How to control healthcare costs in the United States

[sv3n 0]

That could be one part of it, then again one could say that it was to make sure everybody is paying the same amount, like paying their fair share.

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So what does the "fairness" criteria really test for? It determines if a country uses a government mandated and controlled healthcare system funded by an income tax. That's pretty much it.

I thought that was so obvious, that they all gave up on it once it was brought to light.

Nevertheless, that's a very good summary of that study. THANKS

...and you're in violation of your face!

[rehmwa 2]

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That could be one part of it, then again one could say that it was to make sure everybody is paying the same amount, like paying their fair share.

You feel that way about income taxes too? Everybody pay the same amount?

People lose me when they use subjective words like "fair".

...
Driving is a one dimensional activity - a monkey can do it - being proud of your driving abilities is like being proud of being able to put on pants

[sv3n 0]

I don't believe in income tax, it was setup as a temporary entity and then just got moved to the permanent column. A flat sales tax would be more appropriate, especially in a capitalis society......the more you buy the more taxes you pay. But that's another debate.

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That could be one part of it, then again one could say that it was to make sure everybody is paying the same amount, like paying their fair share.

You feel that way about income taxes too? Everybody pay the same amount?

People lose me when they use subjective words like "fair".

...and you're in violation of your face!

[rehmwa 2]

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I don't believe in income tax, it was setup as a temporary entity and then just got moved to the permanent column. A flat sales tax would be more appropriate, especially in a capitalis society......the more you buy the more taxes you pay. But that's another debate.

Crap, I like that concept too. Oddly enough, it's labeled "Fair" by it's proponents.

Back on topic - I still think SHC is a huge disaster for this country.

...
Driving is a one dimensional activity - a monkey can do it - being proud of your driving abilities is like being proud of being able to put on pants

[nathaniel 0]

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And he also doesn't say that there are no options but to cut people off.

Then you are ignoring the parts you disagree with. He says there's no option but to each of

1- increasing taxes
2- cutting costs
3- cutting benefits

Nobody is saying that costs aren't too high, because they plainly are. Reducing costs in a vacuum, if that were possible (it isn't, reducing costs inexorably mean reducing benefits), the effect of reducing costs isn't enough. The benefits have to come down.

Since you missed it in the first reading, the same point is made again by the chairman of the Senate Budget Committee, which was briefed by the Comptroller.

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Asked if he thinks taxes should be raised, the senator says, "I believe first of all, we need more revenue. We need to be tough on spending. And we need to reform the entitlement programs … we need to do all of it."

(edit with clarification on the quote)

My advice is to do what your parents did; get a job, sir. The bums will always lose. Do you hear me, Lebowski?

[mnealtx 0]

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Ouch...this is gonna leave a mark. Ties right back in to the fact that care gets rationed in SHC countries, I believe.

."

Since most of Europe has "SHC", your statement is clearly incorrect.

In your opinion, perhaps - there's plenty of evidence of care being rationed.

Mike
I love you, Shannon and Jim.
POPS 9708 , SCR 14706

[1969912 0]

Want rationing?

WHO has complete instructions.


http://www.who.int/entity/whr/2000/en/whr00_ch3_en.pdf

"Once we got to the point where twenty/something's needed a place on the corner that changed the oil in their cars we were doomed . . ."
-NickDG

[kallend 2,026]

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Ouch...this is gonna leave a mark. Ties right back in to the fact that care gets rationed in SHC countries, I believe.

."

Since most of Europe has "SHC", your statement is clearly incorrect.

In your opinion, perhaps - there's plenty of evidence of care being rationed.

You were comparing the UK with the rest of Europe to fault SHC. Not logical!

...

The only sure way to survive a canopy collision is not to have one.

[1969912 0]

re: rationing


Here's Norway, Switzerland, and Italy. Want more?



http://www.medscape.com/viewarticle/550416

"Once we got to the point where twenty/something's needed a place on the corner that changed the oil in their cars we were doomed . . ."
-NickDG

[nathaniel 0]

It turns out the Chairman's GAO's testimony to the SBC is online, so in case you're still doubting it,

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Absent substantive reform of entitlement programs, federal spending will
grow to unprecedented levels. Our projections are in part driven by
demographic trends in coming decades. In 2000, individuals aged 65 and
older numbered about 35 million people—about 12 percent of our nation’s
total population. By 2020, that percentage will increase to about
16 percent—1 in 6 Americans—and will represent nearly 20 million more
elderly than there were in 2000. By 2040, the number of elderly aged
85 years and older is projected to increase more than 250 percent, from
slightly over 4 million in 2000 to slightly over 15 million (see fig. 2). Social
Security and a large portion of Medicare are financed as pay-as-you-go
systems in which current workers’ payroll taxes pay current retirees’
Page 3 GAO-07-497T
benefits.4 Therefore, these programs are directly affected by the relative
size of populations of covered workers and beneficiaries. Historically, this
relationship has been favorable. In the future, however, the overall
worker-to-retiree ratio will change in ways that threaten the financial
solvency and sustainability of these entitlement programs. In 2000, there
were 4.7 working-age persons (20 to 64 years) per elderly person, but by
2040, this ratio is projected to decline to 2.6.

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Experts note that
the nation’s general tendency is to treat patients with available technology
when there is the slightest chance of benefit to the patient, even though
the costs may far outweigh the benefit to society as a whole. They note
that the discipline of technology assessment has not kept pace with
technology advancements.

My advice is to do what your parents did; get a job, sir. The bums will always lose. Do you hear me, Lebowski?

[lawrocket 3]

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One would have to take an indepth look at what prices were higher and why

See my first post:

1) End-of-life care - EXPENSIVE.
2) Drugs - Expensive
3) Variance in population creating more diversity of medical problems.

Now, how do we solve these problems?

Solving them through leaving people uncovered is not right.

You are right that end of life care is expensive, but I think our elders deserve better than "so gramps, get your ass out on the street" they helped build this country and many have faught for this country.

Drugs are expensive, but since our drug costs are higher than anywhere else in the world....one would assume you would take a look to see if things are "inflated" by the companies and deal with that appropriately. People need the medications and if they're cheaper elsewhere why are the not as cheap here.

Your theory on closing the borders to alleviate the diverse problems that we have because of the diverse population that already lives here is inane and pointless. Those people already live here.......closing the border will have no direct impact on the different number of medical conditions in this country.

Okay. So what do we do about it, for God's sake? All I've heard from you is "That won't work. That won't be nice." I've just simple had it with people who shoot down everything without a solution.

WHAT DO WE DO TO STAVE OFF END OF LIFE HEALTH COSTS? Because from what I'm gathering from you it cannot be done without shocking your conscience.

Ideas. Let me hear them. Because this is the ONLY way that I can think of.

My wife is hotter than your wife.

[1969912 0]

Since we have to feed the poor, might as well kill two birds with one stone.

http://en.wikipedia.org/wiki/Soylent_Green

"Once we got to the point where twenty/something's needed a place on the corner that changed the oil in their cars we were doomed . . ."
-NickDG

[lawrocket 3]

Folks:

Jim, here, has read the now seven year-old WHO report and found what I found when I read it - the report that ranks France No. 1 actually rates which countries do socialized healthcare best.

To rate something "best" you HAVE to list your factors upon which you rate it. The WHO report gives huge creedence to governmental payment of healthcare costs.

It's a nice snippet to say, "France is No. 1 in healthcare and the US is 37th." It's like asking, though, who is the defensive back in the NFL. Many would point to Champ Bailey because he had 10 interceptions last year. Still others, like me, would look to a guy like Kevin Kaesviharn of Cincinatti, who only had 6 picks but had 4 sacks and 9 passes defended. The guy didn't have as many pick opportunities and did more of a variety of special things. Statistically, Bailey wins. But I'm not all about fantasy football.

"Best" is done through your personal beliefs. The WHO report defines "Best" as socialist.

My wife is hotter than your wife.

[rehmwa 2]

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It's like asking, though, who is the defensive back in the NFL. Many would point to Champ Bailey because he had 10 interceptions last year. Still others, like me, would look to a guy like Kevin Kaesviharn of Cincinatti, who only had 6 picks but had 4 sacks and 9 passes defended.

It's more like, in a discussion over who's the best athlete, someone asking who's the better golfer - Phil Mickelson or Michael Jordon.

Then claiming overall victory for Phil in the "athlete" discussion.

...
Driving is a one dimensional activity - a monkey can do it - being proud of your driving abilities is like being proud of being able to put on pants

[kallend 2,026]

it seems Bush agrees with rationing - for middle income families:

www.bloomberg.com/apps/news?pid=20601070&sid=a4nccRlngGpY&refer=home

...

The only sure way to survive a canopy collision is not to have one.

[1969912 0]

I'd like to see him kill the whole program.

"Once we got to the point where twenty/something's needed a place on the corner that changed the oil in their cars we were doomed . . ."
-NickDG

[drae 0]

There is a whole segment of the population that is overlooked. If you are living below 130% of the FPL you can qualify for Medicaid for your children. If you are below 100% of the poverty level you may be eligible to receive Medicaid also. This is great even though there are annual limits and some states are now charging a surcharge for Dr. visits and drug costs. 2.50 to 6.00 for doctors and .50 to 2.00 for drugs is pretty cheap.
If you are not within these limits, and even if you are in the limits but childless, you are not eligible. Many employers do not offer healthcare coverage and some do, for astronomical fees. Therefore, these people have no coverage and are denied the care that those of us that have insurance or Medicaid are able to access. This is a travesty in a country as such as the USA. No one should be denied medical care or receive sub-standard care. I don't have the answer, but there needs to be some way that the working poor, that are making barely enough to pay childcare and housing costs, can have decent medical care.

[georgerussia 0]

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Are you talking to the mirror? Seems to be the case.

When you look in the mirror, you will not see me there - surprise - you'll see yourself!

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1. what I said was you could take any of the pieces in that study out at your convenience and make whomever you wanted come out on top.......leave the study as a whole and it still remains that the report states the France is number 1.

Yes, it will me number one using the criterias based on report. But because the criteria weights are groundless, this "report" has no more value than my report with different criteria. And you have been already shown that; you just decided to ignore it.

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2. i'm not talking about using parts of a system.......I'm talking about replacing the system.

There are two major parts of those system you didn't even talk about: the much higher "insurance rate", which depends on income, and not on how healthy you are, and the regulated doctor salaries. If you ignore those things, you are effectively talking about taking parts of the system.

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the same as you I suspect.

So did I understand you correcly that all your loud expressions here of how good the French healthcare system is were only based on a WHO report!?!?

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If it's a national epidemic then the government needs to intervene.

So let's the government start from you and your company. Could you talk to your colleagues, and tell them that you think they all earn too much, and should work for $2/hour since tomorrow?

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US Government Not Promoting Healthy Living Says Cancer Panel
...
The US government should be doing more to promote healthy living says a new report from the President's Cancer Panel (PCP) out this week.

And again we've got sv3n-type article. So does the Government "not promoting", or they just "should be doing more"? Those are completely different things; you could work more, does it mean you are not working?

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Doctors don't spend enough time with patients helping them to make changes in their lifestyle that would stop them having to visit the doctor so frequently, they only have time to treat the symptoms, resulting in a vicious cycle.

That's typical example. Someone needs a doctor to explain him that smoking is bad, and leads to cancer? Someone needs a doctor to understand that bad food choices and lack of excercise makes you fat? Is there anyone who doesn't know that mountain hiking is much better for your health than spending the weekend in front of TV? Maybe everyone should be provided a personal nanny to kick their lazy asses to do some hiking before going to bed?

* Don't pray for me if you wanna help - just send me a check. *

[1969912 0]

This might be worth reading. It covers a lot of what was discussed here.

http://www.janegalt.net/archives/009873.html

"Once we got to the point where twenty/something's needed a place on the corner that changed the oil in their cars we were doomed . . ."
-NickDG

[sv3n 0]

He said they needed more revenue.............he also said he didn't want to raise taxes.........he also said that the entitlement programs need reform......notices he said reform, not cuts.

So you could reform the program to be more efficient, you could cut costs, and the final results would be more revenue.

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And he also doesn't say that there are no options but to cut people off.

Then you are ignoring the parts you disagree with. He says there's no option but to each of

1- increasing taxes
2- cutting costs
3- cutting benefits

Nobody is saying that costs aren't too high, because they plainly are. Reducing costs in a vacuum, if that were possible (it isn't, reducing costs inexorably mean reducing benefits), the effect of reducing costs isn't enough. The benefits have to come down.

Since you missed it in the first reading, the same point is made again by the chairman of the Senate Budget Committee, which was briefed by the Comptroller.

Quote

Asked if he thinks taxes should be raised, the senator says, "I believe first of all, we need more revenue. We need to be tough on spending. And we need to reform the entitlement programs … we need to do all of it."

(edit with clarification on the quote)

...and you're in violation of your face!

[sv3n 0]

Interesting, are they promoting it or just defining it?

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Want rationing?

WHO has complete instructions.


http://www.who.int/entity/whr/2000/en/whr00_ch3_en.pdf

...and you're in violation of your face!

[sv3n 0]

dead link...........it asks for login info.

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re: rationing


Here's Norway, Switzerland, and Italy. Want more?



http://www.medscape.com/viewarticle/550416

...and you're in violation of your face!

[sv3n 0]

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One would have to take an indepth look at what prices were higher and why

See my first post:

1) End-of-life care - EXPENSIVE.
2) Drugs - Expensive
3) Variance in population creating more diversity of medical problems.

Now, how do we solve these problems?

Solving them through leaving people uncovered is not right.

You are right that end of life care is expensive, but I think our elders deserve better than "so gramps, get your ass out on the street" they helped build this country and many have faught for this country.

Drugs are expensive, but since our drug costs are higher than anywhere else in the world....one would assume you would take a look to see if things are "inflated" by the companies and deal with that appropriately. People need the medications and if they're cheaper elsewhere why are the not as cheap here.

Your theory on closing the borders to alleviate the diverse problems that we have because of the diverse population that already lives here is inane and pointless. Those people already live here.......closing the border will have no direct impact on the different number of medical conditions in this country.

Okay. So what do we do about it, for God's sake? All I've heard from you is "That won't work. That won't be nice." I've just simple had it with people who shoot down everything without a solution.

WHAT DO WE DO TO STAVE OFF END OF LIFE HEALTH COSTS? Because from what I'm gathering from you it cannot be done without shocking your conscience.

Ideas. Let me hear them. Because this is the ONLY way that I can think of.

I've given you ideas.

Such as:

Regulate Costs to a decent level.....that would cut end of life care expenses in half. That would be a pretty hefty chunk.

Get a percentage of the military budget and spend it on healthcare............we don't need $200 hammers or $500 toilet seats. Like we need to spend $2 billion on the developement of a new jet fighter when we have more advanced stuff than anybody else and more than enough to last a decade. There's another hefty chunk.

Take all the money currently spent on healthcare in this country and put it toward one unified system......that's $1.9 trillion dollars.

With all that funding you should be able to buy a lot of healthcare and you'll probably have a lot of excess as well.

...and you're in violation of your face!

[sv3n 0]

Good article.

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This might be worth reading. It covers a lot of what was discussed here.

http://www.janegalt.net/archives/009873.html

...and you're in violation of your face!

[1969912 0]

Link to an article re: HC rationing and the damage it will invariably do to the HC System, your country, and your life.

http://findarticles.com/p/articles/mi_m1571/is_n35_v12/ai_18654508

---------------

Here is what my bad link should have gone to. I can access it from a google search, but links don't work. Might be a referrer issue.

The purpose of this was just to show that rationing is practiced. They will regret ever doing any rationing.

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Prevalence and Determinants of Physician Bedside Rationing: Data from Europe

Posted 02/08/2007

Samia A. Hurst; Anne-Marie Slowther; Reidun Forde; Renzo Pegoraro; Stella Reiter-Theil; Arnaud Perrier; Elizabeth Garrett-Mayer; Marion Danis
Author Information
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Abstract and Introduction
Abstract

Background: Bedside rationing by physicians is controversial. The debate, however, is clouded by lack of information regarding the extent and character of bedside rationing.
Design, Setting, and Participants: We developed a survey instrument to examine the frequency, criteria, and strategies used for bedside rationing. Content validity was assessed through expert assessment and scales were tested for internal consistency. The questionnaire was translated and administered to General Internists in Norway, Switzerland, Italy, and the United Kingdom. Logistic regression was used to identify the variables associated with reported rationing.
Results: Survey respondents (N=656, response rate 43%) ranged in age from 28 to 82, and averaged 25 years in practice. Most respondents (82.3%) showed some degree of agreement with rationing, and 56.3% reported that they did ration interventions. The most frequently mentioned criteria for rationing were a small expected benefit (82.3%), low chances of success (79.8%), an intervention intended to prolong life when quality of life is low (70.6%), and a patient over 85 years of age (70%). The frequency of rationing by clinicians was positively correlated with perceived scarcity of resources (odds ratio [OR]=1.11, 95% confidence interval [CI] 1.06 to 1.16), perceived pressure to ration (OR=2.14, 95% CI 1.52 to 3.01), and agreement with rationing (OR=1.13, 95% CI 1.05 to 1.23).
Conclusion: Bedside rationing is prevalent in all surveyed European countries and varies with physician attitudes and resource availability. The prevalence of physician bedside rationing, which presents physicians with difficult moral dilemmas, highlights the importance of discussions regarding how to ration care in the most ethically justifiable manner.
Introduction

Health care rationing, or withholding interventions that could be of benefit on the grounds of scarcity or excessive cost, is controversial.[1-4] A specific debate has surrounded the appropriateness of physician bedside rationing. The obligation to advocate for patients,[5-11] and lack of trust that physicians will make the right kind of rationing decisions,[12] have prompted reservations about physician involvement in health care rationing. Their involvement, however, has also been defended on the grounds that physicians are entrusted with the stewardship of scarce resources,[13] could make cost control compatible with patient advocacy,[14] and indeed may be in the best position to ration care in an appropriate and justifiable manner.[14-16]

This debate is hindered by insufficient data regarding whether, and how, rationing takes place in clinical practice.[1,15] Descriptive data about what physicians withhold, from whom, and how they make these decisions, can be crucial to make normative judgments about the ethical acceptability of bedside rationing. If one adopts the normative perspective, as we do, that rationing ought to maximize fairness, data can eventually be used to examine whether physicians withhold in a discriminatory or even-handed manner and hence whether or not bedside rationing is morally problematic. If physician reasoning is consistent with practice guidelines, and cognizant of issues of fairness, then bedside rationing might be an ethically acceptable component of the processes dictating the distribution of medical resources.

Studies have explored physicians' opinions regarding rationing,[17-20] their choices in hypothetical cases,[21-24] as well as specific instances of rationing behavior.[25-27] However, 3 key aspects have not been explored: (1) the frequency of rationing decisions made by physicians in clinical practice, (2) the type of interventions to which these decisions are applied, and (3) the criteria used in making these decisions.

To address these 3 aspects, we conducted an international survey of general physicians in Italy, Norway, Switzerland, and the United Kingdom, 4 European countries offering universal access to health care through very different systems, with per capita expenditure on health care ranging from $3,322 in Switzerland to $1,989 in the United Kingdom.[28]

"Once we got to the point where twenty/something's needed a place on the corner that changed the oil in their cars we were doomed . . ."
-NickDG