OBAMA/TRUMPCARE MEGATHREAD

[Balta1701]

I was just reading a story about this (from a few years ago) yesterday, about how some countries like France, with that amazing healthcare system, have higher death rates for more "preventative" cancers because the costs of the drugs/tests to "prevent" or "control" the cancers early on are way too expensive. So, they don't offer them. Do we really want the government deciding what prescription drugs we can/can't get, especially potentially life-savings drugs, because of cost? Especially once everyone is on-board the "oh the gov't will provide everything I need in life!" bandwagon?

Fareed Zakaria had an article yesterday that hit on our recent conversation:

the situation on the ground suggests that markets work imperfectly in this realm. A new study conducted by the pharmaceutical company Novartis and McKinsey and Co. shows a stunning difference among countries with regard to health-care efficiency.

 

For example: Smoking rates are higher in France than in the United States, so the French population has higher rates of lung disease. Yet the French system is able to treat the disease far more effectively than happens in the United States, with levels of severity and fatality three times lower than those in this country. And yet France spends eight times less on treatments per person than the U.S. system. Or consider Britain, which handles diabetes far more effectively than the United States, while spending less than half of what we spend per person. The study concludes that the British system is five times more productive in managing diabetes than is the United States.

 

To be fair, there is one case in which the United States does better, battling breast cancer, where early screening and easy access to advanced treatment make the country the most effective place to tackle that disease. But overwhelmingly, the most effective care for diseases come from countries with much lower costs.

 

To understand the issue better, I spoke with Daniel Vasella, the chairman (and former chief executive) of Novartis and a physician by training. He is also frankly pro-market and pro-American, both of which have made him a target for some criticism in Europe.

 

Vasella emphasized that there is no single model that works best, but he explained that France and Britain are better at tackling diabetes and lung disease because they take a systemic approach that gives all health-care providers incentive to focus on early detection and cost-effective treatment and that makes wellness the goal. “In America,” he said, “no one has incentives to make quality and cost-effective outcomes the goal. There are so many stakeholders and they each want to protect themselves. Someone needs to ask, ‘What are the critical elements to increase quality?’ That’s what we’re going to pay for, nothing else.”

 

I asked him whether the lesson he has drawn is that only the government can produce system-wide improvements. “It pains me to say this as a free-market advocate, but you have to have [the] government act in this case. Health care is very complex. Only at a systemic level can you figure out what works best based on the evidence, and what procedures and treatments are not worth the money,” he said.

 

Economists have often written about “the asymmetry of information” — areas where consumers are not expert enough to be able to determine what product is best. Evidence increasingly shows that this is true of health. After all, consumers freely make the choice to smoke, eat junk food and forgo preventative care, all of which are highly likely to make them sick, force up their health-care costs and lower their quality of life. Having us spend more of the money ourselves is unlikely to solve the cost crisis in health care.

[StrangeSox]

No, Obamacare isn't the largest tax increase in history:

 

[Balta1701]

I don't believe anyone here ever called it that.

[StrangeSox]

I don't believe anyone here ever called it that.

 

It's been the conservative pundit rhetoric for the last week.

[Jenksismyhero]

Fareed Zakaria had an article yesterday that hit on our recent conversation:

 

If i'm reading him right, he's basically arguing that it's the way Americans utilize the health industry, not the health industry itself, that is the problem. Which goes back to my point that we spend so much because from the start we're more unhealthy and need more care. I 100% agree that we don't use our healthcare as efficiently as we should (i'm a good example of this, as I pay for health insurance but haven't been to a doctor in about a decade) and when we do it's for problems that we shouldn't have in the first place.

[Balta1701]

If i'm reading him right, he's basically arguing that it's the way Americans utilize the health industry, not the health industry itself, that is the problem. Which goes back to my point that we spend so much because from the start we're more unhealthy and need more care. I 100% agree that we don't use our healthcare as efficiently as we should (i'm a good example of this, as I pay for health insurance but haven't been to a doctor in about a decade) and when we do it's for problems that we shouldn't have in the first place.

The part in bold is pretty much the opposite of what they're saying. The French have behaviors that make themselves less healthy...higher smoking rates, but they deal with those problems in a more cost effective way, by making effective treatment outcomes more of a priority at the government level. The end result winds up being enormous monetary savings and better health outcomes even when considering the same, self-induced condition.

[southsider2k5]

If i'm reading him right, he's basically arguing that it's the way Americans utilize the health industry, not the health industry itself, that is the problem. Which goes back to my point that we spend so much because from the start we're more unhealthy and need more care. I 100% agree that we don't use our healthcare as efficiently as we should (i'm a good example of this, as I pay for health insurance but haven't been to a doctor in about a decade) and when we do it's for problems that we shouldn't have in the first place.

 

The whole system in the US is more expensive. A good chunk of money is taken up in differences as simple as in what doctors make. Another good chunk of that is our subsidizing drug research and medication for the rest of the world by paying much higher prices. I'd bet things like malpractice rates through the roof and crazy lawsuits are a pretty American phenomenon as well. All of that stuff gets rolled back into health insurance costs, which we have attacked completely backwards as usual. Instead of attacking costs, we find ways to make things more expensive.

[Jenksismyhero]

The part in bold is pretty much the opposite of what they're saying. The French have behaviors that make themselves less healthy...higher smoking rates, but they deal with those problems in a more cost effective way, by making effective treatment outcomes more of a priority at the government level.

 

But how does the US fail there? Kids aren't being tested for diabetes at routine check-ups? Adults aren't asked about their smoking habits and whether they have trouble with their lungs? These things happen all the time.

 

 

 

[StrangeSox]

The whole system in the US is more expensive. A good chunk of money is taken up in differences as simple as in what doctors make. Another good chunk of that is our subsidizing drug research and medication for the rest of the world by paying much higher prices. I'd bet things like malpractice rates through the roof and crazy lawsuits are a pretty American phenomenon as well. All of that stuff gets rolled back into health insurance costs, which we have attacked completely backwards as usual. Instead of attacking costs, we find ways to make things more expensive.

 

FWIW, tort reform has been tried in multiple states and has been found to have essentially no effect on health care costs.

[southsider2k5]

FWIW, tort reform has been tried in multiple states and has been found to have essentially no effect on health care costs.

 

But how do those costs compare to the rest of the world? That is the conversation here.

[StrangeSox]

But how do those costs compare to the rest of the world? That is the conversation here.

 

Still googling, but the US numbers for 2011 were $3.1b in payouts.

 

http://www.statehealthfacts.org/profileind...5#notes-ind-437

 

In 2010, the US spent $2.6t on healthcare.

 

http://www.kaiseredu.org/Issue-Modules/US-...ound-Brief.aspx

 

While the payouts don't capture potentially increased med-mal insurance rates, it does show that it isn't anywhere near being a driving factor in the cost.

[southsider2k5]

Still googling, but the US numbers for 2011 were $3.1b in payouts.

 

http://www.statehealthfacts.org/profileind...5#notes-ind-437

 

In 2010, the US spent $2.6t on healthcare.

 

http://www.kaiseredu.org/Issue-Modules/US-...ound-Brief.aspx

 

While the payouts don't capture potentially increased med-mal insurance rates, it does show that it isn't anywhere near being a driving factor in the cost.

 

How does it compare to the rest of the world? How does malpractice compare to the rest of the world?

[StrangeSox]

Still trying to find that. Americans are known for being particularly litigious.

 

This article references the total costs for med-mal as of 2007. It amounts to $30b or so.

 

http://prescriptions.blogs.nytimes.com/200...lth-care-costs/

[Soxbadger]

.I'd bet things like malpractice rates through the roof and crazy lawsuits are a pretty American phenomenon as well.

 

One of the greatest myth's ever perpetrated on the American public. Medical Malpractice is a very difficult case. You cant just file a lawsuit against a Dr., you need to have an expert (another Dr) sign an affidavit beforehand (at least in Illinois). That is why most medical mal cases settle, because most of the time its abundantly clear that the Dr messed up.

 

 

Why shouldnt you have the right to sue your Dr if he cuts off the wrong leg?

 

Why should your damages be capped?

 

Doctors have a very very powerful lobby, its nothing more than corporate interests beating out the little guy.

Edited July 5, 2012 by Soxbadger

[StrangeSox]

Here's the best comparison I can find so far:

 

http://papers.ssrn.com/sol3/papers.cfm?abstract_id=892981

 

It seems that there were a comparable number of claims in the UK (~7.7k a year vs 10k for the US). Payments were 503 (pounds) in 2004/05, so roughly half of the US payouts in 2011.

 

Given the difference in population here, it seems like the brits are even more litigious. On the other hand, this is a fully nationalized health care system, and I'd imagine that you don't have the same scenario of private doctors getting private malpractice insurance to protect themselves from civil suits.

 

 

[StrangeSox]

One of the greatest myth's ever perpetrated on the American public. Medical Malpractice is a very difficult case. You cant just file a lawsuit against a Dr., you need to have an expert (another Dr), sign an affidavit beforehand (at least in Illinois). That is why most medical mal cases settle, because most of the time its abundantly clear that the Dr messed up.

 

 

Why shouldnt you have the right to sue your Dr if he cuts off the wrong leg?

 

Why should your damages be capped?

 

Doctors have a very very powerful lobby, its nothing more than corporate interests beating out the little guy.

 

When you look at the actual numbers and see its not even quite 10k claims a year, it should really make you question the notion that torts are a major cost-driver and that we should cap damages and make it harder to sue.

[Soxbadger]

Isnt your argument presupposing that these are not valid cases?

 

Why cant it just be that there are more incidents of Dr's f***ing up worse in the US and thus resulting in more lawsuits and damages?

 

Once again, the key question is how many of those lawsuits are without merit. The answer is, at least in Illinois, not many as you have to have an independent expert state there is a meritorious claim, which is basically the highest standard of any civil lawsuit I can think of.

[StrangeSox]

I'm in agreement with you??

[Soxbadger]

I know, Im just saying there is a stronger argument.

 

Most people just do not realize that medical mal is a very difficult case. They have the idea that you can just walk in the door and sue your doctor, which is absolutely false.

[StrangeSox]

I'd call it the McDonalds Myth

[StrangeSox]

How does it compare to the rest of the world? How does malpractice compare to the rest of the world?

 

This is the best fit thus far:

 

http://content.healthaffairs.org/content/24/4/903.full

 

 

The US has slightly higher per-capita payouts, but it still amounts to less than 0.5% of HC spending.

 

[Soxbadger]

The McDonalds case is also another fun one where you can really hammer someone who doesnt know the case.

 

There are actually some really ridiculous lawsuits, the best one (imo) involves a Dr suing BMW for his car being repainted. If you actually work in law you know Dr's love to sue people (oh the hypocrisy.)

 

The Supreme Court Case is:

 

http://www.law.cornell.edu/supct/html/94-896.ZO.html

 

BMW v. Gore

 

The Doctor asked for $500,000 in his original complaint as damages.

[StrangeSox]

The McDonalds case is also another fun one where you can really hammer someone who doesnt know the case.

 

There are actually some really ridiculous lawsuits, the best one (imo) involves a Dr suing BMW for his car being repainted. If you actually work in law you know Dr's love to sue people (oh the hypocrisy.)

 

The Supreme Court Case is:

 

http://www.law.cornell.edu/supct/html/94-896.ZO.html

 

BMW v. Gore

 

The Doctor asked for $500,000 in his original complaint as damages.

 

It's not limited just to doctors!

 

http://en.wikipedia.org/wiki/Pearson_v._Chung

[southsider2k5]

Thanks for all of the liberal spin, but in the rush to politicize it, you are missing the fact that this all adds to the cost of the system, which is the whole point. As earlier when you all were comparing total costs, to total costs, this all factors in. None of that is as a result of health insurance. Health insurance is a result of all of the costs. Until costs are dealt with, health insurance isn't going to get any cheaper.

[Jenksismyhero]

Isnt your argument presupposing that these are not valid cases?

 

Why cant it just be that there are more incidents of Dr's f***ing up worse in the US and thus resulting in more lawsuits and damages?

Once again, the key question is how many of those lawsuits are without merit. The answer is, at least in Illinois, not many as you have to have an independent expert state there is a meritorious claim, which is basically the highest standard of any civil lawsuit I can think of.

 

What's funny is that anymore these "experts" are being ignored by juries. I was just talking to a guy the other day that lost a jury trial and while interviewing the jury they all said they knew the experts were hired guns saying the opposite things, so they didn't really take their testimony into consideration like they would a normal fact witness.