Talk-Polywell.org

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Dr. Constantian is a plastic and reconstructive surgeon

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We have the shortest waiting time for nonemergency surgery in the world; England has one of the longest. In Canada, a country of 35 million citizens, 1 million patients now wait for surgery and another million wait to see specialists.

When my friend, cardiac surgeon Peter Alivizatos, returned to Greece after 10 years heading the heart transplantation program at Baylor University in Dallas, the one-year heart transplant survival rate there was 50%—five-year survival was only 35%. He soon increased those numbers to 94% one-year and 90% five-year survival, which is what we achieve in the U.S. So the next time you hear that the U.S. is No. 37, remember that Greece is No. 14. Cuba, by the way, is No. 39.

But the issue is only partly about quality. As we have all heard, the U.S. spends a higher percentage of its gross domestic product for health care than any other country.

Actually, health-care spending now increases more moderately than it has in previous decades. Food, energy, housing and health care consume the same share of American spending today (55%) that they did in 1960 (53%).

So what does this money buy? Certainly some goes to inefficiencies, corporate profits, and costs that should be lowered by professional liability reform and national, free-market insurance access by allowing for competition across state lines. But the majority goes to a long list of advantages that American citizens now expect: the easiest access, the shortest waiting times the widest choice of physicians and hospitals, and constant availability of health care to elderly Americans. What we need now is insurance and liability reform—not health-care reform.

Msimon wrote:the easiest access, the shortest waiting times the widest choice of physicians and hospitals, and constant availability of health care to elderly Americans. What we need now is insurance and liability reform—not health-care reform.

Annectodal.
Also, not true. Austria beats you guys hands down in every aspect and it is much cheaper here. If it makes you feel better, we also beat Germany and France and by faaar Greece (almost a 3rd world country in my book) and GB (their medical system is really bad, you can see it in their teeth).

Skipjack wrote:

Msimon wrote:the easiest access, the shortest waiting times the widest choice of physicians and hospitals, and constant availability of health care to elderly Americans. What we need now is insurance and liability reform—not health-care reform.

Annectodal.
Also, not true. Austria beats you guys hands down in every aspect and it is much cheaper here. If it makes you feel better, we also beat Germany and France and by faaar Greece (almost a 3rd world country in my book) and GB (their medical system is really bad, you can see it in their teeth).

So why aren't you sending teams to America to teach us how?

I know a few doctors that are specialists in their fields and that are actually touring the world to teach people how to do certain things.
I have quite a few disturbing tales about the US system from them.
It is interesting to note that more than one Austrian doctor that I know, prefers Austria over any other country. My sister is e.g. currently living and working in a German hospital. She said the German system is waaay inferior to ours. She wants to return to Austria and have her children here, because the care is so much better.

We have the shortest waiting time for nonemergency surgery in the world; England has one of the longest. In Canada, a country of 35 million citizens, 1 million patients now wait for surgery and another million wait to see specialists.

Off the cuff, that would seem to be a bit of a self-fulfulling prophecy. From my (perhaps not well informed) outside perspective many Americans would not be able to afford elective surgey - which immediately culls the waiting queues. So the American sterotype is that if you have money or good work-health-insurance then fantastic - but otherwise sucks-to-be-you.

btw, I have my own personal (non-work) private health insurance. In Australia where there are a few tax incentives for people to have private health insurance after a certain age. I'm happy that the public health system is there for other less fortunate people. The main benefit of health insurance is that it is much quicker to get elective surgery.

anyhow, when you compare the waiting queues with Canada - is that the public-health-system-elective-queue or the private-insurance-elective-queue?

BenTC wrote:Off the cuff, that would seem to be a bit of a self-fulfulling prophecy. From my (perhaps not well informed) outside perspective many Americans would not be able to afford elective surgey - which immediately culls the waiting queues.

Exactly, only a privilaged minority in the United States get to see doctors or have surgery. Most people die in the streets. We are one backward ass country us.

Besides, EVERYONE KNOWS that longer waiting lists are far better than short ones. Because, if lists are long then you have to prioritize those people who are going to kick the bucket soon, further pushing off the unnessessary wasteful surgeries for those rich people who would otherwise use their money to get themselves to the head of the list. Overall mortality goes down with long lists.

It's like letting someone cut ahead of you in the grocery store line because they only have a few items. We all do that. Except now you have to pay for their groceries too.

We have the shortest waiting time for nonemergency surgery in the world

I want to see the exact waiting time in absolute numbers. Then I could inquire here and let you know the ones we have. I know that wait times are usually not long.
I have had several non emergency surgery procedures during my lifetime and never had to wait very long. It may be due to the fact that we have more hospital beds and MDs per captita in Austria than the US has.

To seedload: I think that one has to distinguish between life saving procedures with a waiting list (such as transplants) and those that are not life saving procedures with a medical need (having a nasal polyp removed, or an artificial hip joint) and then finally elective procedures without a medical need (such as cosmetic surgery).
All of these are non emergency procedures. But if you throw them all into one pot... The US does a lot more cosmetic surgery than many other countries (it is more socially accepted in your society). Only the rich can afford that and they are expensive so wait times are short.

The life saving procedures with the longest waiting times are usually transplants. These are currently (until solutions through genetics or stem cells will be available) mostly depend on the availability of donor organs. These organs dont grow on trees. You can buy them on the black market of course and some claim that many rich americans have them shipped in from somewhere in latin america. The lack of a will to do that does not say anything about the quality of a health care system though.

seedload wrote:

BenTC wrote:Off the cuff, that would seem to be a bit of a self-fulfulling prophecy. From my (perhaps not well informed) outside perspective many Americans would not be able to afford elective surgey - which immediately culls the waiting queues.

Exactly, only a privilaged minority in the United States get to see doctors or have surgery. Most people die in the streets. We are one backward ass country us.

Besides, EVERYONE KNOWS that longer waiting lists are far better than short ones. Because, if lists are long then you have to prioritize those people who are going to kick the bucket soon, further pushing off the unnessessary wasteful surgeries for those rich people who would otherwise use their money to get themselves to the head of the list. Overall mortality goes down with long lists.

It's like letting someone cut ahead of you in the grocery store line because they only have a few items. We all do that. Except now you have to pay for their groceries too.

I was going to chime in on this with some sharp rebuttal. And then I read it again.

Good one.

Only the rich can afford that and they are expensive so wait times are short.

In a word. No.

Because cosmetic surgery is optional it is VERY cost competitive. When people pay for things out of their own wallet they shop around (when it is not an emergency). And because it is cost competitive doctors work very hard to get more efficient. Cosmetic surgery is affordable by most of the middle class. Skip a vacation.

This also makes it more affordable for those who need it for medical reasons. i.e. disfigurement from injury.

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LASIK is one example I'm aware of. Costs have declined considerably over the years.

You can buy them on the black market of course and some claim that many rich americans have them shipped in from somewhere in latin america.

I'll bet that is especially true of heart transplants.

Some claim there are secret cells of Nazis in German speaking countries who kidnap Jews and ritually kill them in an effort to reincarnate the spirit of Hitler. The ceremonies are elaborate involving blood and debauchery.

Some claim there are secret cells of Nazis in German speaking countries who kidnap Jews and ritually kill them in an effort to reincarnate the spirit of Hitler. The ceremonies are elaborate involving blood and debauchery.

Really where is that? I want to move there!

MSimon wrote:

seedload wrote:

BenTC wrote:Off the cuff, that would seem to be a bit of a self-fulfulling prophecy. From my (perhaps not well informed) outside perspective many Americans would not be able to afford elective surgey - which immediately culls the waiting queues.

Exactly, only a privilaged minority in the United States get to see doctors or have surgery. Most people die in the streets. We are one backward ass country us.

Besides, EVERYONE KNOWS that longer waiting lists are far better than short ones. Because, if lists are long then you have to prioritize those people who are going to kick the bucket soon, further pushing off the unnessessary wasteful surgeries for those rich people who would otherwise use their money to get themselves to the head of the list. Overall mortality goes down with long lists.

It's like letting someone cut ahead of you in the grocery store line because they only have a few items. We all do that. Except now you have to pay for their groceries too.

I was going to chime in on this with some sharp rebuttal. And then I read it again.

Good one.

Thanks, but its not that funny. This is a real thought. Long lines are better. In fact, it is even on the wikipedia page about Canada's health care system.

It has been observed and found in data that the complete elimination of all waiting times is not ideal. When waiting lists arise through a prioritization process based on physician-determined medical urgency and the procedure's risk, (in contrast to patient's ability to pay or profitability for the physician), waiting lists can possibly help patients. It's been postulated that a system of immediate care can be detrimental for optimal patient outcomes due to avoidance of unnecessary or unproven surgery. An example is the Canadian province of British Columbia, where, according to surgeon Dr. Lawrence Burr, 15 heart patients died in 1990 while on a waiting list for heart surgery. According to Robin Hutchinson, senior medical consultant to the Health Ministry's heart program, had the waiting list not existed and all patients given instant access to the surgery, the expected number of fatalities would have been 22 due to the operation mortality rate at that time. Hutchison noted that the BC Medical Association's media campaign did not make reference to these comparative statistics and only focused on deaths during waiting for surgery.[57]

Since, ideally, waiting lists prioritize higher-risk patients to receive surgery ahead of those with lower risks, this helps reduce overall patient mortality. Consequently, a wealthy or highly-insured patient in a system based on profit or ability to pay (as in the U.S.) may be pushed into surgery or other procedures more quickly, with a result in higher morbidity or mortality risk. This is in addition to the better-understood phenomenon in which lower-income, uninsured, or under-insured patients have their care denied or delayed, also resulting in worse health care.

http://en.wikipedia.org/wiki/Health_car ... t_patients

So, if you need heart surgery, you are better off not getting it, because it will kill you. Got it?

Hmmm...

seedload,

We learned that in the military. We called it triage. In fact hospitals have a triage nurse in the emergency rooms.

1. Going to die - certain - hit them with morphine and move on
2. May die - uncertain - do what needs to be done for stabilization immediately - next available service ASAP
3. Will not die severely injured - make comfortable - stabilize - put on a list
4. Will not die lightly injured - make comfortable - stabilize - put lower on a list
5. Minor injury - self treat if what is required is available

Every one on a stretcher gets tagged - esp noted is drugs administered.

And queuing theory is the basis for telephone systems.

And note: if the incoming requirements for service are random and the system is designed to meet the average rate the line will get infinitely long. You have to have excess (wasted) capacity.

Or stated more formally. Given an average service rate requirement of X and random arrival of service requirement a system designed to have exactly X rate of service ability will get a que of infinite length over time.

Which is why economies (systems) running at above 90% capacity are very inefficient. You need slack. Or what is often termed surge capacity. And a large system for a given service will require less proportionate surge capacity than a small one.

Which is why a 6 T1 capacity from my cable provider costs much less than if I had that capacity dedicated to myself alone.

Let me add that near the capacity limits a small increment of extra service can make a very large difference in wait times.

What does that mean? Canada - if it provisions medical service at the same rate as the US will keep a lot more people waiting. If it under provisions re: the US waits will be "excessive".

Or think of it this way: a small town will need a lot more doctors per capita than a large one. It gets expensive when a town needs 1.1 doctors. Because doctors only come in unit quantities.

In military situations it is why the strategy of interior lines allows a weaker defender to hold off a stronger. Resources can be moved to threatened points faster. Provided mobility is sufficient.

Which is why a country like the USA spends about 90% of its military budget on "tail". It allows us to put the tooth where needed when needed.

So a larger tooth to tail ratio may be a bad idea depending on the distances involved.

You want to know who is planning to conquer the world? Look at who is investing what into mobility.

So how do we handle the medical service problem out here in the US hinterlands? Helicopters.