[helene_t]

Winstonm, on Jul 3 2009, 06:02 PM, said:

With the worldwide nature of BBO, it would be nice to hear how healthcare works for them from those who actually live in countries other than the U.S. and use non-U.S.-based healthcare - especially social-type healthcare such as in France, Britain, or Canada

I lived in Denmark from I was born in 1966, to 1996.

The financing of the health care is very smooth as it it just a part of the municipality budget, financed by general income tax, so unless you are a civil servant involved in the budgets fights within the municipality you never see a doctor's bill. Dentists only partially financed but that was smooth as well. The dentist would print out a bill stating 440 kr of which 220 refunded by the municipality so please pay 220 kr, then I would write my bank account number on it and sign it and that's as far as I have had to do with health care expenses. As debit cards and internet banking was introduced it become slightly easier as you didn't have to scrible the 10-digit bank account number twice a year anymore. (I could always pay cash of course).

There were some issues with fights between counties and municipalities about paying in borderline cases (I have never experienced it myself, but heard rumors about it), which must have been solved by now as the counties have been abolished. Also there was a single instance where a psychiatric clinic had to ask the municipality for pre-payment before they could treat me so the procedure was delayed by some three weeks.

Historically there has been a lack of flexibility as municipalities refused to refund expenses by remote hospitals. This is solved now at the national level, but it can still be difficult to get a municipality (or insurance company, or whatever they have) in one EU country pay for treatment in another country. When you go on vacation and get an acute problem it will rarely be a problem to get the costs refunded (unless you go to the US in which case you need a special insurance for the high US costs).

Due to the small size of the country, in combination with the reluctance to refund costs in other countries and at off-sector (commercial) clinics, the choice is sometimes limited. In fact that was the reason I had to leave the country as I had to live in the Netherlands in order to be treated at a Dutch hospital (according to the EU court it should not be necessary, but in practice it is easier and cheaper to emigrate than to hire a lawyer). My own story, as well as my impressions from working at a Danish hospital myself does not give a rosy picture of Danish health care professionals, but whether my experience is typical or not, the system performs quite well as far as one can judge from the statistics. It is extremely cheap, has almost zip administrative overhead, and is good quality. Waiting lists are sometimes a problem but I have had lots of contact with 80+ years old people who obviously are large scale care consumers and I have heard very few complaints. However the coverage is not as complete as in most other countries. For example, is virtually impossible to get the municipality to pay for psychotherapy.

Then I lived in Netherlands from 96 to 07. Generally friendly heath care staff and good quality care, but the financing of the system (private insurance companies) is about as inefficient as one can imagine, causing enormous frustrations to patients as well as an enormous overhead, including lots of people who are trained as caregivers who spent a major part of their time on paperwork. The system has been streamlined a lot recently with the elimination of the different categories of insurances (stratified by subsidy eligibility) but they still have a long way to go. Also I found that hospital administrations committed many mistakes and were very sluggish with patient privacy. And one big problem in the Netherlands is that the way unemployment insurance works makes it very attractive for people who are fed up with their job to be declared "disabled", which means substantial health cares resources are spend on assessment of dodgy disability cases. They are improving in that area too, but again have a long way to go.

Now I live in the UK where the system resembles the Danish one. Unfortunately the statistics w.r.t. quality of care look terrible so if I needed something serious I would probably go abroad. But so far I am very satisfied with the GP and the local hospital.

[mike777]

mycroft, on Jul 3 2009, 11:40 AM, said:

Some people consider prenatal care to be just the kind of cheap(er) health care that, if available to everybody, minimizes "poor lifestyle choices made by the mother" and for some reason, lowers the infant mortality rate.  You can't stop everybody, no, but education works, at least better than no education.

Sort of the same way that a few visits to the doctor each year for preventive purposes - including warning of "poor lifestyle choices" while the consequences are less critical; or just in case that cold isn't a cold, cost less than the emergency treatment for pneumonia, save one cancer treatment (or make it treatable rather than something requiring surgery or palliative care), so lower the health cost while simultaneously improving health.

This sounds horrible but bottom line preventive care increases health care costs. There are many reasons to encourage preventive care, lower costs is not one. However that is not a reason not to encourage very very early detection of the major killers.

Granted how much health care costs and where the money comes from and can a country afford national health care without going into bankruptcy/default is not really the issue in this thread.

[helene_t]

mike777, on Jul 3 2009, 07:26 PM, said:

This sounds horrible but bottom line preventive care increases health care costs. There are many reasons to encourage preventive care, lower costs is not one. However that is not a reason not to encourage very very early detection of the major killers.

I agree that it is generally true that preventive medicine costs more than it saves, and I also agree that this shouldn't be a reason for not trying to prevent disease.

But as for the major killers, I think one can go too far. Routine mammograms for all women at certain ages may cause more cancer deaths than it prevents. Even if that is an exaggeration, I think it's clear that it is better only to screen women who have symptoms and/or family occurrence.

Prevention is many things so I would be surprised if one couldn't find a few examples of preventive measures that reduce health costs. Vaccination programs, toothbrushing lessons in kindergardens, advice on baby nutrition for first-time parents, clean needles for drug addicts. I haven't seen the figures but I could imagine such measures might pay off.

[onoway]

[ bottom line preventive care increases health care costs. ]

I would like to see some background for such a statement. I wasn't aware of anywhere that the emphasis was on preventative health care rather than trying to 'fix' things once they went wrong, so am most interested to know the basis. Is there really somewhere that there is a proactive approach to preventative medicine (beyond such things as prenatal classes, vaccinations, anti smoking ads and so forth?)And why bother doing even those things if they are not cost effective? Job creation?

It's interesting to consider that this would be the one area where prevention is more expensive than cure. It is difficult to believe that it is cheaper to do heart surgery for clogged arteries than to have people taught diet and perhaps the use of a few simple herbals so that the surgery is not required in the first place. In fact, some numbers I have seen suggest that the huge increase in the number of major surgeries is largely responsible for the massive increase in health care costs.

So, where is it that proactive preventative medicine is being practiced and exactly what are they doing?

[onoway]

The waiting in Canada to see specialists and get dates for surgery is often far too long, very true. However, the wait is much longer for people living in countries without health coverage if they cannot afford to pay for treatment.

[jdonn]

What is supposed to be the alternative to long waits, not treating as many people?

[mike777]

"would like to see some background for such a statement."

This is a rather gruesome topic to discuss in any detail. First off if anyone claims preventative care reduces health are costs I doubt you can find much evidence to back it. I repeat there are many reasons to have earlier detection of many killers and to have preventive health care, lower costs are not one.

Here is one common sense example, Polio shots were a miracle for my generation, they did not result in lower lifetime medical costs. Stopping people from smoking 3 packs a day is good preventive medicine, it does not result in lower lifetime medical costs.


btw I assume no matter how long the wait a doctor treats just as many people as if there is no wait. The problem is a lack/limit of supply not a lack of demand for medical care. That is one issue that seems to be not discussed very often. Assuming 50 million uninsured get access to critical care today, I understand that once they are covered by insurance demand for medical care increases by 70%.
If a rich nation such as the USA can supply such medical care we should. The best way is an answer I do not know. IF the USA cannot literally supply such medical care, we got a problem.

[Winstonm]

Quote

I lived in Denmark from I was born in 1966, to 1996.

The financing of the health care is very smooth as it it just a part of the municipality budget, financed by general income tax, so unless you are a civil servant involved in the budgets fights within the municipality you never see a doctor's bill.

Obviously, the people in Denmark do not grasp the finer points of capitalism. Why are you pouring billions into the black hole of good health for your citizens when you could be enriching a select few by drowning your budget in red ink to support global wars on whatever-it-is-at-the-moment-that-sounds-good-to-be-against and paying billions for air-to-air fighter jets to dismantle the great Red threat from the air force of the now-defunct U.S.S.R.?

War is good for health - don't you know? Isn't it cheaper simply to kill everyone who has germs to spread?

[Winstonm]

It seems we in the U.S. have little to fear - all we have to do is deregulate enough (like we did with the banks) and everything will be perfect.

Quote

The ability of Canadian banks to navigate the current financial storm is earning global plaudits. The World Economic Forum in October ranked the country’s financial institutions No. 1 in the world for solvency. U.S. banks came in 40th, two rungs behind Botswana.

When it comes to healthcare, we are gonna kick Botswana's lame ass.

[jonottawa]

The only thing worse than greedy amoral doctors is fat lazy Americans who want to abuse their bodies for decades and then stick someone else with the bill.

No good solution to this problem.

[onoway]

[, Polio shots were a miracle for my generation, they did not result in lower lifetime medical costs. Stopping people from smoking 3 packs a day is good preventive medicine, it does not result in lower lifetime medical costs.]


Well, if you consider that those who died from polio had rather limited lifetimes, then I suppose not. I think , though, that you can't really use that as a basis, or there is nothing to be said for any sort of treatment, as obviously it is more cost effective to let people die than to do anything. We can go back to the evolution argument..

You need to consider the lifetime cost of those who survived with polio vs those who never got it in the first place because of vaccination. Has anyone investigated that? Can you cite the study?

I would like to see something more than just a statement about the cigarette thing ...you are claiming that it costs more to run ads/educate people than to treat them for lung cancer and heart disease, for example?

The problem with putting a value of preventative medicine is twofold; first, that to my knowlege it hasn't actually been embraced as a real commitment anywhere, and second, it takes a long time to see the results. How long to see if fewer people get lung cancer once cigarette smoking is not so prevelant in the general population? What you are trying to see is the absence of illness, and the absence of something tends to be more difficult to evaluate than the presence of something else. This is particularly true when what you are trying to evaluate is not the only factor...lung cancer can have other beginnings other than smoking, and we all deal with various pollutants in the air we breathe, smokers or not.

One thing about health care costs though, it might well be worth setting up tiers of health care in that a lot of the time, a doctor is not really necessary to deal with many of the reasons people wander into clinics and hospitals. However, doctors tend to be so jealous of their territory that they are totally unwillinging to allow anyone to put a toenail into what they consider their exclusive area. It's possible to train people to do the first line of health care, and then refer people up to doctors as they needed a doctor's care, but this isn't possible while doctors insist that only they can deal with anything health related. It's like insisting you have to have a chef to make a grilled cheese sandwich. That would likely take care of about 50% of the increased use of comprehensive health care, maybe more as it would also cut back on some of the use of doctors' time now.

To do anything significant about health care costs you are somehow going to have to get the doctors to ease up on their territoriality. Good luck with that.

[helene_t]

New England Journal of Medicine gave an overview of the issue last year. It is obviously a very complex issue - one should not ask whether preventive care in general is cost effective (since the answer is obviously "it depends"), but whether as specific initiative, say a screening program or a stop smoking campaign, is.

http://content.nejm..../full/358/7/661

[PassedOut]

mike777, on Jun 30 2009, 11:39 PM, said:

Krugman says we can have superior health care at a cost of one trillion...in worst case two trillion bucks......how can anyone be against that!

My guess and only a guess is conservatives are afraid the real total is 35 to 100 trillion......

The US is already slated to spend $33 trillion on health care over the next decade. The extra $1 trillion will expand coverage to every citizen. Paul Krugman's piece yesterday has a good explanation: HELP Is on the Way

Quote

Let me start by pointing out something serious health economists have known all along: on general principles, universal health insurance should be eminently affordable.

After all, every other advanced country offers universal coverage, while spending much less on health care than we do. For example, the French health care system covers everyone, offers excellent care and costs barely more than half as much per person as our system.

And even if we didn’t have this international evidence to reassure us, a look at the U.S. numbers makes it clear that insuring the uninsured shouldn’t cost all that much, for two reasons.

First, the uninsured are disproportionately young adults, whose medical costs tend to be relatively low. The big spending is mainly on the elderly, who are already covered by Medicare.

Second, even now the uninsured receive a considerable (though inadequate) amount of “uncompensated” care, whose costs are passed on to the rest of the population. So the net cost of giving the uninsured explicit coverage is substantially less than it might seem.

Putting these observations together, what sounds at first like a daunting prospect — extending coverage to most or all of the 45 million people in America without health insurance — should, in the end, add only a few percent to our overall national health bill. And that’s exactly what the budget office found when scoring the HELP proposal.

Those fighting universal healthcare in the US do so for reasons other than fear of the cost.

[luke warm]

i have a few questions... does this bill include prescription drugs as part of healthcare? would those eligible for coverage come from a pool of americans who are not presently eligible for coverage under another plan (for example, a person whose company offers health insurance but who can't, or feels he can't, afford it - would that person be eligible)? lastly, would the plan pay the same as medicare a & b (with the same fee schedules/providers)?

[PassedOut]

As I understand it, this bill does not provide full coverage for prescription drugs, but includes some provisions to make prescription drugs less expensive. Here is a draft summary released in mid-June: Summary of Initial Draft of Health Reform Bill from Senate Health, Education, Labor and Pensions Committee

Here is the actual bill reported out of committee: A BILL To make quality, affordable health care available to all Americans, reduce costs, improve health care quality, enhance disease prevention, and strengthen the health care workforce

[andrei]

Winstonm, on Jul 3 2009, 12:02 PM, said:

With the worldwide nature of BBO, it would be nice to hear how healthcare works for them from those who actually live in countries other than the U.S. and use non-U.S.-based healthcare - especially social-type healthcare such as in France, Britain, or Canada

In Canada:

1. My girlfriend had a ski accident at 8:30 PM. We arrived at the closest hospital ( 100 km from home) at 9:30PM, some doctor saw her and told us there was an ACL tear. He said we should wait for an X-ray because that's the procedure, although ligament damages does not show at X-ray's. At midnight we were told that the radiologist is in surgery and we would have to wait 3-4 more hours. We left for home. In the end it turned out the bone was broken and valuable time has passed by.

2. I went to family doctor trying to get an appointment to an urologist, I had to wait 3.5 month for it. It didn't seem to be an urgent case at first, but it became after a few months.

3. I had myself an ACL and meniscus tear, the reconstruction surgery was done 6 month after.

[jdonn]

It sounds like someone could get plenty of business for themselves moving to Canada and becoming a doctor.

[Lobowolf]

andrei, on Jul 6 2009, 01:32 PM, said:

Winstonm, on Jul 3 2009, 12:02 PM, said:

With the worldwide nature of BBO, it would be nice to hear how healthcare works for them from those who actually live in countries other than the U.S. and use non-U.S.-based healthcare - especially social-type healthcare such as in France, Britain, or Canada

In Canada:

1. My girlfriend had a ski accident at 8:30 PM. We arrived at the closest hospital ( 100 km from home) at 9:30PM, some doctor saw her and told us there was an ACL tear. He said we should wait for an X-ray because that's the procedure, although ligament damages does not show at X-ray's. At midnight we were told that the radiologist is in surgery and we would have to wait 3-4 more hours. We left for home. In the end it turned out the bone was broken and valuable time has passed by.

2. I went to family doctor trying to get an appointment to an urologist, I had to wait 3.5 month for it. It didn't seem to be an urgent case at first, but it became after a few months.

3. I had myself an ACL and meniscus tear, the reconstruction surgery was done 6 month after.

In the United States:

I had gallstones and an infected gall bladder, while uninsured. I went to the hospital (St. Jude, in Fullerton, CA), was seen in a couple of hours, and surgery was performed the next day. I had a pretty hefty bill (low-mid five figures), but I was they bonehead who blew off getting the insurance after getting out of school (previously, I was covered through a student plan). The hospital had a program that covered some of the costs, and I able to arrange a reasonable payment schedule on the balance.

I'm curious about the specifics of the "we'll save money on the back end" argument, based on present value considerations. My impression is that a huge reason insurance companies are profitable is due to the "float," i.e. the use of the money they receive up front. Yeah, you can save money by not having to pay more later, but paying later in general IS cheaper, so it's not a given.

[Lobowolf]

jdonn, on Jul 6 2009, 01:35 PM, said:

It sounds like someone could get plenty of business for themselves moving to Canada and becoming a doctor.

Anyone know what your average doctor in Canada makes?

[andrei]

Lobowolf, on Jul 6 2009, 01:47 PM, said:

jdonn, on Jul 6 2009, 01:35 PM, said:

It sounds like someone could get plenty of business for themselves moving to Canada and becoming a doctor.

Anyone know what your average doctor in Canada makes?

don't know that, but I know it is not easy to become a doctor in Canada.

I know plenty of imigrants who have graduated medical schools in their home countries and are trying to become a doctor in Canada, it seems there are lots of exams and very few positions available