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Richard Matthews
(food) - F

Locale: Colorado Rockies
US Health Care on 07/06/2009 15:39:35 MDT Print View

Suggestion on how to start an uncomfortable conversation:

Should people receive a discount on medical insurance for signing a standard living will, aka advance medical care directive?

A living will that is motivated by the desire to retain dignity and privacy is very good policy. I am very uneasy about living wills signed to receive a medical insurance discount.

A high percentage of health costs are in the last six months of life. An uncomfortable discussion, but necessary.

I am looking forward to universal health coverage.

Likely we will end up with a three tiered health care delivery system.

When you visit an emergency room now one of the first things they do is secure your personal items. That allows them to perform the medical procedure that has the most impact on your treatment -- the billfold biopsy. I know a law firm that gives their clients a laminated card for their wallet. They keep a lawyer on call and 24/7 will fax the HIPPA, medical POA, and living will.

The top tier will be for celebrities, athletes and the wealthy. Universal care will not pay for Pam Anderson/Priscilla Presley surgery. We will never see NFL players on Monday in line to have MRIs. Included in the mix will be people with flex spending accounts that desire dental implants, braces, lasik surgery, and many other procedures that are not covered under the universal plan.

The middle tier will be the equivalent of a medicare beneficiary with supplemental health and long term care insurance. Unions are no longer relevant unless they can move their members into the middle or upper tier. Employers that currently provide health insurance will probably provide the insurance to move their staff into the middle tier.

The bottom tier will allow hospitals to retain their tax exempt status because the difference between the usual billing and the payment is considered charity medical service.

There is a huge cost savings by eliminating the bureaucratic redundancy. Health insurance, worker's compensation and auto medical payments could all be consolidated into one plan. No more litigation over who pays what medical bills.

I assume the current health insurance companies will administer the plan under contract. This would be a good contract for Halliburton.

Personal injury lawyers and chiropractors will continue to make their living in court from “soft tissue” injuries.

Once there is universal coverage maybe the focus will be cost cutting and not cost shifting.

Arapiles .
(Arapiles) - M

Locale: Melbourne
Re: Health care systems on 07/07/2009 08:24:25 MDT Print View

"In my view, as British, I have to say that I think the NHS is about as good and egalitarian a health care system as is possible while the US system is appalling and frightening. Of course the NHS isn't perfect but it's better than any alternative."

Hi Chris

I lived in London in 2006/2007. I'm not sure how to put this politely, but I think that there are better alternatives than the NHS and I'd dispute the "good" assessment. One of the reasons we cut short our stay in the UK was the appalling medical care my family were exposed to in London. Some examples: just before we left Japan to move to England the Japanese ultrasound technicians picked up that my three year old daughter had 3mm gall-stones, they suggested that we check them again in London. When she eventually got an appointment in London the ultrasound technician couldn't find her gall-bladder let alone determine if the gall stones were any bigger. One night my son had a 38/39 C temperature but there was not a hospital in London that could take him, nor a paediatrician available anywhere I rang. The people at the emergency number we then rang suggested that we loosen his clothing. I ended up getting Calpol from a service station and hoping it wasn't a meningicocal infection.

My secretary was off work sick for a week on one occasion: when she came back I asked her what she'd had - she didn't know because she'd been unable to get a doctors appointment. She'd just stayed at home and hoped for the best.

In the last three years we've lived in Japan, Australia and the UK. All three countries have national health systems but the UK was clearly the worst (Japan clear first, Australia second). Where we lived in Tokyo - by no means the centre of the city either - we had 4 hospitals within one km, including a newly built and wonderfully equipped childrens hospital. I could see a specialist on any day without an appointment - although I might have to wait a while.

The NHS was innovatice and idealistic when it was set up but the truth is that it's just not delivering.

Edited by Arapiles on 07/07/2009 08:25:47 MDT.

Lynn Tramper
(retropump) - F

Locale: The Antipodes of La Coruna
Re: Re: Health care systems on 07/07/2009 18:53:31 MDT Print View

Japanese health care:

Inspired by D W's story, I read up a little on the Japanese health care system. very impressive. For instance this article:

Japanese Pay Less for More Health Care

Japan produces cars, color TVs and computers, but it also produces the world's healthiest people. It has the longest healthy life expectancy on Earth and spends half as much on health care as the United States.

That long life expectancy is partly due to diet and lifestyle, but the country's universal health care system plays a key role, too.

Everyone in Japan is required to get a health insurance policy, either at work or through a community-based insurer. The government picks up the tab for those who are too poor.

It's a model of social insurance that is used in many wealthy countries. But it's definitely not "socialized medicine." Eighty percent of Japan's hospitals are privately owned — more than in the United States — and almost every doctor's office is a private business.

Health Care for Anyone at Anytime

Dr. Kono Hitoshi is a typical doctor. He runs a private, 19-bed hospital in the Tokyo neighborhood of Soshigaya.

"The best thing about the Japanese medical system is that all citizens are covered," Kono says. "Anyone, anywhere, anytime — and it's cheap."

Patients don't have to make appointments at his hospital, either.

The Japanese go to the doctor about three times as often as Americans. Because there are no gatekeepers, they can see any specialist they want.

Keeping Costs Low

Japanese patients also stay in the hospital much longer than Americans, on average. They love technology such as magnetic resonance imaging; they have nearly twice as many scans per capita as Americans do. A neck scan can cost $1,200 in the United States.

Professor Ikegami Naoki, Japan's top health economist, explains how Japan keeps MRIs affordable.

"Well, in 2002, the government says that the MRIs, we are paying too much. So in order to be within the total budget, we will cut them by 35 percent," Ikegami says.

This is how Japan keeps cost so low. The Japanese Health Ministry tightly controls the price of health care down to the smallest detail. Every two years, the health care industry and the health ministry negotiate a fixed price for every procedure and every drug.

That helps keep premiums to around $280 a month for the average Japanese family, a lot less than Americans pay. And Japan's employers pick up at least half of that. If you lose your job, you keep your health insurance.

An Accommodating Insurance System

Japanese insurers are a lot more accommodating than their American counterparts. For one thing, they can't deny a claim. And they have to cover everybody.

Even an applicant with heart disease can't be turned down, says Ikegami, the professor. "That is forbidden."

Nor do health care plans covering basic health care for workers and their families make a profit.

"Anything left over is carried over to the next year," Ikegami says. If the carryover was big, "then the premium rate would go down."

Perhaps Too Cheap?

So here's a country with the longest life expectancy, excellent health results, no waiting lists and rock-bottom costs. Is anyone complaining?

Well, the doctors are. Kono says he's getting paid peanuts for all his hard work.

If somebody comes in with a cut less than 6 square inches, Kono gets 450 yen, or about $4.30, to sew it up.

"It's extremely cheap," he says.

Kono is forced to look for other ways to make a yen. He has four vending machines in the waiting room. In a part of Tokyo with free street parking, he charges $4 an hour to park at his clinic.

The upside is that virtually no one in Japan goes broke because of medical expenses.

Personal bankruptcy due to medical expenses is unheard of in Japan, says Professor Saito Hidero, president of the Nagoya Central Hospital.

Hospitals Hit Hard

But while the patients may be healthy, the hospitals are in even worse financial shape than the doctors.

"I think our system is pretty good, pretty good, but no system is perfect," he says. "But 50 percent of hospitals are in financial deficit now."

So here's the weakness: While the United States probably spends too much on health care, Japan may be spending too little. In a country with $10-a-night hospital stays, prices just aren't high enough to balance the books.

Hospital prices too low? That's a problem a lot of countries would like.

Arapiles .
(Arapiles) - M

Locale: Melbourne
Japanese health system on 07/09/2009 06:02:39 MDT Print View

Hi Lynne

On the flip side, we found that you could also get really dodgy doctors in Japan - one diagnosed dandruff as nits ...

However, the system came through when we needed it to: our oldest daughter was born 13 weeks prem when we were up in the country visiting my wife's family. Not only did the local base hospital have a brand new NICU it actually had a foetal care unit! Our son had been in NICU in Australia so we had a direct comparison. The care in the Australian public hospital was great, but the equipment was aged, whereas everything in the Japanese hospital was new and state of the art (it's worth pointing out that the hospital was in the process of being rebuilt at the time and the old hospital dated from the austere 1950s so wasn't flash, just very clean and filled with high-tech equipment) - the Japanese must have spent tens of billions on new hospitals in the last 5 years.

Anyway my daughter was 850 grams at birth, dropped to 790, got superb care and exited the hospital 4 months later at 3.2 kg. There was an American couple who had a baby there from the same night and didn't have Japanese health care, so their US health insurer was paying the bills. At one point the insurer (or the parents?) wanted to take their son back to Tokyo - the doctor in charge of the unit told them "we don't discharge premature babies". The idea of sending home a baby that needed an oxygen drip was unthinkable to them but is I understand often the case in the US.

Chris Townsend
(Christownsend) - MLife

Locale: Cairngorms National Park
Health care systems on 07/09/2009 06:11:58 MDT Print View

DW, I've never lived in or near London and I do know that health care does vary across NHS Boards. I would not be impressed with the NHS if I'd had your terrible experience. But mine is completely different. I've been in hospital four times in the last 20 years, twice as emergencies, and treatment has been excellent every time. The local GP Practice is also excellent. I have no experience of other health care systems so I can't compare but as I have no complaints about the NHS they could only be as good. My family and friends have mostly had similar experience of the NHS as myself. Of course it's not perfect but I can't imagine any system could be. Sometimes things will and do go wrong. But it is a system that is free at the point of delivery for everyone - something, like most Brits, I believe in strongly.

Lynn Tramper
(retropump) - F

Locale: The Antipodes of La Coruna
Re: Japanese health system on 07/09/2009 14:05:05 MDT Print View

"On the flip side, we found that you could also get really dodgy doctors in Japan - one diagnosed dandruff as nits ..."

Well, yes, I wasn't gonna bring it up, but my brother lived for 7 years in the Tokyo metropolitan area, and he (and his Japanese wife) basically got nothing but dodgy doctors until they started seeking out western trained docs. I guess if you pay peanuts...Some of the newer hospitals may be top notch, but caveat emptor when it comes to choosing who to go to. Sounds like you might have been lucky having your daughter born close to a modernised hospital. Same has happened here in my town. We used to have a really scummy old maternity hospital until a few years ago. They built a brand new state-of-the-art one and thus the standard of care has risen dramatically. If you're daughter had been born here before the new hospital was built, I'm sure you would have had a similarly negative impressgion of our health care system. We now have two modern maternity and children's hospitals to serve a population of four million. In theory this is good coverage, but our population is sparsely scattered, and if you live far away from one of these fine hospitals and need urgent care, you might think the health system has failed you. I would disagree!