How many Americans are ill?

Its big business, actually. There are advertisments for everything everywhere (radio, TV magazines etc) except no one knows what the drugs are for so you have to go ask the doc if XXXdrug will help. Everyone wants to be cured of everything yesterday if not before. I wonder if we have been brainwashed to think every twinge is catostrophic, anything on our body not "perfect" and needs to be addressed...because of big buisness.

Sad state of affairs.

its just sad

I believe part of the problem is the aging of the boomers in America. We were warned this would happen years ago..........supply and demand.........also pharmaceutical companies are now permitted to advertise, whereas in the past they weren't. It's awful on TV - every ad is for another drug........but it IS big business - and even in this poor economy - business is booming.

PIP, I laughed so hard when I read your post.  I do a lot of road trips to the U.S. too and I always notice the same thing.  With all that advertising and all those facilities, it does seem like everyone in the U.S. must be sick, doesn't it?

In actual fact, since the demographic make up of the Canadian and American populations are pretty similar, I don't think that a greater % of Americans are ill vs. Canadians.  The difference, I think, is that as mke said, providers in the U.S. have to compete for patients, and since they all are trying to make a profit, getting every extra patient is really important.  The U.S. spends more per capita on healthcare than any other country in the world. When you see all those facilities and see all that advertising, you can see where a lot of that money goes.  And then there's all the money that goes to the insurance companies and HMOs that manage healthcare.  It amazes me that people think that government-run health care is be less efficient!   We may spend less per capita on healthcare in Canada but a much greater % of the spending goes to patient care.

Of course, having all those facilities explains why, on average, test results come back faster in the U.S. than in Canada.  To me, that's a small price to pay for our more efficient system that covers our entire population.

People who visit the U.S. only occasionally might not have had the misfortune to see the inside of one of the "health care facilities" that seem to have popped up on every street corner.

If you haven't been inside one, you might not realize that many of the free-standing facilities are simple, walk-in, "urgent-care" clinics.  There might be one or two family-practice physicians, a couple of nurses, and a receptionist on duty at a time.  Such facilities are often open from 7 or 8 a.m. until the same hour in the evening, 6 or 7 days a week.  What some people do not realize is that such facilities provide a valuable service to communities by reducing the burden imposed on hospital emergency departments.  The small, "walk-in" clinics siphon off the patients who have urgent but uncomplicated (i.e., "non-emergency") medical issues that cannot wait 2 weeks for an appointment but do not warrant an emergency room visit.  They also provide incentive for using a primary-care physician instead of a specialist.

Other small, stand-alone facilities offer specialty services, such as outpatient surgery, clinical laboratory diagnostics, or radiographic imaging.  Think of those facilities as "referral centers."  They provide care that would otherwise need to be provided to some extent by every reasonably "comprehensive" clinic or tiny hospital in that area.  Instead, those clinics no longer need to purchase or maintain their own CT or MRI equipment or blood analyzers.  They no longer need to have surgeons on-call.  They can refer patients to the specialty service centers instead. 

This has happened with imaging, in the town where I live.  For decades, routine screening mammograms were done at the large OB/GYN clinic in town. There was no radiologist working there, so films had to be read by a radiologist at the hospital.  That meant there was a wait of a week or longer before anyone--even the doctors--got the results.  Now, routine mammograms are done at a special imaging facility that can conduct all sorts of imaging on breasts as well as other body organs.  This is much more efficient and less likely to incur error.

Some readers might think the prevalence of health care facilities in the U.S. is an indication of a system that has run amok due to lack of government regulation.  IMHO, that position is (understandably) naive. The building, licensing, equipping, and expansion of medical facilities in the U.S. has been regulated by the individual states, according to federal mandate, for the past 35 years.  The mechanism for the regulation is the "Certificate of Need" ("CON").

Submission and approval of a "Certificate of Need" is required in most states before anyone can build, equip, or expand a clinic, diagnostic facility, hospital, etc.  Hospitals cannot add beds without approval of a "CON".  Large equipment purchases require approval of a "CON".  New wings cannot be built without approval of a "CON".

Here is a website that explains the history and purpose of the "CON" statues in the U.S.:  http://www.ncsl.org/IssuesResearch/Health/CONCertificateofNeedStateLaws

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Sorry--that is a very long link.  For some readers it will make the screen size too wide and will cause the text in this thread to overlap the junk in the right-hand sidebar. (I've edited this post to try to split the link--let's see if it works.)

The U.S. (federal) government rescinded its "CON" requirements in 1987, but most states kept their laws on the books anyway.  Here is a map showing the states that had "CON" requirements in 2006:

There is no doubt that the "CON" laws are controversial.  (Read the pro's and con's on the link I provided.)  In a free-market economy like we have in the U.S., the government is not always the best determinant of "need".  Sometimes the market makes that determination...or at least we like to think so.

otter 

Drat.  I really, really hate arguments.

I am going to resist the temptation to post pictures of the 3 walk-in clinics in my community of, oh, 135,000 people (had to look that up).  But, they are called "Doc-in-a-Box" clinics for a reason.  They are anything but "large buildings that sit on landscaped property."  Instead, they tend to be small, square, single-story buildings squeezed in between other buildings in a strip mall.  BTW, most city ordinances in this part of the world require landscaping.

I am also going to try to resist asking why a clinic that is "private" is necessarily inferior to, or even more expensive than, a clinic that is government-managed or government-financed.  Yes, a privately run clinic might be a commercial, for-profit venture; but that doesn't automatically mean it will eat up more resources.  Sometimes it's just the opposite--being privately run, they will be trying to work more efficiently.  A government-run facility sometimes has less incentive to save money, because they don't need to live off what they earn.  They can always ask for more tax money.  (I was a government employee for 25 years; I know how this works.)

Here in the U.S., things often function less efficiently and less effectively when they are managed by the government.  Just today there are newspaper headlines about hundreds--perhaps thousands--of patients in Veterans' Affairs hospitals being exposed to HIV and hepatitis viruses because of cheap, shoddy housekeeping by government employees in those federal hospitals.  So much for relying on our government for quality health care.

I will also try to resist rebutting the claim that for-profit health care facilities will necessarily "recommend that unnecessary tests be done."  We do have checks and balances here.  Generally, the rulings about medical necessity of this-or-that are made by our insurance coverage and/or the federal government (via Medicare governing boards).  As our insurance companies always say, they are not determining what care we will receive--they are just determining whether or not they will pay for it.  Insurance coverage is an amazing equalizer, despite all the claims to the contrary.

I do agree that commercial advertising probably increases the public demand for the advertised products and services.  It's called "direct-to-consumer advertising," and I hate it.  I do think it's useful for our doctors to see advertisements in their own magazines and journals, but I doubt the medical necessity of drug advertisements in "Ladies Home Journal" or in the middle of the 6 o'clock news.  OTOH, just because a patient comes in to a clinic and asks about a drug or procedure he or she saw on TV, doesn't mean that drug or procedure will be ordered by the physician.  I will resist asking why advertising or commercialization of medical services is inherently evil.

Most of the questions raised in this thread are philosophical ones.  They deal with economic philosophies (free market versus government-subsidized health care), political philosophies (how much control should government have over health care resources and decisions?), and social philosophies (to what extent are gainfully employed citizens responsible for financing the health care of citizens who are less well-off?).

These are not simple questions, and they do not have easy answers.  The us-versus-them border disputes over health care that erupt on this board are kind of funny.  What makes any of us so sure our system is the right one for people living in another country???

I do not understand why so many Canadians seem to feel that they want us to adopt their system of health care. To be honest, I think the Canadian system is great for Canadians if that is what they are happy with. I just do not want any part of it here. I think Canadians have a lot of misconception about our system. People are not turned away here because they cannot pay. They show up in hosptials everyday. They just walk out without paying, and the rest of us foot the bill. I have no problem with this for the most part. I just do have a problem with those who work our system, especially non citizens who overtax our system by walking in and getting care that they do not deserve. We already do have socialized medicine in the US. We have it under the guise of medicare and medicaid and it is a disaster. Doctors have to jump through hoops and wade through paperwork to get approval for treatments that are often turned down by some bureaucrat. Doctors will tell us that they are lucky to get paid a third of what they spend on this care from the government. So here again, the rest of us have to make it up with higher prices. We also have a horrible system for our Veterans. They should be getting the best care we have, but are forced to go to VA hospitals that are understaffed and undersupplied because of lack of funds. Anything the gov. does, is a mess. A federal system will not help us more, it will just cost us more.  I do not care to suffer because the government ends up controlling even more. I want to be able to choose my own health care and make my own decisions and not have to wait for answers from some pencil pusher. I have no idea if this is how it is in Canada and frankly, I do not care how it is there. I am just saying I do not want it here, and I really do not like Canadians telling us that we would be better off with socialized medicine. This country has a lot more people and adopting a program that is run by  Washington will cost us trillions that we do not have and cause a lot more problems than it will solve. And what scares me even more is that all the holistic type doctors whom I tend to rely on the most, tell me that they will be put our of work if the Feds take over because they have a hard enough time justifying their existance now with the FDA working against them. It would be nearly impossible for them to offer us chiropratic, naturapathic care with the Feds in their way.

I am having a hard time even figuring out the purpose of this thread. Is it just to poke fun at Americans and brag that things are better in Canada? I find it very condescending.

Vivre, it would seem that if, as you say, anyone can walk into a hospital, be treated, and then walk out without paying, then something is VERY wrong with the current system. JMHO, of course.

I don't believe anyone has told you that you would be better off with "socialized medicine".  We are simply trying to correct some of the statements that have been made here on this board, and in your media.  PiP noticed a few things medically related when she visited your country, and she was asking questions.  I'm quite sure her intention was not to insult, but merely to inquire.  Given that all of us here are certainly intimately acquainted with health facilities, I guess it's only natural!

Thanks, Otter, for you eloquent explanation of our health care system.  And to you, Vivre, for standing up for OUR health care.

People who do not have insurance, including illegals, can walk into the ER anytime they want and get any help they need without paying for it.  Will the Canadian or UK health care system allow non-citizens to get free health care.  AND there is NO free health care.  Taxes, taxes, taxes.

I enjoy the fact that I may go almost ANYWHERE for my health care.  I go over two hours away for my treatment for bc.  I went there before bc.  I go to Duke University Medical Center and it's one of the hospitals that is highly recommended for cancer.  My gyn is there.  I had and still have my mammos there (one breast left).  I don't wait for results...no call backs.  I get my results before I leave the clinic and it's sent right down to my doctor.  If I need an ultrasound I get it before I leave the clinic.  Then I see our doctor..used to be my gyn now my onc after mammo.

I been following the president's "plan" for health care reform.  You must listen to him very carefully.  Plus, they DON'T have a plan and DON'T know how they're going to pay for it.  I know how..they'll raise taxes on everything and anything.  He wants to rush through something as important as health care.  I hope the American people are not stupid enough to fall for this..uh...does STIMULUS PACKAGE bring back memories.  That was pushed through and he didn't sign it for days.  Why the rush.  No one read it.  And now the same with health care. 

And the VA care..ridiculous.  In my town they finally have a small clinic.  A few years ago they didn't.  I had to drive my 90 year old Dad to one VA two hours away and another one more than two hours away when he needed a good eye doctor.  That was a horrid trip for him.  And then wait, wait, wait.  I yelled at the people where he had to have his eyes examined.  And they took him right in.  I bet the patients in the waiting room wished they had someone to yell for them.  Then we have Medicaid and Medicare.  In Medicaid I know there's so much fraud.  Many people who are not eligible to recieve it lie and get it anyway.  And social security..another government run program.  We should take them to court and sue them for messing with our money.

Do we need some kind of reform....yes.  The CBO, in their report, said that the president's health care plan would only cover 16 million people for over one trillion dollars (too many zeroes to type).

http://news.bbc.co.uk/2/hi/health/7257537.stm  

BBC NEWS  

Cancer plan 'needs more funding'  

Government plans to improve cancer care across England could fail because of lack of funding and a postcode lottery of services, campaigners warn.

A coalition of 40 cancer charities said there were "serious concerns" about implementation of the Cancer Reform Strategy launched last year.

Cancer survival in the UK is still below the European average, despite recent improvements.

The government stressed they were committed to implementing the strategy.

Health Secretary Alan Johnson announced £370m investment by 2010 to underpin the five-year plan.

Proposals include speeding up drug approval, more money for radiotherapy services and a possible clampdown on sunbeds and cigarette vending machines.

Breast and bowel cancer screening programmes will also be extended as well as a greater focus on prevention.

The Cancer Campaigning Group said their members were generally delighted with the ambitious strategy but they had not yet seen evidence that plans were being put in place.

And they stressed there was no new money and that announced by the government was existing funding.

Clear plan

Members of the Group also raised concerns that speeding up decisions on use of new drugs in the NHS could mean more treatments are turned down.

And it called for clear work plans for each of the new initiatives, such as clinical nurse specialists, with clear timelines for delivery.

Gina Coladangelo, spokesperson for the Cancer Campaigning Group, told the BBC that some trusts had very good cancer mortality figures but others were seriously lagging.

"We're concerned about how the Department of Health is going to ensure consistency and good standards across the board.

"The charities are increasingly concerned about implementation of the plan.

"There's no timetable for the specific project plans and there is no new funding and a lot of the new things will have to be funded by stopping things that aren't having an impact but that's going to be pretty difficult.

"There's also new treatments and drugs coming online all the time."

However, she did stress the strategy was "a big step forward" in acknowledging the scale of the task to improving cancer treatment and prevention in England.

Health minister Ann Keen said the government was committed to delivering improvements in cancer prevention, diagnosis and treatment.

"Cancer networks and primary care trusts are currently developing implementation plans at a local level.

"We are supporting the strategy through an investment of £370 million by 2010 and we're investing a total of £250 million in capital equipment for cancer over the next three years - £120 million for digital mammography and £130 million for radiotherapy."

I think we all care about correcting lies and misperceptions...or at least we should, no matter which side of what border we're on.

Beesie, as usual I agree with you (mostly).  I cringe when I read about someone who has to pay thousands of dollars out-of-pocket for her cancer care.  I have personally experienced that horrible feeling that occurs when an insurance company denies coverage for a procedure.  (Fortunately, I've managed to get nearly all of those denials reversed with a simple phone call.  Most were due to clerical [coding] errors, which undoubtedly occur under any system.)

In case anyone here hasn't been paying attention, the health care system in the U.S. is based on freedom of choice.  For those of us who are employed, our health insurance is probably a "fringe benefit" of our employment.  We can't negotiate the terms of our health plan like we could our salary, but it certainly should be considered a part of the compensation package when we're thinking about taking a job.  That's neither good nor bad--it's just the way things developed in our free-market economy.

Even once hired, many of us had choices.  A common one is an employer that offers multiple health plans with differing coverage and costs.  Some cost more up-front but have greater coverage and lower deductibles; others are cheaper on the front end but don't cover as much or have higher co-pays and deductibles. 

So, do we choose the "traditional" health plan, which costs a few more dollars each month but allows more freedom-of-choice among doctors and hospitals; or do we choose the "managed care/HMO" plan, which likely has lower monthly premiums but less flexibility?  Some companies have shifted entirely to "managed care" plans, because they are less expensive and costs can be controlled more easily.  There is a reason why the acronym "HMO" is considered a curse word by many people.  Some of the fear of a government-run or government-regulated health care system is because of bad experiences with HMO's.  Many people in the U.S. want to "manage" their own health care, to the extent that is possible.

In most cases, employee-provided health insurance is an option--not a requirement.  Some (foolish) people opt not to get it, because they 1) think they are invincible and/or 2) are unwilling to pay the up-front costs.  Later, of course, many of them regret their short-sightedness, as they are counted among the uninsured.  Similarly, some people who choose the less expensive plans regret that decision later, when they learn their plan does not provide the extent of coverage they need or their out-of-pocket costs begin to climb.  Choices, choices... 

In the U.S., even people who are not eligible for insurance through employment can buy private health insurance, sometimes through a group plan (which is cheaper than individual policies).  Sure, it costs money; and of course, some people simply cannot afford it.

People who truly cannot afford health insurance because they are indigent are usually eligible for a government-run plan, like Medicare, Medicaid and CHIP.  But, those plans are not free either.  Often there are monthly premiums, as with Medicare for retirees; also, every single one of us has money taken out of our paychecks to subsidize those programs.  And, the doctors and hospitals shoulder part of the burden, as their reimbursements can be absurdly low.  (Doctors can "opt out" of participation in Medicare, which is a really scary possibility.)

One cannot take a health care system, such as "the Canadian approach", and simply plug it into another country's politico-socioeconomic structure, assuming it will work.  There are too many variables, and too many subtle differences.  As similar as the U.S. and Canada seem, we really are not that much alike.  We have very different philosophies about many issues, particularly those concerning individual freedom, a free-market economy, and the optimal role of government in society.  At least, that's my understanding.  I could be totally wrong, of course.

otter 

My own experience of health insurance (provided with certain jobs here - but not really commonplace.)

It wasn't great.  It was ok-ish for grumbling complaints, but I wouldn't even think of going near it for serious illness.  One usually had to argue with twerps over every single point and they weren't polite.  However, it was good to have the cover because for non-urgent health problems, the NHS is not always good and you wait for ages for everything.   When I am not covered by insurance plans (frequent) I just pay out of income if I really need to go "private".  I wouldn't bother having a private insurance policy for the very reason that it wouldn't be great for "big illness".  Usually I am in a position to spend the money without trouble.  Now I have been made redundant, things like osteo appointments are a wee bit pricey but worth it. 

There are NHS staff who are deeply resentful toward private healthcare, and have no compunction about voicing their views.  The particular individuals usually think healthcare is free.  They don't seem to connect it with paying taxes. 

As you can see,  here we are coming at things from a totally different direction to your goodselves.

France has a sort of hybrid system which has a bit of insurance and a bit of "nhs".  As far as I know, our French neighbours are pretty happy with their healthcare.

 Shirley's post above showing the BBC comments is alas, all too true.  And this recession will mean big cutbacks across the board.  For years to come.  The mismanagement of our economy is going to cause great pain to my country and much of this was avoidable.

I am fortunate that I am at a specialist cancer hospital.   If you were living in a rural area a long way from London, I think this would be almost impossible.

For my own part, I think there is terrible monetary waste in the NHS, but this is commonplace in any large government organisations.  The management of hospitals are frequently at oddswith the medical staff.  In particular this is wrong and needs changing.  That is what the Director post would be concerned with for me, but really as it is only a non-exec role I am not convinced I could effect any useful changes and am not interested in having a cup of coffee once every 4 months!

I have to say that I do find it extremely annoying that in England, incomers can get free healthcare very quickly.  In particular, it annoys me that elderly people in this country are not treated with respect and the money spent on newcomers really should be apportioned first of all to our indigenous old people.  We ave an island still called Britain because their generation fought for it.  Above everyone, they are due our respect.

I should point out here though, that we have many dedicated and talented people working in the NHS.  Wehave very good research scientists here too.   It is not all doom and gloom.  Good things happen all the time.  But even so, adjustments really do need to be made.

I think whatever our viewpoints or experience, it is clear we all feel strongly that the aree of health and medicine is paramount.  All of us happen to share the same illness, but I imagine we were already passionate on this topic.

 Many thanks for sharing your knowledge and ideas.

I wish you all very well on your journey -

We also choose insurance for things like drugs, eyeglasses, dental care, physiotherapy, etc.  In Ontario none of these things are covered so if you have employer insurance that's fine otherwise one needs to decide on insurance and you can get a Ford or BMW of insurance, or none.  I think that if you are on welfare some of those things are covered.  So there is an area of similarity.

And I don't think many people here call it free health care, we know perfectly well how it is paid for.

I'm not so sure I would welcome that in Canada.  You can already get insurance for a private or semi-private room.  Read the post from the London person, there the combo doesn't seem to be working all that well.  It appears that the private and public compete with each other and competition isn't always beneficial.  Actually I think we have an advantage over the Europeans being next to the US.  Rich people can fly off and pay (like Belinda).  The only ones clamoring for the second tier are the ones who will profit. 

 I suspect that medical tourism is going to be the next big blow to health care.  Many of those doctors in Manilla and India were trained in North Am. and Europe.  The facilities are fine and for routine things, they can do them at 20% of the price.  If you have the money and don't want to wait for your hip replacement or don't have insurance or your insurance has a big co-pay - go to India.  People are doing it now and they will probably do it more for elective stuff.