Health care - administrative incompetence

[xjx388]

Well, at least this post makes your position abundantly clear. I would have at least a modicum of respect for it if you were coming from a tax-free society.

There is no tax free society.

The reality is, though, is that the USA is already part socialist. Every country is to some degree or another.

Much to my chagrin. But it's less socialist than other places, that's for sure.

You already benefit from the tax dollars of other people. We all do. People are "threatened with incarceration" for not paying taxes to support the roads you drive on. Tax dollars ensure that your home and office were built according to safety codes.

I have no issue with taxes for infrastructure. Roads are not a right, but a privilege. Building codes ensure safety and uniformity.

Tax dollars insure that the large sum of money you put in the bank every month will be there. Tax dollars regulate that insurance company with whom you have catastrophic insurance to ensure that they will actually be able to pay your bills should the need arise. And if they go belly-up, tax dollars are going to bail out them and therefore you.

I have a bigger problem with these taxes.

Hell, the college your wife attended before med school is heavily funded by tax dollars. It seems that you're okay with people being "threatened with incarceration" so that your wife could get an education.

Then why did we have to pay all that tuition? I guarantee you, we paid for her education with our own hard earned dollars.

She also did her med school and residency in systems that received tax dollars. It seems you were okay with people being "threatened with incarceration" so that you and she have a job.

You have no clue what you are talking about, do you? We are STILL paying off the med school loans. Tuition was paid 100% by us. Universities and Med Schools might get grants for research and other things, but it doesn't pay for us to go; that's on us. We didn't even get federally subsidized loans.

And yet here you are, inexplicably in my mind, telling us you'd rather let you and your family die than have tax dollars spent on your behalf for medical expenses. Here's a clue: Even if you pay 100% out of pocket, an incalculable amount of tax money will have been spent on your behalf already.

Your grandstanding might impress some people, but you can't dazzle me with bull caca. As you say, people on this board demand proof for claims. Go ahead, show us how someone who pays 100% out of pocket for their healthcare will have had "incalculable" amounts of tax money paid on their behalf. And don't just give me another long-winded opinion piece; cite your sources for this dubious assertion.

 

[xjx388]

Rolfe, you can't say that there isn't poverty and inequity in the UK. You need to take off the rose colored glasses because the real world isn't perfect. The NHS sure isn't perfect. What about taking away obesity surgery? For the morbidly obese, it's the only thing that works. Ah, but the fat people don't deserve it because they'll just get fat again. Ditto for the hip replacements. It's not cost effective. What about the women who get breast cancer who were denied life extending drugs. NICE decided it wasn't cost-effective. So they were denied extra time with their loved ones. The latest cutbacks are equally bad.

How can you deny that any Universal system MUST ration care? There are not enough resources to go around. When you centralize decision making, people become numbers and statistics and guidelines. The only people that need to be making the decisions are the patients and their doctors. What's wrong with that? And don't tell me that doctors in the UK have autonomy; they have to follow the NICE guidelines.

I'd much rather pool my money in a private insurance plan than in the government (I'd rather do none of those things). Government has no incentive to be efficient and I have no choice to change if I don't like it.

 

[Uncayimmy]

There is no tax free society.

Sure there is. Go herd some cattle in Ethiopia.

Then why did we have to pay all that tuition? I guarantee you, we paid for her education with our own hard earned dollars.

I'm sure you did. And so did some of my tax dollars.

You have no clue what you are talking about, do you? We are STILL paying off the med school loans. Tuition was paid 100% by us. Universities and Med Schools might get grants for research and other things, but it doesn't pay for us to go; that's on us. We didn't even get federally subsidized loans.

Just to be clear: Are you saying that you believe the tuition you spent covered the costs of her education without any tax dollars going into it?

Your grandstanding might impress some people, but you can't dazzle me with bull caca. As you say, people on this board demand proof for claims. Go ahead, show us how someone who pays 100% out of pocket for their healthcare will have had "incalculable" amounts of tax money paid on their behalf. And don't just give me another long-winded opinion piece; cite your sources for this dubious assertion.

Ever hear of these guys? They invest $31,200,000,000 annually in medical research.

 

[xjx388]

Sure there is. Go herd some cattle in Ethiopia.

No thanks.

I'm sure you did. And so did some of my tax dollars.

Ridiculous. No pell grants, no subsidised loans. No tax dollars.

Just to be clear: Are you saying that you believe the tuition you spent covered the costs of her education without any tax dollars going into it?

Yes. Tuition pays for attendance. Don't move the goalposts.

Ever hear of these guys? They invest $31,200,000,000 annually in medical research.

See, you are moving the goalposts. We are talking about care delivery systems. The research nih funds benefits the entire global medical community and counts for zilch in health care costs.

 

[Uncayimmy]

No thanks.

Why? No taxes. Personal responsibility. It's right up your alley. You said such a society doesn't exist, but it does. You just don't want to live in it.

Ridiculous. No pell grants, no subsidised loans. No tax dollars.

Yes. Tuition pays for attendance. Don't move the goalposts.

I didn't move anything. I just wanted to be clear. Now that we are, you will learn that you are wrong. Tuition doesn't even cover half of the amount spent on instruction. Source

See, you are moving the goalposts. We are talking about care delivery systems. The research nih funds benefits the entire global medical community and counts for zilch in health care costs.

No goalposts have been moved. Why are you okay with $30B/year of tax dollars being spent on medical research but would rather let your family die than accept tax dollars to pay the providers using the knowledge and equipment gained from those tax dollars?

 

[Rolfe]

Is healthcare really a right? It is one's duty to take care of himself but is it one's duty to take care of another? I personally do not think it should be forced upon someone to take care of another. Americans are one of the most charitable people in the world. I personally give to many charities and am very generous with people in need but I do not think I should be forced to take care of someone else. If someone has no food are you going to force the grocery store to give them food? Assistance should be voluntary, not forced.

And your assertion that people without insurance and without money go without healthcare is ludicrous. If it wasn't against the law I could name 25 people in my town who received 'free' healthcare just today. There are already laws in place requiring hospitals to treat people regardless of their ability to pay.

You are also misleading regarding people not buying healthcare in an effort to force the prices down. It is not a matter of buying it or not buying it but rather a matter of which company you purchase it from. THIS is what causes the prices to come down - competition between companies.

You misunderstand. My post was not about how things are in the USA, but how xjx388 would like them to be. He would like people not to buy healthcare that was too expensive for them, in the deluded belief that this would force the prices down.

First, it would be unlikely to force the price down in time for the first cohort of people to try that route.

Second, it would be just as likely to cause the procedures to disappear from the market altogether, or become luxury niche-market items. Nobody prices their product well below cost simply to sell more units.

Third, it would be likely to put a serious crimp in research. Why invest millions in trying to invent a new and better procedure if nobody is going to be able to afford to reward you for this?

And fourth, xjx388 seems to want doctors to be paid more than international footballers or pop stars, according to some of his other posts. How this is going to be achieved at the same time as prices of complex surgical procedures becoming affordable to someone on the minimum wage hasn't been explained so far.

Rolfe.

 

[xjx388]

You misunderstand. My post was not about how things are in the USA, but how xjx388 would like them to be. He would like people not to buy healthcare that was too expensive for them, in the deluded belief that this would force the prices down.

That's not what I said. I said that eliminating the government and creating a free market health system would drive costs down. Why? Because it would reduce overutilization.

First, it would be unlikely to force the price down in time for the first cohort of people to try that route.

And implementing UHC would initially drive costs way up. There's no guarantees after that.

Second, it would be just as likely to cause the procedures to disappear from the market altogether, or become luxury niche-market items. Nobody prices their product well below cost simply to sell more units.

Which procedures? I might give strep tests for free as a service since they cost me so little.

Third, it would be likely to put a serious crimp in research. Why invest millions in trying to invent a new and better procedure if nobody is going to be able to afford to reward you for this?

Research funding is a separate issue entirely.

And fourth, xjx388 seems to want doctors to be paid more than international footballers or pop stars, according to some of his other posts. How this is going to be achieved at the same time as prices of complex surgical procedures becoming affordable to someone on the minimum wage hasn't been explained so far.

I want doctors to be paid based on the value of their work to society. I want footballers, pop stars, actors etc. to be paid less and doctors, teachers, firemen, policemen, etc. to be paid more. Society has to re-prioritize it's spending. If health care is a basic right and football is not then health care should come first, no?

 

[Rolfe]

Rolfe, you can't say that there isn't poverty and inequity in the UK. You need to take off the rose colored glasses because the real world isn't perfect. The NHS sure isn't perfect. What about taking away obesity surgery? For the morbidly obese, it's the only thing that works. Ah, but the fat people don't deserve it because they'll just get fat again. Ditto for the hip replacements. It's not cost effective. What about the women who get breast cancer who were denied life extending drugs. NICE decided it wasn't cost-effective. So they were denied extra time with their loved ones. The latest cutbacks are equally bad.

How can you deny that any Universal system MUST ration care? There are not enough resources to go around. When you centralize decision making, people become numbers and statistics and guidelines. The only people that need to be making the decisions are the patients and their doctors. What's wrong with that? And don't tell me that doctors in the UK have autonomy; they have to follow the NICE guidelines.

I'd much rather pool my money in a private insurance plan than in the government (I'd rather do none of those things). Government has no incentive to be efficient and I have no choice to change if I don't like it.

I never said it was utopia here, or that the NHS was perfect. Just that it's light-years better than what you guys have. You accused me of being unrealistic when I simply described, factually, the way it actually is here. Nobody has to worry about medical bills or access to healthcare. Not when making choices about employment, or when confronting a chronic illness, or suffering a catastrophic and unexpected accident. Nobody has to spend their lives obsessively saving and denying themselves all luxuries in order to provide for their or their families' healthcare.

It's that simple.

Last I heard, they were talking about extending obesity surgery, even including teenagers, because studies were suggesting it was more cost-effective than the alternatives. Hip replacements are SOP. I've got more friends and relations with new hips and knees and God alone knows what else than you could shake a stick at, all from the NHS, all free. None of them has anything but effusive praise for the treatment they received.

And what the hell breast cancer drug are you talking about? I can only guess it's the Herceptin saga. If it is, the depth of your misunderstanding of that issue rivals that of the Pacific Trench. (Hint. The vast majority of women prescribed Herceptin would not have experienced a recurrence anyway. The public protests had a lot more to do with the drug company organising an astroturf group than with genuine concern. And after all that NICE decided to approve it anyway.)

Yes, care is "rationed", but the ceiling is so high that it's out of sight for most people for their entire lives. The only people I know of who have been "denied" anything are in the pages of tabloid newspapers, so I don't even know how accurate the stories are. I have a very large extended family, most of whom are older than me. I have a 94-year-old mother (who is being positively cherished by the NHS), who has a bunch of geriatric friends. Everybody is getting a fair chunk of healthcare, and none of them is having anything "denied", or having to worry for half a second how it will be paid for.

You seem to find this so unbelievable you accuse me of rose-coloured spectacles and utopianism, but I'm merely describing the situation as it actually is.

NICE has nothing to do with me because I don't live in England, but never mind that for now. NICE is the senior doctors, charged with figuring out what best practice is. Would I rather my doctor just proceeded on what she thinks she remembers from a lecture on the subject 20 years ago, or has access to best practice guidelines produced by a committee of the top experts? What do you think?

And don't tell me doctors in the USA have autonomy. You seem to prefer that an insurance company apparatchik gets to decide whether the procedure your doctor recommends is medically necessary or not. OK, your choice. Just don't expect me to agree with you.

I don't agree that government has no incentive to be efficient. I see it busting a gut to achieve "efficiency savings" all the time. And since our system covers everybody in the country to a standard at least comparable to US outcomes, for half the outlay the USA spends on healthcare. I don't think you're going anywhere with that argument.

Rolfe.

 

[xjx388]

Rolfe, I respectfully agree to disagree.

 

[Rolfe]

That's not what I said. I said that eliminating the government and creating a free market health system would drive costs down. Why? Because it would reduce overutilization.

Might eliminate some unnecessary expenditure. But how it would make the necessary procedures affordable is another question entirely.

And implementing UHC would initially drive costs way up. There's no guarantees after that.

Funny how every other first world country and quite a few others have managed it without anything imploding, and US healthcare expenditure still outstrips each and every one of them.

Americans like to tell us how America is such a great country, can-do attitudes, really efficient and on the ball - but you have no faith at all in your ability to achieve what even bloody Taiwan managed.

Which procedures? I might give strep tests for free as a service since they cost me so little.

Oh come on. Just about anything requiring a hospital stay. You want a coronary bypass to come down in price so that any Joe can afford one, and you still want to pay doctors more than football stars. Get real.

Research funding is a separate issue entirely.

No, it isn't. Research is undertaken ultimately to produce a product which can be sold. If there's no prospect of more than a handful of people ever being able to afford your proposed product, why bother? Go build a better mousetrap instead.

I want doctors to be paid based on the value of their work to society. I want footballers, pop stars, actors etc. to be paid less and doctors, teachers, firemen, policemen, etc. to be paid more. Society has to re-prioritize it's spending. If health care is a basic right and football is not then health care should come first, no?

What happened to free market forces?

Rolfe.

 

[Rolfe]

Rolfe, I respectfully agree to disagree.

What, you agree to disagree with my factual description of how life is where I actually live?

Sounds like someone backing out of an argument because he's too closed-minded to change his attitudes, but knows his position is untenable.

Rolfe.

 

[Rolfe]

Unfortunately, in your case, there is no solution in the present.

This was addressed to Ducky.

How bankrupt is this system, when that's the sort of dismissive attitude to someone with serious cancer issues? Of course there is a solution for the Duckys of this world, in the present. Ducky merely has the misfortune to live in the only developed country in the world where his treatment is not provided either free or at nominal cost.

Fighting tooth and nail to retain the system that throws Ducky on the scrapheap, bankrupt, for no benefit to anyone that I can see (not even lower taxes, though my God what sort of callous bastard would rather pay a few dollarpounds less in tax than see this sort of need taken care of), is simply ridiculous.

Ducky, I know we've had this conversation before, and I also know how strong the ties to home are for all of us, but if you could simply manage a legal way to gain residency in any European country, you'd be sorted.

Rolfe.

 

[Rolfe]

Is healthcare really a right?

Oh and don't start that one again. Healthcare is a right where I live. It is not a right where you live.

Rights are what the society you live in says that they are. In the USA, society does not at the moment believe that healthcare should be a right, so it blocks any suggestion that it should be made a right.

In most other civilised countries, society has decided that healthcare should be a right and has taken steps to make it so.

Your choice.

Rolfe.

 

[Tatyana]

Rolfe, you can't say that there isn't poverty and inequity in the UK. You need to take off the rose colored glasses because the real world isn't perfect. The NHS sure isn't perfect. What about taking away obesity surgery? For the morbidly obese, it's the only thing that works. Ah, but the fat people don't deserve it because they'll just get fat again. Ditto for the hip replacements. It's not cost effective. What about the women who get breast cancer who were denied life extending drugs. NICE decided it wasn't cost-effective. So they were denied extra time with their loved ones. The latest cutbacks are equally bad.

How can you deny that any Universal system MUST ration care? There are not enough resources to go around. When you centralize decision making, people become numbers and statistics and guidelines. The only people that need to be making the decisions are the patients and their doctors. What's wrong with that? And don't tell me that doctors in the UK have autonomy; they have to follow the NICE guidelines.

I'd much rather pool my money in a private insurance plan than in the government (I'd rather do none of those things). Government has no incentive to be efficient and I have no choice to change if I don't like it.

Private insurance companies ration care as well.

NICE guidelines are evidence based medicine. This is a rather new and innovative turn for medicine.

I find it rather odd that you are all for the free market, yet aspects of the free market, like cost effectiveness analysis for medical treatments, are evidence of something wrong.

The government has incentives to be efficient. The NHS tracks all the turn around times and clinical outcomes and has to improve on them.

You are pooling your money into a private insurance plan, so you really don't have anything to worry about, unless of course, you become unwell and your insurance won't pay for it.

If you don't like it in the NHS, you can also have private insurance, so really, we have far more freedom than you do.

Yes, NICE has set a limit on how much money they will spend for each month of life that can be extended, I think it is something like £ 50, 000/month.

I don't see that as unreasonable.

You are also being inconsistent as you say if you can't afford the care, then you should be prepared to die, however, life extending drugs not being given to terminal patients is just bad and wrong and why private, for profit, health insurance is better.

Women are denied some cancer drugs as not all types of breast cancer are the same. If it is not a cancer that responds to blocking hormone receptors, the majority of breast cancer drugs are not going to work.

If you only read the papers, you wouldn't be aware of this.

It would be like giving anti-biotics for a viral infection.

 

[xjx388]

What, you agree to disagree with my factual description of how life is where I actually live?

Sounds like someone backing out of an argument because he's too closed-minded to change his attitudes, but knows his position is untenable.

Rolfe.

No, I disagree with your position that UHC is the way to go in America. I am not well enough informed to truly debate anything here. You aren't either. All we are doing is tossing our opinions back and forth at each other. I'm never going to convince you that free markets can work and you probably won't be able to convince me that UHC works. There has to be a new way, a synthesis of the two or something totally new, but I have no clue exactly what.

 

[xjx388]

Americans like to tell us how America is such a great country, can-do attitudes, really efficient and on the ball - but you have no faith at all in your ability to achieve what even bloody Taiwan managed.

No other country is founded on the same principles of liberty as America. You live in a country where you spend $64 million on the Royal Family. I wonder what kind of healthcare the Queen gets?

What happened to free market forces?

They exist in Football but not in Healthcare. Footballers make tons of cash. Doctors in the UK make squat comparatively. Why is Football valued more highly than Healthcare in the UK? Is Football a basic right?

 

[Tatyana]

No other country is founded on the same principles of liberty as America. You live in a country where you spend $64 million on the Royal Family. I wonder what kind of healthcare the Queen gets?




They exist in Football but not in Healthcare. Footballers make tons of cash. Doctors in the UK make squat comparatively. Why is Football valued more highly than Healthcare in the UK? Is Football a basic right?

The principles of the Englightenment (which the constitution and bill of rights came out of) were not something the founding fathers dreamed up in isolation, they were based on the zeitgeist of the time in Europe.

You have to consider things like the Magna Carta.

Your arguments are becoming more random and emotive, not logical at all.

Have you ever read the New England Journal of Medicine?

They do some fantastic articles on health care reform and the issue with health care.

I find it so ironic that 'liberty' does not include the freedom to be healthy.

As well, as much as you cherry pick issues that may or may not be issues related to health care in the UK, it does appear that you are grasping at strawmen.

The UK is not the best UHC system in the world, we know that.

The point of this thread is to look at the hypothesis that it is administrative incompetence that is responsible for the costs of American health care.

I have always lived in countries with a UHC system, I can't imagine living in a country where there isn't one.

These are the facts: The US pays more for healthcare than any other Western Countries, all of its citizens do not have health care, and the outcomes are not better, and in some cases, worse than those countries with a UHC.

I find it so ironic that so many Americans consider the US to be a Christian country, or 'number one' yet there is this attitude that we are not responsible for those who can't take care of themselves.

You seem to think that the issue of UHC and caring for the poor has been forced upon those of us who live in a more socialist country.

They haven't been, these are democratic countries where the people have voted over centuries to establish things this way.

 

[Agatha]

No other country is founded on the same principles of liberty as America. You live in a country where you spend $64 million on the Royal Family. I wonder what kind of healthcare the Queen gets?

The same as the rest of us, only with private rooms and private consultants (who spend most of their time working in the NHS). Is your argument really "well, the UK spends £38.2m/$60m (xe.com exchange rate) on the Royals or 62p per person per day, and therefore our universal health care is somehow compromised? What does our spending on the Royals have to do with our healthcare system? (Hint, the answer is "nothing".)

They exist in Football but not in Healthcare. Footballers make tons of cash. Doctors in the UK make squat comparatively. Why is Football valued more highly than Healthcare in the UK? Is Football a basic right?

This is such a muddled argument I'm surprised you make it with a straight face. In almost all countries around the world, the very few top sports stars or pop stars get paid daft amounts of money. Again, what does this have to do with UHC? It's not that we value football per se more than doctors, it's that some private companies value a very few people for a very short time very highly. In the US, CNN tells me that the average salary for a surgeon is $219,770. It doesn't tell me what sort of debt the average surgeon has from their education, which might be something that should be set against that kind of salary. But yet, how much did David Beckham get paid from LA Galaxy? How much did Tom Brady earn last year? (to save you looking it up, it was over $8m.) That free market seems to value footballers a great deal higher than surgeons in the US too, which kind of renders your argument moot.

I am not saying you should have a UHC in the US like our NHS if you don't want one, and I doubt Rolfe is either. But when we tell you that our NHS will treat everyone for free, and that everyone gets good quality, 2010 care, that treatments are not denied on the basis of anything except clinical need, that wait times are extremely short - while acknowledging that there is always room for improvement - you could at least do us the courtesy of believing us instead of dismissing it as a utopian vision; it's not. It's the real situation, and it costs us less than your system costs you.

 

[Darat]

No, I disagree with your position that UHC is the way to go in America. I am not well enough informed to truly debate anything here. You aren't either. All we are doing is tossing our opinions back and forth at each other. I'm never going to convince you that free markets can work and you probably won't be able to convince me that UHC works. There has to be a new way, a synthesis of the two or something totally new, but I have no clue exactly what.

I really can't understand how you can say that given the empirical evidence that pretty much every "first world" country in the world has a working system of offering UHC.

It is one thing not to be convinced by someone's reasoning but to ignore the actual evidence, well that is something quite different.

 

[Emet]

I think it should be obvious to those of you who live in countries with UHC, why those of us Americans who favor it are so pessimistic.

Even though the arguments against it on this thread aren't the least bit convincing, and fail in the face of well mounted evidence, there are too many powerful forces in play.

American hubris: Rah rah, blah, blah.

Americans who run in fear of anything that sounds like socialism. Never mind that our economy is mixed and has been.

The powerful and rich health insurance companies, who have made a fortune and spent a significant amount of money spreading disinformation and fear.

Our politicians. Their health insurance is terrific. Most are very wealthy. Yet even they are sometimes unhappy.

The middle class and above who hold the working poor and the poor in contempt.

The utter lack of compassion. Or ability to reason.