Cuban healthcare

by Finn

With the death of Fidel Castro, the healthcare system in Cuba has received some attention.

How Cubans Live as Long as Americans at a Tenth of the Cost

What parts of the Cuban healthcare system do you think could be adopted here?

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U.S. healthcare

by MooshiMooshi

Along with all of today’s articles on the issues with increasing plan costs under Obamacare, came this article.

Why the U.S. Still Trails Many Wealthy Nations in Access to Care

Despite our stereotype that other countries with more socialized forms of medicine are morasses of long waiting periods and lack of access, it turns out that we are worse on those measures than many other countries. And we pay more to boot.

While Obamacare may not be the most perfect system out there (my own opinion is that if they put real teeth into the penalties, they would fix the rising plan costs in a hurry, but I digress), it is clear that our healthcare system is a mess and it was a mess before Obamacare, and that we need to be moving towards the models used in other industrialized countries (which doesn’t have to be single payer, by the way).

I have one pet theory: I think Americans value healthcare less, at least while they are healthy. Perhaps that is why healthy Germans, Swiss, and Canadians will pay more taxes or pay for their mandated plans, while healthy Americans simply won’t. That of course is what leads to the dreaded death spiral – if healthy people don’t participate in the system, only sick people are left, driving up costs. It seems like other industrialized nations have figured out how to get everyone into the system, but we haven’t.

Opinions?

The Administrative Burden of Getting Healthcare

by Honolulu Mother

In this Vox article, Sarah Kliff describes the process of coordinating her health care for a minor medical issue as “a part-time job where the pay is lousy, the hours inconvenient, and the stakes incredibly high.” She writes that

But American medicine demands another scarce resource from patients, and that is their time. The time it takes to check in on the status of a prescription, to wait for a doctor, to take time away from work to sit on hold and hope that, at some point, someone will pick up the phone.

I found dealing with the copious administrivia stemming from my daughter’s broken limb last year to be frustratingly time-consuming, and I wasn’t even dealing with the lion’s share of it. The billing disconnects between providers and insurer, the denial based on my husband’s name having been accidentally entered in the patient slot for one provider, the confusion as to whether some new piece of mail was an issue to be attended to or just another routine notification; it seemed that once we left the safe and familiar harbor of routine annual appointments we were at sea without a compass.

How have your experiences as a patient or patient’s family member been? Do you think the burden of administrative health care management falls on patients because practitioners aren’t aware the burden is there, or do you think it’s a more deliberate outsourcing as suggested by the following quote?

“Patients can often become the health care system’s free labor,” Mayo’s Montori says. “The health care system knows that patients are motivated, that they want to get better. So it gains efficiencies by transferring the work.”

High deductible plans = fewer, not cheaper medical expenditures

by Mémé

A widely reported study last fall, summarized below in a Vox article, found that high deductible plans do not lead to cost shopping, but to lower utilization of medical services.

This study is forcing economists to rethink high-deductible health insurance

The researchers had a particularly fortunate natural testing pool. A corporation changed from a Cadillac plan to a high deductible plan, and deposited 3750, the amount of the deductible, into a Health Savings account for each employee. Economically, the fact that a formerly fully covered service would have a visible cost should have had no effect on behavior. (The article does not state whether the company provided a medical credit card that would draw from the HSA account – I suspect that cash outlay was required followed by reimbursement.) However, people reduced costs by simply not going to the doctor at all, even those with chronic conditions who would easily blow through the deductible quickly and re-enter the fully covered stage early in the year.

I personally noted a change in my behavior – when I have to pony up the “full” health plan reduced cost (I never reach the deductible) for something, I don’t bother to consult the doctor and just use Dr Google and non-prescription remedies. I can certainly afford it – I have a self-funded HSA with a Visa attached. But it just seems wasteful to spend 150 just to be told to put liniment on an aching joint. I used to go to the company nurse for minor complaints when it was free or to the HMO when it was just a small co pay. Last fall I could not shake a cold/bronchitis so I spent the money and went twice. (She finally suggested a Neti Pot. One look at it and the how to video and I was “healed.”) In Sept I start with Medicare advantage and I assume my behavior will change back to my old habits.

For those of you with high deductible plans, do you comparison shop or forgo non-emergency visits? For those who don’t have high deductible plans, is that a conscious choice because of actual usage, or perhaps because of the psychological issue described above?

Cancer

by WCE

I was fascinated by two aspects of this article on cancer — the lay description of how cancer cells work, and the frustration with how outdated laws inhibit cancer research.

Death of cancer

Here’s an excerpt of the biology part:

Humans derive their energy from two forms of metabolism: oxidative phosphorylation and glycolysis. Oxidative phosphorylation, the most efficient form of metabolism, takes place in the presence of oxygen carried by red blood cells in the bloodstream (that’s what ‘oxidative’ means). It results in the complete metabolism of nutrients to glucose; that glucose is then converted into water and carbon dioxide, which are easily excreted by the lungs and kidneys.

On the other hand, humans generally derive energy from less-efficient glycolysis only when oxygen is in short supply. Glycolysis is the metabolic system tapped by the muscles of long-distance runners, for example, after oxygen has been spent.

Very rarely, however, glycolysis can take place when oxygen is present. One of those rare instances includes the circumstance of the cancer cell, which prefers glycolysis, as inefficient as it is, because it burns glucose only incompletely, leaving parts of molecules behind that can be used to synthesise DNA and other large molecules that rapidly dividing cells need. The cancer cell, like the embryo, retains the ability to switch back and forth between the two forms of metabolism, depending on a cell’s needs at the time.

The political aspect of this article is how outdated laws — on overtime, the environment, and cancer research, among others — are very difficult to fix. What do you think of “sunset provisions” for laws, where a law either has to be re-approved after a period of time, re-approved with changes or lapse? Would this result in legal chaos? I know we have enough lawyers that I’ll get an informed opinion.

Telemedicine — Yay Or Nay?

by Grace aka costofcollege

Telemedicine may be the wave of the future for many types of health care.

The same forces that have made instant messaging and video calls part of daily life for many Americans are now shaking up basic medical care. Health systems and insurers are rushing to offer video consultations for routine ailments, convinced they will save money and relieve pressure on overextended primary care systems in cities and rural areas alike. And more people like Ms. DeVisser, fluent in Skype and FaceTime and eager for cheaper, more convenient medical care, are trying them out….

But telemedicine is facing pushback from some more traditional corners of the medical world. Medicare, which often sets the precedent for other insurers, strictly limits reimbursement for telemedicine services out of concern that expanding coverage would increase, not reduce, costs. Some doctors assert that hands-on exams are more effective and warn that the potential for misdiagnoses via video is great.

Legislatures and medical boards in some states are listening carefully to such criticisms, and a few, led by Texas, are trying to slow the rapid growth of virtual medicine. But many more states are embracing the new world of virtual house calls, largely by updating rules to allow doctor-patient relationships to be established and medications to be prescribed via video. Health systems, facing stiff competition from urgent care centers, retail clinics and start-up companies that offer video consultations through apps for smartphones and tablets, are increasingly offering the service as well.

My new doctor has a terrific email system that allows us to conveniently discuss health issues.  I know a person who is very happy with her Skype psychotherapy sessions.  The possibilities are intriguing.

What’s your experience with telemedicine?  Do you welcome the convenience, or fear that it will lead to many errors and lower quality healthcare?