Health care - administrative incompetence

[Emet]

Your source cites two figures from two different sources from two different years. The WHO data is one source, same year (2005) with the raw numbers.

Can you please re-link your data? The thread had gotten very long.

Thanks.

 

[xjx388]

With "sacrifice" being defined as accepting a full-ride scholarship that was paid for by threatening incarceration to get people to pay their taxes. You know, the very same taxes that could be used to, I dunno, pay for medical treatments.

Apparently "sacrifice" also means depending on family members to support you because, well, everybody has lots of family able to support a couple of teenagers who end up with a baby. Tell us, who paid your medical bills for the birth of the child? Right now an ordinary vaginal birth costs about 1,300 hours of minimum wage labor. It would only be about 1,200 hours if we didn't take out FICA/Medicare.

Your continuing efforts to personalize this argument are ridiculous. Stick to the facts.

Sacrifice = putting your immediate wants aside in the near-term to achieve a more rewarding want in the far-term. Personal responsibility = finding your own way through life without using the crutch of "welfare." Two concepts many Americans have forgotten about . . .

 

[kellyb]

You're kidding me right? That's supposed to be the way it works in the US too but since every politician has backroom deals going on there isn't an honest one among the bunch and we get the choice of dishonest Democrat A or dishonest Republican B. The current US healthcare system has more incentive to please consumers than government, period.

We definitely need better, more honest politicians.

False. If we got "hard-core" and implemented an NHS-emulated system on January 1st (or June 1st, or next January, etc.) there would be droves of people flocking to doctors for their "free" healthcare and the system would be overwhelmed and, let's see, there would be rationing. Oh yeah, a large portion of providers would decide they're not going to lose money accepting solely Medicare (or a Medicare-type system) and they'd retire early or quit and go do something else. It would be mass pandemonium with millions of patients and too few providers. The government would raise taxes to "pay for it" so all the people who work 80 hours a week and employ people would decide not to work 80 hours a week just so the government could take their 60%. The people employed by the 80-hour-work-week business owners would then be unemployed and they and the business owners would go on food stamps and welfare in addition to free healthcare (because now most the small businesses would close) and the government would have to raise taxes even further because there would be less workers funding all the stay-at-home welfare/food-stamp/free healthcare people.

Gee, that would be a real utopia.


My rant is now over.

The NHS reimburses PCPs way better than the rates set by the mysterious, anonymous CMS folks who operate under a veil of secrecy. I know a couple of doctors who actually suspect that the PTB are planning on trying to get rid of MD PCPs all together and replace them with NPs. Just to inject some tin foil hattery into the thread.

Most people don't particularly enjoy going to the doctor, so I don't see the health care armageddon you predict being plausible. Nothing of the sort happened when the NHS (or any other single payer system on earth) was created, for example.

 

[xjx388]

Can you please re-link your data? The thread had gotten very long.

Thanks.

It has, hasn't it? Here's the WHO database. You have to input what you want to know and it dynamically generates it for you.

 

[Rolfe]

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.

You're completely mixed-up on this.

Nobody has said the NHS is perfect. Just so much better than the current US system that it's in another universe.

How can "we" justify spending money on luxuries? You have to define that. Are you talking about individual people, and saying they shouldn't spend money on beer and fags and the bingo? We are a free country, you know. We do allow people to spend their money as they choose.

Or are you saying we should tax people to the point where they no longer have any money for luxuries, in order to spend more on healthcare? Coming from a tax-is-evil rightwinger like you, that would be a bit rich.

Or are you saying that we should spend more of our tax take on healthcare and less on other things? Like what? Personally, I can think of a few nuclear weapons I'd happily junk to provide more funding for the NHS but somehow that never seems to happen, really.

Get this into your head. The NHS strives for equality. You will not have any treatment denied because you are poor rather than rich. On the contrary, the NHS puts more funding per capita into deprived areas to try to even out the inequalities. Sociology being complex, it doesn't always succeed. But access to healthcare is specifically the same for everyone.

The only case you have found of someone being "denied" was a woman who received all the evidence-based cancer care the NHS could give her. Absolutely free. She wanted to try something the NHS didn't think was likely to be any significant help, and she found someone to pay for that for her. She had a good survival time.

I can find anecdotes like that, except the extra treatment was homoeopathic. We have no idea why she had the longer survival time. Might have been an unusually good response to the NHS drugs. Might have been an unusually good response to the new drug. Might have been a pure fluke.

But get this. If the drug in question had been guaranteed, or even pretty likely, to produce that result, THE NHS WOULD HAVE FUNDED IT IN THE FIRST PLACE. It was only "denied" because the evidence suggested it wouldn't do much good.

This is not "rationing of care", it's evidence-based medicine.

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.

Our words say that we choose to cover everybody resident in the country for all the evidence-based medicine that they need, up to a ceiling that's so high it's in the realms of marginally-effective drugs that don't cure and may only prolong the dying process for a few weeks.

Your country leaves many people to their own resources, so that the ceiling on their coverage is approximately floor-height.

And you have the gall to criticise us because our ceiling isn't even higher?

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.

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.

You have absolutely no evidence that this equation has any basis in reality. On the contrary, costs are spectacularly lower in universal healthcare systems where the government is very much in. This is a fact.

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.

In the NHS, anyone can access the healthcare they need, without being asked to pay a penny (except for the prescription charge if they are eligible to pay it). It's reality, regardless of xjx388's fantasies.

Sociological factors lead to inequalities in practice, but this is not because the NHS is denying anything to anyone, on the contrary there are strenuous efforts being made to even out these inequalities. That's why you can find articles about it.

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.

But the NHS doesn't tell these people that their treatment isn't covered. If you lived here, you would never be told that the NHS wouldn't pay for your treatment. Nikki Blunden got high-quality cancer care, free. She wanted a drug the NHS didn't think was likely to do her any significant good. We still don't know whether it did or not, because a case series of one is insufficient data.

Obese people and alcoholics get all the care the NHS can give them. They can't get care that is clinically inappropriate for their individual circumstances. This is what you appear not to understand.

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.

Ah. Liberty. What liberty would that be then?

Please, please tell me what liberty (meaningful actual liberty I mean) you have that I don't?

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 yet, when we tell you that Ducky would have been treated free if he'd been a UK resident, that means nothing to you. Because of one tabloid story about one woman who wanted even more than the large amount the NHS had already given her, and because of some bizarre notion about "liberty" that I'll just bet you can't explain rationally.

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.

It may not have stopped you, but then you had that brilliant, high-earning wife. It does stop other people. Just not everybody.

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.

Indeed, you do need to fix your system. I see no evidence that free markets work in healthcare. Find me a real free market in healthcare, if you can, and I'll show you one where access is extremely restricted.

We're showing you one system where access is for 100% of legal residents, to an extremely high ceiling of coverage for everyone. And we point out that there are other systems doing pretty well too. Just not yours.

You have no rational reason for rejecting these examples other than blind ideology.

Rolfe.

 

[Agatha]

Your continuing efforts to personalize this argument are ridiculous. Stick to the facts.

Sacrifice = putting your immediate wants aside in the near-term to achieve a more rewarding want in the far-term. Personal responsibility = finding your own way through life without using the crutch of "welfare." Two concepts many Americans have forgotten about . . .

That's me on the street then. Are you going to address the issue of people with lifelong chronic illness at all? Someone earlier pointed out that some people in the US were making the decision between asthma/type 1 diabetes meds and food. Or do you plan to respond to any of Rolfe's unanswered posts?

Emet, it might be this data: http://www.photius.com/rankings/world_health_systems.html which shows that the USA spends more per capita than any other country on healthcare, and rates 72nd of 191 countries on "level of health performance". The UK comes 26th in the spending table, and 24th on the level of health performance.

 

[Rolfe]

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

And you have shown no evidence that they don't. Other than that one tabloid story about a woman who wanted even more, on top of the state-of-the-art treatment she had already received, wanting something the NHS didn't provide because the evidence suggested it wasn't likely to do her any significant good.

If the evidence showed that the drug in question would indeed predictably provide the sort of benefit you claim the woman experienced, get this, the NHS would be funding it.

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.

Epic fail. An alcoholic will get a liver transplant, subject to the availability of a suitable organ, if the transplant team believe there is an acceptable chance that the operation will be a success. If there is a very poor chance that the operation will be a success, then no, it won't be done. This is not rationing. This is good medicine.

This won't stop the NHS making every effort to get that patient to the point where there is an acceptable chance of success, and so on to the transplant list. Yes, that may involve stopping drinking. Sometimes there's nothing you can possibly do for someone who can't take that level of personal responsibility, no matter how much you might want to. That's not rationing. That's reality.

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.

The NHS will work with the patient to treat the hip in the best way for that individual patient. That will include every possible help with weight loss. It's not "rationing", and it's not "OK for the person to suffer pain for the rest of their life." But doing an operation which is pretty certain to fail and leave the patient in an even worse situation than before is again, bad medicine.

My cousin is diabetic, and let's just say she has a weight problem, and she needed a hip replacement. She went to see the orthopaedic team for an assessment. She was actually fast-tracked there by her GP because her hip was deteriorating so fast. The surgeon did her assessment, and pronounced her "sub-optimal". But decided to go ahead anyway because he thought it was the best option for her - other options were worse. She got the new hip, and she's been fine. This isn't rationing, it's good clinical practice.

My friend who was morbidly obese had a gall bladder problem. She saw the surgeon, who said that her best option was keyhole surgery, but that couldn't be performed unless she lost a stonking amount of weight. She was offered a choice. Lose the weight, with help, and get the keyhole surgery, or don't, and be managed differently. She chose to go for it, and was prescribed a complete emergency weight loss diet. Hey, no grocery bills for her while she was on it! It was mainly liquid with the odd biscuit as far as I could see. Every "meal" was properly nutritionally balanced. She began to lose weight visibly and spectacularly, and said she felt better than she had in years.

What would have happened if she hadn't had the personal responsibility to stick with that prescribed diet? I don't know, because she did, but she wouldn't have been told to go away and suffer, her gallstones would have been treated in a way appropriate for someone who was morbidly obese. She might have had a different type of surgery.

This is the sort of story you are misinterpreting. It's not rationing. It's good clinical practice.

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

What would you have? Equality of access for all, free of charge, to a very high ceiling, or a situation where some people have virtually no access and many are bankrupted by the costs?

Yes, we know. You prefer the latter, for no reason anyone can see,

Rolfe.

 

[Rolfe]

"Nobody needs to worry about the funding for any future healthcare needs because it's sorted." = covering everyone's future needs perfectly.

To certain definitions of perfectly. I for one am not over-concerned about the NHS not approving extraordinarily expensive cancer treatments that only might extend my dying process by a month or two.

Flukes happen, but they happen the other way too. I'm a fan of evidence-based medicine, and the NHS is doing a pretty good job on that front.

Rolfe.

 

[Uncayimmy]

Your continuing efforts to personalize this argument are ridiculous. Stick to the facts.

It was you, not I, who shared the story of teenage pregnancy, so don't accuse me of "personalizing" the discussion. It cuts both ways. You can't share a story of your personal triumph of personal responsibility then cry foul when somebody throws it back in your face.

Are you going to answer the question or not? Who paid for the delivery of your child?

Sacrifice = putting your immediate wants aside in the near-term to achieve a more rewarding want in the far-term.

Is that what you did when you decided to have a child and depend on your family to support you?

Personal responsibility = finding your own way through life without using the crutch of "welfare." Two concepts many Americans have forgotten about . . .

Right. Just use the crutch of your family. You know, if you have one.

Look, if somebody could assure me that 100% of my tax dollars went to only those who needed it, I'd be thrilled. That will never happen. What I want is my tax dollars to get the best bang for the buck in terms of helping those who need it while preventing people from milking the system. As long as there's an ongoing effort to do that, I'm okay with it. Nobody in my family needs my assistance right now. Same for my friends. Personally, I don't object to paying some taxes on an ongoing basis so that should any of them (or us) need it, it's there.

I'm actually okay if your child's birth was subsidized with my tax dollars. I'm okay if some of my money paid for her education. I'm okay that my tax dollars pay for the research she uses to make a profit in her business (it's not like she's actually discovered anything useful on her own). I just find the lines you draw to be hypocritical and not well thought out. You have yet to come up with any reasoning for drawing the line where you do.

 

[Emet]

Emet, it might be this data: http://www.photius.com/rankings/world_health_systems.html which shows that the USA spends more per capita than any other country on healthcare, and rates 72nd of 191 countries on "level of health performance". The UK comes 26th in the spending table, and 24th on the level of health performance.

Thanks, Agatha. I, of course, already knew that-- thanks to you and others.

The link xjx provided requires a lot of searching. This is a forum where one should present easy to read data. Unless xjx wishes to take screen shots, or link to his explicit claims, it isn't worth my time. He has presented no compelling arguments or evidence that I can recall.

There's plenty of readily available data links already on this thread that have provided lots of evidence to support my claim, yours, and many other posters. (I read all of your posts, Rolfe. )

 

[Rolfe]

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.

That is now becoming a lie, as you have had it explained to you so often that you're wrong.

Giving people the care appropriate to their individual circumstances, while at the same time giving them every possible assistance to get themselves in shape for more effective treatment, is not rationing.

No doctor ever says, "Too bad we can't do your surgery. Suffer/die." If surgery is the best option, the patient will get the surgery, even if they're "sub-optimal". If surgery is not the best option, they won't get the surgery. That isn't rationing, that's good evidence-based medicine.

Rolfe.

 

[Architect]

I still can't wait to see XjX's explanation as to why we live longer for half the healthcare costs. Especially given her unsubstantiated claims of UHC rationing. It's been strangely absent so far.

 

[Rolfe]

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 agree that the health insurance industry isn't the whole story, for sure. But you're missing an awful lot with your cherry-picking of posted profits.

The health insurance industry pays out for huge corporate HQs, private jets, huge salaries and bonuses for the top executives, ordinary salaries for enormous armies of ordinary staff, advertising, sales representatives, all sorts of stuff that's pure waste but isn't profit.

It also imposes large costs on the healthcare providers. One GP spoke of having to employ four secretaries just to deal with insurance paperwork. Hospitals have to employ armies of staff to deal with the intentionally complex administration imposed on them by insurance companies. Just re-read the OP.

I don't know how you add all that lot up, but if you could, it's going to come to a lot more than 0.0034% of healthcare spending.

Rolfe.

 

[Architect]

As I read and re-read this thread tonight, one line in particular sprang to mind. It's not in my own language, albeit that I've always found it a particularly compelling piece of work in these difficult political times, however I find it particularly relevant. Apologies to the non-lowland Scots amongs you.

Your doctrines I maun blame, you will hear, you will hear

For that is, I fear, what XJX's position and those of the others on the US right wing is based on; not what is right, nor what is wong. Not compassion, and certainly not Christian compassion. Rather, it is doctrine. And they are, indeed, to blame.

 

[xjx388]

All drugs that have passed NICE (or equivalent) scrutiny as being cost-effective are covered for all people. The sort of things that make the headlines as being "denied" are what you're talking about - something that might extend the dying process by about six weeks, at the cost of tens of thousands of pounds.

That's the operative phrase here. They craft their guidelines putting costs ahead of care as evidenced by the three year recommendation for breast cancer screening.

If you're going to go on clinging to your terminally broken system until you can find something that will unquestioningly cough up millions for almost no benefit for whatever wizard wheeze the pharmaceutical companies just thought up, you'll have a long wait.

I don't want to cling to anything. I want a change. You say health care is a right, but you aren't willing to cough up the millions it takes to truly give it to people who need it?

Meantime, back in the USA, when someone says "some drugs are not covered", they're talking about quite ordinary, well-established things that are available to others with no trouble. For God's sake, Accutane???

Oh and so you pop over to the dermatologist whenever you feel like it and they just give you Accutane with no trouble? I hardly think so. According to this document, they must be referred to a dermatologist but only under certain conditions and after having tried other treatments. Anecdotally, it took a friend of ours in the UK two years to get her GP to refer her. Here in the US, your GP (Family Medicine) can take care of the whole thing. If your severe cystic acne doesn't respond to first-line treatment, you can get Accutane within a few months. I have not heard of any issues with covering it, although it is at a higher "copay."

Your system denies treatment to thousands of people, more or less on the whim of the insurance company. Insurance loss adjusters regularly over-ride the doctor's advice and deny something as "not medically necessary". Not brand new, eye-poppingly expensive drugs that won't stop you dying anyway, but ordinary, standard care.

So you find the extremely high ceiling on "rationing" in the NHS, and point to an exceptional case or two that made headlines, as if that weighs against the routine denials of basic care that go on all the time in the USA.

Hypocrite.

Define ordinary standard care. Cite sources of when such has been routinely denied, then we can talk. Until then all you've got is ranting and insults such as that last little bit there.

 

[xjx388]

It was you, not I, who shared the story of teenage pregnancy, so don't accuse me of "personalizing" the discussion. It cuts both ways. You can't share a story of your personal triumph of personal responsibility then cry foul when somebody throws it back in your face.

Are you going to answer the question or not? Who paid for the delivery of your child?

Both our families pitched in for the medical care. What a concept . . . families who love each other taking care of their own! Bah! Better to just let the nanny-state do it, right?

Is that what you did when you decided to have a child and depend on your family to support you?

Ah, moral judgement! Why am I not surprised by this? We were two kids in love who fooled around. Happens everyday. We could have gratified our immediate needs and driven down the dead-end road that lead to. Instead, our family helped lift us out of that. If not for them, there's no way she could have accepted her scholarship.

Right. Just use the crutch of your family. You know, if you have one.

That's pretty warped to think of a loving family as a crutch. As for those who don't, I have no problem giving them a helping hand with my tax dollars. I have a problem with those who make it a lifestyle. It should be used as a stepping stone to better things. That's why we need to cut Welfare significantly not increase it.

Look, if somebody could assure me that 100% of my tax dollars went to only those who needed it, I'd be thrilled. That will never happen. What I want is my tax dollars to get the best bang for the buck in terms of helping those who need it while preventing people from milking the system.

On this we agree 100%.

As long as there's an ongoing effort to do that, I'm okay with it. Nobody in my family needs my assistance right now. Same for my friends. Personally, I don't object to paying some taxes on an ongoing basis so that should any of them (or us) need it, it's there.

Forever? For an able bodied/minded person?

I'm actually okay if your child's birth was subsidized with my tax dollars. I'm okay if some of my money paid for her education. I'm okay that my tax dollars pay for the research she uses to make a profit in her business (it's not like she's actually discovered anything useful on her own). I just find the lines you draw to be hypocritical and not well thought out. You have yet to come up with any reasoning for drawing the line where you do.

What lines do you think I'm drawing that are hypocritical?

 

[Architect]

Oh the irony!

You find one case of a drug of doubtful worth being denied on the NHS and it's "proof" of cost-led rationing.We find many first-hand examples in the US and it's hand-waved away.

Ah yes, I maun blame.

Or, to (badly) translate phrase from my language, your position seems as steady as an egg on a stick.

 

[Ampulla of Vater]

I still can't wait to see XjX's explanation as to why we live longer for half the healthcare costs. Especially given her unsubstantiated claims of UHC rationing. It's been strangely absent so far.

Jack Rosser and Albert Baxter come to mind here.

 

[Tatyana]

OK, but there are plenty of people in the US -Men being a great example - who don't go to the doctor until something is really wrong. Yet, despite "universal access" compared to the US, your cancer survival rates are significantly worse.

You guys are the ones saying that the NHS provides comparable or better outcomes than the US system for less money. You provide surveys and flawed WHO reports to "prove" your claim. I show you the raw data proving the US has better mortality rates in cancer and your reasoning is that people in the UK don't use the free care given to them. But, I could just as easily conclude, based on the evidence I've seen, that the NHS refuses life-extending treatments based on cost-effectiveness.

Again, as with most of the medical issues, some knowledge is lacking, and there are no links to the evidence.


Yes, the US does quite well with treating cancer in those who get treatment.

You know who also did really well in cancer survival rates? Canada, Japan, Australia and France, all countries with UHC.

If you want to argue of the one or two percent difference in survival, so be it, however, this could be issues with how cancer survival is recorded and/or reported (see below).

http://news.bbc.co.uk/1/hi/health/7510121.stm
Huge gap in world cancer survival

It isn't the UHC.

However, how cancer survival rates are determined can vary, so it isn't always that easy to compare.

There are age-standardised adjustments and as well, different countries have a tendency to have more or less of a particular type of cancer.

You can cherry pick the two cancers that white Americans have great survival with if you like, it is good news for those who do have the money for insurance, however, it isn't good new for those who don't.

http://www.businessweek.com/lifestyle/content/healthday/640380.html
Poor Breast Cancer Survival in Blacks May Not Be Due to Race
Many factors, including access to health care, could affect outcome, analysis finds

You can take 10-15% off the survival rates for poor and rural Americans.

http://iccnetwork.org/cancerfacts/ICC-CFS6.pdf


These are the UK 10 year cancer survival rates, it isn't as if the NHS isn't aware that we haven't done as well with cancer.

It is being addressed.

Just to be fair, I will also post the different cancer survival rates in the UK between the most and least deprived.

It rarely comes close to 10%.

 

[kellyb]

I have a problem with those who make it a lifestyle. It should be used as a stepping stone to better things. That's why we need to cut Welfare significantly not increase it.

Who in the US is on welfare as a lifestyle nowadays?
Did you ever hear about this?

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