Mosh Pit - 93rd Comment
The U.S. Health Care System

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Political commentary follows.  This thread is about the health care system and there is no baseball in it.  A little basketball and football, maybe.  

Top Ten Reasons that we pin this comment/essay to the front page:

1.  "Grumpy" and I are e-friends offline.  Because of that, we realize (1) that he has the only screen name on here more ludicrous and misleading than "Dr. Detecto," and (2) that he would set aside time to write us on the health care system, is no small thing.

1a.  Whatever you would guess his medical judgment was, the real estimation would be higher.  And we can imply, if not state legally, that he's unconscionably generous about it.  :- )  In case you needed more reason to feel warm fuzzies about the site.

Whether you're talking about the rock stars at the UW hospital, or whoever you're talking about, this is the doctor you'd go with.  Just in case you wanted some flavor text.

:- )

2.  Gordon has two baseball posts up today.  When LeBron has a clear-out and is backing down, Kevin Love doesn't run over and wrestle the ball away.

3.  Apologies to the "Original Poster," whose sincerity I take as a given, and whose ideas are respected by all.  Part of the reason for the post is to give him (or anyone) a clear thread in which to play ping-pong.  If he wants his "original post" edited in, that's great; if I were him, I might prefer to reply in the comments - hence this format.  But whichever.

4.  Tournament chess teaches you a lot of valuable life lessons, even if you're not so good at it.  One of the most valuable lessons:  general reasoning only takes you so far.  You have got to "get your hands dirty" in the "real variations," if you ever want to get good.  Grumpy's comment gives a good example of the type of "hands-on" detail analysis that is required before one should venture into a confident position on a complex political issue.

If SSI served only a few "life lesson" purposes, that would be one of them.  Respect for the complexity of the problems.  Which, of course, Dr. D is only too glad to cast behind his back when it suits him :- )

5.  SSI frequently gets applause from the audience for this.  Pinning hyper-expert commentary to the front page, that is.  As you know, Dr. D is a ham and would never turn down a chance for applause.

6.  This might be an interesting comments thread for the subject of Euro-style Health Care generally.  SSI denizens seem to relish "the little side conversations," as MtGrizzly put it.  ... Dr. D is, so far, too squeamish to take The Counselor up on his suggestion of legalized marijuana ...

7.  Two words:  "Extra Traffic"

8.  Your first warning that the U.S. heath care system may not be up to snuff:  Mapquest directions to the Emergency Room includes alarming step "enter trailer park and proceed 0.4 miles"

9.  Second warning :  your chemotherapy drip says "veterinary embalming only" in Korean

10.  Final warning:  you suddenly realize you are taking advice from Dr. D

Enjoy,

Jeff

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Dr. Grumpy, a surgeon, sez

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Sorry for the delayed response.  Been tied up.
 
1) The numbers I recite here are from memory so probably not perfectly accurate, but I remember reading (maybe a decade ago?) that of the 23 top medical advances created in America over the previous couple decades, 16 were the product not of the 'market', but of government funded entities (e.g., CDC) or government funded research projects at universities.
 
It seems like you might want me to argue against government funding or sponsorship of any form.  Just to be clear, my point is that extreme/EU style socialism doesn't (and can't) really work very well, without certain very favorable circumstances (eg the US picking up the tab for world stability, providing huge markets for other countries' exports, and picking up the tab for the development of medical advances).
 
I don't know the exact numbers, but certainly some (many?) advances *begin* at universities or the NIH as government funded projects.  Or at least the ideas/early development.  Of course, that doesn't mean that this research wouldn't get done otherwise.  However, the expensive, risky, and arduous part of bringing things to market happen after the basic research.  Many compounds have to be evaluated and weeded out prior to starting animal trials, then more are weeded out prior to human trials (which necessarily are long, expensive, and paperwork and personnell intensive, and highly regulated.  This is also true of new medical/surgical devices and imaging technology.  This can take decades, even for technologies that have already been proven in other areas.*
 
So, yeah, I have nothing against that sort of funding (though if not done by the government, private money would fund it... think Bell Labs). 
 
It is however, yet another direct example of how the US taxpayer is subsidizing scientific and medical advances which go on to benefit the rest of the world.  This just reinforces my point that these social democracies could not exit in their current forms w/o the direct and indirect subsidies provided by the USA.
 
 
 
 2) The idea of monopsony purchasing power has been raised a couple times. In simpler terms, I'm assuming this plays into patients in America having to pay the proverbial $12 for an aspirin when they're in the hospital.  (And MisterJonez, an RN, points out that it can take more than $12 paid time for him to dispense one aspirin according to hospital policies and procedures - Dr. D)
 
 
It is partially that we're talking about different things here.  $12 aspirins are partly a product of cost shifting, where hospitals charge higher rates to people with money (or ones that have insurance) to cover the costs of providing care to those that don't have insurance.  Also, as others have pointed out, everything medical is expensive, whether it is equipment, physical plant construction, personnel, etc.
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If we 'invented' the advance, why must we wind up paying more for it? (I realize much of the answer is included in your post above). But if we adopted a single-payer system, as have many European countries, could/would we exert that same pressure? Or would that necessarily, in your mind, make the entire global health care network recede/collapse?
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I do think that if the US adopts a single payer system across the board, it would seriously retard medical innovation, innovation that benefits the entire world.
 
It is important to realize that ~50% of the US healthcare market is already basically "single payer":  eg Medicare, Medicaid, or VA (that's pre ACA).  Already, Medicare pays for hospital procedures in block payments (DRG reimbursement)... that is, they pay the same amount for a hospitalization whether you use the latest technology or ancient technology.  And they pay the same whether the pt stays in house 2 days or 10 days for a given DRG (Diagnosis Related Group).  
 
Sure, the US could go to an EU system and dictate terms to the drug companies and deny new device etc.  This would save money on expenditures, but this strategy is not magic... there would be real repercussions.  But where would the market for new innovation come from then?  What would drive people to come up with new advances, pay the development costs, and take the risks involved with production?
 
Say the government just took over the legal industry, and decided to pay 50% less for all services than had been customary previously.  Or the IT industry.  It would certainly "save money", but I suspect it might warp those markets severely.
 
The answer, IMO, is not to cripple what makes the US system such a unique driver of innovation.  The answer would be to get the other rich nations like Canada, Japan, and the EU to start paying their fair share of the costs of development.  Unfortunately, this is unlikely to happen.
 
Just remember that comparing the US system and EU style systems with a mind to efficency or bang for the buck that you are comparing apples to oranges... there's no way the EU systems could perfoem the same way without the US.

- See more at: http://seattlesportsinsider.com/comment/155201#comment-155201

Comments

1

My 78-year-old mother was, a few years ago, diagnosed with terminal cancer.  She was absolutely penniless.
The care and compassion she received?  It absolutely boggled my mind.  Aside from the $300,000 or so (?) of high-tech treatment she got, she was met by wave after wave of compassionate health care professionals.  And she'd be the first to tell you that she wasn't the easiest to get along with :- )
My own experience, the last year, has somehow topped that.  And by the way, lest this be a "Debbie Downer" reference, as of today my health is probably better than yours is, though that was once rather unlikely.  Heh.  Don' sweat it.
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Bill James once said, "a ballplayer who makes a million dollars a year, and wants to go for more, all power to him.  A ballplayer who makes a million dollars a year and complains about it, deserves a good swift kick in the (man region)."
I think the artist above?  Probably outdoes the Percy Harvins and Marshawn Lynches of the world.
Your chance to be born in the U.S. was about 1 in 25, my friend :- )

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You can't use 2 neithers and nors for 3 things.  Dr. D hates grammar nazi-ism, but in this case he's happy to make an exception.  The "slogan" in the image has more errors than words, which morbidly echo'es the last subject:  Hanley Ramirez at shortstop.  
You literally could do a "Where's Waldo" on the errors in this little slogan.  
In fact, why don't we?  See if you can spot the ones I missed!
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2.  Technically, you can't use two words as an adjective for the same noun unless you insert a comma or hyphen.  That's why excruciatingly correct grammar is "Healthcare."  Hey, gimme a second.  We're just getting loose.
We wouldn't be on this turf if the slogan weren't so smug and self-satisfied (a definite no-no in politics and P.R.).  If you're going for "smug," don't make mistakes.  That's free advice.
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3.  I defy you to assert that our health care "system" is not a complex, connected series of parts.  If you do, I'll have you fill out my insurance.
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4.  As far as it "not being healthy," well ... the next time you lose a finger to a bandsaw, I dare you to not use U.S. facilities to improve "the general condition of your body or mind" with respect to illness, injury or pain.  Make a run for the border, why don'cha.
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5.  As far as it not being caring:  tell MisterJonez.
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6.  "Nor" is a conjunction and isn't capitalized, even in a title.  We notice that "a" is not capitalized, so it's not like they're trying to coin a convention here.  Sniff.
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7.  Same goes for "Neither."
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8.  The kindergarten colors, and font, cast a tone like "I'm a 5-year-old and you can't question my innocent wisdom."  But 5-year-olds don't often use neither/nor, in my experience.  Neither do they know what a health care system is.
You could blow off most of the errors as being due to the cutsie-pie K in K-12, except that the author knows what a health care system is, and knows its level of efficiency.
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9.  A bit more seriously:  the IDEA here is that our current system is not even "a system."  (The local Safeway is "a system.")
The basis of the whole idea is that the U.S. health care institution its not NEARLY complex enough for our tastes.  If you want the U.S. health care system to be FAR more COMPLEX, it's because you want the government in total command of everything (especially you).  The subliminal message that we're children, in need of paternalistic attention from the Dictator, is offensive.  
Admittedly, this one is a little subjective.  But no reader appreciates the insinuation that he would be better off moving back in with his parents, even if the author wants to share his room.  You sort of lose empathy with the implication.
Sincere readers do believe that the Feds should take over this 1/6 of our economy because we'd be better off if they did.  But when you claim that we don't HAVE a SYSTEM, you've blown your credibility a little early :- )
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10.  Our "voice" is captured in a soap bubble, nature's perfect Unit, which (unintentionally) conveys the idea that we ARE dwelling in a tight, perfect little system ALREADY.
Admittedly, that's subjective too.  But I as editor would (seriously) have thrown the slogan out on those grounds alone.
I won't even count an extra bullet point for the fact that the graphic makes us feel vaguely claustrophobic.  When we're enclosed.  In a system.
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11.  Optimistic handwriting goes up.  Pessimistic handwriting goes down.  The first half of the slogan is emotionally even, in contradistinction to the emotional chaos of the second half.  Why am I sometimes emotionally content?  Why does this system make me happy half the time?   Are they saying that the situation often makes them happy?  
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12.  The colors are totally cacophonous:  mostly earthtone, partly Arizona'n, occasionally neon.  This also implies that the "voice" is incoherent.  Which, of course, it is.
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13.  Most notably, the word "Our" is totally off-putting, coming from this posse.  In no other situation do they consider "us" a "we," and the reader is well aware of this.  Nancy Pelosi and Sarah Palin are not a "we."
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14.  The slogan has 11 words.  There y'go amigo.
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Y'know on second thought ... I kinda like the graphic.  Maybe one of us should email "for prophets" about a job.  Or to see what they could come up with, for something truly juvenile.  Say, Detect-O-Vision.
 

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In response to this:
The basis of the whole idea is that the U.S. health care institution its not NEARLY complex enough for our tastes. If you want the U.S. health care system to be FAR more COMPLEX, it's because you want the government in total command of everything (especially you). The subliminal message that we're children, in need of paternalistic attention from the Dictator, is offensive.
I suggest you google the name Jon Gruber, all. That is precisely what the architects of the ACA wanted...to be in command of as much as possible and get the bill passed. And they were willing to create a cyclone of lies and obfuscations and complexities to so confuse the Congressional Budget Office and the Congress (and the voters) that they wouldn't realize that's what they were voting for.

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OK, I get it--that graphic is terrible. No problem...I didn't create it.
A European system is not the answer--OK, I'm no expert, I'm not going to go there.
And as for, "...you want the government in total command of everything.."--we're getting a little close to the tin foil hats, aren't we?
But leave all that aside. Here's what I'd like to hear from people in the know. We have the most expensive health care system in the world. Delivering the 42nd best care. Is this not the problem?
So what IS the answer? Fine with me if you throw out Europe...and single payer...and the magic power of prayer.
I could learn a lot hearing what we should be moving TO...rather than what we should be moving away from.

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Which seems to me quite a bit different than the ones I see on TV....
1.  The 'total command of everything' was a quip.  Among other quips...
2.  But I am convinced that many Americans (not you) would like our government to move far, far in a paternalistic direction.
2a.  Associated with this is their low view of the average American in the street.  Gun control is an easy issue through which you can compare these two world views, "trust Average Joe or trust the government."  Educating kindergartners on bisexuality.  Most of the issues that badly divide the flyover states from the population centers.
2b.  Associated with this is income redistribution "in the interests of fairness," even if it harms our economy, as President Obama put it when answering a Q about higher tax brackets reducing tax revenues.   Obviously, socializing 1/6 of the economy is currently the most feasible move in that direction.
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On the most expensive health care system, and 42nd-best care, I'd like to see the metrics by which we documented the 42nd-best claim.  My mom's experience, and mine, was more like "American health care is in the 22nd century already."  That hasn't been my experience.
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What we should move *to,* that's a great Q and quite an issue.  Perhaps Dr. G could chime in.  My first thought would be to make it a lot cheaper by reigning in the trial lawyers and adjusting cultural expectations on how aggressive doctors should be about adding year #84 to the life of a very sick person.
Or not.
Your ideas are always very interesting Diderot.  This is one with legs:  "What exactly do we do?"  Perhaps we could narrow that question.  About what?  About our expenses?

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1) Sorry I missed the quip. Proof again that sarcasm doesn't work on the Internet.
2) Also sorry on the statistical citing; a more recent report from the World Health Organization has moved the U.S. from #42 to #37--hooray for Obamacare! :) Also, the Commonwealth Fund has named the U.S. the worst provider among 11 prosperous nations--for the fifth time. I'm sure the sources can be disputed...but I'm also pretty sure there isn't a conspiracy involved here. In any case, that's the essence of my 'to' question: how do we close the gap between the level of expenditure and the level of care?
3) My anecdotal evidence matches yours--at times. A young person very close to me avoided death due to the efforts of the Seattle Cancer Care Alliance and the UW. I will forever be in their debt. On the other hand, I have seen incompetence to a level that was shocking on two different occasions from a highly-regarded (and extremely well-funded) hospital in our region (which shall remain nameless). So of course, I want to keep all the good stuff! But I wonder how many would agree that the 'good stuff' isn't going to enough people?
4) Paternalism: nothing new in this fear. It's the same warning sounded about Social Security when it was enacted (along with complaints about early implementation SNAFUs). And all that led ultimately to that guy in the audience in South Carolina during the last presidential election warning the speakers to 'keep government hands off my Medicare!'
5) You seem a little surer about my stance on single-payer than I am. I'm honestly conflicted. Which led to my sincere question to Grumpy (and others) to hear their perspectives.
But to repeat my earlier point, I think Oliver Wendell Holmes had it right when he complained about a critic: "I could smash him if he would say what he thought and not only what he didn't believe!"

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misterjonez's picture

I've only worked in a few hospitals, but I have had the privilege of practicing in both union and non-union shops, so here's an example that I think simplifies one of the major issues I see in the health care industry. See if you can guess which of these is the union shop and which one is non-union (or, more accurately, anti-union - at least they were as of the time I practiced there).
One hospital I worked at had an RN-only policy for direct patient care. The only people who were allowed to lay hands on the patients, aside from drawing blood for lab tests, were RN's and MD's. There was significant literature and statistical support strewn throughout the hospital's mission statement, employee handbooks, the nurse's lounge, and even out in the halls in the form of posters suggesting (almost certainly accurately, in my opinion, for whatever that's worth) that patient outcomes improve when only an RN-or-higher professional interacts with the patients. We were assigned a maximum of six patients on the medical or surgical units, which can be a little taxing if the patients are more demanding (receiving active insulin drips, suffer from dementia, are in extreme pain, under the effects of hallucinogenic drugs, combative, threatening respiratory arrest, etc..) but usually the maximum six was pretty easy work. Compared to the nursing homes I've worked in, it was a cakewalk even WITH a load of six time-demanding patients, but the truth is that we probably averaged just a shade below five per RN.
Another place where I practiced had a little different outlook. They had RN's on staff, but they also had LPN's (Licensed Practical Nurse - legally can do just about everything an RN can outside of certain IV administrations) and CNA's (Certified Nurse Aides/Assistants. This is more of a manual labor, lower-skill* job designed to take pressure off the RN's/LPN's by fetching meals, refilling water pitchers, swapping out bedding, helping patients to the bathroom, etc..). In this alignment the RN had, usually, an LPN and a CNA assigned and they formed a team. The RN took care of the periodic assessments, coordinated with the doctors for order updates/changes, and administered any of the medications the LPN was unable to dispense while basically serving as the team leader. The LPN took care of the rest of the medications and helped out with the labor aspects when the CNA needed a hand. And the CNA did basically what I outlined in parenthesis above. This team was assigned a maximum 15 patient load, and they almost always had a minimum of 12. There was no literature in the nurse's lounge, or posters in the hallway of this facility, supporting their in-house system of direct health care delivery. It was simply the way they operated.
One of these hospitals was a union shop and the other was anti-union. One of these hospitals served as a major trauma center for a metropolitan area and the other was a small-town, rural-type hospital (although, to be fair, both hospitals were parts of larger networks which provided all manner of care spanning the entire spectrum).
Unfortunately, I applied for a job at the hospital I really wanted to work at but didn't get the post out of school. So I ended up working at the rural hospital instead.
*CNA's, in my experience working in a nursing home, are almost always the most important cog in the machine. They don't get paid much, they get too much asked of them, but they are the ones that the people who live there relate to and trust the most. I would 'go to war' with a much higher percentage of CNA's that I have had the pleasure of working with than I would RN's or LPN's who I have encountered professionally.

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Funny, and true, too.
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My Q would be, what metrics does the WHO use.  Their overall opinion doesn't mean much to me as such:  I want to know whether their evidence is compelling.  We just had this discussion about expertise.
Also, President Obama *ran for office* on the idea that the world hates us.  I don't trust the WHO to say glowing things about the U.S. at its own initiative.  I don't have a tinfoil hat.  My observation is that every other country in the world, except England and Japan, is green with envy about our nation and culture.  Think plumbers buying $4 lattes, customers in restaurants saying "sir" to the waiter, and ordinary citizens being excruciatingly "sensitive" to the disadvantaged.  It's not for nothing that the ozone is blamed on America.  The world sees us as having everything they want to have.
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An M.D. (not Grumpy) once told me that the U.S. does not accept M.D. certifications from other countries, because NO other country is as rigorous and we simply don't trust their expertise as a general principle.  If Switzerland could have given me or my mom better health care, I'd like to know how.  It's like saying somebody pitched better than Kershaw, and that Kershaw is actually a pretty lousy pitcher.
 

9

Well, I will say that of course the healthcare system can be improved. I will also say that we don't have the 42 best system... I have no idea how something like that would be measured in any meaningful way. It is very easy to cherry pick or manipulate statistics to basically create any outcome you want (like when people used to say that Cuba had the "best" system. Of course this is complete BS). Also, remember that other systems would not be able to perform the way they do without the US direct and indirect subsidies to those economies.
American healthcare is expensive for many reasons:
-we have the most expensive personnel in the world (this is also a major reason the US military budget is so much higher than everyone elses)
-we subsidize innovation for the rest of the world, pay the development costs and provide the markets that stimulate medical advances
-regulations force construction costs and "medical grade" equipment costs to he very high
-educational costs for personnel are astronomical, and overly long
-a typical cultural phenomenon in the US is to "full court press" all patients, including the very frail premature babies and the very old and frail vs other countries that expend less resources on those populations
-as a very rich country, we have the resources to spend more on healthcare, just like we spend more on everything else (luxary goods, entertainment, recreation) than other countries that are less wealthy

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What a great post.  :: standing O :: ... and could you elaborate on this?
++ There was significant literature and statistical support strewn throughout the hospital's mission statement, employee handbooks, the nurse's lounge, and even out in the halls in the form of posters suggesting (almost certainly accurately, in my opinion, for whatever that's worth) that patient outcomes improve when only an RN-or-higher professional interacts with the patients. - See more at: http://seattlesportsinsider.com/comment/155220#comment-155220 ++
A practical issue:  at the UW hospital, students interacted with me constantly -- I intereacted with like 30-40 med students or something -- and it was a plus.  Are med students "RN or higher"?

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because the health care topic is so good...and I stand to learn so much.
But I will branch off to respond to the point about the rest of the world being green with envy about our nation and culture.
It's been my good fortune to travel overseas quite a bit, so here's my reading:
On our prosperity?: absolutely. Who would not want to live in our land of plenty?
On culture?: aside from matters of taste, like the Kardashians, there are two things that sincerely baffle the educated people I meet in other countries:
1) the degree of poverty. To them, it seems logical that all would be supported at some level above what the poorest now endure.
2) the guns. When someone cites 74 school shootings in the last 18 months...I really have nothing to say.

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misterjonez's picture

and most likely higher, depending on how far along in their schooling they are. It's a funny thing regarding med students, though. My only experience in a teaching hospital (where MD's are trained) was brief and it was in nursing school. But basically they (med students) operate outside of, but parallel to, the standard hierarchy in most cases early on in their schooling. So a med student's patient assessments, observations, and such are largely independent of the primary care delivery process (which goes, roughly, Assigned MD --> Physician's Assistant (if applicable --> RN/Respiratory Therapists (they're pretty even when RT takes a direct role in patient care rather than a supporting one) --> LPN --> CNA/Med-tech/Lab-tech/etc..). So a med student, while attached to the team briefly, isn't directly responsible for much other than the procedures they perform (again, my own experience is extremely limited but if you watch TV shows like ER it *seems* that my own experiences line up with those of others). They still make notes on the charts, and they can even order-and-perform procedures with their supervisor's approval, but they kind of exist outside of the delivery chain. I hope that didn't confuse.
But definitely a med student is 'RN or higher' by this particular metric since they're trained in a whole host of things RN's never learn to do (direct wound care, diagnostics, lumbar punctures, and central IV line placement to name just a few). Even when they haven't been trained in those things, a med student has far better theoretical background for analyzing patients than an RN does, although after five or ten years on the job an RN can usually out-diagnose the vast majority of starting med students.
Regarding the literature and statistical data supporting the notion that 'RN or higher only!' is preferable, the majority of the linkage between improved patient outcomes and higher-skilled contact seemed to stem from early detection of condition changes. For example, a patient with COPD (Chronic Obstructive Pulmonary Disease) who only had RN's interact with her would have a higher probability of a pending arrest or critical event being detected and dealt with before it became life-threatening. The actual delivery of care didn't seem to correlate positively in favor of the RN's (actually, if I remember correctly, it was slightly pushed in the other direction since each member of a team like I outlined above (RN+LPN+CNA) would be able to specialize in specific techniques and deliver superior direct care, whether it was ambulatory assistance for post-surgical patients, or dealing with combative patients, or those with dementia, etc..).
The 'RN only' approach was very much a 'one size fits all' approach in a literal sense, and while cooperation between nurses did occur frequently (one nurse may be better at placing IV lines, for example, and would often be called on by her co-workers to fill that role when dealing with a person who had particularly difficult veins) there was a chance that everyone would be too busy to help out, or that someone possessing that particular skill wasn't working at that particular time, leaving someone like me (who wasn't great at IV placement) to try an extra two or three times before succeeding. The plus is that the 'floor' of care quality is set at the minimum standard of an RN, which is to say it's definitely higher than that which a non-skilled person would be expected to deliver. But the downside is that everyone you see when you're in a hospital with this type of policy is going to be paid RN wages - and I already went into how that can, actually, make aspirin cost you $12 apiece when delivered by a nurse. This is, as Doc points out above, most definitely related to the absurd levels of litigation in the USA. It seemed like every three months the hospital I worked at was updating its policies in direct response to a major case going against a health care system which created new definitions of culpability for health care professionals. I'm not saying doctors, nurses, and others involved in health care don't make mistakes and shouldn't be called to answer for those mistakes, but we are well past the point where making your health care workers think about, and address, professional liabilities is a net positive. At this point all we're doing is increasing the costs of health care to cover the liability end, which prompts people to file greater numbers of suits when things don't turn out how they had hoped, and that is the very definition of a vicious cycle.
My own strengths were, oddly enough, social; when dealing with people who were hallucinating, or suffered from dementia, I always got better responses from them than my fellow nurses. Part of it is that I'm 6'2", dark haired, and have a pretty powerful voice (I only ever yelled when dealing with alcoholic dementia) with what many have described as an expressive face. So I could always get people to focus on *me*, rather than whatever it was that prevented them from doing so with others, and more often than not I could help them calm down when they were distressed (which is a very real plus, since hallucinating or demented patients are at extreme risk for falling, and hospital floors aren't exactly soft). I was also the best with little kids; again, I think it's my dark eyebrows, expressive face, and reasonably deep voice.

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The people who make those lists, diderot, are the same people advocating for socialized medicine...the factors that go into their 'formula' for determining the quality of patient outcomes include specifically elements of the medical process that are biased toward the socialized medicine setting. Basically...the same guys making the list and determining how it looks are the ones who want the results to favor EU-style socialized medicine.

14

Because based on the news I've seen lately about the corruption, suffering and death in the National Health system in the UK...if it's ahead of us on that list, that list in invalid.

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misterjonez's picture

I tend to focus on the labor cost aspect of US healthcare, but your second to the last point is also incredibly well-taken.
The phrase I hear that absolutely sets me off is one that starts with, "The least we can do..." when dealing with patient care decisions. The harsh reality is that the 'least' we could do, is nothing. That's where the conversation needs to start, and I think that if it did our entire society would take a different view of healthcare in general.
One thing I say to my girlfriend all the time is, "Two hundred years ago we didn't have names for 80% of the stuff that killed us. We just 'got old' and, invariably, died. Nowadays we have names, and treatments, for everything that killed the elderly a century or two ago and nobody even stops to think about whether or not we should actually DO those things."
I've seen people living in abject misery and barely-mitigated suffering whose lifespans have been prolonged, but whose lives have been completely destroyed, by the healthcare system in the USA. I've also seen people recover from afflictions which would have been utterly untreatable even fifty years ago and go on to live fulfilling, happy lives. Somewhere along the line a decision is being made (or, more worryingly, NOT being made) as to just how far we should go with healthcare delivery.
I love my grandmother dearly, and spent my entire childhood within walking distance of her house. I have countless stories of how she shaped my life, and I will forever speak fondly of her. For the past fifteen years, however, she has been in and out of the healthcare system and has cost the country over a million dollars. I'll say again: I love my grandmother dearly, and if you don't believe that it's best you keep it to yourself. But who, exactly, is paying for that care? My grandfather and her never even sniffed contributing a million dollars to the system (and I do understand the concept of earned interest, net present value of money, and other fairly basic economic principles, thank you very much), so I start looking around my family and adding up our direct contributions to social programs like Social Security and Medicare. You know what? Even if you added all of their children's contributions, they STILL don't make up the bill. You have to get down to us, the grandkids, before you can even think about satisfying the debt. So who's paying for all of this - and, more selfishly, who's going to pay for ME if I decide to avail myself of the same care late in life? (If you think that wealth redistribution, of which socialized healthcare is often recognized as being a part, is anything but an illusion then I will calmly assert that *all* costs are eventually passed on to the consumer, regardless of political rhetoric.)
This is a new problem for humans, because until the last couple of generations we haven't had access to this level of healthcare quality or availability. So I understand the delicate, sensitive nature of the situation fairly well, but we are ignoring the elephant in the room and doing so might be taking us down a very, very dangerous road.

16

Here's an anecdote illustrative of maybe nothing but this one instance.
A couple years ago I went with my wife and kids to London. Stayed in an outlying part of the city (the Docklands) on the way to the National Observatory.
First morning, my wife wakes up with an awful toothache. The vacation looks doomed. I look in the phone book...find a nearby clinic...we walk over and give them our name.
After about 10 minutes the receptionist says, 'the dentist will see you now'. The female dentist is excellent...solves the problem (with a permanent solution prescribed for when we get back home). We pay the (extremely reasonable) bill and are on our way.
No insurance required. We're not even citizens of that country.
You may say it's one in billion...but it worked like a charm that time.

17

I used to believe the same but I have employees in London and our offices there employ a couple hundred people. I've initiated a conversation with them on multiple occasions while over the pond and without exception, they love their health care system. I have literally been unable to find one of our employees there that dislikes it.
Now, our employees are younger tech-savvy types so I'm not saying that they are indicative of the entire country but it's the only direct experience I have with their health care system. If I were to assess it, I would say that it's *probably* not as good as our system at handing the uber-expensive end of life care and the odd corner case disease management but the it does seem to work pretty well for the typical health care needs of the UK citizens. Shrug - if they didn't like it they would change it and from what I can tell, their health care system is the third rail of UK politics.

18

The one core group of people that always love nationalized/socialized medicine are people who aren't sick.
The same positive reports always come out of young working aged Canadians. I have some good friends from Canada though, that have real medical issues like MS and bi-polar disorder. Their stories are radically...radically different. Doctors refusing to give them an actual diagnosis because that will cost the country money once it's official - doctors refusing to change prescriptions that are causing side effects because the next alternative is much more expensive, doctors turfing patients over and over if they don't have something easy to treat, doctor offices with no follow up protocols.
If you knew anyone who was old or infirmed, Grizz...you might get a different picture.

19

The schpiel about the "poor" quality (comparitively) of health care in the U.S. is, of course, much hooey.  
As Matt said, it is often spouted by those who wish a socialized/single-payer system to become the "American way."
But there is much recent data that demonstrates the silliness of all of this.  Examples:
 
1.  A 2008 study showed that the US lead ALL nations in the 5 year survival rate for breast cancer (women), colorectal cancer (both men and women) and prostate cancer.  If the nation performs so badly, why do we do so well in these deadly areas.
2.  Using a regression method and a standardized mean, the average life span in the US was greater than in Switzerland, Norway, Iceland, Canada, German and Belgium  (leading nearly every nation, in fact) when you factored out auto accident deaths and murder, both of which are much more prevalent in the US and have a disproportionate impact on the young.  Both of these mean of death are largely out of the control of the health care system.  The US lifespan increased from 75.3 to 76.9 using this method.  
As well, we live in a nation of generally greater obesity and high smoking rates than most developed nations.  These are behaviors that certainly negatively impact life expectancies and drive up overall health care costs (because of the long-term/chronic health care demands they create) while being beyond the control of the "system."
Anyway, our health care providers are world class, as is our "system."
 
 

20

As students of data and analysis, you'll forgive me if I ask to see the evidence that shows skewed results coming from advocates of socialized medicine.
Kill the messenger hasn't always proved the most conclusive argument...

21

and Matt's response is very interesting ... still:  those yuppies are the ones paying the bill, and if they sign off with gusto, then that's an argument not to be minimized.
Two things that would kick the ball down the field for me:
.........
1.  I could ask 10 people at Boeing what they think of the free U.S. K-12 system and they would all say they love it.  Despite its popularity, I believe it's becoming a pox on our society, a parasite there to serve the NEA's interests.  America is being dumbed down by the decade and indoctrinated to "values clarification" synch'ed to values held by NEA leaders.  "In the absence of criticism, an institution comes to serve only itself."
Personally I would argue that all ten of these folks are not very alert to the systemic costs of our K-12 education.  (My own children went through a hybrid of home schooling, public schooling, charter-type schooling, and higher ed, so I'm one of the few who has lived in all educational worlds, LOL.)
There aren't many confident political positions I have, but one of them is this:  a free market K-12 education system would make the world a far better place to live.
But your report is more like --- > people coming from countries where charter schools are the norm, and preferring our K-12 system.  (They still might not connect the taxation/system issues/etc.)
..........
2.  Still:  the UK is (as I understand it) very primarily capitalist -- for example, its banking network boggles the mind.  But in the abstract, free health care doesn't NECESSARILY imply a bent for socialism/communism, any more than our free K-12 system does.
I couldn't agree more with Matt, that about 25% of the population, 70% of the internet, and 98% of the media are looking for fairly extreme paternalistic government - and very extreme income redistribution.  Most people I meet on the 'net hate Corporate America on principle, and definitely the NYT does.
............
But England and Japan are very interesting, and thanks for the feedback on the UK.

22

Doubt it's one in a billion.  
........
Of course, any non-citizen in the U.S. (escapee from the local pen or whatever LOL) can get a filling at the dentist's for about $75-100.  Your wife's was a lot less?  Or she got a root canal for $10 or something?  :- )
A simple doctor's office visit in the U.S., no insurance, is about $50-100 and if you're hurting, a lot of doc's will give you a break.
Hospitals in the U.S. have to care for dire circumstances, no cost, for those who can't pay.  A guy is wheeled into an ER unconscious from a car wreck, they're going to treat him, right?
........
Not trying to minimize.  Just trying to put it in scale.

23

*Those with the loudest microphones,* overseas, are bitter about the U.S.' prosperity.  But visit an extremely poor family in south Mexico or the Philippines, and they're liable to be more cheerful than a rich U.S. family, and bear America not much animosity.  
Of course, you have your Mexican policemen within 50 miles of the border, or servicepeople who live around the tourism industry, who often fit the stereotype all too well...
Good reply.
.........
On gun control - I'm glad to see that issue was so easy :- )

24
misterjonez's picture

with Doc. There is simply no comparison between the education I received in my seven years of home schooling and the ~six I spent in public schools. (Community) College was a different deal, at least for me, because I was working toward the RN degree from day one. But there were plenty of people there (probably half) who saw it as nothing more than an extension of high school.
I was pulled out of public school at age eight, and by age thirteen I had completed everything my home school network required for me to graduate high school legitimately through one of their partner/affiliated schools. I decided at age fourteen that I wanted to wrestle, so I postponed graduation and went to high school for a couple of years, marveling with a slack jaw at just how little was actually being taught in the classrooms. The AP classes were a bit better, but the homework loads were so onerous that I bailed on them. I aced very nearly every test ever put in front of me, so the idea of doing 3-4 hours of schoolwork AFTER I left seven hours of school was something that never did, or will, sit right with me (note: my TOTAL schoolworkload, if that's even a word, during my home school years was ~1.5 hours per day, and that included blasting through high school from age 11-13 because, frankly, I didn't want to draw the whole thing out any longer than absolutely necessary. Though to be fair to the comparison, my older brother needed about 2.5 hours per day to accomplish largely the same goals.)
I'm 33 years old, so my experience is probably still within a couple of degrees of what's going on nowadays in public schools. I have yet to meet a parent whose kids were home schooled who didn't have great things to say about it. I've known a few people for whom it wasn't a great fit (my sister, for one, and we kept her in public school after trying at home for a couple of years) but the vast majority are simply amazed at how much their kids learn, and how much extra time they have on their hands as a family. Read any study of home school outcomes vs. public school outcomes, even those normalized for family income, geography, and parental education level, and they all have the home schoolers ahead very nearly across the board. Even the socializing aspect, which frequently gets brought up as a supposedly self-evident negative facet of home schooling, shows that home schoolers are better adjusted socially than their publicly schooled counterparts. If you can't do it better institutionally compared to doing it at the home, then you probably need to overhaul (or scrap!) the institution, no? That's what a free market would do, anyway...
Now, obviously, a stay-at-home parent is a seriously beneficial component of the system, but a grandparent works also if the kids are ~well behaved. But my mom once said, in her usually concise fashion, "It takes me less time to help you guys with your schoolwork each day, here at home, than it does for me to prepare your meals, drive you to school, and pick you up again each day. This is a no-brainer; now let's do some anatomy! ::begins cutting open a cow's heart*, eliciting 'ooh's' and 'aaah's' from her spellbound children::"
To my mind, and based purely on my own personal experience at a high school with over a thousand attendees, the modern public school system is little more than a disgraceful daycare system filled with political agendas that are forced on the attendees. That's harsh, I know, but it's how I see it - and how I saw it when I was wrestling for those two years. It is a colossal failure on every level imaginable. Even Diderot's example of school shootings, which are generally blamed entirely on guns, owe the basis of their existence to this horribly failed system.
*during this particular anatomy lesson we learned the names of the various structures of the heart, drew our own versions of them, and were quizzed on said structures for several days. After we had passed that particular course, we ate the heart. It was chewy, but good. My mom was an amazin' cook ;-)

25

And that 74 school shootings meme is a lie. Fact check your assertion regarding guns. fully 58 of the 74 shootings were single-person gun violence "on school grounds" in an urban area where neither the shooter nor the shootee were students at the school and "on the grounds" means...the street in front of the school.
As for the poor in this country...your "educated" European friends should come and see how our poor look.

26

All the proof I need really. Read some of the headlines lately about the savage conditions in National Health hospitals - especially among the elderly in the UK?

27
Auto5guy's picture

This is always the perfect argument to an outsiders criticism of poverty in America. How many of other nations poor have color TVs and cars and cell phones? If someone is malnourished in this country I am willing to say its from an act of criminal negligence. Between EBT cards, food banks and religious charities food is available for those truly in need. There is no excuse for not utilizing available help.

28

Dinesh D'Souza's report:  his friends in rural India wanted "to see a country where the poor people are fat."
We groan and moan that family X can't afford the UW, it really TRIVIALIZES children who do go to bed starving.  In the dictionary sense of the word.
Sigh   :: wan smile ::

29

That made tons of sense, by the way.  If we're talking about CNA's "mini-examining" patients INSTEAD of the RN doing it (at the top of the hour), then sure.
.......
Ya - as far as the community college, we all remember that higher education has to compete in a free(r) marketplace right?
........
My son had a friend in high school who came to live with us for a couple of years.  I taught him how to WRITE HIS NAME.

30

...which essentially means "are you, or are you not, a socialized medicine state" -with bonus points if your healthcare is free for all citizens. That's the most fair right? BULL-LONEY.
Thank you for reminding me.
BTW, I'm not inclined to trust the WHO with anything health related anymore since THIS came up:
http://www.examiner.com/article/catholic-church-finds-bill-gates-poison
http://www.patheos.com/blogs/piadesolenni/did-the-kenyan-bishops-just-ex...
If the WHO thinks it's good medicine to make women infertile to control population (and I know - this isn't confirmed yet, but IF it turns out to be true), I would be in favor of yanking all US financial aid to the WHO and to the UN.

31

Also sorry on the statistical citing; a more recent report from the World Health Organization has moved the U.S. from #42 to #37--hooray for Obamacare! :) Also, the Commonwealth Fund has named the U.S. the worst provider among 11 prosperous nations--for the fifth time. I'm sure the sources can be disputed...but I'm also pretty sure there isn't a conspiracy involved here. In any case, that's the essence of my 'to' question: how do we close the gap between the level of expenditure and the level of care? - See more at: http://seattlesportsinsider.com/comment/155234#comment-155234
Ok, so I looked into the WHO rankings in detail to refresh my memory so I can point out obvious sources of selective use of stats in order to support a preordained conclusion.
First, as far as I can tell, the last time this study was done was in 2000, and the WHO has declined to put out another set of rankings, presumably because of the complexity of doing a good job and the contententiousness of doing so.  
First of all, gross rankings are pretty worthless without context.  What is the spread between 1st place and 10th place?  Is that spread meaningful?
The US is straddled on that list by Costa Rica and Slovenia, and is only a few slots above Cuba.  Now honestly, does that pass the smell test?  Or seem even remotely plausible?  I find that in nearly all situations that is some conclusion just seems ridiculous there's likely an issue with methodology.
Just look at the methodology.  They look at five parameters chosen for the rankings:
Health (50%) : disability-adjusted life expectancy
Overall or average : 25%
Distribution or equality : 25%

Responsiveness (25%) : speed of service, protection of privacy, and quality of amenities
Overall or average : 12.5%
Distribution or equality : 12.5%

Fair financial contribution : 25%
Now, we need to ask why were these particular parameters chosen to rank systems?  They seem rather arbitrary, do they not?  Do they measure important differences that are independent variables determined mostly by the type/quality of the healthcare system, or are they extremely gross measures that are much more heavily impacted by ethnic, cultural,  or nutritional factors?
Are these variables subjective and therefore not really measurable (like responsiveness, protection of privacy, quality of amenities, fair financial contribution)?  How do you measure fair financial contribution?  With "fairness units"?
The only hard data I see cited is life expectancy, and even half of that contribution is subjective (equality).
Furthermore, measures like life expectancy are very gross/poor ways to measure societal health or the quality of a health system. These numbers are determined much more by ethnic, cultural, and nutritional factors.
Life expectancy can be misleading.  It is not the case in ancient times that a life expectancy of 35 years meant that people could expect to live to 35 years and then drop dead.  The numbers were kept low by very high infant and childhood mortality, accidents etc.
In the US, there are higher numbers of people that die young because of accidents, drug violence, etc. than in other countries like Japan.  This suppresses the life expectancy figures in the US.  You can certainly argue that this is an issue for the culture at large but it's pretty hard to pin that on the healthcare system.  If you normalize the life expectancy figures for this factor then US life expectancy jumps right up there with the other western democracies and just shy of Japan, despite our much greater ethnic diversity.
Finally, remember that other systems could not perform as well as they do without the US.
 
*Edited to add that Moe has posted something similar regarding life expectancy as well as important info on cancer survival rates in the US at the bottom of the thread 

32

"Fair financial contribution," "equality" and etc. remind me of the Steve Hutchison contract.  Must be the highest paid offensive lineman.  Conditions that the home team automatically fails.
I knew the WHO criteria would be set up for the U.S. to look bad.  I didn't know it would be based on "ratings" as opposed to metrics.
That list is far, far worse than I'd have guessed, and I'd have guessed something really cynical.  Thanks for spelling it out Dr. G.
.........
But what does it matter?  They were looking for a sound byte and they got it.

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