What the heck is wrong with the US healthcare?

[MJ&RJ 7]

http://smartgirlnation.com/2009/06/popular-ranking-unfairly-misrepresents-the-us-health-care-system/

Here's a couple interesting facts:

Americans have a higher survival rate than any other country on earth for 13 of 16 of the most common cancers.

Belinda Stronach, former liberal member of the Canadian Parliament and Cabinet member (one of the health care systems touted as “superior” to the US) abandoned the Canadian Health Care system to undergo her cancer treatment in California.

EVERYONE WHO THINKS THE US HEALTHCARE "SYSTEM" IS NOT GOOD, BASED ON THE W.H.O. RANKINGS, NEEDS TO READ THIS.

Even though the data is ten years old, let's have a look at the WHO's ranking system, shall we?

WHO’s health care rankings are constructed from five factors each weighted according to a formula derived by WHO. These are:

1. Health Level: 25 percent

2. Health Distribution: 25 percent

3. Responsiveness: 12.5 percent

4. Responsiveness Distribution: 12.5 percent

5. Financial Fairness: 25 percent

Let's now define these factors.

Health Level. A measure of a countries "disability adjusted life expectancy". This factor makes sense, since it is a direct measure of the health of a country’s residents. However, even “life expectancy” can be affected by many factors not related to health care per se, such as poverty, homicide rate, dietary habits, accident rate, tobacco use, etc. In fact, if you remove the homicide rate and accidental death rate from MVA’s from this statistic, citizens of the US have a longer life expectancy than any other country on earth.

Responsiveness. Measures a variety of factors such as speed of service, choice of doctors, and amenities (e.g. quality of linens). Some of these make sense to include (speed of service) but some have no direct relationship to health care (quality of linens). These two factors at least make some sense in a ranking of health care, but each is problematic as well. ((this paragraph was quoted. Having personally been hospitalized in third world country hospitals, the quality of linens matters. But, I highly doubt that quality of linens was any different across the first-world countries in the list))

Financial Fairness: This is the big one. Measures the percentage of household income spent on health care. It can be expected that the “percentage” of income spent on health care decreases with increasing income, just as is true for food purchases and housing. Thus, this factor does not measure the quality or delivery of health care, but the value judgment that everyone should pay the same “percentage” of their income on health care even regardless of their income or use of the system. This factor is biased to make countries that rely on free market incentives look inferior. It rewards countries that spend the same percentage of household income on health care, and punishes those that spend either a higher or lower percentage, regardless of the impact on health. In the extreme then, a country in which all health care is paid for by the government (with money derived from a progressive tax system), but delivers horrible health care, will score perfectly in this ranking, whereas a country where the amount paid for health care is based on use of the system, but delivers excellent health care will rank poorly. To use this factor to justify more government involvement in health care, therefore, is using circular reasoning since this factor is designed to favor government intervention.

Health Distribution and Responsiveness Distribution. These measure inequality in the other factors. In other words, neither factor actually measures the quality of health care delivery, because “inequality of delivery” is independent of “quality of care”. It is possible, for example, to have great inequality in a health care system where the majority of the population gets “excellent” health care, but a minority only gets “good” health care. This system would rank more poorly on these measures than another country that had “equal”, but poor, health care throughout the system.

It is very clear to see, based on this criteria, that a country with the best actual health care measurements in the world could have a lower score on the WHO's rank than a country where all health care is paid for by the government, but has horrible actual health care measurements. The actual quality of care is only 25% of the ranking. And, we don't get to know which criteria they looked at for those bits either. Since we can already see that they're trying very hard to make government-run health care look highly favorable, it's easy to be very skeptical of that measurement as well.

Additionally, the Financial Fairness portion means that a nation with more wealthy people who choose to pay for their own health care (with or without a privately funded coverage plan) will score lower than a country where everyone pays the same percentage of their income on health care. Regardless of the quality of care.

Finally, a very interesting bit of analysis on another part of WHO's data.

http://agoraphilia.blogspot.com/2007/07/whos-healthcare-rankings-part-3.html

All good information but in real life the numbers lie as we have one of the shortest life span than most in the world. We are one of the most obese countries in the world as well. And the cost for healthcare is going up while our wages are not keeping up. We pay a lot for healthcare that is no longer innovative or the best anymore. Most of the newest and innovative procedures don't even originate from here anymore. We need to step back and take the rose colored glasses off and start to see for the richest country in the world we are lacking a great deal in a lot of areas that we shouldn't and healthcare is one of them.

[Kevin- 13]

It's interesting how the WHO data is used to prove a point, and when I empirically demonstrated how it is intentionally skewed and that actually the US has very high life expectancy, then the numbers are lying. Okay.

I addressed the reasons for the high cost of health care a bit in my earlier post. Over regulation in many areas, and under regulation in a few areas. One thing I forgot to mention, is that ordinary folks are having to pay increased fees at hospitals, doctors, etc, to cover their expenses in providing the government-required aid such as medicare. The providers don't get paid enough (especially hospital emergency care) by the government for those government-required services, therefore it drives up cost for everyone else. Additionally, history shows that whenever governments subsidize something, it becomes more expensive. Look at higher education, for example. The more money government puts into it, the more expensive it gets, and the more they say that justifies government money going toward it.

I've given actual information to demonstrate that it's simply false to claim that the US has anything but top-tier health care. The only remaining claims in this argument are "it's too expensive", which I agree with and talked about, and "i know that we really don't have good health care because I just know". I guess that's why thousands upon thousands of people come here every year, from everywhere in the world, when they have life threatening health incidents.

[Flames9_RN 358]

as a RN- I see people abusing the system every day!! And yes it happens in other countries as well! We have the frequent flyers who come in for the dilauded//ativan/etc etc fix!! They know how to play the system and dont pay for it!! And yes DR's over treat--as they don't want to get sued! CT scans//MRI's etc for everyone!!

[Kevin- 13]

as a RN- I see people abusing the system every day!! And yes it happens in other countries as well! We have the frequent flyers who come in for the dilauded//ativan/etc etc fix!! They know how to play the system and dont pay for it!! And yes DR's over treat--as they don't want to get sued! CT scans//MRI's etc for everyone!!

Exactly. Examples of both under and over regulation here. Over regulation in that hospitals are required to treat everyone that comes in to an ER. Under regulation as well in that same area - not preventing the abuses. Another of the under regulations is the malpractice lawsuits need to be reigned in. Any sort of slight mistake often results in gigantic lawsuits. Malpractice insurance rates are astronomical in the US. The malpractice insurance system itself has caused a reduction in the number of practitioners as well. Lower supply with growing demand = higher prices.

People who sue for bajillions of dollars over anything that doesn't actually have a bajillion dollar financial loss associated with it, are generally being greedy entitlement seekers. It's become far too easy for doctors to be made to take blame when they really aren't doing anything wrong in most cases. They make a judgement call based on available information, and sometimes the very best doctors will get it wrong. Sometimes getting it wrong will cause more problems. Misdiagnoses are not always mistakes, sometimes they're unavoidable. It's not exact science in many cases.

Malpractice lawsuits being out of control increases health care costs in several ways. Including:

• Higher malpractice insurance rates get passed right along to the patient (or taxpayer, if my rights are being taken by forcing me to pay for other people).
  
• Doctors over treating to avoid liability. MRIs, etc, are expensive.
  
• Doctors being driven out of business by lawsuits, and people not becoming doctors to start with decreases the supply of health care, while demand continues to increase.
  

[Justine+David 218]

The whole infant mortality thing is a huge misnomer in the WHO rankings...I'm a RN in the NICU field (sick/preemie babies). The problem with that particular statistic is that docs and NPs overall aggressively try to save preemies that other countries might not even give a thought to saving. So the stat is skewed because other countries don't count those preemies as live births whereas the US does, hence our infant mortality rate is artificially higher.

There was an article recently about an Australian preemie who was 27 weeks that the health care folks didn't try to save, gave to mom to die, and the mom held the baby for a few hours and was still alive, so they took to the NICU and the kid is now stable, 8 months later. It's not clear from the article exactly what happened, but it's more than standard (by the US) to resuscitate a 27-weeker (the lower end of standard being 23-24 weeks) and they have a decent chance of making it out alive...of course at that point a few hours after the birth without support the kid likely has lots of brain damage, severe chronic health issues, etc etc. since they didn't intervene right away, which is too bad.

That being said...as a RN...YES, the health care system in the US is screwed up. I cheered on the health care bill while my husband grumbled about it being the "most conservative reform possible" and asking why we couldn't have a single-payer system straight off-the-bat. I told him that we had to have baby steps first

oh-and yes, there needs to be reformed laws about suing doctors. It's pretty ridiculous right now...

Edited September 29, 2010 by Justine+David

[VanessaTony 3,567]

There was an article recently about an Australian preemie who was 27 weeks that the health care folks didn't try to save, gave to mom to die, and the mom held the baby for a few hours and was still alive, so they took to the NICU and the kid is now stable, 8 months later. It's not clear from the article exactly what happened, but it's more than standard (by the US) to resuscitate a 27-weeker (the lower end of standard being 23-24 weeks) and they have a decent chance of making it out alive...of course at that point a few hours after the birth without support the kid likely has lots of brain damage, severe chronic health issues, etc etc. since they didn't intervene right away, which is too bad.

That is such a lie. Wow. The baby was DEAD. Efforts to REVIVE him (see that, they DID try and save him) failed, so his mother was permitted to hug and hold him. Here's the article if you'd like to check: http://today.msnbc.msn.com/id/38988444 I am actually really offended that you would state such a blatant lie. If there is another article you're talking about (which I sincerely doubt) please feel free to post it. In the meantime, please check your facts before making slanderous comments. I'm not saying Australia's perfect but ANY infant, of ANY age is given a chance to live in Australia. There is no cut-off. If a baby is born at 16 weeks they will try just as hard as if it was full term.

[SuperDuper! 230]

FYI, Michael Moore is not a reputable source to quote.

[Justine+David 218]

That is such a lie. Wow. The baby was DEAD. Efforts to REVIVE him (see that, they DID try and save him) failed, so his mother was permitted to hug and hold him. Here's the article if you'd like to check: http://today.msnbc.msn.com/id/38988444 I am actually really offended that you would state such a blatant lie. If there is another article you're talking about (which I sincerely doubt) please feel free to post it. In the meantime, please check your facts before making slanderous comments. I'm not saying Australia's perfect but ANY infant, of ANY age is given a chance to live in Australia. There is no cut-off. If a baby is born at 16 weeks they will try just as hard as if it was full term.

http://allnurses.com/nursing-news/dead-premature-baby-500899.html

http://allnurses.com/nicu-nursing-forum/what-do-you-501089.html

At the time of the posting that I had originally read, it was August 27th and none of the original bulk postings go past September 1st. Your article was written/updated September 3rd. If you click on the news stories in the thread, they didn't mention anything about resuscitation but made it sound like they just handed the babe over to mom. When I read it was I was curious and had tried to look for other articles but none had mentioned anything about resuscitation. Somebody in the NICU forum actually looked up a few articles that stated that neos in Australia aren't as afraid of litigation when it comes to deciding resuscitation matters (which is actually a very good thing), which could have helped account for it if they hadn't resuscitated.

There actually is a cut-off for resuscitation according to that one post, and it's at 23 weeks, which is pretty normal. There is absolutely no way that a 16 weeker would ever make it alive and no one would think of ever trying...the world's recorded earliest babies that make it are at about 21-22 weeks and that's not without severe health issues.

If I offended you, I apologize. I think you'll see many people posting in both threads (especially the one posted in the NICU forum where there are many NICU specific RNs) wondering what exactly happened because the articles gives no indication of resuscitation. I am very glad to find out that I'm wrong because this changes the puzzle that was laid before the posters and I will go back and post this article for everyone to review. I am more than happy to have a moderator amend my original posting if you would like as well.

[VanessaTony 3,567]

http://allnurses.com/nursing-news/dead-premature-baby-500899.html

http://allnurses.com/nicu-nursing-forum/what-do-you-501089.html

At the time of the posting that I had originally read, it was August 27th and none of the original bulk postings go past September 1st. Your article was written/updated September 3rd. If you click on the news stories in the thread, they didn't mention anything about resuscitation but made it sound like they just handed the babe over to mom. When I read it was I was curious and had tried to look for other articles but none had mentioned anything about resuscitation. Somebody in the NICU forum actually looked up a few articles that stated that neos in Australia aren't as afraid of litigation when it comes to deciding resuscitation matters (which is actually a very good thing), which could have helped account for it if they hadn't resuscitated.

There actually is a cut-off for resuscitation according to that one post, and it's at 23 weeks, which is pretty normal. There is absolutely no way that a 16 weeker would ever make it alive and no one would think of ever trying...the world's recorded earliest babies that make it are at about 21-22 weeks and that's not without severe health issues.

If I offended you, I apologize. I think you'll see many people posting in both threads (especially the one posted in the NICU forum where there are many NICU specific RNs) wondering what exactly happened because the articles gives no indication of resuscitation. I am very glad to find out that I'm wrong because this changes the puzzle that was laid before the posters and I will go back and post this article for everyone to review. I am more than happy to have a moderator amend my original posting if you would like as well.

Well I didn't really think a 16 week would survive but they would at least run scans etc right? I would hope they'd check..

Anyway no need to amend your OP. I was in a bit of a mood when I wrote my post which I can go back and amend if you like... long story short, baby lived and that's the good thing

[Justine+David 218]

Glad it's all cleared up and I'm actually excited to go over and post that on allnurses--no one could understand what was going on.

I hope he does okay too...early intervention programs as a toddler are probably his best bet now. His family will probably make a humongous difference as nurturing a child early on in those situations has a dramatic effect on their development since the brain's connections are not fully developed--even in a normal newborn. It makes me very happy that they are advocating for him.

To anyone else, my overlying point earlier that has become a little muddled was that other countries when compared to the US don't have to worry about having the bejeebus sued out of them and therefore can act in the patient's best interest in regards to medical interventions. I have argued with young residents (doctors just out of med school) before about how they want to draw unnecessary amounts of blood from babies because they want to cover their you-know-what. Then when the patient's blood levels show that they're anemic because of all the labs drawn (whose results would not have changed the patient's care plan anyway), we need to give blood, which is introducing foreign materials, which carries its own risks and potential complications. UGH.

Because of this culture of sue-happy Americans, doctors run unnecessary tests, keep patients longer in the hospital, and generally give more than what's needed in the patient's situation...therefore driving up costs (take a look at the c-section rates in the US. Some of those are elective c-sections, i.e. the mom specifically requested for it and some are legitimate emergencies, but the rest are questionable whether or not it was medically appropriate. But OB/GYNs are among the highest in the medical field to be sued, so it's hard to blame them when they are in a legitimate fear of their patients suing them).

Edited September 29, 2010 by Justine+David

[Nik+Heather 121]

And yes DR's over treat--as they don't want to get sued! CT scans//MRI's etc for everyone!!

I don't think that would be over-treatment. My father went in to his dr complaining of very real pain around his back. The Dr said that he was getting old, and it was "probably" deterioration, and that he should do some physical therapy before they stepped it up to any sort of CT scan/MRI. There was some thought that the insurance company wouldn't pay for any advanced imaging until other methods had been tried.

I wonder how different things might have turned out for him if they had discovered his Abdominal Aortic Aneurysm 10 days before he went to the emergency room (who got him into the CT scanner in less than 2 hours), and within hours of that into emergency cardiac surgery to fix the now ruptured AAA. Only 6% of people (in the US even!) survive this sort of thing. Wouldn't it be better if he had been able to get that imaging done??

[Kevin- 13]

I don't think that would be over-treatment. My father went in to his dr complaining of very real pain around his back. The Dr said that he was getting old, and it was "probably" deterioration, and that he should do some physical therapy before they stepped it up to any sort of CT scan/MRI. There was some thought that the insurance company wouldn't pay for any advanced imaging until other methods had been tried.

I wonder how different things might have turned out for him if they had discovered his Abdominal Aortic Aneurysm 10 days before he went to the emergency room (who got him into the CT scanner in less than 2 hours), and within hours of that into emergency cardiac surgery to fix the now ruptured AAA. Only 6% of people (in the US even!) survive this sort of thing. Wouldn't it be better if he had been able to get that imaging done??

A great example of the other end of the spectrum. The sad thing is, this will happen with (some/most) insurance companies, but will most certainly happen with the government paying bills as well. Obama's own speeches have subtly indicated that the new health care bill will tend toward exactly this sort of thing.

Reading your story does give new perspective, though. Obviously doctors should ideally not be worried about cost, ever, when choosing diagnosis and treatment methods. But, they shouldn't be greedy either. Without honesty-detectors or thought police, how is it possible to reach a balance? There's always going to be a few dishonest doctors who will make choices based on getting more money, which means there's always going to be bill-payers (insurance/government) which assume all doctors are doing that, which further means that there will always be doctors who are afraid of financial repercussions when choosing what to do.

For me and my family the ideal will be to stay healthy, trust God, choose a top notch medical plan, and put myself in a financial situation where I have no fear of paying extra for something the insurance company won't cover.

[J&N* 68]

Wow!

Many replies...

I just have one thing to say...

http://www.youtube.com/watch?v=oJix3Eqq5Mo

[ria_s 0]

Yes, the best case is to have a job that provides insurance. The medical insurance amount is deducted each week from your paycheck....for example $20 per week. When you go to the doctor you may have to pay a co-pay, maybe $15-20, but everything else is mostly covered. There are many insurance plans, it depends on which ones your company offers and which one you select. It may be a good idea to ask about health insurance when interviewing for jobs. On my insurance plan, if I have a baby, I pay $300 and everything is covered for the baby. I can't comment on Moore, I don't pay any attention to him.

People where I live don't put a lot of stock on the facts he puts out either. Some of it may be true but it's mostly the negative parts that are emphasized or overblown. I know back home if I got sick or had anything done i'd have to pay for everything myself. Here, some portion of it is paid for by somebody else, well yeah you do have premiums and whatnot. But still I think I have pretty good health insurance; my health benefits are pretty good. My plan pays 80% after I meet deductible which is like $500. Of course my premiums might not be low as anybody else's out there but at least it's not outrageous as the ones I've seen on some others, especially online. And especially if you're unemployed or working part-time.

[james&olya 1,121]

Kevin, you indicate you are an adventist in your post. Do you also consider yourself christian? Jesus Christ is reported to have made many statements about the imperative to take care of those less fortunate and yet you seem to be defending a very right-wing point of view that seems to condone having the best medical care YOU CAN PAY FOR!! Is that the adventist version of christianity? By the way, I have reason to know a lot about our health-care 'system'. The criticisms are occasionally off-target but generally quite valid. The insurance industry in our country sucks away a huge number of dollars that would be better spent on actually providing care. They are a big part of the problem! I personally believe in single-payer as the best model, spreading the risk over the entire population and having one, high standard of care for everyone in this country.