Overworked Americans

[AdamA]

Adam, am I right that the Veteran's hospitals have superb treatment outcome statistics though? Doesn't that make it worth putting up with a Greyhound Bus Station style ambiance (is that what it is like?)?  When I go to hospital I want to get well -period.

I don't know.  I have never seen the numbers. 

[stone]

Adam, I had seen other things about it before but I just googled and found this:
http://www.marketwatch.com/story/its-ha ... 2010-06-02

Health-care providers practice in teams and doctors are salaried as opposed to being paid a fee for service. That helps remove an incentive to order tests and procedures that aren't necessary, a key problem in the broader U.S. health system when physicians practice defensive medicine or try to maximize their income, said Phillip Longman, senior fellow at the New America Foundation and author of a book about the VA called "Best Care Anywhere."
"The rest of the health-care system doesn't have a business case for quality," Longman said. "Quality usually costs them money because they get paid to perform procedures on sick people.
"There are many idealistic people in medicine trying to do the right thing, but in our system no good deed goes unpunished," he said, citing diabetes care as an example.
"The big money is in letting diabetics decline to the point they need an amputation, need dialysis, become blind. That's where you make your big money, not in keeping them well. Once you know a little about how this world works, it stands to reason the VA's the best care," Longman said.
.......Longman estimates the rest of the health-care system is about 15 years behind not just in health-information-technology implementation but also in moving toward a patient-centered care model.

[FarmerD]

Is it true that the US veteran's health care provision is US government run and yet one of the best health systems in the World? Is there any appetite in the US for letting non-veterans buy into such a system? I am asking as a UK citizen and we have a flawed, government run, system here.

I would be very sad if the only health care I had access to was through the veterans hospital system.

If anyone gets a chance, go visit the local VA hospital.  Imagine a bunch of down on their luck vets being herded around like a bunch of cattle through a slum hospital.  Honestly, I felt really, really sad at the end of my visit.  At least that was my impression. 

FYI - There are a lot of active duty officers who carry private health insurance and are seen by providers off base.

[stone]

FarmerD, the picture that is emerging is that the medical treatment is the best of the best in terms of outcomes and what is done is outcome focussed BUT the standard of everything else (eg making the place seem nice) is awful. Are the staff friendly and welcoming but the furniture etc shabby? I'd personally be fine with a shabby look in order to access the best medical care. Rude staff would test my resolve more. In the UK hospitals everything looks shabby. In my experience the staff have been really friendly BUT we have pointless and dangerous delays etc etc. The veteran system you have gets touted as an example of how a system similar to our NHS has been got to work well. That is why I'm so interested that you guys don't see it as good.

[MediumTex]

FarmerD, the picture that is emerging is that the medical treatment is the best of the best in terms of outcomes and what is done is outcome focussed BUT the standard of everything else (eg making the place seem nice) is awful. Are the staff friendly and welcoming but the furniture etc shabby? I'd personally be fine with a shabby look in order to access the best medical care. Rude staff would test my resolve more. In the UK hospitals everything looks shabby. In my experience the staff have been really friendly BUT we have pointless and dangerous delays etc etc. The veteran system you have gets touted as an example of how a system similar to our NHS has been got to work well. That is why I'm so interested that you guys don't see it as good.

I think we don't see it as good because the same or better level of care is available with private insurance and you can go to the facility of your choice.

Over the course of my life, probably 90% of the discusssions in which the term "VA hospital" has been used has been in conjunction with something bad.

Harry Browne would probably say that the VA hospital system delivers about what one would expect from a government run healthcare system.

[AdamA]

Adam, I had seen other things about it before but I just googled and found this:
http://www.marketwatch.com/story/its-ha ... 2010-06-02

My guess is that the care you get at the VA is just as good what the average person would get anywhere.  

Health-care providers practice in teams and doctors are salaried as opposed to being paid a fee for service. That helps remove an incentive to order tests and procedures that aren't necessary, a key problem in the broader U.S. health system when physicians practice defensive medicine or try to maximize their income,

I think this is myth.  I think the reason doctors over test these days is because it's just how they're trained.   I'd bet that salaried doctors order as many silly tests as those who are paid a fee for service.  

Here's a good quote from Emergency Medicine Abstracts.  "Defensive medicine is only partially responsible for the overall provision of unnecessary care. It is also driven by a culture that places excessive value on procedure- and technology-intensive care, and the evolving processes by which high-tech, high-cost interventions are ultimately incorporated into community standards of care."

There probably is some truth to the idea that unnecessary procedures are done for financial gain.  I don't think it's done consciously, though.  What's the saying...It's difficult to get a man to understand something when his salary depends on not understanding it.

Here's a pretty good book about some of this stuff.

http://www.amazon.com/Worried-Sick-Pres ... 0807831875

[moda0306]

I was waiting for the topic of healthcare to hit a true stride on this forum, though I don't have the resolve to really dive into it, I tend to see the statistics of gov't healthcare in western countries as being clearly in favor of gov't healthcare, if you are not putting heavy weight on the freedom of choice and a lot more weight on public health and simple health statistics.

I tend to think both health insurance and patient care are horrible examples of what an efficient market should look like.  Consumers of insurance don't have the knowledge nor the time to read the insanely complicated contract they're entering into, and when they're actually receiving care, they're often sick and under-informed, completely at the whim of whatever their doctor suggests.

"Informational Assymetry" is one of the commonly identified market failures, and it's found in spades within healthcare, not to mention the moral quandry we're in as a society when choosing whether or not to simply let somebody die when they're not properly insured and get sick or get in a car accident.

I think as one becomes more wealthy and intelligent, they're able to become better consumers of healthcare, and therefore benefit by a more free-market system.  However, most people aren't in a position to be good consumers in these areas, and for them, statistically, it appears they'd benefit from some of the protections a government can provide through regulation or administration of health insurance and/or patient care.

[stone]

moda, I'm not sure that being wealthy turns people into astute consumers of health care- look at Michael Jackson. Your point about information asymetry and market failure is well made. One thing that really strikes me is how outcome statistics show that good doctors only stay good if they see a massive number of patients all the time. They need massive immediate experience so that they spot issues "by instinct". That favours a production line approach that is at odds with what appears, at first glance,  to be quality service.
I'm curious that people on here were so repelled by the US veteran hospital system. I wasn't asking whether American's wanted that as the only option, I was only asking whether they would pay to join it if that was available as an option. I'm fascinated that the answer seems to be that people want to pay double the cost to get a worse service in terms of health outcomes because veteran hospitals don't project an aura of respect for the individual (I hope I have understood the gist of the comments-sorry if I haven't).

[smurff]

Stone, I think we here on this forum are mostly a highly educated, inquisitive, affluent, and largely self-directed bunch. So the United Statesians on the forum might have a very different view of gov. Sponsored healthcare systems than our fellow citizens and residents as a whole.

I can see that many Americans would line up to buy into the VA system if given the opportunity and if the cost were reasonable. Same with Medicare (currently, only for over 65 or long-term disabled).  Many are actually begging for the opportunity, with those pleas falling on unhearing ears.

And if individuals did not sign up in droves for the VA or Medicare, the corporations that pay for their healthcare would cause them to do so--unless the fed. Gov. Provided them (companies) with enough incentives and subsidies to keep their employees on their current or similar private plans, as happened with Medicare Part D.

One criticism about VA outcomes data is that since the VA system is designed for former military, a large segment of the population that consumes healthcare is left out of their stats. Children (all ages, from neonates to late teens) are totally excluded, and even today the percentage of veterans who are female is too small on a relative basis for the VA to have reliable stats related to women's healthcare.  I understand that the latter has changed somewhat but I doubt that it has changed enough.

[smurff]

"The majority of USians that filed for bankruptcy, did so due to healthcare bills (especially from some catastrophic bill like cancer), and the majority of that cohort actually had health insurance."

I'm curious about how this works. Does the standard insurance not cover the full treatment? Also if you have had cancer in the past; does that make your future insurance more expensive as with crashing a car for car insurance?

It works in a manner similar to the MF Global imbroglio, without the bankruptcy. Insurance companies In the USA will collect premium payments for years, then challenge every iota of the claim.  The challenges can include whether you neglected to say you had acne as a teen when you filled out the initial application and listed you pre-existing conditions.  When they are finished, the bill for, say a non-auto accident that totals  $155 000 of which the insurance company is expected to pay at least 80%, becomes after insurance company challenges, $55 000 of compensable claims. The insurance company then owes only $44 000 (instead of $124 000) and the patient owes $111 000 (instead of $31 000 or less).  In theory the patient can sue the insurance company, but over the past 30 or so years there has been much legislation and regulation (federal and state) that makes such suits a losing proposition from the beginning--which means it will be very difficult to find a lawyer to help.

Insurance companies are very lightly regulated (some would say unregulated) compared to other corporations, so when they engage in practices like this, there is no braking mechanism to keep them from going forward.

And while we're on the topic of overworked Americans, one of the consequences of that overwork is the lack of opportunity for long-term travel.  Americans generally have no idea what healthcare is really like in other countries because we haven't been in another country long enough to experience it's system. The tendency is to rely on gossip and views of others with agendas.