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Interesting Wiki Chart, is not having UHC bankrupting the US?

Discussion in 'Allopathic' started by surftheiop, 03.18.12.

  1. surftheiop

    surftheiop

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    SDN Members don't see this ad. (About Ads)
    This may be common knowledge to a lot of people, but did you all know the Universal Coverage countries governments spend a smaller percent of their budgets on healthcare than the US government does? (Which is especially crazy considering how huge our defense spending is which really increases our total budget compared to all of these other places)

    Interesting chart I found on wikipedia, scroll halfway down link.

    http://en.wikipedia.org/wiki/Health_care_system


    USA government spends 18.5% of budget on healthcare which is a higher percent than Norway, Sweden, Italy, UK, France, Japan, Germany, Canada.

    And our healthcare costs as percent of GDP are almost twice that of most of those countries.
  2. SpecterGT260

    SpecterGT260 Catdoucheus

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    Many of these countries cap their health care spending. The lower expense is not a result of their system but an enforced limit.

    They also have ling waiting lists for anything outside of primary care. Try to get a lumbar fusion done in canada inside of 6 months...
  3. surftheiop

    surftheiop

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    According to that graph the US system causes the most unnecessary deaths out of all those countries and has the highest infant mortality so it doesn't seem like they are letting folks die over there that we are saving here.

    I understand your elective procedures in Canada point though, but for example in Germany doesn't everyone except the poorest people have private insurance almost identical to america anyway?
  4. SpecterGT260

    SpecterGT260 Catdoucheus

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    Yes. One of the things we lack compared to these other countries is the availability of routine health maintenance. I was just saying it is a fallacy to attribute the %GDP to whether or not we comp primary care. Canada's lower cost is not some end result of universal health care but instead a line item in their budget setting their allotted dollars. Their system catches many before there is a problem but largely hangs you out to dry if a problem arises anyways. Better or worse? That's opinion
  5. surftheiop

    surftheiop

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    Good point, I guess in the American system pretty much everyone gets "free" healthcare if you are really sick (you have medicare if old or the ER has to treat you if younger).

    But in these other systems everyone gets healthcare when they are healthier but then there may be less options once your really sick? (But presumably not too many less options given their increased comparative life spans)
  6. SpecterGT260

    SpecterGT260 Catdoucheus

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    I attribute that to a lower prevalence of mcdonalds.
  7. ElCapone

    ElCapone Mafioso In Training

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    +1. And people die while waiting in line for critical surgeries. Look up Chaoli vs Quebec.
  8. surftheiop

    surftheiop

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    So a random few rare occurrences is enough reason to bankrupt the country? There are almost certainly more deaths caused by failure to be able to pay for health care in the states than people dieing while waiting in line in Canada. Heck more people probably die waiting in ER lines in the US than die waiting for surgery in Canada.
  9. Law2Doc

    Law2Doc 5K+ Member Moderator Emeritus

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    Not only this, but we have litigation issues here and practice defensive medicine in ways not necessary in other countries. Additionally there are drug problems in the US not rivaled by a lot if other nations. Etc. There are dozens of reasons why US health is more expensive. Universal healthcare is really just part of the problem, and probably not going to save much unless other things are simultaneously addressed.
  10. surftheiop

    surftheiop

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    I would think a UHC system would pretty much always include pretty strict limits on litigation seeing as the government would be more likely to be the one on the hook. (Like in the US aren't there already pretty strict rules on how much a citizen can sue the US government for?)


    Whats inherently different about the US compared to all the other countries that causes us to have so many more issues when it comes to health?
  11. jdh71

    jdh71 si vis pacem, para bellum

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    I wonder how much of the US number is skewed by end of life care that is expensive, usually unnecessary, and futile. A lot of the heroics we attempt in the ICU they simply don't do in other countries, and I think much of it is cultural more than horrible mean systems that won't pay for it.

    That and third/fourth/hell, fifth line chemotherapies too.
  12. surftheiop

    surftheiop

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    Yeah this is a good point. Sometimes the cynical side of me thinks that these alleged "death panels" we are supposed to be fearing would actually reduce suffering...
  13. sineapse

    sineapse

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    Few points:

    First is that doctors graduate with huge amounts of debt after med school, therefore a major understandable drive is to pursue careers which pay well. Someone quoted me in another thread talking about general surgeons earning 300-400k after finishing residency, that is a huge amount of money. Those costs must be borne by someone.

    Second is the insurance company 'middleman' who comes in and drives up costs.

    Thirdly, from my limited exposure to medicine in the US, I noticed a lot of what is probably defensive medicine. Very thorough, but the workup for a case of diarrhoea in a relatively uncomplicated case I saw was astounding. The recs ran to something like 15 different investigations.
  14. DeadCactus

    DeadCactus SDN Lifetime Donor Lifetime Donor

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    I'd wager our "worse outcomes" come from more attempts at heroic care rather than lower quality care. Infant mortality is easy to keep down if you say anything less than 26 months is non-viable and refrain from intervening. Much easier to keep "unnecessary" procedural deaths down if you toss grandma into hospice if she needs a surgery or chemotherapy...
  15. dr zaius

    dr zaius Lowly Intern

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    Physician salaries are a pretty small amount of total healthcare expenditures in the US. Uwe Reinhardt (Princeton economist) found that doctors receive about 20% of healthcare spending, with 10% of that going to malpractice insurance and practice fees so in the end physicians only take home around 10% of healthcare spending.

    Pretty good blog article here
  16. NickNaylor

    NickNaylor Daisy the Dog

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    When you consider that an overwhelming majority of people on Medicare use the most resources in their last few months of life, I have to imagine that it's heavily skewed. I wonder what the costs would be if you simply cut neonatal and end-of-life ICU stays (this obviously isn't possible in reality, but pretend we could). I'm guessing they'd fall substantially.
  17. sineapse

    sineapse

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    Interesting, thanks for that! I assumed it would be a bigger proportion. Outsider just looking in here.
  18. SpecterGT260

    SpecterGT260 Catdoucheus

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    Ur still assuming that comping primary care won't actually cost MORE. Do u think america will go for diminished access to specialties?
  19. surftheiop

    surftheiop

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    I dont think Americans would mind a German type system where the rich folks still get treated like rich folks, and the poor people who use the ER because its essentially free to them (ie. they will never pay the bill have no assets to seize) will instead get to go to primary care docs for free.
  20. Marcus Brody

    Marcus Brody Already has the grail.

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    For one, we have about 100 million obese people:

    [​IMG]

    Comparing little homogenous European countries and territories to the US is also apples and oranges...given everything you (should) know about American history- particularly about race, territory expansions, and immigration- do you really think our socioeconomic issues are comparable to those of, say, France?

    And what about inherent ethnic differences involved in health care measures? Certain ethnic groups seem to have longevity in their genetics, while others have genetics that predisposes them to some terrible effects of Western diet and lifestyle. Sickle cell anemia, hypertension, etc.
    Last edited: 03.18.12
  21. SpecterGT260

    SpecterGT260 Catdoucheus

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    Cheap. Fast. Quality. Pick 2
  22. Bacchus

    Bacchus PGY Too-many-expectations Moderator

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    That would be why our infant mortality is high.
  23. link2swim06

    link2swim06 PGY-1

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    They say per person, 50% of your LIFETIME healthcare expenses are in the last few months of your life. If we had better end of life counseling we could cut a ton of money.

    But OP here are a list of real factors US healthcare costs more:
    1) Futile end of life care
    2) Higher obesity rate
    3) Worse average diet
    4) Less active lifestyle
    5) Defensive medicine
    6) More schooling for physicians, nurses, etc (more years in school demands more pay)
    7) Greater availability (no waiting lines for near anything in the US)

    Equalize all those factors and I doubt there is any difference in spending per person between the US and other countries is non-existent.

    In all honestly, the easiest way to pay for healthcare is tax the foods which are bad for people. If there was a 25% federal tax for everything at McDonalds (or similar foods) we would be getting to the revenue to pay for people's future health problems from their ****ty diet. The same can be done for smoking and gym memberships can become tax deductible.

    Changing lifestyles is how you "fix" healthcare...not forcing everyone to pay for everyone else's bad habitats via universal coverage.
  24. startoverat40

    startoverat40 MS2

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    we pay taxes to fix our roads. Should we stop doing that because some people drive irresponsibly? we pay property taxes to pay for local schools even if we don't have kids. Why? because what is good for society is good for individuals. so why not pay for universal coverage? living in a sick society is bad for everyone, even the healthy ones. and it makes the US less competitive globally, when 30% of the population are obese. if we had univeral coverage to provide preventive healthcare, they wouldn't get that way. high healthcare costs also contribute to poverty, and poor people tend to eat poorly, cause they can't afford good food (99cent burger vs fruits at $4/lb).

    a society is a tightly interwoven web of interdependence. paying for universal coverage is the humane and civilized thing to do.
  25. link2swim06

    link2swim06 PGY-1

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    We dont stop fixing roads bc of irresponsible drivers, but we do fine and collect a ton of revenue from irresponsible drivers (i.e. speeding, DUIs, etc). Why not collect revenue from people being irresponsible with their health?

    Also per the bolded statement, there are 308 million people in the US...over 80% of which have insurance (aka preventive care available...yet 1/3 of those people are still obese). So have no clue on your logic on that statement.

    "Preventive care as the cure all" is a great buzz phrase for people who are frankly clueless about medicine, the truth is the "preventive care" is a fraction of our needed solutions. Preventive care is based on the notion of high patient compliance and adjusting lifestyles (in many cases). This is one of the hardest things to do in medicine, especially when "nothing is wrong" to the patient and you are telling them to eliminate their favorite foods/activities. Alot of preventive medicine actually increases costs.

    Also that is b.s. that poor people cant afford good food....here is a list for starters http://www.webmd.com/diet/guide/10-healthy-foods-under-1-dollar ...Sure that cheeseburger tastes better to some than a cup of yogurt and a banana, but its a lifestyle choice, not a financial limitation. If I have only $1.00 I could buy a hundred things with more nutritional value than the McDonalds cheeseburger.
  26. startoverat40

    startoverat40 MS2

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    It is easy to tell when a driver is at fault (speeding, DUI, etc), but it's not easy to tell if a person is at fault for their own health. how much of it is genetic/social/economic and how much is personal? we punish people for illegal driving practices, fine them, jail them, suspend their licenses. But we can't punish people for being unhealthy, for whatever reason. Because the price they pay is their LIFE which they can't get back after they die, and it is inhumane and uncivilized for a society to put a price on people's lives like this, and say "sorry you messed up and got sick, now I dont' care if you die because you don't have the money". I find this abhorant! This is rule of the jungle, not a civilized society!

    Obesity is just on aspect of health, and it was used as an example. In many cases of those so-called insurance policies, when people in fact do get sick, the non-surance companies deny them, or the copays and deductibles become unbearable anyway.

    http://yourlife.usatoday.com/health...owing-burden-the-high-cost-of-care/53271430/1

    Employee provided insurance is rapidly declining ....

    http://www.nihcr.org/Employer_Coverage.pdf (pdf)

    62.1% of all bankruptcies in 2007 were medical (and probably higher now)

    http://www.amjmed.com/article/S0002-9343(09)00404-5/abstract

    I agree with you there that preventive care is not a cure all. A lot of it is also patient education, which has to happen at an early age (seems like adults suffering from obesity, diabetes, cardiovascular disease from smoking, etc, don't change their lifestyles even after seeing all the warnings and knowing the health risks - according to studies). But if your parents are poor and uneducated, your school health classes/services are getting cut due to budget constraints (thanks to those who want to gut every social program in sight), and you can't afford to go to regular visits with your doctor, then how/when are you going to get educatd about health? Yes this is a multifaceted and multigenerational issue, and just "preventive care" provided through a few doctor office visits isn't going to fix it. But if we start with that, and especially focus on the young, maybe after a few decades we can reverse the trend.

    again a good point. Thanks for the low cost groceries list, I'll keep it in mind during med school :) But the debate and budget calculations are not so simple. There are a lot of people who have to make a choice between rent, heat, clothes, medicines, and food. barley and lentils as source of protein? What if they can't afford to pay for the gas or electricity to cook them? http://trenches.wordpress.com/2007/01/31/eating-healthy-when-youre-poor-you-cant/ A lot of people barely get by from month to month. Even a minor illness that would keep them out of work could wipe them out and make them homeless.

    And again, this goes to early adoption of lifestyle habits. If you grow into adulthood with bad habits, it seems impossible to change your lifestyle. but again, is that solely a personal issue, or is it a multifaceted social problem? And do we punish members of our society by letting them suffer and die, or do we act humanely and in a civilized way, to provide them with the care that can be provided to them if we allocate our country's resources properly. we spend trillions of our tax dollors on useless wars. nobody can argue that we can't afford to provide universal healthcare.
    Last edited: 03.19.12
  27. Gut Shot

    Gut Shot

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    Cue the usual responses:
    1. Yeah, well, you have to wait in Canada.
    2. We spend more because we're fatter.
    3. We have more technology, like CT scanners.
    4. Our population is less homogenous.

    Some possible retorts:
    1. We have better wait times for specialist care, but we pretty much drop the ball with routine stuff I reckon this reflects our push for treatment-based medicine, but is it really the measure of a good health system?
    1A. How are the wait times for non-emergent procedures when you're uninsured?
    2. We are fatter, but we have significantly lower rates of smoking and alcoholism than most other developed nations, and our cardiovascular disease is middle-of-the-pack. As much as we would all like to simply blame McDonald's and be done with it, this approach isn't exactly rigorous (read it's intellectually lazy wishful thinking)
    2A. The relationship of chronic diseases to health spending is controversial, since sick people who die young stop consuming resources. It's like how not all preventative care saves money, only in reverse.
    3. Look up how many CT scanners we have per capita. Now look up Japan.
    4. Never have figured out why a lack of "homogeneity" would significantly drive health costs.

    If you want a better picture of why our health system is so expensive, I will leave you with two graphs. UC could address one of them... the other is more difficult.

    [​IMG]

    [​IMG]
  28. SpecterGT260

    SpecterGT260 Catdoucheus

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    How about all of the above?

    Do u have a chart w absolute numbers for docs and administrators? Relative growth % can be very deceiving
    Last edited: 03.19.12
  29. Suncrusher

    Suncrusher ☣ ☣ ☣ ☣ ☣ Lifetime Donor

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    american for-profit insurance companies spend 17% of their money paying themselves, paying their shareholders, paying administrators who figure out how to save money by denying claims, etc. To illustrate how outrageous that is, Medicare, for instance, spends only 3% on administrative costs; the other 97% pays for actual healthcare. For-profit healthcare administrators are the only ones getting rich off of our current system and eliminating them would be a smart way to get more bang for our healthcare buck. Japan and Germany both have efficient, competitive systems of private but NON-profit insurance companies that are still highly capitalistic and efficient but not allowed to pay themselves those sort of dividends; they have to put any extra money towards cheaper rates.
  30. MT Headed

    MT Headed snow, PBR, and bears Lifetime Donor

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    This second chart is terrible. It switches from top percentile to bottom percentile part way through, so you have to look at it carefully to figure out what it is trying to say. It would have been much better and more consistent to display this information as a pie chart, since the spending is coming from a pie of 100%.

    Finally, what is it trying to show exactly? That we spend most of our health money on sick people? I'm sure my auto mechanic spends a lot more on the few cars that have serious mechanical problems, and less on simple tuneups (for the few people that bother to get a tuneup (i.e. physical checkup) anymore).
  31. officedepot

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  32. startoverat40

    startoverat40 MS2

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    I believe it is showing that the majority of healthcare spending is from large expenditures per person, but that money is being spent by very few people. 1% of the population is spending 50k per year per person, and that accounts for 20% of total healthcare spending. in other words most of healthcare spending is on very expensive procedure for very few people. Maybe if we could get more people to be able to afford regular checkups with their primary doctor, they could avoid going to the ER when their condition gets too complicated, requiring expensive treatments. ie, we need universal coverage.

    the other graph is showing that we've got more and more MBAs telling MDs what to do.
  33. officedepot

    officedepot

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  34. sineapse

    sineapse

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    So, the poor don't go to the doctor because they are dumb...are you for real?

    The poor and the ignorant are always going to be challenges to healthcare, this is universal. But they turn up in droves here to our PCPs...still poor, still ignorant, but at least they can get access. The lack of primary care access is killing your health system. More preventative medicine, less picking up of the pieces.

    I saw so many trainwreck patients who's quality of health would have been equal to that of a third world country. 50 years old with an EF of 10% odd? Gobsmacked. Where was the primary prevention to stop something like that? Address the problem for a few cents on lowering lipids, blood pressure etc and save a fortune on the PCI bill. What do you think is the bigger burden: ensuring basic primary care and health coverage or paying for some guys disability allowance and lengthy stays in hospital from his massive MI *replace with some other disabling illness*

    Yes, we have waiting lists. Yes, you will have to wait four months to get that lipoma that has been troubling you excised. But what we do not have is people chasing you down for bills and credit cards the moment you step foot into an ED, nor do we have government advice about filing for bankrupcy just because you got sick. http://www.dhs.wisconsin.gov/guide/spec/probdebt.htm Seriously, as physicians and physicians to be, doesn't this make you really uncomfortable? People being in debt for years, families on the breadline with small kids who through no fault of their own got sick? 24% of children under 18 were in families struggling to pay medical bills? http://news.yahoo.com/many-u-families-struggle-pay-medical-bills-140204312.html Come on...have a heart!

    Seriously, a bit of government intervention isn't that bad. Take the long view, not the short view.
    Last edited: 03.19.12
  35. MT Headed

    MT Headed snow, PBR, and bears Lifetime Donor

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    What the graph tells me is that expensive liver transplant is expensive, and it doesn't occur very often.

    You are trying to tell me that if we spent more money on the bottom 95% of the graph, then the graph would be flatter and that would be a good thing. Some other conclusions are that if we spent more money on the bottom 95% of the graph, we'd be spending more money; the system works because it only spends huge sums on those who actually need it. Another conclusion is that we could flatten that graph by removing some of that spending from the 5% and distributing it to the 95%, i.e. ration health care and not give out so many liver transplants in the first place.

    My point is that the graph can be interpreted many different ways to promote many different agendas (healthcare rationing, single payer health billing, status quo, switching political party registration in the 2012 election, etc), but fundamentally it's just a bunch of isolated numbers that tell us little more than the obvious: annual health care expenditures, like annual health care needs, are not distributed uniformly.
  36. surftheiop

    surftheiop

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    Last edited: 03.19.12
  37. surftheiop

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    Most people who say this in public, will tell you in private that they believe certain ethnic groups are lazy...
  38. link2swim06

    link2swim06 PGY-1

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    Let me state, I am not saying the poor should die on the street if they cant afford medical treatment. We need to reduce the cost per individual so paying for the poor so it isnt going to tank our economy.

    The big change in the past 20 years in American health care is a transitioning from treating acute problems to chronic problems. Chronic problems are ridiculously more expensive and have skyrocketed costs. A majority of chronic problems wouldn't exist if everyone eat well, exercised, and didnt smoke. <--- we could punish people who dont follow these habitats (with taxes).

    A public service TV ad or an appointment once every 6 months with a doctor isnt going to reverse the McDonalds multi-million dollar advertising campaign in the typical American.

    Our culture is to be unhealthy. This isnt going to change in our lifetime, which means medicine is going to become all about managing peoples ongoing problems. This means unsustainable costs regardless if its a universal coverage or a private insurance. I find it comical that a post above me states medicare has 3% overhead vs. the 17% overhead of private insurance...is 15% reduction really the problem???

    Do people who go bankrupt, say if their bills were just 15% less they wouldn't have gone bankrupt?...:rolleyes:. Now put that in terms of the entire healthcare system, this is not the silver bullet. Additionally, many would argue the extra cost is worth it because benefits a non-universal healthcare system has...

    This private vs. public argument is just a diversion to prevent addressing core problems. We need a exponential reduction in costs to be comparable with other countries....this is ONLY done by addressing why Americans are more unhealthy, period.
  39. theseeker4

    theseeker4 MS 3

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    I agree with most of this, but the final part isn't quite enough. Exponential cost reduction will only occur when we stop paying for futile care, heroic measures in the terminally ill, etc. As mentioned already, a huge amount of money is spent on surgeries that have no real hope of improving or prolonging life, tests for people already highly unlikely to leave the hospital alive, expensive drugs and therapies for those with less than a month to live, etc. Cutting those costs by refusing to use Medicare/Medicaid to pay for this type of care will do more to save money than anything else proposed, and is exactly why the UHC countries have lower costs than the US.

    Lifestyle changes would improve America's life expectancy and many chronic problems (as would letting extreme premies that could live just die without counting them toward their statistics, but that is another issue) but the real cost issues are the fact that 95-year-old grandma can go into the hospital with paralysis from a stroke last decade, stage 4 cancer through every part of her body, and a dozen co-morbidities complicating her care, and still have we, the taxpayers, spend in the final days of her life more than some doctors earn in a year. All this is done at the urging of family members who have to pay not a single cent of their own money for her care, yet will sue the doctors and the hospital in an instant if not everything possible was done. Address that problem, and costs will drop drastically.
  40. MT Headed

    MT Headed snow, PBR, and bears Lifetime Donor

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    But wouldn't smoking cessation increase healthcare costs ( http://www.nejm.org/doi/full/10.1056/NEJM199710093371506 ) in the long run? A person is likely to have high end-of-life healthcare costs no matter what we do, so hastening this terminal event would eliminate the additional costs of mid-life health maintenance.

    Of course I am not advocating smoking promotion nor its reductio ad absurdum (just euthanize everybody who shows up at the ER, that would save a ton in heath care costs!). I'm just trying to point out that seemingly obvious health care fixes (like smoking cessation and the promotion of more preventative care http://www.nejm.org/doi/full/10.1056/NEJMp0708558 ) are just as likely to drive health care costs up, not down.

    If this was an easy problem, I'm sure a solution would have been discovered by now.
  41. Gut Shot

    Gut Shot

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    Excellent point. The most easily available reference I have (below) reports the following:

    In 1999 in the United States:
    - 3.21 million people in health care settings were employed in "administrative and clerical occupations"
    - this excluded 926,000 in health and life insurance firms
    - this excluded 724,000 in insurance brokerages
    - this excluded consultants

    By my calculations there are approximately 850,000 physicians in the country.

    From Costs of health care administration in the United States and Canada NEJM 349:768-75, 2003.
  42. Gut Shot

    Gut Shot

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    Do let the folks at Kaiser know.

    The low hanging fruit. Most people are actually quite surprised at the concentration of health expenditure. 15 million people suck up the equivalent of 8.6% of the GDP of the richest nation on earth. That's where the big potatoes are kept.
  43. Gut Shot

    Gut Shot

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    Yeah, but wouldn't it be fun to get someone to admit that out loud?
  44. officedepot

    officedepot

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    .
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  45. officedepot

    officedepot

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  46. surftheiop

    surftheiop

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    Sorry, pet peeve of mine, but you do know the slippery slope is a logical fallacy right?
  47. officedepot

    officedepot

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  48. SpecterGT260

    SpecterGT260 Catdoucheus

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    I disagree.... those arent really comparable terms..... but I see where u are coming from.

    I really only use slippery slope in terms of legal discussions where the idea of precedent can effect change similar to a way that a law would. There is nothing fallacious about it - it is acknowledging the possibility of opening doors we do not want to open
  49. sineapse

    sineapse

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    Paid up Conservative right here.

    Numbers don't lie however. You believe that the CDC was lying when they said one in five families struggle to pay bills? Or those 20% of families are all spending their cash on flat screen TVs? :rolleyes:
  50. officedepot

    officedepot

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