Phileas S4 – Healthcare for dummies

October 19, 2009 by  
Filed under - The Phileas Club, .Episodes, Featured

CaduceusA special episode all dedicated to healthcare, with:

  • Patrick Beja from France (notpatrick on Twitter)
  • Julio Aprea from Argentina / Netherlands (aprea on Twitter – alternaria.tv)
  • Maria from Sweden (pagga on Twitter)
  • Randy Jordan from the US (randydeluxe on Twitter)
  • Samantha Jane from Canada (samjane on Twitter)

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Comments

28 Responses to “Phileas S4 – Healthcare for dummies”
  1. Andy P says:

    Good show guys, as always! In case anyone is interested, here is a link to the World Health Report for 2008 (couldnt find the 2009 one) on the WHO site… http://www.who.int/whr/2008/en/index.html

    • randulo says:

      Brilliant perspective, thanks to all who participated, I was impressed by the intelligence of each speaker. In particular, the American who shares my first name came up with some new thoughts I hadn’t heard before.

      One comment I’d make personally is that I like the work of Michael Moore and I think it’s important to have people like him and Bill Maher around. Having watched Sicko and having lived in France for 28 years, I have to say the segment where he brought a bunch of people together in Paris was total B.S. and tarnished the credibility of the entire movie. Several things said by one or more expats were total fantasy, like the doctor telling him to go rest for six weeks on the Côte d’Azure, give me a break… Surely, Patrick, you’d challenge what was said in that movie about France!

    • Patrick says:

      Well I haven’t seen Sicko yet, mainly because I take everything Moore says with a very big grain of salt. Farenheit 9/11 showing how wonderful Iraq was before the US went in there was ridiculous. I’ve heard of these parts of Sicko, and I have no problem believing that they are equally ridiculous.
      That being said, I agree that Moore is a very important figure in the political debate, and however extreme he is, he does ask the right questions, very often at the right time… or slightly ahead of it.

      The answers however, have to lie within ourselves… :)

    • SteveT says:

      Truly enjoyed your show regarding healthcare. My single greatest concern about the US Government’s desire to play a greater role in providing the service relates to the corruption, inefficiencies and proven inability to deliver that permeate the system. These problems can be seen in existing government operated services such as Medicare, Medicate and the Veterans Administration. The bureaucrats have allowed the growth of cronyism, fraud and bloated administrations while those people serviced by the system face poor care, prolonged delays and lack of quality service. Perhaps a good first step would be to deliver medical services to our congress men and women through one of these existing services. Otherwise, I’ll be happy to sigh up for their healthcare that is fully funded on teh backs of the US Taxpayer.

  2. Foxlore says:

    Great episode. Loved the different perspectives.
    Having gone through the health care systems in the US and in Hong Kong I can site one example, that (for me) is the root of the problem for US healthcare currently.

    In Hong Kong my partner purchased two Health Insurance policies. One from a local HK bank. The other through American firm Prudential.
    Back in 2008 my partner had an issue where she passed out. Our family doc in HK said to just monitor the situation and we did a full physical check up to be safe. Nothing conclusive. Then in 2009 almost a year later it happened again. Doctor recommended MRI and testing at hospital.

    Similar to some of the plans you all talked about in the show, Hong Kong basic coverage is covered by the state (through taxes). Additional care can be taken care of with private insurance, so the rest she was supposed to be able to file claim under both the policies mentioned above to cover all costs. End result HK Bank policy said no problem and paid out the appropriate stipend according to the policy. Prudential denied any claim saying this happened back in 2008 and as such was a ‘pre-existing’ condition.

    Now I don’t mind paying for insurance, but it is this idea of paying for something for years only to be denied when you need it that seems totally outrageous. Insurance companies have gotten far too greedy, but the system is rigged so that the ‘free market’ forces cannot work.

    For example; my parents back in Florida are having to redo entire policies of Health/Home/Auto insurance because the company that they have had policies with (and paid into) for years is trying to leave the state (Losing too much money with hurricanes and those dreaded old people living there). In many states there are few, if any, alternatives.

  3. bryan says:

    Good show. Very interesting.

    One thing I thought I could add to the discussion. I worked for 2 years in Ireland in the biomedical field (microdevices). I saw several talks from successful businessmen in this field. This usually involved pumping money into filling a medical niche, and being sucessful at it. Blood glucose tests to monitor diabetes are a good example.

    Now, in the show, it was mentioned that an argument in favor of the US system was that the money drives research. The roundtable dismissed the idea, citing sucessful and important research in countries besides the US. While I agree with this on the surface, there is a more subtle influence that is at work. All of these businessmen (as well as colleagues where I worked) said that deciding what medical advance to work on was determined entirely by the US medical market. The amount of money involved there was so much greater that tapping into that market defined sucess as a biomedical company. The other markets were just bonus, and after the fact. I don’t point this out to defend the US system. Rather, I wanted to point out that the disproportionate costs are influencing medical research worldwide. If it isn’t a US medical problem, then it is of far lower priority. I would argue that it is in the best interest of world health to not have a US-centric medical market driving such research.

    • Patrick says:

      Hey Bryan,

      While I understand your argument, I don’t see how this changes what we said: you’re talking about something completely different. You’re saying that the US market drives research, which makes a lot of sense: it’s the biggest industrialized country out there. But that is not going to change if the healthcare system there changes. People will still get sick and they will still need to get treated. Many many of them even.

      And if the argument is that research will wane because people will somehow get less sick… well, I would venture to say that’s a good thing. :) (but that’s unlikely)

    • Richard says:

      Patrick, I think you are missing the point. if all healthcare is unified under one provider (the government) then there will be less diversity in the medical treatment. Instead of pitching a medicine or treatment to the hundreds of different providers out there they will be pitching to just one. This will, by it’s very nature, restrict the number of different products that can be sold in a year.

      I do not think it has anything to do with people being more or less sick. it has to do with how many different groups can buy the product.

      In addition as it stands now a patient can go into a doctors office and demand a certain treatment. If they cannot get it there, then they can move a another doctor to get it. under a unified system this would not be possible as everyone would follow the same rules. This would also restrict the possible market penetration of a new product.

    • Vincent says:

      Unfortunately those arguments are only partially viable. Should the world stop looking to the U.S. for it’s lead on what trends to follow in research? Absolutely. Will a unified health care system end innovation in the U.S.? No, not really.

      The reason for both of these points is that research in the U.S. is not based on innovation for the sake of bettering health care or well-being, it’s based on profit. U.S. pharmaceutical company’s pursue drugs that will make them the most amount of money – as a general rule. Smaller firms will go after major advances in medicine, but the way the system works is that those smaller firms get bought up by the larger firms, creating all of those wonderful companies with multiple initials in their names.

      I worked in pharmaceutical R&D and then moved on to the sales and marketing end of the same company and the clear trend was that the spending on the R&D side was far too high with too little yield in drugs actually going to market, leading the sales and marketing end to have to scramble to sell as much volume as possible. This equated to the canceling of projects deemed unprofitable and a focus on re-purposing existing medication for other areas to extend patent life cycles and maintain profits.

      Simply stated, at the very least on the pharmaceutical side, the U.S. is not truly an innovator. Point in case we are very typically behind the EU and Asia in approving treatments that had already been in practice for years.

  4. Chris S. says:

    Greeat Podcast. Randy did a good job of explaining the problems facing Americans these days. I think the problem with this possible solution really is the policians. Most of us see the problem, and I think most of us agree that we need a public payer to normalize the prices and cover the uninsured. But, I think the politicians making at 1500+ page bill goes beyond what is needed to solve the problem, adding a lot of junk to the solution. Even more, the price of the possible solutions is downright scary, considering the already 1.4 trillion dollar deficit this year. In a climate where all of us are cutting back and making less money, the idea of an additional 7 trillion dollars over 8 years is horrifying. There has to be a way to cover the costs of the uninsured without actually tearing down the system.

    • Patrick says:

      The bill cannot be a 3 page essay… I guess there are some unnecessary legislation in there, but you can’t expect it to be a 10 minutes read either.

      And about cost… Well, however much it costs after it’s reformed, it would cost more at the rate you’re going now. And need I remind you once again that we spend a lot less with our system than you guys do? If you’re worried about cost, then change is the only solution, and our “socialists” systems are a good idea…

  5. Devin Baines says:

    I’m mildly annoyed about about your coverage of the Canadian system. Your representative was somewhat inadequate. Plans differ from province to province, but all residents get the same level of basic care. Bottom line, if you get hit by a bus, you’re good. If you want more pills than the Dr. said you should have, you pay (private insurance notwithstanding), depending on the Province. BUT! The Provinces all negotiate their own bulk rates for things like cancer drugs or flu shots, etc. that keeps the cost for prescriptions down.

    Physicians in Canada are small business persons, for the most part. They run their own practices or provide their own specialist services via a private practice or a hospital, but their only clients are the provincial government. Not all services are covered – boob jobs and sex changes are not, for example.

    As a federal employee, my pay cheque is docked extra for things like dental and optical via the federal civil service health care plan, things that folks without some kind of private plan must pay out of pocket. Many private companies have similar plans. Sole proprietors can take out private insurance with folks like Blue Cross (random example) and perhaps offer it to their employees, but do not always do so. However, private extra insurance is available.

    So here in Canada, if you need a hip replacement, you may need to wait a while, but you will not need to pay for it. If you have a cold and show up to emerg, you will not need to pay for it, but the bleeding patients outrank you. If you’ve been shot? You’re first and it will not cost you a dime.

    • Patrick says:

      I’m not certain I understand how what you describe is different from what Sam described. That’s pretty much the picture I got from her explanation.

  6. I am writing from the land of 2 – 5 word catch phrases. A place where people wrap themselves in bumper stickers and then stomp and yell like children to prove their points. Sitting at the at microphone are usually people who preach half truths hype. Stuff for ratings, not digestible. Like rotten candy.

    O.K. not everyone is banging tin cans and chanting nonsense here but you have to search and dig to find civility and rational ideas at times. (I live in the U.S.) And i know other country’s, even the ones with the top rated health care systems, have their problems.

    Just wanted to say, this show was so refreshing! I just subscribed and have listened to three shows so far. Wish i had something to add to the conversation here in the comments section but im still digesting what i herd!

    I’m stuffed.

    Take care.

    ~Aaron

  7. Drazen says:

    Patrick how come you newer have guests from former or current communist countries?

  8. David J Rust says:

    An excellent episode, indeed; very educational and informative! I found learning about Sweden, Argentina, and other countries’ Health Care systems to be very enlightening.

    For those who would like to hear some further, fascinating analysis of the American system, the radio show “This American Life” has dedicated their past two programs to this issue. These two, hour-long programs are online for free MP3 download at:

    http://thisamericanlife.com/Radio_Episode.aspx?sched=1320 (looking at the Health Care system, itself)

    and

    http://thisamericanlife.com/Radio_Episode.aspx?sched=1321 (looking at the Insurance industry impact on it all)

    I found them very interesting!

    Yours,
    David J Rust
    Minneapolis, MN
    (Ok, a small suburb called “Columbia Heights”)

  9. Patrick, I’m a new listener, and I think your show is great. The health care show especially. I live in the US, and as long as we Americans are talking among ourselves and not to people from other countries, virtually everyone will say that our healthcare system is broken. Chris S. Touched on the main problem but didn’t carry it far enough. As part of the founding principles of this country we were warned not to trust our government. I think (and many, many people do as well) this warning was well founded and holds as much validity today as it did 250 years ago. We don’t trust our politicians to do something as important as healthcare correctly. That’s not even the problem. The problem is that we don’t have politicians that we can trust to do the right thing and to put aside the special interests and the desire to bring jobs and money into their home districts so they can be re-elected. We currently have two national healthcare systems: Medicare and Medicaid. Both of those systems are so rife with inefficiencies and corruption that people dread getting involved with them. And none of our politicians has done anything over the last 50 years to correct that. With those two sterling examples of national healthcare out there for all to see, why would we trust our politicians to do it right this time? A definition of insanity is repeatedly doing the same thing and expecting a different result. We expect that the politicians will do the same thing again, expecting and promoting a different result, and get the same old inefficient, corrupt system that we have now.

    Throw the rascals out, you say. I am with you 100%, but most of the population is (maybe at this point in time, was) too apathetic to do anything decisive.

    I look forward to your next show.

    Bob

    • Joe Scott says:

      Agreed Bob. The 2 government run systems of health care in this country (US) are broken. Politicians are exactly what you say they are, motivated by their own self interest. Its disheartening to see my government be so totally inept to do anything about this right now. We did elect our President by a landslide, the democrats took control over the house, and the senate but nothing is still being done about health care. It just goes to show two things. Career politicians don’t care about you, they care about themselves. And……The government is not corrupt. The people are corrupt, and they have the government that they deserve.

  10. Vincent says:

    To elaborate a bit further on my response above (see the reply to bryan and Richard), I’ll add a bit of detail to the costs and ramifications of R&D in the U.S. (as it applies to pharmaceuticals).

    In 2004, when I left R&D and moved on to marketing, the average cost of research on one compound, or drug, was $850 million and 12 years from concept phase to FDA approval and release. The compound I was working on was, at that time, at $1 billion and in it’s 15th year. This compound never made it to market. The accepted average was that 1 in 4 drugs would go to market.

    What this lead to, a trend I could clearly see even in my relatively short number of years in the industry, was that a shift was occurring towards drugs that were known to be profitable rather than ones that could make the most impact on the general health of patients. In fact, recently, the particular company I worked for had a clear market advantage in the vaccine division and pulled funding from almost every other area, including laying off thousands of workers, in favor of pursuing a more vaccine centered market plan.

    It was as simple as chasing profit.

    All this is to say the current U.S. system of “capitalistic” health care management is very much a cause of the problem. Health insurance is crushingly expensive and our level of care is terrible no matter how you look at it. Doctors are being charged such high rates for their malpractice insurance that they are forced to work longer hours, seeing more patients with less time spent per patient, just to make ends meet. Pennsylvania particularly is suffering from this. The next time you visit your primary care physician, ask them how much your HMO (or POS, etc.) is paying them for the visit. You will be horrified.

    Our current system does not foster a competitive market, it drives up costs and lowers accepted levels of care and production.

  11. Richard says:

    So I finally got to listen to the show. Very good show. And I think Randy did a good job showing what is going on in the current system.

    But….

    You know that was coming right? :-)

    there is one issue that you did not address. I love that you used the seat belt analogy, because that particular device is part of my argument. In the US we have passed seat belt laws. these laws were sold to the people as laws that are enforced on top of other laws. In fact most of them (and the ones here in Colorado) are written in a manner that you will not be pulled over for not wearing a seat belt. Fast forward 10 years and we have adds telling you, on huge billboards “click it, or ticket”. In other words you will now be pulled over and punished were you were promised you would not be.

    To apply this to health care now. In the states there is a strong ideal of punishing those that cost us money. the seat belt law is an example of this. the law is needed as people who do not wear them cost us money when they get into crashes. Already we have the state of new york and other areas trying to pass “fat taxes”. These are to punish people for being overweight.

    The problem I have with this is that it is the federal government trying to get in and control your behavior and your life. Which to me is not the place of the government. A national health care system will exacerbate this problem.

    While I agree that the US system is in need of a great deal of reform, it is not fair to discount this very real issue of government getting into my house and trying to tell me what I can and cannot do. This is an area that I feel is not properly addressed in the debate.

    And please do not pull out the red herring of “it will never happen”. It is happening already. It is just hard to get passed now as the health care is not unified. This makes it hard to for a lawmaker to claim that “you ” are paying for it. After a unified health care plan is in place they can point to the exact tax you are paying for fat people to get care. or smokers, or people who like bacon, or do not exercize or any other reasons that can be labeled.

    I also realize that I am a poor writer and that my concern may be coming off, not as well I would like. But I am gonna give it a try anyway. :-)

    Also for a better examiniation of this issue and my concerns with it please listen to Dan Carlins take on it here – http://cdn2.libsyn.com/dancarlin/cswdcb57.mp3?nvb=20091023211953&nva=20091024212953&t=04ff471e0cd66328eb552 It is the second half of the show.

    As an aside, Mr. Carlin here is in my opinion the best political commentator in the US at the moment.

  12. Kevin says:

    First of all, great podcast. I found the various opinions to be very enlightening. Just to give a disclaimer, I’m an American who wants a public option in the US. I’m also currently working as a consultant to the NHS in the UK.

    I want to play a bit of devil’s advocate because very few positive things about US system were mentioned and pro-private advocates were more or less thought to be idiots. I think the main reason many Americans a don’t want a public option was not touched on. It has anything to do with the government telling us we have to get coverage. Take my example for instance. Strictly in terms of care, I have very good health care. As an upper middle-class, single person with company supplied health plan, i can chose any doctor I feel like from thousands in a top 10 US health-system with minimal wait times. I can directly book appointments with elite specialists without a referral (which I admit doesn’t make sense). I’ve been able to see a Orthopedic Surgeon for an ankle injury that our fantastically rich American Football team uses. It is certainly much better than what I see people in the NHS dealing with. One of the main metrics in the NHS is the 18 weeks pathway. I could not imagine waiting 4+ months to see a specialist. I know that the UK is not the only system out there but it’s an example of what many americans fear. I have very little doubt the quality of my care and choice would go down with a national option. I think that is fundamentally the problem. It may be selfish, but many people feel that a national health system would mean less coverage and quality to pay for people who don’t want to work and support themselves.

    I used to feel like that but have changed. Our system is really messed up and unsustainable as Randy pointed out. I changed my opinion due to the amount of waste, the spiral of the uninsured, not being able to get coverage due to pre-existing conditions, and being financially ruined just because you get sick while you were between jobs. A lot of Americans are beginning to feel this way as they’ve seen their health benefits decrease while costs go up. This is why we are even having the national option discussion.

    • Patrick says:

      To respond to you “advocate playing”, I’d say that the public option is different from the “single payer” system. With a public option you can still get a different / better insurance with a private company.
      And honestly, I’ve never seen someone have to wait 4+months to see a specialist here in France (where we have a sort of single payer system+), but maybe the UK is different.

      And as you said, at this point pretty much everything is better than the downward spiral that the US healthcare system is in today… :/

    • Kevin says:

      I thought it was either complete free-market healthcare or wait-in-line-for-bread communism? You mean there’s something in between?

      Seriously though, I would like to see a very basic major medical coverage with preventive care like physicals and appropriate exams based on age. Then fill in the gaps with private coverage. That way you can still pay for better care but at leas you have something and don’t go bankrupt if you’re down on your luck. I also think we need to do something about malpractice insurance. Several doctors i’ve talked to say it’s their biggest expense and can be very oppressive.

      Most people in the UK don’t wait 4 months, but it does happen. If you’re ill and need immediate attention you generally can get seen right away. And of course there’s a thriving private option where you can pay for faster coverage. A lot of employers add private insurance as a perk.

      Pardon me if I’m speaking gibberish. I drank a bottle of Bordeaux while listening to the podcast and decided to write a response.

      Thanks Patrick for all the work you do putting out great content.

  13. Gog Jones says:

    Hey guys.
    Just to drop in and say great podcast, this was the best episode I have listened to so far, and hope they are many more to come.

    Just to put an Aussie perspective forward. By the sounds of it healthcare is a major problem all around the world. Finding a balance between a public system that covers everyone but does not drain the economy is hard, especially now with the older population.

    In Australia, the health system is controlled by each individual state, which gets funding from taxes and some from the federal government. The public system is okay, it pretty much covers what most of the public systems that your hosts talked about cover. Although the waiting times here are a lot longer for things like emergency room procedures and for elective surgery. But you are covered if something bad does happen. The private health system is generally pretty expensive, but is essential if you want to get any dental work or as it was said, any preventative work done. However for most families it is hard to be able to fit private health in their budget, as most businesses here do not offer private health as part as the employment package.

    Summing up, Health care seems to be a problem everywhere with overworked staff, not enough facilities, long waiting times and huge costs where ever you go.

    Thanks
    Gog

  14. Dan says:

    I just listened to this episode (a little late, I know) and I found it very informative. Judging by questions asked by the panelists, there is a great deal of confusion by non-U.S. citizens about the health care system. If you want an in-depth look at the American health system, I suggest a book called “Money Driven Medicine” by Maggie Mahar. Mahar is an investigative journalist who gives a historical overview of the system, how it evolved, and who the players are. She talks to insurers, patients, doctors, hospital administrators, politicians, big pharma (pharmaceutical industry), and industry analysts. It’s really a very well done book. From the time the episode was “aired” until now, there have been major developments in the debate. Now, politicians are kicking around the idea of lowering the age limit on Medicare, but that still leaves a huge number of people with very bad insurance, or none at all. As a healthy 20-something with no issues whatsoever, I can personally attest that everyone, in every age category, is getting ripped off. Thanks to the lousy job market, I’m stuck buying individual health insurance. In the past two years, my premiums have doubled while my insurance company has posted profits for the past decade.

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