What is wrong with the American health care system?

I'm always horrified by what I hear of the American healthcare system. People finding themselves tens or hundreds of thousands in debt, or desperately clinging on to jobs so as not to lose their health insurance. Nasty, nasty, nasty. And very unusual - no other supposedly "modern" democracy I'm aware of doesn't have universal healthcare.

People do whinge here about our system's various shortcomings, but in essence that just boils down to lack of infinite funds. The basic point is that everyone is guaranteed good treatment, free of charge, according to their need, not their wealth.

And if you want it faster or in more luxurious surroundings, you can still pay to go private. Many jobs do actually include private health insurance, but personally I've never used any I've had, or seen it as much of a perk.

I find it very odd that the US system persists. As far as I can tell it's a combination of huge lobbying from those who gain financially from the status quo, and the US electorate not really knowing about the better systems that exist in other countries.

And when I've visited the US, I get really freaked out by all the adverts for prescription drugs on US television. That must be where all your money's going. Seeing patients treated as consumers just makes me want to go and wash. Yeurch.

 

Reforming the U.S. healthcare system is one of my passionate interests.
A few years back I campaigned for a single payer type ("universal healthcare") system here in California. The measure was narrowly defeated, due to a multi-million dollar disinformation campaign by the insurance lobby which frightened voters away from the idea.
Insurance companies are the big losers in a Government-run healthcare system, and as long as their powerful lobby has any say, all we will see from lawmakers is more legislation requiring the mandoratory purchase (perhaps subsidized) of private insurance.

 

The idea in MA is that EVERYONE must have insurance. that will equalize the costs.
Part of the problem is our diet and all the JUNK that we eat, high fructose corn syrup in toooooo many foods!

 

An excellent read on the topic of the healthcare delivery system and its flaws (which was the original intent of the thread -- not specific diseases) is _Epidemic of Care_ by Halvorson.

Some of the rich and privileged people get really, really shitty health care by the way. A specific example: I was working the ER in Seward, Alaska a few years ago, and a wife of a "VIP" came in with some health problems. Now, the concept of "VIP" alone is problematic enough to me as a doctor -- I agree 100% with what you said there, KMO, about treating patients as consumers -- after all, people are all people, all deserving of the same dignity and treatment.

That said...

They had, attached to the entourage, some sort of doctor, an MD I think, who basically just wrung his hands and demanded from-the-hip lab testing and antibiotics for what was not a life-threatening nor bacterial problem. He started babbling nonsense about how with Really Important People you "don't use a flyswatter, you use a bazooka" and put people on the broadest antibiotics when infection is suspected, etc. (He was asking if we had any vancomycin as he looked somewhat nervously around our small ER.) Not a speck of scientific marrow in a bone in the guy's body as far as I could tell.

So don't tell me that rich people get good healthcare; I don't believe that for a second. People going to doctors and demanding specific treatments can be a very, very bad thing, because often people don't know what the **** they are asking for or talking about!

(Sorrry will get back on the thread now and quit rantingl)

 

The article was published in a tier 2 journal (jama). It should be emphasized that the data was collected by SURVEY, which upfront makes the results are at best interesting, at worse garbage; but certainly nothing to fuss over.

Lastly, any author who proposes 'stress' as the indeterminate variable is an idiot. Shame on Paul Krugman, but at least he has an excuse of being an economist and not a physician.

 

in countries where there is a universal healthcare system, not going to the doctor regularly is an option. hell. for many people in america, it is still an option.

but for too many families in the US, going to the doctor at all is not an option for financial reasons.

 

--- cut and pasted - - -
If you ask people in Canada (or in any kind of single-payer system--but let's use Canada as an example), "Do you like your health-care system?"--they love it. Ninety percent plus. If you ask Americans, "Do you like the health-care system?"--they hate it. Then you ask a slightly different question: Do you like the quality of care you get? In Canada, the numbers plummet. In America, the numbers soar. Americans love their personal care and hate their system. Canadians hate their personal care, love their system.

If you look at patterns of mortality for women, and morbidity, there are many, many more things that can go wrong in a 30-year-old woman than there are in a 30-year-old man.
Look at the way that men use the health-care system. They use it not chronically, but acutely.
The Canadian health-care system is a health-care system for women. The American health-care system is a health-care system that is perfectly situated for men. It's the male health-care system. This whole debate about what is better, the American system or the Canadian system, is essentially a variant on the gender war. As a man, I am infinitely better off in America than I am in Canada. Were I a woman, I would be much happier with the Canadian system, where I can go and see my ob/gyn for free, day in and day out if I wanted to, than I would be in America. I think once you think about those systems that way it sort of clarifies what's wrong with each.

If you look at mortality figures, Canadians live just as long or a little bit longer. If you look at their specific death rates from diseases, Canadians aren't dropping like flies, so what's so great about the American system? Well, the issue is not mortality; it's morbidity. If you look more closely, if you take something like heart disease, Americans and Canadians die of heart disease at roughly the same rate. If you look at the levels of suffering, if you look at the guy who is 68 years old and has got blocked arteries, in America that guy gets a bypass and his level of how active he is, whether he's going to work, whether he's playing golf twice a day, the American is way better off. The Canadian isn't going to get... Take a 72-year-old Canadian with severe angina. He does not get a bypass. The American, he gets a bypass in a week!
AG: If he can afford it. If he can afford it.
MG: If he can afford it. Well, most 72-year-olds... Probably a 72-year-old would be on Medicare; so if he's on Medicare, then that question is lifted.
----
http://www.washingtonmonthly.com/features/...wellgopnik.html

In the USA, if you walk into a hospital ER and collapse on the floor, you will be taken care of, regardless of medical insurance coverage.

If you walk into a hospital ER and collapse on the floor - and you have health insurance - you will be taken care of and have little or no medical bill . . . depending on the quality of your health insurance policy.

If you walk into a hospital ER and collapse on the floor - and you are rich – you hand over your credit card and tell them to spare no expense.

If you walk into a hospital ER and collapse on the floor - and you are so poor that you have little or no assets, the state and federal government will sorta (definitely not fully) reimburse the hospital – THAT IS THE LAW! If you get in a horrible car accident miles from the nearest hospital and you're broke, the helicopter still comes and wisks you directly to the trauma center. Some hospitals go bankrupt and close their doors because of these non-reimbursed costs . . . that is one of the things the mandatory health insurance program in MA is trying to solve.

If you walk into a hospital ER and collapse on the floor - and you have assets and no health insurance . . . you WILL pay.

Like any insurance, it is a gamble against your assets whether or not you purchase any coverage.
If you own a house, don't purchase fire insurance, and it burns down - Oh Well, that is a gamble you took. If you have assets to protect and don't at least purchase high deductible insurance, whether health, home, auto, WHATEVER . . . you are being foolish with your assets.

Someone has to pay for health care. Here in the USA it is approximately 15 percent of the GDP, and is done with medical insurance, Medicare, Medicaid, state or county medical clinics, free clinics, VA, etc. In universal single-payer systems like Canada, UK, France, etc. it is paid with high taxes.

For instance gasoline tax . . .
http://www.urban.org/publications/1000845.html

And there are calls to reduce gas taxes in the USA? Give me a break!

In 2001 the United States spent in total 13.6% of its annual GDP on health care. In Canada only 9.5% of the GDP was spent on health care.
http://en.wikipedia.org/wiki/Canadian_and_...ystems_compared

 

<div class='quotetop'>QUOTE(Sufferin' Prius Envy @ May 7 2006, 07:31 PM) [snapback]251190[/snapback]</div>

LOL

 

Here's my two cents worth:

Interesting. I have first hand experience with the Canadian health care system – and I live in the US. Here’s what I am finding…..

1) I received fast, even friendly service in Canada for my condition with little more than my name & address. In the US there are usually many forms to be completed prior to receiving treatment.
2) The same service in the US would have cost my insurance company over double what I was billed from Canada (but yet it’s “out of network†so they only pay 60% - US that is).
3) I now visit the Doctor who treated me in Canada so that I can take advantage of purchasing the same drugs in the same box (well, they do have to put French language on the box) for roughly half of what I can buy them in Florida (amazingly enough, my insurance company reimburses me in US dollars rather than the Canadian dollars I submit).
4) The Canadian Doctor suggested that I keep a diary with certain information so that it would be an easy reference chart for my recovery. My last visit was a comprehensive visit lasting over an hour face-to-face. My US Doctors – yes, two of them for this condition, 10 minutes is about average. They have mild interest in my diary but rely on their observations to treat me.
5) It’s easier to get the insurance to pay the US Doctors (even though they are more expensive), but difficult to get them to pay the Canadian ones. In fact, I have to pay the Canadians first then show that on my claims in order to get reimbursed.

And, this was in January 2006. My condition? Heart attack. Fortunately, I was in Calgary and was admitted immediately to Foothills Hospital where they took very good care of me. I was there 2 days total from diagnosis to angioplasty and stent installation to discharge. And 2 more days after that I flew home to Florida where I spent the next 6 weeks dealing with no less than 3 insurance companies trying to get it all paid for. And my Doctor said “no stress†– LOL!

 

The way I see it, we in America are looking for a simple answer. A simple person or company or group of people to blame.

The problem will START to be solvable when we, the individual, realize that it is IMPOSSIBLE to have universal health care. A-HA, I mean universal health care as we currently imagine it. Meaning no matter what is wrong with us we just go to the Doctor and be cured. There isn't enough money in the WORLD for that.

What we must realize is we need Universal MANAGED care. If you take care of yourself, don't abuse dangerous substances, follow treatment plans..then you will be cared for. Certain people and certain conditions will be limited to "comfort" care until they kill themselves through abuse or neglect.

Also, on top of that, we need to get over this idea that we shouldn't have to PAY anything for our care. We spend and spend on cell phones, cable TV, maintenance for our cars, and on and on, but we yell about $15 co-pays and $50 prescription bills.

I say our Universal Health care only starts after we have spent 10% of our income first....Annually. And we are REQUIRED to have a Health care account (medical savings account)

So, we need a new paradigm.

 

I'll tell you precisely what the core problem is:

Dr. salaries, and the intentional manipulation of the amount of Dr.'s in the US.

Take dentists for example, that 200K plus salary has got to come from SOMEWHERE... You really think crown's cost $1,000? :lol:

Cardiac surgeons making 500K a year, who do you think ultimately floats that bill?

think healthcare costs would remain high if certain governing bodies expanded the MD pipeline and placed a cap. on Cardiac surgeon's salaries at 75K?

Of course, frivolous lawsuits against physicians resulting in astronomical insurance premiums don't help either.... still a function of the core problem though...

 

To respond to the question posed:

around 45 MILLION of our citizens have no health insurance. That's one of every six of us.

How can anyone wonder that we're behind Cuba and other countries whose economic systems we disparage in per-capita infant deaths and other basic indicators?

Shouldn't the RIGHT to a "survival minimum" of health care, guaranteed by your country's national government, come ahead of the RIGHT to show bare buttocks on network television?

I know, I know, apples and oranges. But the point of where our priorities are is valid.

There should be no such thing as a for-profit HMOs or hospitals. There is so much "profit" already in payments to doctors, administrative salaries, use of testing equipment (can anyone explain to me why a CT scan would cost $2,000?), meds dispensed in hospitals and, worst of all, HMO "overhead", that no company should be allowed to skim off the top of all that, too.

 

<div class='quotetop'>QUOTE(Schmika @ May 7 2006, 08:24 PM) [snapback]251286[/snapback]</div>

And what bureaucracy would you implement to monitor and verify that 10%?

Put THAT in your new paradigm and smoke it.

There IS a simple answer, just north of us. What's hard about that? No need for mandatory health savings accounts with a national single-payer system.

 

When was the last time you had to pull your own rotten decayed tooth with a pair of pliers because you couldn't get an appointment with a "free" dentist? If you're thinking about moving to the socialist paradise of the UK, be sure to pack a nice pair of pliers.

"Mind the gap: Britons ache for dental service
By Sarah Lyall The New York Times
MONDAY, MAY 8, 2006
ROCHDALE, England "I snapped it out myself," said William Kelly, 43, describing his most recent dental procedure, the autoextraction of one of his upper teeth. Now it is a jagged black stump, and the pain gnawing at Kelly's mouth has transferred itself to a different tooth, mottled and rickety, on the other side of his mouth. "I'm in the middle of pulling that one out, too," he said."
More ... http://www.iht.com/articles/2006/05/07/news/teeth.php

 

<div class='quotetop'>QUOTE(Florida Prius @ May 7 2006, 08:42 PM) [snapback]251242[/snapback]</div>

That is actually a sore point with many Canadians. Why the hell should Canadian taxpayers subsidize prescription medications for what is supposed to be the wealthiest, strongest nation on earth? It really burns us when entire states want their senior citizens to freeload off another country because for some reason looking after old people is a very low priority in the U.S.

Thanks to the recently elected Conservative government, the days of subsidizing meds for other countries may be over:

http://www.rgj.com/news/printstory.php?id=102599