It’s Time for the Political Left to Step Forward and Start Acting, Not Just Reacting — Part III.a
I was born into a society where the healthcare provider was personified by the friendly and benevolent family physician. Those were the days when the doctor still made house calls and would accept payment when you got paid, payment over time or accept payment in trade. It was a very personal relationship between patient and physician. As such, physicians didn’t view patients as just demographic numbers and a means to achieving substantial personal wealth. The old time physician saw patients as people, neighbors and respected members of the community. However, those days are long gone and we are faced with the new realities of industrialized medicine. What is the impact on the U.S. population of this industrialized healthcare system?
Before surging forward; let’s get some general facts on the table.
- U.S. GDP $15.06 trillion (2011 est.)
- In 1980 the percentage of healthcare costs of GDP was 9.0 percent and by 2010 had risen to 17.6 percent = $2.64 trillion
Taken directly from Wikipedia titled: Healthcare in the United States:
- “The U.S. Census Bureau reported that 49.9 million residents, 16.3 percent of the population, were uninsured in 2010 (up from 49.0 million residents, 16.1 percent of the population, in 2009). According to the World Health Organization (WHO), the United States spent more on health care per capita ($7,146), and more on health care as percentage of its GDP (15.2 percent), than any other nation in 2008. The United States had the fourth highest level of government health care spending per capita ($3,426), behind three countries with higher levels of GDP per capita: Monaco, Luxembourg, and Norway. A 2001 study in five states found that medical debt contributed to 46.2 percent of all personal bankruptcies and in 2007, 62.1 percent of filers for bankruptcies claimed high medical expenses. Since then, health costs and the numbers of uninsured and underinsured have increased.”[5] CNN. http:/money.cnn.com/2009/03/05/news/economy/under-insured/.
- “Life expectancy at birth in the USA, 78.49, is 50th in the world, below most developed nations and some developing nations. Monaco is first with 89.68. Angola is last with 31.88. US statistics are below the average life expectancy for the European Union. The World Health Organization (WHO), in 2000, ranked the U.S. health care system as the highest in cost, first in responsiveness, 37th in overall performance, and 72nd by overall level of health (among 191 member nations included in the study). The Commonwealth Fund ranked the United States last in the quality of health care among similar countries, and notes U.S. care costs the most.”[13] Davis, Karen, Schoen, Cathy, and Stremikis, Kristof (June 2010). Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care System Compares Internationally, 2010 Update”. The Commonwealth Fund. Retrieved June 23, 2010.
- “A 2004 Institute of Medicine (IOM) report said: "The United States is among the few industrialized nations in the world that does not guarantee access to health care for its population. A 2004 OECD report said: "With the exception of Mexico, Turkey, and the United States, all OECD countries had achieved universal or near-universal (at least 98.4% insured) coverage of their populations by 1990. The 2004 IOM report observed "lack of health insurance causes roughly 18,000 unnecessary deaths every year in the United States. While a 2009 Harvard study estimated that 44,800 excess deaths occurred annually due to lack of health insurance.”[16] Davis, Karen, Schoen, Cathy, and Stremikis, Kristof (June 2010). Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care System Compares Internationally, 2010 Update”. The Commonwealth Fund. Retrieved June 23, 2010.
The facts attest to a crisis to the nation that is currently and will continue to have significant impact on our future wellbeing. For a nation that has the second largest GDP, the EU having the largest, in the world and the third largest population, I don’t see any evidence that the current healthcare system is meeting the universal needs of our society. If anything, the data indicates that we are heading in the wrong direction when compared to the rest of the global community.
There are many variables impacting the cost, quality and delivery of healthcare. In this posting I am going to address just one of the variables. We will start at the beginning, which are the high and rising costs associated with healthcare providers, specifically physicians.
Now, don’t get me wrong, physicians or healthcare providers are not the sole driving force to the high cost of healthcare, but, we need to be looking at what is and has been double digit healthcare costs making it unaffordable for a large segment of society.
Physicians and other healthcare providers make a very comfortable living. Physicians and healthcare providers’ high earnings are predicated on individuals having high skill demand with a low number of individuals possessing such skills. Physicians, nurses and other healthcare providers fall squarely into this category. It would not be rational to reduce the required skills to provide healthcare, but it probably does make sense to increase the numbers of those who possess such skills.
Currently the U.S. has 24 physicians per 10,000 of population, while Cuba leads the world with 67 per 100,000. As such, physicians as a single profession, represent the single largest group of individuals in the top 1 percent of earned income. The threshold for entry into this income bracket is approximately $387,000 per annum. The nation’s 137 medical schools graduate approximately 15,500 students each year and it is estimated that the nation in the future 25 years will need at least 7,000 to 10,000 more per annum to keep up and maintain a balance with the retiring boomer physicians. However there are some very real obstacles to achieving such numbers.
Included in the obstacles to increasing the number of trained physicians are as follows:
- The unwillingness of the established medical community to open its ranks to training more physicians.
- The high personal cost to the physician to receive his/her education and training.
- The limited number of medical schools and teaching hospitals.
- An over emphasis on specialist training.
The established medical services community, a self regulated industry, are very cognizant of the impact of supply and demand on providing medical services. If the supply of physicians becomes too great, then it will exert downward pressure on the cost of healthcare and create a much more competitive marketplace to purchase healthcare services. Even though this would be good for the consumer and the nation; it doesn’t translate well into benefit to the medical community and the individual physician, affecting both social status and income.
I am not accusing the physicians or healthcare providers as being only money motivated or any greedier than the rest of society, but without a high probability of a large return on investment of both time and money; it may be more difficult to attract the best and brightest to enter the profession. This argument doesn’t seem to have a high degree of validity.
In the academic year of 2011 – 2012, there were 43,919 applicants to U.S. medical schools with an acceptance of 19,230 accepted. There appears to be a high supply of applicants to fill additional open spots. In fact, since the academic year of 2000 – 2001, enrollment has increased a full 30 percent and we are still not satisfying the need for more physicians.
Currently physicians spend, on average, eleven years after high school in post secondary education and training. They finish their education with school debt averaging approximately $175,000 compared to a PhD with a similar time investment; begin their career with approximately $70,000 in education debt. The availability of funds is critical to the number of people who will enter the medical profession. Few students enter into medical school on either full scholarship or their education completely paid for. Often, medical school students have pursued their education by taking advantage of programs offered by the federal government. The government will pay for medical training for physicians in the Army, Navy, Air Force and Public Health Service. The trade off is a commitment to between six to 10 years of mandatory service. However, the vast majority of medical students go to school on student loans. This can inhibit qualified students from taking on the years of education and training. The bottom line is that newly emerging physicians must “go for the gold” and start earning as much as possible as quickly as possible.
The 137 medical schools are limited to the number of students they can accept. Medical schools are expensive propositions and the start up costs is prohibitive. Associated with the medical schools are teaching hospitals, which are also expensive. There is a plan to increase medical schools by another 25 institutions. However, to meet the demands over the next 25 years the number of medical schools should increase by another 25 with a total of 50 new schools. The real question is where is the money to come from to open all these schools and are there enough experienced teaching physicians to staff them.
Currently, the funding for residence programs is uncertain due to billing issues with Medicare and Medicaid programs, limiting the number of residents per Medicare and Medicaid patient. Funding for training will continue to be an issue as well as the demanding schedules of residents.
The U.S. medical system comes under severe criticism with our emphasis on specialized medicine. Whereas, we, as a nation are always short of general practitioners, especially in the inner cities and rural areas; we are focused on the production and training of specialists. Specialist physicians earn a great deal more money than general practitioners and attract beginning MDs. Since, medical education and training is so expensive it is no wonder that new M.D.s immediately go into high paying specialties. However, if we are to lower the costs of medical care and meet the medical needs of the two to four decades, we must find a way to entice the new MD into general practice medicine.
In the next post I will address an action plan to address the problem with too few physicians for a nation of 311 million people. Included will be a plan to move from our current private system to a mixed private/public partnership that will increase affordable healthcare availability to all.
Bren
5:19 pm on Wednesday, June 27, 2012
A fascinating article, Mr. Ruble! One aspect of the cost of healthcare is overhead, as you mentioned. Each office/clinic must be set up with appropriate equipment that must be upgraded to meet codes and patient expectations. Unlike a NHS country where the government equips the clinic, U.S. doctors must work for an existing clinic or find capital to meet the start-up costs. That usually results in taking on more patients than can be given focused attention and care. Then there is the health insurance issue. A doctor's office/clinic usually has one or two employees whose primary job is to battle the insurance companies. Often the doctor has to get involved in more complicated cases. As one who worked for a time for a health insurer, this is an enormous opportunity cost for doctors. Imagine insurance account reps making (at the time) $12-$15/hour with three months training arguing with doctors about appropriate treatment regimens.
It is a classic stall and evade tactic. People who are sick live in anxiety over medical bills that may not affordable. People have died while their families battle insurance companies over declinations handed out because of a lazy data entry clerk or the cost of care approaches the cost of the premium paid.
The U.S. healthcare system is a disaster. The ACA is a good baby step, but a NHS is needed. It would help citizens, businesses, doctors!
Lyle Ruble
5:27 pm on Wednesday, June 27, 2012
@Bren...I will be addressing those issues in future blog series. I wanted to lay the foundation for healthcare costs. The deadly dance between the provider and the insurance company costs the system tons of money. In the next blog in this series I will talk about a plan that will increase the number of physicians per annum, provide affordable healthcare to the poor, the under insured and those currently receiving Medicare. Stay tuned in for more to come.
Bren
7:52 pm on Wednesday, June 27, 2012
Bravissimo, Mr. Ruble!
Jay Sykes
7:29 pm on Wednesday, June 27, 2012
@Lyle Ruble... Do you think the American philosophy of 'treat at any cost' when facing a condition that does not indicate survival(or good quality of life) adds in a significantly measurable amount to the total dollars spent per capita v. countries with NHS. I believe many countries with NHS practice a more palliative care model for patients with a low likelihood of a good outcome.
Lyle Ruble
7:43 pm on Wednesday, June 27, 2012
@Jay Sykes...i agree that providing palliative care to patients who have low probability of survivability significantly increases the cost of medical care. My current research has not turned up a significant difference between our system and the NHS models concerning this issue. However, the bulk of medical costs expended in our system is during the last six months to two years of life, and it would make sense that we may be paying much more in palliative care. My current research indicates that we spend so much money on so many different areas of the medical care system. We talk about cutting the fat out of government, well there's plenty of fat to be cut in healthcare.
Bren
8:02 pm on Wednesday, June 27, 2012
I recently read a print article while waiting for an appointment, which compared senior quality of life in Great Britain and the U.S. Overall, British citizens were physically and emotionally healthier than their American counterparts. This was due in good part to the NHS, which reduced worries about medical bills and prescriptions, and because NHS doctors focused on preventive care and wellness. The fear of hidden and unaffordable costs keep many seniors from seeking out medical care until they have reached crisis or near-crisis point. This simultaneously drives up the cost of treatment, for them and for taxpayers if the senior hasn't funds to pay the bills.
A few months ago a relative by marriage developed a blood disorder. The relative collapsed, was taken by ambulance to the hospital where they stayed for several days of transfusions and tests to ascertain the condition. The relative returned home, relapsed, and was returned to the hospital via emergency services. Testing, evaluations, and transfusions will continue on a weekly basis. The bills are just starting to come in. Medicare is supporting a good deal of the cost; my relative informs me that their out-of-pocket portion, so far, is more than $100,000. These are people who made double mortgage payments for years and now own their home, have worked three-four jobs between them for years and had excellent credit. At near retirement age, these bills will wipe them out. They are terrified.
JJ Racine
8:32 am on Thursday, June 28, 2012
@Bren - You say that your relative is "at near retirement age"... I wonder why they are already using Medicare for their medical coverage in that case? Shouldn't they have been using some of the boundless extra money they used to pay off their house early to pay for a health plan so that this would not happen to them. Again sounds to me like another case of choices gone badly. I have a good friend who made poor choices with starting their own business and chose not to pay for healthcare and ended up get cancer (twice), the government (taxpayers) stepped in and picked up most of the bills although he is less with a sizable sum and I'm glad he was able to be treated but I do not take pitty on him for owing the money.... again we are all responsible for the choices we make. Unfortunately bad things happen to all people sometimes, there is nothing we or the government can do to stop that but as the old saying goes an ounce of prevention is worth a pound of cure in most cases - plan for the worst, hope for the best - planning as in paying for healthcare to help you out if/when those bad things happen. I do, however, sincerely hope your relative recovers from their illness and is able to work out their financial issues.
Randy1949
8:16 pm on Wednesday, June 27, 2012
So-called professional birth control -- limiting the number of medical school admissions to keep up the income of doctors was being talked about even when I was young.
GearHead
9:37 pm on Wednesday, June 27, 2012
OK Lyle. So Cuba out-doctors US by 3 ta 1? So what? Wanna go there for your next life-saving operation? Do tell. Get real! Isn't that statement like saying Thailand out-farmers us 1000 ta 1? Your commie freak flag has just shot down any last credibility you thought you had. UNBELIEVEABLE!
Lyle Ruble
9:48 pm on Wednesday, June 27, 2012
@GearHead...The reference to Cuba is to show how far we are from the having enough physicians to meet the needs of our society. What is disturbing is that we spend so much and get so little in return. This doesn't have anything to do with whether Cuba is a communist nation or not. It just shows they have more of a committment to healthcare. I don't know about you but I think it's nearly criminal that we are last when compared to all the developed nations in the world.
GearHead
11:24 pm on Wednesday, June 27, 2012
We have plenty of doctors to meet the needs of society. What we don't have is a system were the cost of providing care has anything to do with the price of same, let alone with who pays for it. More free enterprise, portability of insurance and recipients actually having to fork out real money for service rendered will quickly bring the inequalities in line. Get the gov out of the med business (opposite of what you continue to advocate) and prices will drop to zilch for basic care. It's economics, stupid!
Keith Schmitz
7:24 am on Thursday, June 28, 2012
More free enterprise? It's what got us in this -- and other trouble. The idea that someone is going to fork out their own pocket for a heart operation or a long cancer therapy -- especially when someone is too sick to work -- is insane and sociopathic.
When government "is in the way," is a large part of the solution, but of course that doesn't fit in the talking points.
J. B. Schmidt
7:47 am on Thursday, June 28, 2012
@Keith
Wrong, regarding free enterprise. It is heavy government regulation on how the administrative side of medicine is conducted and heavy regulation on how insurance can be sold that has driven up costs.
Insurance costs would go down if people could pick and choose the coverage you wanted based on your needs. For instance, if you could purchase medical insurance like car insurance, you would pick your coverage based on your needs and the insurance would weigh your risks and provide a price. Instead, we live under this screwy model of equality where we have tried to fit all people under the same insurance model. Let me decide if I want cancer coverage, hypertension coverage or viagra coverage; then make me responsible for my poor choices. People would not only be more conscious of the cost, but they would also be more conscious of their lifestyles. This would create competition and drive prices down, just like we see in elective surgeries suck as lasik and cosmetic surgeries.
Bob McBride
10:05 pm on Wednesday, June 27, 2012
I assume you dropped or added a zero here...
"Currently the U.S. has 24 physicians per 10,000 of population, while Cuba leads the world with 67 per 100,000."
Greg
10:36 pm on Wednesday, June 27, 2012
That would be 240/100,000, we win.
$$andSense
10:12 pm on Wednesday, June 27, 2012
Isn't it the same as all those that want to cut the cost of providing services such as garbage collection, snow plowing, etc. but want the level of service to remain the same or better?
Bob McBride
10:16 pm on Wednesday, June 27, 2012
Why, on the one hand, when it comes to physicians and others in the health care field is it assumed that a reduction in compensation (via increasing the number in the field) won't result in a degradation in the quality of services provided when the exact opposite effect is argued as being the result when it comes to those in the teaching profession?
Keith Schmitz
11:17 pm on Wednesday, June 27, 2012
Because doctors get paid a lot more than teachers. It could be argued that there are a lot fewer doctors than teachers, which is true, but it seems many of our partner countries in the western world get away with paying doctors less and teachers more, with better outcomes than we have.
Bob McBride
11:32 pm on Wednesday, June 27, 2012
Got any countries in particular you can point to for that?
Keith Schmitz
7:20 am on Thursday, June 28, 2012
Practically all of Europe.
Bob McBride
7:39 am on Thursday, June 28, 2012
I didn't think so.
Greg
10:34 pm on Wednesday, June 27, 2012
I was thinking about our fully funded pension/healthcare benefits, and how it may retain or even draw quality teachers to Wisconsin, when I came up with a question. I know it is off topic, but maybe some one knows the answer.
Since we did not read it before we signed it, does anyone know how universal healthcare will affect public sector retiree healthcare benefits? Also, will current public sector employees be expected to sign-on to the program?
Keith Schmitz
11:19 pm on Wednesday, June 27, 2012
In reality, public service employees are already on a universal health care system, so they would be unaffected.
Greg
9:42 pm on Friday, June 29, 2012
WEA Trust is a universal health care system? HMMM...
Keith Schmitz
11:20 pm on Wednesday, June 27, 2012
Tomorrow we might find out who the real death panel is.
GearHead
11:30 pm on Wednesday, June 27, 2012
Having the supreme court take out your death panel bugs you, eh Keith?
Keith Schmitz
7:20 am on Thursday, June 28, 2012
You richly live up to your name don't you? Death panels in the ACA were debunked as the standard right wing lies a long time ago.
Steve ®
11:55 pm on Wednesday, June 27, 2012
►will be a plan to move from our current private system to a mixed private/public partnership that will increase affordable healthcare availability to all.◄
yeah that's getting shot down tomorrow
►U.S. GDP $15.06 trillion (2011 est.)◄
And our socialist debt is at $15.8 trillion and counting . . . . . . . .
Let's spend more by giving more cool stuff for free!!!!!!!
J. B. Schmidt
1:07 am on Thursday, June 28, 2012
I don't see how adding doctors or giving the government additional cost control measures will change anything. What we have is a battle between traditional American Freedoms and European socialism. It is nearly impossible to compare the European model and the American model. Most countries in Europe with the best health care are isolated indigenous peoples that have evolved culturally to use medicine responsibly to the benefit of others. Those countries are now facing huge problems with immigrants unable to work within that cultural ideal and their health care systems are being strained just as the US.
In the US, we are a glutinous people. We live hard, we play hard and we expect to be left alone. We are held in check by either supply and demand or the harsh reality of personal responsibility. When you mix freedom with entitlements (such as universal health care) you end up with freeloaders. People unwilling to change because they are no longer hampered by supply and demand or personal responsibility. Then when it goes wrong (or at least less then optimal), we have the ability to take up litigation. Adding a third piece to the puzzle, over testing. Our health care costs have ballooned because 1) Doctors will give you every test +1 in order to CYA. 2) Government has removed supply and demand because no hospital can refuse you whether or not you can pay and company sponsored health insurance has removed all price shopping from the consumer.
Bren
1:32 am on Thursday, June 28, 2012
J.B., how do you think NHS plans are funded? Through taxes. They are not free.
Here's an example, based on a comparison review I had with a Canadian who made approximately the same salary I did at the time (2007). Base salary? Check and check. Taxes, including healthcare for him, about 35%. Taxes and health insurance, about 35%. Here's where the fun started. Office co-pays? His were covered, mine were $20. Pharma? His were covered, mine was $20 co-pay ($6 generic). Medical bills: His were paid through his NHCP, mine had a $5,000 deductible and 20% out-of-pocket. Dental: Not part of the NHCP but many Canadian employers pay for it as a perk. I paid a monthly premium.
So something is really wrong with our system. If you think of NHCP as a really large single payer plan, does that help you understand that people who pay in are not freeloaders? Does the idea of health care access without co-pays or out-of-pockets appeal? It does to me. I pay a fortune for health insurance and the last time I tried to use it (broken leg) my expenses did not meet the deductible so were not covered. That's just ridiculous.
J. B. Schmidt
7:34 am on Thursday, June 28, 2012
@Bren
You completely missed my point. American culture has not adapted to a national health care plan.
In Canada they are prepared to wait nearly double the amount of time for procedures and ER visits then in the US. In the US we litigate at a 350% greater rate then in Canada. Also, in the US we have far greater administrative mandates and insurance mandates that increase the overall cost of doing business in American medicine.
In the universal medical coverage model, you do pay for it via taxes, but you also have unrestricted access to any medicine you want. Since as a society we have felt entitled to the best, this open format to unrestricted care will give many the opportunity to abuse the system. Medicine works best out of necessity and not out of some sense of entitlement. In the US we have already become over dependent on our physicians ability to cure us. When we take our kids into the doctor for the sniffles, we want the correct answer immediately and then drugs to fix it. This already burdens our system with countless meaningless procedures and test. Doctors live by the CYA model of medicine and not common sense. The example of the family practitioner that Lyle eludes to is dead because we as a culture have come to deny the 'take two of these and call me in the morning' routine in favor of immediate actions and solutions. (cont)
J. B. Schmidt
7:34 am on Thursday, June 28, 2012
@Bren (cont)
Under a single payer system, that can be exploited to no ends. Returning the decision making responsibility to the consumer based on free market principles is the only way to prevent abuse under the current American cultural dynamic.
J. B. Schmidt
1:08 am on Thursday, June 28, 2012
3) If I get to be 7000lbs it doesn't matter because Greendale FD will forklift me to St. Lukes where they will give me drugs to lose weight. It wasn't my fault any way, it was McDonald's, relieving me of all responsibility.
The only solution that will work for America because of how our culture evolved is to institute high levels of personal responsibility, return real competition and price shopping to the health care system and remove (or strictly limit) litigation on non-criminal medical procedures gone wrong.
Adding doctors does nothing to cure the above and will only inflame the situation by providing freeloaders with more and easier access. Not to mention, pointing fingers at the medical profession for having high standards and making an MD suffer in order to prove his/her abilities may not be wise. The alternative might look ugly.
Eric
4:55 am on Thursday, June 28, 2012
I’ve experienced socialized medicine during two periods in my life: from NHS as a university student in Great Britain, and from the Department of Defense as a career military member. In both cases I found the care good, but with some limits. First, the choice of physician was sometimes restricted (although I find this to also be true in US civilian healthcare today). Second, elective surgery was usually delayed, often for months. I believe this relates to some things Lyle addressed, in socialized medicine specialized physicians get paid less than their counterparts in the US civilian healthcare system, hence I believe there are fewer specialists in socialized medicine systems, and longer waits for their services.
Eric
4:55 am on Thursday, June 28, 2012
The goal of a health system is to provide services to all members of society at an affordable cost. Our American system clearly struggles with accelerating costs, some inefficient delivery methods, and a shortage of primary care providers. An increase in primary care doctors, physician assistants, and nurse practitioners will help. A shift to compensating providers for successful treatment and away from fees for services to protect against malpractice is working in some places. The need for patients to understand the costs of their care and how it’s paid for – in the current system determining and comparing costs can be mind boggling and when coupled with an impression it’s all free because the insurance or the government pays for it, is a recipe for cost disaster. Co-pays/cost-shares/deductibles are incentives for patients to better understand health services and not abuse them.
Eric
4:56 am on Thursday, June 28, 2012
The term “health insurance” is a misnomer, since in addition to insuring against catastrophes, it also pays for routine care – this would be like your car insurance paying for oil changes. Is the health insurance company an unnecessary middle man for routine care? Seems many have abandoned dental insurance, at least partially for that reason. However, the ability to shop among complicated medical billing rates is difficult at best, and sometimes impossible. Furthermore, there are some folks who will never have the skills to do so. As much as I like Paul Ryan, I shudder at the idea of seniors trying to shop around for medical services or insurance coverage. Perhaps it is time we adopt a national health service that uses provider compensation models based on successful treatment and charges patients cost-shares. This could eliminate primary care in the ER and as employees of the federal government providers would not be subject to malpractice suits. Must admit that at a time when public education is under legitimate challenges for its shortcomings, it seems odd that the private health care system may fare better if nationalized.
Lyle Ruble
7:32 am on Thursday, June 28, 2012
ATTENTION EVERYONE! I missed a typo and the rate of US physicians per 100,000 is not 24:10,000 but 24:100,000. My apologies to all.
Chris
7:40 am on Thursday, June 28, 2012
There are so many layers to why health care costs are what they are. Certainly supply/demand is one large part. Forget just the doctors. What about the medical researchers/scientists? How about the engineering that goes into new devices? How about customer expectation? Third party payers? CYA testing? End of life care?
You can try to compare our costs with other countries, but frankly, it's not an apples/apples comparison.
JB made great points about the health results about indigenous peoples with higher health outcomes. It's familial support. It's a 2 parent families raising kids. It's multi-generational families caring for each other. It's a general knowledge passed on from generation to generation about home remedies for simple illnesses. It's families living in the same area for generations, building community, and caring for their neighbors. Agrarian societies with very low levels of obesity.
Chris
7:50 am on Thursday, June 28, 2012
A great story to demonstrate just one part of the problem.
Most of us on this board, if we get a rash, what will we do. We will first think perhaps it may be a change in soap, or detergent, or perhaps we spent time in the yard. We'll go to Target, get some cortizone cream, rub that on, see how it goes. Most times, it clears up on its own, no trip to the doctor.
I work with mostly lower income employees. One, had a slight rash on her leg, no doubt itching. She showed it to her co-workers. They convinced her the best course of action was for her to leave work, and go to the ER. It was a very light reaction to a spider bite. This is just one symptom of a much larger problem. And whether insurance pays for this, or taxes, this type of behavior costs all of us money...and I'm certain this type of behavior happens all over the country, many times each day. No way this happens in one of the countries often cited for having lower costs/higher health outcomes.
Bob McBride
8:28 am on Thursday, June 28, 2012
I recently injured my leg and ended up going down to the ER at CSM on North Ave. I was taken into an area that I came to learn later was a "fast-track" department - it was anything but, but that's another story. Anyways, apparently it's a set of rooms designed for people who come in with sore throats, coughs, etc. I was there long enough to observe a couple of instances of people just bolting once they got treated for whatever it was they came in for. Very little sense of urgency in the department and none of the disappearances were treated as anything much out of the ordinary.
I wouldn't suggest only low income folks approach medical care in this fashion. I know plenty of folks in the suburbs who hustle themselves or their kids off to the doctors office every time they get a cough or a fever. Plans with low or no copays encourage that kind of behavior. Regardless of who's running the health care system, there should be some incentive to not run off to a doctors office or ER for conditions that can be easily treated with OTC remedies and rest.
I spent 4 hours in the 'fast track" department that day. When it was determined I had insurance, I was asked for an immediate $250 payment. They could have very easily had me in and out of their sooner. I believe that the delay was intentional and probably SOP. For those who go there w/o any ability to pay, that might be the only incentive they can attempt to use to encourage them not to overuse the system.
Randy1949
9:15 am on Thursday, June 28, 2012
Not running to the doctor for every little thing usually saves money ninety-nine times out of a hundred. But you do get that rare occurrence when a simple antibiotic could have prevented a week in the hospital.
I'm completely self-pay, so I usually adopt a wait and see philosophy, even with what once might have been a broken bone. But once, I was bitten severely by a cat, and I did the smart thing and paid the Urgent Care visit and the cost of the expensive antibiotic prescription. It's better than risking the loss of a hand.
People without healthcare access who allow small problems to develop into large problems will actually cost us more in the long run.
Chris
7:53 am on Thursday, June 28, 2012
I certainly don't know what the answer is. I just know what I do. I have a high deductible plan with a HSA. I pay 100% for office visits, yet yearly physicals/vaccinations are covered at 100% with no co-pay/deductible, so the preventable care is covered, and I am actually motivated to use that yearly physical. After I meet my deductible, all services are covered at 100%. This encourages me NOT to run to the doctor for every sore throat/knee ache/light rash, as well as make positive choices in what I put in my pie hole, and what kind of activities I partake in, being exercise, volunteer gardening/landscaping, camping, hiking, etc. This helps to keep my healthcare costs very low.
Chris
8:08 am on Thursday, June 28, 2012
Admittedly, I, nor anyone in my family, has a chronic illness...but on the flip side of that, we do everything within our power to help prevent any of us from getting one.
The solution has to be a large part personal responsibility. Some part social safety net. Part change in customer expectation (expectation of end of life intervention for an example, or having a pill for every malady vs. changing lifestyle). Change in supply/demand.
J. B. Schmidt
8:25 am on Thursday, June 28, 2012
@Chris
I agree. I am not willing to pull the rug of health care out from those that truly can't afford; however, in order to calculation affordability we must factor in the lifestyle choices of those in need of medical assistance. Some companies offer health discounts for participating in health screenings. It needs to go further. We should be providing health discounts for those that make significant improvements in healthy lifestyle choices year over year and at the same time increasing the cost to those that refuse and burden the system with additional risk.
Chris
8:47 am on Thursday, June 28, 2012
@J.B.
There has to be some upside to making positive choices (other than an inner euphoria), and a severe downside to making negative health choices, which would include NOT getting a yearly physical, smoking, obesity, substance abuse, etc.
If I personally make poor decisions regarding my health (perhaps something as benign as not warming up properly before I workout), I have a negative impact (other than the embarrassment of doing something stupid) on my life (added cost).
But his goes to all levels. I have something to lose with any negative decision I make...where we as a society have determined that no matter how many poor decisions one makes, there is a limited downside to that negative behavior. So, once a person has dug themselves a hole, we have removed any incentive for them to stop digging.
Jay Sykes
8:58 am on Thursday, June 28, 2012
Please read this 2009 WSJ detailing the experience of Safeway Grocery with health discounts,health screenings and the overall healthcare market. Be certain to make note that the federal government severely restricts the availability and usage of health discounts. This governmental limitation effectively raises rates,by about 40%, for those of us that act responsibly
http://online.wsj.com/article/SB124476804026308603.html
Daniel S.
12:55 pm on Thursday, June 28, 2012
"However, the bulk of medical costs expended in our system is during the last six months to two years of life" Home Hospice and the acceptance of the reality of death can help to considerably lower this. As for Bankruptcies being due to medical bills, it's highly debatable. You could say numbers don't lie, but people do. We don't know why a bankruptcy was really filed, except that they were over their heads per their filed documents.