Saturday, September 19, 2009


Health care is a very difficult issue because Americans expect that everything will be used to treat their illness without regard for costs. It makes sense, everyone values their own life a great deal and want all possible treatments and methods to be used to help cure their illness or extend their life. But that costs a lot of money.

Take this example. A person has cancer that is at a stage where 80% of people die within a year. Further treatment will cost $50,000 a month, is it worth it to continue treatment? In the US, there is no one who can say no. The insurance company might try, but laws prohibit denial of coverage because "it's not worth it". And of course the person who has cancer is going to say of course it's worth it, any amount of money is worth trying to save my life.

In Europe, the government decides, which would also happen here if Obamacare passes. Someone has to decide if spending X money is worth an X percent chance of extending a person's life. Otherwise, we get huge costs because we try to do everything possible to extend a person's life regardless of the cost. That's why health care is so expensive in this country, that and the fact that we do have the best care in the world. Recent studies have finally provided evidence for what I've suspected all along.

Life expectancy in the United States fares poorly in international comparisons, primarily because of high mortality rates above age 50. Its low ranking is often blamed on a poor performance by the health care system rather than on behavioral or social factors. This paper presents evidence on the relative performance of the US health care system using death avoidance as the sole criterion. We find that, by standards of OECD countries, the US does well in terms of screening for cancer, survival rates from cancer, survival rates after heart attacks and strokes, and medication of individuals with high levels of blood pressure or cholesterol. We consider in greater depth mortality from prostate cancer and breast cancer, diseases for which effective methods of identification and treatment have been developed and where behavioral factors do not play a dominant role. We show that the US has had significantly faster declines in mortality from these two diseases than comparison countries. We conclude that the low longevity ranking of the United States is not likely to be a result of a poorly functioning health care system.
Insurance can't get around the fact that SOMEONE HAS TO PAY! Just because you have insurance and only pay $10000 for $100,000 of health care services doesn't mean the $90,000 disappears! Someone else will have to cover that shortfall. So insurance cannot possibly work if everyone is receiving $100,000 of services for premiums and copays that add up to $10,000. It means that those who don't get sick and have insurance will see premiums that seem very high to them. Again, someone has to make up the difference, someone has to pay. This is what makes health care so difficult to "fix".

And of course there are government regulations and such that prevent health insurers from offering coverage across States, which could reduce risk for the insurers and rates for everyone else. The larger the pool, the easier it is to predict outcomes. Also why do Americans require that doctors treat them or be the primary person to see them? Most illnesses and sicknesses are common ones that we know about and know how to treat. A nurse can be just as effective, let's say stitching up a cut or treating an infection. Doctors could then be reserved for only the most difficult cases, this is what they do in the UK. You don't get to see a doctor unless the nurse doesn't know what is wrong with you and can't fix you up. That saves money, but would Americans be satisfied with that kind of health care? Maybe, read on below.

WSJ -- Retail health clinics are adding treatments for chronic diseases such as asthma to their repertoire, hoping to find steadier revenue, but putting the clinics into greater competition with doctors' groups and hospitals.

Walgreen Co.'s Take Care retail clinic recently started a pilot program in Tampa and Orlando offering injected and infused drugs for asthma and osteoporosis to Medicare patients. At some MinuteClinics run by CVS Caremark Corp., nurse practitioners now counsel teenagers about acne, recommend over-the-counter products and sometimes prescribe antibiotics.

Walgreen, the second-largest pharmacy chain by stores, plans to start a pilot program for managing diabetes in coming months. CVS's MinuteClinic is piloting a rapid test for conjunctivitis, or pinkeye, at its Atlanta clinics and working with the Cleveland Clinic to provide care to asthma patients.

MP: So how are the MDs responding to the increased competition from retail clinics? First of all, they don't like the competition:

Such moves (expansion of services at retail clinics) are raising the ire of physicians' groups that see the in-store clinics as inappropriate venues for treating complex illnesses. In May, the Massachusetts Medical Society urged its members to press insurance companies on co-payments to eliminate any financial incentive to use retail clinics.

But second of all, they are responding to the competition from retail clinics by acting more competitively themselves:

The clinics are helping alter the practice of medicine. Doctors are expanding office hours to evenings and weekends. Hospitals are opening more urgent-care centers to treat relatively minor health problems.

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