# News Let's talk about healthcare

1. Feb 7, 2007

### Schrodinger's Dog

http://www.huppi.com/kangaroo/L-healthcare.htm

http://www.huppi.com/kangaroo/LiberalFAQ.htm#Backhealthcare

Little bit biased but apparently they've become worse, without going into the WHO's pdf's that are very long winded, but if you want to. And if anyone has a concise breakdown, I couldn't find it but apparently Canada and the US are 30th and 37th, ranked by bang for buck, or what you get for your dollar based on mortality, infant mortality, people without adequate healthcare etc,etc.

http://www.usatoday.com/money/industries/health/2006-10-15-health-concern-usat_x.htm

With this in mind do you think North America's healthcare sytems are overpriced don't perform well, and in the case of the US don't tally well with Europe. Why do you think this is or don't you?

13.4% GDP compared to Englands 6.6% GDP? It's not any better now, what are the reasons for the cost? And do you think you need to improve, get up the table to the best European healthcare systems? Or do you think that to do so is socialism and therefore to be fought against at every turn. In a nutshell why does your system proclaimed the best in the world, actually in reality not rank very highly?

http://www.who.int/whosis/en/index.html

If you want to wade through this.

Last edited: Feb 7, 2007
2. Feb 7, 2007

### denverdoc

SD,
wow, those are mindbending stats. I had approximate knowledge of some of the data, but was shocked by others.

Its the best healthcare money can buy. I mean if I had unlimited resources and in need of a heart transplant, I'd sure as hell have it done here. But getting an ingrown nail fixed, would likely cost a helluva lot more here than anywhere else in the world, with I daresay comparable results, or worse on acct of some infection that practically kills you in the process.

It would be easy to blame lawyers. And fun. So let's! The cost of the malpractice insurance and law suits is only a nickel on the health care buck, IIRC. But it has led to a defensive style/CYA style of practice that eats bucks like nobodys business. Take your average panic attack. 32yo female in good health presents to an ER complaining of tachycardia, shortness of breath and weird tingling sensations in her nands. No prior cardiac history. Rather than an EKG and a minor tranquilizer, good chance she will end up in a semi-intensive cardiac unit under telemetry. No one seriously believes this is a life threatening condition, EKG is normal and 30 minutes after getting some Valium like drug, looks fine, feels fine, and is ready to roll. In the mind of the average US physician, there is every reason to believe the case is closed, but then the nagging doubt problem rears it's ugly head. There's a 1/100000 chance that this might be a zebra, and not a horse. Safe thing to do, observe overnight, get a panel of cardiac enzymes, whatever. So this intervention which might have cost a couple hundred--we have EKG machines that cost a bundle more than the average bear so as to have AI interpretations, but any doc worth his/her salt reads them personally, what if the machine missed something? --now is 2000 or more. I'm not making this up.

This is the so called standard of care issue--if you offer less than what other ass covering docs in the community would do as prudent and reasonable practitioners, you have nothing to gain except the satisfaction of having saved Mrs Jones 1800 bucks, and everything to lose even if its 1/100000. To practice sanely is not for the faint of heart, esp with a fat mortgage and two kids in college.

This doesn't begin to address the issue in its entirety, but health care has become really irrational in my opinion, which is likely I seek refuge at the PF!

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3. Feb 8, 2007

### Schrodinger's Dog

What makes me laugh is I pay personally, perhaps about $3000 or so dollars per year the average employer probably a little more, I think the average is probably around the$3500 mark (taking median pay into account) in combined taxes and NI national insurance is about $1600 per year with those earning above$64,000 per year only paying 1% instead of 11.1% to keep up a free healthcare service; you pay on average $3226 not including taxes of the$11765, not including the cost 14.1% or so cost to GDP and thus to your tax bill, 14.1% of whatever tax covers this, and we're ranked 8th in the world and your in 37th?

Does this make any sense? What we pay in insurance doesn't usually cover our health bill in fact in about 99% of people it's not even close, and even with the taxes this is seldom covered, but since the governments only paying 6.6% GDP, it's actually costing us less in taxes and NI than in the US to subsidise healthcare? In other words our bang for buck is why we're in 8th place.

The only objection I can see to national or perhaps state by state healthcare, is it's socialism=communism=evil? And the beureacracy(it's centralised thus there is less) But you also have to remember a health service doesn't work like a business, if you fail in business you go bankrupt, if you fail in the health service, people die.

And what also hikes up your cost, law suits, try seeing how much people will sue when ultimately there paying for it out of their taxes, ie the more you sue the more you pay in taxes, and suing the government has always been an absolute nightmare anyway.

Well sign me up to this particular form of socialism, when 46 million of your people have no adequate health care in the US you know something is rotten in the state of Denmark.

Arnold Schwarzenegger recently announced he was thinking of bringing in a more "European" system into California, I hope it works, because it might just might persuade people that a health care system has nothing to do with socialism, it's just a practical business/ethical essential.

http://www.washingtonpost.com/wp-dyn/content/article/2007/01/08/AR2007010800865.html?nav=hcmodule

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4. Feb 8, 2007

### Staff: Mentor

We discussed these numbers about 2 days ago -- most are wrong, out of date, misleading, etc., and he already knows it. For example, the first link say the following:
But 15 years later.....
http://indexmundi.com/united_states/life_expectancy_at_birth.html

Here's a ranking of 2005 life expectancies (not separated by sex): http://www.airninja.com/worldfacts/LifeExpectancyOfNations.htm [Broken]

Assuming the data is even accurate (a cursory look shows the positions of the US and UK are switched, so that is a clear error in the ranking if not the data), the US's life expectancy has gone up by about 2.7 years in the past 15 while Japan's (I picked one of the higher ones on both charts) has gone up by about 1.8. Germany (sligtly above us in both) has gone up by about 2.8. So the upper end of the chart is compressing.

Going deeper, our life expectancy is still lower than average for developed nations (though by nowhere near as much as the OP suggested). The reason is because infant mortality is higher than average. And infant mortality is high because the US does have about the best healthcare in the the developed world. Confused? The reason is simple:
http://www.skepticism.net/articles/2002/000022.html [Broken]

Whether you have health insurance or not the US puts much more effort into saving low-birth weight babies than most other countries in the world. And that, btw, is kind of a hidden health insurance: if you're in a car wreck, the hospital will save your life before finding out if you have health insurance.

And money stats are, of course, indirect so they don't necessarily paint an accurate picture of what level of care people are actually getting.

Last edited by a moderator: May 2, 2017
5. Feb 8, 2007

YIKES!!!! $3,000.00 annually? I pay$324.00 a year for both my daughter and I for our insurance. Then if we need to go to the doctor, the visit and any associated tests costs a total of $15.00, most prescription medicine costs$5.00. My total annual medical expenses for the TWO of us is less than $500.00 annually. And I have a pre-tax spending account for medical expenses, so I don't pay taxes on the money. Last edited: Feb 8, 2007 6. Feb 8, 2007 ### russ_watters ### Staff: Mentor I pay$129 a month for myself. I don't get health insurance from work, so that is the total cost of my insurance.

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7. Feb 8, 2007

### Staff: Mentor

More on this:
Here's info on cancer surviorship:
http://www.parapundit.com/archives/001666.html

So what is more important, the fraction who have insurance (which is misleading anyway since it doesn't include coverage the uninsured still get) or how people actually fare with diseases? Evo touched on another actual quality of care issue in the other thread: how long you have to wait to get treatment.

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8. Feb 8, 2007

I was last quoted about $680/month as a self-employed male for what I considered so-so coverage. As of now, I am among the 50 million w/o health insurance. I seriously doubt, Russ, the safety net is as wide as you imply. There is some truth that if you're in an accident, you'll get taken care of. Otherwise its treat em and street em. And its not like even then the debt goes away--you'll be hounded to death by bill collectors from the hospital until bankruptcy becomes the best option. So you end up in a paradoxical situation:unless very rich or very poor and on disability/medicaid, a serious illness will for most result in a complete divestiture of assets. Or you don't get care. This can happen with insurance or without, depending on the terms. But its not pretty. I get bankruptcy notices all the time. Just eat the bills. Notice when you call or walk into a doc's office, ER, etc what is the first thing asked for? Tell me about the net then. 9. Feb 8, 2007 ### Evo ### Staff: Mentor My daughter's boyfriend had to go to the emergency room and he doesn't have insurance. When they discharged him, he was given forms to apply for financial aid that will pay most, if not all, of the bill. What kind of insurance company are you going through? I know a lot of people that are self-employed and their insurance costs are pretty close to what Russ pays. My employer pays most of my insurance premium, but the full premium is only$226.75 per month and that covers two people.

10. Feb 8, 2007

### denverdoc

Evo, keep us posted on the outcome of that one. Forgive my skepticism, but I'll bet this financial aid is about as substantial as a desert mirage. And without getting into the details of your coverage, I'm also betting you get what you pay for: high deductibles, crummy pharm benefits, a plethora of exclusions, retricted provider choices, etc. If not the insurer is losing . What looks pretty good on paper ends up being a basic catastrophic coverage in many cases with fairly low caps at that.

11. Feb 8, 2007

### Staff: Mentor

Actually, we didn't include what we pay toward medicare in our personal numbers for healthcare costs. That's 2.9%, or for a middle-income person who makes $50,000 a year,$1,450. Car insurance coveres injuries in car accidents, too.

12. Feb 8, 2007

Well according to you averages, the average person pays $3000 dollars. And I assume yor're not including taxes you pay to support the 14.1% GDP. I'd imagine this takes into account the average persons costs on top of their insurance which probably doesn't cover alot of stuff. Dr's visits, dentists, some are NHS so much cheaper. Medication etc. All Dr visits are free all prescriptions are$12 even if they cost $4000 a pill. So all my medication total value about$1500 is about $144 which means we visit the Dr far more frequently than probably you do. You have to take into account it's nearly$2 to the pound atm as well. plus usually your place of work pays half of that. So in reality you should half my personal figure and then add about $400 Do you not think the fact that 46.6 million people plays a part in your mortality figures and infant mortality too? If your not happy with the figures check out the WHO statisitics I can assure you they are as accurate as they can be. However you want to spin it your still ranked far below many healthcare systems in Europe. Last edited by a moderator: May 2, 2017 13. Feb 8, 2007 ### russ_watters ### Staff: Mentor Actually, no, you don't get what you pay for it with insurance, you get much, much less....unless you get very sick, or very old, in which case you get much, much more. For the first 50 years or so of your life, unless you are very unlucky, most people pay small premiums, but they also don't get sick. The deal is so good for the insurance company that they can provide good coverage and still make enough money to cover the losing proposition that is insuring the elderly. Take me, for example: I've been under my current deal for about 4 years. I've paid more than$6,000 and in all that time I haven't seen a doctor once. Since I don't smoke, don't drink on a daily basis, and do exercise, I don't have a lot of risk. By far the biggest risk for a person like me is a car accident, but that's covered by car insurance. The next is probably a fall or other home improvement injury, but I could have one of those a year and the insurance company would still make money on me. After that is sports injuries and if I ever need to 'scope out a knee (I wrestled in high school...), that'll cost a lot, but it likely won't equal the money I've put in. And after that is one of the many random diseases I could get - the bank-breakers, like cancer. But for someone like me, that's probably a one in a thousand proposition, which means that the insurance company has several million dollars available for each of those.

14. Feb 8, 2007

### Schrodinger's Dog

15. Feb 8, 2007

### sara_87

In America does each and every individual have to have health insurance (or pay some other kind of tax) to get treatment when they need it?

16. Feb 8, 2007

### Staff: Mentor

Already approved. It paid most of his bill, and now the hospital is helping him apply for charity which will probably pay the balance. The catch is you have to be under a certain income level.

ZERO deductibles

All generics are 5.00, no deductible, on non-generics, I pay 20% of cost capped at a maximum of $49, no prescription can cost me more than that. If I buy a 90 day prescription by mail the last month's pills are free. Nope. I also have a list of primary care providers to choose from and all my existing physicians were members. Also, I don't need a referal to go to a specialist. I work for a very large company, I get phenomenal benefits. You should be able to buy insurance under some kind of association. For example the American Bar Association has a group plan that attorneys can get group rates under. Last edited: Feb 8, 2007 17. Feb 9, 2007 ### russ_watters ### Staff: Mentor What numbers are we supposed to be collecting from that link? Sorry, no, you'll have to speak for them... Certainly, but the difference is in what is done on the first day, not in the first year. 18. Feb 9, 2007 ### russ_watters ### Staff: Mentor That isn't a complete sentence. What is missing? I already showed you that many of the numbers are wrong/out of date! Care to defend any of your claims? You are flat-out ignoring information that you don't like. Last edited: Feb 9, 2007 19. Feb 9, 2007 ### russ_watters ### Staff: Mentor No. We discussed it a little above, but doctors are required by ethics and law to treat sick people even if they don't have insurance. Obviously, the amount and quality of care can be lower, though, if you don't have insurance. 20. Feb 9, 2007 ### edward As far as I know only emergency care is mandatory. A person seeking non emergency care must apply for some type of aid, usually at the state level. Walking into a medical facility other than an emergency room is futile. Local facilities such as labs in my area require an insurance card and a picture I.D. 21. Feb 9, 2007 ### denverdoc This is true, and there are laws that prevent dumping of indigents until some minimal amt of stabilization has occurred. It leads to some terrific gamesmanship and outright BS--well he was stable when the ambulance departed. As a result of this law ER costs have become astronomical in the states--darn near anything can rack up a 500 to 1000 dollar bill in nothing flat, this after a 4 hr wait and maybe 3 minutes aith an MD. I think we need a single payer system with rationed care for everyone. Rephrase that: there is a compelling ehtical and moral need to bring the US up to the standards of the civilized world. Beyond that, people can do as they like for additional services. Maybe that means we can't afford to fix every 70 year olds leaky heart valve, but every kid under 18 ahould have access to a high standard of care w/o having to beg or having to be the dole. J 22. Feb 9, 2007 ### Evo ### Staff: Mentor There are free clinics all throughout the US. We have one of the top free clinics in the US here. These are for every day, non-emergency use. Helping out my daughter's friend, although his hospital bill was taken care of, his prescriptions weren't. The prescriptions for antibiotics and other urgent needs were almost nothing, like$20, while medicines for non-critical meds like tranquilizers (he was diagnosed with diverticulitis) were over \$100.

Oh, did I mention that I have pet medical insurance through my employer? My pets also have medical insurance.

Seriously, although only 15 and 1/3 % of Americans don't have insurance, I would like to see more medical coverage for the small percentage that aren't insured and don't have the incomes to afford it. Medicare and Medicaid can be very difficult to deal with due to the fraud.

Only if you are in an inner city high crime area. The ER at the hospital 5 minutes from me has no waiting. The place is always empty. I'm a klutz and have had the opportunity to experience the ER several times.

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23. Feb 10, 2007

### edward

Evo, you are experiencing a very ideal situation.

That is not the average situation however. Emergency rooms in most metropolitan areas are in a crisis. Even those not in high crime areas are experiencing overcrowding. When my father-in-law broke his hip several years ago he had to be diverted from an overcrowded hospital ER that was only 2 miles away, to one that was 12 miles away.

After he was seen by a doctor and X rayed, he was left in a bed in the ER hallway for 4 hrs because there were no hospital rooms available.

One of the big problems is that people with no insurance use the ER as a first resort for care. Many of these people could be treated in urgent care centers, but urgent care facilities require insurance.

Emergency room crisis:

Last edited: Feb 10, 2007
24. Feb 10, 2007

### denverdoc

Right, I'm not talking the knife and gun club, where much of the resources get diverted into serious trauma, just your average suburban ER. Also what they mention as "wait" is usually one of many. And precisely right, urgent care could like take care of most things, but w/o insurance or a wad of cash, its hasta la vista, baby.

Evo, There are three free care clinics in the Denver-Boulder area, all do great work, but treat an infinitesimally small fraction of the problem. It almost seems as if you're suggesting a 1000 points of light approach to this problem is gonna somehow solve it.

I do see that we are finally taking some lessons from the Chinese and now have a wide variety of health care providers--PA's, nurse practitioners, and various nursing specialists including nurse anesthetists who have various skill sets and levels of training. This is a good move, and medical school/post grad training needs a serious overhaul, too.

End the end, the problem is largely one of expectations. We all want to live to be 120 wrinkle and fat free, but expect a pill or surgical procedure to accomplish it, sue whenever there's a bad outcome, and have this absolute faith that ever increasing levels of technical sophistication will be the ultimate fix. Theres a lot more to health than the absence of disease, and I wish more of our MD's took the approach of a gardener vs that of a mechanic
(borrowed from a book title: The Mechanic and the Gardener).

25. Feb 10, 2007

### edward

That is a great perception Doc. The increasing pressure on doctors to cut the cost of treatment down to somewhere near the low reimbursement figure that is allowed by Medicare and insurance companies has brought about an assembly line concept to medical care.

Last summer my cardiologist sent me to an imaging center for a work up. He previously had performed the procedures in his office. It took three weeks to get scheduled into the center. When I got there the place was like a cattle round up. During the various elements of the testing I spent 6 hours going in and out of a small windowless waiting area where there were 15 patients and only 12 chairs.

On the other hand they were efficient and I still have heart of a healthy chimpanzee.