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Another G-Damn socialized medicine thread

Discussion in 'Emergency Medicine' started by EctopicFetus, Feb 25, 2007.

  1. EctopicFetus

    EctopicFetus Keeping it funky enough
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    So while I hung with peter rosen on friday he basically is against NHC (national health care and the single payer system) but what I cant understand is how some of my colleagues are so into this stupid idea. Look I have explored this subject but this is one that just annoys me. The government does NOTHING well except waste money. What makes people think that doing this would be a good idea? It is just insanity to me.

    My only satisfaction is knowing that this wont be a reality anytime soon and thank god for that.

    (steps off pedestal)......:D
     
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  2. Dr. Will

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    This thread is useless without pics! :D
     
  3. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner
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    Do you have a signed copy of his book now?
     
  4. OP
    OP
    EctopicFetus

    EctopicFetus Keeping it funky enough
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    Gonna depend on my inservice score. Im not expecting it. maybe by 3rd yr..
     
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  5. OP
    OP
    EctopicFetus

    EctopicFetus Keeping it funky enough
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    [​IMG]
     
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  6. GeneralVeers

    GeneralVeers Globus Hystericus
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    I'm from Canada originally, and experienced first-hand their healthcare system. While it does have it's advantages, it's inferior to the U.S. system in many ways, such as timely specialty care, elective surgeries, and state-of-the-art procedures.

    The fact remains, that while socialized medicine in the U.S. might raise the quality of healthcare for the 20% who are uninsured, the other 80% would experience a decrease in quality.

    Every single Democrat running for office supports a universal healthcare sytem. While I think they are right on probably > 50% of issues, this singular issue will prevent me from ever voting for them, so long as they advocate a single payer healthcare system.
     
  7. OP
    OP
    EctopicFetus

    EctopicFetus Keeping it funky enough
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    Not super well written but some good points anyhow
     
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  8. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner
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    From where is that article?
     
  9. Dr. Will

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    There's too many words in that post. I need pictures!
     
  10. ERMudPhud

    ERMudPhud Back for a visit
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    I'm a little suspicious of some of the statistics and would want to see the original sources. I think in some cases he may be comparing 5 year survival rates and in others mean survival times, a number that can be influenced by both early detection and aggressive treatment without a meaningful difference in quality of life. If your lethal tumor is found on average 6 months earlier in the US your reported survival from date of diagnosis will be 6 months longer but your actual date of death won't be any different.

    In anycase I'm not sure survival rates for cancer is a great way to compare national health care systems. The health care system is there for a lot more than just cancer. Neonatal mortality and morbidity has a much greater effect on overall lifespan and ongoing costs of health care (all those toaster headed little ex premies with their PEGs and Trachs get real expensive). In that regard our much vaunted free market system blows

    1: Thompson LA, Goodman DC, Little GA.
    Is more neonatal intensive care always better? Insights from a cross-national
    comparison of reproductive care.
    Pediatrics. 2002 Jun;109(6):1036-43.
    PMID: 12042540 [PubMed - indexed for MEDLINE]

    Everyone knows we have way more severely underweight babies because of poor prenatal care and a variety of other societal ills. But did you know that even with twice as many neonatalogists and NICU's the same 1kg kid doesnt really do any better in our system.

    I don't know for sure what the answer is but if we keep our heads buried in the sand my only hope is to be retired (and healthy) before the whole system collapses from health care representing an unsupportable percentage of GDP
     
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  11. qjj

    qjj
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    I guess I'll have to be the voice of reason here. I'll start, by popular demand, with a picture of sorts.[​IMG]
     
  12. OP
    OP
    EctopicFetus

    EctopicFetus Keeping it funky enough
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    The problem with the above stats are....

    For cost, we take care of old and sick people that in other systems wouldnt get the care in other countries they do here.

    For life expectancy we are more sedentary, more obese etc, than other countries, we also have more trauma than other places.

    Infant mortality is one of the most interesting because of how this is measured. Many of the babies that count in that study would count as miscarriages in other places. not too places attempt to keep 24 weekers alive like we do here.

    Physicians per 1k, well we have an imbalance between PCPs and specialists and thats a big prob but people have expectations in this country which are unreasonable. People want their simple rash to be treated by a dermatologist when their PCP might be just fine.

    And Nurses and beds per 1k are actually a function of the fact that people dont sit in the hospital quite as long as other countries.

    Discuss..
     
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  13. Tiger26

    Tiger26 Senior Member
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    That cartoon is great. Pretty much sums up military medicine which is basically the finest example of government wasting as much money as possible while degrading care (socialized medicine).

    Case in point: Me at Basic Training in GA--Ummm. . . I'm pretty sure my fever's really high even in light of the 95 degree heat, I've been shaking with chills, spitting up mucous, and am constantly exhausted. Their response: This excedrin should help you--take that till it gets better. Me: But aren't you going to evaluate me some more? They: No--Next person in line

    Me in the ED a week after finishing basic: Repeated same story to experienced attending. Experienced attending: Yeah . . . ummm. . . this is probably the worst case of pneumonia I've seen in someone in your age/fitness level. That fever hovering over 105 should have been a red flag down there. Good thing for you that you weren't down there another week.
     
  14. ERMudPhud

    ERMudPhud Back for a visit
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    EXACTLY!

    From Ectopic's quote of unknown origin
    "You can get perfectly adequate, functional health insurance for under $100 a month if you're willing to pay $50 for each doctor visit or a reasonable co-payment or have a yearly deductible of $1500 or more or a combination of some of these elements. Try going to ehealthinsurance.com and getting a quote or two. "

    That policy is only available if you are 25, male, with no medical problems. Just ask DocB about his experience trying to get disability insurance with HTN. Now imagine being 50 with high cholesterol, HTN, and lupus for example. You might not be able to get individual coverage at any price and if you could the policy will in all likelihood only cover 80% or less of expenses. The other 20% could be 10's or 100's of thousands of dollars a year with just a one or two hospitalizations.

    Just for fun you should go to your hospital billing office and ask to look at some bills for the uninsured working lower middle class. What do you think an uncomplicated appy, a hit-and-run femur fracture, or an RSV hospitalization for an ex-premie costs? I have a family member who got appendicitis while between jobs and had a bill nearing 30K
     
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  15. ERMudPhud

    ERMudPhud Back for a visit
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    I believe you are wrong here, most of the stats I've seen are for PERInatal mortality and include any loss, miscarriage, stillbirth, NICU death beyond 24 weeks gestation.
     
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  16. GeneralVeers

    GeneralVeers Globus Hystericus
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    As has been mentioned, these stats aren't comparable, as the United States has a number of other serious social problems, like smoking, obesity, sedentary lifestyle, and violence that some of the other countries lack.

    The best way to compare the success of different healthcare systems is to look at morbidity/mortality of comparable disease processes.
     
  17. qjj

    qjj
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    From ectopicfetus: "For cost, we take care of old and sick people that in other systems wouldnt get the care in other countries they do here. "

    Give me some evidence to support that the US spends so much more because they overtreat the sick and elderly. Convince me of this and you have an argument. Certainly the US disadvantage in average life expectancy, though, doesn't make it seem like we're taking better care of the old and sick. In fact, it seems just the opposite.
     
  18. ERMudPhud

    ERMudPhud Back for a visit
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    Have any of you people been to the UK.
     
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  19. Blue Dog

    Blue Dog Fides et ratio.
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    Well, the answer is obvious...we need more hospital beds, and fewer doctors. :laugh:
     
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  20. qjj

    qjj
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    "As has been mentioned, these stats aren't comparable, as the United States has a number of other serious social problems, like smoking, obesity, sedentary lifestyle, and violence that some of the other countries lack."

    If we have a sicker population, and we're assuming that our healthcare system has no responsibilty for the population being sicker, then shouldn't we have more beds per 1K than other countries instead of fewer?
     
  21. OP
    OP
    EctopicFetus

    EctopicFetus Keeping it funky enough
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    I dont recall the exact place but I am pretty sure (isnt that like a large RCT in terms of evidence?).. In most countries they just count them like miscarriages. Or at least thats what I recall.
     
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  22. OP
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    EctopicFetus

    EctopicFetus Keeping it funky enough
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    DocBs disability insurance is different than health insurance.

    I recommended this site to my mother in law and my wife rec'd it to her students. ehealthinsurance.com

    For a 57 yr old male non smoker in Arizona $157 per month with a $3000 deductible, and 25% coinsurance, office visit falls in this coinsurance and deductible. And you get Rx coverage but I didnt look at the details. Keep in mind for an uncomplicated appy or any surgery, you need OR techs, nurses, and 2 docs, on top of that you need meds etc. Im not saying 30K isnt insane but the costs add up really quick!
     
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  23. la gringa

    la gringa Senior Member
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    we obviously had lectures on economic stuff in med school, and one figure stood out to me - that we spend 50% of health care dollars on care of pts in their last year of their life. if that's not taking care of the old and the sick, i don't know what is... some of what our health care system and public needs is a good lesson in palliative care... at my hospital for example (a public hosp where a lot of ca is diagnosed very, very late), the onc folks will throw $12k/dose chemo at anyone with a pulse. but try to schedule a f/u ulcers EGD, and it takes 18 months. geez...
     
  24. OP
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    EctopicFetus

    EctopicFetus Keeping it funky enough
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    Do you think 80 yr olds are getting cathed in the UK or Canada? Keep in mind avg life expectancy also means that we have 20 yr olds who die in drunk driving accidents as well as other trauamas including accidents etc.

    once you hit 70 or 80 the chances of you living another yr are pretty good.
     
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  25. OP
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    EctopicFetus

    EctopicFetus Keeping it funky enough
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    If we are gonna give everyone something for free, shouldnt we start with a roof over their heads? Shouldnt we require something in return? Just a few thoughts..
     
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  26. ERMudPhud

    ERMudPhud Back for a visit
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    The WHO describes Perinatal mortality as anything from 22 weeks gestation to 1 week post partum. By that logic keeping the 26 week'r alive for >1 week actually improves your numbers. If you combine perinatal with neonatal (up to 4 weeks) we come up about equal to UK and worse than Canada, France, Germany and all sorts of other weepy western european social democracies. Keeping that 26 week'r alive for >4weeks still makes us look better than we deserve here even if he ultimately dies at 5 weeks post partum

    http://www.who.int/making_pregnancy_safer/publications/neonatal.pdf
     
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  27. Ceez

    Ceez Senior Member
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    So how would you fix the US healthcare system?
     
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  28. ERMudPhud

    ERMudPhud Back for a visit
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    I know the site. It doesn't let you put in any medical history. Try applying for a policy and then tell them you have HTN. Or even worse something like RA, lupus, or any other significant chronic disease.

    I realize disability is different from health insurance but the insurance industry's reluctance to touch someone with chronic health conditions isn't.

    http://www.latimes.com/news/local/la-fi-reject31dec31,0,6033834.story?coll=la-home-local

    I know why the appy costs so much. Shoot I get paid well because the ER bill for that appy is a few thousand. But when the bill is more than the patient's net worth it doesn't really matter why it costs so much all they know is that they will be either bankrupt or paying on it for the rest of their life.
     
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  29. ERMudPhud

    ERMudPhud Back for a visit
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    Some numbers

    Obesity rates world wide
    http://www.esrcsocietytoday.ac.uk/E...x55.aspx?ComponentId=12741&SourcePageId=15277
    We aren't much of an outlier

    Smoking rates world wide

    http://www.who.int/tobacco/en/atlas5.pdf
    http://www.who.int/tobacco/en/atlas6.pdf

    We're lower than UK, Germany, France, etc...

    Violence world wide

    http://www.who.int/violence_injury_prevention/violence/world_report/en/summary_en.pdf

    Higher than most but still only accounts for an extra 3 or so deaths per 100,000 people
     
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  30. MirrorTodd

    MirrorTodd It's a gas.
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    :laugh: That sounds eerily similar to my experience.
    *medic after listening to my lungs*
    "It sounds like you have some fluid in your lungs. We'll get you some Cepacol."
    *After seeing doctor in AIT*
    "You have pneumonia. Here's some Erythromycin and a shot of Penicillin in the ass."

    Sorry for the hijack.
     
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  31. Apollyon

    Apollyon Screw the GST
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    Yet again - from where does this article originate?
     
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  32. leorl

    Physician Moderator Emeritus Lifetime Donor Verified Account 10+ Year Member

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    I just don't understand how politicians think socialized medicine would work in the US. Way smaller countries (UK/Ireland) can't really handle it (although truth be told, some others can). There aren't enough resources, not enough doctors in rural populations. There's so much bureaucracy that interns spend most of the time being glorified secretaries and nurses rather than doing any real medicine. People running for office really should come and get sick on this side of the pond...then they'll see how far a 1.5 yr. wait for an MRI will get them and have their operation cancelled 3 times. Socialized medicine will never work in the US...we're just too big.
     
  33. dlung

    dlung Postprelim intern oranges
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    The pragmatics of any decision should be less important than the moral implications. Any right-wingers should agree with that. Any supporters of the 80-hour workweek should agree with that!

    Miscellaneous thoughts in no particular order...

    It should be made clear that when we talk about 'universal healthcare' in the United States, it does not equal 'single-payer.' It hasn't for quite some time. The idea of single-payer was kicked around in the early '90s and quickly removed by left-wingers as a solution. Clinton's plan back then, although providing for universal coverage, was not single-payer. All proposed univeral health care plans since produce (for lack of a better description) a 'mixed' healthcare environment.

    Clearly, any health care system makes sacrifices. In developed countries, the potential resources available in health care outstrip our ability to provide it to every single person. It's similar to a triage decision. What do you want to sacrifice? If you want universal healthcare, are you (as a country) willing to sacrifice the high quality that the upper-tier of society enjoys in order to provide a reduced standard of health care equally accessible to all of society?

    Just 'cause it's so much fun to make more people irrate, I would change that last sentence to: "Socialized medicine will never work in the US...we're just too spoiled." :laugh:
     
  34. DropkickMurphy

    DropkickMurphy Membership Revoked
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    And I want to know if you asked Rosen for a copy of his book for me! :laugh:
     
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  35. Hawk22

    Hawk22 Senior Member
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    I've read/studied alot about this issue and honestly don't have time to post much right now, but I wanted to make a few quick points.

    La gringa is dead on point on the comments about end of life care. We spend a huge amount of money on patients in the last 6 months of life and many question whether we spend too much on patients who are basically "unsaveable." That debate opens up a huge number of ethical questions for another topic, but worth noting.

    It is also true that "universal health care" could mean alot of things, which may or may not mean a single payer system for the US. It is our system and we could chose whatever method we want.

    But before this thread goes any further, I have a few question for everyone:

    1. Is healthcare a right or a privilege?

    2. Should everyone receive quality healthcare when they need it or should it only be reserved for those who have the means to pay for it?

    I think the answers to those questions for everyone are good starting points.
     
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  36. OP
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    EctopicFetus

    EctopicFetus Keeping it funky enough
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    Hell keeping it the way it is, is better than changing it to a national system. How I would change it would obviously be a super long answer as there are a ton of problems. I would start by not having universal coverage. Health care is NOT a right in this country and should not be one. I would also group health insurance more by age than by company. One of the reasons why insurance is so expensive for people is that while the old folks are sicker the young workers are generally healthier but in companies they all get grouped together leading to higher premiums which young people dont want to pay since they are generally healthy. This is like playing the insurance lotto.

    I would advocate for health spending accounts with insurance to cover disasters for people, say anything over 5k or 10k. This would greatly reduce costs, this is similar to the insurance provided on the website I discussed previously, and would limit the number of visits for stupid reasons because people would pay out of pocket right then and there. The issue is that when someone sees their doc it is only $10 to see them so why not?

    That would be where I would start. I could outline an answer to every issue but I have the in service coming up and I dont have hours to provide my OPINIONS.

    I would also penalize people who smoke, have a history of violence and who otherwise increase the costs of healthcare through their own stupidity or actions. Oh, I would also penalize the obese and before anyone attacks me, I am not a marathoner and am overweight.
     
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  37. OP
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    EctopicFetus

    EctopicFetus Keeping it funky enough
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    There are insurers out there who might make it more expensive but the reality is that that poses a risk to the insurer, would you invest your money for the same rate of return where you have a 30% chance of losing your money like in a junk bond compared to a 0% chance in a savings account? They have to manage their risk as well. My mother in law has a history of severe allergies, HTN and she is in her late 50s and got insurance for like $200 a month thru this company. Thats my only personal experience.
     
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  38. OP
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    EctopicFetus

    EctopicFetus Keeping it funky enough
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    Obesity is more complicated. Lets look at Diabetes, according to the ADA http://www.diabetes.org/uedocuments/worlddiabetesday.pr.pdf
    http://www.diabetes.org/uedocuments/1.DOCTORSFAILINGTOINTENSIFY.06.10.pdf

    20.8 million people have diabetes, 54 million are "pre-diabetic" this is almost 7% of our population with DM.

    http://www.countrydoctor.co.uk/precis/precis - Diabetes UK.htm
    New statistics revealed today show that there are now 1.8 million people with diabetes in the UK representing three per cent of the population.

    Canada
    http://www.diabetes.ca/files/CostofDiabetesJohnsonJun04.pdf
    1.4 million diabetics (to be fair stats from WHO are different)
    their population http://www.statcan.ca/english/edu/clock/population.htm
    32,839,000

    Or about 4.3% of their population


    http://www.who.int/diabetes/facts/world_figures/en/index4.html

    France
    Diabetics 1,710,000 / Population 60,496,000
    2.8%

    Germany 2,627,000 / population 82,689,000
    3.2%

    So as a summary US Diabetes 6.9%, Canada 4.3%, Germany 3.2%, UK 3%, France 2.8%, We all know how expensive this is to treat, dialysis, meds, doctors visits, BKAs etc etc.

    Lets look at HIV and Hep C rates in this country compared to the UK, Canada, France, and Germany.

    https://cia.gov/cia//publications/factbook/rankorder/2155rank.html
    US 0.6%
    UK 0.2%
    Canada 0.3%
    France 0.4%
    Germany 0.1%

    These meds run what 20K a yr plus numerous office visits etc?

    Hep C
    http://www.epidemic.org/theFacts/theEpidemic/worldPrevalence.html

    The prevalence of hepatitis C is lowest in Northern European countries, including Great Britain, Germany and France. According to one survey, the prevalence of HCV antibodies in blood donors averages less than 1% for the region. (However, other studies have suggested that rates of infection may be much higher, comparable to rates in the U.S. - approximately 2.5%).
     
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  39. OP
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    EctopicFetus

    EctopicFetus Keeping it funky enough
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    MudPhud, while the death rate may only be slightly higher 3/100K how about the ones who dont die? I would argue that paralysis and other chronic issues are way more costly. Death doesnt financially burden the system especially if it is quick. On the other hand a 2 month ICU stay is quite expensive.

    We all know about the "vent farms" they are much more costly than if those people just died.
     
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  40. OP
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    EctopicFetus

    EctopicFetus Keeping it funky enough
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    Crap! I thought I put the link in. I cant find it.. doesnt really matter anyhow does it? Just some dude. I searched for like 10 mins without luck.
     
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  41. qjj

    qjj
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    [​IMG]


    I don't think we gain that much by arguing about which country has more unhealthy people. Even if we all came to an agreement, surely the system of healthcare has an impact on on the underlying health of the population. For instance, how well a system leads to treatment for pre-diabetes will affect how many people in the country are diabetics or pre-diabetic. Similarly, we can't look at treatments for specific diseases to really gain any knowledge. For instance, it not only matters what the survival rate after a first MI is, but also how many people are prevented from getting MIs by having their risk factors managed before pathology develops.

    Instead, I'd like to go back to my chart, at least for a minute, and point out that there is a lot of juggling going on to explain why the infant mortality and life expectancy are better than in other countries despite looking worse with the numbers. But, we're ignoring the top line of the chart. The United States is paying about twice as much for healthcare as other nations. Even if you think the quality data are misleading and the US actually has better care, you can't think it's so much better that we're getting what we pay for. I mean, Jesus F*cking Christ. Enough of theory. Look at the numbers. Twice as much money for earlier death.
     
  42. OP
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    EctopicFetus

    EctopicFetus Keeping it funky enough
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    Some interesting stats..

    http://www.spinalcord.uab.edu/show.asp?durki=21446


    So in the US 3.67/100K new SCIs per yr

    In the UK
    http://www.pjonline.com/pdf/hp/200503/hp_200503_condition.pdf

    800 new people per yr 1.42/100K

    http://www.rickhansen.com/sections/aboutsciandlinks/docs/InventoryExecSummary.pdf
    In Canada, 1000-1100 new SCIs per yr 3.1 to 3.4/100K, no good data, these are the numbers "generally accepted"

    I got to go to work. Good discussion though.
     
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  43. GeneralVeers

    GeneralVeers Globus Hystericus
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    Why do we spend twice as much on healthcare? It has to do with the liability situation in this country. How many unnecessary CTs, X-rays, and ultrasounds do you order just to "cover yourself"? I've ordered tons of them myself, on patients who obviously didn't have whatever condition I was trying to rule out.

    Unfortunately the politicians will never enact serious liability reform, because it's they, along with John Edwards who profit most from suing doctors.

    Also, I've seen attending physicians order Zofran for patients, when much cheaper drugs like Reglan or Phenergan would work just as well.
     
  44. OP
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    EctopicFetus

    EctopicFetus Keeping it funky enough
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    Your chart needs to take into account how sick people are, also to make the numbers look a little better it should look at per capita income. Nurses cost more in the US partly because the cost of living is higher.

    Lastly, if you believe what I bolded you there is a residency in primary care with a spot for you. Reality is this matters little because patients dont take their meds, dont start excercising and dont stop smoking. Thats the reality.
     
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  45. qjj

    qjj
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    Do you really think that the United States spend an entire healthcare system worth of money just on ultrasounds and CTs and other diagnosistic tests that wouldn't be ordered in other nations? Here's a hint: do diagnostic tests comprise more than half of the healthcare cost in the US system? Here's another hint: no.
     
  46. OP
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    EctopicFetus

    EctopicFetus Keeping it funky enough
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    100% agreed!:thumbup:

    http://www.opensecrets.org/industries/contrib.asp?Ind=K01&cycle=2006
    In 2006 attorney and their companys contributed almost $120 million

    Oh and dont get me started on John Frickin Edwards!
     
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  47. OP
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    EctopicFetus

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    They very quickly add up. Is it more than half no. is it a good chunk of money, you better believe it. CMS should be negotiating the cost of drugs (which is currently illegal) which would help as well. A little bit of everything helps, the need for specialists also needs to be changed. Much of this can be done safely at the PCP which would be cheaper.
     
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  48. qjj

    qjj
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    Can you please address the huge disparity in cost between the US and other nations? Nurses' pay isn't cutting it for me for a 100% increase in healthcare cost.
     
  49. Tiger26

    Tiger26 Senior Member
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    The problem with these infant mortality numbers among socialized health care systems is that they don't take into account regional differences within the actual countries themselves. If you look closely, the infant mortality rates in those countries correspond almost entirely with the regional per capita incomes in those same countries. Even though 'infant mortality' is the gold standard for the left, they not coincidentally fail to mention the details.

    Of course, most of these people are also the same ones who don't give a damn about an infant before she/he exits the womb . . . but that's a whole other topic.
     
  50. Miami_med

    Miami_med Moving Far Away
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    Of course, we could let people decide how much healthcare they will access based on what they will pay for. I also think that you've placed a false dichotomy here. Resources are fluid. It's not like there is a static pie that we try and divide up fairly. The problem in US healthcare is a technological component that evolved under limitless government money with no thought for cost in mind. If we made people responsible again, there would be SOME incentive to control costs in order to compete. Right now, more expensive = more government money. This will only get worse in a Universal System. In a more efficient system, almost everyone with even the most remote of work ethics and income will benefit to a degree. Inequality between economic groups won't necessitate a total lower quality of care for any group.
     
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