Waiting for health care, fingers crossed

[chess9]

Charrison:

Thanks for stating the obvious.

Do you have any idea what an MRI costs on average in the U.S.? The last time I had an MRI I was the only patient they had seen in 3 hours and they had a special room for the machine with about 3 million dollars worth of equipment and furnishings. We have an excess of equipment in the U.S. and very poor utiization rates. I.e., in many cases we have the opposite problem of the Canadians.

Query, though: "If your doctor suspects, say, metastasizing bone cancer on your 10th rib, how long will you have to wait for a bone scan?" I assume the Canadians have some sort of graded system for giving care, no?

-Robert

 

[charrison]

Originally posted by: chess9
Charrison:

Thanks for stating the obvious.

Do you have any idea what an MRI costs on average in the U.S.? The last time I had an MRI I was the only patient they had seen in 3 hours and they had a special room for the machine with about 3 million dollars worth of equipment and furnishings. We have an excess of equipment in the U.S. and very poor utiization rates. I.e., in many cases we have the opposite problem of the Canadians.

Query, though: "If your doctor suspects, say, metastasizing bone cancer on your 10th rib, how long will you have to wait for a bone scan?" I assume the Canadians have some sort of graded system for giving care, no?

-Robert

So would you rather have too many machines or too few? The problem I have right now is relatively minor and I would probably be waiting for 6 months in Canada for service. Limping around for another 6 months is not an attractive option either.

 

[charrison]

Originally posted by: BaliBabyDoc
It's not the default. If you have good insurance and live in a resource-rich area you are indeed happy with the status quo. Curiously, the majority of national surveys reveal:

1) Most Americans want broad reforms in healthcare.
2) Most Medicaid recipients are happy with Medicaid.
3) Most physicians are NOT happy with Medicaid . . . in fact they often refuse to take new patients and are pruning their current patient roster.
4) Most Medicare recipients are happy with Medicare.
5) Most physicians are NOT happy with Medicare . . . see #3.
6) Most physicians are NOT happy with private insurance reimbursement or bureaucracy.

What you call "pie in the sky" I call addressing inequities while producing a sustainable system of care. The current system is not sustainable.

The do-nothing/no radical change crowd thinks it's perfectly reasonable that intergenerational income redistribution (Medicare/FICA) funnel billions of dollars each year into funding for major medical centers where many "contributors" cannot get services rendered b/c they don't have acceptable insurance or have no insurance. They think it's perfectly acceptable for hospitals to charge patients without insurance (many of which do attempt to pay their bills) MORE than insured patients b/c the insured patient's plan has negotiated fixed (often artificially low) prices for service rendered.

Ask someone with Stanford Medical Center or UCSF how market forces can bring you to the brink of merger for no reason other than trying to capture "economies of scale".

Assuming you believe that medical technology is on a Moore's Law type of clip . . . the cost of providing those services appears to be on a equally steep curve. How long can it go on? And before you hit the tort angle . . . not even the simplest mind in healthcare economics believes current healthcare cost inflation is due primarily to medmal.

I have posted numerous articles about the failings of socialed medicine around the world.

 

[chess9]

The problem here in the U.S. is every doctor has an MRI machine in his garage and charges $1000 for an MRI, or so it seems.

The Canadian government is trying to keep costs down in a country about the size of the U.S., but with, what, 1/5 the population? So, you folks are spread out all over the place, making scaling a difficult problem. Here, the economies of scale would be much greater because of our higher population density.

-Robert

 

[BaliBabyDoc]

And I've posted numerous articles on the failings of somewhat market-based medicine in the US. Your thesis relies on a premise "central control/organization of healthcare resources provides inferior care" compared to a somewhat de-centralized, sort of market-based system in the US that provides exemplary care to some, acceptable care to most, and no care to many. Your evidence is purely anecdotal with the exception of the oft-cited "wait times" for various procedures and consultations. Curiously, you are oblivious to protracted wait times that exist for multiple medical specialties in America. And give no consideration to the infinite "wait time" for people without health insurance and no money to pay for care.

As opposed to someone who's "read some articles", I have a degree in Public Health from one of the top programs in the nation. Plus systems of healthcare was part of my course of study in medical school. From Canada to the UK (NHS) to Japan, all of these systems of care have positives and negatives. If I was an ideologue I could easily highlight the negative aspects of each one and call "centralized or socialized" medicine a global abject failure. On the otherhand, I could describe the general characteristics of all systems and explain how a major modification of healthcare in America could provide better care for the majority AND provide a semblance of control over costs.

heartsurgeon mentioned the focus each physician places on individual patients. It's true that he reflects the alleged ethos of medicine but it is quite false from a practical standpoint. Physicians are refusing to care for new Medicare/Medicaid patients b/c they hate the paperwork and reduced reimbursement but many of those physicians participate in PPO or HMO networks that apply capitation (fancy way of saying there's a limited amount of money available to cover patient care). As you approach the cap, clearly patient care takes a backseat to available funding. Furthermore, some physicians actually agree to accept the "surplus"; ie any difference between the cap and actual resource utilization goes to the physician. As you can imagine, few physicians (if any) ever tell their patients about such arrangements.

And of course any physician working in an ER knows it is the primary care provider for millions of people with chronic conditions. In some areas it is indeed possible (if not likely) to provide appropriate continuity of care by forwarding ER cases to facilities willing and capable of providing such care without reimbursement. But outside of managing life threatening exacerbations (ketoacidosis for diabetes or malignant hypertension for high blood pressure), it is impossible to offer appropriate care through the ER.