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The US health care wait times myth

theincidentaleconomist.com

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Re: The US health care wait times myth

#31

Post by jbooth »

yummyfajitas wrote: post #24
jbooth wrote: post #16

Yeah, I mean I can understand the philosophical place that one could come from that would make one skeptical of government-run anything. But every other industrial nation beats the crap out of us both in results and in results per $$, while spending far less money. This isn't a theoretical argument -- we could just copy one of those systems wholesale and get way better results than we're getting. At one point does th…

But every other industrial nation beats the crap out of us both in results and in results per $$... What results? Please be specific. In particular, if you want to compare health outcomes, please make sure you controlling for factors like demographics, lifestyle, pollution, food quality, etc. Also, how do you propose to pay US doctors the same salaries paid to doctors in poorer countries? Some numbers: the top 5% of…

A) Call it even for health outcomes if you'd like, we could argue the numbers regarding demographics, lifestyle and all that until the cows come home, but health in Canada/UK/France/Japan definitely isn't materially worse. So for the sake of argument let's just call it even, except we're spending several times as much. (we actually spend more gov't money on healthcare per capita than many companies with socialized medicine, in addition to private sector spending -- that's how broken our system is).

B) Regarding doctors wages, I'm not really talking about "poorer" countries unless you'd call western europe, canada, japan "poorer". If they make significantly less in those countries than here.. sure, fine. Given that we don't offer cheap schooling like those countries there might be a limit to how low we can go, though.

C) Top 5% of income != doctors, necessarily. And the money we're wasting, a tiny percentage of that is going into doctors' pockets. Most of it is just plain pissed away, and a lot goes to insurance company profits. Doctor salaries are pretty far down on that list, so I don't think I was proposing drastically lowering their salaries, no.

Re: The US health care wait times myth

#32

Post by yummyfajitas »

jbooth wrote: post #31
yummyfajitas wrote: post #24

Earlier quoted context omitted.

But every other industrial nation beats the crap out of us both in results and in results per $$... What results? Please be specific. In particular, if you want to compare health outcomes, please make sure you controlling for factors like demographics, lifestyle, pollution, food quality, etc. Also, how do you propose to pay US doctors the same salaries paid to doctors in poorer countries? Some numbers: the top 5% of…

A) Call it even for health outcomes if you'd like, we could argue the numbers regarding demographics, lifestyle and all that until the cows come home, but health in Canada/UK/France/Japan definitely isn't materially worse. So for the sake of argument let's just call it even, except we're spending several times as much. (we actually spend more gov't money on healthcare per capita than many companies with socialized me…

Ok, fine. So we are in agreement that health outcomes are roughly even.

Insurance companies don't make much in the way of profits. Those greedy pigs have profit margins roughly the same as home improvement stores, textile-apparel clothing and slightly less than packaging and containers. (And keep in mind, this was a good year for them. They all raised prices significantly in anticipation of Obamacare.)

http://biz.yahoo.com/p/sum_qpmd.html

You simply won't get much money by soaking insurance companies.

The main thing you need to do to reduce spending is to get people to consume less medicine. That was the conclusion of another (very good) series of articles on the same blog - we spend more on health care because we consume more (in particular, outpatient care).

http://theincidentaleconomist.com/wordpress/what-makes-the-u...

Re: The US health care wait times myth

#33

Post by antidaily »

CWuestefeld wrote: post #8

Data point: I live in the USA, and I've got Crohn's disease. I take medicine for the chronic condition, which keeps it in remission 99%+ of the time. But when it flares up, I need to see a doctor pretty quick -- not just because it hurts, but also because the pain is an indication of bad things happening to my intestines. The thing is, I can't get an appointment to my GI doctor right now , or even tomorrow. So I can'…

Why don't you go to the ER?

Re: The US health care wait times myth

#34

Post by btilly »

CWuestefeld wrote: post #8

Data point: I live in the USA, and I've got Crohn's disease. I take medicine for the chronic condition, which keeps it in remission 99%+ of the time. But when it flares up, I need to see a doctor pretty quick -- not just because it hurts, but also because the pain is an indication of bad things happening to my intestines. The thing is, I can't get an appointment to my GI doctor right now , or even tomorrow. So I can'…

Sorry for the digression.

I have a friend with Crohn's disease who read all of the research on hookworm, found a company that would ship it to Canada, went to Canada, and got himself infected. Several months later he has managed to discontinue most of the drugs and he is feeling better than he has in years.

Unfortunately hookworm has been classified as a medication in the USA, and is unpatentable, so will never be approved as a treatment here. But if you're willing to travel abroad, look into it. Seriously.

Re: The US health care wait times myth

#35

Post by gamble »

raganwald wrote: post #2

What I find interesting about the "We beat Canada" idea is how few Canadians move to the USA in search of better health care. Rich Canadians take advantage of the porous border by travelling to the US and paying for certain procedures, but generally when someone permanently moves from Canada to the US, it's always in search of economic improvement. I would like to see statistics showing that Canadians would happily t…

Public healthcare is a cornerstone of Canadian national identity, in part because we recognize how bad the American system is. There are always ideologues who are inspired to emulate the American system, but they never get any traction with the electorate because healthcare privatization is the third rail of Canadian politics.

If Canadians move to the US it's in spite of the American healthcare system. I've never heard of anyone emigrating because they thought it was an attraction.

Re: The US health care wait times myth

#36

Post by zaidf »

maxharris wrote: post #28
zaidf wrote: post #10

My siblings and I take a pill 3x day for life for a genetic condition. The pill(colchicine) cost pennies in its generic form. It isn't a pill that was made in a lab after millions in research. So there were plenty of generic brands available and it'd cost us 5 bucks/mo from Walmart. That was that. Last year a company came in and got an exclusive on it on the premise that they spent millions in testing the pill for qu…

This is the FDA's fault. Without the FDA, you would keep buying the generic you had been buying, and the company would keep making it for you. But with the FDA, a company can come in and essentially buy a monopoly on a market that would otherwise be free.

Is the solution really FDA or no FDA? Without knowing a lot, I doesn't seem too hard to cite goods that have come from the FDA.

Re: The US health care wait times myth

#37

Post by [deleted] »

CWuestefeld wrote: post #8

Data point: I live in the USA, and I've got Crohn's disease. I take medicine for the chronic condition, which keeps it in remission 99%+ of the time. But when it flares up, I need to see a doctor pretty quick -- not just because it hurts, but also because the pain is an indication of bad things happening to my intestines. The thing is, I can't get an appointment to my GI doctor right now , or even tomorrow. So I can'…

[deleted]

Re: The US health care wait times myth

#38

Post by prewett »

klochner wrote: post #7

The author stumbled over one of the most important pieces of data - GP's per 100,000 people. The author notes we have the lowest doctor:population ratio, adding: "And that’s after spending way, way, way more money than anyone else" The problem is that we don't let the market decide on the right number of doctors - the training of new doctors is a function of the number of residencies, which is jointly controlled by c…

As another commenter mentioned, it's general practitioners that's limited. According to salary.com, in Austin, "general practitioner" and "family practice" make $58k, "family practice physician" makes $73k. I'll assume the salary is about $75k. Compare "surgeon" at $101k, "heart surgeon" at $114k, and "orthopedic surgeon" at $165k. After going $200k in debt for medical school, I'm thinking family practice isn't looking very financially rewarding. (For comparison, $75k - $100k should be easy for an experienced programmer in Austin, and it doesn't take $200k in debt, either)

The economics definitely penalizes family practice.

Re: The US health care wait times myth

#39

Post by dkarl »

CWuestefeld wrote: post #15
klochner wrote: post #7

The author stumbled over one of the most important pieces of data - GP's per 100,000 people. The author notes we have the lowest doctor:population ratio, adding: "And that’s after spending way, way, way more money than anyone else" The problem is that we don't let the market decide on the right number of doctors - the training of new doctors is a function of the number of residencies, which is jointly controlled by c…

I agree with what you said, but there's another dimension as well (as I mention elsewhere in this thread, see http://news.ycombinator.com/item?id=2263931 ). We also enforce MDs being the gatekeeper to various medical stuff. Many things we insist must be done by a doctor could be done without that degree. There are certainly a lot of things that someone with the knowledge of a LPN or Army medic could do just fine (say…

Doctors being the gatekeepers to pharmaceuticals also means that when you seek care for an ailment or symptoms favored by pill tourists, the doctor will make a snap judgment based on your appearance and demeanor and possibly decide not to give you appropriate care. You might just be sent home with a follow-up appointment, or if you're in the emergency room, you might be left on a gurney in a hallway for hours while the nurses ignore you.

Re: The US health care wait times myth

#40

Post by anamax »

yummyfajitas wrote: post #32
jbooth wrote: post #31

Earlier quoted context omitted.

A) Call it even for health outcomes if you'd like, we could argue the numbers regarding demographics, lifestyle and all that until the cows come home, but health in Canada/UK/France/Japan definitely isn't materially worse. So for the sake of argument let's just call it even, except we're spending several times as much. (we actually spend more gov't money on healthcare per capita than many companies with socialized me…

Ok, fine. So we are in agreement that health outcomes are roughly even. Insurance companies don't make much in the way of profits. Those greedy pigs have profit margins roughly the same as home improvement stores, textile-apparel clothing and slightly less than packaging and containers. (And keep in mind, this was a good year for them. They all raised prices significantly in anticipation of Obamacare.) http://biz.yah…

> Insurance companies don't make much in the way of profits. Those greedy pigs have profit margins roughly the same as home improvement stores, textile-apparel clothing and slightly less than packaging and containers.

And, their total profit plus executive salaries is a small fraction of the amount of admitted Medicare fraud.

I mention medicare because it's supposedly more efficient, but that's based solely comparing their cost to cut a check to the "overhead" of private health insurance companies.

Note that folks who have disputes with medicare are less likely to win than folks who have disputes with private health insurance companies.

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