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Health system: pay as you go; ...or Sicko?
Topic Started: May 22 2007, 06:35 AM (149 Views)
Eral
Kopi Luwak
I was going to add this to The World in Numbers, but I love new threads.

Michael Moore's new documentary -described as agit-prop - criticises the American health system. He says America comes out barely ahead of Slovenia, which is true, but so do a lot of other countries, as we know, thanks to Regullus.

His basic contention seems to be that by enabling the organisations who pay for the service (the health insurance funds) to decide whether the service should be provided is putting the cat in charge of the cream, and that adequate health services are a right that is being denied.
I agree with his view, but I am an avowed lefty.

The high cost of many treatments, especially for rare diseases, does give pause, but Moore shows cases of people with common diseases like cancer.

How much is agitation/propaganda, how much a true picture?
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Joe
Coffea Canephora
With Moore, most of what you're getting is propaganda and hyperbole.
In the shadow of the light from a black sun
Frigid statue standing icy blue and numb
Where are the frost giants I've begged for protection?
I'm freezing
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Regullus
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Reliant
Naturally I haven't seen it but I was reading a review and there was some stern questioning of Moore by some Canadian journalists. One of Moore's quoted statistic was a comparison between Detroit, MI and Canadian life expectancy. Talk about stacking statistics. :rolleyes:

I like Michael Moore but he's not, imo, a documentarian and I think he would be more interesting if he played a little less loosely with the statistics.

As to who has the best method of health care, I don't really know. France has the best in the world yet 15,000 (est.) elderly French died in a heatwave. 15,000. :( Think about that figure for a moment and then think to an equal Canadian, UK, Aussie, or US disaster and try and find 15,000 dead.

Canada's has a very nice system but there are complaints of long waits for even serious conditons. I also read somewhere that Canada had less MRIs than the State of Tennessee, not one of our largest states. I have no idea how valuable MRIs are to anything but it didn't sound good but it could quite easily be a Moorian type of stat.

It may shock you to learn that I was uninsured for most of my life and the long and short of it is I paid for my medical/dental. I have never been denied health care and if I ever had a large medical bill, I paid over time.

I have a friend who was in a car accident, uninsured and his medical care cost him $48,000. He paid it over time. He didn't declare bankruptcy, he didn't renege on payments, he paid his bill and you bet it put a crimp in his lifestyle for five years.

Sounds shockingly expensive? How's this for expensive my husband and his various employers have paid over $100,000 for insurance. I doubt his medical expenses have cost the insurance companies 10,000.

Kinda offtopic but does anyone know the point of Drs and Nurses working long shifts? I would think we would want medical pesonnel to be well rested. :shrug2:














tempus_teapot
 
I'd like to add that at this point I have taken my Spider Jerusalem action figure and tied his wrist to my Cassidy (from Preacher) action figure just so I can work out which positions are feasible with them and which aren't.

Read that and weep, internet. Weep!

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Krazy
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I haz powah!
Doctors work long hours here to rack up experience. I know before recent revisions that to become a consultant (top rank like an Attending I guess) required 30,000 hours clinical time. The average time now to become a consultant is 7,000 hours clinical time. Makes you think.

Nurses here work 36 hours per week - usually 3 12 hour shifts, other time is spent studying. This is an average figure though, some weeks you might work four shifts the next week two for instance.

I know the real reason for less doctors/nurses working more though is money.

I don't know too much about the American health system other than I've gleaned from watching American TV shows and I haven't read about Moore's report either, although I'm guessing as Regullus says he has probably cherry-picked some stats to augment his argument and ignored ones that don't.

MRIs are a type of scan (an expensive one though compared to an X-ray), as with all scans, you have to choose the right scan for the job, so without qualifying whether the MRIs taken were useful or not as a pecentage of total MRIs you can't read anything into just the number undertaken.

Back to Eral's questions. Well yes, in essence Moore is probably right, but that's as much as I can say on the matter.

One of the problems though is the increasing cost of healthcare itself. New drugs cost bug money, those drug companies say it funds the future R&D and have to charge ridiculous prices until the patent runs out when generics can make them for peanuts. Probably some truth in that, but how much is profit for shareholders and how much for actual R&D? That's the problem, these are companies out to make fat profits for shareholders and how much is the altruistic desire to rid the world of illness which would end their existence?

In the UK, the NHS has already said that it cannot keep pace nor fund the new drugs that keep coming on the market. Nor can it provide universal healthcare for every complaint. There is just not the money to do it. Things like rationing are already common place, and you may be allowed or denied treatment solely on your postcode. Similarly, there are talks about denying people based on their lifestyle which leads down all sorts of dubious avenues. Two people - same complaint, only one can get treatment, one an overweight smoker never eaten a vegetable in his life, the other normal weight, exercises, doesn't smoke etc - which one gets treatment? Of course the overweight one may have been the one who worked all his life, paid the taxes that funds the treatment and the slim one sat on his backside unemployed. Still a fair choice? But these arguments have been mentioned more than once to lower the load on the NHS.

But as for the treatments themselves, well, I for one cannot see why the NHS is funding fertility problems. It is expensive, unreliable with low success rate, and is ultimately a life-style choice, not a health-problem as such. And with things like cancer treatment (which you mentioned) - there is a big difference between providing funding for a course which may give 90% chance of complete remission to expensive drugs which will extend life for 3 months which is why specificity is required rather than just mentioning common problems like cancer.

I think I've waffled on long enough about this subject.
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underdog
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Irish Breakfast
Krazy
May 22 2007, 04:27 AM


In the UK, the NHS has already said that it cannot keep pace nor fund the new drugs that keep coming on the market. Nor can it provide universal healthcare for every complaint. There is just not the money to do it. Things like rationing are already common place, and you may be allowed or denied treatment solely on your postcode. Similarly, there are talks about denying people based on their lifestyle which leads down all sorts of dubious avenues. Two people - same complaint, only one can get treatment, one an overweight smoker never eaten a vegetable in his life, the other normal weight, exercises, doesn't smoke etc - which one gets treatment? Of course the overweight one may have been the one who worked all his life, paid the taxes that funds the treatment and the slim one sat on his backside unemployed. Still a fair choice? But these arguments have been mentioned more than once to lower the load on the NHS.
ning common problems like cancer.

Which then leads to 'we are paying for your health care we will decide what you will or will not do'
It is just another right you have given up, the right to live the way you want, if you want to smoke you have the right to, if they don't want you to smoke, then ban tobacco, I don't care, but they won't. because the government makes more on a pack of cigerattes then the manufacturer does.

'Cigarette manufacture in the U.S. is a profitable enterprise. In recent testimony before the Senate Agriculture Committee, I estimated that in 1996, the operating profit per pack of cigarettes was $0.30.6 With about 24.2 billion packs of cigarettes sold that year,7 the total operating profits of the domestic tobacco-producing subsidiaries of U.S. manufacturers came to about $7.2 billion.'
http://www.mit.edu/people/jeffrey/Harris_A...rt_May_1998.pdf

factory price $2.28
fed exc tax $0.39
dist markup $0.59
state tax (avg) $1.021
state sales tax (avg) $0.20
final price $4.47
govt profit $1.61

http://tobaccofreekids.org/research/factsheets/pdf/0207.pdf

If they want you to excercise and you don't you won't get HC, if they have decided that you shouldn't drink and do, you won't get HC, more nanny state liberalism, 'WE know what is good for you'
Like Ronad Reagan said, the nine worst words in the english language, 'I'm from the government, I'm here to help you'

The probelm with costs is third party payer's it costs most people nothing, they will get Insurance or medicare(caid) to pay for it, and feel like they have been screwed if they have to pay a co-pay.
People goto the E-room which the insurance will cover but won't make an appointment when sick because they will have to make a co-pay, that just cost the insurance more, but; they don't care, they don't pay for it.

Medical savings accounts would help, you get to set some money aside before taxes that money can be used for medical care, you would check out different clinics/hospitals to see who has the lowest price, and go there, then the clinics would have to start competing with each other, and would start lowering prices.


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Eral
Kopi Luwak
Joe: thanks for the deep and insightful contribution. Why do you even bother?

We had a huge shortfall in the number of nurses staying in the hospital system. Then someone had the brilliant idea of improving their conditions: better pay, putting nurse/patient ratios into place, better management of shifts - and lo and behold, nurses came back to the system. Magic word: UNION.

We have private health insurance here, which is meant to pay for things like elective surgery, and also eliminates waiting for any procedure. But the insurance company doesn't decide if you can have the procedure: they just say how much you will have to fork out yourself. We have the same gripe as Regullus' husband: the company is making squillions, but come the time to actuallly need cover, and you'll be out of pocket.

Krazy's point about cancer patients is a good one. On one hand, it seems really cruel tell the parents of a sick child or the husband of a woman with breast cancer "they're not worth saving"; and there's the idea of autonomy that underdog raised- it's up to the person concerned and their family to make these decisions.
On the other, if extending the person's life will only mean more suffering or is being driven by avoidance of the reality of imminent death, then perhaps a halt should be called.
But I still think the over-riding consideration should be the well-being of the person, not how expensive it is. And that is for doctors and the people concerned to decide - not some anonymous person in a building hundreds of miles away.

I agree with underdog that denying health cover to people with self-inflicted health problems is wrong, because once health insurance is mandatory, then it should mean everyone can access it. But I pay Krazy's point about doctors deciding on who gets treatment, when limited funds are available.
I don't like the idea of shopping for the lowest cost health care: I want a hospital near me that will provide terrific care.

As for drug companies making health care expensive - governments could legislate against that. But they don't. Because enabling a minority to become fabulously wealthy is more important than the basic rights of the majority. :rooster:
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Regullus
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Reliant
A reason for high health care costs is that people who pay, are paying for people who don't/can't pay. Another reason, in the US is litigation. I don't mind paying for people who can't pay but I do obviously object to people who abuse the system. To use underdog's example, they don't want to pay a co-pay so they go to the emergency room. and that costs all of us on many levels.

I also think in the US that there is abuse of the system not only for litigation on the part of patients/lawyers but also by the medical establishment.

I know a woman who lives in assisted housing and receives welfare and support benefits as her sole support. She slipped in icy weather and truly injured herself, I think fractured her wrist and as can happen in a fall, tweaked her back or a tendon. The government paid her medical expenses and she had no additional payments.

She goes to a lawyer to sue the apartment complex. She also went and got physical therapy. However, at some point she felt fine and to get to the therapist was difficult so she stopped going. The therapist called up and reminded her she had a court case and they wouldn't be able testify about her injuries if she stopped coming. :blink: Hmm.

Of course the case never came to court, it was cheaper for the government to pay the claim rather than go to court and she got 10,000 and her lawyer got 20,000 and the physical therapy clinic got income. Does this strike anyone else as totally corrupt and not a unique case.

I'm ultimately paying for this little escapade and this happens all the time.

Here's another thing that drives me insane. After the age of 40, a woman should get a yearly mammagram for early detection of breast cancer. Sounds sensible. I haven't had a mammagram yet but by all accounts the mammagram is exceptionally uncomfortable/painful, people who have given birth cry when they get this test because the breast has to be flattened between two plates. But for the early detection of breast cancer, a sensible test.

Guess what happens if the mammagram finds an anomaly? They give you an ultra sound! :faint: :badmood: An ultra sound is cheap and painless and apparently more accurate and better at early detection.

Based on that, what can we make of the mammogram? A sensible test or a pointlessly painful and expensive test?

I know this because my mother got a mammogram and that's exactly what happened to her.

As to pharmaceutical companies, their easy to villify but not necessarily thorough blackguards.
tempus_teapot
 
I'd like to add that at this point I have taken my Spider Jerusalem action figure and tied his wrist to my Cassidy (from Preacher) action figure just so I can work out which positions are feasible with them and which aren't.

Read that and weep, internet. Weep!

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Eral
Kopi Luwak
I am not vilifying pharm companies: I am pointing out the conflict that arises when a social good is second priority to profit. :eral: Pharm companies are doing great research work, but when decisions have to be made on the basis of making money, social outcomes suffer.

The insurance companies here are always raising premiums. First, they said it was because not enough people were in private health. Then, when the government forced people to join private health funds, they said it's because too many people are making claims. :rooster: :rolleyes:

If we have a dog-eat-dog society, where everyone has to watch their back and get what they can, we create an cycle of exploitation and unfairness. Is the system of litigation the dark side of the "pull yourself up by the bootstraps" independence of American society?

I have no solution for solving rorting:solutions always seem to involve making life harder for people. :(

As for mammograms, Germaine Greer is of the opinion they are an attack on women by the medical establishment, and I totally agree. The reason cited for their use is that mammograms give a photo that can be easily compared year by year. In this age of screenshots, don't know why that doesn't apply to ultra-sounds. :cyber:
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underdog
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Irish Breakfast
Eral
May 22 2007, 09:17 PM


I have no solution for solving rorting:solutions always seem to involve making life harder for people. :(


rorting? :huh1:

Could it be that a mamogram takes a full picture and can see everything at once, and an ultrasould only sees one small part at a time?
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Regullus
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Reliant
Re: mammograms: Ultra sounds take pictures of organs, babies, I don't think that's the problem. There may be a reason that mammograms are superior to ultra sound, I just don't what the reason could be if an ultra sound is used to confirm and detail a mammograms findings.

tempus_teapot
 
I'd like to add that at this point I have taken my Spider Jerusalem action figure and tied his wrist to my Cassidy (from Preacher) action figure just so I can work out which positions are feasible with them and which aren't.

Read that and weep, internet. Weep!

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Eral
Kopi Luwak
underdog, when prostate cancer is screened by a similar process, we'll back mammograms. ;D

re rorting: see Regullus' story about the woman having her costs paid for, and then suing.
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Krazy
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I haz powah!
Ah, litigation, well there's only one thing that will stop that - the idea that someone is liable when something bad happens to you.

That slipping on ice is a prime example - it's ice, you know the really slippy stuff they play things like ice hockey on. It's a shame judges don't throw these cases out and a huge fine on the the person suing for wasting their time. But sadly what with the lawyers fees (another thing that needs regulating perhaps?) it's cheaper to settle and so lawyers have no reason to stop getting people to sue with the someone has to pay mentality.
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underdog
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Irish Breakfast
Eral
May 23 2007, 12:28 AM
underdog, when prostate cancer is screened by a similar process, we'll back mammograms. ;D

re rorting: see Regullus' story about the woman having her costs paid for, and then suing.

It's bend over and put the rubber glove on. :o

you probably meant tort(ing), we do need tort reform in the US.
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Eral
Kopi Luwak
I think we are having a failure of communication, underdog.:lol:
Rorting means ripping off a system, cheating, manipulating so that you receive a benefit that you do not deserve. e.g the wife who applies for welfare benefits under her married name and her maiden name, and thus receives two.

I have no idea if we need tort reform here as well. Time to google.

Bend over and put the rubber glove on? Pfft. Try being checked for ovarian cancer when you pop in for a pap smear every two years. Now that will bring a startled look to your eyes.

EDIT: Wiki says, no, we are OK.
However, an article in the paper suggests we need work on our democracy and freedom of speech laws.
http://www.theage.com.au/news/in-depth/gag...9601484555.html
I am very concerned by this: I didn't know about the consequences to that man before this. :o It seems like Putin is in charge everywhere.
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lara
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Kopi Luwak
Some links:

International health care delivery

The U.S. Health Care System: Best in the World, or Just the Most Expensive? (pdf)

International Health Comparisons (also pdf)

Health Care Systems: An International Comparison (pdf)

A Comparison of the U.S. Health System to that of 15 Nations

Price of care (in Canada)

And this one goes to the issue of cost of care and new treatments, and who should pay for what. I edited it and I thought it was excellent:

Health reporting needs the QALY treatment

I love my website. :-*
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Eral
Kopi Luwak
There is a difference between wanting an incredibly expensive treatment and being refused, and wanting to access regular chemo/radiotherapy + standard drugs and being refused. Moore suggests this is what is happening. His purpose is to raise awareness and discussion, so I'm thinking there will be a fair amount of bathos and pathos, but if he doesn't examine QALYs the film can be dismissed, so I'm wondering how much coverage they get. When you think about it, QALYs are the whole question. What QALYs are the insurance companies using?

When my mother was dying we were given the option of extending her life using tube/peg-feeding. Totally up to us. No mention of cost: the only discussion was about how she would have felt, how we felt, with the focus on the quality of her life. That's how it should be.
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underdog
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Irish Breakfast
Ahhh, never heard of rorting, and couldn't find a reference in a dictionary either , so must be an Australian slang term.
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Eral
Kopi Luwak
I should have subtitles. :lol:
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