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Post by millring on Dec 28, 2014 12:13:32 GMT -5
...the US health care is the most expensive in the world for a good reason -- it's the best in the world.... At the risk of sounding like I don't believe in American exceptionalism, I'd posit that the U.S. healthcare system isn't the best in the world. Two things you have to include in any definition of "best" have to be affordability and access. By those measures, the U.S. healthcare system is lacking. What's the use of a great healthcare system if it is effectively closed to most people? But now we're specifically talking about that aspect. And the very point I'm making is that what is distinctive about our health care is that it is the best care in the world. And should we decide, like the rest of the world, to socialize it and ration it, we won't have the same care because it is quite obvious that the rest of the world does not enjoy the same level of care. I know what you are saying. You're making the point that we needed to reform the system by which the care was paid for so as to equalize outcomes and make sure that everyone had the same care, rather than having the best care that only some were paying for and the rest was going on our national tab. That said, I think you know what I meant. And it was clear during the run-up debates toward the ACA that that particular clouding of the issue was part of what was necessary to get the bill passed. We were being told that our CARE was the worst in the industrialize world. ---at which point I consistently asked Drs Kennedy, Cason, Rogers why they didn't resent the characterization of them as inferior. Of course they didn't mind because they saw the winking eye and agreed. They'll take the bullet for the sake of the greater good. The system of PAYING for it WAS broken, and if it took them agreeing that they were inferior to the rest of the world's doctors, so be it. It had to be done to fix "the system". But the problem with that constant acquiescence is that we are still left with trying to come to terms with socializing a Cadillac of a system -- being led to believe that it is possible by virtue of looking at the rest of the world that has done exactly that -- totally ignoring the fact that either our tab will be significantly higher per person, OR we will have to come to settle for less. In truth, we will have both happen. In truth we will both pay more AND get less. Though "less" will be a moving target because innovation will still play some role, and what may be possible in the future may be a game changer.
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Post by Doug on Dec 28, 2014 12:24:06 GMT -5
Those two things aren't part of the definition of "best". If you made the "best" car in the world or the "best" guitar, affordability and access have no part of it.
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Post by millring on Dec 28, 2014 12:28:48 GMT -5
Those two things aren't part of the definition of "best". If you made the "best" car in the world or the "best" guitar, affordability and access have no part of it. Yeah, that too. I wish I'd thought to put it that way.
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Post by Doug on Dec 28, 2014 12:41:14 GMT -5
I kind of wanted the best car in the world but the $4,000,000 price tag and the fact that only 3 hardtops were made, seems to kill the affordability and access thing.
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Post by Deleted on Dec 28, 2014 12:57:02 GMT -5
Comparing a car or a guitar to healthcare is absurd. You don't need a car or a guitar to survive. (Well, maybe we need guitars....) You don't come down with a life-threatening condition and they say, "Yeah, take two Porsches and call me in the morning" or "Take this Collings D2H and you'll be good as new." We're talking about healthcare, not stuff-I'd-like-to-havecare.
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Post by millring on Dec 28, 2014 13:01:13 GMT -5
Comparing a car or a guitar to healthcare is absurd. You don't need a car or a guitar to survive. (Well, maybe we need guitars....) You don't come down with a life-threatening condition and they say, "Yeah, take two Porsches and call me in the morning" or "Take this Collings D2H and you'll be good as new." We're talking about healthcare, not stuff-I'd-like-to-havecare. But, again, that's still not the same qualitative evaluation. Agreed, it is not some commodity like a car. But the US CARE is the best in the world. To say that it isn't good care because some people pay for it and others access it for free is not the same thing as making the evaluative judgement that the CARE is inferior. In THAT specific way the car analogy works quite well. On the issue of the morality of its providence, health care is indeed on a different plane. But the very good reason for drawing the distinction is that we are now in the midst of deciding how to pay for it. If we keep insisting that it's the worst health care in the industrialized world, it certainly would, then, make sense that it shouldn't, then, cost very much. It's the very distinction that matters -- it's the best and that's exactly why it costs the most.
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Post by Hobson on Dec 28, 2014 13:16:05 GMT -5
My original post was meant as an anecdote and not one to say that the ACA is entirely bad or even that it "isn't working." I think it's great that people with pre-existing conditions can now get health insurance. I think it's great that people can change plans as their circumstances change. I think it's great that people no longer have to rely on their employers to provide coverage. I think it's great that there are no longer catastrophic limits, although that's part of why the premiums are so high. I'm glad that there are subsidies to at least help lower income people with the premiums.
I will point out that proponents of the ACA have used lots of personal stories to support their views. We don't really have much history to provide statistics yet.
Part of the problem with the high premiums and high deductibles is that we have to deal with those and still pay the same taxes. Somebody's gotta pay for those subsidies. I just think that the issue of high health care costs has not been addressed. One approach would be to make more use of RNs and physicians assistants. More emphasis on healthy diets and exercise would be good too.
On the other hand, from the linked Washington Post article that Millring posted, the cut to Medicaid payments to doctors looks unsustainable. I review all of my husband's Medicare and other insurance statements and medical bills and I often think that the amount allowed by Medicare is absurdly low. The Medicaid allowable amounts will be even lower.
I do blame the company that my husband retired from for weaseling out of the health insurance that they promised by blaming the ACA. That's another long story and they always had a clause stating that the health insurance "may change." The part about them dropping the Medicare supplement a couple of years ago has actually been a good thing. The supplement through the company didn't provide good coverage. My husband now has a "Plan F" supplement, which is the best coverage and not very expensive.
If the ACA gets totally repealed, I'll be in worse shape. Already losing the group coverage, in my 60s, and no kind of guarantee that I can even get private health insurance.
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Post by Doug on Dec 28, 2014 13:26:06 GMT -5
Just hang in there a few more years and you'll have Medicare. That's what Chris did but we did sweat a few years of her having no coverage.
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Post by RickW on Dec 28, 2014 13:47:33 GMT -5
Whether the US has the best or worst health care in the 1st world depends entirely on what you are looking at. From the point of view of leading edge medicine, research, production of new drugs, and quality of care, sure, it's the best. But when someone has to pay 20k to get a broken arm cared for, then from that POV, absolute worst.
Hobson, the physicians assistants, etc., no question. But the doctors here have fought that fiercely. No reason a qualified nurse could not prescribe drugs - but they can't. No reason a qualified nurse can't sit in a clinic and do triage - you have a cold, go home, you have meningitis, go to the hospital. It was the same with midwives. They are just finally being accepted here by the doctors. It's ridiculous.
But the whole, "you need to live healthier" thing is a complete red herring. It's not enforceable. It keeps coming up, that people who smoke/are obese/alchoholic/don't exercise should be penalized somehow. But I'm not sure how you measure what's healthy or not.
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Post by Russell Letson on Dec 28, 2014 13:52:38 GMT -5
what is distinctive about our health care is that it is the best care in the world. And should we decide, like the rest of the world, to socialize it and ration it, we won't have the same care because it is quite obvious that the rest of the world does not enjoy the same level of care. I confess that Googling around to figure out in what way we might be "the best in the world" does not yield much support for that proposition. For starters, "best" is not a unitary descriptor, and anything as complex as a health-care system is not going to be simply rankable as an entire system. Cost, accessibility, and even "quality" (which probably needs to be broken down into sub-categories addressing populations, diseases and conditions, treatment regimens, and stuff I can't think of without asking a bunch of doctors and epidemiologists and actuaries) might be quantified and analyzed individually, but it's their interactions are what constitutes the "system." Might "best" mean "US medicine delivers treatments available nowhere else" or "people in other developed nations die of diseases that are cured in the US"? A casual Google of, say, cancer survival rates puts Japan and France in the same class as the US for some cancers. Other statistics, such as death rate and infant mortality suggest--indirectly--that there are other developed nations that might be "healthier." (Though the causes certainly involve more than health-care systems.) And there is plenty of evidence that France, Germany, Japan, Switzerland, and other developed nations can deliver what looks like "world-class" medicine. So--the US has an excellent medical-care system: we support research institutions, specialized treatment centers, and turn out legions of doctors and other practitioners. But those conditions do exist elsewhere, and there is both statistical and anecdotal evidence (some of it on offer on this forum) to show that.
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Post by millring on Dec 28, 2014 13:56:00 GMT -5
what is distinctive about our health care is that it is the best care in the world. And should we decide, like the rest of the world, to socialize it and ration it, we won't have the same care because it is quite obvious that the rest of the world does not enjoy the same level of care. I confess that Googling around to figure out in what way we might be "the best in the world" does not yield much support for that proposition. For starters, "best" is not a unitary descriptor, and anything as complex as a health-care system is not going to be simply rankable as an entire system. Cost, accessibility, and even "quality" (which probably needs to be broken down into sub-categories addressing populations, diseases and conditions, treatment regimens, and stuff I can't think of without asking a bunch of doctors and epidemiologists and actuaries) might be quantified and analyzed individually, but it's their interactions are what constitutes the "system." Might "best" mean "US medicine delivers treatments available nowhere else" or "people in other developed nations die of diseases that are cured in the US"? A casual Google of, say, cancer survival rates puts Japan and France in the same class as the US for some cancers. Other statistics, such as death rate and infant mortality suggest--indirectly--that there are other developed nations that might be "healthier." (Though the causes certainly involve more than health-care systems.) And there is plenty of evidence that France, Germany, Japan, Switzerland, and other developed nations can deliver what looks like "world-class" medicine. So--the US has an excellent medical-care system: we support research institutions, specialized treatment centers, and turn out legions of doctors and other practitioners. But those conditions do exist elsewhere, and there is both statistical and anecdotal evidence (some of it on offer on this forum) to show that. From the point of view of leading edge medicine, research, production of new drugs, and quality of care, sure, it's the best.
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Post by RickW on Dec 28, 2014 13:59:32 GMT -5
As long as the individual can afford them, John.
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Post by millring on Dec 28, 2014 14:01:47 GMT -5
As long as the individual can afford them, John. But then we're talking about something to which Doug's car analogy fits nicely because the very reason this discussion is occurring is because we are trying to figure out how to pay for it. It is for THAT reason we are continuing to talk about it and why it is so much more expensive than we were told it would be.
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Post by millring on Dec 28, 2014 14:26:58 GMT -5
For starters, "best" is not a unitary descriptor, and anything as complex as a health-care system is not going to be simply rankable as an entire system. Cost, accessibility, and even "quality" (which probably needs to be broken down into sub-categories addressing populations, diseases and conditions, treatment regimens, and stuff I can't think of without asking a bunch of doctors and epidemiologists and actuaries) might be quantified and analyzed individually, but it's their interactions are what constitutes the "system." Beyond letting one of the resident Canucks make my point for me, I might point out that I have consistently made that very distinction. I have consistently been making the point that we need to determine the value of the care before we decide what the "system" should cost. I have consistently capitalized or italicized or otherwise highlighted that I am talking about the care we receive here in the US. And I keep circling back to this because the quality of the care has been consistently slandered and smeared as inferior SO THAT we would address the cost -- so that we would accept the characterization that it should be easy to make free for all to access. And I keep pointing out that one cannot accurately assess that cost if we can't first understand that what we have is of greater value than all the other "systems" to which we simplistically compare it unfavorably.
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Post by Russell Letson on Dec 28, 2014 15:32:41 GMT -5
So one fundamental question would be, How do all those other nations afford the level of care they deliver to their citizens? (And I'm still not conceding that "what we have is of greater value than all the other 'systems'"--"greater" and "value" both raise non-trivial issues.) I'm familiar with a number of caveats: That socialized or subsized medicine is not sustainable in the long term; that increasing accessibility requires rationing; that government interference stifles innovation. And the question remains: How do other nations manage? Because it appears that they have managed.
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Post by Doug on Dec 28, 2014 15:36:48 GMT -5
So one fundamental question would be, How do all those other nations afford the level of care they deliver to their citizens? (And I'm still not conceding that "what we have is of greater value than all the other 'systems'"--"greater" and "value" both raise non-trivial issues.) I'm familiar with a number of caveats: That socialized or subsized medicine is not sustainable in the long term; that increasing accessibility requires rationing; that government interference stifles innovation. And the question remains: How do other nations manage? Because it appears that they have managed. They have managed because of rationing. Creating a lower level of care than what we are expecting.
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Post by millring on Dec 28, 2014 16:19:11 GMT -5
So one fundamental question would be, How do all those other nations afford the level of care they deliver to their citizens? (And I'm still not conceding that "what we have is of greater value than all the other 'systems'"--"greater" and "value" both raise non-trivial issues.) I'm familiar with a number of caveats: That socialized or subsized medicine is not sustainable in the long term; that increasing accessibility requires rationing; that government interference stifles innovation. And the question remains: How do other nations manage? Because it appears that they have managed. They have managed by going less in debt in other sectors of their economies. They wisely have stayed out of wars that would bankrupt them. They're smaller in scale. They've managed by making their populace more content that everyone is getting the same thing. It's the new opiate of the masses. It's like a Canadian friend of mine told me, "Everyone is happy with a lower level of care as long as we're sure nobody else is getting any better." We, on the other hand, are more discontent because we're believing less and less in the ability of anything but the government providence for our daily needs. We believe the function of government is to "get things done". We count government success only by what new policies and programs -- no matter HOW redundant or ineffective they may be -- are voted into existence. And, conversely, we are making it illegitimate to "obstruct" that growth. We believe the lie that one has to have a different program to logically oppose a proposed program or project. That, and we are beginning to believe more strongly than ever in "fairness" as the government's job to equalize outcomes rather than opportunities. And we believe more strongly than ever in collective solutions to life's problems.
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Post by Russell Letson on Dec 28, 2014 16:19:18 GMT -5
What level of care is lower than zero or (for those who wind up in the ER) last-minute bare-enough? And in what way is "rationing" different from pricing people out of the market altogether? For that matter, why use the emotive term "rationing" for the inevitable function of allocating and distributing finite resources? Every distributive system has such a function, and I'd admire to hear how a (distinctly not-free) market is more desirable than whatever system it is that other first-world nations use. (And my understanding is that they don't all work the same way.)
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Post by millring on Dec 28, 2014 16:23:17 GMT -5
What level of care is lower than zero or (for those who wind up in the ER) last-minute bare-enough? Are you saying the our ERs turn away folks who cannot pay?
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Post by Russell Letson on Dec 28, 2014 16:42:05 GMT -5
I'm saying that the level of care represented by having only the ER option is not better than, say, the universal care system of [insert developed-nation here]. Doug's assertion is that "rationing" in universal-care countries "creat[es] a lower level of care than what we are expecting." If you don't have insurance, don't have a regular doctor, don't have access even to, say, a community walk-in clinic where you can get a checkup and a flu shot--if you need to wait until you're actually sick enough to go to the ER, that does constitute "a lower level of care than what we are expecting," if "we" means "those of us with even half-assed health insurance." Know of any ER that offers annual checkups, immunizations, and diagnostic testing, absent presenting with serious symptoms? Those preventitive measures are as much part of "health care" as suturing up a cut or setting a broken arm, and a system that cuts people off from them is sub-optimal, to put it mildly.
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