ordering a pizza in 2015

[Capt Worley PE]

Something as large as health care reform should be a multi year long process, not something you can attached an arbitrary time frame to.

That's my problem with it. Why is it THAT WE HAVE TO DO SOMETHING (IE TRASH THE EXISTING SYSTEM) RIGHT THIS VERY SECOND!!!!

 

[Dexman1349]

Here's an interesting read on healthcare reform titled "The Case to Kill Granny" posted from Newsweek:

http://www.newsweek.com/id/215291

It's basically discussing the insane amount of public money (medicare/medicaid) spent on chronically ill and elderly people, which in the long run does not necessarily increase the quality of life for the extended amount of life given.

As President Obama said, most of the uncontrolled growth in federal spending and the deficit comes from Medicare; nothing else comes close. Almost a third of the money spent by Medicare—about $66.8 billion a year—goes to chronically ill patients in the last two years of life. This might seem obvious—of course the costs come at the end, when patients are the sickest. But that can't explain what researchers at Dartmouth have discovered: Medicare spends twice as much on similar patients in some parts of the country as in others. The average cost of a Medicare patient in Miami is $16,351; the average in Honolulu is $5,311. In the Bronx, N.Y., it's $12,543. In Fargo, N.D., $5,738. The average Medicare patient undergoing end-of-life treatment spends 21.9 days in a Manhattan hospital. In Mason City, Iowa, he or she spends only 6.1 days. Maybe it's unsurprising that treatment in rural towns costs less than in big cities, with all their high prices, varied populations, and urban woes. But there are also significant disparities in towns that are otherwise very similar. How do you explain the fact, for instance, that in Boulder, Colo., the average cost of Medicare treatment is $9,103, whereas an hour away in Fort Collins, Colo., the cost is $6,448?

All this treatment does not necessarily buy better care. In fact, the Dartmouth studies have found worse outcomes in many states and cities where there is more health care. Why? Because just going into the hospital has risks—of infection, or error, or other unforeseen complications. Some studies estimate that Americans are overtreated by roughly 30 percent. "It's not about rationing care—that's always the bogeyman people use to block reform," says Dr. Elliott Fisher, a professor at Dartmouth Medical School. "The real problem is unnecessary and unwanted care."

Having 3 direct family members working in the medical industry, I hear about this on a daily basis. Go to a nursing home and you will find just about every patient there on at least 5 different drugs. 1 for a mild heart condition (which if undiscovered would not change the quality or length of life, but should be treated "just in case"), 2 to treat the side effects of the heart meds, 2 more to treat the side effects of the pills treating the heart med side effects, etc, all stemming from a drug that isn't really needed in the first place. You go into the ER with stomach pain and next thing you know you're getting passed through an EKG, MRI, blood tests, etc, when any 1st year med student would correctly tell you to take some pepto and call in the morning, but is scared to death of malpractice he orders everything under the sun.

 

[Guest]

Having 3 direct family members working in the medical industry, I hear about this on a daily basis.

As a guy who used to be married to the Supreme Allied Commander of Nurses for a Longterm Care Facility, I heard it on a daily basis as well. I think it is really unfortunate that people cannot have frank and open discussions about quality of care without people cramming the 'culture of life' arguments down your throat.

It also saddens me that someone like Sarah Palin, who no longer holds accountability, can interject herself into the argument by making clearly inflammatory, untrue statements that continue to frustrate the process.

My dad used to say, if you aren't part of the solution, you are part of the problem. I see A LOT of people who are getting paid to be nothing more than part of the problem.

JR

 

[Supe]

see A LOT of people who are getting paid to be nothing more than part of the problem.
JR

So do I, every time I turn on CNN and they're showing a congressional hearing.

 

[Dleg]

My internets too slow to watch the video, but I think I've seen it before. the attack.
..... think that revising our health care system (which fucking sucks as it is now) is probably not the evil dictator move that we all seem to want to make it out to be.

:appl: :appl: :appl: :appl:

I love it when Sapper lets loose... I couldn't agree more!

I also agree with the statement above that it's a shame both the Democrats and Republicans have dug into their positions so firmly that it no longer seems possible to discuss, rationally, a solution to what everyone seems to agree is a broken system. And I have to put the blame on the radical, marketing-approach driven propaganda coming from the likes of Rush Limbaugh and Fox News. It disgusts me what this approach has done to the process of American democracy. It has turned it into a joke. Wait, check that: I guess it's always been a joke, and has always been driven behind the scenes by competing private interests. Which is such a shame. Mock me all you want for saying this, but the oft-reported statistics about America being far behind the countries of Europe, Japan, Australia, etc., in terms of health care, are all true. And maybe that's partly why America has, historically, been a bigger money maker than these countries. And that works out great for you and me; people who have good educations and good jobs that come with decent health insurance packages. But I honestly believe, as simply a human being, and a human being who was raised a Christian, that the propserity of the well-off is not much measure of the "success" of any nation, as is the condition of the not-so-well off. If that makes me a "liberal" or an "idiot" in anyone's mind, then so be it. But as I said, there are a LOT of other countries that have surpassed us in this respect, and they don't seem to be doing all that bad....

 

[Dleg]

You can find someone to complain about the health care system in any country. Imagine the quotes you could get from dissatisfied Americans if another country decided they wanted to adopt the American model.

My main point is, I am deeply dissappointed that the discussion has been sabotaged by "someone" or "some group" who has turned it into a shouting match. There's no way to discuss ways to improve the system now, because it has become a fight, and the fight has been driven by less-than-honorable intentions.

 

[Dleg]

^^Hmm... the post I replied to has disappeared.

HEre's seomthing that I have been thinking about in this debate: Would a government health care system make it easier to run a small business? If everyone had health care, which they paid for out of their taxes, and employers did not have to provide for that, I would think that very small businesses would prosper - because they could attract better workers, who, under the current system, gravitate to larger employers purely because of health care benefits. Think of it... small stores, small engineering firms, small service companies... to me, it would seem that these types of small businesses would flourish with a public health care system.

Now, someone explain to me why this wouldn't happen...

 

[benbo]

You can find someone to complain about the health care system in any country. Imagine the quotes you could get from dissatisfied Americans if another country decided they wanted to adopt the American model.
My main point is, I am deeply dissappointed that the discussion has been sabotaged by "someone" or "some group" who has turned it into a shouting match. There's no way to discuss ways to improve the system now, because it has become a fight, and the fight has been driven by less-than-honorable intentions.

I deleted my post because I don't want to argue about this - primarily because nobody really seems to have any real data on it. I fully admit I don't have any stats and the only stats I know of are a BS 10 year old WHO study. But I'd be willing to look at any data that shows how horrible our healthcare system is.

Plus, shoot me for this, I actually care more about the healthcare of my own family than the nation as a whole, and we have excellent care. I can only see it getting worse.

 

[benbo]

^^Hmm... the post I replied to has disappeared.
HEre's seomthing that I have been thinking about in this debate: Would a government health care system make it easier to run a small business? If everyone had health care, which they paid for out of their taxes, and employers did not have to provide for that, I would think that very small businesses would prosper - because they could attract better workers, who, under the current system, gravitate to larger employers purely because of health care benefits. Think of it... small stores, small engineering firms, small service companies... to me, it would seem that these types of small businesses would flourish with a public health care system.

Now, someone explain to me why this wouldn't happen...

Well, nobody knows what would happen. I think under the current plans they are asking the business owners to foot the bill one way or the other. Plus, of course as you know, everyone would have healthcare, but not everyone would pay for it out of their taxes because not everyone pays taxes. Not even everyone who works.

 

[benbo]

I am serious that I would like to see data comparing our system to other systems. But not the BS data of life expectancy and infant mortality. This is BS because we cannot compare population A to population B if they are not homogenous and equal populations.

Here are things I would like to know about to compare health / medical research in varous countries:

Doctor training and quality

Doctor to patient ratios

Waiting time for procedures

Procedures and new medicines developed in the country

Percentage of patients given cuting edge treatments and best practices treatments in various countries.

I am a person with a serious chronic illness. I also cared for two parents through end of life. I couldn't be happier with the healthcare we all recieved.

As a person with a chronic illness, I participate on message boards with people with the same malady from around the world. I know this is anectdotal, along with the fact I earlier posted about my brother and sister who live in Australia and their complaints (which I deleted). THat's why I'd like to see actually statistics on health care, not statistics on mortality, which is affected by so many other things.

I am not arguing one way or the other really. Just saying two things:

1. I'd really like to see relevant facts.

2. I'm not worried about paying a bit more in taxes. But I am worried that my family's healthcare will get screwed up.

And I don't ascribe evil motives to most people on either side.

 

[Dleg]

I haven't finished reading it yet, but this report seems to answer your questions, or at least some of them.

 

[benbo]

I haven't finished reading it yet, but this report seems to answer your questions, or at least some of them.

Okay, I just skimmed it.

This report seems fairly good, however it is really pretty equivocal and seems to qualify almost all the data. It says that the US his better in some things, not in others. It says some studies show the US better than Canada, others go the other way. It claims that the US "overuses" revascularization, where to me the use of revascularization is a good thing.

This is the first line of the conclusions "Taken collectively, the findings from international studies of health care quality do not in and of themselves provide a definitive answer to the question of how the United States compares in terms of the quality of its health care."

And I'm sorry - I will admit this is a pretty fair study, but a quick Google of the first author shows her to be affiliated with AARP - which is on record in support of the Health Care Proposals.

Let me just say this. I'm willing to give this all a chance, but if it screws up my family's healthcare in any way I am going to be mightly pissed off. Plus, I hardly consider myself the most conservative person on here. I'm sure there are a lot of folks on here mortified by these healthcare reforms, but for some reason they don't seem to want to argue this. So I'm not going to waste my time doing it.

 

[benbo]

Oh, and thanks for finding the study. I will read it in more detail when I have time. Because I agree that these issues are far too important to be decided by bullshit and bromides on either side.

 

[Dleg]

Well, for the sake of those not reading the whole thing, here is the summary section:

Summary andconclusions

Taken collectively, the findings

from international studies of health

care quality do not in and of

themselves provide a definitive

answer to the question of how the

United States compares in terms of

the quality of its health care. While

the evidence base is incomplete

and suffers from other limitations,

it does not provide support for the

oft-repeated claim that the “U.S.

health care is the best in the

world.” In fact, there is no hard

evidence that identifies particular

areas in which U.S. health care

quality is truly exceptional.

Instead, the picture that emerges

from the information available on

technical quality and related

aspects of health system

performance is a mixed bag, with

the United States doing relatively

well in some areas — such as

cancer care — and less well in

others — such as mortality from

conditions amenable to prevention

and treatment. Many Americans

would be surprised by the findings

from studies showing that U.S.

health care is not clearly superior

to that received by Canadians, and

that in some respects Canadian

care has been shown to be of

higher quality.

To be sure, there are limitations to

the current evidence base. In

particular, there is no data or

evidence by which to answer the

question of whether the United

States is a place where one finds

health care that exceeds the quality

of the best care available

elsewhere in the world — in other

words, whether the “best U.S.

health care is the best in the

world.” Although it is often held

that the U.S. strength lies in stateof-

the-art, technically oriented

care, especially focused on

“rescue” care, rather than care for

more routine acute and chronic

conditions, studies typically do not

compare the “best” care offered in

different countries. Further, there

remain other aspects of health care

for which we have no quality

measures or inadequate data for

comparisons.

Existing studies also fail to tell us

much at all about the reasons for

the apparent differences in quality

observed across countries,

although numerous hypotheses

have been put forward (e.g.,

differences in the use of health

information technology,

differences in the coordination of

care and the fragmentation of

health care delivery, variations in

reliance of incentives for providers

and consumers to provide and

select care based on consideration

of quality). We do know, however,

from a five-country survey of

primary care physicians52 that U.S.

physicians’ practices are more

limited in information capacity,

provide less patient access outside

of traditional work hours, and are

among the least likely to work in

teams or to receive financial

rewards for quality, all factors that

could bear on the quality of

primary care furnished.

Taken together, these studies do

provide a strong basis for

determining whether proposed

health reform initiatives might

threaten or, alternatively,

strengthen the current level of U.S.

quality. While evidence is not

conclusive, it is clear that the

argument that reform of the U.S.

health system stands to endanger

“the best health care quality in the

world” lacks foundation. Like

other countries, the United States

has been found to have both

strengths and weaknesses in terms

of the quality of care available, and

the quality of care the population

receives. The main ways in which

the United States differs from

other developed countries are in

the very high costs of its health

care and the share of its population

that is uninsured.

In the light of the fact that the

United States spends twice as

much per person on health care as

its peers, those who question the

value for money obtained in U.S.

health expenditures are on a firm

footing. The evidence suggests that

other developed countries achieve

comparable quality of care while

devoting at most two-thirds the

share of their national income.

Faced with the evidence, one

might well ask why it is that

assertions of the superiority of

U.S. health care are so common.

Technical definitions and popular

conceptions of quality include

many different dimensions and

there may not be agreement about

which dimensions are most

important. For example, people

who make the claims that the

United States has the “best quality

of care” in the world may be

prioritizing a degree of access to

medical technology and innovation

which they believe to be unique to

the United States. Perhaps media

attention paid to outcomes for a

select few (e.g., multiple organ

transplant recipients, high-risk

delivery of multiple births) has

cast into shadow the average

outcomes of the majority of

Americans with more routine, yet

serious, conditions and other

health care needs.

But a less-than-fully informed

public comes at a cost in that

assertions of excellence divert

attention from the need to inspire

and foster systematic quality

improvement activities.

Furthermore, there seems to be a

routine genuflection to the

widespread belief of U.S. quality

excellence, even among experts. In

an environment where even

insured Americans receive only

about half of the services that

experts consider necessary, there is

a strong argument for placing

quality firmly on the health reform

agenda.53 In short, health reform

can be seen as an opportunity to

systematically improve quality of

care, rather than as a threat to

existing levels of quality.

Health reform provides an

opportunity to build on strengths

and correct weaknesses, work

towards aims for improvement,

such as those defined by IOM in

Crossing the Quality Chasm,54 that

care be safe, effective, patientcentered,

timely, efficient and

equitable. The IOM continues to

push for quality improvement

based on the evident gap between

what is done and what should be

done, what can be achieved and

what is achieved, but international

comparisons have not played a

major role in pushing forward that

message. On the contrary,

unsubstantiated claims that, despite

any shortfalls, the United States

has the “best” quality of care in the

world are sometimes put forward

to support views that reforms are

unwarranted on quality grounds

and even risky — particularly

those reforms that would modify

U.S. health financing, coverage or

delivery arrangements in ways

similar to those used in other

countries.

On the basis of this review it is

safe to say that U.S. health care is

not pre-eminent on quality;

furthermore, one can surely argue

that U.S. health care quality is not

at risk from the kinds of health

reform proposals receiving

attention. On the contrary, our

findings strengthen arguments that

reform is needed to improve the

relative performance of the U.S.

health system on quality. If reform

accomplishes no more than

extending insurance coverage to

the more than 45 million

Americans without insurance, it

will be an important step forward,

but more is needed to ensure health

care quality improvement. To the

extent it is possible to improve

health care delivery through

reforms that strengthen incentives

to apply knowledge and meet

quality standards, employ

technology to reduce errors and

ensure appropriate care, and help

consumers and patients demand

better quality, even more might be

achieved.

 

[Dleg]

And I'm sorry - I will admit this is a pretty fair study, but a quick Google of the first author shows her to be affiliated with AARP - which is on record in support of the Health Care Proposals.

Do you consider this surprising, considering the conclusions of the report?

 

[benbo]

Do you consider this surprising, considering the conclusions of the report?

No, I'm wondering if that is the REASON for the conclusions in this report. All I ever hear is that the current US health system is irretrievably screwed up, that's why we need this massive overhaul. Even from this report I don't get that.

Just cutting a few equivocations from this conclusion:

"While evidence is not conclusive, "

"Instead, the picture that emerges

from the information available on

technical quality and related

aspects of health system

performance is a mixed bag,"

"To be sure, there are limitations to

the current evidence base."

"there may not be agreement about

which dimensions are most

important."

"Existing studies also fail to tell us

much at all about the reasons for

the apparent differences in quality

observed across countries,"

Like I said, I'll read the whole thing if I have time. But I doubt I will find stronger justification in the body of the report than in its own conclusions which are pretty wishy washy. Plus I love how the report is able to predict the effect of future change in this country, when it has no idea what sort of ripple effects they may have, the effect of external factors such as the overall economy, or how those changes are going to be implemented. THat part is complete BS to me.

I'l repeat my concern, which I'll grant is selfish. I went to school, I worked hard to get a job with good healthcare. If anything in these reforms causes my employer to drop my health plan, and I'm forced into a crappy plan which may kill me or my family members, I'll be pissed off, but then it will be too late. I give plenty in charity each year, and I pay plenty in taxes, so I don't feel guilty wanting to protect the best for my family.

 

[Dleg]

The report explains pretty thoroughly why more definitive comparisons cannot be made, pretty much echoing what you said in an earlier point. I'd be a lot more suspect of a report that was any more conclusive than that.

The biggest point for me, which is what I was compaining about, is the 1/5 of Americans who have no insurance coverage, which is by far the biggest difference between the US and the other countries in the comparison, which all have far wider coverage. That's what I find appalling about the US system, especially in light of how much more it costs compared to those other counrties.

 

[Dleg]

The report explains pretty thoroughly why more definitive comparisons cannot be made, pretty much echoing what you said in an earlier point. I'd be a lot more suspect of a report that was any more conclusive than that.

The biggest point for me, which is what I was compaining about, is the 1/5 of Americans who have no insurance coverage, which is by far the biggest difference between the US and the other countries in the comparison, which all have far wider coverage. That's what I find appalling about the US system, especially in light of how much more it costs compared to those other counrties.

 

[Capt Worley PE]

^^Hmm... the post I replied to has disappeared.
HEre's seomthing that I have been thinking about in this debate: Would a government health care system make it easier to run a small business? If everyone had health care, which they paid for out of their taxes, and employers did not have to provide for that, I would think that very small businesses would prosper - because they could attract better workers, who, under the current system, gravitate to larger employers purely because of health care benefits. Think of it... small stores, small engineering firms, small service companies... to me, it would seem that these types of small businesses would flourish with a public health care system.

Now, someone explain to me why this wouldn't happen...

Because the small businesses will be shouldering the burden.

I think Obama mentioned 8% tax on businesses not provideing health insurance. A lot of small businesses that don't provide it already are operating on margins slimmer than 8%. I have friends that own businesses with 1-10 employees that would be driven out of business by this.

 

[wilheldp_PE]

Because the small businesses will be shouldering the burden.
I think Obama mentioned 8% tax on businesses not provideing health insurance. A lot of small businesses that don't provide it already are operating on margins slimmer than 8%. I have friends that own businesses with 1-10 employees that would be driven out of business by this.

That's OK because Obama eats deficits and craps jobs. The world will be saved in short order.