Solve the health care crisis.

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Oh, come on, you guys can do it. Your mission, should you choose to accept it: fix the U.S. health care system, without mentioning Hitler. This post will self destruct in five seconds.

-- Anonymous, June 26, 2000

Answers

Don't think that's possible [in five minutes, at least] but a good start would be to standardize the forms, cutting back on the huge amount of clerical work medical practices have to do.

-- Anonymous, June 26, 2000
That's so unfair -- it's like, "Try not to think of the left eye of a camel." Now every thought I have about health care comes galumphing back to you-know-who. I was going to suggest that we annex Canada and take over their health care system, but nooooo, I can't suggest that, because annexing countries was one of HIS tactics. Then I thought maybe we could solve the problem internally by having discussions about it at local beer halls, but He-who-must-not-be-named led the way on this solution, too. All I can say is, how do you expect to have a free and open exchange of ideas when you make the most relevant, and indeed indispensable and central, historical figure verboten (there it is again!)? I'm sorry, I just cannot operate under these restrictions.

-- Anonymous, June 26, 2000
Tom, you are so totally banned from my forum.

Not really.

-- Anonymous, June 26, 2000

It seems to me that the availability of health care is pretty good considering how many folks get it for free or at reduced rates through the government. If one does not have the inclination or ability to learn what the government provides for free I'm not so sure you DESERVE free health care. My wife is a pediatrician who works in a hosipital environment, and over half the kids she sees are without medical coverage due to their, shall we say, immigrant status, or are covered by medicaid. The persons who are on medicaid frequently have poor routine health mainteneance issues and wait to bring in their children until the problems have been compounded to be a more expensive fix (assuming it is even fixable.) Also, the number of 30 something year old GRANDmothers is absolutely deplorable. No wonder there are so many social and health problems out there when so many kids are having kids. Most of these kids will be raised by a combo of mother/grandmother, not dual parents. I think many issues involving health are more social in nature than the access/proximity to medical facilities, like good nutrition, avoiding drugs, domestic abuse, stupid sex (like where you get STDs).

Healthcare for those who have private coverage is pretty good. The quality of care in the US for these folks is second to none in the world. In fact, the U.S. is where people come if they live overseas and have lots of money. The only gripe most people with private coverage have are the rules one has to follow to get the care they want (i.e. HMO referrals or insurance forms). People/corporate managers want full/all choices but are not willing to opt for the more expensive fee for service plans.

Did you know 50%+ of the price of a hospital stay is to cover insurance for lawsuits and the costs of those who get care but do not pay for it (including the gov't not paying on certain claims or paying a reimbursement rate that is less than the cost to provide the service)?

Overall, I have no ideas for fixes. I have always had good medical coverage because I both get medical coverage as a benefit of WORKING and I go in for routine checks. I don't understand folks who are not able to provide for their own care/needs, and then bitch at "the system". If you want the benefits of a system, do what you have to in order to participate in it.

So, in short, I don't think our current system needs much fixing. However, I am somewhat bitter about having to pay such a high price for care because other people get medical care that they don't pay for. Not only do I support folks through higher taxes, but also through higher premiums and higher hospital bills. Also, I think there are too many cases where too of other people's money is spent to save a life. Most of you would be shocked to see how many premies are born to drug addicted moms, drunks, and teen girls whose bodies are not yet ready to carry a full term preg. The cost of saving these babies are unreal the first couple/few months, and the ongoing costs of these kids who make it are high too- many have lung/eyesight problems and mental development deficiencies. I think too often we spend too much money to save lives that are not going to be of high quality. I do not know where the line should be drawn, but I do know there is alot of money spent on 500 gram babies that never make it or make it for only a short while. And the bill for these babies is never paid for by "mom." Not because they are too cheap, but because they just don't have it. So, when is too much? Is $1 million per baby ok, but $2MM too much? $10MM? $100MM? The line will have to be drawn someday because medical technology is outpacing society's ability to provide it to all who breathe.

I do not think there are any easy answers- but I do think putting any more red tape on the hospital/doctor's back is NOT the answer.

-- Anonymous, June 26, 2000

Good question Beth, although it's kind of Hillary-like to impose prior restraint on what should be a free-flowing conversation.

As I said in another thread, most people in this country have either private health insurance or are eligible for one of the various government programs.

We definitely need to help the folks who have jobs that don't currently provide insurance. It is not right that working people should pay huge social security taxes so that non-workers can get medical care while the workers can't.

I think the government ought to facilitate forming these people into a large group purchasing unit. This group would then allow the group members to buy any insurance plan offered the group. Insurance companies would fight to sell policies into this group, because the group would be very large (~25 million people), so the per person risk would be small. This is the system that the federal government has for civil servants and elected officials, and it works very well. Group members can switch plans once a year, so the participants would be customers, not supplicants.

I'd advocate high deductibles for routine medical care, with everyone encouraged to maintain the deductible amount in a tax free savings account. Once your medical savings account was up to the deductible then you could take tax free money out of it. In other words, you contribute $50/month to this plan. Your objective is to save up $2000 to cover the yearly plan deductible. Once you got the account up to $2000 you could withdraw your $50/month plus the interest on the $2000 tax free, letting you keep the money above $2000. This plan (suggest by the Evil Newt) would reward savings and discourage people from running to the doctor for minor problems.

I am 100% convinced that some plan like this, letting people form large, employment-independent group purchasing plans is the best way to give everyone health care without making us supplicants to a huge post office/IRS like bureaucracy.

This plan would Blitzkrieg across the economy. Think of how much easier it would be to start a small business if you didn't have to give up medical insurance. Think of the medium sized businesses that could redirect resources into production if people could freely and easily buy cheap health insurance from this huge group plan.

We'd pretty much empty out Canada if we had system like this.

-- Anonymous, June 26, 2000

Discourage people from running to the doctor for minor problems ... ? Like a lump in their breast that they're pretty sure isn't cancer? Or a throat that stays sore but probably isn't strep? Or a painful foot bone that makes it hurt to walk but isn't life threatening? Okay, sounds great.

-- Anonymous, June 26, 2000
All of these public policy questions lend themselves to two solutions:

(1) Government can provide the service most efficiently because of economies of scale and because the service at issue is a public good, that is, a good which private individuals will undervalue when left to their own devices;

alternatively,

(2) government should not provide the service because people will abuse it and take more of it than they would buy if they had to go to a private market, and moreover by learning to rely on the government service, they will cease to be able to make smart decisions about the economically efficient limits of the public availability of the good.

I don't mean to be reductionist about it, but there it is.

-- Anonymous, June 26, 2000

Clementine, you are going to pay for a visit to the doctor one way or the other. In giant HMO systems such as the U.S. Army or the British National Health Service, there is really no provision for seeing a doctor for an acute problem (acute = no bones breaking the skin, no high fever or other easily observed symptom). You can try and make an appointment, which may well be weeks or months in the future, or you can sit in an emergency room, possibly for days. Of course if you are friends the staff or are a VIP, you'd go right in, that is just how people are.

The waits are long for acute problems not because the NHS or Army medical administrators are bad people who like to make people suffer. It's their way of reacting to the economic LAW that the demand for free goods tends to approach infinity. There aren't enough health care providers in the world to support a system where anyone could just walk in and see a doctor or other provider for free after a five minute wait. So the "free" systems impose a cost in time, inconvenience, and suffering. Please visit the emergency rooms at Fort Hood, Texas or Banbury, England to see this system at work.

The net result of rationing by time and pain is often that the person with the lump decides she can't wait for days to have it checked, and settles for an appointment with a physician's assistant next month. This may suit her fine, or perhaps she might have been willing to pay $20 if it meant that she would be seen much sooner.

I'd rather see the rationing done by imposing at least a small cost on the office visit, say $20. This would greatly cut down on the waits for acute care. Warning: If take a monopoly health system and impose the fee, nothing will change except that people will be out twenty bucks for the same service. If there is no competition then the health care system still has no real incentive to change even if the supplicants have to pony up twenty bucks.

Note that under a group buying system there will be many different approaches to delivering health care. As a participant you will be the customer, and you can choose a plan that works best for you. If you want very low or free office visits then you plan will probably have limits somewhere else. Perhaps the upper spending limit will be lower, or some treatments that you'd like to have will not be fully covered, like sterilization or eye care. EVERY heath care system will impose limits on what it delivers, because we live in a resource bound world.

Again, I refer you to the system that the federal civil service, Congress , and the president enjoy. I want that system available for all who can't get good insurance at work.

Choice and Competition are what we need!!!!!!!!

-- Anonymous, June 26, 2000

Just an example of how universal health cover works here in Australia - one of the OECD top six growth economies, Jim, in case you're wondering about the Great Satan of socialistic medicine and the drain on the public purse).

My sister was pregnant, her waters broke just before Christmas 98 while she was about 7 hours away from Sydney. She was airlifted to hospital in Sydney, admitted, and kept there for observation for three weeks. After three weeks her baby was distressed, so she had an emergency caesarian. The baby was only 28 weeks gestation, so into intensive care, humidicrib, and the like. The baby had a perforated bowel and was having difficulties; they were transferred to the specialist children's hospital but the baby died at two days. She and her husband had genetic counselling for possible cystic fibrosis (which wasn't the cause, eventually) and physical/psychological followup.

None of this cost her a cent over her Medicare levy - they pay, like I do, 1.25% of their income for this. My partner, an American, was speechless at the comparison with the American health care system.

My own view? Health care, like education, transport and a workable judicial system, is a core responsibility of government. Feel free to pay for your own health care if you like, and people here do (and some are being forced to do so at the moment, by changes to the taxation laws - grrr) but I like living in a society where there is a choice of decent health care on the one hand, or decent health care on the other. Too much to ask?

The Australian health care system is nothing like perfect, but given my extensive experience with it during the Great Baby Crisis of last year, I'm profoundly grateful to be here and not - reading the above - at the mercy of HMO's and private enterprise.

cheers anna

(PS My sister is doing pretty well, they're trying to get re- pregnant, but not as yet succeeding - think baby thoughts for her!)

-- Anonymous, June 26, 2000

And Anna has given me yet another compelling reason to move to Sydney after I'm had enough of London ... things are OK here, but nowhere near that good, and in New Zealand you'd have no chance.

-- Anonymous, June 27, 2000
anna, I'm glad you are happy with your system, ours in the United States needs work we all agree.

The only part of the Austrialian medical system I know about is the Royal Flying Doctor Service which is know world wide as the best air ambulance system in the world. I'm in a volunteer pilot group here in Texas that attempts the same type of service as a charity operation.

I have first hand experience with the U.S. Army and the British NHS, and I DON'T want that kind of thing for this country.

-- Anonymous, June 27, 2000

It seems to me if people go to their doctors for minor problems they are practicing preventive care. Not only that but I know virtually no-one who goes "running off to the doctor" because going to see a doctor is a royal pain in the ass. Better medical coverage won't solve that problem and sure there are hypocondriacs. But lets face it, who wants to spend 40 minutes waiting unless you are pretty sure there's something wrong? I do like that newt (!) plan where you could save up to your deductable in a tax free account, since that's what I do anyway right now. but what if you work but don't have a high income?

-- Anonymous, June 27, 2000
For once I am not giving an answer to a thread that I am posting to. All I wanted to chime in and mention here was the fact that I hate the U.S. health care system. I went to the doctor several days ago and had nothing other than an office visit and one blood test. It cost me (or shall I say it cost my suck-ass insurance) $73 for the office visit (which lasted ten minutes, eight of which were spent with the nurse from hell), $48 for the blood test and then I had to have medication for an infection. That was $139 for ten pills.

All of the HMO's in the world need to go to hell. No, really.

-- Anonymous, June 27, 2000
Quick answer: Either make all healthcare corporations not-for-profit or limit their profit margin. When corporations have again entered reality, we can re-evaluate and come up with a much more workable solution.

I'm not suggesting that healthcare *workers* should not be rewarded for their hard work, rather that they should no longer be exploited by the corporations. Healthcare should not be a "growth industry."

While some people might say this creates a disincentive for research and progress, I would argue that the obscene profits enjoyed by large healthcare corporations (especially pharmaceutical companies) actually might impede progress. When a corporation is making money hand over fist they will protect the status quo ferociously. For example (and this is obviously hypothetical), what if a cure for cancer were discovered and it were a one-shot deal? Would the same amount of money (consider all of the many layers of costs involved in cancer treatment)be generated? Honestly, do you think corporations would do anything not in the interest of making enormous profit? Really? What about tobacco companies?

Healthcare is no place for rampant capitalism.

-- Anonymous, June 27, 2000

In giant HMO systems such as the U.S. Army or the British National Health Service, there is really no provision for seeing a doctor for an acute problem (acute = no bones breaking the skin, no high fever or other easily observed symptom). You can try and make an appointment, which may well be weeks or months in the future, or you can sit in an emergency room, possibly for days. Of course if you are friends the staff or are a VIP, you'd go right in, that is just how people are.

As someone who lives in England, I'd just like to point out that, at least here, that is patently untrue. The longest I've ever had to wait for a doctor's appointment is six days, but usually I can get in within three. This has been the experience of everyone I know, though perhaps there are districts where long waits are the norm. I do not know of such places.

Where waiting becomes a problem is with operations; my husband was diagnosed as having a hernia in February, finally saw a specialist (a specialist is required to give the go-ahead for any operation) in May and has been told that it will be several months before his turn is up. My father-in-law has been on the 'urgent consideration' waiting list for heart bypass surgery since November of 1999, and is tentatively scheduled to have his operation at the end of July.

Still, I look at the fact that my father (who lives in America) has excellent insurance through his employer, but is still being refused treatment for the acute arthritis in his knees and ankles (though if he were an alcoholic, his stay in a $1400 per week treatment centre would be gratis), and I think to myself that I'd much rather have a system in place where I can make doctor's appointments without having to worry about the $30 per visit fee, where my birth control is provided free of charge, and where I only pay #6 (about $9) of the cost of other prescriptions -- especially if I ever have children.

Basically, I think that the only humane thing for the US to do is institute some form of socialised health care. Sure, it'll cost you more, but you get what you pay for; how a country that considers education -- but not health care -- to be a right for every citizen can continue with the system as it is now is nothing short of obscene.

-- Anonymous, June 27, 2000

"My father-in-law has been on the 'urgent consideration' waiting list for heart bypass surgery since November of 1999, and is tentatively scheduled to have his operation at the end of July."

Just a quick question, why such a long wait? In the US, he would have had the surgery long before the end of July.

-- Anonymous, June 27, 2000

About "minor" problems and waiting periods, I don't see how we're so different from countries with socialized medicine. It's been my experience that many HMO systems cannot fit you in to see a doctor right away. (Sometimes this is also true for non-HMO doctors who overbook on a regular basis.) I avoid doctors as much as possible, but there are times when you need to go just to rule out the possibility that nothing major is wrong--you've got a cough that won't go away, you hurt your knee a couple days ago and it's still so painful you can barely put any weight on it, etc. In situations like these, I've often ended up going to urgent care because my doctor didn't have available appointments for 6 to 8 weeks.

Normally this isn't too bad, but first of all, I would have much preferred to see my regular doctor. Second, sometimes it can lead to real problems because you don't consistently get the same doctor. For example, I had a sinus infection that wouldn't go away, and I never could get in to see my regular doctor; you really don't want to wait two months for an appointment when you're currently running a 103-degree fever. Over a four-week period, my doctor's receptionist referred me to urgent care three times, where I was seen by three different doctors who had three different opinions about what was going on. Finally I got in to see my regular doctor, who referred me to an allergist, who discovered I was allergic to California, basically. The kicker is, I'd been treated for sinus infections every year since I'd moved to California, all during the same time of year, but because I always ended up at urgent care, no one put two and two together. I was the one who brought up the possibility of underlying allergies to my doctor at an appointment I scheduled way in advance with the express purpose of obtaining a referral to an allergist, since under the HMO system I couldn't make an appointment with a specialist on my own initiative.

This second point is another reason why HMOs suck. It's a pain in the butt to try to get to a specialist, and god forbid you need to go outside the system. If your doctor refused to refer you to a specialist, you're stuck, or at least until the small annual window when you can change your primary physician, and even then there's no guarantee that the new one will give you that referral. This can have harmful consequences. For instance, my partner has severe asthma, which has been under good control now for many years (i.e., it's been a long time since he's been in the e.r. for an attack and even longer since he's been hospitilized). At one place we've lived, his primary g.p. refused to refer him to an allergist, insisting that he could treat the asthma himself. He then tried to change my partner's entire regimen of medication--which was obviously working well for him--to other medications that my partner had been on before and that had not worked as well, including one that had been proven to have serious side effects. The guy was about 20 years behind the times and had no clue what he was doing, and I honestly believe he endangered my partner's health and life simply to help the HMO save a buck by denying referral to an "expensive" specialist.

Another thing that sucks is that most companies repeatedly change their insurance plans (always looking to save a buck again), so you can suddenly discover that you aren't going to be able to see your physicians anymore and have to start over with new ones. One of the most heart-wrenching things I've ever heard--accidentally overheard part of a phone conversation at work--was one of my coworkers desperately trying to find a way to allow her young daughter to consider seeing the same child psychiatrist even though the doctor wasn't part of our new HMO. She was terrified that all the progress the daughter had made would be put back if the girl suddenly had to switch to a new doctor she neither knew nor trusted.

I've been dealing with HMOs for about 12 years now. My mother is a nurse, and she has always disagreed with me about the health care system, saying that a Canadian-style system would take away our right to choose our provider. I've told her repeatedly that those of us who are covered by HMOs don't really have a right to choose anyway, and if that's the way things are going to be, I'd prefer to have universal coverage than the mess we're in now. Well, a year ago my parents' insurance plan finally converted to an HMO and since then has changed over to a different HMO with different doctors. All of a sudden, she's starting to complain about it and to understand what I've been talking about all these years.

I believe that health care is, or at least should be, a basic right of humanity. I believe that the more coverage provided, the more likely people are to avail themselves of it, the more likely they will receive preventive care or that problems will be caught early on, resulting in better health, better life expectancy, and less cost in the long run to this nation. I believe that our health care system is in crisis. I don't claim to know exactly what would fix it, but I do think some sort of universal health care is paramount. Call me a socialist if you will; I really don't care if people know that I'm more concerned with promoting social well-being than self-centered capitalism.

-- Anonymous, June 28, 2000

Suzy, the long wait is because England has a socialised health system...as we've been discussing on this forum. The surgery, his hospital stay and all doctor's appointments are -- apart from the taxes which naturally fund the NHS -- free of charge. Thus, you're just not going to get your surgery in as timely a manner as you would if you were footing the bill. Everyone (who can afford it) has the option of going private and paying for their health care, but when it's in the neighbourhood of #20k, all told, it's not really an option for my father-in-law.

So, yes, in the US he would have already had his surgery -- if he could afford it, or if his insurance covered it completely. If not, he might never have the operation.

-- Anonymous, June 28, 2000

I just wanted to clarify for Suzy that #20,000 is roughly $30,100 at the current exchange rate. That, and having grown up in America and spent years dealing with that health care system, I would gladly take England's socialised health care any day. It's flawed -- as the American system is -- but it does provide health care without the worry of how to pay for it. That means a lot to me, especially when there are so many young and unemployed mothers who otherwise couldn't afford pre-natal care, something that I feel is underrated.

-- Anonymous, June 28, 2000
For those of you who complain about your medical plans in the US, select the fee for service option and kick in 20% of the costs of your care. People who choose the cheapest option should not complain when you get what you pay for.

Also, if your primary care provider is unavailable (takes 6 - 8 weeks to get an appointment), CHANGE your primary care provider for gosh sakes! I'm in an HMO and can get into my internist within a week or two for routine stuff, and can get into his office's urgent care center TODAY. In fact, he will review my chart within a day or two to make sure he likes the care I was provided by one of the other docs in a box.

And all of you english/canadian/aussie folks who want my healthcare system to be changed you your wait-7-months-and-maybe-you-can-get- that-life-saving-heart-surgery-you-need system you currently have need to get a grip. I have access to the best healthcare in the world here in a timely manner. Of course, I work and have good benefits because I have positioned myself in life to be able to get such things. I for one will not vote to give up the quality of care that I have worked for. I give 10% to my church, i help support a missionary team, i save 15% for retirement, i give 5% to United Way, my wife and I do a small amount of volunteer work, and the Fed government/state gov't take over 35% of what I make on a gross basis. How much more do I have to do? I provide for my own, and help pay other people's way too. Now, I am not suppose to get good healthcare because other people who have not worked as hard or planned as well have to go to county hospital for free care? I dare say the care they get at county is BETTER than that socialized stuff being served overseas.

If there is no ability to get better rewards for harder work or individual talent, than we are just settling for mediocre for all. Why would the most talented folks want to perform surgery as an employee of a federal government instead of being able to charge their own rates (or at least have some negotiating power with individual insurance companies to bargain for fees)? Where is the incentive for finding that new drug or cure? Why do all of these expensive clinical studies? Are any of you so nieve to not notice that we are, on the whole, the most prosperous country in the history of the world because we try harder? And we try harder because we can get individual rewards. We are responsible for the majority of civilation's advancements over the last 50 years, and have access to the most sophisicated procedures/tools/techniques available. I do not want to lose access to that, and I dare say all of those socialized medicene worlds out there do not want that either. How else are they going to advance other than to stand on our coat tails?

-- Anonymous, June 28, 2000

Now, I am not suppose to get good healthcare because other people who have not worked as hard or planned as well have to go to county hospital for free care? I dare say the care they get at county is BETTER than that socialized stuff being served overseas.

Sigh. Uninformed blatherings abound.

Living in a country with socialised health does not mean that you can't also have private health care. As with the US, many employers provide private health care plans. The only difference is that if you're not one of the fortunate (or, as Jarvis seems to feel, entitled), you don't have to worry about not being able to afford that doctor's appointment or prescription for your kid's earache/flu/whatever. There has to be a safety net to catch those who just can't afford the top of the line health care that Jarvis thinks is exclusive to America.

Jarvis, I'm curious: Where did you get your data about the quality of health care in places outside of the US?

-- Anonymous, June 28, 2000

This is probably useless, but I can't stop myself...

Jarvis:

1. To assume that money is the only incentive for doing exceptional work is cynical and de-humanizing (and, I suspect, self-serving.) Not to mention lacking in common sense: if the primary desire is to make more money, then the desire to do perform is secondary. Once the money's in hand, the secondary desire to do exceptional work is like to wane. This is especially dangerous in professions which are rarely held accountable for mediocre (and even negligent) work. You can check the statistics regarding our quality of care in the US for proof of this--please, compare our mortality rates to those of countries with socialized medicine.

2. The notion that healthcare is even close to a "free market" is bogus. Healthcare costs are artificially inflated due to the existence of insurance. While insurance is subjected to what the market can bear, the actual goods and services are not. This ends up being bad for everyone, and is the primary reason that you feel you contribute more than your share.

3. Although I congratulate you on your upright citizen status, I hope you don't display this kind of superior attitude in front of any food service workers, because they are likely to spit in your food. And, despite what you seem to think you know, food service workers (among other minimum wage type gigs) do not have work-sponsored insurance, nor are they given sick days. This means that you have people with very neglected health problems fixing your food. Also, contrary to what you seem to believe, an employed single person below the official poverty level does not have unlimited access to free healthcare. If they are involved in a car accident they cannot be refused service, but trying to get treatment for strep throat (potentially life-threatening) requires significant money out of their empty pockets. Guess who is coughing streptococcus bacteria onto your hamburger? I hope you're not thinking of countering with "Well, they should get a better job," because, obviously SOMEBODY is required to serve the food. Where would our economy be without McDonalds and the like?

4. There are standards for success other than our (the US) economic status. One of them would be compassion for our fellow human beings, and the ability for compassionate people to conduct business without selling their souls. Our public policy and the type of wrongheaded justification for self-serving ideologies that you (and you are far from alone, as I'm sure you're well aware) have offered are indications that we have a long way to go.

5. I don't know where you get the idea that we are the only nation that conducts important research. It's completely false. Other countries, even those with socialized medicine (gasp!), contribute a great deal to the progress of medicine. And, as I said in an earlier post, having large, for-profit corporations conducting research is just a bad idea. And, again, I will say that we just have to look at the tobacco companies to see what kind of ethics we can expect from corporations.

I'm so sick of hearing these tired, misinformed, illogical arguments. The healthcare issue is extremely important. With new bacterial strains of old diseases coming back (thanks to our overuse of antibiotics), and a shortage of new antibiotics, we could have epidemics of proportions we (those who don't remember polio firsthand) have never seen. You can also, I'm sure, find research on the Web about the epidemiological issues involved in having an under- treated populace. You might want to read it and rethink your stance.

-- Anonymous, June 28, 2000

Any privately-run health insurance company has powerful economic incentives to do the following Bad Things: Market pressure from consumers can't do anything to resolve the first two problems. I can't change my own medical history, obviously. I can't pledge life-long fealty to my insurance company, and if I could, it could give them a different way to screw me.

In theory, informed consumers could deal with the third problem by comparing the quality of competing insurance companies and the premiums that they offer, and then they could pick the risk/reward ratio that they felt most comfortable with. Of course, this would mean that all other factors being equal, the poorer you are, the more risk you have to have to face, whether you like it or not.

A regulated private insurance market might ameliorate these Bad Things (I think that's what the Clinton Administration was trying to do with the "managed competition" that they proposed, lo these many years ago), but I suspect that in order for that regulation to be effective, it would require such a large enforcement bureaucracy, and make competing insurers' terms so close to identical, that we might as well skip the middleman and make the government provide baseline insurance directly.

-- Anonymous, June 28, 2000

What Angie and Seth said.

And a couple other things:

> For those of you who complain about your medical plans in the US, > select the fee for service option and kick in 20% of the costs of your > care.

Jarvis, I'm starting to think you've never worked but for one employer your entire career. Guess what--many people don't get the choice of a service option/PPO. They have to take what options their employer gives them.

Speaking of which, as Angie noted, not every full-time employee is given benefits. Especially in the service and retail industries and in small companies, employees are on their own. And it's not just your local fry-tosser but some people who are pulling down respectable money--most car salesmens, for example, are responsible for providing for their own health care. And just because--by your lights--these people may not have wisely "positioned themselves in life" when it came to career choice, it doesn't mean they aren't dedicated, hard-working professionals, just like you. Oh, and then there's the self-employed; in that case, you're definitely on your own, and obtaining health insurance can be nearly impossible.

> Also, if your primary care provider is unavailable (takes 6 - 8 weeks > to get an appointment), CHANGE your primary care provider for gosh > sakes!

Of course I tried that. As I stated in an earlier (rather long ago) thread, I have absolutely no compunction about dropping physicians like hot potatoes if they aren't up to par. However, as I did already point out in my previous post, many plans will only let you change primary care providers once a year--again, Jarvis, you seem to be privileged to have a better plan and therefore superior to those of us working under different constraints not of our own making or choosing.

But yes, I changed my GP, and guess what? I had exactly the same problem with scheduling appointments with the new one. And then there were the specialists--you wouldn't believe how far in advance the allergists were booked, not to mention the gynecologists. In my experience with HMOs, I've found that if overbooking is a problem, it's epidemic throughout the system. The HMO I was in previously never once had a problem getting me in to see doctors readily--even specialists, even on short notice. Unfortunately, my employer decided to dump that plan.

Seth was absolutely right about the "bad things" that insurance companies are tempted to do. Jarvis, you'd better hope you never develop multiple sclerosis, that you're never in a bad accident and sustain severe brain injuries, that you never have a child born with multiple birth defects or a severe chronic illness--because believe me, you will find out faster than you can blink how horrendous dealing with an insurance company can be and how many lengths the company will go to in order to drop you and your family from coverage. And you'll also find out how quickly a catastrophic illness can affect your finances, and how many people will blame you for your own misfortune. But then, I guess you don't have to worry--no doubt you've positioned yourself in life so that nothing will ever strike you down out of the blue.

General comment: England/Australia/Canada/New Zealand aren't the only examples of socialized/govt. health care; there are plenty of other European countries who have it, some which seem to be working better than in the English-speaking countries. A friend of mine lives in Germany and is absolutely delighted with their system, but I don't know much about the particulars. Anyone out there have any experience with health care in Germany, the Scandinavian countries, etc.?

-- Anonymous, June 28, 2000

Angie,

I appreciate your attempt to educate, but I feel you are the one who is wrong. My health care is excellent and as such I do not want it to change. I can't imagine how moving me to a government managed healthcare system will benefit me in the least. Oh, I am not suppose to benefit, is that it?

Now regarding your post, by point:

1) Yes, incentives are a very large part of performance. One of the biggest reasons our country is so prosperous is that we are not socialized in many aspects. We have a free, mostly unfettered captilistic system that thrives on excellence. Why should we standardize what everyone gets? Look at the former Soviet model if you need an example of how a system void of incentives would turn out. You get a dumbing-down effect ... you get a gravitation to a lower common denominator. Your version of idealogy would sound superior only I could live in a utopia. Public policy should ONLY ensure that people have the same OPPORTUNITY free from unfair discrimination, not that everyone should actually have the same ACCESS. Health care, to me, is a benefit. Not an entitlement. Just because one is in the US and breathes does not mean that I think someone else should have to pay their medical bills.

2) I contribute more than my share for one reason only- people take goods and services that they cannot afford. Now, I am game for providing some charity, but don't you think there are too many folks out there taking advantage of the people's generosity? Insurance costs are inflated due to hospitals/care providers having to inflate charges to cover those who do not pay, and my taxes are so high to cover those whom are provided freebies. I'm not complaining about these facts per se, but I give enough and don't want to ALSO have to give up my good care. What is left of the free market should not be torn down. I have a right to excellence, ESPECIALLY IF I AM PAYING THE BILL!

3) You overly generalize. I know for a fact most full-time workers at fast food rest. have acces to medical care. At the Biscuitville I visited this morning, the sign recruiting employees pointed out you got both paid leave AND medical care.

4) You get to define compassion too, huh? Supporting folks through taxes and giving to charity is not enough. I have to also switch to a medical plan that will be WORSE for me because it is BETTER for others. You call me self-serving, which I do not deny, but please note you are the one proposing changes. And your change is going to impact me negatively. And you act like I am suppose to be OK with it! I am not the one who is complaining. I am mostly just pointing out what is so GOOD about what we have here. Maybe you need to try living somewhere else to fully appreciate what we have here.

5) I never stated that we are the only country doing research. I just know we are the best at it and the most technologically advanced society anywhere. We do more, relatively speaking, than anyone! And why? Because of profit-motivation. Most folks who talk about how giving and generous OTHER folks/companies should be with THEIR money and resources fail to step up to the plate themselves. Style over substance, I guess. And please ... about the tobacco companies. Who in the world believes people did not know smoking was bad for their health. The warnings have been on the smokes for 30+ years. I quit, and anyone else worried about their health should too. i admit, I was pissed when I learned I was smoking formaldehyde because it was a cheap filler, but how in the world can i get pissed because of the nicotene or tar? Evilll corporations sound like a nice scapegoat. Corporations are the ones funding most of the pharmaceutical and medical technology innovations we have been referring too. And MUCH of the research is done in the US because our system fosters advances.

Now we are suppose to provide healthcare to the world? That is the final result of your stance! The drug resistent bugs (especially TB) that is becoming so dangerous is due to the improper use of antibiotics in other countries, primarily. In many places you buy antibiotics over the counter! It is also due to poor health conditions in third world countries where AIDS education and general morals are nil, and where people are starving. The US is not responsible for every US citizen's evening meal or filling a prescription order, nor is it responsible for the whole world's healthcare issue too. We should help ... some.

If you want to help provide better care, contribute to the cause. I am just not going to vote WITH you to nationalize the US healthcare system and thus have to accept less quality care than what I have now. The worst thing that happens in the US is people have to pay for some of their services unless they seek out charity care. Healthcare is available to all, it is just not FREE for everyone.

Your arguments appear to be the illogical ones to me. The success of the quality care available to me is the proof our system is better. I am not special, I just worked hard, borrowed money for school, and am paying it back while saving for my future. Anyone could have done the same in this country with some dedication. I'll be damned if I am going to let my daughter have to endure less than the best I can provide without at least speaking up for my beliefs.

And by the way, I'll compare mortality rates with anyone due to MEDICAL CARE AVAILABILITY. Our system is not failing on the medical side, it is doing quite well. What most people complain about is the red tape or expense. Now, if our mortality rates appear lacking in some ways, I bet THOSE stem from our failed Great Society social programs and abusive domestic situations due to the decimation of the family. Not because Booby Sue could not get a pap smear, or her kids could not get the free vaccines from the health clinic/pediatrician.

-- Anonymous, June 28, 2000

Jarvis, your posts are error-ridden to the point where I would almost think you were a troll, were you not so adamant in your misinformed beliefs. I'll tackle the main one:

If you want to help provide better care, contribute to the cause. I am just not going to vote WITH you to nationalize the US healthcare system and thus have to accept less quality care than what I have now.

If America does move to socialised medicine, it does not mean that you have to partake of it. If your employer provides you with great private health insurance now, the creation of national health services would not hamper that; it hasn't in the UK. As it stands now, the American health care system is either really great (if you're fortunate enough to have an employer who provides you with a great insurance package) or really shitty (if you're unemployed, don't have benefits or have benefits that are lacking). As I said above, my father -- who earns a six-figure salary -- cannot get his private insurance company (which he has through his employer) to foot the bill for arthritis treatment. Yet if he was an alcoholic, his stay at a $1400 per week treatment centre would be free of charge.

That kind of discrepancy of quality is rampant with insurance benefits, and just because the system as it is works great for a very small number of people does not mean that that system is acceptable. A nation as rich and prosperous as the United States of America has no excuse for not providing basic health care free of charge to its citizens.

How do you square your beliefs with regard to health care with other issues -- say, education? Do you think that the government should not provide a free basic education to all? Do you think that it should be left to parents to pay for their child's education and that if they can't afford it, tough shit? I'm interested in your viewpoint.

-- Anonymous, June 28, 2000

You people still don't get it. Whether or not I have to partake in a nationalized health care plan is not the issue. The fact is I WILL have to pay for those who do partake.

In the UK, citizens bring home LESS THAN 50% of thier earned wages.

All of you think about what this means for a second. Are you willing to give up OVER HALF of your income to support those, who for whatever reasons, can not afford the same things we as the working class can?

We do not have to pay this extreme yet, but as healthcare and other social issues are handed to the government to take care of, we will increasingly have to pay!

-- Anonymous, June 28, 2000

Jackie,

Regarding your rebuttal to my post- thanks for your input. I disagree with you, but you are certainally entitled to your opinions. If healthcare is provided as a basic entitlement, why would private companies have an incentive to provide healthcare as a benefit? I dare say what the gov't would provide would be crap compared to what I have now. Any just about ANYONE can have what I have, all they have to do is to go to school like I did. I am currently enjoying my rewards for not getting anyone pregnant before I was married, doing my homework, avoiding arrest, etc. And no, neither the Cleavers nor the Gates were my parents. In fact, I had my share of hurdles too, but I didn't cop out and quit doing what is right. ALso, when I accepted my current job, evaluating the benefits package was a part of my consideration. If my work changes my compensation package, I will reevaluate whether I will work here- I will NOT however, complain about being "stuck" with a crappy plan. It is my choice to continue to live with it.

"How do you square your beliefs with regard to health care with other issues -- say, education? Do you think that the government should not provide a free basic education to all? Do you think that it should be left to parents to pay for their child's education and that if they can't afford it, tough shit? I'm interested in your viewpoint. "

I think people should pay their own way , in general. I do it, and I am nothing special. Specifically regarding education, I think we have a pretty fair system now. Through highschool for free is pretty good (although I am MUCH more inclinded to kick people out of school for poor behavior than our current system does). I think college educations are available these days to anyone who wants it. In fact, I think we have a VERY liberal system. I am not calling for changes, but I think it would be silly to make it even more open than it is. Personally, I believe anyone without mental defects who puts enough effort into an endeavor can grow up to be whomever they want to be. Our current prez was born poor by his own account and made it to the highest office in the land.

I do think that if someone opts to send their child to a private school they should get a tax break for full allocated amount of what would go to the public school instead. Our current education system below that of college level suffers terribly from a lack of competition.

So yes, I think children should be given an education as a basic PRIVLEDGE. However, it is not a RIGHT. If they abuse it, or do not respect it, kick them out so that they are not a distraction to those who ARE there to learn.

I also realize that this is socialized to some aspect, but I am ok with it for public education up to a certain part because it is for the GREATER good. I do not see converting to a government health plan as for a GREATER good, it will only help those who are not providing for themselves.

No, I am not a bleading heart as you can tell, but I have some compassion and help those who I think would benefit from some help. My first priority is to my family though. With over 40% of my pay going to the greater good of society (plus over 10% for church), I have decided I want to keep the rest of what I have as MINE. Namely, I do not want that crappy socialized medicene other countries are currently bridled with.

Any you know too that if you could choose between having that life saving operation in the US's finest hosiptal or in England's finest, you would pick the US's everytime if you are honest with yourself.

FWIW, I also believe in soup kitchens, orphanages, and helping out poor parents with formula for thier children (although breast milk is MUCH better!). I do not, however, beleive in the Earned Income Tax Credit where some folks get back more than they paid into the tax system, nor do I think that every school should have to mainstream those with handi-caps. I also do not believe in lowering standards because some people do not put in the effort to keep up. I think, as I've said before, anyone can do anything they want to with their life. It is just up to them to do it, not for me to do it for them.

FWIW, someone stated earlier in a sarcastic tone something to the effect of I sure hope your have planned for anything adverse that might happen to me. Well, I do too. I have a will, disability insurance purchased outside of work, life insurance purchased outside of work, and good company benefits too. Also, I am saving for my retirement so that the state does not have to support my poorly prepared butt later in life. I resent sometimes having to take care of people who did NOT finish school, did NOT buy insurance, had screwed up babies due to alcohol/drug use/underage/too late in life, etc. People should be responsible for themselves, and try to avoid public help, in my opinion. Everyone these days just thinks they are entitled to things because they breathe. The should have been around 100 years ago. The folks complaining today would have NEVER made it then. And these are MY opinions, since you asked.

I hope you think I am being civil, because I am trying to be that AND honest.

-- Anonymous, June 28, 2000

YASSIR, thanks for posting. I was beginning to think I was the only person with some conservative (and logical) ideas on the net.

I am beginning to think that many folks of different opinions to me just want to share the misery- and are not at all interested in a society that has competition within it at all. Afterall, if you have a winner, you must have a loser.

-- Anonymous, June 28, 2000

Jarvis, I am convinced that you (and your alter ego, 'Yassir') are trolls. That said, I feel some things are worth pointing out to anyone who may be reading his and agreeing with the basis for your beliefs:

If healthcare is provided as a basic entitlement, why would private companies have an incentive to provide healthcare as a benefit?

In order to lure the best employees, for one. Listen to me: I live in a country with socialised health, and companies here still offer private health plans to their employees. Your hypothesis that companies wouldn't offer private health care if a socialised system was in place has been tested in England and other countries, and has been proven wrong.

Any [sic] just about ANYONE can have what I have, all they have to do is to go to school like I did.

Oh, where to begin? Jarvis, I went to school. I am university educated and when I lived in America I worked two jobs and went to university, all at the same time. (Thank God I didn't have kids; who knows how I would have coped.) One job was as an account executive for an industrial supply company, my other job was as a computer specialist/salesperson/office worker for a spa. I worked my ass off both at university and both of my jobs, was either in school or working seven days a week, and yet because of where I lived (in a very rural area of Ohio), I didn't have a job where comprehensive health benefits were on offer. I'm sure it's very uncomplicated for you to think that the world is made up of those who are entitled to privileges and those who are not, and that which category each person fits into is determined by those who meet your simple criteria, but the reality is quite a bit different. I didn't get pregnant before I was married (and still haven't, now that I am wed), I did my homework, I didn't get arrested and I worked harder than most of the other 18-, 19- and 20-year olds I knew. Does that mean that health benefits were automatically handed to me? No. If it weren't for the fact that I was in school and thus still covered under my father's insurance, I would have been up shit creek without a paddle. And still, that coverage was flawed.

As I said, I'm sure you're a troll, but the scary thing is that there are people out there who actually think, like perhaps you do, that because things have fallen into place for them that they fall into place the same way for the rest of the world. I would prescribe a reality check.

-- Anonymous, June 28, 2000

OK, I think Jarvis has made it perfectly clear that he doesn't think the U.S. health care system is in crisis and therefore there's no problem to be solved.

Of those of us who think it *is* in crisis, is anyone interested in returning to the original topic, which was how to fix the system?

And Jarvis, I apologize for the sarcasm. I tried not to let it creep in, but it did, probably because I have very strong feelings about this topic. Despite your disability insurance, etc., however, I still hold by what I said. I've heard too many horror stories from people who were well-prepared as you are, who had health insurance and disability insurance and savings and stocks and ad nauseum, and still found themselves literally counting pennies to buy medication and choosing between that and food. Not because they got pregnant as teenagers, not because they were addicted to drugs or alcohol, not because they failed to plan financially for their future, but because of catastrophic medical problems that were in no way their fault.

Some of these people that I've known, by the way, have put their lives back together and done great things, such as the woman who started a self-help group for others with her condition, a group that now reaches people all over the world and sponsors ground-breaking medical research. She's spent decades helping others and achieving reknown for her work. Yet if you were to talk to her about the bad years, you'd find that she was irrevocably changed by them, scarred both physically and emotionally. She is a good conscientious person, and she didn't deserve what happened to her. I guess my main problem is that I don't understand why you apparently feel that you deserve your particular level of health care but the rest of us don't. You've tried to explain, but I still don't understand, and it seems best to simply agree to disagree and move on to other aspects of this topic.

-- Anonymous, June 28, 2000

on the other hand... Jackie's post appeared before I was done composing mine, and she does seem to have a point. If I just apologized to a troll, shame on me for being so gullible.

Hit... Hitl... Stalin!!!

Seriously, shall we move back to the original question, please?

-- Anonymous, June 28, 2000

Brenda, nice post.

I do not feel other people should not have it, I think they just get it themselves instead of relying on ME to provide it. Not only that, but I do not want my health care quality to deteriorate because I helped them to get it.

Where we disagree is that you think people are not able to help themselves, whereas I think they can. They need INCENTIVES, which so many people fond of socialized program are unable to see. I hope everyone gets good health care, and I even help those who have not gotten it get life saving procedures. If someone wants better, they need to go earn it. Life ain't just the cherries, there are pits too.

-- Anonymous, June 28, 2000

Jarvis-

Yes, you are being civil. Wrong, but civil, for the most part.

I'd like to point out that you have made some incorrect assumptions about me (and probably the other participants as well.) I have a good job. I have excellent insurance, as insurance goes. I pay less than $20/mo. for a decent package with a small deductible and small co- payments. I have had insurance for the greater part of my adult life. I don't generally have much misery to share.

I am not a liberal. Neither am I a conservative. I follow my heart and head issue by issue.

I still want better healthcare solutions for the greater good. If that means I have to pay more in taxes, so be it.

My healthcare opinions were formed during the seven years I worked in hospital pharmacies: one not-for-profit and the other owned by the evil-corporation-that-shall-remain-nameless. I lasted 6 happy years at the not-for-profit and less than one year in the other hell-hole. It's the only job I've ever walked out on.

I don't understand how you can on the one hand claim that anyone who works hard can have what you have, and on the other admit that in a competitive capitalist society there must be losers. Even if *everybody* worked hard we would still need losers, because that's the origin of profit.

I'm not advocating adopting pure socialism. I just think it is wrong to subject people to the cruelty of capitalism when their health is at stake. More importantly, it's unnecessary.

I'd like to address your rebuttal of my previous post, but I think I'll wait and see if my frustration just goes away.

-- Anonymous, June 28, 2000

Jarvis:

Since you think that paying for private health care is so easy, what would you suggest that a retired person with scant (or no) pension, living off of their Social Security and whatever their family can send them, should do when they're faced with health problems which require them to spend hundreds of dollars a month on prescription drugs? I used to work in a pharmacy, and elderly people would routinely come through and take away $600 worth of prescriptions in one visit -- and tell me that it was bleeding them dry, they couldn't afford to turn their heat on because they needed to save for medicine, etc etc etc.

My father-in-law is a retired executive from British Gas; they pay him a pension, as does the government (the UK version of Social Security payments, for argument's sake). If he lived in America, it wouldn't matter how fast he could get in for a heart operation, because he wouldn't be able to afford it in the first place. Life- saving operations are not cheap, and even those who have a comfortable living may not be able to pay for them.

Because of Britain's NHS, my mother-in-law (who died in 1996, and I never met) was able to have the medical care her condition -- multiple sclerosis -- required. With a debilitating disease like that, 24-hour care is mandatory, and while it would be nice if everyone could afford to staff a round-the-clock nurse or had insurance which would pay for a round-the-clock nurse, not to mention the wheelchairs, wheelchair lifts, stair lifts and other expensive equipment, the reality is that many hard-working people aren't in a position to do so. If it weren't for the NHS, my mother-in-law would have had a seriously degraded quality of life, and she probably wouldn't have lived as long as she did.

Those to whom much is given, much is required. From those who live the most prosperous, rich nation in the world, much is required. Perhaps you don't like the idea of paying taxes to fund health care for the poor, elderly or otherwise disadvantaged (and their children). You know what? I don't like the idea of all the federal taxes I paid to cover the cost of Bill Clinton's impeachment, the Elian Gonzales debacle and the funding for Hillary Clinton's campaign- related travel. I didn't have a choice in that, and neither did you. But given the choice, I know that guaranteed health care for everyone is the most worthwhile thing on which my tax dollars could be spent.

-- Anonymous, June 28, 2000

I do not know what this troll crap is, but I will make a couple of points and then leave you to a debate that will be only academic, because this country will NOT go to socialized medicene if ever, for a very, very long time.

First, I am not Yassir. That is what calling Yassir my alter-ego means.

Second, why would the US want to model itself after England in ANYTHING? Your faciilites are not as good as ours. Plus, I do not see where you have any interest in this debate since you do not even live here! It's good you like what you have, and I am not interested in changing your system. So, please do not try to raise MY taxes for YOUR causes.

One parting shot is that you need to be more friendly when people do not agree with you. I think you are much more rude than your nation is known for- you know, that old English manners crap.

And lastly, if you were working 2 jobs and going to school, I do not see how one of them could have been a fulltime position. Good benefits usually go with full-time work status.

-- Anonymous, June 28, 2000

Jackie-

Trolls, eh? I'm new to this: What is the proper response to trolls? What makes you think Jarvis is a troll? And am I correct in assuming that a troll is someone deliberately trying to rile people up?

Yes, I know I'm an ignoramus, but please fill me in?

-- Anonymous, June 28, 2000

oh god, Jarvis is a newbie, or at least posing as one...

Before you start lecturing Jackie about being rude, Jarvis, perhaps you'd be interested to know that in netiquette, writing words in all caps is considered to be the equivalent of yelling at the top of your lungs and is thus extremely rude. I've been making a point of ignoring it until now, but if you really honestly didn't know this, you ought to, especially before you get on anyone else's case about manners.

-- Anonymous, June 28, 2000

Jarvis, I am American. I've only lived in England for about three years. I've experienced both health care systems, and I know which one works better. I know which one I'd want my parents, grandparents and other relatives to live under. I know which one I'd want my children to live under. I know which one I'd want to live under when I get old. A health care system which provides basic, life-saving care for all, yet still allows private insurance schemes to thrive -- like here, in the UK.

Now, do you have an actual answer to my above question about what you recommend for the elderly? Please, I'd love to hear you make a case for no socialised health to the old people who cannot work a job that gives them the benefits others have. I would have liked to have such an answer handy for the elderly people who would tell me, with tears in their eyes, how much they and their spouse sacrifice (heat, electricity, hot water, food, other medical care) because they pay through the nose for prescriptions every month. What would you have said to them?

And as to the irrelevant matter of my jobs: I worked 40 hours a week as an account executive, went to school five nights a week and worked all day Saturday and Sunday (and government holidays) in the spa. Both of my employers were small businesses, which can't always afford to provide full health and dental benefits to their employees.

Not that it's of any import to you or this discussion.

-- Anonymous, June 28, 2000

Speaking of prescriptions, and in the interest of returning to the original challenge...

The first step toward a real solution to the healthcare crisis is cost control. The first targets for cost control should be pharmaceutical companies and medical suppliers. The second target should be for-profit hospitals.

Socialized medicine can then be implemented at a much lower cost to tax payers than if we were to skip the cost control part.

As a small example of the type of cost control that is necessary:

Pharmaceutical reps used to bring food and odd little "gifts" to the hospital pharmacy where I was a technician. I used to keep a journal of what the reps brought: I've since lost the journal, but one incident stands out.

The manufacturers of an oral anti-fungal medication took a group of pharmacists to a steak dinner and a golf outing for promotional and "educational" reasons. I shit you not.

Here's the rub: The primary use of the medication was prophylaxis in AIDS patients who are at risk of secondary infections. The tablets cost $40 each. Now, 1) AIDS care is expensive and under-insured so an extra $40 a day is a big deal. Were steak and golf the most ethical use of the company's resources? If they really had extra resources shouldn't they lower the cost of the medication? and 2) It was the *only* medication of that sort. Why did they need to promote it at all?

-- Anonymous, June 28, 2000

Angie wrote:

. Were steak and golf the most ethical use of the company's resources? If they really had extra resources shouldn't they lower the cost of the medication? and 2) It was the *only* medication of that sort. Why did they need to promote it at all?

Well, in answer to your first question, if the steak dinners were working (i.e. they were encouraging physicians to prescribe the medication) then that supercedes the ethical point about lowering the cost of the medication. Pricing of drugs (especially AIDS drugs) is an extremely complicated process, and I think the it is often incorrectly assumed that expensive drugs necessarily generate huge profits for the companies that sell them. It is very expensive to develop and test a new drug, and AIDS drugs have a relatively small potential market (as opposed to medications for allergies or depression or other common illnesses). Maybe the drugs would cost more than $40 if they weren't generating extra business through their promotions.

And, in response to your second point, all new drugs are advertised, even if they are unique, because if doctors don't know about them, they can't prescribe them!

But, I think that all of this does point out the inherent conflict of healthcare as a for-profit industry.

-- Anonymous, June 29, 2000

The list of powerful, effective drugs produced by for-profit American and European companies is very long.

The list powerful, effective drugs produced by governments is very short.

As someone who fears any kind of surgery, I WANT the drug companies to make high profits. The higher their profits, the greater the competition and the greater the incentive to perform research.

One that that is interesting is that the high profits the drug companies earn in the U.S. effectively subsidizes patients in other countries who have price controls on drugs.

If the U.S. ever institutes price controls on drugs then development of new drugs for the whole world will slow way, way down.

-- Anonymous, June 29, 2000

Somebody called Yassir said: All of you think about what this means for a second. Are you willing to give up OVER HALF of your income to support those, who for whatever reasons, can not afford the same things we as the working class can?

Yes, happily. Today I might be the one in the position to earn the money and help somebody else out, but tomorrow I might be hit by a bus and left brain-damaged, in need of constant care. Who will provide for me?

I think it's foolish and complacent to think you'll always be the provider, and never the one who needs the help. If you live in a modern society you have a responsibility to help your fellow man, and if this is a problem you should probably head for the nearest cave and become a hermit.

-- Anonymous, June 29, 2000

I don't think Jarvis is a troll. The Net is full of hard-core libertarians who resent any government attempt to "take" what they've "earned".

Just think of all the ways in which government interference with The Free Market(TM) in the US benefits (certain segments of) the middle and upper classes:

Oh, shame on me, I forgot to close a tag. Let's see if this prevents all future postings in this thread from being indented....

-- Anonymous, June 29, 2000
Jim wrote:

I>The list powerful, effective drugs produced by governments is very short.

That's because our government isn't in the business of producing drugs! If government-funded researchers (of which I am one) develop a new treatment, the rights are then sold to a drug company, which has the resources to distribute and market the drug (see this site: for many examples of this).

The government's failure to produce drugs is about as meaningful as its failure to produce a monkey with four asses.

-- Anonymous, June 29, 2000

Well, I refuse to be a single-issue voter, but it troubles me that the most powerful nation on earth can put a man on the moon, but we have yet to produce a monkey with four asses.

On the related point of health care, does anyone think it might reduce health care costs if there were more doctors? Or is the restricted number of doctors a good way to maintain high quality in health care?

Full disclosure: As a member of a profession that has been overcrowded to the point of suffocation (law), I slightly resent my physician friends whose professional association, the AMA, has taken protective measures to prevent overcrowding. As a result, doctors in rural areas still make near-six figure salaries, and I envy them. If I could do that, I'd be living in the countryside tomorrow.

-- Anonymous, June 29, 2000

Jen,

Thanks for your intelligent response to my post.

While I agree that physicians need to be made aware of the existence of new treatments, I believe there are more cost-effective methods to achieve the same end. Medical journals and mandatory CE, for example. This raises another systemic problem: why should any physician have to be bribed (for lack of a better description) to learn about the most effective treatments for their patients? They are busy people, but is that not their job? I have to say, if they don't have time to read product literature, they shouldn't be taking the time to play golf with drug reps.

And while I admit that I don't know the specifics of the budget for the particular med that I mentioned, I maintain that enormous profits are being made within the same company and industry. The argument you brought up is undoubtedly true in some cases. I don't believe that we should accept that argument across the board. It's often the case that large corporations offer a perfectly valid justification for high costs, or objectionable policy, and then fail to admit how infrequently the justification applies to actual instances. If it were truly difficult to make money in the healthcare industry, the corporate folk would abandon ship.

I'd like to add another suggestion to my attack upon the pharmaceutical companies: No more TV advertisements for prescription medication. Well-informed physicians and their patients' needs should drive pharmaceutical sales--not advertising. I certainly hope that firm and wise doctors everywhere are refusing to prescribe "impulse drug buys." I am especially offended by the Rogaine commercial which implies that male pattern baldness comes from the paternal genes and not the maternal genes. Apparently, the Rogaine manufacturers decided that the actual target market was too small.

Definitely, there are problems inherent in for-profit healthcare corporations. I say let's make 'em all not-for-profit, including the manufacturers of healthcare goods. Sigh. I'm well aware this will never happen. Too bad, because it attacks the healthcare crisis from both the cost and the quality angles.

-- Anonymous, June 29, 2000

I was told about eight years ago that there was actually an oversupply of doctors in the United States - and they've managed to keep their incomes high. The fact that most of them don't want to go off and be GPs in the countryside is a separate problem.

In Eastern Europe the typical doctor is a woman, paid very poorly by the state, who treats friends and neighbors for free or barter after she gets off work. The sense of entitlement that American doctors stereotypically have really isn't so common elsewhere.

-- Anonymous, June 29, 2000

Jen wrote:

And, in response to your second point, all new drugs are advertised, even if they are unique, because if doctors don't know about them, they can't prescribe them!

I thought that medical journals existed to inform doctors about new developments. Obviously it's more complicated than that ;)

-- Anonymous, June 29, 2000

Angie, I don't think anyone ever answered your query about trolls. Yes, you pretty much hit it on the nose with your definition.

Re drug companies, Jen and others have made some good points about the necessity to woo physicians and charge high prices, but overall I think the American pharm. companies are out of control. Case in point is that when the same medication is used for both people and animals, they regularly hike the price of the "people" medication astronomically higher than what the same medication costs pet owners. I can't see why they would do that except sheer profit motive and price-gouging.

The courting of doctors to use a particular medication is also disturbing when a doctor then becomes so enamored of the drug (or so beholden to the company?) that s/he presecribes it exclusively. One trick I learned from my asthmatic partner is to always check a physician's office (especially specialists) for freebies from drug companies: pads of paper, clipboards, calendars, etc. with a particular drug's name emblazoned on it. In some cases, you may find that the doctor tends to push the use of this one drug or this company's products. My S.O. has had new doctors try to change his meds for no good reason--except he noticed that their office was full of goodies advertising the medication they were trying to prescribe to him. Since I've started paying attention to this several years ago, I've also noticed it in a few cases.

Why is this a problem? Well, even very similar drugs can react differently in different people or be more suited for specific illnesses. Different antibiotics work better for different types of infection, and some people might have adverse reactions to erithromyacin (sp.?), say, while being fine on ampicillin. But if you've got a doctor who's prescribing medications primarily based on who's courting him/her the best, that doctor isn't necessarily working in the patient's best interest. Of course, this is partly a problem of the doctor being unethical or unprofessional, but the fact that pharm. companies are allowed to court the doctors like this greatly increases the possibility that some doctors are going to respond in this way.

There was a story concerning drug trials in the New York Times about a year ago that really bothered me (I think it would be on their website's archives for anyone who's interested in trying to find it; Gina Kolata was the author but I don't recall the title or exact date). The major drug companies have been offering doctors monetary payments for each patient they enroll into research studies sponsored by the drug companies, typically $1500-$4000 per research subject enrolled. The reporters found that the companies were targeting general physicians, who were often enrolling patients who because of certain medical histories had no business being in the trials.

The story also reported that the companies were having the doctors participate in running the studies (for additional compensation, of course) with little regard for their expertise in certain areas--for instance, one company put a lot of pressure on a psychiatrist to take part in a diabetes study even though she didn't feel comfortable treating patients with diabetes because it wasn't her field of expertise. As I remember it, this doctor finally refused, but there were documentated cases where other doctors had not, largely because of the financial incentive offered by the drug companies.

If government control of the drug industry--or at least reinstituting tighter regulation of the industry--would reduce such abuses, it would be worthwhile, IMHO.

-- Anonymous, June 29, 2000

hmm, I guess I should suggest my parents (both retired) should not visit Canada for inexpensive medications, but instead try the local veternarian when they take the dog in for his shots.

-- Anonymous, June 29, 2000
A few random comments:

1) Drug companies are owed by their shareholders. If you are shareholder and you don't like the way the drug company promotes its product you can :

a) complain to management at the next stockholder meeting. b) Get together with enough other stockholders and vote out the management, vote in your choice of managers who will manage the company in accordance with your wishes. c) sell your stock.

If you do NOT own stock in a particular drug company, and you dislike the way they promote their products you have two choices: a) don't buy their products b) SHUT THE F*** UP and start your own company and run it however the heck you please.

The drug companies are doing something right. They are producing one miracle drug after another, and they are making record profits doing it. Those two facts are tightly coupled.

2) Here in Austin (the state capital of Texas) it is open medical insurance enrollment season for State workers. The radio is full of ads from different insurance companies trying to sell their insurance products to these government employees. Wouldn't it be nice if these ads were trying to sell to everyone??? All that is needed is to put the working people who need insurance into a purchasing group.

3) Here in Texas we just this month stated a program to provide low cost health insurance for kids whose parents make up to 200% of the poverty level. If I understand it correctly (someone please correct me if I'm wrong) the state contracts with an insurance company to provide this insurance. The rates are very low because the group is very large, and kids are good insurance risks. The state pays for the administration of the program, but the parents pay for the actual insurance. I like this a lot, all I hope is that they can offer the parents more than one choice of insurance provider (as the state does for its own employees). This is a real world example of what I think would be the best solution for providing insurance for the general population of the United States.

-- Anonymous, June 29, 2000

Jim wrote: If you do NOT own stock in a particular drug company, and you dislike the way they promote their products you have two choices: a) don't buy their products b) SHUT THE F*** UP and start your own company and run it however the heck you please.

Oh c'mon, Jim, how am I not going to buy their products? All of the major companies are a problem; it's not like I can go to a competitor who's not doing the same thing. And despite all the advances in "miracle drugs," there are still situations where only one drug is available for a particular use. (Please don't insult my intelligence by telling me this isn't true; I've been on one, and it was still in experimental use at the time. For that matter, how many options are there to AZT? Do you see any competitors selling knockoff brands at deep discount? I'm not going to even get into how drug companies *limit* competition and free markets by patenting drugs and ruthlessly going after copycats, even in impoverished Third World nations where the copycat version is all most patients can afford.)

Sure, in most cases there are a variety of drugs available for a condition (ulcers, high blood pressure, migraines, whatever), but quite frequently individuals don't respond the same to these different brands. Case in point, my dad's doctor had to experiment with various high blood pressure meds for over a year before finally finding one that (a) kept his bp under control (b) without unacceptable side effects.

Would you really, honestly suggest that someone who disagrees with the drug company's practice simply stop taking the one medication that works for them? It's not exactly the same as refusing to drink Coke or boycotting Denny's. "Oh gee, I don't agree with this company, guess I'll stop taking my insulin." I really don't think so.

And that's the same reason why we the patients--the consumers--do indeed have the right to have a say in the actions and policies of these companies. People's health--frequently their very lives--depends on these products.

-- Anonymous, June 29, 2000

Jim,

Swearing and yelling? What, do you own stock in a drug company?

Limiting business practices that are in complex ethical territory is not unprecedented. Drug reps have to follow strict guidelines when they enter medical research facilities. We don't allow tobacco and liquor commercials on television. All I'm suggesting is applying the existing standards more stringently.

As Brenda pointed out, consumers have a right to demand ethical treatment when their health is at stake: I would also add full disclosure.

What "miracle drugs" are you referring to? Just curious.

-- Anonymous, June 29, 2000

Jim said: All that is needed is to put the working people who need insurance into a purchasing group.

It's a good idea that's available in Calif. I've been part of one for 5+ years, and get Blue Cross HMO and dental insurance for around $200/ month. While I consider that a reasonable amount [and it's partially deductible since I'm self-employed], there's a large percentage of the population who simply can't afford it. What are they to do?

As for "miracle drugs":::::I consider the newer generation of anti- depressants [Prozac, Wellbutrin, Zoloft, Effexor, etc.] to definitely fall into that category.

-- Anonymous, June 29, 2000

How about this guys: You can have cheap price controlled drugs as long as they were on the British NHS formulary on January 1, 1990. This will get you the most common drugs whose patents have run out.

Of course if you are too old to be useful then you won't mind if your access to expensive treatment is cut back.

I didn't say drug companies shouldn't follow the law, but I do say that if you don't own their stock then you have no business complaining that YOU don't "like" the way they choose to invest their stockholder's money.

The reason you have these new and experimental drugs available is BECAUSE OF THE HIGH PROFITS EARNED BY THE DRUG COMPANIES. Not for any other reason.

To the extent these new drugs are available at all in England, Canada, France, Australia and all these other utopias is because of the relatively free market we have in the U.S. The day the U.S. price controls drugs is the day research and testing of new drugs comes to a screeching halt.

-- Anonymous, June 29, 2000

Jim wrote: "I didn't say drug companies shouldn't follow the law, but I do say that if you don't own their stock then you have no business complaining that YOU don't "like" the way they choose to invest their stockholder's money."

Jim, does this apply across the board? If I don't own stock in an oil company, I have no right to complain about how much it costs lately to fill my gas tank? If I don't own stock in Microsoft, I have no right to complain about their antitrust activities or their lousy bug-ridden software?

No, I think I do. First of all, it's called free speech. Second, companies should always pay attention to the feedback from their consumers if they want to stay in business. The particular nature of the products sold by the pharm. industry, as I already pointed out, makes it somewhat more difficult for consumers to protest with their pocketbooks--but I would hazard that to some degree that's what's happening when people like Cory's parents cross the border to get cheaper drugs.

Jim also wrote: "The reason you have these new and experimental drugs available is BECAUSE OF THE HIGH PROFITS EARNED BY THE DRUG COMPANIES. Not for any other reason."

Whatever happened to scientific inquiry? What was Newton's profit margin? Whatever happened to the desire to help others and contribute the general good? Was Jonas Salk driven by capitalistic greed?

People have searched for new and better ways of treating illness since prehistoric times. I don't think that quest is going to come to a screeching halt if the pharm. companies are forced to be more reasonable in their pricing.

-- Anonymous, June 29, 2000

Of course if you are too old to be useful then you won't mind if your access to expensive treatment is cut back.

Ummm...What?

And as for your first point: I think you misunderstood the patent issue. The problem is that the patents don't just extend the length of time it takes to pay for the research and make a tidy profit. Also, drug companies often step up their aggressive marketing tactics (to which Brenda and I have both stated our opposition) for drugs when their patent is running out.

The reason you have these new and experimental drugs available is BECAUSE OF THE HIGH PROFITS EARNED BY THE DRUG COMPANIES. Not for any other reason.

I believe that there are plenty of people who would be willing to work for reasonable salaries to further the health of the public and to satisfy their own particular talents and interests. And if there are not...No, I'm not even going to go there...it's too depressing.

-- Anonymous, June 29, 2000

Are the suggestions, that that our only two choices are between socialized drones who fulfill their underpaid and average government quota of healthcare, then hurry home to their middle-income homes, or profit mad companies who cut costs by working everyone harder with less material and selling to the highest bidder, while cutting out the poor and inconvenient customers when they can find loopholes in regulations.

That's a dreary picture either way. I'm not interested in either as a solution. And no sane person would think so either I think.

Healthcare is not (to me) a faceless government accounting job done mediocre, nor a high profit (sell the Mercedes and BMWs to those that can afford it) and the rest be damned with Yugos type affair.

Surely there is both a socialized humane and adequate compensatory middle road.

-- Anonymous, June 29, 2000

Ha! I see that Brenda and I are becoming a little too redundant, and posting at the same time.

I will happily bow out of the discussion :)

And I never even mentioned the forbidden dictator...

-- Anonymous, June 29, 2000

Yassir said:

"In the UK, citizens bring home LESS THAN 50% of thier (sic) earned wages".

Really? Where do you get this information?

not here... http://www.inlandrevenue.gov.uk/faqs/questions/q2.htm

I agree with Jackie on the British NHS issue - she would appear to be the only person here qualified to to make a legitimate comparison

-- Anonymous, June 29, 2000

Louise is right, Yassir is talking complete tripe about how much money we in the UK take home. I take home 67% of my earnings, and it would be an even higher proportion if Sharesave scheme money and my monthly season ticket loan repayment weren't already deducted.

-- Anonymous, June 30, 2000
Jim wrote:

The reason you have these new and experimental drugs available is BECAUSE OF THE HIGH PROFITS EARNED BY THE DRUG COMPANIES. Not for any other reason.

I'd say that this is half-true. It's totally true in the case of drugs that are developed by drug companies. But in fact, a very large number of drugs are developed in government-funded labs and then licensed to pharmaceutical companies for distribution. As long as there are private drug companies, it's true that there will be a need to keep prices relatively high in order to keep the shareholders happy. That's why I don't think private drug companies are such a great idea.

-- Anonymous, June 30, 2000

On take home pay overseas and other thoughts which are not liberal friendly and are wandering in nature ...

I dare say take home pay would be somewhat less in these foreign utopias if they were as open as the US is with who it allows into the country and and the services provided to those who get in to the country. We are a haven for immigrants, and do not only allow those in who can be productive members of society. We limit more in regards to numbers than skills (although some areas we limit regarding skills too)

And I'm not just putting this monkey on the back of immigrants, because on the whole this country is where it is today because of immigration, especially the positive growth of this country! It is just that many people who migrate here are doing so because where they come from is a tough place to live, and they are moving to make a better life. It is hard to get going in a stange place and get on your feet. This is one of many factors why comparing our gov't services offered to the people to that which other country's provide its residents puts the US on a different playing field.

However, it is indisputable in my mind that this country has the largest percentage of folks dependent upon the welfare of the state due to lack of motivation of segments of the population as anywhere in the world (much of it is due to the exploitation of an entire group of people in bygone days). We are already paying SO much money to help support those who won't help themselves, who can't help themselves, and foreign people of the world who need help to resolve their conflicts or feed their people that our tax rate is already inflated. And, social security still might be the death of us because so many people are slotted to take out more than what they ever put in, and our gov't is currently spending the surplus!

Some folks just do not want our taxes inflated more, and I am one of them. In addition, some folks see the role of gov't as something to limit, and not to encourage. We who feel this way believe the government is an expensive administrative organization that does not maximize its resources and is prone to feel good measures. I would rather have my liberty and rugged individualism than to feel like I am always being "shaken-down" so that what I have can be given to someone else, someone whom I also feel is not even appreciative, but instead see this gift as their right to have.

If I can retain my access to quality care, and not have MORE money come out of my pocket, i could consider changing my position on gov't healthcare. However, I really believe the dynamics of our melting pot culture and the size of our welfare society and the generosity of our nation, in general, would not allow BOTH of my conditions to be met. I am skeptical that a nation who has so many takers living in it with such corrupt officials and officials with such self-serving interests could put a program in place that takes 1/8 of our GNP under its control and not screw things up royally. Maybe THAT is really my biggest problem. Government is just not an effective administrative entity, in my opinion, and I am inherently distrustful that it can do things truely for the greater good in a cost effective manner.

So, in my mind, government is rarely the direct answer to solve individual people's problems. People need a pride in themselves and what they have that cannot be earned any way except through their own actions.

Jim had some good points too that many of you just completely ignore. The companies whose policies you want to change are privately owned and are doing good work that would not be getting done had they not taken a risk to find that new drug or build that new machine. And for every drug they get approved for the market, there are probbaly 99 that never make it. All of these moneies must be recovered. Advertising is likely a very small cost of the successful rollout of a drug when compared to all of the R&D cost to get that drug on the market, factoring in the research failures.

I know it makes many of you feel good to say we should take care of all these people, but when a majority of people are not helping out the burden is great on those who do. I see all of the freebies and this cradle to grave mentality as an enemy of a healthy nation. It sure is destroying a lot of citizens in the US already. I am VERY wary of giving things away so that in just one more instance the government is saying don't worry about it people, we will take care of all of your needs.

An intersting note: on NPR earlier this year, I heard for the first time in the US's history (and I bet for any country ever, really), more people in the US do not pay federal employment income taxes as opposed to those who do. OF course, this does not apply to FICA. But isn't that scary to any of you? Those who do not pay federal income taxes out number those who do? The takers are getting a bigger foothold than the providers these days. I swear, Atlas Shrugged is becoming a realtity. Ayn Rand's vision scares me to death.

On a more constructive note, group purchasing power for those who want to participate is something that might work well to getting more privat einsuracne coverage to the poeple. It must be hard to organize a plan that meets all of the all-inclusive terms so many on this board want it to incluude, but could go a long way in helping out if the government took whatever funds it currently is spending on healthcare and supplemented some big national private fund that is used to pay medical bills. Of course, I bet some services would have to be not covered, and the latest greatest pills might not be covered, but at least it could probably provide as good as care as what these advocates for nationalized health plans are holding up as examples. The more choice we take out of the options, the less cost it would be to provide medical care. Also, we could recognize serious savings if we revised tort law so that people could not sue and get crazy sums of money from lawsuits. $50 million to a 60 year old widower of a woman who smokes for over 40 years is ridiculous! I read that based upon a Wisonsin study of healthcare costs at hospitals, over 25% of the cost of services provided goes toward insurance liability costs, and (separately) around half the folks out there do not pay their bills! Maybe some reform could be beneficial after-all, of course my first thought of not providing care to those who cannot afford it would be wildly unpopular ....

That is mostly a joke, but it does illustrate that this is still a generous society ...

Lastly, thanks to all for not taking more pot-shots at me yesterday. This is a forumn that is to express opinions and share thoughts, this is not a senatorial debate where what is decided is going to change anything. I'm not holding back what y'all would deem progress all on my own. However, like it or not, more people believe as I do than as you do in this country, or we surely would already have what some of you are advocating (freebies for all). Although, the numbers on my side are probably declining as rapidly as those who pay any net federal income taxes ...

-- Anonymous, June 30, 2000

Jarvis says in one of his posts, "Health care, to me, is a benefit. Not an entitlement."

I'd rather think a 'minimum' standard of healthcare for all is an "entitlement" in my perfect world. Even if it's not in yours.

Almost every other "benefit" I'm willing to deny individuals if they can't or won't pay for it, but healthcare just doesn't fall on 'that' list.

And I'd certainly be willing to divert healthcare dollars to more minimal needs of many individuals than making sure that the latest greatest drug goes on the market, or a new multi-thousand dollar cardiac surgery gets developed.

It's not that I don't think we need reform -- but the last resort for reform is denial of service if that's what you might imply.

(when you consider everyone from your dry cleaner, to your hotel maid, your garbage collector, and people that fill potholes in front of your house -- I would ask what portion of their income do you think it takes to have the sort of medical insurance you have? Or perhaps they can sacrifice the luxury of 15% for retirement, or the 10% to the church so they won't burden you with excessive taxes! Do you think you can function in society without all these service workers? -- some how I doubt it -- and nor would you probably agree to salaries they would need so you could save on your insurance and taxes)

-- Anonymous, June 30, 2000

interesting points, cory.

I would doubt that there are many persons working for an insurance company or government agency that did not have reasonable healthcare opportunities. Of course, i get the gist of your point.

I guess I too would rather see much of the current dollars spend to help folk get medical coverage than for the museum of corn history being built in kansas, the saving of the habitat for snail species #1067, or the 1.5 million dollars it cost to mainstream 10 handi- capped students in Memphis. I just suspect that there would be people out there who would disagree there too. We all want so much good for so many that it is unreasonable for it all to be done. Then the question is ... what will be cut?

On the whole, I agree with you though. I would rather it were different too. It's nice to think everybody can be a winner.

Your point reminds me of a single co-worker of mine, though, and I'm not sure why right off hand. She did not opt for medical coverage when she started work here because it "was a waste of money. I never get sick." Well, other than colds and sinus infections, that is true. Until last December where she got pregnant. She scrambled to THEN get coverage, believing medical coverage was her right. I'm not sure how it's going to work out, other than I've been told that if our company here can't get her enrolled, she thinks the government will pay for her baby since she does not have coverage. This poor planning individual is NOT the type of person I want my tax dollars to help, and if I know one it just makes me wonder how many folks out there put themselves into bad positions ... and on top of THAT, she still smokes and drinks ... sounds like expensive choices to me ...

oh goodness, i ramble like that Jack guy ....

-- Anonymous, June 30, 2000

This poor planning individual is NOT the type of person I want my tax dollars to help, and if I know one it just makes me wonder how many folks out there put themselves into bad positions ... and on top of THAT, she still smokes and drinks ... sounds like expensive choices to me ...

The thing is, though, she's not the one who's going to suffer the most for her poor planning and, thus, lack of medical coverage. What about her baby? Should a child suffer because of their parents' negligence? I don't believe that they should.

-- Anonymous, June 30, 2000

I agree Jackie. I would lobby to add the baby, but not the Mom! So, she pays for the delivery, but all well child visits/doc care for baby are covered. Sounds fair to me.

I just hate letting people off the hook. ;-)

-- Anonymous, June 30, 2000

While I don't believe that they will actually change Jarvis' or anyone else's minds, I'd just like to add a few things, for the record.

My family was in good shape, financially, and with insurances, until a vicious situation came about where my parents and I all lost our jobs and our insurance. I was 21 at the time.

What was I to do next? I began working full-time, once again, for McDonald's, while I attended my local community college (at my own expense), while assisting my parents with the bills since they were having trouble finding meaningful employment. Our community colleges here offer a health insurance, sure, but at the cost of over $100/month for *hospitalization* costs, where no health maintenance were covered. Sure, I could have paid for private health insurance, at the tune of $150/month or more... but how was I to afford that when we were trying to cover the mortgage, and other basic survival costs? So I had no health insurance.

Fast forward all the way to 1997. I was managing a gas station full- time plus, and going to school full-time at a university. Yes, it's amazingly true--I was a full-time *manager* and no health care was offered. According to some people, that made it my fault that I had no health insurance, because I should simply have gotten another job. I'm not even going to get into the many reasons that was not, and should not have had to have been, an option.

Summer, 1997--a man ran a red light and crashed into my car. Our state is a "no fault" state, so my car insurance was responsible for my costs. I paid extra car insurance since I had no health insurance. My car insurance company sent me to one of their doctors, who amazingly enough said there was nothing wrong with me and so they ended all treatment.

Remember that I still had no health insurance, and had already planned to quit managing the gas station because they would not work around my school schedule (see, here I'm trying to explain that I was trying to get myself into such a situation that I would be able to afford insurances and to give 10% of my income to my religious organization...), so I was not given anything for time off of work. Because of the collision, I was not able to either stand or sit for long periods of time.

Fast forward to February 1999, 19 months after said collision. The pain had progressively gotten worse and worse, and I did not have the hundreds of dollars to go to a doctor. I made too much money to be considered for the state health care for "poor" people. The disk in my back had herniated to the point where I was stuck in bed, on many narcotics, for over two months. I had to borrow money from friends to get the pills I needed, and I did not have access, before getting an attorney, to the MRI I needed. Even after I got the attorney, and finally got to some health care, I was told that while surgery was my only option because of how severe the problem had gotten, I could not have the surgery unless I could put down a $10,000 deposit!

(I know this has been a really, really long post, and I do apologize.) My family begged and borrowed, and we set a surgery date. Miraculously, through some screw up at the hospital, we didn't have to put the deposit down.

The pain was worse than anything I can ever, ever imagine, so I nearly died, because I did not have health insurance.

Life is better (much better) now, and yes, I have access to a HMO. I am blessed with a fantastic doctor who will refer me when I need a referral. My father's doctor (through a different HMO) has now refused to refer him any more to a neurologist, despite the brain lesion and epilepsy he has. My father can only change PCPs once a year.

So--do I believe in some kind of socialized medicine? Hell yes. I don't know enough to know what kinds of solutions would work, but I know that in the richest country in the world no one should die or nearly die from being in the upper-lower class, or lower-middle class.

Oh, and that "welfare" medical treatment? I know people on that... and they've been misdiagnosed, not given the treatments they've needed, and emotionally abused by their physicians, and they have no options of changing physicians--so please don't think it's a great system for the poor people, either. There *has* to be something better out there.

-- Anonymous, June 30, 2000

Jarvis, I'd like to ask you something, and I hope you won't take it as a personal attack. I think it's relevant given your recent statement concerning immigrants and your previous statements indicating that the opinions of residents of other countries aren't applicable in this discussion. But if you see this as too personal, please feel free not to answer.

Judging from your writing style, it seems highly likely to me that you are a non-native English speaker. Over the years, I've taught and tutored numerous ESL students, and I live with a non-native speaker, so I'm very familiar with the hallmarks of ESL writing. Your phrasing and the type of grammar mistakes you make are typical for people who learned English as a second language and are highly atypical among native speakers. My guess is that if you were indeed born in the United States, English was not the primary language spoken in your home when you were growing up. If I'm correct in this hunch, I'd be curious to know where you're originally from, how long ago you came to the U.S., and what the health care situation is like in your native country.

More generally, concerning the costs of government-funded health care, one place we could easily find the money is to end the practice of corporate welfare. I would vastly prefer to see government monies taken away from large corporations such as ADM than from poor people--even if those poor people do sometimes make bad health decisions like smoking and drinking (just as many other people who are more well-off make similar decisions).

Also, I think it's clear that the major pharmaceutical companies are garnering huge profits, hand over fist. Quite a bit of this money is going to CEOs rather than being channelled back into R&D or advertising. To wit, these statistics for total CEO pay in 1999 at some of the major American pharmaceutical companies, courtesy of Executive PayWatch's website:

-Abbot Laboratories, $4.38 million in salary, bonuses, and other compensation, plus $11.89 million in stock option grants.

-Bristol-Myers Squibb, $31.42 million in salary, bonuses, and other compensation, plus $8.32 million in stock option grants--almost $40 million combined.

-Eli Lilly, $1.08 million in salary, bonuses, and other compensation, plus $1.14 million in stock option grants.

-Merck, $6.03 million plus $20.39 million in stock options.

-Pfizer, $15.15 million plus $23.82 in stock options--again, almost $40 million combined.

-Pharmacia & Upjohn, $2.36 million plus $2.67 million in stock options.

-Shering-Plough, $12.50 million plus $6.01 million in stock options.

-Warner-Lambert, $16.48 million plus $5.57 million in stock options.

I admit that these figures aren't out of line when compared to the salaries commanded by other CEOs of large corporations--but I do contend that the figures belie any suggestion that the pharmaceutical companies are ploughing all their profits back into advertising and R&D. I also contend that these CEOs are making their money off the suffering of others--those grandmothers who have to choose between the electric bill and their heart meds, those organ-transplant patients who have to choose between food and anti-rejection drugs, etc. No one has an ethical right to make this much money by placing exorbitant prices on products that are *essential* to people's health.

Oh, and could we please have less yelling on this list. Those of you who--like me--don't have the option of using italics on your computer to emphasize something, please use the asterix key rather than all caps. Or at least only put stuff in caps if you really, really want to yell, so the rest of us can tell the difference.

-- Anonymous, July 01, 2000

Brenda:

to italicize put at the beginning of the phrase, and at the end of the phrase.

-- Anonymous, July 02, 2000

Joy, I'm sorry, but I'm not following you. I'm working with an older browser, which may be the problem. When on the Internet, I don't have ital functions on my toolbar, and hitting ctrl-I causes text to indent rather than italicizing it.

-- Anonymous, July 02, 2000
Brenda, in answer to your italics thing, what Joy was trying to tell you is that you can use italics by putting <i> at the beginning of the italicized phrase and </i> at the end of it. It doesn't take any special browser, platform, or computer to use html tags in your posts here.

And, in reply to your point about the salaries of CEOs of drug companies, I imagine they would dismiss your complaint by saying that these executives earn their huge salaries by generating big profits with their boffo management skills, thereby creating more revenue to invest into R & D. The same could be said of their record profits-- high profits make the stockholders happy, happy stockholders means more stockholders, more stockholders means more money, and more money means more and better research.

Again, I really think there is just a fundamental conflict of interest here. The relevant issue, in my opinion, is not how the drug companies conduct their business, but the fact that they conduct it at all.

-- Anonymous, July 02, 2000

Rudolf Hess

(sorry just amusing myself and no one else probably)

OT: found this link in the process

http://www.laughnet.net/archive/politics/hitler.htm

-- Anonymous, July 02, 2000

I've seen a lot of emotional, screwball statements in this forum, but this takes the cake: "The relevant issue, in my opinion, is not how the drug companies conduct their business, but the fact that they conduct it at all. "

The person who said this must the victim of the modern education system. Perhaps she thinks drugs just grow in the rain forest, and all you have to get them is put on a safari suit and go pick them.

People feeling this way should buy only drugs developed in socialist countries by government labs. This is a pretty short list.

What is it about the idea of profit, earned fair and square, that drives liberals into fits of uncontrollable jealousy? But if the government wants ever more taxes, then that's just fine. Libs go wild over paying a buck for an ATM fee, but they worship government regulators and tort lawyers who cost them thousands of dollars each, not to mention the destruction of millions of jobs.

I'll never understand the liberal "brain".

-- Anonymous, July 03, 2000

The person who said this must the victim of the modern education system. Perhaps she thinks drugs just grow in the rain forest, and all you have to get them is put on a safari suit and go pick them.

People feeling this way should buy only drugs developed in socialist countries by government labs. Uh, Jim, the person who wrote that is a government funded drug researcher, as she said in a previous post. I think she has a pretty good idea of how drugs are developed and how much it costs to produce them.

-- Anonymous, July 03, 2000
"Uh, Jim, the person who wrote that is a government funded drug researcher."

I stand by my statement. This person is clearly deranged.

-- Anonymous, July 03, 2000

Jim-

Are you gonna warm up the Toastmasters with that witty opener? "So then I said to the liberals..." Be sure and make your fingers do the little quoty thing when you mention the liberal "brain."

I really enjoyed this topic...

-- Anonymous, July 03, 2000

Given that Miss Wade knows more about the manufacturing of drugs, and the hows and whys and wherefores of the drug industry than anybody else here, it stands to reason that we clear the floor (metaphorically) and allow her room to speak, rather than to insult her, and perhaps we may all learn something we didn't previously know.

At any rate, it would seem from her always articulate and interesting posts, both here and on her own site, that you needn't worry quite so much about her 'liberal brain' - although it is ever so kind of you to show such concern.

-- Anonymous, July 03, 2000

I agree with Kristin.

Ms. Wade added an informed viewpoint to this discussion. I also appreciate her polite, articulate and non-compromising position. The fact that she doesn't feel the need to qualify her every statement indicates to me that she has a great deal of respect for the other participants abilities to follow her line of logic. That some people are either incapable or unwilling to do so does not reflect badly on her.

I consider us all lucky to have Ms. Wade doing the work she is doing.

-- Anonymous, July 04, 2000

I'm Canadian, and I've always lived in Canada, so I have no experience with the US health care system and have been staying out of this discussion... but feel I must speak up about two myths that keep getting repeated here:

Joanne



-- Anonymous, July 04, 2000
Wow, I'm back here again! I've got more to say about it I guess. Here's the spew:

Keri-

And this is different than the private sector how? My mom bled for ~30 hours in a private hospital bed after a routine hysterectomy despite the fact that the nurses changed the bedsheets repeatedly and should know that hysterectomies should not involve anything more than light bleeding. THEN they tried to send her home bleeding. She refused to go (she was so delirious that she was mostly worried about ruining her bed at home), so they finally ran a CBC and determined that she needed TWO UNITS OF BLOOD. Her hemoglobin was half what it should have been. It took her over 6 months to get her hemoglobin up to a normal level, and she felt weak and ill the whole time. All of it completely unnecessary: she had somehow slipped a stitch and it took all of 5 minutes to put packing in to stop the bleeding. If she had gone home she might have bled to death.

And then, at another private hospital, after a 12 hour operation to fuse her spine and 20 hours in critical care, she was transferred to a regular room and the nurse left her sitting upright in a chair and did not appear again for the entire shift. My dad and I had to figure out how to work the TED hose (inflatable leg coverings to prevent blood clots) and make her do her breathing exercises (to prevent pneumonia) ourselves. We had to beg a different nurse to get morphine when she started crying from pain, and we had to figure out how to get her back in the bed without disturbing her 27 inches of incisions and the two titanium rods in her back. When I did see her actual nurse in the hallway, and asked for help, she yelled at me. She didn't even look at my mom's chart until she'd been in her care for 8 hours--she didn't even know what was wrong with her. For all she knew my mom had spent 8 hours sitting in a chair. She was pissed that my mom had been "dumped" on her at the last minute. And, yes, that was actually what she said to the transferring attendant as my mom was wheeled into the room. I literally was afraid for her life. I was terrified that she would die unnecessarily for lack of proper care, and ended up taking off work for the entire time she was in the hospital. She ended up having a few really fantastic nurses, but the first one scared me so much I couldn't leave.

When corporations want to increase their profits they understaff, when they understaff the staff can get mean or careless and sometimes patients suffer or die as a result. When I worked in a hospital pharmacy for a huge healthcare corp. I was aware of at least one major mistake (not mine) that was administered to the patient--the result of understaffing. I quit within a month. Keep in mind that I was being paid $7.40/hr to mix patient IVs. The thought that I might accidentally cause harm to a patient due to being grossly overworked and stressed out was completely unacceptable. It is a myth that private health care automatically ensures better patient care. Also, it is very difficult to sue hospitals. They control the medical records and also patients are often not aware of what SHOULD have happened. They have to take the caretakers' word for it. If we hadn't known how important the TED hose and the breathing treatments were (and taken care of them ourselves) my mom's chances of having a blood clot or pneumonia would have increased dramatically--and if she had died of "complications" we might never have known that negligence was responsible.

Would we automatically believe any other industry that claimed to be the "best in the world?" We should be asking "the best for who?" and "by what standards?" and "is it the money or the people that make the difference?"

-- Anonymous, August 05, 2000

Angie-

I'm really sorry your mom went went through so much misery.

I'm not saying that the private sector is by any means flawless, but at least you have the option of filing a lawsuit to prevent it happening again, etc. You cannot sue the government doctors. You really don't have any options with the V.A.

-- Anonymous, August 05, 2000

I'm not sure that having the option to sue makes much difference. As I mentioned, proving negligence is difficult even if one is aware that there has been negligence. And, in the case of the government refusing to pay your grandfather's medical bills you would not find an HMO behaving any differently, nor do you necessarily have the right to sue an HMO (it depends on the state you live in.)

Here's some interesting facts from WebMD:

In the past six years, the number of people enrolled in HMOs has nearly doubled, from 42 million in 1993 to nearly 80 million in 1998, according to the Competitive Edge report issued by the research organization Interstudy. Most members are enrolled in for-profit HMOs, which have developed a poor reputation for health care. For- profit HMOs have been accused of denying potentially lifesaving but expensive treatment in order to hold down medical costs.

This year, U.S. Senate Republicans passed a "patient's bill of rights." This highly publicized piece of legislation did not, however, give patients the right to sue their HMOs. Democrats opposed this measure, as did President Clinton, who plans to veto the legislation.

As a result, Republicans in the U.S. House of Representatives have crafted a new bill that gives patients limited rights to sue their HMOs. While this legislation may attract some Democratic support, it's too soon to tell whether the bill will pass. The insurance lobby, which represents HMOs, has argued that giving patients the right to sue will increase health insurance premiums -- costs that will likely be passed on to consumers.

Despite the efforts of legislators, don't expect a federal law expanding your rights to sue an HMO to pass any time soon. History has shown that federal health care legislation is easily derailed by the fear of "socialized medicine." Also, if HMOs convince the public that the right to sue would result in higher insurance premiums, enthusiasm could cool down quickly.

-- Anonymous, August 05, 2000

There isn't a lot of incentive to sue a military doctor (they are paid according to military paygrades, not doctor's wages, and don't have huge malpractice insurance policies backing them up), however there is a right to sue a military doctor - not easy, but you can do it, in the case of dependants. Active duty members (or their family on their behalf) recieving poor medical attention cannot sue the military, no. But old-style military health care has pretty much bitten the dust for everyone but the active duty member's regular healthcare - specialists are hard to come by at all but the largest facilities, and the military now provides a voluntary HMO-style plan called Tricare (replaces CHAMPUS) that involves a deductible (free for the active duty member) and then pays about 80% of the bills. It's much looser than most HMOs about *which* civilian doctor you want to go to.

It's got some problems, for sure - nothing's perfect - but it's better than the old version, CERTAINLY better than trying to get medical attention on base with the current situation, and as far as I can see, better than most HMOs.

-- Anonymous, August 05, 2000

If you're not connected with the U.S. Military skip this note. Lynda, I guess Tricare may work in the D.C. area, but it next to useless here in Austin, Texas.

<RANT%GT; There are NO doctors who partipate in the program, although the hospitals do. Tricare pays 80% of their rate, which is about 50% of what things actually cost. Tricare takes months to process claims, and there is no one who can answer questions. It's more like a lose slot machine than a real insurance plan for those of us in areas without large military bases. </RANT%GT;

-- Anonymous, August 06, 2000

Well, I got close with the html on my last post. I hope I can do better with this one.

Canada: Paridise or Mississippi?

Here in Xeney- land Canada is held up as Utopia. Dozens of Xeney-philes have announced their plans to move to Canada if Bush wins. (I guess they have the $250,000 price of admission Canada requires for new immigrants). There is general accceptance of the notion that Canada has solved all the world's problems, and that if only the United States would just copy everything they do up there, then our troubles would be over.

I've been a little confused about this, because the company I work is systematically hiring all the computer programmers in Canada, and moving them down here to Austin, the land of guns, Republicans, and 105F weather. These guys seem like intelligent people, so I've been wondering why so many them are willing, even eager, to leave Uptopia for the Living Hell that Texas represents to so many of us Xeneyites.

Today I found a pointer in today's Lucianne.com to this enlightening article in the Edmonton Sun

Of particular interest was this information: "Industry Canada produced another study. It showed that Canada now has a lower standard of living than the poorest regions in the U.S. - 10% lower than the Louisiana-Mississippi-Texas area, and a full 40% lower than New England which enjoys the highest standard of living in the U.S. Even Alberta, which has the highest standard of living in Canada, ranks lower than 17 U.S. states, and Ontario which has Canada's second highest is surpassed by the standard of 35 American states and Alberta."

Canada's down there with Mississippi! Wow!

I haven't spent a lot of time in Canada, but I did spend a week in Vancover once. I admit it seemed a tad nicer than parts of Mississippi, and I could understand the accents easier.

But this article does confirm my gut feel that there are better solutions to many of our problems in this country than those implemented by our friendly neighbors to the north, eh?

-- Anonymous, August 06, 2000

Sorry, Jim, but that article confirms jack. A point of interest: the United Nations Human Development Index has placed Canada number one (yep, in the world) for the past six years for standard of living, education and life expectancy. I've extensively searched the Industry Canada's site and can't find the report this article is talking about, but I can't see how UN and IC data could differ so wildly.
I wonder if perhaps Ted Byfield is confusing how much one earns with how much one can buy - I certainly make less than I could in the US, but my salary goes a lot further here than it would in many American cities of comparative size. I know the statistically average American makes just shy of $9,000 currency-adjusted, Canadian dollars (about US$6,000) more than the statistically average Canadian, but you have to also look at the comparative cost of living (hard to do since it varies widely within each country). I couldn't find an average cost-of-living for each country (and I'm not even sure how meaningful that would be), but I'd have to make: $4,600 more to live in Miami, Florida; $3,700 for Bridgeport, Connecticut; $12,500 for Boston, Massachusetts... (according to this thing anyway). So it looks to me like I might be paying a thousand or so a year in lost wages (ie the difference in earnings) for my access to health care. That seems pretty fair to me, actually.
Joanne



-- Anonymous, August 08, 2000
Joanne, according to the U.S. census, the U.S. median per capita income in 1998 was $U.S. 24,307 (http://www.bea.doc.gov/briefrm/tables/ebr5.htm).

According to Statistics Canada the average per capita income in 1997 was $CDN 18,626. (http://www.statcan.ca/cgi-bin/search/search.cgi? DB=40&LANG=e&FROM=1&MODE=and&QUERY=per+capita+income&ACTION=Highlight& ITEM=1#test4).

I'll leave it as an exercise for the reader to normalize these figures to reflect the weaker Canada dollar and one year's worth of inflation, but clearly people in Canada, as nice as they are, haven't figured out how to get free lunches.

I'll also leave it to our readers to judge for themselves if the article I cited in a respected Canadian newspaper is bogus.

Don't get me wrong, I like Moosehead as much as any beer (but I rarely drink, so I'm not really qualified to judge), and I'm happy that the Canadians who brew it are happy.

I admit that if your idea of a good time is huddle in an igloo clutching a block of goverment cheese, a bottle of beer, and a free HMO membership card then by all means go to Canada.

We can learn from our friends up there and do better here in the United States.

-- Anonymous, August 09, 2000

If you're going to give more weight to an op ed piece that reads like a letter to the editor than you give to the United Nations, that's your right. I wouldn't have even bothered to reply except...
"I admit that if your idea of a good time is huddle in an igloo clutching a block of goverment cheese, a bottle of beer, and a free HMO membership card then by all means go to Canada." WTF?? I'm just astonished. I can't believe you just dissed our igloos.



-- Anonymous, August 12, 2000
That reminds me, anyone ever eaten blubber?

What's it like?

-- Anonymous, August 12, 2000

In response to several posts up by Angie when her mom was in the hospital. Hospitals are very understaffed with nurses, and it *can* make a difference between life and death.Every person deserves a nurse while in the hospital who can give them the proper time and attention. No one is going to college to be a nurse either because the work load and stress compared to the salaries offered are not worth it. Many nurses are advising their children not to go to nursing school, and it is sad.

In regards to health care--I believe MD's salaries are way out of control, and yes they work hard and went to school for a very long time but the salary that MD's expect now is a big reason why health care is so high.

Drug companies in the US do charge way too much money. Another problem is the government regulations in the US that don't allow new drugs on the market for sometimes *decades* after they are discovered.

For example, someone mentioned the SSRI's (prozac, zoloft, etc...) as a wonder drug. Prozac was discovered in 1970-71 and I believe people in the US were not allowed to obtain it until the late 1980's. People were going to Europe to obtain it.

-- Anonymous, August 13, 2000

Karen: Regarding the M.D. salary issue, salaries for M.D.s have been going way down over the last 10-20 years. I work with a lot of M.D.s, and most of them are really struggling to get by. I know it sounds outrageous, but most physicians come out of school with about $150,000 of medical school tuition debt, plus whatever undergraduate debt they had, and they go into residency jobs where the average salary is between $30K and $40K per year. After a few years of this, they can finally get real jobs (usually paying $80-120K/year) and start paying off their loans--at the age of 29.

As for the issue of drug approval, don't you think it's important for drugs to be rigorously tested for safety and effectiveness before they are made available to the U.S. market? Drugs deemed to be unique and which treat extremely lethal diseases (such as HIV drugs) are rushed through the process. It is certainly not the norm for a drug to take 15 years to be approved, although I have no doubt that this was the case with SSRIs for a few reasons: there were already anti-depressant drugs on the market, they were a new class of drug which affected a neurotransmitter known to be involved in many diverse physiological processes, and they were designed to treat an illness which is not usually life-threatening.

You needn't look very far in this forum to see that people have a great distrust of the medical establishment. Speeding up the approval process would only put more unsafe drugs on the market, and would deepen this distrust.

-- Anonymous, August 13, 2000

Even though it's off topic, I must defend Canada from those who attack the igloos (funny, everything he said about Canada except for the igloos sounds just like most of the US.)

I've spent quite a bit of time in Nova Scotia ever since I was a child, and often wish I could move there. Medical care aside, I've always considered Canada a saner place to live. It's outrageously clean! They have candy-free lanes in the grocery (for parents with toddlers!) People turn off the lights in public restrooms! They tax with social concerns in mind! The shoreline is not private property (I like knowing that I could walk as far as I want on the shore without someone chasing me off. Well, unless it's the Edward Abbey- readin' Park Ranger protecting the Piping Plover nesting grounds.) I like knowing that mannered people are the norm and not the exception. I like the devotion to furthering new and better potato chip flavors (although the grape flavored potato chips were a bad direction to take, the All-Dressed flavor (mmmm...acidy...) more than makes up for it.) I like that when I listen to the news on the radio I'm more likely to hear about the fuss caused by tourists digging clams during the spawning season or global politics than a school shooting. Sigh. I wish I were there right now. I would gladly sacrifice my somewhat higher income for a better quality of life's less concrete pleasures and comforts--unfortunately, the Canadian government wisely makes it difficult for us US citizens to barge in on a permanent basis.

Jim, you don't know what you're missing.

-- Anonymous, August 13, 2000

Jennifer, I guess we'll have to agree to disagree. One of the very real reasons health care is so expensive is the outrageous amount of money doc's charge, and I'm not going to go into all the details in depth but one of the problems was how insurance companies, medicare/medicaid used to be billed, and still is but not as flagrently as it once was.

Our society also had a problem with regaling MD's as God-like thus again the outrageous salaries...For example, nurses a very important part of the health team, who make very important decisions concerning people's well being are lucky if they are paid 30-40K, these same nurses are also teaching these MD's in their residency, and making the decisions many would think the doc is only making because the nurse has more experience at the time.

It is well known that the US has extremely strigent drug testing intertwined with bureaucratical red tape that greatly increases the length of time drugs are introduced into the market. The same tests are often repeated on the same drug repeatedly for no logical reasons...

-- Anonymous, August 13, 2000

Karen, you seem to be under the impression that the drug approval process in the U.S. moves more slowly than that in other industrialized countries. In general, this is not the case. Between 1996 and 1998, the median total approval time for FDA drug approval was 369 days. In Canada during that period, the mean time was 518 days, in Australia it was 526 days, in Sweden 371 days, and in Britain 308 days.

You also say that "the same tests are often repeated on the same drug repeatedly for no logical reasons" but do not give a source for this dubious assertion. How do you know that tests aren't being repeated to give a larger sample size? Or that they aren't being done repeatedly to assure replicability in different testing sites? Both of these things are hallmarks of good science.

Finally, if you are blaming high M.D. salaries as a major component of health care expense, how do you reconcile the fact that M.D. salaries have been going down while health care costs have been skyrocketing?

-- Anonymous, August 13, 2000

Oops, I made a typo--all the times for drug approval given above are median times, not means, as I stated for Canada etc. If anyone really wants to see the mean times, you can go here:

http://www.cma.ca/cmaj/vol-162/issue-4/0501.htm

-- Anonymous, August 13, 2000

Jennifer, As you ask me for a source, I can ask you the same. Where is your evidence of decresing MD salaries? Competent and effiecient drug testing? This took me less than 5 min. to find here . I am sure you can find opposing info. I've been up over 36 hrs. I'm going to bed.

-- Anonymous, August 13, 2000
Haven't seen bed yet

AIDS drugs too slow here and FDA too slow here

Doctors salaries rise here and here

-- Anonymous, August 13, 2000

also doctors salaries here?

-- Anonymous, August 13, 2000
Karen, your first link on physician salaries doesn't work, and the second cites data from the AMA, which is currently under fire for using questionable techniques in its income data collection process. There are many studies which contradict the AMA data, such as this one.

Your source on AIDS drugs is from 1989 and your link on the FDA being too slow is based on data collected by a libertarian organization which advocates abolishing the FDA's power to stop the sale of drugs found to be dangerous or ineffective! In addition, this data represents the results of an opinion poll where the respondents were physicians, not drug researchers. I couldn't find any info. on drug testing in the link you posted two posts ago. Perhaps you meant to link another page?

-- Anonymous, August 13, 2000

Oh yeah, the part after the link was just my own opinion, not connected.

-- Anonymous, August 13, 2000
This is an interesting and informative link by a doc who proposes well thought out ways to speed up FDA here

-- Anonymous, August 13, 2000
The "speed up FDA" link is by a Ph.D. (not a physician) who works as a consultant to drug companies. The suggestions he provides are not for the FDA to speed up its process, but rather things that companies can do to get their drugs approved faster. One of the techniques he advocates is putting pressure on the reviewer! Another is having a good personal relationship with the reviewer. I don't follow what point you are trying to make with this link.

-- Anonymous, August 13, 2000

Cory, technically I have eaten blubber, but as it was part of a sushi dish I doubt this was what you were going for. I found it rubbery and unpalatable. Hmm, other odd Canadian foodstuffs - I've eaten caribou (it was pratically a staple dish there for awhile when my ex's parents' relatives from Goose Bay sent down a freezer- full of meat), dulse (a type of seaweed, nice dried), Lunenburg bread (something like Pratchett's dwarf bread) and pemmican (a sort of beef jerky thing the Mi'kmaq's make - I've only had it once, when I was little, so I don't really remember much except I didn't like it).
And, to get back on topic, none of this stuff ever put me in hospital, but I do have 'buffalo meat' in my medical charts from food poisoning one time...



-- Anonymous, August 13, 2000
thanks Joanne,

somewhere someone's mother must of said, "Don't waste it. Finish that blubber! There are kids starving...etc."

-- Anonymous, August 13, 2000

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