101. JJBiener - Aug. 2, 1999 - 2:19 PM PT
Wombat - "At present our 'system' is both expensive and inefficient, with bureaucrats in a position to make medical decisions, mountains of paperwork administered by semiliterates, and discontented doctors and patients."
And you would replace this system with one where government bureaucrats make medical decisions, mountains of paperwork are adminstered by semiliterate government workers, and discontented doctors and patients have no choice whatsoever. Brilliant.
As someone who depends daily on our medical system for his very existence, I will fight you in every effort to make health care government run. You complain about bureaucracy in health care then propose turning health care over to the biggest, most bloated bureaucracy on Earth. That, my friend, is insane. Imagine if you will someone with an IRS auditor's mentality controlling your health care. If that doesn't scare you, nothing will.
102. Ronski - Aug. 2, 1999 - 2:23 PM PT
As it has been said before, socialized medicine is health care delivered with all the compassion of the IRS, and all the efficiency of the Postal Service.
103. CalGal - Aug. 2, 1999 - 2:27 PM PT
Incidentally, the CalGal plan is also subsidized in part by government dollars. Poor people and people with chronic health problems would be subsidized more than others.
I await Ronski's disapproval, but I'd point out that *my* subsidization is even handed.
104. CalGal - Aug. 2, 1999 - 2:28 PM PT
Um. Oh, well. Not *completely* evenhanded. But at least the subsidization goes to those who need it most.
105. Ronski - Aug. 2, 1999 - 2:37 PM PT
Cal,
It is a better plan than some...
At least part #2.
106. HardyHarHar - Aug. 2, 1999 - 3:04 PM PT
Ronski,
Re: Message 94:
I don't think the government has any interest in making sure that there are more doctors than we need, or that doctors themselves have lost control over how many join their ranks, there are a number of factors that combine to affect the numbers of specialists....
If a society of specialists determines that there is a shortage, it simply pushes for its members to enlarge their fellowship programs. Aside from scholarships and medical school subsidies, the government doesn't coerce people into or out-of becoming a specialist in something. In fields where the need is great or little is known, people are attracted, a career lasts 20+ years so it takes time for the numbers of doctors in a given specialty to match the need. (At present, there are more neurosurgeons in North America claiming competence in skull base surgery than there are people who require the procedure.)
107. HardyHarHar - Aug. 2, 1999 - 3:19 PM PT
JJ,
Re: Message # 97:
I haven't read the Clinton plant, but if there is a choice between one in which requires "...everyone have health insurance and have the same access to the same medical resources regardless of their financial status" and a string of churches and community clinics providing free, though limited, care, what's the choice?
I don't think that stasticis call for universal health care coverage, I think what they do is illuminate small and large area variations in the rates at which certain illnesses are diagnosed, the efficacy of the standard of care for certain illnesses and the average cost of providing that care. What's wrong with that? After all, it has been our government, through HFCA and its medicare program, that some semblance of reason has entered the resource allocation methods in health care. No private system could affect the wholesale reform that has taken place in the past 5 years.
108. Mazaska - Aug. 2, 1999 - 3:30 PM PT
"Figure $200/month for a family of 4, $2000 deductible"
Well, that's beyond *my* means. So I'm glad you're not in charge CalGal.
"Those who cannot afford proper health care can (and were, historically) helped by a wide variety of religious and industrial charities, and by a medical professional ethic which pretty much dictated that as much as a third of a physician's time was to be spent helping the poor."
1) I don't believe that *ever* happened.
2) Even if it did, I don't think it will happen in today's world. Here's what I think would happen in today's USA - those who can't afford health care and had strong genes/bodies would survive and those who were weaker would die. (My 75 yr old mother says that's what *really* happened in the 30s.) Some people think this would be a good thing. Some don't.
109. ranheim - Aug. 2, 1999 - 3:31 PM PT
Over 40 messages to pour through! I, actually, skimmed.
#66
If americans want to spend 13% or 25% of their money on health care, let them do it. It is not the governments responcibilty to say "You are spending too much money on Yankee season tickets!" Same reasoning should apply to medicine.
#76
Too expensive because the average patient leaving an emergency room has no idea what his bill. He/she shows the insurance card and signs a piece of paper! I would change things : Every patient leaving would be presented an itemized bill. It would be the patient's responciblity to pay that bill. If broke : welfare; If insurance : sign something that has legal standing; etc. In my opinion, it is an assinine system when patients JUST WALK OUT! Particularly if they have no idea what their bill is. Same thinking for surgery : see an itemized bill prior to surgery. Have that copy availble when the "final" bill is submitted. The doctor and/or the hospital have to justify each and every penny over the estimate.
#86
I don't know too many doctors that "screw" a patient on their bill. Every hospital does! How do you think a hospital pays for Medicare which doesn't pay enough; welfare where politicians are notoriously cheap with this class; and those that "welch" on the deal? One of my brothers-in-law is from Wales. I never apologize to him; I will, in advance, to anyone who reads this who is from Wales.
#98
"a state-based single payer system". Did you have the VA in mind?
It, very likely, is the poorest system of clinics and hospitals in the USA. In the VA Hospital closest to me, the staff is close to 100% foreign/poor English speakers. If the patient is not able to understand the doctor, there are going to be failures (there are!)
110. CalGal - Aug. 2, 1999 - 3:34 PM PT
Mazaska,
"Well, that's beyond *my* means. "
$200/month for a family of four? Be silly. $30/kid and $70/adult? If you can't afford it, you're not middle class.
At any rate, that $2400 would also be fully deductible.
And if you are employed, you are getting a benefit at *my* expense to the tune of, probably, $3600/year. Per person, mind you. Untaxed. So how about instead of *my* plan, you just pay taxes on that?
111. CalGal - Aug. 2, 1999 - 3:36 PM PT
I should explain this more:
"If you can't afford it, you're not middle class."
That is the income category Bubba and I were discussing.
The average car owner has to fork out somewhere between $90-300/month for car insurance. So I'm figuring they can manage $200 for health insurance. Especially since it's deductible.
112. HardyHarHar - Aug. 2, 1999 - 4:20 PM PT
ranheim,
"Same thinking for surgery : see an itemized bill prior to surgery. Have that copy availble when the "final" bill is submitted. The doctor and/or the hospital have to justify each and every penny over the estimate."
If you have health "insurance," then the bill has already been figured out before you are cleared for the procedure. Insurance companies negotiate with the hospital to be reimburse based on a code that the hospital uses for a given procedure (ICD-9-CM codes, to be exact.) That code pays a certain amount, and that's it.
The reimbursement code for a hospital billing Medicare for, say, a Radical Vulvectomy (ICD-9-M Code: 71.3 [Excision or destruction, local, vulva or perineum, other]) would receive, on average, either:
$7,193.45
$6,477.18
$3,649.82
$2,343.56
Depending on the diagnosis that led to the procedure.
This amount of money covers the hospital's costs, from the aspirin to the sutures (including the food she eats the next day, too) If it costs the hospital more than that to perform the procedure, or care for the patient afterwards, then they lose whatever amount of money it costs above what the code pays. Where do the codes come from? Statistics.
The doctor, on the other hand, bills the hospital with a CPT (common procedural terminology) codebook, I count 23 "acceptable" CPT codes a doctor could bill when doing a radical ulvectomy from: [11420: Excision, beging lesion, except skin tag (unless listed elsehwere), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less)] to [56515: Vulvectomy, radical, complete, with inguinofemoral, iliac, and pelvic lymphadenectomy]
What the doctor receives is based on the CPT code, and that code, even, is effected by the doctor's Geographically Adjusted Medicare Fee Schedule, which factors in a host of things. Again, the genesis for this fee schedule is a stasticial database (administered by
113. HardyHarHar - Aug. 2, 1999 - 4:21 PM PT
...
(administered by the AMA - not the government) that tells us how long it should take a competant doctor to perform a given procedure, taking into account all of the expected comorbid conditions and possible complications. If you have a shitty surgeon, who takes longer because he fumbles, then at $65 ~ 150/minute that OR time costs he might be a money loser. Guess what, a savvy hospital administrator will see that in an instant and hopefully, for no other reason than the guy just sucks cash, the hospital will do its best to keep that man out of the OR, or schedule his surgeries for weird times.
114. HardyHarHar - Aug. 2, 1999 - 4:23 PM PT
Woah, that per/minute OR figure is off, it should be more like $30 ~ 60 per minute....
115. HardyHarHar - Aug. 2, 1999 - 4:25 PM PT
So, that's how Medicare pays, and believe it, the other big insurance companies take their lead from HCFA. There are some things that HCFA covers that the Blues won't, for instance, but there ain't nothin the Blues cover that HCFA doesn't.
116. Amaxen - Aug. 2, 1999 - 6:06 PM PT
Calgal,
Here's my version of how the medical services industry should be changed:
(note that this is nutjob libertarianism slightly modified to please those people who think people are not capable of looking after their own interests)
1. All workers required to place minimum 5% of their incomes tax-free into a 'medical IRA' account, administered by the private sector.
2. Money from the mIRA can only be used for medical expenses.
3. Appropriate funding of mIRAs by the feds into the accounts of the very/chronically poor.
4. Complicate this formula somewhat by adding clauses to handle transition costs.
117. Amaxen - Aug. 2, 1999 - 6:17 PM PT
Remember,
Insurance can be considered a medical expense.
118. Mazaska - Aug. 2, 1999 - 7:10 PM PT
"The average car owner has to fork out somewhere between $90-300/month for car insurance."
Maybe in CA, but where I live I pay less than $300 for six months and that's with full coverage and PIP. Get a grip CalGal, California is in a whole 'nother universe than most of the country when it comes to living expenses.
If you resent not having employer paid health insurance, get another employer. It's part of the compensation package I signed up for. If my employer takes it away, then I'll go elsewhere or the company will have to raise my salary to make up the difference. Fergadsakes, woman, 7-11 has health and dental insurance!
119. Mazaska - Aug. 2, 1999 - 7:16 PM PT
"Every patient leaving would be presented an itemized bill."
The last time I went to an emergency room, I WAS presented with an itemized bill when I left. I chose that emergency room because I knew that's how they handle it. When you move to a city, go to the different hospitals and check them out BEFORE you have a need for them. Same thing with doctors - make an appointment to INTERVIEW them first, including preventative medicine policy, communication, billing, philosophy, ATTITUDE, and where he/she has priveledges. If the doctor is not willing to go through this process with you FIND ANOTHER DOCTOR. After the interview, check their malpractice lawsuit record if you live in one of the states that have passed laws guaranteeing you this info.
120. Mazaska - Aug. 2, 1999 - 7:19 PM PT
"Did you have the VA in mind?
It, very likely, is the poorest system of clinics and hospitals in the USA. In the VA Hospital closest to me, the staff is close to 100% foreign/poor English speakers. If the patient is not able to understand the doctor, there are going to be failures (there are!)"
I have been a patient in a VA hospital. I'd rather die on the streets than go back to one.
121. jonesatlaw - Aug. 2, 1999 - 7:42 PM PT
Some Fraysters are afraid of government bureaucrats making medical decisions. My experience is that private insurance company bureaucrats are just as ridiculous. For example, the plan administrator for my wife' self-insure plan required that I have an x-ray before they would authorize an MRI for my spine. Nevermind that the x-ray would tell my neurosurgeon nothing of importance and that the proceedure was totally wasted. So we took the x-rays, developed them, placed them in the file and forgot them. I did the MRI the next day.
Most of the awful things that the conservatives fear will happen if the government had a larger role in health care, already happen now.
122. CalGal - Aug. 2, 1999 - 10:12 PM PT
Maza,
I said "average", and try not to assume you know what my motivations are. I don't "resent" anything.
"It's part of the compensation package I signed up for. If my employer takes it away, then I'll go elsewhere or the company will have to raise my salary to make up the difference."
Not if the government says you have to pay taxes on it. The only reason companies give you that benefit is because they can deduct it. The government says they can't deduct it and you have to pay taxes on it (which is what my plan says) then it's all over.
Heavens, attempt to stretch your brain a tad.
You get somewhere in the neighborhood of $3000/year per person in your family untaxed benefits. Your employer is deducting those costs from their taxes. People who are self-employed, contract employees, or those who work part-time are subsidizing you. Both in higher medical costs and in less government income overall.
The government *should* subsidize health care, IMO. But not based on who employs you. So my plan says that people make their own medical insurance decisions, buy what they can afford, and deduct it from their taxes.
Now--this solution will make *no* sense to you unless you realize that much of the employed (read middle-class) insurance costs are subsidized by the uninsured workers and the self-employed.
So swallow that, toots. After the wealthy, the employee of a large company providing *any* health care coverage has it best--they are getting far better coverage than they could afford on their own, they are getting it untaxed, and they are being subsidized.
Long term, those individuals who work for a company providing health care are going to suffer, no matter what solution is chosen. They have it best right now--whether you think so or not. Either a solution is going to be implemented, or things for employees are just slowly going to get worse and worse.
123. CalGal - Aug. 2, 1999 - 10:13 PM PT
Amaxen,
Prepaid plan? Absurd. Buy insurance, pay for the rest.
124. ranheim - Aug. 3, 1999 - 5:06 AM PT
#106
LBJ almost doubled the number of medical students during his watch. It was his belief that the increased number of doctors would compete.
Of course, that never happened! Double the number of doctors treating essentially the same number of patients led to more tests (of all kinds) + doctors doing more "things" to each patient.
There are three 60+(age) doctors in my family : one brother; one brother-in-law. All of us believe that the current medical school graduate is a disaster. Their knowlege of medicine is a veneer.
So, by the time LBJ's beliefs kick in (maybe) the quality of the doctor is decreased. When first I graduated from medical school there was no such thing as a "Hand Surgeon". True, these people become very skilled at their work. But, did you ever consider why they became hand surgeons in the first place.
Because they didn't know enough general surgery! And their confidence level was such that they could not tackle this broad field. I am a country G.P. Possibly, I don't have enough respect for these men and women. But, my first impression of sub-specialists and super sub-specialists is that they RAN into their fields because they could not master the wider field of medicine/surgery that they had originally chosen. The result may be satisfying to the patient, but, to a practicing doctor, this has led to the situation where a surgeon refers a patient to a dermatologist to look at a wart (for another very large fee!). And, of course, this happens every day.
125. bubbaette - Aug. 3, 1999 - 6:11 AM PT
Ranheim
I've seen a hand surgeon 3 times in the past two years -- once for carpal tunnel surgery on each hand and once for surgery when a dog bite crushed part of my right hand. If I'd left those instances up to my g.p., I probably couldn't make a fist with either hand right now.
While my g.p. is possibly a bit greener than most, he rarely seems to be able to diagnose anything more complicated than a runny nose, but instead refers me to specialists. Last year he referred me to an ear, nose and throat specialist for ear wax -- something my old g.p. could handle in one visit instead took two dr. visits, one specialist visit, three co-pays and three different bills. Gotta love them H.M.O.'s and the way they keep costs down.
126. Mazaska - Aug. 3, 1999 - 7:30 AM PT
Well, CalGal, I guess we'll jsut have to agree to disagree.
I think your posts sound resentful and your "plan" sounds harsh and unrealistic and your figures and attitudes seriously skewed by your state of residence.
A plan where no employers can pay for health insurance and eveyone must buy their own has a snowball's chance in hell of ever passing. there are too many voters (to say nothing of elected gov't reps) who like it this way and feel entitled to it. Perhaps you missed in my post that even 7-11 offers health and dental insurance and I don't think those clerks will write their congressmen that they want to lose it, or have it taxed.
So why don't you stretch your brain a little and deal with reality.
127. Mazaska - Aug. 3, 1999 - 7:32 AM PT
"individuals who work for a company providing health care are going to suffer, no matter what solution is chosen. They have it best right now"
No shit, sherlock. Why do you think I posted that I wouldn't work for a company that doesn't offer it.
128. Ronski - Aug. 3, 1999 - 8:09 AM PT
Hardy,
Re: Message #106 --
I'm not sure what your point is here, but government has most certainly affected the numbers and kinds of physicians. For the past decade, and at least until very recently, there has been a widely acknowleged shortage of general practitioners, notably in rural areas and the inner cities. The number of primary care physicians was kept down and the number of specialists inflated by very significant subsidies to medical schools and teaching hospitals, especially to their residency programs. Moreover, the payment structure in medicaid and medicare favored specialists.
The government should have no particular interest in this area, but it very decidely has demonstrated one there anyway.
129. Adrianne - Aug. 3, 1999 - 8:37 AM PT
Make it impossible or impractical for business to provide health insurance for their employees as part of a compensation package, and permanent employee wages rise - of course, the wages of temp employees (or "consultants" or whatever they're called these days) go down.
Sounds like a plan.
130. HardyHarHar - Aug. 3, 1999 - 9:55 AM PT
jonesatlaw,
Spine surgery happens to be my specialty, and to say that an X-ray is unecessary for any spine-related procedure is rediculous. Yes, X-rays are not usefull in examining soft tissue, and especially nerve-root compression, but an x-ray is needed to measure a lot of things that are of great importance to anyone cutting on your back (lordosis and kyphosis angles, Cobb angkle, scoliosis, spondylolisthesis and anterolisthesis &ct....)
For you, what an x-ray would be most important for is evaluating gross instability and the presence of osteophytes prior to making an incision. Also, confirming the operative level (even holding a cadaver spine in your hand, its sometimes hard to find where one vertebral body ends and the anulus fibrosous begins....)
131. CalGal - Aug. 3, 1999 - 9:58 AM PT
"Make it impossible or impractical for business to provide health insurance for their employees as part of a compensation package, and permanent employee wages rise - of course, the wages of temp employees (or "consultants" or whatever they're called these days) go down."
Actually, I don't see either of those following as a given. How do you see that happening? If all companies stop paying health insurance because they can't deduct it, and if all employees have to pay taxes on their benefits, why are they going to get extra money? Employer says, as of today, your benefits are gone. Poof. Employees get the same money, have to go out and buy benefits that are tax-deductible.
Figure that maybe employees get a slight increase the first year, if the employer figures they can afford it. But it is by *no* means a given that they get more money. Many of you seem to think that benefits are rightfully yours. They aren't.
As for contract wages going down--first off, contract wages are what the market will bear. You all, again, have this misguided notion that employers pay contracters more because they know that they don't have benefits. Doesn't work like that.
It is conceivable that companies will start to hire more once they don't have to provide costly benefits--but I wouldn't count on it.
132. HardyHarHar - Aug. 3, 1999 - 10:00 AM PT
ranheim,
I see your point about the effects of whatever Johnson did, but I have to say that you're much better off getting cut on by a guy who has specialized in a certain field. As for GP's, well as it stands now your typical doc has to see over a hundred patients a week to make any money, so you gotta figure that 5 minutes per patient (max) isn't a lot of time to make an accurate diagnosis (unless the diagnosis is "malingerer.")
As to for today: if there is a concerted effort to make sure that there are more doctors than we need, I haven't seen it.
133. Mazaska - Aug. 3, 1999 - 10:03 AM PT
" Many of you seem to think that benefits are rightfully yours. They aren't. " Yes, they are - by contract.
134. bubbaette - Aug. 3, 1999 - 10:03 AM PT
In the case of any employee working under a contract -- union or otherwise, I think you *can* say that the benefits such as health insurance are rightfully theirs, if included in the contract.
135. bubbaette - Aug. 3, 1999 - 10:04 AM PT
X-post, Mazurka
136. CalGal - Aug. 3, 1999 - 10:04 AM PT
Maz,
"I think your posts sound resentful and your "plan" sounds harsh and unrealistic and your figures and attitudes seriously skewed by your state of residence."
Unrealistic, sure. Harsh? Sez the chick who gets her benefits subsidized by the uninsured and the self-employed and whose only solution is to tell those folks to get a job with a company that provides benefits. Be silly.
"A plan where no employers can pay for health insurance and eveyone must buy their own has a snowball's chance in hell of ever passing. there are too many voters (to say nothing of elected gov't reps) who like it this way and feel entitled to it. Perhaps you missed in my post that even 7-11 offers health and dental insurance and I don't think those clerks will write their congressmen that they want to lose it, or have it taxed."
Oh, no argument. I don't think it has any chance of passing. That has nothing to do with whether or not it's an equitable plan. The current system is not.
137. HardyHarHar - Aug. 3, 1999 - 10:05 AM PT
Ronski,
I don't believe that there has been an effort, recently, to fiddle with the number of doctors anywhere....not by the "government." Why would the government try and discourage doctors from practicing in rural areas?
Specialists have arrived on the scene because of the obvious need for them. Basically ever since 1976, with the invention of MRI, lots of doctors who had been "ancillary" were suddenly able to become "interventionists" like interventional radiologists and interventioanl cardiologists... and of course, neuros and orthos....
138. Mazaska - Aug. 3, 1999 - 10:05 AM PT
Specifically - by private contract between the private employer and the private employee. The company made an offer - I accepted - it's in writing.
Now whether the gov't taxes it or not is a separate issue.
139. HardyHarHar - Aug. 3, 1999 - 10:07 AM PT
Mazaska,
I agree, that person does come off as a very resentful, spiteful person. I guess its media like this one that facilitate misunderstandings (or at least, some people would have us believe....)
140. Mazaska - Aug. 3, 1999 - 10:07 AM PT
"Sez the chick who gets her benefits subsidized by the uninsured"
You have never met me, CalGal. If you have some fantasies that you think you know who I am - get over it.
141. CalGal - Aug. 3, 1999 - 10:08 AM PT
"Yes, they are - by contract."
Ha, ha. Check out your handbook. Employment at will. They can change those benefits any time they want.
Realize, people, that I'm talking about a world in which employers can't deduct health benefits and you would have to pay for them.
The minute any such tax change is signed, it's a whole new ballgame. And none of what you have now is worth squat.
142. bubbaette - Aug. 3, 1999 - 10:11 AM PT
To a certain extent, the government's Medicare reimbursement rates could be affecting the number or rural G.P.'s. That's because medicare's payment rates are based on reasonable and customary charges in the area where the doctor practices. Docs who practice in rural areas get paid less for the elderly than do urban docs providing the same services.
I read somewhere that about one-third of the g.p.'s patients seen on any given day are Medicare beneficiaries. Since, over the years, medicare has tended to pay less and less, so that even the more highly reimbursed urban docs say that Medicare patients are a net loss, then rural docs are seeing those patients at a greater loss.
143. HardyHarHar - Aug. 3, 1999 - 10:13 AM PT
What's the big deal in all this "government subsidy" crap?
One way or anothe the government is going to be the biggest contributor to the health system. Whether a corporation gets a tax deduction or a family, the fundamentals don't change, in fact, having your employer be a health care plan provider is probably to most peoples' advantage. Employers who provide health coverage are more understanding about missing work for appointments for the employee and family and if the corp. culture is geared towards healthy living (from the food in the cafeteria to the work environment- like ergonomic chairs, desks and keyboards) then everyone wins. Also, employers that provide coverage are usually fairly active in blood drives, health alers (like ways to keep stress down, and facilitate relaxation.) In general, if a corp. is paying for the health coverage of its employees, it sees the savings it generates when it has healthy, happy employees. End of story.
144. bubbaette - Aug. 3, 1999 - 10:14 AM PT
Actually, my DH's insurance benefits are included in the union's contract, so they are his by right. If he loses his job for cause, then that's another matter.
145. HardyHarHar - Aug. 3, 1999 - 10:16 AM PT
bubbaette,
Medicare started paying "smarter," not less. The numbers play this out: it costs more to run a surgical suite in Manhatten than it does in say, rural Tennessee, so the Relative Work Value of a doc. in rural Tennessee is going to be less. I know of doctors who are fleeing expensive markets because they can't pay their bills with the payor mix they have. This is a bad sign, but the way to fix it isn't to have Medicare overpay, is it?
146. Ronski - Aug. 3, 1999 - 10:21 AM PT
Hardy,
Government has not *tried* to *discourage* primary care physicians from practicing in rural or inner city areas (in fact, they have been making a small effort to the contrary for a couple of decades through a rural residency program). What government has done is to *entice* physicians to become specialists and sub-specialists by directing much more money to these areas through direct and indirect subsidies, and by keeping Medicaid payments to primary care docs so low that it discourages family practitioners.
We seem to be speaking past each other, but I think I see the problem. I think you may expect that an outcome in which the govenrment has played a role to have been the *goal* of the government's involvement.
But often, the results of government intervention in the economy have nothing to do with the government's goals. Medicine (and physician education, training and deployment) is a good example of how these best-laid-plans often go awry.
Those who hold that there is now an excess of physicians (I actually don't think I agree with them) point to rising figures of medical graduates having difficulties finding residencies and of graduates of medical programs having problems finding employment, a phenomenon which is very new.
147. Mazaska - Aug. 3, 1999 - 10:22 AM PT
"Realize, people, that I'm talking about a world in which employers can't deduct health benefits and you would have to pay for them."
OK, keep on talking about that world. I prefer to talk about the real one I live in. Like bubbaette's DH, I have a contract which specifies my benefits, although I am not in a union.
148. bubbaette - Aug. 3, 1999 - 10:25 AM PT
Har D Har Har
I agree that in some cases, Medicare started paying smarter, not less. For example, cateract surgery used to be pretty involved before the advent of laser surgery. With laser surgery, the time and complexity involved decreased dramatically. Medicare payment for cataract surgery then were reduced to take this into account.
From what I've read and hear from my folks, medicare reimbusements for the standard office visit to a g.p. don't cover the cost of seeing the patient. Sure, some expenses are going to be lower in rural areas -- space and clerical help, for example. But if the job market is tight for nurses, the rural doc will have to pay nearly as much as the urban.
In the state where I live, Medicaid is a loosing proposition for most docs -- to the point that there are no gynecologists in some areas of the state that will take Medicaid patients
149. Ronski - Aug. 3, 1999 - 10:27 AM PT
Hardy,
Re: what you call government subsidy "crap" --
What I am arguing against *is* government subsidization of medicine to the extent that it currently exists, and I am also arguing against expanding such intervention in the health care market.
Not that I think anything is going to change in this regard any time soon.
150. HardyHarHar - Aug. 3, 1999 - 10:30 AM PT
Ronski,
I think you're right, and besides, no one is going to be "right" about this stuff, since each person's understanding of a situation will stem from their knowledge and experience.
What I see here : "Those who hold that there is now an excess of physicians [] point to rising figures of medical graduates having difficulties finding residencies and of graduates of medical programs having problems finding employment, a phenomenon which is very new."
Is a situation in which too many people want to make a million dollars a year, so they go for specialties that are "full."
The one universal truth I see in all of this is that if you are poor, you will receive substandard treatment when compared to someone who is rich. If you are poor, then the chances that your "team" will coordinate your care without error are slim.
151. Ronski - Aug. 3, 1999 - 10:34 AM PT
Hardy,
I do see a silver lining, which is, as you may be suggesting here, that getting turned away from Anesthesiology may lead you into family medicine, and we do indeed need more people doing the latter.
My concern here, however, is that in trying to help the poor we do not nationalize all health care, and end up with a U.S. version of the British National Health.
152. HardyHarHar - Aug. 3, 1999 - 10:35 AM PT
bubbaette,
Running a doctors' office these days is a lot more complicated than it used to be. Its more like a lawyers office, I guess. Billing for each 15 minute interval is the key. Why do you think they call you into the little room, tell you take your clothes off and then make you wait for another 15 minutes? They're getting paid, if they can find the right code, for that time. They're not getting paid for you to sit in the waiting room.
"Accurate" coding is the goal, creative coding is the art.
That's why most societies I'm familiar with have "coding clinics" at their annual meetings. And a whole industry has evolved that manage office billing (some advertise that they can bring in an extra $100k a month for a medium size practice.
153. Ronski - Aug. 3, 1999 - 10:36 AM PT
(One problem, which cannot easily be solved, is that medical department chairmen tell their students not to go into family medicine, because they are "too smart" for that.)
154. HardyHarHar - Aug. 3, 1999 - 10:38 AM PT
Yes, Ronski, that is my point as well - I guess we disagree on which way the path to Hell twists and turns - but we agree that the destination would be just as bad.
155. Mazaska - Aug. 3, 1999 - 10:41 AM PT
"The one universal truth I see in all of this is that if you are poor, you will receive substandard treatment when compared to someone who is rich. If you are poor, then the chances that your "team" will coordinate your care without error are slim."
Yep, I see that, too. I admit I don't have a solution either.
156. HardyHarHar - Aug. 3, 1999 - 10:45 AM PT
Mazaska,
We all have horror stories of a friend or neighbor or someone related to someone we know, that has had a condition progress to the point of no return when all it would have taken was a little time and attention and common sense, things that the GP's of old were known for. That, if nothing else, is the danger of a world of specialists...
157. Mazaska - Aug. 3, 1999 - 10:56 AM PT
Hardy -
yep
158. elliot803 - Aug. 3, 1999 - 11:04 AM PT
Ronski:
"My concern here, however, is that in trying to help the poor we do not nationalize all health care, and end up with a U.S. version of the British National Health [Service]."
It would be an improvement on the current mess.
159. CalGal - Aug. 3, 1999 - 11:12 AM PT
Maza,
Union is a different thing entirely. Your benefits are ephemeral.
As for the rest, the whole point is to discuss solutions to the current health care problems. Why are so many people uninsured? What to do about the power of HMOs?
You are free to reject my solution, but you haven't as of yet offered any reasons why it won't work. Other than that you don't like it. Which is fine. But if you can, explain why it isn't fundamentally sounder to remove medical insurance from employment to make things more equitable for *everyone*.
Oh, and btw--no, I have never met you in person. Yes, it is perfectly clear who you are. Don't be silly. That being said, I made no inference in my post other than that you were employed and female. One you yourself offered, the other I believe you've said since you arrived as Mazaska, but if you didn't, it was a reasonable inference. Take any further comments defending your identity to the Playpen.
160. elliot803 - Aug. 3, 1999 - 11:15 AM PT
From the April 1999 issue of Scientific American:
HEALTH CARE COSTS
Rising medical costs are a worldwide problem, but nowhere are they higher than in the U.S. Although Americans with good health insurance coverage may get the best medical treatment in the world, the health of the average American, as measured by life expectancy and infant mortality, is below the average of other major industrial countries. Inefficiency, fraud and the expense of malpractice suits are often blamed for high U.S. costs, but the major reason is overinvestment in technology and personnel. America leads the world in expensive diagnostic and therapeutic procedures, such as organ transplants, coronary artery bypass surgery and magnetic resonance imaging. Orange County, California, for example, has more MRI machines than all of Canada.
Federal policy since World War II has emphasized medical technology and the widespread building of hospitals, even in rural areas. Other industrial countries, in contrast, followed the more cost-effective alternative of building up regional centers. The U.S. has long overinvested in the training of specialists at the expense of primary physicians, leading to a large surplus of specialists. Because specialists have economic incentives to perform unnecessary procedures, they may contribute to cost inflation.
Other industrial countries have managed to slow the growth in costs while achieving near-universal coverage. These include Britain, France and Italy, which have heavily centralized systems; Canada and Germany, which have decentralized systems but whose provinces play a key administrative role; and Japan, which combines strong national policy making with health care administration left largely in private hands. In each instance, central governments imposed strict fiscal controls even though they resulted in long waiting times for elective treatment and considerable delays in seeing specialists.
[continued]
161. CalGal - Aug. 3, 1999 - 11:16 AM PT
Elliot says that national health care would be an improvement on the current mess. While I don't really agree, I do think that it is essential that employment and insurance be disentangled. I think that a single payer system, simply because it removes the reliance on that link, is worth considering. I just hate the idea, and it's even less workable than my oddball solution--here in America, at any rate.
162. elliot803 - Aug. 3, 1999 - 11:21 AM PT
President Bill Clinton attempted to impose central fiscal controls as a part of his 1994 health care plan but was unable to put together a solid supporting coalition. Insurance firms, pharmaceutical companies, small business operators and academic medical centers were opposed to the plan. Labor unions and Medicare beneficiaries generally favored it but lobbied vigorously for changes that would improve their benefits. Republicans opposed the plan on the grounds that it called for new taxes.
According to political scientist Lawrence R. Jacobs of the University of Minnesota, universal access is a key to the success of other countries in imposing fiscal controls because it helps to lessen friction between groups. The American system encourages discord, for example, between health care insurers and high-risk people whom they exclude from coverage. Americans who receive adequate care through employers have little economic interest in seeing coverage extended to the more than 43 million Americans now uninsured.
In recent years U.S. health care expenditures as a percent of gross domestic product have leveled off, probably as a result of the expansion of managed care. The projected increase to 16.6 percent of GDP in 2007 shown on the chart assumes that managed care will grow more slowly, that increasing consumer income will boost the demand for medical services and that medical cost inflation will accelerate. But the period of greatest stress will come after 2010, when baby boomers begin to retire. Not only will federal budgets be strained, but also employers, already paying far more in medical costs than foreign competitors, will be put at a further disadvantage in world trade.
[continued]
163. elliot803 - Aug. 3, 1999 - 11:22 AM PT
How can the federal government ever assert fiscal control over medical costs? Victor R. Fuchs of Stanford University, a longtime observer of the medical economy, believes that comprehensive reform of the U.S. medical system will come only after a major political crisis as might accompany war, depression or widespread civil unrest. Such a crisis might arise as medical costs reach ever higher and threaten Social Security, Medicare and other popular programs; there could be political upheaval of such magnitude that medical reform will seem to be the easy solution.
164. elliot803 - Aug. 3, 1999 - 11:24 AM PT
CalGal:
You oppose "national health care" but you think a single payer system is worth considering.
What does this mean?
165. HardyHarHar - Aug. 3, 1999 - 11:33 AM PT
Elliot803,
I agree with the article: if you are a person who has excellent medical benefits in the US (like I do) then you would naturally oppose any changes to the system that would make it more like the British system.
If you have nothing now, or next to nothing, then the centralized system looks good.
Bottom line = in Britian you have to wait, sometimes years, for procedures that here, in the US (with the proper insurance) can be arranged and completed within a week or two. Personally, I'd rather have surgery in the US than anyplace else on Earth (and apparantly, the richest people in the world agree, since they all come here for treatment, or fly a doctor to their neck of woods...)
166. HardyHarHar - Aug. 3, 1999 - 11:37 AM PT
As to the future, collapse and impending doom.
Having the most effiecient R&D pipeline in the world (like the US does now) is going to lead to a high-end medical experience. Obviously this is resource intensive and can't be extended to all Americans. So, our choice is to lower the standard of care for all, which would have the effect of raising the standard for the poorest, or keep the two-tiered system we have now.
Being in the upper tier at the moment, I have a hard time advocating the alternative.
167. elliot803 - Aug. 3, 1999 - 11:44 AM PT
Hardy:
"I agree with the article: if you are a person who has excellent medical benefits in the US (like I do) then you would naturally oppose any changes to the system that would make it more like the British system."
If your Medicare payroll taxes keep going up sharply, and your employer keeps raising your medical insurance premiums while cutting back on benefits or pushing you into managed care (which is more like the British system), you may come to feel differently.
"Bottom line = in Britian you have to wait, sometimes years, for procedures that here, in the US (with the proper insurance) can be arranged and completed within a week or two."
Actually, waiting times for elective procedures under the NHS have been dropping for several years. And there are supplementary private insurance schemes in Britain that many people use for elective medical care in order to avoid the NHS waiting lists. Many British employers provide this insurance as part of their compensation package.
168. elliot803 - Aug. 3, 1999 - 11:48 AM PT
Hardy:
"Being in the upper tier at the moment, I have a hard time advocating the alternative."
Sounds like you need a spell in the lower tier.
169. Ronski - Aug. 3, 1999 - 11:49 AM PT
elliot,
Re: Message #158 --
Even I have thought that a centralized system might have certain efficiencies we currently lack. On the other hand, other inefficiences would arise under socialized medicine, and Americans would never stand for the systems the Europeans put up with.
A return to a free market system would be best. Easing government out of the health care market incrementally would also be good.
Unfortunately, neither will happen.
As for a catastrophe being necessary for nationalized health care, it is axiomatic that the power of centralized government expands during a crisis (such as war) and rarely receeds once the crisis abates.
170. HardyHarHar - Aug. 3, 1999 - 11:50 AM PT
Elliot803,
With a pregnant wife, I'd rather not....
171. HardyHarHar - Aug. 3, 1999 - 11:52 AM PT
There is no doubt in my mind that the past 50 years have been the Golden Years in health care in the US, ever after will be a steady decline........
172. Ronski - Aug. 3, 1999 - 11:52 AM PT
The need for an elective alternative system in Britain is proof of the socialized system's failure, just as the black and grey markets of the communist countries of Eastern Europe showed Marxism was not working.
173. bubbaette - Aug. 3, 1999 - 11:55 AM PT
I think it's important to recognize that we already have health care rationing and limited access in the U.S. But in our case, the priority doesn't go to the sickest or the health care intereventions with the greatest liklihood of success. And I agree with Cal that those without employer-provided health insurance are paying a higher effective tax rate to subsidize those who do.
I can't help thinking maybe it would be a good trade to have more pre-natal care for the impoverished rather than more ultrasounds for people who want to see what the baby's sex is before birth (or liver transplants, or bone marrow transplants). The rationing is already in place, but there's no rhyme or reason to it.
174. elliot803 - Aug. 3, 1999 - 11:58 AM PT
Ronski:
"The need for an elective alternative system in Britain is proof of the socialized system's failure,"
Nonsense. It's merely proof that the NHS cannot fully meet the demand for medical services. No health care system can.
The low ranking of the U.S. on international health comparisons coupled with the higher level of medical spending is proof that the U.S. system is inferior to those of other nations.
175. HardyHarHar - Aug. 3, 1999 - 11:59 AM PT
The rhyme or reason calculates to who can pay, or has paid in advance...
But don't fool yourself, any other system will lead to a slow-down in the R&D system. If you wan the best, you have to let the people with better "insurance" get access to it first. If you "level" the playing field, nobody will have the incentive to innovate the way they have in the past.
176. HardyHarHar - Aug. 3, 1999 - 12:00 PM PT
Elliot803,
"The low ranking of the U.S. on international health comparisons coupled with the higher level of medical spending is proof that the U.S. system is inferior to those of other nations."
Not necessarily, inferior for whom?
177. bubbaette - Aug. 3, 1999 - 12:03 PM PT
I've never really believed that keeping everyone alive for as long as possible was much of a goal, anyhow. Just think, if we all still kicked the bucket at about the same average age as folks did in the 30's, we wouldnt' have a funding crisis with Social Security or Medicaid.
178. elliot803 - Aug. 3, 1999 - 12:06 PM PT
Ronski:
"Even I have thought that a centralized system might have certain efficiencies we currently lack. On the other hand, other inefficiences would arise under socialized medicine, and Americans would never stand for the systems the Europeans put up with."
Oh please. It's not just Europeans, it's *everyone*, including our closest neighbors, Canadians. The U.S. already has several huge single-payer health care programs, anyway--Medicare, Medicaid, Veterans. Between those programs, coverage for federal employees, and various state and local government health care systems, a huge proportion of the U.S. population is already guaranteed comprehensive health care services by the government. The government's role in funding and providing medical care has been steadily growing for the last half century.
"A return to a free market system would be best."
It would be a catastrophe. And as you say, it'll never happen. People have more sense than that.
179. elliot803 - Aug. 3, 1999 - 12:07 PM PT
Hardy:
"Not necessarily, inferior for whom?"
For the country, the U.S. population, the American people.
180. HardyHarHar - Aug. 3, 1999 - 12:16 PM PT
Absolutely untrue, Elliot803.
Any operation you have on your musculoskeletal system, nervous system, respitory system and upper GI system is going to be, without a doubt, superior within the US than anywhere else in the world.
What may be inferior is the average person's access to these procedures, but if you have access there is simply no better place. To put it another way: Joe Bob with insurance, living near a good hospital, is going to be in better hands than most world leaders in their own countries.
181. HardyHarHar - Aug. 3, 1999 - 12:18 PM PT
Oh, and a pitch for specialists...
Going under the knife for a laminectomy: would you rather have a guy who does 10 a week or 1 a month?
182. HardyHarHar - Aug. 3, 1999 - 12:26 PM PT
Bubbaette,
We're simply not going to be able to keep most people alive. Eventually we'll have charts where a persons life will be boiled down into Quality of Life Adjusted Years and if a person's QLAY score is too low - sorry, onto the trash heap with you.
183. bubbaette - Aug. 3, 1999 - 12:35 PM PT
Har d Har
We could also institute a "well, you asked for it" standard of health care. For example -- no liver transplants for alcholics, no treatment for heart or lung disease for smokers. Women who choose to have a number of children, forget about assistance with that urinary incontenance problem -- that's a lifestyle decision. Obese with knee and back problems, diabetes, etc? Lose some weight before your doc will see you.
184. HardyHarHar - Aug. 3, 1999 - 12:41 PM PT
Bubbaette,
Yes, well the second we have a system of choice and consequence, things will change more rapidly.
(I have a friend who has had three CABG procedures and he still smokes cigarillos and, I swear I have seen him do this, eats liver for breakfast (just on special occasions.)) He has also made millions of dollars for his work for a noted So. San Francisco biotech. company, so I have told him: I think he should have to pay, in cash, for any future bi-passes.
185. elliot803 - Aug. 3, 1999 - 1:39 PM PT
Hardy:
"Absolutely untrue, Elliot803."
Because you say so, I suppose. The FACTS shows otherwise. On a wide range of measures of the quality of health care, from infant mortality to life expectancy, the U.S. lags significantly behind most other industrialized democracies.
"Any operation you have on your musculoskeletal system, nervous system, respitory system and upper GI system is going to be, without a doubt, superior within the US than anywhere else in the world."
I seriously doubt it.
"What may be inferior is the average person's access to these procedures, but if you have access there is simply no better place."
If you don't have access to an operation, it doesn't really matter how well it would be performed if you did, does it?
186. Ronski - Aug. 3, 1999 - 1:42 PM PT
Elliot tells us that the current system is an inefficient mess, and recommends a single-payer system.
On the other hand, he tells us that the current (inefficient) system already has single-payer programs within it, which he takes as a good thing.
Not a very good selling point. Not even coherent.
And claims that U.S. healthcare is inferior to that of Western Europe, Canada and Japan are simply ludicrous.
187. Ronski - Aug. 3, 1999 - 1:49 PM PT
Take Japan's system of socialized medicine, for example (please):
link
188. elliot803 - Aug. 3, 1999 - 1:53 PM PT
Ronski:
"Elliot tells us that the current system is an inefficient mess, and recommends a single-payer system."
I haven't recommended any particular system, but I think any of the various kinds of universal coverage systems used in other countries would be an improvement on the current bloated and inefficient patchwork of public and private health care systems that exists in the U.S.
"On the other hand, he tells us that the current (inefficient) system already has single-payer programs within it, which he takes as a good thing."
Medicare and the other programs are a good thing. They'd be even better if they were part of a comprehensive national system that covered everyone.
"Not a very good selling point. Not even coherent."
Perhaps you could describe this alleged incoherence, since it seems to me that you're just confused.
189. elliot803 - Aug. 3, 1999 - 2:06 PM PT
Ronski:
I guess that to the Libertarian mind, that article you linked to--a few statistics trawled by that well-known unbiased authority on health care, Forbes magazine--is what passes for serious policy analysis.
Read the Scientific American piece again.
190. HardyHarHar - Aug. 3, 1999 - 2:07 PM PT
Elliot803,
I guess we're talking about different things, then.
Procedures involving "...your musculoskeletal system, nervous system, respitory system and upper GI system..." have nothing to do with "...a wide range of measures of the quality of health care, from infant mortality to life expectancy..." They aren't even reconcileable. Basically, I'm concerned with the quality of general quality of life interventions. They're the most common surgeries performed and they make up the most profitble sectors of the health care universe.
Oh, and it should be said: most of the hardware being put in people the world over was manufactured and/or invented and proven in the US, so its literally impossible to separate anything good being done in, say England, from the superiority of the Ameican "system" since without the American system they'd all still be using stainless steel implants....
191. elliot803 - Aug. 3, 1999 - 2:09 PM PT
Ronski: "And claims that U.S. healthcare is inferior to that of Western Europe, Canada and Japan are simply ludicrous."
SciAm: "Rising medical costs are a worldwide problem, but nowhere are they higher than in the U.S. Although Americans with good health insurance coverage may get the best medical treatment in the world, the health of the average American, as measured by life expectancy and infant mortality, is below the average of other major industrial countries."
192. elliot803 - Aug. 3, 1999 - 2:16 PM PT
Hardy:
"Basically, I'm concerned with the quality of general quality of life interventions. They're the most common surgeries performed and they make up the most profitble sectors of the health care universe."
And my primary concern is the overall quality of health care, including basic life-and-death interventions, which seems to me a more important issue than the relative quality of various kinds of elective surgery.
"Oh, and it should be said: most of the hardware being put in people the world over was manufactured and/or invented and proven in the US, so its literally impossible to separate anything good being done in, say England, from the superiority of the Ameican "system" since without the American system they'd all still be using stainless steel implants...."
The American system isn't superior. Most medical research is done in the U.S. because it is the largest market and spends the most on health care overall. Despite that, it still lags behind other countries in the quality of care it provides to its typical citizen.
193. HardyHarHar - Aug. 3, 1999 - 2:34 PM PT
Elliot803:
"And my primary concern is the overall quality of health care, including basic life-and-death interventions, which seems to me a more important issue than the relative quality of various kinds of elective surgery."
But you are making the mistake of assuming that you have selected the proper indices for evaluating the overall quality of health care. Infant mortality, for instance, has a lot more to do with overall education, (which in turn determines nutrition,)than the quality of health care. A child being treated by a Pediatrician in the US is going to do better, overall, than one being treated by a Ped. in any other country. What the study you cite, and most others, does wrong is pool patient populations that don't belong together. What, for instance, does the Scientific American Journal have to say about the mortality rate of age and sex-matched patient-populations who give birth in a hospital? Let's compare apples and apples here! Obviously is a larger percentage of a given population has wider access to basic care, then the numbers coming out the other end will be skewed too.
As to elective surgery: Many of the procedures I had in mind (like on a persons respitory system, for example,) would not be considered elective...unless of course you come from socialized medicine.
Perhaps you ought to stick to peer-review journals rather than Scientific American?
194. HardyHarHar - Aug. 3, 1999 - 2:39 PM PT
"The American system isn't superior. Most medical research is done in the U.S. because it is the largest market and spends the most on health care overall. Despite that, it still lags behind other countries in the quality of care it provides to its typical citizen."
But that all depends on what kind of care you're talking about.
Let's look at spinal fusion:
The stanard of care in the UK for Lumbar Interbody Fusion involves using bone dowels (usually autologous bone - grafted from the patient's own iliac crest) and yes the rates of fusion are relatively high when compared to the procedure that is considered the standard of care in the US (which calls for using carbon-fibre or titanium interbody fusion cages.) What a sloppy comparison of the fusion (thus, success) rates between the US and UK would not capture is the length of follow-up required. If the patient in the US is able to return to work 2 months faster than the patient in the UK, who has the better system for that procedure?
195. HardyHarHar - Aug. 3, 1999 - 2:47 PM PT
191. elliot803 - Aug. 3, 1999 - 2:09 PM PT
"Ronski: "And claims that U.S. healthcare is inferior to that of Western Europe, Canada and Japan are simply ludicrous.""
"SciAm: "Rising medical costs are a worldwide problem, but nowhere are they higher than in the U.S. Although Americans with good health insurance coverage may get the best medical treatment in the world, the health of the average American, as measured by life expectancy and infant mortality, is below the average of other major industrial countries.""
elliot803,
To me, this illustrates our communications problems:
What Sci Amer. is claiming is that by comparing two populations:
I. People insured through their government health plan in countries like Canada and England
and
II. Americans, 43 million of which (you stated earlier) had no insurance
We can make accurate comparisons of the quality of care. This is obviously untrue. All they've evaluated is the quality of access to care.
If you compared the quality of life adjusted years for Americans with health insurance to the quality of life adjusted years for Germans with health insurance, you'd be singing a different tune.
196. elliot803 - Aug. 3, 1999 - 3:25 PM PT
Hardy:
"But you are making the mistake of assuming that you have selected the proper indices for evaluating the overall quality of health care."
I'm using the ones health care experts use. Presumably, they have a better idea of which indices are the best measure of the general quality of health care than you do.
"Perhaps you ought to stick to peer-review journals rather than Scientific American?"
Well, the Scientific American piece is based on peer-reviewed health care research. Since you have presented nothing at all in the way of substantive support for your own claims, your criticism seems misplaced.
"All they've evaluated is the quality of access to care."
Sophistry. If you can't get access to care, then the quality of that care doesn't matter.
197. elliot803 - Aug. 3, 1999 - 3:31 PM PT
Hardy:
"If you compared the quality of life adjusted years for Americans with health insurance to the quality of life adjusted years for Germans with health insurance, you'd be singing a different tune."
Well, if you select a subset of the American population that receives the best care and compare it with the average or typical European, you may find that the American group receives better care, but that doesn't tell you much about the overall quality of the respective countries' health care systems, because you're not comparing like with like. You seem to be saying that because *some* Americans may receive better care than most Germans, the American system is superior overall, and that just strikes me as nonsensical.
198. ranheim - Aug. 3, 1999 - 3:45 PM PT
I have looking at medical statistics (from the point of view of the M.D. since 1957). Best single sentence is from my father, a math professor : Figures can lie; and liars can figure!
I have, essentially, quit reading statistical articles; for every one of these articles has an agenda. i.e. THEY LIE!
I am Norwegian. But, there is no way that a large and diverse contry (such as the USA) can or should be compared to Norway in such areas as child birth deaths; immunization rates; life span; add your own category. If one wants to compare USA stats with Norway's - compare ONLY stats from rural Iowa, Minnesota, Wisconsin; etc. i.e. no blacks! For there are none, statistically, in Norway.
I have no idea how the number of "un-insured" is calculated. Approximately, one-third of my patients have a LA Medicaide "Card". I suspect that these people are counted as un-insured. Yet, they have FREE access to me; to labs; to x-rays; cardiograms; PAP smears; mammograms; etc. The lowest on the income scale recieve medication for a minimal fee : $2 for inexpensive medication; $5 for the most expensive. Should they need difficult evaluations, they are referred to the LSU or Tulane systems in New Orleans; or the LSU system in Shreveport. Appropriate surgery at these three medical school facilities (free). That is as good care as I would be able to obtain for myself and family.
Please be MOST cautious when looking at federal stats. Who but those in Washington, D.C. have more to gain by "cooking" statistics?
199. elliot803 - Aug. 3, 1999 - 3:50 PM PT
ranheim:
What method do you propose for evaluating the relative quality of different nations' health care systems, or do you believe that any such evaluation is impossible in principle?
200. ranheim - Aug. 3, 1999 - 3:53 PM PT
It is impossible.
Everyone has an agenda; and their bias comes into play.