I am not sure if this is a purely American Phenomena, or if people in other areas see it as a more and more common occurance. Why is it that in the worlds richest country we can not pay for everyones healthcare? Is it the docs and scientists? What about them? What about some Doc’s innability to bring themselves down to the plane of the average everyday schmo. As a scientist myself, I see it as a fundamental flaw in the system, something that may very well be eating away the very fabric of which our medical system in this country (USA) is woven.
Last night on CNBC Dr. Andrew Weil spoke about the healing process in America and the state of the healthcare system therein. Talking about his wish for more Open Minded Skeptics, he stated the reasons for the breakdown in the system as being purely the doc’s inability to be open minded. Ones inability to be open to the thought that someone else may be right besides themselves. Science is a not a close minded finite practice in the beginning, testing and infrastructure are the fibers that weave the whole.
Am I making a broad generalization here, or do others see a failing medical system in our country and a rapidly declining medicare infrastructure spiraling out of control?
The richest country in the world can not even provide the basic necessities to some of it’s population, whats wrong with that picture? Doc’s or bureaucrats?
Well, Antiquarian, if we take a less, well, Weilish look at things, consider the following points:
First of all, this concern is not an American-only phenomena. Most Western nations are fighting medical cost creep. The U.S. system is notoriously expensive and inefficient, but we have pretty much the same problem; costs are going up and services per capita aren’t rising.
Having said that, you have to always bear in mind one key thing:
There is no end to it.
Demand for healthcare is basically unlimited. No matter how healthy people are, they want to be healthier. The population will not be satisfied with the amount of health care they get until they’re immortal, and even then they’ll bitch that they still get colds.
Fact is, the health care system objectvely DOES work. Americans live longer and healthier than they did 50 years ago or 100 years ago. They are much, much healthier than the citizenry of most countries. They aren’t as healthy as Japanese or Canadians or some other people, but overall the Western world is a very healthy place, and for the most part it’s getting healthier. The fact that you can never meet all the demand for health care does not necessarily mean that current NEEDS aren’t being met to a reasonable extent.
With all due respect to Dr. Weil, his position that doctors “aren’t open minded” sounds to me like a pitch for the stuff he’s selling. “Other doctors don’t agree with the stuff I’m selling” is not a very convincing argument. Maybe it’s just me, but most doctors I’ve had the occasion to deal with were pretty honest, smart folks who knew what they were doing.
I agree there is no end to it, and I feel slightly snobish whining about it. But as a person who travels quite often and as someone who has been personally affected by cancer in one form or another, I have been on the receiving end of doc’s who insist their way is the right way. Insistent HMO’s, rising insurance costs and surly doctors will always exist, but making an effort to better a semi-flawed system to help the common guy who can’t afford insurance is not in place and is extremely tardy if you ask me.
I am getting married in 6 months, I work for Big Company X in Boston and am ok with paying ungodly amounts for insurance. But my unemployed brother-in-law with non-hogkins Lymphoma is bankrupting his parents. Why can’t the system do anything for them, why do the best docs get skirted around for the first year interns?
RickJay’s post is very good. Rather than a screed on health markets from me, I’ll say just this: there are more and more (costly) things we can do to prolong life (as well as improve it). Whether we’re talking universal health coverage (like most of the developed world) or private insurance supplemented by government subsidy (like the US), people (and/or the doctors who care for them) are going to demand that whatever can be done should be done if they themselves do not bear the full cost of the treatments. If the fiction that the old and the chronically ill need insurance continues to be indulged, insurance and public health systems cannot make ends meet.
The future will be a recognition that those groups are uninsurable and that there is a limit to the amount of subsidy available. Insurance markets (and government scheme equivalents) will still have considerable problems, but without that recognition they are toast. It is a disquieting nettle to grasp.
Antiquarian:
Your post seems to suggest that portions of the pay I earn for myself and my family should be taken from me by force to provide health care for someone else’s family.
Of course, that’s already done in the case of food, in some circumstances; my earnings are taken from me and used to feed someone else’s family.
Before we figure out what the model should be for funding this… can you make the case that this is desirable – or to put it more coldly, why should I pay for your family’s health care as well as my own?
Assuming you are in the United States, it already does, in the form of medicare/medicade. I am saying the Federal Government should reform our healthcare system so it doesn’t impact the modern day schmo as it is now.
Bricker, I can’t stand it when I am in line at a grocer and see someone with 5 kids paying for their filet mignon and bottle of booze with food stamps, but we live with-in a system that allows it. That is the system debated time and time again, that works but only marginally. I say that loosly, because I enjoy many of the comforts that come with it as I am sure you do too.
I do not imply earnings should be taken by anyone by force to pay for anyones family woes including my own. So no, I can not make that case.
Can I make a case for a new healthcare model? Yes, as I am sure many people on these boards have already done. Having read the boards for quite a while before jumping in earlier this month, I can see there are a lot of people here who would love to see a change, but find it hard to come up with a model. We as a nation keep running into too many obstacles so we stop and settle for billion dollar tax cuts which favor the rich. Is that bad, No, in my opinion because the trickle down effect on the middle to lower classes is not nearly as bad as if our current system were to stay with its flaw infested bureaucractic BS.
I’ll not flame here in GD, but I do not want anyone to think I advocate forcing people to pay for my or anyone elses family healthcare. But the infrastructure that support the current system does have wrinkles that can and should be worked out.
Because we live in a wealthy and civilized country where people’s teeth are still rotting in their mouths, cancer eats at that bones and their genitals rot from disease and there is nothing they can do about it? That we have a duty to our countrypeople to see that they do not sit with their bodies falling apart surrounded by unbelievable wealth?
The state of healthcare for people without insurance is almost zero. This not only represents a needless humanitarian crisis in a land with so much abundance, but also a pressing public health crisis when people do not have the means to stop epidemics. Even little stuff like the person who cannot afford an eye doctor, but can’t see well enough to drive, but can’t stop driving because that would mean stopping working, affects all of us. Also remember that preventative care can often prevent more drastic and expensive life-saving steps (which surely you agree there is a moral imperative to provide life-saving emergency medical care) and ends up costing less all along.
Maybe I’m just old fashioned, but I’d gladly give up a couple bucks to see that my uncle doesn’t have to make choices like whether to buy food for the baby or see the doctor. I’d gladly pay so that the bums I step over on the street can at least make sure they don’t have any virulent diseases. It just seems right.
Now you’re just making that up. You know as well as I do that food stamps cannot be used to buy booze. But if it lends moral outrage to your rant, why stick to the facts?
In the most selfish way of putting it: Because the possibility exists that you will not be able to pay for all of your family’s health care. Obviously you feel that you have sufficient resources saved in order to do so, or that your current insurance does so and that you will always continue to be able to have such insurance. However: Suppose you lose your job and thus your insurance, and then develop a very expensive medical problem. The cost of something like a cardiac bypass operation would probably equate to the total equity in your house unless you are in a mansion. Ditto with the cost of caring for one premature baby.
Comparing this to the oft-mentioned alleged overspending of people on welfare, I seriously doubt that people on Medicare or Medicaid are just going around getting operations and expensive treatment just for the heck of it.
If you lose your job/insurance, you can go through your net worth rather quickly. Expand that to a poor schlub who is working hard at a job that doesn’t include medical insurance. Under your plan if his kid is born at 7 or 8 months instead of 9, then what happens? Tough break, kid dies?
Or do we all assume some of the responsibility for the health needs of all of us?
Ok, Fear maybe not buying booze - and actually I did not know that was a rule, but I guess it could have been surmised - but what about abusing the system in general because they can.
13 week extension for welfare, extra incentives for every child you have. Some states are doing well and are making single-moms and or those who continue to have children to stay on state go to programs to help them learn how to live with a healthy system. Some states don’t care. For Instance I live in Vermont, and work in Massachusetts I file taxes with both states, Governor Douglas in Vermont I think runs a fanstastic program with Medicaid reform one of his top priorities. Our unemployment rate is one of the lowest in N.E and the Nation.
This month in MA Gov. Romney announced MA would be getting $550 mill from the Federal Government for prescription advantage and thus reduce the states reliance on the reserves. Hey it’s not called taxachusetts for nothing folks, we’ll see when I file next January if this helps. Clearly I live in Vermont for a reason.
Because it is unavoidable. Do you really think people without health insurance are just going to go home and die in silence? They show up at the emergency rooms of publicly funded hospitals, or they obtain medical care under false pretenses, and default on their debts. Either way you pay, and probably a lot more than if they were taken care of under a properly managed universal health care system.
Americans want [ul]
[li]The best health care in the world[/li][li]Available to everyone[/li][li]At a reasonable cost.[/ul][/li]
They can have two of these three. There is no combination of circumstance or policy that can give them more than two.
We have a couple of choices. We can continue to let health care costs spiral up. Insurance will become more and more expensive. The cost of delivering health care will become more and more expensive.
Or we can institute some form of rationing.
Much of the lifetime cost of health care is incurred during two periods - the first year of life, and the last six months of life. Therefore we can free up some resources, and reduce costs, by rationing care during those two periods. To put it as coldly as possible, we are going to let your grandmother die, because it would cost too much to treat her. We are going to let the premature baby who weighs less than two kilos die, because she probably won’t live long anyway and what we spend to get her to her first birthday will be wasted.
Does this mean that some people will die, who might otherwise live with heroic treatment? Yes.
We don’t have any other choice. You cannot make something cost less by passing a law. Health care cost increases are not being driven by greedy doctors or HMOs. The demand for health care, as has been posted by RickJay, is infinite, and employer- or government-based insurance hides the true cost from the consumer.
We can institute conscious, controlled rationing, which applies consistently, or pretend we aren’t doing so, and have it be much more arbitrary. What we should do is institute some form of DRGs (Diagnostic Related Groupings), as was done in the 70s, and for those who fall into the wrong categories - various forms metastatic cancer, Alzheimer’s, stroke victims, newborns under two kilos - sedate them and wait for them to die.
Cold-hearted, I know. Also unavoidable.
Regards,
Shodan
Slippery slope time, Sho.
I’d go along with you on the 88-year-old guy with dementia, bad circulation, gangrene and advanced cardiac disease. (I just did, last year. My father. He agreed via his living will.) How about the 70-year old with no health problems other than the bad heart valve? No? The 60-year-old, then? 65? 68?
I’d probably even go along with you on the 1-pound preemie, although her parents might not. How about the 3-pounder? The 2-pounds, 15 ounces one? Two pounds, eight ounces? Where’s the line? Does the rich guy’s kid live and the working stiff’s kid die? Tough one.
My ad hoc answer to you Shodan is your wrong and right.
Americans want:
Americans can get more than just two when the parameters are changed.
Mediocre heathcare, available to most, at a reasonable cost. In my opinion this would help those needing to save their preemie because they just spent 20K on fertility treatments and the couple is in their late 30’s.
My friends father has great healthcare from the gov’t because he served in the armed forces for 30 years, his best friend needs a triple by pass and two pig valves he served in the armed forces for 7 years and was layed off with a golden handshake from Pfizer with one tenth the cost of his insurance included.
The system is vastly convoluted and in need of a new transmission. The engine is fine the ability to move ahead is losing gears fast.
I worked in a hospital for a few years and also a hospice. I want to thank you for this post. I believe the closed minded skeptics are legion now, and those that remain open to new ideas few. I am noticing the people I work with talking about how doctor are becoming aloof, remote, and opinionated.
On the other side I know of some, mainly the “psyche” fields, that are trying alternative methods. In the end the people will decide. When they get fed up enough, they will vote in the policitians that will change the laws for them.
So long as your “alternative methods” stand up to peer review and the scientific method, I’m all for it. But I wouldn’t change any laws that protect the public from goofy charlatans that insist that I just “believe” in some unsupportable mumbo-jumbo.
RickJay:
You’re right. I should point out, though, that America’s health care system demonstrably gives by far less bang for the buck than that of any Western nation. My senior year some classmates and I did a project for our Comparative Politics class, real quick and dirty, that took eight countries (US, Canada, Britain, Russia, China, India, Norway, and Ghana, I believe they were), ranked them all according to various health-related quality of life indicia (infant mortality, life expectancy, and the like), and then compared these rankings, individually and in aggregate, to the amount each country spent on health care as a portion of its GDP. The US spent by far more money on health care relative to its GDP than any other country we looked at. It also fared much more poorly on the quality-of-life index than any of the other Western nations; in fact, it only finished just ahead of Russia for fourth place out of eight.
Obviously the study wasn’t scientific, but it gives a decent thumbnail sketch–and WHO has done similar studies that get similar results. For whatever reason, health care dollars in this country are spent in a remarkably inefficient manner. We could, apparently, do much, much better.
Shodan:
I’d probably agree with this. I’d also say that right now, a large majority of Americans, even those who, per #2, have available healthcare, have neither #1 nor #3. Making those two available to most of us is surely more doable than making them available for all of us, isn’t it?
There has to be a method of making the individual manage his healthcare needs most efficiently himself.
It’s true that right now someone who can’t or won’t work hard enough to pay his own way will use inefficient emergency services. It seems the only thing we can do is pass a law making everyone buy health insurance. Here in California we do that with car insurance, I’m not sure how well it’s enforced or how effective that is.
It seems when the government gets to decide everything then wasteful politics takes place, and greater injustices take place. Plus, how resentful would people get if only the rich had private healthcare, and therefore access to the front of the waiting lists for treatment?
-k
It is a difficult issue. One problem is that with the current system some people are PREVENTED from using health care efficiently. A typical example is the person w/out insurance who waits until his problem becomes acute, and then goes to the ER, whereas an earlier, simpler treatment or prevention that they couldn’t afford would have made the ER visit unnecessary.
Similarly, some insurance will not cover preventive or screening tests, which can catch problems before they become expensive, but will cover treatment. Examples of things not covered by some plans include Pap tests, birth control, mammograms, vaccinations, well-baby visits, drugs to help quit smoking, and so on. Some plans are getting better these days, but not enough. When a person is really struggling to make ends meet, it is easy to put off some things indefinitely.
True, which is why I believe we need rationing. We spend lots of money on the hardest cases - extremely premature infants, patients who are dying anyway but for whom the process can be prolonged, defensive medicine and lawyers.
Two of my relatives are doctors. One is an intensive care neonatologist, the other a pulmonary specialist. Their patients usually die, or survive severely compromised and require long-term, extremely expensive care. Both make in the mid-six figures per year.
I believe if we simply classified every one of their patients as “palliative care only”, we could save a ton of money. We would also condemn about 5% of those patients to an avoidable death. Because their patients don’t always die, they usually die. But their patients always consume a lot of money.
The inefficiencies to which you refer occur at the margins of medical care. It takes a lot of time and resources to save the hardest cases, and you usually fail. As a society, however, since patients are shielded from the cost of medicine thru insurance and/or government funding, this makes it too easy to say, “Damn the cost - my baby has to have her chance to live, no matter what” and bring in the technology. And nobody gets into trouble by doing too much - and if you don’t do too much, you are a murderer.
The problem with my scheme of rationing is that it is political suicide.
Anyone who cares to can destroy my rationing scheme. All it takes is a crusading reporter who puts together a riveting story about the cute little (white, if possible) kid suffering from the obscure disease, the heart-broken mother pleading for the system to give her baby a chance (Bake sales! Fund raisers! Don’t let Baby Sarah die!), the heroic surgeon with the risky, experimental operation that gives that one-in-a-million chance of a normal life, and the grim-faced reporter mentioning that to fully fund the operation, it would cost the average tax-payer only a few cents a day, and an edited interview with the visibly nervous hospital administrator cold-heartedly denying this child her life.
And the politicians fall all over each other funding the operation, the baby dies anyway, and the taxpayer or insurance company suffers cut number 875 in its death of a thousand cuts.
No, I doubt that it is.
Currently, I would say that the US has #1. It is available to most, but the cost is outrageous. A middle class person with comprehensive health insurance in the US gets the best care in the world, and pays more for it than he would anywhere else.
My scheme of rationing DRGs means that we would get options 2 and 3. It also means that we are sacrificing the 5% or so of patients who would live normal lives if cost were no object, and also sacrificing a few extra months of life for terminal patients. But we have already done all the easy stuff to prevent disease.
If we increase availability, we increase demand - and the cost goes up. If we increase supply, we also increase demand - and the cost goes up.
The only realistic chance of implementing rationing would be to remove the things that shield consumers from the real cost of their health care. This means things like removing the tax-deductibility of health care, reducing government spending on health care in general, and generally placing health care spending decisions on the consumer. The consumer then has to do his own rationing.
But cost control laws will never work. Neither will demonizing HMOs. Look at the furor over releasing new mothers 24 hours after delivering for a good reason why government intervention cannot reduce the cost of health care.
Regards,
Shodan