these Scandinavian countries, with such a small number of extremely healthy, homogeneous populations, find they can cast dispersions on American healthcare.
The number one problem with healthcare cost comparisons is the diet and lifestyle we love. Until we start eating healthier as a country, healthcare costs will always be high as a percentage of gdp, regardless of whether we adopt a single payor system or not.
these Scandinavian countries, with such a small number of extremely healthy, homogeneous populations, find they can cast dispersions on American healthcare.
Rebel... you may have a point, but the perhaps the best system for the U.S. is a single payer government sponsored plan. And if those with discretionary income want to supplement that with some sort of concierge service, so be it. In other words, a Medicare-like system for everyone.
I practice as a medical specialist and have trained and worked in and outside the United States. During my years of training at McGill university in Montreal, I saw what many believe in the U.S. to be inferior health care. Nothing could be farther from the truth. Care being universal and fully covered in Canada for example does allow for access to the physicians required albeit with waiting times which are longer than in the U.S. The quality of care is excellent once access is obtained. The contingency is that access for some procedures is variable and can lead to frustration for the patients concerned. Contrast this however with the myriad of plans, co pays, 3rd party payers and you can not convince me that the system is not broken and needs fixing. More worrisome to me is that no plan, Trumps or others, will remove the overhanging layer of bureaucracy that makes American medicine so difficult to navigate.
We must be able to come to grips with a system providing universal coverage for all of us. We can not call ourselves the envy of the free world in health care, when statistics prove otherwise. Uninsureds and multiple payers etc. are stiffling American medicine. The sooner we realize that for all we spend we are not better off, the faster we can implement a system that is fair and encompassing. As stated in this article and many others, we pay huge amounts of money for healthcare, more than most countries. Are the results reflecting our expenses? I believe not and agree with the author that we can do much better. We must turn to some form of complete access with coverage for all. Importantly, results from multiple studies confirm that from a cost point of view, this is tenable. What is missing is the backbone and will of our politicians to bend and break their alliances with big business and insurance companies. These decisions will take time, but till then this quagmire that we run amok in on a daily basis, will continue to leave us with less care than we deserve.
great that private healthcare companies profit off of sick people. Wow Medicare I can choose my own doctor and its a government program. Didnt know that was possible.
Most people are aware that the majority of other westernized nations use some form of universal healthcare. The Scandinavian countries are always the most interesting comparison because they seem to have accomplished what the ultimate goal is for the US in regards to healthcare - which is that they've maintained their wealth as a capitalistic society, remained having some of the healthiest populations of people in the world, but have done so while also still spending significant amounts of money on healthcare as a percentage of their GDP.
The number one problem with healthcare cost comparisons is the diet and lifestyle we love. Until we start eating healthier as a country, healthcare costs will always be high as a percentage of gdp, regardless of whether we adopt a single payor system or not.
I think it's more than just unhealthy lifestyles. Here in the U.S., for example, a tremendous amount of money is spent on end-of-life care. In countries like Switzerland, they do everything possible to ensure a patient's end-of-life comfort and ease, but they don't throw hundreds of thousands of dollars at "heroic efforts" that neither extend life very long nor the quality of that "extended life."
I practice as a medical specialist and have trained and worked in and outside the United States. During my years of training at McGill university in Montreal, I saw what many believe in the U.S. to be inferior health care. Nothing could be farther from the truth. Care being universal and fully covered in Canada for example does allow for access to the physicians required albeit with waiting times which are longer than in the U.S. The quality of care is excellent once access is obtained. The contingency is that access for some procedures is variable and can lead to frustration for the patients concerned. Contrast this however with the myriad of plans, co pays, 3rd party payers and you can not convince me that the system is not broken and needs fixing. More worrisome to me is that no plan, Trumps or others, will remove the overhanging layer of bureaucracy that makes American medicine so difficult to navigate.
We must be able to come to grips with a system providing universal coverage for all of us. We can not call ourselves the envy of the free world in health care, when statistics prove otherwise. Uninsureds and multiple payers etc. are stiffling American medicine. The sooner we realize that for all we spend we are not better off, the faster we can implement a system that is fair and encompassing. As stated in this article and many others, we pay huge amounts of money for healthcare, more than most countries. Are the results reflecting our expenses? I believe not and agree with the author that we can do much better. We must turn to some form of complete access with coverage for all. Importantly, results from multiple studies confirm that from a cost point of view, this is tenable. What is missing is the backbone and will of our politicians to bend and break their alliances with big business and insurance companies. These decisions will take time, but till then this quagmire that we run amok in on a daily basis, will continue to leave us with less care than we deserve.
The number one problem with healthcare cost comparisons is the diet and lifestyle we love. Until we start eating healthier as a country, healthcare costs will always be high as a percentage of gdp, regardless of whether we adopt a single payor system or not.
I think it's more than just unhealthy lifestyles. Here in the U.S., for example, a tremendous amount of money is spent on end-of-life care. In countries like Switzerland, they do everything possible to ensure a patient's end-of-life comfort and ease, but they don't throw hundreds of thousands of dollars at "heroic efforts" that neither extend life very long nor the quality of that "extended life."
Yeah. I agree. Seems a shame to save all this money for healthcare only to have a third or so of your lifetime costs in the last few months of life. Seems inefficient and silly
Is that it's a free market system. In a free market, there is competition on price, and consumers can make informed choices. Go to a grocery store and all the prices are marked on the shelf. Go to a hair salon and they have a price list of their various services. You can go elsewhere and compare those prices. That's a free market.
Now go to a drugstore and ask for a price list for prescription medications. Go to a hospital and ask for a price list for common procedures and costs of overnight stays. You won't get one.
That's not a free market. It's an opaque broken one.
I practice as a medical specialist and have trained and worked in and outside the United States. During my years of training at McGill university in Montreal, I saw what many believe in the U.S. to be inferior health care. Nothing could be farther from the truth. Care being universal and fully covered in Canada for example does allow for access to the physicians required albeit with waiting times which are longer than in the U.S. The quality of care is excellent once access is obtained. The contingency is that access for some procedures is variable and can lead to frustration for the patients concerned. Contrast this however with the myriad of plans, co pays, 3rd party payers and you can not convince me that the system is not broken and needs fixing. More worrisome to me is that no plan, Trumps or others, will remove the overhanging layer of bureaucracy that makes American medicine so difficult to navigate.
We must be able to come to grips with a system providing universal coverage for all of us. We can not call ourselves the envy of the free world in health care, when statistics prove otherwise. Uninsureds and multiple payers etc. are stiffling American medicine. The sooner we realize that for all we spend we are not better off, the faster we can implement a system that is fair and encompassing. As stated in this article and many others, we pay huge amounts of money for healthcare, more than most countries. Are the results reflecting our expenses? I believe not and agree with the author that we can do much better. We must turn to some form of complete access with coverage for all. Importantly, results from multiple studies confirm that from a cost point of view, this is tenable. What is missing is the backbone and will of our politicians to bend and break their alliances with big business and insurance companies. These decisions will take time, but till then this quagmire that we run amok in on a daily basis, will continue to leave us with less care than we deserve.
This is a brilliant post, and coming from a Physician who obviously understands the nuances, shortcomings and positive elements of our healthcare system makes it even better.
not getting it. If you add up the governmental funds (federal, state, and local) spent on healthcare, that is already more per capita than -any- other country. I'm not at a place where I can dig up the references, but if memory serves me most of the other countries were spending 7-10% of GDP on healthcare and the USA double that. There are many varieties of national healthcare from completely government run (Britain) to entirely (regulated) insurance based (Switzerland) and every combination in between.
Common to all is same rules for everybody (e.g. no gold plated insurance for congress critters while the rest of us suffer through a maze of insufficient options)
Medicare has an administrative overhead of 3%, until the ACA insurance companies averaged 25%, but now limited to a maximum of 20% due to ACA (Obamacare)
not getting it. If you add up the governmental funds (federal, state, and local) spent on healthcare, that is already more per capita than -any- other country. I'm not at a place where I can dig up the references, but if memory serves me most of the other countries were spending 7-10% of GDP on healthcare and the USA double that. There are many varieties of national healthcare from completely government run (Britain) to entirely (regulated) insurance based (Switzerland) and every combination in between.
Common to all is same rules for everybody (e.g. no gold plated insurance for congress critters while the rest of us suffer through a maze of insufficient options)
Medicare has an administrative overhead of 3%, until the ACA insurance companies averaged 25%, but now limited to a maximum of 20% due to ACA (Obamacare)
But in my opinion something needs to change. I remember the days when you heard the word Cobra coverage and you would cringe on the thought it was so expensive.
When I was laid off last year from work I opted for Cobra figuring I would be back in the saddle pretty quick with work and a month or so would be ok. Well my hopes did not happen still looking for work and had to decide what to do the first of the year.
I figured I would find something on the market place at least comparable to what I had for much cheaper than I was paying for Cobra. Not so much I opted to continue my cobra coverage with a savings of approx 120.00 per month. And the amount I pay for Cobra is no picnic approx 650.00.
The system is broken and I hope they can fixit… I am fortunate and can afford this but far too many Americans cannot.
make available all their pricing. That way for non emergency procedures people could more easily "shop around" and compare. Make for a little competition instead of they having such a rigged system.
I hope the Republicans can do better than the garbage they are offering us. All of a sudden, Obamacare doesn't look so bad.
you realize the experience the Finnish transplant was complaining about was Obamacare, right? Her entire US stay to date has been Obamacare and her main point of reference for American Health Care is Obamacare.
I'm not an expert on this and I fully agree we can learn from other countries but my guess is Americans pay more because of the volume of people who don't contribute anything supported by the people who contribute a lot. Combine that with the ridiculous practices around medical billing and the rest of the bureaucracy and my guess it's not mostly just the healthcare system, but related industries.
The countries the author mentions may be doing fine, but it's hard to compare the US 325 million diverse people, with Sweden (under 10M), Finland (under 6M), Netherlands (under 20M), or other small, mostly non-diverse, small population growth countries. Even Canada has under 40M mostly Caucasian citizens of similar ancestry.
So while learning from Finland is something important, maybe learning from Russia (bad healthcare getting worse), or the UK (the author repeatedly cites OECD: "NHS: UK now has one of the worst healthcare systems in the developed world, according to OECD report
Hospitals so underequipped that people are dying needlessly because of a chronic lack of investment")
Might be smart too, so instead of cherry-picking the countries where it works that aren't really comparable and saying "we could learn from them" it's important to learn from the countries more comparable whether their healthcare system has worked or not.
the self-loathing American is so tedious. as bad as the blindly 'Murica loving American.
Along those lines isn't the personal tax rate in some of those countries around 60%?
It's all relative.
They are all much higher than the US in terms of income tax for the most part (Finland 10% more), but the author claims she paid the same in Finland as she paid in the US, but sources say otherwise.
When people want to make a point, people are willing to take liberties, so who knows what's right.
I love America but think there are problems that we should develop institutions and resources to fix, and healthcare is one of the top of the list.
I don't have the answers, but the system, both before and after the Affordable Care Act, is broken and needs solutions.
Maybe the Scandinavian system has solutions and maybe they won't work here. Would like a bi-partisan approach but given how the ACA was treated as will any republican attempts, it really sucks that the American populace will suffer with expensive and confusing care
I'm just saying when people suggest that what works in Finland or other Scandinavian countries may not work in the US, they're not being all "'Murica fuck yeah" they're actually simply highlighting a non-valid comparison.
Sure there are things Finland may do that the US system can adopt and help it to improve, but I'll tell you the statistics the author cites, that's pretty damn good considering the size, diversity, and vastness of the US. Can it be improved? Absolutely and it needs to be and I too think the best solution should be something bipartisan, but this article seems bloggish to me.
I hope the Republicans can do better than the garbage they are offering us. All of a sudden, Obamacare doesn't look so bad.
you realize the experience the Finnish transplant was complaining about was Obamacare, right? Her entire US stay to date has been Obamacare and her main point of reference for American Health Care is Obamacare.
I'm not an expert on this and I fully agree we can learn from other countries but my guess is Americans pay more because of the volume of people who don't contribute anything supported by the people who contribute a lot. Combine that with the ridiculous practices around medical billing and the rest of the bureaucracy and my guess it's not mostly just the healthcare system, but related industries.
The countries the author mentions may be doing fine, but it's hard to compare the US 325 million diverse people, with Sweden (under 10M), Finland (under 6M), Netherlands (under 20M), or other small, mostly non-diverse, small population growth countries. Even Canada has under 40M mostly Caucasian citizens of similar ancestry.
So while learning from Finland is something important, maybe learning from Russia (bad healthcare getting worse), or the UK (the author repeatedly cites OECD: "NHS: UK now has one of the worst healthcare systems in the developed world, according to OECD report
Hospitals so underequipped that people are dying needlessly because of a chronic lack of investment")
Might be smart too, so instead of cherry-picking the countries where it works that aren't really comparable and saying "we could learn from them" it's important to learn from the countries more comparable whether their healthcare system has worked or not.
the self-loathing American is so tedious. as bad as the blindly 'Murica loving American.
Yes, let's model our healthcare off of Finland. They are very similar to us - alk 6 million of the with their military spending, large immigrant and diverse population. Do they have more than 10 immigrants? I am sure their model will work here splendidly. Moronic.
I practice as a medical specialist and have trained and worked in and outside the United States. During my years of training at McGill university in Montreal, I saw what many believe in the U.S. to be inferior health care. Nothing could be farther from the truth. Care being universal and fully covered in Canada for example does allow for access to the physicians required albeit with waiting times which are longer than in the U.S. The quality of care is excellent once access is obtained. The contingency is that access for some procedures is variable and can lead to frustration for the patients concerned. Contrast this however with the myriad of plans, co pays, 3rd party payers and you can not convince me that the system is not broken and needs fixing. More worrisome to me is that no plan, Trumps or others, will remove the overhanging layer of bureaucracy that makes American medicine so difficult to navigate.
We must be able to come to grips with a system providing universal coverage for all of us. We can not call ourselves the envy of the free world in health care, when statistics prove otherwise. Uninsureds and multiple payers etc. are stiffling American medicine. The sooner we realize that for all we spend we are not better off, the faster we can implement a system that is fair and encompassing. As stated in this article and many others, we pay huge amounts of money for healthcare, more than most countries. Are the results reflecting our expenses? I believe not and agree with the author that we can do much better. We must turn to some form of complete access with coverage for all. Importantly, results from multiple studies confirm that from a cost point of view, this is tenable. What is missing is the backbone and will of our politicians to bend and break their alliances with big business and insurance companies. These decisions will take time, but till then this quagmire that we run amok in on a daily basis, will continue to leave us with less care than we deserve.
This is a brilliant post, and coming from a Physician who obviously understands the nuances, shortcomings and positive elements of our healthcare system makes it even better.
pays such high prices for drugs, it subsidizes other countries costs? That is one of the reasons that we pay more. We also pay more because if we want, we can get an MRI immediately instead of waiting for months. Canadian healthcare may be great, if and when you can get it. Last time I went to the imaging center for an MRI, there were more than a few Canadians there who flew down specifically to get an MRI because they didn't want to wait for months.
isn't to join the chorus of saying European healthcare systems are better than the US, but to make the more finer point about how disingenuous it is to try and sell Americans on a piece of healthcare legislation by saying people will benefit because it provides more freedom of choice.
Really this writer is just pointing out the absurdity of the suggestion that people can shop around for healthcare much in the same way they can shop around for a pair of jeans.
Other countries, like Finland, came to a consensus quite some time ago that it is not realistic to expect it's people to be in a position to make informed-enough decisions related to cost and quality of critical services - or that they should be even burdened with doing so for the such potentially stressful and life-altering moments that take place at a hospital.
More significantly, they recognized that individuals have no leverage to broker lower expensed services through the market. For someone who requires an individual plan, the only option (without incredibly generous government subsidies) that allows them to have comprehensive coverage at a low cost is a single-payer system.
A valid point can be raised about wait times in the Canadian system. They occur for sure and as I mentioned can be frustrating. Some provinces including Quebec, have allowed physicians to set up outside clinics to help alleviate this problem. It is not perfect but the results are improving as the privatisation of the system takes hold. It has always suggested to me that a public system, blended with some sort of private providers for the cases discussed might be what would be best. No solution is ideal, all systems have faults. That said, we can not claim to have a functional system when so many have so little access. Criticizing others solves little, we must learn from them and adopt their best practices. Only then can we be assured of improvements in our own back yard.
The number one problem with healthcare cost comparisons is the diet and lifestyle we love. Until we start eating healthier as a country, healthcare costs will always be high as a percentage of gdp, regardless of whether we adopt a single payor system or not.
Don't tell people that. Healthcare, no matter what the cost, and in spite of whether or not is largely self inflicted due to bad lifestyle choice, is a RIGHT damnit !!
I have said before, create a system in which the federal government is the insurer for catastrophic medical expenses. Private insurers pay a certain amount per year per insured (100-250K). The federal government pays everything over that amount. The amount rests to zero every January 1.
The system is funded with the following taxes:
(1) Reclassify carried interest from a capital gain to ordinary income.
(2) Elimination of "stepped up" basis for stocks, bonds, and most real estate.
(3) 4% national sales tax on all Internet purchases.
(4) 1% financial transactions tax.
Premium is a function of risk. Cap the amount the insurers have to pay, and premiums should come down. The system would still allow for copays and deductibles, but they would be much lower. HSAs would also still be allowed.
One thing I don't think many understand about US healthcare Â
We actually have a single payer system in Medicare and Medicade. It's available to all Americans precisely when their healthcare will be the most expensive and the most necessary and the least profitable. That's right, old people and disabled people qualify for the government to pick up the tab but if you're young and healthy and employed you get private health insurance which is extremely expensive and extrememly profitable to the health insurance industry. Hmmm... I wonder why that might be? Healthcare in the US is a racket. The drug companies manufacture drugs in Ireland to avoid taxes and legislation passed by Congress makes it illegal for me as a US citizen to buy my medication overseas where it's cheaper. Public hardship for private profits, it's the new American way!
If reasonable honest people were making US healthcare policy it wouldn't look anything like what we have today.
Thanks for your service Dr. Snickers.
RE: One thing I don't think many understand about US healthcare Â
We actually have a single payer system in Medicare and Medicade. It's available to all Americans precisely when their healthcare will be the most expensive and the most necessary and the least profitable. That's right, old people and disabled people qualify for the government to pick up the tab but if you're young and healthy and employed you get private health insurance which is extremely expensive and extrememly profitable to the health insurance industry. Hmmm... I wonder why that might be? Healthcare in the US is a racket. The drug companies manufacture drugs in Ireland to avoid taxes and legislation passed by Congress makes it illegal for me as a US citizen to buy my medication overseas where it's cheaper. Public hardship for private profits, it's the new American way!
If reasonable honest people were making US healthcare policy it wouldn't look anything like what we have today.
Yes, let's model our healthcare off of Finland. They are very similar to us - alk 6 million of the with their military spending, large immigrant and diverse population. Do they have more than 10 immigrants? I am sure their model will work here splendidly. Moronic.
GiantsUA--Thank you for saying what I was thinking about this moron. This is your typical mindless post. Nothing intelligent to offer but to attack a person with an opposing point of view. I was not saying America has no issues with healthcare, what I was implying is that it's apples and oranges to compare healthcare in the U.S. to Finland.
"somefan" not GiantsUA. The point of my post had nothing to do with American superiority. I do believe we can learn from other countries, but in regard to healthcare, it's probably not Finland.
RE: One thing I don't think many understand about US healthcare Â
We actually have a single payer system in Medicare and Medicade. It's available to all Americans precisely when their healthcare will be the most expensive and the most necessary and the least profitable. That's right, old people and disabled people qualify for the government to pick up the tab but if you're young and healthy and employed you get private health insurance which is extremely expensive and extrememly profitable to the health insurance industry. Hmmm... I wonder why that might be? Healthcare in the US is a racket. The drug companies manufacture drugs in Ireland to avoid taxes and legislation passed by Congress makes it illegal for me as a US citizen to buy my medication overseas where it's cheaper. Public hardship for private profits, it's the new American way!
If reasonable honest people were making US healthcare policy it wouldn't look anything like what we have today.
Thanks for your service Dr. Snickers.
Medicare is not single payer... straight Medicare pays 80% of outpatient billing so the 20% is either out of pocket or from a supplemental. Medicare advantage plans are administered through private insurance companies. Medicaid is paid for by the federal and state governments.
The closest thing we have to single payer is... the Indian Health Service. Which is an utter disaster that can't attract quality doctors and doesn't provide quality health care. It does have a relatively lower cost though. Win win.
RE: RE: already paying for national healthcare - just Â
not getting it. If you add up the governmental funds (federal, state, and local) spent on healthcare, that is already more per capita than -any- other country. I'm not at a place where I can dig up the references, but if memory serves me most of the other countries were spending 7-10% of GDP on healthcare and the USA double that. There are many varieties of national healthcare from completely government run (Britain) to entirely (regulated) insurance based (Switzerland) and every combination in between.
Common to all is same rules for everybody (e.g. no gold plated insurance for congress critters while the rest of us suffer through a maze of insufficient options)
Medicare has an administrative overhead of 3%, until the ACA insurance companies averaged 25%, but now limited to a maximum of 20% due to ACA (Obamacare)
I agree the 3% Medicare number is faulty at best but the authors metric also needs work.
The author states that the Medicare number is the total admin cost divided by total dollars spent. And it does not include many costs from the admin bucket that are included in private health care. No doubt of it and fully agree. The author also states that Medicare is mostly elderly with higher cost per visit it unjustly lowers the percentage. Also agree.
But, the metric the author states of admin costs divided by beneficiaries is also faulty. The elderly typically have more visits, than the largely under 60 insured privately, therefore more claims. And since the elderly have more complex claims the average cost per claim is higher. I would assume that the admin cost of an elderly beneficiary for exceed that of the average privately insured. Would anyone be surprised to learn that the elderly cost more in admin than the rest of the population?
So I think it is improper to use probably the most costly sector for admin cost as a basis for how efficient the private sector is.
Like I said, the 3% figure is BS but the authors metric is also flawed. What the true cost difference is I don't profess to know but I would use neither of the figures used.
I think my overall point stands even in light of your additions about Medicare. The overwhelming cost of providing healthcare is already born by some form of government. Consider as well, all the public and municiple unions that provide gold plated healthcare to their members.
If you had to pick the best system in the world, which would it be? And how are you quantify your selection?
Sam, the high costs for Vermont were due to the fact that Vermont Â
has a very elderly population; if the entire country had universal healthcare, costs would be distributed in a way that would bring costs per capita down significantly compared to what Vermont was going to deal with.
What started out as a Democracy with decisions made for the common good has evolved into one that has politicians at the beck and call of big money. Today's politician makes decisions based on pleasing his biggest donors and selling it to those that vote for him as being good for them, all for the sole purpose of getting re-elected.
You can't even call it a Capitalist Democracy because that would invoke an idea of a level playing field that would promote innovation and development at a scale we sorely lack right now. Not only is it a fixed game, it's one where every angle is covered. From tax breaks to locking competition out to suppressing competitive research, the medical and Insurance industry is a rigged game here in the states and it is a result not of one party but the political system as a whole.
It will never be completely fixed here until we get people in office that actually put the good of the country before anything else. That won't happen until we develop a politic system that takes the ability away from the Mega-Donors to impose their desires. This is not a rant against the current party in power, this problem goes back for decades and is equally owned by both sides. I don't know the solution and it most likely is naive to believe it could change at this point, but there is no question that the great ideas this country was founded on are nothing more than a footnote in a history book at this point and we are in a steady decline.
+2. Fix the gerrymandering done to determine districts so politicians can stay in power. Term limits for members of Congress. Amend the Constitution to overrule Citizens United. Whatever the merits of that decision, it is politically corrosive.
The increasing contempt for politicians and political institutions is a grave threat to democracy.
+2. Fix the gerrymandering done to determine districts so politicians can stay in power. Term limits for members of Congress. Amend the Constitution to overrule Citizens United. Whatever the merits of that decision, it is politically corrosive.
The increasing contempt for politicians and political institutions is a grave threat to democracy.
Actually I think contempt for the politicians and political institutions (I include the media in here) is good for democracy. We should not trust any of them. A little bit of revolting peasants once in a while is a good thing.
Yeah, buford, but keep the billionaires and corporations Â
creating self-serving policy...that's what's good for the country. Don't respect investigative reporting, because any lie you repeat enough is bound to be as likely to be true as a fact.
The relevant part of Medicare is not the degree of coverage Â
The relevant part is that the coverage is guaranteed. It can be counted on. That’s what its enrollees value about all else. This guarantee does not exist pre 65.
Sam has a history of being unable to discuss this subject in a fair-minded manner. He has stated that he is a specialist, which is wonderful. However his paramount concern has clearly been physician remuneration (hence his kneejerk aversion to Medicare & single payer in general which don’t pay like Cigna et al).
Now, the good physicians should of course be sufficiently and fairly compensated, but it is empirically true that outrageous price gouging and the pushing of often unnecessary fee-for-service care by them & their administrators is a massive part of crippling health care spending in the USA.
To be fair, they’re largely able to do this because when the insured are so markedly shielded from the cost of care, they gleefully want and accept whatever their smiling doctor suggests (“Martha, you know that septum is slightly deviated…we have a procedure…). Or they straight up ask for it themselves (“fuck it, my co-pays only $10…”). They don’t “directly” suffer the consequences, but of course in the aggregate wages are suppressed as premiums balloon and federal debt is readily & consistently accumulated, so they (we) suffer still.
Health care/health insurance policy is sensationally complicated. There are endless moral considerations, economic considerations, practical considerations…all profoundly entangled among the interests of inveterate power brokers: Unions, seniors and their AARP megaphone, providers, businesses who receive preferential tax treatment, owners (I’m one of them) of the cushy plans that tax treatment facilitates, etc etc. Who would willingly submit to a haircut? Whose toes are reformers willing to step on?
It’s probably the single most challenging policy endeavor (tax reform probably 2nd). Especially since the “system” within which we exist is no system at all since that suggests some underlying blueprint. It’s effectively a piecemeal'd accident of history that likely wouldn’t exist without Adolf Hitler. And at this point to ameliorate things you need to be:
A) smart
B) serious i.e. fair-minded
C) willing to expend political capital.
Ask yourself first what % of our elected officials embody those 3 characteristics and then ask what % of the American populace, to whom reformation must be sold, embody the first 2.
It can’t be done with slogans, or chants, or fanciful panaceas:
The left: “Single payer!” Doctors don’t like it. Doesn’t that matter? To say nothing of undoing/transitioning the private insurance establishment which directly or indirectly employs millions.
The right: “Free market!” This for very specific & demonstrable reasons does not meaningfully apply in this case. Health insurance is not like shopping for cars or for that matter like other types of insurance. If you don’t understand why then you probably will not be able to grasp the nuance & intricacies of this issue (buford, etc.) so sit this one out.
It’s difficult to be optimistic. One (virtually imperceptible) silver lining is that both sides presently have skin in the game. The days of farcical 10 million repeal vote grandstanding is in the rearview. And despite the latest proposal – which is ridiculous – some of the debate (like that from the Ohio governor) is healthy. It reminds us that actual lives are affected. Call your reps and tell them to be serious about pragmatic solutions.
Lastly, one should roll their eyes at those dismissing the OP’s article as a smug Euros casting “dispersion” on the US’s MO. I’d read the article and it’s fairly reasonable and well-argued. Fully sensible to steal good ideas from other countries. It’s most often done from the United States, but we stole our very system of government from the Romans. When Taiwan implemented its insurance system in 1995, they studied elements from all over the world.
I wouldn’t steal from the Finnish, however. I’d steal from the Swiss. Like us, a hyper-Capitalist nation with a powerful insurance industry, pharma industry (Novartis, Roche), and influential upper class. Their system could with a few tweaks realistically be scaled within the USA.
creating self-serving policy...that's what's good for the country. Don't respect investigative reporting, because any lie you repeat enough is bound to be as likely to be true as a fact.
I don't want to get into an argument, but where did I say any of that? It's the politicians that are self serving and sorry, but most of the media is right in bed with them. If I see real investigative reporting, It interests me. But most if it is pure partisan hackery. Both sides.
RE: RE: RE: already paying for national healthcare - just Â
not getting it. If you add up the governmental funds (federal, state, and local) spent on healthcare, that is already more per capita than -any- other country. I'm not at a place where I can dig up the references, but if memory serves me most of the other countries were spending 7-10% of GDP on healthcare and the USA double that. There are many varieties of national healthcare from completely government run (Britain) to entirely (regulated) insurance based (Switzerland) and every combination in between.
Common to all is same rules for everybody (e.g. no gold plated insurance for congress critters while the rest of us suffer through a maze of insufficient options)
Medicare has an administrative overhead of 3%, until the ACA insurance companies averaged 25%, but now limited to a maximum of 20% due to ACA (Obamacare)
I agree the 3% Medicare number is faulty at best but the authors metric also needs work.
The author states that the Medicare number is the total admin cost divided by total dollars spent. And it does not include many costs from the admin bucket that are included in private health care. No doubt of it and fully agree. The author also states that Medicare is mostly elderly with higher cost per visit it unjustly lowers the percentage. Also agree.
But, the metric the author states of admin costs divided by beneficiaries is also faulty. The elderly typically have more visits, than the largely under 60 insured privately, therefore more claims. And since the elderly have more complex claims the average cost per claim is higher. I would assume that the admin cost of an elderly beneficiary for exceed that of the average privately insured. Would anyone be surprised to learn that the elderly cost more in admin than the rest of the population?
So I think it is improper to use probably the most costly sector for admin cost as a basis for how efficient the private sector is.
Like I said, the 3% figure is BS but the authors metric is also flawed. What the true cost difference is I don't profess to know but I would use neither of the figures used.
I've been out all day so sorry for late reply. forbes article is misleading. here is one based on non-partisan CBO analysis noting that Medicare administrative cost figures include the collection of Medicare taxes, fraud and abuse controls, and building costs. CBO based analysis - ( New Window )
RE: The relevant part of Medicare is not the degree of coverage Â
Lastly, one should roll their eyes at those dismissing the OP’s article as a smug Euros casting “dispersion” on the US’s MO. I’d read the article and it’s fairly reasonable and well-argued. Fully sensible to steal good ideas from other countries. It’s most often done from the United States, but we stole our very system of government from the Romans. When Taiwan implemented its insurance system in 1995, they studied elements from all over the world.
I wouldn’t steal from the Finnish, however. I’d steal from the Swiss. Like us, a hyper-Capitalist nation with a powerful insurance industry, pharma industry (Novartis, Roche), and influential upper class. Their system could with a few tweaks realistically be scaled within the USA.
Swiss system is very interesting, initially the swiss insurance industry fought it fiercely as mandated universal basic coverage for everyone (we would consider their 'basic' pretty darned good), then the insurance companies noticed that people tend to buy all their insurance in one place (house, car, etc), so now they compete for customers for health insurance, offering goodies above and beyond the basics (as enjoyed by my swiss friend who spends a week at the health spa every year on his insurance!)
I'm just one person who's been on Medicate and the AARP supplement since I turned 65 in 1999.
A friend talked me into opting for a Medicare PPO not long after signing up. It was a mistake that I corrected after a year or two. Even though I saved a fair amount of money, the care wasn't acceptable.
The Medicare/AARP combination is the bomb -- the absolute bomb.
Under Medicare I've had a quintuple bypass, three carotid endardarectomies (roto-rooter) and a spinal fusion -- all while competing at a fairly high level in senior tournament tennis.
Both the American system and an international universal system.
I think the biggest impediment to a universal plan here is the expectation of your average American. I think most people want free healthcare, but they still want the best healthcare in the world, and they don't want to wait for it.
In Australia, which has both 'free' and private insurance, the Australians are morally comfortable with a two tier system. Those who get their care for free are ok either waiting months for care and/or having no say who their doctor will be (you don't have a doctor; you have a hospital. Whoever is there that day can do your surgery and it is likely a different person from who told you you need surgery).
And it's always bandied around that "by most metrics" American healthcare is worse but that's not really true. It depends on how you're ranking and which factors you're looking at. In terms of response time and cure rate for most cancers, for example, America is way ahead.
I'm just one person who's been on Medicate and the AARP supplement since I turned 65 in 1999.
A friend talked me into opting for a Medicare PPO not long after signing up. It was a mistake that I corrected after a year or two. Even though I saved a fair amount of money, the care wasn't acceptable.
The Medicare/AARP combination is the bomb -- the absolute bomb.
If you don't mind me asking what company did you use when you went with the PPO?
where citizens on both sides of the political spectrum move towards "f*** ideology, just get a good system that works for everyone." That's pretty much where I am right now.
are drugs, which I don't know what to do about and hospital/end of life care. I'm a physician as well.
In my experience, the entire nursing home, rehab, hospital chain in broken and needs to be fixed. I can't tell you how many times we'd see admissions to the hospital of nursing home patients who are chronically ill, demented with poor quality of life to begin with. Then they get treated in the hospital, for a small fortune, and sent right back to the nursing home to begin the nursing home/hospital cycle anew. Of course they end up dying anyway in 6 months or so after suffering through the American hospital system. A huge strain on resources and, to be frank, a massive waste of public money.
Then there's the chronically ill elderly who enter the hospital for whatever reason and can't make it back home safely. They then go to rehab to "get strong" but of course get sick again in the rehab and go right back to the hospital. Costs upon costs upon costs all without improving anyone's quality of life or even prolonging it.
This country has a serious issue with accepting the end. Whether that means death or surrendering to the fact that your life as you knew it has changed drastically. Things are better since I began practicing with the advent of palliative care and more widespread use of hospice, but there's a long way to go.
I became so disillusioned with the system I actually left my private practice of 15 years recently and took another position to get away from it.
What can be done? Death panels? Of course not. Better education re end of life issues? Education would be a start. In med school they taught how to prevent and treat disease but barely anything about palliative care and end of life discussions. I had to learn on the job.
before we can fix any of this, we need to get our arms around the increasing costs. I am talking about the cost for meds which is like legal mafia and the ridiculous mal practice law suits which drive up insurance costs for the physicians which eventually gets passed down to us. Finally, we have too many people who don't pay into the system and just walk into a hospital when they need urgent care. These costs contribute to the high cost of healthcare.
Until you fix these things, no plan is going to work well.
Unfortunately our government cannot afford to just give everyone free healthcare OR at a fixed cost no matter who you are. Not unless we begin raising that money other than from our own tax payers.
Interesting point of view but one which can not be easily solved. Our population is aging and treatments and costs naturally rise with the aging patient. The improvement in palliative care and its expanded use is long overdue. This said, the number of physicians comfortable in this area are few and far between. I agree that patients expectations are in many cases exaggerated. Some of this is due to poor communication on the part of the mds and often unwillingness to lay the cards on the table. In my practice, I have usually been forthcoming with prognosis from the first visit lest the patient think that everything will be fine.
We expect too much and because of this our first reaction when things do not go as planned is to seek a lawyer. This endless game would be mitigated if there were not so many false hopes created by pharma, mds and others intimately involved in the health care system. We need to look at what we do and do it without fear that if all is not done, we have failed. Patients need to understand that we have a finite life span and that a point is reached where there is nothing to be gained. End of life care is important and the Europeans certainly are much farther ahead in their vision than we are in this country. Their acceptance of end of life care and its implications in terms of care provided are a model we should emulate. I believe that we must look carefully at our elderly and the care we can provide. Someone has to have the fortitude to tell patients that there is little to be gained by ongoing treatment. Only then can we accept the idea that end of life care has a real place in our health care system. This is a prickly issue but one deserving of our leaders time.
these Scandinavian countries, with such a small number of extremely healthy, homogeneous populations, find they can cast dispersions on American healthcare.
Rebel... you may have a point, but the perhaps the best system for the U.S. is a single payer government sponsored plan. And if those with discretionary income want to supplement that with some sort of concierge service, so be it. In other words, a Medicare-like system for everyone.
Why do you think gasoline costs $8 per gallon in Europe? The extra $5 per gallon is tax to pay for social programs.
Ain't nothing free and Doctors don't make the money in Europe, ours do.
I wouldn't mind a single payer system, but I don't think you would like to find what that costs in the USA.
The relevant part is that the coverage is guaranteed. It can be counted on. That’s what its enrollees value about all else. This guarantee does not exist pre 65.
Sam has a history of being unable to discuss this subject in a fair-minded manner. He has stated that he is a specialist, which is wonderful. However his paramount concern has clearly been physician remuneration (hence his kneejerk aversion to Medicare & single payer in general which don’t pay like Cigna et al).
Now, the good physicians should of course be sufficiently and fairly compensated, but it is empirically true that outrageous price gouging and the pushing of often unnecessary fee-for-service care by them & their administrators is a massive part of crippling health care spending in the USA.
Geez.
I'd love to hear examples of how I'm not fairminded about the subject. We're all opinionated about the subject... some more than others. Based on my experience as a physician, I believe and have repeatedly argued that much of the problems with health care would not be solved if we did away with private insurance.
Medicare, while reimbursing less than many private plans, does tend to pay relatively quickly. My main issue with Medicare/Medicaid is the blatant bullying that CMS lays on the health care provider, and the factless blaming of physicians for the rise in health care costs. In that vein, we now have a preposterous train ride of acronyms to measure health care "quality"... P4P, PQRS, APM, MIPS, MACRA, etc. All of these, mandated by either ACA or CMS, all of which significantly burden health care providers for no good reason than it sounds good to the public. I started practicing in September of 2015. I was then penalized 2% by Medicare because I did not submit PQRS statements for all of 2015. Well, I wasn't practicing medicine for 8 months out of the year. Of course, I have no recourse.
Let's look at the overall physician cost burden to healthcare. I might get paid $200 for a procedure done in the hospital. The anesthesiologist charges $1000 but I don't know what they actually end up collecting. The hospital collects $4000 for an ambulatory procedure. The same procedure would cost less than $2000 at an ambulatory surgery center, but they're not credentialed for that particular insurance plan. The difference is taken up by the hospital CEO to pay for their overhead. Which begs the question... why aren't people looking at the hospital books to see where all those healthcare dollars are going?
It's just easier to point a finger at doctors who order useless tests (that I don't get paid for, but OK...) and useless procedures (even though for most procedures, I'd get paid more if I stayed in clinic than in the OR).
It is not the savings that people think (2%?), but it is a cost and many little cost do add up.
Remember, also, malpractice insurance is ridiculously high - about 33% of the intake in a practice I have been told. When you have a $250k practice and insurance is $80+k, that is just wrong.
All the MDs here can correct me if I am wrong.
I know there's some disagreement about the overall impact of end of life treatment as a percentage of total healthcare cost (see article linked below). But I also know there is extraordinary variation in the cost of end of life treatment across states. New York, I believe, spends substantially more than almost any other state in the union. And this probably goes to any number of points made by our BBI physicians. Some people have unrealistic expectations about chronic and fatal illness. I did notice in the linked article that end of life cost are inordinately high among Medicare and Medicaid.
It is not the savings that people think (2%?), but it is a cost and many little cost do add up.
Remember, also, malpractice insurance is ridiculously high - about 33% of the intake in a practice I have been told. When you have a $250k practice and insurance is $80+k, that is just wrong.
All the MDs here can correct me if I am wrong.
Let me add to this...
The obstetricians are getting absolutely killed with malpractice insurance rates. It may be the highest of all medical doctors. Roughly 10 years ago the Obstetricians in NJ had some kind of march in Trenton about this. Huge numbers of them are now out of business and are working in some kind of clinic instead of their own practice.
What I was referring to before was not just putting a cap on malpractice law suit awards and hoping that insurance rates fall. I am talking about also regulating that insurance just like the government does with PMI. For those of you who have ever gotten a mortgage with less than 20% down and ended up with PMI... that insurance premium is regulated nationally and not at the state level.
BTW, despite my handle I'm now living in Sarasota.
Hey, congratulations on your move to FL. Do you love it? Better quality of life? You know, that in itself can help your health. The warden and I are looking for a place south of there in Cape Coral.
Congrats to most on not sinking into the sewer. A couple of points:
* As many have said, end of life is a large driver of costs and there's no easy solution/
* While tort reform might only lower costs by 2-3%, while the hell not lower costs by 2-3%?
* Drug costs. Am I wrong, or is most of the world free riding off on the American patients? Most countries mandate lower drug prices. However, without the US paying full freight (and more?) for the R&D necessary to develop these drugs, how many never would have reached market? This seems to me to have been going on for decades, and I'm not sure how to solve it.
BTW, despite my handle I'm now living in Sarasota.
Hey, congratulations on your move to FL. Do you love it? Better quality of life? You know, that in itself can help your health. The warden and I are looking for a place south of there in Cape Coral.
Yes, we do love it. Had been coming for a month or more for the last 10 years or so and bought here early in 2013. Moved fulltime at the end of 2015 when Toledo grandsons had graduated and dispersed.
Yes, we do love it. Had been coming for a month or more for the last 10 years or so and bought here early in 2013. Moved fulltime at the end of 2015 when Toledo grandsons had graduated and dispersed.
ok so I am going to bridge my next question over to the solar panel thread that is floating out there right now. What do the electric bills look like down there?
Yes, we do love it. Had been coming for a month or more for the last 10 years or so and bought here early in 2013. Moved fulltime at the end of 2015 when Toledo grandsons had graduated and dispersed.
ok so I am going to bridge my next question over to the solar panel thread that is floating out there right now. What do the electric bills look like down there?
EricJ
Your power company would be Lee County Electrical Co-op. I attached their link so you can get the price per KWh.
Alos they just opened up the first sustainable solar city in the US on 31 called Babcock Ranch.
* While tort reform might only lower costs by 2-3%, while the hell not lower costs by 2-3%?
"Tort reform" doesnt lower costs by 2-3%. It shifts costs to injured patients. Every industry could "lower costs" if they werent made to compensate the victims of their own negligence.
And in any event, I believe the studies have shown that "tort reform" doesnt save a penny. Insurance premiums have a very low correlation to damages caps and even state-wide litigation rates. Several studies have shown that so-called defensive medicine testing rates do not go down after "tort reform" is enacted (e.g. NE Journal of Medicine study re ERs.).
The amount of ink spilled over "tort reform" is truly stunning. It's really one of those sheeple instances -- people with a vested interest in maintaining the status quo are promoting an ancillary issue to distract from more intractable problems.
[and before anyone says "but you're a lawyer" -- my practice has nothing to do with med mal or anything remotely related to it]
"Tort reform" doesnt lower costs by 2-3%. It shifts costs to injured patients. Every industry could "lower costs" if they werent made to compensate the victims of their own negligence.
I don't think anyone would suggest that victims should not be compensated for their costs especially costs related to those victims getting treated the injuries sustained during the mal-practice plus SOME pain and suffering. The latter is the problem. Millions being paid out in some instances for subjective reasons.
an older guy. He is really smart. Ask him a question on any topic and he can give you the answer. Could probably clean up on Jeopardy. However, he chooses to spend his life trying to scam people. He has an attorney on speed dial with multiple law suits going on at the same time. Mostly mal-practice (that are hard to disprove) as well as injury law suits. The shit just has to stop or be controlled.
* Drug costs. Am I wrong, or is most of the world free riding off on the American patients? Most countries mandate lower drug prices. However, without the US paying full freight (and more?) for the R&D necessary to develop these drugs, how many never would have reached market? This seems to me to have been going on for decades, and I'm not sure how to solve it.
There is probably something to this. However, a few things undermine this. Most importantly, drug companies have a staggeringly high profit margin compared to other industries. Now some of that is totally deserved due to risk. But it's tough to say that US patients are subsidizing ex-US patients when what is more likely is that US patients are just providing outsized returns to drugcos.
And second, there is a lot of R&D at pharmaceutical companies that is of questionable social value. E.g. developing the 4th pill in a class, where it shows no improvement over existing drugs. Or worse, turning a 12 hour pill into a 24 hour pill and getting a whole new patent. Or isolating the left/right isomer of an existing drug and getting a patent just on that isomer.
* While tort reform might only lower costs by 2-3%, while the hell not lower costs by 2-3%?
"Tort reform" doesnt lower costs by 2-3%. It shifts costs to injured patients. Every industry could "lower costs" if they werent made to compensate the victims of their own negligence.
And in any event, I believe the studies have shown that "tort reform" doesnt save a penny. Insurance premiums have a very low correlation to damages caps and even state-wide litigation rates. Several studies have shown that so-called defensive medicine testing rates do not go down after "tort reform" is enacted (e.g. NE Journal of Medicine study re ERs.).
The amount of ink spilled over "tort reform" is truly stunning. It's really one of those sheeple instances -- people with a vested interest in maintaining the status quo are promoting an ancillary issue to distract from more intractable problems.
[and before anyone says "but you're a lawyer" -- my practice has nothing to do with med mal or anything remotely related to it]
How does a limit on punitive damages, not actual damages, shift costs to the patient? And count me skeptical to any suggestion that that cap wouldn't lower insurance rates to some degree. Beyond that, IMHO, "punitive" damages should be handled by state medical licensing boards, and not bank accounts.
RE: RE: RE: This thread has a lot of great posts Â
"Tort reform" doesnt lower costs by 2-3%. It shifts costs to injured patients. Every industry could "lower costs" if they werent made to compensate the victims of their own negligence.
I don't think anyone would suggest that victims should not be compensated for their costs especially costs related to those victims getting treated the injuries sustained during the mal-practice plus SOME pain and suffering. The latter is the problem. Millions being paid out in some instances for subjective reasons.
"subjective reasons" meaning what? Improper reasons? A jury hears a case and awards damages. How do you decide the value of, say, having a pair of legs, above and beyond the impaired ability to earn a living? Because that is what we're talking about. Because people think that the non-economic caps are just on "pain and suffering" and decide that that is too loose a concept and juries are stupid. Except, beyond the issue of questioning jurors who actually sat thru a trial, it's not just pain and suffering. California caps non-econ damages at $250,000, which by statute includes "pain, suffering, inconvenience, physical impairment, disfigurement and other nonpecuniary damage". So where is the fairness in that? Some doctor paralyzes you and all you can get beyond lost income is $250k? Isnt that obviously way too little? No one of sound mind would trade working legs for $250k.
5 billion in direct to consumer Pharma advertising doesn't Â
How does a limit on punitive damages, not actual damages, shift costs to the patient? And count me skeptical to any suggestion that that cap wouldn't lower insurance rates to some degree. Beyond that, IMHO, "punitive" damages should be handled by state medical licensing boards, and not bank accounts.
1. No one is talking about punitive damages when they refer to tort reform. The debate is non-economic damages, ie stuff other than out of pocket costs and lost income.
2. Declare your skepticism all you want, it's what study after study shows. Bigger picture, insurance across lines are not as tied to claims as one would think. Much higher correlation to stock market returns.
3. You last point is just a rejection of the idea of punitive damages generally. It's not wrong to think that (Im not much in favor of them), but our law allows them. Im not sure why we should single out doctors for special protection from them.
4. Medical licensing boards are a joke. In fact if doctors were better at policing their own there would be a lot less medical error. 1% of doctors are responsible for more than 1/3 of all med mal claims. The best predictor for which doctor will see a med mal claim is whether they've been sued before.
RE: RE: RE: RE: This thread has a lot of great posts Â
4. Medical licensing boards are a joke. In fact if doctors were better at policing their own there would be a lot less medical error. 1% of doctors are responsible for more than 1/3 of all med mal claims. The best predictor for which doctor will see a med mal claim is whether they've been sued before.
They are under tremendous legal threats, from those people whom they should be punishing.
Denying a license to an individual who has significant means and whose livelihood depends on it creates an adversarial conflict that is a fight to the death. The afflicted have no reason not sue until there is nothing left, and there a plenty of lawyers that will take the case, challenge all the facts and ultimately the equanimity of the board and its right to deny an individual his/her right to practice. Medical boards were made to grant certifications and generally aren't very well prepared, nor organized to take on too many fights. And not fighting them all is poor jurisprudence; once that's established then the whole board can get blown up. So they concede too often, mostly for the purpose of self preservation.
Basically they are getting killed by the people they should be stopping.
My thoughts are that the main reason healthcare costs more in the U.S. than in other countries are: prices and volume.
On prices, the prices are much, much higher in the U.S. And not just drug costs, which are way higher here. Do you think surgeons make $400K in Europe?
On volume: Rates of MRIs, other imaging are higher here than in Europe. Paying for volume just increases spending, in other countries the care is more 'controlled', let's say.
With respect to the overhead/profit argument on Medicare -- much of Medicare is administered by contractors, notably the Medicare Administrative Contractors (MACs). The MACs are the ones that process the claims on behalf of the government (except for Medicare Advantage enrollees -- Medicare pays plans a monthly rate). Everyone uses the overall Medicare spending and then divides the operating costs for Medicare, to get at that 3%. But that ignores the operating costs for the MACs. And the MACs are private companies.
healthcare system (model), you cannot keep malpractice/lawsuits at USA levels. Europeans are not suing at the drop of a hat and they certainly have the same medical issues/failures we have. Their court systems have much stricter requirements for lawsuits and they certainly don't allow the fishing that goes on around here. It is a total package that keeps costs reasonable or at least less than our costs. Doesn't mean that true malpractice shouldn't be compensated or the remedy to the medical issue (if possible) corrected at no cost to the patient. Doesn't mean bad doctors should not lose their licenses. But maybe it does mean the 33% plus expenses shouldn't be the standard cost of recovery.
The providers of health care are mostly in it for a profit. Â
The payers of health care are mostly in it for a profit. The makers of drugs and medical equipment are in it for a profit. Consumers of health care are left with a market where basically everyone is trying to make money off them. And we wonder why our health care costs are so high.
as a red herring by those who were unwilling to recognize and certainly tackle much larger problems within our health care/health insurance system.
That dynamic has now evaporated because they are now largely in power and forced to take the issue more seriously because of the previous president's efforts. Say what you want about the ACA's efficacy (which can be intelligently argued), there are several elements that Americans of all political stripes value.
It is now all but accepted as a given that health care policy must include protections for those with established conditions. This is huge. I cannot overstate that. Going back decades, this was virtually exclusively the territory of the left. Even if it's (in part) repealed, the ACA has cemented the need for that stipulation (not to mention the smaller pieces like up to 26 parents insurance). Whatever happens on Thursday and moving forward, the previous CoC's efforts are responsible for that and he should be applauded.
Getting sick or injured is the ultimate NON left/right thing. If you don't appreciate that directly, I guarantee you know someone who does. And even if you don't care about it on the individual insurance market (as the right basically forever did not) because "hey, I have a job", remember that you're not discriminated against in your group plan because of a Federal law. In other words, the Federal government told private companies, "no, you can't do that." Appreciate it like that.
I don't like the proposed legislation, especially since it's a predictable gargantuan tax cut for those who have thrived in recent years, but what is inarguable is that it is at least a more serious stab at addressing problems. A far cry, in other words, from the days of vacuous & pathetic "tort reform, across state lines, boom, done, let's grab a beer."
Meandering progress, yes. And after a horrifically ugly policy brawl for the past 8 years (or further back if you count '93), but progress still.
RE: RE: RE: RE: This thread has a lot of great posts Â
"subjective reasons" meaning what? Improper reasons? A jury hears a case and awards damages. How do you decide the value of, say, having a pair of legs, above and beyond the impaired ability to earn a living? Because that is what we're talking about. Because people think that the non-economic caps are just on "pain and suffering" and decide that that is too loose a concept and juries are stupid. Except, beyond the issue of questioning jurors who actually sat thru a trial, it's not just pain and suffering. California caps non-econ damages at $250,000, which by statute includes "pain, suffering, inconvenience, physical impairment, disfigurement and other nonpecuniary damage". So where is the fairness in that? Some doctor paralyzes you and all you can get beyond lost income is $250k? Isnt that obviously way too little? No one of sound mind would trade working legs for $250k.
No, subjective is pain and suffering. I would also agree with you that if the mal practice results in the patient's inability to work then that absolutely needs to be considered. What I am talking about here is the $5 million award to someone when there are no real costs that would add up to that.
Although not a mal-practice law suit, the woman who got how many million because she spilled a hot cup of McDonald's coffee in her lap? Pain and suffering...
Don't be stupid and use that as an example of crazy jury's:
Quote:
Mrs. Liebeck offered to settle the case for $20,000 to cover her medical expenses and lost income. But McDonald’s never offered more than $800, so the case went to trial. The jury found Mrs. Liebeck to be partially at fault for her injuries, reducing the compensation for her injuries accordingly. But the jury’s punitive damages award made headlines — upset by McDonald’s unwillingness to correct a policy despite hundreds of people suffering injuries, they awarded Liebeck the equivalent of two days’ worth of revenue from coffee sales for the restaurant chain.
Quote:
And, to avoid what likely would have been years of appeals, Mrs. Liebeck and McDonald’s later reached a confidential settlement.
* McDonald’s admitted it had known about the risk of serious burns from its scalding hot coffee for more than 10 years. The risk had repeatedly been brought to its attention through numerous other claims and suits.
* An expert witness for the company testified that the number of burns was insignificant compared to the billions of cups of coffee the company served each year.
* At least one juror later told the Wall Street Journal she thought the company wasn’t taking the injuries seriously. To the corporate restaurant giant those 700 injury cases caused by hot coffee seemed relatively rare compared to the millions of cups of coffee served. But, the juror noted, “there was a person behind every number and I don’t think the corporation was attaching enough importance to that.”
Not the best example of a "frivolous" lawsuit.
RE: RE: RE: RE: RE: This thread has a lot of great posts Â
Although not a mal-practice law suit, the woman who got how many million because she spilled a hot cup of McDonald's coffee in her lap? Pain and suffering...
That's a terrible example -- here's what the burns from coffee at 180-190 degrees looked like:
The payers of health care are mostly in it for a profit. The makers of drugs and medical equipment are in it for a profit. Consumers of health care are left with a market where basically everyone is trying to make money off them. And we wonder why our health care costs are so high.
Thats too much reductionism. If all health care workers wanted was profit, they probably wouldn't be in health care. And if an organization isn't profitting, its nots going to be around very long to fulfill its mission....
the cost of healthcare is outrageous. My wife and I pay almost $1000 a month for us and our son. And even with that, I am having neck surgery and have to pay $2000 out of pocket for the hospital alone. That doesn't even include what copays I will have for anesthesiologist and my orthopedic. I almost cancelled the surgery because I can't afford that but hoping the hospital takes small payments per month. The rates in this country are outrageous but I also realize healthcare is expensive. I guess it won't bother me as much when I am not in so much pain in two weeks.
RE: RE: RE: RE: RE: This thread has a lot of great posts Â
"subjective reasons" meaning what? Improper reasons? A jury hears a case and awards damages. How do you decide the value of, say, having a pair of legs, above and beyond the impaired ability to earn a living? Because that is what we're talking about. Because people think that the non-economic caps are just on "pain and suffering" and decide that that is too loose a concept and juries are stupid. Except, beyond the issue of questioning jurors who actually sat thru a trial, it's not just pain and suffering. California caps non-econ damages at $250,000, which by statute includes "pain, suffering, inconvenience, physical impairment, disfigurement and other nonpecuniary damage". So where is the fairness in that? Some doctor paralyzes you and all you can get beyond lost income is $250k? Isnt that obviously way too little? No one of sound mind would trade working legs for $250k.
No, subjective is pain and suffering. I would also agree with you that if the mal practice results in the patient's inability to work then that absolutely needs to be considered. What I am talking about here is the $5 million award to someone when there are no real costs that would add up to that.
Although not a mal-practice law suit, the woman who got how many million because she spilled a hot cup of McDonald's coffee in her lap? Pain and suffering...
A doctor is grossly negligent and causes you paralysis below the waist. You're a software programmer so your ability to earn a living is not impaired. You'll have more costs in life as life is more expensive for the wheelchair-bound, so you get that as damages.
Should you get damages for the fact that your life is now way shittier, you cant play sports like you used to, can fuck your wife, you cant take her to small romantic restaurants, you cant pick up your daughter like other fathers, everything physical task takes longer and is harder leaving you exhausted, and you end up depressed because of your shittier life? Because that's what is at issue. Should the victim eat that, or should a doctor (who has insurance for these very reasons) eat that?
healthcare system (model), you cannot keep malpractice/lawsuits at USA levels. Europeans are not suing at the drop of a hat and they certainly have the same medical issues/failures we have. Their court systems have much stricter requirements for lawsuits and they certainly don't allow the fishing that goes on around here. It is a total package that keeps costs reasonable or at least less than our costs. Doesn't mean that true malpractice shouldn't be compensated or the remedy to the medical issue (if possible) corrected at no cost to the patient. Doesn't mean bad doctors should not lose their licenses. But maybe it does mean the 33% plus expenses shouldn't be the standard cost of recovery.
Why? what are the "levels" of med mal spending you perceive. Plaintiff and defendant costs plus payouts are about $10 bn (2010). I dont think there is much growth either -- I've seen that med mal filings are shrinking a lot of places. So $10 bn in a $3.2 trillion industry. I really fail to see the materiality of that.
Then you get to defensive medicine. Some estimates are as high has $50 billion give or take. But you have to buy into the notion that litigation is causing defensive medicine. Doctors certainly say fear of suit leads them to unnecessary testing. But the studies dont back it up. E.g. the RAND study of ERs before and after "tort-reform" showing no difference in testing levels.
Im not saying there arent any changes you can make to the tort system, but it's very functional. Monied interests, notably the AMA (doctors), insurance companies, US Chamber of Commerce (anti-damages suits by consumers, find doctors get more public sympathy than corps), and the GOP (self interest since trial lawyers support Dems) hammer at you on this tort reform issue in ways you dont even realize. They done a good job convincing people that "tort reform" is some big money saver for the system and needed to cure some scourge (I guess of dumb citizens siting on juries??). Dont buy the hype. It's bullshit. The data doesnt lie. Link - ( New Window )
I'd like to read more about Sweden. We hear a lot about the Scandinavian countries. But, the most oft mentioned ones are socialist countries with universal healthcare. I don't think that will ever fly here (although I am not completely opposed to it). So, it would be interesting to see how another capitalist nation handles this type of healthcare.
Realistically, wouldn't we have to move to a fully socialist economy in order to move to fully universal healthcare and education in this nation?
since that is really the only area I can speak with any degree of competence on.
- As was referenced earlier, yes the US does fund the R&D expenses for the rest of the world. This is partially in relation to a "one payer" system many of the European countries have. Also one of the biggest reasons against having a one payer system as many forms of medication are not available in some countries because of how they negotiate.
- Drugs are approximately 10% of the cost of healthcare, which is no where compared to hospitals, physicians's ect. Included within that 10% costs are RD & Marketing associated with manufacturers/innovators and then a very large percentage attributed to distributors (cardinal, mcckesson) and retail chains (cvs, rite aid, etc.). Manufacturers obviously garner the most attention but look at the market cap of the distributers and you will realize they all make more money than any pharma company.
- Product liability is a massive driver of the cost of drugs. The amount of money paid in litigation costs and settlements is staggering. Some of those cases are nefarious but the vast majority are simply a reflection of the way tort law is currently set up and Levine v. Wyeth. You reform product liability tort and you could probably lower drug prices 5%.
- BBI
Rebel... you may have a point, but the perhaps the best system for the U.S. is a single payer government sponsored plan. And if those with discretionary income want to supplement that with some sort of concierge service, so be it. In other words, a Medicare-like system for everyone.
We must be able to come to grips with a system providing universal coverage for all of us. We can not call ourselves the envy of the free world in health care, when statistics prove otherwise. Uninsureds and multiple payers etc. are stiffling American medicine. The sooner we realize that for all we spend we are not better off, the faster we can implement a system that is fair and encompassing. As stated in this article and many others, we pay huge amounts of money for healthcare, more than most countries. Are the results reflecting our expenses? I believe not and agree with the author that we can do much better. We must turn to some form of complete access with coverage for all. Importantly, results from multiple studies confirm that from a cost point of view, this is tenable. What is missing is the backbone and will of our politicians to bend and break their alliances with big business and insurance companies. These decisions will take time, but till then this quagmire that we run amok in on a daily basis, will continue to leave us with less care than we deserve.
I think it's more than just unhealthy lifestyles. Here in the U.S., for example, a tremendous amount of money is spent on end-of-life care. In countries like Switzerland, they do everything possible to ensure a patient's end-of-life comfort and ease, but they don't throw hundreds of thousands of dollars at "heroic efforts" that neither extend life very long nor the quality of that "extended life."
We must be able to come to grips with a system providing universal coverage for all of us. We can not call ourselves the envy of the free world in health care, when statistics prove otherwise. Uninsureds and multiple payers etc. are stiffling American medicine. The sooner we realize that for all we spend we are not better off, the faster we can implement a system that is fair and encompassing. As stated in this article and many others, we pay huge amounts of money for healthcare, more than most countries. Are the results reflecting our expenses? I believe not and agree with the author that we can do much better. We must turn to some form of complete access with coverage for all. Importantly, results from multiple studies confirm that from a cost point of view, this is tenable. What is missing is the backbone and will of our politicians to bend and break their alliances with big business and insurance companies. These decisions will take time, but till then this quagmire that we run amok in on a daily basis, will continue to leave us with less care than we deserve.
Well said, Sir!
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The number one problem with healthcare cost comparisons is the diet and lifestyle we love. Until we start eating healthier as a country, healthcare costs will always be high as a percentage of gdp, regardless of whether we adopt a single payor system or not.
I think it's more than just unhealthy lifestyles. Here in the U.S., for example, a tremendous amount of money is spent on end-of-life care. In countries like Switzerland, they do everything possible to ensure a patient's end-of-life comfort and ease, but they don't throw hundreds of thousands of dollars at "heroic efforts" that neither extend life very long nor the quality of that "extended life."
Yeah. I agree. Seems a shame to save all this money for healthcare only to have a third or so of your lifetime costs in the last few months of life. Seems inefficient and silly
Now go to a drugstore and ask for a price list for prescription medications. Go to a hospital and ask for a price list for common procedures and costs of overnight stays. You won't get one.
That's not a free market. It's an opaque broken one.
We must be able to come to grips with a system providing universal coverage for all of us. We can not call ourselves the envy of the free world in health care, when statistics prove otherwise. Uninsureds and multiple payers etc. are stiffling American medicine. The sooner we realize that for all we spend we are not better off, the faster we can implement a system that is fair and encompassing. As stated in this article and many others, we pay huge amounts of money for healthcare, more than most countries. Are the results reflecting our expenses? I believe not and agree with the author that we can do much better. We must turn to some form of complete access with coverage for all. Importantly, results from multiple studies confirm that from a cost point of view, this is tenable. What is missing is the backbone and will of our politicians to bend and break their alliances with big business and insurance companies. These decisions will take time, but till then this quagmire that we run amok in on a daily basis, will continue to leave us with less care than we deserve.
This is a brilliant post, and coming from a Physician who obviously understands the nuances, shortcomings and positive elements of our healthcare system makes it even better.
Common to all is same rules for everybody (e.g. no gold plated insurance for congress critters while the rest of us suffer through a maze of insufficient options)
Medicare has an administrative overhead of 3%, until the ACA insurance companies averaged 25%, but now limited to a maximum of 20% due to ACA (Obamacare)
So yeah, let's just do single payer cuz it works in some other countries.
Common to all is same rules for everybody (e.g. no gold plated insurance for congress critters while the rest of us suffer through a maze of insufficient options)
Medicare has an administrative overhead of 3%, until the ACA insurance companies averaged 25%, but now limited to a maximum of 20% due to ACA (Obamacare)
False.
https://www.forbes.com/sites/theapothecary/2011/06/30/the-myth-of-medicares-low-administrative-costs/#35e4d2e9140d
When I was laid off last year from work I opted for Cobra figuring I would be back in the saddle pretty quick with work and a month or so would be ok. Well my hopes did not happen still looking for work and had to decide what to do the first of the year.
I figured I would find something on the market place at least comparable to what I had for much cheaper than I was paying for Cobra. Not so much I opted to continue my cobra coverage with a savings of approx 120.00 per month. And the amount I pay for Cobra is no picnic approx 650.00.
The system is broken and I hope they can fixit… I am fortunate and can afford this but far too many Americans cannot.
you realize the experience the Finnish transplant was complaining about was Obamacare, right? Her entire US stay to date has been Obamacare and her main point of reference for American Health Care is Obamacare.
I'm not an expert on this and I fully agree we can learn from other countries but my guess is Americans pay more because of the volume of people who don't contribute anything supported by the people who contribute a lot. Combine that with the ridiculous practices around medical billing and the rest of the bureaucracy and my guess it's not mostly just the healthcare system, but related industries.
The countries the author mentions may be doing fine, but it's hard to compare the US 325 million diverse people, with Sweden (under 10M), Finland (under 6M), Netherlands (under 20M), or other small, mostly non-diverse, small population growth countries. Even Canada has under 40M mostly Caucasian citizens of similar ancestry.
So while learning from Finland is something important, maybe learning from Russia (bad healthcare getting worse), or the UK (the author repeatedly cites OECD: "NHS: UK now has one of the worst healthcare systems in the developed world, according to OECD report
Hospitals so underequipped that people are dying needlessly because of a chronic lack of investment")
Might be smart too, so instead of cherry-picking the countries where it works that aren't really comparable and saying "we could learn from them" it's important to learn from the countries more comparable whether their healthcare system has worked or not.
the self-loathing American is so tedious. as bad as the blindly 'Murica loving American.
It's all relative.
It's all relative.
They are all much higher than the US in terms of income tax for the most part (Finland 10% more), but the author claims she paid the same in Finland as she paid in the US, but sources say otherwise.
When people want to make a point, people are willing to take liberties, so who knows what's right.
I trust nothing anymore.
I love America but think there are problems that we should develop institutions and resources to fix, and healthcare is one of the top of the list.
I don't have the answers, but the system, both before and after the Affordable Care Act, is broken and needs solutions.
Maybe the Scandinavian system has solutions and maybe they won't work here. Would like a bi-partisan approach but given how the ACA was treated as will any republican attempts, it really sucks that the American populace will suffer with expensive and confusing care
I'm just saying when people suggest that what works in Finland or other Scandinavian countries may not work in the US, they're not being all "'Murica fuck yeah" they're actually simply highlighting a non-valid comparison.
Sure there are things Finland may do that the US system can adopt and help it to improve, but I'll tell you the statistics the author cites, that's pretty damn good considering the size, diversity, and vastness of the US. Can it be improved? Absolutely and it needs to be and I too think the best solution should be something bipartisan, but this article seems bloggish to me.
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I hope the Republicans can do better than the garbage they are offering us. All of a sudden, Obamacare doesn't look so bad.
you realize the experience the Finnish transplant was complaining about was Obamacare, right? Her entire US stay to date has been Obamacare and her main point of reference for American Health Care is Obamacare.
I'm not an expert on this and I fully agree we can learn from other countries but my guess is Americans pay more because of the volume of people who don't contribute anything supported by the people who contribute a lot. Combine that with the ridiculous practices around medical billing and the rest of the bureaucracy and my guess it's not mostly just the healthcare system, but related industries.
The countries the author mentions may be doing fine, but it's hard to compare the US 325 million diverse people, with Sweden (under 10M), Finland (under 6M), Netherlands (under 20M), or other small, mostly non-diverse, small population growth countries. Even Canada has under 40M mostly Caucasian citizens of similar ancestry.
So while learning from Finland is something important, maybe learning from Russia (bad healthcare getting worse), or the UK (the author repeatedly cites OECD: "NHS: UK now has one of the worst healthcare systems in the developed world, according to OECD report
Hospitals so underequipped that people are dying needlessly because of a chronic lack of investment")
Might be smart too, so instead of cherry-picking the countries where it works that aren't really comparable and saying "we could learn from them" it's important to learn from the countries more comparable whether their healthcare system has worked or not.
the self-loathing American is so tedious. as bad as the blindly 'Murica loving American.
Well said.
- BBI
Yes, let's model our healthcare off of Finland. They are very similar to us - alk 6 million of the with their military spending, large immigrant and diverse population. Do they have more than 10 immigrants? I am sure their model will work here splendidly. Moronic.
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I practice as a medical specialist and have trained and worked in and outside the United States. During my years of training at McGill university in Montreal, I saw what many believe in the U.S. to be inferior health care. Nothing could be farther from the truth. Care being universal and fully covered in Canada for example does allow for access to the physicians required albeit with waiting times which are longer than in the U.S. The quality of care is excellent once access is obtained. The contingency is that access for some procedures is variable and can lead to frustration for the patients concerned. Contrast this however with the myriad of plans, co pays, 3rd party payers and you can not convince me that the system is not broken and needs fixing. More worrisome to me is that no plan, Trumps or others, will remove the overhanging layer of bureaucracy that makes American medicine so difficult to navigate.
We must be able to come to grips with a system providing universal coverage for all of us. We can not call ourselves the envy of the free world in health care, when statistics prove otherwise. Uninsureds and multiple payers etc. are stiffling American medicine. The sooner we realize that for all we spend we are not better off, the faster we can implement a system that is fair and encompassing. As stated in this article and many others, we pay huge amounts of money for healthcare, more than most countries. Are the results reflecting our expenses? I believe not and agree with the author that we can do much better. We must turn to some form of complete access with coverage for all. Importantly, results from multiple studies confirm that from a cost point of view, this is tenable. What is missing is the backbone and will of our politicians to bend and break their alliances with big business and insurance companies. These decisions will take time, but till then this quagmire that we run amok in on a daily basis, will continue to leave us with less care than we deserve.
This is a brilliant post, and coming from a Physician who obviously understands the nuances, shortcomings and positive elements of our healthcare system makes it even better.
Agreed.
I hope this thread doesn't take any nasty political turns and is allowed to stay up.
Really this writer is just pointing out the absurdity of the suggestion that people can shop around for healthcare much in the same way they can shop around for a pair of jeans.
Other countries, like Finland, came to a consensus quite some time ago that it is not realistic to expect it's people to be in a position to make informed-enough decisions related to cost and quality of critical services - or that they should be even burdened with doing so for the such potentially stressful and life-altering moments that take place at a hospital.
More significantly, they recognized that individuals have no leverage to broker lower expensed services through the market. For someone who requires an individual plan, the only option (without incredibly generous government subsidies) that allows them to have comprehensive coverage at a low cost is a single-payer system.
Exactly. My interest in what this European blowhard has to say is between zero and none.
Don't tell people that. Healthcare, no matter what the cost, and in spite of whether or not is largely self inflicted due to bad lifestyle choice, is a RIGHT damnit !!
The system is funded with the following taxes:
(1) Reclassify carried interest from a capital gain to ordinary income.
(2) Elimination of "stepped up" basis for stocks, bonds, and most real estate.
(3) 4% national sales tax on all Internet purchases.
(4) 1% financial transactions tax.
Premium is a function of risk. Cap the amount the insurers have to pay, and premiums should come down. The system would still allow for copays and deductibles, but they would be much lower. HSAs would also still be allowed.
If reasonable honest people were making US healthcare policy it wouldn't look anything like what we have today.
Thanks for your service Dr. Snickers.
If reasonable honest people were making US healthcare policy it wouldn't look anything like what we have today.
Thanks for your service Dr. Snickers.
THIS^^^^^^^^^^^^^^^^^
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Murica fuck yeah
- BBI
Yes, let's model our healthcare off of Finland. They are very similar to us - alk 6 million of the with their military spending, large immigrant and diverse population. Do they have more than 10 immigrants? I am sure their model will work here splendidly. Moronic.
GiantsUA--Thank you for saying what I was thinking about this moron. This is your typical mindless post. Nothing intelligent to offer but to attack a person with an opposing point of view. I was not saying America has no issues with healthcare, what I was implying is that it's apples and oranges to compare healthcare in the U.S. to Finland.
If reasonable honest people were making US healthcare policy it wouldn't look anything like what we have today.
Thanks for your service Dr. Snickers.
Medicare is not single payer... straight Medicare pays 80% of outpatient billing so the 20% is either out of pocket or from a supplemental. Medicare advantage plans are administered through private insurance companies. Medicaid is paid for by the federal and state governments.
The closest thing we have to single payer is... the Indian Health Service. Which is an utter disaster that can't attract quality doctors and doesn't provide quality health care. It does have a relatively lower cost though. Win win.
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not getting it. If you add up the governmental funds (federal, state, and local) spent on healthcare, that is already more per capita than -any- other country. I'm not at a place where I can dig up the references, but if memory serves me most of the other countries were spending 7-10% of GDP on healthcare and the USA double that. There are many varieties of national healthcare from completely government run (Britain) to entirely (regulated) insurance based (Switzerland) and every combination in between.
Common to all is same rules for everybody (e.g. no gold plated insurance for congress critters while the rest of us suffer through a maze of insufficient options)
Medicare has an administrative overhead of 3%, until the ACA insurance companies averaged 25%, but now limited to a maximum of 20% due to ACA (Obamacare)
False.
https://www.forbes.com/sites/theapothecary/2011/06/30/the-myth-of-medicares-low-administrative-costs/#35e4d2e9140d
Lies, damn lies and statistics.
I agree the 3% Medicare number is faulty at best but the authors metric also needs work.
The author states that the Medicare number is the total admin cost divided by total dollars spent. And it does not include many costs from the admin bucket that are included in private health care. No doubt of it and fully agree. The author also states that Medicare is mostly elderly with higher cost per visit it unjustly lowers the percentage. Also agree.
But, the metric the author states of admin costs divided by beneficiaries is also faulty. The elderly typically have more visits, than the largely under 60 insured privately, therefore more claims. And since the elderly have more complex claims the average cost per claim is higher. I would assume that the admin cost of an elderly beneficiary for exceed that of the average privately insured. Would anyone be surprised to learn that the elderly cost more in admin than the rest of the population?
So I think it is improper to use probably the most costly sector for admin cost as a basis for how efficient the private sector is.
Like I said, the 3% figure is BS but the authors metric is also flawed. What the true cost difference is I don't profess to know but I would use neither of the figures used.
If you had to pick the best system in the world, which would it be? And how are you quantify your selection?
Why do you think many went red this time around?
Many articles come up when googled. I picked one.
Link - ( New Window )
You can't even call it a Capitalist Democracy because that would invoke an idea of a level playing field that would promote innovation and development at a scale we sorely lack right now. Not only is it a fixed game, it's one where every angle is covered. From tax breaks to locking competition out to suppressing competitive research, the medical and Insurance industry is a rigged game here in the states and it is a result not of one party but the political system as a whole.
It will never be completely fixed here until we get people in office that actually put the good of the country before anything else. That won't happen until we develop a politic system that takes the ability away from the Mega-Donors to impose their desires. This is not a rant against the current party in power, this problem goes back for decades and is equally owned by both sides. I don't know the solution and it most likely is naive to believe it could change at this point, but there is no question that the great ideas this country was founded on are nothing more than a footnote in a history book at this point and we are in a steady decline.
+1
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It's very sad.
+1
+2. Fix the gerrymandering done to determine districts so politicians can stay in power. Term limits for members of Congress. Amend the Constitution to overrule Citizens United. Whatever the merits of that decision, it is politically corrosive.
The increasing contempt for politicians and political institutions is a grave threat to democracy.
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In comment 13398984 yatqb said:
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It's very sad.
+1
+2. Fix the gerrymandering done to determine districts so politicians can stay in power. Term limits for members of Congress. Amend the Constitution to overrule Citizens United. Whatever the merits of that decision, it is politically corrosive.
The increasing contempt for politicians and political institutions is a grave threat to democracy.
Actually I think contempt for the politicians and political institutions (I include the media in here) is good for democracy. We should not trust any of them. A little bit of revolting peasants once in a while is a good thing.
The relevant part is that the coverage is guaranteed. It can be counted on. That’s what its enrollees value about all else. This guarantee does not exist pre 65.
Sam has a history of being unable to discuss this subject in a fair-minded manner. He has stated that he is a specialist, which is wonderful. However his paramount concern has clearly been physician remuneration (hence his kneejerk aversion to Medicare & single payer in general which don’t pay like Cigna et al).
Now, the good physicians should of course be sufficiently and fairly compensated, but it is empirically true that outrageous price gouging and the pushing of often unnecessary fee-for-service care by them & their administrators is a massive part of crippling health care spending in the USA.
To be fair, they’re largely able to do this because when the insured are so markedly shielded from the cost of care, they gleefully want and accept whatever their smiling doctor suggests (“Martha, you know that septum is slightly deviated…we have a procedure…). Or they straight up ask for it themselves (“fuck it, my co-pays only $10…”). They don’t “directly” suffer the consequences, but of course in the aggregate wages are suppressed as premiums balloon and federal debt is readily & consistently accumulated, so they (we) suffer still.
Health care/health insurance policy is sensationally complicated. There are endless moral considerations, economic considerations, practical considerations…all profoundly entangled among the interests of inveterate power brokers: Unions, seniors and their AARP megaphone, providers, businesses who receive preferential tax treatment, owners (I’m one of them) of the cushy plans that tax treatment facilitates, etc etc. Who would willingly submit to a haircut? Whose toes are reformers willing to step on?
It’s probably the single most challenging policy endeavor (tax reform probably 2nd). Especially since the “system” within which we exist is no system at all since that suggests some underlying blueprint. It’s effectively a piecemeal'd accident of history that likely wouldn’t exist without Adolf Hitler. And at this point to ameliorate things you need to be:
A) smart
B) serious i.e. fair-minded
C) willing to expend political capital.
Ask yourself first what % of our elected officials embody those 3 characteristics and then ask what % of the American populace, to whom reformation must be sold, embody the first 2.
It can’t be done with slogans, or chants, or fanciful panaceas:
The left: “Single payer!” Doctors don’t like it. Doesn’t that matter? To say nothing of undoing/transitioning the private insurance establishment which directly or indirectly employs millions.
The right: “Free market!” This for very specific & demonstrable reasons does not meaningfully apply in this case. Health insurance is not like shopping for cars or for that matter like other types of insurance. If you don’t understand why then you probably will not be able to grasp the nuance & intricacies of this issue (buford, etc.) so sit this one out.
It’s difficult to be optimistic. One (virtually imperceptible) silver lining is that both sides presently have skin in the game. The days of farcical 10 million repeal vote grandstanding is in the rearview. And despite the latest proposal – which is ridiculous – some of the debate (like that from the Ohio governor) is healthy. It reminds us that actual lives are affected. Call your reps and tell them to be serious about pragmatic solutions.
Lastly, one should roll their eyes at those dismissing the OP’s article as a smug Euros casting “dispersion” on the US’s MO. I’d read the article and it’s fairly reasonable and well-argued. Fully sensible to steal good ideas from other countries. It’s most often done from the United States, but we stole our very system of government from the Romans. When Taiwan implemented its insurance system in 1995, they studied elements from all over the world.
I wouldn’t steal from the Finnish, however. I’d steal from the Swiss. Like us, a hyper-Capitalist nation with a powerful insurance industry, pharma industry (Novartis, Roche), and influential upper class. Their system could with a few tweaks realistically be scaled within the USA.
I don't want to get into an argument, but where did I say any of that? It's the politicians that are self serving and sorry, but most of the media is right in bed with them. If I see real investigative reporting, It interests me. But most if it is pure partisan hackery. Both sides.
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In comment 13398809 george upstate said:
Quote:
not getting it. If you add up the governmental funds (federal, state, and local) spent on healthcare, that is already more per capita than -any- other country. I'm not at a place where I can dig up the references, but if memory serves me most of the other countries were spending 7-10% of GDP on healthcare and the USA double that. There are many varieties of national healthcare from completely government run (Britain) to entirely (regulated) insurance based (Switzerland) and every combination in between.
Common to all is same rules for everybody (e.g. no gold plated insurance for congress critters while the rest of us suffer through a maze of insufficient options)
Medicare has an administrative overhead of 3%, until the ACA insurance companies averaged 25%, but now limited to a maximum of 20% due to ACA (Obamacare)
False.
https://www.forbes.com/sites/theapothecary/2011/06/30/the-myth-of-medicares-low-administrative-costs/#35e4d2e9140d
Lies, damn lies and statistics.
I agree the 3% Medicare number is faulty at best but the authors metric also needs work.
The author states that the Medicare number is the total admin cost divided by total dollars spent. And it does not include many costs from the admin bucket that are included in private health care. No doubt of it and fully agree. The author also states that Medicare is mostly elderly with higher cost per visit it unjustly lowers the percentage. Also agree.
But, the metric the author states of admin costs divided by beneficiaries is also faulty. The elderly typically have more visits, than the largely under 60 insured privately, therefore more claims. And since the elderly have more complex claims the average cost per claim is higher. I would assume that the admin cost of an elderly beneficiary for exceed that of the average privately insured. Would anyone be surprised to learn that the elderly cost more in admin than the rest of the population?
So I think it is improper to use probably the most costly sector for admin cost as a basis for how efficient the private sector is.
Like I said, the 3% figure is BS but the authors metric is also flawed. What the true cost difference is I don't profess to know but I would use neither of the figures used.
I've been out all day so sorry for late reply. forbes article is misleading. here is one based on non-partisan CBO analysis noting that Medicare administrative cost figures include the collection of Medicare taxes, fraud and abuse controls, and building costs.
CBO based analysis - ( New Window )
snip
Lastly, one should roll their eyes at those dismissing the OP’s article as a smug Euros casting “dispersion” on the US’s MO. I’d read the article and it’s fairly reasonable and well-argued. Fully sensible to steal good ideas from other countries. It’s most often done from the United States, but we stole our very system of government from the Romans. When Taiwan implemented its insurance system in 1995, they studied elements from all over the world.
I wouldn’t steal from the Finnish, however. I’d steal from the Swiss. Like us, a hyper-Capitalist nation with a powerful insurance industry, pharma industry (Novartis, Roche), and influential upper class. Their system could with a few tweaks realistically be scaled within the USA.
Swiss system is very interesting, initially the swiss insurance industry fought it fiercely as mandated universal basic coverage for everyone (we would consider their 'basic' pretty darned good), then the insurance companies noticed that people tend to buy all their insurance in one place (house, car, etc), so now they compete for customers for health insurance, offering goodies above and beyond the basics (as enjoyed by my swiss friend who spends a week at the health spa every year on his insurance!)
cheers to all
A friend talked me into opting for a Medicare PPO not long after signing up. It was a mistake that I corrected after a year or two. Even though I saved a fair amount of money, the care wasn't acceptable.
The Medicare/AARP combination is the bomb -- the absolute bomb.
I think the biggest impediment to a universal plan here is the expectation of your average American. I think most people want free healthcare, but they still want the best healthcare in the world, and they don't want to wait for it.
In Australia, which has both 'free' and private insurance, the Australians are morally comfortable with a two tier system. Those who get their care for free are ok either waiting months for care and/or having no say who their doctor will be (you don't have a doctor; you have a hospital. Whoever is there that day can do your surgery and it is likely a different person from who told you you need surgery).
And it's always bandied around that "by most metrics" American healthcare is worse but that's not really true. It depends on how you're ranking and which factors you're looking at. In terms of response time and cure rate for most cancers, for example, America is way ahead.
A friend talked me into opting for a Medicare PPO not long after signing up. It was a mistake that I corrected after a year or two. Even though I saved a fair amount of money, the care wasn't acceptable.
The Medicare/AARP combination is the bomb -- the absolute bomb.
If you don't mind me asking what company did you use when you went with the PPO?
In my experience, the entire nursing home, rehab, hospital chain in broken and needs to be fixed. I can't tell you how many times we'd see admissions to the hospital of nursing home patients who are chronically ill, demented with poor quality of life to begin with. Then they get treated in the hospital, for a small fortune, and sent right back to the nursing home to begin the nursing home/hospital cycle anew. Of course they end up dying anyway in 6 months or so after suffering through the American hospital system. A huge strain on resources and, to be frank, a massive waste of public money.
Then there's the chronically ill elderly who enter the hospital for whatever reason and can't make it back home safely. They then go to rehab to "get strong" but of course get sick again in the rehab and go right back to the hospital. Costs upon costs upon costs all without improving anyone's quality of life or even prolonging it.
This country has a serious issue with accepting the end. Whether that means death or surrendering to the fact that your life as you knew it has changed drastically. Things are better since I began practicing with the advent of palliative care and more widespread use of hospice, but there's a long way to go.
I became so disillusioned with the system I actually left my private practice of 15 years recently and took another position to get away from it.
What can be done? Death panels? Of course not. Better education re end of life issues? Education would be a start. In med school they taught how to prevent and treat disease but barely anything about palliative care and end of life discussions. I had to learn on the job.
Until you fix these things, no plan is going to work well.
Unfortunately our government cannot afford to just give everyone free healthcare OR at a fixed cost no matter who you are. Not unless we begin raising that money other than from our own tax payers.
Sorry, but it's been around 15 years (and two major moves). I was living in northern NJ at the time (10-12 miles from midtown).
We expect too much and because of this our first reaction when things do not go as planned is to seek a lawyer. This endless game would be mitigated if there were not so many false hopes created by pharma, mds and others intimately involved in the health care system. We need to look at what we do and do it without fear that if all is not done, we have failed. Patients need to understand that we have a finite life span and that a point is reached where there is nothing to be gained. End of life care is important and the Europeans certainly are much farther ahead in their vision than we are in this country. Their acceptance of end of life care and its implications in terms of care provided are a model we should emulate. I believe that we must look carefully at our elderly and the care we can provide. Someone has to have the fortitude to tell patients that there is little to be gained by ongoing treatment. Only then can we accept the idea that end of life care has a real place in our health care system. This is a prickly issue but one deserving of our leaders time.
Sorry, but it's been around 15 years (and two major moves). I was living in northern NJ at the time (10-12 miles from midtown).
Alan
Turning 65 this month and went with the AARP United health plan. That the one you have?
All my cardiac issues are covered by workmens comp for a fyi.
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these Scandinavian countries, with such a small number of extremely healthy, homogeneous populations, find they can cast dispersions on American healthcare.
Rebel... you may have a point, but the perhaps the best system for the U.S. is a single payer government sponsored plan. And if those with discretionary income want to supplement that with some sort of concierge service, so be it. In other words, a Medicare-like system for everyone.
Why do you think gasoline costs $8 per gallon in Europe? The extra $5 per gallon is tax to pay for social programs.
Ain't nothing free and Doctors don't make the money in Europe, ours do.
I wouldn't mind a single payer system, but I don't think you would like to find what that costs in the USA.
The relevant part is that the coverage is guaranteed. It can be counted on. That’s what its enrollees value about all else. This guarantee does not exist pre 65.
Sam has a history of being unable to discuss this subject in a fair-minded manner. He has stated that he is a specialist, which is wonderful. However his paramount concern has clearly been physician remuneration (hence his kneejerk aversion to Medicare & single payer in general which don’t pay like Cigna et al).
Now, the good physicians should of course be sufficiently and fairly compensated, but it is empirically true that outrageous price gouging and the pushing of often unnecessary fee-for-service care by them & their administrators is a massive part of crippling health care spending in the USA.
Geez.
I'd love to hear examples of how I'm not fairminded about the subject. We're all opinionated about the subject... some more than others. Based on my experience as a physician, I believe and have repeatedly argued that much of the problems with health care would not be solved if we did away with private insurance.
Medicare, while reimbursing less than many private plans, does tend to pay relatively quickly. My main issue with Medicare/Medicaid is the blatant bullying that CMS lays on the health care provider, and the factless blaming of physicians for the rise in health care costs. In that vein, we now have a preposterous train ride of acronyms to measure health care "quality"... P4P, PQRS, APM, MIPS, MACRA, etc. All of these, mandated by either ACA or CMS, all of which significantly burden health care providers for no good reason than it sounds good to the public. I started practicing in September of 2015. I was then penalized 2% by Medicare because I did not submit PQRS statements for all of 2015. Well, I wasn't practicing medicine for 8 months out of the year. Of course, I have no recourse.
Let's look at the overall physician cost burden to healthcare. I might get paid $200 for a procedure done in the hospital. The anesthesiologist charges $1000 but I don't know what they actually end up collecting. The hospital collects $4000 for an ambulatory procedure. The same procedure would cost less than $2000 at an ambulatory surgery center, but they're not credentialed for that particular insurance plan. The difference is taken up by the hospital CEO to pay for their overhead. Which begs the question... why aren't people looking at the hospital books to see where all those healthcare dollars are going?
It's just easier to point a finger at doctors who order useless tests (that I don't get paid for, but OK...) and useless procedures (even though for most procedures, I'd get paid more if I stayed in clinic than in the OR).
But Hollywood needs it's villians....
It is not the savings that people think (2%?), but it is a cost and many little cost do add up.
Remember, also, malpractice insurance is ridiculously high - about 33% of the intake in a practice I have been told. When you have a $250k practice and insurance is $80+k, that is just wrong.
All the MDs here can correct me if I am wrong.
End of life care costs - ( New Window )
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about malpractice reform. Just look at Texas
It is not the savings that people think (2%?), but it is a cost and many little cost do add up.
Remember, also, malpractice insurance is ridiculously high - about 33% of the intake in a practice I have been told. When you have a $250k practice and insurance is $80+k, that is just wrong.
All the MDs here can correct me if I am wrong.
Let me add to this...
The obstetricians are getting absolutely killed with malpractice insurance rates. It may be the highest of all medical doctors. Roughly 10 years ago the Obstetricians in NJ had some kind of march in Trenton about this. Huge numbers of them are now out of business and are working in some kind of clinic instead of their own practice.
What I was referring to before was not just putting a cap on malpractice law suit awards and hoping that insurance rates fall. I am talking about also regulating that insurance just like the government does with PMI. For those of you who have ever gotten a mortgage with less than 20% down and ended up with PMI... that insurance premium is regulated nationally and not at the state level.
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If you don't mind me asking what company did you use when you went with the PPO?
Sorry, but it's been around 15 years (and two major moves). I was living in northern NJ at the time (10-12 miles from midtown).
Alan
Turning 65 this month and went with the AARP United health plan. That the one you have?
All my cardiac issues are covered by workmens comp for a fyi.
Exactly. My wife and I both have Plan N.
BTW, despite my handle I'm now living in Sarasota.
BTW, despite my handle I'm now living in Sarasota.
Hey, congratulations on your move to FL. Do you love it? Better quality of life? You know, that in itself can help your health. The warden and I are looking for a place south of there in Cape Coral.
* As many have said, end of life is a large driver of costs and there's no easy solution/
* While tort reform might only lower costs by 2-3%, while the hell not lower costs by 2-3%?
* Drug costs. Am I wrong, or is most of the world free riding off on the American patients? Most countries mandate lower drug prices. However, without the US paying full freight (and more?) for the R&D necessary to develop these drugs, how many never would have reached market? This seems to me to have been going on for decades, and I'm not sure how to solve it.
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European transplant reminds America of European superiority. News at 11.
Exactly. My interest in what this European blowhard has to say is between zero and none.
That's called closed-minded.
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BTW, despite my handle I'm now living in Sarasota.
Hey, congratulations on your move to FL. Do you love it? Better quality of life? You know, that in itself can help your health. The warden and I are looking for a place south of there in Cape Coral.
Yes, we do love it. Had been coming for a month or more for the last 10 years or so and bought here early in 2013. Moved fulltime at the end of 2015 when Toledo grandsons had graduated and dispersed.
Yes, we do love it. Had been coming for a month or more for the last 10 years or so and bought here early in 2013. Moved fulltime at the end of 2015 when Toledo grandsons had graduated and dispersed.
ok so I am going to bridge my next question over to the solar panel thread that is floating out there right now. What do the electric bills look like down there?
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Yes, we do love it. Had been coming for a month or more for the last 10 years or so and bought here early in 2013. Moved fulltime at the end of 2015 when Toledo grandsons had graduated and dispersed.
ok so I am going to bridge my next question over to the solar panel thread that is floating out there right now. What do the electric bills look like down there?
EricJ
Your power company would be Lee County Electrical Co-op. I attached their link so you can get the price per KWh.
Alos they just opened up the first sustainable solar city in the US on 31 called Babcock Ranch.
https://www.babcockranch.com/town/
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* While tort reform might only lower costs by 2-3%, while the hell not lower costs by 2-3%?
"Tort reform" doesnt lower costs by 2-3%. It shifts costs to injured patients. Every industry could "lower costs" if they werent made to compensate the victims of their own negligence.
And in any event, I believe the studies have shown that "tort reform" doesnt save a penny. Insurance premiums have a very low correlation to damages caps and even state-wide litigation rates. Several studies have shown that so-called defensive medicine testing rates do not go down after "tort reform" is enacted (e.g. NE Journal of Medicine study re ERs.).
The amount of ink spilled over "tort reform" is truly stunning. It's really one of those sheeple instances -- people with a vested interest in maintaining the status quo are promoting an ancillary issue to distract from more intractable problems.
[and before anyone says "but you're a lawyer" -- my practice has nothing to do with med mal or anything remotely related to it]
"Tort reform" doesnt lower costs by 2-3%. It shifts costs to injured patients. Every industry could "lower costs" if they werent made to compensate the victims of their own negligence.
I don't think anyone would suggest that victims should not be compensated for their costs especially costs related to those victims getting treated the injuries sustained during the mal-practice plus SOME pain and suffering. The latter is the problem. Millions being paid out in some instances for subjective reasons.
* Drug costs. Am I wrong, or is most of the world free riding off on the American patients? Most countries mandate lower drug prices. However, without the US paying full freight (and more?) for the R&D necessary to develop these drugs, how many never would have reached market? This seems to me to have been going on for decades, and I'm not sure how to solve it.
There is probably something to this. However, a few things undermine this. Most importantly, drug companies have a staggeringly high profit margin compared to other industries. Now some of that is totally deserved due to risk. But it's tough to say that US patients are subsidizing ex-US patients when what is more likely is that US patients are just providing outsized returns to drugcos.
And second, there is a lot of R&D at pharmaceutical companies that is of questionable social value. E.g. developing the 4th pill in a class, where it shows no improvement over existing drugs. Or worse, turning a 12 hour pill into a 24 hour pill and getting a whole new patent. Or isolating the left/right isomer of an existing drug and getting a patent just on that isomer.
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* While tort reform might only lower costs by 2-3%, while the hell not lower costs by 2-3%?
"Tort reform" doesnt lower costs by 2-3%. It shifts costs to injured patients. Every industry could "lower costs" if they werent made to compensate the victims of their own negligence.
And in any event, I believe the studies have shown that "tort reform" doesnt save a penny. Insurance premiums have a very low correlation to damages caps and even state-wide litigation rates. Several studies have shown that so-called defensive medicine testing rates do not go down after "tort reform" is enacted (e.g. NE Journal of Medicine study re ERs.).
The amount of ink spilled over "tort reform" is truly stunning. It's really one of those sheeple instances -- people with a vested interest in maintaining the status quo are promoting an ancillary issue to distract from more intractable problems.
[and before anyone says "but you're a lawyer" -- my practice has nothing to do with med mal or anything remotely related to it]
How does a limit on punitive damages, not actual damages, shift costs to the patient? And count me skeptical to any suggestion that that cap wouldn't lower insurance rates to some degree. Beyond that, IMHO, "punitive" damages should be handled by state medical licensing boards, and not bank accounts.
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"Tort reform" doesnt lower costs by 2-3%. It shifts costs to injured patients. Every industry could "lower costs" if they werent made to compensate the victims of their own negligence.
I don't think anyone would suggest that victims should not be compensated for their costs especially costs related to those victims getting treated the injuries sustained during the mal-practice plus SOME pain and suffering. The latter is the problem. Millions being paid out in some instances for subjective reasons.
"subjective reasons" meaning what? Improper reasons? A jury hears a case and awards damages. How do you decide the value of, say, having a pair of legs, above and beyond the impaired ability to earn a living? Because that is what we're talking about. Because people think that the non-economic caps are just on "pain and suffering" and decide that that is too loose a concept and juries are stupid. Except, beyond the issue of questioning jurors who actually sat thru a trial, it's not just pain and suffering. California caps non-econ damages at $250,000, which by statute includes "pain, suffering, inconvenience, physical impairment, disfigurement and other nonpecuniary damage". So where is the fairness in that? Some doctor paralyzes you and all you can get beyond lost income is $250k? Isnt that obviously way too little? No one of sound mind would trade working legs for $250k.
How does a limit on punitive damages, not actual damages, shift costs to the patient? And count me skeptical to any suggestion that that cap wouldn't lower insurance rates to some degree. Beyond that, IMHO, "punitive" damages should be handled by state medical licensing boards, and not bank accounts.
1. No one is talking about punitive damages when they refer to tort reform. The debate is non-economic damages, ie stuff other than out of pocket costs and lost income.
2. Declare your skepticism all you want, it's what study after study shows. Bigger picture, insurance across lines are not as tied to claims as one would think. Much higher correlation to stock market returns.
3. You last point is just a rejection of the idea of punitive damages generally. It's not wrong to think that (Im not much in favor of them), but our law allows them. Im not sure why we should single out doctors for special protection from them.
4. Medical licensing boards are a joke. In fact if doctors were better at policing their own there would be a lot less medical error. 1% of doctors are responsible for more than 1/3 of all med mal claims. The best predictor for which doctor will see a med mal claim is whether they've been sued before.
4. Medical licensing boards are a joke. In fact if doctors were better at policing their own there would be a lot less medical error. 1% of doctors are responsible for more than 1/3 of all med mal claims. The best predictor for which doctor will see a med mal claim is whether they've been sued before.
My point was that should change.
They are under tremendous legal threats, from those people whom they should be punishing.
Denying a license to an individual who has significant means and whose livelihood depends on it creates an adversarial conflict that is a fight to the death. The afflicted have no reason not sue until there is nothing left, and there a plenty of lawyers that will take the case, challenge all the facts and ultimately the equanimity of the board and its right to deny an individual his/her right to practice. Medical boards were made to grant certifications and generally aren't very well prepared, nor organized to take on too many fights. And not fighting them all is poor jurisprudence; once that's established then the whole board can get blown up. So they concede too often, mostly for the purpose of self preservation.
Basically they are getting killed by the people they should be stopping.
My thoughts are that the main reason healthcare costs more in the U.S. than in other countries are: prices and volume.
On prices, the prices are much, much higher in the U.S. And not just drug costs, which are way higher here. Do you think surgeons make $400K in Europe?
On volume: Rates of MRIs, other imaging are higher here than in Europe. Paying for volume just increases spending, in other countries the care is more 'controlled', let's say.
With respect to the overhead/profit argument on Medicare -- much of Medicare is administered by contractors, notably the Medicare Administrative Contractors (MACs). The MACs are the ones that process the claims on behalf of the government (except for Medicare Advantage enrollees -- Medicare pays plans a monthly rate). Everyone uses the overall Medicare spending and then divides the operating costs for Medicare, to get at that 3%. But that ignores the operating costs for the MACs. And the MACs are private companies.
That dynamic has now evaporated because they are now largely in power and forced to take the issue more seriously because of the previous president's efforts. Say what you want about the ACA's efficacy (which can be intelligently argued), there are several elements that Americans of all political stripes value.
It is now all but accepted as a given that health care policy must include protections for those with established conditions. This is huge. I cannot overstate that. Going back decades, this was virtually exclusively the territory of the left. Even if it's (in part) repealed, the ACA has cemented the need for that stipulation (not to mention the smaller pieces like up to 26 parents insurance). Whatever happens on Thursday and moving forward, the previous CoC's efforts are responsible for that and he should be applauded.
Getting sick or injured is the ultimate NON left/right thing. If you don't appreciate that directly, I guarantee you know someone who does. And even if you don't care about it on the individual insurance market (as the right basically forever did not) because "hey, I have a job", remember that you're not discriminated against in your group plan because of a Federal law. In other words, the Federal government told private companies, "no, you can't do that." Appreciate it like that.
I don't like the proposed legislation, especially since it's a predictable gargantuan tax cut for those who have thrived in recent years, but what is inarguable is that it is at least a more serious stab at addressing problems. A far cry, in other words, from the days of vacuous & pathetic "tort reform, across state lines, boom, done, let's grab a beer."
Meandering progress, yes. And after a horrifically ugly policy brawl for the past 8 years (or further back if you count '93), but progress still.
"subjective reasons" meaning what? Improper reasons? A jury hears a case and awards damages. How do you decide the value of, say, having a pair of legs, above and beyond the impaired ability to earn a living? Because that is what we're talking about. Because people think that the non-economic caps are just on "pain and suffering" and decide that that is too loose a concept and juries are stupid. Except, beyond the issue of questioning jurors who actually sat thru a trial, it's not just pain and suffering. California caps non-econ damages at $250,000, which by statute includes "pain, suffering, inconvenience, physical impairment, disfigurement and other nonpecuniary damage". So where is the fairness in that? Some doctor paralyzes you and all you can get beyond lost income is $250k? Isnt that obviously way too little? No one of sound mind would trade working legs for $250k.
No, subjective is pain and suffering. I would also agree with you that if the mal practice results in the patient's inability to work then that absolutely needs to be considered. What I am talking about here is the $5 million award to someone when there are no real costs that would add up to that.
Although not a mal-practice law suit, the woman who got how many million because she spilled a hot cup of McDonald's coffee in her lap? Pain and suffering...
Who cares about facts!
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* McDonald’s admitted it had known about the risk of serious burns from its scalding hot coffee for more than 10 years. The risk had repeatedly been brought to its attention through numerous other claims and suits.
* An expert witness for the company testified that the number of burns was insignificant compared to the billions of cups of coffee the company served each year.
* At least one juror later told the Wall Street Journal she thought the company wasn’t taking the injuries seriously. To the corporate restaurant giant those 700 injury cases caused by hot coffee seemed relatively rare compared to the millions of cups of coffee served. But, the juror noted, “there was a person behind every number and I don’t think the corporation was attaching enough importance to that.”
Not the best example of a "frivolous" lawsuit.
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Although not a mal-practice law suit, the woman who got how many million because she spilled a hot cup of McDonald's coffee in her lap? Pain and suffering...
That's a terrible example -- here's what the burns from coffee at 180-190 degrees looked like:
The US would be more competitive in the world marketplace, citizens would enjoy a better quality of life and longevity.
Thats too much reductionism. If all health care workers wanted was profit, they probably wouldn't be in health care. And if an organization isn't profitting, its nots going to be around very long to fulfill its mission....
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"subjective reasons" meaning what? Improper reasons? A jury hears a case and awards damages. How do you decide the value of, say, having a pair of legs, above and beyond the impaired ability to earn a living? Because that is what we're talking about. Because people think that the non-economic caps are just on "pain and suffering" and decide that that is too loose a concept and juries are stupid. Except, beyond the issue of questioning jurors who actually sat thru a trial, it's not just pain and suffering. California caps non-econ damages at $250,000, which by statute includes "pain, suffering, inconvenience, physical impairment, disfigurement and other nonpecuniary damage". So where is the fairness in that? Some doctor paralyzes you and all you can get beyond lost income is $250k? Isnt that obviously way too little? No one of sound mind would trade working legs for $250k.
No, subjective is pain and suffering. I would also agree with you that if the mal practice results in the patient's inability to work then that absolutely needs to be considered. What I am talking about here is the $5 million award to someone when there are no real costs that would add up to that.
Although not a mal-practice law suit, the woman who got how many million because she spilled a hot cup of McDonald's coffee in her lap? Pain and suffering...
A doctor is grossly negligent and causes you paralysis below the waist. You're a software programmer so your ability to earn a living is not impaired. You'll have more costs in life as life is more expensive for the wheelchair-bound, so you get that as damages.
Should you get damages for the fact that your life is now way shittier, you cant play sports like you used to, can fuck your wife, you cant take her to small romantic restaurants, you cant pick up your daughter like other fathers, everything physical task takes longer and is harder leaving you exhausted, and you end up depressed because of your shittier life? Because that's what is at issue. Should the victim eat that, or should a doctor (who has insurance for these very reasons) eat that?
Why? what are the "levels" of med mal spending you perceive. Plaintiff and defendant costs plus payouts are about $10 bn (2010). I dont think there is much growth either -- I've seen that med mal filings are shrinking a lot of places. So $10 bn in a $3.2 trillion industry. I really fail to see the materiality of that.
Then you get to defensive medicine. Some estimates are as high has $50 billion give or take. But you have to buy into the notion that litigation is causing defensive medicine. Doctors certainly say fear of suit leads them to unnecessary testing. But the studies dont back it up. E.g. the RAND study of ERs before and after "tort-reform" showing no difference in testing levels.
Im not saying there arent any changes you can make to the tort system, but it's very functional. Monied interests, notably the AMA (doctors), insurance companies, US Chamber of Commerce (anti-damages suits by consumers, find doctors get more public sympathy than corps), and the GOP (self interest since trial lawyers support Dems) hammer at you on this tort reform issue in ways you dont even realize. They done a good job convincing people that "tort reform" is some big money saver for the system and needed to cure some scourge (I guess of dumb citizens siting on juries??). Dont buy the hype. It's bullshit. The data doesnt lie.
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Should you get damages for the fact that your life is now way shittier, you cant play sports like you used to, can fuck your wife,
I'm confused. What do you want damages for?
Realistically, wouldn't we have to move to a fully socialist economy in order to move to fully universal healthcare and education in this nation?
But it doesn't matter. The Koch's are withholding millions from reps who vote no
- As was referenced earlier, yes the US does fund the R&D expenses for the rest of the world. This is partially in relation to a "one payer" system many of the European countries have. Also one of the biggest reasons against having a one payer system as many forms of medication are not available in some countries because of how they negotiate.
- Drugs are approximately 10% of the cost of healthcare, which is no where compared to hospitals, physicians's ect. Included within that 10% costs are RD & Marketing associated with manufacturers/innovators and then a very large percentage attributed to distributors (cardinal, mcckesson) and retail chains (cvs, rite aid, etc.). Manufacturers obviously garner the most attention but look at the market cap of the distributers and you will realize they all make more money than any pharma company.
- Product liability is a massive driver of the cost of drugs. The amount of money paid in litigation costs and settlements is staggering. Some of those cases are nefarious but the vast majority are simply a reflection of the way tort law is currently set up and Levine v. Wyeth. You reform product liability tort and you could probably lower drug prices 5%.