I wonder how burdensome it is to even get the tool fully integrated into the ehr. Like are the doctors not using it because it requires manual input of drugs and insurance? Even then, the doctors aren’t necessarily getting paid more for doing this extra work; it’s the payer (insurance) company that is primarily benefiting.
To be clear, I am acutely aware of just how hard it is to get this sort of thing working (MS in health Econ, phd in biomedical and clinical informatics). Just keeping track of all the formularies seems like a pain just to to begin with!
I too am aware of hard solutions are in reality (or "reality"). Still, I believe we should be acutely aware that the need for doctors to get "tools" just to deal with drug prices is an indication of how off-kilter our society's approach to health care has become.
Well due to the rise of EHR and other tech complexities, many doctors are just joining mega-groups/networks that handle their IT just so they don't have to deal things such as integration.
The era of independent doctors is basically coming to a very fast end.
Where I live, there are two competing networks of doctors now that have basically absorbed thousands of doctors in the last 4 years with their signs literally plastered everywhere now.
Yay because arguably it's the only way doctor offices are going to keep up with ever changing tech.
Nay because Americans are going to get fucked in the ass even more by uncontrollable healthcare when the doctors networks become cartels.
My long-time primary care doctor recently told me to find a new one. He’s going to continue practicing his specialty. But he said dealing with the computer systems was too much effort for his small office to continue handling primary care patients.
There's a certain chicken or egg among health economists for the role of HITECH requirements resulting in consolidation [1, 2]. On one hand, these HITECH requirements put additional technological reporting, which may be a driver of consolidation (though this was in large part 'paid' for if you adopted early). On the other hand, centralization of IT services can produce economies of scale, especially if you're a small community hospital that has a small community hospital budget (aka narrow). Hell, you even see the trend of inter-UC health hosting the EHR instance for another UC [3].
In either case, the major role of healthcare consolidation has been to keep up with insurance consolidation, which is to keep up with hospital consolidation, and so on [4].
> Yay because arguably it's the only way doctor offices are going to keep up with ever changing tech.
Keeping up with the tech is not the problem, it's keeping up with the ever changing regulations, many of which do relate to EHR. You basically need dedicated staff to handle the bureaucratic processes, which is only affordable for large organizations.
It is not. For example, BlinkHealth created a widget for athena's EMR.
The caveaat that it would only show Blink's price, which was actually not the insurance price (they are not insurance but instead a PBM pass thru, cheaper-than-usual cash price). The data point was not comprehensive, of course... But my point still stands
"Doctors slow to..." Implies all doctors. Then the article begins with an emotional story about one patient.
Statistical facts don't come from an emotional argument. That's what politicians and marketers do.
What's more likely: that the hardest working, highest average IQ professionals are slow to adopt something that would help them save their patient's lives? Or that the writer of the article is biased and exaggerating things?
This kind of generalization is normally read as "Typically, doctors [as a profession] are slow to…" rather than "Literally every doctor is slow to…". TFA supports that statement with a metric and some reasons why.
> What's more likely: that the hardest working, highest average IQ professionals are slow to adopt something that would help them save their patient's lives? Or that the writer of the article is biased and exaggerating things?
The former. Most doctors work within systems, and can't just start using new tools they think look neat. Instead, they use approved (often mandated) tools.
> This kind of generalization is normally read as "Typically, doctors [as a profession] are slow to…"
Medical professionals need to be slow to adopt alternatives because they are required (and expected) to be highly reliable. Just because there's a particular industry where rebuilding the whole infrastructure every 6 months without fear of any consequence is considered normal or even desirable, that does not mean the rest of the world should or even could operate likr that.
Medicine is currently conservative by design. ‘First, do no harm’.
This approach has pros and cons: too slow to adopt surgeon hand-washing, but too fast to adopt Thalidomide. A few thousand years of experience has led us to err on he side of being conservative these days.
Combine this culture with lack of spare time for young doctors, lack of immediate incentives to save patient money, and lack of exposure to IT innovations, and I can totally see them being slow to adopt new tech.
>the hardest working, highest average IQ professionals are slow to adopt something that would help them save their patient's lives?
This is already the case with checklists, which are proven to save lives but resisted by many doctors:
https://www.newscientist.com/article/2090554-not-all-surgeon... . In my limited experience with doctors a non-insignificant proportion seem to care more about their own ego than saving lives (the kind of people who would bring up their own IQ in a discussion).
Medical error is apparently the third largest cause of death in the US (https://www.cnbc.com/2018/02/22/medical-errors-third-leading...), and surgical checklists have been shown to reduce error rates by 40%: https://www.theguardian.com/society/2009/jan/14/health. In any other profession it would be completely unacceptable to refuse to use a technique like checklists on the grounds that "I don't make silly mistakes"; imagine if an engineer working on safety-critical equipment said "My code doesn't need any testing because I don't make mistakes".
I use checklists extensively, however I'm wondering if mandatory checklists would have the same effect.
I have checklists for holiday packing with different sub checklists for beach, ski, etc vacation.
At work there are checklists for code review that I personally find don't help. Why? I didn't make that checklist myself. It's a checklist basically containing every mistake anyone ever made that could have or should have been caught in review.
This leads to a checklist of hundreds of Well-d'uhs, because a lot of people make many silly mistakes.
I have a personal review checklist with the things I often forget. I think checklists only work if they're full of pertinent information, and for many professions I think that depends on the person using the checklist and whether they're motivated to use it or obliged to.
I worked at a company that used mandatory checklists for some operational roles, they definitely cut down on the number of mistakes (at least the mistakes the checklist was crafted to address). It made people more accountable: whereas previously a certain mistake might be human error (unavoidable), if it still happened after the checklist then either somebody didn't fill out the checklist (and could be punished for negligence) or lied by checking a box on checklist without actually doing the thing (and could be severely punished for dishonesty). This motivated people to thoroughly check the things.
The guardian article linked by the parent says the check list used was two minutes and asked basic questions like “patient has confirmed procedure being performed today”.
>"Doctors slow to..." Implies all doctors. Then the article begins with an emotional story about one patient. Statistical facts don't come from an emotional argument. That's what politicians and marketers do.
At this point I go into every news article fully expecting it to be an attempt by the author to manipulate me.
I don't understand. The article is about a pricing tool. The "might" is that it can't give useful price information for all kinds of insurance. It doesn't seem all that horrific that it might not be able to give useful pricing information for every single patient...?
Doctors schedules are already tight as it is and I’m not sure what benefit there is to the doctor to spend the precious extra minutes looking to see whether they might be able to save their patients some money before prescribing a drug.
Because by saving the patient that sum of money said patient will maybe have enough funds to come visit said doctor for a second time (or a 3rd, or a 4th), instead of postponing the visit for financial reasons.
In other words, if a doctor prescribes me a $1000 medicine instead of a $500 one, and a visit to said doctor costs $500, I might not visit him a second time because I've already paid $1000 for the medicine and I don't have enough money for my health anymore. Not visiting your doctor when you need it (for whatever reasons) is bad for the patient.
That’s not a very strong incentive. I’m not really sure that’s an incentive at all. Most doctors have more than enough appointments. Their schedules are overbooked.
But even if doctors who needed more patient bookings could attract those bookings by saving patients money then logic would follow that doctors who have room in their schedule would consistently use the app from the article. Yet most doctors aren’t using it at all.
So even if your premise is correct I think you’re greatly overestimating the surplus supply of doctors appointments and underestimating how steep/inelastic the demand curve is for healthcare.
Mostly unrelated, is saying “surplus supply” redundant? I can’t decide.
The most valuable asset a doctor has is the trust of their patients. Not going to risk that for a half-baked product with lukewarm support from its developer and a weak endorsement from NPR.
Even if this product could aggregate data from all the PBMs, that doesn't mean the drug will be in stock at a patient's local pharmacy.
Furthermore, there are many commonly prescribed drugs that are cheaper to buy outright using a discount program (not insurance). Also, there are manufacturer-to-patient rebates offered for some brand name drugs without a generic.
In short, there's a lot more information that doctors already factor into their decision-making process. This tool is not compelling enough to bring into the mix.
To me it seems insane that a doctor should care about the price of necessary medicines they're prescribing.
If the insurance is available, and so good, then they should handle the payment stuff. A doctor should be learning about treatment, research and patients, not which company has the cheapest drugs this month.
For drugs that are new enough not to be available as generics, insurance companies typically have a "formulary" that specifies which drugs they will pay for and what the requirements are for them to pay for it. It might specify conditions like "we will only[0] cover drug Y from the class of drugs X" where drug Y is manufactured by AbbMerquibb and has negotiated a good price with the insurance company, or "we will only pay for drugs from class X after the cheaper frontline treatment Y has been tried and failed".
Doctors prescribe specific drugs. They don't prescribe "whatever SLGT-2 inhibitor your insurance plan covers". They also don't prescribe "whatever your approved first-line therapy for rheumatoid arthritis is". If doctors prescribe without caring about the cost to their patients, the best case scenario is that those patients come back for another prescription after the pharmacy tells them that their drug will cost $$$$ because insurance is not covering it. The worst case scenario is that the patients don't come back and decide they can't afford to have their condition treated.
[0] Barring patient intolerance to the preferred drug or various other exceptions.
Why would they be fast? It's not their money. The incentive is not there. Meanwhile on the other side switching anything is work. Of course it doesn't get done super quick.
America is slow to adopt collective, independent negotiating of medical, hospital and prescription charges as happens in insurance, Medicare/Medicaid/Tricare. Med4all would solve this, rather than hunting around for big pharma "sales" and "promotions."
The NHS in the UK pays much lower prices for most drugs than the insurers do (there are the odd egregious cases where a company take the piss, the interesting thing is that we do actually fine them in a rare case of consequences been applied) because simply put they are negotiating for 65 million consumers in one go, if the NHS price is high enough for them to make a healthy profit per patient it is a no brainer.
The system requires numerous feedback loops and clinical overview (ours is called NICE - National Institute of Clinical Excellence).
Is it perfect, no, few human things are.
Is it massively preferable to the average healthcare situation for Americans - hell yes it is.
I pay for my prescriptions which is £9 per drug per month (whatever the cost to the NHS of that drug is), I take 3 drugs so that should be £27 per month except they considered that case and I buy a NHS Pre-Payment Card which costs me about £10 a month and covers me for any number of medications. [1]
So for £10 a month I get the routine medications I need to make my life not just bearable but enjoyable which allows me to work.
So if costs controls in government are your concern the elect better people with better systems.
Lest anyone think I'm all sunshine and roses on the NHS, it requires drastic reformation (and they really really need to get rid of their 'internal market' way of running) but the idea is as sound now as it was in 51 years ago (almost to the day, it was founded July 5th 1948).
You would think that the government gains “leverage” by being the only payer. In practice in the US, this is not what happens. Rampant lobbying (i.e. legal bribery) by interested parties causes spending to spiral out of control, since the benefits are focused and the costs are diffuse.
Arguably the NHS model is the only way to get government healthcare to work at all in the US. You would need to gut both private insurance and private hospitals, whose continued political clout would naturally drive up costs if they were allowed to continue existing in their current form.
(In fact, there is already an “NHS-like” example in the US: VA Hospitals for veterans. I’m not sure what we can learn from them, however, as lessons from treating the veteran population may not be able to be extrapolated to the other 300+ million of us.)
The VA had a massive scandal recently. For years, they had chronic problems with timely follow ups and treatment (ergo. Last resort). They were put on notice to improve their patient turnaround times. Miracle ensued -wait times did go down. But as always, bureaucrats played with stats: they achieved the drop by literally IGNORING veterans seeking medical service and appointments. They would simply find a reason to not log the event at all. This went on for the better part of the year when veterans started dying in greater numbers and someone blew the whistle. Claims of reform were made. No one got fired until trump got elected.yet now we start all over again.
> Is it massively preferable to the average healthcare situation for Americans - hell yes it is.
Your average American has employer-paid health insurance, which covers most of their costs. According to the OECD, average out-of-pocket healthcare expenditure in the U.S. is $1,370, versus $629 in the U.K. https://data.oecd.org/healthres/health-spending.htm. Keep in mind that median household disposable (post-tax) income in the U.S. is $45,000, versus $29,000 in the U.K.
The point is that "some people" is not "average". If we are going to talk about the problems with health care in the US exaggerating the problems is counterproductive.
"The american system is bad for the poor or unlucky" is a very different argument than "the american system is bad for the average person."
The difference in median disposable income between the U.S. and the U.K. is stunning: almost $17,000. Even after you factor in things like student loan debt (averaging $220/month for the minority of people who have student loans at all) and out-of-pocket healthcare expenses and premiums (a few thousand a year on average, versus maybe a thousand or so in other OECD countries), the median American household is coming out way ahead.
Child mortality rates in the US 5.9 per 1000, In the UK 3.8. [1]
> Two-thirds of people who file for bankruptcy cite medical issues as a key contributor to their financial downfall. [2]
United Kingdom suicide rate per 100,000 7.5, United States 13.8 [3]
United States Murder Rate per 100,000 5.35, United Kingdom 1.2 [4]
More to life than money I guess, also your $17,000 is accounting for income distribution, at first glance that looks good but while our income distribution is pretty bad, the US is positively Dickensian.
No jingoism intended here, we get a lot wrong and other countries straight up kick our arse (Spain's infant mortality rate is half ours at 2.0 for example amongst major European countries) but that just means we should be looking to improve.
As to income distribution: that’s the OECD’s estimate of the median household. So it’s not being skewed up by super-rich households.
As to bankruptcies, less than 0.5% of households file for bankruptcy in a given year.
As to homicide or suicide rate: again, that affects a tiny minority. Meanwhile, the much higher income affects 60-70% of the whole population.
The U.K. is a society where you’ve lowered the median to lift up the floor. That’s one way to do it. And I don’t even disagree with you that the US should do more in that regard. But if you support an expanded welfare state (and I do), it’s dishonest to sell that policy to people by pretending that the average person is going to be better off. Unless they place a very high value on security (avoiding low probability outcomes like medical bankruptcy) over material comfort, they’re going to be worse off.
I would dearly love to know what they are including to get an average UK spend of $629. From a brief scan of sources and data set they don't appear break it down any further.
More in the UK get free prescriptions than don't. Even with the most involved care I can't find a way to make it that expensive. So maybe they're including people voluntarily paying some treatment not available on the NHS like homeopathy or unproven experimental treatments, or private insurance generally. Maybe they count dentistry as healthcare.
Prescription charges for some, hospital parking, drinks machine... Unless you include something else it doesn't add up.
I am not going to advocate against negotiating lower prices.
However, i should point out that one reason the NHS drug benefit (and that of mostly every country) is not completely broken and obsolete is because USA effectively subsidizes research for drugs that the rest of the world then copies
Nonsense. This is typical for someone that is uninformed on the dynamics of the industry. Only such a person would volunteer that the solution to the problem is... what created the problem in the first place: government
- it is regulation, not america being "slow" which prevents medicare from negotiating further discounts on drugs
- it is regulation, not america being "slow" which gives practicioners a bona fide monopoly on the market and prevents unfunded apprentices to join
- it is regulation, not america being "slow" which prevents, in most jurisdictions , anyone from opening a hospital unless you get approval of the.... incumbent hospital first. Yes you read that right
We are not slow. The problem is the regulatory machine was fast and working 24/7
The industry is medieval. I had to get a CT scan in the ER while traveling once and the only way the medical records office could communicate to get the scan was fax or email, and they sent me the images by mailing a CD (in 2018)!
What's wrong with using email to communicate with the medical records office?
And as CT scans are private information, why would you assume it would be Ok to make them available through a public server and send them over the internet?
> And as CT scans are private information, why would you assume it would be Ok to make them available through a public server and send them over the internet?
Encryption. A magical tool to make sure things are not available to anyone just because they are available on the Internet. Email on the other hand is so insecure (and cannot be easily encrypted, because many popular programs/email-providers don't support it) that a server sounds like a far better idea.
edit/expanded: I have seen all variants here. Usually you go to another hospital, so they don't have all your things. If this is planned I have all the things I got with me, so the doctors have to filter, sort and scan them (every hospital has to do this again), but at least they have something to start with.
Often the other hospital also sent something before you arrive if this is a planned cooperation. Maybe these two things together are enough, sometimes they are not. If it's just a report the current hospital can ask for it from the other and they get it faxed. But maybe it's a CT, MRT or whatever scan. These things are big, so they get send per courier, which takes time. Now you have to maybe wait longer for whatever you are there for. In extreme cases it can go down to "I here have what you want and you need it now, so you ask me questions over the phone and I answer you" which is asking for all kinds of problems. All in all the current process is slow, involves repeating work and leads to not everyone having the whole picture.
The need to make sure all these private data are safe is very real, but though is the need to get better than this system, cause it doesn't work well and we know that something better is possible here.
My experience with such a system has been that it would quote ridiculously high prices for generic medications, so I'd simply tell patients their drug is on the $4 list at WalMart. An information source that's unreliable is worse than no information at all, since it poisons the well for competing systems.
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[ 62.9 ms ] story [ 1571 ms ] threadTo be clear, I am acutely aware of just how hard it is to get this sort of thing working (MS in health Econ, phd in biomedical and clinical informatics). Just keeping track of all the formularies seems like a pain just to to begin with!
Where I live, there are two competing networks of doctors now that have basically absorbed thousands of doctors in the last 4 years with their signs literally plastered everywhere now.
Yay because arguably it's the only way doctor offices are going to keep up with ever changing tech. Nay because Americans are going to get fucked in the ass even more by uncontrollable healthcare when the doctors networks become cartels.
In either case, the major role of healthcare consolidation has been to keep up with insurance consolidation, which is to keep up with hospital consolidation, and so on [4].
[1]. https://www.hhs.gov/hipaa/for-professionals/special-topics/h...
[2]. https://www.healthaffairs.org/do/10.1377/hblog20190304.99820...
[3]. https://cio.ucop.edu/making-epic-history-ucsd-and-uci-health...
[4]. https://www.healthaffairs.org/doi/full/10.1377/hlthaff.22.6....
Keeping up with the tech is not the problem, it's keeping up with the ever changing regulations, many of which do relate to EHR. You basically need dedicated staff to handle the bureaucratic processes, which is only affordable for large organizations.
The caveaat that it would only show Blink's price, which was actually not the insurance price (they are not insurance but instead a PBM pass thru, cheaper-than-usual cash price). The data point was not comprehensive, of course... But my point still stands
Puff pieces are a dime a dozen.
What's more likely: that the hardest working, highest average IQ professionals are slow to adopt something that would help them save their patient's lives? Or that the writer of the article is biased and exaggerating things?
This kind of generalization is normally read as "Typically, doctors [as a profession] are slow to…" rather than "Literally every doctor is slow to…". TFA supports that statement with a metric and some reasons why.
> What's more likely: that the hardest working, highest average IQ professionals are slow to adopt something that would help them save their patient's lives? Or that the writer of the article is biased and exaggerating things?
The former. Most doctors work within systems, and can't just start using new tools they think look neat. Instead, they use approved (often mandated) tools.
Medical professionals need to be slow to adopt alternatives because they are required (and expected) to be highly reliable. Just because there's a particular industry where rebuilding the whole infrastructure every 6 months without fear of any consequence is considered normal or even desirable, that does not mean the rest of the world should or even could operate likr that.
This approach has pros and cons: too slow to adopt surgeon hand-washing, but too fast to adopt Thalidomide. A few thousand years of experience has led us to err on he side of being conservative these days.
Combine this culture with lack of spare time for young doctors, lack of immediate incentives to save patient money, and lack of exposure to IT innovations, and I can totally see them being slow to adopt new tech.
This is already the case with checklists, which are proven to save lives but resisted by many doctors: https://www.newscientist.com/article/2090554-not-all-surgeon... . In my limited experience with doctors a non-insignificant proportion seem to care more about their own ego than saving lives (the kind of people who would bring up their own IQ in a discussion).
Medical error is apparently the third largest cause of death in the US (https://www.cnbc.com/2018/02/22/medical-errors-third-leading...), and surgical checklists have been shown to reduce error rates by 40%: https://www.theguardian.com/society/2009/jan/14/health. In any other profession it would be completely unacceptable to refuse to use a technique like checklists on the grounds that "I don't make silly mistakes"; imagine if an engineer working on safety-critical equipment said "My code doesn't need any testing because I don't make mistakes".
I have checklists for holiday packing with different sub checklists for beach, ski, etc vacation.
At work there are checklists for code review that I personally find don't help. Why? I didn't make that checklist myself. It's a checklist basically containing every mistake anyone ever made that could have or should have been caught in review.
This leads to a checklist of hundreds of Well-d'uhs, because a lot of people make many silly mistakes.
I have a personal review checklist with the things I often forget. I think checklists only work if they're full of pertinent information, and for many professions I think that depends on the person using the checklist and whether they're motivated to use it or obliged to.
At this point I go into every news article fully expecting it to be an attempt by the author to manipulate me.
You'd be hard-pressed to find many docs (myself included) who are champing at the bit to adopt an informational resource with knowledge gaps.
In other words, if a doctor prescribes me a $1000 medicine instead of a $500 one, and a visit to said doctor costs $500, I might not visit him a second time because I've already paid $1000 for the medicine and I don't have enough money for my health anymore. Not visiting your doctor when you need it (for whatever reasons) is bad for the patient.
But even if doctors who needed more patient bookings could attract those bookings by saving patients money then logic would follow that doctors who have room in their schedule would consistently use the app from the article. Yet most doctors aren’t using it at all.
So even if your premise is correct I think you’re greatly overestimating the surplus supply of doctors appointments and underestimating how steep/inelastic the demand curve is for healthcare.
Mostly unrelated, is saying “surplus supply” redundant? I can’t decide.
Even if this product could aggregate data from all the PBMs, that doesn't mean the drug will be in stock at a patient's local pharmacy.
Furthermore, there are many commonly prescribed drugs that are cheaper to buy outright using a discount program (not insurance). Also, there are manufacturer-to-patient rebates offered for some brand name drugs without a generic.
In short, there's a lot more information that doctors already factor into their decision-making process. This tool is not compelling enough to bring into the mix.
If the insurance is available, and so good, then they should handle the payment stuff. A doctor should be learning about treatment, research and patients, not which company has the cheapest drugs this month.
Doctors prescribe specific drugs. They don't prescribe "whatever SLGT-2 inhibitor your insurance plan covers". They also don't prescribe "whatever your approved first-line therapy for rheumatoid arthritis is". If doctors prescribe without caring about the cost to their patients, the best case scenario is that those patients come back for another prescription after the pharmacy tells them that their drug will cost $$$$ because insurance is not covering it. The worst case scenario is that the patients don't come back and decide they can't afford to have their condition treated.
[0] Barring patient intolerance to the preferred drug or various other exceptions.
https://www.walmart.com/cp/$4-prescriptions/1078664
The system requires numerous feedback loops and clinical overview (ours is called NICE - National Institute of Clinical Excellence).
Is it perfect, no, few human things are.
Is it massively preferable to the average healthcare situation for Americans - hell yes it is.
I pay for my prescriptions which is £9 per drug per month (whatever the cost to the NHS of that drug is), I take 3 drugs so that should be £27 per month except they considered that case and I buy a NHS Pre-Payment Card which costs me about £10 a month and covers me for any number of medications. [1]
So for £10 a month I get the routine medications I need to make my life not just bearable but enjoyable which allows me to work.
So if costs controls in government are your concern the elect better people with better systems.
Lest anyone think I'm all sunshine and roses on the NHS, it requires drastic reformation (and they really really need to get rid of their 'internal market' way of running) but the idea is as sound now as it was in 51 years ago (almost to the day, it was founded July 5th 1948).
[1] https://apps.nhsbsa.nhs.uk/ppc-online/patient.do
Arguably the NHS model is the only way to get government healthcare to work at all in the US. You would need to gut both private insurance and private hospitals, whose continued political clout would naturally drive up costs if they were allowed to continue existing in their current form.
(In fact, there is already an “NHS-like” example in the US: VA Hospitals for veterans. I’m not sure what we can learn from them, however, as lessons from treating the veteran population may not be able to be extrapolated to the other 300+ million of us.)
You can’t sue the government unless they decide to allow it, so at least we’ll see the end of malpractice suits. /sarc
VA is not what you want for USA
Your average American has employer-paid health insurance, which covers most of their costs. According to the OECD, average out-of-pocket healthcare expenditure in the U.S. is $1,370, versus $629 in the U.K. https://data.oecd.org/healthres/health-spending.htm. Keep in mind that median household disposable (post-tax) income in the U.S. is $45,000, versus $29,000 in the U.K.
One case is the obvious cost of having a child in America, even with insurance some people pay thousands of dollars.
Is inequality not a problem, because on average we all have the same opportunities?
The difference in median disposable income between the U.S. and the U.K. is stunning: almost $17,000. Even after you factor in things like student loan debt (averaging $220/month for the minority of people who have student loans at all) and out-of-pocket healthcare expenses and premiums (a few thousand a year on average, versus maybe a thousand or so in other OECD countries), the median American household is coming out way ahead.
> Two-thirds of people who file for bankruptcy cite medical issues as a key contributor to their financial downfall. [2]
United Kingdom suicide rate per 100,000 7.5, United States 13.8 [3]
United States Murder Rate per 100,000 5.35, United Kingdom 1.2 [4]
More to life than money I guess, also your $17,000 is accounting for income distribution, at first glance that looks good but while our income distribution is pretty bad, the US is positively Dickensian.
No jingoism intended here, we get a lot wrong and other countries straight up kick our arse (Spain's infant mortality rate is half ours at 2.0 for example amongst major European countries) but that just means we should be looking to improve.
[1] https://data.oecd.org/healthstat/infant-mortality-rates.htm
[2] https://www.cnbc.com/2019/02/11/this-is-the-real-reason-most...
[3] https://data.oecd.org/healthstat/suicide-rates.htm#indicator...
[4] https://en.wikipedia.org/wiki/List_of_countries_by_intention...
As to income distribution: that’s the OECD’s estimate of the median household. So it’s not being skewed up by super-rich households.
As to bankruptcies, less than 0.5% of households file for bankruptcy in a given year.
As to homicide or suicide rate: again, that affects a tiny minority. Meanwhile, the much higher income affects 60-70% of the whole population.
The U.K. is a society where you’ve lowered the median to lift up the floor. That’s one way to do it. And I don’t even disagree with you that the US should do more in that regard. But if you support an expanded welfare state (and I do), it’s dishonest to sell that policy to people by pretending that the average person is going to be better off. Unless they place a very high value on security (avoiding low probability outcomes like medical bankruptcy) over material comfort, they’re going to be worse off.
More in the UK get free prescriptions than don't. Even with the most involved care I can't find a way to make it that expensive. So maybe they're including people voluntarily paying some treatment not available on the NHS like homeopathy or unproven experimental treatments, or private insurance generally. Maybe they count dentistry as healthcare.
Prescription charges for some, hospital parking, drinks machine... Unless you include something else it doesn't add up.
I have two serious conditions and it costs me a quarter of that.
However, i should point out that one reason the NHS drug benefit (and that of mostly every country) is not completely broken and obsolete is because USA effectively subsidizes research for drugs that the rest of the world then copies
- it is regulation, not america being "slow" which prevents medicare from negotiating further discounts on drugs - it is regulation, not america being "slow" which gives practicioners a bona fide monopoly on the market and prevents unfunded apprentices to join - it is regulation, not america being "slow" which prevents, in most jurisdictions , anyone from opening a hospital unless you get approval of the.... incumbent hospital first. Yes you read that right
We are not slow. The problem is the regulatory machine was fast and working 24/7
And as CT scans are private information, why would you assume it would be Ok to make them available through a public server and send them over the internet?
Encryption. A magical tool to make sure things are not available to anyone just because they are available on the Internet. Email on the other hand is so insecure (and cannot be easily encrypted, because many popular programs/email-providers don't support it) that a server sounds like a far better idea.
edit/expanded: I have seen all variants here. Usually you go to another hospital, so they don't have all your things. If this is planned I have all the things I got with me, so the doctors have to filter, sort and scan them (every hospital has to do this again), but at least they have something to start with.
Often the other hospital also sent something before you arrive if this is a planned cooperation. Maybe these two things together are enough, sometimes they are not. If it's just a report the current hospital can ask for it from the other and they get it faxed. But maybe it's a CT, MRT or whatever scan. These things are big, so they get send per courier, which takes time. Now you have to maybe wait longer for whatever you are there for. In extreme cases it can go down to "I here have what you want and you need it now, so you ask me questions over the phone and I answer you" which is asking for all kinds of problems. All in all the current process is slow, involves repeating work and leads to not everyone having the whole picture.
The need to make sure all these private data are safe is very real, but though is the need to get better than this system, cause it doesn't work well and we know that something better is possible here.