Healthcare & rationing

[pfrit]

TallDave
I had my appendix removed the very same day, I was diagnosed. I had no wait time for the removal of my tonsils when I was 6. I had the best(!) treatment for my heart attack when I had it. I had almost no lasting damage. I would have probably died in the US. It is a known fact that healthcare in the US is much worse than e.g. here in Austria, or in Germany. I got the best treatment known of, provided without any delay and for free. I have to take 200 USD worth of medication every month and it does not cost me a dime.

I actually know a little something about modern treatment of heart attacks. It would seem highly unlikely that you recieved the best(!) treatment for heart attack. Even more unlikely that you would recieve it if you had your heart attack now. The best(!) treatment currently invovles stenting within 2 hours of the attack (preferably 45 minutes) by a team of specialized cardiologists. Very expensive and very few hospitals in the world can do it. As far as I know, most/all are in major US cities. The simple fact is that for a long time, few people (including those in the US) have gotten the best(!) treatment for heart attacks. You now need a surgical cardiac trauma team on site (not on call) 24/7. VERY expensive. BTW recent studies have suggested that if you are at a regular hospital for your heart attack, you should check out and drive yourself to the nearest real cardiac center. Your odds of dying are reduced if you can get there in under an hour. That includes dying behind the wheel. Quality care is vital to survival. If you don't know where the best cardiac care center is in your area, find out now!

[TallDave]

The largest international cancer survival study to date, it found the chances of surviving for at least five years after being diagnosed with cancer ranged from a low of 25.2 percent for men in Poland to 57.9 percent for women in France. Regionally, Scandinavia came out best and Eastern Europe worst.

That compares with a survival rate of 62 percent for men and 63.5 percent for women in the United States. Comparable statistics for other areas of the world were not immediately available.

Oddly, the articleis titled "France, Austria boast high cancer survival rates." I guess it was originally for European consumption.

What's really striking though is that even though Europe has a wide distribution of values, every single country is behind the U.S., even tiny, rich countries like Norway that have a higher PPP GDP per capita.

[Skipjack]

OTOH, should you have a difficult to diagnose problem where an MRI or a highly specialized procedure is needed, you would be in much worse straits (there is a necessary tradeoff between efficiency and risk; do you do an MRI for a 5% chance of finding something, or only 25% or more? do you train doctors for a procedure that is rarely needed?). More diagnostics and more specialists means you find and treat problems sooner, when they can be addressed more effectively, albeit at greater expense. This is why the U.S. has the best cancer survival rates.

But at least your delayed treatment is free, right? Well, you get what you pay for.

Yes it is indeed amazing how people cling to their believes, Mr Simon...
First of all you clearly know nothing. I am from a family of medical doctors (grandfather, father, sister) and I do work in the medical sector myself (to some extent). I am not stupid.

But when we are at naming fallacies of system, let me tell you a nice annectode that you seemingly like so much.
A MD from Austria attended a surgery for colon cancer in the US.
The doctor there was said to be brilliant and the best of his trait. Well, he performed the surgery perfectly, but left the lymph nodes in. This means a 80% or so risk that the cancer will come back. When the Austrian doctor asked why he did not remove them, the answer was: The patient had not paid for it.
Hello? Any Austrian doctor would loose his license for this. Personally I find this disgusting, but that is just my opinion. But yeah, awesome treatment you have in the US. Maybe without delay but definitely not the best.
LOL

Now to you Mr Pfrt. You clearly do not know much about the quality of treatment here in Austria, nor do you have any idea what really happened to me. You should think before you talk, Mr.
We do have world class surgeons and doctors here. Some medical techniques such as laser treatment for brain tumors were developed here. I personally know the professor that developed that. That just as one example. There are many others.

As to my treatment. I had the luck for my heart failure (actually) to happen a few seconds after I walked into the ER. I had been brought there by my mother after severe back and neck pains that I thought were from a slipped disk (the symptoms and my charactistics were atypical for a heartattack so I did not suspect that). Anyway I as lucky and did not have to wait to talk to a doctor. It was a Saturday afternoon. But thanks to our perfect system, I had no wait time. I talked two sentences to the doctor before I collapsed. They emmediately reanimated me and diagnosed a cardiac arrest. They performed a defibrilation to get my heart beating again. I was dead, yes dead, for a few seconds anyway.
I was intubated and attached to a mobile EKG that showed a STEMI of the frontal wall. This was diagnosed while they transported me down to the cardiology station (it is in the basement). On the way down (in the elevator) I was already cooled down to 32 degrees Celsius to avoid neural and heart damage. On the cardiology station, they emmediately performed an emergency coronary angiography. The coronary angiography showed a rupturing plaque in the LAD and a successful direct stenting was performed.
After that a thorax xray was performed. That did not show any further issues. I was in neuroprotective sleep cooled down to 32 degrees C for two days. The wakeup process took another two days. So it was Tuesday when I finally came to (first thing I heard was David Bowie' Ashes to Ashes playing on a radio in the station next door, kinda cool),
Anyway, the intensive care unit was very well equipped. I dont think that there is anything they did not have that any hospital in the US has. I mean pretty much every aspect of my body was monitored constantly. I had a thermometer inside my body (unrinary catheter with built in thermometer), of course an EKG, blood values were constantly checked as was my urine. I had another thorax Xray and two echocardiograms while I was there. I dont think that they could have done anything better.
The heart attack happened on the 2nd on the 15th I was allowed to go home. I was feeling great by then, actually. On the 7th of the following month I was sent into a rehabilitation clinic for 4 more weeks. Yes I had to wait for 3 weeks for this rehab, but I gave them a hard time by requesting a rehab clinic close to home, so I would be closer to my wife and family. That was also fully paid for by the medcare here. Again excellent equipment and an excellent team of doctors there. Food was even good and that means something.
Now of course I might have gotten a nicer room with WIFI and all to myself, had I had an additional private insurance, but from a medical POV, I dont think I was missing out on anything.
I have two MDs in my close family (my grandfather passed away a few years ago) and none of them could think of any procedure or test that I could have gotten but did not. Since then, I have seen my family doctor twice a month. I will have an ambulant rehab (that is one where I go in twice a week for an hour) in November (no wait time here, I just requested a break to take care of a few things and to go on vacation, thats all).
All that for 7.65% of my income (I just checked that is the part of my social insurance payments that is for health insurance). 7.65% for health insurance man! That means the average (self employed!) Austrian pays 230 USD a month for health insurance (and with that I have my entire family ensured). I want to see what you get for that in the US.
And dont forget that with my condition now, I still dont pay a cent more than those 7.65 percent. I doubt that I would get anything with full coverage and full security in the US for that little money, especially with my condition. But please lift a huge rock from my shoulders and show me an insurance quote like that. Because right now I am kinda worried about my plans for moving to the US, because I think that I wont be able to afford the health insurance even with above average income. Dont forget I am self employed, so I do not benefit from any bulk insurance policies that bigger companies have.

[Skipjack]

What's really striking though is that even though Europe has a wide distribution of values, every single country is behind the U.S., even tiny, rich countries like Norway that have a higher PPP GDP per capita.

Let me quote from the same article:

Coleman, a professor of epidemiology and vital statistics at the London School of Hygiene and Tropical Medicine, said the EUROCARE findings cannot be interpreted as an assessment of health care systems across Europe because other factors, including how soon patients go to their doctors in the first place, determine the likelihood of surviving cancer.

One problem is that many countries do not follow all their cancer patients, so if someone is diagnosed in a town that has a registry but then moves to another town that doesn't and they die, they have been lost to the follow-up, which could distort the national picture, Boyle said.

Since in the US you dont have to name your adress to the government (whereas in Europe you have to), the US statistics could be looking a lot better than they actually are, for reasons named right there.
I would not be surprised if this made for at least those 3 or so % difference between France and the US, but I would bet it is even more.
Austrians have a higher life expectancy than US citizens, btw.
79.5 in Austria versus 78.11 in the US. That is according to your CIA factbook btw...

[pfrit]

Now to you Mr Pfrt. You clearly do not know much about the quality of treatment here in Austria, nor do you have any idea what really happened to me. You should think before you talk, Mr.
We do have world class surgeons and doctors here. Some medical techniques such as laser treatment for brain tumors were developed here. I personally know the professor that developed that. That just as one example. There are many others.

Actually, I am quite happy to be wrong. You were indeed very lucky. It sounds like you were in the right place at the right time. I am glad to hear that you hospital has the proper staff and equiptment. The point I was trying to make is that most people in the world, US included, are not so lucky. Getting to the correct hospital in time can and does save lives. The advantage for the US, if any exists, is that we spend money out the wazoo on health care and have cardiac centers that are staffed 24/7. If you work in the medical field, you know what I mean. Your story attests that timely, correct treatment is vital. Know where the nearest cardiac care center is. Make sure that if you or a loved one might be having a coronary event that you are taken to the cardiac care center, and NOT to the nearest hospital!

[gblaze42]

Austrians have a higher life expectancy than US citizens, btw.
79.5 in Austria versus 78.11 in the US. That is according to your CIA factbook btw...

This has no connection to the state of medical care. Many individuals diets affect this as well as stress related, which is most likely higher in the US due to the fact that US citizens take far fewer vacations and work more hours than most European countries.

[Skipjack]

This has no connection to the state of medical care. Many individuals diets affect this as well as stress related, which is most likely higher in the US due to the fact that US citizens take far fewer vacations and work more hours than most European countries.

Diets are roughly the same here as they are in the US. We do have slightly less obese people, but we have been getting fatter too. Oddly enough life expectancy has still increased here.

[Skipjack]

To put another dent into that theory:
I am sure you will agree that infants are hardly affected by badly chosen diets or the lack of vacations. Yet the US has a signifficantly higher infant and child mortality rate than Austria.
6.3 (inf) and 7.8 (<5y) in the US versus 4.4 and 5.4...

I think this has not only to do with the lack of medical checkups for mothers and newborns in the US (expensive) versus Austria (mandatory and paid for by the government). It also has to do with the lack of a maternity leave system. Here mothers stay with their children for up to two years and get paid by the government instead. In the US there is no such system in place and newborns end up in daycares.

[gblaze42]

To put another dent into that theory:
I am sure you will agree that infants are hardly affected by badly chosen diets or the lack of vacations. Yet the US has a signifficantly higher infant and child mortality rate than Austria.
6.3 (inf) and 7.8 (<5y) in the US versus 4.4 and 5.4...

I think this has not only to do with the lack of medical checkups for mothers and newborns in the US (expensive) versus Austria (mandatory and paid for by the government). It also has to do with the lack of a maternity leave system. Here mothers stay with their children for up to two years and get paid by the government instead. In the US there is no such system in place and newborns end up in daycares.

That's all well and good but, if I wanted to have someone look after me I would have staid in Canada, but that's only part of the issue. The onus, in the US, is on the individual to make sure he's taken care of mostly, the US isn't totally void of welfare programs. I certainly prefer that to having to pay for someone else who doesn't feel they should or need to work and take advantage of my tax money and my hard work.

And no really, the insurance isn't that bad, through my company it's roughly $127 a month, $40 co-pay at most. To some it may be bad but we do have medicare, and the fact that no hospital can turn anyone away for medical care. It's not perfect, none are, but I would take it over socialized medicine.

[pfrit]

To put another dent into that theory:
I am sure you will agree that infants are hardly affected by badly chosen diets or the lack of vacations. Yet the US has a signifficantly higher infant and child mortality rate than Austria.
6.3 (inf) and 7.8 (<5y) in the US versus 4.4 and 5.4...

I think this has not only to do with the lack of medical checkups for mothers and newborns in the US (expensive) versus Austria (mandatory and paid for by the government). It also has to do with the lack of a maternity leave system. Here mothers stay with their children for up to two years and get paid by the government instead. In the US there is no such system in place and newborns end up in daycares.

To be fair, diet of the mother is one of the biggest factors in infant mortality. Not enough protein and vitamins can be as bad as gestational diabetes. Overwieght women with crap diets make unhealthy children. Whether this can account for the difference in infant mortality by itself is debatable and I would not want to take the side that this is the only problem. It does, however, make the situation worse. My personal opinion is that when it comes to infant mortality, you should never say your rate is low unless it is as close to zero as genetic disorders allow. There really is no good reason for a baby that has good genetics to die young. OK, accidents can happen, but that is never an excuse, just a reason. If a mother does not have the physical, emotional, and finacial means to raise a healthy child, then we have failed that child, whether it gets lucky and lives or not.

[MSimon]

Dont even get me started on how crappy the medical support for your veterans is. That is shamefull!

I think that is the point.

And add to it that our politicians don't use the VA nor do they have any plan to join the new system they plan on imposing on the rest of us.

It is as if Americans don't trust politicians.

[Skipjack]

Gblaze, I know that some (not all, as it depends on the size) companies do offer rather cheap medicare, but I am self employed. I would not benefit from the bulk insurance contracts that big companies can offer.
Also smaller companies can not offer such benefits and then employees end up paying much. Also, again what happens if you get layed of?

Pfrt, all major hospitals here have a cardiology station. There are doctors for every station doing night shifts. Of course it is better to be at the right place at the right time when tons of staff present. My heart faliure happened on a Saturday evening. Yet, I still got excellent treatment.
I doubt that the treatment would have been much worse in any of the other major hospitals here. These are never more than 35 minutes away via car and 10 minutes via helicopter (of which we have many on 24 hour notice in all cities).

As I said, I have been to the US and I have been here. My wife is an US citizen and she can really compare. Things are not any worse here than they are there. The only disadvantage I have over someone with Blue Cross Blue Shield is that I have to share a room (unless it is an intensive care room) with 5 other people. But heck I sure take that as long as the care is good and people treat me well (and they sure did that).

Again look at the amount of malpractice suits in the US and tell me that that is OK. If you ask me that is a sign of a broken system.

[MSimon]

Again look at the amount of malpractice suits in the US and tell me that that is OK. If you ask me that is a sign of a broken system.

Take it up with the American lawyers guild.

Any new technology will get sued into extinction. Often on spurious grounds.

BTW does your system allow malpractice suits?

===

The following is from: http://powerandcontrol.blogspot.com/200 ... ctors.html

http://www.google.com/hostednews/canadi ... Gu_Z3KXoQw

And what does the doctor say about the cure for ills of the Canadian System?

Ouellet has been saying since his return that "a health-care revolution has passed us by," that it's possible to make wait lists disappear while maintaining universal coverage and "that competition should be welcomed, not feared."

In other words, Ouellet believes there could be a role for private health-care delivery within the public system.

He has also said the Canadian system could be restructured to focus on patients if hospitals and other health-care institutions received funding based on the patients they treat, instead of an annual, lump-sum budget. This "activity-based funding" would be an incentive to provide more efficient care, he has said.

Do Canadians like their health care (video):

http://powerandcontrol.blogspot.com/200 ... -care.html

Obama says take a pain pill. It is cheaper than surgery:

http://powerandcontrol.blogspot.com/200 ... iller.html

Health care in Canada (a video):

http://www.pjtv.com/v/2153

[MSimon]

To put another dent into that theory:
I am sure you will agree that infants are hardly affected by badly chosen diets or the lack of vacations. Yet the US has a signifficantly higher infant and child mortality rate than Austria.
6.3 (inf) and 7.8 (<5y) in the US versus 4.4 and 5.4...

I think this has not only to do with the lack of medical checkups for mothers and newborns in the US (expensive) versus Austria (mandatory and paid for by the government). It also has to do with the lack of a maternity leave system. Here mothers stay with their children for up to two years and get paid by the government instead. In the US there is no such system in place and newborns end up in daycares.

From what I read the infant mortality number variations are mostly due to how infant deaths in the first week after birth are counted. Correct for that and the USA numbers are in line.

http://www.absoluteastronomy.com/topics ... _mortality

While the United States reports every case of infant mortality, it has been suggested that some other developed countries do not. A 2006 article in U.S. News & World Report claims that "First, it's shaky ground to compare U.S. infant mortality with reports from other countries. The United States counts all births as live if they show any sign of life, regardless of prematurity or size. This includes what many other countries report as stillbirths. In Austria and Germany, fetal weight must be at least 500 grams (1 pound) to count as a live birth; in other parts of Europe, such as Switzerland, the fetus must be at least 30 centimeters (12 inches) long. In Belgium and France, births at less than 26 weeks of pregnancy are registered as lifeless. And some countries don't reliably register babies who die within the first 24 hours of birth. Thus, the United States is sure to report higher infant mortality rates. For this very reason, the Organization for Economic Cooperation and Development, which collects the European numbers, warns of head-to-head comparisons by country."

[gblaze42]

Gblaze, I know that some (not all, as it depends on the size) companies do offer rather cheap medicare, but I am self employed. I would not benefit from the bulk insurance contracts that big companies can offer.
Also smaller companies can not offer such benefits and then employees end up paying much. Also, again what happens if you get layed of?

Pfrt, all major hospitals here have a cardiology station. There are doctors for every station doing night shifts. Of course it is better to be at the right place at the right time when tons of staff present. My heart faliure happened on a Saturday evening. Yet, I still got excellent treatment.
I doubt that the treatment would have been much worse in any of the other major hospitals here. These are never more than 35 minutes away via car and 10 minutes via helicopter (of which we have many on 24 hour notice in all cities).

As I said, I have been to the US and I have been here. My wife is an US citizen and she can really compare. Things are not any worse here than they are there. The only disadvantage I have over someone with Blue Cross Blue Shield is that I have to share a room (unless it is an intensive care room) with 5 other people. But heck I sure take that as long as the care is good and people treat me well (and they sure did that).

Again look at the amount of malpractice suits in the US and tell me that that is OK. If you ask me that is a sign of a broken system.

Lets be fair also, we have a population of over 300 million, Austria is little over 8 million, I'm thinking your system may have problems dealing with that large of population. US isn't for everyone, If you want it easy, stay in Austria, there is a risk to living here, we have a plan to save for at least a years worth of unemployment. So far it works.