Spending Increases
I love the way most of the media is interpreting the health care spending increases, like in the Dayton Business Journal:
bq(quote). The costs of health insurance offered through work increased 10.1 percent nationwide in 2003, a marked slowdown from the nearly 15 percent increase in 2002 over the previous year…
10.1 percent is great news? It’s still double digit, it’s still going to force businesses to drop coverage or cut costs for their workers. Some countries had 3 percent increases from 2001-2002, with the average increase at 3.5% per year, since 1975. Imagine that.
Update: And instead of that, we have this. How much longer do we have to be such an embarrassment to the rest of the world? We’re great at making a few people rich, but we can’t even take care our poorest? (via Metafilter)
All medicine is rationed, everywhere. From triage in a disaster to this http://www.iainmsmith.com/cgi-bin/mt/mt-tb.cgi?__mode=view&entry_id=304
there is rationing.
Since there are absolutely NO good models at all of good governmental control of medicine (Cuba, England, Canada, etc) what would you suggest?
Actually, I’d argue that Cuba, England, and Canadian models are all pretty good government control, as far as government control goes. Almost all the countries with better health system rankings than the US have a “government control” system; the one I advocate for is single-payer.
We ration care in this country by ability to pay. I’d rather have it rationed by medical necessity.
So, waiting 3 months for an MRI is your idea of “medical necessity”? Or, women needing mastectomies having to wait for months (and metastasize), while young teenaged girls are getting breast implants (England, again) The girls got on the schedule first. BTW, did you know that it’s common practice in England for surgeons to step out for lunch and a pint while the patient is under general anesthesia and open? I hope they bring something back for the gas passer, btw. It’d be rude otherwise.
Strange models of better medical care you chose. For example, there are more CAT scanners at the Mayo Clinics in Rochester (town population of ~129K) than in the entire country of Canada (population ~ 31.6 Million). Why does that happen? Because the people who are willing to pay for a CAT scan decide it’s worth it, the government of Canada decides to ration their health care. Yeah, the cost of care in Canada may be increasing more slowly than the US, but they’re getting a lot less for it too.
BTW, Cuba is listed below (lower than) the US, not that it matters. The list, without describing the criteria used to make the evaluations, is useless pandering. Anyone can create a website with any nonsense they want, one of the problems of the internet. And as long as countries that support genocide and slavery (Sudan, Syria) can even have a seat on a UN committee on human rights, nothing the UN does (including WHO) has credibility.
Where would you rather get health care? Cuba or New Zealand? I’ve actually been to about half of the countries on the list (thank you, US Air Force!), and I would argue (for example) that the level of medical care overall in say Mexico (61) is better than Morroco (29). And the care in the US (37) is far, far better than both.
A quick search on the WHO website doesn’t reveal either the list itself or the criteria used. However, any study can be designed to result in any outcome, and get through peer-review. The more political the authors or the publishers, the less validity I attribute to the report, but then I’m a cynical old SOB.
The level of medical care in the US can stand improvement, but routine 12 week waits for appointments to PCP’s in Canada (Ottawa, ON, a friend of mine) isn’t an improvement. Those delays are less, btw, than some other provinces, more than others, so they’re average.
While a number of US elderly go to Canada and Mexico to purchase drugs less expensively, I doubt it’s a valid excuse. Despite BS from AARP and others claiming “that’s the only way they can afford it” I doubt that the actual costs would stand up to economic scrutiny, so the trips then become a vacation or a hobby (after all, if they’re going to Canada their US insurance isn’t paying for the drugs or the trip at all). All medicare recipients are (were?) able to purchase co-insurance, those who didn’t made a conscious decision not to. Or, they made (much earlier in their lives) a conscious decision to NOT find out what their insurance was going to be, or plan for their retirement. Now, they expect someone (everyone else, actually) to pay for their poor decisions.
A number of Canadians travel to the US to have diagnostic testing, and surgery, which isn’t available in Canada, at least not in a timely manner. A number of Canadian physicians and surgeons work part of the year in Canada, max out on their province-allowed income, and then spend the rest of the year in the US working – resulting in more work for the remaining physicians, and resulting in more delays for an appointment.
In the UK, medical care is completely rationed – unless you have the cash to pay for it. One of the founders of the Amway Corp. was able to purchase a heart transplant for himself in England, at 75+ years of age he wouldn’t be considered for a transplant at all in the US. In England, not a problem – flew over and had it done, 1-2-3. Not sure where they found a donor, but they did.
There has never, ever, been a single, successful model of any socialized economic or medical system. Medical systems that don’t allow private patients result in long waits and high morbidity/mortality for patients, those that do allow private patients result in wildly disproportionate levels of care.
The system in the US started becoming dysfunctional about the mid-1960′s (medicare), and the more that the politicians try to adjust it (being imperfect, they pander to voters, i.e. the recently passed “improvement” to medicare). Health care systems, being run by imperfect people, strive to maximize their return from the artificial economic system.
In the past (pre-medicare in the US) their was actually MORE medical care for more people. Those who couldn’t afford the care had their care paid for by those who donated to various charities and aid societies. Or, individuals decided that whatever they had wasn’t worth the cost of the care, and lived with it (or decided to not live with it). Nowdays, almost nobody has any idea what their health care costs, and as long as that happens they will demand rofecoxib instead of ibuprofen (which is essentially just as effective). Cost difference? The only difference to almost every patient is that their insurance pays for one (roughly $200/mo), they are expected to spend about $10/month for the other OTC.
The “hero” expectations of families (and lawyers) are another pointless cost. The survivability of a traumatic cardiac arrest is on the order of zero, yet ED’s will spend some $15K on 2 or 3 complete cycles of the ACLS protocols, external pacing, etc to try and revive the cadaver. It hasn’t ever worked for me.
The society in the US is also part of the problem. US society glorifies behavior that is dangerous – from drinking, drugs, smoking, obesity, dangerous sexual relationships, dangerous “extreme” sports behaviors, donor cycle riders without helmets, etc – because we allow people the freedom to be idiots.
Because people don’t have any idea of what health care costs, they don’t value it. But, they expect to be healthy, and when they’re not, they expect to get fixed, NOW. Had a pita-patient last night complain that she had to wait for 4 hours in the ED (oh, boo-hoo) when she showed up with a cold (not flu). Then, she got seriously irate that I wouldn’t Rx antibiotics. ARGH. I didn’t bother asking why she came to the ED (she had a PCP, and insurance), or why she didn’t have the damned sense to just take care of it herself (rest, Tylenol, fluids?) It couldn’t have been her first cold.
Want to improve health in the US? Work to have the governmental economic supports for agriculture removed. No more taxpayer support of corn syrup or sugar or wheat, maybe people will actually quit supersizing everything they stuff into their mouths.
Just for grins, some morning (around 7 – 7:30 or so) go to a 7-11 in a middle-class neighborhood near a middle or high school. How many kids are in there buying breakfast (a Supertanker of Dr. Pepper and nachos? 4 hotdogs?) Where the hell are these kids parents, letting them eat crap like that at all? And, imagine how a kid who just downed a liter of high-sucrose anything is going to behave in class.
Improve the health of lower-income people? Work to fix food stamps so that only certain kinds of foods (no high-carb anything, no processed anything, etc) foods – the beneficiaries of food stamps mostly don’t work, so they CERTAINLY have time to learn how to cook and eat better. Have the FDA do away with that insane “food pyramid” and teach people what to eat that is healthy (11 servings of complex carbs a DAY??) The government is encouraging people both by actions (that pyramid) and their economic support of the agribusiness that makes all that corn syrup and wheat. Lets not forget that the government mandated MTBE in gasoline, and now that it’s found to be a carcinogen and leaching into the ground water we’re going to have to support Another Daschle moment (ADM) in making ethanol for gas – just one problem, the ethanol manufacturing process requires more joules of energy than can be produced by the resulting ethanol. Whats up with that? But, I guess we’re not drinking enough corn syrup.
Want to improve the lives of most of the truly POOR people on earth? Convince the pompous jerks in the EU and UN and WHO that genetically modified food (golden rice) won’t kill them. Convince Al Gore and his cronies that DDT use will prevent most of the malaria that people in equatorial Africa get – but, better hurry, the governments there are resisting the true causes and treatments for HIV, siphoning off money being spent to try and save their people, and if something doesn’t change there won’t be many people in equatorial Africa in 20 years or so.
Want to improve my life? Figure out a solution for the numbers of chronic drug abusers. I actually favor letting almost anyone buy almost anything (including all schedule and legend drugs), if they kill themselves it’s evolution in action. But, if they get to buy whatever they want, the pharma companies can’t be held responsible. Arguably, some small number of people will become addicted who otherwise wouldn’t, but most won’t, and those who will become addicted or OD are going to, no matter what. In the mean time, they take up valuable resources. Frequent fliers in the ED probably account for 5% of the census, and 20% of the cost. Or, lets go back to the days before the ACLU decided that people had a right to be self-destructive and put them in care facilities that feed them, clothe them, and keep them relatively protected. Is it as good as being free? No, but it’s a hell of a lot safer, and results in more medical resources for everyone, less economic and physical crime. Or, lets just take gang-bangers out and teach them HOW to shoot, then they’ll do a better job of killing each other with less collateral damage to innocent bystanders while they reduce their own population cohort.
How about we change the civil tort system to “looser’s attorney pays”? No more specious malpractice lawsuits, but the legitimate ones will continue (as they should). Why are there even lawsuits allowed against a doc that delivers a child with some sort of problem, when the mother never got pre-natal care, the doctor just happened to be unlucky enough to be on duty that night, and the only time he ever saw the two of them (before the deposition) was when they presented in the ED?
Frankly, if I could figure out a way not to get sued over it, I wouldn’t treat lawyers as a class – and I’m the only physician in an extended family of lawyers. The guy who invented the pager better not show up, though!
While we’re at it, why do we (US society) get so worked up when a 5’6 350lb citizen on PCP dies after police are called to HELP that super sized bag of pus and HE gets belligerent?
Want to increase the amount of medical resources available? Work to decrease the BS that government forces on us – triple charting, EMTALA, HIPPA, all the rest of the crap (by the way, ask a ward nurse about their BS paperwork some night – make certain you have time). If we spend less time on CYA and square filling, we’ll have more time for patients.
Want to have more physicians? Work with the AMA to increase the number of medical school students (beware, when the number of providers increases, the value of each provider economically will decrease, i.e. you’ll get paid less). Make medical education better – I’ve never met a non-academic or faculty physician who found ANY use for organic chemistry, and most found that the year of physics they took was pretty useless as well – thanks to Osler though, we still require them both a hundred years later, thereby filtering out people who could otherwise be good physicians.
Want to make more medical care available to everyone? Work to add both the numbers of, and scope of, mid-level practitioners (PA’s and NP’s). I’ve worked with some great PA’s (and even extended-duty medics, technicians with a years training ONLY) over the years, the self-serving crap I’ve seen from physicians about the (economic) threat posed by mid-levels is really appalling (but of course, they”re careful to couch it in terms of what’s best for the patients). Most of what most primary care docs do could be handled by a PA or NP, at aout 1/3 the salary cost, 1/4 the training time and 1/8 the training cost (if you count residency time).
Want to really take simple steps to improve health? REQUIRE that every kid be immunized – no BS excuses for religious reasons, or because someone is afraid that thimerosol causes autism, or any such nonsense. BUT, that takes away from freedom.
Want to make individuals more seriously involved in their own health care? Lets quit developing or distributing nonsense “studies” that exist only to make certain that money is spent on people who lack jobs or sense (the authors). Thimerosol, second hand smoke, radon, silicon (anything, not just breast implants), toxic mold, mercury amalgam dental fillings to name a few – how silly is this? But, people will continue to spend money on copper bracelets for arthritis, or “sea silver” or whatever else detracts from their own mortality or foolishness.