Even as one of them heatedly denies that she advocates "socialized medicine," it is a fact that each major US presidential candidate on the Democratic side favors some form of nationalized health care. Additionally, while governor of Massachusetts, Republican candidate Mitt Romney was firmly behind health-care legislation that, as commentator John Stossel noted back in May, the Wall Street Journal described as "a death warrant for small business in the Bay State."
Given its potential as a top-tier 2008 presidential campaign issue, you would think that there would be Old Media interest in how nationalized health care is working out in other countries.
But if there was, you would have surely heard about this news a week ago without having to go to British newspapers to learn of it:
Drug companies and campaigners yesterday lost a high court appeal for people in the earliest stages of Alzheimer's to be prescribed on the NHS a £2.50-a-day drug (about $5/day in $US -- Ed.) which is said to provide relief from the symptoms and respite for families.
Story Continues Below Ad ↓..... The ruling means the drug will not be available for people in the earliest stages of the disease, allowing the decision of the National Institute for Health and Clinical Excellence (Nice), that Aricept's benefits are too slight to justify prescribing, to stand.
..... Eisai and Pfizer, which make and market Aricept, supported by patient groups, (had) sought a judicial review.
Yesterday, Paul Hooper, managing director of Eisai, said: "The guidance Nice has issued is morally reprehensible. They are denying patients access to early treatment and that is wrong. This is about patients, not profits. For Nice to deny treatment to patients with mild Alzheimer's disease is disgraceful."
The Alzheimer's Society said it was frustrated at the decision.
"Frustrated"? I would characterize the Alzheimer's Society's reaction as a bit stronger than that:
However, the result is deeply disappointing for everyone in the early stages of Alzheimer’s and their carers. Without further change to the guidance, people in the early stages of the disease will still be refused drugs because NICE considers that these people are not worth £2.50 a day. This is insulting and devastating news. People will be forced to deteriorate before they get the treatment they need. Is this the sort of society we want to live in?
NICE failed to listen to the views of thousands of carers who told them drug treatments make a huge difference to their lives. It is deeply disturbing that a public body, required to use rigorous standards of evidence based decision making, can simply guess at vital data. This is simply unacceptable.
When NICE speaks it has huge implications for people's lives. Its decision on Alzheimer's affects hundreds of thousands of people. NICE must get it right. To retain its authority as a public body it must command the confidence of the public. The result of this case must call into question whether NICE has lost that confidence. It is up to Government to consider the changes needed to stop this from happening again.
Some context:
- According to this press release written before the high court NICE ruling came down, "700,000 people in the UK have a form of dementia, more than half have Alzheimer’s disease. In less than 20 years nearly a million people will be living with dementia. This will soar to 1.7 million people by 2051. 1 in 5 people over 80 have dementia." The ruling clearly denies treatment to hundreds of thousands of UK citizens.
- Aricept (also known as Donezepil) was approved by the US Food and Drug Administration, an agency not exactly know for moving quickly, in 1996 -- 11 years ago -- for mild to moderate dementia.
- The FDA approved the drug for use in cases of severe dementia in October of last year. The NHS/NICE, as noted above, is limiting Aricept's use to severe cases.
- This March 2006 Consumer Reports article, written before the FDA's severe-case approval, designated Aricept one of three Best Buy drugs for people with early-stage Alzheimer's disease.
Exemplifying NHS's top-down control, a Nottingham (UK) University Hospital "Medicines Management Report" on "Controlling the Drugs Budget" from two years ago specifically states (in table row C2 near the bottom of the document in the middle column) that doctors are to "Stop all NICE approved prescribing outside guidelines." So the government, aka the British National Health Service's supposedly "NICE" guys, is deciding what drugs every one of its millions of patients are allowed to take -- purely based on NICE's, and not the doctor's or patient's, cost-benefit considerations. There's outrage in the US when a managed-care organization attempts to do this in relatively isolated instances.
Given the stringent guideline just noted and the strong cost-control language in the Nottingham report, it's not unreasonable to believe that doctors will be under severe pressure to defer a diagnosis of severe dementia until the latest possible moment.
Negative government intervention in the doctor-patient relationship has happened in every country that I am aware of where nationalized health care has been imposed. Yet politicians, including many of the 2008 presidential aspirants, continue to pretend that it won't happen here. It will, and it's only a question of how quickly it occurs.
As if anyone should be surprised, a New York Times search on "Alzheimer's" has no articles relating to the UK ruling. A Google News Search on "Alzheimer's NHS" without quotes, and limited to US sources, shows only one Old Media reference -- a CNNMoney.com article that is no longer there.
We don't hear much from Old Media in the US about how nationalized health care is working elsewhere -- because it hasn't worked elsewhere. It's hard not to conclude that the coverage of foreign nationalized health care failures is light because exposing the truth would hurt US presidential candidates who favor it.
Cross-posted at BizzyBlog.com.
—Tom Blumer is president of a training and development company in Mason, Ohio, and is a contributing editor to NewsBusters
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Comments Policy
look what socialized medicine does
August 20, 2007 - 10:48 ET by sarcasmoto socialists! I'm reminded of beaten wives begging the cops not to arrest their attackers... ("Bait and switch" warning: The link is to a website which pushes many politically-incorrect libertarian ideas!)
JMR
Rally online with fans of Dr. Ron Paul.
Shawn
August 20, 2007 - 10:50 ET by BlondeShawn,
Read this post carefully, and then tell me why you think socialized medicine is the way to go? Why you'd prefer to have the government control your access to health care?
Great catch, Tom. Of course we don't hear a word about this from the MsM....they're too busy shilling for their socialized health care candidates.
Huckabee is growing on me, seriously. For this issue alone.
David Gregory, do you know which damn network you lie for? ~ Uncle Jimbo, @Blackfive
Hello,
August 20, 2007 - 11:06 ET by kathleenirishHello, there!
Perhaps the 'Old' Media has a bit of dementia themselves. We know they are invertebrates, that's for sure.
I doubt you'll get an answer from Red Shawn.
My mother-in-law waiting over two years for her operation to have her cataracts removed. Socialized medicine is better my arse!
Anyone who says they support the troops but not the mission is a liar.
hey kath
August 20, 2007 - 11:16 ET by BlondeInvertebrates, indeed! I may have to borrow that one.
Well, Shawn's gone off line for now, but I've been waiting for a really good blog post to go up (this one) to try to draw him out on his position. So we shall see.
Isn't it amazing how the invertebrates ignore the socialist model in other countries? I have a friend whose mum is still in England. The wait for digital hearing aids is like 3 - 4 years. And the doctor actually said something like "your mum is 82, she has Alzheimer's, and the wait is so long, why bother". Now that's the kind of healthcare I've been waiting my whole life for....not!
Not to mention the fact that the British National Healthcare System is recruiting doctors who want to blow things up! Oh yeah, let's go for that option, too.
Hillary, Hillary, can you please explain this to me?
David Gregory, do you know which damn network you lie for? ~ Uncle Jimbo, @Blackfive
blonde
August 20, 2007 - 22:57 ET by shawn228Sorry it took me so long to respond, I just got home about 10 minutes ago. Interesting comment from Kathleen, Red Shawn? Don't think I have heard that one before. I'm not going to talk about you as the third person anymore Kathleen, but what makes you think Blonde would not get a response from me? Do I usually duck questions?
I agree with what you guys are saying about the UK case. I am not saying it is right and there are a heck of lot wrong things with a social medical system. The main things wrong with them are you have to wait much longer for non life threatening surguries, and the govenment makes your decisions for you, like in this case
Read this article when you get a chance. It is about someone that had great medical coverage, but still ending up losing all her money anyway because of rotten luck. The article is about someone that already had good coverage, what about the people that no fault of their own cannot find a job or get laid off. It happens to many white coller workers everyday.
Since this thread is about a alzheimers drug. Lets talk about alzheimers. My mother in law was diagnosed about the disease about 6 months ago. The disease seems to get taking her in a real hurry. Most people don't realize no matter how great their medical coverage is, that the coverage stops when you stop getting better. IE if a person has a stroke or alzheimers or demincia. Unless you have purchased Long Term Care, which the premiums are about 3000 per year, you are SOL. Hospice care or in home care cost about 200 per day. I don;t know about you, but no matter how close you are to relative, it can be very embarrassing to you and to them, if you have to give them a bath, or change their diaper.
I have conceded in the past that right now the US cannot afford social medicare right now because we are spending too much for the wars in Iraq, the war on drugs and social security. My hope is that we can have one someday.
I can understand what you
August 21, 2007 - 08:06 ET by dscottI can understand what you are going through as I have a similar issue with a family member. However, you can't blame the funding levels on the Iraq war, war on drugs or SS anymore than people tried with the MN bridge collapse. It doesn't have anything to do with the price of tea in China because that money was going to be spent anyway. We don't and shouldn't choose public policy and foreign policy based strictly on the budget, it might influence our decisions on cost effectiveness but in the end going to War cost money just as fighting crime does.
No one plans to get this aweful disease, so we need to properly focus not on complaining it's too expensive to have them taken care of them but instead, get the government to facilitate funding of a cure. I use the word facilitate since government doesn't solve problems, people do. Instead of wasting billions of science dollars on AGW research (a non-existant and theoretical problem) we should be spending on those problems that are staring us in the face. Do you think we might have had a cure by now or be close if we had instead spent the 50 billion dollars on altzheimers and dementia instead of AGW???? I think so. Should the government spend millions to billions of dollars on dead end research projects that the private sector has already deemed to be an expensive waste of time like embryonic stem cells versus adult and cord stem cells that have yield hundreds of viable therapies??? Spending dollars is a matter of priorities, we don't have unlimited resources, however, if we are going to spend that kind of money then it should only be spent where there is a likelihood of success in "speeding" a cure versus chasing after elusive promises than never pan out like fusion power.
The object of life is not to be on the side of the majority but to escape finding oneself in the ranks of the insane. Marcus Aurelius
Ha, dscott. I'm in
August 21, 2007 - 08:34 ET by ErgoDyneHa, dscott. I'm in research, working on Alzheimer's. We need funding, but NIG grants were cut this year. Grants were given to fewer groups and with less money than before, for PPGs.
Increase funding for Alzheimer's and you'll get your drug.
"If you don't read the newspaper you are uninformed, if you do read the newspaper you are misinformed." - Mark Twain
Did you hear about the
August 21, 2007 - 08:58 ET by dscottDid you hear about the experimental therapy being done with minimally conscious people? http://news.med.cornell.edu/wcmc/wcmc_2007/08_02_07.shtml I'm wondering if this approach would yield any benefits to dementia patients?? If you know anybody willing to pursue this line of research I'm all for it.
And yes, if a pill costs $20 to cure a disease, especially dementia and altzheimers over a period of a year, I would take the money out of my pocket and pay just because it would save money in the long run not to mention the obvious first consideration of getting your family member back.
The object of life is not to be on the side of the majority but to escape finding oneself in the ranks of the insane. Marcus Aurelius
Interesting article. I'm
August 21, 2007 - 09:10 ET by ErgoDyneInteresting article. I'm not sure it could be applied for dementia similar to Alzheimer's, but it could be worth looking into. With Alzheimer's there's a depletion of cells and transmitters as well as sclerosis, whereas with these minimally-conscious, the DBS is stimulating what's already there. For Alzheimer's new growth needs to be introduced for this to work, if I'm not mistaken.
There is a lot of research associated with neurological disorders going on, but funding is the main issue.
"If you don't read the newspaper you are uninformed, if you do read the newspaper you are misinformed." - Mark Twain
universal medicare
August 21, 2007 - 09:11 ET by shawn228Hi dscott,
I can't help but to let the State of the USA influence my decision about a socialized medical system. Yes the ecomomy is actually quite good, but we are close to 9 trillion in debt. For every dollar we collect in tax revenue, we are spending about 17 cents on repaying for the interest on that debt. I don't agree with President Bush with how he wanted to fix SS, but i do agree with him that if something is not done, it will go broke. That being said, there is no way we can afford a social medical system as of right now.
I hope the day we can afford it we should proceed, with a caveot. Have a social medical system, but at the same time let people have the right to buy private medical services if they so choose.
I wish we had a cure for alzheimers as much as anyone, but the reality is we are at least a decade away from finding one. I disagree with what the poster a few down from us says about signing our homes over to the goverment when our time comes. For those of us that can afford it, we can buy long term care. For people that cannot afford it, it can bring serious hardship to ones family.
When grandma or grandpa first get sick and need to be physically taken care of . Usually all the children are willing to help out. Bathing them, Changing them, helping them to the bathroom, moving them to prevent bedsores. it is a 24 job and it can become tired really fast. As much as there are bad things with social medical system, most countries that have it, their citiizens rarely have to deal with this scenario.
When grandma or grandpa
August 21, 2007 - 09:15 ET by Cool ArrowWhen grandma or grandpa first get sick and need to be physically taken care of . Usually all the children are willing to help out.
Shawn, I think you are talking about the exception rather than the rule.
~LYDSEXICS UNTIE!~
Actually there is a means
August 21, 2007 - 10:17 ET by dscottActually there is a means for those who can't afford it and that's called Medicaid and Medicare. The harsh reality is if a person has exhausted all their finances, using the example of grandma i.e. over 65, she goes to a nursing home paid by either of these two government programs, she is not going on the street. If you are talking about middle class people then of course at some point the financial assets of grandma are going to get exhausted, when that happens again Medicare is going to pay for her nursing home stay just as for the poor person. That means, the family will not inherit anything from their grandma, whereas in the case of the poor there was nothing to inherit in the first place. Yes, it is tragic that grandma will have to expend all of her assets not leaving the family anything however, the point is the nursing home is covered at that point. Yes, families are faced with a choice of expending their finances or just letting the government take over, it's a hard choice, but an option none the less. Having socialized medicine is not going to change that option.
So we are back to the real issue, a cure, and what the government can legitimately do to facilitate the drug companies or medical establishment to find it faster. I do believe their is a legitimate governmental interest in curing a disease that affects a significant portion of it's citizenry, costs the nation untold billions of dollars in health care costs and to that end using tax dollars to expedite a cure is a dollar well spent unlike some other government endeavors I could mention.
The object of life is not to be on the side of the majority but to escape finding oneself in the ranks of the insane. Marcus Aurelius
Dscott
August 21, 2007 - 21:16 ET by shawn228Having socialized medicine is not going to change that option.
True but having a socialized medical system will:)
ehh???? Socialized
August 22, 2007 - 08:31 ET by dscottehh???? Socialized medicine vs Socialized medical system?? Seems like you are changing the terms, crap still smells like crap no matter what you call it. What's the difference medicine and medical system in your mind, explain it.
Maybe you missed the point here Shawn, Socialized means government control and intervention, i.e. micromanage, as a conservative I am against Socialism in all it's insidious forms. There is a difference between government and Socialism, to a conservative, government is a "tool" of the people, to be used appropriately not ham handedly. Socialism on the other hand is a mindset of power and control using government as a "means" for the elites to gain dominion over the masses. The elites are any limited group of people who through manipulation seek to direct the lives of the masses without their express consent. Acquiesence is not consent, rather that's called condoning because you don't have the power to overturn the decision's of other's manipulation. Manipulation whether at the point of a gun or a judge's ruling or a bureaucrat's directive is exploitation for the purposes of power and control. Cradle to grave care of the government is a euphesim for Socialistic exploitation of the masses to control their every thought and move and that is a description of tyranny. Socialism, any way you slice it, is a dictatorship of the few ruling the many which is in direct opposition to Democracy as the consent of the people.
On a tangent, If you think my response on Socialism's controlling thought seems extreme, look at it through our eyes, Ted Kennedy on the floor of the Senate said those who oppose gay marriage are bigots and have committed a hate crime. Ted Kennedy in a moment of liberal self righteousness let slip the true agenda of his Party: Thought Control and implied the threat of arrest to anyone who doesn't not toe the Party line of PC. So according to Ted Kennedy anyone who holds a different opinion and refuses to acquiesce or condon will be charged with the crime of hate speech. Shades of the Soviet Union - Counter-revolutionary speech.
The object of life is not to be on the side of the majority but to escape finding oneself in the ranks of the insane. Marcus Aurelius
dscott
August 22, 2007 - 08:58 ET by shawn228Socialized medicine is kind of what President Bush has done right for seniors. Even though the plan is very confusing. For a small deductible you get your meds for free. Socialized medical system means for a deductible you get all your lab work, therapy, meds, doctor visits for free.
Are you saying if we had a socialized medical system, it would not make things a lot better for the senior citizens that need hospice care? You know, the ones that cannot afford 50.000 a year. Tell me why it would not a difference in their lives.
Hmmm, you posed a good
August 22, 2007 - 11:25 ET by dscottHmmm, you posed a good question. First let's address this notion of Medicare Part D as socialized medicine. Yes, the insurance program is "sponsored" by the government, however, to receive the drug benefit you have to sign up for a private insurance plan offering the benefit. The full cost of the health insurance program "sponsored" by the government is paid for by the Medicare Trust Fund (funded by payroll tax) and in part by the premiums (on the HMO side) paid by those via payroll deduction of Medicare from their SS checks. As I have a family member on Medicare, I know something about the system. So in one sense this is not Socialized medicine as it is a self sustaining "insurance program" run by private companies and paid in part by premiums. But in some sense it is socialized because of the Medicare payroll tax, however even that is no different than taking a payroll deduction for the employee's share of a employer sponsored health insurance plan.
Nothing is for free, all this is paid "before hand" via the premiums and payroll tax during the lifetime of the worker, even the poor ones. Those of us who earn wages via the Medicare Payroll tax are in effect pre-paying our future health insurance under Medicare and also funding the current retirees medical care including nursing homes. Retirees have already pre-paid their health insurance under Medicare via the payroll tax during their career and are now collecting. What makes Medicare a socialized system is the administrators allowing the Medicare Trust fund to be raided as with SS in effect allowing the politicians to spend the money collected for future actuarial purposes and leave an IOU in the form of bonds. That money should have been invested properly just like every private health insurance plan for future use. That is really the difference between Socialism and a self sustaining private insurance system, accountability or fiduciary responsibility. Socialism sacrifices the needs of tomorrow for the needs of today.
Now that I have laid the ground work of understanding how the system works, to answer your question. NO, Socialism will not make things better for poor senior citizens in hospice care or any other medical care as demonstrated by the problems documented in Socialist Europe. They rationed the medical costs via budgeting to seniors resulting in substandard care.
The object of life is not to be on the side of the majority but to escape finding oneself in the ranks of the insane. Marcus Aurelius
dscott
August 22, 2007 - 21:43 ET by shawn228NO, Socialism will not make things better for poor senior citizens in
hospice care or any other medical care as demonstrated by the problems
documented in Socialist Europe
I would have to disagree with that statement. One of your previous post said that a person could get hospice care funded by Medicaid. This is true, but they would only be eligible after all their bank accounts are exhausted. I believe they get to keep about $1500.
A social medical system would allow them to keep the money in the bank that they worked for their whole life. Not only that, but good luck finding a decent facility that would accept Medicaid. In a perfect world, grandma will be in a nursing home a few miles away from home, but most of the time the home that accepts Medicaid is a far far away. I don't blame them, A nice nursing home would obviously want someone that can afford $200 a day.
A Social system would not necessarily be better for someones care with limited financial means, but it is definitely better for them dignity wise.
So what you are saying is
August 23, 2007 - 07:43 ET by dscottSo what you are saying is that a social medical system would allow a person to keep their money while they were in hospice and someone else has to pay for the care? Don't you think that is kind of selfish? Why should society pay for a person who has the means to pay? Since when is society responsible to ensure an inheritance is left to the next generation when in fact that next generation is the tax payer? How is this fair to the tax payers when someone has the means to pay and then decides someone else should pay because they want to hold on to their money? We the tax payer want to hold on to our money too, you can't have it both ways.
In a perfect world, grandma will be in a nursing home a few miles away from home, but most of the time the home that accepts Medicaid is a far far away.
Since when does a social medical system claim that they will build more medical facilities than there are now? Do you actually think the level of care will increase in the existing Medicare facilities if all the other ones are forced into the social medical system? I think not. Furthermore, based on the experience of the European system, any private pay facility once taken over will devolve not stay the same in terms of care since the Social Medical System is a budget based system, hence the long waits for care and the bureaucratically dictated levels of treatment and drug protocols. If you think HMOs are restrictive and heartless, the Socialized Medicial system you advocate is positively cruel to Seniors. They spend far less on Seniors who have greater health care needs than they do on the younger groups. The dirty little secret of those 10,000 people who died in France from the heat wave a few years ago was that they were mostly institutionalized people in government run facilities with NO AIR CONDITIONING. Those poor helpless people literally expired in their beds because the bureaucrats decided they would spend the money elsewhere.
The object of life is not to be on the side of the majority but to escape finding oneself in the ranks of the insane. Marcus Aurelius
Socialized Medicine
August 23, 2007 - 07:48 ET by Sergeant ROCKWould you wager that socialized medicine kills more people than it saves, or at least more than a free market system like ours?
Given that we are hear so
August 23, 2007 - 09:04 ET by dscottGiven that we are hear so many reports on long waits and drug inavailability, intuitively I would presume yes, that Socialized Medicine has a higher mortality rate than the US Free Market system.
Without an actual study, one might be able to make an intuitive guess using the mean life expectancy rates to compare the US to Britian, Canada and France. I don't know if that would yield a valid comparison though as I remember there was a thread on it a while ago giving some podunk country a higher life expectancy claimed due to socialized medicine. There is a lot of factors that go into life expectancy, like automobile accidents, murder rate, premature infant death which may not be recorded in foreign stats, etc.
The object of life is not to be on the side of the majority but to escape finding oneself in the ranks of the insane. Marcus Aurelius
Wager
August 23, 2007 - 09:10 ET by Sergeant ROCKTrue, but I would wager that you have a better chance of dying at the hands of socialized medicine. I just don't see where the advantages outweigh the risks. Just a hunch, though.
dscott
August 23, 2007 - 08:32 ET by shawn228I do not think it is selfish at all. If someone breaks into our house and we call the police, we don't have to pay for those services right? I spent a part of my youth growing up in Canada and I still have many friends there. Yes you might have to wait longer for non threatening surgury, like a ACL, but you would get treatment very quicky like Cancer or serious disease.
It is not just senior citizens I;m talking about. Many good Americans that have medical coverage end up going bankrupt because they have to fight tooth and nail to get their HMOs to pay for services that are declined as well.
The ecomomy is Canada is humming right now. Their dollar is almost on par with ours. Lots of jobs and very high percentage of homeownership now. They pay higher taxes than we do, but I believe we can have a system that works in similar way in the future. Like I said before, there is no way the USA can afford a social medical system right now, it would break the bank.
You also mentioned before that a social system spends money today and does not prepare for tomorrow. The current adminstration took the national debt from 5.6 trillion up to almost 9 trillion. Took the biggest surplus in history to over a trillion dollar deficit. Does that sound like responsible fiscal spending to you?
Deficits
August 23, 2007 - 08:37 ET by Sergeant ROCKTrillion dollar deficits only matter when and IF, it's the result of military spending.
Hmmm, the Canadian system
August 23, 2007 - 09:40 ET by dscottHmmm, the Canadian system is so good that a mom had to go to the US to have her kids delivered? http://newsbusters.org/blogs/scott-whitlock/2007/08/22/abc-glosses-over-fact-canadian-parents-flee-their-country-give-birth
Shawn, I think we have seen enough examples from Canada, Britian and France to recognize Socialized medicine is a non starter and definitely would lower the quality of care here in the US. If the Candian system treats the younger people that way on whom they spend (budget) the most money, then seniors who have the most medical needs are definitely not going to be treated any better under Socialized medicine than here where the US in it's current form spends the most medical dollars.
I think this is a case of expectations (rhetoric) not meeting reality, if Socialized medicine in Canada can't deliver it certainly won't in the US.
The object of life is not to be on the side of the majority but to escape finding oneself in the ranks of the insane. Marcus Aurelius
dsott
August 23, 2007 - 22:33 ET by shawn228Like i said earlier, a socialist medical system is not perfect. I would like to have a social medical system in place with the option of buying private health insurance.
Maybe it is just me but I find nothing wrong with helping out Americans that of rotten luck get laid off. You also did not mention that the great medical system we have here, will not accept you if you have a pre existing condition. In a socialist medical system as long as you pay the premiums you have access to health care.
Getting laid off can happen to anybody, Republican or Democrat. Same with getting diagnosed to a disease.
also did not mention that
August 24, 2007 - 08:21 ET by dscottalso did not mention that the great medical system we have here, will not accept you if you have a pre existing condition. In a socialist medical system as long as you pay the premiums you have access to health care.
Being a non American I can understand your confusion as to how our system "really" works. When someone gets unemployed here in the US, they don't automatically loose their health insurance benefits, it's a law called COBRA, the person is covered to the end of the month they separate from work paid by the employer and then have 90 days to pay themselves for their extended coverage until they get a new job with health insurance coverage. Theoretically, if someone separated from their job on the 5th of the month, and then waited 60 days after the end of that month, they would have time to either get another job or scrape up the money to extend the health insurance coverage in some form.
In the event a person has pre-existing medical conditions, if they sign on with a new employer's health insurance coverage, that pre-existing condition is not excluded, nor is it excluded if an employer changes health insurance providers. The only time it is excluded and that for a limited period of time, not in perpetuity, is if an individual allows their policy to lapse and starts a new one. No responsible person is going to allow their policy to lapse if they have a pre-existing condition. Additionally, just because you can't afford an insurance plan with no or very low deductible doesn't mean you have to loose health insurance. You can opt for a cheaper high deductible plan to maintain the coverage of the condition you are concerned with to protect you against catastrophic medical bills. The point of insurance Shawn, whether it be health, property, theft, fire, etc. is to protect against catastrophic loss, not as you think it should be a no out of pocket cost program.
That is the fundamental difference between Capitalism and Socialism in health care, we expect people to participate in making decisions and bearing part of the cost of those decisions, while in Socialism you trade the out of pocket cost for someone else making the decisions. It's all about control. I choose to control my own fate and not depend upon some bureaucrat making decisions for me. Maybe you are prefectly happy with someone else making the decisions for no out of pocket costs, however, there is no such thing as "free" health care, the money comes from somewhere whether you pay a premium or taxes.
The object of life is not to be on the side of the majority but to escape finding oneself in the ranks of the insane. Marcus Aurelius
dscott
August 24, 2007 - 09:10 ET by shawn228I said i spent part of my youth experiencing another countries health system, but I do not believe I ever said i was not American. What you said is absoloulty true about COBRA. The scenario is not always as rosy as you depict.
Many people that are eligible for COBRA do not sign up for it. The reason is simple"for financial reasons" the premium is about $500 a month."much more with a family of five". Where would they come up with money if no one loans it to them? Your right that someone would be stupid to let a policy lapse with a pre existing condition. This is no always the case. You could get diagnosed with a disease while trying to find a new job, or get into a serious car accident.
I respect your views on not wanting a nanny state. If it is your opinion that it is someone tough luck if they rather put food on the table instead of having health coverage, but I still do not believe it is not right to lose ones live savings because of something beyond their control.
Cobra is crazy, but...
August 24, 2007 - 09:19 ET by The Wicked ConservativeLast year I changed jobs and my cobra for my wife and 2 kids was like $850 a month. I could not have afforded that out of pocket. So I being a responsible family man went into the open market and found some cheap short term insurance. For about $200 a month we got coverage that wasn't exceptional but it would protect us for the three month period till I got onto my new employers insurance. Thank goodness I did because my 2 year old got an infection that hospitalized her for a few days. It still cost me a grand out of pocket but thats better than 8 grand and still less than cobra coverage. There are options out there. If you have no insurance it's your fault. There are options. You do what you have to do to or it doesn't get done.
You can't save the Earth unless You're willing to make other people sacrifice. Dogbert the Green Consultant summing up the elite left.
Control
August 24, 2007 - 09:23 ET by Sergeant ROCK...but I still do not believe it is not right to lose ones live savings because of something beyond their control.
Why then should I pay for theirs when their circumstances are beyond my control?
Kucinich/Paul '09
Tough luck? Not at all, I
August 24, 2007 - 09:34 ET by dscottTough luck? Not at all, I do believe in personal responsibility, that people need to take control of their lives and not just plop their problems at the doorstep of the tax payer just because they don't want to think for themselves. Yes, people do make poor choices at times and those choices have consequences. The problem with cleaning up the mistakes of others is that you 1. enable them to continue to make more poor choices and promote irresponsibility. 2. without suffering the consequences of stupidity or poor choices, people will never learn - that's the human condition. 3. Other people are not responsible (financially) to clean up after the mistakes someone else makes, 4. expecting/presuming other people to clean up after you financially is called theft not generousity.
Yes, there are hard luck cases, those people with the proper coaching and support will get back on their feet.
$500/month plans means you still have the other options of choosing a higher deductible to protect against catastrophic financial loss to lower the monthy premium. To these people I suggest exercising their options intelligently. It's called a cost benefit analysis that every responsible person has to make, that's part of being an adult.
Food vs Health insurance I believe is a false dichotomy when there are many options in life like cutting expenses, living within your means given the circumstances, everyone that is capable of working get a job to support the family since you sink or swim together, moving to another area of better paying employment opportunities, etc. The point being you are either a survivor or a victim. A survivor takes responsibility, a victim does not.
BTW- life savings are exactly for these situations. It's called contingency planning. If life were totally predictable, then we would all be rich, being able to know what the future holds means you can act accordingly to make it so.
The object of life is not to be on the side of the majority but to escape finding oneself in the ranks of the insane. Marcus Aurelius
}}---> Reality Shawn
August 21, 2007 - 08:19 ET by Cool ArrowThe reality is that those of us who are not fortunate enough to die a quick death will likely sign our houses over to pay to keep ourselves alive when our times come.
Our perception that health coverage is broken is due in large part to the fact that health care has improved dramatically.
85 is the new 60.
~LYDSEXICS UNTIE!~
What's the big deal over
August 20, 2007 - 11:25 ET byWhat's the big deal over "socialized" medicine? Aren't our police departments "socialized" protection and our fire departments the same? Our public schools are "socialized" education, and yet that doesn't seem to affect record numbers of students getting into college. Our highway systems are "socialized". Certain business and building practices are "socialized". Don't try to start a business without paying the government for a license or build a home or an addition without paying for a permit, the government will make you tear it down without their approval. Let everybody keep their private insurance and for those who can't afford basic health care, let the government provide it. Isn't the VA already "socialized" health care?
OK, Im going to assume your
August 20, 2007 - 12:00 ET by MindwerkzOK, Im going to assume your serious as I cant tell if this was supposed to be sarcastic. So on that note... every single item you mentioned is proof of an abject failure with the possible exception of fire departments, which are still under funded. The police forces exsist currently in a mildly ineffective state, stripped of their ability to function, I would agree that is a socolist ideal. Our school system, are you serious? Quite literaly the longer someone stays in school, the lower they score on global standards. Our current socolized school system is very good at making our children dumber and less educated than other industralized countries. The notion that there is more people in collage is very misleading. Not only is it increasingly easy to enroll, but the standards for education are decreasing radicaly. A collage diploma is the new high school diploma, its been so devalued by mass enrollment of unqualified persons that it means virtually nothing. As far as needing permits to build something on my own property... can you possibly think this is a good idea? I would say make sure it is up to code, which should be about safety standards, and be done with it. Dont fine me for developing my own land. The VA is a benefit for those who served in the military, and only free to disabled veterans over 30% rating, others still pay for visits, it is not "free universal health care" as some have said. In short, no, socolized anything is bad, and a step tword communisim which I shouldnt have to explain why thats a bad idea.
"Isn't the VA already
August 20, 2007 - 12:03 ET by ckc1227"Isn't the VA already "socialized" health care?"
Yep, and guess what? The VA rations drugs, and doesn't provide access to most of the newer, more advanced drugs that do a better job than the drugs they currently use.
"Let everybody keep their private insurance and for those who can't afford basic health care, let the government provide it."
You mean let me pay for it. But why stop there? Let's give them houses, food, cars, cable tv, internet access, spinner rims, a computer, guarantee them a job, etc.
It's not my responsibility to pay for your stuff. If you want it, get off your ass and earn it.
"It's not my responsibility
August 20, 2007 - 12:41 ET by"It's not my responsibility to pay for your stuff. If you want it, get off your ass and earn it."
Well fortunately, I happen to have great health care that is in part, subsidized by the state. I'm thinking more about the couple who are unemployed or have low wage jobs with no insurance and have a child with cancer.
"I'm thinking more about
August 20, 2007 - 14:48 ET by ckc1227"I'm thinking more about the couple who are unemployed or have low wage jobs with no insurance and have a child with cancer."
I sympathize folks in this situation, but, if they have low wage jobs that prevent them from affording health care for their child, why do they have a child? Instead of encouraging people to have children they can't afford, we should encourage them not to. Then perhaps they will have an incentive to better their lives so they can then have children that they can take care of.
Your solution also ignores a much more fair solution: charities, and non-profit health care sources. People in this country are very generous with their money, including myself. That's how it should be. No one should have their money taken from them against their will and given to another. If less money was taken by the government, more money would be available to be given to such charitable organizations.
Furthermore, if less money was taken by the government from people, they would have more money in their pockets to take care of themselves, and would need the government less. Ultimately, government can't put up with that. ;)
The big deal is that
August 20, 2007 - 12:04 ET by Jack BauerThe big deal is that government run, "socialist" healthcare systems don't work.
The rest of your questions can be answered with a "No."
See how easy that was?
VA is not socialized health
August 20, 2007 - 12:08 ET by bassndudeVA is not socialized health care. It is group health care provided by the goverment for veterans that have some disability from military service. Not ALL veterans can use the VA.
Save a SeAL, club a liberal!!
I guess working in the
August 20, 2007 - 12:21 ET by BruzillaI guess working in the health insurance field gives me a different take on this report. First, I noticed that the writer is quick to stress the point "Nice/The Government doesn't think that people are worth $5 a day!" Well, apparently their families don't think they're worth $5 a day either or they would be buying the drug themselves. And why aren't they? Probably because there isn't enough medical evidence to show the drug is effective enough to spend you own $5 a day on, but there's more than enough to justify the government spending "its" $5 a day.
Also notice that there is no mention of alternative medications that are covered by Nice, only that this new drug isn't covered. Most likely Nice already cover several drugs that have similar or the same benefits, but none of those are mentioned. The implication is that this new "miracle" drug does something no ther drug can do, which isn't the case.
This article reads like any number of similar pieces I've read that have their origins in the Communications department of some drug company, and get lightly changed by some reporter and sent out as news. I think before we condemn Nice it would be nice to get all the facts and not just those that fit the storyline.
That might be possible,
August 20, 2007 - 13:02 ET by dscottThat might be possible, however, given my family member's experience with dementia, these drugs only work for a limited period of time during the EARLY stages with diminishing efficacy after a year or two. Once past the early stage, there is no treatment other than marking time by making the person as comfortable as possible. So basically NICE is incompetent in prescribing these drugs in the later stages as it is too little too late by that point. It's a horrible disease, I wouldn't even wish it on a lib.
There some tantilizing experimental avenues such as adult stem cell therapy (make new brain cells) and viagra (increase blood flow to the brain). But at this time there are no experimental trials that I know of.
The object of life is not to be on the side of the majority but to escape finding oneself in the ranks of the insane. Marcus Aurelius
It May Be
August 20, 2007 - 13:12 ET by Tom BlumerIt may be that in the UK they are not ALLOWED to buy the drug even with their own money, either because such a transaction might be totally prohibited, OR because if it's not approved for a given use, it's considered inappropriate or dangerous, and therefore no one is allowed to sell it.
Someone more familiar with the disaster that is the NHS will have to fill in those blanks.
Besides, the promise of nationalized health care was/is that the state will take care of you, and that it would be "free." With taxes so high, it's little wonder that families might have a tough time scraping together $150 or so a month for one drug. And what are "the poor" over whom so much false compassion is expressed supposed to do?
In fact,Bruzilla, what you're telling these families is "You're on your own." Meanwhile, too many of our politicians are telling us that socialist nirvana health care systems will put an end to that.
Tom, I think you bring an
August 20, 2007 - 13:26 ET by BruzillaIt was my understanding that NHS is a minimum level of service, but if you want to buy additional service there are plenty of private venders and insurers you can deal with.
I think you bring an important element of the discussion to light, that being that people tend to see a black & white situation: you have my position, which is "you're on your own", or your's that the government should help out. How about we look at a third view, which is the actual one I have, which is let the markets drive the use of drugs? What would happen if this drug company's media blitz fails to spur Nice into covering the drug, and the drug is too expensive for people to afford? Is the company going to go out of business, or is it going to lower the price of the drug to a point where people can afford it? As soon as Nice gets involved, the price will never go down and will likely go up. If Nice says no, and people say "too much", the price will come down. That's how you handle drug costs, and that's why Medicare Part D works so well.
It was my understanding that
August 20, 2007 - 21:07 ET by Tom BlumerIt was my understanding that NHS is a minimum level of service, but if you want to buy additional service there are plenty of private venders and insurers you can deal with.
If it is as you describe it, the British system has devolved to being LESS "fair" than ours. The vast majority can't get needed but "too costly" treatments, while only the very well-to-do can afford to pay for and decide what they need. Not exactly what the true believers in socialized medicine envisioned. I suspect their answer would be to totally eliminate the private sector and make everyone equally miserable.
As to the relevance to Med D, I don't get the connection, because I don't think prices came down as much as utilization wasn't as much as was expected. But I haven't studied Med D much, except to know that it's costing less than anticipated -- pretty unusual for any government program.
I Don't Agree
August 21, 2007 - 13:14 ET by stratmanDrug companies typically lower drug prices due to competition and not because a fewer subset of patients requirie the medication.
Certain rare disease medication treatments remain expensive because fewer people require them than, say, Amoxicillin for strept throat. The pharma's are interested in a return for their efforts. If fewer people are buying their drugs due to competition from another manufacturer's brand then a price drop will occur (all things being equal, particularly efficacy and safety). If fewer people are buying the drug because fewer people need the drug then little or no price drop should be expected.
Medicare D is an example of more competition with the same pool/number of patients. NICE refusing to dispense cholinesterase inhibitors for Mild AD results in a lesser pool/number of patients, not from increased competition for brand choice.
Supply and demand are at play but not in the full sense you confer or infer.
Killing them with kindness isn't working. Time to get scrappy with the Donkeys.
Interesting counterpoints,
August 20, 2007 - 13:43 ET by maggieqpublicInteresting counterpoints, Bruzilla. Any chance you know what percentage of U.S. private insurance plans cover Aricept for the early stages of Alzheimers?
Depending on where the facts fall, this is the kind of story that could be used effectively in a political campaign... short, simple and many American voters have some first-hand experience with Alzheimers (and many others fear that they will in the future). If socialized medicine were to restrict access to an effective treatment for early Alzheimers, the voters might not be interested.
Anyone who wants to
August 20, 2007 - 14:00 ET by BruzillaAnyone who wants to seriously fix American healthcare need only do one thing: get people back to paying for their own services. Get rid of health insurance except for Medicare/Medicaid, and implement means testing for both of those plans. Once you get the shared risk (and expense) issue out of the way, and force providers to lower costs to where people can afford them and compete for business based on quality and price, then the system will be fixed.
Look at laser eye correction. Insurance wouldn't pay for it, and at $3,000 an eye most people couldn't afford it. So the providers had to decrease costs to get people in the door. Then, with no issues of participating providers or coverage options, providers had to compete with other providers by investing in the latest technolgies, offering the best customer service, managing costs... just like most other businesses. So we've gone from decent service to excellent service, and from $3,000 an eye to well under $1,000 for both eyes.
Now look at the other side: my daughter supports a group of home heathcare nurses. These gals work about 20 hours a week, and their duties are mainly checking on patients in their homes and checking their vitals, and if anything major is going on they get them sent to the hospital. A fairly low level of service, and these are usually inexperienced people who don't have the experience to get picked up by a hospital. Their pay: the lowest paid nurse makes about $75,000 a year, and the highest paid make well over $100,000 a year. Why so much for so little? because most patients don't know or care how much it's costing because they aren't paying for it. They may see that an hour of a nurses time casts $300-$400, and they don't care because they don't see that money as coming from them... they see that their insurance is paying it, or Medicare. If people had to pay for that hour out of their own pocket, the rate would drop by 90% at least.
Ah, I like your
August 20, 2007 - 14:16 ET by dscottAh, I like your example but you missed one critical piece of the puzzle, that being sued. Laser correction is an optional treatment (not covered by insurance) and as such you can't sue the laser people for screwing up to blind you or not improving your eyesight. Lawsuits add billions of dollars to health care costs in this country. Vastly restrict the lawsuits and you reduce the cost of health care for everyone. Remember, malpractice insurance is a major cost to health care providers and then comes the lawsuit on top, all this must be charged to in the medical bill. The John Edwards' of the world have their 28,000 square foot homes to build and maintain, so everyone of us has to pay more to maintain John Edwards in the lifestyle he is accustomed to. Until we find a fair method of reimbursing those who are harmed by medical care when it is poorly delivered we will all pay way more than necessary. Will their be lawsuits under nationalized health care????? Is the government going to allow itself to be sued when it dictates the treatments given to the patients via the rules under such a plan???? How do the Brits handle lawsuits?
The object of life is not to be on the side of the majority but to escape finding oneself in the ranks of the insane. Marcus Aurelius
What! Who told you you
August 20, 2007 - 14:36 ET by BruzillaWhat! Who told you you can't sue a laser correction provider for malpractice!!! That's not the case. You can sue any professional for malpractice... pharmacists, lawyers, shrinks, etc. Also, the only folks who are saying "get rid of lawsuits and the price of healthcare will go down" are doctors. The cost of healthcare will not go down, and for exactly the reason I stated above, that being people will not shop for healthcare, so there's no reason for providers to lower their costs.
For example, Dr. Smith pays $2,000 a month in malpractice insurance. He charges $500 to treat a broken arm because that's what the insurer will pay. A change to the law means that Dr. Smith is liable for $50,000 in damages for malpractice, and his insurance rate drops to $500 a month. What do you think Dr. Smith is going to do? Lower the cost he bill the insurers by $100 to pass the savings back; or B: Keep charging what the insurer is willing to pay and be thankful he's making an extra $1,500 bucks, which he justifies is due him after paying all that money in insurance? My guess, having worked with providers, is 99.9% would choose option B.
When was the last time you walked into your family physician's office and asked "Doc, how much are you paying a month in malpractice insurance, what percentage of the fee for service my insurer and I are paying for this service will go to cover that insurance, and how do your prices stack up against those of other doctors?" If you're like 99.99% of people your answer is "never". Since there are no set costs for service, there is no way for patients to know what they're paying for. If malpractice insurance premiums drop, the doctors will just find another way to justify the same costs.
Actually, I over stated by
August 20, 2007 - 14:59 ET by dscottActually, I over stated by over simplifying, essentially you are correct you can sue anybody for anything, however on an optional or elective procedure there are different standards of liability which include your choice of having the procedure done and by whom. A doctor or clinic has to really, really screw up as in gross negligence to pay any amount of money. Hence lawsuits against those who practice medicine for elective procedures don't deal with the massive moneitary awards that regular health care providers do. This info. comes from people who litigate in personal injury.
The object of life is not to be on the side of the majority but to escape finding oneself in the ranks of the insane. Marcus Aurelius
"Also, the only folks who
August 20, 2007 - 15:04 ET by ckc1227"Also, the only folks who are saying "get rid of lawsuits and the price
of healthcare will go down" are doctors. The cost of healthcare will
not go down, and for exactly the reason I stated above, that being
people will not shop for healthcare, so there's no reason for providers
to lower their costs."
Getting rid of lawsuits isn't the only solution, but it should be part of the solution, combined with your other suggestions.
But it will never happen. The last thing government wants, especially a democrat-run government, is a nation of self-reliant individuals.
Facts Not In Order
August 21, 2007 - 20:37 ET by stratman"Also, the only folks who are saying "get rid of lawsuits and the price of healthcare will go down" are doctors...".
Umm, a variety of people on NB have said this and I don't think most of them are doctor's.
"Doc, how much are you paying a month in malpractice insurance, what percentage of the fee for service my insurer and I are paying for this service will go to cover that insurance, and how do your prices stack up against those of other doctors?"
A typical primary care physician pays $35,000 or more per year in my area. That is equal to about 15-23% of his gross pay before taxes. An OB/GYN pays $200,000 or more per year. Neurosurgeon up to double the OB/GYN. How much are you paying for your insurance and what percentage is it of your gross income? Even more important from a legal point of view, physician's are not allowed by law to enquire into or pool data with other physician's. You can purchase aggregate data from Medical Group Management Association (MGMA), which is helpful in setting a fee schedule inititially when building a practice or offereing new services. Also, primary care doctors can ask for $200 for a typical ofice visit but insurer's will only pay the discounted contracted amount. In general, your question for the doctor is rude and argumentative. Do you get people asking you how much of their premium goes towards paying your salary? If you're unhappy then go somewhere else.
I am not going to argue about whether a doctor will decrease fees to patients or insurers if medical malpractice decreases. Some will make as much money as possible, but not everyone. Not as an excuse, but, no vendor, utility company , landlord or consumer service/good purchased by the doctor is going to decrease either. What I believe will happen will be more time spent with patients per visit, something most desired by both patients and doctors. When reimbursements decreased and costs continued to rise, doctor's needed to see more patients in the same space of time, or offer ancillary services, in order to break even. If doctors are able to earn the same amount of money seeing fewer patient's in the same space of time, then more time will be spent with each individual patient where needed without fear of losing money.
"Since there are no set costs for service, there is no way for patients to know what they're paying for."
Wrong. There are set costs for services. If there is insurance, then the insurer is in the driver's seat, regardless of what the physician demands, and controls all fees, collections (except POS co-pays though the insurer mandates it be done) and reimbursements. Patients can get a detailed explanation of benefits from their insurer. Patients can also enquire into fees with their physician, but, the contracts from insurers constrain what the physician can tell a patient.
The freshman mistakes you have made regarding what insurers and physicians can and cannot do lead me to believe you are either way down the ladder in the insurance business or are pretending to be something you are not.
Killing them with kindness isn't working. Time to get scrappy with the Donkeys.
You deride Edwards for his
August 20, 2007 - 15:25 ET byYou deride Edwards for his wealth, but Mitt Romney has multiple homes and is worth over $200 million.
Lawyers make money. Get over it. If you don't like it, go to law school and see what it takes to be one.
False
August 20, 2007 - 15:50 ET by dscottFalse equivalence:
Romney was a corporate lawyer not an ambulance chaser like Edwards.
Wrong, I don't deride Edwards "for" his wealth, I mock Edwards on "how" he got his wealth as a leech upon society.
Attorney.
Management Consulting Firm Executive, 1978-84.
Venture Capital Investment Firm Founder & Executive, 1984-2002.
President and CEO, Salt Lake Organizing Committee (2002 SLC Winter Olympics), 1999-2002.
http://www.politics1.com/p2008-romney.htm
The object of life is not to be on the side of the majority but to escape finding oneself in the ranks of the insane. Marcus Aurelius
"Romney was a corporate
August 20, 2007 - 16:35 ET by"Romney was a corporate lawyer"
Which makes Romney worse. Edwards fought for the little guy and went against the corporate machine.
Read his case about the faulty pool drain that disemboweled a little girl and then call him an ambulance chaser.
blaster comes through again
August 20, 2007 - 16:52 ET by RJby ignoring the entire argument made by another poster, blaster "wins" again.
I despair of ever reaching his exalted level in debate skills.....
What exactly was the entire
August 20, 2007 - 17:01 ET byWhat exactly was the entire arguement? Did I miss something pertinent further up the thread?
Don't worry your pretty little head, blaster
August 20, 2007 - 17:06 ET by RJThere were quite a few, and well thought out, but don't worry about it. You made your own brilliant point. You, blaster, are the KING of the non-sequitur argument!
I despair at ever matching your brilliant debate skills.....
Man RJ--you really ought to
August 20, 2007 - 17:16 ET byMan RJ--you really ought to do something for your depression. Go out to a coffeeshop and talk to the locals, take a walk in the park and if that fails, I suggest you just drink yourself into a coma!
It's boredom, blaster
August 20, 2007 - 17:19 ET by RJ...not depression....and your posts don't help at all.
...not at all.
Well RJ, that's why I don't
August 20, 2007 - 18:52 ET by dscottWell RJ, that's why I don't respond after an evasive non sequitor response, it's a pointless waste of time. I've made my point by refuting the false equivalence, Romney is a corporate lawyer, general practice, nothing his the ciriculum vitae indicates he was fleecing the public in some unscrupulous manner and to infer it as blaster did is sheer unfounded assertion. Edwards is no champion of the public, he fleeced the medical community to help himself and he certainly wasn't defending the public against the likes of Romney.
BTW- I am no supporter of Romney, he won't be getting my vote for the Repub nomination.
The object of life is not to be on the side of the majority but to escape finding oneself in the ranks of the insane. Marcus Aurelius
Hillary Clinton was a
August 20, 2007 - 19:01 ET by Jack BauerHillary Clinton was a corporate lawyer at the Rose Law firm.
All she represented were the likes of Dupont, the state of Arkansas and Coca Cola against the "little guy."
What's your point? That a corporate lawyer shouldn't be President?
"Anyone who wants to
August 20, 2007 - 14:20 ET by"Anyone who wants to seriously fix American healthcare need only do one thing: get people back to paying for their own services."
...and let them eat cake. Hope you never get in a car accident and have any head trauma or need surgery for internal bleeding, or need extensive rehab therapy.
Tell me... before medical
August 20, 2007 - 14:48 ET by BruzillaTell me... before medical insurance became a virtual entitlement in the 1950s and 1960s, how did people in auto accidents or with head trauma receive medical treatment? They weren't let to die, and they didn't have insurance, so how did they get treated? They got treated because providers priced their services so that the average person could afford them. It was not a given then that doctors had to be making multiple six-figure salaries, or nurses had to be raking in big bucks.
Then along comes the "deep pockets" of medical insurance, and medical professionals siezed the opportunity to get rich. Before insurance, doctors used to post or advertise their prices, after insurance... try finding a doctor who discusses rates and fees up front. We tried to develop a database of how much providers charge for services, and we were told by the providers to stop immediately or they would cancel their contracts with us.
I think we should let the providers eat cake. If you want to charge $10,000 for 30 minutes worth of your time, $25 worth of supplies, and $50 in overhead costs, fine. See how many people line up to get your services when the guy next door will do it for $3,999, and the guy after that for $999. When medical services are paid for out-of-pocket, the providers will either have to charge much less or go out of business. If you do what the Dems want to do, and open the immensely deep, tax-payer funded, pockets of Uncle Sam, prices are going to do nothing but go up, and up, and up, and up...
"If you do what the Dems
August 20, 2007 - 14:56 ET by ckc1227"If you do what the Dems want to do, and open
the immensely deep, tax-payer funded, pockets of Uncle Sam, prices are
going to do nothing but go up, and up, and up, and up..."
And the supply of medical services is going to go down, down, down....
When you're bleeding and
August 20, 2007 - 15:06 ET byWhen you're bleeding and possibly dying, you don't have a lot of time to doctor shop. It use to be if you were uninsured, you could always file backruptcy, but not anymore. Go visit an emergency room on a Saturday night and see what doctors and nurses do to keep people alive and tell me you could go get that done on any street corner. And if someday you're lying in a pool of your own blood on a highway somewhere waiting for help, be thankful that you have health insurance, if you don't then you better have a very high limit on your credit card.
"And if someday you're
August 20, 2007 - 15:24 ET by ckc1227"And if someday you're lying in a pool of your own blood on a highway
somewhere waiting for help, be thankful that you have health insurance,
if you don't then you better have a very high limit on your credit card."
Well, if people can borrow money to drive cars that they can't really afford, why can't they borrow it for health care? If it were me, I wouldn't hesitate to borrow money to pay for life saving surgery. Sure, it's not quite as important as a flashy new ride with some spiffy spinners, but I'd still take out the loan. What can I say, I like living more than driving.
Besides, last time I checked, many hospitals offer VERY generous repayment options for those without health insurance, at least in my experience. But the bottom line is, for whatever reason, you just don't think people should have to pay for their healthcare. You believe someone else should have to pay for it.
By the way, isn't emergency care needed as a result of car accidents covered by auto insurance, and should government pay for the auto insurance of poor people?
Time to move out of the
August 20, 2007 - 15:36 ET byTime to move out of the folks basement and get a job and your own apartment.
Well, blaster,
August 20, 2007 - 15:55 ET by RJwith fine, intelligent comments like that, how can anyone hope to defeat you in debate?
I despair, I tell you....despair.
Come on RJ--has this guy
August 20, 2007 - 16:36 ET byCome on RJ--has this guy ever paid for auto insurance in his life?
I don't know, blaster
August 20, 2007 - 16:46 ET by RJ..but neither do you, I think. He (like my daughter) could live in NYC and have no car and no idea of what is covered in an auto policy. For that matter, I'd guess that most young people have little idea about auto insurance coverage.
But that's just my poor look at some of life's circumstances. Your posts are so brilliant, I despair...
Don't despair RJ. If it
August 20, 2007 - 17:13 ET byDon't despair RJ. If it makes you feel any better, I pay for insurance on four vehicles.
Thank you for excellent
August 20, 2007 - 23:13 ET by maggieqpublicThank you for excellent arguments from the inside, Bruzilla. This won't be settled soon.
Because of pending healthcare legislation in California, we are seeing television advertisements for both sides, and we are receiving emails and mass mailings from our insurance carrier, Blue Cross of California. Funny, neither side is adopting your point-of-view!!
Not Exactly
August 21, 2007 - 22:58 ET by stratman"Tell me... before medical insurance became a virtual entitlement in the 1950s and 1960s, how did people in auto accidents or with head trauma receive medical treatment? They weren't let to die, and they didn't have insurance, so how did they get treated? They got treated because providers priced their services so that the average person could afford them. It was not a given then that doctors had to be making multiple six-figure salaries, or nurses had to be raking in big bucks."
Doctors then and now provide charity and reduced fee care. Let's see you neighborhod grocery store or insurance company do it at all or to the extent of physicians in general. (Always a greedy doc or a generous grocer. Have yet to hear of an insurer giving charity rates to clients.)
Patients, years ago, also realized that certain medical care was outside the finances they possessed and beared the responsibilty of their own calamity. Medical care was still somewhat a blessing than an "entitlement" as you mentioned.
For those unable to pay their bills, the poorhouse was a real possibility. The emergence of Workman's Compensation, Unemployment and Social Security in the early 20th Century supplanted the need/use of poorhouses. Would you like to go back to poorhouses as a way to deal with debtors? How about debtor prisons? That would be a return to years past methodology. BTW, nursing homes, county and state hospitals and orphanages were the spawn of poorhouses and remain with us today.
Lastly, doctors have always made a good buck in proportion to the general population. Nowadays, the general population appears to be catching up a bit, though the difference is still signifigant. I don't know how you can defend that the doctor's education level and responsibilities should be compensated on par with a skilled laborer or an insurance salesman. I guess if you believe in communism or relativism then one could see all things are equal.
"Then along comes the "deep pockets" of medical insurance, and medical professionals siezed the opportunity to get rich."
Agree, though I would qualify it as "richer". The cash cow looked so inviting that doctors invested in the upstart Blue Cross and Blue Shield businesses. Doctors could set their fee schedules and the insurance companies paid them their asking price (in general). This was known as the Golden Age of medicine by some older doctors. Unbridled fee reimbursement was a crash and burn policy, and rightly so. All this began to change with the advent of not-for-profit Kaiser on the West coast, followed by DRG's (in which the Gubmint paid a set amount per diagnosis of hospitalized patients, ie, the hospital no longer was paid what they asked for) in 1983, and culminated in the the CPT and E/M codes developed for out of hospital medical charges and which form the basis of coding and reimbursement for physicians today. But of course you knew that already being in the insurance biz.
"Before insurance, doctors used to post or advertise their prices, after insurance..."
I never saw that once! Professionals do not post fees like a grocery store or a greasy spoon's specials of the day. You probably can find examples, but it was not customary by any stretch of the imagination. Interestingly, I have read of a doctor in the magazine Medical Economics who has gone back to straight fee for service, no insurance, and he posts his fees on a board in the waiting room. He is making less money but he is happier overall.
"... try finding a doctor who discusses rates and fees up front. We tried to develop a database of how much providers charge for services, and we were told by the providers to stop immediately or they would cancel their contracts with us."
Not exactly. Doctors may be contracturally constrained from discussing fee schedules with patients. It would be a violation, for instance, to tell you what a doctor receives for a service by another insurer. He may be restricted from discussing the fee schedule of the patient's own insurer. The doctor probably can tell you what the self pay fee schedule is but not necessarily the discounted fee structures. If the doctor is an employee, chances are he has no clue about or can't remember the discount fee schedule for every insurer, though he may know who pays well and who are the dogs.
Insurers already know MGMA aggregate physician fee structures. Insurers also know what physicians would like to be reimbursed by the fee schedule physicians submit when requesting an adjustment to the reimbursement model contracted. Insurers also have compiled years of actual and aggregate data over years. Insurers do not suffer from a lack of data. Besides, insurers asking for more data is only for the benefit of the insurer - a further money grab.
I had to laugh at you comment about doctor's threatening to cancel their contracts! Unless the insurer does something so egregious to allow a physician to drop the contract, there will be no "cancelling" by physicians. You obviously have not heard of the legal term "severability". It's in contracts for the protection of the company. Look it up. While I'd like to think you must work for a dirtbag of an insurance company, I can not. Too many of them try or actually get away with shenanigans like you mentioned.
"I think we should let the providers eat cake. If you want to charge $10,000 for 30 minutes worth of your time, $25 worth of supplies, and $50 in overhead costs, fine. See how many people line up to get your services when the guy next door will do it for $3,999, and the guy after that for $999."
Wow. You just described every vendor to medical practices. Nothing like being forced to pay $5000 for 3 dell computers (no dual core or core2duo), then being squeezed for installation, training and ridiculously expensive maintenance/help/upgrade contracts on top of the initial computer cost.
"When medical services are paid for out-of-pocket, the providers will either have to charge much less or go out of business."
As I said in a previous post, there are more than enough patients for doctors to still earn a good salary if insurance companies were to be expunged from the planet tomorrow. The only way doctors are going to go "out of business" would be if the system reimburses less than that individual doctor requires financially. I don't think you want doctors retiring in droves. Implement a socialized medicine model similar to England's or , God forbid, Cuba's where physician salaries are anything but "professional" and you will see doctors retiring to make money elsewhere. Rural areas will have even more difficulty attracting physicians and there will be a dramatic influx of foreign born, foreign trained physicians. Who will treat you then? Nurse practitioners, physician assistants, midwives or pharmacists? Whom will they turn too when difficulties arise? I respect and admirer NP's, PA's, Midwives and Pharmacists. Like nurses, good one's are worth their weight in gold... especially a good nurse! They just are not replacements for physicians.
finally, I do agree with you that the Democrat envisioned socialized medicine scenario will end up costing taxpayers more than the current situation. Services and goods will also be rationed greater as well.
Killing them with kindness isn't working. Time to get scrappy with the Donkeys.
Yes and No
August 21, 2007 - 19:46 ET by stratmanI do agree that one way to fix some of the problems in health care economics would be to remove insurance from the equation. Unfortunately, patient's still will have certain expectations and the realities of their incomes versus the cost of care is going to be a freighttrain heading square at the damsel in distress tied to the tracks. Will people return to a pre-1960 medical mindset? Will anything revert to days past? No. Prior to the days of widespread medical insurance, much less was available as options for diagnosis and treatment of disease processes and injuries. Maybe it was a religious and/or socio-economic mindset of American's in days past such that results expectations were tempered, death and imperfections in health more accepted than it is today, and running to an attorney was not something on the tips of everyone's tongue. That mindset can still be found in this country but is more likely in older people and those immigrated from other countries. American's expect everything to be done and that outcomes are exceedingly positive.
To some extent, the cultural expectations are a result of physicians' allowing and nurturing a place on the ego pedestal. Concurrently, problems arise when laypeople or attorneys attempt to devalue physicians' honestly earned position as a professional both intellectually and economically.
There are more than enough patients such that doctors will not be forced to drastically reduce rates as you suggest. Since I imagine every other business entity will not be reducing their fees for goods and services, unless you are suggesting some sort of socialistic or communistic fantasy, physicians will need to still keep charges at a point where bills can be paid and livelyhoods can be made. If you think paying 33% of a settlement to an attorney seems like a lot, how much is your life, ie not dying, worth to you? I don't see plumbers and electricians and carpenters reducing their fees. Are they more important to you than your doctor? (When my pipes backed up because of tree roots, you bet that plumber and plasterer were damn important)
Your example of laser eye surgery is a poor example of health care in general and market forces. Lasik is a boutique industry theat preys upon the capricious and vain whims of its clientele. Similar to most elective plastic surgery, Lasik is unnecessary for one's health and productivity. If ever there was an argument in favor of the bean counters in the insurance business it would be Lasik. The answer is simple, inexpensive and has no known physiological side effects -- wear glasses! Since the surgery is completely or near completely vanity driven, more and more fast buck charlie's are getting in on the cash-only cow, of course market forces of competition work to decrease prices. But, I can guarantee you that if one group had significantly better outcomes that they would not lower the price, at least as much.
Now compare that with treatment for hypertension, diabetes, cardivascular disease, asthma, etc.. These are illnesses that are not "boutique" or ego driven. These illnesses cause real morbidity and mortality. (When was the last time someone died or became ill because they didn't get Lasik?) Failure to manage these illness can cause real financial and emotional hardship for the patient as well as financial issues for businesses where these people are employed or covered, physicians and hospitals, insurers, US government and US taxpayers.
Returning back to a fee for service environment, to which I am not opposed, will have some inducement for people to restrain their utilization of health care because of the more direct connection of paying for your doctor care directly. But it probably will not improve disease management or decrease Medicare/Medicaid costs. People do what they will do. In fact, having to pay fully at the time of service may inhibit some from going to the doctor. So, it's six of one, half a dozen of the other.
As to your comments about inexperienced home healthcare "nurses" working 20 hrs per week and making $75K --- Bull! Either you are very wrong, this is an outlier in the industry or you are not telling us everything. I don't know a hospital that isn't looking for RN's. Is "inexperienced" a code word for an illegal, legal foreign import, a Medical Assistant or someone off the street taught by the outfit to record vitals? Using your figures, the "nurse" is making $78 per hour in a 48 week work year. Physicians do not earn that much per hour doing home health visits working for a service. I know because I have spoken personally with two owners/managers of one of these services in my town.
Additionally, it is an insurer, Medicare typically though a private insurer may be a co-reimburser, that pays for those home visits and you can be darned well certain the insurer knows what the going rate is. As someone in the insurance business you should know that it is the Insurer that sets the fee schedule, not the doctor. Doctors can ask whatever they want for reimbursement, but, the insurer reimburses only what they want to, when they want to , and how they want to.
Why don't Health Care Insurance business refuse to pay the "$300-400" per hour fees for an unskilled visiting "nurse"? Even the US government figured out how to stop paying for $600 toilet seats and hammers. When will insurers use a universal form which would reduce costs and improve efficiencies? When will insurers stop bundling and downcoding of appropriate charges? When will insurers stop hiding behing the Federal Government concerning monopolistic behaviour? (Yep. Health Care Insurers can not be sued in Federal Court for monopoly violation since the Feds singled them out as a protected industry following WWII.) When will insurers stop attempting to rewrite contracts on the backend in a money grab or comply promptly with their own contracts on the front end consistently? When will insurers stop the mobster-like practice of "holdbacks" on money rightfully earned by physicians? When will insurers detail precisely why a reimbursement claim was kicked back so that corrections can be made successfully and quickly? When will insurers stop making medical decisions, such as denial of care, yet continue to claim they are not?
I've more questions but that is as good a place to begin as any.
Killing them with kindness isn't working. Time to get scrappy with the Donkeys.
Alzheimer's Disease Tratment
August 21, 2007 - 13:04 ET by stratmanAricept is not a "new" drug per se. It was approved for mild to moderate Alzheimer's Disease (AD) in 1996 in the US and then approved for severe AD in 2006. Aricept was approved for use in England in 1997.
A report was presented in England in 2006 on the efficacy and economy of Aricept and other medications for AD. This multiyear prospective and retrospective study (actually studies) found conflicting results from which the decision was made to exclude Aricept from formulary for mild AD treatment.
Aricept is not a miracle drug. Nothing cures AD. Aricept is very well tolerated by patients for its class of medicine (cholinesterase inhibitors) all things being equal. Aricept and other cholinesterase inhibitors work by preventing the breakdown in acetylcholine, a neurotransmitter in the brain that is found in decreased amounts in AD patients as compared to "normals". The medicine keeps a larger pool of acetylcholine available for the brain's neurons to use, theoretically aiding in improved brain functioning by helping the dwindling number of neurons to function better, simplistically speaking. Unfortunately, the continued destruction of neurons eventually overwhelms the effects of the medication and the person deteriorates into the demented state they would be even if they had never taken the drug.
There are other medications used for AD, and all are for palliation of the disease and its symptoms, not cure. Agitation, combativeness, anxiety and depression are treated by pyschoactive drugs including antipsychotics, anxiolytics and antidepressants, none of which affect the underlying disease process. The newest class of medications for AD is represented by Namenda, a N-methyl-D-aspartate (NMDA) antagonists, which can be used with drugs like Aricept to hopefully result in a positive synergistic effect. Nonsteroidal anti-inflammatory drugs have been postulated to modify the disease process, though more research is necessary. Vitamin E, a free radical scavenger, also postulated but requires more data. Estrogent agonists and specific anitbiotic are aslo postulated.
It is important to know what Aricept can and can not do. First it is a temporizer - AD will progress and the person will eventually be as demented as they were even if they never took the drug. Some people improve their cognitive functioning on the drug, some remain neutral and some have zero benefit and continue to express the progressive dysfunction of the disease. Like any drug, not everyone responds well.
What isn't represented in either the article nor any of the posts here on NB is what Aricept does do that is significant. Aricept may or may not provide a boost in cognitive functioning. But it can reasonably maintain the current level of cognitive functioning in the AD patient until the drug's effects are extinguished by overwhelming neuronal loss (once again simplistically speaking).
What's the big deal about that? Let's say you have mild AD and start the medication. If you are a responder then at the very least you will maintain the dysfunction of mild AD longer than if you didn't take the drug. If you start the drug when at the moderate stage, and you are a responder, then you will at least maintain the dysfunction of moderate AD before slipping into the twilight of severe dementia. Simple put, the drug maintains your current level of functioning longer than without the drug. The patient then has more time to take care of affairs and enjoy life, family and friends longer than without the medication.
The British, by withholding the dispensing of Aricept until the moderate form of AD is diagnosed, virtually guarantees that their less economically abled citizens will have missed the opportunity to live for months to up to nearly a couple of years with improved functioning, decreased morbidity (illness), and, less strain on family, health care workers and health care dollars (even though NICE and the judge did not see it that way).
Although the case ruled in England concerned Aricept, NICE has declared than NONE of the cholinesterase inhibitor drugs, including Aricept, may be dispensed prior to a diagnosis of Moderate AD. Namenda is not even considered for use until Severe AD is diagnosed, and a final verdict by NICE is still pending.
Killing them with kindness isn't working. Time to get scrappy with the Donkeys.
Tip of the iceberg
August 20, 2007 - 13:18 ET by roconnellThats just the tip of the iceberg...2 weeks of newspaper stories
Six month waits for critical care
http://news.scotsman.com/health.cfm?id=1296862007
Lack of Care
http://news.bbc.co.uk/2/hi/health/6950259.stm
Doctors ordered when to work
http://www.timesonline.co.uk/tol/news/uk/article2289417.ece
Lack of Dentists
http://www.wigantoday.net/wigan-news?articleid=3123805
What the British just now learned
http://www.timesonline.co.uk/tol/news/uk/article2289277.ece
hospitals closing?
http://www.inthenews.co.uk/news/politics/politics/tories-plan-save-hospitals-$1124867.htm
cut backs
http://www.sundaymirror.co.uk/news/sunday/2007/08/19/5-500-new-nurses-no-jobs-to-go-to-98487-19658134/
Midwife care
http://www.greenocktelegraph.co.uk/article.php?sec=1&id=9187
Wait times
http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20070817/cma_chief_070817/20070817?hub=Health
Wait times
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2007/08/12/ncancer112.xml
Wait times
http://www.thisissouthwales.co.uk/displayNode.jsp?nodeId=161366&command=displayContent&sourceNode=161855&contentPK=18101686&folderPk=88503&pNodeId=161846
Wait times
http://news.independent.co.uk/health/article2814751.ece
Wait times
http://www.mirror.co.uk/news/topstories/2007/07/30/beg-pardon-89520-19540932/
roconnell aka climate change skeptic
http://climatechangeskeptic.blogspot.com/
"Six month waits for
August 20, 2007 - 13:34 ET by"Six month waits for critical care"
They won't take your money?
They won't take your money?
August 20, 2007 - 13:43 ET by roconnellIf you have it you can always go private healthcare..if you have it, so only the rich in England enjoy 'good' healthcare.
roconnell aka climate change skeptic
http://climatechangeskeptic.blogspot.com/
But isn't that the problem,
August 20, 2007 - 14:03 ET by dscottBut isn't that the problem, the British have become conditioned to believe outside of government run health care there isn't any alternative? They have been conditioned by the nanny state to believe the government is the end all be all to solving all problems. Hence, the idea of even offering money in exchange for medical service is an alien concept that no longer occurs to them. Add to that, the Brits are taxed on so many levels for their Socialism that the whole entitlement mentality has taken hold, after all they paid for the service, why should they pay out of pocket for that which they already paid for in taxes???? It's like paying for health insurance only to get nothing and then pay out of pocket for what they should have covered. It's the Socialist vicious cycle of circular reasoning that locks them into the death grip.
The object of life is not to be on the side of the majority but to escape finding oneself in the ranks of the insane. Marcus Aurelius
The Wisconsin experiment.
August 20, 2007 - 15:07 ET by ckc1227The Wisconsin experiment. One to keep an eye on.
http://www.realclearpolitics.com/articles/2007/08/let_wisconsin_experiment_with.html
http://www.opinionjournal.com/editorial/feature.html?id=110010374
TWC
August 24, 2007 - 22:28 ET by shawn228TWC, I put my reponse down here for both you Dscott caus I, hate the skinny thing
I hope all is well and it is good to hear from you. You have done a great job as a father by making sure everybody in your family was covered by medical insurance, and I am glad your daughter is doing okay.
I believe the type of policy you got was short term medical policy. They usually cover an individual and his family for about a year that is paid usually paid in one month increments.
I am assuming that everyone in your family was healthy at the time you purchased this policy because most of the times they do not cover pre existing conditions. You have to be extremely honest filling out that application for you could end up having a claim denied.
"Knock on wood" If someone in your family needed something like dyalisis before you changed jobs, the short term medical would not have covered you. You would not have had a choice but to pay the COBRA premium of $850.00 a month. Now you might be a person that has money in the bank that has saved for a rainy day, or you can borrow from friends from your church, but some folks live paycheck to paycheck and have to pay rent and buy food and there is nothing left over to pay the medical bills.
dscott
August 24, 2007 - 22:16 ET by shawn228Like my post to TWC above, I believe that there are many Americans that live paycheck to paycheck.There are some serious deadbeats in this country, but some are just trying to make ends meet for them and their family.
You said you don't believe in the food or medical insurance choice. Well if a person does not want their family to be homeless and begging from change on the street, they have to put food on the table and pay the rent right? These are necesary needs to survive. Just like maslowes hierchy of needs you need food and shelter first right? If everybody that did not have health insurance are deadbeats, I would tend to agree with you, but many people lose everything along with their dignity because of medical bills.