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Old 06-19-2014, 09:45 AM
 
Location: Inis Fada
16,833 posts, read 29,150,006 times
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Quote:
Originally Posted by cgregor View Post
FrugalYankee, Colombians are healthier than Americans, and they spend only some 6.7% of their GDP on health care, while Americans spend 17.8%.

Given what you report for income difference, it would appear their health care providers are doing better for a lot less.

However, that might not be true, since "purchasing power parity" has to be taken into account-- how far a standard unit of currency will go in a particular country. $100 will probably go a lot farther in Colombia than it does in the US, so economists compute what the 2012 average monthly Colombian wage signifies in purchasing power parity. You can easily find it; it will certainly shrink, if not erase, the wage differential.

How many countries are sending volunteer medical services to the USA(or a single state like VT) as opposed to places like Columbia?

Volunteer in Colombia | Reviews of Volunteer Programs in Colombia | GoOverseas.com

Quote:
Colombia Fast Facts

Work/Tourist Visa: Not necessary for less than 90 days
Popular Destinations: Bogota, Medellin, Cartagena
Poverty Level: 37.2% (World Bank)
Colombia is the only country to be on the Pacific and Caribbean coasts.
Quote:
Health Care: Skilled medical volunteers can be of great help in Colombia. Colombia's health care system has gotten a lot of media and political attention in recent years. In 2012, Colombia will have universal health care. Don't let that fool you though - many disadvantaged citizens are still in great need of help and won't necessarily see benefits from the new health care system anytime soon. One of the country's biggest health issues are deadly diseases like malaria, HIV, and yellow fever. Malnutrition also affects many children in various ways. Whatever your interest in health may be, there are plenty of ways to educate and give greater access of health care to the population as a volunteer.
Colombia | MSF USA

Quote:
As Colombians continued to deal with conflict and obstacles to health care, MSF carried out 67,500 consultations and offered basic health care, vaccinations, reproductive health care, and antenatal care in Cauca, Nariño, Caquetá, and Putumayo departments in the country’s south.

Staff provided 5,400 mental health consultations and care for victims of sexual violence as well. MSF also distributed medical supplies and relief items when people were displaced by violence and provided direct medical and psychological care to 16,000 people.

In Buenaventura, MSF worked with the National Tuberculosis Control Program to start 285 new patients on TB treatment and 60 more on DR-TB treatment. Staff also offered care for victims of sexual violence, sexual and reproductive health care for teenagers, and medical care for children, conducting 13,000 consultations overall.

MSF handed over two programs to the MOH: a Chagas program in Norte de Santander and the River Atrato program in Riosucio, which provides basic health care, mental health care, reproductive health care, and assistance to victims of sexual violence.

 
Old 06-19-2014, 05:11 PM
 
Location: Winter Springs, FL
1,789 posts, read 4,068,567 times
Reputation: 925
Going on and on about healthcare is not what this topic is about, but I will chime in. Healthcare is my profession and we have done a fair amount of research (I didn't do much, primarily data collection) on the differences in world health. The WHO has studied this as well. All the countries that the US is compared to, do not have the health issues we have in the US. You can not compare the US to Columbia, countries in Southeast Asia, etc. You need to look at the US and see what we are. We are a society of convenience. Most people jump in the car to drive 200 yards down the road or they eat fast food or prepared foods from the grocery store. Poor countries are actually healthier than developed countries because of this. Poor areas in Columbia, Asia, ect are perfect examples. They have to exercise (ie walk, ride bikes, etc) to get around and they eat fresh prepared foods, prepared the same way for decades or centuries. When we looked at people in the US who were eating the Mediterranean diet, they were not as healthy as our Mediterranean counterparts. There are many reasons for this, but I had an inside look into the differences. My Mothers family is from an island off the coast of Naples, Italy. I have spent a large part of my life on the island and experienced first hand the differences. The food was not only fresh and the highest quality (in most cases picked or caught a few minutes before it was prepared), but you exercised whether you knew it or not. There wasn't a car to drive. Portion sizes are also another huge difference. Look at what a typical American has for a portion. In the US we fill our plates (in many cases it's several cups of food) and in most other parts of the world they may only serve a cup sized portion. As a kid, one of the things that stuck out was most Europeans were thin. You have to really search for an obese person on the island, but in the US it's now the norm. Obesity is the American downfall. Our health problems are unique to us. That is why we can't be compared to others unless they are inflicted with the same. Just the same as we found when comparing the Mediterranean diet.
The recipe for a healthy life is simple. Eat fresh high quality food and move your body. Long story short, eat crap and live a sedentary life and you will pay more with the chronic diseases from that lifestyle. Colombian doctors and their healthcare system are no better than the US. Healthcare is cheaper because they are typically healthier with fewer chronic diseases. It's much cheaper to treat someone with pneumonia than an obese patient with multiple comorbidities that will require a lifetime worth of healthcare.
 
Old 06-20-2014, 02:07 PM
 
809 posts, read 679,570 times
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The original post was about Vermont being the poorest state in the union, and health care was used to put that observation in context. We can afford to implement a far better system of health care than the US has; 21 other countries with lower per capita GDP's demonstrate that.

68vette is correct about the US having different health issues, but that's not the main difference between the 39 other countries with government-structured health care of some sort or another (I'm excluding Russia, which is only nominally government-structured).

The main difference is access to treatment: In any of those countries, a sick person knows he/she will be seen. On the other hand, before the advent of Obamacare, 42 people in Vermont would die every year for lack of access to care. We probably all know people who back in the day put off having a condition looked at because it didn't fit into the budget. Senator Al Franken once silenced a health industry lobbyist by asking her at the hearing, "How many people in France died of untreated breast cancer?" The answer (which she did not know) was, "Zero." He then gave the number of people in the US for that same year who died of untreated breast cancer-- it was substantial.

68vette is right about learning to live through habits of good health, but sooner or later even that fails us: old age, tragic accidents and genetic inheritance all work against us. Sooner or later we all need affordable health care.

So, we have to do the right thing and show the rest of the country that Vermont is not as poor as everybody thinks it is.
 
Old 06-20-2014, 05:46 PM
 
221 posts, read 266,691 times
Reputation: 375
I consider myself to be far from a socialist(although due to my opinion on healthcare some might think I am) and I agree in part with 68vette but I think there is more to it than that. There is no black and white. Some countries have healthier habits but not all. Granted, I have not collected data - all I can say is based on my personal life experience which includes living in another country for 25 years and visiting over 20 other countries. In Israel for instance which is where I am from there is also very much a culture of convenience, and alot of fast food. Would I say it is as extreme as in the US with the fast food? Probably not, not yet anyway. But you have accessible and affordable health care, and the life expectancy there is actually higher than in the US. My wife who is American and lived all her life in the US has several autoimmune diseases and the only place where they would finally start to figure some things out with her was when she spent 4 years with me in Israel. The example of Italy was given, well for instance in France they eat alot of red meat, yet pretty much every meal they also have a glass of red wine with it - so they are healthier and not as obese. Stuff like that can definitely help, but is not the whole story.
 
Old 06-20-2014, 08:48 PM
 
Location: Winter Springs, FL
1,789 posts, read 4,068,567 times
Reputation: 925
Unfortunately, our health and longevity is partially inherited. How we eat and treat our bodies has everything to do with our health and how our ancestors ate and treated their bodies over the centuries is passed down to us. We are one of the most obese countries in the world and obesity is one of the leading reasons for high health care costs. The yearly cost is between 147 - 210 Billion dollars and the estimated loss in work related productivity is 4.3 Billion dollars. It's clear those dollars can't be completely eliminated, but think of what a reduction can do. Obesity is one of the diseases that effects every body system. The medical costs are not every once in a while. They can be continuous for the patients entire life and the topper is because of genetics, costs will escalate as more and more generations are effected.
I will add that countries such as France and Italy have healthier habits and are typically healthier than Americans will ever or have ever been. It is all cultural when it comes to meals. They don't eat low fat meals by any means and the French for example do eat a fair amount of red meat, but they do not eat the same portion sizes. They also spread mealtime out over several hours. It's more of a social event than shoveling food into our stomachs within 30 minutes.
Don't be fooled into thinking everyone is covered and everything is grand under the ACA. As of May 1, 2014, the Department of Health and Human Services reported just over 8 million people have enrolled. That’s only 2.5 percent of the total U.S. population and recent estimates put the total number of uninsured at close to 50 million, or 15.8 percent. The federal Health Resources and Services Administration estimates that 60 million Americans live in areas without enough primary care physicians. Scarier still is that the U.S. population is growing, and aging, and the demand for primary care is expected to grow by about 17 percent in the next decade, but who wants to be a primary care physician when you are paid less than any other physician and your reimbursement rates are shrinking? Does the government pay hundreds of thousands of dollars per PCP's educational costs so they will take on that job roll? There is this long term time bomb ticking because there are lots of places across the U.S., a fifth of the country live in what’s called primary care shortage areas where there aren't enough PCP's to treat people. So where do these people go? They go to community health clinics, but there is a problem there now. Experts from the Milken Institute School of Public Health at George Washington University are warning that unless a rarely cited but essential funding provision of the Patient Protection and Affordable Care Act is renewed in 2015, the community health centers that provide primary care to over 25 million people will be forced to roll back services or, in many cases, shut down completely. This will cost more money on top of the increasing insurance premiums. Some states are going to see their premiums increase by 100% (Vermont will increase 10%). The rate increases are largely a combination of four factors set in motion by the ACA: Commercial underwriting restrictions, the age bands that don’t allow insurers to vary premiums between young and old beneficiaries based on the actual costs of providing the coverage, the new excise taxes being levied on insurance plans, and new benefit designs.
Without question, there are problems with our healthcare system. There are some major differences with the US and most other parts of the world when it comes to cost. The amount of education and training is exceptional compared to most of the world. In there lies part of the issue. The total cost of education and training cost close to 1 million dollars/ physician over a 11-16 year span with fellowship. Most physicians only end up owing about $200,000, but with interest over 30 year loan time, the cost is over $400,000. They are paid a very good salary, but look what's entailed to get that salary. Wages and benefits are the number one cost of any business. That includes hospitals down to the mom and pop store. Add in malpractice insurance and physicians having to practice defensive medicine, cost are guaranteed to escalate.
America has turned into a country that want's a quick fix and we expect results yesterday (we need to take lessons from our brilliant minds from years gone by). There are incredibly bright people in this country who really are not listened to. Brent James MD who is the Chief Quality Officer from Intermountain Healthcare in Utah testified in front of congress a few years ago about ways to significantly reduce healthcare costs and improve patient care on top of that. This was all based on quality improvement in the way healthcare is delivered. This wasn't some dream he came up with. This was all factual information from what they had accomplished in Utah for the past decade. Through the Intermountain Advanced Training Program in Clinical Practice Improvement (ATP), he has trained more than 3500 senior physician, nursing, and administrative executives, drawn from around the world. This guy is no slouch by any means. They not only reduced costs to the point of being one of the most affordable healthcare systems in the country, they also provided the best patient care in the US hands down. What did our esteemed congress do? And by the way, they really know very little about healthcare outside talking money. They for the most part rejected what he had to say because the ACA was going to fix our healthcare problems. Say you are one of the people who is paying less for your healthcare, is the quality of the care better because it's cheaper? Quality is not fixed and many would argue cost is not fixed either. Sometimes improvements take a little time and I would rather spend a little time getting it done right the first time.
 
Old 06-21-2014, 07:14 AM
 
809 posts, read 679,570 times
Reputation: 1333
Thanks for the information abut the ATP; I'm going to have to read up on it. Maybe Vermont can learn something from it.

You're correct about the ACA; Good as it might be, it is simply a guarantee for the insurance companies to retain 15% of revenues for "administrative costs" and the pharmaceutical companies to make $80 billion in profits over the next decade. Vermont can do better than ACA-- saving 20% of the $2.5 billion we pay in premiums, deductibles, co-pays, etc., having everybody covered all the time. It's going to be a battle royal when the lobbyists descend on the next legislature. (As you point out with the community health centers in the ACA, lobbyists will do what they can to build in a self-destruct mechanism.)

I don't believe that doctors are motivated by profit, but that they are driven by debt. While there might be very little difference in the psychological profiles of a surgeon and a bank robber, that's the exception rather than the norm; most doctors would rather be respected than extremely wealthy and treated like serfs,. Having paid through the nose to get the world's finest medical education, doctors probably feel that their decisions shouldn't have to be subject to the administrative fiat of insurance companies. Dr. Marvin Malek of Barre campaigned for single payer a few years ago and told horror stories: the insurance company telling him to get Patient X out of the hospital now; a couple who could not afford treatment for the woman unless they got divorced; running battles with insurance companies that continually rejected billings. He's not alone, by any means.

So, with some luck and a lot of resolve on the part of both the voters and the legislators they elect, Vermont will show the country how to do it right.
 
Old 06-23-2014, 08:23 AM
 
Location: Winter Springs, FL
1,789 posts, read 4,068,567 times
Reputation: 925
My frustration is cost does not relate to better care. The ACA or single payer do very little for quality improvement. Providing evidence based standardized care with quality as the driving force is not only what makes healthcare better, it also makes it more affordable.
Where I first learned of Dr James was at a meeting sponsored by the Vermont Oxford Network (VON). VON is a network of over 950 hospitals world wide that collaborate to improve the quality and safety of medical care for newborn infants and their families. We have seen very nice results as well as savings for our patients. Granted, neonatal care is a very small segment of health care costs, it helps with the overall picture.
The frustration with insurance companies is complicated. It's not as cut and dry as our politicians make it out to be. They are in business to make a profit, but that's not the whole story. Insurance companies only give a specific amount of money for procedures, exacerbations, etc. based on evidence and profit margins. They don't tell physicians, get the patient out of the hospital by such and such a date. They reimburse based the ailment. If they require more care than what they get reimbursed for, the hospital eats the bill or tries to get the money from the patient. In some cases a hospital will say, I was only given X amount of dollars for this admission and you need to leave by this date because we don't have anymore money to keep you here longer. If someone was critically injured, the insurance company can't tell the hospital this patient needs to leave by this date. If a patient needs care, they will get it (good or bad). If care worked perfect, it's a beautiful world. here is the problem. If a hospital or doctor is not providing the best care, treatment and care take longer, thus more expensive. Some doctors and hospitals look at lower reimbursement and think, if this is all we are getting, we need to improve our care so we don't lose money. Not everyone/everyplace thinks along these lines. Some will just fight government/insurance companies to increase reimbursement. This is where medical associations work with lobbyists to work deals out. I oversimplified it, but this is what happens in a nutshell. Reimbursement is X and the hospital gets you out ahead of schedule, they make a profit. Hospital keeps the patient in longer than reimbursement, they take a loss.
In a way less money should be a driver to improve care and outcomes, but we all know that's not the real world. It's like telling a kid not to do something or else and they do it anyway. Government and insurance companies should be driving or even sponsoring health care providers to meet quality improvement goals. And if providers meet certain goals they should offer some sort of an incentive. This is the only way cost is going to be controlled. There are certain costs that will always be a given. Incomes/benefits for providers will always be on the high end (you have to pay for well educated and trained people), upkeep of equipment and supplies to run a facility and purchasing new equipment so a hospital can stay up with the times. Low reimbursement only means a few possibilities. providers will use that as a driver for quality improvement, Providors/hospitals will go out of business or leave practice because they do not change and can't make it work and/or fewer people will go into health care because of the financial picture. We could even see declining care if lower paid people who are less skilled enter the field or if hospitals shift spending from purchasing better equipment for better patient care to offset losses from poor patient care. If quality was the driving factor, the only thing that happens is better more affordable care. These are the issues countries like Canada and GB are facing with their failing systems. The focus was only about money and not quality. Think about the physician who practices like he did 20 years ago. That person is way out of date. A gallbladder surgery decades ago required a stay in the hospital and now there is less pain, fewer complications and it's an outpatient procedure. It's better for the patient and family, fewer complications and it's cheaper. The name of the game, Quality Improvement!
The only problem is it takes a little time. Politicians want the quick fix for the next election.
 
Old 06-23-2014, 01:22 PM
 
12,131 posts, read 6,710,651 times
Reputation: 12994
Quote:
Originally Posted by 68vette View Post
Unfortunately, our health and longevity is partially inherited. How we eat and treat our bodies has everything to do with our health and how our ancestors ate and treated their bodies over the centuries is passed down to us. We are one of the most obese countries in the world and obesity is one of the leading reasons for high health care costs. The yearly cost is between 147 - 210 Billion dollars and the estimated loss in work related productivity is 4.3 Billion dollars. It's clear those dollars can't be completely eliminated, but think of what a reduction can do. Obesity is one of the diseases that effects every body system. The medical costs are not every once in a while. They can be continuous for the patients entire life and the topper is because of genetics, costs will escalate as more and more generations are effected.
I will add that countries such as France and Italy have healthier habits and are typically healthier than Americans will ever or have ever been. It is all cultural when it comes to meals. They don't eat low fat meals by any means and the French for example do eat a fair amount of red meat, but they do not eat the same portion sizes. They also spread mealtime out over several hours. It's more of a social event than shoveling food into our stomachs within 30 minutes.
But it wasn't always like that in the US. I grew up with a lot of fast food, candy, sugary cereals, and little thought of nutrition except that big slabs of fried meat were full of protein. We all lived on junk food, wonder bread and red meat yet no one was fat. We ate in moderation and moved our bodies even though we grew up with tv for babysitter. A place that served large food portions was great, and we all went home with doggy bags for another meal or two. No red wine, no eating for three hours. Still not fat.

I was out at a small local restaurant this week and 80% of people there were overweight to obese. Two obese women sat next to me and ordered large fried meals with double order of fries. All the overweight people then I noticed were eating fatty greasy huge meals. The place is tiny and everyone sees what everyone else has on the table and talks together because it's so close quarters. Some tables were overspilling with mounds of extra food, side orders onion rings, fried cheese sticks, etc. I had a turkey with lettuce and tomato on rye, mayo on the side and did get fries, but a single order which was quite ample anyway. The sandwich and half the fries was a full meal. Then split an apple pie with my friend. Those women behind me inhaled their meals, finished off the cream pies, got extra whipped cream on them. It's pretty clear what is going on here and it isn't genetic.

So yeah, we have a health care problem in this country and "we" are responsible for a good part of it.
 
Old 06-23-2014, 02:02 PM
 
221 posts, read 266,691 times
Reputation: 375
As far as the ACA is concerned I've already expressed my opinions in the past that I think it was done completely wrong. I am not in favor of just ANY universal health care system, I think it needs to be right and as I have said before I think they should take a good long look at other systems, such as Canada or GB, or Israel, or other systems in Europe or in Asia, or even south America, learn from them, see what works, what doesn't or wouldn't here, what would actually lower costs, what would actually improve quality, and implement it. The ACA is half assed. What I am saying is, as long as Vermont does it right, and it remains to be seen - then I will support it cause I believe everyone has a right to accessible and affordable health care. If they do it wrong I'll be the first to slam it as I have no patience for governments.
 
Old 06-23-2014, 02:42 PM
 
809 posts, read 679,570 times
Reputation: 1333
Good luck with your wishes, Oriz!

If you want health care reform to happen, you have to deal with campaign finance reform as well-- 5% of the donors fund 85% of ALL federal campaigns, and it is now perfectly legal for a corporation (like Meijer's in Michigan) to secretly fund local candidates who will overturn local zoning laws in their favor.

That said, ACA was only passed at the sufferance of Big Pharma and the health care industry, who spent about $1.5 million a day every day up until it was signed into law. They made sure their profit would continue-- primarily by having the government subsidize the premiums for people who would be forced, but were too poor, to now buy insurance.

Pay attention to what Vermont Health Care for All is working on, and I think you'll be pleased to know that in a state where the legislature is too open to the public to be bought off, real health care change for the better will happen.
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