[mike777]

5 grand in usa spent on health care per person in Usa, every year.

In twenty years will half of that be spent on early detection, imaging, chips and a new style of personalized medicine? That would mean an end to medicine as we(I) think of it today.

For more on this subject see Fred Hutchinson Cancer Research Center.

[Winstonm]

Imaging won't do a thing to cure Ebola. It will not help stop Vancomycin-resistance. It does not eliminate prions.

Better imaging may lead to slightly earlier detection of cancer, but only if used as a tool during a routine physical, which would inflate the cost. For most, it is after symptoms appear they go to the doctor and the doctor orders the tests - by that time the cancer is larger enough to been found by today's standard means.

The overriding factor in U.S. healthcare is cost. Improved technology may or may not lower that cost. But it seems to me that to blithely tout that technology in a capatilist society will save the day is more about maintaining status quo politicaly than actual health care concerns.

[mike777]

"Imaging won't do a thing to cure Ebola"

Why not, I do not understand this type of thinking.

If you can see pictures of the Ebola virus acting at the atomic or molecular level, how can that not do something to help find a cure?

Finding any disease at a very early stage must be cheaper to treat than finding it in the later stages. Seeing how any disease interacts at the protein or gene level must be a great first step in finding a cure? What is a better first or second step?

Why is imaging only used in a routine physicals? Can I not use my cheap home version that finds cancer for pennies in the future? We have home tests for pregnancy that we did not have 100 years ago that costs pennies. Why not for some forms cancer or cardio issues in the future?

Yes I think technology in a capitilist society will save the day? If not what will, the government?

[luke warm]

Hannie, on May 28 2007, 11:37 PM, said:

DrTodd13, on May 28 2007, 11:20 PM, said:

Wow.  A lot of stuff here to digest.  The problem with questions like "how should we reform health care" is that the answer depends totally on what one values most and who the "one" is that gets to make the decision.  Do we want to minimize health care costs?  Do we want to maximize care?  Is the "ideal" some tradeoff and if so who sets it?  We have a mechanism for making such decisions and it is called the market.  Unfortunately, the system is currently engineered almost to eliminate market forces.  First, a positive of our system is speed of care.  You hear horror stories from Canada about ridiculously long waits for treatment which is an indication of price controls.  Price controls always lead to scarcity.

The big negative of our system is its cost.  There are several reasons as I see it.  First, demand is sky high.  For any commodity, if the price is invisible the demand will soar and so will the underlying cost.  Low deductibles increase demand for health care because after a point you are spending somebody else's money...at least that is how people see it.  What they don't realize is there is no free lunch and they or someone else is paying for it somehow.  Second, government interference for things like drug imports.    Drugs are cheaper elsewhere than they are in the country they are produced.  There is no reason for this other than limits on market forces.  Third, the focus on treatment rather than prevention.  There isn't as much money to be made in prevention as there is in treatment.  Fourth, malpractice insurance probably adds a lot to the cost of care.  We need to find someway of addressing exorbitant lawsuit awards. 

For me, not being a slave is important and as such being forced to pay for someone else's health care I find offensive.  In an ideal world, everybody would pay for their own health care.  If I could wave a magic wand and convince people the best thing to do, here is what I'd do.  Eliminate all government regulation of everything health and drug related.  Convince everyone to only carry catastrophic health care insurance so that they see the cost of routine care and so competition will drive prices down.  Convince people to eat less and exercise more.

You are disgusting.

i don't understand, han... why?

[jtfanclub]

Rain, on May 28 2007, 02:13 PM, said:

My first *serious* thread, interested to know what you think is the best way to reform health care. Lets limit to USA since otherwise it is too broad.

I will favour practicalilty over idealism. ie, ideal = complete health care provided free, for everyone, but it ain't going to happen.

Going all the way back to the beginning question....

Quote

Favour simplicity.

OK.

1. Each employer has to pay $1000 per year to the government for every full-time equivalent employee they have (ie. fifty cents per hour of work). For every two dollars the employer pays for health insurance for this person/family, the amount gets reduced by one dollar.

2. Require HMOs to cover life threatening pre-existing conditions. To some extent, PECs will be covered by the funds paid by the employers in #1. HMO's will still lose money on PECs, but it won't be the disaster it would be otherwise.

3. The remaining money gained by #1 and not paid out in #2 would be paid to hospitals for uninsured life-threatening medical care.

Eventually, we'd balance out the amount employers have to pay so that HMOs and hospitals would get 75-80% of their bill paid for by the fund, though it would probably start out lower.

That'd at least get all the pre-retirees. Medical coverage for retirees has lots of impossible choices.

[keylime]

This is a very thorny subject, but to be succinct:

1. Universal health care coverage would act as an engine brake on the economy, and cause higher deficits with reduced levels of service; a 2 or 3 tier health care system would develop rapidly, thus enlarging the gulf between the "haves" and the "have nots".

2. Small businesses and non-for-profits would have a harder time recruiting new employees and more importantly, retaining them. Health care and tangible "human benefits" are a lucrative asset that companies are offering to attract folks.

3. The federal government already is the largest funder of health care in the United States. I just don't think the gov't should be in the business of having complete control of health care decisions and allotments and such.

[Winstonm]

Why is it we oppose government health care yet support government wars?

[pbleighton]

Quote

Why is it we oppose government health care yet support government wars?

Health care isn't exciting.

Peter

[mike777]

You guys suggest reforms, I suggest the End of Medicine as we know it.

Think Big!

Is that exciting enough?!

[Winstonm]

mike777, on May 29 2007, 09:39 PM, said:

You guys suggest reforms, I suggest the End of Medicine as we know it.

Think Big!

Is that exciting enough?!

I suggest the end of war as we know it.

Think Bigger!

[helene_t]

jtfanclub, on May 29 2007, 07:42 PM, said:

Quote

Favour simplicity.

OK.

1. Each employer has to pay $1000 per year to the government for every full-time equivalent employee they have (ie. fifty cents per hour of work). For every two dollars the employer pays for health insurance for this person/family, the amount gets reduced by one dollar.
[.....]

This doesn't sound "simple" to me. Why involve employers at all? At least two parties, namely patients and care providers, need to be involved. Insurance companies and/or government are probably unavoidable as well. Add to those the parents in case the patient is a child. (And, in the US, a judge and at least two lawyers, sigh). With at least 3 and maybe 6 parties involved in a single transaction, health care financing is already very complex without the involvement of employers.

Here are two simple schemes:

1) No government interference. People are free to buy all the CT scans, vaccinations, heart transplants, birth control pills, aura healing and snake oil they can afford. The free market determines the prices. Of course if someone wants to set up am insurance company, a charity or whatever they can do it as well. No possibility of malpractice lawsuits (except for outright fraud) but if patients (=customers) are dissatisfied the rumor will spread and the provider will go bankrupt.

2) Everything free of charge. Health workers get a fixed salary from the government and treat those they think need their services the most. No possibility of malpractice lawsuits but if workers receive too many complaints they get fired.

Both scenarios are a little exaggerated but I'd like to see something like 2) for absolute necessities and 1) for services the necessity of which is debatable. (No, "debatable" is the wrong word when it comes to individual decisions: read "matter of taste").

Winston said:

Why is it we oppose government health care yet support government wars?

Because war is bad business and health care is good business. Think of your 90-feet-yaught friend. Of course he doesn't want government to take over his business niche. Then think of all the 90-feet-yaught-people in the weapon industry. Who would buy their toys if the goverment didn't? Do you think some venture capitalist would invest trillions of dollars in a commercial (=no government funding) campaign against the axis of evil?

Mike777 said:

You guys suggest reforms, I suggest the End of Medicine as we know it.

Think Big!

Is that exciting enough?!

Sure. If the title of this thread had been "Write an exiting Science Fiction story about the future of Health Care" then I'd be all for this "end of medicine as we know it" thing.

[Gerben42]

Quote

yaught

You must meen yacht (One of the many borrowed Dutch sailing words in the English language).

Quote

Because war is bad business and health care is good business. Think of your 90-feet-yaught friend. Of course he doesn't want government to take over his business niche. Then think of all the 90-feet-yaught-people in the weapon industry. Who would buy their toys if the goverment didn't? Do you think some venture capitalist would invest trillions of dollars in a commercial (=no government funding) campaign against the axis of evil?

But normally only a tiny fraction of people are involved in the weapons industry and healthcare involves everyone. I wonder if sold correctly how many votes you would win by promoting healthcare instead.

Imagine the difference the $1,000,000,000,000 that were spent on the Iraq war would have made if it were spent on health care. That's one HUGE number. It's a million million dollars. Even for a large country like the USA it means $30,000 per capita. That's right. Your government spent $30,000 per inhabitant on the Iraq war.

Imagine if instead HALF that was simply given back to the people in a fair way (one head - one share). A family of 4 would get $60,000. For the "very poor" in the US that means 6 years of salary!

Health insurance for all the uninsured in the country would have costed significantly less than the Iraq war.

[mike777]

helene_t, on May 30 2007, 02:32 AM, said:

jtfanclub, on May 29 2007, 07:42 PM, said:

Quote

Favour simplicity.

OK.

1. Each employer has to pay $1000 per year to the government for every full-time equivalent employee they have (ie. fifty cents per hour of work). For every two dollars the employer pays for health insurance for this person/family, the amount gets reduced by one dollar.
[.....]

This doesn't sound "simple" to me. Why involve employers at all? At least two parties, namely patients and care providers, need to be involved. Insurance companies and/or government are probably unavoidable as well. Add to those the parents in case the patient is a child. (And, in the US, a judge and at least two lawyers, sigh). With at least 3 and maybe 6 parties involved in a single transaction, health care financing is already very complex without the involvement of employers.

Here are two simple schemes:

1) No government interference. People are free to buy all the CT scans, vaccinations, heart transplants, birth control pills, aura healing and snake oil they can afford. The free market determines the prices. Of course if someone wants to set up am insurance company, a charity or whatever they can do it as well. No possibility of malpractice lawsuits (except for outright fraud) but if patients (=customers) are dissatisfied the rumor will spread and the provider will go bankrupt.

2) Everything free of charge. Health workers get a fixed salary from the government and treat those they think need their services the most. No possibility of malpractice lawsuits but if workers receive too many complaints they get fired.

Both scenarios are a little exaggerated but I'd like to see something like 2) for absolute necessities and 1) for services the necessity of which is debatable. (No, "debatable" is the wrong word when it comes to individual decisions: read "matter of taste").

Winston said:

Why is it we oppose government health care yet support government wars?

Because war is bad business and health care is good business. Think of your 90-feet-yaught friend. Of course he doesn't want government to take over his business niche. Then think of all the 90-feet-yaught-people in the weapon industry. Who would buy their toys if the goverment didn't? Do you think some venture capitalist would invest trillions of dollars in a commercial (=no government funding) campaign against the axis of evil?

Mike777 said:

You guys suggest reforms, I suggest the End of Medicine as we know it.

Think Big!

Is that exciting enough?!

Sure. If the title of this thread had been "Write an exiting Science Fiction story about the future of Health Care" then I'd be all for this "end of medicine as we know it" thing.

Helene

Science Fiction? I named sources and Phd's for more information.
Do you simply dismiss what these guys write about? If so why? Have you read what they write about? This comment comes across as a very unscientific response.

If you have read what they have to say on this matter, where and why are they wrong?

If you disagree with these Stanford Professors or articles coming out of Fred Hutchinson Cancer Inst. here is a list of 70 other articles on this subject and the Professors, universities or companies involved. This is real science and I expect the advances in the next 20 years to be real, not fiction.

http://advancednano....h/label/imaging

[pbleighton]

Quote

You guys suggest reforms, I suggest the End of Medicine as we know it.

Think Big!

Is that exciting enough?!

In the meantime you have consistently refused to address the deficiencies of the current system of DELIVERY, compared to other advanced industrialized nations.

So, hundreds of thousands of dead babies until your fantasies come true.

Peter

[mike777]

pbleighton, on May 30 2007, 07:39 AM, said:

Quote

You guys suggest reforms, I suggest the End of Medicine as we know it.

Think Big!

Is that exciting enough?!

In the meantime you have consistently refused to address the deficiencies of the current system of DELIVERY, compared to other advanced industrialized nations.

So, hundreds of thousands of dead babies until your fantasies come true.

Peter

Peter, yes I did, I listed 2 sites that compare and contrast with other systems.

scroll back a ways.

btw guys and gals the title of the post was "reform health care", not just the "delivery" part of the system. If you wish to invent your own demand and supply system of health care and fool around with the price mechanism, good luck I hope you do not do more harm than good.

I cannot even understand my own health care choices/plans and have yet to find anyone who truly does.

If you are brilliant enough to have the delivery plan to save millions of lives, go for it.

[pbleighton]

Quote

If you are brilliant enough to have the delivery plan to save millions of lives, go for it.

See my first post. Not original, but it would do the job.

Peter

[helene_t]

Mike777 said:

Science Fiction? I named sources and PhD's for more information.
Do you simply dismiss what these guys write about? If so why? Have you read what the write about?

As a researcher at a genetics lab I've been involved in a lot of futuristic projects and when I open my monthly copy of Scientific American, health tech is among the subjects that I read about the first. I won't say that I "know what I'm talking about" because my expertise is limited to a narrow field, namely statistics and informatics in genetics research. I just try to extrapolate what I know about my own field to other fields that are advertised with similarly colorful diagrams.

For the moment I'm working on genetic screening. Until now, it has not been very useful because
1) For most diseases we have no clue if there is a genetic factor, let alone which one
2) The accuracy is way too low for screening purposes - in fact it can only be used when we already have strong suggestions about what disease a particular patient might have.
3) A genetic diagnosis usually doesn't tell us which treatment might work.

Now at least 2) is about to change radically. Maybe in twenty years from now you can by a DNA sequencing kit for a few Euro at any drugstore and get your DNA sequence with an accuracy of 99.999%.

As for 1) and 3) some believe it will change radically as well. I'm skeptical, mainly because it's so obvious why everybody in the field want the public to believe in the usefulness of the research:
- The clinicians want us to believe they can create miracles because such a belief is good for their social status. Just like the witchdoctors in any tripe want people to believe in the witchdoctors' supernatural gifts.
- Researchers want justification for more funding
- The media want the stories they sell to be exiting
- Biology teachers want schoolchildren to pay attention
- People are afraid of getting old and sick. They want to believe in some miracle. Any miracle.

Now suppose all the health-tech dreams came true. One day I can have my whole body screened to minute details. The computer will tell me:
"Your health is deteriorating because you inherited some bad genes from your parents, have been exercising too little, slept too little, ate too much, didn't chew your food enough and ate too few vegetables, but above all because you're getting older. I can advice you to change your lifestyle and I can prescribe some painkillers but basically, you had limited prospects to begin with and part of your prospects you already ruined."

What else is new ......

[jtfanclub]

helene_t, on May 30 2007, 02:32 AM, said:

This doesn't sound "simple" to me. Why involve employers at all?

Which is simpler? A car or a human? Well, a car, of course. and yet, two cavemen can create a human, but good luck on them creating a wheel, let alone a car.

Employers already provide health benefits to their employees. They already report these to the government, as they are tax deductible. They already send money to the government for each employee, for Social Securtiy. The government already pays HMOs and hospitals, thanks to Worker's Compensation.

So to add my proposal, the government changes a number in their computers, which makes the employers pay more taxes. Worker's Comp expands to include off-the-job injuries for non-insured people or people injured with Pre-Existing Conditions, with help from other already existing government agencies what determine what is a PEC.

Is it simple? Well, no, not if you had to build it from the ground up. But to actually implement it? It's incredibly simple. All the complex stuff is already built.

[mike777]

If anyone has a Universal Health care plan, great.

I could care less about the details.

Just tell me two things about it:
1) The opportunity costs involved in your plan versus our present system. What are they and how did you measure them?
2) How are you going to combat rent seeking behavior? What rent seeking behavior will come out of your plan and how will you fight it? I assume you will fight it.

[helene_t]

jtfanclub, on May 30 2007, 05:24 PM, said:

Employers already provide health benefits to their employees.  They already report these to the government, as they are tax deductible.  They already send money to the government for each employee, for Social Securtiy.  The government already pays HMOs and hospitals, thanks to Worker's Compensation.

I don't understand anything of this but that's probably just because I'm not familar with the American system.

Here in the Netherlands we used to have employer-payed health insurance. Fortunately we got rid of it a couple of years ago. It was a nightmare.
- Whenever I changed employer I had to reconsider my insurance plan.
- Some employers had collective insurance plans for their employees which were more expensive than the cheapest individual plans. So those emplyees that were healthy enough to qualify for the cheapest individuals backed out, making the collective pool even more expensive. Eventualy that would lead to a situation in which almost everybody would back out and only those with really poor health would stay, and pay enoumously. They would then start looking for another job that could offer a cheaper insurance etc.
- Whenever I quit one job I had to apply for a temporary individual insurance until I found another employer. For a few weeks this wasn't worthwhile but once I had to renew my residence permit during a gap between two employers, and the imigration required me to show an insurance plan. So I applied for a plan (I knew they would turn me down because my health was too bad but the trick is to apply just a couple of days before the visit to the police so that my application hadn't been turned down yet).
- Some people have multiple employers and it has to be decided which of them organize the insurance thing.
- What if you live in the U.S. and work in Mexico. Should your Mexican employer pay for your U.S. insurance? Or should you have a Mexican insurance? In the latter case, would you have to go to Mexico to get treated? Would any legal issue related to your insurance be settled by a Mexican or a U.S. court? Applying Mexican or U.S. law?

Not everybody has an employer so there will have to be a system for those without an emplyer. Now you might as well extent that system to those who have an employer.