Cutting Medical Costs in India: Could It Work Here Too?
Published on: July 30, 2013
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  • DirtyJobsGuy

    I like to look at my Vets practice as a somewhat good example. He started a solo practice in a well off suburb 15 years ago and now has three Vets. He’s very scientific in his care and our dogs have had everything from routine care to surgery with them. Compared to human care, the primary caregiver (vet or MD) is more involved. The assistants do routine work mostly. He makes additional income from sales of drugs (a traditional path). Specialists typically travel to his office rather than the reverse.

    For my human medicine experience, it makes me think that we are misusing our highly trained and skilled MD’s at the expense of vast increases in highly paid RN’s etc. Concierge medicine focuses on more MD time with patients which is just what the Vet does.

  • Bart Hall

    My father-in-law, after he retired as a physician, nevertheless had to file business tax returns for *four* years, because that’s how long it took for the final Medicare and Medicaid payments to come through. And people think that a single government payor is the way to go? Bizarre.

    His wife BTW is about to mark 55 years working as a nurse. Several years ago she left hospital practice (too much bureaucracy) and now works privately, most commonly as a competent-but-sensitive provider in late-life situations.

    If government health care were any good, people would be clamoring to get into Medicare, or the VA system, or the Indian Affairs system (red Indians, not East Indians, in light of the context here). They are not.

    I lived for more than 20 years in the Canadian system, and there’s a reason that over 400 doctors a month are leaving Canada for the States. As flawed as this system is, it remains far better than the government alternatives.

    • bpuharic

      They’re probably leaving because of more money. Period. And half a million Americans go overseas every year for medical treatment because they can’t afford it here.

      Make you feel better?

      • cubanbob

        You get what you pay for. If you want decent care you are going to have to pony-up and pay for it. Doctors aren’t priests, they haven’t taken vows of poverty.

  • Andrew Allison

    The primary reason that US healthcare costs are so high is that patients see only their co-pays as the cost of care. High-deductible/higher co-pay would bring patients face to face with the real cost, and they would respond accordingly. I apologize to anybody whose seen this before, but my $2,110 deductible Medigap policy has an annual premium which is less that the monthly premium for $250 deductible plans.
    The issue of private versus single-payer insurance is a divisive one which will take a very long time to play out. Promoting high-deductible plans would provide the most immediate cost reductions.

    At the risk of diverting attention from what I believe to be the best solution (above), I’d just like to remind those who are so opposed to single-payer plans that the US system provides no better care to those who can afford treatment than single-payer plans do to everybody, at much higher cost; and do not prohibit private insurance for those who wish to pay for better service.

    • indipete

      I agree with your first paragraph, not your second. I believe the waiting time for single-payer is much longer, and that there is much less medical innovation. These is what I heard/read. But it also just makes sense. Look at the public schools. Why would “public medicine” be any different?

      • bpuharic

        SSHHH…don’t tell the right winger that according to the recent “Forbes” ranking of the world’s medical schools, 2 out of the 3 top schools in the world are in the UK

        Cambridge and Oxford. Both publicly funded.

        Why let facts spoil a Rush (PBUH) talking point?

        • indipete

          Don’t know about that, but how about addressing my question? Look at the public schools. Why would “public medicine” be any different?

          • bpuharic

            See my comment above about public medicine and world class public universities.

            You have a theory that public medicine is inferior

            The evidence shows your theory is wrong

            the fact you refuse to accept it shows you’re right wing.

          • indipete

            Your idea that your view is “scientific fact” supported by the “evidence,” and that, if I disagree with you, I’m refusing to accept the “evidence” (which apparently doesn’t include the history of socialistic enterprises over decades and longer) shows something worse.

          • bpuharic

            You made a claim. That claim is testable. The evidence shows you’re wrong.

            So your theory is wrong.

            My theory is that right wingers won’t accept evidence that contradicts their fundamentalist view of the free market. I cite as evidence our discussion

            The evidence supports my view.


          • indipete

            More specific, please.
            What was the claim I made? What was the evidence that proved it wrong?

          • bpuharic

            You said ‘public medicine’ is comparable in performance to ‘public schools’.

            Since both Oxford and Cambridge are publicly funded world class medical schools, your statement is incorrect.

          • indipete

            Your claim, then, sir, is dishonest. I did not “refuse to accept that evidence.” I acknowledged I was unaware of it, and directed the question back to the “public schools,” not two universities in a different country. Those two universities do not constitute “the evidence.” “The evidence” is found in the tens of thousands of schools in the US, and the appraisal of them is not scientific or objective. Many people (including myself) believe that they are a disaster, both for reasons that can be measured and that can’t. My question was put to people that have that same view of the public schools. Citing two schools in Britain, and asserting that settles the matter, is absurd, and I’m putting it mildly.

          • bpuharic

            Then you need to be more clear. Implicit in your claim is that publicly funded medicine is always inferior to the free market…an article of faith on the fundamentalist right wing

            You have a theory that publicly funded medical research is of inferior quality to private.

            I just disproved that.

            So go ahead and spin. I enjoy a good breeze

          • indipete

            Unclear about what? I just wrote in my prior post what you have just repeated. Yes, there is an assumption that public schools are inferior. I said that.

            You say — you continue to say — that the rating that Forbes gave to British universities (on undisclosed criteria; compared against what) disproves that.

            You obviously will believe what you want to be believe and call it fact.

      • Andrew Allison

        As I wrote, I was afraid that the second paragraph would divert attention from the much more important first one, namely that patients need to see (feel?) the actual cost of their care.

        Regarding single-payer insurance, I fear that I failed to make myself clear: single-payer plans provide medical care to all with the same or better outcomes as the US system does to those who can afford insurance. Doesn’t this suggest that there’s as much innovation in the single-payer environment as in the private insurance market?

        At root, it’s a societal problem: do we want to restrict access to short wait times and tender loving healthcare to those who can afford private insurance, or provide an adequate level of care to everybody and the option for those who can afford it to purchase private insurance to provide better care? It’s my personal opinion that the greater good comes from the latter, but regardless of the choice, the only wat to control costs is the make the patients aware of the cost of their care.

        • indipete

          Social security worked great at the start, but now we’re struggling to sustain it. In this regard, Medicare is much worse. Government agencies have different incentives than private companies.

          Canadian single payer may look good now, but, in the long term, if India sticks with a market system, Canada won’t hold a candle to it. (And, BTW, Canada isn’t the only single payer; why do supporters always point to it. The Soviets had single payer. Cuba has single payer. In Cuba, if you want public services, it’s a good idea to shout Castro’s name the loudest at political rallies. That can’t happen here? IRS.)

          • bpuharic

            To the right there’s no difference between Canada and Cuba.

            Poe’s law…

          • indipete

            I made no such statement.

            You need a course in reading comprehension.

  • Fred

    _Big government types think the best answer is to tighten the screws on doctors as much as possible, force them into large practices, regulate them up the wazoo, and give them lots more complicated forms to fill, pettifogging and dysfunctional regulations to observe and generally more hurdles to jump._

    True, but like it or not (and I don’t), that’s what the collective drooling, mouth-breathing moron that is the American public voted for in 2008 and 2012. Well, idiots, you get what you vote for. Frankly, I don’t see America getting any smarter next year or in 2016.

    • bpuharic

      And the big govt types who believe in wealth redistribution from the middle class to the 1% think the best answer is just to let Americans who don’t have healthcare die.

      WRM has, rightly, pointed out that it’s unconscionable that America would deny to anyone the right to healthcare. Astonishing there are people who think it’s ‘moral’ to watch Americans die while preaching how that proves we’re exceptional

      Which, in a way, it does.

      • indipete

        No one dies for lack money, that’s the law. Because of the insane pricing, however, they very often go bankrupt. (Obama’s brilliant solution is to have taxpayers pay the insane prices.)

        • bpuharic

          I’m not an accountant but I have been a hospice volunteer, a volunteer EMT and a student nurse. It’s NOT the law that people have to be treated. People DO die for lack of access to medical care

          In the US, people who are facing LIFE THREATENING situations are, by law, entitled to treatment. I know that because, as an EMT, I’m covered under that law (EMTALA).

          And Obama’s plan was the best we could do in the face of folks like you who, falsely, believe people AREN’T dying for lack of access.

          • indipete

            Thanks for confirming what I wrote: “No one dies for lack of money.” And, as an EMT, I assume you know people can go to emergency rooms without life-threatening conditions.

            Obamacare is the best we can do? The approach cited by Mead in the article sounded a lot better to me.

          • bpuharic

            And ER’s can refuse to treat them. Last year 26,000 died due to lack of access to medical care. In addition you don’t go to the ER if you suspect you have lung cancer. if you don’t have health insurance you die.

            No Obamacare’s not the best. but given American’s fanatical right wing economic fundamentalism it’s the best we can achieve

          • indipete

            You’re saying two different things: patients have to be treated for life-threatening conditions; and ERs don’t have to give treatment, which resulted in 26,000 deaths. But let’s take the last one. The bottom line is that we have a finite amount of money to spend on health care. The more it costs, the less we will have, and people will die as a consequence. If who dies isn’t determined by money under Obamacare, it will be determined by death panels, or whatever you want to call them. If Obamacare makes medicine more expensive it will lead to more deaths, etc. not less.

            The right offered several solutions to cut costs; Obama reject all. And it wouldn’t be the right wing that would object to the approach I don’t think its the right wing that would object the innovative market treatment in India discussed by Meade.

          • bpuharic

            Healthcare is already rationed in this country, by the least efficient method: ability to pay. Thus people don’t get care for chronic conditions that are easily treatable in early stages and require huge investments when they become critical. That’s a death panel.

            The right offered only to let people get tax deductions to buy health insurance. This is clearly inadequate since insurance companies refused to cover those with previous conditions, etc. So the right offered nothing. In addition, many poor already pay little or no federal taxes so would not eligible. Another form of rationing.

            And I suggest you learn about the difference between a CHRONIC condition and a CRITICAL condition. ER’s are NOT required to treat the former. We emergency service people ARE required to treat the latter. You’re confused about these situations.

          • Andrew Allison

            You are mistaken. ER’s, at least in CA, are required to treat patients. As you are also no doubt aware, ERs triage, so if you are insured with a non-life threatening emergency, you’ll wait while the uninsured are treated.

          • bpuharic

            That may be CA law. EMTALA requires treatment ONLY for emergency life threatening situations

            so you’re wrong.

          • Andrew Allison

            Nope, you are. EMTALA states:

            Any patient who “comes to the emergency department” requesting
            “examination or treatment for a medical condition” must be provided with
            “an appropriate medical screening examination” to determine if he is
            suffering from an “emergency medical condition”. If he is, then the
            hospital is obligated to either provide him with treatment until he is
            stable or to transfer him to another hospital in conformance with the
            statute’s directives.

          • bpuharic

            Guess English isn’t your native tongue. See the words you posted? “IF HE IS SUFFERING FROM AN EMERGENCY CONDITION”???

            See those words? Learn what they mean, right winger. And read the words following them

            SHEESH! Do I have to do EVERYTHING for you guys?

  • Anthony

    Health care and related cost has been extensively discussed issue at Via Media as well as among our national public policy contributors – the reimbursement system creates incentives to maximize costs. A related perspective is provided today by J. Bradford DeLong in “America’s Health-Care Divide.”
    A thought: “The rationale for national health insurance is as clear now as it was to Bismarck 130 years ago. A country’s success…rests on the health of its people.” Now, this may not be answer but reengineering of services going forward as proposed by WRM will definitely encounter opposition…

  • dankingbooks

    This article is very good news. Lots of good things are coming out of India these days. I read some time ago about a guy who invented a portable EKG machine–the cost to the patient is only $10. How much does an EKG cost here?

    I’ve written a relevant article about Future STEM Careers here:

    It posits that employment in healthcare will level off, and then decline sharply.

  • Joshua Rosenblum

    I’m actually kind of surprised we haven’t seen an insurance market crop up around medical tourism. It would cost insurance companies less to physically fly someone to India or Southeast Asia than to treat them here.

    • indipete

      If I understand Obamacare correctly, that’s the type of innovation it would prevent (and perhaps already has.) Government will dictate what insurance you will buy, and you can be sure that the unions (even as they try to exempt themselves) will make sure the insured care will be provided by American unionized workers.

      • bpuharic

        Boy the right wing sure has a fetish about unions. There are virtually NONE in the US for private workers, but by gum, they’re gonna blame it on unions!

        Of course…if you’re a member of a union, you probably have benefits as a result of your job…negotiated by the union

        And if you have benefits, Obamacare doesn’t affect you.

        But don’t let logic scare the right wing. They have enough problems listening to Rush (PBUH)

        • indipete

          One of the features of Obamacare is the facilitation of the unionization of health care professionals.

          • bpuharic

            Which is completely irrelevant to the topic. IF it’s true, that is. With the right’s paranoia about unions, they think EVERYTHING promotes unions.

          • indipete

            Not irrelevant to the response you made to my comment.

        • Andrew Allison

          Your knee is jerking again ;<)

      • Andrew Allison

        I don’t think so. Isn’t the sensible choice to not insure oneself, pay the penalty and, if you need expensive care, sign up. One of the many stupidities of O-care is that it discourages medical tourism, thereby increasing domestic medical costs.

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