Is Our Money-Driven Medicine Really the Best?

[stanmrak]

Money-Driven Medicine is a new documentary about the US healthcare system; just in time! Does anybody out there (besides Fox News) really think that we have the best health care system in the world?

The U.S. happens to be the only industrialized nation that has chosen to turn medicine into a largely unregulated, for-profit business. And the result is that we spend twice as much per person than the average industrialized nation. As someone in the film observes, "We get more care, but not better care.”

Check out some exerpts here:

Money-Driven Medicine: "Medical-Industrial Complex"

[ginkgo]

Our country is not based on kindness, caring, taking care of health or well being. It is based on money. America has or used to have over 400 billionaires. How many healthy and happy people does it have. That is of no concern to anyone.

Capitalism-- an economic system characterized by private or corporate ownership of capital goods, by investments that are determined by private decision, and by prices, production, and the distribution of goods that are determined mainly by competition in a free market.

If you read Daniel Quinn's books, you learn that for 3 million years people lived in villages and everyone took care of each other. There was no need for money or need to worry about tomorrow.

Then 10,000 years ago around the Fertile Crescent area, people started to lock up food for the first time creating a need for money.

A billion dollars is a thousand million dollars. So some people have huge amounts of money just sitting in banks while the portion of society that makes minimum wage is making less money than ever if you adjust for cost of living.

But capitalism and communism makes the country very powerful compared to other countries. So people need to be concerned about their own health and well being.

[Bleicke]

Let me just tell you one thing. Here in Germany, we have socialized medicine. Everyone who works HAS to pay into the social medicine pot. It's about 10-15% of your income.

What do you get? Well, it certainly was "free" (as in I didn't pay directly but through taxation) when I went to the doctor, but then again I had to wait for 6 months for an appointment. At the end of which the team of doctors didn't know what was wrong with me.

Our social medicine system is headed down hill for years now. People are now forced by law to stay in it - they can't change to a private system. Why? Because the government knows everyone would get out immediately, and it would collapse.

So be happy you can pay a doctor to heal you. I wish I could.

[funnyav]

More important question: is a value exchange (ego based) society really the best?

[Writertype]

It's a tough question that deserves more than a sound bite answer. Our system has many strengths and weaknesses, but here are a few points to keep in mind:

1- People need to take more accountability for their own health. Doctors can pour all the money and time they want into you, if you don't choose to eat healthy, be active once in a while, and cultivate reasonably healthy habits you will still have poor health outcomes. When you smoke, drink excessively, and sit around all day eating KFC, what can anyone really do for you?

2- We need more primary care physicians. Regardless of who is paying, if there is no doctor available to see you there will be no treatment. A lot of medical students choose to specialize because they can make several times what they would as PCPs, so you can trace this back to money as well, but a specialist-heavy system is probably always going to be an expensive one.

3- Our culture is money-driven. If you decrease reward (money) without changing what society values, many of the very intelligent people who would have pursued medicine might very well go elsewhere. That leaves you with kindhearted and dedicated people still wanting to pursue medicine, but they might not be as bright.

There is lots more to consider, but I don't want to ramble into an essay so I will leave off here.

[Bleicke]

Originally Posted by funnyav

More important question: is a value exchange (ego based) society really the best?

I think so. All the countries that tried other ways failed: Cuba, USSR, China before Capitalism..

[SomeRandomGuy]

Originally Posted by stanmrak

Does anybody out there (besides Fox News) really think that we have the best health care system in the world?

No!

[Bleicke]

Which ones do you consider superior?

[SomeRandomGuy]

According to rankings performed by the WHO in 2000, there were 36 countries with better health care than the US. I don't have personal experience with health care in those countries, so can't provide a real analysis. I trust that the WHO isn't entirely off base, so expect that at least some of those countries do have healthcare that is superior to what we have in the US.

[Bleicke]

The World Health Organization's ranking of the world's health systems was last produced in 2000, and the WHO no longer produces such a ranking table, because of the complexity of the task.

[Annya]

I live in Canada and am studying to be a doctor. But this comment is all based on my firsthand personal experience: I have never EVER had a problem personally with my healthcare. My father has a myriad of health problems and he has been given the best, most effective, and fastest care possible. My mother has had breast cancer lumps removed, a week after they were found, MULTIPLE TIMES. My grandparents...you get the point.

The downsides: On a couple of occassions appoinments came after a couple of months with specialists BUT if there is anything that really concerns you, most people in Canada just go straight to the emergency room. I've heard a few horror stories as well about Canadian healthcare, but there are always exceptions. I have heard far more horrible things about American healthcare, and not the doctors or the technology mind you, which is top notch, but the money and the system.

Our system is not perfect. No system ever will be. But is it better? In my opinion, Hell to the yes.

[SomeRandomGuy]

Originally Posted by Annya

The downsides: On a couple of occassions appoinments came after a couple of months with specialists

I have heard that most delays in the Canadian Healthcare System are caused by an attempt by the Canadian government to save money. It seems that other countries have systems similar to that of Canada, without the delays.

We often hear horror stories from the Canadian Healthcare System about people waiting months to get treatment. What people don't hear is that the delay isn't caused by faults in the system itself, rather by a decision of the government to spend less on healthcare.

[Aleksander Krstic]

No need for meds when you can go raw.

[ar81]

Originally Posted by SomeRandomGuy

I have heard that most delays in the Canadian Healthcare System are caused by an attempt by the Canadian government to save money. It seems that other countries have systems similar to that of Canada, without the delays.

We often hear horror stories from the Canadian Healthcare System about people waiting months to get treatment. What people don't hear is that the delay isn't caused by faults in the system itself, rather by a decision of the government to spend less on healthcare.

If that's true, then politicians do not understand health economy.
If you make waiting lists longer to "save money", they are reducing supply.
But as those people who wait get worse, their treatment will be more expensive, so indeed costs are higher.

Waiting lists may not look good from a decorative point of view, but 47 million Americans without insurance who have no hope to be in a waiting list is far worst. 47 million might be in the waiting list of death anytime, if they get sick.

The problem of money driven health care is that the transaction is "pay or die", just like a transaction of extortion.

By now US has 9.7% of unemployment. It means people with no money. They won't be able to pay.

Originally Posted by Annya

I live in Canada and am studying to be a doctor.

Our system is not perfect. No system ever will be. But is it better? In my opinion, Hell to the yes.

I have talked to experts in health economy in the past, and I can tell you that Canada, UK, New Zeland and Costa Rica have the most advanced health care systems in the world.

If people in US want to rank a system that has 47 million people without coverage as "the best", that's their problem. The problem is denial. Realizing about a problem is the first step to fix it. Thinking it is the best is a good way not to fix it. And people will suffer because of its performance.

[Strem2]

Originally Posted by Bleicke

Let me just tell you one thing. Here in Germany, we have socialized medicine. Everyone who works HAS to pay into the social medicine pot. It's about 10-15% of your income.

What do you get? Well, it certainly was "free" (as in I didn't pay directly but through taxation) when I went to the doctor, but then again I had to wait for 6 months for an appointment. At the end of which the team of doctors didn't know what was wrong with me.

Our social medicine system is headed down hill for years now. People are now forced by law to stay in it - they can't change to a private system. Why? Because the government knows everyone would get out immediately, and it would collapse.

So be happy you can pay a doctor to heal you. I wish I could.

This 6 month wait is true in America also in some rural areas.... And, some Americans will wait forever because they can't get the medical treatment their doctor recommends because they haven't got medical insurance and aren't rich.

[Strem2]

Rankings always have questions, and this rating gives the questions it uses to come to a decision. In this one, the US is 15th with a score of D. But, take a look and see what you think.

[Strem2]

Originally Posted by ar81

...
Waiting lists may not look good from a decorative point of view, but 47 million Americans without insurance who have no hope to be in a waiting list is far worst. 47 million might be in the waiting list of death anytime, if they get sick.

The problem of money driven health care is that the transaction is "pay or die", just like a transaction of extortion.

By now US has 9.7% of unemployment. It means people with no money. They won't be able to pay.
....

If people in US want to rank a system that has 47 million people without coverage as "the best", that's their problem. The problem is denial. Realizing about a problem is the first step to fix it. Thinking it is the best is a good way not to fix it. And people will suffer because of its performance.

This is going to sound like a non-sequetor, but it's not.

Rape victims blame themselves so that they have some illusion of control. Feeling helpless is among the worst of feelings.

Perhaps those who blame the unemployed for their unemployment are trying to reassure themselves that they can avoid unemployment because ....

Perhaps those who blame the ill for their bad living and bad eating are trying to reassure themselves that they can avoid illness because they ....

Sometimes things happen that are beyond your control. Even the most astute and skilled practitioners of the Law of Attraction will attest to that. The Universe will find the fastest and best way to get for you what you have manifested. Sometimes this appears as a challenging or difficult path.

Against all logic, the US has been affirming that it has the "best health care system in the world." Perhaps we need to go through this struggle to actually manifest our national intention.

[vMike]

The US gvt should instead spend more money on promoting a healthier lifestyle.

[SomeRandomGuy]

Originally Posted by vMike

The US gvt should instead spend more money on promoting a healthier lifestyle.

I have heard a theory that countries with a non-profit healthcare system have much better preventative care. If I recall, the average US worker changes health insurance every 3-5 years. The insurance companies have little incentive to pay for preventative medicine because they expect that a different insurance carrier down the road would be the one reaping the benefits of the reduced cost from their investment in preventative medicine.

In some of the countries with non-profit insurance companies consumers have the ability to choose from dozens or hundreds of carriers and can stay with them as long as they are happy with the provided coverage (even when they change jobs). In these situations the insurance companies have more incentive to invest in preventative medicine, since consumers are not changing carriers as often as they do in the US.

[vMike]

Originally Posted by SomeRandomGuy

I have heard a theory that countries with a non-profit healthcare system have much better preventative care. If I recall, the average US worker changes health insurance every 3-5 years. The insurance companies have little incentive to pay for preventative medicine because they expect that a different insurance carrier down the road would be the one reaping the benefits of the reduced cost from their investment in preventative medicine.

In some of the countries with non-profit insurance companies consumers have the ability to choose from dozens or hundreds of carriers and can stay with them as long as they are happy with the provided coverage (even when they change jobs). In these situations the insurance companies have more incentive to invest in preventative medicine, since consumers are not changing carriers as often as they do in the US.

Yeah I guess with a non-government health-insurance companies have no incentive to do that, on contrary - they need more sick people

So that should be the government's direct initiative

[Brutha]

Speaking about preventive medicine is easy. A lot of preventive things such as diet changes or quiting smoking are however things that you can't simply mandate from the government side.

[Strem2]

Originally Posted by vMike

Yeah I guess with a non-government health-insurance companies have no incentive to do that, on contrary - they need more sick people

So that should be the government's direct initiative

I had a Chinese doctor who said that in China, doctors are paid each month (retainer for each family) as long as their patients were healthy. As soon as a family would get sick, they would stop paying the doctor until everyone was well again.

If the insurance companies (both for-profit and not-for-profit as well) paid doctors on retainer for their complete list of patients, and stopped paying them when one got sick, that would put the onus on the doctor to spend more time on education than on tests!! Whoo, hoo. I like this idea!!

[SomeRandomGuy]

Originally Posted by Strem2

I had a Chinese doctor who said that in China, doctors are paid each month (retainer for each family) as long as their patients were healthy. As soon as a family would get sick, they would stop paying the doctor until everyone was well again.

If the insurance companies (both for-profit and not-for-profit as well) paid doctors on retainer for their complete list of patients, and stopped paying them when one got sick, that would put the onus on the doctor to spend more time on education than on tests!! Whoo, hoo. I like this idea!!

That raises an important point. Right now in the US we pay doctors per vist and/or treatment. It is in their best interest to do a lot of various tests, and to have the patients come back to visit often. I don't want to suggest that doctors keep patients sick just to make more money, but I work in an industry that pays employees based on how many items they complete, and I know that some employees will do anything they possibly can to complete more pieces in a shorter time to make more money. I can't help but think that there are some unscrupulous doctors who might do the same.

[Strem2]

It would save a lot I think. And, it would put the emphasis back on GP rather than on the Surgeon.... This would help more rural areas that have fewer GP's.

It would give docs a more predictable salary so they could pay off their school loans.

[ar81]

Many rescuers, normal citizens, who helped in the rescue at ground zero on September 11th, did not get medical aid for their services. Michael Moore took them to Cuba, where terrorists received the best medical services, but no one let them in, so they went to Cuba, and got free medical attention.

A medicine that would have a cost of $120 in US had a cost of 5 cents in Cuba, and medical attention was free, and the only admission they had was to provide name and date of birth.

How can a third world country provide that and US can't?

Admission doctors are paid a bonus if they reject 10% of patients in US, to save the company some costs.

[Rabbit]

This is a very, very touchy topic. From my exposure in the economics of healthcare, I can suggest this:

Read up on surveys/studies performed by the RAND group on US healthcare during the past few decades.



Most notably, there was a study comparing the 'health outcomes', on average, of Managed Care plans vs. PPOs. PPOs spent on average, I believe, about four times as much money on healthcare inputs as the Managed Care patients did. And guess what they found.... no definable statistical difference in health outcomes. So in a sense, one may claim that PPOs are indeed wasteful.



Another (and less known) study looks at five different new treatments/technologies developed in the field of medicine in the past few decades. I can't recall all of them, but the few I do were heart bypass surgery improvements (even an entirely new procedure within the past two decades?), advances to treat damage to the retina (from cataracts, I believe), and depression.

Their findings.... in the very least, the handful of widely dispersed advances in medical technology (employed in the US) were, in the very least, approximated and calculated out so that their benefit was at least equal to the cost of the new procedure (including all the R&D, new training, etc).

And what's better- for two or three on the list of five, they estimated that the price of these medical improvements were EXTREMELY underpriced, as they increased the quality of life (and thus, extrapolated into an average individual's utility functions) far beyond the cost. The most extreme case I believe was heart surgery improvements. And again, I'm just approximating, but I believe that these improvements were only priced at 1/10 of their actual 'benefit' they were providing.
Thus, in many cases, medicine isn't specifically money-driven. Perhaps that's the intention, but even the researchers and surgeons who learn the new techniques very often completely miss how to apply appropriate pricing (given a 'free market' pricing model)- in this study, leaning extremely towards the underpriced side.

I kind of like that.