I am still surprised by physicians who are in support of socialized healthcare. Why are there so many foreign physicians in this country? As both an MD and a person with chronic disease, I will never support the mediocritization of our health care system. Today the US boasts the most advanced treatment of many different diseases. Medications commonly used here are not covered by socialized plans in Canada and England. Perhaps its selfish to want to remain somewhere that I have a list of options and my treatment plan is devised based on efficacy, as opposed to cost-effectiveness. Ask someone from Canada or England what they think of their country's health care. I have a person from each country in my family and they both hate it. The Englishwoman's family purchases private insurance to enable them to see physicians in their country that can prescribe better treatments.

How is it that so many people in this country have digital cable or satellite television, Playstations, nice cars, plasma tvs, and all of the amenities but balk at the idea of investing in something like health care? Some people cannot afford it, and for them there is Medicaid. For the others, I firmly believe that they should be required to purchase emergency health insurance like they do liability insurance for their cars.

I'm interested to see others' thoughts.

I think our own health care system is becoming mediocre in its own way. There is definitely rationing here, though it is not done as openly as it is in other countries. Doctors are having to see more and more patients in a day to make up for declining pay. I think most people agree that there is a crisis here. The big question is what to do about it. :scratchchin: I think it is a very complex problem and there is no easy solution.

there is no doubt about the health care crisis. I also believe that too few people invest in their own health insurance. Many people have lots of nice things but balk at paying for something so necessary. For instance, my family of 3 lived on less than 30k/year (student loans) yet still manage to pay for health insurance for all of us. Granted it is high deductable with no maternity, but a decent policy. It is a change in lifestyle that so many are resistant to. I think there should always be a safety net and coverage for every child, but I also feel like premiums should be affordable and necessary things should be covered.

In the american system, many companies will not pay for certain meds, and others only in specific indications (despite what the doctor thinks) and that is wrong. There is rationing of care here too, to those who can afford it and denial of treatments for others.

out of time...will continue later...

I don't have insurance and my husband may never qualify for it since he suffered a TBI last summer and had many critical injuries. He is doing GREAT now..in fact you would never know if it wasn't for the scares or slightly less than normal appearance of his eyes. Our daughter qualifies for healthy families, which even has dental and vision.

I guess where I am going with this is I have had to pay out of pocket for doc appts. Luckily, the clinic I go to gives me huge discounts, but a simple little procedure will cost at least $150 if not more. I think this may be a reason why so many people are abusing the use of ER's. They don't have insurance and they know that ER's can't turn them away so they will sit in a waiting room for 8 hours to be told they have a cold when they already knew that but just wanted a prescription for something.

I am from Canada, and I will forever be grateful that I never have to worry about getting medical care.

We do have problems with our system - non critical care does require a wait time, however when my grandmother had a heart attack, the ambulance was there in 4 minutes, and she was in the hospital being treated by a cardiologist in less than 10 minutes. Never was there any question about which hospital, which level of care she received. She was told the procedure that she required, not based on the cost of the procedure or her ability to pay, but on the basis of what would be the best for her. She ended up with a triple bypass, which she received the next day.

My mother decided to have a hysterectomy. Our family has a history of ovarian cancer, and she decided to remove everything rather than worry about a time bomb. As a non critical case, she has to wait for it. The wait time is 40 days. For us, that is a completely acceptable wait time.

When in the US on holiday, I got a strep infection and had to go to a clinic. The cost of the doctors visit, and the prescription was over 700$ US. For a traveler to Canada, that cost would have been about 70$. 55$ is the standard clinic fee, and an antibiotic prescription about 15$.

I am not saying out system is perfect, but I know that everyone in our country will get a good standard of care. And if we don't like it, we can pay to go elsewhere. The hysterectomy in the US would have been about 40,000$ if we decided we couldn't wait the 6 weeks.

Well here in the United States, rationing occurs every day when insurers decide what treatments they will pay for. And there are wait times in the United States as well, because of scheduling issues or when demand exceeds supply of physician services. The only difference I see is that here, most medical care is paid for via third party payers who are largely unregulated and, being for profit, take a huge cut of what the patients pay for their medical care.

I have to agree with KPZR, the rationing is definitely happening here. It is still a have/have not thing and always will be. There are wait times and lack of access to care. And we don't have the best healthcare in the world-our per capita spending is ridiculously high, and our infant mortality rates still suck, and here in this 'great' country there are still kids who aren't getting immunized. I fully support a baseline health insurance which would give people access to a baseline level of care and emergency care. I think people should have to pay for health insurance, for a basic coverage, like auto insurance. Those who have more money would still be able to afford 'the best' but at least everyone would have access to care with some standard. Of course, we need more docs to have this happen. And we need less 'medicine with eye on the profit'. And it would probably still happen that if you had some rare illness you would be treated at the academic centers and have access to that, similar to what it is now. The problem is huge but needs to be dealt with, or things will just get worse.

HAM-I would also add that yes, we have advanced treatment of rare diseases-if you have a rare or complicated case, the US is the place to be...but having a baby, sned me to the other 26 countries that are higher on the list for infant mortality. So I don't think socialization would necessarily mean mediocritization-our social system just isn't set up to allow that to happen. You have to have baseline coverage though, or everyone will continue to use the ERs and it will continue to cost us a ton of money...

That statistic on infant mortality is not exactly correct. Some of these countries count certain premature babies who die as stillbirths, not as live births. Some of it also has to do with our advanced reproductive technologies, which make our multiple-birth rate higher, and with that comes prematurity. And then certain demographics of our country are associated with higher preterm births, such as teen pregnancies, drug use during pregnancy, poverty, etc. All these differences are not caused by the US healthcare system but are being used to denounce it. The differences have been reported upon for years, yet inexplicably the statistic is still accepted as valid.

Think about it: do you really believe that the Czech Republic (ranked 8th) is so much better at saving babies' lives than the US? Are we really as bad as Slovakia (we tied with them)? It really defies common sense.

http://health.usnews.com/usnews/health/articles/060924/2healy.htm
http://www.cdc.gov/nchs/data/hus/hus07.pdf#025

And regarding baseline coverage, if it pays so poorly that doctors won't accept it, then patients will still have problems with access and will still have to go to the ER. Isn't that the case in Massachusetts?

SAHMD-even when you account for preemies and multiple births and such, our infant mortality rates are still not where they should be. The insurance in MA for 'baseline' coverage is not paying poorly. The problem isn't that people don't accept the new insurance, it is that there aren't enough doctors (PCP's)to see all of these people who suddenly have insurance and want to be seen.

Docmomof3, do you happen to know where I can find the references about infant mortality rates, adjusted for all those factors? The only thing I've seen is in the article linked above, which said, "As Nicholas Eberstadt, a scholar at the American Enterprise Institute, points out, Norway, which has one of the lowest infant mortality rates, shows no better infant survival than the United States when you factor in weight at birth."

Re Massachusetts, the report below says that pay is one of the reasons for the physician shortage (see p 19 of the report), but it doesn't go into details about the actual plans:

http://www.massmed.org/Content/Navigatio...mmary_final.pdf

However, I did hear that that affordable plan is proposing to cap physician pay:

http://www.examiner.com/x-2823-Health-Care-Industry-Examiner~y2010m3d22-Massachusetts-Affordable-health-plan-analogy

It sounds like you are somewhat protected from these problems, hopefully by an enlightened employer who knows that retaining PCP's is important.

A couple of problems with the infant mortality statistics.

In many countries, a premature infant that doesn't survive can be characterized as a stillbirth or miscarriage...particularly in countries that don't practice the very aggressive preemie care that we practice here. Also, even higher income countries have more sporadic data collection practices which make evaluating these rates more difficult.

Pre-term births are rising in the US as well as other countries that do have problem-free access to prenatal care (ie Norway). According to the March of Dimes, this is due to: greater usage of assisted reproductive techniques which increase the rates of multiple gestations; a rise in the proportion of births to women over 35 years of age; and changes in clinical practice such as the early induction of labor or performance of Cesarean sections close to, but not at, full term.

https://www.marchofdimes.com/files/66423_MOD-Complete.pdf

Also, according to UPenn, 5 year survival rates for cancer are among the highest in the US...and our mortality rates above the age of 50 can be largely attributed to lifestyle choices and our higher murder rates... http://repository.upenn.edu/cgi/viewcontent.cgi?article=1012&context=psc_working_papers

I think every American has the right to access to health care and I don't know what the answer is...but I can tell you that many people I know want it all and want it for free. They think that other people should have to pay and that this is only fair. My 37 year old brother is a prime example. He earns 30kyear as a home inspector and his health insurance premium monthly is ~200$ through his employer (my dad). My brother absolutely refused to pay the money, so my dad simply signed him up and takes the money from his check monthly to cover it. My brother has complained bitterly about this. He has the money to go out and play pool at night, pay to play in big games of Texas Hold' Em and lose more than his insurance premium in a night if he's unlucky...oh..and he's a 2 pack a day smoker.

He recently bought a brand new truck...and...within the first week, opened the door to get in, banged himself on the head, knocked himself out cold and had to be taken to the hospital for stitches and monitoring for a head injury. Fortunately, he had health insurance. I pointed this out to him and asked what he would have done if he hadn't had health insurance. The answer "Not PAY! Why should I...those doctors are rich." End of story.

SAHMD-My mistake was in thinking the statistic in the 20's was the corrected statistic. Here is an article that attempts to correct for some of the discrepancies.

http://findarticles.com/p/articles/mi_m0795/is_n4_v13/ai_13359858/pg_15/?tag=content;col1

What is especially striking to me are the differences in outcomes within the US depending upon your socioeconomic status. I was on a very low birth weight task force in the city in MA that I used to practice in, and within the same medium sized city there were striking differences dependent on SE status and race. Obviously multifactorial, but still striking.

Re: MA docs not accepting the new insurance-I read the Physician Workforce report when it first came out. It is talking mostly about salaries, and physician shortages and job satisfaction, not about accepting the new insurances. It came out the same year we started universal coverage. One big mistake MA made was to mandate universal coverage without having adequate supplies of physicians in place to deal with the masses of people who suddenly wanted to see the doctor. There was also a huge upfront cost associated with this-imagine-you haven't had insurance for 15 plus years and all of a sudden you are forced to buy some-you obviously want to use it and have healthcare needs you want to have met, as well as things the doc may want for you, like cholesterol screening,pap smears, etc. Huge upfront costs which hopefully will pay off down the line if people end up being healthier b/c they had access to primary care. The trick is getting access for everyone.

I went to a Mass Med Society meeting last week where the president of the society presented on the new national health reform bill, and some MA stats about healthcare expenses that they have been collecting since we instituted health reform. It was interesting....it looked from one of his graphs that we are starting to catch up with the costs that we had at first-the system may be financially solvent by like 2015 or something, according to him-I can't find his presentation on the website or I would be more specific on that but I remember the graph b/c it went against what I have been told about how much money this is costing the state..

In terms of people not accepting the new insurance plans, I can only report what I see from personal experience as a primary care doctor. I was in practice pre and post universal coverage. I work mostly with the uninsured and underinsured. Prior to health reform, we had a system for the uninsured called 'freecare'. It was basically a Peter Pan thing where hospitals and I believe other healthcare organizations in areas that didn't have a lot of uninsured had to put money into a 'pool' that could be accessed by those hospitals and agencies that did have to serve the uninsured. If you had freecare, you could get emergency services and certain primary care things covered if you were seen at a community health center, or an academic center in the 'clinic', for example. Most specialists didn't accept freecare. If you needed specialist care you had to go to an academic center, or I as the PCP had to beg specialist colleagues to see my patients gratis or for very little reimbursement. It was very difficult as a PCP to get care for patients, especially when you added in language and education barriers as well as transportation issues.

Now, with universal coverage, everyone has insurance that is accepted by someone. It is so much easier to refer out if I have to. There may be a wait, but at least they can get an appointment. Personally I think the group that has benefited(sp?) the most are the self employed working class/working poor. They now have health coverage, many for the first time in years. I think people should be mandated to have some sort of health insurance, for the reasons mommd2b lists in her post above about her brother-even if you are relatively young and healthy, you never know when something will happen to you, and I believe you should have to pay into the system that is going to take care of you. By having our ER's not be able to turn patients away, we are basically saying that everyone has the right to healthcare. By mandating health insurance, we are making everyone have to pay for it, at least in some way.

Docmomof3, thank you for the excellent article. I stayed up late reading the whole thing. I agree with you about the socioeconomic factors, which can affect infant mortality (and health in general) in so many ways.

As for correcting for the factors, it seems that individual studies have been done to correct for one factor at a time, but not for all the factors at once. Our infant mortality rate improved significantly when controlling for reported distribution of birth weights. The simulation reported in the article said that birth-weight distribution accounted for 75% of the difference between the infant mortality rates of the U.S. and Japan. It would have been nice to know how much of the birth-weight distribution was due to low-birth-weight babies being counted as "stillbirths" in Japan and "live births" in the U.S., although they touched on that in a different section.

The section about our much higher rate of teenage pregnancies showed how that was an important factor as well, for many reasons, although it was not as important as birth-weight distribution.

Thanks for the information about MA. It will be interesting to see if your state is really catching up financially or not. A lot can change between now and 2015, as people learn how to game the system and as the system adjusts in return.

Also from the article:

"Notably, in the birth weight categories under 2,500 grams, the U.S. [perinatal death] rates were actually lower than those of the two other countries [Norway and Japan]."

Our healthcare system is very good at saving premature babies. I would not want to have a baby anywhere else in the world.