Healthcare Part II

[TrueMetis]

UHC= cheaper, more efficent, and less people die. there's your answer.

If Costa Rica can manage a UHC system America can to.

[TerraPrime]

You recognize that this is an argument based on emotion instead of reason. I don't mean to pick on you ztemhead almost all arguments regarding how we pay for health care are based of fear and insecurity.

But that is how ztem feel about his current coverage of health care. It is not exaggerated, nor is it unrealistic. It's a big difference from when he was working with big bank with systematic health care option as part of the compensation.

I also think it's rather disingenuous to say that "almost all arguments regarding how we pay for health care are based on fear and insecurity." Unless you're willing to go into more detail and make some arguments on why these reasons are based on fear and insecurity, it's hard to take that line seriously.

[ztemhead]

Andy,

yes it's an emotional argument. I haven't even talked about the stuff that sends me into screaming fits yet.

the point is that for all the people who are satisfied with the status quo to get them to envision some alternate scenarios that are entirely possible under it. Chataya said that she's cool with the way things are, except for the cost of medicare and medicaid. I suggest it's because she personally hasn't been on the other side of the fence, and to that end, presented a view from that side.

[Shryke]

Tort Reform hasn't dropped prices a single cent in any state I've read about it being put in place.

[AndyP]

Tort Reform hasn't dropped prices a single cent in any state I've read about it being put in place.

If your talking about the cost of individual procedures then no it wouldn't. The key is this quote for the article.

physicians will continue to practice expensive "defensive" medicine or simply leave states that do not enact tort reform.

In other words doctors ordering unnecessary test in order to protect themselves from being sued.

[The Progressive]

If your talking about the cost of individual procedures then no it wouldn't. The key is this quote for the article.

In other words doctors ordering unnecessary test in order to protect themselves from being sued.

This is a conservative talking point which has absolutely no basis in reality. In actuality, doctors ordered excessive tests are primarily due to two reasons: poor health database, and they could charge a shitload for ordering/performing those tests.

[Annelise]

This is a conservative talking point which has absolutely no basis in reality. In actuality, doctors ordered excessive tests are primarily due to two reasons: poor health database, and they could charge a shitload for ordering/performing those tests.

Actually, I have an example, though I don't quite know what it is indicative of except general dysfunction. Just thought I'd share; it's also a bit of a vent for me, as it left me and the rest of the family extremely frustrated.

So my Mom was set to start chemo this week and then she got a call about a trial drug .. apparently these aren't common for her diagnosis and her oncologist was really enthusiastic about it. She appears to be a good candidate for it, but they want to run some tests to be sure. All but 1 are covered by the trial. The last one, which was not ordered initially, is a pet-scan (I hope I have that right). But with the trial in play, they now want to be absolutely sure the cancer is in the adrenal glands. It was described to us as an initial diagnosis test that should be covered by insurance, although insurance companies are evidently notorious for not wanting to pay for it. So the test is quickly scheduled because they want it fast but insurance denies it (and the only reason we got the answer on that quickly is because the oncologist called himself). So the test is canceled and the oncologist is appealing it because it's evidently a very expensive test (the hospital hesitates to even schedule it until they have approval from insurance so the patient doesn't get stuck with the bill). Hopefully he will win and she can get it next week but if not, I guess the ball is in the trial's court.. whether they will pay for it, or being willing to fore-go it. If not, I guess the ball is in her court, whether or not she wants to pay for it out of pocket or skip the trial, in which case, that's two weeks that will have been entirely wasted.

:bang:

[Guest Raidne]

On Tort Reform - most tort reform has been appallingly stupid in focusing on limiting the amount of the awards. This is dumb, because it, by necessity, places the loss on the people who actually had winning claims. Instead of punishing the dumbass who sued their doctor because they didn't like his personality, your punishing the person who had the surgical towel sown back up into their abdomen, or, and I'm not kidding here, had the wrong leg amputated. Good one. Nice work.

What you can do is increase the evidentiary burden required for making out a prima facie case, or increase the avenues of defense at the summary judgment level, or, even better, dismissal. Decrease the number of frivolous claims, and decrease the number of claims that are eventually going to lose at trial. And make the law clear. If one side has a generalist from another part of the country saying that the Doctor committed malpractice, and the other has a specialist from the same locality, and that's the extent of the evidence, then that case shouldn't go to trial. Similarly, informed consent rules are out of control. That also needs to be fixed. That's how you hear about Doctors being sued for acts committed while they were out of the country. We need some standard foolproof waivers and consent forms, that are universally good and hold up in all courts, in all states.

[TerraPrime]

Re: Annelise

Sorry to hear about your frustration.

The only silver lining I see is that drug trials are not all they crack up to be. First, the side effects for these drugs are not as well-tested. Second, if it's in a double-blind testing stage, you'd be 50-50 likely placed in a placebo group. Third, it might not be as effective, over all, than conventional treatment plans (this, of course, varies from person to person and the type of cancer and the types of treatment plans available).

At any rate, I'd put some letter-writing to the drug trial company and let them know that your mom seems to be a good candidate, but you can't get a PET scan done, and see if they have any resources available.

Best of luck.

[Annelise]

Thanks Terra. :)

[Aemon Stark]

Re: Annelise

Sorry to hear about your frustration.

The only silver lining I see is that drug trials are not all they crack up to be. First, the side effects for these drugs are not as well-tested. Second, if it's in a double-blind testing stage, you'd be 50-50 likely placed in a placebo group. Third, it might not be as effective, over all, than conventional treatment plans (this, of course, varies from person to person and the type of cancer and the types of treatment plans available).

Actually, the practice is to test the current "gold standard" or otherwise proven treatment against the new one. It would be decidedly unethical to place patients in a placebo group when there is a proven treatment available.

[Annelise]

Actually, the practice is to test the current "gold standard" or otherwise proven treatment against the new one. It would be decidedly unethical to place patients in a placebo group when there is a proven treatment available.

In her case, they want to do both at the same time. Chemo plus the experimental drug (it's a phase l trial), taken orally. There is no way she would just do the trial drug, nor could I imagine them recommending that.

[Sariel]

I read the other day that in the US you cover your own legal costs even if you win in court, is that true?

In Norway, if you sue someone and lose you'll generally have to cover the costs of the person you sued. I'd think that pevents most of the truly stupid claims from ever reaching court.

[Ran]

Under certain circumstances, the court will award costs, but not always; and sometimes it turns out that the person who has to pay the costs is just as broke as you are and it's like trying to squeeze blood from a stone. Litigation in the U.S. is a very expensive proposition. More so, I suspect, than in most of Western Europe.

[TerraPrime]

A great little article on the myths of health care in other nations here.

Can anyone confirm what this author states in that the US is the only developed nation that allows a for-profit health insurance model for basic health care? Sounds totally believable but I just want to confirm.

I heard the NPR segment on this a few weeks ago. A very compelling case. Similar to the Frontline piece a year or so ago that traveled to Germany, Taiwan, Japan, and UK, to compare their systems to ours.

Some of the info is worth quoting:

On average, the Japanese go to the doctor 15 times a year, three times the U.S. rate. They have twice as many MRI scans and X-rays. Quality is high; life expectancy and recovery rates for major diseases are better than in the United States. And yet Japan spends about $3,400 per person annually on health care; the United States spends more than $7,000.

Overseas, strict cost controls actually drive innovation. In the United States, an MRI scan of the neck region costs about $1,500. In Japan, the identical scan costs $98. Under the pressure of cost controls, Japanese researchers found ways to perform the same diagnostic technique for one-fifteenth the American price. (And Japanese labs still make a profit.)

The Japanese system relies on being able to cut down cost by the use of a highly regimented price schedule control. Each procedure to be performed is price checked by the government. Each clinic and hospital are required to charge the same for the same procedure, and this price is determined by the government with input from the doctors.

The Japanese system, as with any system that has to sustain a population with more aging people than young people, is facing some financial hard times. But even if they were to raise their taxes, they'd still be spending substantially less than the U.S., and still offer equal or better quality care, for ALL Japanese citizens.

[Aemon Stark]

I think so. For-profit insurance companies exist in Canada for supplementary/dental health care, some drugs, and the like, but I'm not aware of anything else.

[Kalbear]

That's an interesting point about the cost being lower making innovation occur, and one I hadn't thought of. A lot of innovation has come out of being limited in resources; it's reasonable to conclude that this would be the case in health care too.

[Aemon Stark]

The Japanese system relies on being able to cut down cost by the use of a highly regimented price schedule control. Each procedure to be performed is price checked by the government. Each clinic and hospital are required to charge the same for the same procedure, and this price is determined by the government with input from the doctors.

This is how it works in Canada too, though billing schedules do differ from province to province. Each provincial medical association negotiates fee schedules and compensation agreements with the provincial government, so there is uniformity in prices and compensation. In *most* provinces, physicians who opt-out from the public system cannot bill more than they'd get publicly either. I've only heard of this happening to any great degree in Quebec which - unsurprisingly - has the lowest compensation levels. This article gives some background to an increasing trend toward private clinics where patients are charged several hundred dollars or more for annual access to a family physician - an access fee, in other words, to make up for said physician's seeing fewer patients overall. It's controversial, to say the least, and probably illegal if the doctors are billing publicly (charging for access to a doctor is prohibited - and for good reason).

Anyway, we'll see how things develop, and this is still a fairly marginal phenomenon, but it's concerning - and I don't have much respect for the physicians involved. It's not all about you!

[Annelise]

The Baucus bill came out today. Here is one analysis.

The title over on 538 is:

Baucus Compromise Bill Draws Enthusiastic Support of Senator Max Baucus (D-MT)

:lol:

[Annelise]

On choice, Wyden argues, the White House and congressional plans have defined eligibility for the new insurance exchanges so narrowly that the vast majority of Americans won't be allowed to participate.

For all the hullabaloo over the public option, the reality is that most Americans would not be eligible to choose even a private option. In an effort to avoid destabilizing employer-sponsored health care, the exchanges will be open only to the uninsured and small businesses.

"Nobody ever told the folks carrying the public option signs all over America that 85 percent wouldn't even get to choose it," Wyden said. "For hundreds of millions of people, they're going to have no more leverage after this bill passes than they do today. They work in some company, some person they don't know in the human resources department decides what's good for them. Nothing has changed."

http://www.realclearpolitics.com/articles/...alks_98333.html