US healthcare is ranked #1

[SkyDekker 1,465]

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Illegal Imagination:
The average citizen is covering half of Mexico's use of the emergency room. Do you think this is a problem in the Netherlands?

Obviously Mexicans aren't in issue in Holland. However, you should ask them about Maroccans and the Turkish......

[kelpdiver 2]

Interesting, and yet you again left out detail.

The source is an anti illegal immigration site, so you expect any data if off, to be off in the same way as the initial argument. So the $200M for unreimbursed costs should be considered a valid number. But we don't have the other number - how much was paid for. The claim was that unreimbursed was 50%.

Later in your citation:

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Among the largest federal costs: Medicaid ($2.5 billion); treatment for the uninsured ($2.2 billion); food assistance programs ($1.9 billion); the federal prison and court systems ($1.6 billion); and federal aid to schools ($1.4 billion).

That's another 4.7 billion in addition to the 200M. The second number is the cost to the hospitals. The first is the cost to taxpayers.

It doesn't break down Mexicans versus others, so still no validation or elimination of the claim of 50%.

[kelpdiver 2]

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not sure where in Europe they work 30 hour weeks but not here in the UK (unless you average the people on the dole with the rest of us)

The French have been driving the shorter work week, coupled with the early retirement (60, lower for higher risk professions). This was done in large part to try to lower unemployment by reducing the workforce. It certainly would improve health for some, though maybe not for all as the work schedule can moderate people's eating and keep their brain active.

Meanwhile I understand the UK is considering pushing the standard retirement age to 68, while the French consider going all the way to 62.

[champu 1]

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In 2007, health spending was $7,290 per person in the United States, more than double that of any other country in the survey.

We do particularly poorly on going without care because of cost.

The lower the performance score for equity, the lower the performance on other measures. This suggests that, when a country fails to meet the needs of the most vulnerable, it also fails to meet the needs of the average citizen

So Americans seek out medical care more often and have little appreciation for what it costs. Also, we have the most people who, for whatever reason, don't have coverage.

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"The findings demonstrate the need to quickly implement provisions in the new health reform law," the report reads.

Therefore we have to make sure everyone is included in the system that we just said was troubled and broken.

[airdvr 210]

Well sure. It's like the guy who rides around buying aluminum at $.05 and ounce and sells it for $.04. The solution is obvious...a bigger truck.

Please don't dent the planet.

Destinations by Roxanne

[jgoose71 0]

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>The average citizen is covering half of Mexico's use of the emergency room.

Last year hospitals across the country spent $200 million on uncompensated care for illegal aliens. In 2008. Americans spent 2.3 trillion on healthcare. (That's 2,300,000 million.) 200 is not 50% of 2,300,000.

Or put another way we have 12 million illegal immigrants in the US. That means we spend about $16 per illegal alien in terms of hospital and ER costs. Mexico spends about $675 per person in social service health care.

>Despite all of this, Canadian officials still make there way to the US
>for health care, why is that?

And Sarah Palin's family would "scamper across the border" to get free Canadian health care when she was growing up; why do you think that was? Some very experienced skydivers have gone to Sweden to get shoulder surgery; why do you think that is?

Bill, I think your numbers are for just California alone for Health care.

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Data on health care costs for illegal immigrants are sketchy because hospitals and community health centers don't ask about patients' legal status. In California, a 2004 study by the Federation for American Immigration Reform put the state's annual cost at $1.4 billion. Similar studies in Colorado and Minnesota in 2005 came up with much smaller estimates: $31 million and $17 million, respectively.

One thing is clear: Undocumented immigrants are driving up the number of people without health insurance. The Pew Hispanic Center estimates that 59% of the nation's illegal immigrants are uninsured, compared with 25% of legal immigrants and 14% of U.S. citizens. Illegal immigrants represent about 15% of the nation's 47 million uninsured people — and about 30% of the increase since 1980.

http://www.usatoday.com/news/washington/2008-01-21-immigrant-healthcare_N.htm

I think we can all agree that Illegal Immigrants are a part of the problem with the US Health care system.

As far as Americans going over seas to get stuff done, here in the US, you get what you pay for. If you got money, you get the best. That is why Canadian Officials come here.

If you don't got the money, you go over seas to some one who can perform the same procedure but isn't trying to make up the development costs for some of this stuff, or pay for illegals.

When I got laser eye surgery in the 90's I went to Canada. After they adopted the latest technology that the US developed, they were able to offer it at half the cost. They didn't have to pay for development.

I know that the US doesn't develop every medical break through, but for a while we were on the leading edge until lawyers and costs over runs started taking over the health care system.

Again, where is this being fixed in the Health care reform bill?

"There is an art, it says, or, rather, a knack to flying. The knack lies in learning how to throw yourself at the ground and miss."
Life, the Universe, and Everything

[kelpdiver 2]

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When I got laser eye surgery in the 90's I went to Canada. After they adopted the latest technology that the US developed, they were able to offer it at half the cost. They didn't have to pay for development.

I got LASIK done in Canada because they had approved the particular technology a few years ahead of the FDA.

As for the main thrust - Bill confused (intentionally or not) the questions of taxpayer paid care versus uncompensated losses to hospitals.

[kallend 2,184]

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As far as Americans going over seas to get stuff done, here in the US, you get what you pay for. If you got money, you get the best. That is why Canadian Officials come here.

If you don't got the money, you go over seas to some one who can perform the same procedure but isn't trying to make up the development costs for some of this stuff, or pay for illegals.

I know a very wealthy guy who lives in Arizona who flies to Mexico to get his dental work done.

...

The only sure way to survive a canopy collision is not to have one.

[turtlespeed 226]

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As far as Americans going over seas to get stuff done, here in the US, you get what you pay for. If you got money, you get the best. That is why Canadian Officials come here.

If you don't got the money, you go over seas to some one who can perform the same procedure but isn't trying to make up the development costs for some of this stuff, or pay for illegals.

I know a very wealthy guy who lives in Arizona who flies to Mexico to get his dental work done.

Congratulations.
Do you feel more special now?

I'm not usually into the whole 3-way thing, but you got me a little excited with that. - Skymama
BTR #1 / OTB^5 Official #2 / Hellfish #408 / VSCR #108/Tortuga/Orfun

[lawrocket 3]

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Cost - Quality - Quantity

I believe your statement was that one has to suffer to get the other two.

Picture a triangle. The three corners are cost, quality and "availability." "Availability" could also be considered 'quantity" in one sense, but what I am thinking of is "on demand." "Rationing" is a way of thinking of "quantity' but I don't think it works quite correctly.

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Turns out you have bad quality and high costs, but you have a fair amount of it.

This is contrary to the reason why the whole health care debate has been raised. The problem, according to many, is that health care is not available to all in the same quality and amount.

From the article:

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"As an American it just bothers me that with all of our know-how, all of our wealth, that we are not assuring that people who need healthcare can get it," Commonwealth Fund president Karen Davis told reporters in a telephone briefing

This is contrary to your assertion.

From the executive summary:

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Other nations ensure the accessibility of care through universal health insurance systems and through better ties between patients and the physician practices that serve as their long-term "medical homes." Without reform, it is not surprising that the U.S. currently underperforms relative to other countries on measures of access to care and equity in health care between populations with above-average and below-average incomes.

So what the summary is saying is that "equity" and "access" are different between populations. I believe that they are saying, "Wealthy people can afford access to more things than poor." I think, "No shit."

The next paragraph states:

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But even when access and equity measures are not considered, the U.S. ranks behind most of the other countries on most measures. With the inclusion of primary care physician survey data in the analysis, it is apparent that the U.S. is lagging in adoption of national policies that promote primary care, quality improvement, and information technology.

So, they are stating that governmental policies are not as promiment in the US as elsewhere. This is where the tripartite relationship comes in - where do we want our healthcare system to be in that triangle?

Moving to the executive summary:

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Quality: The indicators of quality were grouped into four categories: effective care, safe care, coordinated care, and patient-centered care. Compared with the other six countries, the U.S. fares best on provision and receipt of preventive and patient-centered care.

This means that nobody respects the patient's personal decisions more than the US. PAtient-centered care means, to me, care that has its primary goal of the patient rather than the government, insurance, etc.

Care is provided based upon the wants and needs of the patient. This will, of course, increase costs. But "quality" and "availability" (of course, subjective assessments) will be high, as will costs.

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However, its low scores on chronic care management and safe, coordinated care pull its overall quality score down

Okay. What do they look for in "chronic care management?" The efficacy of the care? The cost? Yes, the costs are excessive in chronic conditions - BECAUSE they are chronic.

Kallend seems to have a problem with pointing out "how social factors are to blame." For example, how smoking, alcohol abuse and drug abuse can cause problems. Or how obesity causes issues. Poor diet. High fat. High in meat and processed foods.

It's why I recommended that Kallend and others read "The China Study." The US is the most affluent country . The US therefore suffers from more diseases of affluence than any other country. Diseases of affluence are chronic by their nature.

Also note - chronic diseases would not be chronic unless there was availability of treatment keeping these patients alive. Renal failure becomes chronic when it is medically managed. Remove medical care and the renal failure becomes acute and the person dies - resulting in lower cost health care.

This becomes a policy-centered question. I know that in many countries, the policy is that of a cost-benefit ratio. When there's a 90 year-old pensioner in congestive heart failure then a policy decision must be made to either: (1) treat her and all like her in an effort to preserve her life; or (2) redirect the resources elsewhere where there would be considered to be some higher marginal societal benefit.

Regarding information technology - considering that the US is a private/public amalgamation without a central databank - yeah. It makes sense that my medical records aren't easily accessible in Waukegan or Walla Walla. A central data system has to be managed. And considering privacy rights enjoyed in the US that are not enjoyed elsewhere, there are other considerations. This is not to say that a centralized databae wouldn't be helpful but there are costs (financial and dignitary) that are worthy of consideration.

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Not surprisingly—given the absence of universal coverage—people in the U.S. go without needed health care because of cost more often than people do in the other countries.

True. People tyically go for healthcare when really warranted. Americans each perform a cost/benefit analysis with regard to treatment. For example, I've broken an ankle and not gotten it treated because it didn't look broken and was non-displaced. I've broken fingers and had them treated. Each had a cost-benefit analysis associated.

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Americans with health problems were the most likely to say they had access issues related to cost, but if insured, patients in the U.S. have rapid access to specialized health care services.

This is key. "if insured." Insurance is an individual decision. I myself rolled the dice for a couple of years in my twenties and I realize that it wasn't too smart. Still, I had access because when I ran a 104.9 fever I went to the ER, paid cash, and had it taken care of. Quick access.

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In other countries, like the U.K. and Canada, patients have little to no financial burden, but experience wait times for such specialized services. There is a frequent misperception that such tradeoffs are inevitable; but patients in the Netherlands and Germany have quick access to specialty services and face little out-of-pocket costs. Canada, Australia, and the U.S. rank lowest on overall accessibility of appointments with primary care physicians

This is where scale comes in. Take the Netherlands. A country with a population of 17 million - of which 80% are Dutch ancestry. Los Angeles Metro has roughly the same population number and a vastly varied racial makeup. Like it or not, different rces suffer from different diseases. Diseases are cultural, too. A multicultural system creates unique difficulties in creating a system to manage it, and a patient-centered approach attempts to provide the best care for the individual - not what is "best" for the society as a whole.

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The U.S. has poor performance on measures of national health expenditures and administrative costs as well as on measures of the use of information technology, rehospitalization, and duplicative medical testing. Sicker survey respondents in Germany and the Netherlands are less likely to visit the emergency room for a condition that could have been treated by a regular doctor, had one been available.

Well, yeah. Duplicative tests, rehospitalization, etc., are all part of issues of tort liability and issues of patient compliance. There is a plethora of primary care physicians in the US who make it known that they want to be paid. Emergency rooms must provide treatment to anyone who shows up regardless of ability to pay. This provides incentive for people NOT to use primary care physicians because it is cheaper for them but more expensive for society.

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Americans with below-average incomes were much more likely than their counterparts in other countries to report not visiting a physician when sick,

Well, yes. How about those with higher incomes and whether they will go to a physician when sick? Lower income people understand the economic cost involved. Higher income people identify the opportunity cost involved.

Again - a cost/benefit analysis takes place. "Is this sore throat enough of a problem that I will go to the doctor?" Yes, a sickness, but usually not worthy of getting medical care.

Incidentally, health care being a finite resource, such activities would lower the cost so long as the issue is treated if it becomes worse. When it gets worse, I go to a PCP and get it treated. The poor go to the ER, which increases costs.

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On each of these indicators, nearly half of lower-income adults in the U.S. said they went without needed care because of costs in the past year.

If they went without it it was not "needed." Maybe it was "wanted" but "needed?" This is argumentative.

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: The U.S. ranks last overall with poor scores on all three indicators of long, healthy, and productive lives.

Yes. Because we are affluent and die of heart attacks, lung cancers, congestive heart failures, strokes, etc. Check out our lifestyles and diets. Shocking, I know.

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The U.S. and U.K. had much higher death rates in 2003 from conditions amenable to medical care than some of the other countries, e.g., rates 25 percent to 50 percent higher than Canada and Australia

Right. Countries with high dietary intake of meats, processed foods and fried foods and with more sedentary lifestyles. Check out the dietary caloric intake stats of the countries and Australia has the lowest calorie intake - and thus ranks best in long, healthy and productive lives.

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not getting a recommended test, treatment, or follow-up care, not filling a prescription, or not seeing a dentist when needed because of costs.

This is something else entirely - patients who are non-compliant with medical advice. This actually includes the diabetic who will not make dietary changes - and cost is not prohibitive. People who won't fill prescriptions to keep their blood pressure low (complaining about the price) and meanwhile not changing their diets or exercising.

The American helth care system may have too many solutions. If we've got problems because of what we're putting in our bodies we get a pill to mitigate the effects - versus simply stopping it.


Back to your post...

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How do you propose to improve this, keeping your equation in mind.

By changing peoples' perceptions of things. My kids are under my control with regards to the things that they can and cannot do. Eventually, however, they will be adults and will be released to make their own decisions and choices. If I coddle them through adulthood, they will not be taking care of themselves.

It does not take a village. It takes a parent. I personally would prefer to help teach my kids how to avoid chronic conditions and the need for continual health care and monitoring.

In the US healthcare is available for those who want it. Wanting it means paying for it. There are, however, so many who choose to pay for other things (exemplified by the skydiver who will pay over five grand for a new rig and spend in excess of $7k per year on jump tickets who femurs in and is uninsured.)

The simplest way I can see of doing it is to go back to a cash-pay system, which would eliminate back-office costs. Insurance would then be available like it is for vehicles and structures - there to indemnify for emergencies. People paying $900 per month for the privilege of a $20 co-pay for a visit dominate the market. Perhaps by paying $300 per month for a $7.5k deductible insurance plan (for things like fractured legs) would be sensible.

But people don't want to do the math. They want their health care as cheap as they can get it and pay whatever it costs to get it.

My wife is hotter than your wife.

[pirana 0]

Not a serious study at all. Outcome studies are the most meaningful measurement of a care system. Nothing else even comes close. How people "feel" is easy to manipulate and quite simply is irrelevant.

Quality and cost are related, but to examine each requires distinctly different treatment.

Compare salaries of docs among these countries and there is the bulk of the cost answer right there. How bised do you think they were to spew forth shit on cost of care without bothering to examine where the money goes?

" . . . the lust for power can be just as completely satisfied by suggesting people into loving their servitude as by flogging them and kicking them into obedience." -- Aldous Huxley

[kallend 2,184]

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Not a serious study at all. Outcome studies are the most meaningful measurement of a care system. Nothing else even comes close. How people "feel" is easy to manipulate and quite simply is irrelevant.

Outcomes would be things like infant mortality, maternal mortality, and life expectancy. US sucks in those areas too.

...

The only sure way to survive a canopy collision is not to have one.

[kelpdiver 2]

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Not a serious study at all. Outcome studies are the most meaningful measurement of a care system. Nothing else even comes close. How people "feel" is easy to manipulate and quite simply is irrelevant.

Outcomes would be things like infant mortality, maternal mortality, and life expectancy. US sucks in those areas too.

But those aren't part of this study, are they?

[kallend 2,184]

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Not a serious study at all. Outcome studies are the most meaningful measurement of a care system. Nothing else even comes close. How people "feel" is easy to manipulate and quite simply is irrelevant.

Outcomes would be things like infant mortality, maternal mortality, and life expectancy. US sucks in those areas too.

But those aren't part of this study, are they?

Take it up with Pirana - he wanted outcomes.

...

The only sure way to survive a canopy collision is not to have one.

[kelpdiver 2]

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But those aren't part of this study, are they?

Take it up with Pirana - he wanted outcomes.

He was commenting on the value of this study we're discussing. Each of those particulars has its own thread to have, and have here already. Full of facts and lies to have fun with.

[jgoose71 0]

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As far as Americans going over seas to get stuff done, here in the US, you get what you pay for. If you got money, you get the best. That is why Canadian Officials come here.

If you don't got the money, you go over seas to some one who can perform the same procedure but isn't trying to make up the development costs for some of this stuff, or pay for illegals.

I know a very wealthy guy who lives in Arizona who flies to Mexico to get his dental work done.

Why am I left with the feeling dental work is just an excuse for other things?

"There is an art, it says, or, rather, a knack to flying. The knack lies in learning how to throw yourself at the ground and miss."
Life, the Universe, and Everything

[turtlespeed 226]

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As far as Americans going over seas to get stuff done, here in the US, you get what you pay for. If you got money, you get the best. That is why Canadian Officials come here.

If you don't got the money, you go over seas to some one who can perform the same procedure but isn't trying to make up the development costs for some of this stuff, or pay for illegals.

I know a very wealthy guy who lives in Arizona who flies to Mexico to get his dental work done.

Why am I left with the feeling dental work is just an excuse for other things?

Donkey Show?

I'm not usually into the whole 3-way thing, but you got me a little excited with that. - Skymama
BTR #1 / OTB^5 Official #2 / Hellfish #408 / VSCR #108/Tortuga/Orfun

[pirana 0]

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Not a serious study at all. Outcome studies are the most meaningful measurement of a care system. Nothing else even comes close. How people "feel" is easy to manipulate and quite simply is irrelevant.

Outcomes would be things like infant mortality, maternal mortality, and life expectancy. US sucks in those areas too.

Outcomes is much broader than the things you mention. Outcome studies measure patient condition pre-treatment against various treatment regimens from different providers. Analysis includes place of service, type of service, patient demographic mix, procedures, provider, and at least 200 other factors. It is much more than just the simple measures you listed.

Infant mortality is a good example. Not only does the measurement criteria differ from country to country; but the stats can be very misleading. One side of the discussion might say mortality is 4 times worse for A than B. The other side might point out that both A and B are so amazingly low that common cause variation actually presents more of a range than special cause variation.

And yes, you can manipulate any study to make pretty much any place or person look bad by cherry picking the observations. Line up the right participants in the right categories and you can make any particular participant look truly evil.

Anybody who thinks health care in the USA actually sucks, that it is horrible, that you would be better off traveling elsewhere, etc . . . has got their head stuck in the sand of some other agenda.

The fundamental problem with health care in the USA is that it is ridiculously fucking expensive - not that it is bad care. It is for the most part a financing problem, not a quality of care problem. But those with some other ax to grind try to make it something else.

" . . . the lust for power can be just as completely satisfied by suggesting people into loving their servitude as by flogging them and kicking them into obedience." -- Aldous Huxley

[pirana 0]

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Yep. ANd the changes we just made are going to make it soooo much better

It is almost laughable that what was passed is called reform. All they've done is expand a system proven to have major flaws - and somehow managed to address not a single major flaw in the process.

Most everything they passed is already law in the more progressive states. About all they did was expand those measures to states without them (not a bad thing), and expand insurance by mandate to those that could not previously afford it. To pay the tab they'll increase costs for everyone else and call it a day without addressing total costs in any significant way.

It really just boils down to your standard Democrat redistribution of wealth tactic. Nothing innovative, no solution to total cost - just take money from one group and give it to the other.

" . . . the lust for power can be just as completely satisfied by suggesting people into loving their servitude as by flogging them and kicking them into obedience." -- Aldous Huxley