"While we have the best Doctors, Surgeons, Nurses, Testing Equipment, etc. we have arguably, the worst health delivery system of any industrialized country."

WHAT? How did you come up with this one? Having been to most industrialized countries, and lots of third-world nations, I can unequivocally say our healthcare delivery system is at the top of the list--NOT THE BOTTOM. I have relatives in the UK and Canada that come here for surgical procedures and medical care. They'll tell you first hand that the health-care delivery systems in their part of the world doesn't give a damned of you live or die--you're just another number on a very long list and you're at the end of a very long, bureaucratic line. While it has been many years since I worked in medicine, I've seen the results first hand. Until you've been there, done that and got the Tee-shirt, don't knock the U.S. health-care delivery system. Spend 15 years working in a large, inner-city hospital and you'll get to see things you won't believe.

Sure, our infant mortality rate is high, but keep in mind that we report everything--not just the good stuff. We report birth mortalities from crack-heads, heroin addicts, coke-heads, huffers, etc.., where many other nations place those deaths in different categories, which makes their infant mortality rate appear much lower than it really is. You will not find this in the liberal press--you'll only get this information by reading the actual studies, which most people will never take time to do.

Damned I hate politics, politicians, and all the SOB's currently in office. Bill, I wish you would not have posted this--even in the bar.

I need a drink,

Gary

I'm basing my comments on our health care system on several different things. There are mountains of peer reviewed research studies that have looked HC around the world and done analysis to compare what we experience in the US. Kaiser Foundation, Robert Wood Johnson Foundation, the National Institute of Health and the WHO, to name a few. I've also followed several different Health System researchers over the last 18-24 months, including Jonathon Gruber who got his BS in Economics from MIT and a PhD. from Harvard, also in economics. Gruber has been a "go to guy" for both Republicans and Democrats. He helped with Mitt Romney's universal coverage efforts in MASS., as well as Pr. Obama's efforts this year. Also, Dr. Aaron Carroll, who in addition to being a practicing pediatrician and professor at Indiana University, is the director of the Center for Health Policy and Professionalism Research. A former Robert Wood Johnson Clinical Scholar. Plus I've read misc. publications from the Rand Corporation, TR Reid's "The Healing of America" and many other papers, studies, etc.

I've never worked in a Hospital, but I have a college education and have invested a lot of time to educate myself on this subject. I don't list the above to impress anyone, but I am prepared to provide links to research and studies if anyone wants them. These aren't my conclusions, they are the conclusions of many industry professionals who job it is to study health care economics and support their claims via data.

Now that that's out of the way, let me make my case.

Three basic components HC economists use to evaluate HC. Access, quality and cost. Our system costs about two to three times per person what most other countries pay. Our outcomes are not as good when compared to other industrialized Countries. We still don't have universal coverage for our citizens. We're not just bad on one of these metrics, not even just two. We perform poorly on all three when compared to the ten richest, industrialized countries in the world. They pay way less, (even in taxes), cover everybody and usually beat us in quality. Our costs alone are unsustainable, so something has to be done...and sooner rather than later.

The US spends 2-3 times more per person than any Country in the world for HC. And we're not getting the best in quality outcomes for the extra money. If we look at it as a % of GDP, we're also in bad shape. We also pay more in public monies (taxes) than any other industrialized country over the last ten years. So, no, they're NOT paying higher taxes than us. But, they get everyone covered, unlike the US.

http://mdcarroll.com/2010/01/20/some-slides-on-costs/

Speaking of quality...

We do poorly not just in infant mortality, but also maternal mortality. And % of immunized for dtp, and life expectancy at birth and preventable years years of life lost, cancer, respiratory illness, Heart attacks, etc.

Now perhaps there's an excuse why the measurements are wrong in "every" one of the above metric or maybe our system isn't that good. Certainly not for the price we pay.

http://mdcarroll.com/2010/01/20/some-slides-on-costs/

Actual OECD research: http://www.oecd.org/document/16/0,3343,en_2649_34631_2085200_1_1_1_37407,00.html

While Gary has relatives who have come to the US for treatment, I'll refer to a peer reviewed study, published in Health Affairs:
http://content.healthaffairs.org/cgi/content/full/21/3/19#R8

In summary, first, they surveyed US border facilities in Michigan, New York, and Washington. It makes sense that Canadians crossing the border for care would favor sites close by, right? It turns out that about 80% of such facilities saw fewer than one Canadian per month. About 40% saw none in the prior year. And when looking at the reasons for visits, more than 80% were emergencies or urgent visits (ie tourists who had to go to the ER). Only about 19% of those already few visits were for elective purposes.

Next, they surveyed �America�s Best Hospitals�, because if Canadians were going to travel for care, they would be more likely to go to the most well-known and highest quality facilities, right? Only one of the surveyed hospitals saw more than 60 Canadians in one year. And, again, that included both emergencies and elective care.

Finally, they examined data from the 18,000 Canadians who participated in the National Population Health Survey. In the previous year, only 90 of those 18,000 Canadians had received care in the United States; only 20 of them had done so electively.

So there you go. Three different methodologies, all with a solid rationale behind them, all showing that the meme is a myth. (Summary by Dr. Carroll)

I'm glad Gary spoke about the value of the research. I'm not getting this info from NBC or some left wing group of crazies. It comes from the studies and research I've cited. It comes from dozens of other works I haven't mentioned. Now, if someone can tear apart each of those citations I provided, that would be something. All this peer reviewed, tested research can't all be left wing propaganda, can it? All of it? not a chance...

We're so screwed up in the Country, we can't even add a simple, straightforward provision into the HC Reform Bill that allows end of life counseling sessions to be reimbursed. Paying for a patients own physician to discuss with them their treatment and care options. The kind of stuff you'd find in a living will. Its not about a "death panel." So, while Gary will warn you about the junk from the Left, I'll make the same warning for the Right. Both sides exploit citizens to gain political ground. Its shameful on all accounts.

Anyway, that's a little bit of why I feel the research supports my earlier claim. The US has the greatest everything, except for delivery systems. Now, if you have money or good insurance, you're all set. But if you don't, good luck.

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Bill in Dayton


[This message has been edited by Bill in Dayton (edited 05-22-2010).]

"The US has the greatest everything"

Bill, with all respect, but such statements make me want to throw up.

Name all the greatest things that the rest of the world doesn't have. Shouldn't be hard since you only have to omit the ONE thing that isn't the greatest. But don't forget to mention all the greatest of "bad" things as well. Oops, dumb me! There's only ONE!

Ah, what do I know about freedom. Who am I to speak up since I'm still living in a hole in the ground and the only cure for a headache is to bang my head against a rock.

If you go carrying pictures of "USA HAS THE GREATEST OF EVERYTHING"
You ain't going to make it with anyone anyhow!

This was supposed to be an intellectual debate but statements like these flush all intellectualism down the drain.

Taike

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Bo pen nyang.

[This message has been edited by Taike (edited 05-22-2010).]

To be fair to Bill that statement was made in regard to medical technology. And that is probably true in that there is most probably more money in medical technology in the USA than anywhere else. But as Bill also said when he made that statement "if you have money or good insurance, you're all set. But if you don't, good luck", so he was admitting this technology was not available to all as it should be. The reason medical costs are so high in the USA is because the private medical insurance companies profit from medical service. Those profits are built into medical costs and aren't really part of the medical service that is provided. That is what is very bad about the US delivery system.

I was very fortunate 10 years ago when I suffered a massive brain aneurysm in Los Angeles. I was in between jobs at the time and had no medical insurance ... very bad timing on my part. Because I had no insurance I was shipped off to a County hospital USC. However this actually worked in my favor surprisingly. Because the USC surgeons had dealt with many severe head gunshot wounds from gang shootings they were able to successfully deal with my brain trauma. They not only saved my life but were able to prevent serious brain damage. I actually think in this case I got better medical attention by not having insurance as I didn't have my choice of surgeon and hospital determined by a profit motivated insurance company. But I admit I was very lucky and this is not always the case with uninsured patients.



[This message has been edited by Nigel (edited 05-23-2010).]

As Nigel said, that remark was directly related to Medical and related things. As I think there may be a slight language barrier, let me clarify. And take a slight step back as well.

There are many good if not great things about the health care system in the US. Our physicians are some of the very best in the world. We also have many of the best hospitals anywhere. Our medical education and training, stacks up favorably compared to other countries. Our technology is high end and excellent.

We have a lack of general practitioners because of an over-focus on sub-specialty care. AS a result, we're probably the best at high end procedures and caring for rare and difficult illnesses. We spend a ton of money on research, which benefits everyone down the road.

I think on the whole, the US is probably the leader when it comes to the various components of a modern day health care system. Its just not put together in a rational way and the inefficiencies have led to fiscal hemorrhaging. Too many people are without access to quality and affordable healthcare and suffer questionable results in terms of quality of care. We reward Doctors for how many tests/procedures they perform, too often without enough regard to the quality of the care they provide. The system has a built-in disincentive to streamline things. Some Hospitals in the US, like the Mayo and the Cleveland Clinics have placed their Docs on Salary. Which is very interesting. They've totally removed any incentive they might have to order extra procedures/tests/etc. Other Hospitals are also looking at going this way.

Again, if you have insurance in the United States, you're probably going to be well treated. However, we shouldn't only view the US and its health care performance on the numbers of the insured. We should, IMO, view the totality of our population and be measured by that standard.

Nigel's story is spot on. Absolutely, sometimes uninsured patients receive terrific care and enjoy great outcomes. But too often they don't.

A terrific, smooth read is "The Healing of America" by TR Reid. An award winning journalist, he travels the wealthiest, industrialized Countries and sees how each would care for his bum shoulder. PBS / Frontline also produced a program based on it, which can be watched here for free:
http://www.pbs.org/wgbh/pages/frontline/...utm_source=grid

Its not too long, but very interesting.

Taike-I'd suggest maybe re-reading some of these posts that appear to you to say this that haven't been said. Again, I chalk this up to a language thing.


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Bill in Dayton




[This message has been edited by Bill in Dayton (edited 05-23-2010).]

Well, the way it's written it's open to more than one interpetration but I accept both yours and Nigel's .

My apologies

Taike



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Bo pen nyang.

Bill,

In case you wish to learn more about Taiwan's NHI system:
http://www.nhi.gov.tw/english/index.asp

--------------------------------------------
Compulsory Enrollment

The National Health Insurance system is a compulsory social insurance program. By law, any Taiwanese citizen with a local ID card or foreign national living in Taiwan with an Alien Resident Certificate (ARC), regardless of age, gender, or employment status, must enroll in the program. Also, those eligible for the system must participate in the system for their entire lives, unless they lose their eligibility (by being convicted of a crime, disappearing, giving up their Taiwan citizenship, moving abroad or having their Alien Resident Certificate expire). Citizens must remain in the insurance system until they die.

Taike



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Bo pen nyang.

(2008 article)
http://www.dissentmagazine.org/article/?article=985

--------------------------------------------
(2004 article):

Universal Problems & Universal Healthcare:

6 COUNTRIES � 6 SYSTEMS
http://www.willamette.edu/centers/public..._healthcare.pdf

Bill,

I suggest getting some first hand experience in these matters and not placing as much reliance on biased studies and books.

Spend a couple weeks in a hospital emergency room and you'll quickly discover that only about 1/3 of those receiving medical treatment pay for it.

You'll also find that half more use the ER for their primary health care instead of visiting a local clinic where they would have to pay for health care. They show up with runny noses, broken toe nails, minor scratches, and they're immediately treated.

Now, for the above studies you posted, I could site an equal number of opposing views for each and every one of them, but it's not really worth my time and effort to go through the archives and list them.

Bill, when it comes to health care there is no substitute for practical, hands-on experience. Yes, you can obtain some basic information from books and studies, but books, studies, surveys and statistics can only go so far. That's why medical students must go through an internship, residencies and post doctoral fellowships. That's where they obtain their hands-on experience, and in some cases, wash out of medicine altogether. The demands of internship, and residency, both physically and mentally, are beyond anything anyone can possibly imagine.

If you believe that socialized medicine is the way to go, that's your prerogative, and in this nation, you have the freedom to choose what your government can and cannot do. For me, I'm still trying to find one thing the government administers that has been successful. I sure as Hell do not want a lying-assed politician in making decisions about how MY health care is administered.

It may seem like a good idea when you are relatively you and still in good health, but one day this will all change. That morning will come when you get out of bed, turn on the PC and check your email, just like every other day. Then a pain will run down your arm, not something like you've felt in the past, but nothing severe. Soon, it will be followed by shortness of breath and increasing pain, dizziness, and your heart begins to slam. The pressure inside your chest makes it feel as an 800-pound gorilla is standing on your chest. Yep--you're having a heart attack.

There's no one at home other than you, you crawl to the telephone, call 911. You're hoping that you survive until medical help arrives, which usually takes a few minutes at best. A well trained EMT breaks down the door, enters your home, connects you to an oxygen tank, while a well-trained assistant starts an IV. Within the next 10 minutes you're on your way to the nearest hospital, and instead of being immediately ushered into the exam room for an EKG by a practicing cardiologist, then off to the Operating Room for a cardiac cathederazation by a highly skilled cardiac team, stenting by a cardiovascular surgeon, and into the recovery room where a team of nurses,technicians and physicians that specialize in cardiology immediately go to work. That's the way the system works NOW!

OR, with socialized medicine, because you are NOW 70 years old when all of the above occurs you no longer meet the criteria for receiving costly stents. You're placed on a stretcher in an ER cubicle, administered some oxygen, then handed a pile of papers to fill out so you can get on the list that needs stenting.

Politics should NEVER be permitted to intrude into health care--and that's not just my opinion--it's the opinion of most every in this nation.

I'm going to work now so I can earn enough money to pay this week's taxes.

Gary

Ok, do studies matter or do they not?

Sure, we could get into a source war, I suppose, but who wants to do that? First you said studies are the only way to get the info, then when I provided those type studies, you then switched and claim they're really limited in what they tell us.

You say that we should straight to those in the trenches. While I'm not sure I agree a person trained to read a catscan is qualified to write policy, I do get your point. They absolutely MUST be in the discussion.

Here's not one, but two research studies from Physicians across a variety of specialties and their feelings on the US establishing national, universal insurance:
http://mdcarroll.com/2009/10/29/research-question-wont-american-doctors-hate-single- payer/

Looks like the data shows that more not less feel we should change systems. Let me guess, these Docs and this research doesn't mean a hill of beans. They lied, its a conspiracy, etc.

Yes, god forbid, any of us has a bad experience in a Hospital. When you had your heart attack, did you pay for everything with private insurance? Out of pocket? If you did, that's awesome...Most people in that age bracket wind up using some level of medicare along the way, which of course is Socialized medicine.

I have the utmost respect for anyone who while qualifying for Medicare refuses any and all payments, beyond which their own contributions over the years have grown to. I've yet to meet one.

Fact is Medicare for all of its imperfections and problems, is highly popular among Seniors. Why is that? Are they Socialists? Same thing with the VA system, the most Socialized health care system in our Country...again, with definite problems that have to be addressed, is very popular among our Vets.

Two examples of "socialized" flavored programs that good, upstanding, Patriotic Americans just like you and me use every day.

Even private insurance plans have a strong socialized element to them. Premium dollars are pooled and the healthiest (Youngest) policy holders wind up paying the freight for the sickest (oldest) ones.

My Dad's had several stent procedures, and in the two instances where there was really no advance warning, upon entering the local ER in a suburb of Pittsburgh, was treated swiftly and effectively. All he's got is Medicare. We shouldn't get caught up in anecdotes. In something as vast and complex
as HC in the US, there will always be horror stories. We should address them, but not base policy on them.

When I started educating myself about healthcare in the US, I didn't come at it with any ideology or pre-conceived ideas or attitudes what was best. I voted for GWB twice, and generally lean towards republican/conservative positions on things.

I'm not, however, a loyalist. I won't take a position just because a political party says I should. I disagree with much of the "Bailout" actions of the last 18 months because I think businesses that go under should face the consequences. I also have issues with some of the mortgage relief programs. When we bought a house, we educated ourselves and stayed away from the dreaded "balloon" mortgages that have killed so many. I do think the Clinton Administration went too far in forcing lenders to loan to those with questionable credit and income, but we shouldn't have to pay their way...On the other hand, I think DADT should be repealed in a sensible time frame. I don't fit into a political box and don't want to.

I started with a pretty blank slate, and formed my opinions on my research, the zillions questions I asked and common sense. I also am married to someone who's got years of hands on experience in emergency rooms, med surge units, long term care facilities who will have her Masters in advanced practice nursing in a few weeks. She agrees with most of my conclusions. She's reviewed the data, the studies, etc.

Yes, I'm going off to play today as well, and no doubt about it, some of my earnings will wind up as taxes paid to Uncle Sam. I wonder how many measures of the first tune we play it takes to pay the taxes for each of our gigs?

Have fun..

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Bill in Dayton

[This message has been edited by Bill in Dayton (edited 05-23-2010).]