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JollyJoker
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posted August 06, 2009 08:30 AM |
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I disagree. It's pretty simple, actually.  Of course, it's not simple anymore, if health in general becomes a matter of insurance.
Anyway, Mv, with Health there are no routine things. Things may start out and look like routine (Uh, what's wrong with me? Probably caught a flu, it has come, it will go, can't afford the time, effort and money to see a doc), but may end up dramatic, in hospital: "Why didn't you come earlier? You have a serious Hepatitis?" "How would I know? Is that routine?"
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mvassilev
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posted August 06, 2009 08:32 AM |
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It's called "taking a risk". Everyone does it every second of their lives.
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Mytical
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posted August 06, 2009 08:33 AM |
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Hmm I just don't see it. I appologize for that. I think it would be no less confusing then current. However, that is not really the problem. The problem is the common person has NO clue what tests should cost. So what would keep the hospital/doctor from charging whatever they want? We all know that there would be doctors/hospitals that would do that. And once you get the test it's not like you can say "But this person over here only paid "X" dollars!" you would have to pay whatever the price was, and for the most part the common person would be absolutely clueless.
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JollyJoker
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posted August 06, 2009 08:49 AM |
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It's worse - you have to decide over treatment. You have a problem, so you go to a doc. Doc makes a disgnosis and SUGGESTS a treatment or even more of them, but the DECISION is the patient's.
Normally (if the market shall work), now, you'd have to go to another doc (and maybe even to a third) to call in another opinion - make sure you do the right thing - you do that with everything important you buy, right? Inform yourself, check for prices, then you buy.
That's obviously not possible. If you have a tooth ache you cannot make appointments with 3 docs, one telling you, Karies, a plastic filling will do, the second says Karies, a different kind of filling, and the third says, drilling will get really deep, so we may need a crown. At this point you have to pay for 3 diagnosesses, still have a tooth ache and no clue about what to do. In the end Joe Smith will opt for the cheapest solution, but, as my Grandma used to say, often cheap becomes expensive later.
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Mytical
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posted August 06, 2009 09:43 AM |
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As one of those people who make just enough not to qualify for any type of 'government assistence' for healthcare but not enough to afford GOOD health care I have to say this. I would be willing to wait for reform if the reform was good/made sense. We really don't need to rush through and make a worse disaster then the current problem.
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mvassilev
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posted August 06, 2009 06:00 PM |
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Mytical:
No, it would be far simpler (and because it'd be simpler, it'd be cheaper too).Quote:
So what would keep the hospital/doctor from charging whatever they want?
The same thing that keeps supermarkets charging whatever they want - competition.
JJ:
You can make several appointments, though. And it's much like shopping around for anything else. Maybe a loaf of bread is cheaper at the next store. But then you'd have to drive there. So you take a risk if you drive there - or not.
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Mytical
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posted August 07, 2009 06:46 AM |
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Yes, but the common person understands the things that supermarkets carry. So pricing is for these things are MUCH easier to understand. The common person does not understand medicine. They have no clue if a test is neccessary (or even if it was done in many cases), or how much it should cost. Which is where your annalogy misses the mark.
Add to that the fact that one symptom could be any of a dozen things (including nothing serious at all) and you have a mess on your hands. Nothing in the current free market is as complicated as medicine. At all. A cough can be as simple as a cold or a symptom of some rare disease.
Ok lets say you go in because you have a rash. They take blood to do tests. 1) They can charge you for a test never done, because how do you know if they ran it or not? 2) You don't know a thing about the tests, so how do you know how much the tests SHOULD cost, or even what all tests they are going to run? 3) It turns out to be poison ivy, but they could tell you it was mexilaitpalapafan (made up word if you are wondering, they would of course use a real term because they would expect you to look it up) and requires a shot. They give you a placebo, rub some cream on it and poof it's gone. Since you have no clue that this is not the case, how would a common person know that they are being ripped off?! With NO oversite to even have a chance of catching them, it would be a lot worse then it is now.
Free market is not the way to go with zero oversite. Now if there was a board of doctors from EVERY hospital checking each others (and not their own) ... MAYBE. Still a chance of corruption and such however. At the hospitals cost, and not taxpayers. 
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mvassilev
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posted August 07, 2009 07:00 AM |
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As I said earlier, it's a risk. Obviously, in medicine, it's going to be a greater risk than in buying bread.
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JollyJoker
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posted August 07, 2009 07:21 AM |
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It's not a risk, it's foolish. There is no serious information possible, because the crucial and central thing with health is DIAGNOSING. If you knew what you had, you didn't need a doc, so you are pretty clueless.
You can't go to the doc either, tell him, I have these symptoms, what will it cost me to become healthy again. The doc is paid mainly for finding what's wrong which is the whole point.
It makes no sense at all to make things a lottery just because you want to protect a general principle of free market. That's fanatism.
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Binabik
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posted August 07, 2009 09:40 AM |
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Health care is not even close to being a free market, and therefore normal market forces only apply in limited ways.
For example a major problem that's been around for at least 25 years is a huge shortage of workers. A shortage of workers drove wages up as expected in a market economy. But without going into detail, the shortage was at least partially artificial. So of the three tiers of supply, demand and wages, one of the three was artificial and therefore the results were artificial.
(some of the above is also due to a major unprecedented shift in demographics)
Another aspect of health care is that it's very highly regulated. If I printed up a bunch of fliers advertising that I do heart surgery, would you hire me? Should I be allowed to do it? Because pure market forces would allow for that, and obviously that wouldn't be a good system.
The US has very stringent requirements for medical professionals, drugs, medical equipment, etc. Again, the supply side of the equation is artificial, and therefore the resulting price increases are also artificial.
The same thing goes for choice of providers. Most people do NOT have much of a viable choice due to many reasons, some of which have already been stated, like the lack of expertise to make an educated decision. Other factors are distance to hospitals, limitations by insurers, primary doctor's association with hospitals, etc.
The bottom line is that even though market forces do play a roll, there are enough limiting factors that health care is basically it's own sub-economy with it's own set of rules.
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Corribus
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posted August 07, 2009 03:14 PM |
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@Bin
The way health-care and insurance is taxed in this country also contributes a lot to the problems and artificial pricing you mention.
@Mytical (quoting back a few pages)
Quote:
Since Corribus has a keener mind then me, maybe he can make heads or tails out of the current 2009 reports at the above website.
The problem with indexes such as this is that they're trying to quantify something that isn't possible to quantify objectively. The fact that the average person's understanding of statistics is woefully inadequate to put such reports into any sort of proper context doesn't help. Rather than tear the report apart and show it for what it is (other people have done it), perhaps I can better illustrate my point by asking a question.
If your job was to rank countries by quality of their healthcare system, how would you do it?
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Mytical
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posted August 07, 2009 03:31 PM |
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Well, first you would need the following (just to even undertake this monumental task). A panel of doctors, nurses, and people who know about hospital administration. Since you want to have as unbiased opinions as you could get you would need them from ALL nations. Also any that are from a nation would not be able to rate their own nations heath care (because of bias).
Of course it would take way way to long if they went to each and every hospital so since there is all ready some 'ratings' they would go to the ones currently ranked the best of in a nation say the top 10 (?). They would observe the care, take surveys, etc. However, that is only a start. This is a monumental task.
You would need financial records, gdp, population...or at least as close as possible to achieve. (There would of course be a fluxtuation and a give or take +/- % that couldn't be helped). Also the ratings from above would be 'averaged' out to help curtail bias.
Of course I have no clue what all would be required, because I have limited knowledge of such things. This would be a good START, but there would be much more needed.
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Corribus
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posted August 07, 2009 03:43 PM |
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No, you misunderstand. I don't mean: what methodology would you use to acquire your data?
I mean: how would you rank health care systems? Let me rephrase. What separates a good health care system from a bad one? What factors would you NEED to measure? Remember, you have to do this quantitatively, so you need some sort of metric. What is it?
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mvassilev
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posted August 07, 2009 06:39 PM |
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Binabik brings up a good point about occupation licensing and regulation. Part of the reason why medicine is so expensive is that the barrier to entry is higher than it should be. Occupation licensing makes it harder for, say, doctors from foreign countries to practise medicine in the US. This reduces competition, which of course raises prices. And the FDA. As the FDA currently stands, it's bad, keeping drugs off the market in the name of "safety".
JJ:
I never said it was perfect. Just better than any alternative.
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Binabik
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posted August 08, 2009 02:19 AM |
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Edited by Binabik at 02:23, 08 Aug 2009.
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When I make a longer post, I tend to spend a lot of time thinking about it ahead of time, sometimes several hours or even days. In that time I can usually focus on what I want to say and get some idea how I want to say it. (actually accomplishing that is an entirely different matter ) However, when I think about this subject, my thoughts are much more scattered and unfocused. There are so many different aspects to it, and they are so intertwined, it becomes difficult to tie them together in a cohesive package. The truth is, I don't even begin to understand this topic with anything more than very amateurish knowledge.
Anyway....
To start with this idea of defining and rating health care, I think it's important to separate "quality" of health care from accessibility. Consider a single doctor who is the most brilliant doctor in the world, has fantastic bedside manner, and he's even cheap. Under his care a patient can get the absolute best care possible. But he can only see a limited number of patients, and the rest go to someone inferior.
On the national scale it's the same thing. With my amateurish knowledge, the US has some of the best health care in the world, maybe even THE best. However, cost and accessibility are problems. Making any kind of attempt to combine these factors into some sort of overall ranking is ludicrous. Quality of care, cost of care, and accessibility of care are three different things.
To say that the US has poor quality health care is just plain wrong. To take rankings like the WHO publishes out of context is extremely misleading. I won't say that rankings like that serve no purpose, but I can't think of any significance to them when discussing the internals of a specific country. When discussing the internals, the "ranking" of one country compared to another is completely irrelevant. If the goal is to use international funding to target the lowest ranked countries, then fine. But once those countries are identified, the ranking is no longer relevant, the focus must turn to asking why and how their health care can be improved.
Moving on....
To lead into a major issue....
Quote:
Part of the reason why medicine is so expensive is that the barrier to entry is higher than it should be
True. But the question is, how much of a role does that play? Is it significant? I don't know the answer to that, but my guess is that it's not very significant.
Quote:
Part of the reason why medicine is so expensive is that the barrier to entry is higher than it should be
Is it higher than it should be? That's a very important question. It seems to me that it's higher than needed, but not by a lot. In theory, competition to get into med school can assure that only the best candidates can enter, and therefore produce the highest quality doctors, in turn producing higher quality health care. (emphasis on the two words "in theory")
So, high quality med schools, nursing schools, and all the zillion specialty schools, all contribute to higher quality medical care. There are many factors, but the general rule is that high quality equates to higher cost.
Now consider medical research and development. All the easy stuff was done long ago. Penicillin has been around for a while. X-ray machines have been around for a while. So what do the pharmaceutical companies research now? What kind of machines do the engineering companies develop now? Again, with my amateurish knowledge, it seems to me that as time passes, the research and development becomes increasingly more complex and therefore more costly (and risky).
So a small pharmaceutical company has done years of research on a new drug to treat xyz disease. They finally announce with great enthusiasm and confidence that they are entering phase 3 clinical trials. Investors pour more money into the company to continue funding the research. Then phase 3 trials are over and successful. A panel has even made a recommendation to the FDA to approve the new drug. More investment money pours into the company. The FDA then announces "so sorry, we aren't going to approve it, try again".
Another 100 million in research money down the drain. So who pays for that $100M? Ultimately it must somehow be rolled into the overall cost of healthcare. The cost of both the successes and failures must be included in the overall cost of healthcare. Now multiply that times 1000s of research projects.
My sister recently had a detached retina. She was in surgery for 3-4 hours. The hospital cost for that 3-4 hours was $25,000!!!!! That doesn't include the doctor who did the surgery (that was only $1200 including follow up care), nor the anesthesiologist, nor several other costs. That was ONLY the cost for the use of an operating room for a few hours plus sitting in a chair in recovery for another couple hours.
The latest Consumer's Report mentions that the cost of operating rooms is $69-270 per MINUTE. These numbers are staggering. I don't want to get into how these costs are justified or whether they are appropriate. The point is that higher quality and more capabilities are going to be associated with higher costs.
Twenty years ago my sister would have gone blind instead of a near total recovery. I don't know what all the costs associated with the operation are. But I know a very specialized piece of equipment was used. And I know that the equipment and procedure were not available 20 years ago, and maybe not even 10 years ago. And I know that the success of the operation was partly due to more mundane things that we normally wouldn't think about, like advanced filtration systems used to create a highly clean operating environment to reduce the likelihood of infection.
I recently read that the US spends as much on medical research as the rest of the world combined. We hear about some place like Cuba which supposedly has higher quality health care than the US. So how much does Cuba spend on medical research? I know this contradicts what I said about "ranking" countries and comparing one to another. But it helps to illustrate a point.
What is the true cost of health care? What if we quit spending tremendous amounts of money on "future" medical care, and spent it all on "current" medical care instead? What if we had done that 50 years ago? Would my sister still have her eyesight? Probably not. If we had done that, a lot of people who are alive today would not be alive. And if we had done that, Cuba would also have lower quality health care.
So how are we going to cut costs?
Is it possible to cut current medical costs and still fund future research and development at the same level? A portion of current medical costs goes toward future medical research. Is it possible to cut costs for hospital procedures without the hospital canceling their current plans for buying newer, more advanced equipment? A reduction in equipment purchases translates to lower R&D budget.
Is it possible to cut labor costs when there is already a major shortage of medical personnel? It's a catch 22.
Some bigwig director at the hospital is making a ton of money, should we sock it to him and cut his pay? I don't know how much money the bigwig makes, or should make, but I can't see it being significant compared to the total costs.
Pharmaceutical companies also make a ton of money. Should we pay them less for their drugs? How much less can we pay them before they cut back on their research? Lower revenue for them would most likely result in an almost immediate reduction in R&D, unless it's believed to be temporary. Same thing applies to medical equipment.
And maybe even more importantly, what should those drug companies be researching? They have a finite amount of money and must decide what to research. "Rare" conditions already get a very small amount of funding. Who decides which drugs will get research funding and which don't? To put this in human terms, will Pandora's son ever have a good drug to treat Asperger's, or will we decide that the money is better spent on something more common that can treat larger numbers of people?
We use the modern term "managed health care". What managed health care really boils down to is that "managed" means taking a finite amount of money and deciding who gets treated and who doesn't. It means deciding how many tests will be run to diagnose a condition.
Managed health care is what we are asking the government to do. No matter how much you cut the "bad guy's" salary, no matter how much you tax the rich guy, the bottom line is still the same. There is some finite amount of money available and we ask our government to determine how to allocate that money. The result of which is that indirectly they will be deciding that person A lives and person B dies.
Back to the first paragraph about focus. I don't remember what I originally set out to say, but I don't think that was it.
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del_diablo
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posted August 08, 2009 02:28 AM |
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Quote:
I recently read that the US spends as much on medical research as the rest of the world combined. We hear about some place like Cuba which supposedly has higher quality health care than the US. So how much does Cuba spend on medical research? I know this contradicts what I said about "ranking" countries and comparing one to another. But it helps to illustrate a point.
Do not forget the "research/size"-factor.
It is quite simple, you got a big country, with a lot of people in it. And you got a good education for the common man, meaning the size is valid in contrast to ex India where the common man is undereducated.
Basicaly, to make the "we spend loads more" a valid argument we need to compare it to something. China or Russia could be good counterparts, or we ignore the borders of the countries currently in EU. Then, we have actual numbers to make the claim valid.
But you do spend a lot, thats a fact.
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Binabik
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posted August 08, 2009 02:33 AM |
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Edited by Binabik at 02:36, 08 Aug 2009.
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Your point is true, but irrelevant to my point.
Try looking a little deeper.
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mvassilev
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posted August 08, 2009 02:48 AM |
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Binabik:
You just made a QP-worthy post in the Wastelands. Good job.
Good points. But I'd like to clarify what I meant byQuote:
Part of the reason why medicine is so expensive is that the barrier to entry is higher than it should be.
For example, a doctor from another country has to take a licensing test that has little to do with the quality of health care the doctor is capable of providing. (I know an optometrist who got her education and started practising in Russia, then moved to the US - and had to study and take an irrelevant test.) And this isn't done to benefit patients, but to keep the wages of doctors up - they're a special interest group just like anybody else. The FDA has the power to keep drugs off the shelves, when it shouldn't - it should only have the power to stamp "This drug has not been FDA-approved" on medicine. That way, if someone wants to take a risk and use unapproved medicine, it's on their own head - and there's a decent chance of it working, too.
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Corribus
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posted August 08, 2009 05:42 AM |
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Edited by Corribus at 05:44, 08 Aug 2009.
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You want to cut health care costs for the average american? Here are three easy things that would help.
(1) Reduce the amount of ridiculous lawsuits. Some yearly malpractice insurance premiums are well into the six figure range. That's all rolled into your hospital bill. The malpractice industry should be regulated to put a limit on what is sue-worthy and, more importantly, what are appropriate penalties for guilty parties.
(2) Restructure insurance programs to encourage people to stay healthy, and to avoid frivolous trips to the doctor. HSAs and HDHPs would be an easy way to make a lot of headway here. Additionally, most people are on group insturance plans (i.e. employment plans); problem here is that healthy people carry the load of unhealthy people, because premiums are based on an average. This is a horrible way to do it. Worse, the way most insurance plans are structured, the average person has no incentive to save costs, because there's no copayment or coinsurance. This also contributes to frivolous doctor visits. Premiums are thus artificially inflated even more. If you are healthy, and inclined to stay healthy, you'd be better off in an individual, private plan where underwriting is done on an individual basis. Unfortunately, private insurance programs are ridiculously expensive, at least in part because of the way health care is taxed, which brings me to ...
(3) Fix the way health insurance is taxed. Because insurance through employers is tax-exempt, whereas insurance obtained privately is paid post-tax, it's much cheaper for an employed person to obtain insurance through a group employment plan than to receive that money in wages and go out and buy their own plan. Unfortunately, all things being equal, for reasonably healthy individuals, a private plan would be better because you're not subsidizing unhealthy people. This structure also unnecessarily ties full-time employment with benefits into getting good care, which isn't really a good thing as it makes it that much harder for unemployed people to get quality coverage for themselves. If more people owned private (individual) insurance, the average health cost would go down a lot, but the way the tax structure is currently set up doesn't really encourage this. Because of this, insurance companies aren't really structured to offer good individual plans, which only exacerbates the problem.
Anyway, those three things wouldn't fix the whole system, but I think they would be good first steps to take without disastrously overhauling the whole system. Unfortunately I don't see it happening, not with our President's myopic vision of what he wants health care to be and the average person's woeful misunderstanding of how insurance works and why it's currently broken.
EDIT: Perhaps it's time to move this thread to a more permanent venue, hmm? I didn't mean it to start out as a thread about health care, but it sort of went that way on its own.
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Mytical
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posted August 08, 2009 07:56 AM |
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The metric for an entire countries health system would be pretty much the following.
Quality of care given.
Accessibility for ALL of the countries population.
Cleanliness of the facilities (this is important for health care facilities)
Success rate of first visit (ie do the people have to return for the same problem, because the diagnoses was incorrect the first time which falls under quality, but should have a category of its own).
Knowledge of the professionals inside that health care system.
Affordability (Falls under Accessibility, but again a category of its own, a sub category if you will)
Life expectancy of the people in the nation. Generally good health care leads to longer life expectancy.
Doctor/patient ratio. May seem not important (and part of accessibility) but the lower the ratio the more time doctors can spend with patients to get to know them for better diagnosis.
Of course this is not everything as I am not somebody knowledgable in the area we are talking. How would you quantify it Corribus?
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