Can someone "dumb down" what Obamacare really means?

SC_RNDude · Aug 22, 2012

Jeweles, coming from England, I know that the problems you mention exist there too. In England, some people, who can afford to do so and are fortunate enough to be accepted by insurers, take out private health insurance. I believe there are a lot of problems with the way the health service is run, and with providing a uniformly good level of care. In the English system there have been problems with lack of organization and funding too, and other abuses. But in spite of the many problems with the service, I still believe that a taxpayer funded health service is a good thing, and I support it because I want everyone to have access to health care throughout their lives.

Despite what the liberal politicians and some of the media tell you, most people want as many people as possible to have access to healthcare throughout their lives, and such access is not magically guranteed by a taxpayer funded health service.

ProgressiveActivist, BSN, RN · Aug 22, 2012

Jeweles, coming from England, I know that the problems you mention exist there too. In England, some people, who can afford to do so and are fortunate enough to be accepted by insurers, take out private health insurance. I believe there are a lot of problems with the way the health service is run, and with providing a uniformly good level of care. In the English system there have been problems with lack of organization and funding too, and other abuses. But in spite of the many problems with the service, I still believe that a taxpayer funded health service is a good thing, and I support it because I want everyone to have access to health care throughout their lives.

Hi Susie2310,

what do you think of Doc Martin on PBS/BBC? Is it a good portrayal of the NHS?

cdsga · Aug 22, 2012

Maybe we should return to the barter system. No cash-just pay me in baked goods or a new roof job.

Susie2310 · Aug 23, 2012

Hi Susie2310,
what do you think of Doc Martin on PBS/BBC? Is it a good portrayal of the NHS?

libbyliberal, I had to google Doc Martin as I have never seen the program, but it sounds like a comedy I might enjoy. I realize my post could have given the impression I still live in England. I actually live in the US and have done for many years. I wish I could answer your question.

Elinor · Aug 23, 2012

With all due respect to Susie2310 and Jeweles26, the plural of anecdotes is not data. To anyone reading this, please look at the actual statistics for ER wait times, patient satisfaction, etc. of various countries -- collected from thousands of citizens -- to enable you to come to an informed conclusion.

From the 2007 "Toward Higher-Performance Health Systems: Adults' Health Care Experiences in Seven Countries, 2007" the differences between countries with universal health care including a public option and subsidizing (UK, the Netherlands, Germany, Australia, New Zealand and Canada) vs. the US are pretty stark.

Here is a graph of the amount spent per capita (per person) in each country:

Please note that in the mere 6 years since 2006 (when this data was collected), the US has increased its health care spending substantially, now outspending other countries by even wider margins.

And here are some statistics derived from this 2007 report:

"We pay more per capita for fewer hospital beds, we pay more per capita for fewer ICU beds, and pay more for ICU stays despite patients staying for fewer days, we have far fewer long term stay facilities, we spend more on fewer practicing physicians per capita, and for all that we perform worse in indices of mortality, and control of chronic disease." (Quoted from a Scienceblog article in partnership with National Geographic, here.)

Excerpted from the report:

The percent GDP is the scary number there. It's actually gone up to 18% now in the US. GDP (gross domestic product) is the value of all final goods and services produced in a country's economy in a year. In the US, health care takes up almost a fifth of the economy. That means that for every dollar spent in the US, 18 cents of that is spent on health care, WAY more than anywhere else.

The take-away from this section is that, while no one is really 100% satisfied with their health care, far fewer Americans think that the US system needs only minor changes (16%) as compared to other countries, and far more think it needs to be rebuilt completely (34%). Far more Americans do not visit the doctor when sick (25%) than in other countries, and skip their recommended treatments and medications. Far more Americans (30%) spent more than $1000 in out-of-pocket expenses for medical bills than in other countries, and more than double the percent of Americans had trouble paying their medical bills or were unable to pay entirely (19%) than in other countries.

This section reveals that, contrary to popular conservative assertions, Americans actually experience GREATER wait times than in other countries, all except Canada. In every other country, far more people are able to see a doctor on the same day. We also have more people going to the ER for conditions that could have been seen by a regular doctor (15%) than any other country except Canada (16%). As for waiting times in the ER, this is somewhat of a mixed bag. Some countries have better wait times, and some have worse. But the data demonstrates that stories about ER wait times being dramatically worse in all public health care systems than in our private system are false.

As ever, most US data has gotten worse in every year since this was published. And for a broader look at the data, people should look at many different studies and their results, not just one, before forming an opinion.

cdsga · Aug 23, 2012

My 87 year old Dad just called me this morning. He came across a bill from 1967-where he had extensive orthopedic surgery, skin grafting and body casting, was in the hospital for 3 weeks. Guess how much his bill was????? $1,300.00. HAHAHAHAHA. He should have lost his leg due to a horse incident where he had a compound comminuted femoral fracture/ but they saved it and he has been on that same leg for all these years. Crazy huh?

Susie2310 · Aug 23, 2012

Elinor, please would you be kind enough to explain what you mean by ..."the plural of anecdotes is not data."

cdsga · Aug 23, 2012

I've read the statistics-still not sure if anyone has effectively captured the quality of care related to medical outcomes. Sure we may speed our ER waiting times, but is the diagnosis correct? Does anyone measure the time of treatment after the waiting time is decreased? The amount of time spent in the ER waiting for an available bed due to lack of staffing, making available beds not available? How many discharged patients accurately complete these surveys? There is alot of error. What determines an accurate reflection of patient satisfaction? Rooms cleaned, food quality, kind nurses who smile and introduce themselves, doctors spending time with the patient explaining procedures, expected outcomes, etc. If you look at HCAPS (or however you abbrev it) scores are not realistic and patients who have an unrealistic expectation of what is to occur at an acute care facility, may be disgruntled and to them our treatment may not meet their idea of what is to happen. This skews the scores greatly, since the scoring system does not allow for below 98%.

I have seen our system work tremendously well, where we have had patients come in the door of the ER and be on the operating table in less than 2 hours. Which has allowed for diagnostic testing, doctor assessment, preparation of OR suite etc. I think this is highly efficient, and this is the norm rather than a rarity. We use alot of expensive technology to decrease the stays at the hospital, which decreases our profit somewhat-and hospitals advertise niche markets to become centers of excellence. I also work in a large city where many foreign patients come in and compliment the US system. They are glad to be here. You can see it on their faces. Kindness, efficiency, all those things they state in comparison with some of their systems of care-these patients have been from Israel, India, Europe, Baltics, Africa, South America, Vietnam, and Mexico. I haven't heard any disgruntled foreign visitor to this date. In fact quite the opposite.

We have spent the last 10 years or so calling patients clients, offering hotel concierge services,etc- which is great, but it comes at a cost where people expect Ritz-Carlton treatment on a Motel 6 budget. We have to have a happy medium somewhere-patient and public education should be the key here to give people a realistic idea of what will happen when you are coming to an acute care facility. Patients should expect cleanliness, efficient-timely care, proper/appropriate diagnostics, nutritional food-based on their individual needs, education regarding their disease process, appropriate instructions to follow if their wait time exceeds a determined acceptable goal-set by the dept (ex-ED), and a list of questions to ask regarding their treatment, services available, and things they should bring with them to the hospital. Those are the basics. It's an interesting business. That is for sure.

Elinor · Aug 23, 2012

Elinor, please would you be kind enough to explain what you mean by ..."the plural of anecdotes is not data."

Yes, sorry. I forget who the quote comes from, but it basically means that there's a difference between reading personal opinions, beliefs, experiences, etc. versus reading data that's been collected using the scientific method. When researchers are collecting data to be published, they have to follow guidelines to control their sample to make sure it is representative of the entire population.

For instance, when Gallup is taking a poll to see who registered voters plan to vote for, they have to make sure they are selecting people truly at random. If they were only to poll people outside of suburban grocery stores, for instance, that would not be representative of the American people because it would skew suburban, white, middle and upper income, and female.

There are ways to control the sample to make sure it's truly randomized, but no poll is ever perfect (or else they wouldn't have a margin of error, and they could always say with 100% accuracy who will win an election). Which is why people should always maintain a healthy skepticism when reading statistics, and you should make sure you check the source -- for instance, it's better to trust an unbiased academic source than to trust a data conducted by (or paid for) big pharma, or a conservative/liberal group.

A way that this can be related to internet forums is that you often are naturally going to see more disgruntled people here. No matter what the issue, people usually only take the time to follow an topic and post about it on a thread if they have strong opinions, one way or the other. On this thread, most people feel strongly about the Affordable Care Act (whether those opinions are educated or not), so you naturally are going to see more polarized opinions, and fewer people in the middle. The bottom line, however, is that people's personal experiences and opinions, however valid, are not a substitute for data that has been collected using the scientific method using a large sample group within a population.

(ETA: It should have been "The plural of anecdote is not..." rather than "anecdotes" -- which makes much less sense.)

Susie2310 · Aug 23, 2012

Yes, sorry. I forget who the quote comes from, but it basically means that there's a difference between reading personal opinions, beliefs, experiences, etc. versus reading data that's been collected using the scientific method. When researchers are collecting data to be published, they have to follow guidelines to control their sample to make sure it is representative of the entire population.
For instance, when Gallup is taking a poll to see who registered voters plan to vote for, they have to make sure they are selecting people truly at random. If they were only to poll people outside of suburban grocery stores, for instance, that would not be representative of the American people because it would skew suburban, white, middle and upper income, and female.
There are ways to control the sample to make sure it's truly randomized, but no poll is ever perfect (or else they wouldn't have a margin of error, and they could always say with 100% accuracy who will win an election). Which is why people should always maintain a healthy skepticism when reading statistics, and you should make sure you check the source -- for instance, it's better to trust an unbiased academic source than to trust a data conducted by (or paid for) big pharma, or a conservative/liberal group.
A way that this can be related to internet forums is that you often are naturally going to see more disgruntled people here. No matter what the issue, people usually only take the time to follow an topic and post about it on a thread if they have strong opinions, one way or the other. On this thread, most people feel strongly about the Affordable Care Act (whether those opinions are educated or not), so you naturally are going to see more polarized opinions, and fewer people in the middle. The bottom line, however, is that people's personal experiences and opinions, however valid, are not a substitute for data that has been collected using the scientific method using a large sample group within a population.
(ETA: It should have been "The plural of anecdote is not..." rather than "anecdotes" -- which makes much less sense.)

Elinor, thank you for clarifying what you meant. I agree with you completely about sampling and statistical validity (statistics was my favorite class in college). I am just not sure how your points relate to your referencing my posts about the English National Health Service. My point was that the English system provides care for the whole population throughout their lives. I did not believe I needed to cite data to support this, but I am sure you will find plenty of data on this if you care to research this subject.

chuckster, ADN, BSN, RN, EMT-B · Aug 23, 2012

Despite what the liberal politicians and some of the media tell you, most people want as many people as possible to have access to healthcare throughout their lives, and such access is not magically guranteed by a taxpayer funded health service.

True enough. The US already has several taxpayer-funded health systems that are very restrictive. One is the Veterans Administration, which is a true health service and its cousin, the military health system. Both are restricted to service members. Another is Medicare, which is a health insurance system, again restricted, generally by age. Unfortunately however, something on the order of 15% of the US population does not have either health insurance coverage or general access to a health system. Another large segment of the population has restrictive health insurance coverage.

While I'm sure everyone wants people to have access to good health care, the fact is that until rather recently, no one did anything about it. I'm not wild about "Obamacare" (and frankly prefer a much more consumer-oriented system that makes individuals responsible for paying for most routine health care costs, reserving insurance for catastrophic events) but at least it is an attempt. Just as importantly, Obamacare also makes an attempt at addressing the hugely important issue of the high cost of health care in the US. Again, this is not a new problem but no one even attempted to address it before.

Actually, I take that back. The Heritage Foundation made an excellent start in addressing both issues back in 1992. Their plan was implemented a few years ago by a very forward thinking governor in Massachusetts and while it has some problems, has worked reasonably well. Perhaps that man will run for higher office and implement the plan nationally after Obamacare is repealed.

Orca, ADN, ASN, RN · Aug 23, 2012

Any health care system in which decisions about care are made entirely by companies with a profit motive does not act in the best interest of the people it supposedly serves. Do an online search for health insurance company deception/deceit/etc. and see what comes back. Insurance companies that institute automatic audits of customers who have had breast cancer surgery, with the intention of finding a technicality to justify canceling the policy. Companies who deny coverage for items that should be covered, with the hope of frustrating customers into quitting, thereby saving the company money. Appeal processes with artificially complicated or arbitrary rules, with many technicalities designed to increase the possibility of an error so they can dismiss the appeal.

I am a long-time veteran of what I call the "insurance wars", and health insurance companies are pretty much at the bottom of my barrel of unscrupulous businesses. They are one of the few remaining pure cash businesses. They sell no product or service, apart from a promise to pay health expenses under certain conditions. Their policies are written vaguely - deliberately, so that they can be interpreted more than one way. Appeals panels are rigged in their favor. Usually the first two steps are internal, followed by an outside (and supposedly objective) arbitrator. Even if the arbitrator doesn't work directly for the insurance company, they won't keep paying him for long if he decides against them too frequently. The more they deny you, the more of your money they get to keep.

This is why I find the proposal for a voucher system laughable. This fixes nothing, only funnels more money into the same broken system we already have, and makes private insurers richer while they still screen out those likely to cost them money. Anything that gives insurance companies more power is not a good thing.