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Tags Affordable Care Act , AHCA , donald trump , health care issues , health insurance issues , obamacare , Trumpcare

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Old 22nd February 2017, 06:14 PM   #521
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Originally Posted by Spindrift View Post
Access is there, but you still have to pay for it. My daughter went to the ER last year, they did some tests, she was released in 3 hours. The bill was $5500.
ERs are obligated to provide stabilizing care regardless of ability to pay.

That doesn't mean they won't bill you. Asking for ER care to be free to everyone is different from asking that ER care be available to everyone.
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Old 22nd February 2017, 06:25 PM   #522
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Originally Posted by Roger Ramjets View Post
Sure it does - you pull the plug when all the patient's assets have been stripped.

In a capitalist system you need to make money to survive. If you run out of money then you are dead, and there's a limited supply so... people don't become doctors to help others, they do it because doctors make more money. Why do they make more money? Because sick people will give up all their money to avoid dying. There is nothing anomalous about this - it's how Capitalism works!

The only alternative is Socialism, but that is un-American so it is no solution. The answer is for everyone to become a doctor, then we can all make enough money to pay for our own healthcare. So what should Republicans do to replace Obamacare? Simply eliminate all regulations that prevent anyone from becoming a doctor!
This site really needs a like button.

As for the bit I bolded, didn't some republican on here complain about licenses to work the other day but not name the ones so hated?
Perhaps this is what they alluded to.
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Old 22nd February 2017, 06:35 PM   #523
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Originally Posted by Emily's Cat View Post
ERs are obligated to provide stabilizing care regardless of ability to pay.

That doesn't mean they won't bill you. Asking for ER care to be free to everyone is different from asking that ER care be available to everyone.
And it's the difference between some people losing their homes because of an accident.
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Old 22nd February 2017, 07:24 PM   #524
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I wonder what Stephen Hawking's lifetime expenses have been?

Or how well he would have fared if he had been an American?
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Old 22nd February 2017, 07:45 PM   #525
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Originally Posted by quadraginta View Post
I wonder what Stephen Hawking's lifetime expenses have been?

Or how well he would have fared if he had been an American?
I've seen that little ****** roll around here like he owns the place. Go back to England! And brush your teeth!!
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Old 22nd February 2017, 08:57 PM   #526
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Originally Posted by Emily's Cat View Post
ERs are obligated to provide stabilizing care regardless of ability to pay.

That doesn't mean they won't bill you. Asking for ER care to be free to everyone is different from asking that ER care be available to everyone.
I did not want it to be free but a single payer type of service you woukd pay monthly for. Once you are stable you have some health options. Many problems can be treated as outpatient service. When you are dead you have no options. You would have a card like a social security card that would cover all ER for all US residents or students with visa on a 1 year basis.
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Old 22nd February 2017, 10:00 PM   #527
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Originally Posted by imodium View Post
This site really needs a like button.

As for the bit I bolded, didn't some republican on here complain about licenses to work the other day but not name the ones so hated?
Perhaps this is what they alluded to.
If Ryan and co. are serious about freedom and personal responsiblility, this is exactly the solution. Let the free market sort out who's good enough to practice and how much they can charge. I'll save tons by getting treatment from some guy at the mall who's watched some medical videos on youtube and be laughing all the way to the bank.
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Old 22nd February 2017, 10:31 PM   #528
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Originally Posted by Spindrift View Post
Access is there, but you still have to pay for it. My daughter went to the ER last year, they did some tests, she was released in 3 hours. The bill was $5500.
But if you have health insurance, the insurer paid most of the bill, probably at a discounted rate, right? If you don't have insurance and got hit with a full retail bill, that's really the issue, isn't it? Under a Medicare-for-All single payer system, everybody's basic care, including ER visits, would be covered, paid for by a tax that would replace insurance premiums.
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Old 23rd February 2017, 09:57 AM   #529
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Originally Posted by Spindrift View Post
And it's the difference between some people losing their homes because of an accident.
Yes it is.

That's why we need a different discussion. Simply saying that ERs should be accessible to everyone doesn't accomplish anything. Accessibility isn't the issue - affordability is. Affordability is a barrier to care, but not a barrier to accessibility.

It's the cost of care that needs to be looked at. Not the cost of insurance, and not accessibility. It's the actual underlying cost of services that needs the most attention in my opinion.
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Old 23rd February 2017, 10:00 AM   #530
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Originally Posted by Tero View Post
I did not want it to be free but a single payer type of service you woukd pay monthly for. Once you are stable you have some health options. Many problems can be treated as outpatient service. When you are dead you have no options. You would have a card like a social security card that would cover all ER for all US residents or students with visa on a 1 year basis.
Again, ER isn't sufficient. ER doesn't provide outpatient coverage, they provide stabilization for emergency conditions. We need a solution that addresses a broad spectrum of treatments, not only emergency care.
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Old 23rd February 2017, 10:03 AM   #531
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Originally Posted by Civet View Post
If Ryan and co. are serious about freedom and personal responsiblility, this is exactly the solution. Let the free market sort out who's good enough to practice and how much they can charge. I'll save tons by getting treatment from some guy at the mall who's watched some medical videos on youtube and be laughing all the way to the bank.
It's a horrible idea
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Old 23rd February 2017, 10:04 AM   #532
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Originally Posted by Emily's Cat View Post
Yes it is.

That's why we need a different discussion. Simply saying that ERs should be accessible to everyone doesn't accomplish anything. Accessibility isn't the issue - affordability is. Affordability is a barrier to care, but not a barrier to accessibility.

It's the cost of care that needs to be looked at. Not the cost of insurance, and not accessibility. It's the actual underlying cost of services that needs the most attention in my opinion.


They're fairly intertwined, I think, but mostly, I'd agree. I think doctors in the US are probably grossly overpaid*. Add into that that you run every test you can or risk litigation and the enormous admin costs brought about by actually having to have a decline process and generally deal with insurance companies and it's all a bit of a mess.





*Although mostly they need to be to be able to keep up the payments on their education they paid a fortune for.
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Old 23rd February 2017, 10:08 AM   #533
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Originally Posted by 3point14 View Post
They're fairly intertwined, I think, but mostly, I'd agree. I think doctors in the US are probably grossly overpaid*. Add into that that you run every test you can or risk litigation and the enormous admin costs brought about by actually having to have a decline process and generally deal with insurance companies and it's all a bit of a mess.





*Although mostly they need to be to be able to keep up the payments on their education they paid a fortune for.
*** And their brand new Mercedes and their 4000 sf house in a gated community and their membership fees for the highly exclusive country club so they can golf 3 days a week

Obviously not every doctor... but an awful lot of them. It's not like most docs are just scraping by because of their crippling educational debt. They're in the same boat I am: I had a lot of debt from college, but it got me a very well-paying job, so the $400+ per month going to pay off my student loans just isn't that big a deal. I don't really have much sympathy for the cost of a medical degree, given the income level that is a result of that investment.
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Old 23rd February 2017, 10:14 AM   #534
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Originally Posted by Emily's Cat View Post
*** And their brand new Mercedes and their 4000 sf house in a gated community and their membership fees for the highly exclusive country club so they can golf 3 days a week

Obviously not every doctor... but an awful lot of them. It's not like most docs are just scraping by because of their crippling educational debt. They're in the same boat I am: I had a lot of debt from college, but it got me a very well-paying job, so the $400+ per month going to pay off my student loans just isn't that big a deal. I don't really have much sympathy for the cost of a medical degree, given the income level that is a result of that investment.

Your point is well taken. I suspect they'd argue that they deserve large rewards for taking a massive risk (All that debt without the diploma to back it up would pretty much end one's life prospects, I would guess?) and the massive amount of work they've had to do to end up a doctor.

Whether the above is a valid argument I don't know.

Any solution one implements is going to be opposed at every turn by those who have already climbed the mountain.
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Old 23rd February 2017, 10:26 AM   #535
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Originally Posted by Emily's Cat View Post
It's a horrible idea
It would be the wrong kind of fun, I'll grant that.
On a more serous note along similar lines, I've heard it suggested that a certain amount of medical work that is currently done by doctors could be done by less expensive medical professionals (nurse-practitioners, nurses, physician's assistants and such) without significantly damaging the quality of patient care. Sounds reasonable to me, but I just don't know enough about the industry to know if it really makes sense.
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Old 23rd February 2017, 10:35 AM   #536
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Originally Posted by Emily's Cat View Post
Yes it is.

That's why we need a different discussion. Simply saying that ERs should be accessible to everyone doesn't accomplish anything. Accessibility isn't the issue - affordability is. Affordability is a barrier to care, but not a barrier to accessibility.

It's the cost of care that needs to be looked at. Not the cost of insurance, and not accessibility. It's the actual underlying cost of services that needs the most attention in my opinion.
Affordability goes hand in hand with accessibility.
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Old 23rd February 2017, 10:44 AM   #537
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Originally Posted by Civet View Post
It would be the wrong kind of fun, I'll grant that.
On a more serous note along similar lines, I've heard it suggested that a certain amount of medical work that is currently done by doctors could be done by less expensive medical professionals (nurse-practitioners, nurses, physician's assistants and such) without significantly damaging the quality of patient care. Sounds reasonable to me, but I just don't know enough about the industry to know if it really makes sense.
It's absolultey true that much of the work could be done by nurses or PAs... it's also true that there's a lot of industry opposition to that. Lots from doctors, some from insurance companies. I can only speak very broadly to the insurance side, as it's not my area of expertise. My understanding is that it gets complicated when the insurer is trying to balance their obligation to the safety and quality of care that is being accessed by their policyholders against the cost being charged to their policyholders. When there are doctors in the mix opposing that shift and arguing that the quality of care might suffer and that the risk to the patient is too great, it becomes a really difficult position.

Of course, my knowledge on this is only from within the insurance industry. And since it's not my particular area, I'm likely to be missing many other elements of the issue. Please assume that my response is both incomplete and likely to reflect some industry bias.
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Old 23rd February 2017, 10:45 AM   #538
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Originally Posted by NoahFence View Post
Affordability goes hand in hand with accessibility.
Not really.

Everyone is allowed to buy a bicycle. Not everyone can afford a bicycle. They are accessible to all, but not affordable to all. Increasing affordability will increase adoption and purchase, but doesn't change accessibility.
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Old 23rd February 2017, 10:54 AM   #539
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Not that I want to see our friend EC out on the street, but the fact that we have this massive health insurance industry in the US that eclipses similar industries in other western nations is our biggest problem. People don't need health insurance, they need health care.

Obamacare's bigger fault was in not offering a medicare for all option alongside the insurance options. We need to take out the middle man.
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Old 23rd February 2017, 10:57 AM   #540
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Originally Posted by Dr. Keith View Post
Not that I want to see our friend EC out on the street, but the fact that we have this massive health insurance industry in the US that eclipses similar industries in other western nations is our biggest problem. People don't need health insurance, they need health care.

Obamacare's bigger fault was in not offering a medicare for all option alongside the insurance options. We need to take out the middle man.
Even at the risk of my career, I happen to agree.
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Old 23rd February 2017, 10:58 AM   #541
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Originally Posted by Emily's Cat View Post
Even at the risk of my career, I happen to agree.
I'm glad you did not see that as an attack. I really appreciate your contributions to these topics and others.
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Old 23rd February 2017, 11:00 AM   #542
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Originally Posted by Dr. Keith View Post
I'm glad you did not see that as an attack. I really appreciate your contributions to these topics and others.
No worries
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Old 23rd February 2017, 11:04 AM   #543
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Originally Posted by Civet View Post
It would be the wrong kind of fun, I'll grant that.
On a more serous note along similar lines, I've heard it suggested that a certain amount of medical work that is currently done by doctors could be done by less expensive medical professionals (nurse-practitioners, nurses, physician's assistants and such) without significantly damaging the quality of patient care. Sounds reasonable to me, but I just don't know enough about the industry to know if it really makes sense.
Actually they may do it better as they are more likely to follow guidelines.

Conversely in the US anaesthetics are often given by nurses, something always done by physicians in the UK (and any suggestion that they could be made redundant and replaced by nurses is not popular with anaesthetists!).

The NHS has a pay structure that grades pay by responsibility, skills etc. So nurses like to do doctor-like jobs as they are well paid. Doctors are excluded from that pay structure because it would mean they would need be paid more than they already are!
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Old 23rd February 2017, 11:29 AM   #544
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Originally Posted by 3point14 View Post
I imagine any country with UHC has a system to limit expenditure. It simply has to happen in any reasonable system.

https://www.nice.org.uk/
Agreed, though this is what the Republicans call death panels.

If health care is supposed to be paid for from a third party, whether public or private, in the end we have to make choices about how much money is too much for the benefit. That's how it goes.
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Old 23rd February 2017, 12:43 PM   #545
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Originally Posted by phiwum View Post
Agreed, though this is what the Republicans call death panels.

If health care is supposed to be paid for from a third party, whether public or private, in the end we have to make choices about how much money is too much for the benefit. That's how it goes.
Called, back when it was Obama's plan. The new death panels will be "budgetary review boards."
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Old 23rd February 2017, 02:29 PM   #546
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Originally Posted by xjx388 View Post
A dog can't choose it's food; they eat what's available. Dogs in the wild aren't fat and I don't think it's possible for wild dogs to get fat.
"Dogs in the wild" is kind of an oxymoron, IMO. Coyotes and wolves aren't fat. Dogs are domesticated creatures. People eat what's available too. But availability has gone through the roof.

Originally Posted by xjx388 View Post
Wild humans, on the other hand . . . well, we see where we are now. Humans have choices. We choose to make our lives easier so we don't have to move around much to get things done and we are capable of creating food that is tasty.
I could be doing my laundry on a washboard with soap made of lye and bacon fat, true. I could chop the wood to build the fire to heat the water, but modern detergents mean the water doesn't need to be hot. I could at least put it on the line instead of tossing it in the dryer, but why? If evolution has favored conserving our energy, many if not most Americans face an uphill battle to lose weight. If there's famine, people carrying extra fat have an edge. Famines have been the norm around the world and through history.

Originally Posted by xjx388 View Post
Those are our choices.
Are they, though? People are animals too. There's no evolved off-switch (AFAIK). People who binged while they could survived to breed. Evolution favors binging on fat, salt, refined carbs while we can. Middle age barely existed.

We have information, and can act on it, but overweight people can still feel famished, and can easily feel too fatigued to exercise. That's why I mentioned barometric surgery: It builds discomfort into overeating.

Originally Posted by xjx388 View Post
I don't read the way the article uses the word "environment" as meaning some natural habitat we have no choice but to succumb to. We do have choice, we just make bad ones.
It's not a natural habitat, but humans (Americans, but others) have created an environment that might as well be our natural habitat if that's all we've ever known. How many fat parents have fat kids? Is that the kids' fault?

Mike Pence agrees with you on the responsibility thing, and maybe it's better to just cut everyone loose. If we make the right choices we won't get sick. Aging, for example, is a terrible habit.

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Old 23rd February 2017, 02:43 PM   #547
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However I think real data would be better than our somewhat abstract philosophizing. Anecdotes not so much.
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Old 23rd February 2017, 03:42 PM   #548
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Originally Posted by Dr. Keith View Post
My impression of UHC countries is that they evaluate a treatment and when and how it should be administered. Then that evaluation applies to everyone equally. So, if the patient falls into these guidelines then it is determined that treatment X would be an effective treatment, but if patient does not fall within the guidelines then treatment X would not be considered effective.

I could be completely wrong, since I'm not in any way associated with medicine or medical policy.
In the UK NICE has a role in determining which treatments are worth paying for.

There is also a judgement based on Quality of life adjusted life years. trying to make the inevitable rationing as fair as possible.
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Old 23rd February 2017, 03:58 PM   #549
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Originally Posted by jimbob View Post
In the UK NICE has a role in determining which treatments are worth paying for.

There is also a judgement based on Quality of life adjusted life years. trying to make the inevitable rationing as fair as possible.
That's what I thought, but I don't know the specifics, so I didn't want to venture too deep.

The point is that the determinations aren't made on a case by case basis (is this person worth this treatment) but on a treatment by treatment basis (when is this treatment worth the expense, if ever).
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Old 23rd February 2017, 04:30 PM   #550
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I don't know how it works in other countries, though
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Old 23rd February 2017, 04:51 PM   #551
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Originally Posted by jimbob View Post
I don't know how it works in other countries, though
Here we ask our insurance company if it is covered. They either allow or deny the procedure with almost no insight into why. Most normal stuff is covered most of the time. If it is denied the patient can appeal the decision within the insurance company if the doctor is willing to go to bat for them and say it is necessary. If it is still denied I would assume you go to arbitration. I don't think these cases often make it into court because the insurance companies don't want them to.
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Old 24th February 2017, 12:39 AM   #552
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Originally Posted by Dr. Keith View Post
That's what I thought, but I don't know the specifics, so I didn't want to venture too deep.

The point is that the determinations aren't made on a case by case basis (is this person worth this treatment) but on a treatment by treatment basis (when is this treatment worth the expense, if ever).
In principle what you say is true. In practice there remains one doctor and the patient in front of her. Excepting very expensive treatments, the doctor can give any treatment. They may be queried on it, but if there is some justification, e.g. the patient will not take any blue tablet, then it will go through.

Most of NICE guidance is more about what the health service should supply, e.g. that hospitals should have thrombolytic service for patients presenting within four hours of a stroke. This then means having an infrastructure of 24 hour emergency brain scans and people to report them. This may mean the scan reported at a neuroscience centre or diverting the patients to the neuroscience centre (depending on time for transfer). The major cost here is not the clot buster drug, but the infra structure. Some individuals will do very well, some will be killed by the treatment, so the QUALY is an average for a population, not an individual gain.

FWIW NICE defines cost effective treatment as < £20,000 per QUALY, and >£30,000 as not cost effective. There is obvious wiggle room. A Qualy is a quality adjusted life year, so if a treatment gives you one year of perfect life that is a QUALY, two years but with significant disability might be a QUALY.

Average expenditure per person on the NHS is about £2,100 / year.

Although much of the headlines focus on NICE saying a new cancer treatment is too expensive (which usually results in a back room deal; the NHS is a big purchaser, and the cost of production of a drug is low, the real cost is the investment in getting to market; so any sale is worthwhile), what is missed is the permissive drive from NICE saying that certain things must be delivered. NICE also sets standards that services should achieve.
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Old 24th February 2017, 10:04 AM   #553
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Originally Posted by Planigale View Post
In principle what you say is true. In practice there remains one doctor and the patient in front of her. Excepting very expensive treatments, the doctor can give any treatment. They may be queried on it, but if there is some justification, e.g. the patient will not take any blue tablet, then it will go through.

Most of NICE guidance is more about what the health service should supply, e.g. that hospitals should have thrombolytic service for patients presenting within four hours of a stroke. This then means having an infrastructure of 24 hour emergency brain scans and people to report them. This may mean the scan reported at a neuroscience centre or diverting the patients to the neuroscience centre (depending on time for transfer). The major cost here is not the clot buster drug, but the infra structure. Some individuals will do very well, some will be killed by the treatment, so the QUALY is an average for a population, not an individual gain.

FWIW NICE defines cost effective treatment as < £20,000 per QUALY, and >£30,000 as not cost effective. There is obvious wiggle room. A Qualy is a quality adjusted life year, so if a treatment gives you one year of perfect life that is a QUALY, two years but with significant disability might be a QUALY.

Average expenditure per person on the NHS is about £2,100 / year.

Although much of the headlines focus on NICE saying a new cancer treatment is too expensive (which usually results in a back room deal; the NHS is a big purchaser, and the cost of production of a drug is low, the real cost is the investment in getting to market; so any sale is worthwhile), what is missed is the permissive drive from NICE saying that certain things must be delivered. NICE also sets standards that services should achieve.
I love NICE's standards. Mostly, I love that they exist. I so wish the US had that same approach.
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Old 24th February 2017, 10:23 AM   #554
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Originally Posted by Emily's Cat View Post
I love NICE's standards. Mostly, I love that they exist. I so wish the US had that same approach.
It does seem like a dream system compared to ours.

Why people trust an insurance company that slow paid them on their clearly covered car repair and haggled over the hail damage to their greenhouse to be fair when it comes to determine whether they get very expensive cancer treatment is beyond me.
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Old 24th February 2017, 10:45 AM   #555
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Originally Posted by Dr. Keith View Post
It does seem like a dream system compared to ours.
I've seen several arguments against NHS that are reasonable. I don't necessarily agree with them, but the arguments themselves were valid. But I've never seen a valid and reasonable argument against NICE. NICE is nice.

Originally Posted by Dr. Keith View Post
Why people trust an insurance company that slow paid them on their clearly covered car repair and haggled over the hail damage to their greenhouse to be fair when it comes to determine whether they get very expensive cancer treatment is beyond me.
See, now we're stepping into grounds where I'm going to end up getting pedantic .

First off, Property, Auto, and Health insurance are all completely different entities, with different standards of practice, different rules, and different regulations. Lumping them all together in your comparison is kind of (but not exactly!) like lumping credit unions, banks, and investment firms in the same bucket. Sure they all deal with money... but they're not interchangeable.

Beyond that... Most of the time (not all the time!) health insurers are quite fair when they come to their determinations. They are fair to the contractual obligations that they and the policyholder are both bound by. The insurer has an obligation to the policyholder receiving treatment, but they also have an obligation to all of the other policyholders that are paying for that treatment. They have a duty to be a prudent and ethical steward of their policyholders' finances. Insurance is first and foremost a vehicle for financial protection. It is NOT a vehicle for delivery of care (with the exception of staff-model HMOs, an entirely different topic). Insurers do not provide care; they contract with providers of care to ensure access and discounted rates for their policyholders. An insurer will (and should) deny care that violates the terms of the insurance contract - failure to do so would disadvantage their other customers by imposing a financial burden to which they did not agree.

Now... that said... it is also absolutely true that in the past, some insurers have taken their obligations waaaay to far to one side or the other. The ones who take it too far in support of the patients using high-cost services tend to become insolvent and go out of business. The ones who take it too far in support of the policyholders not using services tend to be universally hated by the small number of patients for whom they've denied care who are often quite vocal and outrages... and they also go out of business because nobody buys their product. It's a really skinny fence to sit on. Insurance companies have a lot of splinters in really uncomfortable places.
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Old 24th February 2017, 10:49 AM   #556
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Originally Posted by Emily's Cat View Post
See, now we're stepping into grounds where I'm going to end up getting pedantic .
And even if I don't read the rest of your post I hope you know I appreciate it.

And those splinters seem to pay pretty well, no?
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Old 24th February 2017, 10:54 AM   #557
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Originally Posted by Dr. Keith View Post
And even if I don't read the rest of your post I hope you know I appreciate it.
I know you do

Originally Posted by Dr. Keith View Post
And those splinters seem to pay pretty well, no?
Well, they pay **me** pretty well. But if you're talking about the industry as a whole... those splinters are surprisingly mediocre. The average profit margin in the health insurance industry is around 5%. And it's only that high because there are a very few national for-profit companies that skew the averages. Humana, Aetna, and United tend to run at a slightly higher margin - around 8% IIRC. But most of the regional and/or not-for-profit insurers tend to run closer to 2%.

In just about any other industry, a consistently low 2% profit margin would be considered ridiculously low.

Heck, even hospitals, pharmaceuticals, and medical device/supply companies have significantly higher margins than insurers do.
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Old 24th February 2017, 11:03 AM   #558
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Originally Posted by Emily's Cat View Post
I know you do


Well, they pay **me** pretty well. But if you're talking about the industry as a whole... those splinters are surprisingly mediocre. The average profit margin in the health insurance industry is around 5%. And it's only that high because there are a very few national for-profit companies that skew the averages. Humana, Aetna, and United tend to run at a slightly higher margin - around 8% IIRC. But most of the regional and/or not-for-profit insurers tend to run closer to 2%.

In just about any other industry, a consistently low 2% profit margin would be considered ridiculously low.

Heck, even hospitals, pharmaceuticals, and medical device/supply companies have significantly higher margins than insurers do.
Exactly why I wouldn't want to be an investor in a health insurance company but I wouldn't mind working for one. They really aren't investor friendly, they are more executive friendly.
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Old 24th February 2017, 11:59 AM   #559
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Originally Posted by 3point14 View Post
They're fairly intertwined, I think, but mostly, I'd agree. I think doctors in the US are probably grossly overpaid*. Add into that that you run every test you can or risk litigation and the enormous admin costs brought about by actually having to have a decline process and generally deal with insurance companies and it's all a bit of a mess.





*Although mostly they need to be to be able to keep up the payments on their education they paid a fortune for.
Median doctor pay 170 to 200K for their education, and the median GP get 200K per year. Specialist can earn more than the double.
https://thedoctorweighsin.com/how-mu...-doctors-make/

I doubt the median doctor will be long saddled by debt.

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Old 24th February 2017, 01:25 PM   #560
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Originally Posted by Dr. Keith View Post
Exactly why I wouldn't want to be an investor in a health insurance company but I wouldn't mind working for one. They really aren't investor friendly, they are more executive friendly.
Most companies are pretty executive friendly... but most of them are investor friendly as well.

Maybe some day I'll be an executive. Still not there yet.

ETA: On second thought, I'm not sure I really want the headaches and the responsibility that comes with that job. Manager is sufficiently exhausting and gray-hair-ifying already.
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