Keith Nuttle wrote in
:

On 6/29/2012 3:41 PM, Han wrote:
Larry Jaques wrote in
:

On Fri, 29 Jun 2012 09:19:15 -0400, "G. Ross"
wrote:

Lew Hodgett wrote:
Today's vote by the SCOTUS was amazing.

Now let the fun and games begin.

Lew

What was amazing at the start was the premise that you could
furnish health care for more people for less money. Never made
sense, but they said it with a straight face.

I believe their theory is that all of us who rarely use doctors will
be paying for those who do.

I believe that compulsory healthcare insurance is a good thing.
Until now, if your insurance or lack of it does not cover a needed
expense, you are at the mercy of the doctor or other healthcare
provider. Of course you could negotiate to get what you need for
less than half of the "charge", and sometimes you might be
successful, but usually you'd need to pay twice or more of what the
insurance company pays for the same treatment. Now everyone pays the
same in healthcare insurance, and the insurance companies negotiate
with the providers. We "only" need databases to find out actual
amounts paid for each condition to decide where a certain treatment
is most economical (and best, of course).

At the moment, the cost of care often includes a surcharge to help
pay for indigent caren (in NY City, there is a 8.5% or so surcharge
that insurance covers, but that deals with the cost of under and
uninsured).

There wil be no more COBRA where it would cost $1000 plus/month to
get insurance if your hours were reduced to the extent that you don't
have benefits anymore, or get laid off. Skip on the insurance for a
while, and then you have a pre-existing condition, and no more
insurance, period.

Of course, I would think that a nationwide single payor insurance
system would cut out most of the duplications in administering
insurance, but it would also cut what little competition there is
left, so it is doubtful which is worse. I am all in favor of good
wages for healthcare personnel, but currently much of the costs are
associated with needless bureaucracy, duplicating "state of the art"
care that doesn't help more than regular exercise, and I could go on.
Let's focus on that, and on the question how much end of life care
should cost, in comparison to the quality of life. I know I tread
perhaps on sensitive toes, and I would like to submit that at that
time, insurance and treatment choices should be made. I have a
living will etc set up. Do you? In the absence of proper
instructions, the doctors and hospitals will clean you out.


While there are problems with our health insurance system it is still
the best and most responsive in the world, bar none. If the plan for
government review of the medical procedures a person gets, were in
effect today when my wife retina torn loss, she would be blind today,
as the surgery had to be done within hours not the months it would
take the bureaucrats to decide if she should be treated. Check the
time frames to get care under the European Socialist systems. You will
be shocked. As your European friends on Facebook.

As a born Dutchman, firstly I have nothing against Social Democrats (most
often called socialists over there). I have something against
communists, since they are dictatorial, whichtrue socialists aren't.
Secondly, the Dutch healthcare system is a single payer type national
healthcare system, although there are many companies offering insurance
policies (http://en.wikipedia.org/wiki/Healthc...e_Netherlands).

I broke a leg in an amusement/zoo type park (Dolfinarium) in Harderwijk,
a very small city, formerly more a fishing village on the inland sea arm
the Zuiderzee. It is also where Linnaeus, the father of taxonomy and the
system of nomenclature for animals and plants, developed his system
http://en.wikipedia.org/wiki/Linaeus. But it had a first-class
hospital and trauma surgeon on staff. I broke the leg at 10:30 AM, it
took a while for an ambulance to get me to the hospital. I was seen in
the ER almost immediately and the trauma surgeon was called in. By 2:30
PM I was back in a hospital bed after surgery to put a couple of plates
on the 2 broken bones near the ankle, and a dozen or so screws. I spent
3 nights in the hospital. The total costs for ambulance, surgery
hospital stay and doctors was around $9000. The bill for the ambulance
was a 1-liner. The bill for the rest was 2 lines. Because I didn't have
Dutch (or EU) insurance they asked me to pay the bill, and get the money
back from my insurance company (they knew the difficulties dealing with
US insurance). It all worked out for me in the end, with not much more
than my deductible to be paid by me (they screwed me on the exchange
rates).

Here in the US, the orthopedist I used for follow-up was amazed at the
way the Dutch surgeon had inserted one of the plates by not cutting the
leg and placing the plate, but by inserting it under the skin and sliding
it in place. Note that I have now full use of the leg, and (so far) no
sign of the possible arthritic complications which I was told can happen.

So in my personal experience, the Dutch system was very efficient, highly
professional and "modern", and probably quite cheap.

However do you really think a bill that duplicates the FDA, adds taxes
on medical devices, and taxes to those who are least able to pay them,
is the solution to this dilemma.

There are things the FDA isn't very good at, and I don't know exactly how
it could be better. There is a trade-off between safety, approving new
treatments and doing careful followup. The tax on medical devices is
2.3%, I believe, well within the yearly cost increases for healthcare
related items. Those least able to pay don't pay at all now, for various
reasons. Having them pay something is a conservative's dream.

With government limits on medical care, do you think any one would
have developed the spin off from The Star War program into the laser
surgery techniques we use today.

Huh?? Limits on medical care?? What limits? The discussion of what
care a person should get, is and should be between the patient and the
doctor. The doctor shouldn't have to worry about misplaced malpractice
suits, or about getting paid for his services, and the patient should be
assured to get the most appropriate medical care. Now, the insurance
company might suggest hydrochlorothiazide for high blood pressure (a
diuretic costing a few dollars per month) over the latest new blood
pressure pill that has all kinds of side effects and costs $60 plus per
month. Plus I think (and have said so elsewhere several times), people
should ahead of time make their wishes for end of life care known (living
will, advanced directives, whatever). That should be in discussions with
their loved ones, and in written down, notarized and deposited with their
physician formats. And those are difficult questions, that can cause
heartache for years afterwards.

The government regulation has burden the medical industry with a
system that takes 10 to 20 years for the FDA to review and approve a
new drug. Do you think having two government agencies doing the same
review is going to make drugs safer or get new drugs to the doctors
faster.

I was involved in this area as a researcher, doing preliminary research.
I have knowledge of the problems, the bureaucracy and indirectly of the
falsifications during the processes. My considered opinion is that the
FDA should strive to bring new (really new, not me-too or slight
modifications of old drugs) medications and devices to the market place.
But there also should be a more formalized and stricter system of follow-
up. The Vioxx/Celebrex type anti-COX2 antiinflammatories are an example
how a celebrated new class of (expensive) drugs has had minimal effects
on treatment (a gross generalization) and some troublesome and still not
quite understood side effects. The statins have effects that cannot
really be explained by cholesterol-lowering (originally the way they were
designed and thought to act), they appear to have side effects for some
that are bad, but overall they are (I think) good. I'll have to look up
what this new law might do to a corollary of the FDA, because I hadn't
really heard about that aspect other than that the FDA is a heap of
trouble.

--
Best regards
Han
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