U.S. Hospitals - too expensive?

[mongers]

Nowadays you're really not trying hard enough to entertain me.

Maybe the purpose of people in the world isn't just to entertain you?

One thread of yours I fondly remember, was the one about the woman who was having problems with her husband or whatever, and you were providing a shoulder to cry on/hoping to see here; man did I laugh my ass off, at your pathetic display over that.

It is kind of sad to see what delusions you come up with when you are off your meds.  The only one you embarrass with these kinds of stories about supposedly "pathetic" behavior of others in some vague thread (that is lost to time anyway) is you.

I was being charitable, assuming you were trying to amuse, rather than you just being a cunt.

I think I'm happy to leave it up to the court of opinion on Languish as to whom is acting pathetically on the forum; me just posting an opinion/feeling in a normal thread or you're quasi-stalking behaviour following posters around from thread to thread taking pot-shots at them.

[grumbler]

Mongers just wistfully pines for a time when there was a kindler, gentler grumbler.

Look at the comment he got his panties in a twist over.  It was about as innocuous a twig as one could find on the internet.

I mean, really; posting a long, rambling attempt at an insult that involves making shit up and invoking dead threads just because someone implied you might be a bum?  That's evidence of a knickertwist that has cut off the oxygen supply to the brain.

[grumbler]

I was being charitable, assuming you were trying to amuse, rather than you just being a cunt.

See what I mean, Seedy?  I merely imply in a humorous way that he is a bum, and he outright calls me a "cunt" for it.  No over-reaction here! 

I think I'm happy to leave it up to the court of opinion on Languish as to whom is acting pathetically on the forum; me just posting an opinion/feeling in a normal thread or you're quasi-stalking behaviour following posters around from thread to thread taking pot-shots at them.

Oh, I think it is clear to everyone who it is that is doing the stalking and the pathetic over-reactions! 

[mongers]

Mongers just wistfully pines for a time when there was a kindler, gentler grumbler.

Look at the comment he got his panties in a twist over.  It was about as innocuous a twig as one could find on the internet.

I mean, really; posting a long, rambling attempt at an insult that involves making shit up and invoking dead threads just because someone implied you might be a bum?  That's evidence of a knickertwist that has cut off the oxygen supply to the brain.

Let's just see whose supply of oxygen to the brain gives out first; I feel for you, tirelessly giving up you're last few years on earth to post snide comments on internet fora. 

You'll be missed. 

[garbon]

you're quasi-stalking behaviour following posters around from thread to thread taking pot-shots at them.

Awesome! It has been a while since we got a good stalker accusation.

[grumbler]

Let's just see whose supply of oxygen to the brain gives out first; I feel for you, tirelessly giving up you're last few years on earth to post snide comments on internet fora. 

You'll be missed.   

I'm not going to respond to this, I just wanted to preserve it in all its inarticulate glory.

[Capetan Mihali]

Mongers just wistfully pines for a time when there was a kindler, gentler grumbler.

I remember the thread Mongers is talking about.    Days long gone by... 

[The Minsky Moment]

This should be resolved by duel.  Mongers in his penny-farthing vs. grumbler in his scythed chariot.

[Eddie Teach]

Stalking accusations are ridiculous on a forum this small.

[Admiral Yi]

Stalking accusations are ridiculous on a forum this small.

Walk a mile in my shoes.

[crazy canuck]

We really need an NHS. It's too late for anything else; Just nationalize everything.

You don't have to nationalize "everything".  The Canadian model, for example, still has privately run hospitals and clinics.  It's just that there is only one insurer - the national government.

How do you deal with perverse incentives?

Poorly.

That is simply false.  The main problem with the American model is that it has no cost discipline.  There are significant advantages to our system which do remove the kinds of perverse incentives built into the US system.  For example the fact that provincial governments negotiate directly with drug companies to establish the price at which the provinces will pay for medications dramatically reduces the cost.  Hospitals also obtain their medical supplies through the same kind of system which further reduces cost - (ie no one is paying 500 bucks per stitch). That kind of negotiating power would rarely if ever exist in the American model.  Also, the fact that doctors are paid a set tariff fee, depending on their specialty and what they are billing for, controls costs.

The troubles are that the government then sets (or negotiates) the pay rates for a whole variety of procedures.  Doctors are paid per procedure, not for time worked.  As such they have incentive to pack in as many patients in a day as possible.  As well there are few disincentives to not order a whole battery of tests or procedures.

The rates are reviewed regularly (at least here in BC) by the College of Physicians and Surgeons and the Province to ensure the rates reflect the time required for a given procedure.  It would very unlikely a doctor could "pack as many patients in a day as possible" without extending the day....

Regarding your allegation that there are few disincentives to order "a whole battery of tests or procedures" you need to look at what incentive there is to do so.  In the US the main driver of this problem is malpractice litigation.  Because of that risk doctors err on the side of caution to protect themselves in case someone makes an allegation that xyz test ought to have been ordered.  Here in Canada that ligitation risk exists but to a much lesser extent given how our malpractice law has developed.  Also, in Canada the doctor has no profit motive for ordering additional tests.  Doctors in the US may have such a motive (or at lest the hospitals they might work within).

Before you make these kinds of accusations you might want to look at what the College of Physicians and Surgeons is doing proactively to help educate doctors to ensure tests are limited to only those that are necessary.  While it is true that all systems can be improved, your allegation that Canadian sytem creates an incentive for doctors to order whole batteries of tests and procedures that are unncessary is questionable at best.

The government also sets out what procedures will, and will not, be covered (and this is what gets called Death Panels in the US).  But politicians of course are susceptible to political pressure, and it is tough to de-list a procedure even if it's effectiveness is questionable.

I am not sure what not covering optional medical procedures has to do with the US death panels.  I dont think tax payors should have to pay for some vain old person who wants a face lift. 

Regarding your allegation that it is tough to de-list a procedure, if you do a quick google search you will see that the pressure is on the other side - the criticism generally is that procedures and drugs are being de-listed even though it is alleged they might be medically necessary.   

[crazy canuck]

Stalking accusations are ridiculous on a forum this small.

Walk a mile in my shoes.

Stop stalking me

[mongers]

Let's just see whose supply of oxygen to the brain gives out first; I feel for you, tirelessly giving up you're last few years on earth to post snide comments on internet fora. 

You'll be missed.   

I'm not going to respond to this, I just wanted to preserve it in all its inarticulate glory.

But you did. Classic Grumbler attacking a post because it has a couple of typos, rather than the substance of the post; OMG I typed whose instead of who's and you're in place of your. :gasp:

[mongers]

This should be resolved by duel.  Mongers in his penny-farthing vs. grumbler in his scythed chariot.

JR, that's grossly unfair. 

There's no way I'm attacking someone infirm of mind or spirit.

[grumbler]

We really need an NHS. It's too late for anything else; Just nationalize everything.

You don't have to nationalize "everything".  The Canadian model, for example, still has privately run hospitals and clinics.  It's just that there is only one insurer - the national government.

How do you deal with perverse incentives?

Poorly.

That is simply false.  (snip) 

I think that you are correct to note that a failure to completely eliminate perverse incentives is not the same as dealing poorly with them.  The same rules and procedures that yield a positive outcome in 90% of cases can still lead to perverse outcomes in some or all of the remaining 10%, and still be acceptable.

I believe that perverse incentives is a problem to be controlled as far as possible but that it is a problem that, like the problem of false positives, cannot be eliminated without eliminating the good in the system as well.