How would *you* reform health care in USA?

[hrothgar]

My understand is that the French health care system is consistently ranked as one of the best is the world. (I believe that Japan is in the same ball park).

 

Seems that the US could (probably) learn a lot from the French system. I wouldn't (quite) say that the US system is considered to be a joke, but it certain doesn't rate very well unless you're at the very top of the food chain.

[pbleighton]

Peter I have in every one of my posts. What do you think this is all about. Saving lives. Saying technology will not save lives seems to be your fantasy, not mine.

Saying better imaging will not save thousands of babies is your fantasy not mine.

 

When will technology save the lives of those who are unisured, Mike? That seems to be your fantasy. You haven't addressed families making 20,000, 30,000, , 40,000 paying for this stuff.

 

How ould technology have saved my uninsured friend? You seem to not care at all.

 

Peter

[mike777]

Peter I have in every one of my posts. What do you think this is all about. Saving lives. Saying technology will not save lives seems to be your fantasy, not mine.

Saying better imaging will not save thousands of babies is your fantasy not mine.

 

When will technology save the lives of those who are unisured, Mike? That seems to be your fantasy. You haven't addressed families making 20,000, 30,000, , 40,000 paying for this stuff.

 

Peter

Peter you do not need insurance to get health care, repeat after me.

You can have zero money in your pocket and get health care. Is it as full as yours, no, it is better than 50 years ago and better than most of the world, yes. If you think the poorest of the poor are better of in China or Russia or Mexico, I cannot discuss this with you. If you think the poor get worse care than 40 years here in the USA I cannot discuss this with you in any sane way.

 

I do not know the French system, it seems there may be some statisical problems with the ranking but I am not sure. IT is worth a closer look.

 

"France is the only country in which access to care is unlimited: patients can see as many physicians as often as they like. Patients do not need referrals to see specialists, and in general, there is no gatekeeping system of any kind. This may partially account for the World Health Organization's high ranking of France's health care system last year: the rating system emphasized the system's responsiveness (a measure of patients' freedom and flexibility), a quality the French system provides, undeniably at the expense of overall efficiency."

 

http://www.medicalnewstoday.com/medicalnews.php?newsid=9994

[pbleighton]

My understand is that the French health care system is consistently ranked as one of the best is the world. (I believe that Japan is in the same ball park).

 

Seems that the US could (probably) learn a lot from the French system. I wouldn't (quite) say that the US system is considered to be a joke, but it certain doesn't rate very well unless you're at the very top of the food chain.

 

I know a few French people who live here, and fly back to france for what they consider to be better care. The air ticket and hotel is far cheaper than the cost of care in the U.S.

 

Mike's fantasies to the contrary, there are many countries in which people in the aggregate receive better health care than here, at a much lower cost.

 

Peter

[pbleighton]

Peter you do not need insurance to get health care, repeat after me.

 

A flat out lie.

 

Tell that to my dead friend.

 

Peter

[mike777]

Here is a random blog discussing the French system vs. USA. I just found it at random and you can decide if it is worthwhile or not.

 

http://www.marginalrevolution.com/marginal...h_health_c.html

 

Peter step one do not have health insurance.

step two have no money, I mean zero.

step three have a heart attack

step four, did you get any I mean any health treatment

Yes, in fact you can get the worlds best.

 

Now as far as follow up care and many other issues, you may have problems. But to say you will never find one example of a person not getting health care who does not have is a flat out lie. :)

 

In fact I have received health care in my lifetime having no insurance and not a penny to my name. I know others.

[pbleighton]

But to say you will never find one example of a person not getting health care who does not have is a flat out lie.

 

I never said that, but

 

Tell that to my dead friend.

 

You seem to have a fear of the actual.

 

Why all the dead babies, Mike?

 

Peter

[DrTodd13]

Wow. A lot of stuff here to digest. The problem with questions like "how should we reform health care" is that the answer depends totally on what one values most and who the "one" is that gets to make the decision. Do we want to minimize health care costs? Do we want to maximize care? Is the "ideal" some tradeoff and if so who sets it? We have a mechanism for making such decisions and it is called the market. Unfortunately, the system is currently engineered almost to eliminate market forces. First, a positive of our system is speed of care. You hear horror stories from Canada about ridiculously long waits for treatment which is an indication of price controls. Price controls always lead to scarcity.

 

The big negative of our system is its cost. There are several reasons as I see it. First, demand is sky high. For any commodity, if the price is invisible the demand will soar and so will the underlying cost. Low deductibles increase demand for health care because after a point you are spending somebody else's money...at least that is how people see it. What they don't realize is there is no free lunch and they or someone else is paying for it somehow. Second, government interference for things like drug imports. Drugs are cheaper elsewhere than they are in the country they are produced. There is no reason for this other than limits on market forces. Third, the focus on treatment rather than prevention. There isn't as much money to be made in prevention as there is in treatment. Fourth, malpractice insurance probably adds a lot to the cost of care. We need to find someway of addressing exorbitant lawsuit awards.

 

For me, not being a slave is important and as such being forced to pay for someone else's health care I find offensive. In an ideal world, everybody would pay for their own health care. If I could wave a magic wand and convince people the best thing to do, here is what I'd do. Eliminate all government regulation of everything health and drug related. Convince everyone to only carry catastrophic health care insurance so that they see the cost of routine care and so competition will drive prices down. Convince people to eat less and exercise more.

[han]

Wow. A lot of stuff here to digest. The problem with questions like "how should we reform health care" is that the answer depends totally on what one values most and who the "one" is that gets to make the decision. Do we want to minimize health care costs? Do we want to maximize care? Is the "ideal" some tradeoff and if so who sets it? We have a mechanism for making such decisions and it is called the market. Unfortunately, the system is currently engineered almost to eliminate market forces. First, a positive of our system is speed of care. You hear horror stories from Canada about ridiculously long waits for treatment which is an indication of price controls. Price controls always lead to scarcity.

 

The big negative of our system is its cost. There are several reasons as I see it. First, demand is sky high. For any commodity, if the price is invisible the demand will soar and so will the underlying cost. Low deductibles increase demand for health care because after a point you are spending somebody else's money...at least that is how people see it. What they don't realize is there is no free lunch and they or someone else is paying for it somehow. Second, government interference for things like drug imports. Drugs are cheaper elsewhere than they are in the country they are produced. There is no reason for this other than limits on market forces. Third, the focus on treatment rather than prevention. There isn't as much money to be made in prevention as there is in treatment. Fourth, malpractice insurance probably adds a lot to the cost of care. We need to find someway of addressing exorbitant lawsuit awards.

 

For me, not being a slave is important and as such being forced to pay for someone else's health care I find offensive. In an ideal world, everybody would pay for their own health care. If I could wave a magic wand and convince people the best thing to do, here is what I'd do. Eliminate all government regulation of everything health and drug related. Convince everyone to only carry catastrophic health care insurance so that they see the cost of routine care and so competition will drive prices down. Convince people to eat less and exercise more.

You are disgusting.

[helene_t]

Thinking that improved technology will lower costs is to hold an overly simplistic view of the nature of illness and the human body. We have mapped out the DNA of humans but still can't really do much with that information because the interactions of genomes is so complex.

Medical genetics happens to be my field of research and I agree with Winston. Let me add that even if we knew how to interpret gene expression measurements and how a living cell worked, it would not do much for public health. I'm all for rational drug design but the attention such technology gets in popular media is way out of proportion with realistic prospects. If I were the government I wouldn't spent a damn cent on medical genetics research. The money is put to better use in basic science, and maybe in industrial and agricultural applications.

 

In the past few years, a new serum test to indicate MI has been introduced, the troponin level. I asked a cardiologist what the troponin level had done to aid his skills and he in all seriousness said that it allowed him to buy a 90-foot yacht instead of the 60-footer on which he had planned.

This story is quite typical. Actually I' m concerned about what to do with my career once sponsors discover that all this biotech is useless. I'll have to look for some other hype. I'm sure I will find some. Since the death of Yahwee and Allah, people put their uncritical faith in science instead.

 

First, a positive of our system is speed of care. You hear horror stories from Canada about ridiculously long waits for treatment which is an indication of price controls. Price controls always lead to scarcity.

I'll have to agree with this (even if Han calls it 'discusting'). For some reason, people over here (and apparanetly in Canada, too) feel that it is more "fair" if everybody gets slow care, rather than if some get fast care and some get no care.

 

My personal (and political) preferences are slightly different from Todd's, though. I, too, don't like to pay for other people's health care, but then I'd put emphasis on "health care" rather than on "other people". If the government decides that the haves have to transfer more wealth to the havenots, then it's OK with me, I might even vote for such politicians. What I'm against is that the government decides that the havenots must spent the transfered-to-them money on health care. Except for children and morons I think people are better positioned to make that decision themselves.

 

If health care is unequaly distributed in the U.S. I think the discussion should be whether to solve the problem at its root (income distribution) or not to solve it all.

[mike777]

Thinking that improved technology will lower costs is to hold an overly simplistic view of the nature of illness and the human body. We have mapped out the DNA of humans but still can't really do much with that information because the interactions of genomes is so complex.

Medical genetics happens to be my field of research and I agree with Winston. Let me add that even if we knew how to interpret gene expression measurements and how a living cell worked, it would not do much for public health. I'm all for rational drug design but the attention such technology gets in popular media is way out of proportion with realistic prospects. If I were the government I wouldn't spent a damn cent on medical genetics research. The money is put to better use in basic science, and maybe in industrial and agricultural applications.

 

In the past few years, a new serum test to indicate MI has been introduced, the troponin level. I asked a cardiologist what the troponin level had done to aid his skills and he in all seriousness said that it allowed him to buy a 90-foot yacht instead of the 60-footer on which he had planned.

This story is quite typical. Actually I' m concerned about what to do with my career once sponsors discover that all this biotech is useless. I'll have to look for some other hype. I'm sure I will find some. Since the death of Yahwee and Allah, people put their uncritical faith in science instead.

 

First, a positive of our system is speed of care. You hear horror stories from Canada about ridiculously long waits for treatment which is an indication of price controls. Price controls always lead to scarcity.

I'll have to agree with this (even if Han calls it 'discusting'). For some reason, people over here (and apparanetly in Canada, too) feel that it is more "fair" if everybody gets slow care, rather than if some get fast care and some get no care.

 

My personal (and political) preferences are slightly different from Todd's, though. I, too, don't like to pay for other people's health care, but then I'd put emphasis on "health care" rather than on "other people". If a democratically elected government decides that the haves have to transfer more wealth to the havenots, then it's OK with me, I might even vote for such politicians. What I'm against is that the government decides that the havenots must spent their money on health care. Except for children and morons I think people are better positioned to make that decision themselves.

 

If health care is unequaly distributed in the U.S. I think the discussion should be whether to solve the problem at its root (income distribution) or not to solve it all.

helene

 

I can only add that I think radically improving imaging and scanning would answer some of your concerns. If we see genes and the interaction between genes or the interaction between proteins as a picture this will be a huge boom to science.

 

I will stick by my guns and say the extreme growth in imaging and scanning science will yield huge gains in the medical field..So huge as to mean an end to Medicine as we know it. This growth is happening much faster than I have indicated.

 

btw Gerben as an astronomer may know more about the advances in imaging than most of us.

[mike777]

To learn more about this subject see:

Dr. Gary Glazer

Dr. Sam Gambhir ..both at Stanford

 

 

Don Listwen

 

Venture capitalist Jon Medward

 

Yes there is money to made.... :)

[helene_t]

I can only add that I think radically improving imaging and scanning would answer some of your concerns.

 

I will stick by my guns and say the extreme growth in imaging and scanning science will yield huge gains in the medical field..So huge as to mean an end to Medicine as we know it. This growth is happening much faster than I have indicated.

I'm skeptical. Maybe better interpretation of brain scans will be a revolution in the care for psychiatric patients. It might also help some cardiatric patients. But for cancer and bone fracture patients I don't think it will help much.

 

Case in point: we have had intense public debate about general breast cancer screening. For some odd reason people want to know if they have cancer or not. Those screening programs cost money, cause distress in the scanned women even before the receive the diagnosis, and also the scan itself has adverse physical effects. The latter could change with better scans in the future, I admit that. But what won't change much is that a lot of women receive a quasi-positive diagnosis, in which case they might as well flip a coin to decide whether to get treated or not. This is not so much a shortcoming of the scans, but more because the progression of a tumor depends on unknown and/or unpredictable environmental factors, is inherently unpredictable, or may simply be of a semi-benign kind in which case the cases for and against treatment roughly outweigh each other, even with full information.

 

And then there are those women who get a positive scan result, which means that they have to line up for further examiniation. Even if the scans never turned out to be mistakes, there will still be some who eventually learn that the tumor is untreatable, or that it's benign and doesn't require treatment. Except that they might have aquired some psychosomatic disease as a result of the scan result in the meantime. Of course there are some who benefit from the screening but the net impact on public health is probably negative.

[mike777]

Speaking of breast cancer.

1) couple of billion dollars spent each year on mammograms.

2) mental anguish of false positives and risk from biopsies.

3) all that to find 200,000 cases of breast cancer

4) 100,000$ per case, just to find.

 

molecular imaging can only help lower the cost and save lives.

 

GE is doing work on angiognesis and imaging

Merck on an RGD for drug delivery

yes this the free market and not government :)

[mike777]

CA-125 is about 84.7% sensitive for ovarian cancer.

 

Can we find 20 markers to improve that to 95%?

[mike777]

5 grand in usa spent on health care per person in Usa, every year.

 

In twenty years will half of that be spent on early detection, imaging, chips and a new style of personalized medicine? That would mean an end to medicine as we(I) think of it today.

 

For more on this subject see Fred Hutchinson Cancer Research Center.

[Winstonm]

Imaging won't do a thing to cure Ebola. It will not help stop Vancomycin-resistance. It does not eliminate prions.

 

Better imaging may lead to slightly earlier detection of cancer, but only if used as a tool during a routine physical, which would inflate the cost. For most, it is after symptoms appear they go to the doctor and the doctor orders the tests - by that time the cancer is larger enough to been found by today's standard means.

 

The overriding factor in U.S. healthcare is cost. Improved technology may or may not lower that cost. But it seems to me that to blithely tout that technology in a capatilist society will save the day is more about maintaining status quo politicaly than actual health care concerns.

[mike777]

"Imaging won't do a thing to cure Ebola"

 

Why not, I do not understand this type of thinking.

 

If you can see pictures of the Ebola virus acting at the atomic or molecular level, how can that not do something to help find a cure?

 

Finding any disease at a very early stage must be cheaper to treat than finding it in the later stages. Seeing how any disease interacts at the protein or gene level must be a great first step in finding a cure? What is a better first or second step?

 

Why is imaging only used in a routine physicals? Can I not use my cheap home version that finds cancer for pennies in the future? We have home tests for pregnancy that we did not have 100 years ago that costs pennies. Why not for some forms cancer or cardio issues in the future?

 

Yes I think technology in a capitilist society will save the day? If not what will, the government?

[luke warm]

Wow.  A lot of stuff here to digest.  The problem with questions like "how should we reform health care" is that the answer depends totally on what one values most and who the "one" is that gets to make the decision.  Do we want to minimize health care costs?  Do we want to maximize care?  Is the "ideal" some tradeoff and if so who sets it?  We have a mechanism for making such decisions and it is called the market.  Unfortunately, the system is currently engineered almost to eliminate market forces.  First, a positive of our system is speed of care.  You hear horror stories from Canada about ridiculously long waits for treatment which is an indication of price controls.  Price controls always lead to scarcity.

 

The big negative of our system is its cost.  There are several reasons as I see it.  First, demand is sky high.  For any commodity, if the price is invisible the demand will soar and so will the underlying cost.  Low deductibles increase demand for health care because after a point you are spending somebody else's money...at least that is how people see it.  What they don't realize is there is no free lunch and they or someone else is paying for it somehow.  Second, government interference for things like drug imports.    Drugs are cheaper elsewhere than they are in the country they are produced.  There is no reason for this other than limits on market forces.  Third, the focus on treatment rather than prevention.  There isn't as much money to be made in prevention as there is in treatment.  Fourth, malpractice insurance probably adds a lot to the cost of care.  We need to find someway of addressing exorbitant lawsuit awards. 

 

For me, not being a slave is important and as such being forced to pay for someone else's health care I find offensive.  In an ideal world, everybody would pay for their own health care.  If I could wave a magic wand and convince people the best thing to do, here is what I'd do.  Eliminate all government regulation of everything health and drug related.  Convince everyone to only carry catastrophic health care insurance so that they see the cost of routine care and so competition will drive prices down.  Convince people to eat less and exercise more.

You are disgusting.

i don't understand, han... why?

[jtfanclub]

My first *serious* thread, interested to know what you think is the best way to reform health care. Lets limit to USA since otherwise it is too broad.

 

I will favour practicalilty over idealism. ie, ideal = complete health care provided free, for everyone, but it ain't going to happen.

Going all the way back to the beginning question....

 

Favour simplicity.

 

OK.

 

1. Each employer has to pay $1000 per year to the government for every full-time equivalent employee they have (ie. fifty cents per hour of work). For every two dollars the employer pays for health insurance for this person/family, the amount gets reduced by one dollar.

 

2. Require HMOs to cover life threatening pre-existing conditions. To some extent, PECs will be covered by the funds paid by the employers in #1. HMO's will still lose money on PECs, but it won't be the disaster it would be otherwise.

 

3. The remaining money gained by #1 and not paid out in #2 would be paid to hospitals for uninsured life-threatening medical care.

 

Eventually, we'd balance out the amount employers have to pay so that HMOs and hospitals would get 75-80% of their bill paid for by the fund, though it would probably start out lower.

 

That'd at least get all the pre-retirees. Medical coverage for retirees has lots of impossible choices.

[keylime]

This is a very thorny subject, but to be succinct:

 

1. Universal health care coverage would act as an engine brake on the economy, and cause higher deficits with reduced levels of service; a 2 or 3 tier health care system would develop rapidly, thus enlarging the gulf between the "haves" and the "have nots".

 

2. Small businesses and non-for-profits would have a harder time recruiting new employees and more importantly, retaining them. Health care and tangible "human benefits" are a lucrative asset that companies are offering to attract folks.

 

3. The federal government already is the largest funder of health care in the United States. I just don't think the gov't should be in the business of having complete control of health care decisions and allotments and such.

[Winstonm]

Why is it we oppose government health care yet support government wars?

[pbleighton]

Why is it we oppose government health care yet support government wars?

 

Health care isn't exciting.

 

Peter

[mike777]

You guys suggest reforms, I suggest the End of Medicine as we know it.

 

Think Big!

 

Is that exciting enough?!

[Winstonm]

You guys suggest reforms, I suggest the End of Medicine as we know it.

 

Think Big!

 

Is that exciting enough?!

I suggest the end of war as we know it.

 

Think Bigger!