A Brewing Bubble?

[RNtoMD87]

Responsibility without authority is a terrible place to be. If I’m paying for someone’s healthcare, then I should have a say in how they run their life.

If a friend needed to borrow some money, I would dictate how it would be spent.

This is what you’re suggesting

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[762513]

I’m not hearing anyone talk about why our healthcare system costs twice as much per capita as the closets socialist system yet our outcomes are worse. No one wants a socialistic economy, we know that doesn’t work, but a two tiered government funded healthcare system similar to Canada’s should be implemented here. Canadians as a whole are happy with their healthcare system, pay less, and have better outcomes. The physicians there are happy as well.

 

[VA Hopeful Dr]

I’m not hearing anyone talk about why our healthcare system costs twice as much per capita as the closets socialist system yet our outcomes are worse. No one wants a socialistic economy, we know that doesn’t work, but a two tiered government funded healthcare system similar to Canada’s should be implemented here. Canadians as a whole are happy with their healthcare system, pay less, and have better outcomes. The physicians there are happy as well.

Our outcomes aren't worse in most areas actually

 

[RNtoMD87]

Healthcare is so expensive because a. Regulations, and B. physicians are covering their ass with many unnecessary labs and images.

The government really doesn’t improve things. My hospital in just a few short years has gone from less of an outcomes focus to a more “happiness” focus. So doctors hand out pain meds like candy, and when I ask them why the patient is getting 4 of dilaudid Q3 for something that doesn’t usually require it they’ll admit “gotta keep em happy”.

So we are becoming state sanctioned dope dealers.

 

[762513]

Our outcomes aren't worse in most areas actually

I dispute that, but I’ll concede the point that outcomes are equal, why are we paying twice as much?

 

[Angus Avagadro]

I’m not hearing anyone talk about why our healthcare system costs twice as much per capita as the closets socialist system yet our outcomes are worse. No one wants a socialistic economy, we know that doesn’t work, but a two tiered government funded healthcare system similar to Canada’s should be implemented here. Canadians as a whole are happy with their healthcare system, pay less, and have better outcomes. The physicians there are happy as well.

Unail you need an AVR or a total hip replacement. Then you get in line and wait
Why do their govt officials come here for heart surgery? They are good socialists and make everyone wait. Unlike our govt officials who exempt themselves from Obamacare. I have Canadian friends and colleagues who are here because they didnt like the system. The Canadian system works for parents with young children who have ear infections, not so great for specialty care.

 

[762513]

Unail you need an AVR or a total hip replacement. Then you get in line and wait
Why do their govt officials come here for heart surgery? They are good socialists and make everyone wait. Unlike our govt officials who exempt themselves from Obamacare. I have Canadian friends and colleagues who are here because they didnt like the system. The Canadian system works for parents with young children who have ear infections, not so great for specialty care.

I’d be ok with waiting 6 months for a new hip if I someday ever need one if that means the lifelong cost of health insurance were cut in half. You wanna talk about socialists using force to allocate resources, we need to start talking about HMO’s then, too.

 

[atomheart]

Rape! Molestation! Surely I condone those you say! The feels!

Yes you are correct.

Are you suggesting we have a panel to decide which personal tragedies get free stuff from taxpayers? Maybe my feels are different than yours. What if I get bit by a dog and suddenly become afraid to leave my house? Debilitating. Can’t even go outside without having a panic attack. Does the person who got raped who can’t leave the house get free stuff and I don’t because rape is a worse crime than a dog not even though both caused PTSD and agoraphobia?

We have a legal system that handles crimes. If someone rapes someone, you can and should sue that person for damages including compensatory damages.

Societal dysfunction? If you believe someone owes you something, you handle this in court. Not by enacting a law that says every single taxpayer in the country owes you something if something happens to you by the hands of another person or organization.

On the other hand, i would gladly support the use of taxpayer dollars for the surgical castration procedure for the rapist.

If someone needs help they should be able to get it. I don't pass judgment on someone that says they need care. This whole argument is about how to pay for care, and more importantly who gets their care paid for. Disability is it's own subtopic within the realm of continuing care, and is incredibly nuanced (what constitutes 'disabled', what was the cause of disability). The legal system is nuanced (how do I pay for good representation, whose fault is it, and how much in damages is enough), and the insurance market is nuanced (will they pay for care at all). I don't really have a problem with kids becoming beneficiaries, and fair enough, I have also seen plenty who game the welfare system. All this is quibbling over who gets their care paid for.

My main concern is: can our model pay for healthcare problems that occur directly or indirectly from our governance including problems that result from war, poverty, and other forms of dysfunction from within society (drinking, guns, smoking, violent crimes, contributors to obesity, etc)? Is it really as simple as: we pay for functionally disabled kids and adults, everyone else is responsible for their own care, and now our healthcare system is financially solvent? You're the one arguing that only a little bit of change is needed to make it work, and we can keep all the nuance of litigation and competing insurance companies. Prove it.

I'm not being Socratic to one-up anyone. I'm literally someone walking in on 3 pages of discussion, and now I've gone back and read all three pages, and I'm not convinced anyone is correct. It's a mistake to simplify healthcare to "me too" and dirty welfare recipients. I would support an experiment like the one you mention over moving to a complete medicare for all solution, but it doesn't mean it's going to work. Going back to the OP, the only thing I want is a guarantee that fees generated for physician services will be protected in whatever medical system we're talking about. I wont work for free, and I need a way to be solvent while I pay off my loans.

 

[RNtoMD87]

I’d be ok with waiting 6 months for a new hip if I someday ever need one if that means the lifelong cost of health insurance were cut in half. You wanna talk about socialists using force to allocate resources, we need to start talking about HMO’s then, too.

Since when is the government more efficient than private sector though? So it’s more like waiting 6 months for a new hip, AND a cost increase.

 

[762513]

Since when is the government more efficient than private sector though? So it’s more like waiting 6 months for a new hip, AND a cost increase.

In healthcare, Canada compared to USA, the gov is much more efficient in delivering healthcare. Objective fact, not arguable.

When pharma has a moral obligation to charge as much as they possibly can for every pill they sell while the EMTALA act establishes the most expensive version of socialized medicine on the planet we have a death spiral of healthcare costs that we are all currently living.

 

[Angus Avagadro]

I dispute that, but I’ll concede the point that outcomes are equal, why are we paying twice as much?

The American Bar Association is a good start for higher costs

 

[RNtoMD87]

In healthcare, Canada compared to USA, the gov is much more efficient in delivering healthcare. Objective fact, not arguable.

When pharma has a moral obligation to charge as much as they possibly can for every pill they sell while the EMTALA act establishes the most expensive version of socialized medicine on the planet we have a death spiral of healthcare costs that we are all currently living.

Canada is very different from the US. A more homogenous population, about a tenth the population of America.

There is nothing wrong with drug companies charging whatever they can get. The problem is that they have a monopoly on these drugs, and have no competition to drive prices down. Which is caused by government meddling.

 

[762513]

The American Bar Association is a good start for higher costs

It’s only a piece of a multifactorial problem with the very foundations of the entire system itself.

 

[762513]

Canada is very different from the US. A more homogenous population, about a tenth of America.

There is nothing wrong with drug companies charging whatever they can get. The problem is that they have a monopoly on these drugs, and have no competition to drive prices down. Which is caused by government meddling.

I don’t buy this argument, it’s a cop out. We have the same culture, language, basis of government, and we are both nations with high immigrant populations. This is just people not wanting to face the facts that America can do what Canada has done, we just simply have lobbyist who have literally bought our politicians to ensure we continue to be exploited.

 

[VA Hopeful Dr]

I dispute that, but I’ll concede the point that outcomes are equal, why are we paying twice as much?

You'd be wrong then.

Redirect Notice

 

[762513]

You'd be wrong then.

Redirect Notice

That data you posted is on one outcome and uses data that is 20-40 years old. Here’s a better article.

U.S. Healthcare Ranked Dead Last Compared To 10 Other Countries

 

[RNtoMD87]

We have a nurse on our unit from England. He says one reason he feels it’s so expensive is many of these patients we keep alive, they would force to be palliative and wouldn’t have a choice.

 

[762513]

We have a nurse on our unit from England. He says one reason he feels it’s so expensive is many of these patients we keep alive, they would force to be palliative and wouldn’t have a choice.

Definetly one of the reasons. Why were republicans so against Obama’s Medicare “death panels” then?

 

[RNtoMD87]

I’m not. But I’m a huge libertarian, if you can’t pay and no one is willing to help you, too bad kind of person too. Now that’s from a legal side.

From a moral side I think it’s immoral to spend vast amounts on luxury items when others are poor. But once again, it’s not the governments part to force us to help.

But I’m not a republican either. I like them slightly more than I like democrats.

 

[Angus Avagadro]

I’d be ok with waiting 6 months for a new hip if I someday ever need one if that means the lifelong cost of health insurance were cut in half. You wanna talk about socialists using force to allocate resources, we need to start talking about HMO’s then, too.

You'd be ok waiting 6 mos for a total hip replacement? I think you might have spoken a little too quickly without considering 6 mos is a very long time. That is a long time to have very limited mobility. My wife had one at a relatively young age secondary to congenital hip dysplasia. She could walk about50 ft before having to sit. Riding in a car, grocery shopping, all very painful. Being told to wait 6 mos doesnt sound too bad , unless its YOU having to wait and have limited mobility.

 

[Angus Avagadro]

It’s only a piece of a multifactorial problem with the very foundations of the entire system itself.

Still a good place to start. Gotta start somewhere.

 

[VA Hopeful Dr]

That data you posted is on one outcome and uses data that is 20-40 years old. Here’s a better article.

U.S. Healthcare Ranked Dead Last Compared To 10 Other Countries

Did you even read the article?

Here are a few take away points:

First, not sure why we're dead last on this. Several other countries (most notably Canada and Norway) have scores similar to ours. In fact, the only areas where we score poorly are either known issues like cost/efficiency, BS issues like equity, or things that have nothing to do with our healthcare system like healthy lives (if you weight 400 pounds there's not much that I as a doctor can do about it).

Second, the article I posted has numerous outcomes:

Third, the report itself is not very good. I actually went looking at the whole thing so let's go point by point shall we?

For example, one of the measures for effective is not going to f/u appointments because of cost. That has nothing to do with effective care, that's a cost issue. You go based on the care that's delivered.

Another was in safe care, "Patient believed a medical mistake was made..." What kind of a **** measure is that? Not was a mistake made but does the patient THINK one was made? Other than that one, we're middle of the pack for all other safe care.

We actually did better on coordinated care than I expected which is nice.

On patient centered measure the only one we scored poorly on was "With the same doctor 5 years or more". That's not always a systems problem - patients will jump around on their own frequently for who knows why.

Access was a mixed bag - on costs we naturally did poorly. On Timeliness of care we're middle of the road.

Efficiency was also a mixed bag. Some of it where we did poorly makes sense - %GDP, time spent arguing with insurance, stuff like that. One that makes no sense to me is "Doctors report that time spent getting medication approved is a major problem." It really isn't. Most insurance has a formulary that is easy to work with. They don't cover lantus? They will cover levemir. Easy. Procedures you submit the information, if its not covered you tell the patient that. Its an irritant at most. "Visited ER for condition that could have been treated by a regular doctor". That's because patients are impatient and stupid (not always, but often). I had a patient go to the ED at 2pm on a Thursday for a cold. I had 4 appointments open that day. Why should her not even thinking about calling the office mark us down? This also gets us marked down for ED wait times.

Equity is utter nonsense so we'll just skip that one.

Healthy lives as I said is not something that is 100% a systems issue. You have stuff like this: https://www.oecd.org/els/health-systems/Obesity-Update-2017.pdf

Among OECD countries, we're the most obese by a lot. Compared with the 10 countries in your BS study, we're 50% more obese (38% v. 26%) than the next closest and roughly 3X as much as most of the rest - they hover around 12%. Almost everything results from that - more heart disease, worse OB outcomes, more diabetes and its complications, you get the idea. This point is key to most of these irritating discussions because if you gave us Norway's population I promise you our outcomes would be better than Norway's - and I don't mean all white people, I mean 90% not fat people.

 

[atomi]

I’m not hearing anyone talk about why our healthcare system costs twice as much per capita as the closets socialist system yet our outcomes are worse. No one wants a socialistic economy, we know that doesn’t work, but a two tiered government funded healthcare system similar to Canada’s should be implemented here. Canadians as a whole are happy with their healthcare system, pay less, and have better outcomes. The physicians there are happy as well.

We pay more in America at least partially because we want to pay more. We have the best cancer outcomes and we like it that way. We don’t have major wait times for oncologist services. If we want an operation next week, we can get it next week.

I’m not saying it could be more efficient, but it’s a lie to say we are spending more than e.g. the UK for the same thing.

 

[762513]

Did you even read the article?

Here are a few take away points:

First, not sure why we're dead last on this. Several other countries (most notably Canada and Norway) have scores similar to ours. In fact, the only areas where we score poorly are either known issues like cost/efficiency, BS issues like equity, or things that have nothing to do with our healthcare system like healthy lives (if you weight 400 pounds there's not much that I as a doctor can do about it).

Second, the article I posted has numerous outcomes:

Third, the report itself is not very good. I actually went looking at the whole thing so let's go point by point shall we?

For example, one of the measures for effective is not going to f/u appointments because of cost. That has nothing to do with effective care, that's a cost issue. You go based on the care that's delivered.

Another was in safe care, "Patient believed a medical mistake was made..." What kind of a **** measure is that? Not was a mistake made but does the patient THINK one was made? Other than that one, we're middle of the pack for all other safe care.

We actually did better on coordinated care than I expected which is nice.

On patient centered measure the only one we scored poorly on was "With the same doctor 5 years or more". That's not always a systems problem - patients will jump around on their own frequently for who knows why.

Access was a mixed bag - on costs we naturally did poorly. On Timeliness of care we're middle of the road.

Efficiency was also a mixed bag. Some of it where we did poorly makes sense - %GDP, time spent arguing with insurance, stuff like that. One that makes no sense to me is "Doctors report that time spent getting medication approved is a major problem." It really isn't. Most insurance has a formulary that is easy to work with. They don't cover lantus? They will cover levemir. Easy. Procedures you submit the information, if its not covered you tell the patient that. Its an irritant at most. "Visited ER for condition that could have been treated by a regular doctor". That's because patients are impatient and stupid (not always, but often). I had a patient go to the ED at 2pm on a Thursday for a cold. I had 4 appointments open that day. Why should her not even thinking about calling the office mark us down? This also gets us marked down for ED wait times.

Equity is utter nonsense so we'll just skip that one.

Healthy lives as I said is not something that is 100% a systems issue. You have stuff like this: https://www.oecd.org/els/health-systems/Obesity-Update-2017.pdf

Among OECD countries, we're the most obese by a lot. Compared with the 10 countries in your BS study, we're 50% more obese (38% v. 26%) than the next closest and roughly 3X as much as most of the rest - they hover around 12%. Almost everything results from that - more heart disease, worse OB outcomes, more diabetes and its complications, you get the idea. This point is key to most of these irritating discussions because if you gave us Norway's population I promise you our outcomes would be better than Norway's - and I don't mean all white people, I mean 90% not fat people.

I’m sure you’re right on a lot of these confounding factors. Let’s say we’re ranked 5/10 then. Why do we still pay more than twice as much per capita?

 

[VA Hopeful Dr]

We pay more in America at least partially because we want to pay more. We have the best cancer outcomes and we like it that way. We don’t have major wait times for oncologist services. If we want an operation next week, we can get it next week.

I’m not saying it could be more efficient, but it’s a lie to say we are spending more than e.g. the UK for the same thing.

This is a key point. I think we all have lots of patients that get referred to another doctor with something fairly benign/minor who are still very anxious and so we get them seen within a bare handful of days.

Yes, I bet the UK does fine work with emergencies but even the minor stuff we get done fast.

 

[VA Hopeful Dr]

I’m sure you’re right on a lot of these confounding factors. Let’s say we’re ranked 5/10 then. Why do we still pay more than twice as much per capita?

1. Administration

2. Drugs

3. See the post right above yours

 

[762513]

We pay more in America at least partially because we want to pay more. We have the best cancer outcomes and we like it that way. We don’t have major wait times for oncologist services. If we want an operation next week, we can get it next week.

I’m not saying it could be more efficient, but it’s a lie to say we are spending more than e.g. the UK for the same thing.

That data was between 1980 and 2000, so 20-40 year old data. Our cancer outcomes are better? Are you sure?

At half the cost, Canadian colorectal cancer survival similar to that of U.S.

 

[atomi]

We have a nurse on our unit from England. He says one reason he feels it’s so expensive is many of these patients we keep alive, they would force to be palliative and wouldn’t have a choice.

This is absolutely, 100%, correct.

 

[762513]

1. Administration

2. Drugs

3. See the post right above yours

Sounds like our capitalists healthcare system is run poorly and needs major structural changes.

 

[Angus Avagadro]

Sounds like our capitalists healthcare system is run poorly and needs major structural changes.

Maybe we need a structural change, like the Chinese? Workers are offered health ins to buy .if you break your femur, show up at the hospital with no insurance, you lie on a stretcher until your family shows up with the cash
This is what our Beijing guide told us.

 

[Espressso]

Uh ...what?
I was a “victim” (I hate that term) of long standing incest as a child, for nearly a decade. Yes, it does have an effect on you, and yes, it can contribute to issues with mental health. Now... can you claim entitlement to free mental health care due to that, because it wasn’t your fault that you were raped or molested? Okay, I’ll buy that. But claiming disability because of that is unconscionable, because you are victimizing yourself at that point by acknowledging that your trauma has completely taken over your life and has defined you as a person. Like the craziness that rose what’s her name is doing with MeToo. She looks insane, and is being revictimized by the enabling. It’s ridiculous to play the victim card your entire life instead of moving on.

Those who have endured such awful events should be the first to note that it's incredibly irresponsible to tell others who have endured their own trauma to just move on.

 

[762513]

Maybe we need a structural change, like the Chinese? Workers are offered health ins to buy .if you break your femur, show up at the hospital with no insurance, you lie on a stretcher until your family shows up with the cash
This is what our Beijing guide told us.

My dad had his appendix removed in China and had a Harvard trained surgeon provide him excellent care. Just my 2 cents on China.

 

[medschoolzombie]

So from the peanut gallery, let me try to summarize your argument: society should pay for "disability" outside of its control (e.g., congenital disability), but relinquish responsibility for "disability" directly pertaining to societal dysfunction (e.g., trauma induced by rape, molestation).

What is the argument for letting people stay on disability for a long time due to things like trauma? Doesn’t that just encourage these people to never move on with their lives?

I still think it’s insane that doctors don’t have a right to refuse to work. There are many professions that perform labor to enhance people’s lives, but they are the only one that I know of singled out in that fashion.

Seems like MD is the most statist controlled profession, except something obvious like being in government.

I know ED physicians can’t refuse patients but can’t most others refuse to take on patients, especially if they’re in private practice?

We have a nurse on our unit from England. He says one reason he feels it’s so expensive is many of these patients we keep alive, they would force to be palliative and wouldn’t have a choice.

I would agree with this. End of life care is a really large part of our healthcare costs in this country. So much money, Time, drugs and effort is spent trying to keep people alive, who will likely die within the next few days/ weeks, so the family can get more time with them. I’d imagine that we’d have to implement a sort of mandatory palliative option if a socialist system was ever to be put in place

 

[atomi]

That data was between 1980 and 2000, so 20-40 year old data. Our cancer outcomes are better? Are you sure?

At half the cost, Canadian colorectal cancer survival similar to that of U.S.

Well I only do it for a living. So yes.

In some cases it’s comparing apples to oranges due to population differences. For instance differences in ebv status in nasopharyngeal cancers in us vs Asia or histology in bladder cancer in us vs Middle East.

But on the whole the us has the best cancer outcomes. I’d point you to the concord 3 study to start.

There are so many “lemme google something for confirmation bias real quick” fails by libs on this thread.

 

[762513]

What is the argument for letting people stay on disability for a long time due to things like trauma? Doesn’t that just encourage these people to never move on with their lives?



I know ED physicians can’t refuse patients but can’t most others refuse to take on patients, especially if they’re in private practice?



I would agree with this. End of life care is a really large part of our healthcare costs in this country. So much money, Time, drugs and effort is spent trying to keep people alive, who will likely die within the next few days/ weeks, so the family can get more time with them. I’d imagine that we’d have to implement a sort of mandatory palliative option if a socialist system was ever to be put in place

A mandatory palliative option would be fantastic. I’ve spent years in the ICU watching human suffering. Bring on the death panels.

 

[762513]

Well I only do it for a living. So yes.

In some cases it’s comparing apples to oranges due to population differences. For instance differences in ebv status in nasopharyngeal cancers in us vs Asia or histology in bladder cancer in us vs Middle East.

But on the whole the us has the best cancer outcomes. I’d point you to the concord 3 study to start.

There are so many “lemme google something for confirmation bias real quick” fails by libs on this thread.

Libs = ad hom. We were having a polite conversation until now, so thanks for that.

 

[VA Hopeful Dr]

Sounds like our capitalists healthcare system is run poorly and needs major structural changes.

Are you high?

The worse for administration is Medicare. Everyone else takes their lead from them. Medicare for all would make that much worse.

 

[VA Hopeful Dr]

Libs = ad hom. We were having a polite conversation until now, so thanks for that.

No, not an ad hom. At worst its an insult but they didn't use the insult to invalidate your argument, so not an ad hom. Try again.

 

[atomi]

Libs = ad hom. We were having a polite conversation until now, so thanks for that.

Liberal is a slur word now? What are you even talking about? How is identifying a liberal talking point as liberal an ad hominem or even impolite?

 

[VA Hopeful Dr]

Those who have endured such awful events should be the first to note that it's incredibly irresponsible to tell others who have endured their own trauma to just move on.

I don't think she meant like the next day, but keeping the victim role for a long period isn't healthy (and I don't mean you have to stop saying "I am a victim of rape/molestation/whatever" but playing the victim role over time isn't a good idea.

 

[atomi]

A mandatory palliative option would be fantastic. I’ve spent years in the ICU watching human suffering. Bring on the death panels.

How about mandatory abortions for non viable fetuses or ones with genetic anomalies?

If you’re in favor of death panels at the end of life can you at least be ideologically consistent and support them at the beginning of life?

 

[762513]

Liberal is a slur word now? What are you even talking about? How is identifying a liberal talking point as liberal an ad hominem or even impolite?

You know full well you intended it as an insult.

 

[RNtoMD87]

Liberal is a slur word now? What are you even talking about? How is identifying a liberal talking point as liberal an ad hominem or even impolite?

I agree. Liberal is a terrible word to use. Progressive is a more accurate term.

True liberals believe in freedom over everything.

 

[762513]

How about mandatory abortions for non viable fetuses or ones with genetic anomalies?

If you’re in favor of death panels at the end of life can you at least be ideologically consistent and support them at the beginning of life?

Oh hell yes. Abortions and death panels all around. 50 percent of Medicare dollars are spent in the last year of life.

 

[atomi]

Those who have endured such awful events should be the first to note that it's incredibly irresponsible to tell others who have endured their own trauma to just move on.

Ironically you are also telling a survivor what her opinion and feeling should be on the topic.

 

[atomi]

You know full well you intended it as an insult.

What? This is astonishing.

 

[atomheart]

What is the argument for letting people stay on disability for a long time due to things like trauma? Doesn’t that just encourage these people to never move on with their lives?

Doesn't all disability do this? "I have a source of income therefore..." His point was that some people cannot work, therefore it's justified. My point is it's all just a fight for pie slices, regardless of how you justify it, and it's all very nuanced. Some people might see that their needs outstrip others.

 

[762513]

What? This is astonishing.

Not really, you’ve thrown these sideways insults in your posts a few times. I’m not going to stop engaging with you because of it, but we all know what you’re doing.

 

[VA Hopeful Dr]

Doesn't all disability do this? "I have a source of income therefore..." His point was that some people cannot work, therefore it's justified. My point is it's all just a fight for pie slices, regardless of how you justify it, and it's all very nuanced. Some people might see that their needs outstrip others.

Isn't everything?

 

[RNtoMD87]

The trouble is our needs are subjective, no way to objectively look and see who deserves exactly what amount.