How good is American health care?

[Bravus]

Very good, it turns out. But very expensive for the outcomes it produces: http://scienceblogs.com/pharyngula/2011/08/how_good_is_american_health_ca.php

(this topic might be more at home in the Politics forum but I can't post there - in some ways it's worth keeping in World Affairs, though, since it's an international comparison)

[CoAspen]

You have summed it up correctly!

[Dr. Shane]

I get my healthcare in Mexico and am very happy with it.

[bonnie]

Very good, it turns out. But very expensive for the outcomes it produces: http://scienceblogs.com/pharyngula/2011/08/how_good_is_american_health_ca.php

(this topic might be more at home in the Politics forum but I can't post there - in some ways it's worth keeping in World Affairs, though, since it's an international comparison)

I think part of the expense is that efforts are made for some that would not be in other countries.

Someone very close to me gave up US citizenship for citzenship in the UK.Medical costs were part of the reason and the "free care" in the UK

While they do get medical care for neurofibromatosis.It is done only at a time it absolutely must be removed.The growth is painful and gets very heavy,often requiring to be bedridden till such a time as they will operate

For all it's faults,at least here it would be removed long before it is there.

Isn't the UK number 2 in the graph that is considered most important?

[barnz]

So there seems to be a consensus that the problem is not the quality of care or its distribution, but it is the cost (I also believe that is the problem, and perhaps the only real problem). So the question is...why is it so expensive? Was health care always expensive the way it is now? When did healthcare costs really start to increase?

[Jeannieb43]

The U.S. pays for the cost of R&D of new pharmaceuticals. The third-world countries pay little or nothing for their pharmaceuticals, and we subsidize the cost for them by paying high prices.

For physicians, the technical stuff which is now being used is phenomenal. MRIs, ultrasound, CTscans, etc., etc, are extremely expensive. Diagnosis is now made by machine. The doctors these days don't know how to do auscultation, for example, and to determine from that just where something in the chest is awry.

Diagnosis and treatment are now so much more advanced than previously; hence, they're more expensive. But without the high-tech of in vitro fertilization, for instance, four of my grandchildren would never have been born.

[bonnie]

So there seems to be a consensus that the problem is not the quality of care or its distribution, but it is the cost (I also believe that is the problem, and perhaps the only real problem). So the question is...why is it so expensive? Was health care always expensive the way it is now? When did healthcare costs really start to increase?

There is more than one cause for the rise in health care.

The advancement of medical technology,research etc

Prior to medicare and medicaid costs were much lower.

Our first son was born in 1962. My cost for pre-natal care and delivery was 125.00,my hospital for two days was 102.50. We did not have insurance so I refused to stay five days.

Our second son was born in 1962,after a very difficult pregnancy and delivery. He remained in the hospital for 3 months with additional care. I was hospitalized for two weeks. My sons hospital bill was 3700.00,mine was 737.00,prenatal and delivery was still 125.00. Our third son was born in 1965.Prenatal and delivery was 135.00,hospital stay of five days was 375.00. After medicare and the "great war on poverty" the cost of prenatal and hospital had risen substantially. Prenatal and delivery for our fourth son, born in 1973 was 1500.00 and hospital stay for five days had jumped to 1300.00

Dr's and hospitals are going to recoup their cost somewhere.

When taking such a reduction for medicare and patients on welfare,they will get it where they can.Generally from those with insurance,which makes premiums rise or those that can do so with their own resources

[Pockey]

So there seems to be a consensus that the problem is not the quality of care or its distribution, but it is the cost (I also believe that is the problem, and perhaps the only real problem). So the question is...why is it so expensive? Was health care always expensive the way it is now? When did healthcare costs really start to increase?

One of the reasons it's so expensive is the practice of defensive medicine and the fear of litigation in the U.S. due to an overwhelming number of lawsuits. This results in the ordering of many unnecessary tests. Often times the results of these tests are inconclusive and may even create new suspicions that have to be further explored, which means more tests.

Another reason it is so expensive is a lack of focus on prevention. If someone has a stroke or MI, U.S. hospitals will do everything they can to keep that patient alive. However so few dollars and time is spent towards prevention. A CABG (cardiac bypass) costs well over 100K. There are 500K CABGs in the U.S. per year. That's 50 billion just for the CABGs. That cost doesn't factor in the rehab, the follow up visits, subsequent stress tests, medications etc.

So one could argue the typical American diet and lifestyle is the biggest reason why health care is so expensive in this country.

[CoAspen]

There have been some good answers...but....

Healthcare in the US is a business expected to make a profit for its investors. They expect a very good increase, yearly. The public expects the latest and greatest regardless if it changes the results. The public also expects instantaneous access to health care. We the public are simply paying for we ask.

[Pockey]

Yes. I didn't even touch on that. For example, not uncommon for a parent to bring their teenager's sprained ankle to be seen and demand an MRI right away after the injury was 1 hour ago. HMO's often won't even approve the test, nor will PPO's. They (the insurance companies) want to see if an x-ray was done first to rule out a fracture, whether the patient tried conservative measures like time, ice, anti-inflammatories, then physical therapy. The only real reason to get the MRI would be if the ankle wasn't improving and there was the possibility of surgery. Yet the parents still want the MRI, they demand it, because their kid is no doubt going to be the next Lebron James. If the insurance company eats the cost, this raises your insurance premium. If they deny the test but the parents are stubborn and want it anyways, then the cost is shifted to the family. If the doctor doesn't order the test because she knows it's not indicated, then the parents throw a fit and make threats so she ends up ordering it anyways.

However I'm still convinced diet and lifestyle is the biggest cause of the high cost of health care in America. Heart disease is the number one cause of death in the U.S., followed by cancer, strokes, COPD/emphysema. Diabetes is a top ten cause as well. These are predominantly lifestyle diseases.

[Aliensanctuary]

I suspect that many hospitals would have to close if people took better care of themselves through diet, exercise, no obesity, and no self-destructive bad habits.

[Pockey]

Absolutely!

[fccool]

I don't think that it's fair to say that America has a "Healthcare" system. The beast healthcare is prophylactics. When one man's sickness becomes other man's profit... you are asking for a lot of trouble.

[bonnie]

I don't think that it's fair to say that America has a "Healthcare" system. The beast healthcare is prophylactics. When one man's sickness becomes other man's profit... you are asking for a lot of trouble.

Perhaps all should be treated for free.

[fccool]

Quote:

Perhaps all should be treated for free.

Nothing is free. Someone has to pay for it. The question is whether we decide to collectively make a fear of loosing one's health a non-issue, or will we continue to shoot our wounded?

You don't find any problems with collective security that almost a third of our tax money go towards. We don't have a private security and police forces that only guard and protect people who can afford them.

Why would healthcare be any less important or different? Healthy people are a bedrock of healthy society.

[bonnie]

Nothing is free. Someone has to pay for it. The question is whether we decide to collectively make a fear of loosing one's health a non-issue, or will we continue to shoot our wounded?

[fccool]

http://www.photius.com/rankings/healthranks.html

and yet...

http://www.photius.com/rankings/total_health_expenditure_as_pecent_of_gdp_2000_to_2005.html

and, not surprisingly

http://www.allcountries.org/ranks/preventable_deaths_country_ranks_1997-1998_2002-2003_2008.html

http://www.photius.com/rankings/world_health_performance_ranks.html

[bonnie]

Very impressive links.Now maybe you would be willing to explain some things to me.

My husband had to undergo three ten hour days of rigorous medical tests at Abbott Northwestern Hospital. It is known throughout the US and other countries.

During our time there we spent our time in a lounge with others waiting for medical tests. Given that it seems the chance of dying is greater here tell me why out of many families we spent those three days with four were americans?

A good portion of that number were Canadians. They have socialized medicine.Why did they forgo diagnosis/treatment in their own country where it is cheaper out of pocket(after taxes]and come to the US where there chance of dying is greater and the cost of doing so is more expensive? There were two families from France,one from Lebanon,three from Spain. One family from England that had moved there from Australia.

Why would these families be so foolish as to go to the expense and the tremendous inconvenience of coming to a country where their chance of dying is greater?

I have several relatives living in Canada.Most come to the US for all but general care.Why is that? My cousins husband was sick,cause unknown at the time. He was scheduled for tests with a wait time his wife felt was to long to wait.

He came to the US as he does not live to far across the Canadian border.Within hours of the tests and diagnosis he was flown to the Mayo hospital.He had a very aggressive form of cancer.Again why come to a country that has inferior medical care to the country you live in

[fccool]

I think you misunderstand the point, along with many other people who make similar arguments.

Let me give you an example what I'm talking about. Let's say I want to exercise, and I'm looking for affordable gym. I have a certain budget of $50/month for membership costs, and I'm looking to use dumbbells, bench press and elliptical machine. That's all I'm looking for.

Now, I'm walking into the first health club and ... wow. They got everything, all kinds of different machines, all sorts of trainers walking around helping you to exercise, great receptionists who will call in and remind you to exercise regularly, clean and beautiful building with TVs all around, a swimming pool, a game room, a high-tech locker room... whatever.

I ask for a price, and they tell me $500 per month. Now, I ask why is it so expensive, and the answer is given... we are striving to provide the best possible experience to our clients, so the price includes a lot of mandatory overhead, even if the clients don't need, or won't use all of the features. On top of that, there's a required accident insurance charge that will cover the gym legal costs in case the trainers do something wrong to you.

But, as a regular customer, I don't need all of that overhead. I'm coming specifically for A, B & C. If I need all of the high-tech trinkets, I will come to that gym and shell out that money, but overall... I end up paying for overhead that's encouraged by the industry. So, I go to the second gym... the same case. The third one. The same case. Then I find out that there's a gym board that makes sure that certain standards are met, and that all of the gyms would be required to have all of those things.

So, now, as a person on a very tight budget, I have a choice. Do it on my own, or strap up, go into debt, and buy the best exercise experience money can buy.

American healthcare is very similar in that way. I've had miracles performed on me as severely injured star athlete. I'm happy, and can't complain. But that procedure cost $50,000 ++. Do you really think that any doctor would repair my torn ACL if I had no insurance, or could not even partially pay that amount? Looking at the bill, the day I've spent at the hospital post surgery ended up costing $5500. Why? Because of all of the fancy overhead associated with "the best, of the best, of the best".

Some people don't need the best of the best. They need good enough, and efficient and affordable. But, since medical industry words directly with Insurance industry... they can justify charging you 100,000 for some procedures, where in realities of free market economy such simply would not be the case.

Most people who walk into the hospital don't just pay for the healthcare. They pay for collective overhead that's split between the patient visit prices to make sure that hospital as a business would cover these costs. Even with insurance, these bills end up being enormous. But, without insurance, these are mind boggling.

Also, you are sort of implying that doctors will see you without some sort of upfront cash payment, or insurance. In most cases, that's not the case. They may see you, but you will end up with a medical bill of 50k ++. In case of a terminal cancer patients, not only American healthcare can't help them with really low rates of treatment success, their families get stuck with insane medical bills to pick up, even when they do have insurance.

It's not a question of best healthcare. It's a question of accessible healthcare.

[fccool]

To be fair, I understand where you are coming from with these arguments. There is a fundamental difference in some instances. In Ottawa, the average wait in emergency room can extend into 10++ hours during peak crises time. But from my E.R. Experience, I've had better and more expedient treatment under socialized medicine than I did in US, while getting stuck with enormous ER bills.

I remember as a college student I got extremely sick during the Christmas break (early December), which I've spent in the University. Since all of the University medical staff was out, I had to drive to the nearest urgent care, because I was vomiting uncontrollably. They took my temperature, and it was 105.5 . They told me that the doctor will not see me because my fever was above 104, and that I had to drive to ER 45 minutes away. It was insane, really. I told them that I have a flu, and perhaps they can at least give me something that will help take the edge off, since I had to drive myself. They said that the doctor is not permitted to, and that I could call an ambulance if I absolutely had to.

I drove for 45 minutes, because I had an idea what charges would be associated with such call. I ended up spending nearly 5-6 hrs in the ER waiting room. The doctor saw me for probably 5 minutes max. They took some tests, administered IV and sent me out. At that time, I lied that someone will pick me up, but ended up driving myself back... probably a stupid thing to do in my condition on snowed-in roads.

All in all, with this horrible experience, I got stuck with a bill of nearly $2,000. Now, considering that I could have died, $2000 is probably a small price to pay. But overall, I have to ask whether these costs and overhead is necessary, or is it charged because Insurance industry allows for these costs to be so high?

I don't believe that in true free-market healthcare, such would be the case.

[rudywoofs (Pam)]

-deleted-

[fccool]

I'll give you another example.

My wife and I went to visit Ukraine last September. I had sinus infection that developed into a throat infection, and eventually, due to excessive throwing up on the plane (I think the first time I ever threw up on the plane) I've developed laryngitis.

My wife did not sit right, or for whatever reason noticed a swollen lymph node above her ear that really sent her into frenzy. She was really terrified. We scheduled a doctor visit. The doctor arrived a day later, to my parents house. He saw both of us. He checked my wives lymph node and said it was nothing to worry about, and was due to a neck strain and cold, he diagnosed my laryngitis and prescribed treatment for both of us.

How much it cost us? Just the cost of drugs.

I don't doubt that there are horror stories from both side, but they should be taken into consideration with certain degree of objectivity... without political prejudices associated with certain ideas. What I'm talking about is not Obama Care. I don't really care much for his proposal. IMO it solves very little, and in fact makes it illegal not to have insurance, which is idiotic. How will it solve the issue of healthcare affordability for those who can't afford that insurance?

What I'm talking about are the examples of working social medicine around the world, that both allow for specialized treatments for people who are willing to pay for specialists, and does not have people choose between their health, or life in debt and continual harassment from collection agencies.

[fccool]

Quote:

The government has the duty of protecting the citizens of this country from harming one another or being harmed by others.The government does not have the obligationg to protect my health.

You end up being paradoxical here. Government protecting you from harm by other is in fact Government protecting your health. That's the reason why there are laws against people hitting you upside the head with a baseball bat. It's detrimental to your health. People on other hand can scream obscenities at you, and not be charged with criminal misconduct.

That's the reason that EPA and FDA exist. They make sure that the products you buy would not be detrimental to your health. Government has obligation protecting your health, because your health directly relates to your functioning being.

What you probably meant to say is that Government is not obligated to take care of you when you are sick. Sure, not constitutionally. Yet, I think with nearly a trillion (with a T) they spend yearly on financing their military endevours, it's hard to make a solid case as to why they would not cut some of that, and make healthcare more affordable for people who otherwise can't.

I, for example, found it both appalling and disgusting that they would leave the 9-11 responding workers and their families to pick up the healthcare tab that resulted from respiratory illnesses they developed in the aftermath.

[Pockey]

It's not a question of best healthcare. It's a question of accessible healthcare.

A lot of good points fccool, Bonnie too. There is healthcare for the uninsured, but there is no guarantee like Rudywoofs said. It's frustrating for many families because they may make just a little more than the required income limit to quality for some type of medicaid. What irks me is the number of people that game the system. Some people that claim medicaid are driving Mercedes SUVs. How do they do it? They own their own business, and cheat on their taxes. This is a big problem.

I can't believe fccool that they turned you away from the urgent care for having a temp of 105. That is not the usual standard of care in most urgent care centers. Unfortunately the ER is the safety net for the uninsured, and they may walk away from there with a huge bill like you did.

[fccool]

Quote:

I can't believe fccool that they turned you away from the urgent care for having a temp of 105. That is not the usual standard of care in most urgent care centers.

I thought so too, but that's actually a fairly common policy as I later researched and found out. I later inquired, they said they had the same policy in the university clinic. They would send people directly to emergency room with anything above 104.

See the bottom of this page for example:

http://www.emedicinehealth.com/fever_in_adults/page3_em.htm