Health care

Great Debates
21

[rant]
There are multiple contributors to the high cost of health care.

To some extent, it’s you get what you pay for. 50 years ago, someone had a bad stroke, the family took them home, did what they could, but the stroke victim usually died in a month or so. Now, most are admitted to ICUs, get several MRIs, maybe arteriograms, or even surgery to improve blood flow. If they stop breathing (because their brain stopped working) unless there’s a pre-existing living will directing otherwise, life-support (ventilator, etc. to keep the body alive) is at least offered to the family. If the patient does better than that, extensive rehabilitation in special rehab hospitals & then home therapists all help stroke victims recover as fully as possible. Miracles, both small & large, do occur & many people are helped tremendously by all this and most of us count this as money well-spent, but still the cost of treating those who are not helped is staggering.

All the fantastic research that promises the world on our nightly news is expensive, even (especially) that which never makes it into a single human patient.

The commission (JCAHO) that makes sure all hospitals meet certain “minimum” standards started off as a great idea. Now it is an out-of control bureaucracy. They survey your hospital & 2 other local hospitals. All of you are striving to meet all of the requirements. Sometimes to make sure you don’t get “dinged” you interpret a standard more stringently than the inspectors do. The inspectors are so impressed that - voila - it’s next year’s “minimum” standard. The number of full-time staff who never come in contact with a live patient, but only to help the hospital pass it’s inspections is mind-boggling. That’s all overhead that gets tacked onto the cost of every aspirin and bandaid given out.

How to pay for medical care for the poor is a major struggle. Do we pay for their mdicines for high blood pressure & diabetes, or wait to pay for their bypass surgery after the heart attack that leaves them completely unable to be independent again. Or do we just let them die because they weren’t able to hold a job with full benefits, or the expenses of running the farm kept them from being able to buy insurance?

Million dollar claims for pain & suffering contribute to the total cost, as do unneeded tests designed to prevent suits. But a major cause of rising costs is patient expectations. There’s not a doc out there that doesn’t know that viruses can’t be killed with antibiotics. But their HMOs are much more concerned with a) getting patients in & out of an appointment on time & b) keeping patient satisfaction high. Ever try to get a history, examine someone & explain to someone convinced his sore throat needs antibiotics that its just a virus, and send him away empty-handed and feeling like he got good quality care from you? In 10 minutes? 6 minutes, really, because you’re trying to catch up from the 80 year old who took 5 minutes just to get on the exam table, and the mom who wants you to look in her other 2 kids ears in the one appointment for Jimmy.

And don’t even get me started on the disgusting multi-million dollar bonuses that HMO CEOs award themselves for paying people less to do more, while charging people slightly less to get a whole lot less.
[/rant]

Sue from El Paso
members.aol.com/majormd/index.html

22

If car insurance were optional ( I think all states require it), the next thing the insurance companies would do after changing their underwear, would be to double their premiums. They’d have to to offset the number of consumers that would drop or reduce their coverage.

Well, medical insurance is optional. That’s one of the reasons why it’s expensive. That and greed by the industry. If there was a law making medical insuranc mandatory, like single payer coverage, you could watch the cost to consumers literally halved overnight.

Therealbubba

23

CMKeller wrote:

Chaim…are you sure you’re posting to the right board! :wink:

24

Therealbubba;
You said:

Don’t bet on it. You used the comparisson of car insurance so I will, too. Several years ago my state (Illinois) made auto insurance mandatory. My premiums did not drop one dime. My driving record has been absolutely perfect for the past 15 years, so it wasn’t that. I think you have far too much faith in insurance companies. When they get a boat-load of new customers, they think “yeeha, we’re rich!”, not “hey, how can we use this increase in revenue to benefit our customers”.

“I think it would be a great idea” Mohandas Ghandi’s answer when asked what he thought of Western civilization

25

Like any other market, if you lower the cost of health care, you increase the demand. And when you do that, you run into other limits. You’ll find out that there just aren’t enough doctors and hospitals around to serve the demand. So you wind up with waiting lists, which can be more detrimental to public health than the current system.

Countries that have socialized medicine routinely have this problem. In Canada and the U.K. waiting lists for serious surgery can be months long. The head of the Canadian Chamber of Commerce died of a brain tumor while waiting for months for a CT scan. If he’d gotten the scan right away, his life may have been saved.

And, our lists are not nearly as long as they could be because we have a big safety valve - the U.S. People who get put on long lists here often go to the U.S., and the wealthy here will also often go to the U.S. for treatment because at the highest levels it’s better than in Canada. The Premier of Ontario went to the U.S. for his cancer treatments. Thus, the most difficult and time-consuming cases get offloaded from our overworked system. If you guys socialize your medicine, you won’t have that escape valve (although it wouldn’t surprise me to see ‘medical havens’ with top-flight doctors spring up in small countries in the Caribbean and such)

Medical care can never be a ‘right’, because it requires someone to provide it. The only way you can make it a right is to make doctors slaves. In a free society, you can’t do that. What you CAN do is force them out of their profession, or force them to leave the country. And that is what has happened in almost every country that dabbles in socialized medicine - they suffer a ‘brain drain’, where the very best doctors leave and go elsewhere (usually the U.S.).

Health care is very expensive, and maybe too expensive for society to get all they want. You can’t just pass a law and make it so.

It seems to me that the U.S. has a pretty workable compromise right now. The indigent are cared for, the middle class typically has insurance available for reasonable prices, the rich get all they want, and doctors have lots of choices. It’s not perfect, but it never will be.

26

I wish that were true dhanson, but there’s a fourth group here called the working poor. Income too high to qualify for Medicaid, too low to afford individual policies (which cost about 2-3x what groups/employers pay). I’m not talking that they don’t want to pay; I’m talking it would cost them 20% or more of their take-home pay. Food & shelter are higher priorities.

If their part-time, low-paying job doesn’t have full bennies, they’re left out in the cold right now.

Sue from El Paso
members.aol.com/majormd/index.html

27

I agree that the working poor are the biggest problem, but that is counteracted somewhat by hospital charity and subsidies. Hospitals write off a lot of debt every year, usually from this category of people. And the federal government subsidizes hospitals to the tune of 130 billions dollars a year partially because of this problem.

I DID say that the system wasn’t perfect. The problem is that it isn’t perfect simply because it’s very expensive. There also a ‘problem’ in the U.S. that everyone can’t have a yacht. No amount of tinkering with the laws will get everyone a yacht. Health care may fall into the same category. You can have an imperfect system with holes, or you can have massive waiting lists and a decrease in the number of people who become doctors in a market already facing shortages of skilled help. Pick one.

28

You equate an inability to get basic health care with the inability to afford a yacht? Kinda hard to take that thinking seriously.

29

Why pick one when you can have both? The second choice pretty much describes HMOs/managed care.

30

Walk into your local hospital and tell them that you’re the working poor and they can just “write off” your bill because Uncle Sam gives them a subsidy. Our largest hospital in town, a 700 bed medical center, gets 3 million a year for indigent care. That covers about a weeks worth of operating costs, if they’re lucky. They’ll still treat you, and they are going to shift the cost of it to the HMO and PPOs that they have contracts with. And who’s paying for that?

So, the bottom line is that you do pay for indigent care, through taxes and cost shifting to your insurance carrier.

Imagine being able to make a career decision and not have to base it on whether or not your new job has health benefits. Ever feel tied to a job you hate because you need their benefits? What about welfare? How many of the folks on welfare would get off of it tomorrow if they were assure that they wouldn’t lose their medicaid?

Decreaseing costs increases demand? I doubt it. The same patients are coming in the door no matter the cost. By that logic, we can eliminate disease by lowering costs.

In the end, it comes down to a handful of greedy people that will do whatever it takes to keep the status quo and the little man down.

Therealbubba

31

Kudos to pldennison and therealbubba for brilliant posts. I find nothing to disagree with on either. “Gee, the hospitals are cutting their charges; guess I’ll get sick. Can’t miss out on a special!!” (Although come to think of it, I know a few bargain shoppers who might just think that way!) :wink:

32

I wasn’t trying to equate health care with yachts. I guess I should have picked a different example. I was attempting to show that health care may be so expensive that the U.S. simply can’t afford all that it wants. If that’s the case, then you can’t change it by juggling the books. And it certainly does look like that’s the case. The U.S. already spends a huge chunk of its GDP on health care, as does every other modern nation. And yet they all want more. Here in Canada we read headlines about the ‘health care crisis’ every other week.