BS: Universal Medicine in the USA.

Subject: BS: Universal Medicine in the USA.
From: Peace
Date: 30 Sep 07 - 05:40 PM

Assume that it could become a reality. That it's possible. Don't get on the negative side of it for at least 100 posts. What can you come up with to get things rolling in that direction?

Subject: RE: BS: Universal Medicine in the USA.
From: Emma B
Date: 30 Sep 07 - 06:17 PM

From Cradle to Grave
A (very) brief history of the UK transition to a National Health Service

Subject: RE: BS: Universal Medicine in the USA.
From: Ebbie
Date: 30 Sep 07 - 06:17 PM

Well, I'd like to get a dialogue going about cherry picking. So often the wheel gets reinvented when it isn't necessary. I'd like to study the systems that other industrialized nations use and pick from them the things that work...

Subject: RE: BS: Universal Medicine in the USA.
From: Emma B
Date: 30 Sep 07 - 06:19 PM

I confess, I have a vested interest, this system saved my life (the first time) in 1949!

Subject: RE: BS: Universal Medicine in the USA.
From: McGrath of Harlow
Date: 30 Sep 07 - 06:26 PM

I have a vested interest Along with over 60 million more of us.

That doesn't mean it's perfect of course. I imagine the French would say the same about their rather different system, and so would the Germans and Irish...

Subject: RE: BS: Universal Medicine in the USA.
From: Emma B
Date: 30 Sep 07 - 06:28 PM

Ebbie there are numerous websires - too many too list - about the organization of Health Care in Europe (encompassing a number of political systems) that Europeans, such as myself, find the arguements presented by Americans like John Hardley totally incomprehensible.

Subject: RE: BS: Universal Medicine in the USA.
From: Peace
Date: 30 Sep 07 - 06:31 PM

The Official version in Canada.


"Canada's health care system has been a work in progress since its inception. Reforms have been made over the past four decades and will continue in response to changes within medicine and throughout society. The basics, however, remain the same - universal coverage for medically necessary health care services provided on the basis of need, rather than the ability to pay."

Subject: RE: BS: Universal Medicine in the USA.
From: pdq
Date: 30 Sep 07 - 06:37 PM

From the Emma B site:

"The Act took into national public ownership the 1,771 English and Welsh local authority hospitals and the 1,334 voluntary hospitals. The overall administration of the system was the responsibility of a health minister through regional hospital boards. General medical and dental services were directed through executive councils, with other health services catered for by county and county borough councils.

As a result, from 1948, the NHS provided a wide range of medical services to the public, including: hospital and specialist services, general practitioner (medical, dental, ophthalmic and pharmaceutical) services, ambulance services and community health services.

Access to these was to be free of charge for UK residents, unless a statute declared otherwise."


Nationalizing the health care industry in Great Britain may have worked, but it is not the right thing for the United States.

We have over 80% of our population saying they are happy with their health care and do not want any major changes, expecting that things would get worse, not better.

We need to improve the system for the other 20%.

Subject: RE: BS: Universal Medicine in the USA.
From: Don Firth
Date: 30 Sep 07 - 06:47 PM

I posted a few things on "that other thread" that more properly belong here. First of all, a few facts:

The World Health Organization ranks the U.S. health care system 37th in the world for quality and 55th for fairness.

The United States is the only industrialized country that does not have universal health care.

For a country that likes to think of itself as the moral leader of the world, I'd say we're not doing very well.

And second, a powerful advocate for Universal Health Care in the United States is Jim McDermott, Democratic Representative from the 7th Congressional District of Washington State. Jim McDermott, by the way, is a doctor

He has this to say about Universal Health Care:   CLICKY.

Obviously, McDermott favors Universal Health Care (sponsoring a bill in Congress), but his speech is well-laden with interesting facts and figures. Well worth reading as a primer on the subject.

Don Firth

Subject: RE: BS: Universal Medicine in the USA.
From: bobad
Date: 30 Sep 07 - 06:55 PM

The first step to universal health care in the U.S. should be the elimination of the insurance industry in the process. Why should a significant percentage of money spent on health care go to increasing profits for the industry and it's investors? Cut out the middle man and put those monies into providing medical care to ALL citizens.

Subject: RE: BS: Universal Medicine in the USA.
From: Don(Wyziwyg)T
Date: 30 Sep 07 - 07:03 PM

Subject: RE: BS: Shrub begins new war- on sick children
From: Don(Wyziwyg)T - PM
Date: 30 Sep 07 - 06:46 PM

"give everyone any kind of medical procedure that they wish as well as what they need."



Two points John, before you abandon the discussion.

1. This is not a case of elective as opposed to necessary surgery, but of necessary as opposed to emergency surgery, as I am certain you are well aware.

2. How dare you accuse a member of this forum posting under his proper Mudcat moniker of being a troll, simply because he asks whether something reported on an international news channel of considerable repute is true.

You are not noted for meanness of spirit, but this is unworthy of you.

I have copied this to this thread, not to derail discussion, but in the faint hope that it may reach the attention of the man who has falsely accused me of being a troll.

I don't suppose that it will result in the apology I feel is due to me, but it might just prick his conscience.

Don T.

Subject: RE: BS: Universal Medicine in the USA.
From: GUEST,mg
Date: 30 Sep 07 - 07:16 PM

I hope for the day but I fear the interim transition...these are the same types that run our schools, etc.

I would try to have safety nets started right now with public health nurses and public health hospitals...nurses put all over the place, visiting nurses, vaccinating nurses, nurses assigned to churches and neighborhoods and police stations and schools. They are some of the smartest people around and no-nonsense. They can do 95% of what is needed I bet...will miss some things that a doctor would have caught, and vice versa...but overall very helpful.

Numerous sliding scale clinics for routine and non-catastrophic things.

Mobile clinics for rural areas.

Remember, the most horrible things take place on a battlefield, and they are helped by medics...so we overdepend on way more education than is really needed for the usual bronchitis, broken arm, ear infection etc.

We also overprescribe. If we quit doing that, we could save money (and they know that they shouldn't prescribe antibiotics for some things, like viral illness..oh but the patient requested it..so what? )

We misunderstand diabetes and metabolic syndrome and hypoglycemia which is part of the progression. Much dietary advice is bad. People are going to have to divert some of their junk food money and other money (eventually prescription) into the diets that are good for their metabolisms, not that of the 24 year old dietician. Get a handle on what causes this (genetic factors, too many carbs especially white starches and insufficient exercise) and you can reduce heart problems, and all other sorts of chronic diseases.

Train prisoners who are smart enough etc. to be medical workers..they will have trouble getting jobs when out, and this will help, and they can serve the underserved and go where others are not willing to go perhaps to serve the most needy...you have to be sensible aobut this where drugs are concerned of course, but it can be done.

A good percentage of high school students should be earning medical licenses, such as CNA and be in TRACKS oh yes TRACKS so they can get a two or four year degree expiditiously. With more people getting services and not more servers, things could get bad really fast.

Assume people should pay what they can really pay...not 90% of their social security, but some sliding scale..enough to have the ouch factor but not too bad...people have to take responsibility for aspects of their care, but at the same time avoid the catastrophic things that can occur..a $10,000 limit or so on total amount owed might be OK...

Someone has to say when enough is enough...beautification procedures for good enough looking people...fertility treatments above and beyond pretty minimal corrective surgery etc. Heart transplants for 95 year olds...there will have to be a universal understanding of the fact that we will have limits.

Allow people to pay for what they can above and beyond or instead of. These plans that idiotically tie everyone into government and only government care are no good for anyone.

Lots of scholarships for those who go into public health programs.

Private health should not be killed though. The market should be allowed to have its say for a number of things, including medical advances, wiht public health taking up the slack. mg

Subject: RE: BS: Universal Medicine in the USA.
From: Ebbie
Date: 30 Sep 07 - 07:22 PM

"Initially, there was some fierce opposition, including threats of non-cooperation from the British Medical Association (BMA) over issues of responsibilities and pay. But Aneurin Bevan, the Secretary of State for Health, pressed ahead and the NHS was introduced on July 5 1948." From Emma B's link

That's not surprising. Threat of change creates fear. But as some in the UK and in Canada have said, Just try to take it away from us now!

"We have over 80% of our population saying they are happy with their health care and do not want any major changes, expecting that things would get worse, not better." pdq

I really would like to see the documentation for that statement. I've been looking at the statistics tables for 2007 and they, without exception, show millions of Americans without adequate, affordable, available health care. The stats all show tremendous cost and without exception project that the costs will rise.

Subject: RE: BS: Universal Medicine in the USA.
From: Emma B
Date: 30 Sep 07 - 07:42 PM

Of course "medicine for profit" is going to cost a lot more too

I've tried to find comparative figures - I'm sure they're out there somewhere - but the best I can do to date is compare the expenditure per capita in Europe on health care in 2006 as £2348 compared to the US of £5711 in 2003.

Subject: RE: BS: Universal Medicine in the USA.
From: Peace
Date: 30 Sep 07 - 07:45 PM

"Seven years ago, the World Health Organization made the first major effort to rank the health systems of 191 nations. France and Italy took the top two spots; the United States was a dismal 37th. More recently, the highly regarded Commonwealth Fund has pioneered in comparing the United States with other advanced nations through surveys of patients and doctors and analysis of other data. Its latest report, issued in May, ranked the United States last or next-to-last compared with five other nations — Australia, Canada, Germany, New Zealand and the United Kingdom — on most measures of performance, including quality of care and access to it. Other comparative studies also put the United States in a relatively bad light."

From

a New York Times editorial.

Subject: RE: BS: Universal Medicine in the USA.
From: McGrath of Harlow
Date: 30 Sep 07 - 07:49 PM

Doctors would generally be better off in a free-at-the-point-of-use service.

Maybe the ones who are in it to make a killing, rather than make a living, might lose out - but what kind of doctor would it be who was in it to make a killing?

The people who would stand to lose would be some sections of the insurance business (others might stand to gain in fact), and the impression I have is that this is the source of massive propaganda aimed at persuading the public and the medical profession that they have something to fear in changes which would provide free health care for all.

The British National Health Service is a product of a particular time in a particular society, in a relatively centralised country. I suspect that for the USA the German model might be more likely to suit. Here is a short overview of Health Care in Germany Germany, which of course is a Federal Republic, has a system that is insurance based, with, I understand, a major part played by church linked medical services. All things that should translate readily enough to the USA.

Subject: RE: BS: Universal Medicine in the USA.
From: bobad
Date: 30 Sep 07 - 07:51 PM

"Government and private health and public policy analysts have compared the health care systems of Canada and the United States.[1][2][3][4] In 2004, per-capita spending for health care in the U.S. was more than double that in Canada: in the U.S., it totaled US$6,096; in Canada, US$3,038.[5] Studies have come to different conclusions about the result of this disparity in spending. A 2007 review of all studies comparing health outcomes in Canada and the U.S., in a Canadian peer-reviewed medical journal, found that "health outcomes may be superior in patients cared for in Canada versus the United States, but differences are not consistent."[6] Life expectancy is longer in Canada, and its infant mortality rate is lower than that of the U.S., but there is debate about the underlying causes of these differences. The World Health Organization's ratings of health care system performance among 191 member nations, published in 2000, ranked Canada 30th and the U.S. 37th, and the overall health of Canadians 35th to the American 72nd.[7]"

http://en.wikipedia.org/wiki/Canadian_and_American_health_care_systems_compared

Subject: RE: BS: Universal Medicine in the USA.
From: pdq
Date: 30 Sep 07 - 08:24 PM

World Health Organization Assesses the World's Health Systems

"The World Health Organization has carried out the first ever analysis of the world's health systems. Using five performance indicators to measure health systems in 191 member states, it finds that France provides the best overall health care followed among major countries by Italy, Spain, Oman, Austria and Japan.

The findings are published today, 21 June, in The World Health Report 2000 – Health systems: Improving performance.

The U.S. health system spends a higher portion of its gross domestic product than any other country but ranks 37 out of 191 countries according to its performance, the report finds. The United Kingdom, which spends just six percent of GDP on health services, ranks 18 th . Several small countries – San Marino, Andorra, Malta and Singapore are rated close behind second- placed Italy.

WHO Director-General Dr Gro Harlem Brundtland says: 'The main message from this report is that the health and well- being of people around the world depend critically on the performance of the health systems that serve them. Yet there is wide variation in performance, even among countries with similar levels of income and health expenditure. It is essential for decision- makers to understand the underlying reasons so that system performance, and hence the health of populations, can be improved.'"

                            continued here

Subject: RE: BS: Universal Medicine in the USA.
From: pdq
Date: 30 Sep 07 - 08:41 PM

By the way, the US is ranked 37th because of "fairness" and "distribution of financing" and not on the actual quality of care. In that department we are probably the best. We ceratianly are the source of almost all new medicines and most new proceedures.

Subject: RE: BS: Universal Medicine in the USA.
From: Peace
Date: 30 Sep 07 - 08:49 PM

"We ceratianly are the source of almost all new medicines and most new proceedures."

If you say so. However, . . .

Subject: RE: BS: Universal Medicine in the USA.
From: Emma B
Date: 30 Sep 07 - 08:57 PM

The overall performance of the United States health care system was ranked 37th by the World Health Organization (WHO) in 2000, but the same report assessed Americans' overall health at 72nd among 191 member nations included in the study.

The health care system in the U.S. has a vast number of players — there are hundreds, if not thousands, of insurance companies in the U.S........... "The Health Care Crisis and What to Do About It" By Paul Krugman, Robin Wells, New York Review of Books, March 23, 2006

This system has considerable administrative overhead, far greater than in nationalized, single-payer systems, such as Canada's. An oft-cited study by Harvard Medical School and the Canadian Institute for Health Information determined that some 31 percent of U.S. health care dollars, or more than $1,000 per person per year, went to health care administrative costs, nearly double the administrative overhead in Canada, on a percentage basis..........^ Costs of Health Administration in the U.S. and Canada Woolhandler, et al, NEJM 349(8) Sept. 21, 2003

Subject: RE: BS: Universal Medicine in the USA.
From: bobad
Date: 30 Sep 07 - 08:59 PM

Americans spend twice as much on healthcare as other countries, but it turns out that they're not getting twice the quality for the price when they go to the doctor or hospital.

In the first international comparison of healthcare quality, researchers found that of the five countries studied, none is consistently the best or the worst. For instance, Australia had the best breast-cancer screening, but the worst survival rates for childhood leukemia. This was best in Canada, but that country had the worst heart-attack survival rates. And while the United States led the way in five-year survival rates from breast cancer, it was the worst for kidney transplants.

The conclusion: Each country has something to learn from the others

http://www.csmonitor.com/2004/0505/p02s01-uspo.html

Subject: RE: BS: Universal Medicine in the USA.
From: Peace
Date: 30 Sep 07 - 09:00 PM

Well said, bobad.

Subject: RE: BS: Universal Medicine in the USA.
From: Emma B
Date: 30 Sep 07 - 09:09 PM

"Nationalizing the health care industry in Great Britain may have worked, but it is not the right thing for the United States."

possibly........ look to your neighbours America

Subject: RE: BS: Universal Medicine in the USA.
From: Peace
Date: 30 Sep 07 - 09:20 PM

Universal Health Care can be made to work. Indeed, it must. I opine the biggest stumbling block is accepting that it is the right of every human to adequate health care. To suggest otherwise is, imo, akin to saying some folks are just more naturally deserving than others. That'd be a tough one to explain.

Subject: RE: BS: Universal Medicine in the USA.
From: bobad
Date: 30 Sep 07 - 09:23 PM

Good link Emma.

Two big impediments to the US looking to it's neighbours are the "we're no.1" attitude and the "socialism" bogeyman trotted out by politicians and their financiers at the mention of universality.

Subject: RE: BS: Universal Medicine in the USA.
From: Peace
Date: 30 Sep 07 - 09:26 PM

That's easy enough to argue in any country that has had a military draft. If the country is good enough to die for then the country's good enough to live for.

Subject: RE: BS: Universal Medicine in the USA.
From: Emma B
Date: 30 Sep 07 - 09:30 PM

A recent article in Business Week put it bluntly: "In reality, both data and anecdotes show that the American people are already waiting as long or longer than patients living with universal health-care systems.......

.....not all medical delays are created equal. In Canada and Britain, delays are caused by doctors trying to devote limited medical resources to the most urgent cases. In the United States, they're often caused by insurance companies trying to save money.......

.......A cross-national survey conducted by the Commonwealth Fund found that America ranks near the bottom among advanced countries in terms of how hard it is to get medical attention on short notice.

Paul Krugman, New York Times july 2007

full report on The Waiting Game here

Subject: RE: BS: Universal Medicine in the USA.
From: Don Firth
Date: 30 Sep 07 - 10:33 PM

Anecdotal datum:   to keep a particular presciption going, I have to see a specialist once a year. Notified by my pharmacist that the prescription was running out, I called the doctor in August to make an appointment. The earliest opening he had was on October 18th. His nurse did call the pharmacy and told them to keep filling the prescription.

But--two months to get an appointment!

Similar experiences with other doctors. Sometimes what I wanted to see a doctor about simply goes away before the appointment. But what if. . . ?

Don Firth

Subject: RE: BS: Universal Medicine in the USA.
From: pdq
Date: 30 Sep 07 - 10:53 PM

"The Commonwealth Fund is a charitable foundation established in 1918 by Anna Harkness (wife of one of the original Standard Oil investors, Stephen Harkness). Charged with the mandate to "do something for the welfare of mankind," Ms. Harkness founded the organization with an initial endowment of $10 million dollars. Her son Edward Harkness served as its first president, and through additional gifts and bequests between 1918 and 1959, the Harkness family's total contribution to the Fund's endowment amounted to more than $53 million.

The Fund is one of the major philanthropic foundations in the United States today and one of the few established by a woman. Over the years, it has given support to medical schools and to the building of hospitals and clinics in rural areas. In New York City, the Commonwealth Fund was a major contributor to the building of Columbia-Presbyterian Medical Center of the College of Physicians and Surgeons and Presbyterian Hospital at Columbia University in 1922."      ~ Wiki

Subject: RE: BS: Universal Medicine in the USA.
From: Kent Davis
Date: 30 Sep 07 - 11:37 PM

THREAD CREEP AHEAD, but I thought it might be useful.

Don Firth and others,

In our practice, established patients are often seen within 24 hours if they are sick, and the wait is rarely over 72 hours. If they call early in the morning, they are often seen the same day. If the diagnosis is obvious and the risk of complications is low, they do not even need to be seen; we handle everything over the phone (at no charge) including calling in the prescription, if any. This is not only true at our practice but is common among primary care physicians, at least in our area (West Virginia and Appalachian Ohio).

However, sometimes patients tell me that they've waited for weeks for an appointment. This tends to happen when people call for an appointment without saying WHY they want one. Some things can wait; others can't. Patients who are not sure whether something can wait or not can and should ask. As a rule, they'll get an answer that day. If they think it can't wait that long, they probably ought to go to a quick-care facility or emergency room.

For chronic condition such as diabetes or high blood pressure, we set up the NEXT appointment before they leave the office. Try that with your specialist.

Hope this is helpful.

Kent Davis

Subject: RE: BS: Universal Medicine in the USA.
From: katlaughing
Date: 01 Oct 07 - 12:15 AM

That is good information, Kent, but in some areas, such as western Colorado, some specialists are few and far between. For instance, there is now only one nephrologist to serve all of western Colorado. That is a vast area. He had a partner, they both worked through the largest hospital between Denver and Salt Lake City. His partner quit to save her life; she had no time for anything but rushing around. They BOTH are fantastic about giving a patient as much time as they'd like to ask all of the questions, etc. They are both wonderful doctors and truly thorough, understanding, and compassionate. I know if there were an urgent need they could get me in, but usually it takes 6-8 months to get in, esp. now there is only the one. It is an insane way to live and I totally understand the one quitting.

I know of a doctor on Cape Cod who stopped taking ay insurance at all. She notified all of her patients and helped them find other docs who could take them if they just could not pay for her services. She did so because the paperwork was too much. Now, when someone goes to her and pays $100 for an hour, or whatever she is charging, they know they will get to talk to her for an entire hour with no pressure to move along, etc. much the same as I do when I go to my acupuncturist. I know I have a solid hour of treatment and consultation with him.

I know we could never expect all docs to to the same as her, but it sure seems to work for her and those patients who like to work on a cash basis. I respect her for saying "no" to the insanity and scaling back to what she knows she can handle with integrity intact.

IMO, the biggest stumbling block to any kind of universal healthcare in the US is the insurance companies and drug companies. They are in bed together, have incredible profits, and are not going to give any of that power up willingly.

Subject: RE: BS: Universal Medicine in the USA.
From: Kent Davis
Date: 01 Oct 07 - 01:00 AM

katlaughing,

I totally agree that insurance is a huge part of the problem. Have you ever considered what would happen to, say, grocery prices if millions of people had "grocery insurance"? If millions got "free" groceries or had only a low co-pay? If the poor had "Foodicaid" and the elderly had "Foodicare" and both got their groceries without regard to their real cost, but with their grocers heavily regulated?

Kent

Subject: RE: BS: Universal Medicine in the USA.
From: John MacKenzie
Date: 01 Oct 07 - 04:47 AM

My doctor has just bought himself a new Aston Martin DB9!

Subject: RE: BS: Universal Medicine in the USA.
From: Peace
Date: 01 Oct 07 - 09:44 AM

Guitar player?

Subject: RE: BS: Universal Medicine in the USA.
From: Bee
Date: 01 Oct 07 - 10:17 AM

I think many Americans are unaware of how people in other countries regard their health care system - it just seems barbaric to us, that people in a wealthy modern country can go without basic medical care because of insurance or finances.

I have an elderly American aunt who went ten years with a simply corrected common condition which causes incontinence in older women. She couldn't afford to have it fixed. Her medical insurance (through employment) in the US considered it a non-essential procedure. Her eventual solution was to move back to Canada, where she hadn't lived since 1948, and stay long enough for MSI to kick in so she could get some treatment. (Annoying, because she hasn't put anything into Canada, and thinks the US is a much better country, plus was a truly aggravating longterm guest for her relatives).

I've often read on US forums complaints from people made miserable by minor ailments they let go too long because of the cost - infections allowed to get very serious, pneumonia allowed to become disabling, eye infections threatening sight. These people aren't even complaining about the system, but beating themselves up for having a bad insurance company, or being unemployed, or poor.

I cannot fathom why any American would not be pushing their government to start working on a better system, and yet many seem to think public health care = communism (or welfare).

Subject: RE: BS: Universal Medicine in the USA.
From: Emma B
Date: 01 Oct 07 - 10:25 AM

Another situation where a fine word can take on a derogatory meaning

Welfare - well being, freedom from want, sickness etc.
          activity designed to improve social conditions of an
          individual or group.

Subject: RE: BS: Universal Medicine in the USA.
From: Peace
Date: 01 Oct 07 - 11:05 AM

A public welfare system separates civilization from barbarism. We are indeed the keepers of our brothers and sisters.

Subject: RE: BS: Universal Medicine in the USA.
From: GUEST,Neil D
Date: 01 Oct 07 - 02:53 PM

I've seen cited on another thread the high cost of doing business for doctors as an argument against universal haelthcare. The highest cost of doing business in many cases is their malpractice insurance premium. In some regions this is driving some doctors out of fields like ostetrics completetly. Once again insurance is the problem. If malpractice insurance were nationalized along with health insurance would this smooth the way toward universal coverage.
   How about more in the way of grants instead of loans for qualified medical students to get rid of some of that debt burden. I've always thought that free public education should be extended through college anyway. If 12 years of public school was a good idea in the 19th century 16 years should be the equivalent in the 21st.
   If some of the financial burdens on doctors could be eased the medical community might be less hostile to the concept of universal healthcare, although the insurance industry would be more obstructionist than ever.

Subject: RE: BS: Universal Medicine in the USA.
From: PoppaGator
Date: 01 Oct 07 - 03:07 PM

In the current US system, not only does a large share of the healthcare dollar go to insurance-company profits ~ more to the point, a huge proportion of the money and man-hours is spent in finding reasons to DENY care to insured applicants.

The unfairness to uninsured citzens is a whole other ball of wax.

I think we'll get some kind of universal health system fairly soon because it is in the interest of the multinational corporations (often erroneously called "American Big Business") to unload the extra expense of providing health plans to their employees in the US.

These organizations own our governmental representatives, having paid for their elections, and will soon insist that the US government start picking up the tab for medical care, just like every other national government in the "developed world." It's the only way for American workers (and American managers, too, for that matter) to compete globally on a relatively level playing field.

Subject: RE: BS: Universal Medicine in the USA.
From: Don Firth
Date: 01 Oct 07 - 03:36 PM

Yes, indeed, Emma! Now, it seems to me that I learned in my high school civics class (Do they teach civics in high school any more? I went to high school in the late 1940s, shortly after the Big Bang), that a few old geezers scribble something like

We the people of the United States, in order to form a more perfect union, establish justice, insure domestic tranquility, provide for the common defense, promote the general welfare, and secure the blessings of liberty to ourselves and our posterity, do ordain and establish this Constitution for the United States of America.

on some old piece of parchment. But then, who (including our fearless leaders) pay any attention to such old documents anymore?

(Now, Firth, don't be snide!)

Kent, it sounds like things are working pretty well in your area. I have tried making my next yearly appointment (cardiologist) before I leave the office, but am told, "We don't book that far in advance." And it's a bit hard to time the prescription because sometimes the doctor renews it for three months, sometimes six, and sometimes a year. He doesn't tell me.

I sort of wonder if it depends on how many more payments he has to go on his Chris Craft.

I live in an area of the city (Seattle) that's rich (!) with hospitals, clinics, and doctors' offices. I'm just a few blocks from what the "locals" refer to as "Pill Hill." But they all seem to use the same standard recording on their telephone answering machines:   "Please leave your name and telephone number after the beep. If this is a medical emergency, call 911." 911, of course, is the city-wide emergency number for calling fire, police, or Medic One. Seattle, I am told, is a great city to have a heart attack in because if you call 911 and ask for Medic One, a well-equipped van with a couple of paramedics will often appear at your door, amazingly enough, within three to five minutes. They will give emergency treatment on the spot, then transport you to a nearby hospital if necessary.

Medic One is paid for by taxes. And it's one of the services the city is proudest of.

Medic One.

But once you get to the hospital, it's on your dime. Or your insurance company's, which the hospital will determine as you are being admitted. Or, in some cases, before you will be admitted. Stock question:   "Do you have insurance? How is this to be paid for?"

There is one clinic in my vicinity where it is possible to get an appointment within a day or two, sometimes the same day. "The Country Doctor." It has a small permanent office staff that makes appointments and handles the paperwork, processing insurance claims (if there are any). I don't know how the place is supported. The doctors, I am told, are volunteers who take time from their own practices and come in a couple of days a month. The clinic provides primary care service. But if you need X-rays or something like that, they have to send you to a nearby hospital that they have some kind of arrangement with because The Country Doctor has very little equipment, and most of that, as I understand it, has been donated. They have no facilities for a heavy-duty medical emergency. The care there is pretty darned good, considering. But you almost never see the same doctor twice in a row, so there is no continuity. At least, this was the way it was about ten or fifteen years ago.

I have been told that a factor that jacks up the cost of health care in the United States is one of the engines that drives Capitalism:   good old competition. If one hospital in a locality gets an MRI or a CAT scanner (mucho bucks. As in "Mega-!"), all the other hospitals in the area feel they have to have one too. And, of course, the cost of the gadget is divvied up over all the medical bills the hospital sends out (even if you don't get a scan yourself). In other countries, one CAT or MRI scanner in a locality is considered all that is necessary, and all the local doctors and hospitals send their patients there if a scan is deemed necessary. This keeps the cost of medical equipment within a particular locality down.

I have been told that, with its many hospitals, there are more CAT and MRI scanners in the city of Seattle than there are in all of Canada. And Canada is not bereft of such devices.

It has been said that the measure of whether a society is civilized or not is in how it treats its weakest members:    its children, its elderly, its poor, its disabled, and its ailing;   and in how it treats its criminals. Does it attempt to rehabilitated, or does it merely punish?

This has been attributed to many people:   Gandhi, Churchill, Jimmy Carter. . . .

It matters less who said it than it does that we heed it.

Don Firth

Subject: RE: BS: Universal Medicine in the USA.
From: Peace
Date: 01 Oct 07 - 03:37 PM

The insurance companies themselves should be the subject of a congressional review.

Subject: RE: BS: Universal Medicine in the USA.
From: artbrooks
Date: 01 Oct 07 - 06:32 PM

Not to say that the ridiculous cost of medical care in the US is mostly driven by the desire to increase the profit margins of the insurance companies, but medical education also plays a very interesting role.

Most medical schools are university-affiliated and are proud of being very well equipped. One result of this is that medical students are taught that CTs, MRIs, EEGs, EKGs and so forth are standard/normal diagnostic tools and wouldn't consider a medical workup on a patient to be complete without them. As a result of this, they generally won't go to work somewhere after their residency is complete if these aren't available to them, which forces their prospective employers (and a very large number of physicians, especially new graduates, are "employees" rather than having an independent practice) to either own this very expensive equipment themselves or have it available on a contract basis. And of course, to complete the circle, once you have it you are going to use it and bill accordingly.

Subject: RE: BS: Universal Medicine in the USA.
From: John Hardly
Date: 01 Oct 07 - 06:49 PM

You're not implying that you want practices to not have that equipment, are you? ('cause it sorta sounds that way).

Subject: RE: BS: Universal Medicine in the USA.
From: artbrooks
Date: 01 Oct 07 - 06:56 PM

In many cases it is not necessary for a diagnosis, but physicians order a MRI (for example) because their training pushes them to order one each of everything. Then the patient (or the insurance company) pays for it. The physician gets no compensation for ordering the test, in most cases.

Subject: RE: BS: Universal Medicine in the USA.
From: bobad
Date: 01 Oct 07 - 07:02 PM

Often tests are ordered by a physician in order to cover their butts in case a patient brings a malpractice suit against them.

Subject: RE: BS: Universal Medicine in the USA.
From: John Hardly
Date: 01 Oct 07 - 07:28 PM

I think that there's something a little more insidious (not evil insidious -- just hidden insidious) than doctors just doing it *because they were taught that way* to the ordering of all tests.

Yes, I agree that it has to do with CYA for lawsuits. That may even be the biggest factor.

But the other factor is that everyone thinks they're a doctor these days. Sit around and chat with a doctor for a while and the discussion is bound to soon come up -- a large percentage of their patients comes into their appointments loaded for bear.

They've seen all the advertisements for prescription drugs and think they know what's best for them. Additionally, alternative medicines have made a huge comeback and REALLY well-educated people are regularly duped by quackery -- but they are sure they know more than their doctor. And they've been watching every doctor-on-TV show from Marcus Welby M.D. to House. They know what an MRI is for dad-gummit, and they expect it.

It will take some getting used to practices with only government owned equipment. For an MRI one will probably have to travel a bit (All those European countries that are socialized have about the area in miles of one of our States) until the cost of equipment like that goes way down and more machinery can be disbursed everywhere.

Lots of our hospitals are incorporated too. The stockholders (workers with their retirement accounts diversified through mutual funds etc.) will lose the value in medical stocks (just as the average worker did with the enron scandal when the savy saw the collapse but didn't share the info) as they become completely worthless. Maybe with enough lead time the savy ones can pull their medical stocks and reinvest them into something else.

Of course, those hospitals will still exist complete with whatever equipment they already have -- assuming that the government will send government doctor/managers to the hospitals that already know what's what. They'll probably just maintain as much of the staff that a hospital currently has that is willing to work for the government.

And, in reality, those who are put out of business, like my brother, will be selling their services a penny on the dollar at first because their cost of living won't just disappear just because they no longer have their own practices. So government run facilities will probably have a bit of a glut of doctors for a while. Then they can start tracking young students and grooming them as medical workers in the new system. They can manage the number of doctors to make sure that there aren't too many new ones coming into a glutted system, or give incentives to more students if they anticipate a doctor shortage.

Subject: RE: BS: Universal Medicine in the USA.
From: artbrooks
Date: 01 Oct 07 - 07:39 PM

Perhaps so, John Hardley. However, my own experience is based upon working for over 20 years in a government-run medical program, in which all of the employees worked for the government, were immune to personal lawsuits and where the patients were generally ignorant of medical advertisements. This is also a system which normally scores well above the national average in both Joint Commission evaluations and patient satisfaction surveys. I refer to the VA, of course.

Subject: RE: BS: Universal Medicine in the USA.
From: katlaughing
Date: 01 Oct 07 - 07:41 PM

Oh, John, have you read nothing? It doesn't have to be either/or. There are always more than two solutions. Folks have posted plenty of examples of how docs made the transition, still kept their private practices, etc.

I agree with you about the medical ads; people self-diagnose according to the television ads they see and hear. I wrote an editorial about it years ago when they first started allowing prescription drug ads. I wish they would ban them, again.

Not all alternative medicine is quackery.

Subject: RE: BS: Universal Medicine in the USA.
From: Bobert
Date: 01 Oct 07 - 07:59 PM

Well, one thing is for sure and that is the American health care system is not working for US as a country...

We spend the highest percentage of of GNP on it of any developed country and we still don't live as long or as well as most of our developed country counterparts...

This, in itself, should have us scratching our heads 'cause something is wrong...

B~