Health care - administrative incompetence

[xjx388]

In our country, the social security net covers the issues you raise.

How so? In America we have Food Stamps, Govt Housing, Utility Assistance, etc. The fact remains that the these issues still exist, despite the Welfare State. The Colonias are still squalid places to live and there's no help in sight.

Why do we tolerate this yet demand equal healthcare?

 

[Fiona]

In a free society there will be inequalities. These inequalities shouldn't be based on race, sex, creed, etc., but they exist.

Some people live in a $5mil home with all the amenities. Some people live in squalid shacks without even running water.

Some people get to eat a wide variety of nutritious and satisfying foods. Some people don't know where they are getting their next meal.

There are plenty of people in America without the basics of stable food and shelter. I'm sure the situation is similar in the UK.

What makes the provision of healthcare different? Why is inequality tolerated for basic human needs, but somehow healthcare (which is infinitely more complex than either of those needs) must be equal for all?

It is true that the uk has moved in the direction of america over many years and that all political parties have bought into the ideology to at least some extent. It is also true that inequality has grown, as is absolutely predictable if those policies are adopted. This is well known, and there are many who believe that it has no significant adverse effect due to woo notions like "trickle down" and other such nonsense. There are others who do not know and/or do not care.

But to suggest that such things should be used to justify extending that iniquity into ever more fields is mind boggling to me.

 

[xjx388]

I mentioned the word 'poor', right?

I haven't had work since August 20th (when I parted ways with the JREF). I've since sold possessions on eBay, gotten some help from friends, and have enough money to last (with luck) through January.

So I guess the answer to the question is - well, I'm going to have an issue if the cost of air fare is greater than, say, $5. Also, from what I hear about TSA lately, they REALLY wouldn't appreciate a stowaway.

Here's another fun one to throw into the mix, and I'm not sure whether or not it's in violation of the MA to admit to having done such a thing, so I apologize in advance if it is.

I purchased antibiotics from a drug dealer in town quite recently - because my throat had been hurting for days, and it was cheaper to go to a drug dealer than a doctor. While you can find the occasional free clinic in this country, the wait in one of those can be roughly categorized as "forever", and they're packed. If you weren't all that sick BEFORE walking into one, you will be by the time you walk out.

I do not, by the way, recommend that anyone else try that avenue.

Now, come on RemieV. I run a medical clinic. I do plenty of pro bono work for county indigent patients. There are at least three clinics here that will see you for free if you can demonstrate you have no funds. You can get antibiotics for $4. So you have to wait "forever." Big deal! The care you need IS out there.

 

[Delscottio]

How so? In America we have Food Stamps, Govt Housing, Utility Assistance, etc. The fact remains that the these issues still exist, despite the Welfare State. The Colonias are still squalid places to live and there's no help in sight.

Why do we tolerate this yet demand equal healthcare?

The UK generally doesn't.

All I can talk about is Newcastle in the UK - I used to work for the DSS/DWP and at the time there were 4 people who were classed as sleeping on the streets, everyone else had access to basic provisions i.e a roof over their head at night (it may be a different roof tbf) and food etc. They were the real "tramps" and did it through choice.

There are places of real depravation in the city (Scotswood, Byker a few places in the West End of the city) but I wouldn't go as far as squalid, also these areas, under Labour, were recieving loads of regeneration cash to bring them up to scratch - not sure what the Tories will do.

 

[RemieV]

Now, come on RemieV. I run a medical clinic. I do plenty of pro bono work for county indigent patients. There are at least three clinics here that will see you for free if you can demonstrate you have no funds. You can get antibiotics for $4. So you have to wait "forever." Big deal! The care you need IS out there.

You misunderstand me.

In my previous post, I outlined the issues of living with an undiagnosed heart condition. One of these issues is that it would be quite a negative thing to get very sick. It's not the wait I'm complaining about - it is waiting with people who have a variety of infections.

 

[Uncayimmy]

I also have Crohn's, which was diagnosed when I was 17. Could I even have got insurance in the US, and if so at what cost?

Based on my albeit limited personal experience, I believe you could get insurance in the USA quite easily and at a rate similar to a perfectly healthy person. I did even though I have a few chronic conditions (not as severe as yours, of course).

Your condition would be excluded, just like mine were. I could have paid over double the rate to have my conditions covered, which in my case was more expensive than the cost of the most likely treatment I would need (I need treatment every 2 years or so). Should my condition have required surgery, I would have been screwed. Fortunately, a confluence of factors enabled me to get into my wife's plan at work at a similar price to what I was paying for excluded individual insurance, so this is not a major issue for me any longer.

 

[Architect]

How so? In America we have Food Stamps, Govt Housing, Utility Assistance, etc. The fact remains that the these issues still exist, despite the Welfare State. The Colonias are still squalid places to live and there's no help in sight.

Let me be quite specific here. The UK welfare state is built upon the principle that none of its citizens should ne denied the opportunity of education, medical treatment, housing, food, or other basic necessities.

Nai Bevan, the man behind the NHS some 60 years ago, highlighted the unacceptable inequalities in our nation when "there are racehouses which receive better housing than the hardest working miners of the Welsh coalfields". Not one government, even Thatcher, has seriously tried to dismantle this although the Tory right keep trying to inch us towards it, as Fiona mentions. Inevitably we seem to pay more for less.

If a resident of the UK presents themselves at the local authority offices and is homeless then there is a binding legal obligation on that local authority to provide accommodation immediately. In most cases it will be a house, although in certain inner city areas (notably London) then it may be hotel or guest house rooms.

If the local authority becomes aware of a domestic property which is not of legally habitable standard, e.g. no toilet facilities or running water, then it is legally obliged to decant the residents immediately and provide housing of legally acceptable standard. Glasgow City Council used to do this regularly, in conjunction with a massive programme of tenament upgrading.

So to answer your question, we apply exactly the same inclusive approach as we do to healthcare. People will not go homeless unless (for whatever reason but usually substance abuse) they decide to.

Why do we tolerate this yet demand equal healthcare?

So you're happy for people to suffer and die because they can't afford proper healthcare? You consider that the mark of a fair and mature Western society?

Having decided in the UK and , frankly, most of the Western world that healthcare is a right we have then implemented programmes which provide it for a fraction of the cumbersome US system. We enjoy comparable medical standards, life expectancy, and general health. You can't even cover your own 300-odds million for double what we spend.

This makes no sense, no matter which way you look at it, unless you happen to be a $$$ healthcare provider or insurer.

 

[Tatyana]

Quick,

hands up everyone who knows all about "multiple myeloma" what it costs, the treatments involved and the prognosis.

No Googling, now.

It simply amazes me that words like "multiple myeloma" or "chronic condition" and amounts such as "billions of dollars" and "costs upward of 1 million dollars" trip so lightly off the tongues of politicians and forum experts as if it was robots we are discussing and not human beings.

There but for the grace of God.............................................

This is how multiple myeloma works roughly in the UK.

If a patient comes into a GP surgery with fatigue, anaemia and bone or joint pain, and they are over the age of 40, the GP will request a multiple myeloma screen, which is basically blood work, a full blood count, protein electrophoresis, immunoglobulins, and bone and liver profile.

The laboratories also generate screens for multiple myeloma from routine work if a patient has a high total protein or a high or low globulin, the lab will do protein electrophoresis to look for the M-protein.

All patients being seen in the osteoporosis/DEXA clinic will also be screened for multiple myeloma.

If a band is found in the electrophoresis, it will be typed to see if it is a monoclonal anti-body.

Depending on the size of the band, the patient will either be referred immediately to a haemotology consultant, or they will be asked to have a repeat blood test in 6 months to a year (and probably a urine Bence Jones Protein test as well).

Patients with MGUS (monoclonal gammopathy of undetermined significance) /a very small band, are kept on record and asked to come in at least once a year.

The haemotology consultants also have a list of all the bands that are found in GP samples just in case the GP does not realise the significance of it, so if the GP does not refer the patient, the haemologist will ask the patient to come in.

Patients are monitored for decades. Every now and then the files of patients who have demonstrated having a paraprotein/M-band have to be checked to see if the patient has passed.

Some patients are monitored even after the M-protein is no longer visible/has disappeared.

...............................................

I wanted to ask how your clinic deals with abnormal results?

Does the lab phone the surgery when they find something that is life threatening?

 

[Gandalfs Beard]

In a free society there will be inequalities. These inequalities shouldn't be based on race, sex, creed, etc., but they exist.

Some people live in a $5mil home with all the amenities. Some people live in squalid shacks without even running water.

Some people get to eat a wide variety of nutritious and satisfying foods. Some people don't know where they are getting their next meal.

There are plenty of people in America without the basics of stable food and shelter. I'm sure the situation is similar in the UK.

What makes the provision of healthcare different? Why is inequality tolerated for basic human needs, but somehow healthcare (which is infinitely more complex than either of those needs) must be equal for all?

Why should it not? Basic Human Needs should be met as part of a Civil Society. It's part of a concept called the commonwealth. Governments either exist to protect the interests of the Wealthy, everyone else be damned, or in a Civilized society to spend public money on public services. I know what sort of society I'd rather live in.

And it's certainly not Ayn Rand's "Objectivist" society, an extreme form of Libertarianism that is actually a Recipe for Feudalism.

Unfortunately, we live in a world in which the Corporations are doing everything they can to roll back the political/economic democratic gains of the last two centuries. They no longer have any allegiance to the nations they originally incorporated in and are making every effort to institute a neo-feudal model for the world.

The US is the ONLY Western "democracy" that doesn't have some sort of National Health Service. And since Reagan, Keynesian economics, which at least provided a measure of regulation and social safety net, has been dumped in favour of "Free Market" economics, which isn't really a Free Market at all. What we have is Plutocratic Oligopolistic control of ostensibly democratic institutions.

The Plutocrats create economic disasters at will, then raid the public coffers to maintain and enhance their wealth, while imposing Austerity Measures on the people whose livelihoods they have destroyed.

I owned a small business before the Crash killed it. And I didn't even qualify for unemployment because I was "self-employed." None of this is due to "administrative incompetence." It's part of an organized attack on the very principles of political/economic democracy by the Plutocrats. All the evidence you need is to follow Rightist Supreme Court and Legislative decisions that give Corporations MORE rights than actual persons.

The only people who benefit are the Uber-rich Majority Shareholders of those corporations.

If you like living in a "Friendly Fascist" Neo-feudal society, then by all means support the Rich. But unless you are rich yourself, to do so is to work against your own actual interests.

GB

 

[Architect]

Why do you hate America?

 

[Gandalfs Beard]

Why do you hate America?

The classic trope of someone who equates Plutocracy with Democracy.

GB

 

[xjx388]

It is true that the uk has moved in the direction of america over many years and that all political parties have bought into the ideology to at least some extent. It is also true that inequality has grown, as is absolutely predictable if those policies are adopted. This is well known, and there are many who believe that it has no significant adverse effect due to woo notions like "trickle down" and other such nonsense. There are others who do not know and/or do not care.

But to suggest that such things should be used to justify extending that iniquity into ever more fields is mind boggling to me.

Extending? The inequalities exist right now, even in the NHS.

"Whilst it is encouraging that some NHS trusts are meeting the expected requirements on racial equality, this is still not good enough. All trusts need to be fully committed to delivering racial equality and diversity in the NHS. It is shocking that many trusts do not meet minimum standards which are a legal obligation".

Is the British National Health Service (NHS) equitable? This paper considers one part of the answer to this: the utilization of the NHS by different socioeconomic groups (SEGs). It reviews recent evidence from studies on NHS utilization as a whole based on household surveys (macro-studies) and from studies of the utilization of particular services in particular areas (micro-studies). The principal conclusion from the majority of these studies is that, while the distribution of use of general practitioners (GPs) is broadly equitable, that for specialist treatment is pro-rich. Recent micro-studies of cardiac surgery, elective surgery, cancer care, preventive care and chronic care support the findings of an earlier review that use of services was higher relative to need among higher SEGs.

So again, I have to ask: Why is inequality tolerated for the basic human needs of food and shelter, but somehow healthcare MUST be equal for all?

 

[RemieV]

You misunderstand me.

In my previous post, I outlined the issues of living with an undiagnosed heart condition. One of these issues is that it would be quite a negative thing to get very sick. It's not the wait I'm complaining about - it is waiting with people who have a variety of infections.

I feel the need to elaborate because this kind of makes me sound like a jerk - like I don't want homeless germs on me or something.

So, here we go, the last couple of times I was in the ER.

1. Headache. Seems simple enough, but it exacerbated the heart condition because it put my body under stress, and blammo, hypertension (210/160) and tachycardia (220bpm).

2. Sinus infection. Also simple. I have no idea why, but it decided to bring along with it bradycardia (45bpm) and hypotension (80/60). The doctors were, frankly, amazed I was conscious.

3. Stomach bug. Also simple. But combine it with the heart condition, and you get vasovagal syncope, tachycardia, premature atrial contractions, difficulty breathing, etc, etc. It was the first time I ever had a team of doctors standing over me yelling to "Get the crash cart!", which sounds really serious, but on some level I found it amusing that they sounded an awful lot like an episode of Grey's Anatomy.

Each one of these instances was thousands upon thousands of dollars for incredibly simple things that normally wouldn't lay anyone flat. So yes - if the option is between going to a free clinic that is packed to the brim with sick people and sitting there for ten hours with people coughing up a storm while I wait for the doctor to finally see me because, let's face it, whatever I have is something as simple as a sinus infection and I am not a priority - yeah, I'm probably going to skip that step which will wind up costing ten thousand dollars in ER bills and go straight to the drug dealer for antibiotics that cost thirty dollars.

What I'm saying is this - free clinics and reduced cost clinics work great for people who do not have chronic illnesses. What about all the people that do? Why do you think that having free or low-cost clinics has the potential to solve the issue?

I will never, in my lifetime, be out of debt with the medical institutions I have been forced to go to unless I somehow become a multi-millionaire in the very near future. I am not an elderly person who has had the ability to save for their entire eighty years. I am not even a middle-aged person. I am twenty-nine years old. When did I have the opportunity to make the kind of money you're talking about?

 

[Gandalfs Beard]

Extending? The inequalities exist right now, even in the NHS.




So again, I have to ask: Why is inequality tolerated for the basic human needs of food and shelter, but somehow healthcare MUST be equal for all?

But in many countries, gross inequality is NOT tolerated for many of those basic needs. Public Benefits are provided for those in need from Public Funds. Of course there is still inequality. But the fact is an ostensibly democratic form of government's job is to see that basic needs are met.

The fact that Right Wing ideologues keep trying to undermine those systems doesn't stop French and British Protesters from fighting back to retain the benefits they do have, and regain the benefits they had previously won and lost.

GB

 

[Ducky]

This is how multiple myeloma works roughly in the UK.

If a patient comes into a GP surgery with fatigue, anaemia and bone or joint pain, and they are over the age of 40, the GP will request a multiple myeloma screen, which is basically blood work, a full blood count, protein electrophoresis, immunoglobulins, and bone and liver profile.

The laboratories also generate screens for multiple myeloma from routine work if a patient has a high total protein or a high or low globulin, the lab will do protein electrophoresis to look for the M-protein.

All patients being seen in the osteoporosis/DEXA clinic will also be screened for multiple myeloma.

If a band is found in the electrophoresis, it will be typed to see if it is a monoclonal anti-body.

Depending on the size of the band, the patient will either be referred immediately to a haemotology consultant, or they will be asked to have a repeat blood test in 6 months to a year (and probably a urine Bence Jones Protein test as well).

Patients with MGUS (monoclonal gammopathy of undetermined significance) /a very small band, are kept on record and asked to come in at least once a year.

The haemotology consultants also have a list of all the bands that are found in GP samples just in case the GP does not realise the significance of it, so if the GP does not refer the patient, the haemologist will ask the patient to come in.

Patients are monitored for decades. Every now and then the files of patients who have demonstrated having a paraprotein/M-band have to be checked to see if the patient has passed.

Some patients are monitored even after the M-protein is no longer visible/has disappeared.



I wanted to ask how your clinic deals with abnormal results?

Does the lab phone the surgery when they find something that is life threatening?

I am down to visits once a year to my oncologist, however it was 6 years of imaging, bloodwork, bone marrow biopsies that would cost me upwards of 5-10 grand a visit (mostly not covered.)

The big cost for me was having my spine rebuilt (ETA: And the recovery from that: learning to walk again, radiation, etc.)

Make no mistake: I know exactly how much my life costs and I can't afford it.

 

[Ducky]

Once more for xjx388 because I didn't see an answer for this:


So again: How should I have been budgeting for my situation? What personal irresponsibility is to blame for my getting multiple myeloma, having a chunk of spine replaced, learning to walk again and overall medical costs for 7 years of treatment and recovery at 1.2 million (ETA: Of which I personally owe quite a bit, but not all)? What, exactly, do we do about people currently embroiled in out of control medical debt?

Exactly what fiscal or personal irresponsibility is it I can look to in my past and say "yes, were it not for that choice I would not be facing more in medical debt than most people face in their mortgage."?

How is it we are to encourage startup businesses if those starting one cannot possibly hope to have their business survive an illness?

 

[Agatha]

Based on my albeit limited personal experience, I believe you could get insurance in the USA quite easily and at a rate similar to a perfectly healthy person. I did even though I have a few chronic conditions (not as severe as yours, of course).

Your condition would be excluded, just like mine were. I could have paid over double the rate to have my conditions covered, which in my case was more expensive than the cost of the most likely treatment I would need (I need treatment every 2 years or so). Should my condition have required surgery, I would have been screwed. Fortunately, a confluence of factors enabled me to get into my wife's plan at work at a similar price to what I was paying for excluded individual insurance, so this is not a major issue for me any longer.

So I could get insurance, it just wouldn't cover the condition that makes me ill on a regular basis; none of the surgeries, none of the stoma care products I needed before that was reversed, none of the immunosuppressive drugs, none of the yearly colonoscopies, none of the monthly blood tests, nor the consultant appointments,or the unlimited access to a specialist IBD nurse. Hmmm. Sounds like a good deal for the profits of the insurance company but not so good for me, unable to work full time so not earning much. Still, the RA would be covered, wouldn't it? I didn't develop that till about three years ago.

So again, I have to ask: Why is inequality tolerated for the basic human needs of food and shelter, but somehow healthcare MUST be equal for all?

Here, the inequalities exist but are not tolerated. That's why they are tested for and reported on, and why there are programmes in place to eradicate them.

 

[xjx388]

But in many countries, gross inequality is NOT tolerated for many of those basic needs.

Sure it is. The US has a "Food Stamp" program to provide for the poor. This does nothing for the little boys and girls who live in one of those colonias I mentioned earlier. Sometimes they don't have breakfast in the morning or dinner at night. Barak Obama's kids will never have that problem.

Let's talk about people who aren't poor. The average middle-class person in any country can't afford to eat the variety and quality of foods that are available to the rich. Why is this inequality tolerated? Shouldn't we all have equal access to the same variety and quality of food that the rich enjoy? After all, food is a basic right, isn't it?

I won't hold my breath for the law that mandates that my family gets to have prime ribeyes from Pappa's Brothers Steakhouse once a month.

Let me ask this another way. Try to put emotions aside when you read this. Why do people have a right to the best healthcare available, but not the best homes or food available?

 

[Fiona]

Who said they have the right to the best?

 

[RemieV]

Sure it is. The US has a "Food Stamp" program to provide for the poor. This does nothing for the little boys and girls who live in one of those colonias I mentioned earlier. Sometimes they don't have breakfast in the morning or dinner at night. Barak Obama's kids will never have that problem.

Let's talk about people who aren't poor. The average middle-class person in any country can't afford to eat the variety and quality of foods that are available to the rich. Why is this inequality tolerated? Shouldn't we all have equal access to the same variety and quality of food that the rich enjoy? After all, food is a basic right, isn't it?

I won't hold my breath for the law that mandates that my family gets to have prime ribeyes from Pappa's Brothers Steakhouse once a month.

Let me ask this another way. Try to put emotions aside when you read this. Why do people have a right to the best healthcare available, but not the best homes or food available?

So full of holes and logical fallacies.

People don't have a basic right to prime rib. They have a basic right to food. The basic right is the right to not starve.

People don't have a basic right to the 'best health care available'. For a brief period of time, I was seeing a doctor only available to the very rich. His visits are an hour and a half long (no matter what), and they cost two thousand dollars each, and he does not accept any type of insurance whatsoever.

THAT is the kind of health care available to the very rich. I don't see anyone here insisting that we all have that level because it is a basic human right.