My Take on the Health Care Crisis - Part 1
Originally posted almost two years ago, here is my take on the healthcare crisis, the four parts presented in order below. Enjoy!
Here are the two major problems with our current health care system that have everyone in a tizzy:
1) The poor folks in America have limited access to health care services
2) Health insurance (and American medical care in general) costs too much
First, let's get something straight: anyone who is honest and who has even the most basic level of medical knowledge should admit that the quality of healthcare in America is the best in the world. Rich people didn't get that way by being stupid, so when they get cancer they aren't flying to Europe or Canada to get treated....they are going to MD Anderson or the Mayo Clinic.
The same thing can be said about heart disease, diabetes, musculoskeletal disorders, or any other medical problem you can think of: America treats these conditions better than anyone else in the world. When a multimillionaire pro athlete needs a complicated operation to save his career, he turns to American surgeons. When a wealthy foreign dignitary needs a heart bypass, he comes to America. Say it again, repeating as often as necessary until it sinks in: America provides the highest quality medical care in the world.
We also have the best medical training in the world. Physicians from other countries are lined up at our gates, hoping against all odds that they might be accepted into any one of our residency training programs. Only the best will be accepted. Our physicians accept training positions in other countries only as a last resort, because for the most part they are well-known to be inferior.
Of course we also have the best medical technology in the world. We have more advanced medical technology concentrated in 1000 acres in Houston than most other nations can even dream of. Do you really think the average Cuban is likely to get an insulin pump or an LVAD? How about a liver transplant?
Because we have the best physicians, the best medical training, and the best medical technology in the world, we also do some of the most important medical research in the world. Wealth begets wealth.
So why does American health care cost so much? Because it is the best. Why do our poor people have limited access to health care? Because they can't afford it. If we gave it all away, we wouldn't have the best quality healthcare anymore. Other countries ration healthcare by making everyone wait for it equally. That's why wealthy Canadians fly down here to get their hips replaced and upper-class Brits fly over here to get treatment for their breast cancer. They don't want to wait. We ration care by limiting access to those who can't pay for it.
Don't misunderstand and don't buy the baloney the frantic lefties are trying to feed you....poor people in this country still get better care than in any other country. I admitted a penniless patient with bowel obstruction from his colon cancer just last week, and an uninsured man with a large brain tumor last month. Both got the highest quality surgery the world has to offer the very next day.
Yes there are barriers to care for the poor. These people couldn't just walk into the Mayo Clinic and ask for a PET scan. And they will still get a huge bill they will be unable to pay. But they will ultimately get the care they need, thanks to EMTALA.
But our current system is unsustainable over time, as more people discover the EMTALA loophole and the willingness (and ability) of the insured to pay for the care of the uninsured gets stretched to the breaking point. So what is my solution? Stay tuned.
Part 2
Here are the two major problems with our current health care system that have everyone in a tizzy:
1) The poor folks in America have limited access to health care services
2) Health insurance (and American medical care in general) costs too much
First, let's get something straight: anyone who is honest and who has even the most basic level of medical knowledge should admit that the quality of healthcare in America is the best in the world. Rich people didn't get that way by being stupid, so when they get cancer they aren't flying to Europe or Canada to get treated....they are going to MD Anderson or the Mayo Clinic.
The same thing can be said about heart disease, diabetes, musculoskeletal disorders, or any other medical problem you can think of: America treats these conditions better than anyone else in the world. When a multimillionaire pro athlete needs a complicated operation to save his career, he turns to American surgeons. When a wealthy foreign dignitary needs a heart bypass, he comes to America. Say it again, repeating as often as necessary until it sinks in: America provides the highest quality medical care in the world.
We also have the best medical training in the world. Physicians from other countries are lined up at our gates, hoping against all odds that they might be accepted into any one of our residency training programs. Only the best will be accepted. Our physicians accept training positions in other countries only as a last resort, because for the most part they are well-known to be inferior.
Of course we also have the best medical technology in the world. We have more advanced medical technology concentrated in 1000 acres in Houston than most other nations can even dream of. Do you really think the average Cuban is likely to get an insulin pump or an LVAD? How about a liver transplant?
Because we have the best physicians, the best medical training, and the best medical technology in the world, we also do some of the most important medical research in the world. Wealth begets wealth.
So why does American health care cost so much? Because it is the best. Why do our poor people have limited access to health care? Because they can't afford it. If we gave it all away, we wouldn't have the best quality healthcare anymore. Other countries ration healthcare by making everyone wait for it equally. That's why wealthy Canadians fly down here to get their hips replaced and upper-class Brits fly over here to get treatment for their breast cancer. They don't want to wait. We ration care by limiting access to those who can't pay for it.
Don't misunderstand and don't buy the baloney the frantic lefties are trying to feed you....poor people in this country still get better care than in any other country. I admitted a penniless patient with bowel obstruction from his colon cancer just last week, and an uninsured man with a large brain tumor last month. Both got the highest quality surgery the world has to offer the very next day.
Yes there are barriers to care for the poor. These people couldn't just walk into the Mayo Clinic and ask for a PET scan. And they will still get a huge bill they will be unable to pay. But they will ultimately get the care they need, thanks to EMTALA.
But our current system is unsustainable over time, as more people discover the EMTALA loophole and the willingness (and ability) of the insured to pay for the care of the uninsured gets stretched to the breaking point. So what is my solution? Stay tuned.
Part 2
Labels: health care crisis
posted by scalpel at 5:10 AM
60 Comments:
I am very interested in why you think u.s. health care is so much better than in western europe?
I trained at a major east coast center and had many opportunities to interact with european-trained residents who were visiting. The quality and rigor of their education left my jaw hanging open. I don't think we can assert that US training is better than elsewhere. Good? Certainly. Superlative? Let's leave it as good.
Ditto with the over-broad "America has the best health care in the world." Really? You've been to (say) the Netherlands? Are you seeing lots of Flemish millionaires coming to your hospital for their bypasses? Truth is that there are lots of tertiary and quaternary care centers in Europe that serve as international magnets, but most Americans are so self-absorbed not to know about them. An oil magnate from Dubai is just as likely to get his bypass at the Sorbonne or the Royal College as at the Cleveland Clinic. So not a knock on our system, but again, I don't think we can support that assertion.
And this applies also to research: when I read the literature, I see lots of ground-breaking stuff coming from overseas. I think that we have a clearer lead on the rest of the world in this category, though, due to the amount of capital we put into it.
What we do have that nobody else can match is the capital investment in medical infrastructure. In terms of high-tech stuff -- MRIs, PET scanners, linear accelerators, 64-, 128-, 256-slice CT scanners, etc -- we are light years ahead of the rest fo the world. It's not clear that this really translates into better outcomes on a societal scale, but certainly seems to enhance care.
I'm not arguing that American medical care is the ONLY good medical care in the world. Nor would I assert that there aren't isolated centers of excellence around the world that might be just as good at certain things. Obviously there are. The French hand transplant comes to mind.
I too trained with some outstanding brilliant FMGs, and as Chief Resident I also interviewed many more candidates than were actually accepted. The difference is that we probably have as many high quality medical schools in this country as exist around the rest of the globe.
In terms of overall excellence, depth and breadth, I stand by my assertions. And part of my reasoning was simply to get the liberal naysayers to abandon their recent meme and admit that we are just as good.
Mission accomplished. :)
Scalpel-
Frantic Leftie here.
What piece of health care that you ER docs miss is those who *don't* show up to the ER. EMTALA covers them, for better or for worse (I'm certainly not an EMTALA champion).
But when I see an uninsured 50 year old vasculopath in my office with 2 hours of chest pressure, SOB, and diaphoresis who refuses to go to the hospital because to do so would mean a several thousand dollar bill and he's got a house payment and 3 kids at home, we've got a problem.
When I see a 52 year old with positive hemoccults that can't afford a colonoscopy, we've got a problem.
When I see a 40 year old patient with Crohn's disease and active bleeding for 3 months who needs a colectomy but has no insurance and works as a park ranger, we've got a problem.
I don't pretend to have the answers to the health care crisis. But make no mistake, for lots of folks - working folks - it is a crisis.
I'm looking forward to part 2.
As someone who is training in a foreign country (Mexico), let me offer my views. There are individual doctors here that are unsurpassed in their fields. They may not be able to publish as much as US doctors because they lack the support structure that allows them to take "time out" to write articles, but they are no less worthy of recognition.
As I alluded to, however, the health care infrastructure here, with the exception of a few hospitals in the big cities (like where I am), sucks. You can look at the average OR theater or ICU and think, "Thank GOD I'm not a patient here." But outcomes are not as bad as would be expected. In fact, they are quite comparable with the rest of the Western world in many areas in spite of the aging equipment, substandard (to the US) facilities, etc. So whatever your proposed solution is, it has GOT to be able to bridge the gap between the amount of money thrown at the problem and what actually is bought for that sum.
My personal feeling is that the US healthcare system reigns supreme in quality, quality control, and consistency. You are just as likely going to get good quality baseline care in BFE as Manhattan because of the laws, accreditations, etc. that ensure minimum compliance to basic standards. While Mexico and other countries have similar measures, how they actually get enforced is another matter. Having a law on the books is useless if it's not followed through. Compliance, for all the pain in the ass that it is in the US (and, yes, things still fall through the cracks), does ensure a far greater consistency that definitely puts a patient's mind at ease.
(written by liberal lefty whose feathers are not ruffled, btw)
Looking at your link to the US News rankings (for whatever they're worth) I see my hospital is in the top 20 in at least one specialty, and I know for a fact that if you show up in my ER, no matter who you are or your ability to pay, and you need to see that specialty, you will.
I am a bit shocked to see that you think we pay the most for health care because we receive the best health care in the world. Several WHO and other studies have indicated otherwise.
We are #1 in health care spending per person in the world.
We are #72 in the world in life expectancy, lagging behind powerhouses such as Albania, Armenia and Croatia.
However, we are doing quite well in terms of "responsiveness", defined by the WHO in this study as "respect of persons (dignity, autonomy, confidentiality, prompt attention) and client orientation (quality of basic amenities, access to social support networks, choice of providers).
So in typical American fashion, we are paying the most to get really good customer service. But the product is more expensive than it's worth.
I'm not saying that the quality of American health care is lesser than in other countries. I am saying that we spend nearly DOUBLE the amount per person per year than in the next leading country on the list, and yet we are not reaping measurable benefits.
And the reason health care in the United States is so expensive is NOT because it is the best health care in the world. It's because patients are not paying for procedures directly ("my insurance will cover it...I want an MRI for my knee sprain!") and doctors have no reason NOT to order such tests since they aren't paying a penalty for ordering unnecessary tests. (Quite the opposite--defensive medicine is another reason for skyrocketing costs.)
I'm not for social medicine by any means, but are we really okay with the fact that American citizens who *are* working hard to earn a meager living are having to decide between feeding their families and paying for the hypertension medication that will keep them from stroking out or going into renal failure, costing the health care system more money in the long term? I've certainly seen, working in the ER, second-rate care given to those who didn't qualify for "VIP" status. It's the epitome of injustice.
Sorry, make that "socialized" medicine. Sometimes I wonder if I have two cells to synapse.
Laurie-if you work in the ER, you should know where to get the cheap appointments and the cheap drugs. This "people choose between food and drugs" line is tired, not necessarily applicable, and can be reversed at least to some extent with proper teaching and research.
I know I personally get people to be compliant by telling them specific prices for things like drugs and appointments. People have it in their heads (no thanks to the liberals who make it seem you have to drive to Canada to get cheap meds) that drugs and doctors are always expensive so they just opt to do nothing other than calling around to figure out who is cheaper.
A rule of thumb is Wal-Mart, Costco, and Sam's Club are usually cheaper than most other places. At least in my state, CVS and Walgreens are sometimes 4 or 5 times as expensive.
My hospital is relatively close to a Wally World like most hospitals in the country, and I sometimes will print off a list of the $4 meds for my patients who have a hard time affording things. What the Hell, I'll be a Wal-Mart advertising source when they offer the cheapest stuff in town if it gets the patients to be compliant.
If they're on long-term meds, I encourage them to call the MD's office and see if their more expensive BP med can be switched to a generic available for $4 etc. If it means being on no BP med or a different one they can afford...
There are also numerous prescription assistance programs available through drug companies or the state or even individual health care corporations that can help too.
After all that, there will still be patients that would rather spend their money on smokes and crack, and there's little you can do for them.
Wal-Mart's $4 prescription program alone has cut in excess of 600 million dollars of health costs in this country.
I was waiting for someone to bring up the WHO statistics, zelda. Thank you.
Of course, I am going to discount them, because they have zero bearing on the quality of healthcare that is available for those Americans who are willing and able to take advantage of it.
We also have among the most sedentary lifestyles and are more obese than most in the world, we work more hours and take fewer vacations than most, we have a huge undocumented immigrant population and high levels of violent crime and illegal drug use. I shudder to think what our WHO statistics would look like if our healthcare system wasn't as good as it is. Besides, we probably pay 10 times as much on expensive end-of-life and futile care than anyone else in the world.
I've never seen statistics on it, but I also wonder what the statistics would look like if only our suburbanite healthcare consumers were compared to these other countries. You may not think our healthcare system is "fair" because we ration care differently than other countries, but it is what it is. We define "better" at least partially in terms of convenience and it's more important to those paying the bills for the best care to be the best than for everybody's care to be pretty good.
Of course you are right that high administrative costs are responsible for much of the cost, but Americans demand good customer service. Our customers would be quite upset if they had to wait several months for their cholecystectomies or their cancer workups or if they couldn't get their CT scan for little Chase who bumped his head on the nightstand. And of course, we have to be able to file lawsuits if anything goes wrong. So we have lots of extra documentation and CYA expenses too.
Nurse-K,
I think we can both agree that, unfortunately, not all hypertension patients are candidates for the $2.50-a-month diuretics. There will always be those who choose to take advantage of our current entitlement system, but it's been my experience that those who easily dismiss the "meds or bills" question are those who've never had to ask it.
Nurse k, why is it that you always compare the American public, in general, to crack or meth addicts? There are many ill people in this country who are not drug addicts. Does it make your job easier to consider all the patients are drug addicts? I bet you are the ER Doc's, and the patients, worst nightmare!
...it's been my experience that those who easily dismiss the "meds or bills" question are those who've never had to ask it.
A little ingenuity goes a long way. When I was a Type 1 diabetic with a kid, a drunk husband, no money, no heat in my house, and no insurance, I learned how to get around my barriers to care. I wasn't able to have an insulin pump, but I was able to get R and NPH insulin ($22 per bottle after calling every pharmacy in town), a free meter (widely available at most health clinics, but you have to ask for them) and a good supply of free strips.
Part of the problem is that people like you give up on people before you even give them a chance. Patients who go to the ER, especially for primary care, are looking for someone to help them get what they need and you, instead, cop out with the "food or drugs" or "you don't know what it's like Nurse K" line (I do know what it's like and I also know how to get around some of these obstacles).
You have fallen into the mindtrap that people without insurance can't get health care in this country without some government intervention and that's too bad. If someone really can't afford both food and meds (and they've eliminated all extraneous bills like cable, cell phone, car, car insurance, DSL, high rent), then they likely qualify for public assistance, and you can make sure they've applied.
Cheap blood pressure meds are just as effective as expensive blood pressure meds...they just have more side effects and less convenient dosing schedules.
My once a day BP med costs $2 a day copay, but if I was pinching pennies you can bet I'd be on a diuretic first. Most hypertensives should be on one anyway.
Poor people aren't entitled to expensive new medications any more than they are entitled to government-sponsored Lexuses. That's actually a free preview of one of the foundations of my solution to the "crisis."
To anon 7:54, believe it or not but there are indeed plenty of crack, meth, heroin, PCP, alcohol, and tobacco addicts in this country, and they do drive down our statistics and raise the cost of care for everyone else. It may be convenient for the idealists to ignore them, but we see them every day.
And no more personal attacks or mischaracterizations please.
There are more than 50-year-old diuretics on that list, Scalpel.
There are many beta blockers, many ace inhibitors, various combo pills (eg HCTZ/lisinopril), etc etc. Of course there is a selection of those with rate/afib problems, angina, etc too. Click my link; you doubters will be impressed enough to be slightly more hopeful.
Most patients could do well on their selection based on the med lists I have to do continuously morning, noon, and night.
I agree. I could easily manage over 80% of all outpatients using only that list. And the mortality rate wouldn't be affected by the other 20%, it would be purely symptomatic/patient preference issues.
Nurse K:
So you made it through all of that yet you still have no compassion?
Not everyone can survive a situation so dire even after trying their best. You are seemingly under the mindset that if you can do it, so should everyone else. Tut Tut to that argument. Come back to reality, it's not so pleasant here.
Also, the last time I checked, not every patient in the ED was a drug addict, ETOH patient, or psych pt. I have worked in one, I know the patient population. I therefore second anonymous 7:54 on your negative outlook.
I've been reading your blog for several months and I see you have a pattern. Is blogging just an outlet for you? Do you hold different perspectives in "real life"? I would ask on your own blog, but you have blocked comments from non- bloggers.
Scalpel:
Other countries have the same exact technology as we do, they however manage their money and testing necessity better. Studies have shown that the more testing done does not equate to better care. Conversely , it increases mortality. Maybe they have something on us there...
Also of note, there seems to be a point at which a certain amount of money will get you no further in progressive health care. Other countries seem to be aware of this and spend less, but not too little.
I know several Working middle class Americans who would love to access health care. If only they could afford deductibles while raising a family.
To me, it appears that middle class America is quickly disappearing. That leaves the haves and the have nots.
I am interested in hearing Part 2.
Oregonian: Compassionate people in healthcare, in my opinion, empower those to do for themselves when possible. I can treat your emergent problem, and I can give you the resources to keep it from happening again. Many in the ER just treat the problem, give some prescriptions, and send the patients away. This is a missed opportunity.
I like to think my 1-2 minute crash course on "where to get stuff you need for good prices and how to work the healthcare system" helps people and encourages people to seek out good deals and to take control of their health care (a skill many uninsured people lack).
A simple suggestion like "go out to the free phones in the lobby, use the yellowpages and call around to see which pharmacy has it for cheapest" seems obvious to me, but many people have never price-checked drugs or medical services. Next time they get a script, maybe they'll do the same thing.
If you think my attitude of "you can" is ill-advised and not compassionate, I'll never be able to get you to like what I'm saying. Sure, some people may have trouble meeting their needs with generic prescriptions and trips to the cheaper-care clinic (I go to the cheaper-care clinic I recommend to others, BTW, because they're pretty good, in my 'hood, and I consider my kick-ass insurance coverage to be a little bit of a charitable donation).
One group that comes to mind whose incomes oftentimes don't meet their needs for medical treatment through no fault of their own are the chronically seriously mentally ill. Risperdal, seroquel, abilify....those are all expensive drugs for anyone and the cost of therapy, psychiatrist services, and the once-yearly trip to the hospital all make for a big problem. Thus, there needs to be a safety net.
Luckily, many uninsured people are relatively healthy and work, so my advice can do them some good, I hope.
This comment has been removed by the author.
I read a study done recently that compared the treatment of an MI in Canada and in the US (I can't remember where it was published). In general, a patient in the US was more apt to have invasive procedures and surgery performed than one in Canada (probably due to several factors; including lack of resources and a different litigation climate).
The Canadian patient was far more likely to have drugs prescribed and lifestyle changes initiated instead of procedures/surgery. Interestingly, the study found no significant difference in the outcomes between the two countries.
I think that part of what you're talking about is a culture of care in the US, which tends to interventions and procedures, compared to other countries which may not treat quite as agressively. That is not to say that the less agressive approach is bad medicine, it's just different medicine.
Actually, I see the real problem as something completely different than as stated here .
We have a profit driven healthcare system wherein profit is defined solely by dollars. (Whereas I would define profit in healthcare as health.)
So long as corporations are making money off healthcare, there will be no change to the system. Healthcare will first have to become unprofitable, thereby eroding the power base of the political health lobby, before any real reform can be put into effect.
I don't expect to see improvements in cost or accessibility for a very long time.
And just because we're the best doesn't mean we can't or shouldn't improve. There are many areas where we could do better.
M
Nice to see that at playtpus' hospital a patient can see a specialist regardless of ability to pay. That is not true in the 3 hospitals I work at, none of which are in the top 100 in the nation, let alone, top 20.
For the most part, it is a constant struggle to get a patient into see a specialist. I have spent hours trying to get patients who do not need admitted but need further evaluation for Cancers, fractures, etc and then inevitably have to refer them to the county ER just to get them into the system. Right, the EMTALA prevents an ER from turing the patient away, but everyone else can refuse care.
It took me 5 frikkin' weeks to get someone to see a uninsured legal secretary breast cancer pt after her free mammo and needle bx was done.
Walk a night in my shoes in a free clinic I run and you will find out very quickly that health care is not that accessible.
Last night, I babysit a man for four hours in a free clinic for asthma exacerbation because he refused to get another $17,ooo bill for his asthma (spent less than 24 hours in the ER for that). He has a job working for a non-profit (finds housing for the poor) that does not give insurance. He pays his bills and is still working on the last one.
For my diabetics, yes, I can give them a free glucometer BUT only with 10 test strips and lancets. I can put them on Metformin to start for $4 but they often need way more.
I live and breathe the $4 Target list 5 nights a week and have even blogged about it (I hate Walmart, but whatever works for the patient is fine). I signed 3 patients up today on PPARx to get free Advair,refer to clinical research studies, use Abbott to get free DM supplies, my friends get me samples from their cushy Family Practice offices, I beg,plead, borrow and steal from everywhere to get patients help - it is just ain't that simple.
And, many, many patients could be you or me, just no insurance. Currently, I am seeing a huge influx of uninsured computer geeks, real estate and mortgage people. Yeah, they can afford some care, but an admission will wipe them out. And, lots and lots of people hold jobs and do work on payng their bills and doing the best they can to manage their money.
There is definitely a crisis in teh American health care system.
Yeah, they can afford some care, but an admission will wipe them out.
I'll bet you never suggested a high deductible health plan and a health savings account?
It's politically incorrect to suggest someone plan ahead for health care and liberals don't like to promote a program George Bush championed, I know, but a self-employed person could do well on these high deductible plans at least to cover that unexpected whatever and prevent financial ruin.
Refreshing Scalpel - good to here the positive for a change. Perplexing too because there are serious concerns for patients and providers.
Well, you're certainly going to get traffic on this one. I'm looking forward to the rest of it. I assume you might agree with this: the best care is available in this country. The problem -- other than cost -- is that it's unavailable to so many within it. The destitute, as you said, are not the problem. It's those who fall into the broad zone of being too poor to afford coverage, and who make just enough to disqualify for aid. Well, yeah, there's always bankruptcy... And of course, as has been said, the fact that Bill Gates or you can get a liver transplant doesn't mean the whole country has the best care. When our lifespan and infant mortality rates are better than other countries, yes, ok. I'd think it's the overall picture that's dispositive in terms of calling one country or another "the best."
I’m happy to read opinions about this. Now, I’m not a doctor or an economics major, but doesn’t the US spend more than other countries on end-of-life care as well? It is my understanding that quite a bit of money is spent on that type of care, wouldn’t trying to ration such a thing bring in a headache of ethical concerns, plus impact the way we train doctors?
I know we need a reform, but I don’t agree with the current UHC plans (from what we know, and I say that because I’m not sure young Americans will be able to properly sustain it over the years considering student debt is on par with the inflation health care scenarios, social security issues, etc.). Just a thought, but would more funding of Medicare and Medicaid do any good (short term), as they have the lowest pay schedules, but the insurance companies go off of those pay schedules. So, if the government pumped some more money in, the insurers would have to pay more, and possibly the uninsured wouldn’t end up making up for such an discrepancy in cost? (making them seeking their PCPs more)
I’m not sure if that would work, but I would be interested in hearing how people with backgrounds in such fields and keen understanding of the problems would address health care reform, if not through a UHC plan.
NURSE k WROTE: I'll bet you never suggested a high deductible health plan and a health savings account?
Actually, Nurse K, my free clinic patients always see a volunteer "insurance evaluator" before they reach me. This person goes over all their options and high deductibles and HSAs are one of them - all in writing for the patient. Unfortunately, by the time one reaches 35 or 40, they often have a pre-existing condition that will rule them out. Our whole goal at this clinic is to get patients into a system - we are a temporary aid offered to the patients by the hospital. My staff is certified to get patients on both Medi-caid and some county programs.
Yes, we do have lots of success where we can assist patients on to various programs, particularly children. But, I assure you, there are countless people who will not qualify for anything, ever unless it was via an employer.
And while I admire the fact that you personally overcame your barriers, you are intelligent and resourceful. Not everyone has that talent or the know-how to do the same.
"I'd think it's the overall picture that's dispositive in terms of calling one country or another "the best."
I always appreciate your comments Sid, and there is certainly room for differences of opinion in matters of semantics. By extrapolating your definition, Hershey's might well be considered the best chocolate by many folks too, since it is so widely available and relatively inexpensive.
Others (like myself) would disagree. If Hershey's is the only chocolate available, then it is admittedly pretty darn good. But it would be a shame if we couldn't choose to buy the fancy stuff if we were able and so inclined.
I don't get your analogy, and I'm trying hard to fit it into the argument. I'd say this: if, say, Scharffen Berger is better chocolate but only 10% of the population can afford it, and if Hershey is less perfect but reaches 95% of the people, then in terms of providing decent chocolate to the populace, clearly Hershey is the best. I agree that the best of the best medical care can be had in the US, and that kings and shieks come here to get it. But given that it's (using your examples, the Mayo Clinic, or MD Andersen) not available to very many people, and given that there are important areas in which the US lags behind other developed countries (life span, mortality rates), then it's hard to argue that, in terms of caring for an entire nation, the US system is better than, or even as good as, many other countries. So it seems to me.
The success of our country depends upon those who work hard, make money, and pay taxes. I think those individuals deserve the highest quality (tier) of medical services, because it's important to keep them healthy and get them back to work as soon as possible. Besides, they are paying their own bills.
I think it's honorable for our citizens to provide medical care, education, and social services to support the less productive members of society, but the return on investment is often disappointing.
It just isn't important to me to be able to say we provide the best of everything to the masses. What our country provides (better than any other country, I would add) is the opportunity for anyone to be as successful as their ability and desire allows.
You really should read Bill Whittle.
Wow. Ayn Rand we be so proud of most of you.
Clearly we live in different worlds, ideologically speaking.
I would like to spend hours responding to all of this, but instead I'll just offer up my blog for you to go take pot shots, if you like.
Please click on the topic links on the right for specific issues.
http://cmhmd.blogspot.com
Cheers,
Sorry:
Ayn Rand would be so proud of most of you.
Cheers
We be so happy you made that clear.
Cheers.
Dr. scalpel is extremely delusional. For the average citizen, the US health system is incomparably worse than most of those in Western Europe. Sure, for a few fancy rich folk you have the best specialists in the world with the best equipment, but when it comes to caring for a population, the US is way behind. In my opinion, scalpel's insistence that the medical establishment should serve only the interests of the wealthy goes against all the principles for which doctors are normally respected. That he even became a doctor attests to the inability of US medical education to attract and foster ethical doctors.
The US is a world leader in many regards.
Perhaps not in health.
The US spends by far the greatest proportion of GDP on health.
But, from a global (WHO) comparative perspective, there is much room for improvement in performance of the US system.
No matter how you look at it.
I love extremists.
The USA is the best.
Ooorahhhh.
We're the best in the world at everything. No, make that the Universe.
While so many Americans complain about the health system in the USA we'll tell stories about how this guy I was told about by the babysitters brother who knew a guy in Canada that got really bad health care.
Don't change a thing. its great just the way it is.
The great workers who can afford medicine in this great land need to be able to get back to work...like Paris Hilton...
But I digress.
Extremists, is what this is about.
On one hand we have a system where only the rich can afford good healthcare. The opposite is where everyone gets bad healthcare.
The first is the USA.
The second is "socialised medicine" without alternatives.
Typically extremists can't see the middle ground. Its one or the other.
Yet, Canada, the UK, Australia and others do not belong to either extreme. They get the best of both worlds.
They get top shelf care for those who widh to pay extra for it, which still happens to be lower than what the top shelf care costs in the USA. Yes, cheaper and top class care.
They also get affordable care for everyone.
Its not magic.
Its pretty simple.
They have a large basic care base and optional top up cover, private insurance for those who want the extras.
The top up is cheaper than the USA because they don't have to cover as much.
When you look only left and right, you miss whats in front. Every argument from advocates of the USA's system is extremist and anything not at that extreme is classed by them as "socialist".
Digital health care senario's in an analog world.
America: One
Not America: Zero
America makes the best extremists.
Ohhhraahhh
Good article on that topic. Top shelf in the garage sale, perhaps.
Our system is crazy in that someone's insurance options depend on where they end up getting employed. Some companies have great options, others have crap. Now sure, I'm all for working hard and reaping the benefits thereof. But we can't all work for the best companies. What is it about working for company X that should entitle me to far better coverage than somone who ends up at company Y? Not to mention what happens if/when you get laid off. It's a perverse and ridiculous craps game.
And in terms of "world's best health care" -- maybe yes, once you've got some awful condition we have ways of keeping you alive longer. But in terms of wellness and prevention, those things that afect our quality of life, maybe not so much.
The question is, given that US healthcare is about as good as (or perhaps at best 5-10% better than) the healthcare of the rest of the world, why does it cost twice as much?
Or is anyone seriously arguing that US healthcare is twice as beneficial as healthcare in other rich countries?
A Ferrari is only a little better than a Corvette too.
Firstly, I need to know if you support WHO. If you don't then this argument will never go anywhere because there is a difference in belief.
Secondly, if everyone who is unable to pay is already getting this world class health care as some have pointed out, then this topic is redundant.
WHO (and most people) believe that health care should be available to everyone, regardless of ability to pay. From what I can understand, it would appear that this is NOT the case in US. (I have never been to the US, so I am not qualified to comment beyond what I read)
You have taken an open market approach to health care, and, to be honest, it is the most economically efficient. 'Let those who can afford to pay the most get what they need' - however, in a world of insurance and regulation, that mechanism doesn't work all that well due to moral hazard and risk assessments. This is a known problem in health economics.
The biggest flaw in the market model of healthcare is: if you are sick, you most likely do not have the ability to earn a huge income. Ergo, it is a lose-lose situation. Those who are healthy are more able to earn income and hence can afford healthcare which they don't need (insurers love these) and those who are sick are less able to earn income (even if they are willing) hence they can't afford healthcare which they do need (insurers hate those). THIS is the problem that is central to health care. It is not like your car example: you dont NEED a ferrari, or a corvette to survive. There are substitutes like buses or trains or bicycles or walking. However, you kind of need functioning organs to survive - there is no substitute.
According to your 'free market', you pretty much let people who can't pay, die. Fair enough, it is efficient from an economics point of view (since resources have to be spent to keep them alive when they aren't contributing!) I have seen those Obama = Hitler allegations. Here I ask the question, which is more similar to Nazis: a system where the poor and decidedly less productive members of society are left to die because they can't access health care or a system where everyone gets a standard level of health care so they may have a chance to contribute?
You are right in one thing though. America does a lot of research and there are plenty of health economic research material that covers pretty much everything you have suggested and why it doesn't work.
Here are a couple to start (and this is by no means definitive):
1) there is no such thing as a free market in medical industry because it is a monopoly.
2) Doctors do NOT ALWAYS work more based on their reimbursement. There is a point where people value leisure more than money. For example, if you could charge $500 per patient, you would see less patients than you would if you could only charge $50. Why? because after 10 patients at $500 each you may decide you don't need to work for the rest of the week and would rather go golfing. Therefore, your incentive system is flawed.
3) you haven't told us where the funding is coming from...
4) the groups that you have outline will CHANGE. The primary bread earner in the perfectly normal family may suddenly get a disease and BOOM they go down a few levels, and now they are subject to a LOWER level of care. The thing with health is it is UNPREDICTABLE.
"THIS is the problem that is central to health care. It is not like your car example: you dont NEED a ferrari, or a corvette to survive. There are substitutes like buses or trains or bicycles or walking. However, you kind of need functioning organs to survive - there is no substitute."
It always comes down to whether one views medical care as a human right or as a service one can pay for. We view it as both in this country. We do provide free healthcare to the poor and helpless through the Medicaid program, and we are legally bound to provide emergency medical treatment to everyone regardless of ability to pay.
But healthcare is NOT a basic human right, it is a service provided by men, and no man has a right to the service of others.
Nor does one need healthcare to survive; most of us survive quite well without, and we all die eventually no matter how much healthcare we consume. People do need food and shelter to survive, and the UN might give you a bowl of grain and a shared tent if you are lucky, but I don't think they will be providing MRIs or liver transplants for those who "need" them.
All I can say is how glad I am to be living in Germany. I doubt a lot of Germans would go to the States for treatment, why would they? We have excellent doctors and hospitals here. Oh, and we do have socialized medicine.
scapel have you ever being on europe?
Have you ever being in spain, frence?
residencies on spain, last more years than in USA
while an internist do 3 years of residency in USA in spain they do 5 years, same for other specialities.
what would you assume its the best?
"America treats these conditions better than anyone else in the world"
you got some nerve to say that when a cardiologist on europe or an internist train themselves for 5 years on residency(master not included)yet you say your physicians are better.
"Physicians from other countries are lined up at our gates, hoping against all odds that they might be accepted into any one of our residency training programs. Only the best will be accepted"
because they get PAYED more, the issue is the money.
US doctors earn the double than most on the doctors EU excepct for UK.
of course south american doctors are paid 3000$ per year, with not doubt they will fly to US.
I have the chance to go to the US to start the residency there, I finally ended choosing moving to spain, the only thing the highest techonlogy is in US, but you rely much on it, dont ya?
Yeah I've been to Europe. I enjoyed the food, architecture, and beer. And I noticed that most people there speak English, since we are the dominant country in the world.
I don't rely on technology, but it's nice to have. It is always better to have something and not need it than to need something and not have it.
"WHO (and most people) believe that health care should be available to everyone, regardless of ability to pay."
It's easy for WHO to have this belief because WHO does not pay for healthcare.
As an American, I see other Americans give priority spending on big screen TVs, cell phones, video games, cable TV, high-speed internet, houses and cars they can ill afford, all these luxuries, and then when they have to pay for some healthcare, they have no cash to do it.
It's because Americans, as a group, are not good at saving cash for emergencies.
I live in a poor, working class neighboorhood in the US. It is amazing to see the high number of people with satellite TV, fifth wheel campers, motor homes (in the $30,000-$60,000 range), snow mobiles, motorcycles, etc. These are all luxuries. Yet Americans as a group, buy luxuries and fail to save for necessities.
Which world are you in??? I'm glad there are people in America who have more sense than a red neck SOB like you!
Wow. I work and I have health insurance and I STILL can't afford basic health care. There are thousands upon thousands of people just like me.
What the fuck have you been smoking?
I do not think that there is any valid reason to think that American health care system is the best in the world. However this is quite an interesting posting trying to justify the health care crisis in the country.
I find it interesting that your post on American elitism within the confines of medical care has received so many comments. Certainly the good ol' US of A has some of the most skilled and highly trained (specialized) physicians in the world. Not to mention these same physicians enjoy the highest salary as well. However, our medical system hasn't reached this point without someone pointing out the flaws.
Unfortunately, our current healthcare discourse is misaligned. At what point did the philosophy of medicine and healthcare rely so much on the monetary wealth of the unhealthy?
Over and over, even on your blog post and especially on the comments, there is a demeaning environment surrounding a certain subset of the population. Do we ignore the fact that those who devote themselves to a "greater good" look down upon those in positions of need? If medical education was entirely funded by an outside entity and every physician, regardless of specialty, received the same compensation would this decrease the level of specialization in the US? Would this decrease the elite status of US physicians?
How many "dignitaries" travel to this country for primary care?
Is money... capitalism.. the true problem within our system? Have we created an ad hoc caste system where the amount of an INDIVIDUALS available funds decide their status and level of healthcare?
Are you easily "bought?"
Eighty years ago, Americans were also told that their nation was facing a health care crisis. Then, however, the complaint was that medical costs were too low, and that health insurance was too accessible. But in that era, too, government stepped forward to solve the problem. And boy, did it solve it!
Proud to say yes America has the best healh care and the best Doctors and Surgeons and technologies...but there should be some bonus for the poor.If it is good anyway people will fly down from any part of the world.
Hey really I agree with all the above comments... US health care is really better than europe. Thanks very much for sharing this great information about Health care Industry.
Thanks!
Because healthcare in the US is so expensive, many are turning to global healthcare in other countries at a fraction of the cost and with exceptional outcomes. Who can possibly say we don't need to fix our system?
Any country that offers universal health care made that choice on moral grounds. As a people can we accept that a poor man, women, or child be left to die simply because he/she cannot afford the care that is essential for it to survive?
America does have the best quality and quantity of healthcare providers, hospitals, and medical equipment. But, in perspective with what is spent, other countries offer a better value for the money spent. If that same money spent on healthcare in the US is spent in Canada i would guarantee you that quality and quantity would surely surpass what the United States currently has in place.
The US does not have a healthcare care system. The US has multiple health care systems which is the cause of this crisis. By having every type of healthcare system, the country is working very inefficiently. Notice efficiency does not only reflect quality/quantity but reflects quality/quantity in conjuncture with how much is being spent.
America does provide the highest quality in medicine but does so by charging alot more then other countries which rank higher in life expectancy.
Today you might have a job that provides insurance. But come tomorrow, another recession, and you loose your job, what then? Assuming that after loosing your job, you loose your insurance and without a job you cannot afford medical care, do you loose your right to medical care? Don't forget you will probably not qualify for medicare!
At the end of the day the question that should be asked is, does the rich man's life have a greater value than that of a poor man's? If the answer is no, then you must create a system where everyone gets the same treatment. Person A might choose to get more treatment but person A and B should get the same basic level of care. Once you have a benchmark for everyone, then anyone else who wants extra can pay for it. But a minimum must be in place. i.e. rich man might want to keep pursuing life support on brain dead wife, he just has to pay extra to keep her on.
When I read this, I just had to shake my head:
"Yes there are barriers to care for the poor. These people couldn't just walk into the Mayo Clinic and ask for a PET scan. And they will still get a huge bill they will be unable to pay. But they will ultimately get the care they need, thanks to EMTALA."
I'm in the 95th percentile from an earnings perspective. I work hard, don't abuse anything (not ETOH, not drugs, not anything). I have money and am by all accounts a productive member of society. I'm about as well-insured as it's possible to be.
I also have recurring ideopathic angioedema (please pardon the spelling; I'm not certain it's correct). A couple of times a year, I swell up and my airway clogs up and the like. I have to carry an epipen and when bad stuff happens it happens rapidly...and I wind up in an ED with a tube in my throat and a variety of drugs to help defuse the histamine response.
And every time I wind up in the ER it's another bill - AFTER insurance - for three to five thousand dollars. I'm lucky; I can afford it.
And this is in excess of the significant fees I've paid to allergists, various radiology and other scan specialists, bloodwork, and a host of other specialists who have put time and effort into trying to figure out the cause of my ailment.
I spent close to $20k last year because of this. And I *have* insurance, and an income that allows me to pay for this. I have no kids, and a spouse who also works full-time and is insured.
What happens to the people who do have kids, who don't have the income I've got, who don't have the resources? If it's pinching me, then it's way worse for people without much money. Yes, emergent care is expensive, but really, what normal middle-income person (the $48k average income) could afford this?
So where does this leave me? I work my ass off at my job. I pay all of my bills. I don't have cable. I have a minimal phone plan so I can keep in contact with my boss so I can keep my job. I can only afford $200 a month for food expenses, and I have just enough left for gas. I don't have and can't afford insurance and I make too much money to qualify for Medicaid. What am I supposed to do? Just sit around and pray that nothing bad happens? I might be able to recieve health care, but I can't by any means afford it.
I recently came across your blog and have been reading along. I thought I would leave my first comment. I don't know what to say except that I have enjoyed reading. Nice blog. I will keep visiting this blog very often.
So where does the SCOTUS ruling on the ACA leave you, Scalpel? Could it possibly be the trigger that brings you back to blogging?
Post a Comment
<< Home