Here in austria free, yearly "health checkups" are offered to you by every doctor. Meaning, when you go there because of a cold, he will tell you that you ought to do a checkup every year, which include blood tests, psychological screening for alcoholism and other individualized tests like prostate cancer for men.
It's just convenient to use the system. I even had multiple MRIs and dozens of XRays after minor sport injuries just to be sure.
I'm not sure where to draw the line, though. How do you determine when "just in case" costs too much?
Remember, all Austrians paid for your mris and X-rays. I don't doubt it was worth it this specific case, but aren't the incentives wrong?
the physicians usually try to take the safe route just in case - if they deem it worth it. i'm still in the low risk category (~~young~~ not old, passably athletic) so my doctor told me more than once that it's probably nothing and we don't need to do the (expensive) X, the (cheap) Y is enough (maybe Y reveals something that justifies X).
it doesn't always work; as a personal anecdote - my uncle suffered a debilitating headache once and was told to take aspirin for several days until my aunt had enough and drove him to the hospital on her own. turned out to be cerebral bleeding. he barely survived and is now mentally disabled.
this a) takes him out of the workforce, which looses the state money through reduced taxes and b) ensures him an invalidity pension, which costs the state money.
was it worth it to save the money? on paper it's the additional cost of checking N people who're having headaches plus the cost of treating M people who're actually affected vs. the money he would have paid into the system plus the money he now costs the system over, say, 20 years. additionally he consumes less and his wife's business is struggling because he's not much help anymore.
for us, personally, it's still a tragedy, but those cases happen. you have to draw the line somewhere. it's not just additional costs though, it's still a trade off.
Systems like these can be susceptible to abuse and this should be researched and prevented as much as possible but this attitude that any free health care receiver is to be treated with suspicion and distrust till proven innocent is not healthy, sorry for the pun.
This is good in theory but very difficult to implement effectively. The conservatives take an extreme condescending view of social welfare and demand extreme checks on it whereas any checks and balances for abuse is what is attacked by many liberals/leftists.
That's where immigration is playing a destructive force. A lot of immigrants (if not all/most) can be seen abusing social welfare.
Also slightly related is what is happening in Briton w.r.t brexit. Brexit was welcome by many Britons also for this reason.
https://translate.google.com/translate?sl=auto&tl=en&js=y&pr...
> How do you determine when
> "just in case" costs too
> much
Older doctors might still give you referals to specialists or radiographers upon request, and check every tickbox on a blood test sheet, but younger doctors are tought that every additional test puts strain on the solvency and labor capacity of the health care system, and will not have irrelevant or unnecessary tests performed.
In Belgium, MRI and CAT scan capacity is limited, and you can't have an MRI on a whim - you need to be referred by a general practitioner to get one.
No. If you see bad outcomes from wrong incentives, come forth.
Sorry, but this is hard to believe. The use of XRays for minor injuries is not standard anymore. Not only for cost reasons, but also for the still unclear situation about increased cancer risk due to xrays.
Mass screening of healthy men for prostate cancer is probably more harmful than helpful.
About U.S. what saddens me is the natural reflex toward individualism and self responsibility being a better moral value than mutualized health as in France. I wish they could have a more balanced POV on things.
Can you expand on this? I don't know where I could take my money and receive better medical care than someone totally indigent. If anything, the experience as a poor person is better: my friend has had a kid and two major surgeries in the past year, plus regular checkups, and has paid nothing as she is on Medicaid. I see the exact same doctors, but I get a flurry of bills that come months after my visit, multiple bills for the same thing, and have to evaluate what's legitimate or if I need to argue and I end up spending a lot of money out of pocket due to the craze for high-deductible health plans - even though my premium is over 20k/year and I am still paying taxes to support Medicaid and Medicare!
I mean, I guess the ultra-rich can buy their own doctors, or visit special superstar doctors, but I feel like that's probably universally true. But my feeling in the US if that if you qualify for Medicaid, you are actually better off than someone in the middle class - for example, I broke a bone early this year and I didn't bother going to the doctor because I didn't want to spend hundreds of dollars for something medical care couldn't do much about anyway - but if I had Medicaid, I could just go and not worry.
On the subject of the ACA, the best thing it did was expand Medicaid eligibility, though unfortunately due to the Supreme Court decision some states were able to refuse the expansion. I'm not really convinced the rest of the bill really advanced us much in the right direction. If only one of the carriers on the exchange was a public option...
Can you expand on this?
I've heard many critics of Obamacare (that say it doesn't actually work that well in reality), and in general, it seems that it was only tackling a part of the problem. In Europe, you usually have a single payer, single buyer and single executor (or at least each of those is very regulated, so there's less chance for exploitative monopolistic behaviour than in the US).
The best way to move ACA in a progressive direction would be to have a large public player in both insurance and as a provider.
One of the main reasons ACA is more expensive than it should be is because health insurance companies are jacking up the price. The insurance companies are surplus to requirements, once the US gets rid of them (and cuts down on price gouging by the pharmaceutical industry) the overall healthcare costs should drop dramatically.
Back in my native New Zealand, the total income tax for an average household is about $6,000 USD. $14,000 just for insurance vs $6,000 for "free" healthcare and all of the other infrastructure a country needs.
The US healthcare system is a joke. A joke that wastes money and costs lives.
I took my kid to the doctor recently and a 15 minute appointment was $250. It doesn't cost $1,000/hour for a doctor to do a routine exam.
Part of the problem is the US is that the actual cost of insurance is buried in your benefits so people think that the $200/month they pay is the cost of insurance.
1) Too many young people didn't insure themselves meaning that the relatively low cost of having them as insured couldn't be used to balance out the higher cost needed for later on in life. This was putting the primary burden of the cost on the older generations.
By forcing everyone to pay the idea was that you could even out the cost.
2) Pre-existing conditions. I.e. the insurance agencies wouldn't cover you if you came into their plan with an existing condition. To give you an example of that from real life.
I had a stage 1 melanoma. They tried to excise it but didn't get everything out and I had to get more complicated operation.
My insurance wouldn't cover it because they claimed I had that coming into the system. I later convinced them otherwise but until that happened the only thing my doctor could offer me was to monitor my melanoma for the year I had to wait until they would cover me again. Imagine that.
Before ACA I went through a period of unemployment and had to buy my own health coverage. I had been on Kaiser previously through my employer, so they had my health records. And they rejected me for a pre-existing condition -- eczema. Seriously. A decidedly non-fatal skin condition, in my case a minor annoyance, and they won't cover me at all.
This shouldn't be a significant problem. In an actuarial sense, the burden of the cost should largely be born by the party with the risk. If you aren't doing that, it isn't insurance. If you are providing healthcare instead of insurance, you don't pay for it by taxing poor young people (those are the young people opting out of the system, not the wealthier ones).
So the premiums the young people weren't paying should anyway only be high enough to cover the cost of insuring them.
The real problem with cost in the US healthcare system is that the majority of people have a third party payer that will cover almost anything, so they don't care whether prices are remotely fair or not. The "agency problem".
We should stop making it advantageous for employers to provide insurance (I'm sure someone will be outraged by my supporting this opportunity for employers to lower compensation, I don't care, I paid out of pocket for 2 CT scans last year and know our healthcare prices are nonsense).
Worse still, Obamacare was structured with a bunch of subsidies that expire over the next few years, lasting just long enough to push the pain into someone else's presidency.
Anyway, my point in my other comment was that while Obamacare did try to shift costs to younger people, low participation wasn't a problem to be solved, it was seen as an opportunity to grow the pools and make it sort of work. The pools probably should have been grown by ending group policies.
Broadly speaking, I probably agree with you. Spending is unlikely to solve a pricing problem.
Why then are healthcare costs significantly lower in countries where everybody has "a third party payer that will cover almost anything" (i.e., the national health system)? People in these systems also "don't care whether prices are remotely fair or not"--in many cases people don't even know what the prices might be, because they aren't charged--and yet these countries spend much less than the US for health care. Why is that?
National health systems make choices about what to cover. Some of them fix prices.
edit: also, I meant stuff like 'all the expenses of a visit to the ER' rather than 'cosmetic surgery'. So the people I was talking about don't have a lot of visible expenses. If we fixed prices that would work out fine, but we don't fix prices.
But the whole point of insurance is that you make it work because most people wont be needing their insurance so it's a question of interpretation.
And yes I think you are right about your solution. I can compare same treatment in Denmark with those of here in the US and the difference is just too big to be true.
Because this is a bit bait-y, I think a better analogy would be to say: "it's like forcing safe drivers to also have insurance".
> The real problem with cost in the US healthcare system is that the majority of people have a third party payer that will cover almost anything, so they don't care whether prices are remotely fair or not. The "agency problem".
Yes!
The funny thing is people in the U.S. are so indoctrinated and separated from costs that even smart doctors make fun of you (and eventually lash out at you if you EVEN DARE to ask what a specific procedure is going to cost): https://news.ycombinator.com/item?id=12522037
Or look at the condescending post at Quora: https://www.quora.com/How-do-I-find-a-general-physician-in-S...
If the participants in the healthcare industry itself have no understanding of the issues it faces, and suffer from such apathy in realizing when told about it, I am afraid there will never be a solution
> We should stop making it advantageous for employers to provide insurance (I'm sure someone will be outraged by my supporting this opportunity for employers to lower compensation, I don't care, I paid out of pocket for 2 CT scans last year and know our healthcare prices are nonsense).
Yes!
Employers should have no say who the provider/doctor/lab for an employee should be.
Quora: https://www.quora.com/Would-the-average-person-who-gets-his-...
The U.S. has ended up with a system where every party except the patient stands to benefit.
While this is inconvenient for me (I can just fly to another state or at worst, to India for very expensive procedures, it's embarrassing to see Americans get into debt to fix a broken leg!)
As to one, ObamaCare is still failing, because too many young people are able to do the math and realize that, if they don't have chronic conditions or children, the IRS penalty for not having insurance is significantly cheaper than the premiums on the high-deductible, terrible plans that are available to them at any reasonable price. For anything less than a catastrophic illness or injury, the ObamaCare plans I have seen just don't make any sense.
IIRC in the US, the main problem is that those setting the prices have much more bargaining power than the insurers (especially the smaller ones), so they're pretty much free to raise prices...
This is how it works in Germany for example. As a hospital you have to accept the money you'll get or you won't get any at all.
The healthcare market in the US is not balanced and this gives healthcare providers to increase prices to ridiculous levels, especially in rural areas.
Diet has a lot more to to about that than medical care.
From http://data.worldbank.org/indicator/SH.STA.MMRT?view=map
* 0.014% of dying during a pregnancy in the US
* 0.008% of dying during a pregnancy in France
It'd be interesting to see the numbers after accounting for obesity.
Generally if you are well off, the US is a fine place to be. If you are addicted or poor, it's not so great.
In most of Europe, it's easy to get into rehab even if you're destitute. We have drug workers out on the streets providing advice, clean needles and referrals to other healthcare services. Homeless addicts still have access to exactly the same services as anyone else. The death toll from addiction falls remarkably quickly if there's a concerted effort to abate it.
We also avoided the opiate epidemic that is currently blighting the US - pill mills simply don't exist when there's no profit motive to dole out opiates like tic-tacs.
Setting aside the obvious humanitarian issues, failing to address the healthcare needs of the very poorest is costing the American taxpayer dearly. The economic benefits of preventative medicine and social care were described better than I could in Gladwell's essay "Million Dollar Murray".
http://www.newyorker.com/magazine/2006/02/13/million-dollar-...
I think this is the real benefit of socialised health care. Your wealth will survive a health problem. You will not lose your house because you got cancer.
Health insurance works when it works (I have some), but when they decide they're not going to pay your bills, for whatever reason, and you have to pay the bills to keep the doctors working until you can take the insurer to court, then it's a nightmare. Socialised health care avoids this.
Really? Maybe a long duration but highly curable health problems. What happens to the blind or someone who loses both arms? Do they really have more wealth than their counterparts in the US?
http://www.usatoday.com/story/money/personalfinance/2016/10/...
I can almost guarantee that nearly all of the 30% of Americans WITH savings have health insurance with an out of pocket max.
I can almost guarantee that many of the people without insurance are in the no savings group.
So perhaps I am missing something, but I am not seeing a huge group of Americans that have their wealth in danger by the current healthcare system.
And furthermore, that the system doesn't affect them because they're not part of it?
What do the 70% of Americans with no savings do when they get sick?
Analysis of the mid-Victorian period in the U.K. reveals that life expectancy at age 5 was as good or better than exists today https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2672390/ Digging into it you find women have a shorter life expectancy and men had a longer one.
PS: Using birth or at age 70 modern England has longer lifespans.
With the healthcare being paid for by taxes, there is a lot more incentive for governments to push healthy eating. It also means that policies for bike/walking routes pay off more.
Using body mass index as a (arguably quite bad) proxy for a healthy diet we find [0] that many of the southern countries such as Spain, Greece and Portugal are more overweight than many countries farther north.
The Affordable Care Act was not proposed as some "left", "socialist" initiative. Mainstream America as a whole -- including the "conservative" side, business, etc. -- was clamoring for some sort of effective control on health care costs.
Then, the Republicans made it a political issues. They "lost", and they weren't having any. All their rhetoric and obstruction, not of a "liberal", spendthrift proposal, but of a middle of the road plan that would provide, per their worry, a perceived "win" to the "other side."
Once the ACA was passed -- in its further compromised form -- they did their best to kill it via the budget process / spending, which is a separate activity under control of the legislature (House and Senate). Facets written into the law, such as adjustments to control insurance losses during an initial, transitory period (the demographics and so costs of the newly enrolled not being known in advance), simply were not funded.
That America doesn't have fair, cost-effective, productivity enhancing health care, is a function of political self-interest. And, in a Democracy, said politics are tied back to the electorate, however imperfectly.
Republicans lied about health insurance. People bought the lie. Now we are living it -- ever more.
P.S. Not to mention, blocking actual cost-controlling measures at every chance.
By the way, for all the complaint by insurers about their "losing money" on the ACA, as I understand it, they've seen significant savings due to the ACA in their traditional, employer group plans. Are those mentioned and factored into the rhetoric about the ACA?
Health care in the U.S. is indeed in crisis. At this point, it comes down to a simple trope: If you're not part of the solution, you're part of the problem.
The ACA bashing pols are simply part of the problem. Witness their inability to offer up an alternative of any substance.
P.P.S. In other words, I don't give a flying f-ck whether you are "left" or "right". You make progress towards solving the problem, or you don't.
And, I see it both as a economic and structural problem, and as a moral problem. A "moral" Right that is content to leave its fellow citizens suffering when resources and remedy are at hand (and this country can certainly afford them, in the dollar amounts estimated, if it makes the decision to), is not moral. It is merely hypocritical -- at best. I might contemplate using the word "evil".