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Originally posted by NeoPhono You should see a doctor about that.

I can't I would be too ashamed about that. Spoil the reputation of my family etc etc.

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Originally posted by guerra-monstru I can't I would be too ashamed about that. Spoil the reputation of my family etc etc.

Pride; meet prejudice.

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Originally posted by guerra-monstru you just don't get it do you?

I think you'd find Neo gets it pretty well, considering he's directly involved in the field of health care, as am I. We differ on opinions in certain aspects, but I must agree with him that blaming doctors is not the culprit for the major problems with health care in America.

I think he would agree with me to a certain aspect that the problems are more with the insurance companies rather than the providers. The rise in technology has also contributed to the rising costs, but how the insurance companies have handled things (or mishandled things) have made major impacts as well.

What's becoming more evident, at least in the circles I'm hearing is that everyone including the providers and insurance companies are gearing up for an eventual switch over to a single-payer system. Seems to be only a matter of time.

___________________
Whence September dusk grows crisper still,
with leaves all crimson conquered,
I yearn to shout,
and dance about,
and stick pickles in my honker...

Ok here are a little more FACTS but feel to ignore the facts.

Its from the ECONOMIST handbook 2007
Highest health spending % of GDP

1. United States 15.2%
2. Switzerland 11.5%
3. Germany 11.1%
4. Cambodia 10.9%
5. Iceland 10.5%
6. Norway 10.3%
7. Lebanon 10.2%
8. France 10.1%
9. Canada/Greece 9.9%
11. Netherlands/Uruguay 9.8%
Now think about this. 30% of that is due to administrative waste (different plans different forms different paperwork). In a unified system, that is about 10% at most. So, immediate YOU could save a whopping 3% of YOUR GDP (a very non-trivial 400 BILLION dollars a year). Then, if pharmaceuticals were reigned in, this could bring perhaps even another 3% of savings.

Pharmaceutical companies spend more in advertising (which coincidently heavily regulated in Europe, and direct-to-patient advertising BANNED GET THAT BANNED in some countries) than they do on research, and then moan how they need to rob average John Q. Public to recoup their losses. Meanwhile on the backs of DEAD Americans they are among the most disgustingly profitable industries in the US.

Since you seem to like the Economist...

http://www.economist.com/finance/di...tory_id=9407716

You're telling me a completely government-run system would be less regulatory and more cost effective? Show me one other US agency that takes care of the entire population on a daily basis and runs in a cost-effective manner. Show me any US agency that runs in a cost effective manner. Show me a socialized medical system that is not currently facing, or forecasting horrific budget shortfalls or is delivering sub-standard care.

Here's the bottom line...until the field of medicine has unlimited resources, there will *always* be short comings. It's a matter of distributing resources. Unless a country is willing to put all of its GDP into health, there will always be a limit to how good healthcare can be.

Does that mean the US should maintain their current route? No. But that also doesn't mean the US would be successful in having a socialized healthcare system. There are a multitude of factors as to that, even beyond economics. I'm not saying there couldn't be a *universal* healthcare system, but that there shouldn't be one run by the government.

What should happen?

1. Americans should take better care of themselves. An obese patient (30% of the population) costs more than four times the amount of a non-obese individual for healthcare. Want even less incentive for the US to lose weight? Make care for all their weight-related ailments free.

2. Make insurance companies non-profit, allow nation-wide competition.

3. Reduce all government regulation; from insurance companies to the FDA. Why are drug costs so high? Well, the 1 billion dollar price tag for each newly approved drug helps. Add that to the fact that since most European countries and Canada set their drug prices, the recoup comes almost straight from the US. The nearly $400 billion in regulatory costs don't help keep the price of healthcare down, either.

4. Get rid of EMTALA.

5. Somehow impress upon the population the importance of, and responsibility needed to individually manage, healthcare. I'm still disgusted that people see healthcare costs as too high, while at the same time they're more than willing to pay hundreds of thousands of dollars for cars, houses, electronics, vacations, etc. Without your health, everything else is meaningless, yet it always seems to be too expensive. Beyond that, if you are expecting to receive top of the line care, with the latest technology, when and how you need it, it's going to be expensive. That *is* simple economics.

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Originally posted by NeoPhono Since you seem to like the Economist... http://www.economist.com/finance/di...tory_id=9407716 You're telling me a completely government-run system would be less regulatory and more cost effective? Show me one other US agency that takes care of the entire population on a daily basis and runs in a cost-effective manner. Show me any US agency that runs in a cost effective manner. Show me a socialized medical system that is not currently facing, or forecasting horrific budget shortfalls or is delivering sub-standard care. Here's the bottom line...until the field of medicine has unlimited resources, there will *always* be short comings. It's a matter of distributing resources. Unless a country is willing to put all of its GDP into health, there will always be a limit to how good healthcare can be.

So what were the reforms the state of New York did in the 90's?

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Does that mean the US should maintain their current route? No. But that also doesn't mean the US would be successful in having a socialized healthcare system. There are a multitude of factors as to that, even beyond economics. I'm not saying there couldn't be a *universal* healthcare system, but that there shouldn't be one run by the government. What should happen? 1. Americans should take better care of themselves. An obese patient (30% of the population) costs more than four times the amount of a non-obese individual for healthcare. Want even less incentive for the US to lose weight? Make care for all their weight-related ailments free.

And does smoking and drinking help?

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2. Make insurance companies non-profit, allow nation-wide competition.

How exactly would this work with current insurance?

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3. Reduce all government regulation; from insurance companies to the FDA. Why are drug costs so high? Well, the 1 billion dollar price tag for each newly approved drug helps. Add that to the fact that since most European countries and Canada set their drug prices, the recoup comes almost straight from the US. The nearly $400 billion in regulatory costs don't help keep the price of healthcare down, either.

Wait, you are blaming European nations for the price of drugs? How do many of the best pharmaceutucal companies come from Switzerland where taxes are high? Perhaps it would best if government didn't allow for such an easy access to medications that could cause harm to them, such as aspirin? Many American's die from aspirin this is because of the drug companies spending billion's of dollars a year on advertising. It has created a populace that constantly turns to taking medication on their own without realizing the consequences of it. Also if the drug companies are spending less on advertising than perhaps they could spend more on R & D which makes up just 7% of a corporations spending. Most drug companies spend more than 7% on advertising....it is true.

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4. Get rid of EMTALA.

What is this?

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5. Somehow impress upon the population the importance of, and responsibility needed to individually manage, healthcare. I'm still disgusted that people see healthcare costs as too high, while at the same time they're more than willing to pay hundreds of thousands of dollars for cars, houses, electronics, vacations, etc. Without your health, everything else is meaningless, yet it always seems to be too expensive. Beyond that, if you are expecting to receive top of the line care, with the latest technology, when and how you need it, it's going to be expensive. That *is* simple economics.

True and simple economics is *scarcity*.
Can I ask you a personal question are you involved in administration of a hospital? Also, I'd like to know where you stand on the fact that drug companies spend more of their money on advertising than r&d? Also where do you stand on care for terminal patients, such as people with the AIDS virus? do you think they deserve to be treated by doctors without expecting a returned profit or giving them the HAART treatment for free? Im just wondering also if a hospital has to treat someone who is terminally ill or seriously ill do you believe they should be treated and that the hospital (sometimes)shouldn't expect any money back?

Last edited by guerra-monstru on Jan-14-2008 at 23:25

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Originally posted by guerra-monstru So what were the reforms the state of New York did in the 90's? And does smoking and drinking help?

Of course not, but obesity is *the* problem in this country, and it will soon be pandemic if you don't already classify it as such. Smokers are expensive, but their numbers are dwindling and are only about twice as expensive as a non-smoker.

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How exactly would this work with current insurance?

It would be like insurance now, except they'd be non-profit.

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Wait, you are blaming European nations for the price of drugs? How do many of the best pharmaceutucal companies come from Switzerland where taxes are high? Perhaps it would best if government didn't allow for such an easy access to medications that could cause harm to them, such as aspirin? Many American's die from aspirin this is because of the drug companies spending billion's of dollars a year on advertising. It has created a populace that constantly turns to taking medication on their own without realizing the consequences of it. Also if the drug companies are spending less on advertising than perhaps they could spend more on R & D which makes up just 7% of a corporations spending. Most drug companies spend more than 7% on advertising....it is true.

I'm not blaming European countries, if anything they're being smart. However, making new drugs is expensive, no matter where the corporation is based. Every new drug has to be approved by the FDA, regardless of where it was made or where it may have been approved before. If a drug company in Switzerland spends a billion dollars to create and approve a drug, and they see in Europe their price is limited, but in the US it is not, they're going to charge more to recoup their spendings faster. It's another simple economics problem. Drugs are expensive for the manufacturer, they can't make money (as rapidly as they like) in Europe, so they charge much more here.

I do agree that companies spend too much on advertising and that should change. I do disagree with banning simple over the counter medications. The overwhelming majority of Americans use drugs responsibly and for their own benefit. To punish the majority because of the actions of an insignificant few is wrong. It's like pseudoephedrine being replaced with phenylephrine. In order to punish those few who used it for clandestine reasons, we've taking away a safe and beneficial drug and replaced it with one that is completely ineffective.

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What is this?

EMTALA, in a nutshell, basically states that if you come to the ER you must be seen, regardless of your condition. The ER is one of the biggest drains on US healthcare. Now more than half of ER patients never pay, leaving hospitals to either "eat" the costs, or pass it on to other patients by dramatically increasing their costs. In reality only a tiny fraction (around 5-10%) of all ER visits are true emergencies, and only a quarter even constitute "urgencies." In other words, 75% of ER visitors have no reason to be there and most of those won't pay for it.

(An analogy I'd use would be 100 people walking into a 5 star restaurant all demanding food because they're "starving." In reality, only 5 or 10 of those people actually are starving and only about 25 are actually even hungry. Instead of going some place cheaper for food, they go there and half don't even pay. But, we expect the restaurant to just eat the costs caused by those who don't pay, and we don't allow them to refer those who aren't even hungry and won't pay to a cheaper place. On top of that, we get mad because the restaurant is crowded and they charge the paying customers more to make up for those who don't pay. It's a horrific business model and that's what EMTALA sticks us with.)

Yes, the ER is "free," for those who have no other options and I have no problem with that in true emergencies, but even out of pocket, a trip to an urgent care center or even an urban clinic is relatively non-expensive and puts the onus on the patient, not others.

Basically, I'm saying that if you come to the ER with a cold or a bout of diarrhea, instead of costing hundreds to thousands of dollars for ER care, a doctor or triage nurse should be able to refer a patient to an urgent care facility or clinic. There the costs are lower for the patient and much lower for the "system."

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Can I ask you a personal question are you involved in administration of a hospital? Also, I'd like to know where you stand on the fact that drug companies spend more of their money on advertising than r&d? Also where do you stand on care for terminal patients, such as people with the AIDS virus? do you think they deserve to be treated by doctors without expecting a returned profit or giving them the HAART treatment for free? Im just wondering also if a hospital has to treat someone who is terminally ill or seriously ill do you believe they should be treated and that the hospital (sometimes)shouldn't expect any money back?

I don't work for a hospital, I'm on the other end; the patient care side. As I already said, I do believe drug companies spend way too much on advertising, but they've found a cash cow in the US that they don't have other places. I'd love for drug advertising to be banned, as it makes it much more difficult to treat a patient who comes into the clinic/office who has already diagnosed themselves from a TV ad and demands a medication. Online medical health sites do much the same. I'm not saying that information is a bad thing, but when you're looking for something to be sick from, it's easy to self diagnose yourself with just about anything you come across. I've spent quite a lot of time and effort gaining the knowledge I (would like to believe) I have, and to have someone tell me I'm wrong because of a TV ad or WebMD is, to say the least, frustrating.

I of course believe that terminally ill patients need and deserve care, I also believe that charities are the best source for this care, or at least for the money behind it. The hospitals and the government will always have a place in this, but if you decrease costs for the average consumer, you'd be much more likely to see an increase in donations and charitable work. Heck, there are tons of charities out there that never get utilized simply because people don't know about them. A well-run, motivated charity is easily the best place to look for care for those who cannot afford it. Charities cannot pay for everyone, but in a system were we expect those who can afford health insurance to have it, they can care for those who "slip through the cracks."

I do not believe that healthcare is a right. Healthcare is a technology and a service industry. It does deal with life, and that puts a lot of emotion into it, but until we have robot doctors that work for free and robot factories that make drugs free of charge, someone will always have to *work* in order to provide healthcare. I see nothing wrong with doctors making a "profit" in the sense that they should expect to earn enough money to live on. We can argue all day if they make too much, but since the 70's, the average doctor's salary has remained the same, not taking into account inflation (so in reality it has decreased) while their operating costs, malpractice insurance and educational costs have all risen dramatically. I'm looking at 200K just for school and I'll never, ever be rich like the doctors of yesteryear were. If we were to go to a socialized system where my salary would be the same as a Canadian or European colleague, I would be bankrupted by my med school debt. Short of reinstituting slavery, there is nothing that can be done to make healthcare a "right." Medicine is a profession by which people make a living and you can't expect them to work for free or at no profit.

In a perfect world, I hope that people and countries make health their first priority and have no problem with sinking a considerable amount of their income into their health, however I know that won't happen. The best I can hope for is personal responsibility, smart people making smart medical and economic decisions and generous people. Until my perfect world is realized, medicine with always be utilitarian in that the limited amount of resources we have must benefit the greatest amount of people. I hope that vaguely answers your question about advanced and expensive care for various illnesses.

Last edited by NeoPhono on Jan-15-2008 at 05:12

You guys have no idea how powerful the insurance and pharmaceutical companies are. Lobbyists have Washington on a leash.

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Originally posted by Krypton You guys have no idea how powerful the insurance and pharmaceutical companies are. Lobbyists have Washington on a leash.

When did I ever say they weren't? I think I have a pretty good idea how powerful both groups are, especially pharms. I'm not expecting some magic wand to be waved and this to magically be changed. These are big changes that need to be made by, as I sad before, smart people making smart medical and economic decisions. Politicians solely looking at their donation bases never will.

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Originally posted by NeoPhono 4. Get rid of EMTALA.

Haha, I don't disagree with you, but that was the public excuse Bush used after veto'ing the State Children's Health Insurance Program. When asked why he was giving it a veto, and whether that would impede health care for children in poor families, Bush answered:

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I mean, people have access to health care in America. After all, you just go to an emergency room.

Whoops.

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Originally posted by guerra-monstru Cheers mate, my point was that publicly funded healthcare leads to healthier populations

Obviously not considering the UK is second bottom of that list!

We have free health care for all through the NHS, yet we managed only to beat America in terms of health care provision and I'm pretty sure we also have the most unhealthy population in the EU.

Also, not all the heath services in the EU are free or completely publically funded. It varies from country to country so I don't think you really can say that "the European" model is the best.

The problem with the private system is that it favours only those who can afford it, likewise, the problem with public systems is that governments are scared to raise the required amount of taxes to fund it adequetly.

I certainly agree that health care should be free for all, but at the same time the government need to invest heavily in it and shouldn't be afraid to raise the revenues through tax increases (or, looking at our current tax systems, stop letting the fucking rich individuals and corporations off and tax the mother ******s accordingly like everyone else!!!)