Medical Reform- Why Doctors Are Worried

muffy · Guru

RE: Medical Reform- Why Doctors Are Worried

muffy · Guru

CoffeeQueen wrote:

Liz, that song is so funny, but sad.

Hey Megan - Lux is #16. I think I am moving to Malta :)

LOL - whilst i am very content at #16, if other stuff is better in Malta as well I just might join you! (at least come visit!)

CoffeeQueen · Guru

muffy wrote:

CoffeeQueen wrote:

Liz, that song is so funny, but sad.

Hey Megan - Lux is #16. I think I am moving to Malta :)

LOL - whilst i am very content at #16, if other stuff is better in Malta as well I just might join you! (at least come visit!)

16 beats out us at 37. Is that really true? We are 37 when it comes to health care?

muffy · Guru

mctex wrote:

>>What other country in the world comes up with the medical advances that we do? What's ridiculous is that we allow pharmaceutical companies to sell a drug here at an exorbitantly high price but to the rest of the world under a different brand name much more cheaply, because that's all their markets will bear.

Make those reforms, and kiss that cheap/good European healthcare goodbye! ;)<<

as said in my prior post, i somewhat disagree with your claim that only the US comes up with medical advances.

regarding drug costs - yes, i do currently benefit from lower drug costs - a combination of both lower prices from drug companies and gov't subsidy...

I still am a strong believer that what the drug companies are doing are WRONG in their treatment of americans regarding prices. it should not be this way -and if it means higher prices for the rest of the world, so be it. but personally, i dont see it as drastic as you portray - i dont think the world will fall apart because the US changes its medical system. maybe i am an econ flunkie...

i am not only looking out for myself where i am now. my kids are american - they probably will want to live there some day. heck, i might move back when i am really old and need lots of medical care (bert won't live there, so i need him gone first LOL). it hurts and frustrates me to see people like my parents and BFF suffer because of the current system.

it just has to change. do i agree with what is proposed - no. do i think it will work well - no. but it has to change because it cannot go on like this. (hhmmm.... wonder what mccain/palin would have done...)

but as liz pointed out - for being the world dominator, we are 37th. it just somehow does not add up...

mctex · Guru

Lizzy wrote:

mctex wrote:

This is *EXACTLY* what's going to happen. EXACTLY.

The best doctors will not participate in all of this nonsense. As it stands, they already don't.

So they will operate on a cash-only basis, thus putting the final nail in the coffin that ensures that only the wealthiest Americans get the best health care.

And let's play out how that works next... so the government decides to restrict access to medicine to only those doctors who play in the system?

Hello, genesis of a world-class Caribbean health care industry! (Or, more realistically, India -- they already have the educational infrastructure in place.)

To the extent that other countries who have socialized medicine are using OUR technologies and OUR pharmaceuticals, it is not an apples-to-apples comparison. Those countries to not have the same R&D costs that we do -- it's a hell of a lot cheaper to build a house when you're borrowing someone else's stuff, no?

Let's think for a second about how technologies are actually developed.

First, some crazy researcher comes up with an idea that he thinks will work.

It's just on paper. And it's going to take millions of dollars to get the idea to a point to where it can even be tested. AND it might -- will probably -- fail.

How likely are you to invest in this technology, unless the payoff would be substantial enough that if it works, you would make a ton of money?

Said differently... how likely are you to lay your dollar down on a number on a roulette table if the payoff were only 10 cents for every dollar you gambled, instead of 25 dollars (or whatever it is)?

THIS is why you need to see substantial return to investment for healthcare investors. Because for every dollar they are hitting big on, they're losing shitloads elsewhere.

Without the huge payoff, why bother taking on the risk? There are plenty of less risky investment opportunities.

As for the insurance companies, it's really scary to me how few people understand how insurance works.

http://www.ehow.com/how-does_4564303_insurance-companies-money.html

Whether or not the insurance companies are too profitable is an argument that holds some merit... although it would really suck to get to a hospital somewhere to learn that your insurance company is bankrupt.

But how it is that people think they are going to be able to pay their monthly premiums for coverage, and then somehow, the insurance companies are going to be able to magically payout 10x that much for services rendered -- without understanding the economics behind it -- is beyond me.

I *do* think that we need to see some sort of reform to make sure everyone has a most basic level of coverage, sure.

But the unintended consequences in all of this will be that only the wealthiest will get the cutting edge stuff.

I'd bet money on it. ;)

I will say that I still think this might be what's best for the US as a whole.

But we should probably also realize that we are handing over our dominance of health care to some other part of the world in doing so.

I think the article is a little biased (he is a fox news contributor). I would counter with this article and study. btw, looking at the site, I came accross this quote by Martin Luther KIng, Jr.:
"Of all the forms of inequality, injustice in health care is the most shocking and inhumane"

(and this from a man who led the Civil Rights Movement?....you would think that he could say the inequality between blacks and whites.)

when my mom was sick, the cancer doctors did not hesitate to treat her (even without insurance) which leads me to believe that the profit motive is not the only motive at work in health care. Maybe compassion?

which imo, we need alot more of. People should not lose everything because they get sick.....
There was a hearing on C-Span with testimony of people who have lost their livelihood due to a series of events stemming from health insurance or health-related issues. It's beyond depressing and hard to hear but tells an important message.

regarding a cure for cancer - the story of Jonas salk makes the case that cures will come- and most likely through government sponsored research. "He (Jonas Salk) further endeared himself to the public by refusing to patent the vaccine for his personal profit, as he wished to see it disseminated as quickly and as widely as possible and patenting would have hampered this. When asked who owned the patent, Salk replied: "There is no patent. Could you patent the sun?"

If you look at it through purely economic motive - the pharma companies realize the fallacy of curing a disease that brings them so much money.
according to this story, "Pharma and biotech companies are less interested in cures and more interested in medications that require a lifetime of administration, according to scientists..."

I just think that sharing knowledge is so important. why would anyone want to limit that from happening? (the claim made that other countries profit from "our" discoveries). and also, these "discoveries" do not happen in a vaccuum. there is alot of cooperation among scientists. for example, of the top pharmaceutical companies half are not american based.

and as far as your contention that we will hand our "dominance of health care to some other part of the world in doing so" I leave you with this.

-- Edited by Lizzy on Friday 23rd of October 2009 12:23:48 PM

Aargh... I typed out a long response, but then lost it when I clicked to follow the last link. Grr.

Regarding the study of the doctors to which you linked... here's what I really want to see -- a study that would rank the country's best doctors, and then ask them whether or not they would participate in a single payor system. Because one way to interpret the findings is that half the doctors would like a single payor system, and half wouldn't. And by definition, half are "below average" in terms of skill and prestige, and the other half are above. If the 50% who support a single payor system include a normal distribution of leading and not-so-leading physicians... rock on. I suspect that's not what you're going to find, however.

Anecdotally, my ped is voted year after year in our local paper's "Best of Austin" awards. In addition to his normal fee, he charges this. So, right here in Austin, TX, I can guarantee you that the poor are not getting access to "Austin's best doctor." Is he greedy? I don't know -- I don't work for free, so I can't expect him to. And even with the fee, he's so overbooked he's not accepting new patients. (Which means he could charge even more.)

>>when my mom was sick, the cancer doctors did not hesitate to treat her (even without insurance) which leads me to believe that the profit motive is not the only motive at work in health care. Maybe compassion<<

Extending that logic, couldn't you argue that there is no health care problem, because even uninsured patients are receiving the treatment they need? (At great personal sacrifice, and I don't mean to marginalize that whatsoever, but the elephant in the room that no one really wants to talk about is that sometimes life is just not fucking fair. Which really, REALLY, sucks. But that doesn't mean that we as a culture can somehow compensate for that fact.) If compassion were enough to answer, would there be a problem? When I see people employed in other professions agreeing to work for free, I'll expect healthcare providers to.

>>There was a hearing on C-Span with testimony of people who have lost their livelihood due to a series of events stemming from health insurance or health-related issues. It's beyond depressing and hard to hear but tells an important message.<<

I don't think there's a non-sociopathic individual who would tell you that this isn't incredibly unfair and devastating. I don't think that's what the healthcare debate is about. We just need to make sure that we recognize the tradeoffs we make when we start to talk about care for everyone. Not only less sophisticated care, but what is I'm guessing will be an inevitable infringement upon civil liberties. If I'm going to start paying for my neighbor's care, I'm going to be a little more interested as to what he's eating, drinking, drugging. It's potentially not very pretty.

>>cures will come- and most likely through government sponsored research. <<

And since the days of Jonas Salk... what's been cured by the government lately? And where will the money come from? What is the tax rate going to be that will not only insure everyone, but then pick up the research slack from a neutered private market???!?

>>If you look at it through purely economic motive - the pharma companies realize the fallacy of curing a disease that brings them so much money.
according to this story, "Pharma and biotech companies are less interested in cures and more interested in medications that require a lifetime of administration, according to scientists..."<<

Agreed, from the perspective of the established big pharma players. But what about a bright-eyed independent researcher with a clue and a dream? This guy doesn't stand a chance of debunking big pharma without independent venture capital. Which simply will not come to the same degree it is now in a marketplace where profits are capped. (The counter-argument here, BTW, is that even a capped profitability will be more attractive to VC dollars because right now there aren't a lot of better alternatives, outside of the tech space. And I'm not sure that isn't true. But what I do know is that to just say "pharm profits need to be regulated" WILL result in SOME degree of cash flow out of the industry. How much and whether or not it's material remains to be seen.)

>>why would anyone want to limit that from happening? (the claim made that other countries profit from "our" discoveries).<<

Because you can't have it both ways. You can't be bitching about how American citizens are being raped by our pharm companies, but ok with the fact that they're selling the same exact medicines to other countries cheaper than we can buy them here. When we can cross a border and buy the exact same medicine that was developed and sold here for pennies on the dollar, you can't cry both "travesty!" and "bravo!" at the same time.

>> for example, of the top pharmaceutical companies half are not american based. <<

Not all companies are created equal. Take a look at the actual R&D dollars on that chart. Pfizer alone accounts for 10% of the world's R&D. US companies combine to represent 63% of the world's R&D. I'd say we can claim some dominance there, no?

>>and as far as your contention that we will hand our "dominance of health care to some other part of the world in doing so" I leave you with this. <<

Clever -- definitely. But I'd like to know exactly what that means. For example, Houston is America's fattest city. Why? Because they have the lowest public park to restaurant ratio. Not particularly useful, KWIM?

mctex · Guru

muffy wrote:

mctex wrote:

This is *EXACTLY* what's going to happen. EXACTLY.

The best doctors will not participate in all of this nonsense. As it stands, they already don't.

So they will operate on a cash-only basis, thus putting the final nail in the coffin that ensures that only the wealthiest Americans get the best health care.

And let's play out how that works next... so the government decides to restrict access to medicine to only those doctors who play in the system?

Hello, genesis of a world-class Caribbean health care industry! (Or, more realistically, India -- they already have the educational infrastructure in place.)

To the extent that other countries who have socialized medicine are using OUR technologies and OUR pharmaceuticals, it is not an apples-to-apples comparison. Those countries to not have the same R&D costs that we do -- it's a hell of a lot cheaper to build a house when you're borrowing someone else's stuff, no?

Let's think for a second about how technologies are actually developed.

First, some crazy researcher comes up with an idea that he thinks will work.

It's just on paper. And it's going to take millions of dollars to get the idea to a point to where it can even be tested. AND it might -- will probably -- fail.

How likely are you to invest in this technology, unless the payoff would be substantial enough that if it works, you would make a ton of money?

Said differently... how likely are you to lay your dollar down on a number on a roulette table if the payoff were only 10 cents for every dollar you gambled, instead of 25 dollars (or whatever it is)?

THIS is why you need to see substantial return to investment for healthcare investors. Because for every dollar they are hitting big on, they're losing shitloads elsewhere.

Without the huge payoff, why bother taking on the risk? There are plenty of less risky investment opportunities.

As for the insurance companies, it's really scary to me how few people understand how insurance works.

http://www.ehow.com/how-does_4564303_insurance-companies-money.html

Whether or not the insurance companies are too profitable is an argument that holds some merit... although it would really suck to get to a hospital somewhere to learn that your insurance company is bankrupt.

But how it is that people think they are going to be able to pay their monthly premiums for coverage, and then somehow, the insurance companies are going to be able to magically payout 10x that much for services rendered -- without understanding the economics behind it -- is beyond me.

I *do* think that we need to see some sort of reform to make sure everyone has a most basic level of coverage, sure.

But the unintended consequences in all of this will be that only the wealthiest will get the cutting edge stuff.

I'd bet money on it. ;)

I will say that I still think this might be what's best for the US as a whole.

But we should probably also realize that we are handing over our dominance of health care to some other part of the world in doing so.

I just wanted to say I am not sure it is fair that America bears the burden for the world for R&D. there are some excellent research facilities in European countries - Switzerland for example. And, a recent example near and dear to my heart - IVF was pioneered in the UK years ago - and there are techniques I had access to recently that are not yet approved in the US (and a such, as a 41 yo women with almost no ovarian reserve left I was pregnant the first try) - so lots of american women wanting babies suffering from infertility are piggybacking off European R&D...

Maybe this hits a nerve with me, I guess I am making a tangent to the point that some americans feel they carry the world burden for pretty much everything (don't get me started on world peace, LOL).

and this is a hypothetical question - i am just curious... do we "need" medical dominance? why not share some of the costs with at least some of our most sophisticated "allies"? why do we feel the need to dominate so much? why don't we piggyback more? to me if it is true and everyone else is piggybacking off our dominance plus they cover their people's costs and don't have all this surround sound crap that the US system has... what's so wrong with that? (you know i suck at debating - i am just curious as to why that would be bad?)

(oh, and another nerve - my IRL childhood BFF -the one with the pituitary brain tumour/cushings that was removed, died twice in the operating theater, 2.5 years of intensive treatment and now the tumour is growing back - her medicaid is over, she is destitute, no one will insure her - everyhting is "preexisting" - and she is shit outta luck. she needs a $40k surgery in the near future, can't get anyone to pay it so i am in talks with Bert to see if we can give her the money - so i think in many cases it is ALREADY the case that only the wealthy americans get access to the "cutting edge stuff"...)

>>I just wanted to say I am not sure it is fair that America bears the burden for the world for R&D. <<

According to Lizzy's figures, it's 63%. It's not 100%, but it's sure as shit not equal to the percentage of Earth's citizens that we comprise. And I think it's enough to warrant a chip on the shoulder. :dunno:

(Kiss reproductive coverage goodbye in a single payor system. That's politically a pretty damn easy one to take off the table, in the whole scheme of prioritizing life-saving versus life-enhancing...)

>> do we "need" medical dominance? <<

I don't think so, no. I think it's inevitable that the stage is about to be taken from the US, regardless of what we think. I think this is going to suck for a lot of people, though. A lot of people who favor something that they don't realize is going to hasten this exact phenomenon. But me, personally? I'm cool. And I thank God every single day for that.

>>so i think in many cases it is ALREADY the case that only the wealthy americans get access to the "cutting edge stuff"...<<

First, I am SO sorry to hear this about your friend. :( Really sorry. I'll be praying she catches the break she so desperately deserves.

And I agree with what you're saying, Megan -- I really do. My very honest concern is that the proposed solution makes this exact scenario worse. Some jerk who's never taken responsibility for himself gets basic coverage now, and your poor friend gets written off as a statistical lost cause. If someone can point me in the direction of one example where government involvement has made something more efficient, and not less (which is what has to happen for us to get better care for same money, no?), I'll reconsider my position. But I've never, EVER seen that.

mctex · Guru

muffy wrote:

mctex wrote:

>>What other country in the world comes up with the medical advances that we do? What's ridiculous is that we allow pharmaceutical companies to sell a drug here at an exorbitantly high price but to the rest of the world under a different brand name much more cheaply, because that's all their markets will bear.

Make those reforms, and kiss that cheap/good European healthcare goodbye! ;)<<

as said in my prior post, i somewhat disagree with your claim that only the US comes up with medical advances.

regarding drug costs - yes, i do currently benefit from lower drug costs - a combination of both lower prices from drug companies and gov't subsidy...

I still am a strong believer that what the drug companies are doing are WRONG in their treatment of americans regarding prices. it should not be this way -and if it means higher prices for the rest of the world, so be it. but personally, i dont see it as drastic as you portray - i dont think the world will fall apart because the US changes its medical system. maybe i am an econ flunkie...

i am not only looking out for myself where i am now. my kids are american - they probably will want to live there some day. heck, i might move back when i am really old and need lots of medical care (bert won't live there, so i need him gone first LOL). it hurts and frustrates me to see people like my parents and BFF suffer because of the current system.

it just has to change. do i agree with what is proposed - no. do i think it will work well - no. but it has to change because it cannot go on like this. (hhmmm.... wonder what mccain/palin would have done...)

but as liz pointed out - for being the world dominator, we are 37th. it just somehow does not add up...

>>as said in my prior post, i somewhat disagree with your claim that only the US comes up with medical advances.<<

I didn't say only, but I did say most. And as I calculated based on Lizzy's link, 63% of them. Which is certainly more than our fair share per capita. The data is what it is, you know?

>> but personally, i dont see it as drastic as you portray - i dont think the world will fall apart because the US changes its medical system. maybe i am an econ flunkie...<<

When did I say it would? If you mean that I think R&D will slow down if that 63% goes away... do we really need to argue that?

>> but as liz pointed out - for being the world dominator, we are 37th. it just somehow does not add up...<<

Like I said, I'm not going to get really hung up on that stat, because I don't understand the analysis on which it's based. However, I am curious about one thing... how do you think the US compares to the rest of the world in terms of maintaining a healthy lifestyle?

Lizzy · Guru

Tex....I am not following your logic that with health care reform, doctors (or anyone else for that matter) would work for free????

IN addition, why would health care reform neuter private research? or hinder publicly funded research? (I thought big pharma was on board with the curren health care reform).

Even taken to the extreme - a single payer system, I dont' follow the logic.

oh and you wanted a gov't run system that works - how about the military or medicare? I don't know anyone who would give up their military beneits or anyone willing to give up their medicare.

Juanita · Guru

Lizzy wrote:

Tex....I am not following your logic that with health care reform, doctors (or anyone else for that matter) would work for free????

IN addition, why would health care reform neuter private research? or hinder publicly funded research? (I thought big pharma was on board with the curren health care reform).

Even taken to the extreme - a single payer system, I dont' follow the logic.

oh and you wanted a gov't run system that works - how about the military or medicare? I don't know anyone who would give up their military beneits or anyone willing to give up their medicare.

I'm not Tex, but she didn't say she wanted one that works, she said show her one that made things more efficient, and if you talk to ANY case worker in ANY hospital in the country who has to deal with the medicare system every day, you'd have your answer to that.

mctex · Guru

Juanita wrote:

Lizzy wrote:

Tex....I am not following your logic that with health care reform, doctors (or anyone else for that matter) would work for free????

IN addition, why would health care reform neuter private research? or hinder publicly funded research? (I thought big pharma was on board with the curren health care reform).

Even taken to the extreme - a single payer system, I dont' follow the logic.

oh and you wanted a gov't run system that works - how about the military or medicare? I don't know anyone who would give up their military beneits or anyone willing to give up their medicare.

I'm not Tex, but she didn't say she wanted one that works, she said show her one that made things more efficient, and if you talk to ANY case worker in ANY hospital in the country who has to deal with the medicare system every day, you'd have your answer to that.

Indeed, that is what I said. You may speak for me any time. :)

>>.I am not following your logic that with health care reform, doctors (or anyone else for that matter) would work for free???? <<

This was hyperbole in response to your soapboxing about the need for compassion and motives other than the "profit motive". You were suggesting that we needed more compassion. I'm thinking we need a system that works that doesn't rely on provider self-sacrifice. I mean, yay for Barry Doogooder and his framed Hippocratic Oath in the link you provided. But healthcare providers have bills, too. And I'm not going to blame them for wanting to make a buck.

>>IN addition, why would health care reform neuter private research? or hinder publicly funded research? (I thought big pharma was on board with the curren health care reform). <<

You speak of reform as though it is a single-faceted and universally understood concept. If you could quote me as to what's confusing, I'd be happy to answer. But as it is, I think I've already exhausted my word quota for the day... LOL!

And as for the last point... I think Jennifer has that one covered.

muffy · Guru

mctex wrote:

Like I said, I'm not going to get really hung up on that stat, because I don't understand the analysis on which it's based. However, I am curious about one thing... how do you think the US compares to the rest of the world in terms of maintaining a healthy lifestyle?

I dont think it is a surprise - i think the US SUCKS at maintaining a healthy lifestyle. we probably are up there as the worst. for the reasons you already mentioned in a previous post.

the percentage of fast foods, pre-prepared foods, our sedentary lifestyle, our wasting of energy/natural resources, etc. etc. a lot of this is of our own doing - we are on a self destruction course in the US and a lot of people don;t see it.

as a pp said - we are a drug companies wet dream! i remember last season of biggest loser - each contestant is on an average 8 prescription drugs - each individual pays thousands even tens of thousands of dollars on drugs each year - oh yeah, ITA that those drug companies would rather us spend billions a year on prescription drugs than find cures for these illnesses.

crystal · Guru

muffy wrote:

mctex wrote:

Like I said, I'm not going to get really hung up on that stat, because I don't understand the analysis on which it's based. However, I am curious about one thing... how do you think the US compares to the rest of the world in terms of maintaining a healthy lifestyle?
I dont think it is a surprise - i think the US SUCKS at maintaining a healthy lifestyle. we probably are up there as the worst. for the reasons you already mentioned in a previous post.

the percentage of fast foods, pre-prepared foods, our sedentary lifestyle, our wasting of energy/natural resources, etc. etc. a lot of this is of our own doing - we are on a self destruction course in the US and a lot of people don;t see it.

as a pp said - we are a drug companies wet dream! i remember last season of biggest loser - each contestant is on an average 8 prescription drugs - each individual pays thousands even tens of thousands of dollars on drugs each year - oh yeah, ITA that those drug companies would rather us spend billions a year on prescription drugs than find cures for these illnesses.

Threadjack -

megan, i'm just curious what your perspective is on this since you've been living here for a while. why do they not have all the pre-prepared crap here that they have in the U.S.? is it because the people know that it is bad for them and they don't want it? or it is because it is made for americans and too expensive to get here? or what? the people here are very concious of being healthy, and i love that, but i wonder why it is like that here and how the US totally lost it. here, people make an effort to get outside and ride their bikes or go for long walks because it is good for them. my neighbors all have cars, but i only ever see them using them on the weekends, when i know it would be easier for them to use it all the time. they eat vegetables and seem to actually enjoy it, lol. what is up with that? do you think it is just because they were raised to do so more than americans, is it cultural pressure, or what?

i do think part of it is time. americans are all very rushed. both spouses often work full time. and, just as a culture, i think we feel like we always have to rush through things (i'm not sure if this even makes sense, lol), even when we have the extra time to take on something. cooking fresh foods can take a lot of time, but it is so easy to use the rice from a packet. riding your bike to the store takes 4 times as long, so we don't have time to do that (along with crappy infrastructure for bike riding) either. my neighbors say "Why would you drive to the store when you could just ride your bike?". they totally don't understand it. but, it is just more efficient to drive. this has obviously been driven into our heads?

-- Edited by crystal on Saturday 24th of October 2009 03:23:04 AM

muffy · Guru

crystal wrote:
muffy wrote:
mctex wrote:

Like I said, I'm not going to get really hung up on that stat, because I don't understand the analysis on which it's based. However, I am curious about one thing... how do you think the US compares to the rest of the world in terms of maintaining a healthy lifestyle?
I dont think it is a surprise - i think the US SUCKS at maintaining a healthy lifestyle. we probably are up there as the worst. for the reasons you already mentioned in a previous post.

the percentage of fast foods, pre-prepared foods, our sedentary lifestyle, our wasting of energy/natural resources, etc. etc. a lot of this is of our own doing - we are on a self destruction course in the US and a lot of people don;t see it.

as a pp said - we are a drug companies wet dream! i remember last season of biggest loser - each contestant is on an average 8 prescription drugs - each individual pays thousands even tens of thousands of dollars on drugs each year - oh yeah, ITA that those drug companies would rather us spend billions a year on prescription drugs than find cures for these illnesses.

Threadjack -

megan, i'm just curious what your perspective is on this since you've been living here for a while. why do they not have all the pre-prepared crap here that they have in the U.S.? is it because the people know that it is bad for them and they don't want it? or it is because it is made for americans and too expensive to get here? or what? the people here are very concious of being healthy, and i love that, but i wonder why it is like that here and how the US totally lost it. here, people make an effort to get outside and ride their bikes or go for long walks because it is good for them. my neighbors all have cars, but i only ever see them using them on the weekends, when i know it would be easier for them to use it all the time. they eat vegetables and seem to actually enjoy it, lol. what is up with that? do you think it is just because they were raised to do so more than americans, is it cultural pressure, or what?

i do think part of it is time. americans are all very rushed. both spouses often work full time. and, just as a culture, i think we feel like we always have to rush through things (i'm not sure if this even makes sense, lol), even when we have the extra time to take on something. cooking fresh foods can take a lot of time, but it is so easy to use the rice from a packet. riding your bike to the store takes 4 times as long, so we don't have time to do that (along with crappy infrastructure for bike riding) either. my neighbors say "Why would you drive to the store when you could just ride your bike?". they totally don't understand it. but, it is just more efficient to drive. this has obviously been driven into our heads?

-- Edited by crystal on Saturday 24th of October 2009 03:23:04 AM

I think it is a different lifestyle that is a different situation. ( gosh - this ended up being just a lot of verbal vomit about differences - sorry!)

Age - Europe is much older. They have the history/mentality to live close together in cities/villages with the farmland in the outskirts - they will walk/drive their tractor out to tend their land (quite the opposite from American farmers who have a lone solitary farmhouse in the midst of their personal land). This history of closeness and the fact that each village is self sufficient (stores, church, town hall etc.) led them to not need cars to drive places - they walk to get their food, go to the doctor etc. Lots more walking. And then there is an excellent public transport infrastructure - larger cities have busses/metro/trams. and between the big cities there are the trains - fast, direst and very punctual. even today, you see tons of people at the neighborhood bus stops... its a close lifestyle. no cars. did you know that for the first 5 years i personally lived in Luxembourg i DID NOT have a car? i only used public transport. Bert and I met - neither of us had a car for 18 months. Just before Timmy was born we caved in and got an old used car to drive. We just never needed one. America is opposite- everything is spread out. Cars are necessary to drive everywhere. Bad for the environment. Bad for our health. (bertrand ride his bicycle to/from work and town. all year round - even in snow - so cute to see him biking home from market on saturdays with clara on the back with a baguette in her arms and his front basket full of fresh produce...)

you comment - it is more efficient "in america" to drive everywhere - each store is all by itself with a huge parking lot in front. that is not the case in Europe - parking is scarce and far away. shops are in a crowded commercial area. over here is it mush more convenient to bike to these places. or have you seen all the pull trollys with wheels (kinda like a suitcase w/ wheels) that all the people take on the bus? you bus into town, shop and fill your bag while pulling it behind you, then take the bus home - easy!)

conservation of resources - going from this. yes gas is taxed a lot more here than the US - that's OK. people accept it as they have such good public transport. they also drive small fuel efficient cars. their houses have smaller closed rooms with radiators in each room to be turned off when the room is not in use. central air conditioning is rare, even in the most southern countries in Europe - they close the shutters and open the windows during the day to reduce the heat.

Work/Stress - well, many families here are two income as well. And, our work week is 40 hours compared to the is 36.25. and i was pulling easily 50-60 hour weeks at my job, along with most of my 1000+colleagues - so i dont think Europe is necessarily less stressed than America. But here we get into that "socialist" mentality... stores are open weekdays 10-6. and saturdays 10-6. some major supermarkets are open till 7pm. all commercial stores closed on sundays (but some gas stations have a mini market in them you can get food 6am to midnight in a pinch 7 days a week). so, it simply is not possible to be running around at odd hours stopping and doing stuff - people chill out in the evenings and weekends - eat dinner, have a drink, enjoy friends, watch their fave sports, go to museums, take walks.... would those reduced hours fly in the US. no. it's just different - and people here don't complain about it. (in fact, about 5 years ago a french major supermarket opened and they were open on sundays 12-6. they stopped after about 8 months because business was too slow - not enough interest.) while working i had to be well organised - i would typically do a quick grocery shop midweek during my lunch hour or as well run errands during that time, grabbing a quick sandwich along the way

food/tradition - perhaps if it was offered people would buy it more??? but i dont think so. not only is the cuisine here different (kinda hard to prepackage a lot of the traditional meals and make them still taste good) but also because eating is such a social thing here - breakfast -that is a cold meal. never hot carb and fat laden - croissants, jam, a slice of ham or cheese... european people tend to eat "one hot one cold" per day - often. the lunchhour is a social time to eat together in a restaurant, and if you eat hot at linch you have a simple sandwich or salad for dinner. and vice versa - if you are going out to dinner or having a family meal that night, you would have a baguette sandwich for lunch. i did see a lot of colleagues eating in our lunchroom - but they tend to be heating a tupperware full of yummy homemade leftovers from a prev meal rather than something pre-packaged. perhaps for you it is easier to microwave a bag of frozen precooked rice, because you are not as used to taking the 10 minutes to boil it up? i can see why your european counterparts thing it is a big strange - and sure i have become europeanised the past 20 years - i think it is CRAAAAZY and a huge waste of money that my parents eat about 90% of time something precooked/packaged from either trader joes or sams club. and yuk - it does NOT taste as good as a homecooked meal. i cook dinner each night for my parents when i visit - some dishes are recipes my mom used to cook for us as kids - and they LOVE it. but then they say they are too busy to do it themselves... i find that sad. (did you know that bert and i have never owned a microwave? do you think i am the last person in the civilised world not to own one? LOL)

there are a million other things i could mention - but the point is that each society developed differently. i guess the issue at hand with america is that these choices/preferences have lead to an unhealthy lifestyle for many.

oh - my mind just wandered to the asian societies which in many ways are a lot more stressed work wise than America is. they don't seem to have the obesity/health problems the US has. they do have a much healthier cuisine. they tend to take a lot more public transport and get more exercise... perhaps it is just all in all a "deadly" combination for America? i just can't see Americans changing how things are - i can;t see americans giving up any of the things they enjoy. take away their big suv and give them a bike? take away mcdonalds and give them miso soup and sushi? take away their huge house with the great room cathedral ceiling, central air, 3 car garage for a boxy european one with each room having a closed door and only one garage? i dont see that happening at all... but somehow amongst all of this many americans still need to get control of their lives. live within their means. eat healthy. conserve natural resources. prioritise to an acceptable stress level. (And take time to smell the flowers :) )

Lizzy · Guru

Re the Medicare analogy- as anecdotal evidence is subjective, I am not going to try to refute Jen’s claim that Medicare is not more “efficient”; however, according to studies- it does rate higher in patient satisfaction.
(which gets my vote ;)

Those comparisons show the depth of Medicare's popularity. According to a national CAHPS survey conducted by the Centers for Medicare and Medicaid Services in 2007, 56 percent of enrollees in traditional fee-for-service Medicare give their "health plan" a rating of 9 or 10 on a 0-10 scale. Similarly, 60 percent of seniors enrolled in Medicare Managed Care rated their plans a 9 or 10. But according tRo the CAHPS surveys compiled by HHS, only 40 percent of Americans enrolled in private health insurance gave their plans a 9 or 10 rating.

Lizzy · Guru

Intereting perspective (and imo, right on the money), Megan.

I do agree that it is hard to compare any country w/ america because we are so new and alot of our country was built and based upon the automobile.

This leads me to also wonder and worry about what is going to happen when we get older - if we are in the "suburbs" without a car - how tragic and limiting that will become. Old people need to be able to get around to remain healthy.

Megan....do you notice a difference between the american concept of how we deal with old age, ie nursing homes vs. the european? (I heard a public radio story one time how Italy did not even have nursing homes - they stayed in their own home but had caretakers (usually family).

muffy · Guru

Lizzy wrote:

Intereting perspective (and imo, right on the money), Megan.

I do agree that it is hard to compare any country w/ america because we are so new and alot of our country was built and based upon the automobile.

This leads me to also wonder and worry about what is going to happen when we get older - if we are in the "suburbs" without a car - how tragic and limiting that will become. Old people need to be able to get around to remain healthy.

Megan....do you notice a difference between the american concept of how we deal with old age, ie nursing homes vs. the european? (I heard a public radio story one time how Italy did not even have nursing homes - they stayed in their own home but had caretakers (usually family).

i can speak for Lux and france. in Lux, there is currently a shortage of old age homes - people argue it is because the young are "discarding" their elders and no longer taking care of them. of course there is the pot war baby boom to consider and that people are living longer...

in Lux, we have "hellef do heem"(help at home) - it is volunteer based, but organised by the nuns. they will come to the elders house a few times per day to help with personal hygiene, light housecleaning, and bringing meals. i also see that our neighborhood butcher does a special daily hot lunch for EUR 3.50. the meals look good - prepared fresh that morning put in a foil box - still warm. you can either have it delivered but i have also seen the hellef do heem people come in and pick up like a dozen, so they must use those to deliver. in our neighborhood, in fact right down our street, we have the church and on the other 3 corners are a bakery, the butchers and a small corner grocery store. at any given time you will see older people walking down the street, pulling their trolly, to pick up their food for the day. so those prepared fresh meals can be purchased by anyone who wants a quick fresh hot meal.

also, in the neighborhood, we have a dentist, a doctors, dry cleaning, flower shop, lawyer, a cafe/bar, bank, optician, and a few restaurants.

my lux BFF, claras godmom, just had her grandmother pass last year. for about 1.5 years, she was the primary caretaker in her grandma's home - she shared this with her brother. grandma had hellef do heem during the day, 3 times a day, but the evenings grandma needed someone there. my friend and her bro each took turns - 1 week each - to go over and spend the nights at grandma's to take care of her. it surely was stressful, being away from their partners, as well socially - lots of times she could not join us for get togethers because of this. but what you heard is right, thats most often how its done.

also in france - berts grandma's died about 2 years ago - prior to that my in laws took cars of them. the grandmas each lived in a tiny house in the vicinity. fil did the maintenance and drove the to doctors and hair/medical appointments and took care of their finances, mil did the hygiene and "lady stuff" housecleaning, laundry, cooking etc.

both of them had to go into a home at the end, but it was when my inlaws were no longer capable and they passed within months of going into the homes.

in america - in ohio, my grandparent live with my parents. my poppy died a year ago, he was 94 and hospitalised 4 months before he passed because he had a stroke. my grandma is still alive, at my moms home, hospice has visited a few times a week for the past 6 months, and recently my mom has finally had to arrange home care help- two lovely ladies who are there, only recently 24 hours a day as my nana is very much at the end and does not sleep at all during the night anymore... hopefully she will pass peacefully in my parents home in the not too distant future :)

Juanita · Guru

Megan, I'm just curious. Clara's godmother who shared caring for her mother with her brother, did either one of them have kids?

mctex · Guru

Lizzy wrote:

Re the Medicare analogy- as anecdotal evidence is subjective, I am not going to try to refute Jen’s claim that Medicare is not more “efficient”; however, according to studies- it does rate higher in patient satisfaction.
(which gets my vote ;)

Those comparisons show the depth of Medicare's popularity. According to a national CAHPS survey conducted by the Centers for Medicare and Medicaid Services in 2007, 56 percent of enrollees in traditional fee-for-service Medicare give their "health plan" a rating of 9 or 10 on a 0-10 scale. Similarly, 60 percent of seniors enrolled in Medicare Managed Care rated their plans a 9 or 10. But according tRo the CAHPS surveys compiled by HHS, only 40 percent of Americans enrolled in private health insurance gave their plans a 9 or 10 rating.

I think this whole Medicare discussion is a red herring.

What I'd asked for was an example where government intervention had led to gains in efficiency.

Still waiting. ;)

muffy · Guru

Juanita wrote:

Megan, I'm just curious. Clara's godmother who shared caring for her mother with her brother, did either one of them have kids?

my friend, her godmother, does not. but her brother does - he was recently married and has a young child (around 1?)

he did have a rougher time of it, and for holidays (xmas to new years) that year marie-paul stayed so he could be home. also, her DH sometimes spent the night too and helped with the house upkeeping.

but, let me clairfy - it was her grandmother - she is my age (early 40's) and her mother was not able to take care of her mother, thus my friend taking on the burden of her grandmother who was in her 80's. (bad family history - mom estranged from both mother and daughter so she was out of the picture)

i think the general idea is that people the age of my mom and my in-laws - those who are in their 50's and 60's whose children are grown up - that is the generation usually taking care of their elders, not the younger generation who is raising small kids. of course there is always the exception, such as in my friends case. just as there are exception when a grandparent needs to raise a small child, kwim?

Juanita · Guru

Lizzy wrote:

Re the Medicare analogy- as anecdotal evidence is subjective, I am not going to try to refute Jen’s claim that Medicare is not more “efficient”; however, according to studies- it does rate higher in patient satisfaction.
(which gets my vote ;)

Those comparisons show the depth of Medicare's popularity. According to a national CAHPS survey conducted by the Centers for Medicare and Medicaid Services in 2007, 56 percent of enrollees in traditional fee-for-service Medicare give their "health plan" a rating of 9 or 10 on a 0-10 scale. Similarly, 60 percent of seniors enrolled in Medicare Managed Care rated their plans a 9 or 10. But according tRo the CAHPS surveys compiled by HHS, only 40 percent of Americans enrolled in private health insurance gave their plans a 9 or 10 rating.

As a person who is very, very familiar with this whole "patient satisfaction" thing, I can assure you that while this all sounds great, it all depends on WHO you talk to when you conduct these surveys. For example, my hospital has been awarded the "Top 100 Hospitals" several years in a row, all because of patient satisfaction. They call people who 1) leave positive feedback on cards that they receive on admit to the hospital, 2) patients who leave positive feedback on a discharge sheet they recieve that has them rate their stay and 3) patients who send back a survey that they get after they go home on their stay at the hospital.

I know this because they've have all but said that's where they get their information from without fully admitting it and I know because I have filled out 6 surveys myself: 4 of which had positive feedback 2 did not and I've never heard a word out of the negative ones. I have heard from the positive.

So to say that these studies can be a little skewed is probably being generous.

Not saying Medicare is not a wonderful thing, it absolutely can be as can other government run things, but I don't think it's as efficient as it could be. I know for sure Medicaid isn't nor is Social Security, the post office, and most state run things.