Why does the U.S. have a poor healthcare system?

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I wonder why the Cuban government puts so much effort into preventive care while the U.S. insurance companies don't? In the long run, wouldn't the U.S. insurance benefit more from a preventive care model vs. curative care model (less people in the hospital=more long term profit)?

It's because a private, for-profit health care system like the US doesn't make a profit from a preventative care model.

Yes, in the long-term preventative care is more cost-effective than curative care, but private insurance companies won't see those savings. It would take a long period of time, on the order of years, perhaps decades, to see the savings from preventative care, but it is very unlikely that an individual will have the same insurance plan or even be with the same insurance company for that long. If a person changes jobs or moves to a different state or even a different city, they'll likely change insurance providers, which separates the loss from providing preventative care with the savings from it. Moreover, by the time you really see those savings take effect (when people hit 65+), the individuals will likely move from their private insurance to Medicare, further nullifying the benefit of the savings from preventative care.

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It's not that the US doesn't have the ability to give prenatal care, it's that the US doesn't have the incentive or will to give prenatal care nor is it mandated at the federal level (it varies at the state level). This is primarily a function of the US having a predominantly unregulated, private health care system. Insurance companies can choose what procedures their plans cover in the US while in other countries, insurance companies are mandated to cover certain procedures.

Secondarily though, it's because the US really doesn't care about children as much as it should, at least in my opinion. Public education, especially for poor districts, is terrible and underfunded. New mothers are not entitled to maternity leave to care for their newborns. Preschool and early childhood programs are paid largely out-of-pocket by families, so poor families are often unable to afford such care. All of these lead indirectly to greater infant mortality.

A good read is Urban Injustice: How Ghettos Happen by David Hilfiker if you're interested.

Thanks for the read suggestion.

I agree with what you have stated because Switzerland, if I recall correctly, has mandated basic healthcare. However, services beyond that work on a competitive system for private insurance.
 
It's because a private, for-profit health care system like the US doesn't make a profit from a preventative care model.

Yes, in the long-term preventative care is more cost-effective than curative care, but private insurance companies won't see those savings. It would take a long period of time, on the order of years, perhaps decades, to see the savings from preventative care, but it very unlikely that an individual will have the same insurance plan or even be with the same insurance company for that long. If a person changes jobs or moves to a different state or even a different city, they'll likely change insurance providers, which divorces the loss from providing preventative care with the savings from it. Moreover, by the time you really see those savings take effect (when people hit 65+), the individuals will likely move from their private insurance to medicare, further nullifying the benefit of the savings from preventative care.

Awesome, Thanks. This clears up a lot of things I was uncertain of.
 
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I wonder why the Cuban government puts so much effort into preventive care while the U.S. insurance companies don't? In the long run, wouldn't the U.S. insurance benefit more from a preventive care model vs. curative care model (less people in the hospital=more long term profit)?

Up until recently your insurance company could dump you if you actually became ill (rescission is the technical term), so there wasn't much incentive to keep people healthy.

The relationship between prevention and costs is complex. Consider this 1998 paper in NEJM which models the effect of complete smoking cessation on health costs. In the short term they go down, but eventually rise above baseline as people live longer (and therefore consume more health care). In fact most of the published models in this arena show the same thing: the biggest lifetime consumers of health care resources are the healthy people who live the longest. Seems ironic, no?
 
Up until recently your insurance company could dump you if you actually became ill (rescission is the technical term), so there wasn't much incentive to keep people healthy.

The relationship between prevention and costs is complex. Consider this 1998 paper in NEJM which models the effect of complete smoking cessation on health costs. In the short term they go down, but eventually rise above baseline as people live longer (and therefore consume more health care). In fact most of the published models in this arena show the same thing: the biggest lifetime consumers of health care resources are the healthy people who live the longest. Seems ironic, no?

Thanks for the article.

I think I can see why the costs would go up. If one stops smoking, then ones life span gets longer and thus suffers due to other comorbidities (meaning extra hospital costs due to these aliments). I wonder though, what if these other comorbidites are actually preventable ones also? Then by preventing these would the cost go down or would possible unpreventable/curable comorbidities not allow this?
 
Very few people have actually answered the OP's question, which was "by what evidence do we say that the U.S. has a poor healthcare system?" People have replied with rankings that aren't referenced and likely come from the WHO's system which was abandoned due to poor methodology, but at least those replies gave their evidence.

So what is your evidence to say our healthcare is poor? Please don't tell me you're taking the political talking points at face value...
 
It's because a private, for-profit health care system like the US doesn't make a profit from a preventative care model.

Yes, in the long-term preventative care is more cost-effective than curative care, but private insurance companies won't see those savings. It would take a long period of time, on the order of years, perhaps decades, to see the savings from preventative care, but it is very unlikely that an individual will have the same insurance plan or even be with the same insurance company for that long. If a person changes jobs or moves to a different state or even a different city, they'll likely change insurance providers, which separates the loss from providing preventative care with the savings from it. Moreover, by the time you really see those savings take effect (when people hit 65+), the individuals will likely move from their private insurance to Medicare, further nullifying the benefit of the savings from preventative care.

I'm not entirely sure what you mean. Preventative care is covered extremely well by most insurers. The nice thing about preventative care is that it is (mostly) cheap things like vaccines, blood tests, diet, and exercise. I can think of exceptions like colonoscopies.

The logic that we should be spending more on preventative care than treatment doesn't hold water because preventative care is orders of magnitude cheaper and in many cases free.
 
Thanks for the article.

I think I can see why the costs would go up. If one stops smoking, then ones life span gets longer and thus suffers due to other comorbidities (meaning extra hospital costs due to these aliments). I wonder though, what if these other comorbidites are actually preventable ones also? Then by preventing these would the cost go down or would possible unpreventable/curable comorbidities not allow this?

It's a never-ending-cycle. We can try to prevent that one as well, but then something else will come up and we'll need to find a way to prevent that, and on and on. Our work will never be done - there's always the next frontier.
 
I'm not entirely sure what you mean. Preventative care is covered extremely well by most insurers. The nice thing about preventative care is that it is (mostly) cheap things like vaccines, blood tests, diet, and exercise. I can think of exceptions like colonoscopies.

The logic that we should be spending more on preventative care than treatment doesn't hold water because preventative care is orders of magnitude cheaper and in many cases free.

Insurance companies covering preventive care is a relatively new phenomenon of the last 10 or so years.
 
New mothers are not entitled to maternity leave to care for their newborns.

Mothers do have guaranteed maternity leave, but it's a sick joke with 6 weeks unpaid being untouchable. However, if you do take 6 weeks off and when you come back, you can't keep up (because you are 6 weeks behind on work), the employer can fire you and it's up to the fired individual to prove they were fired for giving birth, which is notoriously difficult. In contrast, Pakistan of all places has guaranteed 12 weeks maternity leave with pay. That's how ass-backwards the US system is.
 
Very few people have actually answered the OP's question, which was "by what evidence do we say that the U.S. has a poor healthcare system?" People have replied with rankings that aren't referenced and likely come from the WHO's system which was abandoned due to poor methodology, but at least those replies gave their evidence.

So what is your evidence to say our healthcare is poor? Please don't tell me you're taking the political talking points at face value...

I think you raise a very good point because what I believe that myself and GutShot have tried to address is healthcare accessibility and overall health of the population, which by many standards the US lags far behind the rest of the developed world. The WHO ranking takes into account subjective things like patient satisfaction, etc. etc., but even by objective standards such as life expectancy, the US lags behind other industrialized nations.

However, if we were to rate healthcare systems by quality of physicians, medical research conducted, and the product of new drugs and therapies, the US without a doubt leads the world. However, access to these physicians, drugs, and therapies is severely limited by one's ability to pay for those services, even basic services.
 
I think you raise a very good point because what I believe that myself and GutShot have tried to address is healthcare accessibility and overall health of the population, which by many standards the US lags far behind the rest of the developed world. The WHO ranking takes into account subjective things like patient satisfaction, etc. etc., but even by objective standards such as life expectancy, the US lags behind other industrialized nations..

That was actually one of the biggest criticisms of the WHO report. Life expectancy WAS NOT calculated consistantly across the board. The U.S. reported premature babies as young as 20 weeks as "viable" which hurt us in multiple categories including infant mortality and life expectancy (because many of them die).

Other countries only counted full term babies and omitted statistics related to premature babies, which made their numbers look better. When they controlled for that factor, it put the U.S. among the top 10 overall, but we were still lagging due to our high number of premature births. We have something like 10-20x the number of premature births as any other country and no one really knows why.
 
That was actually one of the biggest criticisms of the WHO report. Life expectancy WAS NOT calculated consistantly across the board. The U.S. reported premature babies as young as 20 weeks as "viable" which hurt us in multiple categories including infant mortality and life expectancy (because many of them die).

Other countries only counted full term babies and omitted statistics related to premature babies, which made their numbers look better. When they controlled for that factor, it put the U.S. among the top 10 overall, but we were still lagging due to our high number of premature births. We have something like 10-20x the number of premature births as any other country and no one really knows why.

The infant mortality criticism is valid, but you can't toss out the baby with the bathwater, so to speak.

Life expectancy has been studied ad nauseum, both inside and outside the WHO, and the results are indeed consistent: there is room for improvement.

You may be interested in this article from Forbes: IBM Unleashes "Primary Care Spring", which outlines some of the obvious deficiencies in our system and illustrates the broad policy shifts that are currently taking place to address them. It has plenty of links.
 
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I'd like to address a few things I take issue in the previous post.



The quality of health care in the US is the best, but access to health care in the US is extremely limited.


True, but my point being, the quality here is the best. Quality in my opinion, is much harder to attain than availability.


There are many proposed solutions to US health care, but there isn't a lot of political will to address the problems that the US health care system faces.



I don't think that I can wait for the government or even depend on the government for a reform that will change healthcare.

The US ranks 40th in life expectancy behind Cuba, Chile, Slovenia, and Costa Rica. Moreover, I argue with the contention that mother's get prenatal care. Mother's in the US are not entitled to prenatal or early infant care, this type of care is only available to those who are able to afford it or who are covered by their employer.

Moreover, the US ranks 34th in infant mortality behind South Korea, Croatia, Cyprus and Cuba, just to name a few.

Now if this were all happening because the US spends little on health care, it wouldn't be a big deal. But that's not the case, and the reasons why is what this post seeks to address. The US spends more money on health care than any other nation, and it isn't even a close race. Yet, despite being the only country in the world that spends 17% of its GDP on health care, we still rank 40th in life expectancy and 34th in infant mortality.


All of these are true. But relatively, we are better off than most nations. I think one needs to simply live in/visit third world countries to realize that. This is based on experience.



Now the reasons you listed for the discrepancy in costs are valid. However, there are other valid reasons for discrepancies in cost and results, such as the cost of pharmaceuticals, greater heterogeneity in the US population, a larger gap between the rich and the poor, etc. etc.



I agree with you. There are more reasons than the ones that I have listed. But we cannot simply fix all of these reasons, and most of them are beyond the control of medicine (i.e economics and politics). I don't have much experience with healthcare, I admit that. But I believe in the phrase; think globally and act locally. As healthcare professionals (or future healthcare professionals) I think it's important to act on what's in front of us first, which are the patients. Maybe we can decrease obesity by intervention or education, maybe we can't, but it's something that we can do. We cannot just complain about how the government and private insurance companies are faulty. I believe that if we want change, we need to take matters into our own hands; no matter how trivial our efforts may be.
 
Administrative costs. America is bipartisanly addicted to bureaucracy. We need administrators for the administrators and to do paperwork on the paperwork.

As long as lawyers make up the majority of lawmakers, the majority of laws will favor lawyers.
 
Fascinating. Do yourself a favor. Google "thomas bodenheimer high and rising healthcare costs" and read Parts 1-4. They are all free access.



"reasons why I think healthcare is rising. The "I" indicates an opinion. From my perspective, these reasons can be solved by healthcare professionals. Sure, the insurance companies, the government, etc. also are involved, but most of the time they are beyond our control. It is much more complicated to convince them to solve healthcare issues given the politics behind it. As doctors (aspiring doctors), we have every reason to treat what's on our doorstep first (i.e overtreatment and obesity), before rallying to capital to ask for a reform that actually works.

I am sure that your reference is useful and I appreciate your suggestion.
 
"reasons why I think healthcare is rising. The "I" indicates an opinion.

Indeed, and with some reading your opinion can be rooted in facts rather than conjecture. Good luck.
 
Do you have any evidence that our healthcare infrastructure is poorly distributed relative to population? Or are you just making it up as you go?
Do you not realize that this is the case?

http://www.reuters.com/article/2011/07/27/us-rural-idUSTRE76Q0MJ20110727

Just look at job postings. Are they desperately trying to hire people for Huntington Beach or Fargo?



To answer the OP's question, I think we have a poor health care delivery system for a number of reasons.

The payer is greatly separated from the person deciding what the patient receives. The physician is put in the position where we have to "do what's best for the patient, no matter the cost." Okay, fine. That means we go all-out and use the helicopter to fly some 98-year old to the level 1 trauma center so that they can be seen by the full trauma team and be rushed to the OR for a craniotomy and hematoma evacuation that resulted from a fall while on warfarin. He develops renal failure post-operatively and gets put on dialysis. Outcomes are expected to be "suboptimal." If the patient or family were at all involved in the cost of this heroic effort, then the palliative route would be prominently featured.

Patients and families expect everything. We go ahead and do it. Awesome article by Panda Bear - http://www.pandabearmd.com/2006/11/24/dawn-of-the-dead/ (can't believe it's already been 6 years since he wrote it)

How about a 97-year old with a ruptured aortic aneurysm who spends months in the hospital? http://www.nytimes.com/2006/12/25/health/25surgeon.html?_r=1&oref=slogin

There's a great deal of CYA attitude pervading medicine. Here's an example from an ED attending:
i would order 1000 ct's to potentially avoid a single lawsuit.

We use the latest and greatest technology. You don't need a da Vinci robot to do a hysterectomy, but patients think that bells and whistles mean better care, so they go to the hospital that advertises the new SURGERY ROBOT on their billboard. $2 million later...

We'll do liver transplants for $500,000 (the average cost) on an alcoholic who comes into the hospital still drunk. My wife saw it happen. Do everything for everyone, who cares what it costs? A little basiliximab is only $20,000 per dose. A round of induction therapy could use a dozen or two doses.

I bet Cuba doesn't place the latest Stryker prosthetic knees. Should they? Maybe not, but it certainly cuts costs.

We also have a long and expensive training process. I owe a lot more for my education than for my house, and I'll have spent 26 years in school/residency.

People want answers, and they want them now. I had a friend (~30-year old woman) go into her PCP with abdominal pain. $350. PCP says "Oh, we'll figure this out." Gets a same-day CT scan. $2000. Uh-oh, loop of thickened bowel, that's no good. Better get a colonoscopy and make sure it's not Crohn's! $4000. Oh good, it was nothing, the pain got better and there's no Crohn's. (these are all the real numbers, btw)

We don't structure our hospitals so that there's elimination of redundancy. Everyone gets the latest CT scanner and starts firing people through it one after the next. The hospitals are all competing with each other, and no one wants to be left behind in the arms race.
 
CEOs, vice presidents, presidents, assistant's secondary coordination assistant to the junior vice president, etc. all sucking down $200k/year+ salaries are part of the problem. You see the same phenomena in higher education and testing or certification industries, funnily enough. I wonder if there's a link between overpaid dead-weight administrators and ridiculous hospital bills/tuition/pre-professional or professional licensing exams/fees? :idea:
 
Less than 20% of hospitals in America are for-profit.

Oh, well that means everything's peachy, then! :rolleyes:

What about all the drug companies that sell the "latest and greatest" drug for 10x the price of the old stuff? A bottle of Isoflurane costs my lab $10, a botle of sevoflurane $150. Guess which one they use? Guess which one hospitals use? And then let's talk about disposables! How many syringes do you think a hospital goes through in a day? How many gloves? How many masks? Each of those things is marked up by the supplier so they can make their quarterly statement look good. What about overhead for our 6-story hospital? What about all the managers and administratlors we now need to manage all these things? What about all the doctors we need to pay?

You say "non-profit" as if you mean "cheap", but the two aren't even close.


Just look at job postings. Are they desperately trying to hire people for Huntington Beach or Fargo?

There is a reason why a newly-graduated surgeon can get hired in Topeka and earn more money than he can get anywhere in New England.

Supply and Demand.


People want answers, and they want them now. I had a friend (~30-year old woman) go into her PCP with abdominal pain. $350. PCP says "Oh, we'll figure this out." Gets a same-day CT scan. $2000. Uh-oh, loop of thickened bowel, that's no good. Better get a colonoscopy and make sure it's not Crohn's! $4000. Oh good, it was nothing, the pain got better and there's no Crohn's. (these are all the real numbers, btw)

My great-grandma had a heart valve replaced at the age of 89. Yes. Eighty-nine. She never had the same energy again and died from a stroke a month later. Apparently her warfarin dose was a touch too low.

Her son (my grandpa) sued the hospital and everyone who even looked at her chart. They settled by waiving the hospital bill and giving him a little cash on the side. I'm not sure exactly how much. In short, the hospital performed a major surgery on an old woman (probably because some surgeon was sure he could do it), and because of a dosing error made by someone else, they had to pay for the entire operation and hospital stay themselves. How are they going to manage that? Obviously, by raising the price on everyone else!
 
Yes, and this is why European countries have such good healthcare systems. You know, because they have minimal government. :scared:

Again, by what evidence can we say that European countries have a better medical system? Are people just dogmatically believing this because they heard it from someone who based it on refuted ranking systems?
 
Yes, and this is why European countries have such good healthcare systems. You know, because they have minimal government. :scared:

More Government control shifts the doctor's loyalty to the state, which is always bad for the patient. Less choice and less privacy, good for the bureaucrat and bad for the patient.

I don't know how good healthcare in Europe is, but I'm sure it's getting worse since the federal government (EU) is growing in size.
 
Again, by what evidence can we say that European countries have a better medical system? Are people just dogmatically believing this because they heard it from someone who based it on refuted ranking systems?

Well, it depends what you value in a good healthcare system. If you value privacy, informed consent and choice then our system will get worse after ACA. If you value imaginary coverage then it will get 'better'

It's all language.
 
More Government control shifts the doctor's loyalty to the state, which is always bad for the patient. Less choice and less privacy, good for the bureaucrat and bad for the patient.

I don't know how good healthcare in Europe is, but I'm sure it's getting worse since the federal government (EU) is growing in size.

The facts vehemently disagree with you. The US ranks dead last in the developed world in every single category of health outcomes save for one, money spent on healthcare.

Secondly, you want the state out of healthcare? Then do away with boarding/licensure/residency. After all, medicine is nothing more than a state-enforced monopoly. Let's go back to the days where anyone could treat and diagnose disease without formal training. Those with MDs will have to compete against anyone with access to WebMD. Is an MD worth 150k/year when anyone can diagnose and treat problems? The free market will decide that. Let's get rid of the FDA so we can market any compound without regard for efficancy and efficacy; the free market will work out the kinks. After all, the FDA is just big government regulating the poor little pharma companies and stifling the free market. Who needs oversight of chemotherapy drugs or inspection of compounding facilities? Let the pharma companies regulate themselves. It's not like several dozen people just got a CNS fungal infection because a compounding facility was skirting regulations. In the end, the market will work it all out. People will run away from those companies that don't provide what they advertise and those people who die/suffer are just casualties in the free market working.
 
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Still not useful to compare Norway to the US, when the population there is smaller than Chicago.

Norway has physicians, nurses, allied health professionals, hospitals, clinics, medical schools, an employment structure for providers, a funding system for medical care, a medical bureaucracy, and medical liability system. Why there is some insurmountable barrier to comparing how their overall system functions versus ours escapes me.

With a population of 4.9 million, Norway is larger than Chicago (2.7 million), and is more populous than 28 of our states. Medicare alone serves over 49 million individuals (ten Norways), so I also fail to see that we are at risk of colliding with barriers to scalability.
 
Norway has physicians, nurses, allied health professionals, hospitals, clinics, medical schools, an employment structure for providers, a funding system for medical care, a medical bureaucracy, and medical liability system. Why there is some insurmountable barrier to comparing how their overall system functions versus ours escapes me.
I didn't say it was insurmountable, did I?

With a population of 4.9 million, Norway is larger than Chicago (2.7 million), and is more populous than 28 of our states. Medicare alone serves over 49 million individuals (ten Norways), so I also fail to see that we are at risk of colliding with barriers to scalability.
The metro area is twice the population of Norway. I assumed you wouldn't nit-pick.

serenade's assertion was that health care is expensive because America has excess capacity sitting idle in the suburbs, quietly sucking up revenue. Your link substantiates that the opposite is true. Thanks for helping make my point. :thumbup:
Please point out where he said that.

Please point out where my link substantiates the opposite. If we have excess capacity, it would be in the urban and suburban areas, because my link discusses the dearth in rural areas.
 
I didn't say it was insurmountable, did I?

I guess the hyperbole didn't shine through. But where some see impossible and you see "not useful" I see rather easy and quite useful. Perhaps we agree to disagree.

TheProwler said:
The metro area is twice the population of Norway. I assumed you wouldn't nit-pick.

I assumed if you meant greater metro Chicago you would have typed "greater metro Chicago."

TheProwler said:
Please point out where he said that.

I was responding to this (from post #7):

"as opposed to the US that needs ever hospital stocked for everything including most situations save for level 1 trauma events ( Which probably ever 3rd hospital is prepared for)."

If this were true the nation would be dotted with idle hospitals, loaded with expensive equipment that is underutilized and staff that is perpetually bored. The reality is that services only extend to areas with enough demand and reimbursement potential to run a business, so while infrastructure is maldistributed from a health care standpoint (as nicely illustrated by your Reuters article), it is very well distributed from an economic standpoint.
 
I guess the hyperbole didn't shine through. But where some see impossible and you see "not useful" I see rather easy and quite useful. Perhaps we agree to disagree.



I assumed if you meant greater metro Chicago you would have typed "greater metro Chicago."



I was responding to this (from post #7):

"as opposed to the US that needs ever hospital stocked for everything including most situations save for level 1 trauma events ( Which probably ever 3rd hospital is prepared for)."

If this were true the nation would be dotted with idle hospitals, loaded with expensive equipment that is underutilized and staff that is perpetually bored. The reality is that services only extend to areas with enough demand and reimbursement potential to run a business, so while infrastructure is maldistributed from a health care standpoint (as nicely illustrated by your Reuters article), it is very well distributed from an economic standpoint.

I never said it was under utilized, nor that there would be idle hospitals. But rather that because people are far more spread out in the US than in Japan for ex, with a pop density far above ours. There's no way to not realize that a lot of money is spent on delivery, stocking hospitals with machinery, etc. It's a reason why a lot of hospitals are underwater now.
Services are extended as far as to prevent a lawsuit. And then some.
 
The facts vehemently disagree with you. The US ranks dead last in the developed world in every single category of health outcomes save for one, money spent on healthcare.

Secondly, you want the state out of healthcare? Then do away with boarding/licensure/residency. After all, medicine is nothing more than a state-enforced monopoly. Let's go back to the days where anyone could treat and diagnose disease without formal training. Those with MDs will have to compete against anyone with access to WebMD. Is an MD worth 150k/year when anyone can diagnose and treat problems? The free market will decide that. Let's get rid of the FDA so we can market any compound without regard for efficancy and efficacy; the free market will work out the kinks. After all, the FDA is just big government regulating the poor little pharma companies and stifling the free market. Who needs oversight of chemotherapy drugs or inspection of compounding facilities? Let the pharma companies regulate themselves. It's not like several dozen people just got a CNS fungal infection because a compounding facility was skirting regulations. In the end, the market will work it all out. People will run away from those companies that don't provide what they advertise and those people who die/suffer are just casualties in the free market working.

Government makes those problems worse.
 
I never said it was under utilized, nor that there would be idle hospitals. But rather that because people are far more spread out in the US than in Japan for ex, with a pop density far above ours. There's no way to not realize that a lot of money is spent on delivery, stocking hospitals with machinery, etc. It's a reason why a lot of hospitals are underwater now.

I would love for you to present evidence that a lot of hospitals are underwater due to delivery costs. While you're at it, perhaps you should tell Walmart, which can ship goods from Shenzhen to Pine Bluff for a pittance.

Most of our health infrastructure is located in densely populated areas (see Prowler's link), and most of our population is located along the coasts. Hell, a third of the US lives in just one of four states (CA, TX, NY, FL). You think shipping Foleys to Fargo is what drives US health care costs?

serenade said:
Services are extended as far as to prevent a lawsuit. And then some.

No, services are extended as far as they can make a buck, and then they abruptly halt.
 
it's not that the us doesn't have the ability to give prenatal care, it's that the us doesn't have the incentive or will to give prenatal care nor is it mandated at the federal level (it varies at the state level). This is primarily a function of the us having a predominantly unregulated, private health care system. Insurance companies can choose what procedures their plans cover in the us while in other countries, insurance companies are mandated to cover certain procedures.

Secondarily though, it's because the us really doesn't care about children as much as it should, at least in my opinion. Public education, especially for poor districts, is terrible and underfunded. New mothers are not entitled to maternity leave to care for their newborns. Preschool and early childhood programs are paid largely out-of-pocket by families, so poor families are often unable to afford such care. All of these lead indirectly to greater infant mortality.

A good read is urban injustice: How ghettos happen by david hilfiker if you're interested.

+1
 
Really?

Really?!

How did government make the problem of tainted antibiotics from a compounding facility that was skirting regulations worse?

look at post history
we are dealing with a notorious troll here
 
look at post history
we are dealing with a notorious troll here

Just your run of the mill libertarian or Ron Paulite.

vkByYa4.gif
 
Most of our health infrastructure is located in densely populated areas (see Prowler's link), and most of our population is located along the coasts. Hell, a third of the US lives in just one of four states (CA, TX, NY, FL). You think shipping Foleys to Fargo is what drives US health care costs?
Among all the other reasons I cited, yes, putting high-end equipment in small facilities costs a lot of money. You're just putting up straw men and knocking them down with aplomb. It's not the Foleys: it's the MRIs and da Vincis.
 
foleys to fargo would b a great name for an indie band

Sent from my SCH-I405 using SDN Mobile
 
It's not the Foleys: it's the MRIs and da Vincis.

So it's the delivery costs for MRIs and da Vincis that are driving health care. Gotcha.

Who knows? Maybe serenade is right:

MRI Scanners:

g4-02-01.gif
 
Health and health care aren't the same thing. That is something that economists/public health people say over and over but doctors don't like to hear. After all, doctors pride themselves on helping patients but the truth is that their patient's health depends a lot more on the patient's choices of diet, exercise, even spirituality, than on whether their doctor does a good job or not.

So when you're talking about health care its important not to get obsessed with comparing the health of the population and assuming that the differences are a byproduct of differences in health care. For instance, blacks have worse health than whites in the US in general but they also have less education, are discriminated against, and are more likely to have a terrible diet (and probably to smoke). I don't think much of the black-white gap in health has to do with how often they see an M.D. and how good the care is.

Anyway, that said, the statistic most people like to cite on how American health care is terrible relative to in Europe is that white people in the US have 5.2ish infant deaths per 1000 births and European countries range from 3.0 to 5.2ish. So the US is one of the worst if not the worst on the most critical thing medicine does. (Medicine has only really reduced mortality two ways in the past 50 years, treating heart disease at the end of life and reducing child mortality at the beginning of life. The rest of the gain in life expectancy are from better nutrition, vaccines, antibiotics, clean water, and not smoking.)
 
Health and health care aren't the same thing. That is something that economists/public health people say over and over but doctors don't like to hear. After all, doctors pride themselves on helping patients but the truth is that their patient's health depends a lot more on the patient's choices of diet, exercise, even spirituality, than on whether their doctor does a good job or not.

So when you're talking about health care its important not to get obsessed with comparing the health of the population and assuming that the differences are a byproduct of differences in health care. For instance, blacks have worse health than whites in the US in general but they also have less education, are discriminated against, and are more likely to have a terrible diet (and probably to smoke). I don't think much of the black-white gap in health has to do with how often they see an M.D. and how good the care is.

Anyway, that said, the statistic most people like to cite on how American health care is terrible relative to in Europe is that white people in the US have 5.2ish infant deaths per 1000 births and European countries range from 3.0 to 5.2ish. So the US is one of the worst if not the worst on the most critical thing medicine does. (Medicine has only really reduced mortality two ways in the past 50 years, treating heart disease at the end of life and reducing child mortality at the beginning of life. The rest of the gain in life expectancy are from better nutrition, vaccines, antibiotics, clean water, and not smoking.)

Just wanted to point out that research has actually shown that there are even differences in the care received by minorities compared to whites:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448154/

http://www.ncbi.nlm.nih.gov/pubmed/12578429

Anyhow, great discussion :thumbup:
 
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