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Re: Natural Limits to Healthcare Expense Growth?
Old 06-08-2005, 09:23 PM   #41
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Re: Natural Limits to Healthcare Expense Growth?

Quote:
Originally Posted by Mountain_Mike
th - As far as illegals using emergency rooms, while I don't dispute or discount your wife's experiences, but I think it is not always the case. Take a look at the ERs in the San Diego or other border areas; many are in dire straits due to this factor. How about the illegals in prision who use health care? I agree that poor whites misusing ERs compound the problem as well. I part company with you on NEEDING illegal workers in order to get cheap veggies and services. My solution there would be to eliminate welfare for able-bodied people. They could either work at wages similar to what we are paying the illegals, or starve. You think that's too harsh?
Sorry, cant let you slip this noose either. Most 'illegals' who commit crimes are deported, not jailed. Most 'illegals' wont come near a hospital emergency room because they're afraid of being deported if discovered. If you want to stretch this thing out to the 9th inning, I'll get US wide stats on the percentage of white scumbags who take up uninsured hospital costs vs all other potential 'illegal' colors.

As far as the illegals and the jobs they work, I think they get something like 10-20 a day to pick fruit around here. How many poor white trash are going to turn their backs on that 12 pack of silver bullets and a regular welfare check to work all day in 100 degree heat for twenty bucks?

None.

How many people are going to hire the nanny, landscaper, housekeeper, ad nauseum for even twice the price they'd have to pay to a 'legal'?

None.

One layer thinking of 'remove those nasty mexicans and nice white people will be able to get off welfare and take all those jobs' is just that...one layer thinking.

Why do you think all the hullabaloo is about giving 'illegals' drivers licenses here in CA. We've already figured out that they serve a function, they're here to stay (well, sort of) and we cant stop them from coming in...not to mention we dont know who would do the work they do now at the rate they work for, or what the economic implications of paying higher wages to 'legals' is, even if the 'legals' would do the work at all.

Considering I live in a farm belt here and most of the local news, interviews and whatnot are about farming, I can tell you that if the 'illegal' labor dried up for any reason, more than half of them would plow the fields under and sell to housing developers. They just wouldnt be able to make a living selling their products vs cheaper central/south american imports. In short, the 'illegals' would stay home, grow the same crops, and send them here for 25% less than a US farmer could produce them for.

Hey, wouldnt THAT be great? :P
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Re: Natural Limits to Healthcare Expense Growth?
Old 06-08-2005, 09:31 PM   #42
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Re: Natural Limits to Healthcare Expense Growth?

And another thing! (I'm really enjoying this JG approach to posting!)

I already gave you the most of the answer.

Most healthcare costs are associated with the final year of someones life...in other words, whatever was done didnt work. The doctors probably knew that. The patient and their family probably knew it. But they had insurance and the insurance company was on the hook for it, so why not?

High liability suit payouts causing high malpractice insurance. Doctors working 12+ hour shifts leading to high incidence of screw ups. You know how you feel after you've been sitting at your desk for 10 hours straight? Try that on your feet with life and death situations flying at you all day, and then at that point be required to save some persons life. Lotsa luck.

And then theres that other couple of bits I threw out there about the BC/BS system floating on $30B and insurers raising rates because their investment returns havent been so good the last 5 years.

The problem aint anything other than money chasing other money, and people who dont know when to stop and say goodbye.
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Re: Natural Limits to Healthcare Expense Growth?
Old 06-09-2005, 07:46 AM   #43
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Re: Natural Limits to Healthcare Expense Growth?

Quote:
Originally Posted by Mountain_Mike
I thought I'd shake things up a bit

Martha - how about "gross negligence?" An insurance company shouldn't even have settle or worry about lawsuits, as long as the proper procedures were followed.
Gee, I want my doctor to use at least ordinary care in treating me. If she doesn't and I am injured as a result, I want compensation. Just because some people bring frivolous lawsuits shouldn't bar me from bring a claim that has merit. I don't know much about PI law, but I do know that in my state, to bring a malpractice claim against a doctor you must have an affidavit from another doctor saying that the standard of care was breached. This is not easy to get and does weed out frivolous suits.

Quote:
My solution there would be to eliminate welfare for able-bodied people. They could either work at wages similar to what we are paying the illegals, or starve. You think that's too harsh?
Except maybe for foodstamps which I don't know much about any more, there is very little welfare for able bodied people. Certainly there is no welfare for the able bodied without children, and for those who are taking care of children, it is cut off pretty quickly. Remember welfare reform?

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Nothing "natural" about these limits!
Old 06-09-2005, 09:29 AM   #44
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Originally Posted by Mountain_Mike
I think some answers are simple:
1. Work on the supply side. Create more doctors, nurses, and other heal care workers. (Each year, thousands of people qualified to enter these training programs are turned away).
2. Eliminate malpractice lawsuits except in cases of intentional negligence. (In any operation or procedure, things can go wrong even if the operation is done correctly--I propose that people not be allowed to sue in cases like these). The same for prescriptions. There are known side effects to all drugs--so, let the patients make the choice and take the risks.
3. Deport the ILLEGALS who are getting "free" coverage, paid for by you and I.
The bottom line is we need to lower the COST of providing health care service in this country.
Years ago, I don't think we even had health insurance, except for catestrophic coverage. I remember leaving the doctor's office, with my mom paying $10 or something, cash, for the visit. You can't tell me that a doctor can't make a decent living on, say $50 for a 15 minute visit.
I don't usually join these healthcare debates because I pay $460/YEAR for my family's TRICARE. Our copay is $12. All of this used to be free when I was working.

But Mike, your post really sparked my recognition reflex, which is unusual for this topic. I couldn't understand why it seemed so familiar... until I realized that you're describing the military's healthcare system! (Eagle, can you back me up here? GD-ER, where are you? Samclem? Tomcat? Otako? Bridget?)

Simple answers are for simple problems. But here's a comparison--
1. The military is recruiting tons of healthcare workers and paying them annual bonuses as high as 50% of salary. The biggest problems are finding the instructors (colleges, teaching hospitals, doctors/nurses who aren't too burned out to pass on their experience) and then finding people who actually want to tackle this avocation. The military even runs its own medical schools & teaching hospitals to try to "grow their own." (A little hint-- if the military will pay you $25K extra per year to take a job that's usually done by people with $50K salaries, it's not gonna be an easy job. But you're allowed to shoot back.)

2. It's darn near impossible to sue a military medical worker (I think it has to do with government liability). Essentially an incompetent surgeon can kill a lot of people before it's even noticed, let alone before it's an issue. We're not just talking negligence-- we're talking gross dereliction of duty. One local hospital had a physician's assistant who was molesting children for nearly five years, a final year of it under "evidence-collecting surveillance", before being arrested & convicted. The kids received "free" psychiatric care and the families received a promise that it wouldn't happen again. Can you see that happening in a civilian hospital? It's actually easier to rein in bad military medical workers with the UCMJ ("duty") than via the civilian penal or civil litigation systems.

3. If they can't get on the base, they can't get in the ER. If you need emergency treatment but can't produce a military ID for the gate security staff, then they'll try first aid and call 911 for you. They'll do that even if you're less than 100 feet from a military ER.

The military is arguably the Wal-Mart of medical care. It's one of the nation's biggest & most expensive healthcare bureaucracies systems with access to advanced equipment and a fairly skilled staff. Other retailers live in fear of Wal-Mart while civilian doctors live in fear of TRICARE. Not only that, but the military exerts a lot of control over its patient's lifestyles-- they're discouraged from smoking, they have to exercise (and be graded on their performance) and they're required to undergo periodic screenings. They're fed reasonably healthy food while living in a reasonably clean, comfortable environment (we're talking shore duty here) and discouraged from risky off-duty behavior (drugs, alcohol, unsafe sex). Military people on drugs/alcohol or diabetic treatment or chronic diseases are frequently discharged, so the patient population is freakishly healthy compared to civilian medical care.

Yet after 24 years in the system I won't use a military physician or dentist. (I have no dental insurance and I pay out of pocket instead of using my
"free" space-available dental care.) In fact on active duty I took darn good care of myself to avoid falling into the system. Even corpsmen still joke about "Military medicine-- where you really understand why an ounce of prevention is worth a pound of cure." Every military member will consider going to a civilian doctor-- if they can afford it-- for a second opinion. When given a choice, the vast majority of parents in the military will choose a civilian pediatrician for their kids instead of a military pediatrician. The military system is on par with civilian healthcare and the costs are certainly reasonable. Yet if the system is so good, then why are the inmates customers trying so hard to leave?

How many of you would submit to the following requirements for your low-cost (free!) no-deductible medical insurance for you and your family? Keep in mind that failure to comply means that you'll be "administratively discharged" (fired):
- If you have a workplace dispute then you have no doctor-patient confidentiality. Your department boss has complete access to your entire medical, dental, & psychiatric records.
- Your bosses can make you go get an exam anytime. They can even make you stay in a hospital for psychiatric observation.
- Annual smoking-cessation classes. You're not entitled to smoke breaks or office smoking areas, either.
- Annual "healthy lifestyle" classes, including anti-drug & -alcohol seminars. Incidents in these two categories may result in being fired, forced to undergo additional training, or take anti-alcohol medication.
- Annual dental screenings/cleanings.
- Annual HIV blood test.
- Extremely graphic annual training on sexual diseases.
- Extremely graphic annual training on workplace safety.
- Anthrax vaccinations. (Hey, our lawyers say it's OK!)
- Annual mental-health & stress-reduction training. (No matter how adversely it affects your morale or stress levels.)
- Annual flu shots. This is not optional but you can get time off for immediately coming down with a respiratory infection (it's not flu because you were just vaccinated against it!).
- Hepatitis A&B vaccinations. This is not optional for most.
- If you travel in your job, many additional exotic vaccinations. Most of them don't have side effects and our lawyers say that we're sure of that.
- Mandatory DNA sampling for a forensic-identification database. Honestly, this info will only be used for official purposes. We really mean that.
- Annual PAP smear. (Unless you're a male, although it's happened before.)
- Semi-annual bodyfat measurements. You must remain within height-weight tables and have a bodyfat lower than a limit deemed as "obese". This system has been validated by the judicial authorities as "legal".
- Semi-annual physical-fitness test. You're only allowed to participate if you're not measured as "obese" by a technician, but if you don't participate then you're fired. Test details differ but essentially you have to be able to run 1.5 miles or swim 500 yards for an aerobic time, do a few dozen pushups in two minutes, and do a few dozen situps in two minutes. Some jobs (USMC, Army infantry) have additional requirements. Criteria get a little easier with age. Extra employment-review points are awarded for extra performance. Marginal reviews will be documented for marginal performance.
- Biennial physicals until age 40. Semi-decennial physicals after age 40. This includes a full blood workup, a comprehensive screening questionnaire with possible additional consultations for problem areas, a physical exam by a technician with additional checks by a doctor, and a doctor's full gynecological exam or a digital rectal exam. It'll take at least two two-hour visits and a lot of paperwork. If you're going on a long trip then we may do everything all over again, especially the physically-invasive parts, just to make sure.
- If you're over 40, annual fecal-occult screenings. (If you don't know, then believe me you don't want to ask.)
- Free psychiatric counseling & assistance. But if you scare us we may have to tell your boss. Some counseling or medications might restrict your access to your career-required jobs, but it's for your own good. Really.

Any takers?

Let's look at the other side of the question. Is it possible that America already has the world's best available healthcare system-- at a price we'd better be willing to pay for it-- and that we're just kvetching around the edges of it trying to raise its efficiency from 85% to 95%? There's nothing wrong with that, but none of the media will publicize the success stories if they can find a scary medical fiasco for the 5 PM news (film at 11).

I think TH has pointed out the key issues-- the vast majority of the expensive care is at the end of life, and quality costs money.

Here's a couple more of my opinions-- the American pharma industry leads the world in R&D and drug advances. Medical tech leads in surgical equipment, methods, & treatments. American medical schools are besieged with foreign students who presumably could choose to attend one in their native countries. American doctors collaborate more effectively and share more information more widely in peer-reviewed journals/websites than the rest of the world. HMO's cost-control criteria have made life a living hell for most physicians in the name of cost efficiency.

Does the rest of the world do their own training, research, & initiatives-- or do they take advantage of the American advances? Which system has more imitators, the American one or the British/Canadian systems?

When you (or one of your loved ones) is sick, no one goes to Wal-Mart if you can find a way to shop at Nieman-Marcus on someone else's credit card...

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Re: Natural Limits to Healthcare Expense Growth?
Old 06-09-2005, 10:30 AM   #45
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Re: Natural Limits to Healthcare Expense Growth?

Nords! Wow, thanks for that long and thoughtful reply. I have not been in the military, and am not terribly familiar with the Tricare system, but you've given some excellent insights.
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Re: Natural Limits to Healthcare Expense Growth?
Old 06-09-2005, 11:14 AM   #46
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Re: Natural Limits to Healthcare Expense Growth?

For the office of President of these great United States, I nominate, from Minnesota, the home of Hubert Humphrey, Martha!!!!! And for Vice President, from the Golden State, th!! It's a can't lose ticket.

I must say, that after working in direct patient care in healthcare for 25 years in the West and Southwest, th and his DW are spot on in their analysis.* Another problem that's not often mentioned, is that* physicians see very few acutely ill people in their offices. They are most often routed directly to the ER or Urgent Care.* I work in an L&D Triage and see women every day who do not need hospital care but the docs schedules are too crammed to get them in.* I know this also happens in the ER.

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Re: Natural Limits to Healthcare Expense Growth?
Old 06-09-2005, 11:25 AM   #47
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Re: Natural Limits to Healthcare Expense Growth?

Hey Martha, I just found the old Kerry/Edwards sign in the garage. Should I cross out the names, putting substitutes in there, and hang it on the wall or just throw it away?

P.S. When you get home, please put the pharmacy tel# on my speed dial.
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Re: Natural Limits to Healthcare Expense Growth?
Old 06-09-2005, 11:42 AM   #48
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Re: Natural Limits to Healthcare Expense Growth?

Sorry Judy, I inhaled.
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Re: Natural Limits to Healthcare Expense Growth?
Old 06-09-2005, 11:49 AM   #49
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Re: Natural Limits to Healthcare Expense Growth?

I did worse than that on occasion...
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Re: Natural Limits to Healthcare Expense Growth?
Old 06-09-2005, 11:57 AM   #50
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Re: Natural Limits to Healthcare Expense Growth?

Quote:
Originally Posted by Martha
Sorry Judy, I inhaled.* *
So did 75% of your constituency, if they're honest!

We'll just have Jimi Hendrix' Purple Haze as your theme song.

Yeaaah, THAT"S the ticket,

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Re: Natural Limits to Healthcare Expense Growth?
Old 06-09-2005, 02:11 PM   #51
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Re: Natural Limits to Healthcare Expense Growth?

Quote:
Originally Posted by Martha
Sorry Judy, I inhaled.
Dude! Martha, you get cooler all the time!
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Re: Natural Limits to Healthcare Expense Growth?
Old 06-09-2005, 02:55 PM   #52
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Re: Natural Limits to Healthcare Expense Growth?

Nords,

Well put on the military side of the healthcare equation, although I don't have as draconian an opinion of it as you. I also, in my civilian job, work for another large integrated healthcare organization which has a similar business model to the military one minus the compulsive checking (as my father always called it the annual 'poke and pry').

I do believe that having some fitness standards in general makes for a better life, so having the military make it compulsory helps my motivation at times. Not too mention showing my civilian colleagues that I have to do 50 situps, 20 male pushups and running 1.5 miles in a certain time boggles their mind. They get angst when the 'wellness' organization of my current employer suggests a physical fitness program.....

As in anything, being armed with knowledge helps in making the decision and understanding that there will always be tradeoffs for any decision makes expectations more realistic. Do I expect Nieman Marcus service at Walmart prices, no. From there I'd like information of what services are available at what prices and what my risks are.

As for helathcare utilization--I think it depends on where one lives. When I lived near the US/Mexican border, and if there was a 'county' facility, there were illegals using the services. At private facilities, no, they want paying customers.

The main thing I realize regarding healthcare is that it is a *business*, not a benevolent charity. The clinicians do care and usually want to be helping people, but they need to make a living, too, and they need to be paid for their services.

In any case - great thread and debate!

Bridget
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Re: Natural Limits to Healthcare Expense Growth?
Old 06-09-2005, 05:35 PM   #53
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Re: Natural Limits to Healthcare Expense Growth?

I did inhale; I just didn't exhale..............
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Re: Natural Limits to Healthcare Expense Growth?
Old 06-10-2005, 09:06 AM   #54
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Re: Natural Limits to Healthcare Expense Growth?

Nords, great post on military healthcare. You know what you're talking about.

Up front: I retired in 1981 and I was 38 when I left, so some of my recollections will be different than yours. During all my 21 years, I spent exactly one week in the hospital (a horse stepped on my back and fractured a rib). I've no complaints, with the exception of the butch nurse who made me blow in that tube to keep my lungs clear! Oh an aside, there was a guy in the next bed with a shattered leg and who was going to be there a long time. Every afternoon a friend of his came in with a brown paper bag. Had a six pack in it. The guy told me the docs had agreed he could have his fix. Try that in Mega Hospital today!

Two of my children were born in military hospitals; one in Florida, other in England. Total cost: about $20-25 each. No problems, routine births.

When you're in the military you don't exactly have the perogatives of civilians. And, of course, it should be that way. Thus, the fitness testing, drug and alcohol indoctrinations, safety briefings, sex abuse trainings, etc. Gawd, do I remember Commander's call. Once a month, all those films about drugs. Paid off, though, as I returned to New Orleans, went to my favorite dive, and had a guy offer me "Christmas Trees", (as I recall). He told me it was a cheap drunk. All of those films came flooding back, and I politely declined.

I remember I had a hard time doing the 1 1/2 miles in 12 minutes. I could easily do that today (knees permitting), and have done it many times. I guess I'm in better shape now.

About the quality of military healthcare, I'm not as negative as you. That said, I do question the "older" doctors. Why would you stay in the military and earn about 1/10th of what you could get outside. Two reasons come to mind. (1) liability insurance costs too much; and (2) incompetence. #2 is the scary one, especially if he/she is a surgeon.

TRICARE is wonderful, at least for now, as I can get good doctors. However, I read that there are fewer and fewer docs willing to take TRICARE because they pay less and they're slower to pay. How they could be slower than, oh say Aetna, beats me, but that's what they say.

Here's a quote from your post that I empatically agree with:
-----------
Quote: Here's a couple more of my opinions-- the American pharma industry leads the world in R&D and drug advances. Medical tech leads in surgical equipment, methods, & treatments. American medical schools are besieged with foreign students who presumably could choose to attend one in their native countries. American doctors collaborate more effectively and share more information more widely in peer-reviewed journals/websites than the rest of the world. HMO's cost-control criteria have made life a living hell for most physicians in the name of cost efficiency.

Does the rest of the world do their own training, research, & initiatives-- or do they take advantage of the American advances? Which system has more imitators, the American one or the British/Canadian systems?
UNQUOTE
--------------------
I think the rest of the world is riding on our coattails, in pharmaceuticals and BTW, in defense spending, too. They are perfectly willing to allow Americans to pay the largest amount whilst they enjoy their great "lifestyle", and criticize us too. Their politicians should be thrown out, cause they're using us as the fall guy to cover up their own shortcomings, high taxes, and of course to further their authority.

Of course, as Dennis Miller says, that's just my opinion. I could be wrong.
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Re: Natural Limits to Healthcare Expense Growth?
Old 06-10-2005, 07:18 PM   #55
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Re: Natural Limits to Healthcare Expense Growth?

Quote:
Quote:* Here's a couple more of my opinions-- the American pharma industry leads the world in R&D and drug advances.
I heard a discussion on the radio between a rep from pharma and a critic -- critic claimed that the drug industry makes FAR more money on treating "healthy" people with meds such as Viagra, drugs for "anxiety disorder," etc. etc. than it ever could by developing meds for the smaller number of truly sick people.* She said that most of the big R&D dollars were going there, and that real diseases (apart from the big ones - heart disease and the like) were of secondary interest.

She also claimed that many of the "new"drugs coming out replace older meds (for instance, my hayfever medication) were no better than the old versions, but were developed and heavily marketed because they could be patented after the old meds' patents had expired.* In some cases, she claimed, the new ones were actually less effective.

I wish to heck I could remember her name so I could provide a source -- all that's left to me is to say that the U.S. drug industry MAY lead the world in R&D and advances, but that there are critics who dispute that.

Food for thought...
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Re: Natural Limits to Healthcare Expense Growth?
Old 06-11-2005, 07:06 AM   #56
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Re: Natural Limits to Healthcare Expense Growth?

I feel like I am a personal expert on medical treatment of allergies, like Nords feels like he is a personal expert on his own tax situation. I agree that the newer prescription anithistamines seem less effective than the older, over the counter pills, like Benedryl. The only upside to the newer ones is that they don't tend to make you sleepy.

In 2002, Claritin became the first non-sedating antihistamine that could be purchased over-the-counter. Since becoming an over the counter drug, the price for Claritin has dropped up to 70 percent. Generic versions of Claritin are also now available because loratadine, the active ingredient in Claritin, lost its patent in December of 2002.

Alavert is the first generic option and is about 40 percent less expensive than Claritin. Alavert is also being sold over-the-counter.



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Re: Natural Limits to Healthcare Expense Growth?
Old 06-11-2005, 12:13 PM   #57
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Re: Natural Limits to Healthcare Expense Growth?

You can buy the knock-off claritin at sams club and costco for something like 200 pills for $6. Benedryl is really, really unbelievable. I get 400 of them for $3.50 at the local sams.

Did you also know that the dominant sleeping tablets are nothing more than benedryl? Check the ingredients. Last time I checked you got 10-12 'sleep helpers' for $5. Or those 400 benedryl.

I take one benedryl before bed, half to help put me to sleep and half to keep me from getting stuffy.

Had allergies all my life although they were almost intolerable when I lived in New England and nothing helped. Either it made me sleepy or didnt work. The allergies havent been bad at all since moving to california although they were undetectable in the bay area I'm a little sniffy in the central valley.

I've taken a few claritin and they seemed to work. My wife takes them and says they're effective, although she tried allegra and said she didnt think it did anything. Seemed to me when she was taking it she had fewer allergy problems though...
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Re: Natural Limits to Healthcare Expense Growth?
Old 06-11-2005, 12:24 PM   #58
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Re: Natural Limits to Healthcare Expense Growth?

Quote:
Originally Posted by Martha
I agree that the newer prescription anithistamines seem less effective than the older, over the counter pills, like Benedryl.
I was on Vancenase & Flonase for five years to reduce allergy congestion leading to ear infections. It all cleared up and went away about six months after ER.

While it's true that the immune system peaks at ~35 and becomes less reactive with age, the ER coincidence is hard to ignore.

Or maybe it's related to sleep deprivation? TH, perhaps you should be giving baby Benadryl to your kid at bedtime!
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Re: Natural Limits to Healthcare Expense Growth?
Old 06-11-2005, 12:31 PM   #59
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Re: Natural Limits to Healthcare Expense Growth?

Dont think the thought hasnt occurred to me...
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Re: Natural Limits to Healthcare Expense Growth?
Old 06-11-2005, 12:34 PM   #60
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Re: Natural Limits to Healthcare Expense Growth?

Claritin saved/changed my life. Constant allergy attacks. Benadryl knocked me out cold. Taking Claritin was like taking the sunglasses off. Weird though, now adays, 6 years after first discovering it, I only get attacks about twice a year, which Claritin clears up right away. Did my body give up trying to punish me?
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