> Dan Minette <[EMAIL PROTECTED]> wrote:
<snippage>
> Let us next go to Medicare. That is definitely
> worse. The yearly shortfall
> is expected to be about 3.5% of GDP by 2075. The
> worst part of the added
> cost is the massive rise in health care costs. This
> will have to be
> addressed, one way or another. The US has far
> higher medical costs than
> other major countries without a corresponding
> advantage in the statistics of health.
> Part of this will our coming to terms with the fact
> that there will be life
> extending health improving procedures that we cannot
> afford for ourselves
> and our parents. Debbie can correct me on this, but
> the present system for
> care of people without health insurance is crazy. A
> hospital can find ways
> to not admit folks without health insurance. But,
> once they admit them,
> they cannot refuse any services on a cost basis.
> So, hospitals have a
> massive incentive to turn people away, and have no
> ability to control costs once they are in.
It's worse than that from a hospital's perspective:
they can only turn away patients who aren't in
imminent danger of dying. IOW, if you're the nearest
Trauma I hospital, and a carload of a large uninsured
family rolled over with 11 persons badly injured, you
have 11 new patients in your ICU, ORs and children's
ward. Refusal of care *does* occur, but lawsuits have
also been successfully prosecuted against hospitals
for refusal, if the turned-away person dies soon
after.
There _are_ ways to refuse "futile care" to a terminal
patient, even if they do have insurance, but this
involves an ethics board review, a lot of time with
the family members, and still a potential lawsuit. I
fear I forget the exact figures, but something like
60-75% of healthcare costs occur in the last months of
a person's life, and I'm guessing that at least 30% of
that is futile. [I'll see if I can find some proper
figures.] Recall also the recent debate over
withdrawal of feeding for the Florida woman in a
persistant vegetative state; these will be devisive
and gut-wrenching decisions to make.
> This can be addressed. It won't be easy, but its
> not unsolvable. We can
> have a very good health care system for all, and
> still not break the
> economy. We just can't have the best for most.
I was against a National Healthcare System as a young
doc, but have since changed my mind (as I've said
on-list before). But realize that we are talking
_rationing_ of healthcare -- if that reality is not
faced, this problem is not solvable. Our current
system of rationing is more-or-less on the basis of
'able to pay,' with the exception of ER intake as
above. I don't have a problem with those who can
afford it paying for Cadillac care, but remember that
this means in some cases potentially life-saving
experimental procedures/drugs won't be available to
young Sandy. S/he will die, unless charity groups are
able to step in. Deciding if the life of one child is
worth more than the health and normal living of 20, or
50, or 100 diabetic or asthmatic children will be
their unhappy lot.
Ronn! asked:
>> What is (are) the reason(s) why the US has far
>> higher medical costs than other major countries
>> without a corresponding advantage in the statistics
>>of health? Is it (are they) something such as an
>> excess of obvious inefficiencies in the system, or
>> is it frex something like that the US
>> spends a disproportionate amount of the money spent
>> on research and development of new medical
>>procedures and medicines, and other countries
>> can take advantage of those new advances without
>>having had to have paid for their development?
Dan replied:
>Its probably a combination of reasons. We do pay far
> more than any other country for drugs. But, since
> twice as much is paid for advertisement as for
>research, (I've seen these numbers several places,
>and I haven't seen them challanged) <snip>....I don't
>think 200% overhead sounds all that efficient,
either.
Read the comments by an outgoing FDA official on the
pharmaceutical industry, as posted here recently;
their profit margin is the _best_ of the Fortune 500.
(18% vs. 3.5-4% IIRC)
>Second, we have yet to deal with the cost issues
>in "once in the hospital, no benefit can be denied"
>type of medicine. The real alternative is some
>sort of system that allows for everyone to have
> Toyota Camery care, but not Lexus....
Not just in-hospital, either, but in clinics and as
outpatients as well.
>Third, our poor way of handling medical malpractice
>adds to the costs. The physicians should find a way
> to self-regulate, but they face the difficulty that
> most self interest groups have to do this. The next
>most efficent means is governmental oversight.
<grimace> Unfortunately spot-on. I think an anonymous
way to send "red flags" to an independent
panel/committee which would then quietly investigate,
and if evidence of malpractice or 'danger to the
public' is found, turn the matter over to the State
Board of Medical Examiners -- with the caveat that if
they do _not_ act, the panel will go public with their
findings -- would encourage us to self-police more.
Those medical personnel who are a danger to the public
should *not* be allowed to practice in *any* state,
and those who commit malpractice must face
prosecution.
There needs to be a better way for patients to get
their legitimate complaints heard, as I have heard
that some State Boards are not responsive. There
should also be an independent panel that weeds out
frivolous malpractice lawsuits before they are allowed
to go to court (my lawyer friends will disagree with
me here!).
>Fourth, our payment system is a nightmare....This
>type of pricing has tremendous overhead costs
>involved...with debt collection agencies buying
> debts, etc.
<another grimace of agreement>
>Fifth, we have a system that won't pay for
>preventative care for the uninsured, but will pay for
> emergancy care. Thus, the logic is to wait
>until its an expensive crisis to do anything.
Apparently they haven't heard the old saw "an ounce of
prevention is worth a pound of cure" - just change it
to "pennies" and "dollars."
I will add that there is also good research going on
in Europe and Japan, including drugs and
interventional techniques - we Americans benefit in
that by the time these are approved for use here,
they've already been tried out on thousands of people,
and the side effects identified or errors in procedure
corrected.
<soapbox mode>
Lifestyle. It costs much less to eat more nutritious
food and get decent exercise than to pay for invasive
procedures, ICU care, and a lifetime of multiple
pills.
As long as behavior is disconnected from cost and
consequences, many people will not choose to change.
Me, I'd rather have tax dollars pay for Granny's care
after being hit by a car than Auntie's and Uncle's and
their brood's bronchitis, hypertension, and heart
attacks from smoking, living on junk food, and sitting
on their lazy derrieres. You can't change your genes
or avoid all accidents, but you *can* alter your own
behavior.
<off the box>
Do not think that this will be resolved without pain;
we have put it off for that very understandable
reason. It is a sobering realization to know that
_your_ decision, _your_ performance will affect
someone's life, and one of the hardest things any
medical professional must accept; I do not condemn
anyone for wanting to avoid that responsibility. But
making no decision merely leads to other, different
deaths, whether you will it or not.
Debbi
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