Nice article about the future of Healthcare. (in Off-topic)

http://online.wsj.com/article/SB10001424052748703436504574640711655886136.html?mod=WSJ_Opinion_AboveLEFTTopM

Yes, it is from the WSJ.

However, as a physician, what is containing in the article is the truth about what will happen if the current reforms get passed.

Interesting article indeed...
Seems like the current system is no peach either.

I've often wondered what does more harm:
A good idea, poorly executed.
or
A bad idea, brilliantly executed.

The sad fact of the matter is that there is often seems to be too much inertia in these matters to allow true reform...

I agree.

Reform could have been done correctly if it was truly bipartisan.

Both sides have good ideas, but in a rush to pass anything, a very flawed, fiscally unresponsible law will be passed.

Just so some people can say "Look, we did it!".

However, as a physician, I can attest to most of the points the article makes.

Where I live, very few people take Medicaid, a lot more do take Medicare.

A very interesting article.

Coming from a tiny background of working for a place setting up health management networks (very small, and a few jobs ago), I was struck with a question on the health care issue. Ranger, perhaps you have some insight...

Let's use the eyes of someone who thinks health care might be bloated and over-expensive and has been for years. I'm not saying that is the case, I am just starting there to illustrate a cycle that struck me.

So, let's say things have inflated because of sloppy insurance and due to the importance of health care. Because it is health care, there is that whole aura of "has to be perfect, has to do everything, has to help everyone" (and I am not saying that is wrong, but sometimes one does have to make the hard decisions that can save money: euthanasia, better preventive care, etc.)

So lets say the gravy train has been running for a while... Equipment makers charge high margins. Competition is somewhat stagnant because everyone is making their cash. Doctors and hospitals might not be trimming budgets and such as much as they can, because the money is rolling in.

Then, along come changes that force price cuts.

How long does it take for that to "trickle back up" and get everyone back into lean mode? Example: Controlling prices for Mayo = bad idea because Mayo can't pass those cuts up the chain. A defibrillator still costs X dollars, a bed still costs Y, and they still need to pay their doctors. They can't just say, "we won't buy equipment," because demand is fixed -- people keep getting sick. They are simply getting paid less for delivering the same expensive product, and their payables are as high as before.

So, won't ANY change to health care take a while to equilibrate (if it even can?), and is anyone making sure the whole industry is kept honest, so to speak? I can totally understand Mayo's pain. They aren't like a Wal-Mart that can put the squeeze on their suppliers and keep lowering prices for the customer. They are getting squeezed from both sides. Above them is a medical industry that is still perhaps a bit fat (I'm not talking about doctor salaries -- there's a lot more to health care infrastructure than that) and slow to lower prices, while on the other side they are having what they can charge controlled by the government. Ouch.

I'm curious -- in countries where health care is nationalized, does the gov't control the system all the way up the supply chain? If not, where to they stop? The problem with health care is that normal rules of economics don't always apply, not even basic "supply and demand". Like Ranger said on other threads, hospitals can't turn patients away when it comes to emergencies (so demand is going to keep coming -- people aren't going to get less sick or shot just because prices rise), and the supply needs to meet whatever demand dictates. Unless health care reform goes all the way up the ladder to equipment suppliers, drug companies, etc., how can hospitals and doctors get a fair shake?

it is very easy to sit back now and say that the current effort is not bipartisan, however if the desire for a bipartisan solution was that strong, why was it not a priority when the other party was in charge? in effect, i will sit on my laurels and accomplish nothing towards a specific goal and then when other people are in charge and attempting to finally accomplish something, whine about how they chose to do it. this has been an issue since at least bill clinton's tenure when he gave the task to his wife, no?

in my book there are two types of people in the world, those that get things done and those that wait until others try to get things done and criticize the effort or those that create and those that destroy.

What a sad sad species we humans are. We charge people more money than they have to save thier lives.

I hope someday we can evolve as a species.

First thing people really need to realize is that most hospitals operate at less then a 4% profit margin. Those that are for profit.

Most academic institutions lose money treating patients but make it up on the government subsidies on residents and interns.

Why did Bush not attack this problem? Special interests.

That is a very small book to classify mankind. So those that get things done, but wrong is OK?

The other side has tried to give their help/suggestions in the health care debate. Every single amendment put forth by the Republicans has been defeated in committee. Every single idea has been squashed.

Yes, of course it is payback for Bush. That is obvious. But why penalize the American people with a bad law just to get a political victory.

In other countries where the government controls healthcare, they control most of it, if not all.

While the British and Canadian systems have differences they both fall into this area.

But when people want the best, most innovative care, where do they go if they have the money to travel? The USA of course.

We have the best care in the world. That is what sets up apart from the rest of the world and why we are the envy of most of the world in this area.

Conflicting results when googling "best healthcare in the world".

Yes,

There are many tables that state we have the worst this or that.

But as a statistician these are very skewed.

One can take one of these markers like infant mortality and analyze it.

The US is near the bottom of most tables. However, the US, unlike most European countries, counts every baby born, even at pre 30 weeks. Of course these babies have a high mortality rate, but if you do not even put those in your sample, you can artificially inflate your numbers.

I know what I have seen in the US medical system, and various others I have seen in my travels. The US is by far the best system.

Where to people go to when they are sick and abroad? The US.

Well in Norway we got "socialized medicine", there are private institutions aswell.
About the control of costs etc, the medicines that we use etc usually comes from medical companies that the norwegian state are just doing business with, so ie you buy some painkillers at a pharmacy, usually the patient pays a price, then the state pays whats between that and the cost the medical companies take (which is insanely much at times, sometimes 4 and 5 times the price a patient pays).
Flawed, indeed, because the norwegian state doesnt control everything thats needed for a fully fit healthcare system, so its forced to deal with private enterprise, thats also why Ive been chanting for government owned morphine production for years, but who would listen :O
Luckily we own our natural resources so we manage to pay off the profiters to make it go around, and naturally some of what Sutekh mentioned also occurs, not euthanazia (not legal) but simply reduced availability for certain procedures.
Personally I think healthcare is a dirty business to try to make a profit in. Swirling around in space, on a cooling rock where the Universe doesn't care for our hopes and dreams, we should be altruistic enough to not fight over resources - specially not when we have the technology and the skills to treat people, but since someone in the chain NEEDS to get paid, people get a lacking service, or a non existent one. Shameful

If it were not for "profiteers" many of the advances in medicine that help keep people alive would not be.

Including CT, MRI or US scans. Most 2nd generation antibiotics. Arthroscopy. Dialysis.

Would you rather have a system where nobody makes a profit, but innovation does not occur?

Sure, here is your penicillin to treat that new superbug going around. Too bad we did not have enough incentive to develop new drugs.

The people in Norway benefit greatly from the US system of medicine, where "profiteers" can exist and so can innovation.

I guess this stuff just makes me sad, it's a bucket of cold water full in the face of the warm fuzzy perspective I've grown accustomed to.

I think Ayn Rand herself couldn't be more cold and succinct than some of the folks publicly involved in this debate. I'm all for questioning motives, and limiting governmental power... but to claim that there isn't a problem is callous beyond belief.

Our current situation is just this side of disastrous. The state of mental health here in the United States is horrifying. Obesity will lay to waste a generation of people. Our food supply is tainted, and the houses we live in are havens of toxicity.

It is not our medical system that needs overhauling, it is our entire way of life. Greed, laziness, and selfishness are seen as virtue. Consumption is a baseline requirement for humanity. We, and our culture are in decline.

Given all this, I find it hard to believe that we can't stop blaming politicians and corporations long enough to look at ourselves and ask "what is my part in all this", "what have I done to hurt my world".
Health Care, Social Welfare, Financial Responsibility... all of these will be useless unless we deal with the issues with ourselves.

Novice,

Would you rather have the government tell us what we can eat? How much we HAVE to exercise? Where we can live? How many children we can have?

People should be free to make choices. And be subject to their complications.

Ranger, to the thing about innovation, YES in our current capitalistic world, profit is the drive of innovation. Why? Because without profit it can't economically survive, it doesn't mean that profit is the foundation of research, its just thats its a _MUST_ to get the intended research started and ended. Thats like saying that profit is the drive of a cozy fire, because an axe you _buy_ at wal-mart is needed to get the needed wood.
Education, researchers and resources is whats needed for research, and today you won't get that without money, its an illusion that personal hunger for wealth is why there is progress. You see that in many cases capitalism stops alot of research, because of the lack of funding, its not that isn't good research, but because there are other places you can make more profit researching, like in mining tools instead of green technology.

About people's choices, habits etc etc. Its no secret that we're mammals that learn, at least most of us have the ability to learn, and for some those prospects to get taught are limited, and unless there is a motive for profit nobody will make a redneck realize certain facts, and voila! there is a society out there that out of humanity might do so still, call it the greater society, government or whatever.
Thing is, people tend to become like their parents unless there is some external source of knowledge or goodwill. Today that role is mostly schools, in countries like the US and Norway (Also why I think good public education is the solution to all our problems, to put it very broad) And it matters, one thing is sure, people need to learn to be altruistic and selfsufficient at the same time, and we can't just let the "free market" of human impulses run amok, then say they put themseleves in that position. Im not saying government should dictate, but some free info about health concerning obesesity etc, why not?

Concerning schooling; well, it dont have to be based on "humanity", good education proves to be economically viable for basically everyone.

Incredibly well said, Dudemus!

i would rather have some one attempt reform and get it wrong rather than an endless bureaucracy that only perpetuates an already wrong system, yes. this is mainly due to the fact that change may make it better whereas stasis or stagnation won't ever improve our lot in life.

with that being said, can you admit that it might take a bit longer to determine if the current course is wrong at all? you yourself have admitted we needed reform i believe.

And that is a key point where we differ.

Change for the sake of change is bad. Change that can make a bad situation worse is far worse than doing nothing at all. And if your one attempt really messes things up, we all are worse off.

I know this bill. I have been involved in quite a lot of town hall meetings. Everyone can see how this bill is being produced. The Republicans have not done anything in the last 8 years. However 6 was with a democratic Congress.

Now with Obama in office, this gets addressed. With the economy, the timing is very suspect but still. To refute ALL the Republican ideas and amendments, cut back room deals, and break a campaign promise of transparency in producing this bill will create such a burden on people and the system, it can do nothing but fail.

There are plenty of other great ideas to increase quality, decrease cost and be fair to most.

This bill will do none of these. The article I quoted is about a teaching institution. What about all the private hospitals that do not get government help via research grants and resident backing.

Yes, those without current insurance will get insurance of some sort. However, if nobody will take them as patients what good is it? When right now, every ER has to see them.

This bill does not address the underpayment to hospitals and physicians with Medicaid, of which we want to put more people under. It does not address why insurance companies cannot compete over state lines. It does not address malpractice issues. Which as a radiologist is 25-40% of my business-defensive medicine. It does, however, add another few layers of bureaucracy with all those government jobs staffed by "friendly" government workers. Making decisions on who gets what care.

To pass something just to pass something is a recipe for disaster.

I and all my colleagues know there has to be fixes. But this is the wrong recipe.

i do not see it as change for changes sake but rather needed reform. i do believe you have stated we need reform as well.

it is a start, which is more than anyone else has achieved. i will not claim it is perfect but i believe you have to start somewhere and hopefully move forward from that point.

after all is said and done, i do think it will end up costing the united states less than the iraqi war and will hopefully benefit americans more than that war has!

Ok then, reform done incorrectly can make a bad situation worse. I have stated the need for reform for years. Every doctor wants reform, at least in the malpractice area. I do believe personally, there are many facets of health insurance coverage which are wrong. But the current "reform" is nothing healthy for 1/6th of our economy.


While it may benefit some Americans, this bill will make things a lot worse for many others. For example, young healthy people who do not need insurance will be forced to pay a tax or pay for insurance. Waits to seen specialists will be longer. That stat MRI for your torn up knee will have to wait, just economically feasible when you can just hobble for a time. That insurance approval to see a specialist, take a number just like the DMV. While there is no public option in this bill that will pass, subsidizing more people while putting others on Medicare/aid puts more government interference in something they have no knowledge. Which is almost never a good thing.

The latest task force recommendations on Mammography was a test to see how people will take rationing. And when bureaucrats get involved, they certainly mess things up. I guess I am just a pessimist on how successful the government can run things. I have yet to see them do something as well as the private sector other than war.

And while the Iraq war was not to your liking, it has made America safer, and saved countless Iraqi civilian lives from Saddam's torture and genocide.

and in a year from now i can make a similar claim that obama's health reform has saved countless americans. both are equally unprovable just as your dire predictions are at this point.

as for iraqi citizenry, why is it ok to dump a ton of money into another country to help its citizenry but horrible socialism to try to spend money on our own countries citizens?

Holy crap, dudemus, you are making far too much sense.

Of course. However, as someone who is in the field and knowing the bill, having read most of it, it is not a good bill. But it is not something I wish to take a chance on, given the way this bill was produced, the lack of transparency, the broad scope of its reach, and the governments history in running things.


There is spending money and then there is wasting money.

Invading Iraq did not make the US safer. I will not argue beyond stating this occupancy only saved Iraq.