Topic: Health Care in England Question

[edbikerii]

Depending upon your insurance plan, it could have cost somewhere around $25 for the co-pay, $25 copay for any prescriptions necessary, and whatever the patient's portion of his insurance premiums might be (often nothing depending upon their employer).  Of course, those premiums are lower if your co-pays are higher, etc.  Also, if you have a deductible, you would have to pay that, too, but the higher the deductible, the lower your premiums.

However, the United States has lower taxes, and fewer taxes (no radio or tv tax, gas taxes are much lower, income tax is lower, etc.), here in the US, and we get to choose our providers, insurance companies, drug providers, etc.

Oh, and if you are a poor American citizen, it would have been FREE under our Medicaid program.

Ogri, I appreciate your experience and I think that is wonderful.  I just don't understand why you think it is free.  YOUR VERY HIGH TAXES pay for that service.

However, I fail to see how giving a liver transplant to an alcoholic is productive.  No matter how much money you have, or what kind of health insurance or taxpayer-based system you have, there are only so many viable livers to go around.  These livers come from organ donors (freshly dead people), who are otherwise in good health (typically young, strong, accident victims).  If you give a liver to a drunk who is only going to destroy it, then you cannot save one other person in need of a liver who probably won't destroy it.  Why deprive the responsible person, but extend the drunk's life only breifly (until he destroys the new liver)?  I'd hope that doctors in the UK have better ethical practices than that.

My Father had a triple heart bypass about 20 years ago when he was 65. It's a big op; basically they cut you open from your throat down to your abs then cut the sternum and open up the ribs like a book. And that's just the start. Took about 8 hours. God only knows what that would have cost in the land of the free.
I don't know of people being refused care because they're too old - don't think it would ever happen. Even inveterate alcoholics are given liver transplants.

He's 85 now, very sharp and active..probably more active than me.

Last year I rode into the side of a car turning right on me. Gashed up my leg, needed stitches in both knees. The stitches started bleeding and I went back and they re-did them. They offered physiotherapy afterwards but I declined as I thought it was getting better on its own. All free, all done very professionally. Sometimes you have to wait an hour or maybe more if your problem isn't life threatening, I take a book to read in the waiting room.

The idea of paying for medical care is very strange.

[edbikerii]

PLEASE EVALUATE THIS PROPOSED SOLUTION.  PLEASE TRY TO BE OBJECTIVE AND NON-PARTISAN.  PLEASE LET ME KNOW WHAT YOU THINK -- CONSTRUCTIVELY

Once again, the solution is not to take away more control from the consumer (the patient, the taxpayer, us), and give it to some government bureaucrat.  Nor is it good to allow the insurance company bureaucrats to keep control, either!

I think the solution is to give the consumer more choice, and give them an incentive to try to reduce the costs THEMSELVES.

I think the problem of rising health care costs is primarily a result of patients not bothering to think about the costs at all because they don't think they have to.  Patients typically don't care, because they know that the insurance company is going to pay.  Patients don't ask simple questions that any normal consumer in any other market would ask like "how much will that cost?", "why is that so expensive?", "do I really need that?", and "isn't there a cheaper way?"

Let me try to illustrate this with an example:
If you walk into a supermarket and you can either buy lobster for $15/lb. or hamburger for $4/lb., how likely are you to buy lobster every night for dinner?

If, on the other hand, you knew that somebody else was paying for your groceries, you might be more inclined to buy the lobster, even though the hamburger may, in fact, have better nutritional value.  In fact, you might even be more likely to buy the lobster JUST BECAUSE you know that other people could buy it on YOUR insurance premium dollar, so "why not".  After all, it will only increase your insurance premium by a couple cents, when spread out among all the other shoppers.  Besides, those other shoppers are probably eating lobster on my insurance premiums, so why shouldn't I?

Now, let's extend that analogy to health care.  if we could incent the patients to be more efficient with their healthcare spending, we wouldn't need the bureaucrats at the insurance company or in the government to ration the care, and the cost would be much lower.  The patients would take responsibility for their own choices, and expect more from their doctors, drug companies, and diagnostic equipment, for the same money.

You might also find that people take better care of themselves because they don't want to spend more money on health issues later.

So, I'm thinking that increasing the deductibles is a major part of the solution.  First off, it will make the insurance premiums cheaper right off the bat.  Secondly, it will incent the patients to bargain with their medical providers and ask the difficult questions about necessity and price, rather than just saying, "sure, let's do it, what the hell".  Then, the costs are lower, the providers would have to compete for business (always a good thing), and the providers would strive to come up with better, and/or cheaper methods to provide the same service.

Now, remember the money saved on the insurance premiums because of the higher deductibles?  GIVE THAT MONEY TO THE EMPLOYEES in order to pay for their regular health care.  You know, the stuff that doesn't exceed the deductibles:  Regular check-ups, etc.  The only restriction should be that they can ONLY SPEND THAT MONEY ON HEALTH-RELATED EXPENSES.  If they manage to save enough, they can use it to get their teeth fixed, to get breast enhancements, whatever.  Let them accumulate the money year after year and save up for costly stuff that they want done like lap-band surgeries, whatever.

Getting the costs down will help with Medicare and Medicaid, and the VA Hospitals, too.  All the learned efficiency from trying to keep the patients happy will lead to cost reductions ACROSS THE BOARD, and will lead to doctors, drug companies, hospitals and medical device manufactures innovating more in order to generate more profit and to make the patients happier.

Sure, I haven't ironed out all the details, but this idea sounds a hell of a lot better to me than anything I'm hearing from that mess of a health care "reform" bill so far.

So, what do you think?  Does this start to meet the needs?  Does it encourage innovation?  Does it preserve our excellent health care system for everyone?  Does it make health care more accessible?  Does it make it better for EVERYBODY?

[CBGBs]

Why don't we deregulate private health insurance industry and support hospitals who operate like the Cleveland Clinic who pays all medical employees salary instead of per/treatment? We can reform regulations on drug companies.
Every government program has been a complete failure based its cost. I'm talking national debt. We cannot afford single payer like medicare-aid, why does it deserve to be expanded. We can't afford anything with almost $10 trillion over 10 years. Reform needs to happen in a way that does not cost the nation.
And I have to say to all you in England, Canada, and Australia who had such a remarkable experience...... it was not FREE.

[Frankenkit]

Why don't we deregulate private health insurance industry and support hospitals who operate like the Cleveland Clinic who pays all medical employees salary instead of per/treatment?

A good reason at least for not paying all employees 'salary' is that at some hospitals, overtime is the rule.  That's not necessarily good management, but it's just the way it is.  For example, MickeyX is getting an average of 16 hours/wk OT.  That adds a lot to the paycheck.  There are a lot of positions that demand mandatory overtime, and/or extensive on-calls.  The thing about a hospital vs. a factory is that if there aren't enough workers in a factory, productivity goes down.  If there aren't enough nurses on a unit/rad.technologists in a department/etc, etc, it becomes a question of negligence.  Quality control at a factory catches broken pieces of product when workers are forced to do 16 hour days several days in a row. Productivity goes down, costs go up, life goes on.  Insurance companies and malpractice suits are the "QC" at hospitals (in a really dehumanizing way) catching all the many things that can go wrong when nurses and techs are forced to do 16 hour days, several days in a row.  Costs go up, insurance goes up, reliability and quality of care go down.

All of this is why I support the Norwegian system, where everyone gets a certain baseline of care (I'm thinking the bottom-rung insurance I used to get as a security guard) with a strong, strong emphasis on early treatment and preventative treatment, and everything else eventually costs.  We would be so far ahead on so many things if people made appointments for coughs and fevers instead of waiting until they need CTs, chest tubes, and heavy duty $$ antibiotics for the pneumonia that's killing them.

[edbikerii]

Yes, Norwegians are very happy with their healthcare, but they also do not have to work to support it.  The Norwegian system is funded by very lucrative offshore oil rigs and abundant hydro-electric power.  The United States is blessed with both resources in great abundance, but our government and the EPA prevent us from taking advantage of them.  Norway would be utterly bankrupt were it not for their exploitation of these natural resources.

I also strongly agree with your points about keeping costs down through early and preventative care.  Both of these are covered by my earlier proposal to give the patients more control, and to incent them to make smarter decisions about their care because they'll be spending THEIR OWN MONEY.

All of this is why I support the Norwegian system, where everyone gets a certain baseline of care (I'm thinking the bottom-rung insurance I used to get as a security guard) with a strong, strong emphasis on early treatment and preventative treatment, and everything else eventually costs.  We would be so far ahead on so many things if people made appointments for coughs and fevers instead of waiting until they need CTs, chest tubes, and heavy duty $$ antibiotics for the pneumonia that's killing them.

[CBGBs]

Here is a video of an American getting treatment in England.
As you may guess it went poorly.
http://www.youtube.com/watch?v=DHT1epPKKFY&eurl=http%3A%2F%2Fwww%2Efacebook%2Ecom%2Fclibon&feature=player_embedded#t=458If any American would like a personal account of health service in Canada going wrong I can tell the story of my wifes very close cousin who was in a horrible car wreck in Canada. I believe 1 in 4 Americans can account for a second hand story of poor healthcare in a foreign country. We have fantastic healthcare here, its just expensive. Gov't run anything has never reduced cost or increased quality of service.

[Inigo Montoya]

Lets see if you say that when you get into a bad accident and go bankrupt and can no longer afford the care that you say is so good. Wonder if your thoughts might change. I'm betting they will. Or should we all run on the hope nothing serious ever happens?

[CBGBs]

The healthcare IS good. Its a fact. If I recieved unfunded care I would be thankful, and I would have to take some desperate measures to repay. Like selling lots of things and finding charities to donate. Thankfully because we live in a country where we have our freedom and are not so oppressed financially by our Gov't, we are a very charitable people. This will not be the case with socialized programs like universal healthcare.
Do any of you know what "affordability credits" are?

[Frankenkit]

[CBGBs]

That was so simple my 2.5 yr old could get it. I feel patronized. Everyone knows there is so so much more to the story, like historical perspective. Which was totally omitted. These services were all originally privatized and some have reverted to partial privatization because the gov't wasn't doing an adequate job. I'm just not as stupid as that guy thinks we are.
Watch this.
http://abcnews.go.com/video/playerIndex?id=8440801

[Duke McDukiedook]

Why don't we deregulate private health insurance industry and support hospitals who operate like the Cleveland Clinic who pays all medical employees salary instead of per/treatment? We can reform regulations on drug companies.
Every government program has been a complete failure based its cost. I'm talking national debt. We cannot afford single payer like medicare-aid, why does it deserve to be expanded. We can't afford anything with almost $10 trillion over 10 years. Reform needs to happen in a way that does not cost the nation.
And I have to say to all you in England, Canada, and Australia who had such a remarkable experience...... it was not FREE.

Yes, yes, deregulation, works so wonderfully in all sectors, like energy in California? That went real swell, didn't it?
Airlines, that's another great one, worked reeel well there too didn't it? We just bailed them out a while ago, didn't we? A couple of times if I remember correctly.

I'm not saying more regulation helps anything but opening the floodgates to total deregulation in this case is NOT the answer.

 

[edbikerii]

Yeah, completely oversimplified, patronizing and totally full of #$%*e.  Please post that link to as many websites as you can, Kit, because that whiney, pimple-faced-sounding moron will turn people off rapidly.  He probably thinks his little "animation" will get him laid with loose liberal "free-spirited" women.  Probably will, too, but they'll quickly tire of him trying to borrow money off of them to pay for dinners.

Here's some highlights:
He claims that Medicare administrative costs are lower than private insurance:  THAT IS TOTAL BULL#$%*.  Per-patient, Medicare administrative costs are much higher.  As a percentage they may appear lower because, according to the Department of Health and Human Services, Medicaid pays, on average, SIX TIMES MORE for the same drugs and services that private insurance companies provide their patients http://oig.hhs.gov/testimony/docs/2002/020611fin.pdf.  THAT MEANS THAT THE INEFFICIENCY -- BESIDES THE HIGHER ADMINISTRATIVE COSTS -- COSTS THE TAXPAYER 500% MORE THAN PRIVATE INSURANCE FOR THE SAME HEALTH CARE SERVICES.  Remember the $1200 wheelchair rental when the same supplier sells the wheelchair for $400?  Well that wheelchair was an ABOVE AVERAGE performance for Medicare's government purchasing lackeys.

Ah, I was gonna pick him apart bit-by-bit, but he isn't even credible enough to waste my time.  Suffice it to say that his claim that government healthcare would be "Free for Everyone" proves that he is an absolute moron.

[MickeyX]

Wow. My version of that video never showed the narrator's face once. How do you know he's got pimples?  

[CBGBs]

Why don't we deregulate private health insurance industry and support hospitals who operate like the Cleveland Clinic who pays all medical employees salary instead of per/treatment? We can reform regulations on drug companies.
Every government program has been a complete failure based its cost. I'm talking national debt. We cannot afford single payer like medicare-aid, why does it deserve to be expanded. We can't afford anything with almost $10 trillion over 10 years. Reform needs to happen in a way that does not cost the nation.
And I have to say to all you in England, Canada, and Australia who had such a remarkable experience...... it was not FREE.

Yes, yes, deregulation, works so wonderfully in all sectors, like energy in California? That went real swell, didn't it?
Airlines, that's another great one, worked reeel well there too didn't it? We just bailed them out a while ago, didn't we? A couple of times if I remember correctly.

I'm not saying more regulation helps anything but opening the floodgates to total deregulation in this case is NOT the answer.

 

We should never have bailed the airlines out. Deregulation does not guarantee success. I don't think you are making a good argument, and just suggesting it in one industry does not equate to "opening the floodgates". The last time I read a comment like this the guy apologized for being drunk. Have a nice day.

[demon78]

And yes folks for every one from the states that has bad stories about Canada's health system we can match them with bad stories of the US's health system and Canadians. So what does that prove, that there's #$%*up's in  every system? Whoopee what a revelation! It's not free  another revelation, and from my perspective of a long life experience nothing is bloody free.
Bill the demon.

[BeSeeingYou]

Here is a video of an American getting treatment in England.
As you may guess it went poorly.
http://www.youtube.com/watch?v=DHT1epPKKFY&eurl=http%3A%2F%2Fwww%2Efacebook%2Ecom%2Fclibon&feature=player_embedded#t=458If any American would like a personal account of health service in Canada going wrong I can tell the story of my wifes very close cousin who was in a horrible car wreck in Canada. I believe 1 in 4 Americans can account for a second hand story of poor healthcare in a foreign country. We have fantastic healthcare here, its just expensive. Gov't run anything has never reduced cost or increased quality of service.

This is such a load of crap I have to laugh.  It's nothing more than a woman telling a "story" in front of a camera for someone with an obvious political motive.  Any truth to it, who knows?

Your statement " I BELIEVE 1 in 4 Americans can account for A SECOND HAND STORY of poor health care in a foreign country" is even more laughable.  Why not just say, "I pulled this stuff out of my ass and this video off YouTube and I want you to believe it".

[edbikerii]

Read this article from the BBC.  The truth speaks for itself.  Note the crazy excuses for not doing the tests or providing the treatments.  For chemotherapy using Taxanes, they don't even attempt to justify, they just straight out say that they are too expensive.  Well, guess what folks?  Chemotherapy using Taxanes saves lives here in the United States.  It is also much more tolerable than the older, more toxic chemotherapy agents.

So, when someone tells you that rationing doesn't exist in the UK, you'll know they are full of B.S.

If this article isn't enough, then let me ask just one simple question:  where were all these new drugs and treatments that "NICE will evaluate" produced?  Clearly they weren't created by NICE/NHS.

http://news.bbc.co.uk/2/hi/health/413654.stm

NHS rationing: The key areas

A drug to relieve flu symptoms will be scrutinised

BBC News Online examines which controversial treatments will be scrutinised by the National Institute for Clinical Excellence - and why they have been chosen.


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


From autumn 1999 onwards

Hip replacement

Prosthetic hips can cost anywhere between £200 to £2,000 or more, and the more expensive, modern models are not necessarily any better than the old, cheap ones.

NICE's job is to find out which one works best for and offers best value.

Hearing aids

Recent developments in hearing aid technology have made a big difference, but which aid you get can depend on where you live in the country.

Guidance from NICE will establish what is the minimum standard of hearing aid a patient can expect.

Wisdom tooth extraction

Many people every year have their wisdom teeth removed even though they are causing no problems - having such a serious procedure can cause complications, and NICE must decide whether the potential benefits outweigh the risks.

Cervical Smear Testing


 
Should checking smear tests be computerised?
New technology, such as computerised smear test reading, could have a major impact on cervical cancer screening, but would cost a lot of money.

NICE will work out whether the possible advantages of more accurately reading slides are worth the investment, or whether the money could save more lives if spent elsewhere in the health service.

Coronary artery stent

Stents are devices placed inside heart arteries after they have been widened using a balloon placed inside the blood vessel. They are thought to reduce the risk of it narrowing again.

However, some experts say the technique is used inappropriately, and NICE has been asked to answer this question, as well as evaluate a lot of variations on the basic technique used by different surgeons to find out which get the best results.

Cancer chemotherapy using Taxanes

Taxanes are the class of drugs, derived from the yew tree, which include Taxol, a treatment for ovarian and breast cancer.

Taxol costs £7,500 per patient per year, and despite evidence that it prolongs life in ovarian cancer patients, some health authorities are still unwilling to pay for it - a classic example of "postcode prescribing".

NICE will attempt to give definitive advice on whether it gives enough benefit to justify the price to the NHS.

Multiple Sclerosis


 
There is some evidence that beta interferon works for MS
Interferon Beta, an MS treatment is expensive, yet there is growing evidence of its benefits in this previously untreatable degenerative condition.

However, many clinicians still feel it is not cost effective enough, and NICE will try to work out whether the NHS should pay.

It will also look at another MS treatment, Glatarimer, and may produce guidelines covering many more aspects of MS treatments.

Influenza drugs

Zanamivir (known as Relenza) and Oseltamivir, although not yet available in this country, are the first ever treatments developed against 'flu.

The NHS fears that demand for these drugs over the winter could leave it with an enormous bills, although the drugs could cut the length of 'flu attacks by days and save the economy money.

NICE is allowed to look at not just the cost to the health service, but the potential benefits to the country.

Asthma inhalers

NICE will look at the variety of devices available to asthma sufferers, but particularly children.

There is much debate on whether some of the more sophisticated of these are worth the money.

Heartburn Treatments

There is evidence that a class of drug called proton pump inhibitors, while effective for some heartburn sufferers, are being used inappropriately by doctors on patients who are unlikely to benefit from them.

NICE will issue firm guidance on who should get these expensive drugs, and who should not.



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

From 2000 onwards

Anti-inflammatory drugs

Anti-inflammatories are often used to treat bowel conditions such as inflammatory bowel disease and Crohn's disease.

A new type of anti-inflammatories, called Cox-II inhibitors, could work as well, but with fewer side effects, such as the ulcers caused by conventional treatments.

Definitive guidance from NICE would encourage doctors to use them in the right circumstances, as many will be unwilling to substitute a more expensive drug for a cheap one.

Keyhole surgery

Keyhole surgery is thought to make operations far simpler for patients suffering from a variety of conditions, such as hernia.

However, there are some concerns that it is wrong to use keyhole surgery to treat some conditions, and that it is far too expensive to use for others.

Wound care

The way wounds are looked after varies from hospital to hospital, and there is strong evidence that doing it the right way improves quality of life, and recovery time, and reduces the risk of infections.

The aim is to tell every hospital the correct procedure for dealing with surgery wounds.

Implanted defibrillators


 
Asthma inhalers for children are to be debated
A tiny device implanted next to the heart, it can deliver shocks to correct abnormal heart rhythms.

But they are very expensive compared to drugs which do the same thing.

As the number of patients being given defibrillators is likely to increase, the NHS has decided that guidance should be given to make sure they only get given to certain patients who can benefit the most.

Treatment of cartillage injury

A revolutionary technique involves growing new cartillage cells outside the body from samples taken from a patient, then reimplanting them to treat joint injuries.

Doctors are worried that there is not enough evidence at the moment to prove it works.

Motor neurone disease drugs

Riluzone is one of the only treatments for MND, and has provoked a great deal of debate as to its efficacy.

NICE will look at the available evidence, and give guidance.

Hepatitis C treatments

On the horizon for this hard-to-treat disease is Ribavarin and alpha interferon, which should be licenced soon in this country.

Again, NICE hopes to be able to tell doctors whether it works and can be afforded by the NHS.

Obesity drugs

Any treatment for obesity opens up a potential funding nightmare for the NHS, given the large number of obese patients in England and Wales.

NICE will evaluate the evidence on recently released drugs such as Orlistat and Sibutramine.

Alzheimer's disease

Aricept and Exelon, the only currently-available treatments for Alzheimer's, will be under scrutiny by NICE.

Diabetes treatment

A new class of drugs for Type II diabetes are expected to by licenced late this year. Glitazones are thought to offer substantial benefits to many diabetics.

The government says NICE will ensure "appropriate targeting".

Unstable Angina

Yet another new drug class, called glycoprotein IIb/IIIa receptor inhibitors, is aimed at people admitted to hospital with unstable angina.

NICE will again evaluate.

[CBGBs]

I pulled the 1 in 4 number out of my ass. So what? I never intended for it to be a factual stat. It was an opinion. Everyone knows that. Thats why it was prefaced with "I believe"
Are you prone to roadrage srust58?
Do you want to hear a more personal story? Is that what it takes?

[masonryman]

It all starts with education, only the kids of doctors could ever afford the education required to become Dr. whoever. the key in any such situation is to start at the grass roots level. You make it easier for working class stiffs to get an education and some of the issues will take care of themselves. If the health care industry had any interest in self help they would be plucking the brightest students right out of highschool and mentoring them through the endless education process just as most successfull apprenticeship programs do.

  I have been a mason for 23 years a foreman for 15 of those. In those years I have seen my insurance cost go from $.70 per hour worked to $6.35 per hour worked if you work less than 1500 hours a year you pay the balance out of your pocket. If you work over 1500 hours you loose the balance of your contributions. my family deductible has when from $200 to $800 per person with a 80/20 and max co pay of $5000.00  

[BeSeeingYou]

I pulled the 1 in 4 number out of my ass. So what? I never intended for it to be a factual stat. It was an opinion. Everyone knows that. Thats why it was prefaced with "I believe"
Are you prone to roadrage srust58?
Do you want to hear a more personal story? Is that what it takes?

Road rage? Nah, didn't you see the smiley faces.   I would think you would want your opinions based on some facts instead of just making stuff up and then getting all huffy when someone calls you on it.  So now everyone knows what your opinions are based on and we can treat them accordingly.

[CBGBs]

I'm exposed! I feel liberated. Thankyou

[Cvillechopper]

Whenever this topic comes up I find myself trying to explain the topic from another point of view than most of my friends so I wrote a white-paper on the topic and am working on editing it to submit to the op ed section of the paper.  Feel free to offer feedback if you want to read it.

James

[edbikerii]

Very interesting perspective.  The largest cost drivers in healthcare are the basically ignored by mainstream.

Whenever this topic comes up I find myself trying to explain the topic from another point of view than most of my friends so I wrote a white-paper on the topic and am working on editing it to submit to the op ed section of the paper.  Feel free to offer feedback if you want to read it.

James

[Cvillechopper]

Very interesting perspective.  The largest cost drivers in healthcare are the basically ignored by mainstream.

Whenever this topic comes up I find myself trying to explain the topic from another point of view than most of my friends so I wrote a white-paper on the topic and am working on editing it to submit to the op ed section of the paper.  Feel free to offer feedback if you want to read it.

James

I work in the industry.  Was a Financial Analyst and am now the Business Operations Supervisor for a small community not-for-profit.  When I took my first position here I couldn't believe how much the media either doesn't know about or filters out when these discussions come up. 

[Pinhead]

Doctors told me it was against the rules to save my premature baby

In fact, the medical guidelines for Health Service hospitals state that babies should not be given intensive care if they are born at less than 23 weeks.
The rules were endorsed by the British Association of Perinatal Medicine and are followed by NHS hospitals.