Health care - administrative incompetence

Speaking of that...does the NHS do its own lab work and imaging?

I'm another sob story about health care debt, in my case, from having the audacity to start having gran mal seizures post partum after the birth of my first kid. I kept waking up in the ER.
Now, most of the bills I got were not even from the hospitals...it was from a variety of lab companies and radiology companies, etc, that I guess have "satellite operations" in hospitals?


Yes. the NHS labs are absolutely state-of-the-art. We have discussed before how US laboratory medicine is in the dark ages, relatively speaking.

As someone in Britain with a career in private (veterinary) laboratory medicine, I know that the standards of the NHS labs are something I can strive for but never attain.

The presence of the NHS labs, their expertise, and their staff dominating in organisations such as the ACB, means that everybody is the richer, including people like me, and the biochemists and haematologists and pathologists working in the private hospitals, who know damn well they have to keep up.

Rolfe.
 
But the whole 'lack of responsibility' thing is extremely pertinent when you are talking about taking even more of my hard-earned money to pay for people who, as a result of their bad choices, are needy. I'm not talking about the Ducky's of the world; I'm talking about the high school drop-outs that have 3 children by 3 different fathers before the age of 18. Why should I be forced to support that?

<snip>

Because maybe with the right interventions their children will not get involved in gangs and end up shooting you and/or your kids, but instead become productive members of society.

Or you can continue spending your money on building an ever more elaborate prison for you and your family to try to keep them from hurting you.
 
Because maybe with the right interventions their children will not get involved in gangs and end up shooting you and/or your kids, but instead become productive members of society.

Or you can continue spending your money on building an ever more elaborate prison for you and your family to try to keep them from hurting you.

That's really the point. You don't have to have compassion: you don't have to be a left wing, pinko commie librul. You just need to have an eye on the costs.

Pay a relatively small amount now to help those "lazy freeloading" disadvantaged folks-- and I'm not saying government is necessarily best capable to do so directly.

Intervene early-- help folks improve the quality of their lives and be contributing, tax paying members of society--or do nothing, and pay a fortune to keep them incarcerated.


By the way, many folks don't realize that they are subsidizing the uninsured right now through their health insurance premiums. The Taxpayer directly pays the cost of Medicaid, so the very poor are insured.

Study: Insured pay 'hidden tax' for uninsured health care

5/29/2009

WASHINGTON — The average U.S. family and their employers paid an extra $1,017 in health care premiums last year to compensate for the uninsured, according to a study to be released Thursday by an advocacy group for health care consumers.
(...)
"I don't think anybody has any idea about how much they are paying because of the need to cover the health care costs of the uninsured," said Ron Pollack, the group's executive director. "This is a hidden tax on all insurance premiums, whether it is paid by business for their work or by families when they purchase their own coverage."
(...)
California Gov. Arnold Schwarzenegger, a Republican, said in a health care speech earlier this month: "We've got to stop that hidden tax. Everyone must be insured."

http://www.usatoday.com/money/industries/insurance/2009-05-28-hiddentax_N.htm
 
I've certainly picked up a helluva a lot of dogs with that condition, just by ordering an electrophoresis if I didn't like the look of the total protein/albumin results. However, it's not a dead cert that you'll spot it.

It's not the poor practice per se that I'm querying, because there are idiots everywhere and NHS doctors are known to have done some brain-dead things too. It's the lack of repercussions I'm baffled by. (We know about the NHS doctors doing it because it's all over the newspapers at the time and then again when the GMC has its hearing into the incident.)

It's also the apparent absence of a compulsory system of CME and re-validation to try to spot and correct sub-standard practitioners before they kill someone. If medical practice in the USA is as great as they keep telling us, where are these simple, standard safeguards?

Rolfe.

You finding paraproteins in pets is exactly what I meant.

I know quite a few labs automatically generate a protein electrophoresis if the total protein or globulin is too high or too low.

A lot of patients have a MGUS (monoclonal gammopathy of undetermined/uncertain significance), tracked for years as it can remain at < 5 g/L.

In the US system, you wouldn't want an MGUS to be found, they often don't amount to anything, they could be the result of a chronic infection, however, it could mean you have increased insurance premiums or never get insurance again.

My query is: If a laboratory generated additional tests on a patient and found something, would that be another out for the insurance company? If the insurance companies refuses to cover, then is the lab sued to cover the medical costs?

From some of the things that were posted from the congressional hearing, I think that this may be the case and the laboratory and/or any other diagnostic lab just wouldn't take the risk, especially if they are private entitites.
 
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You finding paraproteins in pets is exactly what I meant.

I know quite a few labs automatically generate a protein electrophoresis if the total protein or globulin is too high or too low.

A lot of patients have a MGUS (monoclonal gammopathy of undetermined/uncertain significance), tracked for years as it can remain at < 5 g/L.

In the US system, you wouldn't want an MGUS to be found, they often don't amount to anything, they could be the result of a chronic infection, however, it could mean you have increased insurance premiums or never get insurance again.

My query is: If a laboratory generated additional tests on a patient and found something, would that be another out for the insurance company? If the insurance companies refuses to cover, then is the lab sued to cover the medical costs?

From some of the things that were posted from the congressional hearing, I think that this may be the case and the laboratory and/or any other diagnostic lab just wouldn't take the risk, especially if they are private entitites.

I can't speak with direct knowledge here, but my guess is that it doesn't happen in the US.

MDs order tests; MDs evaluate tests and order additional tests based on the results. I can't imagine a scenario where the laboratory acts on its own-- unless a test ordered specifies additional testing with abnormal results.

ETA:

http://www.labtestsonline.org/understanding/analytes/electrophoresis/test.html

When is it ordered?
Protein electrophoresis may be ordered when a doctor is investigating symptoms that suggest multiple myeloma, such as bone pain, anemia, fatigue, unexplained fractures, and recurrent infections. It may also be ordered as a follow-up to other laboratory tests, such as an abnormal total protein and/or albumin level, elevated urine protein levels, elevated calcium levels, and low white or red blood cell counts. Immunofixation electrophoresis is usually ordered when the protein electrophoresis test shows the presence of an abnormal protein band that may be an immunoglobulin.
 
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I just don't understand this recurrent theme in the healthcare debate. Everybody else has politicians they'd happily roast over a slow fire too, but still the governments manage a reasonable job of delivering public services. We're far more afraid of David Cameron hiving off the NHS to the private sector than anything else.

What is it about the USA, the country which likes to present itself as the place everybody is envious of, that it has politicians too uniquely stupid or too corrupt to manage what everyone else takes for granted?
It's not that the government can't manage healthcare reasonably well. It's that 1)The American people don't want the government managing it and 2)The private sector can manage it much better.

Speak honestly now: If the NHS is so Universally Loved in the UK, then how can David Cameron even have a plank of his platform about "hiving off the NHS to the private sector?" It should be political suicide, no? Yet somehow, he's the Prime Minister . . . :confused:

I've heard all this before too. Everybody has freeloaders, and everywhere complains about them. We complain about people with eight kids sitting in a council house on the dole, in much the same terms as you do.
Why do you complain about these people? You don't mind them getting an expensive transplant or spinal surgery, but you would deny them 1)Rights to have as many kids as they want to, 2)A publicly provided shelter and 3)Publicly provided food. So, in your mind Healthcare is a fundamental right, but not Food and Shelter . . . . hmmmmm a bit of a disconnect there I think.

What we do not complain about is these people getting the same level of healthcare as everybody else, just the same way as we don't complain about them being allowed to run their beat-up bangers on the public roads, or being allowed to walk in the public park or borrow a book from the public library or send their kids to the local school. The idea of saying, that person's diabetes or cancer shouldn't be treated because they're a dead-beat, is quite literally shocking.
Oh, I see: Driving is a right! Parks are a right! Libraries are a right! Education is a right!

No Rolfe, those things are privileges that a wealthy nation can provide to it's citizens. Just to be clear here: You don't complain about them getting access to the privileges of a modern society, but you complain when they have 8 kids and mooch off the public food and shelter. How do you resolve the cognitive dissonance implicit in such a position?

It's back to the Victorian concept of the deserving and undeserving poor, which I kind of thought we'd managed to move beyond.
Unless of course they need food and shelter. Moochers!

OK, complain about the undeserving poor as much as you like, as regards subsidised accommodation and food. But as a reason to deny the entire country the benefits of a universal healthcare system, just because some people who are a bit feckless might get their diabetes treated properly, makes cutting off your nose to spite your face look positively rational.
But those same feckless people who get their diabetes treated shouldn't live off the public dole for food and shelter? Hmm, interesting. Don't deny the public the benefits of healthcare, just don't provide them with the benefit of life-giving food and shelter. Got it. I wonder what the NHS would recommend for treating malnutrition?

I think you've exposed a hole in your thinking here, Rolfe.


Well, that's how it works here. The NHS isn't the government. The NHS is paid for by the government. It's run by the doctors, although the government does tweak them a bit by hypothecating payments to encourage things it sees as desirable outcomes, such as high uptake of vaccination and screening programmes.

Uh, Rolfe, anything paid for by the government is run by the government. This is like saying, "The IRS is not the government. The IRS is paid for by the government. It's run by the agents, although the government does tweak them a bit by hypothecating payments to encourage things it sees as desirable outcomes, such as making sure people pay their taxes and punishing those who don't." :boggled:
 
I think you are either misreading Rolfe's posts, or you are filtering what she is saying through your own ideological views.
 
I think you are either misreading Rolfe's posts, or you are filtering what she is saying through your own ideological views.

Really? How does one misread:
Rolfe said:
We complain about people with eight kids sitting in a council house on the dole, in much the same terms as you do.
Rolfe said:
Ok, complain about the undeserving poor as much as you like, as regards subsidised accommodation and food.
Seems pretty clear to me.
 
It's not that the government can't manage healthcare reasonably well. It's that 1)The American people don't want the government managing it and 2)The private sector can manage it much better.

1) Rightwingers don't want the gov managing it

2) This is a claim that, if true, can be supported by evidence. So, where's the evidence?
 
xjx388,

What type of services can the private sector *not* manage as well as government? If you think there are some services government should fund through taxation, what are the significant differences between these services and healthcare?
 
1) Rightwingers don't want the gov managing it
And the results of the last election show that the American people agree with them.

2) This is a claim that, if true, can be supported by evidence. So, where's the evidence?
The private sector works to distribute the two fundamental human needs 1)Food and 2)Shelter. In healthcare markets that are completely private sector: 1)Vetrinary medicine, 2)Lasik, 3)Cosmetic surgery and 4)Self-pay primary care, it works just fine.
 
xjx388,

What type of services can the private sector *not* manage as well as government? If you think there are some services government should fund through taxation, what are the significant differences between these services and healthcare?

Defense is the big one. We need unified National Armed Forces for the common defense.

Police, Fire - Same concept.
 
And the results of the last election show that the American people agree with them.

The private sector works to distribute the two fundamental human needs 1)Food and 2)Shelter. In healthcare markets that are completely private sector: 1)Vetrinary medicine, 2)Lasik, 3)Cosmetic surgery and 4)Self-pay primary care, it works just fine.

There is nothing inherently expensive about food and shelter. Do you not see how this is different from, say, Ducky's treatment?

Lasik and cosmetic surgery aren't needed to keep people alive. You don't have to participate in the market if you don't want to. How is this in any way close to the market forces with ER care and cancer treatment?

Or, are you saying we really need more people (like, say, Ducky) opting out of those markets due to lack of affordability, to bring prices down?
 
It's not that the government can't manage healthcare reasonably well. It's that 1)The American people don't want the government managing it and 2)The private sector can manage it much better.


Well, the private sector is making a right pig's ear of it. If your government is going to do it so much worse, then I think you need a new government.

Speak honestly now: If the NHS is so Universally Loved in the UK, then how can David Cameron even have a plank of his platform about "hiving off the NHS to the private sector?" It should be political suicide, no? Yet somehow, he's the Prime Minister . . . :confused:


Because he had no such plank in his platform. He said, loud and long, during the election campaign, that the NHS was safe in his hands. That he knew how great it was and how much people relied on it, because of his experience with Ivan. If he'd had a breath of a hint about hiving the NHS off on to the private sector, we would not have a Tory government right now. He said the exact opposite, during the election.

We believed him. (I didn't vote for him, but I actually did believe that bit of propaganda, because of Ivan. Time will tell how wrong I was.)

Why do you complain about these people? You don't mind them getting an expensive transplant or spinal surgery, but you would deny them 1)Rights to have as many kids as they want to, 2)A publicly provided shelter and 3)Publicly provided food. So, in your mind Healthcare is a fundamental right, but not Food and Shelter . . . . hmmmmm a bit of a disconnect there I think.


Oh, I don't complain about them, really. But people do, you know. Complain if you like, no skin off my nose. Sells tabloid newspapers and keeps third-rate journalists off the streets. I certainly wouldn't deny people any of the things you suggested I would.

What I was pointing out was that in Britain you will certainly hear people grumbling and complaining about "scroungers" getting subsidised housing and unemployment benefit. You will never hear people complaining about anyone getting free healthcare, any more than you'd hear them complaining about free schooling for their children.

Oh, I see: Driving is a right! Parks are a right! Libraries are a right! Education is a right!

No Rolfe, those things are privileges that a wealthy nation can provide to it's citizens.


You need to be clearer about what rights are. Rights are things that a society grants to its members. So yes, driving on public roads is a right, if you have a car which is legally taxed and MOTed. Going into public parks is a right. Joining a public library and borrowing books is a right. Sending your children to the local school is a right (indeed, it's an obligation unless you can convince the authorities that you have adequate alternative arrangements in place).

And in Britain, healthcare free at the point of need is a right.

You guys have a different society which has decided on a different set of rights. Your privilege.

Just to be clear here: You don't complain about them getting access to the privileges of a modern society, but you complain when they have 8 kids and mooch off the public food and shelter. How do you resolve the cognitive dissonance implicit in such a position?

Unless of course they need food and shelter. Moochers!

But those same feckless people who get their diabetes treated shouldn't live off the public dole for food and shelter? Hmm, interesting. Don't deny the public the benefits of healthcare, just don't provide them with the benefit of life-giving food and shelter. Got it. I wonder what the NHS would recommend for treating malnutrition?

I think you've exposed a hole in your thinking here, Rolfe.


You're not getting it, are you. I'll say it again. Some people in Britain, people who read the Daily Fail and suchlike, complain about people having 8 kids and mooching off public food and shelter. It's a national pastime. However, you will not hear these complainers complaining about the "scroungers" having access to free healthcare.

It was a statement about societal attitudes in Britain. Work it out.

Uh, Rolfe, anything paid for by the government is run by the government. This is like saying, "The IRS is not the government. The IRS is paid for by the government. It's run by the agents, although the government does tweak them a bit by hypothecating payments to encourage things it sees as desirable outcomes, such as making sure people pay their taxes and punishing those who don't." :boggled:


How you imagine a universal healthcare system could be implemented without it being paid for at least to some extent by the govermnent, I have no idea. Feel free to elaborate though.

Rolfe.
 
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There is nothing inherently expensive about food and shelter. Do you not see how this is different from, say, Ducky's treatment?

Lasik and cosmetic surgery aren't needed to keep people alive. You don't have to participate in the market if you don't want to. How is this in any way close to the market forces with ER care and cancer treatment?

Or, are you saying we really need more people (like, say, Ducky) opting out of those markets due to lack of affordability, to bring prices down?

Growing, harvesting, transporting and distributing food is very expensive.
Planning, obtaining materials, building and maintaining a home is very expensive.

People can't opt out of these markets; everyone needs both. Yet somehow, we are able to feed and shelter 99% of our 300,000,000+ people through the free market.

Give me specific reasons why healthcare is different and I can point to a way the free market might help.
 
I'll say it again. Some people in Britain, people who read the Daily Fail and suchlike, complain about people having 8 kids and mooching off public food and shelter. It's a national pastime. However, you will not hear these complainers complaining about the "scroungers" having access to free healthcare.

It was a statement about societal attitudes in Britain. Work it out.


Maybe I should elaborate some more, as it seems I wasn't clear. The armchair fascists who complain about "scroungers" don't want these people to be deprived of food or shelter. They want them to get off their backsides and work for it, like everybody else. If you suggested that their wish was to see these people starving and living rough, they'd be horrified. (They don't necessarily think too clearly, they read the Daily Fail.)

However, they know that pretty much nobody, themselves included, can pay their own way for their potential healthcare needs. They understand without even needing to think about it that healthcare is provided to everyone with no exclusions, and that is right and proper.

Different societies, different mores. I know where I prefer to live.

Rolfe.
 
Growing, harvesting, transporting and distributing food is very expensive.
Planning, obtaining materials, building and maintaining a home is very expensive.

People can't opt out of these markets; everyone needs both. Yet somehow, we are able to feed and shelter 99% of our 300,000,000+ people through the free market.

Give me specific reasons why healthcare is different and I can point to a way the free market might help.

If worst comes to worst, you can grow your own food and build your own shelter.

How are you supposed to give yourself ER care?
 
1) Rightwingers don't want the gov managing it

And the results of the last election show that the American people agree with them.

No. The most important factor was the economy and the recession.


Majority Either Like Healthcare Law Or Want It More Liberal

December 29, 2010

You may have noticed the CNN/Opinion Research poll released earlier this week, which had this all too familiar top-line: 54 percent of voters oppose President Obama’s healthcare reform law. But drill down a bit and you’ll find another number familiar to those who have paid attention--but one generally lost amid the noise of the conservative healthcare narrative of backlash against government overreach. Only a relatively small minority of Americans dislike the new law because it’s too liberal.


"Do you oppose that legislation because you think its approach toward health care is too liberal, or because you think it is not liberal enough?"

Favor 43%

Oppose, too liberal 37%

Oppose, not liberal enough 13%

No opinion 7%

Or to put it another way, 56 percent of Americans either like the law or would prefer that it was more robust.

As Steve Benen notes:

So, when you see the top-line results and see that 54% oppose the law, this is not to say that 54% have bought into the right-wing demagoguery and think Republican criticisms have merit. On the contrary, one could look at the same results and say that a 56% majority either support the law or want it to be even more ambitious in a liberal direction.

http://www.usnews.com/opinion/blogs...e-healthcare-law-or-want-it-more-liberal.html
 

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