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Healthcare Education and Q&A Thread

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Old 07-02-2009, 06:11 PM   #31
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Re: Healthcare Education and Q&A Thread

you say other countries do not allow civil settlements in doctors error. what happens in those countries when mistakes are made?
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Old 07-02-2009, 09:32 PM   #32
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Re: Healthcare Education and Q&A Thread

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you say other countries do not allow civil settlements in doctors error. what happens in those countries when mistakes are made?
Don't know, I guess that would be a legal question. I wonder if any lawyer types know what the deal is in other countries.
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Old 07-02-2009, 09:33 PM   #33
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Re: Healthcare Education and Q&A Thread

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Here's a pretty detailed analysis of the WHO's most recent survey (from a few years ago, which ranked us 37th). PR-2000-43/ WORLD HEALTH ORGANIZATION : ASSESSES THE WORLD'S HEALTH SYSTEMS Looking online it seems like a lot of people have criticized the methodology of this particular ranking, so I'd be interested to hear your take.

Your first observation makes sense but I can't find any information online suggesting that the US has a high cost of living relative to other industrialized nations. Are you sure about this? Speaking anecdotally, it has been my experience from traveling that the cost of living - or at least the cost of things I buy like food and beer - is way higher in other industrialized countries than the US, and I am including Japan, Germany, France, England, Spain, and the Netherlands on this list. Speaking from experience I can tell you that Japan is significantly higher than the US pretty much anyway you measure it. Most information online ranks cities instead of countries (usually putting NYC around 20th in the world) but here's one I found ranking countries across several categories, with the US being pretty average in every category Cost of Living Index By Country

So anyway, while cost of living might explain how Colombia ranks higher than us, unless I'm missing something I really don't think it's true that the US has a high cost of living relative to the EU and the most developed Asian countries.
I'll take a close look at that survey and weigh in.

On cost of living, the question really is what to doctors and nurses get paid in those other countries. I am under the impression it's less, though admittedly I'm not certain; I know a lot more about our healthcare system than I do that of other nations.
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Old 07-03-2009, 09:13 AM   #34
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Re: Healthcare Education and Q&A Thread

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If I'm correct I think my buddy said he pays 85,000 a year for malpractice ins. and it might have been even more than that.
Wow. I wonder if that's the average, or if your buddy has a habit of amputating the wrong limbs.
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Old 07-03-2009, 11:07 AM   #35
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Re: Healthcare Education and Q&A Thread

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MY buddy said he has only been sued once and he admitted that in that case he did make a mistake but that was like 8 years ago. He is the guy they call in to put you back together after a bad accident and he also has a practice which specializes in sports injuries. He does the emergency type stuff because he likes that type of work and he jokes by saying motor cycle riders paid for his house.
Sounds like an Orthopedic Surgeon. They suffer one of the higher malpractice premium rates, probably second highest to obstetricians.

Our Orthopedic Surgeons get paid about $350,000 plus incentives, and then the Medical School pays for their malpractice coverage, about $60-$70K per doc on average. $85K does not sound unreasonable, the only reason our medical school docs have a lower premium is because they're getting a "group rate" of sorts.

Obstetricians deal with about $100K apiece.

Malpractice costs aren't some buzzword or hot button issue; it's a serious problem.
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Old 07-03-2009, 02:07 PM   #36
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Re: Healthcare Education and Q&A Thread

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Yes Orthopedic Surgeon is right I just could not think of what he was called when making the post. I'm sure he makes around that figure himself but I'll have to say the guy puts in alot of hours and works hard for every penny he makes.
There's a nationwide shortage in Orthopedic Surgeons, and for good reason. It's hard as hell to be skilled enough to do it, malpractice is high, and the hours are a bitch (especially for trauma sub-specialists like your buddy). He probably gets paged in the middle of the night to put people back together.

Even non-trauma sub-specialties like Hand, Joint Replacement, Spinal Fusion, they all take incredible skill. Hard to make it as an orthopedic surgeon.
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Old 07-03-2009, 05:25 PM   #37
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Re: Healthcare Education and Q&A Thread

Here's another question -- with a finite supply of doctors, and no more than the usual number of new med students entering the field, what will it mean to instantaneously add 47 million Americans to their workload?
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Old 07-03-2009, 11:15 PM   #38
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Re: Healthcare Education and Q&A Thread

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Here's another question -- with a finite supply of doctors, and no more than the usual number of new med students entering the field, what will it mean to instantaneously add 47 million Americans to their workload?
First, it should be noted that those 47 million you're speaking of (the uninsured) currently do get care in the form of emergency care. If they have a heart attack they don't stay away from the ER.

But on the elective and preventative side, you're right, docs will see a huge influx. With no increase in the supply of capable physicians, but a large increase in demand, you'll see prices for appointments going up significantly. You'll call to request an appointment for this week and will be surprised when they tell you they don't have an open appointment for 3 weeks.

You'll also see physicians move about the country. When those 47 million people become insured, suddenly having a physician practice in the inner city isn't such a bad proposition. Physicians will relocate to fill voids in underserved locations, fleeing from now well-insured but competitive locations.

Short answer: things get a lot better in the poor neighborhoods, but a lot worse in the well-to-do neighborhoods.
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Old 07-06-2009, 08:58 PM   #39
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Re: Healthcare Education and Q&A Thread

Came across this article, thought it a very worthwhile read. It presents both sides' views on the Canadian healthcare system.

Reality check: Canada's government health care system - CNN.com

The realities are:

- Canada does have a longer life span and they spend less on healthcare. This does not at all mean you can conclude they have a better healthcare system, because A) they're not nearly as obese as the US and B) their docs & nurses make less than ours and their patients exhibit lower healthcare utilization.

- Access to care is restricted due to a shortage of physicians and an overabundance of citizens with healthcare coverage. If you're in shitty shape, with a brain tumor or something, you'll get seen swiftly. But if you're just dealing with something painful, like a knee replacement, you've got to wait 3 months. This results in lower healthcare costs because many people say 'ya know what, screw it, seeing a doctor isn't worth it.' In other words, Canada's lower healthcare spend is not so much due to lower costs, it's due to simply not going to the doctor.

This speaks to the issue we began trying to define in this thread: what does "quality" healthcare mean? Is it good enough to provide a balance between life-saving treatments, coping with pain as you wait for non-life-saving treatments, and lower costs? Or like everything else in the world, will we Americans demand more? Ask yourself, are you OK with waiting 3 months for a procedure to replace a hip or knee?

If we demand more, we better be ready to pay for it.
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Old 07-07-2009, 12:20 PM   #40
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Re: Healthcare Education and Q&A Thread

For those interested where the overall national healthcare expenditure went and where it came from you might be interested in this chart produced by the United States Department of Health and Human Services.
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Old 07-07-2009, 07:47 PM   #41
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Re: Healthcare Education and Q&A Thread

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For those interested where the overall national healthcare expenditure went and where it came from you might be interested in this chart produced by the United States Department of Health and Human Services.
This is actually very helpful for illustrating a point, thanks for posting.

You'll see on slide 2 of saden's link, it shows that 19% of healthcare spending was paid for through Medicare, and 15% through state Medicaid programs. Combined, that's 34% of the nation's healthcare spending from government programs.

Government budgets are suffering right now, and Obama's budget includes minimal increases in reimbursement from Medicare. State budgets are even worse off, and most aren't increasing reimbursement at all.

Overall, healthcare expenses are growing 7% per year. But, as noted, no increases are expected to come from the government. This means the rest of the payers need to fund the entire nation's 7% increase in expenses.

So for those of us not covered by government programs, the increase will feel like a 10.6% increase. We have to carry the government's share of the increase (7% / [1-.34] ) = 10.6%.
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Old 07-07-2009, 08:07 PM   #42
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Re: Healthcare Education and Q&A Thread

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Sneed we currently have an HMO or maybe its called a PPO and the rates have jumped to over $700 per month for a family of three. Me and my wife both have a Life/Health ins lic. but we do not sell any health ins. I have been bugging my wife for the past 2 years to switch over to a health savings plan and after taking a course (she had to take something for continued education requirments) she took a course on HSP and has now agreed to switch. We all have appointments to have everything checked out before we switch over so we will know we are all in good health. Besides having a higher ded. is there anything we should look for in a HSP that we may or may not want? I'd also like your opinion on these plans. My figures show we will save almost $400 a month which we can put into the savings sides which I no are tax defered if used for med. bills. I read something that we may want to work out something with our doctor on billing so we don't pay top dollar for every visit and get billed closer to what they bill ins. co's.
Health saving plans, and other plans with higher deductibles, give you the nice benefit of charging you much less on a weekly/biweekly premium basis than a PPO or HMO program. The catch of course is you have the higher deductible.

Generally, the healthier you are the more a HSP (or any plan with a deductible) will financially benefit you. The sicker you are, the more a HSP will hurt you.

The nice thing with the HSP is any money you don't use on healthcare that year gets socked away to personal savings for you.

I have a PPO plan through my employer which contains a higher deductible & higher copays than traditional PPO/HMO plans. It costs me $61 per paycheck to cover my family, compared to $169 per paycheck under the traditional PPO plan. On my plan, inpatient hospital admissions come with a $2000 copay. That's separate from my deductible, which is $500 per person and $1500 for the family. So if I get admitted to the hospital, first I drop $2000 out of pocket and then up to $500 to cover the admission.

26 paychecks times $61 = $1586 per year for my plan.

26 paychecks times $169 = $4394 per year for the traditional PPO.

The difference between those plans is $2808 deducted from the paycheck on an annual basis. So if one person gets admitted to the hospital, plus we have the typical complement of doctor's visits, they would both work out to about the same total cost after paycheck deductions & out of pocket costs.

Where we'd get crushed is if the whole family got in a car accident or something, and I had to drop the $2000 copay for each family member. So there's more risk there, but I'm an odds guy, and I play the odds that I think are in my favor.

So, key things to look for in your HSP plan:

- Are the hospitals and doctors you anticipate using "in network". If they're not in the plan's network, it could make the plan a bad deal.

- Understand what the annual out of pocket max is for your family. You want to know what is the max you could pay in the disaster scenario I mentioned where the whole family gets in a car accident.

- Going into it, know that you have a cash management issue to deal with. Whatever your deductible is, you need to make sure you have that amount of cash laying around in order to cover deductibles and copays. In my situation, I need to have at least $3000 laying around at all times in order to cover out of pocket costs for a hospital admission & typical doctor visits.

A lot of people forget this, and end up unable to pay out of pocket costs because they failed to manage their weekly budget and wound up in debt.
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Old 07-07-2009, 09:52 PM   #43
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Re: Healthcare Education and Q&A Thread

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This is actually very helpful for illustrating a point, thanks for posting.

You'll see on slide 2 of saden's link, it shows that 19% of healthcare spending was paid for through Medicare, and 15% through state Medicaid programs. Combined, that's 34% of the nation's healthcare spending from government programs.

Government budgets are suffering right now, and Obama's budget includes minimal increases in reimbursement from Medicare. State budgets are even worse off, and most aren't increasing reimbursement at all.

Overall, healthcare expenses are growing 7% per year. But, as noted, no increases are expected to come from the government. This means the rest of the payers need to fund the entire nation's 7% increase in expenses.

So for those of us not covered by government programs, the increase will feel like a 10.6% increase. We have to carry the government's share of the increase (7% / [1-.34] ) = 10.6%.
The 2009 budget allocated 262 billion for Medicaid and 425 billion Medicare. The 2010 Obama budget requests 290 billion for Medicaid (+11% from previous year) and 452 billion for Medicare (+6% from previous year) be allocated.

BTW Bush's original 2009 budget for Medicaid and Medicare had to be supplemented. My 2009 Death and Taxes poster says he originally budgeted 215 billion for Medicaid and 409 billion for Medicare.
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Old 07-07-2009, 10:22 PM   #44
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Re: Healthcare Education and Q&A Thread

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The 2009 budget allocated 262 billion for Medicaid and 425 billion Medicare. The 2010 Obama budget requests 290 billion for Medicaid (+11% from previous year) and 452 billion for Medicare (+6% from previous year) be allocated.

BTW Bush's original 2009 budget for Medicaid and Medicare had to be supplemented. My 2009 Death and Taxes poster says he originally budgeted 215 billion for Medicaid and 409 billion for Medicare.
You're right and I misspoke. He's proposing an increase for 2010, but the budget in place now (calendar year 2009) includes no increase.

Healthcare's fiscal year (including Medicare and Medicaid) runs July - June. As we just now enter FY 2010, there is no increase for either Medicare or Medicaid. But I suppose that stems from Bush's final budget, not Obama's.

There may be increases in FY 2011 thanks to Obama's 2010 budget. Of course to pay for it, an income tax increase will be required. And it's not that reimbursement will go up, it's more likely that more people will covered, resulting in the expected increase.
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Old 07-07-2009, 11:56 PM   #45
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Re: Healthcare Education and Q&A Thread

I have no health care currently and don't want any. If Universal Health Care passes will I be forced to buy something I will never use?

Also, will I be forced to pay for some skank to have her 17th abortion in as many weeks, or will she have to pay for it herself?
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