Health care - administrative incompetence

[jimbob]

First of all, show me one post where I used the word "charity."

you didn't use the word charity, I did. However you used the phrase "pro bono". What do you think that "pro bono" is apart from "charity"?

Secondly,

I know where this is coming from, because it describes veterinary practice in the 1970s, when I was in general practice. You can do a lot of ordinary basic care and even simple surgery at prices most people can afford.

Isn't that nice, that xjx388 would like to see US healthcare at the level of 1970s veterinary practice.

I never said any of that. What I said was that there is a free market in Primary Care medicine and it works very well for what it can do, which is actually quite a bit. If this were extended into other specialties, costs would have to come down.

And what about the posters pointing out that there are a lot of costs inherent in expensive high-tech treatments? These are expensive because they require the use of highly trained professionals with expensive equipment and/or expensive new drugs.

Either the physicians themselves are taking a cut in their film-star salaries

I never said this either. I said that any society that thinks healthcare is a right for all people cannot justify expenditures on luxuries until all of the healthcare needs of the people are met. Therefore, how can the British people justify the sums they pay their footballers, pop-stars, movie-stars, etc. while people are denied healthcare they need. I gave examples of people who have been denied in the UK (and if you think they are the only ones who have ever been denied anything, you are very, very naïve). I also said that people should be paid based on the value they provide to society. Teachers, doctors, etc. should be high on that list and footballers, etc. should be lower.

Just two examples of how my arguments have been twisted based on your ideologies and not on what I'm actually saying.

You haven't chosen your examples very well.

We (in the rest of the OECD) do realise that not every treatment can always be afforded. However, the bar is set far higher than in the US unless you are rich.

Are you aware of the percentage of US bankruptcies who cite medical bills as one reason for their bankruptcy?

Tnteresting paper (PDF) PDF here

My highlighting

ABSTRACT
BACKGROUND: Our 2001 study in 5 states found that medical problems contributed to at least 46.2% of all bankruptcies. Since then, health costs and the numbers of un- and underinsured have increased, and bankruptcy laws have tightened.

METHODS: We surveyed a random national sample of 2314 bankruptcy filers in 2007, abstracted their court records, and interviewed 1032 of them. We designated bankruptcies as “medical” based on debtors’ stated reasons for filing, income loss due to illness, and the magnitude of their medical debts.

RESULTS: Using a conservative definition, 62.1% of all bankruptcies in 2007 were medical; 92% of these medical debtors had medical debts over $5000, or 10% of pretax family income. The rest met criteria for medical bankruptcy because they had lost significant income due to illness or mortgaged a home to pay medical bills. Most medical debtors were well educated, owned homes, and had middle-class occupations. Three quarters had health insurance.
Using identical definitions in 2001 and 2007, the share of bankruptcies attributable to medical problems rose by 49.6%. In logistic regression analysis controlling for demographic factors, the odds that a bankruptcy had a medical cause was 2.38-fold higher in 2007 than in 2001.

CONCLUSIONS: Illness and medical bills contribute to a large and increasing share of US bankruptcies.
© 2009 Elsevier Inc. All rights reserved. • The American Journal of Medicine (2009) xx, xxx

.

Following some (pretty unjustified) criticism of this paper in this thread I actually got several answers form one of the authors of this paper, after emailing her. That information is in that thread too.

 

[Ivor the Engineer]

<snip>

I never said this either. I said that any society that thinks healthcare is a right for all people cannot justify expenditures on luxuries until all of the healthcare needs of the people are met.

They are met.

Therefore, how can the British people justify the sums they pay their footballers, pop-stars, movie-stars, etc. while people are denied healthcare they need.

They aren't.

I gave examples of people who have been denied in the UK (and if you think they are the only ones who have ever been denied anything, you are very, very naïve).

You didn't. You quoted an article from the Daily Fail about a pretty useless cancer drug not being available on the NHS. Others have already explained the criteria used to determine what the NHS will provide. BTW, Ben Goldacre's articles in the Gardian and on his Bad Science website are a much more reliable source of information related to healthcare issues in the UK.

I also said that people should be paid based on the value they provide to society. Teachers, doctors, etc. should be high on that list and footballers, etc. should be lower.

<snip>

So now you're against free markets when people you consider to be worth less than you or your wife make more money than either of you do?

The market sets the remuneration for pop-stars and footballers. These people make huge sums of money by using modern technology (broadcast and mass production) to multiply their otherwise limited money-earning potential. Most of us can't do that or think there are more important things in life than making lots of money.

 

[Fiona]

Is it seriously suggested that we can judge how society values people by the amount of money they earn? I think that is rather odd, actually. Since when did remuneration take any account of "value". Do they take a vote? I never got my ballot paper

 

[Agatha]

First of all, show me one post where I used the word "charity."

What is "pro bono" if not charity? Why should I have to rely on a healthcare provider generously deciding to waive their costs? I'm screwed if they've already waived as much as they budgeted for the year, and I still need care.

I never said this either. I said that any society that thinks healthcare is a right for all people cannot justify expenditures on luxuries until all of the healthcare needs of the people are met. Therefore, how can the British people justify the sums they pay their footballers, pop-stars, movie-stars, etc. while people are denied healthcare they need. I gave examples of people who have been denied in the UK (and if you think they are the only ones who have ever been denied anything, you are very, very naïve). I also said that people should be paid based on the value they provide to society. Teachers, doctors, etc. should be high on that list and footballers, etc. should be lower.

Just two examples of how my arguments have been twisted based on your ideologies and not on what I'm actually saying.

The "British people" neither pay, nor set the pay levels of, footballers, popstars etc. Private companies set the levels and those same private companies pay the money. The British public have little influence and no say in the salaries paid, and therefore it's not up to the public to justify them. I might think that Daniel Ratcliffe earns crazy money playing Harry Potter, but it's not the British public paying him (directly) and we have no influence.

People will never be paid on their 'value to society' as you propose, because of the numbers involved. Daniel Ratcliffe can entertain hundreds of millions of people for just a few months work. Even the hardest working doctor will struggle to see ten thousand people a year, and that only gives each person a few minutes of their time.

You gave the example of Ms Blunden; she was not denied healthcare she needed. She was getting all the healthcare she needed, and for you to say otherwise is becoming perilously close to a lie. She wanted to try a different drug which had not been shown to work any more effectively than the drugs she was on. The NHS wouldn't pay for it as the evidence showed it would not help her.

 

[Ivor the Engineer]

xjx388,

Should anyone, irrespective of their medical education or training, be able to offer medical services?

 

[Uncayimmy]

You gave the example of Ms Blunden; she was not denied healthcare she needed. She was getting all the healthcare she needed, and for you to say otherwise is becoming perilously close to a lie. She wanted to try a different drug which had not been shown to work any more effectively than the drugs she was on. The NHS wouldn't pay for it as the evidence showed it would not help her.

And she could have paid for it herself. Or, in this case, get it from charity pro bono.

 

[Gandalfs Beard]

First of all, show me one post where I used the word "charity."

You'd also be amazed at what our local physician-owned hospital provides in the way of heavily discounted (sometimes pro bono) services to these uninsured people.

My Bad! I thought "Pro Bono" = Charity.

GB

 

[jimbob]

I'm re-quoting these posts because you seem to have ignored them, xjx388.

CMAJ had an [editorial with citations] and in 2002 a peer-reviewed research [article] showing profit motive significantly deducts from quality of care in healthcare, rather than enhancing it.

Canada and the US had identical systems until the end of a transition over 1969-1972, and in the time since then, the US has fallen drastically behind in outcomes and is now more than double the cost. This value gap has grown especially fast since 2000.

IIRC, HMOs' costs outside actual care delivery - eg: accounting, marketing/advertising, lobbying, lawsuits, claim screening, collections - has inflated to about 30% of costs, compared to between 1 and 2% in Canada, depending on province.

The efficiency of US healthcare delivery is considered to be less than half of Canada's, even though Medicare is almost as efficient. This means that outside of Medicare (which has a 2% overhead) - so that means HMOs and private hospitals - is less than half as efficient. Maybe about 35% as efficient, based on my back-of-the-envelope estimate.

Thanks for quoting this, as this does highlight one reason why the profit motive doesn't work too well:

The private insurers with whom employers contract are mostly investor-owned, for-profit businesses. They try to keep premiums down and profits up by stinting on medical services. In fact, the best way for insurers to compete is by not insuring high-risk patients (called "cherry picking" or "cream skimming"), limiting the coverage of those they do insure (e.g., excluding expensive services, such as bone marrow transplantation) and passing costs back to patients as deductibles, copayments and claim denials. The US is the only country in the world with a health care system based on avoiding sick people. These practices add enormously to overhead costs because they require a great deal of paperwork. They also require creative marketing to attract the affluent and healthy people and to dodge those who are poor or sick. Not surprisingly, the US has by far the highest overhead costs in the world

These practices are shown by some in the Congressional report I quoted earlier.

It is instructive to follow the health care dollar as it makes its way from employers to the doctors and nurses and hospitals that provide medical services. First, private insurers regularly skim off the top a substantial fraction of the premiums (about 15%–25%) for their administrative costs, marketing and profits. The remainder is passed along a veritable gauntlet of satellite businesses that have sprung up around the health care industry. These include brokers to cut deals, disease-management and utilization review companies, drug-management companies, legal services, marketing consultants, billing agencies and information management firms. They, too, siphon off some of the premiums, including enough for their administrative costs, marketing and profits. It was conservatively estimated that, in 1999, 31.0% of all health care spending in the US was for overhead, nearly twice the estimated 16.7% in Canada. The overhead for Canada's private insurers that year was 13.2%, compared with only 1.3% for its public system.

As you are well aware, this is a reason why simple care would be more expensive under the US system.

These overheads are needed so that the medical suppliers don't spend too much money on the expensive treatments (even where it is clinically justified). I suppose there is a further aspect: if you are very sick, and your medical insurance doesn't pay up, you mightn't have the energy, or resources to sue, and you might run out of time.

 

[xjx388]

No. The most important factor was the economy and the recession.

Nope. I've got a poll too. It shows that 80% of likely voters thought heathcare was equally important as the economy.

http://www.usnews.com/opinion/blogs...e-healthcare-law-or-want-it-more-liberal.html

And I have a poll showing post Americans don't favor the new law.

HC1. In general, do you favor, oppose, or neither favor nor oppose the law changing the health care system that the U.S. Congress passed last March?
Favor strongly 9
Favor somewhat 21
Neither favor nor oppose 30
Oppose somewhat 17
Oppose strongly 23
Refused 0

Only 30% favor it at all.

I also have a poll showing that American's rate their current level of care very highly. Even the ones without insurance . . . weird huh?

Still, the vast majority of insured Americans, regardless of income, as well as about half of uninsured Americans, give high marks to the quality of care they receive.

 

[jimbob]

And what about the other questions? And your assertion that a free market (but with lots of regulation) could work.

And do you accept that "pro bono" is charity?

 

[Fiona]

How do people rate the health care they don't receive?

 

[kellyb]

And I have a poll showing post Americans don't favor the new law.

Only 30% favor it at all.

I also have a poll showing that American's rate their current level of care very highly. Even the ones without insurance . . . weird huh?

Are you not paying attention?
A lot of the people who oppose it are people like me - people who think it's "not liberal enough".

ETA:
And yes, care in the US, WHEN YOU CAN GET IT, is fine.
It's the access to and costs of said care that are the issue.

 

[Gandalfs Beard]

Nope. I've got a poll too. It shows that 80% of likely voters thought heathcare was equally important as the economy.




http://www.usnews.com/opinion/blogs...e-healthcare-law-or-want-it-more-liberal.html

And I have a poll showing post Americans don't favor the new law.

Only 30% favor it at all.

I also have a poll showing that American's rate their current level of care very highly. Even the ones without insurance . . . weird huh?

BS is what I call it. Polls consistently showed that when the poll questions were framed as "Medicare for all," the majority of respondents favoured it. that is until the coordinated verbal assaults at health care meetings, and armed citizens showed up at health care rallies, and the Fox Noise Propaganda machine went into overdrive.

GB

 

[Rolfe]

First of all, show me one post where I used the word "charity."

As has already been pointed out, "pro bono (publico)" is simply a fancy way of saying charity care.

I never said any of that. What I said was that there is a free market in Primary Care medicine and it works very well for what it can do, which is actually quite a bit. If this were extended into other specialties, costs would have to come down.

"For what it is." And what it is, is pretty basic. OK if all you have is a strep throat or a sprained ankle. Not so good if you have cystic fibrosis or a plasma cell myeloma or breast cancer or advanced atherosclerosis.

I never said this either. I said that any society that thinks healthcare is a right for all people cannot justify expenditures on luxuries until all of the healthcare needs of the people are met.

That is an ideological position about as divorced from reality as all the rest of your postings.

We don't "think" healthcare is "a right for all people". We have decided to set up a universal healthcare system, and give everyone legally resident in the country the right to free access to this system as their need requires.

Your own society confers no such right on its citizens. That is your choice, with which we beg to differ. However, it's a pretty poor counter-argument to insist that our universal system somehow "ought" to give even more comprehensive cover than it does. I literally cannot make sense of this objection.

Therefore, how can the British people justify the sums they pay their footballers, pop-stars, movie-stars, etc. while people are denied healthcare they need.

You think footballers and pop stars are paid from tax revenue or something?

Again, I literally can't make any sense of your argument. How are you proposing that our government stop footballers and pop stars from making a shed-load of money? Make it illegal? What happened to freedom and the free market?

Maybe they should tax everyone so highly that they'd have no money left to go to the football or buy music. Sorry, what? This is simply ridiculous.

Or maybe you think everyone should save a shed-load of money instead of having fun, just on the outside chance that they might want some drug of questionable efficacy that might keep them alive on their deathbeds for an extra couple of weeks - even though they are entitled to all the evidence-based care they might need, free of charge.

No? What are you saying, then?

I gave examples of people who have been denied in the UK (and if you think they are the only ones who have ever been denied anything, you are very, very naïve).

No, you haven't. You found one tabloid article about a woman who was getting state-of-the-art care, all for free, who thought she'd like to try a drug of such questionable efficacy it wasn't approved for use in the NHS.

As I said, we have decided, as a nation, to set up a universal healthcare system, and give every legal resident free access to it whenever they need it. We have also decided that new, expensive drugs must pass certain efficacy standards before they're included. That's the position.

US media are absolutely full of stories of people being denied care by US insurance companies, or because they don't have insurance coverage. That's ordinary, basic medical need, not end-of-life drugs of questionable efficacy. So you're not on a very good wicket if that's the best (only?) example you can come up with.

So really, although you keep asserting it, you have not come up with a single example of anyone being denied care that they actually need, within the NHS. British JREF members consistently state that they do not know anyone IRL who has been denied any care that they needed. In contrast, American JREF members are lining up to tell us about the care they or their family aren't getting because somehow, it has been denied.

I also said that people should be paid based on the value they provide to society. Teachers, doctors, etc. should be high on that list and footballers, etc. should be lower.

That's one helluva U-turn from a free-market advocate. Sounds more like some sort of command economy or communism. Totalitarianism, maybe. Stalin would probably have approved.

Just two examples of how my arguments have been twisted based on your ideologies and not on what I'm actually saying.

Maybe you need to express yourself more clearly then. How do you suggest the British government should curtail footballers' salaries? How would you do it, in Libertopia?

Rolfe.

 

[Ivor the Engineer]

Here' what the term free market means:

A free market is a market in which there is no economic intervention and regulation by the state, except to enforce private contracts and the ownership of property. It is the opposite of a controlled market, in which the state directly regulates how goods, services and labor may be used, priced, or distributed, rather than relying on the mechanism of private ownership.

So free market healthcare means no need for providers to have medical qualifications before prescribing drugs or performing surgery. It also means no effective regulation of insurance companies to make them provide cover to those with chronic conditions at an affordable price.

 

[xjx388]

And what about the other questions? And your assertion that a free market (but with lots of regulation) could work.

And do you accept that "pro bono" is charity?

The NHS operates under a pro bono publico philosophy. So if you accept healthcare from the NHS are you accepting charity?

There is no market in the US that I'm aware of, other than the illegal drug market, that is truly free. Everything is regulated. I accept that some regulation is necessary. Even cosmetic surgery and Lasik is regulated.

This does not mean that the market couldn't be "more free" than it is now.

 

[Gandalfs Beard]

The NHS operates under a pro bono publico philosophy. So if you accept healthcare from the NHS are you accepting charity?

There is no market in the US that I'm aware of, other than the illegal drug market, that is truly free. Everything is regulated. I accept that some regulation is necessary. Even cosmetic surgery and Lasik is regulated.

This does not mean that the market couldn't be "more free" than it is now.

BS again. The NHS is NOT pro bono, it's a single government insurance pool paid for by tax dollars; public services paid for by public money--the very opposite of Charity.

You don't help your arguments when you resort to sophistry and conflation.

GB

 

[Agatha]

No (sigh) it's not charity because we all, even people who don't earn enough to pay income tax, pay into the system. Are you being deliberately obtuse? It's free at the point of use, but it's not 'free'. It's paid for by the tax revenue to which every single person in the UK contributes.

 

[jimbob]

And what about the other questions? And your assertion that a free market (but with lots of regulation) could work.

And do you accept that "pro bono" is charity?

The NHS operates under a pro bono publico philosophy. So if you accept healthcare from the NHS are you accepting charity?

That is an odd interpretation of the phrase. The NHS is a publically-funded organisation that provides healthcare that is either free at the point of use, or with minor, fixed costs if you are a taxpayer, which I am.

You suggested that private organisations (hospitals) could provide some healthcare pro bono, which would mean that the private organisation would supply it for free. This is a completely different idea, and is charity.

If the state provides a service that its citizens are have gained an entitlement to, it isn't charity.

There is no market in the US that I'm aware of, other than the illegal drug market, that is truly free. Everything is regulated. I accept that some regulation is necessary. Even cosmetic surgery and Lasik is regulated.

This does not mean that the market couldn't be "more free" than it is now.

Are you going to tell me specifically where my figures are wrong for the inherent costs of complex, high-tech surgical procedures? And how they could be reduced, especially if you seem to think that medics should be paid more than they already are?

 

[Delscottio]

Oh, that's easy. Professional athletes make more money than doctors and teachers, so that means we value them more than we do doctors. Therefore, we value luxuries more than we do necessities, so I'll be damned if I'm gonna support people who value luxuries more than necessities.

Never mind that I am an avid Redskins fan, but they have not received a single dime from me in 20 years. I just watch the games on TV and read free articles on the web.

Football is actually a horrible example to bring up to show how tge free market makes things cheaper.

I remember prior to the formation of the premier league match tickets being the cist of a few pints or so. Then Sky tv got involved and marketed the crap out if the game. The result was increased demand resulting in a new equilibrium of a much higher price, pretty much close to pricing out regular long time fans.

Now can anyone think of another industry with huge demand but a limited supply?