Hmmm... Liposuction isn't really the right example. Let's take an example that a doctor diagnoses that someone needs a conorary atery bypass surgery. While someone needing it is in a somewhat dangerous condition, he is not in a life-threathening condition. Here in .nl someone needs to wait for his turn for that. Typicial is 2-4 weeks.

While this is almost always reasonable (no doctor will let someone wait if his condition doesn't allow it), it cannot be denied that every day of delay introduces a small risk and some rich person in .us would be able to get his treatment quicker, thus has a lower risk.

One has to realise at what cost, because in .us, the ones that do get treatment get it at a many times higher cost, and many would not get any treatment at all.

The idea is that for about half the cost of a procedure in the US someone can book travel to India that includes travel, the procedure performed by US educated doctors, a week's hospital stay along with an additional week's stay at a luxury hotel for "rest and recuperation". And one of the examples of procedures performed mentioned on 60 minutes included coronary bypass surgery that someone without insurance could previously not afford to get treated and so faced a virtual death peanalty. The downside is that if something goes wrong you can't sue for malpractice like you can here.

So the rich of the world use the US to get the "best care in the world" while the US middle class are encouraged to go to India to get their medical treatment. Please move to the back of the bus.

[edit] Here's the link to the 60 minutes piece for those interested. It was originally broadcast in 2005 but it was recently re-broadcast with some updated material although I haven't found any link to that.

http://www.cbsnews.com/stories/2005/04/21/60minutes/main689998.shtml

[/edit]

Yes, but you're missing my point. If we could magically and immediately switch over to one of the better healthcare systems currently employed somewhere in the world, we would see a huge short-term improvement in our overall healthcare (with some localized declines). But in another decade we'll be right back where we are now. But the reality is that in the US any major change to the healthcare system will have to be phased in over many years, which means that by the time the new system is firmly in place it will already or shortly be in need of another major overhaul.

That is why I don't want to just copy someone else's system. I want a better one.

The accessibility of our healthcare system and the individual's superior ability to spend their money are unconnected. The problem isn't that people are making poor spending choices, the problem is that the privatized healthcare system has resulted in unpalatable costs for many people. Giving the government control over our healthcare choices without doing anything about the fundamental problem will just result in an even less efficient system than what we have now. It's probably the case that people will have to give up complete freedom of choice when it comes to healthcare if they want good universal healthcare, but that's because universal anything requires major government control, not because government can spend the same money more efficiently, all else being equal.

It's well proven that the government is less financially efficient than private individuals and companies. Private companies require fractions of what NASA spends to achieve the same results. Companies like Blackwater train mercenaries that are just as effective as and better equipped than US soldiers for a fraction of the cost. Private schools in general can make the same amount of money go a much longer distance than public schools. If the government were really more efficient than private companies and individuals then we'd all be better off giving all of our money to the government and have it decide what to do with it all. But it's not, so we only pay the government to do the things no private company could do, would want to do, or should do.

I agree 100%. That's essentially why the privatized healthcare system isn't working to our standards. There are things the government can do that no individual can - not because of monetary cost, but because of power and control.

One of our problems is that many people in similar situations as yours are either in favor of inaction or just indifferent. It won't affect them, so why should they care? The result is a much tougher job for people who are trying to effect change.

I don't see the problem with that, though. If they can afford it, and the American system can handle the small extra load of foreign patients, then it doesn't really hurt anyone. Maybe it slightly raises certain healthcare costs across the board but I doubt it's big effect. The number of foreign patients vs. domestic patients is negligible.

Completely true, actually. Yeah if someone getting a face lift and someone suffering from a life-threatening condition are in line for the same thing, the one with the serious condition will get through first. But the fact is in every socialist healthcare system around the world waiting lines for tests and serious treatments can be dangerously long. The fact that Canada doesn't have enough MRIs to adequately handle their patient load is the classic example, and still true after all these years (In the early 90's there were more MRI machines in Manhattan than in all of Canada). There can be similarly long waits for serious surgical procedures and intense treatment procedures like chemo and radiation therapy for cancer.

My uncle actually died due to Canada's long waiting lists. He had a minor heart attack and was admitted to the hospital. They couldn't get him scheduled for an MRI for two months. My parents offered to bring him to the US to have it done immediately but he didn't want to leave home. One month later he died, and the autopsy showed that a relatively simple surgical procedure would've saved his life. If he were living in the US (or even agreed to just be treated here) he would have survived; even if he couldn't afford his treatment he still would've gotten it - hospitals can't refuse to perform life-saving surgery in the ER, even if the patient can't afford it. The result is that people who cannot afford life-saving treatment are left with huge medical bills that they have to struggle to pay off afterwards - and these bills often haunt people for the rest of their lives. This is despicable and is a major part of the problem of the US system, but they at least have their lives.

A related problem with the US system, which I think is even worse, is that hospitals can and will refuse treatment that isn't urgent if a patient can't afford it.

Yeah, "expletive deleted liberal" is definitely not the right term for the type of person you're describing. The correct word would be "anarchist."

That problem exists just as much in universal healthcare models. The difference is that in most universal healthcare models the taxes are done more progressively than here in the states. In fact that's essentially the definition. Universal healthcare means that everybody gets more or less the same care, whether you could afford it or not. The only way this can be done is to force the wealthy to pay healthcare costs for the people who can't afford it. It is entirely possible that if you lived in Frace doing the same job you have in the states that you'd be paying an equally disproportionate sum in healthcare taxes (it'd likely be lower in absolute value because the per capita costs are lower, but you'd still be carrying the burden of others).

Also, one of the reasons why we Americans have to pay so much in order to cover the costs for those who can't afford them is because the poor often go to the ER for everything, because that's the one place they'll be treated whether they can afford it or not. And the problem is that ER visits cost much more than a regular doctor or hospital visit.

I also have another question. Has anybody looked into healthcare costs compared to median household income and cost of living? I'm sure the US is still worse off, but it'd be interesting to see.

We have a insurance based system in germany as well and have much lower costs than in the USA (both absolute and as share of GDP), but higher costs then many with a universal health care system. The magic reason why a universal health care system is often cheaper than restrictive ones is that prevention is often many times cheaper than treating diseases.

I have no clue why the healthcare system is so expensive in the USA but that it is insuranced based can't be the sole or primary reason especially as when you look at the costs back in 1970 and 1980 where it wasn't really more expansive than in many other developed countries.

The following are exerpts from http://www.howtogermany.com/pages/insurance.html.

"Health Insurance Options in Germany - 2008

Germany has one of the best health care systems in the world, providing its residents with comprehensive health insurance coverage. The health insurance reform 2007 requires everyone living in Germany to be insured for at least hospital and out-patient medical treatment.

The options available to you for health insurance while living in Germany are the government-regulated public health insurance system, private health insurance from a German or international insurance company or a combination of the two.

Government Health System

Most German residents are members of the government health system (Gesetzliche Krankenversicherung or GKV). If your gross annual salary is below 48,150 Euros per year or 4,013 Euros per month, membership in the GKV is mandatory. The total cost of government health insurance is currently approx. 15% of your gross salary up to a maximum monthly income of 3,600 Euros. If you earn more than this amount your insurance premium remains constant. Your employer will normally pay slightly less than half of the monthly premium."

The key points being that it's government-regulated health insurance with required particiaption (you must be in either the government program or a private program) and it's effectively paid for by a tax since it's proportionate to your income with an income cap of 3600 euros per month. I'm not sure how much a euro is these days but I suspect that 6480 euros (15% of 3600/month times 12 months) is significantly less than my $16,800 yearly health insurance bill. How about this, I'd glady give you 6480 euros for 16,800 US dollars, are you interested in this trade?

Like I said, throw a dart. Sight unseen I'd take the German system over ours in a heartbeat.

You've already mentioned that you wouldn't be wiling to swap healthcare systems with US.

Actually if you could make the changes I proposed above without socializing healthcare then I'd be fine with that as well but I can't see how you get rid of a 400 billion dollar a year industry or control healthcare proffessional incomes without socialization. But certainly the malpractice limits and drug cost penalty that the US consumer face could be addressed without a socialized plan.

As far as the malpractice suits my stance is that no one should become obsenely rich just because a doctor made a mistake. I do believe that if a doctor makes a mistake that causess someone to require care for the rest of their lives that *does* need to be paid for, but no one should get 10 million dollars for "pain and suffering" of which the lawyers take 5 million off the top. I do think that there should be more criminal prosecution of doctors for gross negligence and incompetance but obviously not for an honest mistake.

Cost of living. Not standard of living. Big difference. And yeah, much of the east and west coasts have high costs of living, but there are also places with extremely low costs of living. Like Pittsburgh, Cleveland, and the middle of the country in general. And I know its hard to find data adjusted to things like cost of living and GDP, otherwise I'd have found it already. I was just asking if anyone has seen any such data, or analysis of said data anywhere...

I'm getting really tired of repeating myself. I've said this in every single one of my numerous posts. I'm not saying that, say, France's system blatantly won't work here. I'm saying that it's a silly idea to replace our failing system with another failing system, even if it's not failing as quickly. If we go through the massive undertaking of overhauling our healthcare system, I'm of the opinion that we should try fix it, not temporarily patch it up. If somebody is diagnosed with a serious risk of massive heart attack that could be fixed with open heart surgery, do you proscribe a daily dose of advil, or do you do the surgery?

Why should we settle for throwing a dart? Yeah wherever it lands it'll be better, but we can do better than that. Throwing a dart is the lazy and irresponsible way of going about this. Especially when you consider kryo's point. No two countries are alike - and the US in particular has plenty of its own idiosyncracies. You can't just lift something as major as healthcare policy from one country and place it in another. I could go through this again, but instead I'll just ask you to reread kryo's latest post.

I actually don't think placing wage controls on healthcare professionals is necessarily the right way to go about things. A lot of people are surprised to learn that the number of how many physicians can be accepted for training every year is limited by the US government. Somewhere along the way the government (congress, really) made a major miscalculation and the result is an ever-growing shortage of physicians - largely due to bad advice by the Council on Graduate Medical Education and the AMA. Fixing the shortage would go a long way towards bringing healthcare professionals' wages down from their lofty heights. Now, some sort of wage control might also be a good idea, but government-imposed wage control does kind of make me cringe...

And lol tetleytea - that was a great impression of those damn commercials.

Those ads are a direct result of the lobbying power of PhRMA, among others. They used to be illegal, and IMO they still should be. Tobacco companies can't advertise their self-identified hazardous products on TV, and those swine can? I'm mystified. But then I'm one of those weirdos who does not believe that spending money is directly equal to 'speech' in First Amendment terms. I want Buckley v. Valeo overturned, not continually used to defend the corrupting influence that large campaign contributions have on our political system (inlcuding Mr. Obama's success, and I voted for him).

Folks trying to scare the U.S. away from a civilized health care system often put up a red herring along the lines of "You'll Lose Your Choice of Doctor." HMOs already do that, but they have no public accountability. The profit-maddened actions of PhRMA members make the problem worse because even if you manage to keep a relationship with a given physician, you always need to question their judgement about prescriptions unless you have evidence that they've consistently rejected all the drug-branded office supplies, free meals, and fancy 'educational' events that Big Pharm provides. New drugs come out faster than most busy docs can seriously follow, and 'opinion leadership' in this area is at least as distorted by marketing budgets as our legislative process is distorted by campaign spending.

Well, capitalism?

There has been a heavy battle here recently between insurance companies and pharma companies about this issue. Basically pharma companies were targetting doctors to prescribe their expensive branded drugs. Insurance companies were not happy with this and wanted to stop insuring branded drugs that serve no purpose compared to cheaper alternatives. Government allowed them to do so if there is no medical reason for the more expensive drug.

This is quite an issue, because a doctor has a higher authority than an insurance company, because only he knows the exact medical condition of the patient and could, using his medical authority, prescribe any drug, including the expensive ones.

So, they went to court, did battle for many few years, and recently this came a conclusion. The verdict was basically very expected: if an alternative is available with exactly the same composition, there cannot be a medical reason to prescribe the expensive drug and thus a health insurance company is not required to pay for the higher priced drug.

The result has been that during 2008 there has been a price war between pharma companies, because they all want their drugs being covered, in which case insurance companies want the prices to drop. Many drugs have more than halved in price. The government says it has saved about EUR 400 million last year just because of this (because of the partially private, partially socialized system, many costs are indirectly paid by the government).

I meant more "quality of life" care, not cosmetic. My father recently needed heart surgery; not life threatening, but without it his current active lifestyle would have come to an end. Most European countries would have had him wait listed, as they lack the number of specialists we have. Same with back surgery: it's not a life threatening problem, but if you need it, you want it NOW. Not after being on a waiting list for months. As for dental care, ever see a British smile? They're not much into orthodontics because it's way too low on the priority list (I happen to agree in most cases, but apparently I'm in the minority here).

If I may ask some people from outside the states, how long does it take to schedule an MRI or other tests common in the US? I heard an average 4-6 week wait list for an MRI in Canada, but haven't been able to confirm. Wait, I see this was addressed in a post I hadn't read yet.

No offense intended, I do not believe all liberals are that stupid. Alternatively, there is also large groups I would call (explitive deleted) conservatives. Your stance places you squarely in the rather mundane "sane" category of liberal. I personally know liberals who fall in the (explitive deleted) category, and *insane* is probably the kindest thing I could say about them - or the aforementioned conservatives. Believe it or not, I once had a discussion with some twit who considered it a Second Amendment violation to ban guns in courthouses, because all the government had to do was supoena you to disarm you.

I agree completely, but it won't happen.

That, and reform of the prescription system which you've mentioned, are much my opinion as well. Advertising prescriptions, even indirectly (Ask your doctor about treatments for...) should be illegal.

Another massive expense is insurance and legal fees defending against drug lawsuits. Get rid of the billion-dollar class action lawsuits - if something got through the FDA approval policy, the company making it should not be held liable if something is eventually found wrong with it. The usual exceptions for illegal activities getting it through the process and blatant quality control issues, of course.