Why Is the United States So Sick?

[imagep]

So your argument is that if it is a universal condition of aging, we don't need to treat it? Or we shouldn't call it preventative?

We shouldn't call it preventative, unless of course we can discover a way to prevent aging.

 

[mak2]

Actual aging does not require medical treatment, kinda a funny argument really. The reason American medicine does not emphasize PM more is because there is less profit in it. Looks at one microscopic example, vaccines in children. The payback is enormous. ECBT Advocates - Childhood Vaccines Save Lives and Money

We shouldn't call it preventative, unless of course we can discover a way to prevent aging.

accines

 

[Threegoofs]

I actually have looked it up before and found that you are not correct.

The 'Preventive Care' Myth | National Review Online

A Doctor’s View of Obama’s Healthcare Plans - WSJ.com

http://www.nytimes.com/2008/10/07/health/views/07essa.html?_r=0

Prevention Will Reduce Medical Costs: A Persistent Myth - Health Care Cost Monitor

Preventive Medicine

An Apple a Day

Michael Fumento: The Preventive-Care Myth

The myth that preventive medicine saves money

https://www.actuarialoutpost.com/actuarial_discussion_forum/showthread.php?t=172909

Five Myths About Health Care - Forbes

Should I go on?



True preventive care costs nothing or almost nothing. Exercise and proper eating and staying away from tobacco and excess alcohol and generally being safe with your body. These aren't the types of things that insurance can pay for.

As far as screening, thats really not preventative care either, it's looking for illnesses. Screening is great for the individual, it's not a money saver for society. While early detection can be a big cost saver for individuals who are found to have breast cancer, most individuals do not have breast cancer, and thus in aggregate we actually spend more screening for breast cancer than we spend treating breast cancer.

You might not want to take the WSJ editorial page to seriously on preventive care, or all your other redundant right wing editorials that were written in response to the horror of Obamacare wanting to pay for preventive services. The WSJ and Forbes editorial staff is in firm agreement that the best medicine is being wealthy... why else would wealth correlate with lifespan so well?

Preventative care is often an excellent use of resources - its way cheaper to prevent something with your $3/mo bp pills than to have someone pay for a stroke, an ICU stay, and nursing home care for a decade.

But your bp pills dont really cost $3 per month, do they?

First of all, you need to get seen by a physician, to determine if you bp elevation is essential hypertension, or if it is something more malignant - like an adrenal tumor. Then you have to have the physician determine if you have any symptoms or signs that you may have a compliiction from high bp - neurologic, renal, or cardiac. Then he has to decide on an appropriate treatment given your situation - lots of bp pills cost $3, all might not be appropriate.

All of that stuff costs money- physician time, nursing time, BP reading devices, etc.

That doesnt even go into the sunk costs of developing that cheap drug you have. Someone, sometime, spent millions in research and development to prove that drug was safe and effective.

So your simple three dollar bp med is actually not cheap for the system as a whole. But its way, way cheaper than a stroke or heart failure. And thats what preventive medicne avoids.

Not many people need insurance to pay for the three dollar medicine. But many people need it to pay for the rest. And thats really expensive to treat.

So for your breast cancer screening example. We pay more to screen than to treat (thats news to me, but I'll go with it). Is that wrong? Crazy? Well, given the fact that we are cutting treatment costs down TREMENDOUSLY with screening, that is exactly what we want to see. The investment into screening is cutting down treatment costs... in this case, so much that treatment is a smaller part of breast CA than detection. Thats great! Lots more healthy people walking around, the investment we make is to make people healthy, not slam disease, and millions of women walking about knowing they dont have cancer because they were screened.

Yes, preventive care costs money, but the payoff comes in longer lives. In fact , we look at all of the preventive strategies by looking at QALY- quality adjusted life years, and determine how much you are paying for a year of quality life (i.e. life not seriously ill). What is a QALY worth to you? How much would you pay for an extra few at the end of your life? You seem to be saying not much, but I bet when you get to that point, you'd give all you have.

 

[GottaGo]

Personally, I feel al lot of the 'illnesses' are the pharmaceutical fields method of self-perpetuation.

Toenail fungus? We have a pill for that!
Hair thinning? We have a lotion for that!

Take drugs for things you have, might get, could get, your neighbor has, the kids have, oh wait, medicate the kids too!

No one dies of old age anymore. The underlying conditions must be named so that the medical field said they died of this-that-or-the-other-thing, more disease to try and cure

 

[imagep]

Actual aging does not require medical treatment, kinda a funny argument really. The reason American medicine does not emphasize PM more is because there is less profit in it. Looks at one microscopic example, vaccines in children. The payback is enormous. ECBT Advocates - Childhood Vaccines Save Lives and Money accines

OK, thats a legitimate point. I'll concede that vaccinations may be cost effective, honestly, I never considered them. Vaccines can also be very inexpensive, when administered in mass - like in a school or workplace setting, or at a "minute clinic". I would have no issue with giving free vaccines to school age children.

 

[imagep]

But your bp pills dont really cost $3 per month, do they?...
First of all, you need to get seen by a physician, to determine if you bp elevation is essential hypertension, or if it is something more malignant - like an adrenal tumor. Then you have to have the physician determine if you have any symptoms or signs that you may have a compliiction from high bp - neurologic, renal, or cardiac. Then he has to decide on an appropriate treatment given your situation - lots of bp pills cost $3, all might not be appropriate.

OK, they cost $136/yr including twice a year doctors visits to get the script renewed. Thats two tanks of gas, or less than I spend on food for a week for me and my wife.

All of that stuff costs money- physician time, nursing time, BP reading devices, etc.

That doesnt even go into the sunk costs of developing that cheap drug you have. Someone, sometime, spent millions in research and development to prove that drug was safe and effective.

So your simple three dollar bp med is actually not cheap for the system as a whole. But its way, way cheaper than a stroke or heart failure. And thats what preventive medicne avoids.

Not many people need insurance to pay for the three dollar medicine. But many people need it to pay for the rest. And thats really expensive to treat.

It's typically much cheaper just to pay for a doctors visit, than to pay for "good" insurance. Insurance doesn't actually save us money, we are just paying the insurance company to pay our bills, and then of course we pay the insurance company also for the service of paying our bills, and their overhead, and their profit.

Do I need insurance to pay for my food? Or gas? Insurance isn't really insurance when it is paying for normal care. Insurance is only insurance when it covers unexpected financially catistrophic expenses. Thats why I believe that everyone should have major medical, but pay out of pocket for normal care.

And the argument that insurance companies "negotiate" on our behalf is total bullcrap. I can do my own negotiating thank you. I mostly do this by price shopping for medical care. One of the ways that health insurance runs up the cost of medical care is that it tends to eliminate price shopping, and thus health care providers don't have to price compete. How much would gas be if gas was covered under our auto insurance plan? Naturally, if my auto insurance company paid for my gas, I wouldn't bother to price shop, and without price competition, gas stations would gouge people, just like many health care providers do.

So for your breast cancer screening example. We pay more to screen than to treat (thats news to me, but I'll go with it). Is that wrong? Crazy? Well, given the fact that we are cutting treatment costs down TREMENDOUSLY with screening, that is exactly what we want to see. The investment into screening is cutting down treatment costs... in this case, so much that treatment is a smaller part of breast CA than detection. Thats great! Lots more healthy people walking around, the investment we make is to make people healthy, not slam disease, and millions of women walking about knowing they dont have cancer because they were screened.

Yes, preventive care costs money, but the payoff comes in longer lives. In fact , we look at all of the preventive strategies by looking at QALY- quality adjusted life years, and determine how much you are paying for a year of quality life (i.e. life not seriously ill). What is a QALY worth to you? How much would you pay for an extra few at the end of your life? You seem to be saying not much, but I bet when you get to that point, you'd give all you have.

Quality of life does have value. And people are willing to pay out of pocket for something that has value to them. I don't need insurance to pay for my bp medicine or a $50 doctors visit any more than I need my auto insurance to pay for my gas or an oil change. It amazes me that people can somehow find the money to get their oil changed, and do so without oil change insurance, but some believe people can't get comparably priced preventative medical care without insurance.

 

[TheGirlNextDoor]

We have a lot of unhealthy habits. Smoking is going down, but obesity is going up. Compared to other nations I don't think we have a major problem with alcohol and smoking is improving, but the obesity/poor diet aspect is weighing in heavily when it comes to diabetes and heart disease.

We need to look at ways to make fresh food (not over processed) more affordable.

My own grocery bill has increased 100% over the last two years. I get less food for the same amount of money.

Sad, but it's cheaper to buy unhealthy processed foods than it is fresh.

Hell, even buying crap food is getting ridiculous.

 

[GottaGo]

We need to look at ways to make fresh food (not over processed) more affordable.

My own grocery bill has increased 100% over the last two years. I get less food for the same amount of money.

Sad, but it's cheaper to buy unhealthy processed foods than it is fresh.

Hell, even buying crap food is getting ridiculous.

There are some who will argue that inflation has only been 2.x% over the last number of years, but that number includes large durable goods, which most have dropped in price, giving a slanted picture of the cost of inflation for necessities like food.

Fresh veggies and fruits are vital to good nutritional health, but won't prevent some things that a person is either genetically predispositioned for occurs from something not related to actual dietary health. I'm living proof of that. I've always taken care of myself health-wise, eat nutritionally well, am not overweight or drink. Smoking was my one down fall, but my issue has nothing to do with that.

Preventive medicine wouldn't have stopped it, for me and many others. Not to say that PM is not something that should be practiced, but it seems some people take it to an extreme running to the doctor with every minor ache, pain or sniffle. And that has backlashes of it's own.

 

[Neomalthusian]

You might not want to take the WSJ editorial page to seriously on preventive care, or all your other redundant right wing editorials that were written in response to the horror of Obamacare wanting to pay for preventive services. The WSJ and Forbes editorial staff is in firm agreement that the best medicine is being wealthy... why else would wealth correlate with lifespan so well?

Preventative care is often an excellent use of resources - its way cheaper to prevent something with your $3/mo bp pills than to have someone pay for a stroke, an ICU stay, and nursing home care for a decade.

This has been carefully considered and analyzed. The truth is that just because you can imagine a scenario in which a small upfront cost/procedure prevents a huge long-term cost does not make preventative care in general, across the board, a smart investment.

For the one (presumably rare) patient whose diagnosis is caught early, yes a lot of money is potentially saved. But to put all people through diagnostic tests for the purpose of finding all the diagnoses, money is not saved overall. It's a simple multiplication.

 

[Threegoofs]

This has been carefully considered and analyzed. The truth is that just because you can imagine a scenario in which a small upfront cost/procedure prevents a huge long-term cost does not make preventative care in general, across the board, a smart investment.

For the one (presumably rare) patient whose diagnosis is caught early, yes a lot of money is potentially saved. But to put all people through diagnostic tests for the purpose of finding all the diagnoses, money is not saved overall. It's a simple multiplication.

It has been studied. And many preventive measures are extremely cost effective. Treatment for HTN, cholesterol, and vaccines are three that come to mind.

Some preventive care is too expensive, for example CT scans on all comers to screen for cancer, and those things don't need to be done. We study this stuff via cost effectiveness, and there are entire journals devoted to the topic.

In terms of what insurance should pay for, look at the car analogy.

Many people don't change the oil in their car. And the repair gets really expensive in ten years.

Many people don't get preventive care. And the consequence in ten years is a costly treatment.

So your insurance is there to encourage good health care and make the cost of prevention a non issue so you stay well, since the cost of treatment if complications is very high.

 

[Neomalthusian]

It has been studied. And many preventive measures are extremely cost effective. Treatment for HTN, cholesterol, and vaccines are three that come to mind.

Some preventive care is too expensive, for example CT scans on all comers to screen for cancer, and those things don't need to be done. We study this stuff via cost effectiveness, and there are entire journals devoted to the topic.

So "preventive care" is not just an inherently brilliant idea across the board (like your posts have perhaps inadvertently suggested). Its cost effectiveness is fundamentally dependent on the analysis of the short-term and long-term costs of diagnosis and treatment compared with the prevalence. We might as well call "preventive care" a "diagnostic test/evaluation." Does it make sense to do a diagnostic test or evaluation when someone is asymptomatic?

The problem with preventive care is that it is broad-brushed as universally cost effective, when it's not (you even admit it), and then the inaccurate generalization is used to argue for entitling people to virtually all types of health care, including clinic care (which in the US is by far the most expensive outpatient/clinic care in the world). So this inaccurate generalization used in argument for outpatient medical care entitlements directly contributes to more cost-expansionary ideas.

In terms of what insurance should pay for, look at the car analogy.

Many people don't change the oil in their car. And the repair gets really expensive in ten years.

Many people don't get preventive care. And the consequence in ten years is a costly treatment.

So your insurance is there to encourage good health care and make the cost of prevention a non issue so you stay well

As I said before though what you're advocating health insurance do here is inherently NOT insurance. You're trying to spin the car analogy in a different direction that doesn't make sense. The reason car insurers do not pay for routine maintenance is because it's not a good business practice (it's cost-expansionary). Car insurance insures against accidents and unfortunate events. They won't replace any and every damn thing when your car inevitably nears the end of its useful life (but we do with Medicare). Car insurance does not pay for routine maintenance because that's not insurance either, but you advocate that health insurance do so.

Insurance is supposed to be for uncommon accidents and misfortune, not routine maintenance and inevitabilities. But we ignore this precept, and guess what? The business model is a failure that gets more and more complicated and expensive all the time.

You are apparently in support of continuing to convert insurance into something else entirely (a broad entitlement system).

 

[Threegoofs]

1) if you interpret my posts to say anything you do fro preventive care is cost effective, that's your problem, not mine.

2) if you want to define insurance as covering only catastrophic events, that's your problem. The health care insurance industry has defined it differently for at least 60 years. You apparently want to redefine health insurance.

 

[Neomalthusian]

1) if you interpret my posts to say anything you do fro preventive care is cost effective, that's your problem, not mine.

2) if you want to define insurance as covering only catastrophic events, that's your problem. The health care insurance industry has defined it differently for at least 60 years. You apparently want to redefine health insurance.

Yes I do want to redefine it... back to the real meaning of insurance. Look up the definition of insurance. In each case you will see the word "specific" or "specified" with regard to the loss against which a purchaser is insured. The type of health coverage you're advocating here (and the type we've had for a long time now) is non-specific (i.e. too much is covered). Health insurance is unique in this way, and its cost is also unique(ly high), and that is not coincidence. Those problems are one and the same.

 

[Threegoofs]

Yes I do want to redefine it... back to the real meaning of insurance. Look up the definition of insurance. In each case you will see the word "specific" or "specified" with regard to the loss against which a purchaser is insured. The type of health coverage you're advocating here (and the type we've had for a long time now) is non-specific (i.e. too much is covered). Health insurance is unique in this way, and its cost is also unique(ly high), and that is not coincidence. Those problems are one and the same.

What you seem to miss is that health insurance is unique in that virtually every person in the world will make a claim on it, unlike homeowners or auto insurance. And that it is a public good to have a healthy population - one that regularly has access to medical care for preventive reasons, so we can detect issues that are treatable - diabetes, vascular disease, heart disease - and keep people productive whith those diseases for years.

We could just do the libertarian thing and say "**** them, I got mine"

 

[Neomalthusian]

What you seem to miss is that health insurance is unique in that virtually every person in the world will make a claim on it, unlike homeowners or auto insurance.

No, I don't miss that at all, as this is essentially a restatement of what I have pointed out. I have repeatedly acknowledged this fundamental difference between actual insurance (against specified losses) and health "insurance" which we have basically turned into an entitlement, as you are about to describe in 3... 2... 1...

And that it is a public good to have a healthy population - one that regularly has access to medical care for preventive reasons, so we can detect issues that are treatable - diabetes, vascular disease, heart disease - and keep people productive whith those diseases for years.

We could just do the libertarian thing and say "**** them, I got mine"

Descend into political jabs if you want to. You have already supported my comments with your own.

 

[Threegoofs]

It's not political jabs.

It's reality.

The philosophy you are embracing can be summarized in that phrase.

The problem is, in real life, some of us feel ethically bound to have patients avoid events, not just treat them.

 

[Neomalthusian]

It's not political jabs.

It's reality.

The philosophy you are embracing can be summarized in that phrase.

Your straw man summaries of libertarianism do not interest me. What interests me is why you want "insurance" (keeping in mind its literal definition) to do things like provide for routine/maintenance/preventive care.

If you wanted your argument to be consistent, you'd say "health care should not be payable by an insurance product, it should be a state and/or federal entitlement." I mean, philosophically I disagree with that too, but at least if you said this, it would reflect awareness of what you're really advocating, and how insurance is supposed to work (and why it's failed in the case of health care).

The problem is, in real life, some of us feel ethically bound to have patients avoid events, not just treat them.

What you feel ethically bound to do for others is your business. All I've been saying is how insurance is intended to work, and that it's because we haven't insured health the way we insure other things that it's become such a financial problem.