Insuring the millions who are not...

[g3pro]

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Okay, Einstein. Since you have obviously spent so much time researching this issue (cough), let's play a game. It's called "guess which of the countries on this graph is the only one without universal healthcare"

LOL, since you obviously don't know where you got your data from, and since you didn't realize that Cuba is next to the US in life expectancy, and since you didn't realize that Cuba spends 2% of what the US spends per capita, I would say that you have no idea how to evaluate medical statistics!

 

[Suppuration]

insurance is about hedging risks.

...through wealth distribution. I know I'm being loose with the term, but that's what it boils down to. You pay in a small amount, you have security, you sleep at night. If something bad happens you cash in. If nothing bad happens you get to live your life free of anything bad happening.

Having survived a house-gutting fire and getting multiple cars destroyed by drunk drivers and acts of God, I'm very familiar with insurance.

wealth redistribution is the point of taxation

I'm sure it is in your fcked up world.

 

[Suppuration]

LOL, since you obviously don't know where you got your data from, and since you didn't realize that Cuba is next to the US in life expectancy, and since you didn't realize that Cuba spends 2% of what the US spends per capita, I would say that you have no idea how to evaluate medical statistics!

And I would say that you have the reading comprehension skills of a third grader. I know exactly where Cuba falls in terms of life expectancy, and how little they spend on healthcare relative to the US. That's the point. It simply underscores how pathetic our system really is. You're the one saying that changing our system would be to the detriment of 90% of our population. I'm saying that by every measure available we're paying more than anyone else and getting ****e in return. Not exactly the capitalist's wet dream, is it?

 

[Richard_Premed]

Negligable... I'm sure the interviewer/adcom wouldn't appreciate that remark.

Unlike yourself, not all premeds are altruistic/compassionate people who wan't to save the world. (or so they say, but adcoms know it's bull****) The answer to the original question, if you don't try, because the second you increase taxes to provide better service, people LIKE YOURSELF, get pissed off and wonder why they have to pay more tax.

So to answer the question, why are 40 million americans uninsured? Because YOU don't want to pay 50% tax on your gross income. And neither do I. Period.

 

[BAM!]

Did you type that with a straight face? You do realize that all those problems you listed, supposedly resulting from capitalism, (i.e., famine, environ. damage, military deaths, etc.) were orders of magnitude worse under socialist regimes (like the former Soviet Union and the present Chinese govt.)? Do you have any idea what the USSR did to the environment? What western societies did doesn't even compare. I'm not saying capitalism is without guilt, but if you're proposing we fix these problems by going from capitalism to socialism then all you're going to get is the same problems multiplied by 10 or 100.

he was talking about socialized healthcare - not communism.

Example - Canada has socialized healthcare, but they still have a capatalist government.

 

[BAM!]

but capitalism is without guilt

i think requiring copayment from every patient will improve the healthcare system. no matter how poor they are, they should have to cough up something relative to what they can. everyone can round up a few dollars they are called for. its not the money itself that will help. its that payment is a powerful incentive for consumers to conduct research, use services scrupulously, and demand cost effective treatment. obviously goading people to eat and live well isnt working, so the only way is to make financial appeals, which everyone is receptive to.

many homeless people don't have a few dollars. is it fair to refuse treatment for them?

 

[dilated]

many homeless people don't have a few dollars. is it fair to refuse treatment for them?

Is it fair for supermarkets to refuse them food? Many homeless people cannot afford food. Do you support compelling all bakers to spend some of their workweek making free food for the homeless?

 

[SeventhSon]

Is it fair for supermarkets to refuse them food? Many homeless people cannot afford food. Do you support compelling all bakers to spend some of their workweek making free food for the homeless?

hahaha sorry it's 11:30 and i'm tired on a friday night doing nothing and this thread is just causing me roll on the floor laughing

 

[SeventhSon]

The lawyers that are publicly provided are, generally speaking, of the poorest quality, like the shoes at the bowling alley. Having a ****ty lawyer is one thing, but would you really want to go under the knife of a ****ty doctor, or even have a diagnosis from one?

It would be nice to work out a similar system, where low quality doctors are provided "free" to the poor people at the cost of the government (taxpayers). In law, a ****ty lawyer is better than no lawyer. In medicine, however, a ****ty doctor is just as bad as, or worse, than no doctor.

Dude you have way too little faith in the system. Doctors have to obtain a license to practice and if they are able to obtain a license and are that bad, they have their license revoked. I agree with your statement that these preventative measures are going to have to come about through a social solution. However, I reject the notion that our healthcare system is so great. People smoke and drink like madmen in Europe but they don't have the type of health epidemics that we have.

No matter whether you believe we should move towards universal healthcare, I think it should be clear to everyone that our healthcare system is a failure and the government should be willing to make real steps to intervene. If something doesn't work, admit it frankly and try something else.

 

[morgan]

Cuba is next to the US in life expectancy, and since you didn't realize that Cuba spends 2% of what the US spends per capita, I would say that you have no idea how to evaluate medical statistics!

😕 huh? that doesn't make sense. that's the point.

 

[morgan]

LOL, since you obviously don't know where you got your data from

Um, I don't know why you don't know where Supperation got the data from. If you right click on the image and hit properties, it tells you. 🙄

http://ucatlas.ucsc.edu/health/spend/cost_longlife75.gif

 

[Suppuration]

Is it fair for supermarkets to refuse them food? Many homeless people cannot afford food. Do you support compelling all bakers to spend some of their workweek making free food for the homeless?

In Panama, for example, doctors are required to spend 40 hours per week giving free healthcare to the general populace. Every dime they earn for themselves comes after those 40. Can you imagine that happening in the US?

 

[Suppuration]

Now you might say, "Well, why can't the government just provide high-priced doctors." If you put those doctors on the government pay roll, the government will try to micromanage how that doctor does his job.

HAHAHAHAHAHAHA... ...HAHAHAHAHAHAH.... (coughs, clutches chest)...HAHAHAHAHAHAHAHAHAHAH... (grabs wall)....

...(pants for awhile)...

Thanks man. That's the best laugh I've had in awhile. I can't wait until you actually work in healthcare delivery and have some basis for comparing private vs. public vs. government healthcare bureacracies.

 

[troszic]

I think none is too strong of a word. I mean people become things like teachers all the time. 😉

Fair enough. I'll amend my statement to, "You'd have a lot less people willing to go into medicine, perhaps even a shortage." Indeed, some people would still do it.

Plus, if a doctor is licensed to practice in the U.S., that's a fairly good sign. If they are a bad doctor, they won't be one for long.

I was just trying to point out that the law system and medical systems are structured in such a way where it is easy to provide a lawyer for cheap (so the government might as well do it) whereas the medical system doesn't have cheap doctors, period. Even forgetting about the doctors, the supplies and resources needed to run hospitals are quite expensive.

Look how much money Medicare costs: 300 billion dollars (1/8 the national budget). And that program just covers a small group of people!

Forget about the cheap, crappy doctor thing; I had a weird, hypothetical argument in mind. Doctors are neither cheap, nor crappy, and cannot be otherwise (in theory).

 

[bottles999]

40 million is around 10% of the population. In other words, it's negligable.

OMG - Thats like that quote from Turman... (paraphrashing) "5% unempolyment isn't too bad... Unless YOUR one of the 5%" Nuff said... That answer wont get you anywhere

 

[Andrew_Doan]

Most will agree that preventative care is key. Perhaps a few of us should form a new insurance company that pushes for preventative care: nutritionists, personal trainers, gym memberships, etc... our patients are rewarded for staying in shape. The more in shape, the less co-pay they pay. The premium is low. Premiums are very high. For a family of four, I pay $800/month. We don't even tap into this. Over the last five years, my employer or I have paid over $40,000 in health insurance. My family has used about $2500 of this.

The problem with a for-profit insurance company that is a public company is that their number one priority is shareholder return. You can't be a large public company and truly serve society because if you made 1 billion in profits one year, then the next you need to make 1.1 billion or your stock price will dive. This forces CEOs to drive up insurance costs and payout less to make more profits.

We make a private insurance company, do it right, and reward patients with lower premiums if they meet certain health standards.

 

[will8570]

If you knew anything about economics, you wouldn't have said that. Anyone knows that 5% unemployment is the natural free market rate. THe unemployment rate includes those who are still in the market for a job but are unable to get one, and do not include those who have given up on finding jobs.

If you get much under 5% employment you have people doing jobs that aren't really needed. IE: moving rocks from pile to pile, holding up a wall with their backs, etc. This sounds insane but many socialist countries put people to work doing these meaningless tasks just so they can say that their system is working. It is cheaper and more effective in the long run to have a temporary welfare system in place to assist those currently without jobs who are still in the work force. Abusers of the system should be cut off and left to fend for themselves. Exactly the same needs to happen for the uninsured as well as those on gov't health care that shouldn't be. Add to that harsher penalties for hospitals and doc's ordering unneccesary tests to build up bills (We all know this happens) and greater punishments for patient dumping, which is when hospitals try to move nonpayers to different facilities. Then cut down on the profit margin from HMO's, PCO's, and MCO's which is often adding 20% to the bill. Throw in preventative medicine at the grassroots level and I think we've just solved a lot of the problem.

OMG - Thats like that quote from Turman... (paraphrashing) "5% unempolyment isn't too bad... Unless YOUR one of the 5%" Nuff said... That answer wont get you anywhere

 

[Minion677]

some insurance incentives towards healthy living would be nice. every year or 2 at your physical have them measure height, weight, blood pressure, cholesterol levels, heart rate, body fat, smoking and come up with a health score for you for your age. then base your insurance premiums on that score. the only problem i could see with this is people claiming genetic disorders that predispose them to high blood pressure or something. not sure how we could verify that.

 

[Andrew_Doan]

the only problem i could see with this is people claiming genetic disorders that predispose them to high blood pressure or something. not sure how we could verify that.

Good point. We only allow genetic disorders that are proven in the research literature.

On the other hand, we offer discounts on premiums based on other factors: nutrition education, excercise, weight, etc...

For families that don't eat at McDonalds, eat fruits/veggies, take their multi-vit, and excercise, they will pay lower premiums. For the ones that are all fat, eat grease, and watch TV all day, they can be stuck with a larger bill.

This model is similar to car insurance. If you're a crappy driver, then you pay high premiums.

 

[troszic]

Suppuration posts a graph. The graph shows unusually high spending on health care and low life expectancy for the U.S.

As statisticians know, our first instinct is to assume that the x-axis has some kind of relationship to the y-axis. "My god, they're on the same graph together! They must be connected!"

As the good scientists that we presumably are, we should look further and question that assumption.

Hmmmm, Japan has the highest life expectancy. America has one of the lowest. Here's a hypothesis. What if life expectancy has more to do with personal lifestyle choices?
Japanese people eat healthy foods in moderate quantities, they exercise, etc. In America, obesity is a huge problem; we eat a lot and don't exercise.

Looking just at the countries and the life expectancies, this hypothesis seems plausible. Let's look for more data.
I found some data from the international obesity task force: IOTF
Apparently they have compiled BMI tables for many countries:
BMI tables

Now let's see.
Japan, #1 life expectancy:
obese males = 2.9%
overweight males = 23.9%
Switzerland, #4 life expectancy:
obese males = 14.1%
overweight males = 45.9%
Canada, #10 life expectancy:
obese males = 16%
overweight males = 40%

WAIT, I'M STARTING TO SEE A TREND!

England/UK, 7th from last life expectancy:
obese males = 22.2%
overweight males = 43.2%
United States, 5th from last life expectancy:
obese males = 27.7%!!!
overweight males = 39.3%

These numbers show a general trend, with of course, fluctuations. If you took the time to plot a graph of life expectancy vs. BMI, you'd see a significant correlation.
As I mentioned before, correlation is not sufficient to imply cause, you also need a plausible causal mechanism. In this case, indeed, there is a very plausible explanation for how unhealthy lifestyles affect life expectancy.

The fact of the matter is, per capita spending has little or nothing to do with life expectancy. What really matters is healthy living.

But if healthy living would improve our situation, why are we spending all that money? If indeed proper living is responsible for improved life expectancy, then it doesn't matter how much we spend.

BINGO! We've stumbled upon something interesting. Perhaps, just perhaps, the U.S. is mistaken on dumping money into the healthcare system. We think throwing money at a problem makes it go away. The graph strongly emphasizes how WEIRD it is that we spend so much. The conclusion: politicians have been wasting our money in order to make it look like they are solving the problem, when actually, the real problem is poor living on the part of American citizens. Clearly, we are spending way too much on healthcare, just so we can ignore the real problem: that we are fat and lazy.

Q.E.D.

 

[Andrew_Doan]

BINGO! We've stumbled upon something interesting. Perhaps, just perhaps, the U.S. is mistaken on dumping money into the healthcare system.

Very nice analysis. Thus, this supports my answer that an effective solution is preventative education. This will lower insurance premiums allowing more people to be insured. 😉

 

[amberm4]

I have spent hours shadowing in a prenatal care clinic for the uninsured/Medicaid client. I agree that prevention is key, but people have to WANT to help themselves. Under the grant provisions, these persons are educated in smoking cessation and proper nutrition at every visit. They meet with a social worker at very visit. But they don't change behaviors! They are receiving free health care and believe me, they will tell you to your face they are ENTITLED to government help because they are a US citizen. Last week a client had some "cramping." She was only 5 weeks and 1 day and had already been to the ER 3 times and office once. Everything is perfect with this client. Who is paying for this care - our tax dollars!

When citizens are receiving free health care, I would like to see accountability. Minimal copays should be mandated. For instance, ER visits $15, office visits $5, medications $2. These are the same persons who in my geographical location smoke. If you can afford to smoke, you can take some responsiblity for medical costs.

As a future physician, I want all persons to have access to health care. And education is definitely essential. I just hope some of these people listen to the message!

 

[Minion677]

Good point. We only allow genetic disorders that are proven in the research literature.

On the other hand, we offer discounts on premiums based on other factors: nutrition education, excercise, weight, etc...

For families that don't eat at McDonalds, eat fruits/veggies, take their multi-vit, and excercise, they will pay lower premiums. For the ones that are all fat, eat grease, and watch TV all day, they can be stuck with a larger bill.

This model is similar to car insurance. If you're a crappy driver, then you pay high premiums.

i totally agree, but insurance companies need to find verifiable factors. not sure how they could tell how many times a patient goes to the gym or eats fast food per week besides just asking them, and of course they would just lie as soon as they knew their answer would affect how much they pay. im still not convinced about the genetic disorder loophole.. the whole argument of genetics vs. environmental factors comes into play here. how much of % body fat is due to unhealthy eating and how much is due to genetics. can we really penalize someone for being big boned? the more i think about this the less feasible it seems..

on a note related to means tests.. does malpractice insurance take into account past offenses when they determine how much premium you pay? ive read some old literature that says they dont, but i was wondering if this has/is changing. it would seem like a good idea in my opinion... more along the lines of car insurance and it would reduce premiums for good doctors and provide more of an incentive to become a "safer" doctor (for lack of a better word)

 

[g3pro]

Suppuration posts a graph. The graph shows unusually high spending on health care and low life expectancy for the U.S.

As statisticians know, our first instinct is to assume that the x-axis has some kind of relationship to the y-axis. "My god, they're on the same graph together! They must be connected!"

As the good scientists that we presumably are, we should look further and question that assumption.

Hmmmm, Japan has the highest life expectancy. America has one of the lowest. Here's a hypothesis. What if life expectancy has more to do with personal lifestyle choices?
Japanese people eat healthy foods in moderate quantities, they exercise, etc. In America, obesity is a huge problem; we eat a lot and don't exercise.

Looking just at the countries and the life expectancies, this hypothesis seems plausible. Let's look for more data.
I found some data from the international obesity task force: IOTF
Apparently they have compiled BMI tables for many countries:
BMI tables

Now let's see.
Japan, #1 life expectancy:
obese males = 2.9%
overweight males = 23.9%
Switzerland, #4 life expectancy:
obese males = 14.1%
overweight males = 45.9%
Canada, #10 life expectancy:
obese males = 16%
overweight males = 40%

WAIT, I'M STARTING TO SEE A TREND!

England/UK, 7th from last life expectancy:
obese males = 22.2%
overweight males = 43.2%
United States, 5th from last life expectancy:
obese males = 27.7%!!!
overweight males = 39.3%

These numbers show a general trend, with of course, fluctuations. If you took the time to plot a graph of life expectancy vs. BMI, you'd see a significant correlation.
As I mentioned before, correlation is not sufficient to imply cause, you also need a plausible causal mechanism. In this case, indeed, there is a very plausible explanation for how unhealthy lifestyles affect life expectancy.

The fact of the matter is, per capita spending has little or nothing to do with life expectancy. What really matters is healthy living.

But if healthy living would improve our situation, why are we spending all that money? If indeed proper living is responsible for improved life expectancy, then it doesn't matter how much we spend.

BINGO! We've stumbled upon something interesting. Perhaps, just perhaps, the U.S. is mistaken on dumping money into the healthcare system. We think throwing money at a problem makes it go away. The graph strongly emphasizes how WEIRD it is that we spend so much. The conclusion: politicians have been wasting our money in order to make it look like they are solving the problem, when actually, the real problem is poor living on the part of American citizens. Clearly, we are spending way too much on healthcare, just so we can ignore the real problem: that we are fat and lazy.

Q.E.D.

QFT. 🙂

It's too bad the OP of the graph didn't apply the same logical thought. But what could you expect from that person anyways. Anyone who would think that Cuba and the US are on the same level of health care should automatically sit in the corner and go back to reading Mad Magazine.

 

[SeventhSon]

QFT. 🙂

It's too bad the OP of the graph didn't apply the same logical thought. But what could you expect from that person anyways. Anyone who would think that Cuba and the US are on the same level of health care should automatically sit in the corner and go back to reading Mad Magazine.

actually it is my understanding that other some of our other statistics that measure quality of healthcare such as infant mortality rate are very similar to cuba's.

 

[newguy357]

Okay, Einstein. Since you have obviously spent so much time researching this issue (cough), let's play a game. It's called "guess which of the countries on this graph is the only one without universal healthcare":

Thanks for giving us a graph that starts from zero on one y-axis and at 90% on the other. Any other twisted information for us that will reveal this remarkable 2-3% difference in life expectancy, Einstein?

 

[newguy357]

Dude you have way too little faith in the system.
No matter whether you believe we should move towards universal healthcare, I think it should be clear to everyone that our healthcare system is a failure and the government should be willing to make real steps to intervene. If something doesn't work, admit it frankly and try something else.

And people travel from all across the world to come to our "failed" healthcare system because it has superior quality to all others.

You can complain all day about our system not being FAIR. Fine. But don't say our system is failed. If you want fair, move to any socialist country in this world and you'll get your fair--low quality care, weeks for a CT Scan--just like everyone else.

 

[thegenius]

40 million is around 10% of the population. In other words, it's negligable.

It's more like 15% actually. And we have tens of millions who are under-insured as well. Underinsured being defined as they would lose everything if they incurred a catastrophic disease or trauma.

But I know you are just goofing around.

 

[SeventhSon]

And people travel from all across the world to come to our "failed" healthcare system because it has superior quality to all others.

You can complain all day about our system not being FAIR. Fine. But don't say our system is failed. If you want fair, move to any socialist country in this world and you'll get your fair--low quality care, weeks for a CT Scan--just like everyone else.

newguy - i am talking about the cost of care, not the quality of care.

additionally, while criticism of the life expectancy graph in valid, the basis is on the fact that the OP seems to casually assume a direct correlation between cost per capita and life expectancy, which is haphazard to say the least. Statistically speaking, if this were in fact the only correlation, this 2-3% would be statistically significant... VERY significant over millions of people.

 

[SuzieQ3417]

I just wanted to share an interesting story. So I was surfing the internet yesterday doing some last minute preparations for my committee interview that afternoon, and came across this thread on SDN. It caught my eye and I read through the entire thread and saw some of the good (and awful) arguments people were making. Anyway, I get to my interview, and I was asked this exact question! How would I go about insuring the 46 million who are currently uninsured in the US? Thank you SDN! Just thought I would share, and remind everyone who are just getting angry and throwing around unverified facts that you will probably get asked this during an interview and need to have good, carefully considered and researched, thoughts on the matter.

 

[SeventhSon]

some insurance incentives towards healthy living would be nice. every year or 2 at your physical have them measure height, weight, blood pressure, cholesterol levels, heart rate, body fat, smoking and come up with a health score for you for your age. then base your insurance premiums on that score. the only problem i could see with this is people claiming genetic disorders that predispose them to high blood pressure or something. not sure how we could verify that.

UMMMM how about no, i don't want the government micromanaging my life? Enforcing this will also create huge overhead and cost a lot of what you're saving by *supposedly* convincing people to become healthier.

People get locked into a lifestyle and then don't budge, regardless of the cost to them. Look at the cars we buy. All these idiots in our country continue to buy SUV's FOR NO DAMN REASON and then complain about gasoline prices. Do you really think people are going to make themselves more fit so that they pay less for insurance? I think not.

As someone said before, people have no sense of delayed gratification.

 

[drmota]

Suppuration posts a graph. The graph shows unusually high spending on health care and low life expectancy for the U.S.

As statisticians know, our first instinct is to assume that the x-axis has some kind of relationship to the y-axis. "My god, they're on the same graph together! They must be connected!"

As the good scientists that we presumably are, we should look further and question that assumption.

Hmmmm, Japan has the highest life expectancy. America has one of the lowest. Here's a hypothesis. What if life expectancy has more to do with personal lifestyle choices?
Japanese people eat healthy foods in moderate quantities, they exercise, etc. In America, obesity is a huge problem; we eat a lot and don't exercise.

Looking just at the countries and the life expectancies, this hypothesis seems plausible. Let's look for more data.
I found some data from the international obesity task force: IOTF
Apparently they have compiled BMI tables for many countries:
BMI tables

Now let's see.
Japan, #1 life expectancy:
obese males = 2.9%
overweight males = 23.9%
Switzerland, #4 life expectancy:
obese males = 14.1%
overweight males = 45.9%
Canada, #10 life expectancy:
obese males = 16%
overweight males = 40%

WAIT, I'M STARTING TO SEE A TREND!

England/UK, 7th from last life expectancy:
obese males = 22.2%
overweight males = 43.2%
United States, 5th from last life expectancy:
obese males = 27.7%!!!
overweight males = 39.3%

These numbers show a general trend, with of course, fluctuations. If you took the time to plot a graph of life expectancy vs. BMI, you'd see a significant correlation.
As I mentioned before, correlation is not sufficient to imply cause, you also need a plausible causal mechanism. In this case, indeed, there is a very plausible explanation for how unhealthy lifestyles affect life expectancy.

The fact of the matter is, per capita spending has little or nothing to do with life expectancy. What really matters is healthy living.

But if healthy living would improve our situation, why are we spending all that money? If indeed proper living is responsible for improved life expectancy, then it doesn't matter how much we spend.

BINGO! We've stumbled upon something interesting. Perhaps, just perhaps, the U.S. is mistaken on dumping money into the healthcare system. We think throwing money at a problem makes it go away. The graph strongly emphasizes how WEIRD it is that we spend so much. The conclusion: politicians have been wasting our money in order to make it look like they are solving the problem, when actually, the real problem is poor living on the part of American citizens. Clearly, we are spending way too much on healthcare, just so we can ignore the real problem: that we are fat and lazy.

Q.E.D.

i think every doc should have these figures blown up and posted in their reception area. seriously.
-mota

 

[Suppuration]

Clearly, we are spending way too much on healthcare, just so we can ignore the real problem: that we are fat and lazy.

As one of my internal medicine attendings once put it: "If my patients would quit smoking, drink less, eat slightly better and take an evening walk, I'd largely be out of a job."

If only we could get the boring diseases under control, then the really interesting pathology could shine through. A boy can dream.

 

[Suppuration]

Thanks for giving us a graph that starts from zero on one y-axis and at 90% on the other. Any other twisted information for us that will reveal this remarkable 2-3% difference in life expectancy, Einstein?

I'll type really slow so you have a better chance of understanding this: we spend 50% more per capita on healthcare then our closest lucky contestant (Switzerland), and our life expectancy is a whopping 0.9 years greater than Cuba. Feeling ripped off?

There is no remarkable difference in life expectancy. That's the point. There is, however, a remarkable difference in how much money we blow per capita. Jesus H. Christ, some of you guys need to go back to middle school.

 

[medicomel]

UMMMM how about no, i don't want the government micromanaging my life? Enforcing this will also create huge overhead and cost a lot of what you're saving by *supposedly* convincing people to become healthier.

People get locked into a lifestyle and then don't budge, regardless of the cost to them. Look at the cars we buy. All these idiots in our country continue to buy SUV's FOR NO DAMN REASON and then complain about gasoline prices. Do you really think people are going to make themselves more fit so that they pay less for insurance? I think not.

As someone said before, people have no sense of delayed gratification.

there has to be some way to convince folks that healthier, cleaner living is the way to go. and as i said before, money talks. insurance incentives, tax breaks...SOMETHING. personally i don't think tv and magazine ads featuring tanned hard bodies frolicking on the beach eating apples will convince people to start leading healthier lifestyles.

it's fair to say that you don't want gov't. or insurance agencies micromanaging your life. but don't look to the gov't. or insurance agencies when you need life-saving dialysis because you didn't control your diabetes, or prevent it in the first place by diet and exercise.

back to the preventative medicine argument ---> if diseases like high blood pressure, heart disease and diabetes were PREVENTED, then the cost for insurance should *hopefully* decrease, and those that are uninsured because of the coverage gap could afford health care.

 

[popolus]

I do not know if someone has stated this already, how about cutting out some of the middle people when it comes to healthcare? Seems to me each hospital or pharm. company could fire about half the "management" and still function just fine.

 

[jonsir]

bump 🙂

 

[Shredder]

I do not know if someone has stated this already, how about cutting out some of the middle people when it comes to healthcare? Seems to me each hospital or pharm. company could fire about half the "management" and still function just fine.

when most firms downsize it is the "middle managers" who get cut out of the equation without the company really missing a beat. sigh, bureaucracy

 

[Suppuration]

I do not know if someone has stated this already, how about cutting out some of the middle people when it comes to healthcare? Seems to me each hospital or pharm. company could fire about half the "management" and still function just fine.

To Hell with firing them, sack the insurance company paper pushers. In January of 2004, a Harvard group published an analysis in The International Journal of Health Services. They estimated that administrative costs in the US ran $399.4 billion for the time period they analyzed, and that a national health insurance plan would save $286 billion. To reiterate their points for using these savings:

1. Cover the uninsured ($80 billion)
2. Cover all out of pocket prescription drug expenses for everyone ($53 billion)
3. Cover retraining for the now unemployed insurance company workers ($20 billion)
4. Fund improvements to the existing healthcare infrastructure with the remainder.
5. Get everyone in the country totally ripped on Thunderbird

 

[veenut]

Suppuration posts a graph. The graph shows unusually high spending on health care and low life expectancy for the U.S.

As statisticians know, our first instinct is to assume that the x-axis has some kind of relationship to the y-axis. "My god, they're on the same graph together! They must be connected!"

As the good scientists that we presumably are, we should look further and question that assumption.

Hmmmm, Japan has the highest life expectancy. America has one of the lowest. Here's a hypothesis. What if life expectancy has more to do with personal lifestyle choices?
Japanese people eat healthy foods in moderate quantities, they exercise, etc. In America, obesity is a huge problem; we eat a lot and don't exercise.

Looking just at the countries and the life expectancies, this hypothesis seems plausible. Let's look for more data.
I found some data from the international obesity task force: IOTF
Apparently they have compiled BMI tables for many countries:
BMI tables

Now let's see.
Japan, #1 life expectancy:
obese males = 2.9%
overweight males = 23.9%
Switzerland, #4 life expectancy:
obese males = 14.1%
overweight males = 45.9%
Canada, #10 life expectancy:
obese males = 16%
overweight males = 40%

WAIT, I'M STARTING TO SEE A TREND!

England/UK, 7th from last life expectancy:
obese males = 22.2%
overweight males = 43.2%
United States, 5th from last life expectancy:
obese males = 27.7%!!!
overweight males = 39.3%

These numbers show a general trend, with of course, fluctuations. If you took the time to plot a graph of life expectancy vs. BMI, you'd see a significant correlation.
As I mentioned before, correlation is not sufficient to imply cause, you also need a plausible causal mechanism. In this case, indeed, there is a very plausible explanation for how unhealthy lifestyles affect life expectancy.

The fact of the matter is, per capita spending has little or nothing to do with life expectancy. What really matters is healthy living.

But if healthy living would improve our situation, why are we spending all that money? If indeed proper living is responsible for improved life expectancy, then it doesn't matter how much we spend.

BINGO! We've stumbled upon something interesting. Perhaps, just perhaps, the U.S. is mistaken on dumping money into the healthcare system. We think throwing money at a problem makes it go away. The graph strongly emphasizes how WEIRD it is that we spend so much. The conclusion: politicians have been wasting our money in order to make it look like they are solving the problem, when actually, the real problem is poor living on the part of American citizens. Clearly, we are spending way too much on healthcare, just so we can ignore the real problem: that we are fat and lazy.

Q.E.D.

i agree that a large (no pun intended) part of the healthcare problem in the US is that the average american is overweight. however, infant mortality rates show a similar trend to life expectancy: they're much higher in the US than in other OECD countries.it is difficult to attribute high infant mortality rates to how fat and lazy we are. it's shocking that our infant mortality rates are so high, given the much higher percentage of mothers who smoke and drink during pregnancy in europe. mortality rates are especially high among poorer populations, such as blacks in alabama. it's clear that there is a great deal of waste and ineffiency in healthcare spending in the US, and that the american lifestyle is a leading cause of our overall poor health, but these do not account for many of the other discrepancies between our healthcare systems and those of other OECD countries.

 

[Andrew_Doan]

it is difficult to attribute high infant mortality rates to how fat and lazy we are. it's shocking that our infant mortality rates are so high, given the much higher percentage of mothers who smoke and drink during pregnancy in europe.

They may be related. High fat diet (KFC, fast food, poor nutrition, etc..) leads to weight problems, diabetes, nutritional deficiencies, heart disease, vascular compromise, and other medical problems that affect infant health and survival.

 

[ClearDay]

Good point. We only allow genetic disorders that are proven in the research literature.

On the other hand, we offer discounts on premiums based on other factors: nutrition education, excercise, weight, etc...

For families that don't eat at McDonalds, eat fruits/veggies, take their multi-vit, and excercise, they will pay lower premiums. For the ones that are all fat, eat grease, and watch TV all day, they can be stuck with a larger bill.

This model is similar to car insurance. If you're a crappy driver, then you pay high premiums.

Good plan, but how would you find that out (eating habits, exercise habits, etc) - from what they tell you? People can put all kinds of stuff on paper, but it doesn't mean it's true. Maybe I'm overlooking something???

 

[Suppuration]

Good plan, but how would you find that out (eating habits, exercise habits, etc) - from what they tell you? People can put all kinds of stuff on paper, but it doesn't mean it's true. Maybe I'm overlooking something???

You're not overlooking anything. It would literally take Big Brother to implement such a plan, and frankly I'd rather subsidize some fat slob's Lipitor than have everyone's eating and excercise habits monitored.

As for the car insurance idea, Malcolm Gladwell sums it up nicely:

There is another way to organize insurance, however, and that is to make it actuarial. Car insurance, for instance, is actuarial. How much you pay is in large part a function of your individual situation and history: someone who drives a sports car and has received twenty speeding tickets in the past two years pays a much higher annual premium than a soccer mom with a minivan. In recent years, the private insurance industry in the United States has been moving toward the actuarial model, with profound consequences. The triumph of the actuarial model over the social-insurance model is the reason that companies unlucky enough to employ older, high-cost employees—like United Airlines—have run into such financial difficulty. It’s the reason that automakers are increasingly moving their operations to Canada. It’s the reason that small businesses that have one or two employees with serious illnesses suddenly face unmanageably high health-insurance premiums, and it’s the reason that, in many states, people suffering from a potentially high-cost medical condition can’t get anyone to insure them at all.

from http://www.newyorker.com/fact/content/articles/050829fa_fact