Health care - administrative incompetence

[Emet]

Health Care: The Good, The Bad and The Political
Tuesday, December 28, 2010 at 3:36 pm

First, The Good
The Los Angeles Times finds evidence that some small businesses previously offering no health insurance to their workers are reversing course, in part, due to new tax breaks in the Affordable Care Act. When a September report from the Kaiser Family Foundation showed a sharp uptick in coverage offered by small businesses, I was skeptical it was due to the new law. But the L.A. Times has done good legwork - calling individual insurers and brokers to gather anecdotal and data-driven proof that the new law is having this positive effect.
(...)
Next, The Bad
The new insurance program intended to cover the most vulnerable Americans is not working very well. Under the Affordable Care Act, people with pre-existing conditions were supposed to immediately get new welcome coverage in “high-risk pools” run by states or the federal government. (These people are routinely turned away by private insurance companies or sold policies that exclude coverage for their pre-existing health problems.) Problems with the high-risk pools are making rollout pretty rough. Most people who would be eligible for these plans don't know about them or are turned off by cost.
(...)
And Finally, The Political
The New York Times reported over the weekend that the Obama Administration is flexing its regulation-writing muscles to pay Medicare doctors for chatting with patients about end of life care. A provision doing about the same thing was included in an early version of Democratic health care reform, but was abandoned once Republicans began (dishonestly) saying it would lead to “death panels,” with government bureaucrats deciding which seniors would get care and which ones would be left to die. As Robert Pear makes clear in his article on the provision, included in new Medicare rules set to take effect in January, Democrats were hoping to pass the regulation under the radar, knowing it could be political kryptonite.

http://swampland.blogs.time.com/2010/12/28/health-care-the-good-the-bad-and-the-political/

 

[kellyb]

Of all the anecdotes on this thread, yours is the only one that I don't believe.

GB

I believe it. Some people are like that. My own (republican) brother and father are like that. Of course, they both have had genuine issues with finding (what they consider "acceptable") employment. But neither are willing to just go to LaborReady every morning for work. They are searching for cushier jobs, considering themselves white and "articulate" and all.

 

[Gandalfs Beard]

Approximately 10% of the work force is unemployed. If your story was the norm, that rate would be much, much higher. The lowest common denominator is the most visible (and often the most annoying.) That doesn't mean that it represents the whole.

Actually the real unemployment rate IS much higher, and it has nothing to do with "personal responsibility." It is due to the Economic Collapse.

The Government now has at least 2 methods of tracking unemployment. The U6 measure puts the rate at about 16.6%, and California unemployment rates at 20%. And this was back in June, before unemployment figures rose a couple more %.

http://articles.moneycentral.msn.com/learn-how-to-invest/The-real-unemployment-rate.aspx

Some other unemployment trackers put the figures at 17.5% and 22%. These are near Great Depression levels of unemployment (25%). It just so happens that the high housing foreclosure levels are causing home values to drop at rates not seen since the Great Depression.

http://aomid.com/foreclosures-cause-home-values-to-decline-25-since-2006/224333/

Again, "personal responsibility" has nothing to do with kinds of market manipulation that caused the latest financial crisis, unless you're talking about the personal responsibility of Derivative Speculators.

So, we have something approaching a second Great Depression caused by Financial Manipulators, and instead of taxing the hell out of these people and putting the money towards public services like a National Health Care service, the US Government gives Wall St Billions of dollars.

Then, the same people that caused the Crash turn around and say, "See, we can't fund health care, we have to cut public services, give trillions of dollars in tax breaks to the Rich and pay down the National Debt on the back of the Middle and Lower Classes."

So to the posters talking about "personal responsibility" and giving us bogus anecdotes about people quitting fairly decent paying jobs for unemployment compensation, I say give me a break.

GB

 

[kellyb]

So, we have something approaching a second Great Depression caused by Financial Manipulators, and instead of taxing the hell out of these people and putting the money towards public services like a National Health Care service, the US Government gives Wall St Billions of dollars.

Then, the same people that caused the Crash turn around and say, "See, we can't fund health care, we have to cut public services, give trillions of dollars in tax breaks to the Rich and pay down the National Debt on the back of the Middle and Lower Classes."

So to the posters talking about "personal responsibility" and giving us bogus anecdotes about people quitting fairly decent paying jobs for unemployment compensation, I say give me a break.

GB

I am totally, totally with you there. I would call this the international scam of the century, except this is the biggest international scam in the recorded history of the world, as far as I know.

That said, those of us who know and love actual freeloaders aren't being untruthful. This is a real phenomenon. In the US, they freeload off of we family members, not the taxpayers at large, tho, usually.

 

[Gandalfs Beard]

I believe it. Some people are like that. My own (republican) brother and father are like that. Of course, they both have had genuine issues with finding (what they consider "acceptable") employment. But neither are willing to just go to LaborReady every morning for work. They are searching for cushier jobs, considering themselves white and "articulate" and all.

After being forced to close my business I tried to return to food service making pizzas which I used to do as a manager. I was willing to start at the bottom and work my way up again. Nobody wanted to hire me. They wanted pimply faced teenagers who they figured they could push around more easily. Or I was "overqualified" I was sometimes told.

I even signed on with a number of temp agencies, but still all the jobs went to younger folk. I think a big part of the problem is that employers don't want to hire experienced people who might actually expect to be treated or paid fairly.

I had a great lead in retail that almost went through. Then the Retail Chain I almost got a job at went out of business.

Nearly got a job in food service for a local school district. I scored highest on the test given prospective employees. Still lost out to someone else.

I am a Democrat of course, but I honestly can't fault your father and brother for holding out for jobs that will pay at least close to what they were previously earning. But in this job market they could be waiting a long time. I do agree they should take whatever they can get in the meantime, but most businesses seem to want the cheapest labour they can get, and that means they won't hire people who might actually complain about being forced to work overtime at regular rates, or complain about not getting enough hours to qualify for benefits.

Your father and brother are the kind of unemployed people that the government doesn't track with their standard tracking figures. They would likely fall under the U6 measure of tracking unemployment rates.

This is why the US needs a Single Payer Health Care system like the NHS. So that people being screwed can at least get treated.

GB

 

[kellyb]

After being forced to close my business I tried to return to food service making pizzas which I used to do as a manager. I was willing to start at the bottom and work my way up again. Nobody wanted to hire me. They wanted pimply faced teenagers who they figured they could push around more easily. Or I was "overqualified" I was sometimes told.

I even signed on with a number of temp agencies, but still all the jobs went to younger folk. I think a big part of the problem is that employers don't want to hire experienced people who might actually expect to be treated or paid fairly.

I had a great lead in retail that almost went through. Then the Retail Chain I almost got a job at went out of business.

Nearly got a job in food service for a local school district. I scored highest on the test given prospective employees. Still lost out to someone else.

I am a Democrat of course, but I honestly can't fault your father and brother for holding out for jobs that will pay at least close to what they were previously earning. But in this job market they could be waiting a long time. I do agree they should take whatever they can get in the meantime, but most businesses seem to want the cheapest labour they can get, and that means they won't hire people who might actually complain about being forced to work overtime at regular rates, or complain about not getting enough hours to qualify for benefits.

Your father and brother are the kind of unemployed people that the government doesn't track with their standard tracking figures. They would likely fall under the U6 measure of tracking unemployment rates.

This is why the US needs a Single Payer Health Care system like the NHS. So that people being screwed can at least get treated.

GB

I'm the biggest advocate you'll ever find of the US adopting a "triple payer" (because the UK is not "single payer", now, it's "triple payer") system.

I believe your story about being unable to find employment, and am genuinely sorry. Over here, LaborReady is rocking. Is it not where you live?

 

[Gandalfs Beard]

I'm the biggest advocate you'll ever find of the US adopting a "triple payer" (because the UK is not "single payer", now, it's "triple payer") system.

I believe your story about being unable to find employment, and am genuinely sorry. Over here, LaborReady is rocking. Is it not where you live?

Is LaborReady a temp agency? I don't think that particular one is in my area. I am scraping by, renting rooms out in my house, taking odd-jobs like house-painting, dog-walking, finding stuff to sell on E-bay in the meantime.

Just googled "triple payer health care UK" (first time I've ever heard of it, and I've been following BBC reports on Tory attempts to demolish the NHS). The first hit was your post.

Scrolling down the first page I ran into a few articles about "triple aims" proposed for American cities and proposals for EU member countries, so I don't think "triple aims" means "triple payer". As far as I know, the UK NHS is still Single Payer...at least until the Tories dismantle it.

As I have previously stated to UK posters on this thread, Stop the Tories now before it's too late. Hit the Streets like the Students protesting the tripling of College tuition fees. If enough people make a fuss, enough Lib Dem MPs and some Conservative MPs might revolt causing a vote of No Confidence and new elections.

Believe me, you don't want to end up like the US. I've been following the plans of the current government in the UK, and they are clearly steps towards Privatization.



GB

 

[Rolfe]

What Kellyb means is that in Britain there are three basic ways of paying for healthcare. First is the NHS, which is most of it, but some people also have private insurance while others who do not have private insurance nevertheless choose to pay the private sector to carry out their procedure, out of their own pocket.

The reason the second and third methods are so much of a minority is that the NHS coverage is pretty comprehensive. However, if NHS cover was less comprehensive, then more people would go to private insurance or self-pay. That's one possibility the USA might explore. Having universal coverage for a lot of stuff but still excluding some big-ticket items for which people would be free to take out insurance for, or pay out of pocket.

Rolfe.

 

[Rolfe]

When the Tories were putting forward their election proposals, we were being reassured that the NHS was safe in their hands. One reason, which seemed plausible, was that David Cameron had a severely handicapped son, who died quite recently. I once remarked that it was possible the Grand Purpose of poor Ivan Cameron's life was to keep his Dad honest with regard to the NHS. Because of Ivan, David Cameron was intimately acquainted with the very best aspects of NHS care.

It doesn't seem to be working. Once a filthy-rich right-wing free-marketer, always a filthy-rich right-wing free-marketer, it seems.

I'm extremely glad I live in Scotland, where the NHS is a devolved issue and actually pretty much a separate set-up. I rely on Holyrood to save us from that ideology, and hopefully to achieve independence before we're totally screwed.

Rolfe.

 

[Gandalfs Beard]

What Kellyb means is that in Britain there are three basic ways of paying for healthcare. First is the NHS, which is most of it, but some people also have private insurance while others who do not have private insurance nevertheless choose to pay the private sector to carry out their procedure, out of their own pocket.

The reason the second and third methods are so much of a minority is that the NHS coverage is pretty comprehensive. However, if NHS cover was less comprehensive, then more people would go to private insurance or self-pay. That's one possibility the USA might explore. Having universal coverage for a lot of stuff but still excluding some big-ticket items for which people whould be free to take out insurance for, or pay out of pocket.

Rolfe.

Oh! Well I knew THAT!

I thought Kellyb was suggesting that the NHS was "triple payer" which didn't make sense to me. Anyway, thanks for setting me straight.

Any NHS system ought to cover ALL necessary treatments, big or small ticket. It doesn't make economic sense to leave expensive treatments in the hands of Private Insurers.

I could see making people pay out of pocket or use Private Insurers for unnecessary Cosmetic Surgery (i.e. non-corrective cosmetic procedures), or if they wanted experimental treatment options that weren't generally available, but that's about it.

Any other system would inevitably lead to a tiered system in which only the wealthy could afford life-saving treatments.

The last time I was back in the UK (1999), was when my Mum looked after my grandmother during her last year before she died. I went for a month to help set up care, and then went back again for a month to settle the estate.

My mother had just recuperated from breast cancer surgery with some lymph nodes removed. She stayed for the whole year. While back in the UK she was able to receive far better treatment for her subsequent lymphoedema than she had been getting in the US.

And because my mother looked after my Grandmother in her home, home carers (sort of house call nurses) were available to help several times a day. Which was far less expensive than if my Grandmother would have had to spend her last year in a Care Facility (which is what my Mum's sister had wanted to do).

The home care wouldn't have been an option back here in the US.

Another benefit in the UK (and Canada the last time I checked), is that some painkillers which are controlled substances in the US are available "behind the counter" from pharmacists without a prescription--but that's another topic.

GB

 

[Gandalfs Beard]

When the Tories were putting forward their election proposals, we were being reassured that the NHS was safe in their hands. One reason, which seemed plausible, was that David Cameron had a severely handicapped son, who died quite recently. I once remarked that it was possible the Grand Purpose of poor Ivan Cameron's life was to keep his Dad honest with regard to the NHS. Because of Ivan, David Cameron was intimately acquainted with the very best aspects of NHS care.

It doesn't seem to be working. Once a filthy-rich right-wing free-marketer, always a filthy-rich right-wing free-marketer, it seems.

I'm extremely glad I live in Scotland, where the NHS is a devolved issue and actually pretty much a separate set-up. I rely on Holyrood to save us from that ideology, and hopefully to achieve independence before we're totally screwed.

Rolfe.

That's exactly what some of my Scottish mates in a Tolkien forum related to me. Still, as long is the UK remains one country, if the English NHS falls, the Corporate Pseudo-"Free Marketeers" will be after all the other regions of the UK.

GB

 

[Rolfe]

How does it work in your line of work? Cash or no healthcare for the pet, right? That is the way it used to be in the U.S. No insurance companies, no government healthcare. You traded a jar of jelly (or a chicken or whatever) for whatever treatment you needed. That is what it needs to return to (even though that would put me out of business )

Oh for goodness sake. What planet are you on?

During the war, it was observed that there wasn't enough penicillin in the world to treat both Churchill and Roosevelt if they'd both needed it at once. But since then it's been a mad rush. Antibiotics, beta blockers, ACE inhibitors, cytotoxic drugs, statins, the list is endless. Bigger and better diagnostic instruments - x-rays, then CAT scans, then MRI scanners and sophisticated ultrasonography and PET scanners.... Basic biochemistry, then immunoassays and chemiluminescence and mass spectroscopy and PCRs.... Chloroform then halothane and thiopentone and propofol. Scalpels and forceps then electrocautery and laser surgery and keyhole surgery.... Peg legs and hooks then bionic arms....

And I'm sorry but it all costs money. And nobody is ever going to be able to be certain of getting all they need for the price of a couple of Big Macs. And you can be as economical as you can, and buy the most cost-effective options and avoid all but the most necessary and effective procedures, and it's still going to cost enormous wodges of cash.

It's no longer reasonable to regard this level of service to be something that individuals can reasonably be expected to pay for off their own resources.

I just don't have the words to discuss with anyone who thinks you can pay for this sort of service with "a jar of jelly or a chicken or whatever".

In my line of work, people pay three ways. Straight cash is quite common (credit card maybe commoner to give them time to assimmilate the unexpected expense). Because it really is a lot cheaper to give the same level of care to a small animal as to a human being. However, pet owners are more and more taking out health insurance policies for their pets. These have upsides and downsides, but there's no doubt the existence of such a policy has made it possible to do more for many animals than their owners could have afforded as a lump sum. However, they are also causing some vets to over-investigate and over-treat, because the insurers simply don't look at the itemised bill and ask whether all that was really necessary.

Funnily enough, pet health insurance is less common in the USA than it is in Britain, apparently because the vets know all about the problems with human health insurance in that country, assume they'd be stuck with the same issues, and run screaming.

The third way to pay for your pet's healthcare is by charity funding. If you're genuinely poor, you can access something like the PDSA, if there is a branch in your area. They are funded by charity shops and collection tins and legacies.

It more or less works, because there's always the euthanasia option. This eliminates a pretty large chunk of expenditure, because it's the accepted end-of-life solution for when you know the animal's quality of life is poor and recovery isn't on the cards. Even if you can afford it, you don't, because it's not kind. It also eliminates most significant disability, and in particular congenital disability.

And it's the answer if the owner can't pay for the Noel Fitzpatrick option (though to be fair, Noel can be a soft touch when he feels like it). Vets are quite used to making owners feel that they're doing the right thing in having a pet put down, when they know the cost of treatment would be well beyond what the family can afford.

If you had this option in human healthcare, a lot of your problems would be solved.

Rolfe.

 

[Rolfe]

That's the only free market proposal that might work. In some ways it makes sense. Get rid of the massive army of middlemen and you may get rid of enough of the non-medical costs to make medical care affordable.

Problem is the middlemen represent a billion dollar industry that isn't particularly interested in going away.

I'm sorry but even if you get rid of the middle-men, the actual cost price of a lot of medical treatment is going to be way way over "a jar of jelly or maybe a chicken". How many people would be prepared to go into medical school and come out with tens of thousands of dollars of student debt, knowing that they have to live, start a family and pay off that debt, on an income of jars of jelly and chickens?

Who is going to put investment into high-tech medical technology, if the return on the investment is going to come as intermittent donations of perishable comestibles? Get real.

Rolfe.

 

[Rolfe]

I would really like to hear Rolfe's perspective on this. In a really, really, really free market, she'd be able to treat humans, too.

Do the sort of high tech treatments like Ducky got even exist in vet medicine? If not, is that because not enough people value their pets that highly, or because with 90% of the population being unable to afford it even in theory, it's not worth developing the technology?

To be honest, although it would be theoretically possible to do to a pet what was done for Ducky, I doubt if anyone would. Animals don't understand why they are suffering, and can't look to tomorrow as being brighter if only they can get through this. The sheer level of suffering Ducky has voluntarily gone through is not something that would be regarded as in an animal's best interests. Even if the owner was rich and prepared to pay, I think a vet would say, no.

I've mentioned Noel Fitzpatrick in this context. He is probably the most cutting-edge vet working in this area. He wants to give animals the benefit of modern medical technology just as humans get it, but he has quite a lot of sharp things to say to people who want to put pets through appalling suffering for their own gratification.

The two situations simply aren't comparable. You can talk to a human patient and explain what you are doing, and explain why this suffering is necessary. You can also ask for and get co-operation as regards lying still and doing what nurse says. The patient is informed, and can rationally understand what is going on and why. You can't do that with a pet. When I say I wouldn't do to a dog what was done to Ducky, that isn't a criticism of what was done to Ducky, far from it, but a recognition that Ducky isn't a dog.

Rolfe.

 

[Gandalfs Beard]

I'm sorry but even if you get rid of the middle-men, the actual cost price of a lot of medical treatment is going to be way way over "a jar of jelly or maybe a chicken". How many people would be prepared to go into medical school and come out with tens of thousands of dollars of student debt, knowing that they have to live, start a family and pay off that debt, on an income of jars of jelly and chickens?

Who is going to put investment into high-tech medical technology, if the return on the investment is going to come as intermittent donations of perishable comestibles? Get real.

Rolfe.

Really, it's utter insanity, and deserving of no response but mockery.

I think the GOP national leaders were having kittens over which Tea Party Nutcase was going to win the Republican senatorial Primary in Nevada. Their choice was between the Crazy Chicken Lady, and the Crazy "Bullets if Ballots don't work" Lady.

GB

 

[Ducky]

When I say I wouldn't do to a dog what was done to Ducky, that isn't a criticism of what was done to Ducky, far from it, but a recognition that Ducky isn't a dog.

Rolfe.

That depends on which ex-girlfriend you talk to.

 

[jimbob]

How does it work in your line of work? Cash or no healthcare for the pet, right? That is the way it used to be in the U.S. No insurance companies, no government healthcare. You traded a jar of jelly (or a chicken or whatever) for whatever treatment you needed. That is what it needs to return to (even though that would put me out of business )

Oh for goodness sake. What planet are you on?

During the war, it was observed that there wasn't enough penicillin in the world to treat both Churchill and Roosevelt if they'd both needed it at once. But since then it's been a mad rush. Antibiotics, beta blockers, ACE inhibitors, cytotoxic drugs, statins, the list is endless. Bigger and better diagnostic instruments - x-rays, then CAT scans, then MRI scanners and sophisticated ultrasonography and PET scanners.... Basic biochemistry, then immunoassays and chemiluminescence and mass spectroscopy and PCRs.... Chloroform then halothane and thiopentone and propofol. Scalpels and forceps then electrocautery and laser surgery and keyhole surgery.... Peg legs and hooks then bionic arms....

And I'm sorry but it all costs money. And nobody is ever going to be able to be certain of getting all they need for the price of a couple of Big Macs. And you can be as economical as you can, and buy the most cost-effective options and avoid all but the most necessary and effective procedures, and it's still going to cost enormous wodges of cash.

It's no longer reasonable to regard this level of service to be something that individuals can reasonably be expected to pay for off their own resources.

I just don't have the words to discuss with anyone who thinks you can pay for this sort of service with "a jar of jelly or a chicken or whatever".

In my line of work, people pay three ways. Straight cash is quite common (credit card maybe commoner to give them time to assimmilate the unexpected expense). Because it really is a lot cheaper to give the same level of care to a small animal as to a human being. However, pet owners are more and more taking out health insurance policies for their pets. These have upsides and downsides, but there's no doubt the existence of such a policy has made it possible to do more for many animals than their owners could have afforded as a lump sum. However, they are also causing some vets to over-investigate and over-treat, because the insurers simply don't look at the itemised bill and ask whether all that was really necessary.

Funnily enough, pet health insurance is less common in the USA than it is in Britain, apparently because the vets know all about the problems with human health insurance in that country, assume they'd be stuck with the same issues, and run screaming.

The third way to pay for your pet's healthcare is by charity funding. If you're genuinely poor, you can access something like the PDSA, if there is a branch in your area. They are funded by charity shops and collection tins and legacies.

It more or less works, because there's always the euthanasia option. This eliminates a pretty large chunk of expenditure, because it's the accepted end-of-life solution for when you know the animal's quality of life is poor and recovery isn't on the cards. Even if you can afford it, you don't, because it's not kind. It also eliminates most significant disability, and in particular congenital disability.

And it's the answer if the owner can't pay for the Noel Fitzpatrick option (though to be fair, Noel can be a soft touch when he feels like it). Vets are quite used to making owners feel that they're doing the right thing in having a pet put down, when they know the cost of treatment would be well beyond what the family can afford.

If you had this option in human healthcare, a lot of your problems would be solved.

Rolfe.

Yes, I'd like some assessment as to where my cost estimates are wrong. I have tried looking on google and found cost estimates for building a theatre in a pet hospital (The PDSA, which I suspect is very cheap -£275,000)

some details of running costs of hospitals in South Africa (hardly state of the art), and an article about fire damage to a Scottish hospital hospital, where the damage to the nurses changing area was put at £1-million.

Again, this indicates that my estimates were very conservative:

2. JimBob has attempted to question you on the maths of the issue several times, see (for example) post 207. You've yet to provide a meaningful and comprehensive response.

His numbers are 1. Made up and 2. Based on delivery in the current system.

My estimates for the fundamental costs are conservative estimates. I also did ask where my assumptions or calculations were incorrect, because I have freely admitted to not being an expert in this industry. However, I am an engineer in another capital-intensive industry, and have to factor in the expected return on capital, effects on capacity, and depreciation/amortisation of equipment when comparing technologies.

This is how the free market works in such industries, which I contend is similar in those respects to healthcare. If investors think that they could get a better return in capital by sticking their money in the bank, or buying government bonds, then the required capital for any medical equipment won't get invested.


Please could you give me better numbers then.

In answer to point #2 that the numbers are based on the current system. How will this affect any of these numbers? Especially if you seem to be arguing for an increase in medical salaries elsewhere in this thread.

My questions are highlighted in this

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

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

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

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

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

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

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

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

Walmart has done pretty well suppling to the poor.

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

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

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

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

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

Would 5-hour surgery suddenly require different numbers of staff? Would the salaries suddenly reduce. Note also that I chose the median salaries of inexperienced medical staff, so this is almost certainly a gross under estimate.

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

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

I have no idea how long surgeons can work for, but for intricate, physically demanding work where mistakes are unacceptable, this is also far too long, so this cost multiplier is also far too low

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

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

Now, I couldn't find any information for the capital cost of the theatres but given the cost of medical equipment, and facilities for such a room, I would think this is possibly conservative (I do admit that this is cost that I have least confidence in).

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

You could probably double this for more realistic utilisation rates.



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

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

Unless you are referring to capitalism, for the "current system" that could be changed, these costs are basic costs before any of the overhead to pay for the administration, advertising, and the various profit margins that are needed to actually provide a return on investment.

Where has any poster said anything about limiting the income of medics? In other threads at least (and possibly in this one) it has been pointed out that many NHS consultants also have private practices, in addition to their primary NHS practices, and often use the same NHS facilities for the private practice - which benefits the NHS by paying for the resources.

Earlier on I asked if my calculations for the costs for surgery was incorrect. We could probably see what sort of costs Ducky's treatment entails, and it would be pretty expensive. I doubt he would be a profitable prospect for any insurer anyway.

Do you disagree with my calculations. $1.2 million doesn't seem surprising at all. But I am only an engineer in a capital-intensive industry.

Why should insurers be forced to take on unprofitable customers? Why should people find medical insurance prohibitive simply due to an accident of medical history?

The answer is universal healthcare.

 

[Rolfe]

I was thinking if it was possible to 'fix' the system with some kind of UHC that was not run by the government, would I be okay with that? And I have to say I am definitely more open to that thought than having the government run healthcare. There is so very much waste and abuse of power in our government that frankly, I could never get on board with them running our healthcare system.

I just don't understand this recurrent theme in the healthcare debate. Everybody else has politicians they'd happily roast over a slow fire too, but still the governments manage a reasonable job of delivering public services. We're far more afraid of David Cameron hiving off the NHS to the private sector than anything else.

What is it about the USA, the country which likes to present itself as the place everybody is envious of, that it has politicians too uniquely stupid or too corrupt to manage what everyone else takes for granted?

There is so much lack of personal responsibility in this country that government-run healthcare would just be another type of free ride for so many people. I think many of us who work 60-80 hours a week have about had it with the droves of people who do not produce but rather take, take, take and then want more. I live near a big city and I see first-hand the people I am supporting with my tax dollars. I am an employer and I see first-hand the games people play to get hand-outs in this country. I am wondering if it is UHC/NHC that I am against or the principle of it.

I've heard all this before too. Everybody has freeloaders, and everywhere complains about them. We complain about people with eight kids sitting in a council house on the dole, in much the same terms as you do.

What we do not complain about is these people getting the same level of healthcare as everybody else, just the same way as we don't complain about them being allowed to run their beat-up bangers on the public roads, or being allowed to walk in the public park or borrow a book from the public library or send their kids to the local school. The idea of saying, that person's diabetes or cancer shouldn't be treated because they're a dead-beat, is quite literally shocking.

It's back to the Victorian concept of the deserving and undeserving poor, which I kind of thought we'd managed to move beyond. OK, complain about the undeserving poor as much as you like, as regards subsidised accommodation and food. But as a reason to deny the entire country the benefits of a universal healthcare system, just because some people who are a bit feckless might get their diabetes treated properly, makes cutting off your nose to spite your face look positively rational.

If the government could take the tax dollars it is getting now, stop paying for pork secretly snuck into every bill and implement a healthcare program run by some honest, competent entity then I would rethink my position.

Well, that's how it works here. The NHS isn't the government. The NHS is paid for by the government. It's run by the doctors, although the government does tweak them a bit by hypothecating payments to encourage things it sees as desirable outcomes, such as high uptake of vaccination and screening programmes.

Rolfe.

 

[Rolfe]

But the whole 'lack of responsibility' thing is extremely pertinent when you are talking about taking even more of my hard-earned money to pay for people who, as a result of their bad choices, are needy. I'm not talking about the Ducky's of the world; I'm talking about the high school drop-outs that have 3 children by 3 different fathers before the age of 18. Why should I be forced to support that?

But you are being forced to support that.

People who are that irresponsible are already getting a pretty high level of benefits in the USA. And what's the alternative? One of these three children has a VSD. What are you going to do? Just let the kid die?

I simply can't get my head round the Americans who are so viscerally opposed to anyone they see as undeserving getting any sort of benefit, that they would deny the entire country (which is composed of a hell of a lot more than dead-beats, even I know that) the self-evident, manifest benefits of universal healthcare.

We have undeserving as well, and we don't even think about this. We might bitch about them getting subsidised housing and unemployment benefit, but the idea that they should have their asthma treatment withdrawn or be denied their cardiac bypass surgery would be seen as uncivilised.

But as I said, the real dead-beats in America are already being paid for by the taxpayer. It's people like Ducky and Bookitty's MIL and Roadtoad and so on that you should be thinking about.

Rolfe.

 

[Gandalfs Beard]

Oh for goodness sake. What planet are you on?




I just don't have the words to discuss with anyone who thinks you can pay for this sort of service with "a jar of jelly or a chicken or whatever".

In my line of work, people pay three ways. Straight cash is quite common (credit card maybe commoner to give them time to assimmilate the unexpected expense). Because it really is a lot cheaper to give the same level of care to a small animal as to a human being. However, pet owners are more and more taking out health insurance policies for their pets. These have upsides and downsides, but there's no doubt the existence of such a policy has made it possible to do more for many animals than their owners could have afforded as a lump sum. However, they are also causing some vets to over-investigate and over-treat, because the insurers simply don't look at the itemised bill and ask whether all that was really necessary.

Funnily enough, pet health insurance is less common in the USA than it is in Britain, apparently because the vets know all about the problems with human health insurance in that country, assume they'd be stuck with the same issues, and run screaming.

The third way to pay for your pet's healthcare is by charity funding. If you're genuinely poor, you can access something like the PDSA, if there is a branch in your area. They are funded by charity shops and collection tins and legacies.

It more or less works, because there's always the euthanasia option. This eliminates a pretty large chunk of expenditure, because it's the accepted end-of-life solution for when you know the animal's quality of life is poor and recovery isn't on the cards. Even if you can afford it, you don't, because it's not kind. It also eliminates most significant disability, and in particular congenital disability.

And it's the answer if the owner can't pay for the Noel Fitzpatrick option (though to be fair, Noel can be a soft touch when he feels like it). Vets are quite used to making owners feel that they're doing the right thing in having a pet put down, when they know the cost of treatment would be well beyond what the family can afford.

If you had this option in human healthcare, a lot of your problems would be solved.

Rolfe.

Well pet insurance is starting to catch on here. And I think that could be a good thing for the most part. It really depends on whether the vet doing the treatments can get through to the pet "owners" and point out that extending a dying animal's life is not in the best interests of the pet.

We are fortunate to have some exceptional and compassionate vets in our area, and we often wish that we could get as good treatment for ourselves as our pets receive. Yes, we've gone into hock for our young animals for when the prognosis was for a good outcome, but we've always taken the euthanasia option for our older pets if meant preventing prolonged suffering.

And actually we've become rather good at pet nursing ourselves, if the vet has suggested that our pet could still have a fair quality of life with regular nursing (including administering daily intravenous solutions ourselves), which has saved us considerable costs.

And actually, when it comes to humans, an NHS health care system is the best means of preventing a "let's kill 'em because they can't afford the care" approach (which is basically the option the Right Wing is pushing).

GB