Healthcare revamp won't cure America

[dreamdancer 0]

a scientific viewpoint...

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With the acrimonious debate over healthcare reform poised to return to the US Congress as its members return from their summer break, two new studies bear a sobering message: don't expect an expansion of health insurance coverage alone to improve Americans' health.

Politicians are trying to revamp a system that spends around twice as much per person on healthcare as most European countries, while getting worse results overall, lagging on measures such as life expectancy at birth and infant mortality.

Two teams, one led by Pierre-Carl Michaud of the Rand Corporation in Santa Monica, California, the other by Samuel Preston of the University of Pennsylvania in Philadelphia, have dug into international health statistics to ask why US citizens can expect to die earlier than their counterparts in the richest European nations.

Michaud concludes that the blame lies largely with high rates of chronic disease caused by poor diet, lack of exercise and the lingering effects of tobacco use from a time when smoking was more prevalent in the US than in Europe.

Preston agrees, and also finds that in some respects – screening and treatment of cancer and cardiovascular disease, for example – the US healthcare system is actually performing well.

This means that eliminating profligate spending on ineffective medical interventions by US doctors is only part of the solution to US health woes. Changing citizens' behaviour so that they eat less and exercise more will be vital, both to improve health and reduce costs. "One of the main reasons that US healthcare is so expensive is that we are sicker than other people," says Preston.

The Rand team has put a number on it, suggesting that gradually moving US citizens towards the health enjoyed by Europeans could save up to $1.1 trillion in healthcare costs by 2050.

http://www.newscientist.com/article/dn17711-healthcare-revamp-wont-cure-america.html

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[airdvr 210]

lagging on measures such as life expectancy at birth and infant mortality

Just love how these "experts" start out with a bullshit statement. I read enough.

Please don't dent the planet.

Destinations by Roxanne

[kallend 2,148]

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lagging on measures such as life expectancy at birth and infant mortality

Just love how these "experts" start out with a bullshit statement. I read enough.

I'm sure you did.

...

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[lawrocket 3]

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lagging on measures such as life expectancy at birth and infant mortality.

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suggesting that gradually moving US citizens towards the health enjoyed by Europeans could save up to $1.1 trillion in healthcare costs by 2050

Okay. This seems counterintuitive to me. Seeing as how we've seen that end-of-life care is by far the most expensive, how is it that people living longer lowers health care costs?

Second - take a comparative look at infant mortality.

Third - take a look at the populations of European countries. Melting pots have their disadvatages in health costs because different groups tends to suffer different types of illness.

As more move in to Europe, I predict that we will see expenses increase, as well.

My wife is hotter than your wife.

[airdvr 210]

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lagging on measures such as life expectancy at birth and infant mortality

Just love how these "experts" start out with a bullshit statement. I read enough.

I'm sure you did.

Do we really need to go into how the reporting process is different for infant mortality? Life expectancy...please. Let's not start a violent crimes debate. That has zip to do with healthcare. Those 2 areas are poor comparisons and you know it.

Please don't dent the planet.

Destinations by Roxanne

[GeorgiaDon 380]

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Third - take a look at the populations of European countries. Melting pots have their disadvatages in health costs because different groups tends to suffer different types of illness.

When I've visited various UK cities, they seemed to me to be more ethnically diverse than any comparably sized American city I'm familiar with. Canadian cities too have become very diverse over the last couple of decades.

There are lots of differences between US and European lifestyles that are more likely to account for the differences in health. Cities are less car-friendly, as the roads historically were laid out for horses, so it is more efficient to walk especially if you only have to go a few blocks. People still tend to buy food in small specialty shops (butchers, bakeries) where food is fresh, instead of prepackaged processed food from the mega-mall. People I know (in the UK and the Netherlands) will most often stop on the way home from work to pick up meat/vegies/bread, perhaps walk the remainder of the way home, and use the food right away for dinner while it is still fresh. This also discourages buying more food than you actually need. American (and Canadian) cities aren't laid out in a manner that faciltates that, instead we get in our cars and make a big shopping trip to the supermarket, buy lots of frozen/prepackaged food, then make megameals with 2-3X the amount of food that is really needed (or healthy) because that's what you have to work with.

Also, although this is changing, I don't know too many Europeans who routinely work 10-16 hr workdays, but most Americans I know habitually work long hours, indeed we accept that if you don't do that you'll probably be replaced with someone who will. There is a price to be paid for spending that amount of time sitting on your butt staring at a computer monitor (for those with office jobs), or even standing around behind a counter (for those in retail). Plus, it's hard to invest an hour or more cooking a healthy meal when you don't get home from work until 8 or 10 PM, and if you do you end up eating really late and then going to bed with a full stomach, so you end up storing the calories instead of walking some of them off after the meal.

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Okay. This seems counterintuitive to me. Seeing as how we've seen that end-of-life care is by far the most expensive, how is it that people living longer lowers health care costs?

Everybody dies eventually, so everybody (European or American) faces end-of-life medical costs. A while ago I heard an interview on NPR with an American cardiologist who has written a book comparing American and European end-of-life care. He was motivated by his experience of his mother's terminal illness, where he found he had to fight tooth and nail to enforce his mother's wishes (for pain management, but rejecting "heroic measures" to keep her alive). His situation was complicated by the fact that he was in Boston most of the time (working at Harvard medical school) and his mother was in California, so usually he was told about procedures after they had been done when it was too late to say "no". I think his point is worth considering: American culture, especially the prevailing medical culture, always views death as a defeat, and the automatic role of treating physicians is to prolong life irrespective of the "quality" of that life. Spending $40,000 to keep a 92-year old alive for two more weeks is a "victory", and it doesn't matter that the patient was in a coma and completely unaware of their continued existance during that time. When that 92-yr-old eventually dies, it is because medicine "failed". European popular and medical culture is more attentive to "quality of life" issues, and prolonging life by a few weeks (or perhaps months) is not the automatic default response if that means the patient has to be drugged into unconciousness in order to manage the pain, unless the patient insists on that sort of treatment. As a result (and I think this is the big difference) most Europeans die at home, in their own bed, surrounded by family and friends, and most Americans die in a hostital bed, almost invisible under a mass of tubes and oxygen masks, surrounded by strangers and, if they are very fortunate, one or two family.

That, and European (and Canadian) doctors can make decisions about tests and procedures to order based on medical critia, not on "defensive medicine" driven by the need to protect themselves from ambulance-chasing lawyers. Thank you John Edwards et al!

Don

_____________________________________
Tolerance is the cost we must pay for our adventure in liberty. (Dworkin, 1996)
“Education is not filling a bucket, but lighting a fire.” (Yeats)

[tkhayes 348]

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Okay. This seems counterintuitive to me. Seeing as how we've seen that end-of-life care is by far the most expensive, how is it that people living longer lowers health care costs?

if you live longer, then you are overall healthier. If you are healthier, then your 'health care costs' are probably lower.

Not to mention that healthy, long-living people often still contribute to society, like working, paying taxes, volunteering, etc.

I find it amazing that you could find an issue with 'libving longer'.

[mnealtx 0]

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lagging on measures such as life expectancy at birth and infant mortality

Just love how these "experts" start out with a bullshit statement. I read enough.

I'm sure you did.

Yup, that pretty much describes the proponents of the health scam bill.

http://www.ncpa.org/pub/ba596

http://www.telegraph.co.uk/news/uknews/1560849/UK-cancer-survival-rate-lowest-in-Europe.html

http://online.wsj.com/article/SB10001424052970204619004574322401816501182.html

http://www.telegraph.co.uk/comment/personal-view/4736927/Right-to-die-can-become-a-duty-to-die.html

You were saying?

Mike
I love you, Shannon and Jim.
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[dreamdancer 0]

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Politicians leading the US healthcare reform effort stress the gains to be made by expanding preventive medicine. "If we can use cost-effective screenings and other up-front interventions to prevent tens of millions of occurrences of cancer, diabetes and cardiovascular disease, then we are going to slash healthcare costs significantly," says Tom Harkin, Democratic senator for Iowa, in a statement posted on his blog.

But specialists in health policy warn that improved screening and encouragement to adopt healthy habits can only go so far. "It's not going to fix the underlying problems of poverty, poor diet, lack of exercise and smoking, which are the biggest determinants of health," says Shannon Brownlee of the New America Foundation in Washington DC.

Making US citizens as healthy as Europeans may require widespread changes, from providing more sidewalks in car-dominated neighbourhoods where it's hard to walk around, to improving conditions for impoverished communities so that healthy food becomes a viable alternative to cheap, high-calorie junk.

"You can find a role for the healthcare system, but there are other very strong forces at play," says Michaud.

http://www.newscientist.com/article/dn17711-healthcare-revamp-wont-cure-america.html

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