Health care - administrative incompetence

[Architect]

And then it turned out that our GPs were on a comparable salary.

Bizarre, isn't it?

 

[Garrison0fMars]

And then it turned out that our GPs were on a comparable salary.

Bizarre, isn't it?

Aw come on, don't you know all physicians in the NHS are literal slaves who live in internment camps run by Chairman Mao?

 

[Architect]

And apparently the public are dropping dead in the street from undiagnosed Strep Throat. We have special dustcarts to go around, just picking them up all day long.

Unlike 40,000 Americans who, it would appear, are being allowed to drop dead in the street every year because of crappy health coverage.

 

[Garrison0fMars]

And apparently the public are dropping dead in the street from undiagnosed Strep Throat. We have special dustcarts to go around, just picking them up all day long.

Unlike 40,000 Americans who, it would appear, are being allowed to drop dead in the street every year because of crappy health coverage.

Or none, what so ever. Neighbor of mine was recently sent home from a hospital after being diagnosed with cancer, with only "Tylenol". Suffice to say, I doubt he'll live very long..(and he has no insurance)

 

[Rolfe]

Having caught up a bit on the overnight postings, I see xjx388 hasn't even attempted to address any of his flagrant contradictions.

First, if it's essential for doctors' income to remain very high, how could it be in any way possible for the cost of labour-intensive medical and surgical procedures to come down to a level that could be afforded by someone making minimum-wage sort of money, simply by the operation of the free market?

You can't just say, oh if you deregulate and get the government out of it, it will happen. There is no known example of this happening anywhere in the world. On the contrary, the places where costs have come down very low (such as Japan) have achieved that by very stringent government intervention, and doctors' income is relatively modest as a result.

Second, how come it's OK just to hand-wave away the numerous US citizens who have big-ticket health needs they can never possibly afford, while obsessing constantly over one tabloid news report about one woman in England who got full state-of-the-art cancer care free from the NHS, but also wanted something that hadn't been approved as reliably safe and efficacious?

The NHS has been established with a very high ceiling on available care, and this ceiling is the same for everyone, no matter how impoverished. In the USA the ceiling for many people is effectively at floor level. Hands up anyone who'd rather entrust themselves to a US insurance company that might fund something that might actually make very little difference to your condition (or on the other hand might find a loophole to deny you any coverage at all), than to the NHS, which will treat you, whoever you are, right up to a ceiling that's so high your chances of even seeing it in your lifetime are minuscule?

You don't have to be a raving intellectual genius to be a doctor. You have to be respectably bright, but you also need other attributes such as good people skills, empathy, and a good balance between a caring attitude and becoming too emotionally involved with your patients. Medical schools these days are selecting candidates on more than just IQ and exam results.

It's far more important that a doctor's main motivation is helping the patients, rather than amassing large amounts of money. If the latter is the main driving force, go become a stockbroker or something. Doctors in Britain are very well paid, have a very nice lifestyle, and my school friend who went to medical school and married another doctor does have an ocean-going yacht. Frankly, anyone in a caring profession who wants more than NHS doctors are getting, is in the wrong job.

If it's possible to cover everybody's healthcare to a high standard, and not cripple the population with taxation, and pay doctors pretty well, then that's great. And it obviously is possible, because that's how it is in Britain. But for US citizens, especially those who are in the privileged position of living off a medical professional, to insist that super-rich salaries for doctors are more important than providing a decent standard of healthcare to their fellow-citizens, seems to me to be a complete losing of the plot.

Is it more important to provide decent, affordable healthcare that meets the needs of the patient (even if the patient is Ducky) to every US citizen, or to espouse a right-wing free-market ideology and prioritise medical income levels?

If it is the former, there is only one basic way to do that, and that is to have everyone in the country contributing to the insurance pool, and to have the contributions scaled not according to perceived risk, or even at a flat-rate level, but according to ability to pay.

In this way, people contribute more when they're healthy and able to work and bring in a good income, but reap the benefits when they fall ill (or just become old) and may not be able to work and contribute to at a high level. It's the only way to bring in a sufficient income stream to fund universal healthcare without bankrupting people earning minimum-wage sort of incomes.

Now how you administer this is a different matter. There are various models around the world. But that's what you have to do, and running around bleating about "free markets" and complaining about a non-existent speck in the NHS's eye while ignoring the pile of railway sleepers in the eyes of the US system is not going to help.

Rolfe.

 

[Architect]

That's his fault for being poor. Only the rich deserve to survive. Poor people are only poor because they don't work. And people who don't work are just slackers. And slackers deserve to die. Apparently.

 

[Garrison0fMars]

That's his fault for being poor. Only the rich deserve to survive. Poor people are only poor because they don't work. And people who don't work are just slackers. And slackers deserve to die. Apparently.

Apparently I deserve to die too Oh well, bad luck I guess...

 

[Darat]

...snip...

Now how you administer this is a different matter. There are various models around the world. But that's what you have to do, and running around bleating about "free markets" and complaining about a non-existent speck in the NHS's eye while ignoring the pile of railway sleepers in the eyes of the US system is not going to help.

Rolfe.

And has been mentioned by a few people - but I've yet to see xjx388 acknowledge - there was nothing stopping the woman getting the drug she wanted through the "free market", she certainly wasn't in any worse position than she would have been under the USA system. So it's a completely meaningless argument against adopting UHC in the USA, at best it exposes a problem with the UHC in the UK.

(Although rather ironically it is a problem that the current PM (of our most right winged government in decades) made part of his campaign to alleviate, and has apparently carried through on: http://www.bbc.co.uk/news/health-10772666)

 

[Wildy]

<snip>

Or you could do what Spain does and make organ donation an opt out programme instead of an opt in one have really bad drivers.

<snip>

Opt-out organ donations + bad drivers = good organs for all.

I never said this either. I said that any society that thinks healthcare is a right for all people cannot justify expenditures on luxuries until all of the healthcare needs of the people are met. Therefore, how can the British people justify the sums they pay their footballers, pop-stars, movie-stars, etc. while people are denied healthcare they need.

And when the British Government is doing that then maybe you would have a point.

I gave examples of people who have been denied in the UK (and if you think they are the only ones who have ever been denied anything, you are very, very naïve).

Examples? Well I remember you went on about Nikki Blunden, and that's not really being "denied healthcare they need". Before Nazir Mohammed decided to pay for the drugs she had already received quite a bit of healthcare that was paid for by the NHS. The fact that they wouldn't pay for lapatinib does not mean that the NHS is broken horribly.

I also said that people should be paid based on the value they provide to society. Teachers, doctors, etc. should be high on that list and footballers, etc. should be lower.

And you claim to believe in the free market?

Let me ask you this: Do I have a right to the fruits of your labor?

Well according to the man in Washington you would if you are poor, and the man in the Vatican would say so if you were God and a few decades ago the man in Moscow would say so because it belongs to the people.

Perhaps you could try the impossible and choose Rapture.


Seriously though, in a way anything that the Government is responsible for, like roads, the police, the fire department, are paid for by the fruits of your labour in the same way that they are paid for by the fruits of someone else's labour.

That's how the NHS works, by using the fruits of everyone's labour that they are entitled to to pay for healthcare.

Oooh, you made my head hurt. Could you start a new thread for that?

Rolfe.

Although on the plus side you wouldn't have to pay anything for the Aspirin to stop the pain.

 

[Agatha]

What saddens me most, I think, is the damage that your terrible healthcare system is doing. Not just to individual people, but also to America as a player on the world stage. You have bright people who could be making a contribution to your society - in taxes, in innovation, in science etc - and you keep them stuck in poverty traps, unable to study, unable to work, unable ever to reach their full potential. If Stephen Hawking had had the misfortune to be born in America, the world would almost certainly never have had A Brief History Of Time.

 

[Tatyana]

Not all doctors in the US are paid a lot of money. Typically, family doctors are not paid very much at all. This has lead to a tendency for doctors to go into specialty areas, where there is more money.

As people cannot access a general practitioners, and I have heard some medical journals assert that some of the less skilled doctors remain in the general practice, more patients want their care from specialists.

All of this is going to increase costs.

In the UK, there is a banding system for wages (agenda for change), that basically has jobs with equal education, responsibility and experience pay the same, so it doesn't matter if you are a general practitioner or a haematology consultant, the wages are equivalent.

There are incentives for various doctors, for example, if a certain percentage of their patients over 40 are screened for cholesterol, immunisation rates, control of diabetes, decreased incidence of nosocomial infections, etc

The New England Journal of Medicine has made the claim that your wife, xjx, would be financially better off under the new health care reform, as it stands now in the US.

http://www.nejm.org/doi/full/10.1056/NEJMhpr1006115
Health Policy Report
Health Reform, Primary Care, and Graduate Medical Education

Underscoring the concern over the scarcity of primary care providers and the income gap between generalists and specialists,9 the law awards a 10% bonus for 5 years under the Medicare fee schedule, beginning in 2011, to family doctors, internists, geriatricians, nurse practitioners, and physician assistants who provide 60% of services in qualifying evaluation and management codes. The adjustment will not change the fees that Medicare pays to specialists. The law also requires states to increase Medicaid payment rates to Medicare levels in 2013 and 2014 for providers who deliver certain primary care services.

 

[Garrison0fMars]

Not all doctors in the US are paid a lot of money. Typically, family doctors are not paid very much at all. This has lead to a tendency for doctors to go into specialty areas, where there is more money.

Well, the typical FP here is paid around 140,000 USD/yr. However...the typical FP upon graduation has something like 200,000 to 500,000 USD worth in student loan debt, top that with the fact that insurance companies make the life of an FP very very hard, they flee off to the very high paying specialties. The remaining FPs no longer hold their own practices, or work in small practices, they're all running off to hospital based systems (or in other words "socialized") like Kaiser, where they don't have to deal with insurance filing BS. If things stay the same I'd have to do the same (I plan to practice in primary care)

 

[Gandalfs Beard]

And has been mentioned by a few people - but I've yet to see xjx388 acknowledge - there was nothing stopping the woman getting the drug she wanted through the "free market", she certainly wasn't in any worse position than she would have been under the USA system. So it's a completely meaningless argument against adopting UHC in the USA, at best it exposes a problem with the UHC in the UK.

(Although rather ironically it is a problem that the current PM (of our most right winged government in decades) made part of his campaign to alleviate, and has apparently carried through on: http://www.bbc.co.uk/news/health-10772666)

Ah, yes! Fast-tracking unproven potentially deadly Pharmaceuticals to enrich Big Pharma Shareholders and Execs. The other piece of the "Free Market" exploitation of Health Care equation.

GB

 

[Agatha]

Does the given salary for US doctors take account of the amount they have to pay out in malpractice insurance and the additional student loan debt? Raw comparisons are going to be essentially meaningless if we're not comparing like with like.

 

[Garrison0fMars]

Does the given salary for US doctors take account of the amount they have to pay out in malpractice insurance and the additional student loan debt? Raw comparisons are going to be essentially meaningless if we're not comparing like with like.

Usually it doesn't afaik.

 

[Tatyana]

But South Africa was ours at that stage. Did you check whether they were still British citizens/subjects?

Exactly. My other half's grandfather was in New Zealand, but he was a British Naval Officer.

He has a five year ancestry visa. You can apply for Indefinite Leave to Remain after four years of residency.

 

[jimbob]

Going back to the OP. There are too many examples of poor care under the NHS - inevitable in such a large organisation. These are when the system is not working as it should and are rectified.

The problems in the US system are when it is working as its main players wish. I'd rather have the odd mistake that is remedied rather than the main providers systematically looking for reasons to refuse treatment.

 

[Tatyana]

Does the given salary for US doctors take account of the amount they have to pay out in malpractice insurance and the additional student loan debt? Raw comparisons are going to be essentially meaningless if we're not comparing like with like.

A medical student in the UK only has to pay for their first year of medical school, which is around £ 10, 000.

It might be higher now due to the Tory reforms.

However, if they manage to pass their first year, the NHS pays for the remainder of their medical training.

 

[Darat]

Going back to the OP. There are too many examples of poor care under the NHS - inevitable in such a large organisation. These are when the system is not working as it should and are rectified.

The problems in the US system are when it is working as its main players wish. I'd rather have the odd mistake that is remedied rather than the main providers systematically looking for reasons to refuse treatment.

Totally agree.

And this is further reflected in how the media in the two countries report the health-care news stories - it just isn't news in the USA for someone to be refused healthcare they thought they were insured for, or have to go bankrupt because of medical debts. However in the UK it is news when the media learns that even one person is being "denied" something that could potentially help them.

The NHS is far from being perfect (given that it treats millions of people every single year it must make many mistakes), but at the heart of the system is the right of people to healthcare, whereas in the USA at the heart of the system is profit.

 

[Delscottio]

Or none, what so ever. Neighbor of mine was recently sent home from a hospital after being diagnosed with cancer, with only "Tylenol". Suffice to say, I doubt he'll live very long..(and he has no insurance)

Before i joined this place i wouldn't have believed you, but surely that can't be it? It must rip the heart from the dr. as well to be fair.