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Does Higher Health Care Spending Lead To Better Patient Outcomes?

samzenpus posted more than 2 years ago | from the put-your-money-where-your-health-is dept.

Medicine 504

First time accepted submitter ericjones12398 writes "If you haven't seen the words 'health care' in news headlines lately, you must be living under a rock. What seems most controversial among the latest research and news is a flawed payment scale that undervalues primary care and overvalues specialty care. There is evidence suggesting that publicly funded health care spending (i.e., Medicare) has not been based on primary health care needs. Rather, In the U.S. Medicare spending relies on a resource-based relative value scale (RBRVS) which seems to promote higher spending without evidence of better patient outcomes. A study comparing spending and mortality rates in Ontario had the opposite findings however, supporting a link between higher spending and better outcomes for patients. What are we doing different in the U.S.? "

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"health care" = "disease management" (0, Troll)

Dr.Bob,DC (2076168) | more than 2 years ago | (#39549991)


Higher health care spending leads to DEATH and DISEASE!

Our medical system is a sickness system designed to keep you needing constant infusions of BigPharme medicine and vaccines. How many "MDs" kill people every year? Probably ALL of them. Whitney Houston, Michael Jackson, you name it. They are murdered by subscription-writing MDs who don't care about wellness!

I would love to see just $1 billion spent on proper research into Chiropractic care. We have the proof: millions of patients with pain-free backs, hearing restored, general health and wellness. But as the group-think goes "anectdotes are not evidence" Well, with just that drop in the bucket of money, we could PROVE the benefits.

The Basics for a Healthy Life:
- Eat well. Preferably an organic, vegan diet. Grow your own vegetables if you have the space.
- Get plenty of exercise. If you live in a city, look for a gym with a HEPA air filtration system. You don't want to be breathing heavily and inhaling the toxins of a big city.
- Avoid the Medical System. Once you're caught in the 'health system', you will die. Vaccines, "medicines", and other garbage your body doesn't need. Your body has Innate Knowledge and knows how to repair itself if given the chance.
- Receive regular Chiropractic adjustments. This will help with nervous system function, remove blockages/subluxations, and help with nerve impulse distribution.

Re:"health care" = "disease management" (4, Insightful)

ColdWetDog (752185) | more than 2 years ago | (#39550241)

Hi grub! You're back! We missed you!

Unfortunately, this time you're more correct than insane. (We won't talk about the adjustments - those should be done with a framing hammer for most people).

The little article quoted to support the argument that 'more spending is better healthcare' is illustrative.

mortality rate was 12.7% vs 12.8% for AMI, 10.2% vs 12.4% for CHF, 7.7% vs 9.7% for hip fracture, and 3.3% vs 3.9% for CHF

Note those big differences folks. Right down there in the noise floor.

In the US we spend WAY too much doing things to people that gives very little benefit to them. The major culprit is the 'free market' system where profit (at multiple levels) is considered the appropriate metric. Although everyone and their little sister will go on about how 'patient care is first', everyone in the system realizes that this is just a sop to the weak of mind.

It's been an interesting experiment, but the results are all too clear. Going to be a bit longer before the folks who stand to benefit from this mess get forced to clean it up (just like a couple of other industries, isn't it?).

Re:"health care" = "disease management" (4, Insightful)

Moses48 (1849872) | more than 2 years ago | (#39550737)

1) Mortality rate != quality of life. My "health care" is about the latter, while the former also plays a role.
2) Insurance Scheme != Free Market. If you went to an old lady and said you can either have the $90,000 that a hip replacement costs, or you can get the replacement, THAT is free market. People would be more diligent about the VALUE of their treatment. Can $90K buy more quality of life than the replacement? I suppose that depends on the situation, but at least the person getting the treatment could actually have "informed consent"!

Re:"health care" = "disease management" (4, Insightful)

Artraze (600366) | more than 2 years ago | (#39550867)

> In the US we spend WAY too much doing things to people that gives very little benefit to them. The major
> culprit is the 'free market' system where profit (at multiple levels) is considered the appropriate metric.

How exactly is our healthcare anything like free market? Do you get any real choice in provider? Do you know the prices? Do you evaluate cost vs. benefit before buying the service? Does anyone even perceive healthcare as buying a service?

The reason we have this problem is precisely because healthcare isn't a free market. People see things as being "free" (and will complain bitterly if they're not), and never bother to ask whether or not dropping $10+k on a pointless treatment really matters. (Hell, half the time it's difficult to impossible to figure out what the cost is anyway. Good luck getting a straight answer on that, when the quoted "price" is 4x what would be normally be paid by a healthcare provider.) If there's no cost, there's no competition and no cost-benefit analysis.

When it comes down to it, even thought the service is technically provided by the private sector, the only choice you have in it is, essentially, who your employer is (to the extent you can call that a choice). Even in an illegal conspiratorial oligopoly you can at least pick your poison. As it is you pretty much get what get and nothing if you don't want it (but you'll still be paying for it anyways). If that's a free market then so was communist Russia.

We all know why (5, Insightful)

oldhack (1037484) | more than 2 years ago | (#39550025)

We have a medical-industrial complex. Money's gotta flow.

Re:We all know why (4, Insightful)

englishknnigits (1568303) | more than 2 years ago | (#39550345)

And when you don't directly have to pay for it (ie Medicare) then you don't care about the cost to benefit. This is why most people should really be on something along the lines of an HDHP and treat health insurance as insurance. When you spend your money on yourself you care about both the cost and the benefit. When you spend someone elses money on someone else (ie government spending) you have no incentive to care about cost or benefit.

Re:We all know why (4, Interesting)

ColdWetDog (752185) | more than 2 years ago | (#39550455)

Won't work until you have a much higher penetrance rate for HDHP (HIgh Deductible Health Plans). Right now, anyone with an HDHP gets royally screwed paying top dollar for the care they do get. It does tend to prevent people from using health care resources, but given the broad brush you're sweeping with, that's not necessarily a good thing.

The idea that HDHPs will actually decrease billed costs to something more reasonable (no $60 aspirins) has yet to be shown. It puts the burden on the wrong person and typically will only be used by intelligent, reasonably well off, healthy people - a small subset of the total population.

Re:We all know why (5, Informative)

jjohnson (62583) | more than 2 years ago | (#39550467)

And when you don't directly have to pay for it (ie Medicare) then you don't care about the cost to benefit.

This isn't true in UHC countries like Canada or France or Sweden, so why would it be true in the U.S.? In UHC countries, annual per capita spending is around 55% of what it is in the U.S. (in 2010, $3,900 to $7,400), and they have better aggregate outcomes as measured by things like life expectancy (average 2+ years higher in UHC countries than in the U.S.). With UHC schemes, it looks pretty clearly like they pay less and get more effective medical treatment.

Re:We all know why (4, Insightful)

superdave80 (1226592) | more than 2 years ago | (#39550563)

...as measured by things like life expectancy...

I've never understood why this gets thrown around as a measure of the quality of health care received, when there are tons of other factors that have much more of an affect on this (exercise, smoking, eating right, etc.).

Re:We all know why (5, Informative)

jjohnson (62583) | more than 2 years ago | (#39550765)

Because across a whole population, you would expect that the sum total of benefits of things like exercise, good medical care, healthy lifestyle choices, etc. would show up in life expectancy. When you have two populations, like Canada and the U.S., who have pretty comparable lifestyles overall, it seems like a reasonable, if blunt, proxy for the overall quality of health care.

In the case of Canada and the U.S. at least, more on-point aggregate measures show the same thing: Canadians as a whole get better health care than Americans, and seem to have less trouble making appropriate cost/benefit tradeoffs in their health care.

Re:We all know why (0)

Anonymous Coward | more than 2 years ago | (#39550793)

...as measured by things like life expectancy...

I've never understood why this gets thrown

Not to mention the differences that countries use when making the statistic...

Re:We all know why (1)

Anonymous Coward | more than 2 years ago | (#39550747)

I've yet to see empirical numbers myself, but assuming that your numbers are correct; why is it that those that can afford the very best fly across the world to get their care in the U.S.

Yes, there are many cases of U.S. citizens going elsewhere for care, but these are for treatments that are not available or banned in the U.S. But, when Sheik XYZ needs quadruple bypass surgery and can get it anywhere, he typically goes to the U.S. Not the U.K. not Germany, not Canada, not Cuba, not Switzerland, the U.S. Why?

Re:We all know why (5, Insightful)

Spad (470073) | more than 2 years ago | (#39550791)

Just because the US healthcare system can offer a very high quality of care doesn't mean that it's any use to its citizens when the vast majority of them can't afford it.

If you're fabulously wealthy then the US offers some of the best healthcare in the world, but if you're not, it's a disaster area.

Re:We all know why (5, Insightful)

vlm (69642) | more than 2 years ago | (#39550555)

When you spend someone elses money on someone else ... you have no incentive to care about cost or benefit.

Ah but we're talking about medical care here, and only a microscopic minority of freaks enjoy pain.

As a thought experiment, put out a sign offering "free" root canals. Yes, yes for about a week you'll get a huge backlog of uninsured people with horrific dental pain who could not get any care before and now will joyously sign up for your free root canal. Once you work thru the backlog, the only people voluntarily going to your free-root-canal office are the same tiny fraction of people who really need one, and a couple of freaks with whip lashes and rope burns all other their bodies who do it for the pain. The price of a root canal seems to have very little correlation with the desire of the population for a root canal.

I'm thinking the market for prostate exams, mammograms, broken bone casts is kind of the same.

It's a completely different market from offering, say, free "adult" non-therapeutic massages, or free pr0n pixs, or free movies/music/tv, or addictive drugs, where demand is basically infinite.

Lets say you offered "free" atmospheric oxygen. Well, first I'd breathe deeply, for free, just because I can, but that would get boring real fast. Then I'd probably have a few bonfires in my backyard, since oxygen is free so why the heck not. Hell I'd probably get a pet cat that breathes "free" oxygen. But extremely rapidly the demand kinda levels off. I had "free" water and "free" heat at my bachelor pad apartment years ago, and there is no fundamental reason to waste it, so I didn't. How much water do you think I can drink per day, anyway?

Re:We all know why (4, Insightful)

DrgnDancer (137700) | more than 2 years ago | (#39550661)

That doesn't track. As the article points out, places with true "socialized" medicine (Canada and Europe) typically don't have these problems or have them in lesser degrees. When there's no profit motive, there's less incentive to over-test, less incentive to push unnecessary pills or treatments, and less over specialization. The problem with Medicare isn't that it causes people to overspend because they don't see the pain of the spending (medicare still requires copays and such), it's the system into which it's been pushed.

Doctors and insurance companies have an adversarial relationship that drives cost up so both of them can profit. Enter Medicare. It has to play the game by the rules established by private insurance and doctors. It inherits the waste in system and (being government) adds some of its own. The problem isn't that people are wasteful of things they don't pay for (some are or course, but the national health care systems of numerous countries attest that it's not all of them, nor even an unworkable number of them). It's that the profit motive of both doctors and insurers keeps driving up costs, and Medicare has to live in their world. If socialized medicine is inherently more expensive, why do we pay so much more per capita for health care than any other rich country, but achieve, at best, comparable results?

Re:We all know why (1)

Bengie (1121981) | more than 2 years ago | (#39550709)

I am not saying you're argument is wrong, but it is a delicate balancing act.

Universal healthcare is the next step in social evolution, right after clean water and sewage. Everyone benefits from it, but it needs to be properly balanced.

Hold on a second (4, Insightful)

geoffrobinson (109879) | more than 2 years ago | (#39550503)

What do health care costs, housing costs (pre-bubble bursting), and college tuition costs all have in common?

1) They all have risen much faster than inflation.
2) They are all subsidized by government.

If you hide the cost of a good from people via the tax code and you subsidize the good, you will get no mechanism to control costs. The tax code hides the cost of insurance since employees don't see or feel the employer's payment.

Oddly enough Lasik surgeries haven't gone up in price. It isn't covered by insurance.

Granted, there's a lot more nuance and information to bear on this topic. But it is a dynamic that can't be ignored. If you hide the price from someone, costs will go up. Unless you want to ration. Which when the HMOs tried to do it in the 1990s was about as popular as a skunk crashing a party.

Higher cost in the US... (3, Insightful)

Anonymous Coward | more than 2 years ago | (#39550051)

all goes to someone's profit, not someone's care.

Re:Higher cost in the US... (-1)

Anonymous Coward | more than 2 years ago | (#39550101)

That's just stupid. The profit comes from getting paid for providing the care.

Re:Higher cost in the US... (4, Insightful)

Dr_Barnowl (709838) | more than 2 years ago | (#39550243)

Yes, but if there is a profit, it's not going to care for someone, it's lining someone's pocket.

Plus the mechanism you use to gather the profit is horrendously inefficient - for that 15% margin you are essentially doubling your costs by paying for all the insurance bureaucracy on one side and the bureaucracy on the healthcare side designed to interface with it.

The USA pays double per capita what it's next nearest neighbour among the G8 nations spends on healthcare, for comparable outcomes.

Re:Higher cost in the US... (1, Insightful)

ThePhilips (752041) | more than 2 years ago | (#39550285)

The profit comes from getting paid more while providing less care, or even better - no care at all.

Re:Higher cost in the US... (1)

sjames (1099) | more than 2 years ago | (#39550575)

And in the U.S more entities get paid a LOT more money for that care than anywhere else in the world.

There's a fair profit and then there's gouging.

Re:Higher cost in the US... (1)

Hognoxious (631665) | more than 2 years ago | (#39550705)

The profit comes from getting paid for providing the care.

Where's the profit in prevention?

Re:Higher cost in the US... (1)

hey! (33014) | more than 2 years ago | (#39550759)

That's just stupid. The profit comes from getting paid for providing the care.

In a single payer system,sure, but you're forgetting about how insurance companies make profits.

blame the patients (1)

alen (225700) | more than 2 years ago | (#39550053)

how many old people eat crappy salt/sugar/carb laden food just because their parents made it for them as kids.

and my favorite. yesterday my mother in law brought some pork over. it was marinated and wrapped in plastic. the butcher told to cook it in the plastic and i had an argument with her how its bad for you. she does it all the time at home

Re:blame the patients (4, Informative)

BenLeeImp (1347831) | more than 2 years ago | (#39550209)

Food-safe plastics do exist. I cannot say whether this particular plastic used was food-safe or not, but its at least possible.

Re:blame the patients (2)

the eric conspiracy (20178) | more than 2 years ago | (#39550351)

Depends on the plastic. Some are tested pretty carefully and have various certifications.

Of course you could take the word of internet chain letters over the Harvard Medical School.

http://www.health.harvard.edu/healthbeat/HEALTHbeat_081606.htm [harvard.edu]

It's your choice as to whether or not you want to behave rationally.

Re:blame the patients (2)

alen (225700) | more than 2 years ago | (#39550413)

this was raw pork covered with what looked like saran wrap and tied with kitchen string outside the plastic and the instructions were to cook it in the oven with the plastic on

Re:blame the patients (1)

P-niiice (1703362) | more than 2 years ago | (#39550491)

how many old people eat crappy salt/sugar/carb laden food just because their parents made it for them as kids.
and how many because their medical costs are hundreds per month and they can't afford good food + housing + transpo + medicine?

Re:blame the patients (1)

alen (225700) | more than 2 years ago | (#39550533)

maybe if they didn't eat crap they wouldn't get sick

i think it was on Food inc. they had a family who always ate fast food. dad had diabetes and cost $100 a month in drugs. they continue to eat fast food because peaches cost $2 or $3 a pound and they couldn't find anything else in the store other than peaches or broccoli. idiots

Re:blame the patients (1)

sjames (1099) | more than 2 years ago | (#39550619)

Americans certainly haven't cornered the market on bad diet. Besides that, that might explain needing more healthcare, but doesn't explain why unit for unit, the care in the U.S. costs so much more than anywhere else.

Re:blame the patients (1)

jaymz666 (34050) | more than 2 years ago | (#39550773)

Ignoring the fact that the salt/sugar and carb laden foods are the most affordable in the short term, people just don't know what's good or bad.

There are so many different and flip-flop food advices given that it's hard to keep up.

One day eggs are bad, the next good, and then back to bad.
Same with so many different opinions.

Not enough is being spent on keeping the food chain safe, let alone educating what's good and bad for you.

Obesity (2)

Bovius (1243040) | more than 2 years ago | (#39550063)

75% of money spent on health care in the U.S. is for self-inflicted diseases or the consequences thereof. That might be a good place to start looking.

I'm not saying that people that need dialysis or bypass surgery shouldn't be helped; I'm saying we should be spending money on ways to help them not get there in the first place.

Re:Obesity (1)

Anonymous Coward | more than 2 years ago | (#39550213)

What if spending money isn't the answer? What if the answer deals more with a change in social values?

Re:Obesity (4, Insightful)

Anonymous Coward | more than 2 years ago | (#39550331)

What if spending money isn't the answer? What if the answer deals more with a change in social values?

Do you know how you change social values, especially regarding health? You spend money on health programs and preventative care. If people only go to the doctor when they have a serious illness, then only serious illness will be treated and preventative care will be ignored. Make care free or close to it then spend on getting people to care about health. It will save money in the long run.

Re:Obesity (-1, Troll)

WhiplashII (542766) | more than 2 years ago | (#39550489)

I agree! And since there are obviously no limits on government anymore, why don't we double taxes on the overweight? They are causing everyone else's insurance rates to rise!

Fat=jail!

Burn them!

Re:Obesity (2)

spiffmastercow (1001386) | more than 2 years ago | (#39550729)

Or, maybe, move the corn subsidies to fruits and vegetables? Eating healthy is really expensive.

Re:Obesity (4, Insightful)

ColdWetDog (752185) | more than 2 years ago | (#39550529)

75% of money spent on health care in the U.S. is for self-inflicted diseases or the consequences thereof. That might be a good place to start looking.

I'm not saying that people that need dialysis or bypass surgery shouldn't be helped; I'm saying we should be spending money on ways to help them not get there in the first place.

Citation please. Those are numbers pulled out of various nether regions. Yes, people can do much for themselves to decrease / delay morbidity (not mortality so much). And yes, we should encourage and teach people to watch their weight, not smoke, drink alcohol in vast moderation, do yoga, clean their rooms and brush their teeth twice daily (floss once) but health care still is going to cost quite a bit of money - maybe more as the number of frail elderly that need increasing care climbs dramatically.

Remember, one entertaining factoid in all of this - with all the 'bad things' we're doing (pollution / plastics / obesity / diabetes / whatever disease is popular this month) the average longevity of the population is slowly and steadily INCREASING. Now most of us think that's a good thing. Not many want to go back to the pre medical days of a 35 year average longevity, but it does have it's consequences....

"Hidden" Medicare Costs (1)

getto man d (619850) | more than 2 years ago | (#39550075)

Re:"Hidden" Medicare Costs (0)

Anonymous Coward | more than 2 years ago | (#39550267)

Actual fraud as we know it is actually very low compared to the whole system. Overwhelmingly, the guidelines are confusing, and onerous, and any disagreement is counted as fraud. Just like tax disagreements are fraud as well. Maybe we should audit people more, just like the healthcare system. That would really save a lot of money!

No (5, Insightful)

Cigarra (652458) | more than 2 years ago | (#39550085)

The answer is no [wikipedia.org] . Next question?

I think the world can be grateful... (1)

steve.cri (2593117) | more than 2 years ago | (#39550145)

... for the US having a government not basing its policies on adages, witticisms and one-liners.

Re:I think the world can be grateful... (4, Interesting)

CanHasDIY (1672858) | more than 2 years ago | (#39550279)

... for the US having a government not basing its policies on adages, witticisms and one-liners.

You sure about that bro?

Are you now, or have you ever been, a member of the Communist Party?

Re:I think the world can be grateful... (1)

game kid (805301) | more than 2 years ago | (#39550681)

In that case, the law is amended to answer "No but maybe I should to get obsessive nutters like you out of the damn government!"

The spending is very concentrated (4, Insightful)

repapetilto (1219852) | more than 2 years ago | (#39550095)

5% of the population (15 million people) account for 50% ($1 trillion) in spending.

http://www.ahrq.gov/research/ria19/expendria.htm [ahrq.gov]

Re:The spending is very concentrated (5, Interesting)

NeutronCowboy (896098) | more than 2 years ago | (#39550245)

Not surprising. Sick people cost more than healthy people. At any given time, less people are sick than are healthy. Furthermore, there is a small segment of chronically ill people.

Note: the reason why health care needs the biggest pool possible is because at any given time, you cannot tell who will need expensive health care. Our health care isn't good enough to predict who will get what disease and when, or who will get into an expensive accident. This means that unless you want to bankrupt 5% of the US population and keep them permanently in the poor house, you need a national health care system. Otherwise, the health care system will trend to cost+profit+cost to help uninsured people.

Re:The spending is very concentrated (1)

repapetilto (1219852) | more than 2 years ago | (#39550365)

The point is when comparing cost vs outcome between countries, it is those of this 5% that should be focused on. Most "analysis" done in the news assumes the costs are normally distributed (by reporting cost per capita, etc), when they are not.

Re:The spending is very concentrated (1)

foobsr (693224) | more than 2 years ago | (#39550577)

At any given time, less people are sick than are healthy.

Doubtful:

More than one-third of U.S. adults (35.7%) are obese. (CDC)

An Estimated 1 in 10 U.S. Adults Report Depression. (CDC)

Being too lazy to carry on searching, just add heart deseases, other psychiatric conditions than depression, allergic conditions ... . I know there is overlap, but I am sure you get past (far beyond) the 50% mark.

CC.

The USA is definitely in trouble (1)

ub3r n3u7r4l1st (1388939) | more than 2 years ago | (#39550823)

In the university where I worked, I actually came across a bunch of Computer Science PhD students who thinks that the statement "Childhood and adult obesity leads to skyrocket medical cost" is A MYTH.

The only way to solve the financial trouble of the US government may well be using the "seigniorage hack".

Re:The spending is very concentrated (1)

chrb (1083577) | more than 2 years ago | (#39550843)

you cannot tell who will need expensive health care

We obviously can't predict accidents, but we do know that, for the average person, the bulk of their health care costs will be in old age, and those costs will increase as they get closer to the point of death. 27 percent of Medicare spending covers care for people in the very final year of life (source) [healthaffairs.org] . If we were more accepting of death, then we would probably not bother to squander so much money when the end comes. From a financial perspective, it would make more sense to develop a matrix of cost/benefit, and to offer patients either the treatment or some fraction of the equivalent cash to give to their families. Or to develop a statistical model, and only provide baseline medical service when the probability of death in the next 12 months exceeds 95% or so. Rational, but perhaps not politically/socially viable.

Re:The spending is very concentrated (1)

dkleinsc (563838) | more than 2 years ago | (#39550283)

Perhaps we're spending at least half our health care dollars on people who are seriously sick or injured. The horror!

Re:The spending is very concentrated (2)

ColdWetDog (752185) | more than 2 years ago | (#39550347)

You expect that. It's somebody-or-other's law. There is always going to be a distribution of disease / habit / whatever and thus money spent (or not spent).

Now, those folks are often touted as the low hanging fruit for medical cost savings, but it rarely works out that way because those people are sick. They're the ones that got short changed in the luck of the draw - they've had horrible diseases that are often not the result of anything under their control. Or they've just had the bad luck to walk into a bus.

Yes, we can always manage those folks better and cheaper but as always, most of the area under the curve is in the first two standard deviations off the mean.

PUT THAT TWINKIE DOWN! NOW.

Re:The spending is very concentrated (4, Insightful)

UnknowingFool (672806) | more than 2 years ago | (#39550481)

One of the areas where the US needs more focus is end-of-life care. More often than not, individuals and their families are opting for expensive treatments at the end that may cause suffering and not provide any benefits for a tiny chance at a cure. One of the twists of advances in medicine is that people can be kept alive despite major medical problems, but many would not consider being kept alive in that state as "living" especially when no cure is likely.

This was the background of the infamous "death panels" fiasco at the beginning of the health care reform debate. Under Medicare rules, doctors can only bill for their time for certain things. Discussing end-of-life options was not eligible. So doctors had to (1) not bill, (2) lie about their time, or (3) not discuss the options at all. The proposed change was made so that it would encourage doctors to have these discussions with patients that would reduce costs and suffering. But the Republicans twisted it into some sort of tribunal where people would have to advocate for their lives.

For a more reasoned look at the problem watch this Frontline [pbs.org] about end-of-life care today and the issues surrounding it. The one perspective from the doctors is complex as they all want to save their patients but they question whether some of their treatments cause their patients more suffering more than anything else.

Already Well Studied in the US (3, Interesting)

Kagato (116051) | more than 2 years ago | (#39550841)

The states with some of the lowest Health Care spending (compared to other US states) have the best outcomes. You look at a state like Minnesota which is highly regulated, mandates Health Insurance Companies are not for profit and allows "never pay events" (medical mistakes neither the patient nor insurance company have to pay) and they have some of the best outcomes.

I'd also point out that high medical costs are often attributed to lawsuits. I would point out that Texas passed Tort reform a long time ago and the highest cost counties in the US are in Texas.

Bottom line, you want lower cost health care you restrict profiteering and you don't reward bad behaviors by doctors or insurance companies.

Non-Americans? (2)

Ironix (165274) | more than 2 years ago | (#39550103)

"If you haven't seen the words 'health care' in news headlines lately, you must be living under a rock."

Or perhaps you aren't an American.

Re:Non-Americans? (1)

Spad (470073) | more than 2 years ago | (#39550123)

Or British, though for virtually the opposite reasons.

Where the money goes (0)

T-Ranger (10520) | more than 2 years ago | (#39550127)

Everywhere except the US, increasing money on health care increases health care. In the US, increased money to healthcare increases funding for insurance companies coming up with new ways to deny claims.

Re:Where the money goes (1)

repapetilto (1219852) | more than 2 years ago | (#39550171)

Where is your data? This is not what the data I have seen shows.

We see the same thing with education (0)

Anonymous Coward | more than 2 years ago | (#39550133)

We spend and spend and spend and the quality of our education goes to crap. Why? Because money isn't the answer to a social problem. Just like in health: money isn't stopping people from filling their faces with chips and Ho Hos.

Re:We see the same thing with education (1)

Tyr07 (2300912) | more than 2 years ago | (#39550229)

Problem is with medicare in Canada is that people are apathetic about their jobs in the medical profession, it's mundane, people arent' allowed to use greed as a motivator to perform better work and interest high value patients in requesting their specific services.

So, there you go.

Re:We see the same thing with education (2)

sjames (1099) | more than 2 years ago | (#39550693)

That doesn't sound like a problem. If I need healthcare, I don't want to be sold on more expensive procedures or extra procedures. I want what is necessary.

Re:We see the same thing with education (0)

Anonymous Coward | more than 2 years ago | (#39550749)

Problem is with medicare in Canada is that people are apathetic about their jobs in the medical profession, it's mundane, people arent' allowed to use greed as a motivator to perform better work

False. Most doctors in Canada aren't on salary, they are on "fee for service". So the more patients they see, the more procedures they do, the more they get paid.

However, when it comes to "better", that is much harder to measure. In fact, there is very little supervision of that unless someone complains.

Re:We see the same thing with education (2)

spiffmastercow (1001386) | more than 2 years ago | (#39550859)

If your only motivator to go into medicine is to make money, then you have no business being an MD. Medical professionals should a.) recieve *adequate* compensation for their skills (likely resulting in a middle to upper middle class income, depending on their job and capabilities), and b.) should not be charged ridiculous amounts of money up front for their education. Unfortunately, since we do not properly socialize health or higher education in the US, we have a feedback loop which incentivizes all the wrong things.

Why Doctors Die Differntly (5, Interesting)

haemish (28576) | more than 2 years ago | (#39550159)

The last months of a persons life are overwhelmingly the most expensive, but the outcomes are predicable. There was a great article in the WSJ on this called Why Doctors Die Differently - http://online.wsj.com/article/SB10001424052970203918304577243321242833962.html [wsj.com] . The basic point is that doctors understand death, and when their condition makes death inevitable. They almost always opt for more life in their years than more years in their life. From a healthcare point of view, doctors have much less expensive end-of-life care.

Re:Why Doctors Die Differntly (5, Interesting)

garcia (6573) | more than 2 years ago | (#39550327)

I read that article when it came out and agreed with all of it. However, in many cases it's just simply not as easy as the article makes it seem.

My grandfather passed away several years ago after living for the better part of a decade mentally and physically incapacitated following a serious brain hemorrhage. My father, having power of attorney, noted that he was not to receive anything other than painkillers. He was simply supposed to be made comfortable but no effort was to be made to prolong his life. The cost of that nursing home was astronomical even for care which is basic.

There is also my remaining living grandparent. At 86 she is able to walk by herself, communicate clearly, etc. She also has a ton of health issues including diabetes, pain management, etc. Her costs, mostly shouldered by the taxpayers due to very low available income, are also astronomical and she's living what many may consider an active and acceptable lifestyle for her age.

So yeah. Doctor's (and many others) choose to die quickly and w/o medical intervention which is likely to fail anyway. However these astronomical costs aren't just for those who are likely terminal patients. They're for everyone--even the "healthy" ones.

Re:Why Old People Die Differntly (2)

Chemisor (97276) | more than 2 years ago | (#39550657)

It is really disturbing how ready today's generation is to ship grandpa to a nursing home. What happened to family taking care of their own? Dying in bed, surrounded by your loved ones? Or just plain not spending the last decade of your life abandoned in abject loneliness. If only you had enough compassion and gratitude to your parents to take care of them in their old age as they took care of you in your youth. You know it's the right thing to do. It's even in the ten commandments.

And dementia is a big problem (4, Informative)

Sycraft-fu (314770) | more than 2 years ago | (#39550683)

That's what is happening with my grandma, unfortunately. Probably Alzheimer's in her case. Whatever the case, her mind is almost gone. She requires a full time care taker at home now, and before long will need to move to a complete managed care facility. Fortunately she's got the money, it is no problem. However it is going to cost a boatload of money, particularly since other than that she's in pretty good health for a 85 year old. She could live 5 more years (maybe more).

So what do you do in cases like that? I mean the perfect answer is to find a cure for dementia but it isn't like we can just snap our fingers. For now we have to deal with it. The only cheap solution is basically to just ignore people with it and let them die a horrible death. If you want to be civilized about it you have to care for them and it is damn expensive.

These are new problems on the scale we face now. People didn't used to live long enough on average for this to happen a lot. Now, instead of just dying fairly quick, many people have a downward slide that can last a long time. That is damn expensive and not a situation where yo can "Just pull the plug," unless by that you mean "Ignore the person and let them die of starvation."

Re:Why Doctors Die Differntly (1)

PPH (736903) | more than 2 years ago | (#39550343)

Doctors all die when their private airplane craters in some mountainside.

Lessons of a $618,616 Death (3, Informative)

alexander_686 (957440) | more than 2 years ago | (#39550665)

http://www.businessweek.com/magazine/content/10_11/b4170032321836.htm [businessweek.com]

This is something of a counterpoint. Amanda Bennett wrote an article about her husband's death. He had cancer and was expected to live a year or 2 more. Aggressive, and expense, treatment, meant that he live for 7 more - some of them good - some of them bad. So he beat the odds and thus can be considered a success. On the other hand, Bennett tries to weigh the cost of treatment, quality of life, and how the health care system should be structured. She does not come to concise answer, but she writes very well about the struggle.

Re:Why Doctors Die Differntly (0)

Anonymous Coward | more than 2 years ago | (#39550853)

The last months of a persons life are overwhelmingly the most expensive, but the outcomes are predicable.

Yes. It'd be a lot cheaper if you just shot them. Bullets are a lot cheaper than most modern medical procedures.

Stop the hate (5, Funny)

concealment (2447304) | more than 2 years ago | (#39550223)

There's nothing wrong with living under a rock. It's energy efficient, quiet and affordable. And, no unwanted guests.

Re:Stop the hate (1)

Kardos (1348077) | more than 2 years ago | (#39550493)

except the bugs

Re:Stop the hate (1)

Quiet_Desperation (858215) | more than 2 years ago | (#39550521)

And, no unwanted guests.

I dunno. Ever go outside and lift up a decent sized rock?

Break it down to the basics (5, Insightful)

thechemic (1329333) | more than 2 years ago | (#39550231)

The United States runs a "for profit" model. Canada runs a "for better society" model. In one model the fundamental design of one system dictates that consumers spend as much as possible and receive as little as possible. The fundamentals of the other design dictate that consumers all receive adequate care, and the only reason to spend more is to get more.

Re:Break it down to the basics (2)

vlm (69642) | more than 2 years ago | (#39550393)

Too simplistic. Force all hospitals and insurance companies into non-profit status and the execs will still demand claims be denied to maximize executive bonuses.

What could work is just categorically eliminating waste by changing the system.

Pass a law that no claims can be denied. Instant improvement in customer service. Probably more money is spent trying to catch fraud than is actually spent via fraud. In the adult sex services industry I could imagine high levels of fraud. I'm not seeing why it would exist in the prostate examination industry as that is not quite as much fun.

Billing too much of a PITA and waste of money? Single payer clearinghouse... you can select which "script reader in India service provider" you'd like to talk to, but the checks will all flow in and out of one address. Much like there is a universal clearinghouse for all paper checks, or just a handful of universal clearinghouses for credit reports.

Re:Break it down to the basics (5, Insightful)

Anonymous Coward | more than 2 years ago | (#39550633)

The biggest giveaway for me is that in most places in the US, medicine uses the Caduceus (commerce, trickery, and death) as its symbol; in the majority of the world, medicine uses the Rod of Aesculapius (healing and health) as its symbol.

The purpose of the system (0)

Anonymous Coward | more than 2 years ago | (#39550237)

The purpose of the US health care system is to provide return on capital, it does that very well, what's the problem ?

Re:The purpose of the system (2)

geminidomino (614729) | more than 2 years ago | (#39550293)

The purpose of the US health care system is to provide return on capital, it does that very well, what's the problem ?

That IS the problem.

Someone has to be severely messed up in the wetware to think that a "moral society" and a capitalist approach to the easing and comfort of human suffering are compatible concepts.

Offtopic (0)

Hentes (2461350) | more than 2 years ago | (#39550249)

This is neither about science, nor technology. It's not even a political article that at least has some tiny connection to one of them.

Re:Offtopic (1)

Chruisan (1040302) | more than 2 years ago | (#39550777)

Agreed...why is this on slashdot?

Americanitis (3, Insightful)

girlintraining (1395911) | more than 2 years ago | (#39550299)

What are we doing different in the U.S.?

We're throwing our money at CEOs the same way school girls throw wet panties at Justin Bieber at concerts. Next question.

Re:Americanitis (2)

ColdWetDog (752185) | more than 2 years ago | (#39550571)

What are we doing different in the U.S.?

We're throwing our money at CEOs the same way school girls throw wet panties at Justin Bieber at concerts. Next question.

Man, am I ever glad I've never been to a Justin Bieber concert. What a lucky life I've lived.

Not News (1)

necro81 (917438) | more than 2 years ago | (#39550307)

If anyone in the U.S. doesn't already know this, they damn well should (especially if they are going to start spouting about health care policy). These kinds of conclusions about More Care != Better Care and More Cost != Better Health have been floating around for nearly two decades. Behold: http://www.dartmouthatlas.org/ [dartmouthatlas.org]

The New Yorker put it all to bed (0)

Anonymous Coward | more than 2 years ago | (#39550333)

http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande
"McAllen, Texas, the most expensive town in the most expensive country for health care in the world, seemed a good place to look for some answers."
The answer, as usual, can't be simplified into a sound bite. What's broken is the way doctors are paid, and what they're paid to do, not how much they make. It's about how we measure success. Worth a read.

Top to Bottom Re-evaluation (1, Informative)

sycodon (149926) | more than 2 years ago | (#39550339)

After the Supremes ditch that abortion of a Bill, Obamacare, there needs to be a top to bottom evaluation of the entire medical system.

Fundamental assumptions about the value of a service and the person providing that service need to be challenged. The infrastructure of record keeping, ownership, and payment needs to be overhauled. Information about services and their costs need to be plain and transparent because if any market is to function correctly, all the players need to know all the facts up front.

Sure, absolutely! (0)

Anonymous Coward | more than 2 years ago | (#39550701)

Right after we agree on and solve global warming/climate-change/cooling.

Human nature. Learn it. Live it. Love it.

Re:Top to Bottom Re-evaluation (2)

ColdWetDog (752185) | more than 2 years ago | (#39550717)

there needs to be a top to bottom evaluation of the entire medical system.

And, of course, that won't ever happen. This country can't even come to grips with simple things like Daylight Savings Time. Rejiggering a quarter of the economy at one time?

Coding for diseases and symptoms in the US is done with a system called the ICD-9 (International Classification of Diseases, version 9). This was codified in the 1980s (the ICD has been going on since around 1900). This was superceeded by the ICD-10 in 1992 and is now used in every country except the US (and I think North Korea). It's just a database. We can't even get ourselves arsed to upgrade a bunch of tables, much less completely reframe how health care delivery is done.

We're doomed.

it's not a MARKET! (1)

toby (759) | more than 2 years ago | (#39550857)

It's a basic civilised social service.

Apples and Oranges (1)

number17 (952777) | more than 2 years ago | (#39550369)

The Province of Ontario is rather large and mostly rural. I wouldn't be surprised if most of the higher spending hospitals are located on University Avenue aka Hospital Alley in the largest city in the country, Toronto. It also wouldn't surprise me if it's also the highest spending area in medical research for the country. Most hospitals in the area have also have affiliate ties with the University of Toronto (hence University Avenue) which brings in more research money.

Spend more money on safe, walkable cities. (1)

mc6809e (214243) | more than 2 years ago | (#39550415)

All this debate in the USA about health care spending and delivery ignores the biggest factor in predicting lifespan: how much time is spent walking everyday.

Invest in safe, walkable cities today, and future generations will see an increase in lifespan.

Re:Spend more money on safe, walkable cities. (1)

game kid (805301) | more than 2 years ago | (#39550767)

But...but...then the big box stores would have to hire more of those dirty smelly "employees" for more smaller locations, and there'd be no gas card promotions [simplycvsshopping.com] to bring the mupp--er, customers in!

If you want to cut healthcare costs (1)

Sycraft-fu (314770) | more than 2 years ago | (#39550803)

You want to look at decreasing lifespan. The expensive years are he ones in the end. When someone doesn't die of anything specific, but rather just gets so old that everything starts breaking down. That gets real expensive. Worse yet, if the thing that breaks down is their mind they can spend many years needing fulltime care which is really expensive.

Now I'm not saying we should look at decreasing lifespans, however please don't have this confused idea that it would lead to lower health care costs, which is what the article is about. Some people seem to think you can out-healthy everything. Just be healthy enough and you'll never be afflicted. Nope, sorry, not the case.

Need to adjust spending vs cost of living (1)

Maxo-Texas (864189) | more than 2 years ago | (#39550417)

$5,000 will buy a huge amount of manual activities in some countries. This includes surgury and high quality nursing.

Likewise, liability insurance is much lower since income is so low.

Manufactured goods like beds, sheets, etc. Also cheaper.

Only 1st world manufactured goods and drugs would expensive.

And since they ignore patents and don't pay royalties to help cover the costs of research (by very expensive researchers who are expensive for the same reason above) many drugs will be cheaper too.

----

Healthcare overseas is 10% of the cost.
Healthcare in India is 5% of the cost.

---

It's sort of a red queen's race. Things are expensive here because they are expensive. If we were to suddenly devalue our currency 95%, some products like oil would get more expensive but mostly- we would just suddenly be competative with the other countries.

---

I think if you adjust for relative costs of living, you'll find healthcare in the U.S. is really only about 2x as expensive as in most of the world. Still high.

Sad thing is the top 1% can afford to fly to Guam and India and take advantage of the cheap healthcare.

It depends on where you're starting from (0)

Anonymous Coward | more than 2 years ago | (#39550421)

There is a correlation between health spending and outcomes. If you compare the third world with the first world, then, yes, there is a positive correlation. The first world spends much more on health and is rewarded with much better health. Death is obviously much more likely for those who can't afford any kind of treatment.

On the other hand, comparing within the first world, there is little correlation within the population at large. The question is more about how the health care is distributed. In societies with more equal distribution of health care, the statistical results will be better.

In the USofA, the health care results for those who can afford it are excellent; the best in the world. It's just that lots of people can't afford it and they skew the statistics.

Health Pool (1)

walkerp1 (523460) | more than 2 years ago | (#39550553)

I need ten young, healthy people to sign up with me for a health care pool. Of course, I will statistically receive the lion's share of the proceeds, but content yourselves with the fact that You Care. I'll even send you a certificate suitable for framing that shamelessly declares your uber-caringness.

Re:Health Pool (1)

kenh (9056) | more than 2 years ago | (#39550819)

It was said in the SCOTUS hearing last week that the average young, healthy participant in a healthcare plan will pay, on average, $5,800 in annual premiums in 2014, yet the actual cost/value of the coverage they receive will be around $850... How long will it take twenty-somethings to figure that out and become angered by it and/or efuse to participate?

Many (not, by any stretch all) who are uninsured understand this math - they choose to be uninsured because they couldn't afford to be insured and contribute $5K to pay for other's coverage...

grammar nazi (0)

Anonymous Coward | more than 2 years ago | (#39550565)

What are we doing differently in the U.S.?

Yes, yes it does lead to better outcomes (1)

DickBreath (207180) | more than 2 years ago | (#39550643)

Increased healthcare spending leads to better outcomes for executives in several healthcare related industries.

If one of those executives happens to be a patient, then you could even say it leads to better patient outcomes.

Medicare is not an 'average' collection of people (1)

kenh (9056) | more than 2 years ago | (#39550769)

You have to be real careful comparing anything with Medicare for several reasons:

A) To qualify for Medicare you have to be in your sixties (with some exceptions, but true for the vast majority of enrollees)

B) Medicare takes everyone, with a large percentage (aka not an insignificant percentage) of enrollees coming from being uninsured/self- insured - they likely come with Pre-existing and previously untreated problems

C) Medicare has a policy of pay any invoice submitted, which results in a staggering level of waste and fraud which leads to skewed costs for treatments, as compared with priivate healthcare coverage plans that aggressively investigate fraud and abuse

It's fine to compare other populations with Medicare, but keep those properties of Medicare in mind when you compare things with it.

Preventative Care and Insurance Costs (1)

cluedweasel (832743) | more than 2 years ago | (#39550829)

Three points I'd like to make. The first one is based on my time spent working in Europe (UK, the Netherlands, France and Germany) and the U.S. In Europe, there is much more emphasis on preventative care compared to what I've seen in the U.S. Being a cynic, you could say that's there's more money to be made from letting people get sick and then treating them as opposed to stopping them getting sick in the first place. Secondly, is the insurance aspect. My wife and I both go to the same primary care clinic. I have insurance, she doesn't (her choice which I don't agree with but that's another story). Last bills for an office visit - $395 for me and $90 for her. Out of pocket I paid less ($20) but I'm always surprised at how much less the un-insured rate is at medical practices in my area. Then take the case of the facility I work at. Out of 60 or so people working here (it's an ambulatory surgery center), 6 spend most of the day arguing with insurance companies over billing and denials. Another 3 handle the actual billing. That's a big administrative overhead to have. Lastly, there seems to be a huge number of medical facilities in any town in the U.S. Back in Europe, most issues were either handled by my primary care doctor or referred to a specialist at a local hospital. For my last issue I ended up going to 5 different facilities around town, who all sent my insurance company their separate bills. How inefficient is that?
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