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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
Page 11 of 14 — ← Prev page 1 … 9 10 [11] 12 13 14 Next page →
| From | Phil Allison <pallison49@gmail.com> |
|---|---|
| Date | 2017-05-13 20:39 -0700 |
| Message-ID | <9bce0528-9439-4aa7-958f-75966c3918c4@googlegroups.com> |
| In reply to | #460129 |
Why Don wrote: ----------------- **Don is breaking usenet rules by not putting OT in that heading. OTOH, everything the troll posts is OT and idiotic too. What a pathetic excuse for a man he is. .... Phil
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| From | Rheilly Phoull <rheilly@bigslong.com> |
|---|---|
| Date | 2017-05-14 12:19 +0800 |
| Message-ID | <bYidnfOgjOkjR4rEnZ2dnUU7-QmdnZ2d@westnet.com.au> |
| In reply to | #460184 |
On 14/5/17 11:39 am, Phil Allison wrote: > Why Don wrote: > > ----------------- > > > **Don is breaking usenet rules by not putting OT in that heading. > > OTOH, everything the troll posts is OT and idiotic too. > > What a pathetic excuse for a man he is. > > > > > .... Phil > > > +1 and why the fuck do they put all this political crap in this NG anyway ???
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| From | bill.sloman@ieee.org |
|---|---|
| Date | 2017-05-13 22:08 -0700 |
| Message-ID | <4479ac59-e4b4-482d-a619-5255136c7d66@googlegroups.com> |
| In reply to | #460194 |
On Sunday, May 14, 2017 at 2:19:19 PM UTC+10, Rheilly Phoull wrote: > On 14/5/17 11:39 am, Phil Allison wrote: > > Why Don wrote: > > > > ----------------- > > > > > > **Don is breaking usenet rules by not putting OT in that heading. > > > > OTOH, everything the troll posts is OT and idiotic too. > > > > What a pathetic excuse for a man he is. > > +1 and why the fuck do they put all this political crap in this NG > anyway ??? Who else would pay any attention to it? Some of our regulars do say useful things about electronics, not always in in on-topic threads, so one scans their output in the hope of finding something useful. Sci.electronics.design is an unusually successful and busy user-group, and the electronics may be the glue that holds it together. There are other theories, but they are even less plausible. -- Bill Sloman, Sydney
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| From | Phil Allison <pallison49@gmail.com> |
|---|---|
| Date | 2017-05-13 22:20 -0700 |
| Message-ID | <d2519f58-1dc9-4f2d-aa28-a2457a94be7d@googlegroups.com> |
| In reply to | #460199 |
bill....@ieee.org wrote: ------------------------ Rheilly Phoull wrote: Phil Allison wrote: > > > > > > > **Don is breaking usenet rules by not putting OT in that heading. > > > > > > OTOH, everything the troll posts is OT and idiotic too. > > > > > > What a pathetic excuse for a man he is. > > > > +1 and why the fuck do they put all this political crap in this NG > > anyway ??? > > Who else would pay any attention to it? > > Some of our regulars do say useful things about electronics, not always > in in on-topic threads, so one scans their output in the hope of finding > something useful. > > Sci.electronics.design is an unusually successful and busy user-group, > and the electronics may be the glue that holds it together. There are > other theories, but they are even less plausible. > > > ** There are many examples of NGs that have been completely overtaken by OT and political postings. It's like those nasty weeds that infest and eventually take over a nice lawn. SED is clearly headed that way and may cease to exist within 12 months - cos it is now so accepted that folk are not using "OT". A pox on Don Y and all his ilk. .... Phil
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| From | bitrex <bitrex@de.lete.earthlink.net> |
|---|---|
| Date | 2017-05-18 18:10 -0400 |
| Message-ID | <KZoTA.59544$661.17881@fx18.iad> |
| In reply to | #460202 |
On 05/14/2017 01:20 AM, Phil Allison wrote: > > ** There are many examples of NGs that have been completely overtaken by OT and political postings. It's like those nasty weeds that infest and eventually take over a nice lawn. > > SED is clearly headed that way and may cease to exist within 12 months - cos it is now so accepted that folk are not using "OT". > > A pox on Don Y and all his ilk. > > > > .... Phil Certain users seem to use it similarly to the personal MySpace or Facebook page of a 17 y/o girl nowadays, using it to post pics of what they had for dinner or the cool thing their cat did today.
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| From | rickman <gnuarm@gmail.com> |
|---|---|
| Date | 2017-05-18 21:31 -0400 |
| Message-ID | <oflhmq$kgq$2@dont-email.me> |
| In reply to | #460861 |
On 5/18/2017 6:10 PM, bitrex wrote: > On 05/14/2017 01:20 AM, Phil Allison wrote: >> >> ** There are many examples of NGs that have been completely overtaken >> by OT and political postings. It's like those nasty weeds that infest >> and eventually take over a nice lawn. >> >> SED is clearly headed that way and may cease to exist within 12 months >> - cos it is now so accepted that folk are not using "OT". >> >> A pox on Don Y and all his ilk. >> >> >> >> .... Phil > > Certain users seem to use it similarly to the personal MySpace or > Facebook page of a 17 y/o girl nowadays, using it to post pics of what > they had for dinner or the cool thing their cat did today. The OT label means pretty much nothing. In my reader a new post in an OT thread still shows as the group having new content which I have to open to see what it is. Adding OT to the label doesn't help avoid conversations I don't want to read. Using the features in the newsreader to ignore a thread once I see it degenerating into bickering is useful. -- Rick C
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| From | Martin Brown <'''newspam'''@nezumi.demon.co.uk> |
|---|---|
| Date | 2017-05-14 10:28 +0100 |
| Message-ID | <of980q$12nh$1@gioia.aioe.org> |
| In reply to | #460129 |
On 13/05/2017 23:10, Don Y wrote: > So, for the folks who live/work in places with "national health care" > (whatever THAT means), what's *wrong* with it? I.e., what would you > wish was different/better? How are your "death panels" implemented? I'll try to answer it if you try to understand. It is really quite simple. They do their very best to keep people alive until such time as it is not in the best interests of the patient to be kept alive for longer. A multidisciplinary team decides with input from the family when to switch from aggressive active intervention to purely palliative care and most times there is general agreement that it is time to end their suffering. If anything I'd say they generally err on the side of keeping people alive for a bit longer than is in their best interests assuming a gradual decline. I haven't had to go through the full process myself but I know people who have and they are full of praise for the medical team that looked after their loved ones. If there is a dispute between medics and family with a few really difficult cases where the family refuse to give up hope it goes to the high court which may take a couple of extra years. In America I have a feeling they will keep the patient alive for as long as the insurer will continue paying them to do so irrespective of the pain and suffering it may cause. Contrary to popular belief spawned by the likes of casualty the statistics for defibrillation and resuscitation in hospital are not that great for the elderly and infirm (they are much worse than I had believed for super fit footballers even when the right kit is on hand). > How is care "rationed"? What have you NOT been given (by way of care) > that you feel you ought to have? Nothing. I suppose an American might complain about being on a ward and having only one communal TV (thought these days each bed has one). Care isn't really rationed you get what you need when you need it (within limits) - waiting times for scheduled surgery have been rising recently due to Tory cuts. There is some rationing by weight or fitness in that they are unwilling to do knee and hip replacements on obese smokers these days. This is somewhat controversial and not universal policy - it comes and goes. http://www.bbc.co.uk/news/uk-england-devon-30437965 Nice generally do a good job in deciding which drugs and procedures are most worthwhile for maximum benefit. A few experimental drugs at extortionate prices and dubious worth may not be available (an experiment funding them was a disaster with most achieving nothing more than bad side effects and burning money). They do triage at A&E so that serious cases wait the least time but they do need a hospital bed free before they can admit. Therein lies a problem not with the NHS but with the private for profit care homes. > > I.e., if you were starting from scratch to reinvent YOUR system, what > would you change? I would not have let them sell off their carparks to private operators to obtain a one off payment at the expense of permitting the carpark operators to price gouge patients and visitors to the hospitals. The weak point in the NHS is not the public hospitals but the interface to the privately run care home system for the elderly which results in hospitals being bed blocked by patients fit to be discharged but with no bed in a safe environment to be sent to. This is now a major issue. The care homes run at 100% occupancy rate for maximum profitability. There are a few hell holes that do have beds free but only patients with no relatives to stand up for them will ever end up there. http://www.bbc.co.uk/news/health-35481849 My mum spent nearly 3 months stuck in hospital waiting for a suitable nursing bed to become available in Manchester for instance. This is typical. The record I think is something like 2 years! I have to say that the care that both she and my father received in hospital was excellent (but it was at a top performing hospital). -- Regards, Martin Brown
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| From | Tom Gardner <spamjunk@blueyonder.co.uk> |
|---|---|
| Date | 2017-05-14 10:53 +0100 |
| Message-ID | <aOVRA.13351$EE3.7170@fx09.am4> |
| In reply to | #460216 |
On 14/05/17 10:28, Martin Brown wrote: > On 13/05/2017 23:10, Don Y wrote: >> So, for the folks who live/work in places with "national health care" >> (whatever THAT means), what's *wrong* with it? I.e., what would you >> wish was different/better? How are your "death panels" implemented? > > I'll try to answer it if you try to understand. > > It is really quite simple. They do their very best to keep people alive until > such time as it is not in the best interests of the patient to be kept alive for > longer. A multidisciplinary team decides with input from the family when to > switch from aggressive active intervention to purely palliative care and most > times there is general agreement that it is time to end their suffering. If > anything I'd say they generally err on the side of keeping people alive for a > bit longer than is in their best interests assuming a gradual decline. I haven't > had to go through the full process myself but I know people who have and they > are full of praise for the medical team that looked after their loved ones. > > If there is a dispute between medics and family with a few really difficult > cases where the family refuse to give up hope it goes to the high court which > may take a couple of extra years. > > In America I have a feeling they will keep the patient alive for as long as the > insurer will continue paying them to do so irrespective of the pain and > suffering it may cause. > > Contrary to popular belief spawned by the likes of casualty the statistics for > defibrillation and resuscitation in hospital are not that great for the elderly > and infirm (they are much worse than I had believed for super fit footballers > even when the right kit is on hand). > >> How is care "rationed"? What have you NOT been given (by way of care) >> that you feel you ought to have? > > Nothing. I suppose an American might complain about being on a ward and having > only one communal TV (thought these days each bed has one). > > Care isn't really rationed you get what you need when you need it (within > limits) - waiting times for scheduled surgery have been rising recently due to > Tory cuts. > > There is some rationing by weight or fitness in that they are unwilling to do > knee and hip replacements on obese smokers these days. This is somewhat > controversial and not universal policy - it comes and goes. > > http://www.bbc.co.uk/news/uk-england-devon-30437965 > > Nice generally do a good job in deciding which drugs and procedures are most > worthwhile for maximum benefit. A few experimental drugs at extortionate prices > and dubious worth may not be available (an experiment funding them was a > disaster with most achieving nothing more than bad side effects and burning money). > > They do triage at A&E so that serious cases wait the least time but they do need > a hospital bed free before they can admit. Therein lies a problem not with the > NHS but with the private for profit care homes. >> >> I.e., if you were starting from scratch to reinvent YOUR system, what >> would you change? > > I would not have let them sell off their carparks to private operators to obtain > a one off payment at the expense of permitting the carpark operators to price > gouge patients and visitors to the hospitals. > > The weak point in the NHS is not the public hospitals but the interface to the > privately run care home system for the elderly which results in hospitals being > bed blocked by patients fit to be discharged but with no bed in a safe > environment to be sent to. This is now a major issue. > > The care homes run at 100% occupancy rate for maximum profitability. There are a > few hell holes that do have beds free but only patients with no relatives to > stand up for them will ever end up there. > > http://www.bbc.co.uk/news/health-35481849 > > My mum spent nearly 3 months stuck in hospital waiting for a suitable nursing > bed to become available in Manchester for instance. This is typical. The record > I think is something like 2 years! > > I have to say that the care that both she and my father received in hospital was > excellent (but it was at a top performing hospital). That's thoughtful and accurate. My 95yo mother was offered investigations into augmenting her aortic valve. After due consideration she declined because even if the risky process succeeded, it wouldn't affect her worst health issues. We don't have "death by unaccountable insurance company rules" here :) The bed-blocking issue is largely a dysfunctional consequence of different-pots-of-golds coming from different parts of the government. Anybody that has worked in a large company will have seen similar: "companies are condemned to produce products that reflect their organisational structure" There are moves to break that impasse. They probably will but will bring different dysfunctional behaviour. IIRC the longest "bed blocking" stay in hospital is 50 years! Clearly it would be stupid to design a system around that, just as it would be to base doctors regulation around Harold Shipman!
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| From | Don Y <blockedofcourse@foo.invalid> |
|---|---|
| Date | 2017-05-16 12:30 -0700 |
| Message-ID | <offjpt$j6f$1@dont-email.me> |
| In reply to | #460217 |
On 5/14/2017 2:53 AM, Tom Gardner wrote: > On 14/05/17 10:28, Martin Brown wrote: >> My mum spent nearly 3 months stuck in hospital waiting for a suitable nursing >> bed to become available in Manchester for instance. This is typical. The record >> I think is something like 2 years! >> >> I have to say that the care that both she and my father received in hospital was >> excellent (but it was at a top performing hospital). > > That's thoughtful and accurate. > > My 95yo mother was offered investigations into augmenting > her aortic valve. After due consideration she declined because > even if the risky process succeeded, it wouldn't affect > her worst health issues. > > We don't have "death by unaccountable insurance company > rules" here :) Most 95yo patients, here, would be covered by Medicare. These patients often receive more care than they (in terms of expected value of outcome) "should". SWMBO's 95yo mother was offered dialysis treatment which could have prolonged her life -- the downside being the perpetual visits to the dialysis clinic. Our CHF friend was offered an LVAD that could have prolonged his life (neglecting the time spent recovering from the surgery). Esophageal Ca friend was offered an esophagectomy. etc. The problem is that each of these have costs that are gated by the recipient with no input from the "payer" (tax payer). Attempts to put constraints on are met with screams of "death panels" -- by the same folks who complain about the "out of control costs"! (you know, the ones who complain about the costs of drugs -- but prohibit negotiating rates with Pharma; the ones who complain about end-of-life costs -- but want to restrict doctors from discussing EoL options with patients; see a pattern, here??) > The bed-blocking issue is largely a dysfunctional consequence > of different-pots-of-golds coming from different parts > of the government. Anybody that has worked in a large > company will have seen similar: "companies are condemned to > produce products that reflect their organisational structure" > There are moves to break that impasse. They probably will but > will bring different dysfunctional behaviour. So, why not move those two "parts of government" into the same "healthcare" part? Then, given that the funds are all coming from the same "pie", that "part of government" can figure out how best to shuffle resources between the "providers" to meet the ACTUAL needs. (A household may have an entertainment budget and a food budget but, when you run out of food, there's nothing that PREVENTS you from raiding the entertainment budget!) > IIRC the longest "bed blocking" stay in hospital is 50 years! > Clearly it would be stupid to design a system around that, > just as it would be to base doctors regulation around Harold > Shipman!
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| From | rickman <gnuarm@gmail.com> |
|---|---|
| Date | 2017-05-17 19:17 -0400 |
| Message-ID | <ofilfv$q1f$1@dont-email.me> |
| In reply to | #460567 |
On 5/16/2017 3:30 PM, Don Y wrote: > On 5/14/2017 2:53 AM, Tom Gardner wrote: >> On 14/05/17 10:28, Martin Brown wrote: > >>> My mum spent nearly 3 months stuck in hospital waiting for a suitable >>> nursing >>> bed to become available in Manchester for instance. This is typical. >>> The record >>> I think is something like 2 years! >>> >>> I have to say that the care that both she and my father received in >>> hospital was >>> excellent (but it was at a top performing hospital). >> >> That's thoughtful and accurate. >> >> My 95yo mother was offered investigations into augmenting >> her aortic valve. After due consideration she declined because >> even if the risky process succeeded, it wouldn't affect >> her worst health issues. >> >> We don't have "death by unaccountable insurance company >> rules" here :) > > Most 95yo patients, here, would be covered by Medicare. These > patients often receive more care than they (in terms of expected > value of outcome) "should". SWMBO's 95yo mother was offered > dialysis treatment which could have prolonged her life -- the > downside being the perpetual visits to the dialysis clinic. > > Our CHF friend was offered an LVAD that could have prolonged his > life (neglecting the time spent recovering from the surgery). > > Esophageal Ca friend was offered an esophagectomy. > > etc. Obviously you feel people with medical issues don't deserve the same medical care that others have. I've known people on dialysis and they can live happy lives. The choice of treatment is theirs, not yours. > The problem is that each of these have costs that are gated > by the recipient with no input from the "payer" (tax payer). > Attempts to put constraints on are met with screams of "death > panels" -- by the same folks who complain about the "out of > control costs"! Oh? Do you have names? > (you know, the ones who complain about > the costs of drugs -- but prohibit negotiating rates with > Pharma; the ones who complain about end-of-life costs -- but > want to restrict doctors from discussing EoL options with > patients; see a pattern, here??) Is this all by one person perhaps? The guy who lives in your head as a scapegoat perhaps? Don tends to make up strawmen to poke with a stick. -- Rick C
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| From | Martin Brown <'''newspam'''@nezumi.demon.co.uk> |
|---|---|
| Date | 2017-05-19 11:49 +0100 |
| Message-ID | <ofmije$c75$1@gioia.aioe.org> |
| In reply to | #460567 |
On 16/05/2017 20:30, Don Y wrote: > On 5/14/2017 2:53 AM, Tom Gardner wrote: >> On 14/05/17 10:28, Martin Brown wrote: > >>> My mum spent nearly 3 months stuck in hospital waiting for a suitable >>> nursing >>> bed to become available in Manchester for instance. This is typical. >>> The record >>> I think is something like 2 years! >>> >>> I have to say that the care that both she and my father received in >>> hospital was >>> excellent (but it was at a top performing hospital). >> >> That's thoughtful and accurate. >> >> My 95yo mother was offered investigations into augmenting >> her aortic valve. After due consideration she declined because >> even if the risky process succeeded, it wouldn't affect >> her worst health issues. >> >> We don't have "death by unaccountable insurance company >> rules" here :) > > Most 95yo patients, here, would be covered by Medicare. These > patients often receive more care than they (in terms of expected > value of outcome) "should". SWMBO's 95yo mother was offered > dialysis treatment which could have prolonged her life -- the > downside being the perpetual visits to the dialysis clinic. That is tedious but if she was otherwise fit and healthy then it would not be unusual. If it was because her kidneys were just the most failed organ of a multiple systems failure then it might only delay death by a few days to go for invasive surgery repair. We had a bloke at work who was on dialysis leave twice weekly. He eventually got a kidney transplant after a few years on a waiting list. He was offered them several times before he finally accepted. > The problem is that each of these have costs that are gated > by the recipient with no input from the "payer" (tax payer). Perhaps the difference is in the attitude of the recipients in the UK and the USA. Or the perception of that attitude in the general public. > Attempts to put constraints on are met with screams of "death > panels" -- by the same folks who complain about the "out of > control costs"! (you know, the ones who complain about > the costs of drugs -- but prohibit negotiating rates with > Pharma; the ones who complain about end-of-life costs -- but > want to restrict doctors from discussing EoL options with > patients; see a pattern, here??) It does seem odd that in a market as large as the US has such exceptionally high prices for many common prescription drugs. But then in a country with the best politicians that money can buy and plenty of lobbyists with fat cash stuffed brown paper envelopes I suppose it is only to be expected. That is before unethical buyout specialists grab small pharma companies and then price gouge by orders of magnitude: http://www.independent.co.uk/news/people/martin-shkreli-pharmaceuticals-ceo-who-raised-hiv-drug-price-by-5000-also-hiked-cost-of-pill-taken-10513645.html > >> The bed-blocking issue is largely a dysfunctional consequence >> of different-pots-of-golds coming from different parts >> of the government. Anybody that has worked in a large >> company will have seen similar: "companies are condemned to >> produce products that reflect their organisational structure" >> There are moves to break that impasse. They probably will but >> will bring different dysfunctional behaviour. > > So, why not move those two "parts of government" into the same > "healthcare" part? Then, given that the funds are all coming from > the same "pie", that "part of government" can figure out how best > to shuffle resources between the "providers" to meet the ACTUAL > needs. It is a national government vs local government issue. NHS is national scale funding subdivided into multi county chunks. Whereas personal care is separated out as a local issue paid for by county councils or by the patients themselves if they have any savings or own a house. The only exception is if your medical condition is so severe that the bulk of the care requirement is deemed to be medical then it reverts to national level NHS funding again and at no cost to the patient. http://www.nhs.uk/Conditions/social-care-and-support-guide/Pages/nhs-continuing-care.aspx The above is sufficiently obscure that most people in the UK are unaware of this provision unless they have experience of it. Not surprisingly there are territorial turf wars at each of these boundaries with creative bean counters playing "pass the parcel". > > (A household may have an entertainment budget and a food budget > but, when you run out of food, there's nothing that PREVENTS > you from raiding the entertainment budget!) There is at the moment a genuine attempt in some areas including the one where my mum lived to add some joined up thinking to the local care homes provision (since a bed in the care home costs around 5-10x less per night than an average hospital bed). The problem is that the NHS finds itself as the bed provider of last resort - the medics won't turn anyone away (not even the drunk ones that throw punches at them). -- Regards, Martin Brown
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| From | Don Y <blockedofcourse@foo.invalid> |
|---|---|
| Date | 2017-05-19 12:56 -0700 |
| Message-ID | <ofniet$5vo$1@dont-email.me> |
| In reply to | #460911 |
>>> My 95yo mother was offered investigations into augmenting
>>> her aortic valve. After due consideration she declined because
>>> even if the risky process succeeded, it wouldn't affect
>>> her worst health issues.
>>>
>>> We don't have "death by unaccountable insurance company
>>> rules" here :)
>>
>> Most 95yo patients, here, would be covered by Medicare. These
>> patients often receive more care than they (in terms of expected
>> value of outcome) "should". SWMBO's 95yo mother was offered
>> dialysis treatment which could have prolonged her life -- the
>> downside being the perpetual visits to the dialysis clinic.
>
> That is tedious but if she was otherwise fit and healthy then it would not be
> unusual. If it was because her kidneys were just the most failed organ of a
> multiple systems failure then it might only delay death by a few days to go for
> invasive surgery repair.
I'd think it highly unusual for a practitioner to be able to claim
time of anticipated death to that level of precision, let alone suggest
an expensive course of treatment in that time frame.
> We had a bloke at work who was on dialysis leave twice weekly. He eventually
> got a kidney transplant after a few years on a waiting list. He was offered
> them several times before he finally accepted.
>
>> The problem is that each of these have costs that are gated
>> by the recipient with no input from the "payer" (tax payer).
>
> Perhaps the difference is in the attitude of the recipients in the UK and the
> USA. Or the perception of that attitude in the general public.
From what I'm reading, here, I suspect that's a large part of the difference.
Folks (here) tend to want/demand "the best" rationalizing that they've
(already) PAID for it -- regardless of how much they've paid, whether its a
new insurer, etc. I.e., they tolerate the paying and figure the pay OFF will
be "top shelf".
IME, even the folks complaining about all these "social programs" eating into
their take-home pay seem to be real quick to embrace them when the time comes!
And, grumble if they don't cover *everything* -- THEY suddenly are The
Entitled, having previously complained about OTHERS who FELT "entitled".
[napkin-calc]
E.g., the Medicare tax is currently 2.9% (it has historically been less)
of which the individual is responsible for half while the employer picks up
the other half. If you've been paid throughout your career at a 2017
$100K rate, that's $1450/year out of your pocket for each of < 50 years
(assume you start working at age ~16 and immediately are earning at that
pay level until your retirement at 65).
So, you've paid in $72500 over your lifetime. Without the tax in place,
that would be yours to spend (or bank for future healthcare needs).
Assume your boss, in the absence of that tax requirement, generously
GIVES you his share -- another $72500 for a total of $145000.
On your retirement (assume your healthcare needs prior have magically
been met), you are dumped in the INDIVIDUAL marketplace (cuz you no longer
have an employer and there's no Medicare -- you've got the cash, instead!).
You now have to purchase private insurance for the balance of your life
from that $145K nut.
*And*, hope the insurer that you've chosen has negotiated as good a
deal with the local providers as Medicare would have. (neighbor spent
5 hours in the ER "under observation" for chest pain; $15K that medicare
ended up claiming was only worth a *couple* thousand dollars)
Of course, you are typically at your "most unhealthiest" at this point
in your life -- most in need of expensive (labor intensive) care. Do
you really think you're going to come out ahead? :> Even if you *only*
live the 15 years beyond retirement that the "average" bloke lives?
(I.e., do you think you're going to get the level of care that Medicare
would have provided for $10K/year in premiums at that point in your life)
>> Attempts to put constraints on are met with screams of "death
>> panels" -- by the same folks who complain about the "out of
>> control costs"! (you know, the ones who complain about
>> the costs of drugs -- but prohibit negotiating rates with
>> Pharma; the ones who complain about end-of-life costs -- but
>> want to restrict doctors from discussing EoL options with
>> patients; see a pattern, here??)
>
> It does seem odd that in a market as large as the US has such exceptionally
> high prices for many common prescription drugs.
The gummit is *banned* from negotiating prices for those drugs
in Medicare recipients -- i.e., the portion of the population
that consumes the *most* drugs!
> But then in a country with the
> best politicians that money can buy and plenty of lobbyists with fat cash
> stuffed brown paper envelopes I suppose it is only to be expected. That is
> before unethical buyout specialists grab small pharma companies and then price
> gouge by orders of magnitude:
There are more "ethical" problems as well.
HepC can be cured (in most patients) with Sovaldi. But, its an expensive
treatment (in the US) -- as an alternative to an eventual liver transplant.
Amazingly, the treatment cost is only high in the USA:
<http://www.chicagotribune.com/business/ct-drug-price-sofosbuvir-sovaldi-india-us-20160104-story.html>
Do you disallow the drug in your plan's formulary (list of covered Rx's) due
to its cost ($1000/dose)? Even if that means those patients will end up
incurring HIGHER costs (and poorer outcomes) with liver transplants?
What about treating "destructive behaviors"? Naloxone can reverse the effects
of an opiod overdose (think oxycodone... think heroin!) and potentially save
the victim's life. But, at a cost (in treatment dollars as well as the cost
to society -- by enabling a "destructive behavior" to persist in light of
natural selection:
<https://www.scientificamerican.com/article/massive-price-hike-for-lifesaving-opioid-overdose-antidote1/>
Its easy for folks to get emotional about these sorts of questions -- esp
if their only skin in the game is their tax dollars! :>
>>> The bed-blocking issue is largely a dysfunctional consequence
>>> of different-pots-of-golds coming from different parts
>>> of the government. Anybody that has worked in a large
>>> company will have seen similar: "companies are condemned to
>>> produce products that reflect their organisational structure"
>>> There are moves to break that impasse. They probably will but
>>> will bring different dysfunctional behaviour.
>>
>> So, why not move those two "parts of government" into the same
>> "healthcare" part? Then, given that the funds are all coming from
>> the same "pie", that "part of government" can figure out how best
>> to shuffle resources between the "providers" to meet the ACTUAL
>> needs.
>
> It is a national government vs local government issue.
Ah, so *different* governments, not different DEPARTMENTS (agencies)
in the *same* government. (Of course, to the tax payer, it's still
The Government)
> NHS is national scale
> funding subdivided into multi county chunks. Whereas personal care is separated
> out as a local issue paid for by county councils or by the patients themselves
> if they have any savings or own a house.
>
> The only exception is if your medical condition is so severe that the bulk of
> the care requirement is deemed to be medical then it reverts to national level
> NHS funding again and at no cost to the patient.
>
> The above is sufficiently obscure that most people in the UK are unaware of
> this provision unless they have experience of it.
>
> Not surprisingly there are territorial turf wars at each of these boundaries
> with creative bean counters playing "pass the parcel".
<frown> I guess I can't understand the (apparently common!) "need for a bed".
If I call an ambulance in response to a medical emergency <somewhere>, the
paramedics will do some on-site care and, possibly, arrange to transport me
to a "nearby" hospital. The choice of hospital is typically theirs and
can be driven by the nature of my "problem" as well as the current
"availability" of staff/resources at the various likely hospitals (e.g., there
are two or three equidistant from my home; others if I want to tack a few more
travel miles on). E.g., most trauma care is provided at just *one* of the
local hospitals (in a metro area of 500K+)
If a hospital is "on divert" (rejecting all but CRITICAL patients), they will
be elided from the mix. I suspect if I were to drive myself to such a
hospital, I would be cared for -- though perhaps with much longer wait times.
Once in the ER, triage determines my place in the queue. I may end up
waiting for a bed in the ER department -- unless it is a *real* emergency
in which case I may be treated on a gurney in the hallway, etc.
I can be discharged directly from the ER *or* admitted into the hospital
therefrom.
When my care is complete, I would typically be discharged to my *home*;
an inquiry made as to whether or not someone can drive me home, etc.
In some small number of cases, you might be discharged to a continuing care
facility (convalescent home, nursing home, etc.).
By far, most discharges are to your own home (or apartment) -- even if you
"live alone". My neighbor was hauled off late one night with a heart attack.
And, returned home a few days later -- "his problem" if he thinks he needs
help around the house. Likewise, neighbors who've had hips replaced,
shoulders, back surgery, neck surgery, amputations, etc.
They typically will receive "a la carte" continuing care/therapy on an
out-patient basis in the days/weeks thereafter. But, The System avoids
the cost of housing them during that period.
Prolonged hospital stays are typically in the final stages of life
(folks complaining they don't want to DIE in the hospital -- but
death being almost immediately assured if they were discharged)
>> (A household may have an entertainment budget and a food budget
>> but, when you run out of food, there's nothing that PREVENTS
>> you from raiding the entertainment budget!)
>
> There is at the moment a genuine attempt in some areas including the one where
> my mum lived to add some joined up thinking to the local care homes provision
> (since a bed in the care home costs around 5-10x less per night than an average
> hospital bed). The problem is that the NHS finds itself as the bed provider of
> last resort - the medics won't turn anyone away (not even the drunk ones that
> throw punches at them).
The ER won't turn away anyone who presents for care. But, they may incur
lengthy waits. And, once ready to be discharged, its the patient's problem
where he'll end up living.
E.g., I've a friend who lives in a tent. He was hospitalized for hernia
repair. On his discharge, the hospital cared nothing that he would be
returning to a *tent*.
There is a lot of pressure on hospitals to discharge people earlier instead
of later. Insurers don't want to be paying for "expensive hotel rooms".
Many surgical procedures are now done without an overnight stay.
[This is kinda a Good Thing cuz being IN the hospital is one of the bigger
risk factors (infections, etc.)]
I just don't see the Magic Bullet that makes "single payer" any better
than "private health care" (at least the US form thereof). I suspect
this option will see renewed interest when Trumpcare (whatever it
becomes) also proves inadequate to tackling the healthcare cost crisis.
So, I'd like to have a leg up on the likely downsides that come with
it (based on existing implementations, elsewhere) instead of the
inevitable EMOTIONAL appeals that rely on specious reasoning ("Gee,
that SOUNDS like it might be true, therefore, it IS!")
There are obviously higher administrative costs dealing with multiple
possible payers (*someone* at each provider has to keep track of the
contractual arrangements with the different payers/plans). And,
recordkeeping issues (i.e., ensuring my medical records are "fully portable"
to a new provider necessitated because my old provider was no longer
accessible to me under the NEW insurer's plan).
And, how you regulate health care delivery ("rationing") will differ
based on the mechanisms available in each system (here, not having insurance
is one way to restrict access to healthcare -- but not the NEED for that
care or the externalities arising from its "denial"!)
ISTM that the only way to get those costs under control is to limit the
*need* for them. I.e., have a healthier population. But, perversely,
that tends to require MORE services (at least in the short term) to
"top off" the health of the population. Passing "some" of the cost on
to the patient is demonstrably NOT an effective way to alter behavior!
[I wonder what it would be like if you told smokers (e.g.) "We WON'T cover
any of the following ailments associated with smoking". Or, the obese
(e.g.) "We WON'T cover any of the following ailments associated with obesity".
I suspect even that wouldn't be enough to verifiably alter behaviors]
Or, to alter the *expectations* people have of them ("You have cancer.
Start making your final arrangements...")
I just don't see how changing the payment (*or* provisioning) aspect will
do anything to change the trajectory of healthcare costs.
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| From | krw@notreal.com |
|---|---|
| Date | 2017-05-19 18:05 -0400 |
| Message-ID | <sequhc5e8g5drrk6rch72rnaia4agqok3v@4ax.com> |
| In reply to | #460972 |
On Fri, 19 May 2017 12:56:48 -0700, Don Y <blockedofcourse@foo.invalid> wrote: >>>> My 95yo mother was offered investigations into augmenting >>>> her aortic valve. After due consideration she declined because >>>> even if the risky process succeeded, it wouldn't affect >>>> her worst health issues. >>>> >>>> We don't have "death by unaccountable insurance company >>>> rules" here :) >>> >>> Most 95yo patients, here, would be covered by Medicare. These >>> patients often receive more care than they (in terms of expected >>> value of outcome) "should". SWMBO's 95yo mother was offered >>> dialysis treatment which could have prolonged her life -- the >>> downside being the perpetual visits to the dialysis clinic. >> >> That is tedious but if she was otherwise fit and healthy then it would not be >> unusual. If it was because her kidneys were just the most failed organ of a >> multiple systems failure then it might only delay death by a few days to go for >> invasive surgery repair. > >I'd think it highly unusual for a practitioner to be able to claim >time of anticipated death to that level of precision, let alone suggest >an expensive course of treatment in that time frame. > >> We had a bloke at work who was on dialysis leave twice weekly. He eventually >> got a kidney transplant after a few years on a waiting list. He was offered >> them several times before he finally accepted. >> >>> The problem is that each of these have costs that are gated >>> by the recipient with no input from the "payer" (tax payer). >> >> Perhaps the difference is in the attitude of the recipients in the UK and the >> USA. Or the perception of that attitude in the general public. > > From what I'm reading, here, I suspect that's a large part of the difference. >Folks (here) tend to want/demand "the best" rationalizing that they've >(already) PAID for it -- regardless of how much they've paid, whether its a >new insurer, etc. I.e., they tolerate the paying and figure the pay OFF will >be "top shelf". > >IME, even the folks complaining about all these "social programs" eating into >their take-home pay seem to be real quick to embrace them when the time comes! >And, grumble if they don't cover *everything* -- THEY suddenly are The >Entitled, having previously complained about OTHERS who FELT "entitled". > >[napkin-calc] > >E.g., the Medicare tax is currently 2.9% (it has historically been less) >of which the individual is responsible for half while the employer picks up >the other half. If you've been paid throughout your career at a 2017 >$100K rate, that's $1450/year out of your pocket for each of < 50 years >(assume you start working at age ~16 and immediately are earning at that >pay level until your retirement at 65). > >So, you've paid in $72500 over your lifetime. Without the tax in place, >that would be yours to spend (or bank for future healthcare needs). >Assume your boss, in the absence of that tax requirement, generously >GIVES you his share -- another $72500 for a total of $145000. > >On your retirement (assume your healthcare needs prior have magically >been met), you are dumped in the INDIVIDUAL marketplace (cuz you no longer >have an employer and there's no Medicare -- you've got the cash, instead!). >You now have to purchase private insurance for the balance of your life >from that $145K nut. No, it's more than twice that, even at a paltry 5%. Have you forgotten that money has a time-value? >*And*, hope the insurer that you've chosen has negotiated as good a >deal with the local providers as Medicare would have. (neighbor spent >5 hours in the ER "under observation" for chest pain; $15K that medicare >ended up claiming was only worth a *couple* thousand dollars) Medicare should pay more than other insurers? >Of course, you are typically at your "most unhealthiest" at this point >in your life -- most in need of expensive (labor intensive) care. Do >you really think you're going to come out ahead? :> Even if you *only* >live the 15 years beyond retirement that the "average" bloke lives? A HSA, of say, $200/month at a *very* modest 5% is over $1/2M. At 8%, it's $1.6M. <rest of boring ramble snipped>
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| From | Martin Brown <'''newspam'''@nezumi.demon.co.uk> |
|---|---|
| Date | 2017-05-20 08:36 +0100 |
| Message-ID | <oforlu$5rn$1@gioia.aioe.org> |
| In reply to | #460972 |
On 19/05/2017 20:56, Don Y wrote:
>>>> My 95yo mother was offered investigations into augmenting
>>>> her aortic valve. After due consideration she declined because
>>>> even if the risky process succeeded, it wouldn't affect
>>>> her worst health issues.
>>>>
>>>> We don't have "death by unaccountable insurance company
>>>> rules" here :)
>>>
>>> Most 95yo patients, here, would be covered by Medicare. These
>>> patients often receive more care than they (in terms of expected
>>> value of outcome) "should". SWMBO's 95yo mother was offered
>>> dialysis treatment which could have prolonged her life -- the
>>> downside being the perpetual visits to the dialysis clinic.
>>
>> That is tedious but if she was otherwise fit and healthy then it would
>> not be
>> unusual. If it was because her kidneys were just the most failed organ
>> of a
>> multiple systems failure then it might only delay death by a few days
>> to go for
>> invasive surgery repair.
>
> I'd think it highly unusual for a practitioner to be able to claim
> time of anticipated death to that level of precision, let alone suggest
> an expensive course of treatment in that time frame.
In the very frail and elderly 90+ population it is actually quite
common. Though the most common mode of failure is from falls at home.
The bed rest to recover combined with loss of confidence leads to a
downward spiral and then pneumonia. It is a well trodden path. :(
>> It does seem odd that in a market as large as the US has such
>> exceptionally
>> high prices for many common prescription drugs.
>
> The gummit is *banned* from negotiating prices for those drugs
> in Medicare recipients -- i.e., the portion of the population
> that consumes the *most* drugs!
Wow! Those lobbyists sure are good at buying politicians votes!
>> But then in a country with the
>> best politicians that money can buy and plenty of lobbyists with fat cash
>> stuffed brown paper envelopes I suppose it is only to be expected.
>> That is
>> before unethical buyout specialists grab small pharma companies and
>> then price
>> gouge by orders of magnitude:
>
> There are more "ethical" problems as well.
>
> HepC can be cured (in most patients) with Sovaldi. But, its an expensive
> treatment (in the US) -- as an alternative to an eventual liver transplant.
> Amazingly, the treatment cost is only high in the USA:
> <http://www.chicagotribune.com/business/ct-drug-price-sofosbuvir-sovaldi-india-us-20160104-story.html>
No wonder if the drugs companies can charge what they like!
We are having similar bother with a few unusual off patent drugs and US
style creative accountancy price gouging in the UK market now:
https://www.gov.uk/government/news/cma-fines-pfizer-and-flynn-90-million-for-drug-price-hike-to-nhs
But we do have a competition authority to kick them in the teeth.
> Do you disallow the drug in your plan's formulary (list of covered Rx's)
> due
> to its cost ($1000/dose)? Even if that means those patients will end up
> incurring HIGHER costs (and poorer outcomes) with liver transplants?
It's a pay now or pay a lot more later calculation. The rational
solution depends on future interest rates and worker productivity.
> What about treating "destructive behaviors"? Naloxone can reverse the
> effects
> of an opiod overdose (think oxycodone... think heroin!) and potentially
> save
> the victim's life. But, at a cost (in treatment dollars as well as the
> cost
> to society -- by enabling a "destructive behavior" to persist in light of
> natural selection:
> <https://www.scientificamerican.com/article/massive-price-hike-for-lifesaving-opioid-overdose-antidote1/>
Its a reasonable treatment for poisoning. Making illegal drugs legal and
taxing them like Switzerland would be a far more rational approach.
> Its easy for folks to get emotional about these sorts of questions -- esp
> if their only skin in the game is their tax dollars! :>
>
>>>> The bed-blocking issue is largely a dysfunctional consequence
>>>> of different-pots-of-golds coming from different parts
>>>> of the government. Anybody that has worked in a large
>>>> company will have seen similar: "companies are condemned to
>>>> produce products that reflect their organisational structure"
>>>> There are moves to break that impasse. They probably will but
>>>> will bring different dysfunctional behaviour.
>>>
>>> So, why not move those two "parts of government" into the same
>>> "healthcare" part? Then, given that the funds are all coming from
>>> the same "pie", that "part of government" can figure out how best
>>> to shuffle resources between the "providers" to meet the ACTUAL
>>> needs.
>>
>> It is a national government vs local government issue.
>
> Ah, so *different* governments, not different DEPARTMENTS (agencies)
> in the *same* government. (Of course, to the tax payer, it's still
> The Government)
Exactly but they are from different pots of money. The problem is that
central government has drastically cut local government funding.
>> Not surprisingly there are territorial turf wars at each of these
>> boundaries
>> with creative bean counters playing "pass the parcel".
>
> <frown> I guess I can't understand the (apparently common!) "need for a
> bed".
Because people are living much longer and ultimately end up frail and
disabled or demented - therefore not safe to go home.
> If I call an ambulance in response to a medical emergency <somewhere>, the
> paramedics will do some on-site care and, possibly, arrange to transport me
> to a "nearby" hospital. The choice of hospital is typically theirs and
> can be driven by the nature of my "problem" as well as the current
> "availability" of staff/resources at the various likely hospitals (e.g.,
> there
> are two or three equidistant from my home; others if I want to tack a
> few more
> travel miles on). E.g., most trauma care is provided at just *one* of the
> local hospitals (in a metro area of 500K+)
>
> If a hospital is "on divert" (rejecting all but CRITICAL patients), they
> will
> be elided from the mix. I suspect if I were to drive myself to such a
> hospital, I would be cared for -- though perhaps with much longer wait
> times.
>
> Once in the ER, triage determines my place in the queue. I may end up
> waiting for a bed in the ER department -- unless it is a *real* emergency
> in which case I may be treated on a gurney in the hallway, etc.
>
> I can be discharged directly from the ER *or* admitted into the hospital
> therefrom.
In the UK for patients presenting with complex multiple problems though
most likely one main acute problem they go to the emergency assessment
unit where a multidisciplinary team look at the best approach.
>
> When my care is complete, I would typically be discharged to my *home*;
> an inquiry made as to whether or not someone can drive me home, etc.
>
> In some small number of cases, you might be discharged to a continuing care
> facility (convalescent home, nursing home, etc.).
Ageing population so that this is invariably the dominant pathway.
> By far, most discharges are to your own home (or apartment) -- even if you
> "live alone". My neighbor was hauled off late one night with a heart
> attack.
> And, returned home a few days later -- "his problem" if he thinks he needs
> help around the house. Likewise, neighbors who've had hips replaced,
> shoulders, back surgery, neck surgery, amputations, etc.
>
> They typically will receive "a la carte" continuing care/therapy on an
> out-patient basis in the days/weeks thereafter. But, The System avoids
> the cost of housing them during that period.
It is the same in the UK but they are somewhat more careful about the
welfare of the people they discharge from hospital than in the USA if
things are truly as you describe.
>
> Prolonged hospital stays are typically in the final stages of life
> (folks complaining they don't want to DIE in the hospital -- but
> death being almost immediately assured if they were discharged)
Therein lies the problem hence bed blocking in the NHS.
> There is a lot of pressure on hospitals to discharge people earlier instead
> of later. Insurers don't want to be paying for "expensive hotel rooms".
> Many surgical procedures are now done without an overnight stay.
>
> [This is kinda a Good Thing cuz being IN the hospital is one of the bigger
> risk factors (infections, etc.)]
>
> I just don't see the Magic Bullet that makes "single payer" any better
> than "private health care" (at least the US form thereof). I suspect
> this option will see renewed interest when Trumpcare (whatever it
> becomes) also proves inadequate to tackling the healthcare cost crisis.
> So, I'd like to have a leg up on the likely downsides that come with
> it (based on existing implementations, elsewhere) instead of the
> inevitable EMOTIONAL appeals that rely on specious reasoning ("Gee,
> that SOUNDS like it might be true, therefore, it IS!")
Mostly it just works. Some places are better than others. Chances are
that I may not get value for money out of my contributions to the NHS
scheme but I am *GLAD* of that. We buried one of my friends who has been
struggling with MS for three decades this week. She certainly got her
and perhaps 500 other peoples money's worth of NHS care which kept her
alive this long. What would happen to someone in the USA who was struck
down by such an ailment and so eventually lost their job?
The NHS treats people according to their medical needs and by averaging
the risk over the entire population can treat everyone and not just a
favoured few who can afford extortionately priced private insurance.
> And, how you regulate health care delivery ("rationing") will differ
> based on the mechanisms available in each system (here, not having
> insurance
> is one way to restrict access to healthcare -- but not the NEED for that
> care or the externalities arising from its "denial"!)
>
> ISTM that the only way to get those costs under control is to limit the
> *need* for them. I.e., have a healthier population. But, perversely,
> that tends to require MORE services (at least in the short term) to
> "top off" the health of the population. Passing "some" of the cost on
> to the patient is demonstrably NOT an effective way to alter behavior!
A healthier population is still a problem. The only thing certain in
life is death and taxes. Eventually even if you are fit and healthy you
will fall and break a bone or some internal organ will fail.
>
> [I wonder what it would be like if you told smokers (e.g.) "We WON'T cover
> any of the following ailments associated with smoking". Or, the obese
> (e.g.) "We WON'T cover any of the following ailments associated with
> obesity".
> I suspect even that wouldn't be enough to verifiably alter behaviors]
Rationing access to surgery for those with BMI>30 is one such policy but
it is controversial (and pretty stupid if the surgery is to apply a
stomach band as treatment for being overweight!).
> Or, to alter the *expectations* people have of them ("You have cancer.
> Start making your final arrangements...")
Plenty of cancers are survivable these days if caught early enough.
> I just don't see how changing the payment (*or* provisioning) aspect will
> do anything to change the trajectory of healthcare costs.
The trajectory will always be upwards (unless we completely ruin the
power of antibiotics to knock down infections). We can cure more things
now and keep people alive who would not have survived in the past.
It is now rare for people to die in a few days from blood poisoning
arising from a minor infection like they did before penicillin. MRSA and
other hospital acquired infections are changing that though...
--
Regards,
Martin Brown
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| From | Don Y <blockedofcourse@foo.invalid> |
|---|---|
| Date | 2017-05-20 15:58 -0700 |
| Message-ID | <ofqhep$uo7$1@dont-email.me> |
| In reply to | #461021 |
On 5/20/2017 12:36 AM, Martin Brown wrote:
> On 19/05/2017 20:56, Don Y wrote:
>>>>> My 95yo mother was offered investigations into augmenting
>>>>> her aortic valve. After due consideration she declined because
>>>>> even if the risky process succeeded, it wouldn't affect
>>>>> her worst health issues.
>>>>>
>>>>> We don't have "death by unaccountable insurance company
>>>>> rules" here :)
>>>>
>>>> Most 95yo patients, here, would be covered by Medicare. These
>>>> patients often receive more care than they (in terms of expected
>>>> value of outcome) "should". SWMBO's 95yo mother was offered
>>>> dialysis treatment which could have prolonged her life -- the
>>>> downside being the perpetual visits to the dialysis clinic.
>>>
>>> That is tedious but if she was otherwise fit and healthy then it would
>>> not be
>>> unusual. If it was because her kidneys were just the most failed organ
>>> of a
>>> multiple systems failure then it might only delay death by a few days
>>> to go for
>>> invasive surgery repair.
>>
>> I'd think it highly unusual for a practitioner to be able to claim
>> time of anticipated death to that level of precision, let alone suggest
>> an expensive course of treatment in that time frame.
>
> In the very frail and elderly 90+ population it is actually quite common.
> Though the most common mode of failure is from falls at home. The bed rest to
> recover combined with loss of confidence leads to a downward spiral and then
> pneumonia. It is a well trodden path. :(
Perhaps in *specific* cases. SWMBO's mom (see above) had been pushed
towards kidney transplantation many years earlier; she declined. As
her GFR fell over the following years, the MD's pushed for dialysis;
she declined (despite the retirement home in which she resided having
an on-site "hospital" in which she could receive her treatment).
We had assumed she would have "stroked out" as her BP was significantly
elevated for *decades* (despite medication) -- no doubt one of the causes
of her renal failure.
>>> It does seem odd that in a market as large as the US has such
>>> exceptionally
>>> high prices for many common prescription drugs.
>>
>> The gummit is *banned* from negotiating prices for those drugs
>> in Medicare recipients -- i.e., the portion of the population
>> that consumes the *most* drugs!
>
> Wow! Those lobbyists sure are good at buying politicians votes!
It pays to understand ALL aspects of The Problem before suggesting a
remedy -- hence my attempt to elicit "first hand" details of other
"solutions" (and the little details that make dramatic differences)
>>> But then in a country with the
>>> best politicians that money can buy and plenty of lobbyists with fat cash
>>> stuffed brown paper envelopes I suppose it is only to be expected.
>>> That is
>>> before unethical buyout specialists grab small pharma companies and
>>> then price
>>> gouge by orders of magnitude:
>>
>> There are more "ethical" problems as well.
>>
>> HepC can be cured (in most patients) with Sovaldi. But, its an expensive
>> treatment (in the US) -- as an alternative to an eventual liver transplant.
>> Amazingly, the treatment cost is only high in the USA:
>> <http://www.chicagotribune.com/business/ct-drug-price-sofosbuvir-sovaldi-india-us-20160104-story.html>
>
> No wonder if the drugs companies can charge what they like!
To be fair, they are charging what they feel they can get away with!
I'm sure if the demand fell, the price would, as well. In India,
perhaps they simply couldn't sell *any* doses at $1000/tablet and
decided $4 was what THAT market could bear.
If we did away with insurance, here, (i.e., CASH only, paid by patients)
would the price drop? Probably. But, I suspect a lot of *people* would
end up suffering/dying as well.
Companies worry about the dollars on their bottom line; not their "moral
constraints". The days of the Salks are long past.
> We are having similar bother with a few unusual off patent drugs and US style
> creative accountancy price gouging in the UK market now:
>
> https://www.gov.uk/government/news/cma-fines-pfizer-and-flynn-90-million-for-drug-price-hike-to-nhs
>
> But we do have a competition authority to kick them in the teeth.
OTOH, they can simply decide "not to play" -- exit YOUR market and engage
in a publicity campaign to let your patients (voters) know that there IS
a treatment but that your gummit doesn't want to provide it to them.
You can spin an issue any way you want. Drug developers can claim they've
taken a risk, made an investment, etc. and SHOULD be rewarded -- else they
won't bother developing new products.
It's hard to try to imagine a set of circumstances that would cause folks
to "do the right thing" (whatever THAT might be) in the face of self-interests
to the contrary.
(Witness how poorly folks are at making "investment decisions" -- whether
that's investing in a financial instrument, a product purchase, their
retirement savings, or their own *personal* health decisions. "Smoking
WILL kill you" "You have a 1 in a billion chance of winning the lottery")
>> Do you disallow the drug in your plan's formulary (list of covered Rx's)
>> due
>> to its cost ($1000/dose)? Even if that means those patients will end up
>> incurring HIGHER costs (and poorer outcomes) with liver transplants?
>
> It's a pay now or pay a lot more later calculation. The rational solution
> depends on future interest rates and worker productivity.
But you also have patients expressing *their* "wishes" -- regardless of
the rationale behind them!
What do you do if a population (voters) opt to spend (shared) resources on
care that enables them to continue their destructive/unhealthy behaviors?
Tell them, "No, I know better..."? Or, appease them in the short run and worry
about the proverbial fan, later?
>> What about treating "destructive behaviors"? Naloxone can reverse the
>> effects
>> of an opiod overdose (think oxycodone... think heroin!) and potentially
>> save
>> the victim's life. But, at a cost (in treatment dollars as well as the
>> cost
>> to society -- by enabling a "destructive behavior" to persist in light of
>> natural selection:
>> <https://www.scientificamerican.com/article/massive-price-hike-for-lifesaving-opioid-overdose-antidote1/>
>
> Its a reasonable treatment for poisoning. Making illegal drugs legal and taxing
> them like Switzerland would be a far more rational approach.
So, someone opted to divert resources into saving lives that would have
been lost to overdoses -- despite the fact that most overdoses are the
result of illegal activity.
It's like investing in an "automatic fuse replacer" instead of fixing the
problem that is causing fuses to blow... and, pitching it as a CONVENIENCE
FEATURE ("Save time replacing those pesky fuses...")
>> Its easy for folks to get emotional about these sorts of questions -- esp
>> if their only skin in the game is their tax dollars! :>
>>
>>>>> The bed-blocking issue is largely a dysfunctional consequence
>>>>> of different-pots-of-golds coming from different parts
>>>>> of the government. Anybody that has worked in a large
>>>>> company will have seen similar: "companies are condemned to
>>>>> produce products that reflect their organisational structure"
>>>>> There are moves to break that impasse. They probably will but
>>>>> will bring different dysfunctional behaviour.
>>>>
>>>> So, why not move those two "parts of government" into the same
>>>> "healthcare" part? Then, given that the funds are all coming from
>>>> the same "pie", that "part of government" can figure out how best
>>>> to shuffle resources between the "providers" to meet the ACTUAL
>>>> needs.
>>>
>>> It is a national government vs local government issue.
>>
>> Ah, so *different* governments, not different DEPARTMENTS (agencies)
>> in the *same* government. (Of course, to the tax payer, it's still
>> The Government)
>
> Exactly but they are from different pots of money. The problem is that central
> government has drastically cut local government funding.
<frown> I think you just added another issue to complicate my understanding.
The *central* government (the equivalent of our "federal gummit") is the
source of funds for the *local* gummits?
(I'm having a hard time deciding what our equivalent to your "local gummit"
would be -- a state? county? city? etc.)
Here, funding 9and sources of funding) originate at many different levels
of The Government (an indirect reference to my earlier claim that they are
DIFFERENT gummits).
The Federal gummit ("Washington DC") imposes taxes in the form of income tax,
excise taxes (on certain classes of products), fees, etc. Much of this is
administered (spent) by the Feds. Some is passed out to the "States" for
various purposes.
Each State government has additional, independent sources of funds. Many
states have income taxes, or, (sales) taxes on certain services/products.
They administer those funds and/or disburse portions to other "sub"governments
within the state.
Counties have their own governments and own taxing means -- sales taxes,
property taxes, etc. -- to augment monies received from the state gummit
(in addition to "grants" from the federal gummit).
Cities have their own gummits and funding sources that they administer
(sales tax and property tax as well as fees on services). Some cities
also have "head taxes" that amount to a sort of income tax.
It is usually clear who provides a *service*; but, who (where) provides
the funding source for that may be more complicated. And, can change, over
time.
E.g., our property taxes used to cover the costs of trash pickup. Until the
city decided they could spin that off as a separate "fee" (of course, this is
done to allow TOTAL revenues to be increased as the property tax doesn't
DECREASE by the amount of the trash fee :> )
Our police are funded by property taxes, federal grants, private grants,
state taxes/grants, and local sales tax. So, I know who *hires* the cops
but no idea how much of his salary comes out of my pocket -- and via which
taxing mechanism. (Monies aren't typically explicitly "earmarked")
I would assume your "local gummits" have some sort of "local" revenue source?
Or, are you saying they are (largely) funded from above?
>>> Not surprisingly there are territorial turf wars at each of these
>>> boundaries
>>> with creative bean counters playing "pass the parcel".
>>
>> <frown> I guess I can't understand the (apparently common!) "need for a
>> bed".
>
> Because people are living much longer and ultimately end up frail and disabled
> or demented - therefore not safe to go home.
But people are living much longer here, as well. It is rare for someone to
be DISALLOWED to return to their home (house, apartment). And, I can't
think of anyone opting to pay for them to "reside" in a hospital setting.
(I.e., why don't your hospitals *pay* for the CHEAPER beds in those other
facilities as a means of cutting THEIR costs of warehousing those folks?)
>> If I call an ambulance in response to a medical emergency <somewhere>, the
>> paramedics will do some on-site care and, possibly, arrange to transport me
>> to a "nearby" hospital. The choice of hospital is typically theirs and
>> can be driven by the nature of my "problem" as well as the current
>> "availability" of staff/resources at the various likely hospitals (e.g.,
>> there
>> are two or three equidistant from my home; others if I want to tack a
>> few more
>> travel miles on). E.g., most trauma care is provided at just *one* of the
>> local hospitals (in a metro area of 500K+)
>>
>> If a hospital is "on divert" (rejecting all but CRITICAL patients), they
>> will
>> be elided from the mix. I suspect if I were to drive myself to such a
>> hospital, I would be cared for -- though perhaps with much longer wait
>> times.
>>
>> Once in the ER, triage determines my place in the queue. I may end up
>> waiting for a bed in the ER department -- unless it is a *real* emergency
>> in which case I may be treated on a gurney in the hallway, etc.
>>
>> I can be discharged directly from the ER *or* admitted into the hospital
>> therefrom.
>
> In the UK for patients presenting with complex multiple problems though most
> likely one main acute problem they go to the emergency assessment unit where a
> multidisciplinary team look at the best approach.
The same happens, here. EVERY hospital has these facilities. Many
"urgent care" facilities operate along the same lines -- including
referring folks to more capable facilities (e.g., if you present
with a gunshot wound to the head, they are NOT going to treat you
beyond keeping you alive until the ambulance can fetch you)
>> When my care is complete, I would typically be discharged to my *home*;
>> an inquiry made as to whether or not someone can drive me home, etc.
>>
>> In some small number of cases, you might be discharged to a continuing care
>> facility (convalescent home, nursing home, etc.).
>
> Ageing population so that this is invariably the dominant pathway.
Yes, but *our* population is also aging. Are *your* demographics
that different from ours?
I see a 0.8% figure for >= 90 UK but can't quickly find a
corresponding one for the US (0.44% @ 85+ = 4M souls).
Returning to the 90+ source and adding in the 80-89 figure
suggests 2.3% (1.4M souls)
[NB: data sources differ; UK not, just England]
Wow! What a bunch of old geysers! ;) That might explain the need for
places to warehouse folks. OTOH, its a screwy statistic as out population
is 10 times yours and the over 85 crowd is 3 times yours (instead of 10X)
in terms of body count.
>> By far, most discharges are to your own home (or apartment) -- even if you
>> "live alone". My neighbor was hauled off late one night with a heart
>> attack.
>> And, returned home a few days later -- "his problem" if he thinks he needs
>> help around the house. Likewise, neighbors who've had hips replaced,
>> shoulders, back surgery, neck surgery, amputations, etc.
>>
>> They typically will receive "a la carte" continuing care/therapy on an
>> out-patient basis in the days/weeks thereafter. But, The System avoids
>> the cost of housing them during that period.
>
> It is the same in the UK but they are somewhat more careful about the welfare
> of the people they discharge from hospital than in the USA if things are truly
> as you describe.
I'm thinking of my CHF friend. He was in his early (?) 80's when he gave up
the ghost. He'd be released from the hospital, spend a week or two abusing
his diet until his body had swelled enough to make breathing and moving
difficult. Then, take an ambulance BACK to the hospital. This happened
several times (with decreasing intervals between "visits" and lengthening
"stays") in the last year of his life.
Clearly, he was unable to take proper care of himself at home...
>> Prolonged hospital stays are typically in the final stages of life
>> (folks complaining they don't want to DIE in the hospital -- but
>> death being almost immediately assured if they were discharged)
>
> Therein lies the problem hence bed blocking in the NHS.
>
>> There is a lot of pressure on hospitals to discharge people earlier instead
>> of later. Insurers don't want to be paying for "expensive hotel rooms".
>> Many surgical procedures are now done without an overnight stay.
>>
>> [This is kinda a Good Thing cuz being IN the hospital is one of the bigger
>> risk factors (infections, etc.)]
>>
>> I just don't see the Magic Bullet that makes "single payer" any better
>> than "private health care" (at least the US form thereof). I suspect
>> this option will see renewed interest when Trumpcare (whatever it
>> becomes) also proves inadequate to tackling the healthcare cost crisis.
>> So, I'd like to have a leg up on the likely downsides that come with
>> it (based on existing implementations, elsewhere) instead of the
>> inevitable EMOTIONAL appeals that rely on specious reasoning ("Gee,
>> that SOUNDS like it might be true, therefore, it IS!")
>
> Mostly it just works. Some places are better than others. Chances are that I
> may not get value for money out of my contributions to the NHS scheme but I am
> *GLAD* of that. We buried one of my friends who has been struggling with MS for
> three decades this week. She certainly got her and perhaps 500 other peoples
> money's worth of NHS care which kept her alive this long. What would happen to
> someone in the USA who was struck down by such an ailment and so eventually
> lost their job?
Worked with a guy many years ago who (eventually) succumbed to MS. While
employed, the company's healthcare covered his costs for care. I suspect
he resorted to a combination of COBRA (allows you to continue your employers
health care coverage "out of pocket" for 18 months after leaving a job)
and social security disability benefits.
Another friend who died from ALS had purchased "long term care" insurance
(one of the best "investments" she made) so they covered most of her costs
(incl in-home care).
> The NHS treats people according to their medical needs and by averaging the
> risk over the entire population can treat everyone and not just a favoured few
> who can afford extortionately priced private insurance.
But "ability to pay" doesn't correlate with "health" -- just the amount
of care of which you can avail yourself. Likewise, *price* of care doesn't
correlate with quality of life, etc.
(There was a concerted effort to convince folks of the equivalent efficacy
of ethical drugs, regardless of source. Folks initially considered "generic"
drugs as somewhat inferior to the innovator's variant)
Here, the insurer is just the *payer*; it can't "practice medicine" -- that
is reserved for licensed doctors.
So, if your insurance policy covers a particular illness, treatment, etc.
AND you can get a doctor to recommend that treatment, then you get it
and the policy pays for it. The insurance company doesn't say, "you're
85 and have 4 other comorbidities so we're not going to pay for this
treatment".
Medicare is similar -- except that the "terms of the policy" have these
sorts of constraints built in.
In either case, you can obtain whatever treatment you can "convince" a
doctor to provide if you can pay that doctor directly. Many might resist
"prescribing" a particular treatment plan but there are lots of doctors
and ANY one can act as your source! (CASH talks)
>> And, how you regulate health care delivery ("rationing") will differ
>> based on the mechanisms available in each system (here, not having
>> insurance
>> is one way to restrict access to healthcare -- but not the NEED for that
>> care or the externalities arising from its "denial"!)
>>
>> ISTM that the only way to get those costs under control is to limit the
>> *need* for them. I.e., have a healthier population. But, perversely,
>> that tends to require MORE services (at least in the short term) to
>> "top off" the health of the population. Passing "some" of the cost on
>> to the patient is demonstrably NOT an effective way to alter behavior!
>
> A healthier population is still a problem. The only thing certain in life is
> death and taxes. Eventually even if you are fit and healthy you will fall and
> break a bone or some internal organ will fail.
Of course. But, expectations can change based on typical longevity.
I doubt many folks (today) would complain if they took a fall at 115
and died in short order, thereafter -- having been healthy up to that
point. OTOH, there re audible gasps when someone in their 50's dies.
Esp if a result of something that could have been "treated" or
"managed" -- medically or with lifestyle changes.
The problem we face (US) is chronic illnesses that affect quality
of life AND cost of care. And, because we've found treatments that
can allow people to live WITH these problems for long periods of time,
the costs soar.
>> [I wonder what it would be like if you told smokers (e.g.) "We WON'T cover
>> any of the following ailments associated with smoking". Or, the obese
>> (e.g.) "We WON'T cover any of the following ailments associated with
>> obesity".
>> I suspect even that wouldn't be enough to verifiably alter behaviors]
>
> Rationing access to surgery for those with BMI>30 is one such policy but it is
> controversial (and pretty stupid if the surgery is to apply a stomach band as
> treatment for being overweight!).
But, people complain that they are being unfairly discriminated against!
Tell someone he has to buy *two* airline seats and he'll fly another carrier.
His "freedom" to hang over into the seat adjoining has been impacted.
Tell him he can't have a particular medical procedure and he'll be calling the
local newspapers to complain.
When there are lots of people like (or similar) to him in society at large,
what do you do? He's got "sympathy": "How do I know that they won't deny
*me* that care -- I know I'm 'a few pounds' overweight...?"
That's why its so much easier to pick on drug addicts (treatments for
overdoses), homosexuals (AIDS/HIV), etc. -- people "lacking in some moral
capacity" (surely over-eating isn't such a failing??)
>> Or, to alter the *expectations* people have of them ("You have cancer.
>> Start making your final arrangements...")
>
> Plenty of cancers are survivable these days if caught early enough.
But if access to health care is gated (by policy, price, etc.) then
how do you "catch it"... early?
>> I just don't see how changing the payment (*or* provisioning) aspect will
>> do anything to change the trajectory of healthcare costs.
>
> The trajectory will always be upwards (unless we completely ruin the power of
> antibiotics to knock down infections). We can cure more things now and keep
> people alive who would not have survived in the past.
Exactly. And, people *expect* it. "Don't you have a PILL for that?"
They think that whatever the malady, regardless of their role in its
genesis, there WILL be a magic bullet. And, that magic bullet WILL allow
them to continue life as usual.
A neighbor is diabetic. Both are significantly obese. The canister set
that adorns their kitchen counter is filled with midget candy bars (milky
way, snickers, etc.). Really??? You CAN'T LIVE WITHOUT THOSE?? Yet
the spare bedroom full of exercise equipment is covered in a thick layer
of dust...
> It is now rare for people to die in a few days from blood poisoning arising
> from a minor infection like they did before penicillin. MRSA and other hospital
> acquired infections are changing that though...
[toc] | [prev] | [next] | [standalone]
| From | Martin Brown <'''newspam'''@nezumi.demon.co.uk> |
|---|---|
| Date | 2017-05-23 10:21 +0100 |
| Message-ID | <og0uts$1j0g$1@gioia.aioe.org> |
| In reply to | #461075 |
On 20/05/2017 23:58, Don Y wrote:
> On 5/20/2017 12:36 AM, Martin Brown wrote:
>> On 19/05/2017 20:56, Don Y wrote:
>>> HepC can be cured (in most patients) with Sovaldi. But, its an
>>> expensive
>>> treatment (in the US) -- as an alternative to an eventual liver
>>> transplant.
>>> Amazingly, the treatment cost is only high in the USA:
>>> <http://www.chicagotribune.com/business/ct-drug-price-sofosbuvir-sovaldi-india-us-20160104-story.html>
>>>
>>
>> No wonder if the drugs companies can charge what they like!
>
> To be fair, they are charging what they feel they can get away with!
ie what the market will stand and like Nike and Addidas they have
suckers in American queueing up for the branded product and ignoring
equally good generic alternatives.
>
> Companies worry about the dollars on their bottom line; not their "moral
> constraints". The days of the Salks are long past.
Perhaps the capitalism has lost its way and we are back in a devil take
the hindmost kill or be killed culture. The UK still has some businesses
with an ethical stance on the treatment of their workers.
>> We are having similar bother with a few unusual off patent drugs and
>> US style
>> creative accountancy price gouging in the UK market now:
>>
>> https://www.gov.uk/government/news/cma-fines-pfizer-and-flynn-90-million-for-drug-price-hike-to-nhs
>>
>>
>> But we do have a competition authority to kick them in the teeth.
>
> OTOH, they can simply decide "not to play" -- exit YOUR market and engage
> in a publicity campaign to let your patients (voters) know that there IS
> a treatment but that your gummit doesn't want to provide it to them.
That would backfire spectacularly on the company that tried it here.
>
> You can spin an issue any way you want. Drug developers can claim they've
> taken a risk, made an investment, etc. and SHOULD be rewarded -- else they
> won't bother developing new products.
One really serious problem is developing new antibiotics. The new ones
will be held in reserve and *NOT* used for as long a possible meaning
that all the R&D costs and no foreseeable payback for the company. So
guess what they don't invest much in new antibiotics. We will pay dearly
for this mistake (and also for pumping them into cattle to make them get
fatter quicker).
>
> It's hard to try to imagine a set of circumstances that would cause folks
> to "do the right thing" (whatever THAT might be) in the face of
> self-interests
> to the contrary.
There was a time when industrialists and businessmen in the UK had a
conscience - most but not all of them were Quakers and founded some
major companies with relatively benign (for the time) conditions of
employment. Notable among the was Robert Owen:
https://en.wikipedia.org/wiki/Robert_Owen
These days commerce is dominated by spivs and speculators who are out to
make money and have no ethics or principles beyond selfish greed.
>>>> It is a national government vs local government issue.
>>>
>>> Ah, so *different* governments, not different DEPARTMENTS (agencies)
>>> in the *same* government. (Of course, to the tax payer, it's still
>>> The Government)
>>
>> Exactly but they are from different pots of money. The problem is that
>> central
>> government has drastically cut local government funding.
>
> <frown> I think you just added another issue to complicate my
> understanding.
> The *central* government (the equivalent of our "federal gummit") is the
> source of funds for the *local* gummits?
It is the source of some of the funds for local government. Local in
this sense is counties about the size of your states and then below them
another tier of districts and archaic parishes.
> (I'm having a hard time deciding what our equivalent to your "local gummit"
> would be -- a state? county? city? etc.)
UK County ~ US State
UK District ~ US County
A few of the biggest cities also have elected mayors these days with a
budget at their disposal but this is rare. A man in a monkey suit got
elected as Mayor of Hartlepool to spite the government (a place which
once hung a monkey as a French spy because it didn't speak English) -
though he proved to be quite good at it and served 3 terms.
> Here, funding 9and sources of funding) originate at many different levels
> of The Government (an indirect reference to my earlier claim that they are
> DIFFERENT gummits).
>
> The Federal gummit ("Washington DC") imposes taxes in the form of income
> tax,
> excise taxes (on certain classes of products), fees, etc. Much of this is
> administered (spent) by the Feds. Some is passed out to the "States" for
> various purposes.
Same here although the names are different.
> Each State government has additional, independent sources of funds. Many
> states have income taxes, or, (sales) taxes on certain services/products.
> They administer those funds and/or disburse portions to other
> "sub"governments within the state.
The main local income that the local governments get is the Poll Tax to
provide local services and other amenities. But they are in practice
heavily dependent on national government to give them funding.
> I would assume your "local gummits" have some sort of "local" revenue
> source?
> Or, are you saying they are (largely) funded from above?
The latter. They have some but it is a drop in the ocean compared with
the things they are tasked with providing. The national component of
local government funding is roughly 2/3 of their budget. There is no
equivalent of US local sales taxes.
>>>> Not surprisingly there are territorial turf wars at each of these
>>>> boundaries
>>>> with creative bean counters playing "pass the parcel".
>>>
>>> <frown> I guess I can't understand the (apparently common!) "need for a
>>> bed".
>>
>> Because people are living much longer and ultimately end up frail and
>> disabled
>> or demented - therefore not safe to go home.
>
> But people are living much longer here, as well. It is rare for someone to
> be DISALLOWED to return to their home (house, apartment). And, I can't
> think of anyone opting to pay for them to "reside" in a hospital setting.
>
> (I.e., why don't your hospitals *pay* for the CHEAPER beds in those other
> facilities as a means of cutting THEIR costs of warehousing those folks?)
Because there are no beds in suitable nursing homes available to buy!
The private sector nursing homes are run with 100% occupancy rates and
no spare capacity to obtain maximum ROI. There was a time when the state
did run some nursing homes but they were sold off (and in some cases
then closed down to create a shortfall and increase prices).
>>> When my care is complete, I would typically be discharged to my *home*;
>>> an inquiry made as to whether or not someone can drive me home, etc.
>>>
>>> In some small number of cases, you might be discharged to a
>>> continuing care
>>> facility (convalescent home, nursing home, etc.).
>>
>> Ageing population so that this is invariably the dominant pathway.
>
> Yes, but *our* population is also aging. Are *your* demographics
> that different from ours?
>
> I see a 0.8% figure for >= 90 UK but can't quickly find a
> corresponding one for the US (0.44% @ 85+ = 4M souls).
> Returning to the 90+ source and adding in the 80-89 figure
> suggests 2.3% (1.4M souls)
>
> [NB: data sources differ; UK not, just England]
>
> Wow! What a bunch of old geysers! ;) That might explain the need for
> places to warehouse folks. OTOH, its a screwy statistic as out population
> is 10 times yours and the over 85 crowd is 3 times yours (instead of 10X)
> in terms of body count.
But as a proportion of the working age population it is much higher -
though not as high as it is in Japan.
>> The NHS treats people according to their medical needs and by
>> averaging the
>> risk over the entire population can treat everyone and not just a
>> favoured few
>> who can afford extortionately priced private insurance.
>
> But "ability to pay" doesn't correlate with "health" -- just the amount
> of care of which you can avail yourself. Likewise, *price* of care doesn't
> correlate with quality of life, etc.
> (There was a concerted effort to convince folks of the equivalent efficacy
> of ethical drugs, regardless of source. Folks initially considered
> "generic"
> drugs as somewhat inferior to the innovator's variant)
In the UK most people are unaware of the brand names of such drugs so
the problem of wanting medical pill versions of RoundUp(TM) instead of
generic glyphosate simply do not arise. UK citizens are much less
brandname pill popping hypochondriacs than our US cousins.
>>> ISTM that the only way to get those costs under control is to limit the
>>> *need* for them. I.e., have a healthier population. But, perversely,
>>> that tends to require MORE services (at least in the short term) to
>>> "top off" the health of the population. Passing "some" of the cost on
>>> to the patient is demonstrably NOT an effective way to alter behavior!
>>
>> A healthier population is still a problem. The only thing certain in
>> life is
>> death and taxes. Eventually even if you are fit and healthy you will
>> fall and
>> break a bone or some internal organ will fail.
>
> Of course. But, expectations can change based on typical longevity.
> I doubt many folks (today) would complain if they took a fall at 115
> and died in short order, thereafter -- having been healthy up to that
> point. OTOH, there re audible gasps when someone in their 50's dies.
> Esp if a result of something that could have been "treated" or
> "managed" -- medically or with lifestyle changes.
>
> The problem we face (US) is chronic illnesses that affect quality
> of life AND cost of care. And, because we've found treatments that
> can allow people to live WITH these problems for long periods of time,
> the costs soar.
Well you will have supersize portions and junk food on tap everywhere.
>>> [I wonder what it would be like if you told smokers (e.g.) "We WON'T
>>> cover
>>> any of the following ailments associated with smoking". Or, the obese
>>> (e.g.) "We WON'T cover any of the following ailments associated with
>>> obesity".
>>> I suspect even that wouldn't be enough to verifiably alter behaviors]
>>
>> Rationing access to surgery for those with BMI>30 is one such policy
>> but it is
>> controversial (and pretty stupid if the surgery is to apply a stomach
>> band as
>> treatment for being overweight!).
>
> But, people complain that they are being unfairly discriminated against!
> Tell someone he has to buy *two* airline seats and he'll fly another
> carrier.
If the carriers all do it then they will have no choice.
> His "freedom" to hang over into the seat adjoining has been impacted.
> Tell him he can't have a particular medical procedure and he'll be
> calling the
> local newspapers to complain.
>
> When there are lots of people like (or similar) to him in society at large,
> what do you do? He's got "sympathy": "How do I know that they won't deny
> *me* that care -- I know I'm 'a few pounds' overweight...?"
>
> That's why its so much easier to pick on drug addicts (treatments for
> overdoses), homosexuals (AIDS/HIV), etc. -- people "lacking in some moral
> capacity" (surely over-eating isn't such a failing??)
We haven't reached the point in the UK where being considerably
overweight is normal.
>>> Or, to alter the *expectations* people have of them ("You have cancer.
>>> Start making your final arrangements...")
>>
>> Plenty of cancers are survivable these days if caught early enough.
>
> But if access to health care is gated (by policy, price, etc.) then
> how do you "catch it"... early?
Screening the more common ones and hope that doctors recognise the
symptoms and refer their patients for tests. Otherwise fit men are a bit
of a problem in this respect as they present with symptoms too late.
>
>>> I just don't see how changing the payment (*or* provisioning) aspect
>>> will
>>> do anything to change the trajectory of healthcare costs.
>>
>> The trajectory will always be upwards (unless we completely ruin the
>> power of
>> antibiotics to knock down infections). We can cure more things now and
>> keep
>> people alive who would not have survived in the past.
>
> Exactly. And, people *expect* it. "Don't you have a PILL for that?"
> They think that whatever the malady, regardless of their role in its
> genesis, there WILL be a magic bullet. And, that magic bullet WILL allow
> them to continue life as usual.
>
> A neighbor is diabetic. Both are significantly obese. The canister set
> that adorns their kitchen counter is filled with midget candy bars (milky
> way, snickers, etc.). Really??? You CAN'T LIVE WITHOUT THOSE?? Yet
> the spare bedroom full of exercise equipment is covered in a thick layer
> of dust...
Sigh. You can't prevent people doing stupid things. Over here most (but
sadly not all) diabetics are pretty careful about what they eat.
--
Regards,
Martin Brown
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| From | Don Y <blockedofcourse@foo.invalid> |
|---|---|
| Date | 2017-05-23 13:26 -0700 |
| Message-ID | <og25mc$3rq$1@dont-email.me> |
| In reply to | #461334 |
On 5/23/2017 2:21 AM, Martin Brown wrote:
> On 20/05/2017 23:58, Don Y wrote:
>> On 5/20/2017 12:36 AM, Martin Brown wrote:
>>> On 19/05/2017 20:56, Don Y wrote:
>
>>>> HepC can be cured (in most patients) with Sovaldi. But, its an
>>>> expensive
>>>> treatment (in the US) -- as an alternative to an eventual liver
>>>> transplant.
>>>> Amazingly, the treatment cost is only high in the USA:
>>>> <http://www.chicagotribune.com/business/ct-drug-price-sofosbuvir-sovaldi-india-us-20160104-story.html>
>>>
>>> No wonder if the drugs companies can charge what they like!
>>
>> To be fair, they are charging what they feel they can get away with!
>
> ie what the market will stand and like Nike and Addidas they have suckers in
> American queueing up for the branded product and ignoring equally good generic
> alternatives.
Actually, the difference between ethical manufacturers has pretty much
disappeared. Folks now tend to realize generics to be equivalent (both
in efficacy and manufacturing standards) as their innovator counterparts.
(some "inert" other characteristics may differ -- e.g., dissolution time,
shape/color/size, etc. As such, the "patient information sheet" typically
dispensed with each product will identify the visual characteristics
of the tablet from THIS manufacturer -- cuz it may not resemble the
tablet that was dispensed the last time you filled THIS Rx)
Most Rx forms (paper and electronic) now include a box that the prescriber
can tick that "allows (generic) substitutions". And, many prescribers
don't use "brand names" on their prescriptions. Most insurance plans
will only reimburse for the cost of the generic so foolish to willingly pay
for a more expensive version of the (functionally) same item!
OTOH, pharma can advertise their products, now. This includes the
(brand) name of the product, its indications and, almost always /sotto voce/,
the contraindications and side effects. The goal, obviously, being to
get the PATIENT to suggest the product to their provider -- instead of relying
on the provider to initiate the dosing.
>> Companies worry about the dollars on their bottom line; not their "moral
>> constraints". The days of the Salks are long past.
>
> Perhaps the capitalism has lost its way and we are back in a devil take the
> hindmost kill or be killed culture. The UK still has some businesses with an
> ethical stance on the treatment of their workers.
There is a high degree of variability -- both in the "corporate attitude"
and the attitude of individual workers.
Some firms fold the costs of keeping customers happy into their "cost of
doing business". E.g., most folks would rate Costco's customer experience
highly. No hassles returning items, helpful/friendly staff, etc. OTOH,
there's no haggling over prices -- they are what they are.
I recall buying a copy of AutoCAD in the 80's and haggling with the dealer
over price. Finally settling on a price "with no support" -- made sense
to me as I didn't need help using the product and surely wouldn't want to PAY
for that help without using it. When I encountered a bug in the AME package,
the dealer was quick to remind me of the "no support" condition of the sale.
"Look, I'm not asking YOU to tell me that I'm doing something wrong.
I just want you to pass this tiny demo file that I have carefully created
along to the folks at AutoDesk so they can *see* the bug in their product."
A week later, he called me to pick up another set of floppies and another
license key. Did I get more "support" than I paid for? Or, was this EXACTLY
the usage case that we'd discussed?
>>> We are having similar bother with a few unusual off patent drugs and
>>> US style
>>> creative accountancy price gouging in the UK market now:
>>>
>>> https://www.gov.uk/government/news/cma-fines-pfizer-and-flynn-90-million-for-drug-price-hike-to-nhs
>>>
>>> But we do have a competition authority to kick them in the teeth.
>>
>> OTOH, they can simply decide "not to play" -- exit YOUR market and engage
>> in a publicity campaign to let your patients (voters) know that there IS
>> a treatment but that your gummit doesn't want to provide it to them.
>
> That would backfire spectacularly on the company that tried it here.
Except for the folks who are afflicted with the disease/illness. While they
might grumble that the NHS doesn't cover the care (because the provider
doesn't want to meet the NHS's terms), that doesn't mean they won't try to
figure out how to GET it for themselves!
A certain part of business relies on understanding the psychology of your
customers. And, adjusting your practices (e.g., prices) to maximize their
benefit to *you*.
E.g., pharma knows people WON'T make significant lifestyle changes -- esp
if they can develop a "pill" that will allow them to continue their old,
familiar practices/habits. Trade money for behavioral inertia -- esp if
its someone else's money (vs. YOUR behavioral adjustments)!
>> You can spin an issue any way you want. Drug developers can claim they've
>> taken a risk, made an investment, etc. and SHOULD be rewarded -- else they
>> won't bother developing new products.
>
> One really serious problem is developing new antibiotics. The new ones will be
> held in reserve and *NOT* used for as long a possible meaning that all the R&D
> costs and no foreseeable payback for the company. So guess what they don't
> invest much in new antibiotics. We will pay dearly for this mistake (and also
> for pumping them into cattle to make them get fatter quicker).
Of course! The same is true in other industries. As a kid, I developed a
little tool, disclosed it to the manufacturer. Was surprised (young/naive)
to see that they had an established process by which they evaluated the tool,
its impact on sales of OTHER products/tools AND its value to the company...
and, ultimately, to me as the "inventor".
"We surely don't want to start selling Sandpaper2.0 and cut into sales
of Sandpaper1.0 -- until we are forced to do so by a competitor developing
a product that steals market share from our 1.0 product! We know how to
make Sandpaper2.0 so we'll just keep it in the vault, for now..."
>> It's hard to try to imagine a set of circumstances that would cause folks
>> to "do the right thing" (whatever THAT might be) in the face of
>> self-interests
>> to the contrary.
>
> There was a time when industrialists and businessmen in the UK had a conscience
> - most but not all of them were Quakers and founded some major companies with
> relatively benign (for the time) conditions of employment. Notable among the
> was Robert Owen:
>
> https://en.wikipedia.org/wiki/Robert_Owen
>
> These days commerce is dominated by spivs and speculators who are out to make
> money and have no ethics or principles beyond selfish greed.
That wasn't uncommon in the past, here, either. Some early industrialists
built their fortunes on the backs of The Multitudes.
Here, the most discouraging trend is the short-sightedness of "investments"
and business decisions. The need for more immediate (if not instant)
gratification, the aversion to risk esp on any sort of extended time scale,
etc. (though this largely mirrors how individuals tend to behave)
Its amusing when folks are told to "invest" in an education, etc. -- and
the timeframes are considerably longer than what BUSINESS would consider
as an "investment".
>> Each State government has additional, independent sources of funds. Many
>> states have income taxes, or, (sales) taxes on certain services/products.
>> They administer those funds and/or disburse portions to other
>> "sub"governments within the state.
>
> The main local income that the local governments get is the Poll Tax to provide
> local services and other amenities. But they are in practice heavily dependent
> on national government to give them funding.
The Feds pay for very little of the services that we use on a daily basis.
Property taxes and sales taxes cover most of the costs for services
that aren't directly covered with "fees".
Non-local income sources are subject to being withdrawn on the whims of
those who have control over them. And, rarely do the funds flow back to the
same geographical areas that generated them. I.e., folks in my city may
end up paying $X in gas (petrol) taxes and receive only $Y (< X) in
services/products paid for by those taxes.
>>>>> Not surprisingly there are territorial turf wars at each of these
>>>>> boundaries
>>>>> with creative bean counters playing "pass the parcel".
>>>>
>>>> <frown> I guess I can't understand the (apparently common!) "need for a
>>>> bed".
>>>
>>> Because people are living much longer and ultimately end up frail and
>>> disabled
>>> or demented - therefore not safe to go home.
>>
>> But people are living much longer here, as well. It is rare for someone to
>> be DISALLOWED to return to their home (house, apartment). And, I can't
>> think of anyone opting to pay for them to "reside" in a hospital setting.
>>
>> (I.e., why don't your hospitals *pay* for the CHEAPER beds in those other
>> facilities as a means of cutting THEIR costs of warehousing those folks?)
>
> Because there are no beds in suitable nursing homes available to buy! The
Ah! Then, why not invest in building such facilities? If only to light
a fire under the private sector ("Hey, if you guys can't address this need,
we'll go into competition with you!")
> private sector nursing homes are run with 100% occupancy rates and no spare
> capacity to obtain maximum ROI. There was a time when the state did run some
> nursing homes but they were sold off (and in some cases then closed down to
> create a shortfall and increase prices).
>>> The NHS treats people according to their medical needs and by
>>> averaging the
>>> risk over the entire population can treat everyone and not just a
>>> favoured few
>>> who can afford extortionately priced private insurance.
>>
>> But "ability to pay" doesn't correlate with "health" -- just the amount
>> of care of which you can avail yourself. Likewise, *price* of care doesn't
>> correlate with quality of life, etc.
>
>> (There was a concerted effort to convince folks of the equivalent efficacy
>> of ethical drugs, regardless of source. Folks initially considered
>> "generic"
>> drugs as somewhat inferior to the innovator's variant)
>
> In the UK most people are unaware of the brand names of such drugs so the
> problem of wanting medical pill versions of RoundUp(TM) instead of generic
> glyphosate simply do not arise. UK citizens are much less brandname pill
> popping hypochondriacs than our US cousins.
(see above) I think most folks are comfortable reciting a UNIQUE "brand name"
for a drug than trying to recall a scientific name of a compound. Its
more common for folks to say "Advil" or "Tylenol" than "ibuprofen" or
"acetaminophen". Similarly, folks refer to "Kleenex" and "Xerox" instead
of "facial tissue" and "photocopy".
In each case, rarely would the person requesting the product complain that
"This isn't Advil (TmReg)" or "This isn't Kleenex!"
>>>> ISTM that the only way to get those costs under control is to limit the
>>>> *need* for them. I.e., have a healthier population. But, perversely,
>>>> that tends to require MORE services (at least in the short term) to
>>>> "top off" the health of the population. Passing "some" of the cost on
>>>> to the patient is demonstrably NOT an effective way to alter behavior!
>>>
>>> A healthier population is still a problem. The only thing certain in
>>> life is
>>> death and taxes. Eventually even if you are fit and healthy you will
>>> fall and
>>> break a bone or some internal organ will fail.
>>
>> Of course. But, expectations can change based on typical longevity.
>> I doubt many folks (today) would complain if they took a fall at 115
>> and died in short order, thereafter -- having been healthy up to that
>> point. OTOH, there re audible gasps when someone in their 50's dies.
>> Esp if a result of something that could have been "treated" or
>> "managed" -- medically or with lifestyle changes.
>>
>> The problem we face (US) is chronic illnesses that affect quality
>> of life AND cost of care. And, because we've found treatments that
>> can allow people to live WITH these problems for long periods of time,
>> the costs soar.
>
> Well you will have supersize portions and junk food on tap everywhere.
We also have nutritious foods available (almost) everywhere. But, they
tend to be more expensive -- in terms of direct product costs AND the
associated (in)convenience. I can't eat a piece of salmon while driving
to work -- but, I can wolf down a battered, fried piece of (questionable)
cod held between two slices of bread!
And, I doubt many would complain if given a "supersize" portion of salmon
("Can you wrap up the leftovers for me, please? I'll reheat it and have
it for lunch, tomorrow...")
In general (IME) things tend to be more rushed, here. I recall my first
visit to England and spending what seemed like FOREVER in the executive dining
room: "Sheesh! Where the hell is the food? When can I get back to work
so I can get back *home*??"
>>>> [I wonder what it would be like if you told smokers (e.g.) "We WON'T
>>>> cover
>>>> any of the following ailments associated with smoking". Or, the obese
>>>> (e.g.) "We WON'T cover any of the following ailments associated with
>>>> obesity".
>>>> I suspect even that wouldn't be enough to verifiably alter behaviors]
>>>
>>> Rationing access to surgery for those with BMI>30 is one such policy
>>> but it is
>>> controversial (and pretty stupid if the surgery is to apply a stomach
>>> band as
>>> treatment for being overweight!).
>>
>> But, people complain that they are being unfairly discriminated against!
>> Tell someone he has to buy *two* airline seats and he'll fly another
>> carrier.
>
> If the carriers all do it then they will have no choice.
Yes, but no one wants to be the FIRST to do so! And, if they all "get
together" and "conspire" to do such a thing, it smells of collusion...
esp if it can be seen as a way for them to charge more for the "same"
service!
The subtler way is to quietly put into place such a policy (knowing
full well that it will quickly become public knowledge) *and*, simultaneously,
highlight "enhanced comfort" for the flyers that don't need two seats and
won't be subjected to sitting adjacent to someone whose "body floweth over".
As customers move away from the first carrier to avoid the double seat charge,
the discomfort of the rest of the passengers flying on those carriers
increases until they find the "enhanced comfort" offer more appealing.
But, this is a gamble on the part of the business. And, may take time to
realize any returns. AND, if it just causes your competitors to adopt
the same policy, you haven't gained any advantage!
>> His "freedom" to hang over into the seat adjoining has been impacted.
>> Tell him he can't have a particular medical procedure and he'll be
>> calling the
>> local newspapers to complain.
>>
>> When there are lots of people like (or similar) to him in society at large,
>> what do you do? He's got "sympathy": "How do I know that they won't deny
>> *me* that care -- I know I'm 'a few pounds' overweight...?"
>>
>> That's why its so much easier to pick on drug addicts (treatments for
>> overdoses), homosexuals (AIDS/HIV), etc. -- people "lacking in some moral
>> capacity" (surely over-eating isn't such a failing??)
>
> We haven't reached the point in the UK where being considerably overweight is
> normal.
They are redesigning aircraft to handle an increase in the average
passenger weight -- both in terms of the space allowed for them
and the fuel budgets, etc. (I think previous target was 150#/seat
and that is now up to 200#/seat -- and that's just an AVERAGE!)
<http://www.aircraftinteriorsinternational.com/articles.php?ArticleID=422>
And, more fluff:
<http://www.travelchannel.com/interests/travel-tips/articles/tips-for-the-weight-challenged-traveler>
<http://www.ifly.com/overweight-passengers>
<https://www.cheapair.com/blog/travel-tips/airline-policies-for-overweight-passengers-traveling-this-summer/>
>>>> Or, to alter the *expectations* people have of them ("You have cancer.
>>>> Start making your final arrangements...")
>>>
>>> Plenty of cancers are survivable these days if caught early enough.
>>
>> But if access to health care is gated (by policy, price, etc.) then
>> how do you "catch it"... early?
>
> Screening the more common ones and hope that doctors recognise the symptoms and
> refer their patients for tests. Otherwise fit men are a bit of a problem in
> this respect as they present with symptoms too late.
Again, if folks don't have access to those providers (because of cost),
there's no way for the provider to ever NOTICE the symptoms!
I had two friends eventuall diagnosed with brain tumors by observations
from their *ophthalmologists*. Many people don't have an optometrist,
let alone an ophthalmologist! They buy "reading glasses" to handle
their vision changes.
>>>> I just don't see how changing the payment (*or* provisioning) aspect
>>>> will
>>>> do anything to change the trajectory of healthcare costs.
>>>
>>> The trajectory will always be upwards (unless we completely ruin the
>>> power of
>>> antibiotics to knock down infections). We can cure more things now and
>>> keep
>>> people alive who would not have survived in the past.
>>
>> Exactly. And, people *expect* it. "Don't you have a PILL for that?"
>> They think that whatever the malady, regardless of their role in its
>> genesis, there WILL be a magic bullet. And, that magic bullet WILL allow
>> them to continue life as usual.
>>
>> A neighbor is diabetic. Both are significantly obese. The canister set
>> that adorns their kitchen counter is filled with midget candy bars (milky
>> way, snickers, etc.). Really??? You CAN'T LIVE WITHOUT THOSE?? Yet
>> the spare bedroom full of exercise equipment is covered in a thick layer
>> of dust...
>
> Sigh. You can't prevent people doing stupid things. Over here most (but sadly
> not all) diabetics are pretty careful about what they eat.
Its not an indictment of ALL diabetics. The neighbor across the street
is also diabetic -- keeps his weight under control, exercises daily, etc.
I have no problem gifting him (and his family) 8-10 dozen cookies as I
know he understands the risk he takes if he opts to just "indulge himself".
(He will excitedly announce that he rations "just four daily" for himself).
The other neighbor (mentioned above) would eat himself into a sugar
crisis if given the same treats.
(As I don't want to do things that enable people to hurt themselves,
I only offer him treats that aren't as "risky")
But, in the context of health care, I pay for BOTH of these guys'
problems -- in terms of my insurance premium, the resources that
are diverted to handle their avoidable/controllable problem
and their impact on their families, etc. (are you teaching your
kids to adopt the same unhealthy behaviors?).
What, if any, right do I have to constrain their lifestyle choices?
How does that deprive *me* over some measure of controlling *my*
costs?
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| From | rickman <gnuarm@gmail.com> |
|---|---|
| Date | 2017-05-23 17:41 -0400 |
| Message-ID | <og2a3b$iq3$1@dont-email.me> |
| In reply to | #461424 |
Don Y wrote: > > But, in the context of health care, I pay for BOTH of these guys' > problems -- in terms of my insurance premium, the resources that > are diverted to handle their avoidable/controllable problem > and their impact on their families, etc. (are you teaching your > kids to adopt the same unhealthy behaviors?). > > What, if any, right do I have to constrain their lifestyle choices? > How does that deprive *me* over some measure of controlling *my* > costs? Don repeatedly confuses how insurance works when he says, "I pay for BOTH of these guys' problems". He pays for no one's problems, he pays for his own insurance. Insurance is there to pay for *YOUR* costs if you get sick. You don't pay to protect others, you pay to protect yourself. The cost of premiums are set as closely as possible the chance the insurance company incurs in providing that insurance. They can't know who will get ill and who won't, so they use statistics to give them good information on the cost of insuring a group of people all of who must share those costs equally. You are free to find other groups with lower payouts and lower premiums. -- Rick C
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| From | Clifford Heath <no.spam@please.net> |
|---|---|
| Date | 2017-05-24 08:37 +1000 |
| Message-ID | <xR2VA.8216$8u.7408@fx05.iad> |
| In reply to | #461424 |
On 24/05/17 06:26, Don Y wrote: > On 5/23/2017 2:21 AM, Martin Brown wrote: >> On 20/05/2017 23:58, Don Y wrote: >>> On 5/20/2017 12:36 AM, Martin Brown wrote: >>>> On 19/05/2017 20:56, Don Y wrote: >>>> No wonder if the drugs companies can charge what they like! >>> To be fair, they are charging what they feel they can get away with! >> American queueing up for the branded product and ignoring equally good >> generic alternatives. > Actually, the difference between ethical manufacturers has pretty much > disappeared. Folks now tend to realize generics to be equivalent (both > in efficacy and manufacturing standards) as their innovator counterparts. Don, I believe that, but my wife doesn't. Do you have any evidence that the manufacturing standards are the same? Many synthesis steps produce effective and isomeric products in equal quantities. If you have six steps like that, you have 63 parts isomer for every 1 part active ingredient. Even if most are inactive, there's a fair chance that some are not. The issue is not the dose of the active ingredient. It's the likely presence of (differently bioactive) isomers and side products which are unavoidable results of synthesis. Some of these need to be removed. and a manufacturer of generics could save a lot by skimping on it. So that's why I ask the question. Where is the evidence that this isn't happening? Clifford Heath.
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| From | rickman <gnuarm@gmail.com> |
|---|---|
| Date | 2017-05-24 00:45 -0400 |
| Message-ID | <og32ut$gir$1@dont-email.me> |
| In reply to | #461447 |
Clifford Heath wrote: > On 24/05/17 06:26, Don Y wrote: >> On 5/23/2017 2:21 AM, Martin Brown wrote: >>> On 20/05/2017 23:58, Don Y wrote: >>>> On 5/20/2017 12:36 AM, Martin Brown wrote: >>>>> On 19/05/2017 20:56, Don Y wrote: >>>>> No wonder if the drugs companies can charge what they like! >>>> To be fair, they are charging what they feel they can get away with! >>> American queueing up for the branded product and ignoring equally good >>> generic alternatives. >> Actually, the difference between ethical manufacturers has pretty much >> disappeared. Folks now tend to realize generics to be equivalent (both >> in efficacy and manufacturing standards) as their innovator counterparts. > > Don, I believe that, but my wife doesn't. Do you have any evidence > that the manufacturing standards are the same? > > Many synthesis steps produce effective and isomeric products in equal > quantities. If you have six steps like that, you have 63 parts isomer > for every 1 part active ingredient. Even if most are inactive, there's > a fair chance that some are not. > > The issue is not the dose of the active ingredient. It's the likely > presence of (differently bioactive) isomers and side products which > are unavoidable results of synthesis. Some of these need to be removed. > and a manufacturer of generics could save a lot by skimping on it. > > So that's why I ask the question. Where is the evidence that this > isn't happening? I can't quote you chapter and verse, but when purity is an issue, I believe there are standards. BTW, I think you mean "stereoisomers" rather than just isomers. Isomers that aren't stereoisomers are seldom produced in a side reaction as part of a manufacturing process. If they were, there could easily be many more than just 2 produced at each step. Often a reaction using a stereoisomer will produce only one version of the product, not a mixture. Racemic mixtures are more commonly produced when a compound that is not a stereoisomer reacts to produce a stereoisomer. To have many steps like this would be unusual. Drugs are seldom manufactured from base compounds like CO2. Typically a compound much like the final compound is used with small changes using just a few reaction steps. Haven't you seen Breaking Bad? https://www.youtube.com/watch?v=sIs501ktFfQ -- Rick C
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