Casey, removing fee for service is what HMOs did and they failed because they had to cost control treatment in a way patients rejected. I am not saying we shouldn't eliminate it, just that it may not be the silver bullet. Mayo is owned by the doctors so they set the policies and strategies. For them it works, but they are specialists and their system wouldn't necessarily be the model for the overall generalist system. Why haven't more private clinics copied their system? It must be difficult to duplicate it or everyone would be doing it successfully.
JohnT, other countries cost less because they often provide less and they are not forced into the same level of defensive medicine that we experience here. Most of the developed world is in the 9-12% range and the undeveloped nations in the 2-6% range. Further, much of the technological, procedural and pharmacutical advances come from America. That drives our costs up comparatively speaking.
There is no doubt that in most areas we are the leaders. Often this board has comments on the comparative effectiveness with PCa between the US and UK....in fact you have supplied some of those figures. They are easily 20 years behind us in PCa and Breast Cancer for both morbidity and mortality. We can reduce our costs to their level (9.8% gdp) and then accept their results. Or better, how do we reduce our costs without losing our advantages?
While our costs must come down, to get them to 8% GDP would be to get a system that is nowhere as good as it is now. If we could reduce it to 12-14% of GDP it could save hundreds of billions per year and probably be accomplished without reducing access or effectiveness. Just look at the cost of the waste and fraud within the medicare system, easily hundreds of billions a year. Another aspect of fee for service that Casey points out is the costs of defensive medicine that doctors must practice and are very profitable at it. If we could have true torte reform and a loser pay legal system as most of the world has, what would happen to the needless tests and other costs? We should watch Texas to see how they fair as they are in the early stages of implementing medical torte law reform. The initial news I remember seeing was that they were attracting a lot of new doctors. That should increase access and competition that could drive down some costs.
As to preexisting conditions HIPAA solved most of that in 1996 as long as you didn't go without coverage (for more than 63 days). Additionally it limits the look back period to six months and excludes coverage for the item for 12 months at most. As was stated the new act solves that for people that did go without coverage. With this expansion in coverage there is a large cost for this that we are all seeing in our premiums already. COBRA basically says keep youi coverage but pay the full cost for it. I find that fair, why should the company pay for an ex- employee's coverage for 18 months after termination?
Billinchicago, look what you have done. This is one of most interesting threads I have participated in. Good job. The common thread I sense is that we all like the good qualities and results of the US system, want more people to get the advantages, want to eliminate fraud and waste, and want to pay much less than we do now. Where is the problem????
PSA 59 on 8-26-2010 age 60. Biopsy 9-8-2010 12/12 positive, 20-80% involved, PNI in 3 cores, G 3+3,3+4,and 4+3=G7, T2b.
Eligard and Jalyn started on 10-7-2010. IMRT to prostate and lymph nodes started on 11-8-2010, HDR Brachytherapy December 6 and 13, 2010. PSA <.1 and T 23 on 2-3-2011. PSA <.1 on 4-7-2011. PSA <.1 and T <3 on 7-15-2011. PSA <.1 10-07-2011. PSA <.1 1-3-2012.
Post Edited (JNF) : 8/1/2012 3:20:58 PM (GMT-6)