That's right. I can tell you from personal experience. I lived in Japan from 1995 to 2000. I had the Social National Health Insurance. I paid $70 a month in premiums, which was matched by my employer. It covered full medical AND dental for me, my wife and two kids. I could choose any doctor I liked, so we picked the doctor in the neighborhood. I could go any time, even without an appointment, and still the wait times were less than 30 minutes most of the time. Office visits were $5. Prescription drugs were $5. There was no HMO or other gouging middleman to deal with, and little paperwork involved in being referred to a specialist. I understand that Japan spends less than HALF per capita of what we do on health care, despite its aging population, and still they manage to cover EVERYONE, while we only cover about 60% of the population. *Yeah, National Health Care in Japan, and in European countries with similar systems is a dismal failure. After all, it totally fails to generate huge profits for overpaid CEOs, shell-gaming HMO's and redundant "Health Care Access Administrators". We'd best never emulate those commie systems. After all, who wants to live in a country where everybody's healthy? Just wait till one of your lower-paid co-workers comes down with say, kidney disease, and then you and everyone in the office can just have bake sales and car washes to pay for his care. That's the way to do it! Or if you're really lucky, he just won't mention it for shame of being unable to afford health care, and he'll just die quietly and save you all the trouble, Oh, thank you George Bush for your wonderful health savings plans. I can't wait until you take away the employer deduction for health care and rid us of those pesky benefits once and for all. After all, it's not like we can already put money in a tax-deferred account right now, is it? And EVERYONE has a couple hundred EXTRA bucks lying around at the end of every month to sock away, right?
I have some insurance via my employer. If I had a serious illness and I would have to go to an emergency room I might have to wait for hours/days to see a doctor because hospitals in California are overrun with federally mandated , but not federally paid for, care for illegal aliens. Then after the emergency room if I had to stay for a few weeks it would take away all my savings and bankrupt me because the insurance plan is pretty much a sham. Outside of that I am much, much better off than anybody in the third world, or at least that is what I am told. Those third world people look awfully healthy sometimes however and I doubt that they work 45 hours a week with 10 hours of commuting and breathing that shit they call air on the freeway. Hunter-gatherers work a 2 hour day!! 2 frigging hours!! And they eat a much better diet than this stuff I can get. They die off in a drought but hey... That is my goal, autotrading, etc., I am getting this work thing down to 2 hours or I am dyin' tryin'. if I can get that 2 hour work day I am happy. I am always trying to tell people that WIN stands for Work Is Nonprofit but they usually trample me for sharing my pearls of wisdom.
Excellent post oil trader. IMO this IS the number one problem in this country that is getting the least amount of attention. Americans are going to be in for a rude awakening if something is not done soon. Having worked in health care for over 13 years now, I have seen many changes in the way we do business and very little of it is for the better. True, there are better treatments and methodologies that have come out but the sheer weight of the financial hurdles is taking its toll: http://today.reuters.com/news/newsA...6Z_01_N30288435_RTRUKOC_0_US-PRIMARY-CARE.xml Whether Americans like to think about it or not, the fact is that we ALREADY have a social health care system with an extremely bad twist. The enormous growing number of uninsured patients means that taxpayers are footing more and more of the bills. Its only going to get worse within the next 10 years as the full brunt of the aging baby-boomer generation hits the system with their health problems. Then we throw in the mix of the insurance companies and HMOs that have essentially weaseled their way into the business of practicing medicine without a license by dictating what, how much, and why they will or will not pay for something. The capitalistic health care structure of this country is a serious joke when it comes to paying the bills. However, its not very funny and there won't be any US citizens laughing when it all starts caving in. The quality of care is really starting to take a beating. Most of you would be extremely horrified of the details of neglect and incompetence that are being covered up or ignored on a daily basis. Chances are, most of you have already come into contact with it; you just don't know about it or don't know what to look for. The fact is, those procedures, treatments, and practices that are improving are only happening because they are still profitable. They are readily paid for so they get top priority. The less profitable scenarios are considered a necessary evil and get the least amount of funding, staffing, and attention. You would be extremely wrong to call it profiteering. Health care facilities and personnel have no choice but to adjust to the financial environment. The profitable procedures are being used to pay for the ones that are eating away at the bottom line. Those Americans who are touting a capitalist-at-any-cost approach to health care need to take a closer look at our present system; its not as rosy as you think. I'm not saying that a capitalistic health care system isn't going to work. Its just not going to work at its present condition very well for much longer.
Maxpi; quote, " I am always trying to tell people that WIN stands for Work Is Nonprofit but they usually trample me for sharing my pearls of wisdom." Is trampling covered by your policy? It occurs to me, that black market surgery should be a huge growth industry. Imagine, a floating ship (thats kind of redundant, huh?) where non-emergency procedures, like life saving surgery and all manner of health problems sorted out, for less than the bill via insurance excess payments.....(.in international waters, obviously) .....where palliative care patients could get any damn thing they wanted, to increase their quality of life................. Where people were free to defend themselves from piracy, bad legislation, and had the actual sympathy of doctors (from third world countries, perhaps) rather than morticians...................... Where nurses always wore the uniform you wanted....and if they didnt, they could arrange it...................
I am very interested in this topic. A few questions/observations came to mind upon reading the thread: 1) Why is the cost of US healthcare so high while service quality is poor? 2) Are HMO's and insurers solely responsible for excessive healthcare costs and poor quality care? If so, how is this possible in a free market where existing competitors and new entrants should theoretically bring better value and or lower prices to the consumer? 3) Do legislative or bureaucratic restrictions exist that create a defacto monopoly for US HMO's and health insurers? If so, what are they? 4) Can the free market model of healthcare work, cost effectively? If so, under what conditions? 5) Why is Japans health care efficiency so high while costs are low? (socialized care? tax payer subsidized meds and services?) 6) Can the Japanese model be effectively implemented in the United States? (ie what unique bureaucratic/cultural/legislative hurdles must be overcome prior to implementation?)
Hmm, that's odd. I'm quite impressed with how well it's working here in Canada. But then again, I've been far healthier in general since I left the crowded U.S.
I believe that the relationship between high costs and quality are not directly related. While there are certain conditions that exist where costs start to dictate quality, the largest contributing factors for both are mostly independent of each other. The cost is high because providers are having to offset their loses by continuing to raise prices on services that are well funded and paid for by those that can afford it. Much like any other business, the costs of doing business is passed on to the consumer. Unlike any other businesses, healthcare is not allowed to deny service to those that can not afford to pay. Healthcare providers are forced to comply with federal (Medicare and Medicaid) and state regulations if they wish to get any reimbursement for services rendered. They are also forced to comply with regulatory standards that dictate what is and is not an acceptable level of quality of care. To top that all off, the federal and state agencies that provide funding for healthcare dictate what they will pay for, how much they will pay, and how it will be paid. IMO the costs of caring for the uninsured is THE single largest contributor to the high cost of healthcare. They fall into 2 predominate categories: 1) Since they can't afford primary care or don't have access to them, they flood the emergency rooms with every little sneeze and sniffle and other routine minor ailment. 2) They neglect their health problems to the point where they become horribly ill. By the time they do seek care, their problem has ballooned into an expensive illness. For those that do pay their bills and have insurance and/or belong to an HMO, those institutions are simply fanning the flames when they adopt the same payment practices as their governement counterparts. They dictate what, how, and how they will pay or not pay. In turn providers raise the prices for what they can be compensated for. They KNOW they aren't going to get full compensation, so the price is set to a level that offsets that which isn't reimbursed. Therefore, those that can afford healthcare insurance gets stiffed TWICE. They pay the high costs of their insurance AND they pay higher taxes for government healthcare programs that fund those without insurance. As for the quality of care, staffing shortages are the number one problem IMO, with nursing topping the list. Facilities are putting more responsibilities on those that aren't as educated, experienced, and professionally licensed to meet the demand as well as budgetary constraints as the rate of costs increase faster than the rate of reimbursement. Those that are experienced, skilled, and educated are either retiring or taking higher paying jobs; typically in areas of care that is well funded by insurers and goverment agencies alike. Medical mistakes are increasing as the underskilled and unexperienced are left to perform tasks that the present system had never intended for them to begin with. The educational quality of some of these individuals is dropping as the instutions are pressured to graduate more and more cannidates. Nursing is a HUGE problem in this areana. You would be absolutely shocked at what they are NOT trained to do but are doing anyways because the system demands it. While it may be unfair to say that the quality of care is poor (it isn't entirely; it mostly depends on who your provider is and what part of the country you live in), it is getting worse and its going unchecked for the most part.
No, in my previous post I briefly explained why they are not. However, their practices are contributing heavily to the system's problems. Those that have worked in the industry for any amount of time scoff at the term "consumer" as it is applied to healthcare. You aren't purchasing a piece of furniture or signing up for cellphone service. The majority of "consumers" are pretty much clueless about their bodies, what they are paying for, and what they are getting when they come in for care. As far as "value", what do you consider to be a fair price for your health? When it comes to opening you up or putting chemicals in your body are you going to go with the lowest bidder? Since the consumer doesn't even know or understand what they are getting, how would the consumer know what is a "fair" price? Another big problem are procedures and treatments that are being pushed because they are profitable. The risk factors versus the potential benefits may not necessarily be in favor of the patient, but since studies and tests show blah blah and the "consumer" is clueless, lets go ahead and peddle the idea? Allow me to give you a brief hypothetical: Mr. Smith, I think you MIGHT have a partial bowel obstruction. We don't know for sure, but we think its a fairly decent possibility. So lets go ahead and forgo the bran flakes and continue to eat 3 pounds of red meat daily. Just come in 2 weeks from now and we'll shove this tube up your ass and have a look. Please go ahead and sign this paper here. It merely states that there is a SLIGHT possibility that we could perforate your large intestine during this procedure and you won't hold us liable. Don't worry, your insurance will cover this. Just don't forget to pay your copay at the cashier window on the way out.
I am not aware of any legislation that DIRECTLY creates monopolies within the insurance and managed care industry. However, the sheer costs and legal hurdles alone are enough to stunt the growth of any new players in the system. Coupled with the fact that staying in business is tied directly to profits from a floundering capitalistic model and it certainly discourages any company to join the fray. Thats an extremely good question and I don't have an answer. Any new restrictions and legislation placed on the system is not met well with one player or the other in the system for whatever special interest reasons. They end up crying foul and feeding the general public with the fear of the encroachment of socialization. The "consumer" (who doesn't know what the hell they are consuming), in turn, freaks out and demands answers from their government representative (who is also a "consumer" and/or special interest representative). Its a hideous cycle with the "consumer" paying little attention until they are injected with fear, they experience the negative aspects of the system first hand, they end up getting slammed with paying huge cash out of their own pockets, or all of the above. An example of this is the number of times this thread is viewed versus other threads. People would much prefer to read and discuss about terrorism, war, and whether or not there is a god.
Dump 50 million blacks and Mexicans into Japan, Canada or Scandinavia and see how well socialized health works.