They're no different from any other large industry though. I just read about the costs that we're still paying for the Valdez, and that from a company that makes about a billion dollars per week in profit!

http://www.time.com/time/health/arti...887165,00.html

Things like these make it hard to imagine how Big Business can be regarded as being somehow better than government. They're not even good enough to live up to their own relatively small responsibilities!

Jumping in rather late (been staining both sides of a 5 x 65 foot fence), I can say unequivocally that the best public health care systems are inevitably in countries with very high taxes relative to the USA. One of the problems with "free" is that it is inevitably abused -- lots of folks with the sniffles sitting around in doctor's offices or ERs. That clogs the system. The second problem with "free" is that the only way a government can control costs is to limit the number of hospital spaces and doctors. That leads to waiting lists. Having said that, however, at 72, I'm damned glad I live in Canada. Never (as a previous poster mentioned) had a sick day in my life (in 40 years of teaching at University I never missed a lecture because I was sick). At 65 or so, all hell breaks loose. These are supposed to be our "golden years". The only thing golden nowadays is my urine.

Well, it not free but it's perceived as free. I think our whole concept of health insurance is built on the wrong foundation.

Instead of paying doctors to heal us for illnesses, we ought to change it to pay doctors for keeping us healthy and pay them less when we become ill.

with warm regards
Ronald Cross

...And charge the insurance companies for the Medicare/Medicaid/other taxpayer costs when we become "uninsurable" after losing coverage.

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Interesting and timely thread, Aehurst. :)
Hope to pitch in later.

Now that sounds viable, doctors and insurance companies would then have real motivation for keeping us healthy. :)

All of this is easier said than done...

I think the real question is: Can private insurance provide real value for the money they charge? The answer appears to be no.

I think you're right but it will take a health insurance breakdown similar to what we are seeing in the financial industry today.

It would be nice if Obama can do something about this but he's fighting an up mountain battle with his bare hands and falling once is all that is required to fail.

I think people are beginning to realize that with the current system you're not really insured even if you have a great health plan at work. That's because if you really get sick there are lots of ways that the insurance company can kick you out.

The demand for health care is infinite (especially when pharma companies get to invent new medical conditions). Ergo, health care must be rationed. There are three possible rationing modes: by price, by waiting list, and by personal 'pull'. Pick one.

That's a tough one. Essentially correct I think in the sense that there are limits. At what point do we quit providing health care services? Our insurance companies have simply stated certain things are not covered expenses (translation--not cost effective based on likely outcome), other things have benefit limits.

I think we all understand that near the end of life a point is reached where patient comfort becomes the goal and aggressive treatment ends.

But, when medical attention is appropriate, necessary, and likely to have a good outcome (even if that outcome is to prevent further deterioration), then I see no need to ration health care for any reason.

An excellent point. In countries that are successful in controlling health care costs (while still providing good health care) there is almost always a co-pay, i.e., a small charge to keep the hypochondriacs at bay. Here in Canada there is no co-pay on a doctors or ER visit, but there is on insured drug plans.

Those are the relatively rare cases that they'd like you to pay attention to because it makes things look like the insurance companies are trying to do the right thing with limited resources. The much more common occurrences are the denial of claims based on profit and denial of coverage because of so-called pre-existing conditions.

It's pre-existing conditions where they make a killing. If you have car insurance and have an accident, your current auto insurance has to cover the damage even if you change to another insurer. Try the same with health insurance and it's a different story. You lose all coverage with the old company and the new one won't cover the pre-existing condition. Since it happens frequently with the loss of a job or even a transfer to a different state, that's pure profit for the industry.

During my military years, health care was pretty straight forward. Sick call at 6am and 1pm... be there or be at work. Period. Calling in sick was not an option.

All patients were screened by nurses or physician's assistants... they made the decision about who actually needed care, who needed to see a physician and who just needed a "cold kit" or medicine for the bug of the month. It worked well.... nobody wants to wait hours to see a doc because he/she is the only one who can give you the meds you already know you need or order a test you know you need (e.g. is it strep throat or just sore?)

Amazing how well it worked. Course, under our system the doc cannot bill the insurance company unless the doc actually sees a patient. Hence, you will see the doc no matter how long it takes.

I remember that from RCAF days; not that I was ever sick then, but I was occasionally tasked with taking those who fell out sick from the morning parade over to the infirmary. First question to the assembled was whether all present could walk.

I think a major advance in this regard would be to make much better use of Nurse Practitioners and Midwives. Physician friends of mine make no bones of the fact that lots of their daily patients didn't need to see them.

On the one hand, I hear you. Some years ago I got Giardia lamblia, which you from the South will know about, but which was rare here. Doctors I actually saw were clueless, I was finally diagnosed over the phone by a doctor friend who grew up in Africa. Where, he said, diagnosing and treating Giardia was the job of the nurse, not the doctor.

On the other hand, when the nurse or assistant does the screening, gets it wrong and the patient dies, there's hell to pay. Even when the doctor would probably have gotten it wrong too. I had a very bad experience being blown off by a ER receptionist, who basically did triage based on whether she liked your face or not, when I was really ill. But then, after a six-hour wait, the doctor was no better. TANJ.

The big problem here is that all medical personnel seem to have a presumption in favour of the patient not being really sick. Whether that's related to our having socialised medicine (with a co-pay) or is something to do with the professional culture is a big question that I can't answer here. Bottom line is that it doesn't matter how many degrees the diagnostician has if he or she jumps on the nearest conclusion, smacks its rump and rides it to death; if the only way you can prove you're sick at all is by dying in the waiting room. Which I fully intend to do next time, just to spoil their day.

My physician friends say the same. Despite my more sceptical post regarding screening above, I can never understand people going to a doctor with a common cold. OK, flu can feel like other things, but sneezing, runny nose, weeping eyes, that's a c.o.l.d., by the age of 18 we should all know this; and antibiotics won't do a thing except help breed immune bugs to bite the rest of us. Only two things work: time, and garlic. :D

And I am told a full 80 percent of patients would be fine whether they were treated or not.... that is, the docs are not curing anything, but rather treating the symptoms to make the patient more comfortable while nature takes it course. Course, then there's that 20 % where you get worse or even die without intervention.

Here in the U.S., there is no concept known as the end of life. Most physicians are well compensated for aggressive treatment; they are not well compesated for providing comfort. Unless you have a will specifically stating how you want to be treated during end of the life, the default is aggressive care. You only have to go as far back as the Terry Schiavo case. The woman has no gray matter left in her brain but yet doctors, lawyers, hospitals, politicians all benefited from her being on artificial life support.

Artificial life support wasn't designed to keep people alive indefinitely, its intent was to be used as a life sustaining device until a donor or a procedure is performed that will give the patient a chance at life. Doctors and patients have taken this concept to mean use it at any means to keep me alive even if no procedure will ever be created and there is no chance of a donor. In fact, these systems were tested on younger people and never intended for older people that are dying. This is part of the reason for the high cost of health care. When you really break it down financially, 30-50% of all health cost is charged to the patient during the last 7 to 10 years of the life while it is declining. It's the high cost of keeping someone alive during that last 7-10 years that's the most expensive and the most aggressive. Younger people actually spend less as a whole than older people because they are generally in good health. So when things change, it will most likely be the older people getting screwed and not the younger people.

Yep, this is correct and it's a very good point. The coverage changes from one insurance company to another and there is nothing to stop this foolishness. In the end, you lose because they take all your money and you walk away and you are never covered for what you paid into it. Again, the health care crisis will straighten out this mess. Another couple of decades and we will start to see change. This is the next big bubble. It's unfortunate that it will occur with the baby boomer generation as they will have a rude awakening!

In Terry Schiavo's case, the "artificial life support" the doctors eventually removed was the feeding tube. They let her starve to death. Not because the feeding tube wasn't functioning well, but because others made the determination that her particular life was not worth living given she was, apparently, unaware of her surroundings.

While I don't particularly disagree with the eventual decision in the Schiavo case, there are a million additional examples of people who live life with the help of "artificial life support".... a feeding tube, a ventilator, a mechanical heart valve.... who are aware of their surroundings. Many are quite capable of making a decision to end life but choose not to do so. Others have some degree of mental impairment as a result of traumatic brain injury, stroke, etc., that may or may not be able to make that decision rationally or at least not from the same perspective as a person without their impairment.

Others are born with a condition that requires lifetime "artificial life support" such as a feeding tube or ventilator.

Certainly these situations are tragic and very expensive, but I am not ready to go down the road of medical personnel making determinations as to which life is worth living and which life is not. It's only a short skip from there to terminating non-productive lives, terminating babies born with physical or mental defects, or terminating the elderly when they can no longer care for themselves. All life is a terminal condition.

The living will is one way around some of these issues, but there are many issues with those as well.... probably better not to get into that. In any case, the bean counters at the insurance company should not make these decisions. The heirs to the estate should? The beneficiary on the insurance policy should? I think leaving these decisions to the family is the best we can do, and I think by and large the family will make the right decision. In any case, these decisions should not be about dollars and cents.