Medical Care Gets Outsourced Too 1184
Muppy writes "Here's the summary from the most emailed article in The Washington Post today -- about an American who went to India for heart surgery, which he could never have afforded here. U.S.: $200,000 total cost ($50,000 deposit required) for heart operation. India: $10,000 total bill, including hospital, air fare, and a side trip to the Taj Mahal. And the Indian doctors are probably at least as good as those one is likely to get in the U.S. From the article: 'Eager to cash in on the trend, posh private hospitals are beginning to offer services tailored for foreign patients, such as airport pickups, Internet-equipped private rooms and package deals that combine, for example, tummy-tuck surgery with several nights in a maharajah's palace...'"
And...what will you hear at the end of your visit? (Score:5, Funny)
Canada too, eh? (Score:4, Interesting)
Re:Canada too, eh? (Score:5, Insightful)
I don't know about you or your friend, but I wouldn't want the words "laser," "surgery," and "real cheap" together anywhere near *my* eyes.
Re:Canada too, eh? (Score:5, Insightful)
What a great idea! (Score:5, Funny)
Add sarcasm tags where appropriate.
Re:What a great idea! (Score:3, Funny)
Unless we spend more on education... (Score:5, Insightful)
Re:Unless we spend more on education... (Score:5, Insightful)
Re:Unless we spend more on education... (Score:3, Interesting)
I, personally, wouldn't call it the "best in the world". And I think a lot of that is a matter of o
Re:Unless we spend more on education... (Score:3, Interesting)
Re:Unless we spend more on education... (Score:5, Insightful)
There's a news article today about how a healthy majority of Bush voters think that Bush is popular in the rest of the world, Islamic nations support Bush's international war on terrorism, and that Bush supports the Kyoto air pollution agreements and the landmine anti-proliferation agreement. He is, in fact, openly against the Kyoto and landmine anti-proliferation agreements. (I'm not trying to argue the pros or cons of that political stance.) There is a clear and unquestionaly disconnect between the President's political agenda and what his own supporters believe is his agenda. How can this happen?
Our media has completely failed us. How is it that our health system is in crisis? Because most Americans are not aware that it could or should be different. Many Americans do believe that we have the best health care system in the world (not just quality of care, should you be able to afford it.) Why don't they know? Because our media has completely failed us.
"The first stage of fascism should more appropriately be called Corporatism because it is a merger of State and corporate power"
-Benito Mussolini
(1883-1945), Fascist Dictator of Italy
Re:Unless we spend more on education... (Score:5, Insightful)
It's not exactly a lie: if you're super-rich, the USA probably does have the best healthcare in the world for most procedures. Now, if you're not rich, then you're not important. And if you don't even have insurance, then you aren't even human and don't count. This is the President's point of view, BTW, not mine.
Re:Unless we spend more on education... (Score:4, Informative)
My fiance had foot surgery in Australia on a trip there this summer - $146 Australian for two hours of surgery. None of the waiting lines in all the horror stories about socialized health care, perfectly competent doctors, etc.
Sure, the Mayo Clinic draws people from all over the world, but the average American hospital is no better or worse than the average Western European or Australian one.
Re:Unless we spend more on education... (Score:5, Insightful)
If you consider a "health care system" as consisting of nothing more than the availability of the latest technology and world-class specialists, yes, I'd agree we all want that.
Where I live, I have easy access to auto dealerships which are more than happy to sell and service some the finest motor cars in the world. The problem is that being able to choose between a Maserati and a Porsche, in a real world sense, means as little to me as it does to the other 95% of the other folks in the U.S.
The fact that the health and lives of ordinary people depend on such an economic model strikes me as somewhere between irresponsible and shameful.
Re:Unless we spend more on education... (Score:5, Insightful)
The fact that drug companies charge many times the price in the US for the same drugs they sell in Europe, doesn't make our health system cost more.
Neither does the fact that US insurance companies charge more and make more profit here than in Europe.
Neither does the fact that the FDA insulates American companies from competition by embargoing cheaper drugs and equipment for years after they are proven and used in Europe.
Nope, everybody knows it's lawyers, liberals and welfare mothers who make our system cost so much. But it's still the best in the world, as anybody who can afford really great insurance will tell you.
Retroactively (Score:3, Informative)
Re:Unless we spend more on education... (Score:5, Informative)
Where in God's name do you get a statement like that? Wait times in recent years have been a shade longer than they ought to be for some cardiac procedures, but but the idea that "most" Canadian heat patients die waiting for care is laughable. More important, it's not supported by statistics. Here are links to current numbers for Ontario waiting times for heart procedures. (stats are for the three months ending June 2004; there are further links on the page for historical data.) Open heart surgery [ccn.on.ca]; angioplasty [ccn.on.ca]; cardiac catheterization [ccn.on.ca].
The median wait times for urgent/emergent, semi-urgent, and elective cardiac surgery were three, seven, and twenty-five days, respectively. Four out of five patients receive cardiac surgery within the "recommended maximum waiting time". Despite that, even the ones that do wait longer usually don't die waiting--the RMWTs are a bit conservative.
In Canada, the AVERAGE wait for hip replacement surgery is THREE YEARS.
Not sure where you get this statistic, either. I agree that the wait times for joint replacement surgeries in most provinces are far too long, but three years is overstating the case. There are anecdotes reporting wait times of up to two years for some orthopedic surgeons at some facilities. The UHN (the largest hospital network in Toronto) cites wait times of 13 to 43 weeks [canorth.org] for elective joint replacements at the moment; other Ontario hospitals are scheduled to begin making those figures available this coming April.
Her regional healthcare administrators were killing her, one day at a time, by refusing to let real specialists look at her and maybe make a difference in her life. That would have cost money.
Which "real specialists" was she not referred to? In some circumstances, I can see local specialists having long waiting lists, but outright refusal to refer a patient to a specialist for medically necessary evaluations or procedures isn't cost containment--it's malpractice. It's also perfectly kosher to ask for a second physician's opinion, and seek a referral through him. If none of the doctors who saw her were willing to refer her to another specialist then maybe, regrettably, there genuinely wasn't anything that could be done.
Canadian hospitals ROUTINELY close to all but emergency cases for the last couple of months of the year, when they run out of money. If you have a non-emergency in November, you will just have to wait until January and the new fiscal year.
Are you insane? Canadian hospitals are open and providing the same level of service year-round. You may have a longer wait for some services in the winter, particularly if you show up in the emergency room with a relatively non-emergent problem--it's flu season, and there are more slips and falls, and so forth.
I am also skeptical of your claim since most hospitals operate on the same fiscal year as the provincial governments that fund them. If they were to stop carrying out procedures because they ran out of money at the end of the fiscal year, it would be in March, not December.
From some of your other posts, I gather that your experiences were in Quebec. My own experience is with Ontario's hospitals. Since each province operates its own healthcare system (within the federally-mandated bounds of the Canada Health Act) I suppose it's possible that Quebec health administrators are the bumbling murderers you make them out to be--but I suspect that you're just full of it.
Comment removed (Score:5, Insightful)
Several million spent this year in my city... (Score:5, Insightful)
I haven't seen a school yet that hires an economics teacher, and has them fill in as a coach, but they all seem to be fine with hiring a coach and asking them to fill in as an economics teacher.
Comment removed (Score:4, Insightful)
Re:Spending isn't the problem. (Score:3, Insightful)
Re:Spending isn't the problem. (Score:5, Insightful)
Nope. That isn't competition. That is an elective program that sends money outside the public schools. If the law required that for a school to accept vouchers, they couldn't turn away any students (even those that are "special needs" students) and they were held to the same standardized test schedule and requirements, then it would be a little more equitable. The system, as I've seen it proposed, is little more than welfare for the rich, where those that would have sent their children to private school anyway manage to save money on the tuition. That doesn't help public schools, not the country as a whole.
Re:Spending isn't the problem. (Score:4, Insightful)
I make more now, in a mid-low level tech job than the most that a teacher can make in any public school k-12 I've ever heard of. So, if I were to want to share my experience with students and teach them in any of the subjects I'm qualified in, I'd have to take a pay cut (not to mention that I have as many math classes as needed for a math degree, but because I persued a degree that doesn't match with a course title, I can't teach anyone in any courses under All-Children-Left-Behind - ACLB).
I think that the teaching scales aren't quite right, but as I see them, they are not adequately compensated. You will not see the best people in the subjects go into teaching others when they can easily make more elsewhere. You are left with the incompetent (of which I saw a lot) and those that want to teach (shrinking in number because of the crap, like ACLB, that they have to put up with).
Re:Unless we spend more on education... (Score:5, Insightful)
We don't "spend money" on tax cuts. That implies the money belongs to the government in the first place.
By the way, we still tax Social Security benefits. Read that again. We TAX SOCIAL SECURITY BENEFITS. We tax people who get married. We tax people who sell their house. We tax people who make just enough to eat. We tax everything at enormous, ridiculous rates.
Re:Unless we spend more on education... (Score:4, Insightful)
While I do oppose Bush's tax cuts which have led to massive deficits, I think this is a very strange characterization. That seems to imply that our money belongs to the government from the start.-
Re: (Score:3, Insightful)
UK Total Cost... (Score:5, Insightful)
Even so, I must say I prefer universal healthcare.
Re:UK Total Cost... (Score:5, Informative)
Re:UK Total Cost... (Score:5, Informative)
Re:UK Total Cost... (Score:3, Insightful)
As for the rates of tax, for me, when I look at my tax bill, I can at least look at where it's being spent and think - yeah, that's worth it.
I'm no
Re:UK Total Cost... (Score:4, Interesting)
For a while I was living and working in NZ and my brother was living and working in the US. We were each earning the same amount in local currency. New Zealand has Universal Healthcare, and as we all know, the US does not. Naturally my tax bill was much higher than my brother... except, it wasn't. By the time all the Federal and State taxes, along with various Social Security levies and whatnot, were added up, my borther had a larger tax bill than me.
The US healthcare system is in some weird sort of limbo land where they can't bring themselves to commit to either course of action: they do spend a lot of money of various forms of government subsidising healthcare. I've heard that the US government spends more per person on healthcare than Canada, yet Canada has Universal healthcare*. Now, I haven't seen figures so I don't know if that's true, but I do know that in the US you end up paying as much or more in tax as most of the various "Socialist European countries".
Jedidiah.
* (Canada has its own issues: Fearing the rise of a "two tiered healthcare system, and hence refusing to allow a parallel private system to ease pressure on the public system).
New T Shirt Slogan (Score:4, Funny)
With apologies to George Carlin... (Score:4, Funny)
I sent my liver to Peru
I sent my lungs and my kidneys
For the summer to Sydney
But I'm sending my heart to you!
I'd do it if it came down to it (Score:5, Interesting)
Makes me wonder why someone doesn't just get a ship anchored in international waters off the coast of california to offer similar cut price procedures.
Re:I'd do it if it came down to it (Score:4, Informative)
First off, they must be approved by the Educational Commission for Foreign Medical Graduates (ECFMG), then pass the United States Medical Licensing Examination(TM) (USMLE(TM)) board exam ("the boards" that you may hear med students grumbling about), and then they must complete a residency (3-7 years depending on specialty) in the US even if they were certified and practicing in their home nation. Source: ECFMG fact sheet [ecfmg.org].
Sounds good to me.... (Score:5, Informative)
My first surgery cost about $5,000 (in 1969); the second about $30,000 (in 1976), and over $80,000 (in 1982). You can thank the insurance companies for the cost of health care today. Malpractice insurance for doctors and surgeons in the USA can top $1,000,000 a year depending on their area of practice. The more delicate the organ they work on, the more they pay. In order to stay in practice, they have to charge the patient more. The patient's insurance company pays more, they raise the cost of the insurance, someone sues the doctor for leaving a sponge in them, their malpractice insurance rates go up, etc.
IANAL and I don't know about India's legal system, but I don't think they have the sue-for-every-mistake mentality we do here. Remember, doctors are people too and they sometimes make mistakes. If they doctors in India can do as good a job as the ones in the USA at a lower cost, I'll be traveling overseas if I have to have another surgery.
I would actually encourage you to do so.. (Score:3, Informative)
Infact I have been thinking to start my own little medical tourism practice on the side to encourage people to seek medical help in India. India has some of the world's most renowned doctors and some of the cheapest rates. The care you will experience will be to
It's not the insurance companies (Score:4, Insightful)
It's plaintiffs lawyers (like John Edwards) suing doctors with junk science, judges not doing their jobs, and gullible juries. And of course the "defensive medicine" (runing every test just to CYA) that doctors practice to avoid suits.
And of course, legitimate malpractice claims.
Insurance companies just run the numbers and tack on a profit - they really are the least responsible.
If they doctors in India can do as good a job as the ones in the USA at a lower cost, I'll be traveling overseas if I have to have another surgery.
A BIG "if." What evidence do we have of this? Medical school admission in the US is extremely competitive, likely the most competitive academic process in the US. I'd like to see some evidence that "Indian doctors are probably at least as good as those one is likely to get in the U.S." There are competitive schools in India, but to make a blanket statement about Indian doctors is ludicrous. After all, don't a lot of brilliant Indians come to the U.S. to attend grad school?
Of course, if something goes wrong, don't look for a lawyer to sue - they are all in the U.S.!
Re:It's not the insurance companies (Score:5, Interesting)
I've had to TA pre-med students and while some were bright it was their incessant grade-grubbing that made them stand out. While in grad school I've also had three pre-med students working in lab for me. All three were smart but only one was what I'd call brilliant. All three got into med school. One declined and went to grad school because she thought it'd be more challenging. One got in because her dad made a bri^H^H^H donation, and much to her credit she's having a serious moral dilemma about accepting the spot. The appalling thing is that "donations" to try and influence the admissions committee are not uncommon. As in most things if you're rich then the rules can easily be bent, and the ones that go to med school are disproportionately from wealthy families--so much for academics. The third is now a third year med student at USC and it's largely from her (and from my having to tell a MD that antibiotics don't work on viral infections) that my opinion of med students and MDs has dropped through the floor. Her classmates almost without exception are from wealth and privilege, brought up by maids and nannies and carefully insulated against the world. She was one of the few with real-world experience (academic research, paramedic, firefighter, crisis intervention worker); most simply were memorization machines with high grades but weak problem solving skills--her opinion as a fellow med student, mind you. Most were utterly clueless when it came to dealing with patients or figuring out a diagnosis.
Perhaps this sums it up best: One of her classmates somehow made it to age 24 and was still under the impression that women have a cloaca. Nevermind never having a gf or never seeing any porn, he thought that women only have one opening down under after passing an undergraduate-level human anatomy lab! At least it being USC there's no shortage of porn stars to come in to be model patients for the med students' gynecology exams so that got straightened out real fast.
Re:Sounds good to me.... (Score:5, Funny)
Re:Sounds good to me.... (Score:5, Insightful)
As a US resident, I'll add "The more fundamental issue is that while Americans are increasingly eager to capitalise on the benefits of a nationalised health system, they are adamant in their insistence that such such systems are akin to something between a violation of human rights and communism, and implementing one will lead to disaster."
Communism/Socialism vs Capitalism (Score:5, Insightful)
But if the people who dictate what can and can't be done also get to own the whole thing and rake off enough to get rich, we call it an Insurance Industry -- GOOD!!
our story (Score:5, Interesting)
Given that I am in the top 5% income bracket we opted for just taking the treatment and paying for it. Still not a great thing considering that it could take several treatments after which there is still no gaurantee of success (other then losing the money).
We got lucky. First time was a success.
I have been wondering how the millions of other couples in america for whom this procedure might be the last chance are dealing with the cost. Going abroad maybe?
Re:our story (Score:3, Insightful)
Forgive my callous analysis, but 'needing' IVF is a subjective take on it. You wouldn't die or be sore or suffer in any objective terms if you were unable to conceive. While I feel for you, I think that any insurance company that did cover it would be driving up costs and doing a disservice to people who just wanted to stay well and not pay through the nose if they were injured or ill.
Adopti
Re:our story (Score:3, Interesting)
Anyway, here are some things to consider.
Indeed we where not in 'need' of IVF, more in 'want'. Though we wouldn't have died the other things would have applied. In this particular case my wife was suffering from Endomitriosis and Fibroid tumors of which one had allready been removed through an myomectomy a few years back. Not a pleasant operation. The successfull IVF has had an interesting s
Re:our story (Score:5, Funny)
I too have a natural need encoded into my genes. I note from your earlier post that you're in the top 5% of income. This places you in a perfect position to help my satisfy my genetic requirements for a dual 2.5 GHz PowerMac.
I absolutely, 100% support your views. I hope you can bring yourself to support mine :)
Re:Please, don't (Score:3, Funny)
You keep using those words, "birth rate"
I don't think you know what they mean.
Are Japanese women really going around, squatting over little children. sucking them up and injesting them? Because something like that is the only way you are going to get a negative birth rate.
Re:our story (why do you deserve a child?) (Score:3, Insightful)
That hurts man. Seeing that someone believes that crap about 'devine reason'. If it was available, would you have gotten the flu vaccine or is it meant to be that more people will die this year because of the flu vaccine shortage? If a condom can stop VD's and prevent unwanted pregnancies, are you really claiming that we shouldn't use them? Do you take responsibility for your actions? Do you think for yourself? C
American prices out of line... (Score:5, Insightful)
Remember, perscription medications are very much an IP-based business. The first pill costs millions in research and approvals. Once the pill is ready for mass production, the actual ingredients cost very little to gather and put together. That's the reason why there has to be patents on medications... without that IP-based protection, nobody would pay to do the research that creates new drugs.
Still, when Canada's getting the medications for less than they're being sold in the USA... something's very wrong. It feels like every other first world country has set price controls that the drug makers are bowing to, and because we don't have price limits, they charge us to make the money.
It's an interesting dilema... if we pull out of funding the world's research, that research just isn't going to get done. On the other hand, we're funding the research that the rest of the world is benefiting from and not paying for.
Re:American prices out of line... (Score:5, Interesting)
I read a newsarticle a couple of months ago where they pointed out that not even Medicare is "buying in bulk" but rather "individual packages" depending on how it goes.
Imagine all of Medicare got their act together and would negotiate ONE price with the supplier? Suddenly the prices would drop.
That's whats going on in Canada, and they are currently fighting over a Federal Pharmacare plan which would probably decrease the costs even further.
Re:American prices out of line... (Score:5, Informative)
Oh, right, because the Administration and Congressional Republicans made it explicitly illegal for Medicare to negotiate bulk prices when they passed the recent Medicare prescription drug benefit. The VA's been doing it for years, but Medicare is forbidden by law.
Are you Canadian? Then I guess you can't help us undo this bit of absurdity. For all you other Americans out there, though, I hope you know why Medicare doesn't do it, who to blame, and in less than two weeks you can help the guy who's promised to undo this ridiculous restriction to reach office.
Re:American prices out of line... (Score:3, Insightful)
Re:American prices out of line... (Score:3, Informative)
Certainly -- the parent poster already said that the money for most drugs is spent in R&D, and that later manufacturing costs are tiny in comparison.
But there is another factor here too. If they refused to sell to Canada, then the Canadian govt. might declare open season on their drug patent (which has to be openly viewable in order for doctors to understand and
I don’t understand (Score:5, Insightful)
Re:I don’t understand (Score:4, Informative)
Well, not quite. The soft drinks that are sold in India are probably actually made in India as it would cost too much to ship bottles of Coke over from Atlanta. Yes, the American companies get some small amount of money from each bottle sold, but no American workers were employed in the process.
Software Engineering and Surgical jobs or Softdrink jobs?
Just Like the Lobster Tank at a seafood restaraunt (Score:3, Funny)
supply/demand crisis (Score:4, Insightful)
Re:supply/demand crisis (Score:5, Insightful)
How about a child's education, too? (Score:4, Interesting)
Should have gone to Bangkok (Score:3, Interesting)
On a less serious level, it's long been a well-known spot for budget travellers to get some dental work done, or pick up new glasses, cheap, safely and reliably.
It's even (IMO) a nicer place to visit. Sorry Indian readers
Could someone explain the costs? (Score:3, Insightful)
I'd definitely go to India rather than face that kind of horrorific bill. It makes me think medical costs are truly out of control, and frankly, I don't want to pay them.
D
Here's something about the Canadian system (Score:5, Informative)
Fact 1: Canadian doctors, especially rural family doctors, are in critical shortage.
Fact 2: It is hard as hell to get into Canadian medical schools (GPA: 3.8, MCAT 30-31 + Extracurricular)
Fact 3: There are hundreds of immigrant doctors in Canada driving taxi cabs.
If you said "WTF?" you're not alone. The reason why it's hard to get into medical school is easy enough to explain: When the government pays 70% of your tuition, you're gonna get high demand for a fairly well paying job (about $7000 USD/month).
But what makes very little sense is all these perfectly good doctors roaming the country with crappy little McJobs. The reason is because they can't get into residency programs to get certified. And they can't get into residency programs because Canadian graduates get first pick, and whatever's leftover goes to the immigrants. Since there's always never enough residency spots, and the one's that go to the immigrants are less desireable (family medicine).
That means we could have the world's best opthmalogist living in Canada, and the most he can hope for is it run a rinky-dinky clinic off in the boonies, if he's lucky.
Not sure how it relates to the story, but an interesting tidbit nonetheless.
But... I thought *Canada* had the sucky healthcare (Score:5, Insightful)
Pah.
Canada may not have perfect healthcare, but we sure as hell aren't (a) paying for heart surgery; and (b) taking off to India to get it.
Re:But... I thought *Canada* had the sucky healthc (Score:4, Interesting)
I pay $500 a month for insurance that has a $2500/yr
deductable. Why, because I'm self employed and dont have my employer paying part of the bill. Dont forget, in hte US, for the most part, you employer does pick up part of the bill.
The reason for keeping it, if I ever have to go in for anything, having insurance keeps the bill down. If I went in for anything and had no insurance, I'd have to about 3-5X more. That's the way it works..
India is far (Score:3, Insightful)
This works both ways (Score:3, Informative)
Medical Costs... (Score:4, Insightful)
Costs are high because of several factors, first is the medical billing system. In our country we have countless carriers and each has a different form and another person you have to higher in order to understand what they will and what they won't pay for. This can add up to about 40% of a hospital's operating budget. A single payer health care system could take care of this, or a more standardized set of forms and practices.
Second is malpractice insurance. We are a lititgious society (in the United States) and punitive damages can get out of hand much of the time. For the most part, doctors are not being willfully malicious when there is an accident, or mistake. It is a high pressure job and they are there trying to help people. WHile they should be held accountable for their actions, this accountability should not become a barrier for treatment. Rather than capping punitive damages, Good Samaritan laws could be strengthened and applied to doctors and other emergency service workers, but that's just my opinion.
A single payer system isn't going to fix the problem, it's going to take a lot more than that, and we're not even talking about health care access.
Result of monopolistic market (Score:3, Interesting)
The existance of a monopoly has more effect than even insurance. There is little to no competition among doctors because the number that the AMA allows to be licensed every year is so small. I've heard all the stuff about limiting the number to make sure they are all competent, but that is a crock of shit. How do I know? Because I know some very competent doctors that were rejected a few times before they were accepted. There simply weren't enough spots for them in the schools. Eventually, they got in, became doctors, and lived happily ever after.
The situation reminds me of the cab drivers here. The city council created a fixed number of licenses. Then, they made it so that the license holders have control over new licensees. The effect is that there can never be any new licensees unless the law changes. So you have to pay someone for their license, and they are running at about $40,000 each. That's right, because the people whose income depends on their ability to restrict others from the market are in charge of that market, they will exclude everyone else to increase the value of their license. It is the same with the AMA putting doctors in charge of licensing doctors, and getting the force of law behind it.
Of course, if you try to add medical schools (which have to be AMA certified) they will balk that you will kill people with all the unqualified people that will get in. FUD, it's not just for breakfast anymore.
Oh, and the medical insurance costs don't help, either. And most of the problem with that is the juries. "Shit Happens" should be a valid medical defense for most of the suits. They are cutting you open and moving things around, things will sometimes not go right. If you have a problem with that, don't go in. If they operate drunk, sue them. If you agree to a proceedure and decide later that if it were done a different way the outcome may have been different, then you should sue yourself for being stupid and not getting a second opinion.
An Indian's take on the article (Score:3, Interesting)
The very best Indian doctors and hospitals are, for all practical purposes, as good as any in the West. Unless you are looking for technologies and treatments that are on the very bleeding edge, chances are that it is available in India for a lot less than you would pay here.
The average Indian doctor and hospital are, however, a lot worse than what you get here. Over here, I can walk into any doctor's office, any hospital, and can be assured of a fairly decent standard of treatment. That is not so in India. Outside of the few top hospitals (most of which are located in the major urban areas), it is a total crapshoot. You may get a good doctor but it is equally likely that you will get a complete incompetent who would have had his license revoked many times over in the West.
I lost an uncle of mine to such a quack - in Bangalore of all places (where you would expect a decent level of medical expertise). He was hit by a truck and the idiot doctor who attended to him did not realize that while he didn't look too bad externally, he could be bleeding fairly severely on the inside. So they just sat and watched him bleed to death over the space of several hours.
As far as the cost advantage is concerned, it is there but will slowly get less over time. Medical treatment in India is getting dramatically more expensive each year
- HCE
i heard this somewhere else (Score:3, Interesting)
"the us is a good place to get a heart attack, and canada is a good place to get cancer"
mainly because the us healthcare system is set up in such a way that sudden major healthcare crises are well handled (pay later), but chronic long-term problems are not well-treated (pay first)
meanwhile, canada is the opposite
the fact is, in spite of this article, the rich of the world come to the us for their healthcare, because although affording american healthcare is difficult, it really is top notch in the world (mainly because of all that money)
there's no such thing as a free lunch, and eventually we all die, so healthcare, no matter how you slice it, is a triage system
always was, always will be a triage system: you have a limited amount of money to spend, and you have to decide where to invest it, and there are infinite ways to spend the money, because someone always has a health complaint
therefore, we will always be unhappy with our healthcare no matter what we do, because of the nature of the beast: we are human beings, we fall apart every day, and none of us have enough money to ensure all of us fall apart gracefully
Numbers, people, numbers (Score:5, Interesting)
1. Healthcare is expensive in the US because of high malpractice insurance. ... Moreover, he added, a New York heart surgeon "has to pay $100,000 a year in malpractice insurance.
From the article: Trehan, 58, a former assistant professor at New York University Medical School who said he earned nearly $2 million a year from his Manhattan practice
This guy was making $2mil a year, and paying $100K for MI; just 5%.
2. Doctors there are bad
The founder (as quoted above) was an Asst Prof at NYU, making $2M a year. In fact, a lot of the doctors you find here (in the US) are graduates from the same Indian schools. And many of them working at these top hospitals are those who returned from US/UK. You'll find a good number of them holding advanced degrees (like FRCS) from institutions in US/UK. A good friend of mine (an Indian who finished his residency here) is going back because he couldn't get into the top school he wanted for research. He has his choice of places where he can practice, but he prefers to go back because he says "if I'm going to practice, might as well do it at home". There, the good doctors are put on a pedestal and have a lot of clout in society.
3. Facilities are bad
The hospital mentioned, Escorts, is top-notch and was founded by an Asst Prof at NYU who gave up a $2M/yr package to go back. Here's another quote from the article: Escorts is one of only a handful of treatment facilities worldwide that specialize in robotic surgery,
4. Quality of care will be bad .8 percent. By contrast, the 1999 death rate for the same procedure at New York-Presbyterian Hospital, where former president Bill Clinton recently underwent bypass surgery, was 2.35 percent, according to a 2002 study by the New York State Health Department.
From the article: the death rate for coronary-bypass patients at Escorts is
5. It is cheap because it is bad
Again, from the article: For example, a magnetic resonance imaging (MRI) scan costs $60 at Escorts, compared with roughly $700 in New York
I will relate a personal story. A very good friend of mine hurt his back (slipped disk) while travelling in India in 1997. He had to be hospitalised, and operated upon. After operation, he got 1 month of in-home nursing care. The total bill? $4000.
When he came back, he told his insurance company about this. They asked him to go to a local doctor. He checked him out, and said that the job the Indian doctors had done was as good as anything they would have done locally. And the insurance company paid the $4K even though he hadn't followed procedure (called them and sought approval), saying that just the MRI alone here would have cost $4K. There, the MRI, surgery, post-operative care, etc. all came at the price of just an MRI here.
Re:This is news to ANYBODY? (Score:5, Interesting)
Re:This is news to ANYBODY? (Score:4, Informative)
It is faster than the NHS, cheaper than private clinics, and closer/safer than India.
Re:This is news to ANYBODY? (Score:5, Informative)
Re:This is news to ANYBODY? (Score:5, Informative)
There is a correlation between this behavior and socialized medicine. Especially if that medical system has "waiting lists".
Canadians have come to the US. Brits have gone to India, France, the US. I'm not saying it's a huge trend. But people with money... want healthcare *now* and they will find ways of doing it. Canada has *actually JAILED* doctors for opening a private MRI clinic. That's just plain silly.
Not to mention the story about a Canadian who's son was gravely injured... he brought is son to the hospital, but he couldn't be admitted without a paramedic or an ambulance. So they waited... while the son died... for an ambulance to come from across down so he could be admitted.
Oddly enough Americans are outraged that it's illegal for them to go north and LEECH off of Canada's heavily subsidized presription drugs.
This is a serious issue with rationing health care because now you have given people motivation to leave the country to get (possibly) substandard healthcare. (But that's better than certian death on a waiting list, no?)
Figuring out who will and who won't get healthcare is a terrible choice to make. That being said no matter how you do it it'll be unfair. I personally happen to believe that it's *least* unfair when you directly pay for a service.
~foooo
Subsidized drugs? (Score:5, Informative)
This site [freerepublic.com] says that the drugs are cheap in canada due to price controls and bulk buying.
The problem with this is that they base the price on the per unit production cost, not including research/development/certification costs. For a reasonable return, the company has to make it up somewhere, mainly in the USA. Drugs in the USA are cheaper once the generics make it to market.
Re:This is news to ANYBODY? (Score:5, Insightful)
The percentage of people who have the personal resources to personally pay for the worst case health problems is in the low single digits. That means that health care gets rationed here in the USA, too. It's just a different system; people who have full-time jobs at large corporations usually get first priority. (Why does the size of your employer have anything to do with health care? Who knows.) Then come the perfectly healthy people who are allowed to buy individual policies, and people who work at small employers where none of their coworkers are too sick to lose the group plan. Lowest in the rationing pecking order are uninsured who rely on emergency room triage.
Oh, I forgot that half of the healthcare in this country is fully socialized. It's just for everyone who is old enough to get on medicare so that they can get free coveraged paid for by those of us who actually have to work (but don't get to actually benefit from the socialized healthcare we pay for ourselves).
At the end of the day, almost nobody is actually directly paying for their healthcare in the US anyway.
Re:This is news to ANYBODY? (Score:4, Insightful)
50 years ago, there wasn't much that could be done for you beyond a couple of thousand dollars. Most people could be expected to pay for their own healthcare.
Now it's not unheard of to spend more than 1 million dollars on a single patient (one of my former employers mentioned in a benefits meeting that they had 5 $1 million patients in the previous year). Any reasonable person needs to have insurance, unless they're willing to die for the principal of frugality.
Health savings accounts are fine, as long as everybody qualifies, and as long as they always come with full insurance past some deductible that most people can afford. I do think that all health insurance plans should be required to have a high deductible to encourage people to shop on price. However, I also think that one way or another, there should be a single risk pool that amortizes the risk evenly over the whole population. This would greatly reduce both the outrageous costs of accounting in the insurance industry and the stress most people needlessly experience when they change jobs.
Re:This is news to ANYBODY? (Score:5, Interesting)
You are absolutely right. I used to sell health insurance and I am currently CTO of a company that provides medical practice automation software (which includes claims processing).
When I have had to pay for my own health insurance I get a policy with at least a $5,000 deductible and high maximum benefit. I also open an MSA (Medical Savings Account). That way I pay for my family's routine visits out of my own pocket (cheaper than comprehensive insurance over the course of a year) and I am still protected against a major medical catastrophe.
The next layer to add to this is to, before telling the MD you'll be paying cash, ask if you can get a discount for cash. Sometimes (often?) you can since, on average, it saves the MD about 20% to not have to go through the claims process.
The result is a health insurance set up which is portable and relatively affordable.
Re:This is news to ANYBODY? (Score:4, Informative)
Serveral things to watch out for...
1. Needed services often increase dramaticaly along with fee's for cash Pt's.
2. Insurance companies establish "Usual and Customary fees" and generaly only pay those or a percentage, if the Dr. accepts the insurance; it means that he/she also accepts the fee structure. Normaly they bill the Insurance their normal fee's, the insurance pays the usual and customary, and the DR. writes off the difference. The idea is by billing more than they are willing to accept, the usual and customary goes up. As a cash Pt you may only get a portion or none of the difference how about a 10% discount on a bill inflated 100%.
3. Frequently the insurance looks at things as a package, and only pay so much for a proceedure, as a cash Pt. your probably going to get ala carte pricing i.e. pay for each and everything, offten at 100-1000X mark-up.
4. If your Dr's morals-ethics are looser than most, he'll think "no insurance, medicare-medicade audits, no ovesight of any kind, PT Barnum was right."
I think the biggest problem is the insurance in the first place, insurance is big-biz, which needs lawyers, which attracts more lawyers. This results in law suits, which attracts more lawyers ad-nauseum. All of this drains resources away from healthcare and into legal.
Re:This is news to ANYBODY? (Score:4, Informative)
The US medical system costs an utter fortune. Last numbers I saw, the average American spends - between out of pocket expenses, company-paid expenses, government expenses, etc - over 4,500$ a year. The next closest, in terms of cost, worldwide was Britain, at about 2,900$. I can check for a ref and updated numbers if anyone wants.
Compared to how much we pay, we're getting ripped off. Even Cuba, which is under an embargo that covers medical supplies, has almost as long of a lifespan as the average American does.
Re:This is news to ANYBODY? (Score:5, Insightful)
Of course, you're not going to see the LAWYERS in charge around here fixing their profession anytime soon.
American health care costs (Score:5, Informative)
One major cause is in the demographics. America (as is most of Western Europe as well) is getting older on the average, and old people cost a lot more to treat than younger people. That's only going to get worse over the next 30 years, and it's going to get far, far worse. Medicare is going to collapse under the promises it made decades ago, and nobody in Washington has the balls to do anything about it for fear of angering the AARP. The end result is that the system will come close to collapse under trillion dollars of debt, and it will have to be made up out of emergency tax increases on those of us younger than baby boomers and our children. I predict we'll see the Medicare tax go from it's already high levels to over 25% or even 30% of your income within my lifetime. The cowards in Washington DC are simply allowing this to happen.
The other big cause American health care costs so much IMNSHO is simply that it's a "for profit" system. "For profit" means that somebody is making money above and beyond the basic costs of providing the care. Look at the stock price graphs of the major hospital mangement companies, HMOs, and pharmaceutical companies. Every single point of increase in that stock price reflects a huge profit above and beyond the basic costs of providing health care. A lot of the increase in costs is going into investors pockets (including mine since I have held shares in pharmaceutical companies in the past, though not currently).
The supposed benefit behind the idea of the US system of private health care is that the profits are more than offset by the benefits of 1) competitition between different providers, and 2) increased efficiency and decreased corruption as compared to a governmental system. For various reasons, these benefits have not panned out.
Re: #1 -- Competition exists only to a certain extent between providers. The problem in health care is that the end-consumer of health care (who is insured) is relatively price-insensitive to the actual costs and bills generated from their care. Once they hit their deductible they don't care what it costs at all. The newest and most expensive thing must be the best, so we'll all go for the most costly stuff around. Supply and demand for physicians also doesn't quite follow the simple economic principles we all know and love. One or two interesting studies done some time ago (I don't have the references handy) found that physicians basically create their own demand. Even in areas supposedly "saturated" with doctors, adding more doesn't decrease the prices, it just creates more demand.
Re: #2 -- Increased efficiency is sometimes seen in private hospitals over public ones, but having worked in both I can't say that it's a big difference. Since there's little price sensitivity, why bother ever lowering your prices? Jack up the bills and buy more expensive toys! Efficiency is further decreased in American hospitals by the absolutely amazing explosion in the number of administrative (non-patient care) staff to do the paperwork, file the claims to a slew of governmental and private insurance companies, twiddle their thumbs, or whatever. American hospital CEOs make far more than their European counterparts, and they have much larger highly paid staff than in Europe. I've never worked in a hospital where the hospital CEO made less than two or three times what I do, even if they manage the hospital
Re:American health care costs (Score:4, Insightful)
Malpractice has had an indirect effect upon the cost of healthcare in the US: it has raised the standard of care, at times to ridiculous levels.
Practicing defensive medicine, in order to reduce the risk of getting sued, results in many referrals that aren't strictly necessary. Trivial example:
30 years ago: Kid breaks arm, primary care doctor sees him ($), reads xray himself, puts a cast on, done.
Today: Kid breaks arm, primary care doctor sees him ($), refers to orthopedic surgeon ($$$), who orders xrays, which are read by a radiologist ($$$ for the consult), puts a cast on, done.
These days, if the primary care doctor takes care of it all himself, and the outcome is less than perfect, he'll get sued, and he'll lose because he didn't refer the patient. My point is just that American medicine has overused specialty consults for so long that it's become the standard of care, and now anyone who doesn't make the costly, unnecessary CYA consult risks getting crucified by a lawsuit. The obscene state of malpractice laws in this country have created enormous hidden costs in these uneccessary referrals.
Of course, everbody wants their sprained ankles seen by an orthopedic surgeon because, as you pointed out:
Once they hit their deductible they don't care what it costs at all.
This is just one more reason why socialized medicine is a bad idea. The absolute last thing the US needs is another layer of insulation between patients and the real cost of health care.
Re:This is news to ANYBODY? (Score:4, Insightful)
"Frivolous lawsuits" are less than 2% of the total, and hardly register in terms of actual dollars. No, the skyrocketing cost of medicine in the US can be firmly laid at the feet of PharmaCorps and the out-of-control insurance companies. Lawsuits actually went down in the past couple of years, yet malpractice insurance fees continued to rise.
In fact, ridding frivolous lawsuits and capping patient recoveries would not put a dent in medical costs. [factcheck.org] All that would do is take power out of the hands of judges who should be the final arbiters of what is and isn't a frivolous case and destroy the ability of plaintiffs to adequately address what, due to its nature, is a rather grievous harm.
You want to bring down the costs of medicine? Reign in the skyrocketing costs of drugs and insurance that doesn't adequately cover the insureds.
Re:How to sue? (Score:3, Informative)
That depends somewhat on where. Rates are regularly reviewed in some states, and I know that in California, rates periodically do go down when the Insurance Commissioner has determined that the rates are excessive. Occasionally, there are also market pressures. I know that the cost of my health insurance (a PPO) is dropping by
Re:without lawyers putting doctors out of business (Score:3, Insightful)
Re:without lawyers putting doctors out of business (Score:5, Informative)
Re:without lawyers putting doctors out of business (Score:4, Informative)
According to this report by GAO [gao.gov], it seems that the malpractice premiums are going up but the insurance comanies' net loss is growing as well. That leads me to believe that only one who's profiting from this are the lawyers. So try again, and this time without simply mimicing Democrate talking points.
Re:without lawyers putting doctors out of business (Score:4, Insightful)
He mentioned that the 2% number is bogus, and went on to explain why. He commented that the numerator in that division was comprised of all doctors' malpractice costs, and that the denominator was all costs of all health care institutions, including doctors' offices, nursing homes, hospitals, etc. His conclusion was that if you corrected either the numerator or denominator of that equation so that they both measured costs for the same group of individuals/institutions, the picture wouldn't look appear quite so insignificant.
This wouldn't surprise me in the least, given the inaccuracies and misleading-at-best statistics that seem to run rampant in what we hear from politicians and the media. I sometimes wish there was a group of non-partisan accountants and statisticians who could analyse all this stuff for us and point out the glaring omissions we don't often see until reading the full text of such reports ourselves.
Re:without lawyers putting doctors out of business (Score:5, Informative)
All of them have horror stories about how hard it is to find specialists for certain fields, particularly in rural areas (which Texas, which I'm in, has a lot of), because the cost of malpractice insurance is so high for those specialties.
So no -- malpractice insurance is a real problem, and a big one, I'm not using GOP talking points, but rather hallway-conversation with my coworkers who've genuinely been there.
Re:without lawyers putting doctors out of business (Score:3, Insightful)
It isn't that the cost is too high, it is that the number of procedures to amortize the cost over is too low. If you buy insurance for a car for $1000 a year, that's not too bad - about average. But if you only use that car once a year, then you are operating at a grea
Not in my opinion. (Score:5, Insightful)
When I got a fungal ear infection and my doctor prescribed me antibiotics, which are exactly WHY I got the fungal infection, I stared thinking about it. I haven't taken a prescription since.
When I had to get my wisdom teeth out, I decided to do it at the dentist's office instead of the oral surgeon, I saved over $1200, and the fact that I was awake and could cooperate with the dentist meant that the surgery went smoother and safer, and I recovered much faster because they can really 'beat you up' when you're unconscious. I walked home with some cotton to soak up the blood and a bottle of advil for the rest of the week.
Why on earth would insurance pay for a full-on surgery to extract wisdom teeth? It can be done easily at the dentist's office for a third of the cost.
I really don't think the problem is litigation, it's certainly a problem, but not the major factor in medical costs. The major factor is American aversion to reasonable amounts of blood and pain, coupled with excessive trust in the medical institution and it's practitioners.
Re:the malpractice myth (Score:4, Informative)
Re:the malpractice myth (Score:4, Insightful)
There are a few bad doctors out there, and bad outcomes happen at times to all doctors. We could do better at policing ourselves.
However, the lawsuit-jackpot mentality is not helping the patients or the physicians. It helps the lawyer who gets to take his 30-50% off the top of a big judgement. As a rural family physician, I deliver 30-40 babies a year, but my malpractice premium is about $40,000/year. If I didn't deliver babies, it would be about $12,000. Disturbingly, 40K is actually pretty low for delivering babies. It helps that I live in a rural area.
I have to deliver about 30 babies a year just to cover my malpractice premium and office expenses. That's a lot of late nights, weekends away from home, etc. If I have a bad outcome, even if it wasn't my fault and the jury finds in my favor, my premium will still jump a good 25-50% or so. If you don't love delivering babies for the sake of delivering babies, you start asking yourself why you're exposing yourself to all this litigious risk, missing sleep, and paying higher premiums even if you're right. Then you start seeing physicians retiring or stopping high-risk procedures, and that doesn't serve anyone.
It's an easy sound bite to just blame doctors, or just blame lawyers. All the involved parties need to sit down and work out a solution. I'm afraid that this won't happen until enough pregnant women can't find a physician and end up being delivered in the emergency room.
Malpractice Tort Reform (Score:4, Insightful)
The bulk of costs are not in settlements but actually in legal fees (discovery, court costs, etc). Therefore I propose the following changes:
1) Doctor's insurance covers patients up to a certain dollar ammount due to medical error. Dollar ammount is set by a government regulatory agency.
2) Patients also can purchase additional insurance for medical errors covering them up to a larger dollar ammount. This will be included, presumably, in the medical insurance.
3) Malpractice should be limited to those cases where one can demonstrate that the doctor should not be practicing medicine. However, medical error should automatically provide the patient with an insurance settlement.
Now--- I don't think that that I trust any candidate to do this so....
Re:Ten Grand? Pfft... (Score:3, Funny)
Did you send the email to Gitmo about "Guest 1"? We've got to "find" him this weekend.
Re:Would you bet your life on that? (Score:5, Interesting)
Almost every country in the world will let Anybody sue for serious screw ups, but in almost every country in the world, the burden of proof of error is much higher. You have to prove:
(A) It was directly their fault, or their fault due to non-action or ignorance.
(B) That your quality of life is lower then if nothing had happened to you at all (after recovery and such).
(C) That the doctor did not make normal and standardized efforts for your care and recovery
(D) Also that, in the case of an accident, that if the doctor did not take Reasonable and standard steps to minimize risk.
This is vastly different then in the USA, especially in point A is a big one. In the USA, you could theoretically the doctor that delivered your child for them not making it into college, and would have a pretty reasonable chance of winning (don't doubt it).
Being able to sue, and a criminal system is important, but when it gets corrupt and full of greedy people, things like the ENTIRE MEDICAL SYSTEM get more and more expensive for everybody.
On a semi-unrelated note, I am planning to apply to medical school in Canada, and through my research, its rather disturbing how little standards some USA medical schools have. Many schools will take people with MCAT scores less then 20/45 (while its almost impossible to get in here with a 30/45) and some of the USMLE grades for students are insanely low. Often your residency programs for the same programs are a year or two shorter then here in the Great White North. As mentioned somewhere else in this article, unless you can keep some of the most trained professionals in your country as being quite smart, well educated, and socially aware, your will run into problems.
Countries like India and China have been focusing on building up that qualified and trained elite. While many/most of the people in those two countries have seen little growth in paycheck or quality/standard of life, they have, behind the scenes, a social system being developed to support first class societies.
While I hate to seem exclusionary, I think that we need to redesign the school systems across all of North America. Schools should be focusing on providing two distinct services, one is well-designed life skills training, and hard and aggressive knowledge training. Things like calculus and advanced chemistry should be introduced at as young as 9 or 10. While many will/cannot do this work, the ones that will are the important future engineers, doctors, scientists and professionals that we need.
Re:Don't get too excited, people (Score:5, Interesting)
That's complete nonsense. Sure, public hospitals in India (which are free) are in a horrible state, but no one's talking about them. In private hospitals, as the blurb mentions, the quality is about as good as in the U.S. I know, I'm from India. So quit spreading FUD.
Re:But what about Canada? Australia? Europe? (Score:3, Insightful)
Canadians want 2-tier health: poll [canada.com]
British Columbia is looking to expand its use of private medical clinics [canoe.ca]
Private medical clinic opens in Montreal [www.ctv.ca]
Pettigrew open to discussing role of private MRI clinics [canoe.ca]
Even the Canadian medical pot users complain that "He doesn't need government-grown schwag that cost [medicalmarihuana.ca]