That might be true, but it also seems to be true that we’re a bit over tested in general, which contributes to our higher costs.
5 Likes
Sure. Unfortunately our Medicare system overspends on healthcare.
If our public healthcare programs were as efficient the countries Sanders points to, they would already cover every American.
Hell, if we had Canada’s healthcare system in 2014, not only would every American be covered, every man, woman and child would get a $560 check in the mail.
Which is why I’m hesitant every time Sanders claims Medicare-for-All will save the amount of money unless it does a major revamp of Medicare. If you notice when Sanders’ makes savings claims, he says stuff like “if the U.S. moved to a single-payer system as efficient as Canada’s, we’d save…” when our Medicare system is nowhere near as efficient as Canada’s.
3 Likes
IF their patient is wealthy and/or has stellar private health insurance. Everyone else, a large number of medically-necessary basic treatments are turned down by insurance companies as a matter of policy, so then it becomes a test of wills and whether or not your doctor is part of a practice that can go through the steps to fight for the procedure. As I said, the death panels are at every age in the U.S., except for the lucky few.
11 Likes
I think part of what you’re missing in your comparisons between Medicare and Canada’s system is that Medicare is often hobbled by the government in ways that intentionally make it less efficient and more expensive (for example, Medicare isn’t allowed to negotiate lower prescription drug prices). However, when compared to the egregious abuses and over-runs imposed by our current private insurance “system”, putting everyone on Medicare would be a tremendous economic savings. The reduction in billing and collections overhead alone would save literally millions of dollars a year.
The other thing to keep in mind is that what people pay into the system is only one side of the equation. Procedures and treatments in the US are often astronomically more expensive than they are in other countries, for no other reason than because they can be. That overhead imposed by the people providing treatment is the other side of the equation to lowering costs. Putting everyone in the country on a single insurance platform and telling providers “you either charge this or you get nothing, period,” is the most powerful negotiating tactic you can have in driving down the actual cost of care, and that’s what Medicare for All gives us the opportunity to do.
12 Likes
Oh the savings would be in the hundreds of billions of dollars. I’ve seen estimates of savings equal to 14% of total healthcare spending - which is today over $3 trillion/year.
But then, little of that savings is unique to single payer. The vast majority of the administrative overhead savings is due to uniform billing rates. In France and Japan for instance, they just set the rates ahead of time for every payer which makes them just as efficient as single payer (well, in Japan’s case, far more efficient).
That said, “Medicare-for-All” is simpler to campaign on.
1 Like
But I think that’s partly true because our entire healthcare system has been getting geared towards a profit model for a long time now. There isn’t really any reason why we can’t BECOME more efficient, I think, other than political will. I think the problem rests not with medicare, but with how the rest of the system operates.
12 Likes
No. [quote=“Aloisius, post:101, topic:97721”]
The cost-savings measures that countries do aren’t just end-of-life scenarios. They’re things like cutting way back on MRIs…
[/quote]
Which country? I daresay things like MRIs, technetium bone scans, CT scans, bone density scans, etc. are easier to come by and covered better by insurance in my country than yours. You might have to wait, but for serious cases you will not wait very long. As a prostate cancer patient, I am saying this with some very direct experience.
Certainly. Mammograms are given at need, to be sure, but the high risk group is 50-69. From an actuarial point of view, 80-year old women have survived long enough to be low risk (about 5% of overall mortality rates in that age bracket).
Debatable. This is a situation where my province (Ontario) resembles your overall healthcare in that we have a patchwork of insurers, including the province’s Trillium plan for residents with high drug cost burdens. Drug costs can be separated from other costs, unfortunately. I won’t claim we’re perfect up here - our drug costs may be higher than they should be. This is an area where we can probably learn from New Zealand. However, having said that, drugs are in the main cheaper here (y compris branded drugs) than where you are.
For a person of my age group whose family doesn’t have a history of colon cancer, a fecal occult blood test is recommended every 2 years. Note that this a recommendation, not a hard and fast rule. Colonoscopy is recommended within 8 weeks for abnormal results. This is very much akin to the PSA blood test/transrectal biopsy testing they do for prostate cancer. I’ll put it bluntly: because there is less incentive to go directly to costlier procedures here, we probably have more effective screening. I would suspect that’s one of the reasons we have a longer average lifespan (by about 3 years, which is significant), lower infant mortality, etc… That doesn’t mean that the costlier procedures are forbidden: as a cancer patient myself, I will be seeing more of them than what you are suggesting is the hard limit.
What do you think drives the private insurance industry? They can’t do anything but triage coverage if they want to make a healthy profit.
No. Just no. If an expectant mother, for example, has a worry and goes to see her ob-gyn, it’s covered, regardless of whether it’s the 3rd, 4th or 5th time around. That has been a pleasant surprise to some of your countrywomen who have moved up here. This is cost-effective in that the ob-gyns are far more likely to intercept complications before they become an unwelcome surprise.
There’s a pattern here, if you look at it: medicine is more effective if there is an emphasis on prevention and early detection. Not just cost-effective, please note, but effective in an absolute sense. Low-cost detection methods are far likelier to cover a population than more expensive ones, with the high-power methods called in when things are looking hinky. Note that doctors up here really don’t hesitate to call in these methods when they feel them to be warranted.
The truth of the matter is that effective procedures aren’t particularly constrained here, but there is less economic incentive to use them inappropriately, as is so often the case in your country. The economics of your system have encouraged a reactive rather than proactive form of medicine. The biggest problem is that your Medicare is hobbled in its ability to negotiate pricing. It should have a huge advantage in this, but it’s hobbled by a Congress that is really beholden to the players in the status quo.
16 Likes
At first glance it seems like it’s some kind of illuminati/members of a secret society thing who are sworn to keep a vow of preventing information on how to properly file your tax papers from the unworthy general public but it’s not. Tax consultants here seriously love their jobs. The love the complexity of it. You say you want to give a 5 hour lecture in Germany about an extremely complex, obscure mechanical or engineering process in an industry that affects maybe 50 people worldwide? That’s like announcing free telephone sex.
2 Likes
The overwhelming majority of experimental treatments fail.
I used to work in preclinical research. Most of what we attempt doesn’t pan out; that’s just how it goes in science.
When we find something, occasionally it adds up to sufficient clues that the human trials people have a go. Most of those attempts fail in the close-observation limited-subject trials; a handful make it through to the million-dollar investments of mass human trials.
And most of those turn out to be ineffective or harmful.
Medicine is hard.
In my neighbourhood (Oz), just about any urgent medical care is 100% covered. Elective treatments such as non-indicated cosmetic surgery aren’t covered.
In the “rationing care” realm…we have an independent government agency in charge of negotiating with pharmaceutical companies. They decide what drugs and treatments are covered by the government.
Generally, they cover the most effective proven treatment. On occassion, a pharma company will release a drug that is microscopically better than the previous best treatment, but astronomically more expensive.
In those cases, the government may refuse to cover the drug in order to gain negotiating leverage with the pharma companies. Almost always, the price rapidly drops and the government covers it.
Anyone who wants to pay for an unproven experimental treatment can do so. But the taxpayer ain’t gonna cover it; the pharma companies can pay for their own damned research.
When it comes to necessary surgical stuff, the government just pays the doctors and hospitals directly and lets the surgeons do whatever they think is appropriate,
11 Likes
I’m sporting Aussie taxpayer’s titanium 
5 Likes
mode[quote=“wait_really, post:77, topic:97721”]
decided to treat it like a video game instead
[/quote]
If you’ve found a way to make your dealings with the tax authorities not be permanently locked on Ironman mode, I’m all ears.
1 Like
I’m not sure how you got all that from my comment.
I was responding to a death panel argument. Equating the extension of someone’s life with waste is stupid, because context matters.
How much would you suppose that folks living with AIDS add to our economy today, now that they can live relatively normal lives? How could you consider this in 1992 when it was a death sentence?
I don’t know how it works in Oz, for sure, but in the U.S. the taxpayer already foots ~ 35-40% of the bill through the NIH and various state organizations. (My mother spent her career writing biomedical grants, I asked her outright what effect UHC would have on experimental research; her answer was short and sweet. “None.”) But as shown in the above example, the taxpayer of Oz is most certainly a fool if they think they aren’t going to see a long-term ROI.
All the more reason why profit has no business in health.
4 Likes
Well, if the t-men are keylogging while I’m doing my taxes, I’d be screwed… If I made enough money to be worth the effort in the first place.
1 Like
Point me towards the barricades, Senator.
1 Like
The core problem is that a critical mass of citizens have somehow been conned into believing “government can’t do anything efficiently or correctly,” with cobwebbed or altogether fictional reminiscences of a 1974 Department of Motor Vehicles as “evidence.”
It’s sort of like working in IT or Kabuki costuming. As long as you’re doing your job right you’re invisible.
Oddly enough, the governmental incompetence trope never seems to bleed over into the military realm.
6 Likes
As a resident of Japan I would not call the local system efficient at all.
And if I were a sick person in a bed right now, I would be thinking the same way.
Nevertheless I know that having such people exist, and committing now while I’m healthy to abiding by such a policy when I do become sick, is the only policy capable of maximizing the amount of life saved.
Available resources to spend on health care will always be finite, no matter how high we make it at any given moment. Any given treatment option has some expected $/QALY-saved value. We can choose to spend money consistently or inconsistently. If we’re inconsistent, then what? Eventually you may not have the resources to treat hundreds of people with conditions that don’t actually cost much, because of one exorbitantly expensive case? Hospitals close their doors in October because they burned through the year’s health care budget extending the time people spend on their deathbeds by a few hours or days by extreme interventions?
Or you can be consistent, and say, ”This year we have $X to spend, and since we know the $/QALY values and prevalence of conditions, so we’re covering all treatments with $/QALY<$Y. If we were to increase X to X’, it would let us also cover treatments A, B, an C, saving an extra Z QALYs.” This is transparent, and maximizes human health for any given spending level.
And if you’re worried about innovation and experimental treatments: by all means, set up a fund for that, and support it generously. The value of an experimental treatment isn’t in the lives saved during the trial, it’s in the data produced, and so it shouldn’t be measured by the same metric at that point.
I’m descendant from a long line of German engineers, and the curiosity for minutiae still runs deep in my veins.
1 Like
No one is talking about extreme or experimental interventions. Nice straw man but stick to things I said not things you wish you could argue.
Enjoy that when your denied that epi-pen due to cost overruns and you die despite the actual drug cost being only pennies. Health care isn’t like car insurance where a given percentage of the pool will never use the service in their life - everyone will use health care at some point - it’s inevitable with the sole exception of dying suddenly.
This is why it should never be a for profit industry to begin with - at least not basic care. The only thing profit is to the U.S. Healthcare system right now is wasted resources and capital that could be used to actual care for the sick.
3 Likes
100% agreed.
My apologies. I inadvertantly combined a reply to you with a reaction to other comments from later in the thread. I should have made that comment separately with an @wait_really near it.
Even without considering experimental treatments, and taking into account that the price of treatment in our current ridiculous system has little relation to cost, the fact remains that for any given available pool of money, there is exactly one strategy that maximizes the amount of good you can do. That strategy is to agree to cover the treatments starting with the lowest price/QALY saved (maybe not QALY, but something like it) up to the point where you run out of money. Any other choice necessarily costs more years of healthy life than it saves.
You should also be constantly trying to increase available funding, lower price and cost, and develop better treatment options, but that is much harder to do and largely separate from “What should we cover for each patient?”
1 Like
