PDA

View Full Version : No wonder you can't get an appointment with the GP


Pages : [1] 2

funfly
6th Nov 2014, 18:03
I was called to an "Asthma' clinic today, I don't have asthma but it took up half an hour of a qualified nurses time and, I assume, the Health Centre gets a bonus.
My wife was called for a discussion about her "Asthma" with a doctor a couple of weeks ago. He prescribed medication, she told him that she did not have asthma and did not want it. He told her he was going to put 'refused medication' in her notes.
My father in law, who is a sensible 86 year old, had to visit the nurse today and she asked him some general knowledge questions. When he couldn't answer them correctly she referred him to a doctor presumably to discuss his 'dementia'. I assume more money is involved here.
Soon we will hear of a rise in Asthma cases in the UK. Soon we will hear of a rise in dementia. What we should be hearing is a rise in doctor's incomes as they diagnose more and more people with cash rewarding afflictions.
What they do not do is to recruit more staff to cope with the income attracting work so it surely means that waiting time for appointments gets longer and longer.
I have just checked our own practice and there is a slot with a doctor on 12th. November and the next available slot is 2 December.

Rant over.

FF

Fox3WheresMyBanana
6th Nov 2014, 18:13
If you have nothing wrong with you for years, you just get crossed off their lists (and they "forget" to inform you of same), which is a complete pain when you do have something go wrong.

G-CPTN
6th Nov 2014, 18:18
Dementia diagnosis will earn a GP £55: Incentive scheme unethical, leading doctors say | Daily Mail Online (http://www.dailymail.co.uk/news/article-2802419/dementia-diagnosis-earn-gp-55-inventive-scheme-unethical-leading-doctors-say.html)

goudie
6th Nov 2014, 18:29
I've had Asthma for years but every year I get called in to see nurse, just to make sure I'm using my 'puffer' correctly.

My wife has just had a letter saying she has an app. to see the doctor to review her medicine requirements, of which she has just one item.

Targets and tick boxes come to mind!

VP959
6th Nov 2014, 18:43
I've had mild hypertension for around 30 years (it was picked up on annual aeromed but wasn't bad enough to stop me flying).

Consequently I've been on one or other form of anti-hypertensive drugs for at least 25 years now. Previous medics have insisted on regular (as in three monthly or six monthly) checks, but when I changed to my current GP (around 14 years ago now) I mentioned that I checked my BP myself every few days and kept all the readings on a spreadsheet. I showed him the spreadsheet and we agreed that there was no point in me taking up the practice nurses time, all I needed to to was email him my BP every six months and come in and see him if he or I spotted a problem.

Works a treat, I get a repeat prescription, he has one less patient clogging up his waiting room.

There are a fair few other chronic conditions that could be managed the same way, if only the system encouraged, rather discouraged, it.

SpringHeeledJack
6th Nov 2014, 19:06
There seems to be a gathering of momentum within the NHS in the last year to run programmes whereby symptoms of serious illnesses are caught early so as to save the huge costs of treating patients when seriously ill at a later date. That said it seems like GP's are in an ever increasing drive to up their income streams (this refers to partner practices) and so will jump at the chance to get loads of patients with issues that they didn't know they had :hmm: Net result is more congestion for needy patients and unneeded stress and frustration.


SHJ

con-pilot
6th Nov 2014, 19:13
Thanks to all of you for letting us know what life will be like under Obamacare. :(

11Fan
6th Nov 2014, 19:25
I don't know Con, they may have it better than us when all is said and done.

con-pilot
6th Nov 2014, 19:28
I don't know Con, they may have it better than us when all is said and done.

That would not surprise me in the slightest.

seacue
6th Nov 2014, 20:06
IMO it is gross error to equate the NHS with all other National Health schemes. Other European schemes seem to allow choice of doctor -- and French doctors have Web pages trying to recruit patients. They even make house calls. Many French people belong to a mutuel which covers the copay.

I understand that US Specialists (NOT GPs) are better paid than elsewhere. My US GP backed out of Medicare since he'd have to see 6 patients per hour to have a tolerable income. He says that most students in his US Med School are aiming to be specialists - leaving a shortage of GPs.

Caboclo
6th Nov 2014, 20:08
For you Brits, what happens if you skip the appointment? Bobbies show up with a white coat?

SpringHeeledJack
6th Nov 2014, 20:36
Nada, they just shove the next one in your place. There IS a cost apparently, but it strikes me that the figures are hypothetical. My last few hospital appointments have been covered with a text reminding me that a missed appointment 'costs the NHS £160' so please let them know if unable etc etc. I can't see how in most cases there would be more than a minuscule cost, as they are seeing many other patients before and after. Specialist treatment appointments with equipment could rack up costs if the booked patient decides not to arrive.


SHJ

reynoldsno1
6th Nov 2014, 21:17
https://www.youtube.com/watch?v=zG2DVoRP86g

radeng
6th Nov 2014, 21:48
Radeng went to dentist for a check up, mentioned problems with two molars. X ray taken, abscess diagnosed, and because of all the various drugs I'm, on referred to GP for an applicable antibiotic. One week course, not quite cured, and another week prescribed. Still an adjacent dodgy tooth so another visit to dentist and another X ray. Dentist says that he cannot be sure the particular tooth is guilty but it may be: on the other hand, the X ray suggests that the sinus may be infected. Referred back to doctor, with a suggestion that a referral to an ENT specialist may be justified.......

So see doctor 1520 Friday........

Actually been quite fast. I have found that on the very few occasions when it has been urgent, they have reacted suitably rather than send me to hospital....

Not that it would have anything to do with when I went for a blood test early one Friday morning and the nurse said that they were having a 'Pimm's party' on the Sunday afternoon.......and after the shopping but before lunch, I dropped in with a bottle of Pimm's for them!

Dushan
6th Nov 2014, 21:48
For you Brits, what happens if you skip the appointment? Bobbies show up with a white coat?

Probably the armed response team shows up, as they know they'd be safe, unless you have kitchen knives.

galaxy flyer
6th Nov 2014, 21:52
Dushan, 11Fan, Con-pilot,

Remember, NHS is "free" except for the waiting and the taxes.

GF

Dushan
6th Nov 2014, 21:54
Yes, very familiar with the "free healthcare" concept.

con-pilot
6th Nov 2014, 22:02
Remember, NHS is "free" except for the waiting and the taxes.


Oh, right, forgot that, it is petrol that is so expensive. :p


Down in the $2.50s a gallon here now, forecasted to go even lower the next few months.

Deepest Norfolk
6th Nov 2014, 22:04
I have worked with Doctors. There a some very fair chaps and chapesses who have a calling. There are many who won't do a thing unless it involves extra money in their back pockets. These are to ones who will be diagnosing many more cases of dementia and asthma.

A reason you can't get to see your GP is that they are all out working for companies like the one I worked for which do referral management, ie checking that GP referrals to hospital follow the correct pathway and all the correct information is there. For this they will get in the region of £85 per hour (pensionable) on top of their GP salary. That's why they are never in their surgeries and you and I can't get to see them!

I mean, I work for money but some of these folks are taking the p1ss.


DN

racedo
6th Nov 2014, 22:11
Last time went to see the Doctor he just said I would have thought you had died or moved away if I didn't see SWMBO and the Littlies occasionally.

Do remember about 5-6 years ago having to go back twice because they refused me an anti biotic the 1st time on basis of cutting down use of, previous time had been about 5 years before.

A friend is a GP and they refer to some regulars as Heart Sinks because that is what happens when door opens and they walk in. Lots seem to google what they have as well and her best was telling a guy that there is no way he could have the condition unless he was 6 months pregnant.

Democritus
6th Nov 2014, 22:43
We have lived in our present house 20 miles SW of Aberdeen for the last 20 years and the GP service in our local village is one reason why we don't downsize and move somewhere else. I decided tonight that I need to see my GP. Tomorrow morning I shall roll up at the surgery at 0945 knowing that I will see him. Probably won't have to wait more than 30 minutes.

As long as you turn up between 0830 and 1000 any weekday you will be seen. Appointments available in the afternoons. Fantastic service!

Tankertrashnav
6th Nov 2014, 23:15
Con pilot wrote

Thanks to all of you for letting us know what life will be like under Obamacare.

Nine years ago I got up in the night to have a pee and noticed blood in my urine (actually urine in the blood would be more accurate). The sequence went like this:

0900 ring GP and described what had happened.

GP rings local hospital and rings back to tell me to go in and check in at urology, which I do that afternoon.

Urology decide that they'd better have a peek, which they do the next morning.

I wake up later and my consultant informs that he has removed a growth from my bladder which was 95% likely to be malignant. Tests later in the day confirm it was.

I spend 3 days in hospital and am then discharged, with my programme of chemo and radiotherapy clutched in my hand.

I do the above over the next few months, then start on a sequence of aftercare checks, first 6 monthly, then annually, which will continue for the rest of my life.

It would of course be untrue to say this was all free, because like everybody else I paid NHS contributions all my life, but the point is, I'm not worrying about a cap on my insurance, or the premiums going up because of my condition (which it certainly has done when I've purchased private health insurance for foreign travel) In fact as Im over 65 I dont pay any more NHS contributions, even if I happen to land a highly paid job..

Speak as I find, I've never had the slightest problem with the NHS. Good luck with your new health service which you all seem to call Obamacare for some reason ;)

ricardian
6th Nov 2014, 23:29
Democritus said We have lived in our present house 20 miles SW of Aberdeen for the last 20 years and the GP service in our local village is one reason why we don't downsize and move somewhere else. I decided tonight that I need to see my GP. Tomorrow morning I shall roll up at the surgery at 0945 knowing that I will see him. Probably won't have to wait more than 30 minutes.
As long as you turn up between 0830 and 1000 any weekday you will be seen. Appointments available in the afternoons. Fantastic service!

Same here, small island (Stronsay, Orkney) with 500 inhabitants, one GP, 2 community nurses and a practice manager/receptionist. Walk-in clinic Mon, Tue, Wed, Fri, Sat 0930-1030 with afternoon appointments if required. Had a scare a couple of years ago (blood in stools at 7am), saw GP at 0930, hospital appointment 3 days later, day surgery 1 week later for endoscopy (both ends). Nothing untoward found but repeated 6 months later and now get a 5 yearly colonoscopy. My late wife had been ill with COPD for some months, can't fault the medical care and especially the home carer who called in twice a day to help my wife with bathing, make the bed, etc. Nurse called in at least once a week to check all was OK. Our GP makes home calls 24/7 - once within 10 minutes of the nurse ringing the surgery because she was not happy with wife's breathing.

bcgallacher
7th Nov 2014, 00:30
The Scottish NHS seems to work better than the English and Welsh. Being out of the country for years I had lost my entitlement to free treatment so had private health insurance. When diagnosed with prostate cancer 5 years ago I was treated privately in Edinburgh and was well pleased with the standard of care. I have now had a re- occurence of the problem and receiving treatment by the NHS at the Western General hospital in Edinburgh. The facilities are excellent and the attitude of the staff is confidence inspiring.
Some of our American posters are disparaging about the NHS - perhaps Obama care will reduce American child,infant and maternal mortality below that of poverty stricken Cuba.It might also raise the U S in the world health care league - at present it is about 37th. The US ignorance about national health services worldwide is appalling. How on earth they can support a system that costs the 2 1/2 times the British costs for worse outcomes I do not know. Of course there are failures from time to time - just as in the US - Joan Rivers? Do not forget it is the worlds third biggest employer after the Chinese Army and Walmart.

Dushan
7th Nov 2014, 00:37
It might also raise the U S in the world health care league - at present it is about 37th. The US ignorance about national health services worldwide is appalling

That must be why the worlds richest people come to the Mayo hospitals, the Cleveland Clinic, and the like.

Maybe you can suggest they go to Cuba, or NK.

galaxy flyer
7th Nov 2014, 00:56
BCGALLAGHER,

Depends greatly on how you measure the outcomes--US outcomes for things, like prostrate cancer are much better than elsewhere.

Cancer survival US vs. UK (http://pop.org/content/cancer-survival-rates-far-worse-great-britain-us)

GF

Keef
7th Nov 2014, 01:43
If you have the money, the US system is excellent. I know some US doctors, and they are without doubt at the pinnacle of the profession.
If you don't have the money...

If I want to see my GP, I can book an appointment online - no need to phone. I could book it at 3am if I felt that way inclined (not the appointment, only the booking). Usually it's for the same or next day. That isn't always the way in the UK, but it's been my experience wherever I've lived.

Earlier this year I developed a lump in my neck, saw my GP the next day, was called to the local hospital two days later, diagnosed, and sent to a different hospital that specialised in the after-care needed. The surgeon removed my thyroid, the lump, 12 more secondaries, and various other damaged bits. Cost to me = zero (well, actually, £2 for the hospital car park each visit).

After the op, a series of specialists came to see me - endocrinologist to check parathyroid and calcium levels; speech therapist; physiotherapist, and several more. Most pronounced "all is well". Physio reported that my right accessory nerve had been eaten by the tumour, and that without physio, my right shoulder would gradually collapse as the trapezoid muscle wasted away.

I Googled the subject. I found that in the USA, many people who have what I had don't pay the extra for physiotherapy (or even the checks to see if they need it) and end up with collapsed shoulders (very painful), and then try to sue the surgeon - generally without success. In the UK, they get the physio they need (it's hard to say no!) and most have no further problems.

The exercises are boring, but they take no more than 20 minutes a day and are better than the alternative.

I will have to take thyroid hormone replacement tablets for life. Cost to me = zero.

In between, this year I've had the 'flu jab, shingles jab, general health check, and cholesterol check. Nobody mentioned asthma or dementia.

galaxy flyer
7th Nov 2014, 01:55
I will have to take thyroid hormone replacement tablets for life. Cost to me = zero.

So you don't pay taxes or whatever the NHS charges are? How does that work? I have had several broken bones, never an issue getting physical therapy. If someone here doesn't get it, it's because they refused it, not because they were refused.

GF

cdtaylor_nats
7th Nov 2014, 07:44
The practice I use are having a 3 for 1 sale. I went in to see the nurse to get blood drawn for my diabetes check up and while I was there I was given a flu jab and because I still had another arm I got a pnuemonia vaccine as well.

I suspect its the nurses act of rebellion against the receptionists who wont let you book two things at once.

bcgallacher
7th Nov 2014, 08:30
Dushan - you hit the nail right on the head when you say ' The worlds richest people' the system you have is profit based not need based. I presume you fit in that category and can afford the Mayo clinic,most of your fellow citizens cannot. Better to have good health care for all rather than the best for the rich few. Medical bills are the cause of the greatest number of bankruptcies in the USA. Considering the relative poverty of Cuba they have done well with their health care system and they provide doctors as part of their overseas aid programme. They have over 400 personnel working on the Ebola epidemic in Africa at this time. Some years ago a Cuban doctor vaccinated a large group of us in Nigeria with Meningitis B vaccine When only A and C was available - it had been developed in the Finlay institute in Cuba.
The fact remains that a wealthy country like the US should not be so far down the list of world health care with infant and child mortality worse than some African countries - do a little research .

bcgallacher
7th Nov 2014, 08:50
Galaxy flyer - you do not have to pay for physiotherapy in the US? Many people - 30% is a figure I have seen, have no health insurance in the US, if you have a serious illness how do you pay?you cannot get insurance if you have a serious illness . You can be capped for long term illness. None of these things apply to the NHS. You obviously have never had to use the UK NHS - even as a foreigner if you have an accident you will not be asked for payment,even the ambulance that picks you off the road is part of the service - as an aside it is generally accepted that an ambulance should be on site in a maximum of 7 minutes. I have used the American system and I know which I prefer. The NHS is free at the point of delivery but it is paid for from National insurance contributions .In the US who pays for the patients that receive life saving treatment at inflated costs who cannot pay? - the increased charges to those who can, pay for those who cannot. Private health care is available to all who can afford it in the UK - like the US many come from overseas to use it.

bcgallacher
7th Nov 2014, 09:00
The Washington based Commonwealth Fund, a world renowned organisation has produced a report on Health care in developed countries. It is available on the Internet. I suggest that any American reading it will not be impressed.

Fat Magpie
7th Nov 2014, 09:26
Generally I have been pretty healthy and its been over 15 yrs since I went to a doctor in the UK but recently whilst working abroad in Germany I felt a bit off and rang up a local clinic.
My spoken german is not great yet the receptionist was very polite ( she spoke excellent English) and I was offered an appointment that day within the hour.
I went - the practice was modern,clean, efficient and they had an number of treatment rooms all with some pretty cool looking diagnostic equipment scanners etc. They put me through the works lots of scans all ok etc. I was throughly impressed. I was offered a referral to a specialist the next day, no waiting or queuing at all.

I return to the UK and then ring my local GP (its been yrs) to do a follow up, a rather rude receptionist says the next free slot is in 4 weeks...Christ

Anyhow I went and its night and day, a modern building but dirty, threadbare carpets and stains, the receptionist desk thou not that old was badly worn. papers lying everywhere, dis organised. To cap it all a large hand written poster behind the receptionist which said " we have a zero tolerance policy against aggression and violence in the health centre, any incidents will result in the police being called and barring from this practice"

The doctors surgery was dirty, dis organised paperwork overflowing everywhere. and the only gear they had was as and a blood pressure monitor and an old heart monitor machine thingy...that was it.

The comparison was night and day, strangely UK GP's are paid more than their German counterparts.
The German system is vastly superior but you pay for it via insurance or just with your credit card of you don't want to touch your insurance, then again I pay for my NHS via national insurance and general taxation.

Until you compare a foreign system to the NHS you appreciate how dire things are.
If you have a long term illness with expensive medication then the NHS is great only because its free, otherwise....

Me I'm grand now it was a passing ailment but the state of the NHS frightens me now.

Curious Pax
7th Nov 2014, 09:47
There is certainly a degree of variability between practices. Our local practice is very good - modern surgery, well kept with excellent doctors, though you can have a bit of a wait for an appointment unless it is urgent. When my mother was terminally ill last year she came to stay with us for her last couple of weeks, which involved transferring her to our practice. They couldn't have done more - I had expected transferring at that stage to cause problems, but we just handed the necessary (simple) form in at our surgery, and within a couple of hours the new GP came round to visit, having first called the GP at the previous practice to get updated. Surprisingly (to me) the records seemed to shift over pretty instantaneously too. Several home visits, including the final one just after Mum died to do the paperwork.

My father has been seriously ill this year (thankfully now under control at the moment). He is still at the practice my Mum was previously at, and although the referrals to hospital were done very efficiently (and the hospital have been quick and efficient too), their enthusiasm for taking on tasks that could be done by the hospital, but are (in theory) done more conveniently by the practice leaves something to be desired. I suspect that 'who pays for what' in the different NHS branches is at the heart of it.

UniFoxOs
7th Nov 2014, 09:53
" we have a zero tolerance policy against aggression and violence in the health centre, any incidents will result in the police being called and barring from this practice"

Ah yes, the sign you always find in places where the staff attitude is such as to genrate hostility, annoyance and despair from the customers.

Have, unfortunately, had to attend local GP fairly often recently - broken tendons, inflammation of joints etc. Never heard asthma, dementia or anything else that I would suspect be money-generating mentioned. Waiting time for appointments is around two weeks at the moment, although they have just introduced a drop-in system 0900-1030 for any urgent problems or any sudden worsening of a long-standing problem. As all the sheep are waiting there at 0900, the policy is to check in at 1020 and the waiting is then minimal.

Capot
7th Nov 2014, 10:08
One anecdote, no matter how true, should not be used to condemn a complete service.

My daughter is a Consultant, so is her husband, my wife retired recently as a Childrens' Nurse, her sister was a Consultant as was her husband, and her two sons are both Consultants.

Conversations at family get-togethers are either boring or nauseating; that aside they and their colleagues ALL share a loyalty to the NHS that is quite astonishing (see below) and a love of their work. None has acquired the hard shell that you might expect; if, in spite of their work a patient dies they feel it deeply. I have seen my daughter, as well as my wife, come home in tears because a patient died, and then get up and go back to work next day still deeply distressed.

I am now of an age when I have visited the GP twice in the last 2 years after never going there except following a bad accident. On each occasion I got an appointment within 24 hours when I described the symptoms, and on each occasion I was referred urgently to the local hospital, for a colonoscopy and then an MRI scan, and called in within 3 days for the test. The treatment and staff all the way through were impeccable.

I hear about two problems from these coal face workers. The first is the appallingly inept managers they are required to listen to. As a general rule (there are exceptions) the non-clinical middle managers are low-grade administrators with no imagination and little ability. Money is wasted by them, not the clinical staff, on a prodigious scale; their buying skills are zero as are their forward planning skills. Centralisation has not changed this; the central purchasers are just as incompetent but on a much larger scale.

Secondly, if they are not being shafted by managers, they are being attacked, sometimes physically, by the small proportion of patients who see it as their God-given right to demand priority over everyone else, treatments they don't need (good old Google) and treat clinical staff as they would treat servants if they had any. This behaviour is pretty much exclusively limited to patients from the sink estates who exist on benefits, revel in the opportunity to give someone they see as an authority figure a good kicking, and regard the local A&E Department as a second home. One, a Sikh, recently reported my daughter as an anti-immigrant racist because she would not allow him into a labour ward, in an angry and violent state, carrying a large knife. Insread of telling him to follow the rules or eff off, the managers ran a full-blown disciplinary enquiry that stressed out my daughter for 3 months. Human factors? Forget it. She's an anaesthetist and if she gets it wrong people could die. But the managers are blissfully unaware of, and uninterested in such matters. (By the way, she married an immigrant!)

Dealing robustly with these people is a sacking offence, and that goes back to the managers of course, who NEVER appear on the front-lines of A&E or the wards because "it's not my job".

But by and large I see an NHS in good shape that does what it is supposed to do 99% of the time because of the quality and training of the clinical staff, and in spite of the managers and politicians. What we need is politicians who do not talk it down as a means of scoring political points, and above all who leave it alone without new "initiatives" every 6 months.

charliegolf
7th Nov 2014, 10:21
TTN:

Speak as I find, I've never had the slightest problem with the NHS. Good luck with your new health service which you all seem to call Obamacare for some reason

Plus one.:ok:

Like many of a service ilk, I avoid the doc like the plague. He knows that, so when I do go, I get real service (recently a suggestion to have bloods, psa etc - "Because I haven't seen you in a while"), quick follow up and feedback to close things off.

CG

charliegolf
7th Nov 2014, 10:23
Nobody mentioned asthma or dementia.

Keef: perhaps they did but you forgot!:E

CG

Gertrude the Wombat
7th Nov 2014, 10:58
There is certainly a degree of variability between practices.
Wot not everybody realises, Brits as well as foreigners, is that GPs were never nationalised - they're not NHS employees, they're private subcontractors to the NHS.

goudie
7th Nov 2014, 11:13
In my dealings with the NHS (two major ops, one life saving) and the odd visit to the doctors, I have received nothing but excellent care. Same goes for the rest of my family. It ain't perfect but it's staff does a bloody good job
IMHO, often under difficult circumstances.

As I said in an earlier post, targets and tick boxes, dreamt up by politicians and management detract from the excellent job done by the medical staff

bcgallacher
7th Nov 2014, 11:19
We take our NHS for granted,most of the population never knew any other system. Be grateful for what we have,there may be a few better systems but there are many many much worse.In spite of the present governments attempts to denigrate it and cut funding further it still gives the most efficient health care in the developed world - we get more bang for our buck than anywhere else. Beware this government of multi millionaire classmates does not succeed in its attempts to destroy it and privatise it.

Capot
7th Nov 2014, 11:35
the sign you always find in places where the staff attitude is such as to genrate hostility, annoyance and despair from the customers.Yes, I've often said the same myself.

But I have had to admit that in an A&E in somewhere like Leeds in the evening the clients bring in the hostility and aggression, usually fuelled by alcohol, while the staff are required to treat them with courtesy and forbearance. If a staff member reacts as you or I would to a drunken lout with the IQ of a cardboard box, bleeding from a cut after a brawl in the street which he lost, telling you to "f*****g get on with it I haven't got all f*****g day" they will be hauled over the coals by the management.

I have no doubt that exactly the same happens in a GP surgery from time to time.

At one hospital a few years ago (perhaps now) if a child came into A&E after 2200 it was automatically admitted to the Childrens' ward for observation at least, where my wife might be on night duty, regardless of why it had been brought in. The same hospital had a policy that parents of any child in the ward was entitled to a bed near the child.

The teenage mothers would bring their children in at 2215; "He's feeling poorly in 'imself", and leave them while they went out with that week's tattooed, intelligence-challenged 17-year old boyfriend. They would stagger back at 0300, missing their knickers, and demand their bed. This beats paying a baby-sitter, of course, if Nan is unavailable (ie also out with the latest boyfriend, pissed, and dropping her knickers, too).

On one such occasion one of these junior tarts struggled up at 0800 or so, staggered to the Nurses Station, banged on it and demanded "Where's my f*****g tea, then?". It's quite difficult to remain courteous, but the staff manage it, by and large.

Flyer70
7th Nov 2014, 11:38
What the public do not realise is that any money GP's receive does not go into their pocket, but into the practice. They then have to pay the salary of their nurses and other staff , plus the cost of the building and utilities from this. They than get their income from what is left.

Fat Magpie
7th Nov 2014, 11:52
Flyer70 I agree but its the same in Germany, the Doctor also has to pay for premises and his staff salaries.

On the hostility of reception staff, I do side with them I can only imagine having to deal with some of the general public and "my rights etc" but upon seeing the sign warning of aggression I could not help but think "dear God what have we come to as a society to warrant such a poster".

Perhaps its the city where I live, some 5 yrs ago I had a minor car accident with another vehicle in a private drive, it was a 5mph bump, just a scraped wing.
I later found out the other vehicle was being used to run a small cleaning business yet my insurance flagged it up as a disability car provided free of charge. Quite common in this area, order a takeaway and wonder how the youth driving it can afford a new car on a takeaway drivers salary.
When public services are abused is it any wonder we have GP receptionists with attitude.

EDIT I should explain in the UK we have a disability car scheme ...if you are disabled you can a government grant that allows you to lease a vehicle, the trouble is that there are many genuine users who benefit enormously, there are many older users those who apply and simply hand the keys to a relative as a free car.

Dushan
7th Nov 2014, 14:16
On the hostility of reception staff, I do side with them I can only imagine having to deal with some of the general public and "my rights etc" but upon seeing the sign warning of aggression I could not help but think "dear God what have we come to as a society to warrant such a poster".



I bet you there is no need for such a sign in, let's say, Texas. Knowing that the receptionist may be packing makes everyone very polite.

Just sayin'.

Dushan
7th Nov 2014, 14:24
Dushan - you hit the nail right on the head when you say ' The worlds richest people' the system you have is profit based not need based. I presume you fit in that category and can afford the Mayo clinic,most of your fellow citizens cannot.

No I cannot afford the Mayo Clinic any more than I can afford a Ferrari, or a mansion in the expensive part of town, or a thousand other things that rich people have. I do OK, but I am not rich by any stretch of imagination.

The fact is that I accept that and move along. Some people have less and some have more. Why should health care be any different?

Gertrude the Wombat
7th Nov 2014, 14:44
Why should health care be any different?
Ah! - and there you have it.

SpringHeeledJack
7th Nov 2014, 14:51
I bet you there is no need for such a sign in, let's say, Texas. Knowing that the receptionist may be packing makes everyone very polite.

Just sayin'.

Why would any receptionist be carrying a weapon ? Anywhere, except a high security facility ??? In the UK, the aggression is more in the form of tone, escalating to shouting and a very rare physical attack in GP's surgeries.

A&E at a hospital is another matter, drunk, drugged, mentally ill, shocked, scared etc persons lashing out at staff on a friday or saturday evening is more the norm and a sad reflection on society. If the citizens of the UK had to pay for medical insurance they would perhaps be less inclined to treat the mostly decent staff in a more respectful way.



SHJ

Fat Magpie
7th Nov 2014, 15:42
?v=wihZOJJjZKo
https://www.youtube.com/watch?v=wihZOJJjZKo

At 57 seconds in thats the A&E department of a hospital 3 miles from me one friday night.

Dushan
7th Nov 2014, 15:49
In the UK, the aggression is more in the form of tone, escalating to shouting and a very rare physical attack in GP's surgeries.




And in Texas everyone is very polite and respectful.

Different strokes...

Toadstool
7th Nov 2014, 16:13
Police release name of Ben Taub General Hospital murder-suicide shooter | abc13.com (http://abc13.com/news/police-release-name-of-hospital-murder-suicide-shooter/363277/)

Different strokes indeed.

Dushan
7th Nov 2014, 16:17
But no patients were disrespectful to staff, were they?

Toadstool
7th Nov 2014, 16:19
Workplace Violence Against Nurses | Lawmakers & Hospitals Take Action to Curb Violence Against Nurses (http://www.nursinglicensure.org/articles/workplace-violence.html)

It seems that, in addition to British dickheads in hospitals, some Texans do it in a more polite and respectful manner.

Toadstool
7th Nov 2014, 16:23
Keep going Dush:ok:

Tankertrashnav
7th Nov 2014, 16:31
Further to my last post. Had my quarterly appointment with the podiatrist today at 1145. My ingrowing toenail was playing up and needed attention. She trimmed off the offending part and said I needed antibiotics as my big toe had become infected. No need for a trip to the doctor apparently, as she undertook to ring the surgery and arrange for a prescription.

I then went shopping with Mrs TTN and as we walked in the door at 1325 the phone was ringing. It was the surgery calling to say my prescription had been faxed to my usual chemist, and I could collect the antibiotics at any time.

As I said before, I personally can't fault the NHS, and today's experience has just reinforced that view.

Dushan
7th Nov 2014, 16:37
Workplace Violence Against Nurses | Lawmakers & Hospitals Take Action to Curb Violence Against Nurses (http://www.nursinglicensure.org/articles/workplace-violence.html)

It seems that, in addition to British dickheads in hospitals, some Texans do it in a more polite and respectful manner.

Probably because the hospital was declared a "gun free zone".

Toadstool
7th Nov 2014, 16:46
Yep, we have gun free zone hospitals too in the UK. Shouldn't you be demonstrating against such a scandelous infringement of your rights?

If I were you, I would demand to take your gun into a hospital.

Anyway, apart from the delicious opportunity to completely blow someone out of the water in just one click of the mouse, back on track.

I had the opportunity to use a mid-west hospital two years ago. Amazing service. Saw a doctor immediately, CT scan straight away. Nurses fantastic.

Two weeks later, the embassy received a bill totalling several thousand dollars.

Dushan
7th Nov 2014, 17:28
Two weeks later, the embassy received a bill totalling several thousand dollars.

And you still think it was "free".

Someone had to pay for it, and if it wasn't you, why not? Why would you expect someone else to pay for your medical treatment? Can you walk into a Mercedes dealer and drive away in a new S550 while the embassy gets the bill? If not, why not?

Gertrude the Wombat
7th Nov 2014, 17:50
Can you walk into a Mercedes dealer and drive away in a new S550 while the embassy gets the bill? If not, why not?
It's a political choice.

We choose that everyone should get medical treatment.

We do not choose that everyone should get a Merc.

It really is that simple.

Dushan
7th Nov 2014, 17:58
What about those who would have been able to afford a Merc, of their own, if they didn't have to pay for someone else's medical treatment?

Gertrude the Wombat
7th Nov 2014, 18:53
What about those who would have been able to afford a Merc, of their own, if they didn't have to pay for someone else's medical treatment?
They don't get a Merc.

The theory is that nobody needs a Merc but everybody needs medical treatment.

Anyone who doesn't like it has the following choices:

(1) Become an immigrant somewhere else, if they can find someone to take them.

(2) Vote for someone else, if they can find someone who is willing to stand on a ticket of closing down the NHS. (Hint: that would be an absolutely guaranteed losing ticket, so there are no such candidates for any party.)

(3) Put up with not having a Merc, with the consolation that if any of their family got ill to the tune of several Mercs they'd get treated without having to pay the bills.

wings folded
7th Nov 2014, 18:55
What about those who would have been able to afford a Merc, of their own, if they didn't have to pay for someone else's medical treatment?If you pay a premium for health care and never actually fall ill, are you paying for other people's medical treatment?

MadsDad
7th Nov 2014, 19:12
If you pay a premium for health care and never actually fall ill, are you paying for other people's medical treatment?

Yes. And I spent a lot of time doing that.

And now a lot of people spend* a small amount each paying for my medical treatment.

(* Including me)

charliegolf
7th Nov 2014, 19:22
What about those who would have been able to afford a Merc, of their own, if they didn't have to pay for someone else's medical treatment?

If their contribution to the nhs were that big, they'd already have a Merc.

CG

wings folded
7th Nov 2014, 19:23
Me too. Still paying and not yet drawing. Prefer it that way round. If I was drawing, it would mean I was poorly. Don't want that.

Keef
7th Nov 2014, 19:47
It's a bit like insurance: you pay for it in case you need it.
The difference with the NHS is that the price doesn't go up if you become a higher risk.

There are some GP surgeries that fail to impress, and some where you have to wait far too long for an appointment. There are processes in place to solve those problems.

However, my GP surgery is spotless, the staff are friendly, and they've looked after me supremely well. The local hospitals likewise.

charliegolf - could be, but I think I'm still in possession of most of my faculties.

Dushan
7th Nov 2014, 19:50
They don't get a Merc.

The theory is that nobody needs a Merc but everybody needs medical treatment.



So now you're deciding for me, and telling me what I need and I don't need. Typical socialist, big government tactic.

ex_matelot
7th Nov 2014, 19:51
Since leaving the mob I have seen my doctor 5 or 6 times.
I was med discharged from the mob in 2005. The stuff I need is on repeat prescription.
2 years ago I was in agony and my wife was 7 months pregnant. We both went to the surgery for a routine checkup of my then 6 month year old lad. I described my symptoms to the receptionist and all other appointments were put on hold whilst the doctor saw me.
I had shingles. My wife was then taken in with the nurse for various tests etc.

We both emerged to a very full waiting room of threaders people waiting for their appointments. My doctor expressed surprise I did not want a sicknote as well.

Doctors directly opposite Drake main gate in Guzz.
No such thing as an allotted 10 minutes..he takes as long as it takes. Have received telephone consultations as late as 20:00 off him.

Proper doctor. Chemist virtually next door has a never ending queue of smackheads going in for their supervised methadone hits.

Gertrude the Wombat
7th Nov 2014, 19:56
So now you're deciding for me, and telling me what I need and I don't need.
Nope.

It's simple fact that if you don't have a Merc you're still alive tomorrow.

It's simple fact that if you don't have life saving medical treatment you're dead tomorrow.

What do you think the word "need" means?

OFSO
7th Nov 2014, 19:56
Apointments ? Spanish system is walk into doctor's waiting room, see how many people are there, if too many go and drink an Americano and come back later when it's thinned out a bit. Repeat as often as necessary.

Must admit it's different with specialists, this is where you ask receptionist what time can I see the man ? and she gives you an "hour" on the following day.

con-pilot
7th Nov 2014, 20:05
Tanker


Speak as I find, I've never had the slightest problem with the NHS. Good luck with your new health service which you all seem to call Obamacare for some reason

I'm glad you've never had a problem with the NHS, but many have posted just the opposite, so I can only go by what I read here from your fellow countrymen and women.

As for why the ACA is called Obamacare, I really don't when or who started that, I do know that President Obama is happy that it is called Obamacare and has used that many times himself.

The main problem with the ACA s that it was complied, written and passed without any contribution from the Republican Party, in fact the meetings room where the Democrats formed the bill were locked and no one but Democrats were allowed into the meetings.

Then it was passed with not a single Senator or Congressman knowing what was in the bill. Not a single Republican member of the House voted for the ACA.

One of President Obama campaign promises was that 'No bill would be signed into law by him until it had been posted on e-span for at least a week.' A promise that I thought was an excellent idea.

Of course President Obama lied and the bill was rammed though as fast as possible, with no debate and signed into law as fast as President Obama could.

The entire ACA (Obamacare) is turning into a complete multi-billion dollar disaster.

There are some good things in the ACA, such as pre-existing medical conditions being covered and a few more, but there is so much un-workable things in the ACA that we must step back, defund the ACA and come up with something that both parties can agree on, then make the changes and either pass a new medical care act or refund the old version of the ACA with the changes included.

The reason the Republican made history in the election last Tuesday was that 100% of the Republicans that were elected, was due to their promise that they would end Obamacare or change it.

Dushan
7th Nov 2014, 20:11
Nope.

It's simple fact that if you don't have a Merc you're still alive tomorrow.

It's simple fact that if you don't have life saving medical treatment you're dead tomorrow.

What do you think the word "need" means?

I think that you are still deciding for me. I may choose to have a Merc today and be dead tomorrow.

But that would be my choice.

Not yours.

Not Nanny State's.

Just because I don't need something doesn't mean I can't, and shouldn't, have it just like if I do need something doesn't mean that I should automatically have it or get it.

ex_matelot
7th Nov 2014, 20:16
My Doctor always has trainees in with him also. I am always asked if I want them out when I see him. Thus far I have never asked they not be there.

I have however seen a few chav mothers kicking off with the receptionist when said chav mother objected to a medical student being present at chav mother's kid's appt.

"U'man rights" and data protection act (?) amongst some of the most memorable arguments.

Sadly, I think the kids of they are future methadone prescription candidates.

Watching a 2yr old being rebuked for trying to pull a poster off the wall and him responding effing & blinding says a lot about this country.

pulse1
7th Nov 2014, 20:28
Problem is that the Mercs go to those who are messing the system up, the managers.

Gertrude the Wombat
7th Nov 2014, 21:01
I think that you are still deciding for me.
No, I was explaining what I think the word "need" means in English. It might very well mean something different in American of which I am ignorant - so many words do - which is why I was trying to clarify.

I have already agreed with you that what a society chooses to do, or not to do about meeting needs is a political choice. I was just trying to clarify what on earth the concept of "needing" a Merc could possibly mean in English.

bcgallacher
7th Nov 2014, 22:20
Dushan - you really haven't got a clue. Con Pilot - are you really so dim that you have not realised that the NHS is one of the biggest organisations in the world so it is likely that among the millions treated every year there will be some unhappy. No doubt all Americans who are treated privately in the US are all completely satisfied. Perhaps the huge sums paid by health professionals in the US for malpractice insurance is not really necessary. If you are going to debate a subject first try to be rational.

Dushan
7th Nov 2014, 22:30
There is nothing rational about having to pay for someone else's needs.

OTOH, I never said one "needs" a Merc. It is a simple desire to have, however given the confiscatory nature of taxes to pay for someone else's "needs" one is not able to buy it.

Is that fair?

con-pilot
7th Nov 2014, 22:48
Con Pilot - are you really so dim that you have not realised that the NHS is one of the biggest organisations in the world so it is likely that among the millions treated every year there will be some unhappy.

I have not insulted you or anyone else here, so why are you insulting me?

I only stated that I have read negative remarks by people here, who have had bad experiences with the NHS, that is why I ask what I asked.

And the fact that the British NHS "is one of the biggest organisations in the world", considering the size of the population it serves, shows that there is something very, very wrong.

Shack37
7th Nov 2014, 22:59
There is nothing rational about having to pay for someone else's needs.

OTOH, I never said one "needs" a Merc. It is a simple desire to have,
however given the confiscatory nature of taxes to pay for someone else's "needs"
one is not able to buy it.

Is that fair


FFS, you´re paying for your own needs as is everybody else. The fact that some may use it more than others as they get older (as we all do) or become seriously ill is neither here nor there. It´s there for everyone.

What the **** has a Merc got to do with anything?

Dushan
7th Nov 2014, 23:02
Shack, go back a few posts and you'll see what the Merc has to do with all this.

No problem paying for my own. Big problem paying for someone else's.

VP959
7th Nov 2014, 23:03
Like a fair few here, I expect, I've lived and worked in a few places around the world, and have occasionally had to use medical facilities.

The best treatment, in terms of speed and efficiency, was seeing a dentist in France. The treatment was very good, I was seen immediately, and the payment was modest (this was pre EU days, when Brits had to pay for treatment in France).

Next best was the Middle East (specifically Manama, Bahrain) where I received free treatment for an injury following an accident.

Middle of the group has been the UK NHS. I've had four lots of surgery in the UK, one in Scotland under the Scottish NHS, three in England. The Scottish NHS was more focussed on preventative health care, but the surgery was not that well managed. The the three operations I've had under the English NHS were nothing short of superb, and included extensive physio in two cases, one to regain shoulder function following the surgery, the other to regain knee movement and function.

My worst experiences were two occasions when I needed medical care when working in the US. One case was illness resulting (as it turned out) to a shellfish allergy (I had no idea I was allergic to shellfish, and fell ill a couple of days after starting work at Pax River). The other case was an accident where I received a cut that needed stitches.

In the first case I was lucky, the USN took me to the emergency room (so I didn't have to pay for an ambulance), but I was, by then, pretty ill. I was faced with an admissions clerk who point-blank refused to do a damned thing until she'd swiped my credit card.

The second time in the US I walked into the emergency room myself, understood the system and just handed over my card before sitting and waiting for several hours before someone got around to seeing me and stitching up the cut. They did a good job, but frankly it was impersonal and clearly a business transaction, rather than vocational health care.

Overall I prefer the UK NHS, warts and all. Sure some of the facilities are a bit stretched and tatty, but the emphasis is on medical treatment and care, not collecting your cash upfront before being seen. Sure I've experienced delays in seeing my GP, but I know that the same GP will run out the door to go and see a critical patient, so I'm happy to accept the priority decisions they have to make.

Finally, I know I've paid for health care all through my working life, and have rarely needed it, but I also know that I, and my family, can now have access to any treatment they need without having to be concerned about payment, and now that I've retired I don't make any further payments towards the NHS.

Often NHS treatment is better and faster than private health care too. A few years ago my father in law (20 odd years older than me, who's had BUPA private health care insurance for decades) needed knee surgery. At pretty much the same time I needed shoulder , but I didn't have private health care insurance.

As it happens I was seen first and had my surgery around a month before he did, and I had 6 weeks of follow up physio, all on the NHS. He complained at the time that he'd been paying high health insurance premiums to get fast treatment, yet I'd managed to get faster treatment just by using our NHS.

Sure the NHS is an insurance scheme, in effect, but I don't begrudge that. My mother has had a couple of major surgeries recently, and she's not paid into the NHS for decades. I don't see this as unfair, it's a way for those of us who can pay to ensure that everyone in the country has access to good treatment that is free to them at the point of use.

Here this is not political. It may well have been established decades ago by a Socialist government, but all the political parties here, of whatever flavour, are ardent supporters of the NHS.

racedo
7th Nov 2014, 23:05
Yep, we have gun free zone hospitals too in the UK. Shouldn't you be demonstrating against such a scandelous infringement of your rights?

If I were you, I would demand to take your gun into a hospital.

Anyway, apart from the delicious opportunity to completely blow someone out of the water in just one click of the mouse, back on track.

I had the opportunity to use a mid-west hospital two years ago. Amazing service. Saw a doctor immediately, CT scan straight away. Nurses fantastic.

Two weeks later, the embassy received a bill totalling several thousand dollars.

Friend of one of my cousins, whom I know well, has a son married with kids in one of those flyover GOP states, she was visiting and came down with Pneumonia. She had travel insurance but irrespective of that she went into hospital and aomost felt she was on a conveyor belt in the way after seeing one specialist she was in xray and then seeing more.

Spent 4 hours in the hospital and pretty much saw everybody she needed to have seen plus left with required prescription in hand.

In NHS she reckons 3 weeks and even going private in UK she reckons a week.

Shack37
7th Nov 2014, 23:13
Apointments ? Spanish system is walk into doctor's waiting room, see how many people are there, if too many go and drink an Americano and come back later when it's thinned out a bit. Repeat as often as necessary.

OFSO
Up here I just go on the website, pick day and time, waiting time zero, glass of White and a bun after.:ok:

bcgallacher
7th Nov 2014, 23:20
Your last statement is a bit odd Con Pilot - the NHS serves 63 million people - how big should it be? I have just done a little research - according to the AMA journal something like 225,000 people die due to malpractice in the US on an annual basis and there are about 85,000 malpractice suits filed every year.

con-pilot
7th Nov 2014, 23:25
Your last statement is a bit odd Con Pilot - the NHS serves 63 million people - how big should it be?

Well, that is my question as well. You said it was and I quote;

the NHS is one of the biggest organisations in the world

That to me seems an overkill to service only 63 million people, one of the biggest organizations in the world.

Perhaps I did not understand you.

Tankertrashnav
8th Nov 2014, 00:14
Dushan. Do you agree that people who are in dire medical need but who do not have the wherewithal to pay for treatment through no fault of their own deserve our assistance? I give as an example someone born with a congenital incurable condition to poor parents. They didnt choose their situation, any more than you chose to be born healthy into a wealthy first world country rather than the back streets of Calcutta. Life is a lottery, and I see nothing wrong with the state putting its hand in my pocket to help out people such as I have described who dipped out in life's lottery.

Where I would go along with your sentiments is that I dont wish to extend the same help to idle shirkers and malingerers, but that's a fault of how the system is run, not of the system itself.

Con-pilot - thanks for the explanation. seems like Obama had an opportunity to introduce into the US a health service along the lines of those run by virtually every other first world country I can think of, and screwed up bigtime!

Dushan
8th Nov 2014, 00:20
I see nothing wrong with the state putting its hand in my pocket to help out people such as I have described who dipped out in life's lottery.

I do. The state has no business in my pockets. I will dip into my pockets to help the misfortunate, as I see fit, not some bureaucrat.

seems like Obama had an opportunity to introduce into the US a health service along the lines of those run by virtually every other first world country I can think of, and screwed up bigtime!

He screwed up because he messed with a perfectly good system trying to introduce socialized medicine where it does not belong, not that it belongs anywhere, for that matter.

Tankertrashnav
8th Nov 2014, 00:47
I do. The state has no business in my pockets.

And yet I assume you approve of the state putting its hand in your pocket to pay for defence spending? The US spends a higher proportion of its GDP on defence than any Western country and is only exceeded by a small number of Middle Eastern countries.

Perhaps extending your desire to keep all spending in private hands you would approve of the immediate disbandment of all US armed forces, and the protection of the country handed over to a well armed and well regulated militia?

Toadstool
8th Nov 2014, 01:31
Hey Dush

I have a big spade here if you want to keep digging. :ok:

If I were allowed to have a gun, and a barrel full of fish, this would be so easy.

bcgallacher
8th Nov 2014, 02:00
Dushan - from your statements I understand that you do not have any health insurance as any insurance scheme involves those who do not claim paying the bills of those who do. It appears you had not yet worked that one out . Obviously you do not have auto insurance,house insurance or any other insurance as each involves the same principle. You must be a very wealthy man to be able to cover health care,auto accident damage and fire or flood damage to your home.Did you know that if you have house contents cover it would pay for loss of your firearms as long as you list them?

bcgallacher
8th Nov 2014, 02:09
Con Pilot - if the UK system is too big then the US system must be even bigger per head as our costs per head are 1/4 of the US. Also the US Commonwealth Fund lists the UK NHS as the most efficient in the world - the US system is rated tenth. I think the NHS must be doing something right. Your attitude of 'Pull up the ladder I'm on board' does you no credit - most of your fellow citizens do not subscribe to that philosophy in my experience.

bcgallacher
8th Nov 2014, 02:13
Toadstool - I agree wholeheartedly with your last post - it is a bit pathetic really.As I have stated in another post it is a case of trying to defend the indefensible

bcgallacher
8th Nov 2014, 02:33
Racedo Your statement regarding your relative with pneumonia is nonsense. 3 weeks is a joke. Just asked my wife who is a nurse practitioner in a local NHS practice. A walk in would be treated in her clinic if it was mild, if severe would be in hospital in less than an hour. There is a good chance that you would be dead if not treated for 3 weeks.
In the last few weeks I have had two consultations with a cancer specialist,one MRI scan and two CT scans and start 20 radiotherapy sessions on the 24th. They even postponed the treatment at short notice due to a previously arranged vacation. None of this will cost me a penny ,the consultations and scans were performed in excellent hospitals with state of the art equipment. At last count I have visited 63 different countries - usually working for periods ranging from months to years and I would not swap the system we have. Due to the fact that I was years out of the country I lost my entitlement to NHS care and had to finance my own insurance. This cost more with time limits for treatment and no cover for existing conditions. I know which system I prefer.

Dushan
8th Nov 2014, 04:51
Dushan - from your statements I understand that you do not have any health insurance as any insurance scheme involves those who do not claim paying the bills of those who do. It appears you had not yet worked that one out . Obviously you do not have auto insurance,house insurance or any other insurance as each involves the same principle. You must be a very wealthy man to be able to cover health care,auto accident damage and fire or flood damage to your home.Did you know that if you have house contents cover it would pay for loss of your firearms as long as you list them?

I think you are missing my point. All the instances you listed involve me buying the insurance that I choose to. All other participants in that scheme pay into it or are not covered.

The government run healthcare scam forces me to pay but also covers people who do not pay. Someone here, may have been you, even bragged how he no longer pays into it because he reached a certain age. How is that fair?

Dushan
8th Nov 2014, 04:55
And yet I assume you approve of the state putting its hand in your pocket to pay for defence spending? The US spends a higher proportion of its GDP on defence than any Western country and is only exceeded by a small number of Middle Eastern countries.

Perhaps extending your desire to keep all spending in private hands you would approve of the immediate disbandment of all US armed forces, and the protection of the country handed over to a well armed and well regulated militia?

Damn right I have no problem paying for defense spending. That is one of the main reasons the government exists, to defend its citizens from foreign aggressors.

As for well regulated militia that is to keep the government from going rogue.

Win/win.

AtomKraft
8th Nov 2014, 06:33
Dush.
As far as I can tell, the main 'foreign aggressor' in the world, is......

You lot.

bcgallacher
8th Nov 2014, 07:06
Dushan - the system is fair as it applies equally to all. On retiral you no longer pay National insurance contributions from your salary. With regard to payments to government without your consent - you do pay other taxes such as income and sales taxes which are deducted from you without consent and spent on things you do not approve. The British NHS provides better outcomes for less money than the US system - fewer of our children die,we live longer - what is wrong with that? Just as an aside what do you think it costs the US system to treat the 250 gunshot victims that are brought to E&A every day? For those with no money or insurance the hospital picks up the bill which has to be recovered from those who can pay thus raising the cost to people such as yourself - not so different from the way socialised medicine functions.A case of from each according to their means,to each according to their needs.Not such a bad philosophy is it?

OFSO
8th Nov 2014, 07:17
As far as I can tell, the main 'foreign aggressor' in the world, is......
You lot.

Aha ! The world's best-kept secret has been exposed at last. Canada's plans to take over the planet......

Gertrude the Wombat
8th Nov 2014, 09:02
Dushan. Do you agree that people who are in dire medical need but who do not have the wherewithal to pay for treatment through no fault of their own deserve our assistance?
There is no such concept for the right-wing American.

If someone chooses to be too poor to pay for medical treatment that is their fault - the opportunities are there, anyone who isn't a millionaire has simply chosen to be lazy.

Capot
8th Nov 2014, 11:11
What I think our trans-Atlantic friends don't understand is that the size of the NHS in terms of staff numbers is not large relative to the task it has, and that the number of people who are genuinely and justifiably dis-satisfied with the service and treatment it provides is miniscule relative to the number whose experience leaves them happy and better.

Being British, we excel at looking at the faults in the NHS, which do exist, of course, rather than boasting about the fact that it is hugely successful, staffed by the most dedicated and skilled clinicians in the world, (OK, not me but I declare an interest), and achieves miracles every day of the year. In the USA, for example, a similar service is only available to the very wealthy and insured, and I suspect that most of those who despise it fall into that category.

In a way, it is because we know that it is so fundamentally fantastic that we feel free to discuss its faults. But don't interpret that as meaning we don't like it.


PS.....As for well regulated militia that is to keep the government from going rogue. Shomething wrong there, Shirley? Who do you think regulates the militia, if it is regulated at all?

Gertrude the Wombat
8th Nov 2014, 13:46
Who do you think regulates the militia, if it is regulated at all?
Well, as the first duty of government - any government - is to protect its people, that must include protecting them against any random bunch of gun nutters running round playing soldiers and calling themselves a "militia".

Dushan
8th Nov 2014, 14:56
The very Constitution that says there must be a "well regulated militia", prohibits the use of military on US soil for anything other than defense against foreign enemies (Canada, Mexico:eek::eek:).

So yes, the militia is self regulating and intended to keep the rogue government at bay.

Gertrude, spot on. Anyone can achieve greatness and acquire wealth. Some choose not to.

421dog
8th Nov 2014, 15:12
Nobody, and I stress the absolute nature of this statement, nobody, who presents to an emergency room in the U.S. in need of emergent care is denied such.

We've got this law called EMTALA that mandates that such care must be provided.

I look forward to fielding such attempts at disinformation to the contrary as may be put forth by the peanut gallery in between those times I am busy seeing an icu full of patients, many of whom are uninsured, but all of whom are being afforded far better (and unfettered by government interference) care than any of the half-assed systems that you all are espousing.

Not a lot of people flying in from the Middle East to wait in line for a nhs evaluation, are there?


People come to the emergency room because they are either acutely Ill or injured, or because they lack the foresight to engage in preventive health. In the former circumstance, they are seen as quickly as their condition warrants, in the latter, they are seen when their number comes up.


We don't do wallet biopsies prior to providing care

Gertrude the Wombat
8th Nov 2014, 15:23
We don't do wallet biopsies prior to providing care
So the news stories relating the contrary that we read or hear from time to time are all made up are they?

(If they're in the Wail we could take it as read that they're made up, but these stories haven't all been in the Wail.)

OFSO
8th Nov 2014, 15:29
We don't do wallet biopsies prior to providing care

I don't know if they still do, but it wasn't unusual in my time in Germany for the stretcher to be temporarily stopped entering a German hospital, and the patient asked to pay or at the very least sign for a "Kaution" - prepayment - on the way in. Pretending to be unconscious was no use as the receptionist would wake you up to ask for money !

"Two-hernias" OFSO

421dog
8th Nov 2014, 15:33
Would be interested in any specific episodes of care being denied.

VP959
8th Nov 2014, 15:57
Nobody, and I stress the absolute nature of this statement, nobody, who presents to an emergency room in the U.S. in need of emergent care is denied such.

We've got this law called EMTALA that mandates that such care must be provided.

I look forward to fielding such attempts at disinformation to the contrary as may be put forth by the peanut gallery in between those times I am busy seeing an icu full of patients, many of whom are uninsured, but all of whom are being afforded far better (and unfettered by government interference) care than any of the half-assed systems that you all are espousing.

Not a lot of people flying in from the Middle East to wait in line for a nhs evaluation, are there?


People come to the emergency room because they are either acutely Ill or injured, or because they lack the foresight to engage in preventive health. In the former circumstance, they are seen as quickly as their condition warrants, in the latter, they are seen when their number comes up.


We don't do wallet biopsies prior to providing care

Not quite true. If you're working in the US as a foreign national they absolutely insist on swiping your credit card before treating you in the emergency room. Been there, done that (twice).

It didn't bother me, as the UK/US have a health care exchange agreement, so I was reimbursed by the UK government.

Capot
8th Nov 2014, 16:04
Gertrude

Me: Who do you think regulates the militia, if it is regulated at all?

You: Well, as the first duty of government - any government - is to protect its people, that must include protecting them against any random bunch of gun nutters running round playing soldiers and calling themselves a "militia".I fear you missed the point! Dushan said As for well regulated militia that is to keep the government from going rogue.which struck me as odd; If a militia is regulated by Government, it's unlikely to stop the same Government from going rogue, so I said...........oh, forget it.

421dog
8th Nov 2014, 16:22
IT'S THE LAW
IF YOU HAVE A MEDICAL EMERGENCY OR ARE IN LABOR, YOU HAVE THE RIGHT TO RECEIVE, within the capabilities of this hospital's staff and facilities:
An appropriate Medical SCREENING EXAMINATION
Necessary STABILIZING TEATMENT
(including treatment for an unborn child) and, if necessary,
An appropriate TRANSFER to another facility Even if YOU CANNOT PAY or DO NOT HAVE MEDICAL INSURANCE
or
YOU ARE NOT ENTITLED TO MEDICARE OR MEDICAID

(In every hospital in the USA)

421dog
8th Nov 2014, 16:35
Not quite true. If you're working in the US as a foreign national they absolutely insist on swiping your credit card before treating you in the emergency room. Been there, done that (twice).

Bull$hit.

I treat dozens of illegal aliens each month. We provide exactly the same impeccable care that we provide to patients with insurance.

When you suggest that you would not have been treated absent a credit card swipe in any US hospital for an emergent condition, you are confabulating.

wings folded
8th Nov 2014, 17:21
Following a mishap I had in the greater Chicago region, I was admitted to hospital and treated very competently, I think. (Don't know much about medical matters, but I am still here, so they did not make a complete mess!)

No question of paying or showing proof of ability to pay. I was treated courteously, and when I asked about payment, my questions were swept aside. So, I thought, all those tales of having to pay upfront for treatment in the US were false.

When I got back home, the cascade of invoices from this hospital completely stuffed my letter box. They sent me invoices for absolutely everything except for their air that I had breathed. The invoices contained what I can only think of as belligerent payment terms. The time it took the mail to deliver them, I had already passed their payment deadline. So I then got a fairly nasty stream of follow up debt reclamation style of letter

At a different time, I had a visitor from abroad staying with me, who had a mishap and underwent treatment in a British hospital. Treatment appeared competent (at least sucessful).

There was no question of payment. Neither at the time, nor in the aftermath. It was paid for by my and quite a few others who pay National Insurance contributions.

We do that because we are nice innocent folk, who believe that people who need treatment should get treatment. We do not use capital letters to shout about it. We just get on with it, and find it normal.

421dog
8th Nov 2014, 17:36
The capital letters in the EMTALA notice are from CMS, not me.

Another facet of our health laws is the caveat that one cannot be compelled to pay beyond their means. If a patient racks up a million dollar bill, a payment plan commensurate with his income is agreed upon by the patient and the hospital. It may only be a dollar a month, but as long as the patient is making a good faith effort, he cannot be forced into bankruptcy to meet his obligations.

I don't know what to tell you about billing companies. It isn't the hospitals or the doctors that come on so strong, it's the people who are incentivized to obtain payment on their behalf, usually because patients and payors don't often feel obliged to pay up otherwise.
Same thing happens to me when I need care, so don't feel singled out.

VP959
8th Nov 2014, 17:37
Bull$hit.

I treat dozens of illegal aliens each month. We provide exactly the same impeccable care that we provide to patients with insurance.

When you suggest that you would not have been treated absent a credit card swipe in any US hospital for an emergent condition, you are confabulating.

First off, it happened to me, twice. The first time I was pretty ill with shellfish poisoning, and the guys from Pax River that took me in looked after sorting out my passport and credit card stuff for proof I could pay (I actually paid when they'd treated me). The second time I'd cut myself out sailing and presented at the same emergency room in Southern Maryland and again had to pay.

Now, I was not an "illegal alien", but was a UK guest of the US Defense Department, and was working in the US as part of a UK/US exchange programme. Under this programme there was a reciprocal health care agreement, that meant that the NHS here in the UK picked up the tab for my US health care. Not sure if that makes a difference or not, but I can only say that I did have to pay both times and then get the cost reimbursed from the UK.

421dog
8th Nov 2014, 17:45
So like I said, nobody refused to treat you. They rightly, in a fee-for-service system, asked as to your preferred method of payment, and when you provided it, as a good guy who pays his way in life, they availed themselves of it.

Nobody refused to treat you. Nor would they have refused to treat anyone else with an emergent problem, but, as a person capable of paying for his treatment, and one who, in fact had an insurance scheme in place that apparently required that you do just that, they did what was right.

Why the heck should we have any obligation to provide you with a freebie?

wings folded
8th Nov 2014, 17:49
Get someone to provide medical treatment to your key board, because your capitals were locked on for most of your 16:22 post. Needs to be looked at.

A superb side swerve, putting the focus on billing companies.

Who levied the bills in the first place? The hospital or the billing company?

I mean, please, come on now...

Dushan
8th Nov 2014, 17:59
Wings, I think he copied from somwhere, probably the hospital's web site.

As for payment, of course it was the hospital that initiated it and passed it on to the billing company. So what? It was due, regardless of the method of collection. As he said subsequently, why should you be provided with a freebie.

pulse1
8th Nov 2014, 18:03
So far this debate has focused on medical treatment for acute ailments, operations or accidents. Some of the new treatments for chronic diseases can be very expensive and will have to last for the patient's lifetime.

For example, sufferers of chronic myeloid leukaemia can live a fairly normal life on drugs which can cost over £18,000 a year. Some have already been taking these drugs for over 10 years and a 20 or 30 year life span can be expected.

I know several patients in the USA whose insurance companies have put a limit on the time they will pay for these drugs, leaving the patient to fund it themselves when that time runs out.

The NHS will go on supplying these drugs as long as the patient needs them.

VP959
8th Nov 2014, 18:06
The side swerve was away from the FACT that I was asked to prove that I could pay BEFORE I was treated. I had no problem with paying, I knew from the briefing I'd had before leaving the UK that I'd have to pay, and that this would be refunded. I wasn't after a "freebie" at all.

There was no question of treatment first, ask about payment second. On both occasions they wanted proof that I could pay BEFORE offering treatment.

Krystal n chips
8th Nov 2014, 18:10
" The very Constitution that says there must be a "well regulated militia", prohibits the use of military on US soil for anything other than defense against foreign enemies

Ah, at last the real reason for that little massacre at Kent State can now be revealed...the innocent students were in fact all insurgents intent on wreaking havoc in the Land of the ( T's and C's apply ) Free .

Our cousins will, no doubt be whooping and high fiving when they become aware that, the mercenary approach so beloved of their culture is also in place in the UK.

When my late father's eyes began to give him problems, he was referred to the Manchester Eye Hospital...the "kind" consultant said that, in essence, his condition was deteriorating ......brilliant diagnosis sunshine !...and that, whilst he could be treated, there would, sadly, be a delay due to waiting times.

If, however, he parted with the sum, for starters, of around £ 6000, he could, quite miraculously, been seen and attended to by the same mercenary quack within a few weeks...... as one of his private patients.

I understand my father "declined" this offer and "offered his opinion" to and of the quack at the same time.

wings folded
8th Nov 2014, 18:11
As he said subsequently, why should you be provided with a freebie.I was not provided with a freebie. I paid.
My overseas guest was provided with a freebie as you both charmingly put it, since he did not have to pay anything. Along with fellow contributors to our Health Service, I had paid for it. So nothing was "due". But we are like that. Generous and humane.

421dog
8th Nov 2014, 18:28
That is the mandated signage including the capitalization. I didn't do it, I just copied it directly from the CMS website.

Like I said, billing companies are jerks. I get the same treatment. Sorry.

On the other hand, we don't have a 91% mortality with prostate cancer, girls under 25 can get Pap smears, and I don't have to seduce a nephrologist to start one of my patients on dialysis.

con-pilot
8th Nov 2014, 18:40
BCG

Con Pilot - if the UK system is too big then the US system must be even bigger per head as our costs per head are 1/4 of the US

Sad to say, I agree, but not due to the costs, but it will be due to the mind boggling size of the organization of what the ACA will demand, it will make the UK NHS look like a lemonade stand.

We have already added 15,000 IRS agents to enforce the ACA law and that is just the start.

Personally I believe that we really do need some type of national health care system, but the ACA is not what we need.

wings folded
8th Nov 2014, 18:41
Like I said, billing companies are jerks. I get the same treatment.You wouldn't here. There are no bills.

MadsDad
8th Nov 2014, 18:58
421, not sure why you are quoting those numbers but for prostate cancer we don't have a 91% mortality rate either (in the UK it is 18.6% mortality within 5 years of diagnosis for prostate).

(I suppose the mortality rate is actually 100%, over the course of time. Everywhere).

421dog
8th Nov 2014, 20:35
Ultimate mortality rate WITH prostate cancer is 91% in UK (about 54% die OF the disease ultimately there)

In the US about 45% are cured, and about 10% of all remaining Pts die of the disease ultimately.

There was a popular news item about this a few years ago wherein the BBC was screeching that UK men were 6x more likely to die of prostate cancer than US men. Not strictly accurate, and I don't have all cause mortality numbers, so it's hard to compare years of useful life after diagnosis, but from a disease-free survival standpoint, the numbers look bad.

Gertrude the Wombat
8th Nov 2014, 20:40
You wouldn't here. There are no bills.
And when you do get private medical treatment and reminder bills are sent you just say "look mate, you'll get paid when BUPA have done their bureaucracy" and that's that.
There was a popular news item about this a few years ago wherein the BBC was screeching that UK men were 6x more likely to die of prostate cancer than US men.
This is actually quite a difficult one (and I don't recall what, if anything was the final answer). You can for example get a better "survival rate" by diagnosing lots more cases that were never going to kill the man anyway (something else was going to get them first). In which case your treatment isn't any better, but you've wasted all that resource on pointless diagnosis, which you could have spent on other patients.

ex_matelot
8th Nov 2014, 20:53
Con pilot - I need a recipe for veal cutlets please..sharpish!

421dog
8th Nov 2014, 21:05
Gertrude, I don't have that answer.
Prostate cancer is a pretty indolent disease in the elderly, but it's a bitch in the young. I can see from a public health standpoint how screening results in a bunch of tests that ultimately prove negative and cost the nhs a bunch of money.

On the other hand, if I'm the 50 year old guy who gets diagnosed early and is spared an horrific death (which it tends to be in the under-70 crowd, just ask Frank Zappa), I'd be happy.

OFSO
8th Nov 2014, 21:29
Everybody has to die of something. Its glaringly obvious but if a PM was done on everyone after death you'd get a whole new load of statistics.

I remember when it was discovered that far more people have gallstones than was previously registered just from people coming to their doctor with symptoms - examining skeletons of Roman soldiers proved that.

con-pilot
8th Nov 2014, 21:29
Con pilot - I need a recipe for veal cutlets please..sharpish!

The simplest and quickest to me is to make Wiener Schnitzel, which by any other name is pan fried cutlets.

Pound the cutlets out flat.

Then prepare a dry flour mixture, and a wet egg wash.

Dry; flour, salt and pepper, I add some hot Hungarian sweet and spicy paprika, if you decided to use the paprika, be careful not to use too much.

Egg wash; a couple of eggs, about a tablespoon of milk, with a wire wisk whip until blended. I also add a dash of hot sauce, just a dash mind you.

Dredge the cutlets in the dry mix, then the wet wash, then in the dry mix again. Then place the breaded cutlets on a rack or wax paper for 15 minutes.

While the cutlets are resting, get a large shallow frying pan out, pre-heat the pan on medium/high heat and after it has preheated add enough oil*, I like to use peanut oil, to cover the bottom of the pan to about 1/8 of an inch high.
.
After the oil has reached temperature, put the cutlets in the pan and cook on each side for about two minutes. Remove the cutlets from the pan place on paper towels for a couple of minutes and serve. If don't want to serve them right away and you need to keep them warm, place them on a wire rack and put into the oven at 225f degrees until you are ready serve them.

If this doesn't work for you, let me know as I have more recipes.


Good luck. :ok:

Oh, edited to add, serve with some lemon wedges.

* Some people like to use butter, I don't.

gingernut
8th Nov 2014, 21:34
The NHS is ace. Have served it, and my patient's, for thirty years now, bowing out and letting my younger and more energetic members take the mantle. My patients humble me.

My parting words of wisdom ....... balance demand against capacity.

421dog
8th Nov 2014, 21:45
At 49?

Must be nice, I just got my med school loans paid off.

con-pilot
8th Nov 2014, 21:49
Must be nice, I just got my med school loans paid off.

Well done, now you can upgrade from a 421. :ok:

421dog
8th Nov 2014, 21:59
She's old enough to vote, drinks more than the other girls, she's faster and better dressed. She's soft and cushy inside, but she's still tight where it counts.

What's not to love?

con-pilot
8th Nov 2014, 22:02
It's been a long time since I flew a 421, in fact they still had tip tanks. I loved how roomy the cockpit was for my long legs.

Very nice flying aircraft.

ex_matelot
8th Nov 2014, 22:13
Cheers Con, knew I could rely on you :)

con-pilot
8th Nov 2014, 22:23
No problem, you're more than welcome.

Let me how they turn out. :ok:

421dog
8th Nov 2014, 22:25
On the other hand, if you thought you knew how to fly one, the first time you landed one with straight legs and tuna tanks, you found out differently.

con-pilot
8th Nov 2014, 22:36
On the other hand, if you thought you knew how to fly one, the first time you landed one with straight legs and tuna tanks, you found out differently.

I never had the pleasure to fly the 421s with the clean wing and the trailing link main gear. Those changes had to be an improvement from the original design.

Even so, even the old ones were very nice flying aircraft, I preferred them to the Navajo. Which seeing I flew for a Piper distributor way back then, I kept that to myself.

Capot
8th Nov 2014, 23:16
Ultimate mortality rate WITH prostate cancer is 91% in UK (about 54% die OF the disease ultimately there)I'm not a medical statistician nor do I know the correct numbers, but from what I have read or heard about prostate cancer it's true that a lot of older men die with prostate cancer, frequently un-diagnosed and/or untreated, but relatively few die of it, not least because they receive excellent and very expensive treatment - free of any charge at the point of delivery - in the NHS, which has improved the survivability rate enormously.

But the figures 91% and 54% barely credible, so I had a look around;

The UK's ONS might be a better source. (http://www.ons.gov.uk/ons/rel/vsob1/mortality-statistics--deaths-registered-in-england-and-wales--series-dr-/2012/sty-causes-of-death.html)

That 54% appears to be 4%. By definition, how many men die with prostate cancer but not of it is much more difficult to find out.

421dog
8th Nov 2014, 23:39
Looked briefly and didn't see the statistic in question, but I welcome any correction or better info.

The bbc stuff compared people who were diagnosed with prostate cancer and ultimately died (of something), from the US and UK.

421dog
8th Nov 2014, 23:44
The short nosed ones were a joy and a bit faster than subsequent models.
Giant Electric cowl flaps were a bit strange though.

I really only embarassed myself the first time I landed with paying passengers about 6 inches above the runway and there wasn't a trailing link to make me look like I knew what I was doing.

bcgallacher
8th Nov 2014, 23:47
Why do we live longer than Americans if the NHS is so bad? The simple fact is that the longer men live the more likely they are to have prostate cancer when they die - not of prostate cancer but with prostate cancer. I start 20 radiotherapy treatments on the 24th. My GP tells me something else will cause my death before the cancer does. The plain fact is the NHS provides good health care for all,it is in spite of its critics , a very efficient system. Our infant, child and maternal mortality rates are superior to the US system which spends 2 1/2 times as much per head as the NHS for worse outcomes. We are proud of our system and few UK citizens would exchange it for anything else.

421dog
8th Nov 2014, 23:55
Great.

You are correct, you are very unlikely to die of prostate cancer if you are age 70 at diagnosis. (And I truly wish you the best!)

It's a much different story for younger men, among whom, prostate cancer is much rarer and much more aggressive.

As for the cost, I think some of it is choice on the part of the patients, part is the fact that we are far and away the center of advancement in medicine and, by extension, medical business development.

How do you think you guys get drugs for less than they cost to develop and produce?

As for mortality stats, we do pretty well considering that we have a large segment of the population that takes a purely reactionary stand when it comes to health care.

Dushan
9th Nov 2014, 00:00
" The very Constitution that says there must be a "well regulated militia", prohibits the use of military on US soil for anything other than defense against foreign enemies

Ah, at last the real reason for that little massacre at Kent State can now be revealed...the innocent students were in fact all insurgents intent on wreaking havoc in the Land of the ( T's and C's apply ) Free .



I had to post this a few weeks ago for another ignoramus who didn't know the difference between US Military and a State National Guard.

The Kent State shootings (also known as the May 4 massacre or the Kent State massacre)[2][3][4] occurred at Kent State University in the US city of Kent, Ohio, and involved the shooting of unarmed college students by the Ohio National Guard on Monday, May 4, 1970. The guardsmen fired 67 rounds over a period of 13 seconds, killing four students and wounding nine others, one of whom suffered permanent paralysis.[5][6]

obgraham
9th Nov 2014, 00:29
Our infant, child and maternal mortality rates are superior to the US systemWe have a social problem in the US, rather than a poor maternal-child health system. Whole raft of people not getting any prenatal care -- another whole raft of them not giving a patootie about the child after it's born. Mentioning this labels one, again, as "racist".
Across equivalent populations US rates are as good as any in the world. You'll claim that is a fudging of the statistics, but in reality that is the health care system the average working family deals with.

galaxy flyer
9th Nov 2014, 00:48
Fact is the CONCORD study of 2008 showed the 5-year survival rates for both men and women for all major cancers was significantly higher in the US. Far superior to the UK, who was nearly at the bottom of OECD countries. Google it, but the full report is behind a paywall

GF

Krystal n chips
9th Nov 2014, 07:25
Dushan,

Thank you for the clarification.

Being an ignoramus, this advert confuses me.....

National Guard (http://www.nationalguard.com/)

So, they dress the part, get to operate some very expensive military hardware, get paid by the Gov't, deploy, get benefits including affordable health care, but, by your interpretation are not actually US military personnel.

That's possibly where the confusion lay with the students who encountered them.

Dushan
9th Nov 2014, 08:06
Dushan,

Thank you for the clarification.

Being an ignoramus, this advert confuses me.....

National Guard (http://www.nationalguard.com/)

So, they dress the part, get to operate some very expensive military hardware, get paid by the state Gov't, deploy, get benefits including affordable health care, but, by your interpretation are not actually US military personnel.

That's possibly where the confusion lay with the students who encountered them.

You almost had it right. I fixed it for you.

Keef
9th Nov 2014, 09:53
Hey folks, I'm an ignoramus too. I was that person who didn't know the Ohio National Guard isn't military. Walks like a duck, quacks like a duck, but isn't a duck.

The US military won't defend the US against a militia of aggrieved NRA members, but the National Guard will. I wonder who'd win.

The question is academic, because I don't think the NRA is daft enough to try to overthrow the government of the USA by force. I've already signed (many times) the declaration that it is not my intent to do so: you need not worry about me.

Capot
9th Nov 2014, 11:16
421dog

Looked briefly and didn't see the statistic in question, but I welcome any correction or better info.

The bbc stuff compared people who were diagnosed with prostate cancer and ultimately died (of something), from the US and UK

Really? Why not try again? The statistic is quite easy to find; it's in the first table on the page, "Leading causes of death in men, England and Wales, 2012" on the line headed "Prostate Cancer", in rank No 7.

To most people the number of males who are diagnosed with prostate cancer and eventually die (of something) is going to be the same as the number of males who are diagnosed with prostate cancer, period. "The BBC stuff" wherever you got that from, does not seem to be to provide good support for whatever case you are trying to prove.

The fact (from that table) is that prostate cancer was the primary cause of 4% of male deaths in England and Wales in 2012. Period. I wonder what proportion of male deaths were caused primarily by prostate cancer in the USA. I wonder if that statistic is even reliably collected in the USA, noting that to do so requires the cause of every single male death in every State to be collected and collated by a single agency. With no centralised health care system, who would take responsibility for doing that? What's more, with the well-known differences in racial propensity for prostate cancer, and the different racial demography between UK and USA, comparisons may well be skewed in any case.

Here's the link again. (http://www.ons.gov.uk/ons/rel/vsob1/mortality-statistics--deaths-registered-in-england-and-wales--series-dr-/2012/sty-causes-of-death.html)

bcgallacher
9th Nov 2014, 11:20
421 - One of the big advantages of the NHS is in economy of scale, Contracts for drug and equipment supply are on a massive scale resulting in lower pricing as with any other commercial transaction. Drug prescribing is monitored and generic drugs are recommended where possible.. It is about as efficient as you can get.Of all the advanced countries it is about the most cost effective. The system actually works,with millions being treated per year there will of course be failures and complaints. Some of the complaints are laughable,a few years ago a lady wrote a letter of complaint stating that my wife asked her whether she wanted injecting in her arm or bum - the complainant said she should have used the correct term Gluteus Maximus. We have a good system which is being starved of funding in England especially by a government that is trying to privatise as much as possible with the result that costs will rise as in the US. We are proud of our system as it also does much research,the first so called test tube baby was born under NHS treatment developed in house at no cost to the parents is just one example.
Have a look at the website for the US think tank The Commonwealth Fund - it has an analysis of the leading industrialised countries health services - the US comes last.if the profit motive is removed at the front line and need prioritised it makes for a much better service.

421dog
9th Nov 2014, 12:31
Capot, as I said, that's not the statistic in question. The data you have provided are relevant, but do not speak to the questions at hand:

What percentage of men with prostate cancer die of the disease ultimately (Kaplan-Meyer curve, not five year mortality)

And

What percentage of men who are diagnosed with prostate cancer still have active disease when they die, from whatever cause

421dog
9th Nov 2014, 12:50
I am pleased that you in the UK like your system.

We also like ours, and attempts by our government to dismantle ours wholesale and change it into something like yours are WILDLY unpopular over here.

We pay around 13% of our GDP for healthcare

The per capita income in the us is $26,964

Under Obamacare, the plans essentially have the same coverage with the exception of deductible, so, if we take the maximum oop for an individual on a bronze plan of $6350, that means that an individual is on the hook for about 25% of his total income before he has any coverage. Now there are some subsidies, but that number doesn't change, even if the government is spreading around who pays it.

Basically, we are doubling the amount we pay, losing a massive amount of choice, and putting the IRS in charge of it all.

Sounds like a great thing, right?

Tankertrashnav
9th Nov 2014, 12:54
Why do all JB threads degenerate into "he said - you said" nit picking? The one on UK gun laws has developed into an interminable silly argument about what defines a state employee in the US. This one seems to have got bogged down in how to interpret the statistics on prostate cancer deaths (whether dying with prostate cancer is the same of dying of prostate cancer, etc).

Agree to differ, guys, and move on

(My big toe is a lot less painful, by the way :ok:)

Dushan
9th Nov 2014, 13:23
Tanker, so you stopped eating cheese, soup, and red meat and started eating a lot of cherries. Your gout is a lot better now. Good to hear.

racedo
9th Nov 2014, 15:16
So, they dress the part, get to operate some very expensive military hardware, get paid by the Gov't, deploy, get benefits including affordable health care, but, by your interpretation are not actually US military personnel. I understand it.
National Guard are the State Govenors Military play thing of which he secedes control when they overseas acting within rest of US Military Command

The reason they get all the latest kit has more to do with the Senators who go to DC, they like to arrange that their local National Guard has up to date kit because
1.) They voters
2.) Looks good as they supporting military
3.) An election is always around the corner for photo opportunities

The Senators may be different party from Govenor but they all realise that support NG looks good for them all.

Reason they get all of this as because every state has a National Guard then other Senators will also seek funding for theirs as well.

Reason they get all the benefits is because same Senators want to make sure than in event one of their NG personnel are killed overseas then they treated in exact same way as military.

racedo
9th Nov 2014, 15:19
The US military won't defend the US against a militia of aggrieved NRA members, but the National Guard will. I wonder who'd win.

The question is academic, because I don't think the NRA is daft enough to try to overthrow the government of the USA by force. I've already signed (many times) the declaration that it is not my intent to do so: you need not worry about me.

Think you would find that a lot of the National Guard would also be members of NRA or understanding of them ......... i.e law abiding citizens who hold and use guns.

Tankertrashnav
9th Nov 2014, 15:20
I'm still eating red meat Dushan :ok:

T'was my ingrowing toenail I referred to!

I did have gout once, years ago - jeez was it painful!

Gertrude the Wombat
9th Nov 2014, 15:24
Under Obamacare, the plans essentially have the same coverage with the exception of deductible, so, if we take the maximum oop for an individual on a bronze plan of $6350, that means that an individual is on the hook for about 25% of his total income before he has any coverage. Now there are some subsidies, but that number doesn't change, even if the government is spreading around who pays it.
Sorry but I don't understand a word of that, and possibly other Brits won't either.

You don't make it sound like a proper national health service. A proper national health service should at least try to look as simple to the user as:

(1) if you're ill you go to see a doctor

(2) the docter gets paid out of taxes.

Looks like I'll be trying it out for myself tomorrow morning :sad:

Dushan
9th Nov 2014, 15:25
Tanker, good to know you haven't gone "full Birkenstock" on us.

Dushan
9th Nov 2014, 15:31
Sorry but I don't understand a word of that, and possibly other Brits won't either.



And neither does anyone else. It was designed that way. Remember Pelosi telling us "we have to pass ACA* in order to know what is in it".










* Affordabel Care Act AKA Obamacare.

421dog
9th Nov 2014, 15:45
it's a power grab.
Will save nobody any money, will not improve access to care at all, and will markedly decrease the choice that patients now experience regardless of their socioeconomic status.

Nuff said.

VP959
9th Nov 2014, 15:48
I did have a few goes at trying to understand how the US version of "universal health care for all, free at the point of use" (a.k.a the NHS here) was going to work, but gave up after trying to get to grips with the funding model.

I reached three conclusions:

a) The costs were exceptionally high when compared to the NHS.

b) It was nothing like the NHS in terms of the way it works or the funding model.

c) It was probably designed to ensure that the big private health insurers remained profitable.

If the US population as a whole are content to be at, or near, the bottom of the rankings in terms of health care and life expectancy amongst major high-income countries, and have the highest health care costs as a percentage of GDP, then that's fine, but I suspect that the original motives for change in the US health care system were to reduce the cost and improve the outcomes across the whole population. At the moment the US health care system looks to be grossly inefficient, in terms of cost versus outcome.

I also suspect that the compromise that's been forced on the US government, probably as a consequence of competing political and commercial lobby groups, has made the result a bit of a dogs dinner.

421dog
9th Nov 2014, 15:51
I know nobody wants to hear it, but this will have world-wide implications.

We really do subsidize the development of medical devices and drugs simply because there's nowhere else in the world that pharma can make a buck.

Look at what is happening with generic drugs now. Our major tertiary care hospital is out of Vancomycin and Calcium Chloride for God's sake.

That has everything to do with government regulatory meddling, and nothing to do with supply and demand.

421dog
9th Nov 2014, 15:54
I will only say that you are far more likely to survive if you are injured and treated in the US than anyplace else in the world.

Especially at the extremes of age and injury severity.


Period.

421dog
9th Nov 2014, 15:58
I can, without reservation, tell my indigent, gang-banger patients as well as their affluent, well-less than 1%er unit mates that they are receiving the absolute best care that is provided anywhere in the world.

Period,

Full-stop.

I challenge anyone outside of the US to make the same claim.

If they do, they are flat -out lying.

PTT
9th Nov 2014, 15:59
Do you have any evidence to back those claims up, 421?

VP959
9th Nov 2014, 16:01
I know nobody wants to hear it, but this will have world-wide implications.

We really do subsidize the development of medical devices and drugs simply because there's nowhere else in the world that pharma can make a buck.

True, the same happens here though, and the impact isn't world-wide, but restricted to high income countries.

The US (and several other high income countries) do create an environment where big pharma companies make enough money to invest in research for new drugs, treatments and devices, BUT, and it's a very big BUT, they concentrate on products that are only affordable in high income countries.

The result is that the impact isn't world wide; this will have zero impact on the majority of the world's population, who cannot afford new drugs, treatments and devices anyway.

There is a fundamental divide in health care between those who believe fervently in a capitalist model, where only those with enough income get good health care, and those who believe in an altruistic model, where everyone in the world should have access to the same standard of health care.

VP959
9th Nov 2014, 16:06
I will only say that you are far more likely to survive if you are injured and treated in the US than anyplace else in the world.

Especially at the extremes of age and injury severity.


Period.

and

I can, without reservation, tell my indigent, gang-banger patients as well as their affluent, well-less than 1%er unit mates that they are receiving the absolute best care that is provided anywhere in the world.

Period,

Full-stop.

I challenge anyone outside of the US to make the same claim.

If they do, they are flat -out lying.

If this is the case, then why is it that the average life expectancy in the US is nearly 4 years lower than for the top ranked country, yet the US spends far more than any other Western country, in terms of percentage of GDP, on health care? (evidence is here: U.S. Health in International Perspective: Shorter Lives, Poorer Health (http://books.nap.edu/openbook.php?record_id=13497))

421dog
9th Nov 2014, 16:28
Dream on, guys, we invented organized trauma care and any comparison at all demonstrates that our system is superior

http://www.rcseng.ac.uk/news/docs/FINAL%20trauma%20statement%207%20sept%2007.pdf


We invented ATLS, and it is the benchmark standard in the world.

I've been up for the past 24 hrs taking care of patients who would have died or would have been left to die, in your countries, and I'm going to go to bed for a while.

I'll be happy to entertain your inane arguments when I wake up, but I would ask that ANYONE show ANY RESEARCH that demonstrates that ANYBODY has a better trauma system than we do.

421dog
9th Nov 2014, 16:32
There is a fundamental divide in health care between those who believe fervently in a capitalist model, where only those with enough income get good health care, and those who believe in an altruistic model, where everyone in the world should have access to the same standard of health care

Makes you feel better, but we treat EVERYONE to the same high standard regardless of their ability to pay.

No rationing.

Hell, they even get to sue us if they want, even if they demonstrably had no intention of paying for their care.

VP959
9th Nov 2014, 16:35
Dream on, guys, we invented organized trauma care and any comparison at all demonstrates that our system is superior

http://www.rcseng.ac.uk/news/docs/FI...0sept%2007.pdf


We invented ATLS, and it is the benchmark standard in the world.

I've been up for the past 24 hrs taking care of patients who would have died or would have been left to die, in your countries, and I'm going to go to bed for a while.

I'll be happy to entertain your inane arguments when I wake up, but I would ask that ANYONE show ANY RESEARCH that demonstrates that ANYBODY has a better trauma system than we do.

You can cherry-pick specifics, like trauma care, to make a point, but even your own National Institutes of Health recognise that overall health care in the US is worse than for most other high-income countries, that men have a life expectancy that is just under 4 years less than in the best Western healthcare country and that the US pays more per capita, or more as a percentage of GDP, for poorer outcomes than around 17 other high income countries.

Yes, the US probably does provide good trauma care, but then as a study by the National Research Council concluded, more than half the men who die before 50 die due to murder (19%), traffic accidents (18%), and other accidents (16%). For women the percentages are different. 53% of women who die before 50 die due to disease, whereas 38% die due to accidents, homicide, and suicide. Given the above I'd expect the US to be good at trauma care, as you do more of it than most other countries.

421dog
9th Nov 2014, 16:38
If this is the case, then why is it that the average life expectancy in the US is nearly 4 years lower than for the top ranked country, yet the US spends far more than any other Western country, in terms of percentage of GDP, on health care?

Ask Liam Neeson how he's feeling about the better bottom line from single payor health care when he watched his wife die of an eminently treatable epidural hematoma (that nearly anyone in the US would have survived had they had access to the trauma system) in the midst of a busy ski resort.

VP959
9th Nov 2014, 16:39
Makes you feel better, but we treat EVERYONE to the same high standard regardless of their ability to pay.

No rationing.

Hell, they even get to sue us if they want, even if they demonstrably had no intention of paying for their care.


So, take someone like me, as an example. I was diagnosed with mild hypertension when I was around 33 years old. Since then I've been receiving preventative medical treatment to reduce my risk of stroke or cardio-vascular disease. I'm now 62, so I've been receiving this regular treatment and medication for nearly thirty years.

Would I get the same in the US if I didn't have a high enough level of insurance cover to pay for it?

Dushan
9th Nov 2014, 16:52
VP, so for the last thirty years you must have had a high enough income level to pay taxes which covered your medical care? If not why do you expect someone else's hard earned cash to cover you?

Now think, if you didn't pay confiscatory tax rates what kind of private insurance you could have had?

VP959
9th Nov 2014, 17:16
VP, so for the last thirty years you must have had a high enough income level to pay taxes which covered your medical care? If not why do you expect someone else's hard earned cash to cover you?

Now think, if you didn't pay confiscatory tax rates what kind of private insurance you could have had?

For most of my working life the NHS was funded by National Insurance payments, which also funded my state provided pension and unemployment benefits should I lose my job.

At a guess, I think the average NI payments I made during my working life were around 8 or 9% of my taxable income, but my employer was also obliged to pay in to the scheme as well.

I've no idea how that compares to the US system, but bear in mind that the NI payments I made also fund my state retirement pension and unemployment benefits should I have needed them.

Edited to add:

I've just been reading up on the costs of US health insurance, and it looks like the costs are similar to private health insurance here. Those costs are way more than I could afford for most of my working life, and more than I would have wanted to pay when I could afford it. Now I'm retired and living on a pension, private health insurance is once again unaffordable.

It's perhaps unfair to compare the US and UK systems, as here in the UK we established our NHS just after WWII, around 4 years before I was born. In 1948, health care here was much the same as that in the US, but since then we've developed a universal care system that's free at the point of use for everyone, whilst the US has developed a private sector system. We cannot reasonable expect a smooth transition from one system to another for either the UK or the US, as the established differences are just too great. The UK has become world class at providing a taxation funded health care system, but it's had more than 60 years to do this, and it hasn't been easy.

Flash2001
9th Nov 2014, 17:23
Dushan

Re: Post 162

It puzzles me that anyone sensible ever spoke (or listened) to her after she said that, except perhaps to say "Get the H**l out of my way".

After an excellent landing etc...

Dushan
9th Nov 2014, 17:30
Dushan

Re: Post 162

It puzzles me that anyone sensible ever spoke (or listened) to her after she said that, except perhaps to say "Get the H**l out of my way".

After an excellent landing etc...

Well the Democrats, and their voting base, certainly have. But luckily she has been tossed out of any power, last Tuesday.

Krystal n chips
9th Nov 2014, 17:55
so for the last thirty years you must have had a high enough income level to pay taxes which covered your medical care? If not why do you expect someone else's hard earned cash to cover you

Because we prefer not to have healthcare and the cost of a human life as just another commodity....... being available only to those with the resources to gain access as a result.

Like millions in the UK, I have used the NHS at times, as have my parents both of whom remembered the pre NHS days.....they were not happy memories.

Speaks volumes therefore about yourself that you would begrudge parting with your money to allow others less fortunate than yourself to receive treatment and, as far as possible, a quality of life.

There again, no real surprise as you can't identify a duck when you see one either.

421dog
9th Nov 2014, 19:21
far from it, chief.

We pay more for the best and don't bitch about paying extra so that nobody dies on the doorstep.

You, however, are happy with functional rationing to keep costs down

chacun à son goût

VP959
9th Nov 2014, 20:04
far from it, chief.

We pay more for the best and don't bitch about paying extra so that nobody dies on the doorstep.

You, however, are happy with functional rationing to keep costs down

chacun à son goût

But all of your own country's research (not research from outside the USA) shows that you pay more and have poorer health outcomes, so how can that be "the best"?

As I understand it, it was the poor standards of overall health care, across all sectors of US society, that has been the driving force behind making the recent changes. Your own countries statistics show, beyond any reasonable doubt, that the USA spends more per capita on health care, yet has poorer overall outcomes (in terms of mortality rates, preventative medicine etc) than most other high income countries.

If you can show figures to support your statements then please do, because it seems the bodies that monitor and assess the quality, effectiveness and value for money of your own health care system seem to have research data that don't align with your view.

421dog
9th Nov 2014, 20:13
Really. Is that what you understand?

You should stop listening to Piers Morgan.

I challenge you to refute directly a single statement of mine.

VP959
9th Nov 2014, 20:27
Really. Is that what you understand?

You should stop listening to Piers Morgan.

I challenge you to refute directly a single statement of mine.

Did you not read the links to the paper from your own National Institutes for Health posted earlier?

Have you not read the papers from your own National Research Council?

I'm not at all sure who Piers Morgan is or what he has to do with this, but I am sure that your own country is pretty concerned that it is way down the performance league in terms of health care amongst high income countries, and equally concerned that it spends around 15.5% of GDP on health care, yet still has poorer overall outcomes than many countries that spend 10% or less of GDP on it.

421dog
9th Nov 2014, 20:32
Bring it on buddy.

I don't want generalities, I want a direct refutation of a single statement I have made.

I live this.

You are a fvcking piker.

Just how many charters come into manchester from saudi for the excellent care each week?

oh right. none.

On the other hand, how many fly half way around the world to seek the care that we provide?

Well, at least a "few" more...

(no pressure though)

con-pilot
9th Nov 2014, 20:41
You are a fvcking piker.


Naw, he and those like him here are the equivalent of the "Well I'm not a pilot, but..." on the R&N thread when there is an airline accident or an incident.

"Well I'm not a doctor (although you are) but....", when it comes to medial issues. :p

421dog
9th Nov 2014, 21:01
Sorry. I'm only typed in CE-500/525, Lear 20s and DC3s. I like running with the big dogs, but I'll never fly a wide body.

On the other hand, I do B748 or A380 trauma care every night, and it pisses me off to argue with warrior drivers who think they have a clue what they're on about.

Gertrude the Wombat
9th Nov 2014, 21:03
Just how many charters come into manchester from saudi for the excellent care each week?
The private jets from Saudi seeking healthcare go into London, not Manchester. Have done for decades.

So the answer to your question is quite likely "none".

Hint: to an American, London and Manchester might look quite close together on an American-scale map, but actually they're different places and, by our standards, quite a long way apart.

421dog
9th Nov 2014, 21:10
Yeah.

I was talking more about the 757/767/747 traffic that is scheduled into KRST (for example)

each week.

Those guys aren't even cutting edge, they just provide solid standard of care. (with a health care concierge for everyone, and the option to rent an entire floor of their hotel should you desire)

VP959
9th Nov 2014, 21:16
Bring it on buddy.

I don't want generalities, I want a direct refutation of a single statement I have made.

I live this.

You are a fvcking piker.

Just how many charters come into manchester from saudi for the excellent care each week?

oh right. none.

On the other hand, how many fly half way around the world to seek the care that we provide?

Well, at least a "few" more...

(no pressure though)

My first reaction was to report this post as being a deeply offensive personal attack, as others here have been sin-binned for using language like this as a personal attack on another forum member.

However, I shall refrain and point you, yet again, to the evidence from your own countries National Institutes for Health: U.S. Health in International Perspective: Shorter Lives, Poorer Health (http://books.nap.edu/openbook.php?record_id=13497)

Can we keep this civil, and not make personal attacks, please?

KBPsen
9th Nov 2014, 21:16
I do B748 or A380 trauma care every nightTsk, tsk. Every big dog knows it's A388. Small matters matter, as Einstein once noted.

Incidentally, argumentum ab auctoritat (https://en.wikipedia.org/wiki/Argument_from_authority).

421dog
9th Nov 2014, 21:25
Well, I'm a trauma big dog, and a pilot small dog.

(but I've got a few more nads than some of you)

I'm in awe of those who have 10x my time and have flown planes for a living that I feel privileged to have been on once.

Give me a specific refutation, shut up, or report me and get me banned.

You clearly are interested in wasting my time with generalities and aren't interested in any sort of synthesis.

421dog
9th Nov 2014, 21:27
one statement.

con-pilot
9th Nov 2014, 21:29
Sorry. I'm only typed in CE-500/525, Lear 20s and DC3s. I like running with the big dogs, but I'll never fly a wide body.


Man, I didn't know that you are a real pilot as well! :ok:


P.S. Never flew a wide body either, nor will I now.

con-pilot
9th Nov 2014, 21:33
The private jets from Saudi seeking healthcare go into London, not Manchester. Have done for decades.


You've never been on the ramp at Rochester, Min. have you. :hmm:

Along with Saudi private registered aircraft, I've seen many British private registered aircraft on the ramp there as well.

VP959
9th Nov 2014, 21:36
Give me a specific refutation, shut up, or report me and get me banned.

You clearly are interested in wasting my time with generalities and aren't interested in any sort of synthesis.

Yet again, here is the very specific and precise, analysis from your own National Institutes for Health that refutes your specific points: U.S. Health in International Perspective: Shorter Lives, Poorer Health (http://books.nap.edu/openbook.php?record_id=13497)

The points this paper makes are very clear. The US spends more, yet has poorer overall outcomes, than most other high income countries.

If you want it in a simpler, but possibly less reliable, format, then Wikipedia has a summary here: Health care in the United States - Wikipedia, the free encyclopedia (http://en.wikipedia.org/wiki/Health_care_in_the_United_States) but I would be the first to highlight that, although the data and reports quoted are accurate and properly reviewed, that article displays a degree of bias in the way it is written.

421dog
9th Nov 2014, 21:49
VP, I want a refutation of a single point that I made. Not some point and click MSNBC garbage.

I've wasted a significant portion of my life interacting with you, and, should you wish to remain this side of my ignore list, you'll do the same.

wings folded
9th Nov 2014, 21:52
Dushan
Now think, if you didn't pay confiscatory tax rates what kind of private insurance you could have had?For those born with a congenital defect, none, because private insurance is underwritten. If you have an existing condition you either pay a whopping extra premium, or you have that condition and consequences thereof excluded. or you are turned down.

You make the common mistake of confusing tax and National Insurance. They are not the same.

Do you know how much is the percentage of intermediary commission on private health insurance? And how much is an intermediary commission on National Insurance in the UK?

galaxy flyer
9th Nov 2014, 21:59
Quote:
The private jets from Saudi seeking healthcare go into London, not Manchester. Have done for decades.
You've never been on the ramp at Rochester, Min. have you.

Along with Saudi private registered aircraft, I've seen many British private registered aircraft on the ramp there as well.

Or at any of the hospitals near the US/Canadian border--on the US side, that is

GF

Keef
9th Nov 2014, 22:00
I think I read the above correctly. Despite what I thought until now, healthcare in the USA is free. If you don't have money, the hospitals will treat nevertheless. Did I get that right?

I know the UK system, because my wife's life has been saved twice by prompt action by our GP referring her to hospital where a consultant dealt with the problem. She wasn't asked to pay, and her taxes didn't increase because of the surgery.

My daughter had bone cancer, and needed a prosthetic elbow joint. The operation cost her nothing, and her taxes didn't increase because of the surgery. She has annual follow-ups, at no cost to her.

I was diagnosed with thyroid cancer and secondaries. I went into hospital for operation. I wasn't asked to pay, and my taxes didn't increase because of the surgery. I was visited by several specialists after the operation - not because I asked, but because "joined-up medicine" knew I needed to see them. All but one did their thing and went away.

One, a physiotherapist, knew that I needed his expertise because of the loss of the accessory nerve on the right hand side. He explained that in the USA, some thyroid patients whose accessory nerves are lost end up trying to sue their surgeon because they don't receive the physiotherapy they need, and therefore a shoulder collapses, leading to intense pain and the need for further surgery. He may be wrong, but when I Googled the subject I found Americans looking for advice on a lawyer who would take on the case, because they couldn't afford the (expensive) corrective surgery. I didn't find any British patients with the same problem. Perhaps they don't post on the Internet.

If treatment is free in the USA for those who don't have the money to pay for it, why are those people looking for lawyers to help them get the money they need for corrective surgery?

galaxy flyer
9th Nov 2014, 22:09
There is a fundamental divide in health care between those who believe fervently in a capitalist model, where only those with enough income get good health care, and those who believe in an altruistic model, where everyone in the world should have access to the same standard of health care.

VP959, K&C, et al,

I find it really hard to believe that medicine is magically exempt from the basic economic principle of supply and demand, unlimited wants, limited resources, if you will. I'm pretty sure HMG does not have unlimited resources to apply to NHS, hence there must be some rationing scheme at work to match the demand for services with the resources (read: tax revenue). I understand there exists a board within the NHS that decides what types of care are allowed, what drugs will be offered based on some standard do efficacy; and who will get them. So, if matching supply with demand is done, why is your method (bureaucrats) superior to ours (patient's and their insurers willingness to pay)?

GF

con-pilot
9th Nov 2014, 22:23
I think I read the above correctly. Despite what I thought until now, healthcare in the USA is free. If you don't have money, the hospitals will treat nevertheless. Did I get that right?


Yes Keef, that is correct, however, nothing is free, the NHS is not free.

One of President Obama so-called selling points for the ACA was that it would save the state and federal government money by reducing visits to hospital emergency rooms, who cannot turn a patient away based on their ability to pay. Because the state and federal government picks up the tab for those that cannot pay.

There are ‘private’ hospitals in the US, just like in Britain, that can turn people away that are not covered by insurance or cannot pay, again, just like in Britian.

Also, for the poor there is Medicaid, a government medical insurance program that is free for the poor.

Keef
9th Nov 2014, 22:24
VP959, K&C, et al,
So, if matching supply with demand is done, why is your method (bureaucrats) superior to ours (patient's and their insurers willingness to pay)?

Apart from the threats to the NHS now being debated and argued by the politicians (and it is a VERY hot issue here), supply is adjusted to meet demand. If you need an operation, you get it. If you need treatment, you get it.

In the vast majority of cases, no bureaucrat is involved. You go to your GP who refers you to a consultant who diagnoses and explains to you. If you need surgery, you get it. You aren't asked if you can pay.

If your case isn't urgent, then you will go in a queue. That's where private medical insurance comes in - you can pay for the operation and jump the queue.

If you don't have money, and don't have insurance, you are still treated in the UK. I previously thought the US demanded payment (by insurance or direct), but I read above that those who can't pay are still treated the same.

421dog
9th Nov 2014, 22:25
Though no hospital in the US with an Emergency room is allowed to turn away any patient, Period.

And in the UK system, NEED is a relative term.

Keef
9th Nov 2014, 22:28
So if I pitched up in an emergency room with my cancerous thyroid and secondary tumour in my neck, I would be admitted, treated, given physiotherapy and a regular supply of thyroxin?

con-pilot
9th Nov 2014, 22:32
So if I pitched up in an emergency room with my cancerous thyroid and secondary tumour in my neck, I would be admitted, treated

Sigh, yes.

Now, as for the treatment you posted, I don't have a clue, I'm not a doctor, so I have no idea what treatment you would recieve.

Ask 421dog, he is a doctor.

VP959
9th Nov 2014, 22:35
VP, I want a refutation of a single point that I made. Not some point and click MSNBC garbage.

I've wasted a significant portion of my life interacting with you, and, should you wish to remain this side of my ignore list, you'll do the same.

The refutation is there, in black and white, in a paper published by your own government body that has the task of independently assessing health care effectiveness.

If you cannot be bothered to read it, or the summary in the (somewhat biased) Wikipedia article, then what do you want me to do?

You're reading these posts, and are making statements with no verification, yet when faced with evidence that is counter to your opinion you start swearing and making personal attacks.

I can quote from that article as easily as you could read it, the summary is that the USA pays more than any other high income country for health care, either on a per capita basis or as a percentage of GDP. According to the OECD the USA paid around 15.5% of GDP for health care in 2008:
https://upload.wikimedia.org/wikipedia/commons/a/a1/International_Comparison_-_Healthcare_spending_as_%25_GDP.png

This has now risen, with the WHO reporting that in 2011 the US spent 17.9% of its GDP on health care, the highest costs of any country in the world.

The US government recognised that costs were higher than other nations and outcomes were poorer, and summarised this in this paper in 2009: http://www.whitehouse.gov/assets/documents/CEA_Health_Care_Report.pdf

The National Institutes of Health was sufficiently concerned at the poor outcomes and high expenditure on health care that they published this paper in 2013: U.S. Health in International Perspective: Shorter Lives, Poorer Health (http://books.nap.edu/openbook.php?record_id=13497)

In that paper there are some pretty damning figures on areas such as infant mortality, poor cardio vascular disease outcomes, disability incidence, and a host of other medical conditions where the US lags behind many other high income countries, despite its high per capita health care expenditure.

Many millions of American citizens only have access to very basic health care, as they have no health insurance, and the state funded level of care is far from comprehensive when it comes to areas like preventative medicine, which we know has a significant impact on the overall health of any population. It seems probable that the roughly 50 million Americans without health insurance are those who are creating the greatest impact on the poor overall performance of the US when compared to other countries.

I have no doubt at all that if you have adequate health insurance then you get top notch health care and preventative medicine, but there is a big imbalance between those who earn enough to have good insurance and those who don't earn enough (or who are unlucky enough to have a condition that makes health insurance effectively unobtainable).

No health care system is perfect, and a week doesn't go by here without there being a case in the news where the cost of treatment under our system is too high for the overall benefit to the population as a whole, leaving a few people disadvantaged. Our NHS is very far from being perfect, just like every other health care system in the world, but it is pretty cost-effective.

We spend between a half and two thirds of the money that the US does on health care (on a % of GDP basis) yet have similar, or slightly better, overall outcomes; significantly better in some areas, like infant mortality and male life expectancy. Other countries do better than the UK, so I'm not saying for one moment that we're great, but the fact remains that the US is near the bottom of the highest income nations when it comes to health care outcomes.

KBPsen
9th Nov 2014, 22:40
Keef, what 421dog is so carefully avoiding telling you is this (https://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act).

421dog
9th Nov 2014, 22:58
You're just Wrong, unfortunately.

Please look at what Obamacare covers and what the deductibles are.

Then look at Medicaid (the ostensible "default" for those 49% of our population who choose or are unable to contribute, and thus need to be parasitic)

Neither even come close to paying what is being paid now.

Obamacare was passed in 2010, and your horrific numbers are from 2011.

Socialized medicine is working out great, huh?

421dog
9th Nov 2014, 23:07
Keef, what 421dog is so carefully avoiding telling you is this (https://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act).

I Quoted it for god's sake! and was beaten up for the capital letters that the act mandates.

What the hell else do you want me to do?

We have a system where we care about our patients as people, and behave as professionals (as in "noble professions", not bus drivers)

You have a system where you bring in the cheapest, least experienced labor possible to meet the needs of the masses, and the few doctors who manage to claw their way to the top of the heap get to function outside the system as "consultants"

How the hell is that fair?

If Pablo the illegal alien drug smuggler shows up in my ICU with a 40% burn from making meth in another state and requires a year in the unit to make him better, I'm on the hook for it.

That's where Ill always be, and I'm happy.

galaxy flyer
9th Nov 2014, 23:09
Keef,

Apparently, the BBC reports differently, regarding NICE, bureaucratese for rationing.

BBC on NICE and rationing. (http://www.bbc.com/news/health-21519896)


And then there's this from Wiki,

In the United Kingdom, the National Institute for Health and Care Excellence sets coverage requirements for the National Health Service, which is funded and operated by the government. NICE calculates an incremental cost-effectiveness ratio in terms of quality-adjusted life years. Treatments under £20,000 per QALY gained are considered cost-effective, but those above £30,000 per QALY are rarely approved. Individuals who are able to do so may also pay for private treatments beyond what the NHS offers, but low-income people largely have equal access to health care. The overall level of government funding for NHS is a political issue in the UK.

Point being, care WILL be rationed, the question who does it--the individuals thru price OR the government thru Orwellian offices like NICE.

GF

Gertrude the Wombat
9th Nov 2014, 23:11
Keef, what 421dog is so carefully avoiding telling you is this (https://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act).

Doesn't that mean that people who can't afford doctors have to wait until their condition is an emergency before they can get free treatment?

Wouldn't it be vastly cheaper to intervene at an earlier stage, so that it never becomes an emergency?

galaxy flyer
9th Nov 2014, 23:17
412dog,

If Pablo the illegal alien drug smuggler shows up in my ICU with a 40% burn from making meth in another state and requires a year in the unit to make him better, I'm on the hook for it.

I'm not a doc and I know the law requires what you stated, but Pablo should pay up or be shown the door. He caused his parlous situation by his own, controllable actions, the consequences are his to bear--have the funds, the insurance OR don't be so stupid.

Life is hard, it's a lot harder if you're stupid.

GF

galaxy flyer
9th Nov 2014, 23:21
GtW,

In my state health insurance has been the model for Obamacare--it's running Massachusetts to bankruptcy like a similar system did in Tennessee, TennCare. No buys insurance until it's necessary, then they fetch up to the ER, ask for care and apply for the insurance. Average term of insurance is less than a year, ER visits are ballooning. You think people won't game the system, you'd be wrong.

GF

Tankertrashnav
9th Nov 2014, 23:25
Tanker, good to know you haven't gone "full Birkenstock" on us.

Nope - luscious lamb cutlets this evening, nice and pink just as I like them :ok:

Although I realise some of you dont count lamb as red meat ;)

Never mind, there's a sirloin steak in the freezer with my name on it which won't be there for long!

Sorry for the thread drift but this thread is getting really boring, and needs some.

KBPsen
9th Nov 2014, 23:25
no hospital in the US with an Emergency room is allowed to turn away any patient, Period.Is what you said in response to Keef. It doesn't answer his question and that was probably intentional.

Your statement isn't true either, although it could probably be argued that it is if one was willing to engage in absurd nitpicking and semantic arguments over what 'turn away' means.

Dushan
9th Nov 2014, 23:30
KBPS, read your own link. It says so very clearly, no one gets turned away.

KBPsen
9th Nov 2014, 23:40
Doesn't that mean...Yes it does.

And the semantics are off.

con-pilot
10th Nov 2014, 00:00
Keef

A case in point, that I just read in today's Sunday newspaper a little while ago.

On Oct. 21 a five year old girl was attacked by a Rottweiler-bullmastiff mix, the dog nearly tore the face off of the five year old. She was rushed to the local hospital where it became quickly evident that her injuries far exceeded the capabilities of the local hospital, therefore she was medi-evac in a helicopter to a hospital that could handle her injuries. Where she underwent hours of emergency surgery.

She is still undergoing plastic surgery and will have to for many more years.

Her mother had no insurance, was in fact a nursing student living in a trailer park, never the less, the young girl’s continuing surgeries and medical care will be provided.

Now, who will pay for this medical care, mostly the government, both state and local. The mother will pay what she can, charitable funds will pay for a portion along with local churches, but the majority will be paid by the government, both state and local. Not to mention that her plastic surgeons have donated their services.

Is this a perfect system? No. But then neither is the NHS. Bottom line is, you will receive medical care in the United States whether you have insurance or not.

By the way, no one asked the mother about insurance or ability to pay until after the emergency surgery at the hospital her daughter had been taken to by a medical helicopter. According to the mother, quoted in the article, when she was asked about insurance at the hospital and informed them that she had none, she was told ‘not to worry about it’.

con-pilot
10th Nov 2014, 00:12
Doesn't that mean that people who can't afford doctors have to wait until their condition is an emergency before they can get free treatment?


No it does not. Period or Full Stop.

People can and do all the time show up in emergency room for a common cold and by law they will be treated.

I don't understand just why you people are so hard headed about this. :rolleyes:

galaxy flyer
10th Nov 2014, 00:20
con-pilot,

There are none so blind that refuse to see.

GF

obgraham
10th Nov 2014, 00:33
Two points to throw into this, yet another cross-oceanic pi$$ing match:

My daughter is in 421's line of work, EM attending doc in the largest inner city downtown hospital complex in Detroit, that hotbed of civic success.
99.9% of her patients have zero insurance. 100% of them are seen, evaluated, and treated by a doctor there before being discharged. Many of the patients show up there just like they did four times already that week, mostly because they have not much else to do and wanted a sandwich.
Among that flotsam, of course, is the nightly result of the gang warfare going on outside the door.
So yes, everyone who shows up at the ER gets care there. By law.

Secondly, I actually am not of the same view as 421 regarding the best answer to the health care issues in the US. I would like to see a single payer plan. Extend Medicare to everyone, for instance. Most all of our problems would be improved, and I'm sure 421 would continue to deliver his care. As did I for 35 years.

But what we have not solved, is that the American public makes no differentiation between that they WANT for health care and what they NEED. They want everything, for everyone, and they want it now.
In UK, as you have described, NHS is well known for providing what people NEED. And that's where the rationing has gone on. There are many treatments NHS will not provide, because they have decided not to undertake the cost.

Once again, as I pointed out previously, we in the US have social issues and an entitlement mentality, making it damn near impossible to solve our basic problems.

421dog
10th Nov 2014, 01:29
Though actually I'm a surgeon with 5 years of residency, 3 years of research, a year of trauma, another year of critical care, and yet another year of burn fellowship, that on top of four years of university and four more years of medical school. So the three years of ER residency is 7 or eight years shy of the mark, but I'm sure she's an excellent Doc.

421dog
10th Nov 2014, 01:47
And there's no question that she's smarter than me if she's in eastern Washington.

(the smartest guy in my class had a prime urology residency lined up and blew it all off to be a family practitioner in central Washington).

I sometimes have the privilege of going hunting with him.

obgraham
10th Nov 2014, 06:41
Not gonna get into that, 421. She actually was a reject here by her own state's med school. Eventually finishing up at the top of her residency group in MI, so now graces their state with her services. Medical Ed in WA is a complete balls-up.

VP959
10th Nov 2014, 08:20
Secondly, I actually am not of the same view as 421 regarding the best answer to the health care issues in the US. I would like to see a single payer plan. Extend Medicare to everyone, for instance. Most all of our problems would be improved, and I'm sure 421 would continue to deliver his care. As did I for 35 years.

But what we have not solved, is that the American public makes no differentiation between that they WANT for health care and what they NEED. They want everything, for everyone, and they want it now.
In UK, as you have described, NHS is well known for providing what people NEED. And that's where the rationing has gone on. There are many treatments NHS will not provide, because they have decided not to undertake the cost.

Once again, as I pointed out previously, we in the US have social issues and an entitlement mentality, making it damn near impossible to solve our basic problems.

Sums the differences up well.

You, and others who've said the same thing are right, our system does have a cut off for expensive treatments with uncertain outcomes. I mentioned it in a previous post. This does impact some people, primarily those who have terminal conditions. Barely a week goes by here without a case like this hitting the news.

I know that everyone in the US gets emergency care, or gets care if they become ill, the difference is that here we tend to spend more upfront on preventative medicine for all, before people get ill. We also offer "free" treatment for conditions that are not life threatening or limiting, but which are a nuisance and impact on the quality of life (hernia treatment, removal of benign tumours/cysts, minor cosmetic surgery etc).

Everyone here gets offered (or should get if they have bothered to register with a doctor) regular screening for diseases where screening has a proven positive impact on long term health outcome (breast cancer, cervical cancer, bowel cancer etc). Every single person who falls into the age/sex bracket where screening has been determined to be beneficial gets called up for it, at regular intervals. Pretty much everyone over 40 should be offered regular health checks by their GP here (certainly the four practices I've been registered with since I was 40 have done this).

Does that apply across the whole of the US, or is it only people with health insurance that get screening and preventative medicine?

I'd guess that preventative medicine and non-emergency treatment that's free at the point of use is the main difference between the US and UK systems. Once someone is ill, or is an emergency admission following an accident, then the two systems probably offer similar standards of care.

Our system, just like any other, is limited, no doubt about it, and the people who decide which treatments are affordable (NICE) have a tough job, because the high cost/relatively poor or unknown outcome treatments that they won't fund inevitably impact on those for whom such treatments may offer a few extra months of life, and those cases make the news. I'd not want to make such tough decisions, but I guess the difference is here it's a government body making them, in the US it's the insurers making them.

The bottom line is that the UK system costs the UK as a whole less, for health care that (across the whole population of the country) is broadly similar to that in the US in terms of outcome.

The real issue, and the one I tried in vain to highlight using US research and studies quoted earlier, is the question of WHY does health care in the US cost the nation so much more than it does in other high income countries?

One obvious factor has to be that there is profit in the privately run US system, but profit alone isn't enough to come close to accounting for the cost difference. I am pretty sure (from friends that have worked in the US as doctors/nurses) that staff costs and facility costs are broadly similar to those here, so that isn't likely to be a reason for the cost difference, either.

There have to be other factors that make health care in the US so relatively costly, but it isn't clear as to what those are, and I suspect it is this high, unexplained cost that is causing the US government to look closely at health care (ignoring for a moment the politics, as the relatively high cost of health care to the nation was identified as an issue before Obama became PotUS).

Keef
10th Nov 2014, 09:29
Well summarised! I've learned a lot from this thread, and thanks to those both sides of the pond who have helped to clarify. Old impressions, received long ago and mixing fact, fiction, and interpretation caused much confusion and made it difficult to understand the issues with Obamacare.

Metro man
10th Nov 2014, 12:30
One obvious factor has to be that there is profit in the privately run US system, but profit alone isn't enough to come close to accounting for the cost difference. I am pretty sure (from friends that have worked in the US as doctors/nurses) that staff costs and facility costs are broadly similar to those here, so that isn't likely to be a reason for the cost difference, either.

It's the lawyers and their contingent fees. Sympathetic juries awarding multi million dollar compensation to claiments even if there is no fault on the doctors part, because "the insurance company will pay." Doctors having to order large numbers of unnecessary tests to cover themselves against malpractice cases.

The "free"emergency care that hospitals have to provide is simply costed out onto the bills of those paying for their treatment.

No wonder medical tourism is taking off in Asia.

Curious Pax
10th Nov 2014, 14:09
"the insurance company will pay."

How true. I sometimes wonder how much life would be improved if kids were educated from an early age on where the money that the insurance company uses to pay out actually comes from!

pigboat
10th Nov 2014, 14:38
I sometimes wonder how much life would be improved if kids were educated from an early age on where the money that the insurance company uses to pay out actually comes from!

An excellent suggestion but it will never fly. The not-very-conservative government in this country once floated the proposition that every user of the health care system should be presented with a statement of the value for the treatment (s)he had just received under said system. It was shot down as being discriminatory. Against what, I have no idea, probably for putting the boots to the lie that all that free care isn't free at all. And on that subject, define free. One definition is 'without cost or payment.' Where I live, public health care eats up 42% of the provincial budget, to the exclusion of everything else - law enforcement, infrastructure and servicing of the provincial debt that came about in great part because of all the free stuff.

con-pilot
10th Nov 2014, 18:04
Does that apply across the whole of the US, or is it only people with health insurance that get screening and preventative medicine?


Kind of, there are "free" screening clinics that do operate two or three times a year in this state. They are in part paid for by the state and the hospitals/clinics providing the screening.

However, even with the "free" services provided, there is a segment of the US population that refuses to use these services, those are illegal immigrants. They are afraid that if they show up for "free" medical services, that they will be reported and then deported. Which as far as I know, does not happen. Never the less, the fear is there.

Also, there is a segment of our population that are just flat ignorant of these services, or just can't be bothered to avail themselves of these "free" service until it is too late.

Sorry, no simple answer on this one.

One more reason I believe the US needs some sort of national healthcare system, but not the ACA as it is written now.

421dog
10th Nov 2014, 19:14
Well, we had it in the system of public charity hospitals and clinics that once existed. It was expected that practitioners would provide some free care in these venues in addition to attending patients in the private sector.

A return to this model, coupled with allowing a provider to write off the free care he provides, would solve the problem, markedly improve quality and continuity of care, and save a heck of a lot of money.

(Putting on flak jacket)

OFSO
10th Nov 2014, 19:25
Spain: I decided to get an anti-flu vaccine injection today, 10th November. No appointment.
Walked into doctors, elderly couple waiting, sat down, waited five minutes, doctor came back from lunch, took me first as it was a quick 'un, injection, put shirt back on, paid €33 and left.

United Kingdom: wife said last year the home visits for the house-bound finally got around to injecting her aged mum and aunt against 'flu in early February. But, it was free, and at home.

Says it all really.

421dog
10th Nov 2014, 19:38
US:

Went to the grocery store pharmacy, pharmacist gave me a varicella zoster vaccine for $180

No wait, no prescription needed, not even something that our tertiary hospital's professional health clinic stocks, because it's expensive to acquire and has a poor shelf life.

Now, hopefully, I'll never join the ranks of the miserable bastards with shingles.

OFSO
10th Nov 2014, 19:43
Brazil: one of my relatives had a back "lock up" near San Paulo. When to pharmacy, owner told his son to take my relative round the back and inject a muscle relaxant. My relative said the son looked about eight years old (but hit the spot with the needle and it was worth it, didn't cost much either).

421dog
10th Nov 2014, 19:50
And not an abogado in sight.

Hey, why does that city so often get called "San Paolo" instead of "Sao Paolo"? Is it just Spanish hegemony?

wings folded
10th Nov 2014, 20:56
Nobody has yet explained to me why it is a "good thing" to use public funds to protect people on a particular turf against military aggression from outside, but some believe that it is a "bad thing" to use public funds to protect the same people form disease or accidents on the same turf.

Yeah, you can get private medical insurance if you can afford it and are not "impaired" (a term of art in the industry).

Has anyone here seriously considered the need for private insurance in case of hostilities?

OFSO
10th Nov 2014, 21:06
Has anyone here seriously considered the need for private insurance in case of hostilities?

Yup, but medical reimbursement (or not) depends on whether I have been judicious in getting out of the way of the Spanish army when it invades, or not.

obgraham
10th Nov 2014, 22:07
Well, obviously the US health care system is far superior to that of Spain or UK.

I offer, as proof:

US: Last week, walk into Walgreens, past the booze, cigs, and candy. "Need a flu shot." Present plastic bit. Sign a page long form promising not to sue. Get flu shot, and a red band-aid with a smiley on it. Total time out of car: 6.5 minutes. Cost: $0.00.

G-CPTN
10th Nov 2014, 22:17
Back in late September, I attended a 'turn-up - no appointment' clinic at the local GP surgery, where, in addition to the expected influenza vaccination I was offered (and administered) a shingles jab.

Total waiting time ten minutes (I was early and was the first patient treated).

And all at no charge - now that I am retired I don't even pay National Insurance.

And my monthly bloodpressure, cholesterol and ulcer prophylactics (and sleeping pills) are supplied FOC, too.

Some 20 years ago I had 'emergency' surgery to rectify a life-threatening lung condition (symptoms on the Sunday afternoon, thoracotomy first thing on the Monday) performed in (one of?) the national heart and lung transplant hospital.
Also at zero charge (and no waiting).

(The emergency followed several months of investigations at various hospitals across England (I was travelling each time I collapsed) with CT and MRI scans and biopsies at each. That the operation was not performed earlier was that the symptoms were chronic and not serious enough to justify an exploratory thoracotomy - I was given an 'emergency ticket' to report straight to the cardiothoracic ward for surgery should the situation develop acutely (which it did, some months later). The earlier investigations meant that there was no time spent in diagnosis - it was all documented and they were able to 'go right in'.)

Gertrude the Wombat
10th Nov 2014, 23:40
the proposition that every user of the health care system should be presented with a statement of the value for the treatment (s)he had just received under said system
My GP once offered me a choice of two different treatments, one of which was possibly marginally more likely to be successful.

He then said "I'm not allowed to tell you this" and went on to explain that the treatment that might, or might not, be marginally more successful would cost ten times as much.

So obviously I said "ok, we'll try the cheap one first".

I can see why they're not supposed to tell you - the system doesn't want patients to be turning down beneficial procedures because they feel guilty about the cost to the taxpayer - but in this case I reckon he got it right breaking the rule.

(BTW I did see a doctor today. Phoned first thing, saw doctor at lunchtime, appropriate tests, diagnosis, treatment. It wasn't completely "free at the point of use" because I'm one of the minority who has to pay the £8.05 prescription charge.)

con-pilot
10th Nov 2014, 23:50
One reason, of many, why most Americans are very skeptical about a 'single payer system’ (national healthcare) is what happened with the VA hospitals scandal. Lies after lies all the way up to the top in an attempt to cover up the scandalous treatment of our veterans.

If the government cannot handle a relative small group of people, our veterans, how the hell will they manage the entire country’s medical care?

We’ve got to do something, but what that is and keep from bankrupting the country, the hell I know.

obgraham
11th Nov 2014, 00:19
So, Con, why not just put all those Vets on Medicare. No separate hospitals or bureaucracies.
And then while we're at it, everyone else, too.

I agree with you about probably bankrupting the country. But under our present system, file clerks in insurance companies make these decisions, and are far less accountable than some government clakky.

So we will have to accept a 2-tier system. Good care for everyone. You want some exotic stuff, get private insurance. But we can't bring ourselves to accept that reality.

galaxy flyer
11th Nov 2014, 00:48
Are docs and hospitals even taking Medicare patients? Much of the east coast, providers are doing everything they can to avoid taking them.

GF

Metro man
11th Nov 2014, 01:54
Australia - Fantastic system if you are unemployed or on a low income, treatment free and prescriptions at a nominal charge. Once you get to an average income level you either get insurance or pay a levy on your tax bill to use the system which you are paying for but which is free for those who are not paying for it.:rolleyes:

Singapore - Heavily subsidised health care, only free for those who genuinely can't pay. One set low fee in the emergency room. Health insurance available at reasonable rates. Far smaller percentage of GDP spent on health care with superior results. High western standards achieved at reasonable cost.

Thailand - Cheap and basic for the locals, very reasonable and top class in the private hospitals catering to a growing number of medical tourists who can't afford the high prices or long waiting lists at home. Compare the prices at the Bumrumgrand hospital to US prices or the waiting times for non urgent procedures to the UK and you will see why medical tourism is growing so fast.

obgraham
11th Nov 2014, 04:33
Galaxy: If everyone was on Medicare, trust me, they'd take them.

And all these issues of "who takes what" would be relegated to the dustbin.

charliegolf
11th Nov 2014, 10:53
It wasn't completely "free at the point of use" because I'm one of the minority who has to pay the £8.05 prescription charge.)

FWIW, I think it's scandalous that in Wales, there is an across the board waiving of the prescription cost (just as I feel about anyone other than the low paid getting child benefit).

CG

con-pilot
11th Nov 2014, 18:43
So, Con, why not just put all those Vets on Medicare. No separate hospitals or bureaucracies.
And then while we're at it, everyone else, too.


Have you ever seen what happens when you shut down a major division a government department, such as the VA Hospital/Care system?

Probably not, because that has never happened in the history of the US.

However, I think that putting vets on Medicare and no more separate hospitals or bureaucracies is a great idea. Too bad it will never happen.

Now, what could be done, is to incorporate the VA care and hospital system under Medicare. Merging government departments/divisions happen all the time. It happened to me when I worked for the government. Before 9/11 I might add.

Will the former VA hospitals still be restricted to vets? If so, I don’t see any change, because the bureaucrats that currently runs the VA Health/Hospital system will keep their jobs and positions. The only thing that will change is the name on the letterhead of their correspondence. I lived through that as well when we were merged with the Border Patrol Flight Department*.

If the former VA Hospitals will be open to all Medicare and non-Medicare patients they will be directly competing with privately owned hospitals, which I do believe is against federal law, just as the US Air Force cannot operate an airline or the US Navy cruise ships, or the Marines running vacation summer camps in some swamps somewhere nasty. :p

Obviously due to my age I am on Medicare. However, I also have supplemental insurance, thank God. For without the supplemental insurance there are doctors that will not accept me otherwise. As for hospitals, I know of none that will refuse anyone that only has Medicare. But the co-pays are killers without supplemental insurance, as it is with prescriptions.

Expanding Medicare to cover all Americans is not a bad idea, in fact it could be a great idea. Getting it to work and how to pay for it are the problems. Do you have any ideas about that?



* They were unmerged a couple of years after I left.

bcgallacher
11th Nov 2014, 22:37
Con pilot - fund it the same way as UK by a national insurance contribution. Basically it is collected as a further tax on salary - those who have no income do not contribute. It is about the fairest way of funding health care for all. Nothing is free even health care must be paid for.If you followed the UK system your costs would fall as the profit motive would be removed and due to economy of scale purchasing power would be improved.

con-pilot
11th Nov 2014, 22:59
Con pilot - fund it the same way as UK by a national insurance contribution. Basically it is collected as a further tax on salary - those who have no income do not contribute. It is about the fairest way of funding health care for all. Nothing is free even health care must be paid for.If you followed the UK system your costs would fall as the profit motive would be removed and due to economy of scale purchasing power would be improved.

Well I kind of agree, with the exception of this bit;

those who have no income do not contribute.

I don't think that there is anyone in the US that does not have some sort of income, unless they are terminally ignorant of the services available to them. Such as welfare payments, disability payments, unemployment payments, etc.

So everybody must pay something toward their 'free' health care.

In fact, in the US, if you earn under a certain amount you don't pay any type of income tax and in fact, you receive money from the federal government for not paying taxes. People like this should help pay for their 'free' health care as well.*

Perhaps a five cent tax on fuel, if that is only used for a national health care system and nothing else.

*But I never see that happening. The Democrats would lose too big of a voting block and the Republicans would accused of wanting to kill the poor and aged.

In fact the Republicans already have been if you had seen some of the ads ran on TV by the Democrats this last election.