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      10-04-2013, 01:10 AM   #23
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A few thoughts on this thread:

1. Other countries do not count health statistics the way we do in the US. Infant mortality, for example - in other first world countries, they don't count a live birth until the infant is days/weeks/months old, 30cm long, gestational age past 28 weeks, etc. In the US, we count everything that breathes as soon as it leaves the mother. When you adjust for this difference, the US healthcare system consistently has the best outcomes in the world.

2. The US bears the cost for drug development for the entire world. In no other country can you charge whatever you want for a drug (in order to recoup the cost of drug development, which typically costs $several hundred million, and at least a decade. Other countries only allow the cost of drug production - not development.

3. In the US, we track the "pedigree" of the drugs made all the way to the pharmacy shelf, so we are assured that the drugs we get are the real thing. In a study in the UK about 10 years ago, they found that 12% of the drugs on the pharmacy shelf were counterfeit. That's the primary reason Medicare, etc. won't buy drugs offshore.

4. The US legal system is responsible for a HUGE portion of healthcare cost. No other country encourages lawyers to take cases on contingency - other countries make the loser pay all court costs. The cost of lawsuits leads the cost of insurance, which make doctors order tests/procedures that they may not believe are necessary, but the doc doesn't want to get sued.

5. Most hosps/clinics/docs can't tell you what a procedure will cost, because they typically charge you a co-pay, and bill the insurer the rest. If you have insurance, your insurer has a contract with that doc/hospital, and they bill them directly. It's very frustrating as an individual, but it's not because they are doing it intentionally - their systems and processes are just not set up that way.

There are many things wrong with our healthcare system, but I'd rather be sick here than anywhere in the world.
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      10-04-2013, 01:40 AM   #24
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There are many things wrong with our healthcare system, but I'd rather be sick here than anywhere in the world.
All I can read is profit, profit, and more profit. I've lived in the states, Canada, and Hong Kong for an equal share of my lifetime and I'm sorry but the states wouldn't even make it to my top 3 places to be if I was sick.
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      10-04-2013, 06:47 AM   #25
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All I can read is profit, profit, and more profit. I've lived in the states, Canada, and Hong Kong for an equal share of my lifetime and I'm sorry but the states wouldn't even make it to my top 3 places to be if I was sick.
Profit vs time. You can either wait 12-18 months for knee replacement or get it done in 30 days but pay big bucks. Same goes for cataracts, back surgery, etc.

Besides the a big problem is that even with Obama care the law requiring hospitals to accept patients regardless of whether or not they can pay is drill on the books.

Hospitals take huge losses on these patients.

Funny thing about Canada is that they're exploring a private insurance model. Their country can no longer bear the cost.
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      10-04-2013, 04:15 PM   #26
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All I can read is profit, profit, and more profit. I've lived in the states, Canada, and Hong Kong for an equal share of my lifetime and I'm sorry but the states wouldn't even make it to my top 3 places to be if I was sick.
I certainly respect your opinion. I'm fine with the profit motive - having choices and people competing for my business is a good thing. It also leads to innovation, where the US drives the vast majority of health innovation worldwide, solely because we have a profit motive. Countries with government healthcare have a profit motive as well - to conserve tax dollars.
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      10-04-2013, 06:18 PM   #27
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Originally Posted by bbbbmw View Post
A few thoughts on this thread:

1. Other countries do not count health statistics the way we do in the US. Infant mortality, for example - in other first world countries, they don't count a live birth until the infant is days/weeks/months old, 30cm long, gestational age past 28 weeks, etc. In the US, we count everything that breathes as soon as it leaves the mother. When you adjust for this difference, the US healthcare system consistently has the best outcomes in the world.
It's worth noting that outcomes are also somewhat dependent on the overall condition of the patient to begin with, and may not reflect the quality of the service itself. For example, most first world countries have far lower obesity rates.

If Sweden for example has x % of patients that are morbidly obese, and US has 2x or 3x, then overall, statistically it will have worse outcomes for almost any given procedure, although that may not be related to the quality of the care delivered. As far as I know, none of the stats correct or account for this.

(Clearly the fact that there are so many more obese people is a huge issue in itself, but that's a topic for another thread.)
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      10-04-2013, 08:32 PM   #28
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It's worth noting that outcomes are also somewhat dependent on the overall condition of the patient to begin with, and may not reflect the quality of the service itself. For example, most first world countries have far lower obesity rates.

If Sweden for example has x % of patients that are morbidly obese, and US has 2x or 3x, then overall, statistically it will have worse outcomes for almost any given procedure, although that may not be related to the quality of the care delivered. As far as I know, none of the stats correct or account for this.

(Clearly the fact that there are so many more obese people is a huge issue in itself, but that's a topic for another thread.)
Good point.
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      10-06-2013, 07:34 PM   #29
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      10-07-2013, 04:52 PM   #30
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Profit vs time. You can either wait 12-18 months for knee replacement or get it done in 30 days but pay big bucks. Same goes for cataracts, back surgery, etc.

Besides the a big problem is that even with Obama care the law requiring hospitals to accept patients regardless of whether or not they can pay is drill on the books.

Hospitals take huge losses on these patients.

Funny thing about Canada is that they're exploring a private insurance model. Their country can no longer bear the cost.
Illegals are not eligible for Obamacare (nor should they be). But if they show up at the hospital, they must be treated. So with all the new overhead, taxes, etc. of Obamacare, we will still have a substantial population that is uninsured, and the rest of us will pay for them. This is madness, IMO.
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      10-08-2013, 01:43 PM   #31
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Originally Posted by bbbbmw View Post
A few thoughts on this thread:

1. Other countries do not count health statistics the way we do in the US. Infant mortality, for example - in other first world countries, they don't count a live birth until the infant is days/weeks/months old, 30cm long, gestational age past 28 weeks, etc. In the US, we count everything that breathes as soon as it leaves the mother. When you adjust for this difference, the US healthcare system consistently has the best outcomes in the world.
I would be surprised that other OECD countries would not count from day 1, and even more surprised that official stats like UN/UNESCO reports would not correct for such an obvious bias.

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If Sweden for example has x % of patients that are morbidly obese, and US has 2x or 3x, then overall, statistically it will have worse outcomes for almost any given procedure
This is however an excellent point. It certainly has a great impact of per-procedure outcome, and would off course translate into lower life expectancy across the board. But it cannot explain the whole story. There are a number of obvious cases where unavailability of health care options is to blame (not procedural failure, or at-risk population). It is known, as an example, that heart attack rate is greatly worsened by poor dental health, so overpriced dental service does kill people, in a sense, even if dental care and/or coronary care is top quality. Just one example, of course, and multi-criterion system, so no conclusive answer can be given, that's why one has to rely on aggregates.

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2. The US bears the cost for drug development for the entire world. In no other country can you charge whatever you want for a drug (in order to recoup the cost of drug development, which typically costs $several hundred million, and at least a decade. Other countries only allow the cost of drug production - not development.
Please prove it. Other countries also have their share of very expensive medications on the market. They also have their own big-pharma lobbying their respective governments.

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5. Most hosps/clinics/docs can't tell you what a procedure will cost, because they typically charge you a co-pay, and bill the insurer the rest. If you have insurance, your insurer has a contract with that doc/hospital, and they bill them directly. It's very frustrating as an individual, but it's not because they are doing it intentionally - their systems and processes are just not set up that way.
And I'm not blaming practitioners here. The system is set in a way that forces this to be standard practice (just is the same with needing 3 full time accountants for dealing with claims). I'm just outlining that such a dysfunctional system is not the only way to go. Practitioners would certainly also benefit if claim/payment system was not an obfuscated clusterfuck.

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There are many things wrong with our healthcare system, but I'd rather be sick here than anywhere in the world.
Having tried both, I'd rather be sick in Europe (most of it, and it has some variety among countries, yet all fare better, including the somewhat dysfunctional UK system with its long wait times, I'm sure we could even find developing countries with very decent healthcare systems if one would take the time to look for it). You receive as good treatments as what you get in the US (except that the facility doesn't look like a fancy 4 star hotel), but it has no chance whatsoever to drive you bankrupt being sick. Even with good insurance, the same cannot be said of US health care system.

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      10-08-2013, 04:22 PM   #32
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Differences in statistical gathering across countries:

http://www.nationalreview.com/articl...-scott-w-atlas

US is 5% of the population yet bears 36% of the cost of drug development, according to Wikipedia. Here's another, showing 95%:

http://www.forbes.com/sites/paulrode...hina-steps-in/

The Euro health system won't drive you bankrupt, but it driving their governments bankrupt. And in speaking with my work peers across the pond and in Canada, they all have private health insurance, so they can move to the front of the healthcare line. Please do go be sick in Europe - the Europeans are happy to pay for it.
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      10-09-2013, 09:23 AM   #33
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Differences in statistical gathering across countries:

http://www.nationalreview.com/articl...-scott-w-atlas
This is interesting. Thanks for providing some source, I tried to find some at your first allegation but couldn't. However, the main concern is post delivery complications for pregnant mothers and general low life expectancy for low income population, both of which can be linked with price of service (and again, not saying that service is low quality, but it is difficult to obtain if you are not wealthy).

Quote:
US is 5% of the population yet bears 36% of the cost of drug development, according to Wikipedia. Here's another, showing 95%:

http://www.forbes.com/sites/paulrode...hina-steps-in/
This article on the other hand is far from convincing. It certainly sounds like a partisan spin with little content. It certainly has numbers, but they are unrelated to the issue at hand, and it makes all these claims without any significant proof. Just remember that most medications have been invented in a time were health care was not a luxury (even in the US, things have not always been what they are now). Then it goes on saying that Obamacare will set prices, I don't see anything in that law that would do that, it is just an insurance exchange with some supplementary conditions on insurance policies so that they are not too rigged against the consumer. There is no single payer provision in the voted form of Obamacare.

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Please do go be sick in Europe - the Europeans are happy to pay for it.
No need to be aggressive. I'm not criticizing the US for the sake of being an arse or because "socialist". I live in the US too, there is a reason to that, it's because I like it. I may not be a citizen, but even as a mere resident, I do care about my fellow American neighbors and friends and it saddens me to see them struggle in such unnecessary pain.

It takes moving to other countries to fully understand what works and what doesn't in your own (because I can tell you, beyond health care, there are numerous things that are plain wrong in Europe and much superior in the US). Just take it as an external observation from somebody that has experienced both systems first hand.


BTW, health care in Europe is not bankrupt. It does run deficit (and it may get worse when population continues to get older), but it is far from being unmanageable, and the general cost as a portion of GDP is lower (and in the end, it is what matters in economic terms: this is impacting the cost of labor and competitive edge against foreign goods, how the money is distributed, by taxation or by insurances has no importance in terms of macro economy, one can only witness that pure insurance has been wasteful in allocating the resource and unfair in provided service).

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      10-09-2013, 02:28 PM   #34
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This is interesting. Thanks for providing some source, I tried to find some at your first allegation but couldn't. However, the main concern is post delivery complications for pregnant mothers and general low life expectancy for low income population, both of which can be linked with price of service (and again, not saying that service is low quality, but it is difficult to obtain if you are not wealthy).
There is good comparative information in this article:

http://www.forbes.com/sites/chriscon...-costs-part-1/

In the US, there are many social programs to assist if you are not wealthy, such as Medicaid and Medicare, as well as not-for-profit health systems that offer sliding scale payment (previously discussed in the thread). And, if people are concerned about this, they can purchase health insurance (vs. waiting til they are sick, which is the unintended consequence of Obamacare). Premiums can be expensive if you are purchasing individual insurance, and there are gaps for some people in qualification, but it works for the large majority of the population. Or at least it did - the spikes in premiums this year is largely due to insurers not knowing the impact of people waiting til they are sick to purchase insurance.

Obamacare does de-facto set prices, as there are minimum requirements for health coverage on the Exchange plans. For instance, you can no longer purchase a plan that doesn't include maternity coverage.

I do believe that Obamacare was/is just an interim step to a single payer (100% goverment) health care system - when the costs continue to go through the roof, people will feel the only alternative is to have a federal program.

Healthcare has unfortunately become a hugely political issue in the US, instead of one that everyone tries to solve - it becomes a "who gives me more cheese" issue, instead of how do we delivery the highest quality at the lowest cost, with accountability. If the true intent was improved cost/quality/competition, Obamacare would have started with allowing people to purchase insurance across state lines (there is a large disparity in health insurance premium cost between states), and tort reform, limiting the amount of healthcare lawsuit awards (in the absence of gross negligence).
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      10-09-2013, 04:30 PM   #35
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Healthcare has unfortunately become a hugely political issue in the US, instead of one that everyone tries to solve - it becomes a "who gives me more cheese" issue, instead of how do we delivery the highest quality at the lowest cost, with accountability. If the true intent was improved cost/quality/competition, Obamacare would have started with allowing people to purchase insurance across state lines (there is a large disparity in health insurance premium cost between states), and tort reform, limiting the amount of healthcare lawsuit awards (in the absence of gross negligence).
Excellent point re: people not being allowed to purchase off exchanges in other states.

We'll see how ACA turns out when it fully phases in, but there sure is a lot of potential that it's not living up to.
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      10-24-2013, 12:36 AM   #36
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Thanks for the clarifications guys! Very informative.

So also, from what I gather in this thread, most of you guys are for Obamacare?
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      10-24-2013, 10:13 AM   #37
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Thanks for the clarifications guys! Very informative.

So also, from what I gather in this thread, most of you guys are for Obamacare?
No thanks.
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      10-24-2013, 12:39 PM   #38
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Thanks for the clarifications guys! Very informative.

So also, from what I gather in this thread, most of you guys are for Obamacare?
I hope noone on this board is for Obamacare. Many of us are seeing a huge increase in monthly health insurance costs. Hell, some people are now paying 2x & 3x what they have the previous year.

The poverty stricken areas are enjoying the benefits of Obamacare, however.
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      10-25-2013, 06:50 AM   #39
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-Government regulations prevent healthcare costs from going down
-Government demonizes the healthcare industry
-Government creates healthcare program which surprise surprise is not well run
-Government mandates all must go on healthcare program to make it a success
-We get the socialized medicine nobody wants once they figure out how bad it is
-Healthcare is now a joke like the rest of the world

At least this is how I see it going
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      10-25-2013, 08:10 AM   #40
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Only benefit I see is that I can give health insurance to my FTEs for a split cost (employer / employee) of $171 a month or so for a bronze plan from the NY exchange.

Once you get into plans for FTE + spouse or FTE + child, you get humped just like everyone else with $900+ monthly premiums.

It looks to me like they did a whole bunch of work, and accomplished nothing different from what already existed in the first place.
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      10-29-2013, 01:47 PM   #41
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Here is one issue that I have not heard addressed in this conversation...

It's called a "health care system" because its purpose is to keep people healthy. Yet everyone discussing this keeps talking about treatment for illness. How about preventative care?

Not much money to be made in that, so our "for profit" system largely ignores it. Our country spends so much more on health care because we are so unhealthy. Want stats to back that up? We are 4% of the world's population, yet we take 50%+ of the world's pharmaceuticals.

Now part of that is because we have more illness than most other developed countries. We eat poorly, are largely overweight compared to other developed countries, etc. But another large part of that is the marketing by the pharmaceutical companies. You can't watch 5 commercials in a row on television without seeing at least one commercial for prescription drugs. The commercial always ends by saying "ask your doctor...". So people ask the doctor, the doctor happily writes the prescription, and who pays? The insurance company. How much does it cost? The patient doesn't care since they don't pay the bill.

In the end this all contributes to rising insurance premiums, and rising costs. Profit may give good motive to develop cutting edge drugs, but it also gives lousy motive to prevent and/or cure illness, since the best money is in keeping people sick so they can pay for ongoing treatment.
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      10-30-2013, 05:15 PM   #42
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Here is one issue that I have not heard addressed in this conversation...

It's called a "health care system" because its purpose is to keep people healthy. Yet everyone discussing this keeps talking about treatment for illness. How about preventative care?

Not much money to be made in that, so our "for profit" system largely ignores it. Our country spends so much more on health care because we are so unhealthy. Want stats to back that up? We are 4% of the world's population, yet we take 50%+ of the world's pharmaceuticals.

Now part of that is because we have more illness than most other developed countries. We eat poorly, are largely overweight compared to other developed countries, etc. But another large part of that is the marketing by the pharmaceutical companies. You can't watch 5 commercials in a row on television without seeing at least one commercial for prescription drugs. The commercial always ends by saying "ask your doctor...". So people ask the doctor, the doctor happily writes the prescription, and who pays? The insurance company. How much does it cost? The patient doesn't care since they don't pay the bill.

In the end this all contributes to rising insurance premiums, and rising costs. Profit may give good motive to develop cutting edge drugs, but it also gives lousy motive to prevent and/or cure illness, since the best money is in keeping people sick so they can pay for ongoing treatment.
I don't really understand the "preventive treatment" issue you raise. My health plans (I've had several) in the past 10 years have all paid preventive treatment at 100%, without a deductible. Flu shots, etc. - my plan even gave me a discount for walking every day, and making a "health pledge." Even my high deductible plan covered preventive at 100%. Catastrophic plans may not cover it, because that's not their purpose - the individual is choosing lower premiums over broader coverage. True - docs and hospitals don't care too much about preventive medicine, but the Insurance companies are all over it, in many ways.

As far as Pharma companies advertising - why not? Who in their right mind wants to take medicine, if they don't need it? How else do people find out that there are new alternative treatments? Would you want to know if there was a heart medication that might avoid you having a cardiac stent, or bypass? Would you want to know about a new medication that alleviates Psoriasis? Not sure of the statistic you quoted, but it's probably right - I'm sure Americans take more drugs than other countries - but we are also richer, and often have better access.

And we are fatter, etc. - for many, many reasons. We also have a melting pot society, vs. any other country - comparisons are often not valid.
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      10-31-2013, 02:24 PM   #43
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Those saying we have the best system and top notch healthcare have either never used an outside healthcare or get their info from the Fox News. Our healthcare system/ insurance is a pure business and not a "care". It should offer services better than any other as it charges 20x normal places do. $18k for the baby delivery where my wife spent exactly 23 hours in the hospital!! $1400 for a 3-month old check up and 4 shots!!! $700 for 3 tooth fillings!!!

The system here is insanely overpriced and driven by medical and pharmaceutical cartel.

My family is insured, however, to the OPs point - 15% of uninsured is "only" 50M Americans!!

I have lived in Europe and Asia and have seen their services and prices. My copayment in Europe was $2 and the hospitals and services were very much on-par with what I see in Dallas. On one business trips to Taipei, I got food poisoning, the doctor was called to my room, have me 3-4 shots and a bag of pills. Showed up the next day to my hotel room for the follow up and 2 more shots. My room was billed $90.

A friend of mine (visitor to the US) had a car accident and spent a few days in a hospital recovering with a few broken bones. He received a bill of $160k!!!, left the country and never returned.

Taxes: sales tax, property tax, income tax (wife and 3 kids claimed) some states with state tax, 401k, kids college fund -> easily 50% of salary gone...
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      10-31-2013, 02:27 PM   #44
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Here is one issue that I have not heard addressed in this conversation...

It's called a "health care system" because its purpose is to keep people healthy. Yet everyone discussing this keeps talking about treatment for illness. How about preventative care?

Not much money to be made in that, so our "for profit" system largely ignores it. Our country spends so much more on health care because we are so unhealthy. Want stats to back that up? We are 4% of the world's population, yet we take 50%+ of the world's pharmaceuticals.
Excellent post!!!!
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