The US Health System

[Brian_B]

The U.S. really needs to go in the direction of preventative care. It's been a few years but I recall from a Health Law class that the state of Oregon had (or still has) some scaling plan as to what procedures/surgeries they would pay for that was informed with a variety of factors.

For example: Heart surgery would be at the top of the list with everyone having that subsidized if they couldn't afford it but something like knee surgery wouldn't as it would be too far down the list.

With that in mind, consider this: I run 30+ miles a week, eat healthy, etc. etc. In my sixties I eventually develop a bum knee because I ran so much but I never cost the health system much money because I was always in excellent shape. Couch Potato Joe, meanwhile, ate the worst slop imaginable and smoked five packs a day. His knees are just fine because he never got off the couch but his various health maladies have cost the system thousands of dollars over the years. He'll get subsidized for his heart surgery but I won't get subsidized for my knee surgery.

Yes, it seems draconian, but I would LOVE to see a system implimented that puts incentives on individuals to take better care of themselves.

 

[Speedo]

Our system has flaws, but I prefer it to the waiting lines in the countries w/ universal plans.
-----
gone to an emergency room lately?

Definetly not. I had to go to the ER last year (on a weekend) to get some stitches. 2 hrs waiting before I got a room and saw a Dr. There were only 3 other people in the waiting room, and only 2 people came in while I was waiting. Not to mention that the full cost for those 11 stitches was $850 - that's $77 per stitch, for those of you who aren't math majors. Rediculous. Thank God I had insurance.

 

[7ronin]

If you do not have health insurance and have a medical emergency, you will not be turned away at the emergency room. If you can't pay, the hospitals end up eating the cost. This is one of the complaints about illegal immigration: that illegals are running up the costs of health care for those who can pay because those who can end up paying for those who can't.

A frequent complaint about U.S. health care is that rural areas have trouble attracting doctors and other health care professionals.

Health care for myself and my wife costs approximately $500 annually as part of the military retiree system. We have never been denied treatment or had to wait for treatment. Our medication is free.

 

[Neonanocyborgasm]

I'd ask the doctor who posted here, but think the near union-ish control of the AMA on the hospitals has alot to do with high bills here.

And you know, its not like health insurance is a god-given right, as its made out to be. 100 years ago, we thought leeches were healthy, or something like that.

Our system has flaws, but I prefer it to the waiting lines in the countries w/ universal plans.

The AMA's power is over-rated. Its influence has been waning over the years, and it is not seen as much more than a physicians' social club. It still retains some political power, due to the membership of many old doctors, but as these figures are aging and retiring, so has its influence. The AMA publishes two journals: JAMA (journal of the AMA) and Archives of Internal Medicine. These are considered 2nd rate journals.

They mail me offers to join their membership, but I always refuse.

 

[Verbose]

Lessee, the US spends 15% of its GDP per capita on health care. Comparable OECD countries spend around 10%. Estimates are that for the US this will rise to 20% by 2015 and 25% by 2025. (It will rise elsewhere too, but not as much.)

The US doesn't get a huge return in life expectancy. More importantly the figures for healthy life expectancy is considerably lower in the US. (Interpretation is that Americans are worn out physically sooner than Europeans, or don't get problems under treatment until they have become chronic.)

And the US system leaves something like 45 million of its citizens without health insurance (15%).

The system is unevenly distributed. Unintentionally health care became the business of employes during WWII, when salaries were fixed. One way of offering attractive employees more was to throw in free health care, and the system grew from there.
It worked fine as long as US companies were outperforming international competitors. These days they are not and now the costs for health insurance is starting to hurt US companies (GM...). They are also complaining that they have trouble keeping up with international competitors in countries with national, tax-funded public health.
Bottom line is that someone has to foot the bill for this. Either governement and indirectly all taxpayers, or private enterprise, or the individuals, with their bodies.

The US system to its credit does mean there are huge amounts of money in medicine (if very unevenly distrubuted). One effect is that there are procedures done in the US that European doctors won't even contemplate. The costs are prohibitive, and besides they usually lack the knowledge and skill to perform them.
OTOH few of these procedures are actually life saving, and when they are they are so few rare and few in number they won't affect statistics. Often they improve the quality of life of a suffering individual with a great health plan. So chances are that in Europe you'll just have to live with you aches and pains. But the same is true of those Americans who lack health insurance.

Europeans have centuries of a tradition on national health being a political concern, so they tend to think it's tax money well spent for the most part. They also seem to agree that decent health care is something all citizens should be provided with, like decent education. It's part of the social contract.
It also seems to work. On average US health isn't better and the systems to ensure it much more expensive. Those costs are also starting to hurt US economic performance. (Which is excellent compared to most, but it's still a drag on it.)
Should the costs for the US balloon as projected in the next twenty years, I assume it will be a real problem. (Even if the unevenness of the system might not be for most Americans.)
Changing the US system would deprive us all of some of the most inventive (and expensive) medical technology and clinical procedures around. The US is paying for a lot of that devlopment as the health insurance system isn't really cost-sensitive. But it wouldn't really impact general levels of health.

 

[Urederra]

Actually, I looked for the life expectancy world ranks over the internet and the United States is number 42, not number 21, as somebody mentioned earlier in this thread.

source

Andorra is number one with 83.47 internet years ... Damn, my hometown is just over 100 miles away from Andorra.

United States is number 42 with 77.26 internet years.

I also found the rank of Healthy Life expectancy, which is the time a newborn can expect to have a healthy life. It is called DALE, for Disability Adjusted Life Expectancy.

source2

In this rank Japan hits number one, Spain number 5 and Andorra number ten, which is odd, if you compare the two ranks. United States ranks number 24 in this one, BTW. maybe that is where the confussion comes from.

The WHO rankings show that years lost to disability are substantially higher in poorer countries because some limitations -- injury, blindness, paralysis and the debilitating effects of several tropical diseases such as malaria -- strike children and young adults. People in the healthiest regions lose some 9 percent of their lives to disability, versus 14 percent in the worst-off countries.

In terms of DALE, the rest of the top 10 nations are Australia, 73.2 years; France, 73.1; Sweden, 73.0; Spain, 72.8; Italy, 72.7; Greece, 72.5; Switzerland, 72.5; Monaco, 72.4; and Andorra, 72.3.

DALE is estimated to equal or exceed 70 years in 24 countries, and 60 years in over half the Member States of WHO. At the other extreme are 32 countries where disability-adjusted life expectancy is estimated to be less than 40 years. Many of these are countries with major epidemics of HIV/AIDS, among other causes.

The United States rated 24th under this system, or an average of 70.0 years of healthy life for babies born in 1999. The WHO also breaks down life expectancy by sex for each country. Under this system, U.S. female babies could expect 72.6 years of healthy life, versus just 67.5 years for male babies.

 

[Caprice]

Yes, it seems draconian, but I would LOVE to see a system implimented that puts incentives on individuals to take better care of themselves.

I agree entirely. I think the fact that I consume alcohol should automatically exclude me from liver transplants, for instance. I realize the risks (anyone who doesn't in this informed day-and-age is a moron, as far as I'm concerned) and I choose to do it anyway so it should be my problem.

Same "draconian" measures for smokers. You smoke -- you get lung cancer -- sorry but you are a waste of resources unless you can pay for your own care.

I could carry on with numerous examples, but I won't right now. I'm sure you all are sufficiently intelligent to get the idea.

 

[Panzeh]

I have two reasons to oppose nationalized health care.

1. You still have to pay for nationalized healthcare, just to a different person. Nobody can opt out.

2. Nationalized healthcare gives the state a vested interest in 'personal safety', thus draconian laws can be passed because the state foots the bill.

 

[Verbose]

I have two reasons to oppose nationalized health care.

1. You still have to pay for nationalized healthcare, just to a different person. Nobody can opt out.

2. Nationalized healthcare gives the state a vested interest in 'personal safety', thus draconian laws can be passed because the state foots the bill.

Most European countries have national health care, but no draconian laws.

So your second point calls for a pretty outrageous scenario. Unless the assumption is that specifically in the US national health care would lead to draconian legislation? (Which I find as unlikely as in Europe.)

The US system needs reform because it's inefficient in relation to the expense.

 

[Mise]

It boggles the mind how even the most arrogant jingoist can justify paying two to three times as much for their health service!

 

[sysyphus]

It's a matter of libertarian ideology. Some people view paying someone twice as much for something privately as they would for the same thing through taxation as freedom.

 

[Kayak]

It's a matter of libertarian ideology. Some people view paying someone twice as much for something privately as they would for the same thing through taxation as freedom.

Not only that, they have to justify denying good healthcare to the poor while complaining about paying higher premiums necesitated by the lack of comprehesive coverage.

 

[warpus]

I agree entirely. I think the fact that I consume alcohol should automatically exclude me from liver transplants, for instance. I realize the risks (anyone who doesn't in this informed day-and-age is a moron, as far as I'm concerned) and I choose to do it anyway so it should be my problem.

Same "draconian" measures for smokers. You smoke -- you get lung cancer -- sorry but you are a waste of resources unless you can pay for your own care.

I could carry on with numerous examples, but I won't right now. I'm sure you all are sufficiently intelligent to get the idea.

If the U.S. tried to implement something like this people would be up in arms - Personal responsibility is not a very popular concept in the United States.

 

[Caprice]

Personal responsibility is not a very popular concept in the United States.

I've noticed... kinda sad methinks.

 

[sysyphus]

Americans (and pretty much all of the English speaking world) are particularly bad, but I'd say the disdain for personal responsibility is pretty much a universal trait.

 

[joycem10]

2. Nationalized healthcare gives the state a vested interest in 'personal safety', thus draconian laws can be passed because the state foots the bill.

Thats what scares me the most. The Safety and Health First lobby is scary enough as it is today. Wait until the state really gets some incentive to put you in a protective bubble.

Its funny to see someone say that personal responsibility is not a popular concept in the US, within the context of a thread where most people are advocating for nationalized health care.

 

[El_Machinae]

The US doesn't get a huge return in life expectancy.

Wouldn't it be better to factor out the people who don't get medical care though? I'd wonder what the life expectancy of the people who pay for medical care is?

That way we'd see if everyone is getting the life expectancy they're paying for.

 

[Mise]

Wouldn't it be better to factor out the people who don't get medical care though? I'd wonder what the life expectancy of the people who pay for medical care is?

That way we'd see if everyone is getting the life expectancy they're paying for.

We'd also have to factor out other influences, like better diet, living in healthier conditions, taking sick days instead of being forced to work through them due to financial constraints...

I think all that it would prove (if indeed it does prove anything at all!) is that rich people are healthier than poor people, and wouldn't say a great deal about the effect of the US healthcare system.

 

[IglooDame]

Its funny to see someone say that personal responsibility is not a popular concept in the US, within the context of a thread where most people are advocating for nationalized health care.

 

[Mise]

Its funny to see someone say that personal responsibility is not a popular concept in the US, within the context of a thread where most people are advocating for nationalized health care.

Except we're doing so because it's cheaper and more efficient, and arguably provides a greater level of service to boot, NOT because we want to pass the buck to the government...

I mean you're saying that the government will spam us with "don't hurt yourself" on every billboard and on every TV commercial, but there's absolutely no basis for that assertion in reality. It's just crazy how you can continue to justify it, when all evidence points in the exact opposite direction.