I get that it's very efficient to work this way, but I'm not sure I'll ever get used to it. My father, now long retired, used to be a family doctor back in France. He shared his office with 4 other family doctors + 1 secretary that they paid with their combined income to take care of their appointments. He used to spend 20 minutes in average with each client. One of his colleagues routinely spent 30 minutes.

I should ask him about his churn. :)

Everybody was so unbelievably nice and caring it was a huge improvement over what I'd seen elsewhere.

http://krant.telegraaf.nl/krant/archief/20020319/fotos/bin.v...

It was a pretty bad accident (5 dead, 55 wounded of which 3 critical one of those criticals was my family) with lots of beds suddenly occupied by people not speaking French and a large multiple of that in foreigners roaming the corridors and yet they dealt with all that with grace and understanding.

Its important to remember that in a state economy where healthcare is free or semi free it's operated as a cost center and thus has budgets that are politically mandated not determined by market demand at least not directly.

This leads to a number of limitations on what kind of care patients can get what machines they can buy, what medicine etc.

Not saying the US system is better but all systems have drawbacks.

NL had a very good system which got replaced by something much less efficient, ostensibly because the 'market' would have been better at making things efficient where the only real change is that healthcare is now much more expensive and options are as limited as they were before.

Personally I feel a good society should take care of its sick, poor, elderly and inmates even if it costs but that's an opinion that seems to be out of fashion.

I.e. no one should be bankrupted because they get a serious illness.

With regards to France healthcare system here is an article who seems to think it wont survive though.

https://www.bloomberg.com/news/articles/2013-01-03/frances-h...

Be careful with articles about single payer healthcare systems in the US. Most similar countries to the US have functional single payer plans. It's a false talking point pushed by conservative media that those systems don't work well. Conservative media pushes those falsehoods because the media is funded by the very wealthy and those who want to cut taxes to line their own pockets at the expense of most Americans.

The issue that might make single payer difficult in America is we don't trust our political system to manage good programs, because the GOP is committed to destroying government (to benefit the super rich) rather than trying to get things done.

It's 100% free to go to the doctor yet a lot of people don't go for checkups it's not a common thing to do.

Furthermore the situation is even worse for men over 50.

So access to healthcare has very little to do with that.

  > Its important to remember that in a state economy where
  > healthcare is free or semi free it's operated as a cost
  > center and thus has budgets that are politically mandated
  > not determined by market demand at least not directly.

  > My personal suggestion for a good balanced system is that
  > most people pay most of the cost for normal healthcare costs
  > like going to the doctor for a checkup, most of the cost for
  > one of things like a broken leg but that society pays for
  > more serious and longer term situations like cancer, heart
  > surgeries where you are supposed to stay at the hospital for
  > a longer time.

  > It's 100% free to go to the doctor yet a lot of people don't go for checkups it's not a common thing to do.

So which is it? Does healthcare that is 100% subsidized distort demand so that people seek unnecessary care, or is demand so inelastic that people and populations who would benefit from it decline to use it?

EDIT: add third in situ quotation. Add comma in last sentence/question. Change pronoun to conjunction in last sentence; pluralize noun.

"1000 paid Russian trolls are spreading disinformation on US social media"

And recently said

>Be careful what you read on the internet because paid trolls are influencing what is discussed.

Perhaps parent poster is getting his info from disinformation sources like RT, Breitbart, Fox News, IJR, Limbaugh etc.

I was responding to a post who claimed that if there isn't free checkup for all then people wouldn't go to get checked.

I simply pointed out that even in a country like Denmark which is 100% free people thats not the case.

So you would have to show causation between general checkups and cost of healthcare I don't think you will be able to find that.

On the other hand, in Denmark where basic healthcare is free, the data you allude to (but do not present) show that even then "a lot of people don't go for checkups [because] it's not a common thing to do." Additionally, you write "Furthermore the situation is even worse for men over 50."

So my confusion comes from your contradictory assertions about the effects of fully subsidized basic healthcare. Either free healthcare generates cost overruns because people seek out unnecessary treatment, or free healthcare does not generate cost overruns because people do not seek out even necessary treatment.

Your assertions about the effect of free healthcare are paradoxical, hence my confusion.

EDIT: fix typo, recast first sentence of penultimate paragraph. Remove redundant prepositional phrase from last sentence.

I am not sure where you get that I want less people to go to the doctor. I just want to be able to pay for the situations you can't afford by asking for money in situations where most people can. And yes if you don't have any money then you should get help, but for people who make enough it should cost something.

So there is nothing paradoxial going on here. You just assumed I wanted fewer people to go to the doctor which I never said anything about.

With single payer, taxes cover the cost of care for everyone. With private insurance, the costs for more expensive care is covered by the premiums of healthier individuals, which is sort of like what you suggest but does not financially punish people who get sick.

What you propose may not be workable (or humane, for that matter) because it distributes the costs of extraordinary care to people who already have more-than-routine care. Presumably these people already have paid their premiums and now would shoulder most of the cost for maladies such as broken bones.

EDIT: add missing word "workable".

The main premise of this discussion is that it's not possible to pay enough for healthcare. I.e. even if you taxed people 100% there still would be things they couldn't get because it has to be available to everyone and there are always new treatments being developed, new machines, new drugs.

Whether you find it humane or not is based on what you consider the end-game of healthcare.

I said MOST people should pay MOST of the bill. Do you really think I am talking about those with least amount of money.

> most people pay most of the cost for normal healthcare costs like going to the doctor for a checkup, most of the cost for one of things like a broken leg

Most people are poor. Wealthy people are the exception and most people would not be able to pay for even the simplest procedures.

They typically can't pay for a new washing machine if their current one breaks down.

In Belgium, you are charged based on your income, and they don't ask you how much you can pay when you get admitted.

As US ex-pats, we made enough money that we were in the top payment bracket.

Yet, for a significant surgery that kept my wife in the hospital in a private room for two weeks, we still paid less for the whole surgery plus hospital room WITHOUT insurance, than we would have paid in the US but with insurance.

That kind of social medicine does actually work, and work pretty well.

There is a large number of people who can't afford to buy a washing machine but it's not most people.

Wrong, income distribution isn't normal, it's bottom-heavy, and most people are well below the mean.

Exactly. In 2015, most (50.08666%) wage earners earned less that $30,000/year.

While it isn't a majority, the fact that 3-in-10 (29.72726%) earn less than $15,000/year is a travesty.

Of the income or wealth distribution - not a hope, it's Pareto all the way. You've got a really warped view of the world there.

I don't want people voting based on their appendix, their bad knee surgery, or a skin rash. Involving government in healthcare inevitably leads to possible futures wherein a country is brought to it's knees by colonoscopies. One's enemies can only laugh.

It's easy to sketch convincing strawmen. But if you could actually point to somewhere that is choosing between kidney transplants and bullets, I'd eat my hat.

Plenty of single payer systems decides how long they are going to keep someone on treatment, what kind of products they allow them to be treated with etc.

A single payer system is based on a budget which means that budgets size is based on how it's prioritized.

However when you switch to a for-profit healthcare then the interests of the operators stop being aligned with those of the population. Even if there is more money, like in the US where the budget per person is about double that of France, it is not necessarily spent in a way that benefits the patients. State-run health avoids multiple administrative costs due to multiple actors, it avoids having to pay dividends to share holders, and as a single payer it has much more power over the pharmaceutical industry to lower costs. Overall it is a more efficient use of people's money.

Its also important to remember that in for - profit healthcare, its operated as a profit center and thus has profit margins that are corporately mandated and not determined by need, at least not directly.

This leads to a massive inflation of price and decrease of quality of service, medicine, machines etc.

Not saying the EU system is better, but then that depends whether you are a shareholder or a patient.

The reality is that that so many people in this country have bought into some kind of Capitalist Calvinism, where the suffering is not only pre-ordained by "market forces," but considered salutary itself, that it's sickened our culture beyond the capacity for reason. We'd really rather watch our friends, families, and neighbors die in sickness and poverty, than admit the failure of the grotesque just-world fallacy that is our economic ideology.

The reason why the US system is so expensive is because of perverse incentives given to the industry.

As long as you can afford it I would rather be treated in the US system than the French or Danish system.

So does the US, they just use one's wealth as a proxy to arrive at demonstrably worse results for everyone overall.

If you want to have a system where one's income determines their ability to survive because you have enough money and that works for you right now, go ahead. But at least drop the pretense that it's in any way just or moral.

You can be of the opinion that everyone should get access to the same treatment or you can be of the opinion that they shouldn't and that people who can afford better treatment should be able to.

All I was doing was point out that a single payer system has it's own issues as well.

Whether you are a fan of one or the other is more a political discussion.

Most (but not all) single payer systems coexist with private payer.

In England you can get all your care on the NHS, or you can mix and match with NHS or private care.

"The reason why the US system is so expensive" - Is because an individual with a health condition is in a poor position to negotiate the price of a treatment for themselves. To the extent a private company could give fair prices, they would have to be regulated heavily.

"As long as you can afford it I would rather be treated in the US" - You believe this because much of the massive profit margins goes into advertising.

On the other hand, you will likely have been on the receiving end of millions in advertising, and since your 'opinion' is in line with that advertising... its a good bet it is the result of it.

if you are interested in some conflicting 'studies of one' have a watch; https://www.youtube.com/watch?v=thkBLpRwdSM

I know the documentary but what does that have to do with whether the US system have access to more advanced healthcare than most other places.

I don't need a documentary to tell me the many issues with the US system just like I don't need one to tell me the many issues with the Danish system.

The US system isn't better it's different. The inflated prices aren't due to it being more privately driven but because of lobbying which can be dealt with.

The problem with healthcare is that you can never spend enough money on it. There are always methods, never and better machines. In a singlepayer system the taxpayers pay for that which means there need to be political mandate behind the budgetting. You can only spend money in a singlepayer system.

In a system more driven by market you can actually make money.

It's finding the right balance between those two I consider the most interesting part of this discussion. Unfortunately it's impossible to have this discussion because people either see you as a singlepayer proponent or a 100% marketdriven proponent.

"you can never spend enough money on it" - i say again, 'enough' is defined differently, a 'socialist enough' is enough to please the people; where a 'capitalist enough' is the smallest number that can sustain profit. these 'enough's are radically different.

"In a system more driven by market you can actually make money." - only by denying treatment. this is the cornerstone of the market model, those who can't pay don't matter.

"It's finding the right balance between those two" - In the UK, we are bringing private companies into contracts within the NHS, its always been a disaster, costing much more money that the services needed to cost, the inefficiency inherent in private companies (from bloated wages of CEOs to dividends) drag the whole system into financial crisis. The people who pay for the profits at the top are always the poor users of the service.

If you get more and more treatments available and what people consider being part of healthcare and you are running a cost center then your system gets more and more expensive.

No enough here is meant as there will always be things you can spend to make your system better than it is. It's not a matter of opinion it's a matter of what kind of treatments are available compared to how many you can offer.

The single payer system is also denying treatment exactly because it can't pay if everyone used it. It's just another way to say some people don't matter enough.

In the UK system is also deciding which drugs it will prioritize and which it wont.

You are mixing two things together. Yes there are plenty of issues with the US system but the single payer system have issues too and they are not the same.

'cost center' Vs 'profit center' <why would the profit center be cheaper? its the same as a 'cost center' with an added money drain and incentive to inflate prices..

'[denying treatment] because it can't pay if everyone used it' - This is just false, moneys going into a countries nationalized health system is high return (due to taxes), its also cheaper (due to group union prices). So long as its a healthy part of a healthy GDP (12%) it should have capacity for everyone in the country. compared to the US system which costs over 40% of your GDP and still does not have capacity for all your citizens.

'which drugs it will prioritize' - true, but this is done mostly on evidence of usefulness, not price.

I largely agree with your last statement, but whatever problems a socialist system has, they pale in comparison to the misery caused by Laissez-faire in our health system.

Switzerland has universal healthcare but it's based on private insurance. In other words it's not that simple.

In general I find this discussion hard to have because you are assuming so many things about what I say or mean, that simply aren't true.

I am not saying that a profit center is cheaper than a cost center I am saying that its able to make money which gives it flexibility.

The incentives that drives the US healthcare system are pretty shitty but they aren't incentives which are unique to a private system. On top of that in the public healthcare systems you see more and more new public management to hold down cost, which itself is expensive. But it's not something that's set in stone. It's not a property of the system it can be changed.

Changing the US healthcare system to patient outcomes incentives would do a lot to fix the incentives and there is an active program trying to do that.

And no it's not false that there are limits to a public healthcare system. Believe me I have lived in one and it doesn't only get realized by not doing certain treatments it also reflect in waiting time for operations, to see a specialist etc.

In Denmark if you go to the dermatologist you have to wait 3 week. In the US I went straight in.

In Denmark my biopsy had to be done at the hospital. In the US they made it right away at the dermatologist the same day.

With regards to drugs it's actually based on the cost, the rarity of the decease etc. I think it's in the UK where they have a list in order to prioritize.

Switzerland has very heavy regulations, everyone is covered by a national insurance system like other EU countries, but the very fact that its private companies that carries out the health care show in the stats, they pay almost twice the GDP of the UK for about the same outcomes, same with Germany, which has a similar system, its about 18% of GDP (and their GDP is higher per person).

"I am saying that its able to make money which gives it flexibility" - if this is really what you are trying to say, then you should have started with "Private, profit driven health care is fine for rich people", which i would have agreed with.

"waiting time for operations, to see a specialist" - this is a bad example, how many Americans wait all there lives for an operation, or never see a specialist because of the price. if you factored this in the average waiting times in a private unregulated system would dwarf a socialist waiting list(which by definition includes everyone).

"With regards to drugs" - in England we have 'NICE' which is a public board mandated to approve drugs and procedures on the NHS, with the fist stipulation that the drugs or procedures are shown through proper trials to work. This system is not perfect, but its a hell of a lot better than a private board incentivized to approve any BS treatment on profit basis alone.

"In Denmark if you go to the dermatologist you have to wait 3 week. In the US I went straight in." Try to put your personal feelings aside and look at the stats; http://www.nationmaster.com/country-info/compare/Denmark/Uni...

It's either socialist or Laise-Faire, Switzerland is heavly regulated, Public boards are based on rationality, private boards are based on greed alone.

No a taxpayer paid healthcare system does not make it a socialist system anymore than a taxpayer police force or army does. And the US system isn't laissez faire just because it's broken in many ways. Most economies are mixed economies.

So I am not sure what you are trying to prove here. The fact remains that public healthcare has it's own issues regardless of whether you personally think they are better issues to have and any honest dive into those the countries systems will show you that. You can't both have your cake and eat it. Switzerland is heavy regulated you claim (which is wrong) but they pay twice the GDP for about the same outcome. So what is it? A system governed by the state, a system that's private or something in between? With regards to Germany most of their insurance is covered by public healthcare 80% if not more. So why is that?

Furthermore the US is a huge country with hundreds of millions of citizens and millions of illegal immigrants and spread out over a huge area. Based on it's circumstances it's not doing too shabby regardless of the statistics.

It's just not as simply as you would like to paint it in those extreme corners.

There is an interesting discussion around Medicaid vs. private insurance in the US you can read about here:

https://www.forbes.com/sites/sallypipes/2014/08/14/no-really...

My point was never to say one thing was better than the other yet thats what we are really discussing here.

My point was that there are tradeoffs in both systems.

Healthcare isn't perfect anywhere in the world whether private or public.

And even the US healthcare system isn't really market driven.

Opening with "let's have a market" isn't opening with a cogent position, since rational actor economic theory is completely unable to deal with this (sure, there might be others, but no one making this assertion wants to talk about them).

My premise is that you can never spend enough money on healthcare. There is always a need for better treatment, more treatment, new machines etc. Even if you taxed people 100% you could still spend more money because as you say it's worth everything to save it.

But a political system is made to prioritize the resources that we have and so a singlepayer system cannot escape to have to come to terms with the boundaries of the budget it's given.

There are many areas where a patient will not be treated or where the system decides it's not worth continuing to pay for some treatment.

In a singlepayer system it gets decided what gets treated in a system which is more open to demand the market decides.

None of these are without fault it's just important to keep their limitations in mind. This is why ex. the french system as much rave reviews it's gotten also sets limits to who it will treat.

We can then have a discussion about whether it's better that everyone gets access to the same treatment or whether it's better that some people can get access to better treatment methods than others.

But to ignore that a single payer system comes with it's own problems such as limits on how many people can be treated and for what and how long, is not taking the discussion serious.

And Medicare makes funding decisions based on what sort of care hospitals provide to patients. Critical access hospitals get higher reimbursement; maintaining that certification means a short average for length of inpatient stays and not growing to meet demand.

Medicaid and Medicare are more than a third of spending and don't necessarily cover the total costs of the care provided under the programs (any unmet costs are a hidden tax). The VA is not nearly as expansive as those programs but is another couple whole percentage points of US health spending.

And you've also got Tri Care and some BIA stuff, and state expenditures that are outside of Medicaid.

My point is that a singlepayer system payed by the taxpayers and budgeted by the politicians isn't making money it can only spend less money.

A system like the american overall can make money, it's it's goal to profit.

That's the difference between whether it's a market driven market or not IMO.

The US has all sorts of constraints on the supply side and a lot of the demand side is treated under various mandates.

Without easy entry on the supply side, there can't really be a market response to changes in demand, hence not really market driven.

When care is provided to comply with government mandates and incentives rather than because it can be priced above cost, not a market driven transaction.

Thats not a useful way to look at things.

Why is market demand a good thing?

In the US the government spends more per capita than France, but gets worse health outcomes.

The US system isn't the only way a marketdriven system can be and a lot of it's problems are lobby and politics related.

Market demand is a good thing in the sense that it creates better allocation of resources.

The US doesn't have a healthcare market driven by market demand. But the fact is that the US system has more advanced treatment methods.

The problem is that it's not evenly distributed.

Docs are the chokepoint in the process. Overseers track very carefully how much time you spend, how productive you are, etc. and surround you with lower-wage employees to do every last thing except those responsibilities that you, by law, have sole power to do.

My buddies are in latter years of residency and no one works <90 hrs/wk (including paperwork they have to finish when they get home, 'cause otherwise they'd never see their families). And that's despite running around like their hair is on fire. I assure you, it's not voluntary.

New med schools are opening every day, but they're an irrelevancy when the chokepoint is actually getting narrower.

Additionally, docs are just the most expensive staff members. It's bad business to have someone who costs $10/hr doing work someone else can do for $5/hr. Hospital CFOs don't care if it makes patients feel like shit, and doctors feel like shit; they don't want to pay out the marginal $/hr.

It seems possible that was a hygiene issue. For example the doctor knew that he'd need then to wash his hands again (possibly twice, once before going to the cupboard, once after), or change his gloves, before continuing with your consultation?

From my own experience the US is a weird mix of "can do" attitude on the one hand with strict hierarchies and enforced policies on the other hand.

Yes, this is a lot of bureaucracy, but there is a reason for it. If your surgeon thought there was a good chance that you'd have to go back in for surgery soon, he'd likely want you to be NPO (no food or water intake) to minimize the risk of aspiration and choking during anesthesia and intubation if you were to undergo surgery again. He might want you NPO if you had just had some sort of GI surgery or were due for a barium swallow study. A lot of patients are NPO in the hospital, and for consulting doctors, it's much easier to defer to your nurse or your primary doctor for even basic needs like food and water.

Ok.

> The workflow of doctors in the hospital is complicated, and different doctors and nurses have different privileges for different patients, which can make things appear to be ego related. In your scenario, you're a post-operative patient. Your primary doctor is likely the surgeon that performed surgery on you. I'm thinking the doctor that saw you and wouldn't get a cup of water was a consulting-team doctor that was asked by your primary doctor (the surgeon) to see you.

All that's correct.

Even so, I was in some pretty serious discomfort, the guy asked me if he could do something for me, if I could have I would have gotten up myself and instead we spent a couple of extremely uncomfortable minutes waiting for the nurse (busy elsewhere) to perform a 10 second action. That discomfort could have easily been avoided.

If there was a more complex situation at play then there was plenty of time to explain that but no such explanation was given, when I asked later about why the doctor didn't get me the water himself (to the nurse that got it for me) her answer was because they're too good for that.

So FWIW I think the story is simply as it is at the simplest level without any need to bring in larger scenarios or extra complexity.

After 6 hours of surgery without any water and a tube down my throat a bit of water was not too much to ask for to receive right away, my throat was burning and my tongue was parched.

To me that's basic humanity, it's nothing to do with bureaucracy or complex reasoning, after all if I could have gotten up I would have gotten some water myself.

You mentioned you had a tube down your throat—that's probably an NG or OG tube, which is often used for feeding solids and liquids. If you had one of those tubes, then there's very likely a reason you couldn't take solids/liquids by mouth. Again, I don't know all the details, but I'd imagine what happened is that your consulting doctor saw you had an NG or OG tube and wasn't sure why. He probably deferred the decision on whether you could have water to your nurse who would know for sure what you were and weren't allowed to have. The nurse probably isn't aware of what the different doctors know and don't know about their patients and interpreted the request to get water as an ego thing. If my interpretation is correct, the doctor is still wrong in not giving you or the nurse an explanation of what's going on, but the issue is more communication related than it is ego related. I don't believe what happened to you is ideal or how medicine should work, but it's how medicine often ends up working with so many different people having tangential and partial responsibilities for patients.

Based on my experiences working in the hospital so far, communication issues are massive and frequent causes of problems and conflicts between health care providers and patients as well as between different health care providers. Again, the workflow in the hospital is complicated, and I don't believe any one person really knows what any other person should be doing. Each provider knows the extent and limitations of their own role, but others' roles are a mystery. All of this leads to miscommunication, misunderstandings, and massive/frequent problems like your experience.

No, it was there during the operation, not for feeding.

> Again, I don't know all the details, but I'd imagine what happened is that your consulting doctor saw you had an NG or OG tube and wasn't sure why.

No, this was definitely not the case.

> All of this leads to miscommunication, misunderstandings, and massive/frequent problems like your experience.

This may sound funny to you, but ego or miscommunication doesn't matter to me, the end result is what matters. If you can't communicate or have an inflated ego I'd rather not have you as my doctor because either one of those is an ingredient in a recipe for an accident.

Also, I love it how I relate something where I was present and observing the whole thing and then you come along and tell me what really happened.

No, he definitely was not on a tight schedule, in fact he waited around for the nurse to come and hand me my cup with water from that very same tap before we continued our conversation which indicates the opposite. I'd had a tube down my throat for 6 hours or so and the irritation was such that I couldn't speak otherwise, but I was still too unsteady to get it myself or I would have happily done so. A few minutes would have made a big difference to me.

I'm an engineer. I can't carry a part from one lab to another. Must have a hourly paid union member do that. If I'm caught and they file a greivance, the company has to pay them 1 hour of my salary, then I get chewed out by management. Most of the hourly staff don't care, but there are a few that are hell bent on doing as little work as possible and looking any excuse file to a greivance.

They don't do that anymore, as most people ignored these rules.

Not a chance where I live.