R J Carpenter

"B Vaughan" <[email protected]> wrote in message
news:[email protected]...
    > On Wed, 26 May 2004 21:35:46 +0000, "Donna Evleth"
    > <[email protected]> wrote:

    > The bill came to about
    > >$30,000, our friend said that in the States it would have been $50,000.
    > You must have dropped a zero, because I can't believe it would have
    > cost that little in the US in recent times.

A friend recently had outpatient surgery (here in the USA). She didn't stay
overnight at the hospital. The bill was close to $10,000. Presumably the
health insurance company will negotiate a smaller sum, but an uninsured
person wouldn't have that leverage.

Dae

"Earl" <[email protected]> wrote in message
news:[email protected]...
    > Mxsmanic <[email protected]> wrote in message
news:<[email protected]>. ..
    > > DAE writes:
    > >
    > > > I've read the French Health Care System is excellent also, but it is
nearly
    > > > ready to crumble as it is broke.
    > >
    > > This is news to me. The system of benefits to retired people and other
    > > forms of welfare has serious problems, but the health-care system itself
    > > is not particularly ill as far as I can remember.
    > It has had serious deficits over the last couple of years and rising
    > to 15 billion euros this year. It is planned to be self-financed and
    > the Government will bail it out but is scheduled to be paid back.
    > It is not suppose to fall on the back of the general taxation system.
    > Even so, the French health care system is running 10% of the GNP
    > well below the now 15% (and rising faster) figure in the US. Most
    > of the European systems are running around 10% except England
    > which is considered underfinance. Blair has scheduled their
    > coverage to go up 1-2% points. The European systems generally
    > give close to universal coverage, and does not have the uninsured
    > problem that exists in the US. From health statistics, the Europeans
    > get more for their money.
    > The French have reasonable control of the doctors fees, which have
remained
    > a bit too static over the years. The hospital system is sucking up half
    > the total costs and are rising too quickly. So it is there that the cost
    > savings are more likely to be effective.
    > Medicines? Like the US, the rise in drug expenses has been faster than
than
    > inflation. Drugs are getting better and an ageing population uses more
    > of them than the young. The big move is to use more and more generics,
    > these have been under used in France. Even so, I have priced the
    > blood presure medication I do take on the internet and it is 3
    > times more expensive in the US. The French obviously use their
    > single payer system to force drug companies to offer their drugs
    > more cheaply. HMOs do the same thing in the US. The individual
    > person paying his own drug bills has no countervailing power in
    > a free market system. One can not shop around for a cheaper
    > drug like a cheaper car.
    > The Government is about to propose some reform in the system. This may
    > involved a l euro co-pay on medical acts. The right wing government
    > says this is to "responsibilize" people but it is clearly to get a little
    > more money into the system. 1 euro or even 10 would not bother me.
    > I sometimes pay cash and don't do through the carte vitale use at
    > the pharmacy if the drug is under 10 euros. But with a 50 euro bill
    > I use it. I might have been able to talk the doctor into a prescription
    > to buy a heart pressure monitor or an lung capacity apparatus but
    > I did not. I don't think the insured try to "milk" all their possible
    > advantages. If they are pressed for money they will seek out ot
    > minimize their own payout.
    > Obviously a big co-pay would cause some people not go to the doctor
    > when necessary, so is step in the wrong direction with regard to
preventative
    > medicine. I personally do not go to the doctor which each sniffle even
    > though it costs me nothing to do so. If a cold moves towards bronchitis,
    > which is a chronic condition with me, I go immediately. Right now I have
    > a medical treatment which effectively "prevents" that from happening, so
    > that treatment does save the system money. I get yearly blood tests
    > etc and I think the preventative part pays off for the system.
    > The barrier to going to the doctor is not cost but the bother
    > of calling up and making an appointment. One does not
    > wait long in the waiting room, so that is not a problem.
    > Another move will be to rationalize the medical dossier on a computer
    > so a doctor (a new one) can have a good look at what you take.
    > Older people take a lot of medicine these days and conflicts can
    > occur if a new doctor is not given all the information. I suspect
    > also if this stuff is in a computer, symptoms and all, that soft
    > ware can point out to a doctor a missed diagnosis. The carte
    > vitale has a microchip and I suspect this can all be computerized
    > to the nth degree. Newspaper articles have mentioned the saving
    > through this method.
    > Whatever, more money is also needed. This will probably
    > be otained from increasing the "contributional sociale generalisée"
    > which hits all income. For instance, even though the basic
    > capital gains tax is about 15%, the CSG and associated tax
    > is another 10%. So the next is 25%, although does not apply
    > to personal residence real estate capital gains. So the Government
    > will put together an hodge podge which will come
    > closer to reducing the deficit. The long distance future is
    > harder too see, but more young people working would
    > bring in more money than paid out.
    > One big area of abuse is getting time off while sick. Doctors
    > don't like to say "no" to a patient who is just fed up with working
    > and want a week off. In my 20+ years working for the CNRS, when
    > i was ill for a day or two I just took those days off. But my work
    > was fun and I looked forward to each day.
    > I have a French friend who has had a serious inherited medical
    > condition since mid-adult hood, over 30 years now. It requires
    > steady treatment and frequent visits to the doctor. The system
    > has completely covered this and does all "chronic" conditions.
    > I personally know of no abuse of the system. The fraud level
    > is reported to be low. There are a few gimicks but not many.
    > In the US a good fraction of the Medicaid fraud occurs through
    > doctors in clinic situations. If you do a Google you can
    > seen the magnitude of the problem.
    > Earl

Earl,

Two things not mentioned in this thread is the mal-practice insurance our
Doctor's have to pay. It is totally out of sight and is passed on to the
consumer and Medicare in their fees. Another is the rising costs of
medicine. A company is protected for 10 years by patent before the drug
can become generic. If they don't make back their R&D costs and a profit by
then the drug can be made by anyone licensed and sold at a much lower cost.

I don't know if the European System has these things to contend with or not.

Don

Tom Bellhouse

"Mxsmanic" <[email protected]> wrote in message
news[email protected]...
    > R J Carpenter writes:
    > > It was infinitely cheaper, and she wouldn't be
thrown
    > > out of the hospital after three days.
    > The sooner you leave a hospital, the safer and
healthier you will be.

Drive-by mastectomy anyone?

Mxsmanic

Luca Logi writes:

    > Not true. I almost always run out of time before
    > I run out of money.

If you had the time, you wouldn't have the money.

--
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Mxsmanic

Tom Bellhouse writes:

    > Drive-by mastectomy anyone?

Think infections.

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Mxsmanic

R J Carpenter writes:

    > A friend recently had outpatient surgery (here in the USA). She didn't stay
    > overnight at the hospital. The bill was close to $10,000. Presumably the
    > health insurance company will negotiate a smaller sum, but an uninsured
    > person wouldn't have that leverage.

An uninsured person does have leverage. He or she need only ask for
documentation (physician's orders, test results, etc.). Most of the
charges are bogus and will be immediately dropped if the patient insists
on supporting documentation.

--
Transpose hotmail and mxsmanic in my e-mail address to reach me directly.

Alan Harrison

"Mxsmanic" <[email protected]> wrote in message
news:[email protected]...
    > Alan Harrison writes:
    > > Maybe more time for yourself, rather than spending it at some boring
job?
    > More time doesn't help if you don't have more money.

The answer to that is a decent living wage for a reasonable working week. 35
hours ("nine to five" with an hour's lunch break) is pretty much the
satndard for routine white-collar jobs. Overtime shoud be the exception. I
speak with some feeling, after being warned of the hazards of the "long
hours culture" aftera heart atatck last year.

Alan Harrison

Alan Harrison

"DAE" <[email protected]> wrote in message
news:[email protected]...
    > Two things not mentioned in this thread is the mal-practice insurance our
    > Doctor's have to pay. It is totally out of sight and is passed on to the
    > consumer and Medicare in their fees. Another is the rising costs of
    > medicine. A company is protected for 10 years by patent before the drug
    > can become generic. If they don't make back their R&D costs and a profit
by
    > then the drug can be made by anyone licensed and sold at a much lower
cost.
    > I don't know if the European System has these things to contend with or
not.

There are different systems in each country. The drug price thing is pretty
widespread. In Britain this has manifested itself in the so-called "postcode
lottery", where some local health organizations declare themselves unable to
pay for the best (but expensive) treatments.

Malpractice cases certainly do occur, but probably not yet to the same
extent as in the USA. They are, I think, a product of the patient seeing
him/herself as a "customer".

Another aspect not mentioned is the extremely high cost of training as a
medical practitioner in the USA, inflated by the artificial practice of
making all medical degrees postgraduate and thus requiring students to take
a "pre-medical" degree first (American M.D. as against British M.B., Ch.B. -
a "double" first degree). The quack then has to charge rates which allow him
to recoup that expense.

Alan Harrison

Earl

"DAE" <[email protected]> wrote in message news:<[email protected]>...

    > Two things not mentioned in this thread is the mal-practice insurance our
    > Doctor's have to pay. It is totally out of sight and is passed on to the
    > consumer and Medicare in their fees.

I looked into this a couple of times and the issue is complex. I only
have
the numbers on the tip of my mind.

First, when I looked at this issue in the mid-1990s, the total
insurance
charges to doctors was running around 5 billion a year, but
"cover-my-ass"
medical exams to avoid mal-practice was running 25 billion. This was
out
of a total national outlay for health of 900 billion, I think.

Next, it depends on the speciality. I have a friend who is a doctor,
iinternal
medicine, in Philadelphia. He did not reveal his total income but his
insurance was running about $7000 a year. I recently read that the
average
income of doctors was running $200,000+ (after expenses) and I would
guess that a $7,000 insurance bill on a $200,000 net income is
exceptable.

His main problem was overhead. He estimated that at $50 per office
call,
so that if he charged $80 he made $30. Medicare patients were break
even since he was only paid $50 at that time., Medicaid were losers.
To make money on the later one has to be in a clinic situtation, high
through put.

But some specialities have a high risk of being sued. So surgeons have
a very high income ($500,000 would not be excessive, i guess) but
their
insurance is much higher than $7000. I think I have seen figures as
high
as $50,000 or higher.

An American doctor will have a secretary perhaps a nurse and has
very high overhead. A French GP has nothing like this, no secretary
and no nurse and virtually no paper work with the Secu. Many French
specialists have no extra help unless they are in a collective office
with one secretary handling several doctors. The last French cardio
I visited had nobody.

I have read somewheee that 25% of US medical costs are
administrative.
The advantage of a single insurer system will be in a simplification
of
procedures, cutting the paper work and assuring that the doctors get
paid, fewer medical debts to collect. I suspect that if I were
looking
to rationalize the American system I would reduct the number of HMOs
to about the number of automobile companies (3-4 nationally), make
sure they were Universal and forcing universal insurance. If people
don`t
have enough income the Government makes up the difference but
mostly it would be self-financed.

With regard to mal-practice, this is becoming an increasingly serious
problem and personally I feel that the Government should insure,
not private companies, and set the awards as being reasonable.
Likewise, they must be tougher on yanking the right to practice
for a problem doctor.

    > Another is the rising costs of medicine. A company is protected
    > for 10 years by patent before the drug can become generic.
    > If they don't make back their R&D costs and a profit by
    > then the drug can be made by anyone licensed and sold at a much lower cost.

As a professional chemist I am sympathetic towards the Pharmaceutical
industry , especially the biotechnology area. Even so, it is the one
industry which has the highest profit margins (20% after taxes). This
also
means that one could only reduce drug prices 20% on the average for
them
not to make any money! I think they tend to make most of the profits
on a few drugs. The probability of a particular candidate drug being
successful
is also low, such that the average cost for a successful drug is
something
like 100 million dollars. The end results is that a particular
finally successful
drug might be cheap to manufacture, like a few cents on a $10 pill.
This
falsely appears excessive but $8 of the $10 may have gone to paying
for the failures.
The winners pay for the losers. There are a few winners and lots of
losers.

Still the industry makes misleading statements. The research costs are
actually
less than marketing cost but that is hard to sell to the public. They
also
have some dishonest ways of convincing doctors to prescribe their
drugs.
A real question exists around how effective some drugs are, for prices
charged.

    > I don't know if the European System has these things to contend with or not.

In some respects, yes. But the overall picture is not at all clear.

Earl

Devil

On Fri, 28 May 2004 06:39:52 -0700, Earl wrote:


    > First, when I looked at this issue in the mid-1990s, the total
    > insurance
    > charges to doctors was running around 5 billion a year, but
    > "cover-my-ass"
    > medical exams to avoid mal-practice was running 25 billion. This was
    > out
    > of a total national outlay for health of 900 billion, I think.

A small detail here. I don't believe the real reason for these exams is,
as you say, "cover-my-ass." That's merely the excuse given, and I would
bet even if legislation were put in place to limit claims, these exams
would stay.

Real reason is that the way the system works, they have to have the
equipment, which would end up being underused. But they have to pay for
it, so they prescribe their use. End of the story.

Forget about the notion of your individual practitioner. Thing medical
business, corporations in the hands of physicians who are in the business
of making money. With health as a convenient excuse.

With a situation of in effect monopoly in the hands of the medical
association. So no mechanism to limit prices.

Frank F. Matthews

devil wrote:

    > On Fri, 28 May 2004 06:39:52 -0700, Earl wrote:

    >>First, when I looked at this issue in the mid-1990s, the total
    >>insurance charges to doctors was running around 5 billion a year, but
    >>"cover-my-ass"
    >>medical exams to avoid mal-practice was running 25 billion. This was
    >>out of a total national outlay for health of 900 billion, I think.

    > A small detail here. I don't believe the real reason for these exams is,
    > as you say, "cover-my-ass." That's merely the excuse given, and I would
    > bet even if legislation were put in place to limit claims, these exams
    > would stay.

    > Real reason is that the way the system works, they have to have the
    > equipment, which would end up being underused. But they have to pay for
    > it, so they prescribe their use. End of the story.

    > Forget about the notion of your individual practitioner. Thing medical
    > business, corporations in the hands of physicians who are in the business
    > of making money. With health as a convenient excuse.
    >
    > With a situation of in effect monopoly in the hands of the medical
    > association. So no mechanism to limit prices.

I disagree somewhat with both of you on your analysis of the "excessive"
exams. For the most part the exams are farmed out and are probably
billed at near cost. So there is little profit to the individual
ordering the exam. And, while the justification to the payer may be
malpractice avoidance, I think that there is also a tendency to use
whatever less intrusive diagnostic tool there is available to see if
anything useful can be divulged. A given test may be useless for the
most part and, perhaps, not economically justified overall but the
possibility that it may prove valuable in a few cases pushes the use.
Even without the threat of a lawsuit it would be a hard thing to say
"Well, if we had run the XXX we would have been able to do something in
time but it was so unlikely that it wasn't worth it."