Obama Care vs Republicans

[xoxoxoBruce]

You know what a cardiologist does, arrange for other doctors to take care of you.

[DanaC]

Our health service ain't perfect. But ya know what? We really don't have many people declared bankrupt because they had an accident and ended up with bills of hundreds of thousands of pounds.

We also don't have people with chronic conditions unable to access any medical care until it turns into an emergency and they end up in the ER.

We don't have death panels.

We do have a degree of rationing involved. That basically means that new drugs have to prove themselves as effective and cost effective.

You also have rationing. The difference is that yours is based on what your insurance is willing to cover.

And don't believe the newspapers. They have agendas.


[eta] Also, you don't even need to read a newspaper or watch the news to know how truly fucked up the current US healthcare system is. Just look in the Cellar. We have members here who have been sick and unable to get the right care. We have a member whose son was involved in a terrible car accident and left with serious health problems: his father had to give up work to look after him, which left him without health insurance. We have another member who only last month was unable to get the anti-depressant meds she needed because she had lost her job. Meds that should be withdrawn from slowly which she had to go cold turkey from. Why? because she no longer had health insurance and wasn't eligible for medicare (medicaid?) and couldn;t afford the $400 per month needed for those tablets.

Over here, she'd have to pay £7.75 for a prescription and they'd most likely give her three months supply for that. Or she could buy 3 months or a 1 year cover for all prescription charges.

I have two chronic health conditions requiring regular medication. It costs me nothing to see my doctor and my prescriptions are covered by a three month pre-pay certificate (£27.50). Regardless of what I need. I could need hundreds of pounds worth of medication and it will only ever cost me a prescription charge.

My Dad died in his 70s. The last 10 years of his life he was in and out of hospital. Sometimes staying in for a week or more at a time. They did everything they could for him. It didn't cost him a single penny: free prescriptions over the age of 65 and nobody is charged for staying in hospital - unless they choose to go private.

Your health system is probably better at some stuff than ours. But it is only available for those who can afford it. For the millions of Americans who have no health insurance, or whose insurance only covers basic care the system does not work.

[DanaC]

Most of the problems in our health service, most of the gaps in service, are due to the creeping privatisation of parts of the service.

Our politicians are trying to make our health service more like yours. Why, I do not know. But it is breaking the healthcare system.

Every time you see a news report about failures in the NHS, it ain't because medicine is socialised, it's because it is becoming less so.

[xoxoxoBruce]

Originally Posted by DanaC

Our politicians are trying to make our health service more like yours. Why, I do not know.

Yes you do, everybody knows, £££££££££!

[infinite monkey]

If I were on a real computer instead of my stupid phone, I would put this post in the hall of fame. Very well said, Dana.

Originally Posted by DanaC

Our health service ain't perfect. But ya know what? We really don't have many people declared bankrupt because they had an accident and ended up with bills of hundreds of thousands of pounds.

We also don't have people with chronic conditions unable to access any medical care until it turns into an emergency and they end up in the ER.

We don't have death panels.

We do have a degree of rationing involved. That basically means that new drugs have to prove themselves as effective and cost effective.

You also have rationing. The difference is that yours is based on what your insurance is willing to cover.

And don't believe the newspapers. They have agendas.


[eta] Also, you don't even need to read a newspaper or watch the news to know how truly fucked up the current US healthcare system is. Just look in the Cellar. We have members here who have been sick and unable to get the right care. We have a member whose son was involved in a terrible car accident and left with serious health problems: his father had to give up work to look after him, which left him without health insurance. We have another member who only last month was unable to get the anti-depressant meds she needed because she had lost her job. Meds that should be withdrawn from slowly which she had to go cold turkey from. Why? because she no longer had health insurance and wasn't eligible for medicare (medicaid?) and couldn;t afford the $400 per month needed for those tablets.

Over here, she'd have to pay £7.75 for a prescription and they'd most likely give her three months supply for that. Or she could buy 3 months or a 1 year cover for all prescription charges.

I have two chronic health conditions requiring regular medication. It costs me nothing to see my doctor and my prescriptions are covered by a three month pre-pay certificate (£27.50). Regardless of what I need. I could need hundreds of pounds worth of medication and it will only ever cost me a prescription charge.

My Dad died in his 70s. The last 10 years of his life he was in and out of hospital. Sometimes staying in for a week or more at a time. They did everything they could for him. It didn't cost him a single penny: free prescriptions over the age of 65 and nobody is charged for staying in hospital - unless they choose to go private.

Your health system is probably better at some stuff than ours. But it is only available for those who can afford it. For the millions of Americans who have no health insurance, or whose insurance only covers basic care the system does not work.

[Lamplighter]

Originally Posted by Adak

Those are cheap (relatively) diagnostics, NOT heart transplants!

"patients were subsequently managed by general practitioners,
in consultation with cardiologists or the admitting physician".

Do you know what that means? That means your heart attack care will be handled by a GP,
and probably, by an Internist - not even a Cardiologist. (Internists are more common).

They did however, find not one, not two, but three ways to successfully predict
which one's would die earlier, and approximately when they would die.

Oh! That's FABULOUS medical care, right there!

Adak, your reactions are predictable.
But your first argument was that in the UK, Grandma would be turned
away with only a pain pill. That obviously is not true.
Next you jump to question the treatment... i.e., who gets transplants.

As to the current policy in the US, UK, etc... The following is from the
Guidelines of the International Society for Heart and Lung Transplantation:


NY Times
Judith Graham
4/23/12

Heart Transplants for Older Patients

Just a decade ago, people 65 and older were routinely
rejected for heart transplants at all but a few institutions.
But in 2006, the International Society for Heart and Lung Transplantation
issued new guidelines saying that heart failure patients
should be considered for transplants up to age 70.
[Also see note below]

In 2006, 243 patients age 65 and older in the United States received new hearts;
last year, that number was 332, according to data from the national
Organ Procurement and Transplantation Network.
(Data strictly on patients 70 and older is not available, according to the network.)
<snip>

What about the guidelines in the UK.
This is from the (UK) National Health Service:

NHS

Donated organs are a precious resource.
Their sharing is conducted under rules drawn up by the appropriate UK Transplant advisory committee,
ensuring that each organ is given to the most suitable recipient and that each patient, as far as possible,
is provided with equal access to available organs.

Patients are placed on the transplant waiting list by their local consultant physician or surgeon
in accordance with nationally agreed criteria.
Their names are then notified to UK Transplant for inclusion on the national transplant database.

Individual social and psychological needs are also considered during the clinical decision-making process.
Applying a moral argument to the allocation of an organ for transplant
or any medical treatment is not compatible with the ethos of the NHS.
The health service does not stand in judgement over the people it is being asked to care for.

(NOTE: for technical outcome reasons, organs (hearts) from elderly donors
sometimes do not transplant as successfully as from younger donors.

Rather than have these (older) organs go to waste, individual organs
deemed unsuitable for a young recipient can be offered to older patients on the waiting list.
It then becomes an personal decision by the potential recipient
as to whether to accept a given organ... or to remain on the waiting list
as prioritized according to their own individual health condition.

Adak, I hope your next jump does not go in the direction of UK physicians being more biased, unethical, etc....

[DanaC]

Rationing of organs and waiting lists for them aren't because of money or because gubmint runs healthcare (it doesn't by the way): it's because there is a very limited number of organs available at any one time.

This is the case in every country. Every country rations access to transplanted organs in order to try and get as many successful transplants as possible from the low number of organs available at any given time.

That rationing usually goes along the lines of prioritising certain potential outcomes over others: in other words, if someone is unlikely to live for more than two years after the transplant they will be a lower priority than someone who is likely to live another ten years with the transplant. If the reason for the need for transplant is because of something the patient is doing (such as drinking) and the patient is going to continue to do that thing then they are unlikely to be a higher priority than someone who is making every effort to stop doing that thing.

In an ideal world, everybody who needs an organ would have one, because every person capable of donating an organ would do so. A lot of people do not want to donate organs in death. Or they do not want their relative's organs to be removed for donation.

This is something every country has to cope with.

[DanaC]

Adak, you said:

Then I heard about these commissions in Great Britain. They decide what treatments (if they're expensive), will be used, for what type of patients. The older you get, the fewer expensive treatments you qualify for, or the longer you have to wait.

That's really doesn't sound like anything I've read about health commissions.

Don't get me wrong, the system, as i already said isn't perfect. Sometimes it takes a little while for new stuff to be approved - though often it ends up approved because the drug companies have realised that the NHS will not purchase over-priced drugs and have dropped their wholesale price.

The NICE guidelines that NHS treatments are based on, are constantly updated. They make an assessment as to whether a drug is both effective and cost effective. It is not sensible to spend £50k on treatments that offer a small chance of extending someone's life for 8 months. It is sensible to spend that on a 50/50 shot at an extra ten years.

I pulled those figures more or less out of my arse :p

Also worth remembering that drugs and procedures and devices are much, much cheaper here. The NHS has a lot of leverage on price in the drugs industry (as well as producing or inspiring a high proportion of new drug and medical technology research). And, whilst the scene is changing on this, much less of the money is swept up by a middle tier of shareholder profits.

[Beest]

Originally Posted by Adak

Australia has a two-tier system. Everyone has a basic NHS service account, but if you want very good health care, you better have your private insurance account, as well. It can get pretty ugly pretty fast, otherwise, for the important stuff.The medical care is OK, but the waiting periods are dreadfully long.

Seems to be a little known fact that the UK has plenty of private health insurance. BUPA was the one you would hear about when i was a kid, so I looked them up, founded in 1947, based off an Australian organistaion founded in the '30's. If you have insurance you may well be seen in the same hospital and seen by the same doctors, but ,maybe nicer rooms, better food, shorter wait times etc.
You can be drop in and out of the private stream too, I have a friend whose mother was in pain, so he went private to see a specialist ina couple of days, instead of a couple of weeks or months, and the she was transferred back to the NHS system for treatment.

I also know of someone in the US with severe back pain that was required to take strong anti pain meds, the type for short term relief, that you should only take for a couple of days, for 2 months before her insuramnce would pay for an MRI. (a nurse BTW)

Having had some experience of both systems, the qualiy of the doctorin' is the same in both, beurocracy is equally obscure .
Wait times are longer in the UK for a simple surgery, and the hospitals aren't as new and shiny, but then nobody goes broke or goes without.

[Adak]

I doubt that's true. We see a lot of Canadians coming down to the US to get a by-pass, etc., because they can't wait the 11 months or so that they're required to, in Canada (the waiting period varies).

In the BBC, I was reading about some people who had lost an extreme amount of weight. Over 100 pounds, in fact.

They have applied to have the tremendous excess skin removed - but despite waiting up to 13 years for it, they can't get it done by the NHS. Oh they've stabilized their weight years ago (3 are required), and all that - it's been agreed it's medically necessary, but they can't get the operation scheduled.

You wouldn't see that in the States. The insurer would be in court in a heartbeat (and lose).

I understand you have a grievance system for review of such cases, but then I hear (also on the BBC), about people having to use pliers to pull out their bad teeth, because they can't get scheduled with a dentist.

I admire the good stuff from the NHS, but then I keep hearing about these "fell through the cracks" cases, and I wonder just how big and how many "cracks" are there?

[DanaC]

Every system has gaps. I just told you of a dweller who fell through the gaps in your system.

Here's the difference though: the cases you mention if people unable to get an operation to remove excess skin are a handful and that handful makes the national news. You have 20 million people with no insurance. 20 million people falling through the gap. You shouldn't even call it a gap in America: it's a fucking abyss.

Dentists are a special case: they never fully came into the nhs. Guess what though: you can get dental insurance for private care just like in America. And the stories about people unable to find an nhs dentist are overblown and out if date.

You are picking up a few examples of the system not working perfectly 100% of the time. But you have 20 million people unable to access the system you think works better.

There are gaps here but they're small and they aren't full of poor people or people who've been refused cover because they're already sick with a pre existing condition.

So yeah the insurance companies would cover that operation - for the fortunate insured.

[Lamplighter]

Originally Posted by Adak

I doubt that's true. We see a lot of Canadians coming down to the US to get a by-pass, etc.,<snip>I was reading about some people who had lost an extreme amount of weight.<snip>I hear (also on the BBC), about people having to use pliers to pull out their bad teeth, because they can't get scheduled with a dentist.

There's that mouse again

[Lamplighter]

Originally Posted by Adak

Show me how the Democrats have compromised, lately! <snip>

There was an interview on TV this morning that helped explain (to me anyhow) why
Harry Reid was so emotional yesterday during a news conference on the government shut down.

Reid believes that John Boehner reneged in their September agreement
on the upcoming budget and debt ceiling deadlines.
In such political agreements, your word is more than your bond... it's your entire reputation.

I found this article from yesterday that recounts some of Reid's remarks...

The Hill
10/3/13

<snip>Reid said Boehner could not deliver on a deal the two agreed to
after the August recess to fund the government because conservatives in his party
have pressured him to combine the delay or defunding of ObamaCare with government funding.

Reid was echoing similar comments he made earlier in the day.
He said leaders had already compromised on a deal to keep sequester-level funding
of $988 billion a year as the baseline for the continuing resolution.<snip>

Democrats have preferred a continuing resolution about
$70 billion higher than the current spending bill being debated.
“That is why we agreed to that lower number,” Reid said.
“That is one of the largest compromises since I’ve been in Congress.
That is a big deal, $70 billion just like that. And he couldn’t deliver.”

[Adak]

With record deficit spending, the Republicans OF COURSE, wouldn't go along with another 70 Billion increase in spending by the feds.

That's the teaser to make you think that "we're really getting a good deal here!". But you're not, because that's not actual savings. That's vapor money that was never approved for spending, by anybody. So there is no savings - actual savings - in that proposal.

What was offered was another year of the same record spending as this year. In other words -- no savings compared to this year, whatsoever.

Yeah, that's a great compromise there, Harry!

[Lamplighter]

Originally Posted by Adak

That's vapor money that was never approved for spending, by anybody.
So there is no savings - actual savings - in that proposal.

Adak, I believe that is completely wrong.
Otherwise why would the parties have proposed to use it as an impetus to reach agreement ?

From Wikiipedia:

In 2013 specifically, sequestration refers to a section of the Budget Control Act
of 2011 (BCA) that was initially set to begin on January 1, 2013,
as an austerity fiscal policy.

The reductions in spending authority are approximately $85.4 billion
(versus $42 billion in actual cash outlays[note 2])
during fiscal year 2013,[2](p14) with similar cuts
for years 2014 through 2021.