It's so bad you have to pay people to move to Vermont

[EPB]

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[Orca]

Of Vermont: "Businesses pay an effective property tax rate of 5.27%, the third highest in the country."

-- CNN Business

 

[prsboogie]

I would like to point out an aspect of the healthcare system I have not seen addressed here yet (appologies if I missed it)

Our ERs are inundated with people who do not have enough sense to call their physicians for there stomach aches that they have had for two months. Drunks coming in daily because they are drunk, again,band leave before they can be offered help with their drinking problems. COPDers coming in weekly short of breath and in distress after smoking their 10th cigarette of the day, heart failure patients in with 10 pound weight gains because the won't stop eating TV dinners and fast foods. We see about 5-6 people who come in for STD testing or pregnancy tests.

People who have been given every opportunity to make changes in their lives time and time again continually choose not to. Social welfare comes with unlimited access to these services at the cost of taxes to the Commonwealth. And the state reimbursements to our little facility and all local facilities are on a steep downward trajectory. Despite the cuts in funding all these frevelous services need to be seen and largely go unfunded. How long do people expect healthcare facilities to stay solvent? Small local hospitals will start to shutter and push the burden onto larger urban facilities to absourb the patient flow and cost burden.

An unpopular view extended to elective vs emergent surgeries. We regularly (daily) preform procedures on a population of people who if someone objectively, would never be allowed to have surgeries. I have lost count of the pacemaker/defibrillators that have be put into patients who cannot even tell you their names because their irrational family members refuse to allow nature to run its course. Many other surgeries are allowed to happen because physicians are afraid to tell families no.

For Universal Healthcare to happen there will need to be tremendous amount of regulation on who when and where things will happen and that goes against everything American. We want everything and we want it now (que Veruca voice - I want the goose who lays the golden eggs daddy). The way people access healthcare needs to change as well as the expectations of what healthcare is and can deliver.

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[abc]

Many other surgeries are allowed to happen because physicians are afraid to tell families no.

No, it's because the physicians will get paid.

(It's not a Vermont issue though. It's nationwide)

Yes, it's a systemic problem. As long as physicians get paid for procedures "fit" for the illness but totally inappropriate to the general situation of the PERSON, this problem will continue.

My Mom used to work in hospital, mostly dealing with the poor (and largely under-educated) patients. Expensive AND PAINFUL surgeries were "recommended" to the patients, with total disregard to the overall well being of the patients! The poor patients, where do they get better information to refute the "recommendation" of the surgeons? They ended up being treated like meat on the butcher's table.

There're good doctors, when working with well educated and well informed patients and their family, result in more human care and without wasting resources. (example, my uncle passed away recently, by refusing treatment that would only prolong his suffering) But those are often exceptions to the rule. Our "system" doesn't encourage that nor rewards it.

 

[JimG.]

There're good doctors, when working with well educated and well informed patients and their family, result in more human care and without wasting resources. (example, my uncle passed away recently, by refusing treatment that would only prolong his suffering) But those are often exceptions to the rule. Our "system" doesn't encourage that nor rewards it.

I truly respect your uncle's decision.

And the system discourages personal awareness; it wants to keep you alive until it can suck away all of your resources.

 

[Orca]

"In Vermont, many people — both medical providers and the population at large — are beginning to see OneCare as something akin to the European Union. The University of Vermont Medical Center and Dartmouth-Hitchcock Medical Center clearly run the show. They have bought up most of the independent practices and hospitals in the state and the decisions made for those practices are now made in OneCare’s corporate boardrooms by very highly paid executives, few of whom have any clinical experience. Medical providers in the field are inundated by computerized paperwork and spend over half their time on non-medical clerical work. The medical practices have been homogenized by required algorithms for patient care and practices have become franchises — similar to McDonalds."

-- Louis Meyers, VTDigger, 2 January 2020

 

[JimG.]

Totally true here in NY also. Horrifying if you think about it.

 

[kingslug]

I'm..pretty scared of our health care system...go to a specialist..see how many minutes they spend with you..then see what they proscribe as a fix....
I stopped going to an orthopedist for my shoulders because it seemed like a joke...5 minutes..

 

[Not Sure]

..
I stopped going to an orthopedist for my shoulders because it seemed like a joke...5 minutes..

Reminds of of a George Carlin skit . Somewhere practicing in in the country is the worst doctor ....Audience laughter....
Carlin..."What are you laughing about you might be his patient." There are lots of good doctors out there as well don't give up.

Single payer is what scares me the most ! Putting faith in a government that thinks you're stupid!!! You can keep your plan?
You can keep your doctor ? It was designed to fail from the start!!
https://www.youtube.com/watch?v=g6wljfbRaDM

If you have a number of uninsured focus on them don't blowup the system !!!! I have to wonder if some states plan to bankrupt their budgets so the Federal government will bail them out ? Before that happens they'll declare bankruptcy to screw all the pensioners. If the economy is good now and the state has issues what happens when no one can afford to ski VT?

 

[abc]

I truly respect your uncle's decision.

And the system discourages personal awareness; it wants to keep you alive until it can suck away all of your resources.

It took a lot of ground work prior.

With help from a decent doctor, yes. He gave the family a realistic expectation. No cure, just more and worse suffering.

He also offer a long list of “treatment” he could potentially do, had the family choose the opposite.

That’s how a doctor should be. Many doctors are good.

But sadly, plenty others are not so good. My Mom had seen a few such doctors. They only offer the long list of painful treatment, which may in fact took care of the issue temporarily but only left the patient worse off. Worse than dead.

Truth being, having seen many of those, my Mom is terrified of similar thing happening to her. She reminds me of her wish every so often. Her wish for a quality life and a dignified end.

She was the one who initiated a similar conversation with my cousin (son of my said uncle) only a few years back. At first, my cousin wasn’t sure how to broach the subject with his parents. But his Mom, my aunt, is actually a retired medical school professor (retired 30 years ago) So he talk to her first, then his family had an open discussion, which made clear everyone’s wishes. That, made the actual decision much easier when the time came.

 

[deadheadskier]

"In Vermont, many people — both medical providers and the population at large — are beginning to see OneCare as something akin to the European Union. The University of Vermont Medical Center and Dartmouth-Hitchcock Medical Center clearly run the show. They have bought up most of the independent practices and hospitals in the state and the decisions made for those practices are now made in OneCare’s corporate boardrooms by very highly paid executives, few of whom have any clinical experience. Medical providers in the field are inundated by computerized paperwork and spend over half their time on non-medical clerical work. The medical practices have been homogenized by required algorithms for patient care and practices have become franchises — similar to McDonalds."

-- Louis Meyers, VTDigger, 2 January 2020

UVM Health is in the process of going live right now with a new EMR software from Epic at a cost of $200M. Epic is the Mercedes of EMRs, which might make sense in Burlington, but hardly does in Berlin or Middlebury whose hospitals and local networks will hardly see the benefits and don't have the need for the features Epic provides. Both could have gone with a lower cost EMR product. And those products and patient records can be accessed remotely from the Big House when patients need the advanced care that facility provides. The resulting manual charting required to do this would be infrequent and minimal work.

You see the same thing with OR and Radiology equipment. The big house mandates the community hospitals use the same high cost equipment and it's totally unnecessary. UVM, Dartmouth and MaineHealth (the three big players in Northern New England) are all guilty of this. I've seen $90k Anesthesia systems in Critical Access Hospitals in their networks (which only exist because of government subsidies) who would never use all the features available for patient care on even a $25k system. Essentially, there is a massive lack of fiduciary responsibility in the capital planning of our hospitals in this country.

And to be honest, that article is WAY off base pointing the fingers at Hospital Admins for much of the wasteful spending. The physicians demand the Mercedes no matter where they work. They have a ton of power over these choices. They typically work four days a week at the Big House and then one at the East Bumbfuck Medical Centers in the networks and demand the same equipment.

The problem with this is what you end up seeing is EBF hospitals having no money for new equipment and end up holding onto 15 year old Mercedes that are expensive to maintain, instead of buying a Honda every 7/8 years and actually end up having newer, more reliable and more useful tech. Some of those EBF hospitals end up failing and close because of this and the low income communities they serve get screwed. The lower income patient populations relying on these facilities now have to drive hours to receive care in more urban areas. Those communities get doubly screwed because often times that hospital is the largest employer with the highest wages in town. Best case scenario for these places is the network flagship hospitals at least maintain a 24 hour ED at the former full service hospital.

So, to circle back on the argument that US "capitalism" approach is better than government run healthcare, let's at least become educated first that under our current system, US hospitals don't have to run like an actual business. They're run HORRIBLY because they can. They get bailed out for their inefficiances. If they had to run like a real business, say a ski resort? 75% of hospitals would fold. That's not an exaggeration. And it's not capitalism.

But, you know who does run healthcare more like a business? All those other Commi nations in the developed world who have more government control over their healthcare industries. They have more bargaining power with the drug manufacturers and tech companies like mine because they're the only customer. They're also often ultimately the only customer paying the providers, so they have maximum leverage over what the providers can charge their patients. It's a massively effective and efficient monopoly that sees these Commis spending only around 10-12% of their GDP on healthcare vs our 18%. And the results are often as good or better for 99.9% of the population.

But F it! If Mick Jagger gets his heart surgery in the USA, we must have the best way of doing things AMIRIGHT?!?!!!!



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[JimG.]

Truth being, having seen many of those, my Mom is terrified of similar thing happening to her. She reminds me of her wish every so often. Her wish for a quality life and a dignified end.

Most families do not discuss these issues and that is a big part of the problem.

All 3 of my boys are used to me reminding them of the same thing your mom fears.

 

[JimG.]

So, to circle back on the argument that US "capitalism" approach is better than government run healthcare, let's at least become educated first that under our current system, US hospitals don't have to run like an actual business. They're run HORRIBLY because they can. They get bailed out for their inefficiances. If they had to run like a real business, say a ski resort? 75% of hospitals would fold. That's not an exaggeration. And it's not capitalism.

But, you know who does run healthcare more like a business? All those other Commi nations in the developed world who have more government control over their healthcare industries. They have more bargaining power with the drug manufacturers and tech companies like mine because they're the only customer. They're also often ultimately the only customer paying the providers, so they have maximum leverage over what the providers can charge their patients. It's a massively effective and efficient monopoly that sees these Commis spending only around 10-12% of their GDP on healthcare vs our 18%. And the results are often as good or better for 99.9% of the population.

But F it! If Mick Jagger gets his heart surgery in the USA, we must have the best way of doing things AMIRIGHT?!?!!!!

Fact is US spends the most on healthcare yet is 28th or so in the world for positive outcomes. Our system is a joke.

 

[EPB]

You see the same thing with OR and Radiology equipment. The big house mandates the community hospitals use the same high cost equipment and it's totally unnecessary. UVM, Dartmouth and MaineHealth (the three big players in Northern New England) are all guilty of this. I've seen $90k Anesthesia systems in Critical Access Hospitals in their networks (which only exist because of government subsidies) who would never use all the features available for patient care on even a $25k system. Essentially, there is a massive lack of fiduciary responsibility in the capital planning of our hospitals in this country.


So, to circle back on the argument that US "capitalism" approach is better than government run healthcare, let's at least become educated first that under our current system, US hospitals don't have to run like an actual business. They're run HORRIBLY because they can. They get bailed out for their inefficiances. If they had to run like a real business, say a ski resort? 75% of hospitals would fold. That's not an exaggeration. And it's not capitalism.

But, you know who does run healthcare more like a business? All those other Commi nations in the developed world who have more government control over their healthcare industries. They have more bargaining power with the drug manufacturers and tech companies like mine because they're the only customer. They're also often ultimately the only customer paying the providers, so they have maximum leverage over what the providers can charge their patients. It's a massively effective and efficient monopoly that sees these Commis spending only around 10-12% of their GDP on healthcare vs our 18%. And the results are often as good or better for 99.9% of the population.

But F it! If Mick Jagger gets his heart surgery in the USA, we must have the best way of doing things AMIRIGHT?!?!!!!



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Let's talk about capitalism a minute because I don't think our healthcare system is particularly capitalistic. As the guy with the flowery language about hitting trees mentioned, the consumer has no idea how much their healthcare will cost before they get it. Therefore, they have no way to determine which provider offers the best value. Clinics seem to be helping to break this mold, but we're far from a price transparent system. Without price transparency, it's very difficult to argue you're dealing with a functioning capitalist industry. Fixing prices is rarely the answer; enabling competition is a much more efficient solution.

Before we go assuming that more government is the answer, I wanted to highlight that medicine and education costs are rising the fastest of just about any industry I can think of (I could genuinely be missing one though). Government has its hands all over these - medicine is well documented here, and the advent of government baked student debt has fueled skyrocketing education costs. My generation was sold a load of nonsense when we were told it didn't matter what we majored because our education was priceless. Just sign on the dotted line. I notice you cited that government subsidises these smaller offices that run perpetual losses. I have a feeling they've given hospitals perverse inventives to over spend, but that's just a hunch from reading the tea leaves of what you wrote.

Pharma is a huge issue, too. 100% agree. We subsidize the rest of the world's pharma costs. I don't know how it can get fixed the way our patent laws are set up. I'm no lawyer. Still, I don't see why nationalizing medicine is necessary to achieve pharma remuneration changes.

Regarding people who point to foreigners coming to America for care. Actions speak louder than words. It's the same concept I brought up about Vail not being bought in on catastrophic climate change. There's a reason why people come to the US for treatment: universality ultimately leads to rationing. It's plenty noble to want care for everyone, but it's not wise to dismiss this simple fact as the misguided utterances of toothless fact-hating conservatives.

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[BenedictGomez]

But F it! If Mick Jagger gets his heart surgery in the USA, we must have the best way of doing things AMIRIGHT?!?!!!!

Yes. America has led the world in heart for many decades.

Specifically, Denton Cooley & Michael Debakey were & still are legends in the field, & their multi-generation padawans have fanned-out across America to the major hospitals in most of the big cities (L.A., Chicago, Boston, NYC, etc...).

I realize the cool kids bitch about medicine in America, but in general we are at the top or near the top in virtually all disciplines.

 

[JimG.]

Yes. America has led the world in heart for many decades.

Specifically, Denton Cooley & Michael Debakey were & still are legends in the field, & their multi-generation padawans have fanned-out across America to the major hospitals in most of the big cities (L.A., Chicago, Boston, NYC, etc...).

I realize the cool kids bitch about medicine in America, but in general we are at the top or near the top in virtually all disciplines.

It's a good thing because Americans sure need a lot of heart surgery.

 

[deadheadskier]

Yes, the Lamborghini docs reside here

We're obviously the best! USA!!!! (spoken with Italian accent)



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[cdskier]

Pharma is a huge issue, too. 100% agree. We subsidize the rest of the world's pharma costs. I don't know how it can get fixed the way our patent laws are set up. I'm no lawyer. Still, I don't see why nationalizing medicine is necessary to achieve pharma remuneration changes.

If patent laws didn't exist, why would pharma companies bother to invest millions in finding a new drug just so some other company could come along and simply copy it with minimal investment and effort?

You could apply this same logic if we force pharma companies to charge low rates for drugs. I think the average person has absolutely no idea how much time, money, and effort goes into creating a single new drug. People are quick to say "well it only costs $1 to manufacture drug xyz so why do they charge $100 for it". Meanwhile they completely ignore the cost of the R&D and clinical trials and paperwork to get it discovered and approved in the first place. Who pays for that if we demand lower drug costs? Do we then rely on government grants to fund research? In which case we're now back to everyone paying for the R&D anyway (albeit indirectly so the cost is just part of that big black hole where taxes go).

 

[deadheadskier]

BG.....apologies for deleting your post and glad Jim quoted it to preserve it. I was meaning to edit my response and accidentally screwed up deleting both


In response to your post

Yes, we have the best Lamborghini docs!

That's a fair judgment of what's best yes?

USA!!?!!! (spoken with Italian accent)

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[Orca]

I have a question for those who'd like universal, government-run healthcare for all. Who exactly, and I mean exactly, is "all"? Would that be citizens only? Would it include illegal aliens? Vermont is far from it, but what might you imagine would be the effect of our porous border with Mexico?

I ask this because the source of funding for such healthcare (taxes) is finite in a practical sense, whereas needs could be imagined to multiply without end. All systems must have boundaries. Is the left willing to bound the problem in a serious way?