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Groups > sci.electronics.design > #460129 > unrolled thread
| Started by | Don Y <blockedofcourse@foo.invalid> |
|---|---|
| First post | 2017-05-13 15:10 -0700 |
| Last post | 2017-05-26 13:43 -0700 |
| Articles | 20 on this page of 264 — 26 participants |
Back to article view | Back to sci.electronics.design
What's wrong with "national health care"? Don Y <blockedofcourse@foo.invalid> - 2017-05-13 15:10 -0700
Re: What's wrong with "national health care"? Cursitor Doom <curd@notformail.com> - 2017-05-13 22:54 +0000
Re: What's wrong with "national health care"? Don Y <blockedofcourse@foo.invalid> - 2017-05-13 15:59 -0700
Re: What's wrong with "national health care"? Tom Gardner <spamjunk@blueyonder.co.uk> - 2017-05-14 00:34 +0100
Re: What's wrong with "national health care"? Don Y <blockedofcourse@foo.invalid> - 2017-05-13 17:11 -0700
Re: What's wrong with "national health care"? Tom Gardner <spamjunk@blueyonder.co.uk> - 2017-05-14 08:49 +0100
Re: What's wrong with "national health care"? Don Y <blockedofcourse@foo.invalid> - 2017-05-14 02:00 -0700
Re: What's wrong with "national health care"? Tom Gardner <spamjunk@blueyonder.co.uk> - 2017-05-14 10:14 +0100
Re: What's wrong with "national health care"? Don Y <blockedofcourse@foo.invalid> - 2017-05-14 08:31 -0700
Re: What's wrong with "national health care"? Martin Brown <'''newspam'''@nezumi.demon.co.uk> - 2017-05-14 15:56 +0100
Re: What's wrong with "national health care"? Don Y <blockedofcourse@foo.invalid> - 2017-05-14 09:04 -0700
Re: What's wrong with "national health care"? Tom Gardner <spamjunk@blueyonder.co.uk> - 2017-05-14 18:02 +0100
Re: What's wrong with "national health care"? Don Y <blockedofcourse@foo.invalid> - 2017-05-14 16:10 -0700
Re: What's wrong with "national health care"? Tom Gardner <spamjunk@blueyonder.co.uk> - 2017-05-15 01:12 +0100
Re: What's wrong with "national health care"? Don Y <blockedofcourse@foo.invalid> - 2017-05-16 10:57 -0700
Re: What's wrong with "national health care"? Don Y <blockedofcourse@foo.invalid> - 2017-05-18 10:42 -0700
Re: What's wrong with "national health care"? rickman <gnuarm@gmail.com> - 2017-05-18 14:10 -0400
Re: What's wrong with "national health care"? rickman <gnuarm@gmail.com> - 2017-05-17 10:19 -0400
Re: What's wrong with "national health care"? Tom Gardner <spamjunk@blueyonder.co.uk> - 2017-05-17 15:48 +0100
Re: What's wrong with "national health care"? rickman <gnuarm@gmail.com> - 2017-05-17 13:19 -0400
Re: What's wrong with "national health care"? Tom Gardner <spamjunk@blueyonder.co.uk> - 2017-05-17 18:47 +0100
Re: What's wrong with "national health care"? rickman <gnuarm@gmail.com> - 2017-05-17 15:40 -0400
Re: What's wrong with "national health care"? Tom Gardner <spamjunk@blueyonder.co.uk> - 2017-05-18 00:03 +0100
Re: What's wrong with "national health care"? rickman <gnuarm@gmail.com> - 2017-05-17 19:39 -0400
Re: What's wrong with "national health care"? Tom Gardner <spamjunk@blueyonder.co.uk> - 2017-05-18 08:09 +0100
Re: What's wrong with "national health care"? John Devereux <john@devereux.me.uk> - 2017-05-18 09:13 +0100
Re: What's wrong with "national health care"? Tom Gardner <spamjunk@blueyonder.co.uk> - 2017-05-18 09:37 +0100
Re: What's wrong with "national health care"? rickman <gnuarm@gmail.com> - 2017-05-18 04:57 -0400
Re: What's wrong with "national health care"? Martin Brown <'''newspam'''@nezumi.demon.co.uk> - 2017-05-19 09:58 +0100
Re: What's wrong with "national health care"? bill.sloman@ieee.org - 2017-05-17 08:21 -0700
Re: What's wrong with "national health care"? rickman <gnuarm@gmail.com> - 2017-05-17 13:28 -0400
Re: What's wrong with "national health care"? Martin Brown <'''newspam'''@nezumi.demon.co.uk> - 2017-05-19 09:13 +0100
Re: What's wrong with "national health care"? Tom Gardner <spamjunk@blueyonder.co.uk> - 2017-05-19 10:14 +0100
Re: What's wrong with "national health care"? rickman <gnuarm@gmail.com> - 2017-05-19 13:31 -0400
Re: What's wrong with "national health care"? Tom Gardner <spamjunk@blueyonder.co.uk> - 2017-05-19 19:17 +0100
Re: What's wrong with "national health care"? rickman <gnuarm@gmail.com> - 2017-05-19 17:47 -0400
Re: What's wrong with "national health care"? Tom Gardner <spamjunk@blueyonder.co.uk> - 2017-05-19 23:45 +0100
Re: What's wrong with "national health care"? bill.sloman@ieee.org - 2017-05-19 19:57 -0700
Re: What's wrong with "national health care"? rickman <gnuarm@gmail.com> - 2017-05-19 23:35 -0400
Re: What's wrong with "national health care"? Tom Gardner <spamjunk@blueyonder.co.uk> - 2017-05-20 07:42 +0100
Re: What's wrong with "national health care"? bill.sloman@ieee.org - 2017-05-20 00:48 -0700
Re: What's wrong with "national health care"? Martin Brown <'''newspam'''@nezumi.demon.co.uk> - 2017-05-23 09:24 +0100
Re: What's wrong with "national health care"? rickman <gnuarm@gmail.com> - 2017-05-23 12:19 -0400
Re: What's wrong with "national health care"? Tom Gardner <spamjunk@blueyonder.co.uk> - 2017-05-23 17:44 +0100
Re: What's wrong with "national health care"? rickman <gnuarm@gmail.com> - 2017-05-23 16:49 -0400
Re: What's wrong with "national health care"? Clifford Heath <no.spam@please.net> - 2017-05-24 08:29 +1000
Re: What's wrong with "national health care"? rickman <gnuarm@gmail.com> - 2017-05-23 19:26 -0400
Re: What's wrong with "national health care"? Clifford Heath <no.spam@please.net> - 2017-05-24 11:32 +1000
Re: What's wrong with "national health care"? rickman <gnuarm@gmail.com> - 2017-05-24 01:16 -0400
Re: What's wrong with "national health care"? krw@notreal.com - 2017-05-24 18:04 -0400
Re: What's wrong with "national health care"? Tom Gardner <spamjunk@blueyonder.co.uk> - 2017-05-24 07:40 +0100
Re: What's wrong with "national health care"? Jasen Betts <jasen@xnet.co.nz> - 2017-05-31 11:57 +0000
Re: What's wrong with "national health care"? rickman <gnuarm@gmail.com> - 2017-05-31 09:05 -0400
Re: What's wrong with "national health care"? Jasen Betts <jasen@xnet.co.nz> - 2017-06-20 05:12 +0000
Re: What's wrong with "national health care"? krw@notreal.com - 2017-05-23 21:07 -0400
Re: What's wrong with "national health care"? bill.sloman@ieee.org - 2017-05-23 19:04 -0700
Re: What's wrong with "national health care"? krw@notreal.com - 2017-05-23 18:46 -0400
Re: What's wrong with "national health care"? David Brown <david.brown@hesbynett.no> - 2017-05-24 12:56 +0200
Re: What's wrong with "national health care"? rickman <gnuarm@gmail.com> - 2017-05-24 12:37 -0400
Re: What's wrong with "national health care"? krw@notreal.com - 2017-05-24 18:12 -0400
Re: What's wrong with "national health care"? Lasse Langwadt Christensen <langwadt@fonz.dk> - 2017-05-24 16:11 -0700
Re: What's wrong with "national health care"? krw@notreal.com - 2017-05-24 19:49 -0400
Re: What's wrong with "national health care"? David Brown <david.brown@hesbynett.no> - 2017-05-26 15:41 +0200
Re: What's wrong with "national health care"? krw@notreal.com - 2017-05-23 18:44 -0400
Re: What's wrong with "national health care"? Martin Brown <'''newspam'''@nezumi.demon.co.uk> - 2017-05-14 18:18 +0100
Re: What's wrong with "national health care"? Tom Gardner <spamjunk@blueyonder.co.uk> - 2017-05-14 18:54 +0100
Re: What's wrong with "national health care"? Don Y <blockedofcourse@foo.invalid> - 2017-05-14 23:00 -0700
Re: What's wrong with "national health care"? Tom Gardner <spamjunk@blueyonder.co.uk> - 2017-05-15 15:32 +0100
Re: What's wrong with "national health care"? Don Y <blockedofcourse@foo.invalid> - 2017-05-15 15:01 -0700
Re: What's wrong with "national health care"? Tom Gardner <spamjunk@blueyonder.co.uk> - 2017-05-16 00:52 +0100
Re: What's wrong with "national health care"? kevin93 <kevin@whitedigs.com> - 2017-05-15 19:17 -0700
Re: What's wrong with "national health care"? bill.sloman@ieee.org - 2017-05-15 19:26 -0700
Re: What's wrong with "national health care"? Don Y <blockedofcourse@foo.invalid> - 2017-05-16 12:01 -0700
Re: What's wrong with "national health care"? Tom Gardner <spamjunk@blueyonder.co.uk> - 2017-05-16 21:12 +0100
Re: What's wrong with "national health care"? Don Y <blockedofcourse@foo.invalid> - 2017-05-16 13:51 -0700
Re: What's wrong with "national health care"? krw@notreal.com - 2017-05-16 20:26 -0400
Re: What's wrong with "national health care"? rickman <gnuarm@gmail.com> - 2017-05-17 15:50 -0400
Re: What's wrong with "national health care"? Don Y <blockedofcourse@foo.invalid> - 2017-05-14 13:27 -0700
Re: What's wrong with "national health care"? Tom Gardner <spamjunk@blueyonder.co.uk> - 2017-05-14 22:00 +0100
Re: What's wrong with "national health care"? kevin93 <kevin@whitedigs.com> - 2017-05-14 18:39 -0700
Re: What's wrong with "national health care"? Lasse Langwadt Christensen <langwadt@fonz.dk> - 2017-05-13 16:20 -0700
Re: What's wrong with "national health care"? Don Y <blockedofcourse@foo.invalid> - 2017-05-13 17:05 -0700
Re: What's wrong with "national health care"? Lasse Langwadt Christensen <langwadt@fonz.dk> - 2017-05-13 17:49 -0700
Re: What's wrong with "national health care"? John Larkin <jjlarkin@highlandtechnology.com> - 2017-05-13 18:02 -0700
Re: What's wrong with "national health care"? krw@notreal.com - 2017-05-13 21:25 -0400
Re: What's wrong with "national health care"? rickman <gnuarm@gmail.com> - 2017-05-13 21:28 -0400
Re: What's wrong with "national health care"? bill.sloman@ieee.org - 2017-05-13 19:39 -0700
Re: What's wrong with "national health care"? tabbypurr@gmail.com - 2017-05-15 13:05 -0700
Re: What's wrong with "national health care"? krw@notreal.com - 2017-05-15 20:37 -0400
Re: What's wrong with "national health care"? tabbypurr@gmail.com - 2017-05-15 18:19 -0700
Re: What's wrong with "national health care"? krw@notreal.com - 2017-05-15 21:53 -0400
Re: What's wrong with "national health care"? tabbypurr@gmail.com - 2017-05-16 09:18 -0700
Re: What's wrong with "national health care"? krw@notreal.com - 2017-05-16 12:51 -0400
Re: What's wrong with "national health care"? bitrex <bitrex@de.lete.earthlink.net> - 2017-05-20 11:54 -0400
Re: What's wrong with "national health care"? krw@notreal.com - 2017-05-20 12:05 -0400
Re: What's wrong with "national health care"? bitrex <bitrex@de.lete.earthlink.net> - 2017-05-22 08:58 -0400
Re: What's wrong with "national health care"? krw@notreal.com - 2017-05-22 11:58 -0400
Re: What's wrong with "national health care"? bill.sloman@ieee.org - 2017-05-15 19:29 -0700
Re: What's wrong with "national health care"? Don Y <blockedofcourse@foo.invalid> - 2017-05-13 18:06 -0700
Re: What's wrong with "national health care"? Lasse Langwadt Christensen <langwadt@fonz.dk> - 2017-05-13 18:38 -0700
Re: What's wrong with "national health care"? Don Y <blockedofcourse@foo.invalid> - 2017-05-13 18:44 -0700
Re: What's wrong with "national health care"? "dcaster@krl.org" <dcaster@krl.org> - 2017-05-13 17:35 -0700
Re: What's wrong with "national health care"? Lasse Langwadt Christensen <langwadt@fonz.dk> - 2017-05-13 17:56 -0700
Re: What's wrong with "national health care"? krw@notreal.com - 2017-05-13 21:00 -0400
Re: What's wrong with "national health care"? Lasse Langwadt Christensen <langwadt@fonz.dk> - 2017-05-13 18:11 -0700
Re: What's wrong with "national health care"? krw@notreal.com - 2017-05-13 21:29 -0400
Re: What's wrong with "national health care"? Lasse Langwadt Christensen <langwadt@fonz.dk> - 2017-05-13 18:47 -0700
Re: What's wrong with "national health care"? krw@notreal.com - 2017-05-13 22:37 -0400
Re: What's wrong with "national health care"? Lasse Langwadt Christensen <langwadt@fonz.dk> - 2017-05-13 19:56 -0700
Re: What's wrong with "national health care"? krw@notreal.com - 2017-05-14 00:08 -0400
Re: What's wrong with "national health care"? Lasse Langwadt Christensen <langwadt@fonz.dk> - 2017-05-13 21:20 -0700
Re: What's wrong with "national health care"? krw@notreal.com - 2017-05-14 18:02 -0400
Re: What's wrong with "national health care"? Don Y <blockedofcourse@foo.invalid> - 2017-05-13 18:16 -0700
Re: What's wrong with "national health care"? Don Y <blockedofcourse@foo.invalid> - 2017-05-13 18:02 -0700
Re: What's wrong with "national health care"? Martin Brown <'''newspam'''@nezumi.demon.co.uk> - 2017-05-14 15:58 +0100
Re: What's wrong with "national health care"? Lasse Langwadt Christensen <langwadt@fonz.dk> - 2017-05-14 09:19 -0700
Re: What's wrong with "national health care"? Don Y <blockedofcourse@foo.invalid> - 2017-05-14 13:29 -0700
Re: What's wrong with "national health care"? rickman <gnuarm@gmail.com> - 2017-05-17 18:40 -0400
Re: What's wrong with "national health care"? krw@notreal.com - 2017-05-14 18:04 -0400
Re: What's wrong with "national health care"? George Herold <gherold@teachspin.com> - 2017-05-14 11:12 -0700
Re: What's wrong with "national health care"? Don Y <blockedofcourse@foo.invalid> - 2017-05-14 12:23 -0700
Re: What's wrong with "national health care"? George Herold <gherold@teachspin.com> - 2017-05-14 10:55 -0700
Re: What's wrong with "national health care"? Don Y <blockedofcourse@foo.invalid> - 2017-05-14 13:32 -0700
Re: What's wrong with "national health care"? krw@notreal.com - 2017-05-13 20:44 -0400
Re: What's wrong with "national health care"? rickman <gnuarm@gmail.com> - 2017-05-13 21:03 -0400
Re: What's wrong with "national health care"? bitrex <bitrex@de.lete.earthlink.net> - 2017-05-13 20:17 -0400
Re: What's wrong with "national health care"? rickman <gnuarm@gmail.com> - 2017-05-13 20:57 -0400
Re: What's wrong with "national health care"? Tom Gardner <spamjunk@blueyonder.co.uk> - 2017-05-14 08:55 +0100
Re: What's wrong with "national health care"? bitrex <bitrex@de.lete.earthlink.net> - 2017-05-14 08:11 -0400
Re: What's wrong with "national health care"? Tom Gardner <spamjunk@blueyonder.co.uk> - 2017-05-14 14:25 +0100
Re: What's wrong with "national health care"? rickman <gnuarm@gmail.com> - 2017-05-14 23:54 -0400
Re: What's wrong with "national health care"? Tom Gardner <spamjunk@blueyonder.co.uk> - 2017-05-15 09:09 +0100
Re: What's wrong with "national health care"? rickman <gnuarm@gmail.com> - 2017-05-17 18:43 -0400
Re: What's wrong with "national health care"? Tom Gardner <spamjunk@blueyonder.co.uk> - 2017-05-18 00:05 +0100
Re: What's wrong with "national health care"? bill.sloman@ieee.org - 2017-05-13 19:30 -0700
Re: What's wrong with "national health care"? John Robertson <spam@flippers.com> - 2017-05-13 16:32 -0700
Re: What's wrong with "national health care"? Don Y <blockedofcourse@foo.invalid> - 2017-05-13 17:00 -0700
Re: What's wrong with "national health care"? tabbypurr@gmail.com - 2017-05-13 16:39 -0700
Re: What's wrong with "national health care"? Don Y <blockedofcourse@foo.invalid> - 2017-05-13 17:18 -0700
Re: What's wrong with "national health care"? tabbypurr@gmail.com - 2017-05-13 17:31 -0700
Re: What's wrong with "national health care"? Don Y <blockedofcourse@foo.invalid> - 2017-05-13 17:36 -0700
Re: What's wrong with "national health care"? krw@notreal.com - 2017-05-13 20:58 -0400
Re: What's wrong with "national health care"? rickman <gnuarm@gmail.com> - 2017-05-13 21:40 -0400
Re: What's wrong with "national health care"? tabbypurr@gmail.com - 2017-05-15 12:58 -0700
Re: What's wrong with "national health care"? rickman <gnuarm@gmail.com> - 2017-05-13 21:35 -0400
Re: What's wrong with "national health care"? tabbypurr@gmail.com - 2017-05-15 13:17 -0700
Re: What's wrong with "national health care"? bill.sloman@ieee.org - 2017-05-15 19:04 -0700
Re: What's wrong with "national health care"? tabbypurr@gmail.com - 2017-05-16 09:27 -0700
Re: What's wrong with "national health care"? bill.sloman@ieee.org - 2017-05-16 19:49 -0700
Re: What's wrong with "national health care"? rickman <gnuarm@gmail.com> - 2017-05-13 21:27 -0400
Re: What's wrong with "national health care"? tabbypurr@gmail.com - 2017-05-15 13:13 -0700
Re: What's wrong with "national health care"? bill.sloman@ieee.org - 2017-05-15 18:53 -0700
Re: What's wrong with "national health care"? tabbypurr@gmail.com - 2017-05-16 09:16 -0700
Re: What's wrong with "national health care"? bill.sloman@ieee.org - 2017-05-16 19:43 -0700
Re: What's wrong with "national health care"? rickman <gnuarm@gmail.com> - 2017-05-17 18:52 -0400
Re: What's wrong with "national health care"? bill.sloman@ieee.org - 2017-05-17 18:23 -0700
Re: What's wrong with "national health care"? Martin Brown <'''newspam'''@nezumi.demon.co.uk> - 2017-05-19 09:59 +0100
Re: What's wrong with "national health care"? rickman <gnuarm@gmail.com> - 2017-05-17 18:47 -0400
Re: What's wrong with "national health care"? Martin Riddle <martin_ridd@verizon.net> - 2017-05-13 20:06 -0400
Re: What's wrong with "national health care"? mrdarrett@gmail.com - 2017-05-17 12:53 -0700
Re: What's wrong with "national health care"? Clifford Heath <clifford.heath@gmail.com> - 2017-05-14 13:33 +1000
Re: What's wrong with "national health care"? rickman <gnuarm@gmail.com> - 2017-05-13 23:53 -0400
Re: What's wrong with "national health care"? krw@notreal.com - 2017-05-14 00:11 -0400
Re: What's wrong with "national health care"? tabbypurr@gmail.com - 2017-05-15 13:24 -0700
Re: What's wrong with "national health care"? krw@notreal.com - 2017-05-15 20:39 -0400
Re: What's wrong with "national health care"? bill.sloman@ieee.org - 2017-05-15 19:16 -0700
Re: What's wrong with "national health care"? tabbypurr@gmail.com - 2017-05-16 09:29 -0700
Re: What's wrong with "national health care"? rickman <gnuarm@gmail.com> - 2017-05-17 18:58 -0400
Re: What's wrong with "national health care"? bill.sloman@ieee.org - 2017-05-13 21:04 -0700
Re: What's wrong with "national health care"? krw@notreal.com - 2017-05-14 00:10 -0400
Re: What's wrong with "national health care"? Clifford Heath <clifford.heath@gmail.com> - 2017-05-14 14:29 +1000
Re: What's wrong with "national health care"? rickman <gnuarm@gmail.com> - 2017-05-14 00:48 -0400
Re: What's wrong with "national health care"? Phil Allison <pallison49@gmail.com> - 2017-05-14 00:13 -0700
Re: What's wrong with "national health care"? krw@notreal.com - 2017-05-14 18:10 -0400
Re: What's wrong with "national health care"? bitrex <bitrex@de.lete.earthlink.net> - 2017-05-18 09:44 -0400
Re: What's wrong with "national health care"? krw@notreal.com - 2017-05-18 12:34 -0400
Re: What's wrong with "national health care"? bitrex <bitrex@de.lete.earthlink.net> - 2017-05-18 09:34 -0400
Re: What's wrong with "national health care"? Lasse Langwadt Christensen <langwadt@fonz.dk> - 2017-05-18 09:03 -0700
Re: What's wrong with "national health care"? krw@notreal.com - 2017-05-18 12:36 -0400
Re: What's wrong with "national health care"? rickman <gnuarm@gmail.com> - 2017-05-18 14:12 -0400
Re: What's wrong with "national health care"? Lasse Langwadt Christensen <langwadt@fonz.dk> - 2017-05-18 14:36 -0700
Re: What's wrong with "national health care"? krw@notreal.com - 2017-05-18 17:43 -0400
Re: What's wrong with "national health care"? bitrex <bitrex@de.lete.earthlink.net> - 2017-05-18 18:01 -0400
Re: What's wrong with "national health care"? Lasse Langwadt Christensen <langwadt@fonz.dk> - 2017-05-18 15:18 -0700
Re: What's wrong with "national health care"? bitrex <bitrex@de.lete.earthlink.net> - 2017-05-18 19:39 -0400
Re: What's wrong with "national health care"? rickman <gnuarm@gmail.com> - 2017-05-18 21:26 -0400
Re: What's wrong with "national health care"? David Brown <david.brown@hesbynett.no> - 2017-05-19 09:22 +0200
Re: What's wrong with "national health care"? rickman <gnuarm@gmail.com> - 2017-05-19 13:37 -0400
Re: What's wrong with "national health care"? krw@notreal.com - 2017-05-19 17:51 -0400
Re: What's wrong with "national health care"? David Brown <david.brown@hesbynett.no> - 2017-05-22 11:30 +0200
Re: What's wrong with "national health care"? rickman <gnuarm@gmail.com> - 2017-05-22 12:32 -0400
Re: What's wrong with "national health care"? David Brown <david.brown@hesbynett.no> - 2017-05-23 10:58 +0200
Re: What's wrong with "national health care"? rickman <gnuarm@gmail.com> - 2017-05-23 17:09 -0400
Re: What's wrong with "national health care"? Lasse Langwadt Christensen <langwadt@fonz.dk> - 2017-05-23 14:30 -0700
Re: What's wrong with "national health care"? David Brown <david.brown@hesbynett.no> - 2017-05-24 13:30 +0200
Re: What's wrong with "national health care"? rickman <gnuarm@gmail.com> - 2017-05-24 13:01 -0400
Re: What's wrong with "national health care"? David Brown <david.brown@hesbynett.no> - 2017-05-26 15:43 +0200
Re: What's wrong with "national health care"? rickman <gnuarm@gmail.com> - 2017-05-18 21:13 -0400
Re: What's wrong with "national health care"? Clifford Heath <no.spam@please.net> - 2017-05-19 07:50 +1000
Re: What's wrong with "national health care"? krw@notreal.com - 2017-05-18 20:03 -0400
Re: What's wrong with "national health care"? Phil Allison <pallison49@gmail.com> - 2017-05-13 20:39 -0700
Re: What's wrong with "national health care"? Rheilly Phoull <rheilly@bigslong.com> - 2017-05-14 12:19 +0800
Re: What's wrong with "national health care"? bill.sloman@ieee.org - 2017-05-13 22:08 -0700
Re: What's wrong with "national health care"? Phil Allison <pallison49@gmail.com> - 2017-05-13 22:20 -0700
Re: What's wrong with "national health care"? bitrex <bitrex@de.lete.earthlink.net> - 2017-05-18 18:10 -0400
Re: What's wrong with "national health care"? rickman <gnuarm@gmail.com> - 2017-05-18 21:31 -0400
Re: What's wrong with "national health care"? Martin Brown <'''newspam'''@nezumi.demon.co.uk> - 2017-05-14 10:28 +0100
Re: What's wrong with "national health care"? Tom Gardner <spamjunk@blueyonder.co.uk> - 2017-05-14 10:53 +0100
Re: What's wrong with "national health care"? Don Y <blockedofcourse@foo.invalid> - 2017-05-16 12:30 -0700
Re: What's wrong with "national health care"? rickman <gnuarm@gmail.com> - 2017-05-17 19:17 -0400
Re: What's wrong with "national health care"? Martin Brown <'''newspam'''@nezumi.demon.co.uk> - 2017-05-19 11:49 +0100
Re: What's wrong with "national health care"? Don Y <blockedofcourse@foo.invalid> - 2017-05-19 12:56 -0700
Re: What's wrong with "national health care"? krw@notreal.com - 2017-05-19 18:05 -0400
Re: What's wrong with "national health care"? Martin Brown <'''newspam'''@nezumi.demon.co.uk> - 2017-05-20 08:36 +0100
Re: What's wrong with "national health care"? Don Y <blockedofcourse@foo.invalid> - 2017-05-20 15:58 -0700
Re: What's wrong with "national health care"? Martin Brown <'''newspam'''@nezumi.demon.co.uk> - 2017-05-23 10:21 +0100
Re: What's wrong with "national health care"? Don Y <blockedofcourse@foo.invalid> - 2017-05-23 13:26 -0700
Re: What's wrong with "national health care"? rickman <gnuarm@gmail.com> - 2017-05-23 17:41 -0400
Re: What's wrong with "national health care"? Clifford Heath <no.spam@please.net> - 2017-05-24 08:37 +1000
Re: What's wrong with "national health care"? rickman <gnuarm@gmail.com> - 2017-05-24 00:45 -0400
Re: What's wrong with "national health care"? krw@notreal.com - 2017-05-23 18:52 -0400
Re: What's wrong with "national health care"? Don Y <blockedofcourse@foo.invalid> - 2017-05-15 00:52 -0700
Re: What's wrong with "national health care"? Tom Gardner <spamjunk@blueyonder.co.uk> - 2017-05-15 15:16 +0100
Re: What's wrong with "national health care"? Don Y <blockedofcourse@foo.invalid> - 2017-05-15 08:08 -0700
Re: What's wrong with "national health care"? tabbypurr@gmail.com - 2017-05-15 13:33 -0700
Re: What's wrong with "national health care"? Martin Brown <'''newspam'''@nezumi.demon.co.uk> - 2017-05-19 09:50 +0100
Re: What's wrong with "national health care"? rickman <gnuarm@gmail.com> - 2017-05-16 01:32 -0400
Re: What's wrong with "national health care"? Tom Gardner <spamjunk@blueyonder.co.uk> - 2017-05-16 08:05 +0100
Re: What's wrong with "national health care"? rickman <gnuarm@gmail.com> - 2017-05-17 19:19 -0400
Re: What's wrong with "national health care"? Spehro Pefhany <speffSNIP@interlogDOTyou.knowwhat> - 2017-05-25 08:57 -0400
Re: What's wrong with "national health care"? rickman <gnuarm@gmail.com> - 2017-05-25 11:49 -0400
Re: What's wrong with "national health care"? Tom Gardner <spamjunk@blueyonder.co.uk> - 2017-05-25 18:04 +0100
Re: What's wrong with "national health care"? rickman <gnuarm@gmail.com> - 2017-05-25 13:15 -0400
Re: What's wrong with "national health care"? Martin Brown <'''newspam'''@nezumi.demon.co.uk> - 2017-05-26 09:15 +0100
Re: What's wrong with "national health care"? Tom Gardner <spamjunk@blueyonder.co.uk> - 2017-05-26 09:28 +0100
Re: What's wrong with "national health care"? rickman <gnuarm@gmail.com> - 2017-05-26 04:40 -0400
Re: What's wrong with "national health care"? dagmargoodboat@yahoo.com - 2017-05-31 06:19 -0700
Re: What's wrong with "national health care"? bill.sloman@ieee.org - 2017-05-31 18:08 -0700
Re: What's wrong with "national health care"? krw@notreal.com - 2017-05-25 18:30 -0400
Re: What's wrong with "national health care"? Don Y <blockedofcourse@foo.invalid> - 2017-05-25 13:15 -0700
Re: What's wrong with "national health care"? Martin Brown <'''newspam'''@nezumi.demon.co.uk> - 2017-05-26 09:54 +0100
Re: What's wrong with "national health care"? Don Y <blockedofcourse@foo.invalid> - 2017-05-26 12:23 -0700
Re: What's wrong with "national health care"? Lasse Langwadt Christensen <langwadt@fonz.dk> - 2017-05-26 13:44 -0700
Re: What's wrong with "national health care"? Don Y <blockedofcourse@foo.invalid> - 2017-05-26 13:47 -0700
Re: What's wrong with "national health care"? Jasen Betts <jasen@xnet.co.nz> - 2017-06-24 00:18 +0000
Re: What's wrong with "national health care"? Jasen Betts <jasen@xnet.co.nz> - 2017-06-24 00:24 +0000
Re: What's wrong with "national health care"? Don Y <blockedofcourse@foo.invalid> - 2017-06-24 09:20 -0700
Re: What's wrong with "national health care"? rickman <gnuarm@gmail.com> - 2017-06-24 12:38 -0400
Re: What's wrong with "national health care"? Lasse Langwadt Christensen <langwadt@fonz.dk> - 2017-06-24 12:11 -0700
Re: What's wrong with "national health care"? Don Y <blockedofcourse@foo.invalid> - 2017-06-24 13:04 -0700
Re: What's wrong with "national health care"? Martin Brown <'''newspam'''@nezumi.demon.co.uk> - 2017-06-29 14:20 +0100
Re: What's wrong with "national health care"? Don Y <blockedofcourse@foo.invalid> - 2017-06-29 15:37 -0700
Re: What's wrong with "national health care"? Martin Brown <'''newspam'''@nezumi.demon.co.uk> - 2017-06-30 11:05 +0100
Re: What's wrong with "national health care"? Don Y <blockedofcourse@foo.invalid> - 2017-06-30 08:13 -0700
Re: What's wrong with "national health care"? krw@notreal.com - 2017-06-30 12:26 -0400
Re: What's wrong with "national health care"? bill.sloman@ieee.org - 2017-06-30 03:43 -0700
Re: What's wrong with "national health care"? rickman <gnuarm@gmail.com> - 2017-05-26 21:07 -0400
Re: What's wrong with "national health care"? Lasse Langwadt Christensen <langwadt@fonz.dk> - 2017-05-26 18:59 -0700
Re: What's wrong with "national health care"? krw@notreal.com - 2017-05-26 22:17 -0400
Re: What's wrong with "national health care"? Martin Brown <'''newspam'''@nezumi.demon.co.uk> - 2017-05-27 09:37 +0100
Re: What's wrong with "national health care"? krw@notreal.com - 2017-05-27 09:30 -0400
Re: What's wrong with "national health care"? bill.sloman@ieee.org - 2017-05-27 18:23 -0700
Re: What's wrong with "national health care"? Spehro Pefhany <speffSNIP@interlogDOTyou.knowwhat> - 2017-05-26 08:47 -0400
Re: What's wrong with "national health care"? Don Y <blockedofcourse@foo.invalid> - 2017-05-26 13:43 -0700
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| From | Lasse Langwadt Christensen <langwadt@fonz.dk> |
|---|---|
| Date | 2017-05-24 16:11 -0700 |
| Message-ID | <6ecaf988-ccd6-4419-91d9-ee0cd204032a@googlegroups.com> |
| In reply to | #461589 |
Den torsdag den 25. maj 2017 kl. 00.12.22 UTC+2 skrev k...@notreal.com: > On Wed, 24 May 2017 12:37:44 -0400, rickman <gnuarm@gmail.com> wrote: > > >David Brown wrote: > >> On 23/05/17 22:49, rickman wrote: > >>> Tom Gardner wrote: > >> > >>>> With private health insurance there will be all > >>>> sorts of justifications required, form filling, > >>>> making payments, reclaiming payments and other > >>>> paperwork that the /patient/ has to do. That's an > >>>> unnecessary "bother". > >>>> > >>>> With the NHS the patient misses all that corporate > >>>> fun and games. > >>> > >>> Ok, now that is clear. I'm not a mind reader. This is not how it works > >>> in the US, so I would have no way of knowing the onus is on the patient > >>> to collect from the insurance company. In the US the doctor's office > >>> takes responsibility to file the paperwork with the insurance company > >>> because it is nearly impossible for a patient to do. Ultimately it is > >>> the patient's responsibility to pay, but the insurance company helps > >>> with that by imposing maximum charges as long as the provider is > >>> participating. Also insurance typically has copayments and deductibles > >>> up to some out of pocket maximum. That is still something you have not > >>> mentioned so I have to assume in the UK private insurance doesn't have > >>> copays and deductibles since you didn't mention them. Or is that > >>> something else you forgot to mention under the heading of "bother"? > >>> > >> > >> One thing you have to distinguish here is private health care, and heath > >> insurance (for health care, rather than as a part of a normal life > >> insurance). Health insurance is rare in the UK, and almost always paid > >> for by employers for the employer's benefit, not the employee's benefit. > >> > >> As has already been pointed out, most /treatments/ are handled by the > >> NHS regardless of whether or not the patient is "private". The > >> "private" bit typically covers tests and scans, consultations, and > >> recovery. (And as has been said, the quality of care in recovery is not > >> the same - if something goes wrong, you are much better off in a real > >> hospital than a private clinic.) > >> > >> For a lot of what is covered by health insurance, your choice is to go > >> NHS and get things free at your local doctor or hospital, or go private > >> and deal with paperwork in order to get it "free". It is an extra fuss, > >> and one that many people are happy to avoid. > >> > >> Here in Norway, I have never heard of health insurance. It may exist, > >> but must be very rare. We do have private health clinics, but they are > >> mostly of three types: > >> > >> 1. Scanning (ultrasound, X-ray, etc.) and testing facilities. You can > >> get scans done yourself if you want to, and perhaps get them done sooner > >> than in the hospitals - you would pay for that yourself. > > > >Here in the US you can't even get a test done without an order by a > >doctor. Heck, I've had tests done and they wouldn't give me the > >results! They say I need to get them from the doctor. > > That makes some sense. There is a lot of interpretation that goes > with most tests. Playing doctor on the Internet isn't smart. However, > doctors should share everything with you. If not, fire the doctor and > find one that will. Most the results of tests I've had are posted on > line, though some that I'd rather were, aren't. Any images aren't, > though. here patients have access to everything by law, I think it has been the topic of some debate because some fear it might mean doctors and nurses won't write everything down, knowing the patient might read it and get offended -Lasse
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| From | krw@notreal.com |
|---|---|
| Date | 2017-05-24 19:49 -0400 |
| Message-ID | <ll6cic1cv6b18asaog41fh7jt71m3nr0ut@4ax.com> |
| In reply to | #461596 |
On Wed, 24 May 2017 16:11:18 -0700 (PDT), Lasse Langwadt Christensen <langwadt@fonz.dk> wrote: >Den torsdag den 25. maj 2017 kl. 00.12.22 UTC+2 skrev k...@notreal.com: >> On Wed, 24 May 2017 12:37:44 -0400, rickman <gnuarm@gmail.com> wrote: >> >> >David Brown wrote: >> >> On 23/05/17 22:49, rickman wrote: >> >>> Tom Gardner wrote: >> >> >> >>>> With private health insurance there will be all >> >>>> sorts of justifications required, form filling, >> >>>> making payments, reclaiming payments and other >> >>>> paperwork that the /patient/ has to do. That's an >> >>>> unnecessary "bother". >> >>>> >> >>>> With the NHS the patient misses all that corporate >> >>>> fun and games. >> >>> >> >>> Ok, now that is clear. I'm not a mind reader. This is not how it works >> >>> in the US, so I would have no way of knowing the onus is on the patient >> >>> to collect from the insurance company. In the US the doctor's office >> >>> takes responsibility to file the paperwork with the insurance company >> >>> because it is nearly impossible for a patient to do. Ultimately it is >> >>> the patient's responsibility to pay, but the insurance company helps >> >>> with that by imposing maximum charges as long as the provider is >> >>> participating. Also insurance typically has copayments and deductibles >> >>> up to some out of pocket maximum. That is still something you have not >> >>> mentioned so I have to assume in the UK private insurance doesn't have >> >>> copays and deductibles since you didn't mention them. Or is that >> >>> something else you forgot to mention under the heading of "bother"? >> >>> >> >> >> >> One thing you have to distinguish here is private health care, and heath >> >> insurance (for health care, rather than as a part of a normal life >> >> insurance). Health insurance is rare in the UK, and almost always paid >> >> for by employers for the employer's benefit, not the employee's benefit. >> >> >> >> As has already been pointed out, most /treatments/ are handled by the >> >> NHS regardless of whether or not the patient is "private". The >> >> "private" bit typically covers tests and scans, consultations, and >> >> recovery. (And as has been said, the quality of care in recovery is not >> >> the same - if something goes wrong, you are much better off in a real >> >> hospital than a private clinic.) >> >> >> >> For a lot of what is covered by health insurance, your choice is to go >> >> NHS and get things free at your local doctor or hospital, or go private >> >> and deal with paperwork in order to get it "free". It is an extra fuss, >> >> and one that many people are happy to avoid. >> >> >> >> Here in Norway, I have never heard of health insurance. It may exist, >> >> but must be very rare. We do have private health clinics, but they are >> >> mostly of three types: >> >> >> >> 1. Scanning (ultrasound, X-ray, etc.) and testing facilities. You can >> >> get scans done yourself if you want to, and perhaps get them done sooner >> >> than in the hospitals - you would pay for that yourself. >> > >> >Here in the US you can't even get a test done without an order by a >> >doctor. Heck, I've had tests done and they wouldn't give me the >> >results! They say I need to get them from the doctor. >> >> That makes some sense. There is a lot of interpretation that goes >> with most tests. Playing doctor on the Internet isn't smart. However, >> doctors should share everything with you. If not, fire the doctor and >> find one that will. Most the results of tests I've had are posted on >> line, though some that I'd rather were, aren't. Any images aren't, >> though. > >here patients have access to everything by law, I think it has been the >topic of some debate because some fear it might mean doctors and nurses >won't write everything down, knowing the patient might read it and get >offended Oh, I have access to it. I just have to ask my doctor for it. I don't get blood test results, for instance, until I've seen him but they're posted online after. I'm given a copy of what my doctors do write down (sometimes by dead tree but always online).
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| From | David Brown <david.brown@hesbynett.no> |
|---|---|
| Date | 2017-05-26 15:41 +0200 |
| Message-ID | <og9b3i$ljv$1@dont-email.me> |
| In reply to | #461556 |
On 24/05/17 18:37, rickman wrote: > David Brown wrote: >> On 23/05/17 22:49, rickman wrote: >>> Tom Gardner wrote: >> >>>> With private health insurance there will be all >>>> sorts of justifications required, form filling, >>>> making payments, reclaiming payments and other >>>> paperwork that the /patient/ has to do. That's an >>>> unnecessary "bother". >>>> >>>> With the NHS the patient misses all that corporate >>>> fun and games. >>> >>> Ok, now that is clear. I'm not a mind reader. This is not how it works >>> in the US, so I would have no way of knowing the onus is on the patient >>> to collect from the insurance company. In the US the doctor's office >>> takes responsibility to file the paperwork with the insurance company >>> because it is nearly impossible for a patient to do. Ultimately it is >>> the patient's responsibility to pay, but the insurance company helps >>> with that by imposing maximum charges as long as the provider is >>> participating. Also insurance typically has copayments and deductibles >>> up to some out of pocket maximum. That is still something you have not >>> mentioned so I have to assume in the UK private insurance doesn't have >>> copays and deductibles since you didn't mention them. Or is that >>> something else you forgot to mention under the heading of "bother"? >>> >> >> One thing you have to distinguish here is private health care, and heath >> insurance (for health care, rather than as a part of a normal life >> insurance). Health insurance is rare in the UK, and almost always paid >> for by employers for the employer's benefit, not the employee's benefit. >> >> As has already been pointed out, most /treatments/ are handled by the >> NHS regardless of whether or not the patient is "private". The >> "private" bit typically covers tests and scans, consultations, and >> recovery. (And as has been said, the quality of care in recovery is not >> the same - if something goes wrong, you are much better off in a real >> hospital than a private clinic.) >> >> For a lot of what is covered by health insurance, your choice is to go >> NHS and get things free at your local doctor or hospital, or go private >> and deal with paperwork in order to get it "free". It is an extra fuss, >> and one that many people are happy to avoid. >> >> Here in Norway, I have never heard of health insurance. It may exist, >> but must be very rare. We do have private health clinics, but they are >> mostly of three types: >> >> 1. Scanning (ultrasound, X-ray, etc.) and testing facilities. You can >> get scans done yourself if you want to, and perhaps get them done sooner >> than in the hospitals - you would pay for that yourself. > > Here in the US you can't even get a test done without an order by a > doctor. Heck, I've had tests done and they wouldn't give me the > results! They say I need to get them from the doctor. I have never had occasion to want to get tests done privately, so I am not aware of the details. But I expect you do them through a private doctor or other suitably qualified person. > > >> But usually >> they process work on behalf of public doctors, hospitals or other public >> bodies (like chest X-rays for immigrants to rule out tuberculosis). Out >> patients can be scanned in these private facilities, and reduce pressure >> on the in-house hospital facilities. As a patient, you just turn up and >> get your scan - you don't handle payments or insurance of any sort. > > This is not entirely clear. Are you saying the private facilities will > perform tests that are paid for by the NHS in Norway? Is that what you > call it, same as in Brittan? It is just the "health service" here, but it basically the same thing as the NHS in Britain. And yes, private facilities will perform services for the Norwegian NHS. This applies to a range of services, not just scanning. For example, physiotherapists outside of hospitals are often private. You can go there, and ask for help with some exercises or whatever, and (assuming they have the time - most physiotherapists are heavily booked up) they will take your money and give you what help they can. Alternatively, you can go to your NHS doctor and say "I've got a sore back", and have the doctor refer you to a physiotherapist - in which case, the NHS pays the physiotherapist for your treatment and you never even see a bill or hear the price. In practice, the vast majority of the private physiotherapist's custom comes this way - only rarely will someone go directly rather than go via their doctor. And many general practitioners are also technically "private". Rather than being employed by the public health service (or the municipality), they are self-employed or part-owners with other GP's in a private practice. But you don't pay them directly - the NHS pays them to treat patients. It is not at all uncommon to have private GP's hiring rooms and facilities at a health centre alongside NHS employed GP's, and as far as patients are concerned the service is the same - they are not aware of any difference. I suppose some doctors prefer the stability of being employed, while others prefer the flexibility of being self-employed. > > >> 2. Elective or cosmetic surgery - corrective eye surgery, nose jobs, >> etc. You pay for these yourself. >> >> 3. Specialist outpatient surgery. Again, you will usually be referred >> there by a public doctor or hospital, and you see nothing of the costs >> or payments. > >
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| From | krw@notreal.com |
|---|---|
| Date | 2017-05-23 18:44 -0400 |
| Message-ID | <qhe9ict6g162j4m0mlfp8m8l3bjdo7ga39@4ax.com> |
| In reply to | #461382 |
On Tue, 23 May 2017 17:44:36 +0100, Tom Gardner <spamjunk@blueyonder.co.uk> wrote: >On 23/05/17 17:19, rickman wrote: >> Martin Brown wrote: >>> On 19/05/2017 18:31, rickman wrote: >>>> On 5/19/2017 4:13 AM, Martin Brown wrote: >>>>> On 17/05/2017 15:19, rickman wrote: >>>>>> On 5/14/2017 1:02 PM, Tom Gardner wrote: >>>>>>> On 14/05/17 17:04, Don Y wrote: >>>>>>> >>>>>>>> Is "private health insurance" a sort of "coinsurance"? E.g., the NHS >>>>>>>> is billed for the "basic" care you might receive and the private >>>>>>>> insurance >>>>>>>> picks up the costs that aren't covered by the NHS? I.e., can a >>>>>>>> hospital >>>>>>>> stay result in THREE bills being issued: >>>>>>>> - to the NHS for "basic services" >>>>>>>> - to the private insurer for services above those >>>>>>>> - to the patient for services "not covered" >>>>>>> >>>>>>> It is not co-insurance. All sane people use private >>>>>>> health insurance as a "top up", relying on the NHS >>>>>>> for all basic important services. The insurance clauses >>>>>>> often reflect that. >>>>>> >>>>>> I don't follow. What is an insurance "top up"? Are there things >>>>>> private insurance pays for that NHS doesn't? If not, why would you >>>>>> need >>>>>> private insurance at all since NHS is free? >>>>> >>>>> NHS treatment doesn't normally include gratuitous cosmetic surgery like >>>>> face lifts, breast enhancements and nose jobs unless there is a genuine >>>>> medical need for it. It you want something that isn't truly health >>>>> related but is a medical procedure then you would have to go privately. >>>> >>>> Are you saying insurance in the UK covers cosmetic procedures? It >>>> typically doesn't in the US. >>> >>> No. I am saying that cosmetic procedures are generally only available >>> privately in the private hospitals. >>> >>>>>>> Few people have their own private health insurance; >>>>>>> companies can offer it as a "perk", but that's because >>>>>>> the companies would like to be able to schedule healthcare >>>>>>> appointments around the employee's work schedule. >>>>>> >>>>>> Above you say "all sane people use private health insurance", then here >>>>>> you say few people have it. Are you saying most people are not sane? >>>>> >>>>> It is a perk of having a large corporate employer, but the NHS is plenty >>>>> good enough so that unless you want to queue jump or pick an exact date >>>>> for surgery to suit a busy schedule it isn't worthwhile. You might well >>>>> even have the same surgeon which ever way you go but with a higher trim >>>>> level of room comforts and food in the private sector. >>>> >>>> No one is explaining this clearly. I get that private insurance and >>>> care has advantages. If you have the insurance, why would anyone use >>>> the NHS? If you don't have insurance paid for you, why would you bother >>>> with the high cost of insurance if you can get the same things through >>>> NHS? >>> >>> Because the NHS does a sufficiently good job that even people with >>> company health insurance seldom bother to use it to get treatment. The >>> exception is for cancer treatment where the NHS 8-10 week wait can be >>> shortened to about 2 weeks by using private medicine. >>> >>> The main difference is a higher trim level room and a more personalised >>> service with control of timing to fit in with a busy schedule. NHS give >>> you a date that they will do the procedure privately you get to choose. >>> >>>>>>>> What's to stop >>>>>>>> a new provider coming to town and eating into the "market" of an >>>>>>>> established >>>>>>>> provider? etc. >>>>>>> >>>>>>> Nothing. Cherry-picking happens; sometimes the >>>>>>> contracts are "handed back" to the NHS when the >>>>>>> over-optimistic prices mean the private sector >>>>>>> can't make a profit. >>>>>>> >>>>>>> Cherry-picking makes the rest of the NHS look >>>>>>> more expensive, which is then used as ammunition >>>>>>> for breaking up the "too expensive" NHS. >>>>>> >>>>>> I assume you are talking about doctors and not hospitals. Here a >>>>>> hospital can only be built with approval from the regulators. They >>>>>> specifically want to prevent oversupply and I suppose undersupply as >>>>>> well although they can't make anyone build a hospital. >>>>> >>>>> No. A private sector provider can move in and do only the most highly >>>>> profitable simplest eye surgery leaving all the expensive technically >>>>> challenging operations to the NHS and throwing any of their failures >>>>> back over the wall to be repaired by the NHS at great expense. >>>>> >>>>> https://www.theguardian.com/society/2014/aug/14/nhs-eye-operations-private-provider-musgrove >>>>> >>>>> >>>>> >>>>> As a concrete example of the sort of thing that happens when >>>>> opportunistic private sector cherry pickers make a mess. >>>> >>>> Whatever. This conversation is going nowhere. >>> >>> Your problem. You seem unable to comprehend the English language. >> >> Your post is a perfect example of the self contradiction I'm talking about. You >> say "Because the NHS does a sufficiently good job that even people with company >> health insurance seldom bother to use it to get treatment." indicating there is >> something about using insurance that is a "bother" without saying what it is. >> But then you say, "The main difference is a higher trim level room and a more >> personalised service with control of timing to fit in with a busy schedule." So >> where is the "bother" of using the private insurance and care? >> >> Instead of providing information your post tosses some comments out there that >> are poorly thought out and don't convey the meaning you think they do. > >Again, a failure of the imagination on your part. FWIW, imagination has nothing to do with communication, or at least shouldn't have. This is one place that I'll have to agree with Rick. I've been following along but haven't understood your point at all. >With private health insurance there will be all >sorts of justifications required, form filling, >making payments, reclaiming payments and other >paperwork that the /patient/ has to do. That's an >unnecessary "bother". ...and you think the US system is backwards. >With the NHS the patient misses all that corporate >fun and games. Gee, with my insurance company I miss all those fun and games, too. No thanks! I like my insurance and I want to keep it, no matter what the Obamaites might prefer.
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| From | Martin Brown <'''newspam'''@nezumi.demon.co.uk> |
|---|---|
| Date | 2017-05-14 18:18 +0100 |
| Message-ID | <ofa3gi$fdq$1@gioia.aioe.org> |
| In reply to | #460241 |
On 14/05/2017 17:04, Don Y wrote: > On 5/14/2017 7:56 AM, Martin Brown wrote: >> On 14/05/2017 01:11, Don Y wrote: >>> On 5/13/2017 4:34 PM, Tom Gardner wrote: >>>>> And, which country are you reporting from? >>>> >>>> A variant of the UK, distorted through the lens of >>>> the Daily Sexpress, the Daily Wail, prejudice and >>>> trollery. >>> >>> You're in England, Tom? Can (while you're still a member of the EU) >>> a Frenchman (or other EU citizen) receive care at your NHS? Or, >>> only Brits (et al.)? >> >> Any EU citizen. But you have to be aware that not all national health >> services >> are alike. ISTR Spain's dosn't include food. When I lived in Belgium >> we were >> covered by the EU health insurance scheme (as well as private corporate >> insurance). You can get an EHIC to prove eligibility: >> >> https://www.gov.uk/european-health-insurance-card >> >> And it is free - though there are plenty of private enterprise squatting >> websites sat in the adverts on likely Google searches who will charge >> you (much >> like there are for getting a US Visa waiver) > > Yes, though (per Tom), there doesn't appear to be much "shopping around" > for the best *place* to receive your care. There isn't. At least not unless your condition is so serious and unusual that major city hospitals lack expertise in it. This applied to a friend from Manchester who was shipped to Addenbrokes in Cambridge for a liver transplant after catching hepatitis in a football match. Sadly even their expertise was insufficient to prevent his demise. Likewise in the early days of heart transplants almost all of them were done at Papworth where the first UK procedure was done. https://en.wikipedia.org/wiki/Papworth_Hospital > > E.g., here, we (if responsible, self-interested consumers) typically > do some research into our selection of PCP, specialists, etc. A friend > spent the better part of a year looking for his orthopaedic surgeon. > Had that MD left the "plan" that was providing my friend's coverage > *or* had my friend left (or been forced from) that plan, there is > a chance that the collection of surgeons from which he could choose > would change. And, no guarantee that the "new" surgeon would want him > as a patient (in the time frame that he wanted/needed). If you choose to go privately then you can shop around but then you are restricted to those surgeons who do private work. There are plenty of excellent surgeons who work almost entirely for the NHS. > > Engaging an ultra liberal friend in a discussion of universal health > care, I asked him what LIMITS would apply to the care dispensed. The most rational one is that the procedures done should have a better than evens chance of improving the life quality and duration of the patient. No point in extending life at the expense of massive invasive surgery from which there is a negligible chance of recovery. > His reply, "None"! (WTF? There can be limitless NEED for health > care; surely you can't expect to meet it ALL?!). When I suggested > that folks "from the other side of the tracks" would likely want to > avail themselves of the specialists that he uses (doctors practice > where they want to LIVE; few voluntarily venture into places that > aren't appealing, personally), he was indignant -- realizing that > this would increase HIS wait time when needing to access that > specialist: "No, they should use doctors where THEY live!" This is a bit of a puzzle. There are a few run down places in the UK now where GP's are retiring and the NHS deal is insufficiently good for new graduates to want to take up the vacant posts. But even the poorest areas have GP surgeries (though the doctors don't live in them). > Hmmm... but aren't all (similar) doctors paid the same by the same > payer? Why wouldn't a patient want to travel to the best doctor > qualified to handle his particular condition?? You presuppose that there is a single best doctor. If the whole system is to work you want a doctor who is sufficiently good to be able to do the job well enough. Plenty of common procedures do not need wizard skills to do them. And in the NHS when such skills are required the system automatically routes patients to doctors/surgeons with the right skill levels. No system is perfect but from what I have seen it is very good at matching condition to appropriately skilled surgeon (indeed better than the private sector in that respect). > Surely, there must be some variation in the quality of care > from (EU) country to country or (UK) community to community. > Why wouldn't I want to shop around and get treated by the > cardiologist in Liverpool instead of the local guy in Manchester? > "Heck, I'm willing to make the drive..." Iff the right cardiologist or more likely paedeotrician was in Liverpool or Newcastle and the condition required it then that is what happens. Same with helicopter evacuation to get there (some of which is done by a charity). >> What it doesn't cover are things like repatriation and the small print >> about > > "Repatriation"? If you are in a foreign country and seriously ill you can't expect them to pay for you to be moved back to the UK. > >> what you must pay for and what is chargeable in each country. You may >> not get >> English speaking doctors - need travel insurance for that. >> >> It may well stop when Brexit goes horribly pear shaped. > > Why? Because Brits would want to retain access to foreign providers? At present we have access to EU healthcare when in the EU but after Brexit that may well cease. If I lived nearer the South coast I would be tempted to hop over the channel for some conditions where I know the Belgian health system is better than ours. >>> What about immigrants? Do they have to gain UK citizenship? >>> Do they have to reside in the country for a particular length >>> of time before being eligible for "full benefits" (whatever >>> that means)? Do they have to pay into the system for a minimum >>> length of time in order to qualify? >> >> Depends where they have come from and what status they have. >> Corporate expats tend to have private health insurance that goes with >> their job >> whereas students would invariably rely solely on the NHS. > > Is "private health insurance" a sort of "coinsurance"? E.g., the NHS No. It is a parallel private hospital system in the UK which provides the facilities up to and including full diagnostics and surgery for any surgeons who want to work privately for some of the time. It gives you a bit more flexibility to schedule operations for when you want them and a higher trim level single occupancy room. >> NHS isn't very good at billing non-UK patients unless they run up a >> huge bill >> the cost of invoicing and enforcement outweighs the gains. > > So, no "stick" to discourage that abuse? Couldn't the NHS "simply" > invoice the patient's "country of origin" and develop reciprocal > agreements to facilitate this? > "In the past 30 days, we provided THIS care to THESE citizens of yours > at a cost of X. We acknowledge that, in the same time period, you > provided care to some number of OUR citizens at a cost of Y (< X). > As such, the outstanding balance is..." The number of such cases is small enough that it really isn't worth the effort. But in the interests of reciprocity I think the UK should make all visiting Americans buy ridiculously over priced medical insurance. >>> >>> What "buy in" does the public have regarding "apportionment of >>> resources"? I recall being in Manchester in ~`83 and hearing a >>> "panel" discussing health care dollars on BBC <n>. One of the >>> examples that stuck in my mind was: >>> >>> "Do we repair the 80 year old's broken hip or vaccinate N children?" >> >> They pose these questions on provocative talks shows but in practice >> the NHS >> had no problems at all mending my 90 y.o. mum's broken hip and she >> recovered >> from that pretty well. There is always a tension between what provides >> maximum >> benefit for society and individual needs. > > But where are the limits? I asked exactly that question of a fairly senior doctor when my mum was stuck in hospital and his answer was that she could stay for so long as she needed to be there and no suitable nursing care bed was available. The bean counter side of the system didn't like this and sent me a couple of stiff letters and I fried one particularly unfortunate social worker who really annoyed my with her lack of case knowledge - they are the people who are supposed to liasse hospital to care home/own home transfers for the frail and elderly. > > The fear mongers, here, tell us that universal health care will result in > rationing, death panels, people DYING because they have been denied care > (and, amusingly, acting as if none of these things happen with PRIVATE > health insurance!). There may be some rationing of insanely expensive new drugs that extend life by a couple of months as a concrete example. > > What mechanisms ensure that (NHS) coverage is available to everyone, > everywhere > for "every" need? What's to stop all the providers from settling in London > and its suburbs -- to the detriment of folks farther out? What's to stop > a new provider coming to town and eating into the "market" of an > established > provider? etc. There are a network of large conglomerates that cover several counties each. All major cities have a few big hospitals each but they are not in competition. Some have specialisations others are more general - you may have to travel upto 50 or 100 miles to the right one if your condition is rare or unusual (even further if it is ultra rare). > >>> Of course, if I'm 79, I have a lot different view of that question >>> than if I'm child-bearing age! >> >> Do many men get pregnant in the USA or is Don really Donna? >> https://www.creativereview.co.uk/saatchi-saatchis-pregnant-man-nativity/ > > One can be "of child bearing age" and still not "able to bear > children"! :> Males can beget children whilst quite old... -- Regards, Martin Brown
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| From | Tom Gardner <spamjunk@blueyonder.co.uk> |
|---|---|
| Date | 2017-05-14 18:54 +0100 |
| Message-ID | <KR0SA.54137$xr3.39400@fx43.am4> |
| In reply to | #460252 |
On 14/05/17 18:18, Martin Brown wrote: > On 14/05/2017 17:04, Don Y wrote: >> E.g., here, we (if responsible, self-interested consumers) typically >> do some research into our selection of PCP, specialists, etc. A friend >> spent the better part of a year looking for his orthopaedic surgeon. >> Had that MD left the "plan" that was providing my friend's coverage >> *or* had my friend left (or been forced from) that plan, there is >> a chance that the collection of surgeons from which he could choose >> would change. And, no guarantee that the "new" surgeon would want him >> as a patient (in the time frame that he wanted/needed). > > If you choose to go privately then you can shop around but then you are > restricted to those surgeons who do private work. There are plenty of excellent > surgeons who work almost entirely for the NHS. My family has experience of 4 serious operations (heart valve, prostate, spinal reconstruction, pyleostomy). All outcomes were optimal. For the last 3 we were able to choose the best surgeon. In *all* four cases we suggested "going private" since the surgeons also did private operations. In *all* four cases they recommended that we did not, and stayed in the NHS. Libertarians can't understand that the top-rate professionals repeatedly advised us *not* to put money into their pocket. They all thought it was better to remain (financially) poorer.
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| From | Don Y <blockedofcourse@foo.invalid> |
|---|---|
| Date | 2017-05-14 23:00 -0700 |
| Message-ID | <ofbfvo$18j$1@dont-email.me> |
| In reply to | #460256 |
On 5/14/2017 10:54 AM, Tom Gardner wrote: > On 14/05/17 18:18, Martin Brown wrote: >> If you choose to go privately then you can shop around but then you are >> restricted to those surgeons who do private work. There are plenty of excellent >> surgeons who work almost entirely for the NHS. > > My family has experience of 4 serious operations > (heart valve, prostate, spinal reconstruction, > pyleostomy). All outcomes were optimal. For the > last 3 we were able to choose the best surgeon. > > In *all* four cases we suggested "going private" > since the surgeons also did private operations. I missed this in my earlier reading of Martin's comment. I thought you were picking NHS provider vs. private provider. Here, you are claiming provider can be *both*; presumably, providing the same (similar?) service to a set of patients and billing two different entities -- NHS vs. "private insurer X". (I imagine a third option is also available: CASH patients?) So, in your examples (pick any *one* of them), you settled on Dr Jones for the service provider. Then, approached Dr Jones and said: "would you like us to pay for your services through our *private* insurance plan *or* through our public NHS plan?" The implication (in your final comment) is that he could bill "you" more if he elected the private billing option. In theory, you get the same care (?) -- just get charged more for it? Yet, he's NOT opting for that approach. This suggests he is "getting" something by redirecting you to the NHS channel. Is his liability/exposure different in the two approaches? Does one approach free him from extra paperwork? Or, make available other support services FOR HIM? Hard to imagine *you* telling a client that he can pay you $X through employerA or $Y through employerB -- and that YOU will receive different amounts based on which employer he selects to contract your work and you *prefer* he use the employer who will pay YOU less. Said another way, why would ANY doctor want to support the "private" option? > In *all* four cases they recommended that we did > not, and stayed in the NHS. > > Libertarians can't understand that the top-rate > professionals repeatedly advised us *not* to > put money into their pocket. They all thought it > was better to remain (financially) poorer.
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| From | Tom Gardner <spamjunk@blueyonder.co.uk> |
|---|---|
| Date | 2017-05-15 15:32 +0100 |
| Message-ID | <OZiSA.3226$_f2.1955@fx35.am4> |
| In reply to | #460324 |
On 15/05/17 07:00, Don Y wrote: > On 5/14/2017 10:54 AM, Tom Gardner wrote: >> On 14/05/17 18:18, Martin Brown wrote: > >>> If you choose to go privately then you can shop around but then you are >>> restricted to those surgeons who do private work. There are plenty of excellent >>> surgeons who work almost entirely for the NHS. >> >> My family has experience of 4 serious operations >> (heart valve, prostate, spinal reconstruction, >> pyleostomy). All outcomes were optimal. For the >> last 3 we were able to choose the best surgeon. >> >> In *all* four cases we suggested "going private" >> since the surgeons also did private operations. > > I missed this in my earlier reading of Martin's comment. > I thought you were picking NHS provider vs. private provider. > > Here, you are claiming provider can be *both*; presumably, > providing the same (similar?) service to a set of patients > and billing two different entities -- NHS vs. "private > insurer X". (I imagine a third option is also available: > CASH patients?) Medics can do any combination of private and NHS practice, and sometimes they do private work in NHS facilities. Hospitals are either private or NHS, but the NHS can contract for services from private hospitals. > So, in your examples (pick any *one* of them), you settled > on Dr Jones for the service provider. Diagnosed by Dr Jones as an NHS patient, and offered NHS treatment. Also asked Dr Smith and paid cash privately for the advice and optionally for diagnostics. Note that I might have met Dr Smith first and then chosen to pay Dr Jones for advice. > Then, approached Dr Jones > and said: "would you like us to pay for your services through > our *private* insurance plan *or* through our public NHS plan?" Yes. And, without exception, they advised that I should not pay to have surgery but should have it done under the NHS. In one case I strongly suggested they claim money from my employer's insurance; that was messy but they eventually found a way. But that wasted the most valuable commodity of all: top-rate surgeon's time and energy. > The implication (in your final comment) is that he could bill > "you" more if he elected the private billing option. In > theory, you get the same care (?) -- just get charged more > for it? No idea about relative costs, but the important point is that some of the money would have ended up in the surgeon's personal bank account. > Yet, he's NOT opting for that approach. This suggests he > is "getting" something by redirecting you to the NHS channel. Probably yes. But not financial, and I'm very glad to have money removed from that decision. > Is his liability/exposure different in the two approaches? > Does one approach free him from extra paperwork? Or, make > available other support services FOR HIM? Paperwork probably, otherwise I strongly doubt it. > Hard to imagine *you* telling a client that he can pay you $X > through employerA or $Y through employerB -- and that YOU will > receive different amounts based on which employer he selects to > contract your work and you *prefer* he use the employer who > will pay YOU less. That's the way it is here. The NHS was born in the ruins of WW2, during rationing, when everybody was expected to "do their duty" and "pull together for the common good". The NHS still embodies that ethos, although politicians are doing their best to destroy it.
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| From | Don Y <blockedofcourse@foo.invalid> |
|---|---|
| Date | 2017-05-15 15:01 -0700 |
| Message-ID | <ofd88a$473$1@dont-email.me> |
| In reply to | #460345 |
On 5/15/2017 7:32 AM, Tom Gardner wrote:
> On 15/05/17 07:00, Don Y wrote:
>> On 5/14/2017 10:54 AM, Tom Gardner wrote:
>>> On 14/05/17 18:18, Martin Brown wrote:
>>
>>>> If you choose to go privately then you can shop around but then you are
>>>> restricted to those surgeons who do private work. There are plenty of
>>>> excellent
>>>> surgeons who work almost entirely for the NHS.
>>>
>>> My family has experience of 4 serious operations
>>> (heart valve, prostate, spinal reconstruction,
>>> pyleostomy). All outcomes were optimal. For the
>>> last 3 we were able to choose the best surgeon.
>>>
>>> In *all* four cases we suggested "going private"
>>> since the surgeons also did private operations.
>>
>> I missed this in my earlier reading of Martin's comment.
>> I thought you were picking NHS provider vs. private provider.
>>
>> Here, you are claiming provider can be *both*; presumably,
>> providing the same (similar?) service to a set of patients
>> and billing two different entities -- NHS vs. "private
>> insurer X". (I imagine a third option is also available:
>> CASH patients?)
>
> Medics can do any combination of private and NHS
> practice, and sometimes they do private work in
> NHS facilities.
Yes, but why would they want to EVER do "private" -- given
the cited examples where they steered patients to NHS
treatment (by their same hands)?
E.g., most seniors, here, have "supplement" plans for
their Medicare care (insurance). These plans cover
the costs that Medicare doesn't (e.g., copays).
There are things that Medicare *won't* cover -- based
on the nature of those treatments/procedures or other
criteria ("You're too old for a routine mammogram").
If you want coverage for those, you need to select a
supplemental (private) plan that WILL cover them
(many supplements leverage the existing Medicare
rules and essentially say, "If Medicare won't cover
it AT ALL, neither will we!" I.e., they only pick up
the portion of your care that Medicare coerces YOU
to pay)
Because Medicare is such a big market, most doctors will
accept Medicare patients (i.e., will accept the fee schedule
negotiated universally with Medicare for those services
provided to Medicare patients). You can find some
doctors who won't (don't want to deal with the paperwork,
want to charge more for their services, etc.)
E.g., I can have cataract surgery and pay out of pocket,
pay through my insurer at the "negotiated rate" (which
may mean a copay from me) *or* have Medicare pay the
bill. The provider can end up seeing three different
rates for the same care. And, the patient can see
three different financial exposures.
If the selected provider doesn't accept "Medicare assignments"
(i.e., the fee schedule), then that option is closed to me.
But, likewise, if he doesn't participate with the insurer
that I have -- or, the PLAN that I have selected -- then
THAT option goes away as well.
The doctor is incentivized to take all three options as
it expands his market; if he was willing to "settle"
for the poorest paying of those options, then he should
obviously (?) be willing to accept the HIGHEST paying, as
well!
But, I can't fathom a doctor telling a prospective patient
to choose the option that will result in his being reimbursed
the LEAST -- unless there are other considerations involved.
E.g., I've accompanied Medicare patients to their PCP
and heard the PCP, when asked to perform a SECOND procedure
(e.g., clear the wax from their ears "while they're here"),
reply: "If I do that today, then Medicare won't pay me for it.
So, make ANOTHER appointment and we'll do it, then"
I've heard other PCP's say exactly the opposite -- in one
case, I even challenged the doctor by saying "But, won't
Medicare disallow payment for that as a second procedure, today?"
"Doesn't matter. It would be silly to waste a SECOND appointment
(and my staff's time setting that up, billing, etc.) for
something that I can do in a matter of minutes, NOW"
> Hospitals are either private or NHS, but the NHS
> can contract for services from private hospitals.
>
>> So, in your examples (pick any *one* of them), you settled
>> on Dr Jones for the service provider.
>> Then, approached Dr Jones
>> and said: "would you like us to pay for your services through
>> our *private* insurance plan *or* through our public NHS plan?"
>
> Yes.
>
> And, without exception, they advised that I should
> not pay to have surgery but should have it done under
> the NHS.
To be clear: does Dr Jones receive MORE pay through the private
option? (a "tie" can be seen as going either way, based on the
provider's mindset) I.e., by steering you to the NHS, has he
*significantly* altered the payment he would receive?
> In one case I strongly suggested they claim money
> from my employer's insurance; that was messy but
> they eventually found a way. But that wasted the
> most valuable commodity of all: top-rate surgeon's
> time and energy.
Here, the provider would have staff to handle that. He'd
tick a box on a form (now an e-form) and someone else would
do the followup. Because someone is ALWAYS having to deal
with insurerA, insurerB, medicare, medicaid, CASH, how best
to code the treatment for each of these, etc.
E.g., my PCP shares an office (a "surgery") with two (?) other
MD's. There are *easily* 20 paid staff in that place (including
the three doing the "billable" work). No idea how many IT and
accounting folks are behind the scenes or off-site and shared
among other such "practices" (offices).
>> The implication (in your final comment) is that he could bill
>> "you" more if he elected the private billing option. In
>> theory, you get the same care (?) -- just get charged more
>> for it?
>
> No idea about relative costs, but the important
> point is that some of the money would have ended
> up in the surgeon's personal bank account.
I'd be concerned. I'm not going to sweat a 5% "cut" in
my potential earnings (I donate 500 /pro bono/ hours
annually). OTOH, I'm not going to *work* (the difference
between that and the donated time is that *I* choose
where my time is donated, not the client/employer!) for
"half wages"!
>> Yet, he's NOT opting for that approach. This suggests he
>> is "getting" something by redirecting you to the NHS channel.
>
> Probably yes. But not financial, and I'm very
> glad to have money removed from that decision.
Its hard to ever be *sure* that money isn't a factor, somehow;
i.e., you still *spent* money on the procedure. In my
case, when a guy locally renowned for a particular type of
service recommends AGAINST having that ("I don't think you
need it"), then I figure I'm probably getting an honest
answer (he's getting a couple hundred dollars for his
opinion instead of potentially many THOUSANDS for the
actual service)
>> Hard to imagine *you* telling a client that he can pay you $X
>> through employerA or $Y through employerB -- and that YOU will
>> receive different amounts based on which employer he selects to
>> contract your work and you *prefer* he use the employer who
>> will pay YOU less.
>
> That's the way it is here.
>
> The NHS was born in the ruins of WW2, during
> rationing, when everybody was expected to "do
> their duty" and "pull together for the common
> good".
That's possibly a difference in social experiences between there
and here. We've never lived in *real* fear of bombs falling
from the sky, etc.
And, we are geographically (and culturally) probably far more
diverse with a population 5+ times greater and a land mass of
35 times -- we *don't* even have a common language ("American
English") that binds us :>
> The NHS still embodies that ethos, although
> politicians are doing their best to destroy it.
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| From | Tom Gardner <spamjunk@blueyonder.co.uk> |
|---|---|
| Date | 2017-05-16 00:52 +0100 |
| Message-ID | <rbrSA.19974$MA.12500@fx05.am4> |
| In reply to | #460437 |
On 15/05/17 23:01, Don Y wrote:
> On 5/15/2017 7:32 AM, Tom Gardner wrote:
>> On 15/05/17 07:00, Don Y wrote:
>>> On 5/14/2017 10:54 AM, Tom Gardner wrote:
>>>> On 14/05/17 18:18, Martin Brown wrote:
>>>
>>>>> If you choose to go privately then you can shop around but then you are
>>>>> restricted to those surgeons who do private work. There are plenty of
>>>>> excellent
>>>>> surgeons who work almost entirely for the NHS.
>>>>
>>>> My family has experience of 4 serious operations
>>>> (heart valve, prostate, spinal reconstruction,
>>>> pyleostomy). All outcomes were optimal. For the
>>>> last 3 we were able to choose the best surgeon.
>>>>
>>>> In *all* four cases we suggested "going private"
>>>> since the surgeons also did private operations.
>>>
>>> I missed this in my earlier reading of Martin's comment.
>>> I thought you were picking NHS provider vs. private provider.
>>>
>>> Here, you are claiming provider can be *both*; presumably,
>>> providing the same (similar?) service to a set of patients
>>> and billing two different entities -- NHS vs. "private
>>> insurer X". (I imagine a third option is also available:
>>> CASH patients?)
>>
>> Medics can do any combination of private and NHS
>> practice, and sometimes they do private work in
>> NHS facilities.
>
> Yes, but why would they want to EVER do "private" -- given
> the cited examples where they steered patients to NHS
> treatment (by their same hands)?
IANAD; you'll have to ask a doctor.
> There are things that Medicare *won't* cover -- based
> on the nature of those treatments/procedures or other
> criteria ("You're too old for a routine mammogram").
> If you want coverage for those, you need to select a
> supplemental (private) plan that WILL cover them
> (many supplements leverage the existing Medicare
> rules and essentially say, "If Medicare won't cover
> it AT ALL, neither will we!" I.e., they only pick up
> the portion of your care that Medicare coerces YOU
> to pay)
Typically private insurance will cover you for
whatever the doctor recommends. I'll presume
there are clauses relating to not covering for
wacky "experimental" treatments
> But, I can't fathom a doctor telling a prospective patient
> to choose the option that will result in his being reimbursed
> the LEAST -- unless there are other considerations involved.
Not everything in this world has a $ sign attached.
There is the concept of "doing the right thing for
other people/society in general", plus the self-respect
of knowing that you have put the patient's interests
first. But that is speculation on my part; IANAD.
> E.g., I've accompanied Medicare patients to their PCP
> and heard the PCP, when asked to perform a SECOND procedure
> (e.g., clear the wax from their ears "while they're here"),
> reply: "If I do that today, then Medicare won't pay me for it.
> So, make ANOTHER appointment and we'll do it, then"
>
> I've heard other PCP's say exactly the opposite -- in one
> case, I even challenged the doctor by saying "But, won't
> Medicare disallow payment for that as a second procedure, today?"
> "Doesn't matter. It would be silly to waste a SECOND appointment
> (and my staff's time setting that up, billing, etc.) for
> something that I can do in a matter of minutes, NOW"
A,l examples of money trumping (ho ho) what is
in patients' best interest.
>> Hospitals are either private or NHS, but the NHS
>> can contract for services from private hospitals.
>>
>>> So, in your examples (pick any *one* of them), you settled
>>> on Dr Jones for the service provider.
>
>>> Then, approached Dr Jones
>>> and said: "would you like us to pay for your services through
>>> our *private* insurance plan *or* through our public NHS plan?"
>>
>> Yes.
>>
>> And, without exception, they advised that I should
>> not pay to have surgery but should have it done under
>> the NHS.
>
> To be clear: does Dr Jones receive MORE pay through the private
> option? (a "tie" can be seen as going either way, based on the
> provider's mindset) I.e., by steering you to the NHS, has he
> *significantly* altered the payment he would receive?
IANAD. From patients' PoV the question is unimportant.
>> In one case I strongly suggested they claim money
>> from my employer's insurance; that was messy but
>> they eventually found a way. But that wasted the
>> most valuable commodity of all: top-rate surgeon's
>> time and energy.
>
> Here, the provider would have staff to handle that. He'd
> tick a box on a form (now an e-form) and someone else would
> do the followup. Because someone is ALWAYS having to deal
> with insurerA, insurerB, medicare, medicaid, CASH, how best
> to code the treatment for each of these, etc.
>
> E.g., my PCP shares an office (a "surgery") with two (?) other
> MD's. There are *easily* 20 paid staff in that place (including
> the three doing the "billable" work). No idea how many IT and
> accounting folks are behind the scenes or off-site and shared
> among other such "practices" (offices).
That may be one reason why US care is so expensive:
lots of unproductive paper pushing admin overheads.
>>> The implication (in your final comment) is that he could bill
>>> "you" more if he elected the private billing option. In
>>> theory, you get the same care (?) -- just get charged more
>>> for it?
>>
>> No idea about relative costs, but the important
>> point is that some of the money would have ended
>> up in the surgeon's personal bank account.
>
> I'd be concerned. I'm not going to sweat a 5% "cut" in
> my potential earnings (I donate 500 /pro bono/ hours
> annually). OTOH, I'm not going to *work* (the difference
> between that and the donated time is that *I* choose
> where my time is donated, not the client/employer!) for
> "half wages"!
For dedicated professionals, money is usually a
"hygene factor" in Maslow's terms. If you have
enough to be happy, having 10% more doesn't
make you 10% happier.
>>> Yet, he's NOT opting for that approach. This suggests he
>>> is "getting" something by redirecting you to the NHS channel.
>>
>> Probably yes. But not financial, and I'm very
>> glad to have money removed from that decision.
>
> Its hard to ever be *sure* that money isn't a factor, somehow;
> i.e., you still *spent* money on the procedure. In my
> case, when a guy locally renowned for a particular type of
> service recommends AGAINST having that ("I don't think you
> need it"), then I figure I'm probably getting an honest
> answer (he's getting a couple hundred dollars for his
> opinion instead of potentially many THOUSANDS for the
> actual service)
Agreed; that's why the "go NHS" recommendation is
so powerful.
>>> Hard to imagine *you* telling a client that he can pay you $X
>>> through employerA or $Y through employerB -- and that YOU will
>>> receive different amounts based on which employer he selects to
>>> contract your work and you *prefer* he use the employer who
>>> will pay YOU less.
>>
>> That's the way it is here.
>>
>> The NHS was born in the ruins of WW2, during
>> rationing, when everybody was expected to "do
>> their duty" and "pull together for the common
>> good".
>
> That's possibly a difference in social experiences between there
> and here. We've never lived in *real* fear of bombs falling
> from the sky, etc.
>
> And, we are geographically (and culturally) probably far more
> diverse with a population 5+ times greater and a land mass of
> 35 times -- we *don't* even have a common language ("American
> English") that binds us :>
Geographically yes, but culturally large cities
here are /very/ cosmopolitan. Out in the boondocks
less so, of course.
>
>> The NHS still embodies that ethos, although
>> politicians are doing their best to destroy it.
>
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| From | kevin93 <kevin@whitedigs.com> |
|---|---|
| Date | 2017-05-15 19:17 -0700 |
| Message-ID | <8722a8bd-3583-4fe7-9012-910c8e9ba842@googlegroups.com> |
| In reply to | #460440 |
On Monday, May 15, 2017 at 4:52:59 PM UTC-7, Tom Gardner wrote:
> On 15/05/17 23:01, Don Y wrote:
...
> > And, we are geographically (and culturally) probably far more
> > diverse with a population 5+ times greater and a land mass of
> > 35 times -- we *don't* even have a common language ("American
> > English") that binds us :>
>
> Geographically yes, but culturally large cities
> here are /very/ cosmopolitan. Out in the boondocks
> less so, of course.
>
...
I agree - I think many people underestimate the diversity of the UK, even before there was significant recent immigration.
When I moved to California from the UK in the '70s I found it less of a difference than moving between different parts of the UK.
England consists of 4 countries with multiple language and cultural variations as well as distinct history and industry differences. North vs South, East vs South, cola mines, farming or financial districts. Scotland vs Wales or England.
I am from the south-east and I remember going to a friend's wedding in York and not being able to understand the language of the locals. There can be noticeable dialect variations between villages only 10 or 20 miles apart.
kevin
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| From | bill.sloman@ieee.org |
|---|---|
| Date | 2017-05-15 19:26 -0700 |
| Message-ID | <79ef9f4d-286f-4f14-b4ae-3c2be30d55e5@googlegroups.com> |
| In reply to | #460440 |
On Tuesday, May 16, 2017 at 9:52:59 AM UTC+10, Tom Gardner wrote: > On 15/05/17 23:01, Don Y wrote: > > On 5/15/2017 7:32 AM, Tom Gardner wrote: > >> On 15/05/17 07:00, Don Y wrote: > >>> On 5/14/2017 10:54 AM, Tom Gardner wrote: > >>>> On 14/05/17 18:18, Martin Brown wrote: <snip> > > E.g., my PCP shares an office (a "surgery") with two (?) other > > MD's. There are *easily* 20 paid staff in that place (including > > the three doing the "billable" work). No idea how many IT and > > accounting folks are behind the scenes or off-site and shared > > among other such "practices" (offices). > > That may be one reason why US care is so expensive: > lots of unproductive paper pushing admin overheads. A couple of Canadian economist did and in-depth study of US versus Canadian medical costs, and did blame most of the difference on absurdly high adminstrative costs. How much of that is C. Northcote Parkinson's Law in action https://en.wikipedia.org/wiki/Parkinson%27s_law is anybody's guess. US medical insurers don't seem to compete to have the most efficient adminstrations, but rather all seem to be competing to be the company that pays out the least possible money to to any given patient. Presumably this leads to a larger pool of clerks for the bosses to harass. <snip> -- Bill Sloman, Sydney
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| From | Don Y <blockedofcourse@foo.invalid> |
|---|---|
| Date | 2017-05-16 12:01 -0700 |
| Message-ID | <offi2k$cn6$1@dont-email.me> |
| In reply to | #460440 |
On 5/15/2017 4:52 PM, Tom Gardner wrote:
>>>>>> If you choose to go privately then you can shop around but then you are
>>>>>> restricted to those surgeons who do private work. There are plenty of
>>>>>> excellent
>>>>>> surgeons who work almost entirely for the NHS.
>>>>>
>>>>> My family has experience of 4 serious operations
>>>>> (heart valve, prostate, spinal reconstruction,
>>>>> pyleostomy). All outcomes were optimal. For the
>>>>> last 3 we were able to choose the best surgeon.
>>>>>
>>>>> In *all* four cases we suggested "going private"
>>>>> since the surgeons also did private operations.
>>>>
>>>> I missed this in my earlier reading of Martin's comment.
>>>> I thought you were picking NHS provider vs. private provider.
>>>>
>>>> Here, you are claiming provider can be *both*; presumably,
>>>> providing the same (similar?) service to a set of patients
>>>> and billing two different entities -- NHS vs. "private
>>>> insurer X". (I imagine a third option is also available:
>>>> CASH patients?)
>>>
>>> Medics can do any combination of private and NHS
>>> practice, and sometimes they do private work in
>>> NHS facilities.
>>
>> Yes, but why would they want to EVER do "private" -- given
>> the cited examples where they steered patients to NHS
>> treatment (by their same hands)?
>
> IANAD; you'll have to ask a doctor.
Seems to me that this is the sort of thing that would have been
commonly addressed in that parade of regular "talk shows"!
>> There are things that Medicare *won't* cover -- based
>> on the nature of those treatments/procedures or other
>> criteria ("You're too old for a routine mammogram").
>> If you want coverage for those, you need to select a
>> supplemental (private) plan that WILL cover them
>> (many supplements leverage the existing Medicare
>> rules and essentially say, "If Medicare won't cover
>> it AT ALL, neither will we!" I.e., they only pick up
>> the portion of your care that Medicare coerces YOU
>> to pay)
>
> Typically private insurance will cover you for
> whatever the doctor recommends.
That's not true, here. When the policy is written it states
the limitations on the coverage.
E.g., my dental hygenist had to personally shell out $10K to roll
the "in vitro dice". I have a relative that did this *many* times
(to the tune of $50K) yet the insurer paid for it all.
On smaller scales, some plans may cover doctor visits while others
won't -- or will require a co-pay, etc. The idea of "medically necessary"
doesn't prominently factor into most.
> I'll presume
> there are clauses relating to not covering for
> wacky "experimental" treatments
>
>> But, I can't fathom a doctor telling a prospective patient
>> to choose the option that will result in his being reimbursed
>> the LEAST -- unless there are other considerations involved.
>
> Not everything in this world has a $ sign attached.
>
> There is the concept of "doing the right thing for
> other people/society in general", plus the self-respect
> of knowing that you have put the patient's interests
> first. But that is speculation on my part; IANAD.
That may apply to a portion of the *individuals* involved.
And, perhaps to some "corporate individuals". But, in general,
there is a fiduciary duty of corporations to provide a
return to their "investors". Regardless of how "right" it may
seem to give all of the company profits to the employees by
way of higher wages, a corporation would quickly find itself
sued by its stock holders for doing so.
>>>> Then, approached Dr Jones
>>>> and said: "would you like us to pay for your services through
>>>> our *private* insurance plan *or* through our public NHS plan?"
>>>
>>> Yes.
>>>
>>> And, without exception, they advised that I should
>>> not pay to have surgery but should have it done under
>>> the NHS.
>>
>> To be clear: does Dr Jones receive MORE pay through the private
>> option? (a "tie" can be seen as going either way, based on the
>> provider's mindset) I.e., by steering you to the NHS, has he
>> *significantly* altered the payment he would receive?
>
> IANAD. From patients' PoV the question is unimportant.
I think that a falacy. If, for example, the provider was relieved
of any financial responsibility for errors on his part, then I'd
want to know that ("Gee, if he's opting for the lower exposure option,
what does that tell me about his opinion OF HIMSELF and HIS ABILTIES
as he enters into this procedure -- on ME?"). Or, if the provider
would NOT be obligated to have an ongoing relationship ("continuing
care") with the patient afterwards because <something> would assume
that duty for him, I might wonder how effective that ongoing "third party"
relationship would likely be, given that the third party is less
familiar with me than the original provider.
E.g., I frequently limited contracts to prototype/proof-of-principle
development as I have no desire to get dragged down by the inevitable
politics and paperwork of manufacturing, selecting vendors, researching
alternate parts, resolving manufacturing problems, etc. This presents
a cost to the client ("Don won't be around when those problems creep up,
they aren't HIS problems!") and is reflected in the terms I offered.
OTOH, it's an acknowledgement of a regular aspect of business -- an
employee can come and go (e.g., die) and your business plans SHOULD
be prepared for that at any time... not just when prior warned!)
>>> In one case I strongly suggested they claim money
>>> from my employer's insurance; that was messy but
>>> they eventually found a way. But that wasted the
>>> most valuable commodity of all: top-rate surgeon's
>>> time and energy.
>>
>> Here, the provider would have staff to handle that. He'd
>> tick a box on a form (now an e-form) and someone else would
>> do the followup. Because someone is ALWAYS having to deal
>> with insurerA, insurerB, medicare, medicaid, CASH, how best
>> to code the treatment for each of these, etc.
>>
>> E.g., my PCP shares an office (a "surgery") with two (?) other
>> MD's. There are *easily* 20 paid staff in that place (including
>> the three doing the "billable" work). No idea how many IT and
>> accounting folks are behind the scenes or off-site and shared
>> among other such "practices" (offices).
>
> That may be one reason why US care is so expensive:
> lots of unproductive paper pushing admin overheads.
If the NHS claims 14% overhead, that's roughly half what our
insurance overhead rate. By contrast, Medicare clocks in
below 10%. Amusingly, much of the recent increase of
Medicare overhead costs is associated with the attempts
to privatize (portions of) it.
>>>> The implication (in your final comment) is that he could bill
>>>> "you" more if he elected the private billing option. In
>>>> theory, you get the same care (?) -- just get charged more
>>>> for it?
>>>
>>> No idea about relative costs, but the important
>>> point is that some of the money would have ended
>>> up in the surgeon's personal bank account.
>>
>> I'd be concerned. I'm not going to sweat a 5% "cut" in
>> my potential earnings (I donate 500 /pro bono/ hours
>> annually). OTOH, I'm not going to *work* (the difference
>> between that and the donated time is that *I* choose
>> where my time is donated, not the client/employer!) for
>> "half wages"!
>
> For dedicated professionals, money is usually a
> "hygene factor" in Maslow's terms. If you have
> enough to be happy, having 10% more doesn't
> make you 10% happier.
Who pays the rest of the staff in the doctor's "surgery"?
The receptionist, the nurse/aid, the maintenance staff, the
IT guy, etc.? Are there line-items on your NHS "bills"
that indicate how much of the gummit's remittance to the
provider is allocated to each of these folks? If the
doctor opts for a 10% cut in his reimbursement, do the
rest of his staff have a say?
>>>> Yet, he's NOT opting for that approach. This suggests he
>>>> is "getting" something by redirecting you to the NHS channel.
>>>
>>> Probably yes. But not financial, and I'm very
>>> glad to have money removed from that decision.
>>
>> Its hard to ever be *sure* that money isn't a factor, somehow;
>> i.e., you still *spent* money on the procedure. In my
>> case, when a guy locally renowned for a particular type of
>> service recommends AGAINST having that ("I don't think you
>> need it"), then I figure I'm probably getting an honest
>> answer (he's getting a couple hundred dollars for his
>> opinion instead of potentially many THOUSANDS for the
>> actual service)
>
> Agreed; that's why the "go NHS" recommendation is
> so powerful.
You're missing my point. In my case, its yet another option:
"You don't need ANY care as it would only increase your possible
downside exposure".
This is very different than "pay me $9,000 instead of $10,000
for the procedure (that will only increase your downside risk)"
>>>> Hard to imagine *you* telling a client that he can pay you $X
>>>> through employerA or $Y through employerB -- and that YOU will
>>>> receive different amounts based on which employer he selects to
>>>> contract your work and you *prefer* he use the employer who
>>>> will pay YOU less.
>>>
>>> That's the way it is here.
>>>
>>> The NHS was born in the ruins of WW2, during
>>> rationing, when everybody was expected to "do
>>> their duty" and "pull together for the common
>>> good".
>>
>> That's possibly a difference in social experiences between there
>> and here. We've never lived in *real* fear of bombs falling
>> from the sky, etc.
>>
>> And, we are geographically (and culturally) probably far more
>> diverse with a population 5+ times greater and a land mass of
>> 35 times -- we *don't* even have a common language ("American
>> English") that binds us :>
>
> Geographically yes, but culturally large cities
> here are /very/ cosmopolitan. Out in the boondocks
> less so, of course.
I don't think you realize how much of the country would be classified
as "boondocks". I suspect we could set all of England *in* Texas
and never have a Brit *encounter* a Texan! Texas has a land area 2.5
times larger (250K mi^2) than the UK and slightly LESS population (27M)
with 1/3 of its population in just 10 cities. That population is the
same as the population of NYC (9M) -- almost 30,000 people per square
mile (7 times what you have in London). For a New Yorker to get the
degree of isolation that one can readily experience in Texas, he'd
have to visit an airport...
[It takes me 40 minutes to get *to* the nearest interstate highway from
my current residence -- never having left the city limits and driving
on roads with respectable speed limits (40+MPH). Living in New England,
I could have traveled through 6 "towns" and 2 or 3 *states* in that
same amount of time. Someone growing up *here* obviously has very different
ideas as to what constitutes "accessible" than I did!]
I.e., there are regions of the country that are very dense vs. sparse.
Regions with high service/amenities availability and regions that
suffer scarcities. Regions that "trust in God's will" and regions
that are full of "heathens" :>
<https://en.wikipedia.org/wiki/Amish>
<https://en.wikipedia.org/wiki/Mormons>
<https://en.wikipedia.org/wiki/Bible_Belt>
Appalachia is effectively a different country from Los Angeles (or
even its closer neighbor, NYC!):
<https://en.wikipedia.org/wiki/Appalachia>
Geography has a big/subtle role on behavior and expectations
(incl from gummit). What a new Yorker would expect from HIS
gummit is very different from someone in Billings, Montana.
We had a large wildfire here some years back (we have them often but
this one was the closest, physically). I was commenting to a friend
in New England about the worry expressed over the large telescopes
threatened by the fire -- the proximity of flammable brush to those
structures. He was puzzled, "Why do they let brush accumulate
near the structures? Wouldn't that be a FIRE RISK? Wouldn't they
PROACTIVELY seek to keep those areas CLEAR??"
Different mindsets, different expectations.
Add to that the variations introduced by the different ethnic
heritages (The Polish Neighborhood, Little Italy, Chinatown, etc.).
Recent outbreak of Measles in a Somali neighborhood that avoided
(intentionally) immunizations. By contrast, every child in my grade
school stood in line, one day, in the auditorium to receive our
vaccinations ("Gee, we get to miss an hour of class!!!")
>>> The NHS still embodies that ethos, although
>>> politicians are doing their best to destroy it.
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| From | Tom Gardner <spamjunk@blueyonder.co.uk> |
|---|---|
| Date | 2017-05-16 21:12 +0100 |
| Message-ID | <t2JSA.1490$Ng5.1161@fx08.am4> |
| In reply to | #460554 |
On 16/05/17 20:01, Don Y wrote:
> On 5/15/2017 4:52 PM, Tom Gardner wrote:
>>>>>>> If you choose to go privately then you can shop around but then you are
>>>>>>> restricted to those surgeons who do private work. There are plenty of
>>>>>>> excellent
>>>>>>> surgeons who work almost entirely for the NHS.
>>>>>>
>>>>>> My family has experience of 4 serious operations
>>>>>> (heart valve, prostate, spinal reconstruction,
>>>>>> pyleostomy). All outcomes were optimal. For the
>>>>>> last 3 we were able to choose the best surgeon.
>>>>>>
>>>>>> In *all* four cases we suggested "going private"
>>>>>> since the surgeons also did private operations.
>>>>>
>>>>> I missed this in my earlier reading of Martin's comment.
>>>>> I thought you were picking NHS provider vs. private provider.
>>>>>
>>>>> Here, you are claiming provider can be *both*; presumably,
>>>>> providing the same (similar?) service to a set of patients
>>>>> and billing two different entities -- NHS vs. "private
>>>>> insurer X". (I imagine a third option is also available:
>>>>> CASH patients?)
>>>>
>>>> Medics can do any combination of private and NHS
>>>> practice, and sometimes they do private work in
>>>> NHS facilities.
>>>
>>> Yes, but why would they want to EVER do "private" -- given
>>> the cited examples where they steered patients to NHS
>>> treatment (by their same hands)?
>>
>> IANAD; you'll have to ask a doctor.
>
> Seems to me that this is the sort of thing that would have been
> commonly addressed in that parade of regular "talk shows"!
>
>>> There are things that Medicare *won't* cover -- based
>>> on the nature of those treatments/procedures or other
>>> criteria ("You're too old for a routine mammogram").
>>> If you want coverage for those, you need to select a
>>> supplemental (private) plan that WILL cover them
>>> (many supplements leverage the existing Medicare
>>> rules and essentially say, "If Medicare won't cover
>>> it AT ALL, neither will we!" I.e., they only pick up
>>> the portion of your care that Medicare coerces YOU
>>> to pay)
>>
>> Typically private insurance will cover you for
>> whatever the doctor recommends.
>
> That's not true, here. When the policy is written it states
> the limitations on the coverage.
My statement was a response to your specific points,
and remains true in that context.
The only private health insurance I've had is
from my employer. I've always regarded it as a
"might be nice to have" benefit, and haven't
bothered too much about the fine print.
That's possible, normal and reasonable because
the NHS covers everything necessary.
> I think that a falacy. If, for example, the provider was relieved
> of any financial responsibility for errors on his part, then I'd
> want to know that ("Gee, if he's opting for the lower exposure option,
> what does that tell me about his opinion OF HIMSELF and HIS ABILTIES
> as he enters into this procedure -- on ME?"). Or, if the provider
> would NOT be obligated to have an ongoing relationship ("continuing
> care") with the patient afterwards because <something> would assume
> that duty for him, I might wonder how effective that ongoing "third party"
> relationship would likely be, given that the third party is less
> familiar with me than the original provider.
The concept of sueing medics is new here, and most
people find it repugnant. The starting point is that
if you sue a medic then you are trying to get a
free handout.
Naturally that isn't true in all cases!
>> For dedicated professionals, money is usually a
>> "hygene factor" in Maslow's terms. If you have
>> enough to be happy, having 10% more doesn't
>> make you 10% happier.
>
> Who pays the rest of the staff in the doctor's "surgery"?
> The receptionist, the nurse/aid, the maintenance staff, the
> IT guy, etc.? Are there line-items on your NHS "bills"
> that indicate how much of the gummit's remittance to the
> provider is allocated to each of these folks? If the
> doctor opts for a 10% cut in his reimbursement, do the
> rest of his staff have a say?
Money flow for NHS treatment is opaque to me, and
there's no reason for me to care about it.
>>>> The NHS was born in the ruins of WW2, during
>>>> rationing, when everybody was expected to "do
>>>> their duty" and "pull together for the common
>>>> good".
>>>
>>> That's possibly a difference in social experiences between there
>>> and here. We've never lived in *real* fear of bombs falling
>>> from the sky, etc.
>>>
>>> And, we are geographically (and culturally) probably far more
>>> diverse with a population 5+ times greater and a land mass of
>>> 35 times -- we *don't* even have a common language ("American
>>> English") that binds us :>
>>
>> Geographically yes, but culturally large cities
>> here are /very/ cosmopolitan. Out in the boondocks
>> less so, of course.
>
> I don't think you realize how much of the country would be classified
> as "boondocks". I suspect we could set all of England *in* Texas
> and never have a Brit *encounter* a Texan! Texas has a land area 2.5
> times larger (250K mi^2) than the UK and slightly LESS population (27M)
> with 1/3 of its population in just 10 cities. That population is the
> same as the population of NYC (9M) -- almost 30,000 people per square
> mile (7 times what you have in London). For a New Yorker to get the
> degree of isolation that one can readily experience in Texas, he'd
> have to visit an airport...
Don't forget that "over there 100 years is a long time,
over here 100 miles is a long way". "Boondocks" is a
cultural term rather than a geographical term, although
they are often congruent.
Texan: "It takes me all day to drive across my farm"
Vermonter: "I've got a car like that too"
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| From | Don Y <blockedofcourse@foo.invalid> |
|---|---|
| Date | 2017-05-16 13:51 -0700 |
| Message-ID | <offoif$54u$1@dont-email.me> |
| In reply to | #460572 |
On 5/16/2017 1:12 PM, Tom Gardner wrote:
> On 16/05/17 20:01, Don Y wrote:
>> I think that a falacy. If, for example, the provider was relieved
>> of any financial responsibility for errors on his part, then I'd
>> want to know that ("Gee, if he's opting for the lower exposure option,
>> what does that tell me about his opinion OF HIMSELF and HIS ABILTIES
>> as he enters into this procedure -- on ME?"). Or, if the provider
>> would NOT be obligated to have an ongoing relationship ("continuing
>> care") with the patient afterwards because <something> would assume
>> that duty for him, I might wonder how effective that ongoing "third party"
>> relationship would likely be, given that the third party is less
>> familiar with me than the original provider.
>
> The concept of sueing medics is new here, and most
> people find it repugnant. The starting point is that
> if you sue a medic then you are trying to get a
> free handout.
I don't think that is true, here. Definitely not trying to get
that *care* "for free" -- though, in some cases, there may be
a desire to "retire early -- on someone else's dime!"
But, recall, lawsuits are driven by *damages* incurred. I.e.,
you (the "victim/plaintiff") claim to have LOST something in
the process as justification for your lawsuit. Hard to imagine
folks WANTING to lose their eyesight, limbs, mobility, etc.
just to get a "free ride". You can't just sue because you
*want* to or think you should have been treated better.
[This differs from product liability lawsuits where you can
shift the responsibility for your stupidity/behavior onto the
manufacturer: "The instructions didn't SAY that I should be
careful not to burn down my house..."]
Medicine isn't a science -- and people forget that. There is
a higher expectation that the results will be "positive"
(contrast that with the low opinion folks have of software).
And, when things invariably turn out to be less than ideal,
folks feel cheated -- and, of course, that has to be SOMEONE's
fault!
If you don't know someone that has "suffered" from a mistake in
medical care, you're not looking very hard!
OTOH, if you don't know someone who has suffered (incurred a loss)
from shoddy automobile repairs, bad meal prep in a restaurant,
misdelivered mail, lost garment at the dry cleaner, etc. you're
not looking hard, either!
The difference is entirely in expectations and the consequences
of those "mistakes" -- not in their *frequency*. If I have a bad
meal at a restaurant, I'll pick up something else on my way
home and remember not to visit that restaurant, again. If I lose
the use of my left arm due to a screwup, avoiding the provider
is a *tiny* consolation/remedy.
Despite the claims of outrageous litigation (and overtreatment/testing)
costs, few folks actually sue their providers. There's a pretty high
barrier to initiating such action (i.e., you have to convince a
lawyer that it is worth HIS time to take on the case).
Neighbor's wife suffered from a medical mishap (that effectively ended
her life a decade before she died).
Guy in the hospital bed next to my Dad had thoracic surgery and rolled
out of bed one night cuz the nurse neglected to lift the "side railing"
to prevent that from happening -- split his sutures wide open as a
result, etc.
Another neighbor's dad broke a hip and never came home from the hospital.
Etc.
> Naturally that isn't true in all cases!
>
>>> For dedicated professionals, money is usually a
>>> "hygene factor" in Maslow's terms. If you have
>>> enough to be happy, having 10% more doesn't
>>> make you 10% happier.
>>
>> Who pays the rest of the staff in the doctor's "surgery"?
>> The receptionist, the nurse/aid, the maintenance staff, the
>> IT guy, etc.? Are there line-items on your NHS "bills"
>> that indicate how much of the gummit's remittance to the
>> provider is allocated to each of these folks? If the
>> doctor opts for a 10% cut in his reimbursement, do the
>> rest of his staff have a say?
>
> Money flow for NHS treatment is opaque to me, and
> there's no reason for me to care about it.
It's YOUR money (taxes). If someone doubled the taxes you paid
and claimed it was for NHS but you saw no change in the care
you received, would you NOT care about where the money was going?
I.e., why should *I* care about where my insurance dollars are
spent? Who cares if they are going to the CEO by way of compensation!?
>>>> And, we are geographically (and culturally) probably far more
>>>> diverse with a population 5+ times greater and a land mass of
>>>> 35 times -- we *don't* even have a common language ("American
>>>> English") that binds us :>
>>>
>>> Geographically yes, but culturally large cities
>>> here are /very/ cosmopolitan. Out in the boondocks
>>> less so, of course.
>>
>> I don't think you realize how much of the country would be classified
>> as "boondocks". I suspect we could set all of England *in* Texas
>> and never have a Brit *encounter* a Texan! Texas has a land area 2.5
>> times larger (250K mi^2) than the UK and slightly LESS population (27M)
>> with 1/3 of its population in just 10 cities. That population is the
>> same as the population of NYC (9M) -- almost 30,000 people per square
>> mile (7 times what you have in London). For a New Yorker to get the
>> degree of isolation that one can readily experience in Texas, he'd
>> have to visit an airport...
>
> Don't forget that "over there 100 years is a long time,
> over here 100 miles is a long way". "Boondocks" is a
> cultural term rather than a geographical term, although
> they are often congruent.
My point is that there are many cultures, here. 100 miles
in The West is NOT a long way; OTOH, in the NorthEast, its
a VERY long way!
An item costing $100 is a <shrug> to someone making San Francisco
wages; but, a week's pay to someone living in rural parts of Appalachia.
Yet, we have to have a health care system that addresses all of those
expectations -- and wonder why the big city lawyer is grumbling about
how much he's paying for the health care of the appalachian "hick".
There's little "cross-cultural exposure" that lets one group see
(or understand) the viewpoints of the other(s). I was astonished at
the number of "natives" (folks who grew up, here and have never left)
that I encountered when I moved, here. In other parts of the country,
people are more geographically mobile. The folks that you meet
here that didn't grow up here are retirees -- who CAME here to retire!
Very different than living in a place where folks have more mixed
experiences (and expectations).
[I suspect there are large swaths of the midwest/heartland where
folks grow up and die within sight of their birthplace!]
> Texan: "It takes me all day to drive across my farm"
> Vermonter: "I've got a car like that too"
[toc] | [prev] | [next] | [standalone]
| From | krw@notreal.com |
|---|---|
| Date | 2017-05-16 20:26 -0400 |
| Message-ID | <gk5nhcdj024qaesqb6jh3dq2i235hrbnuu@4ax.com> |
| In reply to | #460554 |
On Tue, 16 May 2017 12:01:09 -0700, Don Y
<blockedofcourse@foo.invalid> wrote:
>On 5/15/2017 4:52 PM, Tom Gardner wrote:
>>>>>>> If you choose to go privately then you can shop around but then you are
>>>>>>> restricted to those surgeons who do private work. There are plenty of
>>>>>>> excellent
>>>>>>> surgeons who work almost entirely for the NHS.
>>>>>>
>>>>>> My family has experience of 4 serious operations
>>>>>> (heart valve, prostate, spinal reconstruction,
>>>>>> pyleostomy). All outcomes were optimal. For the
>>>>>> last 3 we were able to choose the best surgeon.
>>>>>>
>>>>>> In *all* four cases we suggested "going private"
>>>>>> since the surgeons also did private operations.
>>>>>
>>>>> I missed this in my earlier reading of Martin's comment.
>>>>> I thought you were picking NHS provider vs. private provider.
>>>>>
>>>>> Here, you are claiming provider can be *both*; presumably,
>>>>> providing the same (similar?) service to a set of patients
>>>>> and billing two different entities -- NHS vs. "private
>>>>> insurer X". (I imagine a third option is also available:
>>>>> CASH patients?)
>>>>
>>>> Medics can do any combination of private and NHS
>>>> practice, and sometimes they do private work in
>>>> NHS facilities.
>>>
>>> Yes, but why would they want to EVER do "private" -- given
>>> the cited examples where they steered patients to NHS
>>> treatment (by their same hands)?
>>
>> IANAD; you'll have to ask a doctor.
>
>Seems to me that this is the sort of thing that would have been
>commonly addressed in that parade of regular "talk shows"!
>
>>> There are things that Medicare *won't* cover -- based
>>> on the nature of those treatments/procedures or other
>>> criteria ("You're too old for a routine mammogram").
>>> If you want coverage for those, you need to select a
>>> supplemental (private) plan that WILL cover them
>>> (many supplements leverage the existing Medicare
>>> rules and essentially say, "If Medicare won't cover
>>> it AT ALL, neither will we!" I.e., they only pick up
>>> the portion of your care that Medicare coerces YOU
>>> to pay)
>>
>> Typically private insurance will cover you for
>> whatever the doctor recommends.
>
>That's not true, here. When the policy is written it states
>the limitations on the coverage.
>
>E.g., my dental hygenist had to personally shell out $10K to roll
>the "in vitro dice". I have a relative that did this *many* times
>(to the tune of $50K) yet the insurer paid for it all.
Well, duh! In-vitro isn't medically necessary. It's on the order of
elective plastic surgery. My son and DIL had to do the same. I paid
for most of it.
>On smaller scales, some plans may cover doctor visits while others
>won't -- or will require a co-pay, etc. The idea of "medically necessary"
>doesn't prominently factor into most.
Again, Duh! Some policies call for co-pays, some don't. There isn't
a difference in the service, either there is or there isn't (it may
vary based on "specialist" vs. GP). Of course "medically necessary"
figures into the equation. Elective (plastic) surgery is rarely
covered.
>> I'll presume
>> there are clauses relating to not covering for
>> wacky "experimental" treatments
>>
>>> But, I can't fathom a doctor telling a prospective patient
>>> to choose the option that will result in his being reimbursed
>>> the LEAST -- unless there are other considerations involved.
>>
>> Not everything in this world has a $ sign attached.
>>
>> There is the concept of "doing the right thing for
>> other people/society in general", plus the self-respect
>> of knowing that you have put the patient's interests
>> first. But that is speculation on my part; IANAD.
>
>That may apply to a portion of the *individuals* involved.
>And, perhaps to some "corporate individuals". But, in general,
>there is a fiduciary duty of corporations to provide a
>return to their "investors". Regardless of how "right" it may
>seem to give all of the company profits to the employees by
>way of higher wages, a corporation would quickly find itself
>sued by its stock holders for doing so.
There is also a Hipocratic responsibility to the patient. That trumps
a few bucks. Of course contract law figures into the equation, too.
<...>
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| From | rickman <gnuarm@gmail.com> |
|---|---|
| Date | 2017-05-17 15:50 -0400 |
| Message-ID | <ofi9bh$feu$1@dont-email.me> |
| In reply to | #460345 |
On 5/15/2017 10:32 AM, Tom Gardner wrote: > On 15/05/17 07:00, Don Y wrote: >> On 5/14/2017 10:54 AM, Tom Gardner wrote: >>> On 14/05/17 18:18, Martin Brown wrote: >> >>>> If you choose to go privately then you can shop around but then you are >>>> restricted to those surgeons who do private work. There are plenty >>>> of excellent >>>> surgeons who work almost entirely for the NHS. >>> >>> My family has experience of 4 serious operations >>> (heart valve, prostate, spinal reconstruction, >>> pyleostomy). All outcomes were optimal. For the >>> last 3 we were able to choose the best surgeon. >>> >>> In *all* four cases we suggested "going private" >>> since the surgeons also did private operations. >> >> I missed this in my earlier reading of Martin's comment. >> I thought you were picking NHS provider vs. private provider. >> >> Here, you are claiming provider can be *both*; presumably, >> providing the same (similar?) service to a set of patients >> and billing two different entities -- NHS vs. "private >> insurer X". (I imagine a third option is also available: >> CASH patients?) > > Medics can do any combination of private and NHS > practice, and sometimes they do private work in > NHS facilities. > > Hospitals are either private or NHS, but the NHS > can contract for services from private hospitals. When a provider performs a service under NHS, is he working on salary or a fee for service? My limited knowledge if from British TV shows where I had the impression a doctor was paid a salary by the NHS. If fee for service, I assume they get a fee set by the NHS just as in-plan providers do in the US under insurance. >> So, in your examples (pick any *one* of them), you settled >> on Dr Jones for the service provider. > > Diagnosed by Dr Jones as an NHS patient, and > offered NHS treatment. Also asked Dr Smith > and paid cash privately for the advice and > optionally for diagnostics. > > Note that I might have met Dr Smith first and > then chosen to pay Dr Jones for advice. > > >> Then, approached Dr Jones >> and said: "would you like us to pay for your services through >> our *private* insurance plan *or* through our public NHS plan?" > > Yes. > > And, without exception, they advised that I should > not pay to have surgery but should have it done under > the NHS. > > In one case I strongly suggested they claim money > from my employer's insurance; that was messy but > they eventually found a way. But that wasted the > most valuable commodity of all: top-rate surgeon's > time and energy. Seldom the surgeon's time or energy. They have people who deal with that stuff I'm sure. They do here in the US. >> The implication (in your final comment) is that he could bill >> "you" more if he elected the private billing option. In >> theory, you get the same care (?) -- just get charged more >> for it? > > No idea about relative costs, but the important > point is that some of the money would have ended > up in the surgeon's personal bank account. > > >> Yet, he's NOT opting for that approach. This suggests he >> is "getting" something by redirecting you to the NHS channel. > > Probably yes. But not financial, and I'm very > glad to have money removed from that decision. Yes, here it's all about the money. I was personally victimized by a doctor who insisted I have my procedure outside the hospital. Only the morning of the procedure was I informed he had a financial stake in the surgery center. >> Is his liability/exposure different in the two approaches? >> Does one approach free him from extra paperwork? Or, make >> available other support services FOR HIM? > > Paperwork probably, otherwise I strongly doubt it. > > >> Hard to imagine *you* telling a client that he can pay you $X >> through employerA or $Y through employerB -- and that YOU will >> receive different amounts based on which employer he selects to >> contract your work and you *prefer* he use the employer who >> will pay YOU less. > > That's the way it is here. > > The NHS was born in the ruins of WW2, during > rationing, when everybody was expected to "do > their duty" and "pull together for the common > good". > > The NHS still embodies that ethos, although > politicians are doing their best to destroy it. -- Rick C
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| From | Don Y <blockedofcourse@foo.invalid> |
|---|---|
| Date | 2017-05-14 13:27 -0700 |
| Message-ID | <ofaecb$enp$1@dont-email.me> |
| In reply to | #460252 |
On 5/14/2017 10:18 AM, Martin Brown wrote:
> On 14/05/2017 17:04, Don Y wrote:
>> On 5/14/2017 7:56 AM, Martin Brown wrote:
>>> On 14/05/2017 01:11, Don Y wrote:
>>>> On 5/13/2017 4:34 PM, Tom Gardner wrote:
>>>>>> And, which country are you reporting from?
>>>>>
>>>>> A variant of the UK, distorted through the lens of
>>>>> the Daily Sexpress, the Daily Wail, prejudice and
>>>>> trollery.
>>>>
>>>> You're in England, Tom? Can (while you're still a member of the EU)
>>>> a Frenchman (or other EU citizen) receive care at your NHS? Or,
>>>> only Brits (et al.)?
>>>
>>> Any EU citizen. But you have to be aware that not all national health
>>> services
>>> are alike. ISTR Spain's dosn't include food. When I lived in Belgium
>>> we were
>>> covered by the EU health insurance scheme (as well as private corporate
>>> insurance). You can get an EHIC to prove eligibility:
>>>
>>> https://www.gov.uk/european-health-insurance-card
>>>
>>> And it is free - though there are plenty of private enterprise squatting
>>> websites sat in the adverts on likely Google searches who will charge
>>> you (much
>>> like there are for getting a US Visa waiver)
>>
>> Yes, though (per Tom), there doesn't appear to be much "shopping around"
>> for the best *place* to receive your care.
>
> There isn't. At least not unless your condition is so serious and unusual that
> major city hospitals lack expertise in it. This applied to a friend from
> Manchester who was shipped to Addenbrokes in Cambridge for a liver transplant
> after catching hepatitis in a football match. Sadly even their expertise was
> insufficient to prevent his demise.
>
> Likewise in the early days of heart transplants almost all of them were done at
> Papworth where the first UK procedure was done.
>
> https://en.wikipedia.org/wiki/Papworth_Hospital
>>
>> E.g., here, we (if responsible, self-interested consumers) typically
>> do some research into our selection of PCP, specialists, etc. A friend
>> spent the better part of a year looking for his orthopaedic surgeon.
>> Had that MD left the "plan" that was providing my friend's coverage
>> *or* had my friend left (or been forced from) that plan, there is
>> a chance that the collection of surgeons from which he could choose
>> would change. And, no guarantee that the "new" surgeon would want him
>> as a patient (in the time frame that he wanted/needed).
>
> If you choose to go privately then you can shop around but then you are
> restricted to those surgeons who do private work. There are plenty of excellent
> surgeons who work almost entirely for the NHS.
>>
>> Engaging an ultra liberal friend in a discussion of universal health
>> care, I asked him what LIMITS would apply to the care dispensed.
>
> The most rational one is that the procedures done should have a better than
> evens chance of improving the life quality and duration of the patient. No
> point in extending life at the expense of massive invasive surgery from which
> there is a negligible chance of recovery.
>
>> His reply, "None"! (WTF? There can be limitless NEED for health
>> care; surely you can't expect to meet it ALL?!). When I suggested
>> that folks "from the other side of the tracks" would likely want to
>> avail themselves of the specialists that he uses (doctors practice
>> where they want to LIVE; few voluntarily venture into places that
>> aren't appealing, personally), he was indignant -- realizing that
>> this would increase HIS wait time when needing to access that
>> specialist: "No, they should use doctors where THEY live!"
>
> This is a bit of a puzzle. There are a few run down places in the UK now where
> GP's are retiring and the NHS deal is insufficiently good for new graduates to
> want to take up the vacant posts. But even the poorest areas have GP surgeries
> (though the doctors don't live in them).
>
>> Hmmm... but aren't all (similar) doctors paid the same by the same
>> payer? Why wouldn't a patient want to travel to the best doctor
>> qualified to handle his particular condition??
>
> You presuppose that there is a single best doctor. If the whole system is to
> work you want a doctor who is sufficiently good to be able to do the job well
> enough.
Ah, that's the point! People want The Best for themselves! I spent a fair bit
of time researching my health care providers. I surely don't want an "average"
doctor as there's no guarantee that I will have "average" (typical) health
concerns. E.g., the fact that I'm not diabetic, obese, etc. attest to the
fact that my needs aren't "typical".
"Society" (as an organism) may consider "competent" to be a suitable condition.
But, you'd expect ALL doctors to be competent, right?
So, this (and other comments) leads me to wonder how much of the
"opinion"/regard that Brits have for their system, Canadians for
theirs, etc. is one of "adjusting expectations"? I.e., do the North
Koreans think they have an "adequate" system??
> Plenty of common procedures do not need wizard skills to do them. And
> in the NHS when such skills are required the system automatically routes
> patients to doctors/surgeons with the right skill levels.
But, that routing is a human action -- not something "automated".
So, it relies on people being skilled at that level of triage AND
willing to admit when something exceeds their level of expertise.
SWMBO took a fall while out painting with a group of her peers.
One was an MD who dismissed the event: "Oh, you should stay and
paint with us..." Turned out to be a really bad piece of advice
that she lent extra credence to because he *was* an MD!
"Gee, thanks! I hope I can return the favor, sometime!"
> No system is perfect
> but from what I have seen it is very good at matching condition to
> appropriately skilled surgeon (indeed better than the private sector in that
> respect).
In the "for pay" world, it is hard NOT to be suspicious of every
referral. Esp when they are invariably to other practitioners
in the same "financial organization" (which may just be a consequence
of the relationships negotiated by MY health plan's terms *or* the
referring doctor's familiarity with others in his same "organization")
As a perversion of this logic, I tend to give extra credence to
recommendations that are *outside* the "financial interests" of
the referrer. And, reinforced belief in the treatment recommendations
of practitioners that seem contrary to their best interests
(e.g., a renowned surgeon recommending a treatment plan that AVOIDS
surgery -- despite the fact that he's effectively limited his potential
"sale" to me to just this office visit)
>> Surely, there must be some variation in the quality of care
>> from (EU) country to country or (UK) community to community.
>> Why wouldn't I want to shop around and get treated by the
>> cardiologist in Liverpool instead of the local guy in Manchester?
>> "Heck, I'm willing to make the drive..."
>
> Iff the right cardiologist or more likely paedeotrician was in Liverpool or
> Newcastle and the condition required it then that is what happens. Same with
> helicopter evacuation to get there (some of which is done by a charity).
Again, faith in an "honest/unbiased recommendation/evaluation"
>>> what you must pay for and what is chargeable in each country. You may
>>> not get
>>> English speaking doctors - need travel insurance for that.
>>>
>>> It may well stop when Brexit goes horribly pear shaped.
>>
>> Why? Because Brits would want to retain access to foreign providers?
>
> At present we have access to EU healthcare when in the EU but after Brexit that
> may well cease. If I lived nearer the South coast I would be tempted to hop
> over the channel for some conditions where I know the Belgian health system is
> better than ours.
So, there *is* some "shopping for better providers"! Without that
"open border" scenario, you'd only receive emergency care if you
*happened* to be in Belgium and incurred a medical emergency/accident.
Are there things for which non-Brits "hop over the channel" to
take advantage of a particular type of care in the UK?
>>>> What about immigrants? Do they have to gain UK citizenship?
>>>> Do they have to reside in the country for a particular length
>>>> of time before being eligible for "full benefits" (whatever
>>>> that means)? Do they have to pay into the system for a minimum
>>>> length of time in order to qualify?
>>>
>>> Depends where they have come from and what status they have.
>>> Corporate expats tend to have private health insurance that goes with
>>> their job
>>> whereas students would invariably rely solely on the NHS.
>>
>> Is "private health insurance" a sort of "coinsurance"? E.g., the NHS
>
> No. It is a parallel private hospital system in the UK which provides the
> facilities up to and including full diagnostics and surgery for any surgeons
> who want to work privately for some of the time. It gives you a bit more
> flexibility to schedule operations for when you want them and a higher trim
> level single occupancy room.
So, it would be like my having insurance from InsurerA with NetworkOfProvidersA
vs. InsurerB with NetworkOfProvidersB. I can get care from a B provider
who may not be in the A network... but, do so without the benefit(s) that
InsurerA (*payerA*) offers to me. I.e., I paid for coverage for something
and opted to get that coverage elsewhere, "at retail".
>>> NHS isn't very good at billing non-UK patients unless they run up a
>>> huge bill
>>> the cost of invoicing and enforcement outweighs the gains.
>>
>> So, no "stick" to discourage that abuse? Couldn't the NHS "simply"
>> invoice the patient's "country of origin" and develop reciprocal
>> agreements to facilitate this?
>> "In the past 30 days, we provided THIS care to THESE citizens of yours
>> at a cost of X. We acknowledge that, in the same time period, you
>> provided care to some number of OUR citizens at a cost of Y (< X).
>> As such, the outstanding balance is..."
>
> The number of such cases is small enough that it really isn't worth the effort.
> But in the interests of reciprocity I think the UK should make all visiting
> Americans buy ridiculously over priced medical insurance.
Do Americans come to the UK for "covered care" and expect/get it at
some discounted rate? (not "free") I.e., exploiting any (partial)
subsidies (and investments) that YOU have made in your health care system
"on the cheap"?
>>>> What "buy in" does the public have regarding "apportionment of
>>>> resources"? I recall being in Manchester in ~`83 and hearing a
>>>> "panel" discussing health care dollars on BBC <n>. One of the
>>>> examples that stuck in my mind was:
>>>>
>>>> "Do we repair the 80 year old's broken hip or vaccinate N children?"
>>>
>>> They pose these questions on provocative talks shows but in practice
>>> the NHS
>>> had no problems at all mending my 90 y.o. mum's broken hip and she
>>> recovered
>>> from that pretty well. There is always a tension between what provides
>>> maximum
>>> benefit for society and individual needs.
>>
>> But where are the limits?
>
> I asked exactly that question of a fairly senior doctor when my mum was stuck
> in hospital and his answer was that she could stay for so long as she needed to
> be there and no suitable nursing care bed was available. The bean counter side
> of the system didn't like this and sent me a couple of stiff letters and I
> fried one particularly unfortunate social worker who really annoyed my with her
> lack of case knowledge - they are the people who are supposed to liasse
> hospital to care home/own home transfers for the frail and elderly.
So, your current problem (harkening back to my "what would you change/fix"
initial proposition) has to do with follow-on care AFTER hospitalization.
But, this would (should?) only affect a small population? E.g., most folks
who receive "in-patient" care (hospitalization) are released back to their
homes, afterwards. A neighbor had a lobe of a lung removed and was home
in a few days. Hip replacements are a few days stay and then "make way for
the next patient; the RENT on this bed/room is way to high to be paying
it while you recover!". Likewise heart attack victims, etc.
Folks who "stay" in the hospital are often "on their way out" (CtD).
>> The fear mongers, here, tell us that universal health care will result in
>> rationing, death panels, people DYING because they have been denied care
>> (and, amusingly, acting as if none of these things happen with PRIVATE
>> health insurance!).
>
> There may be some rationing of insanely expensive new drugs that extend life by
> a couple of months as a concrete example.
What about drug therapies that act as alternatives to surgeries or other
more costly treatments? E.g., here, if X eliminates the need for Y
with comparable outcomes, as long as price(X) is ever-so-slightly less
than price(Y), it will be preferred as an economy -- even if *cost*(X)
is SIGNIFICANTLY less than cost(Y) or price(Y). We call this investment
incentive! :>
>> What mechanisms ensure that (NHS) coverage is available to everyone, everywhere
>> for "every" need? What's to stop all the providers from settling in London
>> and its suburbs -- to the detriment of folks farther out? What's to stop
>> a new provider coming to town and eating into the "market" of an established
>> provider? etc.
>
> There are a network of large conglomerates that cover several counties each.
OK, so the doctors in the "local surgeries" don't work FOR the NHS. Rather,
they work for a company that has contracted with the NHS. So, if that company
mismanages these assets, it risks alienating them *or* being "found in ill
favor" among the constituency that it serves (and risks losing the NEXT
contract renewal)
> All major cities have a few big hospitals each but they are not in competition.
Not in competition with each other? Why not? E.g., here, we have probably
8-12 full-fledged hospitals (plus numerous "clinic" type care facilities
(e.g., you don't need a full hospital setting for a colonoscopy). They
are all in competition with each other as they earn money based on the
services they "sell" to their "customers" (patients).
There have been attempts to leverage "specialty" hospitals (Heart Hospital,
Women's Hospital, Children's Hospital, etc.) to target particular portions
of the population.
A local hospital advertises to Mexican (not "Latinas" but actual Mexican
citizens) "come to our hospital to have your baby! Get US citizenship
for him/her -- and, tie in a few days of shopping before you return home!"
(said hospital being a few miles from here).
Another hospital has focused on trauma care. etc. Each trying to nibble
away at a portion of the "market" with its own "gimmick".
> Some have specialisations others are more general - you may have to travel upto
> 50 or 100 miles to the right one if your condition is rare or unusual (even
> further if it is ultra rare).
I guess it would depend on what is considered "rare". And, 50-100 miles
means different things in different parts of the country. E.g., I know
folks, here, who *commute* 100+ miles (each way) several times weekly.
By contrast, I can be in Mexico in less. And, growing up in New England,
could easily cross a couple of state borders in that span.
Also, the consequences of NOT having "expert" care can vary a lot despite
being a "rare/ultra rare" condition. E.g., /Myasthenia Gravis/ affects
about 1:1000 people so is probably in the "rare" category (I've known
several people with it, each stunned to see that I knew what they were
talking about!) but very little that can be done "here" vs. "there"
or "somewhere else" that would require a particular specialist. It's
well enough documented that even a GP could diagnose it.
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| From | Tom Gardner <spamjunk@blueyonder.co.uk> |
|---|---|
| Date | 2017-05-14 22:00 +0100 |
| Message-ID | <Nz3SA.42855$Ps3.9997@fx44.am4> |
| In reply to | #460276 |
On 14/05/17 21:27, Don Y wrote: > In the "for pay" world, it is hard NOT to be suspicious of every > referral. Esp when they are invariably to other practitioners > in the same "financial organization" (which may just be a consequence > of the relationships negotiated by MY health plan's terms *or* the > referring doctor's familiarity with others in his same "organization") > > As a perversion of this logic, I tend to give extra credence to > recommendations that are *outside* the "financial interests" of > the referrer. And, reinforced belief in the treatment recommendations > of practitioners that seem contrary to their best interests > (e.g., a renowned surgeon recommending a treatment plan that AVOIDS > surgery -- despite the fact that he's effectively limited his potential > "sale" to me to just this office visit) In my experience, for life-threatening problems that has occurred 4 times out of 4 here :) Money can screw up all types of relationships :)
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| From | kevin93 <kevin@whitedigs.com> |
|---|---|
| Date | 2017-05-14 18:39 -0700 |
| Message-ID | <f5aeea44-9f01-4662-b81c-5cb0aedad475@googlegroups.com> |
| In reply to | #460252 |
On Sunday, May 14, 2017 at 10:18:17 AM UTC-7, Martin Brown wrote: ... > There are a network of large conglomerates that cover several counties > each. All major cities have a few big hospitals each but they are not in > competition. Some have specialisations others are more general - you may > have to travel upto 50 or 100 miles to the right one if your condition > is rare or unusual (even further if it is ultra rare). ... > Martin Brown Here's an interesting article comparing one particular facet of US vs rest of the world hospital care. https://www.propublica.org/article/die-in-childbirth-maternal-death-rate-health-care-system?utm_source=pocket&utm_medium=email&utm_campaign=pockethits kevin
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