Tuesday, November 18, 2008

Socialized Medicine Can Kill You

BLOOMBERG -- Jack Rosser's doctor says taking Pfizer's Sutent cancer drug may keep him alive long enough to see his 1-year-old daughter, Emma, enter primary school. The U.K.'s National Health Service says that's not worth the expense.

The NHS, which provides health care to all Britons and is funded by tax revenue, is spending about 100 billion pounds this fiscal year, or more than double what it spent a decade ago, as the cost of treatments increase and the population ages. The higher costs are forcing the NHS to choose between buying expensive drugs for terminal patients and providing more services for a wider number of people.

Rosser, 57, was told the cost of Sutent, 3,140 pounds ($4,650) per treatment for his advanced kidney cancer, was too high for the NHS -- the government agency that funds the nation's health care. The resident of the town of Kingswood, in southwest England, has appealed the decision twice, and next month may find out if his second plea is successful.

Rosser's wife, Jenny said "It's immoral. They are sentencing him to die. The policies seem aimed more at saving cash than treating people. It seems like a money-saving exercise. If a patient dies, tough.''


HT: Ben Cunningham

46 Comments:

At 11/18/2008 9:24 AM, Anonymous qt said...

What can you say about a service that prescribes books to patients suffering from clinical depression rather than providing counselling and/or anti-depressant medication? It's known as bibliotherapy and of course, the patient pays for the book.

Patients do learn a new word...triage. It isn't just cancer patients. My father-in-law had difficulty getting treatment for pneumonia because he was old and they wouldn't treat him.

 
At 11/18/2008 9:46 AM, Anonymous Anonymous said...

Our national "news" media (ABC,NBC,CBS,CNN,PBS,etc) ignore the horror stories from the U.K., Canada, Australia and the rest. They're are determined to sell the socialist program to an ignorant American public. Tragically, I think they will succeed.

 
At 11/18/2008 9:48 AM, Anonymous Fred said...

Dr. Harold Shipman of Britain's NHS murdered 250 of his patients over a thirty year period.

How is it possible to kill that many patients over that long a period and go undetected? My guess is that Shipman's predations didn't appear to be outside of the norms of routine care.

 
At 11/18/2008 9:54 AM, Anonymous zoroab said...

Thank you Americans for not liking socialized medicine.Thanks to your suspicion on big government we Europeans communists are enjoying several times cheaper drugs.Big pharma is having huge profit margins in USA so they can compensate for low prices all around the world where the evil state dictates the prices.Thanks laissez-faire Joe for subsidizing my medical expenses.

 
At 11/18/2008 10:18 AM, Anonymous Anonymous said...

Too bad he's not here, he could pay out of pocket like we get to do! Or perhaps he could pay out of pocket in England with the money he's saving by not having to pay for his own insurance.

As GWB used to say, "Bring It On", the "socialized" medicine that is, like the "socialized" medicine we already pay: big player bailouts, home mortgage interest deductions, section 121 exclusions and on.

 
At 11/18/2008 10:51 AM, Anonymous jrich said...

The patient's wife hits the nail on the head:

The policies seem aimed more at saving cash than treating people.

It may start out as trying to help the 45 million who don't have health care (many of which choose not to have health care) but it eventually becomes about the money or lack thereof.

 
At 11/18/2008 11:15 AM, Anonymous Anonymous said...

Zorab,

It's true that the governments can use their monopoly position to negotiate lower prices on new drugs, as drug manufacturers have a limited time on their patents in which to recover costs and make a profit, but generic drug makers do not suffer under the same time constraints and there is where the illusion of cheaper drugs fall apart:


"Senior citizens in Canada pay on average twice the amount American seniors do for generic medications, according to a report from the Fraser Institute.

Between 2003 and 2006, prices in Canada for generic drugs increased significantly relative to prices in the United States ...

The Fraser study found Canadian seniors paid 118 percent more than their American counterparts for the same generic drugs in 2006. In 2003, those drugs were 64 percent more expensive for Canadian seniors than they were for Americans.

"High prices for generic drugs are caused by misguided public policies that shield retail pharmacies and generic drug manufacturers from the competitive market forces that would put downward pressure on the price of generic drugs," the report found."

http://am.eri.ca/commerce.web/product_files/SeniorsDrugPrices.pdf


While we're talking about drugs, it's important to note, as the Bloomberg article points out, that under most socialized programs access to new drugs, therapies and technologies is restricted by the government which means that sarcastic Euroweenies like you may die from otherwise treatable sicknesses.

 
At 11/18/2008 11:30 AM, Anonymous RebelRenegade said...

Don't private insurers do this in the US also? Deny experimental treatments based on cost? I could swear this was in the news not too long ago about someone's daughter being sick and the ins. co. refused some kind of treatment.

 
At 11/18/2008 11:47 AM, Blogger rufus said...

Romneycare is the way we'll go.

 
At 11/18/2008 11:48 AM, Blogger Eben Flood said...

Yes they do, but the drug in the article isn't an experimental one, it's an approved and widely used cancer treatment.

 
At 11/18/2008 11:48 AM, Anonymous qt said...

jrich,

That is precisely what happens. Cost containment starts to compromise access to care and quality of care.

We've seen this in Canada. The major costs are in labour and equipment rather than drugs. Cuts to enrollment in medical school enrollment and nursing school, salary caps, inadequate funding for diagnositc imaging, cuts to hospital funding and long term care.

The result of years of underfunding can not be reversed overnight. A prescription drug can ordered and made available at the drop of a hat. You can't fix a shortage of primary care physicians, and nurses overnight. These people take years to train. A major percentage of medical personnel in Canada is set to retire in the next 10 years.

The waiting lists for referral to a specialtist, or for cancer treatment or hip replacement surgery are documented by the Fraser Institute. By contrast, a patient can pay and get prompt treatment in the U.S. which can be the difference between life and death for cancer.

Funding decisions were made by politicians who looked at short run gains rather than consider the long term consequences of their mismanagement. Instead, we got unaudited regional spending on doondoggles like Ontario Place and Science North and a massive national dept courtesy of the Liberal Party of Canada.

The truly ironic thing is that our politicians use private clinics. The Mayo Clinic in NYC is a particular favorite.

It reminds one of the Cuban slogan "Death or Revolution". It's death for you but not for me.

 
At 11/18/2008 12:03 PM, Anonymous zoroab said...

Many people might not have access to new drugs, therapies and technologies but they are not dying of diabetes and other common diseases and their only chance to see a doctor is not in the emergency room(even if they have to wait for a month).American health care system might be great for socialized medicine for neothe top 20% but what happens for example with black males who live less than Brazilians(10,000GDP per head.Unfortunately for neocons socialized medicine means Cuba and Michael Moore.There is no medium solution.Singapore also has a private system but costs are controlled and health statistics are among the best in the world.USA is already spending 12% of GDP and it is as effective as Malaysia(ooops I quoted Michael Moore,the statistic is still true though).

 
At 11/18/2008 12:34 PM, Blogger Adam said...

zoroab,

While some of what you have said is true, you use skewed numbers to arrive at your conclusions. The prime example is the 20%. My health insurance treats me very well and I'm no where near the top 20%, in fact I'm not in the top 40%. I've lived in Canada, and to claim, as Moore and others do, that other systems treat the average person better, is simply not true, and does nothing more than show their opinion, or more accurately, their personal idealogy.

Singapore does not have many of the challenges that the US does, culturally, politically and economically. Simply opening the us health care market in the way Europe has, or anyone else for that matter, is ignoring many finer details, especially unintended consequences. Many of these are personal preferences and display the attitude of the residents, not necessarily better or worse.

Canada is willing to let people die of brain cancer because it took 2 months to get an MRI, and in the US we consider that a tragedy, and a risk not worth taking. This is only one of thousands of specific examples, and could comparisons could be made for months. To say we are wrong, does nothing but show your own pre-suppositions which help construct your personal opinion.

 
At 11/18/2008 12:44 PM, Anonymous Anonymous said...

In what way does this article show that the program there differs from the program in the US? All I see is a report of an individual who was unable to gain treatment because of a policy choice. So it cites one example of a hard choice, huh, not like any insurance companies make choices on who to cover, what treatments are made available, etc... People are denied treatment in part and whole everyday in the US, just here in the US, its not news because it happens so frequently.

 
At 11/18/2008 12:58 PM, Blogger VH said...

zoroab,

Our population “dying of diabetes and other common diseases” does not reflect on the level of U.S. medical care but rather on cultural eating habits. (If you go to an emergency room, do you really think patients wait a month?) Furthermore, there is little correlation among advanced nations between health care expenditure. The U.S. spends more than 14 percent of GDP on health care compared with South Korea’s 6 percent, yet females born in the two countries have roughly the same life expectancy (79.8 years vs. 80.0 years). Mind you, the roughly 12-14% that the U.S. spends on health care is spent by our government for the government –run Medicare program which creates all sorts of perverse distortions in the heath care economy.

 
At 11/18/2008 1:12 PM, Blogger Patrick said...

I guess I don't see the issue here. Yes, it's tragic that he can't get coverage to live for a few years more. That is a choice that people face on a regular basis socialized medicine or not. Not even private insurance will cover all of the cost of that kind of medicine. I think any "successful" HC system has to put a cap on spending money per person. Let's face it, at some point prolonging your life with a terminal illness becomes a luxury, not a necessity. If we were talking about getting an organ transplant to save his life so he could live a "normal" life it would be a different story.

 
At 11/18/2008 1:28 PM, Anonymous LoneSnark said...

I see no problem with this. As long as the NHS does not bar him from obtaining the medicine himself, something it has done in other cases, or prevent him from buying insurance ahead of time that would have provided this medicine, then I have no problem with this.

It is the right of any insurer to decide ahead of time what treatments they will and will not cover, as such the same right should be granted to the government when it makes itself the insurer of first resort.

 
At 11/18/2008 2:04 PM, Anonymous qt said...

Adam,

My husband had to wait 8 months for an MRI for his shoulder. He is unable to raise his right arm above 90 degrees as a result. A condition that could have been successfully treated surgically.

In Ontario, there are thousands of patients who do not have a family doctor.

Patrick,

I agree that in the case of a terminal case, spending an exorbitant amount for treatment does not alter the prognosis. The danger of arguing on the basis of a single victim impact story is that it provides little information beyond its emotional appeal.

What you do not realize is the extent to which care has been compromised in the UK. When a hospital in the UK goes to the extreme measure of turning the bedsheets over between patients rather to reduce laundering expenses, one truly has to question the extent to which cost has taken precedence over basic elements of quality of care as patient safety.

Zorab,

How can one compare Singapore with its highly concentrated population and limited landmass to the U.S. which faces vast challenges to deliver medical services populations spread across a vast geographical area not to mention the difference in diet, indemic diseases (ie. malaria), as well as the difference in diseases relating to the ethnicity of the population? ie. Asian men have a 1 in 100 chance of developing prostate cancer vs. 1 in 7 for American males. Even when an Asian man changes to a western diet (ie. by moving to the U.S.), his risk increases but comes nowhere close to that of the American male.

Singapore would be more comparable to Hong Kong. Canada is a far closer comparison in terms of ethnicity, indemic diseases, diet, geography, family income, etc.

 
At 11/18/2008 2:43 PM, Anonymous Rand said...

The sooner a patient dies, the less money it will cost the National Health Service. Therefore, there is no incentive to keep patients alive. Once the cost of keeping the patient alive exceeds the patient's payments into the system, the patient becomes a write off. Unless, of course, the patient is politically connected or a celebrity.

 
At 11/18/2008 3:01 PM, Anonymous jrich said...

One thing I've not seen addressed or glossed over at best in just about all of the blogs, news stories and other items I've seen on the topic of nationalizing health care in the US is the sheer size of the undertaking relative to the socialzed/nationalized health care of Western Europe. For example, the UK has approximately just over 61 million people as of 1/1/08. On the other hand, the US has just over 305 million. That's a huge difference and the very scale of difference should give Congress and POTUS pause when considering European models of health care policy.

 
At 11/18/2008 3:01 PM, Blogger Patrick said...

QT,
I would agree that cost cutting meausures on the scale of reusing bedsheets is egregious. I actually support the idea of socialized medicine in the U.S. even though I support free-market solutions for almost everything else. The reason I feel that it would be better is that a free-market solution to anything means that someone has to "lose" when that comes to healthcare the consequences are inexcusable. My perception of the current non-socialized system is that you have providers on one side, insurance companies on the other with the patient in-between. The insurance companies already dictate how much they will cover for which procedures. The providers have no choice but to accept what insurance pays and try to get what extra they can out of the patient. The result is something very similar to what a socialized system does which is dictate to providers how much something is worth. The only difference is that insurance companies are still trying to make a profit while a government entity is not. Government entities create waste and inefficiency, but so do insurance companies all while making a profit to boot.

 
At 11/18/2008 3:29 PM, Anonymous amit said...

Maybe someone can explain this to me:

The marginal cost of production for 1 new drug pill/dose is relatively low. Why is UK's NHS charging or being charged so much? Shouldn't the NHS system be getting a cheaper quote with volume buying?

I like America's system better. In America, we don't chose between life and death. Our health care system problems are fixable with creative tax policies and competition.

 
At 11/18/2008 3:41 PM, Blogger Michael said...

No insurance coverage can too! So what's your point?

 
At 11/18/2008 3:48 PM, Blogger Adam said...

qt,

so are you describing a situation in the US? If so, it runs contrary to what I've seen literally hundreds of times...if in canada, it is exactly what I'd expect...in fact, the pastor of my church there had his foot shattered and other parts of his leg messed up really bad, and he's had 12 surgeries, all of them in the US, because they are operations no one in Canada does.

 
At 11/18/2008 3:52 PM, Anonymous qt said...

Patrick,

Certainly, socialized medicine has its attractions. Basic economic theory would suggest that a government monopoly of any resource results less than the socially optimum quantity of the good.

Personally, I favor a mixed system which is what most countries with public systems have. There are certain services which are more effectively delivered by the private sector. It is not much fun being sick and trying to deal with an insurance company nor is it fun to try to fight for access to treatment as many of us outside large metropolitan centres do in Canada.

In Canada, politicians have a zero tolerance for private alternatives to the public system to the point where a U.S. firm providing diagnostic tests to detect risk for stroke was actually thrown out of the province for the infraction of charging less than $100.00 for the tests which included the brackial-ankle index.

Stroke remains the leading cause of institutionalization in long term care and a major cause of disability. Politics trumped the social cost of disability which far exceeds the cost of prevention.

In Canada, healthcare has become highly politicized. Decisions on health care made on the basis of political ideology are little better than those made by an insurance company in quest of ROI. One is merely exchanging one bad master for another.

The Canadian system is a 3 tier system. 1 tier is the private option of seeking treatment abroad. The second tier is the well-connected, patients who receive the best treatment and know all of the best doctors due to their extensive social and professional contacts. The third tier is everyone else who depending on their geographic region gets some form of treatment. There is no rating system for physicians or hospitals to help them find even a primary care physician let alone a specialist. They depend on the kindness of strangers and like Blanche in Streetcar Named Desire, sometimes, that doesn't work out too well.

Milton Friedman said it best when he spoke of the public policy angels that would, in theory, organize our society to look after all of our interests.

There are no angels to take care of us. At the end of the day, our health problems are our reality not the insurance co's or the doctor's. They can all walk away from the problem but the patient cannot.

 
At 11/18/2008 4:06 PM, Blogger Patrick said...

QT,
I fear that you are more than correct about exchanging one bad master for another. I had always envisioned a multi-tier system like you describe actually working fairly well if there was provision for a component of private insurance or payment for additional or discretionary services not otherwise covered.

Do you, or anyone else, know of a socialized system that allows for supplemental private insurance to cover things like experimental or exorbitantly expensive treatments?

 
At 11/18/2008 4:43 PM, Anonymous qt said...

Adam,

The 8 month wait for an MRI was in Oakville, Ontario, Canada. My husband suffered a complete radical tear of the rotator cuff in the shoulder (totally ripped tendon, the end of the muscle) thanks to an orthopaedic specialist who prescribed exercises lifting a weight for a torn tendon in his shoulder. I have encountered 2 other patients with classic rotator cuff tear symptoms (ie. can't lift their arm above 90 degrees without sharp pain) who were also prescribed exercises.

Even a high school student can tell you that a muscle contracts when it is used, the effect of exercising the bicep is to pull on tendon which connects the muscle to the bone. If the tendon is torn, contracting the muscle pulls on the tear further tearing damanged tissue. In my husband's case, lifting a weight repeatedly caused the tendon to completely snap resulting in extreme pain and blacking of the upper arm. He had an MRI scheduled for the left shoulder in 2 weeks but the diagnostic clinic refused to change the MRI to the right shoulder and told him he would have to wait for another MRI for the right shoulder.

Emergency surgery could have reconnected the tendon at this point but instead, he was putting on a waiting list for an MRI.

After 8 months waiting to get an MRI, my husband's rotator cuff tear was no longer operable. The result was permanent disability.

Curiously, I met an architect who worked at a hospital in Toronto who was able to get an MRI on his knee within 48 hours of his injury.

The U.S. experience:

Through the internet, I was able to find the leading orthopaedic surgeon in North America, Dr. James Andrews in Birmingham, AL (you may have heard the name because he treats all the top U.S. atheletes and is a pioneer in the field of shoulder reconstruction and scoping). I was able to get a referral and make an appointment with Dr. Andrews at the Alabama Sports Medicine Clinic within 2 weeks.

When we arrived they took 8 additional x-rays. Dr. Andrews had an extensive consultation and explained that my husband's shoulder could no longer be repaired. He also took the time to explain how the joint worked and what types of movements my husband should avoid in order to minimize his ongoing pain.

The charge for these services in 2004 was exactly $200.00 USD (yes, two hundred).

This information might help another patient. Rotator cuff tears are very common and patients are generally not aware that the condition can result in permanent disability. Quality of care in large urban cities is substantially better than outlying regional areas such as mine.

As the Supreme Court of Quebec says "Access to a waiting list is not access to health care". The system in Canada favors pro-active, highly educated, city-dwelling patients who have contacts in the medical field.

 
At 11/18/2008 4:48 PM, Anonymous qt said...

Patrick,

Best resource to find that would likely be the Fraser Institute. According to what I have read there, Canada is a bit of an anomaly in this regard. Most of the public systems around the world have a combination of private/public options.

 
At 11/18/2008 6:19 PM, Blogger dmarks said...

It makes no sense to advocate socialised medicine, which would put all health care control and decisions into one unaccountable monopoly.

@anonymous said: "not like any insurance companies make choices on who to cover, what treatments are made available, etc... "

But in the US you can go find another insurance company. For now, anyway. If we get a nationalized system, you would have to leave the country in order to have health care choices.

 
At 11/18/2008 6:44 PM, Anonymous Anonymous said...

After all it is all about -- how much the society values life.

It is an economic question not just philosophical issue.

If the cost of saving a life is higher than the saved one who can produce in the future, it is not worth to spend much resources into treating him. It sounds cruel but a hard fact.

mL

 
At 11/18/2008 7:07 PM, Anonymous jrich said...

qt, I live in Birmingham and you're right about Dr. Andrews. World class.

dmarks, you're right on the money when you point out that "...in the US you can go find another insurance company." The only problem with the system right now is that if you're insured through your employer, you may not have a choice, and individual insurance can be expensive, depending on age, family, medical history, etc. It's not an entirely free market as it is, which is why it doesn't work as well as it could...competition is limited.

 
At 11/18/2008 7:24 PM, Anonymous Anonymous said...

---Rosser's wife, Jenny said "It's immoral. They are sentencing him to die. The policies seem aimed more at saving cash than treating people. It seems like a money-saving exercise. If a patient dies, tough.'' ---

Unless she has a source of unlimited money, these decisions will have to be made everywhere, no matter what the system is. Sorry.

 
At 11/18/2008 8:18 PM, Anonymous Ralph Short said...

Here is the deal, if we were tax supporting deadly diseases like Cancer, MS, and other ailments that are not life choices then most Americans would support it. We could do that with private cos. but underwritten by the taxpayer. The disaster of socialized medicine is it always goes for treating everything much of which is imagined. Accordingly, government starts to ration.

In the end, like the case presented it becomes "doctor assisted suicide" in a more malignant form than what a few states here in the USA have approved.

 
At 11/18/2008 8:36 PM, Anonymous qt said...

Anon.,

That is why using the example of a terminal case is only a starting point rather than the end point of the discussion. There have been numerous posts here describing socialized healthcare and its affects on non-terminal patients:

1. inadequate investment in state of the art diagnostic imaging equipment (Canada trails the OECD countries in MRIs per capita; fewer than South Korea or Belgium)
2. lack of investment in training medical personnel (nurses, doctors, diagnostic imaging technicians) creating shortages of qualified medical professionals and increasing waiting times for specialties
3. presently Canada is trying to limit of specializations to one rather than allowing specialists to change fields (ie. a surgeon can only perform for a about 15 years and routinely, surgeons switch to another specialty resulting in specialists with cross functional knowledge that results in better care for patients)
4. imposition of salary caps lowering staff retension and creating an incentive for the best and brightest to take jobs in the U.S;
5. imposing quotas on doctors who are required to push patients through their offices

The question is not what should or should not be spent on a terminal case but:
1. how long is too long to wait for cancer treatments?
2. what is society willing to pay for a physician who has spent 12-15 years training?
3. should by-pass surgery be provided to anyone beyond the age of 65 who no longer generates a return on investment to society? is the answer different if we are talking about keeping a 1 lb. premature baby alive which costs many fold more? do we as a society have a right to put a price on either life since both patients can be saved?
4. is it acceptable that a patient have to suffer chronic pain for 2 years before they can get hip or knee replacement surgery?
5. is it acceptable to provide a waiting list rather than access to timely, quality care?

In short, there are many other moral and ethical questions that need to be asked. The least of those is how much money we wish to spend on terminal cases.

 
At 11/18/2008 8:59 PM, Anonymous Anonymous said...

Patrick,

Insurance companies are part of the problem not because they are trying to turn a profit but because of the government.

Insurance companies are regulated by the states. Each state has its own mandates, which means that the insurance companies can't offer the coverage individuals want but must instead offer the coverage government mandates. This means that people pay for coverage they don't want, leaving less disposable income to spend on treatments they want but the insurance won't cover (Hail Mary treatments, for example). In states like New York, mandates drive the cost of insurance so high that many can't afford it.

State regulation also means that insurance companies are protected from competition, which always increases costs for consumers and regulation itself raises the cost of doing business for the insurance companies. Reducing regulation and allowing insurance companies to cross state borders would cut costs dramatically.

I don't know why you perceive that in a free market system somebody always has to lose. Also, the U.S. doesn't have a free market system, as I've pointed out. In a free market system, people could choose the exact health insurance they want and the insurance companies would be free to compete to provide it to them.

 
At 11/19/2008 12:48 AM, Blogger Patrick said...

Anonymous,
Please don't think that I believe insurance companies are evil simply because they are trying to turn a profit. As I said in an earlier post I am a free-market capitalist on everything but this. I can see your point about state regulation driving up the cost of insurance. I don't know the exact regs, but I'm sure they are illogical and politically motivated at the core. However, I think that if the state is going to mandate what coverage can be provided then they are eliminating the free-market mechanism and therefore introduce costly inefficiencies to the system. I think we agree on that aspect at least.

I would love to see a truly a la carte system where you paid for the insurance you felt you needed and nothing more. I could live with such a solution, knowing full well that not paying for cancer insurance meant I would not get treatment if I were so diagnosed. However, our society does not have the stomach for such a rational solution to health care. People expect that if they are diagnosed with a catastrophic illness they will be taken care of regardless of whether they have the means to pay for treatment or not. This is where somebody has to lose in a free market health care system. Not everyone who is diagnosed with a terminal illness will have opted for the appropriate coverage, and consequently will have to come up with money for treatment or die.

Personally, I think it to be more efficient if there is a state system that takes responsibility for a basic level of care for the people. In our current system we pay for the uninsured anyway because their care is factored into our bills. Doctors take the Hyppocratic oath that they will not deny care to those who truly need it regardless of their ability to pay for the service. That throws a wrench into the whole free-market system and renders is horribly inefficient.

 
At 11/19/2008 2:34 AM, Anonymous poor boomer said...

jrich said:

The patient's wife hits the nail on the head:

[i]The policies seem aimed more at saving cash than treating people.[/i]

It may start out as trying to help the 45 million who don't have health care (many of which choose not to have health care) but it eventually becomes about the money or lack thereof.


Unsocialized medicine kills also. It's just that the people killed are different in either case, and in the case of unsocialized medicine, it's easy to blame (as jrich does) those who die for their own deaths.

 
At 11/19/2008 2:37 AM, Anonymous poor boomer said...

eben flood said:

Yes they do, but the drug in the article isn't an experimental one, it's an approved and widely used cancer treatment.


How many (non-Medicare) Americans have insurance which covers prescription drugs?

And isn't it ironic that the socialized medicine sector covers more prescriptions than does private insurance?

 
At 11/19/2008 2:46 AM, Anonymous poor boomer said...

adam said:

[i]Canada is willing to let people die of brain cancer because it took 2 months to get an MRI, and in the US we consider that a tragedy, and a risk not worth taking. This is only one of thousands of specific examples, and could comparisons could be made for months. To say we are wrong, does nothing but show your own pre-suppositions which help construct your personal opinion.[/i]



And in the US you get care and then you get a stack of bills you can't possibly pay, so you live on ramen and then you die early anyway because your diet sucks and you are ingesting entirely too much sodium.

 
At 11/19/2008 2:53 AM, Anonymous poor boomer said...

vh said:

[i](If you go to an emergency room, do you really think patients wait a month?[/i]


If you're earning minimum wage (and thus don't qualify for Medicaid) and you can't afford to pay, you wait a month or maybe indefinitely.

I waited and ultimately landed in the ER. In my case, I wasn't ambulatory at the time, spent a week in ICU, and stayed in hospital for two months.

By the time I was out of ICU, the hospital had me on Medicaid so they would get paid SOMETHING, because I certainly wasn't able to pay anything.

 
At 11/19/2008 3:26 AM, Blogger VH said...

"If you're earning minimum wage (and thus don't qualify for Medicaid) and you can't afford to pay, you wait a month or maybe indefinitely."

Several of my family members earn close to minimum wage and they qualify for (State or Federal) government assistance. So I don't understand waiting a month or indefinitely. Seems to me that you qualified for Medicaid but had not applied.

 
At 11/19/2008 7:39 AM, Anonymous poor boomer said...

vh said:

Several of my family members earn close to minimum wage and they qualify for (State or Federal) government assistance. So I don't understand waiting a month or indefinitely. Seems to me that you qualified for Medicaid but had not applied.


I'm guessing that your family members are parents or teenagers. In general, childless adults working full-time at minimum wage do not qualify for Medicaid

The rules vary from state to state, as there are federal mandates to cover certain groups (e.g. children below poverty level), with states having discretion to cover and fund others.

Since childless non-elderly adults are at the bottom of the political food chain in this country, they are the last to be covered by Medicaid, and in many states are not covered unless disabled and have extremely low income.

For example, in my state, Medicaid eligibility for a childless adult ends at approx $600/mo income.

While I worked at or near minimum wage for 30 years, I earned too much to be eligible. When I was in hospital, I was completely without income, and therefore eligible. I was unable to work for a year and qualified for Medicaid when I received approx $350 from SSI, then when Social Security Disability ($700) kicked in, I was kicked off Medicaid due to income ineligibility.

 
At 11/19/2008 9:24 AM, Anonymous Anonymous said...

Patrick,

You seem to believe that there are no losers in your system of socialized medicine. The losers are, in fact, the people who are forced to pay for those who won't. The catastrophic care you describe (cancer, in this instance) is actually pretty cheap for insurers to cover. Those who are truly indigent (and they are a tiny number) could receive health care vouchers from the state.

Many doctors are willing to work out payment plans with their patients. Unfortunately, insurance regulation stops them. Example: If a procedure is billed to the insurance company at $200 and the insurance always pays $100 for that code + the doctor collects the $10 co-pay, the doctor receives $110 for the procedure. If he billed the insurance company $100, he would only receive $50 from them. So he must bill $200 to receive $100 from insurance (yes, it's stupid but it's about to get worse). If an uninsured patient walks in and wants the same procedure, the logical thing to do is to charge the patient $110 - the amount the doctor would receive if he billed an insurance company for it. But he can't do that. If he bills the uninsured patient paying cash less than the $200 he bills the insurance company (even though the insurance company only pays him $100), it is INSURANCE FRAUD. Unbelievable, I know. He also cannot negotiate a different price for the patient if he wanted to. He can either charge what he bills the insurance company or he can take the case pro bono but nothing in between. Nice, eh? This is the case in at least Virginia and Illinois but probably in many other states. Who writes that law? Why, the government at the behest of the insurance companies it regulates. This is a government created problem which is easily solved, no? And that's just scratching the surface.

Not everyone who is diagnosed with a terminal illness will have opted for the appropriate coverage, and consequently will have to come up with money for treatment or die.

If they have a terminal illness, by definition, they will die with or without treatment.

Doctors take the Hyppocratic oath that they will not deny care to those who truly need it regardless of their ability to pay for the service.

This is not part of the Hippocratic oath. This is effectively enslaving doctors and it has never been part of the Hippocratic oath. Should a doctor wish to provide care free of charge, that's his business but it is not his ethical obligation. What right does he have to perform whatever procedures he chooses and then force a third party to pay for a patient's care? That's what socialized medicine does. The party forced to pay for the free rider is the loser in a socialized system. The difference is, the "loser" in a free market system is the same guy who didn't bother getting insurance and the loser in the socialized system is the responsible guy who is forced to pay for the guy who didn't bother.

Having lived in several countries with socialized medical systems (and having spent several years in and out of hospital there), here's what I've learned first hand: since socialized medicine is seen as an all you can eat buffet, everyone runs to the doctor for every minor malady imaginable. This puts a strain on the system which requires either an exponentially expanding budget or rationing. Rationing means that access to doctors, medical equipment and treatments is extremely limited and many seriously ill patients are forced to wait - to their detriment. As with all price controls, there are shortages of everything. Don't get into an accident at the end of the month in Britain because they may very well be out of their ration of morphine. More and more doctors opt out of the system. In a fully socialized system with no private options, the Soviet Union (where I spent several years - many of them in hospital), doctors simply refused to provide any treatment at all without "bribes" (adequate payment, really) and you first had to be well connected to find a competent doctor to bribe. The net result of socialized systems is greater waste and inefficiencies than a free market system and a much lower standard of care (one of the cost saving measures is severely reduced liability for doctors, so they don't care as much what happens to the patients).

Yes, it's possible to have a private system in addition to a socialized system. In fact, the socialized system in Europe works so poorly that most Western European countries have a booming private insurance industry and the best doctors won't accept NHS patients. The net result is that the wealthy simply pay for services and get the health care they can afford. The "poor" (whom national health care is supposed to save from not receiving treatment) are forced to wait so long to receive treatment that they either die on the waiting list or become crippled. In systems where there is no private alternative (Cuba, former USSR for example), only the politically well connected receive what an American would recognize as health care and everyone else has no access to aspirin (not hyperbole - that is the case in Cuba).

The moral of the story is there's no free lunch. At the end of the day, in either system, those who can afford it (or have great political connections - which serves to increase the power and corruption of politicians, of course), get health care and everyone else is left to suffer. Do we have the stomach for that?

A better alternative is to make this a truly free market system by making insurance not a third party payer but real insurance and allowing Doctors and insurance companies to compete. Competition is a great way to bring down costs.

 
At 11/19/2008 1:37 PM, Anonymous jrich said...

...it's easy to blame (as jrich does) those who die for their own deaths.

Sorry...I had to go wash out the words that poor boomer put in my mouth there.

Unsocialized medicine kills also. I didn't realize (or assume, as the case may be) that medicine kills anyone (with obvious exceptions of malpractice, etc.).

Do you really believe that it's medicine (or lack thereof) that is primarily responsible for ill health more so than unhealthy lifestyle choices (smoking, unhealthy eating habits, not exercising, excessive drinking)? All the medicine in the world (whether socialized, capitalized, homogenized, subjectivized, or one hour martinized) won't make Joe Schmo push away from the dinner table or skip the fried foods and exercise or stop smoking.

It's not a matter of people being to blame for their own deaths...often times it's their own choices that shorten their lives. They don't kill themselves, but they don't help themselves live longer.

This article is not about that though, it would seem. The situation seems to be a man who is otherwise healthy and his life is being shortened because of the choices of someone else (NHS in this case).

We shouldn't conflate those who are unhealthy because of irresponsibility and apathy with those who stay healthy and are stricken with something completely beyond their control.

We can discuss and debate ways to provide health care, but let's be careful not to absolve those who carry the blame for their own health issues of their responsibility to take care of themselves.

 
At 11/19/2008 6:39 PM, Anonymous poor boomer said...

I wonder whether jrich understands that many "unhealthy lifestyle choices" do not occur in a vacuum, but are often suboptimal responses to unchosen events?

For example, I would agree that a decision to start smoking is a choice. But if someone depressed or under a lot of stress overeats, to what degree is that a choice, and to what degree is it a response to an unchosen trigger?

Like it or not, in a "personal responsibility" society, hardworking underperformance is often very stressful. (Perhaps ironically, it is the most conscientious who become stressed most, while the uncaring slackers aren't bothered much, if at all.) If people self-medicate because they can't get prescriptions, is that an unhealthy lifestyle choice.

 
At 11/19/2008 8:03 PM, Anonymous jrich said...

No choices take place in a vacuum (especially in today's media driven marketplace). It's absurd even remotely to think they do. The problem is that your argument (if someone depressed or under a lot of stress overeats, to what degree is that a choice, and to what degree is it a response to an unchosen trigger?) overstates the case. At what point does it stop? To what degree is any action a choice and/or a "response to an unchosen trigger?" At what point does (insert wasteful spending, alcoholism, cussing, nose picking, gambling, smoking, drug abuse, child/spouse abuse, road rage, nail biting, assault, workaholism, or other action here) become more choice and less "response?" Who will be the arbiter of where that line is?

Mr. Rosser, on the other hand, had no choice in the matter (so it would seem)...good, bad or indifferent. His situation is not the same as the one's we've brought up and been discussing.

 

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