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Hoop, hurdles and health care in US
Old 06-27-2007, 10:26 PM   #1
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Hoop, hurdles and health care in US

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Originally Posted by ladelfina View Post
MKLD:
Now that you have spurred me to look into it, this brand also sells in the EU.. but I would have to find a distributor/representative (of which I see there is 1, in Milan) who is NOT going to sell direct.. that's just not the way things work here. Maybe I could get what I wanted by 1.) calling Milan and getting a local rep 2.) the "local" rep will be someplace 1 hr. + away IF I am lucky 3.) I'd have to go in person and pick up and pay in person later (because they are not going to have anything in stock). Why bother?
I'm surprised the gov't run healthcare system there doesn't keep loads of of CPAP supplies on hand just waiting to be given out for free....especially for such a life-threatening disease. You'd think the gov't there would be more accomodating to people with such a serious illness....especially since the products aren't readily available on the open market there.
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Old 06-28-2007, 05:59 AM   #2
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Why don't we do a poll and see who here gets their CPAP supplies for free in the US? I'm sure they are in the minority, despite their (or someone else like their company) paying megabucks for their insurance. Can you tell us, MKLD what percentage of your ins. companies give out 'free' CPAP supplies...??

Did I not tell the story of my $750/mo health insurer not even wanting to spring for the MACHINE, much less the replacement filters.. get a grip!

At this site you will find a document pertaining to a request for contract bids to supply respiratory products to a particular regional health administration, including home assistance and maintenance:
http://www.aslrmc.it/pls/updown_aslr...ntilazione.doc

As you can see, indicative annual supply consumption is included in the bid (it is stipulated that the winning bidder is obligated to supply superior quantities where prescribed):
Quote:
CONSUMI ANNUALI PREVEDIBILI Dl MATERIALE ACCESSORIO--
Detti consumi hanno valore puramente indicativo e non limitano l’obbligo della Ditta aggiudicataria di fornire quantitativi, anche superiori, nei limiti e nel rispetto delle prescrizioni medico-specialistiche:

• utenti ventilati non invasivamente ( TIPO “A”)

- 2 maschere
- 2 circuito-tubi
- 2 cuffie con reggi-maschera e mentoniera
- 2 filtri aria (se spugnosi) altrimenti 12
- 2 meccanismi anti-rebreathing
- i Kit arricchitore di ossigeno
- eventuale umidificatore con accessori
I don't have the time or patience to translate it all, but even someone not able to read Italian can suss out what they are asking for.

This IS a treatment we could have pursued w/in the Italian health system. It just so happens that we already have the machine, so why should I run around dealing with doctor's app't.s and prescriptions so I can get supplies through them.. just to save $50? Not worth my time, but it might be worth the average Italian's time considering they get by on $1500/mo avg. [They also get pretty much unlimited paid time off for doctor's app'ts., but that's bordering on another topic.] Then it might be just our luck to run into a doc that might want to re-do all the sleep tests/EKGS and so forth, for either professional conscientiousness or bureaucratic necessity.. and that would take even more time (and money for co-payments, gas, parking, etc.).

Ever consider the fact that not being 'readily available on the open market' might be related to the fact that most people go through the public health system and thus don't NEED to buy them? Anyway, as with the ladder example, the mktg./distribution/speedy availability of ANY consumer product here is just not comparable to that in the US; health care products just don't happen to be any different from oven thermometers or yoga mats (just to name a couple of other recent stateside imports).

Even though I've shown you that the Italian public health distributes these supplies.. it doesn't really matter if they didn't. I never said the Italian system was perfect or that expensive drugs and supplies rained down from the skies without any hurdles whatsover. Just please accept that in most cases of developed countries they -overall- get more considering what they spend which is 1/2 of what Americans spend. The extra 100% pays YOUR salary and Wm. McGuire's salary ($125 million - enough to insure 30,000-40,000 people). Just to essentially set up mazes and roadblocks in order to NOT deliver care.

---
Look, most here have given up engaging with you on this stuff altogether. I appreciate the practical advice you've given others, but when it comes to the political and philosophical it's obvious you don't want to accept even the REALITY, much less the questionable morality, of the overall US h.c. picture. I wish you hadn't resorted to such pure snideness and sarcasm in your question; it really doesn't aid your line of argument.
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Old 06-28-2007, 07:47 AM   #3
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Why don't we do a poll and see who here gets their CPAP supplies for free in the US? I'm sure they are in the minority, despite their (or someone else like their company) paying megabucks for their insurance. Can you tell us, MKLD what percentage of your ins. companies give out 'free' CPAP supplies...??
Most insurance pays for Durable Medical Equipment quite substantially AFTER the deductible is met. Mine pays 100% after deductible. I don't mind paying my deductible for durable medical equipment, just as long as I can get them when I need them and don't have to wait or jump through hoops to get them.


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Originally Posted by ladelfina View Post
Ever consider the fact that not being 'readily available on the open market' might be related to the fact that most people go through the public health system and thus don't NEED to buy them? Anyway, as with the ladder example, the mktg./distribution/speedy availability of ANY consumer product here is just not comparable to that in the US; health care products just don't happen to be any different from oven thermometers or yoga mats (just to name a couple of other recent stateside imports).
No. Not being readily available in the open market is a function of supply and demand. I suppose since sleep apnea is heavily related to obesity, we probably do have more of a problem with it here in the USA, but that's more of a lifestyle issue than a healthcare system issue. The customer service and availablity issues for ANY consumer products is just what I'd expect to see in Italy, so I'm not at all surprised about your comments on commerce there. In general, why work harder to please the customer when the incremental income you make is minimal? Why even sell Durable Medical Equipment or anything high tech when there's no profit in it? When profit motive is removed, customer service is and availabity is one of the first things that goes.

When the USA goes nationalized, IMO, we'll have the same problems here. Then where will people go to buy their CPAP supplies?

I jumped into this topic because it really irritates me that people from abroad spend money for medical supplies in the USA. Those numbers get added into our "total healthcare cost" per capita spending figures, and then people use those skewed figures to prove that we spend to much on healthcare in the USA. As a matter of principle, IMO, you should be using the Italian System solely for your healthcare needs...especially since you have such strong opposition to our system. Point is, we spend as much as we do, number one, because we can afford to, we want to, and we CAN. If the supplies weren't readily available here, then people wouldn't be spending their money on them.
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Old 06-28-2007, 10:24 AM   #4
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Most insurance pays for Durable Medical Equipment quite substantially AFTER the deductible is met. Mine pays 100% after deductible. I don't mind paying my deductible for durable medical equipment.
My HMO had no deductible. They just didn't feel like paying. We found out about this after the machine had already been prescribed and delivered and in use for almost a year (in fact, we were advised after we had left the country!!). Maybe there are some families that just can't come up with a couple extra grand they haven't planned for.. stupidly assuming the $10-$12k they already pay per year might actually yield some coverage. Sorry, I can't check my old coverage fine print since I threw all that stuff away. What this same company advertises currently for a no-deductible plan now is $1500/calendar year cap on durable equipment; the machine retails for $1200. I have no idea why they were calling my old workplace trying to shake me down for $1500 -- no idea. We didn't have any other visits or health needs/requests.

Quote:
I jumped into this topic because it really irritates me that people from abroad spend money for medical supplies in the USA.
Why? The manufacturers aren't selling it at a LOSS, AFAIK. (Or maybe they are, seeing as they'd probably charge an insured patient or a hospital $50 for a $5 filter..)

Quote:
Those numbers get added into our "total healthcare cost" per capita spending figures, and then people use those skewed figures to prove that we spend to much on healthcare in the USA.
It's v. hard to believe the handful of expats doing this in Europe to any extent would even register on the radar screen.. and anyway, aren't there FAR more Americans seeking cheap pharma in Canada and Mexico? Seeking operations in Singapore? I'm sure that runs into hundreds of millions of dollars yearly.. nothing to compare with my stupid CPAP filters. Even if I could get them down the street, I might choose to buy them with weak dollars (which I have) instead of converting dollars to Euros (which I don't have unless I absolutely need them). Just as I do with a lot of stuff, like clothes.

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As a matter of principle, IMO, you should be using the Italian System solely for your healthcare needs...especially since you have such strong opposition to our system.
The Italian PUBLIC health system is not some kind of absolute jail like you keep wanting to make it out to be. There are also plenty of PRIVATE insurers and PRIVATE clinics and PRIVATE doctors and labs here where I can use the cash out of my pocket however I like. Would that be wrong, too? It's a blended system and in the end EVERYone is covered somehow. In Italy we don't HAVE 40 or 50 MILLION uninsured. NO one is uninsured. Even those with long-term visas and temporary immigrants can buy in at a few hundred euros/year, from what I understand.

You assumed I couldn't get needed supplies if I had to through the Italian system. I showed you that this isn't so. But I am not going to spend even an hour here running around to get a $10 item I can have sent in an envelope for a buck from the US, just to make you happy.. If I need a drug, I will get it prescribed by an Italian doctor and buy it from an Italian pharmacy. If I get in an accident, I promise you I will go to an Italian public hospital. If I need an operation, I will not fly to the US. Promise.

Quote:
Point is, we spend as much as we do, number one, because we can afford to, we want to, and we CAN.
You CAN also afford to have everyone covered!!! You just don't "want to".

Look, we know the way the world works. Anyone with an advantage seeks to maintain it. The insurance companies in the US have the population over a barrel: the product gets ever more expensive and their profits go ever higher. Personally you would be crazy to bite the hand that feeds you, but I am trying to appeal to a higher, moral, conscience. The US is the only developed country that leaves people to fend for themselves on this; as you point out, America can, and can also afford to, do better.

---
MyDream: your description sounds EXACTLY like my DH, although he was able to get through the test and now sleeps well with his mask. I would be very cautious about the surgery. It does not have a really high success rate and is very painful with a long recovery time. I know a (v. skinny) US friend who had it done and he does NOT recommend it as it didn't really help him.

I would look into different mask styles.. there are new ones coming out all the time with gels and so forth. If you are as tired as you say, it's hard to imagine that a mask would impede sleep entirely.

Maybe you need to look into other aspects of your insomnia as well.. Have you tried things like melatonin, Valerian (they work for me).. or even things that act on a deeper level.. therapy for stress, yoga, etc.? Best of luck to you (and your wife - I feel her pain )!
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Old 06-28-2007, 10:51 AM   #5
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It's v. hard to believe the handful of expats doing this in Europe to any extent would even register on the radar screen.. and anyway, aren't there FAR more Americans seeking cheap pharma in Canada and Mexico?

You can believe it if you want, but no, I don't think it's just a handful of expats buying medical care from the USA. I think it's expats, AND citizens of other countries who can't get immediate care when they need it. I would be very curious to find out how much international commerce influences the "total cost per capita" in the USA. Unfortunately, that information is not readily available, but I think it's far more money than you think it is.

Secondly, when Americans go to Canada or Mexico to get cheaper pharma, it's not the Canadian or Mexican economy they are affecting, it's the American Economy that feels the cost, because it's AMERICA that supplies Canada and Mexico with much of their drugs. I actually think it's a good thing for Americans to go to Canada for prescriptions. The ultimate effect will be an equalizing affect on the cost of prescriptions here. The competition will ultimately bring down prices here in the USA and raise prices in Canada and Mexico....it will also leave Canada and Mexico with shortages, since they can only buy limited supplies of prescription drugs from America (That consequence is not necessarily a good thing, but that's what happens when you impose price controls and supply limits in a nationalized system).

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Originally Posted by ladelfina View Post
The Italian PUBLIC health system is not some kind of absolute jail like you keep wanting to make it out to be.

You assumed I couldn't get needed supplies if I had to through the Italian system. I showed you that this isn't so. But I am not going to spend even an hour here running around to get a $10 item I can have sent in an envelope for a buck from the US, just to make you happy.
I don't think the Italian system is a jail. I just think some of your earlier comments have proven the point that when it comes to the more serious diseases, you have to jump through hoops to get treatment or supplies...especially if you are not among the wealthy who can go outside the system for private care. When people from outside the USA use our system for a fallback for the inconveniences of thier gov't systems, it affects our total cost per capita, and those figures are not taken into account.

We cannot AFFORD to have everyone covered without any out of pocket responsibility here. If we do that, there will be serious consequences with accessibility for high-level care....not just for poor people, but for everyone.
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Old 06-28-2007, 12:36 PM   #6
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Look, you've lost me completely by now.

First it was:
BAD because I bought a CPAP filter from the US because it makes US care look expensive (--even tho' it helps the American economy--)

But if Americans buy anything abroad, that's BAD too because it hurts the American economy (--even tho' it makes US care look cheaper--).



Then you implied the Italian system was:
BAD because you figgered I couldn't get these supplies for 'free'.

But the US system is GOOD exactly BECAUSE people DON'T get them for 'free'.



Then you yourself call apnea both "life-threatening" and a "serious disease" which allows you to lump a stupid filter in with a brain tumor or something.
You're certainly being more generous than my HMO (when it suits your purpose); those are stronger terms than I ever used IIRC. If it were such a big deal and not a 5-cent piece of foam I'd make the primary care appt. and then the specialist's appt. and do the co-pays and get the prescription.. those are the "hoops"! Same as in the US.

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Old 06-28-2007, 12:57 PM   #7
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Look, you've lost me completely by now.

First it was:
BAD because I bought a CPAP filter from the US because it makes US care look expensive (--even tho' it helps the American economy--)
W'ere obviously not communicating very well here because I don't think I ever said it was bad for Americans to go outside of America to get care. In fact, I said it was good for Americans to go to Canada and Mexico for prescriptions, because the competition will ultimately bring down prescription drug costs here in the USA.

I also didn't say "the US system is GOOD exactly BECAUSE people DON'T get them for 'free.....

What I said was that I didn't mind paying my deductible for durable medical equipment (things like CPAP machines and supplies) because I know that I won't have to wait or jump through hoops to get the equipment that I need to survive when I need it.

The implication that the Italian system was bad was not because the supplies weren't free (that was sarcasm), but because the supplies are not readily available there without having to jump through hoops. As a reminder here is what you said about having to get supplies in Italy:

"...why should I run around dealing with doctor's app't.s and prescriptions so I can get supplies through them.. just to save $50? Not worth my time, but it might be worth the average Italian's time considering they get by on $1500/mo avg. [They also get pretty much unlimited paid time off for doctor's app'ts., but that's bordering on another topic.] Then it might be just our luck to run into a doc that might want to re-do all the sleep tests/EKGS and so forth, for either professional conscientiousness or bureaucratic necessity.. and that would take even more time (and money for co-payments, gas, parking, etc.)."


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Originally Posted by ladelfina View Post
Then you yourself call apnea both "life-threatening" and a "serious disease" which allows you to lump a stupid filter in with a brain tumor or something.
You're certainly being more generous than my HMO (when it suits your purpose); those are stronger terms than I ever used IIRC. If it were such a big deal and not a 5-cent piece of foam I'd make the primary care appt. and then the specialist's appt. and do the co-pays and get the prescription.. those are the "hoops"! Same as in the US.
Yes, I do think sleep apnea is serious and can be life-threatening without easy accessibility to the necessary equipment (not just filters, but the machines, too) to prevent you from stopping breathing in your sleep.
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Old 06-28-2007, 08:46 PM   #8
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What I said was that I didn't mind paying my deductible for durable medical equipment (things like CPAP machines and supplies) because I know that I won't have to wait or jump through hoops to get the equipment that I need to survive when I need it.
You have never had to jump through hoops to get medical care, medicine, or equipment you needed? Really? I'd bet most people and their medical providers have to go through all sorts of hoops to get the care they need. Insurance companies employ all sorts of people to do pre-authorization for care and to review claims. What are they there for but to find reasons not to pay?

We have had a number of people here talk about denied claims and you have talked about how to appeal and the importance of appealing. Sounds like hoops, hurdles and a bureaucracy to me. Ladelfina's husband's HMO wouldn't pay for his machine. My sister's doc referred her to a specialist but the HMO dragged its feet for six weeks before she was allowed to make an appointment. What insurer covers surgery without pre-authorization? My doc prescribes one asthma drug and the insurance company thinks I should have another. My doc has to waste her time negotiating.

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Old 06-28-2007, 10:34 PM   #9
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You have never had to jump through hoops to get medical care, medicine, or equipment you needed? Really? I'd bet most people and their medical providers have to go through all sorts of hoops to get the care they need. Insurance companies employ all sorts of people to do pre-authorization for care and to review claims. What are they there for but to find reasons not to pay?

We have had a number of people here talk about denied claims and you have talked about how to appeal and the importance of appealing. Sounds like hoops, hurdles and a bureaucracy to me. Ladelfina's husband's HMO wouldn't pay for his machine. My sister's doc referred her to a specialist but the HMO dragged its feet for six weeks before she was allowed to make an appointment. What insurer covers surgery without pre-authorization? My doc prescribes one asthma drug and the insurance company thinks I should have another. My doc has to waste her time negotiating.

Every day, everywhere.

Actually, to tell you the truth, No...I've never had to jump through insurance hoops to get the services I have needed. I have always known in advance what my insurance will pay, and they have always paid per contract. I guess it depends on which "hoops" you prefer to jump. I like knowing that the services are available when I need them. I can choose to use insurance to pay for those services, and agree to the "hoops" in advance as per the contract I sign.....or, if I don't want to deal with insurance "hoops", I can choose to either just go out and buy what I need or take out a loan to buy the services I need.....at least, the services and supplies are in supply when they are needed.

I don't see anything wrong with insurance companies requiring "step therapy" with certain kinds of medications. It helps keep prescription costs down, reduces demand for expensive drugs that may not work any better than the alternative, AND it puts pressure on drug suppliers to lower pricing on blockbuster "brand name" drugs.

What scares me is the thought that someday, someone might not even be able to get the services or supplies they need because of a lack of supply or a shortage of suppliers. Heck, Ladelfina admitted it would be difficult to just go out an buy a filter she needs. Which is worse..having to deal with insurance to get a CPAP machine (or a prosthetic leg, or kidney dialysis or an insulin pump) or having to wait in line because the product/service isn't available?
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Old 06-29-2007, 04:26 AM   #10
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I don't think I ever said it was bad for Americans to go outside of America to get care.
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it really irritates me that people from abroad spend money for medical supplies in the USA.
yeah.. I guess I misunderstood

Quote:
a doc that might want to re-do all the sleep tests/EKGS and so forth, for either professional conscientiousness or bureaucratic necessity.
No doc or ins. co. or HMO in the US is going to want to start over when presented with a random patient from a foreign country and order his/her/their own tests? Look, I didn't say this DID happen... I just didn't want to possibly get caught up in it over a tiny item.

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I know that I won't have to wait or jump through hoops to get the equipment that I need to survive when I need it.
A.) if you are one of the millions of uninsured without a few grand in your pocket, getting a CPAP filter is the least of your problems.

B.) The filter is not a matter of survival. I can wash out the old one! Look, I'm not thrilled to wait 2 weeks to have my car fixed here, or to wait 2 years for the phone co. to change my billing address either. These are things inherent to ITALY, and not to the underlying argument for single-payer health care. America can do better!!

Italians live longer than Americans. Italy is ranked among the top 10 countries for health care by the WHO; America is #37. I'm not worried about not getting truly life-saving care.

C.) Since you work in the ins. industry I'm hardly surprised that you don't experience delays or snafus the way others do. Maybe ask yourself instead why in the US an entire profession has built up around shepherding patients through the health-care maze. Just like people hire tax attorneys, sick and debilitated patients now have to hire people whose full-time job is sorting out medical and insurance paperwork and billing for them!
This is to say nothing of the full-time consultants doctors can hire to help them do likewise. Besides the pain and confusion, this all adds to the overall cost CREATED by ins. companies.
---
Here's another US example: Sis is trying to get care through her insurer for my nephew (5). Calls the plan for which she is paying the family rate, and they say, well the only center we will pay for is Center X. Center X says they won't treat anyone under the age of 6. SCREWED! Things like this happen, as Martha says.. ALL the time and they are NOT written out for consumers to see and choose; they don't find out until it's already too late.

Quote:
Even after adjusting for wealth, population mix and higher levels of some diseases, McKinsey calculated that we spend $477 billion a year more on health care than would be expected if the United States fit the spending pattern of 13 other advanced countries. That staggering waste of money works out to 3.6 percent of the nation's entire economic output...
Steven Pearlstein - Adding Up the Reasons For Expensive Health Care - washingtonpost.com

I'm going to stop here and put the McKinsey study link in a new thread, just in the hope that the thread can get back to CPAP. Sorry I lost sight of getting sucked OT.
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Old 06-29-2007, 08:17 AM   #11
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I don't think I ever said it was bad for Americans to go outside of America to get care.
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it really irritates me that people from abroad spend money for medical supplies in the USA.
yeah.. I guess I misunderstood

What is it about what I said that you misunderstood? The first sentence says that I think it is fine for AMERICANS to LEAVE the USA for care if they want to...

The second sentence says that I get irritated when people from OUTSIDE THE USA COME TO AMERICA for their care (ESPECIALLY when they are people who oppose the American system).
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Old 06-29-2007, 08:30 AM   #12
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A.) if you are one of the millions of uninsured without a few grand in your pocket, getting a CPAP filter is the least of your problems.
...So let's make it practically impossible (by implementing a single payor system) for ANYONE to get a CPAP machine or for that matter, an even more important item such as an insulin pump. That would be much more fair.

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B.) The filter is not a matter of survival. I can wash out the old one! Look, I'm not thrilled to wait 2 weeks to have my car fixed here, or to wait 2 years for the phone co. to change my billing address either. These are things inherent to ITALY, and not to the underlying argument for single-payer health care. America can do better!!
You really don't see it do you? The reason you have such terrible service, commerce, etc...in Italy is BECAUSE of the mentality of socialism. There is very little profit motive, incomes are low and working harder doesn't bring in more, because it all gets taken away in taxes. THAT'S what makes service and availability so terrible....you are advocating doing the same thing to the healthcare system in the USA! What do you think the longterm affect on healthcare service will be once that happens! Trying to purchase healthcare services, IMO, will be like trying to get your car fixed in Italy!

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Italians live longer than Americans. Italy is ranked among the top 10 countries for health care by the WHO; America is #37. I'm not worried about not getting truly life-saving care.
I've already been through this discussion before. Life expectency has very little to do withe the healthcare system and is more related to socio-economic issues like crime, divorce rates, teen pregnancy rates, racial oppression, etc...so that statistic does nothing to convince me that we need to socialize medicine in the USA.
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Old 06-29-2007, 09:37 AM   #13
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The second sentence says that I get irritated when people from OUTSIDE THE USA COME TO AMERICA for their care (ESPECIALLY when they are people who oppose the American system).
Ok.. yes.. I did misunderstand and responded too quickly in the heat of the moment.

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such terrible service, commerce, etc...in Italy is BECAUSE of the mentality of socialism...you are advocating doing the same thing to the healthcare system in the USA!
FORGET ITALY.. what about places like Germany and Japan? Surely you can't claim they are "inefficient" like Italy is. I'm sure their industries are quite happy that the gov. is footing the bill instead of the employer. They are quite nicely subsidized in that regard. Businesses in the US --outside of the ins. biz-- would love it, too.
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Old 06-29-2007, 11:54 AM   #14
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Ok.. yes.. I did misunderstand and responded too quickly in the heat of the moment.



FORGET ITALY.. what about places like Germany and Japan? Surely you can't claim they are "inefficient" like Italy is. I'm sure their industries are quite happy that the gov. is footing the bill instead of the employer. They are quite nicely subsidized in that regard. Businesses in the US --outside of the ins. biz-- would love it, too.
In Germany, an individual with no kids pays over 50% of their income in taxes...I'm not sure how that can possibly stimulate the economy....heck, why even work? I've never been to Germany, so I don't know how commerce and technology compares with the USA, but with such high tax rates, I can't imagine that it even compares. That's something I would have to do more research on.

In Japan, people are begging for better cancer treatment. There was an article posted on the early retirement forum earlier about how Japanese people are practically begging their gov't for American Quality Cancer care.


Japan's Failing Health Care
"Now, according to a recent release by the American Association of Physicians and Surgeons, it is failing in Japan.
If universal care were the genuine cure-all, the one country where it should work is Japan. They have a homogenous population, healthier lifestyle, eat more fish and soy, more vegetables and far less obesity than here.

If universal care does not work there why should it work anywhere?
According to Japanese legislator Takashi Yamamoto, who was just diagnosed with cancer, "abandoned cancer refugees are roaming the Japanese archipelago." Patients are told they¹ll never get better, even when treatments exist, and many are not even informed of their diagnoses.


Cancer mortality rates in Japan have been steadily climbing and are now more than 250 per 100,000, while U.S. rates are now around 180 per 100,000.
Japanese public television showed the stark contrast. In the U.S., multiple specialists meet to discuss a cancer patient¹s care. In Japan, a single doctor usually makes the diagnosis and carries out treatment with minimal consultation."

Here is a link comparing cancer survival rates in the USA to other European countries....this is what socialized medicine does to quality of care when it really counts, because the first thing that happens in a system with socialized medicine is you begin to lose your supply of specialists over time (they just don't get paid enough)

ACS :: Study Compares U.S. and European Survival Rates
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Old 06-29-2007, 12:17 PM   #15
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Japan's Failing Health Care
"Now, according to a recent release by the American Association of Physicians and Surgeons,
The AAPS is a group (that you cite above) which I'd never heard of in my 33 years of practice, so I thought I'd enlighten myself. From their web site (as an advocacy group for fee-for-service private practices):
  • AAPS is a national association of physicians dedicated to preserving freedom in the one-on-one patient- physician relationship.
  • AAPS members believe this patient-physician relationship must be protected from all forms of third-party intervention.
  • Since its founding in 1943, AAPS has been the only national organization consistently supporting the principles of the free market in medical practice.
Just thought our readers would want to know the academic source of your information. It would appear that you are citing biased agenda-based sources in the guise of objective data analysis. Again.

Thanks for sharing
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Old 06-29-2007, 01:20 PM   #16
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Just thought our readers would want to know the academic source of your information. It would appear that you are citing biased agenda-based sources in the guise of objective data analysis. Again.

Thanks for sharing
Boy oh boy are you critical of my posts, but I've noticed you don't complain if other's links have a more liberal point of view...

Here is one from the Wall Street Journal a more reputable, fair and balanced source for news on healthcare in Japan:

Sponsored by Japan Medical Association and reprinted with permission 1-800-843-0008
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Old 06-29-2007, 03:26 PM   #17
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Boy oh boy are you critical of my posts
Sorry if my criticism of the sources and opinions in your messages troubles you. I just happen to have a very different opinion on many of the positions you hold and I have skepticism about the "evidence" you use to support them.

I find others' points of view to be informative.
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Old 06-29-2007, 05:03 PM   #18
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Sorry if my criticism of the sources and opinions in your messages troubles you. I just happen to have a very different opinion on many of the positions you hold and I have skepticism about the "evidence" you use to support them.

I find others' points of view to be informative.
My position is simple: When we take away the profit motive from healthcare providers by capping salaries, etc.., quality of care will eventually be sacrificed - this will probably take about 20 years to happen. When we give Americans unlimited access to healthcare by providing some kind of very low or zero out of pocket coverage funded by taxpayers, demand will run umuck and we will eventually experience shortages of supply, expecially for the services of specialists. Everyone will have access to good, basic, primary care, and very few people will have access to premium care for complicated illnesses.

Any kind of data that I present to support the ultimate outcome of socialized medicine is criticized as having an agenda, yet there is plenty of evidence to prove that the quality of specialized services is dimished by a socialized system.

Look, I understand the idealism of wanting care for all..I would love that too, but it's unrealistic. No matter how you look at it, how you tweak the system, rationing will occur....it has to, because there simply isn't enough money to go around in a public environment to give everyone all of the services they want or need when they want them or need them. We've talked about that in depth...

The people on one side of the equasion (the left side) mistakenly believe that no rationing (waiting or lack of supply) will occur in a single-payor system, but they also think rationing is OK as long as it happens to everyone...they just can't handle any kind of unfairness, so it's better that everyone suffers the loss of specialized services (like Mayo Clinic), just as long as no one is left out from getting basic services (like primary care). The people on the other side (the right side) think it's better if some rationing happens to a minority of people in order to ensure that the overwhelming majority of people are able to get the best possible care they need when it really counts without having to wait - like when they need heart surgery, or back surgery, or hip surgery, or knee surgery. The left think it's evil to take fair market value (however much the market will bear) for your work, while the right encourages profit taking, because it stirrs on competition, technology and innovation.

When the left gets what they want - a single payor system, they'll be the first ones to cry out, 20 or 30 years down the road, when cancer statistics go on the rise or when they can't get a surgery they need without having to wait for a year, or when they have to wait four or five months to get in to see a specialist or to get durable medical equipment like an insulin pump or a CPAP machine.
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Old 06-29-2007, 05:15 PM   #19
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This discussion was split off from the CPAP thread.
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Old 06-29-2007, 08:18 PM   #20
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Originally Posted by mykidslovedogs View Post
My position is simple: When we take away the profit motive from healthcare providers by capping salaries, etc.., quality of care will eventually be sacrificed -


This is obviously false. If it were not, all these "socialized" systems that bother you so much would be falling down and death rates would be rising- at least toward the US level. But they are not.

Realize too that the best doctors are very likely not primarily motivated by money. Easier to run fat mill than to deal with the challenges of real medicine.

And as to your assertion that specialists disappear from public systems, wrong again. It varies from country to country. England is relatively lower in consultant supply when compared to the US. That is by design of their system, and it one way they hold costs way below the US level. We don't have to do it that way, there are other models.

Even at equal pay many people would prefer the life of a specialist to that of a primary care doctor. The kind of person who wants to know a relatively small area in very great detail would clearly prefer this. There are plenty of these kind of people. The funding of extended residency training would have to take into account that there is no outsize bonanza at the end of the hard slog.

One of my friends has taught and done research in gastroenterology and liver diseases for forty years. He was present as a young doctor at one of the very first flexible sigmoidoscopies in the US. (And if you have ever wondered why that word flexible is always included, ask someone to show you an old rigid sigmoidoscope and imagine how much fun that would be.) Anyway, to return to topic, he has worked in universities and hospitals in Trieste and various Dutch cities, and he says he much prefers practicing there, because one doesn't face the insurance and coverage issues that are so commonplace in America.

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