Healthcare Education and Q&A Thread

[Schneed10]

Originally Posted by dmek25

sorry Joe, but they have to be accountable. if not, Dr.s all of a sudden turn into weathermen. really doesn't matter if they are right or wrong. and contrary to popular belief, there is a such thing as a bad doctor

To that point though, by paying for malpractice insurance, they've essentially removed any financial incentive to avoid mistakes.

It's not like they have to be accountable under the current system; if they screw up their insurance carrier foots the bill. So under a capped system, the insurance premiums paid by doctors would be lower, and there would be no change in penalties felt by the doctor in cases of malpractice.

A loss of license would be effective, but I'm not even sure you need that. Doctors already try their damndest to avoid mistakes for fear of scaring all of their patients away. I wouldn't want to put any more pressure on them, they already practice costly defensive medicine as it is.

When you're trying to avoid malpractice suits, you tend to order more tests and procedures than is truly necessary. The rash of malpractice suits is partly responsible for healthcare expenses being as high as they are; we simply don't always need the tests doctors order. I'd rather not put anything in place that would make them any more defensive.

[JoeRedskin]

Fair points to an extent. The key of course is "sued successfully" , malpractice is a very difficult case to prove. Bad doctors do not necessarily lose lawsuits. In the WC situation, the question is not "did the doctor screw up", it is "was the patient harmed" - big difference. I understand your point about the similarities to 3 Strikes. At the same time, a doctor who causes harm and does so on a consistent basis - even if he causes harm w/o committing malpractice - is not one who should be practicing. A balance would have to be struck. What the balance is, I am not quite sure.

[djnemo65]

Thanks for lending us your expertise Schneed. It is often remarked that the United States spends more per person than any other country in the world on healthcare yet gets less, consistently ranking near the bottom of major industrialized countries in independent international surveys. First of all, do you think these rankings are fair? Second, do you think it would be possible to expand coverage to the unininsured without substantially increasing taxes or cutting other government spending? It seems that other countries are able to get more coverage for considerably less money.

Finally, I know that you have been critical of Obama's healthcare proposals in the past. Does this mean you advocate the status quo? If not, what specific changes would you like to see implemented by congress?

[Schneed10]

Originally Posted by djnemo65

Thanks for lending us your expertise Schneed. It is often remarked that the United States spends more per person than any other country in the world on healthcare yet gets less, consistently ranking near the bottom of major industrialized countries in independent international surveys. First of all, do you think these rankings are fair? Second, do you think it would be possible to expand coverage to the unininsured without substantially increasing taxes or cutting other government spending? It seems that other countries are able to get more coverage for considerably less money.

Finally, I know that you have been critical of Obama's healthcare proposals in the past. Does this mean you advocate the status quo? If not, what specific changes would you like to see implemented by congress?

Cost-wise, a few things in particular separate us from other countries:

Malpractice
Other countries don't allow civil suits to result in large payments to victims of malpractice. Hence our docs pay a ton more in malpractice premiums than do docs in other countries.

Cost of Living
Cost of living in the US is way higher than most industrialized nations. Since healthcare is so labor-intensive, it is unfair to compare per-capita spending on healthcare from one country to another without adjusting for cost of living or wage index.

I'd like to see the surveys you're speaking to be able to comment further as to their fairness. I'd be particularly interested to see how they're determining that we "get less." Does that mean we have shorter lifespans? How the heck do you measure that?

We have shorter lifespans because we're fat, not because our healthcare sucks!

[firstdown]

If I'm correct I think my buddy said he pays 85,000 a year for malpractice ins. and it might have been even more than that.

[BleedBurgundy]

Originally Posted by firstdown

If I'm correct I think my buddy said he pays 85,000 a year for malpractice ins. and it might have been even more than that.

Wow. I wonder if that's the average, or if your buddy has a habit of amputating the wrong limbs.

[firstdown]

Originally Posted by BleedBurgundy

Wow. I wonder if that's the average, or if your buddy has a habit of amputating the wrong limbs.

MY buddy said he has only been sued once and he admitted that in that case he did make a mistake but that was like 8 years ago. He is the guy they call in to put you back together after a bad accident and he also has a practice which specializes in sports injuries. He does the emergency type stuff because he likes that type of work and he jokes by saying motor cycle riders paid for his house.

[Schneed10]

Originally Posted by firstdown

MY buddy said he has only been sued once and he admitted that in that case he did make a mistake but that was like 8 years ago. He is the guy they call in to put you back together after a bad accident and he also has a practice which specializes in sports injuries. He does the emergency type stuff because he likes that type of work and he jokes by saying motor cycle riders paid for his house.

Sounds like an Orthopedic Surgeon. They suffer one of the higher malpractice premium rates, probably second highest to obstetricians.

Our Orthopedic Surgeons get paid about $350,000 plus incentives, and then the Medical School pays for their malpractice coverage, about $60-$70K per doc on average. $85K does not sound unreasonable, the only reason our medical school docs have a lower premium is because they're getting a "group rate" of sorts.

Obstetricians deal with about $100K apiece.

Malpractice costs aren't some buzzword or hot button issue; it's a serious problem.

[firstdown]

Originally Posted by Schneed10

Sounds like an Orthopedic Surgeon. They suffer one of the higher malpractice premium rates, probably second highest to obstetricians.

Our Orthopedic Surgeons get paid about $350,000 plus incentives, and then the Medical School pays for their malpractice coverage, about $60-$70K per doc on average. $85K does not sound unreasonable, the only reason our medical school docs have a lower premium is because they're getting a "group rate" of sorts.

Obstetricians deal with about $100K apiece.

Malpractice costs aren't some buzzword or hot button issue; it's a serious problem.

Yes Orthopedic Surgeon is right I just could not think of what he was called when making the post. I'm sure he makes around that figure himself but I'll have to say the guy puts in alot of hours and works hard for every penny he makes.

[djnemo65]

Here's a pretty detailed analysis of the WHO's most recent survey (from a few years ago, which ranked us 37th). PR-2000-43/ WORLD HEALTH ORGANIZATION : ASSESSES THE WORLD'S HEALTH SYSTEMS Looking online it seems like a lot of people have criticized the methodology of this particular ranking, so I'd be interested to hear your take.

Your first observation makes sense but I can't find any information online suggesting that the US has a high cost of living relative to other industrialized nations. Are you sure about this? Speaking anecdotally, it has been my experience from traveling that the cost of living - or at least the cost of things I buy like food and beer - is way higher in other industrialized countries than the US, and I am including Japan, Germany, France, England, Spain, and the Netherlands on this list. Speaking from experience I can tell you that Japan is significantly higher than the US pretty much anyway you measure it. Most information online ranks cities instead of countries (usually putting NYC around 20th in the world) but here's one I found ranking countries across several categories, with the US being pretty average in every category Cost of Living Index By Country

So anyway, while cost of living might explain how Colombia ranks higher than us, unless I'm missing something I really don't think it's true that the US has a high cost of living relative to the EU and the most developed Asian countries.

[Schneed10]

Originally Posted by djnemo65

Here's a pretty detailed analysis of the WHO's most recent survey (from a few years ago, which ranked us 37th). PR-2000-43/ WORLD HEALTH ORGANIZATION : ASSESSES THE WORLD'S HEALTH SYSTEMS Looking online it seems like a lot of people have criticized the methodology of this particular ranking, so I'd be interested to hear your take.

Your first observation makes sense but I can't find any information online suggesting that the US has a high cost of living relative to other industrialized nations. Are you sure about this? Speaking anecdotally, it has been my experience from traveling that the cost of living - or at least the cost of things I buy like food and beer - is way higher in other industrialized countries than the US, and I am including Japan, Germany, France, England, Spain, and the Netherlands on this list. Speaking from experience I can tell you that Japan is significantly higher than the US pretty much anyway you measure it. Most information online ranks cities instead of countries (usually putting NYC around 20th in the world) but here's one I found ranking countries across several categories, with the US being pretty average in every category Cost of Living Index By Country

So anyway, while cost of living might explain how Colombia ranks higher than us, unless I'm missing something I really don't think it's true that the US has a high cost of living relative to the EU and the most developed Asian countries.

I'll take a close look at that survey and weigh in.

On cost of living, the question really is what to doctors and nurses get paid in those other countries. I am under the impression it's less, though admittedly I'm not certain; I know a lot more about our healthcare system than I do that of other nations.

[dmek25]

you say other countries do not allow civil settlements in doctors error. what happens in those countries when mistakes are made?

[Schneed10]

Originally Posted by dmek25

you say other countries do not allow civil settlements in doctors error. what happens in those countries when mistakes are made?

Don't know, I guess that would be a legal question. I wonder if any lawyer types know what the deal is in other countries.

[Schneed10]

Came across this article, thought it a very worthwhile read. It presents both sides' views on the Canadian healthcare system.

Reality check: Canada's government health care system - CNN.com

The realities are:

- Canada does have a longer life span and they spend less on healthcare. This does not at all mean you can conclude they have a better healthcare system, because A) they're not nearly as obese as the US and B) their docs & nurses make less than ours and their patients exhibit lower healthcare utilization.

- Access to care is restricted due to a shortage of physicians and an overabundance of citizens with healthcare coverage. If you're in shitty shape, with a brain tumor or something, you'll get seen swiftly. But if you're just dealing with something painful, like a knee replacement, you've got to wait 3 months. This results in lower healthcare costs because many people say 'ya know what, screw it, seeing a doctor isn't worth it.' In other words, Canada's lower healthcare spend is not so much due to lower costs, it's due to simply not going to the doctor.

This speaks to the issue we began trying to define in this thread: what does "quality" healthcare mean? Is it good enough to provide a balance between life-saving treatments, coping with pain as you wait for non-life-saving treatments, and lower costs? Or like everything else in the world, will we Americans demand more? Ask yourself, are you OK with waiting 3 months for a procedure to replace a hip or knee?

If we demand more, we better be ready to pay for it.

[saden1]

For those interested where the overall national healthcare expenditure went and where it came from you might be interested in this chart produced by the United States Department of Health and Human Services.