Every time i read a story about American Health care i am reminded how absolutely broken that system is. - written by someone who is not american

x1000 ...

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I can't quite tell if you're mad at your doctor, yourself, Cologuard, or your insurance company - perhaps all of the above.

A Google search will quickly show that while more convenient there are higher rates of false positives with Cologuard. Also, it's very clear that a positive (real or false) Cologuard result will necessitate a follow-up colonoscopy.

Glad to hear you're ok but it seems ther's plenty of "blame" to go around:

Doctor - for failing to take into account your full history
Yourself - for taking the "easy way" out and not fully researching the consequences and being better informed
Insurance company - for some really crappy (pun-intended) coverage
Cologuard - for the false positive and for generally selling this as the "easy way"

I love to blame people for not taking responsibility, but in this instance, I don’t think you can blame the OP. You go to an MD for medical advice. You should not have to Google and form your own opinion (although I do).

I'm mad at my doctor mostly. If you're a professional recommending tests, you should be more aware of possible consequences... I'm mad at myself for not educating myself. However, I was not aware of the issues going in, and would honestly have gone the traditional route if those potentialities were presented. It may seem like the easy way out, but being told by a trusted professional that this is "now the way to go" is persuading.

My Dr. is no longer a trusted professional :>)

I hope others may read about this situation and are able to make better decisions than I was.

I think the real takeaway here is that folks should know you are allowed "1" test for this to be paid by insurance. In a way it makes sense, so best to take the more accurate one first and foremost.

And that is not something your doctor would know, and if did, probably communicate it to you. So many companies with so many different rules, just not in this wheelhouse to know these things.

Had you known that one thing, all the other stuff would not have been a factor. Unless you doc is a marathon runner himself, why would he know more than you would about possible blood in stool? When it comes to athletes and their peculiar physiologies as compared to the general population, most docs won't know what those are. How many times do we go in and have to tell all the nurses and docs not to worry about our 30+ heart rates??

If you had a doc that was well versed in athletes and that was his speciality, then it would be bothersome you were not warned..

Monty,

Good points!!

RE: the DR. knowing of blood in the stool, I learned of the blood stool issue by experience, and also visited this doctor immediately after it occurred to be sure there was nothing sever going on!!! He probably didn't remember....

In my running group, there are two physicians. They were aware of the issue, both the false negatives and the non-coverage for the necessitated second test. By the way, they no longer suggest this as the "way to go".

As a general rule I'm pretty skeptical of all "trusted" professionals. I try to do at least a little bit of research just to make sure there's nothing out there I should be aware of - "trust but verify."

Btw, have you double check with your insurance company what the doctor said about coverage? It might be worth looking into.

Out of curiosity I thought I'd see how my company's insurance plan would deal with something similar. As best I can tell both would be covered and there's nothing in there that would prevent it. The Cologuard would be covered under the "Preventative Care Services" portion of the plan 100% regardless of deductible. The colonoscopy would be covered at 80% (after deductible) under the Diagnostic Scopic Procedures section.

In my running group, there are two physicians. They were aware of the issue, both the false negatives and the non-coverage for the necessitated second test.//

There you have it, maybe time to switch to one of your running buddies!! Doctors that do sport somewhat serious are the best for guys like you and me. Unlike a coach who may or may not have been an athlete, I think this is important for our health issues...I lost my 35 year sport special doc about 6 years ago, and have had a hell of a time replacing him. Have a young guy at the moment that I'm trying to train, but there are few doctors that know more that I do about athlete "special needs". (-;

I agree that the American Health system needs to be improved, however, let me be the first to say I am grateful I have access to it as I got to race this morning because I still have my health and fitness after having been diagnosed and treated for prostate cancer and melanoma. Because of our health system I was diagnosed early for both diseases and received "world class" treatment which resulted in a positive outcome. Yes, there is much to be improved, but when you get the big "C" diagnosis there is no other country that I rather be treated in that the good old capitalistic US of A!

Yes, there is much to be improved, but when you get the big "C" diagnosis there is no other country that I rather be treated in that the good old capitalistic US of A!




Glad to hear you caught it early, and the docs were able to help you. And you are right, if you are insured(not one of the 30 million that are not) you are in pretty good shape here. But I think that 30 million is the rub that most people have, they would not have your outcome in this country where you enjoyed its benefits..

I blame mostly the insurance industry for finding loopholes to not pay.

Tests and non-funded procedures are newer for men, but women have been up against this for decades. Get a questionable or false-positive reading on a mammogram? Well, guess what?? Docs will advise for more frequent or repeat testing, all while not being covered by insurance. You can get the other boob tested on a regular schedule but the questionable reading on the other is now out of pocket.

The list goes on.

Sorry to hear about this. I'm in the town where Colorguard was created by Exact Sciences and have considered the test now that I'm in the AARP club.

Maybe I'll just drink the koolaid and pass out for a few hours.

Logella,

You are correct. At the point of the testing I had no medical expenses to go towards my deductible. Thus the full charge. I didn't go into all the details in my original post.

By the way, the Cologuard test was approximately $695 if out of pocket as compared to the $1300 for the colonoscopy.

I wonder what the insurance companies prefer.......

This ^ x another 1000

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http://en.wikipedia.org/...eoesophageal_fistula
http://en.wikipedia.org/wiki/Cerebral_palsy
2020 National Masters Champion - M40-44 - 400m IM
Canadian Record Holder 35-39M & 40-44M - 200 m Butterfly (LCM)

I did the Cologuard test this summer. I felt bad for the UPS guy at the counter, "Here's my shit - in a box!" A little awkward but at least $700 better than drinking "the mix" and sitting on the toilet for 24 hours. The test came back fine, I have the GI tract of a 25 year old (but alas the prostate of a 66 year old).

I'm a bit torn with the whole medical profession: my dermatologist is kind of a dick but he finds all the bad stuff early and has great surgical skills so I put up with him.
My old GP pronounced me fit as a fiddle on my yearly exam 2 years ago - I had complete heart failure that afternoon and was "mostly dead" like the Dread Pirate Roberts. Off to the ER...
My Cardiologist is a saint, he and my NEW GP are totally awesome. I get to talk and they listen without interrupting.

All of this is now paid for by Medicare and my $300 a month AARP supplement plan. Other than my premium there are no out of pocket expenses for anything, anywhere, with any doctor in the country. The stress reduction is amazing, I wish every American could experience it and vote accordingly for Universal Healthcare.

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"They know f_ck-all over at Slowtwitch"
- Lionel Sanders

Not just American, there are times when i go the dentist or opticians in Canada and i feel like an ATM. Fortunately it doesn't bother me to call them on this and it's normally rolled back.

So. I am an American and am wondering what the 'correct' next step would be (from an insurer POV) following the cologuard positive test. They won't pay for the confirmatory 'traditional' colonoscopy, as I inferred from the OP's description. So, what, then? Exploratory bowel surgery to look for the cologuard positive tissue? Or...what...exactly? I'm not being a dick, I'm trying to understand since I'm a nearly 58 y/o guy with a clean colonoscopy about 5 years ago and expecting to have the same option presented to me pretty soon...

Just to be clear, the second test is probably covered but not as a scheduled "well person" type test. If you've already met your deductible then they would pay at least a portion of your colonoscopy. Of course no matter what you pay, you really don't have much choice in the matter now that you have a positive Cologuard test. You pretty much have to keep going forward. The colonoscopy although more invasive is the gold standard for sorting out your lower GI. While they are looking around they can take samples for more exact tissue testing. Rectal cancer is not to be fucked with. Good luck, the odds are still in your favor for a clean bill of health.

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"They know f_ck-all over at Slowtwitch"
- Lionel Sanders

Thank you for the heads-up!

We still don't have universal pharmacare or dental yet but we have it pretty good. My youngest child has pretty severe CP and we'd be living in a shack if we were American with all her care and equipment.


BTW

"have fun storming the castle"

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___________________________________________
http://en.wikipedia.org/...eoesophageal_fistula
http://en.wikipedia.org/wiki/Cerebral_palsy
2020 National Masters Champion - M40-44 - 400m IM
Canadian Record Holder 35-39M & 40-44M - 200 m Butterfly (LCM)

Careful what you wish for with Universal Healthcare.
The concept is great but I don’t know of any country where the actual application of it works where the patients are happy and well cared for.

My current example of this is my father - a 70+ man in the UK that has been employed all his life and paid into the system.
For the past three months he has been suffering from a debilitating loss of strength in his arms, legs, and hands - this has resulted in his quality of life suffering and affecting his mobility. Well after multiple visits to the doc who initially blew it off as just aging has now agreed that an appointment is deemed necessary with a senior consultant (UK NHS terminology for a specialist). Guess how long he has to wait just to see this specialist for the initial appointment - 20 fucking weeks........ during which he is supposed to just deal with not being able to perform day to day normal functions.

Last year my mum had a lump in her neck that affected her ability to swallow - again took 12 weeks to see the senior consultant.

The US healthcare system may be screwed up but let’s not pretend that the universal healthcare model (NHS in the UK in my personal examples) should be held up as this wonderful alternative. I’ve lived within both systems and neither model seems sustainable/preferable as they actually function.

Yes, had the test a year ago, but was negative. Thx for posting, because I will have to check insurance options when I decide to test again.

The lesson I am taking from this (well... one of them) is that when it's my time for this (and it will be soon), I should probably insist on the full colonoscopy and say no to any suggestion of Cologuard. Yeah a hell of a lot less pleasant but at least I'll know the first time and won't have to pay extra.

Lived in Germany for 5 years. Germans will complain loudly when not happy. Never heard a German complain once about quality of or access to healthcare. Not once.

US is a distant last in most healthcare metrics. Only thing it fares well in is interventionist medicine - where there's profit to be made. That's what you get when you apply capitalism to healthcare. You also get CEO of United healthcare making $66m income.

I asked my Dr about Cologuard, and he recommended against it for that very reason = false positives

"You're gonna have to go in anyway"

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"What's your claim?" - Ben Gravy
"Your best work is the work you're excited about" - Rick Rubin

The lesson I am taking from this (well... one of them) is that when it's my time for this (and it will be soon), I should probably insist on the full colonoscopy and say no to any suggestion of Cologuard.//

Well there are even more reasons to go down this road first. Us guys over 50/60/70, there is a good chance of a polyp, and they can at the same time just snip it off. No extra procedure, and if something else looks funky, then a cut and test too. Just seems to me that the quick easy test is really not there yet, and just causes more headaches than it is supposed to avoid..I have had 4 colonoscopies now, one with a polyp, so that is the way I will be going..At least until they perfect that tiny camera you swallow, and just let it go for a ride while filming the whole trip!! Talk about non invasive, except for picking it out of your you know what of course )-;

No need for that if they can build in a WiFi chip, connect it to an app (PoopStream) and then broadcast it back to the doc. If we can have a camera on our doorbells we can certainly have this too.

I took the Cologuard test two weeks after an Ironman and it was negative so it certainly isn't a given that hard training will cause positives. My doctor recommended the test and he has a bunch of Ironman finishes to his credit.

It's probably worth looking into but I would trust my doctor's opinion before a story on the internet. We have no idea how common that result is.

I assume you have never had to get in as a new patient to a specialist in the US. Every time I see someone comment like this I go back to my wife. Needed a hip replacement, unable to sleep, walking with a cane, referred to the surgeon in early February, appt with surgeon in mid-May, surgery performed end of October.

You don't get to walk in tomorrow to a specialist in the US, you have to wait, just like a lot of other countries.

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I'm beginning to think that we are much more fucked than I thought.

You don't know the half of it. Astronomical bills are probably known to you. That we are at an arbitrary whim of insurance companies is too. What the rest of the world probably doesn't know is that we get multiple bills for the same procedure / same visit, and the bills come 4-8 weeks after the visit. There's no way to know ahead of time what we are going to receive. One bill, or 3-4 bills from 3-4 different directions. This person could get his $1,200 bill as expected, pay it let's say, and then get a bill for $150 from nurses, and $100 from the hospital, and then another week later a bill for $15,000 from anesthesiologist because that is not at all covered. It is fucked up beyond belief.

The story of my life. Due to several pre-existing conditions (several of which I was born with), I have been uninsurable my entire adult life. The only insurance I've ever been able to get is whatever group plans were offered by my employers, and some of those were virtually worthless. I just last week finally paid off surgery I had to rebuild my left leg after an accident in 2005, which the insurance refused to cover because I was "in my mid-40s, and didn't need to do anything anymore"...

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"I'm thinking of a number between 1 and 10, and I don't know why!"

As a physician myself, I can guarantee you he did not remember. Electronic medical records (EMR) have put a large block between patients and doctors (and other healthcare workers). Before EMR, I could recall so many details about my patients.....family members being ill, last procedures performed, visiting grandchildren, etc... Now that we are required to use EMR, I truly do have a very hard time remembering the "little thing" about my patients, and will commonly ask "did I do so and so procedure on you 6 months ago?" It's a bi embarrassing but it's the way of the world with medicine right now.....and it's going to get worse.

As far as your doc's advice is concerned, YES he should have told you "if this comes back positive, you will need a colonoscopy". Also, he most likely had knowledge that some people could face a rather large bill if they need a colonoscopy afterwards so, if i was your doc, I would feel obligated to share that with you as well so you could make an informed consent.

I wish everyone had universal healthcare but I do not wish for a universal healthcare system. We already have a perfect example of universal healthcare in the US and it's called the Veterans Administration (VA). The VA is one of the biggest bureaucracies that has ever existed in our government. I can attest to this as a medical professional who has trained in, and worked withthe VA, as well as my father being a patient at several. In order to make sure the veterans are being properly cared for, in a timely manner, the VA has had to rely on the private medical sector to a large degree. Before congress passed laws mandating the vets receive coverage within 30 days, it could take months to get a patient in for surgery. I would try to refer a patient back to the VA for cataract surgery and would be told "it'll be 4 months before we can get him in for an appointment". I could refer him to a private ophthalmologist and have the procedure done in two weeks. The cataract surgeons have almost NO incentive to take care of a large volume of patients......they pretty much get paid the same whether they do 4 cataract surgeries or whether they do 10 cataract surgeries. There's already a shortage of specialists in almost every field. You go to a universal healthcare system, and you will see wait times go thru the roof unless there is a private option to bail the system out.

100% agree with ya. Even with me being a physician, I get these different bills and shake my head at the absurdity of it all. I have no clue how the "average joe" can comprehend what is occurring. My wife had knee surgery and she gets a bill from the surgeon, the hospital, the radiologist, the anesthesiologist, the nurse anesthetist, and so on. Sometimes, you get a bill saying "this is how much it all costs and this is how much you owe", and this can be before insurance has paid anything at all. So after insurance has paid, then you get another set of bills saying "insurance has paid this, so now you owe X".

Our entire healthcare system makes me sick as well, but I have no clue what to do about it because it is so complex. Right now, insurance companies have way too much power, and continue to be a thorn in the side of both physicians and patients.

Unfortunately, all of us think that due to the FDA and other entities that the days of voodoo, witchcraft, snake oil salesmen, and leeches are gone. Nope.

No single policy says that profit cannot be the driving factor for providers or insurance companies.

When you have a profit driven system, you see more of this.

I won’t go further into politicking about it, but these days if it isn’t a basic office visit or basic pharmacy purchase.....I ask for a quote on what it’s gonna cost me. And how it goes against deductibles and such.

I’m very happy it’s only your wallet that got lighter.

Just always be on guard asking for quotes. Call your insurance carrier before anything more than an office visit.

It sucks it is that way, but have to protect you r health and wallet.

 

It's complex by design, do you think all those companies sending astronomical bills to each other care about complexity? No, that's how they make money and pay their CEO 66 mil per year. It's a well rooted ecosystem with a "to big to fail" defense from the financial industry, fear mongering from their political lackeys and resignation from the medical professionals who really just want to practice good medicine. A medical "Deep State" if there ever was one.

The only way to fix it is to make it simple. Stupid simple. Remove the multiple layers, remove the for profit capitalism, fix prices and use personal and corporate taxes to pay for it. Also include a hefty budget for exposing fraud because we Americans love screwing the government and then complaining that government doesn't work. (/rant)

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"They know f_ck-all over at Slowtwitch"
- Lionel Sanders

I wasn't holding up the US system as this wonderful example of efficiency and economy - rather that when people decry the US system and extol the virtues of "universal healthcare" it seems to me that they look at it through rose tinted glasses. Both systems are broken and both systems currently fail the patient. Further, I don't believe it is the actual principal behind either system rather it is the inept implementation of each system.

I wish everyone had universal healthcare but I do not wish for a universal healthcare system. We already have a perfect example of universal healthcare in the US and it's called the Veterans Administration (VA). //

What about medicare, or the coverage that our politicians get?? Seems most of those folks are pretty happy with what they are getting. I agree the VA is completely broken, isn't there some talk of rolling that into medicare??

In my case it was a two days from the primary care doctor to the specialist. Then it was two days between that specialist to another, and one day to the one that actually specializes in my diagnosis (Multiple Myeloma). My health care insurer covered all of that with the usual deductible, which I maxed out a couple months later so I had about 6 months of zero deductible service. All told the care that I received in 2017 was very prompt, very expensive, and way beyond anything I had ever even thought of before being diagnosed. All told, I only had to deal with $5K out of pocket expenses for more than $600K in treatment costs, so I cannot complain.

The reason for longer waits in other specialties is the low number of doctors in those specialties. Those shortages are usually regional, a long wait in St. Louis might not happen in Tampa, FL for age related care. In my case it was cancer care, which has gotten MUCH better nationwide over the last 20 years.

I know the problem very well. I'm funded by the National Cancer Institute and have several grants for colorectal cancer screening.
The issue is really at the insurer level at this stage. Not your physician.

Currently, the US Preventive Services Task Force recommends 3 possible methods for screening, all at the different frequencies, because there is no clear evidence that one is better than the other, for the overall population (does not apply to higher risk folks, e.g. folks with early onset colorectal cancer in their family history, folks who are obese etc.) So, basically you can choose, with your physician, which test to you. Now some insurers like to not have to pay a colonoscopy.
They have to though because it's rated A by USPSTF. So what they do is if you test positive with cologuard (which has a sensitivity of 92% and specificity of 87%, which are actually pretty good and much better than previous FIT/FOBT tests) then they argue that the follow up colonoscopy is not a screening test but a diagnostic test, and therefore, not covered.

One more reason for a public option and not have that man in the middle system with people getting rich denying claims...

Both of them had and have the option of going to a private consultant. If they can't afford it, then they wait and have it for free in the NHS.
In the US, they wouldn't have an option and would still have to deal with the BS private insurers put our friends here through and more.

So, forget about "happy" - what's the better system?

There is no "free" on the NHS - this is a system that you pay into throughout your working life. People have paid for this healthcare coverage but when it fails its patients your solution is to pay a second time for a service that you have already paid for. For what its worth my dad is trying to go the private route because he can afford it - but many can't.

I have said in other posts that I don't claim that either system (US or UK) is functioning better than the other - they both are failing their patients - so don't hold one system up over the other as being a shining example over the other.

What is wrong with a goal of a patient feeling "happy" about the care they are receiving?
In what other business model is it okay to treat your customers this way and people not have an issue with it?

You didn't answer.

And I've experienced the NHS, HSE and SNS, so that's three national health services within Europe, having worked in two of them as a professional. I know how they work, from tax to treatment. But thanks for the WOT.

Neither is better - they both suck at what they are supposed to provide, healthcare - that is my point and goes back to what my original post in this thread was stating and to which you replied.

I cannot say I have worked in the healthcare systems not being a healthcare professional, but I have been a customer in both. However, my wife is an ER nurse and has worked extensively in both the US system and the NHS. When asked her response has been that from a patient care point of view the US system provides a better outcome, but as far as the financial aspect goes the US system is broken when as licensed medical professional she cannot make fully informed decisions about our healthcare because at the point of medical treatment it is almost impossible to know what your final costs will be.

(maybe I'm not hip but what is WOT?)

THIS THIS THIS!!! The patient care aspect is wonderful in this country (once you are in), but that is I believe a contributing factor to the cost problem. When receiving care, there is NO visibility into costs. Doctors order procedures, patients request things / approve procedures with NO idea what it will cost. There is no where in the delivery of care where a cost benefit analysis is done at the consumer level. Once you are in the care of medical professionals, they treat you as if you have full coverage and cost is no object (to an extent). Only when you get out do you get the bill, and wow!!! If you do not have insurance with negotiated rates, that ## skyrockets. Even with insurance, the provider has billing departments that code the procedures to get the most out of the bill.

My daughter had a visit to the ER earlier this year... 3 hr wait for 15 min in the triage room to find out that she ate too much watermelon and it turned her stool red. The test to confirm... $70. 15 min in the room, $900. Doctor to order the test, $450. The latter two my insurance company didn't have a negotiated rate for the code used, so I had no recourse.

Medicare would be a great start but the costs would be prohibitive. Even just covering the 65 and older population, the government is constantly looking for ways to obtain enough funding to cover the costs. Add the remainder of the population and it would be ridiculously expensive.............especially considering a large percentage of the population would not pay into it (just like a large percentage of the US population does not pay federal taxes).

 the government is constantly looking for ways to obtain enough funding to cover the costs. //

Well there would be that 35 cents on the dollar the insurance companies carve out, that is a huge amount. I bet they could do it for 1/2 that amount, and I think most of us would be happy to pay that amount in extra taxes. Of course there are problems there too, no system is flawless. But from what I hear from folks in those two programs, they are quite happy with them. There are grumblings from some doctors about how much gets paid and such, but that is always going to be an issue, no?


I think the thing that gets lost in the medicare for all is that 1/3 of our dollar that goes straight to a for profit company. Medical already covers those that are less fortunate and cannot pay, so not sure that there would be that much of a drag on the whole system, once they get some of that profit money to run the show..

Do you know why you dislike the EMRs while hospital administrators love them? Because they are a billing system first and an EMR second.

Your point is a good one but it would never happen. The health insurance lobby is very powerful. Similar to the pharmaceutical lobby. An example is when Obamacare was being put together. In the beginning, there was a big push to control drug costs. Negotiate drug prices, restrict certain drugs availability, or a myriad of other ways to help drive down this HUGE expense on our system. The drug lobbyist got involved, with both Democrats and Republicans, and all of those ideas went out the window. The same would happen with health insurance companies. Those guys have very deep pockets.

So we just give up and stop trying? I mean at some point there will be a day of reckoning for the insurance companies, how bad does it have to get for us to throw the bums out? It will be hard for sure, but easier than regulating guns, and I think that day will come too, but maybe not my lifetime.

It will take a lot of people with a lot of pain, and then a Bernie Sanders like leader, with a lot of same thinkers in politics behind him. I believe it can be done, just not sure who will do it and when. But whoever and whenever, I will be supporting them, and hopefully the rest will have reached a critical mass to push it through.

I mean, who would have ever though Brexit could be a thing, or 5 years ago that Donald Trump would be president one day!!! Stranger things have happened, be nice for a change for one of them to actually be good for the people...

We look at them as a way for the government to spy on us. According to our government officials, we are all committing fraud against the American people.......I find this hilarious coming from congress who are buddy buddy with lobbyist and have no problems taking "gifts" from lobbyist, and big donors, when provided.

With EMR, we can copy our notes forward if nothing has changed since the previous visit. For many patients, for retinal eye exams at least, this is true over many visits. I make sure I change at least one or two items with every visit. If I don't change something on my new chart, the government can come along and say "hmmm, this looks just like the old chart so he must be claiming he examined the patient but, in reality, all he did was copy and paste the chart". And I tell my patients this if they ask me why I changed a number or description on the chart......."even though I'm sitting right in front of you, and have just completed the entire exam, the government can come along and accuse me of not actually examining you but copy/paste of the note instead". Now, the government would extrapolate this to say "if he's done this once, he must've done it at least a thousand other times". They can now charge a doctor with 1,000 counts of fraud and abuse of the Medicare system based on this premise.

We can't give up but I don't know what the answer is. Money talks so the situation is going to have to get really really bad in order for true change to occur. And it's going to get worse.
Right now, 10,000 people per day are turning 65 years old. This will continue to occur until the year 2030. The 65 and older group is a large chunk of healthcare consumption in the US. EMR has altered the patient/physician relationship. There is a doctor shortage and it will get worse as more docs retire sooner (the burnout rate among docs is high). Wait times will increase.....not just to get in to a specialist but also in the office once you actually get in. Technology and drugs are expanding,mgiving us new treatments, but these are all very expensive and add even more costs to an already burdened system.

You are right, it does look bleak at the moment. I'm thinking that something like AI might come in and change drastically and forever how we take care of people. I think it is already in use to some degree, but when it becomes the thing in medicine, how many doctors are we going to really need?

To me it will be like the self driving cars. There are always going to be car like things, but just not nearly as many as we have now. When you show up to the office and see the nurse practitioner like I do now, and she can just program my symptoms into the super computer that makes Watson look like a 1st grader, well I think our outcomes at that point will be much, much better than they are now. At least that is what I'm thinking...(-;

Of course one is better than the other. It's factual.
Fortunately we have access to actual data, since common sense is never common and rarely makes sense:

Findings: In 2016, the United States spent nearly twice as much as 10 high-income countries on medical care and performed less well on many population health outcomes(...).
PAPANICOLAS, I., et al. Health Care Spending in the United States and Other High-Income Countries. JAMA. 2018;319(10):1024-1039. doi:10.1001/jama.2018.1150

(WOT - wall of text)

I had a DVT this summer that caused two PEs, and I ended up in the hospital. I go in for my six month checkup with the hematologist on Friday. He'd ordered a CT scan of my lungs to confirm that the PEs went away (had an ultrasound last week to confirm the DVT is gone). The insurance company denied the request for the CT scan, and listed the indications that would justify the scan. None of them applied, the MD was unable to convince them otherwise, and I'm in agreement with them that this is an unnecessary test. Pretty sure my bike power readings are confirmation enough that the PEs have been gone for five months now. It will be interesting to hear what the MD has to say on Friday in defense

Add to that the opportunity to stop taking the $7/pill blood thinner I take twice daily.

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"Go yell at an M&M"

ok - on a metric by metric comparison if you evaluate all healthcare systems against some scale, different systems will get different scores and you could then say that one healthcare system is rated "better" than another - kind of like being the least worst smelling pile of excrement - so yes, if you want to say that one system is better than the other you can. My opinion, worth what you paid for it but mine and I own it, is that neither system is working.

My question to you is do you believe that either of the discussed healthcare systems are performing/providing the services as they are intended in an efficient and beneficial way to the patient - and I mean all patients not just those that can afford to pay twice? (I get that my question has multiple parts so feel free to answer each separately if you like - or not at all).

Ill answer assuming where considering a good patient as an example and I'll say yes. Both efficient and beneficial. The waiting list times are getting worse in all the countries I previously mentioned for different reasons (medical and nursing shortages, defunding seeking deficit zero on the year's balance, general brexit-related BS, etc) and obviously having the money to see a private consultant doesn't suck, but assuming normal funding and normal waiting periods for patients who see their GP/family physician regularly or as soon as signs/symptoms present, yes.

And the fact that this is the same regardless of making minimum wage (600€/mo. or less, in some cases) or 10x that, helps.

I always dislike these discussions of "healthcare in the US is so much worse than X country but you spend X amount more". Comparing healthcare across nations is the classic apples to oranges rather than apples to apples.

- the US population is the most obese in the entire civilized world. This greatly affects the rates of hypertension, diabetes, heart surgeries, etc compared to other, less obese nations. This is a problem of the population but greatly contributes to the costs of US healthcare

- the costs of pharmaceuticals in the US cannot be negotiated therefore our drug prices are automatically higher than almost every other country in the world

- we have a large population (close to 350 million) that is NOT homogenous..........we have many different races/cultures. This, by itself, would make a comparison between the US and, lets say, Denmark a difficult comparison .

- the US overuses both MRI and CT scanners to a much higher degree than almost every other country in the world. This is not because we are sicker, it is to cover for the potential for lawsuits (malpractice defense). Most of these other countries do not have anywhere near the malpractice worries of US docs, and it certainly adds a lot of expense to patient care. I admit I do it myself. I have, and will, order extra labs, or MRI, or angiograms if it can provide protection for me down the road if I ever have to stand in front of a jury. Its a lot easier to order these extra items than to try and defend yourself in front of a lawyer saying "so Dr X, all you had to do was order this simple MRI and you could have found the tumor to save Jimmy's life. But no, you wanted to save money and now Jimmy is dead".

- higher rate of teen pregnancies in the US, and thus, higher infant mortality. Also, the way infant mortality is classified varies from one country to the next so, again, a somewhat apples to oranges comparison here as well

- the US healthcare system, in comparison, has a huge administrative burden (costs) compared to other countries. This goes back to the interference from healthcare insurance companies, as well as the bureaucracy of our already present government run systems (Medicaid, Medicare, VA Healthcare). This is certainly one area where a single payer system would be cheaper to administer

I'm sure there are more but these are the only ones I can think of right now. Quit comparing the overall system and compare your individual experience. if a person is happy with the care they receive in the UK or Canada then that means that system is working for THAT person. Same with the US patient. There will always be people happy with their system, and people unhappy with their system. Unfortunately, no one system is the best and it will be nearly impossible to ever do a true head to head comparison.

Except Finland....because it's better. I am not from Finland but capitalism and healthcare are not a healthy mix.........see what I did there.

Every MBA I've encountered is programmed to come up with a set of metrics and use those to gauge performance. Seems like a very capitalistic thing to do.

These same MBA then go and ignore the metrics and fire/promote people based on whim. Again, that's capitalism.

If you care about life expectancy, infant mortality, cost and accessibilty as being good indicators of a health system then the US is abysmal.

If patient outcome once diagnosed as sick and able to pay is your metric then the US is the best in the world.

The US is so exceptionally out of step with the rest of the world that making broad comparisons is justified.

Anecdote: As someone who pays for full health insurance from my own pocket each month, the fact that I will never get into an ambulance unless unconscious is pretty sad. If I ever get diagnosed with a serious illness I don't know which of "Am I going to die?" or "Am I going to go bankrupt" will be my first reaction.

Again, with all of the above (life expectancy, infant mortality, etc...) it is not as easy as you would think to make an apples to apples comparison when putting one country up against another. Take infant mortality, for example. The definition of when a baby is alive, and when a baby is officially dead, are not the same criteria for every country. This can make a huge difference regarding the actual "true" numbers, and can skew the numbers one direction or another. Also, you are comparison homogenous populations (Japan, for instance) with a very mixed (heterogeneous) population of the US. That's comparing apples to an entire fruit basket.

As you stated, we do great once diagnosed as sick, but we as a country are terrible at the preventative part. In my opinion, this is on the population as much or more than the system itself. Personally, I talk to all of my smokers about quitting. Over the past 20 years of practice, I can count on one hand the number that have quit smoking. Same with obesity as a way to control diabetes and hypertension. I talk to people until I am blue in the face but people want an easy solution ("doc, can't ya just give me a pill for that") or they want to make excuses ("no matter what I eat, I can't get my blood sugar under control".......coming from a 5'2" lady weighing 300+ pounds). Most of our current healthcare costs/problems could be taken care of if people simply cared about taking care of themselves. Unfortunately they don't. I believe the number of obese adults in the US is approaching 40%. Higher than any other nation in the world. There's a big part of our healthcare problem right there.

Glad all is good.

1. Did he get a kickback from the cologuard test kit?
2. How much would your insurance have paid him for the diagnostic colonoscopy? Because insurance usually pays a lower fee to the doctor than a patient pays "ala carte" and because he can now bill is a test other than diagnostic test....

Bottom line: Is he making more money (outside of a second visit fee) because of him suggesting this test?

This is because there are NO consequences to not changing. Their costs are largely the same as mine. Couple that with the "NOW" culture, and it even further disconnects the action from the cost. Stop smoking now or there will be problems in 10+ years.... you're fat, you need to lose weight or the doc won't be able to fix it with a pill in 10+ years (even though the hypertension can be controlled now).

The only place in our system where health of the individual, and the probability of future pay out has any effect on cost is life insurance. My wife and I are level 1 and 2 respectively and pay relatively nothing for coverage vs the fat smoker. Health coverage should be like this too, give incentives in the TODAY for people to make changes. Where I work used to charge an extra $75/mo (which effectively tripled your contribution) if you smoked. That's a good start, but apparently that's not allowed.

You are correct. Unfortunately, with our current culture full of "victims", and no one is responsible for their actions rarely, it will be extremely hard to ever get our current politicians to enact something like this. Almost any plan for healthcare will have a low income cutoff where that group will not pay in to the system. That group also includes a lot of people who most need intervention (smoking cessation, weight loss, blood sugar control, etc...). Maybe there could be some type of rule that if you lose weight, and quit smoking, you will get the highest level of government supported subsidy. If you smoke, don't keep your blood sugar controlled, or fail to show weight loss progress then you do not get a subsidy and must pay in to the system or face a penalty (sort of the same premise as what Obamacare hoped for). I know this is painting a broad stroke, and would be very difficult to monitor, but people have to have skin in the game or they just do not care about making changes.

But as was pointed out, "able to pay" is also a large component here. It doesn't matter how well I take care of myself, if I get sick or injured and can't pay, I don't get care. I've been in debt for medical costs nearly my entire adult life because either I wasn't insured, or the insurance company refused to cover treatment. I've lost a few friends and family members over the years who took good care of themselves, but simply couldn't afford the care needed once they got sick...

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"I'm thinking of a number between 1 and 10, and I don't know why!"

That's not entirely true. I've never turned anyone away for not having insurance. When I worked in emergency rooms, we never turned anyone away there either. Even now, if I have a patient without insurance, I can often find ways to get them free drugs or other treatments. I have turned people away, once under my care, who refuse to purchase their meds, or make any reasonable payment to my practice, but willingly spend their money on the newest iPhone or cigarettes. Not saying you do, but plenty people make choices in their lives what they will spend money on or not. I had a patient fuss at me because I would not give him a drug sample (I did not have any) but instead insisted he buy a medication from WalMart's $4 formulary. He had a pack of cigarettes in his shirt pocket so I asked him "you'll spend X dollars for these cigarettes, probably multiple times per day, but you won't spend $4 to take care of yourself?". He got mad and walked out.

With that being said, I do agree with your premise about the expense of healthcare. It is very very expensive, and much of the costs are ridiculous. Unfortunately, in the US, administrative costs contribute to about 1/3 of the total costs of healthcare. So, every time a person pays for their healthcare, 1/3 of that is going toward our bloated bureaucracy.

OK, so there are some out there who have screwed up priorities in their lives. What about the rest?

The "nobody gets turned away at the ER" line is a bit of a red herring. Yes, you can treated for free* when they bring you in after a heart attack, but you can't just walk in to the ER and request a colonoscopy or have them take a look at a suspicious mole you noticed, or get your cholesterol checked. Waiting for a problem to show up, or get worse (whether its from screwed up priorities or an actual lack of ability to pay) and going to the ER for "free" treatment generally results in higher costs and worse outcomes. So a system that at least guarantees a minimum level of preventative care would go a long way towards moving us up the ranking in care/outcome.

*But its never actually "free". You still get billed, if you don't pay your credit gets trashed, and in the meantime your costs just get passed on to everyone else, raising costs across the board.



And another large chunk of that goes towards executive salaries and shareholder dividends. All of which means we get less healthcare per dollar than another system which has a leaner bureaucracy and not-for-profit healthcare...

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"I'm thinking of a number between 1 and 10, and I don't know why!"