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National education & health care

by Nereid
Tags: care, education, health, national
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Zero
#55
Mar18-04, 11:48 AM
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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?!?)
Zero
#56
Mar18-04, 11:52 AM
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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... You didn't have to be rude about it, though. You can stop being a poopyhead anytime you like.
phatmonky
#57
Mar18-04, 11:52 AM
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Originally posted by Zero


(can anyone spell bureaucratic?!?)
I can now.
Zero
#58
Mar18-04, 11:55 AM
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Originally posted by phatmonky
I can now.
So can I, now, thanks to dictionary.com...let's see how long it lasts, though.
Monique
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Mar18-04, 11:56 AM
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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.
Zero
#60
Mar18-04, 11:58 AM
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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.
adrenaline
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Mar18-04, 04:50 PM
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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.
Nereid
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Mar18-04, 06:06 PM
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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)
Nereid
#63
Mar18-04, 06:31 PM
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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.
phatmonky
#64
Mar18-04, 07:16 PM
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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).
I'm not arguing our system is perfect, I am trying to help you pin point the answers to your questions
Nereid
#65
Mar18-04, 07:52 PM
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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.
GENIERE
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Mar18-04, 08:16 PM
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Monique seems oblivious to the imminent failure of Belgium’s health care system and her government’s serious investigation into “privatizing” healthcare.

The present system is described as free but in reality is costing Monique and others 3.5% or more of their income not including the insidious co-payments demanded of the poor. It is not mentioned that her government is seriously pursuing “privatizing” healthcare. Industry in her country will soon face severe competition from within the EU and will have to relocate to friendlier countries to remain competitive. Monique’s parents may enjoy the fruits of Monique’s labor but it is not likely that Monique will.

Adrenaline is fortunate to be attending med school in the US. If she were from Belgium, the government might have prevented her from attending a med school or even a pharmacy school.

From MarketResearch.com:

“This report covers detailed socio-demographic, market analysis, and business evaluation for private medical insurance coverage in Austria, Belgium, France, Germany, Italy, Ireland, Netherlands, Portugal, Spain, Switzerland, Czech Republic, Hungary and Poland.

The rising cost of medical treatment and aging populations are putting enormous strains on public funding for health. Governments are under increasing pressure to encourage people to subscribe to private cover and alleviate the burden on state facilities.”

The US is to a great extent subsidizing and improving healthcare the world over. American companies develop most technological advances via research paid for by the US worker.
Nereid
#67
Mar18-04, 08:26 PM
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Er, I think that Monique lives in the Netherlands, not Belgium.
Nereid
#68
Mar18-04, 08:28 PM
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GENIERE wrote: The US is to a great extent subsidizing and improving healthcare the world over. American companies develop most technological advances via research paid for by the US worker.
Evidence?
Nereid
#69
Mar18-04, 08:35 PM
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{I don't want to copy the whole post again}

That some European governments are having difficulties funding the health-care of their aging populations isn't the point.

To repeat: why does the US spend - on average, per capita, PPP, inflation adjusted $$ - *twice* as much as the Netherlands, UK, Japan, Australia, Canada, Switzerland, Singapore, ... for essentially the same outcome (health-wise)? That's why it's called "gross economic inefficiency".

Especially as this same thing is not observed in any other significant economic sector (the US gets more bang for its $buck than most other economies), other than agriculture.
GENIERE
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Mar18-04, 08:41 PM
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Er, I think that Monique lives in the Netherlands, not Belgium.
My apologies to Monique.

Evidence?
Good point, I’ll try to provide it although I’m tempted to utilize the liberal ploy of having someone prove the negative.
phatmonky
#71
Mar18-04, 08:46 PM
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Originally posted by Nereid
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.
However, when you mention things like life expectancy, murders, car wrecks, and obesity will all play a large part when the numbers are as high as ours our. That's all I was getting at :)
adrenaline
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Mar19-04, 05:34 AM
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Nereid is spot on. Why can't the US direct its outstanding talents in so many other market forces to correct the dismal iefficiency of our medical system with what we have now?


I believe it comes down to our expectation. For the last 30 years, health-care costs have been rising 6 percent to 8 percent a year—more than double the inflation rate in the rest of the economy—because demand keeps outstripping supply. As people's real income rises, they expect more medical care; our society is aging, so people need more care; and with new technologies treating formerly intractable conditions, people want more care.

In practice, almost everyone, insured or not, has access to health care, especially in emergencies. Insurance affects how much people actually use health services:

The access of the uninsured involves inconveniences and costs that encourage them to underconsume medical services, sometimes with grim results.

By contrast, people with insurance often have such broad access that many overconsume those services. People are running to the doc after two days of dealing with a viral upper respiratory infection. These consumption patterns drive the price increases that ultimately shrink insurance coverage. No politician is going to put it straight to the public. Anyway, who gets elected president by telling people that their health-care costs will soar so long as everybody has access to the most expensive forms of care?

Health care's path began when employers in World War II, desperate to attract workers without breaching wage controls, first offered health insurance as an untaxed fringe benefit. This approach took strong root.

Over time, these beginnings brought most people into an insurance system that insulated them from the full cost of each treatment; they also left government as the insurer for everyone outside the work force, notably retirees and the poor. All insurance markets are subject to "moral hazard," where the small personal cost of using the insurance—a co-payment in this case—encourages people to overuse it for minor complaints. The hazard is intensified in the case of health care, because people don't pay for the insurance directly. To be sure, working people ultimately pay for their coverage in lower and slower-rising wages, but the cost of premiums is still subsidized by its tax-free treatment; when I write the checks for my employees, they don't even feel the pinch directly when premiums go up. (Imagine how much less coverage many would accept if we all had to write annual premium checks for $4,000 or $5,000.) These hazards are even greater in public-sector health care, where the retirees and poor consuming most of the services don't bear most of the taxes financing them.

Individual costs are rising, but other forces continue to undercut greater price discipline. In most markets, for example, this discipline also depends on people having the information required to judge the value of goods or services before they buy them. In health-care markets, how many people have the information to say no to a more expensive test for diabetes or a treatment for a heart murmur? The norms of the medical profession are supposed to align a doctor's incentives with a patient's medical interests (especially when the prospect of a malpractice suit reinforces these incentives). But there's no mechanism to align the financial interests of doctors and their patients. (So doctors can deliver sound health services in ways that maximize their billings. )

When prices rise unusually fast in other markets, people can usually find and substitute cheaper products: Beef prices rise and people eat more chicken, or a real-estate bubble drives up housing prices and people downsize their residential ambitions. That doesn't work nearly as well in health care, when patients are told that the alternative to a costly test or procedure is poor health or even premature death.


As a society we determine how much health care we want . Unfortunately, our desires have no relation to what we would spend. The current system has no balances. Universal health care would not improve that problem, it would only shift the locus of control.
Our health care insurance system is broken. Perhaps we could look at ways to improve that system, and in some way link behaviors with costs (e.g., smokers and the obese would pay higher insurance) and expenditures with graduated co-pays. I can tell you right now, it is the medical treatment and expense of two of my employees, one a smoker and one obese, who has driven up our premiums for the whole office. Only when each individual starts to understand costs will market forces apply. Without the power of market forces, I suspect that we will be continuing this debate forever.


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