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Source: (consider it) Thread: Purgatory: Health Care
Dumpling Jeff
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No one can know everything. Doctors know about drugs by reading reading reference books. They books contain information from the drug companies because they are the ones who do the studies.

But pharmacists specialize in knowing about drugs. They don't fix broken arms or check temperatures or learn diagnostics or any of the thousands of other things doctors learn. They learn drugs. They learn chemical interactions and how they work in the human body.

It would be nice if doctors could learn all that and everything else, but there's only so much time in a day. Instead, they consult pharmacists when they see a problem.

Really, try talking to your pharmacist. They are a lot more than pill counters.

Several people show surprise that doctors swear to keep silent on medical knowledge. Here's the relevant line from the Hippocratic Oath:
quote:
All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.
This seems originally intended to keep knowledge of poisons and the like away from a lay public which might use it to perform undetectable murders (as well as the normal confidentiality issues).

Obviously this oath does not preclude sharing knowledge needed to keep patients alive. It doesn't cover treatment options or dozens of other medical subjects. But some doctors talk less than they should in order to avoid breaking the oath.

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"There merely seems to be something rather glib in defending the police without question one moment and calling the Crusades-- or war in general-- bad the next. The second may be an extension of the first." - Alogon

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mdijon
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quote:
Originally posted by Mr. Spouse:
Why is it wrong for doctors to get knowledge from the drug companies?

Because drug companies lie. They sell drugs, the advertise them, they twist evidence, they exagerate claims, and their primary loyalty is to the share holder.

Granted, the vast majority of the life-saving drugs around today were developed by them. We clearly can't do without them. But taking their sales pitch as knowledge about how to use their drugs is like taking a car salesman's advice on the merits of second hand car purchasing.

Pharmacists train in universities (like doctors) and then get their information from journals and professional bodies (like doctors).

If a drug company has some important data about their drug they can have it published in full in a journal following peer review and it can be discussed openly. If they want to slip in a claim in promotional material with the claim "data on file" but not open to scrutiny we shouldn't pay any attention.

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mdijon nojidm uoɿıqɯ ɯqıɿou
ɯqıɿou uoɿıqɯ nojidm mdijon

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Jason™

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quote:
Originally posted by Imaginary Friend:
The only objections I understand are the ones that say it doesn't go far enough.

...

Public insurance, a single-payer system, further extension of preventative medicine, and many other good things will not now happen.

I agree with you on the first, but not the second statement. I just don't think they could have ever pushed through a single-payer system. There has been so much resistance to even this much, I'm positive that a bill that would have wiped out the entire private insurance industry would have killed the entire thing and made healthcare reform impossible.

I think what President Obama has done is to pave the way for (hopefully) successful results with these first big steps, and maybe our next charismatic president some years down the road will be able to push it through the rest of the way, based on some new impetus as it arises.

Here's hoping, anyway.

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mdijon
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quote:
Originally posted by Dumpling Jeff:
But some doctors talk less than they should in order to avoid breaking the oath.

Erin was less prosaic, but this is just wrong. There are all sorts of reasons why doctors don't talk about medicine (ranging from misjudgement about what the patient wants through to being busy to being bored assholes) but this isn't one.

The Hippocratic oath is rarely taken, and when it is I don't think anyone follows it literally. There's also a promise to teach one's teacher's children medicine, live with the teacher and share one's earthly goods, not do operations for renal stones, not give pessaries for abortion etc.

About learning from drug companies, read my earlier posts.

[ 23. March 2010, 19:00: Message edited by: mdijon ]

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mdijon nojidm uoɿıqɯ ɯqıɿou
ɯqıɿou uoɿıqɯ nojidm mdijon

Posts: 12277 | From: UK | Registered: Sep 2004  |  IP: Logged
Jason™

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# 9037

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quote:
Originally posted by Dumpling Jeff:
Several people show surprise that doctors swear to keep silent on medical knowledge. Here's the relevant line from the Hippocratic Oath:
quote:
All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.
This seems originally intended to keep knowledge of poisons and the like away from a lay public which might use it to perform undetectable murders (as well as the normal confidentiality issues).
That sounds a lot more like, if you hear something that shouldn't be shared with the world, you should keep it secret. Doctor-patient confidentiality. It's "things I find out while doing my job that shouldn't be shared abroad", not "things I learn while studying to be a doctor".
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Imaginary Friend

Real to you
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quote:
Originally posted by Jason™:
I just don't think they could have ever pushed through a single-payer system. There has been so much resistance to even this much, I'm positive that a bill that would have wiped out the entire private insurance industry would have killed the entire thing and made healthcare reform impossible.

Yeah, you're probably right. Having lived my whole life in countries that have either nationalized healthcare, or a single-payer system*, I completely fail to understand why so many Americans don't want it**. I guess that's just the goggles through which I view the world.

quote:
Originally posted by Jason™:
I think what President Obama has done is to pave the way for (hopefully) successful results with these first big steps, and maybe our next charismatic president some years down the road will be able to push it through the rest of the way, based on some new impetus as it arises.

I hope you're right too. I fear that impetus will be a long time coming though.


Edited to add footnotes:
* And in general finding that these systems work quite well.

** If anyone fancies having another go at explaining it to me, then fire away.

[ 23. March 2010, 19:16: Message edited by: Imaginary Friend ]

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"We had a good team on paper. Unfortunately, the game was played on grass."
Brian Clough

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Erroneous Monk
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quote:
Originally posted by Dumpling Jeff:


Several people show surprise that doctors swear to keep silent on medical knowledge. Here's the relevant line from the Hippocratic Oath:
quote:
All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.
This seems originally intended to keep knowledge of poisons and the like away from a lay public which might use it to perform undetectable murders (as well as the normal confidentiality issues).


Erm no. Surely it's about patient confidentiality?

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And I shot a man in Tesco, just to watch him die.

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FreeJack
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You might find that some strict Muslims would object to some forms of insurance. The problem is not insurance or health care, but either the financing, the risk-taking or the presuming on God.

I wouldn't imagine they were the group that Congress had in mind though.

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Erin
Meaner than Godzilla
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quote:
Originally posted by Imaginary Friend:
Having lived my whole life in countries that have either nationalized healthcare, or a single-payer system*, I completely fail to understand why so many Americans don't want it**.

** If anyone fancies having another go at explaining it to me, then fire away.

This is actually fairly easy to understand, as I have some reservations about it myself. Right now the government controls three major payers -- Medicare, Tricare and Medicaid. Medicare and Tricare are administered via regional fiscal intermediaries and carriers; Medicaid through each state. Medicare and Medicaid have had significant, negative impact on the healthcare landscape, in several ways.

First: the government sets the prices that they will pay you for services, regardless not only of what a provider actually charges, but also of what the service actually costs. Many providers lose money on Medicare and Medicaid patients. Medicare providers have to prepare a yearly cost report stating how much it cost us to treat Medicare beneficiaries, which may entitle us to an end-of-the-year bonus to meet actual costs, but may not. You get another couple of bites of the pie if you are a teaching hospital, but not much.

Second: there are regional FIs and carriers who administer the Medicare program on behalf of the federal government. Not only are we constrained by what CMS says, but also by how the FI/carrier interprets the regulations. If your enterprise spans multiple regions (as mine does), you have to figure out how to comply with, say, three different FIs and three different carriers being billed out of the same system. There are more pages in the Medicare regulations than there is in the US tax code. Now imagine trying to adhere to that with four different people interpreting it four different ways without descending into fraud or abuse.

Third: Medicare pulls all kinds of last-minute decisions out of its collective ass that basically fucks everyone else up. For instance, up until a week ago we were preparing for a 22% reduction in the Medicare fee schedule, but at the last minute they decided to forego that until April. You, as a provider, have to bill with their fee schedule, it's not like you bill the charge and adjust the fee to match. Also, they decided late last year that they were no longer paying on the consult CPT codes, which means that we had to scramble (and are still scrambling) to figure out how to switch the CPT code on Medicare patients (and only Medicare patients) to either a new or established CPT code. And all because they just up and decided, hey, let's do this!

Fourth: Medicare decides whether or not they'll pay for a test based on diagnosis alone. If you have abdominal pain and your doctor decides to send you for a CT or a GI study, Medicare isn't going to pay for that even if your medical history supports that test. THEY are the ones telling your doctor what tests he can do just like any other insurance company.

If I thought that this system was going to be shoved down all of our throats, I'd be packed and ready to move. Basically it boils down to the fact that the federal government has thoroughly fucked up the pieces it has its hand in up until now. I don't have much confidence that it would get any better if they took over the whole dance.

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Commandment number one: shut the hell up.

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Seeker963
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quote:
Originally posted by Erin:
This is actually fairly easy to understand, as I have some reservations about it myself. Right now the government controls three major payers -- Medicare, Tricare and Medicaid. Medicare and Tricare are administered via regional fiscal intermediaries and carriers; Medicaid through each state. Medicare and Medicaid have had significant, negative impact on the healthcare landscape, in several ways.....

I'm so glad that I'm not subject to anyone else's decision about my healthcare.

It's simple, the insurance companies have priced me out of the market and I can't afford either health insurance or to get any serious chronic illness.

So I know for certain that I have the freedom to suffer horribly and then die; and I know that I have the possibility to throw myself at the mercy of a hospital and let them decide which treatments they would and would not give me. But so much better for the private sector to decide what I can and cannot have than for the government to decide what I can and cannot have.

Not sure where in the West that anyone would move to where the medical system is completely free of government control. One certainly can't move to Europe.

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"People waste so much of their lives on hate and fear." My friend JW-N: Chaplain and three-time cancer survivor. (Went to be with her Lord March 21, 2010. May she rest in peace and rise in glory.)

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Erin
Meaner than Godzilla
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Don't get pissy with me, I actually support the current healthcare bill (now law). I'm just explaining the way that many Americans view the idea of a single government payer. I have fabulous insurance through my employer; I would cry if I had to switch to a Medicare-type plan. Medicare sucks.

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Commandment number one: shut the hell up.

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Seeker963
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quote:
Originally posted by Imaginary Friend:
Yeah, you're probably right. Having lived my whole life in countries that have either nationalized healthcare, or a single-payer system*, I completely fail to understand why so many Americans don't want it**. I guess that's just the goggles through which I view the world.

From someone who agrees with your view (and so obviously will not be unbiased), and who just returned to the US after 20 years living in the UK....

1) I think all people fear change. We know what we've got now and we don't know what a new system would look like. It could be worse than what we have now.

2) This country was founded on distrust of government. As cliched as that sounds and as far away as that seems, I actually think that significant communal events live for centuries in the values of the communities they gave birth to.

3) There is a deep individualistic streak that also goes back to the founding of this nation. Our ethics tend to focus first on individual rights rather than on the common good.

4) Many people link "common good" with "socialism" with "20th century communist dictators". Thus, to want healthcare decisions made for the common good is also to desire Stalinist or Maoist totalitarian dictatorship. I don't think people would put it in those terms, but I think that there is an unconscious emotional reaction in that direction.

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"People waste so much of their lives on hate and fear." My friend JW-N: Chaplain and three-time cancer survivor. (Went to be with her Lord March 21, 2010. May she rest in peace and rise in glory.)

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Carex
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quote:
Originally posted by Imaginary Friend:

In my opinion, America, the Democrats and Obama have missed the opportunity of a lifetime to do something truly memorable. Now that "Healthcare Reform" has been done, nobody is going to have the political capital or willpower to push reform further for a long time...

Given the legislative process in the US Congress, particularly the Senate, getting anything through is a major accomplishment. I suspect this bill was carefully crafted to get enough votes to pass.

My guess is that, once "Healthcare Reform" is in place and working, it will be much easier to make changes to, since those changes will be more incremental. It is far easier to make small changes to an existing program than to introduce a new program full of uncertainties. But this will establish the notion that all people deserve healthcare that they can afford, and as that becomes accepted over time further changes can be made.

Remember all those who objected to the notion of having the "Gummint" run Health Care, while decrying any changes to their Medicare benefits? They probably would have been firmly opposed to the introduction of Medicare, using similar arguments, at the time it was introduced, but are now firm defenders of it. I suspect we'll see a similar pattern with the recent legislation.

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Mr. Spouse

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quote:
Originally posted by Seeker963:
I'm so glad that I'm not subject to anyone else's decision about my healthcare.

It's simple, the insurance companies have priced me out of the market and I can't afford either health insurance or to get any serious chronic illness.

See, this is what I can't get my head round. Others have decided on your healthcare, by denying you coverage. I can appreciate the reservations about Government-mandated (or denied) treatments - that's no different in the UK - but I still don't see how that is so different from insurance companies controlling what or who can and cannot be treated. If I had stayed longer in the US I would have had to change my treatment regime as the HMO we had would not pay for some of the medications I get for free in the UK.

quote:
Not sure where in the West that anyone would move to where the medical system is completely free of government control. One certainly can't move to Europe.

I presume you are talking about cost, not safety. In the UK anyone is free to elect to pay for their own treatment outside the NHS system.

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Try to have a thought of your own, thinking is so important. - Blackadder

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Mr. Spouse

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quote:
Originally posted by Dumpling Jeff:
pharmacists specialize in knowing about drugs. They don't fix broken arms or check temperatures or learn diagnostics or any of the thousands of other things doctors learn. They learn drugs. They learn chemical interactions and how they work in the human body.

It would be nice if doctors could learn all that and everything else, but there's only so much time in a day. Instead, they consult pharmacists when they see a problem.

Really, try talking to your pharmacist. They are a lot more than pill counters.

In the UK we are encouraged to for minor ailments. But I still don't understand. You trust a pharmacist to tell you which drug works, but not a doctor to diagnose you? Odd.

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Try to have a thought of your own, thinking is so important. - Blackadder

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Imaginary Friend

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Erin, thanks for taking the time to write that long explanation. There is a lot of jargon which I don't really understand, but is it fair to sum up your criticisms of Medicare and Medicaid as follow?
  1. Badly managed
  2. Underfunded
  3. Too bureaucratic
It seems to me that those are pragmatic concerns, rather than ideological ones*. Have I understood you correctly?

Seeker693, let me address your four points individually.
  1. Fear of change. Fair enough!
  2. Distrust of government. That's okay so far as it goes, and I certainly agree that "significant communal events live for centuries in the values of the communities they gave birth to"**. But people trust the government for a whole host of other things, so why not this?
  3. Individualism. I see that this is a Pond difference which I'm not going to understand unless I live in the States (and I am due to move there in a few months).
  4. Socialism. This is the point which I really don't understand and find frankly laughable. But then, I'm left-of-centre by UK standards, so I would say that. I would link this to my response to the second point: The government provides many other services and functions, so why do they not elicit the same reaction (conscious or otherwise)?

Carex, I hope you're right.

* It's not that I think that pragmatic arguments are invalid, but I understand them better (the ongoing arguments about how best to manage the NHS show that these are really difficult issues). It's views such as those that equate socialized medicine to communism that I don't get.

** In fact, it's arguable that World War II (a rather significant communal event in the UK) lead to the formation of the NHS.

--------------------
"We had a good team on paper. Unfortunately, the game was played on grass."
Brian Clough

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Erin
Meaner than Godzilla
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quote:
Originally posted by Imaginary Friend:
Erin, thanks for taking the time to write that long explanation. There is a lot of jargon which I don't really understand, but is it fair to sum up your criticisms of Medicare and Medicaid as follow?
  1. Badly managed
  2. Underfunded
  3. Too bureaucratic
It seems to me that those are pragmatic concerns, rather than ideological ones*. Have I understood you correctly?
Yes. That's why intelligent people have concerns about single-payer government-run healthcare. The rest are deluded teabaggers who listen to Rush, Glenn, Ann et al and think that the aforementioned assholes actually have their best interests at heart.

[ 23. March 2010, 21:40: Message edited by: Erin ]

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Commandment number one: shut the hell up.

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Antisocial Alto
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quote:
Originally posted by Mr. Spouse:
quote:
Originally posted by Seeker963:
I'm so glad that I'm not subject to anyone else's decision about my healthcare.

It's simple, the insurance companies have priced me out of the market and I can't afford either health insurance or to get any serious chronic illness.

See, this is what I can't get my head round. Others have decided on your healthcare, by denying you coverage. I can appreciate the reservations about Government-mandated (or denied) treatments - that's no different in the UK - but I still don't see how that is so different from insurance companies controlling what or who can and cannot be treated.

To be fair, there is a slight difference. People in the US who are free-market aficionados point out that with a number of insurance companies available, you can (in theory) change providers if one of them screws you, whereas with a single-payer system, customer service is not as important to the big provider. Republicans have been suggesting de-coupling health benefits from employers, as well as allowing us to buy health insurance across state lines, to increase competition in the market and maybe make more attractive plans available to the consumer.

Of course the reality is that ALL of the many available providers are likely to screw you, because it's their job to make a profit. But many Americans view the Free Market as being on a par with life, liberty, happiness, motherhood, baseball and apple pie.

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Seeker963
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quote:
Originally posted by Mr. Spouse:
quote:
Originally posted by Seeker963:
I'm so glad that I'm not subject to anyone else's decision about my healthcare.

It's simple, the insurance companies have priced me out of the market and I can't afford either health insurance or to get any serious chronic illness.

See, this is what I can't get my head round. Others have decided on your healthcare, by denying you coverage.
I agree with you and this is precisely the point that I’m “being pissy” about . We seem very happy to have the private sector say “No, we are not going to pay for that procedure” or “No, we are not going to give you health insurance.” or “Pay us 90% of your monthly income to cover you for your good health and one case of mild asthma between the two of you; but you have committed the cardinal sins of being over 50 and not having employer-provided insurance”.

quote:
Originally posted by Mr. Spouse:
quote:
Not sure where in the West that anyone would move to where the medical system is completely free of government control. One certainly can't move to Europe.

I presume you are talking about cost, not safety. In the UK anyone is free to elect to pay for their own treatment outside the NHS system.
I'm saying that if a person is philosophically opposed to government-provided healthcare, why would they want to move to such a horrible place where people value that healthcare so much that they are willing to pay for it? I lived for 20 years in the UK and when I try to tell people here in the US that the NHS works, I get told that I only think the NHS works because of my political bias. And this is from people who have never lived in the UK!

Six weeks before we moved to the US, my husband went to A&E with what turned out to be a detached retina. It took him a total of three hours to leave work, get to the hospital, have laser surgery, and come home with his retina fixed. I honestly thank God this happened before we came here or I don't know what we would have done.

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"People waste so much of their lives on hate and fear." My friend JW-N: Chaplain and three-time cancer survivor. (Went to be with her Lord March 21, 2010. May she rest in peace and rise in glory.)

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Erin
Meaner than Godzilla
# 2

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God help me, because I hate the insurance companies more than I hate the government, but I'd rather argue with them about noncovered services than with FCSO or Noridian. With Medicare, if they decide something isn't covered, it is not covered. Period, end of discussion. There is no medical review to see if they will grant an exception. At least with a private insurer you have an ever-so-minuscule chance of getting the medical director to override their coverage decisions.

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Commandment number one: shut the hell up.

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Seeker963
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# 2066

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quote:
Originally posted by Erin:
God help me, because I hate the insurance companies more than I hate the government, but I'd rather argue with them about noncovered services than with FCSO or Noridian. With Medicare, if they decide something isn't covered, it is not covered. Period, end of discussion. There is no medical review to see if they will grant an exception. At least with a private insurer you have an ever-so-minuscule chance of getting the medical director to override their coverage decisions.

And some people don't have an insurance company they can even argue with and the response is either "Suck it up" or "Trust in God and we'll bring you a casserole."

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"People waste so much of their lives on hate and fear." My friend JW-N: Chaplain and three-time cancer survivor. (Went to be with her Lord March 21, 2010. May she rest in peace and rise in glory.)

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Erin
Meaner than Godzilla
# 2

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Are you aware we just passed a healthcare law that will provide access to insurance to those who don't currently have it for whatever reason?

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Commandment number one: shut the hell up.

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Mr. Spouse

Ship's Pedant
# 3353

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quote:
Originally posted by Seeker963:
I'm saying that if a person is philosophically opposed to government-provided healthcare, why would they want to move to such a horrible place where people value that healthcare so much that they are willing to pay for it?

Ah, I understand what you mean now.

I had to go to A&E with someone not long after getting back from the USA. I spent most of the time thinking, 'how much would this have cost us?'

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Try to have a thought of your own, thinking is so important. - Blackadder

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Spiffy
Ship's WonderSheep
# 5267

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quote:
Originally posted by Dumpling Jeff:

Several people show surprise that doctors swear to keep silent on medical knowledge. Here's the relevant line from the Hippocratic Oath:
quote:
All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.

I would admit you were right, DumplingJeff... if it was the version that docs swear to these days. But it's not. From the very web site you cite:

quote:
The Hippocratic Oath (Modern Version)[10]
“ I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

Nothing in there about keeping medical knowledge secret, buddy.

--------------------
Looking for a simple solution to all life's problems? We are proud to present obstinate denial. Accept no substitute. Accept nothing.
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Posts: 10281 | From: Beervana | Registered: Dec 2003  |  IP: Logged
Dumpling Jeff
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# 12766

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Mr. Spouse, when others decide by their actions, I can decide with my feet. If I don't like health insurance companies not paying on technicalities I can not buy insurance. Sure that sucks, but I don't have to help perpetuate a fraud.

But when government takes over, that's the end. If I don't like the service they provide me, I can always try the service they provide me in prison. There is no choice.

Government is always fair and good -- except when it's not. Then it's off to prison for us dissenters.

Please don't take me as an opponent of this bill. There's a lot to like about it. It's just that people will live or die by the details here and all I've heard has been hype from people with agendas. I have questions and the answers are buried in reams of paper.

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"There merely seems to be something rather glib in defending the police without question one moment and calling the Crusades-- or war in general-- bad the next. The second may be an extension of the first." - Alogon

Posts: 2572 | From: Nomad | Registered: Jun 2007  |  IP: Logged
Seeker963
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# 2066

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quote:
Originally posted by Dumpling Jeff:
But when government takes over, that's the end. If I don't like the service they provide me, I can always try the service they provide me in prison. There is no choice.

Government is always fair and good -- except when it's not. Then it's off to prison for us dissenters.

Actually, I feel fairly confident that an individual will be able to get sick, refuse to use any and all healthcare resources and refuse to buy health insurance without the government bothering to imprison them. Of course, I also bet most people will find that they want to use healthcare resources when they do get sick. Although yours is a good argument for a government-run health system. If healthcare is free at the point of delivery, no one will send you to prison for refusing to go to the doctor or refusing to go to the hospital.

I feel the opposite about what is under the patients' control. I've seen the democratic process improve healthcare in the UK. My feeling is in the US system, one is at the random whim of faceless insurance and pharmaceutical companies whose primary and fundamental concern is their own profit and who don't give a damn about anyone's health. And there is nothing we as a society can do to change this until we come together and say that "profits before people" is a bad way to run a significant portion of the healthcare system. (I think that healthcare professionals who deal directly with patients mainly do care about people but that the entire system is still run as if the raison d'etre is to make money.)

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"People waste so much of their lives on hate and fear." My friend JW-N: Chaplain and three-time cancer survivor. (Went to be with her Lord March 21, 2010. May she rest in peace and rise in glory.)

Posts: 4152 | From: Northeast Ohio | Registered: Dec 2001  |  IP: Logged
Dumpling Jeff
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# 12766

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Seeker, it's my understanding that there will be fines for those who don't get insurance. It's also my understanding that private insurance will be taxed so as to force people to choose the government plan. So not paying the fines, etc. will get one thrown in prison for non-payment which is a felony.

Once most people are on the government plan, it's a short hop to the government mandating certain types of care (exercise plans, low junk food diets, etc.) to reduce public costs.

Live free or diet.

This health bill has a lot of potential to limit freedom. Further, some of the bills supporters seem to have this as a goal.

But that doesn't mean it will end up that way. Sufficient safeguards to freedom may exist in the bill. That's why I asked questions about how the final law is structured. I do find it disappointing that the answers are not available.

The old system was clearly broken. We needed something new. I hope this works.

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"There merely seems to be something rather glib in defending the police without question one moment and calling the Crusades-- or war in general-- bad the next. The second may be an extension of the first." - Alogon

Posts: 2572 | From: Nomad | Registered: Jun 2007  |  IP: Logged
mdijon
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# 8520

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quote:
Originally posted by Dumpling Jeff:
Once most people are on the government plan, it's a short hop to the government mandating certain types of care (exercise plans, low junk food diets, etc.) to reduce public costs.

Yes, that's the path it's taken in every other democracy that has government run health care.

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mdijon nojidm uoɿıqɯ ɯqıɿou
ɯqıɿou uoɿıqɯ nojidm mdijon

Posts: 12277 | From: UK | Registered: Sep 2004  |  IP: Logged
Moth

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# 2589

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quote:
Originally posted by mdijon:
quote:
Originally posted by Dumpling Jeff:
Once most people are on the government plan, it's a short hop to the government mandating certain types of care (exercise plans, low junk food diets, etc.) to reduce public costs.

Yes, that's the path it's taken in every other democracy that has government run health care.
Exactly. Every time I go to the doctor, he makes me sign a pledge to say I haven't eaten in McDonald's for at least three months. I'm sure every American visiting the UK has noticed how slim we all are, how few junk food outlets are available, and how all of us are just exercising like crazy!

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"There are governments that burn books, and then there are those that sell the libraries and shut the universities to anyone who can't pay for a key." Laurie Penny.

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mdijon
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# 8520

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quote:
Originally posted by Dumpling Jeff:
Once most people are on the government plan, it's a short hop to the government mandating certain types of care (exercise plans, low junk food diets, etc.) to reduce public costs.

quote:
Originally posted by mdijon:
Yes, that's the path it's taken in every other democracy that has government run health care.

quote:
Originally posted by Moth:
Exactly. Every time I go to the doctor, he makes me sign a pledge to say I haven't eaten in McDonald's for at least three months. I'm sure every American visiting the UK has noticed how slim we all are, how few junk food outlets are available, and how all of us are just exercising like crazy!

You're giving a misleading impression though, that's only because all the fat ones are locked up until they slim down.

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mdijon nojidm uoɿıqɯ ɯqıɿou
ɯqıɿou uoɿıqɯ nojidm mdijon

Posts: 12277 | From: UK | Registered: Sep 2004  |  IP: Logged
Antisocial Alto
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# 13810

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There is no government plan- that was taken out of the bill months ago. Unless you count the things that already exist, like Medicaid.
Posts: 601 | From: United States | Registered: Jun 2008  |  IP: Logged
Clint Boggis
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# 633

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quote:
Originally posted by mdijon:
quote:
Originally posted by Dumpling Jeff:
Once most people are on the government plan, it's a short hop to the government mandating certain types of care (exercise plans, low junk food diets, etc.) to reduce public costs.

quote:
Originally posted by mdijon:
Yes, that's the path it's taken in every other democracy that has government run health care.

quote:
Originally posted by Moth:
Exactly. Every time I go to the doctor, he makes me sign a pledge to say I haven't eaten in McDonald's for at least three months. I'm sure every American visiting the UK has noticed how slim we all are, how few junk food outlets are available, and how all of us are just exercising like crazy!

You're giving a misleading impression though, that's only because all the fat ones are locked up until they slim down.

Don't TELL them! We WANT them to walk right into the trap and give up their lovely freedom and become government controlled drones like us. Bwahahaha!

[And the only thing they'll get in return is longer, healthier lives and reduced costs!]
.

Posts: 1505 | From: south coast | Registered: Jun 2001  |  IP: Logged
Trudy Scrumptious

BBE Shieldmaiden
# 5647

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Just this morning I was about to grab a Tim Horton's glazed donut for breakfast when the door burst open and two armed, uniformed officials from the Department of Health and Fitness burst in, tore the donut from my hands, ground it to dust beneath their heels, and forced this bowl of All-Bran, trail mix and skim milk upon me. I didn't even buy the stuff -- they brought the little packets with them and mixed it up on the spot. Unfortunately they don't do dishes, but it's a small price to pay for free health care.

I <3 socialized medicine!!!

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Books and things.

I lied. There are no things. Just books.

Posts: 7428 | From: Closer to Paris than I am to Vancouver | Registered: Mar 2004  |  IP: Logged
FreeJack
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# 10612

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quote:
Originally posted by Seeker963:
I'm saying that if a person is philosophically opposed to government-provided healthcare, why would they want to move to such a horrible place where people value that healthcare so much that they are willing to pay for it? I lived for 20 years in the UK and when I try to tell people here in the US that the NHS works, I get told that I only think the NHS works because of my political bias. And this is from people who have never lived in the UK!

Six weeks before we moved to the US, my husband went to A&E with what turned out to be a detached retina. It took him a total of three hours to leave work, get to the hospital, have laser surgery, and come home with his retina fixed. I honestly thank God this happened before we came here or I don't know what we would have done.

And indeed we have the largest eye hospital in the world here in London. (Even if your husband wasn't treated at Moorfields, it is quite possible that he was treated under someone who had been trained there.)

So the base level of care is likely to be as high as you could have got with a million bucks.

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Clint Boggis
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# 633

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quote:
I lived for 20 years in the UK and when I try to tell people here in the US that the NHS works, I get told that I only think the NHS works because of my political bias. And this is from people who have never lived in the UK!
A possible response: "I know the NHS works reasonably well from personal experience over 20 years of using it. Is your view based on long term personal experience or third hand stories? The British live longer and spend less on health than we do. So who's really the one spouting misinformation based on political bias?"
.

Posts: 1505 | From: south coast | Registered: Jun 2001  |  IP: Logged
Rowen
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# 1194

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quote:
Originally posted by Moth:
quote:
Originally posted by mdijon:
quote:
Originally posted by Dumpling Jeff:
Once most people are on the government plan, it's a short hop to the government mandating certain types of care (exercise plans, low junk food diets, etc.) to reduce public costs.

Yes, that's the path it's taken in every other democracy that has government run health care.
Exactly. Every time I go to the doctor, he makes me sign a pledge to say I haven't eaten in McDonald's for at least three months. I'm sure every American visiting the UK has noticed how slim we all are, how few junk food outlets are available, and how all of us are just exercising like crazy!
And Moth, this is true of Australia too! We have government-financed health-care as well.
(No McDonalds here for us to swear not to eat- and I mean that literally, living in a tiny country town miles away from any fastfood joint!)

[ 24. March 2010, 13:24: Message edited by: Rowen ]

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"May I live this day… compassionate of heart" (John O’Donoghue)...

Posts: 4897 | From: Somewhere cold in Victoria, Australia | Registered: Aug 2001  |  IP: Logged
Moth

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# 2589

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quote:
Originally posted by Rowen:
quote:
Originally posted by Moth:
quote:
Originally posted by mdijon:
quote:
Originally posted by Dumpling Jeff:
Once most people are on the government plan, it's a short hop to the government mandating certain types of care (exercise plans, low junk food diets, etc.) to reduce public costs.

Yes, that's the path it's taken in every other democracy that has government run health care.
Exactly. Every time I go to the doctor, he makes me sign a pledge to say I haven't eaten in McDonald's for at least three months. I'm sure every American visiting the UK has noticed how slim we all are, how few junk food outlets are available, and how all of us are just exercising like crazy!
And Moth, this is true of Australia too! We have government-financed health-care as well.
(No McDonalds here for us to swear not to eat- and I mean that literally, living in a tiny country town miles away from any fastfood joint!)

Actually, I'm quite prepared to believe that, Rowen. Any country which produces so many good sports stars must have some secret government programme to ban junk food and force people to exercise. It's not as if you have any nice, sunny weather to tempt people run around outside, is it?

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"There are governments that burn books, and then there are those that sell the libraries and shut the universities to anyone who can't pay for a key." Laurie Penny.

Posts: 3446 | From: England | Registered: Apr 2002  |  IP: Logged
Mr. Spouse

Ship's Pedant
# 3353

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quote:
Originally posted by Dumpling Jeff:
Seeker, it's my understanding that there will be fines for those who don't get insurance. It's also my understanding that private insurance will be taxed so as to force people to choose the government plan. So not paying the fines, etc. will get one thrown in prison for non-payment which is a felony.

Once most people are on the government plan, it's a short hop to the government mandating certain types of care (exercise plans, low junk food diets, etc.) to reduce public costs.

Live free or diet.

Aren't the penalties to be imposed through the tax system? If they are less than the cost of coverage you wouldn't have to take it, and probably won't end up in jail (provided of course that you pay the tax).

In the UK, I've read that around 12% of the population have some form of private healthcare. Those of working age still have to pay for Government care through taxation on top of that.

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Try to have a thought of your own, thinking is so important. - Blackadder

Posts: 1814 | From: Here, there & everywhere | Registered: Sep 2002  |  IP: Logged
mousethief

Ship's Thieving Rodent
# 953

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quote:
Originally posted by Dumpling Jeff:
This health bill has a lot of potential to limit freedom. Further, some of the bills supporters seem to have this as a goal.

Which ones? Please cite sources.

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This is the last sig I'll ever write for you...

Posts: 63536 | From: Washington | Registered: Jul 2001  |  IP: Logged
FreeJack
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# 10612

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quote:
Originally posted by Mr. Spouse:

In the UK, I've read that around 12% of the population have some form of private healthcare. Those of working age still have to pay for Government care through taxation on top of that.

Yes. What's wrong with that? I am one of them, though I have hardly used it, but I have used the tax-paid NHS.

Depending on the coverage, you might get counselling helplines, a better room and food as an in-patient in hospital recovering from an operation, shorter waits for the best specialist for non-emergency care. And you might get the whole cost paid, or you might be able to reclaim say 50% of the cost. You pay your premium accordingly.

About 7% of parents pay for private school education on top of taxes for education too.

Surely it shows that most of the population are happy with the state-funded service most of the time, but there is still choice for those that want it.

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Imaginary Friend

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# 186

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quote:
Originally posted by FreeJack:
Surely it shows that most of the population are happy with the state-funded service most of the time, but there is still choice for those that want it.

No it does not. All it shows is that the choice is there for those who can afford it.

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"We had a good team on paper. Unfortunately, the game was played on grass."
Brian Clough

Posts: 9455 | From: Left a bit... Right a bit... | Registered: May 2001  |  IP: Logged
Mr. Spouse

Ship's Pedant
# 3353

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quote:
Originally posted by FreeJack:
quote:
Originally posted by Mr. Spouse:

In the UK, I've read that around 12% of the population have some form of private healthcare. Those of working age still have to pay for Government care through taxation on top of that.

Yes. What's wrong with that? I am one of them, though I have hardly used it, but I have used the tax-paid NHS.
I never said there was anything right or wrong. I was pointing out to Dumpling Jeff that even with social systems like the NHS there is still capacity for free choice.

But now you have put it that way, what IF said.

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Try to have a thought of your own, thinking is so important. - Blackadder

Posts: 1814 | From: Here, there & everywhere | Registered: Sep 2002  |  IP: Logged
FreeJack
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# 10612

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But our choice is at the choice end of the health system.

How much choice you want in hospital food you want post life-saving operation is a discretionary lifestyle choice. The same ambulance still picks you up from the car crash in 15 minutes and takes you to hospital for the same life-saving operation in an hour first and asks insurance cash and lifestyle questions after.

And as I understand it the small premium I pay for the discretionary extras I choose are proportionately lower than they would be in the USA, and affordable to most of the country if they wanted it. (Unlike private education which is genuinely out of most people's reach.)

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Mr. Spouse

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# 3353

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quote:
Originally posted by FreeJack:
But our choice is at the choice end of the health system.

How much choice you want in hospital food you want post life-saving operation is a discretionary lifestyle choice. The same ambulance still picks you up from the car crash in 15 minutes and takes you to hospital for the same life-saving operation in an hour first and asks insurance cash and lifestyle questions after.

As I understand the US system, emergency treatment in those circumstances would be provided in some form.
quote:

And as I understand it the small premium I pay for the discretionary extras I choose are proportionately lower than they would be in the USA, and affordable to most of the country if they wanted it. (Unlike private education which is genuinely out of most people's reach.)

Chances are you aren't getting anything like the same extent of cover through your insurance. Chronic conditions, for instance, are probably not included in your health plan (because the NHS provide that).

I'm not sure about your definition of affordable. I certainly couldn't afford private healthcare on my current annual income. But I'm not against it for those that can afford to pay. If it eases some of the pressure on the public system then that's not a bad thing.

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Try to have a thought of your own, thinking is so important. - Blackadder

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Doublethink.
Ship's Foolwise Unperson
# 1984

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What annoys me about private health care in the UK, is the right wing think tanks and others bigging up its a efficiency etc. Without acknowledging that it immediately dumps people with chronic and complex conditions back to the NHS.

Yes, the NHS would be more efficient and have lower waiting times if it screened out all the difficult patients. The other fairly stupid thing about private healthcare in the UK is a large portion of the staff are NHS or ex-NHS fitting extra clinics / shifts.

I remember taking my gran to see a priavte opthamologist for laser surgery at a BUPA hospital, and then bumping into him in an NHS hospital a week later. On the other side of the fence, the people I know who choose to work privately tend to do so in order to work less hours for the same money, to have a set of simpler cases or to be able to screen cases so they treat only people who match their special interest.

I work in secondary care in the NHS and treat almost exclusively, people with chronic complex conditions whose conditions leave them without the ability to negotiate effectively and advocate effectively for care. They would be absolutely screwed in a private system.

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All political thinking for years past has been vitiated in the same way. People can foresee the future only when it coincides with their own wishes, and the most grossly obvious facts can be ignored when they are unwelcome. George Orwell

Posts: 19219 | From: Erehwon | Registered: Aug 2005  |  IP: Logged
Doublethink.
Ship's Foolwise Unperson
# 1984

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Is says something about the ass-backwards nature of medical insurance that they don't cover preventative health care.

You'd help to quit smoking would lower your long term costs - but then again the NHS does provide that so I guess they don't think there is the demand.

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All political thinking for years past has been vitiated in the same way. People can foresee the future only when it coincides with their own wishes, and the most grossly obvious facts can be ignored when they are unwelcome. George Orwell

Posts: 19219 | From: Erehwon | Registered: Aug 2005  |  IP: Logged
Olaf
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# 11804

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quote:
Originally posted by Mr. Spouse:
As I understand the US system, emergency treatment in those circumstances would be provided in some form.

True, but there's a problem with emergency rooms in the US. Since people know that they are going to be covered, some people use emergency rooms as their primary care. To make matters worse, some insurance companies cover emergency room visits at a better rate than they cover those quick-care clinics that have been popping up all over. My employer offers an HMO option for insurance, and one of my co-workers on the HMO plan asked the insurance whether she should go to a quick-care clinic or not. The insurance company representative was quite candid and told her to go to the emergency room--it would cost less. Something is clearly wrong with a system that does things like that.
Posts: 8953 | From: Ad Midwestem | Registered: Sep 2006  |  IP: Logged



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