Comments

Screwed for sure! We ARE teasing out extra years but, unfortunately, we're teasing them out of already profoundly ill patients whose lives we're extending. What if we weren't making such steps? Where would our #40 ranking be then? Being the most "civilized" and technologically advanced nation on the planet and being so far behind is a travesty. Please don't read this to mean we shouldn't take every step to add years to the lives of the ill but let's prevent the illness to start with! Invest the money at the opposite end of the lifespan and future medical discoveries will extend healthy lives rather than prolong those of the unhealthy. It's not healthcare. Our megabucks are being spent on sick care.

Posted by Ed Di Gangi at July 9, 2007 10:24 AM

Our government in the UK faces tough questions from the electorate about healthcare spending (we do have a socialist system!) as the tax take increased during the Blair years and is at a historic high. The stock response is always to boast how much the Government spends versus how much the Thatcher and Major governments did,nah nah nah na-na.

This is just plain childish, vapid and wrong. They have made a few improvements BUT they are too focused on spending. They assume that if you spend money, they're addressing the problems and everything is getting better.

When will they ever learn that we're interested in outcomes? The Blair regime was afraid of targets and never properly defined the objectives for our health service. As a result, massive amounts of money were wasted and the value for money delivered was poor. And the resulting health of our nation: negligible difference.

Ed is entirely right: focus healthcare on prevention rather than cure. But also ingrain it into the education of our youngsters. And set healthcare objectives, holding people responsible for the outcome!

Posted by Mark JF at July 9, 2007 10:52 AM

1. Totally agree with the "prevention" thread - far too many enslaved by junk dining & alcohol every day & lazy lifestyle & obesity & depression. Noteworthy that UK National "Health" Service as apparent breeding ground for M.D. Islam homocidists - lazy low-IQ oversight - blind eye & stiff upper lip perversion.

Posted by sean at July 9, 2007 11:06 AM

It's not how long you live, it's how well.

Posted by Billy Oblivion at July 9, 2007 11:37 AM

I don't know where the perfect health care system exists (I am in Canada), but it is a reality that all could be improved.
1. Like a couple of earlier contributors I agree we need to be proactive. Early education about diet, exercise and the need to avoid health issues.
2. Consequences for those who cause their own issues. Smokers, the obese, those who over-indulge in alcohol or drugs, perhaps even those who partake in extreme sports. Give these people lower priority?
3. Re-education of the medical profession. Maybe its OK to accept the results from another medical institution without re-doing them! Perhaps a few minutes spent on prevention could reduce the workload. Maybe pills are not always the answer!

Obviously the issues are systemic and require a change in attitude from the whole populous, but you need to start somewhere. Who has the political will to make that happen? Right!

Posted by Kevin Dee at July 9, 2007 11:39 AM

There are two sectors, health and education, that people generally will never be completely happy with. I'm currently managing a major health system reform for a medium-sized city-state. I'd like to contribute a few thoughts to this debate.

Generally speaking, universal healthcare is the way to go (or "socialist" healthcare as you called it). This is the harder system to implement but has many benefits to the health of the population, including:

1) greater focus on prevention (which reduces cost of healthcare provision and raises health status). There are many reasons for this, the main one being that in a loosely managed health system, specialists (secondary care) tend to suck all the money out of the system leaving little for primary care. In many cases, with better funding, primary care can prevent many incidents that end up with secondary care.

2) Also, a strong primary care front-end for health means that patients get integrated care. Only a family doctor (GP for brits) has the full picture of your health situation. This can help with things like identifying root causes of symptoms that specialists might mis-interpret (e.g. a stomach doctor will treat an ulcer but not catch a problem in another area that caused the ulcer in the first place); or avoiding adverse drug interactions for medicines prescribed by different specialists, etc...

3) what I will loosely call the "critical-mass" effect. This means that when you've prevented communicable disease to some 90% of the population, you automatically protect the other 10% (as there aren't enough carrier agents for viruses and bacteria to spread). In a health system that protects only some people, even those who are covered face higher risks of infection

4) I refer to a previous comment on quality of life (Billy Oblivion); in a universal healthcare system there are greater incentives to improve quality of life through better primary care and public health initiatives.

Ultimately, providing good healthcare is all about putting the right incentive system in place to cause those involved in the system to act in the right way (e.g. to increase focus on prevention). The NHS for example (UK system), while behind in customer service (thus the perceived bad service by end-users) actually has an excellent incentive system in place. The end-result is one of the healthiest populations in the world. The US system on the other hand is such a mess of incentives that I don't actually believe anyone is really looking out for the health of individuals. Thus the low health status ranking (but because it's largely a private sector run system, the high focus on customer service means customers walk away happy, even though they're still sick).

Posted by Sam at July 9, 2007 1:03 PM

Universal healthcare (read "socialism") is the WRONG way to go.

As to hospital errors, see http://www.paperkills.org.

Posted by Tom E. Snyder at July 9, 2007 3:48 PM

Sean, no tobacco, low low fat, plenty of fresh air and exercise, sleep like a baby, BUT--don't take away my bourbon, scotch, or vino please.

Since everyone has "the" answer, now the trick is to get yer politicos to listen. But they don't. They only pander to the LCD crowd. What's the answer to that? Vote the bums out and start over, I say.

BTW, the whole idea of the mass 25 million "uninsured" without access to healthcare is pure BS. Every state and many big-pharma cos. sponsor dirt cheap insurance for youngsters; universities supply dirt cheap insurance for their students; AND WHY IN THE HELL DO SO MANY PEOPLE IN THE USA HAVE SUCH CRAPPY JOBS THEY DON'T HAVE BASIC HEALTH COVERAGE? That's the root of the problem, y'all.

Posted by Red Island Rhodes at July 9, 2007 4:21 PM

As I write this I am preparing myself for the inevitable brickbats but I speak from the heart.

In order to provide some degree of balance to this interesting discussion which is largely anti universal health care systems (which I am an advocate of) I thought you might like to see a report published in May 2007 by the Commonwealth Fund based in New York.

http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=482678

The Commonwealth Fund is a private foundation that aims to promote a high performing health care system that achieves better access, improved quality, and greater efficiency. The Fund carries out this mandate by supporting INDEPENDENT research on health care issues and making grants to improve health care practice and policy. In a nutshell this report concludes the UK Health care system emerges as the top overall performer in terms of value for money in healthcare of 6 countries - Australia, Canada, Germany, New Zealand, UK and US. In fact the US is the worst performer on 4 of the 5 headings. As a former 30 plus year NHS veteran I am the first to admit our NHS in the UK is far from perfect but it is encouraging to know our NHS system is top of the league.

There is excellence in parts of the US healthcare system. Some parts of the NHS are modelling services on US excellence and you guys can therefore be proud of that.

But I am more proud that in the UK wealth is not an advantage and poverty a disadvantage when it comes to access to universal health care. I need some convincing that the US healthcare system has anything to teach the UK regarding COMPREHENSIVE health care for the whole population.

I have the greatest respect for the excellence in US healthcare and Don Berwick’s ideas are wonderful. I hope we continue to learn from each other on both sides of the pond about healthcare and the more important ‘wellness’

I humbly suggest Health is probably the greatest challenge in management in this century.

Posted by Trevor Gay at July 9, 2007 5:20 PM

Yes Tom, we are getting screwed. We don't have healthcare, we have sickness care; controlled by BIG pharma and insurance companies. Heck, they are creating diseases that didn't exist so they can sell you a drug (on TV) to make you feel better (i.e., ADD, obesity, erectile dysfunction).

Who are the top 5 in life expectancy? Bet they don't have BIG pharma, insurance companies, & mcdonalds!

PS - I'm not a big fan of Michael Moore, but can't wait to see SICKO.

Posted by John at July 9, 2007 5:22 PM

The cheapest pro-active treament is the best one: diet-and-exercise. It would save the Brit's National Health Service 1 billion pounds per year ... http://www.healthcentral.com/diet-exercise/news-33150-66.html - How much more would diet-and-exercise save in couch-potato USA?

Posted by Mike L at July 9, 2007 6:37 PM

Isn't a huge amount of money wasted just pushing papers around and making phone calls because insurance companies want to delay paying so they can skim the float from what they owe? So many American medical practices have at least one full-time employee devoted to dealing with insurance companies, that's got to be a big factor in costs. I think an independent claim-processing clearinghouse might help solve that problem, so that there's only one streamlined process for claims, regardless of the insurer. It won't happen without legislation, though, because insurance companies are making lots of money by stringing us along. I think there would also have to be some tough penalties for bogus claim rejections, too, because the incentives are all wrong for insurance companies. Speaking of incentives, it's also probably a bad idea to have insurance policies chosen by an employer. The employers (i.e. the shareholders/owners) do not bear the cost of rejected claims, so the incentive for insurance companies is to make policies cheaper than the competition and make their money on the aforementioned float.

Posted by 123fun at July 10, 2007 2:59 AM

1. More free enterprise is needed - the federal government regulates start-ups to non-existence.

2. And yet in poorly performing USA healthcare - the liberals want more government involved - like that fantasy world is going to be provide solutions.

3. Clean living for moi I thought - 7% bodyfat, daily exercise - runs/weights, eating well. And yet had some pre cancer skin develop - dermatologist said surgery & pharma as solution. Almost instantly though my skin cleared after I went chemical free in everything - organic food/drink, chapstick, lotion, soaps, eyedrops, vitamins, sunscreen, shampoo, shaving cream, filtered air & drinking/shower water, clothes - you name it - ecstatic now.

Posted by Sean at July 10, 2007 9:24 AM

As a sole proprietor of a Professional Service Company. My only option is the private insurance world, I see first hand how BROKEN the health care system is. And If I hear one more comment about people not taking personal responsibility I will just go ballistic. The problem with the Health care system is the profit motive has replaced all regard for the patient - the very reason for the systems existence. What needs to change is the paradigm that sets the goal of getting individuals to pay large corporations and their stock holders masses amounts of money for nothing but a false since of security. And, manipulate them by using the promise of that elusive and mythical fountain of youth to give more and more for less and less. I could go on for pages with personal experience of the abuses and flaws of this system. But the problem and the solution do NOT reside with the individual patient. And the goal should NOT be the extension of life but the avoidance of premature needless death, relief of suffering and quality of life. I for one do not buy into the eternal human obsession with the mythical fountain of youth, nor do I want to live forever. For me living well is MUCH more important than living long. After a half century of staunch opposition of “national” health care, I see no other solution. The track record of other countries and the absolute failure of the US system prove that "Universal" Health Care is the only game in town that works. On this issue the US needs to concede defeat and, in the name of democracy, tear down the walls of access for all its citizens. If we as a country do not act soon, there will be a mass revolt of gargantuan porportions.

Howard Hughs tried the "get rid of everthing harmful" solution and guess what, he died, isolated alone and totally parinoid.

Posted by MLM at July 10, 2007 10:41 AM

The comments so far have been very intriguing and raise the same fundamental questions. Universal Health Care vs. Consumerism and Health prevention vs. Health Treatment. I guess every one is influenced and guided by their own experiences. There is no subsitute for personal accountability and we need to create incentives and benefits to promote this cultural shift. It can and will not happen overnight. But we should avoid doing anything that is gives an escape path to the individual. Before the modern society version of health insurance, coverage health was primarily an individual responsibility. I guess we are ready to complete full circle.

Posted by Arvinder Singh at July 14, 2007 5:58 PM

I've heard that, while US citizens flock to Canada for cheap drugs, some well-heeled Canadians are crossing the border southwards for medical care. The reason: their system is excellent for day-to-day preventive health care. But when you need a specialist, you get on a waiting list, and it may be months or years before you actually see him/her. Private health care, as a profit-making institution, is skewed to favor those who have money -- or good insurance -- and whoever has the dollars goes to the head of the queue. The question, then, is how to provide incentives both for preventive maintenance, and for enough specialists to adequately handle the need for their services.

Posted by Paula at July 16, 2007 3:32 PM

As for "individual responsibility," sometimes (e.g., smoking = lung cancer) there's a clear link between the behavior and the health consequences. But that's not always true: e.g., high blood pressure runs in my family and has no apparent relationship to the person's weight; yet doctors routinely prescribe medication to my skinny relatives and tell the heavier ones to lose weight. (A few years ago, I lost over 40 lbs, and my blood pressure didn't budge!) In the "individual responsibility" world, doctors would refuse to prescribe blood pressure medication to anyone who was overweight -- whether or not that actually had anything to do with the problem -- and the consequences could be fatal.

The fact is that there are many conditions in which overweight may be a causative factor, but it also may not. Denying medical care to the overweight would mean that many serious conditions that they actually had NO control over would remain untreated. (If you want to read some real-life horror stories in which this happened, look up "polycystic ovarian syndrome.")

Posted by Paula at July 16, 2007 4:05 PM

The seaming paradox of lifesaving technology for the individual without similar results in population health outcomes has an explanation. Health care can be divided into two parts, health sciences and health care delivery. You can have the best science, with poor delivery and it will do little good. Or you can have the poorest science and have great deliver and still do a lot of very little. I propose that our Health care system is lacking in both areas.

This industry is blinded by the very values that motivate the incredibly selfless providers within it. For instance; what if a high tech procedure is done where a lower tech response is as good, or better? The high tech approach will work, thus successfully reinforcing the rightness and necessity of what is being done in the eyes of the system. Even if the high tech provider tried a lower tech response, they would likely lack the ability, infrastructure and background to do so, increasing the chances of getting bad results. It is only natural then to compare the best outcomes of what we are familiar with, with the poorest out comes of that which we are not.

The problem lies in the great complexity and risk associated with high tech health solutions. It is possible to very effectively deliver high tech, high risk medicine to a population. However, that can make the population more ill than a less medicated approach could produce. What we ended up with is a system that focuses on individual health in critical times, and has low impact on population health. Belief in the system is continually reinforce by the perceived good results produced, magnified by providers tendency to be passionate about helping people.

To be clear, I am not anti high tech medicine. What I am saying is that our health system does not operate in a totally rational fashion and can be greatly improved upon. The science and delivery systems that can create a more affective approach exist in piecemeal. The challenge is to bring them together in a way that creates enough economic strength to withstand the backlash from ardent supporters of the status quo. As one of the twentieth century's most distinguished scientists and Nobel laureates, physicist Max Planck, observed; 'A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die, and a new generation grows up that is familiar with it.'

female viagra canadian Posted by Aaron Robinson at July 20, 2007 7:05 PM

"The profit motive has replaced all regard for the patient" (MLM) not only in the US health care system but also in some of the biggest international medical tourism agencies in the USA. How can international medical tourism help fuel improvements in the US system if it's cut from the same cloth.

online ordering viagra australia

While still Thailand Country Manager for perhaps the best-known US agent, I was asked to review the company's latest business development plan and comment. I was dumbfounded. Pure hype about increasing profits and hard-selling and up-selling expensive agency services to customers and not a word about patient health or improving customer satisfaction with their surgery abroad experience.

The company had developed the same obscene level of greed as US health care. American customers are paying as much as US$500 before even getting on a plane or seeing a doctor. The virus has spread.

So I quit and set up an agency that: 1) has no fees; 2) puts the needs and best interests of patients first; but 3) still has a viable business model; 4) has generated a complete return on investment in 120 days; and 5) put us in the black; 6) while managing to help a number of people get quality health care at an affordable price. It proves good business does not require obscene greed to succeed. It shows individuals can make a difference if we try.

viagra purchase online usa I'm American. One of my brothers is an orthopedic surgeon. My sister is a nurse. Another is a physical therapist like my mother. Another brother manages group physician practices. I have worked in two northern Ohio hospitals. I do not hate US health care.

But "Sicko" has come and gone. Cuban, French, Canadian and British health care has been clearly shown to work infinitely better than the US system for the vast majority of citizens. But where is the glimmer of hope that anything is going to get better?

MLM is right. Nationalized health care or universal health care or (oh, no! not the "S" word!) socialized medicine is what we need. But the insurance and pharmaceutical companies have total control and I don't see how we are going to bust their grip. As Ed said: "Screwed for sure!"

Maybe international medical tourism really is the only way millions of Americans are ever going to get proper care. But it doesn't seem right that citizens of the most powerful nation in history have to go abroad to get the health care and medical attention given free to the enemy combatants at Guantanamo Bay.

What's wrong with this picture? How can citizens put up with such a grotesquely perverted, unjust, unfair, inefficient and ineffective system that is good only for the doctors, insurers, drug manufacturers, politicians and the rich? We all need to stick our head out the window and say: "I'm angry and I'm not going to take it any more."

Posted by Richard RothHaas at November 18, 2007 1:49 PM