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No Country for pregnant women!

Manc Skipper

Manc Skipper

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The US famously has the most expensive yet inefficient healthcare in the developed world,but even I was shocked to discover that an American woman is three times more likely to die in childbirth than a woman in the UK.

 
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I wouldn't mind seeing some valid discussion about the issue, but that woman was disgusting. I could tolerate her for just about three minutes before I had to shut it off -- she left a really bad taste in my mouth -- like the feeling I get that I need to spit when I see something dead on the side of the road. Gross.

That said, a real discussion with real stats and facts would be interesting. Just not one that features that thing -- ever.
 
Manc Skipper said:
The US famously has the most expensive yet inefficient healthcare in the developed world,but even I was shocked to discover that an American woman is three times more likely to die in childbirth than a woman in the UK.

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What a surprise, ridiculous over regulation plays a large part in it.

There's a hodgepodge of hospital protocols for dealing with potentially fatal complications, allowing for treatable complications to become lethal.
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U.S. Has The Worst Rate of Maternal Deaths In The Developed World : NPR
 
Crovax said:
What a surprise, ridiculous over regulation plays a large part in it.
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"Hospital protocols" are not regulations. The problem they're pointing to there is a lack of standardization of processes across hospitals, not overstandardization.
 
Greenbeard said:
"Hospital protocols" are not regulations. The problem they're pointing to there is a lack of standardization of processes across hospitals, not overstandardization.
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Hospital protocols are how hospitals stay in line with regulations and how they avoid getting sued
 
What a great system we have. We pay more than anywhere else, and yet get worse results. It's seriously time to fix the health care system, and before it totally bankrupts the country.
 
Crovax said:
Hospital protocols are how hospitals stay in line with regulations and how they avoid getting sued
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The theme of the NPR/ProPublica research you are quoting is that the U.S. lacks standardization and that this is a significant driver of the poor outcomes we're seeing. Click through your link.

By standardizing its approach, Britain has reduced preeclampsia deaths to one in a million — a total of two deaths from 2012 to 2014. In the U.S., on the other hand, preeclampsia still accounts for about 8 percent of maternal deaths— 50 to 70 women a year. Including Lauren Bloomstein.
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Earlier this year, an analysis by the CDC Foundation of maternal mortality data from four states identified more than 20 "critical factors" that contributed to pregnancy-related deaths. Among the ones involving providers: lack of standardized policies, inadequate clinical skills, failure to consult specialists and poor coordination of care. The average maternal death had 3.7 critical factors.
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Main and his colleagues then began creating a series of "toolkits" to help doctors and nurses improve their handling of emergencies. The first one, targeting obstetric bleeding, recommended things like "hemorrhage carts" for storing medications and supplies, crisis protocols for massive transfusions, and regular training and drills. Instead of the common practice of "eye-balling" blood loss, which often leads to underestimating the seriousness of a hemorrhage and delaying treatment, nurses learned to collect and weigh postpartum blood to get precise measurements.

Hospitals that adopted the toolkit saw a 21 percent decrease in near deaths from maternal bleeding in the first year; hospitals that didn't use the protocol had a 1.2 percent reduction. By 2013, according to Main, maternal deaths in California fell to around 7 per 100,000 births, similar to the numbers in Canada, France and the Netherlands — a dramatic counter to the trends in other parts of the U.S.

"Prevention isn't a magic pill," Main said. "It's actually teamwork [and having] a structured, organized, standardized approach" to care.
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In New York State, some hospitals have questioned the need for what they call "cookbook medicine," said Columbia's D'Alton. Her response: "Variability is the enemy of safety. Rather than have 10 different approaches to obstetric hemorrhage or treatment of hypertension, choose one or two and make it consistent ... When we do things in a standardized way, we have better outcomes."
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The "hodgepodge of hospital protocols" culprit you honed in on is meant to be a condemnation of the fact that every hospital does things differently.
 
Dittohead not! said:
What a great system we have. We pay more than anywhere else, and yet get worse results. It's seriously time to fix the health care system, and before it totally bankrupts the country.
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Many Americans are opposed to this idea simply because they're scared of "socialism."
 
Manc Skipper said:
The US famously has the most expensive yet inefficient healthcare in the developed world,but even I was shocked to discover that an American woman is three times more likely to die in childbirth than a woman in the UK.

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This is concerning, regardless of how its presented.
 
Soopairik said:
Many Americans are opposed to this idea simply because they're scared of "socialism."
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They're told to be afraid of 'socialism'. Because that's what their masters in Con media tell them. And they refuse to think for themselves. BUT the fact is we already have socialize HC. We have Medicare, medicaid, and even if you have neither nor have Health Insurance you will get treatment .. And taxpayers and people with HI will end up paying for your treatment.. The problem is the socialize HC we have is a mess, it's extremely inefficient and costly.

The people WITH HI pay more for the exact same treatments as the people without HI because the hospitals, doctors, etc. pad the HI companies bills to pay for the people without HI. That's a fact, I've seen it happen.
 
Soopairik said:
Many Americans are opposed to this idea simply because they're scared of "socialism."
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That, and they keep hearing how we have the best health care system in the world, and how busloads of Canadians are coming here for care that they can't get in Canada. What a crock.
 
Dittohead not! said:
That, and they keep hearing how we have the best health care system in the world, and how busloads of Canadians are coming here for care that they can't get in Canada. What a crock.
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Canada does seem to do healthcare better than us.
 
Soopairik said:
Canada does seem to do healthcare better than us.
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I would largely agree with that, given my experience with the Canadian healthcare system. I have a large branch of my family in Canada, and when my late aunt was discovered to have terminal cancer, she was able to see specialists, get the care she needed, and when the end was near, stay in a nice hospice where we could visit and spend time with her until she passed. All of this was cost-free to her at the point of delivery. My only complaint was that there was some time delay in getting doctor appointments, but I would consider that a reasonable trade-off for literally everything being taken care of cost-wise. As someone who has chronic illness issues myself, I can only imagine how much easier my life would be if I did not have to constantly work with insurance companies, healthcare middlemen, and other providers to work out the cost of my medications and other needs. That alone would save me time and stress that would make the Canadian system well worth the trade-offs necessary.
 
RationalPolicy said:
I would largely agree with that, given my experience with the Canadian healthcare system. I have a large branch of my family in Canada, and when my late aunt was discovered to have terminal cancer, she was able to see specialists, get the care she needed, and when the end was near, stay in a nice hospice where we could visit and spend time with her until she passed. All of this was cost-free to her at the point of delivery. My only complaint was that there was some time delay in getting doctor appointments, but I would consider that a reasonable trade-off for literally everything being taken care of cost-wise. As someone who has chronic illness issues myself, I can only imagine how much easier my life would be if I did not have to constantly work with insurance companies, healthcare middlemen, and other providers to work out the cost of my medications and other needs. That alone would save me time and stress that would make the Canadian system well worth the trade-offs necessary.
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Many Americans don't want Canadian style healthcare because they are scared of "socialism."
 
Soopairik said:
Many Americans don't want Canadian style healthcare because they are scared of "socialism."
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I think that is part of it. I also believe that many people feel they would be treated worse or have to wait longer than they do now. They may also think that it would end up being more expensive. Personally, I don't find those arguments compelling, but I don't think it's only fear of "socialism" that's behind people not wanting a Canadian-style system.
 
I recently heard a figure of $32,000 for a normal delivery in the US.

When my son was born in 1969, it cost us $250, which was not covered by insurance. No, that was not a copay. A normal childbirth was not covered. That's why I remember the cost.

When my grandson was born in 2001, just 32 years later, the cost had increased by a factor of 40 to $10,000

Now, it's 120 times as expensive.

A new car in 1969 cost around $3,000. If the cost had gone up that much, a car would now cost $360,000.

And that would be for a 1969 type of car. That new sedan that costs around 25 to 30 grand is far more sophisticated.

That's one problem: the soaring cost of health care. The other problem is that, as the mortality during pregnancy demonstrates, the quality is not up to the cost.
 
Dittohead not! said:
I recently heard a figure of $32,000 for a normal delivery in the US.

When my son was born in 1969, it cost us $250, which was not covered by insurance. No, that was not a copay. A normal childbirth was not covered. That's why I remember the cost.

When my grandson was born in 2001, just 32 years later, the cost had increased by a factor of 40 to $10,000

Now, it's 120 times as expensive.

A new car in 1969 cost around $3,000. If the cost had gone up that much, a car would now cost $360,000.

And that would be for a 1969 type of car. That new sedan that costs around 25 to 30 grand is far more sophisticated.

That's one problem: the soaring cost of health care. The other problem is that, as the mortality during pregnancy demonstrates, the quality is not up to the cost.
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Except we have been over this.. we don't have a soaring cost of healthcare.

Reimbursements to providers have been relatively stagnant. We have been reducing the cost of healthcare since the 1990's.

Now as far as the quality.

Well.. if you read the points of the article.. universal government healthcare isn't going to fix it. In fact.. it could make it worse. The article identified that different hospitals had different protocols.. some that worked well.. some that had problems. Well.. we know that there were problems in part because we could compare to hospitals that had good protocols.

Now.. the hospitals that did not have such a good process? They didn;t have them because "gee.. We don't care about pregnant woman.. who cares if they die". Likely those protocols/procedures were in place as a method of cost cutting, or increasing hospital efficiency.

Its entirely possible that with a government run healthcare system.. especially one trying to get the decrease in healthcare costs that seems to be a huge goal.. could end up developing adopting. protocols/procedures that are actually detrimental across the board.

I give you the UK and cancer care:

US v UK: The breast cancer survival stakes
An American woman's chances of developing breast cancer are slightly higher than her British counterpart - but she is far more likely to survive.
One U.S. woman in eight can expect to have the disease at some point in her life, compared with one in nine in Britain.
But five-year survival rates for all forms of the disease - including the most advanced - stand at 85 per cent in the U.S and just under
74 per cent in the UK. If the cancer is caught early - at what doctors call stage 1 - the differences in survival are even more shocking.
An American woman has a 97 per cent chance of being alive five years after diagnosis.
In Britain, this figure is only 78 per cent.
Routine breast screening in the U.S. starts at 40 rather than 50, as in Britain, and women are thoroughly checked every one to two years, rather than every three years under the NHS.
Breast cancer drugs such as Herceptin, which can extend the life of women suffering the most advanced forms of the disease, was made available in America in 1998.
The drug costs up to £30,000 for a full 38-week course.
Shockingly, it took nearly two years before the drug was approved for NHS use and specialists estimated that in that time, 5,000 British women who needed it had died.
Read more: US v UK: The breast cancer survival stakes | Daily Mail Online
Follow us: @MailOnline on Twitter | DailyMail on Facebook
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jaeger19 said:
Except we have been over this.. we don't have a soaring cost of healthcare.

Reimbursements to providers have been relatively stagnant. We have been reducing the cost of healthcare since the 1990's.

Now as far as the quality.

Well.. if you read the points of the article.. universal government healthcare isn't going to fix it. In fact.. it could make it worse. The article identified that different hospitals had different protocols.. some that worked well.. some that had problems. Well.. we know that there were problems in part because we could compare to hospitals that had good protocols.

Now.. the hospitals that did not have such a good process? They didn;t have them because "gee.. We don't care about pregnant woman.. who cares if they die". Likely those protocols/procedures were in place as a method of cost cutting, or increasing hospital efficiency.

Its entirely possible that with a government run healthcare system.. especially one trying to get the decrease in healthcare costs that seems to be a huge goal.. could end up developing adopting. protocols/procedures that are actually detrimental across the board.

I give you the UK and cancer care:
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If reimbursements to providers have been relatively stagnant, then it follows that the $250 charge back in '69 would be about the same today in constant dollars. That would mean that the $32,000 charge would get an actual reimbursement of around $2,500. Does that sound about right?
 
Dittohead not! said:
If reimbursements to providers have been relatively stagnant, then it follows that the $250 charge back in '69 would be about the same today in constant dollars. That would mean that the $32,000 charge would get an actual reimbursement of around $2,500. Does that sound about right?
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No it doesn't. Not at all.

Number one.. is that the charges are meaningless. meaningless.. particularly in a hospital that's likely under a bundled payment system like a DRG.. (diagnostic related group).

(However, yes.. its entirely possible that the actual reimbursement for that 32,000 dollar charge IS 2500.. )

Number 2: There is the effect of cost shifting within the system. So while one procedure may have gone up more.. other procedures went down when it comes to the insurance company allowable.

I have already been over this example with you many times and provided the reimbursement changes. I don't care to go debunk this meme again. I suggest you do a little research on provider reimbursement.

Start with :

The Balanced Budget Act of 1997, (Pub.L. 105–33, 111 Stat. 251, enacted August 5, 1997), was an omnibus legislative package enacted by the United States Congress, using the budget reconciliation process, and designed to balance the federal budget by 2002.

According to the Congressional Budget Office, the act was to result in $160 billion in spending reductions between 1998 and 2002. After taking into account an increase in spending on Welfare and Children's Healthcare, the savings totaled $127 billion. Medicare cuts were responsible for $112 billion, and hospital inpatient and outpatient payments covered $44 billion.[1] In order to reduce Medicare spending, the act reduced payments to health service providers such as hospitals, doctors, and nurse practitioners.
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And medicare drives the rest of the industry:

While that paper largely studied physician fees and outpatient services, other research published in May found that Medicare pricing for hospitals is similarly influential. The paper, by health care researcher Chapin White and published in Health Affairs, found that a 10 percent reduction in Medicare pricing yielded a 3 or 8 percent reduction in private prices, depending on the statistical method used.
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jaeger19 said:
No it doesn't. Not at all.

Number one.. is that the charges are meaningless. meaningless.. particularly in a hospital that's likely under a bundled payment system like a DRG.. (diagnostic related group).

(However, yes.. its entirely possible that the actual reimbursement for that 32,000 dollar charge IS 2500.. )

Number 2: There is the effect of cost shifting within the system. So while one procedure may have gone up more.. other procedures went down when it comes to the insurance company allowable.

I have already been over this example with you many times and provided the reimbursement changes. I don't care to go debunk this meme again. I suggest you do a little research on provider reimbursement.

Start with :



And medicare drives the rest of the industry:
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Does that mean that overall payments to health care providers haven't gone up faster than overall inflation over the past 50 or so years?
 
A part of the Problem is Catholic hospitals put the life of unborn ahead of the life of a woman and will not attempt to save the life of the pregnant women if in order to save the woman a direct abortion is needed.

That’s what happened to woman in Ireland whose 17 week old fetus was dying and doctors knew it had no chance of surviving but would not follow international protocol because the fetus still had a Heartbeat.

From the following article:

...the tragic death death of Savita Halappanavar.
The 31-year-old dentist was miscarrying, and was left in hospital for days as doctors decided to “wait and see what would happen naturally.” When a spontaneous miscarriage hadn’t occurred, instead of inducing labour, doctors waited for the foetal heartbeat to stop.
Savita had maternal infection, and a day later was diagnosed with Sepsis.

Doctors discussed ending the pregnancy but didn’t – even though the baby would not have survived and international best practice suggested terminating the pregnancy.

She later died.
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Ireland's abortion problem: New report lays bare the horrifying truth - Telegraph
 
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Dittohead not! said:
Does that mean that overall payments to health care providers haven't gone up faster than overall inflation over the past 50 or so years?
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Overall? No.. overall payments have gone up because demand for healthcare has gone up tremendously with an increase in population, with the increasing obesity of our population, and aging of our population, the baby boomers aging as well. the increase in sedentary lifestyles, changes in workplace to more repetitive motion, decreases in vacations taken by americans, and increase stress.

So.. while demand has a huge increase.. rather than reimbursement/price per patient going up... which is what typically happens when you have an increase in demand vs supply. The government has led a decrease in price/payment per patient. The result is that the current system can only make it through volume. So... providers that were independent and could not step up their volume.. had to sell out to form mega hospital system. (the irony is to hear the government and private insurers complain about these mega systems since basically they were created by the private insurances companies and government )

Where physicians used to see their patients.. especially surgeons.. in office visits... now that is all done by PA's or Nurse practitioners and you are lucky and surprised when you see an actual physician. Care that was done by a licensed nurse in the hospital... it now done by certified nursing assistants.

What it has meant is that for the average medical problem.. there is little difference in care. But for those outliers... that needed to see the doctor first.. that needed a nurse to do their basic cares and see that they were developing a pressure sore, or had signs of an internal bleed, etc.. those folks get worse care than before.

Oh.. and lets talk a little about the "its gone up more than inflation"... You should get down on your knees and thank god that it has.

You know why? Its one of the major pillars propping up the economy.

You know why inflation has been held down?.... Outsourcing of jobs to countries that pay a crap load less than America did. So you have the double whammy of having things that were manufactured by the us.. now being cheaper.. because they say "China".. on them..

AND you have wage stagnation as good manufacturing jobs with union representation.. go away.. and go toward service jobs that have little union representation.

So YEAH.. you have less inflation.. and lower wages... but hey.. I can buy a cheap radio at radioshack!.. with less real take home pay.

EXCEPT.. for the fact that healthcare is hard to outsource. So what props up our economy to a good degree.. is all those now.. pretty good jobs in those hospitals etc.
 
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jaeger19 said:
Overall? No.. overall payments have gone up because demand for healthcare has gone up tremendously with an increase in population, with the increasing obesity of our population, and aging of our population, the baby boomers aging as well. the increase in sedentary lifestyles, changes in workplace to more repetitive motion, decreases in vacations taken by americans, and increase stress.

So.. while demand has a huge increase.. rather than reimbursement/price per patient going up... which is what typically happens when you have an increase in demand vs supply. The government has led a decrease in price/payment per patient. The result is that the current system can only make it through volume. So... providers that were independent and could not step up their volume.. had to sell out to form mega hospital system. (the irony is to hear the government and private insurers complain about these mega systems since basically they were created by the private insurances companies and government )

Where physicians used to see their patients.. especially surgeons.. in office visits... now that is all done by PA's or Nurse practitioners and you are lucky and surprised when you see an actual physician. Care that was done by a licensed nurse in the hospital... it now done by certified nursing assistants.

What it has meant is that for the average medical problem.. there is little difference in care. But for those outliers... that needed to see the doctor first.. that needed a nurse to do their basic cares and see that they were developing a pressure sore, or had signs of an internal bleed, etc.. those folks get worse care than before.

Oh.. and lets talk a little about the "its gone up more than inflation"... You should get down on your knees and thank god that it has.

You know why? Its one of the major pillars propping up the economy.

You know why inflation has been held down?.... Outsourcing of jobs to countries that pay a crap load less than America did. So you have the double whammy of having things that were manufactured by the us.. now being cheaper.. because they say "China".. on them..

AND you have wage stagnation as good manufacturing jobs with union representation.. go away.. and go toward service jobs that have little union representation.

So YEAH.. you have less inflation.. and lower wages... but hey.. I can buy a cheap radio at radioshack!.. with less real take home pay.

EXCEPT.. for the fact that healthcare is hard to outsource. So what props up our economy to a good degree.. is all those now.. pretty good jobs in those hospitals etc.
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The government has led a decrease in price/payment per patient, yet it has gone up more than inflation?

Sounds to me like doublethink.

Unhealthy lifestyles lead to more demand for procedures, but the procedures themselves have become much more expensive. Moreover, prescription drugs have gone up astronomically in the USA, even while those same drugs cost much less in Canada, where the government negotiates prices. Here, there is no negotiation of prices, so the pharmaceutical companies can charge what the traffic will bear, which is quite a lot given that the patient only pays a small portion of the actual cost.
 
Dittohead not! said:
The government has led a decrease in price/payment per patient, yet it has gone up more than inflation?

Sounds to me like doublethink.

Unhealthy lifestyles lead to more demand for procedures, but the procedures themselves have become much more expensive. Moreover, prescription drugs have gone up astronomically in the USA, even while those same drugs cost much less in Canada, where the government negotiates prices. Here, there is no negotiation of prices, so the pharmaceutical companies can charge what the traffic will bear, which is quite a lot given that the patient only pays a small portion of the actual cost.
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No.. I don't think you understand that you asked two different questions.

Reimbursment to providers per patient was one question... that has gone down or stagnated for the most part. It has NOT gone up with inflation.

However.. OVERALL payments to providers is UP.. because there are MORE PATIENTS now than there were before.


So.. in 2005, I got say 110 for a procedure. Now in 2017 that same procedure is being reimbursed at 97 dollars.

however.. in 2005 I would have maybe 120 procedures a week..

Now we have outlasted two of my competitors.. and have expanded.. and now we do 264 of that procedure a week.

So my reimbursement per patient is down... and is less than inflation.

BUT the amount of spending on healthcare overall has increased.. because we have more patients. Understand?

I understand why its difficult for folks to understand the numbers in the media because they play fast and loose with the numbers.

Often they will say "look we spent x amount on healthcare procedures). and that spending has increased overall per year because of course their are more patients and sicker patients.

BUT.. the actual reimbursement per patient has gone down or stagnated for the most part.

And then there is the third number which is "prices" or charges.. which is completely useless because they largely mean nothing to what the patient or insurance actually pays. The price or charges is basically a shell game depending on taxes, costs shifting etc.

for example.. that same procedure that I get paid 97 dollars on.. in 2005 I charged 125 for that procedure. In 2017. . I charge 160 for that same procedure. yet get reimbursed less.


now.. on pharmaceuticals.. you have a point. When the medicare modernization act came into being in 2001 (I think).. Medicare for pharma was created and it specifically prevents the government from negotiating prices. (probably because pharma had seen what the government does to us).
 
Soopairik said:
Many Americans don't want Canadian style healthcare because they are scared of "socialism."
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Yet they love Medicare, Social Security, the VA and the U.S military. All socialized programs. Go figure.
 
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