Diagnosis: Insufficient Outrage(nytimes.com)
nytimes.com
Diagnosis: Insufficient Outrage
http://www.nytimes.com/2013/07/05/opinion/diagnosis-insufficient-outrage.html
13 comments
I broke my knee this spring but didn't go to a hospital on my families request because the last time I broke a bone I reset it myself and the hospital still charged $8k.
I still have blood in the joint, but I can't get it drained because no doctor will stick a needle in without an x-ray, but those are expensive. So I'm waiting till I move out and get a full time position in a bigger city to get health care to have it fixed.
Probably going to have arthritis at 40....
I still have blood in the joint, but I can't get it drained because no doctor will stick a needle in without an x-ray, but those are expensive. So I'm waiting till I move out and get a full time position in a bigger city to get health care to have it fixed.
Probably going to have arthritis at 40....
If there is anyway you can get in to see someone with a pre-arranged plan of payment please do. A debt that takes some years to pay off is just that. But a messed up joint may be causing permanent damage (as you well know judging by your comment). I'd be saying that you need an MRI too btw. It may be worth ringing around and seeing what you can get it for. If you ask to speak to the practice manager you might get lucky. Source: I'm a radiographer, our practice manager would check with the managing director would would almost certainly cut you a break - he is a soft touch. I'm not in the US I'm sorry to say.
If you know that arthritis is coming, adjust now and move to Germany (or another similar place). Waiting times for specialists might be a little longer, but you (=everybody) will be treated for treatable diseases and injuries. What you have to do, of course, is to move here legally (work visum?).
How easy is it to move to Germany as an experienced software developer and get a job there? I know Berlin has a large startup community, but is it large enough to absorb as many software developers that show up there like it is in Silicon Valley?
Do you already have to know German or can you get by with learning the language after making the move?
Do you already have to know German or can you get by with learning the language after making the move?
Although Berlin has more of a reputation, I'd recommend to also consider other places within Germany. Berlin, while having a lot of startups, is not the center of the "real" software industry. I recommend taking a serious look at companies in the Rhein-Main-Neckar region. This region has a cluster of big software firms, such as SAP, SoftwareAG and the companies working on software for the financial industry (Frankfurt), as well as Technical Universities (these are the ones that produce CS graduates).
Be warned, however, that you won't find anything comparable to SV in Germany. And I have to admit that there is also a problem regarding startups: The largest cluster of startups is in Berlin, but most of the money in the software biz is in West Germany. Btw, please don't get scammed by the Samwers.
Experience is definitely a plus, but probably more with the more "traditional" software companies than with the startups. Many German startups live off fresh degrees and high hopes (in the sense that they are founded by people out of the University), with all the positive and negative side-effects that this brings.
With regards to language, I'd say English and a willingness to learn German should suffice. Most of the software people already know enough English to work with them, and some corporations that operate internationally even mandate some degree of English usage. A few more rules of thumb: If the company is big or works in an innovative field, English should be all you need. If, on the other hand, it is located in a rural place or in East Germany, there might be problems.
These are of course generalizations. In any case, learning German will be helpful, even if it is only to facilitate the interactions with your surroundings outside work.
Be warned, however, that you won't find anything comparable to SV in Germany. And I have to admit that there is also a problem regarding startups: The largest cluster of startups is in Berlin, but most of the money in the software biz is in West Germany. Btw, please don't get scammed by the Samwers.
Experience is definitely a plus, but probably more with the more "traditional" software companies than with the startups. Many German startups live off fresh degrees and high hopes (in the sense that they are founded by people out of the University), with all the positive and negative side-effects that this brings.
With regards to language, I'd say English and a willingness to learn German should suffice. Most of the software people already know enough English to work with them, and some corporations that operate internationally even mandate some degree of English usage. A few more rules of thumb: If the company is big or works in an innovative field, English should be all you need. If, on the other hand, it is located in a rural place or in East Germany, there might be problems.
These are of course generalizations. In any case, learning German will be helpful, even if it is only to facilitate the interactions with your surroundings outside work.
I don't know where you live, but here there is urgent care that will do everything regarding a single injury for a flat fee of $150, including x-rays and follow ups up to one week.
Look for something like that where you live.
They treat uncomplicated broken bones too for the same flat fee.
Look for something like that where you live.
They treat uncomplicated broken bones too for the same flat fee.
Oh, but you can order your own blood tests. I've done it before. Google "order own blood tests." I've used Health One before to run a test that I wanted done. I had insurance, but I didn't want to go through the awkwardness of convincing my doctor that it was worth doing, and I think it was only $40.
The ability to shop around is great and all, but hardly something I could reasonably expect of somebody currently suffering from kidney stones, or worse (if you can even imagine a worse state).
I think that has a lot to do with upbringing and culture.
We here at HN know a lot about computers and programming -- even some of us for whom it isn't even our profession. We learned a lot of this stuff because it was a hobby.
Several of my real-life friends are this way when it comes to a lot of medical stuff -- despite not being in the medical profession they still know all sorts of odd things you'd expect just doctors to know just because they have been so extensively reading up on their own.
So, I guess what I'm saying is, remember the post a few months back preaching that we should 'all' learn programming? I say we should all learn more about our bodies. If and when we do, that very education will probably affect what we consume, how often we exercise, etc., ultimately improving our lives either way.
We here at HN know a lot about computers and programming -- even some of us for whom it isn't even our profession. We learned a lot of this stuff because it was a hobby.
Several of my real-life friends are this way when it comes to a lot of medical stuff -- despite not being in the medical profession they still know all sorts of odd things you'd expect just doctors to know just because they have been so extensively reading up on their own.
So, I guess what I'm saying is, remember the post a few months back preaching that we should 'all' learn programming? I say we should all learn more about our bodies. If and when we do, that very education will probably affect what we consume, how often we exercise, etc., ultimately improving our lives either way.
If you have the premonition to research it ahead of time and keep updated on it, then good for you. I suspect that the people who do that are the real minority, not HN type people.
Once you are actually in a jam... trust me, you are not going to be spending your time googling for shit when you are in a bad way with kidney stones. Lobbed off a limb with your table saw? By all means, go check the internet first ...but not with kidney stones...
Once you are actually in a jam... trust me, you are not going to be spending your time googling for shit when you are in a bad way with kidney stones. Lobbed off a limb with your table saw? By all means, go check the internet first ...but not with kidney stones...
Thanks very much for dropping that name. I had looked once before but somehow missed Health One.
I was specifically looking for testosterone and thyroid previously (before starting a new training plan) and they seemed to be off limits with the providers I had located. Awesome to see those listed and a participating lab within 10 miles of my home.
I was specifically looking for testosterone and thyroid previously (before starting a new training plan) and they seemed to be off limits with the providers I had located. Awesome to see those listed and a participating lab within 10 miles of my home.
I think you guys are on to something.
I choose to fix my own car when it has small issues, I choose to fix my own computer when things go haywire (whether it's a hardware or software problem), I choose to install/fix issues relating to the washing machine & dryer, furniture, faucets, etc. etc.
To get to the point where I could fix these things I had to learn various things from others, from reading up, and so on.
I can do that quite easily when it comes to my own body too. Only in the most extraordinary of circumstances will I seek medical healthcare.
To relate this to HN: make systems that facilitate acquisition of knowledge, conducting tests, studying those tests, etc. Maybe hook the other end of the system to a database of vetted doctors in India and China who could study the test results and suggest future options?
By golly does this industry need some disruption. Please make it happen guys.
I choose to fix my own car when it has small issues, I choose to fix my own computer when things go haywire (whether it's a hardware or software problem), I choose to install/fix issues relating to the washing machine & dryer, furniture, faucets, etc. etc.
To get to the point where I could fix these things I had to learn various things from others, from reading up, and so on.
I can do that quite easily when it comes to my own body too. Only in the most extraordinary of circumstances will I seek medical healthcare.
To relate this to HN: make systems that facilitate acquisition of knowledge, conducting tests, studying those tests, etc. Maybe hook the other end of the system to a database of vetted doctors in India and China who could study the test results and suggest future options?
By golly does this industry need some disruption. Please make it happen guys.
Unfortunately you still can't fill out your own prescriptions diagnosing your own problem, so you'll still end up paying for a doctor's visit if something is wrong.
> Took me over 2 years to pay all of it off. It pretty much wrecked my personal finances
Why did you pay it then? Tell the hospital you can't pay and move on with life. If you do well financially pay it then.
> threats from collection agencies finally forced me to put it all on my credit card
I don't understand this. Why do you even answer the phone when they call? Or open the letters they send?
Just ignore them, and when you are ready to pay, then pay the hospital directly.
Completely ignore the credit collection agencies. They are utterly impotent, especially when it comes to medical debt which has no effect on your credit score.
I mean it - completely ignore them. I don't mean answer the phone, listen to the threats and ignore it. I mean utterly ignore them. You have caller ID.
Any letters get placed unopened in a box.
Why did you pay it then? Tell the hospital you can't pay and move on with life. If you do well financially pay it then.
> threats from collection agencies finally forced me to put it all on my credit card
I don't understand this. Why do you even answer the phone when they call? Or open the letters they send?
Just ignore them, and when you are ready to pay, then pay the hospital directly.
Completely ignore the credit collection agencies. They are utterly impotent, especially when it comes to medical debt which has no effect on your credit score.
I mean it - completely ignore them. I don't mean answer the phone, listen to the threats and ignore it. I mean utterly ignore them. You have caller ID.
Any letters get placed unopened in a box.
> Why did you pay it then?
Hospitals can be rather unhospitable. They want their money, and they don't exactly hire the nicest/knowledgeable people. I routinely get collection calls for someone else based on this issue (who either had my number prior to me getting my phone OR the person gave them my number randomly), and I wouldn't invite them over for dinner.
Hospitals can be rather unhospitable. They want their money, and they don't exactly hire the nicest/knowledgeable people. I routinely get collection calls for someone else based on this issue (who either had my number prior to me getting my phone OR the person gave them my number randomly), and I wouldn't invite them over for dinner.
Just because they want their money doesn't mean you have to pay it.
Why allow them to decide what you do?
Why allow them to decide what you do?
My point is that they apply pressure, and it's only natural that people will pay to get it off
I got that. My point is why do you allow them to apply pressure?
Simply ignore them.
Simply ignore them.
> Completely ignore the credit collection agencies. They are utterly impotent, especially when it comes to medical debt which has no effect on your credit score.
Source? Googling for medical debt and credit score seems to indicate that it will in fact impact your credit score once they hand the bill over to a third party collections agency.
Source? Googling for medical debt and credit score seems to indicate that it will in fact impact your credit score once they hand the bill over to a third party collections agency.
Thats borderline malpractice, or perhaps more properly, very aggressive monetizing practice: a stone, or any renal cause, is always investigated initially with ultrasound.
I wonder if there is a role for disputing charges on the basis of unnecessary investigations (especially in the ED setting) based on a standard of care- sort of opposite a medical malpractice suit.
But I'm in Australia and don't need to worry about having 2 years worth of debt from an emergency illness..
I wonder if there is a role for disputing charges on the basis of unnecessary investigations (especially in the ED setting) based on a standard of care- sort of opposite a medical malpractice suit.
But I'm in Australia and don't need to worry about having 2 years worth of debt from an emergency illness..
This is why I got my arse in gear and "got a real" job. As I age, I realize that if I was horse, then I wouldn't be betting on myself.
Yes, if prices are skyrocketing it must be a "Crime" caused by all the dirty capitalists enriching themselves. There could be no possible explanation for it. Unless, of course, you want to consider:
1) The stifling HIPAA regime that makes it almost impossible for small, potentially competitive practices to stay open without insane amounts of overhead, explaining their sellouts to larger at-scale healthcare corporations 2) The necessity to offset insanely low negotiated and subsidized Medicare/Medicaid rates with bills on the uninsured, thus bifurcating healthcare recipients into "pays too little" and "pays too much" categories with no in-between 3) The employer-provided insurance scheme--another government-subsidized program--which hides prices from consumers and incentivizes providers to hike up prices 4) Let's not forget about the inability for insurance companies to hedge risk and lower costs by selling insurance across state lines 5) Obamacare destroying any potentially new avenues for innovation by forcing the uninsured to buy into a broken system
What would happen if a doctor or hospital today started practicing medicine at affordable prices, competitively? What's stopping that from happening? If you look for what isn't there instead of what is there, you'd see how we've completely eviscerated any hope of competition, innovation or lower prices in our system.
The "moral outrage" we should have as Americans is not toward the doctors who--as even this article grudgingly acknowledges--are good people working in a bad system. The outrage we should have is toward the captured healthcare-industrial complex that has a stranglehold on our Congress and President, using its influence to send more profits its own way at the expense of patients.
High prices are not a crime. Bad policy is.
1) The stifling HIPAA regime that makes it almost impossible for small, potentially competitive practices to stay open without insane amounts of overhead, explaining their sellouts to larger at-scale healthcare corporations 2) The necessity to offset insanely low negotiated and subsidized Medicare/Medicaid rates with bills on the uninsured, thus bifurcating healthcare recipients into "pays too little" and "pays too much" categories with no in-between 3) The employer-provided insurance scheme--another government-subsidized program--which hides prices from consumers and incentivizes providers to hike up prices 4) Let's not forget about the inability for insurance companies to hedge risk and lower costs by selling insurance across state lines 5) Obamacare destroying any potentially new avenues for innovation by forcing the uninsured to buy into a broken system
What would happen if a doctor or hospital today started practicing medicine at affordable prices, competitively? What's stopping that from happening? If you look for what isn't there instead of what is there, you'd see how we've completely eviscerated any hope of competition, innovation or lower prices in our system.
The "moral outrage" we should have as Americans is not toward the doctors who--as even this article grudgingly acknowledges--are good people working in a bad system. The outrage we should have is toward the captured healthcare-industrial complex that has a stranglehold on our Congress and President, using its influence to send more profits its own way at the expense of patients.
High prices are not a crime. Bad policy is.
| The necessity to offset insanely low negotiated
| and subsidized Medicare/Medicaid rates
1) Government mandates the rates for procedure X to make sure that the government is getting the 'best' deal.
2) Hospitals charge insurance companies using these rates (they aren't allowed to be lower, or it wouldn't be the 'best' deal).
3) Insurance companies trim the difference between the Medicare rate and the real rate from the bill with newspeak like, "charge beyond negotiated rates," or, "over-charge of contractual limits."
It basically amounts to the hospital charging the 'correct' rate, the insurance company refusing to pay that rate, and the hospital not pushing it any further since this is all laid out in their formal agreements.
So, I'm not sure if Medicare can be said to have 'insanely low' rates, if the insurance companies end up with even lower rates. (I'd love for someone to correct me if my understanding is wrong, though)
As it was explained to me by the CFO of a major hospital, you are incorrect.
Hospitals would be out of of business if their average revenue per procedure was equal to the Medicare rates per procedure. But that's not to say that hospitals are "losing money" on every Medicare patient, it's much more complicated.
Running a hospital is like running an airline, there are extraordinary fixed costs just to open the doors, regardless if any patients (aka customers) show up. When you have high fixed and low variable cost, if you are operating below capacity then the marginal cost to serve 'just one more patient' is low, and so providing the service at Medicare rates results in net income, all else equal.
Of course the money for the fixed costs eventually has to come from somewhere. Right now, that comes largely from private donations, and rate shifting (higher rates for the privately insured and uninsured).
Simply put it comes down to buying power. No one buys more than Medicare, so it's not surprising that they get the best rates.
Hospitals would be out of of business if their average revenue per procedure was equal to the Medicare rates per procedure. But that's not to say that hospitals are "losing money" on every Medicare patient, it's much more complicated.
Running a hospital is like running an airline, there are extraordinary fixed costs just to open the doors, regardless if any patients (aka customers) show up. When you have high fixed and low variable cost, if you are operating below capacity then the marginal cost to serve 'just one more patient' is low, and so providing the service at Medicare rates results in net income, all else equal.
Of course the money for the fixed costs eventually has to come from somewhere. Right now, that comes largely from private donations, and rate shifting (higher rates for the privately insured and uninsured).
Simply put it comes down to buying power. No one buys more than Medicare, so it's not surprising that they get the best rates.
> No one buys more than Medicare, so it's not surprising that they get the best rates.
It is almost as if a public option might be economically efficient.
It is almost as if a public option might be economically efficient.
Not at all, because when you have monopsony pricing you end up below market price, which drives marginal producers out of business and ends up reducing supply. It's the same reason the argument for the government buying up all the food and distributing it doesn't work: because no one would go into a business where they are guaranteed to make a loss.
Except this isn't the international experience.
In Aus we have a mixed public private system- everyone is treated free but if you want an elective procedure or to see a doctor of your own choice you can pay to do so. I have private health insurance and it costs me $1,500 a year (get dental and optical rebates etc, if I was to require serious treatment it would cover anything under the sun to be done my way) We have public hospital elective surgery waiting lists but the upside is people with no money can actually get the medical treatment they deserve in order to live functional lives.
I have been involved (as a medical student) in the us system- I know a little about it- and the creation of 'the medical poor' - there are probably better terms for it but basically those unable to get the treatment they need and thus unable to live their lives as functionally as possible - strikes me as sad and unjust.
BTW any comment along the lines of 'but doctors don't get paid for their services so less people will be willing to do it' - next year I will be practicing, in 4 years I can expect to be earning $150,000 and in 10-15 I will expect to be earning $350,000 inflation adjusted. More than enough for a comfortable life in my chosen specialty
In Aus we have a mixed public private system- everyone is treated free but if you want an elective procedure or to see a doctor of your own choice you can pay to do so. I have private health insurance and it costs me $1,500 a year (get dental and optical rebates etc, if I was to require serious treatment it would cover anything under the sun to be done my way) We have public hospital elective surgery waiting lists but the upside is people with no money can actually get the medical treatment they deserve in order to live functional lives.
I have been involved (as a medical student) in the us system- I know a little about it- and the creation of 'the medical poor' - there are probably better terms for it but basically those unable to get the treatment they need and thus unable to live their lives as functionally as possible - strikes me as sad and unjust.
BTW any comment along the lines of 'but doctors don't get paid for their services so less people will be willing to do it' - next year I will be practicing, in 4 years I can expect to be earning $150,000 and in 10-15 I will expect to be earning $350,000 inflation adjusted. More than enough for a comfortable life in my chosen specialty
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In response to #1, I know my uncle had to close his private practice (he is a practicing doctor of 18 years now and had his practice for 8) because of absurd costs and time investment in doing bookkeeping and playing hardball with everyone. He closed and is now working as a surgeon at a major hospital, but says he likes it a lot more since hes actually a doctor now and not a barterer or economist.
I have seen all of my doctors office swallowed up by hospitals in the last year. In Southwestern Ohio Mercy Health Systems and TriHealth are buying them up. They are following the lead of Christ Hospital who started this years ago at an alarming rate.
As far as my rates go, I did notice almost everything, even items done at the local office, was an outpatient procedure billed by the mother hospital, at least in part. Also something I have noticed in the increase in lab work.
I am a chronic patient, I have a heart implant, feeding tube and an infusion pump that puts baclofen directly in the spinal area.
With co-pays going out of this world under this new system, we have elected to do many things at home that used to be done at the office. Changing out my feeding tube used to cost a few hundred dollars and jumped to over $6000 last fall. My wife now changes it at home. I have my Baclofen pump refilled at home instead of the office by a third party. I elected to send my heart readings over the phone instead of going into the office, except twice a year. Finally, when I make all my appointments within days of each other when possible and make them share lab results. They don't like this but I can't afford all the extra charges out of pocket. Even the monthly b-12 shot had a significant rate increase. Once again, I choose a cheaper route. The local non-affiliated walk-in clinic for the b-12 shot.
It is nice to see this article. It explains alot. At 41 with a form of Parkinson's Plus, the nickle and diming has to stop. I don't know where the $$$ is going to come from.
As far as my rates go, I did notice almost everything, even items done at the local office, was an outpatient procedure billed by the mother hospital, at least in part. Also something I have noticed in the increase in lab work.
I am a chronic patient, I have a heart implant, feeding tube and an infusion pump that puts baclofen directly in the spinal area.
With co-pays going out of this world under this new system, we have elected to do many things at home that used to be done at the office. Changing out my feeding tube used to cost a few hundred dollars and jumped to over $6000 last fall. My wife now changes it at home. I have my Baclofen pump refilled at home instead of the office by a third party. I elected to send my heart readings over the phone instead of going into the office, except twice a year. Finally, when I make all my appointments within days of each other when possible and make them share lab results. They don't like this but I can't afford all the extra charges out of pocket. Even the monthly b-12 shot had a significant rate increase. Once again, I choose a cheaper route. The local non-affiliated walk-in clinic for the b-12 shot.
It is nice to see this article. It explains alot. At 41 with a form of Parkinson's Plus, the nickle and diming has to stop. I don't know where the $$$ is going to come from.
NE Ohio is the same way. University Hospitals and Cleveland Clinic own everything. One of the last independant hospitals, Parma Regonal, was purchased by UH this past week.
My uncle works for a hospital system that's doing the same "buy up everything" plan. He says it's because once they own all of the medical providers in the county, then they will be able to dictate the price to the insurance, instead of the other way around. What can the insurance companies tell their customers? Go to the next county for healthcare?
Another relative of mine just merged his surgical practice into the hospital system's. The overhead on his practice was getting too high, in particular malpractice insurance.
Another relative of mine just merged his surgical practice into the hospital system's. The overhead on his practice was getting too high, in particular malpractice insurance.
What if every clinic had to make a price list of procedures publicly available, and could not legally charge people different amounts for the same procedure (regardless of insurance status and so on)? That would solve at least some of the problems.
But I think it's obvious that almost no one actually wants to fix the broken system, because too many people are making too much money from it. (Doesn't that apply to almost everything in the United States nowadays? It's pathetic.) I'm happy to see the author pointing the finger at hospitals and doctors. It doesn't seem like that happens often enough. (When I say "doctors" I really mean specialists. I don't think that GPs are as much to blame.)
But I think it's obvious that almost no one actually wants to fix the broken system, because too many people are making too much money from it. (Doesn't that apply to almost everything in the United States nowadays? It's pathetic.) I'm happy to see the author pointing the finger at hospitals and doctors. It doesn't seem like that happens often enough. (When I say "doctors" I really mean specialists. I don't think that GPs are as much to blame.)
By "almost no one" you mean "probably most people, but some people who make lots of money from the current system are using part of that money to bribe politicians not to fix it, and we live under a government where that is tolerated."
I suppose I meant "almost no one" who actually has the power to do it. So yeah, what you said.
Most of the West has free healthcare - and it works pretty darn well, considering. I would imagine many people are still shocked that healthcare is not free in the US. This is yet another reminder of how lucky we are ... those of us who are covered by free health (eg. in Commonwealth countries).
Actually Indonesia, a country clawing its way out of third world status, is in the process of introducing universal health care, [1] so it's not only commonwealth countries. Hopefully, this 'socialised' system can be implemented in such a way as to flourish within the rapidly growing economy to come.
In the UK, after we've charged you nothing in the NHS, we'll give you the bus fare home.
1. http://www.marketplace.org/topics/world/health-care/indonesi...
In the UK, after we've charged you nothing in the NHS, we'll give you the bus fare home.
1. http://www.marketplace.org/topics/world/health-care/indonesi...
Yes but try getting an appointment with a doctor in a reasonable time under NHS. It's been a while since I've left the UK but I remember getting appointments with a primary care physician using private insurance I would get one the next day, with NHS the next month.
It does seem to have got worse in the last few years - not that I go to a GP often (maybe once every 3 or 4 years) but I was used to getting an appointment within 1 or 2 days and the last time the only appointement was about a week away.
However, it is worth noting that recent published statistics (for 2011/2012) show that:
"85 per cent could see or speak to a doctor or nurse within two working days compared to 90 per cent in 2009/10."
Note that this is for NHS Scotland - there actually isn't a single NHS for the entire UK.
http://www.scotland.gov.uk/Publications/2012/05/8250/3
One of the problems with the NHS is that it seems to suffer from having regular waves of (probably very expensive) management re-organisation inflicted on it in efforts to make it "more efficient" - often with non-medical managers being incentivized on performance, so they end up gaming the metrics.
Still, I think the NHS and the concept of "free at the point of delivery" championed by Nye Bevan "In Place of Fear" are still fantastically important to society the UK - though nobody claims it is perfect. Clearly the absolute best level of individual care are to be found elsewhere (probably in the US). However, when I see quotes elsewhere in this thread such as:
"I broke my knee this spring but didn't go to a hospital on my families request because the last time I broke a bone I reset it myself and the hospital still charged $8k."
Those pretty much fill me with horror/fear that anyone has to put up with that - which is precisely the reason the NHS was created.
However, it is worth noting that recent published statistics (for 2011/2012) show that:
"85 per cent could see or speak to a doctor or nurse within two working days compared to 90 per cent in 2009/10."
Note that this is for NHS Scotland - there actually isn't a single NHS for the entire UK.
http://www.scotland.gov.uk/Publications/2012/05/8250/3
One of the problems with the NHS is that it seems to suffer from having regular waves of (probably very expensive) management re-organisation inflicted on it in efforts to make it "more efficient" - often with non-medical managers being incentivized on performance, so they end up gaming the metrics.
Still, I think the NHS and the concept of "free at the point of delivery" championed by Nye Bevan "In Place of Fear" are still fantastically important to society the UK - though nobody claims it is perfect. Clearly the absolute best level of individual care are to be found elsewhere (probably in the US). However, when I see quotes elsewhere in this thread such as:
"I broke my knee this spring but didn't go to a hospital on my families request because the last time I broke a bone I reset it myself and the hospital still charged $8k."
Those pretty much fill me with horror/fear that anyone has to put up with that - which is precisely the reason the NHS was created.
I actually like the dual system offered in the UK. I was in London back before 97, it appears things have gotten much better (http://www.mirror.co.uk/news/uk-news/exclusive-nhs-hospital-...).
Although specialist visits are still lagging behind the US (23 weeks for knee replacements).
Yes, the non medical managers (i.e. those annoying MPH people who make drastic irrational changes to justify their positions), we have the same problem in Canada.
Although specialist visits are still lagging behind the US (23 weeks for knee replacements).
Yes, the non medical managers (i.e. those annoying MPH people who make drastic irrational changes to justify their positions), we have the same problem in Canada.
Of course, one thing about the NHS in the UK, as with state provided education, you can opt out of using it but you can't opt out of paying for it!
Yes but try getting an appointment with a doctor in a reasonable time under NHS.
You can usually get an appointment with your GP within days, sometimes the next day (depends on your local GP). In an emergency you can call them and get an appointment straight away. It's never been a problem when I needed to see a UK doctor.
The GP can decide with you if you need to see a specialist and refer you (the vast majority of people don't).
You can usually get an appointment with your GP within days, sometimes the next day (depends on your local GP). In an emergency you can call them and get an appointment straight away. It's never been a problem when I needed to see a UK doctor.
The GP can decide with you if you need to see a specialist and refer you (the vast majority of people don't).
It takes me a month to get a physician appointment with private insurance in US (and you cannot go to the doctor
without first going to physician). I don't even bother anymore and just go directly to urgent care.
Part of the problem with US healthcare is not just that prices are insane, but that it does not provide an adequate service even given those prices. Again, a sign of a non-free market.
Part of the problem with US healthcare is not just that prices are insane, but that it does not provide an adequate service even given those prices. Again, a sign of a non-free market.
I actually had a discussion with my doctor on this very subject. He was complaining that he could not actually advertise prices as it is apparently considered price fixing if doctors do that (or so he says). He also told me he would be stupid not to bill the highest possible price he could for things because he doesn't know exactly what the insurance companies will accept and he could be leaving money on the table otherwise. So don't try to distinguish between specialists and GP's, they all do it.
Interesting. It's cool that your doctor tried to be honest with you about it. It would be so much better if you were his customer and not your insurance company.
Since I have an HSA, I write checks to every doctor that I see. (My company buys me high deductible insurance and puts $6k into an HSA each year for my family.) When I visit my GP, it's $72 for usually 20 minutes of his time and I can get in to see him the same day. Specialist appointments are $800+ for what often feels like a more cursory conversation that I waited a month or two for. That's why I am not as quick to blame GPs. They have to rent office space and hire office staff on top of acquiring an expensive education, so the price that they charge (to someone with insurance like me, anyway) feels pretty justifiable.
Since I have an HSA, I write checks to every doctor that I see. (My company buys me high deductible insurance and puts $6k into an HSA each year for my family.) When I visit my GP, it's $72 for usually 20 minutes of his time and I can get in to see him the same day. Specialist appointments are $800+ for what often feels like a more cursory conversation that I waited a month or two for. That's why I am not as quick to blame GPs. They have to rent office space and hire office staff on top of acquiring an expensive education, so the price that they charge (to someone with insurance like me, anyway) feels pretty justifiable.
I was visiting the US (from India) a couple of months back. In the hurry to get to the airport, I forgot to get Medical Insurance. Unfortunately, I got pink eyes while I was there.
I haven't found America all that much more expensive than urban India. In fact, compared to cities in India, a few things might even be cheaper. But not medicine. An eye doctor's visit costs $180, for Pink eyes! A comparable facility here would have charged me about $8.
I totally get the different standards of living and associated expenses. But medical treatment stands out so much that I can't imagine how an uninsured person could afford hospitalization or even moderately complex treatment in the US.
I haven't found America all that much more expensive than urban India. In fact, compared to cities in India, a few things might even be cheaper. But not medicine. An eye doctor's visit costs $180, for Pink eyes! A comparable facility here would have charged me about $8.
I totally get the different standards of living and associated expenses. But medical treatment stands out so much that I can't imagine how an uninsured person could afford hospitalization or even moderately complex treatment in the US.
I think most people just don't go to the doctor for pink eye (including me and 3 other people I know that got it in the past year).
I wasn't planning to either. But buying any medicine requires a prescription in the US, which may be fine depending on how you look at it.
What I was trying to say was that I found treatment 10x more expensive in the US; while other expenses are merely higher and generally affordable.
What I was trying to say was that I found treatment 10x more expensive in the US; while other expenses are merely higher and generally affordable.
I'm agreeing with you.
We don't get medicine for things like pink eye, we just let it run it's course.
We don't get medicine for things like pink eye, we just let it run it's course.
now that is silly. you don't know what kind of infection it is unless you go to the doctor.
You really need to get a health plan if you don't have one. If you're young it might only be $100/$200 a month, even if you're unemployed.
You really need to get a health plan if you don't have one. If you're young it might only be $100/$200 a month, even if you're unemployed.
I broke an arm while in US and this is the breakup of the expense
ER 1800:
Ambulance: 1400
Treatment (no surgery. Just a cast and X-rays for 3 months): 700
I don't get how a cardiac stress test can cost 2000USD. You put someone on a home trainer, let them pedal for 20 minutes, and look at their EKG. It's usually performed by a nurse, and the doctor spends 30 seconds looking at the EKG (the analysis of the EKG is even partially automated).
If there was actual competition on the market, I'm sure a health service provider would find a way to perform the test for 75USD.
If there was actual competition on the market, I'm sure a health service provider would find a way to perform the test for 75USD.
People who have stress tests administered often have underlying cardiac or pulmonary disorders that can be aggravated.
A not insignificant subset of people doing stress tests can enter into hypotensive shock or even cardiac arrest, the facility has to be prepared to deal with adverse effects as those reactions can be fatal.
A not insignificant subset of people doing stress tests can enter into hypotensive shock or even cardiac arrest, the facility has to be prepared to deal with adverse effects as those reactions can be fatal.
Yes - it pays to have a big defib (not one of the 'press button now' mall variety), an experienced and qualified staff member or 5 with high level CPR training, and some good cardiac event type drugs, and a load of proper monitoring gear (heart rate, BP, etc). While these things aren't especially cheap, they would pay off fairly quickly at a decent clinic, and I was involved in the purchase of most this stuff for sub $10k US recently for a clinic (but got a mall style defib as our needs are different). Staff would be the greatest cost. That said, at 2k per test, most expenses for the year would be paid of in the first week or 3 at a busy clinic surely?
$2000 isn't that ridiculous depending on the circumstances, but $75 is impossibly low with America's system. In Canada they bill ~$200 +/- 100 depending on the details. A comparable figure in the states (again factoring insurance non-payment issues and convenience factors, i.e. how soon you can get it, having facilities close by) would be reasonable at $800-$1500.
$2000 is utterly ridiculous for a stress test. I used to work as a neurology tech, mostly dealing with epilepsy. Our tests themselves could invoke seizures, and we frequently saw seizures anyway, which can be life threatening if not handled. We were a private department in a hospital - as techs, we knew enough first aid to keep the person alive and call for the crash cart.
$2000 might sound reasonable if every single patient required emergency attention, but in truth, far from it. Medical tests aren't meant to bring you to the brink of death, and are generally designed to keep you safe. It's not even worth pretending that $2k 'might' be worth it; it's just not. As for covering for insurance non-payment, isn't that chicken-and-egg? When a test costs ten times what it should? That would suggest that for each test that someone pays for, there are nine patients effectively getting it for free.
$2000 might sound reasonable if every single patient required emergency attention, but in truth, far from it. Medical tests aren't meant to bring you to the brink of death, and are generally designed to keep you safe. It's not even worth pretending that $2k 'might' be worth it; it's just not. As for covering for insurance non-payment, isn't that chicken-and-egg? When a test costs ten times what it should? That would suggest that for each test that someone pays for, there are nine patients effectively getting it for free.
You're assuming the cost is $200. In Canada it can be up to 6 months (from my own experience) to get a stress test booking. In the states you can do it the next week. That gets a significant premium. Compare it to buying something on eBay from Hong Kong and waiting 5-8 weeks vs paying 4x and getting it right this second from Best Buy. At the end of the day you're going to get what you need either way but it's how long you're willing to wait.
$2000 is only for uninsured patients, and as has been demonstrated numerous times results in you getting shafted when it comes to pricing. A better problem to attack is reducing the amount of stress tests given, as they're often completely unnecessary. Ontario has recently decided to stop paying doctors who give unnecessary stress tests, resulting in ~5000 fewer tests given every year.
$2000 is only for uninsured patients, and as has been demonstrated numerous times results in you getting shafted when it comes to pricing. A better problem to attack is reducing the amount of stress tests given, as they're often completely unnecessary. Ontario has recently decided to stop paying doctors who give unnecessary stress tests, resulting in ~5000 fewer tests given every year.
A good thing about socialised systems (don't get me wrong, there are plenty of problems too) is that they often have more protocol homogeneity. What this helps with is that best practice gets codified and protocols written. Then a clear pathway is made for clinicians to follow, with a review system to allow for improvements. Fragmented systems with owner operators (usually sub specialists) can have other motives ($) and little to zero feedback on care quality. Large systems with set protocols helps reduce unneeded tests. Getting the money saved put back into other parts of the system however, can be.... Tricky.
As someone living under a "socialist" system, let me tell you : "practice" is codified, yes. Best practice is not, unless some politician's kid or granddad has the disease/condition in question.
Someone I know needed a root canal treatment, and I found out that ... it's not covered - at all - under the national system. Nor is it covered under normal insurance except for a small token amount (< $250 equivalent, and yes it will cost $2k+ here too). And there is no way to get it done quickly, which makes no sense. We're talking about a root canal here. Delaying it at the point where it hurts will make things worse FAST. WTF ?
Someone I know needed a root canal treatment, and I found out that ... it's not covered - at all - under the national system. Nor is it covered under normal insurance except for a small token amount (< $250 equivalent, and yes it will cost $2k+ here too). And there is no way to get it done quickly, which makes no sense. We're talking about a root canal here. Delaying it at the point where it hurts will make things worse FAST. WTF ?
Hmm.. That's bad. I live in a country with socialised healthcare, and there is some dental care. Most isnt covered, but if its an accident or an emergency (such as bad pain), it will get done. Imperfect, yes.
Having been a medical technician, I'm aware of the cost of equipment, consumables, wages, rent, and so forth. The consumables in the bulk of stress tests are minimal - you're basically paying equipment and wages, and there's no real reason why a stress test should be an order of magnitude more than what I used to do (all my tests required vendor equipment). Where I worked had a two-week waiting period instead of a one-week, but there were spaces for emergencies. It's certainly not worth 10x more in order to chop your wait from 2 to 1 weeks.
That it's still $2k for uninsured patients is still very much the problem. It's not particularly mollifying that 'only some people' get hit with that bill. No-one should be fleeced simply because they're unwell.
I think a better tactic is to break the student cap. As long as the students remain high quality and there are facilities to train them, there is no reason to limit the number of graduates. It's basically cartel behaviour if that's happening. Doesn't solve things in the short term, though. This being said, in healthcare, there is no golden bullet. Fixing a failing system requires multitudinous tactics.
That it's still $2k for uninsured patients is still very much the problem. It's not particularly mollifying that 'only some people' get hit with that bill. No-one should be fleeced simply because they're unwell.
I think a better tactic is to break the student cap. As long as the students remain high quality and there are facilities to train them, there is no reason to limit the number of graduates. It's basically cartel behaviour if that's happening. Doesn't solve things in the short term, though. This being said, in healthcare, there is no golden bullet. Fixing a failing system requires multitudinous tactics.
The hospitals just charge that because they can. What most people don't know is that you can often negotiate them down.
The word "cash" works wonders. 4-10x discounts.
If you're paying list price you're not even trying.
If you're paying list price you're not even trying.
The problem is the the overwhelming majority of Americans don't know this. I've had this conversation with many people and almost all don't know that you can get your cost discounted and that you can usually get them discounted to the Medicare/Medicaid price (which you just need to discover by matching it to CPT codes).
My mom was told about a procedure that would have cost her $120k, in one question the price dropped to $30k. That's such an unfathomable discount that I think many people are ignorant because it sounds too good to be true. They end up thinking that it doesn't exist, there is some catch or that they probably don't qualify somehow.
My mom was told about a procedure that would have cost her $120k, in one question the price dropped to $30k. That's such an unfathomable discount that I think many people are ignorant because it sounds too good to be true. They end up thinking that it doesn't exist, there is some catch or that they probably don't qualify somehow.
Fwiw, I've asked this at two locations, mostly for curiosity's sake. In both cases, the cash price was about 50% higher than what would have been paid through insurance, which was 100% not covered by my insurance.
Their reason was that insurance companies usually pay a predictable amount, but people paying cash frequently stop paying and get punted to collection agencies, ending up with (significantly) less money actually going to the hospital.
I'll keep asking, but it's not that clear-cut.
Their reason was that insurance companies usually pay a predictable amount, but people paying cash frequently stop paying and get punted to collection agencies, ending up with (significantly) less money actually going to the hospital.
I'll keep asking, but it's not that clear-cut.
On the proton therapy: As a particle physicist whose best friend just finished (photon) radiation therapy for brain cancer, I know a good chunk about this. First off, not all proton therapy is the same. It's heavily dependent on the linac and gantry a hospital has. UCSF has proton therapy in Davis or somewhere targeting glaucoma and stuff, which is completely different than the facilities at Loma Linda or Massachusetts General. Of higher energy proton therapy centers, there's only about 5 such facilities in the US. As far as general hadron therapy goes, there's none. So a proton therapy center in Washington isn't likely to serve just Washington and/or Baltimore, it's likely to service Virginia, West Virginia, Maryland, New Jersey, and even farther out possibly. On top of that, it's still heavily research based, and moving pretty quickly as we've moved towards modeling human tissue with GEANT4 and Monte Carlo simulations.
Anyway, while I don't know the specifics of the proton therapy centers mentioned, the assumption that a proton therapy center would just service Washington/Baltimore metropolitan areas is silly. After LLNL shut down their proton therapy center/experiment, we don't even have any proton therapy centers in the Bay Area.
Anyway, while I don't know the specifics of the proton therapy centers mentioned, the assumption that a proton therapy center would just service Washington/Baltimore metropolitan areas is silly. After LLNL shut down their proton therapy center/experiment, we don't even have any proton therapy centers in the Bay Area.
Well look past the hospitals and insurance companies when you want to assign blame then. The government creates the laws these entities operate under.
Congress knew damn well what would happen when they used the force of government to compel prices for Medicare/Medicade. Insurance companies got on the ride because of size. Yet it falls to Congress to be the one to look out for the little guy but that was not their concern. Their concern was to maintain the steady flow of campaign contributions.
The ACA was more of a payoff to insurance and hospital industries than looking out for the public. The reason why most members didn't read the bill is because its contents were not important, its effect on their position was what mattered.
For years Federal law has prevented people from shopping across state lines for medical insurance. For years it has been adding elective treatments and surgeries as requirements to even the simplest policies which in turn reduced their affordability.
The solution, try to put everyone in the pool by force of law and reap the rewards of insurance companies and hospitals suddenly with more business than they had means to process.
Congress knew damn well what would happen when they used the force of government to compel prices for Medicare/Medicade. Insurance companies got on the ride because of size. Yet it falls to Congress to be the one to look out for the little guy but that was not their concern. Their concern was to maintain the steady flow of campaign contributions.
The ACA was more of a payoff to insurance and hospital industries than looking out for the public. The reason why most members didn't read the bill is because its contents were not important, its effect on their position was what mattered.
For years Federal law has prevented people from shopping across state lines for medical insurance. For years it has been adding elective treatments and surgeries as requirements to even the simplest policies which in turn reduced their affordability.
The solution, try to put everyone in the pool by force of law and reap the rewards of insurance companies and hospitals suddenly with more business than they had means to process.
A large portion of this cost is because some people don't pay, and they can run huge tabs. Meidicine is a business, and that cost has to be shifted to other patients to compensate.
In socialised systems, like Canada, physicians actually make more money because the government always pays so it's not a greed issue. The downside is that the government has limited funds, so the amount of beds, ORs, and advanced equipment is severely limited and wait lists are rediculous, ER times between 6-8 hours, chemotherapy wait lists of 8 months, surgeries 1 year + for the worst of surgeons. Alberta is the exception as they have rediculously deep pockets from oil revenue.
It's a trade off, this is a case of you get what you pay for. Free healthcare only works when the state has money to blow on quality care, I.e Texas with the Scottish Rite hospital.
You can't directly compare life expectancies with the US and places like France (which have free or near free healthcare) and conclude that it is just as good, if not better than America's. There are many confounding variables here (I.e their very short work weeks).
In socialised systems, like Canada, physicians actually make more money because the government always pays so it's not a greed issue. The downside is that the government has limited funds, so the amount of beds, ORs, and advanced equipment is severely limited and wait lists are rediculous, ER times between 6-8 hours, chemotherapy wait lists of 8 months, surgeries 1 year + for the worst of surgeons. Alberta is the exception as they have rediculously deep pockets from oil revenue.
It's a trade off, this is a case of you get what you pay for. Free healthcare only works when the state has money to blow on quality care, I.e Texas with the Scottish Rite hospital.
You can't directly compare life expectancies with the US and places like France (which have free or near free healthcare) and conclude that it is just as good, if not better than America's. There are many confounding variables here (I.e their very short work weeks).
Seriously, just copy the EU on healthcare. You might need to pay extra taxes, and take an extra insurance against hospitals fees. But it's all very affordable.
If it wasn't for A) getting the same answer for most of my ills: inflammations :p B) The doctor being very busy. C) Basic respect to not stress our medical system. One would go for the tiniest medical complain.
If it wasn't for A) getting the same answer for most of my ills: inflammations :p B) The doctor being very busy. C) Basic respect to not stress our medical system. One would go for the tiniest medical complain.
It isn't a "duh" problem in the US. Especially in the presence of less educated or rural communities, who buy media propaganda that socialized medicine kills grannies, and amongst retirees who are already getting thousand dollar checks each month from the government but don't want anyone else getting any benefits, because the uninsured are "jobless hippies".
That, and there is a huge insurance lobby ripe with exploiting the corruption of congress and the 2 party oligopoly that keep pressure on maintaining insurer profits.
We pay significantly more by having every uninsured person come in with emergency needs rather than seeking preventative care, but the average American doesn't care, because they "deserve it" for not having a job that gives insurance. The ideology is completely backwards, but intentional on the parts of those who profit off it.
That, and there is a huge insurance lobby ripe with exploiting the corruption of congress and the 2 party oligopoly that keep pressure on maintaining insurer profits.
We pay significantly more by having every uninsured person come in with emergency needs rather than seeking preventative care, but the average American doesn't care, because they "deserve it" for not having a job that gives insurance. The ideology is completely backwards, but intentional on the parts of those who profit off it.
Doctors and medical facilities would need to make a lot less money. That is the source of most of the cost difference. The vehicle of payment is maybe a secondary cause. It might be good to change it, but if it's not directly responsible for the majority of the difference in what doctors are getting paid, it's not going to fix the problem.
My Uncle is a doctor, went the full 9 years at Tulane and everything. He had to close his own practice because Medicare paid dirt, insurers would delay payments for years, and malpractice insurance was thousands a month. He was running around a 2,000 a month deficit when he had to fire his secretary and close down. He now works in a general hospital as a surgeon, and is actually happier not having to try to haggle getting paid or getting people to pay more.
Some doctors may be profiting off this, but the principle beneficiary is private insurance companies, at least from my experiences. Doctors spend an eighth of their life learning some of the hardest science and discipline of any profession and you do want to compensate the good ones well. We need more people entering medicine, not fewer.
Some doctors may be profiting off this, but the principle beneficiary is private insurance companies, at least from my experiences. Doctors spend an eighth of their life learning some of the hardest science and discipline of any profession and you do want to compensate the good ones well. We need more people entering medicine, not fewer.
The overhead of insurance companies are minimal. Less than five percent of the overall spend (edit: this is wrong, it is more like 8%, see [1]).
As much as you prefer to think of your uncle as the good guy and faceless insurance companies as the bad guy, a big part of the problem is he makes between 150% and 200% what his European and Canadian counterparts make. http://economix.blogs.nytimes.com/2009/07/15/how-much-do-doc.... Ahmdahls law makes it nearly inevitable that we'll pay doctors less if we want to reduce our overall costs.
1 http://tbd-consulting.typepad.com/healthcare_talent/2010/09/...
As much as you prefer to think of your uncle as the good guy and faceless insurance companies as the bad guy, a big part of the problem is he makes between 150% and 200% what his European and Canadian counterparts make. http://economix.blogs.nytimes.com/2009/07/15/how-much-do-doc.... Ahmdahls law makes it nearly inevitable that we'll pay doctors less if we want to reduce our overall costs.
1 http://tbd-consulting.typepad.com/healthcare_talent/2010/09/...
And I'm not saying his practice went under exclusively from insurance companies. And it wasn't how much they were taking, it was more that it took them months to actually pay him for services rendered, and it consumed tons of time to just keep track of who hasn't compensated him yet (besides copays). And medic___ were just as slow.
He might have made it all up, was living it lavishly and just lied about it, but it seems like that would be hard to hide from the extended family. He's had the same car for 8 years now, and his wife works. But he was still a general practice doctor in Augusta that closed his practice and went to work elsewhere for some reason, and if he was making a lot of money, it wasn't showing in how he was living (one house he had for 20 years).
He might have made it all up, was living it lavishly and just lied about it, but it seems like that would be hard to hide from the extended family. He's had the same car for 8 years now, and his wife works. But he was still a general practice doctor in Augusta that closed his practice and went to work elsewhere for some reason, and if he was making a lot of money, it wasn't showing in how he was living (one house he had for 20 years).
The EU is not a country. The EU has no single healthcare system.
Every country has it's own system, which range from anything between 100% government provided to mostly privatized. No system is the same. And it's not just the EU, it's the entire Western civilization outside the US.
This is extremely important, because the healthcare debate in the US is falsely framed as a choice for or against "socialized medicine", were in reality socialized medicine is a rarity amongst the various healthcare systems.
Whether or not to make quality healthcare accessible to everyone is not an ideological choice, the problem can be solved within the framework of any political ideology.
It's strictly a choice between decent healthcare for everyone or bigger profits for the healthcare industry.
Every country has it's own system, which range from anything between 100% government provided to mostly privatized. No system is the same. And it's not just the EU, it's the entire Western civilization outside the US.
This is extremely important, because the healthcare debate in the US is falsely framed as a choice for or against "socialized medicine", were in reality socialized medicine is a rarity amongst the various healthcare systems.
Whether or not to make quality healthcare accessible to everyone is not an ideological choice, the problem can be solved within the framework of any political ideology.
It's strictly a choice between decent healthcare for everyone or bigger profits for the healthcare industry.
This.
Germany has compulsory health care insurance, Britain has the NHS, New Zealand has a largely free public health care system (with ACC for accident care and private health insurance for those that can afford a slightly higher level of care).
These are all "socialized" schemes of one variety or another, but they all work. You'd get funny looks framing a discussion about health care in those sorts of terms in most of those countries - and the stories shared here sound perverse to anyone in a western democracy outside of the US.
Germany has compulsory health care insurance, Britain has the NHS, New Zealand has a largely free public health care system (with ACC for accident care and private health insurance for those that can afford a slightly higher level of care).
These are all "socialized" schemes of one variety or another, but they all work. You'd get funny looks framing a discussion about health care in those sorts of terms in most of those countries - and the stories shared here sound perverse to anyone in a western democracy outside of the US.
As I understand it, there sort of is the same health care across the EU. There is an EU healthcare card which means any EU citizen gets treated in any EU country. The systems are different, but in the end we can all get healthcare free at the point of delivery. No absurd bill.
The details of how each country does it are different, but the result is the same. No insane bills to stay alive. No poor turned away or treated like second class citizens.
I have to say, of all the things I cant get my head round about the US, the health care system is the biggest jaw dropper for me. Not only is it not universal, but the people who run it make incredible profit out of it. Seems mad to me.
The details of how each country does it are different, but the result is the same. No insane bills to stay alive. No poor turned away or treated like second class citizens.
I have to say, of all the things I cant get my head round about the US, the health care system is the biggest jaw dropper for me. Not only is it not universal, but the people who run it make incredible profit out of it. Seems mad to me.
Health care and health care insurance approaches are not the same across the EU, but the EU does proscribe that residents of any EU (1) country insured in one country get medical treatment in any other country (http://en.wikipedia.org/wiki/European_Health_Insurance_Card)
(1) as always, there are zillions of EUs to choose from. Reading the Wikipedia page, it actually isn't the real EU, but the EU plus (all?) members of the EFTA.
(1) as always, there are zillions of EUs to choose from. Reading the Wikipedia page, it actually isn't the real EU, but the EU plus (all?) members of the EFTA.
How much does the Affordable Care Act addresses this? I know insurance can't be denied to people with pre-existing conditions and there can't be any life-time expense caps. But is there any measure to address the high cost of health care in US?
Effective next year up to 400% of the poverty line is eligible for some fraction of their expenses covered under Medicaid. If you are beyond that threshold is the infamous "uninsured tax". Note that 400% of the poverty line is around $50k a year.
I wonder where the 400% came from; that seems very... odd
The poverty line is a sliding scale based on household size, so for a 4 person household that threshold is 94,200. It is basically the "you make enough money that you can either get insurance through work or the flat rate we are forcing insurers to pay".
Insurance providers don't pay these sky high rates so it effectively reduces the out of pocket expenses of patients, significantly.
Here, in Russia, basic medical assistance is mostly free (or costs peanuts compared to US), but on the flip side you have to sit through enormous queues, talk to incompetent doctors and doctors themselves might extort you. Paid medicine is better and sometimes better qualified, and you get better service, but it's totally out of budget for anyone below middle class.
Good news is that you won't be charged bajillion dollars after you broke your hand, bad news is that you'll have to wait and suffer in horrible insanitary that is Russian polyclinic.
I have mixed feelings about our health care system. I believe, it will gradually disintegrate as doctors from soviet era get older and retire.
Good news is that you won't be charged bajillion dollars after you broke your hand, bad news is that you'll have to wait and suffer in horrible insanitary that is Russian polyclinic.
I have mixed feelings about our health care system. I believe, it will gradually disintegrate as doctors from soviet era get older and retire.
Prescription: Free Market Competition
There is no such thing as the free market when it comes to healthcare. Not only is the consumer not in a position to shop around when dealing with health issues, partly because you're often not in a position of even knowing what treatment you need until you've decided on a provider and undergone expensive consultations, but also, providers are put in positions of not being allowed to refuse service based on ability to pay.
Not to mention, the "free market" solution doesn't actually involve consumers "voting with their wallets" and choosing the healthcare they want, but rather choosing from a very limited set of insurance options where they have no real choice or power. And the choices they are offered basically amount to a small array of socialized healthcare options: you have no control over your benefits and extremely little ability to choose a different one, but everyone pays into a large pool and costs are shared by the group as a whole so outlier costs are not overly burdensome to individuals. It is wholly baffling to me that anyone can support this system but be against socialized healthcare. Our model is socialized healthcare, but instead of being socialized across the nation as a whole, it's socialized across a particular employer or purchasing group. Does this actually give us choice? No. Go analyze your health plan "options" offered by your employer and tell me you're participating in the free market and I will laugh in your face.
Not to mention, the "free market" solution doesn't actually involve consumers "voting with their wallets" and choosing the healthcare they want, but rather choosing from a very limited set of insurance options where they have no real choice or power. And the choices they are offered basically amount to a small array of socialized healthcare options: you have no control over your benefits and extremely little ability to choose a different one, but everyone pays into a large pool and costs are shared by the group as a whole so outlier costs are not overly burdensome to individuals. It is wholly baffling to me that anyone can support this system but be against socialized healthcare. Our model is socialized healthcare, but instead of being socialized across the nation as a whole, it's socialized across a particular employer or purchasing group. Does this actually give us choice? No. Go analyze your health plan "options" offered by your employer and tell me you're participating in the free market and I will laugh in your face.
You point out the very problems that free market competition has in this market. Given that you know the problem, now try to find a solution. Hint: most of them are policy changes.
Free Market would work great if the suppliers couldn't reject people. Free Market ideas work when suppliers want to see to all possible buyers. It's grossly unfair when suppliers can pick and choose buyers based on risk profilers. Essentially, the current system is "get a serious disease, then you do not pass go".
I've seen friends get seriously dicked over because they filled out some insurance paperwork wrong. Ironically (and sadly), they would have been fine without insurance and just invested in a index fund.
I'm a huge fan of socialized medicine simply because I think it benefits everyone simply to have doctors gathering more data. All the stuff we know now is because people had crazy things happen to them (and most of them probably died), so it's in the public interest that people don't go off into the corner and die; rather, the health data is valuable (especially for the rich and upper-middle class who I presume would like to live longer).
I've seen friends get seriously dicked over because they filled out some insurance paperwork wrong. Ironically (and sadly), they would have been fine without insurance and just invested in a index fund.
I'm a huge fan of socialized medicine simply because I think it benefits everyone simply to have doctors gathering more data. All the stuff we know now is because people had crazy things happen to them (and most of them probably died), so it's in the public interest that people don't go off into the corner and die; rather, the health data is valuable (especially for the rich and upper-middle class who I presume would like to live longer).
Why don't you elaborate instead of just yelling "free market!" and waving your hands? How might we encourage competition effectively?
No one can open a new, competing hospital without the permission of the lousy overpriced hospitals that its intended to compete with.
Yes, you need your competitor's permission to enter the market. Its the law.
http://en.wikipedia.org/wiki/Certificate_of_need
Yes, you need your competitor's permission to enter the market. Its the law.
http://en.wikipedia.org/wiki/Certificate_of_need
Eliminate drug patents, remove the annual cap on medical students in doctoral programs, remove that requirement entirely from a medical license and let anyone practice medicine that wants to (albeit with some regulation requiring a practitioner explicitly state their qualifications, and you would have to prosecute impostors).
That would probably lead to what we have today - people only trust literal doctorates from top medical schools - but you could open new medical schools to placate demand, and hopefully reduce the workload required to obtain a medical license (the current 8+ years of schooling is excessive for any profession) or provide some kind of doctoral certification program outside the bounds of academia, though I have no intimate knowledge to know how you would do it.
It does become buyer beware, but it also means you would have treatment at most pay grades. Also, if it wasn't illegal to produce chemical compounds (really, that is dumb, and all the arguments of how they produce progress because of profit motive is pointless if nobody can afford the result, and the investment funds in big pharma would find other avenues to stimulate growth and research). The costs of care would fall absurdly fast if there weren't a dozen golden gates on the road to being a medical professional or medical facility, I wouldn't even mind if they just reduced the barriers, but they are too high and too plentiful right now.
That would probably lead to what we have today - people only trust literal doctorates from top medical schools - but you could open new medical schools to placate demand, and hopefully reduce the workload required to obtain a medical license (the current 8+ years of schooling is excessive for any profession) or provide some kind of doctoral certification program outside the bounds of academia, though I have no intimate knowledge to know how you would do it.
It does become buyer beware, but it also means you would have treatment at most pay grades. Also, if it wasn't illegal to produce chemical compounds (really, that is dumb, and all the arguments of how they produce progress because of profit motive is pointless if nobody can afford the result, and the investment funds in big pharma would find other avenues to stimulate growth and research). The costs of care would fall absurdly fast if there weren't a dozen golden gates on the road to being a medical professional or medical facility, I wouldn't even mind if they just reduced the barriers, but they are too high and too plentiful right now.
That or socialised healthcare...
The problem is that we are going to wind up with strange and mutated in-between solution that's probably going to be terrible.
If only we could just bottle that, it would sell so hard.
I took a trip to the ER around 10pm one evening in agonizing pain and was treated like a drug addict. I wasn't even triaged for over 2 hours (peak flu season) and everyone acted like I was just trying to score pain meds. Finally, after 3.5 hours, I was sent for a CT and only after the CT confirmed a stone was I given non-narcotic pain meds (Ketorolac) and send home to wait it out. Total time in the actual ER was ~1.5 hours (of a >5 hour trip) for a hospital administered dose of an NSAID only after a CT scan.
$4800.
Took me over 2 years to pay all of it off. It pretty much wrecked my personal finances (threats from collection agencies finally forced me to put it all on my credit card). I've been jaded about hospitals ever since.
I've also had another stone in the years since and was diagnosed with a ~$100 sonogram. And I used acetaminophen and ibuprofen to manage the pain for a couple weeks.
I'm still shocked that I had to wait so long and go through such a costly imaging procedure to justify a short prescription of a non-narcotic pain reliever.
I could go on another rant on an intelligent adult not being allowed to order a simple blood panel for self quantification.