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Post by TKennedy on Nov 3, 2009 14:52:33 GMT -5
Right now there is incredible waste in medicine itself with inadequate diagnostic tests that need to be repeated, duplication of facilities, complications stemming from the great difficulty medicine has with policing itself, and the enormous epidemic of medicare and insurance fraud. If that can't be dealt with by improving the system itself and ramping up fraud enforcement, how the hell can we deal with a new system that seems incredibly more complex and ripe for even greater fraud layered on top of what we have now? This is not looking good at all.
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Post by Doug on Nov 3, 2009 14:57:06 GMT -5
At the rate of health care technology advances the cost of heath care in 10 yrs will be such that the cost per person for insurance will be more than the middle class income for a year. I don't think that there is a way to keep up be it private insurance or public funded insurance.
Maybe no insurance at all for people over 50.
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Post by John B on Nov 3, 2009 14:58:05 GMT -5
At the rate of health care technology advances the cost of heath care in 10 yrs will be such that the cost per person for insurance will be more than the middle class income for a year. I don't think that there is a way to keep up be it private insurance or public funded insurance. Maybe no insurance at all for people over 50. I'm all for that, assuming that that part can be reversed in 10 years.
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Post by Ann T on Nov 3, 2009 15:03:07 GMT -5
"One of them has $500,000 in student loans between college and med school." HOLY SHIT! How? That's $62,500 a year for eight years. The most expensive college in America is George Washington University and it only costs $40,100 a year. Harvard only costs $36,000 a year. The most expensive med school is $44,000 a year. Let's see, that is $336,400 for four years leaving $20,000 a year for living expenses. Did this guy buy a car (or three) with his student loans? Have you seen the cost of apartment rent in San Diego? Most places are about $1,500 and up per month. Then there is food, car, clothing, gas, utilities, occasional movies, air travel to go see family...you can't live here on $20,000 a year living expenses.
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Post by Fingerplucked on Nov 3, 2009 15:03:31 GMT -5
At the rate of health care technology advances the cost of heath care in 10 yrs will be such that the cost per person for insurance will be more than the middle class income for a year. I don't think that there is a way to keep up be it private insurance or public funded insurance. Maybe no insurance at all for people over 50. I'm all for that, assuming that that part can be reversed in 10 years. Good luck with that. I'm just glad that I'm grandfathered in.
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Post by Ann T on Nov 3, 2009 15:06:57 GMT -5
At the rate of health care technology advances the cost of heath care in 10 yrs will be such that the cost per person for insurance will be more than the middle class income for a year. I don't think that there is a way to keep up be it private insurance or public funded insurance. Maybe no insurance at all for people over 50. The over-50's need it more than the 20's and 30's (except for childbirth expenses). I heard an evening news story last night advocating "hospice care only" for the elderly with dementia because dementia is now a "terminal disease." (Life is a terminal disease, actually--are any of us going to live forever?) It makes sense, financially, but it is basically throwing grandma under the bus to cut costs, and it would be dangerous to implement it as a "best practices guideline."
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Post by Russell Letson on Nov 3, 2009 15:14:15 GMT -5
Doug, I think you might be costing health care as though it were the same all the way through, like cheese. But while the newest (and possibly most effective) drug or procedure might be very expensive, there's a huge area of preventitive care, screening, and treatment that just doesn't cost that much. My borderline blood pressure gets atenolol, which is generic and pretty cheap, and if my doc chose to prescribe a diuretic instead, it would be dirt cheap. How much should an annual checkup, even with blood tests looking for signs of diabetes, prostate cancer, and the other hazards of aging, cost? As for more expensive and statistically slightly more risky procedures--a colonscopy is probably expensive, but currently recommended only every 5-10 years for those over 50. This kind of regimen would cover the vast majority of people, with the next level of cost and complexity kicking in for trauma or the kind of crisis that can't be easily predicted--for example, an acquaintance who needed emergency surgery for a twisted bowel and developed/was discovered to have pancreatitis. That cascade of misery will bill out well into six figures.
But I digress. The point is, simple linear extrapolation does not predict the future state of medical costs. There is no reason that a body of standard care can't be provided with a cost structure that won't beggar anyone. As Rick points out, it happens every day all over the world--except here.
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Post by Ann T on Nov 3, 2009 15:21:32 GMT -5
Doug, I think you might be costing health care as though it were the same all the way through, like cheese. But while the newest (and possibly most effective) drug or procedure might be very expensive, there's a huge area of preventitive care, screening, and treatment that just doesn't cost that much. My borderline blood pressure gets atenolol, which is generic and pretty cheap, and if my doc chose to prescribe a diuretic instead, it would be dirt cheap. How much should an annual checkup, even with blood tests looking for signs of diabetes, prostate cancer, and the other hazards of aging, cost? As for more expensive and statistically slightly more risky procedures--a colonscopy is probably expensive, but currently recommended only every 5-10 years for those over 50. This kind of regimen would cover the vast majority of people, with the next level of cost and complexity kicking in for trauma or the kind of crisis that can't be easily predicted--for example, an acquaintance who needed emergency surgery for a twisted bowel and developed/was discovered to have pancreatitis. That cascade of misery will bill out well into six figures. But I digress. The point is, simple linear extrapolation does not predict the future state of medical costs. There is no reason that a body of standard care can't be provided with a cost structure that won't beggar anyone. As Rick points out, it happens every day all over the world--except here. Well, it keeps getting repeated quite confidently that there is free or affordable government provided care everywhere but here. I'd like some proof of this, other than people just saying it is so. If it is so, then why are people coming into this country for health care? We get them all the time from Tijuana/other border towns--they come to the doctor in Mexico, get told they have with cancer, and the next thing you know, they are at our E.R. getting admitted (knowing their diagnosis). In Mexico, medical care is cash up front or no care. We've had immigrant families from Eastern Europe bring their relatives from out of the country to get treated in our cancer center (with no money, no insurance). The word is out that you can get free care here if you sneak into the country or come on a tourist visa and show up at the E.R. If the care is so good in their own countries, why are they here?
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Post by bamfiles on Nov 3, 2009 15:25:06 GMT -5
I looked up Harvard medical and their tuition, fees and living expenses is estimated at $65,000/yr. Most students at Harvard get some form of student aid or at least that's what we were told when we looked into it for our son. He wound up getting a scholarship from a school in Illinois where the tuition was closer to 15,000 back in 1990. His scholarship covered about half. Then he got an assistantship for grad school. Still, he came out after 6 years total with about $20,000 in debt due to stupidity on his part about the difference between living expenses and living-really-well expenses. We paid what we could, all the real bills, and didn't know about the debt until later so I stuck him with that part. Since medical school, really, lasts about 12 years I think, correct me if that's wrong Ann, I can see where a med student can rack up $500,000 in debt.
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Post by Russell Letson on Nov 3, 2009 15:45:59 GMT -5
Ann--what problem do you have with the testimony of our Canadian members, one of whom received what sounds like excellent treatment for two very serious conditions? I hear the same kind of thing on another blog with an international membership--UK, Netherlands, and France for certain. The usual qualifier is "industrialized world," though from what I've read there are a number of non-first-world nations that also offer some version of single-payer or government-run health care. There are places worse off than we are, but there are many with our level of resources and social organization that manage to solve these problems.
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Post by bamfiles on Nov 3, 2009 15:48:45 GMT -5
Did anyone look at the list of biggest debtor nations on CNBC this morning? We're number 20. The top most are all those European countries that are drowning in public debt due to their socialist systems. France is so far in debt they're trying to figure out how to start a private healthcare system. Sweden's not too well off either and my sister who lives there has nothing good to day about their healthcare system. My relatives in Canada aren't too happy with theirs either. The U.S. isn't the only place where healthcare costs a lot of money. It's expensive everywhere. Middle class Swedes pay about 60% in federal taxes, for which they can get basic healthcare but if they get sick they go to the private system, all socialist countries have a 2-tiered system, and pay out of pocket and it's expensive. Now, the socialist countries may treat their poor better than we do, maybe, but it's still expensive. Sweden is also one that does not provide much care for the elderly past basic medicines and hospice.
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Post by majorminor on Nov 3, 2009 15:55:22 GMT -5
Cut that out
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Post by John B on Nov 3, 2009 15:59:11 GMT -5
The story upon which I put the most weight regarding Canadian health care is Kate's (Sekhmet). Heart attacks and cancer hitting at the same time, with excellent treatment. No tiered system as far as I can tell.
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Post by millring on Nov 3, 2009 16:05:12 GMT -5
Right now there is incredible waste in medicine itself with inadequate diagnostic tests that need to be repeated, duplication of facilities, complications stemming from the great difficulty medicine has with policing itself, and the enormous epidemic of medicare and insurance fraud. If that can't be dealt with by improving the system itself and ramping up fraud enforcement, how the hell can we deal with a new system that seems incredibly more complex and ripe for even greater fraud layered on top of what we have now? . Excellent question. Echoing the 60 Minutes story last week -- 60 BILLION in medicare fraud. And they assure us they'll fix that AFTER we give them the rest of healthcare. It might make an intelligent fellow ask, "Why not fix THAT first to prove you can? Then we'll talk about you taking over everything else". And, again, we might also ask if there isn't some connection between the way we've paid for healthcare and the fact that we have the best healthcare in the world. If there is a connection, one might ask if we risk that best in the world healthcare if we change what made it so.
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Post by John B on Nov 3, 2009 16:07:16 GMT -5
And, again, we might also ask if there isn't some connection between the way we've paid for healthcare and the fact that we have the best healthcare in the world. If there is a connection, one might ask if we risk that best in the world healthcare if we change what made it so.[/quote] No connection, John - just look at infant mortality rates, for example.
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Post by millring on Nov 3, 2009 16:10:18 GMT -5
No connection, John - just look at infant mortality rates, for example. you forgot the winking smiley.
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Post by bamfiles on Nov 3, 2009 16:10:43 GMT -5
Can't argue with success. My relatives haven't had that much need, other than care for my BIL's mother in Sweden and they had to pay for that but they complain about the long waits and the lack of doctors and the limitations on treatments unless they pay extra. I think we in the U.S. can provide basic healthcare for everyone, and probably in a more cost effective manner than we do now, mostly by getting primary care out of the E.Rs and into store-front clinics but I think people are going to expect all possible care for as close to free as it can be and they're going to be disappointed on that. Incidentally, my recent physical, just the physical no colonoscopy, I'm still awaiting that pleasure, was billed at $450. However, I noticed that the insurance actually paid less than half of that and of course I had about $30 in co-pays. Amount due was $0.00. So now I'm wondering if the quoted numbers in this whole discussion are real. I don't know how to figure that out yet.
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Post by John B on Nov 3, 2009 16:14:54 GMT -5
Good point, BF. Interesting to note how many private clinics are opening up, such as the ones in my local Walgreens stores. I wonder how this trend (as far as I can see it's a trend) will affect health care - both the cost and the quality of treatment.
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Post by theevan on Nov 3, 2009 16:23:43 GMT -5
Apples and oranges.
We have the best that western medicine offers, and we have it in more abundance than anywhere. The problem, and what the debate is about, is access and delivery. Our infant mortality isn't due to poor health care, it's about the decay of social fabric (eg: out of wedlock teen moms from broken homes) and about access.
What I've seen floated so far from the Ds looks like a nightmare. The numbers are flat out not believeable. I favor something bite-sized, piecemeal, aimed directly at deficient areas, incentivized and problem-solving.
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Post by bamfiles on Nov 3, 2009 16:29:10 GMT -5
"I favor something bite-sized, piecemeal, aimed directly at deficient areas, incentivized and problem-solving. "
And you're expecting that from politicians? What planet do you hail from stranger?
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