Health care - administrative incompetence

xjx388 said:
OK, fine. We provide healthcare overseas. Happy now? This still proves nothing about how health care is a right, unless you are talking about the right to clean water, sanitation, etc. Are we paying for liver transplants overseas?
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Wonder if I qualify for the million dollars on that prediction.
 
xjx388 said:
OK, fine. We provide healthcare overseas. Happy now? This still proves nothing about how health care is a right, unless you are talking about the right to clean water, sanitation, etc. Are we paying for liver transplants overseas?
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I just want you to let go of your kneejerk idealogy/religion, man. Stop arguing for the sake of arguing and actually think.

If we the people of the US set out to emulate the NHS, and were for-real about it, we could open medicare up for all without even raising taxes.

If you oppose that goal, why?

I know most Democrat politicians aren't aiming for that (I think they're mostly a bunch of posturing vipers) but why can't thinking people not married to a party agree to work towards that goal?
 
kellyb said:
I just want you to let go of your kneejerk idealogy/religion, man. Stop arguing for the sake of arguing and actually think.

If we the people of the US set out to emulate the NHS, and were for-real about it, we could open medicare up for all without even raising taxes.

If you oppose that goal, why?

I know most Democrat politicians aren't aiming for that (I think they're mostly a bunch of posturing vipers) but why can't thinking people not married to a party agree to work towards that goal?
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Or let go of the idea that somehow fiscal/personal responsibility and budgeting is an answer to everything. I've flat out proved that's wrong and yet all I see is that answer clung to for dear life in a discussion.

You cannot simply apply budgeting and some idea of fiscal responsibility as the answer to the current medical problem because it does not solve the inequity of medical bankruptcies.

Adding more insurance to it is even more futile. Why divvy up risk pools? why not combine the entire populace into a the largest risk pool possible? That would certainly bring down some costs.
 
Ducky said:
Or let go of the idea that somehow fiscal/personal responsibility and budgeting is an answer to everything. I've flat out proved that's wrong and yet all I see is that answer clung to for dear life in a discussion.

You cannot simply apply budgeting and some idea of fiscal responsibility as the answer to the current medical problem because it does not solve the inequity of medical bankruptcies.

Adding more insurance to it is even more futile. Why divvy up risk pools? why not combine the entire populace into a the largest risk pool possible? That would certainly bring down some costs.
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I think the math the NHS is based on is solid. On a national level, their idea of fiscal responsibility "works".

Isn't it crazy that we could get a similar type of health care by emulating the NHS without even raising taxes? Without even raising taxes, we could get similar health care in the US. All we need to do is cut off the gravy train of extreme profits in some industries.

But we need an informed population and a unified political will.
 
xjx388 said:
OK, fine. We provide healthcare overseas. Happy now? This still proves nothing about how health care is a right, unless you are talking about the right to clean water, sanitation, etc. Are we paying for liver transplants overseas?
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Did the founding fathers consider clean water and sanitation a fundamental "right"?
I don't think so. Germ theory of disease wasn't even on the table at that time. So why isn't providing for the general welfare by using taxes to create access to clean water and sanitation unconstitutional? Does the constitution say people can be taxed to bring them clean water? No!
 
kellyb said:
Did the founding fathers consider clean water and sanitation a fundamental "right"?
I don't think so. Germ theory of disease wasn't even on the table at that time. So why isn't providing for the general welfare by using taxes to create access to clean water and sanitation unconstitutional? Does the constitution say people can be taxed to bring them clean water? No!
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Could these fall under the Ninth and Tenth Amendments to the Constitution?

Amendment IX: The enumeration in the Constitution, of certain rights, shall not be construed to deny or disparage others retained by the people.

Amendment X: The powers not delegated to the United States by the Constitution, nor prohibited by it to the states, are reserved to the states respectively, or to the people.

I would think also that the right to food, shelter, and health care might be some of the "others retained by the people," as was the right to privacy in marriage when it was ruled on by the Supreme Court.
 
xjx388 said:
Herehttp://www.aafp.org/afp/2004/0315/p1465.html are the Evidence Based Guidelines we use here. If rapid strep is positive we give penicillin unless they are allergic in which case we give erythromycin. Every positive case unless they are chronic. Then we consider other measures. UK and France, no antibiotics. Wonder why socialized medicine would be so different?
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The evidence you provided doesn't mesh with your assertion that every single patient with a sore throat has a culture.

The issue is with children, not adults, a throat swab is excessive and wasteful.


Sore throat is one of the most common reasons for visits to family physicians. While most patients with sore throat have an infectious cause (pharyngitis), fewer than 20 percent have a clear indication for antibiotic therapy (i.e., group A beta-hemolytic streptococcal infection). Useful, well-validated clinical decision rules are available to help family physicians care for patients who present with pharyngitis. Because of recent improvements in rapid streptococcal antigen tests, throat culture can be reserved for patients whose symptoms do not improve over time or who do not respond to antibiotics.



The paper concludes that there appear to be important inequities in access to some types of health care in the UK...

This report demonstrates that there are big inequalities between rich and poor in the UK.

I conclude there are bigger gaps in healthcare in the UK than you may be aware of.
I'll concede the point that life expectancy and infant mortality are at least quick an dirty measurements of outcomes.

And there are mine with sources disputing yours.
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From your first link:
The paper concludes that there appear to be important inequities in access to some types of health care in the UK, but that the evidence is often methodologically inadequate, making it difficult to draw firm conclusions. In particular, it is difficult to establish the causes of inequities which in turn limits the scope for recommending appropriate policy to reduce inequities of access. The theoretical framework and the lessons learned from the UK are of direct relevance to researchers from other countries seeking to examine equity of access in a wide variety of institutional settings.
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The NHS knows there are issues and is studying and addressing them.

This isn't the case in the US.

Your second link is about inequities in mortality.

Again, it is well known that people from some socioeconomic classes have a greater propensity for lifestyle choices that are not as healthy, such as smoking and food choices.

We don't force people to make lifestyle changes, and changing generations of attitudes and habits is not easy, however, there are campaigns and programs available in the NHS and in the schools to tackle these issues.

Even if they choose things like smoking or overeating, they are still treated within the NHS (within clinical responsibility).

Your insurance premiums would increase though if one was a smoker or obese in the US.

I wouldn't say it was perfect, however, I assert that the poor are not even on the policy making agenda in the US.

If you want better papers trying to prove you point about poor in the UK, I would suggest you look at the Joseph Rowntree Foundation.

http://www.jrf.org.uk/
 
xjx388 said:
So basic healthcare = liver transplants but not breast cancer drugs that extend life?

Oh, sorry. It's successfully feeding and housing 99.8% of all American citizens. Pretty damn good.
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Just a few factual errors I wanted to address.

Breast cancer drugs are provided.

The drugs that are not readily provided (right now) by the NHS are the monoclonal antibody therapies.

The majority of these drugs are very new, and they do not work on everyone, and in some cases, they make the person even worse.

You may recall the clinical trial in England that resulted in the death of several of the participants from a cytokine storm. In theory, this is a possible outcome of monoclonal antibody treatment with a tumour marker that the body has never been presented with before.

http://en.wikipedia.org/wiki/TGN1412

Cytokine storms have been implicated in drug therapies, the potential when introducing antibodies from another animal have to be addressed.

http://en.wikipedia.org/wiki/Cytokine_storm

In the case of the breast cancer MaB treatment and basic theory to demonstrate that it will only work on about 30% of women (the clinical trials also support this)

http://en.wikipedia.org/wiki/Monoclonal_antibody_therapy
Examples include ErbB2, a constitutively active cell surface receptor that is produced at abnormally high levels on the surface of approximately 30% of breast cancer tumor cells. Such breast cancer is known a HER2 positive breast cancer
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Other issues with monoclonal antibody therapy: Evidence it could make you worse

http://www.medscape.com/viewarticle/709024_5
Monoclonal Antibodies in Multiple Sclerosis Treatment: Generic Problems with Monoclonal Antibodies 3: CNS Penetration

There have also been many reports of induction of brain metastases in women with a good systemic response to trastuzumab for HER-2 positive breast cancer [Lindrud et al. 2003],


Another issue with monoclonal antibody therapy: It could make future diagnosis of a number of clinical issues difficult or almost impossible.

This one is standard laboratory knowledge in the UK.

Antibodies uses for diagnostic and clinical treatment are murine, or from mice.

Currently, people exposed to pets, mice, hamsters and birds, have a tendency to have an odd set of antibodies that are generally called heterophile antibodies (this is not to be confused with the test for mononucleosis/glandular fever).

http://www.clinchem.org/cgi/content/abstract/45/5/616
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1553719/
Occurrence and cross-reactivity of heterophile antibodies and anti-kidney antibodies in kidney transplanted patients and patients with renal disease
S. -E. Svehag, R. Olander, and K. -G. Sundqvist

Heterophile antibodies cross react with the antibodies in diagnostic tests (and now, immunoassays account for a phenomenal number of tests from therapeutic drugs, all hormones as well as tumour markers to track the disease), making clinical diagnosis difficult and confused, if not impossible in some cases.

There are issues we may not even be aware of yet. Heterophile antibodies may make things like future treatment impossible.

Monoclonal antibody therapy is currently introducing murine antibodies directly into the body. The potential for forming heterophile antibodies is substantially increased.

These drugs that XJX is claiming are denied in the UK are still currently being studied in numerous clinical trials.

When the drugs cost a phenomenal amount of money and only treat one third of patients with several potential side effects, including death, I for one, cannot see any other manner in not proceeding with caution with this very new medical treatment.

However, as we all know, the emotive appeal of anecdotal evidence is what wins arguments. ;)
 
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And when you read their policy position papers, be aware that these receive regular high-profile coverage in the national media.

http://news.bbc.co.uk/1/hi/education/6982090.stm

http://www.bbc.co.uk/news/uk-wales-11648513

http://www.heraldscotland.com/news/home-news/childless-men-in-poverty-trap-1.1056693

At the risk of being unduly blunt, XjX, we have a media which still reports these kinds of things. We don't have the right-wing crap that is Fox News. Even the right wing press such as the Daily Fascist Mail will pick it up, although usually as an excuse to take a pop at the Labour Party.

So don't assume that it's news to us. Whereas the huge gaps in your health system do appear to be something of a surprise to you.
 
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xjx388 said:
I don't see many facts from the other side either. Plenty of name calling ("repugnant," "stupid") but no actual evidence that a free market system won't work. The fact is that the free market works just fine to distribute our food and shelter which we all agree are basic rights. They are both accessible for pretty much everyone in America. Healthcare, which is heavily regulated, is not. Things that make you go, "Hmmmmmmm..."
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I stated that I find your view repugnant, not you. Kindly refrain from misrepresenting me.

xjx388 said:
Herehttp://www.aafp.org/afp/2004/0315/p1465.html are the Evidence Based Guidelines we use here. If rapid strep is positive we give penicillin unless they are allergic in which case we give erythromycin. Every positive case unless they are chronic. Then we consider other measures. UK and France, no antibiotics. Wonder why socialized medicine would be so different?
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No, you are wrong, it's that whack-a-mole again. We do give antibiotics for throat infections where there is a clinical need for them.
The paper concludes that there appear to be important inequities in access to some types of health care in the UK...

This report demonstrates that there are big inequalities between rich and poor in the UK.

I conclude there are bigger gaps in healthcare in the UK than you may be aware of.
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Your first link either doesn't work properly or is behind a paywall. None of us denies there are inequalities between rich and poor in the UK :confused: It's a mobile society with a mixed economy, like the US, with plenty of opportunities for personal advancement, entrepreneurship etc. Those inequalities don't extend to the right to health care; the poorest person is entitled to exactly the same level of high quality care as the richest person. If there are barriers to access (I can't see your link), then we as a society need to be (and probably are) addressing these; none of us is saying our system is perfect yet. But when things go wrong it's so unusual that it's headline news and reviews are ordered - at public expense - and if necessary, changes are made.

xjx388 said:
Savings + Catasrophic insurance + Free Market = Lower costs so you don't have to save up ridiculous sums. For your current debt, let's give the doctors/hospitals you owe a tax break to write-off all or part of your debt. As for irresponsibility in your past, I can't make judgements on that because I don't know you. You didn't necessarily have to be irresponsible; you're probably just a victim of our current system.
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You haven't evidenced that the free market will lower costs, particularly for the rarer illnesses - the demand just won't be there.

What happens if you fall ill at such a young age that you cannot save up? What happens if the catastrophic insurance reaches the ceiling on what it will pay out - and the illness is still there or recurs? You are avoiding addressing Ducky's points just as you keep avoiding mine about long term chronic illness. I've had Crohn's all my life, it's not going to go away. I'm always going to need a lot of healthcare and it has always limited my ability to study and work, which is why I have a low paid part-time job. How could I save, and what happens when the catastrophic insurance (which may well be prohibitively expensive) runs out? I will still need care.

xjx388 said:
Where do you think his pharmacy gets the bulk of it's income from?
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Unless he's the pharmacist, it comes from a fixed 90 pence per prescription item dispensed (you need a lot of those to make a good living) and the profit whatever he sells over the counter (which will almost certainly be cheaper in the local supermarket) after he's paid his premises costs and paid his staff. So, um, not the government then. If he's the pharmacist, he gets a (not fantastic) salary from the NHS. But he still has the premises costs and his staff costs to pay, just as before.

You continue to claim that the NHS denies "loads" of people life-saving drugs, this is absolutely not the case. Nikki Blunden wasn't denied life-saving drugs, she was already on a cocktail of life-saving drugs. She wanted to try another one which is not recommended by NICE as cost effective. The NHS wouldn't pay for it because it has not been shown to be any better at extending her life than the drugs she was already on; she was at liberty to pay for this drug but couldn't afford it, so someone stepped in and paid for it - we do charity quite well here too. She's still alive [AFAIK]but there is no evidence to judge whether the new drug she's on is doing better than the previous ones she was on at keeping her alive.
 
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It always amazes me when I see such graphs how bloody well the NHS does considering that it is underfunded compared to pretty much all other healthcare systems!
 
Darat said:
It always amazes me when I see such graphs how bloody well the NHS does considering that it is underfunded compared to pretty much all other healthcare systems!
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One of the areas that the NHS is not that great at is the patient centred care, which I personally think is one of the reasons why the strongly individualistic US finds the UK system so repugnant.

There are GPs who are great with the individual, there are several in my surgery, however, I do choose which GP I see based on my needs at the time.

Sometimes I like the very by-the-book approach of one, the laissez-faire approach of another, and the more empathic, compassionate 'female' issue approach of one of the female GPs.
 
 
Tatyana said:
One of the areas that the NHS is not that great at is the patient centred care, which I personally think is one of the reasons why the strongly individualistic US finds the UK system so repugnant.

...snip...
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Given that you'd expect our ratings to go up as the changes over the last 5 years take effect i.e. the focus on "patient centred" care. (Well unless the Tories get their way to privatise it via the front door - sorry political section I know!)
 
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kellyb said:
And whatever happened to the discussion about tax dollars partially funding medical schools?
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Or the fact that his "brilliant" wife got a full ride to college. I guess it's okay for people to be threatened with incarceration to pay for his wife's college.
 
Ducky said:
That's quite a bit of back pedaling on your earlier statement:
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What was the opening sentence of that statement? "If Healthcare is so much of a universal need . . ." Every other part of my "argument" followed from that. Just about all of you here are saying that access to basic healthcare (from strep throat treatment to liver transplants) is a fundamental human right. OK, then put your money where your mouth is. If society has a duty to provide everything to everyone that they will ever need: (health-care wise) then how can that society justify spending money on luxuries? Your continued insistence that the NHS covers everyone's needs perfectly is a utopian fantasy. Find me a source besides you guys that says that. Just one. You will not find such a source. There are inequities between rich and poor and they will never go away. There is rationing of care because of finite resources.

In other words, your words say it's a right, but your actions (i.e., rationing care people have a right to instead of increasing funding to cover those needs) are louder.

Oddly, you did acknowledge the flaw:
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That's right, you can't save the ridiculous sums that healthcare costs under our current system. That's support of my argument, not a flaw. There have to be fundamental changes. Government out + Free Market in = lower cost.

And yet:

How would I have chosen anywhere near correctly not knowing what it is I will become ill with?
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How do you choose car insurance without knowing if you will crash into someone and kill them? How do you choose home insurance without knowing if your house will burn down or not? You're a smart person, Ducky, I think you'll figure it out.

And you still haven't answered my questions. The answer to people who can't afford health care costs is to get more insurance? Really? Then they should budget more? Because current insurance companies drop coverage, have caps, do everything they can not to pay out, why wouldn't someone's catastrophic insurance have the same issues? And catastrophic coverage doesn't change the fact that ongoing illnesses will still put them in huge financial hardship. Once you hit your catastrophic cap, if you're still sick you will still have medical costs.
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Here is a current plan available to a family of four right now in this regulated climate: $7500 individual deductible/ $22,500 family deductible. $1000 prescription drugs deductible with a maximum $5000 out of pocket, no Lifetime Maximum, preventive covered at 100%. Cost per month ~$270. :jaw-dropp

What about those that can't pay all that? What about pre-existing? What about all the other excuses? All of them have solutions. Remember, we are America with the can-do attitude! Eliminate the high costs involved in our current system and the free market will drive healthcare costs down which in turn will drive down the price of catastrophic insurance like this.

Then of course you advocate people just go without:



Let me make this absolutely clear: Your original point was that people should be fiscally responsible enough to budget for future health care costs above their own insurance. You then said if it is not affordable you think the best choice is to go without, demonstrated by the importance you would place on this idea...applying it to yourself.
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That's right. In the NHS, people go without all the time, regardless of what you read on here. It's reality. Go back and read my sources for the inequities in health care between rich and poor and the news reports about cutbacks. If my catastrophic plan told me they wouldn't pay for my treatment, it's no different than the NHS telling people like Nikki Blunden, obese people, alcoholics, and the others cited on here and in the press that their treatments won't be covered. There are finite resources. I opt for the plan that gives me access to the most of those resources at the maximum amount of my liberty.

I owe more in 7 years of medical debt than 90-95% of America pays for their house over 30 years. There is no ability to assign irresponsibility for my medical condition unless you can tell me how my actions 1) lead to me getting multiple myeloma (hint: you can't) or 2) how I could possibly have saved that amount and yet frittered it away on tobacco and big screen tv's (as you pointed out in the following quote.)

Future coverage is questionable at best unless I sneak in on a group plan and my condition gets expensive. I'll probably never be able to own a house and I sure won't get approved for any credit so that leaves me without another avenue of budgeting. Are you saying that once remission is shown to be over if I cannot afford to pay for my treatments I should go without?
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Listen, I feel for your situation, sincerely. Your example is perfectly illustrative of just how messed up our current healthcare market is. It needs to change right now. The nature of that change is what is under debate.

You also never addressed my points regarding small businesses and the encouragement of market growth and competition via small businesses. How would we best serve markets if people won't take the chance of going out of business just because of illness or medical costs?
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I opened a small business. I knew I wouldn't have health insurance provided for me. It didn't stop me from opening a business. It doesn't stop anyone now. We need to fix our system so that everyone can have better access to care.

If you were actually interested in debating I probably would have seen you at least acknowledge the numerous posts either pointing out your sourced cites were not saying what you thought, or the posts giving you new and specific evidence in refutation of your fast held belief that health care could possibly be a free market commodity.
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I see no evidence that shows free markets don't work in healthcare. I see a lot of rhetoric, but no actual study or case where it has failed.
 
xjx388 said:
...snip...

If my catastrophic plan told me they wouldn't pay for my treatment, it's no different than the NHS telling people like Nikki Blunden, obese people, alcoholics, and the others cited on here and in the press that their treatments won't be covered. There are finite resources. I opt for the plan that gives me access to the most of those resources at the maximum amount of my liberty.

...snip...
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You have shown no evidence that an obese person will not receive treatment nor an alcoholic won't receive the medically appropriate treatment under the NHS.
 
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