Can someone explain the health care 'crisis' to me?

[JuntMonkey]

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You're correct that I have contempt for the profession.

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Why?

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Medicine charges outrageous amounts for treatments that don't really do anything. We spend more and more money every year on healthcare, but we don't get any healthier. People get risky 10k gastric bypass surgery when they just need to eat less, or even riskier 100k triple bypass surgery -- that does nothing to improve a patient's life expectency -- when they just need to eat oatmeal and spinach. Type 2 diabetes is an epidemic, even though it is completly preventable, and even reversable through diet and excercise. The number three cause of death in the US is "Death by Medicine" (nosicomical infection+bad drug reactions+medical errors). You get the idea.

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I like it.

[pvn]

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I have a hard time believing your story and I have an even harder time believing that someone could be so incompetent as to let most of the things happen that you describe.

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You are a babe in the woods. We've had it easy, this was just just normal, day-to-day type interaction with insurers.

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Cancelling "children's" insurance doesn't even happen.

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Hoo boy, what to do with you. My wife's only response to your comment was "fffft." The plan was New Jersey Family Care. It's a public program for kids only, but not administered by the state. They hire for profit corporations to run it. They make their money by keeping expenses below what the state contracts to pay them. We were very lucky to be able to speak English and know how to work the phones, and eventually beat coverage out of them.

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Wow. I stopped reading here. You're trying to slam free-market healthcare, using a PUBLIC system as your whipping boy? Oh, but it's farmed out to "for profit corporations"!!! Newsflash, that's still not a free market, it's textbook mercantilism.

Try again.

[bdk3clash]

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I don't know this for sure, but I'd assume Walmart employees have pretty good health coverage available if they want it.

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You'd be wrong.

[pokerbobo]

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You're correct that I have contempt for the profession.

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Why?

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Medicine charges outrageous amounts for treatments that don't really do anything. We spend more and more money every year on healthcare, but we don't get any healthier. People get risky 10k gastric bypass surgery when they just need to eat less, or even riskier 100k triple bypass surgery -- that does nothing to improve a patient's life expectency -- when they just need to eat oatmeal and spinach. Type 2 diabetes is an epidemic, even though it is completly preventable, and even reversable through diet and excercise. The number three cause of death in the US is "Death by Medicine" (nosicomical infection+bad drug reactions+medical errors). You get the idea.

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These are all faults of the patient. the doc didn't make them fat, clogged up etc. Anyone with a brain knows diet will affect weight, health, and life expectancy. Doctors can't force people to do healthy things...they can only fix what the patient is too lazy, unwilling, or stupid to do on their own. [img]/images/graemlins/confused.gif[/img]

[vhawk01]

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You're correct that I have contempt for the profession.

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Why?

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Medicine charges outrageous amounts for treatments that don't really do anything. We spend more and more money every year on healthcare, but we don't get any healthier. People get risky 10k gastric bypass surgery when they just need to eat less, or even riskier 100k triple bypass surgery -- that does nothing to improve a patient's life expectency -- when they just need to eat oatmeal and spinach. Type 2 diabetes is an epidemic, even though it is completly preventable, and even reversable through diet and excercise. The number three cause of death in the US is "Death by Medicine" (nosicomical infection+bad drug reactions+medical errors). You get the idea.

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That seems like a really good reason to hate lazy people, but not a good reason at all to hate doctors. We don't really provide as many treatments that "don't really do anything" as you think, though it might appear that way. Thats because a lot of what we do is aimed at keeping people running in place, wherase without treatment they would spiral downward.

I'm fully on board with your emphasis on preventive over reactive care, however. We're moving there, its taking longer than it should, and we are nowhere near the goal yet.

[vhawk01]

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Mistakes happen in medicine as much as at your mechanic's, just with different results. We didn't sue because that would solve nothing.

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If a physician makes a negligent mistake that costs someone their health or life, should they not be held to the same standard as the mechanic who screwed up your car?

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Holding the doctor "to the same standard" is an attractive principle. Pretty. It sparkles. But a lawsuit would do little to change medical practice, at least not more than a talk with an administrator, "hey, here's what happened," which is what we did. Lawsuits will not change the quality of health care, they just inflate the size of corporate legal departments and butt covering measures. We did not see my father's death as an opportunity to win the lottery, though if a judge could order him back to life, we'd reconsider.

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Agree wholeheartedly, and thats the point I was trying to make earlier. These lawsuits just really don't provide the motivation for improvement that is intended. The reform needs to come from an institutional, procedural perspective. Its starting to.

[mjkidd]

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Higher standard, if you ask me. Medical mistakes are far less forgivable than automotive mistakes, and for that reason much greater measures must be taken to reduce their number. Unfortunately, it seems to be the case that a certain amount of random error is going to occur in any system, so the best way to reduce the overall incidence of medical error is from an institutional approach. Malpractice lawsuits tend to punitively target individual physicians, but fear of making mistakes isn't a good motivator for success. Rather, putting doctors in positions where they cannot fail is more effective.

But I don't have a huge problem with malpractice suits. I'm too young to be a part of this old guard of physicians that imagine themselves to be above reproach. I'm way more interested in perfecting the craft of helping people than covering my own ass.

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Nice post. And I agree that the best approach to making sure that victims of medical errors is an institutional one. What if there was an accountant and an actuary at M&M's as the doctors examined their mistakes. At the end of the meeting, these guys say "your mistake was worth 85k," and the hospital paid up. And it wouln't be about assigning blame any more than the M&M is about assigning blame. That would be optimal. Now, if a doctor makes a mistake HE WON'T EVEN TELL YOU. There will be "complications" or some such vague passive voice nonsense. The only reason there is an adversarial medical malpractice system is because there is no other mechanism for 1) figuring out if you are the victim of a negligent medical error, or 2) recovering compensation for that error.

[pokerbobo]

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I don't know this for sure, but I'd assume Walmart employees have pretty good health coverage available if they want it.

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You'd be wrong.

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If you need HC insurance, maybe find another employer. Last I checked, WalMart can't force anybody to work there.

I know there are many haters of WalMart...this source seems to be one, and the info provided I would not be shocked if it was spun in a bad light.

[vhawk01]

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Higher standard, if you ask me. Medical mistakes are far less forgivable than automotive mistakes, and for that reason much greater measures must be taken to reduce their number. Unfortunately, it seems to be the case that a certain amount of random error is going to occur in any system, so the best way to reduce the overall incidence of medical error is from an institutional approach. Malpractice lawsuits tend to punitively target individual physicians, but fear of making mistakes isn't a good motivator for success. Rather, putting doctors in positions where they cannot fail is more effective.

But I don't have a huge problem with malpractice suits. I'm too young to be a part of this old guard of physicians that imagine themselves to be above reproach. I'm way more interested in perfecting the craft of helping people than covering my own ass.

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Nice post. And I agree that the best approach to making sure that victims of medical errors is an institutional one. What if there was an accountant and an actuary at M&M's as the doctors examined their mistakes. At the end of the meeting, these guys say "your mistake was worth 85k," and the hospital paid up. And it wouln't be about assigning blame any more than the M&M is about assigning blame. That would be optimal. Now, if a doctor makes a mistake HE WON'T EVEN TELL YOU. There will be "complications" or some such vague passive voice nonsense. The only reason there is an adversarial medical malpractice system is because there is no other mechanism for 1) figuring out if you are the victim of a negligent medical error, or 2) recovering compensation for that error.

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I have no rebuttal to this. Would it make you feel better if I said "We're trying to get better?" I'm only a medical student, so my perspective is a bit limited, but I can assure you, we spend lots of time learning about disclosing medical error, and the reason we do this is EXACTLY because of the concerns you have raised here. They are very legitimate concerns. I guess the best I can do is assure you that I will not take this approach, and that I will in fact disclose all medical error that I INEVITABLY will make. And I can give you some assurance that my classmates will act similarly.

[Bill Haywood]

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Newsflash, that's still not a free market, it's textbook mercantilism.

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Just as I predicted, the argument was turned around to say the US's problem is too much collectivism, not too much free market.

Since you argue for a theoretically perfect system of the mind, rather than defend what is, you win every argument.

The US system is closer to free market than the Canadian/European single payer systems, which work better.

If you are interested in actual change, rather than an aesthetically pleasing and consistent philosophy, then you deal with the systems that actually exist. And the single payer systems work better. Once you get AC land up and running perfectly on some island, I'll come join it. Until then, I've got three kids who need health care. (For those interested in my earlier reference to Trotskyism, this post continues the parallel between Leninist utopians and AC utopians.)