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kq4ym
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Re: Health expenditure bang for buck
kq4ym   12/28/2016 9:24:07 AM
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It may be that health care spending isn't the main determinate of lifespan or health. Preventive programs, including as noted alleviated stress may very well have more benefit that hospital or office visits. Interesting how many countries still have pretty good life expectancies without spending as much as the U.S. or other countries with health costs much larger.

Jamescon
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Re: Health expenditure bang for buck
Jamescon   11/2/2016 11:57:38 AM
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@Seth. I didn't realilze that was why there are so few openings in nursing programs. I know that most of the programs are highly competitive with small classes. If the problem is one of finding nurses who can teach, one cause might be the fact that a lot of nurses burn out and want nothing to do with the profession after a point in time. Plus others opt for sort of a semi-retirement, working one or two shifts a week, keeping some income without the full-time commitment.

SaneIT
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Data Doctor
Re: Health expenditure bang for buck
SaneIT   11/2/2016 10:44:32 AM
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@SethBreedlove - I had no idea the shortage was at that level.  I know there have been warnings about the boomer generation requiring more nursing care than generations past but not much after that.  Is it generational or is there a steady increase that we're just not meeting?  Secondly I'd ask what is keeping those numbers from meeting demand, is it training alone or is it related to a lack of promotion, pay, longer schooling requirements when a lower career wage gap.

SethBreedlove
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Data Doctor
Re: Health expenditure bang for buck
SethBreedlove   11/1/2016 5:59:59 PM
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@ SaneIT - I think another thing driving up the cost of healthcare is the lack of nursing programs here in the U.S.   You would think with the demand that wouldn't be the case, but there is a real lack of nurses that can teach leading to the shortage of available classes. 

So very often many hospitals are importing nurses.  Primarly from the Phillipines which have highly skilled nurses.  But it is a shame that we are not educating enough of them here.

SethBreedlove
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Data Doctor
Re: Health expenditure bang for buck
SethBreedlove   11/1/2016 5:55:08 PM
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@ Jamescon -  I would add to that, that many people have become permanet temps with no real benefits.   When the contract ends any money saved up quickly goes out the window until a new contract is found.  The time off isn't a vacation when a person is stressed out about where their income is going to come from.  Really, we have gone back to pre-union day labor rights.  All these things affect the quality of a person's health.

Michelle
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Data Doctor
Re: Health expenditure bang for buck
Michelle   11/1/2016 1:55:18 PM
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@James the progression makes more sense to me now. I am not a fan of the trimmed down team model. It's burned more plans to leave early or take an actual vacation than anything else I've experienced in my professonal life. This model assumes work is the only thing worth doing in life, when that's not reality. Working to provide for a family you hardly see is really tough.

Jamescon
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Editor
Re: Health expenditure bang for buck
Jamescon   11/1/2016 9:41:03 AM
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@TinyM. There have been a number of changes in the workforce that have made it harder to take time off. The latest is the bare-bones staffing approach that had been with us for a while but really got a push from the 2008 recession. Companies laid off workers to survive the recession, but only partially restaffed when the economy turned back upwards. The survivors ended up doing that much more work. Then, new projects and initiatives were added but with minimal if any additional resources.

However, going back even further (I'd say the late 1980s), there was a movement away from people, including white collar employees and managers, working "shifts" to everyone essentially owning a project or task. You worked a day or evening shift and, if necessary, handed off the remaining tasks to someone coming on. We migrated to a model where you worked until your work was wrapped up, regardless of how long.

Once again, it was with fewer people on staff. In the old model if you were out sick for a day or took a vacation there were enough resources to "cover" your projects/tasks (even in non-union companies). With that 1980s model that idea of coverage disappeared, and we started saying things like, "I'm out tomorrow but available (initially by phone and eventually by email or cell) if there are any issues."

Pretty soon, the work that came in while you were gone was waiting for you when you came back. More work, fewer workers.

 

Jamescon
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Editor
Re: Health expenditure bang for buck
Jamescon   11/1/2016 9:20:52 AM
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@SaneIT. Great points about health care. I'd add that even with a single-payer system something still has to be done to manage costs. The popular view is that doctors are greedy and are driven by profit. The fact is that there are well over a dozen profit points throughout the system, with a lot of them being grossly inflated. Those costs are hidden in places as a subtle as someone pushing paper through a medical center or insurance company. They are in the often unnecessary tests conducted to protect the medical profession from malpractice suits. I've seen it in my own family this year with a couple of people who were perfectly ambulatory but had to be transfered to step-down facilities. The default in the system was to send by regular ambulance at high cost. The $5 Tylenol is legendary and lives on.

Why does the system ring up these charges? Because they can, and because it pays for someone's job.

Single payer (government) or private payer, everyone in the system has to take a look at how they justify today's costs.

SaneIT
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Data Doctor
Re: Health expenditure bang for buck
SaneIT   11/1/2016 8:32:07 AM
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@SethBreedlove "There are so many factors that go into the high cost of health care in the U.S, such as the lack of colletive barganing other countries have."

Since we're nearing the end of this political cycle I guess I'll stir things up a little...

You're exactly right with this, even the health care that is run by our government and is large enough to have this kind of leverage doesn't do nearly as much as they should.  Medicare and Medicaid should be able steer costs better than they do.  When the ACA was announced, my biggest issue was that it would not be a single payer system.  I just couldn't see a program with such big goals working if it didn't become its own entity top to bottom.  What we have instead are the same insurance companies begrudgingly covering people and not doing much for them aside from collecting their premiums.  It isn't making health care affordable it is only making it marginally more available through removing disqualification methods.   I know doctors and hospitals complain that Medicare lowers their profits but then I look at how they have changed their billing methods to offset those lower margins and I have a hard time feeling sorry for hospitals who claim that their profits suffer.

 

SaneIT
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Data Doctor
Re: Health expenditure bang for buck
SaneIT   11/1/2016 8:22:07 AM
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I'm not saying this is the only reason that the US health care costs are so much higher later in life but I do think it plays a large role.  We spend so much time pushing ahead that we don't regularly take the breaks that we need.  You have a one day occurrence that will probably mean you don't take that long weekend at all before the end of the year.  Many of us do this and keep pushing the rest time off until a later date.  The problem is that later date never comes.  Typically I only take time off if my wife makes plans or to burn off hours that won't roll over to the next year.  Even then I'm not fully away from work since someone always seems to need something from me.

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