OT: excess cost in US health care

s 42 through 53. It's title "Overkill: An avalanche of unnecessary medical care is harming patients physically and financially. What can we do about i t".

line - "Waste is not just consuming a third of health-care spending: it's c osting people's lives".

US health care compared with French, German and Dutch health care.

The article is more for entertainment than education. Did they say he pract ices in Canada? Canada looks good on paper but the reality there is not goo d, too formulaic, one size fits all, slow and inefficient system. He also h as a really weird way of linearizing his risk statistics over time which do esn't make sense for many health conditions that can go into avalanche mode quite quickly. He seems to be criticizing American doctors for being too p roactive by way of testing for possible problems before they become symptom atic, problems that, although not directly related to the immediate complai nt, are in fact likely for the demographic they're dealing with.

Over-testing is a consequence of pay-for-coding, and of legal liability. But it does save lives.

I've had three CAT scans, one chest x-ray, and one MRI in the last two months. Can't imagine the retail price for all that stuff.

Head MRIs are really, really boring.

A point the article was making was that it does not in fact save lives in general. By definition really, otherwise it would not be "over-testing".

I expect that a lot of test results are ignored.

But blood chemistry tests and colonoscopies save lives. MRIs can be really useful, in deciding what to do next, which includes doing nothing.

Hi Paul,

Most of my pain has been in my legs and feet, but it radiates from the lower back. It is sciatica, where the sciatic nerve root becomes pinched, irritated, and inflamed.

Only recently have I had pain in the neck and problems with my arms and fingers. The surgery made some symptoms worse, but not debilitating, and they seem to be slowly improving. What has totally disappeared is the shooting pain from my neck down to my butt when I coughed, sneezed, or moved in certain ways.

When the damaged discs are removed, it relieves some pressure on the nerve bundles, and then the surgeon uses a sort of grinder to remove bone spurs and open up the space for the nerves. This opening in the vertebrae is called the foramen, and its partial removal is a foraminotomy. The complete removal of discs is discectomy.

impotence, paralysis, etc.)

I have had some of those problems for a long time, and I'm hoping the forthcoming second operation may alleviate them. However, I was told that I may need to wait a year before getting that done.

much of her back treated similarly (scoliosis). She originally claimed "no difference" but has spent the past year largely pain free. Of course, nerves regrow -- albeit slowly -- so she expects the pain to return.

I heard that nerves regrow about 1 mm per day.

All cases are different and unique. I'd be happy to discuss further details by email or on a forum, although SED may not be the best choice. But it's the only one I check regularly, and I only recently returned after a year or so absence. Maybe it would help others, and I'm glad to make it public.

There is much information on the internet, and several excellent videos (and some not so good) on YouTube:

I consider myself basically a centrist, or a conservative democrat. I think we will need to embrace more socialism as unfettered capitalism is once again proving to be harmful to the majority, and the ultimate unsustainability of continued economic growth will eventually decide our course into the future.

Paul

Den tirsdag den 19. maj 2015 kl. 20.03.12 UTC+2 skrev John Larkin:

depends on how you look at it, if a 100 MRIs saves one life, but the same resources could have paid for 1000 other treatments that saved 100 lives is the resources well spend?

-Lasse

For high strength crowns IIRC they use a different material and fire it in a little kiln- it's all taken care of. No sending it off to a lab, multiple visit, temp fillings etc. unless the underlying stuff is in bad shape and has to quiet down. 3D captures, color 3D CAD to get the bite and appearance just right.. beautiful, and worth paying extra for. Maybe not every existing dentist has the skills..

Try Post-Polio Syndrome... 68 years after the fact... my left hand or left foot will seize into a very painful twisted knot for 30 seconds or so :-( ...Jim Thompson

That's philosophical. Any one of us can give up restaurants and vacations and such and send all our money to Africa and save lives.

Chest MRIs aren't any better and a whole lot more claustrophobic.

ges 42 through 53. It's title "Overkill: An avalanche of unnecessary medica l care is harming patients physically and financially. What can we do about it".

y line - "Waste is not just consuming a third of health-care spending: it's costing people's lives".

of US health care compared with French, German and Dutch health care.

ctices in Canada? Canada looks good on paper but the reality there is not g ood, too formulaic, one size fits all, slow and inefficient system. He also has a really weird way of linearizing his risk statistics over time which doesn't make sense for many health conditions that can go into avalanche mo de quite quickly. He seems to be criticizing American doctors for being too proactive by way of testing for possible problems before they become sympt omatic, problems that, although not directly related to the immediate compl aint, are in fact likely for the demographic they're dealing with.

Fred, you seem to be losing your touch

It's easy to find out that Atul Gawande is deeply embedded in the American

- not Canadian - medical system, and nothing in his article suggests otherw ise.

It's generally accepted that American doctors do too much testing, for cond itions that it wouldn't make sense to do anything about if they found them. Proactive testing for potential problems, like diabetes, can make sense, bu t current American practice is extravagantly over the top.

The Cochrane Collaboration exists to do evidence-based reviews of questions like this, and while Atul Gawande doesn't explicitly refer to their work, his examples of how unnecessary or inappropriate testing can send medical p rofessionals down the wrong garden path do have a very Cochrane Collaborati on tone.

ages 42 through 53. It's title "Overkill: An avalanche of unnecessary medic al care is harming patients physically and financially. What can we do abou t it".

ay line - "Waste is not just consuming a third of health-care spending: it' s costing people's lives".

of US health care compared with French, German and Dutch health care.

actices in Canada? Canada looks good on paper but the reality there is not good, too formulaic, one size fits all, slow and inefficient system. He als o has a really weird way of linearizing his risk statistics over time which doesn't make sense for many health conditions that can go into avalanche m ode quite quickly. He seems to be criticizing American doctors for being to o proactive by way of testing for possible problems before they become symp tomatic, problems that, although not directly related to the immediate comp laint, are in fact likely for the demographic they're dealing with.

The whole point of the article was that it doesn't, and can often produce r esults that disadvantage the patient.

CAT scans should cost a few hundred buck each. The real downside is that ea ch one is 4% of a median lethal radiation dose. Atul Gawande makes the poin t that the US is now doing enough of them to significantly increase one's c hances of getting cancer. The chest X-ray should have been less than a hund red bucks. The MRI should have been roughly twice as expensive as the CAT s can - I recently sat through my second lecture on the technology, and it in volves a lot of expensive electronics, not to mention the super-conducting magnet.

And noisy. My father complained bitterly about the noise. Since I'd sat thr ough my first lecture on the technique (at EMI Central Research in 1979) be fore I'd had my first MRI scan, I knew what the noise was about and found i t less threatening, but still loud.

Not enough, if Atul Gawande is right.

Some testing is justified. The "Overkill" came from the point that great de al more testing is done than is useful. Some of it is simply a waste of tim e, and some of it tells you stuff you'd be better off not knowing. Atul Gaw ande did give examples, which a more skilled reader might have noticed.

So what do you think of the prospect of Obamacare imposing price controls on US drugs?

"Ninety five percent of the new drugs coming on the market are developed for sale in the United States. They are paid for by American consumers, while other countries, such as Canada, Germany and France, free ride at our expense. The United States is the last major country that allows the market to set prices high enough to compensate pharmaceutical companies for their R&D investments. Obama Care will increasingly control pharmaceutical prices as costs rise and federal and state funds fall short. Major pharmaceutical advances will stop (How well will government labs work?), and the rest of the world will lose along with Americans. "

The UK system appears better than most socialist places, but somewhat behind the US in drug production. I wonder how many expensive drugs are just copied by other countries and sold at less than market value?..Why do research if you can get someone else to do it? .

"In 2007 the UK had the third-highest share of global pharmaceutical R&D expenditure of any nation, with 9% of the total, behind the United States (49%) and Japan (15%).[32][33] The UK has the largest pharmaceutical R&D expenditure of any European nation, accounting for 23% of the total; followed by France (20%), Germany (19%), and Switzerland (11%).[32]"

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That's really bizarre. It's nothing to do with blindness or hatred, though I'm certainly dead-set against a president redistributing wealth. Maybe I can shed some light on it for you.

Obama's not creating a more equitable distribution of wealth, Obama's creating enormous inequality--his overspending forces quantitative easing, which inflates the stock market, enriching the rich.

But even if he weren't doing that, it's not the government's job to dictate who gets how much. Politicians have no business making those sorts of decisions.

Who's to say what's 'equitable' and who 'deserves' how much? A little study of history & the theory of governments shows politicians are the worst ones to choose, and when they do their societies go unstable, and tip over.

The American ideal is to make it as easy as possible for anyone to work as hard as they want, to do what they want, and be as materialistic or /not/ materialistic as they choose--whatever fills their heart.

One person might want to work 80 hours a week, another might prefer to earn less and spend more time at home. That's not injustice, that's not inequality, that's freedom.

It's beyond presumptuous for Barack Obama--who himself has not made anything except a book--to redistribute everyone's work.

It's strange that wanting to keep what you created is "greedy and materialistic," yet demanding what other people earned is not.

People are upset because Barack's trying to take their stuff and their (and others') opportunities for a decent life.

I'm very well acquainted with Obamacare, the law, and its workings, and you most likely are not. Obamacare simply takes some people's care, and gives it to other people. That's the core. It's not magic, it's not compassionate, and it drives up cost.

There are a bunch of intrusions into people's privacy and choices, and a lot of slimy 'gimmes' to favored groups.

So, of course I don't like that, and I don't like that it was passed dishonestly without the People's permission. That's not right, and being a free person, I won't support it. Indeed, I'll oppose it, vigorously, as does half the country, which means it will fail even sooner than it would've failed on its own.

If President Obama wants to transform America he needs to have honest discussions with the people, then get our permission first. He's not a king, and he's not allowed to just cram things through then taunt everyone. That's not okay, it's not going to be okay, and these things will be undone, or they'll undo us.

Hope you're healing well, and best wishes to Muttley (sp?)(I'm not sure how he spells it).

Cheers, James Arthur

You've got to replace the royal 'we' in that sentence to get to the nut of it, which is that a system with third (insurer), fourth (employer), and now fifth-party (federal gov't) payers rewards the players for the wrong things (mostly for gaming the system), and does not optimally serve the person who should matter most: the patient.

All that goes away in an ordinary situation where people shop for what they want based on price, service, and quality. The suppliers respond to those pressures, quickly offer a wide range, and customers choose.

Cheers, James Arthur

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The correct formulation of that sentence is that "the United States is the last major country that is silly enough to allow the market to set prices h igh enough to compensate pharmaceutical companies for what they claim to be their R&D investments."

Canada, Germany and France have the sense to bargain harder, and get their drugs for something like the incremental cost of producing more than the Am erican market buys.

Major pharmaceutical advances won't stop, but more of them may be made unde r research contracts from governments, NGOs and people like Bill Gates to t ackle the diseases of the less rich. The current system generates a great m any drug for lowering your blood pressure and your cholesterol level, but f alls a bit short on drugs to treat malaria (which isn't a disease of the ri ch).

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The UK population of 64.1 million is somewhat smaller than the US 320 milli on, and the country is somewhat poorer. It's 9% share of global drug develo pment expenditure is rather higher than you'd expect from the ratio's of th e gross national incomes (2.446 trillion for the UK, 16.99 for the US).

Very few, if the international patent system is working as it is supposed t o.

That's what science is all about.

Not exactly "freeloading" then, though the drugs they are developing are in tended to sell into the perversely generous US medical market. Don't give a sucker an even break ...

The article described how over-testing can be harmful even if resources were unlimited.

"More than a third of the population turns out to have these tiny cancers in their thyroid, but fewer than one in a hundred thousand people die from thyroid cancer a year."

...

"Over the past two decades, we?ve tripled the number of thyroid cancers we detect and remove in the United States, but we haven?t reduced the death rate at all. In South Korea, widespread ultrasound screening has led to a fifteen-fold increase in detection of small thyroid cancers. Thyroid cancer is now the No. 1 cancer diagnosed and treated in that country. But, as Welch points out, the death rate hasn?t dropped one iota there, either. (Meanwhile, the number of people with permanent complications from thyroid surgery has skyrocketed.)"

The US system currently costs the patient half again more than the French a nd German systems without delivering any better value. Atul Gawande would s eem to be suggesting that the US medical establishment is currently gaming the system to precisely that extent.

But not in medical care. There's nothing ordinary about a system where peop le shop for their medical care - it doesn't happen in any advanced industri al country, which ought to strike you as strange, but since you have a tunn el-vision commitment to the absolutely free market, you aren't equipped to think about that, or anything else that might derail you ideological apple- cart.