Texas Ranks Next To Last in Health Care

[Nbadan]

How States Rank on Health Care
Michael Moore's new video SICKO covers the depressing state of privatized health-care in the U.S., but did you know that the state of Texas ranks next to last in providing access to affordable health-care to it's citizens?

Hawaii Is First, Oklahoma and Mississippi Are Last on Foundation's First State Scorecard on Health Care
By Miranda Hitti
WebMD Medical News
Reviewed by Louise Chang, MD


June 13, 2007 -- Hawaii leads and Oklahoma lags on a new state scorecard about health system performance.

The scorecard is the first of its kind from the Commonwealth Fund, a private foundation focused on health care.

The Commonwealth Fund rated states based on 32 indicators, including access, quality, cost, insurance, preventive care, potentially avoidable hospital visits, and premature death (death before age 75).

The top five states in order are Hawaii, Iowa, New Hampshire, Vermont, and Maine.

The bottom five states are Nevada, Arkansas, Texas, Mississippi, and Oklahoma.

A full list of state rankings follows later in this article.


Wide Range

The top-rated states scored two to three times higher than the lowest-ranked states.

"Where you live really matters in terms of your experience with the American health care system," Commonwealth Fund President Karen Davis told reporters at a news conference.

"The wide variation and gaps between leading and lagging states add up to substantial human and economic cost for the nation," says Cathy Schoen, the Commonwealth Fund's senior vice president for research and evaluation.

Schoen says that if all states equaled the top-rated states, there would be 90,000 fewer premature deaths before age 75 from conditions such as diabetes, infection, respiratory disease, and treatable cancers. In addition, 22 million more adults and children would be insured, cutting U.S. uninsured rates in half.


Room for Improvement

Every state has room for improvement -- even those leading the scorecard -- notes Schoen, who worked on the scorecard with other experts.

"Each of the top states has some indicators in the bottom half of the state distribution," Schoen says. In other words, though those states may rank highly overall, they're not acing every category in the scorecard.

Insurance tracked with the states' ratings.

"In general, states that did well in the overall rankings had the lowest rates of uninsured in the nation, and states that did poorly had the highest rates of uninsured in the nation," Schoen says.

But high ratings didn't always mean high costs.

"Indeed, some states have high quality and lower cost," Schoen says. She adds that "high costs tend to track higher rates of potentially preventable hospital use and 30-day re-admission rates, indicating a need for a focus on prevention and primary care and care coordination."


State Rankings

Here is the list of how the states and Washington, D.C., ranked overall. States with the same ranking are listed together.

1. Hawaii
2. Iowa
3. New Hampshire, Vermont
4. Maine
5. Rhode Island
6. Connecticut
7. Massachusetts
8. Wisconsin
9. South Dakota
10. Minnesota
11. Nebraska
12. North Dakota
13. Delaware
14. Pennsylvania
15. Michigan
16. Montana, Washington
17. Maryland
18. Kansas
19. Wyoming
20. Colorado, New York
21. Ohio, Utah
22. Alaska, Arizona, New Jersey
23. Virginia
24. Idaho, North Carolina
25. Washington, D.C.
26. South Carolina
27. Oregon
28. New Mexico
29. Illinois
30. Missouri
31. Indiana
32. California
33. Tennessee
34. Alabama
35. Georgia
36. Florida
37. West Virginia
38. Kentucky
39. Louisiana, Nevada
40. Arkansas
41. Texas
42. Mississippi, Oklahoma

WebMD (http://www.webmd.com/news/20070613/how-states-rank-on-health-care?ecd=wnl_nal_071307)

Eight of the top ten are true-blue states...

[UV Ray]

The People's Republic of Hawaii at number one is no surprise.

[Wild Cobra]

I did a little legwork on this report. It may be worthwhile to look at. I am the free market type, so I disagree with some of their benchmarks, however, from what I read so far, it is material worthy of study.

Links:

Page from the source discussing the study:
Aiming Higher: Results from a State Scorecard on Health System Performance (http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=494551)

Links within this page:

Full report (http://www.commonwealthfund.org/usr_doc/StateScorecard.pdf?section=4039) 3096k PDF

Executive Summary (http://www.commonwealthfund.org/usr_doc/StateScorecard_EXEC_SUMM_ONLY.pdf?section=4039) 597k PDF

Chartpack (http://www.commonwealthfund.org/usr_doc/Chartpack.pdf?section=4039) 1261k PDF

Chartpack (http://www.commonwealthfund.org/usr_doc/StateScorecard_ReportChartPack-1.ppt?section=4039) 2877k Power Point

State Data Tables (http://www.commonwealthfund.org/usr_doc/State_data_tables.pdf?section=4039) 834k PDF

Some studies on the 32 indicators used:

1 Adults under age 65 insured: Employee Benefits Research Institute (EBRI) analysis of 2005 and 2006 U.S. Census Bureau Current Population Survey (CPS) March Supplement (U.S. Census Bureau, 2005, 2006).

2 Children insured: EBRI analysis of 2005 and 2006 U.S. Census Bureau CPS March Supplement (U.S. Census Bureau, 2005, 2006).

3 Adults visited a doctor in past two years: Rutgers Center for State Health Policy (CSHP) analysis of 2000 Behavioral Risk Factor Surveillance System (BRFSS) (NCCDPHP, BRFSS 2000).

4 Adults with a time in past year when they needed to see a doctor but could not because of cost: Rutgers CSHP analysis of 2002 and 2004 BRFSS (NCCDPHP, BRFSS 2002, 2004). 2002 data was imputed for one state.

5 Adult age 50 and older received recommended preventive care: Percent of adults age 50 and older who have received: sigmoidoscopy or colonoscopy in the last ten years or a fecal occult blood test in the last two years; a mammogram in the last two years (women only); a pap smear in the last three years (women only); and a flu shot in the past year and a pneumonia vaccine ever (age 65 and older only). Rutgers CSHP analysis of 2002 and 2004 BRFSS (NCCDPHP, BRFSS 2002, 2004). 2002 data were imputed for one state.

6 Adult diabetics received recommended preventive care: Percent of adults age 18 and older who were told by a doctor that they had diabetes and have received: hemoglobin A1c test, dilated eye exam, and foot exam in the past year. Rutgers CSHP analysis of 2002 and 2004 BRFSS (NCCDPHP, BRFSS 2002, 2004). 2002 data were imputed for six states.

7 Children ages 19–35 months received all recommended doses of five key vaccines: Percent of children ages 19 to 35 months who have received at least 4 doses of diphtheria-tetanus-acellular pertussis (DTaP), at least 3 doses of polio, at least 1 dose of measles-mumps-rubella (MMR), at least 3 doses of Haemophilus influenzae B (Hib), and at least 3 doses of hepatitis B antigens. Data from the 2005 National Immunization Survey (NCHS, NIS 2005).

8 Children with both medical and dental preventive care visits: Percent of children ages 0–17 with one or more medical and dental preventive care visits during the past 12 months. Child and Adolescent Health Measurement Initiative (CAHMI) analysis of the 2003 National Survey of Children’s Health (CAHMI 2005).

9 Children with emotional, behavioral, or developmental problems received mental health care: Percent of children ages 1–17 with current emotional, developmental, or behavioral problems requiring treatment or counseling who received some type of mental health care during the past 12 months. CAHMI analysis of 2003 National Survey of Children’s Health (CAHMI 2005).

10 Hospitalized patients received recommended care for acute myocardial infarction, congestive heart failure, and pneumonia: Proportion of cases where a hospital provided the recommended process of care for patients with acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia for 10 indicators. The composite includes 5 clinical services for AMI (aspirin within 24 hours before or after arrival at the hospital and at discharge; beta-blocker within 24 hours after arrival and at discharge; and angiotensin-converting enzyme (ACE) inhibitor for left ventricular systolic dysfunction), 2 for CHF (assessment of left ventricular function and the use of an ACE inhibitor for left ventricular dysfunction), and 3 for pneumonia (initial antibiotic therapy received within four hours of hospital arrival, pneumococcal vaccination, and assessment of oxygenation). Analysis of 2004 CMS Hospital Compare data conducted by A. Jha and A. Epstein at the Harvard School of Public Health (DHHS n.d.).

11 Surgical patients received appropriate timing of antibiotics to prevent infections: Proportion of cases where a hospital provided prophylactic antibiotics within 1 hour prior to surgery and discontinued within 24 hours after surgery. Data from 2005 CMS Hospital Compare (DHHS n.d.), reported in AHRQ 2006 National Healthcare Quality Report (AHRQ 2006).

12 Adults with a usual source of care: Percent of adults age 18 and older who have one (or more) person they think of as their personal doctor or health care provider. Rutgers CSHP analysis of 2002 and 2004 BRFSS (NCCDPHP, BRFSS 2002, 2004). 2002 data were imputed for one state.

13 Children with a medical home: Percent of children ages 0–17 who have at least one preventive medical care visit in the past year; are able to access needed specialist care and services; and have a personal doctor/nurse who usually/always spends enough time and communicates clearly, provides telephone advice and urgent care when needed, and follows up after specialist care. CAHMI analysis of 2003 National Survey of Children’s Health (CAHMI 2005).

14 Heart failure patients given written instructions at discharge: Percent of heart failure patients with documentation that they or their caregivers were given written instructions or other educational materials at discharge. Data retrieved from CMS Hospital Compare database on January 25, 2006 (DHHS n.d.).

15 Medicare fee-for-service patients whose health provider always listens, explains, shows respect, and spends enough time with them: Data from 2003 National Consumer Assessment Healthcare Providers and Systems (CAHPS) Benchmarking Database (AHRQ, CAHPS n.d.), reported in AHRQ 2005 National Healthcare Quality Report (AHRQ 2005).

16 Medicare fee-for-service patients giving a best rating for health care received: Percent of Medicare fee-for-service patients who reported a doctor’s visit in the last 12 months and gave a best rating for health care received. Data from 2003 National CAHPS Benchmarking Database (AHRQ, CAHPS n.d.), reported in AHRQ 2005 National Healthcare Quality Report (AHRQ 2005).

17 High-risk nursing home residents with pressure sores: Data from 2004 CMS Minimum Data Set (CMS, MDS n.d.), reported in AHRQ 2005 National Healthcare Quality Report (AHRQ 2005).

18 Long-stay nursing home residents who were physically restrained: Data from 2004 CMS Minimum Data Set (CMS, MDS n.d.), reported in AHRQ 2005 National Healthcare Quality Report (AHRQ 2005).

19 Hospital admissions for pediatric asthma per 100,000 population: Data from 2002 Healthcare Cost and Utilization Project State Inpatient Databases (AHRQ, HCUP-SID 2002), reported in AHRQ 2005 National Healthcare Quality Report (AHRQ 2005).

20 Asthmatics with an emergency room or urgent care visit: Percent of adults age 18 and older who were told by a doctor that they had asthma and had an emergency room or urgent care visit in the past 12 months. Rutgers CSHP analysis of 2001, 2002, 2003 and 2004 BRFSS (NCCDPHP, BRFSS 2001, 2002, 2003, 2004).

21 Medicare hospital admissions for ambulatory sensitive conditions per 100,000 beneficiaries: Hospital admissions of fee-for-service Medicare beneficiaries age 65 and older for one of 11 ambulatory care sensitive conditions (AHRQ Indicators): short-term diabetes complications, long-term diabetes complications, lower extremity amputation among patients with diabetes, asthma, chronic obstructive pulmonary disease, hypertension, congestive heart failure, angina (without a procedure), dehydration, bacterial pneumonia, and urinary tract infection. Analysis of 2003 Medicare Standard Analytical Files (SAF) 5% Inpatient Data conducted by G. Anderson and R. Herbert at Johns Hopkins Bloomberg School of Public Health (CMS, SAF 2003).

22 Medicare 30-day hospital readmission rates: Fee-for service Medicare beneficiaries age 65 and older with initial admissions due to one of 31 select conditions who are readmitted within 30 days following discharge for the initial admission. Analysis of 2003 Medicare SAF 5% Inpatient Data conducted by G. Anderson and R. Herbert at Johns Hopkins (CMS, SAF 2003).

23 Long-stay nursing home residents with a hospital admission: Analysis of 2000 Medicare enrollment data and MedPAR file conducted by V. Mor at Brown University, under a grant funded by the National Institute of Aging (#AG20557, State Policies and Hospitalizations from Nursing Homes).

24 Nursing home residents with a hospital readmission within three months: Percent of long-stay residents hospitalized within three months of being discharged from a hospital to a nursing home. Analysis of 2000 Medicare enrollment data and MedPAR file conducted by V. Mor at Brown University, under a grant funded by the National Institute of Aging (#AG20557).

25 Home health patients with a hospital admission: Percent of acute care hospitalization for home health episodes. Data from 2004 Outcome and Assessment Information Set (CMS, OASIS n.d.), reported in AHRQ 2005 National Healthcare Quality Report (AHRQ 2005).

26 Total single premium per enrolled employee at private-sector establishments that offer health insurance: Data from 2004 Medical Expenditure Panel Survey – Insurance Component (AHRQ, MEPSIC 2004).

27 Total Medicare reimbursements per enrollee: 2003 data from Dartmouth Atlas of Health Care (Dartmouth Atlas Project 2003). Total Medicare feefor- service reimbursements include payments for both Part A and Part B (exclude capitated payments). Reimbursement rates were indirectly adjusted for sex, race, and age, and were further adjusted for illness, and regional differences in price.

28 Mortality amenable to health care: Number of deaths before age 75 per 100,000 population that resulted from causes considered at least partially treatable or preventable with timely and appropriate medical care (see list), as described in Nolte and McKee (Nolte and McKee, BMJ 2003). Analysis conducted by K. Hempstead at Rutgers CSHP using 2002 mortality data from CDC Multiple Cause-of- Death file and U.S. Census Bureau population data (NCHS, MCD n.d.).

29 Infant mortality, deaths per 1,000 live births: Data from 2002 National Vital Statistics System (NVSS) (NCHS, NVSS n.d.), reported in AHRQ 2005 National Healthcare Quality Report (AHRQ 2005).

30 Breast cancer deaths per 100,000 female population: Age-adjusted to US 2000 standard population. Data from 2002 NVSS (NCHS, NVSS n.d.), reported in AHRQ 2005 National Healthcare Quality Report (AHRQ 2005).

31 Colorectal cancer deaths per 100,000 population: Age-adjusted to US 2000 standard population. Data from 2002 NVSS (NCHS, NVSS n.d.), reported in AHRQ 2005 National Healthcare Quality Report (AHRQ 2005).

32 Adults under age 65 limited in any activities because of physical, mental, or emotional problems: Rutgers CSHP analysis

[xrayzebra]

Am I going to die? I live in Texas! (you know like the little
elf in the travelocity commercials)

[Clandestino]

nbadan hates the us government, but now he wants them to handle his healthcare???

[boutons_]

you motherfuckers always shoot the messenger, while ignoring the message.

Private companies are fucking us all over in health care costs, as the their profits trump patient care. The Repugs made it ILLEGAL for the fed govt to negotiate lower price with Big Pharma. WTF?

[RobinsontoDuncan]

its no coincidence the best health care is concentrated in blue states and the worst is in red states

[SA210]

its no coincidence the best health care is concentrated in blue states and the worst is in red states

[Wild Cobra]

its no coincidence the best health care is concentrated in blue states and the worst is in red states
Only because the report favors socialized medicine.

[xrayzebra]

SA210

John does have nice hair. But he tends to
exclude people from conversations. You know like
gang up with Hillary to shut people up. :p:

You want to help people vote Republican :elephant :elephant :elephant :elephant :elephant

[boutons_]

"Only because the report favors socialized medicine."

Private, for-profit health care delivers the minimum amount of health care (the ideal amount being zero, ie, your procedure is disqualified and/or your deductible is several $1000) for the highest price to the fewest people.

[Spurminator]

Technically we're third-to-last.

Woohoo!

[Extra Stout]

Our current system has combined the worst of two worlds:

1) The current system of private insurance by publicly-traded corporations provides economic incentives for denying preventive care, resulting in exponentially higher costs in interventional care down the road. Many private insurers have responded to this inevitable surge in costs by finding ways to deny interventional care. They have an economic incentive to find creative ways to let expensive patients die, so long as it doesn't get them sued.

2) The current system of public insurance (Medicare) strives to pay for any and every procedure and pharmaceutical product, in order to buy the votes of the elderly. It also lacks any functional mechanism for rooting out fraud.

We have managed to find the way to employ the worst attributes of capitalism and of socialism simultaneously. Just about any other conceivable system would work better than this one, whether it were based upon free-market or collectivist principles.

[Extra Stout]

I think the rich in America would like a health-care system similar to what Chile has. There is no public health care system. Those who can afford private health insurance enjoy good care at reasonable prices. Those who cannot afford it get sick and die in their cardboard shacks.

[Spurminator]

I think people are too attached to the idea that we have the best doctors in the world... We have doctors that can fight the rarest of diseases for anyone who can afford the treatment, but many others needlessly die of common ailments that could have been treated by anyone right out of med school.

[George Gervin's Afro]

why not let people who can afford insurance keep it. and for those who cannot afford it let them get basic and preventative medical care from the govt.. Yoni and I get to keep our private insurance and ray will go on the govt dime.. see everybody wins..

[Extra Stout]

why not let people who can afford insurance keep it. and for those who cannot afford it let them get basic and preventative medical care from the govt.. Yoni and I get to keep our private insurance and ray will go on the govt dime.. see everybody wins..
We have the emerging problem in private insurance where companies let you pay your premiums for years, deny coverage for preventive care, then when you get sick down the road, they try to find a loophole to deny paying for your expensive care so you will die and end any future financial exposure.

The best solution to that may not be so much a single-payer system, as kidnapping insurance executives and their families, and forcing the executives to watch the slow torture and death of their loved ones before they too are killed. The rich need to know that they too can be killed (channeling Ann Coulter).

Denial of care like that hasn't happened to me, but it has happened to far too many of my acquaintances.

[Yonivore]

why not let people who can afford insurance keep it. and for those who cannot afford it let them get basic and preventative medical care from the govt.. Yoni and I get to keep our private insurance and ray will go on the govt dime.. see everybody wins..
The Problem with that is that if you allow any type of private health care to remain, it will always pay doctors more than public health care and so you end up with the same system, the wealthy (or those who can afford private health insurance) will always have access to the better health care.

This is one of the reasons Hillarycare proposed to criminalize the practice of medicine outside of her healthcare program.

It's also one of the reasons universal healthcare will never succeed in a free society.

[Spurminator]

the wealthy (or those who can afford private health insurance) will always have access to the better health care.

It's fine if it's better, so long as the salary for the government doctors is high enough to attract competent doctors. No one would expect for private care doctors to be the same quality. But you still have to get through med school.

[George Gervin's Afro]

We have the emerging problem in private insurance where companies let you pay your premiums for years, deny coverage for preventive care, then when you get sick down the road, they try to find a loophole to deny paying for your expensive care so you will die and end any future financial exposure.

The best solution to that may not be so much a single-payer system, as kidnapping insurance executives and their families, and forcing the executives to watch the slow torture and death of their loved ones before they too are killed. The rich need to know that they too can be killed (channeling Ann Coulter).

Denial of care like that hasn't happened to me, but it has happened to far too many of my acquaintances.


Cost vs health... profit vs health.... one side loses out every time. I think the govt should mandate that if an insurance company denies needed healthcare that notice of denial should be done in person. Face to face.

[Extra Stout]

The poor need not have exactly the same health care as the wealthy.

Assuming we want a system where we care about general health, the idea would be to define which essential services should be covered, and under what circumstances, and then any elective procedures beyond that would be covered solely by private plans.

It works well in theory, but requires some discipline by the state, because of course the right wing is going to want to reduce the list of "essential" services down as close to nothing as possible, while the left wing will want to make things like elective cosmetic surgery and spa vacations "essential."

[Extra Stout]

It's fine if it's better, so long as the salary for the government doctors is high enough to attract competent doctors. No one would expect for private care doctors to be the same quality. But you still have to get through med school.
This can get tricky. In Germany, for example, they control health care costs by paying doctors what the U.S. pays teachers. This means all their good doctors move to the UK.

[Extra Stout]

Cost vs health... profit vs health.... one side loses out every time. I think the govt should mandate that if an insurance company denies needed healthcare that notice of denial should be done in person. Face to face.
Pssht. That's not so hard. You just show up flanked by two heavily-armed friends from Blackwater.

[Yonivore]

It's fine if it's better, so long as the salary for the government doctors is high enough to attract competent doctors. No one would expect for private care doctors to be the same quality. But you still have to get through med school.
I don't think you're understanding my point.

Nothing would change. Whereas now you have those with insurance and those who depend on locally supplied indigent healthcare, with universal healthcare (that allowed for the retention of private coverage) you'd have those with insurance and those with socialized healthcare using the same doctors and facilities previously employed as indigent healthcare services.

No, the only way you level the playing field is to completely socialize medicine. Hillary Clinton understands this.

What she doesn't understand is that instead of raising the level of medicine, in America, she'll wreck it. Capitalism and Socialism are not good partners and they don't play well together.

We need to decide whether or not we're going to be a free markets country or another failed experiment in socialism.

[George Gervin's Afro]

I don't think you're understanding my point.

Nothing would change. Whereas now you have those with insurance and those who depend on locally supplied indigent healthcare, with universal healthcare (that allowed for the retention of private coverage) you'd have those with insurance and those with socialized healthcare using the same doctors and facilities previously employed as indigent healthcare services.

No, the only way you level the playing field is to completely socialize medicine. Hillary Clinton understands this.

What she doesn't understand is that instead of raising the level of medicine, in America, she'll wreck it. Capitalism and Socialism are not good partners and they don't play well together.

We need to decide whether or not we're going to be a free markets country or another failed experiment in socialism.

Yoni how do you know what Hillary ' knows and doesn't know'? From talk radio to internet message boards I hear from people on the right telling us what people's motives are. Hillary has never once uttered the words 'universal healthcare' yet if you were to listen to fox news or talk radio that's all her opponenents talk about.

[Yonivore]

Yoni how do you know what Hillary ' knows and doesn't know'? From talk radio to internet message boards I hear from people on the right telling us what people's motives are. Hillary has never once uttered the words 'universal healthcare' yet if you were to listen to fox news or talk radio that's all her opponenents talk about.
Where were you in 1992?

[George Gervin's Afro]

Where were you in 1992?


I still haven't found a quote attributed to her about 'univesral healthcare' now or in 1992. Yoni admit that language is a scare tactic.. a tactic to rile up the folks on the right..

So maybe her stance has changed? evolved?

[Yonivore]

I still haven't found a quote attributed to her about 'univesral healthcare' now or in 1992. Yoni admit that language is a scare tactic.. a tactic to rile up the folks on the right..

So maybe her stance has changed? evolved?
I doubt it.


In the absence of a crisis like a depression, passing a health care plan was going to be difficult. We wanted a plan that dealt with all aspects of the health care system.

In addition to the President's Task Force, we organized a giant working group of experts that would consider every aspect of health care. This group, comprising as many as 600 people, met regularly to debate and review specific parts of the plan in detail.

On February 24, we were dealt a blow that none anticipated. Groups affiliated with the health care industry sued the task force over its composition, claiming that because I was not a government employee, I was not allowed to chair or attend closed task force meetings.

It was a deft political move, designed to disrupt our work and foster an impression with the public and the media that we were conducting secret meetings.

We were trying to move too quickly on a bill that would fundamentally alter social and economic policy for years to come.
One of the fundamental tenets of the universal health care program she was working on in her husband's first term, was that in order to make sure consistent, quality health care was available to everyone, you had to completely socialize medicine and penalize private practice.

One recommendation was to provide for criminal penalities for doctors found to be treating patients on the side.

[Extra Stout]

Hillary Clinton in 2008 is not calling to "completely socialize medicine." None of the candidates are calling for a single-payer plan, which is what "completely socialized medicine" means. John Edwards' plan comes the closest to out-and-out socialism. Arnold Schwarzenegger's plan in California is more comprehensive than Hillary's proposal.

[Yonivore]

Hillary Clinton in 2008 is not calling to "completely socialize medicine." None of the candidates are calling for a single-payer plan, which is what "completely socialized medicine" means. John Edwards' plan comes the closest to out-and-out socialism. Arnold Schwarzenegger's plan in California is more comprehensive than Hillary's proposal.
Well, any hybrid plan is nothing different than what we have now.

[George Gervin's Afro]

Hillary Clinton in 2008 is not calling to "completely socialize medicine." None of the candidates are calling for a single-payer plan, which is what "completely socialized medicine" means. John Edwards' plan comes the closest to out-and-out socialism. Arnold Schwarzenegger's plan in California is more comprehensive than Hillary's proposal.


That's exactly my point. No one is calling for universal healthcare..of course that doesn't stop hush, whannity, fox news ..etc. from promoting false news..

[Extra Stout]

Well, any hybrid plan is nothing different than what we have now.
Hopefully, a reformed system would not simultaneously have the highest costs coupled with some of the worst results in the developed world, which is what we have now.

One theoretically could devise a more free-market-based approach which could work. The key would be eliminating the economic incentive to deny needed care. Insurance companies will deny a $500 screening that prevents a $100,000 treatment regimen ten years down the road, because they are focused on short-term profits. We need a simpler system where health care is primarily doctors offering services to patients, and actuaries and lawyers stay on the sidelines.

We aren't hearing good ideas on this from the Republicans because unfortunately right now they are rather unapologetically going through a Gilded-Age corporate-whore phase. Proponents of the free market will have to debate good ideas outside of the political process while the GOP decides going forward whether it wants to be the party of Reagan, Rockefeller, or Rebel Yells.

[Yonivore]

That's exactly my point. No one is calling for universal healthcare..of course that doesn't stop hush, whannity, fox news ..etc. from promoting false news..
Hillary's #1 psychophant, Michael Moore, is calling for exactly that.

Now, I realize he doesn't help Hillary form her policies but, it would seem to me that if he weren't confident her election represented a realistice opportunity to institute the type of health care system he envisions he would be fawning all over her and her ideas of health care while pitching his movie "Sicko!" on the Leno Show.

If you want to say Moore is a thoughtful, intelligent, and politically astute film maker (which, certainly, I don't but, some in here do) then you have to wonder what he likes about HillaryCare. I suspect it's the socialist nature of it.

[Spurminator]

Because clearly the status quo and Michael Moore Socialism are our only two options.

Antiprogress 101.

[Yonivore]

Because clearly the status quo and Michael Moore Socialism are our only two options.

Antiprogress 101.
No, but any move towards a socialized single-payer system is a step backward.

[Spurminator]

Right, or it's the same thing we already have. Why bother right?

[DarkReign]

Truth: America's system of healthcare is atrocious. Not only does it cost the most, it kills the most in comparison to other developed countries.

So, we either do something or we do nothing.

I choose something. But thats from a guy who pays for his employees healthcare every month for some crappy HMO. Pathetic really.

[boutons_]

The capitalistic, for-profit, free-market health care system we have now is an inhumane nightmare for patients, and a dream for the health care providers who basically charge whatever they want and keep raising the prices out of all proportion to actual costs. Patients are basically being raped and gouged.

All the other major industrial countries have better health care systems, delivering more health care to more people for less money, and people don't have to worry about their finances being wiped out by a serious sickness, don't have to worry about the health insurance being cancelled or their rates being raised, don't have to worry about declaring personal bankruptcy due to medical bills.

The health care system's winner will slime and swift-boat vehemently anybody who dares propose reforms.

While Clinton's plan in the early 90s was apparently too complex, the violent, well-financed opposition wasn't against the complexity, it was against any kind of reform.

The health care lobbyists will buy enough politicians to kill any reform, no matter that majority of US citizens (who know they are getting screwed) and US corps (who want to get out of the healt care business) are for reform.

[Wild Cobra]

Truth: America's system of healthcare is atrocious. Not only does it cost the most, it kills the most in comparison to other developed countries.

I agree it costs the most, but what do you think the cost would be if we had serious tort reform limiting lawsuits? Almost any medical procedure carries at least a small random risk. Lawsuits should only be awarded when clear malpractice can be shown, and the doctor should lose his license and more.

As for killing more? I have a hard time believing that. have any stats for that which specifies how the numbers are broken down?

[Extra Stout]

I agree it costs the most, but what do you think the cost would be if we had serious tort reform limiting lawsuits? Almost any medical procedure carries at least a small random risk. Lawsuits should only be awarded when clear malpractice can be shown, and the doctor should lose his license and more.

As for killing more? I have a hard time believing that. have any stats for that which specifies how the numbers are broken down?
Malpractice reform would help, but it is far from the biggest piece of the puzzle.

[Wild Cobra]

Malpractice reform would help, but it is far from the biggest piece of the puzzle.
What is the biggest piece? To my knowledge:

Tort reform would dramatically reduce the insurance. Some medical providers pay in excess of $250,000 per year for insurance which means they must make $100 per hour just to pay the insurance.

Excessive tests and procedure are performed to protect from liability claims.

Medicine suffers the same fate. Something like 80% of the net income collected on medicines is set aside for lawsuit pay-outs if I recall the numbers right.

One primary reason socialized medicine is cheaper is that you don't have the ability to sue under the system.

Am I wrong on these points?

[Extra Stout]

What is the biggest piece? To my knowledge:

Tort reform would dramatically reduce the insurance. Some medical providers pay in excess of $250,000 per year for insurance which means they must make $100 per hour just to pay the insurance.

Excessive tests and procedure are performed to protect from liability claims.

Medicine suffers the same fate. Something like 80% of the net income collected on medicines is set aside for lawsuit pay-outs if I recall the numbers right.

One primary reason socialized medicine is cheaper is that you don't have the ability to sue under the system.

Am I wrong on these points?
The biggest reason our healthcare is more expensive is that we scrimp on preventive care, kick the can down the road, and then pay out the nose for interventional care.

The second-biggest reason our healthcare is more expensive is that our lifestyle and food supply promotes obesity and its related chronic diseases.

The third-biggest reason our healthcare is more expensive is that we pay stratospheric pharmaceutical costs basically to underwrite direct marketing of those products to consumers.

Malpractice claims abuse is further down the list.

[Nbadan]

Extra Stout is on a intellectual role.

I think the best sort of system would provide free basic health-care to everyone (pick your level of care) and those who choose to, or can afford too, can purchase catastrophic or supplemental insurance on their own. Right now, we are all paying to research technology that most of us will never use. Why should I supplement the costs of some rich/poor/obese guys live/kidney/stomach transplant when I can't afford a regular doctor visit on my HMO?

[DarkReign]

As for killing more? I have a hard time believing that. have any stats for that which specifies how the numbers are broken down?

...in comparison to other developed countries. So, my point is, we arent comparing the US to, say, Guatemala.

My point is, people die in America because they do not have health insurance. You dont qualify for Medicare/Medicaid if youre a) not a senior citizen or b) below a certain income level.

Therefore, its actually counter-productive to have a job that pays around $30k a year, but doesnt have health insurance, because if you get sick, youre screwed.

While the welfare-sucking, 6 children from 3 different men, mothers of the country have their entire family's health paid for by you and me.

So, in essence, my statement was misleading, Ill admit. While the statement may be true (i dont want to research), lets assume it is not.

Of the other developed countries of the world, the US is the only one without socialized medicine. Coincidence that we are also the most expensive? I dont think so.

Argue it anyway, boutons even though laced with vitriol, is absolutely correct. Healthcare should never be linked with the word "profit". No amount of argument can convince me otherwise.

[Yonivore]

...in comparison to other developed countries. So, my point is, we arent comparing the US to, say, Guatemala.

My point is, people die in America because they do not have health insurance. You dont qualify for Medicare/Medicaid if youre a) not a senior citizen or b) below a certain income level.

Therefore, its actually counter-productive to have a job that pays around $30k a year, but doesnt have health insurance, because if you get sick, youre screwed.

While the welfare-sucking, 6 children from 3 different men, mothers of the country have their entire family's health paid for by you and me.

So, in essence, my statement was misleading, Ill admit. While the statement may be true (i dont want to research), lets assume it is not.

Of the other developed countries of the world, the US is the only one without socialized medicine. Coincidence that we are also the most expensive? I dont think so.

Argue it anyway, boutons even though laced with vitriol, is absolutely correct. Healthcare should never be linked with the word "profit". No amount of argument can convince me otherwise.
So, all that to say you don't have the numbers? He asked for stats not for what countries you're presuming to stack us up against.

I only bring it up because I'm curious as well.

[boutons_]

WC, show us stats where the TX tort reform and $250K cap has lowered doctor insurance premiums in TX and that those savings have been passed along to consumers.

Also show us were medical liability suits are the dominating contributor to high, increasing health costs natiowide, or even a significant contrbutor.

Re-gurgitating Repug talking points isn't credible.

[Jamtas#2]

The biggest reason our healthcare is more expensive is that we scrimp on preventive care, kick the can down the road, and then pay out the nose for interventional care.

The second-biggest reason our healthcare is more expensive is that our lifestyle and food supply promotes obesity and its related chronic diseases.

The third-biggest reason our healthcare is more expensive is that we pay stratospheric pharmaceutical costs basically to underwrite direct marketing of those products to consumers.

Malpractice claims abuse is further down the list.

That's a good take. Another reason of the high costs is that pharm Reps are to Doctors what Lobbyists are to politicians. Drug costs are high in part because of all the marketing and "company dinners" that the reps invite Docs to. I used to work in the healthcare industry and I can tell you that I did not notice a week go by that there weren't reps passing out free stuff, trips or having multiple dinners at places like Morton's or Ruths Chris to promote their products. Cut that out (like lobbyists) and the costs of the mdeications would go down.

[DarkReign]

That's a good take. Another reason of the high costs is that pharm Reps are to Doctors what Lobbyists are to politicians. Drug costs are high in part because of all the marketing and "company dinners" that the reps invite Docs to. I used to work in the healthcare industry and I can tell you that I did not notice a week go by that there weren't reps passing out free stuff, trips or having multiple dinners at places like Morton's or Ruths Chris to promote their products. Cut that out (like lobbyists) and the costs of the mdeications would go down.

Hmm, not sure if it applies, but I know every time I go to the doctor I always steal one of their numerous "Glyco-cylclimean" or some such pens, stationary, buttons, stickers, post-its, toilet paper and license plate when I'm there.


BTW, I totally made that name up.

[boutons_]

The stuff Big Pharma sales babes give to doctors costs pennies to produce. The kind of stuff where the cost to market it costs way more than the cost to produce it.

Has anybody heard of Big Pharma giving away drugs like avastin or other drugs that costs many $1000s, even 10s of $1000?

[Wild Cobra]

The biggest reason our healthcare is more expensive is that we scrimp on preventive care, kick the can down the road, and then pay out the nose for interventional care.

The second-biggest reason our healthcare is more expensive is that our lifestyle and food supply promotes obesity and its related chronic diseases.

The third-biggest reason our healthcare is more expensive is that we pay stratospheric pharmaceutical costs basically to underwrite direct marketing of those products to consumers.

Malpractice claims abuse is further down the list.
It seems to me we view these a little different. Your first two reasons I consider a category of why we need health care rather than the reason it is costly. I have not seen issues with on the prevention side when it comes to things like physical exams. I have seen these encouraged. I agree peoples lifestyle are a major cause, and maybe someday we can even eliminate the need for health care.

If we are going to look at lifestyle and food, we should separate that and remind people that a socialized system will not change such things. Socializing the system may (will in my opinion) make things worse since it removes personal responsibility.

I completely agree that lifestyle is a key factor to needing health care. I will agree it is the greatest reason and therefore the greatest cost factor because of the volume it places on the system. Just not that it changes the cost per visit per doctor in the way that driving insurance rates for doctors do. Yes, it increases the insurance rates for individuals.

I am one that doesn't live natural or organic, but I include them in my foods to get natural vitamins and enzymes that are not killed. At 47, I am far more healthy than most in their 30's, and probable better than half of the college age crowd. There are foods with some ingredients I steer away from, but don’t completely avoid, hike high fructose corn syrup. I seldom drink soda and use 100% maple syrup on my pancakes. It is only slightly used as a sweetener in Power-Aid and I buy that sometimes, but prefer Simply Orange. Hard to find things these days without that poison. When I have those cravings for greasy hamburgers and fries, I buy them. I simply make sure I eat enough foods with good natural nutrients, and eat pretty much whatever I want. I also eat sushi about once a week.

As for the cost of drugs, I covered that briefly. It shares the burden of having to recoup money to pay out lawsuits. They would be far cheaper if they didn’t have that burden.

The one thing I have not seen anyone address was my point regarding settlements. What type of lawsuits would be permitted under universal health care? Would health care prices fall to acceptable levels if only reasonable lawsuits could be pursued?

[Wild Cobra]

Extra Stout is on a intellectual role.

I think the best sort of system would provide free basic health-care to everyone (pick your level of care) and those who choose to, or can afford too, can purchase catastrophic or supplemental insurance on their own.
The problem with such a system is that employers then remove their insurance plans for employees telling them they can get their own for free and the system then gets bigger than planned for.

[Nbadan]

The problem with such a system is that employers then remove their insurance plans for employees telling them they can get their own for free and the system then gets bigger than planned for.

Catastrophic/supplemental health-care insurance would pay for expenses for things that normal basic coverage wouldn't cover, for instance, money lost from work, experimental treatments, electable surgeries and other treatments, top-o-the-line accommodations equipped with the latest technologies. Basic health coverage would cover all non-electable treatments and focus on preventative care. Many of the costs would come from Medicare/Medicade and employer contributions to employee heath-care, after all, healthy, happy employees are more productive employees..

[DarkReign]

The problem with such a system is that employers then remove their insurance plans for employees telling them they can get their own for free and the system then gets bigger than planned for.

That would be inevitable. Thats why, IMO, this whole thing is an all or nothing situation.

[Wild Cobra]

That would be inevitable. Thats why, IMO, this whole thing is an all or nothing situation.
I see the request to go single payer as submitting to the least common denominator. That is the opposite of striving for excellence, and we will lose many of the good things about health care is we ever went the socialized route.

[xrayzebra]

I have a really radical idea. How about we do away with all
health insurance, medicare, medicaid, tricare, and every other
form of medical insurance. Every person will pay for their
health insurance out of pocket. Doctors will go back to the good
old days. People will not run to the doctors for every little ache,
pain, cough or whatever. Which they do now. Cost will have
to go down. Why? Because people will have to rely on what
they have in their hip pocket. Cant wait to hear the screams
about pooooooor people.

I mis-spoke in the above statement:

I said health insurance. I meant to say health care out
of pocket.....

Sorry.

[DarkReign]

I see the request to go single payer as submitting to the least common denominator. That is the opposite of striving for excellence, and we will lose many of the good things about health care is we ever went the socialized route.

I dont know how to say this any other way.

My health insurance, provided thru the company I work for, blows donkey balls.

I just so happen to know how much it costs though because I pay the bill(s).

We have HAP, which sucks. Used to have Blue Cross Blue Shield, which is great.

The difference in price the last time I checked was north of $2000 a month.

We have 7 employees (2006 sucked), 2 of which are family plans....

$3900 a month. Thats $46,800 a year that my company pays in health insurance a year for the worst HMO on the planet. Then, I have to hear the bitching when someone gets sick and suddenly their wives are calling me everyday asking me questions I cant answer about why the insurance company is cutting them off, etc....

There has to be an alternative.

[DarkReign]

I have a really radical idea. How about we do away with all
health insurance, medicare, medicaid, tricare, and every other
form of medical insurance. Every person will pay for their
health insurance out of pocket. Doctors will go back to the good
old days. People will not run to the doctors for every little ache,
pain, cough or whatever. Which they do now. Cost will have
to go down. Why? Because people will have to rely on what
they have in their hip pocket. Cant wait to hear the screams
about pooooooor people.

Its the advent of civilized culture. The free and available healthcare for any citizen. Rome, Byzantine, ancient China and Japan....all had healthcare programs. Its a service to the people who make your country great, like roads and police forces.

[Spurminator]

We're not interested in having a great country. We're interested in having a subservient country that believes it's great because it's been told so since birth.

[DarkReign]

We're not interested in having a great country. We're interested in having a subservient country that believes it's great because it's been told so since birth.

Im not sure more truer words have been spoken.

[PixelPusher]

Its the advent of civilized culture. The free and available healthcare for any citizen. Rome, Byzantine, ancient China and Japan....all had healthcare programs. Its a service to the people who make your country great, like roads and police forces.
"Public Health" - a term utterly alien to some.

[George Gervin's Afro]

I just heard on the sean whannity show that the free market is the cure for all ills..

[PixelPusher]

I just heard on the sean whannity show that the free market is the cure for all ills..
Of course it is! You're always better of trusting a profit-minded corporate bureaucracy over a government bureaucracy.

[George Gervin's Afro]

Of course it is! You're always better of trusting a profit-minded corporate bureaucracy over a government bureaucracy.


Well maybe I have been wrong all along. I should just trust HMO's to do the right thing. of course then the free market folks will say "then choose one of their competitors". unfortunately I'll be dead because the treatment that I needed was denied.. but hey it's the free market!!

[xrayzebra]

Well maybe I have been wrong all along. I should just trust HMO's to do the right thing.


GGA, I belong to an HMO some years ago and had
cancer. They took very good care of me. And guess it
worked out okay. It has been over 10 years and I am
still among the living. I no longer belong to them. They
left, me, well I should say my doctor left the HMO and I
stayed with him. And yes I had some fusses with them,
but hell, I have fusses with my doctor, but I still like
him and he me, I think. At least he hasn't killed me.

[George Gervin's Afro]

GGA, I belong to an HMO some years ago and had
cancer. They took very good care of me. And guess it
worked out okay. It has been over 10 years and I am
still among the living. I no longer belong to them. They
left, me, well I should say my doctor left the HMO and I
stayed with him. And yes I had some fusses with them,
but hell, I have fusses with my doctor, but I still like
him and he me, I think. At least he hasn't killed me.


Hey ray I am VERY FORTUNATE to work for a company that provides excellent benefits for my family and me. I have compassion for the many people that have to sit in an emergeny room for 8 hours..

And on a side note I am gald that you were able to beat that evil disease..

[DarkReign]

At least he hasn't killed me.

And this is the Gold standard all healthcare people should be held to.

(glad to hear youre fine. Cancer's a bitch. It will be my fate, everyone in my family dies from cancer....thats not an exaggeration)

[xrayzebra]

And this is the Gold standard all healthcare people should be held to.

(glad to hear youre fine. Cancer's a bitch. It will be my fate, everyone in my family dies from cancer....thats not an exaggeration)

I have always said and do believe, I will die from the
common cold. It is the one thing that really, really
puts me to the floor. Damn, I hate them with a passion,
even worst than dimm-o-craps, and they me. How can
someone feel so bad and survive. It has always been
a mystery to me.

[Extra Stout]

It seems to me we view these a little different. Your first two reasons I consider a category of why we need health care rather than the reason it is costly. I have not seen issues with on the prevention side when it comes to things like physical exams. I have seen these encouraged. I agree peoples lifestyle are a major cause, and maybe someday we can even eliminate the need for health care.
You may be among the fortunate ones that have an insurance company which encourages preventive care.

It depends upon the business model of the insurance company. Those with a long-term plan understand that spending $500 now might save $100,000 ten or twenty years down the road.

But if you've dealt with publicly-traded American businesses much, you know that few are looking ten or twenty years down the road. They are focusing on this quarter, next quarter, and maybe next year. Under that model, discouraging preventive care saves money in the short term.

Ten years ago, right-wing think tanks actually discouraged preventive care because it was not deemed "cost-effective" under their payback criteria. We are dealing today with the consequences of some of those policy choices.

Furthermore, the uninsured do not receive much, if any, preventive care, and rely a great deal upon interventional care in emergency rooms, which is both expensive and inefficient. For those who cannot pay, that cost is absorbed into what everybody else pays.


If we are going to look at lifestyle and food, we should separate that and remind people that a socialized system will not change such things. Socializing the system may (will in my opinion) make things worse since it removes personal responsibility.
Some "socialized" plans make some form of health insurance mandatory the way auto liability insurance is mandatory. (Those who can't afford it are subsidized only past their ability to pay.) I don't think such a scheme reduces personal responsibility.

Our lifestyle and food supply issues are not just because people are lazy and make bad choices. Stick an American in Europe, and he will lose weight simply because of the way the infrastructure is set up. Stick him in Monterrey, where people do travel everywhere in cars, and stay in air-conditioned buildings like we do, because the climate sucks even worse there than in Texas, and he will lose weight because Mexican food is sweetened by cane sugar rather than corn syrup. (He also will be less prone to diabetes and arteriosclerosis, but "The Evils of Corn Syrup" is a whole separate rant).

He also won't be ingesting all the estrogen-derived hormones we stuff into our domestic meat products, which encourage fat retention.

In addition, I have a big problem with placing all the responsibility for child nutrition on parents, while simultaneously letting corporations get away with manipulative advertising on unhealthy foods for children, that uses teams of psychologists to find ways to undermine parents. If we're going to let them do that, then parents should be able to defend their families by shooting the executives of processed food companies and ad agencies.

You seem to know what to eat, but that is in no small part because you are highly educated and aware. I don't not think it is reasonable to expect the general population to attain the level of education and wariness necessary to monitor their food to that degree.


As for the cost of drugs, I covered that briefly. It shares the burden of having to recoup money to pay out lawsuits. They would be far cheaper if they didn’t have that burden.

The one thing I have not seen anyone address was my point regarding settlements. What type of lawsuits would be permitted under universal health care? Would health care prices fall to acceptable levels if only reasonable lawsuits could be pursued?
No doubt our tort system is grossly out of whack. I certainly agree that product liability awards need to be curtailed sharply.

That alone will not bring pharmaceutical costs under control. The more significant development in pharmaceuticals is the explosive expansion in marketing, especially direct-to-consumer marketing. This is like the $100 sneaker which is endorsed by the NBA superstar, and costs so much more because of the endorsement contract, but really is no better than a $50 shoe. If reducing drug costs is a priority, then that behavior will have to be curtailed.

Meanwhile, our regulatory scheme for drug approval is one of the most cumbersome in the world. Getting FDA approval is significantly more expensive than getting approval to sell drugs in other developed nations, but we really don't get what we pay for in terms of product safety.

[Extra Stout]

I have a really radical idea. How about we do away with all
health insurance, medicare, medicaid, tricare, and every other
form of medical insurance. Every person will pay for their
health insurance out of pocket. Doctors will go back to the good
old days. People will not run to the doctors for every little ache,
pain, cough or whatever. Which they do now. Cost will have
to go down. Why? Because people will have to rely on what
they have in their hip pocket. Cant wait to hear the screams
about pooooooor people.

I mis-spoke in the above statement:

I said health insurance. I meant to say health care out
of pocket.....

Sorry.
This is how it is done in Chile. What happens there is that if you get really sick, and can't afford treatment, you die. Obviously, to many, that is an acceptable social model, and furthermore, it is a lot cheaper overall, because only a fraction of the population receives any health care whatsoever.

Why we have this discussion in the first place is because of the widespread sentiment that people should not have to die from readily treatable diseases simply because of lack of means. Remove that sentiment, and the difficult issues melt away.

[Extra Stout]

I just heard on the sean whannity show that the free market is the cure for all ills..
Did he mean free market literally, in the economics textbook sense, or "free market" in the present-day, corporate-whore sense, which means "industry lobbyists colluding with bribed politicians to set up uncompetitive market rules which grossly benefit large multinational corporations, and totally screw small businesses, consumers, and the general public welfare."

Because free markets actually do work pretty well, it's just that ever since the South took over the Republican Party, they've been a tactic left untried.

[Wild Cobra]

You may be among the fortunate ones that have an insurance company which encourages preventive care.

I haven’t been under any insurance company of HMO that didn’t encourage preventative care.


It depends upon the business model of the insurance company. Those with a long-term plan understand that spending $500 now might save $100,000 ten or twenty years down the road.

But if you've dealt with publicly-traded American businesses much, you know that few are looking ten or twenty years down the road. They are focusing on this quarter, next quarter, and maybe next year. Under that model, discouraging preventive care saves money in the short term.

I k now. That is a major problem with our corporations today, along with day traders.


Ten years ago, right-wing think tanks actually discouraged preventive care because it was not deemed "cost-effective" under their payback criteria. We are dealing today with the consequences of some of those policy choices.

That hard to believe. I can see those short sighted business types advocating such things, but not those with conservative priciples.


Furthermore, the uninsured do not receive much, if any, preventive care, and rely a great deal upon interventional care in emergency rooms, which is both expensive and inefficient. For those who cannot pay, that cost is absorbed into what everybody else pays.

I know, but there is no simple solution.


Some "socialized" plans make some form of health insurance mandatory the way auto liability insurance is mandatory. (Those who can't afford it are subsidized only past their ability to pay.) I don't think such a scheme reduces personal responsibility.

This might not reduce personal responsibility, but it reduces a person drive to work when not getting paid well. I wouldn’t like it either if it doesn’t address risk issue that individuals can control like smoking, weight, etc.


Our lifestyle and food supply issues are not just because people are lazy and make bad choices. Stick an American in Europe, and he will lose weight simply because of the way the infrastructure is set up. Stick him in Monterrey, where people do travel everywhere in cars, and stay in air-conditioned buildings like we do, because the climate sucks even worse there than in Texas, and he will lose weight because Mexican food is sweetened by cane sugar rather than corn syrup. (He also will be less prone to diabetes and arteriosclerosis, but "The Evils of Corn Syrup" is a whole separate rant).

He also won't be ingesting all the estrogen-derived hormones we stuff into our domestic meat products, which encourage fat retention.

You are right about our food. I liven in Korea for two years and Germany for six. Not only are the Germans very healthy compared to us, but the women have nice breasts. Probably from a proper diet.


In addition, I have a big problem with placing all the responsibility for child nutrition on parents, while simultaneously letting corporations get away with manipulative advertising on unhealthy foods for children, that uses teams of psychologists to find ways to undermine parents. If we're going to let them do that, then parents should be able to defend their families by shooting the executives of processed food companies and ad agencies.

The parents should be responsible and makers of children’s products should not be able to market unhealthy foods without warning labels.


You seem to know what to eat, but that is in no small part because you are highly educated and aware. I don't not think it is reasonable to expect the general population to attain the level of education and wariness necessary to monitor their food to that degree.

I expect our schools to teach such things rather than some of the things they do teach.


No doubt our tort system is grossly out of whack. I certainly agree that product liability awards need to be curtailed sharply.

That alone will not bring pharmaceutical costs under control. The more significant development in pharmaceuticals is the explosive expansion in marketing, especially direct-to-consumer marketing. This is like the $100 sneaker which is endorsed by the NBA superstar, and costs so much more because of the endorsement contract, but really is no better than a $50 shoe. If reducing drug costs is a priority, then that behavior will have to be curtailed.

Marketing is a cost of drugs, and that too I would like to see reduced or eliminated. Drug makers should not be marketing prescription drugs to the public. It places the doctors in a bad spot when someone insists of a certain drug.


Meanwhile, our regulatory scheme for drug approval is one of the most cumbersome in the world. Getting FDA approval is significantly more expensive than getting approval to sell drugs in other developed nations, but we really don't get what we pay for in terms of product safety.

Yes, the bureaucracy needs to be reduced. I am an advocate of reducing most bureaucracies anyway.

[boutons_]

"market unhealthy foods without warning labels."

nearly everything coming out of Frito-Lay, Coca-Cola, Kellog's, Kraft Foods, McDonalds, Burger King, Pizza HUt and other pizza/fast food chains and mfrs is unhealthy.

[boutons_]

The Waiting Game

By PAUL KRUGMAN

Being without health insurance is no big deal. Just ask President Bush. “I mean, people have access to health care in America,” he said last week. “After all, you just go to an emergency room.”

This is what you might call callousness with consequences. The White House has announced that Mr. Bush will veto a bipartisan plan that would extend health insurance, and with it such essentials as regular checkups and preventive medical care, to an estimated 4.1 million currently uninsured children. After all, it’s not as if those kids really need insurance — they can just go to emergency rooms, right?

O.K., it’s not news that Mr. Bush has no empathy for people less fortunate than himself. But his willful ignorance here is part of a larger picture: by and large, opponents of universal health care paint a glowing portrait of the American system that bears as little resemblance to reality as the scare stories they tell about health care in France, Britain, and Canada.

The claim that the uninsured can get all the care they need in emergency rooms is just the beginning. Beyond that is the myth that Americans who are lucky enough to have insurance never face long waits for medical care.

Actually, the persistence of that myth puzzles me. I can understand how people like Mr. Bush or Fred Thompson, who declared recently that “the poorest Americans are getting far better service” than Canadians or the British, can wave away the desperation of uninsured Americans, who are often poor and voiceless. But how can they get away with pretending that insured Americans always get prompt care, when most of us can testify otherwise?

A recent article in Business Week put it bluntly: “In reality, both data and anecdotes show that the American people are already waiting as long or longer than patients living with universal health-care systems.”

( Business Week is a bunch of communist hippies )

A cross-national survey conducted by the Commonwealth Fund found that America ranks near the bottom among advanced countries in terms of how hard it is to get medical attention on short notice (although Canada was slightly worse), and that America is the worst place in the advanced world if you need care after hours or on a weekend.

We look better when it comes to seeing a specialist or receiving elective surgery. But Germany outperforms us even on those measures — and I suspect that France, which wasn’t included in the study, matches Germany’s performance.

Besides, not all medical delays are created equal. In Canada and Britain, delays are caused by doctors trying to devote limited medical resources to the most urgent cases. In the United States, they’re often caused by insurance companies trying to save money.

This can lead to ordeals like the one recently described by Mark Kleiman, a professor at U.C.L.A., who nearly died of cancer because his insurer kept delaying approval for a necessary biopsy. “It was only later,” writes Mr. Kleiman on his blog, “that I discovered why the insurance company was stalling; I had an option, which I didn’t know I had, to avoid all the approvals by going to ‘Tier II,’ which would have meant higher co-payments.”

He adds, “I don’t know how many people my insurance company waited to death that year, but I’m certain the number wasn’t zero.”

To be fair, Mr. Kleiman is only surmising that his insurance company risked his life in an attempt to get him to pay more of his treatment costs. But there’s no question that some Americans who seemingly have good insurance nonetheless die because insurers are trying to hold down their “medical losses” — the industry term for actually having to pay for care.

On the other hand, it’s true that Americans get hip replacements faster than Canadians. But there’s a funny thing about that example, which is used constantly as an argument for the superiority of private health insurance over a government-run system: the large majority of hip replacements in the United States are paid for by, um, Medicare.

That’s right: the hip-replacement gap is actually a comparison of two government health insurance systems. American Medicare has shorter waits than Canadian Medicare (yes, that’s what they call their system) because it has more lavish funding — end of story. The alleged virtues of private insurance have nothing to do with it.

The bottom line is that the opponents of universal health care appear to have run out of honest arguments. All they have left are fantasies: horror fiction about health care in other countries, and fairy tales about health care here in America.

===========

As always, the free market chases profits by screwing the customer with the highest price for the shittiest product. When your health or life is involved, the non-competitive oligarchy knows they have you by the short and curlies.

One of the reality/success stories about American govt health care is the Veteran's Administration after Clinton got it reformed in the late 1990s.

The health care industry will battle viciously against universal care, but that battle is coming.

[Nbadan]

Not only is our present health system dangerous, physically and financially, at current annual costs increases, business can't keep up...


LANDOVER, Md. (AP) - President Bush on Wednesday reiterated his threat to veto Senate legislation that would substantially increase funds for children's health insurance by levying a 61-cent-a-pack increase in the federal excise tax on cigarettes.

...

On Friday, a bipartisan group of lawmakers in the Senate signaled their support for a $35 billion increase, bringing total funding to $60 billion over five years. The Senate proposal would provide health insurance coverage to current participants as well as an additional 3.3 million uninsured children, according to estimates from the Congressional Budget Office.

The American Hospital Association, the American Medical Association and the American Cancer Society support the increase. But the administration, which has consistently refers to SCHIP as government-run health care, says billions of dollars in insurance costs will be shifted from the private sector to the federal government under the Senate proposal.

Bush spoke after attending a round-table discussion at Man & Machine Inc. here with small business leaders the president said feel pinched by high health care costs. "They don't like the idea of having to make the decision between providing health care for their employees and not expanding their businesses," he said.

Linky (http://www.katv.com/news/stories/0707/440374.html)

Yeah, CHIP's is not good for kids, but Congress and the WH are under a government sponsored plan....

[Yonivore]

Truth: America's system of healthcare is atrocious. Not only does it cost the most, it kills the most in comparison to other developed countries.
Hey, DR, I'm still waiting on the stats that support this assertion before I decide there's even a problem with healthcare in America.

Found 'em yet?

[Mr. Peabody]

Hey, DR, I'm still waiting on the stats that support this assertion before I decide there's even a problem with healthcare in America.

Found 'em yet?

I found this article. Maybe these are the stats he is referencing.


U.S. Health Care Most Expensive & Most Error Prone

November 4, 2005
Medical Errors

• Computerized Doctors' Orders Reduce Medication Errors
• Physician Burnout Linked to Medical Errors
• Databases A Possible Culprit In Medication Errors
• Medication Errors Hit 1.5 Million Americans Annually
• Airplanes Safer than Hospitals
• U.S. Health Care Most Expensive & Most Error Prone
• Medication Errors Continue Even in Highly Computerized Hospital
• Study Finds Nearly 200,000 Deaths Annually from Hospital Errors
• Errors Common In Cancer Diagnosis
• Medical "Quality Gaps" Cause 57,000+ Deaths Annually


Not only do Americans pay much more for medical treatment than anyone else in the world, they also bear the brunt of the most medical errors, according to a survey covering the USA, Australia, Canada, Germany, New Zealand and the United Kingdom. Almost 7,000 patients were consulted.

The survey supported by The Commonwealth Fund finds that one-third of U.S. patients with health problems reported experiencing medical mistakes, medication errors, or inaccurate or delayed lab results -- the highest rate of any of the six nations surveyed.

While sicker patients in all countries reported safety risks, poor care coordination, and inadequate chronic care treatment, with no country deemed best or worst overall, the United States stood out for high error rates, inefficient coordination of care, and high out-of-pocket costs resulting in forgone care.

Americans are the most likely to have to pay out-of-pocket expenses over $1,000, and 34 percent of the American patients surveyed said they had encountered either medication errors, wrong test results, late test results or treatment errors.

Nation
Errors

USA
34%

Canada
30%

Australia
27%

New Zealand
25%

Germany
23%

UK
22%

One-third (34%) of U.S. respondents reported at least one of four types of errors: they believed they experienced a medical mistake in treatment or care, were given the wrong medication or dose, were given incorrect test results, or experienced delays in receiving abnormal test results.

Three of 10 (30%) Canadian respondents reported at least one of these errors, as did one-fifth or more of patients in Australia (27%), New Zealand (25%), Germany (23%), and the U.K. (22%).

While patient safety efforts have focused chiefly on hospital settings, most patients (60% or more) said these errors occurred outside the hospital?a signal that safety initiatives should also focus on ambulatory care, said Cathy Schoen, the study's lead author and a senior vice president at The Commonwealth Fund.

Patients receiving complex care may be at even higher risk of medical errors: the incidence of patient-reported errors rose sharply with the number of physicians seen. Despite studies showing patients value discussion about mistakes or errors, most patients (61% to 83%) in each country said the health care providers involved did not tell them about the mistakes.

Communication issues also adversely affect patients' experiences during hospital stays. At least one-fifth of patients (19% to 26%) in the six countries reported communication gaps between themselves and hospital staff, and one-sixth said they would have liked greater involvement in decisions made about their care.

Good transitional care -- helping patients transfer from hospital to home -- also relies on clear communication and coordination. In all six countries, however, at least one-third of patients said they did not receive instructions about symptoms to watch for, did not know whom to contact with questions, or were left without follow-up care arrangements.

German patients had the highest rate of coordination deficiencies when discharged from the hospital, with 60 percent reporting failures to coordinate care. According to the authors, poor transitional care can result in complications and increase the likelihood of hospital readmission, raising concerns about costs as well as quality.

While the U.S. performed better than most countries on the hospital transition measure, it had the highest rate of patients reporting coordination problems during doctor visits.

One-third (33%) of U.S. respondents said that either test results or records were not available at the time of appointments or that doctors duplicated tests. These delays and duplications are a clear sign of inefficient care, the authors said, and waste both physicians' and patients' time and resources. Rates of care coordination problems in the other survey countries were significantly lower, ranging from one-fifth to one-quarter of patients reporting such problems.

As was found in past surveys, the U.S. is an outlier in terms of financial burdens placed on patients. One?half of adults with health problems in the U.S. said they did not see a doctor when sick, did not get recommended treatment, or did not fill a prescription because of cost.

Despite these high rates of forgone care, one-third of U.S. patients spent more than $1,000 out-of-pocket in the past year. In contrast, just 13 percent of U.K. adults reported not getting needed care because of costs, and two-thirds had no out-of-pocket costs.

There were wide and significant variations in access and waiting times on multiple dimensions across the six countries. Respondents in Canada and the U.S. were significantly less likely than those in other countries to report same-day access and more likely to wait six days or longer for an appointment.

At the same time, majorities of patients in New Zealand (58%) and Germany (56%), and nearly half in Australia (49%) and the U.K. (45%), were able to get same-day appointments. Waiting times for elective surgery or specialists were shortest in Germany and the U.S., with the majority of patients in both countries reporting rapid access.

The authors say that no country emerges as a clear winner or loser. All survey countries experience high rates of safety risks, failure to coordinate care during transitions, inadequate communication, and a lack of support for chronically ill patients. These areas of shared concern, they conclude, will likely require policy innovations that transcend current payment and delivery systems.

Facts and Figures:

• More than one of four patients in each country (28% to 32%) said risks were not completely explained during their hospital stay.

• In all countries, sizable majorities of patients said physicians had not always reviewed all their medications during the past year, and one-third or more reported infrequent reviews.

• Across countries, one-sixth to one-fourth of patients said physicians only sometimes, rarely, or never make goals of care and treatment clear or give them clear instructions.

• Relative to the U.S. and Canada, the four countries reporting comparatively rapid access to physicians?Australia, Germany, New Zealand, and the U.K.?also had significantly lower rates of emergency room use.

''What's striking is that we are clearly a world leader in how much we spend on health care," said Cathy Schoen, senior vice president for The Commonwealth Fund, a nonpartisan, nonprofit foundation in New York that commissioned the survey. ''Clearly, we should be doing better."

Other specialists agreed, saying the results offer the most recent evidence that the quality of care delivered by the U.S. healthcare system is seriously eroding even as health care costs skyrocket.

[DarkReign]

Hey, DR, I'm still waiting on the stats that support this assertion before I decide there's even a problem with healthcare in America.

Found 'em yet?

Well shitballs, no I havent. To be quite honest, I didnt try to look. I get this mild impression you will just discredit the source, site some blog, and we would all be back to square one anyway.

So I decided to cut the bullshit out and skip to the end of this arrangement.

[Yonivore]

I found this article. Maybe these are the stats he is referencing.
Could be.

A couple of things the article didn't address that I think would be instructive are, what is the longevity of people living in the United States as opposed to the other countries mentioned and how many of the deaths occurred in the age groups of people living beyond those in other countries.

(I don't know that the longevity of Americans is more or less than those in other countries but, if it is, couldn't this explain at least some of the discrepancy.)

Another thing, how many of the deaths -- whether or not due to medical errors -- occurred in people that would not have even survived to be treated in the other countries?

Yes, America has the most expensive health care but, we're also the most innovative and aggressive at treating previously high-mortality illnesses and injuries. Cases in which even a minor mistake could have catastrophic consequences. For instance, premature infants are surviving at a lot earlier age than they were previously...therefore, there is more opportunity for a medical mistake to take their life than them just dying from being born too early.

I think these things should be factored into the equation. But, that's just me.

[Mr. Peabody]

Could be.

A couple of things the article didn't address that I think would be instructive are, what is the longevity of people living in the United States as opposed to the other countries mentioned and how many of the deaths occurred in the age groups of people living beyond those in other countries.

(I don't know that the longevity of Americans is more or less than those in other countries but, if it is, couldn't this explain at least some of the discrepancy.)

Another thing, how many of the deaths -- whether or not due to medical errors -- occurred in people that would not have even survived to be treated in the other countries?



In longevity, we don't fare too well....



Rank Countries Amount (top to bottom)
#1 Andorra: 83.52 years
#2 Macau: 82.27 years
#3 Japan: 82.02 years
#4 San Marino: 81.8 years
#5 Singapore: 81.8 years
#6 Hong Kong: 81.68 years
#7 Sweden: 80.63 years
#8 Switzerland: 80.62 years
#9 Australia: 80.62 years
#10 France: 80.59 years
#11 Guernsey: 80.53 years
#12 Iceland: 80.43 years
#13 Canada: 80.34 years
#14 Cayman Islands: 80.2 years
#15 Italy: 79.94 years
#16 Gibraltar: 79.93 years
#17 Monaco: 79.82 years
#18 Liechtenstein: 79.81 years
#19 Spain: 79.78 years
#20 Norway: 79.67 years
#21 Israel: 79.59 years
#22 Jersey: 79.51 years
#23 Faroe Islands: 79.49 years
#24 Greece: 79.38 years
#25 Austria: 79.21 years
#26 Virgin Islands: 79.2 years
#27 Malta: 79.15 years
#28 Netherlands: 79.11 years
#29 Luxembourg: 79.03 years
#30 Montserrat: 79 years
#31 New Zealand: 78.96 years
#32 Germany: 78.95 years
#33 Belgium: 78.92 years
#34 Saint Pierre and Miquelon: 78.76 years
#35 Guam: 78.76 years
#36 United Kingdom: 78.7 years
#37 Finland: 78.66 years
#38 Man, Isle of: 78.64 years
#39 Jordan: 78.55 years
#40 Puerto Rico: 78.54 years
#41 Bosnia and Herzegovina: 78.17 years
#42 Bermuda: 78.13 years
#43 Saint Helena: 78.09 years
#44 United States: 78 years

[Mr. Peabody]

Yes, America has the most expensive health care but, we're also the most innovative and aggressive at treating previously high-mortality illnesses and injuries. Cases in which even a minor mistake could have catastrophic consequences. For instance, premature infants are surviving at a lot earlier age than they were previously...therefore, there is more opportunity for a medical mistake to take their life than them just dying from being born too early.

I think these things should be factored into the equation. But, that's just me.

I do agree with you that we are more innovative here in the U.S. in terms of developing new treatments and a big factor in that innovation is the potential for profit. However, it's hard for me to agree with the argument that we should allow our healthcare industry to maintain status quo as the most expensive in the world just so that we can be the most innovative. There has to be a different approach we can take to bring down healthcare costs without sacrificing the development of new treatments for disease.

[Yonivore]

I do agree with you that we are more innovative here in the U.S. in terms of developing new treatments and a big factor in that innovation is the potential for profit. However, it's hard for me to agree with the argument that we should allow our healthcare industry to maintain status quo as the most expensive in the world just so that we can be the most innovative. There has to be a different approach we can take to bring down healthcare costs without sacrificing the development of new treatments for disease.
I do think the other side of that coin could be that health care costs are lower in the other countries because of how they benefit from the innovation of our medical industry.

[Yonivore]

In longevity, we don't fare too well....
Okay, that question is answered but, being as the highest ranking "other" country mentioned (Australia) is only 2.62 years ahead doesn't necessarily negate the point I was making. It does, however, eliminate my using our longevity as evidence of such.

Do you think Andorra has a better healthcare system than Australia?

[boutons_]

Foreign countries (single-buyers) also pay a lot less to US Big Pharma than Americans do. That's why buying US drugs from Canada has exploded into a huge industry.

In ridiculous contrast, the Repugs FORBID the US govt from negotiating for lower prices with Big Pharma.

My doctor says there are plenty of foreign medical innovations, even improvements on US ideas, that flow back into US. He says foreign medical, drug, equipment researchers are on the same level as US people.

(eg, retropublic laparoscopic prostatectomy developed in the US didn't really take off (too long to learn and to master) until French doctors re-thought the entire process. When the French procedures came back to the USA, that kind of surgery finally became widely adopted,

As usual, Yoni's xenophobia and chauvinism have no basis in fact, just ideological bullshit.

[Mr. Peabody]

Do you think Andorra has a better healthcare system than Australia?

No, I don't think you can necessarily use expected lifespans as proof of quality healthcare. There are other factors which undoubtedly play a role in determining average lifespan (lifestyle, environment, genetics, etc.). I only posted those stats in response to your post which questioned whether our longer lifespans could be an explanation for the gap in healthcare.

I would say though, Yoni, that at some point the evidence does seem to indicate the possibility that our healthcare system is not the best in the world.

[Mr. Peabody]

Foreign countries (single-buyers) also pay a lot less to US Big Pharma than Americans do. That's why buying US drugs from Canada has exploded into a huge industry.

In ridiculous contrast, the Repugs FORBID the US govt from negotiating for lower prices with Big Pharma.



Right, but you would have to agree that Big Pharma is a business and is only going to put effort into creating new drugs to realize a profit. If you start artificially capping the amount of profit, don't you also take away the incentive to invest in the creation of new drugs?

[Yonivore]

No, I don't think you can necessarily use expected lifespans as proof of quality healthcare. There are other factors which undoubtedly play a role in determining average lifespan (lifestyle, environment, genetics, etc.). I only posted those stats in response to your post which questioned whether our longer lifespans could be an explanation for the gap in healthcare.
I understood that and I was more pointing to my folly in even mentioning it than suggesting you posted it as some refutation of my point.


I would say though, Yoni, that at some point the evidence does seem to indicate the possibility that our healthcare system is not the best in the world.
Could be.

The evidence could also indicate we're a more unhealthy society than the others -- due to lifestyle choices and not medical care -- or that we have a riskier healthcare system due to our propensity to be aggressive in the name of innovation in cure-seeking.

I think the cost is clearly a function of innovation (and the inherent waste and fraud of bureaucracy). None of the other countries expend as much because they merely take what we've invented and apply it there.

[boutons_]

"If you start artificially capping the amount of profit, don't you also take away the incentive to invest in the creation of new drugs?"

One proposal I saw was that US govt would buy drug patents from drug development companies (perhaps $Bs per patent in some cases) and make them generic. This would take the $Bs in profits away from Big Pharma over the life of the patents that now cost the US so much money and put so many drugs out of reach.

Then generic manufacturers could get on with producing the drugs for reasonable mfr-ing profits, often at pennies per dose to manufacture.

The savings in drug costs for Medicare/Medicaid/univseral-health-care/VetAdmin would offset the costs of buying the patents.

This would prevent drug development companies from reformulating their expired patent drugs with little or no improvement, just so they could get a new 17-year patent and then market their new no-better-than-generic drug as much superior to generic drugs.

Since the whole planet benefits from drugs, the whole planet can play the drug development game. They make profits from development, but not from manufacturing. ie, no-profit drugs, instead of the exorbitant profits, just part of the overall approach to no-profit health care.

[PixelPusher]

Right, but you would have to agree that Big Pharma is a business and is only going to put effort into creating new drugs to realize a profit. If you start artificially capping the amount of profit, don't you also take away the incentive to invest in the creation of new drugs?
How is having the ability to negoiate on prices (you know...bargaining?) an "artificial cap"? When I post the winning bid on an item on eBay, and it (inevitably) ends up being less than what the seller was hoping to sell it for, am I "artificially capping" his profit margin? Where's the "artifice"?

[Extra Stout]

USA health care costs, 2005: $2 trillion
USA health care R&D costs, 2005: $111 billion
USA health care R&D costs, funded by private industry: $61 billion.

There is a lot of room to cut health care costs without touching R&D. Don't touch R&D.

[Yonivore]

USA health care costs, 2005: $2 trillion
USA health care R&D costs, 2005: $111 billion
USA health care R&D costs, funded by private industry: $61 billion.

There is a lot of room to cut health care costs without touching R&D. Don't touch R&D.
Yep. You could cut healthcare costs substantially by completely privatizing it and removing government price controls enforced through Medicare and Medicaid. Competition is the best medicine.

Not to mention all the fraud and waste that would go away with the bureaucracy.

Oh yeah, and Tort reform. Doctor's don't need to be afraid of getting their licenses sued out from under them.

Government has beat altruism right out of the medical field.

[boutons_]

"Competition is the best medicine."

yoni's funny. Go back and read where that last Repug Medicare bill FORBIDS the US govt from negotiating for lower drug prices. That type of govt regulation, that stuffs corporate welfare $Bs into Big Pharma pockets, doesn't bother yoni and the conservatives one little bit.

There is NO competition when a drug company has patent on a drug. It's monopoly supplier, and all unregulated monopolies are abusive.

There's no competition in healthcare, and it's not because of govt regulations. Health care orgs join networks run by insurance companies that set the prices they will pay, and IF they will pay. This is completely private, commercial, "free market", NOT govt regulation.

You fuckers don't have a clue when you worship free markets, which are great in text books, but in practice, most markets are cartelized, centralized, controlled by a few dominant players who don't compete on price and buy enough politicians to protect their racket.

[Extra Stout]

Yep. You could cut healthcare costs substantially by completely privatizing it and removing government price controls enforced through Medicare and Medicaid. Competition is the best medicine.

Not to mention all the fraud and waste that would go away with the bureaucracy.

Oh yeah, and Tort reform. Doctor's don't need to be afraid of getting their licenses sued out from under them.

Government has beat altruism right out of the medical field.
Yes, completely privatizing medicine will significantly reduce costs. As mentioned previously in the thread, this is how Chile does it, and AEI/Heritage Foundation types tend to applaud Chile's economic freedom.

The only thing you give up with the complete privatization is the ability of the poor of get medical care. The Chilean solution is to let them die. Simply not treating sick people reduces the cost of their care to nearly zero (sometimes, the state has to dispose of the untended corpses if the family does not).

The thing that we get hung up on is this idea that people should not die of readily treatable diseases simply for lack of means. If we can disabuse ourselves of this notion, the issues get a lot simpler.

[Yonivore]

Yes, completely privatizing medicine will significantly reduce costs. As mentioned previously in the thread, this is how Chile does it, and AEI/Heritage Foundation types tend to applaud Chile's economic freedom.

The only thing you give up with the complete privatization is the ability of the poor of get medical care. The Chilean solution is to let them die. Simply not treating sick people reduces the cost of their care to nearly zero (sometimes, the state has to dispose of the untended corpses if the family does not).

The thing that we get hung up on is this idea that people should not die of readily treatable diseases simply for lack of means. If we can disabuse ourselves of this notion, the issues get a lot simpler.
There's a lot more wealth in American than Chile. I have trouble believing our wealthy and our doctors wouldn't be able to pull together enough free clinics to treat the indigent.

And, I think they'd do it a lot better than government.

[Extra Stout]

You fuckers don't have a clue when you worship free markets, which are great in text books, but in practice, most markets are cartelized, centralized, controlled by a few dominant players who don't compete on price and buy enough politicians to protect their racket.
I have to agree with boutons on thsi one. Corporations' extolling of free market principles is just lip service. They want rigged markets that protect their own interests.

[Extra Stout]

There's a lot more wealth in American than Chile. I have trouble believing our wealthy and our doctors wouldn't be able to pull together enough free clinics to treat the indigent.

And, I think they'd do it a lot better than government.
I think you have an utterly misplaced faith in the philanthropy and altruism of the wealthy in this country.

For every Bill Gates or Warren Buffet out there, there are 100 tycoons who will step on your throat, as you lay bleeding on the pavement, to bend down and pick up a dime.

[Yonivore]

I think you have an utterly misplaced faith in the philanthropy and altruism of the wealthy in this country.

For every Bill Gates or Warren Buffet out there, there are 100 tycoons who will step on your throat, as you lay bleeding on the pavement, to bend down and pick up a dime.
It doesn't take them all. There are enough Bill Gates' and Warrent Buffets out there who will step up to the plate.

Our society is fairly well integrated where the wealthy depend fairly heavily on the labor of poor. This isn't the middle ages -- or, Chile, for example -- where the rich can just use someone until they die and have them replaced with the next future corpse. Much of our national industry depends on a healthy and intelligence work force.

If for no other reason than keeping productivity up, they'll figure out a way to replace government medical care.

And, I guarantee it'll be more efficient than Medicare and Medicaid.

[Extra Stout]

It doesn't take them all. There are enough Bill Gates' and Warrent Buffets out there who will step up to the plate.

Our society is fairly well integrated where the wealthy depend fairly heavily on the labor of poor. This isn't the middle ages -- or, Chile, for example -- where the rich can just use someone until they die and have them replaced with the next future corpse. Much of our national industry depends on a healthy and intelligence work force.

If for no other reason than keeping productivity up, they'll figure out a way to replace government medical care.

And, I guarantee it'll be more efficient than Medicare and Medicaid.
I think you have an utterly misplaced faith in the concern of the wealthy in America for the long-term competitiveness of the U.S. economy.

[Yonivore]

I think you have an utterly misplaced faith in the concern of the wealthy in America for the long-term competitiveness of the U.S. economy.
Well, we just disagree. I believe there are more Gates's and Dells and Buffetts than there are Rockefellers and Hearsts and...pick your villain.

[Extra Stout]

Well, we just disagree. I believe there are more Gates's and Dells and Buffetts than there are Rockefellers and Hearsts and...pick your villain.
The disdain for ordinary Americans among the old-money set is unmistakeable. They are the grandchildren of people in the 1930's who thought the Great Depression represented what the natural order of things should be, and who tried to overthrow FDR and install a fascist dictatorship. They haven't forgotten those values.

You should read and find out what America actually was like for the middle and working classes during the Gilded Age. The reason things changed was that people got sick of it and started killing the wealthy, and the wealthy got scared and gave concessions.

And America was more altruistic then than it is now.

These are the people who actually are quoted as saying that they alone are responsible for 100% of the American economy and should therefore control 100% of the wealth, and that an American worker is no different from a peasant in Indonesia and shouldn't be paid any more.

The default situation for humanity throughout history is that everyone is selfish, and will gladly screw over everybody else to benefit themselves and their families. Capitalism, in principle, counts upon this (which is why it works while utopian systems fail miserably), but if not refereed to protect free markets, laspses into economic oligarchy.

There are rare cases when a society will develop elites who actually are concerned about something besides their own enrichment at the expense of the country. We have had two such periods when that was true: the founding of the nation, and the aftermath of World War II. Nations become great when that happens. It is NOT true today.

I think a lot of your ideas could work in a society where there were no multinational corporations with the power of nation-states, with a drastically diminished state that lacked the ability to control the population. Free markets will work only when the elites lack the ability to manipulate them, or where there is sufficient fear of violent consequences to prevent the rich from doing so.

[Yonivore]

The disdain for ordinary Americans among the old-money set is unmistakeable. They are the grandchildren of people in the 1930's who thought the Great Depression represented what the natural order of things should be, and who tried to overthrow FDR and install a fascist dictatorship. They haven't forgotten those values.

You should read and find out what America actually was like for the middle and working classes during the Gilded Age. The reason things changed was that people got sick of it and started killing the wealthy, and the wealthy got scared and gave concessions.

And America was more altruistic then than it is now.

These are the people who actually are quoted as saying that they alone are responsible for 100% of the American economy and should therefore control 100% of the wealth, and that an American worker is no different from a peasant in Indonesia and shouldn't be paid any more.

The default situation for humanity throughout history is that everyone is selfish, and will gladly screw over everybody else to benefit themselves and their families. Capitalism, in principle, counts upon this (which is why it works while utopian systems fail miserably), but if not refereed to protect free markets, laspses into economic oligarchy.

There are rare cases when a society will develop elites who actually are concerned about something besides their own enrichment at the expense of the country. We have had two such periods when that was true: the founding of the nation, and the aftermath of World War II. Nations become great when that happens. It is NOT true today.

I think a lot of your ideas could work in a society where there were no multinational corporations with the power of nation-states, with a drastically diminished state that lacked the ability to control the population. Free markets will work only when the elites lack the ability to manipulate them, or where there is sufficient fear of violent consequences to prevent the rich from doing so.
Okay. :drunk

[Yonivore]

Extra Stout, what you're saying -- to me, at least -- is that the bleeding heart liberal left is a sham. That if they can't get government to spend my money on your health then they will just give up and not do a damn thing about it.

Right?

Charitible giving us way up in this country. I don't think it's possible for this nation to go back to the era you described. And, if there is another depression, there won't be any federal money for health care either.

[Extra Stout]

Extra Stout, what you're saying -- to me, at least -- is that the bleeding heart liberal left is a sham. That if they can't get government to spend my money on your health then they will just give up and not do a damn thing about it.

Right?

Charitible giving us way up in this country. I don't think it's possible for this nation to go back to the era you described. And, if there is another depression, there won't be any federal money for health care either.
The reason they try to get government to do it is because it has the coercive power to tax, which provides a rather strong funding source.

Now it is perfectly valid to say that your money should not go to pay for the health care of somebody else who can't afford to pay, and that the people who care about such things should place the burden upon themselves to fund it. That just depends upon your personal values.

It is rather disingenuous just to assume that other people will stand in the gap, however. The testimony of history and of the rest of the world says that they don't.

Charitable giving is way up in the United States. The middle class gives five times as much as a share of their income as the wealthy do to charity, and if you take away a small handful of philanthropists, the disparity is even greater. The middle class is the reason giving is up.

And you are correct that if there is another depression, there won't be any money for health care. In fact, the quickest way to a depression for us is to run up such a huge debt that the market loses confidence in the dollar. And we're on that path right now with Medicare/Medicaid and the Iraq war.

With Medicare/Medicaid at least, we can either do nothing until we go bankrupt, drop the program entirely and just hope people won't revolt, or identify and cut out the nearly $1 trillion-per-year waste in the system.

[Yonivore]

The reason they try to get government to do it is because it has the coercive power to tax, which provides a rather strong funding source.

Now it is perfectly valid to say that your money should not go to pay for the health care of somebody else who can't afford to pay, and that the people who care about such things should place the burden upon themselves to fund it. That just depends upon your personal values.

It is rather disingenuous just to assume that other people will stand in the gap, however. The testimony of history and of the rest of the world says that they don't.
There's no other place in the world like America and we're not even the same country we were in the early part of the last century.

Charity doesn't belong in the constitution. You shouldn't be able to take money from me, by force, and give it to someone else. That's a relatively new concept in this country that the socialist liberals have exploited rather well.


Charitable giving is way up in the United States. The middle class gives five times as much as a share of their income as the wealthy do to charity, and if you take away a small handful of philanthropists, the disparity is even greater. The middle class is the reason giving is up.

And you are correct that if there is another depression, there won't be any money for health care. In fact, the quickest way to a depression for us is to run up such a huge debt that the market loses confidence in the dollar. And we're on that path right now with Medicare/Medicaid and the Iraq war.

With Medicare/Medicaid at least, we can either do nothing until we go bankrupt, drop the program entirely and just hope people won't revolt, or identify and cut out the nearly $1 trillion-per-year waste in the system.
You cut the waste by privatizing medical care.

[boutons_]

Here's an example of free-market/commercial-for-profit health care pricing in a a quote I received a few months ago for an OUT-PATIENT procedure:

If you have insurance, the procedure costs $137K.
If you don't have insurance, the procedure costs $37K.

[boutons_]

Not only is demographics (Baby Boomers over 60) putting pressure on health care expenditures, but gluttony is, too.

===================

Study predicts 75 percent overweight in U.S. by 2015

Wed Jul 18, 6:45 PM ET

If people keep gaining weight at the current rate, fat will be the norm by 2015, with 75 percent of U.S. adults overweight and 41 percent obese, U.S. researchers predicted on Wednesday.

( "norm"? how about "average"? norm implies an authoritative target, a rightness or correctness or idealness, as in "normal weight". )

A team at Johns Hopkins University in Baltimore examined 20 studies published in journals and looked at national surveys of weight and behavior for their analysis, published in the journal Epidemiologic Reviews.

"Obesity is a public health crisis. If the rate of obesity and overweight continues at this pace, by 2015, 75 percent of adults and nearly 24 percent of U.S. children and adolescents will be overweight or obese," Dr. Youfa Wang, who led the study, said in a statement.

They defined adult overweight and obesity using a standard medical definition called body mass index. People with a BMI of 25 or above are considered overweight, while those with BMIs of 30 or above are obese and at serious risk of heart disease, diabetes and some cancers.

( BMI haters, chime in )

Studies show that 66 percent of U.S. adults were overweight or obese in 2003 and 2004. An alarming 80 percent of black women aged 40 or over are overweight and 50 percent are obese.

( My guess is that Hispanic women are right there or not far "behind". Genetic or cultural? Hispanic men like their women in barrel shapes? )

Sixteen percent of U.S. children and adolescents are overweight and 34 percent are at risk of becoming overweight, according to federal government figures.

Every group is steadily getting heavier, Wang said.

"Our analysis showed patterns of obesity or overweight for various groups of Americans," said May Beydoun, who worked on the study.

"Obesity is likely to continue to increase, and if nothing is done, it will soon become the leading preventable cause of death in the United States."

Copyright © 2007 Reuters Limited.

===========
,
As these obese people, very often, on the low-end of the economic totem pole get seriously, chronically sick with life-style diseases such Type II diabetes, cardiovascular disease, cancer, etc, the government will pick up tab, an ad lib, de facto national health insurance plan.

Doesn't it make more sense to have a designed national health plan? We know the conservatives would never infringe on these people's absolute freedoms to sicken themselves. The Repugs running Agri/Food Biz, Big Pharma, AMA, HMOs, insurance companies would never interfere with the $Bs of tax dollars flowing into their pockets from treating these people.

[Extra Stout]

As these obese people, very often, on the low-end of the economic totem pole get seriously, chronically sick with life-style diseases such Type II diabetes, cardiovascular disease, cancer, etc, the government will pick up tab, an ad lib, de facto national health insurance plan.

Doesn't it make more sense to have a designed national health plan? We know the conservatives would never infringe on these people's absolute freedoms to sicken themselves. The Repugs running Agri/Food Biz, Big Pharma, AMA, HMOs, insurance companies would never interfere with the $Bs of tax dollars flowing into their pockets from treating these people.
You need to think out of the box. Why treat the chronically-ill poor? You save a lot of money if you let them die -- maybe enough for a tax cut.

[Oh, Gee!!]

but you can't assist them in dying a less painful death

[Extra Stout]

but you can't assist them in dying a less painful death
But life is precious.

[Yonivore]

Who's Really 'Sicko' (http://www.opinionjournal.com/editorial/feature.html?id=110010266)
In Canada, dogs can get a hip replacement in under a week. Humans can wait two to three years.



Thursday, June 28, 2007 12:01 a.m.

TORONTO--"I haven't seen 'Sicko,' " says Avril Allen about the new Michael Moore documentary, which advocates socialized medicine for the United States. The film, which has been widely viewed on the Internet, and which will officially open in the U.S. and Canada on Friday, has been getting rave reviews. But Ms. Allen, a lawyer, has no plans to watch it. She's just too busy preparing to file suit against Ontario's provincial government about its health-care system next month.

Her client, Lindsay McCreith, would have had to wait for four months just to get an MRI, and then months more to see a neurologist for his malignant brain tumor. Instead, frustrated and ill, the retired auto-body shop owner traveled to Buffalo, N.Y., for a lifesaving surgery. Now he's suing for the right to opt out of Canada's government-run health care, which he considers dangerous.

Ms. Allen figures the lawsuit has a fighting chance: In 2005, the Supreme Court of Canada ruled that "access to wait lists is not access to health care," striking down key Quebec laws that prohibited private medicine and private health insurance.

In the U.S., 83 House Democrats voted for a bill in 1993 calling for single-payer health care. That idea collapsed with HillaryCare and since then has existed on the fringes of the debate--winning praise from academics and pressure groups, but remaining largely out of the political discussion. Mr. Moore's documentary intends to change that, exposing millions to his argument that American health care is sick and socialized medicine is the cure.

It's not simply that Mr. Moore is wrong. His grand tour of public health care systems misses the big story: While he prescribes socialism, market-oriented reforms are percolating in cities from Stockholm to Saskatoon.

Mr. Moore goes to London, Ontario, where he notes that not a single patient has waited in the hospital emergency room more than 45 minutes. "It's a fabulous system," a woman explains. In Britain, he tours a hospital where patients marvel at their free care. A patient's husband explains: "It's not America." Humorously, Mr. Moore finds a cashier dispensing money to patients (for transportation). In France, a doctor explains the success of the health-care system with the old Marxist axiom: "You pay according to your means, and you receive according to your needs."

It's compelling material--I know because, born and raised in Canada, I used to believe in government-run health care. Then I was mugged by reality.

Consider, for instance, Mr. Moore's claim that ERs don't overcrowd in Canada. A Canadian government study recently found that only about half of patients are treated in a timely manner, as defined by local medical and hospital associations. "The research merely confirms anecdotal reports of interminable waits," reported a national newspaper. While people in rural areas seem to fare better, Toronto patients receive care in four hours on average; one in 10 patients waits more than a dozen hours.

This problem hit close to home last year: A relative, living in Winnipeg, nearly died of a strangulated bowel while lying on a stretcher for five hours, writhing in pain. To get the needed ultrasound, he was sent by ambulance to another hospital.

In Britain, the Department of Health recently acknowledged that one in eight patients wait more than a year for surgery. Around the time Mr. Moore was putting the finishing touches on his documentary, a hospital in Sutton Coldfield announced its new money-saving linen policy: Housekeeping will no longer change the bed sheets between patients, just turn them over.

France's system failed so spectacularly in the summer heat of 2003 that 13,000 people died, largely of dehydration. Hospitals stopped answering the phones and ambulance attendants told people to fend for themselves.

With such problems, it's not surprising that people are looking for alternatives. Private clinics--some operating in a "gray zone" of the law--are now opening in Canada at a rate of about one per week.

Canadian doctors, once quiet on the issue of private health care, elected Brian Day as president of their national association. Dr. Day is a leading critic of Canadian medicare; he opened a private surgery hospital and then challenged the government to shut it down. "This is a country," Dr. Day said by way of explanation, "in which dogs can get a hip replacement in under a week and in which humans can wait two to three years."

Market reforms are catching on in Britain, too. For six decades, its socialist Labour Party scoffed at the very idea of private medicine, dismissing it as "Americanization." Today Labour favors privatization, promising to triple the number of private-sector surgical procedures provided within two years. The Labour government aspires to give patients a choice of four providers for surgeries, at least one of them private, and recently considered the contracting out of some primary-care services--perhaps even to American companies.

Other European countries follow this same path. In Sweden, after the latest privatizations, the government will contract out some 80% of Stockholm's primary care and 40% of total health services, including Stockholm's largest hospital. Beginning before the election of the new conservative chancellor, Germany enhanced insurance competition and turned state enterprises over to the private sector (including the majority of public hospitals). Even in Slovakia, a former Marxist country, privatizations are actively debated.

Under the weight of demographic shifts and strained by the limits of command-and-control economics, government-run health systems have turned out to be less than utopian. The stories are the same: dirty hospitals, poor standards and difficulty accessing modern drugs and tests.

Admittedly, the recent market reforms are gradual and controversial. But facts are facts, the reforms are real, and they represent a major trend in health care. What does Mr. Moore's documentary say about that? Nothing.

Dr. Gratzer, a practicing physician licensed in Canada and the U.S. and a senior fellow at the Manhattan Institute, is the author of "The Cure: How Capitalism Can Save American Health Care" (Encounter, 2006).
Yeah, we want that system.

[Extra Stout]

I'm shocked that a publication by and for the investor class tells horror stories in order to protect a system that benefits the investor class at the expense of everybody else. I remember Pravda made it read like every other American was homeless back in the 1980's.

[Extra Stout]

Let's see... my family is at nine months and counting for a life-saving surgery. I must not live in the United States.

[Yonivore]

Let's see... my family is at nine months and counting for a life-saving surgery. I must not live in the United States.
What kind of surgery?

[Extra Stout]

What kind of surgery?
I'll admit it's not a hip replacement.

[Yonivore]

I'll admit it's not a hip replacement.
So, what is it?

[Oh, Gee!!]

tell us your personal business, ES.

[Yonivore]

tell us your personal business, ES.
First of all, he said family so, is there any chance we're going to know any more about ES than before if he just reveals the surgery?

I think he's avoiding because the surgery probably requires something that can't just be conjured up on short notice -- a donor.

[Yonivore]

I'm shocked that a publication by and for the investor class tells horror stories in order to protect a system that benefits the investor class at the expense of everybody else. I remember Pravda made it read like every other American was homeless back in the 1980's.
So, you're calling them liars?

[Yonivore]

I'll admit it's not a hip replacement.
Look, you don't have to answer but, I'm curious as to what lifesaving surgery could be withheld for 9 months, in this country, and not make front page news.

Awaiting a donor? Experimental treatment?

I'm curious.

[boutons_]

"You save a lot of money if you let them die"

This was an observation in France a few years,where it was calculated the smokers died sooner of lung cancer and other diseases than non-smokers. Even if it were expensive to treat them until they died in the 50s or 60s, that was cheaper for the country than having them live until 80+, paying their pensions, and covering their increasing old-age medical costs for 20+ years.

There was a recent report that showed low/uninsured US people putting off medical care in their late 50s, early 60s, until they hit 65 become covered by Medicare, at which point they dumped their pent-up health care demands on Medicare. Delayed medical care is often more expensive because the problems have worsened.

Same situation that led Austin to offer free medical care to poor people rather than have them arrive in emergency rooms (dubya's Queen Antoinette solution) with worse and much more expensive problems.

[Extra Stout]

I think he's avoiding because the surgery probably requires something that can't just be conjured up on short notice -- a donor.
It wouldn't make any sense to bring it up in this conversation if it were that.

But no, I'm not going to get specific.

[Extra Stout]

So, you're calling them liars?
They didn't make the story up, but certainly they are cherry-picking an anecdote that fits their ideological agenda.

[Yonivore]

It wouldn't make any sense to bring it up in this conversation if it were that.

But no, I'm not going to get specific.
I'm going to go out on a limb here and say, there isn't any life-saving surgery, short of transplant or experimental, that one would have to wait nine months to receive, in this country.

If you're not going to help figure it out, why'd you even bring it up?

[xrayzebra]

It wouldn't make any sense to bring it up in this conversation if it were that.

But no, I'm not going to get specific.

So obviously it must have something to do with a
lack of funds to obtain the procedure.

[Extra Stout]

I'm going to go out on a limb here and say, there isn't any life-saving surgery, short of transplant or experimental, that one would have to wait nine months to receive, in this country.

If you're not going to help figure it out, why'd you even bring it up?
Well, going through the process (and it is a loooooooooooooong process) has opened my eyes to a lot, and changed my mind about the state of health care in this country. I should have known that revealing a personal detail in a political forum was a mistake, since it opens me up to attack.

I am lucky I have decent insurance, but I see a lot of people who don't.

[Yonivore]

They didn't make the story up, but certainly they are cherry-picking an anecdote that fits their ideological agenda.
I'm looking for the source but, I heard today -- in a discussion about the article I just posted -- a couple of other things.

1) There are over a million people on waiting lists for medical care in Britain. And, there are over 200,000 people waiting to get onto a waiting list. I don't think we have that magnitude of a problem in the U.S.

2) There's an entrepeneur in Canada that started a limousine service that takes Canadians to New York State for medical care. He's making a mint.

[Yonivore]

Well, going through the process (and it is a loooooooooooooong process) has opened my eyes to a lot, and changed my mind about the state of health care in this country. I should have known that revealing a personal detail in a political forum was a mistake, since it opens me up to attack.

I am lucky I have decent insurance, but I see a lot of people who don't.
So, without revealing the surgery or the condition, to what do you attribute the wait?

[Extra Stout]

So, without revealing the surgery or the condition, to what do you attribute the wait?
There is a lot of red tape (not government-related, either), and appointment schedules are booked months in advance.

[xrayzebra]

Well, going through the process (and it is a loooooooooooooong process) has opened my eyes to a lot, and changed my mind about the state of health care in this country. I should have known that revealing a personal detail in a political forum was a mistake, since it opens me up to attack.

I am lucky I have decent insurance, but I see a lot of people who don't.

ES, I or I don't think anyone else is attacking you. Health
issues are very personal to everyone. And serious
health issues affect a family as a whole. I would never
attack anyone over it.

Some health issues can't be fixed by anyone. Sadly.
Money wouldn't help. And sadly government wouldn't
help. And sadly government has been proven to be an
impediment to good health, in my opinion. And some
doctors under government programs have sit themselves
up as the arbitrators of another's health or well being
or treatment thereof. Even to the point of sending
people home to die without even trying to help in
their last days. All in the name of budget restraints.
And yes I do know some insurance does similar things.
But you do have recourse.

[Yonivore]

There is a lot of red tape (not government-related, either), and appointment schedules are booked months in advance.
I guess we need to define life-saving then.

I think Mr. McCreith's malignant brain tumor, over which he waited 4 months for a diagnostic MRI and then months longer for a consult with a neurologist is an unreasonable and unfortunate result of socialized medicine.

Is your condition that urgent?

I'm beginning to believe it's your situation that anecdotal. Because, I've never heard of anyone waiting 9 months for life-saving surgery...unless the wait is necessary (or unavoidable) and not simply bureaucratic.

[Extra Stout]

Well, I don't think society is going to let us just kill the executives of malfeasant insurance companies, so some kind of reform is needed. People can't just pay premiums for years, and then get abandoned by their insurance when they get sick and left to die. To me, that's negligent manslaughter with fraud mixed in.

But part of the problems in the system are because market principles aren't being used, not because the government isn't regulating enough.

[Extra Stout]

I guess we need to define life-saving then.

I think Mr. McCreith's malignant brain tumor, over which he waited 4 months for a diagnostic MRI and then months longer for a consult with a neurologist is an unreasonable and unfortunate result of socialized medicine.

Is your condition that urgent?

I'm beginning to believe it's your situation that anecdotal. Because, I've never heard of anyone waiting 9 months for life-saving surgery...unless the wait is necessary (or unavoidable) and not simply bureaucratic.
Mine is not that urgent. However, the issues with Mr. McCreith also exist in this country, especially the long waits for consults.

[boutons_]

"market principles aren't being used"

market principles work great in text books and academia.

which market principles aren't being used today in health care? and why aren't they being followed?

like any for-profit enterprise, health care delivers the least amount of product, ideally zero, for the highest price. That's a fundamental principle.

[Yonivore]

Mine is not that urgent.
Okay then.


However, the issues with Mr. McCreith also exist in this country, especially the long waits for consults.
If they do, it's not because we don't have socialized medicine. If anything, it's because the lack of tort reform and government meddling into health care had resulted in a lack of qualified specialists.

But, even at that, if you take away the 4 month wait -- for the initial MRI -- wait times for specialists are usually on a priority basis. Your general practitioner, primary care physician, or whatever, has some latitude in moving you up the priority list should he deem it unwise to let you wait for the next available appointment.

Most specialist build time into their schedules for just such emergencies.

I'll relate a recent experience. I had a relative who, during a routine physical, it was discovered had a funky looking mole on their back.

Primary care physician referred him to a dermatologist, the appointment was set for the next week. Dermatologist didn't like the looks of the mole, excised it and submitted to a pathologist for biopsy. 4 business days later, he was told the biopsy was negative for melanoma or any other malignancy.

14 days from start to finish. And, I don't have that great an insurance either. In fact, I'll probably have some hefty co-pays and deductibles to meet but, the point is, ability to pay those was never a consideration. I'll get the bills and make arrangements to pay them out.

[boutons_]

Conservatives address health care

By Barbara Barrett
McClatchy Newspapers

WASHINGTON — A group of conservative Republican senators put forth a plan Thursday that seeks to ensure every American has health insurance, a cause long championed by the political left.

The bill encourages families to find their own health coverage and offers tax credits of up to $5,400 per family. But advocates for the uninsured say the proposal could jeopardize low-income families and chronically ill patients, as well as the employment-based health-care system, which now covers 65 percent of Americans.

"It's time for a major debate on health-care insurance," Sen. Mel Martinez, R-Fla., said in a statement. "Not enough people have access to affordable health care, and the Congress has not done enough about this crisis."

Martinez was joined in introducing the bill by fellow Republican Sens. Richard Burr of North Carolina, Tom Coburn of Oklahoma and Bob Corker of Tennessee.

The bill could bring health coverage to millions of Americans. But Burr said it also would begin taxing the value of health-care plans that many employers now offer workers, a controversial provision sure to face opposition. Such benefits are now tax-free, both for the employer and the worker.

"Our aim is to remove inequities in our tax laws and make tax relief for health insurance available to everyone," Martinez said.

The legislation would offer special tax credits to help cover the cost of health insurance and other health bills: $2,160 per person, up to a maximum of $5,400 per family.

The legislation, called the Every American Insured Health Act, comes amid debate this week in the House and Senate over the renewal of a states-run children's health insurance program, which Democrats want to expand to cover more children.

Polls show health care as one of the top concerns of voters.

But Kathleen Stoll, director of health policy for Families USA, an advocacy group in Washington, said the idea behind the new legislation isn't terribly new. Republicans have long been working to dismantle the employment-based health system that most Americans now use, she said.

"When we eliminate that tax break for [the system], we should do that with extreme caution," Stoll said.

Advocates for the uninsured fear that employers could drop health benefits altogether. And for many families, $5,400 won't buy a lot of health insurance.

Copyright © 2007 The Seattle Times Company

===================

So let's see. A family of 4 buys (goes out of pocket) for health insurance which costs what $12K/year, probably with $3000 deductible. And then next April 15th, they can deduct $5400 off their tax bill. So they are out of pocket for all the insurance (if they can find it), and out of pocket for the withholding taxes, of which they get back $5400. I can see this being jumped on by millions of poor families.

This still leaves the problems:

1. Finding insurance, esp if someone in your family is chronically ill.

2. Keeping the insurance from being cancelled.

3. Paying for insurance if you lose your job.

4. Fighting huge battles and delays with your insurance company that will do everything possible to NOT pay you.

yep, the Repugs are for for-profit, rip-off health care. And what is the hit on federal tax revenues for $5400 tax credits? Of course, the Repugs reducing tax revenues is all about their hidden agenda of "drowning the fed govt in a bathtub".

[Wild Cobra]

I heard some numbers today about socialized health care countries vs, the USA. I had to do with deadly diseases like cancer. Anyway, the survivability of all these were something like 15% to 50% better in the USA rather than any the socialized medicine countries. The reason being not having to wait as long for care of things like breast cancer, where the quicker it’s treated, the better success of curing it is.

It was also explained why the USA had lower life expectancies. It was because of diet, crime rates, auto accidents, etc. As Americans, we drive more miles per capita than any other country. These driving death numbers become part of the life expectancy statistics.

[boutons_]

Here's the kind of for-profit/minized-care bullshit insurance company fight you don't have with a not-for-profit national health care system:

July 29, 2007

Obstacles to Care

Doing Battle With the Insurance Company in a Fight to Stay Alive

By DENISE GRADY

A glorious blend of forces came together to save Gordon Hendrickson’s life: smart doctoring, luck, kindness, and his own wisdom and abundant grit.

Only his insurance company tried to stand in the way.

Five years ago, when Mr. Hendrickson was 66, routine blood work found something amiss with his liver. One test led to another, and then to an awful diagnosis: pancreatic cancer, one of the deadliest kinds.

His doctors thought he was among the lucky few with pancreatic cancer found early enough to be cured by surgery. But they warned him not to have the surgery in his home city, Albuquerque. They said the operation he needed, a Whipple procedure, was so risky and complicated that it should be done only by a surgeon who performed it often and at a hospital with many similar cases. But neither was available locally.

Albuquerque’s population was less than half a million, and the entire state of New Mexico had fewer than two million people, not enough to give local surgeons much practice with a relatively uncommon operation.

An experienced surgeon and hospital can significantly increase the odds of survival for people with pancreatic cancer, studies have found. Lower complication rates can also minimize the cost.

Mr. Hendrickson, a retired administrator for the YMCA and the Spina Bifida Association, had taken care in choosing his internist, Dr. Kristine Bordenave. They liked and trusted each other, and one morning, Dr. Bordenave canceled her other appointments to spend hours on the phone finding a major cancer center that would quickly admit him. It turned out to be the M. D. Anderson Cancer Center in Houston.

But his insurer, the Presbyterian Health Plan, refused to pay for treatment in Houston. The company insisted that the operation be done in Albuquerque and sent him a list of five local surgeons.

He went to M. D. Anderson anyway. But because Presbyterian would not pay, the hospital required a $5,000 deposit. Mr. Hendrickson and his wife had little money and normally threw away any credit cards mailed to them. But his wife happened to have one new card that she had not gotten around to cutting up yet. They decided that this was the one time when they should not worry about money, and they used the card to pay the deposit.

“I was a person who wanted to live,” Mr. Hendrickson said, adding that he assumed it would be cheaper for the insurance company to let him die.

The surgeon at M. D. Anderson told him that without an operation he had virtually no chance of surviving, and even with an operation his chances would be slim. Despite the long odds and the high cost, insurers cover the Whipple operation in patients who are candidates for it — less than a quarter of those with pancreatic cancer — because it offers the only hope of a cure and can prolong life.

Figuring that a small chance was better than none, Mr. Hendrickson had the surgery. It went well. But he was left with more than $80,000 in medical bills, which Presbyterian Health Plan refused to pay.

Dr. Bordenave said she was appalled: “No patient fighting for their life should have to fight for their insurance too.”

Mr. Hendrickson waged a long battle with Presbyterian. “I fought with the insurance company for over a year,” he said.

After Presbyterian rejected two appeals, he took his case to a state review board, where he represented himself because he could not afford a lawyer. Presbyterian showed up with two lawyers, a doctor and a nurse. Dr. Bordenave and a gastroenterologist from Albuquerque testified on Mr. Hendrickson’s behalf.

Mr. Hendrickson and his wife had studied the details of their insurance policy and had also learned — with the help of M. D. Anderson — that in the previous five years, the five surgeons Presbyterian had recommended had performed a total of five Whipple operations.

Ultimately, Mr. Hendrickson won the case, and Presbyterian Health Plan paid the entire bill.

A spokesman for Presbyterian said the case had led the company to allow more patients to be treated at high-volume centers if there was evidence that the results would be better.

Mr. Hendrickson said it was “tough to stand up to attorneys and doctors. I don’t know why I was able to do it. I’m stubborn, I guess. I don’t like to be told what to do. Too many people, I know, they just let it go and they die.”

In June, Mr. Hendrickson went back to M. D. Anderson for a five-year checkup with his surgeon, a visit paid for by Presbyterian.

“He told me that I was cured of pancreatic cancer,” Mr. Hendrickson said in an e-mail message. “I shouted from the rooftops.”

=================

There are 10s of 1000s of stories like this every year, causing incredible stress and anger on people with serious and/or fatal diseases, with the insurance companies running up huge expenses in resources to fight/disqualify their own clients' claims, the costs which of course are charged back to the policy holders. Total insanity.

[xrayzebra]

^^The point being boutons. He got the operation at the place
he wanted. Under National Health, he would not have gotten it and
if he had come to the U.S. for it, you can bet your bottom dollar
National Health would not have paid for it, period. End of story.
And that is a fact. You can carp all you want about our system
and it is expensive, but it is one of the best.

[Peter]

I heard some numbers today about socialized health care countries vs, the USA. I had to do with deadly diseases like cancer. Anyway, the survivability of all these were something like 15% to 50% better in the USA rather than any the socialized medicine countries. The reason being not having to wait as long for care of things like breast cancer, where the quicker it’s treated, the better success of curing it is.

Not surprising.


It was also explained why the USA had lower life expectancies. It was because of diet, crime rates, auto accidents, etc. As Americans, we drive more miles per capita than any other country. These driving death numbers become part of the life expectancy statistics.

Not surprising.

[Peter]

But part of the problems in the system are because market principles aren't being used, not because the government isn't regulating enough.

:tu

I never understood why it is thought that the people who brought you the Post Office and the DMV could do better.

[Nbadan]

:tu

I never understood why it is thought that the people who brought you the Post Office and the DMV could do better.


Well, we haven't completely privatized the most ferocious fighting Armed forces (government run I might add) on God's green earth yet, but were trying....and don't those Republican Senators who won't give poor kids insurance have a very generous Congressional health plan that, eh,gawd...is run by the Government....

[xrayzebra]

Well, we haven't completely privatized the most ferocious fighting Armed forces (government run I might add) on God's green earth yet, but were trying....and don't those Republican Senators who won't give poor kids insurance have a very generous Congressional health plan that, eh,gawd...is run by the Government....

dan, Republican Senators or dimm-o-crap Senators for that
matter do not give you anything. It is paid for by the
citizens of this country by taxes taken from them. Just
because someone has a low income doesn't mean they
cant afford to take their kids to the doctor. It just means
they have to spend their money in a different manner.
You know like not buying that new color TV or game for
the kids. You would think we are in a health crisis because
kids don't have insurance. With few exceptions most
children see a doctor for colds and minor things. Not
major illness. Immunization programs should be
mandatory and paid for by government. But then you
have the same groups carping about forcing shots on
kids and that these shots cause all kinds of side effects.
Which is not the case. When they do cause side effects
it is rare. Most doctors will let people pay for care over
time if the patient will just talk to the doctor about it.

[George Gervin's Afro]

Just because someone has a low income doesn't mean they
cant afford to take their kids to the doctor. It just means
they have to spend their money in a different manner.
You know like not buying that new color TV or game for
the kids.

Hey ray what if they don't have the money for new color tv either? What if they are dirt poor? I really enjoy how most conservatives slip in the caveatwhen talking about the poor in this country. As you notice ray doesn't want to sound like a heartless son of a b*tch so he will slip in the ' It just means they have to spend their money in a different manner.
You know like not buying that new color TV or game for
the kids' remark. See that way ray can get away with saying his tax money shouldn't go towards helping the poor. He can now attack poor people...

[boutons_]

July 30, 2007

An Immoral Philosophy

By PAUL KRUGMAN

When a child is enrolled in the State Children’s Health Insurance Program (Schip), the positive results can be dramatic. For example, after asthmatic children are enrolled in Schip, the frequency of their attacks declines on average by 60 percent, and their likelihood of being hospitalized for the condition declines more than 70 percent.

Regular care, in other words, makes a big difference. That’s why Congressional Democrats, with support from many Republicans, are trying to expand Schip, which already provides essential medical care to millions of children, to cover millions of additional children who would otherwise lack health insurance.

But President Bush says that access to care is no problem — “After all, you just go to an emergency room” — and, with the support of the Republican Congressional leadership, he’s declared that he’ll veto any Schip expansion on “philosophical” grounds.

It must be about philosophy, because it surely isn’t about cost. One of the plans Mr. Bush opposes, the one approved by an overwhelming bipartisan majority in the Senate Finance Committee, would cost less over the next five years than we’ll spend in Iraq in the next four months. And it would be fully paid for by an increase in tobacco taxes.

The House plan, which would cover more children, is more expensive, but it offsets Schip costs by reducing subsidies to Medicare Advantage — a privatization scheme that pays insurance companies to provide coverage, and costs taxpayers 12 percent more per beneficiary than traditional Medicare.

Strange to say, however, the administration, although determined to prevent any expansion of children’s health care, is also dead set against any cut in Medicare Advantage payments.

So what kind of philosophy says that it’s O.K. to subsidize insurance companies, but not to provide health care to children?

( and never forget that dubya's Medicare bill made it IL-fucking-LEGAL for the feds to negotiate drug prices with Big Pharma. )

Well, here’s what Mr. Bush said after explaining that emergency rooms provide all the health care you need: “They’re going to increase the number of folks eligible through Schip; some want to lower the age for Medicare. And then all of a sudden, you begin to see a — I wouldn’t call it a plot, just a strategy — to get more people to be a part of a federalization of health care.”

Now, why should Mr. Bush fear that insuring uninsured children would lead to a further “federalization” of health care, even though nothing like that is actually in either the Senate plan or the House plan? It’s not because he thinks the plans wouldn’t work. It’s because he’s afraid that they would. That is, he fears that voters, having seen how the government can help children, would ask why it can’t do the same for adults.

And there you have the core of Mr. Bush’s philosophy. He wants the public to believe that government is always the problem, never the solution. But it’s hard to convince people that government is always bad when they see it doing good things. So his philosophy says that the government must be prevented from solving problems, even if it can. In fact, the more good a proposed government program would do, the more fiercely it must be opposed.

This sounds like a caricature, but it isn’t. The truth is that this good-is-bad philosophy has always been at the core of Republican opposition to health care reform. Thus back in 1994, William Kristol warned against passage of the Clinton health care plan “in any form,” because “its success would signal the rebirth of centralized welfare-state policy at the very moment that such policy is being perceived as a failure in other areas.”

But it has taken the fight over children’s health insurance to bring the perversity of this philosophy fully into view.

There are arguments you can make against programs, like Social Security, that provide a safety net for adults. I can respect those arguments, even though I disagree. But denying basic health care to children whose parents lack the means to pay for it, simply because you’re afraid that success in insuring children might put big government in a good light, is just morally wrong.

And the public understands that. According to a recent Georgetown University poll, 9 in 10 Americans — including 83 percent of self-identified Republicans — support an expansion of the children’s health insurance program.

There is, it seems, more basic decency in the hearts of Americans than is dreamt of in Mr. Bush’s philosophy.

============

You're doing a heckuva job, dubya!

[Nbadan]

.

Hey ray what if they don't have the money for new color tv either? What if they are dirt poor? I really enjoy how most conservatives slip in the caveatwhen talking about the poor in this country. As you notice ray doesn't want to sound like a heartless son of a b*tch so he will slip in the ' It just means they have to spend their money in a different manner.
You know like not buying that new color TV or game for
the kids' remark. See that way ray can get away with saying his tax money shouldn't go towards helping the poor. He can now attack poor people...

Your right, it's a very conveeeeeeeenient guilt avoidance technique....let the kids starve, and no free-shit because it's their fault their parents have fucked up spending priorities...

[George Gervin's Afro]

Your right, it's a very conveeeeeeeenient guilt avoidance technique....let the kids starve, and no free-shit because it's their fault their parents have fucked up spending priorities...


They all do it. I am surprised nobody has caught on to that but all of them will provide multiple caveats. Especially when talking about the CHIPS program you will surely encounter the "well they shouldn't spend money on tennis shoes' , or ' if they don't buy plasma TVs they could afford it'.. etc...

[Nbadan]

..don't forget the dreaded lone-star card...everyone's buying beer and smokes...


...people would be amazed if they knew how many kids don't even get enough to eat during the summer school break because for many, theirs more month than money....

[gtownspur]

..don't forget the dreaded lone-star card...everyone's buying beer and smokes...


...people would be amazed if they knew how many kids don't even get enough to eat during the summer school break because for many, theirs more month than money....


fucking kids need to work!! :madrun :smokin

[Yonivore]

..don't forget the dreaded lone-star card...everyone's buying beer and smokes...


...people would be amazed if they knew how many kids don't even get enough to eat during the summer school break because for many, theirs more month than money....
So, when's World Vision, Save The Children, and UNICEF gonna set up shop in some American hell hole?

Seriously, where are all these starving children?

[George Gervin's Afro]

So, when's World Vision, Save The Children, and UNICEF gonna set up shop in some American hell hole?

Seriously, where are all these starving children?

Yoni has implied no starving children live in the USA..only kids that are very,very hungry..

[Yonivore]

Yoni has implied no starving children live in the USA..only kids that are very,very hungry..
I haven't implied it, I've flat out stated there are no starving children living in the United States of America except those from whom food is withheld by criminal act.

There's a huge difference between hungry and starving. Nobody voluntarily starves in this country. No-fucking-body.

[George Gervin's Afro]

I haven't implied it, I've flat out stated there are no starving children living in the United States of America except those from whom food is withheld by criminal act.

There's a huge difference between hungry and starving. Nobody voluntarily starves in this country. No-fucking-body.


Why are you so defensive? I just mentioned that you have differentiated starving from very hungry..

[Yonivore]

Why are you so defensive? I just mentioned that you have differentiated starving from very hungry..
I'm not defensive, I'm just pointing out you weren't being emphatic enough when you pretended to speak for me.

[Nbadan]

I haven't implied it, I've flat out stated there are no starving children living in the United States of America except those from whom food is withheld by criminal act.

There's a huge difference between hungry and starving. Nobody voluntarily starves in this country. No-fucking-body.

Nobody starves, hardly, but is Mac and Cheese or Top Ramon a good daily meal for a kid?....it's not like TX increases the amount they give the poor for food during summer months when kids are home more.....and a lot of people won't seek help unless things get really desperate....

[Yonivore]

Nobody starves, hardly, but is Mac and Cheese or Top Ramon a good daily meal for a kid?....it's not like TX increases the amount they give the poor for food during summer months when kids are home more.....and a lot of people won't seek help unless things get really desperate....
Are you suggesting the people who can only afford Mac-n-Cheese or Top Ramen do not qualify for WIC or any other assistance program?

I have a relative, with children, who is the beneficiary our our tax dollars. She applies for every assistance program for which she qualifies. And, she is always "gifting" family members with the bounty of food that would otherwise spoil because she gets more money than she needs to feed her four children every month.

I also know that in Austin, the school district continues the free breakfast program through the summer -- even though the numbers of those who take advantage of it drops by over 75%. I know if my kid were "starving" or "very, very hungry" I'd get their asses in the school cafeteria every morning.

There is absolutely no reason, short of pure laziness, that a child should even go hungry in Texas. Aside from public, tax-dollar supported assistance, there are food pantries and free lunch programs sponsored by private charitable organizations.

My church will feed anyone that comes to the door hungry.

[Yonivore]

While we're on the subject of healthcare, here's another great moment in Socialized Medicine (http://www.guardian.co.uk/uk_news/story/0,,2137719,00.html):

Englishwoman Olive Beal has a hearing problem. According to London's Guardian, she "finds it difficult to hear with her five-year-old analogue [hearing] aid and needs a digital version that cuts out background noise and makes conversation easier."

Mrs. Beal went to the Eastern and Coastal Kent Primary Care Trust, her local office of the National Health Service. No problem, they told her, she'll get a hearing aid. But it'll take her 18 months to get to the top of the waiting list:


Mrs Beal, a former piano teacher who was involved in the suffragette movement, would be 110 by the time she gets her new hearing aid. "I could be dead by then," she said yesterday.
Aw, c'mon, Mrs. Beal, look on the bright side. Just be grateful the thing is free!

[boutons_]

Hearing aids, eye glasses, and dental aren't covered in France, I'm surprised hearing aids are covered in UK.

[Yonivore]

And, another one:

Woman In Britain Forced To Pay For Her Own Hip Replacement

Here’s yet another story proponents of socialized medicine will find a bit inconvenient. A woman in Great Britain needed hip surgery. She applied for the surgery to be done in the national health care system she’d been paying taxes to support. She was told by the bureaucrats in that system that she was too fat to have her hip replaced, so she was forced to raise money so she could travel to another country and pay for the procedure herself.

This would be money spent over and above the money she paid in taxes to fund the national health care system which was supposed to meet all her medical needs.

She then came back to her home country and sued her national health service plan to get the money she spent back. Her case is yet to be decided. But perhaps the most chilling part of this whole ordeal is this:


The PCT had refused her treatment because of its policy of not providing surgery to most people with a body mass index of more than 35 unless they go through a weight-loss plan.
Basically, if some bureaucrat bean counter decides you’re too fat, you can’t get surgery in Great Britain. It doesn’t matter if you need the surgery or not, or that you paid for these services with your tax dollars. If you don’t conform to their standards you don’t get care.

What’s more, the tool they’re using to determine who is and is not fat is an archaic measure that is hardly accurate. Under body mass index measurements, people like professional football player Emmit Smith are “fat.” Along with people like Dwayne Johnson (a/k/a “The Rock), George W. Bush and Tom Cruise.

Could you imagine Tom Cruise not being able to get hip surgery in Great Britain...because he’s too fat? I’m not saying that being fat is a good thing. I’m just pointing out that socialized medicine is an awful, inefficient system that drives government bureaucrats to absurd lengths (like denying surgeries based on an outmoded obesity measure like BMI) in order to ration health services.

This is not something we, as Americans, should want to sign up for.

[Yonivore]

So, what happens if “universal healthcare” is decreed, and there’s no doctor in the house? What happens when the proponents of “universal healthcare” also castigate the best and brightest who choose to endure the rigors of medical training by reducing their financial incentive?

A report in the Wall Street Journal (http://online.wsj.com/article/SB118532549004277031.html) says that the Massachusetts experiment in “universal healthcare” may founder on the lack of enough primary care physicians:


State officials have acknowledged the problem. "Health-care coverage without access is meaningless," Gov. Deval Patrick said in March.

As it happens, primary-care doctors, including internists, family physicians, and pediatricians, are in short supply across the country. Their numbers dropped 6% relative to the general population from 2001 to 2005, according to the Center for Studying Health System Change in Washington. The proportion of third-year internal medicine residents choosing to practice primary care fell to 20% in 2005, from 54% in 1998.

A principal reason: too little money for too much work. Median income for primary-care doctors was $162,000 in 2004, the lowest of any physician type, according to a study by the Medical Group Management Association in Englewood, Colo. Specialists earned a median of $297,000, with cardiologists and radiologists exceeding $400,000.

At the same time, the workweek for primary-care doctors has lengthened, and they are seeing more patients. The advent of managed care in the mid-1990s added to the burden as insurance companies called on primary-care doctors to serve as gatekeepers for their patients' referrals to specialty medicine.
An op-ed in USA Today (http://blogs.usatoday.com/oped/2007/07/us-savior-forei.html), by an immigration lawyer, delves further, with attention to the British experience with terrorist doctors. Strict screening is the key.


Why haven't we heard any links of these foreign physicians to terrorism in the USA? Most likely because of the extensive background checks that all skilled workers, including doctors, undergo before being admitted. British security clearances for skilled workers are not as extensive, and the process is under review.

It might help to know some basic data:
Physicians in the USA: 794,893.
Foreign graduate doctors in the USA: 185,234 (from 127 countries).
Percentage of doctors in U.S. training programs who are foreigners: 24%.
This is not a new phenomenon. Foreign physicians have made up about this percentage of our doctor population for years. A sizable portion work in medically underserved communities and small towns. This at a time when a shortage of doctors in the USA is expected to grow to as much as 200,000 by 2020.

Why is this shortage happening?

First, the USA has opened almost no new medical schools in the past 25 years. So you have a physician population that has remained flat serving a U.S. population that is expected to grow by 25% between 2000 and 2025.
Major demographic changes in the physician population also must be considered. Nearly one-third of doctors are older than 55, with more choosing early retirement. Fifty percent of all medical school graduates are now women. That is affecting both the total hours worked each year as well as the number of specialists. Family demands are causing many women to reduce their hours or to leave the profession when they have children. Some women doctors avoid fields with difficult call hours, such as anesthesiology and radiology.

Then there are our own demographic changes. The number of Americans older than 65 will increase to 54 million by 2020. As we age, our need for medical care increases.

Finally, as more treatment options are available and new technology is developed, Americans are more likely to seek out the services of a physician or specialist.
Yeah, we need universal health care...

[boutons_]

How about some horror stories from US health care, Yoni?
Can't find any? I didn't think so, you jingo motherfucker.

Yoni supports his unsupportabl case with ratshit.

The big picture, that nobody disputes, is that the US's healtcare bill per capita is by far the highest in the industrial world, for delivering less health care, and causing 10s of millions of people to live in fear of medical catastrophe and financial ruin, including the insured middle classes.

[boutons_]

This article is 2 years old, assume that skyrocketing ripoff medical costs is now 2 years worse.

==================

For Americans, Getting Sick Has Its Price

Survey Says U.S. Patients Pay More, Get Less Than Those in Other Western Nations

By Rob Stein
Washington Post Staff Writer
Friday, November 4, 2005; A02

Americans pay more when they get sick than people in other Western nations and get more confused, error-prone treatment, according to the largest survey to compare U.S. health care with other nations.

The survey of nearly 7,000 sick adults in the United States, Australia, Canada, New Zealand, Britain and Germany found Americans were the most likely to pay at least $1,000 in out-of-pocket expenses. More than half went without needed care because of cost and more than one-third endured mistakes and disorganized care when they did get treated.

Although patients in every nation sometimes run into obstacles to getting care and deficiencies when they do get treated, the United States stood out for having the highest error rates, most disorganized care and highest costs, the survey found.

"What's striking is that we are clearly a world leader in how much we spend on health care," said Cathy Schoen, senior vice president for the Commonwealth Fund, a private, nonpartisan, nonprofit foundation that commissioned the survey. "We should be expecting to be the best. Clearly, we should be doing better."

Other experts agreed, saying the results offer the most recent evidence that the quality of care in the United States is seriously eroding even as health care costs skyrocket.

"This provides confirming evidence for what more and more health policy thinkers have been saying, which is, 'The American health care system is quietly imploding, and it's about time we did something about it,' " said Lucian L. Leape of the Harvard School of Public Health.

The new survey, the eighth in an annual series of cross-national surveys conducted by Harris Interactive for the fund, is the largest to examine health care quality across several nations during the same period. The survey was aimed at evaluating care across varying types of health care systems, including the market-driven U.S. system and those that have more government controls and subsidies.

The survey, published in the journal Health Affairs, questioned 6,957 adults who had recently been hospitalized, had surgery or reported health problems between March and June of this year.

"These patients are the canary in the coal mine of any health care system," Schoen said.

Nearly a third of U.S. patients reported spending more than $1,000 in out-of-pocket expenses for their care, far outpacing all other nations. Canadians and Australians came next, with 14 percent of patients spending that much. The proportion reporting similarly high costs was far lower in the other countries.

Americans had the easiest access to specialists, but they experienced the most problems getting care after hours, and Americans and Canadians were the most likely to report problems seeing a doctor the same day they sought one.

Americans were also much more likely to report forgoing needed treatment because of cost, with about half saying they had decided not to fill a prescription, to see a doctor when they were sick or opted against getting recommended follow-up tests. About 38 percent of patients in New Zealand reported going without care; the numbers were 34 percent in Australia, 28 percent in Germany, 26 percent in Canada and 13 percent in Britain.

"If that's not a reason for moral outrage, I don't know what is," Leape said.

About one-third of U.S. patients reported problems with the coordination of their care, such as test results not being available when they arrived at a doctor's appointment or doctors ordering duplicate tests. In the other countries, 19 to 26 percent of patients reported similar problems.

Americans also reported the greatest number of medical errors. Thirty-four percent reported getting the wrong medication or dose, incorrect test results, a mistake in their treatment or care, or being notified late about abnormal test results. Only 30 percent of Canadian patients, 27 percent of Australian patients, 25 percent of New Zealanders, 23 percent of Germans and 22 percent of Britons reported errors.

"The findings show that we have a lot to learn from our colleagues" in other countries, said Carolyn Clancy of the federal Agency for Healthcare Research and Quality during a briefing at which the results were released. She said the federal government has launched a number of initiatives to find ways to improve care, particularly for the increasing number of Americans with chronic illness.

"The findings here reinforce how difficult it is coordinating care. . . . That's the next frontier," Clancy said.

© 2005 The Washington Post Company

[Extra Stout]

So, what happens if “universal healthcare” is decreed, and there’s no doctor in the house? What happens when the proponents of “universal healthcare” also castigate the best and brightest who choose to endure the rigors of medical training by reducing their financial incentive?

A report in the Wall Street Journal (http://online.wsj.com/article/SB118532549004277031.html) says that the Massachusetts experiment in “universal healthcare” may founder on the lack of enough primary care physicians:


An op-ed in USA Today (http://blogs.usatoday.com/oped/2007/07/us-savior-forei.html), by an immigration lawyer, delves further, with attention to the British experience with terrorist doctors. Strict screening is the key.


Yeah, we need universal health care...
Put strict caps on malpractice liability so that doctors get to keep more of their earnings rather than paying exorbitant malpractice premiums (do you notice how deply the insurance companies have their tentacles wrapped around our system?), and watch the financial incentive to practice go up.

[xrayzebra]

How about some horror stories from US health care, Yoni?
Can't find any? I didn't think so, you jingo motherfucker.

Yoni supports his unsupportabl case with ratshit.

The big picture, that nobody disputes, is that the US's healtcare bill per capita is by far the highest in the industrial world, for delivering less health care, and causing 10s of millions of people to live in fear of medical catastrophe and financial ruin, including the insured middle classes.

There are horror stories in all systems. But national
health isn't the answer in any way, shape or fashion.
Oh, I forgot. Universal Health Care. People like you
make others live in fear of catastrophe. How many people
do you actually know who have had a catastrophic
health problem that has not been taken care of in our
system?

[boutons_]

"Put strict caps on malpractice liability so that doctors get to keep more of their earnings rather than paying exorbitant malpractice premiums"

show us that TX cap of $250K (extremely small compared to previous awards) has reduced TX malpractice insurance premiums.

US doctors are wildly overpaid, and corrupted by Big Pharma 100K detailers/drug pushers.

[boutons_]

Emergency Medicine News:Volume 29(6)June 2007p 26

Drug Company Payments to Physicians

[In Brief]

Laws in two states requiring disclosure of pharmaceutical company payments to physicians do not provide the public with easy access to payment information and are of limited quality when accessed, according to a study in the March 21 issue of the Journal of the American Medical Association.

Interactions between the pharmaceutical industry and health care professionals often involve payments, including cash, gift certificates, meals, textbooks, or conference fees. In contrast to many other professions, medicine allows payments from a company to an individual who decides whether and how often to use products produced by the company. The American Medical Association recommends that gifts but not other payments to physicians should benefit patients and should not exceed $100 in value.

Recent legislation in five states and the District of Columbia mandated state disclosure of payments made to physicians by pharmaceutical companies.

In two of these states, Vermont and Minnesota, payment disclosures are publicly available.

The authors of the study found that the laws enacted by Vermont and Minnesota fail to provide the public with easy access to information about payments from pharmaceutical companies to physicians and other health care professionals. The study also found that pharmaceutical companies made substantial numbers of payments of $100 or more to physicians. In Vermont, among 12,227 payments totaling $2.18 million publicly disclosed, there were 2,416 payments of $100 or more to physicians. In Minnesota, among 6,946 payments totaling $30.96 million publicly disclosed, there were 6,238 payments of $100 or more to physicians.

[medstudent]

:greedy

[medstudent]

show us that TX cap of $250K (extremely small compared to previous awards) has reduced TX malpractice insurance premiums.



Actually it really has helped.

---------------------------------------------

Doctors clamoring to come to Texas, creating backlog of applicants
More than 2,000 doctors awaiting Texas licenses, as patients wait to see certain specialists

By Mary Ann Roser
AMERICAN-STATESMAN STAFF
Monday, July 09, 2007

An influx of doctors into Texas has caused long waits for medical licenses, inconveniences for patients wanting to see certain specialists and anxiety for physicians awaiting new colleagues to help with high caseloads.

People in the medical field say the state's limits on malpractice lawsuits have generated a surge of doctors, including specialists, who want to practice in Texas, which is helping bring more doctors to areas of the state that don't have enough.

But the state's popularity has overwhelmed the Texas Medical Board, which screens doctors before issuing them a Texas medical license, a process that involves verifying doctors' medical education, doing a criminal background check and other steps.

Lawmakers have approved $1.2 million to hire six more staffers to process applications faster. Meanwhile, the board is using temporary workers and paying staffers overtime but still can't keep up, spokeswoman Jill Wiggins said.

"The pipeline is just clogged," Wiggins said.

The board received 4,000 applications for medical licenses in 2006, compared with 2,992 the previous year. Wiggins said the board expects to approve 2,750 new licenses this year, 235 more than the previous year.

There is a backlog of 2,398 license applications awaiting approval. The most complicated applications take an average of 6.3 months to process, and the simplest ones average 41 days, according to data provided by the board. The most complicated applications include ones that come from out-of-state doctors or from veteran doctors who have long histories to be checked.

In 2003, the most complex applications took an average of 45 days, and the simplest took 20 days, Wiggins said.

Dr. James E. Kreisle Jr., an Austin psychiatrist, said he and two colleagues have been been waiting since the fall for two psychiatrists from South Carolina and Georgia to get licensed in Texas so they can join the practice.

"There's a shortage of psychiatrists in this town," Kreisle said.
:lol
He said patients have to wait at least three weeks to get in to see him. Some Austin psychiatrists aren't taking any new patients, he said, which can pose serious problems for patients who are severely depressed or have some other condition that requires immediate treatment.

Many doctors are coming to Texas because of a 2003 law that has created a favorable legal environment for them, physicians and others said. The law limits damage awards in malpractice lawsuits and thus has discouraged lawyers from representing patients or their loved ones who want to sue a doctor.

On average, malpractice insurance premiums in Texas have gone down 21.3 percent since the tort law took effect in September 2003, said Jon Opelt, executive director of Texas Alliance for Patient Access. The alliance, which supported changing the medical liability law, describes itself as a coalition of doctors, hospitals, nursing homes, health care providers and medical liability insurers.

The law is "a big factor why Texas has become a popular state to practice in," said Dr. Punit Chadha, an oncologist who moved to Austin from Chicago last summer. "When medical recruitment firms send out information, . . . they will tout the friendliness" of the malpractice environment.

Chadha, who grew up in Houston, said he wanted to come back to Texas but would not have returned if not for the 2003 law. His malpractice insurance premium is now about one-fourth of what it would have been in Chicago, which has some of the highest rates in the nation, he said.

It took him five months to get his license approved in Texas, he said.

Dr. Kevin H. Brown, who started practicing obstetrics in Round Rock in May, applied for a Texas license the same day in September as his obstetrician wife and partner, Ingrid W. Brown. It took six months for his license to be approved; his wife is still waiting for hers because of a paperwork delay, he said.

Brown said that his wife was able to get a temporary license and that their practice is helping alleviate Round Rock's shortage of obstetricians.

The medical board can issue temporary licenses to doctors who have completed the licensing process and are only waiting for final approval from the board, which meets every other month, Wiggins said.

Brown said he and his wife paid $130,000 a year for both of them to have malpractice insurance in Georgia. Now, they pay a combined premium of $82,000 a year, he said.

"It was a $24,000 raise for each of us before we even got started," Brown said.

Many parts of the state that have had doctor shortages are seeing new physicians arrive, Opelt said. Beaumont once had to fly some trauma patients to other cities for treatment because the city didn't have enough trauma surgeons, Opelt said. Now, enough surgeons have moved to Beaumont to handle the caseload.

"Most every area of the state is seeing gains except for far East Texas," Opelt said.

Still, Kreisle, the Austin psychiatrist, said he fears that the backlog could cause physicians to go elsewhere.

Wiggins estimated that it will take "a little over a year" before the new staffers at the medical board can bring the backlog of license applications under control.

"You're turning a battleship around," she said.

[boutons_]

http://www.memag.com/memag/content/printContentPopup.jsp?id=443728


http://www.memag.com/memag/data/site/memag/memaglogoImage1161280633238.gif (http://www.memag.com/) http://www.memag.com/memag/sitewide/images/clear_dot.gif

What drug rep visits cost you

http://www.memag.com/memag/sitewide/images/clear_dot.gif By swearing off meetings with detailers, some doctors are seeing more patients—and watching their earnings rise.

http://www.memag.com/memag/sitewide/images/clear_dot.gif Aug 3, 2007 By: Robert Lowes (http://www.memag.com/memag/author/authorInfo.jsp?id=6634) Medical Economics Benjamin Brewer, an FP in Forrest, IL, turned up the heat on pharmaceutical representatives by framing a simple question: Are their visits worth the patient encounters they cost a doctor?

In 2005, Brewer decided that the 15 or so drug reps—also known as detailers—who visited his office each week distracted him from patient care. So he went cold turkey, refusing to meet with them or accept their samples. Life without reps, as he recently wrote in his online column for The Wall Street Journal, has allowed him to treat a few more patients each week, and earn an extra $6,300 a year.

"I didn't think rep visits cut into my time with patients, but a few minutes here and a few minutes there added up," says Brewer.

It's not just the money or the productivity at issue; it's the overall value of detailing visits, which have faced increasing criticism in recent years. Doctors like Brewer, who find them expendable, view the samples they leave behind as an attempt to lock patients into new medications.

Not everyone sees it that way. Most of the doctors we informally surveyed welcome the attractive men and women who show up with pizzas and meds. But many have nevertheless tried to rein them in, only meeting with them during lunch hour, for example, or limiting how many can come to the office on a given day. Here's a closer look at how some doctors deal with detailer visits.

"Reps cost us far too much money"

Nationwide, there are an estimated 90,000 to 100,000 reps; each calls on eight to 10 physician offices a day. Some practices may get only two to four visits a week. However, in 2005 and 2006, primary care physicians deemed as "heavy prescribers" were called on by an average of 29 reps a week, according to Health Strategies Group, a research firm that tracks the pharmaceutical industry.

How those visits break down hints at the possible strain on physician practice: In 2005, 85 percent were drop-ins, 5 percent were appointments, and 10 percent were lunch dates.

Hearing a drug spiel over a fajita wrap may not disrupt the schedule, but drop-ins and appointments eat up roughly 60 minutes a week, Health Strategies Group reports. If you used that extra time to see four established Medicare patients, using CPT code 99213 for an intermediate visit, you'd collect roughly $60 per visit, $240 per week, and $12,000 over 50 weeks. Subtract 50 percent for overhead, and you'd net an extra $6,000 a year—just a hair under what Brewer cleared after dropping rep visits.

Some doctors eliminate face-to-face conversations but still accept samples, a practice FP Patti Roy in Muskegon, MI, started 10 years ago that freed up a whopping three hours a week. "The staff brings me the form to sign for samples," says Roy. "I don't even say good morning to the reps."

The three-doctor Acacia Family Medical Group in Salinas, CA, takes the same signature-only approach. "We're convinced reps cost us far too much money," says FP and group president Sumana Reddy. "I have always wondered how doctors can spend that precious time listening to a solicitation."

Yet many physicians insist there's little time lost, since they book the maximum number of patients and see drop-in detailers in between.
That time management strategy sounds good in theory; in practice, it can derail a doctor's schedule—and annoy patients.

"Every rep visit makes the patient wait an extra five to 10 minutes," says pediatrician Tammi Schlichtemeier in Coppell, TX. "I often hear their frustration when they open the exam room door, only to find me talking to a rep. The question is always, 'How much longer?' " To stay on track, Schlichtemeier limits detailers to 9 to 11 a.m. and 2 to 4 p.m., with no more than two per session.

Why some doctors love their reps

Time constraints aside, most of the doctors we interviewed say the benefits of rep visits outweigh any disadvantages.

They're particularly thankful for the free drugs. "Samples help a lot, especially for the significant percentage of our patients who can't afford high-priced medicines," says urologist Sivaprasad Madduri in Poplar Bluff, MO. In all, 78 percent of doctors accept samples, according to a recent study published in The New England Journal of Medicine.

( tell the pushers to drop the free drugs through the mail slot)

There's also appreciation for the product information detailers provide. "A drug I'm prescribing has been reformulated, and if I hadn't heard this from the rep, I'm not sure there would have been an easy way to find it out," says pediatrician Katrina Hood in Lexington, KY. New York City psychiatrist Sharon Packer credits a rep with helping to convince another specialist that a prescription he wrote for her patient had an adverse interaction with another medication.

( tell the drug pushers to drop the printed drug info thru the mail slot)

Doctors reap other benefits. Eighty-three percent eat catered meals, according to the NEJM study. At the practice of FP Scott Jordan in White House, TN, a different rep treats the 25-member staff to lunch each day. Some doctors we interviewed see the food as an employee benefit and a productivity stimulant—nobody has to leave the office to grab a meal.

With a physician marketing budget that topped $7 billion in 2006, member firms of the Pharmaceutical Research and Manufacturers of America (known as PhRMA) shower practices with supplies—pens, notepads, staplers, exam room paper—that help keep overhead down. Patient-education materials are also a hit—ditto for golf putters and tickets to sporting events.

Then there are the intangibles. "Detailers are a wonderful community resource," says FP Steven Kamajian in Montrose, CA. They've used their contacts to help him find new employees, for example. Socializing counts, too. "The few reps I see offer a break from patients—they listen to me talk," says psychiatrist Sharon Packer.

"I got turned off being a sales target"

Despite the goodwill, the doctor-rep relationship appears to be eroding. Detailers spent 20 percent less time with doctors in 2004 than in 1999, according to Health Strategies Group. Some medical schools and academic medical centers ban samples and free lunches and admit reps only by appointment. The rationale: Freebies shouldn't influence doctors to prescribe costly brand-name drugs when low-cost generics may be just as effective.

( the US govt should buy up all the major drug patents and license the formulations to generic mfr's world-wide. Consider the savings through the years just in Medicare/Medicaid. Take the $1T wasted in Iraq and buy out drug patents)
The pharmaceutical industry contends that modest meals don't hinder a doctor's ability to render independent professional judgments. And drugmakers defend samples, saying they not only help the uninsured, but also make it easier for doctors to test the efficacy of a new treatment.

Patti Roy takes the middle ground. She dispenses samples for chronic conditions only after establishing that a generic can't do the job and sees no harm in using a sample antibiotic for an acute illness, because it doesn't lead to a long-term prescription. But she avoids reps because she feels she is getting sales pitches, Roy says.

Benjamin Brewer agrees. "I got turned off being a sales target," he says. He couldn't stand drug reps tracking his every prescription with their computer software, which was more sophisticated than his EHR.

He's doing fine, by the way, without samples. "If a patient is uninsured, I'll prescribe a proven generic." He also falls back on old-fashioned charity. Brewer recently saw an unemployed patient who had run out of his antidepressants and charged zero for the visit so the man could spend his scarce dollars on meds.

With extra money in his pocket as a result of his no-rep policy, Brewer finds it easier these days to be generous.

==============

US's for-profit health care is a scandalous, ridiculous, corruption racket.
Many pundits predict health care will will be a primary 2008 election issue. I don't hear Romney talking about it seriously, although I think he has the career management experience to go after it if he chose to.

[medstudent]

US's for-profit health care is a scandalous, ridiculous, corruption racket.
Many pundit predict health care will will be a primary 2008 election issue. I don't hear Romney talking about it seriously, although I think he has the career management experience to go after it if he chose to.

:toast

[medstudent]

If you only knew how many filet mignon dinner's I've had courtesy of drug reps.

[xrayzebra]

[/b]
US's for-profit health care is a scandalous, ridiculous, corruption racket.
Many pundit predict health care will will be a primary 2008 election issue. I don't hear Romney talking about it seriously, although I think he has the career management experience to go after it if he chose to.

Yeah boutons, we want the US Government to run our
health care. Wasn't it you that was really, really bitching
about FEMA and New Orleans. Guess you would like to
put health care under their jurisdiction. Or how about
the FDA. Or should be just create a whole brand new
group of government workers to handle it. All political appointee's. You know like Billary.

Or as you said in another post earlier:

"I'm from the (US) govt, and I'm here to help you" (St Ronnie, sowing hate and ridicule for the govt he presided over)

[boutons_]

I was sitting in a doc's waiting room, and stunning 6-foot lady walked in, slim (0.5% of SA ladies DONT qualify). I asked the receptionist girl (behind the security window?) was that a doctor? "no, a detailer". Sex sells drugs.

[boutons_]

August 14, 2007

Google and Microsoft Look to Change Health Care

By STEVE LOHR

In politics, every serious candidate for the White House has a health care plan. So too in business, where the two leading candidates for Web supremacy, Google and Microsoft, are working up their plans to improve the nation’s health care.

By combining better Internet search tools, the vast resources of the Web and online personal health records, both companies are betting they can enable people to make smarter choices about their health habits and medical care.

“What’s behind this is the mass consumerization of health information,” said Dr. David J. Brailer, the former health information technology coordinator in the Bush administration, who now heads a firm that invests in health ventures.

It is too soon to know whether either Google or Microsoft will make real headway. Health care, experts note, is a field where policy, regulation and entrenched interests tend to slow the pace of change, and technology companies have a history of losing patience.

And for most people, typing an ailment into a Web search engine is very different from entrusting a corporate titan with personal information about their health.

Google and Microsoft recognize the obstacles, and they concede that changing health care will take time. But the companies see the potential in attracting a large audience for health-related advertising and services. And both companies bring formidable advantages to the consumer market for such technology.

Microsoft’s software animates more than 90 percent of all personal computers, while Google is the default starting point for most health searches. And people are increasingly turning to their computers and the Web for health information and advice. A Harris poll, published last month, found that 52 percent of adults sometimes or frequently go to the Web for health information, up from 29 percent in 2001.

If the efforts of the two big companies gain momentum over time, that promises to accelerate a shift in power to consumers in health care, just as Internet technology has done in other industries.

Today, about 20 percent of the nation’s patient population have computerized records — rather than paper ones — and the Bush administration has pushed the health care industry to speed up the switch to electronic formats. But these records still tend to be controlled by doctors, hospitals or insurers. A patient moves to another state, for example, but the record usually stays.

The Google and Microsoft initiatives would give much more control to individuals, a trend many health experts see as inevitable. “Patients will ultimately be the stewards of their own information,” said John D. Halamka, a doctor and the chief information officer of the Harvard Medical School.

Already the Web is allowing people to take a more activist approach to health. According to the Harris survey, 58 percent of people who look online for health information discussed what they found with their doctors in the last year.

It is common these days, Dr. Halamka said, for a patient to come in carrying a pile of Web page printouts. “The doctor is becoming a knowledge navigator,” he said. “In the future, health care will be a much more collaborative process between patients and doctors.”

Microsoft and Google are hoping this will lead people to seek more control over their own health records, using tools the companies will provide. Neither company will discuss their plans in detail. But Microsoft’s consumer-oriented effort is scheduled to be announced this fall, while Google’s has been delayed and will probably not be introduced until next year, according to people who have been briefed on the companies’ plans.

A prototype of Google Health, which the company has shown to health professionals and advisers, makes the consumer focus clear. The welcome page reads, “At Google, we feel patients should be in charge of their health information, and they should be able to grant their health care providers, family members, or whomever they choose, access to this information. Google Health was developed to meet this need.”

A presentation of screen images from the prototype — which two people who received it showed to a reporter — then has 17 other Web pages including a “health profile” for medications, conditions and allergies; a personalized “health guide” for suggested treatments, drug interactions and diet and exercise regimens; pages for receiving reminder messages to get prescription refills or visit a doctor; and directories of nearby doctors.

Google executives would not comment on the prototype, other than to say the company plans to experiment and see what people want. “We’ll make mistakes and it will be a long-range march,” said Adam Bosworth, a vice president of engineering and leader of the health team. “But it’s also true that some of what we’re doing is expensive, and for Google it’s not.”

At Microsoft, the long-term goal is similarly ambitious. “It will take grand scale to solve these problems like the data storage, software and networking needed to handle vast amounts of personal health and medical information,” said Steve Shihadeh, general manager of Microsoft’s health solutions group. “So there are not many companies that can do this.”

This year, Microsoft bought a start-up, Medstory, whose search software is tailored for health information, and last year bought a company that makes software for retrieving and displaying patient information in hospitals. Microsoft software is already used in hospitals, clinical laboratories and doctors’ offices, and, Mr. Shihadeh noted, the three most popular health record systems in doctors’ offices are built with Microsoft software and programming tools.

Microsoft will not disclose its product plans, but according to people working with the company the consumer effort will include online offerings as well as software to find, retrieve and store personal health information on personal computers, cellphones and other kinds of digital devices — perhaps even a wristwatch with wireless Internet links some day.

Mr. Shihadeh declined to discuss specifics, but said, “We’re building a broad consumer health platform, and we view this challenge as far bigger than a personal health record, which is just scratching the surface.”

Yet personal health records promise to be a thorny challenge for practical and privacy reasons. To be most useful, a consumer-controlled record would include medical and treatment records from doctors, hospitals, insurers and laboratories. Under federal law, people can request and receive their personal health data within 90 days. But the process is complicated, and the replies typically come on paper, as photocopies or faxes.

The efficient way would be for that data to be sent over the Internet into a person’s digital health record. But that would require partnerships and trust between health care providers and insurers and the digital record-keepers.

Privacy concerns are another big obstacle, as both companies acknowledge. Most likely, they say, trust will build slowly, and the online records will include as much or as little personal information as users are comfortable divulging.

A person might start, for example, by typing in age, gender and a condition, like diabetes, as a way to find more personalized health information. If a person creates a personal health record and later has second thoughts, a simple mouse click should erase it. The promise, the companies say, will be complete consumer control.

There are plenty of competitors these days in online health records and information from start-ups like Revolution Health, headed by AOL’s founder, Stephen M. Case, and thriving profit-makers led by WebMD.

Potential rivals are not underestimating the two technology giants. But the smaller companies have the advantage of being focused entirely on health, and some have been around for years. WebMD, for example, traces its lineage to Healtheon, a fallen star of the dot-com era, founded by the Netscape billionaire Jim Clark.

Google and Microsoft are great companies, said Wayne T. Gattinella, WebMD’s chief executive, but “that doesn’t mean they will be expert in a specific area like health.”

Specialized health search engines — notably Healthline — are gaining ground and adding partners. AOL recently began using Healthline for searches on its health pages, even though Google is a close partner.

Still, 58 percent of people seeking health information online begin with a general search engine, according to a recent Jupiter Research report, and Google dominates the field. “Google is the entry point for most health search, and that is a huge advantage,” said Monique Levy, a Jupiter analyst.

Indeed, it is the market reach and deep pockets that Google and Microsoft can bring to consumer health information that intrigues medical experts, and has lured recruits. Dr. Roni Zeiger, a graduate of Stanford’s School of Medicine, a medical informatics researcher and a former primary care doctor, joined Google last year. The 36-year-old, who still sees patients some evenings and weekends at a nearby clinic, said, “At Google, I can use my expertise and knowledge to potentially help millions of people each day.”

[boutons_]

Source: University of California - San Francisco
Date: August 16, 2007

Health Care Disparities Start At The Local Pharmacy, Study Shows

Science Daily — Despite years of effort in reaching out to their local communities, the role pharmacists play as health care providers still remains unclear to the people who need them the most -- elderly Americans with multiple medications for chronic diseases.

As a result, many patients with the most complex prescription needs may be hesitant to ask the questions they need to take their medications safely and consistently, according to a new study from the UCSF School of Pharmacy.

In one of the first studies to interview only elderly African-Americans regarding their perceptions of their community pharmacist, UCSF researchers also report that most would like to relate to their pharmacist the way they do with their personal doctors, but very few actually achieve that. Findings were published last month in the spring issue of the journal "Ethnicity and Disease."

"There are many articles describing physician-patient relationships, but there is a paucity of information on patients and their pharmacists," explained Sharon Youmans, PharmD, MPH, a UCSF associate professor of clinical pharmacy who led the study. "When we look at the issues of adherence to prescription regimens and safety in combining medications, that relationship plays a critical role."

The study involved interviews with 30 women and 12 men, all of whom were African Americans over age 60 and living in San Francisco. A majority of these participants took four to six prescription medications regularly and reported an average of two chronic illnesses.

Researchers found that most participants sought a close relationship with a knowledgeable and respectful community pharmacist and most also reported an interest in engaging in informed decision-making, including discussions regarding medication options, side effects and concerns about rising medication costs. Yet few participants reported feeling comfortable initiating such discussions, due to either not being able to identify the pharmacist or a sense that the pharmacist was too busy to talk with them. None said they perceived this as an issue of discrimination.

Youmans said the study highlights the importance of patient-pharmacist communication and identifies the need for far more training of pharmacists and pharmacy staff in cultural competence and communication.


The study also showed that the individual pharmacists, and the profession as a whole, need to make increased efforts to become integral partners of local, state and national initiatives aimed at decreasing health disparities, she said.

( that doesn't seem like an expensive objective, could be handled in the training of new pharmacists and their assisants, and for current pharmacists/assistants, through the pharmacists' associations.

It's only common courtesy and humanity to handle these elderly, repeat customers, for whom life is getting more difficult by the year, with better than the cold, robotic "service" they now get, even in a big city. )

"This is an issue of coming out from behind the counter and making a connection with our patients, no matter who they are," Youmans said. "If we, as pharmacists, are going to help reduce the health disparities in underserved populations, this study shows the first step we all need to make."

Note: This story has been adapted from a news release issued by University of California - San Francisco.

[boutons_]

Brought to you by for-profit health care:

Patient safety takes a back-seat to financial needs

Aug 1, 2007
Contemporary OB/GYN


So says a recent survey conducted by the American College of Physician Executives. Although it's been 7 years since the release of the Institute of Medicine's To Err is Human: Building a Safer Health System, "an absence of any dramatic progress has created a sense of frustration and anxiety" among physician-executives, reported Modern Healthcare (5/7/2007).

The survey found that physician executives face a number of hurdles to implementing patient quality or safety initiatives:

* About 60% said they struggle to find an appropriate balance between what they think is best for patients and what's best for their health-care organization.

* Nearly 55% believe employees of their organization fear reporting errors or safety hazards because of the potential repercussions, including job loss.

* Some 88% said that physician resistance to evidence-based care is "sometimes an obstacle" or "a major obstacle."

* Almost 90% said communication and cultural problems among physicians, nurses, and other providers are "sometimes an obstacle" or "a major obstacle."

* Approximately 39% said that their organization tolerated poor quality care by physicians or departments that generate strong revenue.

[boutons_]

Doctors: Prescription Drug Ads Could Mislead Patients

Last Edited: Wednesday, 15 Aug 2007, 8:16 PM CDT
Created: Wednesday, 15 Aug 2007, 8:16 PM CDT

Ads for prescription drugs: you see them on TV, online and in magazines and newspapers.

Drug companies are spending a huge and growing amount of money on those ads in spite of criticism.

"The impact of it is to create anxiety, to create people thinking they might have a condition they don't have," Dr. Joshua Freeman said.

Drug companies spent more than $4 billion on prescription drug ads in 2005. That was the last year covered in a new report in the New England Journal of Medicine. Since 1996, the spending by drug companies on these ads has increased more than three-fold.

The report says most of the ads are for newer drugs, more expensive drugs, to treat long-term conditions.

The report found the more than $4 billion spent on ads was still far less than the $18 billion spent on drug samples and the $7 billion on marketing to health professionals. That includes the gifts drug companies offer doctors.

Those gifts and talks by drug reps have largely been banned in the family medicine clinic at the University of Kansas Hospital.

"We believe the best way for physicians to learn about drugs is through legitimate scientific channels," Dr. Freeman said.

The report says FDA oversight of the ads is weak.

The drug manufacturers group says the report overlooks the key role the ads play in "improving patient understanding of disease and available treatments."

Meryl Lin McKean, FOX 4 News

http://www.myfoxkc.com/myfox/pages/News/Detail/PrintFriendly?contentId=4079034&version=1&locale=EN-US&layoutCode=TSTY&pageId=3.1.1&siteParams=1020&print=true&detailAction=/News/Detail&portletLogoDisplayed=1

==============

and STILL Big Pharma rakes in obscene profits.

[boutons_]

Spend $B1 on lawyers to avoid paying $5B+ in product liability claims.


August 21, 2007

Plaintiffs Find Payday Elusive in Vioxx Cases

By ALEX BERENSON

KEENE, Tex. — In Carol Ernst’s eyes, two years ago she won a measure of justice.

On Aug. 19, 2005, a Texas jury awarded Mrs. Ernst $253.5 million after concluding that Merck & Company and its painkiller Vioxx had caused the death of her husband, Robert, in 2001. At a news conference after the verdict, Mrs. Ernst said she was pleased that jurors had punished Merck for hiding Vioxx’s heart risks. “This has been a long road,” she said. “I just know that it was a road that I had to run and I had to finish.”

But her comfort was premature. Merck, the third-largest American drug maker, appealed the verdict — which Texas laws on punitive damages automatically reduced to $26.1 million. Until higher courts rule on the appeal, Merck is not obligated to pay. So Mrs. Ernst, 62, has yet to receive any money.

In fact, none of the 45,000 people who have sued Merck, contending that they or their loved ones suffered heart attacks or strokes after taking Vioxx, have received payments from the company. The lawsuits continue, for now in a state of legal limbo, with little prospect of resolution.

In combating the litigation, Merck has made an aggressive, and so far successful, bet that forcing plaintiffs to trial will reduce the number of Vioxx lawsuits and, ultimately, its liability.

Promising to contest every case, Merck has spent more than $1 billion over the last three years in legal fees. It has refused, at least publicly, to consider even the possibility of an overall settlement to resolve all the lawsuits at once.

The strategy’s successes, from the view of Merck and its shareholders, are clear. In the last year, the company has won most of Vioxx cases that have reached juries. Though its stock plunged immediately after the Robert Ernst verdict, it has since risen 80 percent, easily outpacing those of other big drug makers. And estimates of Merck’s ultimate liability, once as high as $25 billion, are now closer to $5 billion, said C. Anthony Butler of Lehman Brothers.

The Merck executive most closely associated with the company’s strategy, Kenneth Frazier, its general counsel, has prospered. In July, Mr. Frazier was promoted to president of the global human health division, where he oversees the marketing and sales forces, half of Merck’s 60,000 employees.

( Merck's ethics: we killed and maimed 1000s of our customers, Frazier's our hero, he's fucked the plaintiffs. )

When Merck withdrew Vioxx from the market in 2004, after a clinical trial found that the drug increased the risk of heart attacks when taken for 18 months or more, some predicted the company’s doom. More than 20 million people in the United States had taken Vioxx, and some scientists estimated that as many as 100,000 might have suffered heart attacks.

Merck said it had adequately warned patients and doctors of Vioxx’s heart risks and that it never knowingly endangered patients.

( so product liability is avoided if the death and illness caused was "unknowing" ?

The pace of Vioxx-related lawsuits, after soaring in 2005 and 2006, has fallen slightly this year, as plaintiffs’ lawyers shy away from cases where they lack strong evidence that their clients took Vioxx for several months before having a heart attack. Lawyers have withdrawn several cases as they were about to go to trial.

“It seems to have worked quite well,” Peter Schuck, a professor at Yale Law School who specializes in complex litigation, said of Merck’s strategy. “They have discouraged the plaintiffs’ bar from litigating these cases.” The legal system is not set up to try thousands of cases at once, and nearly all Vioxx lawsuits are caught up in the pretrial process.

Plaintiffs’ lawyers have tried to get the courts to combine all the potential suits into a single class action. But judges have rejected that tactic. Because the facts of individual cases can vary greatly, each case must be tried separately, courts have ruled.

So far, fewer than 20 Vioxx suits have reached juries, an average of 9 in each of the last two years. At this rate, the backlog of Vioxx cases will take years to work through and many plaintiffs may die before they get their day in court.

Even if they win, it will take years for plaintiffs to be compensated. Merck has appealed every case it has lost. In the case of Mrs. Ernst, if her award is upheld, she will not be paid before 2010 at the earliest, her lawyer, W. Mark Lanier of Houston, said.

After the 2005 verdict, analysts wondered how Merck would overcome evidence presented in the case, showing that the company had been concerned about Vioxx’s potential heart risks as early as 1997, two years before it began selling the drug.

“The possibility of increased C.V. events is of great concern,” a Merck scientist, Dr. Alise Reicin, wrote in a 1997 e-mail message.” “C.V. events” is medical shorthand for cardiovascular incidents like heart attacks. “I just can’t wait to be the one to present those results to senior management,” Dr. Reicin’s message continued.

Other documents offered at the trial showed that in March 2000, Dr. Edward M. Scolnick, then Merck’s top scientist, said a clinical trial had confirmed Vioxx’s risks. Documents also showed that Merck resisted efforts at the Food and Drug Administration to add clear warnings to Vioxx’s label.

Even after losing the Ernst case, Merck did not back down from its strategy of fighting every case.

The company may have felt it had little choice, said Benjamin Zipursky, a law professor at Fordham University, who has followed the Vioxx litigation. Heart attacks are the most common cause of death in the United States, and more than 105 million Vioxx prescriptions were written in the five years before Merck stopped selling the drug. If it had not taken a hard line, Mr. Zipursky said, Merck would have faced an essentially unlimited pool of plaintiffs.

Merck has said it could not be certain that Vioxx caused heart attacks before seeing the results of a clinical trial in 2004. The company has also focused on making plaintiffs prove, with prescription records, that they took Vioxx continuously for months or years before a heart attack. It has also pointed out at trial that patients had other risk factors, like obesity or high cholesterol.

“We’re continuing our strategy of looking at each case on the individual facts,” said Theodore V. H. Mayer, a partner at Hughes Hubbard & Reed, the law firm coordinating Merck’s defense. “Did they really have a heart attack? Did they really take the medicine? Did they take the medicine in proximity to the heart attack?”

Mr. Mayer said Merck was trying to clear the backlog of 45,000 cases. The company is moving through pretrial discovery — the process of learning the basic facts in a case — in 500 lawsuits in New Jersey alone, he said. The company faces 16,000 lawsuits in New Jersey.

Mr. Mayer said Merck had not yet found a single case where it believed that Vioxx caused a heart attack. Heart attacks are “a very, very common injury that occurs with or without medicine in many people,” he said.

It is that attitude that infuriates the plaintiffs’ lawyers. They say that since Merck has acknowledged that Vioxx can cause heart attacks in people who take it for more than 18 months, the company should be moving to settle some cases.

“Merck’s goal is to manipulate the legal system to deprive justice to tens of thousands of people whose cases can never be heard,” said Mr. Lanier, the lawyer who represented Mrs. Ernst. “Justice delayed is justice denied.”

He and other leading plaintiffs’ lawyers say they will continue to pursue cases against Merck.

Robert J. Gordon, a partner at the law firm of Weitz & Luxenberg in New York, which represents about 3,300 Vioxx plaintiffs, maintains that pressure on Merck to reach a broad settlement may increase in 2008.

Judge Eldon E. Fallon in New Orleans, who is overseeing the 8,000 federal lawsuits filed against Merck, and Judge Carol E. Higbee in Atlantic City, who is overseeing state court suits in New Jersey, may be tiring of Merck’s refusal to settle, Mr. Gordon said. “The courts are in the business of removing cases from their dockets,” he noted.

But Mr. Schuck, the Yale law professor, said that plaintiffs might be disappointed if they think that pressure from judges will get Merck to settle. A faster trial calendar might actually benefit the company, which can coordinate its defense experts and trial teams more easily than the plaintiffs can, he said. And Merck’s recent run of successes — it has won five of the last six cases and seven of the last nine, including one mistrial — has given it the upper hand, Mr. Schuck said.

“Nobody can make them settle,” he said.

Of course, the case against Vioxx is not settled either, and Merck’s exposure continues. In the cases the company has lost, it has faced large damage awards. And it still faces the possibility of a class-action lawsuit from the insurers, states and other third-party groups that provided insurance coverage. The New Jersey Supreme Court, for instance, is considering whether a lawsuit should be allowed to proceed as a class action or whether different insurers should be forced to bring separate suits. Several state attorneys general have sued the company, and federal prosecutors continue to investigate.

That leaves plaintiffs like Carol Ernst with little to do but wait.

“They could have all of their money and everything I own if they would just give him back to me,” she said of her husband. “But they can’t do that.”