Meme - "KEEPING MARRIAGE STRONG » LOVE IN MARRIAGE
How To Keep Your Husband Satisfied
1 Dress Like a Nurse so he can live the ultimate fantasy of pretending he has healthcare"
The Affordable Care Act Made Health Care (Slightly) More Affordable - "even a half-trillion dollars over a decade doesn’t have much impact on aggregate health care spending, which in 2018 reached 3.6 trillion dollars"
The Amish Health Care System - "If they’re healthier, why is their life expectancy lower? Possibly they are less interested in prolonging life than we are... the average American spends between five and ten times more on health care than the average Amish person... the Amish community bargains collectively with providers to keep prices low... the Amish are honorable customers. This separates them from insurance companies, who are constantly trying to scam providers however they can. Much of the increase in health care costs is “administrative expenses”, and much of these administrative expenses is hiring an army of lawyers, clerks, and billing professionals to thwart insurance companies’ attempts to cheat their way out of paying... Amish don’t go to the doctor for little things. They either use folk medicine or chiropractors... the Amish never sue doctors. Doctors around Amish country know this, and give them the medically indicated level of care instead of practicing “defensive medicine”... the Amish don’t make a profit... I don’t want to overemphasize this one – people constantly obsess over insurance company profits and attribute all health care pathologies to them, whereas in fact they’re a low single-digit percent of costs (did you know Kaiser Permanente is a nonprofit? Hard to tell, isn’t it?) But every little bit adds up, and this is one bit... the Amish don’t have administrative expenses... the Amish feel pressure to avoid taking risks with their health... Amish try not to overspend on health care. I realize this sounds insulting – other Americans aren’t trying? I think this is harsh but true. Lots of Americans get an insurance plan from their employer, and then consume health services in a price-insensitive way, knowing very well that their insurance will pay for it. Sometimes they will briefly be limited by deductibles or out-of-pocket charges, but after these are used up, they’ll go crazy. You wouldn’t believe how many patients I see who say things like “I’ve covered my deductible for the year, so you might as well give me the most expensive thing you’ve got”, or “I’m actually feeling fine, but let’s have another appointment next week because I like talking to you and my out-of-pocket charges are low.”... Careful price-shopping can look very different from regular medical consumption. Several of the articles I read talked about Amish families traveling from Pennsylvania to Tijuana for medical treatment... a pharma company took clonidine, a workhorse older drug that costs $4.84 a month, transformed it into Lucemyra, a basically identical drug that costs $1,974.78 a month, then created a rebate plan so that patients wouldn’t have to pay any extra out-of-pocket. Then they told patients to ask their doctors for Lucemyra because it was newer and cooler. Patients sometimes went along with this, being indifferent between spending $4 of someone else’s money or $2000 of someone else’s money... Why did health care prices start rising?... The increase started around the same time that health insurance began to spread."
The Complex Relationship between Cost and Quality in US Health Care - "Much of the evidence that variation in health care treatment intensity (including the number or concentration of diagnostic tests, physician visits, hospitalizations, and procedures) is weakly related to quality comes from the Dartmouth Atlas of Health Care. In a landmark study, researchers from the Dartmouth Institute for Health Policy examined patients hospitalized between 1993 and 1995 for hip fracture, colorectal cancer, or acute myocardial infarction, as well as a representative sample of Medicare enrollees in their last 6 years of life, and determined each cohort member’s exposure to different levels of spending on end-of-life care... More recent evidence suggests, however, that higher-intensity care may, in fact, improve patient outcomes... Amber Barnato interpreted these results as meaning that “better hospital quality improves safety (e.g., survival conditional upon hospitalization), but it does not improve population health (e.g., longer life expectancy or slowed functional decline)”. While the United States medical workforce has extensive specialty expertise in intensive medical treatments, the current health care system may fail to prioritize low-cost, low-intensity health care interventions (for example, vaccinations) that could dramatically improve overall public health... expensive new therapies are adopted without good evidence that they improve patient outcomes. A recent example comes from the approval of new cancer drugs, which can cost well over $100,000 per year and are often expected to extend life for little more than a month. Once approved, many treatments—while cost-effective in some cases—are given to patients who have little to gain from them. For example, a study by Tu and colleagues showed that, despite similar survival outcomes, rates of coronary angiography, angioplasty, and bypass surgery following a heart attack were 5 to 10 times higher in the United States than in Canada. Another reason why spending is not highly correlated with quality is that the price of the same service varies... Variation in prices paid by private insurers is due largely to bargains struck with doctors, rather than quality of care."
Many people confuse output (here, money spent) with outcome. So many defenders of the US healthcare system pretend spending more means they're getting better care
Taiwan tops the expat health care charts - "Nearly seven in 10 expats in Taiwan say they spend less on health care than they used to before moving – compared with a global average of just three in 10. Meanwhile almost two-thirds say they enjoy a higher quality of health care in Taiwan than they did at home, against a global average of less than four in 10. Runners-up on the chart produced by HSBC showing affordable and cheap countries in terms of care were the UK, Thailand, Japan and Saudi Arabia. At the opposite end of the scale, expats in Brazil, New Zealand, Ireland and the USA complained that they have to put up with expensive and poor quality health care."
The US is rated as having expensive, low quality healthcare. So much for the best healthcare system money can buy
How Taiwan built “Medicare for all” and gave everyone health insurance - "In the 1990s, Taiwan did what has long been considered impossible in the US: The island of 24 million people took a fractured and inequitable health care system and transformed it into something as close to Sen. Bernie Sanders’s vision of Medicare-for-all as anything in the world... About 1 percent of its funding is spent on administration, according to a 2015 review by Cheng. (Compare that to the US, where researchers have estimated that private insurers spend around 12 percent of overhead, and hospitals spend around 25 percent on administrative work.) Experts say Taiwan’s advanced IT infrastructure deserves a good share of the credit... Health spending has stayed flat in recent years as a percentage of GDP, and it is growing at a slower rate in Taiwan than in the United States. What it all adds up to is a system that patients seem broadly happy with... because Taipei has a lot of traffic accidents, injured drivers and pedestrians come through his emergency department’s doors all the time... Taiwanese hospitals and clinics are understaffed compared to the rest of the world: There are about 1.7 doctors in Taiwan for every 1,000 patients, which is well below the average of 3.3 in other developed countries. There are especially shortages of specialists in less urbanized parts of the country. “Taiwan’s low ratios would be considered inadequate by OECD standards,” Tsung-Mei Cheng wrote in 2015, “especially in view of the high utilization of health care services in Taiwan.” The country does excel at keeping wait times short for services like cataract and hip replacement surgeries. But providers are feeling the strain... Even though Taiwanese patients get a good deal on health care, they don’t come across as entitled... single-payer has clearly improved Taiwanese lives. One metric tells the tale: a rating based on medically amenable mortality, which gives a sense of how often people die of causes for which medical interventions should be available. In 1990, before Taiwan’s single-payer program was implemented, the country held a rating around 60, far behind the United States’ rating of 80. In 2016, Taiwan had nearly caught up with the US, topping 85; the US sat at 88, trailing its socioeconomic peers in Europe... Taiwan spends 6 percent of its GDP on health care, about a third of what the United States does... When I said I was an American reporting on health care, he told me a story. He had a Taroko friend in Los Angeles who broke his arm, he told me, with a government health worker interpreting. Rather than get it fixed in the United States, his friend decided to fly back to Taiwan and have it mended there because he said it would be cheaper."
Clearly Taiwan is a small, homogenous ethno-state, something run by a government will always be inferior to it run by the private sector and in a country with a lot of traffic deaths, universal coverage will never work
Emergency Department Crowding: The Canary in the Health Care System - "Emergency department (ED) crowding is a widespread problem and a source of patient harm. While such crowding may be inaccurately considered a problem of ED operations and inefficiency, in truth, ED status is the sentinel canary in the coal mine — reflective of not just individual department performance or even individual hospital performance, but of health system dysfunction throughout the United States... Even prior to the Covid-19 pandemic, greater than 90% of U.S. EDs found themselves stressed beyond the breaking point at least some of the time. Many remain overwhelmed daily."
I thought US healthcare was superior
No, Medical Errors Are Not the Third Leading Cause of Death - "The supposed fact that medical errors are the third leading cause of death in the United States has become a meme, spreading virally through society from the scientific literature to the evening news. As they're repeated within the scholarly community and popular media, estimates in the range of 200,000-400,000 deaths per year look like settled science. But the methodology applied to arrive at these estimates published in multiple scientific journals falls short of the rigor needed for such an important topic... Medical error death rates extrapolate from small samples, generalize local data to national contexts, ignore the limited life expectancy of many patients, and gloss over the myriad uncertainties in defining error, preventability, and causality... "those who have a financial or philosophical agenda to discredit physicians can bolster their arguments if they seem to originate from within the medical community." Inaccurate memes also pose a risk because they anchor us to higher estimates, producing unwarranted skepticism over more realistic calculations. When our article came out, we received immediate criticism from patient safety activists. One person even seemed to ask us to prove a negative — that medical errors were not the third leading cause of death. Because medical errors are underreported, it's easy to cling to inflated estimates rather than accept gaps in our knowledge. Shojania and Dixon-Woods call this "the bottomless well of medical error" in their BMJ Quality and Safety critique."
Do Prescription Drugs Really Have to Be So Expensive? - The Atlantic - "How is it that pharmaceutical companies can charge patients $100,000, $200,000, or even $500,000 a year for drugs—many of which are not even curative?... On average, citizens of other rich countries spend 56 percent of what Americans spend on the exact same drug. Excessive drug prices are the single biggest category of health-care overspending in the United States compared with Europe, well beyond high administrative costs or excessive use of CT and MRI scans. And unlike almost every other product, drug prices continue to rapidly rise over time. HHS estimates that over the next decade, drug prices will rise 6.3 percent each year, while other health-care costs will rise 5.5 percent. Basic economic principles suggest that drug prices should be going down, not up: For most drugs, manufacturing volumes are increasing, and little new research is being conducted on those already on the market. Reducing these high drug prices has become a major political concern—and a rare bipartisan cause for Democrats and Republicans to rally around, albeit with disagreement about how to actually get it done... Yet every time Congress debates doing something about drug prices, the industry—and the advocacy groups it funds—vociferously returns to the point that lower prices will thwart innovative research. The fear of missing a cure for Alzheimer’s or Lou Gehrig’s disease or depression contributes to stalling reform. But there are many reasons to question the widely held notion that high drug prices and innovative research are inextricably linked... the top 20 best-selling drugs in the United States to the prices in Europe and Canada. They found that the cumulative revenue from the price difference on just these 20 drugs more than covers all the drug research and development costs conducted by the 15 drug companies that make those drugs—and then some... Drug companies tend to say they are unique in needing to spend a higher proportion of their capital on research than almost any other industry. But of all the companies in the world, the one that invests the most in research and development is not a drug company. It’s Amazon... Amazon’s operating margin is under 5 percent. Meanwhile, the top 25 pharmaceutical companies reported a “healthy average operating margin of 22 percent” at the end of 2017... If you watch television, you know part of the answer to where this extra money is going: sales and advertising. Of the 10 largest pharmaceutical companies, only one spends more on research than on marketing its products... The pharmaceutical industry and its advocates tend to peg the cost of creating and bringing to market just one new drug at $2.6 billion. This figure comes from a cost report published in October 2016 by the Tufts Center for the Study of Drug Development. There are several reasons to suspect that number is unreliable... in November 2017, a study published in JAMA Internal Medicine examined the costs of developing 10 cancer drugs approved by the FDA from 2006 to 2015 and provided a strong contrast to the Tufts study from a year before... $757 million—less than a third of the Tufts estimate. Pharmaceutical companies often claim that the research costs of unsuccessful drugs also have to be taken into account. After all, 90 percent of all drugs that enter human testing fail. But most of these failures occur early and at relatively low costs... some former pharmaceutical-company executives say that research costs do not determine drug prices... Exorbitant drug prices have two bad effects. First, high costs mean that lots of patients are unable to take their medications. A recent study in the Journal of Clinical Oncology assessed patients’ access to 38 different oral cancer drugs and found that 13 percent of cancer patients did not buy approved chemotherapy drugs if they had a co-payment of $10 a month, while 67 percent did not when they had to pay $2,000 or more. Another study showed that 25 percent of diabetic patient underuse their insulin because of cost. Second, the high drug prices distort research priorities, emphasizing financial gains and not health gains... many of the drugs that companies are pursuing have low promise, where the health gains are small—weeks of added life, not big cures. While even this short extra time can be valuable to individual families, too much investment in oncology means not enough in drugs for other illnesses whose treatments cannot be so highly priced. Consider antibiotics. The Centers for Disease Control and Prevention ranks antibiotic-resistant infections as one of the nation’s top health threats... the standard economic response to monopoly pricing: price regulation. Every other developed country regulates drug prices, often through price negotiations pegged to cost-effectiveness analysis or some other measure of clinical benefit."
Violet Thee Gamemaster on Twitter - "You can tell that Wolverine is a Canadian character written by an American because his super power is healthcare"
Harold Pollack on Why Managing Your Money Is as Easy as Taking Out the Garbage - Freakonomics - "POLLACK: I think probably we need to pay the medical system less for a lot of the services that we provide in the richest part of our health system. And we need to pay more in the poorest parts of our health system... Biogen, for example, has a recent Alzheimer’s drug that was just approved by the F.D.A. within the past week or so. Average annual tab, it’s predicted to be $56,000 per patient. Three of the F.D.A’s scientific advisors quit over the approval. It has really not been reliably shown to benefit patients and the cost effective price for that medication was judged by an independent group called ICER a more reasonable price wouldn’t be $56,000 be more like $8,300. And we spend so much more than any other country per-capita on healthcare and we just don’t get the kinds of outcomes that we need to, and we don’t focus the resources on the public health problems and on the poverty problems that lead so many Americans to have very serious health problems... According to the New York Times, there’s a prediction that by 2025, this company — their revenue from this drug is going to be $7.5 billion a year. The C.D.C., its total budget for emergency preparedness and response is $842 million. So, there’s one unproven drug we’re going to spend about nine times as much on that drug as we spend on emergency preparedness for the next Covid. Our healthcare system is filled with things like that."
The superior US healthcare system strikes again. Of course, it must all be the fault of government regulation
N.Y. woman charged $40 for crying during doctor's appointment - "“She has a rare disease so she’s been really struggling to find care,” big sister Camille Johnson said in a tweet thread. “She got emotional because she feels frustrated and helpless. One tear in and they charged her $40 without addressing why she is crying, trying to help, doing any evaluation, any prescription, nothing.” “They charged her more for crying than they did for a vision assessment test. “They charged her more for crying than for a hemoglobin test. “They charged her more for crying than for a health risk assessment. “They charged her more for crying than for a capillary blood draw,” Johnson pointed out with her own frustration at the affront... it appears this young woman did not get the service she was billed for. “A brief emotional/behavioral assessment is a mental health screening that tests for signs of attention-deficit/hyperactivity disorder (ADHD), depression, anxiety, suicidal risk or substance abuse,” the Post wrote. “It is usually issued as a questionnaire that is often handed out and filled in before seeing the doctor. “Doctors have been testing and charging for the test since 2015 when it became a federal mandate as part of the Affordable Care Act ‘to include mental health services as part of the essential benefits that must be included in all insurance plans offered in individual and small group markets.’” Johnson told The Independent that her sister was never evaluated. She claimed that the doctor at the unnamed medical facility noticed her sister’s tears but said nothing."
Why Europeans Don’t Get Huge Medical Bills - "One reason insurance companies get a bad rap is that they’re associated with “surprise medical bills.” These billing nightmares occur when insured patients go to a hospital they thought was in-network, but then—sometimes inadvertently—see a doctor who is out-of-network while they’re there. (This is on top of the exorbitantly high medical bills that many uninsured people receive, no matter what doctor or hospital they go to.) When stories come out about surprise medical bills, people tend to blame insurance companies right away. They should have covered that MRI! They should be less greedy! (Until they learn that insurers’ profit margins aren’t that stellar, and that doctors often make the call about whether to be in-network.) There is, however, a way to eliminate those bank-busting surprise medical bills without eliminating health insurance. Just ask Europe. Several European countries have health insurance just like America does. The difference is that their governments regulate what insurance must cover and what hospitals and doctors are allowed to charge much more aggressively than the United States does... Almost all Germans are covered by a variety of health insurance, such as “sickness funds,” which are financed through taxes... A very small number of the country’s physicians are private and don’t accept the sickness funds, but they have to tell patients how much they’ll charge before a patient is treated, removing the surprise element. In France, there are no provider networks, so no doctor can be “out-of-network.”... Doctors have to post their fees on their walls, and you can ask how much the visit will be before you book an appointment. In the United States, it’s easier to find out how much it costs to park at a hospital than to get an electrocardiogram there. In France, the general rule is “the sicker you are, the better your coverage,” Dutton says. If you get hit by a car, the public health insurer picks up more of your tab than, say, if you’re getting acne treatment. There are still some downsides to the health-care systems of these countries, but they are generally considered better than that of the United States. And yet, unlike the United Kingdom or Canada, where health care is government-paid, these countries achieved this while relying primarily on health insurers. In doing so, they provide a potential path forward for Americans who would like to see an end to medical-billing horror stories without doing away with the health insurance they’ve come to know and love—or at least know and fear the absence of."
Weird. I thought regulation only ever makes things worse
How Much More Than Medicare Do Private Insurers Pay? A Review of the Literature - "Private insurers paid nearly double Medicare rates for all hospital services (199% of Medicare rates, on average), ranging from 141% to 259% of Medicare rates across the reviewed studies... Across all studies, payments from private insurers are much higher than Medicare payments for both hospital and physician services"
Some Americans insist that government-funded healthcare costs more than privately-funded healthcare
The Growth Of Administrators In Health Care - "According to one study, the United States spends 39% more on administrative costs compared to Canada in 2011. I think it’s interesting that each year physicians make the news about potential cuts to reimbursements. However, outside of the doctors lounge, no one really talks about administrative costs. I will admit, the problem is not black and white. Grouping all administrative jobs together as unnecessary would be a gross over exaggeration. However, a 63% increase in number of jobs over the last 9 years points to a very quickly expanding market!"
Multiple studies show Medicare for All would be cheaper than public option pushed by moderates - "the average American pays $2,597 per year on administrative costs — overhead for insurers and hospitals, salaries, huge executive compensation packages and growing profits — while Canadians pay $551 per year. Though Canada had costs similar to the United States and worse health outcomes before it adopted its single-payer system in 1962, Canada now has better health outcomes than the United States and only spends 17% of its health care spending on administrative costs, compared to 34% in the U.S... the savings in administrative costs alone would be enough to eliminate "all copayments and deductibles" and still "have money left over."... While critics have claimed that the proposal would lead to "rationing" of health care, a recent Federal Reserve survey found that roughly a quarter of "adults skipped necessary medical care in 2018 because they were unable to afford the cost." Millions of Americans have been forced to ration their insulin or avoid calling an ambulance in emergencies due to sky-high costs, including those who have insurance. Critics also argue that wait times for care are longer in countries with single-payer systems, but a 2017 survey found that wait times have already increased in the United States by 30% since 2014 under the current system. Critics have claimed that Medicare for All would lead to people abusing the free health care system. But a study published in the Journal of General Internal Medicine in November showed that use did not generally increase in countries that moved to single-payer systems."
22 studies agree: ‘Medicare for All’ saves money - "All of the studies, regardless of ideological orientation, showed that long-term cost savings were likely. Even the Mercatus Center, a right-wing think tank, recently found about $2 trillion in net savings over 10 years from a single-payer Medicare for All system. Most importantly, everyone in America would have high-quality health care coverage. Medicare for All is far less costly than our current system largely because it reduces administrative costs. With one public plan negotiating rates with health care providers, billing becomes quite simple. We do away with three-quarters of the estimated $812 billion the U.S. now spends on health care administration. Administrative costs are so high because thousands of insurance companies individually negotiate benefit rules and rates with thousands of hospitals and doctors. On top of that, they rely on different billing procedures — and this puts a costly burden on providers. Administrative savings from Medicare for All would be about $600 billion a year. Savings on prescription drugs would be between $200 billion and $300 billion a year, if we paid about the same price as other wealthy countries pay for their drugs. A Medicare for All system would save still more with implementation of global health care spending budgets. Even more savings are possible in a Medicare for All system because, like every other wealthy country, we would have a uniform electronic health records system. Such a system generates additional savings because system problems would be easier to detect and correct. A uniform claims data system helps reduce health care spending for fraudulent services... Yes, it’s true that some other wealthy countries rely on “private insurers” to provide benefits and spend far less than we do on care. But, these insurers do not operate in any way like health insurers in the U.S. Other wealthy countries dictate virtually every element of the health insurance people receive, including what’s covered, what’s paid, and people’s out-of-pocket costs — all identical for everyone. The insurers operate like claims processors or bill payers. They follow the coverage and payment rules set by the government, nothing like the private health insurers in the U.S. which revel in product diversity (read: complexity and confusion). And, if you’re thinking that having the federal government guarantee coverage to all Americans is a big deal, it’s actually not. The government already pays for about two-thirds of health care costs. Among other things, it pays for Medicare, Medicaid, VA, TriCare and a wide range of state and local health care programs, along with private insurance for government employees and tax subsidies for private insurance."
Medicare Is More Efficient Than Private Insurance - "Medicare Has Lower Administrative Costs Than Private Plans...
So-called “competition” in the private health care market has driven costs up.
In most local markets, providers have monopoly power. Consequently, private insurers lack the bargaining power to contain prices...
Medicare Is Publicly Accountable, Private Plans Are Not"
One cope is that the high cost of insurance is the government's fault, because insurance companies cannot compete across state lines. Ironically, these seem to be the same people who are very big on states' rights. In any event, some US states have more people than many countries with cheaper healthcare, so
