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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [eye3md] [ In reply to ]
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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...
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [Dilbert] [ In reply to ]
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Dilbert wrote:
Do you know why you dislike the EMRs while hospital administrators love them? Because they are a billing system first and an EMR second.

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.
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [monty] [ In reply to ]
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monty wrote:
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 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.
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [eye3md] [ In reply to ]
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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...(-;
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [HoustonTri(er)] [ In reply to ]
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HoustonTri(er) wrote:
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?)
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)
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [djhuff7] [ In reply to ]
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djhuff7 wrote:
HoustonTri(er) wrote:
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.


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.

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.

----------------------------------
"i disagree with your analysis [or judgment], nevertheless you have the responsibility of moderating this board so i honor your authority to make the moderating decisions."
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [Thorax] [ In reply to ]
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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).
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [HoustonTri(er)] [ In reply to ]
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HoustonTri(er) wrote:
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.
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [Thorax] [ In reply to ]
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Thorax wrote:
HoustonTri(er) wrote:
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.
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [TJ56] [ In reply to ]
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TJ56 wrote:
RONDAL wrote:
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


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!

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.
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [eye3md] [ In reply to ]
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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.
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [carlosflanders] [ In reply to ]
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carlosflanders wrote:
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.
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [rayman54] [ In reply to ]
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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?
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [eye3md] [ In reply to ]
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eye3md wrote:
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.

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.
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [djhuff7] [ In reply to ]
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djhuff7 wrote:
eye3md wrote:
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.


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.
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [eye3md] [ In reply to ]
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eye3md wrote:
carlosflanders wrote:
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.

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...

"I'm thinking of a number between 1 and 10, and I don't know why!"
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [Warbird] [ In reply to ]
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Warbird wrote:
eye3md wrote:
carlosflanders wrote:
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.


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...

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.
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [eye3md] [ In reply to ]
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eye3md wrote:
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.



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.

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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.


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...

"I'm thinking of a number between 1 and 10, and I don't know why!"
Last edited by: Warbird: Dec 12, 18 11:54
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Re: Cologuard False Positive - Anyone else??? Beware potential significant out of pocket expense. [Warbird] [ In reply to ]
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Warbird wrote:
eye3md wrote:
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.

Yep, we would be much better off if we had a robust preventative healthcare system, and a public that was willing to invest in themselves and use the system.




Quote:
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...

Very much true. In reading about healthcare systems, in other countries, its interesting to see how the government distributes the money into a system of not for profit insurance companies that then turn around and pay hospitals and doctors. In our country (US), the government distributes the money to for profit insurance companies. An example are the subsidies, for Obamacare. They are called subsidies, but that's a misnomer. The insurance companies are very financially savvy and would NOT take on the Obamacare networks if it was not going to be profitable. These subsidies are essentially a form of kickback saying "please help us cover these extra patients so we can have some success".
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