How many Americans are ill?

You will wait for a joint replacement in Ontario.  I say Ontario rather than Canada because it is usually lost that health care is a provincial responsibility although a federal mandate.  Anyway it is elective, you aren't going to die without it and you will have to get in line.  I'm not sure what the waiting time is now, not awful I think.

The bucket of health care bucks is not bottomless, not in any country.  I find rather horrifying what percentage of health care dollars are spent in the last few weeks of life, and I'm speaking of Canada - I don't know about the US.  It seems that countries are going to have to allocate resources, either by governments or by insurance companies.

I'll read through this thread when I have more time. Right now I'm on a very quick lunch moment from my job as a health care provider in the US. We are pushed to see as many patients as we can. We are not paid for most of what we do - like look at lab work and get those results to patients (which most people don't even do!), answer patient's phone calls, coordinate care with other providers, etc. And when I say we don't get paid I mean it - it's what I do at lunch, before work and after work. My employer only gets paid what the insurance companies say we can get paid for the face-to-face time I spend with patients so they don't feel the need to pay me for doing all of the extras that make my patients want to see me....

But, I did want to respond to the actual first post by encouraging you to read Atul Gawande's piece from the New Yorker:  http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande It will shed some light on why you see what you do here.

Shirley my dear, it isn't just assorted illegals/newcomers of varient types.  It is people like hedge fund peopole who pay no tax here at all even though their companies are here.!!  I have grave misgiving about aspects of the quantity of newcomers to a small island, but "overseas" companies do well out of us here.  Yes , a lot of the time they would go for private care, but not if they were in an auto accident or similar. 

It isn't just the incoming unwealthy that hit us, it is incoming wealthy too!   Labour doesn't want to start taxing them properly because they say we will lose a lot of business if they go.    Like the rest of us Brits are a bunch of thickos and can't create our own business. (but hey , we would have to pay tax for everything wouldn't we....Britain is a very divided country and there is no consensus of who we are, what we want to be, of indeed, is there any point in there being a nation state.

It has made no difference as to whether it is New Labour, (Blair's party) who have beeen in for 12 years, or the Conservative party, who are most likely to win the next election.  We have other small parties too.  We have lost our independence as an island race because of the European Union, amongst other more complex matters.

Private healthcare in England is not tax deductible.  In fact, if you get it as a "perk" with your job, you pay tax at your maximum rate (40%) on the premiums.  Shirley, your premiums are inexpensive compared to what mine would be in England, so that seems good.

I am getting a much clearer picture of how different systems work, and I do think there is much to be said for choice.  I still don't much fancy arguing with insurance companies, but it seems one ends up arguing with someone somewhere anyway, so what the hell.

Here, often one is paying for private care in order to jump forward in line if you've got a niggling problem which also might be painful.  Not all that many would go private really for the big things.  We have some private hospitals, but often the private wards are in NHS hospitals.  Same doctors!!

I don't like the idea of living in any country that would not take care of a poor person in a desperate situation.  However, I have paid in all my life and generally speaking have had a pretty poor time of it with the NHS.  Can I not expect at lest a modicum of manners and efficiency?

I don't think it is a good thing that people like our colleague JORF above is  giving such a lot of unpaid commitment to their work.  That certainly shows a flaw in the system.  None of the rest of us want to work unpaid/subsidise everybody else do we?

Lastly, in April this year, prescription charges were removed for people with cancer.  Howver, there is an institution called NICE in England which decides what drugs can be prescribed by the NHS.  Herceptin is not allowed for certain people with advance cancer.   That to me is not choice of any kind.

 Phew - this would make a great if heated debate on t.v.  wouldn't it?   Over here it would probably come to blows.......

Thanks so much for all the interesting info

I guess now that the presidential election is over we have to find another issue over which to have a p---ing contest?  Is that why pip asked the original question or was it just an innocent grenade thrown out there?  LOL

The question(s) (more like challenges) in the original post did raise my blood pressure; but I've calmed down.

Please, though, if you have time--everyone should read the New Yorker article in the link Jorf gave us. I just found the article this morning.  The article was cited in an op-ed commentary about health care reform that was in an oncology e-newsletter I get.  The claim in the oncology newsletter was that the immense pressure for change to the U.S. health care system, and the "breathtakingly short" legislative timetable, are due, in part, to arguments like those offered in the New Yorker article.

The New Yorker article is very, very long, but well worth the read.  Its author claims that much of the spending for health care in the U.S. is the result of "over-utilization" of resources--that is, tests and procedures that are really not necessary.  The author of the article provides some interesting evidence and, in some cases, sound arguments.  It should be noted that the author does not claim universal over-utilization of resources--he points out several examples of cost-containment despite excellent quality of care.

(I am trying to be open-minded about this, having argued against statements made earlier in this thread that a for-profit system encourages unnecessary testing.)

Anyway, gotta go for now--it's time for post-chemo haircut #3 already!

otter 

Vivre, I strongly disagree with you when you say quality of care is not an issue if you live in the US.  Quality of care is not an issue here if you have adequate insurance.  If you do not have insurance (and are not rich) you can't get quality care.  You can get emergency care - that is what is legally required.  On going care is another issue. 

In 2008 I had a total hip replacement, and two breast cancer related surgeries.  These were not emergency surgeries and I would have had to pay cash without insurance.  The total hosptial bill for my hip surger was over $100,000.  I think it was a bargin, but I would have had a hård time paying for it.  I don't know what the total billing for my breast cancer related surgeries was, but I am sure it was substantial.  The fact that I have insurance made it financially feasible.

I can not walk into the hospital and demand on going care for my le or the physical therapy I require after my mastectomy.  Such care is not considered an emergency and is not available without insurance or money. 

 If I loose my job, I would also loose my insurance and would have a hard time paying for medical care.  I don't know if I would be able to get insurance again as I now have a pre-existing condition.   I don't think I would  be elgible for any public program until I devest myself of all assets.  

I am more scared of the the insurance companies and pharmaceutical companies continuing to control health care than I am of governmental involvement.  We are being choked by high medical costs as it is.  I fear without reform health care will only be an option for the rich.

Well we can call it an argument, a pissing contest, a debate or anything else.  In defense of PIP, when you aren't used to them, all the billboards and other advertisements for health care providers are rather startling.  I was in Indiana and Ohio a few months ago and had much the same reaction.  It's just puzzling.   I've been even more bemused by full page ads for neulasta in the Ladies Home Journal.  I'm appreciating the comments from the UK and elsewhere.

That was a really interesting New Yorker article.  I grew up in the Rochester area and the Mayo clinic was always the ultimate in health care.  The history of it is very interesting, it wouldn't have gotten off the ground without the help of a order of Catholic nuns.  Now Rochester is a health care service town (Carmel, IN is not).  All the washrooms are wheelchair accessable and they have sharps disposals everywhere.  One of my uncles was a surgeon there in the 50-70s.  My sister works there now.  If every US citizen had access to a Mayo like system I think things would be a lot better and I would be less concerned about my friends and relatives.

One question I'd like to ask the president, congressmen/women and senators....would you be willing to be in the same health care plan that you decide WE need? 

As far as advertisements.  I hate prescription advertisements on TV.  I think it's stupid and a waste of money....money that could be used for a much better purpose..like lowering drug costs.  In fact when I hear their spill and then all the side effects I really think twice about the drug.  I certainly wouldn't tell my doctor that I saw such and such on TV and wondered bla bla bla.  One example of drugs I'm scared of....bisphosphonates.  I going to have a dexa July 1, and I'm thinking about the "what ifs."  I'm on Arimidex.  If my bone density is not up to par and if my onc decides whe wants me to take one of the drugs I may decide to decline and try alternative methods instead.

As far as ordering tests...who should make those decisions?  A panel or you and your doctor.  My onc does not do any scans unless there's a need.  And I certainly don't want the stress.  However, some women feel much better if they have scans.  Will the government stop doctors from ordering the tests they want for their patients?  I know that some insurance companies MUST give their approval before certain tests are run. 

We have a problem with doctors making money.  Why?  They spent many years in school and many $$$ getting that degree.  It's called CAPITALISM.  Lawyers (and one comes to mind...John Edwards) make millions suing doctors.  They also advertise.  They drive up doctors malpractice insurance.  Tort reform needs to looked at which the president isn't doing.  The Bar Association would be all over him if he was serious about that.

As someone who makes a living from the current health care system, I may loose my job if health care reform cuts big pharma profits too deeply. 

As someone who has benefited from Herceptin, I worry about innovation in health care drying up if health care reform cuts profits too deeply.

But I still want to see universal insurance of some type.  It is unconscionable that so many Americans have their savings wiped out to pay for their care . 60% of all personal bankrupties are related to medical bills.  

In the US we pay high prices for medical care and the rest of the world pays much lower costs.  This means that high health care costs in the US subsidize drug development and other innovation for the entire world.  This is unfair.

I guess I would like to see some kind of hybrid system, so we can keep our private insurance, and make insurance available to those without it on a sliding scale based on income.  Also, we need to limit reimbursement to providers to help drive prices down.  My hope is that we can do this without killing innovation and my job.  I hope Obama has the wisdom of Solomon.  He'll need it.

I think it's worth pointing out that even with so-called "socialized" medicine, many of us still have private insurance for things not covered by the public system (at least in Canada).  And in that respect, nobody is deciding for us what treatment we'll get.  Our public system in Canada covers mostly mainstream stuff that private insurance covers in the U.S.  But for things like dental work, chiropractic, naturopathic practitioners, even pharmaceuticals, well those are out-of-pocket expenses for reimbursement by employer health plans, if you're lucky enough to have one.  And even those vary in how much is covered.

Dear Orange, with respect, The US is not subsidising other countries.  Many countries are doing research work and developing drugs, treatments , devices for all diseases and these go on to be commercialised and in come then reverts to the developers (rough description but you get my drift).  Before my City career I worked in biotech; amongst other products we developed monoclonal antibodies.  Cost of treatment is predicated by the system in each country.  It would seem that perhaps there3 are aspects of US healthcare that need to address cost inflation.  (as could be said in numerous countries).   Of course I wish you very good luck with your job.

Actually, just to boast about my own country's scientific ability, the world wide web was invented by a Brit.   (sorry, got to have a little boast sometimes!)

Reading through the posts,  we  all seem to be focusing well as we sort through the thoughts, concepts and ideas of different contributors. 

As Churchill said

"Jaw-jaw is better than War-war" !

best wishes to all

I think what orange is saying about drug prices is probably correct.  The big pharmaceutical companies make more profit from drugs they sell here in the U.S. than they do when the same drugs are sold in other countries that have implemented price controls.

The big pharmaceutical companies admit that, up front.  They say that, if the U.S. starts regulating drug prices on a nationwide basis, as was suggested when the Medicare "Part D" stuff was being negotiated in Congress, they would have to cut back on research & development. 

Their research and development efforts are international--lots of their work is being done in countries other than the U.S.  And, once the discoveries are made and translated into marketable products, patients everywhere (worldwide) can benefit.

I'm not saying the drug companies' claims about profits are valid.  They are the arguments they're making to support their claims about free market-pricing of drugs in the U.S.

otter