Health care - administrative incompetence

[Tatyana]

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.




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.

There is already an issue with a shortage of GPs in the US.

This is just one of the many times this is mentioned in the New England Journal of Medicine.

http://www.nejm.org/doi/full/10.1056/NEJMp0911423
Given the serious shortage of primary care physicians in the United States, due partly to the income gap between that field and others,

You are correct, the US is not going to be able to switch to a UHC system very quickly, if ever at all.

I just wonder how bad it has to get before people actually realise that they are some of the people that are going to be priced out of health care?

 

[xjx388]

I still can't wait to see XjX's explanation as to why we live longer for half the healthcare costs. Especially given her unsubstantiated claims of UHC rationing. It's been strangely absent so far.

UK life expectancy: 79.2 years
US life expectancy: 78.24 year

Difference = .96 years.

Neither of us have anything on Singapore = 82.06 years. Interesting health system they have there . . . Kind of a hybrid between a UHC system and a Free Market system.

Components: Compulsory savings of 6.5-9% of earnings, an optional state-funded catastrophic insurance plan and government set price controls. Really, the only thing that makes this "Universal" is that people are forced to save for their own medical needs (I guess I'm not that original after all, huh?). Provision of care is completely in the private sector; i.e. the free market (yes, the price controls mess with how free the market truly is, but it's certainly more free than the US is now). This system is referred to as one of the most effective in the world. GPs earn about $10,000/month there and surgeons about $17,000/month, not quite as good as here but pretty durn-well acceptable.

In 1984, Singapore adopted a health care system of health savings accounts, called Medisave accounts, that emphasizes personal responsibility. Along with the compulsory medical savings accounts, most Singaporeans also enroll in Medishield, a voluntary catastrophic insurance plan. Prior to 1984, the Singapore health care system resembled that of the United Kingdom, where medical services were financed through general taxes and provided free or at a nominal charge. In the face of escalating health care costs and low labor productivity, the Singaporean government developed the National Health Plan to reform the structure and financing of the health care system, creating the Medisave system.

Wow, a health system with ideas very similar to mine that is considered one of the most effective in the world and they used to have a system like the NHS but dumped it. . . Who'dathunkit? I'm not sure I like all of it, but it proves the model works.

 

[Uncayimmy]

That's the operative phrase here. They craft their guidelines putting costs ahead of care as evidenced by the three year recommendation for breast cancer screening.

Please elaborate and show your evidence.

In the UK:

http://www.cancerscreening.nhs.uk/breastscreen/cost.html
In England, the budget for the breast screening programme is now estimated to be approximately £75 million. This works out at about £37.50 per woman invited or £45.50 per woman screened.

Meanwhile in the USA...

http://www.costhelper.com/cost/health/mammogram.html

• For an uninsured patient, typical full-price cost of a mammogram ranges from $80 to $120 or more, with an average of about $102, according to Blue Cross Blue Shield of North Carolina. Some providers charge more, and some offer an uninsured discount. For example, at the Kapiolani Medical Center in Aiea, Hawaii, where the full price is about $212, an uninsured patient would pay about $127 to $148.
• Mammograms usually are covered by health insurance for women in the recommended age bracket. Many states require health insurance companies to cover regular mammograms, usually after age 40. The National Women's Law Center offers a state-by-state chart.
• For women covered by health insurance, some plans require no out-of-pocket expenses, while others charge a co-pay, generally between $10 and $35.

On top of that, the UK has about 78% of women getting screened while the USA gets only about 65% screened. Sources:
http://www.ncbi.nlm.nih.gov/pubmed/9718527
http://www.cdc.gov/cancer/breast/statistics/screening.htm

And most importantly, NIH seems genuinely concerned about the compliance rate and actively trying to increase this number whereas the USA has football players wear patches with pink ribbons. Well, in all fairness, some states have to force insurers by law to cover it.

 

[kellyb]

That's the operative phrase here. They craft their guidelines putting costs ahead of care as evidenced by the three year recommendation for breast cancer screening.

No.

http://www2.cochrane.org/reviews/en/ab001877.html

Screening with mammography uses X-ray to try to find breast cancer before a lump can be felt. The goal is to treat cancer early, when a cure is more likely. The review includes seven trials that involved 600,000 women who were randomly assigned to receive screening mammograms or not. The review found that screening for breast cancer likely reduces breast cancer mortality, but the magnitude of the effect is uncertain. Screening will also result in some women getting a cancer diagnosis even though their cancer would not have led to death or sickness. Currently, it is not possible to tell which women these are, and they are therefore likely to have breasts or lumps removed and to receive radiotherapy unnecessarily. The review estimated that screening leads to a reduction in breast cancer mortality of 15% and to 30% overdiagnosis and overtreatment. This means that for every 2000 women invited for screening throughout 10 years, one will have her life prolonged. In addition, 10 healthy women, who would not have been diagnosed if there had not been screening, will be diagnosed as breast cancer patients and will be treated unnecessarily. Furthermore, more than 200 women will experience important psychological distress for many months because of false positive findings.

It is thus not clear whether screening does more good than harm. Women invited to screening should be fully informed of both the benefits and harms. To help ensure that the requirements for informed consent for women contemplating whether or not to attend a screening program can be met, we have written an evidence-based leaflet for lay people that is available in several languages on www.cochrane.dk.

 

[xjx388]

Who in the US is on welfare as a lifestyle nowadays?
Did you ever hear about this?

http://en.wikipedia.org/wiki/Personal_Responsibility_and_Work_Opportunity_Act

Come visit me in South Texas and I'll show you plenty of people who have made Medicaid and Food Stamps (or whatever they are called nowadays) a lifestyle.

 

[Rolfe]

Okay y'all, I am very interested in this thread but have been extraordinarily busy with family commitments. I am off today so I am wandering back over to catch up on the debate. I have a couple of questions for you guys in the UK.

How much (percentage-wise) do you pay in taxes? I pay upwards of 45% in taxes and I fear that implementing a UHC system will raise taxes.

I think there is something you need to know.

The amount of tax paid by British citizens to fund the NHS is slightly lass than the amount of tax paid by US citizens to fund state-provided healthcare in the USA. This is true whether you compute it on a per-head basis, or as a percentage of GDP.

The only difference is that while most US citizens cannot access the state-provided healthcare in their country, and so have to make other arrangements paid for out of their taxed income, British citizens can all access the NHS and so need not make any additional arrangements unless they choose to do so.

It's very hard to compute exactly what anyone is paying in tax, because there's income tax, national insurance (supposedly to pay for pensions), VAT, council tax, petrol tax, tobacco tax, alcohol taxes, the list goes on and on. All I know is, I seem to have enough left to do what I want!

I think, overall, British citizens do pay more tax than US citizens. But whatever we are getting for that money (better pensions or Trident missile systems, who knows), it's not healthcare. Because, as I said, you're already as things stand paying out more in tax for state-provided healthcare than we are.

Bear in mind also that we are completely free to buy additional insurance over and above that, if we're suddenly terrified by the thought that the NHS might deny us something (or more likely if we want a single room in hospital and no chance of mixing with the Great Unwashed while we have our sinuses done). It's just that most people don't, because simple observation shows that the NHS comes up with the goods when required.

If the NHS was falling short, no doubt there would be a growth in the private insurance business. The option is there, if it was needed. But there's no real sign of that happening. Private healthcare is more a snob thing than anything else.

Rolfe.

 

[Rolfe]

Interestingly, that same spreadsheet ranks the US #1 in "Health Expenditure per capita in International Dollars." Switzerland is #2 and France is #3. So according to that report, we spend less per capita in international terms of reference than any other country . . . interesting, huh?

No, do you have a reading comprehension problem? Have you sleepwalked your way through this entire thread?

The USA is at the top of that list because it spends far more per capita on healthcare than any other country.

For, if anything, slightly worse outcomes.

That you could possibly misinterpret that so crassly makes me wonder whether it's worth my time to go on debating with you.

Rolfe.

 

[kellyb]

Come visit me in South Texas and I'll show you plenty of people who have made Medicaid and Food Stamps (or whatever they are called nowadays) a lifestyle.

Oh, it's Medicaid and foodstamps you want people off of. When you said "welfare" I thought you meant, you know, welfare.

 

[Tatyana]

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.

No, it is not.

Again, evidence based medicine, which it seems is lacking in a significant percentage of your posts.

The US is also modifying the screening procedure to be more in line with evidence based medicine.

The increased screening in the US is because payment is procedure driven, and a mammogram is another procedure.

I assert it is a similar situation with cervical screening in the US.

The texture of breast tissue in women under the age of 40 means that it is difficult to detect tumours.


A few things have been recommended based on evidence based medicine

- screening in women under 50, possibly even 60 is not recommended as the consistency of the breast tissue makes it nearly impossible to detect any tumours.

- there is harm associated with screening which is rarely mentioned in information pamphlets, which more often than not is the unnecessary treatment of harmless lesions that would not have been identified without screening.

Breast screening has not been nearly as successful as cervical screening

- if 2000 women are screened regularly for 10 years, one will benefit from the screening as she will avoid dying from breast cancer

- at the same time, 10 healthy women will, as a consequence, become cancer patients and will be treated unnecessarily. These women will have either a part of their breast or the whole breast removed, and they will often receive radiotherapy and sometimes chemotherapy

- screening has resulted in 30% more surgery, 20% more mastectomies and more use of radiotherapy

- furthermore, about 200 healthy women will experience a false alarm. The psychological strain until one knows whether it was cancer, and even afterwards, can be severe.

This is the summary of findings from 6 countries that have publicly funded screening programs (England, Denmark, Iceland, Sweden, Finland and Norway).

This is from the Feb 21st issue of the British Medical Journal (BMJ vol 338 page 446)

http://www.bmj.com/content/339/bmj.b2587.full?sid=73ba10c3-b333-49f9-a310-4f219dc027c1
BMJ 2009; 339:b2587 doi: 10.1136/bmj.b2587 (Published 9 July 2009)

* Research

Overdiagnosis in publicly organised mammography screening programmes: systematic review of incidence trends

 

[xjx388]

Please elaborate and show your evidence.

¡Ai-yi-yi! . . .
In the UK (Your own source by the way)

The NHS Breast Screening Programme provides free breast screening every three years for all women in the UK aged 50 and over. Around one-and-a-half million women are screened in the UK each year. The NHS Breast Screening Programme is phasing in an extension of the age range of women eligible for breast screening to those aged 47 to 73 starting in 2010. This will be completed in 2012.

Because the programme is a rolling one which invites women from GP practices in turn, not every woman will receive an invitation as soon as she is 50. But she will receive her first invitation before her 53rd birthday.

In the US

The American Cancer Society recommends these screening guidelines for most adults.

Breast cancer

• Yearly mammograms are recommended starting at age 40 and continuing for as long as a woman is in good health
• Clinical breast exam (CBE) about every 3 years for women in their 20s and 30s and every year for women 40 and over
  
• Women should know how their breasts normally look and feel and report any breast change promptly to their health care provider. Breast self-exam (BSE) is an option for women starting in their 20s.

The American Cancer Society recommends that some women -- because of their family history, a genetic tendency, or certain other factors -- be screened with MRI in addition to mammograms. (The number of women who fall into this category is small: less than 2% of all the women in the US.) Talk with your doctor about your history and whether you should have additional tests at an earlier age.

So not only yearly mammograms in the US but MRIs for some rare women. Don't see this advised in the UK . . . I wonder . . . could it be . . .

COST-SAVINGS?

 

[Rolfe]

Okay so humor me here. What is the incentive for the NHS to provide the best care possible? US insurance companies' incentive is to keep the group plan (I realize I am talking group insurance here.) The insurance companies want to keep the consumers happy so the group renews with them.

As far as I can see, the interests of the US health insurance companies are in weaselling out of paying whenever possible. I've read all the reports about rescission, and watched a few documentaries, and it's pretty scary to someone used to knowing that you can't be dumped by the NHS no matter what.

The incentives in the NHS are politically driven and centrally imposed. There are committees of senior doctors debating what is best practice. Their findings are then disseminated as guidelines. Doctors have to do a lot of continuing education and re-validation of their registration to stay in their jobs. Practices are rewarded for meeting certain targets, such as how easy it is to get an appointment, how many children are immunised, how many women get cervical smears and so on. (I've twice had questionnaires sent to me, asking me about my experience with my medical practice, this is part of keeping them up to scratch.)

Overall, rewards are for practising good medicine, not for performing as many procedures as possible. Politicians like to compete for votes at elections by promising to make the NHS even better, and after they're elected they sometimes even deliver on some if it.

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?

There are different systems, and papers and documentaries can be found on the internet comparing and contrasting. Some countries use insurance companies to collect and administer the payments, mandating basic cover and allowing companies to compete on what extras they offer. The basic coverage is mandatory and subsidised if necessary.

In Britain, which is one of the most centralised systems, you pay your taxes and the government pays the doctors and the hospitals. As I said, we get all this for slightly less in tax as you pay for the US government-provided healthcare you can't access.

Right now you pay your insurance company, and if you don't need any healthcare that year, what you paid goes to pay for the healthcare of others. If you need a lot of healthcare, then this is paid for by drawing on the contributions of others who happened not to need it that year. This is what pooling of risk is all about.

In Britain, we pay our taxes, and the taxes pay for the NHS, and we can access the NHS whenever we need it. It's not so different, it's just that the pool of risk is the entire population, so it's a lot more efficient. Where is does differ is that you can't be dumped or denied coverage and it continues seamlessly even if you change jobs or become self-employed or leave the job market entirely for whatever reason.

It's particularly advantageous in that you contribute most when you're able to - when you're well and have a good income. Then when you're ill and maybe have no income, the benefits are still there for you - they don't disappear if you stop contributing.

Rolfe.

 

[xjx388]

No, do you have a reading comprehension problem? Have you sleepwalked your way through this entire thread?

The USA is at the top of that list because it spends far more per capita on healthcare than any other country.

For, if anything, slightly worse outcomes.

That you could possibly misinterpret that so crassly makes me wonder whether it's worth my time to go on debating with you.

Rolfe.

I guess it wasn't that interesting then, huh?

 

[Rolfe]

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.

How do you figure? This sounds like completely made up numbers since there's no possible way for you to know this.

She's not making that up. It's perfectly true. For roughly what US citizens pay to fund Medicare and Medicaid and whatever other state-provided healthcare there is (actually a little less at the last count), Britain funds the entire NHS.

Obviously it's not that simple, because you're starting from a very bad place, but in theory it is obviously perfectly possible to cover the entire population for what the USA collects in taxes just to fund Medicare and Medicaid (and is it the Veterans healthcare too?). This is exactly what happens in Britain.

Assimilate this and weep.

Rolfe.

 

[Uncayimmy]

Both our families pitched in for the medical care. What a concept . . . families who love each other taking care of their own! Bah! Better to just let the nanny-state do it, right?

Why on Earth would they have done that? You guys screwed up, so you should pay the consequences. Personal responsibility and all that. Pip pip.

Ah, moral judgement! Why am I not surprised by this? We were two kids in love who fooled around. Happens everyday. We could have gratified our immediate needs and driven down the dead-end road that lead to. Instead, our family helped lift us out of that. If not for them, there's no way she could have accepted her scholarship.

You mean the scholarship where people were faced with incarceration to pay for?

That's pretty warped to think of a loving family as a crutch. As for those who don't, I have no problem giving them a helping hand with my tax dollars. I have a problem with those who make it a lifestyle. It should be used as a stepping stone to better things. That's why we need to cut Welfare significantly not increase it.

Same with education welfare. I mean, why were my tax dollars used to give your wife a free ride to college? Hell, why did my tax dollars pay for over half the cost of her education? And every year my tax dollars pay for the research that your wife reads and resells to people (and she makes damned good money doing it). Remember how you said your wife (or was it her posting? I forget.) calls gastric LAP banding a joke? The only way she "knows" that is because of my tax dollars that went into the research. Those tests she does on every patient with a sore throat? My tax dollars went into those tests. The antibiotics she prescribes? My tax dollars tell her which ones to prescribe and under what conditions.

She's milking the system and making more money than 95% of the population simply be reselling the information my tax dollars pay for. When it comes to ordinary things like a sore throat, I could do what she does just as well as she does, but I'm not allowed. No free market there. I gotta pay doctors to tell me what I already know. Talk about protectionism.

Forever? For an able bodied/minded person?

Well, I would be okay with obese and alcoholic people getting a full ride. After all, as you say, they have diseases and cannot control their behavior.

/sarcasm

 

[Delscottio]

¡Ai-yi-yi! . . .
In the UK (Your own source by the way)



In the US



So not only yearly mammograms in the US but MRIs for some rare women. Don't see this advised in the UK . . . I wonder . . . could it be . . .

COST-SAVINGS?

Nope the same is offered, on my phone at moment so can't link.

 

[Rolfe]

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.

Well, that's a political problem. You might like to look at how the transition was implemented in other countries. In Britain there was a bit of a rush when the NHS was first introduced, but it was foreseen and coped with. Doctors didn't bugger off, because it was made well worth their while not to. To quote Bevan, who masterminded it, "I stopped their mouths with gold."

Come on, everybody else in the developed world and quite a few not so developed have managed it successfully. Can "can-do" America really not figure out a way?

Rolfe.

 

[Tatyana]

¡Ai-yi-yi! . . .
In the UK (Your own source by the way)



In the US



So not only yearly mammograms in the US but MRIs for some rare women. Don't see this advised in the UK . . . I wonder . . . could it be . . .

COST-SAVINGS?

Are you reading any of the posts?

We use evidence and science for medicine.

http://www.nhs.uk/conditions/cancer-of-the-breast-female/pages/news.aspx?listid=11&currentpage=2&newsid={fc57dfbd-a52b-4d9b-92f9-6ff4ed253fa5}
Many U.S. women do not get recommended mammograms

Thursday, 9 December 2010

By Julie Steenhuysen

CHICAGO (Reuters) - Half of U.S. women 40 and older do not get annual mammograms to screen for breast cancer, and nearly 40 percent of women 50 and older do not get the recommended biannual screenings, even though they have insurance.


The federal advisory panel's controversial guidelines, released late last year, recommend against routine mammograms for women in their 40s and say women in their 50s should get mammograms every other year instead of annually.

http://www.nhs.uk/Conditions/Cancer-of-the-breast-female/Pages/Screeningbreastcancer(female).aspx
Screening for women at high risk of breast cancer

You may be eligible for breast cancer screening before the age of 50 if breast cancer runs in your family. Your risk of developing breast cancer is considered to be higher than average if:

* Two or more close relatives (at least one of whom is your mother or sister) on the same side of your family have or have had breast cancer.
* Three of your close relatives were diagnosed with breast cancer at any age.
* One close relative has breast cancer and one has ovarian cancer (one of them being your mother, sister or daughter).
* Your mother or sister were diagnosed with breast cancer before the age of 40.
* Your father or brother were diagnosed with breast cancer at any age.
* Your mother or sister were diagnosed with breast cancer in both breasts and were diagnosed for the first time under the age of 50.

If any of the above applies to you, see your GP, who can refer you to a breast clinic for assessment based on your family history. If you have a high risk of developing breast cancer and you are over 40, you should be offered screening with a mammogram once a year. If you are under 40, you are entitled to screening using MRI scans instead of mammograms because your breasts may be too dense to produce a clear mammogram.

http://www.nhs.uk/conditions/cancer-of-the-breast-female/pages/news.aspx?listid=12&currentpage=7&newsid={c805422f-4148-4df2-ae57-c9a1fbe6d42b}
Norwegian research questions benefit of mammograms

Thursday, 23 September 2010

By Gene Emery

BOSTON (Reuters) - Routine breast screening with mammograms is less effective at preventing cancer deaths than expected, Norwegian researchers said on Wednesday in a study that reignites a fierce debate over the value of screening.

They said inviting women aged 50 to 69 to have routine mammograms and offering them better care from a team of experts helped cut the breast cancer death rate by 10 percent.

 

[kellyb]

¡Ai-yi-yi! . . .
In the UK (Your own source by the way)



In the US



So not only yearly mammograms in the US but MRIs for some rare women. Don't see this advised in the UK . . . I wonder . . . could it be . . .

COST-SAVINGS?

Or maybe they just want to reduce the health hazards that come from false positives.

 

[Rolfe]

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.

Quoted for truth.

There is no limit on the care anyone can receive on the NHS so long as that care is evidence-based and has a reasonable probability of being effective.

And we do all this for half of what the USA spends on healthcare, in fact for about the same amount (per person) as the USA spends on government-provided healthcare to cover only a fraction of the population.

Rolfe.

 

[Rolfe]

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.

Absolutely not. The NHS crafts its guidelines for maximum cost-effectiveness. Overdosing women with ionising radiation is not cost-effective.

Does the USA screen every woman in the population every year?

Get back to us when you also have universal access to your screening system, and we can talk about outcome comparisons.

Rolfe.