Is it? High quality? Having lived through more than 15 years of family members being misdiagnosed with fatal diseases, dying of hospital borne infections, being recommended optional surgeries that prove fatal, have specialists that run you out the door in 5 minutes, of being turned away from ERs, of enormous costs for what should be routine surgeries and diagnoses…I have to wonder. There are still good doctors and good treatment out there, but at times it feels more like you are being farmed for your insurance money than being treated with Hippocratic care. It doesn’t help that at every stage there’s these wierd incentives to both make as much money as possible and also cut costs as much as possible. Overworked and understaffed nurses and assistants at the same time doctors that literally misread charts and pass the buck to the next doctor on shift 8 hours later or blame the nursing staff.
What the US needs is 3x the staff paid about 1/2 as much, and the cost of procedures, drugs and equipment cut to a 1/4 or less. Places for indigent or uninsured people to receive basic care for free, freeing up ERs. Health coordinators that look comprehensively at your health instead of an army of specialists with definite “political” boundaries about their specialization only dealing with one tiny part of the body and nothing else (lymph nodes on jaw, my problem! - lymph nodes behind ear, not my problem! Lymph nodes behind ear? my problem! - lymph nodes under arm, not my problem! ect) who pass you around like a football between themselves.
That’s true for my first example but apparently you did not read the rest of the paragraph:
So I’m also comparing a service to a service. In most services, you get an estimate up front and if the estimate changes, most states require the consumer be notified and agree to the additional services. Again, health care is the outlier, the exception.
Also, Nesrie, I’m not sure what you are doing here. I understand you feel you are defending the medical profession but I’m not attacking the medical profession. I’m attacking the underlying market imperfections of health care pricing and our “one size fits all” approach in the US of trying to force the square peg of market forces into the round hole of health care pricing.
Unless you feel that the current system of health care pricing in the US is a great system and we should all just LIKE IT? If your position is that the educational costs of the medical profession mean that we should all just pay whatever providers feel like charging and ignore the reality that the health care market is imperfect, then I strongly disagree, but again that’s not a disagreement about the medical profession; it’s about the health care market.
Ex-SWoo put “quality” in quotes as I believe he was not referring to actual quality of results but rather all the amenities and aesthetic flourishes that are common in many of the for-profit hospitals and private practices in the US. The high profits these providers generate do allow for a higher quality of amenities and aesthetics but that doesn’t equate to actual health care results.
He put it in quotes, so I presume there’s some shade of doubt to the actual label. Studies have shown that while the US typically has the most effective care in terms of preventive medicine, it lags behind several other nations in pretty much everything else.
Sorry - I should have clarified in the original post. I did indeed mean the aesthetic aspect of healthcare.
I have experienced the Japanese system for 7 years while living abroad and compared notes with lots of expats while living there on European systems - it’s very effective, but very no frills. I once cracked my rib cage and only was able to get about 5 min of the doctors time when I went to the hospital to get it looked at.
Results wise it’s fine, but my ego did take a bit of a bruising :)
In the US we seem to over index for the opposite extreme on average. Funny enough, I’ve met lots of upper class Asians/Europeans who liked the US system since they get pampered more and can pay to cut in line.
I still think on when my father was in one of the “best hospitals in the world” for a couple weeks due to a heart condition (he’s fine now, no worries). There were complications that the doctors were running into with his GI tract, and had hooked up a tube for his stomach. I visited frequently, but something kept nagging at me every time I was there - the height of the pump and tube in relation to the bed and his body position. I remember siphoning from my childhood and learning about how that worked. None of the staff thought there was an issue, but I finally said enough was enough, jury-rigged the thing, and “amazingly” my father was feeling better very quickly. A nurse came in after I left, changed it around again because it “wasn’t right” but of course his pain came back. I came back the next day and fixed it, but this time waited for another nurse to come by so I could explain the physics. She asked for the doctor to come by so I could share my layperson’s findings, and he agreed - the way the pump was designed, it would automatically turn on when the conditions were right, but the device wasn’t smart enough to realize it was over-pumping due to the way it had been set up. This, in turn, was causing stomach issues. My father was doing better and out of the hospital in 48 hours, instead of being run through a million more pointless (and expensive) tests.
A big trend now is having a “patient advocate” with the person whenever they go into a facility. That’s a really nice euphamism for someone who keeps an eye on all the staff changes, procedures and prescriptions and literally make sure the staff do their job and don’t fuck things up. I mean, isn’t that why you’re paid the big bucks? We have to oversee and coordinate our own treatment because we can’t trust the staff not to make mistakes?
I am not defending medical professions persay so much as repeating what I’ve said before. You can’t really restructure the medical systems without also looking at the systems behind them. This includes the educational system… There is also a lot of concern with the insurance industry which the health systems don’t control, and the government payors are the worst offenders for their complexity and lack of ability to really know what the end result will be. In addition to that, we have an issue with the drugs… which the healthy systems typically don’t make. Sure there are some made in house, mixtures, but for the most part those are controlled, sold and priced by pharmaceutical companies. And then you have the DMEs, the product producers, which, and I’ve said before, it boggles the mind how much the screws cost for some of these replacement parts… the screws.And that’s before you get tot he machines. Patients are always wanting the new shinies even when the 50 year old machine works just fine. The new eye exam machines, they produce very nice pictures to show a patient but the providers pretty much say the added benefit is minor and doesn’t really justify the costs.
I also used healthcare in other countries. It’s not like I haven’t traveled abroad. I paid for my physician visit up front, with cash, in Japan and the physician sold me my drug. Here, that’s a conflict of interest. We don’t let our physicians also sell you the drug they prescribe.
I have said repeatedly that our current system can be better. I don’t even know why you’re asking me that. What I am not okay with is comparing healthcare as product. I did read the rest of it, but when you’re in a health system, that health system is going to supported by the money making departments even though they offer money losing services like… the ER. And again, other countries don’t have malpractice like we do. They simply don’t have that. Several people think insurance is minor… it’s not. And there is a reason you wind up spending an hour in those freaking offices as physicians overbook their calendar… and of course we have the people who show up with a cold that we’ve been telling people for decades not to take drugs for but they still demand it.
But hey, it was a mistake to engage here. It’s clearly not a safe space to actually talk about our industries unless it’s gaming or strictly tech. I’m sure everyone else enjoys being told to fuck off and getting whatever you work on for free.
I agree with this. Bernie-bro dreams of enacting single payer and suddenly dropping US health prices to Euro-equivalent levels are fantasies. What your are pointing out is that we have gone down a path on health care prices in the US, and we have sunk costs and are path-dependent, so reform has to be comprehensive. It should also be gradual.
However, we do have to grapple with health care pricing in this country. My current position is that a gradual phase-in of either a much more robust form of Obama-care or a gradual “buy-in” system of single payer, coupled with gradual pricing reforms like phasing in all-payer rate setting is the way to go. I have no illusions that this will be fast, easy, or a “magic bullet”.
Also, based on the experience of other countries, even fairly strict price reform is unlikely to actually reduce health care prices. The pattern in other countries is that health care price reform reigns in medical inflation to be comparable to overall inflation, such that the share of GDP going to health care tends to stabilize, rather than continuing an upward spiral, but it also doesn’t shrink. This means that health professional incomes will stabilize down to the regular rate of inflation, but they won’t shrink. The rate of future growth will slow. It’s the “bending the cost curve” thing.
There is another wrinkle: you have a valid point on the issue of health education costs: if we stabilize health care professionals down to the regular rate of inflation, it would be appropriate for the cost of a health care education to also stabilize down to that level. However, higher education costs in this country, especially professional education like law school and medical school continue to rise much faster than education. That’s a topic for another thread…
Yeah, the differential in net lifetime earnings for an MD versus a median US worker is about $3 million lifetime for GPs and about $6 million lifetime for specialists. That does include factoring in the years of additional education. If you compare an increased income of $3 million to $6 million versus a typical $200K to $300K of debt, the debt is relatively small.
That said, I do think the continued surge in the cost of higher education is not good in the long term. In many ways, higher education is similar to health care in that it’s a market with inherent imperfections, albeit in the converse. Whereas the problem with health care is inelasticity of demand, the problem with higher education is inelasticity of supply. Not in the overall supply of higher education but the supply of slots at “elite” universities which, for a variety of reasons, carry a huge premium in desirability, perceived status, and lifetime earnings. But, again, that’s a topic for another thread.
Thanks for providing the link to this very good news. This has always been a problem when going to an in-network hospital or ER under a typical PPO plan. Ten years ago, I was charged ~$500 for hospital visit (I think 5% or so of total), with an additional $3000 that came later from the out-of-network anesthesiologist’s services. I had absolutely no idea at the time, that even when at hospital you can be billed by multiple entities. I complained to the PPO provider, and after several months that insurance company agreed to cover 90-95% of the cost. They didn’t even negotiate the price down, rather reimbursed me the actual amount. I was quite surprised by their goodwill gesture, since it was a pretty straight forward case of out of network service.
It’s great for Californians that this surprise billing will not happen any more. I agree that these are the type of systemic problems that can be solved in our current health care system using the already existing methods. It’ll require some three-way negotiations between insurance company, hospitals and service providers, to provide single in-network billing to the patient, and that may not be easy but that should have always been the case.
(1) This is a huge deal and unexpected. Sets up a giant fight over what to put in a 2018 budget resolution.
(2) First, Obamacare repeal currently in limbo in the Senate now has 29 more days to go. So the Menendez/McCain scenarios have a shelf life
(3) Second, the 2018 budget resolution becomes the last chance for a majority-vote vehicle for Congress. What will Rs try to stuff in there?
(4) If they put in taxes and health care that really complicates tax reform. If they leave one out it’s done until the midterms.
(5) All the talk has been about taxes on the Hill lately, so likely scenario is leaving HC out. But that’s a full admission of failure on repeal
(6) Because HC is so high-profile, whether or not it gets in the 2018 budget resolution will be a huge fight. Magnifies potential for no reso
(7) No resolution means no HC OR taxes.
