Sicko: concerns about US medicine

[Gut Shot]

US has the best healthcare system in the world

I couldn't disagree with you more. The US probably has the best tertiary care in the world, but that's hardly the ideal measure of overall quality. Off the top of my head, if we really did have the best system in the world we would have 100% coverage, low infant mortality, adequate numbers of primary care physicians and specialists in all regions, seamless eletronic record keeping, and highly refined QC protocols to prevent errors. What we do have is 85% coverage (with an indeterminant number undercovered), high infant mortality for an industrialized nation, geographic maldistribution of physicians, fragmented, paper-based record systems that were state of the art in the 19th century, and an perventable error rate that can only be described as "embarrassing." And we're paying top dollar for this mess.

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[hawk126]

Gut Shot – To the extent that we have data which conclusively shows that cigarettes are bad for our health, and, insofar as this sort of data justifies excise taxes levied on cigs, we have data that is similarly conclusive about the effects of triglycerides, etc. So… who is the "great decider" in determining which items are taxed? The same institutions that levy sales taxes currently: state and local legislative bodies and taxing authorities. There's no need for a "big brother" style overseer who decides which decisions are good vs. bad because those who purchase the things that contribute to poor health and diminishing lifestyle (according to the data) are the ones funding the reformed system. With respect to distinguishing between conditions that are naturally occurring (beyond patients' control) vs. those precipitated by lifestyle… there isn't a need for this as those who can afford private insurance will and those conditions would be covered regardless of their origins (just like the current system), and those who can't afford insurance will be covered under Medicaid. As an addendum to my original post (meant to add this previously), Medicaid would cover all those who can prove a need, such that the gap that currently exists (between minimum wage employees who can't afford insurance and unemployeed) would be eradicated.

With respect to your philosophical objections… what are they? And, not to be an a** or a flamer, but do you have similar objections to car insurance premiums being higher for those people with poor driving histories? Do you object to life insurance being more expensive for those who have been actuarially identified as presenting higher risk? Both systems provide means for burdening those who are more likely to use the insurance with the greater cost of doing so and have been arrived at (by and large) by markets. How is taxing as I have outlined above any different? Also, do you argue with my contention that markets are more effective than governments in controlling costs? What about the data presented in the PWC link identifying the true factors that primarily contribute to increased costs in healthcare? Does Socialized Medicine truly provide the means by which these factors can be mitigated? If so, I wish someone could explain exactly how. If we are able to stack the market "deck" in order to decrease those costs identified as contributing to the ridiculous year-over-year increases in healthcare insurance premiums, then don't some of the barriers that currently prevent most of the 40-50 million uninsured Americans from gaining access to good healthcare go away? Thanks for the good discussion!!

 

[sirus_virus]

adequate numbers of primary care physicians and specialists in all regions

This one is a social problem more than anything. Unless you plan on drafting physicians military style, you can always expect certain regions and races to be under-served, and subsequently bring down our healthcare statistics. By show of hands, how many of us plan on going to the city of Compton to practice medicine?

All I am saying is: we need to cover the uninsured somehow, and yes insurance companies and HMOs are the enemies of which we must destroy. But do not expect the U.S to rank high in healthcare just because you slapped insurance on every soul here. The bulk of our problems is of a social nature(racial, obesity, teenage pregnancies etc), and most of these other societies don't have it as bad as we do. IMO, if everyone is covered in the U.S, we might move up a couple spots in the rankings, but that is about all you are going to get.

 

[Gut Shot]

With respect to your philosophical objections… what are they?

Where to begin?

My main philosophical objection centers on my role as a physician. My job, my duty is to look out for the patient's interests. They have problems and I treat them to the best of my ability.

If you want to stratify everyone according to risk for actuarial purposes, what have I become? A shill for the insurance company shareholders. My job is no longer to optimize my patient's health, it's to uncover their bad behaviors so some bean counter can jack their premiums. Goodbye, doctor-patient relationship. There goes any incentive to answer questions honestly regarding diet, exercise, smoking, drinking, drug use and anything else they don't feel they can cop to.

For the record, I'm not an advocate of socialized medicine, but I am an advocate of the socialized model of insurance. Penalizing people for risk is all fine, until it's you that has cancer, or it's your kid that has cystic fibrosis. Suddenly it doesn't look so hot.

I apologize as I am short on time (lousy Step 3), but here is some food for thought:

The Health Care Costs of Smoking
Jan J. Barendregt, M.A., Luc Bonneux, M.D., and Paul J. van der Maas, Ph.D.
NEJM, 337:1052-1057, 1997.

ABSTRACT

Background - Although smoking cessation is desirable from a public health perspective, its consequences with respect to health care costs are still debated. Smokers have more disease than nonsmokers, but nonsmokers live longer and can incur more health costs at advanced ages. We analyzed health care costs for smokers and nonsmokers and estimated the economic consequences of smoking cessation.

Methods - We used three life tables to examine the effect of smoking on health care costs — one for a mixed population of smokers and nonsmokers, one for a population of smokers, and one for a population of nonsmokers. We also used a dynamic method to estimate the effects of smoking cessation on health care costs over time.

Results - Health care costs for smokers at a given age are as much as 40 percent higher than those for nonsmokers, but in a population in which no one smoked the costs would be 7 percent higher among men and 4 percent higher among women than the costs in the current mixed population of smokers and nonsmokers. If all smokers quit, health care costs would be lower at first, but after 15 years they would become higher than at present. In the long term, complete smoking cessation would produce a net increase in health care costs, but it could still be seen as economically favorable under reasonable assumptions of discount rate and evaluation period.

Conclusions - If people stopped smoking, there would be a savings in health care costs, but only in the short term. Eventually, smoking cessation would lead to increased health care costs.

 

[Gut Shot]

This one is a social problem more than anything.

Trust me, if the reimbursment formulas were tweaked there would be a mass exodus of primary care physicians to rural areas. Plenty of FP's would live in BFE if they could clear 250K with a reasonable patient load.

 

[AnesthesiaMD]

This movie is nothing but socialist propaganda, however, it does look entertaining.

 

[hawk126]

Where to begin?

My main philosophical objection centers on my role as a physician. My job, my duty is to look out for the patient's interests. They have problems and I treat them to the best of my ability.

If you want to stratify everyone according to risk for actuarial purposes, what have I become? A shill for the insurance company shareholders. My job is no longer to optimize my patient's health, it's to uncover their bad behaviors so some bean counter can jack their premiums. Goodbye, doctor-patient relationship. There goes any incentive to answer questions honestly regarding diet, exercise, smoking, drinking, drug use and anything else they don't feel they can cop to.

I'm sure that I'm missing something, but I don't understand your comment about the stratification of patients and the perceived effects on patient-doc relationships. I must not have communicated my ideas effectively because the increased cost burden born by patients partaking in undesirable behaviors is conferred through taxation. Consequently, the root cause by which a patient contracts an illness is irrelevant because each patient is treated the same whether he's a Medicaid or privately insured patient. The main thrust here is that market based pressures decrease costs of treating patients in general, so resources stretch farther (further?) and as a result you don't have to make decisions about the manner in which you treat patients based on the costs. As an aside, I'm married to a PA and have doc-friends who constantly complain about the extent to which financial resources play into their decisions about delivery of care. Hate to sound condescending, but if you don't think that the limitations on resources will play a part in your decision making in the current system, I don't know what to tell you.

Trust me, if the reimbursment formulas were tweaked there would be a mass exodus of primary care physicians to rural areas. Plenty of FP's would live in BFE if they could clear 250K with a reasonable patient load.

In my relatively limited experience this doesn't jive with reality. I live in the most remote part of West Texas (120 miles east of El Paso) and have shadowed an internist who staffs our small, 15-bed hospital, rural health clinic, and ED for 2 years. This guy gets paid big bucks (approx. $300,000) because the critical access designation imparted by the fed on our community hospital provides for funding that amounts to HUGE subsidization based on the cost for maintaining the solvency of the hospital rather than the patient volume. He gets his big a** payday in spite of sharing the call responsibilities with another doc plus 2 midlevels. Whether or not this critical access designation is a widespread phenomenon, I don't know, but the reimbursement schedule for care provided in similar facilities is highly favorable and the companies that manage these types of facilities make $ hand over fist.

BTW - Good luck with USMLE. I hope to be in your position studying hard very soon.

 

[spartanwarrior]

This one is a social problem more than anything. Unless you plan on drafting physicians military style, you can always expect certain regions and races to be under-served, and subsequently bring down our healthcare statistics. By show of hands, how many of us plan on going to the city of Compton to practice medicine?

All I am saying is: we need to cover the uninsured somehow, and yes insurance companies and HMOs are the enemies of which we must destroy. But do not expect the U.S to rank high in healthcare just because you slapped insurance on every soul here. The bulk of our problems is of a social nature(racial, obesity, teenage pregnancies etc), and most of these other societies don't have it as bad as we do. IMO, if everyone is covered in the U.S, we might move up a couple spots in the rankings, but that is about all you are going to get.

Well spoken. I couldnt agree more with what you said. Logically, if we did what gunshot said, we would be putting a bandaid on an aneurysm or something!!! Clearly, the problem is not that everyone is not covered, it has to do with lifestyle choices and social problems. Clearly, when we have so many illegal immigrants coming into our country for the last 20 years and they are having babies here like crazy, yes then we have a huge problem to cover those millions of immigrants coming in south of the border (which are not only mexican). Just go to a california hospital and see the damage waiting in line. Hospitals and insurance companies are losing so much money on paying for people, indigants, and welfare people, illegal immigrants who cant pay a dime for any healthcare but expect the best treatment nonetheless. Your never going to see a hospital turn away a trauma or code of a person who is not able to pay anything!!! Clearly, we have social issues to deal with in this country which correlate to our healthcare problems!!

 

[novawildcat]

Well,

I would like to ask you something. Have you ever lived in Japan sir? I doubt you have. I have lived there for two and a half years. Researched the Japanese healthcare system and having a clear idea about why the Japanese live longer than US people. It's because of their lifestyle pal, not their healthcare system. Their healthcare system is not as good as ours. The reason that you see the ubiquitous 80 year old woman or man in Japan riding a bike to get groceries or everyone walking to work, or eating a balanced diet. Yes, Japanese smoke, but not as much as Americans do in volume of cigarettes. They work just as hard as Americans. If you lived in Japan, you would know this seeing the typical salary man exhausted after 12 hours of work at the office. Complete ignorance to state things you cant back up without having lived there to see it. I have. You are wrong sir, just as you are most likely incorrect about Europe. US has the best healthcare system in the world and the difference between the US standard of living next to Japan, which is #2 in GDP, is amazing. When 15% of the country is not covered adequately or completely, that is not an excuse to say let's destory the old system, unless most are not covered. Small changes can be done, not drastic ones. Lifestyle has so much bearing on longetivity rates. Yes, readily accessible healthcare is important, but I think you drastically underestimate the significance of lifestyle habits and dieting. Easy to write that off as mundane and trivial things.

Great just what we need, more anecdotal evidence.

I would like to ask you something. Have you ever lived in Japan sir? I doubt you have. I have lived there for two and a half years. Researched the Japanese healthcare system and having a clear idea about why the Japanese live longer than US people. It's because of their lifestyle pal, not their healthcare system.

No one is saying that lifestyle isn't a key determinant in overall health. Why don't you understand this? However you are completely ignoring another key determinant to good health--accessible and affordable quality health care. Life style AND the health care system both have roles in determining overall health. You sound like a fool claiming otherwise.

Their healthcare system is not as good as ours.

where are your facts to prove this bold claim?

Yes, Japanese smoke, but not as much as Americans do in volume of cigarettes.

Do you even know how to interpret data? Rates 90% of the time will always be more important than actual volume. The United States may or may not smoke more total cigarettes than Japan (I don't know I haven't researched it), BUT THE POPULATION OF THE US IS ALMOST 3x's MORE!! You have to take the amount of smoking in Japan vs. the amount of smoking in the US relatively to each other but also keep in mind the total population i.e. a rate! The prevalence of smoking in Japan among adults is definitely higher than in the US, in fact Japan has the highest cigarette consumption per capita in all industrialized nations. So it is just Americans that have unhealthy lifestyle habits eh? Read it in the Wall Street Journal. http://interactive.wsj.com/archive/retrieve.cgi?id=DI-CO-19990812-002140.djml

Quite amazing actually when you see that Japanese have some of the highest rates of smoking but also some of the longest life spans.

They work just as hard as Americans. If you lived in Japan, you would know this seeing the typical salary man exhausted after 12 hours of work at the office. Complete ignorance to state things you cant back up without having lived there to see it.

What does this converstation have to do with how hard people in Japan work? In fact, if you haven't seen it on the news, guess which people get the least amount of vacation time per year and who tend to work the longest work week hours? Americans do. Americans work more hours per week on average than everyone else in industrialized nations.

You are wrong sir, just as you are most likely incorrect about Europe. US has the best healthcare system in the world and the difference between the US standard of living next to Japan, which is #2 in GDP, is amazing.

US THE BEST HEALTH CARE SYSTEM IN THE WORLD?

Also you do realized that according to the UN's human development index, the US has always managed to be in the top 10 for standards of living, but places like Norway, Japan, and Canada have all fared better in terms of standards of living. But this is something else to argue about a different time.

When 15% of the country is not covered adequately or completely, that is not an excuse to say let's destory the old system, unless most are not covered. Small changes can be done, not drastic ones.

Please tell me what small changes need to be made to insure 40-50 million people. I am all ears. I bet if you could figure that out, you would win a nobel prize.

Lifestyle has so much bearing on longetivity rates. Yes, readily accessible healthcare is important, but I think you drastically underestimate the significance of lifestyle habits and dieting. Easy to write that off as mundane and trivial things.

No one in this thread has said lifestyle wasn't important. You are drastically underestimating how many people are dieing and suffering only because of the way the health care system is run in this country. I don't think it is mundane or trivial that there are millions of hard working Americans who can't even afford their own insurance premiums and have to choose between either A.) paying for their medication or B.) being able to eat tthat day. Having to force someone to choose between A or B is just completely sick.

Well spoken. I couldnt agree more with what you said. Logically, if we did what gunshot said, we would be putting a bandaid on an aneurysm or something!!! Clearly, the problem is not that everyone is not covered, it has to do with lifestyle choices and social problems. Clearly, when we have so many illegal immigrants coming into our country for the last 20 years and they are having babies here like crazy, yes then we have a huge problem to cover those millions of immigrants coming in south of the border (which are not only mexican). Just go to a california hospital and see the damage waiting in line. Hospitals and insurance companies are losing so much money on paying for people, indigants, and welfare people, illegal immigrants who cant pay a dime for any healthcare but expect the best treatment nonetheless. Your never going to see a hospital turn away a trauma or code of a person who is not able to pay anything!!! Clearly, we have social issues to deal with in this country which correlate to our healthcare problems!!

ALRIGHT THIS HAS TO BE THE MOST IGNORANT, MOST UNINFORMED, AND DUMBEST POST I HAVE EVER READ ON SDN. The problem isn't the fact that 40-50 million people don't have insurance but it is only because of lifestyle choices? You are completely insane. When one of those 40-50 million person has something happen to them say like breaking a finger or becoming infected with strep throat, but can't afford to go to the doctor to get the finger fixed or can't afford antibiotic medication how is lifestyle to blame for this?

Let me guess, you are the typical premed who has never even set foot out of college yet and has lived under their parent's insurance plan their entire life and will be going to medical school right after graduating from college and won't have even worked in the real world until you are about 28. Well let me tell you this pal, I have lived the hell it is for 50 million Americans with no insurance and did it for a year and a half. Do you have any idea what is it like to live in 5 weeks of excruciating pain because you jammed two of your fingers playing basketball with your friends and most likely tore some of the ligaments in your fingers? Uh oh too bad, you don't have insurance so the only thing that you can do is go to the drug store and pound OTC painkillers like candy until the pain just simply stops.You probably have never had to go through anything like that before. There are quite literally millions of other Americans out there with much much much worse stories than me of having to live with no insurance.

Clearly, when we have so many illegal immigrants coming into our country for the last 20 years and they are having babies here like crazy, yes then we have a huge problem to cover those millions of immigrants coming in south of the border (which are not only mexican). Just go to a california hospital and see the damage waiting in line. Hospitals and insurance companies are losing so much money on paying for people, indigants, and welfare people, illegal immigrants who cant pay a dime for any healthcare but expect the best treatment nonetheless.

More stupidity. 8 out of 10 people who are uninsured DO work and are American citizens. The millions of uninsured aren't simply just illegal immigrants or lazy unemployed folk.

Your never going to see a hospital turn away a trauma or code of a person who is not able to pay anything!!!

What about someone who isn't insured and who isn't in a life or death situation? If someone comes into the ER with a broken arm or a broken collar bone, but no health insurance, what is that person to do? They could get treatment that would cost an outrageous amount and could possibly bankrupt them or they could simply do nothing about it. You'd be surprised at how many people actually choose to do nothing about it because they simply can't afford it.


Seriously you know what scares me more than WMDs, terrorists, AIDS, etc.? It is people like you who are so ignorant of the world around them that aren't even in touch with reality any more. Who are you? The magical man from happyland who lives in a gumdrop house on lollipop lane? I'm sorry my friend, but the world around you and the health care situation in the US isn't as sugar coated as you believe.

 

[emttim]

You're assuming that insurance overhead is the sole reason for high healthcare costs and peoples' inaccessibility to healthcare, which simply isn't true. Theoretically is it a better system, yes. In practice, will it be? I don't think so.

I also don't see the point in "fixing the problem" of a small portion of the population, but forcing the entirety of the nation to participate in it. I think the US could find ways to fund healthcare subsidization for the poor or underinsured without forcing everyone to change their healthcare plan. Even in these cases where people are in socialized medicine, it's not uncommon for people to also take out private insurance so they can be seen by specialists of their choice in a reasonable time at a more private facility. Now that person has to pay twice to get the same thing they were getting before. That's fair..?

Government-run insurance right now is also one of the worst reimbursers, according to what I've heard. It may "reduce healthcare spending," but that means hospitals will be making less. I'm not sure if that's good for the future of our healthcare system, especially as the baby boomers hit retirement and their kids age. We're already on the cusp of a healthcare crisis due to too few doctors and nurses, paying them worse while keeping medical school prices high surely isn't going to fix that problem.

I don't have time to respond to everyone so I'll just seize on this. Firstly, Medicare/Medical/Medicaid pays extremely poorly, if ever...they have peopl devoted to trying to find ways to deny health provider claims so they don't get paid. I just got hired on with an ambulance company and my boss told me that sometimes they get paid as little as $12 for a BLS transport that costs $800.

As far as Americans being fat/lazy/risky, even the ones that maybe aren't due to that such as diabetes usually are when it comes to healthcare costs associated with them. Most of the time that a diabetic has to go to the hospital, its via a 911 call because said diabetic decided not to take his/her medication or eat, so it's their own fault.

It basically boils down to that healthcare costs will be reduced only after Americans stop being idiots and sueing doctors just to get rich, which drives up costs, weighing 800 pounds, which drives up costs, stiffing their medical bills, which drives up costs, and engaging in risky/stupid behavior which again drives up costs.

 

[novawildcat]

It basically boils down to that healthcare costs will be reduced only after Americans stop being idiots and sueing doctors just to get rich, which drives up costs

Evidence from states indicates that premiums for malpractice insurance are lower when tort liability is restricted than they would be otherwise. But even large savings in premiums can have only a small direct impact on health care spending--private or governmental--because malpractice costs account for less than 2 percent of that spending.

-Congressional budget office http://www.cbo.gov/ftpdoc.cfm?index=4968&type=0



Try again.

stiffing their medical bills

50% of all bankruptcies in the US are triggered by medical care bills. If you are bankrupt because you chose to seek medical care, how are you supposed to pay the bill?

Most of the time that a diabetic has to go to the hospital, its via a 911 call because said diabetic decided not to take his/her medication or eat, so it's their own fault.

how many of the 50 million uninsured Americans that are diabetic had to choose between either eating or taking their diabetic medication because the cost of medication is unaffordable? Do you realize that a ton of people end up going to the ER because they chose to forgo medication, tests, and other procedures that they were supposed to get because they simply couldn't afford it?

weighing 800 pounds, which drives up costs, stiffing their medical bills, which drives up costs, and engaging in risky/stupid behavior which again drives up costs.

I think you have ignored what has been pointed out before multiple times in this thread--that people all over the world have unhealthy lifestyle habits, not just Americans, but Americans tend to do worse than everyone else.

You have also ignored the facts that were pointed out earlier--that the administrative costs in the US are a BIG reason why health care is so expensive. Also, people who don't have insurance end up driving up costs because they receive much less preventative care and only get care when things are extremely bad, which is more expensive than if they were treated in the first place with preventative medicine.

Firstly, Medicare/Medical/Medicaid pays extremely poorly, if ever...they have peopl devoted to trying to find ways to deny health provider claims so they don't get paid.

BUT THAT IS EXACTLY WHAT PRIVATE INSURANCE COMPANIES TRY TO DO. Insurance companies will try to make the patient pay for everything by denying claims left and right.

 

[BlackSails]

Evidence from states indicates that premiums for malpractice insurance are lower when tort liability is restricted than they would be otherwise. But even large savings in premiums can have only a small direct impact on health care spending--private or governmental--because malpractice costs account for less than 2 percent of that spending.

This ignores the fact that lawsuits case doctors to practice defensive medicine, which is wasteful and expensive. Uneeded tests push the cost of health care up for everyone.

 

[emttim]

This ignores the fact that lawsuits case doctors to practice defensive medicine, which is wasteful and expensive. Uneeded tests push the cost of health care up for everyone.

Right Rogue, but it's easy for the pro-socialism camp to ignore simple facts such as that because it pokes huge holes in their cause, and that's what I was hinting at anyway when I said pts need to stop sueing their doctors just to get rich if they wanna help make healthcare cheaper...it'd help stop the ridiculous amount of defensive medicine.

 

[kronickm]

Medicine, like everything else in this country, is dominated by money. That is the issue at heart. The problem, as I see it, is that in having FOR-PROFIT insurance companies running the health care decisions for most people there is a direct conflict of interest. A conflict of interest in that, doing what is right for someone's health; tests, procedures and whatever else, comes right out of the profits of the HMO. Thus, the health of the patients, and the goals of the companies maintaining the health of the patients are at odds with each other. Unfortunatly, it is often the doctors who get screwed.

Do I have a solution to this? No. If I did you better believe I wouldn't be some shlump trying to get into med school, I would be holding the damn Nobel Prize (Nobel Prize in Geniusness).

Basically it is a very flawed system. Michael Moore, however, is an inflammatory p.o.s. and although some of us can see through his democratic propaganda and realize that there is a serious issue here, most people either blatantly ignore it because of his idiocy, or blindly follow it because of theirs.

 

[Gut Shot]

I'm sure that I'm missing something,

Likewise, because I cannot figure out what you're saying. I'll just bray on some more and hope that clarifies things somewhat.

Say Patient X comes in and his cholesterol is elevated, he's got early Type 2 diabetes, and his blood pressure is up. He also smokes two packs a day. This puts him in a higher risk category for future cardiovascular events. In my world I counsel him to stop smoking, put him on medications and send him out the door with appropriate follow-up. In a world of actuarial health insurance, his smoking status and laboratory results are forwarded to his insurance company, which reassesses his risk and increases his premium accordingly. I don't know about you, but I don't enjoy the thought of my insurance company digging around in my medical chart.

So what is Patient X's incentive to tell me he's a smoker? What's his incentive to have his cholesterol tested? He might as well stay home, drink cod liver oil and hope for the best. But let's say he's honest and gets dropped due to his risk. Unfortunately he's not going to disappear. Now his cholesterol and smoking will go unchecked, and eventually he'll probably end up in the ER, getting the most expensive and least effective care available. He'll be billed but can't pay, so after entering bankruptcy the hospital will eat the costs and pass them on to someone else. Sounds fair, eh? Call me crazy, but I don't think the best approach to addressing people with higher risk is to make it more expensive and difficult for them to obtain care.

Furthermore, why focus on modifiable variables like smoking? The largest risk-determining factor is age. If you propose that costs be borne by those with highest risk, then you're certainly not immune from the consequences, even if you eat right, refrain from smoking, abstain from alcohol, don't sleep around, and jog two miles per day. As a young healthy person you'll have no problem getting insured, and your premiums will be relatively low. Alas, we will all reach a point when we're a lousy bet for the insurance companies, and the premiums will be far too crippling for virtually anybody to carry.

This is part and parcel with why the market fails in healthcare. Don't get me wrong, I'm a huge fan of free markets, but the aren't a panacea. This isn't a matter of Oster going head to head with Hamilton Beach to make a more affordable toaster oven. Like any other business, insurance companies don't make money by writing checks. Their purpose is to extract more in premiums then they pay out in coverage. Every inpatient facility I have worked in has had at least one full time employee whose entire job is to fight with insurance companies over paying for services deemed necessary by the doctors but questionable by the payor. It's not pretty, but it's the way of things since your insurance's company's goals are often at odds with your health needs.

This is why Medicare exists. People over 65 need healthcare, so they pay about 4% of their gross through their working lives and get coverage when nobody else will take them.

Hate to sound condescending, but if you don't think that the limitations on resources will play a part in your decision making in the current system, I don't know what to tell you.

I am overtly aware of limited resources. Two of my primary training sites are a county hospital and a VA. What is so frustrating is that we are already spending absurd sums of money on healthcare, to the point where a significant increase in distributive efficiency could give "Cadillac care" to every citizen. Yet a sizable contigent of the population remains curiously attached to our fragmented, piecemeal system.

In my relatively limited experience this doesn't jive with reality.

I'm not saying that certain areas wouldn't experience chronic shortages, but I do firmly believe that most of the problem could be solved through stable financial incentives that go beyond loan repayement programs.

BTW - Good luck with USMLE. I hope to be in your position studying hard very soon.

Be careful what you wish for.

 

[LifetimeDoc]

Call me crazy, but I don't think the best approach to addressing people with higher risk is to make it more expensive and difficult for them to obtain care.

I'm beginning to think that people who are against any form of universal health care are of the mind that the majority of illness is the patient's fault, thus they shouldn't have to bear the cost of providing preventative/curative/palliative health care services to those patients.

You'd think people going into health care would wish that everyone could benefit from advances in health care, especially those that are preventative and those that are low cost/basic because we care about human beings and their welfare. If you think of people as undesirable or different than you, you can easily brush them aside.

 

[novawildcat]

This ignores the fact that lawsuits case doctors to practice defensive medicine, which is wasteful and expensive. Uneeded tests push the cost of health care up for everyone.

Right Rogue, but it's easy for the pro-socialism camp to ignore simple facts such as that because it pokes huge holes in their cause, and that's what I was hinting at anyway when I said pts need to stop sueing their doctors just to get rich if they wanna help make healthcare cheaper...it'd help stop the ridiculous amount of defensive medicine.

Wrong again. Do you people have any facts to back up your claims at all?

If you actually took time to read the link from the Congressional Budget Office that I posted you would see that there is a wealth of information in there including

Advocates or opponents cite other possible effects of limiting tort liability, such as reducing the extent to which physicians practice "defensive medicine" by conducting excessive procedures; preventing widespread problems of access to health care; or conversely, increasing medical injuries. However, evidence for those other effects is weak or inconclusive.

Also

Proponents of limiting malpractice liability have argued that much greater savings in health care costs would be possible through reductions in the practice of defensive medicine. However, some so-called defensive medicine may be motivated less by liability concerns than by the income it generates for physicians or by the positive (albeit small) benefits to patients. On the basis of existing studies and its own research, CBO believes that savings from reducing defensive medicine would be very small.

Here is the link again for the 3rd time: http://www.cbo.gov/ftpdoc.cfm?index=4968&type=0

Actually read it this time. You might learn something new.

 

[MagicalTrevor]

Taxes in Canada are astronomical and are in no way cheaper for the average person with insurance. Think about paying out a huge portion of your income to the government in taxes.

 

[Gut Shot]

I'm beginning to think that people who are against any form of universal health care are of the mind that the majority of illness is the patient's fault, thus they shouldn't have to bear the cost of providing preventative/curative/palliative health care services to those patients.

I think it's a common sentiment amongst the young and healthy. It tends to evaporate with age.

 

[hawk126]

double post

 

[hawk126]

Gut Shot - I now understand exactly what you mean and agree with those objections. I think that the misunderstanding originated from my comments about actuarial considerations in assessing premiums for car insurance, etc. With respect to placing the financial burden on those who make unhealthy decsions, I was speaking specifically about my idea of taxing cigs and unhealthy food to fund medicaid more expansively so as to include as many of the 50 million uninsured Americans as possible. I'm absolutely in favor of doing whatever we can (short of socialized medicine or one payer system) to help the uninsured because I believe that to be one of the most signficant factors affecting healthcare delivery costs.

I'm beginning to think that people who are against any form of universal health care are of the mind that the majority of illness is the patient's fault, thus they shouldn't have to bear the cost of providing preventative/curative/palliative health care services to those patients.

You'd think people going into health care would wish that everyone could benefit from advances in health care, especially those that are preventative and those that are low cost/basic because we care about human beings and there welfare. If you think of people as undesirable or different than you, you can easily brush them aside.

I can definitely understand how you'd get that impression, but speaking for myself, this is not the case. My problem with those who posit universal care or a one payer system as the solution to rapidly increasing health care costs is that I honestly can't see how removing consumerism from the equation solves the problem.

In general, I've yet to hear specifically how socialized medicine reigns in costs. All I ever hear about is that Europe's care is "free" and everyone is covered so it HAS to better than our system. To me, this is empty reasoning. Europe's costs per capita are lower because they don't have to worry about an uninsured population or charity care artificially inflating costs, but their nominal costs are going up just as quickly as ours because people are still fat, they still smoke, and they still lead sedentary lifestyles. My belief is that adopting a universal care system doesn't solve the problem of rapidly advancing costs to the consumer as effectively as the introduction of free markets and consumerism would.

The issues with healthcare stem from a system that creates uninformed consumers who are not motivated to shop for value and from the fact that medicaid doesn't cover people who decide to work at, or close to, minimum wage. The transparency issues are enormous and pundits (in my mind anyway) are right to consider moral hazzard issues with one payer systems. I can see some of the benefits of a one payer system, that system doesn't maximize the potential benefits of producer competition. Consequently, I still don't understand why a one payer system is preferable to a one where people can buy their own insurance given that we can extend medicaid to cover hard working people who can't afford premiums.

Any economist or historian of economics will tell you that prices decrease when: producers can take advantage of scale or increase productivity; or the number of producers increases; or consumers gain access to info and have choices!!

According to the following paper, consumerism (read high deductible insurance plans coupled with HSA's) is already working to reign in premium costs because of the consumer's vested interested in shopping for value and because of the increased access to information.
http://www.pwc.com/extweb/pwcpublications.nsf/docid/E6A8ED7ADD70AA038525726F0081E88E

Value shoppers, not government agencies, pressure producers to find ways to be more efficient. Markets work best to curtail price increases when there are lots of producers and lots of informed consumers who can choose which products and services to buy freely not when they are regulated or paid for by governments. Why not give those consumers who purchase their own insurance a big a** tax break and tax unhealthy foods and cigs in order to raise the funds to expand medicaid?

 

[LifetimeDoc]

The problem with applying consumer-driven or profit-motivated economics to health care is that you have to have winners and losers in those types of systems. That's no big deal when we are talking about automobiles, computers, or entertainment. But, when it comes to people's health, can we really accept the fact that in a market-driven system some people will not obtain health care and either suffer or die in the process?

As for choice, people don't have a choice when they are sick or in need of medical care. They goto the doctor, or somebody they were referred to, and may get a second opinion. There is no appreciable "shopping around" that you can do to get the best deal on that appendectomy, CT-scan, blood test, or physical exam...especially when you are not able to afford the cost of seeing multiple physicians or going to appointments while you are working.

The problem with profit-driven insurance is that there is a direct conflict between the patient's health and the profit of the insurance company. The company isn't interested in the long-term health of the patient, but is only interested in what they can obtain for the shareholders in the short term. So what if we don't cover the screening test or whatever procedure the patient needs...it's not like it's going to affect us for 5-10+ years! Don't you see the conflict there?

 

[sirus_virus]

I just get pissed when all these "I ruv to save the uninsured" people make all these arguments for universal healthcare, then when you ask them how we fund it, no one has the balls to use the words "tax increase". Some even kick it up a notch by suggesting it will be free.

Yes, the argument sounds sexy until the funding part comes up. When you guys are ready to tell America how much extra in taxes we need to pay for Universal healthcare, then we can talk. In the meantime, we can all sit back and entertain ourselves with UN statistics and Micheal Moore movies.

 

[LifetimeDoc]

I just get pissed when all these "I ruv to save the uninsured" people make all these arguments for universal healthcare, then when you ask them how we fund it, no one has the balls to use the words "tax increase". Some even kick it up a notch by suggesting it will be free.

Yes, the argument sounds sexy until the funding part comes up. When you guys are ready to tell America how much extra in taxes we need to pay for Universal healthcare, then we can talk. In the meantime, we can all sit back and entertain ourselves with UN statistics and Micheal Moore movies.

Being myself an older person, I have a different perspective than the younger set here on SDN. I can see my own mortality, my own sense of worth, and our place in life. I've seen what not having adequate health care access has done to dozens of people while shadowing/volunteering/personal experience. I've been poor and upper-middle class being without and with health insurance. Luckily I've been healthy, though recently my health is borderline unhealthy with regards to BP and lipids.

I ask the question, what is wrong with tax increases if those funds are used for the greater good and not towards wasteful or selfish interests? Is that second iPOD on your six-figure salary worth funding health care for another human being? I'm all for being against wasteful spending in government. There is way too much spending on special projects or funding wasteful bureaucracy. But, I would give up 10% of my salary if it meant that everyone would have access to life-improving health care if that's what it would take.

Why the hell are we going into health care anyways? To improve health for people or to ensure our own fat financial future?

 

[TheRealMD]

Being myself an older person, I have a different perspective than the younger set here on SDN. I can see my own mortality, my own sense of worth, and our place in life. I've seen what not having adequate health care access has done to dozens of people while shadowing/volunteering/personal experience. I've been poor and upper-middle class being without and with health insurance. Luckily I've been healthy, though recently my health is borderline unhealthy with regards to BP and lipids.

I ask the question, what is wrong with tax increases if those funds are used for the greater good and not towards wasteful or selfish interests? Is that second iPOD on your six-figure salary worth funding health care for another human being? I'm all for being against wasteful spending in government. There is way too much spending on special projects or funding wasteful bureaucracy. But, I would give up 10% of my salary if it meant that everyone would have access to life-improving health care if that's what it would take.

Why the hell are we going into health care anyways? To improve health for people or to ensure our own fat financial future?

At the moment though, the phrase "tax increase" when our current government can't get its **** together is what probably scares most people away. When the government rarely thinks about sound fiscal policy, no wonder people say they don't want to fund "universal healthcare" when the taxes we already pay are so often abused.

Personally, you'd need a strong president to restore trust in the system before we can a) raise taxes so that we will be able to b) fund universal healthcare.

 

[NCF145]

I couldn't disagree with you more. The US probably has the best tertiary care in the world, but that's hardly the ideal measure of overall quality. Off the top of my head, if we really did have the best system in the world we would have 100% coverage, low infant mortality, adequate numbers of primary care physicians and specialists in all regions, seamless eletronic record keeping, and highly refined QC protocols to prevent errors. What we do have is 85% coverage (with an indeterminant number undercovered), high infant mortality for an industrialized nation, geographic maldistribution of physicians, fragmented, paper-based record systems that were state of the art in the 19th century, and an perventable error rate that can only be described as "embarrassing." And we're paying top dollar for this mess.

And all of this can be acheived without the government regulating healthcare. Yes, insurance companies and HMOs are ruining the practice of medicine; however, the government's involvement will cause the efficiency factor of medicine to drop even lower than it already is.

Also, people get upset when some person in a cubicle tells the doctor that some test or procedure can't be performed. By putting the government in control all you are doing is changing who will be dictating what can and can't be done. Instead of an insurance company employee making the decision, it will be an employee of the government.

 

[hawk126]

I respect your opinions but I disagree with absolutely every aspect of your post:

The problem with applying consumer-driven or profit-motivated economics to health care is that you have to have winners and losers in those types of systems. That's no big deal when we are talking about automobiles, computers, or entertainment. But, when it comes to people's health, can we really accept the fact that in a market-driven system some people will not obtain health care and either suffer or die in the process?

Right now, you're right: there are winners (covered people) and losers (hard working people who can't afford insurance). However, the fact that the current system, which bears absolutely no resemblence to a consumer-driven market BTW, produces winners and losers has nothing to do with the potential benefits that could be had by employing a system based on the consumer. I'll say it again... my hope is that we provide a huge tax credit for those people who purchase their own insurance and tax the unhealthy things that cause much of the preventable disease in order to expand medicaid... changing medicaid so that preventative and wellness care is reimbursed would obviously be necessary as well. To state categorically that consumerism produces "winners" and "losers" and is therefore bad is simplistic to say the least. To reiterate: there is no other way to drive prices/costs down (outside of a soviet style regulatory intervention) in any field other than to employ consumerism and initiate competition between providers of goods and services. No matter how badly the commies wished for prices to stabilize, they didn't and couldn't because of the flawed ideology. The same criticism applies here: you can't wish and hope for prices to decrease...

As for choice, people don't have a choice when they are sick or in need of medical care. They goto the doctor, or somebody they were referred to, and may get a second opinion. There is no appreciable "shopping around" that you can do to get the best deal on that appendectomy, CT-scan, blood test, or physical exam...especially when you are not able to afford the cost of seeing multiple physicians or going to appointments while you are working.

There's no "appreciable shopping around" because, currently, there are too many barriers to transparency. With the right approach these barriers could be legislated away... think sarbanes-oxley type compliance in healthcare. Even as I type this response there are more and more companies/hospitals making information on physicians, procedure pricing, and outcomes available on the internet so that healthcare "customers" have more access to the information necessary to "shop around" than ever before. Why have these services cropped up? Due to the advent of high deductible plans which are combined with FSA's, HSA's, etc. in order to facilitate a vested interest in value on the part of the CONSUMER. This information will only become more readily available in the future as these plans become more widespread. Moreover, plans that provide the insured with more leeway in choosing their physicians (PPO's) are more available than ever. For consumerism to work, HMO's must be legislated away and some regulation guranteeing the consumer's right to chose his own physician must be enacted. Once again, you're indicting the limitations of the current system (HMO's in particular) not of consumerism and free markets.

The problem with profit-driven insurance is that there is a direct conflict between the patient's health and the profit of the insurance company. The company isn't interested in the long-term health of the patient, but is only interested in what they can obtain for the shareholders in the short term. So what if we don't cover the screening test or whatever procedure the patient needs...it's not like it's going to affect us for 5-10+ years! Don't you see the conflict there?

This statement belies a serious misunderstanding of the dynamic between consumers and producers. Based on your logic, no entity would ever be motivated to provide quality services or products to any consumer EVER because of the short term interests in producing value for shareholders. This problem is resolved when consumers have the opportunity to vote with their wallets. If you rationale were legitimate, no consumer in any capitalist economy anywhere in the world would have an opportunity to purchase quality because no producer would have an interest in providing it. In fact this particular argument is debunked when you look around at the wealth of quality goods and services available for purchase in capitalist economies all across the world. In the current system, you're absolutely right... insurance providers aren't motivated whatsoever to provide a quality product b/c consumers are handcuffed to their providers. Introduce a tax credit so that insurance is basically "free" (relative to your take home pay in the current system) and suddenly consumers are free to seek out those companies that actually do provide a quality product... low and behold you have created a market where the consumer really can vote with his wallet. Suddenly you have providers rushing to fill the "quality demand."

In your haste to rebutt the merits of a consumer-based model, you forgot to explain how it is that universal care controls costs. I'm still waiting for someone, anyone, to explain to me how the government can effectively save the consumer $ OVER THE LONG TERM via a one payer system or by exerting its regulatory might. And just for fun, I'll preemt the "administrative costs" argument again with this link:

http://www.pwc.com/extweb/pwcpublications.nsf/docid/BB82984D3A7DF2A485257267003C98BC

Which for those of you who don't feel like reading it... $.86 out of every dollar increase (year-over-year) in premiums goes DIRECTLY to patient care. I'll reiterate what I said in post #98 of this thread: the above link shows that even if we got rid of all admin fat by going to a one payer system, we'd still get 86% of the increases that we currently see on a year-over-year basis.

Some proponent of universal care or of a one payer system needs to explain the mechanisms by which costs are "controlled"!!!

 

[leftmid]

Quote:
Advocates or opponents cite other possible effects of limiting tort liability, such as reducing the extent to which physicians practice "defensive medicine" by conducting excessive procedures; preventing widespread problems of access to health care; or conversely, increasing medical injuries. However, evidence for those other effects is weak or inconclusive.
Also

Quote:
Proponents of limiting malpractice liability have argued that much greater savings in health care costs would be possible through reductions in the practice of defensive medicine. However, some so-called defensive medicine may be motivated less by liability concerns than by the income it generates for physicians or by the positive (albeit small) benefits to patients. On the basis of existing studies and its own research, CBO believes that savings from reducing defensive medicine would be very small.


Here is the link again for the 3rd time: http://www.cbo.gov/ftpdoc.cfm?index=4968&type=0

Actually read it this time. You might learn something new.

The report may only indicate that, regardless of the markedly reduction in all aspects of liability, doctors will continue to practice absolute defensive medicine as long as the threat exists. IMO, it's possible that even though a total immunity might be granted, it would still take sometimes for doctors to adjust their habit before they could practice best medicine for the buy. Besides, without the hard evidence to show, the report is as inconclusive as its opposing opinion.


"Still, the question of whether such limits reduce spending remains open, and CBO continues to explore it using other research methods."
I'd rather pay attention to the above quote in the CBO report.

 

[TheRealMD]

The report may only indicate that, regardless of the markedly reduction in all aspects of liability, doctors will continue to practice absolute defensive medicine as long as the threat exists. IMO, it's possible that even though a total immune might be granted, it would still take sometimes for doctors to adjust their habit before they could practice best medicine for the buy. Besides, without the hard evidence to show, the report is as inconclusive as its opposing opinion.

http://www.cbo.gov/ftpdoc.cfm?index=4968&type=0

Quote:"Still, the question of whether such limits reduce spending remains open, and CBO continues to explore it using other research methods."

I'd rather pay attention to the above quote in the CBO report.

I've shadowed a radiologist before and she said that many of the tests done by ER docs aren't 100% necessary. But, she understands that they really do need to cover their butts because it only takes one case for a doc to get sued and premiums go through the roof.

 

[sirus_virus]

Being myself an older person, I have a different perspective than the younger set here on SDN. I can see my own mortality, my own sense of worth, and our place in life. I've seen what not having adequate health care access has done to dozens of people while shadowing/volunteering/personal experience. I've been poor and upper-middle class being without and with health insurance. Luckily I've been healthy, though recently my health is borderline unhealthy with regards to BP and lipids.

I ask the question, what is wrong with tax increases if those funds are used for the greater good and not towards wasteful or selfish interests? Is that second iPOD on your six-figure salary worth funding health care for another human being? I'm all for being against wasteful spending in government. There is way too much spending on special projects or funding wasteful bureaucracy. But, I would give up 10% of my salary if it meant that everyone would have access to life-improving health care if that's what it would take.

Why the hell are we going into health care anyways? To improve health for people or to ensure our own fat financial future?

That's cool, but take a poll of your immediate neighbors and see if they feel the same way. If you think Americans are going to give up 10% xtra to the government, you must be dreaming.

BTW, since you guys want the element of profit removed from insuring patients, why won't the government float a non-profit insurance company, that approves every insurance claim, and accepts every customer regardless of health status and age. Let that company run in competition with the present "money grubbing" insurance companies. If it is true that it is the 'profit' aspect of insurance that is killing our system, then that company should have no problem becoming America's #1 choice. If you are wondering where they are going to get the funds from to jump start this company, we can have them research how the other companies got their capital. They could go take a loan for all we care. Now, if they mismanage this company (and they will), we can ask them how the hell they expect us to entrust the entire healthcare system to their hands.

 

[emttim]

Basically it is a very flawed system. Michael Moore, however, is an inflammatory p.o.s. and although some of us can see through his democratic propaganda and realize that there is a serious issue here, most people either blatantly ignore it because of his idiocy, or blindly follow it because of theirs.

This gets my vote for best quote ever.

 

[novawildcat]

The report may only indicate that, regardless of the markedly reduction in all aspects of liability, doctors will continue to practice absolute defensive medicine as long as the threat exists. IMO, it's possible that even though a total immunity might be granted, it would still take sometimes for doctors to adjust their habit before they could practice best medicine for the buy. Besides, without the hard evidence to show, the report is as inconclusive as its opposing opinion.


"Still, the question of whether such limits reduce spending remains open, and CBO continues to explore it using other research methods.”
I’d rather pay attention to the above quote in the CBO report.

That is exactly my point!! The question over whether or not tort limits would actually decrease health care costs significantly is definitely open for discussion. Hence, the argument that tort limits should be imposed so that health care costs would significantly decrease really can't be used at all because the evidence for such a claim is weak. The argument that we need more tort reform rather than a major overhaul of our health care system therefore is an extremely weak argument against health care reform since there is no conclusive evidence supporting either side in the tort reform debate.


I'd rather keep this quote in mind

Several studies have found that various types of restrictions on malpractice liability can indeed reduce total awards and thereby lead to lower premiums for malpractice insurance. By themselves, however, such changes do not affect economic efficiency: they modify the distribution of gains and losses to individuals and groups but do not create benefits or costs for society as a whole. The evidence for indirect effects on efficiency--through changes in defensive medicine, the availability of medical care, or the extent of malpractice--is at best ambiguous.

I've shadowed a radiologist before and she said that many of the tests done by ER docs aren't 100% necessary. But, she understands that they really do need to cover their butts because it only takes one case for a doc to get sued and premiums go through the roof.

But why is it that in states with tort limits vs. states without tort limits there is no statistically significant difference in health care spending per capita? Where are these so called savings that tort limits were supposed to produce?

I just get pissed when all these "I ruv to save the uninsured" people make all these arguments for universal healthcare, then when you ask them how we fund it, no one has the balls to use the words "tax increase". Some even kick it up a notch by suggesting it will be free.

Yes, the argument sounds sexy until the funding part comes up. When you guys are ready to tell America how much extra in taxes we need to pay for Universal healthcare, then we can talk. In the meantime, we can all sit back and entertain ourselves with UN statistics and Micheal Moore movies.

LOL and what is the difference between being taxed less but having to pay insurance premiums, copays, etc. and being taxed more but having not to paying premiums, copays, etc. There really isn't a fundamental difference in the end. Here in America instead of calling it being taxed more, we call it "paying for insurance coverage". Paying for insurance coverage really is just like being taxed.

I'll break it down for you. The average employer sponsored insurance premium for a family was around $11,000 with employees having to pay roughly 25% of that right out of their pocket (so about employees are paying about $2750 per year for insurance coverage).

http://www.kff.org/insurance/ehbs092606nr.cfm

The median household income in the US is around $46,000 before tax according to the US census bureau. That means every year, the median household is paying about 6% of their income just for insurance coverage. We are even completely ignoring the costs for copayments, prescriptions, deductibles, etc. How is having to pay 6% of your income not like being taxed already?

LOL infact, why don't you read the OECD's report on Taxing Wages 2003-2004 (the most current free one I can find)?

http://www.oecd.org/document/49/0,3343,en_2649_34597_30481201_1_1_1_1,00.html
(tables at the bottom)

Sure places, like Denmark, Germany, Belgium all pay more taxes than we do in the US (40+ % vs. 24.2% in the US) but also check out places like Japan, Canada, France, New Zeland. and others on the table. They pay in income tax+social security benefits 17.4%,
24.7%, 26.7%, 20.7% respectively versus the US @ 24.2%. All of those places have universal health care, but guess what? They still pay just a little bit more or even less than what we do in taxes in the US. Go figure.

 

[BlackSails]

Wrong again. Do you people have any facts to back up your claims at all?

If you actually took time to read the link from the Congressional Budget Office that I posted you would see that there is a wealth of information in there including



Also


Here is the link again for the 3rd time: http://www.cbo.gov/ftpdoc.cfm?index=4968&type=0

Actually read it this time. You might learn something new.

http://www.managedcaremag.com/archives/0501/0501.imaging.html

 

[hawk126]

NovaWildcat - Can you explain how universal care or a one payer system will actually control the rising costs of healthcare delivery over the long term?

 

[BlackSails]

NovaWildcat - Can you explain how universal care or a one payer system will actually control the rising costs of healthcare delivery over the long term?

Well, as proven throughout history, government controlled programs always have lower costs than private programs. This is because of the government's ability to curb waste and beaucracy, in addition to its ability to allocate funds in a non-political manner.

 

[hawk126]

Well, as proven throughout history, government controlled programs always have lower costs than private programs. This is because of the government's ability to curb waste and beaucracy, in addition to its ability to allocate funds in a non-political manner.

well played sir. still waiting for someone to step up to the plate.

 

[novawildcat]

http://www.managedcaremag.com/archives/0501/0501.imaging.html

I think you are missing my point by responding with this article. While, defensive medicine certainly exists, trying to enact tort reform has been shown to be not that effective at lowering health care costs overall.


Consider this--

States with some sort of tort reform and by type:

-Modify Joint-and-Several Liability

Limit Punitive Damages
Various types of limits include outright bans; fixed dollar caps ranging from $250,000 to $10 million; and caps equal to a multiple of compensatory awards.

Alabama, Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Illinois,* Indiana, Iowa, Kansas, Kentucky, Louisiana, Minnesota, Mississippi, Missouri, Montana, Nevada, New Hampshire, New Jersey, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, South Carolina, South Dakota, Texas, Utah, Virginia, Wisconsin
-States have based the amount for which a defendant can be held liable on the proportion of fault attributed, but the formulas differ substantially from state to state. In addition, most of the reforms apply to specific types of torts or have other restrictions.

-Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Hawaii, Idaho, Illinois, Iowa, Kentucky, Louisiana, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Dakota, Ohio, Oregon, Pennsylvania, South Dakota, Texas, Utah, Vermont, Washington, West Virginia, Wisconsin, Wyoming

-Modify the Collateral-Source Rule

-Typical reforms either permit evidence of collateral-source payments to be admitted at trial, allow awards to plaintiffs to be offset by other payments, or both.

-Alabama, Alaska, Arizona, Colorado, Connecticut, Florida, Georgia,* Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas,* Kentucky, Maine, Michigan, Minnesota, Missouri, Montana, New Jersey, New York, North Dakota, Ohio, Oklahoma, Oregon


-Limit Noneconomic Damages

The caps range from $250,000 to $750,000. More than half of the reforms apply to torts involving medical malpractice.

Alabama,* Alaska, Colorado, Florida, Hawaii, Idaho, Illinois,* Kansas, Maryland, Michigan, Minnesota, Mississippi, Montana, Nevada, New Hampshire,* North Dakota, Ohio, Oklahoma, Oregon,* Texas, Washington,* West Virginia, Wisconsin

-Limit Punitive Damages

Various types of limits include outright bans; fixed dollar caps ranging from $250,000 to $10 million; and caps equal to a multiple of compensatory awards.

Alabama, Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Illinois,* Indiana, Iowa, Kansas, Kentucky, Louisiana, Minnesota, Mississippi, Missouri, Montana, Nevada, New Hampshire, New Jersey, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, South Carolina, South Dakota, Texas, Utah, Virginia, Wisconsin

http://www.cbo.gov/ftpdoc.cfm?index=5549&type=0&sequence=1

*means that only reform enacted was found to violate a state's constitution

Now take a look at spending on health care by state as a % of state gross product.

1 West Virginia 20.3%
2 Maine 19.4%
3 Mississippi 18.1%
4 North Dakota 17.6%
5 Kentucky 16.9%
6 Montana 16.7%
7 Alabama 16.2%
8 Rhode Island 16.2%
9 Vermont 16.2%
10 Pennsylvania 16.1%
11 Missouri 15.7%
12 South Carolina 15.7%
13 Florida 15.6%
14 Tennessee 15.6%
15 Ohio 15.5%
16 Arkansas 15.4%
17 Oklahoma 14.8%
18 Wisconsin 14.8%
19 Nebraska 14.5%
20 Indiana 14.4%
21 Kansas 14.4%
22 South Dakota 14.4%
23 Louisiana 14.2%
24 Massachusetts 14.1%
25 New York 13.9%
26 North Carolina 13.8%
27 Iowa 13.7%
28 Minnesota 13.7%
29 Michigan 13.5%
30 New Hampshire 13.5%
31 Maryland 13.3%
32 Idaho 13.0%
33 Oregon 13.0%
34 New Mexico 12.6%
35 Washington 12.6%
36 Arizona 12.5%
37 Hawaii 12.5%
38 Georgia 12.2%
39 Illinois 12.2%
40 Connecticut 12.1%
41 Utah 12.1%
42 New Jersey 11.8%
43 Texas 11.7%
44 Alaska 11.6%
45 Colorado 11.1%
46 California 11.0%
47 Nevada 11.0%
48 Virginia 10.9%
49 Delaware 9.7%
50 Wyoming 9.4%
51 District of Columbia 8.1%

http://www.statehealthfacts.org/comparetable.jsp?ind=263&cat=5&yr=14&typ=2&o=d&sort=n

9 out of the top 10 states that spend the most have some sort of tort reform already. I mean Jesus, look at Delaware and D.C. DC and DE have absolutely 0 tort reform but spend some of the least amount on health care. Granted there are a lot of other factors involved here, but tort reform offers no guarantee at all that health care costs will go down. I mean with tort reform, even if there are savings, there is simply nothing stopping a private insurance company from taking those savings and pocketing them as more profit and still charging the same amounts for premiums, copays, etc.!

NovaWildcat - Can you explain how universal care or a one payer system will actually control the rising costs of healthcare delivery over the long term?

Call me insane, but by increasing health overall, health care costs would go down. How do you increase overall health? Many in this thread simply think that overall health is just based solely on someone's lifestyle habits. While lifestyle is a factor, they forget the fact that access to affordable medicine also plays a huge role in overall health. Increasing access to health care through a universal system, one payer system, etc. would help increase overall health through more utilization of preventative medicine, making it easier to purchase prescribed medications and procedures, etc. Then when health increases overall, costs go down because people need to utilize medicine less. Right now people without insurance AND EVEN PEOPLE WITH INSURANCE choose to forgo many times prescribed treatments, tests, prescription drug therapy, etc. simply because the insurance premiums, copays, etc. are way too expensive. I mean consider this example

In their multicenter study of 2498 patients hospitalized for acute myocardial infarction, Rahimi and colleagues found that self-reported financial barriers to health care services (18.1% prevalence) or medication (12.9% prevalence were common, even among the roughly 69% of patients with health insurance. At a 1-year follow-up, financial barriers to health care or to medication were associated with significantly worse recovery after myocardial infarction, manifested as higher rates of angina, increased risk of rehospitalization, and poorer quality of life.

-JAMA, March 14, 2007-vol 297 No 10


I mean from that example, we are spending double what we should really be spending simply because financial barriers blocked patients from receiving treatment or medication causing significantly worse recovery and rehospitalization which = more $$$. With a universal system situations like this would less likely occur. Uninsured people are much less likely to use preventative medicine and prescribed treatments and don't seek out medical assistance until they are desperate and must go to the ER. Like gunshot already pointed out, ER medicine is by far the most expensive and least effective type of medicine. People that are uninsured will file for bankruptcy after getting the bills from the hospital and the cost will end up being pushed onto everyone else.

How does a more socialized form of medicine decrease cost?? By cutting out the unnecessary middle man for starters. I'm mean just look how much we spend on administrative costs vs. a place with universal medicine like Canada. I'll respond to this

And just for fun, I'll preemt the "administrative costs" argument again with this link:

http://www.pwc.com/extweb/pwcpublica...257267003C98BC

Which for those of you who don't feel like reading it... $.86 out of every dollar increase (year-over-year) in premiums goes DIRECTLY to patient care.

with this:

n 1999, health administration costs totaled at least $294.3 billion in the United States, or $1,059 per capita, as compared with $307 per capita in Canada. After exclusions, administration accounted for 31.0 percent of health care expenditures in the United States and 16.7 percent of health care expenditures in Canada. Canada's national health insurance program had overhead of 1.3 percent; the overhead among Canada's private insurers was higher than that in the United States (13.2 percent vs. 11.7 percent). Providers' administrative costs were far lower in Canada.

http://content.nejm.org/cgi/content/abstract/349/8/768 (yes that was in 1999 but you still get the point)

So according to PCW, 14 cents out of every dollar is never used for patient care but for admin purposes. Tell me what 14 cents times 2 trillion dollars (which is the amount that the US roughly spends per year on health care)? THAT IS 280 BILLION DOLLARS WASTED! How is that "not that much"?

A universal system also helps to reduce cost by increasing accessibility. The more access there is, the less people have to hospitalized (hospital care is the biggest factor for increasing medical care cost). People think that more access to medical care will mean that more people will use much more medical services and end up costing more. But I ask, is this really true? Countries that have virtually unlimited access to medical care for its citizens spend a lot less per capita than we do, why is this? Hmm maybe because more access to medical care has increased overall health, which has thereby led to LESS of a demand for medical care services in the end. It makes perfect sense that a healthier nation needs less medical care.


I know you think that universal health care won't reduce costs, but you have yet to really explain well how countries that do have universal health care end up spending a lot less the the US does on health care costs and still achieve better overall health. And don't hide behind "because of lifestyle habits" argument, this has already been argued about to death, to which I responded with stuff like pointing out that people in Japan by far have the highest rates of smoking in the industrialized world, but tend to have better overall health and still spend less per capita than we do.

 

[Femme Fatale]

*

 

[SAspursfan]

So according to PCW, 14 cents out of every dollar is never used for patient care but for admin purposes. Tell me what 14 cents times 2 trillion dollars (which is the amount that the US roughly spends per year on health care)? THAT IS 280 BILLION DOLLARS WASTED! How is that "not that much"?

I know you think that universal health care won't reduce costs, but you have yet to really explain well how countries that do have universal health care end up spending a lot less the the US does on health care costs and still achieve better overall health. And don't hide behind "because of lifestyle habits" argument, this has already been argued about to death, to which I responded with stuff like pointing out that people in Japan by far have the highest rates of smoking in the industrialized world, but tend to have better overall health and still spend less per capita than we do.

Yes, 280 billion dollars is a lot of money. But even if 99 cents out of every dollar went straight to patient care, that would be... 20 BILLION DOLLARS WASTED!!! Still seems pretty wasteful, even though it isn't.

Using Japanese males' smoking statistics to prove a point is equally deceptive. Yes, 61% of the male population smokes... but only 14% of the female population smokes, so that comes out to 37.5% of the total population compared to 26% for the U.S. However, these statistics are essentially useless because they tell us nothing about the average number of cigarettes each person is smoking, or any other risk factors these people might have. For instance, what percentage of the Japanese population is obese or hypertensive? The development of cardiovascular disease results from the presence of MULTIPLE risk factors, so looking at only one and drawing your conclusions from there is flat-out wrong.

That being said, I am neither for or against the idea of universal health care in the U.S. There have been plenty of positive aspects presented, and many negative aspects as well. However, I am 100% against the use of faulty logic to make any decisions regarding any issue. Using convenient, one-sided statistics to prove a point only hurts your cause by conveying a sense of desperation and implying you think the general public is stupid enough to fall for such tactics... which is why nobody takes Michael Moore seriously anymore. If you can prove that Japan's lifestyle habits are as unhealthy as ours, then by all means do it; but if you can't, don't collect a bunch of statistics and try to manipulate them to fit your cause. Otherwise, undecided people like me will assume you don't have a valid argument.

 

[TheRealMD]

Yes, 280 billion dollars is a lot of money. But even if 99 cents out of every dollar went straight to patient care, that would be... 20 BILLION DOLLARS WASTED!!! Still seems pretty wasteful, even though it isn't.

Using Japanese males' smoking statistics to prove a point is equally deceptive. Yes, 61% of the male population smokes... but only 14% of the female population smokes, so that comes out to 37.5% of the total population compared to 26% for the U.S. However, these statistics are essentially useless because they tell us nothing about the average number of cigarettes each person is smoking, or any other risk factors these people might have. For instance, what percentage of the Japanese population is obese or hypertensive? The development of cardiovascular disease results from the presence of MULTIPLE risk factors, so looking at only one and drawing your conclusions from there is flat-out wrong.

That being said, I am neither for or against the idea of universal health care in the U.S. There have been plenty of positive aspects presented, and many negative aspects as well. However, I am 100% against the use of faulty logic to make any decisions regarding any issue. Using convenient, one-sided statistics to prove a point only hurts your cause by conveying a sense of desperation and implying you think the general public is stupid enough to fall for such tactics... which is why nobody takes Michael Moore seriously anymore. If you can prove that Japan's lifestyle habits are as unhealthy as ours, then by all means do it; but if you can't, don't collect a bunch of statistics and try to manipulate them to fit your cause. Otherwise, undecided people like me will assume you don't have a valid argument.

The real point of Michael Moore's films is rarely to prove he's right (Farenheit 9/11 took 3 years), but merely to draw awareness to the issue. Do you think that so many Americans would be aware of the problems of our system, even if Moore cherry-picked stories? I really doubt it.

At the end of the day, Moore's made some more cash and public slightly more informed today than it really ever has been, so it doesn't matter to me that much that he's called a liar. Personally, I find it odd that they give him so much free publicity if he were really that bad in the first place....

*remember's recently Lindsay Lohan stories*

Oh wait... never mind. It just makes for good TV!

 

[honker]

Several reasons for the problems with the US health care system:

1. influence of medicolegal liability issues-threat of lawsuits
2. conflicting interests of insurance companies and their clients
3. poor health habits of Americans, especially primary care.
4. heterogeneity of the American population.
5. lack of willingness for Americans to pay for health care insurance, especially young adults.

A lot of these issues are discussed ad infinitum, but several are underappreciated. For example, many people living in this country are here illegally, especially from Mexico, SE Asia, and Central America. Many have little understanding of preventive/primary care issues. Prenatal care is a good example. These people contribute to the infant mortality rate and other benchmarks of health care systems. Is that the fault of the system?

Also, many people in this country think nothing of spending $$ for gadgets and material possessions, but balk at paying for health insurance. This is especially true of younger people (under age 35) who don't get coverage through their job. They are taking a risk, because although illness is less likely at those ages, it is harder to get coverage as they get older.

We as Americans don't value primary care. Look at immunization rates. Even when the shots are free, immunization rates are not very good in many areas of the the country. Some of this is cultural, but some is due to ignorance.

I could go on, but .........

 

[SAspursfan]

The real point of Michael Moore's films is rarely to prove he's right (Farenheit 9/11 took 3 years), but merely to draw awareness to the issue. Do you think that so many Americans would be aware of the problems of our system, even if Moore cherry-picked stories? I really doubt it.

At the end of the day, Moore's made some more cash and public slightly more informed today than it really ever has been, so it doesn't matter to me that much that he's called a liar. Personally, I find it odd that they give him so much free publicity if he were really that bad in the first place....

*remember's recently Lindsay Lohan stories*

Oh wait... never mind. It just makes for good TV!

True, Michael Moore's films definately get people talking... but in the end, I think he totally negates any positive outcome his films might have by being so obnoxious. When people hate you, they're subconsciously going to disagree with pretty much everything you say, regardless of whether it's write or wrong. So the ultimate outcome ends up being the following: people who already agree with him pay $7 to watch his movies, then run around regurgitating his flawed logic and pissing everyone else off who might have otherwise agreed with them. This isn't constructive, and it doesn't result in the public being more informed. It divides people, and it makes Michael Moore rich... that's about it.

 

[limpkitty]

Several reasons for the problems with the US health care system:

1. influence of medicolegal liability issues-threat of lawsuits
2. conflicting interests of insurance companies and their clients
3. poor health habits of Americans, especially primary care.
4. heterogeneity of the American population.
5. lack of willingness for Americans to pay for health care insurance, especially young adults.

A lot of these issues are discussed ad infinitum, but several are underappreciated. For example, many people living in this country are here illegally, especially from Mexico, SE Asia, and Central America. Many have little understanding of preventive/primary care issues. Prenatal care is a good example. These people contribute to the infant mortality rate and other benchmarks of health care systems. Is that the fault of the system?

Also, many people in this country think nothing of spending $$ for gadgets and material possessions, but balk at paying for health insurance. This is especially true of younger people (under age 35) who don't get coverage through their job. They are taking a risk, because although illness is less likely at those ages, it is harder to get coverage as they get older.

We as Americans don't value primary care. Look at immunization rates. Even when the shots are free, immunization rates are not very good in many areas of the the country. Some of this is cultural, but some is due to ignorance.

I could go on, but .........

Worst post ever, basically every misinterpretation/stereotype there is about the healthcare system. First of all, costs of defensive medicine are about 50 billion a year, a good amount, but only about 3% on total costs and it pales in comparison to administrative costs. Also, the failure to provide health care to illegals, especially pre-natal care, is the fault of the system. There should be more outreach programs to ensure that these people do get pre-natal care and their children are healthy.

And how can you blame people for not paying for healthcare when it is so expensive. The people who don't have healthcare aren't the people paying 1000 dollars for a new plasma tv.

And the entire system doesn't value primary care, just look at the reimbursment rates for primary care doctors

 

[limpkitty]

True, Michael Moore's films definately get people talking... but in the end, I think he totally negates any positive outcome his films might have by being so obnoxious. When people hate you, they're subconsciously going to disagree with pretty much everything you say, regardless of whether it's write or wrong. So the ultimate outcome ends up being the following: people who already agree with him pay $7 to watch his movies, then run around regurgitating his flawed logic and pissing everyone else off who might have otherwise agreed with them. This isn't constructive, and it doesn't result in the public being more informed. It divides people, and it makes Michael Moore rich... that's about it.

you might hate him and immediatly disregard his opinions, but don't think that everyone else feels the same way.

Most people aren't ultra-conservative, free-market pigs who worship the insurance industry like all these people on sdn

 

[SAspursfan]

... and I hate to be the one to bring this up, but how does a morbidly obese man (who happens to be wealthy) get the audacity to criticize any nation's health care system? If a millionaire like Michael Moore refuses to practice healthy lifestyle habits, what chance do we have of convincing a poor person to get out and exercise? I mean, how can the people who are pushing for universal health care not take this as a slap in the face? The guy is exploiting your cause for his own benefit, while simultaneously fueling your oponents' view that people are to blame for their own health problems.

 

[TheRealMD]

... and I hate to be the one to bring this up, but how does a morbidly obese man (who happens to be wealthy) get the audacity to criticize any nation's health care system? If a millionaire like Michael Moore refuses to practice healthy lifestyle habits, what chance do we have of convincing a poor person to get out and exercise? I mean, how can the people who are pushing for universal health care not take this as a slap in the face? The guy is exploiting your cause for his own benefit, while simultaneously fueling your oponents' view that people are to blame for their own health problems.

You ARE the person who brought it up.

 

[Noeljan]

... and I hate to be the one to bring this up, but how does a morbidly obese man (who happens to be wealthy) get the audacity to criticize any nation's health care system? If a millionaire like Michael Moore refuses to practice healthy lifestyle habits, what chance do we have of convincing a poor person to get out and exercise? I mean, how can the people who are pushing for universal health care not take this as a slap in the face? The guy is exploiting your cause for his own benefit, while simultaneously fueling your oponents' view that people are to blame for their own health problems.

I totally agree with you. Great post.

 

[Jew Alcindor]

And how can you blame people for not paying for healthcare when it is so expensive. The people who don't have healthcare aren't the people paying 1000 dollars for a new plasma tv.

This just isn't always the case. Plenty of lower-income people spend way beyond their means on frivolous luxury items: cigarettes, alcohol, laughably expensive clothes and shoes, consumer electronics amongst many, many other things.

 

[Despina]

How many of the people on this forum have spent a significant amount of time in a country with universal/socialized healthcare? Both my Aunt and Uncle died because of the British NIH. You sit waiting for an appointment forever. Next time you meet an English doc, ask "From start to finish, how long does it take a patient to get the proper diagnostic tests for cancer." Here is what happens. Patient's sees his Primary Care doc, then waits 3-6 months to see the specialist. Then the specialist adds a few tests, and it takes another 3-6 months to have those tests done. With some cancers, you will be dead after a year. My uncle didn't get a much needed CT Scan for 2 years. After, he finally got it, he was diagnosed with cancer and only had only a few more months to live.

Also, The NIH is financially in the hole right now. Walk into most hospitals there and things are far from state of the art. There is a bigger shortage of doctors in most countries with socialized medicine than in the US. The reason the US continues to be the innovator in medicine is because we are a Capitalist country.

 

[ToastyBubble]

Does anyone know of any good books/essays to learn more about the problems/solutions of the healthcare system?... I feel completely uninformed about this topic.