U.S. Health Care System 'Slowly Bankrupting Us,'

Published

"let's take a look at the health care news that's transpired" in the past four weeks, atul gawande, a general surgeon at [color=#394b6b]brigham and women's hospital and a staff writer at the new yorker, writes in a new york times opinion piece. he cites the recent news that [color=#394b6b]daimlerchrysler [color=#394b6b]sold off its chrysler division to [color=#394b6b]cerberus capital management in order to escape the company's health and pension liability costs. "the deal meant that the costs of our job-based health insurance system ... have so broken the automaker's ability to compete that giving it away became the smartest thing daimler could do," gawande says.

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meanwhile, a 2006 survey by the [color=#394b6b]american college of emergency physicians highlighted the fact that "emergency rooms everywhere are drowning in patients," according to gawande. he also notes a recent [color=#394b6b]commonwealth fund [color=#394b6b]study comparing health care in the u.s., australia, canada, germany, new zealand and britain showing, among other things, that half of u.s. residents said they chose to forgo medical care in the past two years because of cost, twice the proportion in the other countries.

gawande writes, "none of this news, however, did more than lift a few eyebrows. so this is the picture of american health care you get after watching for a few weeks: it's full of holes, it's slowly bankrupting us and we're kind of used to it." he concludes, "that leaves two possibilities: (1) we've given up on the country; or (2) we're just waiting for someone else to be in charge. i'm pulling for no. 2 (gawande, new york times, 5/26).

http://www.kaisernetwork.org/daily_reports/rep_index.cfm?dr_id=45210

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Specializes in Cardiac Surg, IR, Peds ICU, Emergency.

Not well thought through.

Corporate sell-off simply transfers the cost to the employee, and liberals are more inclined to force employers to shoulder the cost of health care. I also think it's fantastic that the auto industry would place blame on health-care costs, yet the widespread presence of unions is alleged to have no impact on the ability of American carmakers to compete both domestically and globally.

And when surgeons like Dr. Awande find that noone will pay for their services anymore, they'll reduce the costs.

Liberals want an impossible combination; a socialized single-payer program with unfettered litigation, failing to realize that our rampant sue-happy population is considered one of the flaws of the American culture, and is incompatible with a socialized system.

You cannot reduce costs without making major reforms in the role of the legal industry in medical lawsuits.

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see:

on the tort reform side, the numbers tell a story of squandered dollars. the $809 "tort tax" was invented by taking $233 billion, which is what insurance industry consultant tillinghast-towers perrin says is the cost of the tort system, and dividing it by the population of the united states. but those billions represent not only legal expenses but the total cost of running the insurance industry, including executive salaries, advertising expenditures and much else unrelated to lawsuits. the real figure is probably less than half that amount.

the numbers game misses the point, because while the plaintiff's lawyer is indeed an american creation, billions would still have to be spent to compensate and care for victims even if the tort system were abolished. the legal systems of france, germany, japan, australia and other wealthy countries forbid most personal-injury actions, ban contingent fees and require the loser to pay the winner's expenses, making suits by individuals against corporations impossible. instead, national healthcare or other compensation schemes cover those hurt in any kind of accident. in japan, a special industry fund covers air-pollution victims; another pays for injuries caused by pharmaceuticals. "in some sense it's because of the thinness of our welfare state and the kind of fragmentation of authority in this country that we just do more with the civil courts," says marc galanter, a law professor at the university of wisconsin.

http://www.thenation.com/doc/20041025/zegart/6

productivity

according to a recent survey of 73 independent studies on unions and productivity: “the available evidence points to a positive and statistically significant association between unions and productivity in the u.s. manufacturing and education sectors, of around 10 and 7 percent, respectively.”[color=#333399][2]

some scholars have found an even larger positive relationship between unions and productivity. according to brown and medoff, “unionized establishments are about 22 percent more productive than those that are not.”[color=#333399][3]

product/ service delivery and quality

according to professors michael ash and jean ann seago,[color=#333399][4] heart attack recovery rates are higher in hospitals where nurses are unionized than in non-union hospitals.

another study looked at the relationship between unionization and product quality in the auto industry.[color=#333399][5] according to a summary of this study prepared by american rights at work:

“the author examines the system of co-management created through the general motors-united auto workers partnership at the saturn corporation…the author credits the union with building a dense communications network throughout saturn's management system. compared to non-represented advisors, union advisors showed greater levels of lateral communication and coordination, which had a significant positive impact on quality performance.”

http://aflcio.org/joinaunion/why/uniondifference/uniondiff8.cfm

solving problems requires constructive dialogue not demagoguery. single payer is not socialism. clinics, hospitals etc remain independent while government acts as the agent for managing reimbursements. e can and must do better. single payer systems are more efficient and yield better results at the point of care.

there is plenty of evidence available to show that unionized businesses are more productive and yield better results. the republican congress gave tax breaks to business that in effect encouraged and supported offshoring of manufacturing jobs from the us.

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Specializes in Cardiac Surg, IR, Peds ICU, Emergency.

Solving problems requires constructive dialogue not demagoguery. Single payer is not socialism. Clinics, hospitals etc remain independent while government acts as the agent for managing reimbursements. e can and must do better. Single payer systems are more efficient and yield better results at the point of care.

There is plenty of evidence available to show that unionized businesses are more productive and yield better results. The Republican congress gave tax breaks to business that in effect encouraged and supported offshoring of manufacturing jobs from the US.

I've presented solutions, unashamedly rejected.

If it walks like a duck...well then, it's socialism. A rose by any other name...you get the idea. Clinics and hospitals may remain independent, but they will be forced to reduce available services that are not covered in single-payor services, and they will be forced to accept lower reimbursements for the rationed services that they will be compensated for, simultaneously facing continued rampant litigation from a malpractice legal system that enriches politicians like Edwards and that single-payor advocates refuse to restrict.

And if you'd like to suggest that unionized businesses are more productive and yield better results, could you please explain what happened to the Auto industry, the Steel industry, and the Airlines? I'm sure we'll hear that it was a result of corporate greed and had nothing to do with unions...and someone will assume that corporations planned all along just to greed themselves into bankruptcy and out of business.

And the tax laws that have cultivated outsourcing have existed since before Bush was born...and no democrat has proposed changing the laws so that corporations are protected from overseas income. You can't blame that on a "republican congress" unless you'd like to cite the bill.

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the numbers game misses the point, because while the plaintiff's lawyer is indeed an american creation, billions would still have to be spent to compensate and care for victims even if the tort system were abolished. the legal systems of france, germany, japan, australia and other wealthy countries forbid most personal-injury actions, ban contingent fees and require the loser to pay the winner's expenses, making suits by individuals against corporations impossible. instead, national healthcare or other compensation schemes cover those hurt in any kind of accident. in japan, a special industry fund covers air-pollution victims; another pays for injuries caused by pharmaceuticals. "in some sense it's because of the thinness of our welfare state and the kind of fragmentation of authority in this country that we just do more with the civil courts," says marc galanter, a law professor at the university of wisconsin.

http://www.thenation.com/doc/20041025/zegart/6

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Specializes in Cardiac Surg, IR, Peds ICU, Emergency.

And this is exactly the kind of policies that singler-payor advocates would oppose. They don't want to forbid personal injury action, ban contingency fees, or require the loser to pay the winners expenses.

Air pollution is not medical malpractice.

You rather strengthened my point to some degree; civil action does well in our system, and should not be as lucrative as it is. There are no conditions under which any single-payor gov't system could support current US litigatory practices, and somehow most single-payor/socialize/universal system types obstruct any maneuvers to reduce civil litigation in medicine.

It makes no sense.

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I would like to better understand how the single-payer system works in Canada, the UK, France, etc. I'd also like to better understand why they are able to administer better healthcare at lower costs than the U.S.

If single-payer healthcare is abhorrent because it is socialist, then shouldn't we also abandon public schooling, police forces, fire fighters, etc.?

World Health Organization's ranking of the globe's health systems:

http://www.photius.com/rankings/healthranks.html

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I think that globalization is forcing us (the U.S.) to reconsider our healthcare system. ---It burdens incumbent industries such as GM, Chrysler, etc. and it is often prohibitively expensive for patients.

There was a story recently on NBC news ---BlueCross is encouraging its (American) subscribers to have surgeries overseas --in places like India and Belgium --where the costs are lower ---even with all the travel costs factored in. ---Globalization at work.

So this might get U.S. docs to lower their rates. Overall, unless we come up with a novel solution, I think the American standard of living must decline so that it is more in sync with the realities that globalization delivers. All in all, I think it best for individual Americans to increase their education so that they may effectively compete on a global scale. I am not certain of whether or not a single-payer healthcare system is the answer... I have to learn more about the issues.

By the way, I consider myself a liberal. I hate folks polarizing discussions based on labels. I think it makes constructive dialogue more difficult. I don't toe my party's line in several areas.

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Specializes in Cardiac Surg, IR, Peds ICU, Emergency.
I would like to better understand how the single-payer system works in Canada, the UK, France, etc. I'd also like to better understand why they are able to administer better healthcare at lower costs than the U.S.

If single-payer healthcare is abhorrent because it is socialist, then shouldn't we also abandon public schooling, police forces, fire fighters, etc.?

World Health Organization's ranking of the globe's health systems:

http://www.photius.com/rankings/healthranks.html

The comparisons are improperly used to come to the wrong conclusion.

The single-payer system isn't working in places like Canada, which is why Canada is resorting to relaxing the laws on private insurance and private practice. Anyone can administer a lower-cost healthcare, but it's not necessarily better healthcare.

The primary benchmark used to justify systems like those found in France and Canada is life expectancy. This, however, is not a valid comparison. It does not properly reflect lifestyle, quality of life, and actual medical outcome. For example, the US outperforms these countries in outcomes for cancer and heart disease, indicating that we do a better job of taking care of the disease, but we don't take care to avoid getting the disease. For example, when the former Italian Prime Minister needed heart surgery last year, he went to CLEVELAND, not France, or Canada, or the UK, or his own country which is ranked #2 on the list you shared with us; care to speculate why? Health preservation is an individual responsibility, not a gov't responsibility, and the distorted use of "life expectancy" is inaccurately driving the movement which criticizes the current delivery model for health care, and to advocate modifying the payer system instead of recognizing behavior. And more people could be insured if they simply took the time to purchase insurance, but we can no more force people to buy insurance than we can force them to drop the burger and pick up an apple, or trade the car payment for bicycle.

The current public school system is a toilet. Some people want to abandon it, but socialized mentality refuses to allow that choice. Fact; students who attended private schools score higher on the same standardized tests than students who attended public schools. Private school students were more that twice as likely to go on and complete a bachelor's degree. Just as students are evaluated by their performance, the schools should be held to the same standard. Instead, we keep dumping more money into them as they continue to spiral, and then we wonder why we lose our competitive edge globally. There are few viable alternatives to the police, and one might question their effectiveness given the perrenial unwinnable war on drugs, and the fact that we still have to install alarms on everything we own.

73% of firefighters nationwide are volunteers, and they raise their money through billing, community fundraisers, and revenue activities such as hall rentals. I'd like to know how this is considered a socialist system.

Finally, the WHO is not a scientific agency. Ironically, I noted that one of the items reported by the WHO to be a "main failing" of many healthcare systems was their "focus on the public sector," often disregarding the "frequently much larger private health care sector." I also noticed that Cuba ranked lower than the US in this report, but higher than Switzerland. I'd like to hear the rationale for that.

I have to agree with your very accurate view that the American standard of living must decline to be in sync with the realities that globalization delivers, but this is not at all an element of the philosophy being offered by advocate of a socialized/singler-payer system. It's just idiotic that the average American will leverage themselves into tens-to-hundreds of thousands of dollars of debt for everything from their living room furniture, to late-model cars, and to charging their cable, satellite radio, internet and cell phone service on their credit cards. Then ask them to buy some health insurance and pay a co-pay, and they suddenly become victims and statistics.

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Is there a link for "73% of firefighters nationwide are volunteers"?

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Specializes in Vents, Telemetry, Home Care, Home infusion.
is there a link for "73% of firefighters nationwide are volunteers"?

http://www.nado.org/pubs/aug021.html

pa is largely volunteers only few cities have paid service: philadelphia, pittsburgh, chester, allentown etc ...90% is volunteer service.

while pennsylvania is a diverse state of rural communities, small towns and large and small cities, many of these areas benefit from the services provided by volunteer fire and emergency

service organizations. a recent study conducted by the national fire protection association estimates that nearly 73% of all fire departments in the country are staffed entirely of volunteers

and mostly volunteers staff an additional 15% of fire departments.

1

another study by the national association of state foresters estimated that volunteer fire departments save localities

$36.8 billion nationally each year.2

in pennsylvania, a much higher percentage of all firefighters (approximately 90%) are volunteers, and the commonwealth’s volunteer fire services have been estimated to provide $6.0 billion in tax savings to the state.

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Specializes in Cardiac Surg, IR, Peds ICU, Emergency.
Is there a link for "73% of firefighters nationwide are volunteers"?

http://www.nvfc.org/pdf/2004_fact_sheet.pdf

First bulleted point.

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