No. of Recommendations: 7
Vox is doing a series on countries health care systems. Should be interesting.

First up is Taiwan.

JLC

https://www.vox.com/health-care/2020/1/13/21028702/medicare-...
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The rollout of articles is here:https://www.vox.com/2020/1/13/21055327/everybody-covered
Jan 15-Australia
Jan 17 Netherlands
Jan 21-Maryland-"The Mid-Atlantic state has a payment system for hospitals unlike anything else in the United States: global budgets. By capping payments to hospitals on a yearly basis, the state has strived to incentivize more efficient, higher-quality health care. Some experts think cost containment, not coverage expansion, should be the next step for health care reform."
January 23-UK

No indication that more health care system will be analyzed. Hopefully more systems will be analyzed in February.
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In 2008 Frontline looked at the health care systems in UK, Germany, Switzerland, Japan, and Taiwan.

Well worth watching even now.
https://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/...
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No. of Recommendations: 5
WaPo had an article today that seemed to explain why surgeons wear masks.

The health-care industry is letting surgeons behave like muggers
https://www.washingtonpost.com/opinions/the-health-care-indu...

Then we met the surgeon as I was being prepared to be taken into the operating room. He explained that if he didn’t operate right away, I might get sepsis and die. He also said he didn’t take my insurance but assured us I was in capable hands, as he was very experienced. After asking about our occupations, he announced his fee for my laparoscopic appendectomy would be $15,000. We were stunned by the timing and the amount. Was this supposed to be a negotiation?

Fortunately, my insurance covered all other related hospital costs — the ER doctors and tests, the operating room, medications, the anesthesiologist’s fee — but that still left us with the $17,000 charge from the surgeon. That’s more than seven times the out-of-network, uninsured rate for the hospital’s locale, according to FAIRHealth Consumer.

</snip>


Very interesting. Out-of-network billing based on the patient's occupation. What will the ethically challenged doctor or hospital administrator think of next? <LOL>

intercst
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I liked this from the Australia health system article.

Twelve years ago, she noticed a lump under her arm and went to see a doctor, who ran some tests. When her doctor sat her down to give her the bad news — she was diagnosed with breast cancer — her mom asked which private hospital she should go to for treatment.

No, her oncologist told her. You should use the public hospital. It’ll be easier to coordinate your care across the many people you’ll need to see: oncologists, radiologists, nutritionists. And it will be very inexpensive.

So that’s the route Feldman chose. She still has her private coverage (because with the fines she’d face and the rebate she receives, why not get something?), but she depended on the public sector for the most important medical care of her life.

</snip>


We're seeing that with for-profit Medicare Advantage in the US. People like the fact that the premium is a bit lower than traditional Medicare and a supplement plan, plus you get the "free" Silver Sneakers Gym Membership with Medicare Advantage.

But if you get sick, you find that the out-of-pocket expense with Medicare Advantage is much higher than with traditional Medicare and a supplement plan. Then you realize that Johns Hopkins and the Mayo Clinic isn't "in-network" on the reduced roster of doctors & hospitals Humana wants you to use, but they're the best places for treatment of the rare form of cancer you got.

intercst
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Thank you for recommending this post to our Best of feature.

...

No, her oncologist told her. You should use the public hospital. It’ll be easier to coordinate your care across the many people you’ll need to see: oncologists, radiologists, nutritionists. And it will be very inexpensive.



We've had the same experience in Canada. When a billionaire's daughter had breast cancer the wingnut press in US were reporting she was treated in US to denigrate our public system. She was ... for the cosmetic reconstruction bit after the actual cancer operation was done at a public hospital in Toronto.

Anymouse

https://www.cbc.ca/news/technology/belinda-stronach-speaks-a...
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Australia:https://www.vox.com/2020/1/15/21030568/australia-health-insu......

Just finished reading it and they have the system I'm apt to advocate for - hybrid. But even it is having issues. It is about demographics, young don't need it and don't want to pay for it. The old need it but need the young to be in the pool to keep premiums lower.

JLC
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It is about demographics, young don't need it and don't want to pay for it. The old need it but need the young to be in the pool to keep premiums lower.

Young USians don't "need" Social Security or Medicare, right now, but pay into it. They will need it eventually, and be glad for being in a very large pool that keeps their premiums down.

Show the young people what insurance would cost them when they are old phartz, if they are in a pool of nothing but old phartz.

Steve
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Show the young people what insurance would cost them when they are old phartz, if they are in a pool of nothing but old phartz.

For the majority of young people, long term planning is what to do this weekend. Forty years down the road? Forget about it.

JLC
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No. of Recommendations: 8
Just finished "The Healing of America:A Global Quest for Better Cheaper, and Fairer Health Care" by T R Reid. Reid was the reporter in the Frontline report. Reid headed a news organization in both UK & Japan so had personal experience with those 2 systems. For his book he visited France, Germany, Japan, UK, & Canada. Besides interviewing government but visited with doctors to have them look at his bum shoulder that was broken while serving in the US Navy & screwed together by a Navy doc. His shoulder is stiff but not painful. His range of arm motion is limited though. Reid first had US ortho doc look at his shoulder. The physician indicated a full shoulder replacement could be done but did not recommend it. He got the same advice from the French, German & Japanese doctors. The UK GP doctor said he could refer him to an ortho doc but it would be a 3 month wait. But since Reid could live his life without serious impairment the NHS would not do a shoulder replacement operation. Reid could have it done privately at Reid's expense. Reid couldn't visit with a Canada ortho doc as the waiting period was too long.

One thing I noticed was that France, Germany, Switzerland & Japan utilize private insurers for payment of services. That payment is much swifter than in the US-1 to 2weeks. He reported that France's administrative cost is 5%!

What all the foreign health care systems have in common was that the government negotiated and set pricing for all visits, procedures, tests, hospitalization & drugs. All prices are known. In doctor's offices their are signs & pricing for procedures not covered by their respective governments. So in the countries that utilize private insurers, all the insurers pay the same.

I also noted that malpractice insurance was a tenth of the cost of what US doctors have to pay. And in some nations, the government pays it.

So it is the government negotiating & setting pricing that leads to affordable health care not who is the transfer agent for payment. That in conjunction with low or no cost university education aids in bring down costs as foreign doctors income is half of US compensation. Of course that education ain't free but spread amongst each nation's taxpayers. It is the price those societies impose upon themselves.
I believe that choice was heavily influenced by the 2 world wars europe suffered. Better for government taxes be spent on education & health care than funding large military forces.

Opposing such government intervention here is an array of special interest groups. The Swiss managed to do it. Passing legislation in 1994 & implementing the system in 1996. The Clinton effort was stymied. And the Obama solution did not address cost containment which is the #1 issue IMO. Expanding coverage while not addressing cost put the cart before the horse.
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So it is the government negotiating & setting pricing that leads to affordable health care not who is the transfer agent for payment.

Are you sure?

I note that the US government does not negotiate & set prices for food, and yet there's abundant affordable food.

Only in a few areas of the US does the government get involved in setting prices for housing, and those areas develop housing shortages only a few years after the government gets involved - and primarily in those price ranges where the government is most involved.

The government is not involved in setting prices for computers, and decent cheap computers are available at multiple stores.

What these and numerous other well-served markets have in common, and have in common with health care in France etc. as you describe it, but is DIFFERENT from health care in the US, is that the customer can determine the out-of-pocket cost BEFORE deciding whether or not to buy.
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Reid couldn't visit with a Canada ortho doc as the waiting period was too long.


Which is exactly what almost always happens when you show up with a non-urgent problem. You get put on a waiting list. If you google the waiting list you receive ads from private clinics that will do it much quicker for a price. One clinic told me I could fly to Toronto early morning, get picked up and delivered to their first class facility to have my double hernia repaired, stay one night in their bed and then get taken to the airport to fly back to Halifax the next morning! They never mentioned the price.

Since I had nothing special going on I decided to let my very nice young surgeon (Dr. Watson no less) do the job in Windsor NS (45 minute drive) that bumped me up in the queue from Halifax wait times by about 40 days IIRC.

Tim

http://www.nshealth.ca/
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warrl analyzes,

<<it is the government negotiating & setting pricing that leads to affordable health care not who is the transfer agent for payment.>>

Are you sure?

I note that the US government does not negotiate & set prices for food, and yet there's abundant affordable food.

</snip>


Surely you jest. There are billions of dollars in US Gov't price supports administered by the US Agriculture Dept.

https://www.usda.gov/topics/trade/price-support

intercst
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I note that the US government does not negotiate & set prices for food, and yet there's abundant affordable food.

??

Food is this country is hugely subsidized by the US government, both on the supply side and the demand side. In fact, food subsidies are one single largest discretionary items in the federal budget, dwarfing items like transportation or education.

I have advocated many times on this board and others for reform of these subsidies, mainly because many of them are driven by corruption. But I would never suggest the abundance of food in this country is somehow related to the free market. That's just crazy talk.

But for all the faults of our system including waste and corruption, we no longer have famines. That's generally considered to be positive. But it has very little to do with the free market.
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I note that the US government does not negotiate & set prices for food, and yet there's abundant affordable food.

??

Food is this country is hugely subsidized by the US government


Bring those goalposts back here!
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I note that the US government does not negotiate & set prices for food, and yet there's abundant affordable food.

Food is this country is hugely subsidized by the US government


Bring those goalposts back here!

For example, sugar production is a $2.4 billion industry, but sugar producers receive $1.5 billion in subsidies.

The amount of that subsidy and therefore the consumer price is negotiated.
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For example, sugar production is a $2.4 billion industry, but sugar producers receive $1.5 billion in subsidies.

The amount of that subsidy and therefore the consumer price is negotiated.



What impresses me is that they also subsidize corn (fructose) syrup which is effectively competing with themselves?

Anymouse
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Vox look at the state of Maryland.
https://www.vox.com/policy-and-politics/2020/1/22/21055118/m...

Maryland is the site of two big experiments in containing health care costs. The first: Since the 1970s, the state has set the prices hospitals can charge for medical care, known as all-payer rate setting.

The second experiment: Since 2014, it’s also capped how much health spending can grow overall, including how much revenue each hospital can take in.

These kinds of regulations are common abroad — France, Japan, Switzerland, the Netherlands, and Germany all have some variation of rate setting and set budgets for health care spending. But here in the United States, Maryland stands alone.

Hospitals’ budgets are fixed, as are the rates they can charge for procedures. Once they hit their revenue caps, they don’t make more money on having patients in the hospital — and there is a carrot-and-stick system to ensure hospitals don’t exceed those caps.

Obviously concentrating on preventative is necessary to make such a system work.

Readmission rates at the hospital dropped 26 percent between 2011 and 2018
emergency department visits dropped nearly 20 percent.


The rates Maryland set aren't draconian. Maryland goals are to cut the increase in healthcare costs to 4% increase a year.

There is one big problem with the Maryland system. While Marylanders are paying among the lowest rates for healthcare; their insurance premiums do not decline. Insurers are laughing all the way to the bank. And there is no mandatory coverage requirement in the state.

In France, Germany, & Switzerland insurance is mandatory. And the basic coverage provided by the insurer is required to be on a nonprofit basis. Insurers make their profit on the supplement coverages sold to the public.
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{{Obviously concentrating on preventative is necessary to make such a system work.}}


Why is that obvious? Research has shown that with the exception of vaccines and a few other things, preventative care costs more than doing nothing.
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Why is that obvious? Research has shown that with the exception of vaccines and a few other things, preventative care costs more than doing nothing.

Really?

We've found that just going to a doctor early when you have symptoms without having to worry about costs improves outcomes and reduces costs when they have to send an ambulance.

One of the things my province does is to give insulin to diabetics free for those without private insurance which is far cheaper than sending an ambulance to pick them off the floor of the Mall bathroom?

Tim
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The cost of false positives plus the costs of additional screening.


Preventative care is a good thing. It extends the lives of people. It is however, not a way of reducing costs (with the exceptions of vaccines).
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Why is that obvious? Research has shown that with the exception of vaccines and a few other things, preventative care costs more than doing nothing.

The consequences of not doing preventative health care leads to death & hospitalization that certainly costs more than doing nothing.
A 2004 study showed that about half of all deaths in the United States in 2000 were due to preventable behaviors and exposures.[4] Leading causes included cardiovascular disease, chronic respiratory disease, unintentional injuries, diabetes, and certain infectious diseases.[4]
https://en.m.wikipedia.org/wiki/Preventive_healthcare
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The cost of false positives plus the costs of additional screening.

Yes it can especially when screening tools are used improperly.

https://www.medscape.com/viewarticle/828854
PSA Test Is Misused, Unreliable, Says the Antigen's Discoverer

But is a good revenue generator for the health care provider.
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{{The consequences of not doing preventative health care leads to death & hospitalization that certainly costs more than doing nothing.}}


Some people continue to believe things that just aren't so.

This is one of those lies that has been repeatedly rebutted, but people just keep sticking their head in the sand.

https://www.nytimes.com/2018/01/29/upshot/preventive-health-...
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Here is a fairly well researched article that has a good chart summarizing data.

https://www.niskanencenter.org/the-role-of-prevention-in-hea...


Take a look at the chart entitled "Distribution of cost effectiveness ratios for treatment and prevention interventions."


Less than 20% of all preventive medicine interventions reduce costs. 80% increase costs. Now, some of those preventive interventions that increase costs also increase the life years of people, so may be well worth it.

However, this study identified some preventive measures that require over $1 million dollars in order to increase life by one year. And some preventive measures cost money and decrease health overall.

This is a good tell. If someone claims increasing preventive medicine will reduce costs, they do not know what they are talking about.
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Regarding benefits of preventative health care, well,

IT ALL DEPENDS!

On what is meant and included in preventative health care and how it is done.



Sure as hell worked for me and my family and saved us a hell of a lot of money and misery.

In the Spanish health care system preventative is examined treatment or educational campaign or whatever rather carefully on a cost benefit basis. When combined with reasonable social solidarity the payoffs are clearly part of why their healthcare is quite good for the cost....

David fb
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