Health care - administrative incompetence

[xjx388]

Does anyone know how many hours a week a surgeon can actually perform surgery for? And how many is typical?

Most surgeons I know do surgery in the mornings 6-12ish then see patients in their office in the afternoon. That's pretty typical.

You keep asking me to tell you how your figures were wrong. They are wrong because you are making them up. Are they reasonable guesses? Not really because you they are only valid in the current system.

 

[Architect]

How do people who aren't paying taxes "pay into the system"? How does "every single person in the UK" contribute to the tax revenue? Just curious because it's not that way here.

VAT and other similar taxes

ETA: beaten to it by Rolfe

 

[Ampulla of Vater]

No, it's not what I have been saying in the least. The American Public Service sector is underfunded and targeted for demolition by Right Wingers and the rules for the Public Service sector are enacted by a Corporate Controlled legislature.

A government bureaucracy in a democratic society is accountable to the public. No such accountability exists in the Private Health Insurance industry. Take the Right Wing pseudo-"free market" ideology off the table, and you will end up with a more egalitarian and accountable institution.

Sorry, but your attempt to rewrite my anecdote in your ideological framing is fallacious.

GB

Not "we" you and me but "we" xjx and me.

So you're theory of your recent governmental experience is that it was such a nightmare because the "Public Service sector is underfunded and targeted for demolition by Right Wingers and the rules are enacted by a Corporate Controlled legislature." How will that be any different if/when we turn the whole healthcare system over to them?

 

[xjx388]

Some of it, yes. Legally, at least.

Forget about laws . . .

Let me expand the question.
Do I have an unalienable right to a share of your pay to use for my own needs?

 

[Rolfe]

Exactly what we have been saying. You are dealing with the Federal government (Medicare) and the state government (Medicaid). And you want the government to handle a national healthcare system???? They can handle very little effectively and efficiently.

So your basic argument is that you, a citizen of a country that prides itself in being a world leader, a superpower, the place everybody wants to live, believe your government can't run a piss-up in a brewery?

Even though every government of every other developed nation in the world, and quite a few less developed, seem to manage it?

Oh dear.

Rolfe.

 

[Agatha]

How do people who aren't paying taxes "pay into the system"? How does "every single person in the UK" contribute to the tax revenue? Just curious because it's not that way here.

Because there are more taxes than income tax. VAT and other taxes on consumption mean that one would have to pretty much live off-grid (difficult on our small island) to escape paying any taxes at all. Our tax revenue is not hypothecated, it all goes into the Treasury and gets paid out as per Government spending.

 

[kellyb]

Exactly what we have been saying. You are dealing with the Federal government (Medicare) and the state government (Medicaid). And you want the government to handle a national healthcare system???? They can handle very little effectively and efficiently.

How well governments do at being effective and efficient depends on how much the voting population values the services being administered. For example, during the Cold War, we wanted to win the space race, and NASA got a man on the moon.
If people's trash stopped being picked up in some city and the population became outraged, the local authorities would be under pressure to fix it and would do so.

Of course, all that kind of falls apart when the population loses faith in even the theoretical ability of governments to do what they're supposed to do.

 

[Architect]

Forget about laws . . .

Let me expand the question.
Do I have an unalienable right to a share of your pay to use for my own needs?

Do we, as a society, have a duty to protect those who are most vulnerable?

Moreover, your existing crappy system costs double what ours does, and for that we treat absolutely everybody - to standards comparable with your own.

You're being taken for a mug mate.

 

[Rolfe]

Edited by Tricky: 

Edited for rule 12.

 

[Ampulla of Vater]

Three little letters. V. A. T.

Rolfe.

But don't poorer people not have money to buy items which include V.A.T.? I thought I read that your food was not subject to V.A.T. and that the V.A.T. applies to other items, kind of like our sales tax here does. It does not apply to food or medication or certain services.

 

[Architect]

Everyone still pays a little, however, as everyone occasionally buys taxable goods or those with duty on them

 

[Rolfe]

I think it would be essentially impossible to go through life without paying VAT on at least some items. Bear in mind also that unless you've just been born, or just showed up as a legal resident from another country, then you have virtually certainly paid some sort of tax at some point.

Rolfe.

 

[Rolfe]

Forget about laws . . .

Let me expand the question.
Do I have an unalienable right to a share of your pay to use for my own needs?

You have to give up this erroneous use of the word "right". Jerome did it too, and got the stuffing knocked out of him.

There's no such thing as an "unalienable" right. Rights are things granted to you by the society you live in. They can always be revoked.

As it happens, living in a society where tax is a fact of life, everyone has a "right" to benefit from some of the income of other people.

Rolfe.

 

[Agatha]

Most food isn't subject to VAT. But some is; I haven't dealt with the finer points of it for a while (I did in a previous job), and if you really want to know I can expand on this. Children's clothes and shoes are not subject to VAT. Domestic rents and mortgages are not.

However, adult's clothes and shoes are, as are gas and leccy (at a lower rate). Prescription drugs are not subject to VAT, people in England pay a set rate of £7.20 per item if they have to pay at all, most don't, but OTC meds are subject to VAT at standard rate. This means that a 19p pack of paracetamol will have 3p of VAT built into the price.

 

[kellyb]

Forget about laws . . .

Let me expand the question.
Do I have an unalienable right to a share of your pay to use for my own needs?

I think so.

 

[xjx388]

So your argument boils down to "the government we elect cannot be trusted to run a piss-up in a brewery" and "healthcare is different from police/fire/defence/public parks".

The first is a terrible indictment on your country

Not our country, but the way our government (and any government really) has botched public health care, education, defense spending, etc. America is, despite it's problems, still the greatest country in the world.

and the latter a matter of opinion and degree.

Agreed.

We consider it's good for society to have as many members of that society as possible to be healthy, well-educated and productive. You consider that sick people should stay poor, or just die (your words).

That is a huge twist of what I've said and not worthy of comment.

 

[jimbob]

Most surgeons I know do surgery in the mornings 6-12ish then see patients in their office in the afternoon. That's pretty typical.

You keep asking me to tell you how your figures were wrong. They are wrong because you are making them up. Are they reasonable guesses? Not really because you they are only valid in the current system.

Where exactly are the errors? If you need two highly trained individuals plus support staff to work for five hours, then the cost of all the salaries involved has to cover this. Similarly for the cost of the equipment and the drugs. If you have expensive equipment then it needs to pay for itself over its lifetime from the cost of the healthcare that it enables, otherwise it makes a loss. In fact it needs to do more than this, it needs to provide an attractive return on investment, or else the it wouldn't be an attractive investment.

The additional overhead that I have not included is the 30% to 35% profit that is also needed for the healthcare suppliers. I accept that this is the one bit that will be subject to change with a different system.



Can you be more specific as to your criticisms?

Exactly what we have been saying. You are dealing with the Federal government (Medicare) and the state government (Medicaid). And you want the government to handle a national healthcare system???? They can handle very little effectively and efficiently.

So your argument boils down to "the government we elect cannot be trusted to run a piss-up in a brewery" and "healthcare is different from police/fire/defence/public parks".

The first is a terrible indictment on your country, and the latter a matter of opinion and degree.

We consider it's good for society to have as many members of that society as possible to be healthy, well-educated and productive. You consider that sick people should stay poor, or just die (your words).

this was my earlier reply to this argument:

Looking through the thread I hadn't seen this covered fully:

I agree with you. I don't recognize the validity of corporations to exist. You can't create a limited liability entity that allows individuals to absolve themselves of accountability. This is no different than creating an imaginary friend to take the blame when things go wrong.... no good can come of this. I wouldn't consider it private healthcare if corporations were involved.

I think in a free market I would pay more to see physicians who had the highest cure rates. Physicians should be able to maximize their profits, this would drive the incentive to cure higher and higher.

This is la la land thinking. Modern healthcare (and every other technology) requires more knowledge, ability and technology than any one physician (or engineer or scientist) could possess.

My back of envelope calculations from a previous thread:

Look at the cost of supporting infrastructure...

Bump for Jerome...

The details please.

Will a general hospital in a large prosperous city magically be built on land that is cheap? If not how will the capital cost of a general hospital be reduced?

Will a 5-hour surgery not require a surgeon, anaesthetist, and supporting nurses? Will surgery currently requiring 5-hours in theatre, suddenly need less time?

Will the surgeon and anaesthetist spend a greatrer proportion of their working time in theatre? (Actually my rough calculation, completely unrealistically assumed that they spent 100% of their time in theatre). If this time is to be maximised by the free-market, how?

Aside: Does anyone have any figures for what proportion of a general surgeon's work is actually in theatre?​

Will the general surgeon, and anaesthetist accept lower wages, when their skills are still in demand?

Will the capital cost of the theatre be reduced? If so, how? Will it be depreciated over a longer time?

Why would the cost of medical equipment be reduced?

I have already asked these questions, or simlar ones, and your answers seem to say that you accept my calculations but in later posts deny their validity, why:

Originally Posted by JEROME DA GNOME
Quote:

Originally Posted by jimbob
Any specific examples?

The current problems in the American health-care system.

Quote:

Quote:
In a deregulated market, will economies of scale suddenly vanish?

Nope.

Quote:

Quote:
Will the capital cost and depreciation of medical equipmens suddenly reduse?

Nope.

Quote:

Quote:
Will medical treatment and diagnosis suddenly not need highly qualified workers? Will highly qualified workers, in a field where there is demand for their services suddenly not command high wages?

Nope and nope.

Quote:

Quote:
Will large hospitals not be needed, or will the capital cost of the hospital also not need to be covered? Will the land value of new hospitals vanish.

Nope and nope.

Quote:

Quote:
Without regulation, how do you protect against cartels?

Why should I protect against cartels?

Where are the costs going to be reduced. With specific examples (other than the free market pixie).

ETA: Here are my detailed calculations, hidden for brevity,

Please tell me which parts are not estimating the lowest plausible cost:

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.

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.

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 yse 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.

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 inhospital.

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


Rolfe works in a free-market system providing medical care to animals, so I will ask him this next question:

If someone's pet needs treatment that costs more than they can afford, do you (as the representative of the free market pixie) reduce the price of the treatment, or does the animal not get any treatment?

And as to this argument:

It is because americians are signularly incompetent at managing systems.

...snip...

Well I used to say that was obviously absolute codswallop given the size and success of USA corporations but....

I know US anti UHC proponents have actually argued this...

To which I reply "British Railways...." We have a fine ability to cock up major projects, but the NHS still works far better than the US system.

I don't know, but Italy has a better infant mortality rate than the US accorging to google...

It isn't usualy considered an exemplar of efficient and uncorrupt government....

 

[Agatha]

Rolfe and I are so British, despite she being Scottish and I being English! We both use the phrase "couldn't run a piss-up in a brewery" to describe the apparent view Americans have of the Government they elect.

Rights are granted or revoked by society, they are not inalienable. If you live in the UK, some of your taxes, direct and indirect, fund the health service that everyone can use and which will pay for everything that you need. If you live in the US, more of your taxes go to fund Medicare/Medicaid which not everyone can use, and apparently only provides a very basic level of care.

 

[Rolfe]

I think so.

There's no think about it. You live in a society which requires its citizens to pay tax, to provide services for the common good. Therefore you do have the right to a share of the income of everybody else in your society.

Since I don't live in the same society as xjx388, however, then neither of us has any right to any of the other's income.

Rolfe.

 

[Uncayimmy]

Thank you!

The United States government has not been shown to provide anything effectively and efficiently. We have no choice with some of the things it provides (defense, police, etc) because it's the governments job. But we do have a choice when it comes to healthcare, education, energy, etc.

Let me ask you this: Do I have a right to the fruits of your labor?

Right. They do nothing efficiently or effectively. Ever. Nada. Zip.

There's room for improvement (there always is), but let's look at education. The USA is #1 for average number of years of education attained by adults. Meanwhille, were #20-something for infant mortality. In other words if we can keep a baby alive, we stand a good chance of getting him a decent education.

And education is not all the simple to measure. When you look at test scores and wonder why they are where they are, it's mostly curriculum choice. It's not like the USA is failing to teach what they are teaching, but, as some people put it, they are teaching a mile wide and an inch deep. You can read some commentary here by the testing people. The point is that it's not a failure of inefficiency but of direction.

Other countries do it. The USA can do it.