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**Umfriend** · 19 March 2005, 02:14

Prolly because they give everypne the same care? Can be bad sometimes, bad at least it's as bad for one as for the other? How easy is it to get private (=epxensive) medicare in the UK?

**Brian Ellis** · 19 March 2005, 04:40

I don't know too much about medical care in the UK. I do know my friend's dad was told he could have had an immediate bypass op if he went privately, but he could not afford it, as a retiree. I forget how much he was quoted for it, but I think it was over Â£10k. Whether my friend himself could have had better treatment as a private patient, I cannot say, as there is all the world between diagnostics and surgery. Diagnosis depends on the skill and experience of the toubib in relating symptoms to possible causes. If he had gone to the same quack (and I use the word as pejoratively as I can) as a private patient, would he have been given antiacids?

**Umfriend** · 19 March 2005, 06:58

Knowing little about the NHS and medicine in general (what's an "asperine"?), I would wager that it would still make a difference. Budgetted health-care like we have here (and I think it is rather similar in the UK) allows for a limited number of operations/prescriptions/tests etc. They're not really "fixed" by exact numbers, but the expenditure on them are not that flexible, especiialy upwards.

To safe on costs (as we know supply is always short of demand), the diagnostic procedure is to a large extent prescribed by protocol. Over here, my intepretation typically is that a GP should try and identify the cause of a problem by a fixed program, which of course often does not really give you a positive diagnosis but rather gives a number of options. Then, prescribe for the most common cause and see if it helps in one to three weeks.

If it works, it is great. We have saved on the cost of positively identifying the cause by guessing educated wise. If not, it's not a big issue as the cost of these medications are relatively low.

This can go on for quite some time though, and sometimes with severe consequences. My GP was treating a girl in my kids class for tummy aches, heavy ones. For one reason or another, he did not have a picture taken. She was hospitalised when her appendix burst, leaking infected tissue and causing over 40C fevers. The thing is, according to the protocol, as she did not have a very typical reaction to the tests the GP does when checking for appendicitis and the protocol says to wait for a little while longer.....

In his defence, a lot of operations for appendicitis are done while there is no infection at all, contrary to the expectation. A lot of things are hard to diagnose positively without more expensive tests. On the other hand, I have quite a few of these types of examples where essentially budgetting simply increased illness-duration, increased illness-long term consequences, just not premature death (yet).

Furthermore, checking your symptoms against various outstanding US medical sites and not letting yourself be put off with a lump of sugar helps.

Anyway, long story on budgetting, now on to free market medical care. The situation here is vastly different. The industry will go to great length to positively identify what is the issue. Not to great a length, mind you, but they won't stop short of having a high accuracy diagnosis, and quite a bit faster. Why? They get paid. The more tests they perform, the more they make (no, not an accusation, just trying to state that the industry in this case is not limited in her activities by budgetting) so why not? It is in the best interest of the patient.

Well, that must be way way better than, wouldn't you think? But there is one problem here. Only the ones who can afford that level of care by themselves will get it. The ones who can't won't get *any*. That is the rationale behind government run medicare. All pay some, the higher incomes typically more, and get roughly the same, albiet limited, treatment. Of course, if you're rich, you can go private but you won't be able to escape paying for the "get some for all" medicare as that would destroy the system. So in a way, you'd be paying double.

Anyway, that's my understanding. Wish him well.

**Dr Mordrid** · 20 March 2005, 09:32

Welcome to why the US is so reticent to adopt socialized medicine. In an effort to be "fair" to all everyone gets screwed but those who society deems "worth" (under 50, non-metastatic disease etc. etc.). This is why US border states see so many Canadians running like hell from their oh-so supposedly "advanced" healthy care system.

With all its faults in the US system even the uninsured can get serious illnesses diagnosed and treated in very short order.

**KvHagedorn** · 20 March 2005, 09:55

Originally posted by Dr Mordrid

Welcome to why the US is so reticent to adopt socialized medicine. In an effort to be "fair" to all everyone gets screwed but those who society deems "worth" (under 50, non-metastatic disease etc. etc.). This is why US border states see so many Canadians running like hell from their oh-so supposedly "advanced" healthy care system.

With all its faults in the US system even the uninsured can get serious illnesses diagnosed and treated in very short order.

... while many others never go to the doctor at all because of this. I work 6 days a week and have no insurance. Why? Because I could not GET insurance if I tried, due to a pre-existing condition. Even people WITH insurance are at the mercy of insurance companies not paying for CAT scans and such when the doctor would like to use these expensive tests, perhaps to save the person's life. I suppose I could pretend to be rich and just tell them to send me the bills and then claim bankruptcy.. lots of people do that here. Or I could just go and tell them I have no insurance, and get labeled as an INDIGENT (which pisses me off, since I work pretty hard installing all this stuff, and have many doctors as clients who all want a "better deal", meaning their rich asses want me to make less money so they can keep more of their $25k monthly paychecks) So there I would be, an INDIGENT (worthless piece of shit who doesn't make a huge amount of money, and who has no insurance so is probably just a janitor with an IQ of 2 so to hell with him) and happen to be in a teaching hospital (as our local giant hospital is.) Can you guess what happens? That's right.. a bunch of callow young med students get to practice on the poor, penniless INDIGENT. If I was lucky, I might get an intern who is pulling a 36 hour shift, and is so sleep-deprived that he gives me 100cc of something instead of 10cc. Whoops! Oh, well.. toss him in the lime pit with the rest of the INDIGENTS. Poor scum didn't deserve to live anyhow. Let's go make a bunch of money off this vain rich bitch who wants liposuction and a boob job!

God bless America.. land of opportunity! (For those who have a killer union like the AMA behind them)

**KvHagedorn** · 20 March 2005, 10:07

Oh, and by the way, I am not a child, or over 65, or retarded, or any of those other things which makes me a useless member of society at present, and would warrant some government charity taking care of me and getting me free medical care. I am a hard-working white male perfectionist, which, in a non-sick society, would mean I was probably making a lot of money, but I'm not. And a lot of people are like me, too. We are the ones who really make life worth living in this country, but we get NOTHING for it. Give all the money to cocaine-snorting basketball players and Hunnish CEOs and vain movie stars.. that's who really deserves it..

God bless America (spits)

**Taz** · 20 March 2005, 10:17

The problems with the NHS are largely due to years of chronic underfunding coupled with bad management. It's further compounded in London by the high house price/rent and low pay situation. There's also a shortage of nurses and doctors, plenty train to become them, but find they can get paid considerably more overseas, so leave.

**Umfriend** · 21 March 2005, 00:55

Originally posted by Dr. Mordrid

Welcome to why the US is so reticent to adopt socialized medicine. In an effort to be "fair" to all everyone gets screwed but those who society deems "worth" (under 50, non-metastatic disease etc. etc.).

Nice and catchy, but not the case. The only ones getting "screwed" are the ones who would have the pecuniary power to purchase the medicare they want/need under a free market system. Many are benefitted, effectively by way of a wealth transfer. Morevoer, a healthy but poor person is considered less "worth" than a rich, smoking, drug taking retired rich person who happened to inherit loads of money because his great-great-great father walked into fortune and his descendants so far failed to squander it.

Not sure to which system the under 50 etc refers, it is in any cause not applicable to our (Dutch) system. I will not deny that choices like that are not made at all, but as far as representing the Dutch (and as far as I know the UK NHS) situation goes, it's just scaremongering (?).

I do believe KVH has a strong point (I always knew he was a commie at heart

). I know litle about the US medicare situation and the AMA, but my understanding is (and please enlighten me if I am wrong about this) that the AMA is essentially a monopoly union: the represent the interest of doctors AND are the only organisation able to authoiraise anyone to practise medicine. Tha AMA has the power to (a) limit the entry into the profession (which they do) and prescribe tariffs/wages etc that members can't deviate (downwards) from at risk of expulsion and thus having their license to medicate revoked.

As said, I may be rather misinformed to say the least, but if this is true to a reasonable extent, then what we have here is a free market on the demand side but a monopolist (by _law_ not by _accomplishment_) on the supply side with all the wealth transfers a basic economic demand and supply model will show, which are *large*.

I for one, favor the socialised model we have here, with all its shortcomings, some of which are easy to deal with if politicians did not keep screwing things up (much like they do education etc), then the US model (as I understand it works). BTW, we have an AMA too, it's workings are similar and they should be fined and jailed. I feel much stronger however about the monopoly side of supply then about the US vs socialised mode of operations.

Taz, that is the problem *everywhere* and, basically, it can;t be solved, especially in a socialised system (not even if it would offer better and more medicare than the free US model). It's a matter of simple economic theory. Of course, the most striking mishaps could have been dealt with making it a system of reknown and accepted by most as adequate or good, but a socialised system, by definition, is underfunded.

edit: Took out an irrelevant part.

**James_D** · 21 March 2005, 01:52

Originally posted by Brian Ellis

Yesterday, he was sent to a specialist gastroenterologist who gave him the works and diagnosed a largish tumour in the caecum, probably cancerous. He is going into hospital on Thursday to have it removed and, obviously, biopsied. As it is probably malignant, they will then have to determine the extent of metastasis and what treatment, if any, to contain it.

What kind of health service takes 18 months to have a distress-causing tumour diagnosed?

For the anecdote, this same guy's father had a massive heart attack while mowing his lawn, about five years ago. His heart stopped twice in the ambulance. He was discharged from hospital the following day with a prescription for 200 mg of aspirin per diem and the news that he needed a quadruple bypass, but the waiting list was 6 months. Fortunately, he survived those six months and is now reasonably active for someone in his late 70s.

I simply cannot understand how the NHS can operate under such 18th c conditions of "care".

Well, i dont know wether its the system or just a bad GP, the first case it should only be gone two weeks before sending him two a hospital for a barium meal or colonoscopy.
And even though there are long waiting lists for these procedures, its not more than 3 months at present in the UK. Of course the complaints of the patient can be symptoms of 5 different diseases. But still they would always be the ground for a Colonoscopy or Gastroscopy. Even a simple ulcer should be looked at. And its up to the GP to also work the system. So I would regard this more as a unlucky case or a malpractice case than a fault of the system. Then again i dont have all the details, and its hard to make a real judgement without them.

As for the father, it sounds like a very correct way of doing it, no one would operate on a patient with a recent heart attack. It's the same as playing russian roulette with the patients life. The heart need to stabilize, and fibrosis(scar formation) need to occur before going in. And in the mean time, the only thing to do is conservative treatment, which usually is Beta blockers and Aspirine. If the patient came in and the attack was very recent, then if there is a heart center with the resources there would be an attempt to do a rescue PCI. There should also be given trombolytic treatment(disolve the trombus plug, in the coronaries) in the ambulance if there is less than 2 hours after the attack.

JD.

**Brian Ellis** · 21 March 2005, 02:03

Well, according to the news this morning, Congress are forcing a person to be kept alive indefinitely, against the better judgment of the family, the doctors and the judiciary. To keep this lady, in a vegetative state, alive, when she would have died naturally years ago, and similar hopeless cases, costs a fortune and the same resources could probably help half-a-dozen patients per day have better treatment for curable illnesses. Who pays? Ultimately, everybody living in the USA.

What right do politicians have to be so arrogant as to override sound judgment to allow this lady have a painless and dignified end to her suffering and artificially inflate the cost of medical care for everyone? I am strongly opposed to euthanasia but I do believe that a natural death with minimal suffering and maximum dignity is the right of everyone. Keeping people who are brain-dead alive artificially is a sin against God and mankind (I'll make the exception of short-term cases, purely so that organs may be extracted for trasplantation). I have made it very clear to my family that if I reach that position, the plug has to be pulled immediately, interfering politicians or not.

**James_D** · 21 March 2005, 02:14

I totally agree with you, I was writing some comments about why this wasnt a mercy killing, but i gave up. No one in his/her right mind can support this. She is in laymans term a vegetable. Let her die, this is no life.

JD

**Umfriend** · 21 March 2005, 05:13

Uhm what do you mean by "family". AFAIK, there's only a husband and the parents, and the parents want her to be kept "alive". I do not know what judgement has been called by the doctors, but it's been the husband who's been argiung to pull the plug.

I do not know whether she has ever spoken out her wishes for a situation like this (in a verifiable way), so I am not so sure the parents should not have a say in this.

**Dr Mordrid** · 21 March 2005, 08:34

EXACTLY!!

The situation in this case is not just as simple as Mrs. Schiavo's hubby "doing the right thing". Not even close.

1. she is NOT on life support, just a feeding tube. Lots of people are on feeding tubes.

2. she is NOT comatose, and the diagnosis of her being in a "persistant vegetative state" is controversial at best. Even the definition of PVS is debateable, especially given recent research (see below).

3. her husband is in control of her rather extensive estate (from a malpractice lawsuit), meaning that he has something to gain from her death: not having to pay for her continuing care while inheriting her remaining estate. IF her care was transferred to her blood family much of this money would revert to the control of her caretakers: mom & dad, and they're already well off.

4. he's been living in a common law relationship with another woman for many years and has 2 children by her, yet he's never divorced his wife to legalize the relationship. Oops.

5. for many years he's refused to let physical and speech therapists work with her, dispite the FACT that she does utter words, names etc. appropriately. Speech and physical therapists who HAVE examined her think they can get her speaking and feeding herself, but he refuses to let them work with her.

6. He's also refused to let her parents to pay for doing a functional MRI, which according to recently published research would go a long ways towards ascertaining the actual functional state of her brain.

7. He has also refused to let her have a PET scan, which could also contribute much valuable information as to the state of her brain functions. All she's had is a CAT scan, and that was done LONG ago.

Anyone but me find these situations a bit fishy and convenient?

IMO what's necessary is that Mrs. Schiavo needs to have a court appointed attorney act as her agent, independend of both sides and who'll be HER advocate and willing to persue the true state of her status.

Dr. Mordrid

**Brian Ellis** · 21 March 2005, 08:45

But it's OK for politicians with no medical knowledge to play God and decide???

NEVER!

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