Socialize health care

Originally in alt.support.arthritis

http://observer.guardian.co.uk/uk_ne...939882,00.html

Managers block NHS access
Administrators are intercepting GPs' referrals and turning patients
away in a bid to save money

Jo Revill, health editor
Sunday November 5, 2006 The Observer

Thousands of patients are being denied access to hospital consultants
because the NHS has set up money-saving management schemes which block
GPs' referrals.

In direct contradiction to the government's claims to be encouraging
more choice in healthcare, patients with rheumatoid arthritis, knee
problems and eye and skin conditions are being targeted by managers who
intercept referral letters and send them back to GPs or into
physiotherapy clinics rather than allowing them to be seen by the
appropriate specialist.
The scale of the interference has led some GPs to use extraordinary
subterfuges to get their patients to a surgeon. One practice in
Merseyside has decided to send letters marked 'private and
confidential' to the surgeons when they need a referral, rather than
using the usual computer system which would automatically block the
request.
Another doctor told The Observer that he uses handwritten letters to
hospitals outside his area which he knows will not be blocked from
taking patients.

As the NHS struggles to deal with *£620m of debt, administrators are
using referral management schemes to curb hospital admissions and to
cut waiting lists. The schemes start to operate once a GP sends an
electronic letter to a hospital consultant, requesting an appointment
for the patient.
The letter is scanned by administrators who decide whether it
constitutes an 'appropriate' referral. If they deem it unnecessary, the
patient is 'bounced' back to a clinic within the primary care trust, or
to a nurse manager or a physiotherapy clinic if it is an orthopaedic
problem.
The British Medical Association has warned ministers that the plans
are threatening the relationship between a GP and patients, and that
this goes against the choice agenda even though the government is
adamant that the schemes can save millions of pounds.

Angry GPs in Merseyside are faxing referrals directly to a consultant
to stop managers intercepting them. They are also posting letters
marked 'private and confidential' to prevent hospital staff from
opening them, and pushing patients back into the GP clinics. Doctors at
a practice in St Helens said they were forced to take the action after
patients they had referred for orthopaedic, rheumatology and
physiotherapy were being diverted away from Whiston Hospital in Prescot
to a physiotherapy clinic.
A family doctor in Hertfordshire said that he had started to send
orthopaedic patients to a hospital outside their local area, so that
he knows they will see a surgeon. Dr Gerry Bulger is upset that his
local body, Dacorum primary care trust, set up a system which means
that patients with rheumatoid arthritis or orthopaedic problems cannot
get an appointment with a consultant; instead they are sent to see a
physiotherapist or another GP, who then decides what to do.

Dr Bulger said: 'Sometimes I write a hand-written letter to a hospital
which I know will accept them, to get round the diktat. How can the
government talk about giving patients choice when they are not allowed
in at the front door?'

Evidence from almost 100 PCTs found huge variations in the way GP
referrals are being handled, with some trusts using the centres to cut
up to 15 per cent of referrals. Orthopaedics, dermatology and
physiotherapy were the disciplines where referral management was most
prevalent. As a result, almost half the country's dermatology
departments are suffering from a huge loss of workload and some may
have to close, as patients are siphoned back into GP clinics.

Dr Jonathan Field, consultant leader for the BMA, said: 'Some of the
referrals from one consultant to another in the same hospital are now
being blocked, which is dangerous because it introduces really long
delays.'

In north London, all outpatient follow-up appointments are being
stopped unless the patient has cancer and GPs will be expected to check
on patients. All referrals for skin conditions are being banned unless
GPs stress it is urgent.

Enfield primary care trust is bringing in the measures in the next two
weeks to save *5.5m. Every referral to a hospital specialist is now
being screened by a panel of GPs, clinicians and hospital specialists
under a referral management system known as the Specialist Clinical
Assessment Service. A spokeswoman for Enfield primary care trust said
the changes are in line with government policy to encourage patients to
be treated in primary care near their homes.

A spokesperson for the Department of Health said: 'Referral management
schemes should ensure NHS patients see the most appropriate clinician
in the most convenient setting. These schemes must only be set up where
they will benefit patients.'

* = British pound symbol
___ Blue Wave/QWK v2.12

I have always been partial to socialized medicine, but
I have to admit, this is pretty outrageous.

Unfortunately, the alternatives also have some terrible
problems, including the fact that a large and increasing
number of people in the U.S. have no insurance at all,
and cannot afford anything except the most basic care.

Without insurance, the vast majority of Americans would
be bankrupted by something like prostate cancer treatment.
We have seen some on this newsgroup who are in dire
financial straits. Very poor people with no money at all
can sometimes get some kind of care, but "middle class"
people might as well plan on giving up all of their life
savings and becoming destitute if they don't have insurance
and are unlucky enough to suffer from some lingering
disease.

I'm not arguing for socialized medicine. But I do think
that we, as a society, need to think hard about whether
there are ways to make our health care more rational,
more accessible, less costly, and without the enormous
expenditures for administration and for drugs that we
have.

If I were President, I'd appoint a commission to study
this problem - though I realize that didn't get very far when
Clinton tried it.

Alan

"Alan Meyer" <ameyer2@yahoo.com> wrote in message
news:geCdnX2HipRA5sjYnZ2dnUVZ_qWdnZ2d@comcast.com. ..
>I have always been partial to socialized medicine, but
> I have to admit, this is pretty outrageous.

Don't believe verything you read. There is a shortfall in NHS funding but
the news media thrive on journalistic hyperbole.
>
Mary
>

"Alan Meyer" <ameyer2@yahoo.com> wrote in message
news:geCdnX2HipRA5sjYnZ2dnUVZ_qWdnZ2d@comcast.com. ..

>I have always been partial to socialized medicine, but
> I have to admit, this is pretty outrageous.

Socialized medicine can be a boon for the poor and lower class. I suspect
at its inception, socialized medicine seems to benefit the middle class, but
I doubt that it actually does. And, of course, the rich end up tapped for
the cost without benefit. And, for awhile, people really feel good about
theselves paying for those poor people.

Socialized anything starts out to be a really nice thing to do for those who
have nothing. The concept seems to be at the base of our (US) very
existence -- all men are created equal. But, in the long term, socialism
causes a degradation to the system and to the people. What every country,
community or society has found out is that while all men are created equal,
they diverge to a continuum from the best to the worst. And, if you don't
have to earn your wages, your food, your medical care, etc., then the worst
will not. Once the worst do not, then the next to worst. Eventually, 80%
of the people are living off the toil, intelligence and committment of the
20%.

Emotion and government just do not mix.



--
PSA 16 10/17/2000 @ 46
Biopsy 11/01/2000 G7 (3+4), T2c
RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins
PSA .1 .1 .1 .27 .37 .75
EBRT 05-07/2002 @ 47
PSA .34 .22 .15 .21 .32
Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05,
2/06, 6/06
PSA .07 .05 .06 .09 .08 .132 .145
Casodex added daily 07/06
PSA <0.04
Non Illegitimi Carborundum

Hello all--

steve kramer wrote:
>
> > Socialized medicine can be a boon for the poor and lower class. I suspect
> at its inception, socialized medicine seems to benefit the middle class, but
> I doubt that it actually does. And, of course, the rich end up tapped for
> the cost without benefit. And, for awhile, people really feel good about
> theselves paying for those poor people.
>
> Socialized anything starts out to be a really nice thing to do for those who
> have nothing. The concept seems to be at the base of our (US) very
> existence -- all men are created equal.

>.But, in the long term, socialism causes a degradation to the system and to the people.

Completely untrue. I have a good friend in Denmark and have been to
all the Scandinavian countries. Their quality of life is consistently
rated at the top of the charts. I know because I've seen it their
lifestyle personally. If this is degradation I'd like some of it.

>What every country, community or society has found out is that while
all men are created >equal, they diverge to a continuum from the best
to the worst.

I am disappointed in you, Steve. Suppose you were created with limited
intelligence or with a genetic illness that made it hard or impossible
for you to work. Should you be euthanized like the Nazis did?

> And, if you don't have to earn your wages, your food, your medical
care, etc., then the worst will not. Once the worst do not, then the
next to worst. Eventually, 80%
> of the people are living off the toil, intelligence and committment of the
> 20%.

Here is the reality: You and IP may think you can stand on your own two
feet and have earned enough money to pay for your medical expenses.
But healthcare expenses nowadays can run into hundreds of thousand of
dollars. The average cost of "end of life" care at a hospital is about
$200,000.

What the middle class typically does is this: In NY it's called
"medicaid spenddown." They transfer all their assets so that they can
be in the "impoverished" category and therefore qualify for medicaid
which is provided by the state. These people don't want to use their
own money to pay for long-term care in a nursing home or for a
catastrophic illness. Or they may not have that much money.

If they have money they want to leave it to their children.

If a person can afford to pay a lawyer to do the "Medicaid spenddown"
they will probably do it.

This is the reality. The taxpayer ends up paying anyway.

Any civilized society should provide healthcare to all its citizens as
in done in every industrial country. A person can have a job, be laid
off the next day, and have no health insurance. I know because this is
exactly what happened to my husband (at age 50). And he had saved up a
heck of a lot of money, btw, that is his nature.

The question is how to provide healthcare. I read an article by an
economist who said that the VA healthcare system and Medicare are
examples of quality health care provided by the gov't. They are
efficient, cheaper (because they negotiate prices of drugs, for
example) and the VA healthcare system in his opinion is superior to the
private sector. So there is a model.

Here's another real story. I was recently diagnosed with migraines and
given a drug called Maxalt. The ins. co. paid $457 for the first
prescription. But they refused to pay after that. And I cannot afford
to pay $18 a pill (used three at a time, so $60 per headache) and I
only use the drug if the doctor gives me samples. Otherwise I do
without. And there are no cheaper versions of this drug -- they are
all on patent.

Interestingly, this particular drug is packaged in an interesting way.
You get two pills which come in a little blue plastic carrying case. I
don't know what the case if for but i think they are trying to make a
fashion statement. Maybe your next script will come in a designer
bottle. This is how money is wasted.

All the best,

Leah

"callalily" <lfcjjk@aol.com> wrote in message
news:1163262926.109380.94540@m73g2000cwd.googlegro ups.com...

> >What every country, community or society has found out is that while
> all men are created >equal, they diverge to a continuum from the best
> to the worst.
>
> I am disappointed in you, Steve. Suppose you were created with limited
> intelligence or with a genetic illness that made it hard or impossible
> for you to work. Should you be euthanized like the Nazis did?

That was the National SOCIALIST Party.

You like quotes.... "Those who cannot learn from history are doomed to
repeat it."

But, we should not waste more bandwidth about it on this NG.

callalily wrote:
> Hello all--
>
> steve kramer wrote:
>>> Socialized medicine can be a boon for the poor and lower class. I suspect
>> at its inception, socialized medicine seems to benefit the middle class, but
>> I doubt that it actually does. And, of course, the rich end up tapped for
>> the cost without benefit. And, for awhile, people really feel good about
>> theselves paying for those poor people.
>>
>> Socialized anything starts out to be a really nice thing to do for those who
>> have nothing. The concept seems to be at the base of our (US) very
>> existence -- all men are created equal.
>
>> .But, in the long term, socialism causes a degradation to the system and to the people.
>
> Completely untrue. I have a good friend in Denmark and have been to
> all the Scandinavian countries. Their quality of life is consistently
> rated at the top of the charts. I know because I've seen it their
> lifestyle personally. If this is degradation I'd like some of it.
>
> >What every country, community or society has found out is that while
> all men are created >equal, they diverge to a continuum from the best
> to the worst.
>
> I am disappointed in you, Steve. Suppose you were created with limited
> intelligence or with a genetic illness that made it hard or impossible
> for you to work. Should you be euthanized like the Nazis did?
>
> > And, if you don't have to earn your wages, your food, your medical
> care, etc., then the worst will not. Once the worst do not, then the
> next to worst. Eventually, 80%
>> of the people are living off the toil, intelligence and committment of the
>> 20%.
>
> Here is the reality: You and IP may think you can stand on your own two
> feet and have earned enough money to pay for your medical expenses.
> But healthcare expenses nowadays can run into hundreds of thousand of
> dollars. The average cost of "end of life" care at a hospital is about
> $200,000.
>
> What the middle class typically does is this: In NY it's called
> "medicaid spenddown." They transfer all their assets so that they can
> be in the "impoverished" category and therefore qualify for medicaid
> which is provided by the state. These people don't want to use their
> own money to pay for long-term care in a nursing home or for a
> catastrophic illness. Or they may not have that much money.
>
> If they have money they want to leave it to their children.
>
> If a person can afford to pay a lawyer to do the "Medicaid spenddown"
> they will probably do it.
>
> This is the reality. The taxpayer ends up paying anyway.
>
> Any civilized society should provide healthcare to all its citizens as
> in done in every industrial country. A person can have a job, be laid
> off the next day, and have no health insurance. I know because this is
> exactly what happened to my husband (at age 50). And he had saved up a
> heck of a lot of money, btw, that is his nature.
>
> The question is how to provide healthcare. I read an article by an
> economist who said that the VA healthcare system and Medicare are
> examples of quality health care provided by the gov't. They are
> efficient, cheaper (because they negotiate prices of drugs, for
> example) and the VA healthcare system in his opinion is superior to the
> private sector. So there is a model.
>
> Here's another real story. I was recently diagnosed with migraines and
> given a drug called Maxalt. The ins. co. paid $457 for the first
> prescription. But they refused to pay after that. And I cannot afford
> to pay $18 a pill (used three at a time, so $60 per headache) and I
> only use the drug if the doctor gives me samples. Otherwise I do
> without. And there are no cheaper versions of this drug -- they are
> all on patent.
>
> Interestingly, this particular drug is packaged in an interesting way.
> You get two pills which come in a little blue plastic carrying case. I
> don't know what the case if for but i think they are trying to make a
> fashion statement. Maybe your next script will come in a designer
> bottle. This is how money is wasted.
>
> All the best,
>
> Leah
>
Free care there but you most likely would not get your expensive pills
(Aspirin is "good enough"). Those countries do not and can not afford
to use the most expensive diagnostic and operating equipments.

The sad truth is that if not for the possibility of making big profits
pills such as yours would never be developed.

Steve Kramer wrote:
> "Alan Meyer" <ameyer2@yahoo.com> wrote in message
> news:geCdnX2HipRA5sjYnZ2dnUVZ_qWdnZ2d@comcast.com. ..
>
>
>>I have always been partial to socialized medicine, but
>>I have to admit, this is pretty outrageous.
>
>
> Socialized medicine can be a boon for the poor and lower class. I suspect
> at its inception, socialized medicine seems to benefit the middle class, but
> I doubt that it actually does. And, of course, the rich end up tapped for
> the cost without benefit. And, for awhile, people really feel good about
> theselves paying for those poor people.

It is important to distinguish 'socialized medicine', where physicians
are in effect employed by the government, to single payer health
insurance, where there is one insurer, usually the govrnment. In the
latter case, physicians still operate as individual entrepneurs, but
they do have to negotiate, through professional groups, with the insurer
to decide rates for specific procedures. Canada has a single payer
system and Great Britain has socialized medicine. They are very
different systems.

I am not sure how things work in other European countries, but they
manage by one means or another to be sure that everyone has access to
good quality medical care without respect to means to pay. That is
something which we in the US have certainly failed at. We have growing
numbers of people without medical insurance. It is true that such
people do have access to emergency care for acute conditions. But they
can be bankrupted by serious illness, and the care they get is less than
optimum and ends up costing more than if it were done through regular
ongoing care that they can't afford.

Note that in the US we do have a single payer medical insurance system,
paid for by a dedicated tax, paid by everyone, and a special additional
fee paid by users. It is called Medicare but it is restricted to people
over 65 and some disabled people. It is still largely a single payer
system, but the Bush administration is encouraging the introduction of
multiple private HMO type plans, and is in fact subsidizing such plans
by large subsidies. Also, Medicare does not pay all the costs, which
has led to many separate medicare supplement policies, which tend to be
very expensive and somewhat limited in what they cover.

The US also has one 'socialized medicine' system. It is available to
veterans and run by Verteran's Administration. This system has had its
ups and downs, but, as a result of reforms introduced during the Clinton
administration, it has improved greatly, and today works quite well.
Several men in this forum have received quality care for prostate cancer
through this 'socialized system'. Of course, there is no gurantee that
the quality of the system won't decline, but in a democracy the
political process does provide a way to remedy that. I for one wouldn't
support making veterans pay more for their care in order to reduce my
taxes. I am not worried about 'robbing' them of incentives to care for
themselves.

>
> Socialized anything starts out to be a really nice thing to do for those who
> have nothing. The concept seems to be at the base of our (US) very
> existence -- all men are created equal. But, in the long term, socialism
> causes a degradation to the system and to the people.

I think reasoning like this, on the basis of some abstract general
principles tends to mislead. You have to look at the specifics of how
different systems might work. For example, the start of this discussion
was an objection that managers were limiting referrals. There is
certainly a motivation among insurance managers to do that to control
costs, but it can happen in any system. Indeed, in the US, HMOs and
other insurers have come under great criticism for doing exactly that.
As noted above, the Bush administration wants to push Medicare
strongly in that direction largely because it wants to control costs.
Controlling costs is a legitimate concern, but how to do it so as not to
limit quality care is a difficult problem. I don't think the American
people, as a whole, are willing to accept the idea that the quality of
care should be a function purely of how much you can afford to pay.

The fundamental issue in any kind of insurance scheme is how you
organize the pool of those who are insured. As I see it, the whole
point is to spread the risk over as large a group as possible. If you
segregate the pool into subgroups so that sicker people pay more, then
you run the risk that only wealthy people will be able to afford
adequate care. Indeed, with the increasing cost of the many high tech
procedures available today, it can turn out that only extremely wealthy
people can afford the best care. Another problem with segregation of
the pool is adverse selection. Thus, if you offer lower premium plans
with very high deductibles, healthier people will choose those plans.
That means that the lower deductible plans will tend to attract sicker
people and hence end up having much higher premiums. At some stage only
wealthy people will be able to afford to pay for either insurance of
direct payments to providers. That is basically the system we had
before the advent of private insurance and Medicare. the only control
on phsycian fees was what the traffic would bear. but a family could
easily sink into great debt from any serious illness, and in those days
there weren't many high tech, and expensive, procedures. Indeed, an
argument can be made that without our modern insurance systems, the
kinds of things that are done today would be impossible.

> And, if you don't
> have to earn your wages, your food, your medical care, etc., then the worst
> will not. Once the worst do not, then the next to worst. Eventually, 80%
> of the people are living off the toil, intelligence and committment of the
> 20%.

First of all, some people just can't earn wages to pay for the bare
necessities of life such as food and lodging. That includes children,
disabled people, and people too old too work. All modern societies
have accepted that such people should not starve and should have some
place to live, though in the US you sometimes wonder about how well we
do in both regards. Clearly, for any society to function, there must be
reasonable incentives for people to work, while at the same time, no one
should be left out in the cold because of inability to do so. How you
balance those imperatives is a problem every society must solve. Your
slippery slope argument suggests that any safety net at all will lead to
indolence. I think there isn't much evidence for that. Western
European societies seem to lean towards stronger safety nets than we do
in the US, but they seem to do okay. One can argue about the
differences in efficiencies in our economies, but certainly there aren't
vast differences.

I also wonder why you include medical care in the list of things people
should be responsible for paying for themselves. Why not also police
protection, water supplies, and a host of other things paid for
commonly? Would you agree to the idea that only people who support our
foreign poicy should pay for the military and they should do it through
voluntary contributions?

>
> Emotion and government just do not mix.

We would all like to think that we reach conclusions rationally without
letting emotion cloud our judgement. But if we are honest with
ourselves, we realize that this is an illusion. Indeed recent work in
neuroscience about how the brain works tells us that reason is
impossible without emotion. I can give you all sorts of completely
rational arguments why your position is wrong, and to some extent I did
above, but I don't fool myself in beliving that my moral beliefs and
feelings of empathy towards others don't enter into my conclusions.

>
>
>

"Leonard Evens" <len@math.northwestern.edu> wrote in message
news:kOidndxjlPjD3crYnZ2dnUVZ_o2dnZ2d@comcast.com. ..
> Steve Kramer wrote:
>> "Alan Meyer" <ameyer2@yahoo.com> wrote in message
>> news:geCdnX2HipRA5sjYnZ2dnUVZ_qWdnZ2d@comcast.com. ..
>>
>>
>>>I have always been partial to socialized medicine, but
>>>I have to admit, this is pretty outrageous.
>>
>>
>> Socialized medicine can be a boon for the poor and lower class. I
>> suspect at its inception, socialized medicine seems to benefit the middle
>> class, but I doubt that it actually does. And, of course, the rich end
>> up tapped for the cost without benefit. And, for awhile, people really
>> feel good about theselves paying for those poor people.
>
> It is important to distinguish 'socialized medicine', where physicians are
> in effect employed by the government, to single payer health insurance,
> where there is one insurer, usually the govrnment.

I have tread down this road before and neither I or the person with whom I
bandied were convinced. It is especially difficult to do so when the three
primary examples; Candian, English and Veteran, are used by both sides of
the debate.

For me, I don't care which way it goes. I do worry that my grandchildren
will suffer the same fate as those who began one or two generations ago.


--
PSA 16 10/17/2000 @ 46
Biopsy 11/01/2000 G7 (3+4), T2c
RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins
PSA .1 .1 .1 .27 .37 .75
EBRT 05-07/2002 @ 47
PSA .34 .22 .15 .21 .32
Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05,
2/06, 6/06
PSA .07 .05 .06 .09 .08 .132 .145
Casodex added daily 07/06
PSA <0.04
Non Illegitimi Carborundum

Dear Leonard,

Leonard Evens wrote:

> but I don't fool myself in beliving that my moral beliefs and
> feelings of empathy towards others don't enter into my conclusions

Congratulations! You have a heart. Seems like the old ticker is doing
just fine.

I thank you for your intelligent and compassionate reply. You speak
for a lot of us. I wanted to address some specific points you raised
(to support them) but I am taking a different approach.

I think the greatest commentary on this entire subject is a movie
called "Umberto D." by Vittorio de Sica. I am a movie lover and this
is my favorite movie in the whole world and many critics agree with my
opinion. (From Videohound): "Umberto D. has been described as a
miracle and in terms of analysis it may be best to leave it at that."

I advise anyone who can tolerate subtitles to see this film. It is
amazing and it is available on netflix. And I believe you, Leonard,
would enjoy it. I am going to write about it a little bit not because
I'm doing a movie review but because it concerns a real life example of
a person struggling with the issues we have brought up.

"An aged former civil servant, now trying to live on a completely
inadequate gov't pension, does what he can to maintain a semblance of
dignity in spite of his poverty. Umberto is behind on his rent, and
though he's convinced that suicide is the only possible solution to his
plight, he's reluctant to leave his beloved dog behind to fight for
scraps of food...

Umberto D -- one of the world's greatest movies -- is neither maudlin
or sentimental.

The protagonist (played by a non-prof'l actor) remains a gentleman
throughout this horrifying all-too-familiar plight; he never
understands why the rest of the world doesn't behave with kindness and
compassion. As we sit there and watch the day-to-day details of
Umberto's existence, knowing that there are millions still today in the
same hopeless situation we find it hard to understand as well."

I guarantee that anybody who watches this movie will be affected by it.
I think it should be mandatory viewing for everybody and it may change
some people's minds about this subject.

I have recently had an old person come over to me and ask me if I knew
of any babysitting work for her. She also said she was looking to find
a "boarder" for her 1-bdrm apt. There are so many cases like this.

What I was going to mention is an article in the NY Times called
"Choosing a 'God Squad': When the Mind has Faded." (8/29/06 by Barron
Lerner, MD.) This article describes how the gov't spends $16 billion a
year to pay for dialysis. It is used indiscriminately even when it is
not humane or useful.

The focus of this article is how much of this money is spent on doing
dialysis on severely cognitively impaired patients such as those in a
coma or a vegetative state. It is also "reflexively" given to patients
with advanced Alzheimers, where there is some other type of brain
damage or a terminal disease....

It continues: This aggressive care is hardly limited to dialysis.
Throughout the US, other potentially lifesaving technologies, like
respirators and cancer chemo have been overused.

It is done because nephrologists are afraid of lawsuits.

I think this technology presents a real problem for all of us and it
will only get worse. This needs to be addressed.

This issue is very close to my heart because my father had a stroke and
was on a respirator for a year. It was even worse bec. he was
conscious, somewhat aware but also mute and paralyzed. I can't
describe how cruel it is to put a patient on a respirator -- they have
to have fluids "sunctioned" out of their throats every few hours with a
little vacuum--like device and it is horrible to watch them gag and
cough. Sometimes my father used to cry when this was done. There were
times when I seriously thought of disconnecting the thing...

At the end my father developed kidney failure and the hosp asked
permission to do dialysis. My reaction at the time was, "It's more
like desecrating a corpse."

My mother is a very religious woman but as soon as she got approval
from the appropriate clergy (which was very fast) she signed the "do
not rescusitate" order. She had already told the doctors that she
would not approve of my father having any more "procedures," like MRIs,
CT scans, x-rays etc. I'm sure it was agonizing for my mother to sign
the DNR but it was truly an act of compassion.

My father went quietly a day later.

My cousin on the other hand consented to have dialysis done on his
comatose father and he said he will never forgive himself for it.

Anyway, this insanity needs to be corrected. Patients need to be
rescued from high-tech medicine.

Best to all,

Leah

"Leonard Evens" <len@math.northwestern.edu> wrote in message
news:kOidndxjlPjD3crYnZ2dnUVZ_o2dnZ2d@comcast.com. ..
>
> It is important to distinguish 'socialized medicine', where physicians
> are in effect employed by the government, to single payer health
> insurance, where there is one insurer, usually the govrnment. In the
> latter case, physicians still operate as individual entrepneurs, but
> they do have to negotiate, through professional groups, with the
> insurer to decide rates for specific procedures. Canada has a single
> payer system and Great Britain has socialized medicine. They are very
> different systems.

Thank you Leonard, for a sane voice of reason. Not to mention a
thorough explanation of how things work outside of the US.

I don't know why Steve and a few others think that our Canadian medical
system is *socialist*. Or that it is wrong, or doesn't work, or
whatever negative they can dream up. It works and frankly, our worst
fear is that we get a medical system like yours, or a two tier system.
But that will never happen, period!! We would fire the government
leader that tried to bring that in.

I can remember when we used to pay for a doctor's services, but that
ended by the 60's. That is when a company called PSI (Physicians
Services Inc.) came into being......sort of an insurance plan. But all
of our working lives both we and our employers paid into the provincial
health plan....this is not a freebie. No matter what 2 or 3 of the
nay-sayers on this group think. I paid into it for over 45 years.

>>> I am not sure how things work in other European countries, but they
> manage by one means or another to be sure that everyone has access to
> good quality medical care without respect to means to pay. That is
> something which we in the US have certainly failed at. We have
> growing numbers of people without medical insurance. <<<

I have friends in Texas....and they lost their business and had to go
into bankruptcy. They had one hell of a time getting proper care under
your Medicare System.....the husband had a severely damaged heart, the
wife was in a wheelchair due to a back injury. It took well over two
months just to see a doctor. Perhaps had they been *spongers* of your
system, they could have jumped the queue, but this was the first time
they had ever been in that position.

>> And, if you don't have to earn your wages, your food, your medical
>> care, etc., then the worst will not. Once the worst do not, then
>> the next to worst. Eventually, 80% of the people are living off the
>> toil, intelligence and committment of the 20%.<<<<<

May I just say that besides the above hypothesis being totally wrong,
look at it this way. The neighbours on either side of me have 4 people
each. We are 2......totalling 10. So using Steve's 80/20 ration, are
both of my neighbours expecting me to pay for their healthcare or costs
of living? NO.....that is an idiotic supposition. People in Canada
work for a living......just like in the US. Our unemployment rate is
roughly the same as yours and our homeless people are probably less.
Too damn cold to live on the street up here.

I will just say, Leonard, that the rest of your explanation is spot on
and I am glad that you are here to lend the voice of reason. There is
nothing wrong with wanting to help those who are incapacitated, too old
to work, etc. They do not make up the majority of Canadians. But those
of us over 65 have certainly paid our dues into the healthcare system
and are now enjoying the benefits.

Many thanks.....Ron and Heather
>
> First of all, some people just can't earn wages to pay for the bare
> necessities of life such as food and lodging. That includes
> children, disabled people, and people too old too work. All modern
> societies have accepted that such people should not starve and should
> have some place to live, though in the US you sometimes wonder about
> how well we do in both regards. Clearly, for any society to function,
> there must be reasonable incentives for people to work, while at the
> same time, no one should be left out in the cold because of inability
> to do so. How you balance those imperatives is a problem every
> society must solve. Your slippery slope argument suggests that any
> safety net at all will lead to indolence. I think there isn't much
> evidence for that. Western European societies seem to lean towards
> stronger safety nets than we do in the US, but they seem to do okay.
> One can argue about the differences in efficiencies in our economies,
> but certainly there aren't vast differences.
>
> I also wonder why you include medical care in the list of things
> people should be responsible for paying for themselves. Why not also
> police protection, water supplies, and a host of other things paid for
> commonly? Would you agree to the idea that only people who support
> our foreign poicy should pay for the military and they should do it
> through voluntary contributions?
>
>>
>> Emotion and government just do not mix.
>
> We would all like to think that we reach conclusions rationally
> without letting emotion cloud our judgement. But if we are honest
> with ourselves, we realize that this is an illusion. Indeed recent
> work in neuroscience about how the brain works tells us that reason is
> impossible without emotion. I can give you all sorts of completely
> rational arguments why your position is wrong, and to some extent I
> did above, but I don't fool myself in beliving that my moral beliefs
> and feelings of empathy towards others don't enter into my
> conclusions.
>
>>
>>

Heather wrote:
> Thank you Leonard, for a sane voice of reason. Not to mention a
> thorough explanation of how things work outside of the US.

And shall we thank you for a thorough explanation of how things work in
the US?

Both systems have their drawbacks. The US is not as bad as you say.

Where does a guy from Canada go for Green Light Laser Prostate Surgery?

http://www.sigmacon.com/Canadian%20Healthtech1.pdf

I think I heard they finally are getting some of the equipment.

The problem with most systems is the backlog. Years wait for heart
surgery unless you can pay for it. And as others have pointed out it is
rationed for those that qualify. Dialysis for a 90 year old would
probably be turned down. There has been something on the order of a
three to four year wait for heart surgery in the U.K. (That keeps the
cost down!!). Since it is free the medial system is overloaded with
those seeking treatment for minor ailments.

A little searching shows that the wait for treatment in Canada is
significantly longer than the US.

The cost of Malpractice Insurance in the U.S. is a burden on the patient.

A Canadian doctor summed it up when he said "In the US they ration
health care by price, while in Canada we ration it by queue".

"Rich256" <nospam@nospam.net> wrote in message
news:nJK5h.253458$QZ1.232914@bgtnsc04-news.ops.worldnet.att.net...
> Heather wrote:
>> Thank you Leonard, for a sane voice of reason. Not to mention a
>> thorough explanation of how things work outside of the US.
>
> And shall we thank you for a thorough explanation of how things work
> in the US?
> Both systems have their drawbacks. The US is not as bad as you say.

Of course they both have their drawbacks. But I would take ours over
yours. And that is a *personal* opinion......I live here and know how
it works. And we know how your system works due to our seniors who
migrate to Florida and Arizona every Winter. They pay a lot of money
for private medical insurance in case they should get sick down there.
Our insurance plan covers a lot of it, but not enough.
>
> Where does a guy from Canada go for Green Light Laser Prostate
> Surgery?
>
> http://www.sigmacon.com/Canadian%20Healthtech1.pdf
>
> I think I heard they finally are getting some of the equipment.

Never heard of it and I live in Toronto and we are looked after at one
of the two premiere cancer hospitals there. (Sunnybrook and Princess
Margaret, just so you know). The two that article mentions are not high
on the list for cutting edge cancer care. Also the article is 2.5
years old. If it was such a good prostate cure, why hasn't it been in
the news??

>
> The problem with most systems is the backlog. Years wait for heart
> surgery unless you can pay for it. And as others have pointed out it
> is rationed for those that qualify. Dialysis for a 90 year old would
> probably be turned down. There has been something on the order of a
> three to four year wait for heart surgery in the U.K. (That keeps the
> cost down!!). Since it is free the medial system is overloaded with
> those seeking treatment for minor ailments.

BS!! Those statements apply to the UK which is vastly different than
Canada. We don't pay for medical care as you seem to think.
>
> A little searching shows that the wait for treatment in Canada is
> significantly longer than the US.

But not dangerously longer. And the ops that there is a longer wait
time for are the non-life threatening ones, such as hip and knee
replacement.
>
> The cost of Malpractice Insurance in the U.S. is a burden on the
> patient.

More likely it is a burden on the doctor. That is why quite a few of
our doctors have returned to practice in Canada. The malpractice
insurance fees were astronomical!!
>
> A Canadian doctor summed it up when he said "In the US they ration
> health care by price, while in Canada we ration it by queue".

And how would you suggest we do it other than by urgency and by queue??
We are trying very hard to keep the two-tier privatization out of
Canada. It is not all that popular in Australia and is not wanted here
either.

Where on earth are you getting your misleading information? One article
is ancient and the other info is about England.

Heather wrote:
> And how would you suggest we do it other than by urgency and by queue??
> We are trying very hard to keep the two-tier privatization out of
> Canada. It is not all that popular in Australia and is not wanted here
> either.

This thread is about the UK medical system. Somewhere along the way
Canadian medicine got in too.

Seniors in the US are very well covered by Medicare.

In the US the Green Light laser is the "gold standard" for enlarged
prostate treatment. Has been for a few years.

Yeah, the US needs to do something about the malpractice lawyers. And
there is one that wants to be President!!

>We don't pay for medical care as you seem to think.
It's been a while but I thought you, like England, still had doctors
that work on pay for service.

"Rich256" <nospam@nospam.net> wrote in message
news:UvL5h.50097$Fi1.14458@bgtnsc05-news.ops.worldnet.att.net...
> Heather wrote:
>> And how would you suggest we do it other than by urgency and by
>> queue??
>> We are trying very hard to keep the two-tier privatization out of
>> Canada. It is not all that popular in Australia and is not wanted
>> here
>> either.
>
> This thread is about the UK medical system. Somewhere along the way
> Canadian medicine got in too.

It was.....but it seems that a lot of Americans don't know there is a
big difference between England and Canada regarding health care and we
always get lumped in with them. Leonard obviously knows the difference.
>
> Seniors in the US are very well covered by Medicare.

Why aren't their prescriptions free too?? How come they are coming up
to Canada by the bus load to buy cheaper drugs then. And I am not
joking when I say *chartered bus loads*. See CBS News in 2004......
http://www.cbsnews.com/stories/2004/...in613086.shtml
>
> >We don't pay for medical care as you seem to think.
> It's been a while but I thought you, like England, still had doctors
> that work on pay for service.

It is illegal for a doctor in Canada to charge a fee for *services*.
There are rumblings out west about having a 2-tier system, but most are
not in favour of it. And there is the odd private clinic, but they are
mostly doing cosmetic surgery and that is not covered by our Gov't.
plan......which is as it should be.

HF

On November 12, Rich256 responded to Heather, in pertinent part:

(snip)
> A Canadian doctor summed it up when he said "In the US they ration
> health care by price, while in Canada we ration it by queue".
No less an entity than the Supreme Court of Canada has held essentially
the same:

"The evidence in this case shows that delays in the public health care
system are widespread, and that, in some serious cases, patients die as
a result of waiting lists for public health care. The evidence also
demonstrates that the prohibition against private health insurance and
its consequence of denying people vital health care result in physical
and psychological suffering that meets a threshold test of seriousness.

"Where lack of timely health care can result in death, the (Canadian
Charter) s. 7 protection of life is engaged; where it can result in
serious psychological and physical suffering, the s. 7 protection of
security of the person is triggered. In this case, the government has
prohibited private health insurance that would permit ordinary
Quebeckers to access private health care while failing to deliver health
care in a reasonable manner, thereby increasing the risk of
complications and death."

See, generally, Chaoulli et al. v. Quebec (Attorney General) et al.,
[2005] 1 S.C.R. 791, 2005 SCC 35.

Regards,

Steve J

On Sun, 12 Nov 2006 19:36:51 GMT, Rich256 <nospam@nospam.net> wrote:

>There has been something on the order of a
>three to four year wait for heart surgery in the U.K.


grrrr... (from the uk)

substitute <month> for <year> and you'll be nearer the mark for
current performance..

Leonard Evens wrote:

> Canada has a single payer system and Great Britain has socialized medicine.
> They are very different systems.

Have you heard of the numbers of Canadians paying for treatment in the
U.S. because they have to wait 6, 7, 8, 9 months for an appointment
with a GP or PCP? Yet Americans are crossing the border to purchase
their Rx's because of the lower cost north of here.

> Note that in the US we do have a single payer medical insurance system,
> paid for by a dedicated tax, paid by everyone, and a special additional
> fee paid by users. It is called Medicare but it is restricted to people
> over 65 and some disabled people.

There is also Medicade (Medi-Cal in California) for the druggies and
loafers and bums and lazy mommas who keep popping out babies, who in
turn begin popping out babies as soon as they discover what boys are.
<g> They don't have to have worked one day in their life nor paid a
single cent in taxes before qualifying for free medical care.

I have thought of lots of things to say about all of this, but I
don't think I could say them as well, or with as clear and
balanced a perspective, as Leonard did in his post.

I urge everyone participating in this thread to re-read
Leonard's posting. I think he answers a lot of the questions
that have been raised.

Alan

Alan Meyer wrote:
> a large and increasing
> number of people in the U.S. have no insurance at all

I'd love to see some statistics, but have read and observed that most
uninsured people simply prefer big-screen TVs and nicer cars and homes
to medical insurance. That's their prerogative (unless they have kids,
which many do), but it's also their problem . . . not mine. The vast
majority of my friends with comparable incomes pay 2 or 3 times what we
do for home and cars.

> and cannot afford anything except the most basic care.

If they're indigent, even by their own fault, they get taken care of.
There's Title This and Program That and free prescriptions and ERs and
all sorts of ways to get decent care. I don't EXPECT to get the same
level of care Bill Gates can buy, but he doesn't owe the difference to
me . . . unless Hillarycare goes through. Wonder how Mr. Gates will like
going to prison for choosing a specific doctor to perform Melinda's
spine transplant?

I.P.

callalily wrote:

> steve kramer wrote:
>> socialism causes a degradation to the system and to the people.
>
> Completely untrue.

Proved true over and over and over and over. Ever hear of a little
country called the U.S.S.R.? Or a resources-rich traveler's paradise
called Cuba? Technically they're communist, but relevant to Steve's
observation the difference between that and socialism is moot.

> I have a good friend in Denmark and have been to
> all the Scandinavian countries. Their quality of life is consistently
> rated at the top of the charts.

Let's see how their lifestyle survives depletion of the North Sea oil
reserves; Scandinavia produces more oil and uses far less oil per capita
than the U.S. does. That's not true socialism, because it's funded by
oil, not by taxes.

> Suppose you were created with limited
> intelligence or with a genetic illness that made it hard or impossible
> for you to work. Should you be euthanized like the Nazis did?

Ted Turner, a self-avowed socialist, has said, "Yes". But few people
besides Turner would deny care to the people you describe.

> Here is the reality: You and IP may think you can stand on your own two
> feet and have earned enough money to pay for your medical expenses.
> But healthcare expenses nowadays can run into hundreds of thousand of
> dollars. The average cost of "end of life" care at a hospital is about
> $200,000.

Thus my health insurance on top of my VA and military coverages.

> If a person can afford to pay a lawyer to do the "Medicaid spenddown"
> they will probably do it.
> This is the reality. The taxpayer ends up paying anyway.

Unless the spenddowners violate strict laws governing spenddowns. It's
not as easy as it was a few years ago.

> Any civilized society should provide healthcare to all its citizens

That's your opinion. In practice it has many huge drawbacks, and often
flat fails. What gives me the right to drop out of school and work to go
windsurfing and expect you, under threat of arrest for dodging taxes, to
pay my way? Believe me; if I lived in a socialist country, I'd have been
writing and pursuing sports full-time since I was a teen-ager . . . at
your expense.

> The question is how to provide healthcare. I read an article by an
> economist who said that the VA healthcare system and Medicare are
> examples of quality health care provided by the gov't. They are
> efficient, cheaper (because they negotiate prices of drugs, for
> example) and the VA healthcare system in his opinion is superior to the
> private sector. So there is a model.

But in this model the recipients are a small minority. Reverse the
scenario and see how well it works.

I.P.

Steve Kramer wrote:
>
> But, we should not waste more bandwidth about it on this NG.

By 2008, socialized medicine will be up us to select or reject, and rthe
decision will affect most of us and all of our children.

I.P.

Leonard Evens wrote:

> The US also has one 'socialized medicine' system. It is available to
> veterans and run by Veteran's Administration. This system has had its
> ups and downs, but, as a result of reforms introduced during the Clinton
> administration, it has improved greatly, and today works quite well.
> Several men in this forum have received quality care for prostate cancer
> through this 'socialized system'.

In fact, the overall military health care system, including the VA
system, has declined in availability since the early '90s. From my
retirement in 1988 until the early-mid 90s, veterans' access to military
hospitals was cut drastically, to zero at many military bases. By the
late '90s, their access to VA care was reduced very noticeably, due in
part to ever-increasing numbers of vets in the system. I could waltz
into a VA hospital and get absolutely any problem treated free
immediately until the mid-90s, but since then restrictions and
out-of-pocket charges have significantly cut into that despite Bush's
big VA funding increases. Overall, the free medical care our military
were promised has been a criminal joke on them leading to widespread
legal action and fiscal impact.

I.P.

Steve Kramer wrote:
> I do worry that my grandchildren
> will suffer the same fate as those who began one or two generations ago.

Even though I have no children and would personally benefit from it, I
remain compelled to fight socialized medicine in the U.S. for the good
of the nation. Too many doctors are already advising their teenagers
against going into medicine because it is already too institutionalized;
that's just one aspect of it that will change only for the worse when it
is forced upon us.

I.P.

Heather wrote:
> "Leonard Evens" wrote.
>> It is important to distinguish 'socialized medicine', where physicians
>> are in effect employed by the government, to single payer health
>> insurance, where there is one insurer, usually the govrnment. In the
>> latter case, physicians still operate as individual entrepneurs, but
>> they do have to negotiate, through professional groups, with the
>> insurer to decide rates for specific procedures. Canada has a single
>> payer system and Great Britain has socialized medicine. They are very
>> different systems.

> Thank you Leonard, for a sane voice of reason. Not to mention a
> thorough explanation of how things work outside of the US.
> I don't know why Steve and a few others think that our Canadian
> medical system is *socialist*.

Once again: Socialized medicine, according to Webster: medical care
funded by the taxpayer and provided by the government. How does that not
fit Canada's system?

I.P.

Rich256 wrote:

> A Canadian doctor summed it up when he said "In the US they ration
> health care by price, while in Canada we ration it by queue".

And isn't one of our most enduring images of socialist and communist
countries that of long queues of dreary clones trying to buy anything
from food to toilet paper -- and ultimately surgery -- at
government-regulated prices? How can that kind of society motivate
anyone to excel and provide jobs for people? Think Bill Gates would have
changed the world if his efforts would have been strictly for the
gum'mint's benefit?

The more people I see expecting the government to take care of them from
cradle to grave, from New Orleans Katrina "victims" to bums being paid
significant money to piss in San Francisco streets, the more I resent
what the left half of our nation is doing TO our nation. DAMN, but I'm
glad I had no kids.

I.P.