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Post by millring on Nov 3, 2009 16:29:40 GMT -5
Actually, the infant mortality rate is nothing more than the fact that the US counts it differently from the other developed countries. If comparing apples to apples -- count ours as European counties count theirs -- ours would be no worse.
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Post by patrick on Nov 3, 2009 16:36:17 GMT -5
But I just looked at the slide show and accompanying article. It doesn't say anything about financing of health care. In fact, they point out that Ireland, which has the highest external debt to GDP ratio, is in that position because of its banking sector.
It isn't health care that's driving up the debt, it's banks and financial institutions and the bailouts we made to keep the economy from collapsing..
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Post by Doug on Nov 3, 2009 16:37:49 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. Body of standard care that's the key. What you've had done pre 50 means nothing (short of major malfunction ) but post 50 we are all going to need replacement parts. And as time goes buy the technology to replace parts is improving daily (but at a big cost) All made up just to talk. Reasonably healthy guy. Age 50 knee replacement (HS football) $200k Age 60 treatable cancer $ 100k Age 75 heart replacement (transplant) 900k Age 90 2nd heart replacement (artificial) 2.2 mil Age 95 hip replacement 200k Age 105 lung replacement and 3rd heart (arrtificial) 3.5 mil Never going to be enough money. So you have to live with "Body of standard care" = rationing Hey and you hope your kids are like every one else and they still want you arround for as long as possible. So if you are 40 now it'll be 2075 when you are ready for that 3rd heart. And while we aren't quite to the be able to replace all the parts like a car we are getting there quick. By 2075 you can get your new heart out of a medical replicator but the cost will still be there. ;D
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Post by patrick on Nov 3, 2009 16:41:45 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. I find it difficult to call a health care system that allows over 20,000 Americans to die from lack of medical care the best. 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. You prefer a series of band-aids? We've already got a medical system that is fragmented and piecemeal. And the only incentive is for corporate profit.
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Post by Doug on Nov 3, 2009 16:59:07 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. I find it difficult to call a health care system that allows over 20,000 Americans to die from lack of medical care the best. 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. You prefer a series of band-aids? We've already got a medical system that is fragmented and piecemeal. And the only incentive is for corporate profit. The Dem bill is band-aids about 10000 them. That's the problem. If you think the system is broke the only way to fix it is scrap the whole thing and do it from scratch. Put every thing into a single system, every one in heath care works for the government. Anything else is just a band-aid. If there are specific problems put a band-aid on them. Just writing a check for all the uninsured to pay for their insurance in today's system would cost a lot less than 10,000 band-aids.
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Post by bamfiles on Nov 3, 2009 17:16:36 GMT -5
Patrick, you're right they didn't blame healthcare or for that matter socialist policies and thanks for looking. Those countries were in trouble before the financial meltdown though. They suffered from high unemployment and low GDPs before. The financial meltdown just made it worse. From other reports, I've seen discussions of their efforts to find a way out of the healthcare business because it's unsustainable. That was my take on their underlying problem. If I didn't put in the usual IMHO, and I haven't looked back at my post, my fault, I planned to. Another senior moment. I still think it's funny that they're looking to get out of what we're looking to get in to. Somewhere there's an answer but I don't think they have it and I don't think we have it either. The rich are still going to do better than the poor, but I accept that as a given.
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Post by theevan on Nov 3, 2009 17:26:36 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. I find it difficult to call a health care system that allows over 20,000 Americans to die from lack of medical care the best. Why did I even bother posting the above?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. You prefer a series of band-aids? We've already got a medical system that is fragmented and piecemeal. And the only incentive is for corporate profit. Not so. My HSA gives me incentive to live a healthy lifestyle. It's an incentive to shop, compare, educate myself, etc concerning care i'm receiving or that is proposed.
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Post by Russell Letson on Nov 3, 2009 17:35:41 GMT -5
My incentive for attempting to live healthy is an aversion to being sick or in pain or getting tubes inserted in various orifices. Money runs a dismal 12th-or-worse in that race. Some of the cheapest illnesses also carry spectacular disincentives all on their own--food poisoning, for starters.
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Post by bamfiles on Nov 3, 2009 17:36:34 GMT -5
HSA's are good but they need to be able to be carried over year to year. That way you could put more toward it, for a rainy day, and not have to use it up before tax time. I generally put a grand in mine because I knew we could spend a grand but I think the max was $2500 and I didn't know year to year if we'd spend that much. If I could have carried it over, knowing that eventually I'd probably use it, I'd have put in the max.
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Post by theevan on Nov 3, 2009 17:37:37 GMT -5
They do carry over, year to year, and build up, tax free, if you don;t use it.
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Post by bamfiles on Nov 3, 2009 18:02:02 GMT -5
OK, something changed after I retired and couldn't contribute anymore. I must have missed it since it wasn't relevant to my situation. My wife gets to sign up for one this Friday. I'll have to look in to that. I was telling her to put a grand in it but maybe it's a better deal now.
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Post by millring on Nov 3, 2009 18:19:37 GMT -5
HSAs are, as Evan said, your money. All of 'em. They build up. If you don't use them for medical expenses they can be used as retirement money. They can also be used for medical expenses that many lower cost insurance policies don't cover -- for instance, I can use my HSA to buy eyeglasses or pay my dental bill. But it's my money if I don't use it.
I think that the medical savings accounts to which you refer were a purposeful ruse. And it worked. People still don't understand the nature of real HSAs because of the purposeful promotion of those false HSAs.
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Post by bamfiles on Nov 3, 2009 18:31:24 GMT -5
Does it still come out pre-tax? I could use a few tax sheltered dollars. Did I read something the other day about the house bill putting some limitations on what you could charge off against your HSA? I think it was mostly OTC stuff that was being eliminated.
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Post by Ann T on Nov 3, 2009 18:53:54 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. Well, if you want to use the (thankfully) good experience of two of our Canadian members as evidence of everyone's experience, and to predict the performance of a U.S. system, that's your choice. I wouldn't call it a statistically significant sample. I would also like to see a comparison of demographics of the systems. The U.S. has a porous border and no national ID card (and rampant fraud with counterfeit green cards, social security cards, and proofs of residency). Our tax-payer supported public school systems near the border have anywhere from 25-50% Mexicans enrolled, paying no taxes to support the schools. Families living in Mexico use their aunts and uncles and friends to provide fraudulent residency addresses so they can enroll their kids in U.S. schools. This stresses the schools unbelievably, as they are chronically underfunded for the size of their enrollments, and have additional needs requirements (translators, ESL teachers, bilingual staff, and difficulty meeting No Child Left Behind test school goals).I am very pessimistic that our health care system would not get similarly abused, and it is already abused in a similar fashion. We have some notorious local cases (exposed in the newspapers) of Mexican nationals fraudulently getting into the MediCal welfare system and getting multi-million dollar care at local hospitals. I personally delivered two weeks of expensive urgent care in the intensive care unit to a Mexican national who came in through the E.R., who turned out to be a federal fugitive wanted in the U.S. for gun smuggling. Guess we didn't get paid for that one.
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Post by John B on Nov 3, 2009 19:13:53 GMT -5
BF, are you thinking about pre-tax flexible spending plans for medical expenses? Now up to $5K before tax, use-it-or-lose-it. Run by employers. Infant mortality rates was just some chum, meant to be read with a due to the discussions we've had before about it (and the info that Millring has brought to the SH regarding the rates). Ann, what is the estimated cost of care due to illegal immigrants? ""The economics aren't as great as they've been made out to be," says Paul Fronstin of the Employee Benefit Research Institute. Fronstin says illegal immigrants are younger, and so generally healthier, than the overall population, and studies show they go to the doctor far less than the native born. He estimates their total share of the health care system at about 1 or 2 percent, with only a small slice of that paid for in public money. About $1 billion a year is paid by Emergency Medicaid, a federal program that covers emergency care for patients who would otherwise be eligible for Medicaid but can't prove their legal status. Sheils estimates that an additional $5 billion is uncompensated in any way. He says that's a blip on the national health care system — some two-tenths of 1 percent — but it can hurt when it falls disproportionately on hospitals, say, along the southern U.S. border." The Employee Benefits Research Institute is sponsored by the American Benefits Council, an organization that represents employer concerns (as evidenced by its members such as 3M, HP, United HealthCare, Wal-Mart, Coventry Health Care, Allstate Insurance Company, Medco Health Solutions, etc.).
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Post by theevan on Nov 3, 2009 22:08:55 GMT -5
Bamfiles, I think John nailed it...you're probably talking about employer-run flexible-spending accounts. A think I was going to adopt for my employees but now I'm waiting to see what falls out.
Yes, all HSA money comes out pretax like an IRA contribution. Similarly, there is a limit you can contribute each year. I forget what this years' limit might be. We have a checkbook & debit card on our HSA. I can use those pretax dollars for dental, eyeglass, chiro, even nutritional supplements (if prescribed) and other items not covered by my Blue Saver plan. Those items that are covered still are discounted at my insurer's negotiated rate. No co-pay, per visit dunnage, etc. It kills me they want to scrap this useful and sensible plan.
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Post by Supertramp78 on Nov 3, 2009 22:39:38 GMT -5
Actually, the infant mortality rate is nothing more than the fact that the US counts it differently from the other developed countries. If comparing apples to apples -- count ours as European counties count theirs -- ours would be no worse. The more I look into this, the more I'm starting to question if that is true. The line goes like this.... "Low birth weight infants are not counted against the “live birth” statistics for many countries reporting low infant mortality rates. According to the way statistics are calculated in Canada, Germany, and Austria, a premature baby weighing <500g is not considered a living child. But in the U.S., such very low birth weight babies are considered live births. The mortality rate of such babies — considered “unsalvageable” outside of the U.S. and therefore never alive — is extraordinarily high; up to 869 per 1,000 in the first month of life alone. This skews U.S. infant mortality statistics." This is a reharsh of a 2005 study released by The Discovery Institute - the guys who are dedicated to proving Creationism. So is their study flawed? Well, yeah. For example, they say, "Switzerland, for instance, doesn't count the deaths of babies shorter than 30 cm, because they are not counted as live births, according to Nicholas Eberstadt, Ph.D., Henry Wendt Scholar in Political Economy at the American Enterprise Institute and formerly a Visiting Fellow at the Harvard University Center for Population and Developmental Studies. So, comparing the 1998 infant mortality rates for Switzerland and the U.S., 4.8 and 7.2 per 1,000 births, respectively, is comparing apples and oranges." While this is true, it is beside the point because how Switzerland reports infant mortality internally has nothing to do with how Switzerland reports infant mortality to the World Health Organization that has a standard definition of live birth that all countries ascribe to for the purposes of the WHO. Well, the Czech Republic and Poland don't report to their guidelines, but everyone else does. What are they? "WHO-HFA definition of live birth: Live birth is the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of the pregnancy, which, after such separation, breathes or shows any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached; each product of such a birth is considered live-born." This is the misleading part of the story that is spread daily by the people that want to keep saying we are the best because the WHO study is flawed. The WHO already takes into consideration that different countries define live birth differently. That is why they have their own definiton and all countries (except the two mentioned above) agree to it for the purposes of their stats. That's why our own CIA quotes from it (and rates the US 45th).
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Post by millring on Nov 4, 2009 6:16:29 GMT -5
I don't rely on any of that to have decided that it is, indeed, an apples to oranges comparison (European numbers/USA numbers). I had this long discussion with my brother -- at the time I was buying into the analysis based on those WHO numbers. My brother is a periodontist and practiced in Italy (AF). He told me back then (in other words, independant of the US News And World Report story that demonstrated that the numbers add up to an unfair comparison) that European countries count infant mortality differently. And he told me a story:
A friend on base -- a doctor -- got a late night call. The call came from a neighboring European country and it was a couple who were frantic. The wife had just given birth to a baby that didn't stand much of a chance of survival. In the US the baby would have been immediately taken to intensive care. But in the European country where the woman gave birth, they just set the baby aside until it dies. Unfortunately, they set the baby where the mother could hear the baby's cries. It made the woman frantic and her husband called my brother's friend.
My brother's friend tried to sell the father on the cold logic -- the assessment that the European doctors had made that the baby wasn't going to be in for much of a life -- and that could also lead to much family stress -- trying to raise a baby with such special needs.
The father wouldn't hear of it. Especially as it happened -- the mother being able to hear the suffering child. He kept insisting that Geoff's friend make the short trip and save the baby. Finally, the doctor gave in, did go and did take the measures that would save the baby.
Within a year, the young couple was suing my brother's friend for the hardship having such a special needs child had put on them.
Lots of craziness to go around... but the short of it is that every baby like that, born in the USA, would be an infant death. And every baby born like that in Europe would be a stillborn.
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Post by theevan on Nov 4, 2009 6:50:27 GMT -5
Gack...talk about 'no good deed goes unpunished'!
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Post by Supertramp78 on Nov 4, 2009 8:51:36 GMT -5
John, interesting story, but beside the point. What countries report to the WHO is based on the definition established by the WHO. What we might see are two different mortality rates for a Eurpoean country. Their own and the what WHO says they have.
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