even when measured in constant (inflation-adjusted) US$). Oh, and just to forestall some likely questions, my sources are that well-known left-wing, all-but-communist publication, The Economist, among whose avid readers are most Economics Nobel Prize winners, Henry Kissenger, Pascal Lamy, Robert Zoellick, Tony Blair, Gordon Brown, ... (but not a certain Bush from Texas)
 Recognitions: Gold Member Science Advisor Staff Emeritus The US health-care sector is quite mysterious because, AFAIK, there are no* other large sectors of the US economy that are so far out of whack (cf other advanced economies). *well, there's one other - agriculture (US farmers are grossly inefficient - economically, on average - when compared to those in other countries). However, this sector is well understood, and the gross inefficiencies far from unique - e.g. French farmers are far worse - and the EU's CAP is even worse for *everyone* (except a few thousand rich farmers) than the US's agricultural subsidies.

 That's the paradox; apparently none (of any significance): - no increase in life expectancy - no decrease in infant mortality - no reduction in incidence of major cancers - no increase in 5-year survival rates from major cancers - no decrease in incidence of heart disease - no increase in 'quality of life' for seniors - etc, etc, etc.
I would like to see other country's statistics for cancer rates, murder rates, obesity rates, obesity related illnesses (all of which are typically assumed to be higher in the US than other industrialized nations).

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 Originally posted by phatmonky I would like to see other country's statistics for cancer rates, murder rates, obesity rates, obesity related illnesses(all of which are typically assumed to be higher in the US than other industrialized nations). I'm not arguing our system is perfect, I am trying to help you pin point the answers to your questions
I'm sure someone can dig these up - a few hours with google (and a good nose for BS and agendas) should do it. From memory:
- cancer rates: no significant differences
- murder rates: US way higher (murders involving firearms), but when age adjusted (young men seem especially prone to murder), not that much different
- obesity rates: I don't know
- obesity related illnesses: ditto.

The comparisons that need to be made involve many other economies. For example, the murder rate in Japan is way lower than that in the US. However, does that difference contribute in any significant way to a 2x difference in the economic efficiency of the health-care sector? I rather doubt it. First, I'd guess that murder has next to no impact on either economy's health-care costs (it would've been far, far different in WWII). Second, if it were a significant contributor, the effect should show up in the health care spending in the UK (say), where the murder rate is significantly higher than in Japan.

In the same way, other demographic differences should (could?) matter too. For example, the Japanese population is significantly older than that of the US (look at the age demographics; look at the life expectancies), and older people are heavier consumers of health-care than the rest of the population. You would thus expect that health-care would be a greater proportion of per-capita GDP in Japan than the US (cet. par.). It isn't.
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