It’s been a while since the last time was putting the defenders of “our World’s best HC system” out of their misery, ever since the TP died :-( . Here I prepared a new yummy treat for you. Enjoy!

One measure of the health of Americans—deaths from treatable conditions—still does not compare well with rates in other industrialized countries.

E. Nolte and M. McKee (Measuring The Health Of Nations: Updating An Earlier Analysis. 2008. Health Affairs 27(1): 58–71) compared trends in Age-Standardized Death Rates (SDRs) per 100,000 considered amenable to health care between 1997–98 and 2002–03 in 19 industrialized (OECD) countries.

France ranked first with 65, USA last with 110. The study makes a breakdown of SDR by specific condition. For example, SDRs from Surgical Conditions and Medical Errors in France was 3.96 compared to 6.83 in USA.

The decline in amenable mortality over the study period in all countries averaged 16%. The United States was an outlier. Starting from a relatively high amenable mortality level (115, ranked #15 in 1997) it experienced the smallest progress with a decline of only 4 percent (ranked #19 in 2003).

From the preceding discussion of potential limitations of the study, it is difficult to disregard the observation that the data reflects comparatively poor performance of the U.S. health care system rather than the cultural or demographic differences. The slow decline in U.S. amenable mortality has coincided with an increase in the uninsured population.

The findings presented in the paper are consistent with other cross-national analyses, demonstrating the relative underperformance of the U.S. health care system in several key indicators compared with other industrialized countries. For example: C. Schoen et al., U.S. Health System Performance: A National Scorecard, Health Affairs 25 (2006): 457–475. In this study the authors estimated that if all states of USA achieved HC level seen in the best-performing state in the Union, premature deaths rate would still falls short to achieve levels of amenable mortality seen in the three top-performing countries of OECD.

Did I mention that HC spending per capita in Frence is 1/2 of that in the US?

Warning to cons: for every truckload of bullshit that you’ll make on the go and voices in your head, I have a pile of research published in respectable peer reviewed scientific journals. So, please, don’t embarrass yourself as usual.

Thank you, thank you mountain4!!

The perception you create with these stats is two-fold: 1) Our system excludes too many people, and 2) the HC actually provided is not that good to begin with; at least when compared to France and other developed countries.

I agree with the point that too many people are being excluded due to the costs involved in accessing the system. I can see that the HC reformers (all sides) are looking for ways to get more people covered.

However, assuming the HC itself is so sloppy and studded with ineffective procedures and protocols, what will adding 40,000,000 to the patient list do to improve the care? What, if anything do either side propose that would actually improve qualify of care (mostly in hospitals) and the number of primary care providers i.e. family docs, internists, nurses, PA’s, etc?

We need a Health Care system, not an Illness Management system.

Having worked as a doctor/resident in Germany, France and the US, I want to comment that individual care in the US is quite good, but riddled by too many superfluous procedures and prescription drugs. However, I am deeply skeptical by the Inst. of medicine famous "100 000 preventable deaths due to med. mistakes" study, and others have raised good reasons.

What needs to be done, universal coverage or not (of course I am for UC), is to take the unethical financial incentive from proceduralists docs (IMHO, no doc needs to make more than 400-500K, and most should be between 200 and 300) - and the number of superfluous surgery and procedures will decline automatically. In other words, adjust the fee schedule!

I am not proposing anything. I am raising awareness about the problem. Two points I am making:

1) Stop fooling ourselves that the system is fine and the best in the world, just because we are America and whatever. I hear this nonsense from too many people, regular teabaggers and presidents alike.

2) Experience of other countries is here to learn valuable lessons rather than to smirk arrogantly.

Any attempt to reform the system in this country WILL fail unless a considerable number of people will stop being so ideologically driven, misinformed and just dumb ass arrogant.

traugott

Thanks for adding to the discussion. It sounds like your experience gives you much better insight into those three systems than most of us on this site.

How would you propose to remove the "unethical financial incentives" from proceduralist docs (I assume you mean surgeons and the like?)

Performing unnecessary procedures is different than ordering unnecessary procedures, right?

If my doc orders too many MRI’s, X-rays, etc. I would assume he or she is practicing that form of medicine called defensive medicine to CYA in the event the unexpected happens and the lawyers get fired up; as opposed to padding her own bottom line.

The other is a different issue if doc so-and-so performs more hysterectomies than are actually needed; therefore padding his or her own income. Not defensive in many cases, just financial?

It would seem that some form of tort reform might help, at least in the longer-run after attitudes change, by removing the threat of unwarranted big awards. But in the latter situation I think you have to rely on case reviews and statistics to determine nefarious motives?

I don't know enough about socialized medicine to comment on it, and I consider myself to be Independent politically, but I can't help but notice on almost all of the Slate message boards that it is almost exclusively left-wing posters who result to being vulgar and calling the political right arrogant or ignorant (and not the other way around). This is really not going to help bring others to see your point of view, and often only leaves the poster appearing arrogant or lexically ignorant. I'm not saying it's all liberal posters, but the ones who do resort to this generally are.

Dirtybird, I think you hit the neail on the head with defensive medicine and financial incentives causing most unneceessary tests (overutilization). I would add a third factor: patient preference. A lot of patients want to always see pics or a lot of test results because they feel that that is what a thorough doc does.

My suggestion is: adjust the medicare reimbursement (private insurance will likely follow in a parallel pattern, on a higher level). Docs in a procedure get like 1.2 to 2 times the money you get for evaluating a patient (in other words, if a 1 hour consult is reimbursed with 200 bucks, a cardiologist doing an angioplasty taking the same time gets something like 300 (exact rate depending on risk and training needed for the procedure in question).

That would easily save billions and improve outcomes. Of course that proposal would create a shitstorm from proceduralist docs (not all specialists are proceduralists) and the AMA.

It should be easy to find out about Medicare, RR.

I'll add one simple line to this thread;

Health insurance is not health care.

Dirtybird, I agree with you except for tort reform. California has capped awards for malpractice for several years now but the malpractice premiums paid by doctors haven't gone down. Capping awards can only work if premiums are capped as well.

traugott:

Let's say I'm an "Interventionalist," and you arbitrarily say that no one deserves to be paid more than you. I tell you that every time I stick a needle or knife in someone, I must weight the risk:benefit ratio first for the patient, and then myself. Does the risk to help this paitent with my procedure outweigh the potential liablility for my actions? I see 2 outcomes by your proposal:

1. I put off doing any procedure as long as I can, since I'm gonna get paid up to a certain amount anyway, no use going out of my way, and maybe a little PT/OT on that shoulder wouldn't hurt (see Canada, GB). You saved billions, but how has this improved outcomes? And what about "customer satisfaction", when that "damned doctor didn't do shit for me?"

2. If I want to pay my office staff, I'll have to do as many procedures as possible, since you pay me like shit. When I hit my peak reimbursement, see Option1. You could save billions, but at what price, and how does this improve outcomes?

I hope my cardiologist does not work for you; his skill is worth more than $300 to screw with my LAD.

Dok von Box

Dok, I wrote that no doc should make more than 400-500 K (and BTW, did neither reveal or discuss my own income), and most should be in the 200-300 range. If you call this income "shitty", you reveal all about your priorities and values ... there is nothing to add. Except that very many procedures are superfluous and do not improve incomes, at least not with the liberal indication policies of many money motivated colleagues, as you probably know. But I agree that patient satisfaction is a problem - a lot of patients want "something done", even though it may be nonsensical.

Tragott I take mild umbrage with your comment about nonsensical desires of patients. “Watchful waiting” is one prescription for prostate cancer, but many patients can not handle knowing they have a potentially fatal tumor growing in them without wanting to do something. I would suggest that patient peace of mind is an important part of any treatment and if a physician advises something they should be able to convince the patient that it is the right course, even if it advises doing nothing.

traugott:

The incomes you propose are actually in line with the realities today. Most physicians who have been around make in the 200K- to 300K range, while there is a large portion that make in the $150K to $200K range, very few make beyond the $500K. An interesting data point would be to know how many physicians that really represents (how many represent that 1% or so vs. the demoninator). The ones in the upper register have certain skill sets that I believe command that level of reimbursement, save for the "businessman" who treats patients like a commodity; on this we agree. You also know that for any of the docs, none are sitting on their asses catching money from the sky.

As for "shitty income", I don't have to tell you how many patients one must see 80 hours/week to keep the pace represented above, which is why most docs in that pay bracket would call it quits if they could. Jiffy Lube changes your oil in 10 min for $30. That comes to $180/hour, pay the guy, I dunno, $20/hour, after parts, rag, insurance, you are still >$100/hour earned, 40hr/week payroll.

Hence, once I've peaked at my reimbursibles, why would I take on any new patient, take any call, etc.?

Since you've worked in the European model, could you tell us how much time off physicians allow themselves during the year? Do they get "holiday" like everyone else?

Once they've decided how much we can make, will they regulate how much McKesson, GE, Olympia, etc. can charge for their products, since that's our overhead? Rent control/mortgage rate control for the office? How about General Mills, Kellogs, DelMonte, Shop Rite, HEB, Publix, Pathmark regarding how much they can charge for food?

Dok von Box