Health care - administrative incompetence

Agatha said:
Are you reading this thread (your repeated insistence on cost being the driver of decision making here suggests not)? It's already been noted in this thread that the UK is lagging behind on cancer survival, and the reason is, according to the news reports here, is that we under-utilise our free GPs. People don't go to their GPs with cancer symptoms soon enough, so that cancers tend to be more advanced by the time they are discovered. http://www.bbc.co.uk/news/health-11749078 This is something that the UK needs to work on urgently, and we will be doing.

Anecdotally, this is exactly what my mother did - she didn't want to bother the doctor with her problems, so that by the time her bowel cancer was detected it had already spread to her liver, and she died less than three months after first visiting her GP, at just 49 years old. No blame can attach to her GP or the hospitals she was in, the GP sent her in hospital the same day she first visited him and she had first class treatment at both her local hospital and the regional cancer centre.
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OK, but there are plenty of people in the US -Men being a great example :D - who don't go to the doctor until something is really wrong. Yet, despite "universal access" compared to the US, your cancer survival rates are significantly worse.

You guys are the ones saying that the NHS provides comparable or better outcomes than the US system for less money. You provide surveys and flawed WHO reports to "prove" your claim. I show you the raw data proving the US has better mortality rates in cancer and your reasoning is that people in the UK don't use the free care given to them. But, I could just as easily conclude, based on the evidence I've seen, that the NHS refuses life-extending treatments based on cost-effectiveness.
 
UncaYimmy said:
Or the fact that his "brilliant" wife got a full ride to college. I guess it's okay for people to be threatened with incarceration to pay for his wife's college.
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I guess the way to get ahead of the system in the USA is to be smart enough to be able to secure a highly lucrative job. Or failing that, marry someone who is.

Except, once free market forces have driven the price of medical treatment down to levels everybody can afford, make sure it's not medicine you chose for your safety-net job....

Rolfe.
 
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Rolfe said:
I guess the way to get ahead of the system in the USA is to be smart enough to be able to secure a highly lucrative job. Or failing that, marry someone who is.
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I see what you did there and I resemble resent that remark! :p

You don't have to be smart enough. You have to work hard enough and sacrifice. Plenty of people never went to college and make excellent livings. I used to be a teacher but I quit to help run her practice and save money.

Except, once free market forces have driven the price of medical treatment down to levels everybody can afford, make sure it's not medicine you chose for your safety-not job....

Rolfe.
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I'm not worried about the free market driving prices down. Doctor's will be just fine. Grocers and homebuilders do just fine under the free market. Besides, we (personally) aren't in it to make gobs of money, despite what you may think. I'm more worried about the government stepping in and telling doctors how much "society" thinks they are worth, which, to judge by the UKs pay rates for doctors, isn't very much. I'll take my chances with a free market, thank you.
 
Okay so humor me here. What is the incentive for the NHS to provide the best care possible?
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Politicians are "fired" when the NHS doesn't perform in a way that satisfies the population.

As far as costs go, the majority of healthcare is currently paid for by consumers. If we go to a UHC system, who will pay for it? It still costs money to pay for physicians, hospitals, equipment, drugs, etc. Right now I pay the insurance company for what I want for my healthcare - I am the consumer. In a UHC scenario I am paying the government roughly the same amount (through taxes though) to provide me healthcare plus provide others healthcare too. Is this a correct (albeit simplified) theory?
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Actually, if we got hard-core about emulating the NHS, our costs would go down by about 50%. You'd pay the same as you do right now for Medicare/Medicaid, except you'd be able to actually have it pay all (or 99%) of your medical expenses, too.
 
xjx388 said:
You guys are the ones saying that the NHS provides comparable or better outcomes than the US system for less money. You provide surveys and flawed WHO reports to "prove" your claim. I show you the raw data proving the US has better mortality rates in cancer and your reasoning is that people in the UK don't use the free care given to them. But, I could just as easily conclude, based on the evidence I've seen, that the NHS refuses life-extending treatments based on cost-effectiveness.
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Actually, all these statistics are pretty meaningless.

One of the metrics quoted was percentage of the population dying from cancer. There are two problems with this one. First, everybody has to die of something. Cancer is one of the things people tend to die of in developed countries where diseases that kill at an earlier age have been wiped out. It's a disease of affluence. So if fewer Americans are dying of cancer, I have to ask, what are they dying of?

Second, how sure are you about the US figures on causes of death? In Britain, we're pretty sure, because we have mandatory post mortems on everybody who wasn't actively under medical treatment at the time of death, plus anybody whose doctor thinks needs a post mortem anyway. The NHS pays for these of course. In contrast, non-forensic post mortems in the USA are relatively rare. Nobody much wants to pay for them. So the accuracy of the recorded causes of death has to be suspect.

Another thing that has been quoted is survival times post diagnosis for cancer. The main thing that screws up these figures is the effect of questionable screening programmes which may show up a cancer relatively early (breast and prostate are the main examples). Many cancers are picked up this way which would never kill the patient anyway, which skews the statistics. Many more are picked up early, but this has no effect on the time of death. This of course favours the statistics, because it lengthens the time from diagnosis to death, even though it doesn't advantage the patient at all.

One might hazard a guess that the other side of the US coin might counterbalance this, that of people with no health coverage not showing up to a doctor with their cancer until they're close to death. But we can't tell which aspect might weigh more heavily in the statistics. It's also possible many of these people might not show up at all, and die undiagnosed, and so don't appear in the statistics at all.

To provide a meaningful comparison, the USA would have to have a public health system capable of collecting the relevant data. It doesn't have that.

Rolfe.
 
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I'm not worried about the free market driving prices down. Doctor's will be just fine. Grocers and homebuilders do just fine under the free market. Besides, we (personally) aren't in it to make gobs of money, despite what you may think. I'm more worried about the government stepping in and telling doctors how much "society" thinks they are worth, which, to judge by the UKs pay rates for doctors, isn't very much. I'll take my chances with a free market, thank you.
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It isn't the free market keeping specialist MD salaries inflated in the US - it's the AMA making sure the supply of doctors stays limited:

http://www.usatoday.com/news/health/2005-03-02-doctor-shortage_x.htm

For the past quarter-century, the American Medical Association and other industry groups have predicted a glut of doctors and worked to limit the number of new physicians.
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http://en.wikipedia.org/wiki/American_Medical_Association#cite_note-28

# Critics of the American Medical Association, including economist Milton Friedman, have asserted that the organization acts as a guild and has attempted to increase physicians' wages and fees limit by influencing limitations on the supply of physicians and non-physician competition. In Free to Choose, Friedman said "The AMA has engaged in extensive litigation charging chiropractors and osteopathic physicians with the unlicensed practice of medicine, in an attempt to restrict them to as narrow an area as possible."[citation needed]
# Profession and monopoly, a book published in 1975 is critical of the AMA for limiting the supply of physicians and inflating the cost of medical care in the United States. The book claims that physician supply is kept low by the AMA to ensure high pay for practicing physicians. It states that in the United States the number, curriculum, and size of medical schools are restricted by state licensing boards controlled by representatives of state medical societies associated with the AMA. These claims ignore the fact that the total number of physicians in the United States increased by 142.3 percent between 1975 and 2008, from about 394,000 to 954,000. Physician workforce growth was much greater than national population growth during this period. As a result, the total number of physicians per 100,000 people in the United States climbed from 180 in 1975 to 314 in 2008 (Source - "Physicians Characteristics and Distribution in the US, 2010 Edition," pages 439, 441 and 451). The book is also critical of the ethical rules adopted by the AMA which restrict advertisement and other types of competition between professionals. It points out that advertising and bargaining can result in expulsion from the AMA and legal revocation of licenses. Restrictions against advertising that is not false or deceptive were dropped from the AMA Code of Medical Ethics in 1980 (See AMA Ethical Policy E-5.02). The book also states that before 1912 the AMA included uniform fees for specific medical procedures in its official code of ethics. The AMA's influence on hospital regulation was also criticized in the book.[28]
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xjx388 said:
OK, but there are plenty of people in the US -Men being a great example :D - who don't go to the doctor until something is really wrong. Yet, despite "universal access" compared to the US, your cancer survival rates are significantly worse.
You guys are the ones saying that the NHS provides comparable or better outcomes than the US system for less money. You provide surveys and flawed WHO reports to "prove" your claim. I show you the raw data proving the US has better mortality rates in cancer and your reasoning is that people in the UK don't use the free care given to them. But, I could just as easily conclude, based on the evidence I've seen, that the NHS refuses life-extending treatments based on cost-effectiveness.
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You sure about that? Perhaps you should read this:

The Problem With Survival Rates

As we wrote in a recent post on the FactCheck Wire, one can’t assume that the type of health care system is the only or even a significant factor in apparent differences in countries’ cancer survival rates. Dr. Marie Diener-West, a professor of biostatistics at Johns Hopkins University Bloomberg School of Public Health, told us that one can’t draw too many conclusions. "There are many different factors that could be playing a role," she said. (A five-year survival rate is the percentage of people in a particular group who are alive five years after diagnosis. Calculating this requires one to follow the patients over five years.)
Stephen Finan, senior director of policy for the American Cancer Society Cancer Action Network (ACS’ advocacy affiliate), explains that one of the differences between England and the U.S. is that there’s a higher level of detection of breast cancer here, which increases the survival rate. "We see more breast cancer, and that’s because we place much more emphasis on screening than the U.K. system." (The U.K.’s National Health Service invites women for screening every three years starting at age 50, while the ACS recommends a mammogram every year starting at age 40.) More cancers detected earlier increases survival rates, even if it doesn’t affect mortality rates.
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http://www.factcheck.org/2009/09/a-false-appeal-to-womens-fears/
 
kellyb said:
Politicians are "fired" when the NHS doesn't perform in a way that satisfies the population.
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They are fired here too when they don't follow the will of the people. See the 2010 elections.

Actually, if we got hard-core about emulating the NHS, our costs would go down by about 50%. You'd pay the same as you do right now for Medicare/Medicaid, except you'd be able to actually have it pay all (or 99%) of your medical expenses, too.
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How do you figure? This sounds like completely made up numbers since there's no possible way for you to know this.
 
xjx388 said:
Savings + Catasrophic insurance + Free Market = Lower costs so you don't have to save up ridiculous sums.
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You have shown absolutely no evidence that a free market in healthcare would reduce costs, let alone that it would reduce the cost of something as inherently hyper-expensive as the treatment Ducky has had.

Conversely, we know that if Ducky has developed the same needs in Britain, he would have received his treatment free, without having to pay a penny for it.

xjx388 said:
As for irresponsibility in your past, I can't make judgements on that because I don't know you. You didn't necessarily have to be irresponsible; you're probably just a victim of our current system.
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Ducky had good healthcare in his job when he first presented with the myeloma symptoms. However, he wasn't diagnosed at that point. When he was diagnosed he was no longer in that job and no longer had the insurance. The subsequent ramifications are detailed in other threads.

In contrast, anyone in Ducky's position in Britain would receive the treatment he needed irrespective of what job he did or didn't have at the time. Free. Not one brown penny being asked of him.

xjx388 said:
I'm interested in debating the best way to improve healthcare in America. I'm interested in discussing healthcare/medicine in general. I'm not interested in flame wars, "us vs. them," or just fighting with people for the sport of it.
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No, I don't think you are. I think you're determined to impose your right-wing ideology on healthcare provision, and damn the evidence and damn common sense.

Rolfe.
 
kellyb said:
Politicians are "fired" when the NHS doesn't perform in a way that satisfies the population.
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You're kidding me right? That's supposed to be the way it works in the US too but since every politician has backroom deals going on there isn't an honest one among the bunch and we get the choice of dishonest Democrat A or dishonest Republican B. The current US healthcare system has more incentive to please consumers than government, period.


kellyb said:
Actually, if we got hard-core about emulating the NHS, our costs would go down by about 50%. You'd pay the same as you do right now for Medicare/Medicaid, except you'd be able to actually have it pay all (or 99%) of your medical expenses, too.
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False. If we got "hard-core" and implemented an NHS-emulated system on January 1st (or June 1st, or next January, etc.) there would be droves of people flocking to doctors for their "free" healthcare and the system would be overwhelmed and, let's see, there would be rationing. Oh yeah, a large portion of providers would decide they're not going to lose money accepting solely Medicare (or a Medicare-type system) and they'd retire early or quit and go do something else. It would be mass pandemonium with millions of patients and too few providers. The government would raise taxes to "pay for it" so all the people who work 80 hours a week and employ people would decide not to work 80 hours a week just so the government could take their 60%. The people employed by the 80-hour-work-week business owners would then be unemployed and they and the business owners would go on food stamps and welfare in addition to free healthcare (because now most the small businesses would close) and the government would have to raise taxes even further because there would be less workers funding all the stay-at-home welfare/food-stamp/free healthcare people.

Gee, that would be a real utopia.


My rant is now over.
 
xjx388 said:
OK, but there are plenty of people in the US -Men being a great example :D - who don't go to the doctor until something is really wrong. Yet, despite "universal access" compared to the US, your cancer survival rates are significantly worse.

You guys are the ones saying that the NHS provides comparable or better outcomes than the US system for less money. You provide surveys and flawed WHO reports to "prove" your claim. I show you the raw data proving the US has better mortality rates in cancer and your reasoning is that people in the UK don't use the free care given to them. But, I could just as easily conclude, based on the evidence I've seen, that the NHS refuses life-extending treatments based on cost-effectiveness.
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You'd be wrong in your conclusions, which appears to be a recurring theme. There is no ceiling on the cost of care, no limit on the number of chemo or radiotherapy sessions, no limit on the amount of drugs or surgery someone will get here as long as the procedures/drugs have been shown with evidence to be effective.

24% of all cancers are not detected here until people present as an emergency, that's a shocking statistic and one which we need to address.

Do you have any response to the point that you read the spreadsheet http://www.photius.com/rankings/world_health_systems.html completely wrong? America spends the most per capita on healthcare of those 191 countries, not the least.
 
 
Emet said:
You sure about that? Perhaps you should read this:



http://www.factcheck.org/2009/09/a-false-appeal-to-womens-fears/
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There's a number in there that is telling. The NHS recommends mammography once every three years?!? Now come on, people! Surely you can intuit that the only possible reason for this is cost-savings.

We screen every year and have better survival and mortality rates. Further evidence that the NHS crafts their guidelines to save money at the expense of people's lives.
 
xjx388 said:
You don't have to be smart enough. You have to be well enough to be able to work hard enough and sacrifice.
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Fixed that for you, since you still seem to be unwilling or unable to address people with chronic disease which limits their ability to study/work/save.

I'm not worried about the free market driving prices down. Doctor's will be just fine. Grocers and homebuilders do just fine under the free market. Besides, we (personally) aren't in it to make gobs of money, despite what you may think. I'm more worried about the government stepping in and telling doctors how much "society" thinks they are worth, which, to judge by the UKs pay rates for doctors, isn't very much. I'll take my chances with a free market, thank you.
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Are you comparing like with like, and deducting the cost of malpractice insurance and some of the tuition repayment from the US pay rates? Tuition fees are capped here.
 
Interesting article about AMA’s manipulating the supply of doctors.

kellyb said:
I know it's not just insurance companies. It's also a matter of increased pharma prices over here, medical device prices, radiology companies, for-profit blood work lab companies, etc. LOTS of factors.
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The popular wrong-headed meme is that is if we got rid of the evil insurance companies by going to single payer our healthcare expenditures would magically shrink to that of other countries using a single payer system.
kellyb said:
Politicians are "fired" when the NHS doesn't perform in a way that satisfies the population.

Actually, if we got hard-core about emulating the NHS, our costs would go down by about 50%. You'd pay the same as you do right now for Medicare/Medicaid, except you'd be able to actually have it pay all (or 99%) of your medical expenses, too.
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What steps would have to be taken to completely emulate the NHS?
 
xjx388 said:
They are fired here too when they don't follow the will of the people. See the 2010 elections.
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I'm not going to argue with that.


How do you figure? This sounds like completely made up numbers since there's no possible way for you to know this.
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Look at chart 11-7 here (page 20):
http://www.commonwealthfund.org/~/m...mparisonshltsysdata2006_chartbook_972 pdf.pdf

We in the US are paying the same amount per capita to fund our public systems. We in the US just can't access ours because of inflated pharma prices, etc making everything cost twice as much over here, so only a fraction of our population is covered by the public systems.
 
xjx388 said:
There's a number in there that is telling. The NHS recommends mammography once every three years?!? Now come on, people! Surely you can intuit that the only possible reason for this is cost-savings.

We screen every year and have better survival and mortality rates. Further evidence that the NHS crafts their guidelines to save money at the expense of people's lives.
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It seems you missed this:

The most recent mortality rates for breast cancer are 26.7 per 100,000 women in the U.K. (2007 numbers) and 25 per 100,000 women in the U.S. (2009 numbers), according to Cancer Research U.K. and the U.K.’s Office of National Statistics, and ACS Cancer Facts and Figures 2009. The mortality rates "aren’t that different," Finan says, "and it’s hard to parse out what causes that difference." Weiss, of the ACS Cancer Action Network, told us that using mortality rates "has been a frequent practice of ours because of a long-held belief that survival rates … are not a very reliable comparison."
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:hb:
 
xjx388 said:
You don't have to be smart enough. You have to work hard enough and sacrifice.
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With "sacrifice" being defined as accepting a full-ride scholarship that was paid for by threatening incarceration to get people to pay their taxes. You know, the very same taxes that could be used to, I dunno, pay for medical treatments.

Apparently "sacrifice" also means depending on family members to support you because, well, everybody has lots of family able to support a couple of teenagers who end up with a baby. Tell us, who paid your medical bills for the birth of the child? Right now an ordinary vaginal birth costs about 1,300 hours of minimum wage labor. It would only be about 1,200 hours if we didn't take out FICA/Medicare.
 
ServiceSoon said:
Interesting article about AMA’s manipulating the supply of doctors.


The popular wrong-headed meme is that is if we got rid of the evil insurance companies by going to single payer our healthcare expenditures would magically shrink to that of other countries using a single payer system.

What steps would have to be taken to completely emulate the NHS?
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Yeah, the two popular memes are:
1) It's all insurance company profits at fault!
and...
2) it's all the greedy doctors to blame!!!

There's an element of truth to greedy docs and insurance companies inflating our costs, but those two factors combined still can't account for even a third of our inflated prices, I don't think.

To emulate the NHS, we'd have to appoint some smart and honest people to objectively look at where all the money in the US public and private systems is going, and study how that compares to money going into the NHS.

And then we'd have to be willing to have, well, a massive government takeover of health care.
 
Emet said:
It seems you missed this:
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Your source cites two figures from two different sources from two different years. The WHO data is one source, same year (2005) with the raw numbers.

:hb:
 
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