Eesh. I feel like this is a topic worth discussing, but there must be a different way to approach it than to blame the people shouldering massive healthcare costs. Also, "medically unnecessary...
Eesh. I feel like this is a topic worth discussing, but there must be a different way to approach it than to blame the people shouldering massive healthcare costs.
Also, "medically unnecessary tests" feels super vague. Maybe it's better defined in medical literature and research, but in this article it comes across as somewhat meaningless.
A few years ago I woke up with less sensation in certain parts of my body and back pain. It was a relatively sudden thing, and impacted several areas of my qualify of life. (Being vague because honestly it's tough to talk about and some of it is rather private.) I had a ton of MRIs trying to find something that could be causing it, but my spine looked "great." The only finding was white matter brain lesions, but subsequent MRIs over the years show no increase in lesion load.
Were all those tests medically unnecessary because no one found a cause of my symptoms? Are my yearly brain MRIs pointless because I don't have an MS diagnosis and the lesion load hasn't increased? Rare and poorly understood/defined illnesses can often involve multiple tests to rule out other conditions, and some conditions (like my main illness, CFS) don't even have a direct test. I fear that negative results on tests could be interpreted as those tests being unnecessary, when that negative result is important. It's good to know that I don't appear to have MS, even if that doesn't tell me why I lose sensation or have pain.
It's also worth discussing whether or not lowered costs should be a goal of Medicare for All (or another similar plan). The techniques used to lower costs (step therapy, drug formularies, prior authorization, etc) often hurt chronically ill/disabled people with complex needs. It happens in other countries (if you read accounts from disabled folks in Canada, for example), and it happens already in the US. Medicine is highly complex, and folks with multiple conditions often require unique treatment strategies, and doctors already spend countless hours arguing with Medicare/Medicaid/private insurance trying to get medically necessary treatments covered.
Have we considered the possibility that, 'no, actually, reducing overall health expenditures shouldn't be the aim of universal healthcare'? 'Reducing total cost' is repeatedly cited as an aim of #MedicareForAll, but here's why I'm not at all convinced that should be our goal...
Sorry for the double post, but my brain won't let this article go, haha. Absent any additional info (or better yet, a link to the study), there's no way to determine if this difference is actually...
Sorry for the double post, but my brain won't let this article go, haha.
According to another study, this one of chronic migraine sufferers, 42 percent of U.S. respondents had visited an emergency department for their headaches, versus 14 percent of U.K. respondents.
Absent any additional info (or better yet, a link to the study), there's no way to determine if this difference is actually due to patients themselves or due to the systems they find themselves in. It could be that UK folks have better access to treatments, which keep their condition more stable and less likely to require emergency care. Or it might be that UK patients are more able to go to a doctor's office on short notice instead of the ER. Or maybe the US's overreaction to the opioid epidemic means that many US patients have to resort to going to the ER to get adequate pain meds.
In the US hospital doctors are in the habit of ordering full blood tests for every patient. This is pointless. It's expensive; it doesn't do much to help treat patients; and it may even cause...
Also, "medically unnecessary tests" feels super vague.
In the US hospital doctors are in the habit of ordering full blood tests for every patient. This is pointless. It's expensive; it doesn't do much to help treat patients; and it may even cause harm.
Over testing leads to over diagnosis, which leads to over treatment, and each step causes harm.
This smells like propaganda. I don't know the author's background, so I'm not going to go as far as making direct accusations, but the piece as a whole reads like a PR masterclass. The topic, the...
This smells like propaganda. I don't know the author's background, so I'm not going to go as far as making direct accusations, but the piece as a whole reads like a PR masterclass.
The topic, the phrasing, the gentle but insistent language, the disarmingly personal opening about his good old dad's foibles - it's all pitched to say one thing: "just because it works elsewhere, doesn't mean universal healthcare can work in America". Not only that, it caricatures those it accuses, sets them apart from the fit, lululemon-clad, liberal metropolitan elite reader and says it's their fault that you can't have nice things.
I'm intrigued now. I've skimmed a few of his other articles at random, and he certainly seems to be in earnest, but I've also re-read this one and it still says manipulation to me. He did also...
I'm intrigued now. I've skimmed a few of his other articles at random, and he certainly seems to be in earnest, but I've also re-read this one and it still says manipulation to me. He did also tweet about exactly the kind of criticism I'm making - and again, it strikes me as honest.
I guess he deserves the benefit of the doubt on intent, even if not for outcome.
The article doesn't actually provide any data to substantiate a causal link here though. All we have is anecdotes which leaves me unconvinced. Also, most countries with nationalized healthcare do...
The fact that Americans eat/drink/smoke too much, don't exercise enough, don't listen to the advice of our doctors, and are hostile to health care providers all make sense as adding to those astronomical costs.
The article doesn't actually provide any data to substantiate a causal link here though. All we have is anecdotes which leaves me unconvinced.
Also, most countries with nationalized healthcare do have major public education initiatives to help address these costs. In France when they started getting data from OB/GYNs and pediatric clinics that the children's BMIs were trending upwards they actually went into action and started giving out kitchen scales as a standard part of pre-natal education, including instructions on how much to feed your child based on size and stage of development. Here in the US we don't even have standard pre-natal education as a thing. What's there is expensive and full up with pseudo-sciences. ??
Relative to most other developed countries, our food policies and urban planning policies are also crap. We do food subsidies to encourage overproduction of corn and corn syrup, so the most affordable foods are also the worst for you. Our entire apparatus around food regulation is to maximize calories per dollar rather than any other aspect of what food is for. Our urban planning is a nightmare, and it's still basically illegal to build walkable cities in most of the country, even the central districts of most currently walkable cities. The only walkable neighborhoods we have left now are the ones that were totally neglected by local governments because they had redlined all the minorities into them.
I think bad patient compliance and irregularity reinforces many of the mechanisms that make treatment expensive, and in turn make it even more expensive. It's costly being poor. When you live from...
I think bad patient compliance and irregularity reinforces many of the mechanisms that make treatment expensive, and in turn make it even more expensive.
It's costly being poor. When you live from paycheck to paycheck you can't spend some money now to save more money later. If you have a cushion, you have way better options.
It's the American patient collectively (in the form of the American voter) that values the principle of non-governmental healthcare so much that they're willing to pay a large premium for the system being private.
Non-adherence to medication regimes is a common problem. We find it where the meds are paid for by the patient, but also where they are provided free to the patient. We find it if there are severe...
Exemplary
I take exception to one issue raised in this article that patients don't always take the drugs they are prescribed or generally avoid regular checkups, leading to further issues later on and more emergency room visits. I think you could argue that the high cost of those drugs or lack of affordable health insurance to pay for those regular checkups are more symptoms of the high cost of healthcare in the U.S., rather than the cause.
Non-adherence to medication regimes is a common problem. We find it where the meds are paid for by the patient, but also where they are provided free to the patient. We find it if there are severe consequences for not taking them (most transplanted organ failure is caused by medication non-concordance), and we find it where the consequences are not severe (not taking a statin may slightly increase your risk, but probably isn't going to kill you).
A few years ago about half the English NHS prescription budget (so, about £4bn out of about £9bn) was being spent on meds that would have no effect or reduced effect because of non-compliance.
This, from 2006 gives some idea of the size of the problem.
And poor compliance - or non-concordance to give it its politically correct name - isn't just a problem for drug safety campaigners like Professor Shakir. Studies have shown that as many as 9 out 10 cases of rejection in people who have had kidney or heart transplants happen solely because they don't take their pills properly. And if they don't follow instructions, after all they have been through, then what chance do the rest of us have.
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MCGAVOCK
About 20% of the population take their medicines properly and they get the full benefit. Another 40% take their medicines well enough to get some benefit - which is good. But 40% of people with diabetes and asthma and schizophrenia, high blood pressure, don't take their medicines at all or they take them so erratically as to get no benefit and some harm.
PORTER
So that's nearly half the people who are prescribed medicines in the UK aren't taking them regularly enough to get any benefit, which means that - I mean the drug budget in the UK is something like £8-9 billion, half of that is being wasted.
MCGAVOCK
Yes, I've been doing my sums on this and these are approximate figures but last year UK GPs issued approximately 1 billion prescriptions, costing approximately £12 billion. If 40% of that is indeed wasted and we are fairly sure it is, that means that non-compliers are wasting somewhere around £5 billion per annum, that's eight times the current hospital overspend that's causing so much fuss in the media.
Eesh. I feel like this is a topic worth discussing, but there must be a different way to approach it than to blame the people shouldering massive healthcare costs.
Also, "medically unnecessary tests" feels super vague. Maybe it's better defined in medical literature and research, but in this article it comes across as somewhat meaningless.
A few years ago I woke up with less sensation in certain parts of my body and back pain. It was a relatively sudden thing, and impacted several areas of my qualify of life. (Being vague because honestly it's tough to talk about and some of it is rather private.) I had a ton of MRIs trying to find something that could be causing it, but my spine looked "great." The only finding was white matter brain lesions, but subsequent MRIs over the years show no increase in lesion load.
Were all those tests medically unnecessary because no one found a cause of my symptoms? Are my yearly brain MRIs pointless because I don't have an MS diagnosis and the lesion load hasn't increased? Rare and poorly understood/defined illnesses can often involve multiple tests to rule out other conditions, and some conditions (like my main illness, CFS) don't even have a direct test. I fear that negative results on tests could be interpreted as those tests being unnecessary, when that negative result is important. It's good to know that I don't appear to have MS, even if that doesn't tell me why I lose sensation or have pain.
It's also worth discussing whether or not lowered costs should be a goal of Medicare for All (or another similar plan). The techniques used to lower costs (step therapy, drug formularies, prior authorization, etc) often hurt chronically ill/disabled people with complex needs. It happens in other countries (if you read accounts from disabled folks in Canada, for example), and it happens already in the US. Medicine is highly complex, and folks with multiple conditions often require unique treatment strategies, and doctors already spend countless hours arguing with Medicare/Medicaid/private insurance trying to get medically necessary treatments covered.
This is a good thread from Matthew Cortland, a disabled lawyer who is on SSI/Medicaid and regularly has to use his law degree to get his meds. It begins:
Sorry for the double post, but my brain won't let this article go, haha.
Absent any additional info (or better yet, a link to the study), there's no way to determine if this difference is actually due to patients themselves or due to the systems they find themselves in. It could be that UK folks have better access to treatments, which keep their condition more stable and less likely to require emergency care. Or it might be that UK patients are more able to go to a doctor's office on short notice instead of the ER. Or maybe the US's overreaction to the opioid epidemic means that many US patients have to resort to going to the ER to get adequate pain meds.
In the US hospital doctors are in the habit of ordering full blood tests for every patient. This is pointless. It's expensive; it doesn't do much to help treat patients; and it may even cause harm.
Over testing leads to over diagnosis, which leads to over treatment, and each step causes harm.
This smells like propaganda. I don't know the author's background, so I'm not going to go as far as making direct accusations, but the piece as a whole reads like a PR masterclass.
The topic, the phrasing, the gentle but insistent language, the disarmingly personal opening about his good old dad's foibles - it's all pitched to say one thing: "just because it works elsewhere, doesn't mean universal healthcare can work in America". Not only that, it caricatures those it accuses, sets them apart from the fit, lululemon-clad, liberal metropolitan elite reader and says it's their fault that you can't have nice things.
I'm intrigued now. I've skimmed a few of his other articles at random, and he certainly seems to be in earnest, but I've also re-read this one and it still says manipulation to me. He did also tweet about exactly the kind of criticism I'm making - and again, it strikes me as honest.
I guess he deserves the benefit of the doubt on intent, even if not for outcome.
The article doesn't actually provide any data to substantiate a causal link here though. All we have is anecdotes which leaves me unconvinced.
Also, most countries with nationalized healthcare do have major public education initiatives to help address these costs. In France when they started getting data from OB/GYNs and pediatric clinics that the children's BMIs were trending upwards they actually went into action and started giving out kitchen scales as a standard part of pre-natal education, including instructions on how much to feed your child based on size and stage of development. Here in the US we don't even have standard pre-natal education as a thing. What's there is expensive and full up with pseudo-sciences. ??
Relative to most other developed countries, our food policies and urban planning policies are also crap. We do food subsidies to encourage overproduction of corn and corn syrup, so the most affordable foods are also the worst for you. Our entire apparatus around food regulation is to maximize calories per dollar rather than any other aspect of what food is for. Our urban planning is a nightmare, and it's still basically illegal to build walkable cities in most of the country, even the central districts of most currently walkable cities. The only walkable neighborhoods we have left now are the ones that were totally neglected by local governments because they had redlined all the minorities into them.
I think bad patient compliance and irregularity reinforces many of the mechanisms that make treatment expensive, and in turn make it even more expensive.
It's costly being poor. When you live from paycheck to paycheck you can't spend some money now to save more money later. If you have a cushion, you have way better options.
It's the American patient collectively (in the form of the American voter) that values the principle of non-governmental healthcare so much that they're willing to pay a large premium for the system being private.
Non-adherence to medication regimes is a common problem. We find it where the meds are paid for by the patient, but also where they are provided free to the patient. We find it if there are severe consequences for not taking them (most transplanted organ failure is caused by medication non-concordance), and we find it where the consequences are not severe (not taking a statin may slightly increase your risk, but probably isn't going to kill you).
A few years ago about half the English NHS prescription budget (so, about £4bn out of about £9bn) was being spent on meds that would have no effect or reduced effect because of non-compliance.
This, from 2006 gives some idea of the size of the problem.
http://www.bbc.co.uk/radio4/science/casenotes_tr_20060509.shtml
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