Is the U.S. Healthcare System Overpriced and Underperforming?

[russ_watters]

This may sound odd or even blasphemous, coming from a doctor, but I wonder whether this effort to keep many of the premies alive is worth it. I'm not talking about abandoning care for any kid in trouble, but being selective in our efforts. The life at all costs is part of the problem, IMO. This applies to all parts of the age spectrum, and no I'm not some heartless beancounter. But clearly we cannot afford to provide the state of the art care available to every US citizen. The $$ it costs to die is staggering, even when all are agreement that it is essentially futile care.

No, I'm totally with you on that. It is largely a western (and even more American) ethics/morality thing, but in a lot of cases it means prolonging pain or spending time/money/effort futiliy on a tiny chance of making a difference.

Simple example: the more time you spend trying to resuscite a not-breathing newborn (which, from above, Americans do more than most), the higher the likelyhood that newborn will suffer irreversible brain damage even if "successfully" revived.

 

[denverdoc]

No they don't. In fact SD's estimates are reasonable figures, about 1/6 don't have any form of insurance. Many are denied treatment. Others end up bankrupt after a serious illness. Hospitals are becoming ever more aggressive about collecting debts: generally within 90 days, debtors are turned over to collection agencies, who will soon make their lives hell. Many drugs are excluded from various insurance plans, even when they are by far the best or only available treastment. The only "right to health care" exists transiently when one is in need of immediate live saving measures. Beyond that, its good luck or bring cash. Now there are some exceptions, some of the childrens hospitals will turn no one away, and as Evo mentioned a few threads ago, there are "free clinics" which are not exactly free, but usually based on ability to pay. Collectively they serve less than 5 percent of the population and survive on the shoulders of benefactors and medical personnel willing to work for little or nothing. Because of the cost of extending free care which all facilities are requires to do, the costs of treatment/reimbursement rates depend to a large extent on whether one belongs to a large HMO/PPO. For instance a cash paying customer will generally pay at least twice for the same services as one belonging to a group which has has pre-negotiated rates for particular services. The only citizens with any built in services from tax dollars are those with Medicare, generally available to those over 65, and Medicaid, which is for those who are usually permanantly disabled. Some states have tried to augment services for the youth, which is partially federally funded.
J

PS: Mr Bush recently tried to steal these latter funds, meager as they are, to help pay for the war in Iraq.

 

[denverdoc]

No, I'm totally with you on that. It is largely a western (and even more American) ethics/morality thing, but in a lot of cases it means prolonging pain or spending time/money/effort futiliy on a tiny chance of making a difference.

Simple example: the more time you spend trying to resuscite a not-breathing newborn (which, from above, Americans do more than most), the higher the likelyhood that newborn will suffer irreversible brain damage even if "successfully" revived.

Not only brain damaged, which arguably is the worst kind of damaged, but these kids often have a plethora of problems affecting many organ systems. I hate those argumnts, if man was meant to..., but in this case I can't resist, if 5 month infants were meant to survive, women would have marsupial pouches.

 

[Schrodinger's Dog]

Not only brain damaged, which arguably is the worst kind of damaged, but these kids often have a plethora of problems affecting many organ systems. I hate those argumnts, if man was meant to..., but in this case I can't resist, if 5 month infants were meant to survive, women would have marsupial pouches.

Not to mention that we too also have an extremely sophisticated post natal healthcare system, if you want to know how I know I see it almost every day at work, the PICU has babies which weigh extraordinary small amounts in incubators and hooked up to a bewildering array of drugs.

We do the same things the US does, so this is not an argument it's another pointless obfuscation attempting to devoid itself of the real reason for poor infant mortality: 46.6 million people without health care. And those aren't my figures there yours and there not under negotiation. It works out at 1 in 6. The fact that you have the best healthcare in the world and not the best life expectancy - in fact your way down the list - is another telling statistic which also has a lot to do with the 46.6 million, and a lot to do with your extremely inefficient use of money, 14.1%GDP nigh on 4 times the size of your military expenditure and your at war?

 

[denverdoc]

Instead of looking simply at the number of Canadians pouring across the border in desperate need of proper medical care, break it down for us, how many want cosmetic or other procedures uncovered, or because they are nxious, don't want to wait. Or how about how many Canadians die whiole waiting for life saving surgery? Compare that to the US system, and yes it happens all the time if you're in need of a heart or a liver. Seems to me a lot of US citizens were flocking to Mexico for Laetrille at one time, and still go far and wide for healers of any stripe.

Cubans are very spoiled re health care in some respects, why there athletes seek out more during olympics has little bearing on the larger question.

Re the Brain drain? Maybe they want more $$, and see an opportunity to amass wealth beyond what they deserve?

IIRC, and correct me if I'm wrong, what the soviets attempted to do was to overcome a 150 year industrial head start, in a far flung land with multiple obstacles re languages and customs, and still beat us to space, despite our having grabbed the best and brightest german scientists and most of the V2 parts. Its not a system I agree with. Its too centralized, and when big corporations here in the US fail, often for the same reason. Its why the skunk works succeeded in so many feats of derrring-do, when the mother corp couldn't. Instead of focusing on recompensation, look more closely at communication and flexibility. The US health care system fails miserably on both accts, and is why it drains more dollars than any other. Its all about promises, most of which remain unfulfilled, but to a dieing man, any straw will do.

 

[gravenewworld]

why not have a mandatory healthcare tax taken out of paychecks which could be used for healthcare? that way if someone needs to use the hospital, but has no healthcare, the amount that was taken out of the paycheck could be used to pay for some of the costs. if there was any money that was left over after a person retired it could then be rolled over into a retirement account (this could even help with the huge problem that Americans have with saving money for retirement). also, give people incentives for preventitive measures instead of always looking for a cure. offer tax breaks for people who live healthy lifestyles. public transportation in this country is also terrible. the better the public transportation, the more people are willing to walk to get to places. I believe it was Portland (or possibly Seattle) that is pretty much the only city in the county that has bike paths/side walks for people to use to get in an out of the city. And Guess what? They happen to be one of the fittest cities in America.

 

[Schrodinger's Dog]

why not have a mandatory healthcare tax taken out of paychecks which could be used for healthcare? that way if someone needs to use the hospital, but has no healthcare, the amount that was taken out of the paycheck could be used to pay for some of the costs. if there was any money that was left over after a person retired it could then be rolled over into a retirement account (this could even help with the huge problem that Americans have with saving money for retirement). also, give people incentives for preventitive measures instead of always looking for a cure. offer tax breaks for people who live healthy lifestyles. public transportation in this country is also terrible. the better the public transportation, the more people are willing to walk to get to places. I believe it was Portland (or possibly Seattle) that is pretty much the only city in the county that has bike paths/side walks for people to use to get in an out of the city. And Guess what? They happen to be one of the fittest cities in America.

Not a bad idea, I think I mentioned Arnold Schwarzenegger's thinking of bringing it in in California bloody socialist Two states already have this. I can't remember which ones I think it's in the OP article.

 

[Schrodinger's Dog]

Actually, no, you never did acknowledge until just now that the numbers are out of date, and you still haven't provided an argument for why out of date numbers are valid, when I have shown that there is quite a bit of difference over 15 years.

Ie, while we may be 28th (in the link I provided), but the difference between us and the top (I took Andorra off, though...I think you would agree that it is out of line with the others and not really relevant anyway) is only 4.8%. Would you seriously consider that to be a major problem? How about in light of the improvement over the past 100 years? (life expectancies are roughly double what they were 100 years ago) I gave you the new numbers and you have not commented on them. And I gave you the explanation for it, and for which you responded with a non-factual conjecture.

Also of note is the way the statistics are read. When you deal in single-digit fractions of 1000, differences are amplified over, say, using the survival rate. Ie, an infant's odds of surviving their first year in the US are about 99.3%, while they are, 99.5% in the UK. That doesn't look like a real problem to me. That is meaningless for telling us what the quality of care is. None of that is meaningful, for reasons already stated and not addressed by you. Start defending your point or withdraw it (or we will do it for you again). And as already shown, that is just plain wrong. Well, ok, if that's what you want. If you get cancer or heart disease, you may change your mind, since the actual quality of care (measured by survival rate) is better in the US. The US is certainly not perfect - no country is. But both your figures and logic are inaccurate/misleading/outdated as already shown. There are quite a lot of things about the US system that are the best in the world and quite a lot of others that are comparable to other countries. The primary shortcoming of the US system is in the healthcare for the number that are uninsured, but that problem is not the disaster that some people imply. The tendancy, though, is for people such as yourself to argue a point that implies a rich-poor disparity that has the rich being the few percent at the top and the poor being everyone else and implying that healthcare is only good for that few percent while it is dismal for everyone else. The reality, however, is that while it is certainly true that the healthcare for our poor is worse than the healthcare for a similar fraction of the people in Europe, it is also true that healthcare for the other ~85% of the population is better in the US than in Europe. So if you want to use that as a stick to beat the US with, ok, but watch out for the other end of the stick!: we need to improve healthcare for 15% of our population and you need to improve it for 85% of yours!

13.4% GDP compared to Englands 6.6% GDP? It's not any better now.

Little bit biased but apparently they've become worse

It was implied, and I'm going to ignore you now as your not acknowledging there is a problem, even though there obviously is? Stop playing check the figures.

Two figures that should worry you.

46 million people without health insurance.

14.1% GDP

and ranked 28th in the world, behind most of Europes healthcare providers.

'nuff said I really couldn't care less about playing hunt the statistic, it's irrelevant, and all this crap about premature babies is just a smokescreen, we have the same treatments you do, your not talking about some Eastern Bloc country here.

Unless you can adimit you have a problem then there never will be a solution.

OK I'm a poor European who doesn't know your system, fine, it sucks anyway.