Redesign the system
leo John
Americans can afford to get care.
Its time to go to the drawing boards and start over. The medical
system is so huge that it should have a governing body patterned after
out political system. They would be expected to constantly improve on
how the system does its business.
The system should set itself up to be in control of itself.
Now its a dictator where it has to be, and totally helpless where it
needs to be----to serve greed.
How long does it take to train a good GP? Is the years and the
money for medical school just an excuse to charge more? Why do most
patients prefer to see a nurse practitioner rather than see the dr.
Starting over at the drawing boards ,carte blanch, wow, thats a
creative turn on for whoever is chosen to participate. Of course they
will want to make sure that researchers are sharing their knowledge and
rerun tests aren't being done in different experiments.
A tiered medical system, turning out thousands of nurse
practitioners---before you throw up the old argument that it will mean
second rate medical care--let those who aren't getting any care decide
what they want.
They would set up a close working relationship between gadget
makers and the medical system. For example, the system would say... We
need a simple way to put on plastic gloves and take them off. Presto,
it'd be there in no time. Probably some kind of portable little station
where the gloves blew up and the hands were inserted.
Of course they would make simple plans to fully inform and to
institute a user friendly ,voluntary tracking system.
If the medical system won't appoint a drawing boards committee,
congress should do it.
A drawing boards committee should exist in all our huge internal
systems.
There should also be "freed research" arena that would be funded
by the government. What they found would be free for the asking.
Humans have the intelligence to solve our problems, but once
they run into the dead ends of sick systems, theres nothing they can do.
Tell them, theres the drawing boards, there are no sacred
cows, start from scratch... How should this system be set up.?
Its not about any ism. Communism created the sickest systems
imaginable. It became a good news only, good ole boy network.
We know how systems get sick, we can redesign the parts of the
structure that have fallen victim to that sickness.
Gretchen Evans
wrote:
While I'd be the first to agree that our current system is in dire
need of an overhaul I seriously doubt that trying to turn it into some
comedic copy of the Federal Government is the solution.
You might try to re-read some of the postings here from a year ago, or
more. Lots of changes were discussed, argued.. and flamed. Some of
what I thought to be good ideas came out, too. But not the
methodology for change.
pixie
amp_spamfree
I'm turning over a new leaf - instead of arguing with Leo - I'm going
to help him. I'm going to agree with everything and give examples.
Leo - you are my hero - I have been persuaded.
> Our medical system has already passed the point where all
> Americans can afford to get care.
Why do all Americans need to afford to get care - wouldn't it be
easier just to give them all free care? Yes, that's it - free care
for everyone. Need a labotomy - here, it's free.
> Its time to go to the drawing boards and start over. The medical
> system is so huge that it should have a governing body patterned after
> out political system.
OK - so now we have a three part system and two political parties.
Why? Full employement! Great idea.
>They would be expected to constantly improve on
> how the system does its business.
Exactly the charge of the US government - I remember reading that
somewhere - government, heal thyself.
> The system should set itself up to be in control of itself.
Bladder control is good, self control is good, is that what you had in
mind? Yes - bladder control - make sure everyon can controol their
bladder!
> Now its a dictator where it has to be, and totally helpless where it
> needs to be----to serve greed.
Oh, I get it - you want a three party dictatorship with good bladder
control.
> How long does it take to train a good GP? Is the years and the
> money for medical school just an excuse to charge more?
Well, let's compare and contrast...UK GP, French GP, German GP,
Canadian GP, Pakistani GP, Caribbean GP, Angolan GP, Thai GP, Chinese
GP. Which training standard would you like to employ? I bet I can
get a doc trained in a few hours - a couple of videos and an internet
link. No problem.
>Why do most
> patients prefer to see a nurse practitioner rather than see the dr.
I find most nurse practitioners more attractive - and those nursing
uniforms really are kind of cute.
> Starting over at the drawing boards ,carte blanch, wow, thats a
> creative turn on for whoever is chosen to participate.
Carte Blanch - what exactly is that? If it's like Visa, I want one.
>Of course they
> will want to make sure that researchers are sharing their knowledge and
> rerun tests aren't being done in different experiments.
Never replicate - one test is more than enough - go forth and
anecdote!
> A tiered medical system, turning out thousands of nurse
> practitioners---
A tiered system? Like a wedding cake? Yes, that's it - lets make all
hospitals look like wedding cakes and marry the system to itself!
>before you throw up
oops, too late, leo. I'll try and do better next time.
>the old argument that it will mean
> second rate medical care--let those who aren't getting any care decide
> what they want.
Yes, what do you want in a mental health service, Leo?
> They would set up a close working relationship between gadget
> makers and the medical system. For example, the system would say... We
> need a simple way to put on plastic gloves and take them off. Presto,
> it'd be there in no time. Probably some kind of portable little station
> where the gloves blew up and the hands were inserted.
Is this before or after you take your finger out of your butt? The
advantage of a "glove blowing up station" is? Ooops - never mind, I
figured it out.
> Of course they would make simple plans to fully inform and to
> institute a user friendly ,voluntary tracking system.
Right after I blow up those gloves Leo....simple simple simple.
> If the medical system won't appoint a drawing boards committee,
> congress should do it.
> A drawing boards committee should exist in all our huge internal
> systems.
Because we all know that life cannot exist as we know it without
enough drawing boards! Drawing boards for everyone! Let them eat
drawing boards! Two drawing boards in every garage - a drawing board
in every pot! (in case you didn't notice, these lines have been used
by a previous genre of politicians but I just couldn't help myself -
so Pixie, did the coffee come out your nose?)
> There should also be "freed research" arena that would be funded
> by the government. What they found would be free for the asking.
Yes - lets stimulate innovation - make it free and available to
everyone.
> Humans have the intelligence to solve our problems, but once
> they run into the dead ends of sick systems, theres nothing they can do.
> Tell them, theres the drawing boards, there are no sacred
> cows, start from scratch... How should this system be set up.?
First, bring back institutional care for schizophrenics.
> Its not about any ism. Communism created the sickest systems
> imaginable. It became a good news only, good ole boy network.
> We know how systems get sick, we can redesign the parts of the
> structure that have fallen victim to that sickness.
Yes - we know how it got sick. Denise, it was you and your black
helicopter friends that did it.
amp
George Conklin
The right wing dominated this group for years...and Hillary-Care
was the main point they were making. Fear that Medicare would be
for all ages and that you could not have 'add-on' fees scared the
hell out of the AMA. It still does.
The fact that medical care costs keep much faster than
inflation has been true roughly since World War II. It will have
to stop at some point, but not right now. When the AMA wants
virtually every American on drugs costing several thousand
dollars a year, you can see we are nowhere near stopping.
--
# If HMOs ran the post office, 44.3 million Americans would get no mail. #
# Phono FAQ: http://www.pagesz.net/~henryj/phono.htm. #
# Support Medicare for All Ages. Urban Myth FAQ under development. #
# Support Cygnet Horns for Edison Firesides-george conklin, KB4NCI #
Gretchen Evans
Somehow I thought that you'd bring back your harping on the AMA once
again, George, but you didn't go far enough. How about blaming them
for the Enron fiasco also?
And I don't see that the 'right wing' dominated the ng, I seem to
remember some excellent discussions about UC and the many problems of
Medicare with both sides getting in their points... As it should be.
I continue to feel that UC is a necessity in the US. with the major
unanswered question being the form that UC should take, however after
reading some of the rants recently, expecially by Leo, I've begun to
waiver a bit and might consider Mental Health to be even more of a
necessity than full medical coverage..
Forget about general health and wellness... Work on sanity for
everyone.
pixie
George Conklin
The AMA has always looked out for the income of physicians, and
the fact that we do not have Medicare for All Ages is a direct
result of their very successful actions starting with President
Truman and working on down to the present. It does not matter if
they do not have a majority of physicians paying dues. They
restructured American medicine in the 1920s (see Paul Starr on
how), and that basically outlawed any practical solutions other
than ones they want (for themselves).
As for whether what we spend tons of money on has any health
benefit, we are slowly seeing it really does not have much effect
at all.
>And I don't see that the 'right wing' dominated the ng, I seem to
>remember some excellent discussions about UC and the many problems of
>Medicare with both sides getting in their points... As it should be.
>
>I continue to feel that UC is a necessity in the US. with the major
>unanswered question being the form that UC should take, however after
>reading some of the rants recently, expecially by Leo, I've begun to
>waiver a bit and might consider Mental Health to be even more of a
>necessity than full medical coverage..
>
>Forget about general health and wellness... Work on sanity for
>everyone.
>
>pixie
BFrench
>Path:
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>From: amp_sp...@yahoo.com (amp_spamfree)
>Newsgroups: talk.politics.medicine
>Date: 28 Jan 2002 07:54:51 -0800
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enough to publish -- too bad it's kind of wasted on this leo John character.
Bettina
Bettina
leo John
benefits the system.
leo John
leo John
bulls eye, your nervouse laughter and childish responses are a give
away.
If you menat health is so fragile that you can't stand the heat,
by all means go back to discussing something that isn't at the heart of
the matter.
leo John
I would like to see any group of reformers in any system to be
told.. OK, if you were allowed to redesign the system from scratch, How
would you do it?
Evidently that offends some of the other posters here who don't
like reformers and who are against open minded approaches, ..
When creativity is allowed to flourish it solves the insolvable
like it was just something obvious, When an immovable "city hall" says,
work around me. It kills creativity and creates confused, scatter
brained defenders of it.
I would not be qualified to be in that group but I would be very
interested to see what they would come up with.
Every system needs completed fall back plans to go to if things
get so far out of hand, that changes need to be make,
Enron wouldn't have deteriorated into such a mess if they had
tried this approach.
The "drawing boards" approach is a sick systems worst
nightmare. Those in charge do not want open, free, creative minds
looking at what they have wrought.
Greed builds Rube Goldberg contraptions that don't make any
sense, if you look at it with out being beholden and dependant on it for
a job.
Bettina
My health of my menat is excellent, thank you very much. How's your menat?
leo John
me---As I said, bring you to the bulls eye and you'll find a cop out.
Gretchen Evans
wrote:
> The AMA has no conscience. It always does what finacially
>benefits the system.
>
Well, of course they do, numnuts.... Who do you think the AMA
represents?? And why shouldn't they do what financially benefits the
system ? Would you expect an organization such as theirs to do
something that doesn't benefit their own group?
Only one word can apply.. Idiiot !!
pixie
Gretchen Evans
wrote:
> I have simply pointed out that we know how structures get sick.
> I would like to see any group of reformers in any system to be
>told.. OK, if you were allowed to redesign the system from scratch, How
>would you do it?
You're about two years late, Leo. We've all been there, done that.
> Evidently that offends some of the other posters here who don't
>like reformers and who are against open minded approaches, ..
Open minded or feeble minded?
> When creativity is allowed to flourish it solves the insolvable
>like it was just something obvious, When an immovable "city hall" says,
>work around me. It kills creativity and creates confused, scatter
>brained defenders of it.
Creativity?? in what post of yours have you demonstrated that facet??
> I would not be qualified to be in that group but I would be very
>interested to see what they would come up with.
This is about the first thing you've posted that anyone can agree
with, Leo. You're definitely NOT qualified.... for anything that I
can see.
> Every system needs completed fall back plans to go to if things
>get so far out of hand, that changes need to be make,
> Enron wouldn't have deteriorated into such a mess if they had
>tried this approach.
Hey, Stupido, Enron was breaking the law, not letting things 'get out
of hand'... Or can't you see the difference?
> The "drawing boards" approach is a sick systems worst
>nightmare. Those in charge do not want open, free, creative minds
>looking at what they have wrought.
And you're one of those 'free, creative minds' ??? Yeah, right.
> Greed builds Rube Goldberg contraptions that don't make any
>sense, if you look at it with out being beholden and dependant on it for
>a job.
Huh ??
pixie
Gretchen Evans
wrote:
> You and the others are very skittish when you are brought to the
Yep, Bettina, you better get a grip on yourself. Dr. Leo has you
'targeted'...
All this from someone who couldn't find his rear without
instructions.. What a joke.
pixie
Gretchen Evans
And it's a very lovely menat, Bettina.
pixie
amp_spamfree
> I have simply pointed out that we know how structures get sick.
Yes - incontinent systems - need bladder control.
> I would like to see any group of reformers in any system to be
> told.. OK, if you were allowed to redesign the system from scratch, How
> would you do it?
Pixie would invoke UC
Bettina - I thought you were a proponent of the Canadian system?
Denise is into SP entitlement.
Me, I go for privatization.
No one wants NHS ala the UK, though. Go to deja - there are some very
lengthy threads that, in the past, have gotten quite heated.
So, great God of creativity - what's your proposal? Please pay
attention to continuity of thought, integration of concepts, grammar,
and spelling.
> Evidently that offends some of the other posters here who don't
> like reformers and who are against open minded approaches, ..
That would be Pixie's problem.
> When creativity is allowed to flourish it solves the insolvable
> like it was just something obvious, When an immovable "city hall" says,
> work around me. It kills creativity and creates confused, scatter
> brained defenders of it.
I flashed back on the Wizard of Oz and that little song - "If I only
had a brain" - now I can't get it outta my head.
> I would not be qualified to be in that group but I would be very
> interested to see what they would come up with.
A flash of brilliance!
> Every system needs completed fall back plans to go to if things
> get so far out of hand, that changes need to be make,
changes need to be MADE, not make (urgh).
> Enron wouldn't have deteriorated into such a mess if they had
> tried this approach.
Enron is in the mess that it's in BECAUSE of AA's creativity - not in
spite of it. You need to read last weeks Economist. There was a
great diagram of the Enron pyramid scheme - talk about creative. They
took the financial wheelings and dealings business to entirely new
level. Obviously, you have no concept of Enron....
> The "drawing boards" approach is a sick systems worst
> nightmare. Those in charge do not want open, free, creative minds
> looking at what they have wrought.
You don't read much, do you.
> Greed builds Rube Goldberg contraptions that don't make any
> sense, if you look at it with out being beholden and dependant on it for
> a job.
Greed? Yikes. If there's one thing greed does is that it at minimum
serves one master well. Even Denise would agree to that.
amp
amp_spamfree
Is the menat the long thing or two round things? And why would anyone
want to put their menat in the heat?
But to get to the bullseye of the menat - let's talk about the heart
of the matter - tells oh great sage, what exactly is the Leo Health
Plan?
Perhaps you can provide insight into 1) structure, 2) function, 3)
outcomes. This is the very basic industrila organization model (in
case you didn't recognize it). Under function, let's not forget
financing, OK?
go to it. Start a new thread if you want - title the LEOCARE. And no
fair stealing from Pixiecare.
amp
George Conklin
Except that they do all this 'for the benefit of the patient.'
leo John
system.
Well, of course they do, numnuts.... Who do you think the AMA
represents?? And why shouldn't they do what financially benefits the
system ? Would you expect an organization such as theirs to do something
that doesn't benefit their own group?
Only one word can apply.. Idiiot !!
pixie
me--- You have accurately described what leads systems to not have a
conscience. You have accurately described yourself too.
You think it would be idiotic to put conscience above profits.
leo John
me----dried figs like you are not expected to recognise creativity.
Try to loosen up a little, it will let more blood get to your raisin
brain..LOL, now thats creative.
leo John
me---thats an oldie, its not creative,, Saying no one would want to
find your rear with permission,--- now thats creative.
Do you still want to dance with a dancing man?
leo John
serves one master well. Even Denise would agree to that.
amp
ps---it is not mispelled. LOL
leo John
mesmatta bella---its Italian
amp_spamfree
Too, too funny - even your own sarcasm bites you in the bum (and no,
it's not misspelled either).
Oh you poor poor man. But once again, thank you for continuing a
thread!
amp
Bettina
> tf...@webtv.net (leo John) wrote in message news:<21661-3C...@storefull-246.iap.bryant.webtv.net>...
> > I have simply pointed out that we know how structures get sick.
>
> Yes - incontinent systems - need bladder control.
>
> > I would like to see any group of reformers in any system to be
> > told.. OK, if you were allowed to redesign the system from scratch, How
> > would you do it?
>
> Pixie would invoke UC
> Bettina - I thought you were a proponent of the Canadian system?
> Denise is into SP entitlement.
> Me, I go for privatization.
>
By "privatization " do you mean no more Medicaid or Medicare?
In spite of our disagreements you are a model of clear thinking and
intelligence compared to you-know-who. (I know that's damning with
faint praise)
Bettina
DWood78828
>From: tf...@webtv.net (leo John)
>Date: 1/30/02 7:57 AM Eastern
Hmmm, this must be an example of your creative writing ability. Better get
into another line John, you lack talent as well as creative ability.
Denise
DWood78828
>Date: 1/30/02 8:22 AM Eastern
Amp is correct, greed certainly does serve one master well or even one industry
well.
John, your comment, as usually, makes very little sense and does not appear
germaine to the topic.
Denise
amp_spamfree
I always preferred normative comparisons - so I'll take it as a
complement, though we might want to consider raising the bar a bit?
Regarding privatization - what I was referring to is primarily
delivery and financing, not necessarily funding. Obviously, Medicaid
serves a useful function in principle - a program designed to meet the
medical funding needs of the poor. Medicare, on the other hand
doesn't serve that purpose at all. It simple is an income
redistribution system - a tax if you will.
Health care access for everyone is a laudable goal and one I support -
my preference is to allow for greater competition, more individual
choice, and better accountability for outcomes. In the US there
appear to be constraints on system options in part due to some equity
criterion that I don't quite get. In the UK, it is even more obvious
that equity as defined by the Tories is minimalistic but at least they
are honest and open about it. That, of course, results in a lot of
political infighting and inefficiency, and some real challenges
regarding access as measured by waiting lists.
amp
Gretchen Evans
You could even say that it's damning with NO praise.
pixie
Gretchen Evans
Conklin) wrote:
>In article <3c596b09...@news.edge.net>,
>Gretchen Evans <gle...@edge.net> wrote:
>>On Tue, 29 Jan 2002 07:07:15 -0600 (CST), tf...@webtv.net (leo John)
>>wrote:
>>
>>> The AMA has no conscience. It always does what finacially
>>>benefits the system.
>>>
>>
>>Well, of course they do, numnuts.... Who do you think the AMA
>>represents?? And why shouldn't they do what financially benefits the
>>system ? Would you expect an organization such as theirs to do
>>something that doesn't benefit their own group?
>>
>
> Except that they do all this 'for the benefit of the patient.'
No, George, they CLAIM they do all this for the benefit of the
patient; Just like Firestone was claiming that their tires we "totally
safe" even when the treads were flying off in profusion. The AMA is,
was, and always has been a lobby group for physicians; why shouldn't
they make claims such as they do? Is there some law or regulation
that requires you to believe such fluff?
pixie
Gretchen Evans
wrote:
All well and good, amp, except for the fact that 'competition' has
brought us little other than seeing ads for various hospitals on TV,
each extolling their own version of excellence.
I definitely agree that access for everyone is a natural goal; as is
individual choice and better accountability for outcomes.
Unfortunately the existing system. in general, is so fragmented that
both choice and accountability vary widely in most areas and the only
solution I can come up with to provide a decent level of care for
everyone is a single governmentally sponsored program. The private
sector certainly hasn't risen to meet the challange.
And just to show you how mellow I've become I'm even ignoring your
snide little remark in one of the prior posts.
pixie
Gretchen Evans
wrote:
>The AMA has no conscience. It always does what finacially benefits the
Congrats for finding the "Post Follow-up Message" icon; now do TRY to
develop proper usage.
As to your statement, how do you know what I think, Leo, or anything
of my personal standards.
You're certainly welcome to think what you want, of course, your
statements have always been good for a giggle.
pixie
Gretchen Evans
Not even mentioning common sense.
pixie
Gretchen Evans
wrote:
>All this from someone who couldn't find his rear without instructions..
If you're an example of today's 'dancing man' I'd MUCH prefer to sit
this one out, thank you. I make it a personal policy to never dance
with an idiot.
pixie
Gretchen Evans
wrote:
> Heres another misspelled word to keep you two kittens occupied.
> mesmatta bella---its Italian
Once again Leo demonstrates his lack of ability to post within a
thread. Pity... He was doing well before, and wasn't running with
his scissors, either.
It's so nice to have an international flavor interjected into our
little discussion group. So here's a statement from the forerunner of
Italian; "Quod erat demonstrandum" . Look it up.
pixie
George Conklin
amp_spamfree <amp_sp...@yahoo.com> wrote:
>Health care access for everyone is a laudable goal and one I support -
>my preference is to allow for greater competition, more individual
>choice, and better accountability for outcomes. In the US there
>appear to be constraints on system options in part due to some equity
>criterion that I don't quite get. In the UK, it is even more obvious
>that equity as defined by the Tories is minimalistic but at least they
>are honest and open about it. That, of course, results in a lot of
>political infighting and inefficiency, and some real challenges
>regarding access as measured by waiting lists.
USA-style waiting lists consist of 'dont' come if you don't
have they money.' They are forever.
leo John
get into another line John, you lack talent as well as creative ability.
Denise
flapping, does it.? Do snakes on their bellies, speak to birds on the
subject of fying.? Your as dry as the dust you crawl in.. Try being
a bit of a rebel for once in your life, it will juice you up a little.
You won't sound so dronie.
leo John
system it builds, it serves everyone who is willing to go blind, lose
their conscience and serve it. It serves anyone who accepts the excuses
it hands out at the door of sick systems. Sometimes it doesn't even
serve all its apologists. They are the saddest cases of all.
Like anything else, it is not all good or all bad, but that is to
complicated for you to understand.
If I say that good captilism has an evil twin, it would be like
opening up the gates of STRAW MAN heaven for crows like you.
Saying greed serves only one master well, is a stifled and
stuffed opinion. You better stick to platitudes.
leo John
amp_spamfree
> What lame chowder heads you two are.
There are four of us here - Denis ("Woody"), Pixie, Bettina, and me.
Which two are the "chowder heads"?
No question - I can't make heads or tails of this ramble - so here
comes a platitude (in E minor).
Cry me a river.
amp
amp_spamfree
Go back to one of your MBA text books on marketing Pixie and look at
the underlying assumptions of competition - "perfect or pure" models
require perfect information. That can't happen simply because it
requires all to be all knowing - and that excludes Leo. But models of
competition have a degree of necessary information flow - the key is
in its accuracy and utility in decision making. Simple awareness of
their existance or their product mix adds to the information a
consumer can use regarding choice. Are you familiar with the SEAT?
Well, then you likely wouldn't buy one even if one wsere for sale
across town.
>
> I definitely agree that access for everyone is a natural goal; as is
> individual choice and better accountability for outcomes.
> Unfortunately the existing system. in general, is so fragmented that
> both choice and accountability vary widely in most areas and the only
> solution....
That's always where you and I diverge - we both agree the system has
faults - you argue that there is "only one" solution.
> I can come up with to provide a decent level of care for
> everyone is a single governmentally sponsored program.
You agreed that choice is good but advocate a "single government
sponsored system"? I'm going to take a leap of faith and characterize
it as SP/UC, okay?
So you eliminate choice. Granted, you may still choose your
providers, but your choice set is artificially constrained by a single
system. For example, let's say you have ESRD - you're a candidate for
surgery - except for your age. Now, you've taken good care of
yourself, you are in great shape, and have a wonderful life expectancy
- but the system says - sorry, over 75, no transplant. And if you
think this is far fetched, check out the organ transplant guidelines
for Ontario province (I think it was a CCHOTA report from the mid
1990's).
>The private
> sector certainly hasn't risen to meet the challange.
I'd disagree - certainly the NHS (a model all to similar to SP/UC) has
spawned a rash of private initiatives in the UK to fill gaps and meet
needs. In the US, the overwhelming majority of Americans have fairly
comprehensive health care coverage, ready access, and in most cases,
pretty decent outcomes. Granted, there is an uninsured gap, but that
doesn't necessarily mean it isn't filled. Sort of like unemployment -
sounds bad, but in all honesty, from a purely economic perspective, a
necessary part of employment.
> And just to show you how mellow I've become I'm even ignoring your
> snide little remark in one of the prior posts.
If I snided you, my apologies - it probably was an unintended
misdirection.
amp
Gretchen Evans
wrote:
A little lapse of memory here, amp. Don't you remember when Hillary
and her happy bunch were touting all the advantages of 'her plan', and
how the "market forces" and competition within managed care would
drive down costs, etc., and we'd all live happier.. and healtherll
forever?
Anyone with any working understanding of the biz knew at the outset
that the plan had been dreamed up by the ivied tower chowderheads who
live in theory, and that there was absolutely no chance in hell that
their theories would create any change at all... And, surprise, they
didn't.
In the real world of healthcare there's really little competition.
Sure one facility in an area will erect a shiny new ediface, then
breathlessly proclaim "I'm better than the other guy". Do rates
change? No. Is care actually improved? Perhaps by technology, but
when the other guy puts in his new widget it all washes out.
And what of those communities with only a single hospital? Or a
single group of physicians. Do you REALLY think they compete against
one another?
As an example, Not 50 miles from where I live there's a community of
around 45000 with only one hospital, and aside from a couple of solo
docs. both on the verge of retirement, only one physicians group.
Yep, REAL competition..
And that's not an isolated instance.
Certainly the theory is there, all well and good, but come back to
earth and into the real world.
>>
>> I definitely agree that access for everyone is a natural goal; as is
>> individual choice and better accountability for outcomes.
>> Unfortunately the existing system. in general, is so fragmented that
>> both choice and accountability vary widely in most areas and the only
>> solution....
>
>That's always where you and I diverge - we both agree the system has
>faults - you argue that there is "only one" solution.
>
OK, do we agree that the private sector, in general, has failed to
provide adequate care for all? Remove that and what's left? Back to
the 'only one' solution. Or are you advocating creation of a new, and
totally different methodology of delivery?
>> I can come up with to provide a decent level of care for
>> everyone is a single governmentally sponsored program.
>
>You agreed that choice is good but advocate a "single government
>sponsored system"? I'm going to take a leap of faith and characterize
>it as SP/UC, okay?
>
Don't you think that choice can be built into a SP/UC model?
>So you eliminate choice. Granted, you may still choose your
>providers, but your choice set is artificially constrained by a single
>system. For example, let's say you have ESRD - you're a candidate for
>surgery - except for your age. Now, you've taken good care of
>yourself, you are in great shape, and have a wonderful life expectancy
>- but the system says - sorry, over 75, no transplant. And if you
>think this is far fetched, check out the organ transplant guidelines
>for Ontario province (I think it was a CCHOTA report from the mid
>1990's).
>
Au contrare, amp. You're the one eliminating choice by your
unsupported statement that you can't build that factor into a SP/UC
model.
And as to your sample, let's turn in around. Just how many 75 or over
individuals should have a transplant. How about post-op qualify of
life? Sure the patient is alive... barely... but what then?
>>The private
>> sector certainly hasn't risen to meet the challange.
>
>I'd disagree - certainly the NHS (a model all to similar to SP/UC) has
>spawned a rash of private initiatives in the UK to fill gaps and meet
>needs. In the US, the overwhelming majority of Americans have fairly
>comprehensive health care coverage, ready access, and in most cases,
>pretty decent outcomes. Granted, there is an uninsured gap, but that
>doesn't necessarily mean it isn't filled. Sort of like unemployment -
>sounds bad, but in all honesty, from a purely economic perspective, a
>necessary part of employment.
>
OK, let's compare those two goodies. What do you think the hue and
cry would be if 15% of the workforce of the US were unemployed. Do
you really think that the people would listen to the garbage that
"it's a necessary part of healthcare delivery"? I doubt that.
>> And just to show you how mellow I've become I'm even ignoring your
>> snide little remark in one of the prior posts.
>
>If I snided you, my apologies - it probably was an unintended
>misdirection.
>
>amp
Yep, you were all so wrapped up in bashing Leo... Not that he doesn't
deserve it. But I'll overlook it.
Cheers, the battle is re-engaged
pixie
Gretchen Evans
Conklin) wrote:
>In article <1192abe3.02013...@posting.google.com>,
>amp_spamfree <amp_sp...@yahoo.com> wrote:
>
>
>>Health care access for everyone is a laudable goal and one I support -
>>my preference is to allow for greater competition, more individual
>>choice, and better accountability for outcomes. In the US there
>>appear to be constraints on system options in part due to some equity
>>criterion that I don't quite get. In the UK, it is even more obvious
>>that equity as defined by the Tories is minimalistic but at least they
>>are honest and open about it. That, of course, results in a lot of
>>political infighting and inefficiency, and some real challenges
>>regarding access as measured by waiting lists.
>
> USA-style waiting lists consist of 'dont' come if you don't
>have they money.' They are forever.
Don't you have Medicare, George? Regardless, how often have you been
refused treatment on the basis of ability to pay?
pixie
George Conklin
Medicare is for those 65 and older...but I guess Pixie does not
know that. As for the rest of the population, go beg.
DWood78828
>From: amp_sp...@yahoo.com (amp_spamfree)
>Date: 1/31/02 2:48 PM Eastern
>tf...@webtv.net (leo John) wrote in message
>> What lame chowder heads you two are.
>There are four of us here - Denis ("Woody"), Pixie, Bettina, and me.
>Which two are the "chowder heads"?
Amp, he can't count. I think he means all four of us<g>.
Denise
DWood78828
>Date: 1/31/02 7:32 PM Eastern
> Medicare is for those 65 and older...but I guess Pixie does not
>know that. As for the rest of the population, go beg.
>
Actually George, Medicare is also available to the permanently disabled, at any
age. I should know, I've been on it for 13 years.
Denise
amp_spamfree
In 1994 Hillary decided that the "one solution" was a single
government madated health plan - or lest we forget? In fact, the
proposal included a $5,000 fine for anyone refusing to join the one
for all plan.
http://www.papillonsartpalace.com/weneed.htm
Here's a lively rendition of "managed competition" ala Hillary. So
get up to speed.
http://www.fair.org/extra/9401/debate.html
Regarding the cost-effectiveness of managed care - the data support
that the cost of health care in a managed care system is as low or
lower than that in a fee for service system - the fact that the US
spends a lot isn't evidence that it spends too much. Or did you miss
the diddy about Kaiser California spending no more than the NHS and
that without waiting lists?
If you want to posit based on historical data, I'd suggest brushing up
on it.
> Anyone with any working understanding of the biz knew at the outset
> that the plan had been dreamed up by the ivied tower chowderheads who
> live in theory, and that there was absolutely no chance in hell that
> their theories would create any change at all... And, surprise, they
> didn't.
The underlying concept of the Hillary plan was NOT competition and
private sector - it was big brother government - remeber, she was and
continues to be one of the big D's. Competition and privatization are
four letter words. Entitlement and income redistribution - that's
what the fundamental premise of Democrats (and our very own Labour
party).
> In the real world of healthcare there's really little competition.
Not exactly - but your right - more would be better - which is what I
propose is the better solution to access, quality, and cost.
> Sure one facility in an area will erect a shiny new ediface, then
> breathlessly proclaim "I'm better than the other guy". Do rates
> change? No.
Rates are fixed in the short run. But then again, a bit of history -
you yourself have argued that hospital reimbursement is fixed by
payers (e.g. DRG) when you argued for fixing pharma prices. Recently,
your very own company has fought back and beat up on the insurers to
increase reimbursement - and in some cases successfully, and in others
they lost the business to someone else. That's price competition.
More of this is needed, not less.
>Is care actually improved? Perhaps by technology, but
> when the other guy puts in his new widget it all washes out.
Wish we had a few more widgets here in the UK. We're technology poor
- too few widgets, too many people, one cheapskate payer, and a very
pissed of population. And don't tell me the people aren't pissed
about HC in the UK - It is headline news EVERY day now.
> And what of those communities with only a single hospital? Or a
> single group of physicians. Do you REALLY think they compete against
> one another?
How many hospitals within 40 miles of you? How many physicians in
your phone book? If you are worried about supply issues, then open up
the market. There are no artificial constraints. Take a look at
Walmart, as an example. Look what open competition has done with
regard to access.
> As an example, Not 50 miles from where I live there's a community of
> around 45000 with only one hospital, and aside from a couple of solo
> docs. both on the verge of retirement, only one physicians group.
> Yep, REAL competition..
Why is this? With the average Physician/Patient population average of
around 1000, one would expect a need for 45 docs in the general area
and 5 pharmacies, and one hospital. Give me the name of the town and
I'll look in the Yellow pages and show you how wrong you are.
> And that's not an isolated instance.
Give me the name of another town - and I'll show you that there is
adequate (perhaps not stellar) health care access - based on grocery
access. You need to use grocery access as a leveling variable - but
if there is a chain grocery, then there's health care.
> Certainly the theory is there, all well and good, but come back to
> earth and into the real world.
You want SC/UC - that's Hillary planning and as soon as you get to
that you'll have a better appreciation why disaggregation and
competition is preferred over big brother mandates.
> >> I definitely agree that access for everyone is a natural goal; as is
> >> individual choice and better accountability for outcomes.
> >> Unfortunately the existing system. in general, is so fragmented that
> >> both choice and accountability vary widely in most areas and the only
> >> solution....
> >
> >That's always where you and I diverge - we both agree the system has
> >faults - you argue that there is "only one" solution.
> >
> OK, do we agree that the private sector, in general, has failed to
> provide adequate care for all?
The PUBLIC sector has failed to provide adequate access to health
insurance for the poor or marginally poor. The private sector has
done a pretty good job in the US in providing access to affordable
health insurance to 85% of the population (excluding the over 65's
though that Part b and supplemental are private insurance schemes).
Do you blame the building industry for the lack of affordable public
housing? Do you blame the airline industry for a lack of
transportation in the inner cities? Do you blame GM that some people
don't have cars?
>Remove that and what's left? Back to
> the 'only one' solution. Or are you advocating creation of a new, and
> totally different methodology of delivery?
Get government out of the business of providing and/or financig care -
mandate, as the Germans have done, that insurance be available and
that insurers compete. And for those that can't afford insurance,
figure out a way to subsidize it - just like you figured out how to
fund unemployment,WIC food programs, housing subsidies, or any other
indigent program. Let these people be part of the mainstream - don't
force everyone into rationed government care because it is "better"
for the minority who are poor.
> >> I can come up with to provide a decent level of care for
> >> everyone is a single governmentally sponsored program.
> >
> >You agreed that choice is good but advocate a "single government
> >sponsored system"? I'm going to take a leap of faith and characterize
> >it as SP/UC, okay?
> >
> Don't you think that choice can be built into a SP/UC model?
Not a chance - UNLESS you let people opt out and go private. Think
vouchers.
> >So you eliminate choice. Granted, you may still choose your
> >providers, but your choice set is artificially constrained by a single
> >system. For example, let's say you have ESRD - you're a candidate for
> >surgery - except for your age. Now, you've taken good care of
> >yourself, you are in great shape, and have a wonderful life expectancy
> >- but the system says - sorry, over 75, no transplant. And if you
> >think this is far fetched, check out the organ transplant guidelines
> >for Ontario province (I think it was a CCHOTA report from the mid
> >1990's).
> >
> Au contrare, amp. You're the one eliminating choice by your
> unsupported statement that you can't build that factor into a SP/UC
> model.
You can't - because as soon as you do, you simply have the runaway
train of fee for service. Granted, it may be cheap fees, but you have
no control on utilization UNLESS you ration - and that is the UK NHS.
Everyone gets as much as they want of the covered services - as long
as they are willing to wait. And that my dear, is the downfall of the
NHS - and that is why the private sector health system is groing by
leaps and bounds in the UK - to the point that even the NHS is using
it - and not just in the UK, but in germany, france, the Netherlands -
and soon Greece!
> And as to your sample, let's turn in around. Just how many 75 or over
> individuals should have a transplant. How about post-op qualify of
> life? Sure the patient is alive... barely... but what then?
Since the individual you describe would not qualify medically because
of the risk/benefit, their age becomes a moot point. The issue is
that ALL 75 year olds are excluded in the Canadian plan - not just
those with poor prognoses. Those under 75 with poor prognoses are
similarly excluded.
> >>The private
> >> sector certainly hasn't risen to meet the challange.
> >
> >I'd disagree - certainly the NHS (a model all to similar to SP/UC) has
> >spawned a rash of private initiatives in the UK to fill gaps and meet
> >needs. In the US, the overwhelming majority of Americans have fairly
> >comprehensive health care coverage, ready access, and in most cases,
> >pretty decent outcomes. Granted, there is an uninsured gap, but that
> >doesn't necessarily mean it isn't filled. Sort of like unemployment -
> >sounds bad, but in all honesty, from a purely economic perspective, a
> >necessary part of employment.
> >
>
> OK, let's compare those two goodies. What do you think the hue and
> cry would be if 15% of the workforce of the US were unemployed.
What are the germans saying - they're at 10+ and 25+ in the former
East?
>Do
> you really think that the people would listen to the garbage that
> "it's a necessary part of healthcare delivery"? I doubt that.
When was the last time the US had 15% unemployement? And, if the US
had 15% unemployement would health care be the top priority?
> >> And just to show you how mellow I've become I'm even ignoring your
> >> snide little remark in one of the prior posts.
> >
> >If I snided you, my apologies - it probably was an unintended
> >misdirection.
> >
> >amp
>
> Yep, you were all so wrapped up in bashing Leo... Not that he doesn't
> deserve it. But I'll overlook it.
>
> Cheers, the battle is re-engaged
>
> pixie
"Battle" - I'm trying to avoid it turning out that way - but I will
ask one very important favor - if you would like to use history as a
model, please do so with appropriate references (links). I did and
was able to, quite quickly, diffuse your entire foundation of your
criticism.
amp
amp_spamfree
> In article <1192abe3.02013...@posting.google.com>,
> amp_spamfree <amp_sp...@yahoo.com> wrote:
>
>
> >Health care access for everyone is a laudable goal and one I support -
> >my preference is to allow for greater competition, more individual
> >choice, and better accountability for outcomes. In the US there
> >appear to be constraints on system options in part due to some equity
> >criterion that I don't quite get. In the UK, it is even more obvious
> >that equity as defined by the Tories is minimalistic but at least they
> >are honest and open about it. That, of course, results in a lot of
> >political infighting and inefficiency, and some real challenges
> >regarding access as measured by waiting lists.
>
> USA-style waiting lists consist of 'dont' come if you don't
> have they money.' They are forever.
What about the convicted felony serving time in California who just
got a million dollar heart transplant? Or the New Jersey rapist with
the new 100K kidney?
Just curious.
amp
George Conklin
This changes nothing about the lack of health insurance and
care for those under 65. Or the cost. Or the money wasting on
tests which do not change the outcomes.
George Conklin
No you are not. Magazines are carrying stories about how
female prisoners, for example, get virtually no medical care and
die of things like cervical cancer even after begging for
treatment. We still have collections for children with deadly
diseases who cannot get cancer care unless they have the cash for
the specialists. All they can get is 'emergency' care until
stabilized and that means nothing at all.
Gretchen Evans
Conklin) wrote:
>In article <3c5bcd84...@news.edge.net>,
>Gretchen Evans <gle...@edge.net> wrote:
>>On Thu, 31 Jan 2002 12:42:53 GMT, jep...@shell.ntrnet.net (George
>>Conklin) wrote:
>>
>>>In article <1192abe3.02013...@posting.google.com>,
>>>amp_spamfree <amp_sp...@yahoo.com> wrote:
>>>
>>>
>>>>Health care access for everyone is a laudable goal and one I support -
>>>>my preference is to allow for greater competition, more individual
>>>>choice, and better accountability for outcomes. In the US there
>>>>appear to be constraints on system options in part due to some equity
>>>>criterion that I don't quite get. In the UK, it is even more obvious
>>>>that equity as defined by the Tories is minimalistic but at least they
>>>>are honest and open about it. That, of course, results in a lot of
>>>>political infighting and inefficiency, and some real challenges
>>>>regarding access as measured by waiting lists.
>>>
>>> USA-style waiting lists consist of 'dont' come if you don't
>>>have they money.' They are forever.
>>
>>Don't you have Medicare, George? Regardless, how often have you been
>>refused treatment on the basis of ability to pay?
>>
>>pixie
>
> Medicare is for those 65 and older...but I guess Pixie does not
>know that. As for the rest of the population, go beg.
You might check again, Georgie, certain other individuals aged much
less than 65 are also eligible for Medicare. Guess you just failed to
check the facts out as usual.
And I honestly did think that you were eligible... But if not, just
look what you've got to look forward to.
pixie
Gretchen Evans
wrote:
Yep, and I'll bet that you believed that tripe, too.
>Here's a lively rendition of "managed competition" ala Hillary. So
>get up to speed.
>
>http://www.fair.org/extra/9401/debate.html
>
>Regarding the cost-effectiveness of managed care - the data support
>that the cost of health care in a managed care system is as low or
>lower than that in a fee for service system - the fact that the US
>spends a lot isn't evidence that it spends too much. Or did you miss
>the diddy about Kaiser California spending no more than the NHS and
>that without waiting lists?
>
You're citing the Clintons in providing authoritative statements?
Collectively or individually they haven't a clue as to what "truth"
means..
And yes, Kaiser has historically done an excellent job but,
uinfortunately, Kaiser isn't available nationally, nor is there any
plans that I've heard of for expansion but actually some contraction
of their coverage has been rumored for quite some time. And wouldn't
you also lump them into the SP/UC group that you apparently detest so
markedly?
>If you want to posit based on historical data, I'd suggest brushing up
>on it.
>
The street runs both ways ampie.
>> Anyone with any working understanding of the biz knew at the outset
>> that the plan had been dreamed up by the ivied tower chowderheads who
>> live in theory, and that there was absolutely no chance in hell that
>> their theories would create any change at all... And, surprise, they
>> didn't.
>
>The underlying concept of the Hillary plan was NOT competition and
>private sector - it was big brother government - remeber, she was and
>continues to be one of the big D's. Competition and privatization are
>four letter words. Entitlement and income redistribution - that's
>what the fundamental premise of Democrats (and our very own Labour
>party).
>
Sorry, but I don't buy your claim about the 'underlying concept'..
Yes, she did propose a govenmental plan, and would have required
participation by providers, but one of the keystones of that plan was
that the 'market forces' and 'competition' would drive down costs.
BS, of course, but that was the claim.
And there's nothing wrong with a governmental plan as long as it's
properly designed and implemented. With the diversity and size that
the US represents it's about the only way that UC will ever come
about, IMO we'll NEVER see it honestly proposed from the private
sector.
>> In the real world of healthcare there's really little competition.
>
>Not exactly - but your right - more would be better - which is what I
>propose is the better solution to access, quality, and cost.
>
From the private sector... Yeah, sure... Just like HCA and Tenet will
join hands, smile, and we'll all be forever happy. Egg-head thinking.
>> Sure one facility in an area will erect a shiny new ediface, then
>> breathlessly proclaim "I'm better than the other guy". Do rates
>> change? No.
>
>Rates are fixed in the short run. But then again, a bit of history -
>you yourself have argued that hospital reimbursement is fixed by
>payers (e.g. DRG) when you argued for fixing pharma prices. Recently,
>your very own company has fought back and beat up on the insurers to
>increase reimbursement - and in some cases successfully, and in others
>they lost the business to someone else. That's price competition.
>More of this is needed, not less.
>
Yes, I believe that pharma should be subject to the same rate controls
as other healthcare vendors. Why should they be exempt and enjoy
massive profits to the exclusion of others?
And when you claim the fixing of rates you're overlooking the fact
that the patient portion... the amount due following the plan
payment... has been steadily increasing with more and more of the load
being placed back onto the individual who can least afford the
increase. Not a desirable feature, as Sears used to say in their ads.
>>Is care actually improved? Perhaps by technology, but
>> when the other guy puts in his new widget it all washes out.
>
>Wish we had a few more widgets here in the UK. We're technology poor
>- too few widgets, too many people, one cheapskate payer, and a very
>pissed of population. And don't tell me the people aren't pissed
>about HC in the UK - It is headline news EVERY day now.
>
Who mentioned UK... Here in the US we've got plenty of wigets, more
than we need in some places, but that's a different topic. And we're
blessed with a bunch of cheapskate payers, not just one. As I said,
it all washes out.
>> And what of those communities with only a single hospital? Or a
>> single group of physicians. Do you REALLY think they compete against
>> one another?
>
>How many hospitals within 40 miles of you? How many physicians in
>your phone book? If you are worried about supply issues, then open up
>the market. There are no artificial constraints. Take a look at
>Walmart, as an example. Look what open competition has done with
>regard to access.
>
In the 40 mile area, 3 tertiaries, soon merging into 2, and 10
others, the majority corporate-owned FP as you'd expect. Population
around 1.5 million. We've actually overbedded in the 40 mile area but
VERY well covered. Not so in the more rural areas outside that ring.
And as to citing WalMart as an example, didn't they suceed by forcing
out the competition? But we're not talking about selling toasters,
we're discussing healthcare delivery and there IS a vast difference.
>> As an example, Not 50 miles from where I live there's a community of
>> around 45000 with only one hospital, and aside from a couple of solo
>> docs. both on the verge of retirement, only one physicians group.
>> Yep, REAL competition..
>
>Why is this? With the average Physician/Patient population average of
>around 1000, one would expect a need for 45 docs in the general area
>and 5 pharmacies, and one hospital. Give me the name of the town and
>I'll look in the Yellow pages and show you how wrong you are.
>
Try Dickson, TN... I don't know about the pharmacies as I look at them
as more of a general retail outlet. There's one hospital, now FP, and
virtually all of the physicians are members of the physicians group.
>> And that's not an isolated instance.
>
>Give me the name of another town - and I'll show you that there is
>adequate (perhaps not stellar) health care access - based on grocery
>access. You need to use grocery access as a leveling variable - but
>if there is a chain grocery, then there's health care.
>
You're comparing healthcare access to grocery access??? Asinine! Do
you run down to Krogers when you're sick?
>> Certainly the theory is there, all well and good, but come back to
>> earth and into the real world.
>
>You want SC/UC - that's Hillary planning and as soon as you get to
>that you'll have a better appreciation why disaggregation and
>competition is preferred over big brother mandates.
>
As *I've pointed out over and over, SP/UC doesn't have to be 'Hillary
planning", nor should it be. You want open profiteering with the
little guy picking up the tab... and getting the short end of the
stick in the bargain. Apparently no common ground at all with your
thinking, ampie.
>> >> I definitely agree that access for everyone is a natural goal; as is
>> >> individual choice and better accountability for outcomes.
>> >> Unfortunately the existing system. in general, is so fragmented that
>> >> both choice and accountability vary widely in most areas and the only
>> >> solution....
>> >
>> >That's always where you and I diverge - we both agree the system has
>> >faults - you argue that there is "only one" solution.
>> >
As do you... Always the open, uncontrolled plan where your pets can
reap a harvest of profits.. And that's where we disagree.
>> OK, do we agree that the private sector, in general, has failed to
>> provide adequate care for all?
>
>The PUBLIC sector has failed to provide adequate access to health
>insurance for the poor or marginally poor. The private sector has
>done a pretty good job in the US in providing access to affordable
>health insurance to 85% of the population (excluding the over 65's
>though that Part b and supplemental are private insurance schemes).
>
But you're advocating that the private sector control the delivery
system. I'm simply saying that they've yet to prove that they can...
and will... provide adequate care for everyone.
>Do you blame the building industry for the lack of affordable public
>housing? Do you blame the airline industry for a lack of
>transportation in the inner cities? Do you blame GM that some people
>don't have cars?
>
Try comparing apples to apples for a change. Stick to healthcare.
Why should 15% with without adequate access?; why should an another
10-15% have to scrimp whenever a major medical emergency arises?. Why
to the majority of the elderly have major problems in affording
prescrption meds? The private sector that you so dearly love has
priced that group out of the market. UC would change that.
>>Remove that and what's left? Back to
>> the 'only one' solution. Or are you advocating creation of a new, and
>> totally different methodology of delivery?
>
Same old system, different method of management.
>Get government out of the business of providing and/or financig care -
>mandate, as the Germans have done, that insurance be available and
>that insurers compete. And for those that can't afford insurance,
>figure out a way to subsidize it - just like you figured out how to
>fund unemployment,WIC food programs, housing subsidies, or any other
>indigent program. Let these people be part of the mainstream - don't
>force everyone into rationed government care because it is "better"
>for the minority who are poor.
>
Nice words, but IMO unworkable in the US. Too many diverse
special-interest groups and too much profit at stake. I'll continue
to support a governmentally managed single plan, but one with fully
adequate oversight and control. And that IS doable.
>> >> I can come up with to provide a decent level of care for
>> >> everyone is a single governmentally sponsored program.
>> >
>> >You agreed that choice is good but advocate a "single government
>> >sponsored system"? I'm going to take a leap of faith and characterize
>> >it as SP/UC, okay?
>> >
>> Don't you think that choice can be built into a SP/UC model?
>
>Not a chance - UNLESS you let people opt out and go private. Think
>vouchers.
>
And why not? You don't have to have vouchers, although they're not
something bad in many instances. Why do you continually proclaim that
privatization is the ONLY answer. It certainly hasn't been up to now.
>> >So you eliminate choice. Granted, you may still choose your
>> >providers, but your choice set is artificially constrained by a single
>> >system. For example, let's say you have ESRD - you're a candidate for
>> >surgery - except for your age. Now, you've taken good care of
>> >yourself, you are in great shape, and have a wonderful life expectancy
>> >- but the system says - sorry, over 75, no transplant. And if you
>> >think this is far fetched, check out the organ transplant guidelines
>> >for Ontario province (I think it was a CCHOTA report from the mid
>> >1990's).
>> >
>> Au contrare, amp. You're the one eliminating choice by your
>> unsupported statement that you can't build that factor into a SP/UC
>> model.
>
>You can't - because as soon as you do, you simply have the runaway
>train of fee for service. Granted, it may be cheap fees, but you have
>no control on utilization UNLESS you ration - and that is the UK NHS.
>Everyone gets as much as they want of the covered services - as long
>as they are willing to wait. And that my dear, is the downfall of the
>NHS - and that is why the private sector health system is groing by
>leaps and bounds in the UK - to the point that even the NHS is using
>it - and not just in the UK, but in germany, france, the Netherlands -
>and soon Greece!
>
So it can't be done because you say so? Isn't that just a bit
egotistical? You have absolutely no proof that such a plan can't be
devised and implemented, yet you make such a statement? Strange
thinking at best.
>> And as to your sample, let's turn in around. Just how many 75 or over
>> individuals should have a transplant. How about post-op qualify of
>> life? Sure the patient is alive... barely... but what then?
>
>Since the individual you describe would not qualify medically because
>of the risk/benefit, their age becomes a moot point. The issue is
>that ALL 75 year olds are excluded in the Canadian plan - not just
>those with poor prognoses. Those under 75 with poor prognoses are
>similarly excluded.
>
And there's some perfectly valid common sense about such exclusions.
Medicine has reached the point where they can reverse what used to be
a life-ending situation and maintain the patient but they have yet
taken into consideration the overall qualify of life of that
individual. Many patients, regardless of age, remain in a
quasi-vegetative state and IMO that's wrong. A time comes for
everyone when life will end, some earlier than others, some later.
It's foolish to expend needed resources in attempting to prolong life
simply for the sake of having someone 'alive'... regardless of the
overall outcome.
I don't, however, advocate a strict age limit. Such issues need to be
decided on an individual basis at a local level. Something that can
be provided in any decently designed plan.
>> >>The private
>> >> sector certainly hasn't risen to meet the challange.
>> >
>> >I'd disagree - certainly the NHS (a model all to similar to SP/UC) has
>> >spawned a rash of private initiatives in the UK to fill gaps and meet
>> >needs. In the US, the overwhelming majority of Americans have fairly
>> >comprehensive health care coverage, ready access, and in most cases,
>> >pretty decent outcomes. Granted, there is an uninsured gap, but that
>> >doesn't necessarily mean it isn't filled. Sort of like unemployment -
>> >sounds bad, but in all honesty, from a purely economic perspective, a
>> >necessary part of employment.
>> >
Of course you'd disagree. Where's the surprise here? And of course
the private sector has developed numerous initiatives to supplement
basic coverage. Again, is that news. So why doesn't NHS revise their
plan to fill those gaps.. A well-designed plan would allow for such
modification.
>>
>> OK, let's compare those two goodies. What do you think the hue and
>> cry would be if 15% of the workforce of the US were unemployed.
>
>What are the germans saying - they're at 10+ and 25+ in the former
>East?
>
Huh ????
>>Do
>> you really think that the people would listen to the garbage that
>> "it's a necessary part of healthcare delivery"? I doubt that.
>
>When was the last time the US had 15% unemployement? And, if the US
>had 15% unemployement would health care be the top priority?
>
Ah, but we've got 15% non-covered... And a bunch of other problems on
top of that. And it's not necessary.
>> >> And just to show you how mellow I've become I'm even ignoring your
>> >> snide little remark in one of the prior posts.
>> >
>> >If I snided you, my apologies - it probably was an unintended
>> >misdirection.
>> >
>> >amp
>>
>> Yep, you were all so wrapped up in bashing Leo... Not that he doesn't
>> deserve it. But I'll overlook it.
>>
>> Cheers, the battle is re-engaged
>>
>> pixie
>
>"Battle" - I'm trying to avoid it turning out that way - but I will
>ask one very important favor - if you would like to use history as a
>model, please do so with appropriate references (links). I did and
>was able to, quite quickly, diffuse your entire foundation of your
>criticism.
>
>amp
Perhaps in your own mind, ampie.
pixie
Gretchen Evans
Hmmm. Wonder if he's deformed or suffered some injury. He should be
able to get up to four, if only by including both arms and legs...
Perhaps it's more of a cognitive deficiency..
pixie
George Conklin
Pixie, sweetheart, Medicare is for those 65 and older. You are
back to your fringe group exeption list. The population does not
get medicare care by fringe group exception reduced to poverty by
living on disability insurance below the poverty line.
amp_spamfree
Then post a link to the truth - you said that the proposal from
Hillary in 1993-4 was based on a competitive model. I said that it
was based on a SP/UC model with "managed" competition. I gave you
sources in support - now, please, do the same.
> >Here's a lively rendition of "managed competition" ala Hillary. So
> >get up to speed.
> >
> >http://www.fair.org/extra/9401/debate.html
> >
> >Regarding the cost-effectiveness of managed care - the data support
> >that the cost of health care in a managed care system is as low or
> >lower than that in a fee for service system - the fact that the US
> >spends a lot isn't evidence that it spends too much. Or did you miss
> >the diddy about Kaiser California spending no more than the NHS and
> >that without waiting lists?
> >
>
> You're citing the Clintons in providing authoritative statements?
> Collectively or individually they haven't a clue as to what "truth"
> means..
At least I cited SOMEONE or SOMETHING - that's more than you Pixie.
If you don't agree, provide evidence in support of your opinion, OK?
> And yes, Kaiser has historically done an excellent job but,
> uinfortunately, Kaiser isn't available nationally, nor is there any
> plans that I've heard of for expansion but actually some contraction
> of their coverage has been rumored for quite some time.
Again, where do you here the rumors? Here's facts -
http://www.kaiserpermanente.org/
All upbeat and growth - no rumors of shrinkage.
>And wouldn't
> you also lump them into the SP/UC group that you apparently detest so
> markedly?
No - for a very very simple reason - I can opt in or I can opt out.
Once in, I am under a "single payer" umbrella, but I pay premiums
based on my risk profile not my salary, I have negotiating power for
services, I have access to care, and I can go outside of the network
and get services. Managed care is not a structure, it's a process.
> >If you want to posit based on historical data, I'd suggest brushing up
> >on it.
> >
> The street runs both ways ampie.
I provided a link - you?
> >> Anyone with any working understanding of the biz knew at the outset
> >> that the plan had been dreamed up by the ivied tower chowderheads who
> >> live in theory, and that there was absolutely no chance in hell that
> >> their theories would create any change at all... And, surprise, they
> >> didn't.
> >
> >The underlying concept of the Hillary plan was NOT competition and
> >private sector - it was big brother government - remeber, she was and
> >continues to be one of the big D's. Competition and privatization are
> >four letter words. Entitlement and income redistribution - that's
> >what the fundamental premise of Democrats (and our very own Labour
> >party).
> >
> Sorry, but I don't buy your claim about the 'underlying concept'..
> Yes, she did propose a govenmental plan, and would have required
> participation by providers, but one of the keystones of that plan was
> that the 'market forces' and 'competition' would drive down costs.
> BS, of course, but that was the claim.
Document this. And in context with the SP/UC requirement, ok.
> And there's nothing wrong with a governmental plan as long as it's
> properly designed and implemented. With the diversity and size that
> the US represents it's about the only way that UC will ever come
> about, IMO we'll NEVER see it honestly proposed from the private
> sector.
You argue for standardization BECAUSE of diversity and size? Seems
counterintuitive. What makes you think a thirty-something California
valley girl has the same needs (medical or otherwise) than a 70 year
old bible belt granny?
> >> In the real world of healthcare there's really little competition.
> >
> >Not exactly - but your right - more would be better - which is what I
> >propose is the better solution to access, quality, and cost.
> >
> From the private sector... Yeah, sure... Just like HCA and Tenet will
> join hands, smile, and we'll all be forever happy. Egg-head thinking.
no joining of hands - compete on quality, service, and price. Sort of
like anything else you buy.
>
> >> Sure one facility in an area will erect a shiny new ediface, then
> >> breathlessly proclaim "I'm better than the other guy". Do rates
> >> change? No.
> >
> >Rates are fixed in the short run. But then again, a bit of history -
> >you yourself have argued that hospital reimbursement is fixed by
> >payers (e.g. DRG) when you argued for fixing pharma prices. Recently,
> >your very own company has fought back and beat up on the insurers to
> >increase reimbursement - and in some cases successfully, and in others
> >they lost the business to someone else. That's price competition.
> >More of this is needed, not less.
> >
> Yes, I believe that pharma should be subject to the same rate controls
> as other healthcare vendors. Why should they be exempt and enjoy
> massive profits to the exclusion of others?
So your point is that you were wrong when you said rates don't change
through competitive forces? or do they? or did they? Or did you
loose your train?
> And when you claim the fixing of rates you're overlooking the fact
> that the patient portion... the amount due following the plan
> payment... has been steadily increasing with more and more of the load
> being placed back onto the individual who can least afford the
> increase. Not a desirable feature, as Sears used to say in their ads.
If you're talking about pharma and tiered copays - this is exactly
what you want in a competitive model. Let's assume that there is a
standard $2 copay - does this make the patient at all price sensitive?
Give me the best and the most - whether I need it or not, its only
two bucks.
Now lets assume there is a $20 copay - well, maybe that Tylenol #3 Rx
isn't as valuable than the less costly OTC Tylenol. Maybe waiting a
few days for that antibiotic prescription since its probably just a
virus anyway isn't a bad idea.
Now lets put in a tiered copay - $30 for a brandname drug, $10 for the
equivalent generic.
Let's use a $20 copay for an off formulary drug and $15 for the
therapeutic equivalent on-formulary drug. Want to guess which way the
choices go?
> >>Is care actually improved? Perhaps by technology, but
> >> when the other guy puts in his new widget it all washes out.
> >
> >Wish we had a few more widgets here in the UK. We're technology poor
> >- too few widgets, too many people, one cheapskate payer, and a very
> >pissed of population. And don't tell me the people aren't pissed
> >about HC in the UK - It is headline news EVERY day now.
> >
> Who mentioned UK... Here in the US we've got plenty of wigets, more
> than we need in some places, but that's a different topic. And we're
> blessed with a bunch of cheapskate payers, not just one. As I said,
> it all washes out.
Note in your or my lifetime - trust me, one cheapskate payer doesn't
have to respond to econmomic pressures. Only political pressures and
even then the bobb and weave is so well choreographed. Tony said
yesterday (or the day before), if your on the side of the children be
on the side of the teacher, if your on the side of the patient, be on
the side of the doctors and nurses - get the irony?
> >> And what of those communities with only a single hospital? Or a
> >> single group of physicians. Do you REALLY think they compete against
> >> one another?
> >
> >How many hospitals within 40 miles of you? How many physicians in
> >your phone book? If you are worried about supply issues, then open up
> >the market. There are no artificial constraints. Take a look at
> >Walmart, as an example. Look what open competition has done with
> >regard to access.
> >
> In the 40 mile area, 3 tertiaries, soon merging into 2, and 10
> others, the majority corporate-owned FP as you'd expect. Population
> around 1.5 million. We've actually overbedded in the 40 mile area but
> VERY well covered. Not so in the more rural areas outside that ring.
>
> And as to citing WalMart as an example, didn't they suceed by forcing
> out the competition? But we're not talking about selling toasters,
> we're discussing healthcare delivery and there IS a vast difference.
Should there be? Are the rules of competition different - do the
market forces behave differently?
> >> As an example, Not 50 miles from where I live there's a community of
> >> around 45000 with only one hospital, and aside from a couple of solo
> >> docs. both on the verge of retirement, only one physicians group.
> >> Yep, REAL competition..
> >
> >Why is this? With the average Physician/Patient population average of
> >around 1000, one would expect a need for 45 docs in the general area
> >and 5 pharmacies, and one hospital. Give me the name of the town and
> >I'll look in the Yellow pages and show you how wrong you are.
> >
> Try Dickson, TN... I don't know about the pharmacies as I look at them
> as more of a general retail outlet. There's one hospital, now FP, and
> virtually all of the physicians are members of the physicians group.
Vanderbilt Medical group - 4 cardiologists
Horizon medical - big group - dozens of docs.
A dialysis clinic (now that's novel)
6 Chiropractors
2 dermatologists
27 listings for family practice - though some refer to clinics.
A handful of internists
Literally dozens of other docs
And then there's Waverly down the road (less than 25 miles) with
dozens more.
And then there's Nashville 24 miles away. What are you complaining
about? This is a glut of providers, not a dirth.
Granted - one Hospital - Horizon medical - which is also the home to
the largest group practice - wouldn't you expect it?
But there's Hickman County, Baptist, and Trinity hospitals all within
25 miles, and all the Nashville hospitals in less than a half hour's
drive.
> >> And that's not an isolated instance.
No - it's quite common to have lots of choices across the US,
particularly in the more or less "populated" parts.
For contrast, there are 12 pharmacies within 8 miles of downtown
Dickson Tennessee and 31 food stores (though some are convenience
stores).
> >Give me the name of another town - and I'll show you that there is
> >adequate (perhaps not stellar) health care access - based on grocery
> >access. You need to use grocery access as a leveling variable - but
> >if there is a chain grocery, then there's health care.
> >
> You're comparing healthcare access to grocery access??? Asinine! Do
> you run down to Krogers when you're sick?
They do have a full service pharmacy. What I was suggesting is that
if health care services are as convenient as the grocery store, then
there's not much room to complain about access. get it?
> >> Certainly the theory is there, all well and good, but come back to
> >> earth and into the real world.
> >
> >You want SC/UC - that's Hillary planning and as soon as you get to
> >that you'll have a better appreciation why disaggregation and
> >competition is preferred over big brother mandates.
> >
> As *I've pointed out over and over, SP/UC doesn't have to be 'Hillary
> planning", nor should it be. You want open profiteering with the
> little guy picking up the tab... and getting the short end of the
> stick in the bargain. Apparently no common ground at all with your
> thinking, ampie.
Open profiteering? You want a government monopsonist dictating who
gets what, when, and for how much with the little guy still picking up
the tab. At least the little guy in my scenario gets to choose who
screws him.
> >> >> I definitely agree that access for everyone is a natural goal; as is
> >> >> individual choice and better accountability for outcomes.
> >> >> Unfortunately the existing system. in general, is so fragmented that
> >> >> both choice and accountability vary widely in most areas and the only
> >> >> solution....
> >> >
> >> >That's always where you and I diverge - we both agree the system has
> >> >faults - you argue that there is "only one" solution.
> As do you... Always the open, uncontrolled plan where your pets can
> reap a harvest of profits.. And that's where we disagree.
I argue that the market is the best determinant of the strucure - give
people choices, options, and information and let them choose what'
best for them. If they want a plan that pays only for catastrophic
illness - so be it. If they want a plan with first dollar coverage -
fine. If they want a plan that provides preventive service but
restricts them to a small number of providers - great. If they want
fee for service - they can have that too. The market decides the mix
not the provider. It's like Ford, you can have any color you want, as
long as it's black - well, the US is a technicolor world with
technicolor solutions.
Would you accept a three bedroom two bath one car garage house on a
quarter acre as the ONLY housing choice - as long as every head of
household got one?
Didn't think so - so why should someone accept a single health plan?
> >> OK, do we agree that the private sector, in general, has failed to
> >> provide adequate care for all?
> >
> >The PUBLIC sector has failed to provide adequate access to health
> >insurance for the poor or marginally poor. The private sector has
> >done a pretty good job in the US in providing access to affordable
> >health insurance to 85% of the population (excluding the over 65's
> >though that Part b and supplemental are private insurance schemes).
> >
> But you're advocating that the private sector control the delivery
> system. I'm simply saying that they've yet to prove that they can...
> and will... provide adequate care for everyone.
That's not the point - the marketplace needs to make the options
available - the problem of poverty is not the concern of the medical
marketplace - it should be the concern of the public sector.
Uninsured as a problem isn't because health care delivery is bad, it's
because some people can't afford health insurance. The sytem provides
quite good care to those with insurance. Solve the insurance access
problem for the 15% without - but not by changing the delivery method
for the 85% who do.
> >Do you blame the building industry for the lack of affordable public
> >housing? Do you blame the airline industry for a lack of
> >transportation in the inner cities? Do you blame GM that some people
> >don't have cars?
> >
> Try comparing apples to apples for a change. Stick to healthcare.
> Why should 15% with without adequate access?;
A very good question - some do so by choice, some do so out of
ignorance, but most do so by default.
>why should an another
> 10-15% have to scrimp whenever a major medical emergency arises?.
That one you'll have to document - maybe there's an issue of
inappropriate or inadequate coverage - but no evidence.
>Why
> to the majority of the elderly have major problems in affording
> prescrption meds?
No, it is a minority that have an affordability gap - the data were
published - about 70% of the elderly have drug coverage. granted ,
there is a gap and mandatory medicare drug insurance may be an answer.
I've never opposed that - I simply asked that it be rolled into the
current system of PBMs.
>The private sector that you so dearly love has
> priced that group out of the market. UC would change that.
The private sector hasn't priced people out - 85% are covered. All
your version of UC does is redistribute income until that can't work
any more, and then you get rationing - why? because there aren't any
incentives left to be efficient, to be innovative, or to be prudent in
utilization.
I think on program worth considering is a mandated health insurance
coverage - the German model - where employers are obligated to provide
premium offsets, where the state governments are required to provide
for unemployed, and the federal government provides (in combination
with private schemes) for the elderly to BUY insurance - not to pay
for care or worse, to own the resources that deliver care. This is a
far far cry from SP/UC.
> >>Remove that and what's left? Back to
> >> the 'only one' solution. Or are you advocating creation of a new, and
> >> totally different methodology of delivery?
> >
> Same old system, different method of management.
Where's the evidence and history that management by Washington works?
> >Get government out of the business of providing and/or financig care -
> >mandate, as the Germans have done, that insurance be available and
> >that insurers compete. And for those that can't afford insurance,
> >figure out a way to subsidize it - just like you figured out how to
> >fund unemployment,WIC food programs, housing subsidies, or any other
> >indigent program. Let these people be part of the mainstream - don't
> >force everyone into rationed government care because it is "better"
> >for the minority who are poor.
> >
> Nice words, but IMO unworkable in the US. Too many diverse
> special-interest groups and too much profit at stake. I'll continue
> to support a governmentally managed single plan, but one with fully
> adequate oversight and control. And that IS doable.
No - it's not. It has never worked in any country that has tried it -
Canada, Sweden, and the UK are the three classic examples. Each of
these countries has developed a privatization plan, or, at minimum,
now allows for competition between providers and insurer to the
benefit of customers.
> >> >> I can come up with to provide a decent level of care for
> >> >> everyone is a single governmentally sponsored program.
> >> >
> >> >You agreed that choice is good but advocate a "single government
> >> >sponsored system"? I'm going to take a leap of faith and characterize
> >> >it as SP/UC, okay?
> >> >
> >> Don't you think that choice can be built into a SP/UC model?
> >
> >Not a chance - UNLESS you let people opt out and go private. Think
> >vouchers.
> >
> And why not? You don't have to have vouchers, although they're not
> something bad in many instances. Why do you continually proclaim that
> privatization is the ONLY answer. It certainly hasn't been up to now.
But Pixie - it's worked for 85% of the people. Sure, it's expensive,
but for the richest country in the world not to invest in health care
seems almost foolish. If you can afford SUVs at 40K a pop....why not
raise the tax on gasoline to the UK standard? Now there's an
opportunity to make health care affordable.
>
> >> >So you eliminate choice. Granted, you may still choose your
> >> >providers, but your choice set is artificially constrained by a single
> >> >system. For example, let's say you have ESRD - you're a candidate for
> >> >surgery - except for your age. Now, you've taken good care of
> >> >yourself, you are in great shape, and have a wonderful life expectancy
> >> >- but the system says - sorry, over 75, no transplant. And if you
> >> >think this is far fetched, check out the organ transplant guidelines
> >> >for Ontario province (I think it was a CCHOTA report from the mid
> >> >1990's).
> >> >
>
> >> Au contrare, amp. You're the one eliminating choice by your
> >> unsupported statement that you can't build that factor into a SP/UC
> >> model.
> >
> >You can't - because as soon as you do, you simply have the runaway
> >train of fee for service. Granted, it may be cheap fees, but you have
> >no control on utilization UNLESS you ration - and that is the UK NHS.
> >Everyone gets as much as they want of the covered services - as long
> >as they are willing to wait. And that my dear, is the downfall of the
> >NHS - and that is why the private sector health system is groing by
> >leaps and bounds in the UK - to the point that even the NHS is using
> >it - and not just in the UK, but in germany, france, the Netherlands -
> >and soon Greece!
> >
> So it can't be done because you say so? Isn't that just a bit
> egotistical?
You can't give me an example where it has been successful. I applied
simple economics based on history and you call it ego. Sorry.
>You have absolutely no proof that such a plan can't be
> devised and implemented, yet you make such a statement? Strange
> thinking at best.
I gave you three examples of how it's been tried and failed to varying
degrees. Most notably in the UK, but also in Canada and in Sweden.
The nice thing about Canada and Sweden is that they are small
countries (22 and 8 million respectively) so the fix and bandaids are
not so draconian. The UK - well, they are exporting their problems to
Germany - where private hospitals compete for patients based on
quality of outcomes and price.
OK - now, what examples can you provide that show evidence that
government controlled, funded, and administered health care is
efficient and effective - Cuba? Medicare? Medicaid?
> >> And as to your sample, let's turn in around. Just how many 75 or over
> >> individuals should have a transplant. How about post-op qualify of
> >> life? Sure the patient is alive... barely... but what then?
> >
> >Since the individual you describe would not qualify medically because
> >of the risk/benefit, their age becomes a moot point. The issue is
> >that ALL 75 year olds are excluded in the Canadian plan - not just
> >those with poor prognoses. Those under 75 with poor prognoses are
> >similarly excluded.
> >
> And there's some perfectly valid common sense about such exclusions.
Exclusion based on prognosis, not one based on race, gender,or age
because of a budget contstraint line.
> Medicine has reached the point where they can reverse what used to be
> a life-ending situation and maintain the patient but they have yet
> taken into consideration the overall qualify of life of that
> individual. Many patients, regardless of age, remain in a
> quasi-vegetative state and IMO that's wrong. A time comes for
> everyone when life will end, some earlier than others, some later.
> It's foolish to expend needed resources in attempting to prolong life
> simply for the sake of having someone 'alive'... regardless of the
> overall outcome.
I like the Netherland solution/option. But the point is, a 75 year
old with an excellent post-transplant prognosis is denied a transplant
because he's 75 and no other reason. That's rationing based on a
budget constraint line.
> I don't, however, advocate a strict age limit. Such issues need to be
> decided on an individual basis at a local level. Something that can
> be provided in any decently designed plan.
Absolutely too funny. You need to draw a line somewhere and someone
has to implement the decision. Want to argue Oregon again? They took
the diseases and rank ordered them - I took the patient age as an
example - what criterion do you want to apply? Perhaps we ought to
bring back the league tables? even the Canadians got rid of them
(overtly at least).
> >> >>The private
> >> >> sector certainly hasn't risen to meet the challange.
> >> >
> >> >I'd disagree - certainly the NHS (a model all to similar to SP/UC) has
> >> >spawned a rash of private initiatives in the UK to fill gaps and meet
> >> >needs. In the US, the overwhelming majority of Americans have fairly
> >> >comprehensive health care coverage, ready access, and in most cases,
> >> >pretty decent outcomes. Granted, there is an uninsured gap, but that
> >> >doesn't necessarily mean it isn't filled. Sort of like unemployment -
> >> >sounds bad, but in all honesty, from a purely economic perspective, a
> >> >necessary part of employment.
> >> >
> Of course you'd disagree. Where's the surprise here? And of course
> the private sector has developed numerous initiatives to supplement
> basic coverage. Again, is that news. So why doesn't NHS revise their
> plan to fill those gaps.. A well-designed plan would allow for such
> modification.
This is what they do - they buy resources from the private sector.
But the downside is that the availability of those resources is not
guaranteed and the price is not negotiable. The result now is that
the waiting lists are being mandated down and the NHS has allocated
resources to outsource these patients. In the short run, it's very
effective (hardly efficient, though)in achieving the political goal -
waiting list reduction - but is a lousy solution to the underlying
problem of impossible administration of an unworkable economic
concept. That's where BUPA et al come in. In my opinion, the NHS as
the core to the health care delivery scheme in the UK will disappear
in 10 years to be supplanted by a rather disjointed but marginally
functional private insurance system. The only losers will be the poor
and the old.
>
> >>
> >> OK, let's compare those two goodies. What do you think the hue and
> >> cry would be if 15% of the workforce of the US were unemployed.
> >
> >What are the germans saying - they're at 10+ and 25+ in the former
> >East?
> >
> Huh ????
The unemployment in German is 10 percent - in the former eastern part,
it's 25%. What are they saying? well, they are still getting good
health care in a quasi-competitive insurance market.
> >>Do
> >> you really think that the people would listen to the garbage that
> >> "it's a necessary part of healthcare delivery"? I doubt that.
> >
> >When was the last time the US had 15% unemployement? And, if the US
> >had 15% unemployement would health care be the top priority?
> >
> Ah, but we've got 15% non-covered... And a bunch of other problems on
> top of that. And it's not necessary.
So fix the 15% - don't putz with the 85%.
>
> >> >> And just to show you how mellow I've become I'm even ignoring your
> >> >> snide little remark in one of the prior posts.
> >> >
> >> >If I snided you, my apologies - it probably was an unintended
> >> >misdirection.
> >> >
> >> >amp
> >>
> >> Yep, you were all so wrapped up in bashing Leo... Not that he doesn't
> >> deserve it. But I'll overlook it.
> >>
> >> Cheers, the battle is re-engaged
> >>
> >> pixie
> >
> >"Battle" - I'm trying to avoid it turning out that way - but I will
> >ask one very important favor - if you would like to use history as a
> >model, please do so with appropriate references (links). I did and
> >was able to, quite quickly, diffuse your entire foundation of your
> >criticism.
> >
> >amp
>
> Perhaps in your own mind, ampie.
But you're still link free - so pixipinion it is. Because you can't
find credible support for your position doesn't make it inherently
right.
amp
Bettina
> I think your talent lies in designing maizes.
So you think Amp is into designing corn! Very interesting --
maybe you think he works for Monsanta and is developing a new
genetically engineered strain of maize. At last you are beginning
to address on the topic of medicine and politics.
Bettina
Bettina
*****
> >
> >The underlying concept of the Hillary plan was NOT competition and
> >private sector - it was big brother government - remeber, she was and
> >continues to be one of the big D's. Competition and privatization are
> >four letter words. Entitlement and income redistribution - that's
> >what the fundamental premise of Democrats (and our very own Labour
> >party).
> >
> Sorry, but I don't buy your claim about the 'underlying concept'..
> Yes, she did propose a govenmental plan, and would have required
> participation by providers, but one of the keystones of that plan was
> that the 'market forces' and 'competition' would drive down costs.
> BS, of course, but that was the claim.
>
> And there's nothing wrong with a governmental plan as long as it's
> properly designed and implemented. With the diversity and size that
> the US represents it's about the only way that UC will ever come
> about, IMO we'll NEVER see it honestly proposed from the private
> sector.
>
>
You guys covered a lot of territory (here we go again, but it's better
than
playing games with what's-his-name) but on the above point, I agree
with Pixie, as usual. The Clinton plan stressed "managed competition"
and
was actually a very good plan if anyone could get through the
extremely lengthy and convulted description. IMO it failed not because
it was Big Brother Government but because it was incomprehensible and
she didn't play the political game right by getting buy-in first from
the right groups.And Harry and Louise didn't help, either.
I'm outta here for a while (going to observe the effect of Margaritas
on the Mexican health care system for a couple of weeks in Puerto
Vallarta) and I hope when I get back you and Denise will have
dispensed with you-know-who and gotten back to something relevant. My
theory, by the way, is that he is a young kid -- maybe about 11 or 12,
tops.
Bettina
DWood78828
>Date: 2/1/02 8:24 AM Eastern
> No you are not. Magazines are carrying stories about how
>female prisoners, for example, get virtually no medical care and
>die of things like cervical cancer even after begging for
>treatment. We still have collections for children with deadly
>diseases who cannot get cancer care unless they have the cash for
>the specialists. All they can get is
>'emergency' care until
>stabilized and that means nothing at all.
And just what states do these people live in George? The south? Which
frequently covers fewer and fewer services for medicaid recipients, in order to
avoid taxing their state people.
As for children. If they lived in NY or Florida, their parents could get them
covered under a special insurance offered within the state and at a low cost.
George, instead of throwing out blanket statements, be a little more specific
in your complaints.
Denise
DWood78828
> Pixie, sweetheart, Medicare is for those 65 and older. You are
>back to your fringe group exeption list. The population does not
>get medicare care by fringe group exception reduced to poverty by
>living on disability insurance below the poverty line.
George, you need to check out your facts a little better. There is no means
teat for Medicare. I went on it in 1991. And have remained on it. And I
certainly am not 65 or older, although I'm sure my annual income is less then
yours.
Medicaid doe have a means test and it is extremely difficult to qualify for
that.
Denise
Gretchen Evans
Conklin) wrote:
>In article <20020201022433...@mb-mt.aol.com>,
>DWood78828 <dwood...@aol.com> wrote:
>>>Subject: Re: Redesign the system
>>>From: jep...@shell.ntrnet.net (George Conklin)
>>>Date: 1/31/02 7:32 PM Eastern
>>
>>> Medicare is for those 65 and older...but I guess Pixie does not
>>>know that. As for the rest of the population, go beg.
>>>
>>
>>Actually George, Medicare is also available to the permanently disabled, at any
>>age. I should know, I've been on it for 13 years.
>>
>>Denise
>
> This changes nothing about the lack of health insurance and
>care for those under 65. Or the cost. Or the money wasting on
>tests which do not change the outcomes.
Which 'tests' CHANGE the outcome of a specific disease or condition,
George?
pixie
Gretchen Evans
Conklin) wrote:
Nor did I make such a claim, George. But you seem to be a bit
confused in your claim that Medicare being only available to those
over 65, the original program, popularly titled "Medicare", was
modified to include certain disabilities and diseases for individuals
less than 65 quite some time ago.
pixie
Gretchen Evans
Lucky you. Have a wonderful time, Bettina, and do try to stay away
from those home-grown Margaritas... The after-effect is terrible
although the immediate one is wonderful. .
pixie
Gretchen Evans
wrote:
Chopped a bit of the statement in support of your claim, huh? I
thought you were above such tactics, ampie. And as to your 'demand'
to provide a citation, I'm not going to waste my time posting a bunch
of nonsensical references when common sense should tell you what I was
referring to. If you don't like that, too bad.
>> >Here's a lively rendition of "managed competition" ala Hillary. So
>> >get up to speed.
>> >
>> >http://www.fair.org/extra/9401/debate.html
>> >
>> >Regarding the cost-effectiveness of managed care - the data support
>> >that the cost of health care in a managed care system is as low or
>> >lower than that in a fee for service system - the fact that the US
>> >spends a lot isn't evidence that it spends too much. Or did you miss
>> >the diddy about Kaiser California spending no more than the NHS and
>> >that without waiting lists?
>> >
>>
>> You're citing the Clintons in providing authoritative statements?
>> Collectively or individually they haven't a clue as to what "truth"
>> means..
>
>At least I cited SOMEONE or SOMETHING - that's more than you Pixie.
>If you don't agree, provide evidence in support of your opinion, OK?
>
Read.... and digest... my previous statement. I some quarters it's
called an opinion.... Or is that too much for you?
>> And yes, Kaiser has historically done an excellent job but,
>> uinfortunately, Kaiser isn't available nationally, nor is there any
>> plans that I've heard of for expansion but actually some contraction
>> of their coverage has been rumored for quite some time.
>
>Again, where do you here the rumors? Here's facts -
>http://www.kaiserpermanente.org/
>
Only in various discussions with individuals close to the business...
and in reading trade journals...Do you have a problem with that?
>All upbeat and growth - no rumors of shrinkage.
>
>>And wouldn't
>> you also lump them into the SP/UC group that you apparently detest so
>> markedly?
>
>No - for a very very simple reason - I can opt in or I can opt out.
>Once in, I am under a "single payer" umbrella, but I pay premiums
>based on my risk profile not my salary, I have negotiating power for
>services, I have access to care, and I can go outside of the network
>and get services. Managed care is not a structure, it's a process.
>
An individual can 'opt in' or 'opt out' of Medicare, too. So by YOUR
definition it's not SP? Or do you simply change the rules to meet the
standard of the moment?
>> >If you want to posit based on historical data, I'd suggest brushing up
>> >on it.
>> >
>> The street runs both ways ampie.
>
>I provided a link - you?
>
I provided an opinion. Why do you have so much of a problem with
someone who does that? Does someone else having an opinion have such
a affect on your ego?
>> >> Anyone with any working understanding of the biz knew at the outset
>> >> that the plan had been dreamed up by the ivied tower chowderheads who
>> >> live in theory, and that there was absolutely no chance in hell that
>> >> their theories would create any change at all... And, surprise, they
>> >> didn't.
>> >
>> >The underlying concept of the Hillary plan was NOT competition and
>> >private sector - it was big brother government - remeber, she was and
>> >continues to be one of the big D's. Competition and privatization are
>> >four letter words. Entitlement and income redistribution - that's
>> >what the fundamental premise of Democrats (and our very own Labour
>> >party).
>> >
>> Sorry, but I don't buy your claim about the 'underlying concept'..
>> Yes, she did propose a govenmental plan, and would have required
>> participation by providers, but one of the keystones of that plan was
>> that the 'market forces' and 'competition' would drive down costs.
>> BS, of course, but that was the claim.
>
>Document this. And in context with the SP/UC requirement, ok.
>
Stuff it
>> And there's nothing wrong with a governmental plan as long as it's
>> properly designed and implemented. With the diversity and size that
>> the US represents it's about the only way that UC will ever come
>> about, IMO we'll NEVER see it honestly proposed from the private
>> sector.
>
>You argue for standardization BECAUSE of diversity and size? Seems
>counterintuitive. What makes you think a thirty-something California
>valley girl has the same needs (medical or otherwise) than a 70 year
>old bible belt granny?
>
>
Who said 'same needs'? Does your sample have medical requirements?
If so they tend to fall into the same group.
>> >> In the real world of healthcare there's really little competition.
>> >
>> >Not exactly - but your right - more would be better - which is what I
>> >propose is the better solution to access, quality, and cost.
>> >
>> From the private sector... Yeah, sure... Just like HCA and Tenet will
>> join hands, smile, and we'll all be forever happy. Egg-head thinking.
>
>no joining of hands - compete on quality, service, and price. Sort of
>like anything else you buy.
>
>>
>> >> Sure one facility in an area will erect a shiny new ediface, then
>> >> breathlessly proclaim "I'm better than the other guy". Do rates
>> >> change? No.
>> >
>> >Rates are fixed in the short run. But then again, a bit of history -
>> >you yourself have argued that hospital reimbursement is fixed by
>> >payers (e.g. DRG) when you argued for fixing pharma prices. Recently,
>> >your very own company has fought back and beat up on the insurers to
>> >increase reimbursement - and in some cases successfully, and in others
>> >they lost the business to someone else. That's price competition.
>> >More of this is needed, not less.
>> >
>> Yes, I believe that pharma should be subject to the same rate controls
>> as other healthcare vendors. Why should they be exempt and enjoy
>> massive profits to the exclusion of others?
>
>So your point is that you were wrong when you said rates don't change
>through competitive forces? or do they? or did they? Or did you
>loose your train?
>
And your point apparently is that you remain silent on rate controls
for pharma? It's OK for everyone else, but your precious industry
MUST be exempt?
>> And when you claim the fixing of rates you're overlooking the fact
>> that the patient portion... the amount due following the plan
>> payment... has been steadily increasing with more and more of the load
>> being placed back onto the individual who can least afford the
>> increase. Not a desirable feature, as Sears used to say in their ads.
>
>If you're talking about pharma and tiered copays - this is exactly
>what you want in a competitive model. Let's assume that there is a
>standard $2 copay - does this make the patient at all price sensitive?
> Give me the best and the most - whether I need it or not, its only
>two bucks.
>
As you should recognize if you're beiing totally honest, I was
speaking in generalized terms. More and more of the cost has been
pushed back on the patient. And you know that to be a fact so why not
admit it?
>Now lets assume there is a $20 copay - well, maybe that Tylenol #3 Rx
>isn't as valuable than the less costly OTC Tylenol. Maybe waiting a
>few days for that antibiotic prescription since its probably just a
>virus anyway isn't a bad idea.
>
>Now lets put in a tiered copay - $30 for a brandname drug, $10 for the
>equivalent generic.
>
>Let's use a $20 copay for an off formulary drug and $15 for the
>therapeutic equivalent on-formulary drug. Want to guess which way the
>choices go?
>
See above.
>> >>Is care actually improved? Perhaps by technology, but
>> >> when the other guy puts in his new widget it all washes out.
>> >
>> >Wish we had a few more widgets here in the UK. We're technology poor
>> >- too few widgets, too many people, one cheapskate payer, and a very
>> >pissed of population. And don't tell me the people aren't pissed
>> >about HC in the UK - It is headline news EVERY day now.
>> >
>> Who mentioned UK... Here in the US we've got plenty of wigets, more
>> than we need in some places, but that's a different topic. And we're
>> blessed with a bunch of cheapskate payers, not just one. As I said,
>> it all washes out.
>
>Note in your or my lifetime - trust me, one cheapskate payer doesn't
>have to respond to econmomic pressures. Only political pressures and
>even then the bobb and weave is so well choreographed. Tony said
>yesterday (or the day before), if your on the side of the children be
>on the side of the teacher, if your on the side of the patient, be on
>the side of the doctors and nurses - get the irony?
>
Perhaps not one payer.... and why do you catagorize them as
"cheapskate"? Don't you believe in equal rights?
Hospital owned by HCA.. Horizon is an HCA group, most of the 27 you
mention are affiliated with the Horizon group as are the internests.
And it's 67 miles, not 27. Try again.
>Granted - one Hospital - Horizon medical - which is also the home to
>the largest group practice - wouldn't you expect it?
>
>But there's Hickman County, Baptist, and Trinity hospitals all within
>25 miles, and all the Nashville hospitals in less than a half hour's
>drive.
>
Try making that drive in less than 30 minutes. And for what matter
why should the people have to drive an hour to obtain needed medical
care?
>> >> And that's not an isolated instance.
>
>No - it's quite common to have lots of choices across the US,
>particularly in the more or less "populated" parts.
>
And also quite common for people in the less populated areas to have
no medical care available at all. How does this jibe with your
claims? Oh, sorry, I forgot. In your book it's perfectly OK to have
to drive an hour or so to obtain treatment.
>For contrast, there are 12 pharmacies within 8 miles of downtown
>Dickson Tennessee and 31 food stores (though some are convenience
>stores).
>
So ????
>> >Give me the name of another town - and I'll show you that there is
>> >adequate (perhaps not stellar) health care access - based on grocery
>> >access. You need to use grocery access as a leveling variable - but
>> >if there is a chain grocery, then there's health care.
>> >
>> You're comparing healthcare access to grocery access??? Asinine! Do
>> you run down to Krogers when you're sick?
>
>They do have a full service pharmacy. What I was suggesting is that
>if health care services are as convenient as the grocery store, then
>there's not much room to complain about access. get it?
>
Unfortunately, healthcare services aren't as convenient in many areas
as grocery stores, or McDonalds, or even banks.
>> >> Certainly the theory is there, all well and good, but come back to
>> >> earth and into the real world.
>> >
>> >You want SC/UC - that's Hillary planning and as soon as you get to
>> >that you'll have a better appreciation why disaggregation and
>> >competition is preferred over big brother mandates.
>> >
>> As *I've pointed out over and over, SP/UC doesn't have to be 'Hillary
>> planning", nor should it be. You want open profiteering with the
>> little guy picking up the tab... and getting the short end of the
>> stick in the bargain. Apparently no common ground at all with your
>> thinking, ampie.
>
>Open profiteering? You want a government monopsonist dictating who
>gets what, when, and for how much with the little guy still picking up
>the tab. At least the little guy in my scenario gets to choose who
>screws him.
>
Yep, and one is generally named pharma... And that's OK ???
>> >> >> I definitely agree that access for everyone is a natural goal; as is
>> >> >> individual choice and better accountability for outcomes.
>> >> >> Unfortunately the existing system. in general, is so fragmented that
>> >> >> both choice and accountability vary widely in most areas and the only
>> >> >> solution....
>> >> >
>> >> >That's always where you and I diverge - we both agree the system has
>> >> >faults - you argue that there is "only one" solution.
>
>> As do you... Always the open, uncontrolled plan where your pets can
>> reap a harvest of profits.. And that's where we disagree.
>
>I argue that the market is the best determinant of the strucure - give
>people choices, options, and information and let them choose what'
>best for them. If they want a plan that pays only for catastrophic
>illness - so be it. If they want a plan with first dollar coverage -
>fine. If they want a plan that provides preventive service but
>restricts them to a small number of providers - great. If they want
>fee for service - they can have that too. The market decides the mix
>not the provider. It's like Ford, you can have any color you want, as
>long as it's black - well, the US is a technicolor world with
>technicolor solutions.
>
>Would you accept a three bedroom two bath one car garage house on a
>quarter acre as the ONLY housing choice - as long as every head of
>household got one?
>Didn't think so - so why should someone accept a single health plan?
>
No ampie, you don't 'suggest' as you claim. You demand, and there's a
vast difference. In many instances the general market can be the best
determinant of structure, I've never disagreed with that. However
when certain elements of that market dictate the structure to the
detriment of everyone then change must be enacted. And it wll come
about.... In my lifetime, too.
>> >> OK, do we agree that the private sector, in general, has failed to
>> >> provide adequate care for all?
>> >
>> >The PUBLIC sector has failed to provide adequate access to health
>> >insurance for the poor or marginally poor. The private sector has
>> >done a pretty good job in the US in providing access to affordable
>> >health insurance to 85% of the population (excluding the over 65's
>> >though that Part b and supplemental are private insurance schemes).
>> >
>> But you're advocating that the private sector control the delivery
>> system. I'm simply saying that they've yet to prove that they can...
>> and will... provide adequate care for everyone.
>
>That's not the point - the marketplace needs to make the options
>available - the problem of poverty is not the concern of the medical
>marketplace - it should be the concern of the public sector.
>Uninsured as a problem isn't because health care delivery is bad, it's
>because some people can't afford health insurance. The sytem provides
>quite good care to those with insurance. Solve the insurance access
>problem for the 15% without - but not by changing the delivery method
>for the 85% who do.
>
I wouldn't disagree with that statement just as long as the 15%.. or
the 30%, which is a more realistic number IMO, do gain full accesss.
But that hasn't taken place, and there's no indication that it willl
take place without governmental intervention.
>> >Do you blame the building industry for the lack of affordable public
>> >housing? Do you blame the airline industry for a lack of
>> >transportation in the inner cities? Do you blame GM that some people
>> >don't have cars?
>> >
>> Try comparing apples to apples for a change. Stick to healthcare.
>> Why should 15% with without adequate access?;
>
>A very good question - some do so by choice, some do so out of
>ignorance, but most do so by default.
>
Oh yeah.. I forgot about those that simply default out of treatment. A
lot like the homeless that prefer to be homeless. Right.
>>why should an another
>> 10-15% have to scrimp whenever a major medical emergency arises?.
>
>That one you'll have to document - maybe there's an issue of
>inappropriate or inadequate coverage - but no evidence.
>
So by your claim ONLY the 15% uninsured have a problem with healthcare
costs and everyone else is both happy and fully covered? Just a tad
out of touch with reality aren't you?
>>Why
>> to the majority of the elderly have major problems in affording
>> prescrption meds?
>
>No, it is a minority that have an affordability gap - the data were
>published - about 70% of the elderly have drug coverage. granted ,
>there is a gap and mandatory medicare drug insurance may be an answer.
> I've never opposed that - I simply asked that it be rolled into the
>current system of PBMs.
>
OK, so 70% have some form of drug coverage, if only through their
Medicare+ HMO and with a severe annual limit. The fact remains that
there is a definite gap, and that gap is harmful to that 30% of the
population. Drug coverage is only one factor, although a significant
one, that needs to be changed. And UC will provide that change.
>>The private sector that you so dearly love has
>> priced that group out of the market. UC would change that.
>
>The private sector hasn't priced people out - 85% are covered. All
>your version of UC does is redistribute income until that can't work
>any more, and then you get rationing - why? because there aren't any
>incentives left to be efficient, to be innovative, or to be prudent in
>utilization.
>
Back to common sense again, ampie, when costs of any needed service
reach a point where individuals cannot afford that service then that
group has been priced out. And as to the 'rationing', we're already
rationing based on the pocketbook, where's the difference?
>I think on program worth considering is a mandated health insurance
>coverage - the German model - where employers are obligated to provide
>premium offsets, where the state governments are required to provide
>for unemployed, and the federal government provides (in combination
>with private schemes) for the elderly to BUY insurance - not to pay
>for care or worse, to own the resources that deliver care. This is a
>far far cry from SP/UC.
>
>> >>Remove that and what's left? Back to
>> >> the 'only one' solution. Or are you advocating creation of a new, and
>> >> totally different methodology of delivery?
>> >
>> Same old system, different method of management.
>
>Where's the evidence and history that management by Washington works?
>
Where's the evidence and history that management by cartel works?
>> >Get government out of the business of providing and/or financig care -
>> >mandate, as the Germans have done, that insurance be available and
>> >that insurers compete. And for those that can't afford insurance,
>> >figure out a way to subsidize it - just like you figured out how to
>> >fund unemployment,WIC food programs, housing subsidies, or any other
>> >indigent program. Let these people be part of the mainstream - don't
>> >force everyone into rationed government care because it is "better"
>> >for the minority who are poor.
>> >
>> Nice words, but IMO unworkable in the US. Too many diverse
>> special-interest groups and too much profit at stake. I'll continue
>> to support a governmentally managed single plan, but one with fully
>> adequate oversight and control. And that IS doable.
>
>No - it's not. It has never worked in any country that has tried it -
>Canada, Sweden, and the UK are the three classic examples. Each of
>these countries has developed a privatization plan, or, at minimum,
>now allows for competition between providers and insurer to the
>benefit of customers.
>
You might preface your statements with something like "In my opinion".
I happen to have an opinion that there's too much greed and political
power by certain groups and those groups will oppose any workable
system as long as possible. Apparently you don't hold that opinion,
too bad. But I am entitled to that opinion, just as you are yours.
>> >> >> I can come up with to provide a decent level of care for
>> >> >> everyone is a single governmentally sponsored program.
>> >> >
>> >> >You agreed that choice is good but advocate a "single government
>> >> >sponsored system"? I'm going to take a leap of faith and characterize
>> >> >it as SP/UC, okay?
>> >> >
>> >> Don't you think that choice can be built into a SP/UC model?
>> >
>> >Not a chance - UNLESS you let people opt out and go private. Think
>> >vouchers.
>> >
>> And why not? You don't have to have vouchers, although they're not
>> something bad in many instances. Why do you continually proclaim that
>> privatization is the ONLY answer. It certainly hasn't been up to now.
>
>But Pixie - it's worked for 85% of the people. Sure, it's expensive,
>but for the richest country in the world not to invest in health care
>seems almost foolish. If you can afford SUVs at 40K a pop....why not
>raise the tax on gasoline to the UK standard? Now there's an
>opportunity to make health care affordable.
>>
And it's totally ignored 15%, and also caused severe financial
distress to many more. A single uniform system that's fully workable
can be developed so why not try it. Why all the clouds of smoke and
bile? Over the long run the profits will be there, don't worry..
>> >> >So you eliminate choice. Granted, you may still choose your
>> >> >providers, but your choice set is artificially constrained by a single
>> >> >system. For example, let's say you have ESRD - you're a candidate for
>> >> >surgery - except for your age. Now, you've taken good care of
>> >> >yourself, you are in great shape, and have a wonderful life expectancy
>> >> >- but the system says - sorry, over 75, no transplant. And if you
>> >> >think this is far fetched, check out the organ transplant guidelines
>> >> >for Ontario province (I think it was a CCHOTA report from the mid
>> >> >1990's).
>> >> >
>>
>> >> Au contrare, amp. You're the one eliminating choice by your
>> >> unsupported statement that you can't build that factor into a SP/UC
>> >> model.
>> >
>> >You can't - because as soon as you do, you simply have the runaway
>> >train of fee for service. Granted, it may be cheap fees, but you have
>> >no control on utilization UNLESS you ration - and that is the UK NHS.
>> >Everyone gets as much as they want of the covered services - as long
>> >as they are willing to wait. And that my dear, is the downfall of the
>> >NHS - and that is why the private sector health system is groing by
>> >leaps and bounds in the UK - to the point that even the NHS is using
>> >it - and not just in the UK, but in germany, france, the Netherlands -
>> >and soon Greece!
>> >
Could it be that the UK system simply wasn't properly designed or
implemented? Naaaaa, of course not. And here in the US who cares
about the UK, Germany, France, the Netherlands... even Greece.. We
have our own needs and certainly have the resources to develop a fully
workable system. Just as soon as the die-hards get pushed out of the
way... And that WILL happen.
>> So it can't be done because you say so? Isn't that just a bit
>> egotistical?
>
>You can't give me an example where it has been successful. I applied
>simple economics based on history and you call it ego. Sorry.
>
Yes, IMO it's your ego that motivates you. Sorry if it hurts but
that's the way you come across to me. What's that word?? pompous,
yes, that's it.
>>You have absolutely no proof that such a plan can't be
>> devised and implemented, yet you make such a statement? Strange
>> thinking at best.
>
>I gave you three examples of how it's been tried and failed to varying
>degrees. Most notably in the UK, but also in Canada and in Sweden.
>The nice thing about Canada and Sweden is that they are small
>countries (22 and 8 million respectively) so the fix and bandaids are
>not so draconian. The UK - well, they are exporting their problems to
>Germany - where private hospitals compete for patients based on
>quality of outcomes and price.
>
And we have SAMSA's in the US that approximate those nations in size,
along with resources that far outstrip any other nation. It's a
matter of properly allocating those resources in the development of a
sound plan. And of ignoring the nay-sayers, of course.
>OK - now, what examples can you provide that show evidence that
>government controlled, funded, and administered health care is
>efficient and effective - Cuba? Medicare? Medicaid?
>
And why is that necessary? Take another tack. Just a few short years
ago no one had set foot on the moon. Considered impossible by some.
So instead of accepting the word of those nay-sayers we turned the
trick. Not any more difficult than developing a sound healthcare
delivery system for all.
>> >> And as to your sample, let's turn in around. Just how many 75 or over
>> >> individuals should have a transplant. How about post-op qualify of
>> >> life? Sure the patient is alive... barely... but what then?
>> >
>> >Since the individual you describe would not qualify medically because
>> >of the risk/benefit, their age becomes a moot point. The issue is
>> >that ALL 75 year olds are excluded in the Canadian plan - not just
>> >those with poor prognoses. Those under 75 with poor prognoses are
>> >similarly excluded.
>> >
>> And there's some perfectly valid common sense about such exclusions.
>
>Exclusion based on prognosis, not one based on race, gender,or age
>because of a budget contstraint line.
>
That's right, and that's the way it should be. There's really no
reason to expend resources in providing curative treatment when no
cure can be obtained. It's a terrible decision but sometimes the best
thing to do is to accept reality.
>> Medicine has reached the point where they can reverse what used to be
>> a life-ending situation and maintain the patient but they have yet
>> taken into consideration the overall qualify of life of that
>> individual. Many patients, regardless of age, remain in a
>> quasi-vegetative state and IMO that's wrong. A time comes for
>> everyone when life will end, some earlier than others, some later.
>> It's foolish to expend needed resources in attempting to prolong life
>> simply for the sake of having someone 'alive'... regardless of the
>> overall outcome.
>
>I like the Netherland solution/option. But the point is, a 75 year
>old with an excellent post-transplant prognosis is denied a transplant
>because he's 75 and no other reason. That's rationing based on a
>budget constraint line.
>
In Canada, perhaps, but that's not the type of system I would envision
for the US. If others wish to use other methods, so be it.
>> I don't, however, advocate a strict age limit. Such issues need to be
>> decided on an individual basis at a local level. Something that can
>> be provided in any decently designed plan.
>
>Absolutely too funny. You need to draw a line somewhere and someone
>has to implement the decision. Want to argue Oregon again? They took
>the diseases and rank ordered them - I took the patient age as an
>example - what criterion do you want to apply? Perhaps we ought to
>bring back the league tables? even the Canadians got rid of them
>(overtly at least).
>
Yes, it is funny, amp. You tend to demand absolute answers and then
use those as reasons to deny progress. Funny on one hand, pathetic on
another.
And if the UK wishes to move in that direction, that's their business.
I happen to feel that the US will move... and fairly quickly, say
within the next decade, towards a comprehensive UC plan that will be
available to all.
>>
>> >>
>> >> OK, let's compare those two goodies. What do you think the hue and
>> >> cry would be if 15% of the workforce of the US were unemployed.
>> >
>> >What are the germans saying - they're at 10+ and 25+ in the former
>> >East?
>> >
>> Huh ????
>
>The unemployment in German is 10 percent - in the former eastern part,
>it's 25%. What are they saying? well, they are still getting good
>health care in a quasi-competitive insurance market.
>
The general public of the US simply wouldn't accept 15% unemployment
excluding a total financial disaster ala 'The Depression". And again,
it's immaterial what other nations prefer.
>> >>Do
>> >> you really think that the people would listen to the garbage that
>> >> "it's a necessary part of healthcare delivery"? I doubt that.
>> >
>> >When was the last time the US had 15% unemployement? And, if the US
>> >had 15% unemployement would health care be the top priority?
>> >
>> Ah, but we've got 15% non-covered... And a bunch of other problems on
>> top of that. And it's not necessary.
>
>So fix the 15% - don't putz with the 85%.
>
Wrong again, bring everyone under the same umbrella; we've got the
resources and a workable plan can be developed. First start, shoot
the nagging nay-sayers. That, at least, will clear the air.
>
>>
>> >> >> And just to show you how mellow I've become I'm even ignoring your
>> >> >> snide little remark in one of the prior posts.
>> >> >
>> >> >If I snided you, my apologies - it probably was an unintended
>> >> >misdirection.
>> >> >
>> >> >amp
>> >>
>> >> Yep, you were all so wrapped up in bashing Leo... Not that he doesn't
>> >> deserve it. But I'll overlook it.
>> >>
>> >> Cheers, the battle is re-engaged
>> >>
>> >> pixie
>> >
>> >"Battle" - I'm trying to avoid it turning out that way - but I will
>> >ask one very important favor - if you would like to use history as a
>> >model, please do so with appropriate references (links). I did and
>> >was able to, quite quickly, diffuse your entire foundation of your
>> >criticism.
>> >
>> >amp
>>
>> Perhaps in your own mind, ampie.
>
>But you're still link free - so pixipinion it is. Because you can't
>find credible support for your position doesn't make it inherently
>right.
>
My favorite link is common sense. Try using it a bit more.
And just a side note. I'm not planning on participating in your
favorite little 1K+ postings. I simply don't have the available time.
>amp
pixie
George Conklin
I see you are back to the old Usenet shuffle. If you cite
specific cases, then you and your cohorts state that the examples
are not true in general. If you cite general problems, you state
they are not specific. Shame.
George Conklin
DWood78828 <dwood...@aol.com> wrote:
>>Subject: Re: Redesign the system
>>From: jep...@shell.ntrnet.net (George Conklin)
>>Date: 2/1/02 12:12 PM Eastern
>
>> Pixie, sweetheart, Medicare is for those 65 and older. You are
>>back to your fringe group exeption list. The population does not
>>get medicare care by fringe group exception reduced to poverty by
>>living on disability insurance below the poverty line.
>
>George, you need to check out your facts a little better. There is no means
>teat for Medicare.
Social security disability payments are poverty level,
sweetheart. Give up your inability to read for a change.
George Conklin
Warning: The Usenet shuffle. Cite specific cases. Complain
they are not general enough, vice versa. Shame.
amp_spamfree
Gave you the link - did you want the entire link reposted? Are you
URL impaired like George?
>And as to your 'demand'
> to provide a citation, I'm not going to waste my time posting a bunch
> of nonsensical references when common sense should tell you what I was
> referring to. If you don't like that, too bad.
When you can't support your statements with any think but pixisense -
too bad indeed.
>
> >> >Here's a lively rendition of "managed competition" ala Hillary. So
> >> >get up to speed.
> >> >
> >> >http://www.fair.org/extra/9401/debate.html
> >> >
> >> >Regarding the cost-effectiveness of managed care - the data support
> >> >that the cost of health care in a managed care system is as low or
> >> >lower than that in a fee for service system - the fact that the US
> >> >spends a lot isn't evidence that it spends too much. Or did you miss
> >> >the diddy about Kaiser California spending no more than the NHS and
> >> >that without waiting lists?
> >> >
> >>
> >> You're citing the Clintons in providing authoritative statements?
> >> Collectively or individually they haven't a clue as to what "truth"
> >> means..
> >
> >At least I cited SOMEONE or SOMETHING - that's more than you Pixie.
> >If you don't agree, provide evidence in support of your opinion, OK?
> >
> Read.... and digest... my previous statement. I some quarters it's
> called an opinion.... Or is that too much for you?
Opinion based on what? You started out by saying Clintons proposal
was a market based proposal with choice and competition. It's not and
you can't refute it so you simply avoid it and expect acceptance of
your opinion as reality. OK - dream on.
> >> And yes, Kaiser has historically done an excellent job but,
> >> uinfortunately, Kaiser isn't available nationally, nor is there any
> >> plans that I've heard of for expansion but actually some contraction
> >> of their coverage has been rumored for quite some time.
> >
> >Again, where do you here the rumors? Here's facts -
> >http://www.kaiserpermanente.org/
> >
> Only in various discussions with individuals close to the business...
> and in reading trade journals...Do you have a problem with that?
Then post the reference. You aren't the only one "close to the
business" Pixie - so which trade journals, which authors, and which
evidence? Just because you heard it or feel it doesn't make it true.
I gave you a link directly from the organization outlining its growth
strategy and you suggest that they are somehow dying?
> >All upbeat and growth - no rumors of shrinkage.
> >
> >>And wouldn't
> >> you also lump them into the SP/UC group that you apparently detest so
> >> markedly?
> >
> >No - for a very very simple reason - I can opt in or I can opt out.
> >Once in, I am under a "single payer" umbrella, but I pay premiums
> >based on my risk profile not my salary, I have negotiating power for
> >services, I have access to care, and I can go outside of the network
> >and get services. Managed care is not a structure, it's a process.
> >
> An individual can 'opt in' or 'opt out' of Medicare, too. So by YOUR
> definition it's not SP? Or do you simply change the rules to meet the
> standard of the moment?
I can't opt in or opt out of making contributions for Medicare. As an
expat, I still have the priviledge of paying taxes to the US and get
to pay the Medicare supplement...just like you. I can certainly opt
out of the benefit, but I can't opt out of the contributions. See the
difference?
>
> >> >If you want to posit based on historical data, I'd suggest brushing up
> >> >on it.
> >> >
> >> The street runs both ways ampie.
> >
> >I provided a link - you?
> >
> I provided an opinion. Why do you have so much of a problem with
> someone who does that? Does someone else having an opinion have such
> a affect on your ego?
You argue points based on opinion but the opinion has no bases in
fact. If I opied that the earth was flat, would that make it a valid
opinion? Your opinion that my definition makes Medicare a non-SP is
based on an incorrect assumption. Your opinion is yours, and you have
every right to be as wrong and ignorant as you like.
>
> >> >> Anyone with any working understanding of the biz knew at the outset
> >> >> that the plan had been dreamed up by the ivied tower chowderheads who
> >> >> live in theory, and that there was absolutely no chance in hell that
> >> >> their theories would create any change at all... And, surprise, they
> >> >> didn't.
> >> >
> >> >The underlying concept of the Hillary plan was NOT competition and
> >> >private sector - it was big brother government - remeber, she was and
> >> >continues to be one of the big D's. Competition and privatization are
> >> >four letter words. Entitlement and income redistribution - that's
> >> >what the fundamental premise of Democrats (and our very own Labour
> >> >party).
> >> >
>
> >> Sorry, but I don't buy your claim about the 'underlying concept'..
> >> Yes, she did propose a govenmental plan, and would have required
> >> participation by providers, but one of the keystones of that plan was
> >> that the 'market forces' and 'competition' would drive down costs.
> >> BS, of course, but that was the claim.
> >
> >Document this. And in context with the SP/UC requirement, ok.
> >
> Stuff it
>
Can't do it - because it's not true. Stuffing it only works with
turkeys and feet in mouth. Congratulations - you win on both counts.
> >> And there's nothing wrong with a governmental plan as long as it's
> >> properly designed and implemented. With the diversity and size that
> >> the US represents it's about the only way that UC will ever come
> >> about, IMO we'll NEVER see it honestly proposed from the private
> >> sector.
> >
> >You argue for standardization BECAUSE of diversity and size? Seems
> >counterintuitive. What makes you think a thirty-something California
> >valley girl has the same needs (medical or otherwise) than a 70 year
> >old bible belt granny?
> >
> >
> Who said 'same needs'? Does your sample have medical requirements?
> If so they tend to fall into the same group.
One wants BC pills, the other doesn't want anyone to have anything
resembling birth control. Reconcile this in your One for All.
You assume that pharma doesn't have price controls - again, you're
wrong. The industry prices based on market forces. Other than the
sliver of cash based retail left (less than 15% in the US) the price
of pharmaceuticals is negotiated - and fixed by contract. The feds do
it with DoD and the FSS, Medicaid does it with MAC, Kaiser does it
through formularies, Merck-Medco does it through rebates. The
industry is far from exempt of price controls - in the US or
elsewhere. That's the reality - irrespective of your opinion.
> >> And when you claim the fixing of rates you're overlooking the fact
> >> that the patient portion... the amount due following the plan
> >> payment... has been steadily increasing with more and more of the load
> >> being placed back onto the individual who can least afford the
> >> increase. Not a desirable feature, as Sears used to say in their ads.
> >
> >If you're talking about pharma and tiered copays - this is exactly
> >what you want in a competitive model. Let's assume that there is a
> >standard $2 copay - does this make the patient at all price sensitive?
> > Give me the best and the most - whether I need it or not, its only
> >two bucks.
> >
> As you should recognize if you're beiing totally honest, I was
> speaking in generalized terms. More and more of the cost has been
> pushed back on the patient. And you know that to be a fact so why not
> admit it?
It isn't a fact, pixie. Cost-sharing is an attribute of all systems -
including those you oft promote - in canada, there is 100% cost
sharing on Rxs for the majority of the population. Even your sacred
Medicare entails cost sharing on the part of the patient - and that
cost sharing has increased.
> >Now lets assume there is a $20 copay - well, maybe that Tylenol #3 Rx
> >isn't as valuable than the less costly OTC Tylenol. Maybe waiting a
> >few days for that antibiotic prescription since its probably just a
> >virus anyway isn't a bad idea.
> >
> >Now lets put in a tiered copay - $30 for a brandname drug, $10 for the
> >equivalent generic.
> >
> >Let's use a $20 copay for an off formulary drug and $15 for the
> >therapeutic equivalent on-formulary drug. Want to guess which way the
> >choices go?
> >
> See above.
You don't get it - if you want to manage utilization, you put patients
at risk for part of the cost so that they can become more
participative consumers. You don't do it by waitlists.
> >> >>Is care actually improved? Perhaps by technology, but
> >> >> when the other guy puts in his new widget it all washes out.
> >> >
> >> >Wish we had a few more widgets here in the UK. We're technology poor
> >> >- too few widgets, too many people, one cheapskate payer, and a very
> >> >pissed of population. And don't tell me the people aren't pissed
> >> >about HC in the UK - It is headline news EVERY day now.
> >> >
> >> Who mentioned UK... Here in the US we've got plenty of wigets, more
> >> than we need in some places, but that's a different topic. And we're
> >> blessed with a bunch of cheapskate payers, not just one. As I said,
> >> it all washes out.
> >
> >Note in your or my lifetime - trust me, one cheapskate payer doesn't
> >have to respond to econmomic pressures. Only political pressures and
> >even then the bobb and weave is so well choreographed. Tony said
> >yesterday (or the day before), if your on the side of the children be
> >on the side of the teacher, if your on the side of the patient, be on
> >the side of the doctors and nurses - get the irony?
> >
> Perhaps not one payer.... and why do you catagorize them as
> "cheapskate"? Don't you believe in equal rights?
You spout UC/SP - not me. I'm all for universal access to health
insurance - but only if the purchaser is provided the choice of plan
and benefit design.
It's 27 miles accordong to AOL's Yellow pages finder system.
> >Granted - one Hospital - Horizon medical - which is also the home to
> >the largest group practice - wouldn't you expect it?
> >
> >But there's Hickman County, Baptist, and Trinity hospitals all within
> >25 miles, and all the Nashville hospitals in less than a half hour's
> >drive.
> >
> Try making that drive in less than 30 minutes. And for what matter
> why should the people have to drive an hour to obtain needed medical
> care?
They don't - they have dozens of docs and a hospital. And they have
choices. Your one doc model fell apart completely. Dickson is a
mecca of access not a wasteland of backwoods health care.
> >> >> And that's not an isolated instance.
> >
> >No - it's quite common to have lots of choices across the US,
> >particularly in the more or less "populated" parts.
> >
> And also quite common for people in the less populated areas to have
> no medical care available at all. How does this jibe with your
> claims? Oh, sorry, I forgot. In your book it's perfectly OK to have
> to drive an hour or so to obtain treatment.
Should a health care system support an infrastructure as wasteful as
you propose? In a town of 900 (West Texas), there is one doc and one
pharmacy. The closest medical facility of any size (about 40 beds) is
60 miles away. The nearest trauma center well over 100 miles. This
is pretty poor in terms of access - so you propose that this little
town build a hospital with all the latest gadgets and gizmos, bring in
a dozen docs, and then what? Tell me how your magically SP/UC is
going to change this little town?
>
> >For contrast, there are 12 pharmacies within 8 miles of downtown
> >Dickson Tennessee and 31 food stores (though some are convenience
> >stores).
> >
> So ????
Using the grocery store model is one that has merit.
> >> >Give me the name of another town - and I'll show you that there is
> >> >adequate (perhaps not stellar) health care access - based on grocery
> >> >access. You need to use grocery access as a leveling variable - but
> >> >if there is a chain grocery, then there's health care.
> >> >
> >> You're comparing healthcare access to grocery access??? Asinine! Do
> >> you run down to Krogers when you're sick?
> >
> >They do have a full service pharmacy. What I was suggesting is that
> >if health care services are as convenient as the grocery store, then
> >there's not much room to complain about access. get it?
> >
> Unfortunately, healthcare services aren't as convenient in many areas
> as grocery stores, or McDonalds, or even banks.
I guess if you want an MRI you likely won't find one with a drive
through. In Dickson, health care is as convenient as grocery stores.
> >> >> Certainly the theory is there, all well and good, but come back to
> >> >> earth and into the real world.
> >> >
> >> >You want SC/UC - that's Hillary planning and as soon as you get to
> >> >that you'll have a better appreciation why disaggregation and
> >> >competition is preferred over big brother mandates.
> >> >
> >> As *I've pointed out over and over, SP/UC doesn't have to be 'Hillary
> >> planning", nor should it be. You want open profiteering with the
> >> little guy picking up the tab... and getting the short end of the
> >> stick in the bargain. Apparently no common ground at all with your
> >> thinking, ampie.
> >
> >Open profiteering? You want a government monopsonist dictating who
> >gets what, when, and for how much with the little guy still picking up
> >the tab. At least the little guy in my scenario gets to choose who
> >screws him.
> >
> Yep, and one is generally named pharma... And that's OK ???
If the screwing is good, more market entrants, more competition, less
screwing. Hows that work again in a tax based system? Oh, that's
right, everyone is screwed and the guy with the bigger wallet is
screwed even more.How much did you pay for your last prescription,
Pixie?
Bull - you disagree with that every chance you get. You can't
rationally supportwhy health care is different in economic terms than
housing. Yet you somehow think that market behaviour and economics
don't apply to health care.
>However
> when certain elements of that market dictate the structure to the
> detriment of everyone then change must be enacted.
What "certain elements"? What "everyone"? Once again you ramble off
on some op ed bent and provide no support - you use vague terms and
profess omnipotence.
>And it wll come
> about.... In my lifetime, too.
If it does, hope it isn't over your dead body.
> >> >> OK, do we agree that the private sector, in general, has failed to
> >> >> provide adequate care for all?
> >> >
> >> >The PUBLIC sector has failed to provide adequate access to health
> >> >insurance for the poor or marginally poor. The private sector has
> >> >done a pretty good job in the US in providing access to affordable
> >> >health insurance to 85% of the population (excluding the over 65's
> >> >though that Part b and supplemental are private insurance schemes).
> >> >
> >> But you're advocating that the private sector control the delivery
> >> system. I'm simply saying that they've yet to prove that they can...
> >> and will... provide adequate care for everyone.
> >
> >That's not the point - the marketplace needs to make the options
> >available - the problem of poverty is not the concern of the medical
> >marketplace - it should be the concern of the public sector.
> >Uninsured as a problem isn't because health care delivery is bad, it's
> >because some people can't afford health insurance. The sytem provides
> >quite good care to those with insurance. Solve the insurance access
> >problem for the 15% without - but not by changing the delivery method
> >for the 85% who do.
> >
> I wouldn't disagree with that statement just as long as the 15%.. or
> the 30%, which is a more realistic number IMO, do gain full accesss.
And where do you get this idea? Regardless - still well over two
thirds even under pixipinion have full access. Fix the other 30% then
(assuming it exists which is a big stretch).
> But that hasn't taken place, and there's no indication that it willl
> take place without governmental intervention.
Get the government out of delivery and fiancing and get them focused
on poverty. Its not the insurance or medical industry denying access,
its poverty. Lets get employers motivated to provide insurance as a
benefit. Let's get a tax code that supports individuals investment in
health care. Lets take the artificial market constraints off of the
delivery of care. Don't cram a size three shoe on a size nine foot
and call it progress.
> >> >Do you blame the building industry for the lack of affordable public
> >> >housing? Do you blame the airline industry for a lack of
> >> >transportation in the inner cities? Do you blame GM that some people
> >> >don't have cars?
> >> >
> >> Try comparing apples to apples for a change. Stick to healthcare.
> >> Why should 15% with without adequate access?;
> >
> >A very good question - some do so by choice, some do so out of
> >ignorance, but most do so by default.
> >
> Oh yeah.. I forgot about those that simply default out of treatment. A
> lot like the homeless that prefer to be homeless. Right.
8% of individuals earning 75K or more annually in the US are NOT
covered by helth insurance. This is out of the same dataset that the
15.4% uninsured number comes from. Tell me again how they can't
afford even 5K a year for health insurance. Regarding homeless - an
anecdote - in the most socialistic western country in the world there
are 400 homeless in the capital city. Why? Much to the embarassment
of the government, they just don't want homes. But that's tangential
- no doubt homelessness is an issue which needs to be addressed. But
let me ask you - do you do it by giving them a home, or by giving them
a job so they can afford a home?
> >>why should an another
> >> 10-15% have to scrimp whenever a major medical emergency arises?.
> >
> >That one you'll have to document - maybe there's an issue of
> >inappropriate or inadequate coverage - but no evidence.
> >
> So by your claim ONLY the 15% uninsured have a problem with healthcare
> costs and everyone else is both happy and fully covered? Just a tad
> out of touch with reality aren't you?
I don't even buy into the fact that the 15% without insurance don't
have access. Look at your own hospital's system and look at the
amount of uncompensated care. Somebady is using those services and it
isn't the BC/BS subscriber.
>
> >>Why
> >> to the majority of the elderly have major problems in affording
> >> prescrption meds?
> >
> >No, it is a minority that have an affordability gap - the data were
> >published - about 70% of the elderly have drug coverage. granted ,
> >there is a gap and mandatory medicare drug insurance may be an answer.
> > I've never opposed that - I simply asked that it be rolled into the
> >current system of PBMs.
> >
> OK, so 70% have some form of drug coverage, if only through their
> Medicare+ HMO and with a severe annual limit. The fact remains that
> there is a definite gap, and that gap is harmful to that 30% of the
> population. Drug coverage is only one factor, although a significant
> one, that needs to be changed. And UC will provide that change.
No, UC won't change it UNLESS the UC covers drugs. In Canada, it
doesn't except for the poor and the elderly. If you want the 30% to
get drug benefits, then do so through Medicare Drug Benefit schemes.
Get these folks access to insurance to cover drug expenditures. There
are plenty of programs out there - it just is a matter of funding it.
> >>The private sector that you so dearly love has
> >> priced that group out of the market. UC would change that.
> >
> >The private sector hasn't priced people out - 85% are covered. All
> >your version of UC does is redistribute income until that can't work
> >any more, and then you get rationing - why? because there aren't any
> >incentives left to be efficient, to be innovative, or to be prudent in
> >utilization.
> >
> Back to common sense again, ampie, when costs of any needed service
> reach a point where individuals cannot afford that service then that
> group has been priced out.
It's not the services stupid - it's the insurance necessary to
alleviate the risk of catastrophic expenses.
>And as to the 'rationing', we're already
> rationing based on the pocketbook, where's the difference?
No - and that's the beauty of the private sector approach. Let's deal
with the 15% uninsured by providing a mechanism to get them insurance.
What do you think the waiting time is for coronary bypass surgery in
the US for someone with medical insurance? For an insured patient,
typically days to weeks. In the UK, weeks to months. This comes right
out of a recent JAMA publication. I didn't make this up, Pixie, it's
not my opinion, its cold hard facts - go to the medical library, pick
up last weeks JAMA and read it yourself. The only difference is that
it's completely free in the UK, if you live long enough whereas in the
US, you have to be in the 85% that have insurance.
> >I think on program worth considering is a mandated health insurance
> >coverage - the German model - where employers are obligated to provide
> >premium offsets, where the state governments are required to provide
> >for unemployed, and the federal government provides (in combination
> >with private schemes) for the elderly to BUY insurance - not to pay
> >for care or worse, to own the resources that deliver care. This is a
> >far far cry from SP/UC.
What - no response?
> >> >>Remove that and what's left? Back to
> >> >> the 'only one' solution. Or are you advocating creation of a new, and
> >> >> totally different methodology of delivery?
> >> >
> >> Same old system, different method of management.
> >
> >Where's the evidence and history that management by Washington works?
> >
> Where's the evidence and history that management by cartel works?
Cartel? A health care cartel? OK - over the top. But let's play.
Other than 1973, have you ever waited in line for a gallon of gas?
> >> >Get government out of the business of providing and/or financig care -
> >> >mandate, as the Germans have done, that insurance be available and
> >> >that insurers compete. And for those that can't afford insurance,
> >> >figure out a way to subsidize it - just like you figured out how to
> >> >fund unemployment,WIC food programs, housing subsidies, or any other
> >> >indigent program. Let these people be part of the mainstream - don't
> >> >force everyone into rationed government care because it is "better"
> >> >for the minority who are poor.
> >> >
> >> Nice words, but IMO unworkable in the US. Too many diverse
> >> special-interest groups and too much profit at stake. I'll continue
> >> to support a governmentally managed single plan, but one with fully
> >> adequate oversight and control. And that IS doable.
> >
> >No - it's not. It has never worked in any country that has tried it -
> >Canada, Sweden, and the UK are the three classic examples. Each of
> >these countries has developed a privatization plan, or, at minimum,
> >now allows for competition between providers and insurer to the
> >benefit of customers.
> >
> You might preface your statements with something like "In my opinion".
> I happen to have an opinion that there's too much greed and political
> power by certain groups and those groups will oppose any workable
> system as long as possible. Apparently you don't hold that opinion,
> too bad. But I am entitled to that opinion, just as you are yours.
You professed that it IS doable. I gave you three realtime, real
life, real experience examples of how it isn't doable and how in those
three real time real life situations people are realizing the
undoability (new word I think) and are changing - moving toward
privatization, choice, and competition based models of care delivery.
Moving away from UC/SP and toward a more rational approach.
Give me one example, other than Cuba, where pixicare works.
> >> >> >> I can come up with to provide a decent level of care for
> >> >> >> everyone is a single governmentally sponsored program.
> >> >> >
> >> >> >You agreed that choice is good but advocate a "single government
> >> >> >sponsored system"? I'm going to take a leap of faith and characterize
> >> >> >it as SP/UC, okay?
> >> >> >
> >> >> Don't you think that choice can be built into a SP/UC model?
> >> >
> >> >Not a chance - UNLESS you let people opt out and go private. Think
> >> >vouchers.
> >> >
> >> And why not? You don't have to have vouchers, although they're not
> >> something bad in many instances. Why do you continually proclaim that
> >> privatization is the ONLY answer. It certainly hasn't been up to now.
> >
> >But Pixie - it's worked for 85% of the people. Sure, it's expensive,
> >but for the richest country in the world not to invest in health care
> >seems almost foolish. If you can afford SUVs at 40K a pop....why not
> >raise the tax on gasoline to the UK standard? Now there's an
> >opportunity to make health care affordable.
> >>
> And it's totally ignored 15%, and also caused severe financial
> distress to many more. A single uniform system that's fully workable
> can be developed so why not try it. Why all the clouds of smoke and
> bile? Over the long run the profits will be there, don't worry..
The 15% are not ignored - that's why you have free clinics, public
hospitals, and patient in need programs - charity. The "severe"
financial distress comes from all sorts of places. There are poor
people Pixie, quite a few. But poor people are provided for through
social service, government funded resources. If that's inadequate,
then fix that. A single uniform system is not workable. It's been
tried - in everything from transportation to health care. Show me ONE
model where this has worked. Just one.
he only way you'll be able to avoid the profits is if you nationalize
the system - and that would be interesting. The only way you keep
down costs is when you ration.
> >> >> >So you eliminate choice. Granted, you may still choose your
> >> >> >providers, but your choice set is artificially constrained by a single
> >> >> >system. For example, let's say you have ESRD - you're a candidate for
> >> >> >surgery - except for your age. Now, you've taken good care of
> >> >> >yourself, you are in great shape, and have a wonderful life expectancy
> >> >> >- but the system says - sorry, over 75, no transplant. And if you
> >> >> >think this is far fetched, check out the organ transplant guidelines
> >> >> >for Ontario province (I think it was a CCHOTA report from the mid
> >> >> >1990's).
> >> >> >
>
> >> >> Au contrare, amp. You're the one eliminating choice by your
> >> >> unsupported statement that you can't build that factor into a SP/UC
> >> >> model.
> >> >
> >> >You can't - because as soon as you do, you simply have the runaway
> >> >train of fee for service. Granted, it may be cheap fees, but you have
> >> >no control on utilization UNLESS you ration - and that is the UK NHS.
> >> >Everyone gets as much as they want of the covered services - as long
> >> >as they are willing to wait. And that my dear, is the downfall of the
> >> >NHS - and that is why the private sector health system is groing by
> >> >leaps and bounds in the UK - to the point that even the NHS is using
> >> >it - and not just in the UK, but in germany, france, the Netherlands -
> >> >and soon Greece!
> >> >
> Could it be that the UK system simply wasn't properly designed or
> implemented? Naaaaa, of course not.
It worked for about 20 years - until technology become more expensive,
people lived longer, and the demand for services doubled while the
population only went up 10%. It is a non-functional, wasteful,
bureaucratic quagmire of politics and un kept promises. The schools
aren't a whole lot better, either but that's a whole other thread.
>And here in the US who cares
> about the UK, Germany, France, the Netherlands... even Greece.. We
> have our own needs and certainly have the resources to develop a fully
> workable system. Just as soon as the die-hards get pushed out of the
> way... And that WILL happen.
But you want to build a system in isolation - you'd rather barrel
ahead and not lean anything from the mistakes other countries have
made? tell me, hoe is pixicare differnt than the UK NHS?
>
> >> So it can't be done because you say so? Isn't that just a bit
> >> egotistical?
> >
> >You can't give me an example where it has been successful. I applied
> >simple economics based on history and you call it ego. Sorry.
> >
> Yes, IMO it's your ego that motivates you. Sorry if it hurts but
> that's the way you come across to me. What's that word?? pompous,
> yes, that's it.
OK - so we start with the insults - you're not only pompous, but you
are ignorant to boot. Ignorant because you make no effort whatsoever
to learn. You have an opinion and you'll be damned if you'll even
consider the merits of alternatives regardless. At least I have taken
the time to provide you with examples of failed pixiecare - with
links, data, and documentation.
> >
> >>You have absolutely no proof that such a plan can't be
> >> devised and implemented, yet you make such a statement? Strange
> >> thinking at best.
> >
> >I gave you three examples of how it's been tried and failed to varying
> >degrees. Most notably in the UK, but also in Canada and in Sweden.
> >The nice thing about Canada and Sweden is that they are small
> >countries (22 and 8 million respectively) so the fix and bandaids are
> >not so draconian. The UK - well, they are exporting their problems to
> >Germany - where private hospitals compete for patients based on
> >quality of outcomes and price.
> >
> And we have SAMSA's in the US that approximate those nations in size,
> along with resources that far outstrip any other nation. It's a
> matter of properly allocating those resources in the development of a
> sound plan. And of ignoring the nay-sayers, of course.
Give me a hint how this sound plan of yours is any different in design
of the UK NHS and why the outcomes will be different.
> >OK - now, what examples can you provide that show evidence that
> >government controlled, funded, and administered health care is
> >efficient and effective - Cuba? Medicare? Medicaid?
> >
> And why is that necessary? Take another tack. Just a few short years
> ago no one had set foot on the moon. Considered impossible by some.
> So instead of accepting the word of those nay-sayers we turned the
> trick. Not any more difficult than developing a sound healthcare
> delivery system for all.
My proposal is as radical and different from the staus quo as yours.
However, if you've seen a dozen astronauts die of hypoxia because they
forgot about the vaccum of space, do you believe that the 13th will
not because he can hold his breath longer because he has bigger lungs?
> >> >> And as to your sample, let's turn in around. Just how many 75 or over
> >> >> individuals should have a transplant. How about post-op qualify of
> >> >> life? Sure the patient is alive... barely... but what then?
> >> >
> >> >Since the individual you describe would not qualify medically because
> >> >of the risk/benefit, their age becomes a moot point. The issue is
> >> >that ALL 75 year olds are excluded in the Canadian plan - not just
> >> >those with poor prognoses. Those under 75 with poor prognoses are
> >> >similarly excluded.
> >> >
> >> And there's some perfectly valid common sense about such exclusions.
> >
> >Exclusion based on prognosis, not one based on race, gender,or age
> >because of a budget contstraint line.
> >
> That's right, and that's the way it should be. There's really no
> reason to expend resources in providing curative treatment when no
> cure can be obtained. It's a terrible decision but sometimes the best
> thing to do is to accept reality.
And you will be drawing these lines and telling us your opinion? The
canadians set the 75 yo line. Care to hear examples of cataract
removal rationing in the NHS? Sorry, only one eye at a time and only
once every 5 years. Look out Amsterdam, here we come.
> >> Medicine has reached the point where they can reverse what used to be
> >> a life-ending situation and maintain the patient but they have yet
> >> taken into consideration the overall qualify of life of that
> >> individual. Many patients, regardless of age, remain in a
> >> quasi-vegetative state and IMO that's wrong. A time comes for
> >> everyone when life will end, some earlier than others, some later.
> >> It's foolish to expend needed resources in attempting to prolong life
> >> simply for the sake of having someone 'alive'... regardless of the
> >> overall outcome.
> >
> >I like the Netherland solution/option. But the point is, a 75 year
> >old with an excellent post-transplant prognosis is denied a transplant
> >because he's 75 and no other reason. That's rationing based on a
> >budget constraint line.
> >
> In Canada, perhaps, but that's not the type of system I would envision
> for the US. If others wish to use other methods, so be it.
So, tell me again how you plan on staying within the budget? No
matter your opinion, there is no such thing as an unlimited budget.
Not even in Pixieville.
> >> I don't, however, advocate a strict age limit. Such issues need to be
> >> decided on an individual basis at a local level. Something that can
> >> be provided in any decently designed plan.
> >
> >Absolutely too funny. You need to draw a line somewhere and someone
> >has to implement the decision. Want to argue Oregon again? They took
> >the diseases and rank ordered them - I took the patient age as an
> >example - what criterion do you want to apply? Perhaps we ought to
> >bring back the league tables? even the Canadians got rid of them
> >(overtly at least).
> >
> Yes, it is funny, amp. You tend to demand absolute answers and then
> use those as reasons to deny progress. Funny on one hand, pathetic on
> another.
Your solution has no foundation. Your solution can't address even the
most basic question of allocative efficiency. But then again, it must
be doable because that's your opinion?
I agree - the US will move to universality - but not in the way you
envision. There will be affordable access to health insurance.
Insurance schemes and health care delivery will move to private sector
competition. Other than Medicare, the insurance side is already
there. The difference will be in the employer side. All ready seen
this - employers are offering benefit schemes that allow employees to
purchase a market basket of insurance products while the employer
simply provides them a stipend and access to plans. You can pick and
choose what you want and how much - varying copay plans for health,
optional disability programs, the level of life insurance benefit.
> >>
> >> >>
> >> >> OK, let's compare those two goodies. What do you think the hue and
> >> >> cry would be if 15% of the workforce of the US were unemployed.
> >> >
> >> >What are the germans saying - they're at 10+ and 25+ in the former
> >> >East?
> >> >
> >> Huh ????
> >
> >The unemployment in German is 10 percent - in the former eastern part,
> >it's 25%. What are they saying? well, they are still getting good
> >health care in a quasi-competitive insurance market.
> >
> The general public of the US simply wouldn't accept 15% unemployment
> excluding a total financial disaster ala 'The Depression". And again,
> it's immaterial what other nations prefer.
No - it's quite material to the discussion since their experiences
provide tremendous value and insight. Your inability to recognize or
appreciate it is consistent with a very ethnocentric myopia -
fortunately not one subscribed to by that many Americans any more.
> >> >>Do
> >> >> you really think that the people would listen to the garbage that
> >> >> "it's a necessary part of healthcare delivery"? I doubt that.
> >> >
> >> >When was the last time the US had 15% unemployement? And, if the US
> >> >had 15% unemployement would health care be the top priority?
> >> >
> >> Ah, but we've got 15% non-covered... And a bunch of other problems on
> >> top of that. And it's not necessary.
> >
> >So fix the 15% - don't putz with the 85%.
> >
> Wrong again, bring everyone under the same umbrella; we've got the
> resources and a workable plan can be developed. First start, shoot
> the nagging nay-sayers. That, at least, will clear the air.
If you can't convince 'em, kill 'em? Now that's progress.
> >
> >>
> >> >> >> And just to show you how mellow I've become I'm even ignoring your
> >> >> >> snide little remark in one of the prior posts.
> >> >> >
> >> >> >If I snided you, my apologies - it probably was an unintended
> >> >> >misdirection.
> >> >> >
> >> >> >amp
> >> >>
> >> >> Yep, you were all so wrapped up in bashing Leo... Not that he doesn't
> >> >> deserve it. But I'll overlook it.
> >> >>
> >> >> Cheers, the battle is re-engaged
> >> >>
> >> >> pixie
> >> >
> >> >"Battle" - I'm trying to avoid it turning out that way - but I will
> >> >ask one very important favor - if you would like to use history as a
> >> >model, please do so with appropriate references (links). I did and
> >> >was able to, quite quickly, diffuse your entire foundation of your
> >> >criticism.
> >> >
> >> >amp
> >>
> >> Perhaps in your own mind, ampie.
> >
> >But you're still link free - so pixipinion it is. Because you can't
> >find credible support for your position doesn't make it inherently
> >right.
> >
> My favorite link is common sense. Try using it a bit more.
Will, let me provide you with my opinion of common sense - pixipinion
is as far from common as it is from sensical. And for that the rest
of the country can be happy and proud.
> And just a side note. I'm not planning on participating in your
> favorite little 1K+ postings. I simply don't have the available time.
> >amp
Nor do you have a workable plan - though I did challenge you with a
very simple assignment - describe how pixiecare is different than the
NHS - and I honestly don't believe you will - not because you wouldn't
love to rub my pompous nose in your wisdom, but because you simply
have no depth of thought beyond the single line - its doable.
amp
>
> pixie
Jerome Bigge
>A little lapse of memory here, amp. Don't you remember when Hillary
>and her happy bunch were touting all the advantages of 'her plan', and
>how the "market forces" and competition within managed care would
>drive down costs, etc., and we'd all live happier.. and healtherll
>forever?
>
>Anyone with any working understanding of the biz knew at the outset
>that the plan had been dreamed up by the ivied tower chowderheads who
>live in theory, and that there was absolutely no chance in hell that
>their theories would create any change at all... And, surprise, they
>didn't.
Not enough people voted Democrat in 1994. One reason is that
the Dems didn't get off their butts and get the non-voters to the
polls. While the R's did everything to scare people, get them
to get out on election day and get to the polls and vote "R".
>In the real world of healthcare there's really little competition.
>Sure one facility in an area will erect a shiny new ediface, then
>breathlessly proclaim "I'm better than the other guy". Do rates
>change? No. Is care actually improved? Perhaps by technology, but
>when the other guy puts in his new widget it all washes out.
Standard when you have legal, licensed monopolies. Closest
parallel is probably the cable TV industry. Not much competition
there either. The only true competition you see in America is that
between businesses that are free to truely compete with one another.
>And what of those communities with only a single hospital? Or a
>single group of physicians. Do you REALLY think they compete against
>one another?
I recall once reading that "professionals" do not compete on "price".
>As an example, Not 50 miles from where I live there's a community of
>around 45000 with only one hospital, and aside from a couple of solo
>docs. both on the verge of retirement, only one physicians group.
>Yep, REAL competition..
>
>And that's not an isolated instance.
>Certainly the theory is there, all well and good, but come back to
>earth and into the real world.
Jerome Bigge
NRA Life Member
Supporter of National Health Insurance
CompTIA A+ Certified Computer Technician
Author of the "Warlady" & "Wartime" series.
Download at "http://members.tripod.com/~jbigge"
Jerome Bigge
>>Health care access for everyone is a laudable goal and one I support -
>>my preference is to allow for greater competition, more individual
>>choice, and better accountability for outcomes. In the US there
>>appear to be constraints on system options in part due to some equity
>>criterion that I don't quite get. In the UK, it is even more obvious
>>that equity as defined by the Tories is minimalistic but at least they
>>are honest and open about it. That, of course, results in a lot of
>>political infighting and inefficiency, and some real challenges
>>regarding access as measured by waiting lists.
>>
On the other hand uninsured Americans are worse off than
their counterparts in the UK who do have the NHS. As was
pointed out by someone in the latest AARP "BULLETIN",
medicine here in the US is a "commodity". To be sold
to those who can afford to purchase it.
Jerome Bigge
wrote:
> No you are not. Magazines are carrying stories about how
>female prisoners, for example, get virtually no medical care and
>die of things like cervical cancer even after begging for
>treatment. We still have collections for children with deadly
>diseases who cannot get cancer care unless they have the cash for
>the specialists. All they can get is 'emergency' care until
>stabilized and that means nothing at all.
Anyone from the countries that have UC? Do you see
such things there?
DWood78828
>Date: 2/2/02 7:02 AM Eastern
> (George
>Conklin) wrote
>>> Medicare is for those 65 and older...but I guess Pixie does not
>>>>know that. As for the rest of the population, go beg.
>>>Actually George, Medicare is also available to the permanently disabled, at
>any
>>>age. I should know, I've been on it for 13 years.
>>>
>>>Denise
>>
>> This changes nothing about the lack of health insurance and
>>care for those under 65. Or the cost. Or the money wasting on
>>tests which do not change the outcomes.
>Which 'tests' CHANGE the outcome of a specific disease or condition,
>George?
>
>pixie
Pixie, I don't know why we attempt to educate George or any of his fellow
non-believers. They lack of knowledge is abysma George's statement that
money is wasted on test that do not change outcomes is a prime example.
Perhaps he has forgotten the blood test that are done for diagnostic purposes.
And the treatment that is initiated following the results.
Perhaps he doesn't believe that glucose tolerance tests or blood sugar
monitoring is a necessary fact of life for a diabetic.
Perhaps he should pin a note to his shirt or have it tattooed on his chest:
DON'T RUN ANY DIAGNOSTIC TEST ON ME, THEY WILL NOT CHANGE THE OUTCOME OF MY
DISEASE.
Denisel
DWood78828
>>George, you need to check out your facts a little better. There is no
>means
>>teat for Medicare.
>
> Social security disability payments are poverty level,
>sweetheart. Give up your inability to read for a change.
Well then, why can't I qualify for Medicaid. The qualifying income is 150% of
the federal guideline for poverty.
Sorry George, I may exist at the lower income scale but I do not exist a t the
poverty level, either in florida or here in New York.
I suggest YOU check your facts.
Denise
Gretchen Evans
wrote:
That seems to be the thinking of many anti-UC people, Jerome, and
isn't it a shame?
pixie
Gretchen Evans
Which would give the funeral home personnel a little chucke.
pixie
Gretchen Evans
Conklin) wrote:
>In article <ohgn5u46e00qvkvmu...@4ax.com>,
>Gretchen Evans <gle...@edge.net> wrote:
>>On Fri, 01 Feb 2002 13:21:50 GMT, jep...@shell.ntrnet.net (George
>>Conklin) wrote:
>>
>>>In article <20020201022433...@mb-mt.aol.com>,
>>>DWood78828 <dwood...@aol.com> wrote:
>>>>>Subject: Re: Redesign the system
>>>>>From: jep...@shell.ntrnet.net (George Conklin)
>>>>>Date: 1/31/02 7:32 PM Eastern
>>>>
>>>>> Medicare is for those 65 and older...but I guess Pixie does not
>>>>>know that. As for the rest of the population, go beg.
>>>>>
>>>>
>>>>Actually George, Medicare is also available to the permanently disabled, at any
>>>>age. I should know, I've been on it for 13 years.
>>>>
>>>>Denise
>>>
>>> This changes nothing about the lack of health insurance and
>>>care for those under 65. Or the cost. Or the money wasting on
>>>tests which do not change the outcomes.
>>
>>Which 'tests' CHANGE the outcome of a specific disease or condition,
>>George?
>>
>>pixie
>
> Warning: The Usenet shuffle. Cite specific cases. Complain
>they are not general enough, vice versa. Shame.
Preferable to the usual generalized mumblings that your spew forth,
Georgie.
pixie
Gretchen Evans
Conklin) wrote:
>In article <20020201223049...@mb-cn.aol.com>,
>DWood78828 <dwood...@aol.com> wrote:
>>>Subject: Re: Redesign the system
>>>From: jep...@shell.ntrnet.net (George Conklin)
>>>Date: 2/1/02 12:12 PM Eastern
>>
>>> Pixie, sweetheart, Medicare is for those 65 and older. You are
>>>back to your fringe group exeption list. The population does not
>>>get medicare care by fringe group exception reduced to poverty by
>>>living on disability insurance below the poverty line.
>>
>>George, you need to check out your facts a little better. There is no means
>>teat for Medicare.
>
>
> Social security disability payments are poverty level,
>sweetheart. Give up your inability to read for a change.
But Georgie, as Denise said, there is no means test for Medicare
coverage. End of statement. Now you're trying to bring SSI payments
into the scene... Do try to understand.
pixie
Gretchen Evans
usual multi-K line postings. I realize that verbosity is your stock
in trade but I simply don't have the time to waste.
pixie
On 2 Feb 2002 13:41:39 -0800, amp_sp...@yahoo.com (amp_spamfree)
wrote:
amp_spamfree
> Sorry, ampie, but I told you that I wasn't going to wade through your
> usual multi-K line postings. I realize that verbosity is your stock
> in trade but I simply don't have the time to waste.
>
> pixie
Bailed on this one too. Come on Pixie - you aren't making this enough
of a challenge. I thought you'd changed but the tactic stays the same
- slip to insults and then bail when pixipinion goes sputter blubber
phttt.
amp
leo John
Except when greed perverts the basics.
leo John
finish, they see nothing inbetween.
Their feebleness cannot understand that you are tallking about
diagnostic tests that won't change anything.
To them you are against ALL DIAGNOSTIC tests. Their logic is
limited to building straw men..
The opposite of this would be for you to say they advocate doing
every diagnostic test anyone can dream up, for every patient who still
has funds, or insurance to pay for it.
Amanda Williams
> The AMA has no conscience. It always does what finacially benefits the
> system.
> Well, of course they do, numnuts.... Who do you think the AMA
> represents?? And why shouldn't they do what financially benefits the
> system ? Would you expect an organization such as theirs to do something
> that doesn't benefit their own group?
> Only one word can apply.. Idiiot !!
> pixie
>
> me--- You have accurately described what leads systems to not have a
> conscience. You have accurately described yourself too.
> You think it would be idiotic to put conscience above profits.
I think an overhaul of the system is needed. Doctors seem to have
forgotten the oath they take in medical school stating that the
general health and well being of their patients will be their utmost
goal. We are kidding ourselves if we think that the average dr. visit
(which lasts about 5.4 minutes) is enough to satisfy those
requirements. People want a doctor who is genuine about their
concerns. Alternative medicine is gaining support because of the poor
care doctors are giving. Oh, and back to the statement that everyone
can afford medical care. Perhaps minimal care is provided for
everyone but the best care is reserved for those who have the best
insurance. Money rules this system.
DWood78828
>Date: 2/3/02 7:43 AM Eastern
>t (George
>Conklin) wrote
>The population does not
>>>>get medicare care by fringe group exception reduced to poverty by
>>>>living on disability insurance below the poverty line.
> Social security disability payments are poverty level,
>>sweetheart. Give up your inability to read for a change.
>>>George, you need to check out your facts a little better. There is no
>means
>>>teat for Medicare.
>But Georgie, as Denise said, there is no means test for Medicare
>coverage. End of statement. Now you're trying to bring SSI payments
>into the scene... Do try to understand.
>
>pixie
>
I think that he doesn't understand how the system works. If an individual is
poverty stricken, he/she gewnerally qulifies for Medicaid. And in many states,
if totally disabled, the state will pay the premium for Medicare.
SSI is a whole different ball game. Qualifing for that doesn't necessarily
bring you up above the proverty level.
I believe that neither George or John have an understanding of
SSDI,SSI,Medicare and Medicaid. And it appears pointless to try and educate
them.
Denise
amp_spamfree
> >Subject: Re: Redesign the system
> >From: Gretchen Evans gle...@edge.net
> >Date: 2/2/02 7:02 AM Eastern
>
> > (George
> >Conklin) wrote
>
> >>> Medicare is for those 65 and older...but I guess Pixie does not
> >>>>know that. As for the rest of the population, go beg.
>
> >>>Actually George, Medicare is also available to the permanently disabled, at
> any
> >>>age. I should know, I've been on it for 13 years.
> >>>
> >>>Denise
> >>
>
> >> This changes nothing about the lack of health insurance and
> >>care for those under 65. Or the cost. Or the money wasting on
> >>tests which do not change the outcomes.
>
> >Which 'tests' CHANGE the outcome of a specific disease or condition,
> >George?
> >
> >pixie
>
> Pixie, I don't know why we attempt to educate George or any of his fellow
> non-believers. They lack of knowledge is abysma George's statement that
> money is wasted on test that do not change outcomes is a prime example.
> Perhaps he has forgotten the blood test that are done for diagnostic purposes.
> And the treatment that is initiated following the results.
>
> Perhaps he doesn't believe that glucose tolerance tests or blood sugar
> monitoring is a necessary fact of life for a diabetic.
Glucose tolerance tests are pointless for a diabetic - however, quite
useful in identifying if the patient has diabetes. What george seems
to forget is that diagnostic tests, as he puts it, are part of the
diagnostic process and part of therapeutic management. He gets all
incensed when the specificity and sensitivity of the diagnostic fails
to meet his acceptability criterion, but can't seem to grasp that
professionals use the information, not in exclusion of, but in
combination with other information.
Would I use mammogram results to rationalize a total mastectomy? No,
but George believes that this is what happens. You almost wonder if
he's had breast cancer and is speaking from personal experience.
What is more interesting, though, is that pixie is arguing that tests
don't CHANGE outcomes, yet you are arguing that they do. I can
empathize with the readers confusion. Certainly pixie is right, the
test itself changes nothing. The knowledge gained from the results of
the test can (should?) influence treatment decisions and unless you
believe all medical treatment is worthless, should change outcomes.
So another debate of semantics. Does anyone in the NG really care
about the underlying knowledge, or is it more fun just to play the
contradiction game followed by "i didn't say that/yes you did".
amp
amp_spamfree
leo snipped (for obvious reasons)
Amanda writes:
> I think an overhaul of the system is needed.
The delivery system of the insurance system?
>Doctors seem to have
> forgotten the oath they take in medical school stating that the
> general health and well being of their patients will be their utmost
> goal.
Not the oath I remember, exactly, but certainly the patient's welfare
is an integral part of the physician's responsibility.
>We are kidding ourselves if we think that the average dr. visit
> (which lasts about 5.4 minutes) is enough to satisfy those
> requirements.
Two leaps of faith - first, that the average visit is only 5.4 minutes
(I'm assuming we are still debating the US system, right?) and second,
that the length of the visit is too short to provide adequate care.
The first is pretty easy to verify - and I'd put the visit length at
15 minutes or so - at least based on the Lin data in Archives. see:
Chen-Tan Lin, MD; Gail A. Albertson, MD; Lisa M. Schilling, MD;
Elizabeth M. Cyran, MD; Susan N. Anderson, BS; Lindsay Ware, BA;
Robert J. Anderson, MD Is Patients' Perception of Time Spent With the
Physician a Determinant of Ambulatory Patient Satisfaction? Archives
in Internal Medicine, vol161 no. 11, June 11, 2001.
This isn't much different than what Blumenthal found in the early
1990's using NAMCS data.
If you can document the 5.4 minutes from something other than
USAToday, please do so.
>People want a doctor who is genuine about their
> concerns. Alternative medicine is gaining support because of the poor
> care doctors are giving.
I'm not convinced that physicians are providing poor care. But at
least your perspective is a bit clearer.
>Oh, and back to the statement that everyone
> can afford medical care. Perhaps minimal care is provided for
> everyone but the best care is reserved for those who have the best
> insurance. Money rules this system.
Rich people live in the nicest homes and drive the nicest cars and
take the nicest vacations. They make that choice because they can.
If you would like to be the allocator of all that is owned, should we
call you Cszarina?
amp
Gretchen Evans
wrote:
Wouldn't she have to be married to you to assume that title ampie?
Didn't you already assume control?
pixie
Gretchen Evans
wrote:
Bailed?? Again, just common sense. Why wade through multi-thousand
line posts and the endless rhetoric that you tend to spew out.. '
'
And if you don't like it, I assume you DO know where you can stuff it.
pixie
Gretchen Evans
wrote:
Which is what I said to Georgie. The fact that a diagnostic test is
performed certainly has no outcome on the outcome, however the
knowledge gained from that test can, most definitely play a part in
the outcome.
>So another debate of semantics. Does anyone in the NG really care
>about the underlying knowledge, or is it more fun just to play the
>contradiction game followed by "i didn't say that/yes you did".
>
>amp
Naaaah.... It's more fun to post multi-thousand line postings and
proclaim oneself as Czar of the ng.
pixie
Gretchen Evans
wrote:
OK, leo, which of the diagnostic tests actually 'changes' anything in
a patients status or condition?
I'm NOT saying that there aren't countless procedures performed that
cannot be justified on the basis of being medically necessary as
documented within the patients record, because there are. I see them
every day. But in the vast majority of instances those procedures
were ordered/performed for a very valid reason, usually to r/o (or
confirm) some facet of the physicians thinking that simply wasn't
included within his documentation of the patient.
Regardless of the situation, the results of that procedure/test do
not 'change' anything. they merely confirm or deny.
George made one of his usual asinine blanket indictments and most of
the regulars in the ng challenged that statement. As one might
expect, you supported the asininty.
pixie
Gretchen Evans
wrote:
You make some good points, Amanda; IMO the current system is in need
of a general overhaul and while there still are SOME very good
physicians out there (and, fortunately, I include mine as one of the
good ones), there is too strong of an emphasis on the financial side.
But isn't this indicative of the current attitude of the entire
nation? Look at all the messes in various industries that have
arisen over the perceived need to continually post profits and gains;
and look at how quality and service has declined in most areas. It's
sad, and we're certainly not the better for it, but I honestly doubt
that we'll EVER see a return to the 'good old days' of the Robert
Young style physician as a generic model of the profession.
I certainly don't know the solution, I doubt that there really is one
available under the current climate. About the only thing a person
can do is to keep shopping for a physician until you find one that's
willing to expend the time and energies that you feel comfortable
with.
But on the other hand the overall outcomes of treatment have
continually improved so not all has been lost.
pixie
Gretchen Evans
wrote:
> combinations, numbers and degrees, its never simpler than that..
>Except when greed perverts the basics.
Leo, what in hell are you babbling about now? If you don't keep to a
particular thread there's little reason to post, other than to see
your name on the 'net
pixie
amp_spamfree
> On Fri, 01 Feb 2002 13:24:30 GMT, jep...@shell.ntrnet.net (George Conklin)
> wrote:
>
> > No you are not. Magazines are carrying stories about how
> >female prisoners, for example, get virtually no medical care and
> >die of things like cervical cancer even after begging for
> >treatment. We still have collections for children with deadly
> >diseases who cannot get cancer care unless they have the cash for
> >the specialists. All they can get is 'emergency' care until
> >stabilized and that means nothing at all.
>
> Anyone from the countries that have UC? Do you see
> such things there?
Absolutely - those with money in the UK have a better chance of cancer
survival than those without - and EVERYONE has NHS.
Don't believe - here's the evidence.
http://www.guardian.co.uk/uk_news/story/0%2C3604%2C221568%2C00.html
And George, just out of curiosity, what's your evidence? The reason
why I asked is that Sloan Kettering and MD Anderson both have very
extensive pediatric cancer programs and acceptance is independent of
ability to pay. The NIH does, as well. Doesn't Duke have a program
for kids? Or were you just making this up, again.?
amp
Janitor, Podunck Kentucky
1-800-555-1212
George Conklin
The medical system has hijacked the nation priority list.
--
# If HMOs ran the post office, 44.3 million Americans would get no mail. #
# Phono FAQ: http://www.pagesz.net/~henryj/phono.htm. #
# Support Medicare for All Ages. Urban Myth FAQ under development. #
# Support Cygnet Horns for Edison Firesides-george conklin, KB4NCI #
George Conklin
When you ask about price, the physician says, "Ask the nurse."
The nurse says, "What's the matter? Don't you have insurance?"
Or: the insurance company will pay whatever it feels like. You
are responsible for the difference.
George Conklin
No they were all USA-style medicine. The jails don't want to
spend the money. I guess the chain gangs did not provide any
medical care either.
George Conklin
DWood78828 <dwood...@aol.com> wrote:
>>Subject: Re: Redesign the system
>>From: Gretchen Evans gle...@edge.net
>>Date: 2/2/02 7:02 AM Eastern
>
>> (George
>>Conklin) wrote
>
>>>> Medicare is for those 65 and older...but I guess Pixie does not
>>>>>know that. As for the rest of the population, go beg.
>
>>>>Actually George, Medicare is also available to the permanently disabled, at
>>any
>>>>age. I should know, I've been on it for 13 years.
>>>>
>>>>Denise
>>>
>
>>> This changes nothing about the lack of health insurance and
>>>care for those under 65. Or the cost. Or the money wasting on
>>>tests which do not change the outcomes.
>
>>Which 'tests' CHANGE the outcome of a specific disease or condition,
>>George?
>>
>>pixie
>
>Pixie, I don't know why we attempt to educate George or any of his fellow
>non-believers. They lack of knowledge is abysma George's statement that
>money is wasted on test that do not change outcomes is a prime example.
I see. You want to spend billions on tests which do not
change the out come. Typical.
George Conklin
The best care is reserved for those who pay, in addition to
insurace, a flat fee of $4,000 to $8,000 and up in advance to a
private physician who will then offer the serve we used to expect
from the family doctor. "Bootique" Medicine folks.
George Conklin
leo John
allowed to be owners of labs where they send patients for tests...
That was one example.
Another excuse is that drs are running every test they have to
protect themselves from lawsuits. If you can pay you will get every test
in the book.
It is being abused, some of the tests done on terminal patients
are useless. My aunt is 85 yrs old and very ill. They found blood in
her stool and wanted her to take a test where she had to drinK a gallon
of water with laxatives before the test.
The family stepped in and said NO. she couldn't survive an
operation if they found anything.
recently mamograms have been called into question, their
accuracy and their benefit in finding tumors early.
George is right.