[kenberg]

c_corgi, on 2013-November-17, 07:23, said:

"If I were to implement an efficient and fit-for-purpose healthcare system, I wouldn't wish to start from where the US is now". But Obama doesn't have much choice where to start from.

I am in complete agreement with this.

c_corgi, on 2013-November-17, 07:23, said:

Perhaps this question should be rephrased: at the moment it seems to imply that the ethnicity of a president's support can compromise the validity of his mandate.

All of these polling numbers, breaking us all into demographic groups that we may or may not wish to identify with, is a really bad feature of modern life. Kathryn Hepburn had many good lines during her career. One was in the 1948 movie State of the Union. Spencer Tracy is running for president and a campaign stgrategist is speaking of the Polish-American vote. Hepburn, as Tracy's wife, sweetly asks "Oh. Can you be both?". So the problem has always been with us, but like many things we are getting to good at this dicing and slicing, and it is to our disadvantage.

[Trinidad]

FM75, on 2013-November-17, 00:40, said:

A few Europeans and Euro wannabes have chimed in how much better their system is.

I realize that the internet is not all about me, but when it comes to my posts this is simply not true (which is why I feel that I can speak relatively objectively about this topic).

I am a citizen of the Netherlands, I was born there and I currently live there which makes me Dutch. I thought I had made it clear that the current Dutch (market based) system is significantly worse than the Scandinavian government run systems that I know.

My posts were not of the type "My system is much better". I wrote: Scandinavian government based > Dutch free market with mandatory minimum insurance (my system) > US health care system.

When you have lived in a few different countries, you will see that certain things are best in one country and others are best in other countries. Obviously, when things are worse than you know they could be, your thoughts go to the country where that particular thing was best.

Don't worry, the USA are at the top of my list in quite a few things, but health care simply isn't one of them... And you can repeat that sentence and replace "USA" by "the Netherlands".

So, my posts are not based on misplaced nationalism, but on first hand experience with different systems that shows that neither the US' nor my own system is best.

Rik

[Cthulhu D]

It's not even how much better anyone else's is, it's that the US has a healthcare system that is just amazingly bad. It has everyone elses problems AND a whole bunch more! If you want to see why everyone's healthcare systems are apocalytipically awful, check out what percentage of recommended care is delivered to AIDs patients (it typically ranges between 40 and 60% of what the WHO guidelines are), and the prescription error rates - studies in Europe indicate that somewhere over 40% (ranging to as high as 80% for non pediatrics specialists doing pediatric care) of all prescriptions are either contraindicated or proscribed in incorrect doses for the patient and symptoms presented.

The Australian system kills about a 747 load of people a year through prescription errors alone - but that's not an exceptionally high rate, it's slightly better than average. The reason why the US system is awful is this

A) It's doesn't do any better than anyone else
B) costs two to three times what other people pay
C) doesn't cover a huge chunk of your population.

Thats why everyone sits around an laughs at the US in this regard - it's the tri-defecta (sic) of problems. But make no mistake - everyone's healthcare system is screwed up because doctors are unable to do their jobs effectively any more (which is why I laugh when people say they want to choose their doctors, how the hell do you know when they are making mistakes? These guys all make like 10+ errors a day and they don't notice and they are doctors with medical training!)

[Trinidad]

Cthulhu D, on 2013-November-17, 09:07, said:

These guys all make like 10+ errors a day and they don't notice and they are doctors with medical training!

I don't know about you, but I certainly make 10+ errors a day (despite my fantastic training ) and my job is easier than that of a doctor.

Rik

[Winstonm]

The misguided belief most difficult to overcome is American exceptionalism.

[kenberg]

I grew up here in the USA, and I don't much understand the health system. I always like personal experience, here is a recent event.

Looked through my mail, I find loads of stuff wanting me to buy something, Also a big package from Maryland about Medicare Part D. Part of the contents is a booklet, 87 pages plus appendices, that says Express Scripts Medicare (PDP). Further down I see what I guess is a sub-title: Evidence of Coverage. You might think I would say "Great, new benefits". My actual reaction was "Good grief do I have to read this crap?". I have no idea what, if anything, I am supposed to do. My wife has more patience with such things than I do, but she is still in the hospital with physical therapy after having both knees replaced last Monday (she has been described there as the superstar of recovery) so maybe I shouold try to carry some of the paperwork load.

Driving home drom the hospital yesterday I was listening to NPR. Some psychologist was talking about a book he wrote on the paradox of choice. His example was that you go into the grocery store to buy salad dressing and find that there are 175 options. I have expressed my strong preference for choice, and I am not backing down on that. But sometimes, when something is working just fine, I am not delighted to get a heavy package in the mail offering me more choices.

OK, you have to get along without me for a while, I am on my way to see Becky.

[phikappaph]

The reality is that in spite of what was said by the Administration early on about the Health care provisions, contrary to what was said in public, the Act was defended in the Supreme Court as a tax, something denied by the supporters. Second, medical expenses in the U.S. skyrocketed when third party payers began to enter the scene, something that started a generation ago. Up to 1/3 of federal payments for health services is estimated to be fraud. Everyone has seen the ads for motorized wheelchairs, "free" ( i.e., paid for by Social Security).

What is happening is the biggest money grab in the history of the Country is about to start. Anyone who thinks it's a Democrat or Republican issue underestimates greed. Florida recently had a huge scandal as hundreds of medical patients were found to simply be names known to the crooks who received fictitious services and routine bills submitted for payment to the feds. Millions of dollars were brought in and the only way it was discovered is when one of the "named" people received a letter from the government mentioning a test she never had. She took the time to call and say it wasn't her. Federal programs are totally out of control. -- Think about the "free" phones program for needy families that was supposed to supply communication for that group that could not afford home phones, -- now costs over 2 billion a year. Food stamps cost $80 billion, Medicaid cost $549 billion, and so on.

Government programs in countries the size of California may work. But the U.S. simply can not have a national program whose biggest expenses are something other than the benefit of the program itself. My favorite example: The Department of Energy was brought into existence by President Carter in 1977 for the stated purpose of reducing dependence on foreign energy. $200 billion dollars later an agency with almost 20,000 people was able to help the U.S. go from 20% reliance on imported oil to over 50% by 2006, a figure that has come down thanks solely to private industry creation of new technology, something the energy department opposes!

Long rant, but the point is why does anyone think the federal government will not totally screw this up the way they screwed up every other federally funded program they have initiated? The costs will bury this program, or us, or both, in five years.

[Trinidad]

phikappaph, on 2013-November-17, 10:13, said:

Florida recently had a huge scandal as hundreds of medical patients were found to simply be names known to the crooks who received fictitious services and routine bills submitted for payment to the feds.

It is hard to commit such fraud when the doctors are on government salaries and there are no bills.

Rik

[mike777]

Trinidad, on 2013-November-17, 11:47, said:

It is hard to commit such fraud when the doctors are on government salaries and there are no bills.

Rik

Actually it is quite easy to give kickbacks, bribes and many other perks to govt doctors, nurses, aides, staff, tech people, etc on a salary. There are going to be bills to many people involved in health care. Again health care is much much more than the doctor.

Keep in mind the big crimes will be in the millions and millions, not the little stuff. I expect docs will play a somewhat small role in the big crimes, docs will be a small part if the govt owns the entire health care system. Big stuff can be union pension plans of the union employees, equipment sellers, garbage collection, buildings/construction, and cleaning the offices...etc...all part of the health care system.

Ya I throw in garbage collection as that could be a big possible bill the govt pays over 50 states

[mike777]

phikappaph, on 2013-November-17, 10:13, said:

The reality is that in spite of what was said by the Administration early on about the Health care provisions, contrary to what was said in public, the Act was defended in the Supreme Court as a tax, something denied by the supporters. Second, medical expenses in the U.S. skyrocketed when third party payers began to enter the scene, something that started a generation ago. Up to 1/3 of federal payments for health services is estimated to be fraud. Everyone has seen the ads for motorized wheelchairs, "free" ( i.e., paid for by Social Security).

What is happening is the biggest money grab in the history of the Country is about to start. Anyone who thinks it's a Democrat or Republican issue underestimates greed. Florida recently had a huge scandal as hundreds of medical patients were found to simply be names known to the crooks who received fictitious services and routine bills submitted for payment to the feds. Millions of dollars were brought in and the only way it was discovered is when one of the "named" people received a letter from the government mentioning a test she never had. She took the time to call and say it wasn't her. Federal programs are totally out of control. -- Think about the "free" phones program for needy families that was supposed to supply communication for that group that could not afford home phones, -- now costs over 2 billion a year. Food stamps cost $80 billion, Medicaid cost $549 billion, and so on.

Government programs in countries the size of California may work. But the U.S. simply can not have a national program whose biggest expenses are something other than the benefit of the program itself. My favorite example: The Department of Energy was brought into existence by President Carter in 1977 for the stated purpose of reducing dependence on foreign energy. $200 billion dollars later an agency with almost 20,000 people was able to help the U.S. go from 20% reliance on imported oil to over 50% by 2006, a figure that has come down thanks solely to private industry creation of new technology, something the energy department opposes!

Long rant, but the point is why does anyone think the federal government will not totally screw this up the way they screwed up every other federally funded program they have initiated? The costs will bury this program, or us, or both, in five years.

You may have missed some of the pro health care posts. The point they make is the federal govt does a better job, it is more efficient, not less.

[mike777]

Trinidad, on 2013-November-17, 09:01, said:

I realize that the internet is not all about me, but when it comes to my posts this is simply not true (which is why I feel that I can speak relatively objectively about this topic).

I am a citizen of the Netherlands, I was born there and I currently live there which makes me Dutch. I thought I had made it clear that the current Dutch (market based) system is significantly worse than the Scandinavian government run systems that I know.

My posts were not of the type "My system is much better". I wrote: Scandinavian government based > Dutch free market with mandatory minimum insurance (my system) > US health care system.

When you have lived in a few different countries, you will see that certain things are best in one country and others are best in other countries. Obviously, when things are worse than you know they could be, your thoughts go to the country where that particular thing was best.

Don't worry, the USA are at the top of my list in quite a few things, but health care simply isn't one of them... And you can repeat that sentence and replace "USA" by "the Netherlands".

So, my posts are not based on misplaced nationalism, but on first hand experience with different systems that shows that neither the US' nor my own system is best.

Rik

Rik, thanks for your post, it would be helpful to describe how these systems work. For example the govts UK and Canada don't have just a single payer system, there are large parts of the system they don't own. As far as I can tell there are vast parts of the health care system in Sweden not owned by the govt. Docs are just a small part of the system

You mention Sweden and others are govt based but you don't really say what they own or don't own and who makes the economic decisions. Who decides where capital is allocated and how and based on what?

For example in the USA these decisions are made by millions and millions of people in the market, not one person.

[phikappaph]

mike777, on 2013-November-17, 12:59, said:

You may have missed some of the pro health care posts. The point they make is the federal govt does a better job, it is more efficient, not less.

You do well to sum up my point which is simply that the U.S. federal govt has never been more efficient at undertaking such tasks. It has been a disaster in every respect. Comparing a country like the Netherlands which is entirely different in culture and economic structure to support the idea that the U.S. could make use of a similar system is unrealistic. The inefficiencies you refer to, which I assume are demonstrated by the costs of U.S. health care, are a problem and a serious one. However, those problems arose when 3rd party payors began to be the norm here. I am amazed that people do not understand the current costs of Medicare and Medicaid, both federal programs, and both completely out of control. The problem is that federal programs are essentially immune from anything but bloated growth and inefficiency that dwarfs any other structure. Costs overruns at the Department of Defense, a multibillion expense for the Presidency, etc. Reform can fix the private sector abuses. Nothing will fix the federal problems existing and those which will dwarf what we are now seeing.

[Trinidad]

mike777, on 2013-November-17, 13:03, said:

Rik, thanks for your post, it would be helpful to describe how these systems work. For example the govts UK and Canada don't have just a single payer system, there are large parts of the system they don't own. As far as I can tell there are vast parts of the health care system in Sweden not owned by the govt. Docs are just a small part of the system

You mention Sweden and others are govt based but you don't really say what they own or don't own and who makes the economic decisions. Who decides where capital is allocated and how and based on what?

For example in the USA these decisions are made by millions and millions of people in the market, not one person.

You are right that not everything in Sweden (or Finland) is owned by the (or even a) government. There are private practices and though it is not a large fraction, there are enough of them to not call them an exception. (As a matter of fact, the doctor's office that I had in Sweden was a joint private practice run by -what seemed to me- college friends.)

To the best of my knowledge (but I could easily be wrong, any Swedes out there to correct me?) doctor's offices get funded based on the amount of registered patients. I could imagine that there are correction factors for things such as above average age patients or patients with a difficult social background or other groups that statistically need to see their doctor more often. (I know for a fact that in the Netherlands funding for schools is allocated like that. I think they have something similar in Swedish schools too, and then it seems reasonable that they have it in health care.)

The situation in the USA is very different from the Swedish situation. In Sweden "the government" knows literally everything about you, among others: your doctor, your pensions, the amount of money in your bank accounts, your employer, your salary, your employment history, how much rent you pay or what you have paid for your house, the amount and interest rate on your mortgage, and many other things (I could imagine that they knew what bridge clubs I was a member of). They get this information from you, but also from the other party (your employer, your bank, your doctor, your bridge club, etc.) All government databases are linked to each other and information is continuously shared between government agencies.

So when I am registered as a patient of Dr. Smith and Dr. Jones says that I am his patient, alarm bells will be ringing.

I realize that in many countries an all-knowing-government would be terrifying (it was to me when I moved there), and I don't think it will have a chance in the USA, but once I was settled, I found out it really worked well.

Rik

P.S. Just one of the nice side effects of these linked databases: I basically never needed to do my taxes. The IRS equivalent always sent me a completely filled out tax form. After each number they have a line where you can correct their number if you don't agree with the value that they report. I only needed to fill in my travel expenses, sign and return. (I guess you can do it over the internet now.) I always had my taxes and my wife's done in 5 minutes.

[mike777]

Rik, again docs and nurses are just a small part of the system, who owns all the other huge parts. For example, the offices, computers, tech, xy and mri machines. Who owns the medical equip and medical supply companies, who owns the drug companies..etc etc.

---


Wow are you joking about all the private info the govt knows in Sweden?

[blackshoe]

Different strokes, I guess. For me, well, "Quis custodiet ispos custodes?" The answer to that, btw, here and now, in the United States, seems to be "no one".

[kenberg]

Help a guy out here. I realized with a shock that I know absolutely nothing about the interaction of Medicaid with the ACA. Suppose that I am a woman woth kids, no husband, and a crappy job. I get Medicaid, don't I? How will the ACA interact with this? I have absolutely no idea. I assume that some of you do.

I am not looking for explanations that a single payer system would obviate the need for Medicaid. I am asking a simpler question. How do Medicaid and the ACA interact, or how will they interact in 2014?

[PassedOut]

kenberg, on 2013-November-17, 18:42, said:

Help a guy out here. I realized with a shock that I know absolutely nothing about the interaction of Medicaid with the ACA. Suppose that I am a woman woth kids, no husband, and a crappy job. I get Medicaid, don't I? How will the ACA interact with this? I have absolutely no idea. I assume that some of you do.

I am not looking for explanations that a single payer system would obviate the need for Medicaid. I am asking a simpler question. How do Medicaid and the ACA interact, or how will they interact in 2014?

The short answer is that Medicaid is expanded under the ACA with the federal government funding the expansion fully for the first three years. Some states have opted to refuse the expansion because of the increased expenditures after three years and to encourage poor people to move to other states. The ability of the states to do that was permitted by the Supreme Court decision that affirmed the rest of the ACA.

[kenberg]

Would the above poor woman still need to sign up through the website for insurance, or is it that if you are on Medicaid then you are deemed to have adequate insurance and so you don't need to sign up? Let's say she lives in a state that has accepted the new expanded Medicaid plan

[HighLow21]

kenberg, on 2013-November-17, 19:04, said:

Would the above poor woman still need to sign up through the website for insurance, or is it that if you are on Medicaid then you are deemed to have adequate insurance and so you don't need to sign up? Let's say she lives in a state that has accepted the new expanded Medicaid plan

Then she has Medicaid and she's good to go. If she's in one of the states that rejected the expansion, she's still uninsured and ineligible for subsidies.

The real rationale for rejecting this expansion was to make Obamacare fail, truth be told. This is a prime example of Republicans sabotaging government so they can continue to run on the platform of "government is bad" and be re-elected. I've never known anywhere else that someone can interview for a job with the attitude of "this job is lousy, so hire me!" and get hired with such alacrity.

[mike777]

[" and be re-elected. I've never known anywhere else that someone can interview for a job with the attitude of "this job is lousy, so hire me!" and get hired with such alacrity.
[/quote]


You must be rich...many do this


I have done this


Many don't own a car or mobile phone.....posters don't seem to get this.

guys start from the point we don't own a car or even a cell phone......you are rich.

ACA helps us...you pay for it ....you need to pay more.

I predicted in other posts aca will help millions of us.

If you are rich enough to own a car or cellphone you pay for us.