"The United States has the worst healthcare"

[morning]

It's hard to think that the U.S. is dead last when sooo many people from Canada come to the U.S. for medical care. I work EMS in Michigan, and about twice a week I am transporting someone from the hospital back to their home in Canada or vice versa. People would rather spend their money than get it for free apparently.

Americans also go to Mexico for healthcare/dental work...

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[oaklandguy]

Americans also go to Mexico for healthcare/dental work...

I legitimately wonder why. The connotation I have received from speaking to patients is that they feel the care offered in America is better than that offered in Canada and they were willing to spend the money on an American trained doctor rather than spend the money seeing a cash-only Canadian doctor or any other Canadian doctor for that reason. It could be paranoia, or that these people are so loaded that they don't know what to do with their money. I just think it's interesting that I have to have an enhanced drivers license or a passport card with me at all times due to the heavy amount of transports we get across the border.

 

[Hirudo]

Just curious, but has anyone here not been able to afford health insurance for any portion of their lives?

Let's just say you're a kid, your single mom can't afford health insurance for you and your siblings, doesn't know Medicaid exists, and you break one of your vertebrae. Your mom refuses to take you to see a doctor because she can't afford the bills, and seeing as you can still walk, it's probably all right. Make your brother carry your backpack for you.

If this can happen, does the US still have "the most accessible healthcare on the planet"?

Call me crazy, but I feel like anyone who insists the US has accessible care hasn't been a poor person without insurance who is ignorant of social services/lives in a completely rural, isolated place. I'm pretty sure there's a problem.

 

[morning]

Just curious, but has anyone here not been able to afford health insurance for any portion of their lives?

Let's just say you're a kid, your single mom can't afford health insurance for you and your siblings, doesn't know Medicaid exists, and you break one of your vertebrae. Your mom refuses to take you to see a doctor because she can't afford the bills, and seeing as you can still walk, it's probably all right. Make your brother carry your backpack for you.

If this can happen, does the US still have "the most accessible healthcare on the planet"?

Call me crazy, but I feel like anyone who insists the US has accessible care hasn't been a poor person without insurance who is ignorant of social services/lives in a completely rural, isolated place. I'm pretty sure there's a problem.

It really depends. I've never had health insurance in my entire life, but I've been reasonably healthy, never broken a bone or had a major illness and been just fine. I recently had to shell out $300 for some blood tests, which was painful (the money, not the needles!) but not the most expensive thing I've ever bought. One of my siblings broke bones on multiple occasions and had to be taken to the ED, where he did get treatment. Sad to say I don't know how or if my mother paid the bills. Probably not.

My dad was a minimum wage worker and he died because he waited WAY too long to call the ambulance after he started having chest pains. If he had called to tell me what was happening, I would have driven him myself, but it wasn't just the extreme ambulance fees...he knew he could not pay the hospital bills, and there is ALWAYS, ALWAYS that fear that nothing is wrong and you'll be incurring a bill for nothing. It wasn't the first time he had had chest pain. However, he could have gotten the care he needed if he arrived at the hospital. Again, there's really absolutely no way he could have paid for hospital care...but he would have gotten it.

The real issues come when you have a major illness that needs prolonged or lifelong management by a physician and you have no health insurance. Emergencies are treated. There are some people who do believe you shouldn't be treated in an ED without the ability to pay, though.

 

[Parts Unknown]

It's hard to think that the U.S. is dead last when sooo many people from Canada come to the U.S. for medical care. I work EMS in Michigan, and about twice a week I am transporting someone from the hospital back to their home in Canada or vice versa. People would rather spend their money than get it for free apparently.

Research on this topic: http://content.healthaffairs.org/cgi/content/full/21/3/19

Results from these sources do not support the widespread perception that Canadian residents seek care extensively in the United States. Indeed, the numbers found are so small as to be barely detectible relative to the use of care by Canadians at home.

 

[Parts Unknown]

Still, after looking at this website, I can say that the US should NOT be ranked last in this comparison.

That's not much of a victory. The point here isn't that we're last, it's that for the amount we spend we should be at or near the top in virtually every category presented. Nilf is half right, we have the most advanced technology, but since our "system" has no overarching design framework it is severely misapplied. Essentially we are sitting on a nuclear missile with a gyroscopic 1940's-era guidance system.

You will all feel this someday when you are trying to interpret someone's chicken scratches in a paper chart, and when you spend half your morning calling and Faxing outside hospitals to try and get a given patient's history sorted out. A truly advanced system would allow for the efficient collection and distribution of necessary patient information. We still have one foot in the Dark Ages in this regard. The only place I have worked where this issue is successfully mitigated is the VA.

 

[MegaProjectile]

That's not much of a victory. The point here isn't that we're last, it's that for the amount we spend we should be at or near the top in virtually every category presented. Nilf is half right, we have the most advanced technology, but since our "system" has no overarching design framework it is severely misapplied. Essentially we are sitting on a nuclear missile with a gyroscopic 1940's-era guidance system.

You will all feel this someday when you are trying to interpret someone's chicken scratches in a paper chart, and when you spend half your morning calling and Faxing outside hospitals to try and get a given patient's history sorted out. A truly advanced system would allow for the efficient collection and distribution of necessary patient information. We still have one foot in the Dark Ages in this regard. The only place I have worked where this issue is successfully mitigated is the VA.

I wonder how other industrialized countries stack up in this regard?

 

[link2swim06]

Hmmm I know a lot of foreign doctors who can't pass step 1 and are forced to work in labs. Granted step 1 is more basic science but still I think that speaks to the intelligence and quality of doctors in the US.

While the US may suck at preventive care, I don't think there is anywhere in the world you will get treat once in front of a doctor (this is based on the educational standards/ entry requirements for MDs compared to other countries).

BTW I would bet my car that 99.9% of the people who go to Mexico or oversees for care are doing so solely for cost, not an illusion of better care.

 

[NickNaylor]

It really depends. I've never had health insurance in my entire life, but I've been reasonably healthy, never broken a bone or had a major illness and been just fine. I recently had to shell out $300 for some blood tests, which was painful (the money, not the needles!) but not the most expensive thing I've ever bought. One of my siblings broke bones on multiple occasions and had to be taken to the ED, where he did get treatment. Sad to say I don't know how or if my mother paid the bills. Probably not.

My dad was a minimum wage worker and he died because he waited WAY too long to call the ambulance after he started having chest pains. If he had called to tell me what was happening, I would have driven him myself, but it wasn't just the extreme ambulance fees...he knew he could not pay the hospital bills, and there is ALWAYS, ALWAYS that fear that nothing is wrong and you'll be incurring a bill for nothing. It wasn't the first time he had had chest pain. However, he could have gotten the care he needed if he arrived at the hospital. Again, there's really absolutely no way he could have paid for hospital care...but he would have gotten it.

The real issues come when you have a major illness that needs prolonged or lifelong management by a physician and you have no health insurance. Emergencies are treated. There are some people who do believe you shouldn't be treated in an ED without the ability to pay, though.

At what point do you draw the line for people being responsible for their own well-being?

Part of the process for approving an organ transplant includes financial approval. If a family is unable to pay for the costly procedure or the lifetime drug supply afterward, they aren't placed on the transplant list. Depending upon their condition and the organ they need, they WILL die. Tough reality, but that's how it works.

If a transplant patient fails to take their immunosuppression medication and their organ is rejected, they will not be listed for another transplant until they can demonstrate through lab testing that they take their medication regularly. Two strikes and you're basically out. They may end up dying because of their mistakes.

A woman comes to the ER driving a nice car, wearing expensive clothing, and clearly living well beyond her means. She doesn't have health insurance. Does she deserve charity treatment?

There must be some compassion in medicine. There are people who truly cannot afford medical treatment, and for them they should receive their care for free. For many, though, that's not the case. They simply wanted to use their money on other things rather than health insurance. Why should we, as a society, pay for their decisions? I know it's crude and, to a certain extent, cruel, but these decisions ARE made on some level. Whether it's the poor who don't receive treatment or the policyholders whose pre-authorizations for medically necessary procedures are denied, someone will not be treated. There are simply not enough resources for everyone to get the care they think they need and use the system as they currently do.

I would recommend the book Who Killed Healthcare? (http://www.amazon.com/Who-Killed-Health-Care-Consumer-Driven/dp/0071487808) for a good look at how a market system might be effective in reigning in health care costs.

 

[Web MD]

Hey, this is amurica - if you don't like it you can get out

 

[morning]

At what point do you draw the line for people being responsible for their own well-being?

Part of the process for approving an organ transplant includes financial approval. If a family is unable to pay for the costly procedure or the lifetime drug supply afterward, they aren't placed on the transplant list. Depending upon their condition and the organ they need, they WILL die. Tough reality, but that's how it works.

If a transplant patient fails to take their immunosuppression medication and their organ is rejected, they will not be listed for another transplant until they can demonstrate through lab testing that they take their medication regularly. Two strikes and you're basically out. They may end up dying because of their mistakes.

A woman comes to the ER driving a nice car, wearing expensive clothing, and clearly living well beyond her means. She doesn't have health insurance. Does she deserve charity treatment?

There must be some compassion in medicine. There are people who truly cannot afford medical treatment, and for them they should receive their care for free. For many, though, that's not the case. They simply wanted to use their money on other things rather than health insurance. Why should we, as a society, pay for their decisions? I know it's crude and, to a certain extent, cruel, but these decisions ARE made on some level. Whether it's the poor who don't receive treatment or the policyholders whose pre-authorizations for medically necessary procedures are denied, someone will not be treated. There are simply not enough resources for everyone to get the care they think they need and use the system as they currently do.

I would recommend the book Who Killed Healthcare? (http://www.amazon.com/Who-Killed-Health-Care-Consumer-Driven/dp/0071487808) for a good look at how a market system might be effective in reigning in health care costs.

You're stating the obvious here. There will never be enough resources to cover everyone perfectly, and some people defraud the healthcare system or don't take care of themselves. I for one am surprised.

What you fail to take into account is the productivity lost from having people die without care. If a parent dies, leaving their child an orphan or a remaining parent without support, that kid is more likely to end up receiving government money in some other way, up to and including prison. There are a million different ways this puzzle can play out, and you can't simplify it down to the point you have. A person with a house, a job, and a family becomes sick and cannot pay for care. What happens to their house? Their family? People don't exist in a bubble. There are real consequences to having people falling sick and dying without any safety net (if you remove the ED from the equation.) A kid in college who has been receiving financial aid and support via public education their entire life falls ill and dies. ALL that money that was spent on them is wasted. All the potential they could have had to contribute to the economy is gone.

This is not to say I know the answer to what will fix healthcare, because I don't. It's clear a system that cannot be paid for is not something we should transition to (unfortunately, we won't be able to pay for private insurance, either...health insurance premiums have doubled in the last 10 years, and there's no reason to believe they won't double again in the next 10.) I'm just saying your analysis is only skimming the surface.

We'll never have a healthcare system that is perfect or satisfies everyone. Improvement is not a goal, it is a journey, and it never stops. We can't just throw up our hands and say things will NEVER be perfect, so let's stop trying. We can make things slightly better. And then slightly better. And then slightly better.

Organ transplants vs. the rationing you advocate is an extreme comparison. Demand for organs outstrips organ supply to a FAR greater extent than demand for healthcare outstrips financial resources. It's like comparing a Tesla Roadster to a wheelbarrow. If we ever get to a point where only 50% of the people in the country can receive healthcare because the other 50% can't utilize it the way it needs, then your comparison will become apt.

 

[oaklandguy]

Research on this topic: http://content.healthaffairs.org/cgi/content/full/21/3/19

This paper seems like it had an agenda, but either way the number is going to be small compared to the entire population of Canada. But if you look at a place like Ontario, or specifically Windsor which borders Detroit and is only an hour away drive from amazing care then you may understand why I occasionally transport Canadians and I only work part-time. I'm not saying it's an enormous amount of people, we don't have a medical pipeline running from Canada lol, but my experiences dealing with these people have given me the idea that the highly specialized Docs here are better than those north of us. I'm not saying they don't have great docs there, but I am under the impression that the Canadian people feel as though U.S. doctors are trained more thoroughly. I know for a fact that I've taken several patients for knee and hip replacements to William Beaumont Hospital for orthopedic surgery by a certain Doc who drives an orange lambo. I think there's a good reason why he drives an orange lambo, because he is regarded as the best knee/hip replacement doc in the state. It doesn't surprise me that I've had several patients from across the border wanting him to operate on them.

 

[Parts Unknown]

This paper seems like it had an agenda,

Papers always seem that way when their data contradicts one's preconceived notions. I don't hold it up as an airtight study, but compared to anecdote it's a much stronger foundation for argument.

The simple fact is that yes, some Canadians go abroad for care. Some Americans go abroad for care. Canadians do it to get more advanced therapy. Americans do it to keep from going broke. What does this say about our respective systems? A long time ago a Canadian physician friend of mine with experience in both countries told me that if you're sick and rich you're better off in the US. Everyone else would probably be better off in Canada. After mulling it over for 12 years I think I see his point.

As a personal aside, I actually know someone who emigrated from the US to Canada for health care reasons. She had frontotemporal dementia (aka Pick's Disease) and figured her long-term care options were better North of the border. So she and her daughter moved up there, and after a year qualified for palliative care on the Red Maple Leaf's dime. Had she stayed in the US she would have been put in a nursing home until her estate was exhausted, then transferred to a state facility (aka the Third Ring of Hell). As it was her daughter was able to have an inheritance and attend law school.

 

[Afrocan]

The reason is that uninsured people are included in the statistical measurements.

This is an unfair comparison going up against countries with universal healthcare. Its like comparing speeds of a guy with a car and a guy with a bike.

If we only include people with health insurance in the official measurements, i am confident that our health care system would be the best in the world.

 

[Mbeas]

solid bump, bro

 

[Fregoli and Me]

My uncle is an PM&R physican in MI. He said that during the warm months more than 20% of his patients are Canadian citizens. Just one doc and just one example. Yet, 20% seemed pretty damn large for not that many Canadians coming to MI for care.

 

[oaklandguy]

My uncle is an PM&R physican in MI. He said that during the warm months more than 20% of his patients are Canadian citizens. Just one doc and just one example. Yet, 20% seemed pretty damn large for not that many Canadians coming to MI for care.

Agreed. I've transported Canadian patients to every major hospital in the metropolitan Detroit area; there is no way that less than 1,000 Canadians use Michigan facilities per year.

That study someone posted probably polled small rural hospitals located in unpopulated parts of Michigan. Realistically, Canadian patients are not going to go to Grand Rapids for a physician. So the majority of Canadian patients go to the same few hospitals. Beaumont, DMC, and Henry Ford are the main 3 hospitals in the metropolitan Detroit area. Not to mention there are numerous private clinics. Yet this study makes the majority of it's claims as saying hospitals haven't been seeing patients who identify themselves as Canadian. "This is equivalent to approximately 8.5 percent of all prostate and breast cancer patients treated with radiation therapy in Ontario during the same time frame." 8.5 percent of all prostate and breast cancer patients in Ontario crossed the border. In my opinion that is significant. Something is offered essentially for free, yet 8.5% of the people choose to pay to have that same treatment done. I think a more realistic study would be to show how many Canadian citizens making enough money to afford to cross the border for physicians actually do so.

The amount of Canadian citizens visiting physicians in Michigan is growing. The numbers have probably doubled since 1997. These people are crossing the border even though there are doctors in Canada who don't accept their universal health insurance and don't have long waits etc.

If the reality is that the U.S. has the worst healthcare then docs in MI sure are good at making Canadian patients believe otherwise.

 

[Remuneration]

A true revolution of values will soon cause us to question the fairness and justice of many of our past and present policies. On the one hand we are called to play the good Samaritan on life's roadside; but that will be only an initial act. One day we must come to see that the whole Jericho road must be transformed so that men and women will not be constantly beaten and robbed as they make their journey on life's highway. True compassion is more than flinging a coin to a beggar; it is not haphazard and superficial. It comes to see that an edifice which produces beggars needs restructuring. A true revolution of values will soon look uneasily on the glaring contrast of poverty and wealth. With righteous indignation, it will look across the seas and see individual capitalists of the West investing huge sums of money in Asia, Africa and South America, only to take the profits out with no concern for the social betterment of the countries, and say: "This is not just." It will look at our alliance with the landed gentry of Latin America and say: "This is not just." The Western arrogance of feeling that it has everything to teach others and nothing to learn from them is not just. A true revolution of values will lay hands on the world order and say of war: "This way of settling differences is not just." This business of burning human beings with napalm, of filling our nation's homes with orphans and widows, of injecting poisonous drugs of hate into veins of people normally humane, of sending men home from dark and bloody battlefields physically handicapped and psychologically deranged, cannot be reconciled with wisdom, justice and love. A nation that continues year after year to spend more money on military defense than on programs of social uplift is approaching spiritual death.

 

[Libtech]

What you fail to take into account is the productivity lost from having people die without care. If a parent dies, leaving their child an orphan or a remaining parent without support, that kid is more likely to end up receiving government money in some other way, up to and including prison. There are a million different ways this puzzle can play out, and you can't simplify it down to the point you have. A person with a house, a job, and a family becomes sick and cannot pay for care. What happens to their house? Their family? People don't exist in a bubble. There are real consequences to having people falling sick and dying without any safety net (if you remove the ED from the equation.) A kid in college who has been receiving financial aid and support via public education their entire life falls ill and dies. ALL that money that was spent on them is wasted. All the potential they could have had to contribute to the economy is gone.

Pathos - represents an appeal to the audience's emotions, a communication technique used most often in rhetoric. (http://en.wikipedia.org/wiki/Pathos)

I actually like your use of it, and understand that we should never be content with imperfection, but should strive for something better continuously.

However, if the potential you mentioned is GREATLY valued by the individual, then this individual should invest a fair amount to protect their health.(i.e. part of being an adult, making decisions, taking responsibility for consequences and risks etc..) There is the valid side to the argument that part of medicine is forgiveness, but there is the other end that being an adult means individual (not collective) accountability too. We are after-all mortal creatures, and no matter how much I would love to fly off that 100-ft kicker in park city, my better-half reminds me of the cost/pain of my shoulder surgery and my medical school loan.

Yes, there is a large population of people unable to have a valid channel to protect their "potential." Yes, the for-profit insurance system often prioritizes returns to shareholders (who are just other human beings pursuing their happiness/401k/retirement) over welfare of patients. But you have to admit, there are those who'd purchase 19'' rims and a new iphone this month before worrying about paying for their health insurance. All because these individuals maybe "too healthy to worry about stuff that won't ever happen." (I've been guilty of this one too)

Often it's not the system but rather the individual that "mis-prioritizes" enjoyment over necessity (I think we are all guilty of this one to an extent.) But then again we are just being human

In the end we have to find a happy medium.

And I'm just happy there's a discussion going on Cheers everyone.

 

[45408]

People around the world end up coming to the country with the worst health care when they have the worst diseases.

The quality of the health care delivered is superb, but the egality is terrible. We also suffer from significant excess. But if I had a baby that needed a heart transplant, and I could go anywhere in the world, I certainly wouldn't head to Belgium.

 

[Parts Unknown]

That study someone posted probably polled small rural hospitals located in unpopulated parts of Michigan.

Sigh.

[SIZE=-1]From the American side.[/SIZE] Based on this framework, we developed a multiprong sampling and data collection strategy. We conducted a telephone survey in the fall and winter of 1998–99 of all ambulatory care clinical facilities located in specific heavily populated U.S. urban corridors bordering Canada (Buffalo, Detroit, and Seattle) that offered services that might be less available in Canada. These services included diagnostic radiology, ambulatory surgery, ambulatory eye surgery, cancer evaluation and treatment, and mental health and substance abuse treatment. Facilities performing these procedures were identified using a variety of federal, provincial, state, and local sources including local health care consultants and provider groups, the U.S. Federated Ambulatory Surgery Association, the American Hospital Association, the American College of Surgeons, and the SMG Marketing Group.

 

[TDX]

People around the world end up coming to the country with the worst health care when they have the worst diseases.

The quality of the health care delivered is superb, but the egality is terrible. We also suffer from significant excess. But if I had a baby that needed a heart transplant, and I could go anywhere in the world, I certainly wouldn't head to Belgium.

It's not just the egality that's terrible.

Look at MRSA, for example. In the US, it currently causes about 20,000 deaths per year. In the Netherlands, on the other hand, MRSA outbreaks are extremely uncommon and deaths are exceedingly rare.

US health care is great for advanced and expensive procedures, but when it comes to the basics, the US just doesn't do very well compared to other countries.

 

[45408]

It's not just the egality that's terrible.

Look at MRSA, for example. In the US, it currently causes about 20,000 deaths per year. In the Netherlands, on the other hand, MRSA outbreaks are extremely uncommon and deaths are exceedingly rare.

US health care is great for advanced and expensive procedures, but when it comes to the basics, the US just doesn't do very well compared to other countries.

These aren't equal comparisons. When you take a huge number of critically ill people who are prone to infections and try to take on every one of their problems, you're going to get more problems. The Netherlands doesn't try to put 85-year olds with heart failure on dialysis after they've had a stroke, so they don't have to worry about the Mahurkar getting MRSA. I've certainly seen it here. They don't try, so they don't get infections.

Not that I think they should, but you can't say we have lots of MRSA infections and they don't. You need to compare the number of infections to number of days stayed, number of patient co-morbidities, and number of invasive procedures being done.

We do the basics just fine, it's just that many people don't have access to them. We also have too many people that need a lot more than the basics (smoking, obesity, alcoholism, diabetes, blah blah blah).

 

[Remuneration]

Enough with the tired arguments from privilege about personal responsibility. Most arguments from personal responsibility rely on bull**** self/group-referential anecdotes. Well, my middle/upper-middle class family could afford to buy insurance, live in a good school district, invest considerable time in my childhood, live comfortably, help fund my education, etc. and through them and their support I learned the importance of planning ahead, etc., etc. Therefore it's reasonable for me to expect everyone else to do the same. Nevermind the difficulty working conditions, poor school systems and support networks, consumer culture, etc. that both fail to provide poor with the skills for success and even encourage irresponsibility, let's take a few exceptional (and dubiously significant) examples of irresponsibility to paint the majority of the uninsured at fault for their lacking coverage.

Many Americans, especially in our current recession, do live hand to mouth. Many Americans have very limited capabilities to manage what finances they do have. Many Americans, even were they capable of thorough, thoughtful cost-benefit analysis would likely find better immediate investments (barring serious unforeseen consequences) than health insurance. Our government is happily spending billions upon billions on the MIC (so many wonderful wars) and other forms of corporate welfare, but cannot provide a proper social safety net and maintain infrastructure? Yes, it's the poor who fail to meet their responsibilities.

P.S.: How about that terrible welfare system? All of those good for nothing, nonexistant welfare queens are running our nation deeper into the red!

 

[TDX]

These aren't equal comparisons. When you take a huge number of critically ill people who are prone to infections and try to take on every one of their problems, you're going to get more problems. The Netherlands doesn't try to put 85-year olds with heart failure on dialysis after they've had a stroke, so they don't have to worry about the Mahurkar getting MRSA. I've certainly seen it here. They don't try, so they don't get infections.

Not that I think they should, but you can't say we have lots of MRSA infections and they don't. You need to compare the number of infections to number of days stayed, number of patient co-morbidities, and number of invasive procedures being done.

We do the basics just fine, it's just that many people don't have access to them. We also have too many people that need a lot more than the basics (smoking, obesity, alcoholism, diabetes, blah blah blah).

In the US, over 50% of staph infections are MRSA. In the Netherlands, that's <1%. So yes, I can say that the US has lots of MRSA infections and the Netherlands doesn't.

That difference is caused by two factors, neither of them among the things you mentioned. The first is the "search and destroy" policy for MRSA in all Dutch hospitals, and the second is the ridiculous overprescription of antibiotics in the US.

The latter is a good example of not getting the basics right. In the US, over 100 million courses of antibiotics are prescribed every year. Over half of those are unnecessary, for example because they are prescribed for viral(!) infections.

 

[TexasFight]

Enough with the tired arguments from privilege about personal responsibility. Most arguments from personal responsibility rely on bull**** self/group-referential anecdotes. Well, my middle/upper-middle class family could afford to buy insurance, live in a good school district, invest considerable time in my childhood, live comfortably, help fund my education, etc. and through them and their support I learned the importance of planning ahead, etc., etc. Therefore it's reasonable for me to expect everyone else to do the same. Nevermind the difficulty working conditions, poor school systems and support networks, consumer culture, etc. that both fail to provide poor with the skills for success and even encourage irresponsibility, let's take a few exceptional (and dubiously significant) examples of irresponsibility to paint the majority of the uninsured at fault for their lacking coverage.

Many Americans, especially in our current recession, do live hand to mouth. Many Americans have very limited capabilities to manage what finances they do have. Many Americans, even were they capable of thorough, thoughtful cost-benefit analysis would likely find better immediate investments (barring serious unforeseen consequences) than health insurance. Our government is happily spending billions upon billions on the MIC (so many wonderful wars) and other forms of corporate welfare, but cannot provide a proper social safety net and maintain infrastructure? Yes, it's the poor who fail to meet their responsibilities.

P.S.: How about that terrible welfare system? All of those good for nothing, nonexistant welfare queens are running our nation deeper into the red!

I think you missed the point of this thread.

 

[Animus]

In the US, over 50% of staph infections are MRSA. In the Netherlands, that's <1%. So yes, I can say that the US has lots of MRSA infections and the Netherlands doesn't.

That difference is caused by two factors, neither of them among the things you mentioned. The first is the "search and destroy" policy for MRSA in all Dutch hospitals, and the second is the ridiculous overprescription of antibiotics in the US.

The latter is a good example of not getting the basics right. In the US, over 100 million courses of antibiotics are prescribed every year. Over half of those are unnecessary, for example because they are prescribed for viral(!) infections.

Please take a step back and reread what P wrote. He responded to your original statement and you only reiterated it for more dramatic effect. You are not taking all things into consideration when quoting your statistic.

 

[Animus]

Also to begin to refute Morning and Austinap would make my head spin due to the shear ignorance portraited so far. Both of you keep talking and talking but offer no real data or studies of your own. You back pleas to emotion and continually talk about "last place" and "poor care" with no real ideas of what these concepts mean.

Finding a group of opinions on a subject that match your own and claiming it as fair or good or representative of reality reminds me of watching american idol worst auditions.

 

[NickNaylor]

Enough with the tired arguments from privilege about personal responsibility. Most arguments from personal responsibility rely on bull**** self/group-referential anecdotes. Well, my middle/upper-middle class family could afford to buy insurance, live in a good school district, invest considerable time in my childhood, live comfortably, help fund my education, etc. and through them and their support I learned the importance of planning ahead, etc., etc. Therefore it's reasonable for me to expect everyone else to do the same. Nevermind the difficulty working conditions, poor school systems and support networks, consumer culture, etc. that both fail to provide poor with the skills for success and even encourage irresponsibility, let's take a few exceptional (and dubiously significant) examples of irresponsibility to paint the majority of the uninsured at fault for their lacking coverage.

Many Americans, especially in our current recession, do live hand to mouth. Many Americans have very limited capabilities to manage what finances they do have. Many Americans, even were they capable of thorough, thoughtful cost-benefit analysis would likely find better immediate investments (barring serious unforeseen consequences) than health insurance. Our government is happily spending billions upon billions on the MIC (so many wonderful wars) and other forms of corporate welfare, but cannot provide a proper social safety net and maintain infrastructure? Yes, it's the poor who fail to meet their responsibilities.

P.S.: How about that terrible welfare system? All of those good for nothing, nonexistant welfare queens are running our nation deeper into the red!

 

[45408]

In the US, over 50% of staph infections are MRSA. In the Netherlands, that's <1%. So yes, I can say that the US has lots of MRSA infections and the Netherlands doesn't.

That difference is caused by two factors, neither of them among the things you mentioned. The first is the "search and destroy" policy for MRSA in all Dutch hospitals, and the second is the ridiculous overprescription of antibiotics in the US.

The latter is a good example of not getting the basics right. In the US, over 100 million courses of antibiotics are prescribed every year. Over half of those are unnecessary, for example because they are prescribed for viral(!) infections.

There's an even bigger difference that you're not mentioning. You're neglecting the fact that 70% of antibiotics prescribed in the US aren't for human use. They're for agriculture. One major factor in drug-resistant bugs in American health care isn't even part of our health care system.

Either way, I'm not sure what your point is. There is morbidity in US hospitals that results from factors that are present here (population demographics, patient expectations, the overpowering urge to treat all disease) that simply aren't present in other countries. If you're going to compare us to them, then you need to control for those factors. The Netherlands doesn't have much MRSA. That's nice. What about nosocomial infections as a whole? What are their infection rates in heart failure patients on dialysis in the ICU with central lines?

 

[Remuneration]

Entitled, indignant babies on SDN? Well, I never.

 

[NickNaylor]

Entitled, indignant babies on SDN? Well, I never.

I lol'd.

 

[45408]

You laugh out loud'd? Shouldn't you have LedOL?

 

[TDX]

Please take a step back and reread what P wrote. He responded to your original statement and you only reiterated it for more dramatic effect. You are not taking all things into consideration when quoting your statistic.

No, I'm not taking all things into consideration - mainly because most of those things aren't particularly likely to be a major influence on the topic at hand.

See, what I'm talking about is not the mrsa infection rate by itself, but mrsa infections as a percentage of staph infections on the whole.

Patient demographics would be an extremely important factor when considering the former, but have far less of an effect on the latter - and certainly nothing that could come even close to explaining a rate that is 50+ times higher in the US.

A far more likely explanation would be the radically different policies pursued by both countries (search & destroy plus restrictive antibiotics use for the Netherlands, something that can best be described as "derp" for the US). And, indeed, studies confirm the effect of the Dutch policies:

Wertheim HF, Vos MC, Boelens HA, Voss A, Vandenbroucke-Grauls CM, et al. (2004) Low prevalence of methicillin-resistant Staphylococcus aureus (MRSA) at hospital admission in the Netherlands: the value of search and destroy and restrictive antibiotic use. J Hosp Infect 56: 321–325.

van Trijp MJ, Melles DC, Hendriks WD, Parlevliet GA, Gommans M, et al. (2007) Successful control of widespread methicillin-resistant Staphylococcus aureus colonization and infection in a large teaching hospital in the Netherlands. Infect Control Hosp Epidemiol 28: 970–975.

What adds to the likelihood of that conclusion is that countries which employ strategies similar to those used in the Netherlands, such as Sweden and Denmark, also have an extremely low prevalence of MRSA. Furthermore, among western countries, there is a clear correlation between antibiotics prescription rates and MRSA prevalence.

There's an even bigger difference that you're not mentioning. You're neglecting the fact that 70% of antibiotics prescribed in the US aren't for human use. They're for agriculture. One major factor in drug-resistant bugs in American health care isn't even part of our health care system.

Yes, that's a rather big factor - but one which is also present in the Netherlands, which happens to be the country with the highest ratio of pigs/population in the world.

Either way, I'm not sure what your point is. There is morbidity in US hospitals that results from factors that are present here (population demographics, patient expectations, the overpowering urge to treat all disease) that simply aren't present in other countries. If you're going to compare us to them, then you need to control for those factors. The Netherlands doesn't have much MRSA. That's nice. What about nosocomial infections as a whole? What are their infection rates in heart failure patients on dialysis in the ICU with central lines?

My point is that the US is great at providing highly advanced health care for those who can afford it, but that it doesn't do nearly as well when it comes to basic care.

Here's another study, which concludes that primary care in the US lags behind that of other western countries:

C. Schoen, R. Osborn, M. M. Doty, D. Squires, J. Peugh, and S. Applebaum, A Survey of Primary Care Physicians in 11 Countries, 2009: Perspectives on Care, Costs, and Experiences, Health Affairs Web Exclusive, Nov. 5, 2009, w1171–w1183.

That fits with a general pattern. Look at the number of med students and pre-meds on this forum who want to become primary care physicians. Look at the current shortage of primary care physicians in the US. Look at how NPs are moving towards taking up many of the duties of primary care physicians.

Or let's look at yet another one of the basics: preventive medicine.

E. Nolte and C. M. McKee, Measuring the Health of Nations: Updating an Earlier Analysis, Health Affairs, January/February 2008, 27(1):58–71

The US ranks near the bottom when it comes to preventing mortality amenable to health care, and is a negative outlier when it comes to progress over the past few decades.

To pretend that the US does well when it comes to the basic parts of medicine - such as primary care, preventive medicine, responsible prescribing and taking broad action against the spread of infectious diseases - is to deny reality.

 

[NickNaylor]

You laugh out loud'd? Shouldn't you have LedOL?

I see what you did thar.

 

[FIREitUP]

It's hard to think that the U.S. is dead last when sooo many people from Canada come to the U.S. for medical care. I work EMS in Michigan, and about twice a week I am transporting someone from the hospital back to their home in Canada or vice versa. People would rather spend their money than get it for free apparently.

That's because US healthcare is amazing, if you have the money for it.

 

[chman]

Dude, seriously...

USA has be most technologically advanced and the most accessible healthcare.

Please stop saying this. It seriously damages your credibility.