Universal Healthcare System

[onlykelsey]

That is a great book.  I disagree with your conclusions about what we need to do as a country (I mean, yes, we SHOULD also drink less soda, etc), but end-of-life care is a good point.  Even though very few people want aggressive medical intervention, and most express a desire for pallative care, we seem obsessed with eking out one more (crappy quality) month of life against their will and at great cost.  I suppose certain pharmaceutical companies, medical equipment folks and professionals benefit a bit from that extra month, but that shouldn't be the goal of healthcare.

[sjc0816]

I will give that book a look. We just went through an excruciating situation with my father in law....where he had end-stage cancer but refused to stop treatments (despite being told there was no hope). He was in the hospital for 8 weeks until he was unconsious and MIL transfered him to hospice where he died the next day. Insurance covered every bit of the 500K bill.  The whole thing was really eye-opening to me as far as them allowing him to be treated because he was too scared to die. Obviously, this goes beyond insurance/healthcare....it was a very delicate situation...but the money they spent to keep him barely alive was staggering.

[naners]

I'm a Canadian expat who has been living in the US for 5 years now. Having talked to people from all over the world about how their health system is run, no one's system is perfect. But, I was very happy on the whole with the Canadian system. My dad had several heart attacks and cancer; his wife had breast cancer two years ago. IMO their treatment was speedy and top-notch. There isn't really any "rationing" for urgent issues, although some treatments that offer little benefit at great cost aren't covered. That said, depending on where you live there can be waits for "non-urgent" treatments (which can suck if you're an elderly person waiting for a knee replacement). I have no specific stats or anecdotes on those kinds of waits though. Another issue is that some places have physician shortages, although that's not because of any rationing, usually because there's just a shortage of either doctors in that particular specialty or doctors who want to live in the middle of nowhere. To me, these disadvantages - although real- are far outweighed by having coverage that can never be taken away and isn't linked to employment. It also costs less overall.

Re: physician choice, that's not something I ever thought about before coming to the US. Generally your GP is your entry point to care, and they refer you to specialists. I'm not actually sure that I believe different physicians have dramatically different outcomes, anyway, since there are so many standards of care these days. I think it is possible to get in to see particular doctors although I'm not sure how it's done - maybe you ask your GP for a referral to that particular person? And yes, clinical trials do happen in countries with universal health systems, maybe even more since less money is wasted on for-profit care.

[grizz]

The wife and I have private medical cover, $2600 a year, which mainly allows us to jump the queue if needed, as it was for me two years ago when I got early stage bladder cancer, now cured. My specialist shot me into hospital for a cystoscopy quickly because I had private cover. There are public hospitals and private hospitals,and the food in the private ones are better.

Just curious: hypothetically, let's say you did not have the private medical coverage already and found out about the diagnosis. In your country, can the insurance companies deny you based on a pre-existing condition? Could you have bought the private coverage and still jumped the queue after having found out about the cancer?

Glad you're recovered, too. :-)

[shelivesthedream]

Aside from the benefits to the individual of the NHS (free at point of care, everyone gets the same, no one would deny themselves treatment for financial reasons), I do think there is a community benefit to nationalised healthcare (that is somewhat underused in the UK). UK doctors are really not touting for your custom. Yes, there are ratings and targets, but their earnings are not tied to the tests or treatments they prescribe, and they don't need to keep you a happy customer. There is some local choice for GPs and specialists but not so much that one can truly comparison shop.

 This means that they can prescribe/advise what is actually best for the patient and one can enact national policy to reduce unnecessary drug use. For example, if you ask an NHS GP for antibiotics for a cold, good luck getting them! But unless you go private, there's nowhere else to go. And GPs can prescribe exercise instead of medication for blood pressure problems. I'm not saying all GPs do this all the time, but the potential is there to combat antibiotic resistance and to make people take some responsibility for chronic preventable disease in a way that there isn't in a healthcare market.

[Yaeger]

I think the US has two options, what we have now is failing horribly. Our hybrid government/private healthcare system is flawed and is the very model of inefficiency. It takes the worst from private (profit oriented) and uses government to eliminate all the normal checks on controlling a private market system (competition, consumer choice, innovation, cost reduction, etc).

Two options:
More likely: The federal and state governments will expand to encompass the supply and demand side of the healthcare market. This is probably the 'fairest' option and will lower costs, yet will probably more expensive than option 2.

Less likely: The federal and state governments will pull out of the healthcare markets and deregulate to allow more consumer control. This will allow competitors to move into market to drive prices down and profit-oriented business will be motivated to deliver quality customer service for lower prices. Less fair, but by far the more inexpensive and efficient option.

[TrMama]

As a Canadian who has always lived in Canada the main difference between what goes on here and what appears to happen in the US is that when someone gets sick here, they get to make decisions about their case based solely on what the best treatment is for them. Since the cost of all treatments is $0, it's not a factor when making a decision.

I'm an example of this. I have a congenital heart defect that's recently become symptomatic. I'm considering having it "fixed". My only hesitation is that the procedure to fix it isn't risk free. It's the current standard treatment for this condition around the world so my doctor certainly isn't offering me sub-par care. I actually have no idea what the cost of the procedure is since I won't pay anything for it regardless of what I decide. If my condition worsens, I'd get treatment immediately. Plus, I won't ever have to deal with any insurance paperwork. After any kind of treatment I can just go home and rest.

I also disagree with the posters who imply that unhealthy lifestyles are the main cause of ballooning healthcare costs. I've been spending some time in cardiologist's waiting rooms and the cardio wing of the hospital. I haven't seen a single overweight person yet. Just lots of older people who look like they've done their beset to live healthy lives. Frankly, I was kind of surprised by this.

[Cassie]

At age 50 I was not overweight and walked between 4-8 miles a day. That year I was diagnosed with HBP, a heart problem and asthma all at once. I went from taking no meds at all to taking them for all 3 conditions.  Life happens.

[goatmom]

Big Pharma also plays a part in the big mess.  Many people are being prescribed medications that provide very little proven benefit.  Providers aren't even thinking sometimes when they hand out these medications. We have providers that are not well trained and order more tests and labs because 1.  clinical skill are lacking 2. fear of lawsuit.  And yes, for the most part people should die at home.  But we are very afraid of death in this country and although hospice care is helping - people don't like to take care of their dying loved ones.

I am not sure how to fix the system - but the military system does work well but that is mostly healthy young people that don't abuse substances.  The VA does not run quite as smoothly.

[Yaeger]

Big Pharma also plays a part in the big mess.  Many people are being prescribed medications that provide very little proven benefit.  Providers aren't even thinking sometimes when they hand out these medications. We have providers that are not well trained and order more tests and labs because 1.  clinical skill are lacking 2. fear of lawsuit.  And yes, for the most part people should die at home.  But we are very afraid of death in this country and although hospice care is helping - people don't like to take care of their dying loved ones.

I am not sure how to fix the system - but the military system does work well but that is mostly healthy young people that don't abuse substances.  The VA does not run quite as smoothly.

Yeah, only 1 in 4 are eligible to join the military. Plus military personnel are generally much more fit than the average person. However, even with these factors in play military medical costs are skyrocketing and the Pentagon is continually looking at methods to cut medical costs.

In my, perhaps flawed, opinion the more of a role government takes in caring for people, the less of a role people take in caring for each other. Looking at charity, the US is consistently ranked as being far more charitable that our more socialist European brothers. Meaning, all being equal, we're far more likely to take care of those in need.

https://www.cafonline.org/about-us/publications/2014-publications/2014-infographic
http://www.forbes.com/2008/12/24/america-philanthropy-income-oped-cx_ee_1226eaves.html

[Abe]

Americans on average are just too unhealthy to get the life expectancy we have now without significant pharmaceutical help. I'm sure the people in this community are on the healthier/physically active side of the spectrum. Unless you are in healthcare, you may not see just how unhealthy people are on average. That's the main reason things cost so much. The other reasons are: unreasonable end-of-life expectations resulting in futile ICU care, and increasing expenditure on medications with a very low benefit/cost ratio. The latter are partly a result of the first reason, partly due to society's expectations of what healthcare provides. Bottom line: it costs a lot of money ($10k on average per year according to Medicare) to keep an overweight elderly patient with heart disease and/or diabetes alive in good to fair condition. Most of this expenditure is not for maintenance medications, but for hospitalizations for acute exacerbations of various ailments.

http://kff.org/medicare/state-indicator/per-enrollee-spending-by-residence/
http://kff.org/medicare/fact-sheet/medicare-spending-and-financing-fact-sheet/

[Leisured]

The wife and I have private medical cover, $2600 a year, which mainly allows us to jump the queue if needed, as it was for me two years ago when I got early stage bladder cancer, now cured. My specialist shot me into hospital for a cystoscopy quickly because I had private cover. There are public hospitals and private hospitals,and the food in the private ones are better.

Just curious: hypothetically, let's say you did not have the private medical coverage already and found out about the diagnosis. In your country, can the insurance companies deny you based on a pre-existing condition? Could you have bought the private coverage and still jumped the queue after having found out about the cancer?

Glad you're recovered, too. :-)

Sorry for the slow reply, grizz. I have been in the health fund for decades. I understand that a preexisting condition, present for up to six months before joining fund, will mean a 12 month waiting period before claiming for that particular condition

Thank you for your concern.

[EnjoyIt]

I work in healthcare in the US.  Our patient population is indeed much sicker today than it was the last few decades.  10 years ago it was rare to see a patient 300+ pounds.  Now we see them on a regular basis.

If it wasn't for fast food, cigarettes, and sugared beverages many people in the healthcare industry would be out of work.