RE: U.S. health care

2007-07-20 Thread Dan Minette


 -Original Message-
 From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On
 Behalf Of Ronn! Blankenship
 Sent: Saturday, July 14, 2007 9:08 AM
 To: Killer Bs Discussion
 Subject: RE: U.S. health care
 Well, it would put the small pharm out of business too.  And, then, who
 would develop new drugs?  I assume you favor governments?  Historically,
 governments have had a much worse track record in technical innovation
 than
 private concerns.  Planned economies tend to be ponderous and very bad at
 reacting to changes in demand, available possibilities, etc.  They are
 particularly bad at innovation.
 
 
 So who do you see who should/will make vaccines, search for new
 antibiotics, search for _cures_ for diseases etc., when the profit
 lies in coming up with pills which must be taken every day for the
 rest of the patient's life in hopes of warding off some future serious
 disease?

Well, a couple things come to mind.  First, countries with government health
care could invest in research in vaccines to see if they can prove me
wrongthat government sponsored drug development can be effective.  It
would be nice to have other developed countries take up more of the burden
of paying for medical developments.  If they wanted to sell it in the US to
recoup  some of their coststhat's not a problem with me.

Using a capitalistic model, the first thing that comes to mind is reduce the
risks inherent in developing new vaccines.  Protection from liability...as
long as the company was above board in providing the results of studies to
authorities, and guaranteed purchase of vaccines for X sound like some
possibilities.

As for preventing diseasessome of the medicines people take everyday now
do that.  High cholesterol is not the disease, clogged arteries isso
that is really prevention.  I don't think most prevention would be a
one-shotbut allowing for big payments for a one-shot makes sense.  

Dan M. 


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RE: U.S. health care

2007-07-19 Thread Ronn! Blankenship
At 01:02 PM Wednesday 7/18/2007, Dan Minette wrote:


  -Original Message-
  From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On
  Behalf Of Charlie Bell
  Sent: Friday, July 13, 2007 10:53 PM
  To: Killer Bs Discussion
  Subject: Re: U.S. health care


   'm not sure you have an adequate picture of the US system and how it
   works for the average person who works for a big company.
 
  I have an adequate picture of the US system being ranked well below
  several European ones...

Which is certainly enough for Schadenfreude, but not for solving the
problem. Let me give you an example from one of the clearest numbers for
which the US performs relatively poorly: infant mortality.

The US's rate, about 7/5000 live births is far above the EU rate of
5.6/1000.  This is a horrid statistic.

We find, though, that the white, non-Hispanic rate is close to the EU:
5.8/1000.  The black rate, on the other hand, is very high: 13.8.

There is an obvious conclusion to be reached: this is a function of the
disparity of income between whites and blacks causing differences in medical
care.  However, looking at different numbers, we see that it's not this
simple.  The Hispanic rate (5.7/1000) is below that of white, non-Hispanics
at 5.7.



Is a difference of 0.1 per thousand statistically significant given 
the data being analyzed?  (I'm not saying it's not.  Just asking.)


-- Ronn!  :)



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RE: U.S. health care

2007-07-18 Thread Dan Minette


 -Original Message-
 From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On
 Behalf Of Charlie Bell
 Sent: Friday, July 13, 2007 10:53 PM
 To: Killer Bs Discussion
 Subject: Re: U.S. health care


  'm not sure you have an adequate picture of the US system and how it
  works for the average person who works for a big company.
 
 I have an adequate picture of the US system being ranked well below
 several European ones...

Which is certainly enough for Schadenfreude, but not for solving the
problem. Let me give you an example from one of the clearest numbers for
which the US performs relatively poorly: infant mortality.  

The US's rate, about 7/5000 live births is far above the EU rate of
5.6/1000.  This is a horrid statistic.

We find, though, that the white, non-Hispanic rate is close to the EU:
5.8/1000.  The black rate, on the other hand, is very high: 13.8.

There is an obvious conclusion to be reached: this is a function of the
disparity of income between whites and blacks causing differences in medical
care.  However, looking at different numbers, we see that it's not this
simple.  The Hispanic rate (5.7/1000) is below that of white, non-Hispanics
at 5.7.  While Hispanic households average more income than black households
(I'd guess it's because of the greater likelihood of a Hispanic household
containing multiple adults) its far closer to the black number than the
white, non-Hispanic.

Further, one sees that even black women who completed college have a
significantly worse rate than white women who haven't completed grade
school. 10.6/1000 vs. 6.3/1000.  These data indicate that something besides
income is affecting the situation.

One good candidate, bemoaned by black ministers and physicians, is the
general distrust of physicians by the black community.  They are far less
likely to use medical services than Hispanics or non-Hispanic whites, even
when it is available.   That problem will not be solved by switching the
system of insurance.

That's just one example of the complexity of the problem, there are a score.
There is no flip solution to the problems with the US health care system.  

Dan M. 




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Re: U.S. health care

2007-07-14 Thread Ronn! Blankenship
At 10:53 PM Friday 7/13/2007, Charlie Bell wrote:

On 14/07/2007, at 4:04 AM, Dan Minette wrote:

 
 
  That assumes you keep providing care the way you do.
 
  Increase preventative medicine and primary nursing, and you reduce
  other healthcare threefold.
 
  How?

...because hospital stays reduce and recovery times increase. Good
prevention and primary treatment is the most effective way of
maximising returns on healthcare investment.



The contrarian in me sometimes wonders how much 
will indeed be saved by so-called preventative 
medicine for the major serious chronic 
conditions, because I'm sure most of us can think 
of people we know who had heart attacks or were 
diagnosed with diabetes or something like that 
who had none of the known risk factors for the 
disease prior to the time it hit, as well as the 
cliche grandfather who smoked like a chimney and 
drank until he was killed when he was hit by a 
bus leaving a brothel one night when he was in 
his 90s . . . and of course how much 
preventative medicine will be used as a 
justification for further regulations on the average person's life . . .

(I get a laugh — when I can spare the air — from 
being diagnosed with chronic bronchitis because 
that has traditionally been a euphemism for 
smoker's cough and I never smoked a day in my life.)



  'm not sure you have an adequate picture of the US system and how it
  works for the average person who works for a big company.


It works fine as long as neither you or any of 
your family members who are on your insurance get sick or injured . . . :P


-- Ronn!  :)



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RE: U.S. health care

2007-07-14 Thread Ronn! Blankenship
At 05:14 PM Friday 7/13/2007, Dan Minette wrote:
  dan, i'm confused i realize that it doesn't work that way in other
  countries, but are you defending the way it works in america, or
  denying that lobbies have enormous influence in congress?

Lobbies do have an influence in Congress, and changes that they oppose are
often beneficial.  However, getting rid of the lobbies does not get rid of
the fundamentals of the problem.  If you take the profitability out of drug
development by private companies, you will stop private drug development.
The history of the latter half of the twentieth century has shown the
//disadvantages of economies where the government owns/controls major


  i realize there are costs in creating new drugs and marketing them.  do
  you believe there are instances when drugs are kept on the market when
  the side effects can be dangerous and law suits contribute to the cost?

That's part of it, but it the cost of eliminating any drug that might have a
dangerous side effect is having no new drugs.  The gauntlet that a drug has
to run through before being approved is fairly formidable.  Even then, when
it is given to millions, after a careful study of thousands, side effects
may be seen at levels too low to have observed in the study of thousands.

   i have a friend who was given viagra when it was still being tested;
  he had a massive heart attack.

And, without large, statistically significant studies we won't know if that
is a coincidence.

  the fact there is little interest in new research on vaccines because
  it doesn't pay, yet any new drug for ed is a great investment, make me
  wonder if capitalism is the right incentive for health care?  this is
  what sicko points out...

There are a couple of obvious conclusions that can be made here.  First,
people are more willing to spend money on ed than on vaccines.  Second, this
is a case where the uninformed public outcry on the danger of vaccines makes
people very leery about spending money in this area.

Third, wouldn't this be a perfect place for the more socialist countries
than the US to show the disadvantages of capitalism by developing new
vaccines through public spending?  Since virtually all of the innovation
first targets the US market, I think Gautam quoted here a site where 85% of
the major innovations in the last 5 years were in the US and the other
tended to target the US first.

Isn't it logical to assume that, if the US market for this innovation dries
up, that the source of the innovation would also.

  i have no problem with cheap third world drugs flooding the market and
  putting big pharm out of business.

Well, it would put the small pharm out of business too.  And, then, who
would develop new drugs?  I assume you favor governments?  Historically,
governments have had a much worse track record in technical innovation than
private concerns.  Planned economies tend to be ponderous and very bad at
reacting to changes in demand, available possibilities, etc.  They are
particularly bad at innovation.


So who do you see who should/will make vaccines, search for new 
antibiotics, search for _cures_ for diseases etc., when the profit 
lies in coming up with pills which must be taken every day for the 
rest of the patient's life in hopes of warding off some future serious disease?


-- Ronn!  :)



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Re: U.S. health care

2007-07-13 Thread William T Goodall

On 13 Jul 2007, at 04:01, Dan Minette wrote:


 Governments could step in, but in countries with price
 controls/negotiations...they haven't.  Instead, they rely on the US
 providing the profits that pay for innovation, then negotiate a  
 price for
 themselves. It's not rock bottom, but that's why the same meds are  
 cheaper
 in Canadaroughly the same reason why US TV shows sell for less  
 overseas
 than in the US.

The BBC recently paid £400,000 ($812,000) per episode for first run  
of season 2 of _Heroes_.

Rising Prices Maru

-- 
William T Goodall
Mail : [EMAIL PROTECTED]
Web  : http://www.wtgab.demon.co.uk
Blog : http://radio.weblogs.com/0111221/

Every Sunday Christians congregate to drink blood in honour of their  
zombie master.


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Re: U.S. health care

2007-07-13 Thread Charlie Bell

On 13/07/2007, at 1:01 PM, Dan Minette wrote:


 of GDP.  If everyone were to get the care available to those with  
 the very
 best insurance policiesthen it would probably jump to 20% or
 so...immediately (That assumes that the health care denied by  
 reasons of
 costs represents only a 20% reduction in total care).  As it is,  
 without
 universal coverage, it's projected to reach 20% in a few years.

That assumes you keep providing care the way you do.

Increase preventative medicine and primary nursing, and you reduce  
other healthcare threefold.

Whatever the french are doing? Do that.

Charlie
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RE: U.S. health care

2007-07-13 Thread Dan Minette


 -Original Message-
 From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On
 Behalf Of jon louis mann
 Sent: Friday, July 13, 2007 1:03 AM
 To: Killer Bs Discussion
 Subject: U.S. health care
 
 
 it that is the dynamic, dan, then anerica is sunsidizing the rest of
 the world, which would be justice.  

If you are talking about Sub-Sahara Africa, and other third world countries,
I would certainly favor ways of lowering the cost of drugs in those
countries.  But, I don't think we need to subsidize Canada, Japan, the EU,
and other developed prospering countries.

Dan M. 


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RE: U.S. health care

2007-07-13 Thread Dan Minette


 -Original Message-
 From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On
 Behalf Of Charlie Bell
 Sent: Friday, July 13, 2007 7:55 AM
 To: Killer Bs Discussion
 Subject: Re: U.S. health care
 
 
 That assumes you keep providing care the way you do.
 
 Increase preventative medicine and primary nursing, and you reduce
 other healthcare threefold.

How?  I'm not sure you have an adequate picture of the US system and how it
works for the average person who works for a big company. While the lack of
health insurance for about 15% or so of Americans is a horrid fact that must
be addressed, these people do not represent the majority of health care
costs.

For example, most of the lifetime cost for medical service in the US is
accrued after age 65. Everyone over 65 is eligible for Medicare. Under basic
Medicare, the co-pay (the out of pocket cost) for a primary physician visit
is $5.  For most on Social Security and Medicare, this is not a major
worry...other factors (an unwillingness to bother a neighbor for a ride is
my mother's favorite excuse) are more important. Most of the time, the
elderly make an appointmentbut when a member of the family living with
us this summer became ill, she walked in without an appointment to an urgent
care facility, and saw a nurse practitioner within 1.5 hours.  

So, an inability to afford primary health care is not the most important
factor in the cost structure of the US. For the elderly, the cost problem in
seeing a physician/nurse is not that they cannot afford $5, but that when
they do get sick, the treatment is expensive. My wife has arthritis, and
just one of the meds that provides her relief costs about $200/month.  My
mother is on a number of expensive meds...that are mostly covered by
insurance...she has a small co-pay.

 
A major source of cost, in the US, is the legal system. Hospitals are not
required to accept every potential patient, but, once a patient is in a
hospital, no service can be denied because of cost.  If it is, the hospital
and the doctors open themselves up to lawsuits that run in the multiple
millions.  As a result, tens of thousands of dollars are spent prolonging
the life of dying people by a few weeks or months.  My brother-in-law, a
physician, talked about having to code (bring back from clinical death)
someone twice a day for a month until the family accepted the fact that he
was dying and nothing could be done but prolong the death.  In most cases,
it takes weeks for the family to come to grips with that, and allow the
person to die.

There are other factors, like the horrid bureaucracy of paperwork, poor
health habits, etc. that contribute to this problem.  But, a lack of
available primary care medicine is not the critical problem.  This has been
tested experimentally for the last 15-20 years in the US when HMOs first
came out.  Primary co-pays were very small (near token), and primary care
was encouraged.  Indeed, my health insurance paid me $100 to get a physical.
Studies of people who had this insurance showed, at most, a modest health
gain over those in more traditional plans.

Dan M. 



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RE: U.S. health care

2007-07-13 Thread Dan Minette


 -Original Message-
 From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On
 Behalf Of jon louis mann
 Sent: Friday, July 13, 2007 12:23 PM
 To: Killer Bs Discussion
 Subject: U.S. health care
 
  if that is the dynamic, dan, then anerica is subsidizing the rest of
  the world, which would be justice.
 
 If you are talking about Sub-Sahara Africa, and other third world
 countries,
 I would certainly favor ways of lowering the cost of drugs in those
 countries.  But, I don't think we need to subsidize Canada, Japan, the
  EU, and other developed prospering countries.
 Dan M.
 
 i doubt they would be doing it if it were not profitable. big pharm
 doesn't have strong enough lobbies in other developed countries to fix
 the price of their pills, etc... 

Huh?  That's not how it works. Let's say the a new cholesterol drug is
developed, that not only reduces the level of cholesterol, but over a year,
virtually eliminates the buildup that causes heart attacks.  It's a hot
commodity, and will sell well.

In the US, they charge what the market will bear.  Folks lobby their
insurance companies to put it on the formulary, and it goes on  It costs
about 10 cents/pill to make, but can be sold for $5.00/pill.  The company
can see 1 billion of these pills per year in the US for gross profit of
almost five billion dollars per year.

Now, other countries are interested in this pill, and start to negotiate
prices for use in their nations.  Even if they negotiate for only
$2.00/pill, it's a lot of profit for the drug company.  If it sells another
billion pills/year overseas, that's another 1.9 billion/year profit.

So, what happens if the US negotiates on drug pricesand the price
available in the US is only $1.90/pill.  Don't they still make billions?

Yes, but...that's knowing the pill will work.  When the particular drug
starts testing, odds are long against it working without unacceptable side
effects.  People doing cost-benefit analysis beforehand make decisions
concerning whether starting on the path to develop the drug based on the
expected profits.

Profits in the drug industry are high as a percentage basis...I think
something like 15%-$20 of revenue for net profits is typical.  FWIW, this is
not too unusual for high risk ventures.  Most new drugs never make it to
market.  It's the relatively few multi-billion drugs that pay for all.  The
US can, today, mandate lower prices on may drugs, remove patent protection
on these drugs, etc. and get lower prices.  One side effect will be a drop
in research into new drugs...the amount it drops is dependant on how much
the projected income for a successful new drug drops.

This is not, at all, a bad thing.  I hope the price in the rest of the
developed world rises to meet the falling US price, so the cost of research
is born more evenly.  But, if not, we will see more and more field match
what is seen in vaccines...you can find companies to manufacture them, but
there is little interest in new research because it doesn't pay.


  the poorer countries pay what the
 market will bear and the profit there is minimal.   maybe it limits the
 black market...?

Right now, companies are afraid that cheap Third World drugs would find
themselves back in developed countriescompeting with their own product
there.  It took strong arm tactics by governments in the developed world to
initiate such programs.  

Dan M. 


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RE: U.S. health care

2007-07-13 Thread Dan Minette
 dan, i'm confused i realize that it doesn't work that way in other
 countries, but are you defending the way it works in america, or
 denying that lobbies have enormous influence in congress?

Lobbies do have an influence in Congress, and changes that they oppose are
often beneficial.  However, getting rid of the lobbies does not get rid of
the fundamentals of the problem.  If you take the profitability out of drug
development by private companies, you will stop private drug development.
The history of the latter half of the twentieth century has shown the
disadvantages of economies where the government owns/controls major 


 i realize there are costs in creating new drugs and marketing them.  do
 you believe there are instances when drugs are kept on the market when
 the side effects can be dangerous and law suits contribute to the cost?

That's part of it, but it the cost of eliminating any drug that might have a
dangerous side effect is having no new drugs.  The gauntlet that a drug has
to run through before being approved is fairly formidable.  Even then, when
it is given to millions, after a careful study of thousands, side effects
may be seen at levels too low to have observed in the study of thousands.

  i have a friend who was given viagra when it was still being tested;
 he had a massive heart attack.

And, without large, statistically significant studies we won't know if that
is a coincidence.  

 the fact there is little interest in new research on vaccines because
 it doesn't pay, yet any new drug for ed is a great investment, make me
 wonder if capitalism is the right incentive for health care?  this is
 what sicko points out...

There are a couple of obvious conclusions that can be made here.  First,
people are more willing to spend money on ed than on vaccines.  Second, this
is a case where the uninformed public outcry on the danger of vaccines makes
people very leery about spending money in this area.

Third, wouldn't this be a perfect place for the more socialist countries
than the US to show the disadvantages of capitalism by developing new
vaccines through public spending?  Since virtually all of the innovation
first targets the US market, I think Gautam quoted here a site where 85% of
the major innovations in the last 5 years were in the US and the other
tended to target the US first.

Isn't it logical to assume that, if the US market for this innovation dries
up, that the source of the innovation would also.

 i have no problem with cheap third world drugs flooding the market and
 putting big pharm out of business.  

Well, it would put the small pharm out of business too.  And, then, who
would develop new drugs?  I assume you favor governments?  Historically,
governments have had a much worse track record in technical innovation than
private concerns.  Planned economies tend to be ponderous and very bad at
reacting to changes in demand, available possibilities, etc.  They are
particularly bad at innovation.  



perhaps governments would then

 realize its responsibility is to promote research that saves rather
 than kills people.

Before I answer this, let me check my assumptions. I assume that you think
that far too much is spent on the US military, and that a military with,
say, the combined capacity of the EU would be adequate? Is that a good read
of your position?
 
Dan M. 


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RE: U.S. health care

2007-07-13 Thread Dan Minette

 Lobbies do have an influence in Congress, and changes that they oppose are
 often beneficial.  However, getting rid of the lobbies does not get rid of
 the fundamentals of the problem.  If you take the profitability out of
 drug
 development by private companies, you will stop private drug development.
 The history of the latter half of the twentieth century has shown the
 disadvantages of economies where the government owns/controls major 

sections of the economy.


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RE: U.S. health care

2007-07-13 Thread Dan Minette


 -Original Message-
 From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On
 Behalf Of jon louis mann
 Sent: Friday, July 13, 2007 3:26 PM
 To: Killer Bs Discussion
 Subject: U.S. health care
 
 dan, are you certain only 15% of americans lack health care coverage?

The number's I've seen quoted are in the high 40s of million.  I was
rounding to the nearest 5% when I said that.  If you look at a website that
advocates insuring these people:

http://www.nchc.org/facts/coverage.shtml

They quote nearly 47 million.  With slightly over 300 million people in the
US, this comes close to 15.5%..maybe 15.6%.  I'll accept 16% as slightly
more accurate, but I don't think my rounding to 15% vs. their rounding to
16% is worth quibbling over. . 

 do you believe a single payer system would reduce costs effectively?
Well, I do know that the present system is, in many ways, the worst of both
worlds.  It's a mess.  It should be very possible to construct a single
payer system that's better.  


 
 i agree that red tape is a bureaucratic  nightmare and poor health
 habits contribute to the problem, even if there was available primary
 care.  i have a friend who has excellent insurance and refuses to see a
 doctor.  i don't know the solution.


 do you have any suggestions how to reduce escalating costs from the
 legal system, without increasing the amount of malpractice.  i was a
 victim, myself and was intimidated from seeking redress.

The obvious recourse that would be available would be to let medical review
panels handle complaints (I think most other countries do this)..I know it's
much harder and riskier to sue in Great Britain.   


 what can be done about prolonging life when death is inevitable?  in my
 brother's case, the doctors asked me to sign in order to remove him
 from life support and i refused.  that was 10 years ago, my brother's
 liver recuperated and he recently completed interferon treatment for
 hepatitis c.   fortunately he lives in hawaii, which has an excellent
 health care system. he is a lifelong alcoholic and is only off the
 sauce when he is on probation or institutionalized.  if was anyone but
 my brother i might say pull the plug.

From what I understand, the US is unique in that hospitals and physicians
worry about the consequences of using their best medical judgment.  From
what my physician friend in the UK told me, your brother would not have been
a candidate for intensive care in Great Britain. That saves money.  So, I
don't think a system more like other Western systems would be likely to
spend money on someone in your brother's conditions. 

Dan M. 


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Re: U.S. health care

2007-07-13 Thread Charlie Bell

On 14/07/2007, at 4:04 AM, Dan Minette wrote:



 That assumes you keep providing care the way you do.

 Increase preventative medicine and primary nursing, and you reduce
 other healthcare threefold.

 How?

...because hospital stays reduce and recovery times increase. Good  
prevention and primary treatment is the most effective way of  
maximising returns on healthcare investment.


 'm not sure you have an adequate picture of the US system and how it
 works for the average person who works for a big company.

I have an adequate picture of the US system being ranked well below  
several European ones...

Charlie.
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RE: U.S. health care

2007-07-12 Thread Dan Minette


 -Original Message-
 From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On
 Behalf Of Deborah Harrell
 Sent: Tuesday, July 10, 2007 12:19 PM
 To: Killer Bs Discussion
 Subject: RE: U.S. health care
 
  Dan Minette [EMAIL PROTECTED] wrote:
  [not sure who wrote]
 
   SImply put, the weakest area of the American
  health system is
   preventative care. Poorer people with chronic
  conditions can end up
   with repeated emergency hospital treatment for
  conditions which are
   manageable with drugs which, while not cheap, are
  far cheaper than repeated hospital admitance.
 
  OK, let's try to do an experimental test on this.
  Drug coverage was just
  added to Medicare.  To the extent that your
  hypothesis is true, we would see
  a drop in hospital costs that correspond to the
  increase in prescription payments.
 
 The major problem with the current added coverage is
 that _by law_ the gov't can't negotiate with the
 pharmas for drug pricing...which will not lower health
 care costs at all overall, just shift it back to the
 taxpayers ultimately.

Sure, but lowering costs is somewhat of a game.  Other countries ration
health care, even though it's universal.  I remember a friend of mine who
was a UK doc interning in the US after interning in the UK.  She told me how
she witnessed how a lack of insurance drastically changed treatment plans
for a baby with a bloody diaper in the US, while in the UK floor nurses
decided who got more than the basic treatment based on their assessment of
the value of the life they were returning to.  

We would, of course, lower drug prices if the government did hard line
negotiating on buying large quantities of the drugs.  A side effect would
be, of course, to lower the potential profitability of any new drug that was
developed.  Right now there are scores, if not hundreds of drug companies,
all trying to hit home runs (i.e. get a drug through testing and onto the
market).  I have several friends who work for small drug companies.

These companies are often/usually financed by venture capital. If these
capitalists see the potential payoff drop by a factor of two or three, then
the economics of producing new drugs changes tremendouslyand the money
supply available for this will decrease dramatically.  Developing a drug is
a high risk venturehundreds of millions can be spent only to find
dangerous side effects during or even after the final, large clinical
tests...resulting in the money being totally written off. 

Governments could step in, but in countries with price
controls/negotiations...they haven't.  Instead, they rely on the US
providing the profits that pay for innovation, then negotiate a price for
themselves. It's not rock bottom, but that's why the same meds are cheaper
in Canadaroughly the same reason why US TV shows sell for less overseas
than in the US.

This doesn't mean that I'm opposed to negotiations...I don't see why the US
should shoulder the lions share of the cost of medical innovationso I
think that negotiating a lower price should be part of the deal.  It's just
that I'm aware that there is a downsidewe'll have to find some other way
to make innovation profitable...or else it won't be done.

Governments could sponsor drug development, but government
support/sponsorship of innovations does not have a good track record.  Part
of the reason for this is that spending large amounts of tax money is,
inherently a political decision.  When the means of doing this is clear, (as
with Social Securityyou provide income to seniors by sending them checks
every month), then the government can do a phenomenal job (the overhead on
Social Security is 97%).  When a government is asked to guess the form of
the next innovation in a field, the track record is dismal.  Innovations
often come from left field, and are obvious only after they succeed.  Lots
of people trying and failing, losing their own and/or their investors money
in the process, but some hitting has been seen to work better.

But, going back to my support for government negotiations, it's getting
close to the point where we cannot afford health care.  It's now about 16%
of GDP.  If everyone were to get the care available to those with the very
best insurance policiesthen it would probably jump to 20% or
so...immediately (That assumes that the health care denied by reasons of
costs represents only a 20% reduction in total care).  As it is, without
universal coverage, it's projected to reach 20% in a few years.

Dan M. 




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RE: U.S. health care

2007-07-10 Thread Deborah Harrell
 Dan Minette [EMAIL PROTECTED] wrote:
 [not sure who wrote]

  SImply put, the weakest area of the American
 health system is
  preventative care. Poorer people with chronic
 conditions can end up
  with repeated emergency hospital treatment for
 conditions which are
  manageable with drugs which, while not cheap, are
 far cheaper than repeated hospital admitance.
 
 OK, let's try to do an experimental test on this. 
 Drug coverage was just
 added to Medicare.  To the extent that your
 hypothesis is true, we would see
 a drop in hospital costs that correspond to the
 increase in prescription payments.  

The major problem with the current added coverage is
that _by law_ the gov't can't negotiate with the
pharmas for drug pricing...which will not lower health
care costs at all overall, just shift it back to the
taxpayers ultimately.
 
snip 
 Since I have said I support universal health care,
 the obvious conclusions
 from the above statement is that we need a radical
 retooling.

Yes; it needs to be metamorphosed, not just tweaked
here and there.

Debbi
Still In May Posts, Oh Dear Maru


  

Shape Yahoo! in your own image.  Join our Network Research Panel today!   
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Re: U.S. health care

2007-06-02 Thread Julia Thompson
Ronn! Blankenship wrote:
 At 10:21 AM Wednesday 5/23/2007, Dan Minette wrote:
 
 
 -Original Message-
 From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On
 Behalf Of jon louis mann
 Sent: Sunday, May 20, 2007 11:04 PM
 To: Killer Bs Discussion
 Subject: U.S. health care

 Why do we behave the way we behave?  What has become of us? Where is
 our soul?

 DUMPED ON SKID ROW - Hospitals drop homeless patients on the city's
 Skid Row, sometimes dressed in only a flimsy gown and without a wheel
 chair, even if they're not healthy enough to fend for themselves.
 Anderson Cooper reports on the practice known as hospital dumping.
 The first thing that comes to mind is that this is an expectable, albeit
 immoral, response to the mess that hospitals find themselves in with regard
 to treatment of the indigent.

 I have had some extended conversations with my brother-in-law (a physician
 who has a low income private practice in Northern Michigan (he sees a lot of
 Medicaid patients, and the area is very poor).  We agreed that what is
 needed is a system in which everyone can get a Chevy, but you have to pay
 your own money if you want a BMW.
 
 
 I have heard in recent months on other lists reports of children 
 (sometimes grandchildren or nieces/nephews, etc., of listmembers) who 
 were born with multiple problems which required the baby to stay in 
 the hospital for months after birth during which they had to undergo 
 multiple expensive medical procedures of various sorts and in many 
 cases will require extensive care once they are released from the 
 hospital and will have to go back to the hospital several times for 
 more procedures and/or care for unexpected crises caused by the 
 problems they were born with.  In some cases, such special care and 
 repeated hospitalizations will have to continue for the rest of their 
 lives (which in some cases will be cut short while in other cases 
 they may live well into adulthood or even a full, normal life-span 
 but will never be able to become a contributing member of society and 
 in particular will always be a net economic drain).  Even if the 
 necessary care only lasts a few months (a year or less, maybe) and 
 afterward the child is able to live an entirely or mostly normal life 
 and grow up to become a contributing member of society, the costs for 
 the care required during that first year or so may easily run into 
 the hundreds of thousands of dollars (maybe even top a million 
 dollars in some cases, particularly when the problems are due to 
 multiple births and each of the n-uplets requires such care because 
 they were all born with low birth weight).  Such care is certainly in 
 the BMW (or perhaps Ferrrari or Lamborgni) price range, but what 
 should we (as a nation, a government, a health-care system, etc.) 
 do about it?  Let us presume as was the case in the cases I have 
 heard of on other lists that the families are ordinary middle-class 
 working people who when it comes to cars typically look for a 
 late-model used Chevy rather than a new car of any type and certainly 
 never imagine themselves owning a BMW (except perhaps in their 
 daydreams when they win the Powerball lottery) and that no one can be 
 considered at fault for the problems that the child was born 
 with:  the parents were as far as anyone knew or could tell healthy, 
 did not smoke, drink alcohol, use drugs, work in a factory or other 
 environment where they were exposed to toxic chemicals or use such at 
 home or in some second job or hobby, did not engage in any other 
 risky behaviors, did not have any known genetic defects, had early 
 and regular pre-natal care (during which we presume nothing amiss was 
 detected, or at least not until it was too late medically or legally 
 to do anything about it), nothing untoward happened during labor and 
 delivery, etc.
 
 How should such cases be addressed by the US health care system?

Well, at present, any baby considered to be a micro-premie, i.e. 1200 
grams or smaller at birth, gets whatever NICU charges the parents' 
insurance won't cover covered by Medicare -- but you have to apply to 
get that.  So that's one thing that's being done.  But, yeah, that can 
be a million dollars per baby in some cases.  It's a lot more likely to 
happen in the case of multiple births.

(Me, my Twin B was over 8 lbs. and we all went home after 2 days -- 
and if we'd stayed another day, it would have been because MY doctor 
wanted ME to, not that the pediatrician was concerned about either of 
the babies.  I can't stand hospitals as a patient (or at least that one, 
aside from when I was born I've stayed overnight in exactly 1 hospital) 
and told the doc that if she really needed to monitor the platelet 
count, my husband could take me somewhere the next morning for a blood 
draw, but I really wanted to go home.  She discharged me.)

Julia
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Re: U.S. health care

2007-06-02 Thread Julia Thompson
Dan Minette wrote:
 
 -Original Message-
 From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On
 Behalf Of Nick Arnett
 Sent: Thursday, May 24, 2007 2:57 PM
 To: Killer Bs Discussion
 Subject: Re: U.S. health care

 You don't think there's a place for simple stories in the political
 process?  
 
 Depends on the story.  I would place Moore's story telling with the young
 buck buying steak with food stamps story.  There was a documentary at the
 South by Southwest film festival (I think I got the name right) in Austin,
 by self-proclaimed leftists, on Moore.  One tidbit about his technique is
 that he did get an interview of the Roger in Roger and me.  It didn't fit
 his film, so he didn't include it.

Yeah.  SXSW.  :)  I know people who work it.

If you're going to be heading to anywhere near downtown Austin on an 
evening when that's going on, parking is going to be a bear, unless 
you're going to someplace like Whole Foods or Book People that has its 
own parking garage.

Julia


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Re: U.S. health care

2007-06-01 Thread Ronn! Blankenship
At 08:44 PM Friday 5/25/2007, Robert Seeberger wrote:

I've worked in a few hospitals here in Houston and everyone of them is
undergoing large expansions. One is left to wonder who is paying for
all this construction if not the end customers. In every hospital I
have worked in, doctors are daily treated to sumptuous meals (for free
of course) in a lavish (as compared to any other hospital facility)
dining room. And the food served is of a quality not seen in any other
part of the hospital, prepared in a separate kitchen solely for the
doctors. I've seen this at St. Joseph, a relatively poor hospital, and
at M.D. Anderson, a rich state run hospital.
I know this to be the case at the other hospitals in the Houston
Medical Center because my company works in pretty much all of them.

If one were to drive through the medical center and observe all the
construction (every bit of it medical expansion) one would be hard
pressed to understand how we would need medical care rationing.


FWIW:

Why you still can't find a builder
Home building is in free fall but construction employment is steady, 
a sign housing won't tank the job market.
By Chris Isidore, CNNMoney.com senior writer
May 31 2007: 3:36 PM EDT

NEW YORK (CNNMoney.com) -- There's no doubt the bottom has fallen out 
of the home-building market in the last year. But if you're trying to 
find an out-of-work carpenter or skilled craftsman today, you'd think 
the nation was still in the middle of a building boom.

Employment in home building has fallen 4 percent from a year ago, 
according to government figures, but construction employment overall 
has slipped just 0.2 percent over that period. The difference? A 2.7 
percent jump in the number of workers on construction sites for 
hospitals, roads and other projects aside from homes and residences. 
And the shift may be even more dramatic than those numbers suggest.

http://money.cnn.com/2007/05/31/news/economy/jobs_construction_outlook/index.htm?postversion=2007053115


Bigger Is Better Maru


-- Ronn!  :)



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Re: U.S. health care

2007-06-01 Thread Julia Thompson
Mauro Diotallevi wrote:
 On 5/30/07, Julia Thompson [EMAIL PROTECTED] wrote:
 Mauro Diotallevi wrote:

 --
 Mauro Diotallevi
 Hey, Harry, you haven't done anything useful for a while -- you be the
 god
 of jello now. -- Patricia Wrede, 8/16/2006 on rasfc
 ___
 OK, that ranks up there with, Nothing says 'Aliens, land here!' like a
 9' pyramid!

 (My friend Patric, Saturday afternoon.)
 
 
 I think I would like your friend Patric.

He's great.

Wanna go camping in Texas?  :D

Julia

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Re: Mauro's latest .sig, was Re: U.S. health care

2007-05-31 Thread Mauro Diotallevi
On 5/29/07, [EMAIL PROTECTED] [EMAIL PROTECTED] wrote:



 BTW, are you also a fan of GWAR?



Heh.  I saw GWAR -- which I believe stands for God What A Racket -- in a
bar in KC when they were touring to support _America Must Be
Destroyed/Phallus in Wonderland_.  That must have been... 1992? 1993?  I was
forewarned and stayed well back from the stage...

For their very last set, they came out without any of the costumes and did
an acoustic set.  Half of the audience loved it and half decided they were
ready to move on to another bar.  I had a great time.

-- 
Mauro Diotallevi
Hey, Harry, you haven't done anything useful for a while -- you be the god
of jello now. -- Patricia Wrede, 8/16/2006 on rasfc
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Re: U.S. health care

2007-05-31 Thread Mauro Diotallevi
On 5/30/07, Julia Thompson [EMAIL PROTECTED] wrote:

 Mauro Diotallevi wrote:

  --
  Mauro Diotallevi
  Hey, Harry, you haven't done anything useful for a while -- you be the
 god
  of jello now. -- Patricia Wrede, 8/16/2006 on rasfc
  ___

 OK, that ranks up there with, Nothing says 'Aliens, land here!' like a
 9' pyramid!

 (My friend Patric, Saturday afternoon.)


I think I would like your friend Patric.

-- 
 Mauro Diotallevi
 Hey, Harry, you haven't done anything useful for a while -- you be the
 god of jello now. -- Patricia Wrede, 8/16/2006 on rasfc
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Re: U.S. health care

2007-05-30 Thread Julia Thompson
Mauro Diotallevi wrote:

 --
 Mauro Diotallevi
 Hey, Harry, you haven't done anything useful for a while -- you be the god
 of jello now. -- Patricia Wrede, 8/16/2006 on rasfc
 ___

OK, that ranks up there with, Nothing says 'Aliens, land here!' like a 
9' pyramid!

(My friend Patric, Saturday afternoon.)

Julia

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RE: U.S. health care

2007-05-30 Thread Deborah Harrell
I'm jumping ahead to this thread, but have much to say
in the conservation one still (and I've only time for
one more post today)-

 Dan Minette [EMAIL PROTECTED] wrote:

 It will have to be addressed by some sort of health
 care rationing.  The
 only question is when and how. We may not be there
 now, but there will be a
 point at which we cannot afford to give the best
 health care that's
 available to everyoneeven if that's the focus of
 the entire economy. 

Unfortunately too true.
 
 How we do that rationing is a very difficult
 decision.  This is one reason
 that I think we should start working towards the
 most reasonable rationing
 system we can have as soon as possible.

Yes.  Some basic care, especially preventive or
preemptive, ought to be available to all (it's
actually cheaper in the long run).  Immunizations,
treatment for infectious diseases such as
tuberculosis, and screening for serious common
illnesses before they manifest are examples, which I
think most could agree with.  Health education is also
very important, to improve people's lifestyle choices.

However, we can't afford to keep alive everyone whom
we technologically are capable of prolonging death;
end-of-life care is extremely expensive for small
return of quality living.  The real poser, for me, is
taking care of those who could exist for years/decades
but whose quality of life requires massive support,
like physical, occupational, and other ancillary
therapies.  I believe Ronn mentioned extreme preemies,
and others include head/brain injuries, massive
trauma, various cancers...

Rationing, which as you pointed out is going on in a
piecemeal way, will need to be more - rational.  But
it will not be pleasant.  I have my own criteria for
myself; I'm not sure how many would find them
acceptable.  And when a child's life or well-being is
at stake, few can be impartial.  I've posted
previously that I would be very strict on who
'deserves' to get organ transplants (frex no
alcoholics or IV drug users), yet I'd be hard-pressed
to create rules for, say, preemies...even though
statistically speaking, a 24 weeker is most likely to
need major ongoing care, there will be a few who
manage to have a near-normal life.

I'd have a much easier time working on drugs: as
somebody else pointed out, these ought to be used on
the basis of proven efficacy (*real* endpoints, not
just presumed-relevent markers).

Urf, gotta run-

Debbi
Guidance Systems Breakdown Maru   :(


   
Be
 a better Globetrotter. Get better travel answers from someone who knows. 
Yahoo! Answers - Check it out.
http://answers.yahoo.com/dir/?link=listsid=396545469
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RE: U.S. health care

2007-05-30 Thread Ronn! Blankenship
FWIW, from CNN AM QuickNews this morning:

An open letter to the candidates
Business legend Andy Grove shares a few modest proposals to fix 
health care, from Fortune Magazine.

http://money.cnn.com/2007/05/29/news/economy/grove_column.fortune/index.htm


-- Ronn!  :)



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Re: Mauro's latest .sig, was Re: U.S. health care

2007-05-29 Thread Mauro Diotallevi
On 5/24/07, Ronn! Blankenship [EMAIL PROTECTED] wrote:

 At 03:36 PM Thursday 5/24/2007, Mauro Diotallevi wrote:

 --
 Mauro Diotallevi
 Hey, Harry, you haven't done anything useful for a while -- you be the
 god
 of jello now. -- Patricia Wrede, 8/16/2006 on rasfc



 There is already a god of Jell-O™.

 Just go to Utah and visit any activity where food
 is served at a church building of the major
 religion for which the area is known and you will
 conclude that the serving of Jell-O™,
 particularly green Jell-O™, must be one of the
 required practices of that religion . . .


There was a band who had a fairly popular album out about 10 or 15 years ago
or so that was originally called Green Jello (the band, not the album),
but they were forced to change their name to Green Jelly due to a lawsuit
from Kraft Foods.  The album was called _Cereal Killer_ and the big hit from
the album was their version of the Three Little Pigs -- the second pig was
a ganga-smoking beach preacher, I don't remember the other two -- with video
done in claymation.  Maynard Keenen, lead singer of Tool and A Perfect
Circle, did background vocals and I think Tool's drummer was also involved.

Former brineller Reggie gave me a copy of the video for Christmas one year.

Ah, the memories...

:-)

-- 
Mauro Diotallevi
Hey, Harry, you haven't done anything useful for a while -- you be the god
of jello now. -- Patricia Wrede, 8/16/2006 on rasfc
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Re: Mauro's latest .sig, was Re: U.S. health care

2007-05-29 Thread dcaa
My...GOD. The memories indeed...

I like the live concert footage too...

BTW, are you also a fan of GWAR?

Damon.

Damon Agretto
[EMAIL PROTECTED]
Qui desiderat pacem, praeparet bellum.
http://www.geocities.com/garrand.geo/index.html
Now Building: Trumpeter's Marder I auf GW 38(h)
Sent from my BlackBerry wireless handheld.

Sent from my BlackBerry wireless handheld.  

-Original Message-
From: Mauro Diotallevi [EMAIL PROTECTED]
Date: Tue, 29 May 2007 12:08:39 
To:Killer Bs Discussion brin-l@mccmedia.com
Subject: Re: Mauro's latest .sig, was Re: U.S. health care

On 5/24/07, Ronn! Blankenship [EMAIL PROTECTED] wrote:

 At 03:36 PM Thursday 5/24/2007, Mauro Diotallevi wrote:

 --
 Mauro Diotallevi
 Hey, Harry, you haven't done anything useful for a while -- you be the
 god
 of jello now. -- Patricia Wrede, 8/16/2006 on rasfc



 There is already a god of Jell-O™.

 Just go to Utah and visit any activity where food
 is served at a church building of the major
 religion for which the area is known and you will
 conclude that the serving of Jell-O™,
 particularly green Jell-O™, must be one of the
 required practices of that religion . . .


There was a band who had a fairly popular album out about 10 or 15 years ago
or so that was originally called Green Jello (the band, not the album),
but they were forced to change their name to Green Jelly due to a lawsuit
from Kraft Foods.  The album was called_Cereal Killer_ and the big hit from
the album was their version of the Three Little Pigs -- the second pig was
a ganga-smoking beach preacher, I don't remember the other two -- with video
done in claymation.  Maynard Keenen, lead singer of Tool and A Perfect
Circle, did background vocals and I think Tool's drummer was also involved.

Former brineller Reggie gave me a copy of the video for Christmas one year.

Ah, the memories...

:-)

-- 
Mauro Diotallevi
Hey, Harry, you haven't done anything useful for a while -- you be the god
of jello now. -- Patricia Wrede, 8/16/2006 on rasfc
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RE: U.S. health care

2007-05-26 Thread Andrew Crystall
On 25 May 2007 at 16:10, Dan Minette wrote:

  If I need to see a doctor, I inform my workplace and go. I make up
  the hours. That's pretty standard for non-shift workers here. As
  opposed to being told to take holiday..
 
 That's pretty standard here too...at least as far as I've seen.

For lower income workers? Not so much.

  
  
  Well, I don't know about authorising drugs. But I do know this: many
  more drugs in America are prescription. This is because there are
  only two catagories of drugs, over the counter and prescription
  (excepting a few drugs under specific state laws). The UK has a third
  category, which is behind the counter - a trained pharmacist can
  dispense the drug, and it's kept literally behind the counter, not on
  the shop floor. And that's not a small category here either.
 
 Well, that seems like a reasonable thing, but I don't think it will have a
 major impact on costs...unless antibiotics for kids are on that list, and

It's not costs. It's that for a lot of drugs which, in America you 
need to see a doctor to get a prescription for, you can get from a 
pharmacy (in your lunch hour) here.

 I'm not sure that the general dispensation of antibiotics is a good
 ideacreating immunity and all.  The seniors I know should have their
 meds tracked by a physician or nurse practitioner because of the long term
 nature of their use, the chances for interaction, etc.  

Actually, that's why most antibiotics remain prescription. Several 
are not, but they're older drugs which are general useless these days 
as antibiotics and are prescribed for other effects (anti 
inflamatory, for example).

Talking about resistance, we've actually had a policy in place for 
the better part of a decade that doctors can write you a non-
prescrption, explaining why they won't give you antibiotics in a 
given situation (viral illness, usually).

AndrewC
Dawn Falcon

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Re: U.S. health care

2007-05-26 Thread Doug
jon louis mann wrote:

 michael moore was on bill maher tonight talking about how the richest
 country in the world is 37th in health care, because the system is
 being looted by the health care providers and pharmaceutical companies.
  they toss enough crumbs to the doctors to keep them happy, but their
 bottom line is profit, so people die if they can't afford the premiums.


 we have the best medical technology in the world, designed to keep our
 obese population alive, IF their treatment is authorized.  it certainly
 works well for the wealthiest people in the country,

 moore expressed hope that this time his message will be heeded because
 it crosses party lines, everyone needs medicale care.  he may be in
 trouble for attempting to take a bunch of rescue workers injured after
 9/11 to the guantanamo bay internment facility and brazenly asked for
 health care. he was ignored so they moved on to havana where they
 received excellent medical care, which is free in cuba.

Moore also noted that his film had been praised by Fox News and that he  
had been complimented by tearfull Republicans at Cannes.

Maybe a person should see a movie before comparing it to The Birth of a  
Nation?

Doug
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RE: U.S. health care

2007-05-26 Thread Dan Minette


 -Original Message-
 From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On
 Behalf Of Robert Seeberger
 Sent: Friday, May 25, 2007 11:32 PM
 To: Killer Bs Discussion
 Subject: Re: U.S. health care
 
 Ackkk!!!
 That isn't the way one fairly compares such things Dan. My company
 charges around $80/hour for my services, but I'm grossing $24/hour or
 so. (My total package is around $45/hour).

OK, I can see why you would say thatalthough private draftsmen don't
discount that much from temp agencies.  Good engineers who are independent
command $75-$125/hour, even if they only have a BA degree.  I should have
talked about the programming help at $100/hour from 7 years ago...when the
programmers owned the company they worked for.

The physician's $50/hour was the sum total of his package.  He paid both
sides of SS from it.  It was contract labor.
 
 So if your specialist friend Takes $50/hour, what does the draftsman
 Take?

From the temp, probably little more than full timebut the draftsman on
his own would probably take $40-$50/hour.  In the case of the temp
agency...probably about $30.  But, in other cases, closer to $40.


 I understand the point you are trying to make here and am not trying
 to disparage your sincerity in any way. But apple and oranges
 comparisons can distort perceptions and I'm wary of such in a
 post-Enron enviroment.

OK, but I'm familiar with what engineers make, and every engineer I know of
commands more than $50/hour as contract labor. 

 As for the rest of what I wrote earlier, what I hoped would be taken
 from what I said was that there are a *lot* of inefficiencies in the
 system that could be eliminated.

There are still significant inefficiencies in the system.  From what I've
heard from folks who worry about costs (like my friend who was chief
administrator for a major hospital in NW Houston), _that's_ not where the
waste is.  

Let's look at your suggestion, that hospitals share facilities.  Wouldn't
that mean that patients who need tests are likely to have to be transported
in ambulances?  That might be more efficient...but if it was _a lot_ more
efficient, couldn't the hospitals save money by outsourcing that part of the
work?  

That was the idea behind the negotiations insurance companies do with
hospitals and clinics.  They have a profit motive to keep costs
downbecause if they increase them...they risk losing customers as their
rates go up.

From what I've heard from friends in various places in the industry is that
the relatively higher costs are due to:

1) The amount of money spent on prolonging death.  Intensive care can cost
$10k-$20k/day.  That adds up while/if the family argues over what to do.  I
was fortunate that my sister's a hospice nurse, so my dad died at the
nursing home without heroic intervention. The US tends to concentrate on
that aspect of health care than any other country.  

2) Hospitals and physicians are very worried about lawsuits.  I know my
brother-in-law has been threatened by more than one patient who was refused
drugs they didn't need (likely drug addicts).  He lives in fear of losing
everything.

3) The system we have is, indeed, an unholy mess.  Nurses spend most of
their time on documentation, not patient care.  I don't think though, we can
use Alexander's solution to a knotty problemwe're going to have to undo
a lot of the knots.

4) The US pays for most of the innovation in health care for the world.
Canada gets much cheaper drugs than the US for some of the same reasons that
TV shows are sold cheaper there.  The costs are already paid for with US
sales, as well as a good profit.  Canada sales are icing on the cake.  It
would certainly be the interest of the US to share these costs, but others
will have to pay more for drugs as a result.

The same is true with a number of other medical innovations over the last 20
years.  RD costs and initial profits can be made in the US market.  The US
is kinda like the fellow who needs the hottest electronics while the world
is like the majority of consumers.  

Dan M.






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RE: U.S. health care

2007-05-25 Thread PAT MATHEWS
I got the link perfectly. The video hung up the entire screen on Loading 
... and I had to get out completely. What is it with msnbc videos? That's 
the second one that's done this to me.



http://idiotgrrl.livejournal.com/

'Earth is just a starter planet.' Stephen Colbert





From: Ronn! Blankenship [EMAIL PROTECTED]
Reply-To: Killer Bs Discussion brin-l@mccmedia.com
To: Killer Bs Discussion brin-l@mccmedia.com
Subject: RE: U.S. health care
Date: Thu, 24 May 2007 21:54:06 -0500

At 10:37 AM Wednesday 5/23/2007, PAT MATHEWS wrote:
 One way would be to have a string of simple health clinics that could do
 checkups and make ordinary repairs - stitches, shots, setting broken 
bones,
 monitoring diabetics, etc - and refer people to other facilities if there
 were problems. They need not be staffed by doctors: they could be staffed 
by
 medics, paramedics, medtechs, nurse-practitioners, etc - with a doctor on
 call who also made the rounds of the clinics on a regular schedule.


Anyone else see the NBC Nightly News tonight (Thursday 24 May
2007)?  If not, this seems to be a direct link to the story of relevance 
here:

http://video.msn.com/v/us/msnbc.htm?g=017AC738-1170-4471-97D9-5EB66C5C9243

If that doesn't work, try going to
http://www.msnbc.msn.com/id/3032619/ and look for the When you're
sick, they're quick! link.


-- Ronn!  :)



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Re: U.S. health care

2007-05-25 Thread Charlie Bell

On 25/05/2007, at 7:09 AM, Dan Minette wrote:


 That's true, but if one is really broke, beans and cornbread are  
 very cheap.
 You can get the makings for a family of four for about a dollar.

And that's a sustainment diet.

 It's hard to get fruit and fresh veggies cheap.

It's not hard to keep a couple of chooks and have a few herbs and  
veggies. We grow herbs, tomatoes and jalapenos (and a pitcher plant)  
on a tiny balcony.

That can be enough to turn a sustainment diet into a healthy one.

Charlie
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Re: U.S. health care

2007-05-25 Thread [EMAIL PROTECTED]


Original Message:
-
From: Charlie Bell [EMAIL PROTECTED]
Date: Fri, 25 May 2007 22:27:58 +1000
To: brin-l@mccmedia.com
Subject: Re: U.S. health care



On 25/05/2007, at 7:09 AM, Dan Minette wrote:


 That's true, but if one is really broke, beans and cornbread are  
 very cheap.
 You can get the makings for a family of four for about a dollar.

And that's a sustainment diet.

 It's hard to get fruit and fresh veggies cheap.

It's not hard to keep a couple of chooks and have a few herbs and  
veggies. We grow herbs, tomatoes and jalapenos (and a pitcher plant)  
on a tiny balcony.

That can be enough to turn a sustainment diet into a healthy one.


Looking up reccomended fruits and veggies, I see several sites that say at
least 5 servings/day.  I recall two of you, so that's ten servings a day or
3500 servings/year.That's a heck of a balcony garden.  :-)

Is there any chance that this garden provides a tasty accent to your diet,
and you get most of your fruits and veggies from another source?  If not,
can you give us gardening tips?

Dan M.


mail2web - Check your email from the web at
http://link.mail2web.com/mail2web


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RE: U.S. health care

2007-05-25 Thread Dan Minette


 -Original Message-
 From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On
 Behalf Of Andrew Crystall
 Sent: Thursday, May 24, 2007 3:32 PM
 To: Killer Bs Discussion
 Subject: RE: U.S. health care
 
 On 23 May 2007 at 21:38, Dan Minette wrote:
 
 
 
   SImply put, the weakest area of the American health system is
   preventative care. Poorer people with chronic conditions can end up
   with repeated emergency hospital treatment for conditions which are
   manageable with drugs which, while not cheap, are far cheaper than
   repeated hospital admitance.
 
  OK, let's try to do an experimental test on this.  Drug coverage was
 just
  added to Medicare.  To the extent that your hypothesis is true, we would
 see
  a drop in hospital costs that correspond to the increase in prescription
  payments.
 
 But that doesn't prove anything. The barriers to seeing a doctor in
 America in the first place are still there (there is no chance to the
 philosophy of access, or of methods of treatment), 

I'm not sure what you are getting at. With basic Medicare, one can chose any
physician or hospital that takes Medicare (the overwhelming majority do).
My mom can has her choice of many different physicians on Medicare. Are you
talking about the co-pay (about $15.00 for an office visit), difficulties in
getting to the physician or what?

and getting a prescription can be difficult for many drugs in the first
place.

Well, it's true that some of the newest, most expensive drugs are not on the
formulary, but I haven't heard a lot a squawk from the AARP (American
Association of Retired People): the strongest lobby group in the US (by
far).  And, I haven't heard of any real restrictions on med from either my
mom, or my sister (who's a geriatric nurse).  

Are you talking about differences in requirements for FDA vs. UK approval of
drugs?  I know the FDA is rather conservative that way...and that is a topic
that can be discussedbut it's a tradeoff situation I think.

If so, could you gave an estimate of the impact of quick approval of these
drugs?  If not, could you give examples of approved drugs that are widely
prescribed and paid for under British National Health, but not on the
Medicare formulary?

Dan M. 


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RE: U.S. health care

2007-05-25 Thread Andrew Crystall
On 25 May 2007 at 12:52, Dan Minette wrote:

  But that doesn't prove anything. The barriers to seeing a doctor in
  America in the first place are still there (there is no chance to the
  philosophy of access, or of methods of treatment), 
 
 I'm not sure what you are getting at. With basic Medicare, one can chose any
 physician or hospital that takes Medicare (the overwhelming majority do).
 My mom can has her choice of many different physicians on Medicare. Are you
 talking about the co-pay (about $15.00 for an office visit), difficulties in
 getting to the physician or what?

If I need to see a doctor, I inform my workplace and go. I make up 
the hours. That's pretty standard for non-shift workers here. As 
opposed to being told to take holiday..

 and getting a prescription can be difficult for many drugs in the first
 place.
 
 Are you talking about differences in requirements for FDA vs. UK approval of
 drugs?  I know the FDA is rather conservative that way...and that is a topic
 that can be discussedbut it's a tradeoff situation I think.

Well, I don't know about authorising drugs. But I do know this: many 
more drugs in America are prescription. This is because there are 
only two catagories of drugs, over the counter and prescription 
(excepting a few drugs under specific state laws). The UK has a third 
category, which is behind the counter - a trained pharmacist can 
dispense the drug, and it's kept literally behind the counter, not on 
the shop floor. And that's not a small category here either.

We also have, in the last decade, shifted quite heavily towards 
collective doctor's practices - five or six doctors, as many nurse  
practices and often a dentist in one large collectively owned 
building. They can see you quickly (if you're not worried about 
seeing precisely the same person, they have all your records so it 
doesn't bother me) and have deacently long opening hours.

I won't get into the entire societal attitude thing.

AndrewC
Dawn Falcon

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RE: U.S. health care

2007-05-25 Thread Ronn! Blankenship
At 07:38 AM Friday 5/25/2007, PAT MATHEWS wrote:
I got the link perfectly. The video hung up the entire screen on Loading
... and I had to get out completely. What is it with msnbc videos? That's
the second one that's done this to me.


Since the ms in msnbc stands for Micro$oft you ***have*** to 
use IE:  attempting to view stuff on the NBC web site with another 
browser will cause the browser to lock up.


-- Ronn!  :)



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RE: U.S. health care

2007-05-25 Thread Dan Minette


 -Original Message-
 From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On
 Behalf Of Andrew Crystall
 Sent: Friday, May 25, 2007 2:13 PM
 To: Killer Bs Discussion
 Subject: RE: U.S. health care
 
 
 If I need to see a doctor, I inform my workplace and go. I make up
 the hours. That's pretty standard for non-shift workers here. As
 opposed to being told to take holiday..

That's pretty standard here too...at least as far as I've seen.

 
 
 Well, I don't know about authorising drugs. But I do know this: many
 more drugs in America are prescription. This is because there are
 only two catagories of drugs, over the counter and prescription
 (excepting a few drugs under specific state laws). The UK has a third
 category, which is behind the counter - a trained pharmacist can
 dispense the drug, and it's kept literally behind the counter, not on
 the shop floor. And that's not a small category here either.

Well, that seems like a reasonable thing, but I don't think it will have a
major impact on costs...unless antibiotics for kids are on that list, and
I'm not sure that the general dispensation of antibiotics is a good
ideacreating immunity and all.  The seniors I know should have their
meds tracked by a physician or nurse practitioner because of the long term
nature of their use, the chances for interaction, etc.  

 We also have, in the last decade, shifted quite heavily towards
 collective doctor's practices - five or six doctors, as many nurse
 practices and often a dentist in one large collectively owned
 building. They can see you quickly (if you're not worried about
 seeing precisely the same person, they have all your records so it
 doesn't bother me) and have deacently long opening hours.

We've had urgent care centers here for, I don't know, 15 or so years?  The
closest one is open 12 hours/day 6 days a week and 6 hours on Sunday. Their
ad says Walk ins welcome.  If you walk in, you might have to wait an hour
or two (from experiences with relatives with emergencies), but appointments
are fairly easy to get. Dentist sre usually separate, but I've been able to
see a new dentist with an appointment made two days before hand, from one of
many openings. There are a number of relatively low cost dental practices
with 10+ dentists not too far from here.  I picked on about 10 minutes away.

Given this, I'm not sure why the data on Medicare is not applicable.  

Dan M. 


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RE: U.S. health care

2007-05-25 Thread Dan Minette


 -Original Message-
 From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On
 Behalf Of Ronn! Blankenship
 Sent: Thursday, May 24, 2007 7:45 PM
 To: Killer Bs Discussion
 Subject: RE: U.S. health care
 
  Let us presume as was the case in the cases I have
 heard of on other lists that the families are ordinary middle-class
 working people who when it comes to cars typically look for a
 late-model used Chevy rather than a new car of any type and certainly
 never imagine themselves owning a BMW (except perhaps in their
 daydreams when they win the Powerball lottery) and that no one can be
 considered at fault for the problems that the child was born
 with:  the parents were as far as anyone knew or could tell healthy,
 did not smoke, drink alcohol, use drugs, work in a factory or other
 environment where they were exposed to toxic chemicals or use such at
 home or in some second job or hobby, did not engage in any other
 risky behaviors, did not have any known genetic defects, had early
 and regular pre-natal care (during which we presume nothing amiss was
 detected, or at least not until it was too late medically or legally
 to do anything about it), nothing untoward happened during labor and
 delivery, etc.
 
 How should such cases be addressed by the US health care system?

It will have to be addressed by some sort of health care rationing.  The
only question is when and how. We may not be there now, but there will be a
point at which we cannot afford to give the best health care that's
available to everyoneeven if that's the focus of the entire economy. 

How we do that rationing is a very difficult decision.  This is one reason
that I think we should start working towards the most reasonable rationing
system we can have as soon as possible.


Dan M.


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Re: U.S. health care

2007-05-25 Thread Robert Seeberger
- Original Message - 
From: Dan Minette [EMAIL PROTECTED]
To: 'Killer Bs Discussion' brin-l@mccmedia.com
Sent: Friday, May 25, 2007 5:18 PM
Subject: RE: U.S. health care




 -Original Message-
 From: [EMAIL PROTECTED] 
 [mailto:[EMAIL PROTECTED] On
 Behalf Of Ronn! Blankenship
 Sent: Thursday, May 24, 2007 7:45 PM
 To: Killer Bs Discussion
 Subject: RE: U.S. health care

  Let us presume as was the case in the cases I have
 heard of on other lists that the families are ordinary middle-class
 working people who when it comes to cars typically look for a
 late-model used Chevy rather than a new car of any type and 
 certainly
 never imagine themselves owning a BMW (except perhaps in their
 daydreams when they win the Powerball lottery) and that no one can 
 be
 considered at fault for the problems that the child was born
 with:  the parents were as far as anyone knew or could tell 
 healthy,
 did not smoke, drink alcohol, use drugs, work in a factory or other
 environment where they were exposed to toxic chemicals or use such 
 at
 home or in some second job or hobby, did not engage in any other
 risky behaviors, did not have any known genetic defects, had early
 and regular pre-natal care (during which we presume nothing amiss 
 was
 detected, or at least not until it was too late medically or 
 legally
 to do anything about it), nothing untoward happened during labor 
 and
 delivery, etc.

 How should such cases be addressed by the US health care system?

 It will have to be addressed by some sort of health care rationing. 
 The
 only question is when and how. We may not be there now, but there 
 will be a
 point at which we cannot afford to give the best health care that's
 available to everyoneeven if that's the focus of the entire 
 economy.

 How we do that rationing is a very difficult decision.  This is one 
 reason
 that I think we should start working towards the most reasonable 
 rationing
 system we can have as soon as possible.

What I gather from what you are saying Dan, is that the people who pay 
for the health care system are going to have to settle for less in 
order to preserve the status quo otherwise. I am taking health care 
rationing in it's simplest terms here, and doing my best to avoid 
extrapolation of your words. So please expand on this if I am 
misunderstanding you.

I've worked in a few hospitals here in Houston and everyone of them is 
undergoing large expansions. One is left to wonder who is paying for 
all this construction if not the end customers. In every hospital I 
have worked in, doctors are daily treated to sumptuous meals (for free 
of course) in a lavish (as compared to any other hospital facility) 
dining room. And the food served is of a quality not seen in any other 
part of the hospital, prepared in a separate kitchen solely for the 
doctors. I've seen this at St. Joseph, a relatively poor hospital, and 
at M.D. Anderson, a rich state run hospital.
I know this to be the case at the other hospitals in the Houston 
Medical Center because my company works in pretty much all of them.

If one were to drive through the medical center and observe all the 
construction (every bit of it medical expansion) one would be hard 
pressed to understand how we would need medical care rationing.
A walk through the parking lot where doctors park their 
vehicles...wellthey are obviously not worried about fuel 
efficiency.
I live next door to St. Johns Hospital. They have commercials on TV 
promoting their hospital, saying they have over 900 doctors on staff. 
This is a small hospital.
St Josephs used to advertize on the NPR affiliate saying similar 
things. M.D.Anderson is currently advertizing on the NPR station. All 
this advertizing costs *us*.
I've worked in Central Stores at St Joes and what the hospital pays 
for simple pieces of plastic is amazing. So when people complain about 
the pharmas, I tend to be somewhat sympathetic. It seems to me that 
the entire medical industry is being treated as a cash cow by anyone 
who can get a hand in the till.

Maybe what we need is a new economic model for medical care. Not for 
the patients and insurance providers, but at the operational level. 
There is far too much ostentation currently and the expansion I see 
belies rationing.
And perhaps doctors should consider a pay cut? (G As if the fat cats 
would even consider it) It may be that some austerity now would 
prevent a bubble collapse later.

(Hey!? Did I just coin a term? Medical Care Bubble?)

Qualifiers: I'm in a big city with a very very large medical research 
and care center. It may be that my views are skewed by proximity to a 
growth sector of the industry.


xponent
M.D.Anderson Cancer Center Maru
rob


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Re: U.S. health care

2007-05-25 Thread [EMAIL PROTECTED]


Original Message:
-
From: Robert Seeberger [EMAIL PROTECTED]
Date: Fri, 25 May 2007 20:44:13 -0500
To: brin-l@mccmedia.com
Subject: Re: U.S. health care


- Original Message - 
From: Dan Minette [EMAIL PROTECTED]
To: 'Killer Bs Discussion' brin-l@mccmedia.com
Sent: Friday, May 25, 2007 5:18 PM
Subject: RE: U.S. health care


 It will have to be addressed by some sort of health care rationing. 
 The only question is when and how. We may not be there now, but there 
 will be a point at which we cannot afford to give the best health care
that's
 available to everyoneeven if that's the focus of the entire 
 economy.

 How we do that rationing is a very difficult decision.  This is one 
 reason that I think we should start working towards the most reasonable 
 rationing system we can have as soon as possible.

What I gather from what you are saying Dan, is that the people who pay 
for the health care system are going to have to settle for less in 
order to preserve the status quo otherwise. I am taking health care 
rationing in it's simplest terms here, and doing my best to avoid 
extrapolation of your words. So please expand on this if I am 
misunderstanding you.

I think you may be.  Right now, we have a make shift form of health care
rationioning.  It includes HMO rules, general insurance
limitationsexclusions by employers, admissions decisions, etc.  Everyone is
not getting the best care they can.  If they did, we'd be spending more on
health care.

Even so, heath care spending as a fraction of GDP is rapidly rising in the
US.  Bewteen 1960 and 1990, it rose from 5.1% to 13.4%.  This growth led to
intererst in health care reform.  But, as HMOs and other insurance
companies started to work on costs, the percentage held essentially flat
through the '90s.  By the end of that period, they had found virtually all
of the cost savings from these techniques, and costs rose again.

In '06, it was about 16% of GDP.  It is projected to go to 20% in 2015.  I
don't have total numbers beyond that, but Medicare costs, as a function of
GDP are expected to triple by 2045 and increase 4-fold by 2080.  Now, a lot
of that is the increased number of baby boomers who are elegible, but
that's a real expense. A third of GDP is a reasonable estimate.

And, this is extrapolating from a situation in which there is means based
determination of the quality of health careand the fraction of insured
patients falling.  If we were to continue that, there gap between the haves
and have nots will just increase. 

I've worked in a few hospitals here in Houston and everyone of them is 
undergoing large expansions. One is left to wonder who is paying for 
all this construction if not the end customers. In every hospital I 
have worked in, doctors are daily treated to sumptuous meals (for free 
of course) in a lavish (as compared to any other hospital facility) 
dining room. And the food served is of a quality not seen in any other 
part of the hospital, prepared in a separate kitchen solely for the 
doctors. I've seen this at St. Joseph, a relatively poor hospital, and 
at M.D. Anderson, a rich state run hospital.

I'm not arguing that there is not a lot of money flowing into health care. 
I'm arguing that the supply of money is not unlimited. 

I also know, from a friend of mine who was in charge of Northwest Medical
Center, that hospitals are cutting corners where you can't see.  The snazzy
look of major medical center hospitals is part of the marketing...and thus
makes money.  There are enough wealthy people who will pay extra for the
best to make that make sense.  But, a good regional hospital has to watch
costs carefully in order not to lose money.  She's worried that care is
close to suffering.

Part of it is the paperwork overhead that staff must deal with.  Patient
care is usually a small fraction of the total staff time.

I know this to be the case at the other hospitals in the Houston 
Medical Center because my company works in pretty much all of them.

If one were to drive through the medical center and observe all the 
construction (every bit of it medical expansion) one would be hard 
pressed to understand how we would need medical care rationing.
A walk through the parking lot where doctors park their 
vehicles...wellthey are obviously not worried about fuel 
efficiency.

Well, I see the other side.  I had a neighbor who was a blood
specialist..and couldn't find work in his specialty.  He supplemented his
income as a doc-in-the-box, at an urgent care center.  He made $50/hour for
doing this.  That's less than temp agencies charge for draftsmen.  My
brother-in-law's practice is just getting by.  He does drive a SUV, but
they bought it used, it has 130k miles on it, and he has to drive on roads
that are often covered with deep snow (they have gotten as much as 10
meters of snow one year).

The right specialists in the right hospitans can still make tons of money. 
But, physician saleries

Re: U.S. health care

2007-05-25 Thread Robert Seeberger
- Original Message - 
From: [EMAIL PROTECTED]
To: brin-l@mccmedia.com
Sent: Friday, May 25, 2007 9:46 PM
Subject: Re: U.S. health care





Well, I see the other side.  I had a neighbor who was a blood
specialist..and couldn't find work in his specialty.  He supplemented 
his
income as a doc-in-the-box, at an urgent care center.  He made 
$50/hour for
doing this.  That's less than temp agencies charge for draftsmen.

Ackkk!!!
That isn't the way one fairly compares such things Dan. My company 
charges around $80/hour for my services, but I'm grossing $24/hour or 
so. (My total package is around $45/hour).

So if your specialist friend Takes $50/hour, what does the draftsman 
Take?
What does the Doc-in_the_box charge for the doc's services 
compared to what the Temp Agency charges for a draftsman?

I understand the point you are trying to make here and am not trying 
to disparage your sincerity in any way. But apple and oranges 
comparisons can distort perceptions and I'm wary of such in a 
post-Enron enviroment.

As for the rest of what I wrote earlier, what I hoped would be taken 
from what I said was that there are a *lot* of inefficiencies in the 
system that could be eliminated.
I understand that medical facilities feel the need to market but 
they do not to the extent they are. What I see happening is an 
overabundance of capacity and then a need to fill it.
In the current enviroment there is a need to coordinate medical care. 
Not every facility needs to have the latest and greatest geegaw, just 
send the patients to the nearest geegaw. But it seems that every 
hospital wants to have that new geegaw and then they have to compete 
for patients. This is inefficient and this costs.
(I've seen situations where a new catscan or MRI was used 10 or 20 
hours a week in a facility that had several of each. But they had 
staff on hand for 40 to 60 hours a week to facilitate it's use)

xponent
Geegawgantic Maru
rob 


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Re: U.S. health care

2007-05-24 Thread Mauro Diotallevi
On 5/20/07, jon louis mann [EMAIL PROTECTED] wrote:

 Why do we behave the way we behave?  What has become of us? Where is
 our soul?

 DUMPED ON SKID ROW – Hospitals drop homeless patients on the city's
 Skid Row, sometimes dressed in only a flimsy gown and without a wheel
 chair, even if they're not healthy enough to fend for themselves.
 Anderson Cooper reports on the practice known as hospital dumping.

 http://www.cbsnews.com/stories/1998/07/08/60minutes/main13502.shtml


NPR has been following this story for a while.  Here's an audio link to the
first story I remember hearing them air.
http://www.npr.org/templates/story/story.php?storyId=5066463

-- 
Mauro Diotallevi
Hey, Harry, you haven't done anything useful for a while -- you be the god
of jello now. -- Patricia Wrede, 8/16/2006 on rasfc
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Re: U.S. health care

2007-05-24 Thread Mauro Diotallevi
On 5/23/07, PAT MATHEWS [EMAIL PROTECTED] wrote:


As it is, I know a fair number of people who go to herbalists and other
 alternative practitioners for a lot of their health care, partly because
 of
 all the hassle and expense involved in using the health care system


My best friend's wife goes to an herbalist for what she calls health
support and to a regular doctor for critical care issues.  The herbalist
practices traditional Chinese herbalism and regularly refers his patients to
MDs if they have health problems that he thinks they are better equipped to
handle.

I think the two biggest problems with the standard health care system in the
U.S. today are laziness and money.

The laziness issue is that too many people eat unhealthy foods and live
unhealthy lifestyles and then go complain to their doctors when they become
unhealthy.  They expect modern medicine to be able to fix any problem they
happen to acquire along the way, instead of taking the responsibility and
doing the work it takes to stay healthy.  Our doctors and nurses -- and our
health care dollars --  are taken up treating people who could have avoided
their health problems by making healthier decisions.  Reducing the number of
people in the health care system would go a long way towards fixing the
system.

The money issue (part one) is that big health care companies are typically
much more interested in making money than in actually helping people -- for
example, I had a friend who had suffered pain from carpal tunnel syndrome
for a number of years, and the medical establishment couldn't offer much to
her except the eventuality of surgery.  She was recently talking to a man we
both know who had previously mentioned having carpal tunnel syndrome but who
is now mostly without symptoms.  She asked him how he did it, and he taught
her a few relatively quick and simple exercises to stretch the long muscles
in the forearms, and since she started doing those every day, her symptoms
have cut back drastically.  These exercises probably wouldn't work for
everyone, but exercises like this aren't even taught as a possibility in
most medical school programs.  Many doctors would probably use some of these
exercises if they knew that they exist and work.  But the medical
establishment as a whole has a vested interest in medical procedures that
make lots of money for the doctors and guarantee lots of follow-up care.
Again, I'm not faulting individual doctors (mostly), it's the system as a
whole that is broken.  And the worst part of the system is the
pharmaceuticals industry.  But that's a whole other e-mail.

The money issue part two is insurance companies.  I worked as a temp in an
underwriting center for an insurance company -- in fact, it was while
temping there that I met the former list participant who started me lurking
here oh-so-many years ago -- and believe me, the industry is all about
making money and minimizing risk.  Insurance companies are not interested in
helping people get the medical treatment they need.  Insurance companies are
interesting in getting the biggest dividends they can for their
shareholders.

So people start out unhealthy, get treated by doctors who are overburdened
and were trained in a system that is more interested in propagating itself
than in finding the best and least expensive way to get people healthy.
Then they -- both the patients and the doctors -- get told by insurance
companies what treatments they can and can't use, and then patients are
prescribed medicines that cost them far much more than they should.

And anyone that argues that medicines have to cost as much as they do in
order to pay for research and development hasn't looked at the figures.  I
don't have the link handy and I have to get back to work so I don't have
time to google it right now, but I saw an article within the past year or so
that showed a breakdown of how a typical pharmaceuticals company spends its
money, and if I recall correctly something like 15 percent of the money went
to RD and 20 percent went to shareholders in the form of dividends.  That's
dividends, money going to shareholders in addition to any money they might
make due to the growth of the stock value.

--
Mauro Diotallevi
Hey, Harry, you haven't done anything useful for a while -- you be the god
of jello now. -- Patricia Wrede, 8/16/2006 on rasfc
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Re: U.S. health care

2007-05-24 Thread Nick Arnett
On 5/23/07, Dan Minette [EMAIL PROTECTED] wrote:




 This problem is a good one for discussion here.  However, it will not be
 solved by polemics that provide simple stories with heroes and villains
 like
 that provided by Moore.  There is a hard way out for this, just no easy
 way
 out.


You don't think there's a place for simple stories in the political
process?  Seems to me that simple stories often have been the most powerful
means of changing a system.  For example, what does the name Rose Parks
refer, but a simple story illustrative of a systemic problem?  Simple
stories bring big issues home, don't they?

Nick


-- 
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[EMAIL PROTECTED]
Messages: 408-904-7198
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Re: U.S. health care

2007-05-24 Thread Nick Arnett
On 5/23/07, PAT MATHEWS [EMAIL PROTECTED] wrote:

 Heavens - even to me, reared in the system, they are often
 repugnant.


You reminded me of the fact that now that I'm 50, I have to have a
colonoscopy.  Reared in the system, indeed.

Nick



-- 
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[EMAIL PROTECTED]
Messages: 408-904-7198
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Re: U.S. health care

2007-05-24 Thread Nick Arnett
On 5/24/07, Mauro Diotallevi [EMAIL PROTECTED] wrote:



 The laziness issue is that too many people eat unhealthy foods and live
 unhealthy lifestyles and then go complain to their doctors when they
 become
 unhealthy.


And I think we can credit some very effective and profitable marketing for
part of this behavior.

Wish I knew how to address that problem, but I don't.  Education, perhaps,
but if they're competing with each other, marketing has a lot more money.

They expect modern medicine to be able to fix any problem they
 happen to acquire along the way, instead of taking the responsibility and
 doing the work it takes to stay healthy.  Our doctors and nurses -- and
 our
 health care dollars --  are taken up treating people who could have
 avoided
 their health problems by making healthier decisions.  Reducing the number
 of
 people in the health care system would go a long way towards fixing the
 system.


By letting those who are to blame for their own illnesses just die?  ;-)
Seriously, though, I'd have a hard time differentiating personal from
systemic causes for unhealthly lifestyles when there's so much effort
invested in advocating them in advertising, marketing and so forth.  People
are social creatures; it's naive to imagine that some sort of Just say no
mentality would make all those problems go away.  I'm not saying you're
making that argument, but I've certainly heard it.

The money issue (part one) is that big health care companies are typically
 much more interested in making money than in actually helping people


Those that are private corporations and thus are legally obligated to be
more interested in making money than anything else.  They're subject to
shareholder litigation if they don't maximize profits.  This is not, to me,
an obviously good legal structure for organizations that provide basic human
services.  Ditto for the insurance companies, of course.

Nick


-- 
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[EMAIL PROTECTED]
Messages: 408-904-7198
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Re: U.S. health care

2007-05-24 Thread Alberto Monteiro

Nick Arnett wrote:
 
 By letting those who are to blame for their own illnesses just die?  
 ;-) Seriously, though, I'd have a hard time differentiating personal 
 from systemic causes for unhealthly lifestyles when there's so much effort
 invested in advocating them in advertising, marketing and so forth.  
 People are social creatures; it's naive to imagine that some sort of 
 Just say no mentality would make all those problems go away.  I'm 
 not saying you're making that argument, but I've certainly heard it.
 
There is a big part in parents responsability. Now (partly because
of economic pressure) I seldom bring my kids to unhealthy foodstores
like McDonalds, but even when I was less miserable the max was 
1 MacDonalds per month.

And there's a very Evil aspect of this: food with trans fat costs
_much_ less than a similar food without trans fat. If I were
paranoid, I would suggest that the reason is that Food Companies
and Medical Companies are owned by the same evil and greedy people.

Alberto Monteiro

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RE: U.S. health care

2007-05-24 Thread Andrew Crystall
On 23 May 2007 at 21:38, Dan Minette wrote:

 
 
  SImply put, the weakest area of the American health system is
  preventative care. Poorer people with chronic conditions can end up
  with repeated emergency hospital treatment for conditions which are
  manageable with drugs which, while not cheap, are far cheaper than
  repeated hospital admitance.
 
 OK, let's try to do an experimental test on this.  Drug coverage was just
 added to Medicare.  To the extent that your hypothesis is true, we would see
 a drop in hospital costs that correspond to the increase in prescription
 payments.  

But that doesn't prove anything. The barriers to seeing a doctor in 
America in the first place are still there (there is no chance to the 
philosophy of access, or of methods of treatment), and getting a 
prescription can be difficult for many drugs in the first place. 
(leaving aside the whole issue of the suitability of the prescription 
system in America - suffice to say that I don't think it IS 
suitable).

AndrewC
Dawn Falcon

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Re: U.S. health care

2007-05-24 Thread Mauro Diotallevi
On 5/24/07, Nick Arnett [EMAIL PROTECTED] wrote:

 On 5/24/07, Mauro Diotallevi [EMAIL PROTECTED] wrote:
 
 
 
  The laziness issue is that too many people eat unhealthy foods and live
  unhealthy lifestyles and then go complain to their doctors when they
  become
  unhealthy.


 And I think we can credit some very effective and profitable marketing for
 part of this behavior.

 Wish I knew how to address that problem, but I don't.  Education, perhaps,
 but if they're competing with each other, marketing has a lot more money.

 They expect modern medicine to be able to fix any problem they
  happen to acquire along the way, instead of taking the responsibility
 and
  doing the work it takes to stay healthy.  Our doctors and nurses -- and
  our
  health care dollars --  are taken up treating people who could have
  avoided
  their health problems by making healthier decisions.  Reducing the
 number
  of
  people in the health care system would go a long way towards fixing the
  system.


 By letting those who are to blame for their own illnesses just die?  ;-)
 Seriously, though, I'd have a hard time differentiating personal from
 systemic causes for unhealthly lifestyles when there's so much effort
 invested in advocating them in advertising, marketing and so
 forth.  People
 are social creatures; it's naive to imagine that some sort of Just say
 no
 mentality would make all those problems go away.  I'm not saying you're
 making that argument, but I've certainly heard it.


Nope, I'm not advocating anything as drastic as, you've made your bed, now
butter it (to quote an old teacher of mine who preferred his metaphores
well-mixed) (or is that, You buttered your bread, now lie in it.)  (Or is
that, lay.)   :-)

I'm just advocating people taking more responsibility for themselves.  I've
seen too many people who eat nothing but junk food and never exercise
complaining about the low quality of health care that they receive, when
they are being a big part of their own problem.  I know there's no quick and
easy way to make people act responsibly.  People just need to take more
personal responsibility, and not only in healthcare issues.

-- 
Mauro Diotallevi
Hey, Harry, you haven't done anything useful for a while -- you be the god
of jello now. -- Patricia Wrede, 8/16/2006 on rasfc
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Re: U.S. health care

2007-05-24 Thread Mauro Diotallevi
On 5/24/07, Alberto Monteiro [EMAIL PROTECTED] wrote:


 Nick Arnett wrote:
 
  By letting those who are to blame for their own illnesses just die?
  ;-) Seriously, though, I'd have a hard time differentiating personal
  from systemic causes for unhealthly lifestyles when there's so much
 effort
  invested in advocating them in advertising, marketing and so forth.
  People are social creatures; it's naive to imagine that some sort of
  Just say no mentality would make all those problems go away.  I'm
  not saying you're making that argument, but I've certainly heard it.
 
 There is a big part in parents responsability. Now (partly because
 of economic pressure) I seldom bring my kids to unhealthy foodstores
 like McDonalds, but even when I was less miserable the max was
 1 MacDonalds per month.

 And there's a very Evil aspect of this: food with trans fat costs
 _much_ less than a similar food without trans fat. If I were
 paranoid, I would suggest that the reason is that Food Companies
 and Medical Companies are owned by the same evil and greedy people.



You raise an interesting and important point.  It is less expensive --
sometimes *much* less expensive -- to each unhealthy foods than it is to eat
healthy.  Maybe instead of subsidizing the military-industrial complex, the
government could subsidize healthy food.  :-)

I'm only half-way kidding.

-- 
Mauro Diotallevi
Hey, Harry, you haven't done anything useful for a while -- you be the god
of jello now. -- Patricia Wrede, 8/16/2006 on rasfc
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Re: U.S. health care

2007-05-24 Thread Alberto Monteiro
Mauro Diotallevi wrote:

 And there's a very Evil aspect of this: food with trans fat costs
 _much_ less than a similar food without trans fat. If I were
 paranoid, I would suggest that the reason is that Food Companies
 and Medical Companies are owned by the same evil and greedy people.
 
 You raise an interesting and important point.  It is less expensive -
 - sometimes *much* less expensive -- to each unhealthy foods than it 
 is to eat healthy.  Maybe instead of subsidizing the military-
 industrial complex, the government could subsidize healthy food.  :-)

Maybe the g*vernments _want_ this to happen. Old rich people sequester
their money and prevent the heirs to expend, so when old rich people
die, there's an inflationary pressure. Old poor people are a burden
to Social Services, because they generate no income and cost a lot.
So, the Maximizer Social Strategy is to let poor people die younger
than rich people.
 
 I'm only half-way kidding.
 
Me too - as always.

Alberto Monteiro

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Re: U.S. health care

2007-05-24 Thread Charlie Bell

On 25/05/2007, at 6:36 AM, Mauro Diotallevi wrote:


 You raise an interesting and important point.  It is less expensive --
 sometimes *much* less expensive -- to each unhealthy foods than it  
 is to eat
 healthy.

Not really. It's just a lot more effort to go to the market, or plan  
out your meals, than it is to just order pizza.

Charlie
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RE: U.S. health care

2007-05-24 Thread Dan Minette


 -Original Message-
 From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On
 Behalf Of Nick Arnett
 Sent: Thursday, May 24, 2007 2:57 PM
 To: Killer Bs Discussion
 Subject: Re: U.S. health care
 
 On 5/23/07, Dan Minette [EMAIL PROTECTED] wrote:
 
 
 
 
  This problem is a good one for discussion here.  However, it will not be
  solved by polemics that provide simple stories with heroes and villains
  like
  that provided by Moore.  There is a hard way out for this, just no easy
  way
  out.
 
 
 You don't think there's a place for simple stories in the political
 process?  

Depends on the story.  I would place Moore's story telling with the young
buck buying steak with food stamps story.  There was a documentary at the
South by Southwest film festival (I think I got the name right) in Austin,
by self-proclaimed leftists, on Moore.  One tidbit about his technique is
that he did get an interview of the Roger in Roger and me.  It didn't fit
his film, so he didn't include it.

Seems to me that simple stories often have been the most powerful
 means of changing a system.  For example, what does the name Rose Parks
 refer, but a simple story illustrative of a systemic problem?  Simple
 stories bring big issues home, don't they?

Simple true stories that go to the heart of the matter, do.  Polemic films,
like birth of a nation, don't.

Dan M. 


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RE: U.S. health care

2007-05-24 Thread Dan Minette


 -Original Message-
 From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On
 Behalf Of Charlie Bell
 Sent: Thursday, May 24, 2007 3:54 PM
 To: Killer Bs Discussion
 Subject: Re: U.S. health care
 
 
 On 25/05/2007, at 6:36 AM, Mauro Diotallevi wrote:
 
 
  You raise an interesting and important point.  It is less expensive --
  sometimes *much* less expensive -- to each unhealthy foods than it
  is to eat
  healthy.
 
 Not really. It's just a lot more effort to go to the market, or plan
 out your meals, than it is to just order pizza.
 
That's true, but if one is really broke, beans and cornbread are very cheap.
You can get the makings for a family of four for about a dollar.

It's hard to get fruit and fresh veggies cheap. 

Dan M. 



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Re: U.S. health care

2007-05-24 Thread Ronn! Blankenship
At 03:36 PM Thursday 5/24/2007, Mauro Diotallevi wrote:

You raise an interesting and important point.  It is less expensive --
sometimes *much* less expensive -- to each unhealthy foods than it is to eat
healthy.  Maybe instead of subsidizing the military-industrial complex, the
government could subsidize healthy food.  :-)

I'm only half-way kidding.
--
Mauro Diotallevi


At 03:54 PM Thursday 5/24/2007, Charlie Bell wrote:

Not really. It's just a lot more effort to go to the market, or plan
out your meals, than it is to just order pizza.

Charlie


I was reading a series of articles and letters in 
the _Salt Lake Tribune_ recently which covered an 
experiment in Utah:  government officials were 
challenged to live for a week on the same amount 
that a similar-sized family would receive from 
the state in food stamps.  Those who believe that 
the point which Mauro makes is not important — 
that starchy foods like potatoes are much cheaper 
to get enough of to fill up to the point where 
you and your kids do not feel hungry and 
miserable all the time than fresh fruits and 
vegetables — and that the primary problem is that 
it is so much easier simply to eat out or order 
in might consider trying the same 
challenge:  find out what the state you live in 
pays a family the size of yours in food stamps 
and live on that amount.  (As some of the 
aforementioned items in the SLTrib brought out, 
it is not permitted to supplement the food which 
the food stamp amount will purchase from any 
other source, including what you may have on hand 
before beginning the experiment — most folks who 
have to apply for food stamps or other assistance 
from the government have little if anything on 
hand by the time they reach that point and 
certainly do not have the opportunity or in many 
cases the skills to plan ahead for hard times 
like that — and to be more fair and accurate, 
since food stamps are paid on a monthly basis in 
most states the experiment should last a full month rather than just a week.)


-- Ronn!  :)



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Mauro's latest .sig, was Re: U.S. health care

2007-05-24 Thread Ronn! Blankenship
At 03:36 PM Thursday 5/24/2007, Mauro Diotallevi wrote:

--
Mauro Diotallevi
Hey, Harry, you haven't done anything useful for a while -- you be the god
of jello now. -- Patricia Wrede, 8/16/2006 on rasfc



There is already a god of Jell-O™.

Just go to Utah and visit any activity where food 
is served at a church building of the major 
religion for which the area is known and you will 
conclude that the serving of Jell-O™, 
particularly green Jell-O™, must be one of the 
required practices of that religion . . .


-- Ronn!  :)



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Re: U.S. health care

2007-05-24 Thread Nick Arnett
On 5/24/07, Mauro Diotallevi [EMAIL PROTECTED] wrote:


 I'm just advocating people taking more responsibility for
 themselves.  I've
 seen too many people who eat nothing but junk food and never exercise
 complaining about the low quality of health care that they receive, when
 they are being a big part of their own problem.  I know there's no quick
 and
 easy way to make people act responsibly.  People just need to take more
 personal responsibility, and not only in healthcare issues.


I agree -- and I think society also needs to take more responsibility for
systemic issues, such as marketing of harmful stuff.  I read the U.S.
Constitution as saying that we, as a nation, have a responsibility to look
after our people, even as those people are individually responsible for
their choices.

Nick


-- 
Nick Arnett
[EMAIL PROTECTED]
Messages: 408-904-7198
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Re: U.S. health care

2007-05-24 Thread Ronn! Blankenship
At 03:21 PM Thursday 5/24/2007, Alberto Monteiro wrote:

Nick Arnett wrote:
 
  By letting those who are to blame for their own illnesses just die?
  ;-) Seriously, though, I'd have a hard time differentiating personal
  from systemic causes for unhealthly lifestyles when there's so much effort
  invested in advocating them in advertising, marketing and so forth.
  People are social creatures; it's naive to imagine that some sort of
  Just say no mentality would make all those problems go away.  I'm
  not saying you're making that argument, but I've certainly heard it.
 
There is a big part in parents responsability. Now (partly because
of economic pressure) I seldom bring my kids to unhealthy foodstores
like McDonalds, but even when I was less miserable the max was
1 MacDonalds per month.

And there's a very Evil aspect of this: food with trans fat costs
_much_ less than a similar food without trans fat. If I were
paranoid, I would suggest that the reason is that Food Companies
and Medical Companies are owned by the same evil and greedy people.


Another possibility is that foods prepared with trans fats reportedly 
have a longer shelf-life than the same foods prepared without trans 
fats, making them cheaper to transport and stock because they do not 
require so much in the way of other preservation techniques and can 
be kept on the shelves longer without losses due to spoilage and so 
larger shipments can be made less often than would be required to 
keep fresh stock of more perishable foods on the shelves, which could 
cut down on transportation costs . . .


-- Ronn!  :)



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RE: U.S. health care

2007-05-24 Thread Ronn! Blankenship
At 10:21 AM Wednesday 5/23/2007, Dan Minette wrote:


  -Original Message-
  From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On
  Behalf Of jon louis mann
  Sent: Sunday, May 20, 2007 11:04 PM
  To: Killer Bs Discussion
  Subject: U.S. health care
 
  Why do we behave the way we behave?  What has become of us? Where is
  our soul?
 
  DUMPED ON SKID ROW - Hospitals drop homeless patients on the city's
  Skid Row, sometimes dressed in only a flimsy gown and without a wheel
  chair, even if they're not healthy enough to fend for themselves.
  Anderson Cooper reports on the practice known as hospital dumping.

The first thing that comes to mind is that this is an expectable, albeit
immoral, response to the mess that hospitals find themselves in with regard
to treatment of the indigent.

I have had some extended conversations with my brother-in-law (a physician
who has a low income private practice in Northern Michigan (he sees a lot of
Medicaid patients, and the area is very poor).  We agreed that what is
needed is a system in which everyone can get a Chevy, but you have to pay
your own money if you want a BMW.


I have heard in recent months on other lists reports of children 
(sometimes grandchildren or nieces/nephews, etc., of listmembers) who 
were born with multiple problems which required the baby to stay in 
the hospital for months after birth during which they had to undergo 
multiple expensive medical procedures of various sorts and in many 
cases will require extensive care once they are released from the 
hospital and will have to go back to the hospital several times for 
more procedures and/or care for unexpected crises caused by the 
problems they were born with.  In some cases, such special care and 
repeated hospitalizations will have to continue for the rest of their 
lives (which in some cases will be cut short while in other cases 
they may live well into adulthood or even a full, normal life-span 
but will never be able to become a contributing member of society and 
in particular will always be a net economic drain).  Even if the 
necessary care only lasts a few months (a year or less, maybe) and 
afterward the child is able to live an entirely or mostly normal life 
and grow up to become a contributing member of society, the costs for 
the care required during that first year or so may easily run into 
the hundreds of thousands of dollars (maybe even top a million 
dollars in some cases, particularly when the problems are due to 
multiple births and each of the n-uplets requires such care because 
they were all born with low birth weight).  Such care is certainly in 
the BMW (or perhaps Ferrrari or Lamborgni) price range, but what 
should we (as a nation, a government, a health-care system, etc.) 
do about it?  Let us presume as was the case in the cases I have 
heard of on other lists that the families are ordinary middle-class 
working people who when it comes to cars typically look for a 
late-model used Chevy rather than a new car of any type and certainly 
never imagine themselves owning a BMW (except perhaps in their 
daydreams when they win the Powerball lottery) and that no one can be 
considered at fault for the problems that the child was born 
with:  the parents were as far as anyone knew or could tell healthy, 
did not smoke, drink alcohol, use drugs, work in a factory or other 
environment where they were exposed to toxic chemicals or use such at 
home or in some second job or hobby, did not engage in any other 
risky behaviors, did not have any known genetic defects, had early 
and regular pre-natal care (during which we presume nothing amiss was 
detected, or at least not until it was too late medically or legally 
to do anything about it), nothing untoward happened during labor and 
delivery, etc.

How should such cases be addressed by the US health care system?


-- Ronn!  :)



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RE: U.S. health care

2007-05-24 Thread Ronn! Blankenship
At 10:37 AM Wednesday 5/23/2007, PAT MATHEWS wrote:
One way would be to have a string of simple health clinics that could do
checkups and make ordinary repairs - stitches, shots, setting broken bones,
monitoring diabetics, etc - and refer people to other facilities if there
were problems. They need not be staffed by doctors: they could be staffed by
medics, paramedics, medtechs, nurse-practitioners, etc - with a doctor on
call who also made the rounds of the clinics on a regular schedule.


Anyone else see the NBC Nightly News tonight (Thursday 24 May 
2007)?  If not, this seems to be a direct link to the story of relevance here:

http://video.msn.com/v/us/msnbc.htm?g=017AC738-1170-4471-97D9-5EB66C5C9243

If that doesn't work, try going to 
http://www.msnbc.msn.com/id/3032619/ and look for the When you're 
sick, they're quick! link.


-- Ronn!  :)



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Re: U.S. health care

2007-05-24 Thread Ronn! Blankenship
At 05:08 PM Thursday 5/24/2007, jon louis mann wrote:

there is a part of me that believes [...] there are already too many people
on this planet.



Let me ask you some of the questions I ask everyone who says that:

(1)  What do you think is the maximum number of people who could? 
should? be on this planet?  (A range is acceptable, but some sort of 
more-or-less definite number is requested.)

(2)  How do you propose to get from the current population to the 
figure you gave in #1?

(3)  Would you volunteer to make the excess one less right 
now?  Justify your answer.


-- Ronn!  :)



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RE: U.S. health care

2007-05-23 Thread Dan Minette


 -Original Message-
 From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On
 Behalf Of jon louis mann
 Sent: Sunday, May 20, 2007 11:04 PM
 To: Killer Bs Discussion
 Subject: U.S. health care
 
 Why do we behave the way we behave?  What has become of us? Where is
 our soul?
 
 DUMPED ON SKID ROW - Hospitals drop homeless patients on the city's
 Skid Row, sometimes dressed in only a flimsy gown and without a wheel
 chair, even if they're not healthy enough to fend for themselves.
 Anderson Cooper reports on the practice known as hospital dumping.

The first thing that comes to mind is that this is an expectable, albeit
immoral, response to the mess that hospitals find themselves in with regard
to treatment of the indigent.

I have had some extended conversations with my brother-in-law (a physician
who has a low income private practice in Northern Michigan (he sees a lot of
Medicaid patients, and the area is very poor).  We agreed that what is
needed is a system in which everyone can get a Chevy, but you have to pay
your own money if you want a BMW.  The system we have now is that a hospital
is not required to take any given patient (I think there are exceptions for
some public hospitals such as Ben Taub in Houston).  However, once a patient
is in, they must be afforded the best care available...until they meet
discharge criteria.  This is an overwhelming cost to the hospitals, with
virtually no hope of recovering the costs.  

Insurance companies have the leverage to bargain down bills...as anyone who
has seen a hospital bill before and after adjustments can tell.  So, the
bills for those paying privately are through the roof...especially if they
do not pre-pay an negotiated amount.  For example, we got a bill for 50k for
the use of an operating room, a day in intermediate care, and 2 days in a
regular room.and had to prove that we pre-paid a negotiated 12,500. The
insurance rates were lower than this, of course...so the hospitals can only
recoup so much of indigent care from insurance coverage for other patients.

Given this, we can see why hospitals would be strongly motivated to release
indigent patients that meet discharge criteria...particularly those who are
candidates for extensive expensive care. While this is certainly wrong, I
think the real problem is the system.

And, fixing this is not as easy as Moore might suggest.  As it stands, over
16% of GDP is spent on health care.and this is with a significant
fraction of Americans obtaining sub-standard care If everyone was given the
BMW service, this would rise to 20% to 25% quickly.  As it stands, costs are
expected to rise to 20% within 10 years, which means that BMW care for all
would cost 25%-30% within 10 years.  

There are a lot of things that can be done to address these costs, but they
will involve sacrifices by average people who now have good insurance.  We
will have to allow, as do other countries, government bureaucrats to decide
services that will be offered as well as waiting lists for non-emergency
procedures.  

This problem is a good one for discussion here.  However, it will not be
solved by polemics that provide simple stories with heroes and villains like
that provided by Moore.  There is a hard way out for this, just no easy way
out.

Dan M. 


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RE: U.S. health care

2007-05-23 Thread PAT MATHEWS
One way would be to have a string of simple health clinics that could do 
checkups and make ordinary repairs - stitches, shots, setting broken bones, 
monitoring diabetics, etc - and refer people to other facilities if there 
were problems. They need not be staffed by doctors: they could be staffed by 
medics, paramedics, medtechs, nurse-practitioners, etc - with a doctor on 
call who also made the rounds of the clinics on a regular schedule.

As it is, I know a fair number of people who go to herbalists and other 
alternative practitioners for a lot of their health care, partly because of 
all the hassle and expense involved in using the health care system. If 
anyone wants to howl about witchcraft, all I can say is, the witch gives 
decent service at affordable prices, and is usually either an experienced 
practitioner of traditional medicine (hence with a long tradition of knowing 
when to send the patient to Public Health) or a college-educated person of a 
New Age persuasion. And both the latter are far more skilled at taking care 
of the patient's emotional, spiritual, and family-oriented needs than the 
health care system (which for the most part does not address them.)

For example: a Navajo veteran might see the VA for combat wounds, but for 
PTSD would also have an Enemy Way Sing done, and the sing can be very 
effective.

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From: Dan Minette [EMAIL PROTECTED]
Reply-To: Killer Bs Discussion brin-l@mccmedia.com
To: 'Killer Bs Discussion' brin-l@mccmedia.com
Subject: RE: U.S. health care
Date: Wed, 23 May 2007 10:21:12 -0500



  -Original Message-
  From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] 
On
  Behalf Of jon louis mann
  Sent: Sunday, May 20, 2007 11:04 PM
  To: Killer Bs Discussion
  Subject: U.S. health care
 
  Why do we behave the way we behave?  What has become of us? Where is
  our soul?
 
  DUMPED ON SKID ROW - Hospitals drop homeless patients on the city's
  Skid Row, sometimes dressed in only a flimsy gown and without a wheel
  chair, even if they're not healthy enough to fend for themselves.
  Anderson Cooper reports on the practice known as hospital dumping.

The first thing that comes to mind is that this is an expectable, albeit
immoral, response to the mess that hospitals find themselves in with regard
to treatment of the indigent.

I have had some extended conversations with my brother-in-law (a physician
who has a low income private practice in Northern Michigan (he sees a lot 
of
Medicaid patients, and the area is very poor).  We agreed that what is
needed is a system in which everyone can get a Chevy, but you have to pay
your own money if you want a BMW.  The system we have now is that a 
hospital
is not required to take any given patient (I think there are exceptions for
some public hospitals such as Ben Taub in Houston).  However, once a 
patient
is in, they must be afforded the best care available...until they meet
discharge criteria.  This is an overwhelming cost to the hospitals, with
virtually no hope of recovering the costs.

Insurance companies have the leverage to bargain down bills...as anyone who
has seen a hospital bill before and after adjustments can tell.  So, the
bills for those paying privately are through the roof...especially if they
do not pre-pay an negotiated amount.  For example, we got a bill for 50k 
for
the use of an operating room, a day in intermediate care, and 2 days in a
regular room.and had to prove that we pre-paid a negotiated 12,500. The
insurance rates were lower than this, of course...so the hospitals can only
recoup so much of indigent care from insurance coverage for other patients.

Given this, we can see why hospitals would be strongly motivated to release
indigent patients that meet discharge criteria...particularly those who are
candidates for extensive expensive care. While this is certainly wrong, I
think the real problem is the system.

And, fixing this is not as easy as Moore might suggest.  As it stands, over
16% of GDP is spent on health care.and this is with a significant
fraction of Americans obtaining sub-standard care If everyone was given the
BMW service, this would rise to 20% to 25% quickly.  As it stands, costs 
are
expected to rise to 20% within 10 years, which means that BMW care for all
would cost 25%-30% within 10 years.

There are a lot of things that can be done to address these costs, but they
will involve sacrifices by average people who now have good insurance.  We
will have to allow, as do other countries, government bureaucrats to decide
services that will be offered as well as waiting lists for non-emergency
procedures.

This problem is a good one for discussion here.  However, it will not be
solved by polemics that provide simple stories with heroes and villains 
like
that provided by Moore.  There is a hard way out for this, just no easy way
out.

Dan M

RE: U.S. health care

2007-05-23 Thread PAT MATHEWS
You said: even though  i am a skeptic about
chanting, gris gris and juju cures, i never negate the power of
suggestion.

Those aren't supposed to work on the body, or at least not directly. They 
are supposed to work on the mind, emotions, cultural background etc, which 
will then help the body do its job, or at least not fight it. It's analogous 
to explaining the treatment in the language (to quote the old Episcopalian 
prayer book) Understanded of the people. Because to many traditional 
people, the ways of our health care system are not only alien, but in some 
cases, repugnant. Heavens - even to me, reared in the system, they are often 
repugnant.




http://idiotgrrl.livejournal.com/

'Earth is just a starter planet.' Stephen Colbert





From: jon louis mann [EMAIL PROTECTED]
Reply-To: Killer Bs Discussion brin-l@mccmedia.com
To: Killer Bs Discussion brin-l@mccmedia.com
Subject: U.S. health care
Date: Wed, 23 May 2007 10:37:47 -0700 (PDT)

Why do we behave the way we behave?  What has become of us? Where is
our soul?
DUMPED ON SKID ROW - Hospitals drop homeless patients on the city's
Skid Row.
-- jlm

--The first thing that comes to mind is that this is an expect-able,
albeit immoral, response to the mess that hospitals find themselves in
with regard to treatment of the indigent.
... what is needed is a system in which everyone can get a Chevy, but
you have to pay your own money if you want a BMW.  The system we have
now is that... (sic) once a patient is in, they must be afforded the
best care available... This is an overwhelming cost to the hospitals.
(sic)

i just had routine microsurgery for my lower lumbar region and the bill
was well over $20,000.  my in network portion is over $10,000.  they
kicked me out after one day with very little followup.  i would have
been better off spending the money on prevention and seeking
alternative medicine.

i suppose hospitals have to compensate for losses when they provide
services for indigent patients like my alcoholic and homeless brother.
the hospital wanted me to sign a release to take him off life support,
but  i couldn't do it.  miraculously his liver recovered, probably due
to the expensive intensive care he received.  the last time he tried to
go into rehab he was refused, so he robbed a bank for $100 and went to
the police station to turn himself in.  he spent thirty months in a
federal detention center, which is the longest he has been sober in
forty years...  the insurance and pharmaceutical companies seem to be
doing quite well, which is part of the reason my brother became
addicted to prescription medicine when he worked for a think tank and
had great coverage.


--This problem is a good one for discussion here.  However, it will not
be solved by polemics that provide simple stories with heroes and
villains like that provided by Moore.  There is a hard way out for
this, just no easy way out.
Dan M.

i think michael moore has done a real service with his controversial
documentaries.   he doesn't pretend not to have an agenda when he has
louis armstrong singing it's a beautiful world with a collage of all
the world's inhumanities as background, or bush sitting dazed like a
deer in the headlights for seven minutes while america is under attack.
  the message is much more powerful than rants by dennis miller or bill
o'reilly, who also have an agenda.

i very much like the idea of a string of simple health clinics staffed
by medics, med techs, nurse-practitioners, and physician assistants -
with doctors on call, so they can be free for important emergencies.  i
do believe there are some good alternative medicine resources, and some
out right snake medicine scams.  there are plenty of quacks in the
medical profession, as well and doctors who think they are god, or are
in the profession for the money.  even though  i am a skeptic about
chanting, gris gris and juju cures, i never negate the power of
suggestion.
--jlm

Knowledge is Power




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RE: U.S. health care

2007-05-23 Thread Andrew Crystall
On 23 May 2007 at 10:21, Dan Minette wrote:

 And, fixing this is not as easy as Moore might suggest.  As it stands, over
 16% of GDP is spent on health care.and this is with a significant
 fraction of Americans obtaining sub-standard care If everyone was given the
 BMW service, this would rise to 20% to 25% quickly.  As it stands, costs are
 expected to rise to 20% within 10 years, which means that BMW care for all
 would cost 25%-30% within 10 years.  

Assuming, once more, no cost benefits. But there are.

SImply put, the weakest area of the American health system is 
preventative care. Poorer people with chronic conditions can end up 
with repeated emergency hospital treatment for conditions which are 
manageable with drugs which, while not cheap, are far cheaper than 
repeated hospital admitance.

And it improves their health as well.

AndrewC
Dawn Falcon

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RE: U.S. health care

2007-05-23 Thread PAT MATHEWS
Ah. We here in the Southwest tend to feel we're the only ones who know 
anything about Native Americans (blush).

Apologies.

http://idiotgrrl.livejournal.com/

'Earth is just a starter planet.' Stephen Colbert





From: jon louis mann [EMAIL PROTECTED]
Reply-To: Killer Bs Discussion brin-l@mccmedia.com
To: Killer Bs Discussion brin-l@mccmedia.com
Subject: U.S. health care
Date: Wed, 23 May 2007 12:16:19 -0700 (PDT)

You said: even though  i am a skeptic about chanting, gris gris and
juju cures, i never negate the power of suggestion.

Those aren't supposed to work on the body, or at least not directly.
They are supposed to work on the mind, emotions, cultural background
etc, which will then help the body do its job, or at least not fight
it. It's analogous to explaining the treatment in the language (to
quote the old Episcopalian prayer book) Understanded of the people.
Because to many traditional people, the ways of our health care system
are not only alien, but in some
cases, repugnant. Heavens - even to me, reared in the system, they are
often repugnant.

i understand that, pat. i had a brother-in-law who was raised on a
reservation in saskatchewan, and was a medicine man.  he tried his
remedies on me, but i lacked faith.  i have friends who rely on
positive imaging which is the same thing.  i think one of the reasons i
have such excellent health is i have always felt indestructible, which
has allowed me to take the kind of  risks which probably resulted in my
back problems.  i think stress is also a factor because i don't shrink
from conflict in my life.



Why do we behave the way we behave?  What has become of us? Where is
our soul?
DUMPED ON SKID ROW - Hospitals drop homeless patients on the city's
Skid Row.
-- jlm

--The first thing that comes to mind is that this is an expect-able,
albeit immoral, response to the mess that hospitals find themselves in
with regard to treatment of the indigent.
... what is needed is a system in which everyone can get a Chevy, but
you have to pay your own money if you want a BMW.  The system we have
now is that... (sic) once a patient is in, they must be afforded the
best care available... This is an overwhelming cost to the hospitals.
(sic)

i just had routine microsurgery for my lower lumbar region and the bill
was well over $20,000.  my in network portion is over $10,000.  they
kicked me out after one day with very little followup.  i would have
been better off spending the money on prevention and seeking
alternative medicine.

i suppose hospitals have to compensate for losses when they provide
services for indigent patients like my alcoholic and homeless brother.
the hospital wanted me to sign a release to take him off life support,
but  i couldn't do it.  miraculously his liver recovered, probably due
to the expensive intensive care he received.  the last time he tried to
go into rehab he was refused, so he robbed a bank for $100 and went to
the police station to turn himself in.  he spent thirty months in a
federal detention center, which is the longest he has been sober in
forty years...  the insurance and pharmaceutical companies seem to be
doing quite well, which is part of the reason my brother became
addicted to prescription medicine when he worked for a think tank and
had great coverage.


--This problem is a good one for discussion here.  However, it will not
be solved by polemics that provide simple stories with heroes and
villains like that provided by Moore.  There is a hard way out for
this, just no easy way out.
Dan M.

i think michael moore has done a real service with his controversial
documentaries.   he doesn't pretend to not have an agenda with
louis armstrong singing it's a beautiful world and a collage of all
the world's inhumanities as background, or bush sitting dazed, like a
deer in the headlights, for seven minutes while america is under
attack.
his message is much more powerful than rants by dennis miller, or bill
o'reilly, who also have an agenda.

i very like the idea of a string health clinics staffed by medics
med techs, nurse-practitioners, and physician assistants - with
doctors on call, so they can be free for important emergencies.  i
do believe there are good alternative medicine resources, and some
out right snake oil scams.  there are plenty of quacks in the
medical profession, as well, and doctors who  are in the profession
for money, think they are god, .  even though  i am a skeptic about
chanting, gris gris and juju cures, i never negate the power of
suggestion.
--jlm

Knowledge is Power



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oneSearch: Finally, mobile search
that gives answers, not web links.
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RE: U.S. health care

2007-05-23 Thread PAT MATHEWS
Get Back To Work.

Pat, taking care of business all day and ready to veg out by the boob tube.

http://idiotgrrl.livejournal.com/

'Earth is just a starter planet.' Stephen Colbert





From: jon louis mann [EMAIL PROTECTED]
Reply-To: Killer Bs Discussion brin-l@mccmedia.com
To: Killer Bs Discussion brin-l@mccmedia.com
Subject: U.S. health care
Date: Wed, 23 May 2007 15:51:43 -0700 (PDT)

Ah. We here in the Southwest tend to feel we're the only ones who know
anything about Native Americans (blush).
Apologies.
http://idiotgrrl.livejournal.com/

none necessary, i also live in the southwest.  my brother-in-law was a
canadian native american.  i am one of those rarities, a mexican
canadian!~)

now, i know what STFU means; please tell us, WTF is GBTW?
jon m.

This needs to be inscribed on my computer
I finally found an acronymic slogan that is more to the point and more
concise than Robert Heinlin's old favorite, TANSTAAFL, short for There
ain't no such thing as a free lunch. Meaning, if something looks like
one, look for the hidden costs.

Today. Pink Splice on the Fourth Turning Forums website added a very
nice and all-too-true prescription for Crisis Era America:
STFU  GBTW.
What that means, I leave as an exercise for the reader. Or will answer
you offline at [EMAIL PROTECTED], since the F stands for precisely
what you think it does.

Knowledge is Power



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RE: U.S. health care

2007-05-23 Thread Dan Minette


 SImply put, the weakest area of the American health system is
 preventative care. Poorer people with chronic conditions can end up
 with repeated emergency hospital treatment for conditions which are
 manageable with drugs which, while not cheap, are far cheaper than
 repeated hospital admitance.

OK, let's try to do an experimental test on this.  Drug coverage was just
added to Medicare.  To the extent that your hypothesis is true, we would see
a drop in hospital costs that correspond to the increase in prescription
payments.  

I looked it up, and there is a small effect on the rise in hospital costs,
but it's only a fraction of the increase in cost.  This doesn't prove that
the same thing will happen if we do this for other age groups, but it is
data.

I realize that I don't tend to calculate synergy benefits.  I've seen scores
of these calculations from various sources, and they are usually pipe
dreams.  The subset that is not tends to be characterized by tangible
quantitative arguments...not general ones.

Having said that, I'll agree that there will be some benefit, so maybe it's
just 25% of GDP in 10 years if we do nothing but add universal health care.


Since I have said I support universal health care, the obvious conclusions
from the above statement is that we need a radical retooling.

Dan M.


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