quote:Originally posted by Lisa: Actually, for a chart of the type Rabbit posted, the best thing is to use the "code" tag. It'll preserve formatting. For example:
posted
One interesting tidbit from the site I linked to before.
Public expenditures (i.e. Tax dollars) spent per capita on health care average $2100 in the developed countries. In the US, that number is $3300. The only country that spends more public money on health care is Norway, and they cover 100% of the population whereas the US covers only 40% of the population through taxes (medicare, medicaid, VA, and public employees).
Bottom line, the average US citizen pays more taxes to cover health care than everyone but Norwegians and we have to pay for insurance on top of that.
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quote:Originally posted by Stephan: Premiums will rise if they can't turn down pre-existing conditions. I fully support socialized care. Its this in between stuff I can't stand. You can't force insurance companies to take higher risk people, and expect rates not to rise.
Are they still punishing people who choose not to get it with a fine?
The highlighted portion is crucial to keeping premiums down- if a large enough pool of people who need minimal care pay their premiums, then you can take on people who will be a net loss for the system.
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I spent some time looking at the infant mortality issue a while back in the middle of an argument with an anti-healthcare-reform person and some of the disparity apparently can be explained by differing definition of "live birth". When that was taken into consideration, the US ended up more middle of the pack on that statistic than the WHO numbers indicate. That doesn't necessarily justify how much more we spend for similar outcomes, but it's worth mentioning.
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I've researched that same issue and don't believe that accusation is true. The WHO definition of live birth does not depend on viability of the fetus.
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One big factor is that the US has more premature births, in large part because we're more willing to attempt them. Due to the much higher proportion of premature births, despite also having a much lower infant mortality rate when comparing premature births to other premature births, total infant mortality goes up.
Of course, infant mortality among non-premature births is still somewhat worse in the US.
posted
What do you mean by "willing to attempt them"? Are you referring to the difference in number between countries that allow them to die and are thus not charged for the live birth, versus the United States who attempts to help them, but then suffers statistically from the failure?
TIME magazine had a couple of great articles a few months ago on premature births in America. It talked about how premature births are on the rise in the United States, and for about half of them, the cause is unknown, and doctors are baffled. 2/3rds of infant deaths in America come from premature births, and premature births make up 12.5% of all births. 2% of all births are very premature, and that's where most of the deaths come from. The other 10%, who are premature but late-stage preemie, have a 99% survival rate.
It's very premature births, babies born before 32 weeks, that are the biggest cause of the spike in the US infant mortality rate. I pulled this info from a TIME article I have sitting next to me, and it looks like much of it is confirmed in fugu's link. Doctors are struggling to figure out why so many more premature babies are born in the United States than in other countries of the developed/modern/whatever world. It could be that there's something wrong with our nation's health that causes more premature babies, and thus a higher infant morality rate, which I think should be factored into the equation.
Lots of attention has been directed at poor, unhealthy mothers, who seem as a demographic to have a higher rate of premature births, but from what I have seen and read, there isn't enough data to make a firm connection that there's any sort of causal relationship yet. There have been some studies that have taken poor, unhealthy expecting mothers and have enrolled them in a program to make them healthy and get them regular checkups. The result? As a group, they had a "regular" number of premature births.
Some of that is off-topic I suppose, but it's fascinating. And a bit scary by itself.
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quote: The status quo cannot fail to be improved. It is the absolute worst, by far, in the modern world. We pay over twice as much into a system that delivers us less and leaves thousands to die.
Our health care system is the absolute worst in the world? By far? Who are these thousands being left to die? Are you suggesting that someone seeking treatment is not treated or able to be treated?
Typically you aren't addressing what's being said. First of all, the "modern world" which is being referred to is the developed world. According to a long list of reliable metrics, the American system *is* the worst in the developed world. And yes, thousands of people die every year in America because of the problems associated with our system, who would otherwise not die.
Do you actually believe that there are not people who seek treatment and are unable to get it? Do you think cancer, heart, and diabetes patients who cannot afford their treatment receive effective care in America? Do you think that care measures up in any way to the care provided such people in other developed countries? If so, how have you come to believe these things? Honestly, you've been posting on this subject for how many years, and you're still incredulous about the most basic established facts involved. It's like you're walking into a high school algebra classroom, and proclaiming that it is impossible to determine the length of one side of a triangle if you know the lengths of the other two sides. I'm so sick of this willful ignorance on the part of conservatives: "It's cold so there's no climate change!" "I haven't read about anybody dying so it isn't happening!" "My friends says they have to wait in line for the flu shot in France!" "I haven't seen Barack Obama's birth certificate so he's not really an American!" It's all really so pathetic.
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My uncle died because he was unable to get medical treatment. He was middle class America. After he ran into medical problems, he lost his job and insurance. He then tried to get on medicaid. He died while waiting on the paperwork, so he could have the tests he needed. Of course, we didn't realize that waiting for the paperwork would cost him his life, otherwise we would have gotten him the money, somehow, someway. But he said that medicaid would be covering him soon and everything would be ok. Not something we are vocal about and a lot of people who knew my uncle probably didn't know those facts about his death, but maybe we should, since people seem to think people like him don't exist. Except it still hurts and politicizing a family member's death is not an easy thing.
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Is it obvious the tests would have saved him? Perhaps they would have told him "You have two months to live. Sorry."
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KofM- that is a possibility. We don't really know. Once dead, beyond ruling out homicide, they weren't that interested in figuring out what went wrong. So, I guess we have to technically say there is an unknown statistical probability that the denial of health care factored in to his death.
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scholarette, I'm sorry to hear about your uncle.
I know we've gotten beyond this point a bit, but I had a question about this:
quote:Originally posted by The Rabbit: All you people who are asking for "socialized" health care, is that what you really mean or are you talking about single payer because there is a big difference.
In a socialized health care system, all the doctors and other health care providers are employed by the government. In a single payer system, everyone has health insurance from the government but hospitals are still privately owned and health care workers are still privately employed.
I get what you're saying about the difference here, but if there is only one insurance company paying the many hospitals, doctors, etc. for their work, then how marked is this difference, really? In one case the government is the boss, in the other case the sole customer.
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posted
Well for one, the governmental overhead in a single payer system would presumably be a fair bit lower in admin costs than a National system where the government was the HR department for the entire healthcare system.
At least, I'd hope so.
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posted
One consequence of the latter case, the government has the option of out-sourcing certain jobs potentially allowing for more aggressive negotiating on things like salary since it can just switch who it out-sources to rather than wrangle with unions and the like if all health care workers were employed by the government.
(If you're familiar with the Toronto area, it would be the difference between the TTC where all transit workers are government employees and York region VIVA service where that is outsourced)
posted
Is there a large hurdle beyond the obvious money outlay to creating a health insurance company? I'd want to see more competition in the health insurance field. I also want to see a system that: - Encourages preventative care such as routine follow ups and appropriate screening tests. - Covers emergency medical costs without encouraging casual ER use. - Rewards cost-concious decisions that are evidence based. Both provider and patient should be invested in this. - Requires at least minimal coverage (low cost emergency coverage at least) for as many possible
I don't see how the above requires one version of socialization than another. All private health insurers, a mixture of public or private, or all public should be able to accomplish the above.
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quote:Is there a large hurdle beyond the obvious money outlay to creating a health insurance company?
Well considering how expensive health care is and the need for a huge pool to offset the risk, I'd say the money outlay in and of itself is a gigantic hurdle. To the point of exclusion.
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posted
The hurdles in creating a health insurance company are largely regulatory. That multiplies the startup cost significantly, since you can pretty much only afford to start in one state (instead of starting by gaining a few customers in a number of states).
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posted
There are the regulatory/money outlay hurdles and then there's the fact that the market itself is in rather dire shape. Most young people who feel they can go without health insurance are also undergoing what the Atlantic calls the "jobless era" — financially, the mechanisms faced by the demographic ensure that they won't fill the gaps in the risk pool. By and large, they can't afford it. I have no less than 43 (at last count) friends in my age group who officially as of the end of 2009 have no health insurance, because it wasn't economically feasible for them. In 2008, they were all individually covered or had some form of company coverage.
The ones who have remained on insurance are remaining on it because they really REALLY have no other option and if they get even a single gap in their coverage, they're completely screwed. This includes two with Crohn's and one with hashimotos. They receive family assistance to stay on their insurance because there's pretty much no other option that isn't disastrous for all involved.
they're an anecdotal demonstration. a microcosm of the death spiral at play. Go back in my post history, you hear me constantly and angrily jabbing at the unsustainability of the system. As far back as my first months here. I prod constantly at examples like South Dakota ("Where Health Care Goes to Die™") as exacerbated test cases showing where the nation as a whole would be in less than a decade.
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Health insurances need regulation, but I wonder if there's a way to allow for more competition.
Samprimary, I totally hear you. I have several friends my age (20s) who have "pre-existing conditions" that make loss of health insurance dangerous but make getting health insurance very expensive and difficult. The death spiral is going to keep going as unemployment stays high.
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posted
Competition isn't the end all be all fix it. There are many markets where there are few or no regulatory barriers to competition and they are still dominated by a few companies simply because the entrance costs are that high.
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posted
Well, the death spiral is also fed by another mechanisms. Most notably, the sustained double-digit inflation for healthcare expenses.
This reality is anathema to the deregulatory/free market proposals for keeping the system 'working,' since it is a demonstration of how profit motive and actuarial market models render the system massively inefficient. Basically, we don't have a system that rewards keeping people healthy.
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quote:Originally posted by Christine: I get what you're saying about the difference here, but if there is only one insurance company paying the many hospitals, doctors, etc. for their work, then how marked is this difference, really? In one case the government is the boss, in the other case the sole customer.
I can see why people think the difference is immaterial, but in practice it really is very significant. Right now, many (possibly most) physicians are effectively self employed. They either own or pay rent on their office, they pay the nurse, the aid, the receptionist, and the light bill. They pay the hospital to use an operating room, they buy their own equipment and so on. They bill insurance companies and patients for services, and they must pay all the overhead costs and themselves out of that.
That's a bit simplified because of course some doctors are employed by HMOs or work for large clinics or hospitals directly, but the bottom line is that a health care provider gets paid based on the services they provide. Those that can manage their businesses more effectively and attract more customers, will end up making more profit.
Under a single payer system, none of that changes. Doctors still own their own businesses and have the incentive to build the business and manage it efficiently.
Under a nationalized (socialized) system, it changes entirely. The government owns the buildings and equipment, pays the utility bills, pays the receptionist, the nurse, the accountant and the doctor.
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Alcon: I would never suggest that there is one problem to solve and health care would be fixed.
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quote:Originally posted by dabbler: Health insurances need regulation, but I wonder if there's a way to allow for more competition.
The US has the most market driven competitive health care system in the world and it costs us more than double the amount others are paying with worse outcomes. Why in the world would we want to make it more competitive when competition is working so much worse than more cooperation oriented health care systems?
All the evidence suggests that competition in health insurance and health care makes it more expensive and less effective and not vice versa.
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quote:Alcon: I would never suggest that there is one problem to solve and health care would be fixed.
I completely believe you, that wasn't directed at you so much as the world. I've seen way too many people suggests that the be-all end-all solution to everything (but especially our health care system) is getting rid of all regulatory barriers to competition.
I know way too many people, particularly of the Objectivist or Libertarian persuasion or are convinced that more free market competition is the silver bullet to all our problems. To which I can only point at the computer sector. Microsoft and Intel established their monopolies with little help from government regulations.
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quote:Originally posted by dabbler: Health insurances need regulation, but I wonder if there's a way to allow for more competition.
The US has the most market driven competitive health care system in the world and it costs us more than double the amount others are paying with worse outcomes. Why in the world would we want to make it more competitive when competition is working so much worse than more cooperation oriented health care systems?
All the evidence suggests that competition in health insurance and health care makes it more expensive and less effective and not vice versa.
Also - what she said. Competition isn't actually good for a health insurance market. Competition requires having multiple smaller companies trying to undercut each other. But that also means multiple smaller risk pools. The smaller the risk pool the higher the premiums and costs associated.
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I'll buy that. I don't have much invested in the idea that we need to reduce the threshold for new insurance companies.
Honestly I think health insurance companies cover too much and distance the prescriber and patient from the true costs of health care.
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quote:Alcon: I would never suggest that there is one problem to solve and health care would be fixed.
I completely believe you, that wasn't directed at you so much as the world. I've seen way too many people suggests that the be-all end-all solution to everything (but especially our health care system) is getting rid of all regulatory barriers to competition.
I know way too many people, particularly of the Objectivist or Libertarian persuasion or are convinced that more free market competition is the silver bullet to all our problems.
To which it is important to remember: recession, lifetime caps, and exclusion of pre-existing conditions are all done because health insurance isn't regulated against it. Virtually all of the problems with health care in America are from the lack of regulation, not too much of it.
We have an example of an environment of greater non-regulation of health coverage. Unfortunately for the people who desperately want a success story for the actuarial/market model, it's China.
quote:To which I can only point at the computer sector. Microsoft and Intel established their monopolies with little help from government regulations.
It will do no good. They will find a way to blame this on 'statist' influence. They must believe that these issues do not exist in a properly free market. This isn't a matter of preference, it's absolutely crucial to the function of the ideology.
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quote:Originally posted by dabbler: Honestly I think health insurance companies cover too much and distance the prescriber and patient from the true costs of health care.
This is the biggest fallacy in the US system, the idea that if the patient bears more of the cost of health care it will bring overall costs down. This paradigm might work for other things, but it simply doesn't work for health care. There are numerous studies that bare this out but you don't even need to look at the studies, just look at the world around you. In countries where health care is free to the patient, overall health care costs are much lower.
Health care isn't a commodity and if you treat it like a commodity you get things horribly wrong. People wouldn't be lining up for extra stays in intensive care or open heart surgery if they were free, and when they need them they aren't going to shop around for the best deal. What the studies have found is that when people bear the cost of health care, they cut back on the wrong things. They cut back on preventative care, regular check ups, screening, medication for chronic conditions and so on. That means that more problems go undetected and untreated in the early stages when treatment is most effective and least expensive.
US health care isn't more expensive because patients go to the doctor too much. In fact, the average American consults their physician less than in all but one of the OECDs and about half the OECD average. US health care is more expensive in part because too many Americans don't consult their physicians until problems have gotten seriously out of control and require expensive treatment.
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posted
"distanc[ing] the prescriber and patient from the true costs of health care" is ultimately necessary, unless you only want the top 5% of the economic classes to be able to independently access the tools necessary to manage expensive, life-imperiling diseases like Leukemia that strike people independent of choices they have made in life. Genetic diseases, cancer, chronic conditions. They can't be managed with a neo-puritan mindset because in so many conditions they are not a matter of 'personal choice' or 'financial independence.'
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posted
You're misreading me. I'm not saying that the patient needs to pay out of pocket or bear more of the cost. The costs need to be more transparent. Preventative care is very important. However medications (for example) are most frequently regulated by the insurance company because the provider and the patient have no idea what the cost of that medication is.
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posted
It's only the patient who usually remains unaware of base medication cost -- that issue is more related to the collusion between providers and pharmaceutical companies, and only in recent years have these issues become semi-managed by copay mechanisms.
quote:Originally posted by dabbler: You're misreading me. I'm not saying that the patient needs to pay out of pocket or bear more of the cost. The costs need to be more transparent. Preventative care is very important. However medications (for example) are most frequently regulated by the insurance company because the provider and the patient have no idea what the cost of that medication is.
You've lost me. Every medication I've ever purchased on any insurance plan has come with a receipt that listed both my copay and the total cost. I guess a lot of people don't read the receipt but still I can't see how they could make the cost any more transparent unless the patient is asked to pay a larger fraction of the total cost.
And quite honestly, I can't see what difference it makes to know the full cost of the medication if you don't have to pay it. If you are right and people don't know the real cost of their medications, its not because the information is hidden, its right on the receipt. It's because they don't care unless it comes out of their pocket.
edited to add: For several years I was the care giver to my MIL and SIL who were chronically ill and I purchased all their medications. So my experience isn't just with the occasional drugs my husband and I need and our own insurance. My SIL is disabled and on Medicaid and at one point when they were debating cutting prescription drug coverage, we went through all the receipts to calculate what her medications would cost if we had to pay the full amount. That information wasn't hidden. It was on every receipt.
[ February 23, 2010, 03:35 PM: Message edited by: The Rabbit ]
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posted
Maybe there needs to be a concerted effort to advertise the goodness of using Medication A that's 10% the cost of Medication B but is just as good (and sometimes better). Maybe there need to be incentives for choosing Tier 1 medications (Gym Memberships!). Maybe as part of informed consent the prescriber should be taught to include average cost with the risk/benefit and alternatives discussion. If you lose your health insurance, you will suddenly be burdened with that medication cost. It should gain more importance in the decision making process. Prescribing guidelines are rarely taken into account when someone gets Awesome Expensive Med X.
There's a clinic I like in RI that focuses on the uninsured for primary care. They have a subscription model in which you pay a flat fee for the year (sliding scale) then a small ($10 or so) copay for each acute visit. One would still need catastrophe insurance but I think it's a great way to serve an uninsured population and get them into preventative and routine care.
I'm sure each of us come from our own anecdotal background, but I'm writing this as a health care professional who is very concerned with the unnecessary and wasteful spending of health care dollars.
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I think it's too late once you've already picked up your medication to find out how much it would cost by cash.
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quote:Originally posted by dabbler: I think it's too late once you've already picked up your medication to find out how much it would cost by cash.
Only if it's a one time thing and one time prescriptions aren't a significant fraction of the cost of pharmaceuticals.
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posted
So you tell your doctor "Oh, that medication you gave me is awesome, but it's $300 without health insurance. Can we switch?" It's how samples work. People don't want to change medications once they're on them.
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This article suggests that mere knowledge isn't enough, but programs such as the Canadian programs of generic substitution and reference drug programs had potential. We do generic substitution in the US but I don't think we have a reference drug program.A study on a reference drug program and the benefits/problems.
I don't want to fight you. I want to collaborate on useful and reasonable strategies to reduce health care costs (in the theoretical sense, as neither of us are congressmen). It's going to take a LOT of strategies to make the differences this health care system needs to make.
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posted
I'm definitely in favor of regulation that wouldn't let them pull crap like this. Insurance shouldn't be some kind of black box that returns answers with no disclosure of how it got them. It should be clear when you're picking your policy what sorts of things and up to what amounts will be covered.
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posted
The Republican party can catch quite a lot of breaks in this day and age, but their timing on this one is as poor as their statements on the economy pre-crash during the 2008 elections.
This won't have as much of an impact because it is not as immediately visceral nor does it have the same amount of media coverage, but right as we get to the issue of reconciliation over obstruction on the subject of health care reform (and Brown becomes a goat in conservative spheres for daring to vote against a filibuster on the jobs bill ... that was fast), it's happening.
The system is entering a rapid phase of collapse.
quote:WASHINGTON (Reuters) - A third of young U.S. adults -- nearly 13 million people -- had no health insurance coverage in 2008, according to a government report released on Wednesday.
quote:More findings from 2008 National Health survey:
* Although 58 percent of those surveyed had private health insurance coverage, men with insurance were less likely than women to seek medical services.
* Young adults with no insurance were four times as likely as those with private insurance and two times as likely as those with Medicaid to have unmet medical need.
* Uninsured young women were almost twice as likely as uninsured young men to have had unfilled prescriptions in the past year.
* 10 percent of young adults needed medical care in the past year but did not get it due to cost.
posted
Hey DK, I'm still awaiting your response to the pile of evidence you've been presented with - I'd like to know what you make of it.
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posted
Yeah, dabbler, that's what I figure. So I'm just going to keep this thread near the top until he returns - I really do want to see what he thinks of the data.
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quote:Originally posted by Alcon: Well, DK, you asked for data. It has been presented to you. A lot of it. What say you?
Data's not his strong suit. Try some BS. He's got skills in that area.
It's also possible that the guy is just busy with his life, and isn't able to get to a computer in order to subject himself to a dogpiling. He might be more willing to engage you in discussion if you didn't openly insult him.
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