What A Sustainable Health Care System In The U.S. Might Look Like

Start with the Maternal Morality Stats for America

https://tcf.org/content/commentary/worsening-u-s-maternal-health-crisis-three-graphs/
Now let’s look per state


Don’t you think those stats should be lower?

 

So you believe caring means you get upset and whiny? Hasn't anybody ever cared about you?

 

Why are they that high?

 

Lots of people care about me and I care about lots of people. We love being together. We laugh and enjoy ourselves. Being happy is much better than whining and being unhappy.

 

Several reasons but one of the core ones seems to be lack of standardised care. I mean I looked into this recently and found a significant number of deaths were from peripartum haemorrhage. Now THAT is bloody unforgivable. My state spent a couple of million dollars putting together maternity care guidelines so even a nurse working in a single nurse station somewhere like Camooweal (population 208 + dogs) could quickly reference a plan of action if needed (they also have Telehealth support too).
https://www.health.qld.gov.au/qcg/publications
It also means that “cowboy medicine” is limited as the TWONK who thinks that say, pyramids, crystals and homeopathy is going to cure blood loss of 700mls a minute could face discipline for not following guidelines

 

But little replaces the satisfaction of knowing you have helped another human being

 

Well, first, I said Medicare is an "earned" benefit because "For premium-free Medicare Part A, an individual must have worked 40 quarters."

"During a quarter of coverage, an employee pays Federal Insurance Contributions Act (FICA) taxes, which combine withheld taxes for Medicare and Social Security.

On a paycheck, Medicare withholding tax appears as Fed Med/EE. Each year has four quarters. Roughly, 40 quarters equals 10 years of work." Link: https://www.medicalnewstoday.com/articles/40-quarters .

Granted, that's not really a hell of a lot... merely 10 years, and most people work three or four times that long during their lives.

Next, if you really expect Americans to "take responsibility" for themselves, you're subscribing to a paradigm from 50 years ago. Many of us are so irresponsible now that we have come to believe the government should provide everything we want and need. And personal health and well-being? Look at how many of us wreck our health with far too many drugs, alcohol, and other "fun" behaviors caused essentially by mindless stupidity!

And never forget -- in the United States, we allow stupid, irresponsible people and people on government welfare programs to VOTE in every election! No one should be surprised at the inevitable, resultant 'death-spiral'.

 

Generally speaking, those who are content exhibit this life-balance in what they do, rarely in what they say.

 

Then you will be happy to know that a combination of government and corporation interests are doing everything in their power to stamp out the last vestiges of any humanity/individualism from this health care system. The last institution I worked for spent 99% of the time in our monthly provider meeting attempting to convince all the docs and other providers that doing the same thing was The Enlightened Way. This was always met with rolling eyes and dedicated professionals getting ready to once again bend over and take up... .

I could write a book only on this subject and why this philosophy leads to horrendous patient outcomes. OTOH, it is the most efficient path to enormous profits for corporations [who purchase the standard of care sweepstakes] and government whose only interest lie in making all citizens uni-form [so as to create the least amount of work for them].

 

This is why the adults have to be in charge once more. Allow people to do what they wish but make them responsible for their behaviors. That's the answer...always was...always will be.

You don't respond this total dys-function by saying that it's baked int the cake. Things are the way they are because of massive corruption. Decent people need to stand up and say ENOUGH IS ENOUGH! Listen to Ramaswamy. If he has the guts to do this, there are others. Most Americans are incredibly weak.

 

Sorry, I don't speak touchy-feely very well, and I understand it even less.

 

Touchy-feely? What's that?

 

Psychobabble.... like "life balance".

 

This is less bout “individualised care” than it is about EBP EVIDENCE BASED PRACTICE. Look at the NICE guidelines in the UK. “Sepsis bundles” etc etc etc

Look there are some wonky bloody practitioners out there e.g. “Lotus Births”. This is where the umbilical cord is not cut because that can cause “separation anxiety” later in life. instead the placenta is left attached until it “separates naturally” I swear there was one site recommending this who listed as a side effect that the “smell could attract cats”. I had a mental image of the windows of the nursery lined with salivating Moggies looking in!

There are medical staff who actually believe in homeopathy Best yet look at that stupid

 

The bottom-line is that it is only individuals who are capable of compassion. Yes, there will always be people out on the fringe but if you destroy individual innovation, you will end up with what you saw in the USSR or Communist China. The larger the institution, the further away it gets from treating patients like actual people who have individual needs.

Although "one size fits all" might be great for corporate profits and makes the numbers look acceptable, it is the worst kind of care because the system cares nothing about you, only what the percentages look like. If you need something other than what everybody is getting, nobody cares...and you lose [maybe your life].

 

The fundamental rule for any policy idea is to align incentives with the goals in mind. People will vary in doing right and wrong. The best policy can do is make it easier to do the right thing. So there is some validity to your concerns about profits and lack of personal responsibility. However, there's a few issues.

So what are some things we want, universally or mostly, as a society, when it comes to healthcare? We want healthcare that has value (low cost, high quality). We want to live long, enjoyable or meaningful lives. We want there to be fairness, which usually means equality of opportunity (not necessarily outcomes), but can also mean "people get what they deserve."

On the fairness front, healthcare really ought to be treated as a right. In the modern context, all rights are really subordinate to health, as not much can be done without your life or health. Many health challenges are tied to random chance, and so the most fairness is ensured by equal access to life-saving healthcare. A return to the fee for service model
would really make the situation worse in that regard. Poor people would go without care. And even middle-classed people would be randomly financially devastated by bad health challenges,
some their fault, some not. This would stunt productivity, even ignoring the human cost, and would cause some people to hoard money instead of fuel the economy.

Another issue with fee for service is it aligns incentives against preventive and early care. People avoid going to the doctor because they don't want to spend time or money. If you make people pay more out of pocket for routine care, they are less likely to get routine preventive care. But for cost-effectiveness, we want them to be getting more routine preventice care, not less.

Profit is also a tool for aligning incentives. In healthcare innovation, you want to reward novel and effective drugs/techniques/devices. But in healthcare delivery, you want
to reward appropriate care, not just more care (or less care with HMOs). Fee for service may lead to a general decrease in prices, but it would also incentivize doing more
care rather than appropriate care, leading to more inefficiency and lower value. Profit can be a useful incentive for private healthcare suppliers (with regulation, and evidence and value-based formularies for the government), but more of a public model for healthcare delivery where doctors are rewarded for giving appropriate care, rather than more or less per se. I think salary usually does fine. It errs on the side of doing less, but doctors seem to be mostly appropriate in this context compared to fee for service.

Healthcare costs are indeed an issue, and it's unsurprising given increasing capabilities. But America in particular could do more to decrease unnecessary costs. For-profit health insurance is an example of something that doesn't really add value to the equation for anybody except their shareholders.

 

Sorry but there is no destruction of “individual innovation”. In fact things like the maternity guideline ENCOURAGE innovation as they are regularly reviewed, anyone in the state working in the maternity sector can put their hands up as part of that review. I should know I have done my fair share of writing guidelines.

As for “patient centred care”. Individualised care is a massive priority in state health here. We have monster quality assurance programs that feedback not just errors/issues but also patient complaints. All untimely deaths are referred to the state coroner who makes recommendations for statewide policy. I think the best example of this process is “Ryan’s rule”

https://clinicalexcellence.qld.gov.au/priority-areas/safety-and-quality/ryans-rule

https://clinicalexcellence.qld.gov....and-quality/ryans-rule/development-ryans-rule

Take it from me Ryan’s rule once called, triggers action and incident reports to feedback.

 

Plus there is the issue of “over servicing”. There was a research paper from some years ago (pre-COVID) that showed 1:5 deaths in USA hospitals occurred in ICU. That is not 1:5 patients in ICU die that is 1:5 dying patients are admitted to icu prior to death. This strongly suggests that people who are terminal are being admitted.

 

Who is "we?"

Fairness? This is adult life, not the playground.

I completely disagree with all of this. A free market for health care would serve all markets. What do people do today when there are no cures available?

This is why you want a real health care system, not a sick care system.

You are forgetting that only individuals are capable of human compassion.

Spoken by somebody who is completely unaffected by the crisis in the American health care system.

 

Perhaps you might find out what that is at some point in your life. Perhaps not.

 

Fairness is the ideal in everything when it can be created. It's a vehicle for rights, and a foundation of meritocracy. That's how we set up our courts. It's a major consideration in law. It's a basis for sports. Where in the world are you coming from?

They die? What's your point? Free markets don't work as well for healthcare delivery as most other sectors. I alluded to some of the reasons (profit not a good incentive for delivering ideal care). The consumers are also very much uninformed compared to those delivering the care - they didn't go to medical school. Healthcare demand for an individual is often uncertain, and when it's needed the demand is inflexible. A healthcare emergency is not a good time to be negotiating for prices or shopping around... lol. It is not a good area for the free market at all. It's not like buying a car, a computer, or getting a massage - things that respond well to the give and take of supply and demand.

We want both, but ideally we want to encourage people to go see their PCP before things get worse when possible.

Uncertain of the point.

What do you mean unaffected? I'm a pathologist in California with a degree in public health. You think I'm from another country or something? I know bowerbird and I tend to agree on most things but I'm not from Australia, not that I would mind living there.

 

The adult world. You believe that fairness is the basis for all these things? Come on, what world do you live in?

Rule #1 Life is not fair.

Free markets work the best for everything. Otherwise, you are tampering with markets which always ends badly. How can health care be a "right?" An individual's health care is up to the individual. You have raised the collective above the individual...really shocking for somebody who lives in CA.

Perhaps you can send somebody over to their house and they can hold there hand as they bring them into the clinic.

What is your path degree?

 

I disagree about the fairness. See it is part of Aussie culture to “give a fair go” we have a “fair work commission”. And a common saying is “fair is fair”. ALL people are to be treated equally and not just under law ergo healthcare is for everyone

 

if you ever decide to visit contact me - I will give you free language lessons

 

Of course it is. And people operate better when they feel like fairness is promoted. Sure, **** still happens, but fairness is an ideal to strive for.

Seems to work better for the rest of the developed world. But healthcare is the clearest exception to the free market being ideal, because it does not follow normal rules of supply and demand as I have alluded to. Economic systems are tools to be tailored to the situation, not religions.

In the modern context, access to it promotes equal opportunity and fairness. And no rights can be enjoyed without basic health.

Personal choices matter for some diseases more than others. Toddlers with leukemia didn’t make some mistake, they were unlucky. The government should make sure they get care, not leaving it to whether their parents have the means or people in churches or gofundme take pity. And the average consumer is simply unequipped to be an informed consumer of healthcare, particularly during a healthcare emergency.

This is all about individuals. You’re the one who wants to leave people to the mercy of chance and unfairness. Just so what, rich people can keep more?

MD. Board certified in anatomic and clinical but mostly use anatomic, like most. Bulk of my work is looking at biopsies under the microscope. Fortunately don’t have to do autopsies anymore, Dr. Omalu does ours now.