Health Service Blues

You can imagine how delighted I am about this ....:

http://news.bbc.co.uk/1/hi/health/7029809.stm


*growls a bunch of very, very bad words*

Argh. So the NHS is going to use services from private companies. Which by definition are run to make a profit. And yet this is somehow more cost effective that providing them themselves. Ho hum.

We have found that privatization generally saves at least 25% of costs while providing increased benefits. It rescued the budgets of several large cities in the 90s including Philadelphia.

Unfortunately, our system doesn't quite work that way. There have been numerous attempts to meld the private sector with the NHS (like the computerised records system and the PFI hospitals not to mention some areas where third parties are brought in for some services) and they always cost the NHS more.

Do they not bother with writing solid contracts and putting out open bids?

At least you still have health care, Dana. Here in the US, something like 30% of the population has no health insurance at all. Sure, they can resort to a hospital ER, but an ER visit is far more expensive than a regular doctor's visit. The people who can't afford insurance can't afford to pay that high ER bill either, so costs get passed along in the form of higher bills for those who have insurance. The insurance companies pass the cost along to the consumer and tah-dah! What results is actually a highly expensive, very ineffective form of national health insurance. But don't tell anybody. We wouldn't want to have a system that might actually be cost effective and even save lives. Not here in the good old US of A. Nope. :eyebrow:

The people who can't afford insurance can't afford to pay that high ER bill either, so costs get passed along

...to Medicaid. You forgot Medicaid.

Undertoad;392580 wrote:

The people who can't afford insurance can't afford to pay that high ER bill either, so costs get passed along

...to Medicaid. You forgot Medicaid.

Medicaid covers the cost of prescriptions for certain eligible low income disabled and/or elderly. It may also confer other benefits, as well. MediCARE is probably what get hits with the higher hospital costs, just to pick bones.;)

People with Medicare/Medicaid usually have their own health care providers and don't need to resort to the ER unless they've been hit by a truck.

As a tax payer/health insurance consumer which would you rather pay?

A) $70 for a doctor's visit
B) $300 for a trip to the ER
C) $? if we just stop providing any health care what-so-ever to those whose incomes/employment don't allow them to buy private insurance.

I put a "?" for part C, because you have to factor in such intangible costs as lost productivity from a wage earner, sick children going to school and possibly infecting others, babies with failure to thrive, etc., etc. Plus you have to consider the psychological/sociological impact of US cities and streets becoming even worse than they are now with blind and sick and other disabled people begging for coins.

I experienced "C" when I traveled in South America, and I emphatically reject it as an option for the US. Therefore, I choose "A." But its a free country, and most of my fellow citizens seem to be choosing "B" because they are unaware or indifferent or in a deep coma of some sort. :headshake

It seems you have chosen to lecture us about health care without knowing what Medicaid is.

This is off topic- but did you really just use Wikipedia as a source?!? In all seriousness at that? I understand using it to make fun of someone.......or jokingly...but....

Ok. Everyone. I have an announcement...that's it!
We are functioning out of a parallel universe...the merge must have happened so slowly and painfully, that no one noticed! It is my professional alternate universal reoccuring opinion that the merge completed sometime last month (next month for the laymen) Be advised.


Or
We have a "Michael Scott" on our hands.
:)

It seems you have chosen to lecture us about reality, truth, and the nature of the Internet without stopping yourself from being a flaming asshole.

Undertoad;392628 wrote:

It seems you have chosen to lecture us about reality, truth, and the nature of the Internet without stopping yourself from being a flaming asshole.

I was actually trying to lighten things up after someone else was being a flaming asshole.

In fact....if you haven't noticed...no one is here anymore because of the "Survivor" mentality obliterating the members of this board. What you are doing right now is a great example of it.

And:
Just depends on how you read it UT. I thought it was pretty comical. And your claims about my response being the truth, a lecture, reality, or a history of the internet?.....wow. Just wow.


I thought using the fact that people use wikipedia as a source- as undeniable proof of a parallel universe shift was hilarious actually......just a tough crowd.

It would appear you have chosen to lecture me about the nature of The Cellar and online community.

Jesus...knock it the fuck off.

Cicero;392630 wrote:

In fact....if you haven't noticed...no one is here anymore because of the "Survivor" mentality obliterating the members of this board. What you are doing right now is a great example of it.

......just a tough crowd.

Siss, no problems with you at all, but there are plenty of people still here. A few have left for very specific issues (Shawnee hurt herself by her reactions to things and chose to leave, Uisgae left because we have a strident Atheist etc etc) but a wholesale desertion isn't true. The fact there is a Missing Cellarites thread is testament to the fact we are a close-knit board.

And what UT said referred solely to what you posted. Not, "Let's attack Cicero, yay, easy target" If you posted in humour you only have to say that. I've certainly posted what I thought were jokes, only to have them fall pancake flat.

Tough crowd? Yes & no. You're drawn back because it's a tough crowd - you get a laugh or approval you know you hit a zinger. Don't take one poster's opinion (even if he hosts the board) as everyone's opinion - this board moves slowly, and that is part of its charm.

/There endest the lesson.

DanaC;392559 wrote:

Unfortunately, our system doesn't quite work that way. There have been numerous attempts to meld the private sector with the NHS (like the computerised records system and the PFI hospitals not to mention some areas where third parties are brought in for some services) and they always cost the NHS more.

So...what? Is the NHS just not reducing its spending when moving services over to contractors or private peeps?

Undertoad;392634 wrote:

It would appear you have chosen to lecture me about the nature of The Cellar and online community.

Oh jeez.........

See what you started? Now I'm getting the lectures........

That's a neat trick UT.

I don't want you to think I was lecturing you. If you didn't mean me I eat a huge slice of humble pie & please ignore the following text.

It may not have come across well, but honestly I was trying to slip some personal advice to someone whose posts I enjoy. There have been some issues in the Cellar recently, but they have been almost exclusively between established Dwellars. I can't remember what has happened since you joined (a year ago) but we have had some very confrontational newbies and also some slow burning issues.

Oh I don't know why I'm typing this... I can't explain it intelligently but I adored Shawnee and she's gone. She was a support, a comfort and made me laugh. Often in posts, sometimes in PMs. She had her own issues with other Dwellars but never tried to get me "on board".

I like you. And I worry that if I'd spoken more to Shawnee on the board and less on PM she'd still be here & making many people laugh.

.................................?

SamIam;392575 wrote:

At least you still have health care, Dana. Here in the US, something like 30% of the population has no health insurance at all.

:eyebrow:

"Something like 30%" is a lot more than 16%, don't you think?

Sorry if I have got thnigs completely wrong Cicero.
I'd prefer if you gave me a clue though.

you can't read minds either SG? lol

So...what? Is the NHS just not reducing its spending when moving services over to contractors or private peeps?

Well. It is different in different situations. But what often happens is, political and business interests collide and a scheme gets under way which goes drastically wrong and needs rescuing to avoid somethng catostrophic happening, or where the relationship between the state sector and the business sector skews all the advantage to the business sector. PFI hospitals gave a quick fix solution to the problem of out of date (from years of underfunding) or inadequate hospital facilities, but whereas the old buildings were ownwed by the NHS, the new buildings, built partially with government funding, end up as the property of the company. Effectively we pay a large percentage of the building costs and then lease the building from the private body.

Attempts to plug the service gaps (again, caused by years of underfunding) by bringing in third party organisations (so for instance a particular type of testing may be done by a private firm, with their own private staff. This has been trialled in some areas using, I think, a South African company, with their own staff). Another way of plugging service gaps is to utilise current Private medical facilities (such as Bupa hospitals). Naturally this costs more.

Thing is, the doctors who work at Bupa, also work in NHS hospitals, and have been trained by the NHS. Not all work carried out in private hospitals is private medicine.....not all work carried out in the NHS hospitals is social medicine. The lines have become confused. An attempt to meld a universal social medicince system has resulted in a massive culture clash within medical provision.

The whole thing has been further complicated by the drive to 'decentralise' medicine, resulting in "Primary Care Trusts". These essentialy run medical provision in some areas. Problem is, as with the Police and Fire services, these areas are larger than any single authority. My local authority and two others are covered by our Primary Care Trust. We as an authority, have our targets and mission statement on health, involving building a partnership with various bodies, including the PCT. They have their targets and mission statements and they are supposed to achieve that in partnership with each of the authorities. These partnerships don't always run smoothly. Because Councils are represented to the trust but have no democratic powers over it, there is very little democratic accountability.

At the point that they broke everything up into this decentralised system, they also broke the funding up, so that Trusts operate their own seperate budgets. This has led to some serious problems in terms of universality in the services which are available in any ne area.

It's better than it was ten years ago, in many ways. Service levels are better, waiting times are lower and most people, though they'll express an opinion that the NHS is going down hill, will if asked say that their own personal experience of it has been fine. But...with the amount of money we've poured into it we should have fixed it a damn sight more than we have. It was broken when we got hold of it...and we've fixed a lot of stuff, but we're busy unbolting some fairly important components along the way.

Oh yeah....and the PFI hospitals are really quite shoddily built. Very shiny, lots of glass and pretty desk at reception...but very shoddily built.

Aliantha;392660 wrote:

you can't read minds either SG? lol

Oh, so since when did you guys quit reading my mind?!? Oh....you only read my mind when it's convenient for you.....great.
:D

No harm, no foul SG! All my comments were directed at UT in that scenario...so don't worry 'bout it.

jinx;392653 wrote:

:eyebrow:

"Something like 30%" is a lot more than 16%, don't you think?

My bad for not going back and reveiwing my information. According to the latest info from the US Census (Press release of August 28, 2007), more than 30% and close to 40% of Americans do not have insurance through work. I think this is the statistic that lodged in my mind. At any rate, we still have 47 million Americans with no insurance at all. This is not a good situation, and according to the Census, the percentage of uninsured continues to climb.

As far as Mediciaid versus Medicare, the question is complicated because Medicaid is administered by the states with some federal guidelines. Thus, what Medicaid coverage will do for you can vary widely from state to state. Medicare is the same throughout the US, and administered strictedly by the Feds. Thus, I can say with some confidence that inflated hospital costs will also turn up as more charges to Medicare and Medicare premiums across the board. If someone has Medicaid in addition to Medicare, the two programs will share the costs, but again Medicaid is more variable in who get coverage and what gets paid, so if I'm going to generalize, I'd rather generalize about Medicare.

This is actually a rather dry topic. Do you guys always get so mad at each other over trivia? :eek:

SamIam;393168 wrote:

My bad for not going back and reveiwing my information. According to the latest info from the US Census (Press release of August 28, 2007), more than 30% and close to 40% of Americans do not have insurance through work. I think this is the statistic that lodged in my mind. At any rate, we still have 47 million Americans with no insurance at all. This is not a good situation, and according to the Census, the percentage of uninsured continues to climb.

As far as Mediciaid versus Medicare, the question is complicated because Medicaid is administered by the states with some federal guidelines. Thus, what Medicaid coverage will do for you can vary widely from state to state. Medicare is the same throughout the US, and administered strictedly by the Feds. Thus, I can say with some confidence that inflated hospital costs will also turn up as more charges to Medicare and Medicare premiums across the board. If someone has Medicaid in addition to Medicare, the two programs will share the costs, but again Medicaid is more variable in who get coverage and what gets paid, so if I'm going to generalize, I'd rather generalize about Medicare.

This is actually a rather dry topic. Do you guys always get so mad at each other over trivia? :eek:

Medicare is for old people, Medicaid is for poor people.

TheMercenary;393189 wrote:

Medicare is for old people, Medicaid is for poor people.

Well, that's one way of looking at it. Actually, some, but not all, poor people get Medicaid. Most poor people get Medicare. Some, but not all, elderly get Medicaid. Almost everyone over 65 gets Medicare. So, it is Medicare, NOT Medicaid which is the constant.

But what interests me goes beyond the difference in Medicare vs. Medicaid. What interests me most is those 47 million Americans with no health insurance at all, even "-caid" or "-care."

I mentioned that those with no insurance at all must resort to a very expensive hospital ER visit. In many cases, the law requires the hospital to treat, at a high cost, whomever darkens the hospital ER's door. Well, should these laws be changed? Taxpayers and/or private health insurance consumers are the ones paying for these costs.

Do we, as a people, write off 47 million fellow Americans? If so, why? Is it a matter of eugenics and/ or xenophobia? Is it a matter of the bottom line and what we will and won't tolerate as a society? Do we figure that the people who get treated in an ER are either illegal immigrants, or homeless alcoholics, or poor white trash trying to beat the system? Where are the statistics on THAT?

Are we willing to throw 47 million people to the dogs in our cities and towns with no medical care, what-so-ever? Some of those people would die. Let's get real. We kill convicted murderers. Shall we also kill wetbacks for daring to transgress, the old man who DOESN'T have Medicaid, the young mother of two trying to escape an abusive situation, the Afro-American "welfare queen" PLUS her children, the white trash drunk passed out on a park bench, etc., etc.?

In a different thread, RK mentioned the HUNDREDS of billions that Congress is planning to appropriate to Defence Department. A large percentage of this will go to conducting our current wars, where both enemy soldier AND civilian will be killed. WE are willing to spend billions killing others in the name of the defense of the United States. How do we best spend our money defending ourselves at home?

THAT is my question. AS a society, how shall we determine who lives and who dies and for what end?

Before I leave I would like to mention that I just saw the B.J. smilie, and I am quite speechless.


Duck and cover Sam.
.....................:bolt:

Cicero;393217 wrote:

Before I leave I would like to mention that I just saw the B.J. smilie, and I am quite speechless.


Duck and cover Sam.
.....................:bolt:

Oh, my! Is that bad? Do you think I should keep quiet about having an affiliation with the Communist Party? I for sure won't tell anyone I'm originally from Iraq. Thanks for the head's up! :noevil:

What a Trot! *grins*

Waiting: In 3-2-1.........

SamIam;393212 wrote:

THAT is my question. AS a society, how shall we determine who lives and who dies and for what end?

Actually the only question is who should pay for it.

TheMercenary;393303 wrote:

Actually the only question is who should pay for it.

I disagree. One way or another, society does pay, and society means every last one of us via taxes, insurance premiums, and quality of life in the US.

Sorry to hi-jack your thread, Dana. What's a "trot"?:confused:

Trotsky?

*chuckles* that wasn't a hi-jack, that was the heart of the issue.


A 'Trot' is a trotskyist. It's generally used as an insult (sometimes affectionately, or alternatively with venom) by left-wingers of those they consider too far left to be sensible.....or that they just want to insult, it's a bit of a catch all. On the other hand it's also a slightly admiring term used by left-wingers describing some well-loved rabble rouser...or as a slightly self-effacing way of waving your left wing credentials, as in "Yeah, well i was a bit of a trot back then..."

I'm guessing that wasn't really that helpful huh? *smiles*