Universal Healthcare...

[RBFC]

C'mon...
In country like UK, France or Italy, if you're in an emergency condition, you're treated as the emergency recommends. And you will never be denied because of age of "too much" serious condition!
Long lists are created if people want to be examined as periodical checks rather than for a situation. And time goes by because all the people that are in serious conditions come before, as the good sense would recommend.

Valerio,

Thanks for the comments. Compare the age and wait times for hip replacement surgery. I wasn't referring to emergency department admittals, since those are treated by triage and law.

Lee

 

[Ron Party]

And one person's thoughts about Meghan McArdle: http://inversesquare.wordpress.com/2009/07/29/why-andrew-sullivan-is-right-about-megan-mcardle-but-not-in-the-way-he-thinks/

 

[RBFC]

And one person's thoughts about Meghan McArdle: http://inversesquare.wordpress.com/2009/07/29/why-andrew-sullivan-is-right-about-megan-mcardle-but-not-in-the-way-he-thinks/

Which is why those interested in this line of discussion should do the research for themselves.

Lee

 

[docvale]

... Look at medical school enrollment data to see the effect the reform (and proposed earnings reductions) is having upon interest in going to medical school. ...

Lee,

do you mean that, with a potential risk of income reduction, the best guys won't study medicine and the future MDs are going to be of lower quality? Are university choices just driven by the perspective of profit?
According to what the medical student in NYU told me, access to the program is super-competitive. This notwithstanding, I've learnt that the most competitive residency programs are dermatology and radiation oncology, as the working hours are milder and the income higher. So, independently on the reform, people that will treat heart conditions, metabolic diseases, cancer or strokes would anyway be either least competitive students or those students who are less focused on money.
In Italy* the best guys go to internal medicine, oncology, general surgery, cardiology, neurology...

* I know it can be tedious I'm using Italy as a constant comparison example, but it's a reality (the medical one) I know really well and I think it provides a nice balance between efficiency of the system, general costs and medical incomes.

 

[jazdoc]

Pt. II: Medicare and Medicaid

Continued from prior post...

Established in 1965, the federal healthcare programs Medicare & Medicaid (I will use Medicare as proxy for both) are the largest healthcare providers in the US. These programs are not insurance as generally defined; they are pay as you go. In other words, your current taxes pay the health care expenses incurred by current beneficiaries. Your taxes DO NOT pay premiums for your future policy costs.

One consistent feature of Medicare has been costs well in excess of predictions. At its inception in 1966, Medicare cost $3 billion and the initial (conservative!) inflation adjusted cost estimate of $12 billion in 1990 when in fact the cost in 1990 was $109 billion! Actual spending in 2010 grew to $524 Billion.

Despite the rising costs, Medicare reimburses below market rates. This results in "cost-shifting" as providers increases prices to consumers with private health care plans. The size of this is cost shifting is debated although a recent study by Wu demonstrated a 21% cost shift effect as Medicare further decreased reimbursement. Analysis of claims data in 2009 demonstrated Medicare also has the highest rate of denied claims, just ahead of Aetna and 1.7x the average of private insurers. As a result providers are dropping Medicare patients including the Mayo Clinic in Arizona. Self-referral of imaging is also notorious for not accepting Medicare. Poor Medicare reimbursement also plays a part in the rise of so called "concierge practices".

Medicare and single payor advocates point to the efficiency as measured by low overhead costs. Superficially, this is true; Medicare has the lowest overhead costs. However, Medicare patients have greater per capita expenses than private insureds resulting in a higher denominator in the calculation of efficiency (overhead/total expenditures). More importantly, a significant part of overhead cost for private insurers is for battling fraud and abuse. This is not the case with Medicare. How big of a problem is Medicare fraud and abuse? The GAO estimated the cost at $24.1 Billion in 2009 but conceded that "this may not be a full picture" while other estimates range up to 15% of total Medicare expenses. Politicians of all stripes and from both parties continue promising to cut fraud and waste, yet it persists. In the parlance of the software industry 'it's not a bug, it's a feature'.

 

[RBFC]

No problem using your home familiar country as a basis for comparison! I know that the higher cost of education, and the loans that accompany it, is a daunting factor when less available income for payback is predicted. The Association of American Medical Colleges last estimated the debt for student loans at the end of residency at over $200,000. Almost like having a second home mortgage....

I would imagine that any incumbent student in a medical school will think that the program is ultra-competitive for admission. However, if you examine the total number of applications for the available slots, you will find a decrease. Remember that there are now more medical schools available. (In 1930, there were 76 accredited medical schools. There are now 133 in the USA.) The number of potential students does not track the population growth. In the 2010-2011 year, there were several thousand less applications submitted in the US than in 1996-1997. The total number of applications has remained pretty consistent for the last five years.

In one school I looked at (Johns Hopkins), there were 499 applications. Of those 499, only 88 were interviewed and 33 accepted. It may therefore be apparent that the total number of students actually finishing medical school may not be sufficient to meet demand as the population has risen. It may also be proposed that the applicants are of lower quality, resulting in the failures to make the cut. I welcome the opportunity to see more data that is free of confounding factors.

Lee

 

[docvale]

Valerio,

Thanks for the comments. Compare the age and wait times for hip replacement surgery. I wasn't referring to emergency department admittals, since those are treated by triage and law.

Lee

Lee,

This message is not to have "the last word", but I understand that there's some background aspects that differ me (or many Europeans) from the US people. Maybe you could consider me socialist (and probably, in many aspects, I am), but I really think that a Country is stronger when certain needs are provided to everyone. Health care is one, but I would also extend the problem to education in general.

The girl I was speaking about before defined me and Italy as socialist. She poured **** over the Italian health system as she felt lack of efficiency when her grandmother (who's Italian) was hospitalized in a small village in Southern Italy. But she was extremely upset when, after an erroneous glass prescription, the NY ophthalmologist wanted to consider the correction a second visit (not covered by her insurance), and she was very grateful to me when I provided her some ciprofloxacin for free, as she should had paid >$100 for her pills. Clearly, those are all just anecdotes, but I think that the experience can provide several faces of the same perspective...

You guys made a great Country. USA are a land of opportunities, open to people from all over the World, open to let people make their success. I wish USA would turn a little more "socialist": the competitive spirit that drive the Country wouldn't be affected if some basic needs were provided independently on the wealth or the professional success of the individuals.

 

[RBFC]

Understood, Valerio. Freedom of opinion is why there are discussion forums, and there is certainly diversity of opinion on many topics here! There are several obstacles to be overcome in order to begin a curative process on our healthcare system. I've stated things from one perspective, things that I don't necessarily like or believe in. I hope for effective reform that addresses the concerns of both "sides".

Lee

 

[docvale]

... In one school I looked at (Johns Hopkins), there were 499 applications. Of those 499, only 88 were interviewed and 33 accepted. It may therefore be apparent that the total number of students actually finishing medical school may not be sufficient to meet demand as the population has risen. It may also be proposed that the applicants are of lower quality, resulting in the failures to make the cut. I welcome the opportunity to see more data that is free of confounding factors. ...

I don't know... Less than 10% of the candidates were admitted, so selection occurred. If they picked 33 only, I would say it's because they cannot train, at the same quality, 100 guys or more. In EU there's an international law that recommends to restrict the admission to the med school in consideration of the actual needs of the territory. The goal is to avoid to make unemployed MDs.
Anyway, I went to the med school as I wanted to do molecular cancer research with a previous clinical background. I had the very highest scores in my class and I decided (with no regrets) for the least remunerative possible career. So my choice has been driven by my interests, rather than by the chances I would have had because of my scores/quality. And I know excellent guys that preferred to study law, economics or engineering, as they were not interested in a medical career: I guess that the seductive future offered by companies like Google or Facebook encourages very ambitious student to study marketing or computer sciences rather than medicine. In any case, I'd wish a Country had the best youth proportionally divided in health care providers, engineers, lawyers, politicians...

 

[docvale]

Understood, Valerio. Freedom of opinion is why there are discussion forums, and there is certainly diversity of opinion on many topics here! There are several obstacles to be overcome in order to begin a curative process on our healthcare system. I've stated things from one perspective, things that I don't necessarily like or believe in. I hope for effective reform that addresses the concerns of both "sides".

Lee

Of course. If I thought for a single second that this thread would have be governed without freedom of opinion I would have never posted a single word