10 replies to this topic

[MaryAM]

I don't normally agree with Bernie Sanders - but I just did some simple calculations for my town and it appears we are paying nearly 30 million in health care benefits out of a 98 million total budget - for approximately 1,500 employees in the education system (union) and 400 employees in the town (400 - union) This is over 20K per year per person. This is insane. Expand this into 170 towns (Connecticut) then add in state union employees at 20K per person per year - what is the insurance industry doing to this country? Israel gets better health care than the US. Actually 27 countries do better than the US. Will anyone please take Joe Libearman from us? Mary Anne

[Rogerdodger]

Actually 27 countries do better than the US.

Tell that to all the Canadians who come here for care.
In the first 7 months of this year 17,500 Canadians have come to the U.S. to receive health care.
Many would have died in Canada, waiting to see a doctor. Maybe that's on purpose?
The average wait time for a Canadian to obtain treatment from a specialist after seeing a primary care physician? About 4-1/2 months. In the U.S.? Virtually none.

This bit of mis-information is often quoted:
"Life expectancy in the U.S. is shorter than in 27 other countries."
Here's one reason why: different countries count differently.

The officially reported U.S. infant mortality rate has been indisputably high compared with similarly industrialized countries since at least the 1920s. (This lowers the overall life expectancy statistics.)
That fact has led to a widely accepted conclusion among public health professionals in the U.S. that these rates are "caused" by poorly distributed health-care resources and can be "solved" by adopting a socialized government-paid system of health care.

But let's look at the numbers.
While comparing statistics among countries can be tricky, in the case of infant mortality figures, the comparisons are downright treacherous. For starters, different countries count differently.

According to the World Health Organization (WHO) definition, all babies showing any signs of life, such as muscle activity, a gasp for breath or a heartbeat, should be included as a live birth. The U.S. strictly follows this definition. But many other countries do not.
Switzerland, for instance, doesn't count the deaths of babies shorter than 30 cm, because they are not counted as live births, according to Nicholas Eberstadt, Ph.D., Henry Wendt Scholar in Political Economy at the American Enterprise Institute and formerly a Visiting Fellow at the Harvard University Center for Population and Developmental Studies. So, comparing the 1998 infant mortality rates for Switzerland and the U.S., 4.8 and 7.2 per 1,000 births, respectively, is comparing apples and oranges.

Other countries, such as Italy, use different definitions in various parts of their own countries. Eberstadt observes that "underreporting also seems apparent in the proportion of infant deaths different countries report for the first twenty-four hours after birth. In Australia, Canada, and the United States, over one-third of all infant deaths are reported to take place in the first day. ..." In contrast, "Less than one-sixth of France's infant deaths are reported to occur in the first day of life. In Hong Kong, such deaths account for only one-twenty-fifth of all infant deaths."

A UNICEF press release noted: "Under the Soviet era definition ... infants who are born at less than 28 weeks, weighing less than 1,000 grams or measuring less than 35 centimeters are not counted as live births if they die within seven days. This Soviet definition still predominates in many [formerly Soviet] CIS countries."

The release also points out: "The communist system stressed the need to keep infant mortality low, and hospitals and medical staff faced penalties if they reported increases in infant deaths. As a result, they sometimes reported the deaths of babies in their care as miscarriages or stillbirths."

Since the United States generally uses the WHO definition of live birth, economist John Goodman and others in their 2004 book, "Lives at Risk," conclude, "Taking into account such data-reporting differences, the rates of low-birth-weight babies born in America are about the same as other developed countries in the OECD [Organization for Economic Cooperation and Development]." Likewise, infant mortality rates, adjusted for the distribution of newborns by weight, are about the same.

American advances in medical treatment now make it possible to save babies who would surely have died only a few decades ago. Until recently, very-low-birth-weight babies, those weighing less than 3 pounds, almost always died. Now some of these babies survive with the help of breathing assistance and other recent inventions.

While such vulnerable babies may live with advanced medical assistance and technology, low-birth-weight babies (weighing less than 5.5 pounds) recently had an infant mortality rate 20 times higher than heavier babies, according to the WHO. And these deaths count as infant deaths even though most would have been counted as stillbirths if they hadn't received the gift of life, however transitory.

Ironically, American doctors' ability to save babies' lives causes higher infant mortality numbers here than would be the case with less advanced medical treatment.

Because of varying standards, international comparisons of infant mortality rates are improperly used to create myths about how the United States should allocate local or national resources. If we want to lower our infant mortality rate so it compares better with that of other countries, maybe we should bring our measuring into line with theirs to better determine the actual extent of the so-called "problem."

Enhancing the survival and well-being of our babies is vital and important. More government interference in medicine will only subject them to the unhealthy, malarious swamps of socialism – infant mortality myths notwithstanding.
Editor's Note: Robert J. Cihak wrote this week's column.
Robert J. Cihak, M.D., is a Senior Fellow and Board Member of the Discovery Institute and a past president of the Association of American Physicians and Surgeons.

PS: Health Care is "FREE" in Canada and the UK. How's that working?

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When something is free, it will be in short supply.
That is the law of economics.
Ignore it at your own peril.

Edited by Rogerdodger, 17 December 2009 - 12:24 AM.

[Rogerdodger]

In St. Petersburg, American health care attracts Canadians
December 7, 2009
This is Can-Care Clinic, and from now until spring up to 70 percent of its patients will be from Canada.
"I've always liked Canadians," says Dr. William Handelman, the clinic's owner. "They're so appreciative because (in Canada) they can't get the kind of care that we provide without waiting for months."

In the Great American Health Care Debate, those could be fighting words to advocates of a Canadian-style universal health care system. Aren't Canadians supposed to be better off because they don't have to pay for doctor and hospital visits? Don't studies show Canadians are healthier and live longer than Americans even though the United States spends far more per person on medical care?

That's what the advocates argue. But a contrarian view emerges at a clinic like Can-Care, which treats both Americans and Canadians and sees firsthand the results of two very different health care systems.
On a recent day, the clinic saw 46 patients — 29 of them from north of the border.

In general, the Canadian patients are slimmer than Americans, in line with statistics showing that Canada has a lower obesity rate. The Canadians also tend to take fewer prescription drugs.
But that doesn't necessarily mean they're healthier.

"A lot of times, certain things are not treated, but the patient is not too concerned about it," says Dr. Jenny Chamblain, a French-speaking Montreal native who joined the staff this year. "I'll see patients with blood pressure in the 160s over 100, which is considered hypertension, but they're not on any medication."

The clinic treats people who've faced two of the biggest problems with the Canadian system — a shortage of doctors in some areas and long waits for MRIs and other nonemergency tests.

One woman hadn't had a Pap smear in years even though the tests are key in detecting cervical cancer. "She said she couldn't find a doctor," Myung Joo Handelman recalls.

Another patient was suffering from diarrhea, but surprised the staff by asking for an X-ray of her left knee. The reason: She was planning to have surgery for torn cartilage in Canada but realized she could get the X-rays done much faster in the United States.

And yet another patient, this one with melanoma, the deadliest form of skin cancer, had gotten a biopsy in Canada in July, but had yet to be treated by the time he arrived in Florida four months later. Can-Care referred him to a St. Petersburg surgeon.

Travelers insurance, which can cost up to $3,000, depending on age and length of visit, does not cover pre-existing conditions, but does reimburse for simple lab tests, X-rays, EKGs and two office visits.
Preauthorization is required for further testing and hospitalization; insurers sometimes decide they can save money by paying for a patient to fly back to Canada, where they can be treated at government expense.
But many snowbirds gladly pay for noncovered services.

Recently, 79-year-old John Mercer of Grand Falls, Newfoundland, took advantage of one of the clinic's specials — a $149 heart and stroke screening. To get the same screening back home could entail a lengthy wait for both tests and results.
"It has become a problem in Canada," said his wife, Joan, 80. "We're from a small town and to see a specialist you have to go five hours to St. John's. He had an MRI the other day, which we paid out of pocket, too."

Each year, the clinic hosts an open house exclusively for its Canadian patients; last year's party drew 450.
LINK

[OEXCHAOS]

We don't have a health care crisis, we've got a price discipline crisis. It should all be high deduct insurance with HSA's/MSA's. So much cheaper and folks are suddenly aware of how much they're consuming or IF they're consuming the charged-for service. Put Medicare on that system too. Wanna watch 18% of fraud EVAPORATE overnight? Put my mom on the case with her HSA! M

[diogenes227]

Roger, I'm always impressed how informed you are on this issue. Thanks for keeping us up on the topic. I've often seen the stats on how low the US ranks against other industrialized countries in health care. And those stats are always called into question as you've done here. But I do have a question. Given your research on this this, have you ever been able to identify the strengths of the health care systems in other countries. I've seen repeated complaints about the Canadian and British systems but what countries are doing well with their universal coverage? Japan? Germany? France? Sweden? I'm not sure if I'm asking the question right. Let me put it this way -- outside of the U.S., let's say if you had to take one industrialized country providing universal coverage for its population for yourself and your family, what country would that be and why, or maybe, in other words, what country IS is getting the biggest bang for its health-care bucks? Maybe you've written on this before and I've missed it but if you have the time, I'd very much appreciate what you think. Thanks in advance. diogenes

[MaryAM]

We don't have a health care crisis, we've got a price discipline crisis.

It should all be high deduct insurance with HSA's/MSA's.

So much cheaper and folks are suddenly aware of how much they're consuming or IF they're consuming the charged-for service.

Put Medicare on that system too. Wanna watch 18% of fraud EVAPORATE overnight? Put my mom on the case with her HSA!

M

How about all the Americans who leave the US because they can't get insurance but can pay a reasonable charge for treatment in Japan or Mexico. Even my brother would go to Mexico when he lived in Arizona - especially for dental care. I actually had to take my son to Canada about 10 years ago because he has a mental illness and was clearly not getting proper treatment here. We went to foothills medical center in Calgary. The doctor there seemed to think his medical history was IMPORTANT. About 1/2 hour into the interview he said "your son has Chromosome 22 deletion" and immediately ordered an echo cardiogram because a ventricular septal defect is a common symptom of the deletion and he had always had a heart murmur. They also did a genetic test (by the way performed by a lab in Washington State) to determine what medications he was GENETICALLY COMPATIBLE WITH - which he has been on ever since. Chromosome 22 Deletion has about 160 recognized symptoms - including all types of mental illness - as well as flat feet, asthma, cleft palate, deviated septum, inguinal hernia, typical facial features and many other health issues that my son has to deal with every day. When we came back to the US I was met with complete hostility - because in the US and only here mental illness is not a developmental genetic disease but a DISORDER and if they recognized it as a DISEASE Suzie psychology degree WOULD NOT BE ABLE TO CHARGE HER TIME TO AN INSURANCE COMPANY OR WRITE PRESCRIPTIONS BECAUSE SHE IS NOT MEDICALLY TRAINED. Now because I have a good diagnosis - my son can only see a licensed neuropsychiatrist and must be seen by other medical specialists. All of which has to be paid by medicaid because no one will insure him. I wonder how many other DISEASES are treated this way in this country because of POLITICS and not science. Oh yes, and we were in Canada for four weeks with him in the hospital for three weeks to bring him off of all medications that he was taking that were not working but making him sick - and putting him on the right medications. How much did this cost me - roughly $23,000. Same care in the US would have been over $100,000.
Mary Anne

[Rogerdodger]

I'm not sure if I'm asking the question right. Let me put it this way -- outside of the U.S., let's say if you had to take one industrialized country providing universal coverage for its population for yourself and your family, what country would that be and why, or maybe, in other words, what country IS is getting the biggest bang for its health-care bucks?

Maybe you've written on this before and I've missed it but if you have the time, I'd very much appreciate what you think

That's an excellent question. I've asked for the same:
Show me a model which works well with similar issues faced here in the US.
What an obvious question.
The current proposed 2,000 page unseen legislation does not do that.
It is a compilation of lobbyist dreams.

But I'm for sure no wiz on this and I often ask myself what would I do if I were the law maker.
Can you just imagine all of the complexities involved?

How about all the Americans who leave the US because they can't get insurance but can pay a reasonable charge for treatment in Japan or Mexico.

Here is one big problem:
I know that many countries do not have to deal with large numbers of non-insured "non-citizens" draining and even bankrupting their hospital emergency rooms.
Another cost is the "Anchor Baby Syndrome' where non-citizens in labor rush across the border to have their baby on US soil so that it will automatically be an American citizen, thus "anchoring" them here.
These costs are passed onto our system, costs which are not faced in many other countries.
That is usually not considered in cost-comparison analysis of one country's health care with another country.
Japan and Mexico do not have this problem.

And as far as the US government being in charge of anything, I think of the bankrupt mis-handling of everything it touches, from the Social Security system, to the outright corruption and destruction of Fanny and Freddie by those who stripped it of millions without any accountability (many of those same people forced banks to loan mortgage money to those who had insufficient income... and they are still in office acting like O.J., looking for the real killers), the bankrupt US post office, FEMA's handling of hurricanes, government housing, the TARP political slush fund, shall I go on?

There are so many factors which make the US' medical care/insurance position unique.
For those who say that the free market system has failed us, I reply that ours is not a free market.
The government and lobbyists have their noses in every aspect of coverage just as they did the collapsed housing financing fiasco.
As a result of lobbyist influence, I cannot buy drugs from Canada.
I cannot buy a health-care policy from another state. There is NO FREE MARKET COMPETITION.

Insurers cannot sell me specifically what I want because of various mandated coverages.
Sex changes, hair transplants, drug & alcohol abuse treatment, In Vitro Fertilization, Well-Child Care, Mental Health Care are just a few mandates I may need but do not want my insurance to pay for or me to be charged for.

Over the last 30 years, state and federal governments have enacted legislation requiring that health insurers provide coverage, or offer to provide coverage, for specific providers or procedures. The number of health insurance mandates has swelled to over 1,800 nationwide.
Because legislators have saddled health insurance plans with so many mandates, the choice for many people is "Cadillac coverage" or no coverage at all.

LINK

Several states have adopted legislation that requires health insurers to accept anyone who applies, regardless of their health status, known as "guaranteed issue." Or they limit insurers' ability to price a policy to accurately reflect the risk an applicant brings to the pool, known as "community rating" or "modified community rating." Both guaranteed issue and community rating can have a devastating impact on the price of health insurance, especially as younger and healthier people cancel their coverage, leaving the pool smaller and sicker.

LINK

As far as traveling to MEXICO for medical procedures...try suing for malpractice.
There you will find arbitration rather than litigation.
So there are no "medical lottery winners" for health care providers to pay in Mexico.
LINK

But that arbitration has another benefit: doctors do not feel the need to ask for additional dubiously beneficial tests and procedures, just to be "safe" from potential ligation.
Whereas in the US even those performing the tests have to charge more because of their potential for malpractice litigation, as the cost of medical care snowballs due to litigation.

I think that is one model the US system should follow, but the lobbyists have been very successful in preventing such from being allowed.
Howard Dean admitted as much at an August 26 town hall meeting when he remarked, "The reason why tort reform is not in the bill is because the people who wrote it did not want to take on the trial lawyers."

But lookie at what Texas has done:

In the year prior to the Texas Legislature's 2003 tort reform, CHRISTUS Health spent $153 million in liability defense payments in medical malpractice lawsuits. Last year, its lawsuit-expense payments totaled only $2.3 million. Why the dramatic decrease? Dr. Tom Royer, CHRISTUS Health's CEO, has stated the savings are due entirely from the tort reform measures enacted by the Legislature. Half of its facilities are in Texas and Texas' lawsuit reform had a dramatic impact. While $150 million per year is a large number for CHRISTUS, how does that translate to the patient? CHRISTUS has made the conscientious effort to use those savings to substantially increase the charity care it provides and to invest in quality initiatives that further improve the care it provides its patients.

LINK

72 percent of Americans think that fear of lawsuits compromises doctor decisions, and fully 83 percent want any health-care reform to address medical-malpractice litigation.

Notwithstanding the president's remarks and popular opinion, Congress has been laboring to expand medical liability against nursing homes, medical-device makers, and military doctors—changes that would be expected to drive up, not down, health-care costs. The reason is simple: with massive campaign contributions and lobbying clout, the organized plaintiffs' bar—whom the Manhattan Institute has dubbed "Trial Lawyers, Inc."—has bought Congressional leaders' support. In the last election cycle, the trial lawyers' political action committee gave over $2.5 million to Congress members.
Overall, lawyers and law firms gave almost $234 million to federal campaigns in 2008, including almost $127 million to Congressional candidates—more than any other industry group and significantly more than all health-care-related contributions combined.

LINK





So if I'm in charge: I'd allow arbitration, at least as an individual choice and limit government (read lobbyist) involvement, thus allowing customers of Health Care Insurance to FREELY shop for what they want.

Edited by Rogerdodger, 18 December 2009 - 12:57 AM.

[Rogerdodger]

How about all the Americans who leave the US because they can't get insurance but can pay a reasonable charge for treatment in Japan or Mexico.

PS: It is comparing apples to oranges when comparing the US system to Mexico and Japan for a number of other reasons besides what's briefly mentioned above.
For example:

The United States has the highest birth rates in the West, largely within poor minority groups, most of which have more than double the infant mortality rate of the US population as a whole. SIDS deaths among American Indian and Alaska Natives is 2.3 times the rate for non-Hispanic white mothers. Smoking and bed sharing have been identified as common causes of SIDS.
Whereas Japan has the lowest birth rate in the world.
It's even being called a national crisis in Japan.
This skews the "comparative" statistics as infant mortality per capita would obviously be lower, average life expectancy would increase dramatically.

Medical Mal-practice Litigation in Japan? Forgedaboudit.

The present research has demonstrated that the Japanese tendency to avoid medical malpractice litigation can be ascribed to Japan's medical malpractice litigation system, and not the Japanese legal consciousness. From this standpoint, the present research has made clear the specific problem areas of the litigation system by looking at all cases from the last 10 years in the main district courts. The total average time taken for medical malpractice litigation is 3.0 years – much longer than the average time for normal litigation. Furthermore, the average amount of money needed to bring a medical malpractice complaint was 2,200,000¥, far too much for the patient's family to bear. We have also demonstrated to what extent the amount is inversely related to the patient's age. Naturally, it is possible to bring a case without reliance on a lawyer, but in 90.0% of cases a lawyer was employed, and the success rate of litigants that had not employed a lawyer was 0%. Through the above discussion, we have show the present situation regarding time and costs in medical malpractice litigation, and it is suggested that these are the important reasons why medical malpractice disputants demonstrate a tendency to avoid litigation.

LINK

Medical Malpractice in various countries. LINK

Other differences:
Surgeons in the United States perform more than four times the number of operations per capita than their Japanese colleagues.

The United States has between two and three times the number of intensive care beds per capita compared to Japan.

Japan has the highest expenditure on drugs as a percent of total health expenditures. The high spending on drugs appears to be directly related to the fact that Japanese physicians dispense and may make profits on the drugs they prescribe.

In contrast to the United States, Japan's low rate of hospital admissions reflects its tendency to emphasize ambulatory over inpatient care. But once hospitalization occurs, Japan has an OECD record for long lengths of stay and low hospital staffing ratios. It is the only industrially advanced nation with over 25 percent of hospital beds in private physicians' offices known as clinics, which, by law, must have less than 20 beds.

The US has a vast range of rules governing claims processing along with enormous government regulation have reinforced a largely hospital-centered medical system (to the detriment of primary care) and resulted in spending over 20 percent of health care expenditures on administrative services (Himmelstein and Woolhandler 1990), a figure that probably exceeds that of any other OECD country.


Health care insurance is a complicated subject which I believe should be debated and examined at length, not rushed through with un-read legislation written by lobbyists.
The president has promised repeatedly that the health care debate will be televised on C-SPAN, not assembled in some back room in secret.
Enormous government regulation is a friend to no one's health.

NOTHING WORTH HAVING IS FREE.
Don't be fooled.

Edited by Rogerdodger, 18 December 2009 - 02:16 AM.

[Rogerdodger]

We don't have a health care crisis, we've got a price discipline crisis.
folks are suddenly aware of how much they're consuming or IF they're consuming the charged-for service.

True story about a colonoscopy.
When you have a low co-pay or deductible, your concern is only your out of pocket expense, not the expense of the whole procedure.

So the charge for a colonoscopy with insurance at a hospital is over $1500.
Across the street at a doctor's office it is under $600 including lab work.

My father-in-law needed dentures but balked at prices in the thousands.
He considered Mexico's clinics.
But by shopping around, my father-in-law found a nearby dental clinic which would pull all of his teeth and make dentures for about what it costs across the border in Mexico.
Because it was out of pocket, he shopped around and still got very satisfactory results.

I broke a tooth and my dentist recommended a dental surgeon since it was un-repairable.
I made an appointment but since it was self-pay asked for a cost estimate.
He said around $400. I called the same dental clinic where my father-in-law went and it was under $150.
The clinic was new and fresh, the procedure was fast and painless.

Having the patient sensitive to the actual cost is another key to reducing medical costs.
High Deductable Health Savings Accounts make the most sense to me.
Make them tax deductible.
But they are not even considered in the 2000+ page secret bill.
Lobbyists don't like HSAs.

Edited by Rogerdodger, 18 December 2009 - 03:24 AM.

[MaryAM]

That's what the advocates argue. But a contrarian view emerges at a clinic like Can-Care, which treats both Americans and Canadians and sees firsthand the results of two very different health care systems. On a recent day, the clinic saw 46 patients — 29 of them from north of the border. Can-care doesn't see anyone from Cuba or anywhere else except Canada? sounds like a lot of propaganda to me. Check out what Israel gets. We are simply screwed in the US.