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Re: Why does health insurance vary state to state
Old 04-20-2007, 10:34 AM   #101
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Re: Why does health insurance vary state to state

Quote:
Originally Posted by FIRE'd@51
Doesn't that mean the only people who would sign up for that coverage are those who consider themselves potential LASIK candidates? Certainly, no one with normal vision would want to pay extra for it. So where is the benefit unless it's forced upon everyone through regular insurance.
Well, not exactly. Vision insurance, in itself, is riddled with adverse selection, so it's priced as it needs to be to take that into consideration. Most people who buy vision insurance are people who will use it. Insurers are now discovering that in the longrun, LASIK, isn't costing that much more than paying for contacts and glasses year after year, so VSP is now starting to offer policies that include it in the coverage, and the rates are still very competitive. Try getting that in a universalized system

....Now wait a minute....I thought you were FOR everyone paying a little bit extra to help others out...oh, but not for non-urgent services...OK then, let's design a BASIC plan that the gov't can subsidize and define as guaranteed issue as X price. All people will have access to that plan, which BTW only pays for preventive and life threatening illnesses. Anything else must be purchased through the private system.
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Re: Why does health insurance vary state to state
Old 04-20-2007, 10:42 AM   #102
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Re: Why does health insurance vary state to state

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Do you carry Blue Cross Blue Shield, if you don't mind?
              Do you have your card with you?
              Do you know your number?
              You are not leaving this room until I have this information.
              Do you mind if I at least ask this gentleman to fill out his chart?
              May I have your AHS policy number, sir?
              Do you carry Blue Cross Blue Shield?
              Dr. Spezio!
              I think one of your patients in here is dead.
                      Why do you say that, Mrs. Cushing?
              Because he wouldn't give me his Blue Cross number.
                      Christ!
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Re: Why does health insurance vary state to state
Old 04-20-2007, 11:11 AM   #103
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Re: Why does health insurance vary state to state

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Originally Posted by mykidslovedogs
Well, not exactly. Vision insurance, in itself, is riddled with adverse selection, so it's priced as it needs to be to take that into consideration. Most people who buy vision insurance are people who will use it.
I'm not following your logic. If that is the case, then the cost will be spread across the insured. The only way insurance works to lower the cost per person is when there are people paying premiums who don't use the benefits. If everyone in the LASIK pool has LASIK, where is the saving? The premiums would have to cover the cost of the surgery plus administrative expenses and profits.

Quote:
Originally Posted by mykidslovedogs
Insurers are now discovering that in the longrun, LASIK, isn't costing that much more than paying for contacts and glasses year after year
Do we really know this? I have read about many cases in which LASIK has resulted in costly complications. Also, does anyone really know what the long-term effects of LASIK to the eyes are?
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Re: Why does health insurance vary state to state
Old 04-20-2007, 11:24 AM   #104
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Re: Why does health insurance vary state to state

MKLD.. not having kids, I went here:
http://www.ask.hrsa.gov/pc/

The programs listed for an area where I used to live (Boston) are all well and good as far as they go, but half or more of the places listed are homeless shelters, battered women's shelters, drug/AIDs outreach/screening clinics and the like.

The "Regular" medical places listed (for example, Fenway Community Health Center-- a place I actually went to once) are regular practices that send out regular bills for services.

Quote:
Payment Options
While Fenway accepts all major insurance plans and participates in a number of managed care plans, no single plan is likely to cover all the services we offer. Therefore, we recommend that you confirm with your insurer that you are covered for a specific service or provider before obtaining treatment.

If you belong to a managed care plan, you must inquire about our physicians/providers by name; Fenway Community Health will not be listed as a participating provider, although our doctors will be. When checking with your health plan, make sure that the service is covered and that you can be seen at Fenway.

Fenway can estimate the costs of services but actual costs will vary based on the services that occur during your visit. For more on the services Fenway provides call 888-242-0900. For questions about coverage, call your insurer.

Health Plans
Fenway Community Health and South End Associates of Fenway Community Health accept most major health plans, including the following:

MassHealth
Medicaid
Blue Cross Blue Shield
Harvard Pilgrim
Tufts
Cigna
Klais
Consolidated
Neighborhood Health Plan
Aetna
United Health Care
This list is by no means exhustive and we accept many other types of insurance. If your insurance carrier is not on this list, please call Fenway's main number at 617-267-0159 and ask to speak to someone about insurance coverage.

Not all of our medical specialties or complementary services may be eligible for coverage. Be sure to check with your health plan.

In most cases, we can bill your insurance company directly. You are expected to bring your current insurance card to every appointment so we may bill your insurance carrier. In addition, we require that co-payments be made when you check in for each appointment. Before booking an appointment, find out what your plan covers and obtain any referrals.

Although we accept most insurances, Fenway services might be considered "out-of-network" for some plans. If this is the case, you should know that you are responsible for any fees not covered by your insurance. For example, if your insurance covers 80 percent of "out-of-network" costs, Fenway will bill you directly for the remaining 20 percent after the claim has been submitted to your insurance company. You are also responsible for any co-payments.

Financial Assistance
For eligible clients, medical services may be available at no cost or reduced cost through special grants or free-care programs, such as CenterCare and MassHealth. Mental health services may be available on a sliding scale, based on a client's ability to pay.

In order to receive this help, you must apply for financial assistance at the time of service.

If you need assistance covering the cost of your care, request an appointment with our financial assistance advisor by calling 617-927-6007. The advisor will review your financial circumstances and process your enrollment.
http://www.fenwayhealth.org/site/Pag...t_faq#becoming



MassHealth sounds like a good plan to fill in some of the gaps. You can be eligible if you don't make more than $27k for a couple, $41k for a family of 4. You have to go, obviously, to places like the Fenway that accept MassHealth.

But hey.. that's "socialistic" Massachusetts.. sounds essentially like a single-payer mini-Medicare.. which is what many people here have been arguing FOR all along.

Now, why not just expand it?

.. 'cause if you make $42k for a family of 4 and live in Boston, believe me, you don't have $700/month to pay for health insurance. The help only goes so far.
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Re: Why does health insurance vary state to state
Old 04-20-2007, 11:43 AM   #105
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Re: Why does health insurance vary state to state

I am all for the expansion of some of these programs to assist the working poor. Gov't has a difficult time making changes to eligibility rules as inflation occurs. A better way might be to plan an inflationary schedule by which individuals can be subsidized on a sliding scale through vouchers to purchase private options. I'd rather do that than take away the private options that others here enjoy.

Here is an interesting article on the Lasik. My whole point with Lasik and the advancements in cataract surgery is that, at least here in the USA, we have the OPTION to get it when we want it. In other countries, the technology is not readily available. Insurers are SLOWLY warming up to coverages for the Lasik procedure:

http://www.detnews.com/2005/business.../01-248049.htm

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Re: Why does health insurance vary state to state
Old 04-20-2007, 12:01 PM   #106
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Re: Why does health insurance vary state to state

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Originally Posted by mykidslovedogs
Here is an interesting article on the Lasik. My whole point with Lasik and the advancements in cataract surgery is that, at least here in the USA, we have the OPTION to get it when we want it.
It's completely changing the military. My nephew the Army Ranger was put in a LASIK queue at West Point last fall and it'll be interesting to see how it's changed his life. Every cadet not at 20/20 has the option for the surgery.

It's also turned around the Navy's selection process for military pilot training. Very few candidates could pass the 20/20 eye exam but now everyone can have the surgery and the competition for pilot selection is much more fierce-- so much more so that the submarine & surface-warfare communities are starting to come up short.
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Re: Why does health insurance vary state to state
Old 04-20-2007, 12:45 PM   #107
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Re: Why does health insurance vary state to state

Not sure what the obsession is with LASIK.., but here:

Quote:
LASIK prices, after rising for several years, have stabilized in 2006. Industry sources report that the average LASIK price in the second and third quarters of 2006 was about $1,950.
http://www.allaboutvision.com/vision...cost.htm#other

University of Pisa Center:
http://www.unipisa.it/box/eccimeri.htm

Quote:
Costi in ospedale pubblico a Pisa
In attesa di nuove comunicazioni da parte del Ministero della Sanità e della Regione Toscana (è probabile che nel giro di breve tempo in pratica tutti gli interventi di chirurgia refrattiva saranno a totale carico dell'utente) i costi per gli interventi eseguiti tramite SSN attualmente sono i seguenti:

1) Per miopia inferiore o uguale alle 7 diottrie il costo e' di 877,98 Euro a occhio per la LASIK e 774,69 Euro a occhio per la PRK. Per miopie superiori il costo e' di 46.15 Euro a occhio.
2) Per ipermetropia inferiore o uguale alle 5 diottrie il costo e' di 877,98 Euro a occhio per la LASIK e 774,69 Euro a occhio per la PRK. Per ipermetropie superiori alle 5 diottrie il costo e' di 46.15 Euro a occhio.
3) Per astigmatismo inferiore o uguale alle 3 diottrie il costo e' di 877,98 Euro a occhio per la LASIK e 774,69 Euro a occhio per la PRK. Per astigmatismi superiori alle 3 diottrie il costo e' di 46.15 Euro a occhio.
4) In caso di differenza fra i 2 occhi superiore alle 3 diottrie (anisometropia) il costo per l'occhio peggiore è di lire 46.15 Euro mentre il costo per l'occhio migliore è di 877,98 Euro per la LASIK e 774,69 Euro per la PRK.
Translation:

Costs in the public hospital in Pisa:
Waiting for new communications from the part of the Minister of Health and from the Region of Tuscany (it's probable that soon all surgical refractive eye operation costs will become entirely the burden of the patient) the costs of operations performed under the National Health Plan are currently the following:

1.) For myopia less than or equal to 7 diopters the cost is $1184 per eye for LASIK and $1045 for PRK. For higher levels of myopia the cost is $62 per eye.

2.) For hyperopia less than or equal to 5 diopters [idem]. For levels higher than 5 diopters [idem: $62].

3.) For astigmatism less than or equal to 3 diopters [idem/idem]..

4.) In the case of a difference between the two eyes of more than 3 diopters (anisometropia) the cost for the worse eye is $62 while the cost for the better eye is $1184 for LASIK and $1045 for PRK.
----

I think on top of this you pay a $62 "ticket" for the pre-op specialist visit.


No idea of "market" rate, except I did come across one hospital site FAQ (undated) that mentioned a €200 initial exam, €650 PRK, and €100 follow-up exams (followups not included in "public" price above). That leads me to question at what level Pisa is being subsidized, since PRK for one eye with initial exam plus 2 follow-ups = about $1200 in Pisa, vs. $1400 in this private structure in Monza (and vs. $1950 in the US; per the first link above PRK is noted as equivalent in cost to LASIK).

No idea of waiting times either way.
What's neat is the $62 public procedure if your eyes are REALLY bad!

From what I can see there are dozens and dozens of laser eye centres in Italy..
..again, Italy is not a 3rd-world country.. mostly

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Re: Why does health insurance vary state to state
Old 04-20-2007, 01:09 PM   #108
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Re: Why does health insurance vary state to state

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Originally Posted by ladelfina
Not sure what the obsession is with LASIK...
Because presbyopia sucks!

The concern holding me back is that it won't really fix the focusing problem, just put one eye at distance and the other at reading.
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Re: Why does health insurance vary state to state
Old 04-20-2007, 01:51 PM   #109
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Re: Why does health insurance vary state to state

Hey, I wear glasses, too.. but right now I am too chicken to have someone fry my eyes. I hear there's a burning smell! :P :P :P

I meant: why would people insert it into a discussion on public health care and insurance? It's clearly an optional procedure.
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Re: Why does health insurance vary state to state
Old 04-20-2007, 02:04 PM   #110
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Re: Why does health insurance vary state to state

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Originally Posted by ladelfina
I meant: why would people insert it into a discussion on public health care and insurance?
Because their arguments have absolutely no credibility, so they use the "Chewbacca defense."
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Re: Why does health insurance vary state to state
Old 04-20-2007, 03:41 PM   #111
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Re: Why does health insurance vary state to state

Quote:
Originally Posted by ladelfina
Hey, I wear glasses, too.. but right now I am too chicken to have someone fry my eyes. I hear there's a burning smell! :P :P :P

I meant: why would people insert it into a discussion on public health care and insurance? It's clearly an optional procedure.
I guess we really did off the subject here, but the whole point I was trying to make with the Lasik is how readily available it is here in the USA and how the private system here in the USA is what I believe has helped the USA to be one of the early adopters of the technique. To tell you the truth, I'm really not sure how "big" the procedure is in other countries and if there are any waiting times. On the other hand, I think the waiting times for cataract surgery in countries with universal plans is quite long as compared to the USA.
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Re: Why does health insurance vary state to state
Old 04-20-2007, 08:58 PM   #112
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Re: Why does health insurance vary state to state

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Originally Posted by mykidslovedogs
I guess we really did off the subject here, but the whole point I was trying to make with the Lasik is how readily available it is here in the USA and how the private system here in the USA is what I believe has helped the USA to be one of the early adopters of the technique. To tell you the truth, I'm really not sure how "big" the procedure is in other countries and if there are any waiting times. On the other hand, I think the waiting times for cataract surgery in countries with universal plans is quite long as compared to the USA.
Translation: "I can't see past the borders of my (marginally, heh) red state. USA, USA, USA!!!"
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Re: Why does health insurance vary state to state
Old 04-21-2007, 01:07 AM   #113
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Re: Why does health insurance vary state to state

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Originally Posted by FIRE'd@51
I have read about many cases in which LASIK has resulted in costly complications. Also, does anyone really know what the long-term effects of LASIK to the eyes are?
my coworker had lasik - and now she cannot drive at nite - she was not told that her condition - dry eye? or something made her a bad candidate for the procedure - i think people are more aware these days but it really complicates her life and travel arrangements!

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Re: Why does health insurance vary state to state
Old 04-21-2007, 05:36 AM   #114
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Re: Why does health insurance vary state to state

Yes.. the POPULARITY (or, I might add, availability) of a procedure does not determine its overall efficacy or its apppropriateness for an individual patient.

Bright-eyed.. sorry about your co-worker. I don't think I could bring myself to get LASIK if it were performed by Dr. LASIK himself.

Here's a emergency story hot off the press (I'll get more details when I can.. this is the 60-second version related by his wife who is in our yoga class): Italian acquaintance of ours has stomach pains; doctor tells him it's constipation or wind or some such; pain gets worse and they go to the hospital where they give him a CAT scan and take X-rays which are inconclusive; they open him up, and it's appendicitis. He's OK now. I'll try to find out exactly the time frame; I think just a day or two... as in Friday afternoon pain.. Saturday operation.

I was surprised to see that they were using a CAT scan to diagnose appendicitis. My surgeon dad would just poke with his finger in a certain place (of course by now I forget where) and tell us basically, if it hurts here.. it's appendicitis. Just leads me to wonder how many times common things are overlooked because more exotic tests are used and people know more about exotic complaints, crowding the field of possibilities.. of course if you're someone with the more exotic complaint, you're happier!

I think both this and the LASIK story show that it always behooves patients to find out as much as they can about symptoms they perceive and procedures they may choose to undergo.. easier now that there is the Internet.. as long as you take it with a grain of salt. For example, looking up appendicitis, I found an article that said that every year 7% of Americans develop appendicitis. HuuuH? Elsewhere it says 7% will develop it in their lifetimes.. infinitely more believeable.

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Re: Why does health insurance vary state to state
Old 04-21-2007, 09:05 AM   #115
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Re: Why does health insurance vary state to state

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Originally Posted by ladelfina

I was surprised to see that they were using a CAT scan to diagnose appendicitis. My surgeon dad would just poke with his finger in a certain place (of course by now I forget where) and tell us basically, if it hurts here.. it's appendicitis. Just leads me to wonder how many times common things are overlooked because more exotic tests are used and people know more about exotic complaints, crowding the field of possibilities.. of course if you're someone with the more exotic complaint, you're happier!
Whoa -- good point, maybe not the best example. Though I'm pretty restrained in my practice pattern, CT is -- and should -- be used to confirm the diagnosis of acute appendicitis if the presentation is not classical.

Yes, in the old days Doc Parker would harrumph and poke and prod and pronounce your appendix as inflamed. Problem was, he was wrong more than 15% of the time. Surgeons would run a 15% "normal appendix removal" rate (considered standard, acceptable practice), and peritonitis -- sometimes fatal -- was not rare for patients whose appendicitis was not recognized (for example in an unusual location within the abdomen). While CT may not be needed in patients who have obvious findings, there is a place for them in this disease.

So I certainly agree that some tests are overused and unnecessary, but maybe there are better examples. I can offer a few: CT head for routine headache; CT thorax for pneumonia when the x-ray is negative; total body scanning for "screening," cardiac stress tests for little or no reason in the wrong populations.

But if I develop abdominal pain suggestive but not classic for appendicitis, please get a CT scan before you open me up and yank out my body parts. .
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Re: Why does health insurance vary state to state
Old 04-21-2007, 10:10 AM   #116
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Re: Why does health insurance vary state to state

Thanks for the clarifications, Rich.. you certainly do earn your keep around here!

I was recounting the story mainly to demonstrate that here there is prompt emergency care AND routine use of high-tech equipment.. it's not necessary to "do without" just because it's publicly-financed health care. My surprise was due in part to my own ignorance.. not trying to second-guess the docs.

I guess I just keep posting here to dispel MKLD's myth that public health care has to be bad per forza. Just because the Canadians have a bad system in certain respects doesn't mean Americans have to copy that one in particular.

To get only somewhat back on topic, this really got me:
Quote:
2.) ...If they didn't contract with insurance companies, they'd probably have trouble getting paid for services since most Americans think healthcare is an entitlement and not a service deserving of a six figure or greater salary...
Insurers are a cartel.. they dominate the market. I have no doubt that their top 20% of employees/executives make more than doctors do. That's money that could be spent on either doctors' and nurses' salaries or on patient care. We choose to subsidize a vast insurance bureaucracy just as Italy chooses to subsidize a vast public works bureaucracy. Neither is as efficient as it could be, nor does either have much to do with "market forces".

Here's a nifty calculator..
http://www.aflcio.org/corporatewatch...u/database.cfm
I chose WellPoint:
http://www.aflcio.org/corporatewatch...m?tkr=WLP&pg=4

A lot of interesting stuff here, as well:
http://www.pnhp.org/

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Re: Why does health insurance vary state to state
Old 04-21-2007, 10:12 AM   #117
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Re: Why does health insurance vary state to state

I have stayed out of this debate because there has been more heat than light. So I am posting now just to state a few facts and correct some factual errors.

Health status has less to do with healthcare than it does with social, environmental and lifestyle determinants of health.

Quote:
Originally Posted by mykidslovedogs
It is also never mentioned that Canadians still have to pay a premium ON TOP of TAXES to their goverment amounting to about $125.00/mo.
Only in selected provinces, notably Alberta.

Quote:
Originally Posted by mykidslovedogs
And...they still have to wait an AVERAGE of 17 weeks for many services
See actual data here

Quote:
Originally Posted by mykidslovedogs
and it is ILLEGAL for them to try to pay a doctor privately if they want to move up on THE LIST.
Doctors in Canada must elect to (a) join the public system or (b) work exclusively privately. There is no law that prevents me, as a Canadian citizen, from using and paying for the services of a private clinic such as this one if I choose to.

The Canada Health Act has five principles. One is universality. That means that everyone, rich or poor, is entitled to health care. Period. Another is portability. That means that if I move to another province or territory, or need health care while visiting, my home province pays for the first three months, and after that, I have coverage in my new province or residence. Nothing is perfect. But this does make life very simple.

I think societies choose their health care systems based on values. The US values individual choice. Canada values equity.

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Re: Why does health insurance vary state to state
Old 04-21-2007, 10:38 AM   #118
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Re: Why does health insurance vary state to state

Quote:
Originally Posted by Rich_in_Tampa
Yes, in the old days Doc Parker would harrumph and poke and prod and pronounce your appendix as inflamed. Problem was, he was wrong more than 15% of the time. Surgeons would run a 15% "normal appendix removal" rate (considered standard, acceptable practice), and peritonitis -- sometimes fatal -- was not rare for patients whose appendicitis was not recognized (for example in an unusual location within the abdomen). While CT may not be needed in patients who have obvious findings, there is a place for them in this disease.
But if I develop abdominal pain suggestive but not classic for appendicitis, please get a CT scan before you open me up and yank out my body parts. .
I wonder how well that belly-poking diagnosis works among today's overweight American population.

When I was on sea duty I had a vague impression that the scary medical emergencies would be workplace injuries (bleeding, burns, broken bones), pneumonia, a stress-induced heart attack, drug-resistant TB, kidney stones (ouch), or hepatitis.

When I was working SUBPAC Operations I quickly learned that the scariest medical emergency of all is appendicitis. It can have vague & extremely variable symptoms in a high-stress environment, corpsmen have relatively poor diagnosis tools, and it's a heckuva long drive to the ER. IIRC the first thing everyone wanted to know was whether the patient's symptoms included an elevated white blood cell count, and if so then SUBPAC's doctor (a captain) would be stomping on the admiral's desk for a MEDEVAC. My boss learned that resistance was futile-- no requests for additional tests, no staying on station waiting for the situation to resolve itself, no "missions of extreme importance to national security" BS-- just get to a helo pickup right now. No one actually died during my two-year tour but we cut managed to cut it pretty close a couple times.
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Re: Why does health insurance vary state to state
Old 04-21-2007, 11:46 AM   #119
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Re: Why does health insurance vary state to state

Quote:
Originally Posted by Meadbh
I have stayed out of this debate because there has been more heat than light. So I am posting now just to state a few facts and correct some factual errors.
Thanks!

I too have stayed out of this 'discussion', having decided some time ago that it was pointless to argue with Mr. Dogs.

Fact is that most (all?) first world nations provide universal health care access, and pay less for it than we do. Also their general levels of health, as measured by infant mortality and life expectancy, are better than ours.

And the NHS care received by my parents and other relatives in the UK is superior in most respects to that received by my late wife here in California.

Enough ....

Peter
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Re: Why does health insurance vary state to state
Old 04-21-2007, 12:08 PM   #120
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Re: Why does health insurance vary state to state

Meadbh.. thanks for the Canada info.. it sounds much like Italy where there are parallel systems in which doctors and patients can choose which route to take. Sorry that I may have inadvertently maligned the Canadian system under certain adverse influences... .

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