I was simply refuting your assertion that I felt scientists were either "lazy" (as you said) or there was a conspiracy to not cure cancer. If you had the reading comprehension of an American third-grader, you'd see that I said neither of those things are true, and now you're just being an ass.
I submitted an entry to Lego Ideas, and if 10,000 people support me, it'll be turned into an actual Lego set!If you'd like to see and support my submission, follow this link.
But in healthcare, if you think you need care, regardless of actual physical acuity (severity), you can go to a hospital and they have to give you the best care they can provide, by law.
That's not entirely true. They are required by law to provide you emergency care, which is usually defined in terms of stabilizing the patient. What exactly constitutes an emergency does have some grey areas for some conditions (panic attacks, fibromyalgia flareups, or migraines are examples) but, in general, patients do not have that much power to dictate what level of care they receive. Emergency departments are fully within their rights to turn away a patient without providing any care at all if they determine that the condition in question isn't actually an emergency. It doesn't happen often because it's usually quicker and easier to scribble somebody a prescription for Vicodin or Ativan and send them on their merry way than it is to argue with them (and possibly disrupt other patients), but that's entirely a judgment call on the part of the attending doc, not a legal mandate.
Without making a value judgment on that fact, you have to admit that devising a system that both capably serves its clients and doesn't bankrupt its providers is a tenuous ordeal, at best.
One of the bogeymen that gets thrown around in arguments is the phrase "health care rationing." I understand why it's used, because "rationing" brings up scary images of people standing in line for bread in Cold War Poland or WWII-era posters imploring people not to drink coffee so our GIs fighting the krauts can have a spot of joe in the morning. But health care rationing is already a reality - in the ED, it's called "triage" and in office visits it's governed not by necessity or severity but by deductibles and coverage limits. Rational rationing (see what I did there?) is a necessary fundamental component of any functional healthcare system. If somebody might see 85% improvement on a $100/month drug but 90% improvement on a $500/month drug, unless they're paying the difference with cold hard cash I don't think any collective payer (whether governmental or private insurance) should be shelling out the extra money just for marginal improvement.
In my years as an ER nurse, my positions on socialized care have changed somewhat because I see the types of people who would most directly benefit from government care. I've worked in small communities of less than $30,000, I've worked in metropolitan areas such as Dallas, TX, Stamford, CT, and Manhattan, NY. And with rare exception, the patients fit a certain template regarding economic class, education, profession, self-hygeine routines, and lifestyle choices.
You've used this argument before and I find it mind-bogglingly bigoted. Lack of education or profession doesn't render somebody less deserving of medical care. ED nurses by and large don't have enough exposure to any particular patient to pass judgment on their lifestyle choices. In the 15 minutes you took to get somebody's blood pressure, did you talk to them about their childhood? Their parents? Their life experiences? Unless your EDs were 100% unlike all the EDs I've ever seen or been in, your understanding of the "lifestyle choices" of your patients were superficial at best.
Seeing this, I can't honestly say that a great share of people without insurance are victims of circumstance, as most of these patients have addictions of some kind (be it smoking, drugs, or alcohol)
People who moralize about "addictions" are a huge pet peeve of mine. It's not a scarlet letter A that you get to brand people with if you don't particularly feel like treating them with a modicum of human respect. Addiction is a medical issue and addicts deserve medical care just as much as anybody else.
Did you ever think that maybe some of those addicts became addicts because they were self-medicating a chronic disorder? I've seen meth heads go clean after getting antidepressants and Adderall; alcoholics who improve after getting antianxiety meds; pot smokers who needed Haldol; opioid addicts with verifiable back problems that presented clear as fucking day on an MRI. Just because they take drugs doesn't mean they aren't sick.
or choose to purchase material goods inappropriate to their level of income (i.e., young mothers on federal assistance with new cell phones or designer clothing).
You superficial twit.
Cell phones are neither expensive nor frivolous. Telcos are slowly phasing out pay phones, which means if you are mobile (say, because you're couch-surfing or staying with relatives) and you want to be able to get in touch with the people who might be able to help you get places if you find yourself stranded somewhere, you need a cell phone. There are charities (like Call to Protect) who give out cell phones to high-risk groups because having a cell phone in the case of emergency is a near-necessity.
As for designer clothing, I'm not even sure I should give that argument the respect necessary to refute it. Implying that the clothes somebody wears are even remotely relevant to how deserving they are of medical care is both offensive and stupid. But here, let me throw this monkey wrench into your neatly compartmentalized worldview: I buy designer clothes at a nearby Goodwill for $5-10 an article. See, I can take the subway to a Goodwill that's just outside a very ritzy suburb of San Francisco called Hillsborough, where parents of teenagers drop off last month's fashion du jour. Their loss is my gain. Now if you were to tell me that because I was able to buy J. Crew slacks and a Banana Republic shirt for a grand total of $20 that I obviously could afford medical insurance (remember, folks, I spent about three years without insurance because of a pre-existing condition, a story I've told to death on these forums) then I'd tell you to sit and swivel.
And you know what else? Try being a patient for a while, with a chronic condition, that has occasional flareups that require urgent intervention. (Like, say, migraines!) Perform a small experiment for yourself. Try going to the ED a few times in jeans and a ratty sweater; then for your next few visits put on your best date clothes and go in. Watch how much better you get treated when you're wearing nice clothes. Nice clothes say you're responsible, they say you take care of yourself, and I will guarantee that you will be treated in a much more respectful fashion - and possibly even receive superior care - on average wearing nicer clothes. (Largely because of people like you who make snap judgments based on a patient's wardrobe.)
Another branch of increased costs is ignorance, which I don't mean in a derogetory fashion. Just the simple ignorance of patients or their parents not knowing how to treat something at home, or not even worrying about it and coming straight to the ER for care. Ninety-five times out of a hundred (especially in children), the problem can be solved with medicine available at Duane Reade for $6.99, but instead it now costs several hundred dollars in triage and physicians' fees. As you can expect, many parents are more concerned with getting their children well than if they can actually pay for the service, and as a result do not pay the bill. They know they do not have to have money to be seen, and that's all they need to know.
Non-urgent walk-in ambulatory care clinics definitely need to be more widespread. You see such drop-in community clinics in urban areas and on university campuses, but for a significant proportion of the population, the only drop-in medical care available are emergency rooms.
In that regard, there are things we could do better as a nation. We need to pressure research laboratories into developing more cures than treatments, especially in oncology wherein a lot of money is spent over years and months per patient.
The first company to develop a cure for cancer would make astronomical amounts of money.
Mere treatments aren't better business than cures, because treatment invites competition. Cures do not.
There's nobody sitting in an office chair somewhere looking at two different proteins and choosing one as a target for drug development because it's more of a treatment than a cure. Drug development is much more random than that; you follow every viable lead within your budget because you have no idea which ones will pan out. Even so called "rational" drug design is more like betting on a horse race than a game of chess; your best strategy is a matrix of educated guesses.
Feral on
every person who doesn't like an acquired taste always seems to think everyone who likes it is faking it. it should be an official fallacy.
the "no true scotch man" fallacy.
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AtomikaLive fast and get fucked or whateverRegistered Userregular
That's not entirely true. They are required by law to provide you emergency care, which is usually defined in terms of stabilizing the patient. What exactly constitutes an emergency does have some grey areas for some conditions (panic attacks, fibromyalgia flareups, or migraines are examples) but, in general, patients do not have that much power to dictate what level of care they receive. Emergency departments are fully within their rights to turn away a patient without providing any care at all if they determine that the condition in question isn't actually an emergency.
Not true on either account. All patients receive the same minimum federally-mandated level of competent care, as determined by the attending physician. It's highly regulated by JCAHO, and on top of that by individual licensing agencies and hospital boards. Emergency departments, especially the designated county hospital, does not have the authority to turn away anyone for treatment, ever. The most they can do is refer them to on-site clinics, which are also run by the hospital, should their triage determine them to be unemergent and the patient would like expedited care. The catch there is, the clinic asks for a minimum payment up front, so I bet you can guess how many patients choose that option.
One of the bogeymen that gets thrown around in arguments is the phrase "health care rationing." I understand why it's used, because "rationing" brings up scary images of people standing in line for bread in Cold War Poland or WWII-era posters imploring people not to drink coffee so our GIs fighting the krauts can have a spot of joe in the morning. But health care rationing is already a reality - in the ED, it's called "triage" and in office visits it's governed not by necessity or severity but by deductibles and coverage limits. Rational rationing (see what I did there?) is a necessary fundamental component of any functional healthcare system. If somebody might see 85% improvement on a $100/month drug but 90% improvement on a $500/month drug, unless they're paying the difference with cold hard cash I don't think any collective payer (whether governmental or private insurance) should be shelling out the extra money just for marginal improvement.
I'm not really certain which thing you're addressing. Please clarify, as I never proposed any type of "care rationing."
ED nurses by and large don't have enough exposure to any particular patient to pass judgment on their lifestyle choices. In the 15 minutes you took to get somebody's blood pressure, did you talk to them about their childhood? Their parents? Their life experiences? Unless your EDs were 100% unlike all the EDs I've ever seen or been in, your understanding of the "lifestyle choices" of your patients were superficial at best.
Questions asked in triage also regard the patient's age, smoking history by years and number of packs, number of pregnancies and abortions (biological or therapeutic), occupation (past and current), medical history (from broken bones to HIV and Hep C), and history of substance abuse. Also, we note outstanding physical anomalies (deformities, missing limbs, oral care) and current and past prescriptions.
If during triage, your query presents you with a 29 y/o female who has four children and seven pregnancies, a history of PID, Hep C, track marks on her arm, old prescriptions for Seroquel, and teeth rotting away from poor dental hygiene, we begin to build a patient profile. It's what we're taught to do in medicine to expedite proper care. If this woman presents with a cough, we're going to immediately check her for tuberculosis based on her personal history, unlike most patients with coughs who we check for mono and strep throat first.
I can understand how a steadfast humanist like yourself would take issue with some of that, but that's how it is and that's how it's taught and that's how doctors the nation over treat patients. A doctor is paid by the patient, not the hospital. Why would the doctor waste resources on patients who are obviously (and have histories of being) non-compliant with care, especially if that same patient will be back in the ER in a few months anyway for some new non-compliance-based illness?
People who moralize about "addictions" are a huge pet peeve of mine. It's not a scarlet letter A that you get to brand people with if you don't particularly feel like treating them with a modicum of human respect. Addiction is a medical issue and addicts deserve medical care just as much as anybody else.
But is addiction an emergency?
In the hospital, we make over a dozen referrals to psychiatric facilities each shift to ensure that patients with psychological problems, including addiction, are treated after being medically cleared by us. The problem is, unless the patient is determined to be an immediate threat to themselves or other, the law forbids involuntary commitment.
Addiction is not an emergency, and if patients can't get the proper treatment that we push them towards, it's not our problem. Is addiction something that needs to be addressed in a comprehensive single-payer plan? Absolutely. But it's not worthy of ER resources. Wring your hands all you want, but people are ultimately responsible for themselves.
You superficial twit.
I can see that you've obviously got some personal bias in this argument, so I won't press any further. But heart-wrenching testimony and bleeding of hearts (figuratively, in this case) aren't viable alternatives to actual plans, and certainly not any plan that begins with taxation being a magical cure.
Tweaks are needed to coverage and criteria. Community urgent care centers are needed in more densely populous areas. Federal spending needs to be directed at research for cures. But the bottom line is, in general, people need to be more accountable to taking care of their selves. Personally, one the few reasons I support a limited single-payer option is for the ability to turn the non-compliant away once and for all. I'm tired of treating people who won't take necessary steps in maintaining their health, and if their death results from their own poor self-care, so be it.
I think once people have a chance to see first-hand how pitiful a tax-based solution would be, and watch as they lose coverage for non-compliance, they'll remember why the US avoided such a system for so long in the first place.
That's not entirely true. They are required by law to provide you emergency care, which is usually defined in terms of stabilizing the patient. What exactly constitutes an emergency does have some grey areas for some conditions (panic attacks, fibromyalgia flareups, or migraines are examples) but, in general, patients do not have that much power to dictate what level of care they receive. Emergency departments are fully within their rights to turn away a patient without providing any care at all if they determine that the condition in question isn't actually an emergency.
Not true on either account. All patients receive the same minimum federally-mandated level of competent care, as determined by the attending physician. It's highly regulated by JCAHO, and on top of that by individual licensing agencies and hospital boards.
Can you link or site? Because I can't find anything that suggests that JCAHO mandates that all patients be provided care. JCAHO mandates that care that is provided meet a certain minimum standard, not that care be provided at all.
And the relevant federal law to this is EMTALA, which very specifically states that it is up to the hospital staff to determine whether a patient presenting at the ED requires care, and only mandates care in the case of emergency medical conditions, which are again very specifically defined.
Emergency departments, especially the designated county hospital, does not have the authority to turn away anyone for treatment, ever
Again, you're going to have to link or cite, because I can't find any relevant law that states this. And besides that, it's directly contrary to my experience, because the ED physicians that I've known have had absolutely no problem discharging a patient without treatment if they feel that the patient's condition is not severe enough.
ED nurses by and large don't have enough exposure to any particular patient to pass judgment on their lifestyle choices. In the 15 minutes you took to get somebody's blood pressure, did you talk to them about their childhood? Their parents? Their life experiences? Unless your EDs were 100% unlike all the EDs I've ever seen or been in, your understanding of the "lifestyle choices" of your patients were superficial at best.
Questions asked in triage also regard the patient's age, smoking history by years and number of packs, number of pregnancies and abortions (biological or therapeutic), occupation (past and current), medical history (from broken bones to HIV and Hep C), and history of substance abuse. Also, we note outstanding physical anomalies (deformities, missing limbs, oral care) and current and past prescriptions.
None of which qualifies you to pass judgment on a person's life.
I can understand how a steadfast humanist like yourself would take issue with some of that, but that's how it is and that's how it's taught and that's how doctors the nation over treat patients. A doctor is paid by the patient, not the hospital. Why would the doctor waste resources on patients who are obviously (and have histories of being) non-compliant with care, especially if that same patient will be back in the ER in a few months anyway for some new non-compliance-based illness?
Have you considered that their noncompliance is at least partly related to (real or perceived) barriers to access of proper office visits and non-emergency medical advice?
Yes, there will always be horses who refuse to drink no matter how close they're led to water. And those people are going to be a drain on any medical system, whether public or private. However, there are also people who would comply with care if they could have regular access to physician consultations that last longer than a minute and a half or could schedule a doctor's visit less than six weeks out once in a while.
Whether the first category of patient outnumbers the second is irrelevant - getting all those people out of the ED and into clinics and offices is going to be cheaper no matter the demographics involved.
I can see that you've obviously got some personal bias in this argument, so I won't press any further.
Huh, so instead of addressing the substance of my post you only address the first line, because apparently I "have bias?"
You're right, I'm biased. I'm biased against classism. I'm sick of seeing you come into every thread on UHC with a paragraph bemoaning poor people and how its their own damn fault they're sick. I'm sick of you slipping into every discussion on the subject an argument along the lines of "well, I've worked in EDs across the country, and let me tell you, sometimes uninsured people have cell phones!"
But heart-wrenching testimony and bleeding of hearts (figuratively, in this case) aren't viable alternatives to actual plans, and certainly not any plan that begins with taxation being a magical cure.
Neither is perenially bitching about those damn poor people and their cell phones.
Personally, one the few reasons I support a limited single-payer option is for the ability to turn the non-compliant away once and for all. I'm tired of treating people who won't take necessary steps in maintaining their health, and if their death results from their own poor self-care, so be it.
I think once people have a chance to see first-hand how pitiful a tax-based solution would be, and watch as they lose coverage for non-compliance, they'll remember why the US avoided such a system for so long in the first place.
I'd rather people lose coverage for non-compliance than lose coverage because they lost their job and couldn't afford $350/mo COBRA payments.
Feral on
every person who doesn't like an acquired taste always seems to think everyone who likes it is faking it. it should be an official fallacy.
Big news in the UK/EU - There are moves afoot (based on a recent European Court of Justice decision) to offer all EU citizens the right to chose any EU country's national health system to perform operations, with the cost being claimed back off their national health provider. So in theory a British person could go to France and get that knee operation then let the French health provider bill the NHS (UK health provider).
I don't know if it will actually happen, but it is kind of interesting
Big news in the UK/EU - There are moves afoot (based on a recent European Court of Justice decision) to offer all EU citizens the right to chose any EU country's national health system to perform operations, with the cost being claimed back off their national health provider. So in theory a British person could go to France and get that knee operation then let the French health provider bill the NHS (UK health provider).
I don't know if it will actually happen, but it is kind of interesting
Oh wow, I should really look into renewing my UK passport...
I'd rather people lose coverage for non-compliance than lose coverage because they lost their job and couldn't afford $350/mo COBRA payments.
Aye, that's pretty much what happened to me. And the moment you can't pay COBRA, you lose your "continuous coverage" status and instantly all the ailments you had up to that point in your life become "preexisting conditions" when you try to get back into a healthcare program.
That's painful.
VThornheart on
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AtomikaLive fast and get fucked or whateverRegistered Userregular
I can't find anything that suggests that JCAHO mandates that all patients be provided care. JCAHO mandates that care that is provided meet a certain minimum standard, not that care be provided at all . . . . . And besides that, it's directly contrary to my experience, because the ED physicians that I've known have had absolutely no problem discharging a patient without treatment if they feel that the patient's condition is not severe enough.
JCAHO sets the minimum standard of care, that's what I was referring to. Regardless of class, race, gender, and lifestyle, every patient will receive the same protocol and response to their presentation. Hospitals don't use separate forms and break out crappier instruments when they find out you're poor.
The law mandates that each patient receive a medical screening exam by a physician or practitioner directly under their supervision. If the exam determines an illness or injury that can be treated without intervention by hospital staff, doctors will usually discharge them with the instructions on how to seek proper care. This actually saves patients vast sums of money, as all they pay for is triage and physicians' fees instead of fees for tests, procedures, and radiology. It's the doctor's job to diagnose, not the patient's.
Every patient that comes into the ER will be seen by a doctor. Simply entering the ER does not earn you the right to treatment should the medical staff determine a lack of acuity. That's not what emergency rooms are for.
Questions asked in triage also regard the patient's age, smoking history by years and number of packs, number of pregnancies and abortions (biological or therapeutic), occupation (past and current), medical history (from broken bones to HIV and Hep C), and history of substance abuse. Also, we note outstanding physical anomalies (deformities, missing limbs, oral care) and current and past prescriptions.
None of which qualifies you to pass judgment on a person's life.
Sure it does. It's actually part of my job duty to make assumptions about people's life, and it affects how we treat patients. If it's a busy day with a high acuity in the census, say you've got two identical patients slowly going into respiratory failure. One is a person having an allergic reaction, the other is a frequent repeat patient who smokes four packs a day and has a history of substance abuse. Both conditions being equal, guess who the doctor is going to see first and spend more time with?
In the ER you often have limited resources and physicians. You make judgments on people's lives all the time. It's a responsibility, and it's unfair to the acutely ill who don't have histories of non-compliance.
However, there are also people who would comply with care if they could have regular access to physician consultations that last longer than a minute and a half or could schedule a doctor's visit less than six weeks out once in a while.
And you think that would be better under a single-payer system? Why don't you ask any Canadian or Brit who's been through the system and waited three months on an MRI or six months on a biopsy to test for cancer? I think they'd love to hear an American bitch and moan about long wait times.
You're right, I'm biased. I'm biased against classism. I'm sick of seeing you come into every thread on UHC with a paragraph bemoaning poor people and how its their own damn fault they're sick. I'm sick of you slipping into every discussion on the subject an argument along the lines of "well, I've worked in EDs across the country, and let me tell you, sometimes uninsured people have cell phones!"
Getting all foamy and lathered up about it won't change the facts, though. While I've already mentioned that insurers' criteria for coverage is far too strict, perhaps criminally, that's simply one tier of the argument. The number of uninsured in this nation is estimated at 46.6 million. The entire population is over 300 million. So roughly 15% of the nation is uninsured, and at least half of that figure represents the statically uninsured. So what, we're going to gut our healthcare system, the most advanced and successful in the world, to better suit 8% of the population?
While I'll fight against a tyranny of the majority all day long, that's just preposterous.
And you think that would be better under a single-payer system? Why don't you ask any Canadian or Brit who's been through the system and waited three months on an MRI or six months on a biopsy to test for cancer? I think they'd love to hear an American bitch and moan about long wait times.
Hi, I'm Canadian. I dont mind waiting on an MRI or Biopsy while people with more urgent cases are seen ahead of me. Just like I'm glad that if I'm in a life threatening situation I'm seen before people that simply got in line before me.
So what, we're going to gut our healthcare system, the most advanced and successful in the world, to better suit 8% of the population?
Bahahaha! The American healthcare system is the running joke of the world. We fly there to have expensive and experimental procedures done on our citizenry, but thank the various gods that we don't live there.
I can't find anything that suggests that JCAHO mandates that all patients be provided care. JCAHO mandates that care that is provided meet a certain minimum standard, not that care be provided at all . . . . . And besides that, it's directly contrary to my experience, because the ED physicians that I've known have had absolutely no problem discharging a patient without treatment if they feel that the patient's condition is not severe enough.
JCAHO sets the minimum standard of care, that's what I was referring to. Regardless of class, race, gender, and lifestyle, every patient will receive the same protocol and response to their presentation. Hospitals don't use separate forms and break out crappier instruments when they find out you're poor.
Again, this isn't entirely honest. JCAHO maintains a minimum standard - but not every patient gets a minimum amount of care. A hospital isn't going to give an MRI to everybody who complains of a headache, but they are much more likely to give an MRI to somebody who has $5000 in cash to pay for it. An extreme example, sure - a more realistic example (and one from my own life) was when I was receiving treatment for sleep apnea. While uninsured, the best I could afford was a used 10-year-old CPAP; it wasn't until I got insurance that I could get the surgery that cured me of the condition.
The law mandates that each patient receive a medical screening exam by a physician or practitioner directly under their supervision. If the exam determines an illness or injury that can be treated without intervention by hospital staff, doctors will usually discharge them with the instructions on how to seek proper care.
This is true. This is also a vastly different statement from:
But in healthcare, if you think you need care, regardless of actual physical acuity (severity), you can go to a hospital and they have to give you the best care they can provide, by law.
Questions asked in triage also regard the patient's age, smoking history by years and number of packs, number of pregnancies and abortions (biological or therapeutic), occupation (past and current), medical history (from broken bones to HIV and Hep C), and history of substance abuse. Also, we note outstanding physical anomalies (deformities, missing limbs, oral care) and current and past prescriptions.
None of which qualifies you to pass judgment on a person's life.
Sure it does. It's actually part of my job duty to make assumptions about people's life, and it affects how we treat patients. If it's a busy day with a high acuity in the census, say you've got two identical patients slowly going into respiratory failure. One is a person having an allergic reaction, the other is a frequent repeat patient who smokes four packs a day and has a history of substance abuse. Both conditions being equal, guess who the doctor is going to see first and spend more time with?
Making a professional judgment as to who receives what treatment is an inherently different thing from making a moral judgment that implies that certain people deserve medical care less than others. And when you come into a thread (as you've done across multiple threads) and mention poor patient compliance or possession of luxury items among the uninsured, you're willfully implying that some people - particularly poor people - don't deserve medical coverage.
However, there are also people who would comply with care if they could have regular access to physician consultations that last longer than a minute and a half or could schedule a doctor's visit less than six weeks out once in a while.
And you think that would be better under a single-payer system? Why don't you ask any Canadian or Brit who's been through the system and waited three months on an MRI or six months on a biopsy to test for cancer? I think they'd love to hear an American bitch and moan about long wait times.
I've said this before and I'll say it again: arguing against UHC based on problems with the Canadian healthcare system is like saying that import cars suck because of problems with the Yugo. The Canadian system (and, to a lesser extent, the British system) are among the worst examples of UHC worldwide, largely because they are 100% socialized. No serious proposal for UHC in the US includes scrapping private healthcare entirely. Every serious proposal involves a system like - well, like most the world, but most notably France, Germany, Switzerland, and Australia - where the govt plan covers basic coverage for the low and middle classes while middle and upper classes can get more comprehensive supplemental coverage and/or pay cash.
Beyond that, reports of long wait times in Canada are deliberately exaggerated by pundits on the right and the insurance lobby. Besides being based on old statistics that don't take into account recent reforms, they also involve cherry-picking data: taking the worst wait times for the longest-wait procedures in the most impacted province (Alberta) in one of the worst UHC systems in the western world (Canada). It's as relevant to the system we're proposing as Yugos are to Honda Accords.
The number of uninsured in this nation is estimated at 46.6 million. The entire population is over 300 million. So roughly 15% of the nation is uninsured, and at least half of that figure represents the statically uninsured. So what, we're going to gut our healthcare system, the most advanced and successful in the world, to better suit 8% of the population?
Again, nobody's suggesting that we gut it. Every serious proposal involves a hybrid system that keeps private insurance around - though most proposals involve streamlining records keeping and claims reporting as well to reduce the burden that the plurality of insurance companies places on care providers - while establishing a public payer as well.
So what, we're going to gut our healthcare system, the most advanced and successful in the world, to better suit 8% of the population?
Bahahaha! The American healthcare system is the running joke of the world. We fly there to have expensive and experimental procedures done on our citizenry, but thank the various gods that we don't live there.
You're an idiot.
You freely admit that you pay money to come here to get the best care, but somehow still find that laughable. Conversely, I'm thankful for living in a country where I know that not only will I get fast care, I'll get some the best care available.
I don't know where you're from, but I can't really think of anywhere that offers the same level of speed and competence that the US does. So if your happy with your tax-subsidized system that makes you wait months for half-assed care, more power to you.
I wouln't have responded to this thread if I had known its author was such a mook.
Atomika on
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AtomikaLive fast and get fucked or whateverRegistered Userregular
Again, this isn't entirely honest. JCAHO maintains a minimum standard - but not every patient gets a minimum amount of care. A hospital isn't going to give an MRI to everybody who complains of a headache, but they are much more likely to give an MRI to somebody who has $5000 in cash to pay for it. An extreme example, sure - a more realistic example (and one from my own life) was when I was receiving treatment for sleep apnea. While uninsured, the best I could afford was a used 10-year-old CPAP; it wasn't until I got insurance that I could get the surgery that cured me of the condition.
It depends on the acuity. That cashless person with the headache will get an MRI if the doctors suspect a stroke or ischemic attack. If the MDs don't suspect it, well it's like I said earlier: patients do not get to diagnose themselves. But you are right in the fact that if a poor-looking patient complains of a headache, but does not present with signs of a stroke, the doctors will not likely prescribe one. But then again, that isn't a medical decision based on perceived ability to remunerate, it's a medical decision based on presentation of care. The doctors have a responsibility to give the patients the best care that fits their presentation, but the doctors can't go spending the hospital's money on procedures people don't need. The hospital can't operate if a doctor is wasting money that won't be recouped on procedures for patients that don't need it.
All that stuff is covered by licensing boards and doctor/hospital protocols, and are constantly being evaluated and revised.
The law mandates that each patient receive a medical screening exam by a physician or practitioner directly under their supervision. If the exam determines an illness or injury that can be treated without intervention by hospital staff, doctors will usually discharge them with the instructions on how to seek proper care.
This is true. This is also a vastly different statement from:
But in healthcare, if you think you need care, regardless of actual physical acuity (severity), you can go to a hospital and they have to give you the best care they can provide, by law.
Again, "best care" is determined by outcomes, not customer service. The patient has no business in trying to evaluate if they received the best care they could unless they thought they were misdiagnosed, which could only be assessed by another physician. Just because patients think they need to get certain treatments in the hospital doesn't entitle them to it. They aren't MDs. I'd much rather receive spartan care that completely solved my illness than extremely enjoyable care that didn't fix anything. That's why people go see doctors for care based on science and medicine, and not their grandmother for care based on cookies and chicken soup.
As far as I (or most any other medical professional) is concerned, your top priority is patient outcome and speed of care. It's taught in every university across this nation. Finding time to see if the patient enjoyed themselves on their visit is way down the list, especially when you consider the dire nursing shortage in the US that makes them responsible for five or more patients at a time.
Bottom line, "best care" is not a judgment most patients are qualified to make.
Making a professional judgment as to who receives what treatment is an inherently different thing from making a moral judgment that implies that certain people deserve medical care less than others. And when you come into a thread (as you've done across multiple threads) and mention poor patient compliance or possession of luxury items among the uninsured, you're willfully implying that some people - particularly poor people - don't deserve medical coverage.
My belief on the matter is that in any system that requires my tax dollars going to pay for the care of others (especially in the event of me using my own, privately-funded insurance), I do not support a program that would allow for those types of people to benefit from free care. I'll support subsidized care for poor children and the legitimately disabled, but simply being poor is not a disability to me. There are ways to better yourself to get out of that situation, just as there are poor life choices that entrench you all the moreso. No one ever moved out of poverty by being enabled.
Every serious proposal involves a system like - well, like most the world, but most notably France, Germany, Switzerland, and Australia - where the govt plan covers basic coverage for the low and middle classes while middle and upper classes can get more comprehensive supplemental coverage and/or pay cash.
And while I'm absolutely for a system that offers alternatives for lower-income citizens, how is it not descrimination to bar the wealthier people from a system they are likely paying more for? All it does is create welfare states that rob people of any desire to propel themselves any further than the government requires. You bring up France and other nations, but then compare their unemployment levels to ours. Compare their absolute poverty rates to ours. Do that, then get back to me regarding how well social programs benefit nations and their economy.
8% of the population is a big enough number on it's own, but this cancer is malignant and it's only to grow unless something drastic is done to stop it.
True enough, but there are many more variables in the equation than most people realize, and many who champion the systems of other nations would be irate at the conditions that demand it. The system needs to be fixed, but installing a low-quality lethargic care system that creates a class of low-income government dependents while increasing taxes on the middle and upper class isn't the way to get it done.
Support tort reform, pressure insurance agencies to relax their criteria, set up on-site community care centers that direct patients to more affordable care for non-emergent conditions, enforce immigration laws and deportation, amend "anchor baby" clauses, press Big Pharm companies to direct R&D toward cures, set aside grants for university research . . . . all of these things will go toward solving insurance costs without destroying the economy, disproportionately affecting taxpayers, or creating a cyclical class of poor people dependent on government assistence. Hell, some of those steps even create jobs.
No one ever moved out of poverty by being enabled.
Actually, for those who are legitimately living below the poverty line in America, just about the only way to escape it is cross-generational and involves being enabled by the U.S. military.
Just saying.
Also, I consider your stance that health care is 'enabling' per the pejorative sense despicable. Yes!, ensuring the health of our nation's less-than-middle-class will do nothing but mire them further, those lazy bastards!
No one ever moved out of poverty by being enabled.
Actually, for those who are legitimately living below the poverty line in America, just about the only way to escape it is cross-generational and involves being enabled by the U.S. military.
Just saying.
If a white kid from a lower-middle class family like me can get college paid for (twice, actually), the opportunities for the less-weathly and less-melanin depleted are tenfold. I didn't join the army, I just did well in school and took advantage of the government's grant program for certain curriculums.
Also, I consider your stance that health care is 'enabling' per the pejorative sense despicable. Yes!, ensuring the health of our nation's less-than-middle-class will do nothing but mire them further, those lazy bastards!
Like I've said over and over, wringing your hands and acting repulsed at certain notions don't alone change or disprove things. I prefer practical application of logical rationale to vague notions of humanistic pseudoaltruism, but if that works for you, hey, good on ya.
A-R, you really don't appear to have a clue how your own healthcare system screws your fellow citizens over, particularly the disabled and chronically ill. Go find some reading material, there's plenty of blogs written by people who've been copping the short end of the stick for years. Educate yourself.
A-R, you really don't appear to have a clue how your own healthcare system screws your fellow citizens over, particularly the disabled and chronically ill. Go find some reading material, there's plenty of blogs written by people who've been copping the short end of the stick for years. Educate yourself.
Did you not see where I voice support for a plan that helps low-income children and the disabled? I'm not saying the system is perfect. Far from it. But a lot of you seem to be calling for a scenario that trades a Ferrari that needs a tune up in for a perfectly working 1973 Buick Regal.
But ask yourself this: should it be the legal obligation for taxpayers to support healthcare programs, especially considering the inverse relationship between the amount of tax paid to support the system and the population who would use it? In my book, not only is that a misappropriation of property, but of personal liberty as well. Not to mention it being flat-out socialist in nature.
Once you start legislating moral judgments that don't involve the direct disenfranchisement of one party against another, that's a slippery slope, and not one that could support our current national framework.
Atomic Ross, you might want to look up "privilege" as it applies to being born white, male, straight, and middle-class, and see how it applies to you having rather an easier time in the world than lots and lots of other people. Of course, I doubt you will; you'd rather complain about those lazy, lazy poor people, as if no other factor works at keeping the impoverished in bad conditions but their own sloth, and as if nobody ever was influenced by their environment for good or ill.
And, by the way, saying "but I support health care for little kids and the disabled, because I can't find a way to blame them for their own condition" doesn't exactly make you sound like a saint, either.
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AtomikaLive fast and get fucked or whateverRegistered Userregular
edited December 2007
So . . . .
The only refutations are ad hominem attacks?
Gotcha.
At least Feral is offering counterpoint. But then again, what do I know? I'm an entitled white guy of privilege who obviously has no idea what it is to be sick or poor.
Before I became a nurse, I worked evenings in a factory. I drove a forklift and made $7 an hour, dumping industrial waste. I went to school at night, online, and every Summer. My mother is a teacher and my dad is only ever intermittently employed, most recently because of his cancer. I took most of my nursing classes at junior college because that's all that the government would pay for and I couldn't afford to live anywhere else.
I may be white, but I don't think "privileged" quite covers it.
And personally, I find it lazy to throw up old chestnuts as you have when you can't or won't offer a better defense for your position. Because God knows I have no insight to the subject at hand, what with me being caucasian and all. :roll:
Shit man. I went to uni with a girl who had no frickin' arms. She got there with help. help is good.
I never said it wasn't. I fully support help. Help is fantastic.
Gutting the world's most advanced provider of medicine in order to usher in a universal plan to give EVERYONE the same shitty care is not so good.
I've delineated several steps that would decrease costs of insurance and care in America, but somehow people still see this as a condemnation of the poor. I guess people would rather see the lower-incomed be spoon-fed by the government and thus completely dependent instead of decreasing the barriers to democratic market entry.
Loathe the terminology as much as you will, but offering a thing to someone who can't do the things necessary to afford it is enabling, pure and simple.
Feral said that the UK and Canadian systems are some of the worst examples of "UHC" in the world. Can you elaborate on that in detail providing comparative examples? I would be interested to see how/why you think that is the case.
I always see people state the above on American focused healthcare debates but usually (not always) the evidence isn't really there. Often right wing think tanks from the US are cited in reference to Canada (the old MRI bugbear) or tabloid news articles in reference to the UK (like "woman dies due to dirty hospital"). Neither of which are really credible sources, not on their own anyway.
Shit man. I went to uni with a girl who had no frickin' arms. She got there with help. help is good.
I never said it wasn't. I fully support help. Help is fantastic.
Gutting the world's most advanced provider of medicine in order to usher in a universal plan to give EVERYONE the same shitty care is not so good.
You still have categorically failed to argue that extending care lowers care standards. We have a great system over here. The only two things holding it back are a) an underfunded education system, and b) in some areas, a very unhealthy administrative culture. Neither problem is an inherent feature of a public health care system. Neither is inevitable! This is a shit argument.
Loathe the terminology as much as you will, but offering a thing to someone who can't do the things necessary to afford it is enabling, pure and simple.
You spent half of the last page describing how you were enabled. Getting college paid for twice. Being provided with night and online courses, which other people had to fight for on your behalf, because you can be sure as shit that universities don't offer those things out of the goodness of their hearts. Taking advantage of government help at every turn. And somehow, when its you doing that, you're being all self-empowered and shit, but when other people need similar help, they don't deserve it? This is exceptionalism at its finest, which is to say its most vomit-worthy. You got where you are through the same systems you'd deny extending to other people.
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AtomikaLive fast and get fucked or whateverRegistered Userregular
Feral said that the UK and Canadian systems are some of the worst examples of "UHC" in the world. Can you elaborate on that in detail providing comparative examples? I would be interested to see how/why you think that is the case.
I always see people state the above on American focused healthcare debates but usually (not always) the evidence isn't really there. Often right wing think tanks from the US are cited in reference to Canada (the old MRI bugbear) or tabloid news articles in reference to the UK (like "woman dies due to dirty hospital"). Neither of which are really credible sources, not on their own anyway.
I only have anecdotal evidence at hand, but my girlfriend hates the NHS. She spent six months in the hospital with them running tests and coming up with nothing, causing great harm to her livelihood. She scrounged up enough to purchase private coverage, went to a private practice, and had her adrenal tumor diagnosed and out of her within two weeks.
Indeed. Whereas I've had positive experiences so far.
There must be screeds of scholarly studies out there on this kind of thing. I know back at law school the Masters of Bioethics was a popular course of study, and they studied this kind of thing (health rationing etc).
So what, we're going to gut our healthcare system, the most advanced and successful in the world, to better suit 8% of the population?
Bahahaha! The American healthcare system is the running joke of the world. We fly there to have expensive and experimental procedures done on our citizenry, but thank the various gods that we don't live there.
You're an idiot.
You freely admit that you pay money to come here to get the best care, but somehow still find that laughable. Conversely, I'm thankful for living in a country where I know that not only will I get fast care, I'll get some the best care available.
I don't know where you're from, but I can't really think of anywhere that offers the same level of speed and competence that the US does. So if your happy with your tax-subsidized system that makes you wait months for half-assed care, more power to you.
I wouln't have responded to this thread if I had known its author was such a mook.
If you had cared to give that poster even a cursory amount of consideration, you would have noticed that he was from Australia.
I think everyone can accept that at the top tier, America has some excellent specialist centeres. So does Britain, Sweden, Switzerland, hell the entirety of the EU and yes... even Australia. It is all dependant on the type of procedure you need done.
Oh, and my advice to you is if you haven't lived and experienced the quality of another countries healthcare first hand then you need to shut your pie-hole immediately. The Australian healthcare system is very good for what it does (and looks set to get even better now that we have kicked out the idiot liberals) and no you don't wait months for surgery unless its an ortho procedure. In fact, almost all acute care (eg Cancers) are dealth with in the public sector and are free to the people. My best friend recently recovered from Leukemia and was treated to world's best practice over 9 months. His bill? $600. He didn't have to have a bone-marrow transplant but if he did, it would also come courtesy of the taxpayer. And you know what, any sane person would realise that this is how things should be.
FYI, I have lived in both countries for many years apiece, and I can tell you that your trumpeting of American healthcare supremecy sounds as hollow as all the rest of that rah-rah American superiority bullshit the rest of the world hears all day long.
Indeed, I should have better phrased my humor - the point was that America is the top of the game when you're paying top dollar or have some unimaginably rare condition, in which case generally speaking the research to treat it was done there.
But at the completely mundane level, at the level of GPs, aged care or chronic condition management the system fails terribly and in many ways this is the level which actually matters - the rich will always be able to get the best treatment no matter what, but people should not go bankrupt by virtue of essentially problems they did not have a choice in.
And of course here's the real kicker - the thing about healthcare is that prevention is always better then the cure. The problem with making it expensive and inaccessible to the lower and middle class is that you dissuade people from going to the doctor if they have a minor problem until it becomes a major problem. Now naturally, this tends to accompany a level of waste because people come in for mundane things but the advantage is you generally are far more likely to catch the crippling things early - my mother took a biopsy of a mole once and happened to get the entire melanoma in the biopsy sample, it was that small and that early.
Feral said that the UK and Canadian systems are some of the worst examples of "UHC" in the world. Can you elaborate on that in detail providing comparative examples? I would be interested to see how/why you think that is the case.
Don't know about Canada, but the NHS is not the great white hope that Michael Moore amusingly made it out to be in Sicko.
Also, the NHS is currently (or at least, was under Blair) being semi-privatised in essence, and everyone knows (but does not want to admit) that with an aging population, it is practically impossible to sustain under current conditions. Either more private healthcare will be introduced, standards will decline, or it the massive budget share it already has will increase still further.
@electricity - the American healthcare system isn't the running joke of the world, especially in the medical community. Nobody particularly wants to work the general nurse/doctor jobs, and nobody particularly wants to be on the patient end, but there is recognition that it provides by far the most technical & prodcedural innovation in the world, as well as ample funding that doesn't exist in national systems. Don't be so quick to dismiss research & cutting-edge medicine, without it we'd still be using leeches. (Actually, we still are, but never mind)
Also, I completely disagree with your assertion about chances of catching things early being necessarily increased in national systems. Certainly the NHS is so apt to overcrowding that routine procedures are actually skipped or cut down, and doctors/nurses are dealing with many more patients, so there is less chance of catching things early. The number of standard tests etc that are carried out on US patients is far higher than those on NHS patients.
Indeed. Whereas I've had positive experiences so far.
There must be screeds of scholarly studies out there on this kind of thing. I know back at law school the Masters of Bioethics was a popular course of study, and they studied this kind of thing (health rationing etc).
Not really, it's too politicised. Standard problem (apparently) brought up by the government; people have good experiences in the NHS, but read that it is going down the plugholes, and believe the media. Of course, the fact that the govt. continually twist figures & such doesn't help either. I also have a relation who is a senior nurse-consultant, who confirms that a lot of the massive administrative problems are true.
That is most likely the problem point of the NHS - not that the care is necessarily very bad, but that the amount of waste in the system is absolutely vast, and might be better managed by a private system. Equally, it might be better managed by a better run public system.
Still, the fact that if it remains a public system, it is going to either get worse or more expensive (or both), is pretty undeniable.
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Why don't you try arguing coherently?
I was simply refuting your assertion that I felt scientists were either "lazy" (as you said) or there was a conspiracy to not cure cancer. If you had the reading comprehension of an American third-grader, you'd see that I said neither of those things are true, and now you're just being an ass.
When people can easily get preventative (ie - regular) care, everyone benefits because it's cheaper and we're all healthier.
That's not entirely true. They are required by law to provide you emergency care, which is usually defined in terms of stabilizing the patient. What exactly constitutes an emergency does have some grey areas for some conditions (panic attacks, fibromyalgia flareups, or migraines are examples) but, in general, patients do not have that much power to dictate what level of care they receive. Emergency departments are fully within their rights to turn away a patient without providing any care at all if they determine that the condition in question isn't actually an emergency. It doesn't happen often because it's usually quicker and easier to scribble somebody a prescription for Vicodin or Ativan and send them on their merry way than it is to argue with them (and possibly disrupt other patients), but that's entirely a judgment call on the part of the attending doc, not a legal mandate.
One of the bogeymen that gets thrown around in arguments is the phrase "health care rationing." I understand why it's used, because "rationing" brings up scary images of people standing in line for bread in Cold War Poland or WWII-era posters imploring people not to drink coffee so our GIs fighting the krauts can have a spot of joe in the morning. But health care rationing is already a reality - in the ED, it's called "triage" and in office visits it's governed not by necessity or severity but by deductibles and coverage limits. Rational rationing (see what I did there?) is a necessary fundamental component of any functional healthcare system. If somebody might see 85% improvement on a $100/month drug but 90% improvement on a $500/month drug, unless they're paying the difference with cold hard cash I don't think any collective payer (whether governmental or private insurance) should be shelling out the extra money just for marginal improvement.
You've used this argument before and I find it mind-bogglingly bigoted. Lack of education or profession doesn't render somebody less deserving of medical care. ED nurses by and large don't have enough exposure to any particular patient to pass judgment on their lifestyle choices. In the 15 minutes you took to get somebody's blood pressure, did you talk to them about their childhood? Their parents? Their life experiences? Unless your EDs were 100% unlike all the EDs I've ever seen or been in, your understanding of the "lifestyle choices" of your patients were superficial at best.
People who moralize about "addictions" are a huge pet peeve of mine. It's not a scarlet letter A that you get to brand people with if you don't particularly feel like treating them with a modicum of human respect. Addiction is a medical issue and addicts deserve medical care just as much as anybody else.
Did you ever think that maybe some of those addicts became addicts because they were self-medicating a chronic disorder? I've seen meth heads go clean after getting antidepressants and Adderall; alcoholics who improve after getting antianxiety meds; pot smokers who needed Haldol; opioid addicts with verifiable back problems that presented clear as fucking day on an MRI. Just because they take drugs doesn't mean they aren't sick.
You superficial twit.
Cell phones are neither expensive nor frivolous. Telcos are slowly phasing out pay phones, which means if you are mobile (say, because you're couch-surfing or staying with relatives) and you want to be able to get in touch with the people who might be able to help you get places if you find yourself stranded somewhere, you need a cell phone. There are charities (like Call to Protect) who give out cell phones to high-risk groups because having a cell phone in the case of emergency is a near-necessity.
As for designer clothing, I'm not even sure I should give that argument the respect necessary to refute it. Implying that the clothes somebody wears are even remotely relevant to how deserving they are of medical care is both offensive and stupid. But here, let me throw this monkey wrench into your neatly compartmentalized worldview: I buy designer clothes at a nearby Goodwill for $5-10 an article. See, I can take the subway to a Goodwill that's just outside a very ritzy suburb of San Francisco called Hillsborough, where parents of teenagers drop off last month's fashion du jour. Their loss is my gain. Now if you were to tell me that because I was able to buy J. Crew slacks and a Banana Republic shirt for a grand total of $20 that I obviously could afford medical insurance (remember, folks, I spent about three years without insurance because of a pre-existing condition, a story I've told to death on these forums) then I'd tell you to sit and swivel.
And you know what else? Try being a patient for a while, with a chronic condition, that has occasional flareups that require urgent intervention. (Like, say, migraines!) Perform a small experiment for yourself. Try going to the ED a few times in jeans and a ratty sweater; then for your next few visits put on your best date clothes and go in. Watch how much better you get treated when you're wearing nice clothes. Nice clothes say you're responsible, they say you take care of yourself, and I will guarantee that you will be treated in a much more respectful fashion - and possibly even receive superior care - on average wearing nicer clothes. (Largely because of people like you who make snap judgments based on a patient's wardrobe.)
Non-urgent walk-in ambulatory care clinics definitely need to be more widespread. You see such drop-in community clinics in urban areas and on university campuses, but for a significant proportion of the population, the only drop-in medical care available are emergency rooms.
The first company to develop a cure for cancer would make astronomical amounts of money.
Mere treatments aren't better business than cures, because treatment invites competition. Cures do not.
There's nobody sitting in an office chair somewhere looking at two different proteins and choosing one as a target for drug development because it's more of a treatment than a cure. Drug development is much more random than that; you follow every viable lead within your budget because you have no idea which ones will pan out. Even so called "rational" drug design is more like betting on a horse race than a game of chess; your best strategy is a matrix of educated guesses.
the "no true scotch man" fallacy.
Not true on either account. All patients receive the same minimum federally-mandated level of competent care, as determined by the attending physician. It's highly regulated by JCAHO, and on top of that by individual licensing agencies and hospital boards. Emergency departments, especially the designated county hospital, does not have the authority to turn away anyone for treatment, ever. The most they can do is refer them to on-site clinics, which are also run by the hospital, should their triage determine them to be unemergent and the patient would like expedited care. The catch there is, the clinic asks for a minimum payment up front, so I bet you can guess how many patients choose that option.
I'm not really certain which thing you're addressing. Please clarify, as I never proposed any type of "care rationing."
Questions asked in triage also regard the patient's age, smoking history by years and number of packs, number of pregnancies and abortions (biological or therapeutic), occupation (past and current), medical history (from broken bones to HIV and Hep C), and history of substance abuse. Also, we note outstanding physical anomalies (deformities, missing limbs, oral care) and current and past prescriptions.
If during triage, your query presents you with a 29 y/o female who has four children and seven pregnancies, a history of PID, Hep C, track marks on her arm, old prescriptions for Seroquel, and teeth rotting away from poor dental hygiene, we begin to build a patient profile. It's what we're taught to do in medicine to expedite proper care. If this woman presents with a cough, we're going to immediately check her for tuberculosis based on her personal history, unlike most patients with coughs who we check for mono and strep throat first.
I can understand how a steadfast humanist like yourself would take issue with some of that, but that's how it is and that's how it's taught and that's how doctors the nation over treat patients. A doctor is paid by the patient, not the hospital. Why would the doctor waste resources on patients who are obviously (and have histories of being) non-compliant with care, especially if that same patient will be back in the ER in a few months anyway for some new non-compliance-based illness?
But is addiction an emergency?
In the hospital, we make over a dozen referrals to psychiatric facilities each shift to ensure that patients with psychological problems, including addiction, are treated after being medically cleared by us. The problem is, unless the patient is determined to be an immediate threat to themselves or other, the law forbids involuntary commitment.
Addiction is not an emergency, and if patients can't get the proper treatment that we push them towards, it's not our problem. Is addiction something that needs to be addressed in a comprehensive single-payer plan? Absolutely. But it's not worthy of ER resources. Wring your hands all you want, but people are ultimately responsible for themselves.
I can see that you've obviously got some personal bias in this argument, so I won't press any further. But heart-wrenching testimony and bleeding of hearts (figuratively, in this case) aren't viable alternatives to actual plans, and certainly not any plan that begins with taxation being a magical cure.
Tweaks are needed to coverage and criteria. Community urgent care centers are needed in more densely populous areas. Federal spending needs to be directed at research for cures. But the bottom line is, in general, people need to be more accountable to taking care of their selves. Personally, one the few reasons I support a limited single-payer option is for the ability to turn the non-compliant away once and for all. I'm tired of treating people who won't take necessary steps in maintaining their health, and if their death results from their own poor self-care, so be it.
I think once people have a chance to see first-hand how pitiful a tax-based solution would be, and watch as they lose coverage for non-compliance, they'll remember why the US avoided such a system for so long in the first place.
4) The American citizen did it.
5) McDonalds (or other fat-filled product producer) did it.
6) Capitalism did it.
Its very rational and correct description.
Can you link or site? Because I can't find anything that suggests that JCAHO mandates that all patients be provided care. JCAHO mandates that care that is provided meet a certain minimum standard, not that care be provided at all.
And the relevant federal law to this is EMTALA, which very specifically states that it is up to the hospital staff to determine whether a patient presenting at the ED requires care, and only mandates care in the case of emergency medical conditions, which are again very specifically defined.
Again, you're going to have to link or cite, because I can't find any relevant law that states this. And besides that, it's directly contrary to my experience, because the ED physicians that I've known have had absolutely no problem discharging a patient without treatment if they feel that the patient's condition is not severe enough.
None of which qualifies you to pass judgment on a person's life.
Have you considered that their noncompliance is at least partly related to (real or perceived) barriers to access of proper office visits and non-emergency medical advice?
Yes, there will always be horses who refuse to drink no matter how close they're led to water. And those people are going to be a drain on any medical system, whether public or private. However, there are also people who would comply with care if they could have regular access to physician consultations that last longer than a minute and a half or could schedule a doctor's visit less than six weeks out once in a while.
Whether the first category of patient outnumbers the second is irrelevant - getting all those people out of the ED and into clinics and offices is going to be cheaper no matter the demographics involved.
Huh, so instead of addressing the substance of my post you only address the first line, because apparently I "have bias?"
You're right, I'm biased. I'm biased against classism. I'm sick of seeing you come into every thread on UHC with a paragraph bemoaning poor people and how its their own damn fault they're sick. I'm sick of you slipping into every discussion on the subject an argument along the lines of "well, I've worked in EDs across the country, and let me tell you, sometimes uninsured people have cell phones!"
Neither is perenially bitching about those damn poor people and their cell phones.
I'd rather people lose coverage for non-compliance than lose coverage because they lost their job and couldn't afford $350/mo COBRA payments.
the "no true scotch man" fallacy.
I don't know if it will actually happen, but it is kind of interesting
Aye, that's pretty much what happened to me. And the moment you can't pay COBRA, you lose your "continuous coverage" status and instantly all the ailments you had up to that point in your life become "preexisting conditions" when you try to get back into a healthcare program.
That's painful.
JCAHO sets the minimum standard of care, that's what I was referring to. Regardless of class, race, gender, and lifestyle, every patient will receive the same protocol and response to their presentation. Hospitals don't use separate forms and break out crappier instruments when they find out you're poor.
The law mandates that each patient receive a medical screening exam by a physician or practitioner directly under their supervision. If the exam determines an illness or injury that can be treated without intervention by hospital staff, doctors will usually discharge them with the instructions on how to seek proper care. This actually saves patients vast sums of money, as all they pay for is triage and physicians' fees instead of fees for tests, procedures, and radiology. It's the doctor's job to diagnose, not the patient's.
Every patient that comes into the ER will be seen by a doctor. Simply entering the ER does not earn you the right to treatment should the medical staff determine a lack of acuity. That's not what emergency rooms are for.
Sure it does. It's actually part of my job duty to make assumptions about people's life, and it affects how we treat patients. If it's a busy day with a high acuity in the census, say you've got two identical patients slowly going into respiratory failure. One is a person having an allergic reaction, the other is a frequent repeat patient who smokes four packs a day and has a history of substance abuse. Both conditions being equal, guess who the doctor is going to see first and spend more time with?
In the ER you often have limited resources and physicians. You make judgments on people's lives all the time. It's a responsibility, and it's unfair to the acutely ill who don't have histories of non-compliance.
And you think that would be better under a single-payer system? Why don't you ask any Canadian or Brit who's been through the system and waited three months on an MRI or six months on a biopsy to test for cancer? I think they'd love to hear an American bitch and moan about long wait times.
Getting all foamy and lathered up about it won't change the facts, though. While I've already mentioned that insurers' criteria for coverage is far too strict, perhaps criminally, that's simply one tier of the argument. The number of uninsured in this nation is estimated at 46.6 million. The entire population is over 300 million. So roughly 15% of the nation is uninsured, and at least half of that figure represents the statically uninsured. So what, we're going to gut our healthcare system, the most advanced and successful in the world, to better suit 8% of the population?
While I'll fight against a tyranny of the majority all day long, that's just preposterous.
Hi, I'm Canadian. I dont mind waiting on an MRI or Biopsy while people with more urgent cases are seen ahead of me. Just like I'm glad that if I'm in a life threatening situation I'm seen before people that simply got in line before me.
MWO: Adamski
Bahahaha! The American healthcare system is the running joke of the world. We fly there to have expensive and experimental procedures done on our citizenry, but thank the various gods that we don't live there.
Again, this isn't entirely honest. JCAHO maintains a minimum standard - but not every patient gets a minimum amount of care. A hospital isn't going to give an MRI to everybody who complains of a headache, but they are much more likely to give an MRI to somebody who has $5000 in cash to pay for it. An extreme example, sure - a more realistic example (and one from my own life) was when I was receiving treatment for sleep apnea. While uninsured, the best I could afford was a used 10-year-old CPAP; it wasn't until I got insurance that I could get the surgery that cured me of the condition.
This is true. This is also a vastly different statement from:
Making a professional judgment as to who receives what treatment is an inherently different thing from making a moral judgment that implies that certain people deserve medical care less than others. And when you come into a thread (as you've done across multiple threads) and mention poor patient compliance or possession of luxury items among the uninsured, you're willfully implying that some people - particularly poor people - don't deserve medical coverage.
I've said this before and I'll say it again: arguing against UHC based on problems with the Canadian healthcare system is like saying that import cars suck because of problems with the Yugo. The Canadian system (and, to a lesser extent, the British system) are among the worst examples of UHC worldwide, largely because they are 100% socialized. No serious proposal for UHC in the US includes scrapping private healthcare entirely. Every serious proposal involves a system like - well, like most the world, but most notably France, Germany, Switzerland, and Australia - where the govt plan covers basic coverage for the low and middle classes while middle and upper classes can get more comprehensive supplemental coverage and/or pay cash.
Beyond that, reports of long wait times in Canada are deliberately exaggerated by pundits on the right and the insurance lobby. Besides being based on old statistics that don't take into account recent reforms, they also involve cherry-picking data: taking the worst wait times for the longest-wait procedures in the most impacted province (Alberta) in one of the worst UHC systems in the western world (Canada). It's as relevant to the system we're proposing as Yugos are to Honda Accords.
Again, nobody's suggesting that we gut it. Every serious proposal involves a hybrid system that keeps private insurance around - though most proposals involve streamlining records keeping and claims reporting as well to reduce the burden that the plurality of insurance companies places on care providers - while establishing a public payer as well.
Besides that, it's not just the uninsured who are affected. Over 75% of people who file for bankruptcy due to medical debt were insured at the time of illness. And the number of uninsured is increasing. 8% of the population is a big enough number on it's own, but this cancer is malignant and it's only to grow unless something drastic is done to stop it.
the "no true scotch man" fallacy.
You're an idiot.
You freely admit that you pay money to come here to get the best care, but somehow still find that laughable. Conversely, I'm thankful for living in a country where I know that not only will I get fast care, I'll get some the best care available.
I don't know where you're from, but I can't really think of anywhere that offers the same level of speed and competence that the US does. So if your happy with your tax-subsidized system that makes you wait months for half-assed care, more power to you.
I wouln't have responded to this thread if I had known its author was such a mook.
It depends on the acuity. That cashless person with the headache will get an MRI if the doctors suspect a stroke or ischemic attack. If the MDs don't suspect it, well it's like I said earlier: patients do not get to diagnose themselves. But you are right in the fact that if a poor-looking patient complains of a headache, but does not present with signs of a stroke, the doctors will not likely prescribe one. But then again, that isn't a medical decision based on perceived ability to remunerate, it's a medical decision based on presentation of care. The doctors have a responsibility to give the patients the best care that fits their presentation, but the doctors can't go spending the hospital's money on procedures people don't need. The hospital can't operate if a doctor is wasting money that won't be recouped on procedures for patients that don't need it.
All that stuff is covered by licensing boards and doctor/hospital protocols, and are constantly being evaluated and revised.
Again, "best care" is determined by outcomes, not customer service. The patient has no business in trying to evaluate if they received the best care they could unless they thought they were misdiagnosed, which could only be assessed by another physician. Just because patients think they need to get certain treatments in the hospital doesn't entitle them to it. They aren't MDs. I'd much rather receive spartan care that completely solved my illness than extremely enjoyable care that didn't fix anything. That's why people go see doctors for care based on science and medicine, and not their grandmother for care based on cookies and chicken soup.
As far as I (or most any other medical professional) is concerned, your top priority is patient outcome and speed of care. It's taught in every university across this nation. Finding time to see if the patient enjoyed themselves on their visit is way down the list, especially when you consider the dire nursing shortage in the US that makes them responsible for five or more patients at a time.
Bottom line, "best care" is not a judgment most patients are qualified to make.
My belief on the matter is that in any system that requires my tax dollars going to pay for the care of others (especially in the event of me using my own, privately-funded insurance), I do not support a program that would allow for those types of people to benefit from free care. I'll support subsidized care for poor children and the legitimately disabled, but simply being poor is not a disability to me. There are ways to better yourself to get out of that situation, just as there are poor life choices that entrench you all the moreso. No one ever moved out of poverty by being enabled.
And while I'm absolutely for a system that offers alternatives for lower-income citizens, how is it not descrimination to bar the wealthier people from a system they are likely paying more for? All it does is create welfare states that rob people of any desire to propel themselves any further than the government requires. You bring up France and other nations, but then compare their unemployment levels to ours. Compare their absolute poverty rates to ours. Do that, then get back to me regarding how well social programs benefit nations and their economy.
True enough, but there are many more variables in the equation than most people realize, and many who champion the systems of other nations would be irate at the conditions that demand it. The system needs to be fixed, but installing a low-quality lethargic care system that creates a class of low-income government dependents while increasing taxes on the middle and upper class isn't the way to get it done.
Support tort reform, pressure insurance agencies to relax their criteria, set up on-site community care centers that direct patients to more affordable care for non-emergent conditions, enforce immigration laws and deportation, amend "anchor baby" clauses, press Big Pharm companies to direct R&D toward cures, set aside grants for university research . . . . all of these things will go toward solving insurance costs without destroying the economy, disproportionately affecting taxpayers, or creating a cyclical class of poor people dependent on government assistence. Hell, some of those steps even create jobs.
Just saying.
Also, I consider your stance that health care is 'enabling' per the pejorative sense despicable. Yes!, ensuring the health of our nation's less-than-middle-class will do nothing but mire them further, those lazy bastards!
If a white kid from a lower-middle class family like me can get college paid for (twice, actually), the opportunities for the less-weathly and less-melanin depleted are tenfold. I didn't join the army, I just did well in school and took advantage of the government's grant program for certain curriculums.
Like I've said over and over, wringing your hands and acting repulsed at certain notions don't alone change or disprove things. I prefer practical application of logical rationale to vague notions of humanistic pseudoaltruism, but if that works for you, hey, good on ya.
Did you not see where I voice support for a plan that helps low-income children and the disabled? I'm not saying the system is perfect. Far from it. But a lot of you seem to be calling for a scenario that trades a Ferrari that needs a tune up in for a perfectly working 1973 Buick Regal.
But ask yourself this: should it be the legal obligation for taxpayers to support healthcare programs, especially considering the inverse relationship between the amount of tax paid to support the system and the population who would use it? In my book, not only is that a misappropriation of property, but of personal liberty as well. Not to mention it being flat-out socialist in nature.
Once you start legislating moral judgments that don't involve the direct disenfranchisement of one party against another, that's a slippery slope, and not one that could support our current national framework.
And, by the way, saying "but I support health care for little kids and the disabled, because I can't find a way to blame them for their own condition" doesn't exactly make you sound like a saint, either.
The only refutations are ad hominem attacks?
Gotcha.
At least Feral is offering counterpoint. But then again, what do I know? I'm an entitled white guy of privilege who obviously has no idea what it is to be sick or poor.
Before I became a nurse, I worked evenings in a factory. I drove a forklift and made $7 an hour, dumping industrial waste. I went to school at night, online, and every Summer. My mother is a teacher and my dad is only ever intermittently employed, most recently because of his cancer. I took most of my nursing classes at junior college because that's all that the government would pay for and I couldn't afford to live anywhere else.
I may be white, but I don't think "privileged" quite covers it.
And personally, I find it lazy to throw up old chestnuts as you have when you can't or won't offer a better defense for your position. Because God knows I have no insight to the subject at hand, what with me being caucasian and all. :roll:
you really should take my advice about reading some stuff.
I never said it wasn't. I fully support help. Help is fantastic.
Gutting the world's most advanced provider of medicine in order to usher in a universal plan to give EVERYONE the same shitty care is not so good.
I've delineated several steps that would decrease costs of insurance and care in America, but somehow people still see this as a condemnation of the poor. I guess people would rather see the lower-incomed be spoon-fed by the government and thus completely dependent instead of decreasing the barriers to democratic market entry.
Loathe the terminology as much as you will, but offering a thing to someone who can't do the things necessary to afford it is enabling, pure and simple.
I always see people state the above on American focused healthcare debates but usually (not always) the evidence isn't really there. Often right wing think tanks from the US are cited in reference to Canada (the old MRI bugbear) or tabloid news articles in reference to the UK (like "woman dies due to dirty hospital"). Neither of which are really credible sources, not on their own anyway.
You still have categorically failed to argue that extending care lowers care standards. We have a great system over here. The only two things holding it back are a) an underfunded education system, and b) in some areas, a very unhealthy administrative culture. Neither problem is an inherent feature of a public health care system. Neither is inevitable! This is a shit argument.
You spent half of the last page describing how you were enabled. Getting college paid for twice. Being provided with night and online courses, which other people had to fight for on your behalf, because you can be sure as shit that universities don't offer those things out of the goodness of their hearts. Taking advantage of government help at every turn. And somehow, when its you doing that, you're being all self-empowered and shit, but when other people need similar help, they don't deserve it? This is exceptionalism at its finest, which is to say its most vomit-worthy. You got where you are through the same systems you'd deny extending to other people.
I only have anecdotal evidence at hand, but my girlfriend hates the NHS. She spent six months in the hospital with them running tests and coming up with nothing, causing great harm to her livelihood. She scrounged up enough to purchase private coverage, went to a private practice, and had her adrenal tumor diagnosed and out of her within two weeks.
As I said, however, it's just anecdotal.
There must be screeds of scholarly studies out there on this kind of thing. I know back at law school the Masters of Bioethics was a popular course of study, and they studied this kind of thing (health rationing etc).
If you had cared to give that poster even a cursory amount of consideration, you would have noticed that he was from Australia.
I think everyone can accept that at the top tier, America has some excellent specialist centeres. So does Britain, Sweden, Switzerland, hell the entirety of the EU and yes... even Australia. It is all dependant on the type of procedure you need done.
Oh, and my advice to you is if you haven't lived and experienced the quality of another countries healthcare first hand then you need to shut your pie-hole immediately. The Australian healthcare system is very good for what it does (and looks set to get even better now that we have kicked out the idiot liberals) and no you don't wait months for surgery unless its an ortho procedure. In fact, almost all acute care (eg Cancers) are dealth with in the public sector and are free to the people. My best friend recently recovered from Leukemia and was treated to world's best practice over 9 months. His bill? $600. He didn't have to have a bone-marrow transplant but if he did, it would also come courtesy of the taxpayer. And you know what, any sane person would realise that this is how things should be.
FYI, I have lived in both countries for many years apiece, and I can tell you that your trumpeting of American healthcare supremecy sounds as hollow as all the rest of that rah-rah American superiority bullshit the rest of the world hears all day long.
And it's also not true.
But at the completely mundane level, at the level of GPs, aged care or chronic condition management the system fails terribly and in many ways this is the level which actually matters - the rich will always be able to get the best treatment no matter what, but people should not go bankrupt by virtue of essentially problems they did not have a choice in.
And of course here's the real kicker - the thing about healthcare is that prevention is always better then the cure. The problem with making it expensive and inaccessible to the lower and middle class is that you dissuade people from going to the doctor if they have a minor problem until it becomes a major problem. Now naturally, this tends to accompany a level of waste because people come in for mundane things but the advantage is you generally are far more likely to catch the crippling things early - my mother took a biopsy of a mole once and happened to get the entire melanoma in the biopsy sample, it was that small and that early.
I read this and I can safely say that you are an idiot.
Don't know about Canada, but the NHS is not the great white hope that Michael Moore amusingly made it out to be in Sicko.
Also, the NHS is currently (or at least, was under Blair) being semi-privatised in essence, and everyone knows (but does not want to admit) that with an aging population, it is practically impossible to sustain under current conditions. Either more private healthcare will be introduced, standards will decline, or it the massive budget share it already has will increase still further.
@electricity - the American healthcare system isn't the running joke of the world, especially in the medical community. Nobody particularly wants to work the general nurse/doctor jobs, and nobody particularly wants to be on the patient end, but there is recognition that it provides by far the most technical & prodcedural innovation in the world, as well as ample funding that doesn't exist in national systems. Don't be so quick to dismiss research & cutting-edge medicine, without it we'd still be using leeches. (Actually, we still are, but never mind)
Also, I completely disagree with your assertion about chances of catching things early being necessarily increased in national systems. Certainly the NHS is so apt to overcrowding that routine procedures are actually skipped or cut down, and doctors/nurses are dealing with many more patients, so there is less chance of catching things early. The number of standard tests etc that are carried out on US patients is far higher than those on NHS patients.
Not really, it's too politicised. Standard problem (apparently) brought up by the government; people have good experiences in the NHS, but read that it is going down the plugholes, and believe the media. Of course, the fact that the govt. continually twist figures & such doesn't help either. I also have a relation who is a senior nurse-consultant, who confirms that a lot of the massive administrative problems are true.
That is most likely the problem point of the NHS - not that the care is necessarily very bad, but that the amount of waste in the system is absolutely vast, and might be better managed by a private system. Equally, it might be better managed by a better run public system.
Still, the fact that if it remains a public system, it is going to either get worse or more expensive (or both), is pretty undeniable.