Author Topic: Healthcare  (Read 13809 times)

DerekSmith

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Re: Healthcare
« Reply #45 on: April 13, 2010, 07:52:54 PM »
@TrippleSpittle - I could not have put it better - my sentiments exactly.

@Fairlead - get out of there as quickly as your legs can carry you - NHS hospitals kill people - good luck.

Derek

Sweeney

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Re: Healthcare
« Reply #46 on: April 14, 2010, 09:38:03 AM »
This is an interesting contrast between public and private but wherever you look it's the same people - just different managers and different drivers. The profit motive enables a business to have a strong focus and without customer service profit will suffer  - that said many very large businesses operate on the basis that customer service doesn't matter as long as you have enough customers to be able to lose a few (try banks as an example). In the public sector what drives is political direction which changes more often than the weather. Without a profit barometer, measuring effectiveness becomes mired in targets and over-reliance on consultants (management not medical) whose own profit motive drives them to ever more ridiculous heights of inventiveness based on poorly understood systems. At the bottom end motivation suffers and the same people who might work happily in a well run small to medium or even large business become demotivated by the latest missive from on high itself driven by people at the centre with no experience of the inside of a typical NHS hospital. Removing layers of management and privatisation have long been dogma in the public sector to save money. Now you can see what happens when you do. Neither system is perfect - but the parts of both that work best have the best managers not the best systems.

Barry

SpitfireTriple

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Re: Healthcare
« Reply #47 on: April 14, 2010, 10:41:54 AM »
Agree with most of what you say Barry though I'll comment on..
This is an interesting contrast between public and private but wherever you look it's the same people - just different managers and different drivers.
Before I joined the public sector, I imagined it would be packed full of pinko lefties, and lazy ones at that.  I was wrong. There were more bright, hardworking, committed people than I ever thought there would be.  But they were, on the whole, a very different bunch from the people I worked with years ago in a merchant bank (probably the epitome of a capitalist business).  There were quite a few people allowed to work in the public sector, some of whom had even managed to get promoted, who simply would not have been tolerated in a merchant bank:  Incompetent, too bolshy, too many sickies, too lazy.  But I'll concede that the managers and the drivers are the main thing that makes the difference.


... it is cooked in Wales and transported to Portsmouth then re-heated on the wards!
 My office was consistently one of the top three performers out of 20-plus offices around the country.  Yet it was shut down and we were made redundant. The jobs were transferred to a new office in... Wales.  Was it a coincidence that my office was in a constituency where Labour could not win?  And that the new office in Wales was in a Labour weak seat?   (I've nothing against Labour in particular here, I feel the same about pretty much all political parties, I just want to underline how good business sense goes out the window when politics creeps in).  Good luck with the big C Fairlead.


Well Americans?  Getting any insight on the healthcare debate?


PS Derek:  If I could think of a way of mangling your name, I would.  But I can't! ;)
« Last Edit: April 14, 2010, 11:03:02 AM by SpitfireTriple »

Lasse_C

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Re: Healthcare
« Reply #48 on: April 14, 2010, 05:39:55 PM »
OK, let us get a couple of things very clear:
1) Good health care costs a lot of money. This is a basic fact, and that fact is not changed by who is running it.
2) The funding is limited. No matter where you get it from; taxes, insurances or your own wallet - it is just a matter of where the limit is.

It might be good to think of which model will - if run effectively, that is - that can deliver the most care for a given amount of money; The health service that also has to make a profit for their owners, and those who do not...  ::) (Now, a lot of public health service is ineffeiciently run, and ruled by political priorities instead of medical - this is of course not good, and makes the system bleed money into bureacracy. I am talking about what it should be)

In Sweden we have seen a lot of private local health centres in recent years. They advertise, they practically trip on their own feet in their eagerness to get people to register with them. So, are they any good? Well, there is nothing wrong with the quality of the care they offer, absolutely not! But... they do not want patients who need any effort! They want people to be registered with them, because that it what generates money for them - but they do not want to do any work! They want "quick-and-simple" patients. You know; "Sinusitis? Here?s a prescription for penicillin and something to reduce the swelling, thank you - NEXT!" If you have a condition that is just a little more complex, or even more than one condition or - Heaven forbid! - you have an opinion or want something, they would not touch you with a ten-foot pole. They just want you to go away... That?s private health care for you.

Lasse C


DerekSmith

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Re: Healthcare
« Reply #49 on: April 15, 2010, 11:38:03 AM »
Now, there Lasse_C, you have a major point.

My good lady has been a type 1 diabetic since her early teens.  Without the NHS she would by now be dead.  Private health insurances have two 'get out' clauses -  the first is the 'Conditions not covered clause' and the second is the 'Existing conditions clause', fall foul of either of these and your insurance is as a valuable as a Politicians promise.  Some even have a third nasty clause tucked into the tiny print - the 'Illness duration limit clause' but these limitations are the fault of the greedy Insurance companies, not the private health care providers, who (at least in the UK) tend to be equipped with state of the art systems, staffed with experts and well managed.

By contrast, the NHS is simply a governmentally authorised means of providing profit for 'big Pharma'.  Although the NHS will always see you, no matter what your condition nor how long you have had it, don't expect to be cured and if you are a realist, you should even consider the very real risk of being exposed to life threatening diseases and incompetence.  While the private health care providers deal with volume by being efficient, the NHS deals with it by utilising the 'Queue Here' system.

Something wrong? Phone the local GP surgery and make an appointment - you can have one today with the doctor who has been nearly struck off twice, or a half decent doctor in two weeks, or a doctor you respect in four weeks.  Make the appointment and see the GP - get referred to the hospital to see a consultant.  A month later an appointment arrives for an initial consultation in two months time.  Go to the hospital and register on time and get sent to the path lab - queue in the path lab for 40 minutes, take the results back to your clinic reception - get sent to X-ray - queue in X-ray for 35 minutes and eventually take your films back to reception - get sent to MAU for assessment, queue for 30 minutes, chase staff in case they have forgotten you, wait another 30 minutes, fill in a questionnaire and take it back to the clinic where you then wait for your turn to see the consultant.  Three trips to the loo later (what do they put in that coffee?) and the place is starting to look a little empty - got to be your turn soon - then up trundles the cleaning lady - "Hello dearie, have they forgotten you?  They all went home an hour ago".  She then goes on to tell you her life story, oblivious to the shock on your face and your need for yet another pee.  As she chatters, she sprays polish and lovingly rubs one little spot - sprays and rubs, sprays and rubs - always the same spot, while amazingly never going near that nasty stain that looks like blood - or worse?  Where is her supervisor to check that she is working and not gassing, to check that she has cleaned the whole surface and not just that one spot to a gloss that would blind you should the sun ever glint off it.  Of course, there is only one supervisor to 500 staff spread over ten hospitals - all she ever has time for is to ensure that the right number of people turned up for work so that the cleaning agency can bill for their time, what they do when they get to work is up to the hospital (hospital staff don't know this of course) - she just tells them to keep cleaning, look busy and don't get in anybodies way - after all, her bonus is determined by how many staff she provides, not by how well they clean, and if they cleaned too well, the hospital would not need so many and her bonus would suffer.

I once saw a bed bay in a ward stripped, cleaned and remade by two nurses in six minutes (that was several years ago before the hospitals could not afford to provide sanitiser for the clean downs).  Recently I saw a whole Intensive Care bed bay stripped, cleaned (ceilings, walls, equipment, tubes, cables, pipes, bed, railings, floor) and reassembled in 18 minutes by two nurses - the senior ICU ward nurse and an ICU nurse.  I actually saw them doing it several times - it was efficient and impressive - some parts of the NHS are really good - most is poor verging on lethal.

Yes, with the NHS, no matter what ails you, they will see and 'treat' you, but that 'treatment' might not be in your best interests.  As I said, my better half has type 1 diabetes, and as here carer, I was given instructions on what food she should have - the dietitians advice for the main meal was 'half the plate should be slow release carbohydrate' which I duly provided, and her weight began to increase as all the other diabetics at the clinic did.  Her feet started to loose feeling and she developed a 'Charcot foot' - the first stage to amputation.  That was several years ago when I started to question the NHS advice we were being given.  Turns out, carbohydrate (slow release or otherwise) is the worst thing a diabetic can eat - yes they need some, but basically as little as possible - they also need masses of vitamin C to mop up free radicals and limit nerve and kidney damage.  The standard advice from the NHS was wrong and was hastening her death - it is not the NHS, it is the NSS - the National Sickness Service, and just like the cleaning service, they only get to keep their jobs by keeping you sick.

My good lady is now using less insulin, is off blood pressure and statin medication and her heart, kidneys, eyes and neuropathy are all improving.  Thanks for the advice NHS, but No Thanks - we will take the insulin, but you can keep the rest.  Yes, we need the NHS for the insulin, because insurance companies are allowed to pick and choose what they will cover and what they wont, but the rest of the NSS is there to self perpetuate itself and its customer base, and we their 'customers' have absolutely no say in how they operate.

Is it possible to have a system that does not suffer from these extremes?  Yes, I believe it is.

I was once employed by a large organisation who provided health insurance for all its employees (after all, we made the profit for the corporation, so it paid them to keep us in work).  The corporation had the buying power to negotiate a competitive insurance rate and it also had the clout to insist that all its employees were insured, no matter what the condition, existing or otherwise.  When I left the organisation I had a shock - the insurance cost shot up and the coverage shrank badly.  The lesson is that it is possible to have a good private system, but only when the means exist to keep the greed and power of the insurance companies within check - that is a challenge that will not be answered in a hurry and will never be answered by politicians...

Derek

Son of Liberty

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Re: Healthcare
« Reply #50 on: April 15, 2010, 04:58:00 PM »
The greed of the insurance companies does have a big effect on their rates.  Here?s a brighter story you don?t hear much from critics though: I have a friend who is diabetic as well, but he has a fairly good company.  He gets insurance from a small business, but his payments are still very manageable even though he comes from a lower-middle class family.  Yes his payments are slightly higher because of his preexisting condition, but in reality, he uses the coverage much more than an average person might for needles, insulin, etc.  In the long run, he pays just about the same as I do, if not less.  In fact, he still finds the money to go on more fancy vacations than I do  >:(.

If we had better regulations on the private system to counteract the crimes of certain greedy companies, I believe the system here in America would be have been fine and our government takeover might not have happened.  Of course, with more regulations, the closer you get to a socialist system, but I believe our mixed system would have remained intact as long as the government focused on only those regulations that are needed to protect its citizens.

--Son of Liberty
All men die.  Few men really live.
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Lasse_C

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Re: Healthcare
« Reply #51 on: April 18, 2010, 01:58:31 PM »
If we had better regulations on the private system to counteract the crimes of certain greedy companies,
--Son of Liberty
And, I might add, from meddling politicians. After all, we (I am a nurse in psychiatrics) who actually work in the health care system do want our patients to have the best care we are able to provide. Who runs the system is, actually, not really that important. What is important is what priority they give to caring for the patients.

Of course, with more regulations, the closer you get to a socialist system,
--Son of Liberty
Oh, PLEASE! Are there still educated people who actually believe in that old cliche?
Man, you really need to check up some facts on how things actually work. Begin by checking out the rules for getting a visa to the US, for example...  ;)

Lasse
« Last Edit: April 19, 2010, 07:01:16 AM by Lasse_C »

squarerigger

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Re: Healthcare
« Reply #52 on: April 21, 2010, 02:08:25 AM »
SOL,

I have two things to ask for your opinion:

1.     Is a genetic disorder a pre-existing condition?  I have a genetic disorder titled essential tremor that was not diagnosed until later in life.  Is that a pre-existing condition?
2.     I also have late-diagnosis diabetes type 2 - this is something to which I was apparently pre-disposed because of family history (it is not genetic as far as I know) and I now have to limit my blood-glucose levels.  Is this tendency a pre-existing condition?

I believe very firmly in the National Health System in the UK - I was born to it, brought up in it and then came to the USA where I have been forced to pay for things I know I do not need.  Example?  I had a spider-bite recently - the hospital bill came to over $8000.00.  The treatment?  Wait in the emergency room for over an hour to be seen (there seem to be a rash of urgent happenings at that time of 2 am), be triaged and declared not urgent, wait for a further two hours to be seen by an on-duty nurse who decided that ibuprofen or equivalent accompanied by an un-needed anti-biotic treatment (physician determined no need for anti-biotic on her thirty-second visit to the treatment cubicle) was the only treatment that was authorized by the insurance company.

So - how much did the insurance company pay of the $8000?  Only $3000 because they said that the billing was too high.  Who has been passed the bill for the remainder of the treatment?  I have.  Does that sound correct?

SR
« Last Edit: April 21, 2010, 02:22:39 AM by squarerigger »

Son of Liberty

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Re: Healthcare
« Reply #53 on: April 21, 2010, 04:24:20 AM »
Mr. Lasse,


Of course, with more regulations, the closer you get to a socialist system,
--Son of Liberty
Oh, PLEASE! Are there still educated people who actually believe in that old cliche?
Man, you really need to check up some facts on how things actually work. Begin by checking out the rules for getting a visa to the US, for example...  ;)

Lasse

I'm not sure I follow; can you elaborate on the visa?

Socialism: Any of various theories or systems of social organization in which the means of producing and distributing goods is owned collectively or by a centralized government that often plans and controls the economy (dictionary.com).

By enacting regulations on a product (insurance), the government obtains greater control of the economy and takes power away from private business.  Therefore, each regulation is a step in the socialist direction, even though it might still be contained in the realm of a "mixed economy."

SOL,

I have two things to ask for your opinion:

1.     Is a genetic disorder a pre-existing condition?  I have a genetic disorder titled essential tremor that was not diagnosed until later in life.  Is that a pre-existing condition?
2.     I also have late-diagnosis diabetes type 2 - this is something to which I was apparently pre-disposed because of family history (it is not genetic as far as I know) and I now have to limit my blood-glucose levels.  Is this tendency a pre-existing condition?

I believe very firmly in the National Health System in the UK - I was born to it, brought up in it and then came to the USA where I have been forced to pay for things I know I do not need.  Example?  I had a spider-bite recently - the hospital bill came to over $8000.00.  The treatment?  Wait in the emergency room for over an hour to be seen (there seem to be a rash of urgent happenings at that time of 2 am), be triaged and declared not urgent, wait for a further two hours to be seen by an on-duty nurse who decided that ibuprofen or equivalent accompanied by an un-needed anti-biotic treatment (physician determined no need for anti-biotic on her thirty-second visit to the treatment cubicle) was the only treatment that was authorized by the insurance company.

So - how much did the insurance company pay of the $8000?  Only $3000 because they said that the billing was too high.  Who has been passed the bill for the remainder of the treatment?  I have.  Does that sound correct?

SR

Mr. Philpot,

I'm no insurance expert, but I think "preexisting" is from the prospective of the insurance company.  The reason someone with diabetes might pay a higher monthly payment is that, in the long run, the insurance company will have to pay out more money to cover their testing strips, insulin, etc.

I went to the ER last year, got an X-ray, was sent to a specialist, and only had to pay $400 out of my pocket (including the trip to the specialist).  I don?t know why your visit ended up costing $8,000 though?I think for someone like you it doesn?t usually get higher than $3,000 pre-insurance (don?t quote me on that particular number though.)

As for waiting times, I can?t seem to find a good, unbiased site.  The ones I have found usually come from either side.  If anyone has a good study that has been published by an unbiased source, please post it.

--Son of Liberty
All men die.  Few men really live.
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Lasse_C

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Re: Healthcare
« Reply #54 on: April 21, 2010, 06:22:57 PM »
I'm not sure I follow; can you elaborate on the visa?
The requirements for gettin a visum to USA are complicated, detailed and, I must say, in several ways rather peculiar - not to say apparently irrelevant. According to a friend of mine, as late as last summer the application form for example still had the question as to if some relative (including grandparents) had suffered from mental illness. Now, if my grandfather in his old age suffered from paranoid delusions (which he, as a matter of fact, did) and deep depressions (which he also did) - in what way would that make me a danger to the US society if they let me in? As a matter of fact I am a licensed nurse in the field of psychiatrics, which means my mental health is probably better monitored that the average person...  ::) Anyway, the visa rules was perhaps not a good example.

My definition of "socialist" is somewhat different from the definition at dictionary.com. The term "centralized government" also means that just about any totalitarian state (or a strongly feudal society, for that matter  :o) could be called "socialist" - which it, at least in my terms, is most certainly not. My reaction was against the very generalized statement "more regulations = socialist system". That is a huge oversimplification.

At the risk of generalizing myself I find that many US citizens have a kind of Pavlovian reflex (most likely a remnant from the McCarthy era) that makes them sound like the sheep in Orwell?s "Animal farm" might have done: "US society - good! Socialism and communism - baaaaad!" In reality, it is far from being that simple.

Lasse C

Son of Liberty

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Re: Healthcare
« Reply #55 on: April 22, 2010, 01:40:51 AM »
My reaction was against the very generalized statement "more regulations = socialist system". That is a huge oversimplification.


I agree that "more regulations = socialist system" is oversimplification.  What I meant though, is that with each regulation, you get closer to a socialist society, even if you aren?t in that realm yet.  To better explain, here?s a simplified version of what I see when I think of the political spectrum:

---Communism---Socialism-----Liberalism---Conservatism-----Fascism---

(Now there are many theories and charts on the political spectrum that are more detailed and accurate than this, but this one is probably the most well known.)

So, even if you are technically liberal or conservative, for every regulation you add you move in the direction of Socialism.  It?s important to note this because small changes add up overtime.  Just look at the huge difference between George Washington?s time and the present.  Back then, the federal government basically had to beg the states to pay their taxes.  Now the federal government has much more power.  We are still in the ?mixed economy? class, but we?ve moved to the left a significant amount.

[At the risk of generalizing myself I find that many US citizens have a kind of Pavlovian reflex (most likely a remnant from the McCarthy era) that makes them sound like the sheep in Orwell?s "Animal farm" might have done: "US society - good! Socialism and communism - baaaaad!" In reality, it is far from being that simple.

Lasse C


The sheep you talk about probably exist in most every society and hail from most every economic system.  They usually don?t research the systems themselves, and might believe something based on nationality, race, friends? opinions, etc.  For example, I had a roommate who claimed to be socialist, but when asked why, all he could say was that capitalism is evil.  He couldn?t name a single specific point to back up his argument, and when I asked him questions about it, he usually agreed with my conservative views.  I like to refer to him as a ?closet conservative.?  ;D

I can?t speak for those people, but I can say that I?ve met plenty of Americans who have done the research and have formed their own opinions.  All of my economics and most of my business teachers travel to communist or socialist countries every year to teach a few classes of business to certain schools.  Every one of these professors has seen communism and socialism first hand, and every single one of them prefers our system.

--Son of Liberty
All men die.  Few men really live.
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Lasse_C

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Re: Healthcare
« Reply #56 on: April 22, 2010, 08:46:31 AM »
To better explain, here is a simplified version of what I see when I think of the political spectrum:
---Communism---Socialism-----Liberalism---Conservatism-----Fascism---

--Son of Liberty
OK, now we are on a platform we can agree on.  ;D
I can accept that spectrum (granted that it is highly simplified).
The level of regulations does not work as an indicator of how far to the left you are on this scale, however. If you look at the actual examples in history (which, I am well aware, does not necessarily give a complete and correct picture of the ideology itself) I would rather say liberalism in the middle at least tries to hold the lowest level of regulations and control, while the level of regulations and control increases rapidly the farther out towards the ends of the spectrum you go. This was also why I flipped at the statement "more regulations = socialism". There have, luckily, not been many fascist governments in history - but they had an abundance of regulations and control! So, more regulations does definitely NOT equal a socialist system, if you ask me. If anything, the amount of regulations and control is a measure of how oppressive a ruling system is, regardless of ideology.

What I find important is that the level of democracy appears to be lowest at both ends of the scale, too. All put together it may sound as I am a liberal, but if I were to describe my political opinions according to this scale (again, we simplify) I would say I am for a "democratic socialism". I believe strongly in democracy, but I also believe very strongly in the principle that key (more or less "survival") functions in the society should not be run for profit (efficiently run, yes, but non-profit): Health care, care of old people, childcare, schools, police & fire dept, water & sewers, roads, etc.

A few years ago the Swedish market for electricity was "de-regulated" and opened up for a lot of private companies. The government promised us that the competitive market would make it soo much easier and soo much cheaper for the consumer. Yeah, my ass! >:( Now it is a jungle of companies, you need a lawyer to understand the contracts they offer (of which there are, I am told, more than 1900 different ones to "choose" from) - and electricity has never been so expensive (approximately triple the cost from what it was before de-regulation). That is the unregulated bloody "free market" for you! The stockholders get rich(er) and the little guy pays.

Lasse C
« Last Edit: April 26, 2010, 02:08:54 PM by Lasse_C »