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One thing I observed is that both countries got less different over the years: If you look at the policies regarding the social-net, Europe has tried to become

by yardie 14y ago

One thing I observed is that both countries got less different over the years: If you look at the policies regarding the social-net, Europe has tried to become more american (http://en.wikipedia.org/wiki/Hartz_concept http://en.wikipedia.org/wiki/Hartz_concept) while the US has tried to become more european (http://en.wikipedia.org/wiki/Affordable_Health_Care_for_Amer... http://en.wikipedia.org/wiki/Affordable_Health_Care_for_Amer...). Countries in the EU have a mandate to bring down public debt and the easiest place to do that is the welfare system (depending on the economy, most voters think it's too generous in some cases). Since social welfare is so large in Europe there are many places you can "trim". In the US this is not the case at all. The welfare system has gotten aggressively more meager since the 80s. The AHCAA also isn't about more benefits but cutting public expenditure on healthcare in the long run. It's ridiculously expensive to treat someone in the ER for an infection rather than them having regular doctor visits. The same for birth control, pap smears, and breast exams. Treating early saves the government money. Don't confuse this act with the European welfare system, it is absolutely about saving money for the govt, your health is side benefit.

yummyfajitas 14y ago
It's ridiculously expensive to treat someone in the ER for an infection rather than them having regular doctor visits. No, it's billed at ridiculously high rates. That's not the same thing. ER docs are not paid that much more than primary care docs. The cost of treating an infection in the ER is 1 hour of a doctor's time + drugs. The cost of a regular doctor visit is also 1 hour of the doctor's time + drugs. The hospital might bill at some ridiculous rate, but that doesn't mean it costs a lot. Breast exams are actually well known not to be cost effective (or even beneficial) for women under 50 (though oddly, congress demands they be provided). The idea that early action is always better is silly.
- eru 14y ago
  I agree broadly. Some minor points: You are probably right about the direct labour costs of treating an infection in ER. However, to use the language of computing, the difference between a GP and ER comes down to latency. An ER should be able to react fast, clogging it up with ailments that could be resolved at a leisurely pace earlier, doesn't strike me as a good idea.
  - yummyfajitas 14y ago
    An ER should be able to react fast, clogging it up with ailments that could be resolved at a leisurely pace earlier, doesn't strike me as a good idea. Fortunately this is a solved problem - the solution is called "triage". No matter how many coughing people are ahead of you in the queue, spurting blood gets immediate treatment.
- yardie 14y ago
  When you go into an ER for an infection you know it's going to be expensive so you wait until the infection has advanced pretty far. Now it's far from 1 hour and may require many days of 24 hour monitoring. While the hospital might be expensive what are you paying for? 24 hour availability, rapid response, and knowledgable staff. Something that most GPs don't provide. Breast exams are actually well known not to be cost effective Please provide a citation. The idea that early action is always better is silly. So dying from easily treatable diseases (when they are caught) is so much better.
  - yummyfajitas 14y ago
    Please provide a citation. http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca... http://www.bloomberg.com/news/2012-07-31/in-mammogram-debate-politics-trounces-science.html http://www.bloomberg.com/news/2012-07-31/in-mammogram-debate...
    - yardie 14y ago
      Your link doesn't say that the screenings aren't cost-effective. It says that if you are in a certain age group these are the recommended amount you should do <40: 2-3 years, 40-49: 2 years, 50-74:1 1 year, 75+: none. Annual screenings were too aggressive, not ineffective.
      - yummyfajitas 14y ago
        "In conclusion, the USPSTF reasoned that the additional benefit gained by starting screening at age 40 years rather than at age 50 years is small, and that moderate harms from screening remain at any age...The USPSTF notes that a "C" grade is a recommendation against routine screening of women aged 40 to 49 years." Note that this recommendation is solely on medical grounds - that is, the medical cost/benefit ratio suggests routine screenings for women < 49 is pointless. They don't even take into account the financial cost.

by yardie 14y ago

yummyfajitas 14y ago

It's ridiculously expensive to treat someone in the ER for an infection rather than them having regular doctor visits. No, it's billed at ridiculously high rates. That's not the same thing. ER docs are not paid that much more than primary care docs. The cost of treating an infection in the ER is 1 hour of a doctor's time + drugs. The cost of a regular doctor visit is also 1 hour of the doctor's time + drugs. The hospital might bill at some ridiculous rate, but that doesn't mean it costs a lot. Breast exams are actually well known not to be cost effective (or even beneficial) for women under 50 (though oddly, congress demands they be provided). The idea that early action is always better is silly.

eru 14y ago
I agree broadly. Some minor points: You are probably right about the direct labour costs of treating an infection in ER. However, to use the language of computing, the difference between a GP and ER comes down to latency. An ER should be able to react fast, clogging it up with ailments that could be resolved at a leisurely pace earlier, doesn't strike me as a good idea.
- yummyfajitas 14y ago
  An ER should be able to react fast, clogging it up with ailments that could be resolved at a leisurely pace earlier, doesn't strike me as a good idea. Fortunately this is a solved problem - the solution is called "triage". No matter how many coughing people are ahead of you in the queue, spurting blood gets immediate treatment.
yardie 14y ago
When you go into an ER for an infection you know it's going to be expensive so you wait until the infection has advanced pretty far. Now it's far from 1 hour and may require many days of 24 hour monitoring. While the hospital might be expensive what are you paying for? 24 hour availability, rapid response, and knowledgable staff. Something that most GPs don't provide. Breast exams are actually well known not to be cost effective Please provide a citation. The idea that early action is always better is silly. So dying from easily treatable diseases (when they are caught) is so much better.
- yummyfajitas 14y ago
  Please provide a citation. http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca... http://www.bloomberg.com/news/2012-07-31/in-mammogram-debate-politics-trounces-science.html http://www.bloomberg.com/news/2012-07-31/in-mammogram-debate...
  - yardie 14y ago
    Your link doesn't say that the screenings aren't cost-effective. It says that if you are in a certain age group these are the recommended amount you should do <40: 2-3 years, 40-49: 2 years, 50-74:1 1 year, 75+: none. Annual screenings were too aggressive, not ineffective.
    - yummyfajitas 14y ago
      "In conclusion, the USPSTF reasoned that the additional benefit gained by starting screening at age 40 years rather than at age 50 years is small, and that moderate harms from screening remain at any age...The USPSTF notes that a "C" grade is a recommendation against routine screening of women aged 40 to 49 years." Note that this recommendation is solely on medical grounds - that is, the medical cost/benefit ratio suggests routine screenings for women < 49 is pointless. They don't even take into account the financial cost.