Thanks for making that post, hobbes. It was very informative.

You can come up with some definitive metrics for which healthcare system is better, and not just cherrypicking areas that suit your views with the usage of data. This is why your arguments have no merit and just come off as Trumpian nationalist type propaganda.

I second that!

Why should I go all through that work to answer a poorly worded off the cuff question. Instead I answered it honestly by saying "I don't know". You progressies don't care about honest answers though. The only answers that satisfy you are ones that match your warped world view. I could have come up with all kinds a metrics and someone here would still claim I was cherry picking. Are you sure it isn't you guys cherry picking?

Two not three. Math is hard.

They skew the numbers for the very small (in the case of gun related deaths) and small (drug related deaths) disproportionately because of the age cohorts they impact. Suicide comes in as the #10 cause of death in the US. Drugs don't make the top 10.

The top nine causes of death are all medical conditions of various types. We're all gonna get one sooner or later, no matter where we live, if we live long enough. Where is this magical non ****hole country free of those problems?

MM MD

we're getting away from the core lol aspect of american healthcare imo. it's not the fact that per head more american babies die in the first 5 years of life than do polish ones, it's that america's public spending as a % of gdp is larger than most western nations



just a diabolical state of affairs. you spend more on medicare/medicaid than we do on the NHS and cover, what, 20% of your population vs our 100%. very poor indeed

dunno why this is but the laws barring medicare from negotiating drug prices is most likely a big factor imo

I don't call myself a progressive. I'm fine with the word liberal though.

You cherrypicked in your post to try and prove something (no clue what that something was). I'm simply establishing the point you trying to dismiss Wookie as a bad poster is humorous because all your posts are pretty badly thought out.

Well, maybe. For now.

It's going to be a problem in the future, though. A lot of the cutting edge therapies for cancer are basically custom designed immunotherapies/genetic therapies that (for now ) are VERY pricey. I'd expect prices will come down, but even allowing for that it's hard to see it being anything less than expensive, and it's going to weigh on the health care system because we're going to be paying a lot of money per year of additional life, as most cancers occur in older patients. As I've noted before, if they ever come up with a good treatment for Alzheimers, it's REALLY going to impact health care - although something that keeps people functional and out of long term care would obviously save a ton of $$.

It isn't going to be a matter of 90% of Americans being able to afford it - it's going to be if society decides WE want to afford it.

MM MD

Did you give up on Latvia because the data from there doesn't support your claim and now want to start over with Poland? If at first you don't succeed, keep cherry pickin to you do right?

You come off more as a progressie than a classical liberal.

To be fair Gordo, from a cost perspective, you gotta admit that US healthcare is in bizarro land.

I agree 100%.

A brief scan of the 2018 update from the UN Development Program (pg 60) suggests the US lags far behind similarly developed nations and many more less developed ones on every metric they chose to include except the prevalence of TB. You can also add stillbirths to that list. In the US people are significantly more likely to die before they are 1, die before they are 5 and die between the ages of 15 and 60 than in any other of the 25 most advanced nations. They are also likely to have ~4 fewer years of healthy life.

This is despite often forking out almost double the $$$ of other nations.

Obviously much of this is due to the US remaining a deeply unequal society, but its deeply unequal healthcare is a feature of this. I can imagine US healthcare is second to none when you can afford access to the resources it can provide, the problem is so many are excluded from this.

Inequality is obviously key to the poor (by Western standards) life expectancy of Americans, and the bizarre healthcare system is an aspect of enforced inequality.

There are other factors, like pollution and, of course, diet. Less well-off Americans tend to subsist on processed foods high in fat, salt, sugar and that damned corn-syrup, and low in trace minerals, vitamins and fibre. And the FDA's food standards are laughable. They permit a staggering weight of hair, rodent faeces and maggots per ton of any given foodstuff, where the permitted maximum in the EU is zero. And they permit the famous hormone-injected beef and chlorine-washed chicken, outlawed in Europe. And they permit these things because it's what big business wants, and the people just have to take what they're given unless they can afford to shop at upscale grocery stores and buy real fresh food.

You take all that, and you take the appalling insurance scam (under which you can have the best and most expensive policy but if you need an operation you can still find that the anaesthetist's fee isn't covered and you've suddenly got a six-figure debt you weren't expecting -- they'll charge you the price of a car just for someone to wheel you down the corridor into theatre, but for the anaesthetist or any other specialist they'll charge you the price of a Ferrari), and you get depressed life expectancy.

Why Americans, who can do almost anything they put their minds to (they flew to the Moon half a century ago, in a stupendous feat of engineering, imagination, daring and government finance), keep putting up with this and pretending the system can't be reformed... I really do not know.

an operation you can still find that the anaesthetist's fee isn't covered and you've suddenly got a six-figure debt you weren't expecting --

Cite please. It's absolutely true that you can end up with a horrifying bill, but the vast majority of the time the bulk of it comes from out of network fees charged by the hospital (as in the Zucker case)

I know because I was chief of my group for 8 years, and on occasion a billing problem would land on my desk (that wasn't supposed to be part of my job - we had someone else dealing with that) If I decided to check into it, invariably the person was pissed about a, say 40K bill for a visit, usually trauma related. I'd tell them to page thru the four pages of charges, find the charge for "Hobbes'reallygoodERdocsgroup" which was generally for about $450 dollars or so, and tell them that was my piece of the bill. The 14K trauma activation fee and the 26K for surgery/ICU/rehab etc. pretty much all went to the hospital/state for reasons I talked about in a previous post (might have been in the Obamacare thread)

The most recent data I could find was that just under 16% of health care $$ goes to physician services. It's certainly a healthy amount, and MD's are well compensated. But in hospitalized patients, the % is MUCH lower, just because there's only so much stuff you can bill for compared to all the stuff the hospital is doing.

A few years ago there was some asshat consultant in Vegas (ENT, I think) that was charging people insane amounts for stuff the did on call, because they were in a pissing match with the hospital over call reimbursement. That stuff happens, shouldn't, and IMHO the state board should suspend the doc in question to contemplate his/her sins. State medical boards used to be pretty much a good-old-boy system where the default was the patients were wrong and the docs were right - from what I can tell, and certainly in Nevada, that's changed. I think that's mostly for the good. Dunno how it is in every other state, though.

Generally speaking, for better or worse most docs now are hospital employees, for a lot of reasons that we don't need to go into here (mostly Medicare compensation issues/pain in the nuts factor of running a business) so MD fees billed by the hospital go to the hospital, who determines what to pay the docs and what to keep for themselves. A few specialties (plastics/derm/optho) will likely stay independent for the foreseeable future, although I suspect optho could wake up and find their cataract surgery codes cut by 40%, which would result in them flocking to employment status - a huge chunk of their practice comes from cataract surgery. A couple of years ago cardiologists were informed that the office stress testing codes were being cut by 30+% , which instantly made it almost impossible to stay open, and a buttload of cardiologists became employees instead of practice owners pretty much overnight.

As usual, there are a LOT of moving parts.

MM MD

I am not going to spend several days thinking up the right search terms to break it out, but it was last year and it involved an anaesthetist whose services were for some reason 'non-networked' and the patient got a six-figure bill, without, so far as I know, having been advised at any point that this might happen.

They really don't. It just doesn't skew the number that much.

This post has a ton of other errors and reads as a weird defence speech for health system that really doesn't deserve it. Nobody is here criticizing individual doctors or even hospitals but the system.

As I referenced, it can happen, it shouldn't, and it isn't even a small % of the problem overall. And I agree, that's ****ing ridiculous.

MM MD

Well, errors that are pointed out are appreciated. I'm always happy to learn, and I freely admit the the view from inside the fishbowl is probably distorted to some degree.

OTOH, from a recent Fortune article, who I wouldn't think would have reason to lie about it:

Life expectancy in the U.S. dropped for the second year in a row, according to the CDC’s National Center for Health Statistics.

The new average life expectancy for Americans is 78.7 years, which puts the U.S. behind other developed nations and 1.5 years lower than the Organisation for Economic Cooperation and Development (OECD) average life expectancy of 80.3. The OECD is a group of developed countries that includes Canada, Germany, Mexico, France, Japan, and the U.K.

A new study published in the BMJ journal looked into a broader cause behind the decline: despair.

“We are seeing an alarming increase in deaths from substance abuse and despair,” said Steven Woolf, an associate professor of emergency medicine at Virginia Commonwealth University and co-author of the report.

So, yeah. How much of the despair piece of this is due directly to drug issues isn't made explicit, but I'd suspect it's a pretty good chunk of it, whether from the simple misery of being an addict to the problems that accrue in terms of lost prospects/opportunity after a drug conviction in terms of your future. I'm assuming deaths from despair is mostly referencing suicide, although it's pretty well established that patients with clinical depression have a decreased life expectancy even if you parse out suicides.

And in no way am I defending the current system. Most docs I know are surprised the wheels haven't come completely off already. And a small but significant number of doctors deserve criticism (although I agree the system allows bad behavior, or at least doesn't do enough to stop it) OTOH, most insurers deserve all the criticism they get and more - but I believe a lot of that stems from the fact that they're profit driven operations rather than patient care operations. Every claim dollar Blue Cross/Anthem pays out is a dollar off their bottom line, no different from Amazon or Alphabet. That seems....unwise.

MM MD

Yes, drug problem and despair most definitely does have a significant impact. The guns themselves while being pretty huge waste of life, just that the increased homicide-rate don't really affect the average life expediency much.

Edit: You don't need even do much math, just get somewhat used to working with big numbers in head. US homicide rate is 5.3 / 100 000 ppl, Japan 0.3 /100 000 ppl (numbers not completely accurate but it doesn't matter, only zeroes matter). Assumption murder at 30, miss 60 years. So average is 300 years lower. 300 years divided to 100 000 ppl= 0.003 years lower life expediency.

Don't disagree that the homicide rate has a minimal impact. The drugs, I suspect are different.

You'll be able to tell as a society that we're serious about improving public health when we start funding mental health/detox/rehab even remotely appropriately.. I'm not holding my breath....

MM MD

Total US homicides (almost all of them gun deaths) are up to about 15,000 a year, which is more than the US death toll in Vietnam for every year except 1968, and multiple times the Vietnam death toll for every year except '67, '68 and '69.

https://en.wikipedia.org/wiki/Vietna...War_deaths.png

The US is inflicting a major war on itself, permanently. But the population is in excess of 326 million. So even if most homicide victims are young, the effect on average life expectancy is marginal.

This is all very foreign to me. In Britain, even the private sector does not operate in this way. I see that US states are introducing laws, as NJ did in September, to try and regulate 'out-of-network billing', where, as I understand it, the billing physician belongs to a practice or group that does not have an agreement with the patient's insurer.

https://info.hapusa.com/blog-0/out-o...to-be-aware-of

The NJ law seeks firstly to limit the patient's liability in emergency cases (I'm not sure who pays in that event, but, to a Brit, this whole thing is like an abstruse doctrinal discussion in the Vatican in the 15th century), and, in non-emergency cases, the law requires that the patient be advised of out-of-network billing 'before the appointment', which, in the case of a heart patient (I think the case I was talking about was a heart op), means, presumably, before the operation.

I'm slightly astonished that such advice isn't already necessary in any case, on ethical grounds. When you're in recovery from a heart op, you really do not want to be told that you've suddenly incurred a life-damaging debt you didn't know about and weren't warned about.

I've seen a consumer site claiming that an anesthesiologist (as anaesthetists are apparently called over there) would bill only $2,500 for a six-hour heart operation. That sounds a bit low. Actually it sounds more like the bill for the porter to wheel you into theatre.

The anesthesiologist bill sounds about right - I mean, its better than $400 an hour, which is pretty good pay, I think.

As I've previously agreed, doctors are well compensated - we get about 16% of health care dollars, and that's a big pie we're talking about. OTOH, if we suddenly paid doctors nothing (somewhere Einbert just got an erection) in 5 years health care spending would be pretty much be right back at its current level. (Actually, I'd be making less than nothing - it costs me about $11 to see a patient for my malpractice coverage, last I looked, but we'll ignore that)

The advising patients SHOULD happen routinely - I transfer a patient every couple of shifts who end up in the wrong (my) ER when they need to be admitted for whatever. ER visits in Nevada are supposed to be covered by a prudent layperson statute, meaning if a reasonable person thought they might be having a significant health problem even if the evaluation is negative it's covered, and it doesn't matter what ER you show up in - it only matters if you need to be admitted. Some states don't have prudent layperson statues, or they're so weak that the insurers can (and do) take a shot at not paying claims.Of course insurers LIVE to decline claims, and in some states (Pennsylvania currently has a bad reputation) they're hyper aggresive about it. Not all insurers do it - I think there are only a couple of really bad actors, but they aren't small companies, so a lot of people are affected. Another strategy is to routinely refuse to pay and hope the patient will cough up the money - it doesn't cost the insurer anything, and if they only succeed .5% of the time it's a free roll. That stuff isn't restricted to private insurers, either - until a few years ago it was the policy of Medical (California medicaid) to refuse to pay on 100% of claims to ER's and make you appeal the denial - which was a gigantic pain in the ass, and had paperwork costs associated. Since medical paid something like 30% of medicare, after it was done you MIGHT get a few $$ months later on a patient. Our billing company did the numbers and figured out we were better off just walking away from it. Seemed unfair. (They've since changed for the better)

MM MD

Actually this is mostly not true. If you control for two things - the US's higher rates of murder/suicide (5-10 higher than in W. Europe), and the greater distances driven by folks in the US compared to folks in W. Europe (so more fatal autowrecks) - the US has life expectancies as high as any country. (Both the mentioned factors hit young men disproportionately, so have a big effect on life expectancies.)

What is true is that access to healthcare is not equal in the US and that the same care in the US costs twice what it costs in W. Europe.