VA医院还大量的使用NP，VA医院有的科室一个医生都没有，就一个NP 管理整个科室，看所有的病人，因为VA的法规规定NP可以完全的100% 独立看病人。全民医保以后，肯定NP也会100%独立的看病人。 很多中国人连DO都看不上，让你的生老病死掌握在NP手里，你愿意？？？？ 你去问问老兵，如果能够去私立医院看病，他们愿意去VA医院看病不？ 支持全民医保的，自己去VA医院看几次病就知道了。你自己去试一试预约APPOINTMENT还有看病的体验，到时候看你还支持全民医保不。 在美国，nothing is free, 免费的东西可能是最贵的，免费的医疗意味着你的小命都掌握在政府手里。你的命运就不由你自己了。 说到全民医保，加拿大一个省所有的MRI， CT机器数量，还不如美国一个普通的小城市的MRI，CT机器多，而且机器还旧，落后好多年。 为啥加拿大看病需要等那么久？ 人性如此，美国现在私立医保制度下，私人诊所医生或者IMAGING CENTER有钱赚，才有动力干活啊。中国人的医生诊所，一天可以看五十个病人，那些中国人医生开的IMAGING CENTER也是积极干活，有钱赚才有动力。 如果搞全民医保，医生每天就只看16个病人，也没有人有动力出去自己开IMAGING CENTER，买CT/MRI机器。 这样一来，医生的生活质量倒是高了，最后苦的还不是病人？？？ 现在私立医疗制度下，病人付钱看病都有各种不满的地方，但是毕竟你有医保，你可以理直气壮的抱怨，因为你交钱了，花钱买了服务。 如果真的全民医疗了，肯定只能抱怨更多，而且小命都拽在政府手里了，政府可以ration 医疗资源，你在呼吸机上了，政府到时候搞一个什么COMMITTEE，想啥时候拔管就给你拔管，而且你压根没有地方去抱怨，政府说你一分钱没有花，有啥资格抱怨？ VA scandal shows the realities of rationing care VA‘s troubles highlight realities of rationing Regarding the story “VA to send more vets to private care," the Veterans Affairs Department is an example of single-payer, government-provided healthcare. Those individuals who are eligible to receive services under the VA system depend upon VA medical centers and physicians to satisfy all their healthcare needs. Taxpayers provide all the funds necessary to operate the huge VA system. Inherent in such a system is the need to ration care. Ultimately, demands for “free” healthcare services must exceed existing resources. The recent scandals involving secret “waiting lists” may represent abusive practices, but the reality of rationing in single-payer systems cannot be denied. Dan Groszkruger Principalrskmgmt.inc Solana Beach, Calif. Editorial offers balanced look at VA healthcare story As a veteran and retired Army Medical Department leader, I commend Modern Healthcare for the May 26 editorial "Beyond the theatrics of the VA scandal." It does a good job balancing the story of high-quality VA healthcare with the frustration of an ever-increasing and aging eligible beneficiary population. There will be much more to learn, regret and discuss as more information is gleaned and released. My wish is that those discussions are as level-headed as this editorial. Maj. Gen. David Rubenstein, retired Clinical associate professor of health administration Texas State University Is a Trojan horse lurking behind transparency push? Regarding the article "Health insurance giants to make payment data accessible to public,” the Health Care Cost Institute is, according to its website, “supported by Aetna, Humana, Kaiser Permanente and UnitedHealthcare to promote independent, nonpartisan research and analysis on the causes of the rise in U.S. health spending.” HCCI is going to build a database of healthcare payments based on claims data submitted by health plans. That reminds me of something. Oh, yes, Ingenix, the UnitedHealth Group-owned database of usual and customary charges that, according to the New York attorney general, was manipulated by health plans through selective contribution of claims data in order to bilk plan enrollees of hundreds of millions of dollars in benefits. One wonders why health plans might want to send claims data to a plan-supported, not-for-profit enterprise that is collecting payment information. Could it be that by selectively submitting claims with lower payments (i.e., deeply discounted contracted payments), the plans could leverage this data in negotiations with providers for deeper discounts, or change legislature and regulator perceptions of the reasonable value of provider services? Fair Health is an established not-for-profit that already has such a database of payments, and it was funded by the fines levied against the plans that abused the Ingenix scheme. It has an elaborate audit mechanism in place to ensure that claims data submission to the database are not selective. That is where this data ought to be collected and accessed. I see the tracks of a Trojan horse. Dr. Myles Riner Mill Valley, Calif. Price controls usually hurt those they intend to help Regarding the article "Excessive drug costs could invite price caps: AHIP‘s Ignagni,” price controls have failed in every case that they have been applied. Command and control and government intervention, while often well-intended, usually hurt the people they are designed to help. John Hope Marblehead, Mass. https://www.modernhealthcare.com/article/20140531/MAGAZINE/305319970/va-scandal-shows-the-realities-of-rationing-care
A recent Johns Hopkins study claims more than 250,000 people in the U.S. die every year from medical errors. Other reports claim the numbers to be as high as 440,000. Medical errors are the third-leading cause of death after heart disease and cancer. https://www.cnbc.com/2018/02/22/medical-errors-third-leading-cause-of-death-in-america.html 医院每个星期都有mortality and morbidity meeting 讨论病例，这里面就有做错了，做的不好的案例讨论。有一次，神经外科医生就把脊柱手术做错了，该做1-2 脊柱 ，做成了3-4 脊柱。这种事情在医院真的是偶尔有发生的。 反正正规的医院都有quality improvement department,risk management department,regulatory affairs department,就是为了分析错误发生的原因，然后建立更好的系统，避免以后发生类似的错误. 北京医科大学附属医院曾经做过一次尸检，发现误诊率30%。 国内其他医院基本只能更高, 不可能更少
为啥美国看病这么贵 ? 美国医院的QA department其实挺贵的。比如医院一个外科科室的QA 部门（他们是很大的一个外科部门，反正本州第一大） ， 有12 个staff，一个经理，还有一种专门的QI软件，每年需要花几百万美金买LICENSE。然后12 个员工每个人的工资加上福利十几万美金，经理工资加福利30 万美金，平时还需要电脑，开会的费用，仪器以及各种办公用品，参加培训，交给American College of Surgeon的费用等等，算下来一年基本要一千万美金了。这个外科科室就需要为这一千万买单 为啥美国看病这么贵 ?医院每个不同的科室都有自己的QA部门, 想想需要花多少钱，这些都是羊毛出在羊身上 医疗行业的法律法规多如牛毛， 基本仅次于核废料处理,各种规定都需要遵守 遵守就意味着要花钱，最简单的，医院的各种纸张因为有病人INFORMATION，就需要放进sheredder,然后专门的公司来收走，处理掉，这就是一笔开支。
美国排名第一的MD ANDERSON 几年前LAY OFF 900员工就是因为他们搞EPIC电子病历系统，亏损了几亿美金，只能裁员。 MD Anderson lays off 900 staff members During the first three months of the fiscal year that started Sept. 1, 2016, the cancer center lost $110 million on its operations. MD Anderson lost $267.1 million in fiscal 2016. Other large freestanding cancer centers aren’t reporting operating losses: Memorial Sloan Kettering Cancer Center reported $164 million in operating income through the first nine months of 2016, a 14.6% increase from the same period last year. Growth in the volume of outpatient visits and overall surgical visits resulted in an 8.9% growth in operating revenue to $2.9 billion. Operating expenses grew 8.6% to $2.8 billion. Fred Hutchinson Cancer Research Center reported total revenues of $126.4 million and operating expenses of $117.1 million, giving it a $9.3 million operating surplus for the first quarter, which ended Sept. 30, 2016. For the fiscal year ended June 30, Fred Hutchinson reported total revenues of $615.5 million and expenses of $484.6 million, creating a $130.9 million surplus. https://cancerletter.com/the-cancer-letter/20170106_2/
当年Kaiser砸了4亿美金和IBM一起开发自己的电子病历系统，后来不满意，决定用EPIC，砸了 六十亿美元，平均每个医生五十万美金。感觉医生都是帮电脑公司打工 KP HealthConnect In 2002, Kaiser Permanente abandoned its attempt to build its own clinical information system with IBM, writing off some $452 million in software assets. This information technology failure led to major changes in the organization’s approach to digital records. Under George Halvorson''''s direction, Kaiser looked closely at two medical software vendors, Cerner and Epic Systems, ultimately selecting Epic as the primary vendor for a new system, branded KP HealthConnect. Although Kaiser’s approach shifted to "buy, not build," the project was unprecedented for a civilian system in size and scope. Deployed across all eight regions over six years and at a cost of more than $6 billion, by 2010, it was the largest civilian electronic medical record system, serving more than 8.6 million Kaiser Permanente members, implemented at a cost exceeding a half million dollars per physician.[53] As of 2020 KP HealthConnect supports 12.2 million members.
我根本不care，是你们老提加拿大。用来比较。 我只是告诉你们加拿大76%人满意现行全民医疗，安大略省82%满意。多伦多85%满意。 In the survey of a representative national sample, 76% of Canadians are “very confident” or “moderately confident” that the country’s health care system。 On a regional basis, Ontarians are more likely to express confidence in the health care system (82%) than residents of British Columbia (75%), Alberta (also 75%), Quebec (74%), Saskatchewan and Manitoba (69%) and Atlantic Canada (67%).
VA医院还大量的使用NP，VA医院有的科室一个医生都没有，就一个NP 管理整个科室，看所有的病人，因为VA的法规规定NP可以完全的100% 独立看病人。全民医保以后，肯定NP也会100%独立的看病人。 很多中国人连DO都看不上，让你的生老病死掌握在NP手里，你愿意？？？？ 你去问问老兵，如果能够去私立医院看病，他们愿意去VA医院看病不？ 支持全民医保的，自己去VA医院看几次病就知道了。你自己去试一试预约APPOINTMENT还有看病的体验，到时候看你还支持全民医保不。 在美国，nothing is free, 免费的东西可能是最贵的，免费的医疗意味着你的小命都掌握在政府手里。你的命运就不由你自己了。 说到全民医保，加拿大一个省所有的MRI， CT机器数量，还不如美国一个普通的小城市的MRI，CT机器多，而且机器还旧，落后好多年。 为啥加拿大看病需要等那么久？ 人性如此，美国现在私立医保制度下，私人诊所医生或者IMAGING CENTER有钱赚，才有动力干活啊。中国人的医生诊所，一天可以看五十个病人，那些中国人医生开的IMAGING CENTER也是积极干活，有钱赚才有动力。 如果搞全民医保，医生每天就只看16个病人，也没有人有动力出去自己开IMAGING CENTER，买CT/MRI机器。 这样一来，医生的生活质量倒是高了，最后苦的还不是病人？？？ 现在私立医疗制度下，病人付钱看病都有各种不满的地方，但是毕竟你有医保，你可以理直气壮的抱怨，因为你交钱了，花钱买了服务。 如果真的全民医疗了，肯定只能抱怨更多，而且小命都拽在政府手里了，政府可以ration 医疗资源，你在呼吸机上了，政府到时候搞一个什么COMMITTEE，想啥时候拔管就给你拔管，而且你压根没有地方去抱怨，政府说你一分钱没有花，有啥资格抱怨？ VA scandal shows the realities of rationing care VA‘s troubles highlight realities of rationing Regarding the story “VA to send more vets to private care," the Veterans Affairs Department is an example of single-payer, government-provided healthcare. Those individuals who are eligible to receive services under the VA system depend upon VA medical centers and physicians to satisfy all their healthcare needs. Taxpayers provide all the funds necessary to operate the huge VA system. Inherent in such a system is the need to ration care. Ultimately, demands for “free” healthcare services must exceed existing resources. The recent scandals involving secret “waiting lists” may represent abusive practices, but the reality of rationing in single-payer systems cannot be denied. Dan Groszkruger Principalrskmgmt.inc Solana Beach, Calif. Editorial offers balanced look at VA healthcare story As a veteran and retired Army Medical Department leader, I commend Modern Healthcare for the May 26 editorial "Beyond the theatrics of the VA scandal." It does a good job balancing the story of high-quality VA healthcare with the frustration of an ever-increasing and aging eligible beneficiary population. There will be much more to learn, regret and discuss as more information is gleaned and released. My wish is that those discussions are as level-headed as this editorial. Maj. Gen. David Rubenstein, retired Clinical associate professor of health administration Texas State University Is a Trojan horse lurking behind transparency push? Regarding the article "Health insurance giants to make payment data accessible to public,” the Health Care Cost Institute is, according to its website, “supported by Aetna, Humana, Kaiser Permanente and UnitedHealthcare to promote independent, nonpartisan research and analysis on the causes of the rise in U.S. health spending.” HCCI is going to build a database of healthcare payments based on claims data submitted by health plans. That reminds me of something. Oh, yes, Ingenix, the UnitedHealth Group-owned database of usual and customary charges that, according to the New York attorney general, was manipulated by health plans through selective contribution of claims data in order to bilk plan enrollees of hundreds of millions of dollars in benefits. One wonders why health plans might want to send claims data to a plan-supported, not-for-profit enterprise that is collecting payment information. Could it be that by selectively submitting claims with lower payments (i.e., deeply discounted contracted payments), the plans could leverage this data in negotiations with providers for deeper discounts, or change legislature and regulator perceptions of the reasonable value of provider services? Fair Health is an established not-for-profit that already has such a database of payments, and it was funded by the fines levied against the plans that abused the Ingenix scheme. It has an elaborate audit mechanism in place to ensure that claims data submission to the database are not selective. That is where this data ought to be collected and accessed. I see the tracks of a Trojan horse. Dr. Myles Riner Mill Valley, Calif. Price controls usually hurt those they intend to help Regarding the article "Excessive drug costs could invite price caps: AHIP‘s Ignagni,” price controls have failed in every case that they have been applied. Command and control and government intervention, while often well-intended, usually hurt the people they are designed to help. John Hope Marblehead, Mass. https://www.modernhealthcare.com/article/20140531/MAGAZINE/305319970/va-scandal-shows-the-realities-of-rationing-care
A recent Johns Hopkins study claims more than 250,000 people in the U.S. die every year from medical errors. Other reports claim the numbers to be as high as 440,000. Medical errors are the third-leading cause of death after heart disease and cancer. https://www.cnbc.com/2018/02/22/medical-errors-third-leading-cause-of-death-in-america.html 医院每个星期都有mortality and morbidity meeting 讨论病例，这里面就有做错了，做的不好的案例讨论。有一次，神经外科医生就把脊柱手术做错了，该做1-2 脊柱 ，做成了3-4 脊柱。这种事情在医院真的是偶尔有发生的。 反正正规的医院都有quality improvement department,risk management department,regulatory affairs department,就是为了分析错误发生的原因，然后建立更好的系统，避免以后发生类似的错误. 北京医科大学附属医院曾经做过一次尸检，发现误诊率30%。 国内其他医院基本只能更高, 不可能更少
为啥美国看病这么贵 ? 美国医院的QA department其实挺贵的。比如医院一个外科科室的QA 部门（他们是很大的一个外科部门，反正本州第一大） ， 有12 个staff，一个经理，还有一种专门的QI软件，每年需要花几百万美金买LICENSE。然后12 个员工每个人的工资加上福利十几万美金，经理工资加福利30 万美金，平时还需要电脑，开会的费用，仪器以及各种办公用品，参加培训，交给American College of Surgeon的费用等等，算下来一年基本要一千万美金了。这个外科科室就需要为这一千万买单 为啥美国看病这么贵 ?医院每个不同的科室都有自己的QA部门, 想想需要花多少钱，这些都是羊毛出在羊身上 医疗行业的法律法规多如牛毛， 基本仅次于核废料处理,各种规定都需要遵守 遵守就意味着要花钱，最简单的，医院的各种纸张因为有病人INFORMATION，就需要放进sheredder,然后专门的公司来收走，处理掉，这就是一笔开支。
美国排名第一的MD ANDERSON 几年前LAY OFF 900员工就是因为他们搞EPIC电子病历系统，亏损了几亿美金，只能裁员。 MD Anderson lays off 900 staff members During the first three months of the fiscal year that started Sept. 1, 2016, the cancer center lost $110 million on its operations. MD Anderson lost $267.1 million in fiscal 2016. Other large freestanding cancer centers aren’t reporting operating losses: Memorial Sloan Kettering Cancer Center reported $164 million in operating income through the first nine months of 2016, a 14.6% increase from the same period last year. Growth in the volume of outpatient visits and overall surgical visits resulted in an 8.9% growth in operating revenue to $2.9 billion. Operating expenses grew 8.6% to $2.8 billion. Fred Hutchinson Cancer Research Center reported total revenues of $126.4 million and operating expenses of $117.1 million, giving it a $9.3 million operating surplus for the first quarter, which ended Sept. 30, 2016. For the fiscal year ended June 30, Fred Hutchinson reported total revenues of $615.5 million and expenses of $484.6 million, creating a $130.9 million surplus. https://cancerletter.com/the-cancer-letter/20170106_2/
当年Kaiser砸了4亿美金和IBM一起开发自己的电子病历系统，后来不满意，决定用EPIC，砸了 六十亿美元，平均每个医生五十万美金。感觉医生都是帮电脑公司打工 KP HealthConnect In 2002, Kaiser Permanente abandoned its attempt to build its own clinical information system with IBM, writing off some $452 million in software assets. This information technology failure led to major changes in the organization’s approach to digital records. Under George Halvorson''''s direction, Kaiser looked closely at two medical software vendors, Cerner and Epic Systems, ultimately selecting Epic as the primary vendor for a new system, branded KP HealthConnect. Although Kaiser’s approach shifted to "buy, not build," the project was unprecedented for a civilian system in size and scope. Deployed across all eight regions over six years and at a cost of more than $6 billion, by 2010, it was the largest civilian electronic medical record system, serving more than 8.6 million Kaiser Permanente members, implemented at a cost exceeding a half million dollars per physician.[53] As of 2020 KP HealthConnect supports 12.2 million members.
VA有大概有8--900万病人，他们看病不要钱，基本就是全民医保。但是主流媒体上经常有VA的负面新闻。而且老兵对VA医院也是各种不满。
才几百万人的全民医保都搞得如此怨声载道，如果美国三亿人都用全民医保，那还不得屋顶都要被掀翻。
VA的医生和护士都是有工会的，很难被炒鱿鱼。而且VA的医生工资比外面低，所以很难雇佣到好的医生。VA医院的医生一般2-30万美金一年，私立医院的医生如果能干，可以年入一两百万美金。你说能干的医生会去哪儿上班。VA医院的医生工会和VA医院签订的合同是这样的，每半个小时一个病人，每天八个小时最多只有16个病人，每个星期四十个小时，必须要有至少10%的administrative time,就是自己可以给病人回信，或者finish charting等等。VA医院 的医生是死工资，所以医生都是尽量少干活。VA医院的外科医生一天只做一台手术，外面的私立医院的外科医生，一天可以做六七台手术。无他，私立医院是记件制，每台手术都有钱赚。VA医院，做再多的手术或者做一台手术，那到手的工资都一样。所以一个普通的家庭医生门诊的APPOINTMENT需要等几个月，专科门诊的APPOINTMENT要等一年。
从CREDENTIALING就可以看出来做事的风格的极大不同。 普通的私立医院，医生申请PREVILEGE，大概几个星期，最多不到两个月就够了。VA医院，拖你个一年两年都不是稀奇的事情。
VA医院还大量的使用NP，VA医院有的科室一个医生都没有，就一个NP 管理整个科室，看所有的病人，因为VA的法规规定NP可以完全的100% 独立看病人。全民医保以后，肯定NP也会100%独立的看病人。 很多中国人连DO都看不上，让你的生老病死掌握在NP手里，你愿意？？？？
你去问问老兵，如果能够去私立医院看病，他们愿意去VA医院看病不？
支持全民医保的，自己去VA医院看几次病就知道了。你自己去试一试预约APPOINTMENT还有看病的体验，到时候看你还支持全民医保不。
在美国，nothing is free, 免费的东西可能是最贵的，免费的医疗意味着你的小命都掌握在政府手里。你的命运就不由你自己了。
说到全民医保，加拿大一个省所有的MRI， CT机器数量，还不如美国一个普通的小城市的MRI，CT机器多，而且机器还旧，落后好多年。
为啥加拿大看病需要等那么久？
人性如此，美国现在私立医保制度下，私人诊所医生或者IMAGING CENTER有钱赚，才有动力干活啊。中国人的医生诊所，一天可以看五十个病人，那些中国人医生开的IMAGING CENTER也是积极干活，有钱赚才有动力。
如果搞全民医保，医生每天就只看16个病人，也没有人有动力出去自己开IMAGING CENTER，买CT/MRI机器。
这样一来，医生的生活质量倒是高了，最后苦的还不是病人？？？
现在私立医疗制度下，病人付钱看病都有各种不满的地方，但是毕竟你有医保，你可以理直气壮的抱怨，因为你交钱了，花钱买了服务。
如果真的全民医疗了，肯定只能抱怨更多，而且小命都拽在政府手里了，政府可以ration 医疗资源，你在呼吸机上了，政府到时候搞一个什么COMMITTEE，想啥时候拔管就给你拔管，而且你压根没有地方去抱怨，政府说你一分钱没有花，有啥资格抱怨？
VA scandal shows the realities of rationing care
VA‘s troubles highlight realities of rationing
Regarding the story “VA to send more vets to private care," the Veterans Affairs Department is an example of single-payer, government-provided healthcare. Those individuals who are eligible to receive services under the VA system depend upon VA medical centers and physicians to satisfy all their healthcare needs. Taxpayers provide all the funds necessary to operate the huge VA system. Inherent in such a system is the need to ration care. Ultimately, demands for “free” healthcare services must exceed existing resources. The recent scandals involving secret “waiting lists” may represent abusive practices, but the reality of rationing in single-payer systems cannot be denied.
Dan Groszkruger Principalrskmgmt.inc Solana Beach, Calif.
Editorial offers balanced look at VA healthcare story
As a veteran and retired Army Medical Department leader, I commend Modern Healthcare for the May 26 editorial "Beyond the theatrics of the VA scandal." It does a good job balancing the story of high-quality VA healthcare with the frustration of an ever-increasing and aging eligible beneficiary population. There will be much more to learn, regret and discuss as more information is gleaned and released. My wish is that those discussions are as level-headed as this editorial.
Maj. Gen. David Rubenstein, retired
Clinical associate professor of health administration Texas State University
Is a Trojan horse lurking behind transparency push?
Regarding the article "Health insurance giants to make payment data accessible to public,” the Health Care Cost Institute is, according to its website, “supported by Aetna, Humana, Kaiser Permanente and UnitedHealthcare to promote independent, nonpartisan research and analysis on the causes of the rise in U.S. health spending.”
HCCI is going to build a database of healthcare payments based on claims data submitted by health plans. That reminds me of something. Oh, yes, Ingenix, the UnitedHealth Group-owned database of usual and customary charges that, according to the New York attorney general, was manipulated by health plans through selective contribution of claims data in order to bilk plan enrollees of hundreds of millions of dollars in benefits.
One wonders why health plans might want to send claims data to a plan-supported, not-for-profit enterprise that is collecting payment information. Could it be that by selectively submitting claims with lower payments (i.e., deeply discounted contracted payments), the plans could leverage this data in negotiations with providers for deeper discounts, or change legislature and regulator perceptions of the reasonable value of provider services?
Fair Health is an established not-for-profit that already has such a database of payments, and it was funded by the fines levied against the plans that abused the Ingenix scheme. It has an elaborate audit mechanism in place to ensure that claims data submission to the database are not selective. That is where this data ought to be collected and accessed.
I see the tracks of a Trojan horse.
Dr. Myles Riner
Mill Valley, Calif.
Price controls usually hurt those they intend to help
Regarding the article "Excessive drug costs could invite price caps: AHIP‘s Ignagni,” price controls have failed in every case that they have been applied.
Command and control and government intervention, while often well-intended, usually hurt the people they are designed to help.
John Hope
Marblehead, Mass.
https://www.modernhealthcare.com/article/20140531/MAGAZINE/305319970/va-scandal-shows-the-realities-of-rationing-care
A recent Johns Hopkins study claims more than 250,000 people in the U.S. die every year from medical errors. Other reports claim the numbers to be as high as 440,000. Medical errors are the third-leading cause of death after heart disease and cancer.
https://www.cnbc.com/2018/02/22/medical-errors-third-leading-cause-of-death-in-america.html
医院每个星期都有mortality and morbidity meeting 讨论病例，这里面就有做错了，做的不好的案例讨论。有一次，神经外科医生就把脊柱手术做错了，该做1-2 脊柱 ，做成了3-4 脊柱。这种事情在医院真的是偶尔有发生的。
反正正规的医院都有quality improvement department,risk management department,regulatory affairs department,就是为了分析错误发生的原因，然后建立更好的系统，避免以后发生类似的错误.
北京医科大学附属医院曾经做过一次尸检，发现误诊率30%。 国内其他医院基本只能更高, 不可能更少
为啥美国看病这么贵 ?
美国医院的QA department其实挺贵的。比如医院一个外科科室的QA 部门（他们是很大的一个外科部门，反正本州第一大） ， 有12 个staff，一个经理，还有一种专门的QI软件，每年需要花几百万美金买LICENSE。然后12 个员工每个人的工资加上福利十几万美金，经理工资加福利30 万美金，平时还需要电脑，开会的费用，仪器以及各种办公用品，参加培训，交给American College of Surgeon的费用等等，算下来一年基本要一千万美金了。这个外科科室就需要为这一千万买单
为啥美国看病这么贵 ?医院每个不同的科室都有自己的QA部门, 想想需要花多少钱，这些都是羊毛出在羊身上
医疗行业的法律法规多如牛毛， 基本仅次于核废料处理,各种规定都需要遵守 遵守就意味着要花钱，最简单的，医院的各种纸张因为有病人INFORMATION，就需要放进sheredder,然后专门的公司来收走，处理掉，这就是一笔开支。
美国排名第一的MD ANDERSON 几年前LAY OFF 900员工就是因为他们搞EPIC电子病历系统，亏损了几亿美金，只能裁员。
MD Anderson lays off 900 staff members
During the first three months of the fiscal year that started Sept. 1, 2016, the cancer center lost $110 million on its operations.
MD Anderson lost $267.1 million in fiscal 2016.
Other large freestanding cancer centers aren’t reporting operating losses:
Memorial Sloan Kettering Cancer Center reported $164 million in operating income through the first nine months of 2016, a 14.6% increase from the same period last year. Growth in the volume of outpatient visits and overall surgical visits resulted in an 8.9% growth in operating revenue to $2.9 billion. Operating expenses grew 8.6% to $2.8 billion.
Fred Hutchinson Cancer Research Center reported total revenues of $126.4 million and operating expenses of $117.1 million, giving it a $9.3 million operating surplus for the first quarter, which ended Sept. 30, 2016. For the fiscal year ended June 30, Fred Hutchinson reported total revenues of $615.5 million and expenses of $484.6 million, creating a $130.9 million surplus.
https://cancerletter.com/the-cancer-letter/20170106_2/
美国绝大多数医院压根不赚钱，一个普通的私立社区医院，即使赚钱也就是几十万美金到1百万美金一年, 利润率在1% 到3%。 美国的电脑公司利润率肯定要高一个数量级
所以我觉得电脑公司把钱都赚走了 医院就是赚吆喝
当年Kaiser砸了4亿美金和IBM一起开发自己的电子病历系统，后来不满意，决定用EPIC，砸了 六十亿美元，平均每个医生五十万美金。感觉医生都是帮电脑公司打工
KP HealthConnect
In 2002, Kaiser Permanente abandoned its attempt to build its own clinical information system with IBM, writing off some $452 million in software assets. This information technology failure led to major changes in the organization’s approach to digital records. Under George Halvorson''''s direction, Kaiser looked closely at two medical software vendors, Cerner and Epic Systems, ultimately selecting Epic as the primary vendor for a new system, branded KP HealthConnect. Although Kaiser’s approach shifted to "buy, not build," the project was unprecedented for a civilian system in size and scope. Deployed across all eight regions over six years and at a cost of more than $6 billion, by 2010, it was the largest civilian electronic medical record system, serving more than 8.6 million Kaiser Permanente members, implemented at a cost exceeding a half million dollars per physician.[53] As of 2020 KP HealthConnect supports 12.2 million members.
电脑影响各行各业 收割每个行业
Uber 公司拿走 60% 司机最多能拿到40%
加拿大再烂的全民医疗能让人无忧无虑活到82岁，美国有效率医疗保险需要和保险公司扯皮，花了200%钱活到78岁嗝屁 谢谢
人均寿命有球用，看亚裔的
资本手伸太长，一是野蛮，二是冷酷。最好不要一家独大。
美国是花了两倍钱 但结果不是简单的平均78 有钱人活得长 穷人活得短 两极分化了
跟国内一样，一般人去挤公立医院，有钱人去私人医院。
亚裔一笔糊涂账， 首先现在死的都是中国最有钱的人，那时移民都是宋美龄这样衣食无忧高官巨富，和现在政庇和秃顶劳工不同。 其次，很多人都落叶归根，有病身体差早回国投奔亲戚了。
白人寿命才是最准确衡量标准，78.6
预期寿命
那为什么举退伍残疾军人例子来diss全民医疗，VA不是美国最穷bottom 5% 如果私人医疗，这些人早死光了。
Re 就像公校和私校，应该是互相补充，而不是有公校了就不许有私校，有钱你去上私校请家教，但是穷人的最起码孩子也可以上学
现在穷人的孩子已经有mediicaid了，还愁啥。真的穷人政府已经保底了。
欧巴马医保通过之前说的是，每个家庭会节省2400美金，然后你喜欢你的医生，你就可以KEEP你的医生。
欧巴马医保实施以后，医保涨了几倍，但是每个家庭付的医疗账单越来越多。很多自己开业的医生不愿意接收 欧巴马医保的病人，因为给的钱少。
全民医保只能让事情更差，而不是你想象中的更好。
任何事情，政府来做，往往比私立来做，效率低下至少十倍，开支也增加十倍。
造成美国医疗现在这样的原因就是政府，然后你指望政府take over,然后突然你看病就便宜了，然后得到的healthcare 就更好了？
这和当年中国的人民公社食堂吃大锅饭有啥区别？？？
就是，穷人明明就已经有保底了
现在是premium也要中产付。
中产就是傻，被人卖了还帮着数钱
加拿大全民医疗好，你不是已经在加拿大了，应该满足了啊。为啥还这么着急要拉美国跟加拿大一样呢。
作为一个跟雇主买保险的普通社畜，我是不愿意全民医保的，像我这样的人很多。不在美国生活，你完全不懂我们的担心。
凭什么看 specialist在你看来不是基本权利? 非要refer, 这是我看来最蠢的，家庭医生水平有限，很可能耽误病情，耽误时间，完了把你 refer到跟他们有合作关系的医生那里。作为病人基本的选择权都没有。
Chiropractic, 我个人很喜欢用，这个就算你有保险，一年也有次数限制，而且自付也不便宜。
你所谓的全民医保，明显就是降低我们普通中产目前可以享用到的医疗水平，去给穷人买单。来美国，结果是为了共产， 和全体人民过上同质量的生活?!
滚你的蛋吧!
不要錢的大鍋飯 有錢人不會去吃的 一般中產也不想吃的 因為吃飯 除了吃飽外 還得講衛生和口味
沒錢 沒選擇 中產 可以吃免錢 或自費和合味道 有錢 除了有私廚外 還能到世界各地吃 這是自由市場
我根本不care，是你们老提加拿大。用来比较。 我只是告诉你们加拿大76%人满意现行全民医疗，安大略省82%满意。多伦多85%满意。
In the survey of a representative national sample, 76% of Canadians are “very confident” or “moderately confident” that the country’s health care system。
On a regional basis, Ontarians are more likely to express confidence in the health care system (82%) than residents of British Columbia (75%), Alberta (also 75%), Quebec (74%), Saskatchewan and Manitoba (69%) and Atlantic Canada (67%).
对啊。所以现在推动全民医保的不是穷人，恰恰是中产。或者说是中产的企业。Medicaid,Medicare依靠政府，有很强的bargain power。Medicaid的同等医疗的价格是商业保险的一半，Medicare是70%。而中产的工作单位除了超大企业，完全和保险公司，医疗企业不在对等地位，完全没有bargain power,任人宰割。很多企业希望政府能提供一些选项，企业能把这些负担转移出去。
任何事情，政府来做，往往比私立来做，效率低下至少十倍，开支也增加十倍。
如果私立做得不好，凭啥认为全民医保就能够做得更好。
美国现在也有很多政府的公立医院，公立医院都有工会，医生和护士都有工会，他们倒是生活质量高。但是你要指望看病方便快捷，good luck.
因为现在你和你同事的chiropractor 都是你们那些年轻健康的同事在付钱。 我相信没有全民医保，左派也会把medicare taxes搞得越来越贵让美国越来越没有竞争力。 我相信在美国现在这个左的气氛中，已经不是穷人该不该有医保的问题。而是穷人是用各种好用的Medicaid，obcare, 免费emergency room,还是用像加拿大那样有各种限制的全民医保。
人均寿命长主要是压力小。加拿大大锅饭大家都不怎么干活。美国是女人当男人用
穷人有medicaid啊，现在是穷人不满意，要求中产跟自己一样
恰恰现在Medicaid和medicare比商业保险效率高。当然VA是一个反例。所以政府做什么，怎么做需要研究讨论，不能完全否定。
怎么没有 bargain power, 市场上那么多保险公司，没有垄断吧。如果是雇主希望减少开支，那说到底还是资本的逐利性，就是cut cost, 拉升股价。
在看到任何可行的方案前，我个人绝对不会希望全民医保。
中产辛辛苦苦工作的愿意之一就是好的保险，想看病就看病，而不是跟一堆流浪汉一起无限制的排队看医生。
最好的還是公私營醫院並存，全民醫保+商業保險
莫名其妙，我看病，我年轻的同事在付钱? 那我年轻时候也替其他人付过钱，很公平!
你们这些喜欢福利的人都观点永远是，共和党将来会怎么样，所以让我们现在就接受民主党的bullshit.
另外你提到的medicaid, 你要稀罕你可以把自己搞到赤贫去用用看，去公立试一试，看着是不是像你说的那么好。好的医生基本都不接受这东西。别以为穷人拿到的free的东西有多好，美国人都眼巴巴的盯着。
你是因为本身是医疗体系的吧。 全民医疗，穷人富人谁赢谁输不一定，但是医疗体系的确是绝对是输的
什么叫我本身是医疗体系? 我在医疗系统工作? 我从来没有过，家人也没有过。
总之一句话，我对目前的医疗系统没啥抱怨，除了每年上涨的费用，但是是哪个王八蛋搞成这样的，大家也都知道。我也完全不期待全民医疗，全民的东西，有脑子的都知道是哪个阶层在负重而行。
至于你所说的，什么医疗体系绝对是输，不知道，中产肯定是输，是肯定的。
前面说过了，穷人已经有Medicaid，你现在已经和homeless一起排队看病。中产面临医疗费用不停无节制上涨，整天担心network问题，以及surprise bill。这些现在看来目前市场经济无法解决。
你在扯什么蛋? Homeless基本没有medicare, 只有medicaid, 没有几个正经医生接受。
而你们想做的就是让我们这些辛苦工作的人去和homeless一起排队看病。逼着中产去和穷人在一个pool 里看病!
建议你去搞清楚，medicare是什么资格才能挣到。
平均寿命这个，美国拖后腿的太多了，枪杀死的车祸死的吸毒死的还有各种探险猎奇死的太多，而且都是年轻人居多，芝加哥贵人区天天火拼死的基本都是early 20s。本本分分过日子的美国亚裔老太太的平均寿命90岁好吧。
白人可不是78，很多年前白男的life expectancy 就是84 了
可惜的是，既得利益集团的腐败你是挡不住的，全民医保是趋势，大屎坑的最大一锤，另外一锤毒品合法化也快了，虽然土工也腐败，可是至少还是正常人的价值观，没人会关心龙虾疼不疼
你觉得obcare 之前那种动不动preexisting condition不保，lifetime maximum 1百万挺好的？ wow，100万的maximum你可能都不敢看chiropractor 吧。
不会啊。homeless 很多都是拿disability and Medicare的。
芝加哥枪战死亡的都是黑人，黑人人口10%，就是平均低10年也拉不下1岁，况且黑人人均寿命只低6年。 美国白人寿命也就78.6。
至于吸毒致死哪里都一样，欧洲加拿大更宽容。
为什么只看亚裔？难道美国只有亚裔用医疗系统？
白人78.6又不是我说的
Burd-Sharps S, Lewis K. "Geographies of Opportunity: Ranking Well-Being by Congressional District". Measure of America of the Social Science Research Council.
ABC也有报道，你自己找找。
现在本本分分亚裔老太太也经常大街上被人打想平平安安活到90也不容易了
我发过帖子，反对全民医保，对比我们自己家在全民医保国家和美国得到到待遇不同，在美国待遇好很多，她于是接话说’美国的医保最大问题是‘穷人的医疗太好了’，本意是挖苦我这种穷人都可以通过医保获得很好的看病体验，可惜，她辩论水平不行，既然‘穷人的医疗太好了’那么就不用全民医保了呀？干嘛还费劲？
还有帖子里我透露过孩子是特殊孩子，对比过美国的特殊服务好过欧洲全民医保的国家，也说过我家宝宝还有其他的医疗需要，所以我怀疑她上个帖子没尽兴，这个帖子，继续说这些刺激的话，故意在本帖说‘给特殊孩子的服务太好了，应该砍掉’还有什么穷人因为不花钱过度医疗，就我自身经验而言，不花钱过度医疗’的人我还没见过，有个东西叫co pay有个东西叫out of pocket， 我家一年医保外要花个七八千吧，还有我们医保是老公公司的self-funded， 占不到它的便宜的，我去的干预机构也不收保险，而且但凡有长期病的人，都打怵去医院，所以网友你帮我一起给这个‘大衣’网友祝福，这么羡慕我们特殊孩子和其他医疗问题的孩子的‘过度医疗’，就让她自己的娃也体会一些这样的‘福利’吧，有助于她成长。
VA 外的医生 不是热门的specialist，这个楼主张嘴就来一两百万美金。。。
美国医生比全世界医疗费用第二高的国家的医生工资高出一大截 水平还那么烂。这个楼主 还好意思拿出来比
如果你老公丢了工作，没保险了，你怎么给孩子看病？哪些therapy自费你能负担吗？你老公就算一直有工作，你知道他的保险能保到你孩子多大吗？一辈子？保到26岁，而这是Obamacare给你争取的，没Obamacare前只保到17岁。你儿子17岁能自己赚一份保险吗？
你恰恰是需要全民医保的。不要咀咒别人
加拿大医保确实不包自闭啥的，但不代表美国的全民医保不包。2011你之前，你知道美国的商业保险在behavior health方面都包什么吗？你现在觉得美国的保险好，那都是因为obmacare的原因，它把那些限制全废除了。你是Obamacare的直接获益者
这里边反对全民医保的，都是单身年轻人，无孩，能理解。一年不看一次病，交很多保费。但不能理解你。
大部份人不知道什么是Obamacare，以为它是卖给穷人一个保险计划。其实它是保险法。它把以前的很多限制废除了。
这倒是的，看看南非暴乱好可怕，希望不要南非化，否则亚裔老头老太更没人身安全了
我说了啊。你真好谢谢obare. Obcare act之前很多保险lifetime maximum 非常低，甚至只有50，100万。有些还有规定，比如精神科只有2万，比如physical therapy 只有1万等等。还有preexisting condition不保。你孩子的情况如果属实，真的是obcare巨大的受益者。
你可能来美国比较晚。当年ob推obcare的时候，就是找一堆父母，在电视上哭诉孩子怎么有medical condition,不敢换工作，因为有preexisting condition 换了工作不保，或是已经max out lifetime maximum,现在每个月十几万医药费，买不起药。
把华人大妈送到南非吧
美国人均寿命底的原因不是因为医疗系统，是因为肥胖率太高和某些族裔拉了后腿吧
那加拿大几千万人的全民医保为啥做的比VA几百万人的全民医保好？