Health Care Procedural Machinations

Post Reply New Topic

It may not be better than the U.S. under the old system, but it's better than the UK, if you have first world amounts of money to throw around at doctors paid at third world rates. For some procedures, it's worth making the trip to India - and a lot of people in the UK do.

Actually, my father had a heart attack in China a few years ago and got care as good or better than the U.S. as well. It was covered by his health insurance, which at first glance was surprising but became less so when you realized that the cost was an order of magnitude less than in the U.S. The insurance company must have thought it was a great deal! Obviously you can't arrange to have your heart attacks in China, but it could work for other procedures.


I wonder how many American will still not get treatment because they are part of the 15% left uninsured under the new law. In my state, that's an increase in the percentage uninsured.


Indeed. And there are changes that could help fix that.

- Prescribing drugs is safe from a tort perspective, because it's accepted practice. Prescribing the Atkins diet, which has been shown to be the most effective of popular weight loss diet, is lawsuit bait because it's not accepted practice and is unpopular in the medical world. Medical tort reform could help fix that. But that was left unaddressed in the law, presumably because lawyers who benefit from lawsuits are more politically powerful than malpractice insurers.

- Having insurance that was portable from job to job would give the insurance companies a strong incentive to improve their patients' long term health, and insurance companies may be in an even better position than individual doctors to change medical practice to things that work. However, the new law makes this even more difficult by imposing even stiffer disincentives than now for breaking the tie between health care and the employer.

- Having insurance that was portable from state to state would provide some of the same benefits as insurance that was portable from job to job. Again, this was completely unaddressed in the new law.

I'm not opposed to health care reform. I just want reform that makes things better, rather than worse as the law just passed does.

I'm absolutely not trying to claim that the new law is perfect - just pointing out that the Brittish system is, in many ways, better than the *current* American system and that the *current* American system has a lot of problems.

That whole, "America has the best health care in the world!" schill is absolute BS, to the degree that I'm amazed that politicians aren't embarassed to say it out loud.

In the U.S.A. first rate medical technology is available and constantly being developed. It is in the area of delivery and cost control the the American system suffers the most. Our poorest people are forced to use Emergency Rooms which are the most expensive way of delivering care. It is utter and complete madness. We should fund good base level care to our poorest just to keep the out o f the emergency rooms and so people who have real emergencies can be treated quickly. Or triage system is just plain crazy. From a cost point of view it is cheaper to give the wretched and the poor sufficient crumbs so they do not have to gouge out care from the emergency care delivery system. Give the beggars some alms. It will shut them up and we will have peace and quiet.

ruveyn

There's also the problem of poor people who have truly emergent conditions, and are honorable enough to be concerned about paying their bills. It's not unusual for a middle-aged man with chest pain to tell himself, 'it's just a pulled muscle,' for a week because he has no insurance or because his ER deductable is to high for him to afford. By the time he comes in, what could have been cured (or nearly so) with a trip to the cath lab, has turned into permanent congestive heart failure that the guy will have to live with for the rest of his life, with decreased quality of life and decreased productivity.

If one sees the problems of our medical service delivery from a purely dollars and sense p.o.v. then it makes very good sense to provide medical care early to prevent a treatable condition from becoming acute or untreatable later on. This would cut down overhead costs considerably. From this p.o.v. the money spent can be seen as an investment in health and productivity.

There is only one problem. Our government is corrupt, stupid, short-sighted and incompetent. It cannot be trusted to take a sound engineering and accounting principle to a successful and useful condition. In short, the governments at the various levels in the United States are likely to screw up any good idea with a .99 probability. I surely would not trust the government that brought us the Challenger Disaster, the Columbia Disaster, the utter failure of emergency services in response to Hurricane Katrina to do anything right. We have a government that is not capable of boiling eggs. On the home front I would not trust the State of New Jersey which is run by people from central casting for -The Supranos- to do anything honestly, openly or with competence.

On the matter of medical service delivery, I am at my wits end. Government can't do it right. The market place is so distorted with laws generating perverse incentives that the market can't do it right. I know what has to be done, and I am damned if I can find a way of making it happen.

ruveyn

Is it really true that government is so incompetent? I believe you are falling to the availability heuristic: government's failures are very high-profile, while their successes are less visible simply because you take them for granted. Here's a brief listing of successful government programs:
The Interstate Highway System, a crucial part of our national infrastructure and something completely unparalleled in the private sector
Public health efforts, including the global eradication of smallpox and the eradication (or near eradication) from the United States of polio, malaria, measles, tetanus, rubella, cholera, and many others. Furthermore, safe and effective flu vaccines come out every year like clockwork, courtesy of the government-run CDC.
FDIC, which by guaranteeing your bank account up to a certain amount effectively prevents the mass bank failures that were last seen during the Great Depression.
Medicare, which you personally benefit from.
Educational subsidies for veterans and low-income Americans, allowing many people a route into the middle class. I collect federal money to help pay for my education, even though I attend a private university.
Safety regulations: companies do not always recall defective and dangerous products on their own, and the meddling hand of the federal government does a fair bit to keep you safe from harm.
Pollution regulations: Air and water quality is better now than it was in the 1960s before these regulations were implemented.
Military: No other nation in the world can possibly match our military; in fact, the rest of the world combined would have a difficult time matching our military might, even though we have only 6% of the world population.
Science: The government funds 80% of basic research in America.
The Aqueduct.
[youtube]http://www.youtube.com/watch?v=ExWfh6sGyso[/youtube]

The reason this middle aged man doesn't go to the doctor for chest pain is because the doctor inevitably tells me, "it's just a pulled muscle". He won't tell me how he tells the difference, though. I figure I'll wait til I get a real heart attack and it will be obvious.

The diaphoresis, shortness of breath, radiation of pain to the back, jaw, and/or left arm, weakness, and complaint of 'an elephant standing on my chest' are pretty good indicators. In the absence of those indicators, the doctor can still order blood for cardiac enzymes and an EKG.
It's true that the two are still occasionally confused and diagnoses are missed, but it does not happen as often as episodes of "ER" and other medical dramas would have you believe. Heart attacks *are* missed fairly often in women, who make comments like, "well, sure, my chest hurts, but it's nothing compared to childbirth," and tend to have the associated cues less frequently than men.



You're forgetting that NASA is an independent organization, and FEMA at the time of Katrina was run by an Arabian-horse expert appointed by a man whose political party has the stated intention of 'getting the government small enough to drown in a bathtub.'

It's not really very easy to help out after natural disasters when one's organization is small enough and weak enough to drown in a bathtub.

NASA was created by Congress and is 100 percent funded by the taxpayers.

ruveyn

Yes, but it is independently administered. The people who made the choice to launch the Challenger despite the engineers' warnings were not government appointees nor elected representatives.

The engineers were contractors. The management is hired by whom? The head of NASA and the board of directors is government appointed. NASA is government from stem to stern. You can tell by its botched operations.

Here is the blurb from Wiki telling how NASA came to be:
The National Aeronautics and Space Administration (NASA, pronounced /ˈnæsə/) is an agency of the United States government, responsible for the nation's civilian space program. NASA was established by the National Aeronautics and Space Act on July 29, 1958, replacing its predecessor, the National Advisory Committee for Aeronautics (NACA). The agency became operational on October 1, 1958



ruveyn

Are you saying that I should be able to tell without a doctor? If so, why do we need a doctor again?

So Ruveyn, ignoring my list of successful government programs? And NASA has had a number of successes as well. They got some men to the moon and back, and a lot of useful technologies have emerged as a result of their efforts.

A broken 12 hour clock tells the right time twice a day.

Overall, government has no incentive to perform well. The sheeple tend to vote whoever looks prettiest on t.v., so there is little hope of improvement from the people at large.

ruveyn

It is both amusing and appalling, ruveyn, in he way you have these ironclad attitudes towards both government and the vagaries of a free capitalist society so that one is accredited with all the marvels of the world and the other with all the total failures. To be indoctrinated your whole thinking life with science and logic which demands great mental flexibility and end up as a petrified mind is truly unfortunate. No doubt great things have come from the bubbling creativity of open enterprise but it is obvious even to the most casual observer that monstrous stupidity and horrible failure lurks in that jungle as well. The government is the force of control to turn this wildness into social utility and there is no doubt any insane asylum is inferior to the halls of the various legislatures and government bureaus in evidencing total stupidity and ignorance. But the results of both can be monstrously evil or hugely beneficial. A balanced view is worth considering.

Still no response to my list. Success in government programs actually tends to be more the rule than the exception. And there is no way private industry could ever produce something like the Interstate Highway System, or the effective pollution controls we have, or effectively eradicate childhood diseases. You are old enough that you probably remember when polio was still claiming lives and relegating children to the iron lung. I have never met anyone who suffered from that disease. During my entire lifetime, no one on this planet has suffered from smallpox, and this is due to government efforts in eradicating it.