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

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Old 17th January 2017, 12:30 PM   #121
Giordano
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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).
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Old 17th January 2017, 12:32 PM   #122
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Originally Posted by CynicalSkeptic View Post
Well, it is possible that the lobbyists and corporate overlords have prevented congress from fixing it, and Trump's drain-the-swamp transition team can come up with a reasonable solution that helps (most of) the people and just screws over the bloated corporate execs of the drug and insurance companies.

But somehow I doubt it's that simple... or even if it was Trump's plan would get through congress because we're back to the lobbyists and overlords who own congress.
I await the Trump plan first. He has announced great goals. Many have. But what is his plan to achieve them? Let's see.
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Old 17th January 2017, 12:37 PM   #123
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Originally Posted by CynicalSkeptic View Post
Well, it is possible that the lobbyists and corporate overlords have prevented congress from fixing it
But even in that case, the plan would have been discussed elsewhere. I mean, this is the internet. Everything gets discussed somewhere.
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Old 17th January 2017, 12:56 PM   #124
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Originally Posted by pgwenthold View Post
But even in that case, the plan would have been discussed elsewhere. I mean, this is the internet. Everything gets discussed somewhere.
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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Old 17th January 2017, 01:05 PM   #125
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Originally Posted by Bob001 View Post
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."
Hey, hey, hey. They won't be allowed to reject applicants with pre-existing conditions. They will just make it prohibitively expensive. As I said the other day, this way, it is the patient's fault if they don't have insurance.
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Old 17th January 2017, 01:22 PM   #126
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Originally Posted by marplots View Post
Who do you have to deny service then? It's an important part of any health care system - the authority able to ration care.
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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Old 17th January 2017, 01:26 PM   #127
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Originally Posted by Beelzebuddy View Post
That has nothing to do with the cost of the pills, and everything to do with not getting sued because you OD'd on goofballs under their watch. If they're responsible for you taking a medication, it'll be their medication. Full stop. Even in situations where the rule is completely silly, it's just not worth the risk of something going wrong otherwise.

The in-house cost of everything is so high for you because you're already subsidizing healthcare for the uninsured. And not in the cheapest way.

If you don't have health insurance and you can't pay for treatment, you have to wait until it's a real emergency and then go to the ER. They have to treat you, and you'll rack up a hundred times more charges than if you had health insurance and could have gotten your problem fixed months ago.

Now, like I said, you can't pay those exorbitant bills. So the hospital gives the bill to some debt collection agency to collect on you, with all the scum-of-the-earth that entails, and resigns itself to handling a major loss of revenue by boosting the prices for everything else across the board. Again.


The solution is to insure everyone. Not to have insurance "available," but actual freakin' insurance you can actually afford and depend on. For everyone. It'll be expensive at first, because - surprise! - there are a LOT of people out there nursing serious medical problems they can't afford to treat. But, as the next batch of serious problems gets nipped in the bud by preventative care, costs will gradually drop and we'll get to enjoy having cheap, first-world health care like the rest of civilized society.
and this says a lot about the mentality, should i go to hospital tomorrow, i would be expected and expect to continue to take my mantainace dose of meds,
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Old 17th January 2017, 01:33 PM   #128
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Originally Posted by mikado View Post
my god, no one. our health care is not rationed.

if you are sick you get treated.
end of.

and that's the difference.
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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Old 17th January 2017, 01:44 PM   #129
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Originally Posted by mikado View Post
my god, no one. our health care is not rationed.
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.
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Old 17th January 2017, 02:01 PM   #130
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Originally Posted by Giordano View Post
You and I disagree on this and many broader points as a philosophical issues. But for me a simple line to draw is when an elderly or sick individual is mentally or physically unable to save their life (or is doomed to severe pain and suffering) without the assistance of the government, then the government (which in a democracy hopefully is the collective representation of the majority of the people in the society as a whole) should do so. I basic on my own moral code, in which helping others is very high in the listing of my ethical obligations. I see it as not very different from the city fire department throwing a life preserver to a man who fell into a lake and can't swim- should we just say that everyone should learn how to swim and to hell with him?

Obviously you are free to disagree if indeed you do. But given the basic difference originates in differing philosophies, I don't see that I could convince you otherwise.

Regards!
My question was more broad. How do you test a hardship to determine which ones people must endure and which ones the government should intervene?
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Old 17th January 2017, 02:21 PM   #131
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Originally Posted by BobTheCoward View Post
My question was more broad. How do you test a hardship to determine which ones people must endure and which ones the government should intervene?
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.
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Old 17th January 2017, 02:26 PM   #132
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Originally Posted by mikado View Post
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.....
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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Old 17th January 2017, 02:33 PM   #133
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Originally Posted by Beelzebuddy View Post
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.
None of those are health care issues so they are not rationed under Canada's health care plan. They are just not covered.

Originally Posted by Beelzebuddy View Post
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?
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.

Originally Posted by Beelzebuddy View Post
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.
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Last edited by Steve; 17th January 2017 at 02:48 PM. Reason: Trying to fix messed up quotes
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Old 17th January 2017, 02:36 PM   #134
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Originally Posted by Giordano View Post
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.
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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Old 17th January 2017, 02:40 PM   #135
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Originally Posted by Giordano View Post
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.
Where is Mikado from? If the UK then NICE is the rationer (so is wait times).
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Old 17th January 2017, 02:43 PM   #136
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Originally Posted by Giordano View Post
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.
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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Old 17th January 2017, 02:44 PM   #137
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Originally Posted by BobTheCoward View Post
Where is Mikado from? If the UK then NICE is the rationer (so is wait times).
Not really, NICE decides if a treatment should be available on the NHS, it does not decide how many people can have a treatment.
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Old 17th January 2017, 02:45 PM   #138
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Originally Posted by Darat View Post
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.
Triage is the rationing of finite resources.
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Old 17th January 2017, 02:47 PM   #139
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Originally Posted by Darat View Post
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.
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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Old 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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Old 17th January 2017, 02:49 PM   #141
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Originally Posted by Darat View Post
Not really, NICE decides if a treatment should be available on the NHS, it does not decide how many people can have a treatment.
Rationing is not just deciding how many people can have a treatment. It includes all controlled distribution of scarce resources.
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Old 17th January 2017, 02:50 PM   #142
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Originally Posted by BobTheCoward View Post
Triage is the rationing of finite resources.
In terms of the NHSs in the UK triage would mean an emergency situation, not everyday practice.

Remember there is only a finite number of people requiring a particular treatment so finite resources doesn't necessarily mean people won't be treated.
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Old 17th January 2017, 02:51 PM   #143
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Originally Posted by BobTheCoward View Post
Rationing is not just deciding how many people can have a treatment. It includes all controlled distribution of scarce resources.
Which is why I said you were wrong to state that NICE rations treatments,
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Old 17th January 2017, 02:54 PM   #144
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Originally Posted by Darat View Post
Which is why I said you were wrong to state that NICE rations treatments,
Nice refusing to approve okambi for cystic fibrosis is rationing.
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Old 17th January 2017, 02:57 PM   #145
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https://www.pri.org/stories/2010-12-...ns-health-care

Quote:
"We have a limited budget for health care, voted by Parliament every year, and we have to live within our means," said Michael Rawlins, chairman of a government agency called the National Institute for Health and Clinical Excellence (NICE).

NICE decides which drugs and other treatments can be prescribed by NHS doctors.

NICE was created in 1999 to clarify the reasons why certain drugs are approved and others are rejected. "In the old days it used to be done in secret, behind closed doors, in smoke-filled rooms," Rawlins said. "Now it's explicit. Everybody knows what the rules are."

Edited by Agatha:  Trimmed for rule 4

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Old 17th January 2017, 03:00 PM   #146
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And?
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Old 17th January 2017, 03:03 PM   #147
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Originally Posted by Darat View Post
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.
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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Old 17th January 2017, 03:11 PM   #148
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Originally Posted by BobTheCoward View Post
Nice refusing to approve okambi for cystic fibrosis is rationing.
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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Old 17th January 2017, 03:19 PM   #149
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Originally Posted by Darat View Post
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.
Trying to do? I'm using how rationing is used. The Head of NICE describes how care is rationed. And since the vast majority of the world does not use market clearing prices to determine quantity supplied, the vast majority of healthcare services are rationed.
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Old 17th January 2017, 03:27 PM   #150
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Originally Posted by BobTheCoward View Post
Trying to do? I'm using how rationing is used. The Head of NICE describes how care is rationed. And since the vast majority of the world does not use market clearing prices to determine quantity supplied, the vast majority of healthcare services are rationed.
Tell me how NICE rations the number of broken bones that can be treated in the NHSs of the UK?
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Old 17th January 2017, 03:30 PM   #151
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Originally Posted by Giordano View Post
Sorry, but although I think that your health care is very, very good, I would be surprised if there was NO rationing.
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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Old 17th January 2017, 03:33 PM   #152
BobTheCoward
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Originally Posted by Darat View Post
Tell me how NICE rations the number of broken bones that can be treated in the NHSs of the UK?
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.
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Old 17th January 2017, 03:34 PM   #153
Cain
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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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November 2nd, 2016:
Cain: Americans are so ******* stupid.
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Old 17th January 2017, 03:51 PM   #154
Aepervius
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Originally Posted by BobTheCoward View Post
Nice refusing to approve okambi for cystic fibrosis is rationing.
You were already told this is only approved under breakthrough therapy with a priority review by the FDA and only 18 months ago. Try something which has a normal approval. But nice try repeating that one.
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Old 17th January 2017, 03:55 PM   #155
BobTheCoward
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Originally Posted by Aepervius View Post
You were already told this is only approved under breakthrough therapy with a priority review by the FDA and only 18 months ago. Try something which has a normal approval. But nice try repeating that one.
Which isnt relevant to anything I said then or now.
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Old 17th January 2017, 04:03 PM   #156
Aepervius
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Originally Posted by BobTheCoward View Post
Which isnt relevant to anything I said then or now.
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.
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Old 17th January 2017, 04:06 PM   #157
BobTheCoward
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Originally Posted by Aepervius View Post
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,.
They choose to do those things.
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Old 17th January 2017, 04:39 PM   #158
Giordano
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Originally Posted by Steve View Post
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.
Whatever it is called I am happy that enough money is provide to allow fairly wide accessibility to the very best health care. Not true in the USA, and somewhat limited in some other countries.
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Old 17th January 2017, 04:41 PM   #159
Giordano
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Originally Posted by pgwenthold View Post
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.
Absolutely, but somehow people in the US still can be convinced by politicians that this is only true of "socialized" medicine...
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Old 17th January 2017, 04:46 PM   #160
Giordano
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Originally Posted by BobTheCoward View Post
Nice refusing to approve okambi for cystic fibrosis is rationing.
Orkambi is a mildly effective, very new drug that works only for 3% of CF patients. It is enormously expensive. I can understand the NHS being cautious about approving this drug. It is made up of two separate components- are these approved individually?
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