My friend’s grandma in Norway had trigeminal neuralgia and the meds weren’t doing much for her pain, so her doctor recommended neurosurgery to sever the nerve sending painful signals to her face, etc. She waited 5 years to be seen since trigeminal neuralgia won’t KILL you (although it is called ‘the suicide disease’ because many people kill themselves to put an end to the pain) but is severely painful, and when she finally got to be seen, the doctor said, “Hi, you are 85, and I don’t operate on any 85-year-olds for things like this. Sorry.”

Just to corroborate your comments, I saw a Norwegian woman in consultation recently. He family had flown her to the US for treatment. She had waited many months for a covered consultation, and her Norwegian consultant allegedly dismissed her after 5 minutes. The family and the woman were desparate.

But hey, it was “free.”

‘The answer is not as simple as increasing the money. What needs to happen is to incentivize pepople to utilize resources in a productive way. ‘

Yes, but where exactly is _money_ not being used productively? What money exactly and how can it be better spent?

‘A simple matter like a sore throat that might not be costly to treat in an appropriate setting is expensive to treat in an ER. Reallocate those dollars, treat 5 sore throats for the price of one.’

What dollars, and who does the reallocating?

‘Perhaps we spend twice as much because of this perverted system. For what it takes to provide care for 10 such patients in my office. But there is no disincentive to keep people from using the ER inappropriately.’

How would you incentivise people to come to your office and how would they pay you?

‘I believe I answered all three of your questions, though briefly.’

Sorry - you’ve not even started.

I thought it was a pretty good dust-up, and it kept me amused during an otherwise tedious day of number crunching.

“… if you’re too old, you’re F’d … non-emergency consultations … are nearly unheard of. Wait times of years are common … Dental is not covered there …”

Geez, K, I wish we had a system like that here.

Just a bunch of people shouting at each other, not necessarily sticking to any particular subject matter. Yawn.
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Here’s what I learned about Norwegian health care when I was there:

If you are stuck on a mountain village somewhere (of which there are many) and ask for a helicopter ambulance to come take you to the hospital for your breathing difficulty or whatever, they are allowed to say “sorry, you’re too old for the helicopter, find your own way down the mountain”. Doesn’t matter if there is no way to get down the mountain; if you’re too old, you’re F’d.

Also, non-emergency (eg immediately life-threatening) consultations with people like neurosurgeons/orthopods are nearly unheard of. Wait times of years are common.

Dental is not covered there, so people take the ferry to Sweden to get their teeth cleaned because it’s cheaper. Same with buying meat and beer, incidentally…people take the ferry and buy 10 or 20 cases of beer in the duty-free store on the ferry, get off the ferry, buy meat in Sweden, and come back. Speeding tickets are $1500 US.

EMTALA- Hospitals are closing because they cannot afford to keep the ER open.
Medicare - right…. can you say Donut Hole.
Critical access - the critical access hospital in my area is the one that is on the block for sale.
HIPAA - bad in concept, worse in implementation.

Marc - The answer is not as simple as increasing the money. What needs to happen is to incentivize pepople to utilize resources in a productive way. The market does this naturally. Gov’t intervention, like EMTALA (good intentioned, but too sweeping) puts unnatural forces to work. Causes the exhaustion of resources. A simple matter like a sore throat that might not be costly to treat in an appropriate setting is expensive to treat in an ER. Reallocate those dollars, treat 5 sore throats for the price of one.

Perhaps we spend twice as much because of this perverted system. For what it takes to treat an innapropriate patient in the ER, I can provide care for 10 such patients in my office. But there is no disincentive to keep people from using the ER inappropriately. So how about some of the money coming from more approriate use of resources. The right incentives (rather than force - that is forcibly removing money from the peoples collective wallet)
I believe I answered all three of your questions, though briefly.

But what do I know, anyway. I am just a “free market moron.”

Of course not - but what I’d like you address is:

1 - The US spends about twice as much per head on healthcare as nations in western Europe - agreed?

2 - If the hospitals are still going broke, is the answer to increase payments, and if so where will the money come from?

3 - If you don’t want to spend any more money, are there costs you can take out of the system and what are they?