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Global health care study: America's ranking is 'an embarrassment'


Public Release: 18-May-2017

First-ever global study finds massive health care inequity

People dying of preventable causes at rates higher than expected; study informs US health care debate; America's ranking is 'an embarrassment'

Institute for Health Metrics and Evaluation

SEATTLE - A first-ever global study finds massive inequity of access to and quality of health care among and within countries, and concludes people are dying from causes with well-known treatments.

"What we have found about health care access and quality is disturbing," said Dr. Christopher Murray, senior author of the study and Director of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. "Having a strong economy does not guarantee good health care. Having great medical technology doesn't either. We know this because people are not getting the care that should be expected for diseases with established treatments."

For example, on a scale of 1 to 100 for health care access and quality, Norway and Australia each scored 90 overall, among the highest in the world. However, Norway scored 65 in its treatment for testicular cancer, and Australia scored 52 for treating non-melanoma skin cancer.

"In the majority of cases, both of these cancers can be treated effectively," Dr. Murray said. "Shouldn't it cause serious concern that people are dying of these causes in countries that have the resources to address them?"

The top-ranked nation was Andorra with an overall score of 95; its lowest treatment score was for Hodgkin's lymphoma at 70. The lowest-ranked nation was Central African Republic at 29; its highest treatment score was for diphtheria at 65.

Professor Martin McKee, from the London School of Hygiene & Tropical Medicine, who participated in the study, commented: "Using deaths that could be avoided as a measure of the quality of a health system is not new but what makes this study so important is its scope, drawing on the vast data resources assembled by the Global Burden of Disease team to go beyond earlier work in rich countries to cover the entire world in great detail, as well as the development of a means to assess what a country should be able to achieve, recognizing that not all are at the same level of development. As the world's governments move ahead to implement the goal of universal health coverage, to which they committed in the Sustainable Development Goals, these data will provide a necessary baseline from which they can track progress."

The United States had an overall score of 81, tied with Estonia and Montenegro. As with many other nations, the US scored 100 in treating common vaccine-preventable diseases, such as diphtheria, tetanus, and measles. But the US had nine treatment categories in which it scored in the 60s: lower respiratory infections (60), neonatal disorders (69), non-melanoma skin cancer (68), Hodgkin's lymphoma (67), ischemic heart disease (62), hypertensive heart disease (64), diabetes (67), chronic kidney disease (62), and the adverse effects of medical treatment itself (68).

"America's ranking is an embarrassment, especially considering the US spends more than $9,000 per person on health care annually, more than any other country," Dr. Murray said. "Anyone with a stake in the current health care debate, including elected officials at the federal, state, and local levels, should take a look at where the US is falling short."

The study was published today in the international medical journal The Lancet, and represents the first effort to assess access and quality of services in 195 countries from 1990 to 2015. Researchers used a Healthcare Access and Quality (HAQ) Index, based on death rates from 32 causes that could be avoided by timely and effective medical care, known as "amenable mortality."

Scores were based on estimates from the annual Global Burden of Diseases, Injuries, and Risk Factors study (GBD), a systematic, scientific effort to quantify the magnitude of health loss from all major diseases, injuries, and risk factors by age, sex, and population. With more than 2,300 collaborators in 132 countries and 3 non-sovereign locations, GBD examines 300-plus diseases and injuries.

In addition, data were extracted from the most recent GBD update and evaluated using a Socio-demographic Index (SDI) based on rates of education, fertility, and income. SDI goes beyond the historical "developed" versus "developing" nations. Previous assessments of health quality and access were limited primarily to high-income countries, particularly in Western Europe.

Nations in much of sub-Saharan Africa, as well as in south Asia and several countries in Latin America and the Caribbean, experienced the lowest rankings. Nonetheless, many countries in these regions, including China (score: 74) and Ethiopia (score: 44), have seen sizeable gains since 1990.

The paper does offer some favorable signs of improvement in health care access and quality. Since 1990, several countries have achieved progress that met or surpassed levels reached by other nations of similar development. These countries included Turkey, Peru, South Korea, the Maldives, Niger, Jordan, and several Western European nations such as Switzerland, Spain, and France.

IHME plans each year to update the report, "Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990-2015: a novel analysis from the Global Burden of Disease Study 2015." It aims to use these results to better understand gaps and opportunities for improving health care access throughout the world.

The Healthcare Access and Quality (HAQ) Index is a summary measure based on 32 causes, that in the presence of high-quality health care, should not result in death. These 32 causes were selected as part of research that Professor Martin McKee and Dr. Ellen Nolte, both co-authors in this study, began in the early 2000s. The causes are:

    Tuberculosis
    Diarrhea-related diseases
    Lower respiratory infections
    Upper respiratory infections
    Diphtheria
    Whooping cough
    Tetanus
    Measles
    Maternal disorders
    Neonatal disorders
    Colon and rectum cancer
    Non-melanoma skin cancer
    Breast cancer
    Cervical cancer
    Uterine cancer
    Testicular cancer
    Hodgkin's lymphoma
    Leukemia
    Rheumatic heart disease
    Ischemic heart disease
    Cerebrovascular disease (stroke)
    Hypertensive heart disease
    Chronic respiratory diseases
    Peptic ulcer disease
    Appendicitis
    Inguinal, femoral, and abdominal hernia
    Gallbladder and biliary diseases
    Epilepsy
    Diabetes mellitus
    Chronic kidney disease
    Congenital anomalies
    Adverse effects of medical treatment

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5/20/2017, 2:27 am Link to this post PM John1959 Blog
 
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Re: Global health care study: America's ranking is 'an embarrassment'


It's about money, I saw Andorra was quoted as a top ranked overall of 95, not surprised has having been there it is a dot on the map with some very wealthy persons.
5/20/2017, 4:23 am Link to this post PM katie5445 Blog
 
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Re: Global health care study: America's ranking is 'an embarrassment'


Not an embarrassment, it is deliberate.
It is Hillary who could have fixed things in 1993, but instead she calculated a way to make even more profit for insurance companies, while creating even more of a monopoly on health care.

Health care is easy to fix.
All they have to do is go back to the way it was in the 1950s, before then created the tax break for employer benefits, which started giving control over health care to for profit insurance companies.
Before then, people went to state or country run hospitals and clinics that were a fraction of the cost.

But there are many, many other ways to fix it as well, such as single payer, remove the age restrictions on Medicare, interest free health care loans after the fact, government clinics, etc.
5/20/2017, 4:54 am Link to this post PM Rigby5
 
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Re: Global health care study: America's ranking is 'an embarrassment'


Seems to me that the only way to get equality is with a single payer system.

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5/20/2017, 10:15 am Link to this post PM Noserose
 
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quote:

Rigby5 wrote:

Not an embarrassment, it is deliberate.
It is Hillary who could have fixed things in 1993, but instead she calculated a way to make even more profit for insurance companies, while creating even more of a monopoly on health care.



You really do have to learn something about insurance in general and health insurance in particular. Profit margins in the health insurance business typically run in the 3-5% of premium range. And that's including all investment income (including investment income earned on the insurance companies own funds).

quote:

Health care is easy to fix.



Seems to me that we recently heard somebody say "who knew that health care was so complicated?" You're making the same mistake.

quote:

All they have to do is go back to the way it was in the 1950s, before then created the tax break for employer benefits, which started giving control over health care to for profit insurance companies.

Before then, people went to state or country run hospitals and clinics that were a fraction of the cost.



I just sprayed coffee all over my monitor.

quote:

But there are many, many other ways to fix it as well, such as single payer, remove the age restrictions on Medicare, interest free health care loans after the fact, government clinics, etc.



Single payer might work if (and it's a big if) premiums charged were adequate.

As for Medicare - you do realize that program is completely underwater. Fact is, the unfunded liabilities for Social Security and Medicare combined total something well north of $120 Trillion (yes, that's with a "T") and the bulk of that relates to Medicare, not SS. To put that in perspective the total value of all real property in the US is only about $50 Trillion.

No idea how after the fact health care loans are supposed to solve the problem. And why do you think government clinics would either?
5/20/2017, 11:29 am Link to this post PM shiftless2 Blog
 
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Re: Global health care study: America's ranking is 'an embarrassment'


quote:

Noserose wrote:

Seems to me that the only way to get equality is with a single payer system.



Cannot agree more Rose, but how with the adulterated system(s) already emplaced as stop gap that are in evidence absolute failures for the majority benefitting only a small few while costing the majority even more than ever?

Single payer could be developed out of the Medicare system based on income taxes but would slug the economics of consumer purchase power and in fact put a stake in the heart of most major investment based retirement plans that basically utilize Insurance Company annuity schedules and programs which could lead to a collapse of retired individuals incomes.

This is not a double edged sword but a random chargeable angered bull in a china shop. Congress knows this as is why they continue to pursue a 'Insurance' program, but in that they basically encourage more of the same endured issues that have faced the US consumer for decades.

Forced insurance purchase with taxation of employer based insurance for subsidizing the previous is not the answer, one leads to the eventual destruction of the other and inevitable decline of both where neither is worth the paper written on.

5/20/2017, 1:31 pm Link to this post PM cooter50 Blog
 
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Re: Global health care study: America's ranking is 'an embarrassment'


quote:

shiftless2 wrote:

quote:

Rigby5 wrote:

Not an embarrassment, it is deliberate.
It is Hillary who could have fixed things in 1993, but instead she calculated a way to make even more profit for insurance companies, while creating even more of a monopoly on health care.



You really do have to learn something about insurance in general and health insurance in particular. Profit margins in the health insurance business typically run in the 3-5% of premium range. And that's including all investment income (including investment income earned on the insurance companies own funds).

quote:

Health care is easy to fix.



Seems to me that we recently heard somebody say "who knew that health care was so complicated?" You're making the same mistake.

quote:

All they have to do is go back to the way it was in the 1950s, before then created the tax break for employer benefits, which started giving control over health care to for profit insurance companies.

Before then, people went to state or country run hospitals and clinics that were a fraction of the cost.



I just sprayed coffee all over my monitor.

quote:

But there are many, many other ways to fix it as well, such as single payer, remove the age restrictions on Medicare, interest free health care loans after the fact, government clinics, etc.



Single payer might work if (and it's a big if) premiums charged were adequate.

As for Medicare - you do realize that program is completely underwater. Fact is, the unfunded liabilities for Social Security and Medicare combined total something well north of $120 Trillion (yes, that's with a "T") and the bulk of that relates to Medicare, not SS. To put that in perspective the total value of all real property in the US is only about $50 Trillion.

No idea how after the fact health care loans are supposed to solve the problem. And why do you think government clinics would either?




We have been over this and what you claim is not true I think.
The narrow profit margin claim is fake because insurance companies get premiums decades before payouts, so they can establish mutual funds, and make billions off that money before they have to give it back.
They could pay out twice what was paid in, and they sill would be making over 50% profit.

Health care IS easy to fix, and Trump is right. All you have to do is get rid of third and forth party payers, because they have no incentive to keep costs down.
Insurance companies like high medical charges because that is what forced everybody to NEED insurance. No one should need health insurance. No system where you pay ahead of time ever works, because you can never control quality or performance. It is just like Prepaid Legal Services, which is just a total scam.

Of course Medicare is underwater, because it is supposed to be and designed to be.
It is not a for profit system, and its goal is to ensure society is civilized, by small subsidies of those who need health care and are poor, by those who don't and are wealthier. That is a normal and essential social function, which for profit insurance companies can not possibly provide.

After the fact loans would be much better because each patient would have an interest in keeping costs down. Single payer in a distributed way.

Government clinics and hospitals did keeps costs down before the 1960s, by government being a single payer that cut out profit making layers, and had an interest in keeping costs down.

And the unfunded liabilities of Medicare are tiny. You are projecting over time, and with a growing GDP, that is insignificant. Medicare costs are less than 2% what we spend on private health insurance. That is the BIG waste.
5/20/2017, 3:12 pm Link to this post PM Rigby5
 
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Re: Global health care study: America's ranking is 'an embarrassment'


You misunderstand the actions of insurance UNDERWRITING.

Insurers take our premiums and repay those that have invested in the company NOT building mutual funds for later. I started learning of the insurance industry as my nephew and sis in law entered the field, profit margins are narrow at best, you do not get coverage from previous years and years of unused premiums as they are as noted premium for a service AVAILABLE. Investors buy into insurers to make profit to retire upon or gain advantage to buy more from, those fees are repaid by premium unused but paid by by the insured.

Single payer eliminates the availability to add income to repay investors by reducing the necessity of private insurance so the niche retirement investor would have no reason to invest with little to no return.
5/20/2017, 6:11 pm Link to this post PM cooter50 Blog
 
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There is a lot to gain from investigating that which you wish to invest within.

The nation goes into single payer and you will see major insurance provider underwriters merge into larger companies with less and less application to public sectors. Industrial insurers covering liability for ships, planes, structures as to liability will absorb the old health insurers. Auto, life and industrial will remain with few health policy underwriters as in EU currently.

Does not even come into the realm of how hard it would be to turn investments into retirement capabilities.

Last edited by cooter50, 5/20/2017, 6:28 pm
5/20/2017, 6:24 pm Link to this post PM cooter50 Blog
 
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Re: Global health care study: America's ranking is 'an embarrassment'


I calculated how much I have paid into health insurance so far, and it is over half a million dollars.
I never go over the deductible, or was between jobs, so not once have I ever gotten a cent out of health insurance.
5/20/2017, 10:35 pm Link to this post PM Rigby5
 
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And you still consider it a 'Good Thing'?? Never a cent?

5/20/2017, 11:22 pm Link to this post PM cooter50 Blog
 
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Re: Global health care study: America's ranking is 'an embarrassment'


quote:

Rigby5 wrote:

We have been over this and what you claim is not true I think.

The narrow profit margin claim is fake because insurance companies get premiums decades before payouts, so they can establish mutual funds, and make billions off that money before they have to give it back.
They could pay out twice what was paid in, and they sill would be making over 50% profit.



That is absolute nonsense. Health insurance doesn't work that way - to be technical it's written on a "claims paid" basis - that means that this year's premiums are used to pay this year's claims. The companies do not get to sit on premiums for years. At best the company gets to invest the money for a couple of months.

But if you really think that profit margins are that high you should report the companies to the IRS. After all, by your logic the insurance companies, their auditors, and the SEC are all conspirators in a massive tax fraud - if that were true it's a RICO case in the making.

I stand by my comment. Profit margins (including investment income) are in the range of 305% of premiums.

The rest of your comment doesn't warrant a response. (And you you should learn something about Medicare before you make any more uneducated statements. That estimate of unfunded liabilities takes a growing economy into account.)

5/23/2017, 5:01 pm Link to this post PM shiftless2 Blog
 
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The figures on that study were grossly uneven and inconsistent, to some extent, dishonest.
5/23/2017, 7:12 pm Link to this post PM Yobbo
 
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quote:

Rigby5 wrote:

I calculated how much I have paid into health insurance so far, and it is over half a million dollars.
I never go over the deductible, or was between jobs, so not once have I ever gotten a cent out of health insurance.



Which has absolutely nothing to do with your claim. A fundamental tenet of insurance is

The premiums of the many pay for the losses of the few.

The fact that you haven't made any claims does not mean that the insurance company has some sort of magical bank of your funds just waiting for the day you make a claim. The fact that you haven't made a claim simply means that the insurance company used your premiums to pay for other people's claims. No bank. No magic mutual fund. Just that 3-5% profit margin.

5/23/2017, 7:44 pm Link to this post PM shiftless2 Blog
 
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The majority of insurers have invested funds they work from, these are the retirement accounts from so many that almost all here if they have a retirement 401K is invested in. These funds pay the bills until the premiums repay those accounts and repay the invested share owners their dividend. All too many think premiums are the only money on the accounts of insurers, they have shares and pay dividend on those shares just as any large company does. They do not have banks of money sitting in one place.

You buy a life policy, you pay in $1000 premiums a year for 25 years, $25,000 for a $100,000 policy that pays for itself from that point in dividends and you pay no more premiums. Strictly an example but typical in the math. In that respect those dollars you 'invested' are now available to loan for added income to repay that investment to build structures, industries, etc.
5/23/2017, 9:32 pm Link to this post PM cooter50 Blog
 
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Re: Global health care study: America's ranking is 'an embarrassment'


I have made the same notation on how major utilities fund there finances, the bills only repay those invested accounts for interest growth and dividends with a small profit line to add or re-invest into the company infrastructure.
5/23/2017, 9:49 pm Link to this post PM cooter50 Blog
 
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Re: Global health care study: America's ranking is 'an embarrassment'


cooter, you're confusing different lines of business that are rarely written by the same company.

You are correct that insurance companies do have their own share capital (technically it's really "capital and surplus" but the distinction between the two isn't important for purposes of this discussion).

Yes, the insurer invests those funds along with the premiums - the profit margins I quoted above includes all the investment income (i.e., that generated by their own funds as well as that generated on premium and loss reserves).

5/23/2017, 10:53 pm Link to this post PM shiftless2 Blog
 
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Still very similar concepts
5/24/2017, 12:03 am Link to this post PM cooter50 Blog
 
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Not quite - the investment income on those retirement accounts is going to be used to pay benefits to the individuals when they retire. It doesn't constitute income to the insurance company.
5/24/2017, 12:59 am Link to this post PM shiftless2 Blog
 
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Re: Global health care study: America's ranking is 'an embarrassment'


quote:

cooter50 wrote:

And you still consider it a 'Good Thing'?? Never a cent?




Remembering how much better it was before the 1960's, before anyone but the extreme, wealthy, elite had health insurance, I can say for sure that private health insurance is not a good thing at all.

The money should be invested in single payer, that can keep costs down, and is not profit motivated.
5/24/2017, 3:35 am Link to this post PM Rigby5
 
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Re: Global health care study: America's ranking is 'an embarrassment'


quote:

shiftless2 wrote:

quote:

Rigby5 wrote:

I calculated how much I have paid into health insurance so far, and it is over half a million dollars.
I never go over the deductible, or was between jobs, so not once have I ever gotten a cent out of health insurance.



Which has absolutely nothing to do with your claim. A fundamental tenet of insurance is

The premiums of the many pay for the losses of the few.

The fact that you haven't made any claims does not mean that the insurance company has some sort of magical bank of your funds just waiting for the day you make a claim. The fact that you haven't made a claim simply means that the insurance company used your premiums to pay for other people's claims. No bank. No magic mutual fund. Just that 3-5% profit margin.




No, almost no one I knows has gotten anything at all out of health insurance. I know several thousand people at least, and one person got open heart surgery. Another person I know needed a pacemaker, but they went back to France and got one for free.
I know a few people who had hip or knee replacements, but those were less then $20k, so were not significant enough to warrant even their own half million in payments, much less the money I and thousands of others have paid in.

There are about 65k heart surgeries every year. That is only 1.6% of the population.
When I go to a hospital, the beds seem all empty. There are no crowds. They don't even have wards any more. The ratio of doctors and nurses to patients seems about 20 to 1.
It seems totally and completely ridiculous.

There is not way around the statistics.
The cost of private insurance is over 3 times greater than public health care, like Medicare. Private health care through insurance is totally and completely unsustainable, while Medicare is actually doing quite well.
5/24/2017, 3:51 am Link to this post PM Rigby5
 
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quote:

shiftless2 wrote:

Not quite - the investment income on those retirement accounts is going to be used to pay benefits to the individuals when they retire. It doesn't constitute income to the insurance company.



It must constitute some income, or else all the mutual fund companies would not be run by insurance companies, that have lots of excess capital to loan out.

Typical payouts for these mutual funds are 2 to 5%, while the insurance companies are making more like 7 to 12% on most of these mutual funds investments.
5/24/2017, 4:04 am Link to this post PM Rigby5
 
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Rigby, reading your posts it's becoming clear that I should never have written all those actuarial exams. Clearly you "know" more about insurance than anyone else. And that includes people that have worked in the insurance industry for 40 years.

The fact that pretty much everything you say on the topic is wrong is besides the point - you "know" it and that's all that counts.
5/24/2017, 10:25 am Link to this post PM shiftless2 Blog
 
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quote:

shiftless2 wrote:

Not quite - the investment income on those retirement accounts is going to be used to pay benefits to the individuals when they retire. It doesn't constitute income to the insurance company.



Which is similar to repaying investment to stock/share holders in utilities, banks, major investment opportunities. All work essentially the same where a payment is made for a service AVAILED or provided or convenience supported those are in turn initial setup/construction or production paid for thru major $$ invested funds that are repaid to those investors with the payments $ made. Simplification but in essence fact.
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quote:

cooter50 wrote:

quote:

shiftless2 wrote:

Not quite - the investment income on those retirement accounts is going to be used to pay benefits to the individuals when they retire. It doesn't constitute income to the insurance company.



Which is similar to repaying investment to stock/share holders in utilities, banks, major investment opportunities. All work essentially the same where a payment is made for a service AVAILED or provided or convenience supported those are in turn initial setup/construction or production paid for thru major $$ invested funds that are repaid to those investors with the payments $ made. Simplification but in essence fact.



No.
5/24/2017, 1:45 pm Link to this post PM shiftless2 Blog
 
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Rigby5 wrote:

quote:

shiftless2 wrote:

quote:

Rigby5 wrote:

I calculated how much I have paid into health insurance so far, and it is over half a million dollars.
I never go over the deductible, or was between jobs, so not once have I ever gotten a cent out of health insurance.



Which has absolutely nothing to do with your claim. A fundamental tenet of insurance is

The premiums of the many pay for the losses of the few.

The fact that you haven't made any claims does not mean that the insurance company has some sort of magical bank of your funds just waiting for the day you make a claim. The fact that you haven't made a claim simply means that the insurance company used your premiums to pay for other people's claims. No bank. No magic mutual fund. Just that 3-5% profit margin.




No, almost no one I knows has gotten anything at all out of health insurance. I know several thousand people at least, and one person got open heart surgery. Another person I know needed a pacemaker, but they went back to France and got one for free.
I know a few people who had hip or knee replacements, but those were less then $20k, so were not significant enough to warrant even their own half million in payments, much less the money I and thousands of others have paid in.

There are about 65k heart surgeries every year. That is only 1.6% of the population.
When I go to a hospital, the beds seem all empty. There are no crowds. They don't even have wards any more. The ratio of doctors and nurses to patients seems about 20 to 1.
It seems totally and completely ridiculous.

There is not way around the statistics.
The cost of private insurance is over 3 times greater than public health care, like Medicare. Private health care through insurance is totally and completely unsustainable, while Medicare is actually doing quite well.



I don't know where you got the 65k but in 2016 there were 500,000 open heart surgeries, 2,300 heart transplants, over a 100,000 valve replacements then there are the hundred of thousands of stents, pacemakers, angioplasties, yet only since Obamacare has the figures from the past been reduced, preventative care!
5/24/2017, 5:43 pm Link to this post PM katie5445 Blog
 
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By the way we have no more wards because they spread disease. In the UK wards are being constantly closed and patients contaminated and there is no facility that has nurses 20 to 1 patient. Most people gripe they can't get one when needed, most people gripe because nurses don't do what they used to for patients. You also do not get a pacemaker in France for free. My knee replacement cost 60k two years ago, on medicare and with my secondary, I paid $300 out of pocket. Exactly Rigby there is no way around statistics, you might want to check them out sometime.
5/24/2017, 5:49 pm Link to this post PM katie5445 Blog
 
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My back surgeries was in one day, home the next. No intention of keeping me longer regardless unless developed a instant infection.
5/24/2017, 9:45 pm Link to this post PM cooter50 Blog
 
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Same as my hip surgery, if you do well with bypass surgery you can be out in three days. Sending post op patients home helps prevent infection and people do better at home and we all know why, being an inpatient sucks.
5/24/2017, 9:52 pm Link to this post PM katie5445 Blog
 
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Rigby5 wrote:

... while Medicare is actually doing quite well.



You really have to learn something about the subject. Medicare is way under water.

As I said before the combined funding shortfall for Social Security and Medicare is in the order of $135 Trillion (that is with a "T") while the total value of all real property in the US is in the order of $50 Trillion.

And don't try to argue that things will be okay because of a growing economy. Economic growth is already taken into account when that deficit was calculated.

Speaking from memory, when those programs were originally established there was something like 16 active workers per retiree. Now there are three and that ratio is projected to fall below two in the relatively near future.

The trust funds are completely inadequate and will be exhausted in the relatively near future as well.

5/24/2017, 11:03 pm Link to this post PM shiftless2 Blog
 


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