Insurance inefficiency

Insurance inefficiency

: Health care better become an issue in this campaign, for the state of things keeps getting worse as it gets more expensive and inconvenient. But it’s not just doctors and hospitals that need reforming; it’s insurance companies. They are adding more and more rules in its effort to save money by harrassment — if we make it really tough and expensive to get this prescription, maybe he won’t take it, goes the logic. But what this really does is add more work and thus more expense in doctors’ offices. It’s a vicious cycle and it’s not getting better.

In Todays’ NY Times, Jeff Madrick writes:

Americans spend some 14 percent of gross domestic product on health care, while other advanced nations spend an average of 8 percent. In the United States, the proportion may rise to 18 percent by 2013.

Yet in general, judging by life span and infant mortality, most developed nations are healthier than the United States….

What may surprise readers, and certainly surprised this writer, is that Americans, by paying so much more, do not have many more services. In fact, according to recent research, they typically have fewer. Consider the number of doctors. In 2001, the United States had 2.7 doctors per 1,000 people, compared with a median of 3.1 in the countries in the Organization for Economic Cooperation and Development. France, accused of having a doctor shortage in last summer’s heat wave, had 3.3 per 1,000.

Also, consider the number of hospital beds. The United States has only 2.9 hospital beds per 1,000 people, compared with the O.E.C.D. median of 3.9. Germany has 6.3. The United States is also behind in the actual days spent in a hospital and hospital admissions per capita. These are not necessarily bad in themselves, but the question is why we spend so much.

The reason for the high level of American spending, argue the researchers – Uwe E. Reinhardt of Princeton and Peter S. Hussey and Gerard F. Anderson of Johns Hopkins – is that American doctors and hospitals charge much more. Americans also usually pay significantly more for drugs, they say, and administration expenses are exorbitant.

Administration expenses are exorbitant.

I can’t wait until Hillary is president. We will get health care reform then. Just as Bush the younger finished Bush the older’s job in Iraq, I hope Clinton the Mrs. will finish Clinton the Mr.’s work — and her own work — in health care.

39 responses to “Insurance inefficiency”

  1. GCW Avatar

    I think it’s nuts to believe that centralizing health care will help people in the long run.
    The image that springs to mind is the DMV.

  2. Jackie D Avatar

    If you think health care is expensive now, wait till you see how much it costs when it’s free.
    With apologies to PJ O’Rourke, having lived under the American system and a socialised healthcare system in Britain, there is simply no contest: Nationalised healthcare sucks and, I would argue, is a dangerous road for a country to go down. Politicians running hospitals and telling doctors how to heal sick people? It does not work.

  3. Matthew Cromer Avatar
    Matthew Cromer

    We spend more money on healthcare because it costs a lot more to save a premature baby than let it die, it costs a lot more to perform a transplant than let the patient die, and it costs a lot more to do fertility treatment than tell the would-be parents that it’s hopeless.
    Our infant mortality rates are higher because we have more older women having babies, more fertility treatment, and lots more multiple pregnancies (due to fertility treatment) which are always high risk, and because people in Europe / Japan are having so very few children that those who do have them are in better health and younger than here.
    http://www.cnn.com/2004/HEALTH/parenting/02/11/infant.mortality.ap/
    If you are indigent you can get medical care in the US that is unavailable to the middle class in Canada and Europe — only to those who supplement their restrictive and horribly backlogged public health systems.
    And yes, doctors here cost more than in Europe, which is why so many of the best and brightest come here to practice.

  4. Jackie D Avatar

    …And why so many doctors in countries like Britain don’t stick around once they get a taste of how it is to have a bureaucrat telling you how to heal the sick and that you need to fill out fifty forms in triplicate for everything you do.

  5. syn Avatar

    I agree we need to address our health issue, but I guestion ‘the cost’.
    A relative of mine under Medicare recently went into the hospital for a gall-bladder operation, came out a week later after having had $40,000 worth of ‘other tests’ requested by the hospital done at government expense.
    I lived in a country with socialzed medicine, it was horrible. I had to have six stitches, free yes, but I worried more about gaining infections from paltry conditions in the hospital than from my initial injury.
    A couple of years ago, when my father had cancer he went to the Arthur-Anderson Hospital in Houston TX, great hospital. I was told by a hospital staff member that 100,000 people a day go through this hospital. One time, during a visit to the emergency room at Anderson, a women from France was bitching wildly about having to wait despite the fact that other people in the room had situations far more dire, she bitched how terrible it was for her and that in Frace she would have never been forced to endure such horrible treatment. I keep wondering to this day why this women flew across the Altantic in order to receive treatment when, according to her, her own country was better. Apparently, this was the women’s fourth trip to the American hospital.
    I have a friend from Germany who abhors the German health care system. He tells me that the system is bad because people have overloaded the system with pointless visits to the doctor. Most Germans, my friend believes, simply go to the doctor because it is free and not because of need.
    Universal Free Health Care but at what cost?
    When the government controls health care we will all be paying a terrible cost in every way imaginable.
    I am self-employed, I use a medical savings account for primarily catastrophic care. For me, I would rather pay $400 a month for great health insurance than pay $400 for a pair of shoes or $300 for a 2 hour madonna show or would rather give up going to the movies entirely in order to pay for my own health care.
    I have experienced the alternative of ‘univeral health care’ and have learned an important lesson, univeral health care is a bad idea.

  6. Charlie (Colorado) Avatar
    Charlie (Colorado)

    *sigh*
    I hate health care. Not the problem, but the issue.
    But let’s look at what the article says. First of all, all those figures about number of doctors and number of hospital beds are statistics without any obvious correlation to actual heathcare outcomes.
    We’ve got fewer beds per thousand … but we’ve also got hospitals losing for lack of patients. Why? We tend to treat people before the problem is sufficiently acute to require hospitalization.
    In fact, these statistics say as much: “we’re behind in days spent in hospital and hospital admissions per capita. “Behind”? This implies there’s something desirable about having more hospital admissions.
    We also have fewer doctors per 1000 — but it’s not the US that has months or years-long waiting lists for a specialist’s care.
    Americans pay significantly more for drugs — but that’s because we’re subsidizing all the price-controlling European countries. And administration costs are significantly higher — but it’s real hard to imagine that governmental control would reduce administration costs.
    I dunno what the answer is — and worse, I’m not sure the problem is a problem: we may be getting the most expensive health care because we’re on average, getting the best health care, and it costs more.
    Maybe the answer to the real problem of people getting really sick and being made paupers by the health care is government action to make catastropic care insurance more available. (They could start by making health insurance deductable by an individual — there’s a real disincentive for me to buy the health insurance I want, rather than what I get from a job, because I buy it with after-tax dollars, which more or less doubles the real cost.)

  7. fat kid Avatar

    I can’t wait until Hillary is president.

    I detect some sarcasm there, at least I hope I do. I do agree that there are changes that need to be made, however, I don’t think *anyone* in today’s political arena has the cojones to propose, let alone force through (b/c that’s what it’s gonna take) the requisite changes.
    What *does* need to change, IMNSHO, is people going to the doctor for every little ailment they have. Not to start stereotyping, but why is it the elderly and the poor are the only ones I ever see in the doctors office? My Mother works in a docs office and I hear all the stories of people going to the doc for splinters etc etc. Now I can’t quanitfy how much of a problem this is, but I think the solution is more behaviour based, as opposed to regulation or efficiency based.

  8. Jackie D Avatar

    Now I can’t quanitfy how much of a problem this is, but I think the solution is more behaviour based, as opposed to regulation or efficiency based.
    If you could get the government to produce legislation that prevents people from acting like big babies, I might just become a government-loving statist.

  9. Angelos Avatar
    Angelos

    I pay $500 a months for my own insurance, as I am self-employed. I don’t go to the doctor or emergency room willy-nilly, but damned if I’m not going to take advantage of what I’m buying.
    The real problem is the artificial cost structure.
    If an uninsured person goes to the ER and requires an emergency appendectomy, they’ll get a bill in the thousands, maybe over ten thousand (someone out there must know).
    But my insurance company or Medicare will only pay $1000 or so. That’s worse than the arlines.
    There must be a way to balance a universal safety net, along with a capitalist system that lets people with the means buy better options.
    Government-run health care sounds great until you see what it does to your tax bill. But when everyone has health care, the wait times for even basic x-rays or MRIs become months (witness Canada). But when I tore my ACL playing soccer, I was at my orthopedits next day, had an MRI in a week when the selling sent down, and had surgery the next week. Try that in a socialist health care system.
    How to find the balance is a real issue.
    I’ve heard mentions of government insurance for catastrphic events only. But that’s terrible medicine, because people will wait and wait and wait because they can’t afford the doctor’s visits to nip the problem in the bud, and OF COURSE it will wind up catastrophic.
    Every solution will have a lot of pain attached. But there has to be a better what we have; the richest country in the world shouldn’t have so many uninsured.

  10. Dann Avatar

    Much agreement with what has already been said in support of our (semi)free market health care system instead of a “free” socialist health care system.
    At the same time, there are some things that could be done to make things better. Tort reform comes to mind. If a doctor makes a $20,000 mistake, his insurance company will wind up paying millions after the civil suit has been concluded. The lawyers get rich, the patient gets a few bucks, and the doctor goes out of business.
    Culturally, we could develop an understanding of our own mortality. I have read news accounts regarding the expense of dying in America. Some people keep mom or dad on life support for months when the expectation of a return to a reasonable quality of life is at best slim.
    Life could be made better for patients when there are two working adults with health insurance. Currently, patients are the first to be billed for any deductibles and then the insurance companies ‘cooperate’. Would it not be a better option for the insurance companies to split the expenses and leave the patients with fewer costs? I mean, if there were only (1) insurance plan for a patient with $1,000 worth of medical costs, the insurance company would have to pay out $750 to $950. With two plans, each company would only have to pay $500.
    [Just my own personal beef with the insurance companies.]
    Trusting Hillary with health care is like trusting a mouse with cheese. IIRC, one of the initiatives that came out with her health plan included increased payments to medical schools in exchange for a decrease in the number of doctors trained.
    IMO, the solution to the problem (as with most other problems) can be found in expanding freedom; freedom of patients to “re-inport” medicines from other countries; freedom of lesser trained people (i.e. physician’s assistants) to perform lesser procedures; etc.
    Regards,

  11. Jim in Texas Avatar
    Jim in Texas

    Maybe some of our british readers can comment on this, but this it

  12. red Avatar

    As someone who gets to use a universal health care system when I need it, I find the hostility to the idea and practice of “socialized medicine” on this thread interesting. Yes, wait times for CATS and MRIS can make one anxious. Ministers of finance are reluctant to buy “too much” diagnostic machinery.
    But only Angelos seems to show some sympathy for the many uninsured. The other side of single payer universal health care is the scene in our pediatrician’s office. The poorest immigrants are there, along with my boys. No disputing of credentials, no concern about payment: all are equal in their possession of a health services number. You present your number: no paper work, no consultations about suitability of treatments. The doctor’s medical judgment, not the insurance company’s financial motive, will prevail. Sometimes we adults wait for diagnostics but, in my experience, sick children never wait. Can you defenders of ther American market system make that claim?

  13. DDavila Avatar
    DDavila

    I pay 400 a month for my wife and I since we are also self employed, but my plan pays 100% after the co pay of a low 25$, it’s called Kaiser and I really think you should look into that outfit Angelos, sounds to me like your plan sucks ;)
    That being sid I notice a huge glaring omission in this discussion, the horrendous costs of insurance that doctors/hospitals must pay. My Kaiser doctor for my recurring ear problems (I am in the water a lot) just joined Kaiser from her privvate practice because it was no longer feasible for her to be a private practioner. Her insurance, only for malpractice, was over $85K. Before rent. Before equipment costs. Before payroll and it’s attendant costs, worker comp, employees med coverage etc. etc. etc. As a result of her closing her office, the owners of her building lose a renter, the lab she split with her fellow doctors went under laying off 4 employees and her office laid off 4 others as well.
    If this an honest discussion of the rising costs of medical insurance, I think it is also wise to take a look at where those costs are are coming from. Trial lawyers like John Edwards did not get richer that Croesus by trying to keep doctors employed at low rates for the general public. Neither do insurance companies post record profits by charging doctors low rates either.
    Just my two cents, your mileage may vary…

  14. Jackie D Avatar

    Who’s said the American system is perfect, though? What about a system where, if you’re too poor to afford private health insurance, the government takes care of you? That’s a far cry from having politicians running the healthcare system.
    Those who can pay for healthcare, should. No one is born with the “right” to free medical care. People in western countries, contrary to what many claim, are not really choosing between living out of poverty or getting medical care in most cases. Having to go without a TV or only having three pairs of jeans instead of five isn’t poverty, and if those are the kinds of sacrifices you have to make to pay for medical insurance…Well, that’s fine by me. True poverty means you really have no more sacrifices to make, and there’s no reason why those who can afford to pay should be catered to as if they cannot.

  15. Angelos Avatar
    Angelos

    My father lives in Greece, and seems to think the universal system they have there works. There is a base level of care, and he can pay the difference.
    Say the government plan allots $100 per night for a bed. That will get a “poor” or “average” person a bed in, say, a triple-occupancy room in one of the many government-sponsored hospitals. If my dad wants to have a private room in YGEIA or another higher-end private hospital that costs $300 per night, he can pay the difference out of pocket, or with his extra private insurance coverage through his employer. Seems fair to me.
    That’s a pretty simple example though.
    How does that affect wait-times for procedures? I don’t know, and he’s not here right now, but I’ll ask later. Say he needs back surgery, but so does another guy who only has the government plan. Does my dad go first? Or are those things mandated first-come-first-serve for EVERYONE on equal ground, but my dad can use his greater means for the perks later (better room, etc.)

  16. Angelos Avatar
    Angelos

    My plan is great, actually. Pricey, but I go to any doctor I choose, whenever I choose. No referrals needed, no approvals for most tests.
    Much better than the HMO I had when I was someone else’s worker bee.

  17. Daniel Avatar
    Daniel

    Soviet health care was free and very efficient. Very low administration costs and doctor’s fees when 98% of patients seeking a heart operation die before receiving treatment. (God knows how well those patients who actually received treatment fared).
    Yes it will be great when we can all look to a day when all Americans are entitled to the same crappy doctor.

  18. red Avatar

    Yes, jackie d. and daniel: large numbers of people outside the United States do believe that medical care is a basic right. Without health, one cannot fully enjoy and pursue life, liberty, and opportunity. In my city, the poorest,shambling bum can walk into the same clinic I use. If, in his alcoholic haze, he has lost his health services number, the nurses will usually be kind enough to phone the commission to verify. After all, he is a human being.

  19. me Avatar

    “Does anyone here buy private insurance for themselves and/or their family? I’m curious what an average policy would cost.”
    I lost my job summer of 2001 and was on a family catastrphic plan for 3 months. Bill was about $100 a month. I wasn’t about to do COBRA – that was going to be about 900 a month. The catastrophic plan did not cover well visits or anything non-emergency and had a 5k deductible, but paid up to 2 million after the 5k + 50% of the next 5k, 7500. This worked great for the period I was unemployed, granted the deductible was steep, but I was covered at a certain point which really was my only short term concern – the auto or freak accident that really is the purpose of insurance. Not sure why more folks who complain about not having insurnace after they lose a job don’t do this. I hear complaints about the high deductible but on Cobra I would have paid 7500 for 8 months of coverage anyway. But now I’m employed and back on a 10k a year health plan, but would take the cash if I could and go back to the catastrophic plan in a heartbeat, but my employer will only give me 700 a year to opt out.

  20. Matthew Cromer Avatar
    Matthew Cromer

    Government will make an utter botch job of public health care just like it has made of Public education.
    Food is even more important than health care. Should we nationalize the grocery and restaurant businesses?
    BTW the uninsured still have access to medical care in America.

  21. Matthew Cromer Avatar
    Matthew Cromer

    Red, the other problem not mentioned is that health is not something that can be given to a person. The majority of health problems are created by lifestyle choices. Do we want the government to mandate exercise and diet choices for its citizens? No thanks!

  22. Paul A'Barge Avatar
    Paul A’Barge

    “I can’t wait until Hillary is president. We will get health care reform then”.
    Oh yes. It will be so much more efficient when run by the government. Like all those other well-run government programs.
    If you like that fairy tale, you’ll love this one …. there once were a boy and a girl named Hansel and Gretel …. You get the point.

  23. jon h Avatar

    It’s a matter of whose mandates you want to live under– an HMO’s or a national system’s (likely run by an experienced board, not Tom DeLay or the DMV).
    I don’t see that a national system would be that much worse than now…
    –where millions of the adequately-covered must spend hours or days managing their coverage or appealing bad decisions
    –where there are millions of uninsured, some healthy and yet some uninsurable, that would be brought in under a national umbrella
    –where there are millions more inadequately insured,
    –and still more folks stuck in jobs they hate strictly for a decent health benefit.
    Is it worth eliminating a couple dozen insurance bureaucracies so that the eliminated overhead is funding coverage for the uninsured?
    Is it worth bringing millions of people at risk for, or actually sick with, serious illness into a system where they get adequate preventive care or earlier-than-usual treatment, and thus prevent even MORE serious health issues down the road– issues which get paid for by taxpayers and the healthy at a much higher rate?
    Is it worth un-skewing the labor market– Jeff’s great point– so that miserable people aren’t doing jobs they hate, shifting their hate onto customers and coworkers? (what would THAT productivity boost look like? would it make up for insurance workers thrown out of work for a while? I’d vote yes, again)
    Is our experience with Medicare all THAT bad?
    They cover tens of millions of seniors with hundreds of millions of visits per year. And sure they have problems, but they’re fixable problems. Would your mother or grandmother seriously choose the free market instead of what they have now?
    Sure there will be horror stories and bureaucratic snafus and inadequacies under a new single-payer plan, and the scandals will be directed at one single entity so they’ll be more visible– but they’ll also be fixable, nationwide, in a way they just aren’t now.
    Sometimes the devil you don’t know is preferable to the chaos we’re used to.

  24. kate_q Avatar
    kate_q

    Red, many Americans believe that the only right people really have is the right to be left in peace to pursue their business. You are not entitled to food, shelter, etc.; you are entitled to the pursuit of those things. Health insurance is something you may choose to buy if you have earned the money to pay for it.
    I understand that other people believe otherwise; luckily for them, there are many countries that do have socialist health programs. It’s so nice to have a choice.

  25. Dann Avatar

    Another thought on the subject.
    We in the States have several huge bureaucracies devoted to providing health care funds for the needy. At the same time, our various governments also provide very generous benefits for our public employees.
    I wonder if we might be better off by simply qualifying the needy for inclusion in those government employee health insurance pools? We could certainly eliminate a number of employees used to evaluate claims and so forth.
    One of the primary problems we have is that the poor only qualify for health services at the emergency room. Instead of having a diabetic needing insulin going to the ER periodically, doesn’t it make more sense to send that person to see a doctor on a regular basis. It would certainly cost less.
    Additionally, why shouldn’t an individual citizen (or a small private business) be eligible to buy into the federal or state government’s health insurance plan. The whole point of insurance is to spread the liability across a larger pool of people.
    The concept was tried in New York where the Kodak Corporation permitted businesses close to their facility (Buffalo??) to buy into the Kodak health insurance pool. The entire city benefited from much lower premiums.
    Again, the solution seems to be in the freedom to participate in government programs (or the privilege of participating in a larger insurance program from a private company or cooperative).
    Regards,

  26. Hunter McDaniel Avatar
    Hunter McDaniel

    This is very refreshing, a thread that hasn’t degenerated into namecalling.
    I’d like to see something done for the uninsured, although I think real cases of patients being denied care for life-threatening conditions are very rare. My worry isn’t that we’ll turn health-care into a DMV, but that it will be like the public schools – run by and for the providers, not the customers.

  27. Michael Avatar
    Michael

    Goverment health care will be as effective as goverment schools — everybody loses, except the government. But, my guess is, it will happen — just as this blogger said, right after Hillary Clinton is president.
    If that happens, we American will deserve it. We always get the goverment we deserve — just like with Bush/Cheney. If fact, the multiple excesses of this administration is causative to Hillary’s (or some equally liberal) future presidency.

  28. kevin Avatar

    are there any not for profit insurance companys? this would seem to solve some problems. take the bottom line out of it. it might work in small scale situations,maybe a doctors group affiliated with a hospital. it just seems the insurers are running the whole show,both sides of the street,no motive for reasanable costs. one can dream.

  29. joni Avatar

    Angelos –
    According to my sister-in-law, socialized medicine means having to pay twice: first the government, then the doctor. They don’t get timely visits if they don’t slip the doctor something under the table.
    It’s probably better in Athens or Saloniki, but my mother-in-law had to spend time in a smaller Greek hospital and my husband was appalled to find it filthy. He said, embarrassed, that our animal hospitals are cleaner. He reported stains, including blood, on the walls and trash on the floors. When he complained about the health hazard he couldn’t get anyone to admit there was a problem. I think when you turn it over to the government, you lose pride of ownership, not to mention personal responsibility.

  30. MD Avatar

    red,
    You make a very eloquent plea for the uninsured and I would be the first to say that we have a lot of areas to improve on in the US regarding healthcare. I am a practicing physician and know that first hand. I am also a patient with multiple sclerosis. Waiting for MRI’s and CAT scans has a more significant impact than simply feeling ‘anxious’. I had a scan immediately after I visited my physician complaining of headaches and double vision. The next week, literally. It could have been sooner if I could have scheduled it. Everyone was suprised at my diagnosis of MS and I started Avonex therapy right away. More and more research is showing that the sooner you start the meds, the better off you are.
    I don’t think we need a Canadian or British or French system. We just need a better American system. We have expensive medicine in part because we do expensive things (more tests and more procedures and more medications). What we need to do is find a way to make the consumer (patient) a part of the process in terms of allocating resources. Excessive litigation, insurance costs, patient expectation, doctor training, excessive beaurocracy all play a part in this mess.
    Despite these problems we have a fine system. Many docs in my department are ‘refugees’ of other medical systems and they are glad to be practicing here.

  31. red Avatar

    What an interesting thread! Jeff should be pleased with the result(a good outcome).
    Being a consumer of the services sometimes tardily provided by the Canadian single-payer system, I would be willing to see some private parallel services. For many procedures, they are now available. One proviso: doctors would be required to take one-third to one-half of their cases in the public system. If I understand it, this is done in Sweden, Germany, France, and Britain.
    The problem in Canada in recent years has been that the feds took too much money out of the system in too short a time, resulting in shortages of doctors and equipment.
    Very curable, though, without compromising the principle of basic equality that puts Somali refugees in Salvation Army clothes in seats beside me and my boys in the pediatrician’s office. They have the same card I have(but my taxes are a lot higher than theirs).
    Canadians have shown as recently as the June 28 federal election that they will not tolerate anything that hints of “devil take the hindmost.”
    By the way, I have lived equal halves of my life in both countries, and have received very good medical care in both . And “red” is not for politics, but Red river, a geographical scene dear to me.

  32. Charlie (Colorado) Avatar
    Charlie (Colorado)

    Red: As someone who gets to use a universal health care system when I need it, I find the hostility to the idea and practice of “socialized medicine” on this thread interesting. Yes, wait times for CATS and MRIS can make one anxious. Ministers of finance are reluctant to buy “too much” diagnostic machinery.
    You’re misunderstanding several things. First of all, I’m not unsympathetic to the problem of poor people who need health care. On the other hand, most people who live in other countries are ignorant of the degree to which it’s actually a problem here; most people seem to think that sick poor people are left in the gutter to die. In fact, what happens is that people who have no health insurance show up at emergency rooms, where by law they must be treated. If they can’t pay, these costs are absorbed by the hospital, which transfers them to paying customers.
    Look, I’m not claiming that it’s a smart system, but people don’t miss out on acute care because they’re poor.
    On the other hand, it’s not just a matter of people not getting “unneeded” MRIs because some Finance Minister doesn’t want to pay for another machine. And just to be clear, I attended Duke Medical School, as a grad student rather than an MD student, but none the less have extensive medical background. I’m not an MD, but I’m pretty well-informed about medicine. I also lived in both Germany and Canada, and spent a good bit of time in the UK, so I’ve seen National Health Care systems up close. And just among my friends and acquaintances, I’ve seen these examples:

    • A friend — distant cousin, actually — who showed up in the ER at a major hospital in Toronto, haemorrhaging badly from an acute GYN problem. They packed her up, got the bleeding stopped, gave her progesterone to induce uterine contractions — and sent her home, having made an emergency GYN appointment for her. Six weeks hence. At Duke hospital, she would have seen a GYN resident or attending before she took her heels out of the stirrups; she could have made an emergency appointment later that day.
    • A very close friend of mine in the US had a particularly nasty brain tumor: a glioblastoma multiforme. She received agressive treatment, and after nearly dying made an astounding recovery — she’s one of the one in a thousand who survived more than five years.
      In either Canada or the UK, she would have been on a waiting list of six to eight weeks before the MRI that revealed the tumor; assuming she lived long enough to receive a diagnosis — not a great bet, actually — the standard treatment would have been to give her steroids and tell her to settle her affairs; it’s not financially efficient to risk funding on someone who’s going to die.

      Sure, maybe that’s the “sensible” option — but she saw her 12 year old graduate from high school, and her 7 year old get his Eagle Scout badge. (And, as far as I know, she’s still alive — we lost contact when she re-married.) You tell them their Mom should have died.

    • Another Canadian friend with a severe and degenerative eye problem. If he had surgery, he wouldn’t go blind. The only problem was, it hadn’t progressed far enough to qualify for quick turnaround in surgery, so basically he had to wait until he was nearly blind — which would have meant being unemployed — or else hope it didn’t progress so quickly that he couldn’t wait to come up on the waiting list.
      Three years from the diagnosis.

    I don’t claim I’ve got the Answer. What I do know is this: people in the UK and Canada are dying, every day, who would have lived in the US. Or sometimes, maybe, just going blind, being maimed, losing their fertility.
    Whatever the answer is, I’m pretty certain that’s not it.

  33. Kim Avatar

    Every State has a program for kids if you don’t qualify for Medicare. You have to apply. In NY and NJ there are State programs that are free to parents who have children and make 34K and under. Over 34K and you have a charge per month. Two friends, one in NJ makes 40K with three kids pays $11 per child per month and the other in NY she makes under 34K and it’s free but not considered Medicare. They are HMO plans. Every State has these programs. http://www.insurekidsnow.gov/ If they could do something like they have done for children for adults it would be a step in the right direction. More adults could afford a health plan if it was based on their income.

  34. Charlie (Colorado) Avatar
    Charlie (Colorado)

    Is it worth eliminating a couple dozen insurance bureaucracies so that the eliminated overhead is funding coverage for the uninsured?
    My grandfather used to say “If the bird book and the bird disagree, believe the bird.”
    As I wrote above, I’ve seen NHS in action in three countries. None of them show any sign that what you’re saying is actually true.
    Give me an existence proof of even one system that actually works better and I’ll listen. But without it, this theory is just wishful thinking.

  35. h0mi Avatar

    Sorry about the long winded comments but I’d been thinking about this all day long for various reasons. Disclaimer/Caveat/disclosure- I work for an HMO, albeit in a supporting role (I work on the systems we use that bill people for the care my HMO delivers, not in the actual delivery of health care.)
    My employment with this HMO has not had a major effect on my view of the government, but I have seen the effects of government mandates. When the state of California enacted legislation regulating mental health copays, it forced my company to spend millions of dollars enhancing a system to ensure we remained in compliance with Medicare regulations regarding benefits offering to individual members and to members enrolled via employer groups but also did what the state of California required. I’ve seen what HIPAA has done (second hand- this stuff didn’t directly affect me or my work but it’s affected my department and coworkers significantly more) and the various regulations and requirements have affected significantly the way we operate and do business.
    The libertarian in me opposes a government take over of health care. The ‘realist’ in me recognizes that something is going to eventually take place, as the “critical mass” of people affected negatively by our current system grows, and the “cynic/realist” in me recognizes that we’re not going to go to a full scale private system where no government assists the poor or elderly in paying medical bills. I don’t propose any specific solutions but I believe we need to figure out the exact problems first with healthcare in this country.
    I do not believe that life expectancy or infant mortality are necessarily good indicators of a working/non working health care system. There are aspects of life that affect both of these that no amount of money in health care can possibly address- the affect of accidents killing people (auto accidents and alcohol related deaths) homicide/suicides, and the prevalence of diseases that are incurable. I have questions about whether we calculate these figures in precisely the same manner (ie- I’ve read that France does not consider infants who die in the first X days in the infant mortality rates … where X is some value between 1 and 30 depending on the article posted. It’s also possible other nations do this sort of thing as well when determining infant mortality.) The significance of the difference is also important but not mentioned- there may be 20 nations ahead of us, but if the difference between #1 and us is 0.01 babies per 1000, or 1 year, is that really that significant a difference? If #10 is 0.0004 babies and 2 months difference(s), is that significant? Obviously it is if you’re the 1 baby or got an extra 2 months, but we’re not even certain as to the “why” other systems work better, if they do at all.
    Furthermore, the issue regarding % of GDP spent. “Other advanced nations spend an average of 8%”. So some nations spend less, others spend more. Who are they? For example- If Sweden spends 9%, France spends 11%, Germany spends 4%, and there are no significant differences between the stats of these 3 countries, it’s clear Germany is doing something that France and Sweden are not. Is medical research included in this figure? I’d expect it not to be. I’m also not clear that a government takeover is necessarily the most efficient way of delivering services. In fact I strongly doubt that. The only way it “makes more sense” is by consolidation of multiple bureaucracies into 1… but how do you expect to sell health care reform if it means 100,000 people are losing jobs on top of the shifting of burden and the increased taxation/government spending?
    This reminds me somewhat of baseball and the way players tend to be rated. Many baseball writers/columnists/etc. overvalue certain stats (RBI, RS) which doesn’t give us a very good indication of how good a specific player is because other people affect these stats (by getting on base to be driven in, or by getting hits to drive you in.)

    What may surprise readers, and certainly surprised this writer, is that Americans, by paying so much more, do not have many more services. In fact, according to recent research, they typically have fewer. Consider the number of doctors. In 2001, the United States had 2.7 doctors per 1,000 people, compared with a median of 3.1 in the countries in the Organization for Economic Cooperation and Development. France, accused of having a doctor shortage in last summer’s heat wave, had 3.3 per 1,000.

    So “fewer doctors’ means “fewer services”? I don’t think that’s necessarily the case. Based on a population of 294 million, to meet the ratios of 3.1 and 3.3 respectively per 1000 people, the US would need to hire another 117,600 or 176,400 doctors. This would serve to boost the amount spent as a % of GDP even more.
    I’d like to see how these various statistics look when looking at different regions of the US. I’d predict that the north east would look good (lots of hospitals, lots of people, the sparsely populated Midwestern states & Alaska would look good (at least the ratios- fewer people) and the more populated (but not dense) states of Texas, Florida, Illinois & California to all look pretty poor (too many people, not enough hospitals).

    The United States has only 2.9 hospital beds per 1,000 people, compared with the O.E.C.D. median of 3.9. Germany has 6.3

    Germany, assuming population = 82.4 million, has about 519,000 beds. The US would have about 852,600. To reach a ratio of 3.9 beds, we’d need 294,000 more beds added. To reach 6.3, you’d need to add nearly 1 million more hospital beds.
    With some hospitals being under utilized, and others overutilized, it seems there are significant inefficiencies that simply adding more beds won’t resolve- you have to add them where they are needed. And shuttering underutilized facilities seems proper to me … or otherwise revamping it so they are more properly utilized.
    Now… why do we think that the Feds can do a better job at this than the private sector? I envision a future where powerful senators will get more hospitals built in their states… to hell with the states (or areas) that actually need them.

    The United States is also behind in the actual days spent in a hospital and hospital admissions per capita. These are not necessarily bad in themselves, but the question is why we spend so much.

    This is a legitimate point- it’s clear there is some sort of disconnect between the cost and amount of services provided. But having patients linger in hospitals isn’t good, and it’s entirely plausible that we have fewer doctors and fewer hospitals and fewer hospital stays because the quality of care is higher, justifying the additional cost. Or the fact that longer stays would simply increase the costs further, or more hospitals/doctors would mean that our costs would be that much higher.

    The reason for the high level of American spending, argue the researchers – Uwe E. Reinhardt of Princeton and Peter S. Hussey and Gerard F. Anderson of Johns Hopkins – is that American doctors and hospitals charge much more. Americans also usually pay significantly more for drugs, they say, and administration expenses are exorbitant.
    Administration expenses are exorbitant.
    I can’t wait until Hillary is president. We will get health care reform then. Just as Bush the younger finished Bush the older’s job in Iraq, I hope Clinton the Mrs. will finish Clinton the Mr.’s work — and her own work — in health care.

    Administration costs are expensive due to a variety of things. A significant reason is government’s affect on health care costs, including reimbursement for medicare and the like.
    Health insurance companies would be smart to work together to integrate their systems better together to keep administration costs cheaper.

    Our infant mortality rates are higher because we have more older women having babies, more fertility treatment, and lots more multiple pregnancies (due to fertility treatment) which are always high risk, and because people in Europe / Japan are having so very few children that those who do have them are in better health and younger than here.

    Fertility treatment isn’t cheap either, in and of itself. Many health plans require members to pay the entire costs, but some patients have 1/2 of it covered. And if people are able to afford to do this, you’re looking at insurance paying 5,000 or so a treatment with the member paying the other 5000 or so.

    We also have fewer doctors per 1000 — but it’s not the US that has months or years-long waiting lists for a specialist’s care.
    Americans pay significantly more for drugs — but that’s because we’re subsidizing all the price-controlling European countries. And administration costs are significantly higher — but it’s real hard to imagine that governmental control would reduce administration costs.

    The argument is that instead of having to coordinate different insurance companies, doctors wouldn’t have to navigate the seas of Aetna, Healthnet, Blue Cross, etc. to get reimbursed for a doctors visit for a patient who paid a $15 copay. I’d think the insurance business could work it out amongst themselves to figure out a way to lower costs for providers but I wouldn’t hold my breath for that to happen.
    I agree with Angelos. What a shock :). The cost structure is out of whack, but the government hasn’t helped. Remember- there are incentives for employers to provide care, and IMO this is the big problem with it… the tax breaks that are not afforded individuals. Insurers want more healthy people getting insurance because their utilization is lower, and if more people are buying but not using health care, they can pass along those savings to their other customers. Which is true essentially of all insurance (and essentially what a “universal health care” system would end up doing- everyone pays for it directly or not, and only the sick utilize it).
    The costs to see a doctor, to get medicine for a relatively simple thing (a cold, allergies, or what have you) are high, and delays in treatment lead to more expensive treatment (going to the ER with pneumonia). But are people bearing the true costs of that appointment when they have a $5 copay? No.
    The libertarian in me dislikes efforts to have a more “socialist” type health care system and believes that the free market system/free market reforms can and would help. The cynic in me says that this is unlikely. That same cynic, however, fears that shifting to a more socialistic side will simply give us more of the negatives and few of the positives of health care.
    Malpractice reform seems to be really needed, but this reform needs to take place in the doctor’s office, the hospital and in the courtrooms. Something like 90 thousand people die from medical errors each year. (How does this contrast to those European/Canadian systems?) There are times where malpractice awards are warranted. There are times where it isn’t. The current system is broken, and keeping it this way is not desirable. But it isn’t just broken in the hospitals. It isn’t just broken in the legal offices. It’s not just broken in the emergency room or in the court room. It’s all over.
    I think more pressure needs to be applied to foreign countries to respect drug patents and to remove their price controls- I’m convinced that Americans are subsidizing foreign country drug use which is why (among other reasons) our drugs cost as much. As far as medical savings accounts, the current situation of that is that the amounts do not roll over… or at least the MSA that I could sign up for. If they did roll over, I’d sign up for it, which would compliment the insurance I currently get now. With the idea that healthy people can save and save this for when they get sick/older, MSAs would/should be a good thing.

    Does anyone here buy private insurance for themselves and/or their family? I’m curious what an average policy would cost.

    Not sure but premiums for most families are at least 400.
    Insurance is too expensive for people who don’t really have a need for it, but these people are needed by insurance companies to essentially “subsidize” the rest of us because we are not bearing the true costs of the medical care we are using.
    That $15 copay for liportol (sp) which runs, say $150… the HMO pays the $135 and “recoups” that cost from you in your premium. Unless you’re a medicare patient, in which case they recoup it from what Medicare gives them (because your premium is at most maybe 70 dollars unless you’re part of your employer’s retirement group). But odds are, if you’re taking liportol, you’ve seen the doctor this month. That’s a $15 copay for a visit that would normally cost, say 100. And I’m not talking about so called “fair market” or “member rate” values. I mean the actual cost per visit to have a doctor see a patient. Any sort of tests increases this cost significantly, and many insurance companies don’t require copays for Xrays, blood work, urine samples or biopsies. So that $120 doctor’s visit can reach $400 relatively easily. (1 xray, 5 blood samples… and this doesn’t include MRIs or CT or PET scans.)

    I don’t see that a national system would be that much worse than now…

    Most people, if I recall polls taken about this properly, are pleased with their medical coverage. I’d prefer a plan that offered more options to me, but I have no need to see “any doctor I want, anytime’ at this moment. If I become severely sick, that’d be a different story perhaps. The overall primary concerns I see is a need to reduce malpractice (costs and the actual acts themselves) and how to keep medical costs more affordable. I do not think what we have now is terrible.

    Is it worth eliminating a couple dozen insurance bureaucracies so that the eliminated overhead is funding coverage for the uninsured?

    It isn’t this simple. The cost of consolidating these 24 or so insurance companies into 1 will be extraordinarily expensive. Jobs will be lost, and you will see shutterings of hospitals because 1 area might not need that many clinics/hospitals while other areas will. And who makes these decisions? The people who bring all sorts of pork barrel “corporate welfare” to their states via the national parks/defense/etc. programs.

    Is it worth un-skewing the labor market–

    I’m in favor of this. But there are various ways of doing this. Nationalizing health care isn’t the only way to do this.

  36. Raj Avatar

    As a UK citizen I certainly think that the system here does not work.
    However, the french system of copayments & compulsory insurance seems to work well. i.e. no waiting lists ,but equally, less inequality of treatment than in the US.
    One thing that amazes me is that in the US there does not seem to be any productivity gains in healthcare.
    e.g. when my wife had our son, she rarely saw an obstretricion, most basic care was by a mid wife & only if the situation warranted it was the Obstretrician called.
    My understanding of the US is that she would have been always been seen by her doctor & even if she had a normal delivery the doctor would have been called. Surely this is more expensive & less productive without beeing any better for the patient?
    Can anyone comment on why the normal efficiencies of private industry are not present in US healthcare?

  37. Kim Avatar

    Raj – It’s the same here. The OB practice I went to had midwives also. You could request doctors only but I saw the midwives and doctors throughout 3 pregnancies.

  38. h0mi Avatar

    One thing that amazes me is that in the US there does not seem to be any productivity gains in healthcare.

    Hm I dunno. I remember in 94, I had a CT scan done at a VA hospital. The equipment was old enough that to do what was needed, I had to go twice for 2 different scans. (and I got very sick from the contrast)
    Subsequent CT scans that were done elsewhere used much newer equipment that was faster & I never had those problems again.