Why your healthcare insurance keeps going up
Moderator: Available
I don't know the details, but I remember it sounded sketchy. There are some tricks, eg I had a patient here who moved to florida because the wait list is shorter there. And yes, you can just move and pop up on their wait list. Dumb, right? We also see out of pocket guests from the middle east here for transplant eval and listing, something I saw done in Boston and San Diego.
Those issues shouldn't prevent us from facing the main issue: we must ration, we do ration, so how will we ration? Spending for the most bang for the buck? Or pouring any money at a problem because it is sad, or when it is hard to say no?
Those issues shouldn't prevent us from facing the main issue: we must ration, we do ration, so how will we ration? Spending for the most bang for the buck? Or pouring any money at a problem because it is sad, or when it is hard to say no?
--Ian
Well, what I had in mind was my decision tree, the one that would approximate my own decision making process if I were a) in my right mind and b) able to think and speak for myself. HOWEVER, I don't think my wishes should be the only factor. I think inevitably there will be, implicitly or explicitly, a process that decides when to invest the public treasure in super-expensive treatments. We are living in an age where the cost of a treatment can be effectively unbounded. The math doesn't work then. If I know how that decision process works ahead of time, and if I don't like it, I should be able to purchase private insurance to cover such catastrophic circumstances. It might even be fairly reasonable in cost if enough people would want it, as most people would probably not be in position ever to use it.Panther wrote: Well maybe he didn't and then again maybe he did. My problem is in your statement that we shouldn't offer it if he did. That's the only thing I disagree with Mike about... the thought of Ian(or anyone) standing over me or anyone else (especially someone I love that has made their feelings known to me) with an actuarial clipboard deciding whether treatment should be provided isn't funny at all... it's sad, maddening and downright scary!
Mike
I think we're on the same page in most of this, especially in our own personal decision trees, wishes and "how it'll work"...mhosea wrote:Well, what I had in mind was my decision tree, the one that would approximate my own decision making process if I were a) in my right mind and b) able to think and speak for myself. HOWEVER, I don't think my wishes should be the only factor. I think inevitably there will be, implicitly or explicitly, a process that decides when to invest the public treasure in super-expensive treatments. We are living in an age where the cost of a treatment can be effectively unbounded. The math doesn't work then. If I know how that decision process works ahead of time, and if I don't like it, I should be able to purchase private insurance to cover such catastrophic circumstances. It might even be fairly reasonable in cost if enough people would want it, as most people would probably not be in position ever to use it.
Not so sure that any private insurance will be available much longer at all, so there probably won't be any option to purchase special coverage for catastrophic circumstances... unless of course the federales think they can raid that fund and go ahead and let you die anyway.
Cynical? ... yeah, just a little...
So we need to ration and we already ration (things like transplants at least)...IJ wrote:I don't know the details, but I remember it sounded sketchy. There are some tricks, eg I had a patient here who moved to florida because the wait list is shorter there. And yes, you can just move and pop up on their wait list. Dumb, right? We also see out of pocket guests from the middle east here for transplant eval and listing, something I saw done in Boston and San Diego.
Those issues shouldn't prevent us from facing the main issue: we must ration, we do ration, so how will we ration? Spending for the most bang for the buck? Or pouring any money at a problem because it is sad, or when it is hard to say no?
It appears that, for the most part, HOW we ration has already been decided. If you're part of the wealthy and/or power elite, you just buy what you need regardless of age and/or condition, while those who aren't wealthy and/or well-connected simply "takes your chances" with the worst cases put at the top of the (secondary, since enough money can obviously get you on the extra-special one) list regardless of what's best overall.
idunno how I feel about all that actually... it's not a simple this or that decision.
I do have a question from a medical perspective tho...
If an organ, say a liver or kidney, has been donated and then the person who gets it passes away (within a certain time), why can't it be re-donated? What prevents good donated organs from being reused (as it were) if the recipient doesn't last too long? I know this is a really bad analogy, but it's the easiest one I can think of right now... If I have a car that dies and I have another car that needs a part from the first car that is compatible, then I just swap it over... (Say the same make, but different model cars with the same... say "alternator"...)
Just wondering...
"If you're part of the wealthy and/or power elite, you just buy what you need regardless of age and/or condition, while those who aren't wealthy and/or well-connected simply "takes your chances" with the worst cases put at the top of the (secondary, since enough money can obviously get you on the extra-special one) list regardless of what's best overall."
We can't very well tell people they CAN'T buy services freely, can we? If executives want care they don't need, like executive physicals with scans, they have the right to make that mistake (professional societies have an obligation to encourage doctors not to offer junk like this, however).
Otherwise, the USA is great at providing insane rescue care, and I wouldn't take the scarce-organ case to represent how the rest of it works. That's a very, very niche aspect of the whole pie. Think about renal failure. If you're a citizen, and you get end stage renal failure, you're insured. Boom. Medi-care. Sweet! Now you can get expensive dialysis treatments 3x a week, and that applies if you're 110 and have metastatic cancer, even though we should not be offering such patients dialysis on the public dime. It's not cost effective enough. If you just have terrible heart disease, though, nah, no such guarantee. Nor have we any interest in keeping you from getting your end stage renal failure. We'll let your diabetes, high blood pressure, high cholesterol, whatever rot you until you have a major heart attack, rotting foot, or other crisis, and then we've got you covered 100% in the hospital, doing PET scans and costly whatever, even if you're on death row, or if you're a drug dealer on the lam from another country. Go figure. That's why I had a patient get chemotherapy and surgery for a cancer, followed by a bone marrow transplant (this care easily costing a million bucks) as an uninsured illegal immigrant, then being saved from life threatening complications with top notch medicine, spending weeks in the hospital, and then the family refusing to take him home because they didn't have enough people to supervise (although 6 would visit every day, and someone was free 100% of the time but across the border, so if he went there he'd never be able to return for free followup), and the family became extremely irate the hospital didn't want to just board him indefinitely for free, expressing severe displeasure and anger when he was sent, gratis, to a nursing home (as was totally appropriate), because they didn't like every aspect of the place.
Huh--we've lost track of reality, people. Not sustainable.
That isn't the best way to use those community resources. We know it. We just find it easier to say NO to someone who we could really help, but isn't in crisis, as we don't HAVE to help them then. LATER, when crisis ensues, then we'll cover everything, less effectively, at great cost.
Anyhoo, your question about redonating an organ that's been transplanted--yeah, it could be redonated, but probably won't. First, only a tiny tiny fraction of deaths result in donations of major organs because the donor has to be brain dead but organs living, which is very rare. The odds such a death will be a transplantee is very low. Second, surgical changes may have made the organ less usable--it may not have enough vessels attached for reuse, or gotten scarred in, whatever. Third, these transplant recipients are immunosuppressed so many of their deaths entail active infection preventing transplant. Fourth, some of the transplants are done FOR infections, eg, hepatitis C, meaning the new liver recipient would infect anyone who got any parts because they still have the hep C. Fifth, these people are commonly ill, eg, transplant meds often cause kidney failure rendering the kidneys less useful. That's off the top of my head, but there's no reason I know of why the reused, or native organs, or a transplant recipient are completely off the table if they are in good health and they end up brain dead.
Incidentally, some people would want to keep brain dead people alive for years on your dime, instead of dividing the organs to needy people. That one we DON'T have to follow, because they don't usually live long and because they're LEGALLY DEAD so we can turn off their ventilator no matter what family thinks. But would you permit THAT, if we had a cardiac death statute? Permitting a (brain) dead body to stay on lifesupport for 100,000 bucks? If yes, do you plan to donate the funds yourself? Take them from a more efficient program that needs them? Or borrow the money from China and let your kids inherit the debt?
We can't very well tell people they CAN'T buy services freely, can we? If executives want care they don't need, like executive physicals with scans, they have the right to make that mistake (professional societies have an obligation to encourage doctors not to offer junk like this, however).
Otherwise, the USA is great at providing insane rescue care, and I wouldn't take the scarce-organ case to represent how the rest of it works. That's a very, very niche aspect of the whole pie. Think about renal failure. If you're a citizen, and you get end stage renal failure, you're insured. Boom. Medi-care. Sweet! Now you can get expensive dialysis treatments 3x a week, and that applies if you're 110 and have metastatic cancer, even though we should not be offering such patients dialysis on the public dime. It's not cost effective enough. If you just have terrible heart disease, though, nah, no such guarantee. Nor have we any interest in keeping you from getting your end stage renal failure. We'll let your diabetes, high blood pressure, high cholesterol, whatever rot you until you have a major heart attack, rotting foot, or other crisis, and then we've got you covered 100% in the hospital, doing PET scans and costly whatever, even if you're on death row, or if you're a drug dealer on the lam from another country. Go figure. That's why I had a patient get chemotherapy and surgery for a cancer, followed by a bone marrow transplant (this care easily costing a million bucks) as an uninsured illegal immigrant, then being saved from life threatening complications with top notch medicine, spending weeks in the hospital, and then the family refusing to take him home because they didn't have enough people to supervise (although 6 would visit every day, and someone was free 100% of the time but across the border, so if he went there he'd never be able to return for free followup), and the family became extremely irate the hospital didn't want to just board him indefinitely for free, expressing severe displeasure and anger when he was sent, gratis, to a nursing home (as was totally appropriate), because they didn't like every aspect of the place.
Huh--we've lost track of reality, people. Not sustainable.
That isn't the best way to use those community resources. We know it. We just find it easier to say NO to someone who we could really help, but isn't in crisis, as we don't HAVE to help them then. LATER, when crisis ensues, then we'll cover everything, less effectively, at great cost.
Anyhoo, your question about redonating an organ that's been transplanted--yeah, it could be redonated, but probably won't. First, only a tiny tiny fraction of deaths result in donations of major organs because the donor has to be brain dead but organs living, which is very rare. The odds such a death will be a transplantee is very low. Second, surgical changes may have made the organ less usable--it may not have enough vessels attached for reuse, or gotten scarred in, whatever. Third, these transplant recipients are immunosuppressed so many of their deaths entail active infection preventing transplant. Fourth, some of the transplants are done FOR infections, eg, hepatitis C, meaning the new liver recipient would infect anyone who got any parts because they still have the hep C. Fifth, these people are commonly ill, eg, transplant meds often cause kidney failure rendering the kidneys less useful. That's off the top of my head, but there's no reason I know of why the reused, or native organs, or a transplant recipient are completely off the table if they are in good health and they end up brain dead.
Incidentally, some people would want to keep brain dead people alive for years on your dime, instead of dividing the organs to needy people. That one we DON'T have to follow, because they don't usually live long and because they're LEGALLY DEAD so we can turn off their ventilator no matter what family thinks. But would you permit THAT, if we had a cardiac death statute? Permitting a (brain) dead body to stay on lifesupport for 100,000 bucks? If yes, do you plan to donate the funds yourself? Take them from a more efficient program that needs them? Or borrow the money from China and let your kids inherit the debt?
--Ian
It seems that the long response I wrote somehow got lost... I'm not going to take the time to even attempt to recreate it, but I did want you to know that I wasn't and am not ignoring you...
Observation: "Modern" medicine seems to just now be starting to focus in bits and pieces here and there on true prevention. Annual screenings and physicals are NOT prevention. Helping people to accomplish life-style changes, exercise more, eat better, etc. THAT'S prevention. The majority of current medical doctrine (current company may or may not be excluded, but I'm pretty darn sure that Bill doesn't follow this) is to handle things with pharmaceuticals. They're even trying to get people who don't really have cholesterol problems on cholesterol meds as a "preventative" measure! At least to me it appears more and more that every time they come out with "new guidelines" it's just a means for the drug companies to sell more product!
Question: Why is it that once a "diagnosis" has been made and put in someone's "permanent record", even if later followups show that it isn't the case and there were other causes for the things that lead to the diagnosis, it is basically impossible to get that "diagnosis" removed?
Thanks for the explanation. Like in so many things the answer is much more complicated than a simple analysis would make it appear. I'm against keeping (brain) dead bodies alive just because some aren't ready to let go and move on. If someone has brain activity, but their body fails... that usually results in death when there is no intervention available. But if someone is in a situation where their heart (or some other organ) fails while they are brain alive and their body can be kept alive, then I'm against "pulling the plug" on a conscious person. (We can debate whether that is "right" or not. But it comes down to who makes the decision to pull that plug, what criteria is used, why it is used, and the fact that the person pulling the plug in that case is pushing the boundaries on "playing GOD". Then there are the arguments on both sides about what is or is not "playing GOD"... but that is an entire thread in and of itself...)
I am also completely against borrowing money from other countries, putting our future generations on the hook when they (and the vast majority of us "regular joe's") have not and never will see one whit of benefit from all of that monetized debt!
You should know by now that I'm a big advocate of allowing people to freely buy services and products that they can afford... without government intervention. Unfortunately, even if it was the case (which is debatable * ) it no longer is the case after the passage of the current "healthcare bill". Under the new law it is illegal for anyone (I'm sure there are exemptions for those who are politically connected) to privately contract for medical services outside of the system. You must go through the government regulated system. ( * When a private individual tries to pay cash for products or services and is told a price that is wildly higher than the price paid by "special" companies for the exact same product and service... thus forcing the private individual to use the "services" of those "special" companies, then that - IMNSHO - is a form of extortion/coercion and takes away the free-market.)IJ wrote:We can't very well tell people they CAN'T buy services freely, can we? If executives want care they don't need, like executive physicals with scans, they have the right to make that mistake (professional societies have an obligation to encourage doctors not to offer junk like this, however).
I generally agree. However here is an observation and a question:IJ wrote:Otherwise, the USA is great at providing insane rescue care, and I wouldn't take the scarce-organ case to represent how the rest of it works. That's a very, very niche aspect of the whole pie. Think about renal failure. If you're a citizen, and you get end stage renal failure, you're insured. Boom. Medi-care. Sweet! Now you can get expensive dialysis treatments 3x a week, and that applies if you're 110 and have metastatic cancer, even though we should not be offering such patients dialysis on the public dime. It's not cost effective enough. If you just have terrible heart disease, though, nah, no such guarantee. Nor have we any interest in keeping you from getting your end stage renal failure. We'll let your diabetes, high blood pressure, high cholesterol, whatever rot you until you have a major heart attack, rotting foot, or other crisis, and then we've got you covered 100% in the hospital, doing PET scans and costly whatever, even if you're on death row, or if you're a drug dealer on the lam from another country. Go figure. That's why I had a patient get chemotherapy and surgery for a cancer, followed by a bone marrow transplant (this care easily costing a million bucks) as an uninsured illegal immigrant, then being saved from life threatening complications with top notch medicine, spending weeks in the hospital, and then the family refusing to take him home because they didn't have enough people to supervise (although 6 would visit every day, and someone was free 100% of the time but across the border, so if he went there he'd never be able to return for free followup), and the family became extremely irate the hospital didn't want to just board him indefinitely for free, expressing severe displeasure and anger when he was sent, gratis, to a nursing home (as was totally appropriate), because they didn't like every aspect of the place.
Huh--we've lost track of reality, people. Not sustainable.
That isn't the best way to use those community resources. We know it. We just find it easier to say NO to someone who we could really help, but isn't in crisis, as we don't HAVE to help them then. LATER, when crisis ensues, then we'll cover everything, less effectively, at great cost.
Observation: "Modern" medicine seems to just now be starting to focus in bits and pieces here and there on true prevention. Annual screenings and physicals are NOT prevention. Helping people to accomplish life-style changes, exercise more, eat better, etc. THAT'S prevention. The majority of current medical doctrine (current company may or may not be excluded, but I'm pretty darn sure that Bill doesn't follow this) is to handle things with pharmaceuticals. They're even trying to get people who don't really have cholesterol problems on cholesterol meds as a "preventative" measure!
At least to me it appears more and more that every time they come out with "new guidelines" it's just a means for the drug companies to sell more product! Question: Why is it that once a "diagnosis" has been made and put in someone's "permanent record", even if later followups show that it isn't the case and there were other causes for the things that lead to the diagnosis, it is basically impossible to get that "diagnosis" removed?
IJ wrote:Anyhoo, your question about redonating an organ that's been transplanted--yeah, it could be redonated, but probably won't. First, only a tiny tiny fraction of deaths result in donations of major organs because the donor has to be brain dead but organs living, which is very rare. The odds such a death will be a transplantee is very low. Second, surgical changes may have made the organ less usable--it may not have enough vessels attached for reuse, or gotten scarred in, whatever. Third, these transplant recipients are immunosuppressed so many of their deaths entail active infection preventing transplant. Fourth, some of the transplants are done FOR infections, eg, hepatitis C, meaning the new liver recipient would infect anyone who got any parts because they still have the hep C. Fifth, these people are commonly ill, eg, transplant meds often cause kidney failure rendering the kidneys less useful. That's off the top of my head, but there's no reason I know of why the reused, or native organs, or a transplant recipient are completely off the table if they are in good health and they end up brain dead.
Incidentally, some people would want to keep brain dead people alive for years on your dime, instead of dividing the organs to needy people. That one we DON'T have to follow, because they don't usually live long and because they're LEGALLY DEAD so we can turn off their ventilator no matter what family thinks. But would you permit THAT, if we had a cardiac death statute? Permitting a (brain) dead body to stay on lifesupport for 100,000 bucks? If yes, do you plan to donate the funds yourself? Take them from a more efficient program that needs them? Or borrow the money from China and let your kids inherit the debt?
Thanks for the explanation. Like in so many things the answer is much more complicated than a simple analysis would make it appear. I'm against keeping (brain) dead bodies alive just because some aren't ready to let go and move on. If someone has brain activity, but their body fails... that usually results in death when there is no intervention available. But if someone is in a situation where their heart (or some other organ) fails while they are brain alive and their body can be kept alive, then I'm against "pulling the plug" on a conscious person. (We can debate whether that is "right" or not. But it comes down to who makes the decision to pull that plug, what criteria is used, why it is used, and the fact that the person pulling the plug in that case is pushing the boundaries on "playing GOD". Then there are the arguments on both sides about what is or is not "playing GOD"... but that is an entire thread in and of itself...)
I am also completely against borrowing money from other countries, putting our future generations on the hook when they (and the vast majority of us "regular joe's") have not and never will see one whit of benefit from all of that monetized debt!
I'm interested in hearing more about how people couldn't obtain healthcare outside of the government "system." Does that mean no more cosmetic surgery in private clinics? Seems impossible. I thought it was just "get insurance or pay a tax (or Panther and Ian will pay for your insurance if you don't make enough)."
Modern medicine is NOT just beginning to notice prevention. AMERICAN modern medicine is. You get what you pay for. Our system doesn't care about you till you get really sick then you're guaranteed. That is the best way to design into a system high costs and worse outcomes. We also pay for doctors to do procedures that don't work, that are invasive, redundant, costly, inefficient, and dangerous; we reward screwups with more payments. We do not incentivize doctors to prevent illness, avoid screwups, save monies, etc.
Annual screenings and physicals ARE prevention. How do you think you prevent stroke? Screen for and treat hypertension. How do you prevent breast cancer deaths? Screen and treat with early surgery. However, the physical part isn't usually rewarding, and we could train an army of NP's to deliver the lifestyle education, encouragement, and so on that you'd like to see. Doctors mostly manage things with meds because there simply isn't funding to pay us to have lengthy chats about prevention (I will, time permitting, counsel people for hours about their diabetes and diet and so on in the hospital, recognizing a "teachable moment" their primary doctors haven't seized on in their 15 minute checkups, but I think that's both rare and a luxury). Take the specific case of psychiatry. They always push meds because 1) partly the field is completely insane itself and every kid has ADHD or bipolar which is nuts but 2) MDs will not get paid to deliver psychotherapy. You get that paying out of pocket, or you see a psychologist. The only way psych gets paid "doctor dollars" is to do 15-20 minute med checkups; otherwise, they're reimbursed less than a massage therapist with a high school diploma. No kidding!
You get what you pay for.
As for guidelines, they do need to be conflict of interest free. BUT most of them are excellent and they're designed to deal with Americans. The cholesterol ones, for example, do start with diet and exercise, but focus on drug therapy (that's what doctors do). We don't need 80% of guidelines to be about diet and exercise; that's just not where the questions are. Should we push harder? I guess, sure... I'm just trying to keep my patients walking at all, so getting them to join me at brutal exercise DVDs is a fantasy. I do mention it, and they look at me like I have 3 heads. A lady with a BMI of 60 just told me she wanted to keep the weight since she was a "BBW." Her diabetes and hypertension were off the charts of course. I brought in my lunch--trimmed chicken, steamed veg, dry salad--to show a guy whose blood was so fatty it's milky and zapped his pancreas. He told me I was insane. I told him maybe but HE was the one in the hospital bed.
It depends what you mean by "cholesterol problem." If the drug reduces events, then your cholesterol wasn't ideal. Period. I mean, people take aspirin when they don't have a "platelet clotting problem" because it reduces events (complex issue, discuss with a smart doctor if you have questions).
Why is it impossible to remove your wrong diagnosis from the "system?" Well, there is no system. There's a million different broken medical record offices that don't talk to each other and don't prepare a list of active problems. Once written, medical records are legal documents and can't be altered or destroyed. So you just have to be louder in the latest progress note. It took me screaming it into the dictaphone for a whole paragraph to cure a man of HIV--by documenting that someone had only dictated that he was HIV *negative* and future people misread it so it began one of his active problems. Those wrong records are still there, right there with his HIV test which is negative and none of them looked at. They're just people.
Oh and they get paid the same to write bad notes and good ones. You get what you pay for.
To your scenarios: NO ONE pulls the plug on conscious people who get to decide themselves. Exceptions may occur (I remember a big fuss that came out of the Katrina disaster) but generally we're only talking neurologically devastated people. Like the man I had. He had no quality. Alive, but not. Death would take him any moment we stopped intervening. Death would take him in any other country. But here, we are handsomely paid to do monstrous things to people who can't speak for themselves anymore...
You get what you...
Modern medicine is NOT just beginning to notice prevention. AMERICAN modern medicine is. You get what you pay for. Our system doesn't care about you till you get really sick then you're guaranteed. That is the best way to design into a system high costs and worse outcomes. We also pay for doctors to do procedures that don't work, that are invasive, redundant, costly, inefficient, and dangerous; we reward screwups with more payments. We do not incentivize doctors to prevent illness, avoid screwups, save monies, etc.
Annual screenings and physicals ARE prevention. How do you think you prevent stroke? Screen for and treat hypertension. How do you prevent breast cancer deaths? Screen and treat with early surgery. However, the physical part isn't usually rewarding, and we could train an army of NP's to deliver the lifestyle education, encouragement, and so on that you'd like to see. Doctors mostly manage things with meds because there simply isn't funding to pay us to have lengthy chats about prevention (I will, time permitting, counsel people for hours about their diabetes and diet and so on in the hospital, recognizing a "teachable moment" their primary doctors haven't seized on in their 15 minute checkups, but I think that's both rare and a luxury). Take the specific case of psychiatry. They always push meds because 1) partly the field is completely insane itself and every kid has ADHD or bipolar which is nuts but 2) MDs will not get paid to deliver psychotherapy. You get that paying out of pocket, or you see a psychologist. The only way psych gets paid "doctor dollars" is to do 15-20 minute med checkups; otherwise, they're reimbursed less than a massage therapist with a high school diploma. No kidding!
You get what you pay for.
As for guidelines, they do need to be conflict of interest free. BUT most of them are excellent and they're designed to deal with Americans. The cholesterol ones, for example, do start with diet and exercise, but focus on drug therapy (that's what doctors do). We don't need 80% of guidelines to be about diet and exercise; that's just not where the questions are. Should we push harder? I guess, sure... I'm just trying to keep my patients walking at all, so getting them to join me at brutal exercise DVDs is a fantasy. I do mention it, and they look at me like I have 3 heads. A lady with a BMI of 60 just told me she wanted to keep the weight since she was a "BBW." Her diabetes and hypertension were off the charts of course. I brought in my lunch--trimmed chicken, steamed veg, dry salad--to show a guy whose blood was so fatty it's milky and zapped his pancreas. He told me I was insane. I told him maybe but HE was the one in the hospital bed.
It depends what you mean by "cholesterol problem." If the drug reduces events, then your cholesterol wasn't ideal. Period. I mean, people take aspirin when they don't have a "platelet clotting problem" because it reduces events (complex issue, discuss with a smart doctor if you have questions).
Why is it impossible to remove your wrong diagnosis from the "system?" Well, there is no system. There's a million different broken medical record offices that don't talk to each other and don't prepare a list of active problems. Once written, medical records are legal documents and can't be altered or destroyed. So you just have to be louder in the latest progress note. It took me screaming it into the dictaphone for a whole paragraph to cure a man of HIV--by documenting that someone had only dictated that he was HIV *negative* and future people misread it so it began one of his active problems. Those wrong records are still there, right there with his HIV test which is negative and none of them looked at. They're just people.
Oh and they get paid the same to write bad notes and good ones. You get what you pay for.
To your scenarios: NO ONE pulls the plug on conscious people who get to decide themselves. Exceptions may occur (I remember a big fuss that came out of the Katrina disaster) but generally we're only talking neurologically devastated people. Like the man I had. He had no quality. Alive, but not. Death would take him any moment we stopped intervening. Death would take him in any other country. But here, we are handsomely paid to do monstrous things to people who can't speak for themselves anymore...
You get what you...
--Ian
Thanks for the explanations. They're a big help to my understanding.
But...
You say we get what we pay for...
Then why is it that a woman from Kenya, who was diagnosed with cervical cancer, sewn back up in Kenya and sent home to die... Was told that since she had no insurance that she would have to have ~$100k liquid assets before even being admitted in the U.S. ... ended up going to India, got treated by U.S. & U.K. trained MDs in a modern, clean hospital with the latest equipment, and her entire treatment including chemo & radiation was a little over $10k? (She's been deemed "cancer free" for two checkups now. I realize that she's still early in the scope of things, but she was told to go home and die... and now she's had two "clean" followups. This all happened just this year...) So... What are we not paying for here? What is the difference? I thought that it was perhaps malpractice insurance, but having found out that the same drugs she got in India cost over 25X as much here in the U.S., I think there's more to it...
But...
You say we get what we pay for...
Then why is it that a woman from Kenya, who was diagnosed with cervical cancer, sewn back up in Kenya and sent home to die... Was told that since she had no insurance that she would have to have ~$100k liquid assets before even being admitted in the U.S. ... ended up going to India, got treated by U.S. & U.K. trained MDs in a modern, clean hospital with the latest equipment, and her entire treatment including chemo & radiation was a little over $10k? (She's been deemed "cancer free" for two checkups now. I realize that she's still early in the scope of things, but she was told to go home and die... and now she's had two "clean" followups. This all happened just this year...) So... What are we not paying for here? What is the difference? I thought that it was perhaps malpractice insurance, but having found out that the same drugs she got in India cost over 25X as much here in the U.S., I think there's more to it...
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Jason Rees
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Here the maker's rights to the drug haven't expired. There, those same rights guaranteed by law here, are not, and therefore generics are available.What is the difference? I thought that it was perhaps malpractice insurance, but having found out that the same drugs she got in India cost over 25X as much here in the U.S., I think there's more to it...
Pharmacuetical companies justify the high costs of drugs by the cost of researching and creating new drugs... by the time those rights expire, they should have recouped the cost of research and development.
Asia is a pirating-friendly environment, from movies to medicine.
Life begins & ends cold, naked & covered in crap.
But she didn't get generics...
Also, the hospital stay, the doctor's bills, the tests, the surgery and on and on were ALL cheaper by leaps and bounds. I've read about people going to South American private hospitals, taking vacation time, paying the full private hospital/doctors/treatment bills, and also paying for an interpreter and ending up having their procedure for a fraction of the cost.
And these same name-brand drugs are available in Canada for much lower costs than here.
Something doesn't add up...
Also, the hospital stay, the doctor's bills, the tests, the surgery and on and on were ALL cheaper by leaps and bounds. I've read about people going to South American private hospitals, taking vacation time, paying the full private hospital/doctors/treatment bills, and also paying for an interpreter and ending up having their procedure for a fraction of the cost.
And these same name-brand drugs are available in Canada for much lower costs than here.
Something doesn't add up...
Surely somebody has studied that phenomenon in depth. I would guess that some of the extra expense has to do with malpractice insurance and payments. You might think everything is fixed in price at the country of origin, and simply subject to exchange rates from there, but you'd be wrong in general. One thing is that the medical system here in the US is not engineered to charge for anything based on its actual cost. It is set up to extract as much money as it can from some patients/sources in order to offset that it doesn't get any money from others. There is no possible way to justify the amount they try to charge you for, say, a pair of 325mg acetaminophen tablets in a hospital if you suppose that the cost of the item provided/used has anything to do with it. There probably is also a factor related to the local cost of living, since the staff must be paid. Factors like these, and many more, are probably conspiring to make the situation as bad as it is.Panther wrote: Something doesn't add up...
Mike
More later, but I concur with what's been written here by others about the cost of pharmaceuticals and the false pricing. Why do they fake prices? Because the hospital, to cover the cost of care for nonpaying and underpaying people who can be exorbinantly expensive, have to extract the cost of care from everyone else. Hence the $10 tylenol tablet.
Do you think India provides that ladies care to their hordes of indigent people living in slums? Hardly. I've read accounts of people who are just turned away with simple problems that could be cured. Pay or die there--and so people who can't pay aren't inflating costs for the rest.
Do you think India provides that ladies care to their hordes of indigent people living in slums? Hardly. I've read accounts of people who are just turned away with simple problems that could be cured. Pay or die there--and so people who can't pay aren't inflating costs for the rest.
--Ian
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Jason Rees
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Malpractice insurance... paying for people who can't, like Ian wrote... doctors, nurses, and even technicians being paid more here... tons more being spent on diagnostic equipment... sadly, it does add up to a beast of a system.Panther wrote:But she didn't get generics...
Also, the hospital stay, the doctor's bills, the tests, the surgery and on and on were ALL cheaper by leaps and bounds. I've read about people going to South American private hospitals, taking vacation time, paying the full private hospital/doctors/treatment bills, and also paying for an interpreter and ending up having their procedure for a fraction of the cost.
And these same name-brand drugs are available in Canada for much lower costs than here.
Something doesn't add up...
Life begins & ends cold, naked & covered in crap.
Oh... Rationing based on economics there... Rationing based on other criteria here... Hmmmmm...IJ wrote:Do you think India provides that ladies care to their hordes of indigent people living in slums? Hardly. I've read accounts of people who are just turned away with simple problems that could be cured. Pay or die there--and so people who can't pay aren't inflating costs for the rest.
Still doesn't add up because they had the same diagnostic equipment there, but charged much less for the use. Malpractice insurance is one that I think about. There are plenty of good doctors that take a huge hit in that regard here when they aren't the cause and too many incompetent morons with MDs who cost the insurers way too much money. I understand that statistically there are competent and incompetent in every field, but in some fields being incompetent has higher consequences (and that goes beyond medicine)... also before the current system was put in place if someone was incompetent they pretty much had to correct their errors or move to a different field... caveat emptor...Jason Rees wrote:Malpractice insurance... paying for people who can't, like Ian wrote... doctors, nurses, and even technicians being paid more here... tons more being spent on diagnostic equipment... sadly, it does add up to a beast of a system.
Finally, I have seen first-hand that who is deemed to be able to pay and who is given a pass is not done in any real "fair" manner. After seeing some things happen in this country along those lines, I'd almost (not really, but "almost") prefer India's method. The whole "ideal" that "everyone will be treated" is just a load of bull. It should really read "everyone will be treated that we want to treat based on the established PC criteria".
I don't begrudge anyone making a decent living and I certainly don't begrudge any medical professional at the top of their game from doing even better. I do not agree with having to pay some idiot an exorbitant amount (way above "making a decent living") simply because they're wearing a white lab coat with their name embroidered on it and have a stethoscope around their neck. And I've run into plenty of those as well... It reminds me of people who wear satin gi's with lots of embroidery and extra-long, extra-wide black belts that think they know best how to handle every situation. I guess, as Van-Sensei has pointed out to me on many occasions, that will ruffle a few feathers, but I'm just calling it like I see it.
Along those lines, I actually asked and got a copy of my current MDs' transcript (from years ago, but was also given transcripts for continuing classes... it was actually pretty impressive). I like my current MD and we work on my health as a team, but I was just interested in the academic performance... like I am in any interview situation. BTW & FYI, to show I'm not a hypocrite in this regard, I did a 5-yr program in 3-yrs with highest honors in my current field. In my "previous life", I didn't get those high honors, but I did do a 4-yr degree in 2-1/2 years. Not trying to brag, just some data-points. Sometimes it is hard to quantify what makes a good person in any given field and it can rely on personal "feelings", but there are also some non-subjective things that can point one way or another. I "interviewed" my doctor as I would any other employee because I want to know where my doctor falls in the curve. Just as it's the case in most situations, it is also true here that there are many more things that go into it than simply academic achievement (subsequent performance being a big one), but it is nice to know if the person you're hiring/working with is an "A" person or a "C-" person... just my NSHO...
Finally, perhaps we'd be better off if it wasn't such a beast of a system. It strongly appears that the current "system" is broken and only going to get more broken with the way things are going.
