Scotland's healthcare system doesn't suck!

[Rolfe]

There are so many lies and misinformation stories currently being fed to American voters about universal healthcare systems, including the NHS in Britain (which is actually four national systems with complete reciprocity), that I thought a few examples of what actually happens in the 21st century to actual patients might be helpful.

Last night, the news was full of a healthcare story. A 26-year-old woman, who is pregnant, was taken to hospital with Mexican flu. (The hospital concerned was Architect's local hospital, so he may have more information.) She deteriorated, and was placed on life support. However, things got worse. [newspaper article (http://www.theherald.co.uk/news/news/display.var.2521789.0.Swine_flu_Scot_is_flown_to_S wedish_hospital.php)]

But her state deteriorated so quickly that she was airlifted to the first available European centre for a procedure known as extra corporeal membrane oxygenation, which involves the patient's blood being circulated with oxygen in an artificial lung before being brought back into the body.


Why did she have to go to Stockholm? This procedure is very rarely required in adults, so although there is a specialist unit in Glasgow which provides the treatment to children, there are only five beds in the whole of Britain for adults. These are located in Leicester, all together for maximum efficiency. Normally, this is entirely sufficient. However, England has flu coming out of its ears, and these five beds were all occupied last night.

The NHS recognises that this is possible during times of unprecedented demand such as a pandemic, and so there are arrangements in place to share these facilities right across Europe. These arrangements were called on last night, a bed was found in Stockholm (which is actually not all that far, as the NHS air ambulance flies), and the patient was transferred. (The arrangements are reciprocal, so a Swedish patient will end up in Leicester if the situation is reversed.)

(ETA: OK, it's a bit further than I originally thought (http://maps.google.co.uk/maps?f=q&source=s_q&hl=en&geocode=&q=europe&sll=55.830854,-3.224016&sspn=0.035576,0.094757&ie=UTF8&ll=57.183902,6.503906&spn=17.659117,48.515625&z=4).)

The name of the patient has not been released. We have no idea if she is a single mother on welfare or a well-off upper-middle-class housewife. It doesn't matter. This is the sort of care Scottish (and British) citizens get as of right from the NHS. It's only in the news because she was sent to Sweden - if she'd simply been flown to Leicester, in England, over 300 miles away, it wouldn't even have been remarked on.

Nobody had to check her insurance cover. Nobody had to give authorisation. Nobody had to ask any "bureaucrat", government or otherwise. The need had been foreseen, a patient was identified who had that need, therefore the system sprang into action. I imagine the NHS may have to reimburse the Swedish health system for this, but that's no concern of the patient's (and if this flu hits Sweden in the same way, the NHS may well get its money back!).

There is flu in the USA too. I imagine there are US patients who have suffered the same extreme reaction and need the same treatment. I imagine the USA also has facilities for extra corporeal membrane oxygenation. Can anyone tell us how access to these facilities is managed in the USA? If an uninsured patient, or a patient with very basic health insurance, were to be in the situation the Scottish woman was in last night, would they get the same standard of care?

The gross lies and misrepresentation of the standard of care provided by the NHS which are currently circulating in the USA are making the news here. People are horrified at the way mistakes and aberrant experiences are being blown up out of context to imply that we don't have decent healthcare.

Please use this thread to discuss this counter-example, and others that may be appropriate.

Rolfe.

[Oliver]

Nor does the Israeli UHC suck. But they don't seem to be easy targets for the "Healthers".

[JAStewart]

I love the NHS up here in Scotland.

Free prescriptions, saved my Grandad's life, saved my Dad's eyes. Its great!

You are treated like a human and not something to make profit from.

Unfortunately this belief does contradict my soft Libertarianism.

[Delscottio]

My personal story, I was installing a glass roofing panel on a conservatory and to cut a long story short put my back out.

A few days went by with me being a typical man and refusing to go to the doctors while in horrific pain. I expected my back to "click" into place. Finally the wife made me go to the doctors, within 48 hours I was seen by the GP referred to Newcastle General Hospital and operated on for a slipped disk.

The hospital has the regional centre of excellence for Neuroscience and the routine op was performed by a consultant with years upon years of experience. No complaints from me.


As an aside Newcastle is a relatively small city in the North East of England that acts as the regional capital, within there we have the above, The Freeman Hospital which has an excellent reputation and the forth coming Science City stuff http://www.newcastlesciencecity.com/ an absolute boat load of investment in infrastructure fr a relatively smallish city imo.


p.s this is England not Scotland.

[Rolfe]

However, the reciprocity is complete, and I had no intention of excluding examples from other parts of Britain, or indeed from any other country with universal healthcare. (The thread title was just to draw attention, and mimic the Canada one.)

Since you mention the Freeman hospital, I'll post another example from there, again involving a Scottish patient taking advantage of reciprocal arrangements between Scotland and England.

Abigail's new heart. (http://www.theherald.co.uk/news/news/display.var.1982567.0.Six_weeks_ago_she_made_histo ry_now_Abigail_is_ready_to_play.php)

This article is now more than 18 months old. I first linked to it on the day it appeared, because I read it in the dead-tree paper. I have been linking to it with monotonous regularity ever since, when US posters claim that we don't provide cutting-edge treatments, that universal healthcare systems wouldn't be able to provide air ambulances, and all the rest of it.

I ask, if the care we get in Britain is so inferior to that in the USA, please tell me what further care Abigail would have received if she'd been an American girl? I also ask, if Abigail had been an American girl, would she have been guaranteed that level of care, no matter what background she came from or the circumstances of her parents? Thirdly, I ask what "bureaucrats" standing between Abigail and that Berlin Heart had to be overcome, and whether such treatment would be provided in the USA purely on the grounds that the cardiologists thought it was needed (as was the case here), without any other authorisation?

I've been asking these questions for 18 months. The only actual responses I've had from US posters are a comment (from Jerome) that Abigail's mother's teeth don't look too good in the photo, and one from Dan that the first artificial heart was developed in Texas.

Anyone care to address the actual points raised?

Rolfe.

[Rolfe]

Still talking of the Freeman hospital, JREF poster Mark Corrigan told in an earlier post of how he himself was rushed to the Freeman hospital at the age of six weeks for lifesaving heart surgery.

In all such cases there is huge anxiety about the patient's clinical condition. Parents in particular are frantic with worry. However, at least they do not have to concern themselves for a second about how they are going to pay for all this, or whether their insurance company will deny them cover. And I hope we're becoming clear that anxiety that treatment will be substandard is not an issue either in such cases.

Rolfe.

[Darat]

(Rolfe hope you don't think this is off-topic.)

Rolfe and others have supplied some examples of the medical care that people in the NHS have received. What (medically required & non-experimental) treatments available in the USA (say that 75% of the USA population can get access to) are not available via the NHS?

[Professor Yaffle]

I've written here before about the excellent care my niece received at the Freeman Hospital in Newcastle, but to recap, she was diagnosed with a congenital heart condition which meant she only had one ventricle, causing a her heart to be come very enlarged and putting enormous stress on her body. She was scheduled for a series of operations which would hopefully correct the condition gradually over several years. After the first operation, it became clear that her body wasn't coping with the new circulation as it had become partially adapted to the old one. The only real hope was a heart transplant,which - after an agonising wait for a heart to become available - she received. During this time, the staff at the hospital were amazing and my sister was provided with a bed at Ruby's cotside so she could stay overnight whenever she wanted. Ruby is now doing amazingly well. She gets requent check-ups at the hospital when they check everything is going as it should and adjust the substantial amount of medication she has to take. All without any paperwork, other than consent forms for operations, and never a single mention of money or insurance or worry about getting into debt over it.

[Rolfe]

(Rolfe hope you don't think this is off-topic.)

Rolfe and others have supplied some examples of the medical care that people in the NHS have received. What (medically required & non-experimental) treatments available in the USA (say that 75% of the USA population can get access to) are not available via the NHS?


Totally on-topic. I want to compare the provision of big-ticket and cutting-edge healthcare items between countries with universal healthcare and the USA.

But don't you think 75% is a bit low? If there was such a procedure in Britain that 25% of citizens were being denied, it would be a public scandal.

Rolfe.

[Lothian]

As an aside Newcastle is a relatively small city in the North East of England that acts as the regional capital, within there we have the above, The Freeman Hospital which has an excellent reputation and the forth coming Science City stuff http://www.newcastlesciencecity.com/ an absolute boat load of investment in infrastructure fr a relatively smallish city imo.Relatively there is no larger city in the North East. I live in a relatively small city in the North East.

Our hospital was rebuilt (PFI) a few years ago. While the care is free; the car parking and charges for watching the TV thingy are extortionate. That said I would agree that in the UK there is no worry about expense arising from getting ill. I found the American system (albeit that portrayed in Sicko) shocking.

[Rolfe]

[....] she was diagnosed with a congenital heart condition which meant she only had one ventricle, causing a her heart to be come very enlarged and putting enormous stress on her body. She was scheduled for a series of operations which would hopefully correct the condition gradually over several years. After the first operation, it became clear that her body wasn't coping with the new circulation as it had become partially adapted to the old one. The only real hope was a heart transplant,which - after an agonising wait for a heart to become available - she received.


I want to highlight this, because I didn't see that much detail in your earlier posts on the subject.

I think what you describe is a "three-chambered heart", which is, I think, very similar to Abigail Hall's condition. This experience illustrates that this isn't any sort of one-off situation, it happens fairly commonly. The reason Abigail's story got in the newspaper was that her own heart was failing before a donor heart could be sourced, and so the Berlin Heart was used (in an experimental procedure) to keep her going during that crucial period. That's what made it news.

Just as the only reason the flu victim's treatment got on the news was that she was flown to Stockholm because the Leicester facility was full. If she'd just been flown to Leicester, we'd have heard nothing at all about it.

Paediatric heart transplants and extra-corporeal membrane oxygenation are standard care, when required. It takes that little bit extra to get them in the newspapers.

Rolfe.

[volatile]

Totally on-topic. I want to compare the provision of big-ticket and cutting-edge healthcare items between countries with universal healthcare and the USA.

But don't you think 75% is a bit low? If there was such a procedure in Britain that 25% of citizens were being denied, it would be a public scandal.

Rolfe.

In the Canada thread, Mrs GodFearing claims that there are "procedures that are routine in the USA that are denied in England [sic]". What are they? Anyone know?

[Oliver]

Totally on-topic. I want to compare the provision of big-ticket and cutting-edge healthcare items between countries with universal healthcare and the USA.

But don't you think 75% is a bit low? If there was such a procedure in Britain that 25% of citizens were being denied, it would be a public scandal.

Rolfe.


That would be an outcry in every UHC-system, just like the precondition-policy. I have no idea how the insurance industry managed to get away with that all the time.

[Oliver]

In the Canada thread, Mrs GodFearing claims that there are "procedures that are routine in the USA that are denied in England [sic]". What are they? Anyone know?


I didn't find the answer to your question yet, but so far I found this comparsion between the systems you asked about:

http://www.npr.org/news/specials/healthcare/healthcare_profiles.html

[Darat]

Totally on-topic. I want to compare the provision of big-ticket and cutting-edge healthcare items between countries with universal healthcare and the USA.

But don't you think 75% is a bit low? If there was such a procedure in Britain that 25% of citizens were being denied, it would be a public scandal.

Rolfe.

Well I was trying to be reasonable. We know that the USA does not have 100% coverage and there is a lot of argument of the exact number of people who are are not insured or are "under" insured so I thought 75% of the population was a conservative estimate to use.

I do wonder what figure of USA folk would be able to have something like a heart transplant (assuming, as with all systems, a suitable donor organ could be found in time) and have all the costs covered, including all the follow-up costs such as anti-rejection drug therapy?

[Rolfe]

Well I was trying to be reasonable. We know that the USA does not have 100% coverage and there is a lot of argument of the exact number of people who are are not insured or are "under" insured so I thought 75% of the population was a conservative estimate to use.

I do wonder what figure of USA folk would be able to have something like a heart transplant (assuming, as with all systems, a suitable donor organ could be found in time) and have all the costs covered, including all the follow-up costs such as anti-rejection drug therapy?


I think you're being too "reasonable"! My main point is that these treatments are available to all. Saying, gosh yes, but in the USA only 24% of people would be excluded so that's fine, is kind of missing it.

ETA: I do see what you mean though. Is there anything that insured Americans can get routinely, that we can't all get from the NHS. Indeed, also a very relevant question, sorry I butted in. Please proceed.

Rolfe.

[Rolfe]

Trying to drag this thing back on-topic, I've ported this post from the Canada thread.


My favorite anecdote on "socialized health care" is similar. Last year (or possibly late 2007, the article (http://www.aftenposten.no/meninger/debatt/article2481515.ece) doesn't give an exact date) , a woman in Stavanger was hospitalised with a severe blood poisoning with following lung failure. She is stabilized and it's arranged to have her flown from Stavanger Universitetssykehus to the larger Rikshospitalet in Oslo for ECMO treatment.

On the way into the airplane, her condition detoriates to the point where she would not survive the flight. So instead, over night the ECMO machine is flown in from Oslo and an intensive care ambulance drives the 600 kilometers from Oslo to Stavanger with additional equipment. The patient is put on ECMO and loaded into the ambulance, then the ambulance is loaded onto a C-130 Hercules requesitioned from the Air Force and flown to Oslo.

The point of the story? The decision to put all these resources on the line for the patient was made by the anesthetist who accompanied the patient, on his own authority. What a terrible government burauecracy nationalised health care causes.


Rolfe.

[Professor Yaffle]

I've split off the colonoscopy derail as best I could - let me know if you think any of hose posts should have stayed here and I'll move them back

http://forums.randi.org/showthread.php?t=149044

[Rolfe]

I've ported this one back, or rather a part of it, because I thought it was at least as relevant to this topic.

Most Americans can get the high tech treatments Rolfe is describing, but if they don't follow the right path, they could be out hundreds or thousands of dollars, and it might depend on where a blood sample is sent out to for test. I changed which emergency room I go to, which fortunately doesn't happen often, when I realized that one hospital's billing procedures resulted in an extra 500 dollars out of pocket cost for me. It wasn't the type of care they provided. It was the way they filled out the forms.


This is bizarro-world! So you're saying, someone might be in the position of the Scottish woman with the flu, or the Norwegian woman described above, and the critical care team might make a life-or-death decision to go for something high-tech that had to be done immediately or not at all - and later, the insurance company could simply say they didn't authorise it, and leave the patient with the bill?

:jaw-dropp

Why you people put up with this treatment I have literally No Idea.

Rolfe.

[Professor Yaffle]

I think it is simply because they have always experienced healthcare privately and therefore see it as a business transaction that has nothing to do with the government. So they don't have that sense of entitlement that we have. I suppose you have to think back to pre NHS days in this country when if you didn't have money to pay a doctor, or a charity to help, then it was just your hard luck, and nobody would think to blame the government. I don't think it was campaigning and votes of the people excluded from healthcare that got the NHS started in Britain.

[Rolfe]

I see your point, but on the other hand this is 2009, not 1948. Americans have the example of what everybody else has got, to illustrate what a raw deal they are getting. And yet they'd rather stick their fingers in their ears and shout "la-la-la your healthcare sucks" than set about improving their situation.

No, you're right, this actually makes perfect sense in the context of human nature.

Rolfe.

[Random]

I think it is simply because they have always experienced healthcare privately and therefore see it as a business transaction that has nothing to do with the government. So they don't have that sense of entitlement that we have. I suppose you have to think back to pre NHS days in this country when if you didn't have money to pay a doctor, or a charity to help, then it was just your hard luck, and nobody would think to blame the government. I don't think it was campaigning and votes of the people excluded from healthcare that got the NHS started in Britain.

Exactly. Indeed, one of the stated motivations for the GOP stopping the implementation of any kind of universal healthcare plan is that if the plan is implemented, it will be tremendously popular and they will not be able to kill it after the fact.

[Ysidro]

Why you people put up with this treatment I have literally No Idea.

Rolfe.

Because we keep being told that otherwise would be un-American! And apparently we can't trust our government to help us. And only massive corproations out for nothing more than a profit can oversee our health.

Yeah, I don't get it either and I LIVE here.

[Rolfe]

I would really like to hear from some of the Americans who are opposed to universal healthcare here, and who have painted the NHS as a poor-quality system.

How would access to extra-corporeal membrane oxygenation be obtained in the USA? Would an uninsured person be given this treatment? Or someone with only basic insurance? Is it possible that an insurance company would refuse to pay for this after the event?

Could you name one or two of these elusive treatments that are allegedly routine in the USA but which people cannot access in universal healthcare systems?

Rolfe.

[Undesired Walrus]

'Mexican' flu? Have you re-christened it with its original, less catchy name? I prefer 'H1N1' myself, it sounds like a very bourgeois hair product.

[Shalamar]

And yet, still, there will be people (And some on this board!) who will claim that yes, ALL public health care sucks.

[Rolfe]

'Mexican' flu? Have you re-christened it with its original, less catchy name? I prefer 'H1N1' myself, it sounds like a very bourgeois hair product.


Well, I'm a vet. To me, swine flu is something pigs get. :D

You should meet my shampoo. Kerastase Resistance Bain de Force. Also doubles as an extra in the Star Wars films.

Rolfe.

[Rolfe]

And yet, still, there will be people (And some on this board!) who will claim that yes, ALL public health care sucks.


I'd seriously like to hear from these people. Of course there's nothing in this thread to counter those who are opposed to "dead-beats" having their lives saved in this way. I have no idea if the patient in the OP was a dead-beat or a brain surgeon. The care is there for everyone. So if you object to this, and you want the dead-beats to be left to die, then your objection is not countered by this example.

However, the frequent claim that in Britain (and in Europe) all we get is "some" care, or "very basic" care, or "on the cheap" care (all of which I've heard claimed), then yes, we have examples here to counter that.

There's no shame in changing your mind when better information becomes available. Anyone like to try it?

Rolfe.

[Meadmaker]

I see your point, but on the other hand this is 2009, not 1948. Americans have the example of what everybody else has got, to illustrate what a raw deal they are getting. And yet they'd rather stick their fingers in their ears and shout "la-la-la your healthcare sucks" than set about improving their situation.

Americans don't generally pay a lot of attention to the rest of the world, frankly.

In 1948, Germany was a rubble pile, much of Europe had a lot of ruins in it, all of the economies had been shattered, and outside of Europe and Japan, the rest of the world was largely dealing with non-industrial areas without electricity.

As a result, America shot ahead in technology, consumer goods, and things like high quality medical treatment. We grew up being told that we were special and superior. Up until about the mid 1980s, we really were way ahead of almost any other country.

Most Americans think it's still that way today. As a people, we don't really get around much.

[The Mutha]

I've ported this one back, or rather a part of it, because I thought it was at least as relevant to this topic.




This is bizarro-world! So you're saying, someone might be in the position of the Scottish woman with the flu, or the Norwegian woman described above, and the critical care team might make a life-or-death decision to go for something high-tech that had to be done immediately or not at all - and later, the insurance company could simply say they didn't authorise it, and leave the patient with the bill?

:jaw-dropp

Why you people put up with this treatment I have literally No Idea.

Rolfe.

My sister, who lives here in Houston, has been diagonsed with ankylosing spondylitis. She is the sole support of her family of four (husband, two sons). She has been in incredible pain for the past year, but very reluctant to take pain meds as they make it hard for her to concentrate on anything, much less her job. She has what is considered "great" healthcare insurance.

She recently went in for epidurals into her spine so that she could walk more then 100 feet without keeling over in pain. Her rheumatologist set up the epidurals at a specific clinic and they were done. The shots made a world of difference to her and she's been much more active because of them.

Yesterday, she received in the mail a bill for $2,200 because the clinic and the anestheologist (sp?) were not covered under her health care plan. That was for one of the rounds of injections and she had three rounds... $6,600 total.

And now the rheumatologist wants her on Enbrel, which will basically make her uninsurable should she ever lose her current coverage. She was seriously considering not going with the Enbrel because of the non-insurability factor, but is picking the prescription up today.

Oh, and she's not into woo at all and has had to stop visiting the Rheumatoid Arthritis boards and the AS boards because the woo is very prevalent therein. There are people taking methadone as a way to treat their undiagnosed rheumatoid arthritis and swear by it! :jaw-dropp The boards also are full of the "horrors" of the UK's system and how terrible it would be to have that in the States.

It's WAY past time for a health care system wherein people wouldn't have to be afraid of losing their coverage should they lose their job or because of pre-existing conditions.

[Meadmaker]

How would access to extra-corporeal membrane oxygenation be obtained in the USA? Would an uninsured person be given this treatment? Or someone with only basic insurance? Is it possible that an insurance company would refuse to pay for this after the event?

Generally, life saving medical care is never denied for any reason. Usually, an insured person would be covered in full for such treatment, minus deductibles and copays. An uninsured person would receive it, and go bankrupt.

The biggest problem that would arise after the fact would come in a case where the insurance company claimed that there was a less expensive procedure that would have been good enough, at least according to the insurance company. In such a case, they would refuse to pay. You would have a chance to appeal that decision, providing documentation for why that procedure was necessary under the circumstances, but rest assured that "my doctor said so" will not be considered an adequate response. If they turn down that appeal (and it is the insurance company that judges the appeal), then you can sue, except that in most cases part of your contract is that you can't sue, but you can submit your case to binding arbitration.

Bottom line: If there's a doctor saying that this procedure is necessary to save your life, you will almost certainly get the procedure. Of course, you might not have a house to come to when you are released from the hospital, but those cases are pretty rare for those who have insurance.

[Delscottio]

My sister, who lives here in Houston, has been diagonsed with ankylosing spondylitis. She is the sole support of her family of four (husband, two sons). She has been in incredible pain for the past year, but very reluctant to take pain meds as they make it hard for her to concentrate on anything, much less her job. She has what is considered "great" healthcare insurance.

She recently went in for epidurals into her spine so that she could walk more then 100 feet without keeling over in pain. Her rheumatologist set up the epidurals at a specific clinic and they were done. The shots made a world of difference to her and she's been much more active because of them.

Yesterday, she received in the mail a bill for $2,200 because the clinic and the anestheologist (sp?) were not covered under her health care plan. That was for one of the rounds of injections and she had three rounds... $6,600 total.

And now the rheumatologist wants her on Enbrel, which will basically make her uninsurable should she ever lose her current coverage. She was seriously considering not going with the Enbrel because of the non-insurability factor, but is picking the prescription up today.

Oh, and she's not into woo at all and has had to stop visiting the Rheumatoid Arthritis boards and the AS boards because the woo is very prevalent therein. There are people taking methadone as a way to treat their undiagnosed rheumatoid arthritis and swear by it! :jaw-dropp The boards also are full of the "horrors" of the UK's system and how terrible it would be to have that in the States.

It's WAY past time for a health care system wherein people wouldn't have to be afraid of losing their coverage should they lose their job or because of pre-existing conditions.

I know this may sound naive but what happens now with the $6,600 bill? Is there an appeal? Does she have to pay or bankruptcy?

What a mess, seriously on the NHS the only thing she would have had to worry about is turning up for the appointment. How this can be twisted into a horror story has to be almost admired.

[Darat]

My sister, who lives here in Houston, has been diagonsed with ankylosing spondylitis. She is the sole support of her family of four (husband, two sons). She has been in incredible pain for the past year, but very reluctant to take pain meds as they make it hard for her to concentrate on anything, much less her job. She has what is considered "great" healthcare insurance.

She recently went in for epidurals into her spine so that she could walk more then 100 feet without keeling over in pain. Her rheumatologist set up the epidurals at a specific clinic and they were done. The shots made a world of difference to her and she's been much more active because of them.

Yesterday, she received in the mail a bill for $2,200 because the clinic and the anestheologist (sp?) were not covered under her health care plan. That was for one of the rounds of injections and she had three rounds... $6,600 total.

And now the rheumatologist wants her on Enbrel, which will basically make her uninsurable should she ever lose her current coverage. She was seriously considering not going with the Enbrel because of the non-insurability factor, but is picking the prescription up today.

Oh, and she's not into woo at all and has had to stop visiting the Rheumatoid Arthritis boards and the AS boards because the woo is very prevalent therein. There are people taking methadone as a way to treat their undiagnosed rheumatoid arthritis and swear by it! :jaw-dropp The boards also are full of the "horrors" of the UK's system and how terrrible it would be to have that in the States.

It's WAY past time for a health care system wherein people wouldn't have to be afraid of losing their coverage should they lose their job or because of pre-existing conditions.

This is another example where someone would be better off under a UHC like the NHS.

In the UK everything you described is standard treatment for AS, including TNF inhibitors. (Admittedly it took sometime before NICE approved their use.)

AS is my predominate underlying health issue, and from the age of 13 (when I was diagnosed with it) I have been treated under the NHS and have never ever had to worry about my treatment in terms of costs. Indeed I was treated for the first 10 years at a hospital that was (don't know if it still is ETA: it is http://www.wwl.nhs.uk/Internet/Home/Hospitals/wrightington.asp) a world-wide renowned centre for rheumatology (they pioneered hip replacements there) - which is a NHS hospital.

[Tanja]

My only knowledge of the US health system is through various Internet boards like this. On some of the weight loss boards that I frequent, health is a common subject. It never stops shocking me how often people from the US post things like "I am really ill but I can't afford to go to the doctor right now" and then try to get medical advice from other posters. I find it shocking (but then, I grew up in communist Yugoslavia and currently live in the UK, so of course the lack of universal health care shocks me).

[Darat]

Still waiting to see if anyone has examples of medically required treatments (paid for by insurance) in the USA that are not available via the NHS in the UK. Are there any?

[Toke]

I got a bit of a shock last month when I had to get out my credit card at the physician.
Health certificates and vaccinations for my job are billed to my employer, but by some new rules I have to pay the physician and then get the money reimbursed on my travel account.
When I asked "why all the new paperwork" the secretary just smiled and said it was easier for her.

[tkingdoll]

NHS healthcare can be incredible. It can also be inferior to private healthcare, but that's not a surprise, and not an argument against it. If BUPA had the number of patients the NHS did, their service level would be similar, I feel. In general though, the NHS is probably the greatest benefit to living in the UK.

NHS dentistry, on the other hand, is a freaking shambles. They're even now charging the unemployed, single parents etc for cleaning (essential for healthy gums) because it's, get this, cosmetic. Despite being carried out by a Hygienist, that is.

The idea of not being able to afford essential healthcare, or being afraid to risk insurance, upsets me greatly. Of course I only have the perspective of my own experience, but I can't see any benefit to the USA model over the UK model.

[The Mutha]

I know this may sound naive but what happens now with the $6,600 bill? Is there an appeal? Does she have to pay or bankruptcy?

What a mess, seriously on the NHS the only thing she would have had to worry about is turning up for the appointment. How this can be twisted into a horror story has to be almost admired.

She's contacted the Doctor and her insurance company to appeal their turning the charges down for payment, but chances are, she'll have to pay it. Slowly, over time. I know folks who paid $10 a month to the hospital where their child was born prematurely and finally paid off the bill when the kid was 10 or so... Although Helen definitely would pay it off sooner than that, I'm sure. My thing is the insurance company has to "pre-qualify" all procedures, why the heck didn't they let her know that the procedure was scheduled at a location they didn't cover?

[Leif Roar]

[...] from the age of 13 (when I was diagnosed with it) I have been treated under the NHS and have never ever had to worry about my treatment in terms of costs.

That's the thing that gets me about how health care works in the USA: the amount of worry it engenders. Worry about losing health insurance, worry about whether a procedure or drug is covered, worry about whether they can afford treatment that isn't covered, even worry about paying ambulance bills.

I have friends in the USA who have serious health conditions and little in the way of means to cushion them through, and I always end up with a twinge of a kind of survivor's guilt because all I have to worry about when I get sick is a) whether I'm going to get better or not and b) that my potted plants aren't being watered.

[Delscottio]

She's contacted the Doctor and her insurance company to appeal their turning the charges down for payment, but chances are, she'll have to pay it. Slowly, over time. I know folks who paid $10 a month to the hospital where their child was born prematurely and finally paid off the bill when the kid was 10 or so... Although Helen definitely would pay it off sooner than that, I'm sure. My thing is the insurance company has to "pre-qualify" all procedures, why the heck didn't they let her know that the procedure was scheduled at a location they didn't cover?


Disgusting, absolutely disgusting. Then again would you say anything if you could get out of spending $6600 by simply keeping your mouth shut?

[Rolfe]

The boards also are full of the "horrors" of the UK's system and how terrible it would be to have that in the States.


Now this is one reason I started this thread. Feel free to link!

Rolfe.

[Rolfe]

Generally, life saving medical care is never denied for any reason. Usually, an insured person would be covered in full for such treatment, minus deductibles and copays. An uninsured person would receive it, and go bankrupt.

The biggest problem that would arise after the fact would come in a case where the insurance company claimed that there was a less expensive procedure that would have been good enough, at least according to the insurance company. In such a case, they would refuse to pay. You would have a chance to appeal that decision, providing documentation for why that procedure was necessary under the circumstances, but rest assured that "my doctor said so" will not be considered an adequate response. If they turn down that appeal (and it is the insurance company that judges the appeal), then you can sue, except that in most cases part of your contract is that you can't sue, but you can submit your case to binding arbitration.

Bottom line: If there's a doctor saying that this procedure is necessary to save your life, you will almost certainly get the procedure. Of course, you might not have a house to come to when you are released from the hospital, but those cases are pretty rare for those who have insurance.


I'm still not sure about this. You have an uninsured person, and they have flu, and they're in serious respiratory difficulty. You've done all you can so far as regular treatment goes, but the patient continues to deteriorate. Do you sigh in resignation and let it go, or do you move heaven and earth to get this patient transferred to the central unit that has the facility to carry out this very rare procedure?

I may be wrong, but I have a feeling that the former might just be the more likely approach.

Also, if such a transfer (for an insured patient) is a matter of extreme urgency, maybe in the middle of the night, would the insurance company demand that the patient's life be endangered by waiting for authorisation to go ahead?

Rolfe.

[The Mutha]

Now this is one reason I started this thread. Feel free to link!

Rolfe.

I've emailed Helen asking her for specifics and I'll get back to you. She's off today, picking up the Enbrel ($50 co-pay for a month's supply), getting her second son enrolled in high school and her oldest enrolled in college.

ETA (Sister's response):

The first board I found is
http://www.spondylitis.org/patient_resources/main.aspx. The second board is http://www.kickas.org/. I tend to pay attention to the people who can cite research and seem pretty involved in their care and diagnosis but also level-headed about what they're dealing with. There are a lot of people on the first site who spend way too much time wallowing in how awful it all is, and a lot of people on the second site who are convinced that medicine is evil while being willing to take every supplement that comes their way.

This guy's posts are ones that I tend to actually read for instance...

http://www.kickas.org/ubbthreads/showflat.php?Number=355692

[Lisa Simpson]

I'm still not sure about this. You have an uninsured person, and they have flu, and they're in serious respiratory difficulty. You've done all you can so far as regular treatment goes, but the patient continues to deteriorate. Do you sigh in resignation and let it go, or do you move heaven and earth to get this patient transferred to the central unit that has the facility to carry out this very rare procedure?

I may be wrong, but I have a feeling that the former might just be the more likely approach.

I doubt any doctor would sigh in resignation and let it go.

Also, if such a transfer (for an insured patient) is a matter of extreme urgency, maybe in the middle of the night, would the insurance company demand that the patient's life be endangered by waiting for authorisation to go ahead?

The doctors would send the patient ahead and then the patient would be forced to cough up the money later. Every insurance I've had (all PPOs, not HMOs) emergency services do not require authorization.

[Undesired Walrus]

Any word on the condition of this woman?

[Leif Roar]

The doctors would send the patient ahead and then the patient would be forced to cough up the money later. Every insurance I've had (all PPOs, not HMOs) emergency services do not require authorization.

How exactly is emergency services defined? Does it cover all immediate, life-saving treatment?

[Lisa Simpson]

How exactly is emergency services defined? Does it cover all immediate, life-saving treatment?

For my insurance (Anthem Blue Cross of California), yes. Obviously, I cannot speak to every insurance company across the country.

[Delscottio]

For my insurance (Anthem Blue Cross of California), yes. Obviously, I cannot speak to every insurance company across the country.

Apologies if it seems like you're getting a grilling about your insurance but could the company dispute you needed the treatment / any part of the treatment and refuse to pay?

[The Mutha]

Okay, heard back from the sister, don't know if the SI fusing thing is valid in the UK or not...

****************

The difference that I can see is that the US doctors will use it almost prophylacticly (sp), while the UK requires x-rays to show fusion in the SI joints. I think technically, despite having the HLA-B27 gene, noticeable damage to the spine on an MRI, calcifying tendonitis in both shoulders, arthritic damage in the c-spine, swelling in multiple joints, and incredibly high SED and CRP rates, because my sacroiliac joints are painful but not fused, I probably wouldn't get an AS diagnosis in the UK until the joints do visibly fuse on an x-ray.

From talking to my rheumatologist, she's really worried about UHC because right now, she can put the diagnosis in and it's highly unlikely that someone will go rummage through her medical records. Once they're computerized, though, she will lose that ability to make a diagnosis that doesn't meet certain strict criteria. So her thinking is that by treating me proactively she can delay the damage and hopefully reduce my pain now, but once the records are electronic, someone presenting with my same symptoms may have to be treated much less aggressively, and may have a lot more quality of life issues.

***********

My sister is definitely in favor of a UHC plan, for the record.

[Rolfe]

Any word on the condition of this woman?


I heard a short update at the end of the news about 45 minutes ago. They gave her name, and where she's from. "Her family said she is getting the best possible care but she is still gravely ill."

Here you are. (http://news.bbc.co.uk/1/hi/scotland/glasgow_and_west/8166781.stm)

Rolfe.

[Lisa Simpson]

Apologies if it seems like you're getting a grilling about your insurance but could the company dispute you needed the treatment / any part of the treatment and refuse to pay?

Well, I have a list of procedures that are subject to post-service review. Glancing through it, they do not look like life-saving emergency procedures. However, it does use big medical words that I don't understand.

[Agatha]

Okay, heard back from the sister, don't know if the SI fusing thing is valid in the UK or not...

****************

The difference that I can see is that the US doctors will use it almost prophylacticly (sp), while the UK requires x-rays to show fusion in the SI joints. I think technically, despite having the HLA-B27 gene, noticeable damage to the spine on an MRI, calcifying tendonitis in both shoulders, arthritic damage in the c-spine, swelling in multiple joints, and incredibly high SED and CRP rates, because my sacroiliac joints are painful but not fused, I probably wouldn't get an AS diagnosis in the UK until the joints do visibly fuse on an x-ray.

From talking to my rheumatologist, she's really worried about UHC because right now, she can put the diagnosis in and it's highly unlikely that someone will go rummage through her medical records. Once they're computerized, though, she will lose that ability to make a diagnosis that doesn't meet certain strict criteria. So her thinking is that by treating me proactively she can delay the damage and hopefully reduce my pain now, but once the records are electronic, someone presenting with my same symptoms may have to be treated much less aggressively, and may have a lot more quality of life issues.

***********

My sister is definitely in favor of a UHC plan, for the record.
I am aware of people in my Crohn's support group who have been diagnosed with AS prior to having fused joints, so I'm not sure that it is accurate to state that a diagnosis would be so delayed in the UK. Anyone coming to the group with joint or back pain is advised by other members to get their doc to test for HLA-B27.

I have received exemplary care from the NHS, if I had had to pay for it I would have had to declare bankruptcy. Although I used to have a well-paying job I now only work part time (due to my illness) and as a single parent I have to worry about every penny; insurance would be a luxury I probably couldn't afford and with a pre-existing condition, would presumably be very expensive. I don't have to pay the normal £7.20 per item prescription charge due to my low income.

In the last six months alone I have had one inpatient stay of four days, two colonoscopies, one barium meal & follow-through, five consultant appointments, eight nurse-practitioner appointments, seven GP appointments, 26 blood tests, eleven telephone calls to or from my IBD nurse-practitioner, and 37 prescriptions.

[Rolfe]

The difference that I can see is that the US doctors will use it almost prophylacticly (sp), while the UK requires x-rays to show fusion in the SI joints. I think technically, despite having the HLA-B27 gene, noticeable damage to the spine on an MRI, calcifying tendonitis in both shoulders, arthritic damage in the c-spine, swelling in multiple joints, and incredibly high SED and CRP rates, because my sacroiliac joints are painful but not fused, I probably wouldn't get an AS diagnosis in the UK until the joints do visibly fuse on an x-ray.

From talking to my rheumatologist, she's really worried about UHC because right now, she can put the diagnosis in and it's highly unlikely that someone will go rummage through her medical records. Once they're computerized, though, she will lose that ability to make a diagnosis that doesn't meet certain strict criteria. So her thinking is that by treating me proactively she can delay the damage and hopefully reduce my pain now, but once the records are electronic, someone presenting with my same symptoms may have to be treated much less aggressively, and may have a lot more quality of life issues.


I don't work in the NHS, I'm a vet not a doctor, so I may be wrong. But to the best of my knowledge there is nothing in the British system for the rheumatologist to get concerned about. So far as I know, the diagnostic criteria for that one are not nearly so prescriptive as that.

I have no idea whether any universal healthcare scheme the US might introduce would try to deny patients early treatment in that way, but I think she's another one who's been frightened by the black propaganda flying around about how terrible universal healthcare is.

Rolfe.

[Darat]

I am aware of people in my Crohn's support group who have been diagnosed with AS prior to having fused joints, so I'm not sure that it is accurate to state that a diagnosis would be so delayed in the UK.

...snip...

My AS was diagnosed even before I had a full set of x-rays, diagnosis was based on symptoms, examinations and carrying HLA-B27, and that was was about 30 years ago.

Even back then the aim was to try and prevent joint fusion if at all possible so waiting for fusion before the diagnosis would have been a tad a-about-t.

NHS patient leaflet about AS shows that fusion is not required for a diagnosis: http://www.cks.nhs.uk/patient_information_leaflet/ankylosing_spondylitis

[Rolfe]

[....] the UK requires x-rays to show fusion in the SI joints. I think technically, despite having the HLA-B27 gene, noticeable damage to the spine on an MRI, calcifying tendonitis in both shoulders, arthritic damage in the c-spine, swelling in multiple joints, and incredibly high SED and CRP rates, because my sacroiliac joints are painful but not fused, I probably wouldn't get an AS diagnosis in the UK until the joints do visibly fuse on an x-ray.

From talking to my rheumatologist, she's really worried about UHC because [....] someone presenting with my same symptoms may have to be treated much less aggressively, and may have a lot more quality of life issues.


OK, here's the actual facts on this one, and it's as I believed it to be.

My AS was diagnosed even before I had a full set of x-rays, diagnosis was based on symptoms, examinations and carrying HLA-B27, and that was was about 30 years ago.

Even back then the aim was to try and prevent joint fusion if at all possible so waiting for fusion before the diagnosis would have been a tad a-about-t.

NHS patient leaflet about AS shows that fusion is not required for a diagnosis: http://www.cks.nhs.uk/patient_information_leaflet/ankylosing_spondylitis


Once more, we encounter a false account of the restricted care allegedly provided by the NHS. Once again, it's not true. Mutha, where did you get this from? Who is spreading these vicious falsehoods?

Rolfe.

[Tsukasa Buddha]

I say it does suck!

Well, from what I understand (which is very little, mind you), the organizations that determine quality of care are not independent from the government, which could lead to politicizing issues best left to evidence-based medicine.

But one anecdote from the States about the bad thing about the lack of a national program is about mental health. At the community health center, patients get diagnosed before entering the program I am in. However, they have to be careful what diagnosis they list on their charts. Different insurance companies have different books that use different codes for disorders, and often the NOS variety is not covered. So then they have to try to figure out what to put down so the person can get their treatment.

[Meadmaker]

I'm still not sure about this. You have an uninsured person, and they have flu, and they're in serious respiratory difficulty. You've done all you can so far as regular treatment goes, but the patient continues to deteriorate. Do you sigh in resignation and let it go, or do you move heaven and earth to get this patient transferred to the central unit that has the facility to carry out this very rare procedure?

I may be wrong, but I have a feeling that the former might just be the more likely approach.

Also, if such a transfer (for an insured patient) is a matter of extreme urgency, maybe in the middle of the night, would the insurance company demand that the patient's life be endangered by waiting for authorisation to go ahead?

Rolfe.

Generally, it's as Lisa said. What happens is the doctors say, "Do this, now" and it happens, then the bills get sorted out later. When you present yourself for treatment, they'll ask you for insurance, but if your condition requires immediate attention, they won't worry about it.

Definitely, if it appears that life is in danger, treatment won't be held up waiting for payment.

But then you are left with that "worry" that Leif mentioned. The doctor said do it, and didn't pass it by for review, but perhaps the insurance company will have a different opinion later. There are some conditions you would like treated now, but if the difference is $1,000, you can wait until morning. There's no way for you to know, medically, whether it's safe to wait. If the insurance company decides it wasn't necessary to treat you, they'll stick you with the bill. Meanwhile, there's no way for the doctors to know, and they aren't going to wait around to find out.

[Delscottio]

I say it does suck!

Well, from what I understand (which is very little, mind you), the organizations that determine quality of care are not independent from the government, which could lead to politicizing issues best left to evidence-based medicine.


From what I can remember the NHS has a number of Public Service Agreements to meet, in that the government and NHS will meet and agree budgets and what will be delivered for those budgets in the coming year (s). How what is agreed is delivered is pretty much left the the NHS.

A taste of the PSA is here, but they are a lot more in depth
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/Browsable/DH_5209573

The individual departments who deliver the care are Consultant led - I would take a massive punt these people will follow evidence based procedures.

Obviously political pressure can be applied but its usually only when the people who own (the people who use it..) the service want that change

But one anecdote from the States about the bad thing about the lack of a national program is about mental health. At the community health center, patients get diagnosed before entering the program I am in. However, they have to be careful what diagnosis they list on their charts. Different insurance companies have different books that use different codes for disorders, and often the NOS variety is not covered. So then they have to try to figure out what to put down so the person can get their treatment.

It doesn't seem confined to mental health.

[Rolfe]

Well, from what I understand (which is very little, mind you), the organizations that determine quality of care are not independent from the government, which could lead to politicizing issues best left to evidence-based medicine.


If you're talking about the NHS, well, no not really. They're pretty hot on evidence-based medicine apart from a ridiculous blind spot on homoeopathy, that everybody seems to scared of Prince Charles to consign to the dustbin. The politicians don't interfere, and if treatment availability was politicised there would be riots in the streets.

But one anecdote from the States about the bad thing about the lack of a national program is about mental health. At the community health center, patients get diagnosed before entering the program I am in. However, they have to be careful what diagnosis they list on their charts. Different insurance companies have different books that use different codes for disorders, and often the NOS variety is not covered. So then they have to try to figure out what to put down so the person can get their treatment.


Bizarre.

Rolfe.

[Camillus]

Last night, the news was full of a healthcare story. A 26-year-old woman, who is pregnant, was taken to hospital with Mexican flu. (The hospital concerned was Architect's local hospital, so he may have more information.) She deteriorated, and was placed on life support. However, things got worse. [newspaper article (http://www.theherald.co.uk/news/news/display.var.2521789.0.Swine_flu_Scot_is_flown_to_S wedish_hospital.php)]

Why did she have to go to Stockholm? This procedure is very rarely required in adults, so although there is a specialist unit in Glasgow which provides the treatment to children, there are only five beds in the whole of Britain for adults. These are located in Leicester, all together for maximum efficiency. Normally, this is entirely sufficient. However, England has flu coming out of its ears, and these five beds were all occupied last night.

The NHS recognises that this is possible during times of unprecedented demand such as a pandemic, and so there are arrangements in place to share these facilities right across Europe. These arrangements were called on last night, a bed was found in Stockholm (which is actually not all that far, as the NHS air ambulance flies), and the patient was transferred. (The arrangements are reciprocal, so a Swedish patient will end up in Leicester if the situation is reversed.)

(ETA: OK, it's a bit further than I originally thought (http://maps.google.co.uk/maps?f=q&source=s_q&hl=en&geocode=&q=europe&sll=55.830854,-3.224016&sspn=0.035576,0.094757&ie=UTF8&ll=57.183902,6.503906&spn=17.659117,48.515625&z=4).)

The name of the patient has not been released. We have no idea if she is a single mother on welfare or a well-off upper-middle-class housewife. It doesn't matter. This is the sort of care Scottish (and British) citizens get as of right from the NHS. It's only in the news because she was sent to Sweden - if she'd simply been flown to Leicester, in England, over 300 miles away, it wouldn't even have been remarked on.

Rolfe.

I had a meeting this morning with a consultant from one of the largest intensive care units in the UK. He brought up this case and told me that there were adult ECMO beds available in London but they were not asked to take this patient. Very odd.

[Rolfe]

That is odd. The news here has consistently stated that there are only five adult beds in Britain, and they are in Leicester. There must be crossed wires somewhere, or poor communication.

Rolfe.

[Camillus]

Poor communication. I suspect the referring hospital didn't realise that although there are only five beds at the national specialist centre there are several intensive care units that have the facilities to do it. The consultant I was talking was saying they'd already had one patient on ECMO this year and were expecting to do more.

[Rolfe]

Well, this is Kilmarnock we're talking about!

Rolfe.

[gtc]

Are there differences between the US and the UK for treatment for routine ailments like a throat infection?

How long would it take to get to see a doctor, how much would it cost for antibiotics?

In Australia I can make an appointment to see a GP of my choosing (which might mean waiting until the next day) or I can turn up to a surgery of my choice and take my chances on waiting (I have been turned away once or twice for turning up too late in the day and have waited anywhere from 10 minutes to 2 hours). Some GPs stay open until 10pm or midnight but none in my area but there is a hospital nearby.

GPs recieve a fixed payment from the government for seeing patients which gives the dodgier ones an incentive to churn through patients as quickly as possible. Some GPs charge an extra fee on top of this but none do so in my area and from my perspective it, oddly enough, doesn't seem to affect the quality of their care.

Antibiotics have cost me up to USD25 or 15 pounds but usually less and usually much less for the generic brand. Prices seem to vary by neighbourhood as competition between pharmacists is somewhat limited by government regulations.

[Darat]

Are there differences between the US and the UK for treatment for routine ailments like a throat infection?

How long would it take to get to see a doctor, how much would it cost for antibiotics?

In Australia I can make an appointment to see a GP of my choosing (which might mean waiting until the next day) or I can turn up to a surgery of my choice and take my chances on waiting (I have been turned away once or twice for turning up too late in the day and have waited anywhere from 10 minutes to 2 hours). Some GPs stay open until 10pm or midnight but none in my area but there is a hospital nearby.

GPs recieve a fixed payment from the government for seeing patients which gives the dodgier ones an incentive to churn through patients as quickly as possible. Some GPs charge an extra fee on top of this but none do so in my area and from my perspective it, oddly enough, doesn't seem to affect the quality of their care.

Antibiotics have cost me up to USD25 or 15 pounds but usually less and usually much less for the generic brand. Prices seem to vary by neighbourhood as competition between pharmacists is somewhat limited by government regulations.

Apart from the "extra fee" that is as it is here. There has been a big push recently to get more GP surgeries to provide more evening and weekend appointments. (There is a legal obligation for all GPs to provide an out-of-hours service, most choose to out-source this and use (wait for it) a for-profit private company.)

As for the antibiotics, the maximum anyone in the UK pays for any drug would be £7.20 but the majority of people in the UK pay nothing for their NHS prescribed medication.

[Architect]

What Darat said, subject to the caveat that there are no prescription charges in Wales IIRC and Scotland is shortly going the same way.

[lionking]

Further to gtc's post, Australia has a very good basic UHS, but if you are needing elective surgery, including things like hip replacements, prepare to be put on a waiting list. True emergencies will always be treated free of charge (well, apart from the 1% medicare tax levy).

I choose to take out private health insurance as well, which currently costs $A250 a month. This covers my family for "queue jumping", private wards, dentistry, orthodonty etc (the etc, sadly, includes homeopathy).

A universal basic system with insurance for extras is fine by me.

[Francesca R]

Generally, it's as Lisa said. What happens is the doctors say, "Do this, now" and it happens, then the bills get sorted out later.Does anyone not agree that this situation is massively inferior to "Do this now and there will never be a bill later"?

I can't really reconcile what heights of paranoia of free-riders are required to prefer it the first way.

[Rolfe]

Does anyone not agree that this situation is massively inferior to "Do this now and there will never be a bill later"?

I can't really reconcile what heights of paranoia of free-riders are required to prefer it the first way.


I'm not sure how well thought-out the paranoia is. Many of the group who declare that they don't want their money paying for dead-beats to have medical treatment, at the same time hotly deny that they're comfortable with the idea of leaving the poor to suffer and die without treatment.

It's irreconcilable, but that's their stance. I think they want to feel that there's a bill there, even though it can never be paid.

Rolfe.

[Leif Roar]

Many of the group who declare that they don't want their money paying for dead-beats to have medical treatment,

What I don't get is why they're fine with the fire departments being funded centrally. Shouldn't they be arguing that fire departments should work in the same way as ER, with the departments mandated to answer calls within their district and putting out any fires / assisting at accident scenes, and then billing the house-owner or accident victim after the fact?

[Chaos]

I'm not sure how well thought-out the paranoia is. Many of the group who declare that they don't want their money paying for dead-beats to have medical treatment, at the same time hotly deny that they're comfortable with the idea of leaving the poor to suffer and die without treatment.

It's irreconcilable, but that's their stance. I think they want to feel that there's a bill there, even though it can never be paid.

Rolfe.

I think the idea is that charity will take care of that; at least that´s what I recall from my conversations with Shanek. Meaning, of course, that the greedy free-ride at the expense of those stupid enough to donate to the charities that clean up the mess the greedy leave.

[Rolfe]

What I don't get is why they're fine with the fire departments being funded centrally. Shouldn't they be arguing that fire departments should work in the same way as ER, with the departments mandated to answer calls within their district and putting out any fires / assisting at accident scenes, and then billing the house-owner or accident victim after the fact?


Many of them say that's exactly how they'd like it to be. Schools should all be paid for by the parents, I don't suppose there would be a public park or a library book either in their little utopia.

Rolfe.

[Rolfe]

I think the idea is that charity will take care of that; at least that´s what I recall from my conversations with Shanek. Meaning, of course, that the greedy free-ride at the expense of those stupid enough to donate to the charities that clean up the mess the greedy leave.


The usual continuation of that line is to imply that the other party in the discussion is a hypocrite for suggesting that anyone else should contribute unless they themselves have already given all they own to charity.

The other tack is that Republican supporters are generous to a fault, and it's only these selfish Democrat supporters not pulling their weight that causes the shortfall in charity funding. I suggested to one of these that they should be very keed on tax-funding the system then, to ensure that the selfish Democrats pay their way, and stop them getting a commercial advantage because of their lower outlay, but that didn't seem to fly either.

Rolfe.

[Francesca R]

I was considering this more from the perspective of patient distress.

"We will do whatever it takes to treat you, and there is no cost" [1]

is very different from

"We will do whatever it takes to treat you, and there is no need to worry just yet about the cost which might mean future financial ruin for you" [2]

In particular I wonder what strength of belief in the evils of free-riders getting away with hugely expensive unnecessarily self indulgent yet probably life-saving medical treatment is required so that one thinks that [2] is at least as good as [1] in the moment of need.

[kellyb]

I was considering this more from the perspective of patient distress.

"We will do whatever it takes to treat you, and there is no cost" [1]

is very different from

"We will do whatever it takes to treat you, and there is no need to worry just yet about the cost which might mean future financial ruin for you" [2]

In particular I wonder what strength of belief in the evils of free-riders getting away with hugely expensive unnecessarily self indulgent yet probably life-saving medical treatment is required so that one thinks that [2] is at least as good as [1] in the moment of need.

In their moment of need, they're just happy to be treated, period. (it's really not difficult to brush aside money worries when in the ER and faced with death.)
In the aftermath, should they find themselves in financial ruin, they just blame gov intervention for making it all so expensive in the first place.

[Francesca R]

I don't really know where you're coming from with that, but it looks as though you are saying [2] is really no worse than [1], and that the possibility of severe financial penalty at some point in the future does not impair patient experience (is not a social bad). Were that a correct interpretation I consider it utterly delusional.

I don't think you mean that . . .

[Rolfe]

I mentioned on another thread about the new car I've got on order, and speculated that I might be less inclined to stimulate the economy of Lower Saxony if I thought I might need that money for a hip replacement or cancer chemotherapy in the future. One poster replied that if I was hit that hard by healthcare costs (as an American) I'd be screwed anyway, so I might just as well get some fun out of the money before it all disappears in a sea of red ink.

I find this a completely horrendous prospect. I don't want to spend my declining years as a bankrupt, with all my assets gobbled up in healthcare costs. And yet I see that appears to be the only real option for many Americans.

I can also to an extent understand the thinking. If future healthcare costs are going to bankrupt me whatever I do, I might as well spend the money now, rather than leave it to be gobbled up by healthcare costs before the inevitable bankruptcy.

What a bloody mess.

Rolfe.

[Meadmaker]

I find this a completely horrendous prospect. I don't want to spend my declining years as a bankrupt, with all my assets gobbled up in healthcare costs. And yet I see that appears to be the only real option for many Americans.


For millions of Americans.

I am fortunate. My 85 year old mother is in relatively good health, and actually still works part time as a Registered Nurse, in an assisted living center. As a consequence, her and my fathers' savings will probably not be depleted completely before she dies. Also, dad helped that cause by dying relatively young (73), and suddenly, before a lingering illness could drain all of his accounts. As a result, I don't have to worry about my parents being a financial burden to me as I save for college for my son.

If you want to know about life in America, google the phrase "sandwich generation."

Meanwhile, the economic collapse of this last year has seen a lot of people in my mom's facility move out. Government doesn't cover the cost of assisted living, and many people she tended to had their life savings in the stock market, so they could not afford to live there anymore.

I wish more Americans could read this thread.

[Darat]

Somewhere in the bowels of this thread I asked what treatments were available in the USA (for 75% of the citizens) but not available to someone living in the UK via the NHS.

I've been trying to answer my own question and apart from experimental and clinical trials I've come across nothing so far but I thought one of the reports I did come across may be of interest to folks reading this thread: http://www.independent.co.uk/life-style/health-and-families/health-news/brain-tumour-patient-unaware-treatment-was-available-on-nhs-1301570.html

[Alt+F4]

Meanwhile, the economic collapse of this last year has seen a lot of people in my mom's facility move out. Government doesn't cover the cost of assisted living, and many people she tended to had their life savings in the stock market, so they could not afford to live there anymore.

That's another problem. I bet many of those people will end up in nursing homes (which they might not need) paid for by Medicare, yet Medicare won't pay for assisted living facilities even though the cost per paitent is much less than a nursing home.

[kellyb]

I don't really know where you're coming from with that, but it looks as though you are saying [2] is really no worse than [1], and that the possibility of severe financial penalty at some point in the future does not impair patient experience (is not a social bad). Were that a correct interpretation I consider it utterly delusional.

I don't think you mean that . . .

It is delusional.
Ideology can be powerful stuff.

[The Mutha]

OK, here's the actual facts on this one, and it's as I believed it to be.




Once more, we encounter a false account of the restricted care allegedly provided by the NHS. Once again, it's not true. Mutha, where did you get this from? Who is spreading these vicious falsehoods?

Rolfe.

In my sister's case, her Doctor.

[Rolfe]

OK, I probably phrased that wrong. Who is originating these vicious falsehoods?

I've no doubt your sister's doctor believes what she says to be true. However, it is not true. We constantly encounter a drip, drip, drip of erroneous statements that this or that or the other is not available under a universal healthcare system, so Americans should not support such a system, because it will result in their care being restricted.

Where are these lies coming from? Who is feeding them to peole like Mutha's sister's doctor? In fact, the chances of care being restricted in the USA are far higher than the chances of it being restricted in the NHS - either because of sheer inability to pay (the uninsured or those having difficulty affording co-payments), or because of insurance company bureaucrats who stand between you and your doctors.

People, you are being lied to, systematically, comprehensively and maliciously. And I think we only have to look at the "Dirty tricks" thread to see what's behind it.

Rolfe.

[kellyb]

OK, I probably phrased that wrong. Who is originating these vicious falsehoods?

I've no doubt your sister's doctor believes what she says to be true. However, it is not true. We constantly encounter a drip, drip, drip of erroneous statements that this or that or the other is not available under a universal healthcare system, so Americans should not support such a system, because it will result in their care being restricted.

Where are these lies coming from? Who is feeding them to peole like Mutha's sister's doctor? In fact, the chances of care being restricted in the USA are far higher than the chances of it being restricted in the NHS - either because of sheer inability to pay (the uninsured or those having difficulty affording co-payments), or because of insurance company bureaucrats who stand between you and your doctors.

People, you are being lied to, systematically, comprehensively and maliciously. And I think we only have to look at the "Dirty tricks" thread to see what's behind it.

Rolfe.

I think it's mostly some grotesque mutant form of confirmation bias? And it's running at epidemic levels in "American thought"?

Here's the real physician response to the AMA's endorsement of Obamacare. (from the biggest "US MD-only" forum on the web. You have to be an MD to even view it. They published this thread to prove that the AMA is not speaking on their behalf with the endorsement.)

(I'm starting my selective quoting about halfway through. It starts with the worst of the worst, because that was what motivated me to open up a word document. But I really, really encourage everyone to at leat skim the thread for themselves.)

http://www.sermo.com/ui/blog/comments/physicians_respond_to_ama_endorsement_of_hc_bill.h tml


First, a psycho:
I have no interest in meeting the needs of the population as a whole and absolutely no interest in providing health care for all citizens. I think it is time that (some) of us doctors make our "ugly" feelings known;

"Those that cannot afford health care need not receive it"

Yes, I am absolutely fine with people dying and (ideally not) suffering if they cannot purchase our services.
Now, call me a monster!

ps: I'm all for reducing costs by eliminating malpratice lawyers, CPT codes, and insurance companies. They do no good for patient nor physician.

Now, it's the patient's fault the costs are so high:
All of the comments are very valid. But, I agree with mm1484...in that No HealthCare Reform will work until patients Reform their lazy American Lifestyles. Any plan will bankrupt our country unless patients change their bad choices...and you don't hear this sober fact in any of the healthcare reform discussions. 85% of all healthcare dollars are due to lifestyle choices...so why aren't Reformers starting with education and 'mandates' to change individual behaviors? All healthcare reform is a complete joke and will be a complete disaster until this is addressed

Now, a reasonable respone:
Tort Reform is A MUST. without that no doctor will stop practising defensive medicine. Argument that malpractice pressure maintains good medical care and less mistakes ( obviously by our friendly trial lawyers, as it appeared in last Sunday's NY Times ) is a hogwash. Physicians are by and large caring human beings and that is precisely why they are in this noble profession.
Without Tort Reform there is no chance of significant reduction in healthcare expense.
I am dismayed that Mr. Obama is missing this vital point.

Now, a run of the mill jerk:
Physicians need to have the courage to say, "Nobody has a 'right' to my medical care." I have the right to my life first, and nobody has a right to any part of my life. Our forefathers did not risk their lives to cast off a dictator King George III, just so we could have another dictator rule over us. I will not work under the conditions the government is attempting to foist upon us. If Physicians have the guts to say this and stand by it, they can trot out whatever plan they want but it will go nowhere without us. If we acquiesce, we deserve what we get. For me, I will never work under a government plan, period. I will choose freedom, even if I have to give up medicine.

Blame the sick, again:
yes, raising taxes on some and lowering provider reimbursement will NOT lower healthcare costs....but only continue to subsidize bad patient lifestyle choices. Healthcare Reform was started because of escalating costs.... Then start by addressing what is causing those escalating costs! Reward those that make good or maintain good lifestyle choices and punish those who don't....is the ONLY way people will change their behavior (I.e. Car insurance). Free healthcare is fine....but then those paying for it should be able to dictate your lifestyle choices.

Another reasonable response:
I am against the bill proposed, although I am strongly "for" major changes in the current medical system. What galled me most was the absence of malpractice reform. I have spoken to many physicians from countries with socialized medicine such as France- they NEVER have to worry about lawsuits! It is considered ridiculous! Especially if the government limits access to testing (or does not fund it, which is exactly the same), I do not want to be on the receiving end of a lawsuit when a migraine patient's asymptomatic 1 cm meningioma is discovered 10 years later.
I recently attended a health care conference sponsored by the medical school where I am employed. In discussing costs, the "experts" invited to speak on the issue entirely excluded and discounted the cost that practicing defensive medicine adds to the system, suggesting instead that physicians should make less money. I subsequently discovered that they did so because they were not sure how to measure the cost of defensive medicine, not because they could prove that it is unimportant. I pointed out that not only does defensive medicine cost money, but that depending on the tort system to punish and exclude "bad" doctors is highly ineffective.




And another reasonable response:
Family Medicine
Posted Jul 18, 2009 at 3:08 PM
Some thoughts/responses to the community:

I realize I'm swimming against a strong current, but I think it's critical for other voices to be heard.
I enjoyed the Peter Singer article in the New York Time, 7/15/09: Why We Must Ration Health Care—thanks for the recommendation, drapp1952. Trijcpg—you may want to take a look, as it challenges the basic premise of the WSJ article from 7/9/09 (the WSJ article argues against rationing).

Many argue against NP/physician extenders having the same value as physicians and some including suvarov worry about the enormous med school tuition. I agree, when medical school costs well over $200K, and you pay PCPs ½ to ¼ of their physician "colleagues," there should be no surprise when med. students opt against primary care. The solution? Government subsidized medical school, residency, and fellowships and leveling the salary playing field between types of physicians. As auburngal points out though, not all docs are created equal, and we should be able to discern who are "the best." So, within fields there has to be a way to reward quality, and I believe different specialty organizations should make recs on this, be it polyp detection rate for GI, percent of DM patients having A1C's done within a certain time frame and BP control for primary care, mammo/pap percentages, complications among surgeons, etc.

JA1930 points out that outpatient primary care docs don't get paid enough, which I agree with, but he believes that their salaries should not be increased at the expense of specialists. I disagree. Primary care physicians aren't starving and neither are specialists. But, we can't afford to pay everyone specialist salaries and so the playing field needs to be leveled. Discrepancies in reimbursements are basically arbitrary anyway, and favor procedure and surgery driven fields, negotiated unfairly against PCPs, in the 1960s. I'm willing to bet that if you were to let the public in on medicines dirty little secret, that many specialist make $300-500K while many primary care docs make 1/3 of that, they would have very little sympathy for this argument. JA1930 fears that if we lower specialist salaries, no one will match in GI, cards, and ortho. Yeah. I lay awake at night with the same fear. The fear should be that most primary care will be done by NPs and PAs, who have less training and expertise (this is what really worries me) and FMGs, who lack cultural awareness, which is not insignificant, but otherwise do good jobs from my experience. I also have to disagree with JA1930 about the UK, Canada, and many other industrialized nations. They do have equal or better outcomes for all of their citizens, and their citizens are happier than ours in terms of their health systems (75% v 50%--see NY Times, Peter Singer article, 7/15/09). And, most importantly, they don't kick a quarter of their citizens to the side of the road.

sailingdad made many good points about the demise of primary care. Also, he pointed out that the medical community does not speak with one voice, which is clearly true. I hope his diagnosis of the "terminal" condition of primary care is wrong and that we do get together with one voice to speak out against the enormous profits of insurance companies and Pharma, that come at the expense of health care for all..

tnkaiser believes that if we embrace a single payer system, our entire economy would embrace socialism. Single payer systems cost half as much and cover all citizens, with better health outcomes. It's not a single payer national system that will break our economy, but the current free-for-all money grab that is costing 18% of the economy and growing and which causes more individual bankruptcies than any other cause not to mention a huge burden on our nations small and large businesses, who try to give their employees insurance, but are hampered by the unreasonable expense.

Drdawgfan says that "single payer systems work for the young and the healthy, they never have to use the services." Actually this statement applies better to the current insurance systems, with their prior authorizations and rejection of those with pre-existing conditions.

xrayangiodoc --wow, a specialist and a radiologist at that who supports a single payer system! Glad to have you on board.

merthin said, "If you think dealing with multiple insurance companies is a hassle, wait until you only have to deal with the government." As a primary care doc, I would welcome a single payer system which is electronic and streamlined, covers everyone, would have one type of paperwork and I would know exactly what I have to do to get reimbursed. This system would place more emphasis on prevention than on procedures, and would thus level the playing field among physicians. Optimally it would include tort reform as well. It would not be without its problems, but beats the monstrous, untenable system we have now.

And to this next one, :rolleyes: .
I wonder how many of the folks who post onto this blog giving opinions that are so sharply opposed to what the majority of us here think are "plants" from the AMA or Representative Waxman or are Obama's personal MD, or the like.

Justin Matrisciano MD


A response:
Family Medicine
Posted Jul 18, 2009 at 7:08 PM
To JA1930, congratulations on a fantastic specialty that manages to do minimally invasive procedures and get reimbursed top-notch. Most here would commend you on great choice and even I can see the wisdom. However, many of us, esp. PMDs working in clinics, have an ever harder time turning a blind eye to a pathetic system that doesn't provide basic care to most of our poorest and most vulnerable citizens. In addition, I must point out that you are mistaken in your data, where you say that 70% of Americans are happy with the health care system in the U.S. (it's 56%). Actually, it's the Brits and Canadians who are much happier (73%). You are also incorrect in your belief that there is no need for rationing. Unbeknownst to you, and apparently this is a big surprise, but rationing already does occur in the U.S. Please click on the NY Times, 7/15/09 for Peter Singer's article:
Sermo Doc
It also seems clear how little you value primary care but I would remind you that we should all be a team and that investing in primary prevention leads to more savings than curing a problem after it has developed. In any system where one group is paid so much less than another, which is mainly an artifact of a backwards payment system, you will get disrespect and dissatisfaction from those on the bottom. I haven't yet figured out why there's so much dissatisfaction from the top dogs though.
In response to the extra years of training to become a specialist, I've already mentioned the need to subsidize the few extra years of GI training for example v primary care, but in the big picture, it will take a specialist 3-4 years to make up the lost money from not working earlier, and after that, the next 25 years are all gravy, probably to the tune of millions of dollars more or income, assuming $100K/y higher salary. This is the reason why people choose single organ doctoring, no more no less. You've confused how much they pay you with how much you're worth. If we do start to pay less for procedures, the main result will be less procedures—see the Dartmouth study:
Sermo Doc
If the result is less specialists that would be a good thing. Currently, 70-80% of U.S. Physicians are specialists, a figure that is probably at least 30% too high, considering the needs of the population. Again though, I don't hate specialists and I certainly see the need for them, we just need to level the playing field with the neglected field of primary care.
To louermd: That orthopod only makes $400K b/c of an artificial reimbursement plan. Are you saying if we dec. reimburesments for orthopedic procedures by 25%, esp. the huge number of unnecessary arthroscopies, to decrease the average ortho's salary from $300k to $225/y, the field would collapse? It's preposterous. If orthopedists. actually had to collect real fee-for-service, most wouldn't survive. The only reason they can actually garner such high incomes is because of the artificially high reimburesements for procedures and surgeries. I think that this is the real reason most specialists are against change.
In response to Jmatrisciano, I find your suggestion that the physicians who don't tow the interests of specialists to be "plants" from the AMA etc." to be bizarre. I would venture that the average citizen, were he/she to peruse these comments, would be disturbed by what he finds and would take away the message that couldn't be clearer. Specialist physicians want to protect their salaries first and patient care comes a distant second. I am not a member of the AMA, though they continue to send me their journal, I imagine to pad their membership. I believe the AMA does not hold the interests of patients first. The groups I belong to, as I've mentioned, are PNHP and NPA.


And I left out all the ones just complaining about socialism and restricting the free market.

:eye-poppi

[Francesca R]

I've no doubt your sister's doctor believes what she says to be true. However, it is not true. [ . . . ] Who is feeding them to peole like Mutha's sister's doctor?Your question implies that doctors could not manufacture and propagate the lies themselves. They can of course, being human rather than paragons of unerring virtue, and having vested interests (even misguided ones) in protecting their status quo.

[Rolfe]

Your question implies that doctors could not manufacture and propagate the lies themselves. They can of course, being human rather than paragons of unerring virtue, and having vested interests (even misguided ones) in protecting their status quo.


No, I don't imagine doctors couldn't manufacture the lies themselves. However, the particular story Mutha told didn't seem insincere. It had more the feeling of someone passing on something she'd been told.

Rolfe.

[Darat]

Your question implies that doctors could not manufacture and propagate the lies themselves. They can of course, being human rather than paragons of unerring virtue, and having vested interests (even misguided ones) in protecting their status quo.

I was thinking about this just before you posted and it may well be the case in this instance that there is more than just ignorance at play.

If the doctor in The Mutha's sisters case is actually a specialist/consultant rheumatologist then I would find it very strange that they would believe that fusion was somehow required by government bureaucrats in the NHS before a rheumatologist was allowed to diagnose someone with AS. Then again given the sheer scale of the fabrications and ignorance shown by many folk in the USA in regards to the NHS, perhaps it is not so strange.

[Rolfe]

Oh, I wouldn't be at all surprised at a consultant being wrong about something like this. Especially if the misinformation she encountered fed into her existing prejudices.

Rolfe.

[gtc]

Somewhere in the bowels of this thread I asked what treatments were available in the USA (for 75% of the citizens) but not available to someone living in the UK via the NHS.

I've been trying to answer my own question and apart from experimental and clinical trials I've come across nothing so far but I thought one of the reports I did come across may be of interest to folks reading this thread: http://www.independent.co.uk/life-style/health-and-families/health-news/brain-tumour-patient-unaware-treatment-was-available-on-nhs-1301570.html

Was that the usual sort of bungle we expect from such organisations or is it an attempt to rein in costs by not informing doctors of the options?

This is where my understanding of organisations like the NHS falls down. No government has an unlimited budget so how do they limit expenditure while offering a more-or-less 'whatever it takes' approach to health care.

Is a British doctor less likely to decide that a particularly expensive treatment is needed than an American doctor (with a wealthy enough patient)? Are waiting queues longer?

[ponderingturtle]

That's another problem. I bet many of those people will end up in nursing homes (which they might not need) paid for by Medicare, yet Medicare won't pay for assisted living facilities even though the cost per paitent is much less than a nursing home.

No medicare has a certain limit on how many days it will pay for a nursing home. Medicaid is the one that keeps most people in nursing homes. Of course that means that they must have gone through most of their assets.

I am not sure if medicaid will pay for assisted living.

[Darat]

Was that the usual sort of bungle we expect from such organisations or is it an attempt to rein in costs by not informing doctors of the options?

...snip...

I'd say SNAFU.


This is where my understanding of organisations like the NHS falls down. No government has an unlimited budget so how do they limit expenditure while offering a more-or-less 'whatever it takes' approach to health care.

Is a British doctor less likely to decide that a particularly expensive treatment is needed than an American doctor (with a wealthy enough patient)? Are waiting queues longer?


We do have "rationing" and sometimes it is based on cost, but generally when cost is a considertion it is based on "cost effectiveness. So we have "NICE (http://www.nice.org.uk/aboutnice/whatwedo/what_we_do.jsp)" that produces guidelines for NHS England & Wales (NHS Scotland has a similar body).

As for waiting times - well I don't know if there are any comparable figures for NHS UK v USA, because in the USA some people just don't get access to the treatment no matter how long they wait.

Certainly for elective and minor procedures I would be surprised if a well-insured person in the USA wasn't treated in a shorter period of time compared to a non-insured Brit. But otherwise the time waited is usually a function of clinical need, and the NHS will (when there simply aren't the resources in the UK to provide the treatment quick enough) even pay for patients to receive medical care in other countries.

[Rolfe]

Is a British doctor less likely to decide that a particularly expensive treatment is needed than an American doctor (with a wealthy enough patient)? Are waiting queues longer?


The answer to the first question is simple. Within the NHS, no doctor cares how wealthy the patient is or isn't, if he even knows. If an NHS patient needs a procedure that is covered by the NHS, they get it. And if there is a wait (for elective procedures only, obviously, let's not fantasise about people with appendicitis going on a waiting list) the patients are prioritised by clinical urgency, not by their bank balance.

The difference you're searching for is that a wealthy patient in Britain may choose not to exercise his right to NHS treatment. He may purchase private insurance, or he may simply pay for the procedure privately. This gets him in a swanky private clinic away from these uncouth poor folk, and if there is a wait in the NHS for the procedure he needs, it will circumvent that.

Actually, you don't have to be all that wealthy to do that. The option is open to everyone who has a little bit of spare cash. You choose - go with the NHS, get your treatment free, but maybe wait a bit longer, or ask to be treated as a private patient and get faster service. My mother, a clergyman's widow on a pension, did this when she needed cataract surgery. She had the cash (about £3,500 for both eyes). But if she hadn't, she would still have got exactly the same operation, just a few months later.

Does this answer your question?

This is where my understanding of organisations like the NHS falls down. No government has an unlimited budget so how do they limit expenditure while offering a more-or-less 'whatever it takes' approach to health care.


By setting the limits very high. Very expensive treatments which offer only limited benefits are not approved by the system, often to the fury of the few people caught in that net. Google "QALY" for more information. A cancer treatment costing £100,000 which offers a 1 in 1000 chance of extending the patient's life by a couple of weeks is not going to be approved, even if the drug has a product licence. If you want that, you will have to go private. However, most things with a reasonable prospect of benefit are approved. You can get an awful lot for 8% of GDP if you try to budget wisely (and maybe some day we'll get that last bit licked....)

I'll post these two examples again. They made the news because there was something unusual about them, but it wasn't the quality of care. In the first case, the artificial heart in question had never been used for a patient with that condition before (so it was experimental, so would almost certailny have been denied by US insurance companies). In the second case, the air ambulance flight went all the way to the Karolinska Institute in Stockholm, maybe about 1,000 miles (guessing) instead of just to Leicester (maybe 300 miles), which is why it was news.

Abigail's new heart (http://www.theherald.co.uk/news/news/display.var.1982567.0.Six_weeks_ago_she_made_histo ry_now_Abigail_is_ready_to_play.php)
Flu patient gets a free trip to Sweden (http://www.theherald.co.uk/news/news/display.var.2521789.0.Swine_flu_Scot_is_flown_to_S wedish_hospital.php)

These two reports are standard of care in the NHS, where the clinical need exists. And note that the only wait involved (in the former case) was for a donor heart to become available, and that nobody in the system was even thinking about how the procedures were going to be paid for. These procedures are offered by the NHS, here we have a British resident who needs them, so the system springs into action. The wealth of the patient is irrelevant.

Rolfe.

[Darat]

...snip... This gets him in a swanky private clinic away from these uncouth poor folk,

...snip...

Bad news - when there is a resource issue sometimes the NHS forks out the money for an oink to be treated in one of those swanky hospitals... No getting away from the great unwashed in socialist Britain!

[Rolfe]

Oh, I'm sure they only select the better class of oiks to be sent to the private clinics...
[/Hyacinth Bucket}

Rolfe.

[Toke]

My favorite:
We had to eat with the crew [/Onslow] (after his 1. class cruise on queen mary)

[Francesca R]

oink
oinksOik (http://en.wiktionary.org/wiki/oik)

Sort it out--I'm not even British (well, wasn't)

[Darat]

I'm squealing like a pig in embarrassment.

[Ducky]

A cancer treatment costing £100,000 which offers a 1 in 1000 chance of extending the patient's life by a couple of weeks is not going to be approved, even if the drug has a product licence.

This would likely not be approved for coverage by a private system in the US either.

[Lothian]

I'm squealing like a pig in embarrassment.Ham acting at its wurst.

[Rolfe]

This would likely not be approved for coverage by a private system in the US either.


OK, I was exaggerating for effect. The point is that there are some treatments so outrageously expensive for minimal benefit that only a crazed egomaniac would expect them to be covered. And there are treatments with such clear benefits that they go through on the nod.

The devil is in exactly where you draw the line. That's where the QALY comes in. It allows as objective as possible an assessment to be made of the cost-benefit equation from any particular procedure. And inevitably there are procedures which fall just outside the parameters. And inevitably there are two or three people whose doctors would like them to get that procedure. And inevitably they make a Great Big Fuss about it, which is entirely within their rights.

And inevitably, the tabloid press sees a sob story, and prints something about brave cancer patients being denied care by the evil NHS bean-counters. So then some right-wing US campaigner finds this article, and uses it to rant about the evil rationing in the NHS, where you can't get cancer drugs because some "bureaucrat" has denied them.

What is usually missing from these stories is the whole QALY assessment, and the fact that no "bureaucrats" are involved at all - these decisions are taken by a committee of top consultants, who try to take the pain off their colleagues by making the decisions unclouded by concern for their own particular patients. Oh yes, and the fact that US citizens are far more likely to be dumped by their health insurer than a UK citizen is to find themselves on the wrong side of a decision by NICE or its equivalents.

Rolfe.

[Ducky]

OK, I was exaggerating for effect. The point is that there are some treatments so outrageously expensive for minimal benefit that only a crazed egomaniac would expect them to be covered.

<snip>

Rolfe.

You are talking about Americans. Of course we are crazed egomaniacs.

What really bothers me is that people seem to think "socialized" medicine is going to be to the patient any different. All that's being proposed is a complete rework of the administration and costs of coverage, not the medical system itself. People will still be treated in order of severity, no emergency/critical treatment will be refused (which exists now in the US) etc.

The only thing changing is how that is managed. Those that argue that they don't want a government office deciding what is covered for them or not already deals with EVERY OTHER TYPE OF COVERAGE THAT DOES THE SAME THING.

Private or not, someone will make a decision on whether your treatment is covered by your insurance and it's not going to be your doctor.

ETA: And I would rather the person making that decision not be the people I have seen absolutely fail me already in the private sector. (http://forums.randi.org/showthread.php?postid=4945797#post4945797)

[Rolfe]

no emergency/critical treatment will be refused (which exists now in the US)....


I still wonder about this. I know that's the theory, but does it always work that way? Do hospitals always throw everything they've got at the critical emergency (I'm thinking about people being flown 1,000 miles to get the treatment they need (http://www.theherald.co.uk/news/news/display.var.2521789.0.Swine_flu_Scot_is_flown_to_S wedish_hospital.php), for example), even if they know there isn't a snowball's chance in hell they'll ever see a penny of the cost?

I'm remembering the child in Sicko, acutely ill with meningitis, who was taken to the nearest hospital. It transpired that the mother's insurance would not pay out for that particular hospital, and the insurers demanded that the child be taken to another hospital some distance away. The mother tried to get the first hospital to treat the girl, but without success. According to her version of the story, they were concerned that they wouldn't get paid if the insurance company denied cover for that hospital. The little girl died soon after arriving at the "right" hospital.

Now I've seen a lot of alleged universal healthcare stories that were either blatant lies, or represented things that simply Should Not Have Happened and one is astonished that they happened even once. However, nobody has ever explained that one away in those terms. How does that one square with "no emergency/critical treatment will be refused"?

Rolfe.

[ponderingturtle]

I still wonder about this. I know that's the theory, but does it always work that way? Do hospitals always throw everything they've got at the critical emergency (I'm thinking about people being flown 1,000 miles to get the treatment they need (http://www.theherald.co.uk/news/news/display.var.2521789.0.Swine_flu_Scot_is_flown_to_S wedish_hospital.php), for example), even if they know there isn't a snowball's chance in hell they'll ever see a penny of the cost?

I'm remembering the child in Sicko, acutely ill with meningitis, who was taken to the nearest hospital. It transpired that the mother's insurance would not pay out for that particular hospital, and the insurers demanded that the child be taken to another hospital some distance away. The mother tried to get the first hospital to treat the girl, but without success. According to her version of the story, they were concerned that they wouldn't get paid if the insurance company denied cover for that hospital. The little girl died soon after arriving at the "right" hospital.

Now I've seen a lot of alleged universal healthcare stories that were either blatant lies, or represented things that simply Should Not Have Happened and one is astonished that they happened even once. However, nobody has ever explained that one away in those terms. How does that one square with "no emergency/critical treatment will be refused"?

Rolfe.

If true then the hospital would be violating the law. It might well have happened, but at face value it would be illegal.

[Fiona]

Well that may well be right. I think any human-made system will have errors and so you can probably point to things that go wrong no matter what health care system you are considering. Just as those errors are misused in the ways this thread is designed to counter when UHC is being attacked:so it may well be that the situation in America is not as black as it is painted.

It is hard to remember that though, because much of what I know about it comes from this board and I have been deeply shocked by what I have heard here. One thing that is odd is that those who are most vocal in opposition to UHC on other threads have not come to this one to answer the factual questions put.

The impression is that this is driven by ideology: but it is really hard to understand that people would rather die or see their family and friends suffer in the name of ideology. I guess I would have to call that a principled stance. I would admire it if it was not imposed on those who disagree, I suppose.

[Policenaut]

If the US does go to a national health care system what way do people think it will be best implemented? State by state? By region? For state by state it is already proving to be a problem in Massachusetts (spending has doubled in only two years of operation) and Hawaii (which just closed its universal child health care program after seven months).

[ponderingturtle]

If the US does go to a national health care system what way do people think it will be best implemented? State by state? By region? For state by state it is already proving to be a problem in Massachusetts (spending has doubled in only two years of operation) and Hawaii (which just closed its universal child health care program after seven months).

Univeral care by itself will not lower costs. At least not if done in the way that current suggestions are.

The goal really is to use this as a place to start getting a hand on medical expenses. BUt that will take lots of regulation that is unpopular with those who have the money to spend in washington. Look at the medicare perscription drug coverage that was written in large part by the pharmacutical industry.

[Chaos]

I still wonder about this. I know that's the theory, but does it always work that way? Do hospitals always throw everything they've got at the critical emergency (I'm thinking about people being flown 1,000 miles to get the treatment they need (http://www.theherald.co.uk/news/news/display.var.2521789.0.Swine_flu_Scot_is_flown_to_S wedish_hospital.php), for example), even if they know there isn't a snowball's chance in hell they'll ever see a penny of the cost?

I'm remembering the child in Sicko, acutely ill with meningitis, who was taken to the nearest hospital. It transpired that the mother's insurance would not pay out for that particular hospital, and the insurers demanded that the child be taken to another hospital some distance away. The mother tried to get the first hospital to treat the girl, but without success. According to her version of the story, they were concerned that they wouldn't get paid if the insurance company denied cover for that hospital. The little girl died soon after arriving at the "right" hospital.

Now I've seen a lot of alleged universal healthcare stories that were either blatant lies, or represented things that simply Should Not Have Happened and one is astonished that they happened even once. However, nobody has ever explained that one away in those terms. How does that one square with "no emergency/critical treatment will be refused"?

Rolfe.

Wasn´t there a case some time ago (early this year, I think) where a woman spent 24 hours in a hospital waiting room, most of that collapsed and unconscious, before she died from lack of treatment?

[Francesca R]

BUt that will take lots of regulation that is unpopular with those who have the money to spend in washington.Yes. So?

[Rolfe]

Wasn´t there a case some time ago (early this year, I think) where a woman spent 24 hours in a hospital waiting room, most of that collapsed and unconscious, before she died from lack of treatment?


I've heard one or two stories like that. However, I entirely accept the explanation. Which was that the patient had simply got themselves into the A&E waiting room and sat down. Nobody was alerted to their presence, nobody booked him or her in.

This was in a busy department which had a regular problem with local down-and-outs simply parking themselves in the waiting room for the free warmth and shelter. In the case (or cases) in point, the patient was mistaken for one of these until someone finally investigated.

No, of course it shouldn't happen. But I can see how it might. Staff are busy with the emergencies they know about. They only half-register a figure slumped on a bench in the corner, taking it for a wino, or possibly thinking that someone else is attending to this. Then finally someone realises it's been there rather a long time....

Rolfe.

[ponderingturtle]

Yes. So?

So the politicians who would need to rework the system aren't going to shaft those who pay them.

[Francesca R]

Sounds like a "To get there I wouldn't start from here" argument, often interpreted as "The USA has a uniquely busted political system that cannot be fixed".

So unless you want it to sound like that, what's the next step?

[ponderingturtle]

Sounds like a "To get there I wouldn't start from here" argument, often interpreted as "The USA has a uniquely busted political system that cannot be fixed".

So unless you want it to sound like that, what's the next step?

It is fairly much that we have a broken political system though. Insurance and drug companies have shown that they can buy the legislation or block the legislation that they want. I see no reason to expect that to change.

[Rolfe]

Let's face it, and hope Obama will too, getting from where the USA is to anywhere sane is going to be difficult. If the system currently pays out twice what it actually needs to to get the results it's achieving, then 50% of the money is going in unproductive directions. Some people are trousering a lot of cash, which is going to have to be redirected elsewhere if anything constructive is going to be done. They are not going to be very happy with this redirection. And some of these people have enough of said cash already trousered to buy them a great deal of influence.

OK, that's simplistic, but it's the nub of the problem in that respect.

Rolfe.

[Lothian]

Perhaps if the Americans altered the representative’s allowances system and allowed the flipping of second homes they wouldn’t be so reliant on the insurance and healthcare bribes.

[ponderingturtle]

Perhaps if the Americans altered the representative’s allowances system and allowed the flipping of second homes they wouldn’t be so reliant on the insurance and healthcare bribes.

See how that worked for Italy where they elected one of the richest men in the country. He is so rich he has to be honnest right?

[Francesca R]

Let's face it, and hope Obama will tooAccording to the prognosis ponderingturtle appears to be alluding to, Obama won't face it, because the blockage to reform is one of executives and legislatures being bought off by coalitions that want to protect the status quo contrary to the public interest. (Isn't that why Hillary Clinton's efforts were skewered?)

[Toke]

See how that worked for Italy where they elected one of the richest men in the country. He is so rich he has to be honnest right?

And still Italy, not known for it's streamlined and incorruptible administration have a healthcare system that works.
What does that say about american politics?

[Fiona]

Well it wasn't exactly easy to set up the NHS in the UK either. If the political will is there it must be possible

[Francesca R]

Hmmm. Yeah but being bankrupted by a world war is a "luxury" unavailable to the USA.

[Rolfe]

According to the prognosis ponderingturtle appears to be alluding to, Obama won't face it, because the blockage to reform is one of executives and legislatures being bought off by coalitions that want to protect the status quo contrary to the public interest. (Isn't that why Hillary Clinton's efforts were skewered?)


Just thinking here. Hillary's original efforts happened mid-1990s, right? The Internet wasn't a tenth of what it is now, back then. More importantly, back then the Internet was more of a noticeboard than a conversation. You could put up a page or a web site expressing your ideas or opinions, but you couldn't really discuss them publicly with anyone and everyone. You just had to hope that people came by and read your little piece.

Now things have moved on. Lots of people are reading stuff, and discussing stuff, that simply wouldn't have come their way 10 or 15 years ago. I've noticed a number of US posters here say that they've changed their mind since discussing healthcare issues on the internet, especially when they realise how satisfied most people living with universal healthcare are with their system. Some of these people even emerge from cyberspace and start discussing what they've learned with real people.

I have no idea if this effect is big enough to shift opinion significantly, but it's certainly something that wasn't an issue last time.

Rolfe.

[Francesca R]

Now things have moved on. Lots of people are reading stuff, and discussing stuff, that simply wouldn't have come their way 10 or 15 years ago.Perhaps, though the hope that "the net" will mobilise popular opinion and shift power is suggested a lot more often that it happensRofe.Oops.

[ponderingturtle]

According to the prognosis ponderingturtle appears to be alluding to, Obama won't face it, because the blockage to reform is one of executives and legislatures being bought off by coalitions that want to protect the status quo contrary to the public interest. (Isn't that why Hillary Clinton's efforts were skewered?)

He hasn't, he is bending over backwards to get drug companies, insurance companies and the AMA to sign off on his plans. This is not going to result in cost cutting reforms.

[Francesca R]

Well it wasn't exactly easy to set up the NHS in the UK either. If the political will is there it must be possibleThere's a less dodgy/flippant response to this than the one I made (sorry).

The problem (and I think I agree it is a problem) is that there isn't enough political will, and that could be the case despite public opinion being highly supportive, though I don't know if it is. Put simply, public opinion which is not well organised and is diverse and diffuse and--at the end of the day--diluted by a lot of other concerns that the non-organised public has, has to work very much harder than the very-well-organised and concentrated special interests of the coalitions that benefit from the present US health system, in order to overcome them and prevail in getting policies that serve the public better than insurance and pharma and the AMA.

According to a brilliant book (http://www.librarything.com/work/17464/reviews/34407452) by political economist Mancur Olson, the efficiency-retarding accumulated influence of special interest groups grows stronger over time the more a country is at peace, democratic, settled and so on. Events that sever these networks of relationships between self-advancing coalitions and government (lost wars, revolutions, state bankruptcy, and I would include Naomi Klein's laundry list of "shock therapies" too), can sometimes restore policies that better reflect public interest not private special interests. I would classify the establishment of the NHS into this situation, though Olson does not mention it but covers many other schisms such as Germany and Japan's post WW2 economic dynamism.

So in all seriousness, I think it is much more difficult for the US to get to UHC than it was for the UK to set up the NHS and the other welfare state institutions that it did post-1945. And that is not because of political will per se.

However, I don't think it can happen without torpedoing some of the financial incentives that drive politics.

[ponderingturtle]

There's a less dodgy/flippant response to this than the one I made (sorry).

The problem (and I think I agree it is a problem) is that there isn't enough political will, and that could be the case despite public opinion being highly supportive, though I don't know if it is. Put simply, public opinion which is not well organised and is diverse and diffuse and--at the end of the day--diluted by a lot of other concerns that the non-organised public has, has to work very much harder than the very-well-organised and concentrated special interests of the coalitions that benefit from the present US health system, in order to overcome them and prevail in getting policies that serve the public better than insurance and pharma and the AMA.


And lets not forget the TV advertisements with blatant lies in them either.

[Fiona]

All reasonable points, Francesca R. However I do think that a settled political will on the part of the people is the crux. You are correct in saying that public opinion is seldom united and active: but all that is required is a leadership which wants it enough to do what it takes; and a population which is also in favour.

Special interest groups can do nothing in face of that combination. They are very good at preventing such a consensus emerging: that is what all the lies are about. They aim to confuse people about where their interests lie, amongst other things. And they are quite good at preventing the election of anyone who is ideologically committed to that kind of couse. But politicians want to be elected: if the interest groups are strongly against what the voters really want I know which way I think they will jump. Thus committed leadership and voter recognition of their power is a virtuous circle. I do not think it is more difficult for the reasons you give: I think it is more difficult because american politics is bedevilled by defeatism. That is strange in view of the "can do" attitude they are famous for: but all I seem to hear is "it can't be done"; "no point in trying"; "they won't let us"; and stuff like that. I have been very surprised at that and I am sure it is not as pervasive as it seems on this board. But it seems to be growing in this country too and it may be a feature of the kind of political/economic certainties which are normally put under the "anglo american" label. I do not know. I do know it was managed in the UK when we had no economy to speak of: and it was managed because people wanted it and voted for it. No excuse would have been acceptable so far as I can see.

[kellyb]

Let's face it, and hope Obama will too, getting from where the USA is to anywhere sane is going to be difficult. If the system currently pays out twice what it actually needs to to get the results it's achieving, then 50% of the money is going in unproductive directions. Some people are trousering a lot of cash, which is going to have to be redirected elsewhere if anything constructive is going to be done. They are not going to be very happy with this redirection. And some of these people have enough of said cash already trousered to buy them a great deal of influence.

OK, that's simplistic, but it's the nub of the problem in that respect.

Rolfe.

True.
But I personally take heart in:

1) "this is not a principled fight"

and the campaign theme that got Obama elected of...

2) Yes We Can!

:cool:

[Francesca R]

all that is required is a leadership which wants it enough to do what it takes; and a population which is also in favour.Yes, though it is not that often that the stars align themselves for this combination for action. Disregarding political colours (and not talking about health policy), let's say it happened with Attlee, Thatcher and Blair in the UK (and Blair did less with his chance) and with <well I dunno> Reagan and <maybe?> Obama in the US. The jury is way out on the last one. So it's rare to get the opportunity for political representation of the public to overcome embedded coalitions of vested interest. Things need to get bad enough I suppose, and people fed up enough of a broken status quo. (And national emergencies "help")

[Rolfe]

News flash. About 3 minutes ago, a front-tooth crown of mine fell out. This is a crown that was put in by the NHS in 1982, by the way.

I will have to wait till tomorrow to phone the dentist, of course. Let's see how long it takes me to get seen and get the crown replaced.

Rolfe.

[Darat]

You mean your NHS dentist will not see you NOW!!!???

Another sad failing of socialised medicine.

[Rolfe]

Shocking, isn't it? :D

Based on previous experience, the limiting factor might be me being able to get off work for whichever slot they can fit me in. However, as we're not really pushed at work this week (unless she says Friday afternoon.... :( ) and I don't mind which dentist I see in the practlce, I'd say there's a good chance this will be sorted before the weekend.

She might even grind down a rough filling I have on a wisdom tooth while I'm there. I was keeping that one for my next routine checkup, but that's six weeks away.

Rolfe.

[Toke]

In Denmark you pay for your dental work, quite a lot.

My left pinkie and ring finger have been sleeping for the last week.
I suspect I will have to get the hand/wrist sliced up, my problem is not cost as I am not paying, but more with the slicing and recovery part.

[Rolfe]

Oh, I'll pay for this, but it's a small job. I'll post the price as well. :D

Rolfe.

[Eskarina]

In Denmark you pay for your dental work, quite a lot.

It's the same in Germany.

My left pinkie and ring finger have been sleeping for the last week.
I suspect I will have to get the hand/wrist sliced up, my problem is not cost as I am not paying, but more with the slicing and recovery part.

Just make sure it's no back problem, okay? :)

[gtc]

Oh, I'll pay for this, but it's a small job. I'll post the price as well. :D

Rolfe.

Good luck. Is it not covered by the NHS?

Does this answer your question?

Yes thank you.

I can see why ordinary Americans may be fearful of changes to the system - even if they are unhappy with the existing system.


The basic parameters of a system seem to be:
What treatments are covered.
Whether there is a co-payment for those treatments.
Whether enough government money is tipped into the system (this determines where the line between cost-efficient and not cost-efficient is drawn).
How easy is access to a private system for people who want to jump the queue or access treatments not considered cost effective.
Where the government raises the money to pay for the system (if the government has to pay extra than they do currently)
And this is before there is discussion about how efficient the system is run and who gets paid what.

There is also a re-distribution of income. By the sounds of things the wealthy in Britain seem to get the same treatment they would get in the US but seem to pay more taxes (or more of their taxes) to subsidise the health care of the poor.

[Fiona]

By the sounds of things the wealthy in Britain seem to get the same treatment they would get in the US but seem to pay more taxes (or more of their taxes) to subsidise the health care of the poor.

Just a small point,gtc. In the UK the wealthy can and do pay for private insurance sometimes. This does give them certain privileges, such as the right to treatment at a time of their choosing, better accommodation etc. It does not generally get them treatment from different doctors (there are some who have a wholly private practice, but not many). More importantly, this cover is generally used for more minor and/or short term conditions. When something goes wrong in a private hospital the patient is usually moved to an NHS facility. When the wealthy are diagnosed with a very serious and/or chronic condition they frequently revert to the NHS as well: because private insurance seldom covers that, just as it does not in the US. There is some redistribution of income, as you say, if the person is treated as a private patient in an NHS hospital. They pay extra but for tangible services and that money is part of the funding of the NHS. But the chances are that they will use NHS service directly at some point in their lives and the amount they have paid in will not cover the cost of that in very many cases. The difference between this and the US system is that they have the right to treatment they cannot afford, just as the poor have

[gtc]

Just a small point,gtc. In the UK the wealthy can and do pay for private insurance sometimes. This does give them certain privileges, such as the right to treatment at a time of their choosing, better accommodation etc. It does not generally get them treatment from different doctors (there are some who have a wholly private practice, but not many). More importantly, this cover is generally used for more minor and/or short term conditions. When something goes wrong in a private hospital the patient is usually moved to an NHS facility. When the wealthy are diagnosed with a very serious and/or chronic condition they frequently revert to the NHS as well: because private insurance seldom covers that, just as it does not in the US. There is some redistribution of income, as you say, if the person is treated as a private patient in an NHS hospital. They pay extra but for tangible services and that money is part of the funding of the NHS. But the chances are that they will use NHS service directly at some point in their lives and the amount they have paid in will not cover the cost of that in very many cases. The difference between this and the US system is that they have the right to treatment they cannot afford, just as the poor have

My point was a little different.

Given the combination of the government and private health cover, the wealthy should recieve no worse health care under a properly functioning universal health scheme than they would in a purely private system. The poor, however, receive better coverage.

[Architect]

I've got to pop into hospital today for a quick investigative op - all routine, nothing serious, I hasten to add. I'm having it done on my wife's work's healthcare cover. As I mentioned before, and as Fiona says above, it's the same doctor I'd get at the local NHS hospital. So why am I doing it? Well, it knocked a few weeks off the waiting time (about 4, I think), and I get to choose the day of the op. Oh, and I get a private room for the hour or two it takes me to recover from the sedatives or local anaesthetic, or whatever.

If it was me paying the cash, out my own pocket, would I bother with private health cover? Heck, no. It's the same treatment, by the same people. NHS is fine.

I like to think of it as a bit like travelling first class on the train. Whether I go standard or first, the train still gets me there in the same time. The only difference is slightly comfier seats and a bit more legroom.

Whereas with the American model, some people are going to be hanging from the outside and at least some will have got left behind at the station.


[I've been fasting for 12 hours now and am grouchy as heck, so apologies if it comes across in the post]

[Francesca R]

Well it is coming out of your household income of course. The feeling that you have a free upgrade is just an illusion.

[Rolfe]

Good luck. Is it not covered by the NHS?


Gaaaaahhhhh!!!!!

It's just as well that I typed that comment about the crown falling out last night. Just after it happened, before I even typed the post, I slipped it back into place. Partly because it felt better, and partly because I know it's important to keep the crown cavity clear and not let it start to "heal up" before the thing is replaced.

It's still there. I ate my supper and it was still there. I slept all night and it was still there. I ate my breakfast and it was still there. I just had my coffee, and it's still there.

I had completely forgotten all about it! And I could well have gone on forgetting all about it until it did it again. Maybe tonight, who knows.

Anyway, I just grabbed the phone and called the dentist, and the receptionist said, it's Karen you usually see, isn't it? I said yes, but I really didn't mind who I saw on this occasion, just anyone who could fit me in.

11 o'clock tomorrow morning, with Karen.

This is on the NHS, but you still have to pay something. Don't know which US term it would be, co-pay or deductible or something. It won't be much.

I could have called up any dentist at all (Karen is actually some distance away, because I didn't change dentists when I moved house two years ago) and they would have done it privately at a rather higher fee, but I chose to travel to my own dentist for continuity of care.

Rolfe.

[Lothian]

This is on the NHS, but you still have to pay something. Don't know which US term it would be, co-pay or deductible or something. It won't be much.


NHS Dentist Charges Structure (http://www.whatprice.co.uk/dentist/nhs-prices.html)
£16.50 - This charge includes an examination, diagnosis and preventive care. If necessary, this includes X-rays, scale and polish, and planning for further treatment. Urgent and out-of-hours care also costs £16.50.
£45.60 - This charge includes all necessary treatment covered by the £16.50 charge PLUS additional treatment such as fillings, root canal treatment or extractions.
£198 -This charge includes all necessary treatment covered by the £16.50 and £45.60 charges PLUS more complex procedures such as crowns, dentures or bridges.

NHS dentist treatment is completely free if you are:

Under 18 years old
18 but in full-time education
Pregnant or have given birth within the last 12 months
Receiving Income Support, Job-seeker's Allowance or 'Guarantee Credit' on your Pension Credit - or your partner is receiving one of these

[Rolfe]

I expect it will be £16.50 then.

I'm not sure what it would cost if I had it done privately by a more local dentist, but more than that.

Thinks.... The trip to the dentist will be 60 miles (30 each way). At 40p a mile, that's £24. So, about £40 all told. Yes, still probably less than going locally, as a private patient. However, it's all relatively small change, I just prefer to see my regular dentist.

Rolfe.

[ponderingturtle]

Gaaaaahhhhh!!!!!

It's just as well that I typed that comment about the crown falling out last night. Just after it happened, before I even typed the post, I slipped it back into place. Partly because it felt better, and partly because I know it's important to keep the crown cavity clear and not let it start to "heal up" before the thing is replaced.

It's still there. I ate my supper and it was still there. I slept all night and it was still there. I ate my breakfast and it was still there. I just had my coffee, and it's still there.

I had completely forgotten all about it! And I could well have gone on forgetting all about it until it did it again. Maybe tonight, who knows.

Anyway, I just grabbed the phone and called the dentist, and the receptionist said, it's Karen you usually see, isn't it? I said yes, but I really didn't mind who I saw on this occasion, just anyone who could fit me in.

11 o'clock tomorrow morning, with Karen.

This is on the NHS, but you still have to pay something. Don't know which US term it would be, co-pay or deductible or something. It won't be much.


That would likely be a copay. A deductible is where you have to pay the first X ammount, like on my car where the first $500 in dammage is not covered by insurance.

I could have called up any dentist at all (Karen is actually some distance away, because I didn't change dentists when I moved house two years ago) and they would have done it privately at a rather higher fee, but I chose to travel to my own dentist for continuity of care.

Rolfe.[/QUOTE]

[Architect]

It's called an "excess" for insurance related matters. Dunno if there's a specific term for it here.

My dentist isn't NHS, alas, but she is very good and comparatively cheap so I don't lose any sleep over it.

And yes, that's me back from the hospital already.

[Rolfe]

£8.44. Though where she pulled that figure from I don't know.

Put the crown back, discussed renewing it if it started to come out on a regular basis, and ground down the filling that was rough.

Done and dusted.

Just for the record, next time someone tells you that the Brits have to "stand in line" for months to see an NHS dentist.

My regular checkup is scheduled for 11th September also, but this was an extra, unscheduled stop.

Rolfe.

[gtc]

I'm glad to hear it went well.

Australia's version of the NHS doesn't cover dentistry although this is being debated at the moment which is why I asked about it. My private health insurance has covered all the work I have ever needed and only once have I made a co-payment.

Unfortunately my private health insurance premiums are also paying for:

Acupuncture, Alexander Technique, aromatherapy, Bowen Therapy,Feldenkrais, herbalist, homeopathy, iridology, kinesiology, naturopathy, reflexology, and Shiatsu

[funk de fino]

Oh, I'll pay for this, but it's a small job. I'll post the price as well. :D

Rolfe.

I am one of the few left with an NHS dentist and my waiting times are terrible. Not had emergency stuff for a while though.

Doctors and hospital no problems but not dentists.

[richardm]

Waiting times for NHS dentists are often so long because there's so few of them left that they're hopelessly oversubscribed. I practically had to wait for someone to die before signing up to my last one.

Well... I say "wait"...

My village is lucky enough to have a new NHS dentist though, and that presents no problem because so few people live here. But it really is one aspect of the NHS that needs an overhaul.

[Ryokan]

I originally posted this in the Surrogate Rant: Euthanasia Counseling (http://forums.randi.org/showthread.php?t=149253) thread:

My father split when I was ten years old, and my mom was left with raising three kids. Dad wasn't far off, really, but it was an every second weekend sort of thing, until he started another family.

Mom was born without side vision, something that wasn't discovered until she was in her forties. Everyone, including her, just assumed she was clumsy. When you're born without something like that, you don't really know that you don't have it - you have nothing to compare it to. Because of this she did really bad in school, and was branded stupid. She got pregnant with me right after high school, and spent the next 20 years raising kids on her own. We were never rich, but our government took care of us, made sure we had a house, food and clothes. But that's a topic for a different thread.

Mom's bad sight is a hereditary disease that shows up every other generation, and gets worse the older she is. It started getting really bad in her forties, and now she's practically blind. Luckily, she found herself a good husband that has been very understanding and really takes care of her. But financially, it could've been really bad. Luckily, I live in a country that thinks people shouldn't suffer for medical conditions that they can't control, and has supported her in every way, even going as far as offering her a guide dog - something she so far has declined, as she still sees a bit.

Then in her late forties she got colon cancer. That was a great ordeal for the family. The tumor was quite large, but she got immediate medical care the second it was discovered, and she lived through it. Then, a year later, it was discovered that the tumor was back, and once again she got immediate medical care.

A few years ago my (half-)brother crashed into a tree with a sled, and broke his face. He got immediate medical care. A few years before that, my 16 year old sister got pregnant and needed an abortion. The same sister has always suffered from terrible migraines, and has several times been admitted to the hospital for them. No waiting list, we called and said we were worried, and she got immediate medical care. She got immediate medical care. And a few years before that again, I got an infection in my testicles that made one of them swell up to the size of a tennis ball. I got immediate medical attention.

Those are just the major highlights of my family's medical history. We were never a well to do family, yet this at least was never a problem.

I can give you the total sum for all our medical bills: Zero.

And you know what? We Norwegians like it that way! From the parties furthest to the left, real socialists, to the parties furthest on the right, none of them want to change this. None of them. Not only do they all accept that free medical care has been a great boon for the country, but the vast vast majority of the population wouldn't even dream of having it any other way.

I'm a liberal of the classic kind, the dictionary definition of a liberal. I want small government, as few laws and regulations as possible, a market driven economy and the lower the taxes are the better it is. But there are some fundamental things I think the government should supply its citizens, and medical care is one of them. No one should have to live in misery and pain, even die prematurely, just because they can't afford medical care.

I shudder to think what kind of life my mother would have had in the USA.

[funk de fino]

I shudder to think what kind of life my mother would have had in the USA.

me too.

[Rolfe]

Me three! I've got nothing to match that story, but most of my cousins are older than me, and family gatherings seem to be a constant exchange of stories of joint replacements and diabetes management and glaucoma management. All free.

Or, not free.

We pay for it with our taxes. And the point about taxes that the Americans seem to hate is the "from each according to his means, to each according to his need" part. Though frankly, if this is valid for any aspect of human life, it's healthcare.

But think of it another way. "From each when he has the means, and to him when he has the need." Of course it's not that simple, some people go through life healthy and then get hit by a bus, some are born with expensive problems. But by and large, it does tend to work like that. We pay in when we're prosperous, which is often when we're healthy, but because we're prosperous it's not a burden. Then when we're sick, and maybe not so prosperous, well, we've paid our dues, we've made our proper contribution to the funding of the system, and we can access it without having to worry about payments at what is really the worst time in your life to have to worry about that sort of thing. And really, if we end up not needing to take much from the system, who's worrying? Who is actually upset about not being sick?

This is really why people like it. But right-wing Americans seem so obsessed with some illusory concept of "freedom" that they think is denied in that system, that they simply will not even look at the benefits. But look at what they have to put up with? They can pay in for years while they are healthy, and then when they need something, hey, to bad you're not covered. (Look at Ducky's experience for a start.)

As I said to BaC in another thread when he was wittering on about his "freedoms" - as regards healthcare, I have a whole bunch of freedoms you don't even dream about.

Rolfe.

[Undesired Walrus]

This lady pull through?

[Rolfe]

I haven't heard any further news since the second day, when they said she was "still gravely ill but getting the best possible treatment." However, they sounded guardedly optimistic, and they did say she would probably have to stay in Sweden for at least a couple of weeks.

ETA: I found this from yesterday (http://news.bbc.co.uk/1/hi/health/8175241.stm), but I'm not clear whether it's new, or whether they're just quoting the earlier bulletin.

Ms Pentleton, who is having her blood circulated through a machine, is described as "stable, but critical".


Rolfe.

[Rolfe]

Waiting times for NHS dentists are often so long because there's so few of them left that they're hopelessly oversubscribed. I practically had to wait for someone to die before signing up to my last one.

Well... I say "wait"...

My village is lucky enough to have a new NHS dentist though, and that presents no problem because so few people live here. But it really is one aspect of the NHS that needs an overhaul.


Yes, they really screwed up when they made it uneconomic for the dentists to take on NHS work, and they could make a much better income in private practice. And since very little dental treatment is critical (and when it is, you can go to a hospital), then there isn't the same ethical imperative to provide care.

Of course, this is a prime example of how universal healthcare is still capitalist. The dentists are free to run their businesses as they choose, and it's up to the government to make it worth their while to work for the NHS. If it wants to, that is.

Ironically, I think the more prosperous the area you're in, the harder it is to find an NHS dentist. If most people are quite well-to-do, they'll pay, and the dentists know that and act accordingly. On the other hand, anyone practising in a poorer area really needs NHS work to keep the practice going.

When I came back from living in England, I was immediately taken back on with the practice I'd been with before I left, 25 years earlier, and which was still treating my mother. I happened to lose a filling a month or so after I moved back, and I was in there and treated within two days, and back on their NHS list even though I said we were planning to move out of the county in the next few months.

So, it's only 30 miles, and I know when I'm on to a good thing.

Rolfe.

[Eskarina]

But think of it another way. "From each when he has the means, and to him when he has the need." Of course it's not that simple, some people go through life healthy and then get hit by a bus, some are born with expensive problems. But by and large, it does tend to work like that. We pay in when we're prosperous, which is often when we're healthy, but because we're prosperous it's not a burden. Then when we're sick, and maybe not so prosperous, well, we've paid our dues, we've made our proper contribution to the funding of the system, and we can access it without having to worry about payments at what is really the worst time in your life to have to worry about that sort of thing. And really, if we end up not needing to take much from the system, who's worrying? Who is actually upset about not being sick?

And healthy people contribute to the UHC system of your choice ;), so it's really in the interest of everyone to keep people healthy or help them regaining their health to become contributors again.

[Rolfe]

Yesterday, one of the inserts inmy daily paper was a 12-page tabloid booklet called "Health News", published by the Greater Glasgow and Clyde NHS region. It informs people about the sort of work the NHS is doing, and highlights a number of good news stories.

I suppose the nay-sayers will just call it propaganda, but it does provide insght into the level of service available in the system. The booklet itself is well laid out and illustrated. I was hoping for a pdf online, but no such luck, all I could find was as Word document with what seems to be a draft of the text only, probably incomplete, and with typos.

Still, it's here is anyone's interested.

library.nhsggc.org.uk/.../nhsggc_healthnews_2009_08-09_text.doc

Damn, I don't think that will work. Google "all too often the daily miracles"

Rolfe.

[Toke]

Type 1 diabetes maybe caused by virus?
And maybe a vaccine on the way?
Why not, it works for uterus cancer, and ulcers is a bug.

[Rolfe]

Oh, you got it then. It's a shame there isn't a pdf, the final document is much better with cool graphics and pictures of the patients.

It's an interesting counter to Beerina's repeated, ignorant assertion that universal healthcare stifles research. That's just the showcase parts of what's going on in one region of Scotland's NHS, which is itself only a tenth of the size of England's.

Rolfe.

[Agatha]

I went to see my GP on Wednesday 23rd July, and she suggested a referral to a physio, and said she would write a letter and I should wait to hear from them. I had a phone call yesterday, my physio appointment has been arranged for Monday 4th August. I'm sure opponents of UHC keep asserting that we in the UK have long waiting times, especially for non-urgent treatment, but that's not my experience.

[Earthborn]

I had a phone call yesterday, my physio appointment has been arranged for Monday 4th August. I'm sure opponents of UHC keep asserting that we in the UK have long waiting times, especially for non-urgent treatment, but that's not my experience.Really? Then why do you have to wait until 2014 for a physio appointment? :p

[Agatha]

:D That would be crazy!

[Rolfe]

Since it's a healthcare subject, I just called to do a bit of shameless self-promotion for the July TLA (http://forums.randi.org/showthread.php?t=149701).

Vote early, vote often!

I make great tablet, by the way.... :D

Rolfe.

[Agatha]

Mmm tablet. So sweet it sets your teeth on edge, but delicious all the same.

[Shalamar]

Since it's a healthcare subject, I just called to do a bit of shameless self-promotion for the July TLA (http://forums.randi.org/showthread.php?t=149701).

Vote early, vote often!

I make great tablet, by the way.... :D

Rolfe.

Don't listen to him! Vote for me!

[Cactus Wren]

Wasn´t there a case some time ago (early this year, I think) where a woman spent 24 hours in a hospital waiting room, most of that collapsed and unconscious, before she died from lack of treatment?I've heard one or two stories like that. However, I entirely accept the explanation. Which was that the patient had simply got themselves into the A&E waiting room and sat down. Nobody was alerted to their presence, nobody booked him or her in.

Umm, no. (http://www.washingtonpost.com/wp-dyn/content/article/2008/07/02/AR2008070202799.html)

The woman, Esmin Elizabeth Green, 49, was taken to the hospital by emergency medical service workers on June 18. She was suffering from agitation and psychosis and was admitted involuntarily, according to the Health and Hospitals Corp.

She'd already been admitted to the hospital and sat in the waiting room for twenty-four hours before she collapsed.

[Francesca R]

Just for the record, next time someone tells you that the Brits have to "stand in line" for months to see an NHS dentist.

Waiting times for NHS dentists are often so long because there's so few of them left that they're hopelessly oversubscribed. I practically had to wait for someone to die before signing up to my last one.My experience is that I effectively can't get NHS dental treatment. I consider it to be de-facto outside the NHS. It must be highly location-dependent. I think I've been private forever (I moved to the UK with my family in the 1980s)

This NHS "dentist finder (http://www.nhs.uk/ServiceDirectories/Pages/ServiceResults.aspx?Postcode=EC1R&Coords=1821,5314&ServiceType=Dentist&JScript=1)" throws up a number of practices within a km or two of me, but nowhere near enough to service the catchment. And if one enquires, they are simply capped-out on NHS quotas so there's nothing doing. I'm not aware that this has anything to do with demographics either. The area is densely populated and probably about one third public housing, one third private and the other third business.

[gmanontario]

Been reading this thread through and it's amazing how much the NHS and our OHIP system are the same in terms of coverage and treatments. We have no provincial dentistry here unless you are on welfare or disabled, but most mid to large size employers have drug and dental plans. I work for the gov't so I have pretty good dental and drugs, but my wife who works in the private sector has better benefits.

Our prescription dispensing fee is around $10 now and the cost of the drugs is on top of that. You are always allowed to substitute generic unless the doctor says not to.

There are private clinics here but they are specialized (cancer, hernia, genetics, etc etc) and not GP doctors. OHIP will pay for a private clinic if you can't get timely care in the public system. If you want entirely private care you must head for the USA or Quebec (IIRC) for non-UHC health care.

Anyways I've seen the propoganda ******** on the American TV stations and there technique is simple...find people who fall through the cracks and then trumpet them as typical events. I have a horror story from an American friend concerning her jaw and eyes. She needs some maxillo-facial(sp) surgery to correct a defect in her jaw that makes it very painful to use it every now and then and she has cataracts in both eyes. Her HMO told her the coverage she and her husband have will only cover one operation. Each eye is considered separate surgery.:eye-poppi So her choices are a good jaw and near blindness or one good eye and the same jaw problems. Nice system the Americans have..:boggled: I just got off messenger with them and oddly enough, she and her husband are dead set against UHC :confused: Can't figure that out at all. She works at McDonalds and her husband is self-employed so she provides the insurance. I'd really love to understand the resistance when UHC would provide all the care needed.

Now I am a success story for socialized medicine. I have had two catastrophic events, an accident and an illness that would have surely bankrupted my family if I was in the US. I had a fractured spine in a freak accident and got into surgery in 6 days...then spent a year recovering and a few smaller surgeries (those damn screws HURT!!!!) and of course intensive therapy. I had to ask if they went to Home Depot before fixing my back after seeing all the hardware they had put in there.
Cost to me? $0 and it kept me a hardworking taxpayer rather than leaving me a state-assisted pain-wracked cripple.

Then I had a benign brain tumour. Since it was slow growing and not an immediate threat, I had to wait six months for surgery but I had CAT scans every 3 weeks to make sure the tumour behaved. I had the surgery, had some serious adverse side effects like meningitis and temporary blindness but those socialist doctors didn't quit until I walked out of the hospital and was able to drive home (although I didn't).:) Cost to me? $0 and kept me a hardworking taxpayer rather than a slowly wasting away welfare case. 11 years cancer free because of socialized medicine. 19 years as a productive taxpayer because of dem dadgum socialized gubmint docs:D. You won't be seeing me anytime soon on those propaganda commercials the lobbyists keep showing.

I wonder how an HMO would have treated me if I had to depend on them for my health care? Would they have cut me off after the accident? Both treatments cost the taxpaying public about a quarter million dollars or so.

It's also true that getting a family doctor can be a challenge, but where I live there are numerous clinics where you can walk in at any time day or night if you need to see a doctor.

I've paid a LOT of money in taxes in those 19 years since my accident, about enough to cover the cost of my care. I also have no problems paying those taxes when I have peace of mind all the time concerning my health care and care delivery.

Thanks for the conversation Rolfe and it really made me take a look at the NHS and how it operates.

Go Obama Go, make this change happen....

BTW if anyone is wondering, the accident happened when I was walking backwards using a brand new full sized VHS camcorder. It seems that there are things called curbs (kerbs) that you are supposed to step up and over.:( Oopsie daisy and down I went landing on a concrete sidewalk while in a "V" position with a heavy camcorder on my shoulder. My butt simply wasn't padded enough to provide the necessary protection. Funny thing was it didn't really hurt until a few hours later. Thats when I went to the emergency room when the pain made me see bright white fireballs shooting though my eyeballs. :boggled:

[Rolfe]

Thanks for these stories, Gman. Of course it's the same with the NHS horror stories. Find a few people who fell through the net, and present them as if this is what happens to everyone. Or find a few people who are disgruntled even though they didn't get poor care, or just lie about it.

Of course these people were entitled to care, they hadn't been dumped and they hadn't been refused. And the NHS learns from its mistakes, and things get sorted out. I've yet to hear a US insurance company discussing how to cover the people it currently turns down, or how to ensure that people don't get retrospectively denied care because of a mistake on their application forms....

We have private healthcare too, and private health insurance companies - lots of them. They just cater to the well-off who like the swanky private clinics and so on. The premiums are quite reasonable, because the existence of the NHS means that coverage doesn't have to be so comprehensive. If there was a real problem in the NHS of the scale suggested, you'd find private insurance to be far more popular than it is. I used to have it myself, through my work, but I didn't bother to continue it because my experience of the NHS (and that of my family and friends) has been that it looks after everybody pretty well.

Rolfe.

[Rolfe]

I have a horror story from an American friend concerning her jaw and eyes. She needs some maxillo-facial(sp) surgery to correct a defect in her jaw that makes it very painful to use it every now and then and she has cataracts in both eyes. Her HMO told her the coverage she and her husband have will only cover one operation. Each eye is considered separate surgery.:eye-poppi So her choices are a good jaw and near blindness or one good eye and the same jaw problems.


Now if that isn't rationing, I don't know what is. The NHS would never do that to anyone. If you need three surgeries, you get three surgeries. For goodness sake, what if she had one of her cataracts fixed and then got appendicitis? Should she stay blind and with a painful jaw because she might need her one operation for something really life-threatening?

Nice system the Americans have..:boggled: I just got off messenger with them and oddly enough, she and her husband are dead set against UHC :confused: Can't figure that out at all. She works at McDonalds and her husband is self-employed so she provides the insurance. I'd really love to understand the resistance when UHC would provide all the care needed.


I've been thinking about that, and I wonder. If you have really cruddy service, and you've been told time and time again that the proposed new system will make it all ten times worse, would you want to change?

Rolfe.

[Rolfe]

I was thinking about the cataracts thing. To operate on just one eye would be considered third world medicine here. (Unless of course only one eye was affected.) However, cataract surgery was what my mother chose to go private for.

Why? Interesting tale.

She has had glaucoma for many years, treated medically, until at one checkup her surgeon decided it wasn't under proper control and she needed surgery. This was arranged very quickly, at a local hospital. They did the eyes one at a time, and the ward was full of little old ladies, mostly having cataracts done. Mum was disappointed her own eyesight wasn't miraculously restored as theirs had been, but glaucoma isn't like that.

However, although the surgeon was pleased with the way the glaucoma operation had gone, Mum's eyesight deteriorated further, quite quickly. Further examination revealed that her mild cataracts which were now deteriorating rapidly. Apparently this is a recognised complication after glaucoma surgery. So, when could they do it?

Oops. Thirteen months.

There was a problem. The eye ward was closed. All patients were having to be sent to East Kilbride, and that hospital was barely managing to keep up with the glaucoma operations, which of course were all urgent, and a waiting list was building up for cataracts.

Why was the eye ward in Stonehouse closed? Sterility breakdown. They's had an unacceptable incidence of postopertaive infections, closed the ward, revised all their procedures, and opened again. And still got infections. The problem was that althought the hospital had sterilised its own instruments for decades, this was in the days of Thatcherism and the Free Market as a solution to everything. Whatever happens in America must be The Best. So they had put the instrument sterilisation out to tender, and all the instruments were being taken to Airdrie to be sterilised in bulk, then brought back. That was what had introduced the problem.

So what do you expect if you give the contract for this sort of service to the lowest bidder? Ain't capitalism wonderful!

The private healthcare system in Britain is excellent, in the way that a Porsche or a Rolex is excellent. It's a luxury product for people who can afford it. Nobody skimps on the cleaning to make an extra buck. But as soon as you get into the budget mass market the pressures start to show. If you give a hospital matron a reasonable budget, and she's been trained to be a stickler for cleanliness, it'll get done. If you think you can save money by putting it out to tender, where a private company does the job for even less, while still pocketing a profit, you're in la-la land. But that's what they did.

So there we had it, Mum aged over 80, living alone, and deteriorating eyesight. The odd thing is that now, looking back from ten years distance, it seems relatively trivial. Even if she'd waited, it would all be in the past by now, she'd have had the operations nine years ago. But at the time I was worried. Worried that she'd trip and fall and injure herself. So I persuaded her to have the operations done privately.

The arrangements were quite simple, the surgeon wasn't her usual chap but his colleague whom she liked better anyway, and it was done in a private hospital in Glasgow, both operations done in about two months from first asking as far as I remember. Total cost £3,500. And she still had enough savings left to have her kitchen and bahtroom completely refitted the following year.

So yes, it was terrible that the NHS was going to make her wait over a year. But she had a choice, just as US citizens have, to buy what she wanted on the open market, so she did.

But remember two things. One, if she hadn't had the money, she'd have got the surgery eventually (and looking back, I wonder if we didn't over-react, I suspect she'd have been fine if she'd chosen to wait). She wouldn't have been denied treatment. And two, the reason for the wait was because of one of the bad consequences of introducing competition and the free market into mass-market, budget level healthcare.

Rolfe.

[gmanontario]

Now if that isn't rationing, I don't know what is. The NHS would never do that to anyone. If you need three surgeries, you get three surgeries. For goodness sake, what if she had one of her cataracts fixed and then got appendicitis? Should she stay blind and with a painful jaw because she might need her one operation for something really life-threatening?

Sorry bad wording. She had to choose one of those three surgeries. There was no mention of anything past them.
OHIP would also do all 3 surgeries, although just one at a time especially for the eyes. All she would ever need is a doctor's signoff and then an appointment at the hospital.

She chose to get one eye fixed anyways and is quite happy about it. :confused:


I've been thinking about that, and I wonder. If you have really cruddy service, and you've been told time and time again that the proposed new system will make it all ten times worse, would you want to change?

Rolfe.

Yep and they are what the CT crowd call sheeples. No research or thought, just knee-jerk reaction to whatever they want to hear.

I watched the town hall meeting videos. What a bunch of a-holes at those meetings. Wonder how many HMO paid rabble rousers were there?

[Rolfe]

Oh, one a year or something like that? Not quite so bad then. And they always do the eyes one at a time for medical reasons. I talked to Mum's ophthalmologist about it. He said that post surgery the patient can't use the eye for a period, and the idea is they still have the other one. Also, if anything went wrong, like an infection, the possibility of that affecting both eyes was just scary. So I've escorted Mum to eye surgery four times now!

Rolfe.

[Undesired Walrus]

Look like the lady will pull through. Hooray!

[Rolfe]

Have you seen something recent? I can't find anything dated more than a day or two after she went to Sweden.

Rolfe.

[geni]

Now if that isn't rationing, I don't know what is. The NHS would never do that to anyone. If you need three surgeries, you get three surgeries.

The NHS has been known to stick to useing more expensive options on only one eye.

[funk de fino]

We have private healthcare too, and private health insurance companies - lots of them. They just cater to the well-off who like the swanky private clinics and so on. The premiums are quite reasonable, because the existence of the NHS means that coverage doesn't have to be so comprehensive.
Rolfe.


Ahemm..also those who have a employer who pays for it.

An american employer;)

[Rolfe]

The NHS has been known to stick to useing more expensive options on only one eye.


Agreed. But not with cataract or glaucoma surgery.

Rolfe.

[Rolfe]

Ahemm..also those who have a employer who pays for it.

An american employer;)


I had it through my work at one stage, and I was the employer! No Americans involved.

Rolfe.

[Darat]

To get back to the thread's title:

http://news.bbc.co.uk/1/hi/scotland/glasgow_and_west/8197337.stm


...snip... bowel cancer.

As part of a national screening programme, self-testing kits are being sent out to all 50 to 74-year-olds.

...snip....

[Rolfe]

I'll let you know how we get on with that.... :D

Rolfe.

[Vorticity]

I had it through my work at one stage, and I was the employer! No Americans involved.

That's just what us Americans wanted you to think.

We are all knowing... all seeing. We were involved, but (like the wily ninja) didn't want to be seen.

ETA:

Ninja care at its finest. (http://www.drmcninja.com/)

[sophia8]

To get back to the thread's title:

http://news.bbc.co.uk/1/hi/scotland/glasgow_and_west/8197337.stmI had one of those kits a few months back. I think it came via my GP. Anyways, it cost me nowt and the result was negative. One less thing to worry about, and it's made me a bit more aware of the symptoms of bowel cancer.

[krx]

Have you seen something recent? I can't find anything dated more than a day or two after she went to Sweden.

Rolfe.
I'm reading in one of the Swedish daily newspapers, where they say she has recovered and has left the Karolinska Hospital, to be transferred to an intensive care unit at Crosshouse Hospital in Ayrshire. (Cool, I've been to a conference in Ayr, Ayrshire! Best ever, as I skipped the last day for a weekend tour to Isle of Islay...)

krx

[Undesired Walrus]

She's come back and is recovering. (http://news.bbc.co.uk/1/hi/scotland/glasgow_and_west/8199517.stm)

[Fiona]

I'm reading in one of the Swedish daily newspapers, where they say she has recovered and has left the Karolinska Hospital, to be transferred to an intensive care unit at Crosshouse Hospital in Ayrshire. (Cool, I've been to a conference in Ayr, Ayrshire! Best ever, as I skipped the last day for a weekend tour to Isle of Islay...)

krx

Drunken bum :D

[gtc]

As an example of Australian health care, I came down with some sort of infection yesterday.

At 4:30pm I went to my local medical centre and asked to see the next available doctor. By 5:15pm I had filled my prescription for a course of antibiotics and also picked up a 60 pack of soluble asprin. Total out of pocket costs were $20 Australian or about 10 pounds.

[Darat]

I'm having to go for a routine ...er.. procedure (one that has to be done in a hospital under light sedation by a consultant).

Went to my GP's, she requested the procedure, the computer churned out a list of the (about) 12 hospitals in the area I could attend, listed their distances from my address, whether they had car parking facilities and other ancillary details including average "waiting times". I didn't have my calendar with me so I didn't book the appointment there and then so the GP provided me with a booking reference and a password and a print out of the details.

I came home, went to the NHS website, typed in my booking details and password. Up came the list of hospitals, and it gave me the ability to do a comparison of the various hospitals (which takes you to another site that lists the ratings of the hospital and provides statistics like the number of MRSA infections per 100,000, how other patients have rated the hospital, it's like one of those insurance comparison sites). After that I click on which one or ones I want to check for an appointment.

A long list of appointment dates and times comes up (about 5 pages worth!) and I picked an appointment for the second week in September. Now that may seem a long time - it's 3 and a bit weeks from the GP visit but it wasn't the earliest appointment for this routine procedure, that was exactly for 14 days. (But that clashed with some holiday plans I have so I've picked a date and time that suited me.)

And to think we have some folk in the UK that claim the NHS hasn't improved since it was better funded....


(That is NHS England but I believe NHS Scotland has a similar system in place.)

[Francesca R]

And to think we have some folk in the UK that claim the NHS hasn't improved since it was better funded.....Do we? Well naturally some will complain about things whatever. But the debate I have heard much more often in the UK concerns the dramatic rise in real health spending under Labour and the observation that this is unsustainable. Most people tend to agree that the output of the NHS is considerably better*, but worry that this was a one-off, and that--given the dreadful state of UK public deficits--it will have to go into reverse from here even if the next government soaks the rich with tax hikes.

This chart (http://www.ukpublicspending.co.uk/downchart_ukgs.php?year=1980_2011&view=1&expand=&units=p&fy=2009&chart=10-total&bar=1&stack=1&size=m&color=c&title=Health Care) shows the trend in health spending as a fraction of the economy. Before Labour it was slightly below comparable numbers in the rest of Europe. Now I think it's edging above. (International comparison would probably indicate that only spending 5% GDP on a universal health system and all the rest of it, is too tight-fisted and won't get you anything decent)

This report (http://www.hsj.co.uk/nhs-spending-what-does-the-future-hold?/1897072.article) mentions the growth of real (net of inflation) spending on health: Average growth rate 1949-97 was 3.4% per year. 1999-2008 it was +6.4% per year.

It would be a disaster if there was no discernable improvement from that. (I also agree there has been)

(*Of course there have often been criticisms that "we" did not get value for money, and to-be-expected bleatings that it has been squandered on pay rises (http://www.thisislondon.co.uk/standard/article-23422416-details/Salaries+of+fat+cat+NHS+chiefs+soar/article.do). Not for doctors/nurses so much--but "fat cat layers of management". Managers in the health service are perennially regarded as parasite pen-pushers, in stark contrast to hard working carers of the highest moral fibre :D)

[Darat]

Do we?

...snip...)

Unfortunately yes. I've argued with folks from the UK about the NHS on the Forum when they were giving the last few governments a kicking, and until this last week or so I'd say any, even remotely, negative story about the NHS on the BBC site had them crawling out of the woodwork on "Have your say".

[Rolfe]

Now I know this story didn't actually happen in Scotland. But hey, England is awesome too!

The NHS surgeons who saved 15 lives in record-breaking transplant op using just TWO donors (http://www.dailymail.co.uk/health/article-1206527/Pictured-The-people-lives-saved-British-surgeons-record-breaking-transplant-op-using-just-TWO-donors.html)

IN total around 55 medical staff and support workers were involved in the multiple transplant operation with some surgeons and doctors taking part in up to four operations.

Consultant transplant surgeon Mr Paolo Muiesan led a team of doctors, anaesthetists and nurses during a six-hour operation to secure the organs from the first donor. These included the stomach, pancreas and intestine and two kidneys.

In addition a separate thoracic surgical team removed two lungs and a heart.

The liver was divided in half in the donor and then, like the other organs, individually packaged for transportation to the Children's Hospital and the Queen Elizabeth Hospital.

Consultant transplant surgeon Mr Darius Mirza led the team performing the transplant for an 11-year-old boy, using organs from the first donor. The six-hour operation involved the transfer of a stomach, pancreas and intestine.

Consultant transplant surgeon Mr Khalid Sharif led the transplant team giving a left half of the new liver to eight-month-old Lubaya Turpin. At the same time, at the Queen Elizabeth Hospital, consultant transplant surgeon Mr Simon Bramhall led the team giving the right half of the new liver to 30-year-old Sandie Lee Smith.

He then led the team performing the 'domino' procedure in which Sandie's liver was transferred to Sean O'Brien at the same hospital.

Simultaneously, Mr Mirza also led the team who retrieved the organs from the second donor, and carried out the transplant operation on 14-year-old Damien Simpson using those organs, the last of the five transplant operations on the day.

Each surgical team would consist of ten to 12 people.

At least four surgeons were needed for the retrieval operations, plus an anaesthetist, two technicians, two nurses, two coordinators and one theatre assistant.

The transplant teams consisted of at least one or two transplant surgeons, plus two assistant surgeons, an anaesthetist, two technicians, one nurse, one coordinator and one theatre assistant.


Oh yeah, it's evil and Orwellian, and the recipients were probably the few survivors of the "death panels" and even worse they probably didn't deserve the transplants because their illnesses were the result of poor life choices....

Why do so many Americans not understand how wonderful it is to know that your society will provide this sort of care for you if needed, without the word "money" even needing to be mentioned?

Rolfe.

[gtc]

it's evil and Orwellian

Depends how they came by the donors.

The surgeons weren't trained in Edinburgh (http://www.scotshistoryonline.co.uk/burke.html) by any chance?

[Rolfe]

:D

More seriously, from the accompanying photograph and the names, it looks as if several of the surgeons are of Middle Eastern ethnicity, and probably even Muslims. Oh noes, universal healthcare systems are a breeding ground for terrorists! (If that accusation hadn't been seriously made, I wouldn't have dared make it up as a parody.)

Rolfe.

[Architect]

Argument by anecdote, and not at the same end of the scale as the lady in Sweden, but there you go.

Yesterday, whilst sitting at my deska t the office circa 8.30am, something landed in my eye. Don't know what it was, but it hurt like heck. The eyebath in the office first aid kit and dunking head into sink full of water (with eyes open) didn't make any different.

Rang doctors surgery at 8.45am. Told to get in at 9 sharp, when they opened, and the practice nurse would fix it. Doctor's surgery across the road from office, so that was easy enough.

9-9.30, practice nurse works through a series of eyebaths, eyedrops, and examinations. Got most but not all out.

9.30-9.45,one of the doctors in the practice comes in, uses gizmos to look in and above eye (dye, UV, etc). Given local anaesthetic. Eye swabbed progressively (that was fun), remaining gunk removed. Given week's supply of antibiotic eye drops and told to come back at 2pm if any problems, failing which they could fit me in first thing this morning if it flared up.

So, in our "hellish" health system, the GPs surgery basically went out their way to help. And it cost me.......zilch.

[volatile]

Argument by anecdote, and not at the same end of the scale as the lady in Sweden, but there you go.

Yesterday, whilst sitting at my deska t the office circa 8.30am, something landed in my eye. Don't know what it was, but it hurt like heck. The eyebath in the office first aid kit and dunking head into sink full of water (with eyes open) didn't make any different.

Rang doctors surgery at 8.45am. Told to get in at 9 sharp, when they opened, and the practice nurse would fix it. Doctor's surgery across the road from office, so that was easy enough.

9-9.30, practice nurse works through a series of eyebaths, eyedrops, and examinations. Got most but not all out.

9.30-9.45,one of the doctors in the practice comes in, uses gizmos to look in and above eye (dye, UV, etc). Given local anaesthetic. Eye swabbed progressively (that was fun), remaining gunk removed. Given week's supply of antibiotic eye drops and told to come back at 2pm if any problems, failing which they could fit me in first thing this morning if it flared up.

So, in our "hellish" health system, the GPs surgery basically went out their way to help. And it cost me.......zilch.

Bbbuttt.... what about the waiting lists? The rationing? Think how much you personally just shaved off the technology R&D budget of those pharma companies! People will DIE because of you! And their video games will be more expensive! My tax money paid for your mistakes! Now you'll NEVER learn not to get crap in your eye again! I can imagine it now - you, at your desk, jabbing things into your eyes willy-nilly and all because you KNOW Ol' Johnny Taxpayer here will fix you up good and proper!

Take care of yourself, for once! All those years training to be an arcitecht, and for what? You should have gone to night school and learnt how to deal with eye problems, not sat around waiting for others to be forced, AT GUN POINT, to take the crap out of your eye for you! Take responsibility for your own life for once! Sheesh.

[Darat]

Poe's law in action..... :D

[zooterkin]

Depends how they came by the donors.

The surgeons weren't trained in Edinburgh (http://www.scotshistoryonline.co.uk/burke.html) by any chance?

Not to mention that Edinburgh isn't what it used to be. (http://www.guardian.co.uk/media/organgrinder/2009/jun/08/the-apprentice-margaret-mountford)

[Rolfe]

She's come back and is recovering. (http://news.bbc.co.uk/1/hi/scotland/glasgow_and_west/8199517.stm)


She's fine now! (http://news.bbc.co.uk/1/hi/uk/8257686.stm)

Rolfe.

[Darat]

She's fine now! (http://news.bbc.co.uk/1/hi/uk/8257686.stm)

Rolfe.

Until the death panel sends round the official culler!

[tyr_13]

Until the death panel sends round the official culler!

See the ninja death squads needed in UHC are also government run, making them even less efficient at killing you all than the health care.

[Undesired Walrus]

She's fine now! (http://news.bbc.co.uk/1/hi/uk/8257686.stm)

Rolfe.

Medical science is remarkable. People were writing off her chances in July.

Glad to see she is doing fine. And it's tremendous that her unborn child is still here. Curse you Clement Attlee!

[Architect]

Attlee? Bevan, surely?

[Undesired Walrus]

Bevan, Attlee, all them socialists look alike.