Quote:
Originally Posted by leaana
most of the billions in healthcare costs are for things that can be prevented.
those who live unhealthy lifestyles and don't take responsiblity for thier care don't deserve healthcare for it such as smokers, obese, and alcoholics.
if people were more responsible with their health in the first place, it wouldn't be such a major drain on the healthcare system. but then again, that's how they make money.
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As appealing as this approach might be; it isn't practical. Shifting the burden for bad decisions onto the public is one fashion that this can occur and does occur within universal healthcare plans.
In many countries; if you are in need of coronary artery bypass surgery and you smoke; you'll not be getting that bypass until smoking cessation has occurred and is confirmed.
Now over 50% of the U.S. population is either overweight or obese and these numbers are growing rapidly. Access to preventive and primary care is dismal (I believe ranked 47th in the world last time I looked) and costs are greater per capita than anywhere in the world.
Better engineering of healthcare is needed and UHC has this possibility; if done correctly. More people will benefit, at lower cost. Exotic treatments will have costs borne by the individual who wants them and placing maximal dollars into the last months or days of life will be replaced by comfort care; and albeit at much lower cost and no significant detriment to mortality rates.
NICE is an interesting group in the U.K. that actually looks at treatments in an evidence based fashion and either approves the treatment as being beneficial and reasonably evidence based or not. In this fashion, that health system doesn't allow swift talking pharma groups to simply gets doctors to prescribe the newest drug, until a careful process occurs that shows benefit and superiority to current treatments.
There are upsides and downsides to UHC -- but the mix that occurs in most of the countries that have UHC (such as Australia) allow a baseline support and care for everyone in society at a very low cost (relative to the U.S.) and then should you decide to add private health cover to avail yourself to all manner of more exotic treatments that are more rapidly delivered, you can choose to do so. Even in the case of private health cover, you are not immune to the costs of your choices; which I believe is a reasonable situation. People need to be cost aware and realize that choices have expenses.
I've had the scenario many times in the U.S. where some 80+ year old demented person with little quality or meaning to their life has their relative say "do everything" when their relative comes in with a bad pneumonia. Next thing we have the person on a ventilator, central lines, pressors, high dose antibiotics .... the whole set of every technology, which is very appropriate for a 50 year old with this -- but not a demented elderly person. If we could only express the cost involved and tell the relative:
Option #1: Your Mom is quite elderly, isn't who she used to be, doesn't have quality of life and in the best case scenario, despite as giving all this care and her possibly surviving, she'll be worse off than before this illness. So it is my advice that we provide comfort measure, keep her comfortable.
Option #2: You have opted not to go with my advice and you still want me to do everything, now you have the financial liablity of that choice. So for the first 24 hours, it will be approximately 10K and then likely ~ 5K/day -- how would you like to pay for that, check, Visa or MC?
This is how this should occur -- we shouldn't be putting massive resources into situations where life expectancy and quality is poor and our ability to impact it is not good, despite all available medical care.
The problem is priorities.
Just recently I listened to a lecture by an FP professor from Tennessee -- he stated statistics, that in Tennessee adults, just 13% of high blood pressure is properly and adequately controlled. Much of this is poor compliance, lack of diagnosis, lack of followup, lack of being able to see a primary care physician, etc. So -- these people who could have been controlled for very little money, now show up in the ED with stroke, heart attack and renal failure -- so every last resource is now thrown at them.
This is classic penny wise and pound foolish.
So -- there are great examples of how to get value for the money; which is what the U.S. should look at. As to whether such a dysfunctional political system will ever generate a smartly engineered system; I'm much more skeptical. However, to the skeptics of the concept of UHC -- you need to be well aware that better systems are available when looking at outcomes and right now the U.S. is being completely ripped off by a healthcare system that costs a lot and delivers less than it should.
The U.S. healthcare system also is amazing in what it can deliver; the problem is that it is delivering it to all the wrong people and for all the wrong reasons due to lack of focus and lack of ability to make the decisions of who should receive care and who shouldn't. It is not playing God to make these decisions; it is common sense and done everywhere in the world except the U.S.
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