I am sure the US approach to healthcare is great for you Silvaire as it would be for me. If we can compare it to the hangarage on our private aircraft then we are not exactly representative. If you are a normal worker who can’t get insurance for example it is terrible. I have personal experience of people not poor enough to get free care but caught in the middle.
I am a very right of centre capitalist but believe health care must be a safety net for people in a mature society.
I am sure the US approach to healthcare is great for you Silvaire as it would be for me. If we can compare it to the hangarage on our private aircraft then we are not exactly representative.
Whatever. I don’t buy it.
Breaking Bad has an interesting twist on health insurance and the entrepreneurial drive in New Mexico 
Silvaire 12-Jan-15 21:08 #69
I am sure the US approach to healthcare is great for you Silvaire as it would be for me. If we can compare it to the hangarage on our private aircraft then we are not exactly representative.
Whatever. I don’t buy it.
Spoken from a guy whose health plan is supported by his or wife’s employer.
Most people in the US take crap jobs mostly women just to have health insurance. Because most of the US work force works for small business that are being killed by insurance premiums. When Im speaking of crap Im referring to low pay. Thats how they keep them also. If you leave your job, get fired, you better not have been sick or have an ongoing medical condition because you’ll be hard pressed to get insurance even with a new employer.
Of course with Obamacare thats not supposed to happen. We’ll see.
Cost comparison Colonoscopy With insurance I pay $50 to see the specialist and $50 for the anesthesiologist in office setting. After fighting with the insurance company that the anesthesiologist was supposed to be cover. That was a $1200 hit if it wasn’t. The tissue samples went to a lab that was not cover by my plan $400+ hit there.
So I got shafted twice one under medical care then under insurance care.
Germany same procedure 650 Euros. No hassles. More expensive no. Because here my insurance is $30/ month Im not paying $600/month with all the BS associated with it. I could opt for pvt insurance here and everyone loves private insurance no wait or anything cost $400/month. Its worth it not to be hassled.
So Ill admit it Im not the average American when it comes to wealth but what I see going around me (in the US) is just plain wrong.
By the way MR scans are being contracted out at $4-500 with insurance companies. I doubt that you had contrast so if your insurance paid more than $800 it would have been unusual. Remember its not what they charge its what the Docs get paid unless you have no insurance than youll pay full boat, the $3000.
Thank god the US system has changed for the better – a bit.
I saw a documentary the other day about poor people who have no chance getting a transplant or comparable high tech treatment, and simply die. And they die for ilnesses that can be cured.
As much as i love the USA – Europe’s social networks do have advantages when you’re poor.
This is much too complex an issue to deal with on a flying website, particularly a European website. I will throw in my opinion that the US system has changed, for the worse. I am still happier with US health care than what I’d get in Europe, but less so than before.
Self employed people like a friend of mine who has a successful US aircraft parts business are not happy. My friend is really very angry that his health insurance policy was by law cancelled as ‘substandard’, like so many other self employed people. He and his wife liked what they had, i.e. good care on terms they liked, but lost their first choice and are now paying much more to buy what they’d prefer not to buy. The insurance companies are as happy as can be with the political deal they made with the Feds.
Re employer supported health care. I made some choices in employer that are helpful, and in doing so limited my salary to that of a employee. I like making choices and that one worked for me when my total worldwide resources were about $100 in the bank, maybe $125 
My ultimate long term choice for health care, after leaving regular employment (30 years later) would be 100% cash payment under a high insured deductible, say $10,000 per year… as I understand it insurance of that type has been made illegal now. Its very sad for me to see real choice disappear and be replaced by regimentation that’s unwanted by most people in the US. We’ll see if that can’t be politically turned around again going forward.
Oddly enough my wife has a bad UTI today (too much info, I know…) and I’ll be taking her to get some antibiotics in a few hours. In these circumstances I have 31 insured options for extended hours urgent care within 20 miles, I just printed them out, but I typically choose a very good hospital, one that attracts patients literally world wide. Overkill, and that’s fine with me. It’s the benefit of being a 9-5 guy on a salary, one that I chose and will use today.
Overkill isn’t always fine though. Take the example of a CT head scan to look for a bleed on the brain… The chances of killing a kid by scanning them are actually pretty high – the chances of causing a cancer are probably in the range of 1/2000 to 1/4000 per scan. That might not sound like much, but every kid bumps their head at some point – probably more than once, so unless you set the threshold for scanning reasonably high you’re going to kill quite a lot of people. As you get older the risks are lower, but still substantial.
A more alarming example – if you have chest pain, a CT scan to look for a pulmonary embolism might cause one extra cancer for every 80 scans in a 20 year old. I’ve not counted, but I’ve probably ordered that many.
Antibiotics for older people who are a bit chesty – significant chance of causing a fatal Clostridial infection.
Certainly in the UK we are considerably more frugal with CT scans. In 2005 we did 0.05 scans per year per patient, whereas in the USA it was 0.25.
Medical ‘care’ is dangerous – you want the right amount of it; neither too much or too little.
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My prejudice against private healthcare is that everything it touches seems to get complicated, sometimes by ulterior motives:
e.g. A flatmate got expensive laser treatment for her verrucas in Taiwan. She couldn’t walk properly for a few weeks. Knowing that the virus that causes verrucas is related to the one that causes cervical cancer, she had asked whether she was at risk of cancer because of them. ‘Yes’ came the reply. I suppose it’s not impossible, but I’m fairly sure there’s no evidence for this and even less evidence for the idea that cancer can be prevented by lasers. In any case, the verrucas came back.
A British national working in Africa used to make regular trips to the UK to have CT scans to look for any recurrence of his very treatable cancer. As he was getting older and finding the trips increasingly wearying he sold up and moved to the UK where he was seen on the NHS and immediately discharged from follow-up – entirely appropriately.
Young lady falls from a horse and needs her ankle fixed. She has insurance to have the operation done privately, but finds that it doesn’t cover the cost of her staying in hospital whilst waiting for the operation. Neither does it cover the cost of the ambulance to take her from the National health service hospital to the private hospital. She ends up having her surgery carried out by the same surgeon she would have seen on the NHS but in a hospital with nicer decor, which she only stays in briefly because she’s discharged home the day after.
Local NHS hospital contracts scans out to a private hospital joined by a corridor. Neither the private nor public hospital porters can agree on whose responsibility it is to push the patients down this corridor, so the NHS junior doctors end up doing it.
The NHS has its own problems, but at least as a clinician you can, within reason, say ‘what does my patient need?’ then do it without regard to cost. And you don’t get paid any more or less if you choose not to do a test. Game theoretically speaking, I think this arrangement where your only incentive is to do well by your patient, is a good way to optimise treatment.
Also, I think money is more likely to get spent on the right things i.e. healthcare. Patient satisfaction with their treatment is often based on features such as ‘hotel services’ and doesn’t always correlate very well with actual health outcomes. Unfashionable as it may be to say so, to work well, doctors need the freedom to disregard consumer preference from time to time in order to provide good care and avoid causing harm.
Incidentally, this is a link to our guidelines for CT scanning:
Specifically:
For adults who have sustained a head injury and have any of the following risk factors, perform a CT head scan within 1 hour of the risk factor being identified:
GCS less than 13 on initial assessment in the emergency department.
GCS less than 15 at 2 hours after the injury on assessment in the emergency department.
Suspected open or depressed skull fracture.
Any sign of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign).
Post-traumatic seizure.
Focal neurological deficit.
More than 1 episode of vomiting.
A provisional written radiology report should be made available within 1 hour of the scan being performed.
For patients (adults and children) who have sustained a head injury with no other indications for a CT head scan and who are having warfarin treatment, perform a CT head scan within 8 hours of the injury. A provisional written radiology report should be made available within 1 hour of the scan being performed.
as a p.s. I hope your wife is feeling better soon.
Thanks much for the well wishes. I’m writing this from the pharmacy/chemist, picking up Cipro for the lady. I’m bored Obviously for every medical opinion (regardless of source) there is a learned counter example and that’s what medical journals are for. The UK NHS is well known for its approach. My own opinion is based among other factors on having two close relatives die due to very clear under care. I don’t see that happening to me because I take an active role in actively managing my body, and don’t trust any single source of data, something I think intelligent consumers of medical care everywhere have learned to do.
Factual data FYI, $35 total cost to me today, relatively high because our insurance allows total flexibility in seeing any doctor, any time. I’m happy with that, and the ability to listen to many well paid professional opinions before forming my own.
PS Every time somebody in the house feels ill or even worried, the huge geriatric dog gets pronounced digestion problems. Today is no exception. What a life we lead…
I guess most people writing in this forum are highly paid professionals. That kind of people won’t have problems with healthcare under any system, so maybe our personal experiences are not the best basis for a discussion of the relative merits of how it is done in different countries…
Airborne….Thats only true if you are on the outside looking in. Which I am regarding other types of Medical models. My experiences within the US model has been as both a provider and as an Insurance company board member. The perspective I have is unique because few have the opportunity to observe and participate on both sides of the aisle.
I am infinitely familiar with US healthcare, pre Obamacare. I do know the system he, Obama, eventually set up, basically favors the insurance companies. That is why all the small business owners are unhappy. The previous model favored the small business owner initially which eventually became unsustainable. Yes while the small business owner had better insurance for themselves but their employees had a much worse system as the years went by to the point the employees had insurance only in name. Eventually even that went by the wayside. Why is everyone hired as part time workers? Even the hospitals are not hiring full time but part time employees. No Benefits! No sick days, no vacation, no healthcare, did I miss anything else?
By the way Pre Obamacare 20-25% of every premium $ went not to patient care but fees for administering the plan which included profits. That also included hassling the sick.
Well now we’ll see what will happen. Will the US resemble Venezuela where million $ high rise buildings rise above the slums below or will it be a society like Switzerland which although boring is a place you can live.
