Why is Obama saying that our healthcare costs are way too high?

[Anonymous]

Countries with socialized medicine routinely have rationing treatment.this is something we have never done in the states and I hope we never do. Also countries with socialized medicine are on the brink of financial collapse because, at some point, even the money from the rich in taxes just runs out. If people really knew what was going to happen in healthcare they wouldn't consider a government option. The problem is too few people in our country think critically and just go along with everything Obama says, even when it makes no financial sense.

[jsteele]

Anonymous wrote:Countries with socialized medicine routinely have rationing treatment.this is something we have never done in the states and I hope we never do. Also countries with socialized medicine are on the brink of financial collapse because, at some point, even the money from the rich in taxes just runs out. If people really knew what was going to happen in healthcare they wouldn't consider a government option. The problem is too few people in our country think critically and just go along with everything Obama says, even when it makes no financial sense.

'

This might be an interesting argument if Obama were proposing socialized medicine. He's not.

[Anonymous]

Anonymous wrote:Medical malpractice claims (or defense of such claims) might only account for 1% of US healthcare costs but defensive medicine practices account for probably 25% of all testing/interventions in the US. Ask any doctor and they'll agree that a huge chunk of what they do, they do because they have to cross every last T and dot every last I in the event that they will be accounting for their actions later and not because the interventions lead to better health outcomes.

Frankly, I don't see "defensive medicine" ever ending in this country because what have become the "standards of care" in medicine are such based on years of practicing defensively. This is not going to change overnight or ever regardless even if we ever get tort reform. Case in point. I have a long history of migraines. Last month I had a horrible migraine that was not helped by my prescription migraine medicine. It was obvious that my headace was a migraine (had the classic aura, etc). I was 100% convinced of this. Went to the ER for pain control. ER doctor insisted that he needed to get an MRI of my head which he said he 100% expected to be normal but he felt obligated to order. Of course it was benign. In my excruciating pain I didn't protest. Did I need a $4K scan to tell the doctor what he and I both already knew? No, but standard of care for head-ache work-up in the hospital these days is a head scan because God forbid one not be done and the hospital be held liable for something they missed while I was under their care. Would this MRI have been done 15 years ago? probably not. Will it ever not be done in the future even if we had all sorts of liability caps? No, because it has become standard of care and changing this at every ER and in every practice setting across the country won't happen.

It's not 25%, though. The largest number produced by any real analysis is 9% for malpractice + defensive medicine.

[Anonymous]

Anonymous wrote:Countries with socialized medicine routinely have rationing treatment.this is something we have never done in the states and I hope we never do. Also countries with socialized medicine are on the brink of financial collapse because, at some point, even the money from the rich in taxes just runs out. If people really knew what was going to happen in healthcare they wouldn't consider a government option. The problem is too few people in our country think critically and just go along with everything Obama says, even when it makes no financial sense.

A. He's not proposing socialized medicine.
B. Only a tiny part of health care involves waits in Europe. If you took all procedures types subject to waits in the UK, it would be around 3% of our healthcare expense, ie, the whole rationing argument is way overblown.

[Anonymous]

Oh god please. He is proposing socialized medicine. He knows that when the government gets into the mix, it will push the privates out in a matter of years. His hope is for a single insurer, the government. He is not stupid and will not admit this because it would send everyone running but the dollars don't work out. Look at what he is already proposing..taxing your benefits at work, taking away tax credit to companies, reducing medicare and medicaid payments to hospitals. This will send a lot of people right to the government plan and it will be too late to turn things around after the process has been started. God look at Social security, look at medicaid and medicare. Why not fix those first before ruining our insurance. I don't know any doctors in private practice who think his ideas make any kind of sense.

[Anonymous]

It's not 25%, though. The largest number produced by any real analysis is 9% for malpractice + defensive medicine.

I'm a physician (as is my husband) and there's no way in hell it's only 9%. "Defensive medicine" leads to an extraordinary amount of extra testing being ordered.
We do it all day, every day and so do all our colleagues.

[Anonymous]

don't know whether it's one in a hundred, one in a thousand, or whatever, but if you happened to be one of the unlucky few with a brain tumors, wouldn't you consider it worth the expense? I am not claiming it is a clear call, only that the practice has some benefits.

Yes, but you simply CANNOT insure an additional 46 million people and practice medicine that does 4K MRIs for all headaches in hopes of discovering the 1/1000 or 1/10,000 cases of brain tumors when the clinical symptoms clearly point to another diagnosis (migraine). You can't have it both ways. You sure as heck wouldn't get an MRI like this in the ERs of Great Britain or Canada. And you won't get them here (a very good thing in my opinion as a health care provider) in this country if we are serious in insuring the uninsured by reducing costs. Something will give.

[Anonymous]

Anonymous wrote:

It's not 25%, though. The largest number produced by any real analysis is 9% for malpractice + defensive medicine.

I'm a physician (as is my husband) and there's no way in hell it's only 9%. "Defensive medicine" leads to an extraordinary amount of extra testing being ordered.
We do it all day, every day and so do all our colleagues.

Agree. I am also a doctor. In Australia, the management of back pain is much cheaper than here. No MRIs, no surgery except in special cases. Heck, we get labs on everyone who comes for a physical. Why? A healthy 25 year old male needs NO lab work.

[Anonymous]

Anonymous wrote:

Anonymous wrote:...ER doctor insisted that he needed to get an MRI of my head which he said he 100% expected to be normal but he felt obligated to order. Of course it was benign. In my excruciating pain I didn't protest. Did I need a $4K scan to tell the doctor what he and I both already knew? No, but standard of care for head-ache work-up in the hospital these days is a head scan because God forbid one not be done and the hospital be held liable for something they missed while I was under their care...

I don't know whether it's one in a hundred, one in a thousand, or whatever, but if you happened to be one of the unlucky few with a brain tumors, wouldn't you consider it worth the expense? I am not claiming it is a clear call, only that the practice has some benefits.

No, she said that she had a long history of migraines. Any doctor should be able to use his judgment and treat it as a migraine. There is no need for an MRI. It could be an intracranial bleed, but the history would be a bit different. It might be a tumor, very rare, but an MRI is still not warranted.

[Anonymous]

Anonymous wrote:

It's not 25%, though. The largest number produced by any real analysis is 9% for malpractice + defensive medicine.

I'm a physician (as is my husband) and there's no way in hell it's only 9%. "Defensive medicine" leads to an extraordinary amount of extra testing being ordered.
We do it all day, every day and so do all our colleagues.

I don't doubt that you order a lot of extra tests, but you may not be in a position to see the overall cost to health care. That's more of a financial analysis. But do the math on this a second. We are 240% of the average cost of OECD nations. In order to explain the difference between us and them in terms of defensive medicine, you would need to charge $140 dollars in services for every $100 dollars of services needed. That means that less than half of everything charged is defensive medicine. Not half of diagnostic tests. Half of everything. That's just not possible.

[Anonymous]

That wasn't quite clear. You would need to charge $140 in defensive medicine fo every $100 of needed services provided.

[Anonymous]

Yes 240% of the average, but 150% the next highest.

BUT, yes we can explain the extra costs by looking at malpractice. Also, the culture that comes from patient power. Doctors in the US are afraid of their patients. We are afraid to tell them what to do, and they often do not listen. That can be expensive. There was a time when GPs would routinely give antibiotics for viral infections because they could not get their patients to stop calling them if they weren't given something. That was sad, some of that continues. It goes on and on. We can't just ask a woman about whether or not she's pregnant prior to a procedure, god forbid she is wrong, you get sued, so pregnancy test on EVERY woman/girl who menstruates prior to surgery.
You should see the thick charts generated by 89 year old granny. Every orifice gets a scope, every thing that can be x-rayed is x-rayed, every lab value is done, then we find a cancer, then she gets surgery, a port, chemo, then kidney failure, then dialysis, then surprise, she still dies. Hope she does not die in your care, because you get blamed, and yes the family sues.
I know of one family who sued when their adult daughter died after trying to kill herself with an acute hunger strike. By the time she got to the hospital, she was malnourished and immunocompromised. The IV caused a sepsis and infection in her heart, which killed her. They won a lot. This is someone who wanted to die.

[Anonymous]

Anonymous wrote:Yes 240% of the average, but 150% the next highest.

BUT, yes we can explain the extra costs by looking at malpractice. Also, the culture that comes from patient power. Doctors in the US are afraid of their patients. We are afraid to tell them what to do, and they often do not listen. That can be expensive. There was a time when GPs would routinely give antibiotics for viral infections because they could not get their patients to stop calling them if they weren't given something. That was sad, some of that continues. It goes on and on. We can't just ask a woman about whether or not she's pregnant prior to a procedure, god forbid she is wrong, you get sued, so pregnancy test on EVERY woman/girl who menstruates prior to surgery.
You should see the thick charts generated by 89 year old granny. Every orifice gets a scope, every thing that can be x-rayed is x-rayed, every lab value is done, then we find a cancer, then she gets surgery, a port, chemo, then kidney failure, then dialysis, then surprise, she still dies. Hope she does not die in your care, because you get blamed, and yes the family sues.
I know of one family who sued when their adult daughter died after trying to kill herself with an acute hunger strike. By the time she got to the hospital, she was malnourished and immunocompromised. The IV caused a sepsis and infection in her heart, which killed her. They won a lot. This is someone who wanted to die.

Yes, but there is a huge drop off from there. Most big countries are half our cost. Besides, do we really only aspire to go from "worst by a lot" to "nearly tied with the 2nd worst?"

[Anonymous]

I think it's intersting that doctors fixate on malpractice lawyers. What about the insurance companies? Aren't they effectively calling the shots, telling doctors that they can only do X if they've done ABC. Case in point: I went to the ER with a massive headache and vomiting. The doctor wanted to admit me for observation. She could not without doing a spinal tap first! A spinal tap! I have other examples. My doctors complain more about the insurance shackles than defensive medicine. Would some kind doctor explain this to me?

[Anonymous]

Anonymous wrote:I think it's intersting that doctors fixate on malpractice lawyers. What about the insurance companies? Aren't they effectively calling the shots, telling doctors that they can only do X if they've done ABC. Case in point: I went to the ER with a massive headache and vomiting. The doctor wanted to admit me for observation. She could not without doing a spinal tap first! A spinal tap! I have other examples. My doctors complain more about the insurance shackles than defensive medicine. Would some kind doctor explain this to me?

Related question: Have any of you seen (or is someone ambitious enough to look up) figures of the profitability of malpractice insurance? I am wondering how much the cost is driven by legal suits and how much by the profit motive.