Topic: Health Care in England Question

[masonryman]

weight charts are crap @ 5-6 and 225 I am considered morbidly obese, even thou heart rate, blood pressure, cholesterol are all good

[BobbyR]

I just checked, I am about an inch taller than you. I should be 154 and you should be 151. I am 190. Which would be fine if I were 6' 1". I have always maintained that I am not to heavy, I am just too short.

[masonryman]

This is part of my problem with the health care issues, I started a new family Dr. he was concerned with my weight so he done an EKG and had me go to the hospital to do a stress test (treadmill) and a heart scan which they do with the stress test. I was told this was pretty standard at or after age 40 ...... Heart looked good, I took 21 minutes on the treadmill to get my heart rate up and hold it for the required time I went the equivalent of 2.5 miles.

Insurance said much of it was unnecessary and did not pay, to the tune of about $2500.00. but, hay i did get my oil checked

[Cvillechopper]

Medical necessity is a very subjective part of the process and one that you can argue back with the insurance company about, with your MDs assistance.  Something that many people do not realize is that if you get a claim denied as "not necessary" it is because there is a list of standard procedures for common conditions with many other variables attached but it is far from perfect.  It is possible to get the procedures covered with a solid medical argument.

[masonryman]

My wife is in AR, medical billing, her previous job was with a mental heath center with 500 employees, she now does payroll for a construction company that has 2000 employees. We have fought it but it has come to the point that the bills are being turned over.

[andy750]

I understand why my argument does not make sense to you....

Now I didnt say it didnt make sense...I can see your argument but I dont accept it as its full of holes. Ill refer to your Aristotle signature line on this one. 

There is one basic principal around which all aspects of the healthcare debate fall.  This is the idea that the human life is precious and that everyone must think the same to live in a given society. 

I think this is also incorrect. Everyone does not need to think the same in order to function in society. We do need though to be humane in our treatment of our fellow citizen something you seem to leaving out of the equation. Ill show why.

I think that there are acceptable losses in any compromise that protects the freedom of individuals from governmental control when balanced against providing protection for every single human being. 

It sounds cold but only if you look at it in the short term.  The current plan (and any that expands the government's involvement in healthcare) will lead to the slow and inevitable decline in profits of providers.

What are you trying to say here as its not quite clear? It almost sounds like a Euthanasia policy from the 1920s such as was used in Vermont among other states that legally sterilized the mentally ill. Should we cut loose the poorer, less fortunate members of society from a subsidized program in order to shift them to a higher paying scheme to ensure a profit for the providers?

Do you have a family? Lets say hypothetically that you do and one day your daughter comes back from the doctors and she has been diagnosed with leukemia. Unexpected, out of the blue diagnosis. Unfortunately your health care coverage is not good enough and you either have to pay out of pocket (thereby ensuring the profits of the providers) or you reach a ceiling on how much the provider is willing to pay (its in the contract you signed after all) and you cant afford any more. Do you tell her that she is an acceptable loss? 

Providers MUST make profits in order to re-invest in new equipment keeping the care provided up with the recent advancements.  The US is at the forefront of new developments in healthcare technology.  Without the providers purchasing the new equipment the researcher and developers will not make profits needed to invest in R&D and the next technology will not be invented. 

Is this the basis for your argument that its ok for insurers to make a profit out of peoples poor health so that they can reinvest in R&D and buy new equipment? If so you have a serious problem. Who exactly are these "providers" that re-invest in new equipment - what equipment?! - and do you REALLY think US health insurance companies are buying equipment (whatever you might that be) and passing it on to researchers in for-profit industries such as biotech?? And how is this equipment being made in the first place and by whom and for what initial purpose? I know of no Health insurance provider who is reinvesting in any R&D. They are in the business to make money for their share holders. Let me give you an example...MRI - commonly used in hospitals around the world..and one of the high-cost procedures used in the US - Nobel Prize was awarded to 2 researchers - one from the US and one from the UK - both worked at Universities at the time of the discovery. Science breakthroughs are not country-specific but occur through international cooperation. Dont be so pompous to think that its America thats making all the life-saving innovations as thats incorrect.

I dont know where you are getting these ideas from but they are not based on reality. As Mick has pointed out, new research into human disease is primarily carried out my Universities around the world, not only in America. New developments, new technological innovations, breakthroughs in understanding how and why human disease occurs, happens for the most part at Universities or government-funded research institutions (funded by the respective countries government).  Bio-techs usually start off as small companies run by University-trained scientists who are taking their ideas and findings and commericialising them. Where do the US healthcare insurance providers come into this?

Before you reply get your arguments straight and logical and based on fact. I see you are a follower of Plato and Aristotle and they would tell you the same thing 

cheers
Andy

[Cvillechopper]

I am sorry that I didn't make clear the definitions as used in the healthcare industry.  Providers are those that provide a medical service, direct patient care.  Insurance companies are referred to as Payors (Payers depending on where you are) and are not providers. 

Let me know if that clears up some of what I said.

I'll add this to the equation since it seems that most of the discussion leads back to the insurance companies.  I would be fine with a plan that eliminated health insurance all together thereby forcing individuals to plan for their future.  In this case you would see a dramatic increase (over time) in the donations to charitable entities (where I believe all charity belongs, not in government hands).  These, usually local, entities are much better suited to assist a community than a national agency with zero understanding of what benefits an individual locality the most.  They also benefit from having volunteers (an aspect that I think would also increase if this were to happen) that can help with the individualized attention needed in evaluating medical cases. 

You ask about my family and I'll share with you a recent experience that may clarify some of my perspective.  My grandmother, in her 70s, has COPD, had 2 heart attacks last year, was a chain smoker most of her life, and recently had a triple bypass surgery covered by Medicare.  This extended her life by no more than a year. 

1/70th additional life and the cost of somewhere between $100K and $120K, no including follow-ups.  Given the average Gross income in the US of around $42K that is 2 to 3 years worth of Gross, not Disposable, income used to extend a life without actually increasing the ability to live (she is in severe pain, unable to do much of anything, and probably will be until she passes). 

How is this an intelligent use of tax-payers $$?  The money would have been better spent on younger persons that will gain more than just a year from the care.  Smaller charitable organizations can also provide emotional guidance through these types of situations and help the family understand when it may be time to allow nature to take it's course.  For a chain smoker to make it into her 70s, that's a long life and we should not expect more.

[andy750]

I am sorry that I didn't make clear the definitions as used in the healthcare industry.  Providers are those that provide a medical service, direct patient care.  Insurance companies are referred to as Payors (Payers depending on where you are) and are not providers. 

Let me know if that clears up some of what I said.

No not really. My point still stands that Providers as you define them do not reinvest in R&D as you implied. They are NOT at the forefront of new scientific breakthroughs. I hope thats clear to you as it seems the basis for your argument why they should make profit. Hospitals fall into 2 categories -non-profit and for-profit. If they are for-profit it is for the benefit of shareholders NOT R&D. If you refer to insurance companies - who we were talking about in any case -they do make a profit and they do NOT contribute to R&D, medical breakthoughs etc. So your argument still has no merit. I am sorry.

I'll add this to the equation since it seems that most of the discussion leads back to the insurance companies.  I would be fine with a plan that eliminated health insurance all together thereby forcing individuals to plan for their future.  In this case you would see a dramatic increase (over time) in the donations to charitable entities (where I believe all charity belongs, not in government hands).  These, usually local, entities are much better suited to assist a community than a national agency with zero understanding of what benefits an individual locality the most. 

In my last example to you regarding your hypothetical daughter - you cannot plan for everything in the future. You cannot plan for walking across the road and being struck by the drunk driver. You cannot plan on getting cancer (with no previous risk factors where indicated). You give the impression of someone who thinks its all about risk assessment, inputing the data into a "model" and getting an answer at the end...a very modern computer-based approach and one which is used extensively in insurance companies and banks for example.....but to use it to assess your life in the future is limited by the unknown variables and all the models in the world are only as good as the data given to them and even then they are only of limited use. You clearly think differently. 

How is this an intelligent use of tax-payers $$?  The money would have been better spent on younger persons that will gain more than just a year from the care.  Smaller charitable organizations can also provide emotional guidance through these types of situations and help the family understand when it may be time to allow nature to take it's course.  For a chain smoker to make it into her 70s, that's a long life and we should not expect more.

The grandmother example is not a good one. You are quoting at one end of the scale.  I agree that she should have been allowed to die. Switzerland and a few other Euro countries have humane euthanasia programs. No problem with that. I am talking about people in the prime of their life who have unfortunate conditions, unforseen diagnoses, poor genetics, etc etc...that are paying excessive amounts of money to for-profit insurance companies who are making money off them. This idea is morally repugnant. You seem to argue this is the ideal for a capitalist society. I disagree. I favour the universal health care approach as used in every other western country.

cheers
Andy

P.S. You are still sidestepping the issue of R&D and innovative science. Can you see that you were incorrect?

[andy750]

Relevant article from today:

Study links 45,000 U.S. deaths to lack of insurance:

http://news.yahoo.com/s/nm/20090918/us_nm/us_usa_healthcare_deaths

[Cvillechopper]

I said that hospitals invest in new equipment.  This fuels the companies that invest in the R&D to create new equipment or do you think that a company will spend billions of $$ to invent the next generation of equipment if there is no market in which to sell it?

I never side-stepped the argument.  You obviously did not re-read my first statement with the corrected definitions in mind.  Never would I claim that insurance companies invest in medical R&D.  That is not their concern.  They are in the insurance business, not the healthcare business.

Please do take to time to try and understand an argument before spouting off contradictions to statements that were never made.

I do understand that you can not plan for everything.  That is where, assuming you have planned for some type of catastrophe and the one you experience is abnormally burdensome, charity organizations could step in to help.  I do not believe in helping those that do not try to help themselves.  If you make $40K/year and do not put at least 10% into savings than you are fiscally irresponsible and should suffer the consequences.  So many people live outside their means and then complain that life to too tuff.  Does the person who claims they can not pay their daughter's medical bills have cable tv, more than one vehicle, drink beer, etc?  If so than they have caused their current situation and should find a way to deal with it.  

Yes it would be very tough in the first several years as it requires a large shift in the way our country view personal responsibility.  Many would die and that is tragic but would lead us back to a sense of personal accountability that is sorely lacking in this country.  



Before any attacks come on me claiming that I must not know what it's like to be poor let me assure you that I am very familiar with what it means to live from week to week not knowing if you will be able to pay the electric bill, buy food, etc.  I grew up in a household making less than $30K combined income with 3 boys.  My parents had to prioritize and spend wisely to provide for us.  We could not afford health insurance and set up payment plans when I would break a bone or my brothers would get sick.  Never once did my parents apply for social assistance because we did not need it although many making much more than them thought that they did (and got it).  

I worked hard in HS and got into one of the best schools in the nation only to find that I could not afford to go.  It took some maneuvering but my mother got her boss to co-sign the loan for the first year.  I was able to get the subsequent years loans through a federal subsidy and have just recently been able to take advantage of the market rates to refinance and use a drop in equity to pay off the loans (several 10s of thousands of $$).  

After school I lived on couches, with girlfriends, etc for years due to the job I sought (very low pay, long hours, etc) and worked odd jobs consistently.  Lost a motorcycle to collections, went badly into debt, and hit rock bottom.  I have several years on record where my income was below $10K and I never applied for gov't assistance.  It has been many years since I decided to get myself out of that condition, working everything from McDonalds Assistant manager, short-order cook at a small bar, painter, landscaper, etc finally ending up as a temp with a company that saw my potential and I have moved up the ladder since.  

It is ok to let people hit rock bottom where they have to go hungry, get their cable tv cut off, no electricity (I've done that when I was a kid and as an adult) because it will show them the necessity of good fiscal management.  You don't have to go to college to learn this but we, as a society, seem hell-bent on keeping others from learning these type of lessons.  

[andy750]

I said that hospitals invest in new equipment.  This fuels the companies that invest in the R&D to create new equipment or do you think that a company will spend billions of $$ to invent the next generation of equipment if there is no market in which to sell it?

I hate to nitpick as its clear you dont really understand what you are talking about with respect ot R&D and innovation, but which companies do you see spending billions on R&D for equipment? Its not the reality. Applied Biosystems is one of the biggest companies to provide DNA sequencing machines and other high-throughput machines to big Pharma, Universities etc...the technology was invented in Universities. You seem to be overlooking these facts (same with the MRI example before). Yes its honed and developed by companies (globally) but the base is government-funded research. On a GLOBAL scale. You seem not to understand that US hospitals are NOT the only ones funding this development. 


"Yes it would be very tough in the first several years as it requires a large shift in the way our country view personal responsibility.  Many would die and that is tragic but would lead us back to a sense of personal accountability that is sorely lacking in this country.  "

So an acceptable loss? And what kind of inhumane, hard-nosed country would you end up with?

[Cvillechopper]

I said that hospitals invest in new equipment.  This fuels the companies that invest in the R&D to create new equipment or do you think that a company will spend billions of $$ to invent the next generation of equipment if there is no market in which to sell it?

I hate to nitpick as its clear you dont really understand what you are talking about with respect ot R&D and innovation, but which companies do you see spending billions on R&D for equipment? Its not the reality. Applied Biosystems is one of the biggest companies to provide DNA sequencing machines and other high-throughput machines to big Pharma, Universities etc...the technology was invented in Universities. You seem to be overlooking these facts (same with the MRI example before). Yes its honed and developed by companies (globally) but the base is government-funded research. On a GLOBAL scale. You seem not to understand that US hospitals are NOT the only ones funding this development. 


"Yes it would be very tough in the first several years as it requires a large shift in the way our country view personal responsibility.  Many would die and that is tragic but would lead us back to a sense of personal accountability that is sorely lacking in this country.  "

So an acceptable loss? And what kind of inhumane, hard-nosed country would you end up with?

Of course I don't mean that GE does all of the research that invents the new technology which the machines they do create use.  They spend their R&D on making those machines more reliable and accessible to smaller providers.  The original ideas come from companies that do not sell these machines but do get plenty of funding from the manufactures by way of patent sales or licensing and direct donations. 

Nor do I mean that US hospital are the only ones funding the manufactures.  All providers help with this but hospitals are the overwhelming market share for large medical equipment sales.  Without their influx of capital the market stagnates.
 
To the last question, you'd end up with a much softer country (again, you have to look long term) as more people would be self sufficient and accountable for their own well being which would in turn reduce the level of animosity underlying much of the current political climate. 

[edbikerii]

Right back at ya:

"One in six doctors have seen patients die because of rationing in NHS resources, according to a new survey".

http://www.dailyexpress.co.uk/posts/view/20086

Relevant article from today:

Study links 45,000 U.S. deaths to lack of insurance:

http://news.yahoo.com/s/nm/20090918/us_nm/us_usa_healthcare_deaths

[Cvillechopper]

Right back at ya:

"One in six doctors have seen patients die because of rationing in NHS resources, according to a new survey".

http://www.dailyexpress.co.uk/posts/view/20086

Relevant article from today:

Study links 45,000 U.S. deaths to lack of insurance:

http://news.yahoo.com/s/nm/20090918/us_nm/us_usa_healthcare_deaths

I'd like to add that 45,000 is not a material variance when looking at the total population.  That's about 1/100th of a % of the US population.  Not material in any discussion on national policy (or shouldn't be any way).

[andy750]

The original ideas come from companies that do not sell these machines but do get plenty of funding from the manufactures by way of patent sales or licensing and direct donations. 

You clearly havent read my previous posts. The original ideas in 99% of the cases come from basic research done in Universities..funded by the taxpayer of the relevant country. I have given two examples already.  In any case read your sentence again...it makes no sense the way its written....


The purchasing of equipment is NOT related to new design and innovation and if the market stagnates its due to that particular piece of equipment becoming obsolete or is overpriced or whatever other market force causes its decline. You seemingly fail to grasp the basic concept that scientific and human disease related innovation comes from Universities. It always has.

With regard to your last point...how do you see a country that is prepared to let "many die" (your own words) to achieve this new Utopia of healthcare as you see it become softer? It sounds more like a Nazi-style solution with a far-away in the distance pie-in-the-sky idea that it will somehow make the populace healthier, stronger, more intelligent  (more Aryan like perhaps?), and accountable through being controlled by the healthcare corporations policies and contracts you seem to cherish....but softer...I dont see it.

 

[Inigo Montoya]

So what percentage of the population needs to do before it is relevant? What if one of the deaths was a close member of your family, it bet you would feel it relevant then.

[Cvillechopper]

So what percentage of the population needs to do before it is relevant? What if one of the deaths was a close member of your family, it bet you would feel it relevant then.

Not at all.  I do my best to completely remove my personal outcomes (and those of my family, friends, etc) from any analysis on large scale policies.  In fact, my basic premise that individuals should be accountable for their selves would most certainly have a negative impact on several members of my family that refuse to take constructive advice even when it is within their means. 

The original ideas come from companies that do not sell these machines but do get plenty of funding from the manufactures by way of patent sales or licensing and direct donations. 

You clearly havent read my previous posts. The original ideas in 99% of the cases come from basic research done in Universities..funded by the taxpayer of the relevant country. I have given two examples already.  In any case read your sentence again...it makes no sense the way its written....

I read that post and disagree.  There are MANY research companies that make discoveries.  Also, Universities get sources of funding (not quite equivalent to the government funding but material) from private enterprises and individuals.

I am not sure what you think does not make sense about the sentence above.  It is perfectly correct.  Try again.

[andy750]

I read that post and disagree.  There are MANY research companies that make discoveries.  Also, Universities get sources of funding (not quite equivalent to the government funding but material) from private enterprises and individuals.

Now I am curious...what research companies have made scientific discoveries that surpass or outweigh the vast majority made my Universities - which are predominantly government funded (private enterprise and endowments are only a small % of the total funding)?? And I am talking from bench to bedside here?

I have yet to hear of research company personnel getting a Nobel Prize for contributions to medicine or the sciences..perhaps you know differently?

[Duke McDukiedook]

So much for preventive care, huh masonryman.
Guess that doesn't figure in their profit margins too well, too short term thinking on their parts.

Long term they'll save money but good luck getting the insurance company to see the long view.
 

[paulages]

Right back at ya:

"One in six doctors have seen patients die because of rationing in NHS resources, according to a new survey".

http://www.dailyexpress.co.uk/posts/view/20086

Relevant article from today:

Study links 45,000 U.S. deaths to lack of insurance:

http://news.yahoo.com/s/nm/20090918/us_nm/us_usa_healthcare_deaths

a conservative tabloid? nice reference. 

[Cvillechopper]

So much for preventive care, huh masonryman.
Guess that doesn't figure in their profit margins too well, too short term thinking on their parts.

Long term they'll save money but good luck getting the insurance company to see the long view.
 

I've said it before but will reiterate that information and its dissemination into consumers hands is paramount to and industry in a capitalist society working well.  Assuming that more information is available, there will be better use of the information.  
If there is more personal accountability, preventative care becomes more of a priority.  All else being equal, if an individual knows that regular check-ups are shown to reduces the severity of illness down the road, an intelligent and responsible approach would be to prioritize that check-up high on the list of to-dos.

Insurance coverage is an aside.  I mentioned that the system would be most effective if there were no insurance companies to confuse the discussion.  Get rid of them.  Everyone is responsible for their own expenses, period (aside from charitable donations).  The overall cost to the provider was just reduced by a very large % and that savings would have to be passed to the end consumer or the consumers would not buy the service (very bad outcomes for everyone).  You end up with a system that has much more individual choice and responsibility, much less bureaucratic waste, and is sustainable.

[Inigo Montoya]

So what percentage of the population needs to do before it is relevant? What if one of the deaths was a close member of your family, it bet you would feel it relevant then.

Not at all.  I do my best to completely remove my personal outcomes (and those of my family, friends, etc) from any analysis on large scale policies.  In fact, my basic premise that individuals should be accountable for their selves would most certainly have a negative impact on several members of my family that refuse to take constructive advice even when it is within their means.

You still didn't answer how many people need to die for them to relevant. You might not think 45000 is much but then you need to stop looking at it in a numbers format. 45000 is a fair size town. 45000 just because they do not make enough money to afford private insurance and too much to get medicade. But that is ok? I have to say that is how you sound as you seem very reluctant for anything to change in our current system.

As for removing the personal aspect, I still submit that you would not be so cavalier about it if it was close family.

I fail to see how getting rid of all insurance would help in any way. More personal choice? Of what? This does nothing to drive down health costs. Going by your idea, all I see is more people NOT going to the doctor. I pay almost 5000 a year for insurance, that could be whipped out in a simple procedure. Unless medical rates were seriously cut down, that system would only be sustainable by those with the money for it.

[andy750]

Insurance coverage is an aside.  I mentioned that the system would be most effective if there were no insurance companies to confuse the discussion.  Get rid of them.  Everyone is responsible for their own expenses, period (aside from charitable donations).  

In other words a return to health care Dickens-style. If you cant afford it then off to the poor house with you...great idea  

I am sorry but your ideas and arguments so far do not have much basis in reality or fact. This mornings "discussion" has shown that. You seem to make health insurance a "bean-counting" exercise where you can input the data into your model and whatever it spits out you will accept as "this is what the model says". You talk of acceptable losses and people dying but what you are failing to grasp is the human connection. I understand you have commented on this "human issue" already but...your comments are not based in reality. You do need to consider the human nature of health care, period. For both political and moral grounds as a country. 

And once again how do your ideas differ from Nazi-social policies? You failed to answer that.

[Cvillechopper]

So what percentage of the population needs to do before it is relevant? What if one of the deaths was a close member of your family, it bet you would feel it relevant then.

Not at all.  I do my best to completely remove my personal outcomes (and those of my family, friends, etc) from any analysis on large scale policies.  In fact, my basic premise that individuals should be accountable for their selves would most certainly have a negative impact on several members of my family that refuse to take constructive advice even when it is within their means.

You still didn't answer how many people need to die for them to relevant. You might not think 45000 is much but then you need to stop looking at it in a numbers format. 45000 is a fair size town. 45000 just because they do not make enough money to afford private insurance and too much to get medicade. But that is ok? I have to say that is how you sound as you seem very reluctant for anything to change in our current system.

As for removing the personal aspect, I still submit that you would not be so cavalier about it if it was close family.

I fail to see how getting rid of all insurance would help in any way. More personal choice? Of what? This does nothing to drive down health costs. Going by your idea, all I see is more people NOT going to the doctor. I pay almost 5000 a year for insurance, that could be whipped out in a simple procedure. Unless medical rates were seriously cut down, that system would only be sustainable by those with the money for it.

I'll attach this again as it does help to illustrate how the provider's costs are driven by things that most do not understand.  It might help answer your last statement.

Personal choice:  You could choose what procedures, through discussion with your doctor and an understanding of the costs, you would like to purchase.  Today many of the procedures that are performed are unnecessary but are done anyway so a dr can cover his ass due to the overly litigious nature of this society.  If you take the responsibility of paying for a procedure you would be more likely to spend time learning about that procedure, talking with your doctor about the pros and cons, and make a choice based on your situation.  

45,000 because they do not have insurance, not because they could not afford insurance.  There is no indication as to what percent of this group is deemed to not be able to afford insurance, just that they don't have it.  I have read several studies (sorry, I don't have them in front of me right now but will try to find them to reference) that indicate as much as 40% (usually closer to 30%) of the uninsured # quoted repeatedly through this debate make at or above the average US income.  These are people that choose to not have insurance.

How many would it take, probably 2 to 3 % from my point of view but at least 1% would be nice.  Even 1/10th of a percent would be reasonable.  We're wasting time talking about a fraction of that even.  

[edbikerii]

Funny, but that is exactly how NHS calculates its rationing.  Acceptable losses are certainly part of the equation when they delay MRIs, CTs and chemotherapy for cancer patients.  Turns out that the acceptable losses are much higher after the government runs the system.

Insurance coverage is an aside.  I mentioned that the system would be most effective if there were no insurance companies to confuse the discussion.  Get rid of them.  Everyone is responsible for their own expenses, period (aside from charitable donations).  

In other words a return to health care Dickens-style. If you cant afford it then off to the poor house with you...great idea  

I am sorry but your ideas and arguments so far do not have much basis in reality or fact. This mornings "discussion" has shown that. You seem to make health insurance a "bean-counting" exercise where you can input the data into your model and whatever it spits out you will accept as "this is what the model says". You talk of acceptable losses and people dying but what you are failing to grasp is the human connection. I understand you have commented on this "human issue" already but...your comments are not based in reality. You do need to consider the human nature of health care, period. For both political and moral grounds as a country. 

And once again how do your ideas differ from Nazi-social policies? You failed to answer that.