heat;h care in america

[Fenir_LacDanan]

The long waits, and their are long waits, are all for ELECTIVE surgery. You want bigger boobs? You can wait behind the kid with leukemia...


Actually what we do is put much more money into Health...And less into Arms. Trust me...it balances out.

Anyone, and I mean ANYONE, who needs care gets it, with not the singlest little bill for paper clips. And its all top of the line. Americas health system is good, but, (IF THE WORLD CAN ACTUALLY TAKE IT FOR A MILLISECOND), most of Europe's is better. It is utterly free, and top of the range.

This is for the crowds...:: America CANNOT be the best at everything!

Once again...bring on the usual...

[Fenir_LacDanan]

Originally posted by The Gaffer

However, if you have acute illness, the level of care is up there with the best in the world.

Bang on Gaff, bloody Bang on.

[The Gaffer]

I know what you mean about insurance. All the more reason to cast the net as wide as possible (spread the risk, man).

The UK standard of care is on a par with places like the US (probably slightly below the level you'd get if you were fully insured), as a whole, and below places like France.

If we're talking oxymorons, I'd say "caring corporations" were more relevant to this topic than "government workers".

[Valandil]

Originally posted by Fenir_LacDanan
...Actually what we do is put much more money into Health...And less into Arms...

Yes... *sigh* - we DO have to take care of THOSE messy matters worldwide for the rest, don't we?

Say - Gaffer, if you didn't see it - after your edits I also edited my last post with more observations/questions. I believe it was all consigned to obscurity by landing at the bottom of the previous page. Please check it out if you're still hanging around.

[The Gaffer]

Here's an anecdote which, to my mind, captured the cultural difference between the UK and the US in health care.

I was talking to an audience of about 30 postgrads from the states who were doing a course in Health Economics, along with their professors.

It turned out that what they understood by that term was something like " the economics of the health industry", so profit margins, market share, trends, financial and corporate strategy, etc etc.

What I understand by Health Economics is "the systematic assessment of the cost-effectiveness of health care interventions". It amazed me that here was a whole class full of postgrad medical students who had no concept of measuring the effectiveness of what they do and comparing it with the cost.

We had an interesting discussion!

Anyway, guys, you are getting burned!

[Fenir_LacDanan]

[The Gaffer]

Originally posted by Valandil
Say - Gaffer, if you didn't see it - after your edits I also edited my last post with more observations/questions. I believe it was all consigned to obscurity by landing at the bottom of the previous page. Please check it out if you're still hanging around.

Thanks for the note; here goes.

Some would like to see health care become government funded... others fear that this would be even LESS efficient than what we have today.

Could it BE less efficient? I mean, really. Look at all those adverts trying to get you to rush down to the doctor to demand the latest whatever (whether or not it actually works). The amount of unnecessary prescribing that goes on is monumental. The docs, HMOs and pharmas have no incentive to eliminate it; on the contrary, they are doing just fine because they just slap a profit on top then fire it right back to your premium. A good start would be to ban advertising of prescription drugs to patients.

Also - as I understand it, some of the rising costs of health care are simply because we (all - not just in America) can do SO MUCH MORE for people than we used to. My real fear is that in America, our system would be so huge, it would be hard to keep it as efficient as the model you have in the UK.)

That's true, and it's a big issue for health system everywhere. I don't know of ANY system which can do everything it possibly can for everybody.

It also contributes to the over-prescribing problem too, what with the latest hi-tech mumbo-jumbo being shoved down our throats all the time. Heart transplants are a great example, so too neonatal intensive care.

I don't pretend to have the answer, but I do know that we can have a greater impact on our health by applying what we already know (about effectiveness and cost) than we will from any new technology likely to appear in the next ten years. Naturally, drug companies do NOT like to hear this.

Sorry, bit of a hobby horse this one for me. Actually, it's my job, so, let's see, I'm bunking off work to chat on an LOTR board about work. How sad am I?

* flies off to save the world *

[jerseydevil]

Originally posted by The Gaffer
.. ban advertising of prescription drugs to patients.
[

I agree with this. However it is only in the last 10 - 15 years that they have been advertising perscription drugs. I don't agree with advertising perscription drugs on tv - but I think patients should have a place to RESEARCH various drugs - because many people have been able to come up with better medication than their doctors. It is impossible for doctors to KNOW every drug and every new medical procedure.

I have also consulted for several pharmaceutical companies - Eli Lilly and Merck, Bristol Meyers Squibb is down the street from me. The number of years it takes and the money it costs to get a drug developed, tested and out on the market is EXTREMELY expensive.

As for other countries health care - yeah - Canada has paid health care - they just are running out of doctors. People don't see the sense of being doctors there because their pay is capped and it doesn't pay to go through medical school. They had about that while I was there. There is a severe shortage of doctors in Brantford the city next to Trish's house.

Te owners of the British company my father sold part of his company too - had said how in Britain - people who can afford other insurance have other insurance and use that. They did not have anything nice to say about the British Health Care.

French News has been having on how they're health care system is nearly bankrupt. That is why they have been increasing taxes on cigarettes and alcohol - to try to pay for their health care. They have been cutting back on benefits and things, which has been causing a huge outcry in France. This is coming from French news.

Say what you want - but our health care isn't going backrupt - the main problem we have is ridiculous lawsuits against doctors that raise the malpractice insurance so much that they just can't afford to practice at all. A lot of times, not always of course, many people look at suing a doctor as a way to make a quick buck.

[Earniel]

Originally posted by jerseydevil
French News has been having on how they're health care system is nearly bankrupt. That is why they have been increasing taxes on cigarettes and alcohol - to try to pay for their health care. They have been cutting back on benefits and things, which has been causing a huge outcry in France. This is coming from French news.

They're not the only ones, I believe last year the Netherlands cut back significantly on the number of medicines and treatments that their health care system used to pay for.

Simulations show that Belgium may run into problems with health care in the future too because of the lower birthrate and the higher number of pensioned people who will need more medical aid. In the end the number of working people may be too small to raise enough money to keep the extended health care system running. Although all this is only a possible future projection, but it shows one of the possible dangers of a state-steared health care.

IMO both systems have benefits and negative points. Somebody has to pay in the end either way, whether that's directly or through a state health system. Personally I prefer the state health care, even if it can be overextended.

[jerseydevil]

Originally posted by Eärniel
IMO both systems have benefits and negative points. Somebody has to pay in the end either way, whether that's directly or through a state health system. Personally I prefer the state health care, even if it can be overextended.

I agree - we have a combination system. The ppor generally get health care through medicaide and medicare, but then people who are working - but whose companies don't supply healthcare - aren't eligible. There are different rules and so forth. The thing is - contrary to belief - US hospitals can not and do not turn people away who need care. It may not be top of the line care - but they do get care and aren't just left to die. if a homeless person needs an ambulance - they get them and bring them to the hospital and give them care. This cost then gets past onto the people who do pay for care though.

[Hemel]

Please help me out here. Because I have a number of USAmerican friends, and a couple of them do have severe medical problems. One told me that she'd had to work through one of her serious illnesses (cancer) just to be able to pay for the treatment - another (diabetic and unable to work) tells me that she cannot afford to pay both her rent and the costs of her drugs. Another tells me that his elderly parents have to buy the drugs they need from Canada, because they are just too expensive in the US. A fourth (a student) tells me he can't afford medical coverage at all, and prays that he won't become ill.

You see, the image I get from this, from talking to them, is that people can fall through the system in the US and that there really is true medical hardship. From what they say, it does seem over there to be based on ability to pay - health is seen as a commodity rather than a right.

So what actually is the situation?


PS to Gaffer - yes, I agree. That BBC article did contain a clear subtext

[Sister Golden Hair]

From what they say, it does seem over there to be based on ability to pay - health is seen as a commodity rather than a right.

So what actually is the situation?

The thing is that people here that are below poverty level do get 100% free health care.

Um, what is a USAmerican?

[Hemel]

Okay, SGH - so then how is it that some people (according to my USAmerican friends) seem unable to get access to the care they need? Is there some sort of bit in the middle where people fall through either because they aren't poor enough or aren't rich enough?

That is a genuine question. Not for any political or stirring reasons, or anything else - but simply because I really would like to know

And for your question

Um, what is a USAmerican?

Ah, I assume that's a genuine question too, though I'm sure it's fairly easy to work out, and I'm sure also you saw some of the discussion on the term. It's what I call citizens of the United States of America

[Sister Golden Hair]

Originally posted by Hemel
Okay, SGH - so then how is it that some people (according to my USAmerican friends) seem unable to get access to the care they need? Is there some sort of bit in the middle where people fall through either because they aren't poor enough or aren't rich enough?

That is a genuine question. Not for any political or stirring reasons, or anything else - but simply because I really would like to know

And for your question Ah, I assume that's a genuine question too, though I'm sure it's fairly easy to work out, and I'm sure also you saw some of the discussion on the term. It's what I call citizens of the United States of America

Well, the poor are covered through medicaid which is provided by the government and funded by the taxpayers. Everyone that is employed, pays for health insurance through their employers. This may not be total coverage depending on the insurance. Elderly people that have worked most of their lives have insurance after retirement, and are eligible for medicare after the age of 65. Depending on how much they qualify, they may also receive a combo of medicare and medicaid. It depends on a lot of things.

There is no such thing as USAmericans.

[Lizra]

Hemel, I think your term USAmericans is cute! Of course, I'm too lazy to use it, but I still enjoy it.

[jerseydevil]

Originally posted by Lizra
Hemel, I think your term USAmericans is cute! Of course, I'm too lazy to use it, but I still enjoy it.

Off subject...

I have determined I'm using B.EU to refer to Britain and F.EU to refer to France and G.EU to refer to Germany and so on. Also - citizens of said countries witll be EnglishEU, FrenchEU, GermanEU since they are losing their countries to the European Union umbrella and will no longer be British, French or Germans, btu will be controlled by the government of the EU. if someone from England can just decide that we are no longer Americans - then I guess we can just decide they are no longer British - but are just part of the European Union and should be represented as such and actually lose their national identity.

I find it a bit disrepectful that she has taken it upon herself to determine this.

[azalea]

Originally posted by Hemel
Okay, SGH - so then how is it that some people (according to my USAmerican friends) seem unable to get access to the care they need? Is there some sort of bit in the middle where people fall through either because they aren't poor enough or aren't rich enough?

These are refered to as the working poor. They are those who have low paying jobs and thus cannot afford health insurance, but make too much money to qualify for Medicaid. This is where the real problem lies, and there are many people in this catagory. Health insurance takes up a good chunk of one's paycheck, and then you still have to pay on top of that a co-payment for both doctor visits and prescriptions, plus a percentage of whatever further care you might need (as in the case of surgery or hospital stay, etc.)

HMOs work a little differently, but they are widely criticized by those who use them because you are restricted to what they allow in terms of doctors, hospitals, procedures, etc.

Also, when you're dealing with insurance companies, you may have to wrangle over a pre-existing condition, which they can refuse to allow coverage for. So if a diabetic (in the case of an earlier example) gets laid off and goes to a different company, it is possible that they could say the person is not eligible for coverage for related problems (although diabetes is so common that I don't think they usually do that, it's more for major stuff like cancer. This was part of the premise for the movie John Q starring Denzel Washington).

I don't know that socialized medicine is completely the right way to go either. Isn't there a problem in Canada because the doctors aren't making enough and are coming down here, thus creating a shortage of doctors there? (I think we discussed that in a similar thread). If you pay them a lot, taxes will be extremely high, and that in itself creates a new hardship for the working poor. Plus, aren't there limits on choice?

I think there has to be a third option, but I don't know what that is. Maybe we need to do something radical, like include medicine in the common core of subjects, more than just the low level health classes. That way, people could self treat a lot more at home, and would avoid clogging the system as much.

Also, allow more prescriptions to become over the counter. (It's ridiculous that when my son got pinkeye, I had to pay $20 for a dr. to tell me I needed eyedrops, then have to wait for the pharmacy to open to get them. Duh! If it wasn't prescription, I could have just gone and bought it myself, and saved the $20!)

In any case, I hate insurance companies, and I hate dealing with doctors' offices. I would love to go back to the neighborhood dr. who'd make house calls and saw a whole family, and would negotiate his own pay. But then I'm sure there were problems with that too.

[jerseydevil]

Originally posted by azalea
I think there has to be a third option, but I don't know what that is. Maybe we need to do something radical, like include medicine in the common core of subjects, more than just the low level health classes. That way, people could self treat a lot more at home, and would avoid clogging the system as much.

One problem is that a lot of people go to emergency rooms no matter what the problem. I had a friend - no matter what - she would take her and her children to the emergency room instead of seeing a doctor. It causes HUGE costs that the insurance companies have to pay and clogs up the emergency rooms for TRUE emergencies.

As for your statement regarding Canada - yes there is a huge problem. When I was up there it was all over the news how they had a severe doctor shortage. They were talking about increasing doctors pay - but then cost would go up and they would have to raise taxes or cut benefits.

[The Gaffer]

This is an interesting discussion. I think it's important to distinguish problems that are specific to a particular system from problems that are generic to health care in general.

For example, all systems face a theoretically infinite demand for health care, so some sort of rationing has to take place somewhere. They also face rising costs, since our populations are aging and birthrates are falling. These issues are there no matter what system you're talking about.

We also have the problem of doctors' pay here, though not as bad. A bigger problem is the lower grades of health professional: you can earn more stacking the shelves in Tesco than you can wiping bottoms in an old folks' home. To tackle it, the UK government has pumped money into the system, and as a result, pay is going up.

One thing to point out is that doctors here are still free to do private practice. Their NHS contracts allow them quite generous time off to do their own thing, which many of them do to very lucrative effect.

Another interesting development here is an increasingly primary care-led (that's "family practice" to our transatlantic cousins) service: 80% of NHS spending will be commissioned by local Primary Care Trusts, leading to much greater responsiveness to local needs and efficiency.

That's an interesting point about prescriptions, azalea. The approach that is being pushed here is to have nurses and pharmacists take on these roles, reducing the costs of the "patient encounter" to everyone involved.

I don't know enough about the US system to say what I think would be the best way forward. I'd be interested to hear what people think about the concept of socially-funded medicine being inherently more efficient than privately funded.

[Hemel]

Ah, thanks Azalea Now that makes sense, and I can understand now why some of my friends seem to be having problems.

To a certain extent we have a similar problem here - visits to the doctor you don't have to pay for, but a dentist will charge what I think is a lot of money for a consultation ... which means, of course, that those who aren't so well off can't afford to go, or to get treatment (unless they get insurance, which, of course, is the same problem). NHS dentists are very very hard to find.

Also things like prescription charges can be expensive - I'm now poor enough not to have to pay medical charges at all, but when I did then I found that needing a prescription was quite a chunk out of my money (especially as if there are two or more things on the form you have to pay for each). And there are certainly things that the NHS can't cover - we hear quite often of fund-raising schemes either for specific treatments or initiatives or to help particular hospitals. There are also, of course, the private schemes - lots of people pay extra to companies (or have it as a work-benefit) so that if they need treatment they can go private and maybe have more choice as to when things are done and where. (Which then leads to accusations that ultimately we'll end up with a two-tier system ... )

There are too, problems with socialised medicine. For a start it can't possibly hope to meet everyone's needs and yet still keep the financial contributions- just because medical care will always be expanding (new treatments, etc). I have concerns too over the pay issue - are we, perhaps because we can't afford to pay our medical staff enough, losing many of them elsewhere ... and then, even worse, importing some and thus effectively robbing the training schemes of poorer countries? And most certainly there are people who would be more discriminating in their use of medical resources if they had to pay ....

It's a problem, and yes, I agree, there's a lot you can do at home. It does seem silly if you know what the problem is that you then have to go and pay to be told it, just to get a prescription (though of course I'm sure doctors would be looking out for other things as well, making certain). But some things are pretty obvious. Also, over here, we're constantly being told to ask the pharmacist - or maybe call a directline for 'phone advice - so this tends to help in terms of not having doctor appointments too.

My view is that everyone should have access to health care. I see it as the right of a citizen that good care should be available without the filter of whether the individual can afford it. (Even the home doctor system that we had before the NHS meant that some families just couldn't afford it ) Access to healthcare in my opinion is one of the things that's too important to leave mainly in the private market - just because, ultimately, the rationale of that is profit, which I do think is at odds with patient-care. But then of course ... one can't keep socially spending and spending ....

JD, can you explain a bit more about emergency rooms - how they work, what they are for, and how they are funded? That's because I've heard of them, but don't really know much more, except one friend has had to go a couple of times.




Ooops, sorry - just went to post and have seen The Gaffer's post - which covers far better some of the things I have tried to say


Thanks, Lizra