But but… your reduced long term wellness and premature death is so profitable!
Aren’t these statistics distorted because the US, unlike the EU and other places, views every single infant delivery – even the incredibly high risk ones where the baby was born extremely early – as viable lives to be lost, with no expense spared?
I remember reading this was the source of these “huge” mortality rate differences?
The following graph shows this inequality. The top 5% of spenders accounts for almost half of all health care spending in the US.
Those “spenders” could be risky births?
Thus, one-third (nearly 8,000) of infant deaths in the United States would be averted if the United States had Sweden’s distribution of births by gestational age. This provides evidence that lowering the percentage of preterm births could have a dramatic impact on infant mortality in the United States.
The top 5% are people with cancer, heart disease, and chronic conditions. I’d be surprised if 8,000 births moved the needle on $3 Trillion in costs. (if the top 5% are half of all US healthcare spending, that’s $1.5 Trillion, or $187.5 million per baby. That’s expensive indeed!)
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Perhaps, maybe the overall “high” rate of mortality is affected by the way births are counted?
The link you posted shows that, at least for the 2005 data it uses, the US reported infant deaths the same as most countries in Europe (and came out near the worst). The same link shows that even if we used the more restrictive reporting used by the Czech republic and a couple others (basically: not counting deaths that happen with extremely preterm babies), we would still come out as almost the worst. So that link itself shows that (a) we already have the same reporting as most countries; and (b) changing the reporting doesn’t change our outcome much.
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Firstly, it’s nice to see a post from someone who has the background.
I don’t want to overwhelm the thread with clinical lingo, I just want to run a few numbers. (I worked with two hospitals on the DOJ settlement negotiations. My background is in billing and HIM, I was on a team with EP cardiologists and CV nurses.)
The two hospitals had about 7200 total ICD implants over the years at issue. Originally, the feds gigged them on 465 cases. After negotiations, this came down to a grand total of 66 (less than one percent) for which they were fined.
Not one of those 66 cases was determined to be a needless implant. Every single one was beneficial to the recipient’s health.
Now for the benefit of the rest of the readers here, the reason the feds dropped their claim on the 399 (out of 465) cases, was because they could clearly see that even though the implants did not meet Medicare’s obsolete criteria, the patient’s lives were incontestably saved and lengthened by the procedure.
The government emphatically did not want to have any of these cases go to trial and have patients on the witness stand saying “Yes, I am here today, living a complete and happy life, because my doctor did something for me which the Medicare program characterizes as fraud”.
And that’s where the problem lies. If we are going to have a government-run single payer system in the USA, we simply cannot carry over to it the Medicare template of criminalizing physician decision making.
Every doctor I have talked to about this is concerned that if we go to single payer, s/he will be at risk of prosecution based on their medical judgment for 100% of their patients instead of the 40% exposure they have today.
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One more thought. If it’s necessary to make tradeoffs between cost and the delivery of life-saving care, I do not have a problem with that. It is the taxpayer’s money, after all.
But I have a real problem with sanctimonious bullshit that tries to cover up those tradeoffs with soothing talk about “medical necessity” and “quality”.
One of the docs I worked with made the on-target observation that “nothing is better for the financial health of the Medicare trust fund than massive, untreated cardiac arrest at age 60”. You know that it’s true…
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No it didn’t. If you had a good policy before (you were very fortunate, and) it was not legal to take that away from you.
ACA was for the large majority of citizens who could not get health insurance before, thanks to working at small companies or being self-employed or having a pre-existing condition (or a made-up “potential for” a pre-existing condition, which is why I wasn’t able to get insurance).
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My Lord, you people must really do things differently than the rest of us, even for tax-funded healthcare…
We have had these systems working for more than 40 years now, you know. I don’t think the level of physician liability is any higher than it is currently in the USA - probably less so, given that our courts tend to frown on frivolous torts.
All of our systems are funded in roughly the same fashion as your Medicare (only with a much more inclusive clientele, that is, everyone). I don’t think they tend to encourage “massive, untreated cardiac arrest at age 60” - if they did, our average lifespans would be lower than your country’s, and that is very definitely not the case. If a Medicare-style administration was, by its very nature, cause for large-scale spending inefficiencies, then we’d all have much higher per capita costs than your country, and that is so far from true that it is risible.
Maybe, just maybe, it is time to quit saying what can’t be done, and have a good look at what has been done instead, even if it takes looking outside your borders for a change. You’re doing it wrong.
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It’s cultural.
The American public wants:
- a continuing flow of new, high tech procedures and pills to cure them quickly and with 100% positive outcomes
- the medical care they want, when they want it. No waiting, no getting a referral from a primary care doc.
- The medical care they want, where they want it. Every hospital, every doctor covered.
- the right to sue and hit the jackpot every time their medical care falls .0001% short of perfect results
- and last but not least, they want all this with very low premiums, and no copays. Some one else will pay!
So we don’t need a new system, we need new patients.
Edit: If our Medicare system would stop threatening to prosecute hospitals and doctors for following the Hippocratic Oath when said oath is at odds with Medicare’s groaning bookshelf of regulations, I’d say we have the potential to take a step in the right direction.
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I do not know who you speak for. I would just like to get medical help when I wake up at 3AM and feel like I’m having the symptoms leading to a heart attack, without having to weigh the risk of dying against the risk of failing to pay my bills / my families bills.
Incidentally I took risk of death and came out ahead, but my friends and family would probably be horrified to hear that, and I would never wish that decision on anyone else.
ETA: I am guessing it was a panick attack, as I’ve had several more since, but I have not had it diagnosed because my provider UHC will not cover such a diagnosis. UHC also happens to be campaigning against the single payer initiative in my state of Colorado. Presumably to maintain my quality and freedom of care /s.
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Sure there is. It’s not a question of cost but price.
Step 1: Don’t allow hospitals to charge a 10,000% markup on the generic tylenol they give you. Or $10 for the little paper pill cup they give it to you in, etc. Institute a reasonable markup cap that would cover overhead and yield a reasonable profit, then penalize any providers who violate it.
Step 2: Don’t allow the Shkreli’s and Epipen bandits - make them refund all their price-gouging plus double as punitive damages.
Step 3: Eliminate the systemic parasites - Networks, HMOs, Insurance Companies - all those people who are contributing nothing to health care while sucking money out and telling people which doctors they are allowed to go to and which treatments they are allowed to have (regardless of what the doctor says) - they only stand in the way of health care.
Those 3 steps could probably cut health care expenses by 66% or more while providing better care.
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While it’s better than what you had before, if the ACA were proposed in most countries with existing socialised healthcare systems it would be denounced as a right-wing plot to destroy public healthcare by stealth.
It’s Romneycare; a scheme devised to fend off demand for single-payer healthcare while maintaining corporate profits.
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He speaks for the jaded medical industry bean counters. (At least that’s my take from a few of the comments up thread.)
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But aren’t those procedures themselves overpriced?
Do you mean to say that paying less for care means getting worse care? Because it seems more like the current profit model in the health care sector is similar to that of free to play model of smartphone apps, where a few whales pay hundreds and thousands of dollars in micro transactions while people who would pay a couple of bucks for a free game make do with the silly arbitrary rules that keep the whales spending more and more money to play candy crush on their phones.
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It might have been sugar coated, but Obama care wasnt intended to address cost. The main goal was to increase coverage. Costs have risen at about the same rate they did before.
I’m surprised since they mentioned outliers pay for half of medical spending they didn’t show a graph without them. I imagine average pay would be more in line with other countries but outcomes would still be lower.
Radiolab had a good story[1] about Seneca, Nebraska where encouraging people to have a plan reduced end if life costs considerably–no forced cost reduction. I’m a bit surprised insurance companies haven’t run with this and offer discounts for people who do this.
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I’m sure you mean well, but this is misperception way beyond Trumpian levels. If there are any other participants on this thread who actually have job experience working in health care and who see the budgets, I invite them to chime in.
Edit: I do agree with you about the escalating drug costs. We need to get the FDA to stop throwing roadblocks in the way of companies who want to compete with the price gougers, and we need to allow American consumers and providers to easily buy medications from outside the USA. But doing those things will maybe take a few percentage points out of the cost of care, it’s not a game changer.
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If you live in the United States, every hospital is required to evaluate and treat you when you show up in the emergency room, even if you don’t have two nickels to rub together. This is mandated by a law called the Emergency Medical Treatment and Active Labor Act (EMTALA). Apparently you are not aware of its provisions. I urge you to check it out, you may find it reassuring.
And of course, the care and treatment that are provided to indigent patients by hospitals under EMTALA is paid for by exactly nobody. The care and treatment that are provided to Medicaid patients by hospitals under EMTALA is paid at perhaps 50-70 percent of what it costs to deliver that care, depending on where you live. That’s why you get things like
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Increasing “coverage” amounts to jack shit unless there are sufficient numbers of quality doctors willing to participate in your insurance plan and accept its payment levels.
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As a brit this just underlines how much more work the Tories are going to have to put in if they want the NHS to function as a US-style system. These things don’t fuck themselves up on their own you know!
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