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~

Subject: RE: BS: Universal Medicine in the USA.
From: John Hardly
Date: 01 Oct 07 - 08:13 PM

I read, kat. That doesn't mean I agree. No evil intent there, I'm just not seeing how an already existing practice -- for instance a practice that already KNOWS it cannot survive on medicare/medicade levels of payments (not in theory, but in real life practice) could expect that it will suddenly have its fixed costs of doing business taken care of when all payments are at the government-determined medicare/medicade level. It's not a hypothetical. It's real and my brother lives it.

And sure, it's just doctors. They're expendable just like any other worker whose livilhood is based on an outmoded idea. I'm sure no tears were wept for the slide-rule manufacturer when TI came along and made them obsolete.

On the other hand, it's a little different too. The slide-rule manufacturer was made obsolete and just went to another industry. But we will still need the doctors. Even the ones who used to be able to have a private practice (it'll be sort of a rich irony -- the private practices like my brother's will go up for sale and be picked up by younger doctors who will be able to buy them a penny on the dollar from the suckers like my brother, and with a new financial structure (that doesn't include a huge business loan -- having gotten the business so cheap), may well be able to make the same practice then work with medicare/medicade level payments).

This discussion has made me think about contacting my cousin to get his opinion. I hadn't really thought about him (relative to this discussion) because I just met him. We're both in our fifties, but because my father died when I was very young, and our families have always lived more than 700 miles apart, I never met the guy 'til last Summer. Anyway, he's a doctor who lectures internationally on stem cell treatment. He's a Johns Hopkins guy and has always been hospital-connected. I'd be curious to hear his take on the whole thing and how he thinks it will impact him. Would anyone be interested in his response if I called him and discussed it?

Subject: RE: BS: Universal Medicine in the USA.
From: McGrath of Harlow
Date: 01 Oct 07 - 08:28 PM

their cost of living won't just disappear just because they no longer have their own practices.

Why won't they have their own practices? How on earth do you think medicine runs in my country? Of course doctors have their own practices. Or put it the other way, of course patients have their own doctors.

I really do get the impression that the kind of system that you are objecting to, John, must have been dreamed up by people who are trying to sabotage universal health care in the States. Is this system you are on about actually really proposed, or is it black propaganda, maybe put out by the big insurance companies?

If it's real, it would hardly be difficult to come up with a system that wouldn't have those kind of drawbacks - just look around to countries which have been running systems like that for decades. And that's the way to oppose it, not trying to defend a totally absurd system that happens to have grown up in the absence of something better.

"they no longer have their own practices." Weird!!

Subject: RE: BS: Universal Medicine in the USA.
From: John Hardly
Date: 01 Oct 07 - 09:11 PM

McGrath, The doctors in your country did not buy their practices (which generally entails paying for them -- an ongoing thing when practices cost deeply into six figures) under a system whereby they could make the payments on their practices and still have sufficient left over for living...

...and then have the entire payment structure upon which those commitments to pay were pulled out from under them. All your doctors who own practices bought them under your current system. Do you think they could hold onto them if suddenly your "system" decided that all of a sudden your government was not going to pay as much as it had paying all along? Do you think the doctors who own their own practices could keep them if they were suddenly given only a small percentage of the fees upon which they had predicated the purchase of their practices?

Subject: RE: BS: Universal Medicine in the USA.
From: artbrooks
Date: 01 Oct 07 - 09:16 PM

McGrath, to the best of my knowledge, nobody has proposed a plan that has all medical providers either working for the government or required to accept Medicare payments. Hillary Clinton's plan, which has been seriously lambasted by her critics as the prelude to socialized medicine, is if you have a [insurance] plan you like, you keep it. If you want to change plans or aren't currently covered, you can choose from dozens of the same plans available to members of Congress, or you can opt into a public plan option like Medicare. And working families will get tax credits to help pay their premiums. That is from her campaign website.

Subject: RE: BS: Universal Medicine in the USA.
From: Bee
Date: 01 Oct 07 - 09:26 PM

Doctors here in Canada all have their own practices, their choice of how they deliver care, their choice of where they want to practice, how much time they want to put into it - why would a doctor lose his practice because of public medical care? We have shortages of doctors in some rural areas because most doctors prefer living in cities, but those shortages are usually short term: sometimes incentives are offered young doctors to practice in rural settings.

I live sixty five km from the city. There's a small 'emergency care' hospital about 20km away, attached to a nursing home. There's a medical clinic near that mini-hospital which has six doctors and three nurses in family practice, all with their own patients. One of them is my family doctor, but if I need an appointment before he can see me (he's very popular), one of the others will see me (I've never had to wait more than three days to see someone on a minor complaint - and that was my judgement; if I needed to be seen, I would get a same day app.). There are also plenty of single practice doctors in the city, and most specialists have private practices.

Doctors get paid per service, they aren't on salary.

Subject: RE: BS: Universal Medicine in the USA.
From: bobad
Date: 01 Oct 07 - 09:28 PM

The way it works here in Canada is that doctors either join an established practice or open one of their own, they then bill the government instead of the patients for services rendered. Pretty simple really.

Subject: RE: BS: Universal Medicine in the USA.
From: Barry Finn
Date: 02 Oct 07 - 02:52 AM

In this rich & wealthy land of ours we rate internationally pretty low overall on the health care scale, infant mortality, life expectancy, acess to proper medical treatment, costs, etc are 37th though we are consided to be one the formost in technology & wealth, so something isn't right. Our system is not in need of repair it is broken & is in need of replacement. It's not hard to take a lookat some US state systems that work as well as looking to those nations that run better programs (there are at least 36 of them) & taking a look at what works for them & applying the better parts of their systems into one that would work for us. Ms Clinton's plan may not be the best but at least she's looking towards a start which is better than what most are doing & even the presenting of a national health care plan is a step that most others are refusing to do. She was slamed the last time she brought this up & even then it's time was well over due.
I'd love to see her (once she's in the Oval Office) set up a commision to look at what the rest of the world is doing & go from there.
As it is outside of the wealthy one of the most important attractions of ione's job today is it's health benifits & those range anywhere from complete coverage at hardly any cost to no coverage & they either pay out of pocket, get their own coverage or go without. Much of the population that I see are trapped by their on the job health care coverage. Retire or quit, forget it your coverage costs skyrockets & the actual coverage plumets (don't tell me about Medicare coverage I opted for as much coverage as possible & that's slim for someone who needs a lot of it & very costly to boot). Your kids are screwd once the turn 18 (with the exception of a few states that are only now just changing that coverage to age 23-26 weither they're in college or not. Unions usually provide better coverage for their people because they are in a beter position to bargin for it but their getting hit too as we see from the new Auto contract. The Drug manufactures are making a killing on the living. My mother used to raise dogs, we have one of her's, she mentioned a medication & I said that that's the same thing my son takes. We were sure it couldn't be the same because she paid about .50 per pir for her dog's perscription when my son's cost about $5 for the same pill, it turns out to be the exact same pill & then we found out r=that this isn't uncommon. Canada's become an American market place for many older & not so old who are in need of cheaper med's, there's absolutely no just reason for this, it's a shame.
The high costs of liability medical insurance is uncalled for. Malepractice is more a threat than a reality, it's the insurance companies scapegoat for unduly raping the medical community. IN the Boston aarea yrs ago we had a scandle at a day care facility, three people were charged with abuse (falsely in the opinion of many) this gave the insurance companies the excuse they needed to hit this industry with uncalled price gouges for premium to be paid for even though incidents of this kind were extremely uncommon & still are even 15 yrs later but the costs of those premiums are still sky high even with the general knowledge that these 3 were not guilty of what they'd been convicted of. This is what the malepractice insurance is about high costs for high profits! Many of our elderly even though they're covered by medicare & medicade have to make the discision between medical care &/or prescriptions or decent food shopping, that's a system gone broke.
Much of the insurance industry today believes that they are the botton line on what type of medicane & medical procedures are exceptable too. They decide weither or not some prescriptions & procedures will be covered regurdless of what the medical staff may say. Many companies just routinely deny pretty much anything as policy & then it's a case for the sickly sucker to start chasing the insurance money down for the medical parctice that's getting the same shaft as the insured, that's part of what's killing the patient & the doctor, aside from the insurance companies overwhelming both to death in paper work that neither can afford to keep up with. So both doctor & patient head towards becoming bankrupt. The government is just as bad as the insurance companies in this aspect, they are extremely slow sometimes in paying they per set undercutting costs, it's funny that everyone except the uninsured pays out so little for services rendered that costs so much higher for the same & the payment is usually collected upon reciept from the same too or else the leg breaker comes for the deed to the family ranch or whatever else.
Anyone who thinks the system works hasn't had much experience dealing with it or is well off or one of the lucky ones to either have a very good plan from work or belongs to a very healthy family!

Barry

Subject: RE: BS: Universal Medicine in the USA.
From: McGrath of Harlow
Date: 02 Oct 07 - 03:33 AM

John's assumption seems to be that in a universal free-at-the-point-of-use system the doctors would get paid less than under the present one, and insufficient to cover their costs and give them an adequate income.

I suppose it would be possible to invent a system that worked like that, perhaps as a way of making sure it didn't get introduced, but it's not how it works in the other industrialised countries which have such systems.

Subject: RE: BS: Universal Medicine in the USA.
From: mandotim
Date: 02 Oct 07 - 06:19 AM

Just to correct a couple of assumptions about the UK National Health Service; General practitioners ('family doctors') do indeed have to buy their practices in the UK, as they are set up as independent contractors to the NHS. Hospital doctors are partially salaried, but are free to develop whatever private practice they wish, and they have to fund premises, staff etc. for this practice.
In a recent comparison, UK doctors were described as the best rewarded (financially) in the developed world.
Also; US healthcare is no longer a world leader in all areas of clinical practice and research (though it remains high on the list); much important work is now done in countries where costs are lower, such as the former Soviet states, China and India. This is particularly true in pharmaceutical development.
Hope this helps to inform a good debate.
Tim

Subject: RE: BS: Universal Medicine in the USA.
From: John Hardly
Date: 02 Oct 07 - 08:22 AM

"John's assumption seems to be that in a universal free-at-the-point-of-use system the doctors would get paid less than under the present one, and insufficient to cover their costs and give them an adequate income."

My assumption is that:

1. ....in a universal free-at-the-point-of-use system OUR doctors (in private practice) would get paid less than under OUR present one, and insufficient to cover their costs --costs, the financial risks of which were fixed and figured under our present system -- and give them an adequate income -- adequate enough to keep their present practices

2. This isn't a blind assumption -- we have the track record of insufficient payment from medicare/medicade to go on.

3. Many regular, middle class sorking grunts in America are invested in the medical care system we have -- by virtue of stocks and mutual funds in which their retirement accounts have been placed. Those too would become severely devalued.

We may decide that that's okay. We may decide to hell with doctors like my brother who invested his life into something for which he will get nothing. That happens all the time. That's why they call it "risk". But don't claim it's a win/win for everyone.

And, please....It doesn't help to have five or six of you repeating that your countries doctors own their own practices. I understand that. I read it the first time. I answered it the first time. Your doctors bought their practices (assumed the risk) under the system you have -- in other words, they knew going in what they could expect to be paid for services rendered. To make a comparison to what we are up against, you would have to imagine that your doctors assumed the risk of buying their practices AND THEN your health care system suddenly told them that their fee for services rendered was going to be severely reduced.

Subject: RE: BS: Universal Medicine in the USA.
From: Emma B
Date: 02 Oct 07 - 08:38 AM

John, I think it has already been explained to you that that is PRECISELY what happened to private practice when the National Helath Service was set up in the UK after World War 2.

There was initially considerable resistance, much as you have dwelt on

"Despite Bevan's repeated guarantees of clinical autonomy for both family doctors and specialists, and a massive majority in favour of the NHS Act in parliament, the BMA chose defence of "clinical freedom" as its rallying cry for opposition to the new service. One BMA leader described the NHS as "a step toward Nazism as practised in Hitler's Germany". Only four months before the NHS was due to start in 1948, the BMA was still refusing even to negotiate with the Minister, a stand endorsed by 9 out of 10 GPs on an 84% vote."

However.......

"Two months after the appointed day, 93% of the population was enrolled, reaching 97% by the end of the year. In spite of themselves, the doctors' feet were indeed set on a new path entirely. They learned from their own experience that release from fee- earning improved rather than impaired doctor-patient relationships. Public service enabled them to serve more people more effectively, at lower cost to the nation, with greater personal security and integrity than they ever had in private practice. By the end of the 1960s, most were supporting the NHS as vigorously as they had once opposed it, and so they have remained."

from ORIGINS OF THE NATIONAL HEALTH SERVICE

I think many other people from the UK have also commented on the excellent remuneration that General Practioners receive for this service.

Subject: RE: BS: Universal Medicine in the USA.
From: artbrooks
Date: 02 Oct 07 - 08:47 AM

Emma, I don't think John Hardley has yet answered McGrath's question: Is this system you are on about actually really proposed, or is it black propaganda, maybe put out by the big insurance companies? It appears to be an imaginary target, designed to provide an opportunity to rant. At any rate, having been involved in health care for many years as an administrator, and with a wife who is a health care provider, I follow the news on that topic pretty closely, and I've never heard of such a thing being seriously proposed.

Subject: RE: BS: Universal Medicine in the USA.
From: John Hardly
Date: 02 Oct 07 - 08:50 AM

" I've never heard of such a thing being seriously proposed."

You've never heard Universal Health care proposed? What is this thread about?

Subject: RE: BS: Universal Medicine in the USA.
From: John Hardly
Date: 02 Oct 07 - 08:54 AM

BTW, EmmaB, I appreciate the response. And that may well be the way things will work out. Though risks and investments are exponentially higher than they were back when your country made the switch, it's all a matter of scale.

Besides, our doctors are, by evidence of what they do, among our brightest citizens. They'll land on their feet. Many will probably lose their private practices and investments and retirements, but on a percentage basis, there are probably a number of them young enough to start over. They won't all be like my 60-year-old brother. And he won't starve either. He may just have to work longer. I know my brother. He'll work longer anyway.

Subject: RE: BS: Universal Medicine in the USA.
From: Emma B
Date: 02 Oct 07 - 09:49 AM

According to the philosopher Hegel, the only lesson of history is that men never learn anything from history!

Private Practice, Public Payment
Canadian Medicine and the Politics of Health Insurance 1911-1966
C. David Naylor Published 1986
McGill-Queen's Press

An interesting and objective look at the Canadian experience - many pages are available to read on the web site.

Subject: RE: BS: Universal Medicine in the USA.
From: Peace
Date: 02 Oct 07 - 10:01 AM

The reason history repeats itself is because historians repeat each other.

Subject: RE: BS: Universal Medicine in the USA.
From: John Hardly
Date: 02 Oct 07 - 10:06 AM

...that, and there's a tiny little scratch on the LP...on the LP...on the LP...on the LP...on the LP

If only there was some cosmic nickel to place on the tone arm.

Subject: RE: BS: Universal Medicine in the USA.
From: Peace
Date: 02 Oct 07 - 10:06 AM

In the parlance, 'drop a dime'.

Subject: RE: BS: Universal Medicine in the USA.
From: John Hardly
Date: 02 Oct 07 - 10:14 AM

I don't usually drop dimes in the parlance. Heck, I don't even refer to it as "the parlance". I call it "my livingroom". I had a cute little parlance guitar once, though.

Jack Parlance was scary.

Subject: RE: BS: Universal Medicine in the USA.
From: Peace
Date: 02 Oct 07 - 10:16 AM

You are a SICK man, John. Very sick. I could get to like you!

Subject: RE: BS: Universal Medicine in the USA.
From: John Hardly
Date: 02 Oct 07 - 10:21 AM

maybe Universal Health care could help me?

prolly not.

Subject: RE: BS: Universal Medicine in the USA.
From: artbrooks
Date: 02 Oct 07 - 11:27 AM

Universal health care, by some definition of the term, has certainly been proposed. A system of single-payer health care, with all medical providers either (1) limited to the amount of compensation authorized by Medicare or some equivalent or (2) required to work for a government entity of some sort has not, by any major political candidate or main-stream political party. If I am incorrect, please refer me to a creditable source for verification otherwise. I will readily admit that there may have been such suggestions made by entities on the idiot fringe.

Subject: RE: BS: Universal Medicine in the USA.
From: Peace
Date: 02 Oct 07 - 11:37 AM

"During his 42 years in politics, Tommy Douglas proved himself as an outstanding Canadian leader. He is largely responsible for our central banking, old age pensions, unemployment insurance, and our universal Medicare. When asked why he stayed with NDP when he could have done better with a more powefful party, Douglas simply replied, " I have watched politicians for the last forty years drop their principles in order to get power only to find that those who paid and controlled the party which they joined prevented them from all the things they really believed in."³ To the end of his days Tommy Douglas was true to himself, to what he stood for, and to the people he represented."

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

But why on Earth should the money doctors get be any less? If anything they could expect to get more since there'd be more people able to make use of their professional skills.

It may be that the proposed system that's been offered in the States is twisted in such a way as to work in way that screws doctors as well as patients by cutting costs to the bone, but that's just a reason to push for a better system that doesn't have those disadvantages and that still provides the kind of comprehensive health care that works pretty well in every other advanced country.

Or perhaps the appropriate way of putting it, that works pretty well in every advanced country.

Subject: RE: BS: Universal Medicine in the USA.
From: DougR
Date: 02 Oct 07 - 01:26 PM

I, for one, have no interest in a government run healthcare system. I just returned from a two week visit to Scotland and according to stories I read in the British press their system is anything but ideal if you really need healtcare. The government cannot efficiently run itself. We don't need government to screw up our system in the US.

DougR

Subject: RE: BS: Universal Medicine in the USA.
From: McGrath of Harlow
Date: 02 Oct 07 - 01:35 PM

We don't need government to screw up our system in the US.

That certainly appears to be the case...
...............................................

"anything but ideal" - well that's true of everything in this world isn't it?   Of course we don't think everything here is perfect, still less actually say so, because that's not the way we work over here - but I don't think there are many people, doctors or patients, who'd switch with the American system.

Subject: RE: BS: Universal Medicine in the USA.
From: DougR
Date: 02 Oct 07 - 01:48 PM

McGrath: A guaranteed way to further screw it up (our healthcare system) is to turn it over to bureaucrats.

DougR

Subject: RE: BS: Universal Medicine in the USA.
From: artbrooks
Date: 02 Oct 07 - 01:55 PM

Since there is no proposal to turn the system over to bureaucrats, other than the proposal set up by opponents of the imaginary proposal, there seems to be no real threat of such a proposal being implemented.

Subject: RE: BS: Universal Medicine in the USA.
From: Peace
Date: 02 Oct 07 - 02:00 PM

The most difficult thing to see is why people would be opposed to Medicare.

Subject: RE: BS: Universal Medicine in the USA.
From: McGrath of Harlow
Date: 02 Oct 07 - 02:08 PM

A guaranteed way to further screw it up (our health care system) is to turn it over to bureaucrats. And that's a good reason to do look into ways or organising a comprehensive health system that wouldn't do that.

But isn't your present health service largely run by bureaucrats already?   "An official who is rigidly devoted to the details of administrative procedure." Sounds familiar? For example accountants and other deskbound people working in insurance companies and hospitals.

Subject: RE: BS: Universal Medicine in the USA.
From: artbrooks
Date: 02 Oct 07 - 02:13 PM

Peace, the basic problem with Medicare is that rates are set by Act of Congress, on a national basis, and don't reflect the different costs in different parts of the country. Where I live, in Albuquerque, New Mexico, there is no problem at all in finding a doctor that accepts Medicare rates. The situation varies from place to place, since the cost of doing business (office rent, staff salaries, equipment costs, living expenses, etc.) is not the same nation-wide.

Subject: RE: BS: Universal Medicine in the USA.
From: McGrath of Harlow
Date: 02 Oct 07 - 02:23 PM

That rerally sounds rather a daft way of doing it. You're a federal republic, so why not have that kind of thing done at a state level?

Doing it that way really does sound like you've got a system designed by people who don't really want it to work.

Subject: RE: BS: Universal Medicine in the USA.
From: Peace
Date: 02 Oct 07 - 02:26 PM

Canada, due to its size, has the same difficulty. BUT, we are dealing with it. Pneumonia in Alberta is the same as pneumonia in Quebec. I'd figure the same in the US. Comes down to a matter of will I think. The problems are surmountable.

Subject: RE: BS: Universal Medicine in the USA.
From: John Hardly
Date: 02 Oct 07 - 02:31 PM

"You're a federal republic, so why not have that kind of thing done at a state level?"

Curiously, it has to do with our development as a political state. The most liberal among us are the most against State's Rights and the most in favor of homogeneous States in the name of fairness. And at the same time, it is those who deem "fairness" in those terms that most want our medical care socialized.

That's one of the reasons that I really hope some good conservative minds can enter into the develpment of a better system before it's too late. We will socialize. It's inevitable.   And I'd like some reasonably good business sense in the mix before it's too late.

Subject: RE: BS: Universal Medicine in the USA.
From: Don Firth
Date: 02 Oct 07 - 03:06 PM

A quick mention to Peace:   I think there may be a bit of confusion of terms. I wasn't aware until just a bit ago that the Canadian health care system is referred to as "Medicare."

In the United States, "Medicare" is the word that is used when referring to health care reserved for people over age 65 (or is it now 67?) who are receiving Social Security benefits (and part of which, the SS recipient must pay for out of their monthly SS check). "Medicaid" is for very low-income people. Both Medicare and Medicaid pay some to health care providers, but barely adequately. And as noted above, many private physicians refuse to take Medicare and Medicaid recipients because they pay so little, and there is a mountain of paperwork involved. Incidentally, in most states, both Medicare and Medicaid are administered, not by government bureaucrats, but by private insurance companies under contract to the state government.

So much for the contention that it's "government bureaucrats" who render a system unwieldy.

####

I haven't had a chance to research this yet, so if someone has the skinny on it, perhaps you can parse it for us.

There are "health care costs" and then there are "health care costs." I think most people consider the amount of their income that they have to pay for health insurance (either directly, or deducted from their paycheck by their employer—plus the employer's contribution, which, in reality, also comes out of the employee's paycheck) as "health care costs." Often this amounts to a couple thousand dollars a year, sometimes even more. Add all of that together, and it comes to many billions of dollars placed into the hands of insurance companies.

Now. When we refer to "health care costs," are we referring to the money paid to insurance companies in health insurance premiums plus money paid directly to health care providers by patients? Or are we referring to the money that is actually paid to the health care providers, by both insurance companies and by patients directly?

I think that needs to be clarified when we talk about "health care costs."

What prompted me to wonder about this is that within recent weeks, there has been a flurry of commercials on the radio and television in this area against Referendum 67, slated to appear on the Washington State ballot in the next election.

From the Seattle Times:    "Under the new law [Referendum 67], courts can approve triple damages if an insurance company is found to have unreasonably denied coverage or payment of claims."

This law was proposed as a result of an "abnormal" number of denials of payment by insurance companies, often despite what the contract and the sales literature says the insurance company covers. Basically, Referendum 67 is an attempt to get the insurance companies to honor their promises, with a punitive charge of triple damages if a court determines that they are in default.

Insurance companies are pouring vast amounts of money into a campaign to defeat the referendum. The ads are claiming that the referendum is being proposed by "unscrupulous trial lawyers" and "ambulance chasers" in search of huge fees, and using a further scare-tactic of claiming that if the law is passed, it will cause insurance rates to skyrocket.

Two local insurance companies, Safeco and Pemco, are declining to join the campaign, saying that they consider the law to be fair, and that the campaign to defeat the referendum is being financed by a number of large out-of-state insurance companies.

So, again:    How much of America's health care costs go to insurance company profits and how much actually goes to pay health care providers?

Don Firth

Subject: RE: BS: Universal Medicine in the USA.
From: DougR
Date: 02 Oct 07 - 03:39 PM

I think the major problem with Medicare in the US is too many decisions regarding healthcare are made by federal beauracrats instead of patients and physicians. If a universal federal plan is ever adopted I can just imagine how more screwed up the system will become. We certainly don't have a problem free system in the US, but I think it's the best medical care system in the world. Otherwise why would there be so many Canadians coming south for medical care? I would not oppose a federal program designed to insure healthcare for the truly needy and cannot afford one, but I would also anticipate that it would not be a very well run program.

DougR

Subject: RE: BS: Universal Medicine in the USA.
From: Peace
Date: 02 Oct 07 - 04:25 PM

"We certainly don't have a problem free system in the US, but I think it's the best medical care system in the world."

Why is that, Doug?

Subject: RE: BS: Universal Medicine in the USA.
From: McGrath of Harlow
Date: 02 Oct 07 - 06:33 PM

No one is saying that American doctors aren't pretty good and American medical facilities aren't great. But how much help is that for millions of Americans who can't afford them?

"I would also anticipate that it would not be a very well run program." Another case of "Only in America"? Don't write yourself down and assume you Americans aren't just as competent as anyone else, when you set your mind to it.

I'm sure if you did that it really could become "the best medical care system in the world."

Subject: RE: BS: Universal Medicine in the USA.
From: John Hardly
Date: 02 Oct 07 - 07:27 PM

"No one is saying that American doctors aren't pretty good and American medical facilities aren't great."

wow.

Subject: RE: BS: Universal Medicine in the USA.
From: pdq
Date: 02 Oct 07 - 07:28 PM

"How much of America's health care costs go to insurance company profits and how much actually goes to pay health care providers?"

The figure of 15% has been thrown around, so that may be right. Sounds reasonable, and remember, that is overhead and profit, not just profit..

When you consider that a tax dollar you send to Washington comes back to your home town as about 28¢, I don't think anyone is getting gouged here. Still, 20% of the US population is unhappy with their care, or lack of it. New ideas are needed.

Subject: RE: BS: Universal Medicine in the USA.
From: Peace
Date: 02 Oct 07 - 07:31 PM

"Still, 20% of the US population is unhappy with their care, or lack of it. New ideas are needed."

Well said.

Subject: RE: BS: Universal Medicine in the USA.
From: McGrath of Harlow
Date: 02 Oct 07 - 07:37 PM

Well, if the richest country on the planet didn't have some good doctors and some great medical facilities it'd be pretty weird, wouldn't it, John?

Subject: RE: BS: Universal Medicine in the USA.
From: bobad
Date: 02 Oct 07 - 07:38 PM

By several measures, health care spending continues to rise at the fastest rate in our history.

In 2005 (the latest year data are available), total national health expenditures rose 6.9 percent -- two times the rate of inflation (1). Total spending was $2 TRILLION in 2005, or $6,700 per person (1). Total health care spending represented 16 percent of the gross domestic product (GDP).

U.S. health care spending is expected to increase at similar levels for the next decade reaching $4 TRILLION in 2015, or 20 percent of GDP (2).

In 2006, employer health insurance premiums increased by 7.7 percent � two times the rate of inflation. The annual premium for an employer health plan covering a family of four averaged nearly $11,500. The annual premium for single coverage averaged over $4,200 (3).

Experts agree that our health care system is riddled with inefficiencies, excessive administrative expenses, inflated prices, poor management, and inappropriate care, waste and fraud. These problems significantly increase the cost of medical care and health insurance for employers and workers and affect the security of families.

http://www.nchc.org/facts/cost.shtml

What's 15% of $2 trillion?

Subject: RE: BS: Universal Medicine in the USA.
From: Peace
Date: 02 Oct 07 - 07:43 PM

More than $73 dollars.

Subject: RE: BS: Universal Medicine in the USA.
From: pdq
Date: 02 Oct 07 - 07:45 PM

Back to the WHO report...

"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..."

"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."

Again, the report used five categories to evaluate each health care system, so the ranking of "37th" has little to do with the actual operating room performance or therapy or any other guage of medical talent. It is about "fairness" and "financing" and "respect for patient dignity" and, er, you get the point.

We have the finest health care in the world, just not everybody is able to receive it.

Subject: RE: BS: Universal Medicine in the USA.
From: Peace
Date: 02 Oct 07 - 07:48 PM

"We have the finest health care in the world, just not everybody is able to receive it."

We have the second-best health care in the world, and everybody IS able to receive it.

Subject: RE: BS: Universal Medicine in the USA.
From: Emma B
Date: 02 Oct 07 - 07:51 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."

posted 30 Sep 07 - 08:57 PM

Subject: RE: BS: Universal Medicine in the USA.
From: pdq
Date: 02 Oct 07 - 07:55 PM

"What's 15% of $2 trillion?"

Not a valid concept since 'health care managed by insurance companies who are for-profit' is only one of may methods of management. The last office visit I made, the doctor sent me a bill. I sent him a check.

Subject: RE: BS: Universal Medicine in the USA.
From: John Hardly
Date: 02 Oct 07 - 08:09 PM

Yeah, MofH, we've got some "pretty good" doctors. Don't be so darn effusive next time.

Subject: RE: BS: Universal Medicine in the USA.
From: John Hardly
Date: 02 Oct 07 - 08:10 PM

...oh yeah. I forgot. House is actually a Brit affecting an American accent. That changes everthing. What was I thinking?

100!!!!!!!!!!!!!!!!!

Subject: RE: BS: Universal Medicine in the USA.
From: McGrath of Harlow
Date: 02 Oct 07 - 08:36 PM

"Pretty good" counts as pretty effusive in England.

Subject: RE: BS: Universal Medicine in the USA.
From: bobad
Date: 02 Oct 07 - 09:17 PM

From Emma's link on another thread:

"The bottom line is that the opponents of universal health care appear to have run out of honest arguments. All they have left are fantasies: horror fiction about health care in other countries, and fairy tales about health care here in America."

http://select.nytimes.com/2007/07/16/opinion/16krugman.html?_r=4&adxnnl=1&oref=slogin&adxnnlx=1190367339-/20RYgCrVnWKw4gQ1yB+qw&oref=slogin

Subject: RE: BS: Universal Medicine in the USA.
From: John Hardly
Date: 02 Oct 07 - 09:39 PM

"The bottom line is that the opponents of universal health care appear to have run out of honest arguments. All they have left are fantasies: horror fiction about health care in other countries, and fairy tales about health care here in America."

Gee, what an even-tempered, moderate, objective statement to add to a discussion.

Nope, that won't shut down discussion. That's "pretty good".

Subject: RE: BS: Universal Medicine in the USA.
From: Don Firth
Date: 02 Oct 07 - 10:52 PM

Here is an excerpt from a fairly lengthy post on the "thread with the controversial title" that spawned this thread (this isn't controversial?).

Along with my manual wheelchair, I have a power wheelchair. It can move at a good, swift jogging pace, it has a 25-mile range on a full charge, and with it, I can go a lot of places that I couldn't otherwise, including riding the city busses (which are equipped with wheelchair lifts). A couple of months ago, the batteries had to be replaced. It takes two 12-volt deep-cycle batteries. The charge to have Care Medical (where I bought the chair) replace the batteries was $500 ($220 per battery, plus $60 for installation).

I asked the technician who was installing the batteries "Why so much?" "Well," said the tech, "the batteries are classed as medical equipment, and they figure some insurance company is going to pay for them anyway."

I checked the labels on the batteries and called my nephew, who works for an auto supply store that, among other things, sells batteries. He said, "Those are standard marine batteries, like for a power boat. You can get them at any battery store. They should cost about 50 bucks apiece, max! Next time your chair needs batteries, fer gawdsake, call me!"

We know that Americans pay a lot more—a lot more—for prescription drugs than people in other countries do. A fair number of Americans who live near the Canadian border find that, even including the cost of the trip, they can get the same prescription drug for less in Canada than they can at their local pharmacy. And I've compared prices for manual wheelchairs with prices for good quality bicycles, which, apart from the design, contain more parts and are generally a bit more complex than a wheelchair. Wheelchairs are much more expensive, for no manufacturing or parts reasons that I can detect, than a considerably more complex bicycle. Why?

I think the Care Medical technician I mentioned above provided the answer.

This raises the question of how much in the way of medical bills, especially ones charged to insurance companies, are heavily padded?

Don Firth

Subject: RE: BS: Universal Medicine in the USA.
From: katlaughing
Date: 02 Oct 07 - 11:51 PM

Don, the uninsured usually wind up paying more, in my experience, than folks do who have insurance. That is, the insurance companies negotiate lower rates with the service providers and wind up not paying full-price. A self-pay, as I was for several years, is expected to pay full price because they have no one allowed to bargain for them.

There is more about it HERE.


More about hospital charges HERE, if you scroll down. Also, from there, obvious the uninsured are not spending much time in hospital:

Together, Medicare and Medicaid are billed for more than half (58 percent) of all hospitalizations. Private insurers are billed for 35 percent while uninsured hospitalizations account for about 5 percent of hospital stays. The remaining 3 percent of hospitalizations are billed to other insurers or the expected payer cannot be determined.

Subject: RE: BS: Universal Medicine in the USA.
From: katlaughing
Date: 03 Oct 07 - 12:18 AM

Oops, I misread your posting a little bit, Don. Just to clarify: I am sure hospital bills ARE padded; probably why they are open to negotiations with insurance companies, which could also be a big reason for why they are padded. Still the uninsured wind up paying for all of the padding.

Subject: RE: BS: Universal Medicine in the USA.
From: artbrooks
Date: 03 Oct 07 - 08:46 AM

Don, I once had a boss (who had excellent health insurance, BTW) who demanded an itemized bill for each period of care. She found, for example, that she had been billed for such things as $12.50 per day for the tissues next to her bed. The insurance paid, no questions asked, whatever their "reasonable and customary" negotiated rate was.

I don't personally believe that those who are uninsured pay for the care of those who are, but that's certainly where much of the profit margin comes from. If I were advising someone who was uninsured, I'd say to get that itemized bill first and then sit down with the billing office to discuss a reduction.

Subject: RE: BS: Universal Medicine in the USA.
From: katlaughing
Date: 03 Oct 07 - 10:08 AM

art, my daughter did just that for me when I went into the hospital with congestive heart failure and no insurance. They were very hostile and reduced the bill only by about 1%, leaving me with a bill of over $13,000 which I am paying off $50 per month.:-<

Subject: RE: BS: Universal Medicine in the USA.
From: Don Firth
Date: 03 Oct 07 - 01:18 PM

In the lengthy post on the other thread that I mention above (HERE, if you care to read it), I talk about three weeks I spent in a hospital in Feb-Mar of 2000.

While I was there, my regular doctor checked to see that there would be no interaction problems with the prescription drug that I take regularly (blood pressure) and the stuff they were giving me at the hospital, then told me to keep taking it. My wife brought me my pills from home. A couple of people at the hospital had a hissy-fit about my "self-medicating," even if I had been told to by my regular physician. They wanted to confiscate my pills and then dole them out to me. With my regular doctor's support, I insisted that they back off!

One of the nurses (bless her pea-pickin' heart—on several occasions—for putting patient welfare before hospital regulations; I would nominate her for sainthood!) informed me that, had I given in, they would have charged me about $12.00 a day to give me my own pills!

A nickel here, a nickel there. . . .    Ain't it grand how the money rolls in?

Don Firth

Subject: RE: BS: Universal Medicine in the USA.
From: Peace
Date: 03 Oct 07 - 01:22 PM

Yeah. And that amounts to "Mr Firth, take two of these with water right now. [gulp] Thank you Mr Firth."

That took all of 20 seconds. At $12 for that, I'm making $2160 an hour. Good business to be in.

Subject: RE: BS: Universal Medicine in the USA.
From: Peace
Date: 03 Oct 07 - 01:44 PM

Remember when the Pentagon/Militar was charging for tailet seats at something like $5000?

Subject: RE: BS: Universal Medicine in the USA.
From: GUEST,mg
Date: 03 Oct 07 - 02:38 PM

Here is part of my plan:

Called the Ex-Con Clinics

1. Ex-prisoners have very hard times getting jobs (and housing).
2. They can be, sometimes are, and definitely should be, getting job training and credentials whilst in prison.
3. There are very unserved parts of the population, incluidng other ex-prisoners, drug users, homeless, mentally ill etc.

Kill a few birds with one stone. Train the prisoners, set up free or very low cost clinics and have some mobile and fixed clinics for the destitute run by ex-cons. Supervised of course by highly qualified professionals, nurses, doctors, administrators. Extra security on board. Extra special precautions around drugs, child welfare etc. Perhaps total video monitoring of every single interaction. Extreme security where drugs are concerned. Obviously not placing violent or sex offenders. Full disclosure that the medical providers are former whatevers.

mg

Subject: RE: BS: Universal Medicine in the USA.
From: McGrath of Harlow
Date: 03 Oct 07 - 02:59 PM

A second class medical service for second class people...
..............................................

I'm not really sure that "opponents of universal health care" is really a fair way of putting it. Most of the doubters seem to think it'd be a good idea, but it would just be impossible, because Americans could never manage to run something like that without screwing it up, unlike everyone else.

I think they are needlessly underestimating their country's ability to get things right, when it sets its mind to it. I'm sure when America actually gets round to it it'll come up with a system that other people will admire and even wish to emulate.

Subject: RE: BS: Universal Medicine in the USA.
From: GUEST,mg
Date: 03 Oct 07 - 04:30 PM

A service now provided for people who have nothing by people who now have nothing. While we wait for the perfect system, people die, starve, wander the streets. mg

Subject: RE: BS: Universal Medicine in the USA.
From: bobad
Date: 03 Oct 07 - 04:48 PM

There's No Way Like The American Way

Subject: RE: BS: Universal Medicine in the USA.
From: Peace
Date: 03 Oct 07 - 05:49 PM

It's difficult to put billions into Universal Health Care when you use that money for bombs. Sometimes it's just that simple.

Subject: RE: BS: Universal Medicine in the USA.
From: McGrath of Harlow
Date: 03 Oct 07 - 06:13 PM

Not really. There is already more than enough money being spent on health to give the USA a universal health service that would be admired by the world.

"The United States continues to spend significantly more on health care than any country in the world. In 2005, Americans spent 53 percent per capita more than the next highest country, Switzerland, and 140 percent above the median industrialized country, according to new research from the Johns Hopkins Bloomberg School of Public Health."

Subject: RE: BS: Universal Medicine in the USA.
From: Peace
Date: 03 Oct 07 - 06:16 PM

Huh. So is it then "I've got mine and fu#k the rest of you"?

Subject: RE: BS: Universal Medicine in the USA.
From: McGrath of Harlow
Date: 03 Oct 07 - 06:31 PM

"I'm all right, Jack" is how we put it here.

Subject: RE: BS: Universal Medicine in the USA.
From: bobad
Date: 03 Oct 07 - 06:34 PM

Exactly.

Subject: RE: BS: Universal Medicine in the USA.
From: Kent Davis
Date: 03 Oct 07 - 06:48 PM

MORE THREAD CREEP, but again it may be useful,
katlaughing and others,

Many hospitals have programs which will discount all or part of your bill, depending on your income. It might be worth asking about. At our hospital it is called "Ohio Free Care". Hospitals also frequently offer discounts to anyone who pays cash. I think our cash rate is about 80%.
For the future, you might look into high-deductible insurance. Some of my patients have it and are well-satisfied. Premiums are much lower. Ideally, one would keep an amount equal to the deductible in a savings account. They will not cover pre-existing conditions.
On another but related topic, the high cost of prescription drugs, remember that medicines are like many other goods in that each incremental increase in quality raises the price dramatically. You want good medicine, but not necessarily the very best. For example, in our area, the very best medicines to lower cholesterol costs about $70 a month or more, depending on the dosage. However, Giant Eagle pharmacy sells an almost-as-good generic for $4 a month. The diabetes medicine Actos can run over $600 for a three-month supply, but metformin, another diabetes medicine is about $12 for a three-month supply at Wal-Mart and K-Mart. The same price differences are true for blood pressure medicine, anti-depressants, antibiotics, etc. TELL your doctor if you are willing to accept an almost-as-good medicine. Sometimes there is no inexpensive alternative, but ususally there is.
Kent

Subject: RE: BS: Universal Medicine in the USA.
From: McGrath of Harlow
Date: 03 Oct 07 - 07:11 PM

That was me.

Subject: RE: BS: Universal Medicine in the USA.
From: GUEST,petr
Date: 03 Oct 07 - 07:41 PM

on that point McGrath, its worth noting what the drug companies in Africa re; malaria drugs.. when Gates foundation and other philanthropists started funding malaria research and drug programs
suddenly the price of anti-malarial drugs skyrocketed..
(and in general there wasnt much research into it by the drug companies since its the worlds poor who are most affected and they dont have the money)

Subject: RE: BS: Universal Medicine in the USA.
From: Peace
Date: 03 Oct 07 - 08:20 PM

In Canada they are called generic drugs. For those people who have health plans for drug coverage, unless specifically prescribed, the folks who cover the cost will pay the cost of the generic.