Ladies, are you receiving better healthcare in the United States?

[Ronnie]

I'm no expert in the subject of medicine nor can I offer a plan that will solve the perceived problems in any given system of healthcare.  What I can offer is my conviction free market capitalism while imperfect is the most efficient means of rationing goods and services and finding appropriate price according to quality, quantity and demand.  Individuals using their own discretion are the best judges of how to allocate their limited resources.

How does one measure quality when it comes to medicine?  If I may be permitted to offer one possible measurement:

Each year since 1901, the Karolinska Institute selects Nobel Prize Laureates in several disciplines, one of them being Physiology and Medicine.  Since 1950, there have been 140 such laureates.  Despite representing just 5% of the world's population, 53% of those prizes have gone to American citizens or residents.  

Brits and others don't go on medical holiday to the states for any other reason except their perception of quality.  Please don't lecture the US about the poor.  We have medicaid for the poor, VA for our veterans, medicare for seniors and free insurance for our children, even if not poor.  All this has been accomplished without resorting to a nationalized, single payer, quality-killing system.  Americans and indeed, the world are better off because we have done so.

So when Americans protest that our leftist politician want to place us under their medical thumb by passing legislation these leaders cannot read nor understand (except to be sure that they themselves will remain unaffected) and which will destroy the greatness of our system, then we are protesting no only for the majority of Americans who oppose this monstrosity, but also on behalf of the world's citizens who benefit from America's capital investment in for-profit medical innovation.

[55North]

Even Italians .

What surprised me was how his first prescription for some pills (10, IIRC) was handled by a nearby pharmacy. I handed over his prescription and was told to come back a half hour later, when I was given a stoppered plastic tube containing the EXACT number of pills prescribed, with a self-adhesive label on it specifying its contents , rather than a manufacturer's box containing a higher number of pills.

55North, is this procedure still in use in the UK, or is it a relic of the past?

Indeed it is.  For the uninitiated, this is the ONLY part of our health service where a patient parts with folding money.  I think it's about £ 7.00 per prescription (11 US$ ).  The one price is for any prescription, regardless of real cost to the NHS (National Health Service) (taxpayer).  If you are in hospital, or in receipt of most government benefits, or a child, the prescription is without charge!  Clearly, regarding true cost, the NHS is able to get a good price as purchaser due to its size. 

I understand that the NHS is the world's 3rd largest employer, after the Chinese Army and Indian Railways.  But I may be wrong.
 
How glad we are that the bureaucracy to run this (Prescription Pricing) in my home city.

[Ronnie]

I don't understand.  Aren't all prescriptions everywhere written and filled according to a precise dosage and for a precise period of time? 

[BC]

I don't understand.  Aren't all prescriptions everywhere written and filled according to a precise dosage and for a precise period of time?  

Ronnie,

Being quit familiar with systems in both Germany and Italy, it goes like this:

Pharma companies provide the medicine already packed in 'consumable quantities'.. like 10, 20, 25 pills.. the quantities are roughly what the doctor will prescribe anyway depending on gravity of illness.

The doc's know what the quantities are and just write down something like pack of 10 pills..

Go to the pharmacy, hand over the Rx and get your pills, pay your pharma supplement (two bucks or so regardless how much it costs the health system) and you are on your way.. no coming back or waiting for the pharmacist to produce a label, count pills, sometimes creating confusion which pills are in what bottle etc etc..  For generic meds no supplemental payment needed.

The pharmacists here are also MD's, so fairly often you can get prescription type drugs by just asking them if you know what worked in the past.. but paying the full price especially on weekends but if you go to your doc afterwards and he gives you the Rx, the pharmacy will refund the difference.

Overall pretty good system, but also a good bit of waste involved.. we have half a cabinet full of meds FSU style.

[SANDRO43]

Overall pretty good system, but also a good bit of waste involved.. we have half a cabinet full of meds FSU style.

Yes, but on the pharmacy side it saves manpower, and possible errors - giving you somebody else's pills .

[BC]

Yes, but on the pharmacy side it saves manpower, and possible errors - giving you somebody else's pills .

..AND you get the full pharmaceutical company leaflet included on how to use, dosage, side effects and interaction, something you never see in the US.  Leads to better patient knowledge, even allowing patient critique when in doubt which is also good.

[SANDRO43]

..AND you get the full pharmaceutical company leaflet included on how to use, dosage, side effects and interaction, something you never see in the US.

Indeed ? I thought the bugiardino was a universal institution, I'm surprised it's not common practice also in the USA - but then fortunately I never had to take any medicines while over there.

One thing I really appreciated were the Curad band aids - so much simpler to unwrap and apply than our equivalents. I had a friend living in San José/Palo Alto for some years, and always asked him to bring over a supply when he was visiting back.

[BC]

Indeed ? I thought the bugiardino was a universal institution, I'm surprised it's not common practice also in the USA - but then fortunately I never had to take any medicines while over there.

One thing I really appreciated were the Curad band aids - so much simpler to unwrap and apply than our equivalents. I had a friend living in San José/Palo Alto for some years, and always asked him to bring over a supply when he was visiting back.

No bugiardino.. only a stick on lable saying take one pill three times a day with meals or such and that's it.

The only thing I ask my parents to bring when they come over, or buy when we're there is one of those huge bottles of generic aspirin and some ben gay for muscle aches.

OTOH my wife takes a couple packs of Aulin to RU when she visits but knowing the FSU penchant towards self medication with the stronger stuff makes me still wonder which of the two 'systems' is better, or less risky.

[SANDRO43]

some ben gay for muscle aches.

Never heard of that, I had to look it over:

Bengay: Muscle Pain/Ultra Strength contains 30% Methyl Salicylate, 10% Menthol, and 4% Camphor.

You could probably get the same from a local pharmacy that has its own laboratorio galenico, looks simple enough to custom-prepare .

[Blues Fairy]

Mrs 55North agrees, whilst being wowed by how she's having all her imported complaints, real and imagined, being checked by specialist consutants, free and gratis, in 3 5-star hospitals depending on discipline, all a short bus ride from home, in a city with an excellent medical school.

Awwww. 
I imagine if she was able to import her complaints, they were not particularly urgent?
 
Just saw this today: UK health care wait times
http://news.bbc.co.uk/2/hi/health/3749801.stm

[BC]

Never heard of that, I had to look it over:

Bengay: Muscle Pain/Ultra Strength contains 30% Methyl Salicylate, 10% Menthol, and 4% Camphor.

You could probably get the same from a local pharmacy that has its own laboratorio galenico, looks simple enough to custom-prepare .

probably so... thanks for the tip!  Most of the pharmacies down here in the south still mix on demand.. -I'll try..

Might save my parents the hassle since most goes to the neighbors anyway.. LOL

[ECOCKS]

Since facts work better than suppositions, it should be noted that in US pharmacies you receive an attachment to the prescription with descriptions of side-effects, warnings of proscribed behavior and counter-measures for overdosage. If the medication is particularly potent or prone to misuse, the pharmacist discusses it with you and asks for questions. Most reputable pharmacies then have you sign that you received the appropriate warnings.

This is also true of the mail-order programs where you receive up to 90-days supplies, often for less than $11 per scrip.

It is pretty rare to ask for meds which are not in stock or available within 24 hours or less.

Additionally, there already are numerous FDA-approved and inspected laboratories which produce the popular over-the-counter (non-prescription) as well as the generic form of medicines which are not protected by patent or licensing restrictions as private label equivalents with full quality control.

It is always more fun to make up a story that fits your agenda as you go along but you really need to check facts before making statements like this.

[BC]

Awwww. 
I imagine if she was able to import her complaints, they were not particularly urgent?
 
Just saw this today: UK health care wait times
http://news.bbc.co.uk/2/hi/health/3749801.stm

Blues Fairy,

Faced with the choice between 6 8 or even 12 months waiting for non critical operations vs several years of hefty payments even if somewhat insured what would you choose?  There is a premium on instant gratification.

OTOH faced with a life threatening condition, which is better.. Instant care with no bills or instant care with an installment plan or possible loss of property and home?.. unless you have nothing to begin with of course..

I honestly believe there is a balance somewhere..

[Blues Fairy]

Faced with the choice between 6 8 or even 12 months waiting for non critical operations vs several years of hefty payments even if somewhat insured what would you choose?  There is a premium on instant gratification.

Apparently the taxes you pay are not counted toward the payments for healthcare - in this case, it's truly free, isn't it.   Can't beat that.  Still I would pay extra to have the quality of life I deserve, instead of being denied necessary surgery ("instant gratification" in your lexicon) when I need it.  But in UK, I can't even pay for it unless I'm prepared to lose my coverage, can I?

[BC]

Since facts work better than suppositions, it should be noted that in US pharmacies you receive an attachment to the prescription with descriptions of side-effects, warnings of proscribed behavior and counter-measures for overdosage. If the medication is particularly potent or prone to misuse, the pharmacist discusses it with you and asks for questions. Most reputable pharmacies then have you sign that you received the appropriate warnings.

...

It is always more fiun to make up a story that fits your agenda as you go along but you really need to check facts before making statements like this.

ECOCKS,

I admit it has been a while since the last time I had a Rx filled in the US.  Things may have changed a bit in the meantime, but likely because of the risk of litigation rather than sharing of information. If you have an example of what they print out for a popular prescription Rx I'll go get what is in the package here and we can compare.. might be interesting.

I also remember well in the past researching pharma products at US websites that basically said 'we can't give you this information' or MD's  must register first to download etc etc..  The German website of the same company had full info.

If things have changed, that's great but it wasn't that way when I grew up.. brown plastic bottle, white cap and a label.. that was it.

[BC]

Apparently the taxes you pay are not counted toward the payments for healthcare - in this case, it's truly free, isn't it.   Can't beat that.  Still I would pay extra to have the quality of life I deserve, instead of being denied necessary surgery ("instant gratification" in your lexicon) when I need it.  But in UK, I can't even pay for it unless I'm prepared to lose my coverage, can I?

Blues Fairy,

Of course it is paid for out of our taxes, no doubt about that, OTOH at least you never see a bill and your co-participation fee goes towards meals, phone and TV if you want the headphones LOL..  I have never had to even think about losing our house because of a medical emergency.. just doesn't happen like it does in the US.

No one is denying treatment, just putting you in line if your case is not urgent.

Have no experience with UK, but can give you an example here..

Our boy at 2 required surgery for an inguinal hernia, definitely not life threatening..  I reckon with standard waiting time something like 6 months at the state hospital.. however there are many hospitals that are not state run.. We paid 150 bucks at the time for a private consult with a great surgeon who arranged surgery for the next week. Nothing underhanded or illegal, just private firms competing with government. Result, all well and today not even a visible scar.

What's really strange is that if we had used our private insurance, the hospital would have released the same day of the operation, whereas if government insurance was used, mother and son were given a 2 bed room for the night, meals, and supervision..   I pay around 900 EUR per year for the private insurance mainly because it provides for 3000 EUR per month for loss of income if I have to be admitted.  Of course we chose the State route, mother and child a relaxing stay with cartoons.

One thing is sure, if you don't like the system where you are, you do have a choice.. just move!.. I think we'd be happy to see you here down south!  The weather here is a lot better too.

[myrddin]

Indeed ? I thought the bugiardino was a universal institution, I'm surprised it's not common practice also in the USA - but then fortunately I never had to take any medicines while over there.

I've edited and proofread a large number of things called "Patient Inserts" and "Direction Inserts" that give thorough descriptions of drugs, side effects, and so on (for the US and other countries).  But that doesn't mean people actually read it. 

Doctors are supposed to cover the basics when they make the prescription, and pharmacists (who may not be MDs but Pharmacy degrees are not exactly easy) also.

[Ronnie]

Here's the real issue for Americans, unlike perhaps in Europe:

We are, as you may recall, a federal republic of 50 states.  Our states are sovereign.  The federal government was formed by the sovereign states in order to provide for certain needs that were best handled in an interstate way.  Those needs and power to provide them were enumerated as:  

1. Collect taxes
2  Regulate interstate commerce
3  Coin money, regulate currency, set standards of weights and measures
4  Declare war
5  Raise and maintain an army and navy

Nowhere within these powers is there found the power to take over private businesses or professions or to provide universal healthcare.  If individual states have those powers in their own constitutions, then let them try it.  Some have done so.

What is clear to most of us is that the federal government does not have the power to do many of the things it has done over the past 100 years or so and the result has been that congress has borrowed so much money that in order to pay off the debt, each American family will have to come up with nearly $100,000 while struggling to pay their necessary bills and taxes.

Obama promised hope and change. Yet no other president before him has presided over such a breathtaking increase in spending and debt leaving so little hope for our children and grandchildren.

[55North]

Awwww.  
I imagine if she was able to import her complaints, they were not particularly urgent?
 
Just saw this today: UK health care wait times
http://news.bbc.co.uk/2/hi/health/3749801.stm

I think BC has answered this fairly well.  It's that concept again, wherein you attempt to harbour all your resources, and share back on the basis of necessity and proven need.  Some might call that 'society', or even 'Socialist'.  This, even as we have to acknowledge a general problem of rapidly ageing population with their own medical issues.  Putting it crudely, to what extent do you patch up the 'dying' at the expense of of the younger elements of society.
 
By the way BF, the date was 2004.   This is now.

http://www.18weeks.nhs.uk/endwaiting/faster_window.html
 
As the population profile changes, so must society's organisation, but expect a time lag.


Regarding 'imported' complaints,  Mrs 55 comes from the North Caucasus.  Like mountainous regions the world over, where the ice has recently withdrawn (climatic warming, Ronnie!) and man reoccupied, the young, developing soils are washed out, or otherwise devoid of important trace elements prior to the development of good humus, leading to a high incidence of goitre.  This is a particular problem in Stavropol and Krasnodar Krais, where a tendency towards desertification doesn't help.  Despite Mrs55's certainty that she arrived in the UK with some 'symptoms' attributable, nary a trace of a goitre condition has been found, after free exhausting tests.

[Ronnie]

This, even as we have to acknowledge a general problem of rapidly ageing population with their own medical issues.  Putting it crudely, to what extent do you patch up the 'dying' at the expense of of the younger elements of society.

Quite crude indeed.  These are not the problems of society to be decided by a community council.  We are all dying, where do you wish to draw the line?  Shall all living persons have DNA checkups to see if they hold genes that might lead to a short life span.  Then what, deny expensive treatment?  Dr Mengele would be proud!

[55North]

The NHS is huge (passim).  It is led by the Minister for Health c/w extensive input from specialist organisations and policy groups.  There are documentaries on TV and extensive articles and discussion in the quality press.  All the attributes of a modern functioning democracy.

A Community Council it is not.

There is an extensive public debate going on in all advanced states, regarding the grey future (I am weeks from my 60th birthday thus have a direct interest).  Call it fiscal forecasting if you like, but not to do would be criminal IMHO.
 
Thank heavens, your administrators agree.......

http://www.healthystates.csg.org/NR/rdonlyres/B810343C-5D88-4210-B999-1A1A42711F62/0/agingLPB.pdf
 
Quote

   What State Legislators Need to Know About Health in the Ageing

ß The ageing population is increasing rapidly. The population of Americans age 65 and older
is expected to double in the next 25 years due to increased life expectancy and the aging of the
baby boomers.

ß The ageing population is becoming more diverse. Projections by the U.S. Census Bureau indicate
that by 2030, the composition of the older population will be 72 percent white, 10 percent
African-American, 11 percent Hispanic and 5 percent Asian.2 Studies show health disparities
exist among certain racial and ethnic groups who are disproportionately affected by chronic
conditions such as high blood pressure, diabetes and cancer.

ß Health care costs for the aging will increase. The anticipated growth in the aging population
will result in an expected 25 percent rise in health care costs by 2030.3 As the baby boomers turn
65, the financing of their care will begin shifting from the private sector to publicly financed
programs, including Medicaid and Medicare.

[kievstar]

Hi 55 North, I see your from England.  I am sure your aware that England is going to ask for 70 years old to be the retirement age as healthcare and pension for the old are becoming to expensive.  By 2030 retirement age will be 80 as healthcare and pensions will be to expensive.  Eventually there will be no retirement benefits the way things are headed in England.

[docetae]

I don't know about USA. My experience was with 3 countries: France, Canada and Ukraine.
France: The best healthcare in the world. Yes, you pay a premium with taxes but you have really good and fast services. Doctor come to your home when you are sick, you have to pay only a minimum payment to avoid abuse (I think around 20 euros now)
Ukraine: Quality of service seems to be disparate. But same as France for speed of services. Only infrastructures are not in good shape.
Canada: Very good accessibility and quality of services but lack of specialist doctors. Doctors will not come to your home. You have to learn about places to have good and very fast services (ie, in Montreal, go to english hospitals for emergencies, there are less people than the french).

My wife is pharmacist, she does not like the canadian system because she must see a doctor to make analysis and can not go to a laboratory directly, She need always to be referred.

My understanding of US system: bad, everybody should have healthcare and people with more money paying for those who have not. Nobody knows what can happen in life.. Market values should not be in perspective when it is about health. A public, almost free system is for me the only viable alternative.

[BC]

Quite crude indeed.  These are not the problems of society to be decided by a community council.  We are all dying, where do you wish to draw the line?  Shall all living persons have DNA checkups to see if they hold genes that might lead to a short life span.  Then what, deny expensive treatment?  Dr Mengele would be proud!

I believe health insurance companies, if they remain private will go the route of DNA profiling to fill their actuarial data.. taking this step is logical to reduce risk and raise profits.

Unless governments ban such practice at the outset (which I doubt they can), one of two paths exist:

The private sector will insure only who they want to, leaving the rest to end up in costly government medical access institutions. I call this 'skimming the icing off the cake'.

or

Government simply takes over the whole marketplace which may be somewhat ineffective, but does still allow proper spread of risk, keeping a somewhat balanced financial situation.

In both scenarios the taxpayer will foot the bill, but at least in the second maybe less so since insurance industry profits are cut out of the ballgame.

It will be tough, but yes limits to treatment will have to be forthcoming, especially if on the government program.  Modern medicine has taken us well beyond our natural 'best used by' dates. 

May sound strange, but in the long run, our evolution as a specie is also being retarded with medicinal overkill.

[55North]

Hi 55 North, I see your from England.  I am sure you're aware that England is going to ask for 70 years old to be the retirement age as healthcare and pension for the old are becoming to expensive.  By 2030 retirement age will be 80 as healthcare and pensions will be to expensive.  Eventually there will be no retirement benefits the way things are headed in England.

Docetae, as a previous regular traveller to Kyiv, I am glad you can be so positive about the health service there given some reports.  Even though the system is 'free', it is generally acknowledged that without self-supply and bribes, you die.

http://news.bbc.co.uk/1/hi/world/europe/8182795.stm


Kievstar, you are accurate in your report of another aspect of the public debate regarding pension age, particularly as regard to state pension.  This debate is also going on across the EU, though possibly not so publicly.  Also, with the appropriate twist on it, in the FSU (in that their economies seem to be structurally doomed for a generation or so ahead).
 
I have certain financial liabilities (due mainly to me visiting Ukraine and Russia regularly in the past).  It is not 'appropriate' for me to retire on (a very basic) state pension at 65.  I'm fairly fit and active.  I wish to work on to at least 70 (75 will be good).  I welcome a law change prohibiting my employer from 'retiring' me at 65.  Furthermore, there seems to be evidence that folk who work on, or are otherwise meaningfully active lead more rounded and healthy lives.
 
A point often made now is that when our state pension was established, men in particular did not live much beyond their work retirement age.  Clearly the mathematics of that do not hold water any longer.
 
Add that to the huge public debt our governments have just entered into ('the crisis'), it is clear that something must be done.

Agree BC, about 'our natural 'best used by' dates'.

My mother suffered from very severe dementia for some years before her death, which meant living in special care home.  The cost is means tested.  If you have the means, the state demands you pay (not unreasonably).  Her care, as someone who was technically alive, but not living or functioning in society, was paid for by the entire value of my parents' house.  The only ones to gain from the whole exercise were the care-home corporation and the drug companies (probably both American).  This is now the subject of another public debate, whereupon the government is flying the idea of mandatory insurance deducted from pay (as in tax) to provide everyone with a basic care-home facility when the time comes.  I think that a sound proposal.  This rise in the amount of people who need care is exponential.  Apart from the drug industry keeping us alive beyond our natural term, it is fairly normal, certainly in an Anglo-American culture, for the middle-aged not to be burdened with taking in their parents and caring for them.

I have suggested to Mrs 55 that, should I start to dribble excessively, and not appear to know who she is (she's 15 years younger), she should sell the house directly and take us both to Russia (and hide me away from the authorities)

Her first in-laws are pharmacists!