This is why socialist health care doesn't scare me at all

[terry1156]

[mom-from-missouri]

I don't think the life span is a entirely a result of our system. We are also one of the most lazy countries.

We are wealthier so have gagets to do a large part of our work for us--cars instead of biking, tractors instead of hand farming...

We normally work 8 hours a day--5 days a week or 40 hours. Others work 10 or 12 hours.

We sit in front of TV's and computers. We get much less exercise.

We also eat a lot more fried and fatty foods and less fiber, more meat.

[disneysteve]

Originally Posted by InsuranceGuy

So if overhead is the problem, then why is Medicare running such huge deficits?

Those are two totally unrelated issues.

Overhead is the cost of administering the care. That is very low for Medicare, much better than private plans.

The deficit is due to underfunding and rising costs of providing the care. As more and more people live longer and longer lives, the pressure on Medicare grows. As the cost of procedures and medications rises, the pressure on Medicare grows.

[jIM_Ohio]

Originally Posted by disneysteve

Those are two totally unrelated issues.

Overhead is the cost of administering the care. That is very low for Medicare, much better than private plans.

The deficit is due to underfunding and rising costs of providing the care. As more and more people live longer and longer lives, the pressure on Medicare grows. As the cost of procedures and medications rises, the pressure on Medicare grows.

Just to add to this, a deficit is when income into the program (the tax imposed on our paychecks) is lower than the actual costs of the program (the benefits paid to doctors and health care providers).

Income there are many causes of the deficit (which is what Steve alluded to).

Costs are going up more than the income is going up, hence a deficit.

[Seeker]

Originally Posted by mom-from-missouri

I don't think the life span is a entirely a result of our system. We are also one of the most lazy countries.

We are wealthier so have gagets to do a large part of our work for us--cars instead of biking, tractors instead of hand farming...

We normally work 8 hours a day--5 days a week or 40 hours. Others work 10 or 12 hours.

We sit in front of TV's and computers. We get much less exercise.

We also eat a lot more fried and fatty foods and less fiber, more meat.

lol -- actually there's a very effective counter arguement to this view, on the loadedterms.com website (where the chart come from). It's the second one down from the main page and begins, "Counter-Counter-Argument: How to handle the obesity argument"

And this one further in is interesting as well:
Five tips on how to change the language of the healthcare debate (Loaded Terms)

The fact is that our system is a capitalist system and it's not working for millions of people whom are uninsured or underinsured.

I don't know what the answer is... I don't really honestly understand how the costs are formulated in the equations of healthcare.

[swanson719]

An argument I've yet to see a solution to is that many people in America use Emergency Rooms as a way to get seen without good insurance, without waiting for a normal doctor. Also, try finding a hospital that delivers babies within 50 miles of the Mexican border. They aren't very common. Our Emergency Rooms are very abused - I'd be curious to see the number of visits vrs. the number of admissions.

[blankcheck]

A bit about the financial situation from one physician's perspective, and one I happen to share:

http://www.nytimes.com/2009/07/07/health/07essa.html

If you're told an ideal that you are supposed to keep up on one hand, and forced into dealing with a completely different system on the other hand, you are going to end up with everyone unhappy, regardless of who runs the system.

[southerndoc]

Originally Posted by disneysteve

The deficit is due to underfunding and rising costs of providing the care. As more and more people live longer and longer lives, the pressure on Medicare grows. As the cost of procedures and medications rises, the pressure on Medicare grows.

Actually Medicare reimbursements over the past 10 years have not kept up with inflation. Doctors and hospitals are paid less than what they were 10 years ago when indexed for inflation.

Medicare really is a faulty system. Typically reimbursement is a 1/3 of what insurance companies reimburse. This is why hospitals charge more for privately insured patients. They have to get their budget somewhere.

The quality indicators for other countries as compared to the US don't take into account everything. How many obese people are in France and the UK? Not that many. If you were to spend 8% of GDP on healthcare in the US, chances are life expectancies would drop to 65. We are a fat, lazy country that eats high-fat/high-cholesterol foods and sits on the couch watching reality television all day long.

Having said all this, I am actually a supporter of a single payer system. I do have mixed feelings about it, but generally support it. In fact, I'm a member of PNHP. I think we have a major problem in society when people need to file bankruptcy because of medical expenses. Some would argue that they are responsible for their own fate since they elected to skip insurance premiums to spend on other items (sometimes marijuana and alcohol among the youngest ages). The private insurance industry rescinds coverage of people or excludes those with pre-existing conditions. If everyone could get insurance, and everyone was required to get insurance, then things would be a lot better.

My philosophy of a single-payer system is NOT to have a government operated system. Instead, a large non-profit organization should provide insurance. Perhaps two or three NPO's. The current insurance industry is too profit driven. By having a NPO insurer you eliminate all the earnings requirements for Wall Street investors.

America will never go for a single payer or socialistic medical system because we wouldn't tolerate the waits. The long waits for elective surgeries, specialty care, chemo, etc. are not exaggerations. I've lived in the UK and studied their national health service.

Healthcare costs would be reduced dramatically if tort reform were established. I don't know how many patients with abdominal pain who I genuinely think have nothing going on that I order a CT scan of their abdomen/pelvis just to make sure they don't have appendicitis, or labs on someone just to ensure I'm not missing an acute renal failure.

[jIM_Ohio]

Originally Posted by southerndoc

Actually Medicare reimbursements over the past 10 years have not kept up with inflation. Doctors and hospitals are paid less than what they were 10 years ago when indexed for inflation.

Medicare really is a faulty system. Typically reimbursement is a 1/3 of what insurance companies reimburse. This is why hospitals charge more for privately insured patients. They have to get their budget somewhere.

The quality indicators for other countries as compared to the US don't take into account everything. How many obese people are in France and the UK? Not that many. If you were to spend 8% of GDP on healthcare in the US, chances are life expectancies would drop to 65. We are a fat, lazy country that eats high-fat/high-cholesterol foods and sits on the couch watching reality television all day long.

Having said all this, I am actually a supporter of a single payer system. I do have mixed feelings about it, but generally support it. In fact, I'm a member of PNHP. I think we have a major problem in society when people need to file bankruptcy because of medical expenses. Some would argue that they are responsible for their own fate since they elected to skip insurance premiums to spend on other items (sometimes marijuana and alcohol among the youngest ages). The private insurance industry rescinds coverage of people or excludes those with pre-existing conditions. If everyone could get insurance, and everyone was required to get insurance, then things would be a lot better.

My philosophy of a single-payer system is NOT to have a government operated system. Instead, a large non-profit organization should provide insurance. Perhaps two or three NPO's. The current insurance industry is too profit driven. By having a NPO insurer you eliminate all the earnings requirements for Wall Street investors.

America will never go for a single payer or socialistic medical system because we wouldn't tolerate the waits. The long waits for elective surgeries, specialty care, chemo, etc. are not exaggerations. I've lived in the UK and studied their national health service.

Healthcare costs would be reduced dramatically if tort reform were established. I don't know how many patients with abdominal pain who I genuinely think have nothing going on that I order a CT scan of their abdomen/pelvis just to make sure they don't have appendicitis, or labs on someone just to ensure I'm not missing an acute renal failure.

Good post, thank you for sharing.

[disneysteve]

Originally Posted by southerndoc

Actually Medicare reimbursements over the past 10 years have not kept up with inflation. Doctors and hospitals are paid less than what they were 10 years ago when indexed for inflation.

Thanks for posting this. So many people are still under the faulty impression that doctors make a ton of money. My income in actual dollars is the same as it was 6 years ago, meaning I've lost ground to inflation with each passing year.

As for Medicare, even though reimbursements haven't kept up with inflation, overall costs have still risen due to increased utilization. More patients living longer getting more tests, taking more meds, seeing more doctors and having more procedures. Even if you pay each of those providers less than you used to, the end result is higher costs.

I had an interesting conversation today with a pharmaceutical rep who used to be a chiropractor. She got out of it because it was so mentally draining. All she saw were patients who didn't want to do anything to help themselves, people who were obese and coming for back or knee pain, people who did no physical activity and complained of stiff joints, etc. I told her that she had just described my life. Easily 75% of what I see every single day is self-induced and preventable. There is no healthcare reform that will succeed long-term if you don't change people's attitude and behavior toward their health.

[southerndoc]

Originally Posted by disneysteve

I had an interesting conversation today with a pharmaceutical rep who used to be a chiropractor. She got out of it because it was so mentally draining. All she saw were patients who didn't want to do anything to help themselves, people who were obese and coming for back or knee pain, people who did no physical activity and complained of stiff joints, etc. I told her that she had just described my life. Easily 75% of what I see every single day is self-induced and preventable. There is no healthcare reform that will succeed long-term if you don't change people's attitude and behavior toward their health.

I haven't been out of residency that long, and I'm considering giving up medicine and going into another career.

I love helping people, but unfortunately for every minute I spend with a patient, I spend about two minutes documenting. The Joint Commission and their stupid requirements (like me needing to date and time everytime I sign something, which usually means 20 signatures for every patient).

The hassle of medicine is just too great. Patients aren't appreciative, they view you (ER physician) as a lottery ticket, they don't want to follow up with a primary care physician and instead keep presenting to the ER wanting to know why we don't order the MRI that needs to be done as an outpatient (even insured patients do this!), etc.

I spend a few months each year volunteering in Africa. I get immense satisfaction there. I'm not compensated at all for my work there, and I even pay for my own airfare and housing. Yes, I can deduct it from my taxes. But you know what? Patients actually appreciate you helping them and will say thank you.

[maat55]

Our system is not 100% capitalist, so we can't know how well it would work if it were. Excessive regulations, lack of tort reform, over use due to medicare, expensive FDA approvals.

Government forcing emergency rooms to see the uninsured leads to those who choose not to get insurance, along with they do not want to prioritize it. High deductable insurance is affordable for most.

The cost associated to GDP is not comparing apples to apples, Under socialized systems you are taxed much higher and allowed less usage. Ask Canada why they are beginning to introduce a two tier system(patient out of pocket) to allow many not to wait.

[Seeker]

I don't know Maat.... more excessive than already exists?

Insurance companies are a MAJOR portion of the problem here. 47 million people not insured. How many people who are insured, are denied coverage on a specific treatment? How many people are tied to working someplace for paying for medical things that that cannot currently live without? How many people wrongfully denied coverage for pre-existing conditions or having missed a line on paperwork.

And finally, what about the previously working and under any type of medical coverage, but now unemployed and having to do without?

Is medical failing entirely because of people themselves? Or because big business (Insurance campanies) greed and politics?

Canada was not a system that Obama really considered for America. Canada has some sort of priority system where the really sick, can get help without too much wait -- and the people waiting for elective surgery may end up waiting a bit longer. Yes, taxes are higher... but people can get care.

[whitestripe]

i don't have anything to contribute to the argument - except WOOHOO my country is second for life expectancy and all the other stuff. (australia)

i can't complain about our system - some people do though. the hospitals are always full, the doctors and nurses get a hard time because they're overstretched etc. people also abuse the emergency rooms here too, you're not alone on that fact.

having a baby through the public system is quite normal here - apparently, according to a friend who lived in the US for several years, she was terrified of having a baby in the US through the public system, so she got private health insurance. so when she got back here she thought the same thing, but then her brothers girlfriend went through the public system and said everyone was amazing.

[markusk]

Originally Posted by Seeker

I don't know Maat.... more excessive than already exists?
Canada was not a system that Obama really considered for America. Canada has some sort of priority system where the really sick, can get help without too much wait -- and the people waiting for elective surgery may end up waiting a bit longer. Yes, taxes are higher... but people can get care.

One of my patients sent me this link:
Debunking Canadian health care myths - The Denver Post
The title is "Debunking Canadian health care myths."

I admit, I don't know too much about Canadian healthcare, so I found it interesting.

[cameraeye]

Another interesting aspect of the cost of healthcare to all of us that doesn't get much press:

http://www.nytimes.com/2009/07/08/bu...ardt.html?_r=1

[Seeker]

Originally Posted by markusk

One of my patients sent me this link:
Debunking Canadian health care myths - The Denver Post
The title is "Debunking Canadian health care myths."

I admit, I don't know too much about Canadian healthcare, so I found it interesting.

Thank you for posting that. Yes, it's a very interesting comparison.

[Seeker]

Originally Posted by cameraeye

Another interesting aspect of the cost of healthcare to all of us that doesn't get much press:

http://www.nytimes.com/2009/07/08/bu...ardt.html?_r=1

This too is interesting.

When my Dad was diagnosed with this cancer, they told us that he will die of something else long before the cancer became an issue for him. They've watched and pretty much there's minimal growth of the cancer.... they give him some hormone from time to time.. to slow down the growth. He is 82 years old now; Aunts and Uncles have passed... but nobody will live forever.

But I believe that if a doctor thinks whatever procedure will prolong life and the patient too wants to live that life, then who are the Insurance Company people to come along and say "No, we will not pay?" It should be between Doctor and patient, nobody else should have any right to intrude.

[maat55]

Originally Posted by Seeker

I don't know Maat.... more excessive than already exists?

Insurance companies are a MAJOR portion of the problem here. 47 million people not insured. How many people who are insured, are denied coverage on a specific treatment? How many people are tied to working someplace for paying for medical things that that cannot currently live without? How many people wrongfully denied coverage for pre-existing conditions or having missed a line on paperwork.

And finally, what about the previously working and under any type of medical coverage, but now unemployed and having to do without?

Is medical failing entirely because of people themselves? Or because big business (Insurance campanies) greed and politics?

Canada was not a system that Obama really considered for America. Canada has some sort of priority system where the really sick, can get help without too much wait -- and the people waiting for elective surgery may end up waiting a bit longer. Yes, taxes are higher... but people can get care.

I watched an documentary recently where a women with a back problem could not get an MRI for a year. She had to pay out of pocket at a new non- government facility.

I think we all know that with either system, not everyone will get serviced. I would rather not be serviced based on my merits than on those of the government.

Pre-existing problems are something that has to be dealt with, but I do not accept that the government will be a viable solution in this country due to its past record of poorly managing its current entitlements.

We can have the best army in the world, but that doesn't mean we did it efficiently. Our deficit is growing fast, our obligation to future entitlements is massive, I can't help but believe that NHC will do nothing but compound these problems.

[disneysteve]

Originally Posted by maat55

I watched an documentary recently where a women with a back problem could not get an MRI for a year. She had to pay out of pocket at a new non- government facility.

This really isn't the best point to argue. The vast majority of spine MRIs done in this country are unnecessary. They don't alter treatment regimens one bit. If a patient presents with a history of low back pain radiating down one leg, especially with a history of trauma , a physically demanding job or in an obese patient, I don't need an MRI to assume they have a herniated disc. Without the MRI results, I would order anti-inflammatory medicine and physical therapy. If I get the MRI and confirm the diagnosis, I would order anti-inflammatory medicine and physical therapy but would have blown $1,000 on an MRI.

That's part of the problem in this country. Patients have come to expect a million dollar workup for every ache and pain, and doctors have become far too dependent on technology over taking a good history and doing a thorough physical exam, partly due to fears of litigation. If you speak with many older physicians, you'll hear that before all the high-tech testing was around, patients were treated just as well and at a much lower cost, and doctors had much better honed diagnostic skills.