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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 12 of 14 — ← Prev page 1 … 10 11 [12] 13 14 Next page →
| From | krw@notreal.com |
|---|---|
| Date | 2017-05-23 18:52 -0400 |
| Message-ID | <21f9ictnh8qhl3288h243png73sifc1s3j@4ax.com> |
| In reply to | #461334 |
On Tue, 23 May 2017 10:21:00 +0100, Martin Brown <'''newspam'''@nezumi.demon.co.uk> 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. You act like that's something that's uniquely American. Branding does matter. >> >> 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. No, they are simply providing what people *WANT*. It's a whole lot better than your socialist utopia where you're told what deodorant you can use (see: Bernie Sanders - in case you don't get the reference). <sorry - not sifting through a thousand lines of incoherence>
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| From | Don Y <blockedofcourse@foo.invalid> |
|---|---|
| Date | 2017-05-15 00:52 -0700 |
| Message-ID | <ofbmgn$ikg$1@dont-email.me> |
| In reply to | #460216 |
On 5/14/2017 2:28 AM, Martin Brown wrote:
> On 13/05/2017 23:10, Don Y wrote:
>> 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.
Where does the *patient* fit into this?
I.e., here, the patient has the final say (assuming he is competent, conscious
and hasn't appointed a health care PoA). In the past year, I've had friends
who clung to life to the detriment of their families' (financial,
psychological and emotional) well being. And, others who opted for a more
expeditious exit to the dismay of their families (who wanted to cling to THEM!)
> 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.
So, if a person typically dies over the course of 6-24 months, the court is
largely out of the picture.
> 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.
A patient is almost always offered "hope". And, even when the outcome is
inarguable (i.e., only the TIMING, expense and suffering of issue), there
are usually services offered that *might* prolong life.
A friend who died of esophageal Ca a few years ago had eeked out a couple
of years of life at some reasonable -- though slowly degrading -- QUALITY
of life after his Dx. But, eventually got to the point where the only option
was an esophagectomy. Apparently (by his recounting), this leads to a pretty
lousy quality of life so he opted to take a pass on that option.
Another friend had throat Ca and squeezed a year or two out of it -- but,
with a perpetually dry mouth (radiation damage to salivary glands). Of course,
even if these issues are presented to the patient prior to making the
decision re: the proposed treatment, it's awfully hard to imagine what
they would be like to LIVE through. Couple this with the fear (dying)
and the typical time pressure ("We've got to act SOONER rather than
LATER) and you've got an Rx for sub-optimal decision making.
One of the political parties even works to prevent discussions of EoL
options with patients:
<https://www.usatoday.com/story/news/2017/02/09/kaiser-docs-bill-medicare-end--life-advice-death-panel-fears-reemerge/97715784/>
I'm *sure* it's because they VALUE LIFE (almost as much as they VALUE THE
FAMILY and the lives of the unborn... until they exit the womb) -- as long
as it results in monies flowing ONE way (hint: not AWAY from them!)
> 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).
So, coupled with the above, it boils down (to a certain extent) to your
*acceptance* that death is inevitable, resource limitations exist, etc.
This differs from the US experience where "spare no expense (cuz I *think*
I've already BEEN PAYING FOR IT) when it comes to MY care!"
> 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.
There are some attempts to ensure truly expensive or "short supply"
resources aren't "wasted" on the undeserving. E.g., you wouldn't want
to donate a healthy heart to someone who has other comorbidity
(including lifestyle) issues.
Should a drunk get a new liver that could go to benefit some healthier
(and younger) recipient:
<http://www.nytimes.com/1995/08/02/sports/questions-are-raised-on-mantle-transplant.html>
<http://www.nydailynews.com/sports/baseball/yankees/mickey-mantle-liver-transplant-1995-article-1.679619>
> Nice (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.
The same applies, here. The difference being that they don't typically wait
for a "secondary care facility" for most cases. "Go home; not our problem!"
>> 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.
carpark == parking lot/garage?
> 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.
So, a likely improvement would be to nationalize that aspect of care?
Or, come up with new criteria that would allow more folks to be
returned to their homes?
> 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.
There are "continuing care" facilities of various sizes and service
capabilities, here. A private home a few blocks away operated as
such for a while (a license is required to do so -- plus having
licensed/trained nursing staff available, etc.). Most places are
ambulatory living facilities where some portion of the "resident's"
care is handled by the facility/staff (meal prep, laundry, housekeeping,
facility maintenance, medical oversight, etc.) but the "patient" is
largely able to function (not purely bedridden). This is common, for
example, for folks of advanced age, dementia, etc. where living on
their own would put them at risk (nutritionally, safety, etc.)
Other facilities provide more advanced services "on site" (e.g.,
having an attached "mini hospital" or "advanced care" facility into
which residents can be relocated, temporarily, until they are
capable of returning to their LESS service intensive "appartments")
Still others are effectively hospitals without the operating rooms.
> 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!
Her *care* was essentially the same (?) -- but the cost of providing that
care was markedly higher (?)... and, came at the expense of denying someone
ELSE the bed that she occupied?
> 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).
The quality of care in hospitals varies considerably, here. There is an
agency that evaluates hospitals <http://www.jointcommission.org/> but few
folks are aware of its work. Even fewer aware of the nuances in HOW it does
its work and what its results say (and DON'T say).
[Sort of like folks thinking the better business bureau "vouches" for
the integrity of its member businesses. Most folks have never explored
a BBB rating or tried to understand what it DOESN'T say!]
Many are operated by religious organizations so they subtly impart
their beliefs on the care provided -- always without leaving a provable
case. Others are "community hospitals" that you would avoid unless you
happened to have a heart attack on their front doorstep (and would
then strive to transfer OUT of ASAP)
But, you don't always get to PICK the place where your care will be
delivered.
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| From | Tom Gardner <spamjunk@blueyonder.co.uk> |
|---|---|
| Date | 2017-05-15 15:16 +0100 |
| Message-ID | <QKiSA.3032$_f2.991@fx35.am4> |
| In reply to | #460326 |
On 15/05/17 08:52, Don Y wrote: > On 5/14/2017 2:28 AM, Martin Brown wrote: >> On 13/05/2017 23:10, Don Y wrote: >>> 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 isit 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. > > Where does the *patient* fit into this? > > I.e., here, the patient has the final say (assuming he is competent, conscious > and hasn't appointed a health care PoA). In the past year, I've had friends > who clung to life to the detriment of their families' (financial, > psychological and emotional) well being. And, others who opted for a more > expeditious exit to the dismay of their families (who wanted to cling to THEM!) A compos mentis patient is always has the last say. It would be illegal in several ways to treat a patient without their permission. (There is a "Courts of Protection" for non-compos mentis patients). Typically the medics will offer continuing treatment and, when it is declined, say something to the effect "you do know what that decision means, don't you". >> 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. > > A patient is almost always offered "hope". And, even when the outcome is > inarguable (i.e., only the TIMING, expense and suffering of issue), there > are usually services offered that *might* prolong life. Patients are offered hope here too, but it can be tempered with "what outcome are we realistically looking for here?". > One of the political parties even works to prevent discussions of EoL > options with patients: > <https://www.usatoday.com/story/news/2017/02/09/kaiser-docs-bill-medicare-end--life-advice-death-panel-fears-reemerge/97715784/> Here we try to keep religion out of politics, thank dog. > The quality of care in hospitals varies considerably, here. There is an > agency that evaluates hospitals <http://www.jointcommission.org/> but few > folks are aware of its work. Even fewer aware of the nuances in HOW it does > its work and what its results say (and DON'T say). We have a "Care Quality Commission" which sounds like your BBB. In reality the CQC was a political invention to act as a sop to those that believed private businesses would do enough to get a contract but too little to fulfil the contract. The CQC was little more than a box ticking exercise, and there were some scandals about its lack of oversight and teeth. There are murmurings it might have improved, but I'm continuing to breathe at my normal rate.
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| From | Don Y <blockedofcourse@foo.invalid> |
|---|---|
| Date | 2017-05-15 08:08 -0700 |
| Message-ID | <ofcg2a$abf$1@dont-email.me> |
| In reply to | #460342 |
On 5/15/2017 7:16 AM, Tom Gardner wrote:
>>> 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 isit 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.
>>
>> Where does the *patient* fit into this?
>>
>> I.e., here, the patient has the final say (assuming he is competent, conscious
>> and hasn't appointed a health care PoA). In the past year, I've had friends
>> who clung to life to the detriment of their families' (financial,
>> psychological and emotional) well being. And, others who opted for a more
>> expeditious exit to the dismay of their families (who wanted to cling to THEM!)
>
> A compos mentis patient is always has the last say. It
> would be illegal in several ways to treat a patient
> without their permission. (There is a "Courts of
> Protection" for non-compos mentis patients).
>
> Typically the medics will offer continuing treatment
> and, when it is declined, say something to the effect
> "you do know what that decision means, don't you".
But I think that's part of the problem -- the "innuendo" approach.
"You do understand that this means your death will be hastened?
We can (hospice) take extra measures to try to make it as
comfortable as possible..."
or:
"You do understand that this procedure will probably increase
your level of discomfort -- at least as will be related to the
procedure, itself. And, the 'recovery' time therefrom. And,
may do nothing to postpone your inevitable death or improve
the quality of your life in any 'added time' you might gain;
indeed, there is a very real risk that you may suffer more and
die sooner as a result of this -- including DURING the treatment..."
As I said before, everyone wants to think THEY are the exception.
THEY are the AIDS patient that will survive the disease; they are
the ALS patient that will manage to live WITH the disease for
decades; they are the CHF patient whose heart will miraculously
struggle on...
THEY are the person who will win the lottery!
The difference being that this "lottery" has a much higher up-front
wager (the physical/emotional/psychological/financial cost of the
procedure) with even more dubious return (including loss BEYOND the
limits of your initial wager -- dying 'on the table', etc.)
>>> 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.
>>
>> A patient is almost always offered "hope". And, even when the outcome is
>> inarguable (i.e., only the TIMING, expense and suffering of issue), there
>> are usually services offered that *might* prolong life.
>
> Patients are offered hope here too, but it can be tempered
> with "what outcome are we realistically looking for here?".
Again, I think that isn't confrontational enough. Too easy to
dismiss it with "anything is better than nothing!" The provider
needs to be (psychologically) able to push back with "you
understand you WILL be in pain and have a significant chance of
ending up WORSE off...?"
A friend (actually several!) has back problems. I asked him why he
hasn't had THEM fixed.
"Well, the success rate isn't very high for this type of problem.
And, there's always the risk of things going wrong (infection,
"ooops", etc.) leaving you WORSE off. And, the SECOND procedure
typically has a worse prognosis than the first. I'm 26 years
old, I think it a safer bet to tolerate the pain and mobility
constraints now, while I can, than to roll the dice and spend
the next 50 years living with the consequences and KNOWING
that I've used up my "shot" at it..."
>> One of the political parties even works to prevent discussions of EoL
>> options with patients:
>> <https://www.usatoday.com/story/news/2017/02/09/kaiser-docs-bill-medicare-end--life-advice-death-panel-fears-reemerge/97715784/>
>
> Here we try to keep religion out of politics, thank dog.
Its most definitely NOT "religion". Hard to imagine any prophet proclaiming:
"All life is sacred -- so long as it's not COSTING me anything"
>> The quality of care in hospitals varies considerably, here. There is an
>> agency that evaluates hospitals <http://www.jointcommission.org/> but few
>> folks are aware of its work. Even fewer aware of the nuances in HOW it does
>> its work and what its results say (and DON'T say).
>
> We have a "Care Quality Commission" which sounds
> like your BBB. In reality the CQC was a political
> invention to act as a sop to those that believed
> private businesses would do enough to get a contract
> but too little to fulfil the contract.
>
> The CQC was little more than a box ticking exercise,
> and there were some scandals about its lack of oversight
> and teeth. There are murmurings it might have
> improved, but I'm continuing to breathe at my normal rate.
The BBB doesn't get involved in health care (that I know of).
Rather, it is associated with businesses, in general. But,
they have no teeth and don't actually *do* anything -- other
than leaving the (false) impression with the public that
they *do*!
E.g., the BBB will tell you how many complaints have been lodged
WITH IT for a particular business that have GONE UNANSWERED.
It makes no claims about how the previous complaints were resolved.
Just, that they were "answered" by the business.
It's sort of like keeping track of how often someone attends
church service -- and ignoring the fact that they are molesting
children the other 6 days of the week.
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| From | tabbypurr@gmail.com |
|---|---|
| Date | 2017-05-15 13:33 -0700 |
| Message-ID | <82da1ae0-5dba-40de-a828-aec7f71fa983@googlegroups.com> |
| In reply to | #460216 |
On Sunday, 14 May 2017 10:29:03 UTC+1, 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). I don't know how to put it, but you're just wrong. Our NHS is not the utopia you dream of. NT
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| From | Martin Brown <'''newspam'''@nezumi.demon.co.uk> |
|---|---|
| Date | 2017-05-19 09:50 +0100 |
| Message-ID | <ofmbk6$1u9i$1@gioia.aioe.org> |
| In reply to | #460426 |
On 15/05/2017 21:33, tabbypurr@gmail.com wrote: > On Sunday, 14 May 2017 10:29:03 UTC+1, Martin Brown wrote: >> On 13/05/2017 23:10, Don Y wrote: >>> So, for the folks who live/work in places with "national health care" >>> (whatever THAT means), what's *wrong* with it? I.e., what would you >>> wish was different/better? How are your "death panels" implemented? >> >> I'll try to answer it if you try to understand. [snip] >> I have to say that the care that both she and my father received in >> hospital was excellent (but it was at a top performing hospital). > > I don't know how to put it, but you're just wrong. Our NHS is not the utopia you dream of. I take it you are a Daily Wail reader then. I have recent direct experience of it. Do you? -- Regards, Martin Brown
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| From | rickman <gnuarm@gmail.com> |
|---|---|
| Date | 2017-05-16 01:32 -0400 |
| Message-ID | <ofe2nn$bkn$1@dont-email.me> |
| In reply to | #460216 |
On 5/14/2017 5:28 AM, 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. In the US the insurer has no say in the matter other than the effectiveness of treatment. If the patient has reached a point where treatment provides no benefit the insurance company may not pay further, but a patient may continue treatment by paying themselves. Funny that you say the decision in your country is up to the doctors and family. In the US the patient (or the designated decision maker if the patient is not able to make decisions) is the only one who can make the choice of palliative care. Medical care can not be forced on a patient. > 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). So I guess people in your country complained about having one communal TV in a ward? Here insurance doesn't pay for TV. > 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. "Within limits" is an interesting term to use. So care is limited..., you just can't explain how. That's like "unlimited" internet access on a phone. I'll just say it's *not* unlimited. > 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 What does smoking have to do with hip replacements? > 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. It is a universal truth that you can't put a person in a bed if you don't have a bed to put them in. Not sure how the lack of beds in hospitals relates to private 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. Ah, now I get it. > 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 In the US bad facilities are shut down... eventually. It helps tremendously if someone complains officially which is *very* hard for a patient to do. > 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). > -- Rick C
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| From | Tom Gardner <spamjunk@blueyonder.co.uk> |
|---|---|
| Date | 2017-05-16 08:05 +0100 |
| Message-ID | <ixxSA.25133$ZZ1.2737@fx14.am4> |
| In reply to | #460473 |
On 16/05/17 06:32, rickman wrote: > On 5/14/2017 5:28 AM, Martin Brown wrote: >> 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 > > What does smoking have to do with hip replacements? The whole topic is a fraught minefield, medically, ethically, and politically. Hence everybody treads very carefully. I am not aware of hard limits nor of absolute bans. However, the stated justification is based on the probability of a good/bad outcome that improved/reduces the patient's life and quality of life. Apparently morbidly obese people are far more problematic w.r.t. anaesthesia. Smokers and very obese people obviously are likely to have heart/circulation problems. "Obese smokers", the point being made, doubly so. As such, that sounds sensible, but such "being put at the back of the queue" could result in rationing by stealth, and probably does have that effect. So far the perception is of heightened sensitivity, but there are no scandals nor outrage.
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| From | rickman <gnuarm@gmail.com> |
|---|---|
| Date | 2017-05-17 19:19 -0400 |
| Message-ID | <ofilke$q1f$2@dont-email.me> |
| In reply to | #460475 |
On 5/16/2017 3:05 AM, Tom Gardner wrote: > On 16/05/17 06:32, rickman wrote: >> On 5/14/2017 5:28 AM, Martin Brown wrote: >>> 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 >> >> What does smoking have to do with hip replacements? > > The whole topic is a fraught minefield, medically, > ethically, and politically. Hence everybody treads > very carefully. I am not aware of hard limits nor > of absolute bans. > > However, the stated justification is based on the > probability of a good/bad outcome that improved/reduces > the patient's life and quality of life. > > Apparently morbidly obese people are far more problematic > w.r.t. anaesthesia. Smokers and very obese people > obviously are likely to have heart/circulation problems. > "Obese smokers", the point being made, doubly so. > > As such, that sounds sensible, but such "being put > at the back of the queue" could result in rationing > by stealth, and probably does have that effect. > > So far the perception is of heightened sensitivity, but > there are no scandals nor outrage. Everything you have written is speculative or based on stereotypes. "Likely" as you use it is applesauce. -- Rick C
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| From | Spehro Pefhany <speffSNIP@interlogDOTyou.knowwhat> |
|---|---|
| Date | 2017-05-25 08:57 -0400 |
| Message-ID | <mikdic1lv1gos8oknlopo225hhe5lqf93n@4ax.com> |
| In reply to | #460129 |
On Sat, 13 May 2017 15:10:31 -0700, the renowned Don Y <blockedofcourse@foo.invalid> 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? >How is care "rationed"? What have you NOT been given (by way of care) >that you feel you ought to have? > >I.e., if you were starting from scratch to reinvent YOUR system, what >would you change? I think it's pretty good here (Ontario, Canada). Some of the newest, most expensive, and of dubious efficiacy treatments are apparently not covered. Relatives who have needed critical care and emergency care have been treated well. It would be nice if there were more GPs- it takes a while to get an appointment sometimes with mine, but they've dealt with long waits at hospital emergency with a lot of walk-in clinics for minor stuff. Waiting times for things like hip replacement are in the months, but you've probably been putting that off for years, so not all that bad. If you show up at emergency with something that isn't killing you at the exact moment on a Saturday night you might spend hours- it would be nice if they could triage some of those idiots I see (like the Russian young guy who busted his arm up doing something stupid - involving alcohol) right out the door to a clinic. Sometimes they cheap out a bit on things like casts- but you can pay extra and get the spiffy new ones and most working people have some kind of supplimentary insurance like Blue Cross that covers a private room, drugs, dental, etc. that the basic plan every resident gets doesn't cover. AFAUI, the standards are set federally but it's administered on a provincial basis, and hospitals etc. are privately run so the actual government employees are minimized. I think it would be a mistake to have it run federally. Death panels? Not so much though I've seen doctors question whether the quality of life that a severely impaired person has justifies heroic measures to restart their heart etc. --sp -- Best regards, Spehro Pefhany
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| From | rickman <gnuarm@gmail.com> |
|---|---|
| Date | 2017-05-25 11:49 -0400 |
| Message-ID | <og6u7u$hji$1@dont-email.me> |
| In reply to | #461647 |
Spehro Pefhany wrote on 5/25/2017 8:57 AM: > > Sometimes they cheap out a bit on things like casts- but you can pay > extra and get the spiffy new ones and most working people have some > kind of supplimentary insurance like Blue Cross that covers a private > room, drugs, dental, etc. that the basic plan every resident gets > doesn't cover. Drugs aren't covered by your national health system? > AFAUI, the standards are set federally but it's administered on a > provincial basis, and hospitals etc. are privately run so the actual > government employees are minimized. I think it would be a mistake to > have it run federally. > > Death panels? Not so much though I've seen doctors question whether > the quality of life that a severely impaired person has justifies > heroic measures to restart their heart etc. I think that qualifies as a "death panel". Here in the US a patient can register a "living will"/"advanced directive" to not require resuscitation. Otherwise a doctor is obligated to do what they can to prolong life. This is not a decision a doctor can make *for* a patient. I've had some experiences where doctors are applying criteria on care what would/would not provide care to extend someone's life (not urgent restart the heart stuff, but more like chemo for cancer) where age was a determining factor. I realized they are using age as if it were a medical condition. Age is not an indicator of health. Trying to draw conclusions about a person's health or life expectancy based on their age is bogus. Those are based on statistics which only apply to populations, not individuals. A 90 year old friend is in excellent health, takes no prescriptions, has never had any heart or other vital organ trouble. If you said he had a 4 year life expectancy, you would be WRONG! A person is not a statistic. Statistics only apply to populations. -- Rick C
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| From | Tom Gardner <spamjunk@blueyonder.co.uk> |
|---|---|
| Date | 2017-05-25 18:04 +0100 |
| Message-ID | <J8EVA.44031$Bl1.3360@fx27.am4> |
| In reply to | #461671 |
On 25/05/17 16:49, rickman wrote: > Spehro Pefhany wrote on 5/25/2017 8:57 AM: >> >> Sometimes they cheap out a bit on things like casts- but you can pay >> extra and get the spiffy new ones and most working people have some >> kind of supplimentary insurance like Blue Cross that covers a private >> room, drugs, dental, etc. that the basic plan every resident gets >> doesn't cover. > > Drugs aren't covered by your national health system? > > >> AFAUI, the standards are set federally but it's administered on a >> provincial basis, and hospitals etc. are privately run so the actual >> government employees are minimized. I think it would be a mistake to >> have it run federally. >> >> Death panels? Not so much though I've seen doctors question whether >> the quality of life that a severely impaired person has justifies >> heroic measures to restart their heart etc. > > I think that qualifies as a "death panel". A "death panel" is really inside an insurance company, probably in the form of some jobsworth that hides behind "you've reached your lifetime payout limit" or "we don't sanction using that treatment/drug". > Here in the US a patient can > register a "living will"/"advanced directive" to not require resuscitation. > Otherwise a doctor is obligated to do what they can to prolong life. This is > not a decision a doctor can make *for* a patient. I suspect Sphero has slightly misinterpreted what was happening. I note he did not say what the /result/ of the question was. > I've had some experiences where doctors are applying criteria on care what > would/would not provide care to extend someone's life (not urgent restart the > heart stuff, but more like chemo for cancer) where age was a determining > factor. I realized they are using age as if it were a medical condition. Age > is not an indicator of health. Trying to draw conclusions about a person's > health or life expectancy based on their age is bogus. Those are based on > statistics which only apply to populations, not individuals. A 90 year old > friend is in excellent health, takes no prescriptions, has never had any heart > or other vital organ trouble. If you said he had a 4 year life expectancy, you > would be WRONG!A person is not a statistic. Statistics only apply to > populations. Here I've seen age as one of /many/ factors in decisions as to what's in the /patient's/ best interest. Quite right too. Thus when my 96yo mother goes to A&E, they ask questions about her lifestyle. When they find she lives on her own and cares for herself, all treatments (including aortic valve surgery) are discussed. Thus if something goes wrong with surgery on me, they will use all techniques to keep me alive, even if that means I would be a vegetable. Memo to self: write a living will. OTOH, when my half-brother was about to be born and there was a question of hydrocephalus, the surgeons told my mother "if that happens, don't worry, the midwives will know what to do". That was a great /relief/ to my mother, since her husband had been killed on active service. OTOH, if a senile patient gets pneumonia, then with the agreement of all, they might not treat it. Good. Not for nothing is pneumonia known as "the old person's friend".
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| From | rickman <gnuarm@gmail.com> |
|---|---|
| Date | 2017-05-25 13:15 -0400 |
| Message-ID | <og739b$4u5$1@dont-email.me> |
| In reply to | #461683 |
Tom Gardner wrote on 5/25/2017 1:04 PM: > On 25/05/17 16:49, rickman wrote: >> Spehro Pefhany wrote on 5/25/2017 8:57 AM: >>> >>> Sometimes they cheap out a bit on things like casts- but you can pay >>> extra and get the spiffy new ones and most working people have some >>> kind of supplimentary insurance like Blue Cross that covers a private >>> room, drugs, dental, etc. that the basic plan every resident gets >>> doesn't cover. >> >> Drugs aren't covered by your national health system? >> >> >>> AFAUI, the standards are set federally but it's administered on a >>> provincial basis, and hospitals etc. are privately run so the actual >>> government employees are minimized. I think it would be a mistake to >>> have it run federally. >>> >>> Death panels? Not so much though I've seen doctors question whether >>> the quality of life that a severely impaired person has justifies >>> heroic measures to restart their heart etc. >> >> I think that qualifies as a "death panel". > > A "death panel" is really inside an insurance company, > probably in the form of some jobsworth that hides behind > "you've reached your lifetime payout limit" or "we don't > sanction using that treatment/drug". Nope, we don't have lifetime maximums in the US anymore thanks to Obamacare (the ACA). Well, we do, but it is applied unevenly. If you have insurance there is no lifetime maximum. If you don't have insurance the lifetime maximum only allows emergency care, all other treatments are not provided. >> Here in the US a patient can >> register a "living will"/"advanced directive" to not require >> resuscitation. >> Otherwise a doctor is obligated to do what they can to prolong life. >> This is >> not a decision a doctor can make *for* a patient. > > I suspect Sphero has slightly misinterpreted what was > happening. I note he did not say what the /result/ of > the question was. > > >> I've had some experiences where doctors are applying criteria on care >> what >> would/would not provide care to extend someone's life (not urgent >> restart the >> heart stuff, but more like chemo for cancer) where age was a determining >> factor. I realized they are using age as if it were a medical >> condition. Age >> is not an indicator of health. Trying to draw conclusions about a >> person's >> health or life expectancy based on their age is bogus. Those are >> based on >> statistics which only apply to populations, not individuals. A 90 >> year old >> friend is in excellent health, takes no prescriptions, has never had >> any heart >> or other vital organ trouble. If you said he had a 4 year life >> expectancy, you >> would be WRONG!A person is not a statistic. Statistics only apply to >> populations. > > Here I've seen age as one of /many/ factors in decisions > as to what's in the /patient's/ best interest. Quite right > too. Not at all "right". Age is a way to group people *instead* of using facts about the person. It has no bearing on medical treatment. As I have already explained, state of health is independent of age other than when looking at populations. If you can't grasp the distiction between statistics that apply to groups and facts that apply to individuals we can end the discussion here. > Thus when my 96yo mother goes to A&E, they ask questions > about her lifestyle. When they find she lives on her own > and cares for herself, all treatments (including aortic > valve surgery) are discussed. So where did age enter into it? > Thus if something goes wrong with surgery on me, they > will use all techniques to keep me alive, even if that > means I would be a vegetable. Memo to self: write a > living will. Where did age enter into it? > OTOH, when my half-brother was about to be born and > there was a question of hydrocephalus, the surgeons > told my mother "if that happens, don't worry, the > midwives will know what to do". That was a great > /relief/ to my mother, since her husband had been > killed on active service. I have no idea how this connects to anything else you have said. > OTOH, if a senile patient gets pneumonia, then with > the agreement of all, they might not treat it. > Good. Not for nothing is pneumonia known as > "the old person's friend". More irrational analysis of the facts. If the person has dementia to the point they are in misery, then that is the issue. HOW DOES AGE ENTER INTO IT??? -- Rick C
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| From | Martin Brown <'''newspam'''@nezumi.demon.co.uk> |
|---|---|
| Date | 2017-05-26 09:15 +0100 |
| Message-ID | <og8o7a$1o5d$1@gioia.aioe.org> |
| In reply to | #461686 |
On 25/05/2017 18:15, rickman wrote: > Tom Gardner wrote on 5/25/2017 1:04 PM: >> On 25/05/17 16:49, rickman wrote: >>> Spehro Pefhany wrote on 5/25/2017 8:57 AM: >>>> >>>> Sometimes they cheap out a bit on things like casts- but you can pay >>>> extra and get the spiffy new ones and most working people have some >>>> kind of supplimentary insurance like Blue Cross that covers a private >>>> room, drugs, dental, etc. that the basic plan every resident gets >>>> doesn't cover. >>> >>> Drugs aren't covered by your national health system? In the UK there is a nominal fixed charge for any drug prescription if you are able to pay (ie typically not on benefits or under 16). If you have a long term chronic condition then you can apply to pay an annual fee instead (which works out cheaper). >>>> AFAUI, the standards are set federally but it's administered on a >>>> provincial basis, and hospitals etc. are privately run so the actual >>>> government employees are minimized. I think it would be a mistake to >>>> have it run federally. >>>> >>>> Death panels? Not so much though I've seen doctors question whether >>>> the quality of life that a severely impaired person has justifies >>>> heroic measures to restart their heart etc. >>> >>> I think that qualifies as a "death panel". >> >> A "death panel" is really inside an insurance company, >> probably in the form of some jobsworth that hides behind >> "you've reached your lifetime payout limit" or "we don't >> sanction using that treatment/drug". > > Nope, we don't have lifetime maximums in the US anymore thanks to > Obamacare (the ACA). I am sure Trump will rectify that for you. > Well, we do, but it is applied unevenly. If you have insurance there is > no lifetime maximum. If you don't have insurance the lifetime maximum > only allows emergency care, all other treatments are not provided. Can't you see that only treating the uninsured for expensive emergency care instead of fixing chronic conditions is a lousy strategy? It is even worse when they have infectious diseases like multi drug resistant TB which is making a comeback thanks to systemic US healthcare failings. Snag is with having insurance how do you retain your insurance policy once you are chronically ill and unable to work? No doubt renewal premiums go up enormously when they know you have an expensive incurable disease (or possibly even a genetic predisposition). The UK system where most healthy people are glad that they are not getting their money's worth of treatment from the NHS is far superior. >>> Here in the US a patient can >>> register a "living will"/"advanced directive" to not require >>> resuscitation. >>> Otherwise a doctor is obligated to do what they can to prolong life. >>> This is >>> not a decision a doctor can make *for* a patient. >> >> I suspect Sphero has slightly misinterpreted what was >> happening. I note he did not say what the /result/ of >> the question was. In the UK it can also be made by a relative of the patient if they are too young or unable to express their wishes. Do Not Resuscitate being the most obvious one where the frail elderly are concerned. The crash cart procedure would almost certainly kill them anyway with an 88% fail rate for the frail elderly. Broken ribs and internal organ damage being the common side effects of CPR and defib. Guidelines are pretty clear: https://www.uhb.nhs.uk/Downloads/pdf/PiCardioPulmonaryResuscitation.pdf Unfortunately TV hospital dramas give people a false impression of the magical life saving effects of modern equipment. The success rate even on fit adult males with a heart attack is worse than I had expected (and worse than is depicted for frail elderly in TV dramas). >>> or other vital organ trouble. If you said he had a 4 year life >>> expectancy, you >>> would be WRONG!A person is not a statistic. Statistics only apply to >>> populations. Actually the remaining life expectancy is on average about 5 years if you reach 90. Something has to fail at some point. There will always be a few outliers and treatment *is* based on the fitness or otherwise of the individual not on their calendar age. >> Here I've seen age as one of /many/ factors in decisions >> as to what's in the /patient's/ best interest. Quite right >> too. > > Not at all "right". Age is a way to group people *instead* of using > facts about the person. It has no bearing on medical treatment. As I > have already explained, state of health is independent of age other than > when looking at populations. If you can't grasp the distiction between > statistics that apply to groups and facts that apply to individuals we > can end the discussion here. They do both. Age and weight are good predictors of how well someone will cope with a general anaesthetic and how they will recover with rehab for example. Too light or too heavy and the outcome is worse. >> OTOH, if a senile patient gets pneumonia, then with >> the agreement of all, they might not treat it. >> Good. Not for nothing is pneumonia known as >> "the old person's friend". > > More irrational analysis of the facts. If the person has dementia to > the point they are in misery, then that is the issue. HOW DOES AGE > ENTER INTO IT??? They are not necessarily in misery but their quality of life is as near zero as makes no difference. Even so the NHS will do their best to keep someone alive who wants to stay alive as they did for my friend who we buried last week. Most famous high profile example of NHS car being Stephen Hawking whose life they have saved several times. http://www.telegraph.co.uk/news/worldnews/northamerica/usa/6017878/Stephen-Hawking-I-would-not-be-alive-without-the-NHS.html That did not stop the American Right "alternative truth" brigade trying to claim that he would not still be alive if he lived in the UK. -- Regards, Martin Brown
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| From | Tom Gardner <spamjunk@blueyonder.co.uk> |
|---|---|
| Date | 2017-05-26 09:28 +0100 |
| Message-ID | <%GRVA.156221$op5.122268@fx39.am4> |
| In reply to | #461777 |
On 26/05/17 09:15, Martin Brown wrote: > On 25/05/2017 18:15, rickman wrote: >> Tom Gardner wrote on 5/25/2017 1:04 PM: >>> On 25/05/17 16:49, rickman wrote: >>>> Spehro Pefhany wrote on 5/25/2017 8:57 AM: >>>>> >>>>> Sometimes they cheap out a bit on things like casts- but you can pay >>>>> extra and get the spiffy new ones and most working people have some >>>>> kind of supplimentary insurance like Blue Cross that covers a private >>>>> room, drugs, dental, etc. that the basic plan every resident gets >>>>> doesn't cover. >>>> >>>> Drugs aren't covered by your national health system? > > In the UK there is a nominal fixed charge for any drug prescription if you are > able to pay (ie typically not on benefits or under 16). If you have a long term > chronic condition then you can apply to pay an annual fee instead (which works > out cheaper). > >>>>> AFAUI, the standards are set federally but it's administered on a >>>>> provincial basis, and hospitals etc. are privately run so the actual >>>>> government employees are minimized. I think it would be a mistake to >>>>> have it run federally. >>>>> >>>>> Death panels? Not so much though I've seen doctors question whether >>>>> the quality of life that a severely impaired person has justifies >>>>> heroic measures to restart their heart etc. >>>> >>>> I think that qualifies as a "death panel". >>> >>> A "death panel" is really inside an insurance company, >>> probably in the form of some jobsworth that hides behind >>> "you've reached your lifetime payout limit" or "we don't >>> sanction using that treatment/drug". >> >> Nope, we don't have lifetime maximums in the US anymore thanks to >> Obamacare (the ACA). > > I am sure Trump will rectify that for you. > >> Well, we do, but it is applied unevenly. If you have insurance there is >> no lifetime maximum. If you don't have insurance the lifetime maximum >> only allows emergency care, all other treatments are not provided. > > Can't you see that only treating the uninsured for expensive emergency care > instead of fixing chronic conditions is a lousy strategy? It is even worse when > they have infectious diseases like multi drug resistant TB which is making a > comeback thanks to systemic US healthcare failings. > > Snag is with having insurance how do you retain your insurance policy once you > are chronically ill and unable to work? No doubt renewal premiums go up > enormously when they know you have an expensive incurable disease (or possibly > even a genetic predisposition). > > The UK system where most healthy people are glad that they are not getting their > money's worth of treatment from the NHS is far superior. > >>>> Here in the US a patient can >>>> register a "living will"/"advanced directive" to not require >>>> resuscitation. >>>> Otherwise a doctor is obligated to do what they can to prolong life. >>>> This is >>>> not a decision a doctor can make *for* a patient. >>> >>> I suspect Sphero has slightly misinterpreted what was >>> happening. I note he did not say what the /result/ of >>> the question was. > > In the UK it can also be made by a relative of the patient if they are too young > or unable to express their wishes. Do Not Resuscitate being the most obvious one > where the frail elderly are concerned. The crash cart procedure would almost > certainly kill them anyway with an 88% fail rate for the frail elderly. Broken > ribs and internal organ damage being the common side effects of CPR and defib. > Guidelines are pretty clear: > > https://www.uhb.nhs.uk/Downloads/pdf/PiCardioPulmonaryResuscitation.pdf > > Unfortunately TV hospital dramas give people a false impression of the magical > life saving effects of modern equipment. The success rate even on fit adult > males with a heart attack is worse than I had expected (and worse than is > depicted for frail elderly in TV dramas). > >>>> or other vital organ trouble. If you said he had a 4 year life >>>> expectancy, you >>>> would be WRONG!A person is not a statistic. Statistics only apply to >>>> populations. > > Actually the remaining life expectancy is on average about 5 years if you reach > 90. Something has to fail at some point. There will always be a few outliers and > treatment *is* based on the fitness or otherwise of the individual not on their > calendar age. > >>> Here I've seen age as one of /many/ factors in decisions >>> as to what's in the /patient's/ best interest. Quite right >>> too. >> >> Not at all "right". Age is a way to group people *instead* of using >> facts about the person. It has no bearing on medical treatment. As I >> have already explained, state of health is independent of age other than >> when looking at populations. If you can't grasp the distiction between >> statistics that apply to groups and facts that apply to individuals we >> can end the discussion here. > > They do both. Age and weight are good predictors of how well someone will cope > with a general anaesthetic and how they will recover with rehab for example. Too > light or too heavy and the outcome is worse. > >>> OTOH, if a senile patient gets pneumonia, then with >>> the agreement of all, they might not treat it. >>> Good. Not for nothing is pneumonia known as >>> "the old person's friend". >> >> More irrational analysis of the facts. If the person has dementia to >> the point they are in misery, then that is the issue. HOW DOES AGE >> ENTER INTO IT??? > > They are not necessarily in misery but their quality of life is as near zero as > makes no difference. Even so the NHS will do their best to keep someone alive > who wants to stay alive as they did for my friend who we buried last week. Most > famous high profile example of NHS car being Stephen Hawking whose life they > have saved several times. > > http://www.telegraph.co.uk/news/worldnews/northamerica/usa/6017878/Stephen-Hawking-I-would-not-be-alive-without-the-NHS.html > > > That did not stop the American Right "alternative truth" brigade trying to claim > that he would not still be alive if he lived in the UK. That's a thoughtful and accurate response. I doubt that the information therein will change rickman's mind since, for reasons that escape me, he seems unable to understand and believe such statements. It is as if he speed reads too fast through a filter of preconceptions. "There's none so deaf as them's won't hear".
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| From | rickman <gnuarm@gmail.com> |
|---|---|
| Date | 2017-05-26 04:40 -0400 |
| Message-ID | <og8pgb$s1c$1@dont-email.me> |
| In reply to | #461777 |
Martin Brown wrote on 5/26/2017 4:15 AM: > On 25/05/2017 18:15, rickman wrote: >> Tom Gardner wrote on 5/25/2017 1:04 PM: >>> On 25/05/17 16:49, rickman wrote: >>>> Spehro Pefhany wrote on 5/25/2017 8:57 AM: >>>>> >>>>> Sometimes they cheap out a bit on things like casts- but you can pay >>>>> extra and get the spiffy new ones and most working people have some >>>>> kind of supplimentary insurance like Blue Cross that covers a private >>>>> room, drugs, dental, etc. that the basic plan every resident gets >>>>> doesn't cover. >>>> >>>> Drugs aren't covered by your national health system? > > In the UK there is a nominal fixed charge for any drug prescription if > you are able to pay (ie typically not on benefits or under 16). If you > have a long term chronic condition then you can apply to pay an annual > fee instead (which works out cheaper). > >>>>> AFAUI, the standards are set federally but it's administered on a >>>>> provincial basis, and hospitals etc. are privately run so the actual >>>>> government employees are minimized. I think it would be a mistake to >>>>> have it run federally. >>>>> >>>>> Death panels? Not so much though I've seen doctors question whether >>>>> the quality of life that a severely impaired person has justifies >>>>> heroic measures to restart their heart etc. >>>> >>>> I think that qualifies as a "death panel". >>> >>> A "death panel" is really inside an insurance company, >>> probably in the form of some jobsworth that hides behind >>> "you've reached your lifetime payout limit" or "we don't >>> sanction using that treatment/drug". >> >> Nope, we don't have lifetime maximums in the US anymore thanks to >> Obamacare (the ACA). > > I am sure Trump will rectify that for you. > >> Well, we do, but it is applied unevenly. If you have insurance there is >> no lifetime maximum. If you don't have insurance the lifetime maximum >> only allows emergency care, all other treatments are not provided. > > Can't you see that only treating the uninsured for expensive emergency > care instead of fixing chronic conditions is a lousy strategy? It is > even worse when they have infectious diseases like multi drug resistant > TB which is making a comeback thanks to systemic US healthcare failings. Why are you asking me? I didn't create the system we have. > Snag is with having insurance how do you retain your insurance policy > once you are chronically ill and unable to work? No doubt renewal > premiums go up enormously when they know you have an expensive incurable > disease (or possibly even a genetic predisposition). I was still in my 30s when I asked that at an benefits presentation. The bottom line is after some months the company would dump you and you get 18 months of COBRA which is the same insurance, but now you pay all the premiums yourself. After that you fuck off and die. > The UK system where most healthy people are glad that they are not > getting their money's worth of treatment from the NHS is far superior. > >>>> Here in the US a patient can >>>> register a "living will"/"advanced directive" to not require >>>> resuscitation. >>>> Otherwise a doctor is obligated to do what they can to prolong life. >>>> This is >>>> not a decision a doctor can make *for* a patient. >>> >>> I suspect Sphero has slightly misinterpreted what was >>> happening. I note he did not say what the /result/ of >>> the question was. > > In the UK it can also be made by a relative of the patient if they are > too young or unable to express their wishes. Do Not Resuscitate being > the most obvious one where the frail elderly are concerned. The crash > cart procedure would almost certainly kill them anyway with an 88% fail > rate for the frail elderly. Broken ribs and internal organ damage being > the common side effects of CPR and defib. Guidelines are pretty clear: > > https://www.uhb.nhs.uk/Downloads/pdf/PiCardioPulmonaryResuscitation.pdf > > Unfortunately TV hospital dramas give people a false impression of the > magical life saving effects of modern equipment. The success rate even > on fit adult males with a heart attack is worse than I had expected (and > worse than is depicted for frail elderly in TV dramas). I'm not sure how it works in the US if you don't have an advance directive and you are not able to make your own decisions. No, that's not true. I know someone who was in that position. She was non compos mentis and lost the ability to swallow. The guardian gave permission to let her starve. They can do the same thing with stroke victims. But doctors don't get to decide, only the person responsible for making their decisions. >>>> or other vital organ trouble. If you said he had a 4 year life >>>> expectancy, you >>>> would be WRONG!A person is not a statistic. Statistics only apply to >>>> populations. > > Actually the remaining life expectancy is on average about 5 years if > you reach 90. Something has to fail at some point. There will always be > a few outliers and treatment *is* based on the fitness or otherwise of > the individual not on their calendar age. You don't get it! The age is irrelevant if their condition is the indicator. The only thing we know for sure is no one has ever lived forever... except for everyone alive. Those people have not died... There's more of us than all the dead people, so how good an indicator can the past be? lol >>> Here I've seen age as one of /many/ factors in decisions >>> as to what's in the /patient's/ best interest. Quite right >>> too. >> >> Not at all "right". Age is a way to group people *instead* of using >> facts about the person. It has no bearing on medical treatment. As I >> have already explained, state of health is independent of age other than >> when looking at populations. If you can't grasp the distiction between >> statistics that apply to groups and facts that apply to individuals we >> can end the discussion here. > > They do both. Age and weight are good predictors of how well someone > will cope with a general anaesthetic and how they will recover with > rehab for example. Too light or too heavy and the outcome is worse. You *really* don't get it. It isn't age. It is *all* their state of health. Someone who is 50 can be no better off than someone who is 70 and vice versa. >>> OTOH, if a senile patient gets pneumonia, then with >>> the agreement of all, they might not treat it. >>> Good. Not for nothing is pneumonia known as >>> "the old person's friend". >> >> More irrational analysis of the facts. If the person has dementia to >> the point they are in misery, then that is the issue. HOW DOES AGE >> ENTER INTO IT??? > > They are not necessarily in misery but their quality of life is as near > zero as makes no difference. Even so the NHS will do their best to keep > someone alive who wants to stay alive as they did for my friend who we > buried last week. Most famous high profile example of NHS car being > Stephen Hawking whose life they have saved several times. > > http://www.telegraph.co.uk/news/worldnews/northamerica/usa/6017878/Stephen-Hawking-I-would-not-be-alive-without-the-NHS.html > > > That did not stop the American Right "alternative truth" brigade trying > to claim that he would not still be alive if he lived in the UK. Sometimes you prattle as much as the others here. I've never heard of the 'American Right "alternative truth" brigade'. Are they connected to the Salvation Army? I suppose there are no idiots in the UK? -- Rick C
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| From | dagmargoodboat@yahoo.com |
|---|---|
| Date | 2017-05-31 06:19 -0700 |
| Message-ID | <d621b74b-38fd-4fe6-9e38-d44db1f09ad6@googlegroups.com> |
| In reply to | #461777 |
On Friday, May 26, 2017 at 4:15:44 AM UTC-4, Martin Brown wrote: > Can't you see that only treating the uninsured for expensive emergency > care instead of fixing chronic conditions is a lousy strategy? It is > even worse when they have infectious diseases like multi drug resistant > TB which is making a comeback thanks to systemic US healthcare failings. The U.S. MDRTB threat comes from I.V. drug-users (whose immune systems have often been ravaged by AIDS/HIV), and immigrants. They're usually found in big U.S. cities. https://wwwnc.cdc.gov/eid/article/20/5/13-1037_article "Among these patients, 87% were foreign born and 36% had prior TB disease [...] Similar to all foreign-born TB patients in the United States, most foreign-born MDR TB study participants arrived from Mexico, the Philippines, India, and Vietnam." Care is provided to the indigent, e.g., "Of the 135 patients, 7% were homeless before diagnosis (6 patients) or during treatment (3 patients). Case management to obtain housing during treatment was needed by 23 (17%) patients; 38 (28%) patients had been unemployed before diagnosis, and of the 97 remaining patients, 27% stopped work because of MDR TB. Intravenous drug-users are a source of MDRTB because they have high rates of HIV, making them susceptible to TB, and high rates of failure to complete treatment for ordinary TB, producing resistant strains. e.g., https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3110742/ "Though drug use was described as a TB risk factor even before the HIV era[74], HIV-induced immunosuppression is the most important reason for the high TB incidence among IDUs[75]." That's not a "comeback" due to a "systemic US healthcare failure." Cheers, James Arthur
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| From | bill.sloman@ieee.org |
|---|---|
| Date | 2017-05-31 18:08 -0700 |
| Message-ID | <1ec6441d-0366-4e71-9f09-bf1459ee9ae4@googlegroups.com> |
| In reply to | #462414 |
On Wednesday, May 31, 2017 at 11:20:07 PM UTC+10, dagmarg...@yahoo.com wrote: > On Friday, May 26, 2017 at 4:15:44 AM UTC-4, Martin Brown wrote: > > > Can't you see that only treating the uninsured for expensive emergency > > care instead of fixing chronic conditions is a lousy strategy? It is > > even worse when they have infectious diseases like multi drug resistant > > TB which is making a comeback thanks to systemic US healthcare failings. > > The U.S. MDRTB threat comes from I.V. drug-users (whose immune systems have > often been ravaged by AIDS/HIV), and immigrants. They're usually found in > big U.S. cities. > > https://wwwnc.cdc.gov/eid/article/20/5/13-1037_article > "Among these patients, 87% were foreign born and 36% had prior TB disease > [...] Similar to all foreign-born TB patients in the United States, most > foreign-born MDR TB study participants arrived from Mexico, the Philippines, > India, and Vietnam." > > Care is provided to the indigent, e.g., > "Of the 135 patients, 7% were homeless before diagnosis (6 patients) or > during treatment (3 patients). Case management to obtain housing during > treatment was needed by 23 (17%) patients; 38 (28%) patients had been > unemployed before diagnosis, and of the 97 remaining patients, 27% > stopped work because of MDR TB. > > Intravenous drug-users are a source of MDRTB because they have high rates > of HIV, making them susceptible to TB, and high rates of failure to complete > treatment for ordinary TB, producing resistant strains. > > e.g., https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3110742/ > > "Though drug use was described as a TB risk factor even before the HIV > era[74], HIV-induced immunosuppression is the most important reason > for the high TB incidence among IDUs[75]." > > That's not a "comeback" due to a "systemic US healthcare failure." High levels of intravenous drug use are symptom of a systemic US health care failure. The US preference for a "war on drugs" which it can't win, over "harm reduction" which does turn out to be more effective in reducing the number of drug users, s driven by an irrational prejudice, and isn't doing anybody any good. James Arthur has been indoctrinated to think that this kind of irrational prejudice should be taken seriously, and seems to have lost the ability to understand just how many unnecessary and avoidable deaths it is causing. -- Bill Sloman, Sydney
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| From | krw@notreal.com |
|---|---|
| Date | 2017-05-25 18:30 -0400 |
| Message-ID | <vbmeiclcbm2t42r1cbvsm83s1n7qcprcm3@4ax.com> |
| In reply to | #461683 |
On Thu, 25 May 2017 18:04:45 +0100, Tom Gardner <spamjunk@blueyonder.co.uk> wrote: >On 25/05/17 16:49, rickman wrote: >> Spehro Pefhany wrote on 5/25/2017 8:57 AM: >>> >>> Sometimes they cheap out a bit on things like casts- but you can pay >>> extra and get the spiffy new ones and most working people have some >>> kind of supplimentary insurance like Blue Cross that covers a private >>> room, drugs, dental, etc. that the basic plan every resident gets >>> doesn't cover. >> >> Drugs aren't covered by your national health system? >> >> >>> AFAUI, the standards are set federally but it's administered on a >>> provincial basis, and hospitals etc. are privately run so the actual >>> government employees are minimized. I think it would be a mistake to >>> have it run federally. >>> >>> Death panels? Not so much though I've seen doctors question whether >>> the quality of life that a severely impaired person has justifies >>> heroic measures to restart their heart etc. >> >> I think that qualifies as a "death panel". > >A "death panel" is really inside an insurance company, >probably in the form of some jobsworth that hides behind >"you've reached your lifetime payout limit" or "we don't >sanction using that treatment/drug". Nonsense. Any of that would be in the insurance contract. No, insurance doesn't pay for experimental therapies but it does cover what it's contractually required to cover. No age restrictions or party membership calculated into the formula. >> Here in the US a patient can >> register a "living will"/"advanced directive" to not require resuscitation. >> Otherwise a doctor is obligated to do what they can to prolong life. This is >> not a decision a doctor can make *for* a patient. > >I suspect Sphero has slightly misinterpreted what was >happening. I note he did not say what the /result/ of >the question was. > > >> I've had some experiences where doctors are applying criteria on care what >> would/would not provide care to extend someone's life (not urgent restart the >> heart stuff, but more like chemo for cancer) where age was a determining >> factor. I realized they are using age as if it were a medical condition. Age >> is not an indicator of health. Trying to draw conclusions about a person's >> health or life expectancy based on their age is bogus. Those are based on >> statistics which only apply to populations, not individuals. A 90 year old >> friend is in excellent health, takes no prescriptions, has never had any heart >> or other vital organ trouble. If you said he had a 4 year life expectancy, you >> would be WRONG!A person is not a statistic. Statistics only apply to >> populations. > >Here I've seen age as one of /many/ factors in decisions >as to what's in the /patient's/ best interest. Quite right >too. Quite right for the *patient* to consider these factors, perhaps guided by doctors, family, and religious leaders. A government bureaucrat, not so much. > >Thus when my 96yo mother goes to A&E, they ask questions >about her lifestyle. When they find she lives on her own >and cares for herself, all treatments (including aortic >valve surgery) are discussed. > >Thus if something goes wrong with surgery on me, they >will use all techniques to keep me alive, even if that >means I would be a vegetable. Memo to self: write a >living will. > >OTOH, when my half-brother was about to be born and >there was a question of hydrocephalus, the surgeons >told my mother "if that happens, don't worry, the >midwives will know what to do". That was a great >/relief/ to my mother, since her husband had been >killed on active service. Oh, great. A midwife is appointed God. >OTOH, if a senile patient gets pneumonia, then with >the agreement of all, they might not treat it. >Good. Not for nothing is pneumonia known as >"the old person's friend". At that point its up to the family. No one else has a say.
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| From | Don Y <blockedofcourse@foo.invalid> |
|---|---|
| Date | 2017-05-25 13:15 -0700 |
| Message-ID | <og7dp9$aae$1@dont-email.me> |
| In reply to | #461647 |
On 5/25/2017 5:57 AM, Spehro Pefhany wrote:
> On Sat, 13 May 2017 15:10:31 -0700, the renowned Don Y
> <blockedofcourse@foo.invalid> 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?
>> How is care "rationed"? What have you NOT been given (by way of care)
>> that you feel you ought to have?
>>
>> I.e., if you were starting from scratch to reinvent YOUR system, what
>> would you change?
>
> I think it's pretty good here (Ontario, Canada). Some of the newest,
> most expensive, and of dubious efficiacy treatments are apparently not
> covered.
Sovaldi is a pharma treatment for HepC -- something like 90% cure rate
in a 12 week treatment plan. So, I'd consider that an "effective"
treatment. Esp in light of the worst-case alternative (liver transplant).
And, at $1000/dose (i.e., $84K/12 weeks), its definitely "expensive" (US).
How would the Canadian system deal with this?
> Relatives who have needed critical care and emergency care
> have been treated well.
Emergency is a red herring -- people in desperate need of IMMEDIATE
care seem to always be able to get it, in any system. There may be some
issues regarding the number of such people and any externalities that
are driving those up/down that can be debated.
Most medical care is NOT dispensed in an emergency setting. So,
that's where the details are more pronounced. How do I *stay* healthy
in the face of the myriad of threats encountered in day-to-day living.
> It would be nice if there were more GPs- it takes a while to get an
> appointment sometimes with mine,
If you have to wait a week to get an appointment for a URI, then your
health is at risk AND, at the very least, you spend a week "uncomfortable"
relying only on your "natural defenses".
[OTOH, for the 25% of visits where the Rx is "do nothing", then you can
potentially find yourself "cured" before seeing the provider! :< ]
My PCP is moving steadily towards retirement. So, is aggressively
cutting his working hours. For many of his Pt's, a call for an appointment
would probably see a week or two wait -- with a referral to the
nurse-practitioner if need be.
As I've cultivated a relationship with him, his assistant and his office
staff -- and, as I tend to have THOUGHT about my need for care before
asking for it -- I can usually get in to see *him* when he is next
available, instead of incurring that wait.
> but they've dealt with long waits at
> hospital emergency with a lot of walk-in clinics for minor stuff.
> Waiting times for things like hip replacement are in the months, but
> you've probably been putting that off for years, so not all that bad.
>
> If you show up at emergency with something that isn't killing you at
> the exact moment on a Saturday night you might spend hours- it would
> be nice if they could triage some of those idiots I see (like the
> Russian young guy who busted his arm up doing something stupid -
> involving alcohol) right out the door to a clinic.
I've visited the ER twice in ~25 years (I can't recall EVER visiting
one in any other municipality). In each case, I was triaged as "#1".
In each case, it was a 5 hour visit. Despite the "problems" being
things that an MD could probably handle in his office (if it had
been during "office hours").
I.e., the ER is an inefficient way of delivering care. *But*, is a very
CAPABLE way of delivering it as damn near EVERY sort of tool and technology
is available, WAITING to be used! (In an MD's office, he'd have sent me off
to another place for films, etc.)
> Sometimes they cheap out a bit on things like casts- but you can pay
> extra and get the spiffy new ones and most working people have some
> kind of supplimentary insurance like Blue Cross that covers a private
> room, drugs, dental, etc. that the basic plan every resident gets
> doesn't cover.
So, there's a difference between the role your "(private) insurance" plays
and that described by Martin/Tom. I.e., yours is a *supplement* (coinsurance)
and not an ALTERNATIVE. Like using airline miles to get an *upgrade* on
a seat instead of paying for the whole seat with those "miles".
> AFAUI, the standards are set federally but it's administered on a
> provincial basis, and hospitals etc. are privately run so the actual
> government employees are minimized. I think it would be a mistake to
> have it run federally.
That's similar to how our insurance and Medicare/Medicaid are delivered.
Private providers *contract* with the payers (insurers/gummit) to deliver
the care and then bill the payers. Some self-insured companies may
contract with an insurer to process their *paperwork* (claims) and
"bill" the company for the services that its members consumed -- plus
a fee for the administrative overhead (but, the RISK remains with
the self-insured company).
The (big) difference, IMO, is that, here, the provider has no idea
what your "payer" will cover by way of treatments AND what conditions
there may be ON those treatments (e.g., your provider may need to have
tried X and Y before he can try Z -- else your payer might not cover
the payment for Z, even if it solves your problem!).
And, as your "payer" may change from visit to visit, this is an
ongoing administrative effort ("Can I make a photocopy of your CURRENT
insurance card(s)...?"). The provider's response to you isn't solely
driven by an assessment/understanding of your symptoms (and personal
knowledge of you, as an individual) but, also, conditioned by the
CURRENT terms of his financial relationship with you (assuming he
wants to minimize the costs that you incur by keeping his treatment
plan to the guidelines preestablished in your payer's plan).
> Death panels? Not so much though I've seen doctors question whether
> the quality of life that a severely impaired person has justifies
> heroic measures to restart their heart etc.
Historically, that is rarely done, here. And, if even "mentioned",
it is with a very light touch -- the Pt (or his legally appointed agent)
has control over the care received. I think the provider is only "off
the hook" (in withholding additional care/procedures) when he has
made every effort to preserve the Pt's life. E.g., tried repeatedly
to resuscitate and the Pt simply isn't responding.
This is indirectly reflected in other ways (depending on locale).
E.g., I am under no obligation (as a private citizen without medical
license) to try to resuscitate "you" if you aren't breathing, etc.
OTOH, if I *start* to do that, then I *assume* the responsibility
for it -- both in terms of if I injure you in the process AND if
I prematurely WITHDRAW that treatment!
I.e., you continue providing that treatment until you are relieved
(by another) *or* "exhausted". You can't just opt to "give up"
cuz you don't think it is working, etc.
Only fools *don't* have living wills, medical PoA, etc. here.
Otherwise, you leave your treatment to the actions/wishes of
others when you are incapable of directing them yourself. Even
then, you risk providers imposing their own "religious beliefs"
on your care -- despite the legal requirement that they honor
your directives ("Oh, he didn't give them to us; they were misplaced;
the nursing staff was unaware that they were on file; they were
written 10 years earlier so we weren't sure they represented his
CURRENT thoughts on the matter; etc.")
So, how is *your* care "rationed" (as rationed it must be, lest it
consume your entire GNP!)
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