Do we generally actually have better outcomes here? I'm sure that's measurable. Compared to Canada and the United Kingdom and other countries with universal healthcare do we have better medical outcomes?
I know I remember reading that we have worse outcomes than much of the developed world in terms of maternal and infant mortality. If that's the case, if you aren't even getting a better statistical outcome why are we supporting a system where childbirth costs 20k or more.
And for other things- so there is less wait for an mri here. But do we have better outcomes overall for sports medicine injuries?
I mean I don't know the answers but I feel like those are the things we should look at, medical outcomes as a whole looking at the country not anecdotes about wait times.
I believe the answer to your first question is "yes, if you have the money."
Artificially low drug prices?? It's not artificial if it's reasonable. Why can a drug manufacturer just raise the cost of their product hundreds of percent?
There will always be r&d. We cannot let the fear of them not developing new drugs allow us to accept their ridiculous bullshit no matter what
Do we generally actually have better outcomes here? I'm sure that's measurable. Compared to Canada and the United Kingdom and other countries with universal healthcare do we have better medical outcomes?
I know I remember reading that we have worse outcomes than much of the developed world in terms of maternal and infant mortality. If that's the case, if you aren't even getting a better statistical outcome why are we supporting a system where childbirth costs 20k or more.
And for other things- so there is less wait for an mri here. But do we have better outcomes overall for sports medicine injuries?
I mean I don't know the answers but I feel like those are the things we should look at, medical outcomes as a whole looking at the country not anecdotes about wait times.
I believe the answer to your first question is "yes, if you have the money."
Well that goes for any system because you can always pay more.
But if we are making decisions about a country as a whole we should look at the statistics of entire countries I think so the decision is one in the best interests of the majority
Do we generally actually have better outcomes here? I'm sure that's measurable. Compared to Canada and the United Kingdom and other countries with universal healthcare do we have better medical outcomes?
I know I remember reading that we have worse outcomes than much of the developed world in terms of maternal and infant mortality. If that's the case, if you aren't even getting a better statistical outcome why are we supporting a system where childbirth costs 20k or more.
And for other things- so there is less wait for an mri here. But do we have better outcomes overall for sports medicine injuries?
I mean I don't know the answers but I feel like those are the things we should look at, medical outcomes as a whole looking at the country not anecdotes about wait times.
It depends on what you are measuring, but generally, no, we do not have better medical outcomes. I don't know relative specifically to sports medicine, but my guess would be that we DO have better outcomes for that because sports medicine is a relatively new field and the US pioneered it. But sport-related injuries would not be a great way to measure overall medical outcomes, it seems to me. I would look at things like percentage of adults with uncontrolled X, Y, Z... infant mortality, length of ICU stays relative to mortality and morbidity, survival rates post transplant, survival rates post cancer dx. There are a number of studies out there showing that we spend more as a percentage of GDP, but don't have a longer life expectancy. That's pretty compelling evidence that what we do doesn't work.
There is also some good data that if you lump together education, health care, and social services, the US spends in total on all of those things the same as European countries (as a percentage of GDP). But we break it down differently. We spend a huge amount on health care and a paltry amount on education and social services. Other countries like Sweden do the exact opposite. The suggestion is that while we have maybe roughly the same outcomes, the actual quality of life for Americans is much worse. We are sick and sad and spend a shitton of money on that. If we restructured things so that we were paying for social services, we wouldn't be sick and sad and wouldn't have to spend a shitton of money on health care. We also spend an astronomical amount of money on prisons compared to Europe. So we're sick, sad, and in jail. And that's what we spend money on.
The bolded is what it all boils down to. I know that that is what I consider when reading all of these health care threads. Unlike a lot of political threads where debate is somewhat of an intellectual exercise, the cost of an error or a change in policy in this arena is death. (post-heart transplant husband) There's no "welp, he can't get his treatment and medicine anymore because the government doesn't want to fund it, so let's just go overseas and do it."
He can't even get life insurance of any kind except whole life. Why would a government official think it worthwhile to sanction spending for visits, medicine, and so forth? Why not just ration him out completely? We're already seeing fewer doctor visits and increases of 20% in premiums for our good health care coverage as a result of the ACA, which in turn squeezes out other benefits in negotiations because we place health care coverage above wages and maybe even sound evaluation language.
No one said it, so I will. There will obviously be less research and development if drug prices were set artificially low.
Is this an actual issue in other countries? I mean, people have heart transplant in Canada, UK, France, etc, right?
Transplant is much more likely to be rationed in other countries. But, I mean, it's rationed here by affordability, so... i just read an article a few months ago stating that Medicaid in AZ was going to stop covering transplantation and since one of the requirements of getting on a waiting list for an organ transplant is being able to demonstrate that you can comply with (i.e. afford) post transplant care, that pretty much means if you're on Medicaid in AZ, you aren't even getting listed for an organ transplant.
Is this an actual issue in other countries? I mean, people have heart transplant in Canada, UK, France, etc, right?
Transplant is much more likely to be rationed in other countries. But, I mean, it's rationed here by affordability, so... i just read an article a few months ago stating that Medicaid in AZ was going to stop covering transplantation and since one of the requirements of getting on a waiting list for an organ transplant is being able to demonstrate that you can comply with (i.e. afford) post transplant care, that pretty much means if you're on Medicaid in AZ, you aren't even getting listed for an organ transplant.
I think I knew this. The first part. I know my cousin was an organ donor when she died, and one of the people that got one of her organs was a very wealthy Mexican (extremely long story how we know this).
I have absolutely no idea how he was able to get on a list that would give him an organ from someone in the US, bit I'm assuming $$$ came into play.
Transplant is much more likely to be rationed in other countries. But, I mean, it's rationed here by affordability, so... i just read an article a few months ago stating that Medicaid in AZ was going to stop covering transplantation and since one of the requirements of getting on a waiting list for an organ transplant is being able to demonstrate that you can comply with (i.e. afford) post transplant care, that pretty much means if you're on Medicaid in AZ, you aren't even getting listed for an organ transplant.
I think I knew this. The first part. I know my cousin was an organ donor when she died, and one of the people that got one of her organs was a very wealthy Mexican (extremely long story how we know this).
I have absolutely no idea how he was able to get on a list that would give him an organ from someone in the US, bit I'm assuming $$$ came into play.
Almost certainly. You don't have to be a US resident to get on a US transplant list. And there are allllll kinds of fun data out there about how this population, a third of whom pay out of pocket at the non-insurance bargained rate, just magically seems to have a lower wait list mortality rate and a MUCH lower wait time on the list. Like I think the last numbers I read put US residents on the liver transplant wait list at 12 mos or so. Non-residents (like the wealthy Mexican) are less than 5 months. Responses to this have been that that is because those people are generally sicker by the time they even get on the wait list here so they enter higher up. They also justify the overall practice in a number of ways, some of which are persuasive to me and most of which are not.
After working for a major health insurance company, I can never again support our current model.
There are all kinds of things that suck and the system is so complicated, people can't even understand why they suck. If you have employer funded care, your employer chose your insurance plan designs. They decide if IFV, gastric bypass, gender reassignment surgery, etc is covered. They decide how much you contribute on individual vs family plans. They see detailed claim information. Sure, PHI is redacted but if you were the only one that had twins in ICU, its not that hard to figure out that it was your large claim. This is too much control and too much info.
The ACA has individual affordability thresholds but none for family. Plus, because all kinds of people wanted to keep things the way they were, plans could be grandfathered giving employees no benefits of the reform.
When budgets get tight, employers shift more cost to employees by contribution strategies designed for people to utilize less care. This is the higher copays, coinsurance, deductibles. Your employer decided to raise those because their claims were rising, not because of the ACA.
Group health insurance isn't even insurance in the sense that most people think. The risk sharing for all but very small businesses is contained within the employer group. So a business is paying for the full amount of claims of their employees. Your coworkers having more claims could raise the cost for you.
Depending on how much risk an employer decides to assume, for group health plans they pay the full amount of estimated claims for the next year plus 10-17% in expenses (goes right to health insurance companies to use their provider discounts), around 3 points in broker compensation (for a broker helping you shop for coverage but not necessarily recommending the most affordable), and 3-10,15+ points in insurance company profit. Because of the scrutiny healthcare has received, most of this is built into dental, vision, pharmacy products-which is still healthcare to me at least. For an average midsized company, you're looking at around 25% of the healthcare dollars going to keep this system as it is. That's quite a large margin for the government to get under in a single payer system. Not to mention, the government has fixed provider reimbursement rates for Medicare and Medicaid so private insureds subsidize that shortfall.
Insurance company provider discounts range up to 65% off of provider prices and providers determine which insurance carriers to give deeper discounts to. Claims lag is about two months.
So the cost of an uninsured person seeking care would have to pay the equivalent of an insured person's claim+25% for the insurance company+the difference in provider discounts. If an insured's claim is $100, theirs is $250. No wonder people couldn't afford care.
If we had a single payer system, your care wouldn't change. Health care providers are still the ones providing your care and they already see medicare and Medicaid patients. You have to wait a while to get into see doctors because there is a healthcare provider shortage. That's a separate problem we need to work on. If there is a longer wait after adopting a single payer system, its because more people always needed that care but now they have access to it.
By saying you don't want to change the system because its working for you, you have to admit its keeping other people from care because of cost. I don't think that's defensible.
I think we can do better than allllllll of this waste. I could go into those ideas but this has already turned into quite a wall of text.
Aren't there certain regions which have lower wait times too? Someone famous got a transplant in a random location - Steve jobs maybe?
Generally the regions without cyclist helmet laws have lower wait times.
I know someone who moved from NY to Florida because he needed a kidney. He was able to get one within 3 months as opposed to waiting in NY and possibly waiting years.
Aren't there certain regions which have lower wait times too? Someone famous got a transplant in a random location - Steve jobs maybe?
Generally the regions without cyclist helmet laws have lower wait times.
I know someone who moved from NY to Florida because he needed a kidney. He was able to get one within 3 months as opposed to waiting in NY and possibly waiting years.
NY's problem is its orthodox jewish population, which opposes donation, but not receipt of donor organs. Which is a whole other bag of worms - what to do about all the cultural objections to organ donation.
Generally the regions without cyclist helmet laws have lower wait times.
I know someone who moved from NY to Florida because he needed a kidney. He was able to get one within 3 months as opposed to waiting in NY and possibly waiting years.
NY's problem is its orthodox jewish population, which opposes donation, but not receipt of donor organs. Which is a whole other bag of worms - what to do about all the cultural objections to organ donation.
Years ago I got flamed big time for saying that if a person isn't willing to be an organ donor, they shouldn't be able to receive one as long as we have the wait lists that we do. If there were no wait lists, I wouldn't care if a person said, "I won't give but I'll take." My opinion hasn't changed. I don't know if it really is that flameful of an opinion or if it was a slow day here, lol.
With all the criticism of other countries healthcare systems, have you ever met a non-wealthy person from Canada or Germany or France who wished their system was just like the American system instead? Because I definitely haven't. I've heard a lot of "well yeah xyz sucks but thank God it's not like what you guys have in the US!"
NY's problem is its orthodox jewish population, which opposes donation, but not receipt of donor organs. Which is a whole other bag of worms - what to do about all the cultural objections to organ donation.
Years ago I got flamed big time for saying that if a person isn't willing to be an organ donor, they shouldn't be able to receive one as long as we have the wait lists that we do. If there were no wait lists, I wouldn't care if a person said, "I won't give but I'll take." My opinion hasn't changed. I don't know if it really is that flameful of an opinion or if it was a slow day here, lol.
With all the criticism of other countries healthcare systems, have you ever met a non-wealthy person from Canada or Germany or France who wished their system was just like the American system instead? Because I definitely haven't. I've heard a lot of "well yeah xyz sucks but thank God it's not like what you guys have in the US!"
I would consider our HHI as wealthy and I feel this way. I had to wait more than a month for an MRI (twice) and I still have no problem with our system because I waited the same length of time as someone who has a HHI that is half of ours.
And again, like with many things, those of us who have great (usually company subsidized) health insurance don’t really suffer. I mean, we have great healthcare. So we’re fine. But there are tons of people in this country who can only afford a crappy high deductible plan and have to just hope nothing big happens or they are screwed. Or people who can’t actually even afford the medications prescribed to them so they have to not take them, or take a cheaper medicine that may not be as effective.
Why are pharmaceutical companies allowed to charge whatever they want for a life saving drug? Why does it cost $30,000 to give birth in the USA? Why is a five minute visit to a doctor billed at hundreds of dollars?
Yes we have higher costs due to malpractice insurance as doctors need to cover their asses when it comes to possible lawsuits but I can’t believe that alone accounts for the VAST differences between what things cost here and in other developed countries.
My sister lives in London and she’s had a great experience with the NHS. My family still lives in Ireland and they get decent health care. Yes like with Canada there are delays for non emergency things. Often the wait lists are ridiculous. People pay supplemental insurance to get some better benefits so it’s not perfect by any means.
But the system here is only great for those of us who have enough money to pay for a good plan and choose their doctors and who can afford a copay every doctor visit and who, if they go to the pharmacy to pick up their RX and the pharmacist says “that’s $40 copay on that” they just say, oh ok and hand them the money. This is not everyone’s reality.
So we trade one crappy system for another? Why not wait until we can figure out a solution that actually is better for everyone? We had crappy insurance for a while while I was laid off. It sucked. Dd was sick, $40 copay, prescription, $40 copay. Allergic reaction to prescription cost us another $40 visit copay and another $40 presciption. All while I had no job and dh was working two. I get it. But everyone needing to wait hours at a clinic for a basic sick visit (similar to what we experience at the ER) sounds crappy too. It's not better it's just a different set of flawed rules.
Why can't we wait? Because people are literally dying as a result of our system. Thousands of them. And frankly, what you describe sounds pretty darn good compared to what many Americans have. A $40 copay may seem like it sucks but it's a hell of a lot better than "your visit will be $190 plus $120 for the labs" and "that prescription will be $575, we'll need that now before we can give it to you."
Also who are these people who have never had to wait at the doctor?? These fears about the possibility of having to wait for hours at the doctors for a regular sick visit baffle me because that's exactly what I've already experienced. Not to mention the time I had a suspicious mole and the soonest I could get into the dermatologist was four months, or the time I was worried H might have a serious lung problem like emphysema and the earliest they could see him was approximately five months.
Oh but if I wanted Botox ($$$) I could come in tomorrow morning!
The only Canadian I know who wants the U.S. System is my father in law, who is extremely wealthy and lives there 4 months of the year. He loves showing Up to the doc, waving cash and getting same day treatment.
He's annoyed because he's waiting a month right now for kidney stone surgery while his doc is on holidays. He can't be referred because technically it's not an Emergency. I agree with him that his situation sucks, and it's an example of where we need more $$ in our system. Non-urgent surgeries right now aren't happening thanks to a lack of funding,, and surgery quotas being met late 2015. That's a serious problem in Ontario.
I still wouldn't want the U.s. System. I don't believe my FIL should be able to pay for faster care simply because he's rich. End of story. I do think we need to figure out a way to get more $$ in our system, and I'm not opposed to some privatization but not where it would impact the outcome of a Lower income individual. So really, I don't have a solution.
Wow, I came into to see how this thread got to 5 pages....
The US healthcare system is so messed up and in so many ways. I have good insurance and my out of pockets costs for recent tests seem exorbitant - like that should have been the total cost for a little blood draw and minor procedures.
But I will say, I've had two technically "elective" shoulder surgeries. Each time I got to pick one of the top surgeons in the area, and I was in and done within 4-6 weeks. It's like the NIMBY issue for healthcare reform...(fix it, but don't change any of the good stuff that I get)