CorruptUser wrote:- The US doesn't have a worse outcome than most. We have 1/3 the complication rate than the next best major country, though this data tends to be polluted by the fact that so many of the procedures done were unnecessary to begin with.
Could you expand on that a little bit? What kind of complications -- post-surgical, iatrogenic infections, prescription errors?
- We all agree that the US is expensive and that there is a large amount of waste. I was mainly arguing that a large part of the waste was because of legal issues. Another huge part is end of life care for people whose death is inevitable (and no, not that "we are all going to die, man").
People disagree about how much legal costs contribute to medical costs. About 2% is the best estimate I've seen (http://health.usnews.com/health-news/ma ... year-in-us
Another good discussion:
http://prescriptions.blogs.nytimes.com/ ... are-costs/
Q.But critics of the current system say that 10 to 15 percent of medical costs are due to medical malpractice.
A.That’s wildly exaggerated. According to the actuarial consulting firm Towers Perrin, medical malpractice tort costs were $30.4 billion in 2007, the last year for which data are available. We have a more than a $2 trillion health care system. That puts litigation costs and malpractice insurance at 1 to 1.5 percent of total medical costs. That’s a rounding error. Liability isn’t even the tail on the cost dog. It’s the hair on the end of the tail.
Q.You said the number of claims is relatively small. Is there a way to demonstrate that?
A.We have approximately the same number of claims today as in the late 1980s. Think about that. The cost of health care has doubled since then. The number of medical encounters between doctors and patients has gone up — and research shows a more or less constant rate of errors per hospitalizations. That means we have a declining rate of lawsuits relative to numbers of injuries.
The malpractice system is badly broken and should be fixed for the sake of all involved. It is a long, expensive, inconsistent process that hurts physicians, and even more importantly, hurts patients, who in many case do not have the knowledge of when they should sue, or the resource to sue and wait years for a verdict.
But the broken malpractice system does not seem to be a major driver of healthcare costs, as my sources reflect. It needs reform, but reform seems unlikely to do much about the cost problem. End of life care is another story, that's a big piece of the puzzle, I think.
- The main problem with the health insurance industry that I saw was that the insurance companies were covering things that people don't buy insurance for. Maybe I'm wrong on this, but I buy insurance in case I get cancer or break my arm, not for the routine (and cheap) things like teeth cleanings.
The problem is this. Some people are not responsible enough to pay for their routine healthcare. When their minor health problems suddenly become major catastrophes, the cost is socialized. As long as anyone in status asthmaticus can get intubated and admitted to the MICU (cost: high five figures to low six figures), it makes no sense to charge people money for inhalers. And the same goes for heart attacks vs aspirin and statins, or stroke care and coumadin.
So the markets for catastrophic coverage and minor expenses are linked, and the only way to definitively separate them would be to deny emergency care to people who were irresponsible with routine care. And that's something that, as a society, we have so far declined to do.
- Keep in mind when comparing the whole US to other countries, you are comparing the WHOLE US. That includes the shithole that is Mississippi with the paragon that is Connecticut. If you were to make comparisons to, say, Europe, and include Eastern/Southern Europe in there... Not that the US is a paragon of health, but keep in mind how much things vary across the country.
We're an extremely rich country, on average, and we're spending more than anyone else. You can certainly make the argument that the health of our population is compromised by huge inequalities and a crappy social safety net, but that is not an argument most of the defenders of our healthcare system are inclined to make.
Even if you look only at the rich and the white, though, the outcomes are still pretty mediocre. And that's while spending >70% more per capita than the average OCED nation.
The hard truth, in my opinion, is that while many of the people in the system are great, and lot of the technology and treatments are great, the system overall just isn't impressive on any meaningful metric. It hurts our national pride to say it, no doubt, but we don't provide the best healthcare any more than we make the best cars. That doesn't imply any particular solution, but the existing system does not work very well. Just my 2 cents.
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