Healthcare Education and Q&A Thread

[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?

[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.

[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!

[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.

[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]

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.

[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.

[Schneed10]

Originally Posted by firstdown

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.

There's a nationwide shortage in Orthopedic Surgeons, and for good reason. It's hard as hell to be skilled enough to do it, malpractice is high, and the hours are a bitch (especially for trauma sub-specialists like your buddy). He probably gets paged in the middle of the night to put people back together.

Even non-trauma sub-specialties like Hand, Joint Replacement, Spinal Fusion, they all take incredible skill. Hard to make it as an orthopedic surgeon.

[firstdown]

Originally Posted by Schneed10

There's a nationwide shortage in Orthopedic Surgeons, and for good reason. It's hard as hell to be skilled enough to do it, malpractice is high, and the hours are a bitch (especially for trauma sub-specialists like your buddy). He probably gets paged in the middle of the night to put people back together.

Even non-trauma sub-specialties like Hand, Joint Replacement, Spinal Fusion, they all take incredible skill. Hard to make it as an orthopedic surgeon.

Yes he does get paged at all hours of the night and that's why we wonder why he puts himself through that when his sports medcine practice does very well. He says he just likes the challange that comes with trama cases. With the sports thing he does alot of joint replacement stuff and its kind of cool because his son is a sales rep selling replacesment joints.

[Beemnseven]

Here's another question -- with a finite supply of doctors, and no more than the usual number of new med students entering the field, what will it mean to instantaneously add 47 million Americans to their workload?

[Schneed10]

Originally Posted by Beemnseven

Here's another question -- with a finite supply of doctors, and no more than the usual number of new med students entering the field, what will it mean to instantaneously add 47 million Americans to their workload?

First, it should be noted that those 47 million you're speaking of (the uninsured) currently do get care in the form of emergency care. If they have a heart attack they don't stay away from the ER.

But on the elective and preventative side, you're right, docs will see a huge influx. With no increase in the supply of capable physicians, but a large increase in demand, you'll see prices for appointments going up significantly. You'll call to request an appointment for this week and will be surprised when they tell you they don't have an open appointment for 3 weeks.

You'll also see physicians move about the country. When those 47 million people become insured, suddenly having a physician practice in the inner city isn't such a bad proposition. Physicians will relocate to fill voids in underserved locations, fleeing from now well-insured but competitive locations.

Short answer: things get a lot better in the poor neighborhoods, but a lot worse in the well-to-do neighborhoods.