Would really argue eye laser surgery is efficient, its expensive over sold (ie getting it at 40 when you will need glasses anyway due to age). I passed on it when they said they wanted to do both eyes at the same time as this saves them money

mrjonno wrote:Would really argue eye laser surgery is efficient, its expensive over sold (ie getting it at 40 when you will need glasses anyway due to age). I passed on it when they said they wanted to do both eyes at the same time as this saves them money

Compared to comparable surgeries, yes. Assuming they have their own operating rooms they also often perform cataracts, usually at a fraction of the cost of typical hospitals.

Something typical of US hospitals is they don't correlate time with money, a hospital will perform a cataract surgery in about an hour. An ophthalmology clinic can do it in 15 minutes. There are a few hospitals that are figuring this out, but its a ways out. Americans and policy makers still often associate more time with better care.
http://www.marketplace.org/topics/life/ ... ealth-care

It appears Britain is experimenting with it a bit. We'll have to watch and see how it goes.
http://www.independent.co.uk/news/uk/ho ... 62415.html

Laser corrective surgery in the UK is generally done by specialised clinics that only do this (entirely private). Studying the visual system at the moment and from I can see cataract surgery is an entirely different league when it comes to complexity, the actual laser burst for corrective surgery due to what is involved should be no more than a couple of seconds, it takes longer due to safety etc

Also you do know who first developed bulk corrective eye surgery its that well known bastion of capitalism Cuba!!

Sorry I would say current private eye surgery represents everything that is wrong with private medical care and I'm saying that as someone who could afford it and considered it but was completely pissed of due to some dodgy salesman who over sold the benefits and underplayed the risks. If you have the money its probably worth doing at 20 its absolutely not at 37 when I looked into it. While its obviously has some physical benefit its only step a above cosmetic plastic surgery and is still vanity surgery so I'm quite happy to leave it to a highly regulated private sector like it is in the UK

mrjonno wrote:Laser corrective surgery in the UK is generally done by specialised clinics that only do this (entirely private).

Sorry I would say current private eye surgery represents everything that is wrong with private medical care and I'm saying that as someone who could afford it and considered it but was completely pissed of due to some dodgy salesman who over sold the benefits and underplayed the risks. If you have the money its probably worth doing at 20 its absolutely not at 37 when I looked into it. While its obviously has some physical benefit its only step a above cosmetic plastic surgery and is still vanity surgery so I'm quite happy to leave it to a highly regulated private sector like it is in the UK

It's typically done by private clinics here as well. For a while there were quite a few dodgy ads (get it done for only $400, stuff like that), the much better clinics have risen above to become the most profitable though. I can really only speak for Texas though. I don't know much about it in the rest of the US.

I had PRK done last year and have been very happy with it. My mother had lasik done in her 40's and she's happy with it.

Also you do know who first developed bulk corrective eye surgery its that well known bastion of capitalism Cuba!!

I attempted to find information on this but was unsuccessful. This isn't the glaucoma thing is it?

Laser eye surgery is non-essential.

I heard somewhere that John Lennon's recognisable glasses where actually the standard issue NHS ones back then.

When people spend 1000's on irreversible optional surgery its very rare for them to be unhappy about the results, saying you are unhappy about it is just another way of saying you think you were stupid for having it in the first place which people obviously don't like to say.

Cosmetic plastic surgery/corrective eye surgery is the sort of thing that is only done by private care as on the whole the public sector doesnt touch. I assume if it was done it would be a lot cheaper but with waiting lists.

I have to admit the idea of private health care being most cost effective than public care really is absurd. Some of the reasons that US medical care is so expensive is you have too many under utilised hospitals, over treatment (without better results) and turning hospitals into 5 star hotel

You Americans have a mess of a health service.
How many are not insured?
How many people wait for days for the free clinics.
You should stop even trying to compare your lousy system to any country in Europe.
Even the worst health care system in europe is far superior that you have.

Please just get a life.

Scot Dutchy wrote:You Americans have a mess of a health service.
How many are not insured?
How many people wait for days for the free clinics.
You should stop even trying to compare your lousy system to any country in Europe.
Even the worst health care system in europe is far superior that you have.

Please just get a life.

...well...someone had to say it...

I'm With Stupid wrote:

Loren Michael wrote:Competition gives incentive to increasing efficiency. Lack of competition provides one less incentive to increase efficiency. If something is scarce, surely we want to be as efficient with it as possible?

Efficiency towards what goal though? Businesses are only efficient in producing a profit.

If there's competition, there's incentive to lower costs, improve the product, or both, in the interest of producing a profit.

Profit can be a motive to be more efficient, but it can also be an added bill.

If there's no concern that a competitor will undercut said bill, that's a salient point, but that's an additional assumption on would have to make.

There's any number of market failures that might lead to what you're talking about, and there's enough regulatory capture, information asymmetry, and other such factors to make for a dysfunctional market in healthcare in America, but America isn't the final word on markets; it has its own unique history for why things have turned out the way they have.

mrjonno wrote:When people spend 1000's on irreversible optional surgery its very rare for them to be unhappy about the results, saying you are unhappy about it is just another way of saying you think you were stupid for having it in the first place which people obviously don't like to say.

I don't know if that was an indirect way of saying I'm stupid, but I took it that way. I had a -8.0 glasses prescription pre-op and now have 20/15 vision. Its pretty quantifiable. Why the hell would I want to reverse it?

Cosmetic plastic surgery/corrective eye surgery is the sort of thing that is only done by private care as on the whole the public sector doesnt touch. I assume if it was done it would be a lot cheaper but with waiting lists.

Cheaper to the individual but its pure speculation to say it would be cheaper to society. I'm very dubious of that claim.

I have to admit the idea of private health care being most cost effective than public care really is absurd. Some of the reasons that US medical care is so expensive is you have too many under utilised hospitals, over treatment (without better results) and turning hospitals into 5 star hotel

This has much to do with the way our system is setup. 70% of our expenditures are in the last year of life. We allow medicaid to subsidize empty hospitals. The top 1% consumes 30% of the total expenditures. I'm a bit dubious given the way the NHS works that the cost of a typical procedure is that much cheaper than in the US.

The 5 star hotels do exist but are few and far between and typically require people to pay out of pocket.

Scot Dutchy wrote:You Americans have a mess of a health service.
How many are not insured?
How many people wait for days for the free clinics.
You should stop even trying to compare your lousy system to any country in Europe.
Even the worst health care system in europe is far superior that you have.

Please just get a life.

Patently false and misleading . Go troll elsewhere.

This has much to do with the way our system is setup. 70% of our expenditures are in the last year of life. We allow medicaid to subsidize empty hospitals. The top 1% consumes 30% of the total expenditures. I'm a bit dubious given the way the NHS works that the cost of a typical procedure is that much cheaper than in the US.

Old people and the last year of life is going to take the majority of costs anywhere. The NHS is cheap as medicine is basically the same anywhere in the 1st world so I wouldnt expect to be much variation in cost as the actual doctor level, its the profit margin, bureacracy , empty beds ,wages ( I don't think US doctors actually get paid that much more outside plastic surgery), more expensive drugs (due to NHS 'free market' bulk buying delayed treatment for people who arent insured that makes things expensive.

You do realise if a doctor comes up with a new treatment thats better/cheaper it will be around the world in hours. All the drugs are basicalily a combination of usually state funded universities and free market drug companies

Scot Dutchy wrote:

nearestthingtonone wrote:

Scot Dutchy wrote:Another thread on this!

Apologies if I introduced a tired subject. I wasn't around for the previous thread and didn't find one on this topic during my preliminary searches.

My personal feeling is that a government-run system will likely be moderately inefficient, but that such a thing can be ameliorated with an independent inspection/regulatory body whose job it is to find inefficiencies and stamp them out. We'll never be able to achieve a perfectly streamlined public health system, but I'd still rather have a universal, free healthcare system run inefficiently than one run by people whose allegiance is with private shareholders. It may be an overly soppy way of looking at it, but the great thing about the NHS and similar institutions in other countries is that the shareholders (i.e. the taxpayers) are the ones actually using the service.

That is where the Dutch system (the best in Europe) is so unique. It is not run by government. The government runs the health inspectorate which has strict control on the whole system. We do not have a any private health at all. Everybody is treated the same. There is no jumping of queues or getting special treatment.

Treatment is equal, sure, but if you have the bad luck of having for instance an innate disease or other condition not covered by the basic insurance package it still can get costly. And overall, we score quite high on expenditure on healthcare - though it's still way less than the US (they spend around 60% more per capita than us) and we don't differ that much from other European countries. Of course, part of that is the result of good care having a cost and another part of the Dutch tendency to overinsure, but there are some possible caveats.

For more, see this: http://www.oecd-ilibrary.org/social-iss ... ce-2011-en

mrjonno wrote:
Old people and the last year of life is going to take the majority of costs anywhere. The NHS is cheap as medicine is basically the same anywhere in the 1st world so I wouldnt expect to be much variation in cost as the actual doctor level, its the profit margin, bureacracy , empty beds ,wages ( I don't think US doctors actually get paid that much more outside plastic surgery), more expensive drugs (due to NHS 'free market' bulk buying delayed treatment for people who arent insured that makes things expensive.

The National Institute for Health and Clinical Excellence has a system in place that doesn't allow procedures to be performed through the NHS that don't have a certain level of benefit(this is what Palin was going on about with death panels). Don't get me wrong, I think this is a wonderful idea and absolutely necessary. Its failed at every single attempt to try and establish something like that here. As a result the number of procedures done here are extraordinary in the last year of life. I can't find data on it for Britain but here it is for the Netherlands.
http://rivm.openrepository.com/rivm/bit ... polder.pdf
Its not allowing me to copy and paste a quote due to formatting but it says about halfway down

Given the age profiles of health expenditure for decedents and survivors total costs of people in their last year of life amounted to 2.1 billion euro (11.1% of total expenditure on included servies).

It looks like the Netherlands has been able to regulate its system well.

I didn't want to turn this into a US vs EU healthcare debate.

You do realise if a doctor comes up with a new treatment thats better/cheaper it will be around the world in hours. All the drugs are basicalily a combination of usually state funded universities and free market drug companies

I think this is partially true, usually its not a single person but a research institute nowadays. I've read before that 60% of health research was done by corporations in the US, they would have patents and thus limit availability. There's also very expensive large capital expenditure on more expensive machines, like proton therapy centers. The private sector often nabs this technology up much more rapidly even though it was developed in coalition with the NIH.

NICE doesnt allow treatments that don't work, work = cure, extend life by more than a few days or ease pain. I would rather have doctors and scientists working this out than insurance sales people.

The only real controversy from NICE has been the use of drugs for terminally ill people with their refusal to issue some drugs that only work on a small % of people and may extend life for a couple of months. Reckon insurance companies would authorise these?.

What is does stop is tabolid press reporting dodgy cures and the NHS paying for them (there was some bollcoks about a cure for alzheimers that got stopped) , when it comes down to it you're a patient not a customer which is why we don't have the absurd concept of advertising drugs to 'customers' in the UK. Thats must be another reason for high US costs, any idea how insane advertising the lastest cancer medicine to 'customers' seems to the outside world

NICE doesnt allow treatments that don't work, work = cure, extend life by more than a few days or ease pain. I would rather have doctors and scientists working this out than insurance sales people.

I would as well. In the US almost all elderly are on medicare, not private. So you could have a regulating body like NICE in theory but it hasn't materialized.

What is does stop is tabolid press reporting dodgy cures and the NHS paying for them (there was some bollcoks about a cure for alzheimers that got stopped) , when it comes down to it you're a patient not a customer which is why we don't have the absurd concept of advertising drugs to 'customers' in the UK. Thats must be another reason for high US costs, any idea how insane advertising the latest cancer medicine to 'customers' seems to the outside world

I agree with everything here. It drives doctors here a little nuts when patients come in and say "I want that one".

EDIT: I might add that we have a number of members of the house and senate that want medicare to start accepting quack cures. At least we don't have Prince Charles though

Loren Michael wrote:I'm not sure why that should be particularly salient. More people means a more expensive healthcare system. More people means the military is cheaper, per capita. The effect of the costs of war depend on the nature of the war. Are we talking a protracted campaign of drone bombing of a poor country? Something else? I don't really care, it's tangential to my point.

A big chunk of healthcare costs are not dependent on the number of persons treated. This includes the cost of research (compare the price of a generic drug, where you just pay for the production with the cost for a non-generic one that has to recoup the investment in R&D during the protected period, then check how this difference changes for drugs for common and rare diseases) and the cost of infrastructure. Add to this the costs incured by trying to protect against risks, which goes down as your number of insured goes up (basically Chebyshev's inequality tells you that the per capita cost to ensure that keeping the probability that medical costs can´t be covered below some value x scales at n-0.5). The combination of these effects can actually result in situations where the absolute cost of providing health care to a larger number of people can be lower.

I´ve used an analogy on another forum to break this down:

Me, somewhere else wrote:Imagine sitting on a bus as the only passenger paying 50 bucks for a short ride, because your fee has to cover the wages and gas on its own and also buffer for the times when the bus is empty on the whole route. Then somebody suggests that if you dropped the fare to 2 bucks, there´d be 30 people who could afford to ride it as well - you´d have saved 48 bucks, 30 people wouldn´t have to walk and the bus company would have made $12 more in revenue. That person is obviously a socialist and the correct response is to note that people who can´t afford $50 for a bus ticket clearly don´t deserve a ride.

I get great medical and dental care, can't complain at all. I pay for it. No problem.

Loren Michael wrote:

Wiðercora wrote:

Loren Michael wrote:

Wiðercora wrote:I've often heard opponents of UHC declare that 'healthcare is a privilege, not a right'. This baffles me. Healthcare is one of those things, that if you don't get, you might die - how can not dying not be a right?

I assume it's just a phrase people just use without mind to the meaning, but it could be that the people who do think about it are referring to the scarce aspects of healthcare. It's a limited resource. Rights like the ability to vote, freedom to assemble, these sort of things can be reasonably thought of as qualitatively different.

If it's limited, surely it should be managed by a central authority with the logistical ability to look after such an enterprise, instead of a disaparate group of competing companies.

Food is also limited, and its absence similarly means death. Would you have food production managed by a central authority?

Competition gives incentive to increasing efficiency. Lack of competition provides one less incentive to increase efficiency. If something is scarce, surely we want to be as efficient with it as possible?

This is the theoretical argument that's always posed to justify privately operated healthcare. The problem with it is doesn't reflect the facts of actual outcomes. It's just a theory, and the actual practice of it does not measure up to the theoretical notion.

In the US, expenditures for healthcare are twice what they are in Canada (about $6K per capita versus about $3K) and yet Canada has better outcomes and longer life spans. So who's being more efficient? You only get one guess. Profit taking alone makes a private system less efficient than a not-for-profit system.

Incentive you say? My doctor's incentive is to keep me healthy, that's his job, he does it with pride and dedication, because he's a fucking doctor for Christ's sake! He also, by dint of being a well educated person, keeps tabs on procedural things and regimens and seeks ways to make his work more efficient, it's just common sense.

This battle has been fought in the forum dozens of times, and each time its been debated the proponents of private systems have had their teeth kicked in by the mountains of facts and evidence that speak against it and prove beyond the shadow of any doubt that UHC is a far better approach to delivering healthcare and maintaining good public health, which is necessary for everyone to enjoy a vibrant culture.

When will they ever learn?

susu.exp wrote:

Loren Michael wrote:I'm not sure why that should be particularly salient. More people means a more expensive healthcare system. More people means the military is cheaper, per capita. The effect of the costs of war depend on the nature of the war. Are we talking a protracted campaign of drone bombing of a poor country? Something else? I don't really care, it's tangential to my point.

A big chunk of healthcare costs are not dependent on the number of persons treated. This includes the cost of research (compare the price of a generic drug, where you just pay for the production with the cost for a non-generic one that has to recoup the investment in R&D during the protected period, then check how this difference changes for drugs for common and rare diseases) and the cost of infrastructure. Add to this the costs incured by trying to protect against risks, which goes down as your number of insured goes up (basically Chebyshev's inequality tells you that the per capita cost to ensure that keeping the probability that medical costs can´t be covered below some value x scales at n-0.5). The combination of these effects can actually result in situations where the absolute cost of providing health care to a larger number of people can be lower.

I wasn't factoring in research costs, and infrastructure definitely is affected by population. Regardless, the fact that there are some elements that aren't affected by population doesn't take away from the significant chunks that are affected by population. As for larger numbers being cheaper to cover, I'll believe it when I see the data.

My point is that the military is non-analogous. A doubled population can be served by the same military. A doubled population will definitely require more doctors and nurses, more hospitals, more drugs though.