Re: Medicare and the Lily Pond Analogy --> RE: Re: France is healthcare leader, US comes dead last: study --> was R

[Guest guest]

I've heard the same kind of stats .... basically things like ... For many

decades the combined cost of food and health care are the same % of the economy.And I believe I've seen supporting data for that. Basically, per

calorie, food in USA is now cheaper (as percent of income) than at any time in

history, anywhere in the world. So even though we spend a good deal more of our

money for food outside the house, the relative cost of food is much less than it was

in the past.And I've heard economists say that Americans can pay

whatever they are willing to pay for health care. Other things change as a

percent of the economy (both up and down)But I guess the challenge is

the uneven distribution of services and the relative hardship for a relatively large

portion of the population, many of whom have served our country in the military, or

are working and paying taxes and law-abiding.I certainly hear patients

say out loud today more than ever in my 15 yr medical career that they have to make

choices about paying for meds, having medical appt or other payments (insurance,

college tuition, etc) and that the insur premium is getting so big (our area had

about 11% increase for the largest insurer in town).In those ways, I'd

say the system already is broken and deserves fixing. The challenge for us and

the " powers that be " (define as you will) is whether we can fix the

problems without toppling the apple cart (ie- the parts of our system that do work),

and can we find the best balance of Uwe's triad of factors to optimize health and

make primary care a secure career.... and, by many, many criteria the

systems around the world that seem to do that best are at least somewhat

nationalized health care systems ... but the docs ain't paid as much as here ... and

there are waits, etc ... thus the final question is what is the " best

balance " of Uwe's 3 factors. I feel we'll all have different opinions

about that.Sorry for an email without any answers ...Tim > On Tue, January 29, 2008 9:14 pm EST,

Locke's in Colorado wrote:> > > Jim, very interesting remarks. Thanks for throwing them in the mix.>

> Couple thoughts.> > I updated the sign to say Access to

Care rather than Speedy Service.> > I'm not sure I understand this

comment --> overall the cost of living in the> US has declined radically

over the last 100 years. It use to be that> families worked and spent

>90% of their income on food shelter and clothing.> Now the figure is

more like 40% with the rest being disposable income.> > Wouldn't

that mean we are better off? -- less of our income is going to the>

necessities of survival -- food, shelter, clothing.> > In regards

to the ever self sustaining health care system that eternally> seems on the

brink of collapse, but doesn't.> I sort of wonder if this is one of those

situations where everything seems> to be going fine until the last day -

when it collapses....sort of like the> lily pond parable.> > Below is talking about population, but I think the analogy could apply to> health care -- especially Medicare acceptance by physicians.> The

Medicare value (when compared with cost of doing business) keeps going>

down and down -- doctors continue taking it and taking it until finally,>

they just can't take it anymore -- and the system collapses.> It's not

clear to me that the acceptance of Medicare is an S-curve -- what I> mean

is that as the price goes up or down, slowly more and more take it or> drop

it.> It seems more like a cliff -- where docs hold out as long as they can

while> the value goes down and down until suddenly they can't take it

anymore and> stop accepting enmasse.> > Or perhaps -- a

few physicians stop taking it -- then a few see that those> doctors did OK,

then a few more -- sort of a compounding interest thing --> til suddenly a

lot of docs stop takin Medicare much faster than anyone> thought.>

> http://www.woodworkforums.com/showthread.php?t=32628> >

> http://www.ecofuture.org/pop/facts/exponential70.html> > The Lily Pond Parable> > > > 1. If a pond

lily doubles everyday and it takes 30 days to completely> cover a pond, on

what day will the pond be 1/4 covered?> > > >

2. 1/2 covered?> > > > 3. Does the size of the

pond make a difference?> > > > 4. What kind of

environmental consequences can be expected as the 30th> day approaches?> > > > 5. What will begin to happen at one minute

past the 30th day?> > > > 6. At what point (what

day) would preventative action become necessary> to prevent unpleasant

events?> > > > 7. With respect to human

population, what corresponding day are we at> in the world? The United

States?> > > > > Answers to The Lily

Pond Parable> > > If a pond lily doubles everyday and it

takes 30 days to completely cover a> pond, on what day will the pond be 1/4

covered?> > > > Answer: Day 28. Growth will be

barely visible until the final few days. (On> the 25th day, the lilys cover

1/32nd of the pond; on the 21st day, the lilys> cover 1/512th of the

pond).> > > > 1/2 covered?> >

> > Answer: Day 29.> > > >

Does the size of the pond make a difference?> > > > Answer: No. The doubling time is still the same. Even if you could

magically> double the size of the pond on day 30, it would still hold only

one day's> worth of growth!> > > > What

kind of environmental consequences can be expected as the 30th day>

approaches?> > > > Answer: The pond will become

visibly more crowded each day, and this> crowding will begin to exhaust the

resources of the pond.> > > > What will begin to

happen at one minute past the 30th day?> > > >

Answer: The pond will be completely covered. Even though the lilys will be>

reproducing, there will be no more room for additional lilys, and the excess> population will die off. In fact, since the resources of the pond have

been> exhausted, a significant proportion of the original population may

die off> as well.> > > > At what point

(what day) would preventative action become necessary to> prevent

unpleasant events?> > > > Answer: It depends on

how long it takes to implement the action and how full> you want the lily

pond to be. If it takes two days to complete a project to> reduce lily

reproductive rates, that action must be started on day 28, when> the pond

is only 25% full -- and that will still produce a completely full> pond. Of

course, if the action is started earlier, the results will be much> more

dramatic.> > > > With respect to human

population, what corresponding day are we at in the> world? The United

States?> > > World Population Timeline> > " Anyone who believes exponential growth can go on forever in a finite

world> is either a madman or an economist " -- Boulding> > > > > > > >

Just some thoughts to throw in the pot and stir.> > Locke,

MD> > > > RE:

Re: France is healthcare leader, US> comes dead

last: study --> was R> > How is this not national health

insurance, when on the first page it states> Our Mission: Single-Payer

National Health Insurance> .> > A few years ago I worked

with an economist who wrote the book " oxymorons " > about the

health care system. He asked then, and continues to ask, " so what>

will make the US health care system collapse? " We have been saying it will> for over 20 years and yet economically, there is nothing to suggest that> this is will happen. His other point was that overall the cost of living

in> the US has declined radically over the last 100 years. It use to be

that> families worked and spent >90% of their income on food shelter and

clothing.> Now the figure is more like 40% with the rest being disposable

income. His> point was that even though we pay as much as 16% of income on

health> insurance, that is not really a problem. Of course, for some this

is not> true and the percentage of income that would be needed to buy

health> insurance is much greater and truely out of reach for some. For

some, it is> merely a choice to spend less on health care and more on

disposable things> (I would fall into this category.) The issue with simply

cutting 31% of the> overhead of the administrative medical cost, is that

this represents many> things besides inflated compensation to executives.

Most of this represents> those many clerks, sales agents, claims reviewers

that many us argure with> weekly, as well as those who toil in our offices

to file claims and get> money back. This represents as many as 600, 000

people involved in the> health care industry. If this 31% went away that

would leave 600,000> unemployed people in the ecomony, (triple the

unemployment rate) they would> not pay taxes either. A lay off like this is

not politically possible nor is> good for the ecomony. Health care is one

of the main drviers of the ecomony> and a lay off like this would be

similar to closing all the auto and steel> plants in the entire country.> Of course this does not solve the uninsured issue. and there will always

be> rationing. 10 years ago Uwe Reinhart published a study that showed

that> there are three issues in health care, access, affordability, and

quality.> HIs study showed you can only have 2 of the 3 at any given time.

So if we> wish for universal access, we will sacrifice quality or access.

Tough> issues.> > ________________________________> > > > > >