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On January 28 2011 15:47 TanGeng wrote:Show nested quote +On January 27 2011 03:18 BroodjeBaller wrote:
Thats a lot of words to basicly say nothing at all.
You just make assumptions based on false assumptions.
Way to go.
You asked for sources in general about the whole post. It is a lot more messy than one shout for "sources!" will command. Health care systems are complicated. I prefer complicated. It give people an nuanced understanding of the world. If you don't like complicated, I can offer you vacuousness, instead. I can even put that in a neat little gift box for you.
Hmm maybe something is wrong with your reading comprehension, but I didnt ask for sources in general about the whole post.
I asked for sources of your statements in just these 2 lines:
Show nested quote +Long wait lines, doctor shortages, poor distribution of specialization, poor geographical distribution of doctors, etc. There's plenty of crap under the veneer. Can you back this up? Link me source which compares the US to welfare states such as Germany, Netherlands, Denmark and Sweden. I'm absolutely sure that your statement is false.
All these things are measurable in numbers. I assume you dont say these things without reason, so I guess you have seen these numbers somewhere.
A quick google search already showed me that your "long wait lines" statement is completely false.
Poor geographical distribution of doctors doesnt even make sense when look at the density of population and the size of these countries.
You are simply just shouting nonsense and you cant back it up.
And yes I know health care systems are complicated, but werent talking about the details of health care systems and how certain health care systems work.
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Sanya12364 Posts
On January 28 2011 21:21 BroodjeBaller wrote:
Hmm maybe something is wrong with your reading comprehension, but I didnt ask for sources in general about the whole post.
I asked for sources of your statements in just these 2 lines:
Ahhh, you jumped into the middle of that exchange. No wonder, it makes no sense. In an exchange that was broadly about Europe and Japan, you want to very specifically it to apply my blanket bludgeon to four countries. If we're at 4 countries, how about narrowing it down even further to one single country? Then instead of a bludgeon I can apply a very specific critique to said country.
But for starters you can look at Sweden's specialty wait time: http://www.thelocal.se/31554/20110120/ It was dissatisfying enough to the Swedes there their government felt it necessary to pass a new law trying to ban long waits.
But the metrics of maximum wait time can be gamed by adding delay to those with more urgent needs. There's more to waiting lines than the metrics that are published.
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On January 28 2011 23:05 TanGeng wrote:Show nested quote +On January 28 2011 21:21 BroodjeBaller wrote:
Hmm maybe something is wrong with your reading comprehension, but I didnt ask for sources in general about the whole post.
I asked for sources of your statements in just these 2 lines:
Ahhh, you jumped into the middle of that exchange. No wonder, it makes no sense. In an exchange that was broadly about Europe and Japan, you want to very specifically it to apply my blanket bludgeon to four countries. If we're at 4 countries, how about narrowing it down even further to one single country? Then instead of a bludgeon I can apply a very specific critique to said country. But for starters you can look at Sweden's specialty wait time: http://www.thelocal.se/31554/20110120/ It was dissatisfying enough to the Swedes there their government felt it necessary to pass a new law trying to ban long waits. But the metrics of maximum wait time can be gamed by adding delay to those with more urgent needs. There's more to waiting lines than the metrics that are published.
"For starters look at Sweden" ... !? Is that really an "innocent pick". It's certainly true that Sweden has problems with waiting times ... , but why not "continue" and look at the other countries like Germany, France, Denmark, the Netherlands, etc:
Take the Commonwealth Survey for example which indicates that all of the above countries have an equally or better performing health system at lower cost.
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Popping in to advertise an interesting article on reducing costs of US healthcare:
"The Hot Spotters
Can we lower medical costs by giving the neediest patients better care?"
http://www.newyorker.com/reporting/2011/01/24/110124fa_fact_gawande?currentPage=all
highlights:
Brenner wasn’t all that interested in costs; he was more interested in helping people who received bad health care. But in his experience the people with the highest medical costs—the people cycling in and out of the hospital—were usually the people receiving the worst care. “Emergency-room visits and hospital admissions should be considered failures of the health-care system until proven otherwise,” he told me—failures of prevention and of timely, effective care.
If he could find the people whose use of medical care was highest, he figured, he could do something to help them. If he helped them, he would also be lowering their health-care costs. And, if the stats approach to crime was right, targeting those with the highest health-care costs would help lower the entire city’s health-care costs. His calculations revealed that just one per cent of the hundred thousand people who made use of Camden’s medical facilities accounted for thirty per cent of its costs. That’s only a thousand people—about half the size of a typical family physician’s panel of patients.
+ Show Spoiler [example patient #1] +The first person they found for him was a man in his mid-forties whom I’ll call Frank Hendricks. Hendricks had severe congestive heart failure, chronic asthma, uncontrolled diabetes, hypothyroidism, gout, and a history of smoking and alcohol abuse. He weighed five hundred and sixty pounds. In the previous three years, he had spent as much time in hospitals as out. When Brenner met him, he was in intensive care with a tracheotomy and a feeding tube, having developed septic shock from a gallbladder infection.
Brenner visited him daily. “I just basically sat in his room like I was a third-year med student, hanging out with him for an hour, hour and a half every day, trying to figure out what makes the guy tick,” he recalled. He learned that Hendricks used to be an auto detailer and a cook. He had a longtime girlfriend and two children, now grown. A toxic combination of poor health, Johnnie Walker Red, and, it emerged, cocaine addiction had left him unreliably employed, uninsured, and living in a welfare motel. He had no consistent set of doctors, and almost no prospects for turning his situation around.
After several months, he had recovered enough to be discharged. But, out in the world, his life was simply another hospitalization waiting to happen. By then, however, Brenner had figured out a few things he could do to help. Some of it was simple doctor stuff. He made sure he followed Hendricks closely enough to recognize when serious problems were emerging. He double-checked that the plans and prescriptions the specialists had made for Hendricks’s many problems actually fit together—and, when they didn’t, he got on the phone to sort things out. He teamed up with a nurse practitioner who could make home visits to check blood-sugar levels and blood pressure, teach Hendricks about what he could do to stay healthy, and make sure he was getting his medications.
A lot of what Brenner had to do, though, went beyond the usual doctor stuff. Brenner got a social worker to help Hendricks apply for disability insurance, so that he could leave the chaos of welfare motels, and have access to a consistent set of physicians. The team also pushed him to find sources of stability and value in his life. They got him to return to Alcoholics Anonymous, and, when Brenner found out that he was a devout Christian, he urged him to return to church. He told Hendricks that he needed to cook his own food once in a while, so he could get back in the habit of doing it. The main thing he was up against was Hendricks’s hopelessness. He’d given up. “Can you imagine being in the hospital that long, what that does to you?” Brenner asked.
I spoke to Hendricks recently. He has gone without alcohol for a year, cocaine for two years, and smoking for three years. He lives with his girlfriend in a safer neighborhood, goes to church, and weathers family crises. He cooks his own meals now. His diabetes and congestive heart failure are under much better control. He’s lost two hundred and twenty pounds, which means, among other things, that if he falls he can pick himself up, rather than having to call for an ambulance.
Was this kind of success replicable? As word went out about Brenner’s interest in patients like Hendricks, he received more referrals. Camden doctors were delighted to have someone help with their “worst of the worst.” He took on half a dozen patients, then two dozen, then more. It became increasingly difficult to do this work alongside his regular medical practice. The clinic was already under financial strain, and received nothing for assisting these patients. If it were up to him, he’d recruit a whole staff of primary-care doctors and nurses and social workers, based right in the neighborhoods where the costliest patients lived. With the tens of millions of dollars in hospital bills they could save, he’d pay the staff double to serve as Camden’s élite medical force and to rescue the city’s health-care system.
But that’s not how the health-insurance system is built.
“Take two ten-year-old boys with asthma,” he said. “From a disease standpoint, they’re exactly the same cost, right? Wrong. Imagine one of those kids never fills his inhalers and has been in urgent care with asthma attacks three times over the last year, probably because Mom and Dad aren’t really on top of it.” That’s the sort of patient Gunn uses his company’s medical-intelligence software program to zero in on—a patient who is sick and getting inadequate care. “That’s really the sweet spot for preventive care,” Gunn said.
He pulled up patients with known coronary-artery disease. There were nine hundred and twenty-one, he said, reading off the screen. He clicked a few more times and raised his eyebrows. One in seven of them had not had a full office visit with a physician in more than a year. “You can do something about that,” he said.
As he sorts through such stories, Gunn usually finds larger patterns, too. He told me about an analysis he had recently done for a big information-technology company on the East Coast. It provided health benefits to seven thousand employees and family members, and had forty million dollars in “spend.” The firm had already raised the employees’ insurance co-payments considerably, hoping to give employees a reason to think twice about unnecessary medical visits, [tuna comment: LOL] tests, and procedures—make them have some “skin in the game,” as they say. Indeed, almost every category of costly medical care went down: doctor visits, emergency-room and hospital visits, drug prescriptions. Yet employee health costs continued to rise—climbing almost ten per cent each year. The company was baffled.
Gunn’s team took a look at the hot spots. The outliers, it turned out, were predominantly early retirees. Most had multiple chronic conditions—in particular, coronary-artery disease, asthma, and complex mental illness. One had badly worsening heart disease and diabetes, and medical bills over two years in excess of eighty thousand dollars. The man, dealing with higher co-payments on a fixed income, had cut back to filling only half his medication prescriptions for his high cholesterol and diabetes. He made few doctor visits. He avoided the E.R.—until a heart attack necessitated emergency surgery and left him disabled with chronic heart failure.
The higher co-payments had backfired, Gunn said. While medical costs for most employees flattened out, those for early retirees jumped seventeen per cent. The sickest patients became much more expensive because they put off care and prevention until it was too late.
it goes on but i don't want you to flood you guys to death =( please read it.
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On January 28 2011 23:23 SpiritoftheTunA wrote:Popping in to advertise an interesting article on reducing costs of US healthcare: + Show Spoiler +
"The Hot Spotters
Can we lower medical costs by giving the neediest patients better care?"http://www.newyorker.com/reporting/2011/01/24/110124fa_fact_gawande?currentPage=all
highlights:Brenner wasn’t all that interested in costs; he was more interested in helping people who received bad health care. But in his experience the people with the highest medical costs—the people cycling in and out of the hospital—were usually the people receiving the worst care. “Emergency-room visits and hospital admissions should be considered failures of the health-care system until proven otherwise,” he told me—failures of prevention and of timely, effective care.
If he could find the people whose use of medical care was highest, he figured, he could do something to help them. If he helped them, he would also be lowering their health-care costs. And, if the stats approach to crime was right, targeting those with the highest health-care costs would help lower the entire city’s health-care costs. His calculations revealed that just one per cent of the hundred thousand people who made use of Camden’s medical facilities accounted for thirty per cent of its costs. That’s only a thousand people—about half the size of a typical family physician’s panel of patients. + Show Spoiler [example patient #1] +The first person they found for him was a man in his mid-forties whom I’ll call Frank Hendricks. Hendricks had severe congestive heart failure, chronic asthma, uncontrolled diabetes, hypothyroidism, gout, and a history of smoking and alcohol abuse. He weighed five hundred and sixty pounds. In the previous three years, he had spent as much time in hospitals as out. When Brenner met him, he was in intensive care with a tracheotomy and a feeding tube, having developed septic shock from a gallbladder infection.
Brenner visited him daily. “I just basically sat in his room like I was a third-year med student, hanging out with him for an hour, hour and a half every day, trying to figure out what makes the guy tick,” he recalled. He learned that Hendricks used to be an auto detailer and a cook. He had a longtime girlfriend and two children, now grown. A toxic combination of poor health, Johnnie Walker Red, and, it emerged, cocaine addiction had left him unreliably employed, uninsured, and living in a welfare motel. He had no consistent set of doctors, and almost no prospects for turning his situation around.
After several months, he had recovered enough to be discharged. But, out in the world, his life was simply another hospitalization waiting to happen. By then, however, Brenner had figured out a few things he could do to help. Some of it was simple doctor stuff. He made sure he followed Hendricks closely enough to recognize when serious problems were emerging. He double-checked that the plans and prescriptions the specialists had made for Hendricks’s many problems actually fit together—and, when they didn’t, he got on the phone to sort things out. He teamed up with a nurse practitioner who could make home visits to check blood-sugar levels and blood pressure, teach Hendricks about what he could do to stay healthy, and make sure he was getting his medications.
A lot of what Brenner had to do, though, went beyond the usual doctor stuff. Brenner got a social worker to help Hendricks apply for disability insurance, so that he could leave the chaos of welfare motels, and have access to a consistent set of physicians. The team also pushed him to find sources of stability and value in his life. They got him to return to Alcoholics Anonymous, and, when Brenner found out that he was a devout Christian, he urged him to return to church. He told Hendricks that he needed to cook his own food once in a while, so he could get back in the habit of doing it. The main thing he was up against was Hendricks’s hopelessness. He’d given up. “Can you imagine being in the hospital that long, what that does to you?” Brenner asked.
I spoke to Hendricks recently. He has gone without alcohol for a year, cocaine for two years, and smoking for three years. He lives with his girlfriend in a safer neighborhood, goes to church, and weathers family crises. He cooks his own meals now. His diabetes and congestive heart failure are under much better control. He’s lost two hundred and twenty pounds, which means, among other things, that if he falls he can pick himself up, rather than having to call for an ambulance. Was this kind of success replicable? As word went out about Brenner’s interest in patients like Hendricks, he received more referrals. Camden doctors were delighted to have someone help with their “worst of the worst.” He took on half a dozen patients, then two dozen, then more. It became increasingly difficult to do this work alongside his regular medical practice. The clinic was already under financial strain, and received nothing for assisting these patients. If it were up to him, he’d recruit a whole staff of primary-care doctors and nurses and social workers, based right in the neighborhoods where the costliest patients lived. With the tens of millions of dollars in hospital bills they could save, he’d pay the staff double to serve as Camden’s élite medical force and to rescue the city’s health-care system.
But that’s not how the health-insurance system is built. “Take two ten-year-old boys with asthma,” he said. “From a disease standpoint, they’re exactly the same cost, right? Wrong. Imagine one of those kids never fills his inhalers and has been in urgent care with asthma attacks three times over the last year, probably because Mom and Dad aren’t really on top of it.” That’s the sort of patient Gunn uses his company’s medical-intelligence software program to zero in on—a patient who is sick and getting inadequate care. “That’s really the sweet spot for preventive care,” Gunn said.
He pulled up patients with known coronary-artery disease. There were nine hundred and twenty-one, he said, reading off the screen. He clicked a few more times and raised his eyebrows. One in seven of them had not had a full office visit with a physician in more than a year. “You can do something about that,” he said. As he sorts through such stories, Gunn usually finds larger patterns, too. He told me about an analysis he had recently done for a big information-technology company on the East Coast. It provided health benefits to seven thousand employees and family members, and had forty million dollars in “spend.” The firm had already raised the employees’ insurance co-payments considerably, hoping to give employees a reason to think twice about unnecessary medical visits, [tuna comment: LOL] tests, and procedures—make them have some “skin in the game,” as they say. Indeed, almost every category of costly medical care went down: doctor visits, emergency-room and hospital visits, drug prescriptions. Yet employee health costs continued to rise—climbing almost ten per cent each year. The company was baffled.
Gunn’s team took a look at the hot spots. The outliers, it turned out, were predominantly early retirees. Most had multiple chronic conditions—in particular, coronary-artery disease, asthma, and complex mental illness. One had badly worsening heart disease and diabetes, and medical bills over two years in excess of eighty thousand dollars. The man, dealing with higher co-payments on a fixed income, had cut back to filling only half his medication prescriptions for his high cholesterol and diabetes. He made few doctor visits. He avoided the E.R.—until a heart attack necessitated emergency surgery and left him disabled with chronic heart failure.
The higher co-payments had backfired, Gunn said. While medical costs for most employees flattened out, those for early retirees jumped seventeen per cent. The sickest patients became much more expensive because they put off care and prevention until it was too late. it goes on but i don't want you to flood you guys to death =( please read it.
Very interesting. I don't see how gov't sponsored healthcare solves any of the problems outlined in that article. If anything, that just translates the system from private to public. Instead of insurance premiums and copays you'd just have taxes.
And to respond to the original topic: The healthcare bill was a bloated inefficient and possibly unconstitutional piece of garbage. It didn't accomplish anything that liberals actually would - all it did was increase risk for insurance companies, which would drive up costs, force small businesses to increase overhead massively, and tax healthy people for other people's problems.
It was a disaster and should never have been passed. Any intelligent person, democrat or republican, should see that.
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On January 28 2011 23:38 [Eternal]Phoenix wrote:Show nested quote +On January 28 2011 23:23 SpiritoftheTunA wrote:Popping in to advertise an interesting article on reducing costs of US healthcare: + Show Spoiler +
"The Hot Spotters
Can we lower medical costs by giving the neediest patients better care?"http://www.newyorker.com/reporting/2011/01/24/110124fa_fact_gawande?currentPage=all
highlights:Brenner wasn’t all that interested in costs; he was more interested in helping people who received bad health care. But in his experience the people with the highest medical costs—the people cycling in and out of the hospital—were usually the people receiving the worst care. “Emergency-room visits and hospital admissions should be considered failures of the health-care system until proven otherwise,” he told me—failures of prevention and of timely, effective care.
If he could find the people whose use of medical care was highest, he figured, he could do something to help them. If he helped them, he would also be lowering their health-care costs. And, if the stats approach to crime was right, targeting those with the highest health-care costs would help lower the entire city’s health-care costs. His calculations revealed that just one per cent of the hundred thousand people who made use of Camden’s medical facilities accounted for thirty per cent of its costs. That’s only a thousand people—about half the size of a typical family physician’s panel of patients. + Show Spoiler [example patient #1] +The first person they found for him was a man in his mid-forties whom I’ll call Frank Hendricks. Hendricks had severe congestive heart failure, chronic asthma, uncontrolled diabetes, hypothyroidism, gout, and a history of smoking and alcohol abuse. He weighed five hundred and sixty pounds. In the previous three years, he had spent as much time in hospitals as out. When Brenner met him, he was in intensive care with a tracheotomy and a feeding tube, having developed septic shock from a gallbladder infection.
Brenner visited him daily. “I just basically sat in his room like I was a third-year med student, hanging out with him for an hour, hour and a half every day, trying to figure out what makes the guy tick,” he recalled. He learned that Hendricks used to be an auto detailer and a cook. He had a longtime girlfriend and two children, now grown. A toxic combination of poor health, Johnnie Walker Red, and, it emerged, cocaine addiction had left him unreliably employed, uninsured, and living in a welfare motel. He had no consistent set of doctors, and almost no prospects for turning his situation around.
After several months, he had recovered enough to be discharged. But, out in the world, his life was simply another hospitalization waiting to happen. By then, however, Brenner had figured out a few things he could do to help. Some of it was simple doctor stuff. He made sure he followed Hendricks closely enough to recognize when serious problems were emerging. He double-checked that the plans and prescriptions the specialists had made for Hendricks’s many problems actually fit together—and, when they didn’t, he got on the phone to sort things out. He teamed up with a nurse practitioner who could make home visits to check blood-sugar levels and blood pressure, teach Hendricks about what he could do to stay healthy, and make sure he was getting his medications.
A lot of what Brenner had to do, though, went beyond the usual doctor stuff. Brenner got a social worker to help Hendricks apply for disability insurance, so that he could leave the chaos of welfare motels, and have access to a consistent set of physicians. The team also pushed him to find sources of stability and value in his life. They got him to return to Alcoholics Anonymous, and, when Brenner found out that he was a devout Christian, he urged him to return to church. He told Hendricks that he needed to cook his own food once in a while, so he could get back in the habit of doing it. The main thing he was up against was Hendricks’s hopelessness. He’d given up. “Can you imagine being in the hospital that long, what that does to you?” Brenner asked.
I spoke to Hendricks recently. He has gone without alcohol for a year, cocaine for two years, and smoking for three years. He lives with his girlfriend in a safer neighborhood, goes to church, and weathers family crises. He cooks his own meals now. His diabetes and congestive heart failure are under much better control. He’s lost two hundred and twenty pounds, which means, among other things, that if he falls he can pick himself up, rather than having to call for an ambulance. Was this kind of success replicable? As word went out about Brenner’s interest in patients like Hendricks, he received more referrals. Camden doctors were delighted to have someone help with their “worst of the worst.” He took on half a dozen patients, then two dozen, then more. It became increasingly difficult to do this work alongside his regular medical practice. The clinic was already under financial strain, and received nothing for assisting these patients. If it were up to him, he’d recruit a whole staff of primary-care doctors and nurses and social workers, based right in the neighborhoods where the costliest patients lived. With the tens of millions of dollars in hospital bills they could save, he’d pay the staff double to serve as Camden’s élite medical force and to rescue the city’s health-care system.
But that’s not how the health-insurance system is built. “Take two ten-year-old boys with asthma,” he said. “From a disease standpoint, they’re exactly the same cost, right? Wrong. Imagine one of those kids never fills his inhalers and has been in urgent care with asthma attacks three times over the last year, probably because Mom and Dad aren’t really on top of it.” That’s the sort of patient Gunn uses his company’s medical-intelligence software program to zero in on—a patient who is sick and getting inadequate care. “That’s really the sweet spot for preventive care,” Gunn said.
He pulled up patients with known coronary-artery disease. There were nine hundred and twenty-one, he said, reading off the screen. He clicked a few more times and raised his eyebrows. One in seven of them had not had a full office visit with a physician in more than a year. “You can do something about that,” he said. As he sorts through such stories, Gunn usually finds larger patterns, too. He told me about an analysis he had recently done for a big information-technology company on the East Coast. It provided health benefits to seven thousand employees and family members, and had forty million dollars in “spend.” The firm had already raised the employees’ insurance co-payments considerably, hoping to give employees a reason to think twice about unnecessary medical visits, [tuna comment: LOL] tests, and procedures—make them have some “skin in the game,” as they say. Indeed, almost every category of costly medical care went down: doctor visits, emergency-room and hospital visits, drug prescriptions. Yet employee health costs continued to rise—climbing almost ten per cent each year. The company was baffled.
Gunn’s team took a look at the hot spots. The outliers, it turned out, were predominantly early retirees. Most had multiple chronic conditions—in particular, coronary-artery disease, asthma, and complex mental illness. One had badly worsening heart disease and diabetes, and medical bills over two years in excess of eighty thousand dollars. The man, dealing with higher co-payments on a fixed income, had cut back to filling only half his medication prescriptions for his high cholesterol and diabetes. He made few doctor visits. He avoided the E.R.—until a heart attack necessitated emergency surgery and left him disabled with chronic heart failure.
The higher co-payments had backfired, Gunn said. While medical costs for most employees flattened out, those for early retirees jumped seventeen per cent. The sickest patients became much more expensive because they put off care and prevention until it was too late. it goes on but i don't want you to flood you guys to death =( please read it. Very interesting. I don't see how gov't sponsored healthcare solves any of the problems outlined in that article. If anything, that just translates the system from private to public. Instead of insurance premiums and copays you'd just have taxes. And to respond to the original topic: The healthcare bill was a bloated inefficient and possibly unconstitutional piece of garbage. It didn't accomplish anything that liberals actually would - all it did was increase risk for insurance companies, which would drive up costs, force small businesses to increase overhead massively, and tax healthy people for other people's problems. It was a disaster and should never have been passed. Any intelligent person, democrat or republican, should see that.
Oh yeah I should note, that article really had nothing to do with the healthcare bill at all except it kind of shows the inefficiencies of the private insurance companies in using their data to create their own policies. The article shows hope that they're figuring it out, and once they fix up incentivizing (lower cost) preventative care, hopefully a big part of the healthcare problem will go away.
I agree that the government trying to intervene is being a bit distracting, and as I've mentioned in other threads, I'm in favor of throwing out and recreating the FDA, and also possibly creating new regulatory agencies for ensuring quality of healthcare with more transparency and with more merit-based hiring rather than spoils-system appointing. Our current model of bureaucracy for regulatory agencies is really inefficient and contaminated, when theoretically bureaucracy isn't supposed to be an inefficient method of service disposal (ala Max Weber's writings on it).
Article also shows that since the two main forms of care right now are only private practice doctor visits and ER visits, there may be an open market for more casual preventative clinics or something. I dunno the exact logistics of that kind of thing, but preventative care (including possible personallifeintervention strategies for those patients with harmful environments) is definitely being neglected overall.
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On January 28 2011 23:38 [Eternal]Phoenix wrote:Show nested quote +On January 28 2011 23:23 SpiritoftheTunA wrote:Popping in to advertise an interesting article on reducing costs of US healthcare: + Show Spoiler +
"The Hot Spotters
Can we lower medical costs by giving the neediest patients better care?"http://www.newyorker.com/reporting/2011/01/24/110124fa_fact_gawande?currentPage=all
highlights:Brenner wasn’t all that interested in costs; he was more interested in helping people who received bad health care. But in his experience the people with the highest medical costs—the people cycling in and out of the hospital—were usually the people receiving the worst care. “Emergency-room visits and hospital admissions should be considered failures of the health-care system until proven otherwise,” he told me—failures of prevention and of timely, effective care.
If he could find the people whose use of medical care was highest, he figured, he could do something to help them. If he helped them, he would also be lowering their health-care costs. And, if the stats approach to crime was right, targeting those with the highest health-care costs would help lower the entire city’s health-care costs. His calculations revealed that just one per cent of the hundred thousand people who made use of Camden’s medical facilities accounted for thirty per cent of its costs. That’s only a thousand people—about half the size of a typical family physician’s panel of patients. + Show Spoiler [example patient #1] +The first person they found for him was a man in his mid-forties whom I’ll call Frank Hendricks. Hendricks had severe congestive heart failure, chronic asthma, uncontrolled diabetes, hypothyroidism, gout, and a history of smoking and alcohol abuse. He weighed five hundred and sixty pounds. In the previous three years, he had spent as much time in hospitals as out. When Brenner met him, he was in intensive care with a tracheotomy and a feeding tube, having developed septic shock from a gallbladder infection.
Brenner visited him daily. “I just basically sat in his room like I was a third-year med student, hanging out with him for an hour, hour and a half every day, trying to figure out what makes the guy tick,” he recalled. He learned that Hendricks used to be an auto detailer and a cook. He had a longtime girlfriend and two children, now grown. A toxic combination of poor health, Johnnie Walker Red, and, it emerged, cocaine addiction had left him unreliably employed, uninsured, and living in a welfare motel. He had no consistent set of doctors, and almost no prospects for turning his situation around.
After several months, he had recovered enough to be discharged. But, out in the world, his life was simply another hospitalization waiting to happen. By then, however, Brenner had figured out a few things he could do to help. Some of it was simple doctor stuff. He made sure he followed Hendricks closely enough to recognize when serious problems were emerging. He double-checked that the plans and prescriptions the specialists had made for Hendricks’s many problems actually fit together—and, when they didn’t, he got on the phone to sort things out. He teamed up with a nurse practitioner who could make home visits to check blood-sugar levels and blood pressure, teach Hendricks about what he could do to stay healthy, and make sure he was getting his medications.
A lot of what Brenner had to do, though, went beyond the usual doctor stuff. Brenner got a social worker to help Hendricks apply for disability insurance, so that he could leave the chaos of welfare motels, and have access to a consistent set of physicians. The team also pushed him to find sources of stability and value in his life. They got him to return to Alcoholics Anonymous, and, when Brenner found out that he was a devout Christian, he urged him to return to church. He told Hendricks that he needed to cook his own food once in a while, so he could get back in the habit of doing it. The main thing he was up against was Hendricks’s hopelessness. He’d given up. “Can you imagine being in the hospital that long, what that does to you?” Brenner asked.
I spoke to Hendricks recently. He has gone without alcohol for a year, cocaine for two years, and smoking for three years. He lives with his girlfriend in a safer neighborhood, goes to church, and weathers family crises. He cooks his own meals now. His diabetes and congestive heart failure are under much better control. He’s lost two hundred and twenty pounds, which means, among other things, that if he falls he can pick himself up, rather than having to call for an ambulance. Was this kind of success replicable? As word went out about Brenner’s interest in patients like Hendricks, he received more referrals. Camden doctors were delighted to have someone help with their “worst of the worst.” He took on half a dozen patients, then two dozen, then more. It became increasingly difficult to do this work alongside his regular medical practice. The clinic was already under financial strain, and received nothing for assisting these patients. If it were up to him, he’d recruit a whole staff of primary-care doctors and nurses and social workers, based right in the neighborhoods where the costliest patients lived. With the tens of millions of dollars in hospital bills they could save, he’d pay the staff double to serve as Camden’s élite medical force and to rescue the city’s health-care system.
But that’s not how the health-insurance system is built. “Take two ten-year-old boys with asthma,” he said. “From a disease standpoint, they’re exactly the same cost, right? Wrong. Imagine one of those kids never fills his inhalers and has been in urgent care with asthma attacks three times over the last year, probably because Mom and Dad aren’t really on top of it.” That’s the sort of patient Gunn uses his company’s medical-intelligence software program to zero in on—a patient who is sick and getting inadequate care. “That’s really the sweet spot for preventive care,” Gunn said.
He pulled up patients with known coronary-artery disease. There were nine hundred and twenty-one, he said, reading off the screen. He clicked a few more times and raised his eyebrows. One in seven of them had not had a full office visit with a physician in more than a year. “You can do something about that,” he said. As he sorts through such stories, Gunn usually finds larger patterns, too. He told me about an analysis he had recently done for a big information-technology company on the East Coast. It provided health benefits to seven thousand employees and family members, and had forty million dollars in “spend.” The firm had already raised the employees’ insurance co-payments considerably, hoping to give employees a reason to think twice about unnecessary medical visits, [tuna comment: LOL] tests, and procedures—make them have some “skin in the game,” as they say. Indeed, almost every category of costly medical care went down: doctor visits, emergency-room and hospital visits, drug prescriptions. Yet employee health costs continued to rise—climbing almost ten per cent each year. The company was baffled.
Gunn’s team took a look at the hot spots. The outliers, it turned out, were predominantly early retirees. Most had multiple chronic conditions—in particular, coronary-artery disease, asthma, and complex mental illness. One had badly worsening heart disease and diabetes, and medical bills over two years in excess of eighty thousand dollars. The man, dealing with higher co-payments on a fixed income, had cut back to filling only half his medication prescriptions for his high cholesterol and diabetes. He made few doctor visits. He avoided the E.R.—until a heart attack necessitated emergency surgery and left him disabled with chronic heart failure.
The higher co-payments had backfired, Gunn said. While medical costs for most employees flattened out, those for early retirees jumped seventeen per cent. The sickest patients became much more expensive because they put off care and prevention until it was too late. it goes on but i don't want you to flood you guys to death =( please read it. Very interesting. I don't see how gov't sponsored healthcare solves any of the problems outlined in that article. If anything, that just translates the system from private to public. Instead of insurance premiums and copays you'd just have taxes. And to respond to the original topic: The healthcare bill was a bloated inefficient and possibly unconstitutional piece of garbage. It didn't accomplish anything that liberals actually would - all it did was increase risk for insurance companies, which would drive up costs, force small businesses to increase overhead massively, and tax healthy people for other people's problems. It was a disaster and should never have been passed. Any intelligent person, democrat or republican, should see that.
I disagree strongly. Right now, people pay more for health insurance for less coverage than under a public plan, because insurance companies are notorious for keeping costs high but benefits low.
Until this year, when I entered college, my mom encouraged me to not go to the doctor unless something was very seriously wrong, because her copay was too much. Now, I go to university, and thanks to financial aid, I get free health insurance here at UC Berkeley. (normally student insurance is $1500 a year.) I went to the dentist for the first time in a couple years, and I will probably be going in for checkups more often, simply because I can afford to.
On January 28 2011 14:47 TanGeng wrote:Show nested quote +On January 27 2011 11:50 wherebugsgo wrote:On January 27 2011 00:01 TanGeng wrote:
Japan and Europe have problems, sure; Europe, especially, too many old people and vacations and benefits and pensions. But their health insurance systems are not one of them.
I don't know how you can translate a sovereign bankruptcy inducing issue into not a problem. Long wait lines, doctor shortages, poor distribution of specialization, poor geographical distribution of doctors, etc. There's plenty of crap under the veneer. False, again. Wait times in the UK and Germany are shorter than the wait times in the U.S. Both countries spend less money on healthcare than the U.S. (heck, EVERYONE does.) There is no "poor distribution of specialization, poor geographical distribution of doctors, etc." Their health standards are better than here, and citizens are not afraid of going to the doctor because of the risk of medical bankruptcy. First of all, what a terrible mess. There is a too much to look when talking about "Europe and Japan. Their systems are different in details. It's also valuable to have forward looking perspective to see where the system will take you rather than just looking backwards. Here's a taste of what is needed to put numbers, statistics, and metrics in perspective. If we are talking about Germany, the system is largely privatized but heavily regulated - a bit of overview: http://economix.blogs.nytimes.com/2009/04/17/health-reform-without-a-public-plan-the-german-model/. Reinhardt misses that a lot of cost cutting is carried by underpaid doctors, so there's doctor flight: http://www.spiegel.de/international/0,1518,399537,00.html. Education is subsidized and the true cost of system should add in education subsidies: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2716556/. There is the budget shortfalls, http://www.bloomberg.com/news/2010-07-06/merkel-raises-german-health-premiums-to-15-5-of-gross-pay-to-plug-deficit.html. There are more factors to look at, but the overall trend in Germany is towards more privatization and cuts in benefits. Long wait times are worst in Canada. US is poor as well and relatively you might say UK and the such look good, but objectively it's terrible everywhere. Poor distribution of specialist and poor geographical distribution is a Japanese problem. There is some rural unavailability and a shortage of obstetrics. US has poor distribution as well with most the talent gravitating towards sports medicine, cosmetics, and radiology and away from the heavily regulated areas or most vulnerable to malpractice. US has the AMA regulatory guidelines to thank for constricting physician supply. You can probably point out more problems with the US system. Anyways, saying that a foreign system is relative better or worse at this specific moment in time is neither here nor there in judging that system. I can complain about the US system, too. The real issue is whether the system is good and whether it is sustainable. Also when looking to replicate foreign systems, it is highly necessary to look at all factors involved. The German system is not just a tax on employees. Highly crucial to its "success" is enough regulatory power to depress or fix prices and nearly complete subsidization of education so they can have workers willing to accept the depressed prices. I believe the ACA is going to be an unmitigated disaster precisely because it is missing some crucial pieces around the individual mandate to control costs and ensure supply. Those pieces like price setting regulator power and education would not have been palatable to Americans, so we got this half step which is worse than doing nothing at all. And even if we could copy the entire system, there is the question of whether it is prudent to adopt a system that is presently moving in the opposite directions and and showing chinks in sustainability. I guess all these ACA proponents want to pigeon-hole my position as "objectively defending the status quo." I haven't done that at all. It's an alternative critique which also applies to all of the European systems. You folks can go on slamming the US health care system for how much it sucks. On a side note, Professor Reinhardt, the author of the economix blog, is always worth reading because of interesting observations. It's true even if you don't agree with his conclusions.
First of all, the first link supports my assertion that standardized, universal healthcare is more efficient than the hodge podge system of private insurance companies we have here in the U.S. There is a LOT of government involvement in the healthcare industry in Germany, which is precisely why their system is so good. Here, deregulation and poor regulation results in a shitty system.
In Germany, the health insurance system is more than 75% government funded! Yes, private insurers exist in Germany, but 85% of German citizens are covered by the public health insurance plan. Germany has the oldest universal healthcare system in the world, at over 120 years old, and it is by far one of the most efficient.
So NO, Germany's healthcare system is NOT heavily privatized. Please stop deliberately spreading misinformation. Did you even read all of your own article?
Your second link is broken. It's also in Deutsch (I can read German, thank you very much) and it's a standard 404 error. I don't know what you were trying to accomplish there, but it's clear you probably have never even opened the link.
What the hell does education subsidy have to do with health insurance?
And again, you're blatantly wrong. How hard is it to understand these statistics?
Here's a graph of public vs private insurance coverage in Germany If you can't read German, the graph shows the percentage of publicly insured citizens on the left (Gesetzliche literally means "legal" ) and the bar on the right is the privately insured citizens.
And of course the American health system sucks. It sucks precisely because 50 million people in this country are uninsured, and countless more are insured but too afraid to go to the doctor for fear of financial woes. As a middle class citizen, I've felt this myself. Yet, in New Zealand, or hell, in India, my family never found this to be a problem.
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I love it when American's argue against nationalised healthcare. It's better than watching them argue about terrorism and religion combined.
I wonder if one non-American argued against it in this thread actually 
User was warned for this post
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You didn't read my post above yours, did you? lol
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I find it so funny that Republicans keep claiming the individual mandate strips people of their liberty, is unconstitutional, and is just, in general, bad. Here are some points that, for some reason, aren't made clear to the public by any media source:
1. The individual mandate, and the healthcare bill at large, is not unconstitutional. It's an income tax, and it's clear by the way it's worded. Basically, you pay the tax of $695 or 2.5% of your income, whichever is greater, if the minimum health plan costs less than 8% of your income, you refuse to buy insurance, and your earnings fall above the poverty line. The tax is DEFINED by your income. Those who are against this individual mandate are basically saying they're against federal income taxes. I say to them: take your fight to the 16th amendment to the Constitution, then. If you're so gung-ho about individual liberties and "what this country was founded upon," then go learn about the supreme law of the land.
2. This part of the bill keeps premiums down for those involved. Basically, it makes the system universal. Everyone's in the pool one way or another, so premiums are kept low. It prevents people who are healthy from saying, well, fuck the system, I'm gonna opt out, and then causing premiums for everyone else to skyrocket as a result because of the higher proportion of "unhealthy" people in the pool.
3. If you feel like you can risk not buying insurance, this is a very good option for you. If you pay the tax, you can opt to buy insurance later when you get ill. The best part about this is that, when you do choose to buy insurance (like when you get seriously ill or whatever) you cannot be denied coverage because of your preexisting condition. This is not possible currently; if you opt out of health insurance, get sick, and choose to buy health insurance, you'll be promptly denied.
It's been pointed out before that the Civil Rights Bill received similar flak to what the health insurance bill is receiving today. Some Americans just can't deal with big change, it seems.
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That makes 4 (at least?) federal court rulings about the bill. 2 upholding it, 1 striking down the mandate, 1 striking the whole thing.
Looks like Anthony Kennedy will be deciding the future of PPACA.
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On January 28 2011 23:22 MiraMax wrote:Take the Commonwealth Survey for example which indicates that all of the above countries have an equally or better performing health system at lower cost.
Yes this is a good source, shows direct comparisons between some of the major types of HC systems.
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EPT
