single-payer system ... singled out

[Darat]

...snip...

I'll stand by my claim.

...snip...

Just a pity you couldn't find the evidence to support it.

 

[Ziggurat]

What's stopping Americans from taking a good look at the different systems, weighing the pros and cons and come up with their own workable solution?

And what makes you think people aren't trying to do that?

 

[Ziggurat]

No you don't since the systems actually exist and they work, to deny evidence and facts is not skepticism.

Evidence of what, pray tell? That those systems work in environments quite a bit different from ours? Oh, I believe that perfectly well. That they can be transplanted here and produce the same results? Well, where is the evidence for that? Matter of fact, where's the evidence that any country's medical system can be transplanted to another country and produce the same results? It doesn't exist.

 

[Mobyseven]

Fine. Drop the word simple.

Did anyone say that adopting another system would be?

Que sera, sera?

 

[Oliver]

Well, so I was right after all with my question?

Given the time-span, I will consider your dodging as a yes, Ziggurat.

 

[Darat]

Evidence of what, pray tell? That those systems work in environments quite a bit different from ours? Oh, I believe that perfectly well. That they can be transplanted here and produce the same results? Well, where is the evidence for that? Matter of fact, where's the evidence that any country's medical system can be transplanted to another country and produce the same results? It doesn't exist.

This is called a strawman since no one has argued for that.

 

[Architect]

I wonder how Ziggy is going to feel if we turn that argument of his around should he ever suggest that those of us in other countries should copy/learn from US practices in different fields?

 

[3point14]

I forgot how simple things seem from the outside. Healthcare is much more complicated than that. Firstly, a "denial" isn't final. It never is. The insurer is just one of several players in the game. Every practice has employees whose job it is to get the money out of them. That's what "reimbursement" is about. It's a whole industry in itself, with a complex set of rules and best practices and jargons. They have conventions. It's a career path.

Just because the insurer first says "we don't cover that", or says they'll stop at a particular dollar figure, doesn't mean it's so. Negotiation occurs. The patient doesn't have to do it all themselves. Most of the work is undertaken by their doctor's office, because they're the ones that want the money. There's drug replacement, and appeals. They won't cover x % of x drug? What about the secondary? File for Medicaid. Swing a deal with the insurer. Go through the contract again, not the insurer's contract with the insured, the practice's contract with the insurer. There are financial counselors, there are account reps, their are insurer reps, there are contract negotiators and auditors and things, and that's not even including the clinical people. Healthcare is a huge industry, did you really think that all the paperwork and bureaucracy and offices full of people pushing paper and fighting for money were all on the insurance side? The insurer wants to keep the money. The provider wants to pry it out. From the fact that doctors stay in business it's clear who's winning that war.



Uh, not everybody thinks Herceptin's "unproven". There are hundreds of cancer practices in the US who use it quite a lot, and quite successfully. It's main controversy is because it can damage the heart in some cases, so it's not risk-free. But not many drugs are. Cisplatin works well, but it may make you deaf. There's even one that kills cancer cells but can induce male lactation.

And as for the department for denied claims, that is totally standard. "Denied claims" isn't what it sounds like exactly. It's not final. It's perfectly normal to have people whose job it is to work the paperwork, and explain how to get the reimbursement from the various companies and government agencies. This isn't some sinister thing by the Herceptin people. Every drug company dispenses information on reimbursement to the practices, who use it. Just as every insurer dispenses information to the practices on which drugs they think work and deserve to be covered, and every practice (well, the larger ones) dispense information to the insurers on which drugs they want covered. (I don't think practices are allowed to talk to the drug companies, though, communication there is one-way.)

So, no, it doesn't suggest "desperate, dying US breast-cancer patients demanding herceptin also often face obstacles in getting the drug the advertising (and not the science) has convinced them they need?" Cancer patients tend not to demand particular drugs, most of which don't get advertised on television. Oncology is a field complex and serious enough that even patients leave it to their doctors. It's the doctors who prescribe the drugs, and they have departments full of people dedicated to making sure they get paid for that drug. (And if they don't, then most practices just eat the loss. But there are a lot of avenues that can be pursued before it comes to that.)



Everyone possibly faces bankruptcy with cancer. It's pricey. But as I've said, there are many avenues. Very few doctors will actually let someone die because they can't afford treatment.



I can only say that Herceptin is in wide use, and given its expense it's less likely to be prescribed if it didn't actually work. Think about it--the practice has to fight to get paid for it, and probably won't recover all of the cost. Given that, why on earth would we go on prescribing it if there were a better alternative?

I know healthcare is a political and divisive area. But the fact is, the whole industry is much more complicated than people know. I think it's the vocabulary that throws them-- "denial" sounds scary. And the bills don't help, with all those numbers instead of one single figure. There's the charge, the allowable, the insurance payment, the copay, the deductible, the write off...and then most medical bills come aged, which is further complicating matters. Healthcare is an elaborate dance between patient, provider, insurer, and government, with drug companies wafting in and out. It is not simple. And it's so hard to explain every nuance--even people who've been in the business for years don't know it completely.

Which is why I totally distrust news coverage, politicians' ideas, and media punditry on the topic of "healthcare industry", like it's a simple, monolithic, easily-understood entity. Oh god it's not. There can be no simplistic solutions because the system is complex.

I don't think I can possibly explain this any better.

Maybe there is a large amount of money to be saved somewhere in the system?

 

[Ziggurat]

I wonder how Ziggy is going to feel if we turn that argument of his around should he ever suggest that those of us in other countries should copy/learn from US practices in different fields?

Considering that I don't go around telling other countries they should copy from us, you'll be waiting a long time for that. And when it comes to learning something from the US, well, I've never said we couldn't (or shouldn't) learn from other countries. So this post displays quite a bit of ignorance about what I'm saying.

 

[Ziggurat]

This is called a strawman since no one has argued for that.

Yet you repeatedly use the cost savings of European systems (savings there is no evidence we would achieve) as a large part of your justification for arguing why we should change.

 

[Architect]

Considering that I don't go around telling other countries they should copy from us, you'll be waiting a long time for that. And when it comes to learning something from the US, well, I've never said we couldn't (or shouldn't) learn from other countries. So this post displays quite a bit of ignorance about what I'm saying.

With respect, you've spent a lot of time telling us all how our UHC type systems wouldn't work in your country, and damned little telling us what you might learn from them.

In fact the only thing I can ascertain is that (a) you really don't think you've any sort of duty to provid of reasonable standards healthcare for those less able to care for themselves, and (b) you don't think your government could run a piss-up in a brewery.

In fact the only thing we seemed to agree on was that it would be a good starting point to try and reform your medicare-aid system.

 

[Architect]

Yet you repeatedly use the cost savings of European systems (savings there is no evidence we would achieve) as a large part of your justification for arguing why we should change.

Listen, it's not as if there's just one or two comparable UHC systems chearper than yours - they all are. And we're not talking about a few dollars/pounds/euros/canadian dollars, either, but rahter a whole shedload.

 

[Bombastic Penguin]

snip

 

[Ziggurat]

With respect, you've spent a lot of time telling us all how our UHC type systems wouldn't work in your country

And absolutely no time telling you to copy us on anything.

and damned little telling us what you might learn from them.

And this is equivalent to denying that we can learn anything from anyone else... how? Oh, that's right, it isn't.

 

[Bombastic Penguin]

OK, so you feel that a UHC didn't give you the levels of care you believe you deserved.

Nice choice of weasely wording

How would a privatised system have been better? After all, as Rolfe has already pointed out, had you chosen to take private insurance, your overall costs would still have been lower than they would have been in the USA. This was an option available to you. If you couldn't afford privatised care, what makes you think you could have afforded it in a fully-privatised system, where premiums are necessarily higher?

Oh stop with the strawmen. I have penchant for the Singapore type of healthcare. For example, government can help out during a natural catastrophe where the private cannot. The only protest I make is in the area of Agorism, where the government and private sector should not mingle with each other.

I don't understand how you believe yours is an argument against socialized healthcare, rather than an argument for the specific care in your specific region to be improved. Rolfe's explained it well elsewhere - you're not entirely content with care you're entitled to. In the USA, you may not have been entitled to any care at all.

To further expand upon my opinion of socialized health: It's a form of glorified insurance that covers some areas of healthcare. Doesn't sound so sexy now does it? Question is why do you need the government to provide that insurance (form of protection racket nonetheless)?

As for the scandal ridden NHS? Okay, I'll bite. What are you referring to?

http://news.bbc.co.uk/2/hi/health/2339593.stm

http://www.thisismoney.co.uk/news/article.html?in_article_id=408740&in_page_id=2

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

http://www.timesonline.co.uk/tol/life_and_style/health/article4040146.ece

and Wikipedia even has its own subsection on NHS scandals:

http://en.wikipedia.org/wiki/Criticism_of_the_National_Health_Service#Scandals

And to respond to another point, risk of Crohn's depends on its treatment progress, or so I was told by the doctor. There are several other factors, such as pain, dysfunction etc... The low factor of death in your opinions' do not justify such exorbitant waiting periods. Then again, if it's convenient to the subjective mind.....

It's covered earlier in the thread. In detail, with links.

I'm not going to waste my time on a scavenger hunt, and speculating which link it is that I am looking for.

but posted a single reference suggesting that the US was "middle of the pack". We've therefore settled on simply saying that healtcare in comparable developed countries with UHC is at least equal.
But really, if you want to claim our healthcare standards are lower then do produce some linkys of you own.

Why ignore the wiki link? If you wish to claim that my and other's situations are esoteric, then back up that claim.

All provinces are under the scrutiny of the federal government due to the Canada Health Act. If the provinces want funding then they'll have to abide. The claim that this is provincial or only exclusive to a few hospitals is disingenuous at best.

 

[balrog666]

Nice choice of weasely wording



Oh stop with the strawmen. I have penchant for the Singapore type of healthcare. For example, government can help out during a natural catastrophe where the private cannot. The only protest I make is in the area of Agorism, where the government and private sector should not mingle with each other.



To further expand upon my opinion of socialized health: It's a form of glorified insurance that covers some areas of healthcare. Doesn't sound so sexy now does it? Question is why do you need the government to provide that insurance (form of protection racket nonetheless)?



http://news.bbc.co.uk/2/hi/health/2339593.stm

http://www.thisismoney.co.uk/news/article.html?in_article_id=408740&in_page_id=2

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

http://www.timesonline.co.uk/tol/life_and_style/health/article4040146.ece

and Wikipedia even has its own subsection on NHS scandals:

http://en.wikipedia.org/wiki/Criticism_of_the_National_Health_Service#Scandals

And to respond to another point, risk of Crohn's depends on its treatment progress, or so I was told by the doctor. There are several other factors, such as pain, dysfunction etc... The low factor of death in your opinions' do not justify such exorbitant waiting periods. Then again, if it's convenient to the subjective mind.....



I'm not going to waste my time on a scavenger hunt, and speculating which link it is that I am looking for.



Why ignore the wiki link? If you wish to claim that my and other's situations are esoteric, then back up that claim.

All provinces are under the scrutiny of the federal government due to the Canada Health Act. If the provinces want funding then they'll have to abide. The claim that this is provincial or only exclusive to a few hospitals is disingenuous at best.

To be fair, at least from my point of view, none of the arguments presented so far are intended to be an argument against the UNS systems most of these silly people have grown up with their entire lives (and who really know of nothing else), but only to be an argument against the US government running such a system (especially when we know just how badly the US government can screw up anything it touches [see Amtrak and Medicare and Medicare and AIG and Chrysler and GM and ...])

 

[Architect]

Now I'll come back to your linked scandals in a bit, but a quick question first. In framing a response I'm looking into similar scandals in the US, i.e. not disputing that serious problems occur but investigating the extent to which they occur in other systems.

Do you agree that this is a fair path to tread?

 

[Architect]

In the interim, there seem to be some major misconceptions about what many of us here are saying and it may be helpful if I clarify.

The critics of those promoting UHC seem to be suggesting that there are two choices; a government-run healthcare system along the lines of the UK model or an insurance led market similar to that currently employed in the US but with greater efficiencies. As far as I can tell, despite much prodding, there doesn't seem to be much recognition that there might be third ways.

Broadly speaking, UHC systems fall into two categories - a national health service model funded from centralised general resources (either in the form of income tax or, in the case of the UK, a separate national insurtance contribution) and those based on a regulated social insurance model which still involves extensive private sector input.

Germans, for example, are largely free to choose among social insurance funds, which to a limited extent compete for their business, and competition likewise occurs in the Netherlands and Switzerland because of the way their systems are structured.

I have yet to see a compelling argument as to why the US cannot look at all the systems and come up with one which would work in their domestic environment. Instead we have objections along the lines of "oh just because it works in 10 different other countries doesn't mean we can do it".

Let me also point out, since Balrog is back, that no-one has suggested that any such a system would prevent the public from obtaining additional private insurance should they so wish (just like in the UK). So any comments about "freedom" are really just oratory.

Next, let's look at costs. Most of the developed countries with UHC cluster in terms of expenditure, however the US costs roughly double this benchmark. What explains this? Well, so far we've seen a number of suggestions; better treatment, malpractice, administration, new medical technologies, generally high costs/prices. Yet, on a fair reading of the health statistics, Americans do not enjoy any better healthcare than the rest of us. So at the end of the day, it would appear that public healthcare financing systems are more effective than holding down overall costs without any reduction in clinical treatment indicators.

The final comment I'm going to make is about privatisation in the NHS.

Margaret Thatcher viewed competition as a way to challenge entrenched, inefficient, and unresponsive public services in education, municipal services, and health care. Health authorities were changed from being administrative offices to being purchasers. Hospitals, community health services, and specialists became semi-autonomous “trusts” that had to sell their services, although most just continued as before under contracts with their health authorities. Switching from global budgets to unit prices and setting up markets was very costly. Mrs Thatcher also viewed patients as consumers and encouraged them to be demanding. She then transformed the NHS from a public service for sick patients to a public system of purchasers and providers trying to please patients-turnedconsumers.

By 1996, the Conservatives (who were then in power) concluded that these competition policies were not working well. Competition required more regulation and government monitoring, because health care has so many kinds of market failure.The costs of setting up and running a market became apparent and large. The salaries of top managers escalated, and the number of managers at least tripled. Overall costs rose, not shrank. Procuring, say, cleaning from the lowest tenderer led to a drop in standards and some major scandals around the likes of MSRA. As a result the entire policy is pretty much consigned to the dustbin.

Thatcher and her government were also very guilt of underfinancing the NHS, something that we're only just coming to see finally disappearing as the last of the new PPP/PFI hospital building programmes come to a close. Waiting lists have been down, treatment rates up, and only pressure on costs from wage demands seem to be a significant blot on the horizon.

So you'll forgive my cynicism when I hear the private sector trumped as the be-all and end-all of the system.

 

[Rolfe]

a national health service model funded from centralised general resources (either in the form of income tax or, in the case of the UK, a separate national insurtance contribution).

Architect, I have to correct you on this.

National Insurance is theoretically hypothecated to fund the state retirement ("old age") pension. Note that the amount of old age pension you will get is absolutely determined by your history of NI payments. People who have not paid the "full stamp" for a sufficient number of years don't get the full pension. Lost years can however sometimes be made up in the form of supplementary payments. Married women who paid a reduced married women's stamp have found themselves disadvantaged in later years. My own mother had her entire NI contribution negated by a law passed many years later which decided that contributions made before (about) 1950 didn't count if the person had made no contributions since. As a result her state pension was reduced.

This has been described by some as a Ponzi scheme, in that pensions to current pensioners are funded from the contributions of those currently working. This was how the government was able to introduce the "old age pension" de novo to people who had not paid any contributions before the date of introduction. (I imagine the contributions qualification for payments only dated from after the introduction of the legislation.) It therefore relies on continuing contributions from future generations to fund our pensions, which is why the "baby boomer" generation may suffer from the declining birth rate.

It is true that the actual (as opposed to hypothecated) fate of NI contributions is somewhat murky. Many people simply describe these as another income tax. However, they are not and never have been in any way intended to fund the NHS. The NHS is funded from general taxation. Eligibility for NHS treatment is however in no way linked to paying income tax - children who have never earned, adults who have never earned above the personal allowance tax threshold and new immigrants are all eligible for NHS treatment. The criterion is legal residency in the country (as opposed to simply being here on a visit).

Rolfe.

 

[Architect]

You are correct, it's a mistake I made once before and should have picked up. CRAFT moment.