The best healthcare?

[glassgowkiss]

Really?

Overpriced, overmedicated- yes, the best- no. System needs to be fixed.

[KaskadskyjKozak]

GGK speaks:

 

[JayB]

I'm always suspicious of studies that use high-level abstractions and statistical aggregates to define "waste," particularly those that make broad retrospective claims about what tests were warranted for a particular individual, etc....but let's assume that these figures are accurate for the sake of argument:

 

* Unnecessary care such as the overuse of antibiotics and lab tests to protect against malpractice exposure makes up 37 percent of healthcare waste or $200 to $300 billion a year.

 

* Fraud makes up 22 percent of healthcare waste, or up to $200 billion a year in fraudulent Medicare claims, kickbacks for referrals for unnecessary services and other scams.

 

* Administrative inefficiency and redundant paperwork account for 18 percent of healthcare waste.

 

* Medical mistakes account for $50 billion to $100 billion in unnecessary spending each year, or 11 percent of the total.

 

* Preventable conditions such as uncontrolled diabetes cost $30 billion to $50 billion a year."

 

If these numbers are accurate, you'd think that people who are ostensibly concerned with making healthcare more accessible and keeping costs down would have spent twice as much time and energy on efforts to reform the medical malpractice system as they have parsing the administrative-efficiency stats.

 

 

[JayB]

Unfortunately, this is the kind of non-sequiter that typically accompanies these statistical analyses:

 

"All this could help explain why Americans spend more per capita and the highest percentage of GDP on healthcare than any other OECD country, yet has an unhealthier population with more diabetes, obesity and heart disease and higher rates of neonatal deaths than other developed nations."

 

Hospitals and doctors have zero control over how people conduct themselves when they're not physically in hospitals or clinics. The fact that we spend so much on medical care is one of the primary reasons that the mortality rates from diabetes, obesity, and heart disease aren't significantly higher. Good luck getting that gastric bypass before you eat yourself to death in other countries.

 

 

[pink]

the best kind is the kind OBAMA and his family will receive when it's all said and done..

[kevbone]

the best kind is the kind OBAMA and his family will receive when it's all said and done..

 

So true. Why cant the American people have the same health care coverage that congress has?

[Pete_H]

Obama isn't in Congress you moron.

[kevbone]

Obama isn't in Congress you moron.

 

 

So true. Why cant the American people have the same health care coverage that congress has?

 

Which part of this statement talks about Obama? Who is the moron now?

[Pete_H]

You actually are right. I am a moron for assuming you possess the intelligence to put two sentences together that bear any logical correlation to eachother.

[kevbone]

You actually are right. I am a moron

 

 

Spot on......

[G-spotter]

Those who remember the street parties of Election Night 2008 might think the testosterone levels of Obama voters had shot up in triumph. That would be wrong.

 

Instead, liberal testosterone levels stayed stable, while those of male Republican voters plummeted. The latter also reported feeling submissive and unhappy.

 

There are many ways to read these results, which are based on saliva samples taken from 183 men and women as the polls closed, and again when President Obama’s victory was officially announced.

 

First, male voters get the same vicarious boost from a candidate’s political victory as they would their favorite sports team beating a rival. That’s the main academic finding of the study, published Wednesday in Public Library of Science ONE, but one that seems rather self-evident.

 

election_testosteroneMuch more interesting is the split. Obama voter testosterone merely stabilized. The researchers suggest that, as nighttime testosterone levels typically dip, stabilization “is conceptually similar to a rise.”

 

But if testosterone usually just dips at night, it positively plummeted for Republican men.

 

Indeed, Republican men “felt significantly more controlled, submissive, unhappy and unpleasant at the moment of the outcome” than those who voted for Obama, the researchers wrote. “Moreover, since the dominance hierarchy shift following a presidential election is stable for four years, the stress of having one’s political party lose control of executive policy decisions could plausibly lead to continued testosterone suppression in males.”

 

Women of both political parties, it should be noted, experienced no significant testosterone changes on election night

[Phil K]

Indeed, Republican men “felt significantly more controlled, submissive, unhappy and unpleasant at the moment of the outcome” than those who voted for Obama, the researchers wrote. “Moreover, since the dominance hierarchy shift following a presidential election is stable for four years, the stress of having one’s political party lose control of executive policy decisions could plausibly lead to continued testosterone suppression in males.”

 

 

I suppose that explains why KKK's been so cranky lately.

[JayB]

Really?

Overpriced, overmedicated- yes, the best- no. System needs to be fixed.

 

Fix here:

 

http://www.theatlantic.com/doc/200909/health-care/1

 

Unfortunately, what we'll actually get is reform that merely adds more people to the current system, a development which will hasten it's demise and bring about single-payer, the costs of which will eventually result in a debt-burden and rationing mechanisms so severe that people might actually start to consider implementing this guy's ideas.

[pink]

Those who remember the street parties of Election Night 2008 might think the testosterone levels of Obama voters had shot up in triumph. That would be wrong.

 

Instead, liberal testosterone levels stayed stable, while those of male Republican voters plummeted. The latter also reported feeling submissive and unhappy.

 

There are many ways to read these results, which are based on saliva samples taken from 183 men and women as the polls closed, and again when President Obama’s victory was officially announced.

 

First, male voters get the same vicarious boost from a candidate’s political victory as they would their favorite sports team beating a rival. That’s the main academic finding of the study, published Wednesday in Public Library of Science ONE, but one that seems rather self-evident.

 

election_testosteroneMuch more interesting is the split. Obama voter testosterone merely stabilized. The researchers suggest that, as nighttime testosterone levels typically dip, stabilization “is conceptually similar to a rise.”

 

But if testosterone usually just dips at night, it positively plummeted for Republican men.

 

Indeed, Republican men “felt significantly more controlled, submissive, unhappy and unpleasant at the moment of the outcome” than those who voted for Obama, the researchers wrote. “Moreover, since the dominance hierarchy shift following a presidential election is stable for four years, the stress of having one’s political party lose control of executive policy decisions could plausibly lead to continued testosterone suppression in males.”

 

Women of both political parties, it should be noted, experienced no significant testosterone changes on election night

 

that's a load of canadian bacon.... i had two libtard employees show up at work the next day (after the election) and both said the same thing at separate times... "in your face andrew, obama won, we have the first black president" neither one of these guys could fight their way out of a wet paper bag and didn't even know they had testosterone pumping through their veins.

 

if we had all black presidents prior to obama i guess all white people would be running saying we have the first white president..

[mattp]

There’s definitely something to that article, Jay.

 

To be sure, healthcare reform as presently proposed is merely going to put more people into the existing system and fix little of its ills. To the extent that you believe health care should be a for-profit enterprise at all (something that is illegal in many civilized nations), we should find a way to link profit with outcomes, not with procedures. The article suggests that day-to-day expenses would be linked in this fashion if they were not covered by insurance but I think the same problem – that of providers profiting from procedures and not from outcomes – exists with respect major medical services.

 

Personally, I think the idea that the solution lies in having everybody make “market-based” decisions about their own care priorities and efficiencies is folly. I don’t think you, I or anybody else is really in any position to say to their doctor “no thanks. I don’t need that procedure.” Certainly not based on any rational analysis. And I don’t think competition, if it is based on simply being able to advertise wart removal or flu shots for less than the shop next door, is really the answer.

 

It’s nice to see something other than the argument “government isn’t the answer,” though. But wait: that is really the thesis, isn’t it?

 

[ivan]

this whole inane argument would be easy to resolve if we could just figure out which country's healthcare system is having the most fun

 

[JosephH]

* Administrative inefficiency and redundant paperwork account for 18 percent of healthcare waste.

Keep in mind that includes inefficiencies and redundancies in each of the thousands of insurance companies which are themselves incredibly redundant in every respect, but especially so in claims processing. I'm guessing administrative and systems redundancies actually run more like 75-85% over a single payer clearing house.

[glassgowkiss]

 

I suppose that explains why KKK's been so cranky lately.

 

no, in his case it's called pms, as his pussy is bleeding for republifuck president

[JayB]

There’s definitely something to that article, Jay.

 

To be sure, healthcare reform as presently proposed is merely going to put more people into the existing system and fix little of its ills. To the extent that you believe health care should be a for-profit enterprise at all (something that is illegal in many civilized nations), we should find a way to link profit with outcomes, not with procedures. The article suggests that day-to-day expenses would be linked in this fashion if they were not covered by insurance but I think the same problem – that of providers profiting from procedures and not from outcomes – exists with respect major medical services.

 

Personally, I think the idea that the solution lies in having everybody make “market-based” decisions about their own care priorities and efficiencies is folly. I don’t think you, I or anybody else is really in any position to say to their doctor “no thanks. I don’t need that procedure.” Certainly not based on any rational analysis. And I don’t think competition, if it is based on simply being able to advertise wart removal or flu shots for less than the shop next door, is really the answer.

 

It’s nice to see something other than the argument “government isn’t the answer,” though. But wait: that is really the thesis, isn’t it?

I have to wonder if you read the article to the end, or very closely, since the author did actually propose a single payer plan underwritten by the government as part of his solution. He also discusses a mechanism for dealing with cases where the stakes are high, the potential costs are higher, and the best choice is far from clear. People general retain an attorney to represent them in complex legal matters that satisfy these criteria, and the author arrives at the reasonable conclusion that people would probably retain someone with the expertise necessary to help them make the right choices and coordinate their care in especially daunting medical situations.

 

Anyhow -I don't imagine it will surprise you if I respond by saying that consumers already have to contend with a daunting array of information assymetries in that permeate pretty much every exchange that they participate in - yet somehow we manage. I don't know that kind of margin that Safeway is making on a particular head of lettuce, I know next to nothing about auto repairs, most people have no frame of reference with which to evaluate the RMI guide that they're counting on to lead them up and down Rainier safely, and if I need legal representation I'm even further out at sea.

 

Do my injectors really need cleaning? Is a $5,000 fee really necessary, standard, or fair for divorce cases? Does my heli-skiing guide really understand the snowpack? Etc, etc, etc, etc, etc, etc.

 

When you need to retain the services of an expert in an area that's far outside your expertise - are you really helpless or are there mechanisms and resources that you have recourse to? How are costs and outcomes linked everywhere else in the economy?

 

As someone who gets more or less daily reports about what transpires in emergency rooms, and as someone who doesn't carry comprehensive insurance - I can tell you that people who are spending their own money on medical care can and do engage in a dialogue with physicians about costs, benefits, and risks associated with a particular course of action.

 

To take but one example, people that come in to the ER with minor facial lacerations and insist that a plastic surgeon be called in to close the wound will often reconsider when the costs and benefits of doing so are explained to them - if they're bearing a meaningful portion of the cost. There's lots of reasons why it might make sense for someone to pay quite a bit more to avoid a facial scar, and lots of reasons why any number of other things might seem like a better use of the money. Once they start paying with other people's money - the cost/benefit calculus changes dramatically.

 

Amplify that by a factor of a few billion interactions and you start to get a sense of the scale at which third-party payment mechanisms currently distort total spending on medical care.

 

In the end - it's going to have to be insurance companies, government bureaucracies, or individuals that evaluate the costs and benefits and weigh all of the infinite number of subjective and contextual tradeoffs that drive medical spending. I don't think a HSA driven system will be perfect, but it certainly sounds more appealing than the alternative.

 

I suspect that we'll wind up with that kind of system eventually, but only after insolvency and third-party rationing drive us to it.

 

 

[JayB]

* Administrative inefficiency and redundant paperwork account for 18 percent of healthcare waste.

Keep in mind that includes inefficiencies and redundancies in each of the thousands of insurance companies which are themselves incredibly redundant in every respect, but especially so in claims processing. I'm guessing administrative and systems redundancies actually run more like 75-85% over a single payer clearing house.

 

Sounds to me like that's all included in the 18% figure, but if you have the time, consult the original study and let me know.

 

It would definitely be helpful to know precisely how they define and quantify inefficiencies.

[JayB]

BTW - where exactly is it illegal to turn a profit selling medical services (is this even true in practice in Canada any more since that court ruling a couple of years ago?)?

 

Also - does changing "market based" to "according to their own particular values subjective assessments of costs and benefits" change things at all for you?

 

I also have to wonder how folks who want to make it illegal for people to get their medical treatment from someone who may or may not make money on the deal reconcile that with (apparently sincere) concerns for preserving individual liberties elsewhere.

 

Having a hard time understanding the folks who feel a deep resonance with "Keep the Government Out of My Uterus" signs while simultaneously idealizing a system that grants the state a kind of veto-power over medical choices involving everything from your urethra to your amygdala.

[mattp]

As someone who gets more or less daily reports about what transpires in emergency rooms, and as someone who doesn't carry comprehensive insurance - I can tell you that people who are spending their own money on medical care can and do engage in a dialogue with physicians about costs, benefits, and risks associated with a particular course of action.

 

I participate in medicaid hearings on a regular basis. Today I had a hearing concerning the costs, benefits, and risks associated with a particular course of action. I have also been making my own healthcare decisions for decades and am familiar with the decisions made by friends and families over the years. I have also had a lot of experience with private paid services and private paid insurance coverage. I don't know if you are an expert or not, but I must certainly have had a different set of experiences than you.

[prole]

Those who remember the street parties of Election Night 2008 might think the testosterone levels of Obama voters had shot up in triumph. That would be wrong.

 

Instead, liberal testosterone levels stayed stable, while those of male Republican voters plummeted. The latter also reported feeling submissive and unhappy.

 

There are many ways to read these results, which are based on saliva samples taken from 183 men and women as the polls closed, and again when President Obama’s victory was officially announced.

 

First, male voters get the same vicarious boost from a candidate’s political victory as they would their favorite sports team beating a rival. That’s the main academic finding of the study, published Wednesday in Public Library of Science ONE, but one that seems rather self-evident.

 

election_testosteroneMuch more interesting is the split. Obama voter testosterone merely stabilized. The researchers suggest that, as nighttime testosterone levels typically dip, stabilization “is conceptually similar to a rise.”

 

But if testosterone usually just dips at night, it positively plummeted for Republican men.

 

Indeed, Republican men “felt significantly more controlled, submissive, unhappy and unpleasant at the moment of the outcome” than those who voted for Obama, the researchers wrote. “Moreover, since the dominance hierarchy shift following a presidential election is stable for four years, the stress of having one’s political party lose control of executive policy decisions could plausibly lead to continued testosterone suppression in males.”

 

Women of both political parties, it should be noted, experienced no significant testosterone changes on election night

 

"That's 'cause Obama's cutting off the NATIONAL BALLS!!!"

--Rush Limbaugh

[tvashtarkatena]

BTW - where exactly is it illegal to turn a profit selling medical services (is this even true in practice in Canada any more since that court ruling a couple of years ago?)?

 

Also - does changing "market based" to "according to their own particular values subjective assessments of costs and benefits" change things at all for you?

 

I also have to wonder how folks who want to make it illegal for people to get their medical treatment from someone who may or may not make money on the deal reconcile that with (apparently sincere) concerns for preserving individual liberties elsewhere.

 

Having a hard time understanding the folks who feel a deep resonance with "Keep the Government Out of My Uterus" signs while simultaneously idealizing a system that grants the state a kind of veto-power over medical choices involving everything from your urethra to your amygdala.

 

You're simply not in touch with reality.

 

 

[tvashtarkatena]

* Administrative inefficiency and redundant paperwork account for 18 percent of healthcare waste.

Keep in mind that includes inefficiencies and redundancies in each of the thousands of insurance companies which are themselves incredibly redundant in every respect, but especially so in claims processing. I'm guessing administrative and systems redundancies actually run more like 75-85% over a single payer clearing house.

 

And you would be wrong. the inefficiencies you speak of actually run, on average, about 350% higher in the U.S. verses all other industrialized countries who offer some form of public option: about 5% versus our 18%.

 

Look, the 'debate' is over. The experiment's been done since WWII in all industrialized countries including our own. Our employer based private health care system sucks ass: it's a joke to the rest of the civilized world, it's near the bottom overall regarding outcomes and stats (despite JayB's endless stream of 'my wife's fresh out of med school so I'm an expert complete and utter bullshit' and it's incredibly cruel. Witnessing what is happening to a large number of friends makes me an expert on that one.

 

We need a strong, not for profit, public option. The exact form doesn't matter than much: they all work fine elsewhere and herere where they are used.