Dear Rolfe. You're drowning me in words. Baby steps pretty please
Except when it's denied by the NHS (see post 275 for 2 examples). Those evil conniving eugenicist government jerks. Your refusal to provide any criticisms of a UHC system shows you're disingenuous. I mean that in the most polite way. It really frustrates me.
Oh, I can provide plenty criticism. It just isn't in the areas you want it to be in. I got round to your cherry-picked examples above.
I agree with your assessment. The consequence of this is a lot more people than necessary use the ER. Everybody knows that treatment in the ER is more expensive.
That wasn't actually what I was talking about, although it certainly seems to be another factor.
Why would the amount of required administrative assistances increase from one system to the other?
I would have thought that was fairly obvious. If you charge everything out in itemised lists, and insist on complex approval and pre-approval protocols for every procedure, you tend to need armies of clerks. There seem to be more armies of financial advisors trying to help people figure out a way to pay their medical bills, and more armies trying to negotiate the bills down to manageable levels.
You have multiple competing insurance companies, each with their own plush HQs and corporate jets and gold-plated cutlery, and their armies of salesmen trying to sign up as many blue-chip customers as possible. And more armies of loss adjusters combing through paperwork to find ways to deny coverage when the customer develops something expensive....
I'm not saying it's the whole story, but these people all have to eat, and there are rather a lot of them. Some of them are eating extremely well.
If the NHS doesn't approve of a certain drug or procedure your only choice is to pay for it out of our own pocket or live with the ailment. I didn't makeup this bogeyman, it's based in fact.
And once again I point out that very very few people ever find that the NHS isn't going to pay for something they might benefit from. The boundaries of the rationing are very wide. And no I'm sorry, hundreds of thousands of pounds for someone to live a couple of extra weeks isn't going to happen, even if it is his little grand-daughter's birthday. You agree there is rationing in every system, well there it is.
Also, since the NHS is the only insurer you're stuck with whatever they decide is best. Who knows where this will end. Maybe they decide not to give knee surgeries and hip replacements to obese people. Perhaps they decide that smokers should not be treated for cancer. Maybe they decide that circumcision shouldn't be offered.
And maybe the sun will blow up, or grow cold.... Actually, and far more likely, maybe any government that allowed anything like that to happen would be voted out and wouldn't see power again for a couple of generations. And they know that, too.
You may be told to stop smoking if you want your cancer operation, because the surgery is too high-risk on a smoker. You may be told to lose weight if you want to have your joint replacement, because the mechanical joint is simply not going to work beyond certain tolerances. And surprise surprise, some journalist will work this up into an outrage story about nanny denying treatment to children who have been naughty. It's simple medical common sense.
And again, you overlook the fact that if you don't like the look of what the NHS has to offer, you can take out private insurance, or simply pay for it yourself - just like an American!
Lets write that off in-network and out-of-network off as a necessary evil to having more than one insurance company, which means I have more than one choice at what treatment or drugs are or aren't available.
But so would an NHS patient have. Any physician or surgeon will go over the range of options for treatment with a patient, and help the patent decide. That doesn't change just because the patient is in the NHS.
I'm currently recovering from a frozen shoulder. The doctor I saw sent me to the physiotherapist. The physiotherapist actually made the diagnosis and went over the treatment options with me. She mentioned the possibility of intra-articular steroid injections, and said that the doctor I'd seen never did them, but Dr. Scott was quite keen on them, so if I wanted to go that route, just ask to see Dr. Scott. I said I'd pass on that one thanks, just carry on with the physio. But hey, I had the choice.
Actually, the NHS is really big on patient choice, within the range of evidence-based options of course. Why does your choice suddenly get better just because you have more than one provider?
Correct me if I'm wrong, but doesn't your system actually
restrict choice when it matters? You don't know what conditions you might later develop, at the time you choose your insurer. You might pick one on particular criteria, but then later find that for the condition you actually have, a different one offers better options. But it's too late to change....
I don't know if this assessment is correct, but it seems a likely scenario to me.
You really like to repeat that. We've already discussed that converting the US system to a UHC wouldn't magically erase the additional expense American's pay. Otherwise Medicare/Medicad would already be covering everybodies medical expenses.
No. The reason I've said that several times is that it addresses this perpetual nonsense about British citizens somehow having less "freedom" because of universal healthcare. I point out that we have
more freedom, and that one area we have freedom in is the freedom to access the healthcare system we're forced to pay for.
I'll be able to use it when I become eligible.
Well, whoopee. But in the mean time, you do not have that option. You pay for it, but you're not allowed to benefit from it.
Thanks for not getting picky. It's your experience with UHC that I seek. It's also NICE's responsibility to refuse expensive treatment for cancer. Apparently the US fairs better in the treatment of cancer than the UK. That explains a lot of the additional expense in the US system. We both know that cancer treatment is an expensive, experimental endear.
It's way past my bedtime, and this seems like groundhog day. These assertions have been deconstructed in years-old threads. "The US fares better in the treatment of cancer than the UK" is a blanket statement that covers a lot of fancy statistics, which are subject to a lot of biases. Pushing early screening for cancer on well-insured patients can result in very early diagnosis, which makes the survival time from diagnosis to death look better - even if the patient didn't live a second longer than they would have done without the early detection. For example.
Actually, the US system is so fragmented, with such a large percentage of the population falling through the cracks, and such a low level of diagnostic
post mortem examinations being done, that meaningful comparisons are probably impossible.
NICE decides what care every individual can choose from. Maybe there's only one choice and that isn't much of a choice.
Maybe, maybe, maybe. The NHS is, as I said, very big on patient choice. It's one of the reasons we're finding it so hard to get it to stop funding these damn homoeopaths. Someone comes along bleating that patient choice is being restricted, and the politicos capitulate.
The US has plenty of social safety nets for these people. They choose not to participate for a variety of reasons.
Come on. We can all read. We read about innumerable case of people collapsing under the weight of medical costs, even insured people. If you're trying to say no, it's really fine, everyone can access whatever they need and still eat and not go bankrupt, it's just that they don't want to do this, then really, I don't believe you.
Ah, there we go, finally. You mean to tell me that a doctor suggested a treatment that wasn't approved. Who decided it was or wasn't approved? Maybe this person could choose another insurance provider...oh, that's right, there's only on insurance provider in a UHC system.
Er, you yourself said that there has to be some rationing of care. I'm telling you where you'll find that. Isolated newsworthy stories of someone who is inevitably dying, who wants hundreds of thousands of pounds spent on them so they might have a chance of seeing their grandchild's birthday. Very big human interest story. Makes the headlines. You'll be lucky if you can find half a dozen cases in ten years, I think.
So, you're in that position in the USA. You have cancer, you're dying. Big Pharma says it has a new drug that can keep you breathing for an extra month, but your insurance company won't fund it. You can just go to a different insurance company and sign up for it?
I thought these guys didn't like "pre-existing conditions" much. I thought they weren't into covering things that were definitely going to happen. You need to explain to me again how that works.
Suing! That's America's second most popular recreational activity. That's the second thing we agree on
<--group hug
Well, yes, it has happened. Patient's doctor thinks he'd benefit from drug not yet approved by NICE. Patient decides to pay for it himself. NICE then completes the evaluation of the drug and approves it. Patient sues to have the money returned. Patient wins, and NICE doesn't only have to refund that patient, but any others in the same position, as the precedent has been set.
It's all very public, too. If a drug isn't approved, and a patient or a group of patients think it should be, they can apply for a judicial review, and if they're successful that's it. The drug is now approved, for everyone. None of this pick-em-off-one-at-a-time deliberations in secret.
That you like it when the government decides what's best for the general public thereby ignoring the individual?
The general public is made up of individuals. That's the whole point. And that's why the NHS is so big on patient choice, too. I like it when the government decides it's best for everyone to have an informed choice among all the effective approaches for their condition, yes. Why not?
It might surprise you, no, it will surprise you. Because of the conversations I've had with you, I'm not completely against a state run UHC system in the US. From the wiki article it seems that the UK has started to devolve in this manner.
Wiki articles have been known to be edited by people with political agendas, you know....
Actually, there's no such thing as the UK in this context. The four countries have their own NHS systems, though with complete reciprocity. There is a bit of a mindset in England that "the American Way" must be best in everything, even when it isn't. A lot of people are scared rigid by this. It's one reason why I hope the USA gets something sensible and workable sorted out soon, because I see no prospect of ever persuading English politicians that copying America isn't necessarily the way to organise everything.
Fortunately, it's not going that way in Scotland at the moment, and we hope it never does.
Rolfe.
