Wow - here's a book for this forum:

[InvisibleTouch]

Critical Condition: How Health Care in America Became Big Business - and Bad Medicine

Just finished reading it this morning. It describes how for-profit healthcare (the term itself is a bit of an oxymoron) has led to the disasterous system we face today:

* The muddle of insurance companies whose main goal is to deny treatment wherever possible in order to save money - while still raking in obscene profits which line the pockets of the company officers and shareholders. They also screw doctors, paying for lesser procedures when more extensive work was done, and then giving both patient and doctor the runaround through a convoluted call-center system, so that these "mistakes" are time-consuming and stressful to sort out.

* Patients die while waiting for treatment approval from their insurers, or are unable to get through to their doctors to schedule a timely appointment. Patients are kicked out of the hospital on a drive-through schedule because the insurance company is going by an unrealistic set of guidelines - only to have the patient return, sicker than ever, running up even higher costs and sometimes paying with their lives.

* "Cost-cutting" has led to hospitals running out of basic supplies, operating rooms and even implements that aren't properly sterilized, and nurses who quit from the sheer stress of being overwhelmed, to be replaced by lower-paid and less-trained workers.

* Ambulances cruise from one hospital to the next bearing critically ill patients because there's no more space in the ERs (they are on "divert status") - due to non-critical patients filling them up because they can't get in to see their own doctors in anything resembling a reasonable amount of time.

* The FDA tries to crack down on people going to Canada and Mexico to get cheaper prescriptions, claiming (erroneously) that there are safety issues with drugs from other countries (in fact they are manufactured and shipped in the same production plants overseas), and yet stays silent on safety concerns for "approved" drugs while other countries have already pulled them from the shelves.

* The tricks of the trade of pharmaceutical advertising, going way back to a relatively harmless inception (making people paranoid about having bad breath) and culminating today in the barrage of drug ads on television.

These are just the topics that stick in my mind right at the moment. With lots of examples and an easy-to-follow narrative, the book details how healthcare became big business during the "free market" mania of the Reagan era, and as a result everyone in the system suffered except the investors.

You might think this is a boring or cumbersome topic to read a whole book on, but in fact it was well-written and engaging, a quick read, not to mention informative. To take a quote directly from the book, "it explains why Americans are the most overtreated, undertreated, and mistreated health care patients on earth."

Critical Condition: How Health Care in America Became Big Business - and Bad Medicine

[liberalmike27]

1. It makes me so happy

That people have started seeing insurance companies for the bloodsuckers they are.

Insurance is the worst way to ameliorate disasterous consequences, and just like banks, and financial, and big pharm, it preys on the poor and middle class far too much. I have instinctively hated them since I was a child. The whole idea of making money off people's misery irritates me.

A government pool system would work much better, taking away the profit motive, and even if a few folk abused it, it'd still be cheaper for us than buying it from companies whose CEO's make hundreds of millions a year, from premiums, while they try forgo paying the benifits they promise.

[InvisibleTouch]

4. I hate them too.

I'm of the mind that it would do me no good to pay for health insurance (not that I can afford to, anyway) because if I should need it, it won't be there for me anyway. Best to try to squirrel a little something away for emergencies, and take my chances.

[Crunchy Frog]

9. They're parasites.

They're like a gigantic, bloated tapeworm on the intestine of the country.

[uppityperson]

2. Insurance companies exist for 1 reason. To make money.

They want to make as much as possible so charge more and pay less.

This looks like an interesting read. I agree with the clip you wrote, have seen much of this in my 30+ yrs as a nurse. The system has peaked and is going down rapidly. I'll check out the book, thanks.

[Jim__]

3. 'how healthcare became big business during the "free market" mania of the Reagan era'

I absolutely agree with that. In the 70's I worked for this little Mom and Pop store. I had Blue Cross. I could go to any doctor, never paid a penny, they never sent me a bill to tell me how much they had paid out. Health Care was just a given. How we got from there to here, where health care is a privilege for the rich, is beyond me. The "free market" sure didn't improve health care.

[trotsky]

7. We got here because we got better at treating problems.

CAT scans, MRIs, advanced diagnostics, life-saving surgeries, drugs to make conditions that used to be fatal quite manageable. All these things save lives, but they also cost money. And of course you've got the insurance bastards in the middle taking a cut. So there are lots of factors, not all of them bad, that have helped to increase the cost of healthcare.

[Crunchy Frog]

10. Yeah, all they had in the 70's was leaches. I remember.

[trotsky]

11. Oh yeah, totally the point of what I said.

Sheesh.

[Crunchy Frog]

12. Okay, well they had saws for amputations as well.

[Jim__]

13. Guess again.

Both the CAT scan and MRI were invented in the 70s. They also had life-saving surgeries and drugs to make formerly fatal diseases manageable.

[trotsky]

14. Were they nearly as widespread in use?

Of course not. Both of you are choosing to be obtuse just to defend your failed point. Health care costs a lot more than it did in the 70s, and a large part of that is because many more expensive procedures and drugs are available to more people. Take for just one example how many prematurely born infants can survive now vs. 30-40 years ago. Just last night on the news was a story about a baby born at 25 weeks who is going home. This was virtually unheard of in the 70s - yet not that uncommon today.

Million-Dollar Babies (Business Week, June 2008)
The cost of care for preemies is sky-high—some 15 times the expense of full-term infants and rising. Is there such a thing as too young?
...
Preemies are a quickly expanding class of patients in the U.S., Britain, and other advanced nations. And the costs and technical challenges of caring for them are a growing source of controversy. Nearly 13% of all babies in the U.S. are preemies, a 20% increase since 1990. A 2006 report by the National Academy of Sciences found that the 550,000 preemies born each year in the U.S. run up about $26 billion in annual costs, mostly related to care in NICUs. That represents about half of all the money hospitals spend on newborns. But the number, large as it is, may understate the bill. Norman J. Waitzman, a professor of economics at the University of Utah who worked on the National Academy report, says the study considered just the first five years of the preemies' lives. Factor in the cost of treating all of the possible lifelong disabilities and the years of lost productivity for the caregivers, and the real tab may top $50 billion, Waitzman says.
...
Billie Lou Short, NICU director at Children's National, says the typical 28-week-old preemie had a 20% rate of survival in the 1980s. Now those infants "have a 90% survival rate and considerably reduced side effects."

More...

We live longer (a "vicious" cycle, partly because those drugs and procedures help us live longer in the first place), thus requiring more drugs and procedures for conditions we might not have lived long enough to suffer from in the first place! Aging sucks, and we're fighting a battle against nature that we've evolved to lose.

Average life expectancy in 1970: 70.8 years.
Average life expectancy in 2004: 77.8 years. (Source: http://www.cdc.gov/nchs/fastats/lifexpec.htm)

The point is, it's not all because of greedy insurance companies and pharmaceuticals. Rest assured they contribute to the problem. But hey, they're the catch-all demons in the Health Scare Lounge so who cares about the rest of the facts? :eyes:

[Jim__]

15. "...so who cares about the rest of the facts?"

Apparently not you. Yes, the US has the capacity to provide outstanding health care. The problem is that it is incapable of delivering it to a large portion of its population. As I stated previously, in the 1970s, working for a very small company, less than 15 employees, I had employer paid health insurance - fully paid by my employer. That health insurance plan - Blue Cross when it was a non-profit - far exceeds the health insurance I have today, health insurance that costs me a lot, and costs my employer a lot. I currently work for a large corporation, over 2000 employees. My health care situation is more the norm than the exception. So, yes, I absolutely consider health care has deteriorated between the 1970s and today.

The development in the 1970s of the technologies that you trumpet, is fair proof that the increased cost and lower availability has neither significantly increased the value of our health care, nor our ability to develop cutting edge technology. Of course today's technology is better; however, my estimation is that in the 1970s, the US stood in a better position relative to the rest of the world than it does today. The WHO ranks the US 37th in health care. So what is the extra cost buying us?

As to being obtuse, the thrust of the thread is about the extremely well-documented problems in the US health care system. Responding that there are some good aspects, is totally beside the point. The problem is the bad aspects. From a review of the book on the page cited in the OP:

Bestselling investigative journalists Barlett and Steele (America: What Went Wrong?) deliver a devastating indictment, supported by excellent research, of a health-care system that they say is failing to provide first-rate services to its citizens, 44 million of whom are without insurance. According to these Pulitzer Prize–winning reporters, now with Time magazine, the U.S. compares poorly with other Westernized nations in delivering quality care and a healthy life expectancy, and preventing infant mortality. Per capita health-care spending continues to exceed the amount spent by many other countries, the authors say, because one out of every three U.S. dollars pays for administrative costs. The authors also present case histories of patients, some with life-threatening conditions, who were ignored by bureaucratic HMOs that put profit first. Barlett and Steele describe how health care first became driven by profits on Wall Street during the Reagan administration. Competing insurance plans, they say, led not to better choices for consumers, but to physicians who are prevented by insurers from prescribing needed treatments; a severe shortage of nurses; and unsafe hospitals where staff shortages and unsanitary conditions result from cost-cutting. The authors, who strongly advocate a single payer plan, successfully depict a health-care system in crisis.

As to the cost of US health care, it is out of line with costs in other countries (many of them ranked above the US in overall health care):

...

An additional insight from the graph, however, is that even after adjustment for differences in G.D.P. per capita, the United States in 2006 spent $1,895 more on health care than would have been predicted after such an adjustment. If G.D.P. per capita were the only factor driving the difference between United States health spending and that of other nations, the United States would be expected to have spent an average of only $4,819 per capita on health care rather than the $6,714 it actually spent.

Health-services researchers call the difference between these numbers, here $1,895, “excess spending.” That term, however, is not meant to convey “excessive spending,” but merely a difference driven by factors other than G.D.P. per capita. Prominent among these other factors are:

1. higher prices for the same health care goods and services than are paid in other countries for the same goods and services;

2. significantly higher administrative overhead costs than are incurred in other countries with simpler health-insurance systems;

3. more widespread use of high-cost, high-tech equipment and procedures than are used in other countries;

4. higher treatment costs triggered by our uniquely American tort laws, which in the context of medicine can lead to “defensive medicine” — that is, the application of tests and procedures mainly as a defense against possible malpractice litigation, rather than as a clinical imperative.

There are three other explanations that are widely — but erroneously — thought among non-experts to be cost drivers in the American health spending. To wit:

1. that the aging of our population drives health spending

2. that we get better quality from our health system than do other nations, and

3. that we get better health outcomes from our system

source

Before calling other people obtuse, you might try to understand the topic under discussion.

As to remarks about "the Health Scare Lounge", they're merely childish, and contribute nothing to the discussion.

[trotsky]

16. My goodness, what a noble attempt!

A failed attempt, but a noble one nonetheless.

How many people get MRIs today versus the 1970s? How many people have bypass surgery vs. the 1970s? Transplants? Surgery in utero?

How many drugs are available today versus the 1970s that help manage health conditions?

How about that life expectancy increase since 1970?

You are ignoring ALL the other factors and choosing to focus on just one. Not surprising, since it doesn't support your agenda to do otherwise.

Ultimately, my argument is not as simplistic as yours - I readily admit insurance and the free market contribute to increasing health costs too. So really, nothing you just posted does anything to disprove what I said. You just want to focus on one part of the problem.

---

On edit: I suggest you take your argument to the Congressional Budget Office, who in January of THIS YEAR said:

about half of all growth in health care spending in the past several decades was associated with changes in medical care made possible by advances in technology

[Jim__]

17. Once again, you response is not on point.

I'll keep it simple for you:

1. The US health care costs are out of line with other countries:



2. The US is ranked 37th by the WHO in health care.

We're spending way too much for the results we're getting.

[trotsky]

18. Once again, you ignore what you don't want to hear.

"about half of all growth in health care spending in the past several decades was associated with changes in medical care made possible by advances in technology" - United States Congressional Budget Office, January 2008.

[Jim__]

19. You're looking at a major part of the problem. Too bad you can't recognize it.

As I said in my previous post: We're spending way too much for the results we're getting.

The information is easily available. For instance:

The culprit behind long-term health care inflation, the study reveals, is not a “who” but a what: “advancing medical technologies” combined with low productivity. Yes, that’s right: while improved technology has boosted efficiency in other sectors of the economy, when it comes to healthcare, technological advances are associated with lower productivity. There is no one group to be blamed for runaway healthcare inflation; the problem is systemic.

...

Moreover, much of our technology is overpriced. The U.S. pays significantly more than other nations for precisely the same products and services. Finally, and most importantly, we often use the technology on a broad swathe of patients when only a few, who fit a very specific profile, actually benefit from it.

Just because you're spending a lot of money on something, doesn't mean you're getting a lot out of it. Again, the US is ranked 37th in health care.

[trotsky]

20. You argument is with the CBO now, not me.

Talk to them. I'm sure once you've straightened them out, things will be great.

[Jim__]

21. The CBO is well aware of the problem.

From a CBO paper:

... Although the aging of the population is frequently cited as the major factor contributing to the large projected increase in federal spending on Medicare and Medicaid, it accounts for only a modest fraction of the growth that CBO projects. The main factor is excess cost growth-or the extent to which the increase in health care spending exceeds the growth of the economy. The gains from higher spending are not clear, however: Substantial evidence exists that more expensive care does not always mean higher-quality care. Consequently, embedded in the country’s fiscal challenge are opportunities to reduce costs without impairing health outcomes overall. ...

I really didn't believe there was anyone in the country who was not aware of the serious crisis in US Health Care.

[trotsky]

23. Good thing I never disputed that point, huh?

That's a strawman you've kept trying to replace my argument with. I have not once in this thread said that there is NOT a crisis in the US health care system.

All I ever said was that it's not as simple as ONLY declaring health care costs increasing because of Reagan free market principles, the statement from the OP that you enthusiastically endorsed in post #3.

You have evidently conceded that point, realizing how weak your position was, and now somehow want to make this about you arguing more money doesn't make things better, and me taking the opposite stance.

I'll leave you to argue with your strawman now, since you have in essence admitted you didn't see the whole picture in post #3.

[Crunchy Frog]

22. You got the response that you did

because the poster is a member of a select group of "skeptics" who come into the "Health Scare Lounge", with enormous chips on their shoulders, to do battle against the "woo woos" hereby defined as anyone who has anything remotely critical to say about any aspect of the way conventional medicine is practiced in our society.

These people must act tirelessly, as they are practically the only sources of enlightenment on the whole of DU.

I wouldn't have thought that this particular thread would provoke a flamewar, but I was obviously naive. :)

[trotsky]

24. As compared with the other group in here,

who routinely disparage hard-working medical professionals and researchers, and when they can't argue with facts, must turn instead to personal attacks like your post here.

[HamdenRice]

26. All the "hard working medical professionals" I know hate the insurance companies

so it's odd that you would defend the insurance companies in the name of doctors and nurses.

[trotsky]

28. Which of course, I'm not.

Just the latest in your infinitely long line of strawmen.

[HamdenRice]

27. You seem to be missing most of the important issues

Your own stats say that technological costs are only 1/2 of the cost increases. But cost isn't the main issue -- it's lack of universal coverage, unnecessary expense, restriction of the insured pool, insurance companies "gaming" the system for those who are covered (denials of reimbursement), and insurance company micro management of doctors time and treatment decisions, leading to less optimal care.

Also, most of the increase in technological expense comes at the end of life, not at the beginning -- a problem of agency created once again by insurance companies.

[Hannah Bell]

25. They have CAT, MRI, & drugs in Europe & Japan. But in those places,

they cost less. Not to mention the populations generally have a higher life expectancy.

[NV Whino]

5. Thanks for posting this

I'll check it out.

[mzmolly]

6. Off to the greatest.

:kick:

[tavalon]

8. Thank you

I worked at Tricare as a "healthcare finder" but I quickly learned that my job was to keep people from getting their care but I simultaneously learned how to circumvent that system. It's the only reason I stayed for a year - I got real good at making sure the retirees got the healthcare. I redefined "healthcare finder" to mean more of what I thought it should. But, in the end, I organized a workers revolt and then, um, resigned.