Jay, I have had to adjust my incredibly low opinion of Michael Moore since seeing a recent interview (I think on Leno) regarding "Sicko", his latest movie. He investigated healthcare around the world and mentioned that in England, the doctors are paid based on how much healthier their patients are - I need time to look into this for its accuracy, but it seemed like a sound idea when I heard it. (My second thought was 'if I'm dying, will my British doc drop me like a bad habit to avoid ruining his quota?)

He also mentioned taking a boatload of sick Americans to a Cuban ER, where they received top notch treatment. Furthermore, he told a story of a TV special where he was seeking a winner to the country with the best healthcare. Cuba won, but the network (NBC?) said "Cuba can't win" and made Canada the winner. Is it possible that a communist backwater nation is providing better healthcare to its citizens that we are getting? I'll be PISSED if it's true!

Has anyone seen or investigated the truths in "Sicko"?

I agree that the government can't take over our healthcare system. They can screw up a two-car funeral (if DHHS in Maine is any indication of their skill level).

I usually simplify healthcare reform. Everybody wants three things in health care. Fast, Cheap, and Good. The problem is, you can have any two of those three, but not all three. If its Fast and Good, it isn't cheap, if it's fast and cheap, it isn't good, If it's good and cheap, it isn't fast. Simple.
We will likely end up with a two tiered system. Cheap and Good for all, where everyone waits (Canada..sort of) and Fast and Good for those who can pay.
The real problem will come if everyone is shoehorned into the same system as that is when the system starts to slide (again..Canada)
Full Disclosure..I'm a specialist MD who has Canadian partners and takes care of Canadians who cross the border...and yes, I've got lots of horror stories.

Candy;

Just have a look at this.

Candy,

"if I'm dying, will my British doc drop me like a bad habit to avoid ruining his quota?"

You bet your life. In a cost-controlled system, one of the easiest ways to control costs is to deny medical care to those who are assumed terminally ill. Think about it -- as a person gets older, they require more and more health care. Also, someone with cancer may incur more health care expense in the last year of their life than in the earlier years of their life combined.

"... taking a boatload of sick Americans to a Cuban ER, where they received top notch treatment."

Cuba has very nice hospitals for government officials and foreigners who can afford to pay top dollar (and I believe that US dollars are preferred) for Cuba's finest doctors and the most modern diagnostic equipment that the Cuban government can afford.

It is the common folk, the peasants (read: people like you and me) who end up in hellholes like this one, filthy, understaffed, out of prescription meds, 40 year old lab equipment, and not a CT or MRI machine in sight.

"Historically, government regulation and control has been more destructive than beneficial -- especially when it comes to financial matters. "

True, but what government can do that would do much more good than harm would be to get the lawyers under control. It would be the easiest way to save the largest amount of money in our health care system. It might not "fix" everything, but it would be the easiest and largest step in the right direction.

Of course that will never happen-- congress will never act to protect us from the litigious predators-- until there are less than 60 Democrats in the Senate.

The US is beginning to institute a Pay for Performance system. Doctors and hospitals must meet certain benchmarks or their re-imbursement for services will be cut by 1.5% if they faill to meet said benchmarks. This is a Medicare law.

It is the slippery slope to outcomes pay. Sick patients will not be able to find a physician willing to take an extra cut in pay for the honor of treating them.

Candy, whatever happened with your kidney stone? Are you OK.

DOH! I meant less than 40 Democrats...

And Candy, there are probably better ones out there, but this site makes some good points.

Hint: if it's from Micheal Moore you can be sure it's full of falsehoods & misleading facts designed to create an overall fabrication of reality. He fools a lot of retarded people though.

Outcomes pay is an evil thing.

For instance, the pure fantasy BMI charts the government creates. If you discount the pay of a doctor who can't get his patients in line with those bugus numbers, that's absurd.

For instance, blood pressure numbers. All the underlying causes are still not understood by any stretch, so we arbitrarily apply meds that may lower the blood pressure numbers without addressing causes. That would be like the goal of prescribing pain meds that make your headache go away, whether the cause is a brain tumor, migraines, infection, whatever. It's artificial and arbitrary, and if your numbers don't respond to meds, if you can't or won't do something lifestyle-wise to meet given numbers, you risk doctors dropping you. That sn you risk further intrusiveness into your life by the government in the name of helping your doctor beat you into "health" as defined by arbitrary numbers.

Jay, I suggest you review this report on the state of our healthcare system and ways to improve quality and reduce costs:
http://www.commonwealthfund.org/usr_doc/site_docs/annualreports/2006/msg_pres07.htm

A shorter version is here:
http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=401577

As I stated before we spend way too much for our healthcare (two to three times that of England, Canada or France) and we still don't insure nearly 50-million people.

As far as wait time, this was reported at the Commonwealth Fund as well (from Newsweek):

In a study of five developed counties CF looked at how many adults had to wait six days or more for an appointment. Canada was the worst followed by the US and then the others.

The ulmtimate issue here is that people want healthcare, the cutting edge healthcare we're used to - which DOES cost a lot (and note the difference between price, cost, and value), but they don't want to actually pay for it.

I don't want to pay for it either... so I don't, not having insurance. My doctor visits, prescriptions, and dental care - a couple times a year - are paid for in cash, out of pocket. I have no long waits, no problems. Being a student in my mid 20's, I can deal with this a couple more years.

I think that the main problem is that health care is not a free market. When I was in an HMO, or a PPO, I had a copay. I paid the same amount, no matter what my doctor had negotiated with the insurer. There was no downward price pressure on the doctor or the drug companies, because I picked the product or service, and somebody else paid the bill.

High-deductible plans, combined with HSAs, can help solve this. They certainly have for me. The employer, the consumer, and the healthcare providers have to work together, but it can be done. Instead of using up Jay's disk with my diatribe, you can read my explanation at

http://realityblogz.blogspot.com/2007/07/lowering-cost-of-healthcare.html

BarneyG:

We pay a lot for out healthcare, but a MASSIVE chunk of that is tied up in research and development for the whole planet. Every time you see those "how much does the US pay" studies, they include EVERYTHING. Including basic medical research (about 2/3 of all high-end research in the world), and those insanely expensive drug trials that establish whether or not a drug is safe enough to use (not to mention the initial search for chemicals that might make good drugs).

We also use technology here that most of the rest of the world won't see for five or ten years - after the initial costs have been paid back by US medical services.

Look at MRIs, for example. A few years ago, I was at a conference (I do trade shows for a living), and one of the doctors mentioned that there were (at that time) more MRI machines in Orlando, Florida than there were in all of the UK (the place they were invented). The US healthcare system bought so many MRIs that the price dropped, enough so that other countries started buying them for their "midrange" patients. Even so, it's still bordering on the "exotic" in places like the UK or most of Europe, while it's literally a walk-in diagnostic system here in the US (at $500 a pop for a full-body MRI scan in some markets).

Once you knock R&D out of the equation, US health costs are a LOT cheaper overall.

Looks like I get to post this article again.

The index is deliberately set up to make tax financing look good, direct out of pocket expenditures look bad, inequality of treatment is as important as the actual level of treatment: and then people express surprise that the US system, which violates all of those implicit rules, looks bad?

Just to hammer the point home. On this system of measurement, the actual level of treatment in the US could fall, but the amount tax financed rise: and the US would be declared to have improved its system. Yes, really, a decrease in the absolute level of treatment could mean a rise up the rankings.

Read the whole thing. Especially you, Barney.

Tim, if I might be so bold as to expand upon your initial point, I believe the primary problem here in America is that everyone wants the best of everything, but is not willing to pay the price for it (I am using "everyone" loosely, here, bear with me). We have become too much an entitlement society, as if being alive somehow granted you certain things... as if people should be rewarded for their company and presence alone (even though most of those people of that mindset are individuals I could not be in the same room with for more than five minutes).

And, as Jay said, it does, and our Founding Fathers saw to that, and as long as you can secure it for yourself, you are guaranteed all the life (and associated health care, though, personally, I do not see the latter being inexorably interwoven with the first), liberty, and happiness you can grab. But the second you start demanding something from someone else without proper recompense... that is called "robbery", and any system based upon it is doomed to failure from the start.

The problem with healthcare in America is that people are insulated from the true cost of medicine. When you have insurance through an employer, and it only costs $15 for a doctor visit, you already have an unrealisitic expectation of the costs.
Employers should not be in the business of providing health insurance. It is a throwback to World War II when their were wage controls, so employers started including benefits like healthcare because they couldn't increase wages. The most obvious solution is to use a model everyone is already familiar with, car insurance.
With my car insurance, I am covered if I get into an accident. I don't file a claim to change the oil, replace the tires or other routine maintenance. Medical insurance should work the same way. I pay for checkups, and other routine costs. Medical insurance should be for large unexpected medical events, like cancer, trauma etc.
Require people to carry their own health insurance. Then require insurance companies to insure everyone.

Here's the firat senternce of the second paragraph of CCG's touted "article."

"Admittedly, I've not seen the film and it's most unlikely that I ever will so please feel free to reject it as you wish: perhaps the sour grapes of one who doesn't like the conclusions, perhaps just the witterings of one who knows not of which he speaks"

We should pay attention to an article with that tag line, shouldn't we?

ccg, I read the report. I like the part where the author calls Moore a dam lier then admits that he hasn't and won't watch the movie, and then says the movie is mostly accurate? The guy has got a lot of credibility.

He still does not explain why we pay 15.3% of GDP on healthcare that leaves almost 50-million Americans uninsured and about the same or more under insured while France pays 10.7% of GDP on healthcare and covers all their citizens with full coverage and rates higher than the US in healthcare studies, has shorter waiting periods, lower infant mortality rates and higher life expectancies than in the US?

Hey barneygoole how many of that 50 million are to lazy to get a job--you know the ones that set around and wait on their welfare checks.

So much for the French system that couldn't even take care of its elderly during a heat wave. Also on infant mortality rate, other countries didn't include the deaths of prematurely born babies. They just let them die (I guess that 's why they advocate "mercy killing" to improve the statistics) and exclude them from the statistics. In the US, we include the deaths of premature babies in the statistics and we spend the money and have the technology to save them. Again, Barney forgot that the rest of the world adopts the parasitical model of riding on the US expense (just like defense for example). About the life expectancy issue, taking out the homocide/accident deaths, the US is the best for health-related life expectancy. The discussion is here

http://wizbangblog.com/content/2007/07/27/canadian-doctor-describes-the-nightmare-of-canadas-health-care-system.php

And if we measure a health care system by how well it serves its sick citizens, American medicine excels. Five-year cancer survival rates bear this out. For leukemia, the American survival rate is almost 50%; the European rate is just 35%. Esophageal carcinoma: 12% in the U.S., 6% in Europe. The survival rate for prostate cancer is 81.2% here, yet 61.7% in France and down to 44.3% in England -- a striking variation.

Anyone can buy catastrophic health insurance at a reasonable cost. You pay out of pocket for normal visits. My friends did that when they were out of a job for several months. Again, socialized medicine as socialized economy has been shown to be a failure (esp for the poor).

Barney spews: "He still does not explain why we pay 15.3% of GDP on healthcare that leaves almost 50-million Americans uninsured ..."

The amount of GDP spent has no relation to whether or not someone has insurance. The first is a measure of the total amount of the nation's economic output that is health care, the second is a measure of how many people are with the contractual provision of a health insurance company.

Its not even apples and oranges since the two numbers are not even in the same food group.

This is a classic example of Barney's utter ignorance and misuse of statistics.

jhow, how many because they are lazy? I do not know but France has a much higher unemployment rate than we do (4% to 10%) and they still cover everyone for less cost.

oclarki,

You're absolutely right. Health "insurance" isn't really "insurance" as traditionally offered for your auto or your home or for professional liability, etc. In those kinds of coverages, routine expenses are the responsibility of the insured. The insurance only provides indemnity (financial compensation and/or legal counsel) for catastrophic events such as accident, fire, or lawsuits.

There are at least two, no three problems with structuring health "insurance" in such a manner. First, people are used to having the insurance company pay for everything. Second, what is a "routine expense"? Maybe you could put a dollar amount on it, but you would be stuck in a perpetual battle with those continually seeking to lower that dollar amount or exclude specific medical procedures from the "routine" category.

The third problem is related to the finances of the insured. With home insurance, for example, the insurance company usually compensates you for your loss and then either terminates your coverage or adds a number of exclusions to your coverage that prevents them from covering the same loss again.

How could we do that with health insurance? For example, if someone had a heart attack, should the insurance company simply cut them a check for the cost of hospitalization and the projected cost of future medical care related to the heart attack (maybe $250,000?) and then exclude all future coverage of heart-related maladies?

As it is, health insurance has so altered the financial end of medical care that I'm not sure it can ever be really overhauled.

Employer-funded health insurance is a quirky development of FDR's wage and price controls. An alternative would be a health-care system built on individuals and families purchasing their own health coverage. The advantages are numerous:

http://www.nationalreview.com/comment/gratzer200505160830.asp

Here is a discussion about the system in Germany and France

But public systems are relatively similar--they simply attempt to ration health care in one way or another. In my travels and in my conversations with colleagues, I have yet to come across any particularly interesting approaches to health care management in the countries you list. It's not that governments have pioneered novel types of primary care or that they have rethought the institutional provision of services. These countries simply use wage and prices controls to temper demand. Sure, the Canadian and British approaches seem particularly problematic, but France has its share of dissatisfaction and problems.

http://www.tnr.com/doc.mhtml?i=w070416&s=cohngratzer041807

From the same Canadian doctor who knows socialized medicine.

-----------------------------------
In my book, I talk about ways to insure more uninsured, to increase quality and trim costs. A summary of my core ideas: Make health insurance more like other types of insurance, foster competition, reform Medicaid using welfare reform as a model, revisit Medicare, and address prescription drug costs by addressing the FDA's size and scope.

So, no, I don't look to France for inspiration; I look to the United States.

"The U. S. health system spends a higher portion of its gross domestic product than any other country but ranks 37 out of 191 countries according to its performance, the report finds. The United Kingdom, which spends just six percent of gross domestic product (GDP) on health services, ranks 18th ."

http://www.who.int/inf-pr-2000/en/pr2000-44.html

Health Care Lie: '47 Million Uninsured Americans'

http://www.businessandmedia.org/printer/2007/20070718153509.aspx

Looks like they didn't measure this performance at all.

And if we measure a health care system by how well it serves its sick citizens, American medicine excels. Five-year cancer survival rates bear this out. For leukemia, the American survival rate is almost 50%; the European rate is just 35%. Esophageal carcinoma: 12% in the U.S., 6% in Europe. The survival rate for prostate cancer is 81.2% here, yet 61.7% in France and down to 44.3% in England -- a striking variation.

http://www.medicalprogresstoday.com/spotlight/spotlight_indarchive.php?id=1720

Market reforms are catching on in Britain, too. For six decades, its socialist Labour Party scoffed at the very idea of private medicine, dismissing it as "Americanization." Today Labour favors privatization, promising to triple the number of private-sector surgical procedures provided within two years. The Labour government aspires to give patients a choice of four providers for surgeries, at least one of them private, and recently considered the contracting out of some primary-care services--perhaps even to American companies.

Other European countries follow this same path. In Sweden, after the latest privatizations, the government will contract out some 80% of Stockholm's primary care and 40% of total health services, including Stockholm's largest hospital. Beginning before the election of the new conservative chancellor, Germany enhanced insurance competition and turned state enterprises over to the private sector (including the majority of public hospitals). Even in Slovakia, a former Marxist country, privatizations are actively debated.

Under the weight of demographic shifts and strained by the limits of command-and-control economics, government-run health systems have turned out to be less than utopian. The stories are the same: dirty hospitals, poor standards and difficulty accessing modern drugs and tests.

lovie, your facts are just not true. Here are the facts from the US Government:

http://www.cdc.gov/nchs/data/nhis/earlyrelease/insur200706.pdf

In 2006, 43.6 million persons of all
ages (14.8%) were uninsured at the
time of the interview, 54.5 million
(18.6%) had been uninsured for at
least part of the year prior to the
interview, and 30.7 million (10.5%)
had been uninsured for more than year at the time of the interview.