So with all the talk about healthcare, what is your ideal?

[PinkyandtheBrains.]

 

I was looking for this to link.

[livetoread]

I don't know how the free market can effectively handle a product that people would give every bit of money they had to get. My daughter needed open heart surgery at 6mos. There was one surgeon within a several hour drive that could do it, and only one hospital. I would have paid my last cent to them if I had to. So what is the fair market price for my daughter's life? Priceless.

 

There can be no real competition because there isn't enough demand for two or more pediatric hospitals or two or more pediatric heart surgeons in this area. Not to mention that you can't get the information you need as a consumer to compare even if there were. And thirdly, do you really want to pick your baby's heart surgeon by who is running a special discount on open heart surgeries that week? So that surgeon had a monopoly on a priceless commodity. Who is going to tell him he can't charge $200k, when I would have been willing to pay that and more?

[ThatHomeschoolDad]

I'd like to see universal, single payer, but there is a conundrum that seems present with my little bug (and perhaps others).  A HS friend with dual citizenship flew her daughter back to Ireland to have an appendectomy because even with the flights, she cam out ahead of staying here.  On the flip side, I know so many patients who come here because this is where the trials and treatments are for Stage IV OM patients.  I've had experimental things done that patients just can't get approval for in other countries.  Are existing single-payer countries pretty good at care up to, but not necessarily including the way-out-bleeding-edge stuff which is very expensive?  There must be comparative data out there.

 

How about a streamlined FDA?  I can appreciate a randomized, double-blind study as much as the next guy, but the pipeline is so sloooooooooooooow, and I've seen treatments shot down for reasons that seemed more bureaucratic and financial than medical.

 

How about tort reform?  Insane malpractice premiums keep new grads out of family practice and obstetrics.

 

We also have a horrendous relationship with mental health care at all levels... Maybe because we're stuck in a mode of self-reliant cowboy individualism; maybe because of misleading portrayals of mental health in media; maybe because GPs with one semester of psych throw Prozac at patients like Tic Tacs; maybe because the brain is the only conscious organ that has to choose to seek treatment for itself.  Of all the possible changes, I'm most pessimistic about seeing any movement here.

[regentrude]

. When I want the healthcare system to end up like the post office, I'll be all about government-run healthcare. 

 

Hm, considering that the post office delivers letters to all people, whether they live in a city or in a remote rural location, whether they are poor or affluent, whether they are "members" or "in network" or just have one single letter a year, and the price of a letter is the same for everybody... I think a health care system that does that would be an improvement.

[mommymilkies]

As someone who worked in the healthcare industry and is married to someone who worked for the pharmaceutical industry, I am 100% for nothing short of universal healthcare. Everyone deserves it and I've never heard a valid complaint (valid to nullify UH's positives) to convince me otherwise. Tax me. I don't care. I'd rather pay more taxes and know that it will cover my child, or someone else's if they get cancer, god forbid.

[IHaveNoIdeawhatIAmDoing]

Hm, considering that the post office delivers letters to all people, whether they live in a city or in a remote rural location, whether they are poor or affluent, whether they are "members" or "in network" or just have one single letter a year, and the price of a letter is the same for everybody... I think a health care system that does that would be an improvement.

 

Sure. That's what I meant. It has nothing to do with the fact that it's almost bankrupt and run inefficiently. 

[ChocolateReignRemix]

Sure. That's what I meant. It has nothing to do with the fact that it's almost bankrupt and run inefficiently. 

 

Perhaps you should look into why it is almost bankrupt? Hint: it has to do with a 2006 Congressional mandate to fund the healthcare of future retirees now.

 

[Murphy101]

I can't figure out why dental and eye care are separated from normal health insurance. Eyes and teeth are very important parts of my health. Medical insurance doesn't pay for cosmetic surgery so I don't see why it should skip covering eyes/teeth at all in order to avoid covering cosmetic procedures.

 

 

Me either. It's absolutely crazy inducing infuriating. The ONLY reason that would EVER make even remote sense is to avoid the most common medical need of every demographic being paid out by insurance.

 

In my experience (and you can speak to this too, I'm sure)? This actually leads to *some* better practices. For example, a uncomplicated childbirth in Germany is attended by a midwife, not a doctor.

It very important to note that a midwife in Germany or England is not at all equivalent to a midwife in the USA. Many midwives are far better trained and educated than many OBGYNs in the USA. It's like comparing a USA midwife to a candy stripes. Iow, there's no comparison. I had a midwife here who actually had delivered more babies than my OBGYN and I still don't think either would compare to a decent midwife in Germany or UK.

 

I completely disagree with the idea of the free market running health care. Honestly, it seems completely contrary to American values. What happened to, "give me your tired, your poor, Your huddled masses yearning to breathe free, The wretched refuse of your teeming shore. Send these, the homeless, tempest-tost to me, I lift my lamp beside the golden door!" Do you really want consumerism to drive medical care?

 

Well to be fair, that was added after the author's death and is just on the plaque. Many a person has lamented that though it was a successful fundraiser poem, it has never been accurate.

 

Seriously? We discriminated the Catholics, the Irish, the chinaman, .... And they all came poor and huddled. No nation wants the poor and huddled masses. They rarely generate healthy tax revenue. (Tho their cheap labor is always appreciated.)

 

But maybe I'm just cynical. A bit.

 

I don't want to derail this thread, but I'd like to hear what others think about this question. What makes the US so different from other first world countries (particularly our neighbor to the north, Canada) that a significant portion of our citizens are opposed to some type of universal healthcare?

Other than being triple or more the size geographically? Rebels from the start? Founded by extreme independent natured peoples? (Tho Australia with their convict start really feels a bit of brotherly understanding at times. :) ) Being several hundred years younger as a nation? (Tho canada and Australia are similiar in age, they kept many of their British ties and government arrangements.)

 

I HAVE government health care. We're a military family. We don't generally pay anything for health care. My son has had hospital stays that cost over $10k, and that's not even counting the one where his lung collapsed. We never had to pay anything for them. We've paid occasional co-pays when we chose to pick meds up from a pharmacy instead of a military facility (for convenience), have chosen a brand name drug over the generic or have seen a doctor out of network. But, even those instances are few and far between over the last 20 years. 

 

edited for clarity

? Military healthcare is not the same as Medicaid or Medicare, which the vast majority if citizens consider "government healthcare"? If I'm wrong, I'm happy for you. My understanding is military healthcare is an excellent insurance program? If I'm accurate that they are not at all the same, then kindly I disagree strongly. I don't know anyone in the military that says they have government healthcare. They say they have military healthcare and they seem very aware that it is not the same thing.

[Frances]

Free market healthcare system. And yes, I think it's ethical. 

 

I'm really curious to know more about how this would work. How would those with pre-existing conditions get insurance? How would people without insurance or extra disposable income pay for healthcare, especially in the case of a serious medical condition? From an economic standpoint, the demand for healthcare is just not like the demand for most other products and services, so I'm really trying to understand how free market principles would work in practice.

[Cammie]

Ok, I can share how things are here in India.

 

The rich have healthcare, of course, as do the rich in every country.  There are great private hospitals  - some with floors almost like hotels.  People who are well employed generally have hospitalization coverage only.  For our family our insurance only kicks in if there is an overnight at the hospital.  You should see the battle we had when they tried to make us stay overnight when my son just got a few stitches.  The thing is we were trying to SAVE them money.  They were insisting they HAD to pay MORE.  Here, however, if you shout long and hard enough, you can get your way in the end.

 

If we need to see a doctor the cost is fairly reasonable - we pay about $10 to see a GP or a dentist or an eye doctor or a pediatrician.  Vaccinations can be $20 or so.  For the middle class it doesn't break the bank.

 

There are many clinics here that in about 4 hours will do all your yearly tests (all blood work, echo, gyno, eye check up, bone density, etc., etc) for about $100.  We do this once a year.

 

What about everyone else?  Many medications are subsidized by the government so your typical antibiotics and other common drugs are fairly accessible to most people.  However, government hospitals are horrible, terrible places that you wouldn't wish on your worst enemy.  Vast majority of people have no insurance at all so a hospital stay is a crushing burden.  People will try to go to slightly better private hospitals but they will be faced with having to pay cash for bills that can often be $2000 for a day or two in an ICU.  This is a terrible burden on a family and I know many families that have had to pull loved ones out of hospitals much earlier than they should have because the costs was killing the family.

 

Frequently you see appeals in the newspaper for charity donations to save a child's life with an operation the family cannot afford.

 

I think the idea that we should leave the weakest and the poorest to fend for themselves is a horrible, selfish idea that is the antithesis of what every major world religions preaches.

[kubiac]

Don't laugh, but if you're really asking what I want (besides everything), here are a couple of items on my wish list:

 

(1) I would love my "preventative maintenance" doctors to have drop-off childcare. Just a dream. :)

 

(2) Birth doulas and post-partum doulas or post-partum recovery centers should be provided as the standard of care.

[kubiac]

It's not that simple. We all pay for healthcare now, we just doing it through a  middleman. That's never made anything cheaper. And I never said anything about a denial of care. I've seen how the government runs things. When I want the healthcare system to end up like the post office, I'll be all about government-run healthcare. 

 

You'll note that your mail is still coming, despite the government shutdown. USPS has certain government-protected monopolies and certain legal obligations, but it doesn't get direct federal funding.

 

If private enterprise is the optimum method for everything, should we also have privately operated armed forces? Should the highways all be toll roads? Should our children plan their vacations at Yellowstone Park Brought to You by High Plains Uranium® and Coors Light®? Is all environmental regulation bunk? Should the Library of Congress be liquidated?

 

I'm genuinely curious: For those who advocate a free-market system, are there any areas of the current public sphere that you think do belong properly to government? Do you distinguish between the potential value of federal government and say, a small township government or a municipal waste-management council? 

[Murphy101]

Heh. Off topic but a popular FB meme is that our soldiers should be as well paid as ___ (sports players, congressmen, etc.. It varies by season).

 

And all I can think each time I see it is we are one amazing country (seriously, I take pride in this about the USA) that not only has an entirely volunteer military, but manage it without employing mercenaries, tyvm.

 

But I never respond bc I figure that's not the opinion they want to hear.

 

*runs and dives for cover*

[Murphy101]

You'll note that your mail is still coming, despite the government shutdown. USPS has certain government-protected monopolies and certain legal obligations, but it doesn't get direct federal funding.

Yes. That was a terrible analogy. If I honestly thought our government could run healthcare half as well as USPS, I'd not be fretting at all. Sadly, I highly suspect it will be more like the worst of DMVs.

 

I'm genuinely curious: For those who advocate a free-market system, are there any areas of the current public sphere that you think do belong properly to government? Do you distinguish between the potential value of federal government and say, a small township government or a municipal waste-management council?

I don't advocate a free market medical system, but I do think universal care would be better coming from the states than the Feds. In general, I'm pro states rights over federal. General having quite the addendum section of exceptions.

[Laura Corin]

I can't figure out why dental and eye care are separated from normal health insurance. Eyes and teeth are very important parts of my health. Medical insurance doesn't pay for cosmetic surgery so I don't see why it should skip covering eyes/teeth at all in order to avoid covering cosmetic procedures.

 

The NHS covers basic dental care: for example, both my boys are having/have had free braces, because in both cases it was assessed as a medical need.  Cosmetic braces are not covered.  I've been very happy with the standard of orthodontics.

 

Dentists are independent agents, so not all will do work for the NHS.  This can lead to problems finding an NHS dentist in some areas.  We were driving to a rough area (scary people with scary dogs on the streets) for dental treatment for four years until we heard that a local dentist had NHS places.

 

In Scotland (the system is slightly different in England) you get a free eye test ever two years, or any time that you think that your prescription has changed (if it turns out it hasn't changed, you pay £20).  Eye glasses are free for children and for people on proven low incomes.  The optician will also check for eye disease and will advise visiting a doctor if s/he spots issues with blood pressure or cholesterol, for example.

 

L

[Laura Corin]

Oh - about high taxes.  Let me lay out the UK tax system, so that you can have an idea.  

 

The first £8,000 you earn, you pay no taxes on income

 

Up to £35,000 you pay 20%

 

From £35,000 to £150,000 you pay 40%

 

Anything earned over £150,000 you pay 50%

 

Additional taxes: 20% VAT (similar to sales tax ) on 'non-essentials', so food and children's clothes, for example, are excluded.

 

Local taxes: about £2,000 per year for a 3 bedroomed house in my area.

 

This covers all the normal things that taxes cover - roads, army, free schooling up to age 18.  It also covers NHS treatment for all citizens and residents.  The maximum a university can charge is £9,000 per year.

 

ETA: forgot to include high taxes on petrol.  I pay £1.30 per litre.

 

L

 

 

[Camelfeet]

I like Canada's health care system, we just need about 4x as many doctors to improve access and wait times.  We need to get foreign doctors certified/vetted faster.  I like that if something happens I could go into Emerg or see the family doc or go to a walk in clinic, present my health card and not worry about anything except getting better.

 

I had to use insurance for the first time in the middle east.  We spent 20 minutes sitting in the waiting room while the secretary checked to see if my daughter's hearing test (she had a hearing impairment that was surgically corrected) would be covered by my husband's insurance.  All I could think of was how barbaric that is - that someone else's bottom line and profit margins determines whether or not a child gets to hear. I'm thankful for universal healthcare when my daughter needed the surgery because I was working two min wage jobs and going to university part time so I wonder if I would have had insurance or been able to afford it.      

 

 

 

[Mrs Mungo]

Military health care works much in the same way as Medicare. There is a LOT of crossover. My experience with a lot of military people is that a lot of them don't like admitting that to themselves.

 

 

And all I can think each time I see it is we are one amazing country (seriously, I take pride in this about the USA) that not only has an entirely volunteer military, but manage it without employing mercenaries, tyvm.

 

Not true. We definitely hire mercenaries.

[Pawz4me]

 

Other than being triple or more the size geographically?

 

Canada is *much* bigger geographically than the U.S.

 

 

And all I can think each time I see it is we are one amazing country (seriously, I take pride in this about the USA) that not only has an entirely volunteer military, but manage it without employing mercenaries, tyvm.

 

Goodness.  I doubt the U.S. military could function w/o "contractors."  And not all of them are exactly doing desk jobs, if you understand what I mean.  A mercenary by any other name . . . .

[Donna]

My ideal would be

 

-a legal system that does not allow people to sue for every ridiculous thing and makes people who bring frivolous lawsuits pay all court costs if they lose so that hospitals and doctors do not settle frivolous lawsuits because it is cheaper than fighting them in court. (completely necessary to bring healthcare costs down)

 

-a healthcare system that allows doctors to decide what the patient they are treating needs rather than some government entity or not medically trained person behind a desk. Case in point- dd stepped on a toothpick that broke off in her foot a few weeks ago. They wanted to CAT scan it to see where it was or if it was actually in there and wasn't a broken toothpick before she stepped on it but they could not do the CAT scan without first doing an x-ray even though they knew an x-ray would not show wood but they had to do an x-ray first because insurance would not pay for a CAT scan without first having an x-ray. (and that is just a small example)

 

-I do not know what my ideal is as far as payer. Universal Healthcare "sounds" good in theory but I hear how people in other countries wait months and months for treatment or treatment is denied or subpar. I don't want that. I have insurance so I probably have a different viewpoint than those who don't and I admit that. I see my insurance prices going higher and that of people around me who are already having difficulty paying for their own. I don't trust the government not to screw universal healthcare up by putting their cronies and friends in positions of administration or as lawyers to suck money out of the system rather than it going where it should. I also don't trust the bill that passed because those who passed it didn't read it and the more I hear about it and how it affects those around me, the less I like it.

 

-I rarely go to the doctor. I try to live a healthy lifestyle. I think leaning more in that direction is the way to go but I don't think the government should be able to force lifestyle choices on people. 

 

-I think less expensive alternatives to taking a child with the sniffles to the ER are completely necessary. (I used to do hospital billing so I saw how many times this happened and what the costs involved were.)

 

-I think there needs to be a more fair way to provide services and necessary medical equipment to children with special needs. I see way too many children do without therapies and medical equipment because of insurance issues. 

 

It's early and that's all I can think of at the moment. (I didn't read the other replies so sorry if I repeated anyone.)

[ktgrok]

A few thoughts, aside from my fervent desire for universal healthcare, which I think I'd give up a non essential organ for. 

 

 

1. make becoming a doctor easier, in the sense of money and time. In the UK it is my understanding that you go to medical school without doing 4 years of college first. 

 

2. Group medical appointments (optional) for things like diabetes, prenatal appointments, well child visits, etc. This is being tried here in a few places and it seems to be working well. The idea is that instead of 10 patients each seeing the doctor for 6 minutes over the course of an hour, all 10 would see the doctor for an hour, together. This way the doctor isn't answering the same question half a dozen times an hour, a community of sorts is built which is helpful, and the patients get enough time to develop a relationship with the doctor which has been shown to be the very best way to prevent lawsuits. it turns out people don't sue doctors they like, most of the time. 

 

3. More well care handled by nurses and midwives. 

[Laura Corin]

A few thoughts, aside from my fervent desire for universal healthcare, which I think I'd give up a non essential organ for. 

 

 

1. make becoming a doctor easier, in the sense of money and time. In the UK it is my understanding that you go to medical school without doing 4 years of college first. 

 

 

 

Yes - medicine is an undergraduate degree.  For the sake of balance: there are those who think that coming to medicine later and with more maturity is preferable, but I'm not knowledgeable enough to argue the benefits either way.

 

L

[ktgrok]

 

 

-I do not know what my ideal is as far as payer. Universal Healthcare "sounds" good in theory but I hear how people in other countries wait months and months for treatment or treatment is denied or subpar. I don't want that. I have insurance so I probably have a different viewpoint than those who don't and I admit that. I see my insurance prices going higher and that of people around me who are already having difficulty paying for their own. I don't trust the government not to screw universal healthcare up by putting their cronies and friends in positions of administration or as lawyers to suck money out of the system rather than it going where it should. I also don't trust the bill that passed because those who passed it didn't read it and the more I hear about it and how it affects those around me, the less I like it.

 

 

 

Just wanted to add that most of those "long wait" scenarios are scare tactics. Yes, some non emergency procedures might have a wait, but better for everyone to be able to afford care and have to wait a bit than the rich get care quickly and the poor not get care at all, which is what happens now. 

 

As for government officials appointing corrupt buearocrats, the good news is that we can then,as a people, vote out that government official. As it stands now I have zero power over the head of my insurance company. I can't vote him out. And I can't "vote with my dollars" because my husband's company only offers insurance through one company. I'd rather a governement worker I can vote out be in charge. 

[flyingiguana]

I don't want to derail this thread, but I'd like to hear what others think about this question. What makes the US so different from other first world countries (particularly our neighbor to the north, Canada) that a significant portion of our citizens are opposed to some type of universal healthcare?

 

I'm curious too.

 

Given the example we have of many other countries making this work, about the only hypothesis I've been able to come up with is that people who are against universal healthcare are just clueless about what it entails.  And with all the propaganda coming out against it, I guess it's not that surprising.  (Where and why that propaganda stems from is something a lot more people who are against universal healthcare ought to be asking themselves.)

 

Explanations for why people would rather go with a free market for things like health and road systems have never made sense to me. 

 

The free market may sound like a good idea from an overall population perspective, but if people truly understood what a strict free market can do to individuals it could change a lot of minds.   It's a crap shoot as to whether you are one of the ones who is benefiting from the current system -- and whether next year you will be one of the underdogs who loses everything because of how things are set up.  If people knew what their chances were to be one of the losers (and how they have no control over whether this happens), it might completely change their minds about how to handle the health care issue.  It's easy to say free market when you're riding on top.  Not so easy when you fall to the bottom. 

 

That's got nothing to do with charity, but just plain old self interest. 

 

Was there not a study done asking people which society they would like to live in -- when they were given no idea as to whether they'd be one of the ones who did well, or one who did poorly?  In that circumstance, didn't most choose to live in a more equitable society?  A free market does not result in a more equitable society.

 

Basically, only someone like Warren Buffet (who has SO far to fall that he'd probably never hit bottom) should take the gamble on a free market system.  Everyone else has too much to lose.  Even if a person fervently believed in the idea of a free market system, if everyone had a better sense of the risks this entailed for each individual, most individuals would sensibly NOT choose a free market, particularly if they had children or other vulnerable people in their family.

 

So I can only infer from the sheer number of people espousing free market systems that they do not actually understand the risks to them personally.  (Because I doubt there are many Warren Buffets on this forum  -- or Koch brothers.  For those who hope for a free market health care system who don't know who the Koch brothers are, I suggest you look them up.  It's quite enlightening.  I will stand back when you discover how you've been brainwashed by the super rich.)

 

A somewhat related editorial:

"The U.S. likes to think of itself as friendly to small businesses. But, as a 2009 study by the economists John Schmitt and Nathan Lane documented, our small-business sector is among the smallest in the developed world, and has one of the lowest rates of self-employment. One reason is that we’ve never had anything like national health insurance. In a saner world, changing this would be a reform that the “party of small business†would celebrate."

 

(I was surprised to see that Nathan Lane was also an economist.)

 

(That was a joke....)

[ThatHomeschoolDad]

One positive trend that is already happening, and will likely accelerate, is increased use of nurse practitioners. I've had some awesome cnps and apns.

[flyingiguana]

I don't advocate a free market medical system, but I do think universal care would be better coming from the states than the Feds. In general, I'm pro states rights over federal. General having quite the addendum section of exceptions.

 

Actually, there is one very good reason to have the federal govt do it -- bargaining power.

 

If the federal govt negotiated prices costs would go WAY down.  This is likely the reason health care is SO much cheaper in most other countries.

[ktgrok]

Actually, there is one very good reason to have the federal govt do it -- bargaining power.

 

If the federal govt negotiated prices costs would go WAY down.  This is likely the reason health care is SO much cheaper in most other countries.

 

the other reason is lack of paperwork/isurance bull poop. 

 

In a doctor's office here you have to train a bunch of people to know how to handle 30 different insurance companies. It is a full time job just begging these companies to pay what they owe. IN a governement run system there is ONE form, and it is just a matter of sending it in. No time wasted verifying IF the person has insurance and is covered. No money spent on marketing various insurance plans. etc etc etc. 

[ktgrok]

This is being done here for informational visits...for ex. once a month the hospital runs a session on knee & hip replacements. The roomful of people can ask anything about the procedure and the aftercare offered. The cost is included with the price of surgery.  I don't see how it would work well with prenatal and well child ... I wouldn't be interested in the violation of my privacy or the acquiring of germs from the other people.

 

I think I'd like to see a portable emergency room and a clinic at the precinct in cities where there is a lot of time spent by officers transporting people to the ER.  That would cut down on the unreimbursed ambulance expenses by having the patients with cuts/abrasions treated on the spot.

 

The way it has been done for prenatal is that you first get weighed, measured, etc by a nurse. Pee in the cup, whatever. If you have a private question you could ask then, or schedule a separate appt. But then you go into the group for the rest of it. And it was optional, if you preferred the regular appointment system you could stick with that. 

[flyingiguana]

From the history of military pricing, I doubt that costs would go down to the point that a lower middle class person could pay for ordinary,noncatastrophic care out of pocket.

 

http://economix.blogs.nytimes.com/2013/03/29/u-s-health-care-prices-are-the-elephant-in-the-room/?_r=0

http://www.commonwealthfund.org/News/News-Releases/2012/May/US-Spends-Far-More-for-Health-Care-Than-12-Industrialized-Nations-but-Quality-Varies.aspx

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/03/26/21-graphs-that-show-americas-health-care-prices-are-ludicrous/

The last is bit misleading if one wants to compare averages to averages (not average to 95th percentile), but I'm guessing the highest bar is there so it's obvious not only that the US has higher rates, but that they vary incredibly.

 

Not sure why "the greatest nation on earth" can't do as well as all those other countries in negotiating health care prices.

(I use that phrase in all snarkiness...)

 

I haven't seen any studies of military pricing as to whether it is actually high (beyond the anecdotes we see), and whether those high prices are actually paying for externalities that we personally cover in other ways when we buy a cheaper hammer or toilet or whatever.

 

 

A few random quotes from the above articles:

A central reason U.S. health care spending is so high is that hospitals and doctors charge more for their services and there’s little transparency about why. There is no uniformity to the system, in which public and private insurers have separate, unrelated contracts with hospitals and doctors. The result is a tangled, confusing and largely secretive collection of forces driving health care prices higher and higher.

This isn’t possible in many other countries either because governments set prices for health care services or broker negotiations between coalitions of insurers and providers. Known as “all-payer rate setting,†insurers in these systems band together to negotiate as groups. In contrast, U.S. insurers closely guard the secrecy of their contracted prices with health care providers and negotiate individually. This is why a hospital hosting five patients for knee replacements might get paid five different amounts for the surgeries.

 

Traditionally, the theory driving discussions on the high cost of health care in the United States has been that there is enormous waste in the system, taking the form of excess utilization of care. From that theory it follows that methods of controlling the growth of health spending should focus on ways to reduce the use of unnecessary or only marginally beneficial health care.

 

 

Largely overlooked in these discussions has been the elephant in the room: the extraordinarily high prices Americans pay for health care. However, as a group of us noted in a paper in 2004, “It’s the Prices, Stupid,†it is higher health spending coupled with lower – not higher — use of health services that adds up to much higher prices in the United States than in any other member nation of the Organization for Economic Cooperation and Development. Aside from a few high-tech services, Americans actually use less health care and rely on fewer real health-care resources than do residents of other industrialized countries.

 

 

 

 

High spending in the U.S. might be explained, in part, by the nation’s high rates of obesity and the associated medical costs. However, at the same time, the U.S. also has a very young population and few smokers relative to the other study countries—factors that could offset higher spending linked to obesity, the report notes.

[Mbelle]

I would like to see universal healthcare.  I'd like to be careful about implementing it.  

 

For instance as a woman I personally most certainly do not want any nurse/midwife coming to my home after I have a baby.  I would be fine if it was a choice and you could just say no. ( I would like to have homebirth available.)  I would never want anyone to come to my house for any reason other than hospice care.  In countries where you have nurse visiting after a baby is it an option to say no?  Can you just go into the office for a visit instead?  

 

As a family with a chronic illness (and a fairly normal one), we spend thousands of dollars in healthcare.  We have a very hard time getting decent coverage.  It is a major reason why we haven't gone back to owning our own small business.   

[Laura Corin]

For instance as a woman I personally most certainly do not want any nurse/midwife coming to my home after I have a baby.  I would be fine if it was a choice and you could just say no. ( I would like to have homebirth available.)  I would never want anyone to come to my house for any reason other than hospice care.  In countries where you have nurse visiting after a baby is it an option to say no?  Can you just go into the office for a visit instead?  

 

 

 

I can't imagine that being an issue.  I just liked not having to get out of my PJs.  And we didn't have a car, so it was nice not to have to make the journey.

 

L

[Pawz4me]

I would like to see universal healthcare.  I'd like to be careful about implementing it.  

 

For instance as a woman I personally most certainly do not want any nurse/midwife coming to my home after I have a baby.  I would be fine if it was a choice and you could just say no. ( I would like to have homebirth available.)  I would never want anyone to come to my house for any reason other than hospice care.  In countries where you have nurse visiting after a baby is it an option to say no?  Can you just go into the office for a visit instead? 

A nurse came to our house after oldest DS was born.  It was a service offered by our insurance company, fully covered.  I'm sure I could have declined and saved them some money, but I really didn't think about it.  The visit itself was certainly no big deal beyond giving a first-time mom some peace of mind, and having the opportunity to speak to a professional in my home environment, where I felt very comfortable and at ease.

 

I just don't see why so many people have such an objection to something like a nurse visit.  Are you (general) fearful of Big Brother?  Doing something illegal? I dunno -- at the time we lived a typical, fairly boring middle class life in a typical, well-kept middle class home.  I simply didn't see any reason to be paranoid about it.  And please note I'm not asking these questions or using the word "paranoid" to be contentious or snarky.  But I can't think of another term to aptly describe the attitude that I'm sensing.  FWIW, my aunt is a nurse who for a few years worked performing home visits for a low-income program targeted at new mothers.  There was absolutely no Big Brother/spying component to her job at all.

[Murphy101]

Military health care works much in the same way as Medicare. There is a LOT of crossover. My experience with a lot of military people is that a lot of them don't like admitting that to themselves.

 

Hmmm. Okay. I'll take your word for it. I'd have to finagle a very unPC conversation with those I know in the military to see if they agree.

 

Not true. We definitely hire mercenaries.

 

 

 

 

Goodness.  I doubt the U.S. military could function w/o "contractors."  And not all of them are exactly doing desk jobs, if you understand what I mean.  A mercenary by any other name . . . .

 

D@mn. You have me there and I agree. *blush of shame for not seeing that obvious error on my part* Though I think it's ...possibly shameful and certainly very worrisome.

[ktgrok]

A nurse came to our house after oldest DS was born.  It was a service offered by our insurance company, fully covered.  I'm sure I could have declined and saved them some money, but I really didn't think about it.  The visit itself was certainly no big deal beyond giving a first-time mom some peace of mind, and having the opportunity to speak to a professional in my home environment, where I felt very comfortable and at ease.

 

I just don't see why so many people have such an objection to something like a nurse visit.  Are you (general) fearful of Big Brother?  Doing something illegal? I dunno -- at the time we lived a typical, fairly boring middle class life in a typical, well-kept middle class home.  I simply didn't see any reason to be paranoid about it.  And please note I'm not asking these questions or using the word "paranoid" to be contentious or snarky.  But I can't think of another term to aptly describe the attitude that I'm sensing.  FWIW, my aunt is a nurse who for a few years worked performing home visits for a low-income program targeted at new mothers.  There was absolutely no Big Brother/spying component to her job at all.

 

 

Honestly, I was thought they were objecting more because they didn't want a stranger seeing the house torn apart and dishes in the sink right after a baby was born, lol. That's what I was thinking! Although, my midwife does make two home visits after a birth, and my doula came once. But I knew them enough to not worry too much about it. 

[Murphy101]

Canada is *much* bigger geographically

 

I wouldn't call 1.6% *much* bigger.

 

http://www.unitednorthamerica.org/simdiff.htm

[Murphy101]

Honestly, I was thought they were objecting more because they didn't want a stranger seeing the house torn apart and dishes in the sink right after a baby was born, lol. That's what I was thinking! Although, my midwife does make two home visits after a birth, and my doula came once. But I knew them enough to not worry too much about it.

I would be thrilled to completely do away with dr offices and instead have home visits return.

 

That aside, some mentioned daily visits for like 10 days iirc? For folks like me who are used to poor maternity care ... (Well, I guess I am not used to it bc it still ticks me off, but I do expected it at this point.)... It seems annoying and intrusive. Many of us moms are highly frustrated and annoyed to have to deal with hospital staff and regulations through labor and shortly after delivery. For many such women they view going home as finally escaping and being able to relax with their new joy. So for them, and that would include me, the idea of having that follow me home would be very stressful and upsetting. And sure the medical staff here always talk as though we have no right to refuse and they sure don't encourage that attitude. So saying they could turn it down and them feeling safe turning it down would be quite the hurdle to overcome.

 

And yes, there's the whole, "just leave them alone half naked nursing in bed with the tv on and kids playing around us and decidedly NOT interested in strangers visiting" aspect too. :)

[ktgrok]

I would be thrilled to completely do away with dr offices and instead have home visits return.

 

That aside, some mentioned daily visits for like 10 days iirc? For folks like me who are used to poor maternity care ... (Well, I guess I am not used to it bc it still ticks me off, but I do expected it at this point.)... It seems annoying and intrusive. Many of us moms are highly frustrated and annoyed to have to deal with hospital staff and regulations through labor and shortly after delivery. For many such women they view going home as finally escaping and being able to relax with their new joy. So for them, and that would include me, the idea of having that follow me home would be very stressful and upsetting. And sure the medical staff here always talk as though we have no right to refuse and they sure don't encourage that attitude. So saying they could turn it down and them feeling safe turning it down would be quite the hurdle to overcome.

 

And yes, there's the whole, "just leave them alone half naked nursing in bed with the tv on and kids playing around us and decidedly NOT interested in strangers visiting" aspect too. :)

 

Perhaps a better idea would be a daily phone call with the offer to stop by and check on things. That way if a mom IS having a hard time with nursing, or bleeding, or what not someone can stop in and help. And if not, the phone call will be quick and easy. I do think a few check ups are a good idea, my midwife does one at 2 days after birth and 2 weeks after birth, but the option to go into the office versus have her come is always there. 

[Mbelle]

I like to have my privacy. I just want to be relaxed in my home after I have babies, and just my family and close friends pop by.  I need to not worry about a messy house etc with strangers coming by, and because of my personality I would not be comfortable unless it was nice looking.  I'd probably be stressed out about it and don't need that on me at that time.  Just need to snuggle and nurse a sweet baby.

Also, in our area defacs is a little insane.  I used to roll my eyes and think people were paranoid too, until i saw it up close and personal with friends.  I could not believe it.  Then I heard more and more stories from honestly really normal people.  I'm not into conspiracy theories or any other crazies.  I'm not sure what is going on in my area, but it is getting ridiculous.  I can see where it might seem paranoid in writing.

 

 

[Murphy101]

Perhaps a better idea would be a daily phone call with the offer to stop by and check on things. That way if a mom IS having a hard time with nursing, or bleeding, or what not someone can stop in and help. And if not, the phone call will be quick and easy. I do think a few check ups are a good idea, my midwife does one at 2 days after birth and 2 weeks after birth, but the option to go into the office versus have her come is always there.

Ha! With my last baby we turned the ringer off as soon as we got home and then forgot to turn it back on for months. If I knew to expect daily nagging, I'd turn the ringer off.

 

Why can't they just make it very clear that if the woman has concerns, to call them anytime? That seems far more reasonable to me? Especially if they can actually get assistance. They say that here, but it's total bull. They're useless. Pretty much no matter what you say, the response is, "If you're worried, you should come back in for a doctor to evaluate you." And breastfeeding help is even worse. And a good portion of it is downright an obstacle. Twice I had the breastfeeding consultant at the hospital tell me to just give a bottle. Geez. I know that there are better lactation consulting options out there, but here it really is the luck or bad luck of the draw. I've often wished I could do lactation consulting. I'd love to share with new moms all over learned from 18 years of breastfeeding... I feel bad for how difficult it is for new moms to get breastfeeding help and encouragement. Especially past the first 2 months. But anyways.. That's another topic... :)

[ThatHomeschoolDad]

I wouldn't call 1.6% *much* bigger.

 

It's bigger when you count in the depth of snow -- it's a cubic volume thing.

[Murphy101]

It's bigger when you count in the depth of snow -- it's a cubic volume thing.

*snort* That's enough to keep me out of Canada. So I guess if anyone finds out I've moved to Canada or Outer Mongolia, they'll know just how hellish US healthcare must have gotten for me to appreciate that cold weather.

[Upward Journey]

*snort* That's enough to keep me out of Canada. So I guess if anyone finds out I've moved to Canada or Outer Mongolia, they'll know just how hellish US healthcare must have gotten for me to appreciate that cold weather.

Sometimes all it takes to make the leap is being unemployed and getting a job offer that will pay moving expenses....

[Murphy101]

Sometimes all it takes to make the leap is being unemployed and getting a job offer that will pay moving expenses....

Nope. Dh turned down a job in Toronto three years ago. There may come a day when we regret that, but not so far.

 

Though to be fair he also turned down a job in Costa Rica 5 years ago and he regrets that one. Sorta. I not want to be low income AND a country away from every person we know and love. When grandchildren or grandparents or friends I've known my entire life need us, I want to be able to be there. That's extremely important to us both. Way more important than income or even our personal health to a some extent.

 

If we could afford the move AND still do that? I probably would be okay with it.

[regentrude]

For instance as a woman I personally most certainly do not want any nurse/midwife coming to my home after I have a baby.  I would be fine if it was a choice and you could just say no. ( I would like to have homebirth available.)  I would never want anyone to come to my house for any reason other than hospice care.  In countries where you have nurse visiting after a baby is it an option to say no?  Can you just go into the office for a visit instead?  

 

We have visiting postpartum midwives in Germany, and of course you can opt out. I must say, however, that I much preferred NOT having to drag my exhausted body and a newborn to a doctor's office where I'd sit in a waiting room full of sick kids, crawling with germs... way safer to stay home and have somebody come check on us.

 

[Murphy101]

We have visiting postpartum midwives in Germany, and of course you can opt out. I must say, however, that I much preferred NOT having to drag my exhausted body and a newborn to a doctor's office where I'd sit in a waiting room full of sick kids, crawling with germs... way safer to stay home and have somebody come check on us.

 

No, I don't think you understood the question. Can you opt out? Not "can you go to them instead?"

 

I wouldn't have done either! I don't want checking on. I'll let you know when or if I do, thanks anyways. :)

 

If I did, I would love to have a home visit for the same reasons you note.

[Mrs Mungo]

No, I don't think you understood the question. Can you opt out? Not "can you go to them instead?"

 

I wouldn't have done either! I don't want checking on. I'll let you know when or if I do, thanks anyways. :)

 

If I did, I would love to have a home visit for the same reasons you note.

 

Most people take their babies to the pediatrician at regular intervals for weight checks, for a two week appointment, 4 week appt, etc. I think that is what regentrude was talking about. 

[Murphy101]

Most people take their babies to the pediatrician at regular intervals for weight checks, for a two week appointment, 4 week appt, etc. I think that is what regentrude was talking about.

Good grief. Really? Why take a healthy baby in every 2 weeks?! Oh never mind. That's also yet another topic.

 

My pediatrician sees them within 24 hours at the hospital and thereafter only if I had a concern. With my home births, my dh took the baby in the next day.

[Catherine]

I haven't read any of the responses, but my perspective, as an internist, is that specialization is also a big driver of increased costs.  Widely available, competent primary care is cost-effective.  

Medicare payment rates for care are set by a committee, and many of its members are subspecialists that of course arrange to pay themselves nicely.  

 

I'll give a tiny example. When called my pediatrician for an appointment for my son's garden-variety acne, I was hoping for a quick visit and prescription for tetracycline. Instead she referred us to a dermatologist.  Why?  I'm guessing it's because experience has shown her than many patients insist on seeing a dermatologist for acne, and their insurance happily picks up the tab for this unnecessary expense.  Maternity care is another example.  Here in the USA we pay far, far more for maternity care than what is typical in Europe, with worse outcomes.  It's at least partly driven by patient demand, but insurance again happily pays for the ultrasounds, C-sections, and their complications.  

 

There was an excellent article on the front page of the NY Times that looked a hip replacements, their costs compared to Belgium (the article profiled an American who traveled there for his surgery to save costs), and the largest components of the cost. The biggest expense by far in a hip replacement is the hip itself.  Though the actual costs of producing a hip prosthesis is about $300, near-monopoly conditions, probable price-fixing by manufacturers of prosthetic hips, and other anticompetitive practices are common and tolerated as part of the cost of doing business.  My ideal system would eliminate those kinds of anti-competitive practices by medical equipment manufacturers.  Here is the article:

 

http://www.nytimes.com/2013/08/04/health/for-medical-tourists-simple-math.html?pagewanted=all&_r=0

 

The difference in cost between Belgium and the USA for hip replacement is nearly an order of magnitude.  And we offer absolutely nothing to justify this higher cost.  That kind of spending is unsustainable.  

[Mrs Mungo]

Good grief. Really? Why take a healthy baby in every 2 weeks?! Oh never mind. That's also yet another topic.

 

My pediatrician sees them within 24 hours at the hospital and thereafter only if I had a concern. With my home births, my dh took the baby in the next day.

Doctors generally want to see babies at 2 weeks because the women get released from the hospital after 24 hours. That's not enough time to know that breastfeeding is going well and that baby has no issues. Understand, I live in a much different situation than you do. I've been surrounded by women often separated from their families (and husband) by thousands of miles. It's my experience as a former breastfeeding support person that doctors often have good reason to be concerned about mother/baby pairs, especially in that situation. The women frequently have no support, little knowledge and don't know what right looks like. You live in a situation where women are usually surrounded by experienced family members who can help, who can tell mom when something is wrong, who can help with breastfeeding support. Not everyone has that. Don't take it for granted.

[WishboneDawn]

I think one reason for the high health care costs in this country is not the existence of technology per se, but the litigious society with people so eager to sue their doctors. Doctors have to order unreasonable tests because they can not afford the minute chance of missing something, and doctors have outrageous liability insurance premiums. I know obstetricians who are on the verge of stopping their practice because their liability insurance is so ridiculously high (several $100,000 per year; cost that has to be recovered from the patients before the practice sees any profit). Pediatric neurosurgeons are becoming rare because of the very high risk of law suits. I think this is a unique facet of the

But perhaps the litigiousness is a result of the system?

 

Malpractice suits aren't a big issue here in Canada but if a surgeon makes a mistake (or someone thinks they have) then then resulting medical care isn't an issue because of our health care system. In the USA it can carry huge financial costs for the individual. Malpractice suits are how that's addressed.

 

That's the cost of the way the USA has chosen to handle health care and it likely won't change until the system changes.