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Keyasa wrote:I trained for 2 days in a hospital as a health care assistant in England and I was let loose on the hospital wards. Sure, it wasn't handing out drugs but they barely showed me how to help a patient with walking difficulties how to safely get to the toilet. I left after 2 months because I was so distraught with the situation. The people who worked there were lovely, but completely over-worked, stressed-out and very tired with zero time to spend showing me how to do things in the correct manner.

Every year we pump more and more money into the NHS but where the feth does it all go?? Hospitals are labelled a success nowadays if they have the time to clean the toilets out, wipe down the surfaces, and keep killer hospital-generated super-viruses under control!

The NHS is a noble idea that needs something, just something, to sort it out.

I wish the Health Minister would stand up in prime ministers question-time and rip his suit off, exposing his superman outfit, kick the PM in the gut, uppercut David Cameron in the face, and just SORT OUT THE MESS!

A lot of the money went into my daughter. She contracted Osteomyelitis in the femur. I had to take her to Kingston A&E at 3 in the morning. Within an hour she had been seen by two doctors, provisionally diagnosed, put on antibiotics, blood taken for tests, admitted to the childrens ward and the consultant consulted. Over the next 10 days she had an X-Ray, a gamma camera scan, and an MRI scan, plus blood tests and bacterial cultures to determine the best treatment. A whole bunch of anti-biotics of two different types were given. Everything came right and her leg was saved.

My anecdotal evidence trumps your anecdotal evidence.

SilverMK2 wrote:Although drug companies etc make a lot of profit, they also have huge expendatures (excluding legal costs). Only a tiny fraction of their products will make it through to market, for every drug which they sell, there will be 100 or even 1000 others which have failed at some point in their development cycle.

I'm an engineer. I fully understand R&D costs. When you post "record profits" for ten years in a row, then you're exploiting that excuse. You know, if they said "record revenues" I'd be okay with that. That shows that whatever they're charging, they're reinvesting in the next generation of drugs. That's part of the business model. But that's not it, it's record profits. Repeatedly. That means that they're not really spending that money on R&D, they're banking it. And if they can bank record amounts year after year, that means they're gouging people, and they're getting away with it because it's not (usually) the individuals who pay for the drugs, it's insurance companies, who then bury that fee in their premiums.

Redbeard wrote:I'm an engineer. I fully understand R&D costs. When you post "record profits" for ten years in a row, then you're exploiting that excuse. You know, if they said "record revenues" I'd be okay with that. That shows that whatever they're charging, they're reinvesting in the next generation of drugs. That's part of the business model. But that's not it, it's record profits. Repeatedly. That means that they're not really spending that money on R&D, they're banking it. And if they can bank record amounts year after year, that means they're gouging people, and they're getting away with it because it's not (usually) the individuals who pay for the drugs, it's insurance companies, who then bury that fee in their premiums.

I'm an engineer too, and I understand that in order to create the next generation of anything requires large start up capital. You can't predict when and where you will need that capital and it is not always obvious when and where you will need to spend it.

As you say, revenue and profit are two distinctly different things, however, having a stockpile of ready cash (or being able to prove that you are good for the cash if you need to borrow) means you can quickly invest in the next magic bullet. Though I also agree that there is profit and then there is grabbing and grasping hand over fist.

What has made it this way is there being only a handful of companies in the business, meaning that they can charge near whatever they want for anything they make. It is also not helped by drugs companies continually "updating" their drugs, meaning that a small change here and there in the chemical makeup of a drug means that they can get a new patent and stop people manufacturing a "generic" brand medicine which does all that the original model did at a fraction of the cost.

Well the thing is, in america you can get taken care of regardless of insurance or not. Homeless people and illegal immigrants are given hospital care despite lack of insurance. The end result is the hospital footing the bill and charging those with insurance more for care. As to drug costs, that goes along with the R&D and how its expensive to research and yadda, yadda. Unfortunately, the same pharmaceutical companies supplying the U.S also supply Canada and other countries with nationalised health care. This increases demand and unless drugs become easy to make the supply is either going to stay the same or decrease, raising costs.

I mean like making jewelry you have to find the metal and precious gems, refine them, and then fashion them into a ring. Drugs have to be researched, and made often to low yield supplies. This then increases price of the drugs.

The other issue is the quality of care given by the doctors, on average american doctors spend more time with patients than their nationalised counterparts.

Kilkrazy wrote:

Keyasa wrote:Stuff

A lot of the money went into my daughter. She contracted Osteomyelitis in the femur. I had to take her to Kingston A&E at 3 in the morning. Within an hour she had been seen by two doctors, provisionally diagnosed, put on antibiotics, blood taken for tests, admitted to the childrens ward and the consultant consulted. Over the next 10 days she had an X-Ray, a gamma camera scan, and an MRI scan, plus blood tests and bacterial cultures to determine the best treatment. A whole bunch of anti-biotics of two different types were given. Everything came right and her leg was saved.

My anecdotal evidence trumps your anecdotal evidence.

Don't get me wrong, the NHS saved my cousin from bowel cancer, saved me from a branch in the eye (crawling into a bush to retrieve a ball), saved my brother when his appendix popped (he turned green for a week. Very strange after effect) and so on ad infinitum. But when dear old ladies can be left on trollies in the corridor to die because no one has the time to see them and make sure they have a drink of water?? Come on, there's something amiss. It's the system that is not perfect, not the people who work within. I have ultimate respect for everything that they do (a damn sight more respect than I have for most aspects of this great nation).

Also, your story about your daughter shows the NHS in it's best light, doing what it should do, treating people without prejudice of money, creed or standing. Exactly what I experienced with my bro, cous and my eye (I was a bit young at the time). This is the UK at it's best. Hope she made a full and healthy recovery!

The idea of of the NHS was always to provide both a minimum level fo care required to stay alive, and to provide emergency care for unavoidable circumstances, such as accidents, or contracting X condition or Y.

What the NHS has never provisioned for, or will never provision for, is obesity related illnesses, smoking, drinking and drug related conditions and accidents. It was never made to cope with the raising levels, the change in the global climate has put a massive strain on the system and although it's doing everything it can to make people self aware, it's our fault as a nation that the NHS is over stretched, as much as it is the government's for malmanagement.

drakedeming wrote:46.6 uninsured Americans is a pretty good sign

That number is inflated. It includes illegal aliens, and those that are in transitions between one sytemt to the other (most companies have a thirty day period when you start before your insurance kicks in) . It also includes those that in fact do have insureance, but Kennedy and his crew deem as bing underinsured.

Another issue is this, you can give a national healthcare program, like medicaid or medicare, but there's nothing that forces a doctor to accept said insurance. So you could make a new government insurance programbut if no doctor accepts it then the program is a total bust.

The current plan is just spending money to get what we already have.

halonachos wrote:Another issue is this, you can give a national healthcare program, like medicaid or medicare, but there's nothing that forces a doctor to accept said insurance. So you could make a new government insurance programbut if no doctor accepts it then the program is a total bust.

The current plan is just spending money to get what we already have.

This problem was got around in the UK by the government employing doctors. Their contracts define the terms and conditions of employment, thus compelling them to see patients if they want to be paid.

halonachos wrote:Well the thing is, in america you can get taken care of regardless of insurance or not. Homeless people and illegal immigrants are given hospital care despite lack of insurance. The end result is the hospital footing the bill and charging those with insurance more for care...

Last time I was there in Spain our national healthcare program was treating people regardless their origin and footing the bill. So I don´t get to see what´s the problem here.

M.

Medical bills for the people without health insurance coverage averaged $26,971, and for those with insurance, medical costs leading to bankruptcy averaged $17,749 due to high deductibles and out of pocket expenses associated with co-payments and procedures not covered by insurance.

And all this prior to the current economic woes.


take that Slovenia

Tyras wrote:
That number is inflated. It includes illegal aliens, and those that are in transitions between one sytemt to the other (most companies have a thirty day period when you start before your insurance kicks in) . It also includes those that in fact do have insureance, but Kennedy and his crew deem as bing underinsured.

That number is from the US Census Bureau. Available here.

The chance of systemic transition having a significant impact on the data is incredibly small. You're talking about at least 1 million people changing plans during the data collection period, and permitting themselves to go without coverage for some period of time (which is generally unnecessary).

The study makes no mention of the under-insured.

As for illegal immigrants...

2007 Census Data wrote:
Nativity

* Between 2005 and 2006, the number of U.S.-born residents who were uninsured increased from 33 million to 34.4 million, and their uninsured rate increased from 12.8 percent in 2005 to 13.2 percent. The number of foreign-born who were uninsured rose from 11.8 million in 2005 to 12.6 million, and their rate was statistically unchanged at 33.8 percent in 2006.

Even if you assume that all foreign-born uninsured can be classified as illegal the number of U.S.-born uninsured remains shameful.

You have a system that more or less fell into place by mistake, additional benefits offered to employees slowly but surely becoming the basis for an entire health system. No-one anywhere would ever create such a thing, because it manages to include the profit motive (leading to insurers following aggressive denial policies to grow profits) while simultaneously removing the benefits of individual healthcare choice (as individual consumers can't choose their own plans, they're just stuck with the plans of their employers). As unemployed people have no coverage in this systemAs a kludge to this system

The result is that despite spending more per capita than any other country you get healthcare that ranks worse than every other developed country. There are countries on the list provided by reds8n who spend less than half as much money per citizen but have better health outcomes.

You have a very bad system, accept that and move on with finding a solution.

halonachos wrote:The current plan is just spending money to get what we already have.

which looks so good.

I can tell you from personal experience that it sucks a lot to be poor in the U.S. and if you lose your precious job (recession ding ding) you will be sitting high and dry w/o any health coverage. Medi-cal is practically a joke, and the Governer of California (Ahnuld uv corz) actually attempted to cut even that recently. The dental available has been cut to a nonexistent minimum, it is like a joke now.

Regardless of your background people should have healthcare available, and I can't imagine anything worse than what we have now, I mean seriously though... MY FREAKING GOD PEOPLE!!!

Even people WITH healthcare are totally screwed by their insurance companies, and I have seen this first hand from nearly anyone on serious prescribed medication (which I actually have a problem with personally, this gak isn't candy ffs) namely my Grandmother. I have heard here talk about the changes over the past few decades, and it honestly scares me that the insurance companies and pill companies have developed so much power.

I see kids in schools being prescribed nothing less than fancy meth, and adults being prescribed fancy downers, it all seems very unhealthy to me. I was actually prescribed some stuff by some quack at one point in middle school because I was disruptive in class... brainwashing, plain and simple. The stuff they gave me was probably the strongest substance I have ever taken, and it literally changed who I was in a matter of 1/2 hour. Funny thing is I was later blamed by the same people who tried to drug me for setting a gasoline fire in a girls bathroom... you know what was odd about that? I wasn't even at school that day, and I think I know who passed the blame to me. Crazy stuff man... I do not understand why people go to such drastic lengths to change others, like they don't have opinions themselves and they fear mine for even existing.

The thing i find funny about the UK's NHS is that their is a common misconception that you are entitled to any drug you want whenever you want it. What people don't tend to realise about healthcare is that the money to pay for these drugs has to come from somewhere.

UK citizen's like any other country complain about paying more tax and yet want more for their buck. Expecting everyone else to foot the bill.

And on a slightly off-topic note, I love the way that every single prime minister thinks the answer is to throw money at the NHS thinking it will fix it, it won't, and I'm not even going to make a suggestion as I'm not qualified to do so without a better understanding.

The other main factor for both UK and USA users of healthcare is that people are generally living longer and thus using more healthcare and more & more dieases and illness's are cureable than ever before so the drain on health care is considerably more.

You also have to consider that more and more people are abusing the healthcare because of ... well ... stupidity, like going to hospital for a case of common cold. And in other cases by their own hand, people who smoke or eat excessive amounts of fatty foods are more likely to aquire disorders and illness's for example. As population increases, the above issue's become fair greater as there are greatr numbers doing it

The dental available has been cut to a nonexistent minimum, it is like a joke now.

You're just like us really.

Don't you have some sort of 3 pound rule with options to have it free for any medication in the U.K.?

Sounds slightly preposterous to me, but I do know that some medication should be that cheap if not even cheaper.

reds8n wrote:

The dental available has been cut to a nonexistent minimum, it is like a joke now.

You're just like us really.

You know that scene in castaway where he has to knock his bad tooth out? Yeah... that is the situation out here now...

The US Healthcare system needs change. And massive change. It's a huge, bloated, festering bureacracy. And people like presidential hopeful John Edwards got rich from it (by being the lawyer for families suing for damages in very tragic cases involving children).

Having the US government take it over - doesn't inspire me. This is the same government that developed the Susan B. Anthony dollar and funds Amtrak. The same government that is posting record deficit spending and has 'managed' social security to the point it's going backrupt in a few years. I won't oppose regulation and reform, but I don't support the government taking it over.

One of the problems with the US government taking over the program, is they always seem to underestimate the human factor. They'd do something like eliminate profit on new drugs, but then expect pharm companies to keep developing new drugs. The reason they do now, is to post record profits. If that goes away, their incentive goes away. Now, maybe the profits should be reduced, but the government would do something like make them so small, it won't offset the R&D.

To me, reform needs to consist of:
1. More competition, which drives prices down
2. Reducing the medical bureacracy (for example, when my wife was in OSU hospital, we got like 4 separate bills for the same visit)
3. Reducing legal expenses
4. Realizing that patients are clients and should be treated appropriately
5. Making doctors more professional. My doctor's has a bunch of freebies from pharm companies. I'm an engineer, and if I was taking freebies from vendors, that'd be considered unprofessional. Why should I recommend American Pipe when another product is just as good and cheaper? Claritin is great, but instead of putting me on claritin, shouldn't my doctor just tell me to get the generic substitute that's half the cost? But, because claritin gave him some pens and kleenex boxes and a lunch - they expect him to recommend the name brand.

Now, I think that doctor's should be held accountable if they make mistakes. But, I don't see how paying someone $100 million because their child died tragically helps the victim's family. The doctor doesn't pay that - everyone else does due to higher insurance costs spread around to all the doctors, which pass it onto their clients.

I am not an expert on this by any means, but some of what you have proposed sounds pretty lofty if you ask me. I actually like the idea of socialized health care, as long as the U.S. takes measures to improve on the present system.

At this point ANY change is good, but I hope for something that will actually create improvement in the availability of health care in the U.S. We need this badly, and any more procrastination could prove to create even more serious problems for out nation.

I see two problems in US healthcare. One is to many people going to the hospital/emergency room for no good reason. If a kid has a fevor they are in the emergency room and two catastrophic care.

These are the two areas that need improvement. There should be a place for primary care that doesn't involve emergency rooms. A nurse practicinor (sp) or some equivilent can be the initial evaluator and if they can solve it great, if not then it gets moved up the food chain. The problem comes from people going to the hosptial for things that aren't emergencies. It's easy to just go when you have your insurance to pay for it, but it's expensive and those costs bring everything else up. When I was young my Mom used to threaten us in going to the doctor. "Stop complaining or you'll go to thedoctor." That would pretty much get us to shut up. She's not a doctor, but she knew enough about illness to know when it was serious and when it wasn't.

Next is catastrophic care. There should be a government fallback for catastrophic care available to all Americans. Long term catastrophic care can be controled by government and provided for through a minor tax everyone would pay for. Sales, income, property, or just everyone pays $10 a year on tax day to go into the catastrophic care fund. Most of us will never see it and not use the money, but that safety net would be there in case the unthinkable happens and whole families won't lose their savings in the aftermath.

Frazzled wrote:

But thats not how it currently is in the US. If you're working full time legally you pretty much have insurance. If you're not you have medicaid.

That is so not true. I don't... I work on average 50 Hours a week for the county in the court system and I DO NOT have health insurance. The last two people chronologically in my office do not get ANY benefits. Conveniently though the person who is under me is a retiree from the sheriff's department, so he retained his Insurance as a retirement perk. So... I am the ONLY employee in my office who does not get health care. I am desperately waiting for someone who is above me to leave in whatever means necessary, be it quitting, getting fired or just out right dieing. Quite honestly... I can not tell you how happy I wold be if I came to work and heard that one of those three outcomes had happened to anyone there above me.

One is too many people going to the hospital/emergency room for no good reason.

Ah, that reminds me.

I'm not having a pop or anything here, honest, but friends and acquaintances who have been over the pond all come back saying how surprised they are at the amount of medicine adverts and health warnings that fill up every advetising break on the telly, and from what I've read it seems that the average person ( if they have insurance I'm assuming) is almost encouraged to see a Dr. at the slightest sign of discomfort or potential malady. Is this generally the case or not ?

And if so, do you think this inflates or impacts ( be it positively or negatively) upon your health services.

Wrexasaur wrote:I am not an expert on this by any means, but some of what you have proposed sounds pretty lofty if you ask me. I actually like the idea of socialized health care, as long as the U.S. takes measures to improve on the present system.

At this point ANY change is good, but I hope for something that will actually create improvement in the availability of health care in the U.S. We need this badly, and any more procrastination could prove to create even more serious problems for out nation.

Yeah, I'm like that. I'm sure it won't happen. What will happen is another band-aid treatment. Sometimes, you need to stop putting band-aids onto the wound and just dig down to the bottom of the wound and dig out any infection or embedded objects. The healthcare system evolved over a couple hundred years, it's not going to be fixed overnight.

Also, there's multiple compounding problems in the system. If someone doesn't have insurance, they won't go see a primary care physician when they get sick. Then, they may get so sick, they're going to ER and admitted to the hospital. And if they didn't have insurance, they probably can't afford the doctor bills either.

I think a lot of the issue is there are not enough primary care physicians (because being a specialist pays more), and not enough people go to see a primary care doctor (whether it's because they don't have insurance, time, or for whatever reason).

At the same time, you can't just give everyone open access to a primary care doctor, because you'll have hypocondriacs in there three times a week. As always, it's a balance issue - how do you make sure the people who really need help are seen, but the ones who don't need to, don't? And, sometimes, something is really wrong with a person and the doctor doesn't see it (I don't know how many people know someone who had a tough-to-diagnose issue that was ignored/not diagnosed for years before a doctor figured out what was wrong. My wife went through this before being diagnosed as a celiac.).

Aren't there something like 400,000 bankruptcies a year due to medical costs? Even if they did have insurance, there is a limit to nearly all policies, after which it becomes a matter of "pay or die."

http://www.bankruptcylawnetwork.com/2008/09/01/aarp-185-million-americans-go-bankrupt-due-to-medical-bills-in-one-year/

One way or another, somebody is funding this stuff. Somebody is also deciding who gets what care. Given that medicine is de facto nationalized, why not give up the fig leaf?

Medicare and medicaid cover a huge chunk of the population, with federal employees, veterans, and dependents another big chunk. Drug companies enjoy ludicrous tax benefits and subsidies. Med schools, hospitals, and clinics all recieve government grants and funding. Free clinics operate in most cities, charities operate massive networks of free care facilities, and all emergency care is provided regardless of ability to pay. Health insurance provided by an employer is currently partially subsidized by the tax break to the employees, and medical spending is tax deductible above a certain point. At the end of the road, those that declare bankruptcy leave the bill for the government. Guess what? We have social health care. We just have social health care that's ad hoc and has plenty of gaps.

I don't' have a ton of faith in the plans floated, but the facts are stunning, given our spending and results compared to other countries. The debate isn't about universal health care, its' about what kind to have. I, for one, would rather have the kind where there's more security for more people against the most common stuff. yes, it's callous to tell a person that a 0.5% chance of recovery isn't enough to justify the treatment, or that six more months isn't worth the cost for meds. The current system is just as callous.

dietrich wrote:One of the problems with the US government taking over the program, is they always seem to underestimate the human factor.

The government isn't taking over the program. Why do people keep talking about this? Why are people falling the Republican framing of the argument again?

To me, reform needs to consist of:
1. More competition, which drives prices down
2. Reducing the medical bureacracy (for example, when my wife was in OSU hospital, we got like 4 separate bills for the same visit)

1. How about you build a system which formally recognises a basic level of care, including some preventative care. But to provide competition, have private insurance providing a higher level care for those who can afford it. There would actually be competition because it would be direct marketed from the insurer to the individual. You could tailor your individual insurance, adjusting the extent of your care and level of excess to raise or lower your monthly payment.
2. Hospitals would perform treatment surgery and produce a single bill. If other specialists outside the hospital were involved they would charge the hospital, who would then add that to the total bill. If covered by government you would provide your Medicaid number and govt would be charged. If covered by private insurance the bill would be sent to the private insurer, who on completion of the surgery would provide a single bill to you for the total of your excess.


By the way, what I just described was one of the 'socialised' systems used elsewhere in the world.

The trouble with rationing is you might be happy in saying that the 1% of sufferers of "insert illness" have to buy the drug that cost £100,000. But what if you were in the 1%? would you be ok with it? Sure as heck not.
And yet the 50% sufferers of "insert illness" get it for free where theirs only cost £19.99 or something daft.
(figures are made up to show an example of what I am trying to say)

Don't get me wrong, I agree that drugs should be rationed and maybe go on a case by case basis, the trouble is that someone will always lose out and be let down by the system. Rationing is a fantastic concept, overseeing it in a fair and just manner, is a pipe dream. unless you want to raise taxes to such a level to support your healthcare further.

At the end of the day, no matter what you do, someone will lose out and they will be the ones that try to change it all again to suit them, meaning that another will lose out who will try to change the system again and so on, and so on, and so on.

"You can please some of the people some of the time and all of the people none of the time" No idea who said this, but thought it was apt

sebster wrote:

dietrich wrote:One of the problems with the US government taking over the program, is they always seem to underestimate the human factor.

The government isn't taking over the program. Why do people keep talking about this? Why are people falling the Republican framing of the argument again?

The problem is there's several debates going on at once.
1. What Obama has proposed is dumping another $1 trillion or so to provide coverage for uninsured.
2. What people want is some sort of national health care program combined with reform.

And the two are being combined, even by myself at some points.

While giving insurance to the uninsured, by the US gov't dumping $1 trillion into the system, helps those individuals, it doesn't overhaul or help the system. It's just spending tax dollars. And while that means there'd be fewer uninsured going to the hospital - how much will that affect overall cost in the system? How good is that health coverage? And why should employers still offer an benefit if there's a government program to fall back on?

I'd like to see the system improved. It can be and should be. I don't want the US gov't to take it over in an effort to reform it though.

Wrexasaur wrote:Don't you have some sort of 3 pound rule with options to have it free for any medication in the U.K.?

Sounds slightly preposterous to me, but I do know that some medication should be that cheap if not even cheaper.

reds8n wrote:

The dental available has been cut to a nonexistent minimum, it is like a joke now.

You're just like us really.

You know that scene in castaway where he has to knock his bad tooth out? Yeah... that is the situation out here now...

In the UK a Doctor can only prescribe a medicine on the NHS if it has been licensed by NICE (the National Institute for Clinical Excellence.) This stops super expensive new drugs from being prescribed willy-nilly and bankrupting the system.

Drugs can still be prescribed privately (the patient pays full cost) unless they haven't completed testing to UK standards.

A standard NHS prescription now costs £7.20. People exempt from charges include children, pregnant mothers, the unemployed, pensioners, war pensioners and long-term disabled. There is also a sheap rate 1-year prescription scheme to help employed people on long-term medication.

Kilkrazy wrote:


In the UK a Doctor can only prescribe a medicine on the NHS if it has been licensed by NICE (the National Institute for Clinical Excellence.) This stops super expensive new drugs from being prescribed willy-nilly and bankrupting the system.

So if it could cure your cancer but its reallyexpensive you're screwed? Yep that is indeed NICE.