The Tyranny of Medical Bills in America

[Rob C]

And let's get something out of the way.  To argue that you want your doctors to be doctors who never think about money for themselves is just unrealistic.    If that was true, the best doctors wouldn't raise their prices for their services.  The truth is they are human,.  Who would have guessed?  They have family's too.  And they want the best for their families and children just like everyone else.  Who here would turn down a raise if it was offered to you by your boss?  Well, doctors also want more money so they can send their children to the best schools and rear them in the best neighborhoods and provide the best clothes, food, and other things.  Wouldn't you?  The idea that doctors check their ego and pride and desire for the good things in life at the medical college door is just silly.  Some may.  Most don't.  (I'm not talking here about doctors who are crooks, who lie to Medicare and bilk the system).   They want to be recognized for their work and paid accordingly.  And that doesn't mean they dopn't care about their patients or the work they do.  

I don't know for sure if you are responding to me, Alan, but I certainly didn't write what you are arguing against. I repeat it here:

"If those smart kids are driven into medicine by money alone, do we really need them in the job?"

The 'bold' is my addition just for here.

Rob C

[RSL]

The reality is that Canada, and other nations with government run health care, *are* able to retain doctors. Hypotheticals are one thing, but reality is quite another.

That said, there is a flow of practitioners across the border, north to south. I don't know about the other direction, and suspect that it's smaller. You can make more money in the USA than in Canada.

As for the state of health care in Canada, here's a another little dose of reality: MRI machines and the like are not free. The USA's astronomical health care costs are driven, in a large part, but unnecessary procedures and tests. The fact that there is an MRI machine down every hall sitting idle, does indeed cause a trend of more MRI tests. Canada doesn't have an MRI machine down every hall, that's a fact.

There's a benefit of being able to get an MRI on a moment's notice. That's real. That saves lives.
There's also a cost.

Much as I dislike the idea of placing a dollar value on human life, we have to recognize that our attitude of "no amount is too great" is a big slice of why we're going broke on medical care in this country.

I've just gotta drop out of this discussion and get some work done.

I wish you could listen to some of the stories I get from Canadian snowbirds during our winters in Florida, Andrew. Evidently it's quite true there isn't an MRI machine down every hall in Canada. In fact it sounds as if there are very few MRI machines down halls in Canada. Some of the wait times for various things I've been told about are close to astronomical.

But I agree with you that health care in the U.S. has jumped the tracks. I've been around for 85 years, and I remember when I was a kid and got sick our doctor would appear beside my bed, take my temperature, feel my gut, make a diagnosis and write out a prescription. The bill for all that was a long way from unreasonable. Things changed when the government got into the act, and as usual when that happens, the change wasn't for the better.

And I certainly agree with you that the idea of "no amount is too great" is a foolish mistake. I think part of the problem is that having lost their faith, people are afraid of death -- not just afraid to die but put off by the whole idea that death is a natural part of life. I hope I can go gentle into that good night, because I know death isn't the end of it all.

[RSL]

But for some reason you apparently don't wish to say if you have used "government-controlled" healthcare. That is kind-of "funny".

Isaac, it's time for you to go read a book about photography. Nobody nowadays can avoid "government-controlled" healthcare because now that the government is in the act, that's all there is. As Ron Reagan said, the nine most terrifying words in the English language are: "I'm from the government and I'm here to help." Our health care is being "helped" by the government, and that's why it's imploding.

Beyond that, it's none of your damned business and I ought to report you to the moderators for asking. I know you'd do that. But I won't.

[DeanChriss]

I assume you meant the health of the population? As far as I know, U.S. healthcare is the best in the world. Meaning the most advanced. Everyone who is anyone flies to the States for the level of advanced treatment not available anywhere else. If thay can afford it, of course.

Rolls Royce may be the best car, but sorry, I can't afford to have one. The difference between cars and healthcare is that I won't die if I don't choose to go bankrupt buying a Rolls Royce. One of the biggest problems with the US healthcare system is that many US citizens, even college educated ones with good jobs and insurance, can't afford to get sick.

EDIT: Major indicators of healthcare performance:

"Quality: The indicators of quality were grouped into four categories: effective care, safe care, coordinated care, and patient-centered care. Compared with the other 10 countries, the U.S. fares best on provision and receipt of preventive and patient-centered care.

Access: Not surprisingly — given the absence of universal coverage — people in the U.S. go without needed health care because of cost more often than people do in the other countries.

Efficiency: On indicators of efficiency, the U.S. ranks last among the 11 countries, with the U.K. and Sweden ranking first and second, respectively. The U.S. has poor performance on measures of national health expenditures and administrative costs as well as on measures of administrative hassles, avoidable emergency room use, and duplicative medical testing.

Equity: The U.S. ranks a clear last on measures of equity. Americans with below-average incomes were much more likely than their counterparts in other countries to report not visiting a physician when sick; not getting a recommended test, treatment, or follow-up care; or not filling a prescription or skipping doses when needed because of costs. On each of these indicators, one-third or more lower-income adults in the U.S. said they went without needed care because of costs in the past year.

Healthy lives: The U.S. ranks last overall with poor scores on all three indicators of healthy lives — mortality amenable to medical care, infant mortality, and healthy life expectancy at age 60."

[Slobodan Blagojevic]

Rolls Royce may be the best car, but sorry, I can't afford to have one....

By the same token, you can not claim that RR is the worst car just because you (or the majority of people) can not afford it.

[Isaac]

Beyond that, it's none of your damned business and I ought to report you to the moderators for asking. I know you'd do that. But I won't.

You're usually so insistent that other people should demonstrate they have experience of what they speak.

[DeanChriss]

By the same token, you can not claim that RR is the worst car just because you (or the majority of people) can not afford it.

That depends on the metric.

[Rob C]

And I certainly agree with you that the idea of "no amount is too great" is a foolish mistake. I think part of the problem is that having lost their faith, people are afraid of death -- not just afraid to die but put off by the whole idea that death is a natural part of life. I hope I can go gentle into that good night, because I know death isn't the end of it all.

Amen! I have no faith in organized religion but an absolute one in a God in my own mind.

The more I see or hear about medical/scientific discoveries about what we actually are, the more absurd the concept that accident had some pivotal rôle. Evolution provides no discomfort to that faith; it strikes me as just another part of the process.

One day or night I shall find out for sure; if I am wrong, then where the rub?

Rob C

[Slobodan Blagojevic]

That depends on the metric.

In which metric would RR be the worst car? Mao Tse-tung's? Khmer Rouge's?

[DeanChriss]

In which metric would RR be the worst car? Mao Tse-tung's? Khmer Rouge's?

Gasoline mileage? Maintenance cost? Convenience of finding a factory service facility in your area?

[amolitor]

Oh come now, the economist can't create a metric for "value" that places RR at the bottom of the heap?

[RSL]

You're usually so insistent that other people should demonstrate they have experience of what they speak.

Yes. I'll always insist that people demonstrate proficiency in a discipline they have the cojones to critique. I'm not in a position to critique medicine, so I don't do it. You might want to think about following that same approach when it comes to photography.

[Slobodan Blagojevic]

Oh come now, the economist can't create a metric for "value" that places RR at the bottom of the heap?

Sure... but it would be specific for that "value" (like RR and gasoline mileage, if true).

Dean Chriss, however, made a sweeping generalization about the value of the U.S. health care as "the worst among developed nations." None of the criteria in Michael Reichmann's linked article (that Dean repeated) have anything to do with the quality of health care, but mostly with factors not directly related to medical issues: poverty, income inequality, affordability, life style, junk food, etc.

[Alan Klein]

I think you'll find the better doctors charge more.  They're usually affiliated with the better hospitals, which often are teaching hospitals affiliated with medical universities.  

[amolitor]

I can't speak particularly broadly to the quality of health care in the USA relative to other developed nations.

I do have a single data point, which may be illustrative, however. Our rate of cesarean-sections is wildly, absurdly, high. This is, as far as we can tell, for a couple of reasons. The main theme is that it's always "safe" for the medical team to section. No matter the outcome, they're in a position to assert that they did everything possible.

This renders them proof (as far as possible) against malpractice suits.
This also makes things easy. C-section rates rise as the end of shift approaches, and as holidays approach. You may speculate on the reasons as well as I.

So there's a couple factors in play here. There's no penalty for sectioning the mother, basically. They're extraordinarily good at it, and rarely kill anyone. There IS benefit, you get to go home, and you generate a bunch of money. The USA is extraordinarily litigious, and the argument that "look, in my best judgement not sectioning was the best course" while statistically perhaps saving lives is not going to save your bacon the one time it doesn't. You can kill ten moms on the operating table, but kill one by electing not to operate and you've got trouble.

This sort of thing, I am given to understand, pervades the US medical system. It is this sort of thing that causes blanket statements like 'the USA has the worse medical care in the developed world' which may or may not be true. There's no denying that the care is excellent, but by some measures it comes in slightly below a lot of Europe.

[Slobodan Blagojevic]

If those smart kids are driven into medicine by money alone, do we really need them in the job?... that it's a vocation as much as anything else...

Rob,

Life has a strange habit of getting in the way of romantic notions pretty quickly. Once a doctor goes bankrupt, what's the point of his vocation? And doctors going bankrupt is happening here more and more often. Then the doctor is forced to work for a hospital, where his vocation will be managed by beancounters who are going to force him to spend a specific limited time per patient, among other things, and force him to order unnecessary and costly procedures. If the good doctor continues to follow his vocation and defies the management orders, he will be fired. At this point, he/she could join Médecins Sans Frontières in the jungles of Amazon, for instance, to follow their vocation.

[amolitor]

Doctors are notorious for being the worst profession at managing their own money. That's not really apropos of anything, but it's a fact.

Possibly getting these guys some more personal finance education could go a ways toward making things better

[DeanChriss]

Sure... but it would be specific for that "value" (like RR and gasoline mileage, if true).

Dean Chriss, however, made a sweeping generalization about the value of the U.S. health care as "the worst among developed nations." None of the criteria in Michael Reichmann's linked article (that Dean repeated) have anything to do with the quality of health care, but mostly with factors not directly related to medical issues: poverty, income inequality, affordability, life style, junk food, etc.

I suppose I should have said "healthcare system" instead of "healthcare", i.e.; the "healthcare system" that makes the excellent "healthcare" inaccessible for so many.

[Rob C]

Doctors are notorious for being the worst profession at managing their own money. That's not really apropos of anything, but it's a fact.

Possibly getting these guys some more personal finance education could go a ways toward making things better

Damn! And to think I'd imagined that photographers had won that cup!

Rob C

[Alan Klein]

I live in New Jersey where the state requires a helmet when riding a motorcycle.  If you go right over the border into Pennsylvania, that state allows you to ride without a helmet if you're over 21 and passed a test.  Of course it's safer with a helmet.  But many are willing to risk not using a helmet in order to be free to decide what they want to do and how they wish to feel.   http://www.fastfreds.com/helmetlawmap.htm


It's the same with medical care and how it's delivered.


I think the issue with most Americans is not what's necessarily best for them.  It's much about not having the government telling us what to do and how to live.  I think that independent spirit is more ingrained in Americans than Europeans although lately Americans seem to be willing to give up their independence to a greater degree than before.  So many of the arguments about socialized health care are about freedom to choose.   Unfortunately, with Obamacare, we've put the final nail in the coffin of private health care.  We're eventual going to have a one-payer system run by the government much like Medicare.   Most Americans don't trust their government or the people who run it who they think are in it only for themselves.  Whether public schooling, the post office or the Veterans Administration, when the government gets involved, not only do you lose your ability to choose, you wind up with worse services that costs more, which is what's going to happen with medical care as well.  When more countries begin to look like Greece and Venezuela politically as well as economically, than my point might be taken more seriously.  Until then, everyone is going to believe what they want to believe.