New Client Denied Health Coverage...

[Col Hogan]

So much hot air, Cat...yet you never lift the discussion....


How is that???

My intent is not to lift the discussion, Hoagie. It is simply to gore the Conk beast at every turn.

Yet you miss just about every try...

[Cap'n Cat]

My intent is not to lift the discussion, Hoagie. It is simply to gore the Conk beast at every turn.

Yet you miss just about every try...

That ain't what all the blood on the floor is sayin', Hoagie.

[Col Hogan]

Yet you miss just about every try...

That ain't what all the blood on the floor is sayin', Hoagie.

That's Democratic/donk blood you're looking at...better check for exit wounds...

[mebison]

Native, can you please explain why the US is the outlier on this graphic?

You should know that the US "dot" has moved right, and is closer to $8000 on the x-axis with no real change in the y.

A few things about this graph:

1) The trend is highly exaggerated by the y-scale used. Extend that properly so that it goes from 0 to 82 and that line looks a lot flatter.

2) Part of the reason the U.S. is so far on the right is because they are effectively subsidizing everyone to the left. There's no way anyone's getting $4 prescriptions in Cuba if the drug companies weren't making money hand-over-fist in the U.S. Heck, there's no way many advanced treatments, implants, etc even exist if companies didn't make enough money in the right-most countries to reinvest in the hugely expensive research and development it takes to bring a new product to market.

3) Everyone's comments about lifestyle are dead-on. If we don't try to stay healthy, its going to cost more to try to get healthy again.

4) Life expectancy can be skewed by infant mortality. I've heard before that decreases in infant mortality are actually responsible for most of the increase in life expectancy in the last few year. I'm not sure how that would effect this graph.

5) A better metric to use is the cost of the same procedure in different countries. Generally a spine surgery in Europe costs 1/3 what the same surgery in the US costs. That IS a problem, in my book.

[Cap'n Cat]

That ain't what all the blood on the floor is sayin', Hoagie.

That's Democratic/donk blood you're looking at...better check for exit wounds...

Um, I did. Definitely smells Conky to us.




Bomb shrapnel courtesy of General Dynamics.
Poison explosives courtesy of 3M.
Bandages courtesy of Johnson & Johnson.
Child sized body bag courtesy of Haliburton.
Blanket courtesy of the People's Republic of China.

[89Hen]

Looks like we just need to start bombing Japan again to get that life expectancy down. Iceland and Switzerland... bomb them too.

[Cap'n Cat]

Looks like we just need to start bombing Japan again to get that life expectancy down. Iceland and Switzerland... bomb them too.

Tell you what, Hen, why don't you shut up and get back to foreclosing on the same black families you shouldn't have approved in the first place? Do you get a kickback on the poor you shit on?

[89Hen]

Tell you what, Hen, why don't you shut up and get back to foreclosing on the same black families you shouldn't have approved in the first place? Do you get a kickback on the poor you shit on?

I don't need to foreclose, I have a couple of wops that do that for me.

[Cap'n Cat]

Tell you what, Hen, why don't you shut up and get back to foreclosing on the same black families you shouldn't have approved in the first place? Do you get a kickback on the poor you shit on?

I don't need to foreclose, I have a couple of wops that do that for me.

I was kidding in the first place.

[GrizFanStuckInUtah]

So much hot air, Cat...yet you never lift the discussion....


How is that???

My intent is not to lift the discussion, Hoagie. It is simply to gore the Conk beast at every turn.

It is an old tactic:

if you can't dazzle them with brilliance, baffle them with bullshit.

[00bluehen]

Right. We're a fatter, unhealthier society. I certainly am plenty knowledgable about that.

Let me rephrase my question (again, in terms of the graphical data): Why are we spending twice as much on healthcare than other nations to live less? We're spending more, but we're not seeing a positive result from that spending (in terms of longevity AND quality of care provided). One would assume most of those costs are for higher-end procedures (cardiac catheterizations, cardiothoracic/spinal surgery, hemodialysis) and end-of-life (i.e. cancer) treatments/imaging. WHY?

We're fatter and unhealthier, fine...but what the graph is showing is that we're spending an awful lot of money per person for things that do not improve longevity. So, WHY are we doing that?

I would also argue we're spending an awful lot of money per person on things (i.e. back surgery for disc herniations) for things that don't improve quality of life, too. Again, WHY?

[Wedgebuster]

Right. We're a fatter, unhealthier society. I certainly am plenty knowledgable about that.

Let me rephrase my question (again, in terms of the graphical data): Why are we spending twice as much on healthcare than other nations to live less? We're spending more, but we're not seeing a positive result from that spending (in terms of longevity AND quality of care provided). One would assume most of those costs are for higher-end procedures (cardiac catheterizations, cardiothoracic/spinal surgery, hemodialysis) and end-of-life (i.e. cancer) treatments/imaging. WHY?

We're fatter and unhealthier, fine...but what the graph is showing is that we're spending an awful lot of money per person for things that do not improve longevity. So, WHY are we doing that?

I would also argue we're spending an awful lot of money per person on things (i.e. back surgery for disc herniations) for things that don't improve quality of life, too. Again, WHY?

Because EVERYBODY is in it, and in it for money. Doctors, hospitals, insurance companies, and lawyers. That is why.

[AZGrizFan]

Right. We're a fatter, unhealthier society. I certainly am plenty knowledgable about that.

Let me rephrase my question (again, in terms of the graphical data): Why are we spending twice as much on healthcare than other nations to live less? We're spending more, but we're not seeing a positive result from that spending (in terms of longevity AND quality of care provided). One would assume most of those costs are for higher-end procedures (cardiac catheterizations, cardiothoracic/spinal surgery, hemodialysis) and end-of-life (i.e. cancer) treatments/imaging. WHY?

We're fatter and unhealthier, fine...but what the graph is showing is that we're spending an awful lot of money per person for things that do not improve longevity. So, WHY are we doing that?

I would also argue we're spending an awful lot of money per person on things (i.e. back surgery for disc herniations) for things that don't improve quality of life, too. Again, WHY?

If you don't think knee/hip replacements or back surgerys "improve quality of life", you're high. I know people who've had all three and couldn't WALK before, now lead active lives. Yeah, they're expensive, but in the vast majority of cases, they're worth it.

[89Hen]

Let me rephrase my question (again, in terms of the graphical data): Why are we spending twice as much on healthcare than other nations to live less? We're spending more, but we're not seeing a positive result from that spending (in terms of longevity AND quality of care provided).

Not true at all. The ONLY case the chart made and that you've been trying to make is that somehow the amount spent on health care must increase longevity to be effective. First off, that's simply NOT the case. Take my hip replacement question as an example of a VERY expensive procedure that DRASTICALLY increases quality of life for the recipient without changing their expected longevity one iota. Do you think many people in Somalia are getting hip replacements?

Secondly, you have no evidence that what we spend on healthcare doesn't actually result in an increase in life expectancy for Americans. Our obesity percentage is so damn high that without spending as much as we do, our life expectancy might be 5 years less than it is.

[00bluehen]

Right. We're a fatter, unhealthier society. I certainly am plenty knowledgable about that.

Let me rephrase my question (again, in terms of the graphical data): Why are we spending twice as much on healthcare than other nations to live less? We're spending more, but we're not seeing a positive result from that spending (in terms of longevity AND quality of care provided). One would assume most of those costs are for higher-end procedures (cardiac catheterizations, cardiothoracic/spinal surgery, hemodialysis) and end-of-life (i.e. cancer) treatments/imaging. WHY?

We're fatter and unhealthier, fine...but what the graph is showing is that we're spending an awful lot of money per person for things that do not improve longevity. So, WHY are we doing that?

I would also argue we're spending an awful lot of money per person on things (i.e. back surgery for disc herniations) for things that don't improve quality of life, too. Again, WHY?

If you don't think knee/hip replacements or back surgerys "improve quality of life", you're high. I know people who've had all three and couldn't WALK before, now lead active lives. Yeah, they're expensive, but in the vast majority of cases, they're worth it.

AZ, on an individual basis, you're absolutely right. In my defense, I never mentioned hip/knee replacements in this discussion.

I mentioned back surgery because there's plenty of data showing we're doing it in the wrong instances and with no overall effect more often than not. Rates of surgery are rising, despite only a small minority of back pain patients meeting the well-defined criteria for surgery. (Spine (Phila Pa 1976). 2006 Nov 1;31(23):2707-14.) That is not to say that there aren't instances where it's being done for the right reasons, in the right instances, with good outcomes, though. There are very clear, defined indications for these procedures, and when used correctly and depending on the type of surgery done, surgical intervention can have great benefit. For every person who can walk again because of back pain, I can give you 3 who curse their surgeons for ever doing a procedure. If you have data that shows that a "vast majority of cases are worth it" that counters my data, please let me know. Otherwise, I'd argue that the majority of cases are not done the right way, and have produced more harm than good...but the success stories help surgeons sleep better at night.

[Cap'n Cat]

Let me rephrase my question (again, in terms of the graphical data): Why are we spending twice as much on healthcare than other nations to live less? We're spending more, but we're not seeing a positive result from that spending (in terms of longevity AND quality of care provided).

Not true at all. The ONLY case the chart made and that you've been trying to make is that somehow the amount spent on health care must increase longevity to be effective. First off, that's simply NOT the case. Take my hip replacement question as an example of a VERY expensive procedure that DRASTICALLY increases quality of life for the recipient without changing their expected longevity one iota. Do you think many people in Somalia are getting hip replacements?

Secondly, you have no evidence that what we spend on healthcare doesn't actually result in an increase in life expectancy for Americans. Our obesity percentage is so damn high that without spending as much as we do, our life expectancy might be 5 years less than it is.

We're all making good points here, but allow The Cap'n to shed some light from another angle, please. CitadelGrad and I got into a very respectful, calm debate in one of his threads a couple weeks ago. Generally, he contends, rightfully so, that individuals make choices to stuff that other Big Mac in their pie hole and make us all pay for their irresponsibility when it comes to health care expenditures and it xcomes time for their emergency bypasses. Help me, Graddy, if I'm misquoting.

Cap'n Cat's extension and counter to that is, on the other hand, fast food companies and other food marketers jam those Big Macs and Pillsbury sugar cookies down our throats in their advertisements. Food pushing, modeled after tobacco, is as American as apple pie and corporate America bears some responsibility in this.

Somehow, we need to stop the vicious cycle of promote-eat-coronary-recover-promote-eat-coronary-recover.....but I have no faith it will happen, ever. We're too lazy as a nation and we're too sensitive to being pushed into shape.

Were are Rome and it's sunset over the Tiber.

[89Hen]

Cap'n Cat's extension and counter to that is, on the other hand, fast food companies and other food marketers jam those Big Macs and Pillsbury sugar cookies down our throats in their advertisements. Food pushing, modeled after tobacco, is as American as apple pie and corporate America bears some responsibility in this.

Somehow, we need to stop the vicious cycle of promote-eat-coronary-recover-promote-eat-coronary-recover.....but I have no faith it will happen, ever. We're too lazy as a nation and we're too sensitive to being pushed into shape.

Interesting. You're for legalizing pot, but making ads for food illegal.

[00bluehen]

Not true at all. The ONLY case the chart made and that you've been trying to make is that somehow the amount spent on health care must increase longevity to be effective. First off, that's simply NOT the case. Take my hip replacement question as an example of a VERY expensive procedure that DRASTICALLY increases quality of life for the recipient without changing their expected longevity one iota. Do you think many people in Somalia are getting hip replacements?

Again, as it relates to you, your procedure is a success. No doubt about it. For a one time procedure that costs roughly $40K, it was worth it. Contrast that with dialysis, which costs $43K per year (minus additional care such as EPO, phosphate binders) without altering quality of life (not many dialysis patients, if any, will tell you their lives are better because they get to sit in an HD unit for 4 hours a day 3 days a week) but increasing life expectancy. Hip replacement surgery is absolutely a 100% "worth-it" both in terms of overall functionality for "younger" adults AND in terms of mortality benefit for active elders. That said, you wanna come tell the demented 89-year-old I'm currently treating for a septic hip who was limited in her overall mobility prior to sustaining a hip fracture that a surgeon deemed "necessary to repair" that her quality of life was improved (while she's in the midst of 6 weeks of IV antibiotics after an ICU stay)? No one is arguing about Somalia here. Somalia isn't exactly construed as a "like" country in terms of overall wealth.

Secondly, you have no evidence that what we spend on healthcare doesn't actually result in an increase in life expectancy for Americans. Our obesity percentage is so damn high that without spending as much as we do, our life expectancy might be 5 years less than it is.

Healthcare spending as percent of GDP: http://blog.american.com/wp-content/upl ... ealth1.jpg" onclick="window.open(this.href);return false;
US Life Expectancy trend from birth: http://krusekronicle.typepad.com/kruse_ ... expect.gif" onclick="window.open(this.href);return false;
The GDP percentage curve increases yearly while the life expectancy curve is flattening out (even regressed in the period from 1992-1994 and 96-98!). The slope is now averaging an additional 3 months to US life expectancy per year, but that slope is on the decline.
Spending more with lessening returns.

[89Hen]

I mentioned back surgery because there's plenty of data showing we're doing it in the wrong instances and with no overall effect more often than not...

You actually made me think of another thing... does anyone know if that chart showing how much we spend on healthcare includes elective surgery?

[native]

Not true at all. The ONLY case the chart made and that you've been trying to make is that somehow the amount spent on health care must increase longevity to be effective. First off, that's simply NOT the case. Take my hip replacement question as an example of a VERY expensive procedure that DRASTICALLY increases quality of life for the recipient without changing their expected longevity one iota. Do you think many people in Somalia are getting hip replacements?

Secondly, you have no evidence that what we spend on healthcare doesn't actually result in an increase in life expectancy for Americans. Our obesity percentage is so damn high that without spending as much as we do, our life expectancy might be 5 years less than it is.

We're all making good points here, but allow The Cap'n to shed some light from another angle, please. CitadelGrad and I got into a very respectful, calm debate in one of his threads a couple weeks ago. Generally, he contends, rightfully so, that individuals make choices to stuff that other Big Mac in their pie hole and make us all pay for their irresponsibility when it comes to health care expenditures and it xcomes time for their emergency bypasses. Help me, Graddy, if I'm misquoting.

Cap'n Cat's extension and counter to that is, on the other hand, fast food companies and other food marketers jam those Big Macs and Pillsbury sugar cookies down our throats in their advertisements. Food pushing, modeled after tobacco, is as American as apple pie and corporate America bears some responsibility in this.

Somehow, we need to stop the vicious cycle of promote-eat-coronary-recover-promote-eat-coronary-recover.....but I have no faith it will happen, ever. We're too lazy as a nation and we're too sensitive to being pushed into shape.

Were are Rome and it's sunset over the Tiber.

Good point. If someone can afford to pay for the promote-eat-coronary-recover cycle out of their own money, good for them. They should be alowed to so so.

If not, they should adjust their own life styles.

[89Hen]

US Life Expectancy trend from birth:
The GDP percentage curve increases yearly while the life expectancy curve is flattening out (even regressed in the period from 1992-1994 and 96-98!). The slope is now averaging an additional 3 months to US life expectancy per year, but that slope is on the decline.
Spending more with lessening returns.

Ummm, I'm not sure at which chart you are looking. That looks like a pretty steady climb to me. Cherry picking a two year stretch in the 90's? Suspect at best.

[Cap'n Cat]

We're all making good points here, but allow The Cap'n to shed some light from another angle, please. CitadelGrad and I got into a very respectful, calm debate in one of his threads a couple weeks ago. Generally, he contends, rightfully so, that individuals make choices to stuff that other Big Mac in their pie hole and make us all pay for their irresponsibility when it comes to health care expenditures and it xcomes time for their emergency bypasses. Help me, Graddy, if I'm misquoting.

Cap'n Cat's extension and counter to that is, on the other hand, fast food companies and other food marketers jam those Big Macs and Pillsbury sugar cookies down our throats in their advertisements. Food pushing, modeled after tobacco, is as American as apple pie and corporate America bears some responsibility in this.

Somehow, we need to stop the vicious cycle of promote-eat-coronary-recover-promote-eat-coronary-recover.....but I have no faith it will happen, ever. We're too lazy as a nation and we're too sensitive to being pushed into shape.

Were are Rome and it's sunset over the Tiber.

Good point. If someone can afford to pay for the promote-eat-coronary-recover cycle out of their own money, good for them. They should be alowed to so so.

If not, they should adjust their own life styles.

Yeah, but it's hard, native. I know it firsthand. I hate being part of Fat America.

[00bluehen]

Ummm, I'm not sure at which chart you are looking. That looks like a pretty steady climb to me. Cherry picking a two year stretch in the 90's? Suspect at best.

I can assure you it's not just me doing the cherry-picking. The primary care community as a whole are noting this issues, as are leaders in both family/internal medicine who've been asked to explain to national media why costs are increasing.

I think Cap'n hits a very good point as well--but it's not just the fast-food advertising. Pharmaceutical industrial spending is off the charts, and the costs of medication are through the roof without a means to curtail it.

My personal belief is that physicians are ordering more tests, placing patients on needless medications at an alarmingly high rate because of the evolution of "C-Y-A Medicine." To me, Obama failed because his legislation didn't curtail litigation and lawsuits. Obviously, egregious errors need to be punished...but docs are getting sued at such a ridiculous rate, I was schooled by attendings who told me "You're not a good doctor unless you've been sued!" It's comical (and sad) that it's even EXPECTED anymore...but you still feel like ish when it's your name on the subpoena despite having performed standard practice and then some.

Oh, to the person who claimed that doctors stand to make a buck by ordering more tests...I can assure you I don't see a dime for doing so. As an added bonus, I invite you to take on my medical school loans for a year. While that may be entirely true of some professions, most doctors would tell you they'd take hitting the lottery in a heartbeat. Most physicians are comfortable, but nowhere near as wealthy as you'd think.

[native]

...
Let me rephrase my question (again, in terms of the graphical data): Why are we spending twice as much on healthcare than other nations to live less? We're spending more, but we're not seeing a positive result from that spending (in terms of longevity AND quality of care provided). One would assume most of those costs are for higher-end procedures (cardiac catheterizations, cardiothoracic/spinal surgery, hemodialysis) and end-of-life (i.e. cancer) treatments/imaging. WHY?

We're fatter and unhealthier, fine...but what the graph is showing is that we're spending an awful lot of money per person for things that do not improve longevity...

What is the source reference and the context for the graph, Hen?

[Ursus A. Horribilis]

Good point. If someone can afford to pay for the promote-eat-coronary-recover cycle out of their own money, good for them. They should be alowed to so so.

If not, they should adjust their own life styles.

Yeah, but it's hard, native. I know it firsthand. I hate being part of Fat America.

Cap'n, I'm in the same boat so don't take this as disingenuous but so fucking what if it's hard? It's completely YOUR choice to do what you do. Chew, drink, eat, whatever you want. The blame for any bad decisions goes to one individual and one individual alone. It doesn't go to, and nor should it to anybody else.

It's hard...fine...but who ever told you that it should be easy?.