Medical Reform- Why Doctors Are Worried

Juanita · Guru

RE: Medical Reform- Why Doctors Are Worried

mctex · 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.

I completely agree with you -- with all of this.

Which is why I'm not surprised by any statistic that would say that for dollars on healthcare spent, we suck. Crap in, crap out -- KWIM?

And my concern is that until these underlying societal issues are fixed, I'm not sure we can fix healthcare. The best way to shut down the impact of big pharma is to stop needing their meds.

My gym actually publishes a kick ass magazine, and a few months ago had an article about how they're starting to rethink cholesterol medication... that high cholesterol is merely a symptom of another underlying condition (like inflammation), and that medicating to lower it is equivalent to seeing your car's "check engine" light come on and hitting it with a sledgehammer. (The full article is here.)

It's complicated, that's for sure. I think the best strategy that we as Americans can adopt is to try our best not to need the healthcare system to begin with.

Lizzy · Guru

mctex wrote:

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. ;)

I honestly don't think that there is going to be a case where it is more efficient, per se. However, the US has never tried a single payer system so there is no way to gauge if it would be more efficient or not.

When I said it "works" - I meant it was doing what it was supposed to do and it was taking care of a need, namely healthcare for the elderly.

I don't think that the US can continue to subsidize healthcare for the sickest, ie. Medicaid and Medicare. A system that mixes private enterprise and gov't subsidy just doesn't work.

crystal · Guru

muffy wrote:

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 :) )

thanks for your perspective, megan. makes a lot of sense. maybe lux is different, but it is VERY common for women to work part-time here. since i'm home, i see all my neighbors home quite a lot. most of the women with small children work 2-3 days per week, and they told me that is very common once you have kids. as a local dutch employee, companies are apparently required to let you work 50% time for one full year for each child that you have. so, if you have 2 kids, you can go 2 years working 50% time. also, it seems like people just tell the companies that they are going to work part-time and the companies cannot do anything about it. one of the americans i know here says he keeps hiring "full-time" dutch employees. they come in for a couple weeks and then they tell him that they are only going to work 4 days per week, ect, and he can't do anything about it. i think with the dutch law, you can get away with a lot and not have to worry about losing your job. however, i have been looking for a part-time job, and seem to be out-of-luck. i thought that all the moms had this great schedule because the companies were flexible, but now i'm wondering if maybe it is because the companies don't have a choice. i'm not seeing much flexibility with the jobs i'm applying for (although, i guess it could be my industry too).

i used to get sooooo annoyed that nothing was open on sundays. but now, even though it still annoys me occasionally, i kind of enjoy being "forced" to relax and stay home with my family.

muffy · Guru

crystal wrote:
thanks for your perspective, megan. makes a lot of sense. maybe lux is different, but it is VERY common for women to work part-time here. since i'm home, i see all my neighbors home quite a lot. most of the women with small children work 2-3 days per week, and they told me that is very common once you have kids. as a local dutch employee, companies are apparently required to let you work 50% time for one full year for each child that you have. so, if you have 2 kids, you can go 2 years working 50% time. also, it seems like people just tell the companies that they are going to work part-time and the companies cannot do anything about it. one of the americans i know here says he keeps hiring "full-time" dutch employees. they come in for a couple weeks and then they tell him that they are only going to work 4 days per week, ect, and he can't do anything about it. i think with the dutch law, you can get away with a lot and not have to worry about losing your job. however, i have been looking for a part-time job, and seem to be out-of-luck. i thought that all the moms had this great schedule because the companies were flexible, but now i'm wondering if maybe it is because the companies don't have a choice. i'm not seeing much flexibility with the jobs i'm applying for (although, i guess it could be my industry too).

i used to get sooooo annoyed that nothing was open on sundays. but now, even though it still annoys me occasionally, i kind of enjoy being "forced" to relax and stay home with my family.

no, you won't just have the choice they do - that is all part of their "maternity leave" package.

the 2 years at 50% is mandatory for the employers to offer - its "parental leave" ...the reason the employers don't just offer it to you is that it comes with the maternity leave - you need to have another kid in holland :)

we have a similar law here in luxembourg - the woman is allowed 6 months fully paid maternity leave, and an additional optional parental leave - additional 6 months full leave or 50% time for 1 year. (this is not at full salary to all - there is a cap of i think EUR3,000 per month.)

on top of that, if a mother chooses, she can take a "leave of absence" - she can walk away from her job for 2 years and her position is guaranteed for her to come back to after that time. there is no compensation during this.

In lux, the maternity leave is obligatory, the 2 year unpaid leave of absence is optional for the mother, but she needs to take it at the same time of the maternity leave, just after the mat leave finishes - she can't go back to work and then after decide she wants to leave for this 2 year leave. the parental leave can be taken by either the father or the mother, its one of the other - it cannot be taken by both and it cannot be shared. this can be taken any time until the child is 5 years old - the parental leave needs to be completed by the childs 5th birthday.

these rules are "per child" if you have twins, the maternity leave and the parental leave is doubled. (but the "sabbatical" stays at 2 years) if is not uncommon for a woman to take mat leave, then parental leave, then come back pregnant and leave a month or 2 later to do it all again...

CoffeeQueen · Guru

Did anyone see this. I guess they say he was fired for this piece?

http://www.youtube.com/watch?v=q9GMKK_fWKg

I am interested in what Sonya thinks of this.

Sonya · Guru

I think that piece was remarkable slanted.

Canada by far does not have the perfect system. There are long waits, etc but he was very selective with what he showed.

The mom of quads who had to go to the US? The gov't paid to send her to the US because the hospital she was to deliver at had a unusually high number of babies already in the NICU and they didn't feel they could handle quads (the huge number of babies needing the NICU is a totally different debate).

I mean, I do all my own dental work because I really like super glue (lmao). Actually, in Canada, dentists are private so they don't fall under the medical system.

Anyway, all I am saying here is that this is a very slanted piece. I'm sure you could find way more people who had an excellent experience in the Canadian system and were extremely happy with the situation.

From my side of it, I have a cleft palate. All of my plastic surgeries were free to my parents, even the ones that were more cosmetic than necessary. My braces were free because of the palate and my dentistry was free until I was 21. I may have had to wait for surgeries (i'm not sure) but never for the medically necessary ones.

Sonya · Guru

Sonya wrote:

I think that piece was remarkable slanted.

Canada by far does not have the perfect system. There are long waits, etc but he was very selective with what he showed.

The mom of quads who had to go to the US? The gov't paid to send her to the US because the hospital she was to deliver at had a unusually high number of babies already in the NICU and they didn't feel they could handle quads (the huge number of babies needing the NICU is a totally different debate).

I mean, I do all my own dental work because I really like super glue (lmao). Actually, in Canada, dentists are private so they don't fall under the medical system.

Anyway, all I am saying here is that this is a very slanted piece. I'm sure you could find way more people who had an excellent experience in the Canadian system and were extremely happy with the situation.

From my side of it, I have a cleft palate. All of my plastic surgeries were free to my parents, even the ones that were more cosmetic than necessary. My braces were free because of the palate and my dentistry was free until I was 21. I may have had to wait for surgeries (i'm not sure) but never for the medically necessary ones.

wow, that was a long way of saying i think he was showing the exception rather than the norm.

lol

CoffeeQueen · Guru

Sonya wrote:

I think that piece was remarkable slanted.

Canada by far does not have the perfect system. There are long waits, etc but he was very selective with what he showed.

The mom of quads who had to go to the US? The gov't paid to send her to the US because the hospital she was to deliver at had a unusually high number of babies already in the NICU and they didn't feel they could handle quads (the huge number of babies needing the NICU is a totally different debate).

I mean, I do all my own dental work because I really like super glue (lmao). Actually, in Canada, dentists are private so they don't fall under the medical system.

Anyway, all I am saying here is that this is a very slanted piece. I'm sure you could find way more people who had an excellent experience in the Canadian system and were extremely happy with the situation.

From my side of it, I have a cleft palate. All of my plastic surgeries were free to my parents, even the ones that were more cosmetic than necessary. My braces were free because of the palate and my dentistry was free until I was 21. I may have had to wait for surgeries (i'm not sure) but never for the medically necessary ones.

I was hoping you would say that. My MIL claims this is what will happen to us.

I really thought that we were looking at the way the Swiss health care was structured. I think there is such false info on both sides floating around.

You crack me up with your dental. Dental here is so expensive and that is with insurance.

I was curious as to what others thought and you.

Sonya · Guru

I think you could do the same thing in the US - find the horror situations and use them as scare tactics.

I know there was a woman all over the US news from Canada saying how she had a brain tumour and she couldnt' get it treated and finally went to the US. It turns out it was never a brain tumour and it wasn't life threatening but it is all in the spin.

I try to stay out of the debate about what is best for your country. I just think that truthfully, most Canadians are basically happy with our system. There are definitely issues and I am not trying to push that under the table but I am not worried that my family will not have care when we need it.

As to wait times for family doctors (something else in the video), when we were in Boston, we had to go on a wait list to get a family dr. We were on for months before we ever got one assigned to us. Here, I got a doctor right away.

CoffeeQueen · Guru

Sonya wrote:

I think you could do the same thing in the US - find the horror situations and use them as scare tactics.

I know there was a woman all over the US news from Canada saying how she had a brain tumour and she couldnt' get it treated and finally went to the US. It turns out it was never a brain tumour and it wasn't life threatening but it is all in the spin.

I try to stay out of the debate about what is best for your country. I just think that truthfully, most Canadians are basically happy with our system. There are definitely issues and I am not trying to push that under the table but I am not worried that my family will not have care when we need it.

As to wait times for family doctors (something else in the video), when we were in Boston, we had to go on a wait list to get a family dr. We were on for months before we ever got one assigned to us. Here, I got a doctor right away.

Totally agree. I mean there can be tons of stories about the US health care. I mean that is why so many want it to change. That is what is so frustrating to me in terms of truth. It seems these days I can never get my hands on it.

I think like anything you can find good and bad.