News Most US doctors now support a national health plan

[mheslep]

Some of these are strawmen and self contradictory.

Debunking Canadian health care myths


Myth: The Canadian system is significantly more expensive than that of the U.S.
...

Strawman. Everybody, and I mean everybody acknowledges US health is expensive.

Myth: Canada's government decides who gets health care and when they get it.While HMOs and other private medical insurers in the U.S. do indeed make such decisions, the only people in Canada to do so are physicians. In Canada, the government has absolutely no say in who gets care or how they get it. Medical decisions are left entirely up to doctors, as they should be.

There are no requirements for pre-authorization whatsoever. If your family doctor says you need an MRI, you get one. In the U.S., if an insurance administrator says you are not getting an MRI, you don't get one no matter what your doctor thinks — unless, of course, you have the money to cover the cost.

Myth: There are long waits for care, which compromise access to care.There are no waits for urgent or primary care in Canada. There are reasonable waits for most specialists' care, and much longer waits for elective surgery. Yes, there are those instances where a patient can wait up to a month for radiation therapy for breast cancer or prostate cancer, for example. However, the wait has nothing to do with money per se, but everything to do with the lack of radiation therapists. Despite such waits, however, it is noteworthy that Canada boasts lower incident and mortality rates than the U.S. for all cancers combined, according to the U.S. Cancer Statistics Working Group and the Canadian Cancer Society. Moreover, fewer Canadians (11.3 percent) than Americans (14.4 percent) admit unmet health care needs.

"If your ... doctor says you get an MRI, you get one". Stuff and nonsense. You may, or you might wait a year. Why? Because the doctor thinks that is the best schedule? No. Because the Canadian government has decreed how much MRI equipment will be purchased, or how many 'radiation therapists' will be trained, or which medications it deems worthy, and there's an under supply of these so you wait, all of which has to do with money.
These two are, at the least, self-contradictory.

 

[mheslep]

It is not a perfect system, but it has its merits. For people like my 55-year-old Aunt Betty, who has been waiting for 14 months for knee-replacement surgery due to a long history of arthritis, it is the superior system. Her $35,000-plus surgery is finally scheduled for next month. She has been in pain, and her quality of life has been compromised. However, there is a light at the end of the tunnel. Aunt Betty — who lives on a fixed income and could never afford private health insurance, much less the cost of the surgery and requisite follow-up care — will soon sport a new, high-tech knee. Waiting 14 months for the procedure is easy when the alternative is living in pain for the rest of your life.

Rhonda Hackett of Castle Rock is a clinical psychologist.

The superior system? In the US:

What is the cost of a knee replacement?
The cost of a total knee implant depends on your individual needs, but typically costs from a few thousand to several thousand dollars, plus orthopaedic surgeon fees and the cost of your hospital stay. However, most insurance companies as well as Medicare and Medicaid cover knee replacement surgery. You should contact your insurance provider to see whether knee replacement is covered under your plan.

Also:

...Remember, there is no cure for osteoarthritis. It is a degenerative disease, which means that your condition will get worse over time if left untreated.3

http://www.kneereplacement.com/DePuy/docs/Knee/Replacement/BeforeSurgery/knee_FAQs.html

The fact that Medicare/Medicaid covers the procedure in the US is easy to find, yet in the face of pain and suffering by a family member Hackett clings to the state system like a character from Orwell's Animal Farm. She'd likely report the Aunt to the commissar if she crossed the border for help.

 

[Alfi]

Alfi do you have a link for this source? Was this published in a major news source or is it a personal blog page or the like?

I've asked the person that posted it. He may not be able to get back to me till later today.

 

[turbo]

I've asked the person that posted it. He may not be able to get back to me till later today.

I believe that the article was originally published in the Denver Post. Maybe there's still a link up somewhere.

Edit: Yep! Denver Post. My guardian software warns me that the paper's web-site appears to host some mal-ware, so I'm not going to post a link.

 

[Alfi]

http://www.denverpost.com/recommended/ci_12523427

I get no warnings :)
but...
As per the post above - open with caution.

 

[mheslep]

... Despite such waits, however, it is noteworthy that Canada boasts lower incident and mortality rates than the U.S. for all cancers combined, according to the U.S. Cancer Statistics Working Group and the Canadian Cancer Society. ...

No, for purposes of comparing health care systems incident rates are not noteworthy. Incident rates are related to all kinds of factors having nothing to do with the health care system, especially diet which notoriously bad in the US. That, and genes of course. http://apps.nccd.cdc.gov/uscs/Table.aspx?Group=3f&Year=2005&Display=n#Asian/PacificIslander" . What matters are outcomes, that is, what are your chances of surviving once you are in the system. And for outcomes of all cancer types on average across the population at large, the US has better outcomes than Canada as posted above.

* For women, the average survival rate for all cancers is 61 percent in the United States, compared to 58 percent in Canada.
* For men, the average survival rate for all cancers is 57 percent in the United States, compared to 53 percent in Canada.

http://www.ncpa.org/pub/ba596#footnotes

 

[mheslep]

http://www.denverpost.com/recommended/ci_12523427

I get no warnings :)
but...
As per the post above - open with caution.

Thanks for the link

 

[mheslep]

As a Canadian living in the United States for the past 17 years.

That, plus her professional standing, should merit more than someone that has not experienced both systems.

Note Hackett claims to be a psychologist, not an MD. She need not have ever stepped into a hospital.

 

[turbo]

Note Hackett claims to be a psychologist, not an MD. She need not have ever stepped into a hospital.

That does not invalidate her claims that the "faults" of the Canadian health-care system are overblown by the insurance companies and their shills. The idea that only doctors can properly evaluate a health-care system is pretty lame. I was the IT guy for a large ophthalmic practice for years, and we constantly had to fight the insurance companies for timely payment, and sometimes for any payment at all. The administrative costs foisted on the health provider by the insurance companies' false denials and delays are incredible, and people who have never worked in private health practice have no idea how pervasive the problem is.

 

[mheslep]

That does not invalidate her claims that the "faults" of the Canadian health-care system are overblown by the insurance companies and their shills. The idea that only doctors can properly evaluate a health-care system is pretty lame. ...

Note that I was responding to Alfi's statement about 'professional standing', implying that should give additional weight. And I agree doctors are not the only ones that are entitled to opinions on health care economics, though their experience on the inside certainly carries weight, since in the US system they are the ones in diatly contact with the middlemen, the patients rarely are in comparison.

 

[turbo]

Actually, the doctors in large practices are heavily insulated from day-to-day contact with insurance companies. Those roles are filled by coding specialists, accounting managers, practice managers, and IT specialists such as myself. Doctors know from their staff about the generalities surrounding delays and denials of payment, but they are not "in the trenches".

 

[mheslep]

Actually, the doctors in large practices are heavily insulated from day-to-day contact with insurance companies. Those roles are filled by coding specialists, accounting managers, practice managers, and IT specialists such as myself. Doctors know from their staff about the generalities surrounding delays and denials of payment, but they are not "in the trenches".

Yes, yes, I mean their offices, their agents if you will, and thus the docs are very cognizant of the costs and time involved.

 

[WheelsRCool]

This is the reason that Medicare and Medicaid are so horrendously expensive. They are publicly funded, but they are forced to obtain services from a private system that is terribly expensive, inefficient, and laden with administrative overhead. The insurance companies have bought Congress (both sides of the aisle) to prevent the establishment of a single-payer or public-option program.

Not saying you are wrong, but are you sure you don't have this backwards? From my understanding, it is Medicare and Medicaid that drive up the costs of healthcare in the private sector, because there is a price ceiling on how much the private sector can charge them.

They are publicly-funded, government-run health insurance companies, that themselves are very inefficient and expensive, but since the private sector cannot charge people on Medicare and Medicaid beyond a certain price, the private sector is thus forced to yank up prices elsewhere or flat-out ration to make up for the lost money.

 

[turbo]

Not saying you are wrong, but are you sure you don't have this backwards? From my understanding, it is Medicare and Medicaid that drive up the costs of healthcare in the private sector, because there is a price ceiling on how much the private sector can charge them.

They are publicly-funded, government-run health insurance companies, that themselves are very inefficient and expensive, but since the private sector cannot charge people on Medicare and Medicaid beyond a certain price, the private sector is thus forced to yank up prices elsewhere or flat-out ration to make up for the lost money.

The coding standards and rules enforced by Medicare and Medicaid are simple and relatively easy to understand and comply with. Thus, even if their reimbursal rates are somewhat lower than the ideal private insurer, the doctors can live with that because the administrative overhead that private payers impose on them to fight arbitrary denials and delays aren't present. If there was a single-payer insurer in this country with ONE set of rules and coding standards, doctors and hospitals could eliminate a vast amount of waste imposed by administrative overhead. Private insurers love to create mazes of rules and coding standards allowing them to (seemingly legally) delay or deny payments to providers. This behavior should be criminal. The insurance companies make fortunes on pools of unpaid claims, much like the banks used to do by dragging their feet while clearing checks. The unpaid balance is called the "float". The government forced the banks to clean up their acts, but allows the insurance companies to perpetrate much more egregious frauds on the public - for profit.

 

[Hurkyl]

The coding standards and rules enforced by Medicare and Medicaid are simple and relatively easy to understand and comply with...

Was there supposed to be a reply to WheelsRCool's objection in there? It looks to me as if you completely ignored him and went off on a canned spiel.

 

[turbo]

Was there supposed to be a reply to WheelsRCool's objection in there? It looks to me as if you completely ignored him and went off on a canned spiel.

The administrative overhead imposed on health-providers by the varied and ever-changing coding requirements of the private insurers is onerous and is making US health care far more expensive than it should be. In contrast, Medicare and Medicaid requirements are simple, monolithic, and easier to comply with, requiring doctors and hospitals to spend less money to secure timely payment. Doctors can submit a claim to a private insurance company only to have it denied because the doctor did not require some elaborate screening/diagnostics (which the insurance companies don't want to pay for anyway) in order to justify the medical necessity of a procedure of treatment, or because their staff did not justify the care based on some treatment code that the insurer did not previously demand.

Is that clear enough? What you call a "canned spiel" is a cogent response from a person who has spent years in the bowels of the health-care industry. Do you want a Master's thesis on the subject? I don't have that much time.

 

[WheelsRCool]

A problem though is I do not see single-payer as a magical solution to our healthcare problems either, especially when looking at ones in other countries.

Private insurance companies versus government-run health insurance companies, both have bureaucrats, in private companies, corporate bureaucrats focus on squeezing out as much profit as possible, which can lead to denying care they otherwise could give, whereas in government-run companies, government bureaucrats focus on spending as much money as possible, which leads to inefficiency, too much bureaucracy, etc...plus as also is a concern, the control it gives to government.

 

[Hurkyl]

Is that clear enough? What you call a "canned spiel" is a cogent response from a person who has spent years in the bowels of the health-care industry.

I called it a "canned spiel" not because of whatever merits it may or may not have as an argument, but because you seem eager to make point X, despite the fact WheelsRCool was talking about the related, but different point Y.

Clear would be:
* "No, Y doesn't happen. (insert proof)", possibly followed with "X is what's happening. (insert proof)"
or
* "Yes, Y does happen. However, X is a much more significant factor. (insert proof)"
or
* "Yes, I think Y does happen", possibly followed with "X is happening too. (insert proof)"
or even
* "I have no idea about Y", possibly followed with "however, I know X is happening. (insert proof)"

 

[turbo]

To get the insurance-company supporters educated, please Google on "medical coding" and see what comes up. Instruction in how to properly code medical procedures in order to actually get paid by the insurance companies is a huge industry. Every year, new coding guides come out, and every year, doctors are denied payments as the insurance companies change their coding requirements.

My cousin is a coding specialist for a pediatric ophthalmologist. It is a one-doctor practice. The only reason that he can afford to pay his staff based on a primarily Medicaid clientel is that the coding requirements are simple and easy to comply with, and he gets paid promptly. She previously worked for the large multi-location ophthalmic practice that I worked for. Because of the simplified coding for public health-care payers, she is able to also act as his office manager. If he was reliant on private insurers, he would have to go back to a group practice with their high overhead in order to make a living.

 

[turbo]

I called it a "canned spiel" not because of whatever merits it may or may not have as an argument, but because you seem eager to make point X, despite the fact WheelsRCool was talking about the related, but different point Y.

Clear would be:
* "No, Y doesn't happen. (insert proof)", possibly followed with "X is what's happening. (insert proof)"
or
* "Yes, Y does happen. However, X is a much more significant factor. (insert proof)"
or
* "Yes, I think Y does happen", possibly followed with "X is happening too. (insert proof)"
or even
* "I have no idea about Y", possibly followed with "however, I know X is happening. (insert proof)"

It is easier and cheaper to gain timely payment from Medicare and Medicaid than from private insurers, because their standards and coding requirements are consistent. When you overlay a public-payer program on top of a private-payer system that is already expensive and overly complicated, you subject the public-payer system to much higher base costs than would be extant, absent the demands of the private insurers.

 

[bleedblue1234]

We simply cannot afford a public plan at this point, period- end of story...

 

[drankin]

We simply cannot afford a public plan at this point, period- end of story...

Pretty much the most practical statement in this whole thread. This isn't the time to spend money we don't have.

 

[mheslep]

We simply cannot afford a public plan at this point, period- end of story...

Pretty much the most practical statement in this whole thread. This isn't the time to spend money we don't have.

Yes, but as I posted https://www.physicsforums.com/showpost.php?p=2247474&postcount=72", I suggest we have had enough of the their-idea-is-broken, period, type responses. There are problems and what we need is more discussion of ideas that will work.

 

[bleedblue1234]

One thing I can tell you is no one in Washington or anywhere else, no select group of people (even the "experts") can pretend to know what is best for each individuals specific medical needs... thus a "national plan" would most likely envolve HUGE amounts of waste and mal-investment, and since the public plan has absolutely no need to have a balanced budget or stay solvent in any way, the public option can get as big as it wants...

Barrack Obama put out the old straw-man when he said something in effect to this, "well if public health care is so bad then why would you want to switch if it can't compete with private healthcare"... well it will compete just at a much greater cost and people also fail to realize these health care costs are coming from somewhere (whether it be taxes, inflation, whatever) SOMEONE somewhere is footing the bill for this public plan... and unfortunately it will most likely be the middle and lower classes... as it usually is...

We have $65+ trillion liabilities projecting into the future, and we simply CANNOT afford any form of nationalized health care... especially throughout the United States (great EU countries can do it but they are a fraction of the size and complexity of the US, and they have their own issues with it)...

But the current system is undoubtedly badly broken and we need to stop this nonsense, and I don't have an answer as to how, but a government option is surely the wrong way to go about it, as it will be even worse...

 

[mheslep]

One thing I can tell you is no one in Washington or anywhere else, no select group of people (even the "experts") can pretend to know what is best for each individuals specific medical needs... thus a "national plan" would most likely envolve HUGE amounts of waste and mal-investment, and since the public plan has absolutely no need to have a balanced budget or stay solvent in any way, the public option can get as big as it wants...

Barrack Obama put out the old straw-man when he said something in effect to this, "well if public health care is so bad then why would you want to switch if it can't compete with private healthcare"... well it will compete just at a much greater cost and people also fail to realize these health care costs are coming from somewhere (whether it be taxes, inflation, whatever) SOMEONE somewhere is footing the bill for this public plan... and unfortunately it will most likely be the middle and lower classes... as it usually is...

We have $65+ trillion liabilities projecting into the future, and we simply CANNOT afford any form of nationalized health care... especially throughout the United States (great EU countries can do it but they are a fraction of the size and complexity of the US, and they have their own issues with it)...

But the current system is undoubtedly badly broken and we need to stop this nonsense, and I don't have an answer as to how, but a government option is surely the wrong way to go about it, as it will be even worse...

More of the same. At the moment I don't care to here any more about Barack Obama, or what can not be done. Health care costs are increasing 7 to 9 percent a year. The pool of people without coverage is increasing as these costs increase. What do you propose be done about this unsustainable problem?

 

[Al68]

More of the same. At the moment I don't care to here any more about Barack Obama, or what can not be done. Health care costs are increasing 7 to 9 percent a year. The pool of people without coverage is increasing as these costs increase. What do you propose be done about this unsustainable problem?

First, do no harm. Doctors used to think if someone was sick, they had to do something. Not anymore. Now they consider doing nothing to be much better than doing something unless they have good reason to believe that the something will make the problem better. Hence, first, do no harm in the Hippocratic Oath.

Maybe we need such an oath in politics to replace the "well, we must do something" attitude that has done so much harm, just like it used to do to medical patients before the Hippocratic Oath.

 

[mheslep]

Which is not connected any way this case: the economic of heath care. Think your car if you must: its been wrecked[*]. Not totaled, it still runs, quite fast in fact but the tires are shot, it leaks oil all the time and the repair costs are killing you. You do not sit on the porch musing about 'do not harm'. The dam thing is going to leave you on the side of the road soon or worse.

The Mechanic:
http://www.hoover.org/publications/digest/3459466.html

*Wrecked by the government in WWII.

 

[Hurkyl]

"Do nothing" is a choice of a specific course of action to adopt, and as such it must be evaluated on the same level as the choice of any other specific course of action.

 

[turbo]

Which is not connected any way this case: the economic of heath care. Think your car if you must: its been wrecked[*]. Not totaled, it still runs, quite fast in fact but the tires are shot, it leaks oil all the time and the repair costs are killing you. You do not sit on the porch musing about 'do not harm'. The dam thing is going to leave you on the side of the road soon or worse.

The Mechanic:
http://www.hoover.org/publications/digest/3459466.html

*Wrecked by the government in WWII.

Thank you. Of every dollar spent for health care in the US, over 30 cents goes to pay for administrative costs. We cannot afford not to have public health care, or at least a public health care option against which private health care must compete.

This not a liberal vs conservative situation. It is an economic choice in which most real conservatives would select the most effective/least expensive option. Ironically, neo-cons rail against the more conservative option almost reflexively. The GOP hard-line is that if you cannot afford health care and preventive treatment, too bad. Not good, because poorer patients that cannot afford preventive health care present themselves to doctors too late to be good prospects for survival and drive up the cost of all our own coverages.

 

[Al68]

"Do nothing" is a choice of a specific course of action to adopt, and as such it must be evaluated on the same level as the choice of any other specific course of action.

Fortunately, modern doctors reject that notion due to the Hippocratic Oath.

They consider "do nothing" the default correct action in the absence of good reason to "do something". Not to mention the obvious fact that a lack of action is not morally equivalent to action.

This results in a doctor being restricted to only those actions that he/she has good reason to think will help. My suggestion was that maybe we need to extend that oath to politicians.