Health care - administrative incompetence

[Rolfe]

OK!

Rolfe.

 

[Darat]

...snip...

I think there's a similar problem with your comments regarding personal responsibility as a means of reducing medical usage; specifically that the UHC systems in the likes of the UK have unrestricted access to GP facilities and ready access to acute treatment, yet there's no evidence that it has placed an unreasonable burden on the NHS or encouraged abuse.

...snip...

And the evidence is actually against such an abuse happening. That is why the various NHSs want more people, especially men, to see their GPs because that is best way to detect problems early enough to improve survival rates and the like.

ETA: Just to add to this: http://news.bbc.co.uk/1/hi/magazine/8154200.stm

...snip....

Cancer survival rates in the UK are among the lowest in Europe because the British - both sexes - are for some reason less inclined to go to a doctor and cancer is diagnosed late, says the professor.....
...snip...

[/quote]

And remember we are a country that has had universal healthcare for literally generations.

 

[Ivor the Engineer]

How so? In a free market, if enough people choose not to buy commodity x because it's too expensive, then the price of commodity x has to come down.

Firstly, healthcare is not a free market like, say, the market in recorded music. People don't wake up one morning unable to function because they haven't got the latest album by their favourite artist. They are free to or not to enter the recorded music market at no cost. Contrast this to the market in healthcare where very often people have to choose between suffering and/or dying, or entering the healthcare market. There are differences on the supply side as well. I can set up a shop selling recorded music tomorrow if I want, but the supply of medical professionals is severely limited by the need to train and qualify from a medical school and obtain a medical license. I am prevented by the law from offering medical treatment to the public. These two factors ensure there will NEVER be a realistic chance of free market in healthcare emerging, no matter how much you want there to be one.

Secondly, people respond to incentives. Pay medical professionals per unit of care and they will strive to produce lots of units of care until producing an extra unit costs more than doing something else (e.g., playing golf or sailing one's yacht). Similarly, sick people will put off seeking medical care until their condition deteriorates to the point that the costs of not being treated are equal to the costs of being treated. It's a well established fact that virtually all medical conditions are less expensive to treat the earlier they are detected. So all co-pay does in reality is provide medical professionals with patients who are sicker when they come to see them and so start supplying more expensive (and profitable) units of medical care from the outset. There would be a temporary decline in healthcare usage while the level of sickness increases to the threshold and then the same or greater demand as before would ensue.

This is not very complicated economics and is well established. Your (probably Republican/Libertarian) sources of information are filling your brain with ********.

 

[Rolfe]

Oh geez... This is why I dislike debates on discussion boards. Someone always has to make it personal or emotional. Why can't people just argue the facts and ideas dispassionately?

If I was being personal and emotional (and it was very late at night), it was because we've been over this time and time again with other posters making the same points, and it gets a bit like whack-a-mole. Frustrating. We demolish these spurious arguments, and the previous posters either agree in the end or leave the discussion, and then another one comes along.

Yeah, it's demoralising.

Your utopian vision of brotherly love and compassion and rosy cheeked common folk enjoying a show at the cinema is appealing, but we both know the world doesn't work that way.

Er, it does here. I was describing actual reality, as she is right where I'm sitting.

Your suggested solution to healthcare costs was for people on limited incomes to forego all the little pleasures of life to prioritise saving for a possible, hypothetical healthcare requirement in the future. I was pointing out that this would lead to a pretty miserable existence, even when healthy. No money to spend on any little luxuries, just sit and look at the growing savings pot you daren't touch because you don't know when you might break a leg or go down with systemic lupus. Some American Dream!

It's no utopian vision to point out that where I live, this isn't a consideration at all. Nobody needs to worry where the funding for any future healthcare needs is going to come from, because it's sorted. And nobody appears to bear any ill will towards the people who find themselves in the position of needing that healthcare.

And I see no disadvantage whatsoever in the fact that this system doesn't include your valued "personal responsibility".

I also developed this argument further, to examine the possible economic consequences of people actually doing what you want them to do. Everything beyond the basic necessities of food and shelter becomes a luxury item, only to be purchased by those who already have sufficient savings to cover any possible future healthcare need for themselves and their dependants. How big a market is that going to be? Damn small.

Instead of people getting out there and spending, "spending our way out of the recession" as some economists put it, everyone is salting away every penny they possibly can. Almost nobody is buying consumer goods, entertainment, maybe even higher quality food. Are they even maintaining their homes? What is more important, fixing the roof or having the money to pay for the heart bypass I might need in 20 years time?

It would strangle large sectors of the economy. It would be catastrophic.

These were the points I was making, and I think I made them fairly plainly. That you could only respond by accusing me of being "emotional" is somewhat telling, I think.

Rolfe.

 

[Rolfe]

How so? In a free market, if enough people choose not to buy commodity x because it's too expensive, then the price of commodity x has to come down.

Let's just elaborate a bit more on this. You want a lot of people to choose not to buy healthcare, because it's too expensive, so that the price will come down.

Oh, that's nice. How many people have to suffer and die because they've had to forego the treatment they needed, before this utopia (and this one really is unrealistic) comes to pass?

However, you overlook another important economic consideration. The price of a commodity cannot come down below the cost of production, or at least not long-term. If a producer cannot sell their product at a profit, then they will simply stop selling it. They'll move into a different market.

Or, as someone else remarked, the product becomes a luxury, niche item. You want a replacement hip? Well, I want a penthouse in Manhatten, tough.

Oh dear.

Rolfe.

 

[Ivor the Engineer]

<snip>

However, you overlook another important economic consideration. The price of a commodity cannot come down below the cost of production, or at least not long-term. If a producer cannot sell their product at a profit, then they will simply stop selling it. They'll move into a different market.

<snip>

That's not strictly true. If not offering an product results in reduced sales of other profit-generating products, then suppliers will be prepared to subsidise the costs of producing that product.

 

[jimbob]

How so? In a free market, if enough people choose not to buy commodity x because it's too expensive, then the price of commodity x has to come down.

ETA2: added in post to which I was mainly responding:

How, exactly, would you have had me budget for 1.2 million dollars in healthcare costs for cancer over the past 7 years (a significant amount of which wasn't covered under insurance?)

In our current system, I wouldn't. 1.2 million is a crap-ton of money and there's no way it should cost so much. You indicated that the insurance didn't cover much of that figure. Are you saying that your out-of-pocket is 1.2 mil or that the total bill was 1.2 mil, the insurance paid a chunk and you are left with a chunk? If so, what was your chunk?

It's hard to argue when the argument becomes personalized in this way. I'm not trying to offend you and I apologize if I did so, sincerely.

I did some calculations earlier, and I'd like you to answer where they are wrong:

Individuals can soon run up costs that are excessive. That is why we need some pooling of risk to as "insurance". You need some administrative overhead, and I'd contend that the US has a wasteful system.

You are wrong that the poor are not an attractive market.

Walmart has done pretty well suppling to the poor.

But they wouldn't make any money in selling inherently expensive treatment at below cost.

According to this the median net worth of a renting household was $4k in 2004 (if I am reading the data correctly)

How could a household with a net worth of that actually pay any more than $4k for anything? Especially as they are likely to be poor credit risks, so borrowiong the money would be difficult.

Can we get the coronary healthcare cost below $4k?

5-hour bypass surgery: General surgeon with less than 1-year experience, $170k, Anaesthetist , less than 1-year experience, median salary $145k.

Both work 60 hour weeks for 50 weeks a year. This means that their combined equivalent hourly rate is $105/hour.

Now they are not performing surgery all of that time, so the actual money that the they are paid as an hourly rate whilst in theatre has to be higher.

As well as the two highly-skilled doctors, you need support staff, (in one photo, the team seemed to be four people), so that makes two other wages that need paying directly during the surgery.

You also need to pay for the use of the theatre, and expensive equipment, say $3million, depreciated over 5-years, when the equipment is in yse 52 weeks per year, gives a theatre cost of $11.5k/week. Now the theatre can't be in use all this time, there has to be preparation, so (generously) we could also assume a 60-hour week for the theatre, which gives $190/hour just for the theatre. Actually it will cost a lot more than this, but I am making a conservative point.

So far just taking the cost of the theatre depreciation and the salaries of the surgeon and anaesthetist, both at the bottom of their respective pay scales, and both working 60-hr weeks in theatre, we get to $295/hour, or $14745 for the five-hour surgery.

You could probably double this for more realistic utilisation rates.

You now need to add in the cost of the other two team members, and of the provision of facilities, and of the proportion of the hospital capital cost that is being depreciated (say over 30 years), and the cost of the bed and accomodation over (three days) stay in hospital.

It soon costs more than the $4k that these people have.


Rolfe works in a free-market system providing medical care to animals, so I will ask him her this next question:

If someone's pet needs treatment that costs more than they can afford, do you (as the representative of the free market pixie) reduce the price of the treatment, or does the animal not get any treatment?

ETA: corrected one typo, and one misconception from the original post (in blue)

 

[Rolfe]

Well, I'm not in general practice, but I know how it works.

First, we're obliged to help animals in distress regardless of cost, so anything needing emergency treatment is going to get it. However, sometimes that emergency treatment to relieve suffering will be euthanasia, of course.

Second, yes, some vets are soft touches, and will occasionally treat an animal on a pro bono basis because they've been turned to candyfloss by the pleading brown eyes or whatever. However, you can't do this on a regular basis or you'll go out of business, it's as simple as that.

Third, the most usual course of action is to direct the client to one of the charitable institutions like the PDSA, which survive on donations specifically given to provide veterinary care for the pets of those who can't afford much. Of course, what they can offer depends entirely on how generous the public have been when confronted by a collecting tin.

Fourth, sorry, but if push comes to shove (and it quite often does, with problems that would otherwise need a high-cost solution), we have the euthanasia option.

Sometimes I think right-wing Americans would be happy if human healthcare worked like this.

Rolfe.

 

[jimbob]

Thanks again for the reply Rolfe, you did respond in the original thread along similar lines. Not surprising, as it is just basic economics.

 

[RemieV]

Rolfe, I nominated one of your posts in this thread, and I feel at least somewhat inclined to do it again already.

I actually have an even more bizarre situation to add to the mix. And I get that it's anecdotal - just realize that these are the lengths people go to.

I have an undiagnosed heart condition that lands me in the ER roughly six times per year. I also have no money, and no insurance.

The doctors that I have been to refuse to diagnose me. They are doing this on purpose, as a benefit to me in the future should I ever actually get insurance. If they give me a diagnosis of something that will wind up being quite expensive, then no private insurance company is ever going to have me again. In the meantime, they try to control the heart episodes with medication - which, as I have pointed out, must not be working terribly well since I'm still in the hospital roughly six times per year.

One of the cardiologists I have seen made me an offer that was difficult to refuse (and didn't involve a severed horse's head). He offered to completely skip the diagnosis stage and jump straight into treating what his best guess was. See, he couldn't leave a paper trail of diagnosis. But if he jumped right into treatment, well, that could potentially be very helpful.

What he offered to do was cardiac ablation - wherein they insert a catheter into the heart and burn away an electrical pathway in the hopes that it will stop the heartbeat from rebounding and causing extreme tachycardia (which comes with all sorts of other fun symptoms that make it UNBELIEVABLY difficult to work anywhere).

Said doctor told me that if I went to the hospital crying "emergency" and asked for him to be called in as my specialist, he would perform emergency surgery on the spot.

While this might appear like nice guy doctor who was willing to go the extra mile for the patient, think about this:

1) The potential to be wrong.

If the doctor was wrong in his guess (which he absolutely cannot verify in advance of this procedure), then he would be ablating a normal heart. This would cripple my heart's ability to function, cause me to require a pacemaker, and would shorten my life by a rather shocking amount.

2) Even if he was right...

Even if he was right, he'd essentially be going in blind, which could ALSO significantly shorten my life.


The only way he would agree to do this on my behalf was if I made abundantly clear to him how miserable my life currently is. It is impossible to function when one of these heart episodes comes along. It's like sprinting a marathon (complete with all the marathon sprinting symptoms like difficulty breathing, sweating, difficulty concentrating on anything else) without ever having signed up to do so.

My choices, then, without insurance, are a miserable life or the potential of no life.

Having never made an amount of money that would cover the health care required by this wonderful heart condition, what on earth, then, should I do?

While I agree that I cannot force anyone to care about my situation, and cannot in this current political climate force someone to do something, I sure wish that they would just because it was the right thing. Just because they don't want poor people to die in the streets of completely curable illnesses.

It sure as hell is a personal situation.

 

[RemieV]

P.S. To add - I have since become so impoverished that I cannot afford to see even the cheapest cardiac specialist. I am now surviving strictly on leftover heart medication and the occasional ER visit. Were I to begin again, despite having a file full of the past eighteen months of heart condition readings, blood work, etc, etc, it would go a little something like this:

Visit with cardiologist: $350
30 day Holter monitor: $4,000
Yet another pointless imaging: $2,000
Follow up with cardiologist: $350

And that's just the beginning, because they would once again tell me the same thing - "You need an electrical study."

I have no idea what the cost of one of those is, but I can imagine.

 

[Professor Yaffle]

RemieV - every time I hear a story like yours (and I have heard far too many for my liking), I am flabbergasted that anyone could delude themselves that this is an OK way to run things. Yes we have the odd horror story here too, but that's always when something goes wrong (eg misdiagnosis or mistakes) not part of how the system is set up and accepted by many.

 

[Architect]

Likewise. I remember the first time Travis laid out his own fairly serious medical problems in a couple of posts, I PM'd him and recommended he move to the UK pdq - good standard of living, NHS treatment after 3or 6 months (can't remember which), plus get to see the world. Mind you, I didn't mention the weather.

 

[Delscottio]

How hard is it for a US citizen to move over here? Seriously RemieV please think about it. It must be dusty in here as I seem to be near leaking from the eyes.

 

[Architect]

Damned sight easier than us moving there.

And remember, they have the option of trying to pick up an Irish passport if they can find it on a map. Then they get access to all of Europe. Mate of mine came to the UK that way and has decided just to stay for life. Or at least that's what he's told his Scottish wife.

 

[Gandalfs Beard]

As a British expat in the US, I have to say the Health care system here is appalling. And I am distressed that the Tories seem hellbent on Privatizing Britain's NHS.

Years of Back pain and depressive episodes prevented me from obtaining health insurance as they were considered pre-existing conditions. Now that I am unemployed due to the economic collapse I am in even more dire straits.

I was only recently qualified for a local government Medical human service due to my utter lack of funds, and yet I still have co-pays that I can't afford, limiting my ability to obtain medications and doctor visits.

GB

 

[Architect]

Not think about returning home?

 

[xjx388]

In a free society there will be inequalities. These inequalities shouldn't be based on race, sex, creed, etc., but they exist.

Some people live in a $5mil home with all the amenities. Some people live in squalid shacks without even running water.

Some people get to eat a wide variety of nutritious and satisfying foods. Some people don't know where they are getting their next meal.

There are plenty of people in America without the basics of stable food and shelter. I'm sure the situation is similar in the UK.

What makes the provision of healthcare different? Why is inequality tolerated for basic human needs, but somehow healthcare (which is infinitely more complex than either of those needs) must be equal for all?

 

[Architect]

In our country, the social security net covers the issues you raise. There is a statutory requirement on local authorities to provide accommodation for the homeless, and the law requries that it have the basic facilities you identify (rather more, in fact). Income Support and associated programmes provide money for food and clothing, albeit at a basic level.

 

[RemieV]

How hard is it for a US citizen to move over here? Seriously RemieV please think about it. It must be dusty in here as I seem to be near leaking from the eyes.

I mentioned the word 'poor', right?

I haven't had work since August 20th (when I parted ways with the JREF). I've since sold possessions on eBay, gotten some help from friends, and have enough money to last (with luck) through January.

So I guess the answer to the question is - well, I'm going to have an issue if the cost of air fare is greater than, say, $5. Also, from what I hear about TSA lately, they REALLY wouldn't appreciate a stowaway.

Here's another fun one to throw into the mix, and I'm not sure whether or not it's in violation of the MA to admit to having done such a thing, so I apologize in advance if it is.

I purchased antibiotics from a drug dealer in town quite recently - because my throat had been hurting for days, and it was cheaper to go to a drug dealer than a doctor. While you can find the occasional free clinic in this country, the wait in one of those can be roughly categorized as "forever", and they're packed. If you weren't all that sick BEFORE walking into one, you will be by the time you walk out.

I do not, by the way, recommend that anyone else try that avenue.