Saturday, October 09, 2010

And oh crap I forgot:

Y'all can talk about anything you like in the comments. I was enjoying the socialized medicine discussion. Please do continue if you feel the urge. Don't let the fact that this is a single- or dual- focus blog stop you, 'k? Thanks.

11 comments:

MamaDoodle said...

Just catching up and saw the socialized medicine thread running through the comments.

A little reminder for the folks who always bring up the cousin in Canada or friend's uncle's brother's cousin in England who had to wait longer than what might be deemed acceptable for an insured person in the U.S.:

A great many people in the U.S. don't even have the opportunity to discover that they have something that needs care because they don't have any means to access preventative care and/or basic care when they are ill. The socialized medicine systems aren't perfect and there will always be anecdotal stories of how socialized medicine screwed someone.

But perhaps we ought also consider what would have happened to that very same cousin or friend of a friend had they been uninsured in the U.S.

(For the people who know said person, I apologize for my crass attitude. I really do care about people and what happens to them. I just happen to spend far too much time with very poor people who don’t even get basic care and think that these people, living in our own neighborhoods, deserve as much concern as the cousin in Canada.)

Stepping off my soap box now.

(BTW Jo, I've been thinking of you whenever I wear my Fluevogs. I knew I had to stick around and read more when you posted a picture of my favorite shoes EVER back in March. How many nurses love truly great shoes? Sending happy/healing thoughts South whenever I look at my feet!)

Lynda Halliger-Otvos said...

K. As I was winging about my prior life with no insurance, it occurred to me that I know a half dozen families still in that position. Families with kids and working parents and parents going to grad school and sculpting and managing a B & B and working for the City on a contractual basis.....

Why do they have to suffer for decent care? What can we do against the enormous money bags of the insurance industry? How do we wrestle their several billion dollar a year profit away from them and turn it into Care, not insurance or coverage or access; Care and good decent, timely care, too. Not that fake shit they pass off as Medicaid here in the richest country in the world.

Thanks for listening....

Cartoon Characters said...

;)sorry, couldn't resist!

Anonymous said...

It's interesting - people on either side of the socialized medicine argument tend to dismiss the other side's points as "oh, a few stories..." "Oh, a few people think they got screwed...".

Our whole family lives in the UK. Still. Today. I'm not talking about a single incident, I'm talking about what went on whenever a family member got/gets sick or needed something worked up. And all the other people we know over there.

There are waits. If anyone really wants, I can find newspaper articles, statitics from the actual health trusts, etc. It isn't just a few stories.

At a recent visit to Mayo Clinic, the staff talked about how a lot of Canadians who had too long of wait times came to Mayo.

And here in the US, there are often options for the uninsured. My friend, an oncology nurse, often talks about the uninsured, homeless, etc. people she's giving chemo to. So some do get treatment.

But there's the flip side to all of the above.

In the UK, for many things, the NHS would be "better" than the US system. You don't pay for much, don't have to worry about that. If you need to see the GP, or you're hit by a truck and go to the ER, it's generally just fine.

When the problem can come, is referral to specialist care, or a painful but not life threatening condition (like a hip replacement for example). People can, and do, wait months or even longer. Not on rare occasion either. Things like biopsy results can take a very long time. Not days.

It also depends which health trust (area of the country) you are in. In the wealthy areas, things might go faster. And some treatments are available in some trusts that aren't in others. It's not all perfectly equal and fair.

re dentists btw - it's almost impossible to get in with a NHS dentist these days. And paying private costs the same as the US, sometimes more.

The NHS is currently underfunded, and things have changed from what used to be.

Now the US - I think underinsured might almost be worse than uninsured. It seems like it's harder to find help then. Some people delay getting care, because they're afraid of the bills. So they might be able to get charity care etc. once they're really sick - but not keep from getting sick in the first place.

I believe everyone should have access to medical care. The argument is just how, imo. The last people I personally trust to run programs and make decisions is the government. Just my opinion.

I do care about poor people who can't get the care they need. However - rich people aren't less than poor people. I also care about people, like our familiy member, who paid taxes into the system his whole life and then don't get good care - and died as a result. Neither is acceptable.

The US system works pretty well, for those with good insurance.

The NHS works pretty well, for many things.

I don't see either of them as a perfect model. But personally, I'd prefer improving the US system over moving to a socialized one. It's really hard to argue with the government, and I believe the govt. also tends to be ineffecient.

Penny said...

Regarding Anon's "I think underinsured might almost be worse than uninsured,": That is the understatement of the UNIVERSE.

I worked for a few months as a pharmacy tech. I put the drug orders in every night, and saw with my own bulging eyes what the store paid for the drugs. Hint: It was pennies on the dollar that was charged to the patient. On top of that, I regularly saw drugs go for a $10 or $20 copayment to people with great insurance. The people with sucky, substandard insurance would pay a copayment of $60, if they were lucky. More often than not they would pay completely out of pocket, even though they DID have insurance. Have you ever had a woman on a fixed income burst into tears when told that the Proventil she's picking up equals half her food budget for the week?

The people with no jobs and no insurance? What they paid for Proventil and drugs hundreds of times more expensive?

Zero.

Zilch.

Nada.

I was working there as one of three jobs after my husband lost his job and the $$ around Casa de Pens were lean indeed. It was almost enough to make me just throw up my hands and say, "Fuck it all." Why keep fighting to work and pay one's bills, when the people who don't work at all get that golden Medicaid card and "no charge" stapled to their pharmacy bags?

I'm about as flaming a liberal hippie socialist as there is. However, I had to quit at the pharmacy. The fact that it was making me bugnuts insane out of my MIND was not a small part of that decision. I WANT to want the very best for my fellow humans. I WANT to embrace love and compassion and have it be real in my life, not just something I talk about. I don't want to turn into a "fuck you, I got mine" right-winger. Working at the pharmacy was nudging me towards that. If I had to wait on one more Medicaid recipient who was pissy at me for having to wait three extra minutes for the FREE drugs that the working woman just paid $200 for, I was going to just start shooting people.

Yes, socialize medicine has its issues. No, it's not perfect. However, the system we have now in the United States is fucked beyond repair, in my humble opinion. It penalizes the people who are honestly TRYING and rewards the people who have thrown up their hands and said, "Screw it. I'm out."

I just recently fulfilled the hellishly high deductible on my insurance for the year. Part of my consideration on whether or not I should be thinking about the surgery that has been mentioned for me is the fact that if I'm going to have to do this, I need to do it before 12/31/2010, or I won't be able to afford it next year. Yes. I'm pondering whether or not I'm going to subject myself to being sliced open based partially on my bank account.

It's fucked, I'm sick of it, and we can't keep this up much longer.

Eileen said...

Anon 5.49 - I'm not claiming the NHS is perfect - and you're right, it is underfunded. But so is every healthcare system in the world and it's because they were all set up at a point where no-one envisaged the advances that would happen and how much that level of care might one day cost.
Biopsies taking a long time might be because of the sorts of tests needing to be done - if necessary they can be chased up. But as I've just posted at the other thread - there are rules about how long referrals are allowed to take and if they are exceeded and a complaint is made all hell lets loose. Anyone can find out the different rules if they can use tinternet.

And if you have a problem with the NHS, the same applies actually as in the US: you can go to a specialist anytime you like by paying for a private consultation if you have the money. And if, at that private consultation, the specialist thinks there is something that needs to be done cos it might be serious and nasty - they can transfer you to their care in the NHS. The vast majority of consultants who do private work also work in an NHS hospital and will willingly allow you to have chronic illness followed up there. In the case of cancer where the longterm costs are likely to be very high, the logical place is to be in the NHS. In the case of a hip replacement you could elect to have that done privately (usually about 6 or 7K I think) end of story for that episode, back to NHS care in future. They won't refuse to cover you because you have an "existing condition".

And when you choose to have a nose job or liposuction done in a private clinic and something goes wrong, you start bleeding out, your gut gets perforated, - have you ever thought who it is who sorts that out? There are very few private clinics in Europe that have a doctor on at night and even fewer where that doctor is an anaesthetist who can deal with that sort of emergency. No blood transfusion service in house, no 24-hour staffed OP, no ICU - so what do they do, if they realise how ill the patient is, that is? They dial 999 and get the patient transferred to the local NHS hospital which has an A&E and ICU. If the patient survives long enough they'll get taken to theatre for an NHS surgeon to sort out the mess his colleague down the road was charging megabucks for creating. If it's needed, they will get the plastic or reconstructive surgery to make the mess livable with. Who pays? The NHS.

Many of the stories in the Daily Mail (otherwise known as the People's Medical Journal) and its ilk are embellished to make a good headline - my 2 are not, they happened in hospitals I know. The nose job was at a clinic less than a mile from one of the top hospitals in the country and the lady concerned died despite the NHS staff doing their best - she'd been bleeding for too long and her body was already shutting down. Her husband's comment "I liked her nose as it was".

I, too, have been on the receiving end of less than perfect care in the NHS, but none of it was for anything life-threatening. When I had pre-eclampsia and a very premature baby as a result we both survived - and it cost us not a penny. When my husband had a very rare form of what is normally testicular cancer 16 years ago - the same despite chemo, very fancy surgery and radiotherapy. And the hernia and DVT a few years ago - also dealt with speedily and correctly.

Eileen said...

Continuation of my other post starting Anon 5.49:

I read a lot of blogs by patients, nurses and doctors in the USA and participate in medical forums for rheumatology. I've not come across much that suggests the system there is any better than the NHS. There are still specialists who can't diagnose something that presents in textbook format and practically says "Hi, I'm...". Or don't know the gold-standard treatment for the disease. Or are such dimwits as not to know when they don't know and to refer. The big difference? The NHS dimwits aren't handing me a bill for what they didn't get right and my copay is restricted to a maximum of about £100 for the year for drugs (the pre-pay ticket for the pharmacy which will cover everything approved that appears on a script from your doctor, including compression stockings and diabetes gear). And if I'm really poor I won't be asked for that either. It's less in Scotland and in Wales I think it is free.

Eileen said...

Dear Jo - hope you can sort this out - should be 2 bits, one starting "Anon 5.49" and the other "Continuation of". Italian blogger does this occasionally and I have no idea what's posted and what's not!!!!

Anon 5.49 - I'm not claiming the NHS is perfect - and you're right, it is underfunded. But so is every healthcare system in the world and it's because they were all set up at a point where no-one envisaged the advances that would happen and how much that level of care might one day cost.
Biopsies taking a long time might be because of the sorts of tests needing to be done - if necessary they can be chased up. But as I've just posted at the other thread - there are rules about how long referrals are allowed to take and if they are exceeded and a complaint is made all hell lets loose. Anyone can find out the different rules if they can use tinternet.

And if you have a problem with the NHS, the same applies actually as in the US: you can go to a specialist anytime you like by paying for a private consultation if you have the money. And if, at that private consultation, the specialist thinks there is something that needs to be done cos it might be serious and nasty - they can transfer you to their care in the NHS. The vast majority of consultants who do private work also work in an NHS hospital and will willingly allow you to have chronic illness followed up there. In the case of cancer where the longterm costs are likely to be very high, the logical place is to be in the NHS. In the case of a hip replacement you could elect to have that done privately (usually about 6 or 7K I think) end of story for that episode, back to NHS care in future. They won't refuse to cover you because you have an "existing condition".

And when you choose to have a nose job or liposuction done in a private clinic and something goes wrong, you start bleeding out, your gut gets perforated, - have you ever thought who it is who sorts that out? There are very few private clinics in Europe that have a doctor on at night and even fewer where that doctor is an anaesthetist who can deal with that sort of emergency. No blood transfusion service in house, no 24-hour staffed OP, no ICU - so what do they do, if they realise how ill the patient is, that is? They dial 999 and get the patient transferred to the local NHS hospital which has an A&E and ICU. If the patient survives long enough they'll get taken to theatre for an NHS surgeon to sort out the mess his colleague down the road was charging megabucks for creating. If it's needed, they will get the plastic or reconstructive surgery to make the mess livable with. Who pays? The NHS.

Many of the stories in the Daily Mail (otherwise known as the People's Medical Journal) and its ilk are embellished to make a good headline - my 2 are not, they happened in hospitals I know. The nose job was at a clinic less than a mile from one of the top hospitals in the country and the lady concerned died despite the NHS staff doing their best - she'd been bleeding for too long and her body was already shutting down. Her husband's comment "I liked her nose as it was".

I, too, have been on the receiving end of less than perfect care in the NHS, but none of it was for anything life-threatening. When I had pre-eclampsia and a very premature baby as a result we both survived - and it cost us not a penny. When my husband had a very rare form of what is normally testicular cancer 16 years ago - the same despite chemo, very fancy surgery and radiotherapy. And the hernia and DVT a few years ago - also dealt with speedily and correctly.

Anonymous said...

Well Jo, I hope we are at least distracting you a bit here :) I've split my response up into a couple posts.

I'm sitting next to someone from the UK in a medical field, and these responses are coming from that person. I myself am not a Brit.

We agree that the underfunding and waits have gotten worse because of the advances in technology.

re. biopsies, often the biopsies are done in perhaps 2 weeks. But, you can't get the appointment for them to tell you the results. A standard histology (no special testing) takes on average 6 weeks for the patient to get the results. For example, a family member with breast cancer recently got results in 6 weeks - the person who died of melanoma waited 8.

Yes, you can make a complaint if a wait is “against the rules”. But, it can take as long for the trust to address your complaint as the wait is. A family member, whose father had just died from melanoma took 8 weeks to have suspicious moles looked at. Initially they were not even going to biopsy them, they were going to wait six months, with a stated 5% risk of melanoma. After much complaining, it took 8 weeks. They were abnormal and had to be removed. Thankfully, he knew enough to make a fuss. Unfortunately, his father with the melanoma didn’t know enough to complain, and trusted that it would be ok. It wasn’t.

Yes, a private specialist can transfer you to their care in the NHS. However, then you’re back on the waiting list. It may improve the wait some, if you’ve already seen them and they say it’s bad. But, waiting lists for surgery, etc. will then still apply.

Re. following up chronic illness and/or cancer on the NHS after private treatment, yes you sometimes can. The NHS can, and sometimes does refuse this because they don’t want richer people to be able to jump the queue. For example, they can and have refused to administer chemo drugs that a person is paying privately for.

I agree, in emergencies the NHS will certainly take care of you, even if private treatment led to the problem.

Anonymous said...

I am not saying the NHS is all bad. I’m not saying the people who work for it are any less qualitified than those in the US. But – I am saying with socialized medicine, wait lists are real, and don’t just happen for a few. It does appear that the NHS is having a push to improve the wait times, which I applaud.

Here’s a few example articles. This one’s from 2008:

http://thescotsman.scotsman.com/health/Sturgeon-vows-to-halve-NHS.3752316.jp

“In Clydebank yesterday, Ms Sturgeon said health boards would have to meet a series of milestones on the path to 2011. Currently, patients can wait up to 18 weeks from GP to outpatient appointment and 18 weeks for treatment.

In the first step, these waiting times must be cut to 15 weeks by March 2009. Waiting times for diagnostic tests will also be cut from nine to six weeks.”

“She said the government had yet to decide on a "tolerance level" – the percentage of patients seen within the 18-week target. "In England it is set at 95 per cent, which is a benchmark, but I would like to get it a bit higher than that," she said.”

In 2009. achieving some goals:

But what exactly does this mean – an appointment might just be an initial evaluation, not treatment?

http://news.scotsman.com/health/Scots-NHS-waiting-times-less.5304420.jp

“PATIENTS needing a hospital appointment in Scotland are now waiting less than 12 weeks, figures showed yesterday.
The statistics showed that 99.9 per cent of patients needing an outpatient appointment were not waiting longer than 12 weeks.”

“But she said there is more to do and boards must direct efforts to reaching a "whole journey" target for 18 weeks from GP referral to treatment by the end of 2011.”

http://www.scotsman.com/latestnews/NHS-finally-hits-target-.5282785.jp

“NHS finally hits target for cancer waiting times – three years late
Published Date: 20 May 2009
By Lyndsay Moss, Health Correspondent
A KEY target to make sure the majority of cancer patients wait no more than two months before starting treatment has finally been met in Scotland – three years behind schedule.
Figures yesterday revealed 95.4 per cent of patients began treatment within 62 days of being urgently referred by their GP.”

“Three of the longest waits were in NHS Lothian with 223 days for a lung cancer patient, 147 days for a lymphoma patient and 216 days someone with skin cancer.”

Cartoon Characters said...

"At a recent visit to Mayo Clinic, the staff talked about how a lot of Canadians who had too long of wait times came to Mayo." - per anon@5:49

Of course they are going to talk about the one or two canadians that appear at Mayo clinic - because they don't SEE the MILLIONS that stay at home and have procedures done.

I still say the stats are on the side of socialized medicine.