Health care - administrative incompetence

[Darat]

This is nit-picking. You have shown no evidence that everyone in the UK gets all the treatment they need for their healthcare.

What if an alcoholic needs a liver transplant? They won't get one because of the drinking. So it's OK to let the alcoholic die.

What if an obese person needs a hip-replacement? They won't get it until they lose weight. They can't lose weight easily so they may never get it. So it's OK for the obese person to suffer with pain the rest of their life.

Rationing of healthcare is a fact, even in the NHS.

For a start what you describe above is not rationing...

That aside you seem to not realise that whether the alcoholic gets a liver will depend on two things the availability of a suitable donor organ and their medical/clinical assessment. If it is determined on the medical grounds (and the availability of a suitable organ) not on cost.

The same follows for an obese person - if it is not medically indicated that a hip replacement is the appropriate treatment the obese person in the UK will still have access to appropriate medical treatments which will include access to dieticians, to pain medication, counselling and so on, they will not be left to "fend for themselves".

 

[tsig]

This is nit-picking. You have shown no evidence that everyone in the UK gets all the treatment they need for their healthcare.

What if an alcoholic needs a liver transplant? They won't get one because of the drinking. So it's OK to let the alcoholic die.

What if an obese person needs a hip-replacement? They won't get it until they lose weight. They can't lose weight easily so they may never get it. So it's OK for the obese person to suffer with pain the rest of their life.

Rationing of healthcare is a fact, even in the NHS.

What if an alcoholic needs a liver transplant and doesn't have insurance? They won't get one because of the drinking lack of insurance. So it's OK to let the alcoholic die.

 

[Emet]

Okay y'all, I am very interested in this thread but have been extraordinarily busy with family commitments. I am off today so I am wandering back over to catch up on the debate. I have a couple of questions for you guys in the UK.

How much (percentage-wise) do you pay in taxes? I pay upwards of 45% in taxes and I fear that implementing a UHC system will raise taxes.

Welcome back. I'm in the US, so I'll defer here. But I hope you will take the time to address the posts in response to your own.

Several posters have referenced enormous bonuses and salaries paid to certain executives. What constitutes a ridiculously large bonus/salary? Who should determine what is considered a colossal salary/bonus?

Well, here is some data from 2007-8. What do you think?
http://www.healthreformwatch.com/2009/05/20/health-insurance-ceos-total-compensation-in-2008/

 

[Darat]

Right. The care is rationed. Too fat? No treatment. You drink? No treatment. First let's cure those other problems. Can't cure those other problems? Too bad, we can't do your surgery. Suffer/die.

No.

Treatments in the NHS are based on clinical need; it may be that the likely outcome (based on evidence) for an obese person needing a hip transplant is that the hip transplant will fail therefore that is not the appropriate i.e. medically determined treatment for that patient. They will still be treated, they will still receive the medically appropriate treatment.

 

[tsig]

Right. The care is rationed. Too fat? No treatment. You drink? No treatment. First let's cure those other problems. Can't cure those other problems? Too bad, we can't do your surgery. Suffer/die.

Looks like all that's left of your argument is ragging on alkies and fat people.

 

[Darat]

Okay y'all, I am very interested in this thread but have been extraordinarily busy with family commitments. I am off today so I am wandering back over to catch up on the debate. I have a couple of questions for you guys in the UK.

How much (percentage-wise) do you pay in taxes? I pay upwards of 45% in taxes and I fear that implementing a UHC system will raise taxes. ...snip...

Of course any system implemented could increase the tax burden but a 1:1 comparison with the UK tax system isn't a good indicator for this because we have a much larger "welfare" system regardless of the NHSs.

There is a Wikipedia article that covers this: http://en.wikipedia.org/wiki/Tax_rates_around_the_world but I haven't checked whether the article is accurate so as usual keep a bit of salt to hand!

 

[Agatha]

Tax is a complex issue in the UK but briefly:

The first £6745 per year is free of income tax for most people
All income above that is called taxable income, and is taxed in slices.
Taxable income from 0-£37400 is taxed at 20%
Taxable income from £37,401 to £150,000 is taxed at 40%
Taxable income above £150,000 is taxed at 50%

Then we pay National Insurance at 11% of all income above £5715 per year but below £43875 per year, and 1% on earnings above £43875 per year.

If you pay into a pension scheme, you get a partial rebate on your tax and NI. All parents of children under 18 except those earning enough to put them into the 40% bracket get a tax free weekly payment of child benefit. Working tax and child tax credits (more tax free payments) paid to lower income working people boost the income of those who qualify, and people with disabilities get extra (tax free) payments depending on the nature of their disabilities and how they impact their lives.

The best thing to do is to go to a site such as www.thesalarycalculator.co.uk and put in some representative salaries and see how the tax & NI deductions work out.

Because Child Benefit, Working Tax credit and Child Tax Credit (and Disability Living Allowance) are all tax free, the effective tax rate of lower earners is a lot less than the calculator will initially show.

 

[Tatyana]

This is nit-picking. You have shown no evidence that everyone in the UK gets all the treatment they need for their healthcare.

What if an alcoholic needs a liver transplant? They won't get one because of the drinking. So it's OK to let the alcoholic die.

What if an obese person needs a hip-replacement? They won't get it until they lose weight. They can't lose weight easily so they may never get it. So it's OK for the obese person to suffer with pain the rest of their life.

Rationing of healthcare is a fact, even in the NHS.

Do you seriously think that it is ok to give an alcoholic who is going to continue to drink one of the limited number of livers available?

It isn't rationing, it is ethical practice and good clinical practice.

There is no exclusions for obesity for hip replacement on the NHS. However, there may be medical reasons why it is necessary for someone to lose weight before they can be operated on.

It isn't rationing, it is best clinical outcomes.

If you are going to keep using tabloid newspapers reports as evidence, I think that the exorbitant prices and exclusion of patients from insurance in the US media would be far more damaging.

Compare and contrast the criteria between the UK and the US, both use MELD.

It is medical reasoning, not rationing.


http://www.nhs.uk/Conditions/Liver-transplant/Pages/Who-can-use-it.aspx

Reasons why a liver transplant may not be available

There are a number of factors that usually indicate that you would be unlikely to survive following a liver transplant, and would therefore not be a suitable candidate for the procedure. These are five of the factors:

Continued alcohol misuse

If you continue to misuse alcohol after receiving a diagnosis of alcoholic liver disease, it is likely that you will be refused a transplant.

Most transplant centres expect a clear commitment from you to avoid alcohol for the rest of your life. In practical terms, this usually means that you have to abstain from all alcohol for at least three months before you are considered to be suitable for a transplant.

Continued drug misuse

If you have contracted hepatitis B or hepatitis C because you are an intravenous drug user, you will be expected to enter a drug rehabilitation programme and successfully quit your drug habit before you are considered suitable for a transplant.

Advanced liver cancer

If you have advanced liver cancer that has spread beyond your liver to other parts of your body, it is unlikely that you will be offered a liver transplant.

End-stage HIV

If you have end-stage HIV, it is unlikely that you will be offered a liver transplant because the risk of you dying during or shortly after the operation is too high.

However, a number of people with a well-controlled HIV infection who have responded well to their HIV medication have received successful liver transplants.

Advanced age

As a general rule, liver transplants are not recommended for people who are 70 years of age or over because their general state of health is usually too poor to safely withstand the effects of the operation. However, exceptions can be made if you are physically fit and in a good state of health.


US Criteria
http://www.emedicinehealth.com/liver_transplant/article_em.htm
Who may not be given a liver: A person who needs a liver transplant may not qualify for one because of the following reasons:

* Active alcohol or substance abuse: Persons with active alcohol or substance abuse problems may continue living the unhealthy lifestyle that contributed to their liver damage. Transplantation would only result in failure of the newly transplanted liver.

* Cancer: Cancers in locations other than just the liver weigh against a transplant.

* Advanced heart and lung disease: These conditions prevent a transplanted liver from surviving.

* Severe infection: Such infections are a threat to a successful procedure.

* Massive liver failure: This type of liver failure accompanied by associated brain injury from increased fluid in brain tissue rules against a liver transplant.

* HIV infection

 

[Uncayimmy]

What you described is not a restriction of any market. You are deluded or willfully twisting terminology to phrase it that way. Show me an economist who thinks that tort reform=restricting markets. Ludicrous.

You've got to be kidding me. The government restricts how much a business has to pay for its mistakes, and you claim it's not a restriction on the free market? The cognitive dissonance is strong in this one.

 

[Ducky]

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.

Wow we went from health care to "everything everyone will ever need." Those goalposts didn't just move, they flat out danced their way to another place.

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.

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.

You seem to be terribly confused. We are discussing your words not mine. Your premise was that people need to save up huge sums and take out more insurance. It's not going to fix the problem and I've shown that.

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.

Oddly my auto insurance has no chance of ending up leaving me in huge sums of debt the same way health care insurance does.

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.

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.

I'll take your word for this pricing? because it's absolutely pulled out of your arse without a source, therefore meaningless. It's also nowhere near the reality of my situation.

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.

You've seemed to miss a whole slew of posts from people in the UK refuting this notion, and provided no source of your own. More hand waving.

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.

And you're not offering any viable solution except that I should have been less irresponsible, apparently, and need to budget more. I make a rather good living and yet I live at the same level as someone who makes poverty level income. When I should own a house, I pay for my spine, and when I should be able to afford groceries every week I eat ramen and live in a crappy tiny apartment. This is apparently completely acceptable to you because hey, I should go broke for my health care (inequities, right?)

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.

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.

Excuse me, you should re-read my posts. This situation explicitly forced me to shut down my business so I could sneak in on a group health care plan with a large employer.

More hand waving.

When you're actually going to address the warts on your arguments let me know.

 

[Ampulla of Vater]

Well, here is some data from 2007-8. What do you think?
http://www.healthreformwatch.com/2009/05/20/health-insurance-ceos-total-compensation-in-2008/

I think I'd rather be the CEO of Aetna than Wellpoint. But that's not the issue. All sorts of CEO's are paid exhorbantly. The CEO of Kraft (a food company) was one of the top paid in the country, according to this article:

http://www.reuters.com/article/idUSN2820660920100428

My question is who decides what is too much? Currently it is the free market, is it not?

 

[Darat]

xjx388 - do you believe that everyone in your country should have access to a good level of healthcare?

 

[Ampulla of Vater]

I know that someone already addressed this in a very small-scale way, but I'd like to emphasize it a bit more.

ERs absolutely do not TREAT people. They stabilize people and send them home. The time that the hospital folk were standing over me yelling "Get the crash cart!" and all that? They released me four hours later. I had to, in fact, walk five miles home as they had brought me in in an ambulance.

Obviously I cannot speak to what happened to you but I can assure you when an "undocumented alien" presents to the E.R. with cholelithiasis, the diagnosis is made and the gallbladder is removed before s/he is sent home. I do think there are many cases where the E.R. only stabilizes the patient for discharge.

 

[Agatha]

I want to see data on morbidity and mortality for the major killers: cancer, heart disease, etc. Those are real health outcomes. For example, the WHO has a pretty cool database on cancer mortality for many countries. If you fiddle around a bit, you can get a table for the US and the UK. If you select for: all cancers, Male, you will find that in the UK, the death rate from cancer (all 2005 numbers) is 272.09 per 100,000 and in the US 195.23. Pretty significant difference in outcomes don't you think? Breast cancer? UK = 36.68, US =26.77. So in cancer, the US system has the UK's NHS beat. Those are the kind of numbers we need to see to compare outcomes.

Are you reading this thread (your repeated insistence on cost being the driver of decision making here suggests not)? It's already been noted in this thread that the UK is lagging behind on cancer survival, and the reason is, according to the news reports here, is that we under-utilise our free GPs. People don't go to their GPs with cancer symptoms soon enough, so that cancers tend to be more advanced by the time they are discovered. http://www.bbc.co.uk/news/health-11749078 This is something that the UK needs to work on urgently, and we will be doing.

Anecdotally, this is exactly what my mother did - she didn't want to bother the doctor with her problems, so that by the time her bowel cancer was detected it had already spread to her liver, and she died less than three months after first visiting her GP, at just 49 years old. No blame can attach to her GP or the hospitals she was in, the GP sent her in hospital the same day she first visited him and she had first class treatment at both her local hospital and the regional cancer centre.

 

[Uncayimmy]

I think I'd rather be the CEO of Aetna than Wellpoint. But that's not the issue. All sorts of CEO's are paid exhorbantly. The CEO of Kraft (a food company) was one of the top paid in the country, according to this article:

http://www.reuters.com/article/idUSN2820660920100428

My question is who decides what is too much? Currently it is the free market, is it not?

Honestly, I really don't care what CEOs make. For the purposes of this discussion, the issue is that in a nationalized health care system, we don't have people who are rewarded financially for extracting more profit from the market. CEOs of insurance companies have an incentive for increased health care costs. It's a bit complicated to understand, but stated simply there's an incentive in the very short term to cut costs to maximize the immediate profit, but there are limits on the amount of profit (a regulated industry). In the long term there is an incentive to increase health care costs because their profit is based off a percentage of the total cost. When health care rates go up, so does profit in actual dollars even though the percentage remains the same.

In no case do insurance companies have an incentive to provide the best health care possible. Hell, they don't even provide health care. They have no reason to care if somebody has good or bad outcomes. Furthermore, insurance companies are very disconnected from the individuals. The bulk of their business comes from employer plans. Those with individual plans have very few options and virtually no power to exert an influence.

If somebody wants to argue that in principle they are against nationalized health care, I can respect that. I disagree, but I respect the position. I challenge them to look at other aspects of "socialism" in their "capitalist" economies to see how their ideologies hold up.

Usually, however, the ideological argument comes down to costs. All of the evidence points to lower costs and better outcomes with socialized medicine. CEO compensation is one example of costs that would not exist.

 

[Agatha]

C'mon, now. This was a ranking based on attainment of the WHO's goals for each country. One of the criteria is "Fairness in Financial Contribution." What the heck is that and how do you measure it? Interestingly, that same spreadsheet ranks the US #1 in "Health Expenditure per capita in International Dollars." Switzerland is #2 and France is #3. So according to that report, we spend less per capita in international terms of reference than any other country . . . interesting, huh?

I think America's #1 slot there is because they spend MORE per capita than any other country.

Edit - having looked at the table again, it's definitely more. Look at the rankings for say Somalia and Burkina Faso. Do you really think they spend more per capita on healthcare than the US? http://www.photius.com/rankings/world_health_systems.html

 

[kellyb]

I disagree because it is not true. You can not account for the difference in healthcare spending per capita between the US and (pick a country) due to the mere existence of the health insurance industry. The US spent $2.47 trillion on healthcare in 2009. The top 14 health insurance companies posted $8,500 million in profits. That's .0034% of the US's healthcare expenditures in 2009.

I know it's not just insurance companies. It's also a matter of increased pharma prices over here, medical device prices, radiology companies, for-profit blood work lab companies, etc. LOTS of factors.

 

[varwoche]

This was in response to my pointing out that Rolfe's picture of the UK was a utopian vision that doesn't work in reality

Despite Rolfe's poor choice of words, the gist is correct. Especially in comparison to the US. And as for the free markets which you lament the non-existence of:

Government determines two of the most basic aspects of health care: (1) the drugs that are available and (2) who is permitted to be a health care provider.

Do you consider this appropriate? Or should the market sort this out, and tough luck for the suckers?

That's got to be a tough question for you. If no, that's some pretty hardcore ground (water? ) to stake out. But if yes, this means that the mythical free market you tout is just that -- mythical, even in the context of your own mind. Which makes this bit of arm waving even more ridiculous:

I see no evidence that shows free markets don't work in healthcare.

 

[Ampulla of Vater]

In no case do insurance companies have an incentive to provide the best health care possible. Hell, they don't even provide health care. They have no reason to care if somebody has good or bad outcomes. Furthermore, insurance companies are very disconnected from the individuals. The bulk of their business comes from employer plans. Those with individual plans have very few options and virtually no power to exert an influence.

Okay so humor me here. What is the incentive for the NHS to provide the best care possible? US insurance companies' incentive is to keep the group plan (I realize I am talking group insurance here.) The insurance companies want to keep the consumers happy so the group renews with them.

Usually, however, the ideological argument comes down to costs. All of the evidence points to lower costs and better outcomes with socialized medicine. CEO compensation is one example of costs that would not exist.

As far as costs go, the majority of healthcare is currently paid for by consumers. If we go to a UHC system, who will pay for it? It still costs money to pay for physicians, hospitals, equipment, drugs, etc. Right now I pay the insurance company for what I want for my healthcare - I am the consumer. In a UHC scenario I am paying the government roughly the same amount (through taxes though) to provide me healthcare plus provide others healthcare too. Is this a correct (albeit simplified) theory?

In the long term there is an incentive to increase health care costs because their profit is based off a percentage of the total cost. When health care rates go up, so does profit in actual dollars even though the percentage remains the same.

And how can their profit be based on a percentage of the total cost? The total coast of what? I am not following you here. Profit is based on the net, after costs.

 

[Delscottio]

Right. The care is rationed. Too fat? No treatment. You drink? No treatment. First let's cure those other problems. Can't cure those other problems? Too bad, we can't do your surgery. Suffer/die.

Strange use of the word when the treatment plan as a whole will, when a success ,will be more expensive.

Maybe this is why the NHS works out cheaper, it tries to treat the whole problem not the immediate symptons as is currently done in the US for those under insured.