Containing Healthcare Costs in the US

[Coopmv]

I wonder how much such a surgery costs and who is paying for it?  With exotic transplants such as hand transplant and face trasnplant that may happen on a more regular basis going forward, how the hell can the healthcare costs be reigned in?       

Hand transplant patient hopes to feel wife's touch 

By DAN NEPHIN, Associated Press Writer Dan Nephin, Associated Press Writer – Thu Jul 16, 9:38 pm ET

PITTSBURGH – From a Pennsylvania hospital bed, Jeff Kepner says he is looking forward to being able to feel his wife's and his daughter's hands when he holds them. The 57-year-old Augusta, Ga., man is the nation's first double hand transplant patient. He held hands with his wife Valarie on Thursday as he talked to news reporters about his recovery at the University of Pittsburgh Medical Center, where he underwent the nine-hour surgery in early May.

But Kepner cannot feel his wife's touch.

So far, he can move his fingers a little bit but has no feelings in his new hands because the nerves have not grown into them. Nerves grow about an inch a month, according to his doctors.

Kepner said he does daily therapy to develop muscle strength to use his hands, and he hoped to inspire others who need such surgery to consider it. He lost his hands and feet a decade ago to a bacterial infection, and said he did not want to undergo the surgery at first.

"I thought 'Are you kidding me?' I said, 'There's no way I'm going to do that,'" Kepner recalled telling his wife when she told him about the possibility last fall.

Showing off his hands Thursday, Kepner said he's glad he went through the surgery. He had been ambivalent because he could manage with his prosthetics and had read that the world's first double hand transplant patient had to have the hands removed because his body rejected them.

But Valarie Kepner was persistent. She had contacted UPMC without telling her husband. She wanted him to be able to regain some of his independence after being on her schedule for years. She gets up for work at 4:30 a.m., and that meant he had to as well.

Eventually, Kepner met with Dr. W.P. Andrew Lee, the hospital's chief of plastic surgery, who helped put his mind at ease.

Lee said that for the May 4 surgery, 21 surgeons worked in teams of four: two prepared Kepner's forearms and two prepared the donor's hands. The teams worked simultaneously.

UPMC developed a protocol to reduce the amount of toxic anti-rejection medications that must be taken so that the hands are not rejected, Lee said. The medications can increase the risk for diabetes, infections and other complications.

While Kepner shows no sign of rejection and is making steady progress, it could be a year or two until he gains full movement of his fingers, Lee said. Kepner could be at the hospital another couple months.

Demonstrating some exercises, Kepner struggled a bit because the muscles in his fingers are tight. He tried passing a small ball between his hands and used his right hand to unstack a set of small cones and build another stack.

Kepner said he looks forward to being able to shower and cook, explaining he became a pastry chef after retiring from the Air Force.

"I want to try these hands out. I want to put them to use," he said. "It will really free me up and free her (Valarie) up. The independence will be nice, to get that back. And the touch and the feel. That's the big part for me."

Eight double hand transplants have been performed abroad. UPMC performed its first hand transplant in March on a Marine who lost his hand in a training accident. Lee said that patient is recovering well and can do crossword puzzles.

[Todd]

I wonder what percentage of total costs such acute procedures represent.  I believe a higher proportion goes to more mundane procedures that are unnecessary or of questionable benefit, as well as questionable drug prescriptions.  There's also the problem of uninsured and ignorant patients using emergency rooms for basic care - this costs enormous sums nationwide.  And there's still not enough focus on preventative care, which has been shown to reduce the need for more acute care over time.  There's a lot of room to reduce costs without necessarily reducing access to the most advanced care when it's needed, though some tough choices would need to be made there as well.

If cost control is the focus, then more attention needs to be paid to the more common practices than the more glitzy ones.

[Passau]

Surely there are a variety of reasons why heath care is so expensive in the U.S, but the principal one, it seems to me, is the pig ignorance of a lot of Americans. As a Canadian/American dual citizen who's experienced the systems on both sides of the border, it blows my mind listening to American politicians debate health care, acting as though the approach taken by Canada and pretty much the entire civilized world -- i.e. single payer national insurance and cost control boards -- is somehow inherently evil and leads to massive problems. False. In Canada, where I live at present, everyone is covered, the debt to GDP ratio is among the lowest of western democracies, and Canadians are healthier than Americans. The government here would fall in a single day if it tried any of that American B.S..

[Coopmv]

Surely there are a variety of reasons why heath care is so expensive in the U.S, but the principal one, it seems to me, is the pig ignorance of a lot of Americans. As a Canadian/American dual citizen who's experienced the systems on both sides of the border, it blows my mind listening to American politicians debate health care, acting as though the approach taken by Canada and pretty much the entire civilized world -- i.e. single payer national insurance and cost control boards -- is somehow inherently evil and leads to massive problems. False. In Canada, where I live at present, everyone is covered, the debt to GDP ratio is among the lowest of western democracies, and Canadians are healthier than Americans. The government here would fall in a single day if it tried any of that American B.S..

The politicians are still debating like crazy down in Washington while the lobbyists are working on them non-stop.

[DavidW]

it blows my mind listening to American politicians debate health care,

Once you get used to listening to our politicians you get used to the absurd analogy soundbites and how inane they sound!   My advise, watch the Daily Show and laugh.

[Josquin des Prez]

http://www.youtube.com/watch?v=ho-0SHFEgGo

[Bulldog]

http://www.youtube.com/watch?v=ho-0SHFEgGo

The siren at the end was a nice touch.

[Josquin des Prez]

Surely there are a variety of reasons why heath care is so expensive in the U.S, but the principal one, it seems to me, is the pig ignorance of a lot of Americans.

How does the ignorance of a "lot of Americans" translate to higher health care costs?

False. In Canada, where I live at present, everyone is covered, the debt to GDP ratio is among the lowest of western democracies, and Canadians are healthier than Americans.

I'm not exactly sure how the "dept to GDP ratio" has anything to do with healthcare costs. Furthermore, Canadians may simply be healthier then Americans because they lead healthier lives rather then any particular benefit their receive from their government. Several other countries which too enjoy "free" healthcare aren't exactly better off in terms of general health when compared to the US. How has their system failed them?

But really, one surely has to wonder why those ignorant Americans are so paranoically weary of anything even remotely associated with
socialism:

http://www.telegraph.co.uk/comment/columnists/christopherbooker/5858902/Evil-destruction-of-a-happy-family.html
http://www.express.co.uk/posts/view/115736/Sin-bins-for-worst-families
http://www.dailymail.co.uk/news/article-1203151/Mother-40-thrown-police-cells-pleading-bullies-leave-daughter-alone.html
http://www.express.co.uk/posts/view/116650/Get-500-to-spy-on-neighbours-
http://www.timesonline.co.uk/tol/comment/columnists/article6169378.ece

Who wouldn't want to live in some bizarre Orwellian soft dictatorship in exchange of lower healtcare costs?

[Josquin des Prez]

The siren at the end was a nice touch.

"Your honor, the evidence we just witnessed which proves beyond doubt the accused actually committed the murder is not admissible due the untrustworthy nature of the source"

[drogulus]

     Is there a successful private health care system somewhere? Everyone knows there isn't. The Republicans don't want to admit that they don't really want to privatize the best parts of health care, which are all public. If you try to decode what they really want it's to prevent what's good about health care plans from being offered to everyone that isn't covered or who are stuck in lousy plans that they will lose if they change jobs anyway. I'd love to have a private plan that I could take from job to job, one that wouldn't cost a fortune and that wouldn't refuse to pay for care I need. Where do I get one?

     No, people don't want "socialized medicine" because they are ideologues, they want it because it's the only way anyone has come up with that does what needs to be done. Which is why not a single country with public plans is contemplating reprivatization. Can you imagine privatizing a public system to make it better? Better how? More universal? Obviously not. Better quality for the vast majority who aren't rich? If that was the case why isn't there a public clamor in the rich democracies for a return to medicine for profit? Look, I'd love it if that would work. Anything the private sector can do better than a government program should be left to the private sector. But the dynamics of health care is incompatible with a purely private incentive system. We've been running this experiment long enough.

     

Surely there are a variety of reasons why heath care is so expensive in the U.S, but the principal one, it seems to me, is the pig ignorance of a lot of Americans.

     No, it isn't that. We know that the propaganda about Canada is just that. It's the way that our politics is skewed to favor rural and southern interests over the more populous regions that are urbanized and better educated. The Republicans have replaced the old Dixiecrats. They thrive on the resentment of Red Staters. It's ironic since the Red States live on welfare handouts from the Blue's.

[Coopmv]

An article I read a while back in BusinessWeek, I believe it was last year just before the election, which described how the French healthcare system should be the one for the US to learn from since it is largely private and yet has pretty good costs control ...

[bwv 1080]

The nationalized healthcare systems around the world are able to be a free rider on the innovation created by the US's for profit healthcare system.  Drug and device companies can recoup their research and development costs and earn their cost of capital in the US then offer their products at discounted prices to national HC plans as the marginal revenue is all profit.  Messing with this ecosystem threatens the pace of future medical innovation, which is ultimately what is necessary to reduce costs.  The US has the best medical care in the world for those who have the resources to pay for it.  For example, this paper from the Lancet documents that the US leads the world in survival rates for various forms of cancer:
http://v1.theglobeandmail.com/v5/content/pdf/CONCORD.pdf

It is not American "stupidity" that is wary of the plan, its the fact that for those with insurance the care is the best in the world and Americans will not accept the waiting times for treatment that are typical of the Canadian or UK plan

The public choice problems with a national plan are insurmountable IMO.  Already lobbyists from the healthcare industry are steering the votes of the blue dog democrats who now control the outcome of the Obama plan.  We will get corporatist medicine, not socialized. Tom Harkin is leading a drive to get quack treatments like homeopathy covered  by the plan (the UK plan covers homeopathy and chiropractic and has created powerful lobbies that will file libel suits on anyone who challenges the lack of evidence for the efficacy of these treatments).

Healthcare is not a right, it is a privilege of living in a wealthy society.  it a legitimate choice to include some form of health coverage into social safety nets, but the best thing to do would be to follow the swiss model of providing vouchers for private insurance.

http://en.wikipedia.org/wiki/Healthcare_in_Switzerland

[Coopmv]

The nationalized healthcare systems around the world are able to be a free rider on the innovation created by the US's for profit healthcare system.  Drug and device companies can recoup their research and development costs and earn their cost of capital in the US then offer their products at discounted prices to national HC plans as the marginal revenue is all profit.  Messing with this ecosystem threatens the pace of future medical innovation, which is ultimately what is necessary to reduce costs.  The US has the best medical care in the world for those who have the resources to pay for it. 

The US taxpayers do indeed subsidize the rest of the world by having to pay the highest prices in prescription drugs.  Indeed, most US pharmas and I suspect European pharmas as well, charge the US patients much higher prices on prescription drugs.  One way to reduce theese costs is to have the US government pressure the rest of the world to pay their fair shares for the prescription drugs.  It is plain and simple. 

[Josquin des Prez]

the more populous regions that are urbanized and better educated.

Better indoctrinated to liberal social engineering is what you mean.