Health care - administrative incompetence

[Architect]

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.

And yet you still can't explain why our healthcare system produces comaprable results for half the money. Strange that, eh?

 

[Ampulla of Vater]

I truly think you are comparing apples to oranges in comparing the US to other countries with UHC. There are so many other issues at play like I stated upthread. For instance, what would become of the sue-happy people? Agatha states that an average surgeon's income is $219K but how about the $120K a year s/he pays for malpractice insurance because it is all but a certainty that some people will sue for something? So somehow UHC would have to address tort-reform because if we are taxed for the UHC we surely cannot be taxed even more for the lawsuit settlements.

And then there's the illegal immigrant issue which is huge. Very few mind paying for people in their communities who are in need but very few can afford to additionally pay for people in need from other countries. If nearly a million people a year are sneaking in, how on earth can you expect the same set of taxpayers to maintain footing the bills? And this holds true for footing the bills for education as well.

Did you know that physicians in the U.S. are the only profession (to the best of my knowledge) whose expenses increase every year yet their government reimbursements (Medicare/Medicaid) decrease? How would you function if instead of getting a raise each year you instead had a decrease in salary year after year. Your rent still goes up, your staff still wants a raise, all your expenses rise, yet you get less. How would one fare if 100% of their income was based on one government payor?

I know our system is not perfect; in fact it has many flaws. I just think other things need to be fixed before UHC is even an option.

.

 

[Uncayimmy]

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?

I'd really love to hear an answer to this. I am not saying that a line can't be drawn, but I'd like to hear the reasoning for the line you're drawing.

Take a person with a seemingly ordinary infection. We'll spend tax dollars to educate a doctor in how to treat it. We'll spend tax dollars to do the research to find out what works and doesn't work so the doctors can utilize that knowledge. If a person doesn't have enough money to visit the doctor for a routine exam and some antibiotics, we won't spend tax dollars to pay for the visit. However, if he lets the infection fester and become gangrenous, we'll spend tax dollars when he shows up in the emergency room, maybe even paying to amputate a limb.

What's the line of reasoning that explains this type of policy?

 

[Tatyana]

I truly think you are comparing apples to oranges in comparing the US to other countries with UHC. There are so many other issues at play like I stated upthread. For instance, what would become of the sue-happy people? Agatha states that an average surgeon's income is $219K but how about the $120K a year s/he pays for malpractice insurance because it is all but a certainty that some people will sue for something? So somehow UHC would have to address tort-reform because if we are taxed for the UHC we surely cannot be taxed even more for the lawsuit settlements.

And then there's the illegal immigrant issue which is huge. Very few mind paying for people in their communities who are in need but very few can afford to additionally pay for people in need from other countries. If nearly a million people a year are sneaking in, how on earth can you expect the same set of taxpayers to maintain footing the bills? And this holds true for footing the bills for education as well.

Did you know that physicians in the U.S. are the only profession (to the best of my knowledge) whose expenses increase every year yet their government reimbursements (Medicare/Medicaid) decrease? How would you function if instead of getting a raise each year you instead had a decrease in salary year after year. Your rent still goes up, your staff still wants a raise, all your expenses rise, yet you get less. How would one fare if 100% of their income was based on one government payor?

I know our system is not perfect; in fact it has many flaws. I just think other things need to be fixed before UHC is even an option.

.

Medics get sued in Europe as well.

There is also an issue with illegal immigrants in Europe, I think someone pointed out in this thread that it works out to be the same percentage of the population of the UK and the US.

In addition, we also have legal immigration. We have issues in the UK coping with the number of people who come to England for work, (the EU open boarders thing) right now it seems to be that we have a lot of Polish people.

Yes, there are issues that need to be addressed in the US system.

I personally don't see a UHS happening in the US.

I also think that not demanding that the health care system undergo an overhaul is going to result in some dreadful situations for a lot of Americans that just never thought it could happen to them.

I find it really sad.

 

[Agatha]

I truly think you are comparing apples to oranges in comparing the US to other countries with UHC. There are so many other issues at play like I stated upthread. For instance, what would become of the sue-happy people? Agatha states that an average surgeon's income is $219K but how about the $120K a year s/he pays for malpractice insurance because it is all but a certainty that some people will sue for something? So somehow UHC would have to address tort-reform because if we are taxed for the UHC we surely cannot be taxed even more for the lawsuit settlements.

That's a fascinating point, PDiGirolamo, and one of which I wasn't aware. So the high pay of doctors, touted by xjx388 as proof of how the US values doctors more highly than the UK does, needs to be cut down by something like half to pay for malpractice insurance? That $219k suddenly looks a lot less. In the UK, the NHS rather than the individual pays for the insurance against any malpractice of NHS staff (and of course, the UK is a less litigious society in general). NHS staff who also take on private work do need additional insurance for which they are responsible.

And then there's the illegal immigrant issue which is huge. Very few mind paying for people in their communities who are in need but very few can afford to additionally pay for people in need from other countries. If nearly a million people a year are sneaking in, how on earth can you expect the same set of taxpayers to maintain footing the bills? And this holds true for footing the bills for education as well.

I have no idea how you should address the illegal immigration problem in your country. Here we have a dedicated UK Border Force but we do, of course, have no control over EU citizens immigrating here, they are not counted in the numbers of illegal immigrants as all EU citizens have the right to free movement within the EU.

Did you know that physicians in the U.S. are the only profession (to the best of my knowledge) whose expenses increase every year yet their government reimbursements (Medicare/Medicaid) decrease? How would you function if instead of getting a raise each year you instead had a decrease in salary year after year. Your rent still goes up, your staff still wants a raise, all your expenses rise, yet you get less. How would one fare if 100% of their income was based on one government payor?

It doesn't work like that in England. It's a bit complicated, but premises and IT costs are covered by the NHS, then around half the money paid to GP practices is based on the size of their patient list (weighted to take account of the demographics of the list), then additional payments are made according to outcomes and targets; the better outcomes and the more targets met, the more money paid. Linky. But there are changes afoot http://www.bbc.co.uk/news/10565668 and I haven't got my head round the changes yet.

I know our system is not perfect; in fact it has many flaws.

As does ours. None of us here in the UK is saying our system is perfect, but it is effective. If you need to see a doctor, you see one, if you need surgery you get it, if you need a psychiatrist you get one, if you need advice or physio or counselling or a midwife or a health visitor or a home care nurse or a hearing aid or glasses or medication or gluten-free food or a wheelchair or a wig then you are entitled to it. And yet, we have a real problem with people not wanting to 'bother' doctors which is why our cancer survival rates aren't as high as they could be.

I just think other things need to be fixed before UHC is even an option.

We probably said that sixty two years ago, but we had the political will to change. Maybe you are not there yet, but for the sake of people being faced with the choice between medical care that they need and bankruptcy, those people who simply cannot afford the treatment they need before they become so sick they need more invasive treatment in the ER just to stabilise them, never mind cure them, isn't it time you wondered why you are the only first-world country that treats healthcare as a privilege for the few instead of a right for the good of the whole of society?

 

[varwoche]

Be careful what you put into Beerina's head, because you will never get it out again.

Go easy. It's a difficult thing to learn that one's carefully crafted world view is grounded in fairy tales.

 

[xjx388]

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?

No. What I'm saying is that the UK has a very different culture than the US. You pay tax money to support an outdated and irrelevant monarch and somehow justify this significant expenditure.

What does our spending on the Royals have to do with our healthcare system? (Hint, the answer is "nothing".)

It has to do with the fact that you guys prioritize things differently. $62 million dollars could have easily paid for the drugs that helped Nikki Blunden and others like her.

...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.

By paying footballers more than doctors you are saying they are more valuable. The same is true in the US.

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.

The surgeon does not operate in a free market. Tom Brady does. Let the doctor operate in a free market. Tom Brady's salary will have to go down because the people will stop spending so much on football. They will be forced to re-prioritize their spending to things that are actually important. Some people will choose not to save/plan for their healthcare and will still contribute to Tom Brady's salary. I wish them luck that they never get sick. But most will save/plan and contribute to the doctor's salary so they are covered in case they get sick. It's your choice, what do you value more? You can't have both. You may think you have both now, but Nikki Blunden might disagree with you.

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.

I do believe you. I think it could be much better. You can't possibly know that everyone who needs care gets it. Everyone YOU know does, but what of the people who are denied care everyday in the UK, because they are obese, because the NHS doesn't think their lives are worth extending, because they drink . . . a whole host of reasons? I think a free market system could fix many of those inequities. I understand that you think a free market will leave people out in the cold. People are left out in the cold now. But a free market will let each individual decide how important healthcare is and provide the market forces to drive costs down.

 

[RemieV]

...
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.
...

I know that someone already addressed this in a very small-scale way, but I'd like to emphasize it a bit more.

ERs absolutely do not TREAT people. They stabilize people and send them home. The time that the hospital folk were standing over me yelling "Get the crash cart!" and all that? They released me four hours later. I had to, in fact, walk five miles home as they had brought me in in an ambulance.

 

[Emet]

I truly think you are comparing apples to oranges in comparing the US to other countries with UHC. There are so many other issues at play like I stated upthread. For instance, what would become of the sue-happy people? Agatha states that an average surgeon's income is $219K but how about the $120K a year s/he pays for malpractice insurance because it is all but a certainty that some people will sue for something? So somehow UHC would have to address tort-reform because if we are taxed for the UHC we surely cannot be taxed even more for the lawsuit settlements.

August 31, 2009
Would Tort Reform Lower Costs?

http://prescriptions.blogs.nytimes.com/2009/08/31/would-tort-reform-lower-health-care-costs/

And then there's the illegal immigrant issue which is huge. Very few mind paying for people in their communities who are in need but very few can afford to additionally pay for people in need from other countries. If nearly a million people a year are sneaking in, how on earth can you expect the same set of taxpayers to maintain footing the bills? And this holds true for footing the bills for education as well.

Cost of Illegal Immigrants
April 6, 2009

http://www.factcheck.org/2009/04/cost-of-illegal-immigrants/

Did you know that physicians in the U.S. are the only profession (to the best of my knowledge) whose expenses increase every year yet their government reimbursements (Medicare/Medicaid) decrease? How would you function if instead of getting a raise each year you instead had a decrease in salary year after year. Your rent still goes up, your staff still wants a raise, all your expenses rise, yet you get less. How would one fare if 100% of their income was based on one government payor?

Did you know that:

From Medscape Medical News
Physicians Seeing Fewer Medicare Patients Because of Low Pay and Threat of Cut

http://www.medscape.com/viewarticle/722925

Do you have any data of a of annual physician income, and where it's heading? I could only find annual surveys, not year-by-year comparisons.

I know our system is not perfect; in fact it has many flaws. I just think other things need to be fixed before UHC is even an option.

Well, are we so incompetent that we can not address multiple issues that are critically important to the health and well being of our citizens?

Those outside of the US: don't answer that.

 

[Uncayimmy]

I truly think you are comparing apples to oranges in comparing the US to other countries with UHC. There are so many other issues at play like I stated upthread. For instance, what would become of the sue-happy people? Agatha states that an average surgeon's income is $219K but how about the $120K a year s/he pays for malpractice insurance because it is all but a certainty that some people will sue for something? So somehow UHC would have to address tort-reform because if we are taxed for the UHC we surely cannot be taxed even more for the lawsuit settlements.

I'm not following you. Tort reform is an issue that needs addressing, but what's your issue with taxing to cover malpractice? It's a cost of doing business. We pay for it now. Why would you not think we'd pay for it under UHC?

Here's what I do know: Someone in a high risk medical field (obstetrics) is paying $100K/year for $250K of liability insurance. Meanwhile, a podiatrist is only paying $5K/year for $5M in insurance (numbers are realistic). It's essentially the same issue some of us face with getting insurance with pre-existing conditions. The same logic that makes UHC a good idea applies to reforming malpractice.

 

[tsig]

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.

Really? Then train more nurses, doctors and build hospitals.

 

[tsig]

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?

Goalposts, I saw them a while ago but they seem to have moved.

 

[xjx388]

I'm not following you. Tort reform is an issue that needs addressing, but what's your issue with taxing to cover malpractice? It's a cost of doing business. We pay for it now. Why would you not think we'd pay for it under UHC?

Let's tax to cover my overhead too, then. How many taxes do you propose we add?

Here's what I do know: Someone in a high risk medical field (obstetrics) is paying $100K/year for $250K of liability insurance. Meanwhile, a podiatrist is only paying $5K/year for $5M in insurance (numbers are realistic).

Are you just pulling these numbers out of your bum? Do you even understand how malpractice insurance works? I'd like you to cite a source for this.

It's essentially the same issue some of us face with getting insurance with pre-existing conditions. The same logic that makes UHC a good idea applies to reforming malpractice.

In Texas we reformed malpractice. We pay under $7,000 per year. OB/Gyns that I've spoken with pay about $50k. These rates are significantly lower than they used to be before reform. Boom, we just lowered the cost of health care. But the price of care won't come down until government get's out of the picture as an insurer.

 

[xjx388]

Really? Then train more nurses, doctors and build hospitals.

And where does the NHS get money to build new hospitals from?

 

[xjx388]

Goalposts, I saw them a while ago but they seem to have moved.

I haven't moved anything. Do you value healthcare more than football?

 

[FattyCatty]

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.

This is what is so shaming and shameful about America today. And it is the main reason for my pessimism regarding any positive change in our health care. It is shaming to have to admit to the rest of the world that our country is run by people who can't reason and who have no compassion for those less fortunate. It is shaming to have to admit that it is the majority of Americans, sharing those characteristics, who elect them. It is shameful that Americans have turned into this kind of people. I used to think we were the best country in the world. Evidence is becoming stronger (health care, education) that we are not.

For years (after reading it in, of all places, a murder mystery), my solution to America's health care problems has been to make it a national service. As with members of the Armed Forces, doctors will be educated by the government in exchange for a specified number of years in national service; they would also be allowed to stay in until retirement, i.e., become a "lifer."

Doctors provide a service essential to the well-being of the citizens of the country; so do policemen and firemen and the military. Why should doctors be disproportionately rewarded when they don't even risk their lives in their duties the way the others do? Greater education? If the government pays for it, it's not an issue. Have to make life-and-death decisions? So do the other providers of essential services. I think we should have a health service along these lines that would give access to health care to all Americans. Because it is unconscionable that we fall so far behind other countries in extending this right to our citizens.

ETA: One of the main benefits of this system is getting rid of the for-profit health insurance industry and its high cost of administration and executive reimbursement (and political contributions). Having all health care administration under one roof would be much more efficient and would cost less.

Also, an aside to xjx388: I personally think a constitutional monarchy is a superior form of government. I would rather have my tax dollars supporting that monarchy than have giant corporations and other public interests in America getting a "free pass" in terms of taxes. It would be nice to have a representative/symbol of the country that didn't change from election to election, that could be for the whole country regardless of politics (especially the bitterly divisive politics that have developed in the United States).

 

[Emet]

In Texas we reformed malpractice. We pay under $7,000 per year. OB/Gyns that I've spoken with pay about $50k. These rates are significantly lower than they used to be before reform. Boom, we just lowered the cost of health care. But the price of care won't come down until government get's out of the picture as an insurer.

Really?

September 15, 2009

Medical Malpractice Myths Debunked – Texas, California and Some Michigan Thrown In

http://www.thepoptort.com/2009/09/medical-malpractice-myths-debunked.html

A Tale of Two Stories on Texas Medical Malpractice Reform

So did Texans benefit from tort reform?
Doctors, some.
Insurance companies? A lot.
Most Texans probably couldn’t say.
But if you lost your baby after a difficult delivery, tort reform may have taken away your ability to find answers.
Melody Pinsukanjana said, “We’ve lost access to the courts and that’s the biggest frustration I have.”

http://www.civtrial.com/medical-mal...-stories-on-texas-medical-malpractice-reform/

Malpractice curbs hailed, faulted

But the cap, said Dr. Donald W. Patrick, the Texas Medical Board's executive director, has clearly helped to make medical care more accessible to many residents by increasing their medical options. "I don't think [doctors] come to Texas strictly because of tort reform, but it's a factor they take into consideration," he said.

Patrick said most of the out-of-state doctors are either in their first few years of practice, or have just finished their residencies elsewhere. Veteran doctors are less likely to make a move, even in the face of rising insurance premiums - a reluctance confirmed by a recent study at the Harvard School of Public Health.

But even as younger doctors move into Texas in far greater numbers, they tend to locate in the same urban areas - undercutting one of the strongest arguments for Proposition 12.

Supporters of the curb on jury awards had said that malpractice laws were responsible for shortages of doctors in rural Texas, specifically highlighting 152 counties that did not have an obstetrician. But an analysis in Texas Observer magazine found that as of September, the same number of counties remains without one. It also found that 124 counties have no obstetrician, neurosurgeon, or orthopedic surgeon.

http://www.boston.com/news/nation/articles/2007/11/26/malpractice_curbs_hailed_faulted/?page=2

 

[kellyb]

Everyone YOU know does, but what of the people who are denied care everyday in the UK, because they are obese, because the NHS doesn't think their lives are worth extending, because they drink . . . a whole host of reasons?

This is a hypothetical, imaginary, evil government service, not the actual NHS.
Do you understand what kind of political s***-storm it would cause if the NHS actually started doing the stuff you suggested?

 

[Uncayimmy]

Let's tax to cover my overhead too, then. How many taxes do you propose we add?

You have a very limited understanding of accounting. I really don't know how to respond without covering a few semesters of basic business education. Insurance companies right now pay your overhead - it's built into your pricing.

Are you just pulling these numbers out of your bum? Do you even understand how malpractice insurance works? I'd like you to cite a source for this.

Maryland malpractice rates:
Internal Medicine - $19K
General Surgery - $74K
OB-GYN - $144K


According to this discussion board, dentists pay $2K to $5K per year for $3M in liability insurance.

As for the ballpark numbers I used:

http://www.msnbc.msn.com/id/5234637/ns/health-health_care/
Routman’s [orthopedic surgeon] policy last year would have cost $94,835 for $250,000 worth of coverage, even though he’s had no settlements or judgments against him in 18 years of private practice.

In comparison, Routman’s brother, an ear, nose and throat specialist in Birmingham, Ala., has $5 million worth of coverage and pays $5,000 a year.

Good enough for you?

In Texas we reformed malpractice. We pay under $7,000 per year. OB/Gyns that I've spoken with pay about $50k. These rates are significantly lower than they used to be before reform. Boom, we just lowered the cost of health care. But the price of care won't come down until government get's out of the picture as an insurer.

Except for all the places where that has actually worked. Can you cite some free market examples as evidence of the resulting price drop?

 

[Tatyana]

No. What I'm saying is that the UK has a very different culture than the US. You pay tax money to support an outdated and irrelevant monarch and somehow justify this significant expenditure.

It has to do with the fact that you guys prioritize things differently. $62 million dollars could have easily paid for the drugs that helped Nikki Blunden and others like her.



You may think you have both now, but Nikki Blunden might disagree with you.


I do believe you. I think it could be much better. You can't possibly know that everyone who needs care gets it. Everyone YOU know does, but what of the people who are denied care everyday in the UK, because they are obese, because the NHS doesn't think their lives are worth extending, because they drink . . . a whole host of reasons? I think a free market system could fix many of those inequities. I understand that you think a free market will leave people out in the cold. People are left out in the cold now. But a free market will let each individual decide how important healthcare is and provide the market forces to drive costs down.

If the British people didn't want the queen, we wouldn't have the queen.

It is a remnant of being the dominant empire on the planet until not that long ago. The British Empire has left its mark, and continues to.

What do you think the remnants of the American Empire are going to be besides Starbucks, Mackie-D's and KFC?

The same applies to at least fifteen countries in the Commonwealth that have the queen as some form of governor-general.

I just had a look at the articles on Nikki Blunden.

She had been treated for three years on the NHS. Her cancer had metastasized to her brain and lymph nodes, not a good prognosis.

The drug in question has only been approved for use in the US for three years.

It is used for the treatment of advanced or metastatic breast cancer, and the preliminary trials indicate that it only works in 35% of women with HER2 advanced breast cancer.

What happened to your attitude that if you can't afford it, be prepared to die?

If Nikki Blunden was a black American woman, the odd are she wouldn't have had any treatment at all.

I am sure that there are people who should be denied treatment because they are at risk of not surviving the operation, however, for the most part, everyone is treated regardless of their age, race, or health condition.

Yes, you can pull out the individual cases that make HUGE press in the UK, however this is in stark contrast to one-sixth of the American population that, as a nation, the US has deemed not worthy to treat.