The Club takes on Healthcare - Free Market Style

hardhat said:

Doog_de_Jour said:

creepycoug said:

hardhat said:

creepycoug said:

hardhat said:

1to392831weretaken said:

https://www.youtube.com/watch?v=h4rg-DJBd34

I think it's difficult to discuss this because so many people refuse to even entertain the idea that the U.S. healthcare system isn't the gold standard in the world. All they hear is how we get the best care in the world, so changing the system would result in a lower standard of care. I don't understand how anybody could look at the data and come to that conclusion, though:

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I think it's best to separate the quality of care vs how we pay for it. I don't think anyone would argue that most hospitals deliver quality outcomes. I don't think it's a secret that when a wealthy person from another country on one of those charts needs emergency heart surgery that they come to the USA for it. There's obviously a problem when someone goes bankrupt due to medical bills though.

I'm watching the Crown on Netflix. I get most of my information from Netlfix and pendantically pass it off as my own knowledge.

Anyway, Churchill's Foreign Sec'y, Anthony Eden, is in the US meeting with someone, and he's having severe pancreas issues and needs surgery. Wants to do it in Boston because it's the best place in the word for that surgery. But not because of capitalism. He says to Churchill, he says, "because of the high fat diet in the US"; so we're good at fixing things caused by being like @CFetters_Nacho_Lover and @CfettersNachoLover . According to the pasty Brits.

So, I wonder, but don't necessarily know or believe, if we're good at some things and other countries are good at other things. Are we good at some medical technology because of the nature of our demographics and not because of the system? IDK. Maybe it doesn't matter.

Anyway, thought I'd throw some causation analysis in for fun.

Interesting point. I chortled at a brit mocking any other country for their diet. In the UK, I also think mr. pancreatitis would have had to wait his turn for his procedure. Or maybe if he was a bigwig he could have jumped the line.

I don't know about the fat content, which I'd guess is just as bad; but the fucking taste and the things they eat ... JFC those people can't cook.

The royal family apparently eschews garlic. Literally forbidden in the Buckingham palace kitchen. Hey Britty, try it sometime. It might make your disgusting food taste a bit better.

Anyway, I digress.

We’re all having big belly (YSWIDT) laffs in the press room about diet, but this another example of what I’m talking about with challenges that the US faces that, until recently (because we?ve exported American fast food), is obesity and diet.

I know it’s fashionable on this bored to make fun of fat people, but it is a very real problem for many that leads to other serious conditions and ultimately drives up the cost of healthcare.

Again, I have no clue how to solve it. But that’s another layer of complexity to the issue.

Good point about obesity. No easy solutions, and I want to enjoy my food and my god given right to mock fatties, but there are some better approaches:

...only about 3.5% of the population is classified as obese, compared to rates as high as 30% or greater in countries like the U.S. And it's not just a generally healthier diet and lifestyle that's kept the Japanese trim.

Citizens must adhere to government-mandated waistline limits or face consequences. The government has established waistline limits for adults ages 40 to 74. Men must maintain a waistline at or below 33.5 inches; for women, the limit is 35.4 inches. The "metabo law" went into effect in 2008, with the goal of reducing the country's overweight population by 25% by 2015. The government's anti-obesity campaign aims to keep "metabolic syndrome" — a number of factors that heighten the risk of developing diabetes and vascular diseases, such as obesity and high blood pressure, glucose and cholesterol levels — in check, thus minimizing the ballooning health care costs of Japan's massive aging population.

https://www.mic.com/articles/84521/japan-has-cut-obesity-to-3-5-in-a-controversial-way-that-wouldn-t-fly-in-america

That approach might work in Japan, that is more homogeneous in make up and culturally puts a high emphasis on not straying to far from the norm. Plus they’re less reliant on cars (walk more) and have mostly higher quality, more nutritious food.

I didn’t mean to derail this topic into how to fight obesity, by the way. Again, I just think whatever is done with healthcare needs to work (at least in the short term), within an *American* framework.

Doog_de_Jour said:

hardhat said:

Doog_de_Jour said:

creepycoug said:

hardhat said:

creepycoug said:

hardhat said:

1to392831weretaken said:

https://www.youtube.com/watch?v=h4rg-DJBd34

I think it's difficult to discuss this because so many people refuse to even entertain the idea that the U.S. healthcare system isn't the gold standard in the world. All they hear is how we get the best care in the world, so changing the system would result in a lower standard of care. I don't understand how anybody could look at the data and come to that conclusion, though:

/>

I think it's best to separate the quality of care vs how we pay for it. I don't think anyone would argue that most hospitals deliver quality outcomes. I don't think it's a secret that when a wealthy person from another country on one of those charts needs emergency heart surgery that they come to the USA for it. There's obviously a problem when someone goes bankrupt due to medical bills though.

I'm watching the Crown on Netflix. I get most of my information from Netlfix and pendantically pass it off as my own knowledge.

Anyway, Churchill's Foreign Sec'y, Anthony Eden, is in the US meeting with someone, and he's having severe pancreas issues and needs surgery. Wants to do it in Boston because it's the best place in the word for that surgery. But not because of capitalism. He says to Churchill, he says, "because of the high fat diet in the US"; so we're good at fixing things caused by being like @CFetters_Nacho_Lover and @CfettersNachoLover . According to the pasty Brits.

So, I wonder, but don't necessarily know or believe, if we're good at some things and other countries are good at other things. Are we good at some medical technology because of the nature of our demographics and not because of the system? IDK. Maybe it doesn't matter.

Anyway, thought I'd throw some causation analysis in for fun.

Interesting point. I chortled at a brit mocking any other country for their diet. In the UK, I also think mr. pancreatitis would have had to wait his turn for his procedure. Or maybe if he was a bigwig he could have jumped the line.

I don't know about the fat content, which I'd guess is just as bad; but the fucking taste and the things they eat ... JFC those people can't cook.

The royal family apparently eschews garlic. Literally forbidden in the Buckingham palace kitchen. Hey Britty, try it sometime. It might make your disgusting food taste a bit better.

Anyway, I digress.

We’re all having big belly (YSWIDT) laffs in the press room about diet, but this another example of what I’m talking about with challenges that the US faces that, until recently (because we?ve exported American fast food), is obesity and diet.

I know it’s fashionable on this bored to make fun of fat people, but it is a very real problem for many that leads to other serious conditions and ultimately drives up the cost of healthcare.

Again, I have no clue how to solve it. But that’s another layer of complexity to the issue.

Good point about obesity. No easy solutions, and I want to enjoy my food and my god given right to mock fatties, but there are some better approaches:

...only about 3.5% of the population is classified as obese, compared to rates as high as 30% or greater in countries like the U.S. And it's not just a generally healthier diet and lifestyle that's kept the Japanese trim.

Citizens must adhere to government-mandated waistline limits or face consequences. The government has established waistline limits for adults ages 40 to 74. Men must maintain a waistline at or below 33.5 inches; for women, the limit is 35.4 inches. The "metabo law" went into effect in 2008, with the goal of reducing the country's overweight population by 25% by 2015. The government's anti-obesity campaign aims to keep "metabolic syndrome" — a number of factors that heighten the risk of developing diabetes and vascular diseases, such as obesity and high blood pressure, glucose and cholesterol levels — in check, thus minimizing the ballooning health care costs of Japan's massive aging population.

https://www.mic.com/articles/84521/japan-has-cut-obesity-to-3-5-in-a-controversial-way-that-wouldn-t-fly-in-america

That approach might work in Japan, that is more homogeneous in make up and culturally puts a high emphasis on not straying to far from the norm. Plus they’re less reliant on cars (walk more) and have mostly higher quality, more nutritious food.

I didn’t mean to derail this topic into how to fight obesity, by the way. Again, I just think whatever is done with healthcare needs to work (at least in the short term), within an *American* framework.

It's an important point because obesity is a leading factor for heart disease, diabetes, and cancer. And in the US this approach is not helping:

hardhat said:

I think it's best to separate the quality of care vs how we pay for it. I don't think anyone would argue that most hospitals deliver quality outcomes. I don't think it's a secret that when a wealthy person from another country on one of those charts needs emergency heart surgery that they come to the USA for it. There's obviously a problem when someone goes bankrupt due to medical bills though.

I think the quality of care in the USA vs. other countries is often overstated. Take your example of emergency heart surgery: For starters, it's probably not that big of an emergency if there's time to travel abroad to get on the operating table... But also, there are plenty of countries with cardiac clinics that rival the best in the USA. I went looking for top rated cardiac clinics in the world, and it turns out that it's hard to find real data. The USA tends to dominate the tippy top of the list, but only on lists that are based off of things like positive reviews. What I wanted to see was hard data on outcomes, but I didn't have time to keep looking. There are cardiac centers in Germany, the UK, Japan, Isreal, etc. that are world class. If rich people are coming to the USA for treatment, it's probably because the USA is good at letting rich people pay $100K cash for a surgery and skip to the front of the line. Agree on your last sentence, though. Last I heard, medical bankruptcy is a thing that exists only in our country.

Doog_de_Jour said:

I am going to skirt dangerously to Tug talk here, but the fact that the US is not only footing the in pharma but in things like biomedical devices is definitely problematic. We might not have the best standard of care, but we’re still the best in scientific/medical research. That research ain’t cheap and the cost has to be passed on to somebody.

That’s why when people start comparing the US healthcare system to other countries, I get a little upset. There are some very unique problems that the US has to deal with that other countries do not. It’s fine to look to these places for ideas, but trying to replicate Canada or anyone else probably won’t work.

DawgsCanDance said:

Summary: our health care provider network has the greatest access to technology available, and also the highest profit generating basis of operation on the planet ~ no wonder it doesn't profile like any other health care system ~ the entire basis of operation is fundamentally different.

To these last two, I also think the notion that the USA is king shit of turd mountain when it comes to R&D and technology is also very overstated here. Unfortunately, I don't have time to find data that breaks down R&D spending in specific fields like medical research, but the OECD, World Bank, etc. track gross R&D spending for all nations as a total (USA #1!), percentage of GDP (USA #10 behind countries with public medical systems like Isreal, South Korea, Sweden, Japan, Switzerland, Austria, Germany, Denmark), and per capita (#2 behind South Korea). Per capita is interesting, too, as it's fair to ask the question: In the USA, we pay so much more per capita for our medical care, so how far down the list would we be once you subtract the premium we pay over even the next most costly medical system? Well, we wouldn't even be on the list, as our premium over Switzerland is larger per capita than the highest per-capita cost of R&D on the whole list.

Let's just look at this practically, too. Whiz bang medical research and technology is worthless if only the rich can afford to use it. When I separated my shoulder and wanted surgery, I asked for an MRI so I could be referred to a surgeon. I was told I had to do six weeks of physical therapy first on a broken wing before that was an option. In Japan, your family doctor would have an MRI machine in his office. You'd walk down the hall and climb in. There is one such machine in my entire county.

Doog_de_Jour said:

We’re all having big belly (YSWIDT) laffs in the press room about the fatty shit Americans eat, but this another example of what I’m talking about with challenges that the US faces and other nations don’t (well, until recently as we?ve gotten very good at exporting fast food), is obesity and diet.

Doog_de_Jour said:

I didn’t mean to derail this topic into how to fight obesity, by the way. Again, I just think whatever is done with healthcare needs to work (at least in the short term), within an *American* framework.

But that's the thing. America faces challenges other nations don't because we're too stubborn to fix things. Deregulation and muh freedoms are the greatest virtue here, and people are perfectly happy to suffer just to stick it to the man. In the USA, we don't prevent disease and the underlying conditions, we treat these conditions in the emergency room once they've become 100 times costlier. Fixing healthcare "within an American framework" is an oxymoron.

Doog_de_Jour said:

BleachedAnusDawg said:

My plan is all people who have medical conditions due to being obese or smoking, etc get no help from taxpayers. Costs of everything go down for people who try to lead a decent lifestyle. Leave the fat people to the churches.

We must not forget about people who use pot, have unprotected sex, drink alcohol, do extreme sports, don’t floss, etc.

I get where you’re coming from, we do have to have some accountability in all of our own individual healthcare. But until there’s better access to preventative care and address some of things in America that contribute to a sedentary lifestyle (for example) I don’t think punishing people will work.

Many of those things are examples of things you can use in moderation and not have issues. Being obese leads to a cascading effect of conditions. If you're going to subsidize obese people they should be on a policy of "hit these weight loss targets or lose your care."

Unprotected sex would probably be a net positive right now given the birth rate is at a historic low and we're having to import more labor than ever.

HoustonHusky said:

I'd argue there are several concepts being grouped together here that are separate. The US by far has the best health care system when you have something wrong...in identifying it and in treating it. You have cancer and you will likely have it diagnosed here before anywhere else. You have money and cancer you come to the US for treatment. You are an average Joe and tear up your knee you would much rather be here than anywhere else in the world.

US system is shite for preventive/proactive treatment...you are overweight instead of paying more insurance and losing weight we'll give you a pill.

Well said. If our healthcare system was a football team we’d be tearing it up on offense and special teams, but our defense sucks.

Divorce healthcare from employment. It's fucking absurd.

I hate hr people.

Here's a csb from Norway:
Relative of mine in her 70s hurt her shoulder skiing, needed surgery. Didn't have to wait too long. Surgery was botched, leaving her in even more pain. She had to wait for nearly a year to get the surgery to fix the mistake. During that time she couldn't ski or do other things she enjoyed doing. Two years later she died of cancer.

I have no axe to grind with Norway, the women are pretty, the air is clean, it's a great place. The healthcare system seems fine to me. It's just that there are tradeoffs.

hardhat said:

Here's a csb from Norway:
Relative of mine in her 70s hurt her shoulder skiing, needed surgery. Didn't have to wait too long. Surgery was botched, leaving her in even more pain. She had to wait for nearly a year to get the surgery to fix the mistake. During that time she couldn't ski or do other things she enjoyed doing. Two years later she died of cancer.

I have no axe to grind with Norway, the women are pretty, the air is clean, it's a great place. The healthcare system seems fine to me. It's just that there are tradeoffs.

Another CSB:

Kid I know is 15 years old and buckle-tears his meniscus playing freshman football. Has arthroscopic surgery, fast recovery, spent the night at a friend's house the same day watching Monty Python movies. Great outcome.

One year later, other knee blows out. Surgeon who did a great job on the first knee is booked out nine months, so he goes with a different surgeon who's available in a month. Wakes up from surgery with a giant soft cast from groin to halfway down the foot. Cooling pouch fed by an Igloo cooler that could be raised to circulate icewater inside the cast and wrapped around the knee. He couldn't get off the couch except to piss or shit for two weeks, and the trips to the bathroom included extreme pain. Immobilizer brace for a month, re-learn how to walk, three months before even a light jog was possible. Turns out this kid was knocked out on the operating table, the surgeon went in with the scope, looked at the knee, and said, "Hey, this looks like a perfect candidate for trying out that new procedure I learned at the conference last month. The one where we suture the tear through the scope instead of just cutting the flap out."

First time this kid gets hardly touched on a football field--six months after what should have been a simple arthroscopic surgery--his knee explodes again. Surgery number three, at sixteen years old. Football season starts in three months, so once again no time to wait for the surgeon who seemingly did a great job on the other knee. This time, it was back to the butcher for another round. Once again, it's knock-out time, surgeon goes in, cleans up the tear... "You know, it felt like there might have been something behind the patella. Let's cut a fourth hole, another through the patella, and have a look behind there."

Kid wakes up again with yet another groin to foot Igloo cooler immobilization device. The hole in the patella made the swelling ten times as worse and doubled the recovery time. Tons of pain, feeling of no stability. Had to rush recovery, and it was only two weeks prior to the junior season starting that he could finally sprint. Dives on and recovers an onside kick in the first game of the season.

*pop*

There was plenty of time to wait for the doctor who fixed the first knee to finally clean up the other.

This all happened in the United States. The country with the greatest doctors, technology, and standard of care in the world, right? Be careful with small sample sizes.

Pitchfork51 said:

Divorce healthcare from employment. It's fucking absurd.

I hate hr people.

The Throbber is not employed. (But his wife who carried the Cadillac plan is - and she'd bolt her job in a heartbeat if it wasn't for the fucking bennies, not the least of which is the health insurance).

What I did see during my six hour ER debacle - there's a lot of fucking fat people in this country. Not, kinda sorta could use to lose 10 pounds....OBESE FAT PIGS. And there are a fuck ton of crackhead drug addicts.

Perhaps if we attacked those two items alone, we'd see a massive improvement in the healthcare system and homelessness.

1to392831weretaken said:

hardhat said:

Here's a csb from Norway:
Relative of mine in her 70s hurt her shoulder skiing, needed surgery. Didn't have to wait too long. Surgery was botched, leaving her in even more pain. She had to wait for nearly a year to get the surgery to fix the mistake. During that time she couldn't ski or do other things she enjoyed doing. Two years later she died of cancer.

I have no axe to grind with Norway, the women are pretty, the air is clean, it's a great place. The healthcare system seems fine to me. It's just that there are tradeoffs.

Another CSB:

Kid I know is 15 years old and buckle-tears his meniscus playing freshman football. Has arthroscopic surgery, fast recovery, spent the night at a friend's house the same day watching Monty Python movies. Great outcome.

One year later, other knee blows out. Surgeon who did a great job on the first knee is booked out nine months, so he goes with a different surgeon who's available in a month. Wakes up from surgery with a giant soft cast from groin to halfway down the foot. Cooling pouch fed by an Igloo cooler that could be raised to circulate icewater inside the cast and wrapped around the knee. He couldn't get off the couch except to piss or shit for two weeks, and the trips to the bathroom included extreme pain. Immobilizer brace for a month, re-learn how to walk, three months before even a light jog was possible. Turns out this kid was knocked out on the operating table, the surgeon went in with the scope, looked at the knee, and said, "Hey, this looks like a perfect candidate for trying out that new procedure I learned at the conference last month. The one where we suture the tear through the scope instead of just cutting the flap out."

First time this kid gets hardly touched on a football field--six months after what should have been a simple arthroscopic surgery--his knee explodes again. Surgery number three, at sixteen years old. Football season starts in three months, so once again no time to wait for the surgeon who seemingly did a great job on the other knee. This time, it was back to the butcher for another round. Once again, it's knock-out time, surgeon goes in, cleans up the tear... "You know, it felt like there might have been something behind the patella. Let's cut a fourth hole, another through the patella, and have a look behind there."

Kid wakes up again with yet another groin to foot Igloo cooler immobilization device. The hole in the patella made the swelling ten times as worse and doubled the recovery time. Tons of pain, feeling of no stability. Had to rush recovery, and it was only two weeks prior to the junior season starting that he could finally sprint. Dives on and recovers an onside kick in the first game of the season.

*pop*

There was plenty of time to wait for the doctor who fixed the first knee to finally clean up the other.

This all happened in the United States. The country with the greatest doctors, technology, and standard of care in the world, right? Be careful with small sample sizes.

Think this isn’t a US thing...there is a wide distribution of competence in every single job/career and if you blindly let somebody do surgery on you...you should expect a distribution of results.

Had my right ankle rebuilt 3-4 years ago...tore it up from decades of soccer. First doctor I went to told me about a new procedure they had where they remove all the cartilage and regrow new cartilage, wouldn’t be able to put pressure on it for 6 months, and wanted to know when I wanted to schedule it. Told him thanks, left, and then found the doctor who works on the Texans and set up an appointment with him. Took 3 months to get in, but he thought the first guy was nuts and ended up fixing my ankle.

In Europe they regulate to reduce the crazy experimental surgeries, but you also are regulated/limited against doctor-shopping to find the best doctor for you if you are smart enough to do it. There is no perfect system...pluses and minuses to everything.