I often can not tell in advance what will strike a chord and what will not.
The most comments ever was on It’s the oil, stupid! but most of it was just political bickering. That post also generated the most private hate mail as well.

But reading the responses to Healthcare Fiasco I found a startling number of sincere and unique looks at the US healthcare system. Many people do not read comments so I thought I would share some that stuck out in my mind.

Following are some public posts from my Blog followed by a two responses on the Motley FOOL, one of them my own personal experience …..

Mish:
I’m a physician. Here’s a little further info about the power of drug companies: they know exactly which medications I am prescribing, or not. The drug rep for company X knows exactly how many prescriptions for drug Y that I have written and what doses I have prescribed. One drug rep that drops by is fairly overt about it. When she asks me what I think of the medication she is pushing I ask “what does big brother there say?” (referring to her notepad computer).

I heard on NPR there was a bill in congress to prevent drug companies access to this information. I know no other specifics about the bill. I hope it passes.

Your two articles on medical tourism I think are great, and I think your points are spot on, and that US healthcare is overburdened with unreasonable fees for what we receive, and it can’t and shouldn’t last. Patients will often ask me about Canadian medications and medical tourism, and I suggest they investigate their sources carefully as for both drugs and services there is potentially a lot of fraud out there, but also that they can get perfectly good medications and reputable treatment this way.
SFMechanist | 08.21.06 – 12:01 pm | #
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Well I have lived in both Norway and Canada that have nationalized health care.

There is a correct statement that generally most people there have healthier life styles even though quite a few people smoke in Norway, amazingly enough. I don’t and when ever I traveled outside the country I had people lining up to brink smokes in duty free.

The new pharma bill was a joke. Pushed by the president and congress it added $8 trillion to the natiional debt. We need to really attack this problem.

Among other things roll back the pharma bill and put in place something that really works.

Also, we should allow nurse practitioners. Two third of doctor visits are for colds and flu that the nurse can handle. Why run up a bunch of costs for a cold.

Also, I would call up ole Vicente or who ever is the President down south and tell him we are going to start charging Mexico for services rendered in our hospitals to his citizens. Same for every other country. Our hospital system is clogged with illegal aliens.

Finally, as I posted other wise, the country really needs to start looking at some form of national health care. We already have it in some ways since a hospital can not turn away a sick person. Maybe add some fee on top of that for people who want premium services.
John | 08.21.06 – 12:10 pm | #
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The key is not the best drug or the shiny machine that goes “Bing” it’s free access to doctors. Cuba has few of the fancy gadgets are rarely has the newest drugs yet has one of the higher doctor to patient ratios in the world. A good ratio and free access allows good preventative practices which are always cheaper than fixing a major problem later. Lack of access to simple cheap/free neonatal care not only raises infant mortality in the States but over burdens hospitals with more underweight and premature babies. This is exasperated by the rich having access to fertility treatments which severely overburden NICUs with whole litters of premies. The life time cost of medical problems linked to low birth weights can be over 100gs each child.

Universal access gives people, dietary advice, anti smoking information, Birth control education for teens, anti drug intervention etc. All things which will raise life expectancy at a very affordable cost. Catching a disease early and treatable is usually cheaper than dealing with extreme measures later in treatment or not catching it until the patient is too sick to work and contribute to society which is a hidden cost of illness. All doctors will tell you a dollar of prevention will yield more results than a dollar of treatment.

Another thing – Ban the drug company lobby and direct to consumer advertisements for prescription drugs. Then force the companies to lower prices to compensate for the money no longer spent on these endeavors.

Of course, maybe people are just dying worrying about their ARMs resetting.
kubera | 08.21.06 – 12:20 pm | #
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I am convinced that I will probably have to commit suicide in my later years to spare my family from financial ruin should I ever succomb to a terminal illness. There isn’t really that much hospital can do or will do for you anyway by that stage other than to prolong the pain and cost. (I know of 2 young women, late 20’s to early 30’s, whom passed away from breast cancer recently. It’s so inhumane that we allowed these women to suffered as much as they have suffered because we have to let them die the “natural” way.) US need to legalize euthanasia and give me this choice if they can’t offer affordable health care in my old age.
David F. | 08.21.06 – 12:31 pm | #
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We spend twice as much in terms of GDP as Canada, and get worse service. There is no comparison between the US and the amount of money spent in other industrialized nations as a portion of their GDP. We are obviously getting screwed by a freight train. The whole “but the US pays for all the pharmaceutical research” is a crock as well since most pharmaceutical companies spend more on marketing (why do you need to spend a dime on marketing a “life-saving” drug?) than they do on R&D.;

The US healthcare system is in crisis, and will remain so as long as our system is run by a corrupt, greedy plutocracy.

Rant over.
Plymster | 08.21.06 – 12:34 pm | #
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Hello from Germany,

Tourism in healthcare is also picking up in Germany (for the self insured). they are going to eastern Europe mainly to treat their teeth.

http://www.immobilienblasen.blog…n.blogspot.com/
jmf | Homepage | 08.21.06 – 12:49 pm | #
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I will weigh in on the physician salary issue. As a physician I will let you know a little of what it took to get to where I am:
1) 4 years of college at which time I had to be in near the top of my class to make the cut into medical school
2) 4 years of medical school leaving me with about $200k in student loans
3) 6 years of residency training at which time, on a hourly basis, I was making less than minimum wage for the privilege of learning.

Now in my mid 30’s I am finally making a decent living where I can afford to buy a house, start a family, start making payments on my student loans ($1000 a month not tax deductible thank you), etc. And now I can have the pleasure of being visited by drug reps who , maybe, have a college education and at the ripe old age of 26 are making more than most primary care doctors.

Some little stats I found:
1) 31% of all health care dollars are spend on administrative costs (paper shuffling)
2) the only number I could find said 22% of all health care dollar goes to pay doctors salaries, of course the doctor also has to give a cut of that money to his or her own army of paper shufflers mainly to get the insurance companies to pay the bills, office overhead, malpractice insurance, etc. (FYI OB/Gyn’s pay an average of $100k a year for malpractice insurance)
3) 36% of all hospitals money goes to administrative costs (more paper shuffling)
Bill | 08.21.06 – 1:19 pm | #
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I came back from India after three week vacation.

In Bangalore, I for executive medical checkup done for myself and my wife.

Cost Rs 2000 or less than $50 each. It included all blood work, urine analysis, ECG, and abdominal sonography.

Doctor discovered some thing in my ECG and liver and order EEG and liver analysis too. Cost $20 and $13 respectively.

In Bangalore there are so many diagnostic centers and so well equipped, both in tools and people , that I have not seen such centers here in the US(I live in LA), except in the hospitals I guess.

The doctor I consulted with was a FRCS FRCP from UK , with 25 years of experience.

I know of a cousin who visits India every two years and get here vision and dental work done in the neighborhood facility.

Here my insurance does not even allow my doctor to prescribe these check ups with out a reason. Few years ago, I don’t remember the exact details, my doctor ordered some test and the results were negative and insurance refused to pay for the test as it was deemed unnecessary as indicated by the result!

WTF!
desidude | 08.21.06 – 3:04 pm | #
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People can yell, scream and protest, but the flow of demand to cheapest cost producers can’t be prevented. Welcome to Globalization ! Employers are being squeezed on Healthcare costs – this trend is only going to increase.

For $6500, the best hospitals in India will roll out the red carpet for you and you’ll be operated on by the best surgeons.

There’s another possibility that could very well unfold here. Hospitals like Apollo or Bumrungrad can open up centers in countries geographically near the US – Mexico, Costa Rica and the Caribbean, staff these hospitals with the best of doctors, nurses and facilities and still offer treatment options that are significantly cheaper than those in the US. This will cut down on travel to India or Thailand and break down potential barriers further.

Wonder how long it will take before that happens.
mohan srinivasan | 08.21.06 – 3:05 pm | #
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We all can agree that something is wrong with this system. I think its the profit incentive. The incentive is to make money in this system not to make people healthy. In most countries health care is a good that society primarily provides because it believes that having a healthy work force is good. In the US, the health care system is primarily a business to make money, any benefits derived from this business are secondary. I got a whiff of the sense in Mish’s post (correct me if I am wrong) that he thinks the market is the answer. It is not. We have a free market health system where all the big players ( Insurance and Pharmaceutical and Medical device industry) write the legislation. We need a single payor system similar to many other countries in the developed world. Medicare can work, if congress would let it. The republicans are destroying Medicare because they want to privatize health care thinking markets solve everything. It’s ideological and not based on evidence. In the case of the health care system, a free market insurance system makes things worse. The way insurers make money is not by competing with each other to provide better cheaper services, but by hiring hordes of “administrators” to pass the bill to you or another insurer and by refusing to cover services. They make money by refusing to cover care. That is where their incentive is. Just think how ridiculous the current system is. Medicaid (government) insures the poor and disabled (need lots of care), Medicare (government) insures the old who use lots of health care. The VA (government) insures the veterans (mostly poor or wounded) and guess who the market insures? Me and you, the young by and large healthy work force. We have socialized the losses and privatized the profits. You need a single payor where risk is spread across the entire population to keep premiums down, you also need sound negotiating by government to cover effective and cost effective services. Why should I (taxpayer) pay for a 2 dollar a day pill when a 5 cent per day pill is just as good? I do, because republicans won’t allow Medicare to negotiate drug prices or designate a reasonable formulary. We should cover drugs and devices that are effective and cheaper or the same price as the competition provides. But people think cost-effective is a four letter word. No, its sound fiscal policy. It will never happen because of the “pigs at the trough” (Insurance and pharmaceutical and medical device industry). They make tons of money from the fragmented health care system with deep pockets (brought to you by republicans–they have held the power for the past decade). Also because Americans are deluded into thinking that everything private is good. Those in power call the health system in Canada socialism in this country, that’s our propaganda. Canadians have free choice of doctors and hospital with one payor. The market doesn’t work in favor of the consumer in the US, it works in favor of the big deep pocket players. As for greedy doctors, I find that insulting. I have a lady who cleans my place for 2 hours once a month and she charges me 60 dollars an hour. If you assume a 40 hour work week, my pay is 55 dollars per hour. Also I work on average 60 hours per week, you do the math. Many physicians don’t make that much after you account for the 14 years of education and massive debt. You don’t start making a living till your 30 and then you have to pay off loans. In other countries medical school is free. By the way ( on a point that Mish raised), if everyone that can travel starts going to India for care, costs of care will rise because only the people that are too sick to travel stick around and that will cause a rise in premiums for everyone that doesn’t want to go to India for a persistent headache or sinusitis.
By the way, love your blog Mish, stopped me from buying a house.
Sam.
sam | 08.21.06 – 3:46 pm | #
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I went to Honduras and got 2 cavities filled 20$..they use this black light and i could see the cavities(why all the xrays in US?)..i hadn’t been in 5 years…teeth whitening in Buenos Aires 50$..with the moulds overnight whitening agents..

with US corruption why not believe many diseases are made up..and people don’t pay any attention to AIDS in brazil or little..

gary | 08.21.06 – 4:19 pm | #
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Hospital charges are completely outrageous in the US. I had an outpatient procedure done earlier this year at an HCA hospital in Denver. I was in the hospital for 5 hours, approximately 1 hour in the operating room. The hospital charge? $19,000.(yes, NINETEEN THOUSAND!)

Plus the surgeon ($1500) and the anesthesiologist ($1400). No wonder HCA got bought out in the biggest private buyout ever. We’re being raped in the US on healthcare.
DenverKen | 08.21.06 – 5:23 pm | #
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From “Entangled” on the Motley FOOL

Just because students come here from India to study medicine, does not mean the medical care is India is bad. Actually, the best doctors I have ever met have been in India. Most doctors there cannot run twenty expensive tests to diagnose a problem, so they are actually good at diagnosing just from symptoms and simple tests. The guys at Appolo hospital are comparable to some of the best places in the world: latest medical equipment from the US while having some of the most skilled doctors in the world. I can vouch for that because of my family’s medical experiences with them and we researched this in depth. From some other family medical issues that happened recently, it seems that if you are in the middle class in India, you can afford a private room in some of the best hospitals, immediate consultations with the leading specialists, etc.

Less than 10% of Indians are in or better than the Middle Class, so on average the healthcare available to Indians is pretty bad. But due to the purchasing power difference, an average person from the US can afford some of the most expensive medical care in India, which is better than the average here in the US.

Respectfully,
Entangled.

From Mish:

Here is a post of my own that I made earlier today on the Motley Fool.
I have been totally unimpressed with the doctors in my HMO. One was downright awful and refused to send to a specialist for a sore throat I had that would not go away for months. He kept upping and upping dosages of stuff and trying different antibiotics but the problem only got worse. I demanded to see a specialist after 2 months and he finally relented. The problem was not viral at all. It was acid reflux. I suggest that doctor was downright incompetent.

Doctors in HMOs get “demerits” for incurring costs and sending people to specialists. We have a sick system.

Mike Shedlock / Mish/