Stossel Solves the Health Crisis with Capitalism

[Rolfe]

Semi-soc in the sense that there are many private alternatives.

Uh, yes. Keep your eye on the ball.

It's not about whether or not there are private alternatives. There are loads of private schools around here. Went to one myself. However, every child has the right to attend a public school, free of charge, no matter how filthy rich his or her parents are. This is what universal education means. Universal right of access to publicly-funded education.

Same with universal healthcare. It's about universal right of access to publicly-funded healthcare.

In any sane system (Canada's mileage may vary) there will always be private alternatives. You can in fact gauge the effectiveness of the publicly-funded system by the extent to which patients decide to seek their service elsewhere. As it happens, the private healthcare sector in Britain is small. The only thing preventing it from getting bigger is demand.

Work that out for yourself.

Rolfe.

 

[Rolfe]

Darat, why did the post get merged? Just so I don't make the same mistake again?

Since Darat didn't answer, I'll try.

There is history here of woos who are getting their backsides handed to them in one thread, starting another so that they can go in with a clean slate and repeat all the arguments that have already been chewed up and spat out in the first thread. Management tends to frown on this, and prefers the original thread to continue.

While I do not suspect for a moment that you were trying to do that, it probably looked as if you were, especially as that "Comparative Effectiveness" article has a very similar slant and agenda to the Stossel film.

Don't worry about it. And don't worry about the length of an active thread until it starts to rival TRSOTTTWND.

Rolfe.

 

[Professor Yaffle]

Nobody really knows what's going on with our infant mortality. I have the dubious honor of living in the city with the worst infant mortality in the country, and in the zip code with the worst in the city. It's as bad as a third world country here.
I've looked into the research on what causes it here, and a lot of it is the result of a shockingly high rate of prematurity. What causes the prematurity is a mystery, but they've ruled out maternal behaviors (such as smoking, drug and alcohol use, etc) and lack of prenatal care.
Maternal stress seems to be the most significant risk factor. What causes the working class to be so stressed out is complex, but the lack of UHC certainly is involved, albeit indirectly.

What's the income disparity like where you are compared to the rest of the country? I was just reading this article:

The opening sentence of their new book, The Spirit Level, cautions, "People usually exaggerate the importance of their own work and we worry about claiming too much" - yet by the time you reach the end you wonder how they could have claimed any more. After all, they argue that almost every social problem common in developed societies - reduced life expectancy, child mortality, drugs, crime, homicide rates, mental illness and obesity - has a single root cause: inequality.
And, they say, it's not just the deprived underclass that loses out in an unequal society: everyone does, even the better off. Because it's not absolute levels of poverty that create the social problems, but the differentials in income between rich and poor. Just as someone from the lowest-earning 20% of a more equal society is more likely to live longer than their counterpart from a less equal society, so too someone from the highest-earning 20% has a longer life expectancy than their alter ego in a less equal society.

http://www.guardian.co.uk/society/2009/mar/12/equality-british-society

 

[Architect]

As it happens, the private healthcare sector in Britain is small. The only thing preventing it from getting bigger is demand.

Just to confirm Rolfe's comment, we have private healthcare through my wife's work. It's apparently quite cheap for the company because it's not used very much.

I used it once, to get my knee fixed. It was the same surgeon as I would have had on the NHS, likewise the same anaesthetist. The wait on the NHS would have been 3 weeks or so as it was quite a serious injury. In the private system, I was just on the fortnight and no more. The only difference between the two was that in the private system I got a private, comfy room and in the NHS I would have been in a 6 person ward. I was then put through the NHS physiotherapy system for 6 months (yup) at no cost, 3 times a week.

It wouldn't have bothered me if I'd gone NHS (but that room was really comfy) and I'd have got exactly the same treatment. If I was getting asked to pay £200/month to AXA for the cover, I'd tell 'em to stuff it and stick with the NHS.

 

[kellyb]

What's the income disparity like where you are compared to the rest of the country? I was just reading this article:

It's one of the worst in the country, too.

Social determinants of health and the effects of inequality are fascinating.

This is interesting:
http://www.jointcenter.org/healthpo...nt-Mortality-In-The-Global-Village/Page1.html (it's free to download the full report)

 

[kellyb]

That's a very interesting plan KellyB refers to. Like so much of what has been brought up in this discussion (including a couple of Stossel's suggestions), it's a clear improvement for US citizens on what they have at the moment, but at the same time it still leaves them massively worse off than people with universal healthcare entitlement.

It probably would benefit a lot of people. I think Dan would be mad not to take something like that if he left his job to set up his own business. The problem is that it still leaves fairly obvious cracks that some people will slip through. And you don't know if it's going to be you.

I note that it says the cover continues during brief periods of unemployment. So you better not be out of the job market for too long by the sound of that.

If you have a catastrophic event while you're on the plan, you're screwed, then and there. And this is going to happen to some people, guaranteed.

Perhaps worst of all, it seems to leave people wide open to the trap that caught the woman in the Stossel film. Young, healthy, expecting to go on and earn more, and be able to afford a better health plan - then she gets something catastrophic that leaves her uninsurable. The limited cover she had was never designed to deal with something like that, and doesn't. And now she has it, she can't insure against it.

It's better than nothing, and it's going to make life a lot easier for people who don't have catastrophic health events. But it's still going to leave a minority in a very bad place.

Rationally, the best cover for all eventualities is something with no (or a very high) ceiling. The trouble is that such plans tend to have very high premiums. And the only way to mitigate that is to accept a very high excess. So you end up still having to budget for all realtively routine items to be paid for out of pocket, and the cost of the premiums. A bit like Stossel's preferred insurance plan. It's life, Jim, but not as we know it.

Rolfe.

I agree with everything you're saying, except that bolded part...there is a third option in our "semi-soc" state program:

http://www.covertn.gov/web/access_tn.html

AccessTN provides comprehensive health insurance for Tennesseans who are uninsurable due to pre-existing medical conditions. Three different plans are available with varying deductibles and participants can select the plan that is best for their situation.

http://www.covertn.gov/web/access_eligible.html

To be eligible, all new participants in AccessTN must meet each of the following criteria:
• No income limits, no asset test
• Tennessee resident for six months
• U.S. citizen or qualified legal alien
• Age 19 or older
• Medically uninsurable as demonstrated by one of the following:
» A doctor's statement that applicant has one of more than 50 medical conditions pre-approved for presumptive eligibility
» Denial by two unaffiliated insurance carriers for individual coverage due to a health-related condition
» Qualification through medical underwriting using the health history information in the application —$75 fee required

• No access to employer insurance, except CoverTN
• No health insurance for previous three months (special rules may apply to those finishing COBRA, TennCare of CoverKids policies)


No one will be turned away due to existing medical conditions.

(I see the problem with the three month wait, if one has a medical problem where time is of the essence)

And the benefits:

http://www.covertn.gov/web/accesstn_benefitgrid.pdf

Maximum Lifetime Benefits $1,000,000

It still has holes, but yeah...it's a lot better than nothing.
My optimistic inner conspiracy theorist likes to muse that perhaps this is phase one of a three phase conversion to UHC or something.

 

[Rolfe]

Found this video with that link you gave: http://vimeo.com/1390455?pg=embed&sec=1390455

This poor neck-less man seems to really despise the NHS: http://vimeo.com/1189814.

OK, watched the clips now.

The woman with the "brain tumour" had pituitary-dependent Cushing's syndrome!!!!! The minute I saw her, I said - brain tumour? she's got Cushing's! - and sure enough she had.

I happen to know a lot about this because it's an endocrine problem (I'm a biochemist) and it's extremely common in dogs and horses (I'm a vet). I also happen to know that although it's relatively unusual in human patients, it's pretty much the same disease.

The woman was grossly misled. It's certainly technically true to say that pituitary Cushing's is a "brain tumour", but it's not a brain tumour as we know it, Jim. It's a small, endocrinologically active neoplasm of the pituitary, which produces excess ACTH. This ACTH causes the adrenal glands to produce too much cortisol, and the clinical problems are a result of the excess cortisol. (You can get pretty much the same clinical problem if a tumour arises in an adrenal gland.)

It's chronic, and very slowly progressive. It can be hard to be sure of the diagnosis in the early stages, especially if you don't have access to brain scan equipment (as many vets don't), and you have to rely on hormone analyses. My subject. My ghost will be heard reassuring colleagues, "The great thing about Cushing's is that they don't just drop dead of it, and you've got plenty time to make sure of the diagnosis. Nothing ever died of that one while you were still trying to figure it out. If it is Cushing's, it'll get more obvious as it progresses, and you lose nothing by delaying treatment until you're sure."

I then go on to stress, speaking from decades of experience, that the important thing in such cases is to keep the client on board. "So long as you make sure they understand that your investigation is continuing, that the last thing you want to do is leap in with dangerous treatment prematurely, and that you haven't just parked them, they'll be OK. The last thing you want it for them to go off to the practice down the road, and then these guys see the dog when it's a lot more obvious, and they're the heroes and you're the idiot." I tell you, I say that so often it's a script! This is because I've seen exactly that practice-switch occur a lot. It's not because practice 1 wasn't looking after the dog, it's because they weren't communicating with the client.

I have no idea who is lying, or who is simply grossly mistaken, in that bit where the patient on the video says that the US doctors told her that she would be dead in a couple of weeks without surgery. They were either entirely unaware of the chronic nature of Cushing's, or lying to her, or she completely misunderstood them, or she's lying/exaggerating for her own reasons.

With dogs, we don't even operate. We use medical treatment to suppress the adrenal glands so that they don't secrete so much cortisol. (There's an odd wrinkle to this, in that the most useful drug for this job is not available in the US, for human or animal use, and there's a huge black market in the UK-market pills - or at least that was the case last time I looked.)

I understand that in human medicine, surgery is the treatment of choice, partly because it gives an actual cure instead of merely managing the condition, and partly because the surgical approach is a lot easier in man for obvious reasons.

Here's a US web page explaining the condition - very well, actually.

Several therapies are available to treat the ACTH-secreting pituitary adenomas of Cushing’s disease. The most widely used treatment is surgical removal of the tumor, known as transsphenoidal adenomectomy. Using a special microscope and fine instruments, the surgeon approaches the pituitary gland through a nostril or an opening made below the upper lip. Because this procedure is extremely delicate, patients are often referred to centers specializing in this type of surgery. The success, or cure, rate of this procedure is more than 80 percent when performed by a surgeon with extensive experience. If surgery fails or only produces a temporary cure, surgery can be repeated, often with good results.

After curative pituitary surgery, the production of ACTH drops two levels below normal. This drop is natural and temporary, and patients are given a synthetic form of cortisol such as hydrocortisone or prednisone to compensate. Most people can stop this replacement therapy in less than 1 or 2 years, but some must be on it for life.

If transsphenoidal surgery fails or a patient is not a suitable candidate for surgery, radiation therapy is another possible treatment. Radiation to the pituitary gland is given over a 6-week period, with improvement occurring in 40 to 50 percent of adults and up to 85 percent of children. Another technique, called stereotactic radiosurgery or gamma knife radiation, can be given in a single high-dose treatment. It may take several months or years before people feel better from radiation treatment alone. Combining radiation with cortisol-inhibiting drugs can help speed recovery.

Drugs used alone or in combination to control the production of excess cortisol are ketoconazole, mitotane, aminoglutethimide, and metyrapone. Each drug has its own side effects that doctors consider when prescribing medical therapy for individual patients.

Note no mention on the US page of the drug treatment available in Britain. I don't know if it's available in Canada or not. And I still think surgery is the treatment of choice in man. But no way is this OMG you have a Brain Tumour!!! It must be removed NOW or you'll DIE!!!

Sigh. I never thought I'd see a classic Cushing's defection in human medicine, but here we have it. Suspected Cushing's under (leisurely) investigation (because let's face it, one of the tricks with Cushing's is to drag out the testing as long as you can in the hope that the clinical and endocrinological picture will become more clear cut as the condition progresses) goes off to another provider because they're getting restless and don't understand your strategy. Other Provider gets lucky, and is presented with a Cushing's case ripe for confirmation. And if Other Provider is really unscrupulous, he'll imply that you weren't trying. Seen it all before.

I can well believe that the patient herself didn't understand, and thought she'd been badly treated. Especially if some idiot told her that she was going to die of the condition. But the woman presenting this case is a nurse and surely should know better. Unless she has an agenda? Sad story, indeed.

And the "poor neck-less man"? Dan, I thought you really meant a patient who had had a medical disaster to his neck! All this was, was a plump pundit coming out with the standard right-wing free marketeer criticisms of the NHS. Nothing wrong with him at all. Dan, there are 60 million people in Britain. Any view you like - sane, wacky, rational, mad, obsessed, politically-crackpot - you can DEFINITELY find someone to present it to a camera.

Oh dear.

Rolfe.

 

[Rolfe]

Just to confirm Rolfe's comment, we have private healthcare through my wife's work. It's apparently quite cheap for the company because it's not used very much.

I used it once, to get my knee fixed. It was the same surgeon as I would have had on the NHS, likewise the same anaesthetist. The wait on the NHS would have been 3 weeks or so as it was quite a serious injury. In the private system, I was just on the fortnight and no more. The only difference between the two was that in the private system I got a private, comfy room and in the NHS I would have been in a 6 person ward. I was then put through the NHS physiotherapy system for 6 months (yup) at no cost, 3 times a week.

It wouldn't have bothered me if I'd gone NHS (but that room was really comfy) and I'd have got exactly the same treatment. If I was getting asked to pay £200/month to AXA for the cover, I'd tell 'em to stuff it and stick with the NHS.

Well, exactly. This does rather argue against Ivor's objection from a thread or two back, that the existence of the private sector removes "signalling" from the system by taking some people out of the waiting lists. The popularity of the private sector is "signalling" in itself. And it's currently signalling that nobody's that bothered.

I had private medical insurance through my work for about ten years. I did use it a couple of times. Thinking about it, though, I always used the NHS as my first line of service. It was only when I needed sinus surgery, that the BUPA policy got me operated on sooner (before Christmas rather than after), and in a swanky private hospital. Same surgeon though. I'd actually forgotten about the BUPA policy until my (NHS) GP asked me if I had insurance, and when I belatedly said yes, she said, well, you might as well have this one on them.

But most of the time, I just went to my NHS doctor for everything. BUPA never had to worry for a second about my minor ailments or even my HRT, and it wouldn't have occurred to me to involve them. Also, BUPA wouldn't have had to worry about accidents or emergencies. When we're in extremis, we expect the NHS to deal with it - and it does. It's only when we wake up with the fractures stabilised or the appendix removed, that we might start bleating for our private room in the exclusive clinic.

So it's no great surprise that health insurance in Britain is cheaper than it is in the USA. They don't have to cover all eventualities. But still, most of us don't bother. When I changed jobs, BUPA whined a bit and invited me back. I'm entitled to a good rate as a BVA member. But frankly, I haven't bothered.

I know about far more NHS screw-ups than Dan does. I never said it was perfect. But I also know about the normal, standard, excellent care that all my friends and relations have had over the years. For the price of free. I didn't even bother to ask BUPA what they'd charge me to continue my policy when I changed jobs. I know I could have afforded it. But really, there was no point. I know what the performance of the NHS is like, and I'm quite happy to take my chances. And so are most other people in my position.

Dan, consider that when next you hear someone (with or without a neck) pontificating about how terrible the NHS is.

Rolfe.

 

[Rolfe]

It still has holes, but yeah...it's a lot better than nothing.
My optimistic inner conspiracy theorist likes to muse that perhaps this is phase one of a three phase conversion to UHC or something.

Well, if the plan involves giving people who are guaranteed to be needing expensive treatment medical cover for an affordable premium, then it has to be publicly-funded to some extent. That's a daunting list of conditions, but it does sound like another form of state-funded ("soc") safety net.

Rolfe.

 

[DaN K. StAnLeY]

I still don't get why this post got merged.

 

[Rolfe]

Here's another perspective on UHC from our former landlords across the pond:

http://www.heritage.org/Research/HealthCare/bg2239.cfm

This doctor seems to think the NHS is in worse shape than Amy Winehouse.

I'm just wondering if the are any lies, cherry pickings, or misrepresentations in this critique of the UHC systems in Europe and in general. I also thought the Stossel thread was getting a little long.

OK, sorry to take so long. I did skim it earlier, but I needed to read it more slowly to make sure I wasn't missing anything. (When there's so little of substance, you tend to assume you've missed something....)

As Architect noted, the author is not a doctor. She is in fact a nurse. A nurse with a lot of opinions, it seems. Her personality comes over remarkably clearly in that and the other article, but I won't turn this into a psychological ad-hom, tempting though that may be. In addition, she has not, in that article, as far as I can see, said anything even remotely resembling "bugger-off to the NHS".

Put simply, she doesn't like NICE. She doesn't like any way to assess the cost-effectiveness of medical treatment. She thinks patients should get any treatment they want (that is recommended by their doctor), without anyone being able to say "no, a 1 in 1000 chance that you might live an extra week is not worth £100,000" (or words to that effect).

She wants the "free market" to be the only regulator. Which of course it is in cases where the patient is paying for all his treatment out of his own pocket. However, where insurance companies come in, and even more so where public funds are paying, somebody has to look at value for money. Thus, various measures have been devised (such as the QALY) to try to quantify the benefit conferred by a particular treatment. Healthcare providers look at these measures to help decide whether the latest wonder drug is good value for their clients.

Opinionated Nurse Lady doesn't like this. She thinks the QALY is pseudoscience (dearie me, whay am I not surprised that someone - probably in the Humanities - has given her a PhD for this drivel....) She believes the free market should sort it out. I think, she believes that insurance companies should be able to compete on what they will or won't cover (as I think they do at the moment anyway). She's not really very clear on that, especially on how it might be possible for clients to be properly informed about any decisions they make in that area.

Opinionated Nurse Lady believes that any attempt to apply cost-effectiveness criteria to medical interventions is "rationing", just these evil socialists who promised the proletariat "free" healthcare ratting on their solemn promise when they realise that some of the proletariat really might be demanding £100,000 spent on them for a 1 in 1,000 chance of an extra week of life.

That's actually the beginning and the end of that entire rant. She doesn't like rationing, she doesn't like anyone looking at the cost-effectiveness of medical treatment, and she really doesn't like NICE.

It appears that Barack Obama, keenly conscious of the fact that the USA spends a greater proportion of its GDP on government-funded health provision than Britain does (yes, she got that, something we got such a shock over when we found out), is considering setting up something like NICE in the US.

Through major entitlement and welfare programs such as Medicare and Medicaid, which contribute to rapidly growing American health care costs, government takes a historically higher proportion of gross domestic product than does even the British NHS.

Just for the record. In case anyone was still in any doubt about that.

Obama may even be thinking of legislating to require insurance companies to be bound by these cost-effectiveness criteria when authorising treatment.

Oooh scary!!

The end of the rant is simply a loud "don't do it!"

Lots of people have a beef with NICE. The decisions aren't always as obviously rational as one would hope. A number of its decisions have been overturned after public campaigns. It's too political.

However, I think it's difficult not to argue that where any finite communal pot of money is concerned, whether it be public funds or an insurance fund, there should be some consideration of cost-benefit, especially when extremely expensive procedures or drugs are concerned.

Opinionated Nurse Lady with a PhD in right-wing pontificating on healthcare markets thinks otherwise. That's all that article says. I wonder who's paying her to say it?

I would really like to know her opinion on healthcare in Britain. especially whether she wants to abolish the NHS, put healthcare back into the private sector, and operate a publicly-funded ghetto for the underprivileged. And if she does, I'd like to see how many votes she'd get.

I also bear in mind that these two videos were on her own web site. The woman with Cushing's syndrome being presented as a brain tumour patient who needed (and was denied) immediate surgery, and the talking neckless head just - talking.

If that's the best she can do, she and Stossel would make a lovely couple.

Rolfe.

PS. There's one statement she makes that could do with highlighting.

The intellectual roots of effectiveness research can be traced back to mid-18th century Scotland and the "arithmetical medicine" practised by the graduates of the Edinburgh medical school. It was there that James Lind famously undertook a controlled trial of six separate treatments for scurvy.

Yayyyy! Scotland invented Evidence Based Medicine!

 

[Rolfe]

I still don't get why this post got merged.

Because the admins thought you were trying to run away from the argument and start again in a new thread with the reset button pressed. Is my guess. It all happened while I was doing post mortems on a couple of lambs, by the time I'd done that and eaten lunch and checked for ongoing homoeopath activity on the forum, it was a fait accompli.

I shouldn't worry. Opinionated Nurse Lady hasn't got enough to say to sustain much of a thread anyway.

Rolfe.

 

[Architect]

Opinionated Nurse Lady (I do like that title) also seemed unaware that NICE did not have UK-wide authority and that our own Scottish clinical authorities had - on occasion - take a different view on eligible drugs. Likewise she overlooks the fact the NICE are, and have been, subject to rapid judicial review in the courts where patients have profoundly disagreed with the outcome (the funding of the case for the plaintiff coming, IIRC, from the state in the form of legal aid).

Yes, there are undoubteldy issues around the NHS. There are, for example, complaints about postcode "lotteries" or waiting lists for elective work. On the other hand absolutely everyone perminently resident in the UK - regardless of their tax position or national insurance contributions - is entitled to free-at-the-point-of-delivery healthcare the standard of which (for serious conditions) is of high quality.

 

[Rolfe]

Well, yeah, I thought I'd leave out my remark that NICE's writ doesn't even run here, in the interests of simplification. And you're right of course, about the judicial review putting NICE in its place when public opinion disagrees.

This is part of what I meant earlier about patients in universal healthcare systems being empowered by entitlement. If someone does not get the treatment they believe they should have been entitled to, they can take it further. They can go to court. (Funded, as you note, by Legal Aid.) And get redress. Patients who fall through the cracks in the US system, in contrast, seem seldom to have any redress. You weren't covered. Tough. End of.

Herceptin was an interesting example. NICE disallowed it. I had a little trouble getting my head round it, but in the end it was quite simple. It halved your risk of having your breast cancer come back. But you had to treat 18 patients (at very high cost) to save one life. Who was right?

Turned out that the drug was a follow-up treatment for a certain type of breast cancer that only recurs in 18% of patients anyway. 82% of patients will be absolutely fine even if nobody gets it. (But you don't know which is the 18% who won't.) But if you give the drug to everyone, only 9% will come back. Treat 100 people to save 9. Something like that.

NICE thought it wasn't worth it. I'll say straight away that I think they were wrong. And in the end the courts agreed. But the campaign wasn't pretty. Dozens of breast cancer patients convinced that of they didn't get herceptin right now, they would inevitably die, while if they did, they would inevitably live. Not helped by the rumours that the campaign was actually being whipped up by the drug manufacturer.

And not helped by one health authority deciding to pay for one woman's treatment because she had a young child. Well, she's different. Her daughter needs her. WHAT!!!! So the childless women, and the ones with grown-up families, and the ones with a lot of other things to contribute to society, all these aren't worth saving???? No wonder there was outrage. I understood the statistics, but I was still a bit outraged.

Then there was the other side of it, the unpopular needs, the people involved in delivering geriatric psychiatric services and things like that, who were afraid that if these savvy, articulate, active, middle-class women got their way, then the unglamorous areas would lose out.

All very nasty.

But the women were entitled to challenge the decision, and they won. And they got the herceptin free, and new cases are getting herceptin free. Because in the end the NHS is ours, and under democratic control, and we get the final say, not a government apparatchik, and not an insurance company.

Opinionated Nurse Lady is free to disagree. And she's free to go to America and say so. Whoever paid for her to do that, and I still wonder. But she's still not a doctor, and she still didn't, as far as I can see, say anything even remotely resembling "bugger-off to the NHS".

Rolfe.

 

[kellyb]

You can either have some sort of open and transparent process like NICE, which people can appeal, or you can have what we have here, which is profit-driven insurance companies deciding behind closed doors how to do the rationing.
It's not like "private" means "unlimited funds".

The only way to prevent rationing is to either un-invent all the expensive and effective technology, or make everything fee-for-service without any sort of third party payer pooling risks and resources, and thus limit expensive healthcare access to the extremely wealthy.

 

[Rolfe]

Or both. You can have a pooling of resources in which there is some sort of cap or rationing to prevent one or two people competely draining the pool for negligible benefit, and you can still allow the mega-rich to buy stuff that isn't sanctioned in the rationed system.

It's a dirty word to suggest that NHS care is rationed, but it's inevitable. At least, as you say, NICE (and the Scottish equivalent) are transparent and subject to appeal. The trick is to make the ceiling at which the rationing comes into play high enough that only blatantly non-cost-effective interventions aren't funded, and to be seen to be fair.

Of course if they would also apply the cost-effective criteria to woo like homoeopathy instead of ignoring it for political expediency (yes, the heir to the throne does have influence), and because the actual total cost isn't that much, it would be even better.

Opinionated Nurse Lady is weird. She seems to have a nice little earner going as an advocate of free-market healthcare, must be a better living than taking temperatures and collecting blood samples. To me, she sounds like the sort of not-as-bright-as-all-that theoriser who can't actually think through the consequence of her ideas across the entire spectrum of society, and just homes in on a single argument presented with persuasive rhetoric. I'd still love to know who paid for her to go to the USA and deliver that right-wing speech.

If she adamantly opposes any sort of rationing of cost-effectiveness screening on the NHS, I'd like to know how she thinks healthcare in Britain should be organised. If she's seriously advocating the abolishing of the NHS and the introduction of a free-market healthcare system, I'd like to see her stand on that one at the next general election!

Rolfe.

 

[DaN K. StAnLeY]

Since Darat didn't answer, I'll try.

There is history here of woos who are getting their backsides handed to them in one thread, starting another so that they can go in with a clean slate and repeat all the arguments that have already been chewed up and spat out in the first thread. Management tends to frown on this, and prefers the original thread to continue.

While I do not suspect for a moment that you were trying to do that, it probably looked as if you were, especially as that "Comparative Effectiveness" article has a very similar slant and agenda to the Stossel film.

Don't worry about it. And don't worry about the length of an active thread until it starts to rival TRSOTTTWND.

Rolfe.

okay, cool. I just didn't want to make the same mistake twice.

 

[DaN K. StAnLeY]

The woman was grossly misled. It's certainly technically true to say that pituitary Cushing's is a "brain tumour", but it's not a brain tumour as we know it, Jim. It's a small, endocrinologically active neoplasm of the pituitary, which produces excess ACTH. This ACTH causes the adrenal glands to produce too much cortisol, and the clinical problems are a result of the excess cortisol. (You can get pretty much the same clinical problem if a tumour arises in an adrenal gland.)

Uhhhh, huh, huh........

And was that a shout out to Star Trek thrown in there?

 

[Wudang]

This is part of what I meant earlier about patients in universal healthcare systems being empowered by entitlement.

You're okay with that word but have you noticed some USAians see it as a very negative word - "It leads to a sense of entitlement". I think americans seem to regard rights as good and inalienable but entitlement as bad and more whim-driven, perhaps. Perhaps another indicator of a different mindset or perhaps just of different tones of a word, dunno.

 

[Rolfe]

You're okay with that word but have you noticed some USAians see it as a very negative word - "It leads to a sense of entitlement". I think americans seem to regard rights as good and inalienable but entitlement as bad and more whim-driven, perhaps. Perhaps another indicator of a different mindset or perhaps just of different tones of a word, dunno.

Well, yeah. Americans seem very weird sometimes. The point I'm trying to make with that statement is intended as a reply to those who continually insist that universal healthcare will deliver substandard service, or that "the government" will dictate what treatment patients can get.

The latter is true as it pertains to a tiny minority of people who are arguing around the fringes about very expensive treatments with arguably minimal benefit. And even there, as we've seen, they can be appealed.

Mostly, though, Americans are talking about people being left to languish on waiting lists, or in some other way being failed due to restricted resources. My point is that while this can happen (though it's happening a lot less now than it used to), patients failed by the system in this way have the right to redress. If you need a hip replacement, you have a right to a hip replacement, and if you're not getting it, you have the right to pursue that right, through the courts if need be.

This seems to me to be in sharp contrast to, for example, the people shown at the beginning of the Stossel film. The breast cancer woman had insurance that would not pay anything after a certain date, even if the disease was contracted during the period of insurance. So she had no entitlement to treatment, and nobody she could take to court to insist pay for her treatment. So often it seems that American patients let down by the system just have to sit back and take it, while British patients can stage mass demonstrations (herceptin again), take their health authority to court, lobby their MP to step in on their behalf, or even stand for parliament on a pro-NHS ticket (been done, and the guy won the seat!). This is what comes of having the government, who are after all ultimately accountable, providing treatment, rather than a private company.

I've been musing about starting a thread about the concept of "public goods" and why healthcare should (or should not) be in that category, but I don't want to distract from the present discussion, and it would only be overrun by mad hard-line libertarians anyway.

Rolfe.