Originally Posted By fkurucz I just has my gall bladder removed this morning. I have no doubt that if I had to buy individual insurance on the open market it would either unavailable or prohibitively expensive.
Originally Posted By davewasbaloo Glad to see you back on line my friend. Here's to a swift and speedy recovery.
Originally Posted By davewasbaloo Ok, there are some interesting points in here, thanks for the mature and considered debate. DAR - you raise an interesting point about private vs public provision. It doesn't actually have to be a one or another option. Here in the UK, they are currently piloting individual budgets. A notion that each patient is given a budget in relation to their needs, and with guidance they can spend it where they like (as long as it relates to their treatment). So if they have state provided services, it is likely they get more for their money, or they can go to a private provider and top it up if they like. So far the results have been pretty encouraging.
Originally Posted By davewasbaloo Wahooskipper said "Many folks also making the argument that whenever rich folks in other countries want specialized services they board a plane and head to the Cleveland Clinc (or Mayo, etc) because they will get better care in the States.". That's true, but people travel 3000 miles to go to those clinics, just as people come to the UK from the US for IVF treatment and some heart procedures. Sometimes it is down to, who has the best skills and knowledge, and that is spread around the world. There have been huge numbers of American children at Great Ormand Street when I used to volunteer there.
Originally Posted By davewasbaloo >>>That's fine but you also need to attract people to work for those companies by offering a reasonable wage.<<< Ok, what is a reasonable wage. Run of the mill Drs here tend to pull down a min of $110,000 a year, for a basic doc. If they have larger practices or set up a private practice (they can run both private and NHS practices out of the same clinic), they can earn huge amounts. Also add in performance bonuses.
Originally Posted By davewasbaloo >>>There is an easy explanation -- marketing and propaganda.<<< This is the key one I figured, but on my current facebook discussion there have been some legit concerns worthy of exploration. I will save those until I get to the end of these points.
Originally Posted By davewasbaloo >>>A friend of mine told me the other day that one of the things he takes costs $3,000 a bottle. I think it it was social medicine, or regulated in some way to keep costs affordable, that could be a huge help to a lot of people.<<< Agreed. Even my blood pressure meds would be $110 at a cheap rate in the US each month. They cost me $7 a month, and people complain about that over here (lol, they have no idea how expensive some meds are). And again, a lot of HMOs do not seem to pay for all meds. In fact, it is amusing when we come to the US about how many commercials there are for medications and indeed how obsessed many people seemed to be with over the counter meds. It is a demonstration that it is a multi-million (if not billion) dollar industry. And some people say, but that's what motivates reseach. Funny, given the numerous breakthroughs in Pharmacology and Surgery techniques in Europe. I am not disputing the money helps research, but I am sure far more goes on marketing and sales budgets, bonuses and shareholders. How much are optometrists in the US? The four of us all had our eyes checked on Saturday and it was $75 (though it is free for kids, elderly, disabled etc.)
Originally Posted By davewasbaloo ecdc - I am using both my personal experience and the statistical one. Sadly in some fora, both fall on deaf ears. It is really sad. The jingoism that promotes America as the best country in the world forgets these stats or writes them off as being insignificant. Now America is one of the best countries in the world for many things, but I just wish people would open their eyes.
Originally Posted By davewasbaloo Now for the one point the opposition have raised is a concern about the inefficiency of the American government to manage something like this (like the DMV for example). Now there is some validity to this point. But then again, this is the same government that put man on the moon, and also acts as the world's police. Surely, if America is so great, with the right resourcing and attention, this can totally work. If enough people want it, can't it?
Originally Posted By davewasbaloo Interesting report in the Guardian today: "Dentists' earnings leave bad taste in the mouth. One in every 30 dentists earned more than a quarter of a million pounds last year ($375k), statistics reveal A total of 654 dentists in England and Wales earned more than £250,000 ($375,000) last year, new official NHS statistics reveal today. Data from the NHS information centre shows that 159 dentists earned between £250,000 and £275,000 ($375,000 - $387,000), 113 earned between £275,000 and £300,000 ($387,000 - $450,000), and 382 earned more than £300,000 (>$450,000). With about 19,500 dentists in England and Wales, this equates to one in every 30 dentists earning more than a quarter of a million pounds. The figures, based on dentists' own tax returns, reveals that: • The average income for all dentists was £89,062 ($135,000) (before tax)." These are pay rates in a socialised medicine structure, how does this compare with the US?
Originally Posted By mawnck >>And some people say, but that's what motivates reseach.<< Aye, but it motivates research only in areas where drugs are obscenely profitable. How many heartburn medications does one need? And then there's the sad fact that these heavily advertised drugs are rarely any more effective than the cheap generics already on the market - sometimes less so. But try telling that to Joe 6-Pack the TV zombie. >>Now for the one point the opposition have raised is a concern about the inefficiency of the American government to manage something like this (like the DMV for example). << Our DMV was wonderfully efficient before the budget cuts. Ditto the post office, the police, social services, libraries, parks, museums, fire, schools .....
Originally Posted By Sport Goofy << Now for the one point the opposition have raised is a concern about the inefficiency of the American government to manage something like this (like the DMV for example). >> Why is the DMV and example? Is it because you have to wait in line once every 5 or 6 years to get a license renewed? I'd say the government runs the DMV very efficiently. They don't allocate unnecessary resources to an administrative function. They conduct most of the DMV business by mail so you don't even have to go to an office. Sure, you may have to wait in line for an hour once every 5 years, but your tax dollars didn't go towards paying for services that are unnecessary and wasteful. That's generally the definition of efficiency. It might not be convenient to you, but it's not inefficient.
Originally Posted By TomSawyer Since none of the options currently on the table involve a government takeover of healthcare worrying about it's efficiency is moot. Those folks who wind up choosing a public option plan will probably have the same level of service as those Medicare, which is pretty efficient.
Originally Posted By davewasbaloo I used DMV as an example most people of aware of. My worst experiences of the government transactions are the registration services at the US embassy, and before investing in new business process reform, LA County Human services was only open to the public 2 hours a day. Personally I am a huge fan of health reform. I thought I would just try to show a balanced side by discussing the issues some have raised as concerns.
Originally Posted By Sport Goofy << I used DMV as an example most people of aware of. My worst experiences of the government transactions are the registration services at the US embassy, and before investing in new business process reform, LA County Human services was only open to the public 2 hours a day. >> Understandable. I just wanted to offer that those are examples of customer inconvenience and not inefficiency. Should custome convenience be an important part of health care? I think so. Efficiency and convenience are sometimes mutually exclusive things, though.
Originally Posted By davewasbaloo True, but we know that if we are to convince the right wing on social medicine, we need to demonstrate both convenience and efficiency. I remember last summer being at a conference, and the CEO of some American Health firm came in and started talking about how LEAN processes helped improve the way their hospitals operated. He was riveting, until he showed the slides where it had the most impact: Valet parking (he was laughed of the stage for that one) Catering (again, a necessity, but hardly core business) And the two that did matter were on pharmacy and OR processes. But he was proudest of the valet parking. It was a real education in different value sets.
Originally Posted By Dabob2 <>>And some people say, but that's what motivates reseach.<<> True story: one of my uncles in MO who is a farmer came down with colon cancer. He was scheduled for chemo that was hugely expensive and not covered by his bare-bones insurance policy (which, as an independent farmer, was all he could afford). Then he found out from a friend of his who raises sheep that the drug in question was first developed as a sheep wormer. They discovered later that it was effective on colon cancer (kind of like they discovered Minoxidil grew hair when it was developed for blood pressure). The exact same drug was available for literally 1/100th of the cost as a sheep wormer. My uncle, after checking into it with his doctor and discovering that it was, in fact, the exact same thing, bought it from his friend as sheep wormer and took it - and his cancer went into remission. But the same stuff costs 100 times as much for use in humans. And the R&D money went into it as a sheep wormer! So don't tell me they had to charge 100 times as much for humans because of R&D costs. No, they charge 100 times as much because scared, vulnerable people will pay it, and thus the pharmaceutical company can get away with it.
Originally Posted By davewasbaloo Agreed Dabob, the mark ups are rediculous and the the techs who do a lot of the research are paid peanuts. But you have to admit, money makes some of these companies push the envelope (though we know charity and publically funded research do too).
Originally Posted By queenbee Money is definatly a motivator. My limited understanding of research is that often public money provides for pioneering research and private money follows-up promising ideas. In other words the really risky, expensive part is paid for by the taxpayer but the benefit of the research is privatized.
