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17th January 2017, 12:30 PM | #121 |
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Paying for health care in one way or another is essential, yet quite complicated. Devising a useful system in the USA will require much compromise and an absolute minimum of political posturing. It will also causes significant shifts in financial obligations among patients, insurance companies, and government. And it will be imperfect even when there are large net gains for society as a whole. Finally as health care itself gets more expensive the cost of paying for it will increase, even if changing the system saves money compared to what it might have cost otherwise. Looking at the current political situation I expect a successful manned mission to Jupiter before these requirements are met.
Honestly if Trump succeeds in this I will definitely give him enormous credit. But for now I am not holding my breath (and not only because I am slightly anemic). |
17th January 2017, 12:32 PM | #122 |
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17th January 2017, 12:37 PM | #123 |
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Gunter Haas, the 'leading British expert,' was a graphologist who advised couples, based on their handwriting characteristics, if they were compatible for marriage. I would submit that couples idiotic enough to do this are probably quite suitable for each other. It's nice when stupid people find love. - Ludovic Kennedy |
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17th January 2017, 12:56 PM | #124 |
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The real plan is to go back to the pre-ACA situation, where people who have group insurance from a large employer (which coincidentally pretty much includes all of the decision-makers in the matter) are in good shape, but insurance companies can reject individual applicants with pre-existing conditions, look for excuses to cancel clients who file expensive claims, and set annual and lifetime limits on payouts. A lot of people will be hurt, but a lot more are in a position to say "I don't care, this doesn't affect me."
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17th January 2017, 01:05 PM | #125 |
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Gunter Haas, the 'leading British expert,' was a graphologist who advised couples, based on their handwriting characteristics, if they were compatible for marriage. I would submit that couples idiotic enough to do this are probably quite suitable for each other. It's nice when stupid people find love. - Ludovic Kennedy |
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17th January 2017, 01:22 PM | #126 |
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my god, no one. our health care is not rationed.
if you are sick you get treated. end of. and that's the difference....I think my real surprise showed through in that first response. I really didn't realise that the u.s. system is that bad... so i become ill and have no insurance, do I just die? or hope to get better..... |
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17th January 2017, 01:26 PM | #127 |
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17th January 2017, 01:33 PM | #128 |
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Whose? In the U.S., nobody says "rationed," but access to health care is limited first by whether or not someone has insurance, then by what your insurance company is willing to cover, including what doctors and hospitals are in that company's particular network, then by what you can afford for co-pays and deductibles. You get the care you can pay for, either with insurance or your own savings.
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17th January 2017, 01:44 PM | #129 |
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Of course it is. You just haven't seen the rationing personally.
Consider elective procedures. Can you decide, one day, to get cost-free cosmetic surgery? A boob job? Facial reconstruction to look like Hatsune Miku? I assume not. But that raises the question: what is an "elective" treatment? Is cosmetic surgery after a disfiguring accident elective? Are prosthetic limbs elective? Is a sex change elective? Replacement organs? Replacement organs in a terminally-ill cancer patient? Wherever you choose to draw the line, you've got to draw it. Otherwise tell me where you live, because I am moving in next door tomorrow. |
17th January 2017, 02:01 PM | #130 |
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17th January 2017, 02:21 PM | #131 |
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Sorry-I thought I had answered by providing one of my criteria- a life or death situation that a person cannot deal with alone and which the government can help by intervening. This is a moral and ethical test as would apply it.
But are you asking how do we test if the person actually requires outside help to survive and if the government intervention can deliver that help? In specific, terms? Or how deep must the hardship be? From my own experience and observations of relatives and friends, I am absolutely convinced that being elderly, ill, and/or ignorant of even basic medical and legal issues, does result in people being unable to obtain essential support from their insurance companies to allow them key life extending care. Not that it takes them a just extra hour on the phone. Instead I have observed that they simply cannot negotiate the many steps, forms, discussions, transfers to other representatives that are required and they simply give up end assume what they were initially told by the first insurance rep must be the truth. Also remember that the very people who are ill enough to require expensive treatments are often weak, worried, not thinking too clearly, and feel miserable; not a good basis for astutely arguing their case with 4 different entities (insurance company. doctor, pharmacy, hospital billing), multiple phone trees, multiple company representatives, each telling them different things, etc. For success one must be insistent, understand how to present the problem clearly using the correct medical terms, be very patient yet alert, understand what each person on the phone is telling you, and use that information for working out the next person you should contact. This took enormous effort for my spouse and me, and we are reasonably well versed in biology and basic medical concepts/terminology. From my observations of my elderly relatives, I cannot imagine how they could possibly can do so- they often can't even accurately explain there medical problem ("Oh the doctor said it was some kind of growth, but not a cancer. I think he called it a cannanoma or something like that."). They have just given up. |
17th January 2017, 02:26 PM | #132 |
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Sorry, but although I think that your health care is very, very good, I would be surprised if there was NO rationing. If you are 92 and have arthritic hips, I have no doubt that you would be treated in some reasonable fashion. But you would probably be treated with physical therapy and a cane, not with being given an artificial hip (whereas a 19 year old would get the artificial hip). It is great if both the 19 and 92 year old would get the hip operation (presuming the 92 year old was a reasonable candidate for surviving the operation)- I don't know enough to say this wouldn't happen. But I would be very (pleasantly) surprised.
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17th January 2017, 02:33 PM | #133 |
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None of those are health care issues so they are not rationed under Canada's health care plan. They are just not covered.
None of those are elective. They are all considered medically necessary and are covered. None are rationed. A terminally ill cancer patients would, in all likelihood, not be considered for an organ transplant. |
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17th January 2017, 02:36 PM | #134 |
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Not 92, but in his early eighties my dad was considered eligible to have his worn out hip replacements re-done. He chose not to do it, but it would have been done and covered if he had wanted it.
ETA: I think both you and Beelzebuddy might be confusing "rationing" with prioritizing. |
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17th January 2017, 02:40 PM | #135 |
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17th January 2017, 02:43 PM | #136 |
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Hip replacements are not rationed in the UK, they are decided on clinical need and of course such things as survivability, quality of life etc. That does not mean you will not have to wait, thanks to the last and current governments waiting times are once again becoming a shameful matter for the NHSs in the UK.
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17th January 2017, 02:44 PM | #137 |
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“If only it were all so simple! If only there were evil people somewhere insidiously committing evil deeds, and it were necessary only to separate them from the rest of us and destroy them. But the line dividing good and evil cuts through the heart of every human being. And who is willing to destroy a piece of his own heart?” Aleksandr Solzhenitsyn, The Gulag Archipelago |
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17th January 2017, 02:45 PM | #138 |
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17th January 2017, 02:47 PM | #139 |
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Are hip replacements done in a more timely fashion in the US?
I don't know about hip replacements, but I do know that you don't even need to bother trying to get an appointment with dermatology (can be 3 months with a doctor referral; that's a long time to deal with a rash). Heck, getting a well-patient physical exam with her PCP takes more than 2 months for my wife. Waiting times in the US suck, too. |
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Gunter Haas, the 'leading British expert,' was a graphologist who advised couples, based on their handwriting characteristics, if they were compatible for marriage. I would submit that couples idiotic enough to do this are probably quite suitable for each other. It's nice when stupid people find love. - Ludovic Kennedy |
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17th January 2017, 02:48 PM | #140 |
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By the way I don't think adopting a UK style NHS would be a good idea for the USA. There are many other current successful systems for providing universal medical care and I would say the USA would probably be better with something like the German model.
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“If only it were all so simple! If only there were evil people somewhere insidiously committing evil deeds, and it were necessary only to separate them from the rest of us and destroy them. But the line dividing good and evil cuts through the heart of every human being. And who is willing to destroy a piece of his own heart?” Aleksandr Solzhenitsyn, The Gulag Archipelago |
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17th January 2017, 02:49 PM | #141 |
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17th January 2017, 02:50 PM | #142 |
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“If only it were all so simple! If only there were evil people somewhere insidiously committing evil deeds, and it were necessary only to separate them from the rest of us and destroy them. But the line dividing good and evil cuts through the heart of every human being. And who is willing to destroy a piece of his own heart?” Aleksandr Solzhenitsyn, The Gulag Archipelago |
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17th January 2017, 02:51 PM | #143 |
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“If only it were all so simple! If only there were evil people somewhere insidiously committing evil deeds, and it were necessary only to separate them from the rest of us and destroy them. But the line dividing good and evil cuts through the heart of every human being. And who is willing to destroy a piece of his own heart?” Aleksandr Solzhenitsyn, The Gulag Archipelago |
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17th January 2017, 02:54 PM | #144 |
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17th January 2017, 02:57 PM | #145 |
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17th January 2017, 03:00 PM | #146 |
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And?
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“If only it were all so simple! If only there were evil people somewhere insidiously committing evil deeds, and it were necessary only to separate them from the rest of us and destroy them. But the line dividing good and evil cuts through the heart of every human being. And who is willing to destroy a piece of his own heart?” Aleksandr Solzhenitsyn, The Gulag Archipelago |
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17th January 2017, 03:03 PM | #147 |
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The system best-known in the U.S. is Medicare. If you're not on Medicare yourself, your parents, grandparents, neighbors etc. are. Quite a number of people think expanding Medicare to include everyone would be the most practical road for the U.S. Private providers, one payer. An alternative would be to allow anyone under 65 to choose to buy into Medicare for reasonable premiums with low-income subsidies. That would become the "public option." People could still buy private policies directly if they wanted to, as they can buy Medicare Advantage plans now, but the competition from the public option would hold down the private premiums.
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17th January 2017, 03:11 PM | #148 |
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Then every single medical procedure in every country in the world is "rationed". People just don't use the word as you are trying to do.
NICE is a gatekeeper of which treatments are available via our universal health care systems. But once it has decided a treatment can be provided it has no input into how many people can have that treatment, it doesn't ration the number of people who can have a procedure. |
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“If only it were all so simple! If only there were evil people somewhere insidiously committing evil deeds, and it were necessary only to separate them from the rest of us and destroy them. But the line dividing good and evil cuts through the heart of every human being. And who is willing to destroy a piece of his own heart?” Aleksandr Solzhenitsyn, The Gulag Archipelago |
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17th January 2017, 03:19 PM | #149 |
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17th January 2017, 03:27 PM | #150 |
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“If only it were all so simple! If only there were evil people somewhere insidiously committing evil deeds, and it were necessary only to separate them from the rest of us and destroy them. But the line dividing good and evil cuts through the heart of every human being. And who is willing to destroy a piece of his own heart?” Aleksandr Solzhenitsyn, The Gulag Archipelago |
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17th January 2017, 03:30 PM | #151 |
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In Australia there is of course rationing (unless you also have Private Insurance above the compulsory 2% Medicare levy), based in general on the following:
Life threatening - free and immediate and available to everybody. (e.g., a car accident, a Heart Attack, a Stroke, even a broken leg) Semi-elective - Defined as a potentially future life threatening illness which requires monitoring but is not immediately life threatening (e.g., Bladder Cancer, some tumours) where you may be checked out once every 6 - 12 Months depending on the change in status of your illness. All free under the Universal Health Care system. (However if you start peeing blood again, you move up the list awfully quickly - you are back to life threatening) Elective Still free, but the waiting lists can be quite long. Hip replacement, Cataract operations again free, fall under this header. The waiting list can be years long. Cosmetic As far as I know, not covered at all. And as I mentioned above, Private Health Insurance is readily available in Australia to either reduce/eliminate co-payments or get that Cataract operation next week instead of waiting 2 years. Oh, and anybody on a health care card - aged pensioners, unemployed, Disability Pension, Carers - pay no ambulance fees, pay scripts at around $6 each with an annual cap, and can often go to Medical Centres who Bulk Bill Government and do not ask for the co-payment ("the gap"). And of course, you can also buy Ambulance Insurance at quite low rates. Norm |
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17th January 2017, 03:33 PM | #152 |
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That is a "when did you stop beating your wife" question because you are trying to take one narrow type of rationing and call it the whole thing.
Rationing is the controlled distribution of scarce resources. In this case, they ration care by setting limits on which services they will purchase. |
17th January 2017, 03:34 PM | #153 |
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I like how we're supposed to look to Canada, the UK, and Australia as better health-care systems when those people can't even properly use the word "hospital" in a sentence.
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17th January 2017, 03:51 PM | #154 |
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17th January 2017, 03:55 PM | #155 |
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17th January 2017, 04:03 PM | #156 |
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It *is* highly relevant, as experimental or breakthrough therapy take time to get approved in nearly all EU countries. Everybody remember Thalidomide. Furthermore drugs have to prove they are effective, (and frankly seeing Lumacaftor/ivacaftor for what it does, it does not seem really that effective - add 3% lung function and provide a reduced hospitalization time in 1/3 of case of hospitalization).
The only exception are usually national programs for life saving drugs, e.g. cancer drugs which may sometime be used also as a breakthrough therapy. You may refuse that, but it is quite clear for everybody how wrong you are. |
17th January 2017, 04:06 PM | #157 |
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17th January 2017, 04:39 PM | #158 |
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17th January 2017, 04:41 PM | #159 |
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17th January 2017, 04:46 PM | #160 |
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