European healthcare

Old Aug 10th, 2007, 05:29 AM
  #81  
LJ
 
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Very interesting discussion and I thank Rex for advancing the cause with some timely numbers to anchor the chat.

I have particular reason to second his notion of the physician (but, indeed, the entire system, especially "scrips and tests") that is increasingly advantaged by keeping the elderly and dying alive at any cost.

We, as a society, have to face this unhealthy alliance of the pocket-book and the fear of death.
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Old Aug 10th, 2007, 05:46 AM
  #82  
ira
 
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Hi Rex,

>I was proposing that you use your imagination - - and think how the entitlement notion would lead to never-ending demand ...<

A reductio ad absurdum, doesn't necessarily prove a case.

You've given us a very thoughtful and useful analysis of who pays for healthcare.

>...by the way, the figure cited for percent of healthcare costs from public funds is 47% not 28% as you said in your posting.<

I subtracted the Medicare portion, since that is the same as insurance, ie, I pay a certain sum per month to someone, whether it is the FedGov or Mutual of Omaha, and they take care of my medical bills.

Medicaid and other public funds come out of my taxes - that's public money.

I'm willing to hear arguments that Medicare is not actuarially sound
and should be considered a public subsidy.

>A superwealthy family contributes $100,000 to the federal coffers for health care expenditures and $20,000 from its own pockets. Probably another $10,000 in state and municipal - - so the total contribution is about $140,000.

I think that you are somewhat too high here in your estimate.
http://tinyurl.com/27gdww (1999) says that 19% of Federal expenditures go to Medicare (12%) and Medicaid (7%).

However, Medicare is an insurance plan.
I think that it should not be included in your calculations of subsidies. More later.

I'm willing to add State and local contributions and raise the Fed spending to make Medicaid as high as high as 12%.

Thus, your very wealthy family contributes about $36,000 in direct subsidy, $20,000 for it's own good, and about $40,000 to Medicare - also for its own good.

This doesn't affect your initial contention: some people are paying the health care of 3 other families. For that you get an "A", a gold star, and my apologies for doubting you.

A word or three on insurance: private and social.

As you recall, once upon a time fire departments were paid by insurance companies, and only the well off could afford the insurance. If you had a fire, only the insurance company of which you were a customer would put out the fire.

It was noted, that this put other houses at risk. Eventually, cities decided to fund fire departments from public funds, because the cost to the municipality was less than staying with the old way.

Yes, some people are being protected from fire at increased cost to the rest of us, but it is still cheaper than having your house burn down because the people next door didn't have insurance.

>there is a larger and larger segment of the population whose medical care costs approach, or even greatly exceed 100% of their entire contribution to society.<

I suggest that this has always been true.

I pay to send other people's kids to school. I pay private insurance premiums that support care for infants, pregnant women, drug addicts, alcoholics, the mentally ill, careless people who are injured on the job or in auto accidents, old people with Alzheimer's and cancer, people who smoke, people who eat too much and don't exercise.

My auto insurance rates are too high because I subsidize careless drivers, drunk drivers, crazy drivers, young men under 25, old women, etc.

My fire insurance is too high because I subsidize people who smoke in bed, those who have poor wiring, people without smoke detectors, etc.

However, someone else subsidized my schooling, my auto insurance, etc.

>Dr, Jones increasingly returns Mrs. Smith to the nursing home, for an ever greater number of days - - and the soap salesman, her son Joe Smith, has to subsidize those also. I remain cynical as to how it improves his life to do so.<

Ummmmmmmmmmmmmmmmmm. I think that you meant that someone else, other than her son is subsidizing her nursing home.

It doesn't improve his life now. However, when he is sent off to a nursing home because his family doesn't have the resources to care for him 24/7/365.25 he will be pleased that someone is helping to pay for his care.

>You asked what fraction of medical care is "unnecessary"? I don't think that "unnecessary" is the way I choose to look at it. I call it economically unjustifiable.<

Dear colleague, I shall not go there, except to say that when we start talking about how much money an individual life is worth we are on a slippery slope indeed.

Thanks for an excellent intellectual exercise.

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Old Aug 10th, 2007, 08:47 AM
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What would be wrong about personally paying for personal medical services? One of my doctors charges $50 for a 10 minute visit. Another the same for a 30 minute procedure. All these requirements are elective. Much the same occurs with dental services. Replace the tooth? Fill a cavity? Great medical service this week as we had a pet cat neutered.
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Old Aug 10th, 2007, 10:24 AM
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>>I call it economically unjustifiable.<<

It was always said that the NHS in the UK is as much a cost control device as a means of delivering care: and the process of determining what treatments are value for money, and therefore recommended for the NHS, is pretty transparent (www.nice.org.uk). It sounds heartless, but is it any more considerate to leave it to individuals, who don't have the clinical expertise but only their desperation?

Are drug companies allowed to advertise prescription medicines? Not in the UK - but they are pushing hard, and I wouldn't be surprised if they're also pushing hard in Brussels to get an EU-wide ruling in their favour.
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Old Aug 10th, 2007, 12:35 PM
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Perhaps a few people have failed to realize that a generally healthy population will cost less to everyone in the population of a country than a country that allows people to get sick without proper treatment.
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Old Aug 10th, 2007, 12:39 PM
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and then when the uninsured get sick they go to the ER at huge expense to the public who has to pick up the tab

And right the polyps W had removed with his colonoscopy for the average bloke with no insurance may have developed into full blown cancer at again huge expense to the public trough

of course i guess W's polyps were probably some left-wing 'liberal' plot
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Old Aug 10th, 2007, 12:52 PM
  #87  
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The US health system is so much more expensive than health plans in the rest of the developed world and the results are so poor that no one can defend it on rational grounds other than aversion to general welfare programs or self-interest. Pragmatism is suppose to be America's unique contribution to philosophy. I wonder how it vanished from our public discourse.
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Old Aug 10th, 2007, 02:47 PM
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sjj wrote: "Pragmatism is suppose to be America's unique contribution to philosophy. I wonder how it vanished from our public discourse."

It was found not to work.
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Old Aug 10th, 2007, 02:51 PM
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kerouac wrote "Perhaps a few people have failed to realize that a generally healthy population will cost less to everyone in the population of a country than a country that allows people to get sick without proper treatment."

More than a few, including many of those responsible for the administration of healthcare policies. Quite apart from the financial savings that can result from a well-designed preventative medicine programme, a lot of misery could be obviated.
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Old Aug 10th, 2007, 03:49 PM
  #90  
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<< ... a generally healthy population ... >>

I submit that the widespread access to unlimited medical care, available in the US - - which is quite different from health care - - does not equate, at least not perfectly, by any means, to...

"a generally healthy population"...

In fact, it may contribute to widespread proliferation of a substantially UNhealthy population (keeping the chronically ill in a state of extended, but viable illness).

A focus on highly subsidized health care (counseling, education, reinforcement of good health habits) would make for a very different country from the one in which we live.

It might, indeed, be better - - though there is still a good argument that we already do have the best country in the world (that we are capable and willing to give ourselves).

The comment about Soylent Green was a good ROFL for me - - contributed as much or more to the dialogue in sixteen words as I did with my thousand plus...
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Old Aug 11th, 2007, 01:02 AM
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Rex's point is interesting. The Government is pushing the NHS in just that direction. A crude simplification is that for its first 50+ years, the NHS was essentially a trade-off with the top-level hospital consultants first, and then the GPs second. But now there are supposed to be incentives in the system precisely for advice on keeping healthy (cue screams of "Nanny state!"); and subterranean arguments about how far you can go in creating disincentives for a healthy lifestyle (e.g., do you penalise smokers, drinkers and the obese in some way when they come to be treated for illnesses they could have prevented?).
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Old Aug 11th, 2007, 06:09 AM
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Back to the ER in Italy.

Three years ago I fell and dislocated my finger while hiking in CT. I took the train to the small hospital in Levanto where the doctor on duty saw me immediately. He did not want to try to set my finger b/c there was no radiologist on duty and he was afraid it might have been broken. So he personally called the Croce Rossa to drive me to the hospital in La Spezia. He also called the hospital to tell them to expect me.

The Croce Rossa driver stayed with me the whole time, and escorted me first to the ER, then XRay, then to the orthopedists who set my finger, back for a second set of XRays, then back to the orthopedists for a second examination. The doctors were all friendly and attentive and seemed to enjoy having a paisana from America as a patient.

The driver then took me back to the hospital in Levanto where the first doctor also checked the setting. He noticed that the doctors in La Spezia had forgotten to give me my XRays, which he said I'd need for my insurance at home.
He said he would pick them up for me and that I should come back the next day to get them. True to his word, he had the XRays for me the next day.

What could have been a nightmare turned out to be a very pleasant experience.
Total cost: $0, (altho' I did send a contribution to the Croce Rossa when I got home).

The doctor I saw in NY when I got home charged my ins. co. $500 for a 10 minute office visit.
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Old Aug 11th, 2007, 07:34 AM
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In come countries visitors are given better care than the citizens ( a matter of pride and show of hospitality).

We have a young doctor in the family ; his main frustration is not with the system ( we do not live in the US) but that many patients do not follow instructions or ignore advice - especially when it comes to nutrition, drinking, smoking etc.

Prevention and one's own responsible behavior might be a factor in reducing the cost of health care everywhere.
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Old Aug 11th, 2007, 07:45 AM
  #94  
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>What would be wrong about personally paying for personal medical services?

A. Some people just don't have $50

B. Some people have $50, but can't find affordable insurance.

C. Some people have affordable insurance, but it isn't enough for major hospitalization.

D. Some people, if they become paupers, can afford major hospitalization.

Which brings us back to A.

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Old Aug 11th, 2007, 09:05 AM
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Ira, some people say they can't afford $50, which is true because they spend their money on drugs, alcohol, women, and down payments on stuff they won't make monthly payments on.
Sounds unreal, but unfortunately not at all uncommon. 10 years of budget counseling lead to this disappointing conclusion. There's a second world out there with totally different ethics and values.
This is not to say there are some unfortunate people with legitimate needs; just that if no one needs to be responsible for their actions, then we all pay. No need to buy a hamburger for the 1300 pound man who just finished his 6th Big Mac of the morning. Otherwise, "A reductio ad absurdum", the end result is some fool suggesting the government payoff of a mortage for anybody who can't make the payments.
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Old Aug 11th, 2007, 09:18 AM
  #96  
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tomboy - Consider the following health system:
1) you have to buy health insurance if it isn't supplied by your employer, and you receive a government subsidy based on your income level;
2) the insurance company you buy it from has to be on a government approved list, just like the suppliers of prescription drugs under Medicare D;
3) a percentage of your pay (matched by your employer) is deducted from your pay check and deposited in a medical savings account to be used in case of major medical expenses;
4) Medicare continues as before.
I'd accept this. Would you?
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Old Aug 11th, 2007, 09:33 AM
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tomboy articulates a point of view that I think is more commonly held in the US than in Europe -- that poor people are poor by choice, and undeserving of help.

There also seems to be a second difference of emphasis between European and American attitudes: many Americans think of healthcare as a personal responsibility, even a discretionary choice, whereas many Europeans see healthcare as a social concern.
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Old Aug 11th, 2007, 10:04 AM
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Last year, I dumped my "employee/employer" health insurance coverage and bought my own. The reason: It costs me the same each month, for better coverage, than it was costing me having my employer paying 50%.
Our coverage at work went up every year. The amount depended on whether they would keep the same coverage, or opt for lesser coverage and keep the increase lower. Either way...it went up. Why? Because of a few folks who were in the doctors office weekly. 2-3 people were responsible for 80% of the claims. These same people are still there. For them, employer sponsored insurance is great...they would be considered "uninsurable" otherwise. It's a bargain, since they only pay a portion of the actual cost. Not such a bargain for healthier folks.
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Old Aug 11th, 2007, 10:47 AM
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" Because of a few folks who were in the doctors office weekly. 2-3 people were responsible for 80% of the claims.""

sounds a lot like car insurance, house insurance etc , because that IS what American system of health care is all about.
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Old Aug 11th, 2007, 11:39 AM
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Poor people are not poor because they choose to be poor. Many, however, make choices that create or exacerbate their poverty. I thought my examples were clear enough, unless filtered thru vision that precludes clarity.

One can be raised 'poor', but one can choose whether to grasp or disdain education that can lift one out. One can be 'poor' because the payments on the $3000 LCD television are so large.
One can be 'poor' because, after two Starbucks and 3 $1.75 sodas a day, there's no money available for fruit or vegetables for your child.
But this has little to do with healthcare. Yes, sij, but I believe such a plan already exists (France? Germany?), and is still subject to the same risks of not discouraging unhealthy (hence costly) behaviors. Nothing is perfect however; my brother in UK complains (mildly, because he's used to it and doesn't remember shorter times in his youth) of long wait times. When he finally got his eye exam after 8 months, he was satisfied to hear he had no glaucoma.

I suppose some day the US will have univ hlth care, and life will go on as before. But we'll still hear of the unfortunate people who will suffer from rationing or constraints on procedures necessitated by cost issues
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