Re: OT The good National health care system


"MarkH" <MarkH_sliprwet@xxxxxxxxxxx> wrote in message
news:571c5531-353d-4c20-85fb-13832b9e9b67@xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
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.

********************
Athena was outraged when I told her that you said that what happened to her
Aunt "does not happen." She said, yes it did.
*************************************************
Moreover, paliative care is an excellent solution. Life is extended
outrageously for many elders,

***************
Evidently, you are unaware of what palliative care means. It does not mean
"curing" nor does it mean "helping" it means to maintain the status quo. It
means that no aggressive measures are taken. If you have a failed knee
joint and you can't walk, it means that they will give you pain killers and,
possibly, a wheel chair to get around in but they will not take care of your
knee or your joints. You want it fixed, you go outside the system and pay
for it yourself.
*********************

even when quality of life is near nil.
*****************************
You seem to be confusing hospice and machine enabled life with palliative
care.
You can be 25 years old and receiving palliative care.
**********************
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.
**********************************
The decision to stop treatment on "non responsive" and "terminal" patients
will be decided not by doctors but by financial concerns. At the moment,
Canada, with a much smaller population, has yet to deal with a great many
boomers requiring extensive and expensive treatments.

In the US there has already been an "outcry" about how it isn't "fair" that
boomers will be receiving social security payments when their succeeding
generations will have to pay for them. Now, social security was presented
and enacted as a law as national security insurance, not just for the poor
but also the elderly. Retirement income was guaranteed for EVERYONE who
paid into the system. Not just for those "who need it." It was presented
by FDR as a program for the future for ALL. Now they, people who think that
the social security system is overburdened with the "Boomers" are demanding
that the retirement age to receive benefits be raised to 70+ and that those
who have a seperate retirement income not be allowed to receive benefits.

Well, exactly what do you think is going to happen when you have 78.2
million [US Census figures] people who are over 70 and about 20% or more
have Alzheimer's and need 24/7 care and they are NEVER getting better, or 45
million of them have cancer or need hip replacements or whatever? Do you
really think that a national health service is going to be able to take care
of those numbers and still deal with all the other people who are going to
be in on a "single payer" service, which is, of course, the government? Do
you really think that there is not going to be an outcry over the amount of
money that will be spent on "people who don't have much time left, anyway?"
Do you have any idea how many nursing homes and assisted living places are
going to be needed? The number of physicians, nurses, cafeteria personnel,
cleaners, etc, who will be needed to man the trenches so to speak?

Yes, I am aware that everyone thinks that the only motive for doctors, etc,
to oppose this system is because they are all greedy bastards. Except no
one has addressed how this will be paid for when the stuff hits the fan.
****************************************8
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.

***********************************
Well, in Stephen's case he is neither a drug abuser nor an alcoholic nor
does he have Hep C or anyother chronic condition. They told him that the
cut off age was 50 and he was fifty and therefore, no transplant.
***************************************

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.

**************************
NO, basic research and Phase 1 and 2 trials are NOT funded by the
government. I do not know who told you that, but they are so wrong. Bayer
developed two drugs a few years ago, they researched them and spent their
own money. One was interferon and the other was a wound healer. They could
not afford the costs of drug trials for both, so they went with interferon
because they thought it would have the most potential as a cancer panacea.
The sold off the wound healer which has turned into a miracle drug for dogs
and horses, but it cannot be used in humans because they can't afford the
testing. It has turned my 16 year old Brittany into a dog, physically, ten
years younger. It rebuilds joints and they use it in race horses and I use
it on all scratches, wounds, etc.

See:
http://www.drugresearcher.com/Research-management/Drug-development-costs-hit-1.7-billion

http://www.washingtontimes.com/news/2009/mar/13/blocking-drug-development/

http://www.ftc.gov/be/workshops/pharmaceutical/DiMasi.pdf
*******************************

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.

**********************
I repeat, they also have much smaller populations.
********************************



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."

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.
***********************************
Just how much do you think it costs to run a clinic? Who is supposed to pay
for the supplies and other costs of doing "business?"

Are you saying that the only cost for the patients should be, what, four
bucks because he only "saw" the doctor for ten minutes?

Then why have an office at all? If the patient doesn't need heat or light
or a room or cotton swabs or anything like that, why not just have the
doctor come out to your car, hell, meet him in a parking lot somewhere.

********************************

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

***************************

BTW, that four bucks was from a newspaper article based on government
documents concerning investigations into what insurance companies reimburse
physicians for office visits. The cost is figured on an average of two
charges from "prevailing" charges among clinics. The two that they used
were one clinic charged 9.00 and the other charged 9.45. Both, however, are
what are considered "free clinics." Thus the insurance companies decided
that nine bucks was sufficent compensation for an office visit.

***********************************

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.

****************************
BTW, why doesn't someone do something about the salaries that lawyers make?
************************************

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.

*******************************
My friend is 37 years old, in excellent health and very athletic. My
husband broke his arm and the orthopod told him that a cast was a really
shoddy way to heal a broken arm. It was like curing hemophilia with spider
webs. Just because it looks like it works, doesn't mean it will and just
because they always did it that way, doesn't mean it will still be the best
course of treatment.

Look, you and I are never going to agree on this because you have seen a,
supposedly, successful system. But as you have pointed out you have never
participated in any other system.

What it boils down to is people do not want to pay for their health
services, they want someone else to pay whether it is an insurance company
or the government. The problem is that they think that the government is
going to be better. No government can possibly fund and operate a system
more efficiently than a business. You may jump on that, but I would like to
point out the 1200 dollar toilet seats and the 160 dollar wrenches.

Government must justify expending money and to do that they have to have
many people doing a job. That job is NOT paying for your health care, but
to make sure that you are not getting something you do not deserve. And who
decides? The same people who are running the system. Not you, not your
doctor, not anyone other than the people who have set up the system. Why?
Because that is how a bureaucracy works. And you are going to have the
mother of all bureaucracies in existence when you have the so-called "single
payer" system.

There is not going to be a list of things that they will pay for. Because
people don't get sick by the book. What happens when someone comes in and
they have cancer because they smoke and refuse to quit? Do we continue to
treat them, when it is taking money away from people who take care of
themselves? What about people who are over weight?

You are looking at the immediate, I am looking at the future. And what I
see is not pretty.

I am just glad that I don't have grandchildren because the potential for an
dictatorial government comes cloaked in money for "the masses."

my2cents
p



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