The Thread Where We Debate About Healthcare in America

#101
#101
USMC-TNVOL said:
1.4 Million Americans Will Go Abroad for Medical Care This Year. Should You? | The Fiscal Times

Actually it is more cost efficient to go abroad from the US if needed.

Something I watched in class comparing us to others.

PBS Frontline: Sick Around the World - YouTube
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https://www.usitc.gov/publications/332/executive_briefings/chambers_health-related_travel_final.pdf

Those are some great numbers you cited. Of the 1 million travelers who leave the US in search of “better” healthcare nearly 90% are returning to their countries of origin in Central and South America. Are you suggesting they have better healthcare in those nations? My wife has cancer. She goes to MD Anderson for treatment. It is like the UN, people from all over the World come there for treatment with cancer. When you have a wife or a child with cancer or any other life threatening disease you don’t look for the most efficient, cheapest option, you look for the best. Foreign individuals spend nearly 4 billion dollars each year coming to the US for treatment. Of the 4 billion dollars, nearly 30% comes from Europe. Of the 1 million who seek care elsewhere from the US, less 3% seek care in Europe.
 
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#103
#103
davethevol said:
People used to be able to afford to go to the doctor. What changed?
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That's a complex question, but I'll give it a go.

Employers used to shoulder more of the costs of health insurance. Additionally, health insurance used cover more of the costs. You'll notice that deductibles are higher, as are co-pays. They have also been changing global windows. That means when you have a procedure or surgery, the follow-up used to be covered completely. Now, it may require another co-pay. The carriers are passing more on to the patient. On top of that, health care costs keep increasing, primarily driven by drug and device costs. So, multifactorial.
 
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#104
#104
midnight orange said:
https://www.wsj.com/articles/banning-surgery-for-the-obese-and-smokers-

Ban Nudges, Not Soda | Psychology Today

NHS provokes fury with indefinite surgery ban for smokers and obese
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The only individuals who argue for socialized medicine are individuals who see the government as the solution not the problem. They believe the US has always been this way in terms of high insurance rates and high deductibles but they don’t blame the government for creating the current situation. It is confusing
 
#106
#106
TheDeeble said:
If the govt wants single payer, I want smoking banned. Alcohol too.

Bunch of needless medical expenses that shouldn't be paid for by someone else.
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Absolutely not. It is those healthy bastards that live until parts starting wearing out due to age that really cost us.
 
#108
#108
Vol_Doc said:
That's a complex question, but I'll give it a go.

Employers used to shoulder more of the costs of health insurance. Additionally, health insurance used cover more of the costs. You'll notice that deductibles are higher, as are co-pays. They have also been changing global windows. That means when you have a procedure or surgery, the follow-up used to be covered completely. Now, it may require another co-pay. The carriers are passing more on to the patient. On top of that, health care costs keep increasing, primarily driven by drug and device costs. So, multifactorial.
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In the longer term, I think health insurance itself increased the cost of care. It added a layer of administration and profits that were not previously in the mix. It took a lot of the pain out of health care since it was provided by employers and made it "affordable" to go to the doctor for whatever reason without requiring patients to consider the cost/value of going.

Also, artificially low doctor education is another factor. Doctor's time cost more because they limit the number of doctors that graduate per year which keeps the cost up for everyone.

Medical as a profit center (talking about costs continuing to rise). Hospitals used to be not-for-profit or non-profit, but are now for profit. Drugs-you only need to look at the recent stories of drugs being bought and prices being increased in order to drive profits (not to drive R&D, i.e. pharma-bro, etc). What is an acceptable profit margin for a life-saving drug, device, stay in the hospital, surgery, etc...10%, 100%, 1,000%, 10,000%??.

Multifactoral for sure and I certainly don't know the answer.
 
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#109
#109
landscapingvol said:
https://www.usitc.gov/publications/332/executive_briefings/chambers_health-related_travel_final.pdf

Those are some great numbers you cited. Of the 1 million travelers who leave the US in search of “better” healthcare nearly 90% are returning to their countries of origin in Central and South America. Are you suggesting they have better healthcare in those nations? My wife has cancer. She goes to MD Anderson for treatment. It is like the UN, people from all over the World come there for treatment with cancer. When you have a wife or a child with cancer or any other life threatening disease you don’t look for the most efficient, cheapest option, you look for the best. Foreign individuals spend nearly 4 billion dollars each year coming to the US for treatment. Of the 4 billion dollars, nearly 30% comes from Europe. Of the 1 million who seek care elsewhere from the US, less 3% seek care in Europe.
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Only the richest can come here for their healthcare if they want. It's not the poorer people.

Of course the cheapest option isn't going to be looked at for cancer but high costs don't equal good healthcare and the US shows that.
 
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#110
#110
Roustabout said:
One problem is that being a physician has become a career path to pursue extreme wealth.

Historically, medicine has been a career of benevolence.
Not to say there aren’t doctors who pursue medicine because of pure motives. There are.

For the better part of this country’s history the Christian church funded hospitals. As long as profit is the driving factor nothing will be fixed.
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False.

As a physician, I can tell you that no one (anymore) goes into medicine to get rich. Actually, medicine is one of the few career paths you can take where you are guaranteed to see your pay, as a function of standard of living, decrease over its course. You end up having to work harder, seeing more patients in order to keep your pay stable. You see, doctors are easy targets for health care cuts. We don't have good lobbies, like pharma, medical device manufacturers, insurance, and hospital systems. We're usually the first on the chopping block. Docs are retiring early to get out of the mess, and not enough are coming in to cover the loss. We're relying more on so-called "mid-levels" (sorry, if that's derogatory to anyone here), such as nurse practitioners, physicians assistants, etc to deliver care. It's only going to get worse, unfortunately.

So, anyone going into medicine to get rich is a fool. There are very few specialties that can pull that off without working ridiculously hard (I know a guy in my field that sees over 100 patients a day to maximize income, which is about half of what my partners and I see). They are typically the ones with a high cash basis model, like plastic surgery and cosmetic dermatology.

Now that said, do doctors struggle to survive? Of course not. Most make in the low to mid 6 figures, but that's far from rich nowadays. They also spend an average of 8 extra years in school beyond college and accumulate considerable debt to get there. I think the average is around $200k. If you want to be rich, get an MBA and get into business. Less investment and more potential lifetime income, if you do it right.
 
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#112
#112
I would support a single payer system if many of the regulations were removed that are bogging down the system. Also, I would support removing much of the red tape and expense that it takes to bring a drug to market. In the case of drugs, perhaps create 2 or 3 year window in which the drug has an experimental status. Patients are given the option and agree to hold harmless the drug company for the ability to try experimental drugs.

There is a whole lot of crap that binds up the system, costs a ton of money and provides no value. Whoever compared it to education was spot on.
 
#114
#114
USMC-TNVOL said:
Only the richest can come here for their healthcare if they want. It's not the poorer people.

Of course the cheapest option isn't going to be looked at for cancer but high costs don't equal good healthcare and the US shows that.
Click to expand...

So the rich purposely look for substandard healthcare? Are you arguing for the best healthcare system with the best treatments or are you arguing for just average like the education system?
 
#116
#116
volkyries said:
Everyone dies, the question really is, would their outcomes have been better if they were to foot the whole bill themselves under a completely private system.

Since the article mentioned chronic diseases then I doubt they would since those are the first patients insurance companies would get rid of if they had the chance. They would probably just wait to die while bankrupting their family in that case.
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So yes they will.
 
#117
#117
USMC-TNVOL said:
As a conservative leaning person, it pains me to see Republicans not look at the problem and see what has worked in many other countries. I've learned a lot as I'm pursuing my Master in Health Admin.

Right leaning people cry out about socialized healthcare but doesn't realize people like Teddy Roosevelt attempted it back in the early 1900s. If our GDP is almost 20% from healthcare while others are about half or lower, there is an issue of profit being built in and we need to do something about it. Insurance companies are corporations with one bottom line which is profit. The government should require insurance to be non profit or become a single payer system.
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So you want to make the people who pay the bills non profit but refuse to touch the health care industry that is building in huge profit. You want to manage the the ones that pay the bills but not the ones who send them? Makes little sense.

Your matters in health Amin send to be training you up on how to exacerbate the cost of health.
 
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#118
#118
DEFENDTHISHOUSE said:
How healthcare can be a partisan issue is beyond me. Let doctors treat patients, get out of the way.
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If only. Sadly, we have many pressures on our decision-making.

Partly, this is due to the minority of bad apples in my profession that have gamed the system over the years. That has resulted in numerous regulations, mandates, and other bureaucratic red tape for us to deal with. This not only affects our decisions, it results in us having to hire more staff and otherwise increase overhead just to remain compliant. My practice has 10 full time employees per physician. That's ridiculous.

Insurance carriers can be very finicky about what they will cover, and it usually comes down to money. They are not in the business of taking care of patients, like we are. They are in the business of making money for their shareholders. The less they pay out, the better. Even when we can provide good evidence for a particular method of care, the carriers may still say no. I've had to go to bat numerous times for patients that were failing other treatments, so the carriers would agree to pay for more expensive, more effective alternatives, but I'm not always successful. The carriers may also mandate step therapy, which means the patient has to fail a cheaper treatment before a more expensive treatment will be covered.

The FDA also limits us indirectly. If a drug, for instance, is approved for an indication, then it's discovered that it will work for another, similar indication, the drug company must go through the FDA again for that separate indication. That's a big cost to them that's mostly unnecessary and may not be worth their investment. Then, if we want to use that drug, it's called off-label and many times won't be covered by insurance.

This all creates significant frustration for us in trying to care for our patients.
 
#119
#119
USMC-TNVOL said:
As a conservative leaning person, it pains me to see Republicans not look at the problem and see what has worked in many other countries. I've learned a lot as I'm pursuing my Master in Health Admin.

Right leaning people cry out about socialized healthcare but doesn't realize people like Teddy Roosevelt attempted it back in the early 1900s. If our GDP is almost 20% from healthcare while others are about half or lower, there is an issue of profit being built in and we need to do something about it. Insurance companies are corporations with one bottom line which is profit. The government should require insurance to be non profit or become a single payer system.
Click to expand...

This is an interesting angle. I agree about insurance companies. However, single payer would be awful. All you have to do is look at the VA health system as an example.

My thought is that insurance should be owned by the patients. There are examples of this model around the country. Basically, the patients pay into the plan, and after expenses, any profit is returned to the patients as a refund. This encourages more efficient utilization and, hopefully, better self-care. You are essentially rewarded for being healthy. Would be tricky to apply this model across the country, though. It really should be a state level design.
 
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#120
#120
theFallGuy said:
Despite what you say about socialized healthcare, our capitalist system is responsible for most of the world's medical advancements.

"Today, 12 of the top 20 medical device companies are headquartered in the U.S. Last year, U.S. companies had more than 3,000 new pharmaceutical products in development.

The cost of developing a new drug now exceeds $1.3 billion and takes an average of 12 years, and only a small percentage of new molecular entities ever reach the market"

Though The U.S. Is Healthcare's World Leader, Its Innovative Culture Is Threatened
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It's a catch-22, honestly. The free market pushes innovation, but the current patent protection (10+ years in some cases) makes costs ridiculous by limiting competition. We pay so much more than other countries because they have government cost controls, while we do not. So, essentially, we're subsidizing the rest of the world when it comes to drug and device costs. It's a tough situation. If we stay where we are, we'll continue to pay more. If we implement cost controls, we'll suppress innovation. I'm thinking we should at least reduce the insane patent protections to start.
 
#121
#121
Vol_Doc said:
False.

As a physician, I can tell you that no one (anymore) goes into medicine to get rich. Actually, medicine is one of the few career paths you can take where you are guaranteed to see your pay, as a function of standard of living, decrease over its course. You end up having to work harder, seeing more patients in order to keep your pay stable. You see, doctors are easy targets for health care cuts. We don't have good lobbies, like pharma, medical device manufacturers, insurance, and hospital systems. We're usually the first on the chopping block. Docs are retiring early to get out of the mess, and not enough are coming in to cover the loss. We're relying more on so-called "mid-levels" (sorry, if that's derogatory to anyone here), such as nurse practitioners, physicians assistants, etc to deliver care. It's only going to get worse, unfortunately.

So, anyone going into medicine to get rich is a fool. There are very few specialties that can pull that off without working ridiculously hard (I know a guy in my field that sees over 100 patients a day to maximize income, which is about half of what my partners and I see). They are typically the ones with a high cash basis model, like plastic surgery and cosmetic dermatology.

Now that said, do doctors struggle to survive? Of course not. Most make in the low to mid 6 figures, but that's far from rich nowadays. They also spend an average of 8 extra years in school beyond college and accumulate considerable debt to get there. I think the average is around $200k. If you want to be rich, get an MBA and get into business. Less investment and more potential lifetime income, if you do it right.
Click to expand...

I like you because you think that 200K doesn't make you rich.
 
#122
#122
Vol_Doc said:
It's a catch-22, honestly. The free market pushes innovation, but the current patent protection (10+ years in some cases) makes costs rhttps://mises.org/wire/how-government-regulations-made-healthcare-so-expensiveidiculous by limiting competition. We pay so much more than other countries because they have government cost controls, while we do not. So, essentially, we're subsidizing the rest of the world when it comes to drug and device costs. It's a tough situation. If we stay where we are, we'll continue to pay more. If we implement cost controls, we'll suppress innovation. I'm thinking we should at least reduce the insane patent protections to start.
Click to expand...

Hey Vol_Doc here’s a somewhat condensed version of medical care in the 20th century from Mises. Just seeing what you thought about it.

How Government Regulations Made Healthcare So Expensive | Mises Wire
 
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#123
#123
Vol_Doc said:
This is an interesting angle. I agree about insurance companies. However, single payer would be awful. All you have to do is look at the VA health system as an example.

My thought is that insurance should be owned by the patients. There are examples of this model around the country. Basically, the patients pay into the plan, and after expenses, any profit is returned to the patients as a refund. This encourages more efficient utilization and, hopefully, better self-care. You are essentially rewarded for being healthy. Would be tricky to apply this model across the country, though. It really should be a state level design.
Click to expand...
I'm in a faith based co-op that works exactly like that. It feels somewhat like a throwback to the old days when people carried major medical insurance and paid for the rest.
 
#124
#124
Vol_Doc said:
False.

... We're relying more on so-called "mid-levels" (sorry, if that's derogatory to anyone here), such as nurse practitioners, physicians assistants, etc to deliver care. It's only going to get worse, unfortunately...
Click to expand...

Shouldn't this be a good thing for patients? If someone qualified to diagnose/treat smaller issues/common ailments, it should be allow more access to healthcare for the patient and should make it cheaper assuming mid-levels don't get paid the same as a doctor. It would also free doctor time to focus more on complex issues which is what he is trained for. I could see how this would be a negative for doctors though, since it takes the easy, billable cases and gives them to someone else which means less income for the doctor.

Vol_Doc said:
So, anyone going into medicine to get rich is a fool. There are very few specialties that can pull that off without working ridiculously hard (I know a guy in my field that sees over 100 patients a day to maximize income, which is about half of what my partners and I see). ...
Click to expand...

So if he works a 12 hr day, he is devoting 7 minutes to each patient. An 8 hour day, he would spend less than 5 mins on each and that leaves no time for anything else (eating, bathroom/smoke breaks, surfing volnation, etc) while working those hours. That would certainly make me feel confident of his diagnosis.
 
#125
#125
Yes, there are several areas in healthcare that attribute to the high cost of healthcare, but do not believe for one second that equipment manufacturers and vendors are not a huge part of the problem.

As a leadership member in healthcare, I have a couple of stories to share concerning cost.

Long story short, a huge healthcare equipment manufacturer tried to charge me $10,000 for a $950 battery back-up. If I had not been diligent at my job, that would have been $9000 that my company would have over-paid for a battery back-up.

When building new wing for hospital, we had received quotes for tv's for patient rooms. A few months later when it came due to get those tv's, the sales person was no longer with that company. When dealing with another sales person, after they found out we were a hospital, tried to increase the cost by 35% for the exact same tv's. The comment he made to the person getting the tv's was, "This is how it's done. If it is the government or healthcare, everyone raises the price at least 35%. Don't rock the boat."

Those of you whom may be vendors dealing with hospitals, you are part of the problem.
 
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