On Mon, 22 Feb 2010 03:28:49 -0500, "Ed Huntress"
wrote:
"F. George McDuffee" wrote in message
.. .
On Mon, 22 Feb 2010 01:34:46 -0500, "Ed Huntress"
wrote:
snip
You make sure it isn't unpaid. First, you try to reduce it with a
universal
system that, one hopes, will lead to more early detection.
As indicated in another post the US ALREADY has universal medical
care. If you show up at an emergency room, they must treat you
as a matter of law, without regard to citizenship, ability to
pay, or legal immigrant status. Unfortunately this is about the
most expensive system possible, as crisis management and heroic
medical care are then the norm. The less expensive and more
effective preventative measures such as immunization and prenatal
care are not covered for many people, and are thus avoided.
Right. But addressing the point to which you appear to be responding, what
we have is universal emergency and disaster treatment, not universal health
care. The point is to *avoid* invoking the emergency treatment for the
currently uninsured.
Exactly, as Grandma repeatedly told us "an ounce of prevention is
worth a pound of cure."
For example, once Gunner had his stents a few years back, he should have
been on a regular stress-test schedule that could have detected his
impending second heart attack. They may not have had to saw him open. Then
he may not have had a stroke.
Another question is what meds did they have him on? The correct
meds may well have prevented further problems, and a lifetime of
such drugs would be cheaper than the heroic hospital treatments
for a second heart attack and then stroke.
You'd have to ask him. I'm on a cocktail of five medications, after stents,
but I see a cardiologist every few months, too.
Same here, and I get to see her for at least five minutes every
three months...
The problem being
that the drugs are expensive, and are frequently skipped if you
have a marginal income. Another example of "penny wise and pound
foolish" by contemporary society.
Exactly.
This is all statistical/actuarial stuff. The numbers are out there, in the
professional medical literature.
snip
This is one of the major areas of weakness of the Obama health
care effort. (The other is completely ignoring the
history/experiences of the other OECD nations with their
universal health care programs. We appear to be determined to
make their mistakes all over again.)
I don't think so. There are hardly any practices from other countries that
have been copied to the ones proposed in the US. Do you know of another
system in which the primary payers are profit-making private insurance
companies, subsidized or not? Do you know of any that have no drug price
controls?
This is exactly the point, and why I included "history." Much of
the problem appears to originate from the lack of a definitive
problem statement, thus leading to "mission creep" and attempting
to again nail "jelly to a tree" Anytime you attempt to be all
things to all people, you wind up being nothing to anyone, and in
any event it is impossible to evaluate
progress/effeciency/effectiveness without quantifiable goals
(which may be the intent).
It appears that the accumulated medical data from the
governmental programs such as Medicaid, Medicare and the VA and
the private insurance data bases were *NEVER* used to create a
computer model of medical care costs and benefits. Thus, *ALL*
of the numbers being discussed are SWAG estimates.
Ah, George, medical data like that is available in excrutiating detail from
commercial sources. Medicare also has highly detailed actuarial data. That's
how insurers set their rates and how Medicare and Medicaid costs are
projected.
There are indeed tons of information. The problem is that little
of this is reduced to data, and the little data that is available
is not being used, other than in the most selective and
self-serving way.
One of the problems is that to effectively use such a model, you
must ask detailed and explicit questions, and to do this you must
understand the problem. Ask the wrong questions and you get the
wrong answers.
Given that there is finite pot of money available, it would seem
logical to structure coverage and policies so that the greatest
number of people and largest number of conditions will be
covered, but again there is no definitive problem statement to
this effect. Unfortunately, such a model (if honest) model will
produce answers you don't want or that are
politically/ideologically unacceptable when treatment of certain
conditions or groups are found to be not cost effective and thus
should be excluded or receive [much] lower funding/treatment
priority.
There is also the problem that after the model is created and
validated, the results will be ignored if they are not what "the
boss" wants to hear. This appears to have been what occurred
with the financial/derivative programs and computer simulations
at many of the banks and brokerages.
Here ya' go. Knock yourself out. There's lots more where this came from:
http://www.cms.hhs.gov/nationalhealt...sprojected.asp
By this time it should be possible to input changes such as
medical priorities, exclusions or $ caps for certain conditions
and population groups [e.g. illegals in or out? to see how the
total cost changes. What we getting are ever increasing amounts
of heat and smoke (as in blowing up the public's ***), but no
light.
It's been done for decades.
For medical insurance company profit optimization, with
qualifications such as pre-existing condition exclusion.
Now lets do it to maximize coverage, and lets get the results
into a format that the public can understand. Does anyone know
if either the OMB [Office of Manpower and Budget] or the CBO
[Congressional Budget Office] have [access] to such a model, and
how many "what if" alternatives have they evaluated?
http://www.whitehouse.gov/omb/
http://www.cbo.gov/
http://www.cbo.gov/publications/collections/health.cfm
196 page report
http://www.cbo.gov/ftpdocs/99xx/doc9...-KeyIssues.pdf
Such a computer model is a major undertaking, but very necessary
if we are to minimize the chances for unpleasant surprises as the
priorities and caps for conditions change and various
demographic/socio-economic groups are covered or excluded.
In one sense I am simply complaining about human nature where we
never learn from past mistakes, but continue to lurch, stagger
and reel from one debacle, catastrophe and fiasco to the next.
The Communists were widely ridiculed for making scientific and
medical decisions on the basis of ideology. This is no better,
and we should be taking a close look at what went so wrong in the
USSR before we go down that same road.
Unka George (George McDuffee)
...............................
The past is a foreign country;
they do things differently there.
L. P. Hartley (1895-1972), British author.
The Go-Between, Prologue (1953).