Annals of Medicine: The Cost Conundrum

Discussion in 'Politics, Religion, Social Issues' started by mactastic, Jun 9, 2009.

  1. mactastic macrumors 68040

    mactastic

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    #1
    Intriguing article. Long, but I would suggest anyone interested in the health care debate read the entire thing.

    Some excerpts:
     
  2. gauchogolfer macrumors 603

    gauchogolfer

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    #2
    I posted this article in one of the health care threads, and didn't get much response. It's very well written, albeit a bit long for some I suppose.

    Hopefully your standalone thread will generate more interest.
     
  3. Don't panic macrumors 603

    Don't panic

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    #3
    brilliant article.

    i have to say i am not too surprised that one of the root causes of the problem is one of the root causes of most problems: Greed.

    Also one for which there is no easy solution, especially in a place where any moves toward common sense tend to be addressed by large swats of the populations (including those who would most benefit from said moves) by shrill cries of : Socialism! Socialism!
     
  4. mactastic thread starter macrumors 68040

    mactastic

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    #4
    My apologies. I completely missed that when you posted it. And yes, hopefully a standalone thread will help generate discussion. This article certainly merits that level of discussion, as I think it hits the nail right on the head in identifying the problem with health care in this country.
     
  5. Ugg macrumors 68000

    Ugg

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    #5
    It's a great article and I didn't see it either or I would have commented on it.

    I do agree that "build it and they will come" has been the mantra of the health industry and the results have been disastrous. Greed trumps common sense all too often.

    One thing that's really been bothering me these last weeks is the all or nothing mentality coming from each side. Private medicine and health insurance have proven again and again since the Reagan years to be a total failure in most measurable ways. I, although a strong advocate of government sponsored health care of some sort believe that a totally public system would also fail.

    Germany allows people who make over ~4000 euros a month to buy private insurance, and everyone else has to buy into the public system. Employees pay half and employers pay half. The insurance system is treated like the US treats public utilities. No, it's not perfect, doctors are underpaid but the standard of care is far superior to that offered in many US states. Nor is there a post code lottery like in Britain. The only regional difference is largely due to the difficulty in attracting doctors to rural ares.

    Dual systems have a way of providing a minimum of competition as well as allowing a certain amount of aspiration. I know that most Americans are horrified at the idea of "class" but de Toqueville never really understood that while the rich and the poor may mingle in the street, when it comes to all things behind closed doors, there has never been any equality, ever.

    Better to label a spade a spade and be done with it.
     
  6. Shivetya macrumors 65816

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    #6
    Germany and Great Britain both have similar allowances, you want to know what it means. If your on the public insurance you can be assured to have crap service. You can get booted from individual rooms for real paying customers.

    how do you think that will fly here?



    Look, the idea of government sponsored health care sucks. They can't even get Medicare to work. Why not make that one work first? It already is a burden to doctors. It already has a high percentage of fraud and waste.


    About that "profit kick" which shows a women would get x,x,x,and x treatments. Guess what, a lot of what occurs is mandated by local, state, or federal laws. I can guarantee that in many cases if said person were sent home there would be just as many articles bemoaning cruel and profit seeking private health care and that sending her home PROVES you need government care.

    In other words, they can take the same scenario and get a positive result for their case regardless how the scenario was handled.


    Go look at Canada, they are back tracking FAST from their government mismanaged health care. Doctor shortages, waits for common investigations, and treatments.
     
  7. .Andy macrumors 68030

    .Andy

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    #7
    I went to a lecture the other day where the speaker spent a lot of time comparing universal healthcare systems with the american system. The general thesis of his talk was that under the universal healthcare systems such as that in australia, it was the overwhelming majority of general practitioners compared to specialists that kept the costs down. i.e. people being treated by a GP and in a sense triaged through to specialists as required results in an overall lower cost with superior outcome measures. It was interesting and I'm going to pursue it more in my spare time.

    No you can't.

    It does suck. But it's eminently better than the system the US employs. The US infant mortality rates and life expectancy are an atrocity for a first world country. Let alone the richest first world country.

    No they're not. Like all healthcare systems they need to be dynamic as the needs and characteristics of society change. But again, even though universal healthcare coverage isn't perfect by any stretch of the imagination it's still much better than the US system. You've got upwards of 40 million people without health insurance who therefore don't have access to basic healthcare. That's just plain abhorrent and has a massive and detrimental shockwave through society.
     
  8. SLC Flyfishing macrumors 65816

    SLC Flyfishing

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    #8
    They've got to do a major overhaul of the US drug R&D system if they want to make any leeway here. As it stands a drug company is generally spending ~10 billion to bring a drug to market and jump through all the FDA hoops (not that the hoops are a bad thing, I think they work quite well actually) but then after all is said and done they have usually 10 years or less to make up the funds before the patent expires and the generics hit.

    source http://www.forbes.com/2005/03/09/cx_mh_0309plavix.html

    Since it takes 10 years or more to get a drug through FDA approval, the company has to make a billion a year on average on the drug just to break even before cheap generic competition spoils all opportunity to do so.

    I'd love to participate some more in this discussion, I have a lot of input that I'd share but I've got to go get ready for work now, perhaps later today.

    SLC
     
  9. SLC Flyfishing macrumors 65816

    SLC Flyfishing

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    #9
    Can you pin this stat solely on the lack of universal health care? I'm pretty sure the fact that we're caring for a ton of very pre-term babies here has a lot to do with our infant mortality rate.

    SLC
     
  10. .Andy macrumors 68030

    .Andy

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    #10
    You can pin in on the lack of basic healthcare of all kinds that a large proportion of your population receives.

    All other western healthcare systems do this as well. The US isn't specifically special when it comes to caring for premature babies. edit: just tried to check some papers for this but can't find anything that shows a difference. Would welcome data otherwise.....

    The US infant mortality has come down dramatically, however those in lower socioeconomic groups haven't benefitted as much and are what is holding your figures back. Which is exactly what the system that the US employs is set up to do. Provide better care to those that can afford it. Those who can't bear the brunt with horrible consequences that are largely avoidable. An equitable system benefits all. However it might not necessarily be a european model of universal healthcare that is the best for the US. It'll be interesting to see what is debated and what is instigated. Either way it's going to take some balls and a large investment in time and money to change the current system.
     
  11. Desertrat macrumors newbie

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    #11
    The McAllen area has a much higher percentage of retirees and snowbirds than El Paso. Many more Olde Pharts. Ergo, many more heart attacks, strokes and cancers--which are the most expensive types of medical treatment.

    FWIW, my cancer in 2003 cost Medicare $30K; my out-of-pocket cost was $10K. No other medical costs to any insurance coverage for the previous 45 years.

    'Rat
     
  12. SLC Flyfishing macrumors 65816

    SLC Flyfishing

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    #12
    All the lecturers in my Public Health Classes have listed the following as the top 5 infant mortality statistics:
    1. Congenital Malformation/Chromosomal Abnormality
    2. Low Birth Weight (less than 2.41 kg)
    3. Sudden Infant Death Syndrome
    4. Respiratory Distress in the infant
    5. Maternal Complications of Pregnancy

    Most of those I can't see clinicians having too much of an ability to prevent, and only limited tools to use to treat. Clinicians can do nothing about SIDS in reality. What are the top 5 causes of infant mortality in the countries which rank highly?

    #2 and #4 are very closely correlated with prematurity.

    I know 5 or 6 couples personally who have lost newborns to congenital heart defects. Most didn't live more than a few hours, and those influence the infant mortality statistics. Others are given the opportunity to give birth to a very premature baby that is known to have a lethal birth defect so that they can spend a few moments with the baby. These would also make it onto the statistics if they survived the labor. Are situations like that allowable in Australia?

    Here's another bit of opinion I dug up quickly.

    Source: http://www.scientificamerican.com/b...baby-come-back-us-infant-mortality-2008-10-15

    SLC
     
  13. Ugg macrumors 68000

    Ugg

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    #13
    It's amazing that you totally ignore prenatal wellness programs in your "scientific" analysis. Preventative care is one of the major reasons that Europe in general has such a low infant mortality rate. By claiming that clinicians are helpless in reducing infant mortality is ignoring over a hundred years of preventative care in Europe.

    Obesity is a major cause of miscarriages as well as infertility. Preventative care would tackle obesity head on.

    Rather than throw your hands up in the air and say your god will do what he will do, why don't you face up to the fact that America has done a piss poor job on health care since LBJ.
     
  14. SLC Flyfishing macrumors 65816

    SLC Flyfishing

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    #14
    Excuse me? I have ignored nothing. All I've done is list the top 5 infant mortality statistics for the USA and given the prevailing opinion as I can find it as to why some of it occurs.

    You lecture me about my "scientific analysis" and then blabber on about miscarriage and infertility which has absolutely nothing to do with infant mortality?

    I'm not throwing my hands in the air at all. I'm looking at causation which you should know is the first step in fixing a problem. I haven't mentioned anything of my "God" or what he will or will not do, so I don't know where that came from. And I beg to differ that America has done a "piss poor job" on healthcare since LBJ. America's health care system is the most technologically advanced in the world, our physicians are th most skilled in the world, and we have the largest health care infrastructure in the world. I don't know where you come off making the statement that we've done a "piss poor job" at all. You really need to qualify that statement, and think about what you type before you go off all half cocked in future posts.

    I don't even know where you got your angry tone from, my post wasn't malicious in any way, and not directed at anybody or anything.

    SLC
     
  15. mactastic thread starter macrumors 68040

    mactastic

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    #15
    Surely you're not claiming that it's the government's fault that care providers commit fraud? Is it the cops fault that people commit crimes too? :confused:

    Got a link to prove that "a lot of what occurs is mandated by local, state, or federal laws"?

    I would agree, although with the caveat that there needs to be some kind of dual-track system for drug development, one for profit and another for other drugs. Currently, drug makers are incentivized to develop drugs that don't cure, but are rather designed to be taken for a lifetime. They are also incentivized to produce drugs for things like ED rather than other less lucrative products.

    They also need to seriously clamp down on the schmoozing (aka bribing) big pharma is allowed to do with doctors.

    That doesn't explain things. Many other communities also attract snowbirds, but are able to keep costs down. The culprit seems to be a culture of maximizing profits at the expense of the taxpayer and insurance payer.
     
  16. SLC Flyfishing macrumors 65816

    SLC Flyfishing

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    #16
    There is a "dual track system" in place already (If I understand correctly what you're hinting at here). Drug companies are on their own in developing drugs which will be used widely and often; with the idea that they will be able to turn a profit eventually. But the orphaned drug act essentially renders assistance in various forms for drug companies to incentivize the development of drugs that would never have a hope of being profitable in the market. This act helps in the development of drugs for conditions that few people are afflicted with, or that are necessary but used rarely. The Federal Government will help pay for R&D, will extend patents, among other things to help ensure that the company that develops the drug will be compensated for doing so. It's a pretty good system from what I can gather.

    I agree 100%. I think extending the patents so that Drug companies didn't have to make such a scramble to make it into the black would go a long way toward reducing this. Not 100% (they are still businesses after all) but I can't help but imagine that a lot of the pressure put on doctors comes from this issue.

    SLC
     
  17. miloblithe macrumors 68020

    miloblithe

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    #17
    The dual track idea is that there's one track like the current system where companies can patent drugs that they believe will be profitable because they are targeted at high-income customers (the best example being ED or hair loss medication), and another track where companies are paid according to the health impact the drugs have (disability adjusted life years?), and would be paid out of a global fund for such medications (an example being something like antimalarials that are designed for poorer malaria-endemic environments rather than rich-world travelers). Companies can choose their track depending on whatever they think will yield them the greatest profit.
     
  18. .Andy macrumors 68030

    .Andy

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    #18
    2, 3, 4, 5 all have higher rates in low socioeconomic classes. Those that can't afford adequate healthcare. Addressing inequality will hence reduce the infant mortality rates.

    Likewise those that can't afford treatments for 1 - and some congenital heart defects are most certainly curable. There's no reason why the US has a greater burden on congenital malformations than any other country. There is no special US bad heart gene.

    This is not true. Clnicians have done wonders in reducing the rates of SIDS. Figuring out the links between sleeping position and SIDS has been a great boon. Also things smoking and head-covering. Again SIDS is higher in low socioeconomic groups. What you're claiming here is rather dangerous.

    And prematurely is higher in low socioeconomic groups that have limited access to healthcare.

    The US doesn't have a higher burden of congenital defects than any other country.

    If it's indicated and won't cause the child unnecessary pain and suffering. There is no massive difference between the US and australia in what it does with premature babies. We've both got the same healthcare and use the same scientific evidence. There are no systematic differences as you're trying to indicate.

    The US infant mortality has long been lagging. It isn't due to a recent increase in premature babies. All western countries are experiencing a similar trend with increases in maternal age and increases in the use of assisted reproductive technologies.
     

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