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What US Health Care Needs

kdawson posted more than 4 years ago | from the velluvial-matrix dept.

Medicine 584

Medical doctor and writer Atul Gawande gave the commencement address recently at Stanford's School of Medicine. In it he lays out very precisely and in a nonpartisan way what is wrong with the institution of medical care in the US — why it is both so expensive and so ineffective at delivering quality care uniformly across the board. "Half a century ago, medicine was neither costly nor effective. Since then, however, science has... enumerated and identified... more than 13,600 diagnoses — 13,600 different ways our bodies can fail. And for each one we've discovered beneficial remedies... But those remedies now include more than six thousand drugs and four thousand medical and surgical procedures. Our job in medicine is to make sure that all of this capability is deployed, town by town, in the right way at the right time, without harm or waste of resources, for every person alive. And we're struggling. There is no industry in the world with 13,600 different service lines to deliver. ... And then there is the frightening federal debt we will face. By 2025, we will owe more money than our economy produces. One side says war spending is the problem, the other says it's the economic bailout plan. But take both away and you've made almost no difference. Our deficit problem — far and away — is the soaring and seemingly unstoppable cost of health care. ... Like politics, all medicine is local. Medicine requires the successful function of systems — of people and of technologies. Among our most profound difficulties is making them work together. If I want to give my patients the best care possible, not only must I do a good job, but a whole collection of diverse components must somehow mesh effectively. ... This will take science. It will take art. It will take innovation. It will take ambition. And it will take humility. But the fantastic thing is: This is what you get to do."

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584 comments

also: more doctors, less pay, more compassion. (5, Informative)

adam (1231) | more than 4 years ago | (#32637582)

If I want to give my patients the best care possible ... This will take science. It will take art. It will take innovation. It will take ambition.

...it will also take the AMA not artificially restricting the number of new doctors. More than half of ostensibly qualified applicants every year are turned away. In the 1800s there were 400+ medical schools in the united states. By the early twentieth century there were less than eighty. The fewer doctors we have, the more each doctor is paid. The AMA carefully guards doctor salaries. This practice can be seen over and over (and resistance to influx of doctors willing to work for cheap) in country after country (the film Salud covers this well).

Furthermore, we need to eliminate the debt load for student doctors. You can't expect doctors to work for lower salaries (as I propose above) when they are graduating with hundred of thousands in debt. Basically we need way more medical schools (or slots in existing schools) and we need to lower their cost in exchange for a willingness to work for less money. This has the benefit of more doctors and lower cost, as well as shifting the pool of applicants to those who want to be DOCTORS and not just those who want to make MONEY or play GOLF all the time (and so on).

Cuba is a perfect example of this. They have better or equivalent health outcomes to the United States, yet they spend a fraction (read: less than 1/20th) as much per person on healthcare. They achieve these same outcomes using finnicky x-ray machines from the 1980s and out of date textbooks. They do this by having the greatest doctor-to-patient ratio of any nation, and by focusing on preventative medicine. But that's evil socialism. Insert dramatic music here. At any given time more than a third of Cuban doctors are voluntarily serving abroad (often in Africa) doing global health work. More than a third. What percentage of American doctors voluntarily serve in Africa? And they have a 98% retention rate, so any claim that this service is to "escape Cuba" is pretty well dispelled. (and just to go on the offensive for a sec, since I don't generally reply to those who reply to me, unless they actually make good points, since as you know /. has a typical signal-to-noise comment ratio... for those who want to doubt my claims above, calling them propaganda, etc, they are backed up by reputable sources. Paul Farmer, for instance, has written extensively about Cuba [and also happens to be the UN Envoy to Haiti and runs Harvard's School of Social Medicine at their Medical School, so he tends to be considered a reputable source] and almost never has a bad thing to say about their healthcare attitudes or outcomes. The list goes on.)

Re:also: more doctors, less pay, more compassion. (4, Funny)

Anonymous Coward | more than 4 years ago | (#32637664)

An informative first post! Is it the apocalypse already?

Re:also: more doctors, less pay, more compassion. (2, Informative)

JumperCable (673155) | more than 4 years ago | (#32637844)

No. That isn't until 2012.

Re:also: more doctors, less pay, more compassion. (1)

fishexe (168879) | more than 4 years ago | (#32637908)

No. That isn't until 2012.

In other words, the year that every first post will be informative. It's a sign of the end times.

Re:also: more doctors, less pay, more compassion. (0, Troll)

davester666 (731373) | more than 4 years ago | (#32637920)

When the LHC finally goes online...

Re:also: more doctors, less pay, more compassion. (1)

kilodelta (843627) | more than 4 years ago | (#32637688)

You make some very good points. One of the prime reasons I didn't go into medicine was the cost. Chose the I.T. field instead.

The other thing that should be mentioned is that health care in the U.S. excels in one area and by relation another. Medicine excels at trauma medicine. It is at the point where even deaths from gunshot wounds are declining. The relation is in diagnostic technology.

Re:also: more doctors, less pay, more compassion. (5, Insightful)

rtfa-troll (1340807) | more than 4 years ago | (#32637690)

The thing is, that you don't actually have to go as far, politically, from the USA to see a working health care system. Before Margret Thatcher's management reforms crippled it, there used to be one in the UK and to a large extent there still is one in Scotland. The key element is to understand that money is a terrible motivator in health care.

There are always many many treatments and tests possible. For any given patient, most of those tests will either do more harm than good or be unjustifiable financially (costs 100,000, has a 1 in a million chance of helping you). The doctor has to be trustworthy to say "no, it's not worth it". That means that you have to believe that a) he has nothing to gain from not giving the treatment and b) he really has to have nothing to gain from giving the treatment c) he has to be competent and well enough trained to make that judgement.

Unfortunately, as soon as we have insurance companies, financial administrators and ignorant courts involved this breaks down. The insurance means that the doctor is doing the treatment for profit, so the more he gives, the more a non-involved third party pays. The financial administrators (e.g. in UK state care) mean the opposite. Now the patient knows the doctor is under pressure to not deliver treatment and will not leave until they get it (even if they don't need the treatment). The courts mean that the doctor can get away with killing hundreds of people with extra CAT scans, but if he misses one brain tumor by not doing one he goes bankrupt.

We need to take the direct money out of front line medicine, or at least pay it much more cleverly. For example, if you pay doctors by results (percent patients cured) they will only work on easy cases. Almost any such system I can think of can be gamed.

Re:also: more doctors, less pay, more compassion. (2, Interesting)

Jah-Wren Ryel (80510) | more than 4 years ago | (#32637772)

We need to take the direct money out of front line medicine, or at least pay it much more cleverly. For example, if you pay doctors by results (percent patients cured) they will only work on easy cases. Almost any such system I can think of can be gamed.

Which is yet another reason to dump the entire concept of prepaid medicine to begin with. Sure, keep true insurance around for catastrophic events, but otherwise let each person decide how to spend their own money on their own regular health care. If you want to subsidize the poor, give them vouchers and let them spend their own vouchers on their own health care the best way they see fit. The idea being that since there is pretty much no optimal 'command-and-control' style solution, you might as well put the responsibility for the spending back in the hands of the people with the most to lose or benefit.

FWIW, I practice what I preach - I carry the closest thing I can get to true catastrophic insurance (and have not needed it yet) and pay cash for everything else. When I think a doctor is jerking me around for money (like the time they convinced me to do strep and mono tests despite being asymptomatic just because they could do them in their in-house lab so they were super-profitable) I dump them and move on. On the down side it is getting harder and harder to find doctors who are cash-friendly. Its like they've all just caved to the system and forgotten how to do business the normal way - even though the overhead of dealing with 'insurance' companies can easily equal 50% of the bill.

I've always really liked that idea (5, Insightful)

Sycraft-fu (314770) | more than 4 years ago | (#32637972)

For just about everything else in life, insurance is just that: Ensuring that in the event something happens, you are covered. It is a risk transfer for certain situations. For example I carry insurance on my house. In the event it burned down, or everything was stolen or the like, I could not afford to replace it all. My cash reserves are insufficient and, indeed, I have to have a mortgage to own the place. So, in an emergency, the insurance company will cover my loss. However, it is only in an emergency. They do not cover regular maintenance and upkeep of the house. Even in terms of qualifying emergencies, like theft, there's a $500 deductible. So if someone breaks in and steals a couple speakers, I'm paying for that myself, but if they steal everything the insurance company will pay.

It is all about transferring risk. I take care of the high risk, low cost stuff, they assume the low risk, high cost stuff. It is a certainty I'll have to repair things, the risk of something breaking down is as high as it can be, more or less. But the cost is low, I can afford it. The risk of my place burning down is quite low, but the cost is high, too high, so I transfer that risk. Doesn't cost a lot, since it is low risk. Likewise, my insurance company does the same thing. They cover individual incidents. However for large things, like disasters, they have their own reinsurer. That company only deals with extremely rare stuff, the risk of it happening is minimal, but the costs are astronomical.

But for health insurance, that's all turned around. It covers EVERYTHING. I pay, at most, $10 for anything. Insurance pays the rest. Doctors visits, tests, hospital, etc. I only bear the cost if it is extremely cheap, like a generic drug. Otherwise they pick it up. However they also pick up high cost stuff. If I have a major accident and require intensive care, they pick all that up. They are liable for ALL risks to my health.

Is it then any wonder that it costs more per month than my home insurance does per year?

I really thing a medical savings account kind of plan is the right idea. You save money to pay for normal things. In the event of something catastrophic, no problem, your insurance is there to pay any and all costs.

However finding that is hard. They started offering one at work... And it wasn't worth it. My premiums stayed the same, my employer had to put in just as much money, and my personal financial risk increases. How he hell is that useful? It should cost my employer much less, but it doesn't.

And what about poor people with a handicap (3, Insightful)

SmallFurryCreature (593017) | more than 4 years ago | (#32637990)

Your suggestions tells poor people who happen to have a handicap or chronic condition to get stuffed.

You sir fail at humanity. Congrats, you can now enroll in US politics.

Re:And what about poor people with a handicap (2, Interesting)

RightSaidFred99 (874576) | more than 4 years ago | (#32638086)

No, poor people can go to government clinics. If you're poor, you should get minimum care - that's it. Any other suggestion just proves you fail at maths.

Let's look at world demographics - who's having the most babies? Poor people. You propose that the rapidly growing population of poor people the world over should get top notch medical care? Are there dragons in this fantasy land you've concocted?

Re:also: more doctors, less pay, more compassion. (5, Insightful)

toadlife (301863) | more than 4 years ago | (#32638012)

Sure, keep true insurance around for catastrophic events, but otherwise let each person decide how to spend their own money on their own regular health care.

This leads to people avoiding preventive care, which drives up costs in the long run. There are already dozens of health care models around the world that deliver better outcomes for a fraction of the cost that the U.S. pays. There is no need to reinvent the wheel.

even though the overhead of dealing with 'insurance' companies can easily equal 50% of the bill.

And yet you advocate sticking with a system that involves private insurance.

Re:also: more doctors, less pay, more compassion. (0)

Anonymous Coward | more than 4 years ago | (#32637804)

Yeah, so if you want to have teeth as lovely as late 20th century brits, follow their lead!

Re:also: more doctors, less pay, more compassion. (3, Informative)

nido (102070) | more than 4 years ago | (#32637896)

Yeah, so if you want to have teeth as lovely as late 20th century brits, follow their lead!

There's a formula for good teeth. It goes something like this:

Calcium + Phosphate + Vitamin D + (misc other vitamins minerals) -> normal teeth

If a child's diet doesn't have enough nutrients, bone structures will not develop properly. Good teeth come from good nutrition and sunlight (Vitamin D), NOT nationality.

See Gerard Judd's work [healingtee...urally.com] , Dr. Weston A Price's work, [westonaprice.org] etc

Re:also: more doctors, less pay, more compassion. (0)

Anonymous Coward | more than 4 years ago | (#32637968)

Wait a second, are you suggesting that there may be something besides a nation's health care system that impacts people's health?

Re:also: more doctors, less pay, more compassion. (0)

Anonymous Coward | more than 4 years ago | (#32638064)

Haha, UK and sunlight, good joke there.

Re:also: more doctors, less pay, more compassion. (0, Redundant)

nido (102070) | more than 4 years ago | (#32637916)

Yeah, so if you want to have teeth as lovely as late 20th century brits, follow their lead!

There's a formula for good teeth. It goes something like this:

Calcium + Phosphate + Vitamin D + (misc other vitamins minerals) -> normal teeth

If a child's diet doesn't have enough nutrients, bone structures will not develop properly. Good teeth come from good nutrition and sunlight (Vitamin D), NOT nationality.

See Gerard Judd's work [healingtee...urally.com] , Dr. Weston A Price's work [westonaprice.org] , etc.

Re:also: more doctors, less pay, more compassion. (3, Insightful)

cappp (1822388) | more than 4 years ago | (#32638122)

Actually British kids have the healthiest teeth according to a recent article on the Economist http://www.economist.com/research/articlesBySubject/displaystory.cfm?subjectid=7933596&story_id=15060097 [economist.com]

Polish children have the worst teeth in any OECD country; a 12 year old has nearly four teeth that are missing, decayed or have a filling. American adults are renowned for having perfect sets of pearly whites, but each child has one decayed or missing tooth. Britain's children (along with Germany's) have the healthiest teeth, if not the straighest or whitest in later life.

Simply put, health and viability are not necissarily correlated with cosmetic appeal.

Re:also: more doctors, less pay, more compassion. (1)

shawnap (959909) | more than 4 years ago | (#32637698)

Furthermore, we need to eliminate the debt load for student doctors. You can't expect doctors to work for lower salaries (as I propose above) when they are graduating with hundred of thousands in debt.

Would these lower salary expectations not put downward pressure on education costs? After all, if we shift the burden of costs to those who cannot make individual cost/benefit decisions, have we not re-created the very health care market dysfunction we seek to remedy?

P.S. A comparison of average general physician salaries across countries: http://www.worldsalaries.org/generalphysician.shtml [worldsalaries.org]

"ostensibly qualified" is fuzzy (2, Interesting)

r00t (33219) | more than 4 years ago | (#32637716)

Who is to say where the cut-off line should be?

You could put that line almost anywhere without being unreasonable. I think we can agree that it's unreasonable to have 99.999% of the applicants on one side of the line or the other, but beyond that? What about taking only the best 10%, or only the best 90%, would one of those be OK with you?

It seems the AMA decided that the lower 50% are unfit. OK. Well, would you want one of those doctors instead of one in the top 50%? The top 50% is dangerous enough.

Re:"ostensibly qualified" is fuzzy (4, Interesting)

martin-boundary (547041) | more than 4 years ago | (#32637776)

It seems the AMA decided that the lower 50% are unfit. OK. Well, would you want one of those doctors instead of one in the top 50%? The top 50% is dangerous enough.

Doesn't that depend on what your ailment actually is? If you've got the flu, a doctor in the bottom 20% is good enough, while if you've got brain cancer, then you'll want a doctor in the top 10% or better. You could have a system, let's call it "triage", where someone qualified could decide what kind of doctor you need...

Re:"ostensibly qualified" is fuzzy (1)

gd2shoe (747932) | more than 4 years ago | (#32638026)

That's an appealing theory. The problem is that there are serious conditions which masquerade as common ailments, and require a great doctor to catch (such as Cushing's). The more mediocre doctors we have, the more misdiagnosis we will have. You seem to suggest better doctors closely oversee lesser doctors, but that will either become an exercise in rubber stamping or a horrible bureaucracy (the former tends to fail and become regulated into the latter). How do you suggest dealing with misdiagnosis?

I agree, though, that we need more doctors and that the AMA has a vested interest in maintaining irrational wages.

Let's ask the AMA (5, Informative)

adam (1231) | more than 4 years ago | (#32637798)

Don't listen to me, just listen to the AMA instead; they're happy to admit their mistake (although they won't overtly admit the motivation behind it). Basically in the 1980s they wrongly predicted in 10-20yrs we'd have a surplus of hundreds of thousands of doctors and the market would crash (yeah, wouldn't that be horrible, to have too many doctors? I mean, horrible if you want to drive a Lexus and you're a doctor, I suppose...). Of course they got it wrong ("accidentally," I am sure) and overshot in the other direction and now we have a huge shortage. "Whoops." Unfortunate byproduct: ridiculous salaries (mostly for specialists). Not so unfortunate if you're a dermatologist, though.

Some quotes from the AMA themselves [ama-assn.org] :

"Not a single allopathic medical school opened its doors during the 1980s and 1990s ... The surge in new medical schools is taking place as the Assn. of American Medical Colleges predicts a shortage of at least 125,000 physicians by 2025 ... But some experts on work-force issues say new schools are not enough. They say that without more federal funding for residency slots or changes in the doctor payment system, the schools are unlikely to avert an overall work-force shortage or address the undersupply of primary care physicians and general surgeons ... 1 in 3 active physicians is 55 or older."

I think we can agree that it's unreasonable to have 99.999% of the applicants on one side of the line or the other, but beyond that? What about taking only the best 10%, or only the best 90%, would one of those be OK with you?

How about 98% rejection rate? From the AMA article above: "Many private medical schools have 5,000 or more applicants for a class of 100 students."

Again, I hope it comes across, I know something about this issue. I said "ostensibly qualified" and "more than half" in my OP because I didn't want to get into a big debate about the exact percentage of people who apply and are grossly underqualified and rejected versus the legit applicants who are rejected, but basically the former is not happening, since you need to take the MCATs (not easy) and complete the equivalent of a degree in Molecular Biology simply to even apply to med-school (and currently to be competitive you need hundreds of hours of volunteer work, professional medical experience such as EMT work, and even then it is often a crapshoot, I know many qualified applicants who have been rejected more than one year in a row).

Re:"ostensibly qualified" is fuzzy (1)

fishexe (168879) | more than 4 years ago | (#32637962)

It seems the AMA decided that the lower 50% are unfit. OK. Well, would you want one of those doctors instead of one in the top 50%? The top 50% is dangerous enough.

That's largely a false dilemma. At this point, for millions of Americans, the choice is between the lower 50% and no doctor at all.

Re:also: more doctors, less pay, more compassion. (0, Troll)

RightSaidFred99 (874576) | more than 4 years ago | (#32637766)

Cuba is a perfect example of this.

Wait, people still think Cuba has this magical, awesome health care system? Wow.

Cuba has a dog and pony show. Shit for the vast majority of the population, and high quality care for VIPs and foreigners.

Re:also: more doctors, less pay, more compassion. (0)

Anonymous Coward | more than 4 years ago | (#32637814)

You said,

Cuba is a perfect example of this.

Wait, people still think Cuba has this magical, awesome health care system? Wow.

Cuba has a dog and pony show. Shit for the vast majority of the population, and high quality care for VIPs and foreigners.

And the GP that you refer to said:

since I don't generally reply to those who reply to me, unless they actually make good points, since as you know /. has a typical signal-to-noise comment ratio... for those who want to doubt my claims above, calling them propaganda, etc, they are backed up by reputable sources.

I'll take an educated guess that you are an example of the noise in the signal to noise ratio, and why the GP doesn't (usually) respond to comments.

Re:also: more doctors, less pay, more compassion. (1, Interesting)

Anonymous Coward | more than 4 years ago | (#32637948)

Let's see...

Infant mortality rates. OK, first most of the world measures them in different ways. The US measures them more strictly. Oh, and I wonder why Cuba's abortion rates are so high? I'm sure that rampant abortion of non-viable infants has anything to do with it.

But if all it takes to be convincing is to claim that I am "backed up by reputable sources" and just label anyone who disagrees with me as noise, I guess that's easy enough. [nationalcenter.org]

But really, all you need is a taste test. Even poor people in the US have access to multimillion dollar equipment and highly trained doctors, expensive medications, etc... Do you really think a little shithole poor country like Cuba has better healthcare? Really? I'm sure Cuba does a good job with what they have, they just don't have, well, jack shit.

Re:also: more doctors, less pay, more compassion. (1)

MyFirstNameIsPaul (1552283) | more than 4 years ago | (#32637984)

Well, if we're to believe anything from this documentary [thebusines...ngborn.com] , the problem with high U.S. infant mortality rates is caused by the popular method of delivery.

Re:also: more doctors, less pay, more compassion. (0)

RightSaidFred99 (874576) | more than 4 years ago | (#32638098)

There is no problem with US infant mortality. We try _very_ hard to make every child survive. Paradoxically, this makes our numbers worse - most countries just say the baby was nonviable and don't count it as a death. We don't.

Re:also: more doctors, less pay, more compassion. (0)

Anonymous Coward | more than 4 years ago | (#32637986)

I'm sure that rampant abortion of non-viable infants has anything to do with it.

So you're saying the reason for Cuba's low infanct mortality rates is because when they discover early on that a fetus will not be able to survive once born they suggest abortion instead of get down on their knees and pray for a miracle since abortion is inheretly evil (but the death penalty clearly isn't, yeee-hawww! Fry those bastards!)?

AC for AC. (2, Interesting)

Anonymous Coward | more than 4 years ago | (#32638048)

OP here. Infant mortality rates? Yeah, there are two ways to measure them. Yeah, Cuba uses a marginally different one that makes their stat slightly better. And they "cheat" by having widely available abortions. When it comes to their life expectancy do they "cheat" by reanimating their dead? Because we also have life expectancy on parity with them, despite the fact that they have a per capita income of something like 1/5 of ours (off the top of my head) and according to you "dog and pony show" medical care that amounts to utter neglect. So why do they live as long as us?

Regarding your source:

1: good job linking a right wing thinktank [spinprofiles.org] . Funded by philip morris and headed by a former coordinator of Bush campaign? I'm SHOCKED that they don't like Michael Moore's film, haha.

2: i win a prize for calling it... you're a disgruntled Moore hater. Well, so what. Get over it, and start contesting some of the legitimate non-fiction academic literature on Cuba instead of stuff that plays alongside action movies in theaters across the US.
 
 

Even poor people in the US have access to multimillion dollar equipment and highly trained doctors, expensive medications, etc... Do you really think a little shithole poor country like Cuba has better healthcare?

Tiger Woods is a billionaire. So I'm sure he wear condoms all the time he's banging cocktail waitresses, right? That's about the same sort of stretch in logic you use above.

SOME poor people have access to multimillion dollar equipment in the US. And for every one of them, there are 20 persons who have health insurance, get cancer, and are dropped by their insurance company or denied coverage (because a commission is paid to reps every time they find a way to deny coverage, and those who don't are fired). The vast majority of American poor are victims of structural violence, are highly marginalized, and have essentially no access to first world medical care.

Mod Troll. (5, Informative)

adam (1231) | more than 4 years ago | (#32637902)

Cuba has a dog and pony show.

...and you know this how, exactly?

I already warned you in my original post not to trot this shit out, because I'm not some idiot who happens to have seen a Michael Moore film and now thinks Cuba is a utopia. Instead I'll choose to believe the guy who runs Harvard Medical School's Social Medicine program (see: end of my original post), Jim Kim MD (former Prof of Medicine and Chair of Global Health for Harvard Medical School, now president of Dartmouth), and the World Health Organization, amongst many other credible sources.

Because I am busy and you make no effort to substantiate your claims, I'm just going to paste a chunk from Tracy Kidder's (Pulitzer Prize winner) biography of Dr Farmer, where Farmer talks to Kidder about dispelling myths about Cuba (and then after that some of Farmer's own writings)...

"For me to admire Cuban medicine is a given," Farmer said. It was a poor country, and made that way at least in part by the United States' long embargo, yet when the Soviet Union had dissolved and Cuba had lost both its patron and most of its foreign trade, the regime had listened to the warnings of its epidemiologists and had actually increased expenditures on public health. By American standards Cuban doctors lacked equipment, and even by Cuban standards they were poorly paid, but they were generally well-trained, and Cuba had more of them per capita than any other country in the world-more than twice as many as the United States. Everyone, it appeared, had access to their services, and to procedures like open heart surgery. Indeed, according to a study by WHO, Cuba had the world's most equitably distributed medicine. Moreover, Cuba seemed to have mostly abandoned its campaign to change the world by exporting troops. Now they were sending doctors instead, to dozens of poor countries. About five hundred Cuban doctors worked gratis in Haiti now-not very effectively, because they lacked equipment, but even as a gesture it meant a lot to Farmer.

One time he got in an argument about Cuba with some friends of his, fellow Harvard professors, who said that the Scandinavian countries offered the best examples of how to provide both excellent public health and political freedom. Farmer said they were talking about managing wealth. He was talking about managing poverty. Haiti was a bad example of how to do that. Cuba was a good one.

He had studied the world's ideologies. The Marxist analysis, which liberation theology borrowed, seemed to him undeniably accurate. How could anyone say that no war among socioeconomic classes existed, or that suffering wasn't a "social creation," especially now, when humanity had developed a grand array of tools to alleviate suffering. And he was more interested in denouncing the faults of the capitalist world than in cataloging the failures of socialism. "We should all be criticizing the excesses of the powerful, if we can demonstrate so readily that these excesses hurt the poor and vulnerable." But years ago he'd concluded that Marxism wouldn't answer the questions posed by the suffering he encountered in Haiti. And he had quarrels with the Marxists he'd read: "What I don't like about Marxist literature is what I don't like about academic pursuits-and isn't that what Marxism is, now? In general, the arrogance, the petty infighting, the dishonesty, the desire for self-promotion, the orthodoxy. I can't stand the orthodoxy, and I'll bet that's one reason that science did not flourish in the former Soviet Union."

He distrusted all ideologies, including his own, at least a little. "It's an ology, after all," he had written to me about liberation theology. "And all ologies fail us at some point. At a point, I suspect, not very far from where the Haitian poor live out their dangerous lives." 'Where might it fail? He told me, "If one pushes this ology to its logical conclusion, then God is to be found in the struggle against injustice. But if the odds are so preposterously stacked against the poor-machetes versus Uzis, donkeys versus tanks, stones versus missiles, or even typhoid versus cancer-then is it responsible, is it wise, to push the poor to claim what is theirs by right? 'What happens when the destitute in Guatemala, El Salvador, Haiti, wherever, are moved by a rereading of the Gospels to stand up for what is theirs, to reclaim what was theirs and was taken away, to ask only that they enjoy decent poverty rather than the misery we see here every day in Haiti? We know the answer to that question, because we are digging up their bodies in Guatemala."

For me, the first sights of communist Cuba were a great relief after Haiti. Paved roads and old American cars, instead of litters on the gwo wout Ia. Cuba had food rationing and allotments of coffee adulterated with ground peas, but no starvation, no enforced malnutrition.



And now some of Farmer's own writing on Cuba. I have chosen a quick general passage on Cuba from his book Pathologies of Power, which also quotes another noted Harvard historian. This book references Cuba in detail in too many places to list. It recounts Farmers experiences of actually visiting many times the palatial estates where Cuban HIV patients receive free medical care (and in fairness I should note recounts how the initial policy was mandatory HIV testing and mandatory treatment there, and how this policy was relaxed after the initial panic of the AIDS epidemic faded — Farmer can occasionally say things about Cuba that are critical too). Don't take my word for it. You can find it on books.google.com. Search "cuba" within it and read a few different pages. Then search his other books. Repeat. Then try to find a way to prove he's somehow not one of the world's foremost authorities on Global Health (good luck here).

Perhaps the Elián Gonzalez story will help to expose some of the hypocrisy surround both our policies toward Cuba and our attitudes and policies regarding Haitians. The idea that the Gonzalez child would have his rights violated by returning to Cuba with his father is laughable, especially if one regards social and economic right as important to child welfare. Harvard historian John Coatsworth put it trenchantly:

"In Cuba, Elián will have his father and the rest of his immediate family, a decent standard of living, free public education through university, cradle to grave medical care, and a relatively crime-free environment. His life expectancy will be about what he could expect in Miami (73 years). His chances of getting into college will be a bit lower. The likelihood of being assaulted, robbed, or murdered substantially less.

In short, Elián's chances in Fidel Castro's Cuba appear to be infinitely better than in most of the developing world. Better than in most places-like Haiti, for example-to which U.S. authorities routinely deport undocumented immigrants and their children. In Haiti, one out of eight children dies before the age of and nearly half have no school to go to. Malnutrition and violence are endemic and male life expectancy at birth is 51 years."


So we have you, with no substantiation, and well, lots of noteworthy experts, at least three of whom (plus the WHO) I've invoked above. Unless you reply and have stellar examples of the "dog and pony show," consider yourself branded a troll, or at best to be uninformed.

Re:Mod Troll. (1)

RightSaidFred99 (874576) | more than 4 years ago | (#32638068)

I don't deny Cuba does a lot with what they have, which is shit. They are certainly at the top of the heap for a poor country. Besides, Cuba almost literally set out to be a nation of doctors. Kind of hard to do unless you're, you know...a dictatorship?

The problem is this myth that Cuba is a world leader in health care quality. They simply aren't. Let's address a few of the supposed Cuban wonders.

Infant Mortality

The measurement is shit [overpopulation.com] . Furthermore, Cuba has a high rate of abortions - literally somewhere between 3 and 4 times the rate in the US [this is easy enough to google]. Aborting nonviable babies certainly helps you publish some propaganda about wonderful infant mortality rates.

Breast Cancer Survival

See the Concord study [mdconsult.com] for some details on this. Cuba's numbers are shit, and nobody believes it. Also, it seems they don't count secondary causes, e.g. if breast cancer metastasized to other parts of the body and caused death.

It all boils down to common sense. Cuba is dirt poor. Sure, they've trained a lot of doctors but they are _poor_. They put on a dog and pony show to convince the world they have great care, but nobody can prove it. You have foreigners who visit and get enchanted, but no hard facts.

How about a nationwide census of hospital quality? Reliable (not state provided) survival rate data for major illnesses? Fucking _nothing_. Just glowing reports from foreigners who visited a few times and were wooed or from people who trust bad data provided by the Cuban government which is completely contrary to basic common sense.

Re:also: more doctors, less pay, more compassion. (1)

fishexe (168879) | more than 4 years ago | (#32637978)

Cuba has a dog and pony show. Shit for the vast majority of the population, and high quality care for VIPs and foreigners.

Do you have any data or empirical evidence to back this up?

Re:also: more doctors, less pay, more compassion. (0)

Anonymous Coward | more than 4 years ago | (#32637934)

In the 1800s there were 400+ medical schools in the united states. By the early twentieth century there were less than eighty.

Sorry, but I call bullshit, [citation needed]. Seriously.

If you do manage to source it, I know from my own research that most of those schools aren't "medical schools" in any way shape or form like we would consider them now. Did you know that for quite awhile in the 1800's, homeopathy was considered a legitimate medical practice, and was quite popular, rivaling "allopathic" care (or what you'd now just call medical care). Other traditions were also rampant, in the 1800's scientific knowledge was nearly unknown. As this gentleman said, even 50 years ago, the medical profession was leaps and bounds behind, so imagine what it was like 200 years ago for a second.

The reason we have less schools now (even though I'm not sure we ever had such a huge difference to begin with, though I'll grant you there was one) is because we now have more rigour in medicine and less snake oil (that now is the realm of wonderful pharma companies, but that's another story altogether).

I'm not saying we don't need more doctors, and I agree the AMA does preciously guard the salaries of the doctors, but it has less to do with number of schools, and more to do with insurance costs and artificial inflation in the vicious cycle of: doctors charge more -> insurance companies demand more -> patients sue for more -> doctors need more to make up difference -> ....ad nauseum.

So there you go. Just my $0.02.

Profit driven (1)

Runaway1956 (1322357) | more than 4 years ago | (#32637936)

Insurance companies, hospitals, and even individual doctors are profit driven.

While it is certainly no crime to make a dollar, that dollar shouldn't be THE_MOTIVATING_FACTOR in health care.

If/when every doctor, every hospital, and every insurance agent actively seeks to provide the best REASONABLE care possible, at the lowest REASONABLE cost possible, then we will have gone a long way toward solving our health care problems. Ambulance chasing lawyers need to be reigned in as well. An accident in which a person's neck is broken should involve some pretty big money - but the sum of money involved shouldn't guarantee that the victim can live on Easy Street with all his freinds and relatives for the rest of their lives, either. Worst of all - those ambulance chasers pocket half the settlement anyway, so the victim is screwed in the end, no matter what!

And, insurance fraud needs to be punished much more seriously than it is today. Any moron who defrauds an insurance company should get automatic prison time, the sentence to be determined by the amount of the fraud. 1 year for each ten thousand dollars sounds about right to me, sentences to include any and all executives of any companies involved.

In short, let's clean up our act, and stop looking at health care as a cash cow. Start looking at health care as an obligation to take care of each other. And, ourselves, of course.

Re:Profit driven (-1, Troll)

Third Position (1725934) | more than 4 years ago | (#32638120)

While it is certainly no crime to make a dollar, that dollar shouldn't be THE_MOTIVATING_FACTOR in health care.

Every time I see that sentiment expressed, I have to bust out laughing!

Seriously. Presumably idealists like you are gonna be signing up for the expense and commitment required to get through medical school to bring us all medical care at earnings no better than a union welder could make?

Why the fuck would anyone want to do that?! Where are we going to find such angels? Any volunteers out there?

Somehow, I never hear that sentiment expressed by anyone that actually has the wherewithal and the smarts and who actually did the work to become a doctor.

Dude, the profit motive is why I work at all. And if my occupation didn't pay better than any number of less stressful careers, I'd be in one of those less stressful careers. When was the last time you volunteered to practice your trade without getting paid?

Where's the Link? (1)

coaxial (28297) | more than 4 years ago | (#32637586)

Is there a link, or are we just supposed to read the blurb.

Oh hell, this is slashdot, no one reads the article anyway. Never mind. Carry on.

Re:Where's the Link? (0)

Anonymous Coward | more than 4 years ago | (#32637866)

yeah, where's the link?

Interesting... (4, Insightful)

nametaken (610866) | more than 4 years ago | (#32637604)

One side says war spending is the problem, the other says it's the economic bailout plan. But take both away and you've made almost no difference. Our deficit problem -- far and away -- is the soaring and seemingly unstoppable cost of health care.

I'll admit that my concept of our spending is probably skewed by intentionally misleading infographics and such, but this doesn't seem to jive with anything I've ever seen. Can someone explain how this is true, or point to something that does?

Re:Interesting... (3, Informative)

xcut (1533357) | more than 4 years ago | (#32637720)

It is true. Here's an article in the economist, which has good coverage of this: article [economist.com] .

Note: The proportion of GDP devoted to health care has grown from 5% in 1962 to 16% today. Rising health-care costs appear to have suppressed wages, as firms seek to make up for the expense. America spends 53% more per head than the next most profligate country and almost two-and-a-half times the rich-country average..

There is a systemic problem in the US that is well document: that of wrong incentives in the system (over-testing by doctors because of bad payment models, lack of litigation protection, etc). Not easy to fix.

Re:Interesting... (0)

Anonymous Coward | more than 4 years ago | (#32637762)

Check to see how much the population segment aged greater than 55 has grown since then. Old people get sick and need care. Our elderly population has exploded in the interval you cite, and that explains a lot of that increase.

Re:Interesting... (1)

xcut (1533357) | more than 4 years ago | (#32637782)

That explains nothing in the context of international comparisons, the US has a younger population than most of Europe, and Japan.

Re:Interesting... (1)

Kral_Blbec (1201285) | more than 4 years ago | (#32637834)

Not even bothering to challenge your dubious claim of Europe having an older population, it also has a much less active one. They are also much less likely to say "I'm ready to die". The American mentality is now "Do everything possible to save me" regardless of the cost.

Re:Interesting... (1)

xcut (1533357) | more than 4 years ago | (#32637928)

Shall we take the data from here [wikipedia.org] and here [wikipedia.org] then, on the 65+ year olds? That's 16.81% in Europe vs 12.6% in the US. You're probably joking about the "much less active" bit, so I'll let it slide.

Most importantly: you are of course entitled to the "do everything possible to save me" mentality, that is a cultural difference. Note, though, that with spending at 16% of GDP, that's a dangerous game. The US does not have the ability to raise infinite debt.

Re:Interesting... (3, Informative)

evilviper (135110) | more than 4 years ago | (#32637726)

It's called Medicare. It's a large percentage of federal spending right now, and it's projected to exceed 100% of all federal spending by about 2020, baring any changes.

If you don't know this, it's simply because you aren't informed at all. Experts have been sounding the alarm bells for at least a decade, loudly and repeatedly. It seemed to be the top topic just a handful of years ago, when ballooning medical costs were the largest problem facing the general public, just a while before the economy started to fail completely, and more immediate concerns became paramount.

Obama, Clinton, and McCain talked about it all through their presidential primaries and campaigns, in no uncertain terms. It was a major issues discussed endlessly in the house and senate for about a year as Obama tried to push health care reform through. I have no idea how you could be ignorant of this fact, if you pay attention to national/world events at all.

http://blogs.abcnews.com/theworldnewser/2009/12/president-obama-federal-government-will-go-bankrupt-if-health-care-costs-are-not-reigned-in.html [abcnews.com]

Re:Interesting... (4, Informative)

nametaken (610866) | more than 4 years ago | (#32637788)

Of course I've heard all the clamor over Medicare. Medicare represents $491 billion. DOD's annual budget alone is something like $1 trillion. I believe we've spent over a $1 trillion on the wars in Afghanistan and Iraq. Iirc the bailout ran into many trillions of $'s (certainly correct me if I'm wrong, some more inflammatory sources seem to put it at $24 trillion). Not to say that Medicare isn't a serious problem, but this doesn't seem to answer this question of our war and bailout costs being a fraction of what medicare costs us. No?

Sounds like the earlier posters overall estimation of all healthcare costs as a percentage of GDP was more likely what he was talking about.

Re:Interesting... (2, Interesting)

MsGeek (162936) | more than 4 years ago | (#32637888)

Here's how you fix it:
1.) You re-tool Medicare to widen its coverage, in preparation for what will actually save it:
2.) You open Medicare to everyone. Until 65, Medicare is a buy-in system. You will actually have to pay for it. Just like you pay for an insurance policy. Actuarially-sound price scales are created, with sliding scales derived from them for income sensitive pricing. Basically Medicare becomes an option on the "Exchanges" that will be up and running beginning in 2014.

And how will this fix Medicare?
1.) A flood of young, healthy people ditch their private insurance for this "public option" that provides better value for the money. Medicare has a 5% overhead rate. The private insurers take something like 30 cents out of every dollar paid in premiums for overhead and promotional costs.
2.) This pool of new, young blood in the Medicare program spreads the risk and re-balances the pool of insured.
3.) This will not harm private insurers one bit: instead of trying to sell people insurance policies they sell people "MediGap" policies that cover the things Medicare won't. Like gynecological and obstetric care, for instance...you can bet this new expanded Medicare will not touch women's health issues...third rail time.

There, fixed it for you.

I'll throw in a bonus: I'll fix Social Security too. Did you know there is a ceiling on income taken by FICA? After a certain point, your income is not subject to FICA taxation. You know how to fix Social Security and not have to worry about it for another century? You remove the ceiling and subject all earnings to FICA taxation. Bada bing bada bang Social Security is solvent. You take that money and put it in that lock box Al Gore was going on about in 2000, so that Republican raiders can't get their grubbies on it. Fixed that for you too.

Re:Interesting... (1)

fishexe (168879) | more than 4 years ago | (#32638056)

Here's how you fix it...There, fixed it for you. I'll throw in a bonus: I'll fix Social Security too....Fixed that for you too.

I'm sorry, but until you come up for a plan for how to get all your fixes through the congressional sausage-factory, you've fixed exactly nothing.

Interesting...Paper debts. (0)

Anonymous Coward | more than 4 years ago | (#32637924)

It's called Medicare. It's a large percentage of federal spending right now, and it's projected to exceed 100% of all federal spending by about 2020, baring any changes.

Would that be the same Medicare were congress has been looting the fund and leaving IOUs? Or is that Social Security? It's hard to keep boondoggles straight these days.

Re:Interesting... (1)

Sycraft-fu (314770) | more than 4 years ago | (#32638006)

Yes, unfortunately we DO need to put a price on life. This attitude of "Do whatever you can, whatever it takes, no matter how little good it does," doesn't work. We have some extremely expensive procedures these days, and can dump a lot of money in to the last few months of a person's life and make little difference. Unless we want to become a nation where healthcare is more or less what we do, we need to start thinking about economics.

Now this doesn't mean saying "A person is worth $300,000, once that much has been spent they get no more." It means looking at cost vs benefit of treatments. In terms of benefits this includes how likely it is to succeed, what success and failure mean, how quality of life is affected, etc, etc.

So, if a person is involved in an accident and needs $100,000 of critical care or they'll die, however with the care they are likely to nearly fully recover and live a high quality life for many decades, we spend the money. It is worth it. However if a terminally ill old patient needs $100,000 of treatment to attempt to prolong their life a few months, all while they are in a coma, unaware of the world, the money is not spent, it is a waste.

This is the simple reality of the situation. If we aren't willing to do this, aren't willing to talk costs and benefits, well there'll be one of two situations:

1) Costs will continue to spiral as medical science gets better and better at dealing with problems. People will be able to be kept clinically alive by throwing tons of money at the problem, though it won't do much good. This is what's happening in the US now. Everyone wants all the care, regardless of the cost, for their loved ones and costs go through the roof.

2) Care will be rationed via wait lists as happens in Canada. You will have to wait great lengths for many treatments because there's only so much to go around. This can mean waiting half a decade on a surgery like a hip replacement that will greatly increase quality of life. Resources will largely be spent on critical care, everything else will suffer from increasing waits.

If we don't want that, if we want good affordable care, we HAVE to discuss what is and is not worth paying for.

Re:Interesting... (1)

antifoidulus (807088) | more than 4 years ago | (#32638072)

I always found the whole "you cannot put a price on life" argument to be total bullshit, like it or not we put a price on our own lives almost every day. You ever go to work? Then essentially you have agreed that there is, for all intents and purposes, a price on your life. Barring some incredibly unlikely and unforeseen advance in medical science we all essentially have a finite number of hours to live, so unless work is 100% pleasure(and lets face it, despite what your high school guidance counselor says, very few people fall into that category) you are essentially putting a price on a certain percentage of your life.

Like you said, resources are unfortunately finite no matter how much we want to believe they are not, "rationing" really is the only way to distribute limited resources in a collective system. And despite what Republicans may have you believe, health insurance really is a collectivization scheme, it makes no difference whether or not the government runs it.

Cutting bailout and wars would almost cover it (0)

Anonymous Coward | more than 4 years ago | (#32637728)

Looks like the esteemed Atul Gawande was stretching it a bit when he said "One side says war spending is the problem, the other says it's the economic bailout plan. But take both away and you've made almost no difference."

Some nice wikipedia pie charts demonstrate that reducing defence spending would fix a lot:

http://en.wikipedia.org/wiki/2010_United_States_federal_budget

Then again, total defence spending is still less than Medicare + Medicaid, but also remember that the original article refers to "war spending", which is presumably only a fraction of total defence spending.

As for bailout costs: the cost of the Troubled Asset Relief Program ($154 billion in 2009) plus the American Recovery and Reinvestment Act of 2009 ($353 billion in 2010) is a total of $500 billion, while Medicare + Medicaid is $750 billion.

I reckon covering 2/3 of the budget would do a helluva lot more than make "no difference".

Re:Cutting bailout and wars would almost cover it (1)

Kral_Blbec (1201285) | more than 4 years ago | (#32637852)

Yup, cutting defense solves everything. Right up to the point where you start wishing you really could defend yourself.
If you think that a world war will never happen again you are fooling yourself. Do you really think the Chinese would hesitate for a moment if the American military vanished over night?
It is also one of the few federal expenses that the Constitution actually even permits.

Re:Cutting bailout and wars would almost cover it (2, Informative)

Hognoxious (631665) | more than 4 years ago | (#32637870)

war spending != defense spending.

There aren't many nuclear submarines deployed in Afghanistan.

Re:Interesting... (1)

AHuxley (892839) | more than 4 years ago | (#32637748)

In most of the world you have
Public health for all, private if you want it, gov health bureaucracy.
Take your chances with either system, free or some $ gap, good dr, bad dr.
But nobody has to stress, working, not working, young ,old, rich, poor as a citizen you have a safety net to see a local Dr, go to the ER, get expert services ect.
Or you can go private and pay for them.
The US seems to have stuck in an extra layer of private health bureaucracy.
The gov to pay for a safety net, public health ect and then not request any of the saving that come with scale.
The US is paying for a public option by default in taxes and then private on top.

Re:Interesting... (0)

Anonymous Coward | more than 4 years ago | (#32637848)

Um....isn't that what Obama's healthcare bill was supposed to fix? Or did it just spend a lot of money and do nothing?

Re:Interesting... (1)

AHuxley (892839) | more than 4 years ago | (#32637898)

People without cover will get to buy in?

Re:Interesting... (0)

Anonymous Coward | more than 4 years ago | (#32637758)

Medicare is an enormous part of the federal budget. Look at the charts on page 153 of the budget report issued by the Office of Management and Budget: http://www.gpoaccess.gov/usbudget/fy11/pdf/summary.pdf . The numbers are on page 151. Medicare and Medicaid are budgeted $726 billion this year.

Re:Interesting... (2, Insightful)

phantomfive (622387) | more than 4 years ago | (#32637784)

Look here [wikipedia.org] and especially pay attention to this graph [wikipedia.org] . Here's a good one [wikipedia.org] to show what has happened with military spending: basically over the last 50 years military spending has dropped (until recently when it remained constant) and the money went to welfare/medicare/medicaid.

The Iraq/Afghanistan war has only cost a little over a trillion dollars over the last decade, and that amount presumably will drop in the future. The stimulus also cost around a trillion dollars, but it was mostly a one time expense. Healthcare expenses are only going up. A lot of what we call the Bush deficit, the Obama deficits (and the Clinton surplus) is actually due to circumstances beyond the control of the president. People are retiring, and the government has promised to take care of them. Now they are cashing in on those promises, and it remains to be seen how good they are.

Re:Interesting... (2, Insightful)

fishexe (168879) | more than 4 years ago | (#32638088)

The Iraq/Afghanistan war has only cost a little over a trillion dollars over the last decade, and that amount presumably will drop in the future.

Which is why we'll have to go find a couple more wars to start. Don't you just love the military-industrial complex?

Link to the address transcript here (0)

pturley (412183) | more than 4 years ago | (#32637626)

Re:Link to the address transcript here (1)

pturley (412183) | more than 4 years ago | (#32637632)

Oh - dang it - that's NOT the right address.

Buffet style insurance. (2, Insightful)

RightSaidFred99 (874576) | more than 4 years ago | (#32637634)

Buffet style insurance is a huge part of the problem. People don't see the costs of their health care, and they're accustomed to getting as much as they want (not need) for a set amount of money, much of which is paid "magically", "somehow" by their employer.

I'm not saying this is the entire problem, but it's a huge part of it. If you don't see the costs of your health care, you won't wisely use it. It's the same problem plaguing college tuition costs. "Oh, it's free money - either I'm getting a loan (free money!) or someone else is paying for it!". Yeah, until schools notice this and start charging $25k a year to attend because nobody cares - it's "free money".

My solution is a high deductible plan. If you can't afford it, the government picks it up for you. You pay the first $5k of your health costs out of pocket, the HDHP kicks in afterwords. If you're too poor for that, then they have government clinics for you.

Re:Buffet style insurance. (1)

MichaelSmith (789609) | more than 4 years ago | (#32637670)

Based on the cost of private health care here in Australia I reckon I would be better off investing the money and paying for health care in cash.

(in 99.9% of cases anyway).

Re:Buffet style insurance. (1)

RightSaidFred99 (874576) | more than 4 years ago | (#32637682)

Most HDHP plans negotiate highly discounted rates. You'd be paying what the insurance companies pay, not what you as a private cash customer might pay in most cases.

Re:Buffet style insurance. (4, Interesting)

beelsebob (529313) | more than 4 years ago | (#32637754)

Buffet style insurance is a huge part of the problem. People don't see the costs of their health care, and they're accustomed to getting as much as they want (not need) for a set amount of money, much of which is paid "magically", "somehow" by their employer.

Which is why in the UK, where everyone can use the health service for free and is insured automatically by the government provides better health care cheaper?

Doesn't sound like you've sorted that out right.

Re:Buffet style insurance. (-1, Flamebait)

Anonymous Coward | more than 4 years ago | (#32637830)

First, UK health care sucks. I have better health care available than anyone in the UK unless they pay for their own. They may provide better health care to poor people than the US government does to poor people in the US. I don't care about that, frankly.

Second, the UK is tiny. 1/5 the size of the US. Vastly different wealth distribution and demographics. We're fatter and unhealthier, by and large.

Besides, we have free health care too. Medicare/Medicaid. And its costs are ballooning.

For the most part it comes down to whether middle America (and up) is willing to give up their quality of health care for the good of the rest of America. Personally, I'm not.

Re:Buffet style insurance. (1, Insightful)

roman_mir (125474) | more than 4 years ago | (#32638046)

If you thought that Greece has problems, just wait until you find out how much debt UK has to other nations and what their trade imbalance is.

It seems nobody is paying attention to HOW things are funded anymore, bankers give out loans to companies and to governments without understanding the first thing about the ability of the debtors to pay this money back.

Imagine what will happen to all of the entitlements once nobody wants to bankroll it any longer.

UK government, like all other governments consists of politicians who want to be reelected, this is a major problem, they give out entitlements like the money comes out of a money well. Money was taken from taxes, from social security, then wars came so it was no longer enough, more and more was borrowed, all while the manufacturing was outsorced, the 'service economy' grew, all of which means that the trade imbalances grew and ability to pay back the debts diminished.

When the big one hits, UK will no longer be able to provide its services, at least not for the money that is paid by the government for these services right now. I expect UK and US to behave in the same way, by printing cash/bonds and eventually to see the value of their money to diminish into nothingness.

Re:Buffet style insurance. (2, Insightful)

interkin3tic (1469267) | more than 4 years ago | (#32637892)

Buffet style insurance is a huge part of the problem. People don't see the costs of their health care, and they're accustomed to getting as much as they want (not need) for a set amount of money, much of which is paid "magically", "somehow" by their employer.

While that would -sound- like a convincing idea, I see no evidence of that being the case. From personal experience, I don't decide to schedule myself, fill out the forms, disrupt my schedule, and then take the MRI for my sore throat, and I wouldn't even if it were absolutely free, no questions asked. A buffet of food, yeah, I'll take extra because I like eating food. Extra medical procedures? Who wants more of those? Are you telling me that people pointlessly waste other's money and their own time, and that's really a significant contributor to the problem? Because I'd like to see a citation for that.

I'd believe with your idea, there would be fewer of them, but if we're only talking about 1% of the problem, then let's not bother.

Buffet Kevorkian style. (1)

Ostracus (1354233) | more than 4 years ago | (#32637956)

Buffet style insurance is a huge part of the problem. People don't see the costs of their health care, and they're accustomed to getting as much as they want (not need) for a set amount of money, much of which is paid "magically", "somehow" by their employer.

So what is the cost of a human life?

Re:Buffet Kevorkian style. (1)

mellon (7048) | more than 4 years ago | (#32638052)

In most countries, less than a dollar. In the U.S., it depends on whether the human in question is insured or not. I.e., you asked a dumb question.

Standard profit meme (2, Insightful)

mjwx (966435) | more than 4 years ago | (#32637692)

1. Put old system into barrels marked "nuclear waste".
2. Throw barrels off cliff.
3. Pick working system like that from Australia or Canada.
4. Copy it.
5. Don't let the rebulocrats change anything.
6. Profit.

I'm serious, even if you choose to keep private health your premiums will go down as they now have to compete with the lowest cost alternative (public health), which is net profit for you. Another boon will be increased service from private health funds as public health sets the minimum standard for care.

Re:Standard profit meme (2, Insightful)

AHuxley (892839) | more than 4 years ago | (#32637820)

The public/private Australian system would be great for the US.
All the private practice you want with a free system for all "citizens" if/when needed.
This would expose the union free, interchangeable, disposable workforce and not be allowed to pass.

Navel gazing (1)

xcut (1533357) | more than 4 years ago | (#32637696)

This will take science. It will take art. It will take innovation. It will take ambition. And it will take humility. But the fantastic thing is: This is what you get to do...

This is just lovely. Go on, start innovating, spend lots of money. By no means must you look at other countries to find out why your healthcare expenditure is so high, you can look forward to your "not invented here" syndrome to keep costing you a fortune.

Re:Navel gazing (0)

RightSaidFred99 (874576) | more than 4 years ago | (#32637732)

Our health care expenditure is higher because we have better care. The problem is it's not available to everyone, only the middle class and up get the best care, and it's very expensive because of our insurance system.

And please don't quote me infant mortality rates where the US uses a different system to determine infant mortality, or expected lifespans which are heavily dependent on cultural and external influences other than health care quality. Instead, go investigate cancer treatment success rates. Heart disease treatment rates. The list goes on.

We're an unhealthy country of pigs, but we have superior health care available. So the mortality rates kind of balance out almost. We just pay a shitload more.

Re:Navel gazing (1)

xcut (1533357) | more than 4 years ago | (#32637774)

Alright - I guess I won't quote you on any relevant statistics then. I am not sure whether you are happy or unhappy with the state of affairs, since you conclude with "we just pay a shitload more". That shitload is more than 16% of your GDP, which is insane.

Expected lifespans are important, even if you put your head in the sand. It is irrelevant how good your health care is for the top 10% of the population, you will never manage to establish this sort of care across the board. And yes, obesity is a health problem, not a "cultural" one, because it is the health care system that pays the price in the end. Persistent failure to tackle the problem as a health issue does not mean you just get to redefine it.

Re:Navel gazing (1, Insightful)

Anonymous Coward | more than 4 years ago | (#32637832)

Our health care expenditure is higher because we have better care. The problem is it's not available to everyone, only the middle class and up get the best care, and it's very expensive because of our insurance system.

Perhaps, you've been sold a pig in a poke? Did you even check the bag?

It's expensive because sick people will pay lots of money to live. It's just capitalism to an extreme.

The US has a healthy belief in the strong survive and the weak perish.

You let wars and bailouts deplete your ecomony but scream if money is put into healthcare where it's needed.

I hate to bring it out but no, your system is in shambles.

Get your facts straight.

Re:Navel gazing (1)

AHuxley (892839) | more than 4 years ago | (#32637912)

Infant mortality should be like 1, 2, 3 - easy stats to collect and publish, a bit like U6 for unemployment.
Expected lifespans should show if a population had access to health care over their life or not.
"external influences" is what, alcohol, war, pollution?
Most of that would average out as most of the developed world is not that drunk 24/7, at real war or living under toxic smog.

Re:Navel gazing (1)

frenchbedroom (936100) | more than 4 years ago | (#32637792)

Also, the "But the fantastic thing is: This is what you get to do" part sounds to me like a lovely way to say "We old geezers couldn't figure it out. You young ones are our only hope, and you better not f*ck up"

Re:Navel gazing (1)

phantomfive (622387) | more than 4 years ago | (#32637884)

Uh, you do realize that most other countries have problems with healthcare too, right? It's really a hard problem, and getting it right is not easy. Sure, take the good ideas from other countries, but don't expect that to solve all your problems.

A universal supply of expensive services (2, Insightful)

LambdaWolf (1561517) | more than 4 years ago | (#32637722)

Half a century ago, medicine was neither costly nor effective. [...] Our job in medicine is to make sure that all of this capability is deployed, town by town, in the right way at the right time, without harm or waste of resources, for every person alive.

This is the problem in a nutshell. The notion that leads people to call for universal health care is intuitively moral: that every human being deserves the best medical care possible, even if they can't pay for it. It seems cruel to deny that. But medical care is some of the most expensive labor in the world. And justly so: pharmaceutical patent abuse aside, doctors and nurses deserve to be paid a bundle for how long they have to study to get certified and for what a general pain in the ass their job is. So to say that every human being should be provided with ample attention from doctors, at the government's expense if necessary, is akin to campaigning for a universal supply of platinum bars.

I get that the speaker isn't necessarily speaking as though socialized medicine is the only answer, but he seems to implicitly acknowledge that the government is the only one who will pay doctors to care for poor people. Even if you don't oppose such a thing on political grounds, the money just plain isn't there. I can't really suggest a solution except to keep science and technology marching along and hope that medicine eventually starts getting cheaper when the remedies we invent finally start outpacing the diseases we discover.

we'll do it, sort of... (1)

r00t (33219) | more than 4 years ago | (#32637812)

You're right that the money isn't there, but we can still promise the care. We don't have the stomach for death committees or official rationing. We will refuse to accept the problem.

Of course, the waiting lists will grow as required to ration out the supply. Everybody gets healthcare, except the people who die while waiting for treatment.

Maybe you can bribe your way to the front of the list, make friends with a senator, or claim to be part of some disadvantaged group that needs special treatment. The blackmarket possibilities are endless.

Re:we'll do it, sort of... (0)

RightSaidFred99 (874576) | more than 4 years ago | (#32637854)

You don't even need a black market. Ironically, universal health care puts a wider gap between the rich and the rest of us. I get stuck with shitty government care, if you're wealthy you can just walk into a top notch clinic with the best doctors (who know they can make more money privately) and pay in cash. The rest of us don't have that option.

At least with the current system (which is broken, I admit) the middle class also gets top notch care. In fact, for the most part even poor people in the US get top notch care, most states have aid programs available.

Re:A universal supply of expensive services (1)

rtfa-troll (1340807) | more than 4 years ago | (#32637828)

Your post has quite a bit right and I hate to pick nits, but you conflate two different things and they are very very different.

[..] every human being deserves the best medical care possible [...] every human being should be provided with ample attention from doctors

We can certainly afford to provide pain relief and basic medical care for every member of humanity. "the best medical care possible" is a completely different thing. There is always one "the best heart surgeon in the world" and he will never be able to see everyone. Hopefully he gives access to people with difficult and interesting cases, but in the end money or pot luck may not be a bad way to control access to him. However, we can ensure that everybody can see a doctor who has a reasonably good chance of being competent.

"The best is the enemy of good." said Voltaire - if we try to pursue perfect care we won't be able to afford to do basic stuff for everyone.

I can't really suggest a solution except to keep science and technology marching along and hope that medicine eventually starts getting cheaper when the remedies we invent finally start outpacing the diseases we discover.

That seems to be the solution we're following so far.. I don't think it has a good track record. Everybody really needs to face up to these kinds of issues. I guess soon we'll have "health care problem denialists" who will claim that spending 90% of GDP on health care is a natural state.

The Movie "The Blob" Supports the Case Against Gov (1, Interesting)

Anonymous Coward | more than 4 years ago | (#32637734)

The Movie "The Blob" Supports the Case Against Government Healthcare [campaignforliberty.com]

Okay, this isn't exactly the most serious piece I've ever written, but I think it's interesting and may make a good point. This past Spring, I was sifting through Comcast OnDemand, and found two versions of the movie "The Blob"- the original 1958 version, and the 1988 remake. The 1958 version is an old favorite of mine, so I decided to check out the 1988 version for comparitive purposes. I didn't get very far into the movie- I thought it was awful compared to the original -but I did get far enough into it to notice one crucial difference between the remake and the original.

In both movies, an old man in the woods is attacked by the Blob, which sticks to his arm, and is then taken to get help by teenagers that find him. In the orignal film, they bring him to the town doctor, who is about to leave town on business. The doctor immediately forgets his previous plans and brings the old man into his office for treatment. The doctor sifts through books, and calls friends to attempt to diagnose the problem with the man's arm. He is clearly dedicated to helping the old man and the idea of payment is never even mentioned.

In the remake, the teenagers bring the old man to the town hospital, but when they rush him to the front desk, they are greeted by an indifferent secretary who simply asks if the man has health insurance. The two teenagers become very upset and irritated at this point. The old man is eventually led into a room, and apparently forgotten. The doctor is uncaringly sitting at his desk doing paperwork.

If each movie can be considered a reflection of the time it was produced in, a case may be made against government interference in healthcare. In the 1958 version, the doctor is apparently providing healthcare because he feels that it is his duty to do so, not because he is looking to make lots of money. In the 1988 version, the hospital is clearly only giving healthcare to make money, and it does not deem human well-being important. If one remembers Ron Paul's discussion on healthcare in "The Revolution: A Manifesto," this difference makes perfect sense. Ron Paul writes that when he became a doctor (in the fifties), it was standard for doctors to give free healthcare to those who needed it, but couldn't afford it. He then goes on to say that this benevolence ended when the government increased regulation on the healthcare industry (in the sixties), making free healthcare too expensive to give.

So there you have it- the same story, with two different scenes (which doesn't really matter to the story, because the Blob does what it does best in both cases). Now, I don't really like it when people make art into things that it's not. But I really do think that each movie is accurately reflecting its own time period, and I think that government interference may be resonating even through the movies we watch. Really though, I just wrote this article for a little fun. Beware of the Blob! [And government :)]

Re:The Movie "The Blob" Supports the Case Against (1)

fishexe (168879) | more than 4 years ago | (#32638074)

Yeah, and the movie Birth of a Nation supports the case for the KKK, while the movie Terminator 2 supports the case against improving computer technology. Lets all base our political decisions on this.

Re:The Movie "The Blob" Supports the Case Against (1)

fishexe (168879) | more than 4 years ago | (#32638108)

Ron Paul writes that when he became a doctor (in the fifties), it was standard for doctors to give free healthcare to those who needed it, but couldn't afford it.

Was this before or after they stopped exchanging chickens?

If past experience is any indication... (1)

Lord_of_the_nerf (895604) | more than 4 years ago | (#32637742)

...the US Health System just needs more people who stand to make a significant short-term profit from all citizens who are healthy and treated promptly.

OK, time for another rant (5, Interesting)

Anonymous Coward | more than 4 years ago | (#32637778)

1. Uniform billing codes and realtime price-lists so that we know we're not getting ripped off. California's chargemaster publication requirement is a step in the right direction, but it needs to be updated more quickly, and rural hospital exemptions are BS. If you can run a hospital, you can update your billing DB no matter where you are.

2. No anti-trust exemptions. This is so fundamental it's mindblowing.

3. Nationwide competition.

4. No more buyer's clubs. If the doctor and/or hospital is *licensed* then the insurance must pay out. You get to keep your doctor no matter what. Any company that wants to keep having a buyer's club can do that; but you can't be compelled to purchase into a club, only real insurance.

5. Real insurance means you can't lose your life savings due to a percentage payment or a cutoff. After all, you can't actually insure health. Only genes and behavior can do that. When we talk about health insurance, we're really talking about medical bankruptcy insurance, and the current system fails to do that. In order to be considered a real insurance plan, you have to prevent medical bankruptcy. That means, for example, you can lose no more than 10% of your net worth or income in any calendar year. That way, you could be severly ill for 5 years, on chemo, and emerge with roughly 60% of your life savings intact instead of nothing.

6. Stop torturing doctors. No, really. Many people won't even consider med school because it's torture. Maybe we need to put some doctors through boot camp. Maybe it's important for brain surgeons; but I can't imagine this system is really doing much to increase the number of competent family doctors.

7. Malpractice/tort reform. Duh! If a doctor is so incompetent that we're better off taking him out of the profession then let's do that. Requiring all the other doctors to pay out as if they're that bad is insane. Multimillion $ payouts won't bring back your relative. License revokation, however, will prevent it from happening to somebody else. Note, this is tricky since it's possible for competent people to make mistakes. You actually need to make sure that the number of mistakes is statisticly significant. Otherwise, nobody will want to risk becoming a doctor (see point 6). Statistics is a bizarre thing. There's actually an expected number of botched operations; but the odds of a single doctor botching 10 operations in a row are probably low enough so you can safely conclude that doc needs to lose his license.

8. Everybody self-pays and submits claims. That's right. You run healthcare like a normal business. I know it's hard to believe, but it really is just like buying a loaf of bread. Fire the beurocrats. No biggy. They'll get free health care while they look for a real job.

9. No paper work until the patient is well. No signing anything under diress.

10. You can put a pharmacy in the hospital. Quit making sick people drive to get meds.

Re:OK, time for another rant (1)

fishexe (168879) | more than 4 years ago | (#32638040)

After all, you can't actually insure health. Only genes and behavior can do that.

I think you're confusing insure with ensure. The way you seem to define insure, fire insurance would be a payment you make to prevent fires from happening, and flood insurance would somehow prevent floods.

what it dont nead (-1, Troll)

Anonymous Coward | more than 4 years ago | (#32637790)

is commynism.

Missing the Point (1)

Nartie (1128613) | more than 4 years ago | (#32637818)

For most of human history our ability to care for the sick has been limited by knowledge. It was relatively easy to do everything we knew how to do. So we have this idea that we need to do everything possible to help people. The trouble is our medical knowledge has rapidly outpaced our ability to pay for it. We argue a lot about how to give everyone the best medical care, but that just isn't possible. What we need to do is decide how much of our wealth we want to spend on medical care and then worry about spending it well.

defective medical philosophy (2, Interesting)

Anonymous Coward | more than 4 years ago | (#32637840)

science has... enumerated and identified... more than 13,600 diagnoses — 13,600 different ways our bodies can fail. And for each one we've discovered beneficial remedies... But those remedies now include more than six thousand drugs and four thousand medical and surgical procedures.

It's too bad that Western medicine doesn't have a comprehensive guiding philosophy. Imagine if they taught principles like these in M.D. schools:

  • The body must be properly nourished, and must be able to assimilate nutrients from food and the environment.
  • The body must be able to evacuate waste products from the system. The organs of elimination are the skin, the lungs, the kidneys/bladder, and the large intestine/colon. If any of these systems are compromised, problems will result.
  • The body's structure must support the functionality of the body's organ systems.
  • The activities of mind have a major influence on the body's state.
  • The body has electrical properties which must be balanced for optimal health

Western medicine plays whac-a-mole [wikipedia.org] with the body's symptoms - a pill for high blood pressure, a pill for acid reflux, a pill for high cholesterol, ad infinitum - while health practitioners guided by superior philosophies (there are many) try to distill down to the fundamental reasons for a given body's dysfunction.

The brand of medicine represented by this commencement address is defective because medical education was hijacked by the Carnegie Foundation (who represented the drug trusts). My favorite articles on this bit of history are 100 Years of Medical Robbery [mises.org] and the followup, Real Medical Freedom [mises.org] . "How The Cost-Plus System Evolved" (pt 1 [ncpa.org] , pt 2 [ncpa.org] , pt 3 [ncpa.org] ) is also well-written.

US Healthcare needs guiding principles: nothing more, nothing less.

Is there a meme for this? (2, Interesting)

MyFirstNameIsPaul (1552283) | more than 4 years ago | (#32637850)

/.tivism? Slashtivism? This is the first time I've seen the editors directly come out on the side of a political issue in the form an article on the main page.

Re:Is there a meme for this? (2, Insightful)

fishexe (168879) | more than 4 years ago | (#32638014)

/.tivism? Slashtivism? This is the first time I've seen the editors directly come out on the side of a political issue in the form an article on the main page.

If this is the first time you've seen it on /., why would you name it after /.?
Also, I suggest you look up meme [wikipedia.org] .

government out of economy (0, Flamebait)

roman_mir (125474) | more than 4 years ago | (#32637858)

In US 50 years ago a family of 4 could have actual health insurance (covering of up to $50,000 of expenses, which was enough for everything) for a year for $25 dollars (payment for an entire year!) with a $500 deductible.

Multiple attacks on this happened since that time, especially during Nixon administration. Government got into the business of doling out money to medical workers and just like with government giving out loans for education this lead to rising costs for everybody, just like it leads for universities raising their costs.

Basic problem is the government giving out public funding for any sort of endeavor. This leads to very rapid price increases. Before Nixon, a day in a hospital could cost $100, today it could cost up to 100 times that much. Obviously this has nothing to do with inflation. Costs to treat cancer could go as high as up to 20,000 dollars before then, now it could easily reach between 500,000 to a cool million.

Any time a government is involved in giving out money, the costs for any services/products go up because .... because they can go up, because there is a government guarantee that no matter what the costs are to the public coffers they will be covered.

In the infamous words of Nixon himself: "it will cost no American more than he can afford to pay". Then he yapped something about how no new taxes would be used, only existing public money (so as always, this includes your social security money).

AFAIC all government behavior that touches economy leads to pyramid scheme being created.

As long as government gives out money through laws for certain items/services and collects this money through taxes+borrows it+prints it, there is nothing that can stop the prices for the items/services to skyrocket way above what markets can bear.

Government is an anti-competitive, monopoly creating machine that destroys economy by causing massive inflation and kills productivity by regulations and tax laws that kill small business. All of this is obviously done under the guise of doing some form of good.

Get government out of economy, take government's ability to screw with market prices out of the equation, take away government's ability to kill off small business through regulations and various taxes, take away government's ability to create/maintain monopolies through giving out money/special privileges and take away government's ability to cause inflation through printing money/borrowing, take away government's affinity to corrupting everything around it through income taxes, switch to a sales tax + allow people who are poor to file for tax refunds, take government power out of economy and you will see the return of SANE prices on things, sane prices on sane insurance plans.

Of-course there is a matter of shortage of doctors - this is about the collusion that prevents the necessary number of medical professionals to enter the business, this also needs to be addressed, this creates monopolies just as well as free money.

No, what US Health Care Needs (0, Troll)

djh2400 (1362925) | more than 4 years ago | (#32637868)

is for people to realize that "Health Care" is (read: 'should be') concerned with people's health and not be thrown around as "injury care". If someone goes out on vacation to go bungee jumping or runs a recreational boat into a bridge pier, there's no reason that my taxes should pay for injuries that were induced by a conscious (idiotic) decision on their own part.

Now, providing "health care" to people who have health problems? Yes, that's what Health Care is.

How many different service lines? (5, Insightful)

bezenek (958723) | more than 4 years ago | (#32638096)

Dr. Gawande suggests the "13,600 different service lines [doctors] deliver" is an issue in health care costs. I put forth these comments:

* How many services are listed in the manual which guides the number of hours an auto mechanic is allowed to charge for a repair, e.g., replace spark plugs: 0.75 hours. How many items are in this book?

* How many different services does a software engineer deliver over a year's time?

I suggest the problem is related to control over charges. Car mechanics have a job with similar complexity to what doctors face. Software engineers often face a problem much more complex. (How many "surgeries" require several weeks to solve a single-line bug?)

The control of health care "service" in the US is in the hands of the AMA and the bureaucracies created around hospitals and other facilities. If they were willing to reduce their profit margins (assuming we can eliminate the defaults they see because of uninsured/under-insured patients), we could see significant reductions in general health-care costs.

This is just a thought...

-Todd

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