Re: OT The good National health care system

On Jun 13, 8:57 pm, "Pat Wadley" <m...@xxxxxxxxxxxxx> wrote:
OK, first of all the "unnecessary" tests are to protect a doctor as well as
a patient.  Which tests do you think are unnecessary?

Unnecessary tests will vary on the individual case. But as long as an
excess of tests is ordered to protect the provider from litigation,
rather than for any real outcome benefit in the patient, said test is
unnecessary. We can, of course, look at a plethora of health services
research studies to document this.

Second of all, not everyone fits into a "one size fits all" medicine.  And
that is what socialized medicine does becasue the government decides what
treatment you need and what you can NOT have.  And they will do this because
of cost.  And they will be directed in this, by us, the tax payer.  We will
read stories about some treatment that will cost millions of dollars and
"only" benefit a few people.  This treatment will require money that could
go to "help" a greater number of "other" people.  Thus the decision will be
made to not help those who need treatments for a "rare" problem.

Guideline-based medicine, usually structured on the basis of
systematic meta-analyses based primarily on Level 1 Evidence, and
usually developed via consensus panels, is practiced universally. In
socialized medicine countries. In the US. Even Blue Cross will
refuse to authorize off-label drugs, unconventional tests, etc. Many
insured Americans are enrolled in HMOs, which are far more restrictive
in what they allow than any socialized system (because of the profit
motive). Managed care is the norm everywhere, even for those who
believe they have "traditional insurance". And it is not a bad thing.

An oncologist friend of mine, for example, is leaving his practice
because his partners have greatly increaded the number of tests and
treatments for profit reasons. That can't happen when the profit
motive has been removed.

What about children born with no "hope?"  And keeping them alive will cost
millions of bucks and they are going to "die anyway?"  What about elderly
people who need hip replacements and have "only" a few years left?  Or who
have cancer?  Or who have heart disease?  What about people with problems
caused by drug usage or alcohol?

My understanding, from Canada, is that survival rates for all of the
above conditions are equal or better than in the US. To suggest that
socialized medicine would fail to treat these individuals is
inaccurate, and is the kind of distortion that the fear-mongering for-
profit special interests in the US have perpetuated at least since
Hilarly Clinton first took on health care reform.

Then the decision will be made to "ease" up on treatments for people who are
over a certain age.  And yes, it does happen in Canada, England and other
countries.  My best friend Athena, who was a Canadian, born and raised
there, now lives in California.  When her mom wanted to come visit her in
California she wanted to bring her sister with her.  The sister, who had
several problems and was on "pallative" care, was told that she could not
travel to California with any assurance that she would be "taken care" of..
They told her that if she got sick in California and they took her to a
hospital and the hospital commenced treating her for her kidney disease that
not only would Canada's health care not pay for it but when she got back to
Canada they would NOT continue her care there.  Now this may not sound too
unreasonable because you are thinking that she was "old" and it would never
happen to you.  But I guarantee one thing, you., too, will get old.

No, it does NOT happen.

Moreover, paliative care is an excellent solution. Life is extended
outrageously for many elders, even when quality of life is near nil.
In Canada as in the US, the decision to enter palliative care is made
by the individual patient and his/her family, in consultation with
medical professionals. This decision can NEVER be made by a
practitioner alone, by rule of law, in Canada.

It is important to note that the physician's financial motive, in both
Canada and the US, is to extend care. Since socialized medicine works
throught he primary care physician, there can be no motive to
terminate care. All of this is fallacious special interest fear
mongering. Kinda like... well, I won't start.

This also happened to friend of mine who lives in England, his kidneys are
shot and though the health service provides him with dialysis, they have
deemed him, at 50 to be "too old" for a transplant.  And if he goes out side
the country for a transplant, the health care system will not do anything to
help him.

The placement on the transplant list here in the US is based on a
special prediction equation. For example, at the university hospital
where I work, a transplant conference is held for each patient.
Physical parameters, age, psychological status, likelihood to be
compliant with a medical regime, etc. are ALL considered in that
equation. That equation determines one's priority score on the
transplant list. In the US, as in Canada, the individual has LITTLE
control over their priority score.

Very often, compassionate physicians will tell someone it is because
of their "age", when in fact it is because they are drug/alchohol
abusers, etc, or because other comorbidities make it likely the organ
would be wasted.

Now as to "coordinating" with other branches of government, that will be
another layer of bureaucracy to meddle in your life.  Do you really think
that some government official who is paid to do a job, which is facilitate
government policies, is going to do a "good" job for you?

Nope. Nope. Care coordination in the US is already done at the level
of the primary care physician, using guidelines/treatment regimens
approved by the insurance company. This is ALREADY being done. A
socialized system simply shifts these EXACT SAME PRACTICES to a single
payer (realizing more economic efficiencies for two reasons--first,
the profit motive is removed from the equation, and second, because
the absolute number of staff and support infrastructures are reduced
by a single payer). A secondary benefit of the single payer system is
often a single coordinate medical record, which greatly improves care
outcomes because all providers can consult a centralized information
base for each patient.

\> As to research, you really, really, really think that the
government, which
is basically, us, is going to put up with the staggering costs of research
and development?  Especially when it costs around 4 billion bucks to bring
ANY drug to "use?"  ANY drug, even a drug that only benefits a small
percentage of the population will cost about 4 billion dollars for
development and testing to pass FDA standards.

The United States spends more $$ on RDA, per capita, than any country
in the world. Most the drugs you enjoy were initially based on
federally funded research. The basic research and Phase I/Phase II
trials are almost always federally funded. It is when a drug company
begins to finalize the drug for market, patents it, works on the FDA
approval, and funds some of the Phase III/Phase V trials that the drug
companies get involved.

Thus, with the US' current infrastructure for R&D, there is no reason
for anything to change if one moved to a single payer system. It
should be noted that drug companies fear single payer systems because
of their "monopolistic" structure. It is true that a single-payer
system has the POWER to refuse to pay outrageous prices for drugs.
Indeed, drug prices are intolerably higher in the US than in other
parts of the world. Drug companies justify this as needing the $$ to
pay for drug development, but a careful look at their balance sheets
shows record profits (which do NOT go into drug development, but into
shareholders). Drug companies deserve to make profit, but at the
patient level, a single-payer system is the single most effective
system for negotiating fair drug prices for customers.

There has NEVER been a government "program" except for the military and
diplomacy, which was more efficient and responsive than the private sector.

Inaccurate. Government owned telecoms in most of the world, and
socialized medicare enjoy substnantially greater efficiencies outside
of the US.

Now, it used to cost about 250,000 bucks to go through med school.  I have
no idea how much it is now.  But you cannot work your way through med school
and you still have to pay for housing and food and transportation and books
etc.  Most physicians have over a million dollars of debt when they get out
of med school and when they used to intern they got paid 35 bucks a month..
Now, they pay them more.  But these are really "greedy" people, how dare
they work so hard to become a physican and then, how dare they, charge for
it.

Most of my friends are physicians...they vary from med school through
senior. They're not hurting for $$. It is true that new resident is
still saddled with debt and with a lower income. That ends very
quickly, of course, when training is over. We should not cry for the
income status of physicians. They remain close to the top of the pay
ladder.

It is interesting that other advanced degrees (e.g., MBAs, DBAs,
Ph.Ds) incur educational training costs that are not substantially
below those of medical schools. Their income is never equal to that
of physicians.

Ergo, it follows that physicians are adequately compensated.

In socialized medicine countries, there is an interesting tradeoff.
In Canada, for example, all schools are public (and many are of high
quality...for example University of Toronto and McGill are frequently
compared to Harvard). Thus, the cost of medical education is mostly
borne by the people. Physicians graduate with much smaller debt
loads. Their level of income is correspondingly lower, and this seems
fair, given the social support they were provided to attain their
degrees.

Sadly, Canada loses a portion of physicians every year who enjoy
subsidized Canadian education, and then flee to the US for the
outrageously higher physician salaries. I believe the Canadian
government should impose pay-back rules for the costs of medical
education in those physicians who refuse a certain in-country service
period.

In the US, the NIH already does this with many of its career
development awards.

You don't mind some singer getting paid millions of bucks to screech, why
should you get so bent out of shape about someone who works so hard?  Or do
you think that you have a right to that person's labor and knowledge and you
get to set the cost?


I have not defended entertainer salaries. Perhaps you are referring
to another member of the thread?

The "greater social good" oh man, I cannot tell you the number of
governments that have imposed draconian laws to control the populace by
using that very statement.  WHO decides what is actually "the greater social
good" what is the standard?  Who benefits and who suffers?  What kind of
control are you willing to use to FORCE people to obey the "greater social
good?"

Most philosophical treatments of the above quote rely on John Stuart
Mill's utilitarianism concept--"The greatest good for the greatest
number". That is the sense in which I meant it.

Or you can simply reference Mr. Spock: "The needs of the many
outweight the needs of the few, or the one."

And by the way, the reason most physicians do not accept Medicare now is
because Medicare demands so many forms to fill out.  My physician quit
practicing about fifteen years ago.  She said that she employed four
secretaries just to fill out insurance forms and keep up with demands and
three book keepers to comply with Medicare in insurance requirements.  She
couldn't afford to keep her office open.  She quit.

The claims-reimbursement infrastructure is horrendously complex in the
US, and a key problem is the multi-payer system (each with different
systems). Physicians manage much easier in Canada, where there is
only one form for everything.

In the US, Medicare (esp. Medicare HMO, which now claims about 50% of
enrollees) is admininistered by individual insurance companies. This,
if your physician was complaining about Medicare forms, odds are good
that those forms came from a private insurance company.

That said, you are right, the administrative/paperwork burden is not
essentially intolerable for the single-provider office.
Correspondingly, most of such offices have disappeared like...Marcus
Welby. (Even Welby had a junior partner). The physician group is the
new norm, and the multi-provider practice allows physicians to share
the overhead costs of this insurance infrastructure. It seems to be
working quite well.

You go to the doctor for an office visit.  Without any treatment, other than
a consultation, you have seen a nurse, a receptionist, used electricity,
possibly water, heat or air conditioning, impinged on insurance, required
the use of supplies, not to mention the clinic and its insurance and costs,
and seen the doctor.  The doctor generally charges between 90 and 145 bucks
for the visit.  You know how much Medicare and insurance reimburses the
doctor?  NINE DOLLARS.

This is an interesting and spurious artifact of the new system. You
are correct. Almost every provider shows a bill with the "true" cost
of the service. This is usually a cost that far exceeds the real
costs of the service (including the overhead you list above). Then, a
"discounted" rate, negotiated with the insurance provider, is shown.
The implication is, as you have stated, that physicians are not paid
the real costs of the services they provide.

In truth this is a game. The "real cost" is inflated, to allow health
care special interest to CLAIM they are not reimbursed.

For the truth test, look at the homes and cars of these physicians who
claim to be paid only pennies on the dollar. Does it look like they
are not receiving adequate compensation? Of course not...the
practices stay open, and everyone is doing quite well.

When I have to have lab work done the insurance company reimburses the lab
about 20% of the cost.  How is that going to guarantee that I will continue
to have "quality" care?

See above. The real cost is quite different from the "real cost" and
"discounted cost" semantics game played on your bill. It is all
nonsense, smoke and mirrors.

Yes, in simple things you will receive, probably, good care.  But when it
becomes more complicated, when it demands more specialists, tests and
hospital care it is very unlikely that it will be as good as it should be
and probably not good at all.

Inaccurate. Simply not borne out by the data from Canada and Western
Europe.

I have another friend, who is Canadian, and now lives in Sweden.  He broke
his arm.  It was a bad break.  He told me they set it with a cast.  I was
appalled.  He should have had surgery to set it.  That is "too expensive."
He never saw a doctor.  That was considered "unnecessary."  He saw a
"practitioner" who set it in a cast.  Now it is so screwed up, it did not
heal and he is going to have to have the arm rebroken and reset and that is
another three to four months out of his life.  But hey it is free so what's
his beef?  Even though it is shoddy medicine it was done EXACTLY by the
government's "book."

With your friend, without knowing more, it would seem that an
appropriate course of action was taken. One should initially explore
conservative treatment. Unfortunately, with advancing age, bone
healing is less likely to occur naturally. At that point, the surgery
you mention should be done. Surgery opens many risks (beyond cost).
Thus, it should be treatment of last resort.

This has NOTHING to do with Canada/Sweden. I know THREE bone-breaks
here in the good ole USA with for-profit medicine, and they followed
the IDENTICAL course of action with each of those three older
patients. And two of those older patients had "cadillac" Blue Cross
insurance. It has nothing to do with the payer. It has to do with
evidence-based medicine and the relevant clinical guidelines for each
condition.

You get what you pay for and when the government pays for it you get what
some bureaucrat decides you need regardless.  And that goes for your kids,
too.  You better hope that they never have anything out of the ordinary..

Inaccurate. You do not understand the system. In socialized
medicine, as in most American insured cases, care decisions are made
by the provider. Insurance company staff become involved only when
the treatment deviates from established guidelines/formularies. In
those cases, the "bureaucrat" is almost always an advanced-practice
nurse with expertise in the underlying condition. In many of those
cases, when the physician provides established evidence for the
protocol deviation (usually in the form of meta-analyses or relevant
clinical trials in the research literature, with which the provider
should be familair), the insurance company will relent.

This is true TODAY for most of us in the US. It is true in Canada and
Germany (the two systems I know well). The only difference is that
this negotiation can be achieved more simply in Canada, because of the
efficiencies of the single-payer system.

Please note that the greatest heart, cancer, and other treatment centers are
based in the US.  Not Canada, not England, not France, but in the US.  That
most of the cutting edge treatments and surgeries and drugs are developed in
American labs and hospitals.  I wonder why?

America ROCKS. America is the LEADER! Why?

NIH

Socialized R&D.

Those "specialized" centers are mostly vast for-profit machines.
EVERY hospital covets cancer and heart patients, because the money
just FLOODS in. At least in the US. Those big treatment centers have
an advantage-- because of their treatment flow, they are terrific
settings for clinical trials. And who pays for those trials? NIH.

America is absolutely the leader. I love America. I love medical
research. But that's NIH and NSF and CDC and so forth.

Let me also be clear: If you have a bankroll, you DO get better care
here. No question. If I go to one of those specialized hospitals you
mention, and I'm willing to pay what the insurance company will
not...I am going to get PREMIUM care.

But that's even true if I live in Canada or Germany. If I have the
nest egg, I can fly to one of those for-profit hospitals and pay for
cadillac treatment too. But it seems silly to talk about something
that only 1% of us can enjoy.
.

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