US Healthcare Reform - PPACA

[Valandil]

Passage of the legislation is somewhat old news now - but what do you think of the "Patient Protection and Affordable Care Act" (aka "Obamacare")? Or even - how much do you know about it?

[Insidious Rex]

Im all for it. Only wish he hadnt had to compromise so much (single payer, etc.). Its stunning to me how many people are crawling out of the wood work renouncing this because they dont want to subsidize other peoples health care needs yet they will scream bloody murder if you touch medicare, medicaid or social secuirty. Hypocrites all. Anything to jump on Obama.

[The Gaffer]

Hard to be sure from this distance but the perception here is that America has the worst health care system in the developed world and that Obamacare is a tiny, tiny step in the right direction.

Cuba has a better HC system than the US, for goodness sake.

I write as a professional who has worked in health care for over 15 years, during which time I have worked in, visited and/or collaborated with people who work in health care systems all around the world.

However, I am led to believe things are perceived somewhat differently from within your borders.

[inked]

The Gaffer, that would be the perception from jolly ol' where the wait for a cholecystectomy is 12 months after 3 hospitalizations for severe pain untreatable by OP medication to just get in the queue? Or the resident who spent a year in England and never saw an unruptured appendix in the OR because of the surgery wait times? Or the "no CABG" rule so the heart patients can go home and die to save money for the NHS?

Or are you elsewhere?

[brownjenkins]

Originally Posted by inked

The Gaffer, that would be the perception from jolly ol' where the wait for a cholecystectomy is 12 months after 3 hospitalizations for severe pain untreatable by OP medication to just get in the queue? Or the resident who spent a year in England and never saw an unruptured appendix in the OR because of the surgery wait times? Or the "no CABG" rule so the heart patients can go home and die to save money for the NHS?

Or are you elsewhere?

Red herring.

Un, or underinsured Americans... children... die all the time in our country simply waiting in line at the emergency room.

Basic, to advanced, coverage is available at will in many single-payer systems in other first world coutries. And you still have the option to buy supplemental insurance if you either have the money or expect to have the need. They pay much less for their basic coverage, plus that additional option, than we do in the states.

I followed the terminal cancer of my aunt in Denmark and my uninsured aunt here in the States over the past ten years, and I can tell you that the treatment Liz received in Denmark, was light years ahead of what Anne saw in Oregon. Both were terminal cases with basically no chance of recovery, but Liz received a treatment plan, a nurse at home, and support along the way. Anne got a prognosis and a few weeks in the hospital at the end.

[Gwaimir Windgem]

My take on it is that an option for public health is pretty much required ethically. My belief in separation of church and state is half-hearted at best, and if Scripture says we should care for the sick, then we'd better damn well care for them, from where I'm standing, and that includes ensuring health care is available to all.

Originally Posted by Ezekiel

You eat the fat, you clothe yourselves with the wool, you slaughter the fat ones, but you do not feed the sheep. The weak you have not strengthened, the sick you have not healed, the injured you have not bound up, the strayed you have not brought back, the lost you have not sought, and with force and harshness you have ruled them.

[The Gaffer]

Inked, your information is inaccurate and out of date. Post a source and I will happily check it out for you.

Great to read that GW. I really hope you live to see that enacted in the US. It is (IMO, literally) criminal that the richest, most advanced country in the world has such a self-serving health system.

Your doctors, insurers, policy makers and drug companies take over 15% of your GDP, and deliver higher infant mortality, shorter life expectancy and poorer coverage of care. France, which is generally reckoned to have the best health system in the world, spends 11% of GDP on health. In the communist UK, it's 8%. (WHO figures: http://www.who.int/whosis/whostat/2010/en/index.html)

Why is that?

[Earniel]

Obamacare? Really?

It often surprises me how many Americans just seem absolutely terrified of the mere wiff of socialism, however light it is. Socialism appears to actually be a bad word, which is rather odd to someone on this side of the pond who isn't even the slightest bit of a socialist on my national scale. Always curious to see the differences in political make-up between lands even when using the same identifiers such as socialists, liberals or christian-democrats...

To get to the point, is all the negativity against this only because "socialism is bad", or are there other non-political arguments against it? I think I remember the new system would provide another 60 million Americans with care they otherwise did not have access to. That's quite a lot. I haven't been following this issue closely, but I had heard more than enough horror stories concerning American healthcare (both from Americans and visitors) to think that the USA could indeed use a broader health care system.

[inked]

I had two residents in 2003 who had spent the prior year in jolly ol' doing the training year. Both reported what I have told you from their personal experiences. That was consistent with the reports of Scottish medical students in the US in 1983-84. So the intervening 20 years hadn't changed much in NHS.

However, Gaffer, is such enormous progress towards equalization has ocurred in the NHS in the past 3 years, I congratulate your system.

Now, how many CABG's are performed under the NHS annually versus privately insured wealthy Brits who can actually pay for the services.

And, lest the conversation wax too serious, here is the prediction for dental care under the new socialist Obamacare provisions...
http://www.youtube.com/watch?v=HAa5HpHbgYs
as predicted decades earlier.

[The Gaffer]

Cholecystectomy wait time is 18 weeks max. Waiting times for many surgery areas used to be hellish. But this was in large part due to the systematic starving of investment the NHS experienced in the 1980s and early 90s under a succession of conservative governments. When we got a "socialist" government, they invested heavily in staff, they bought in additional capacity from the private sector, and they slashed waiting times enormously. Statistics for NHS England for 2009

So thanks for bringing up that example: it shows nicely how public sector investment is a good way to improve the effectiveness and efficiency of health care.

Re: unruptured appendices, I take it you refer to the Scottish medical students from the 1980s. I won't pass comment on your sample size as you are, of course well aware that 20 year-old anecdotal evidence is far superior to actual data from last year, systematically gathered.

So anyway, I refer you to my previous answer.

Coronary Artery Bypass Graft is an interesting one. Again, if you look up current statistics, CABGs are now done in a timely fashion, within a few weeks of referral. What happens, of course, is that you see a surgeon and he tells you you can have the operation in, say, six weeks on the NHS or tomorrow if you go private and pay him lots of money. Lots of people go for that because they are frightened. This surgeon will then use the same theatre, the same staff (paid for and trained by the NHS), will pay a fee to his hospital for the use, and will pocket the rest.

Important note:

Under the British system, people can always opt to go private if they want. Many people do so, and many have additional health insurance. They don't lose their NHS benefits if they do this. Which is another massive lie that I have heard propagated in the US in order to scare people away from adequate public provision.

[inked]

Gaffer, I am delighted to corrected. All the better for the Brits. I also appreciate that you acknowledge the reality of the data I was given in the designated time frames. It is amusing that you base it all on conservative governments, though. Frankly, we'd have to go back to the"brain drain" of the '60s when the great excursion of physicians from jolly ol' to Canada and the USA took place because of the socialization of medicine. Of course, we then had the excursion of British Canadian physicians to the USA when Canada committed the same atrocity.

Bright fellows, those. I trained under several transplanted Brits who were excellent physicians.

Seems like it took a while for the Brit system to recover from socialization of medicine in my perspective, which, if I recall correctly, was not a conservative ploy, now was it?

[The Gaffer]

I didn't acknowledge that, other than to comment on the suspect rigour of your sampling method. What I did was provide some up to date information about the recent performance of our state system in the areas you mentioned.

Coincidentally, there is new data out today, comparing death rates after CABG across European countries. The UK performs best, even though we have a higher-risk population. http://www.bbc.co.uk/news/health-11831159

I know it's difficult, but are you ready yet to acknowledge the superior performance of a state-funded system against key outcome measures such as mortality?

[GrayMouser]

Benedict's on a roll!

VATICAN CITY (CNS) -- Pope Benedict XVI and other church leaders said it was the moral responsibility of nations to guarantee access to health care for all of their citizens, regardless of social and economic status or their ability to pay.

Access to adequate medical attention, the pope said in a written message Nov. 18, was one of the "inalienable rights" of man.

http://www.catholicnews.com/data/sto...ns/1004736.htm

[brownjenkins]

My sister is a doctor in both the US and Germany and, eventhough the salaries in Germany for her profession are nowhere near what they are in the US, she's still trying to change our system to a more Federal one.

[The Gaffer]

Good for her. I hope she isn't a lone voice.

Clearly some people are more interested in shoring up their personal wealth at the expense of public health.

[inked]

Ah, another great Democrat provision for health care to kids...

http://www.nytimes.com/2010/12/08/he...ml?_r=2&ref=us

"In a last-minute change sought by some drug manufacturers, Congress stipulated in the new health care law that rural hospitals, children’s hospitals and certain free-standing cancer centers could not get discounts on orphan drugs through the 340B program. Ms. Barnes, at Galion Hospital in Ohio, said: “The list of orphan drugs is small, but it involves big dollars. Many, perhaps most, of our cancer patients receive at least one orphan drug during their treatment.” "

Gee, see how the Democratic majority kowtows to Big Pharma! And you thought it was just Republicans............

[The Gaffer]

Could you explain what an orphan drug is and why this issue is an example of kow-towing to Big Pharma?

[Insidious Rex]

As noted in your link:

A House Democrat who worked on the health care law said the situation had resulted from “an honest mistake in drafting,” and he added, “No one intended to take away any of the drug discounts that children’s hospitals already had.”

Furthermore, the new health care bill has for the first time extended discounts to rural hospitals that they didnt have before.

So this change is hardly purposeful and according to legislators concerned with the issue

The House has voted to restore discounts for children’s hospitals. Similar legislation has been bottled up in the Senate

. And I wonder who is "bottling it up"... Last I heard the repubs werent going to let ANYTHING pass unless it was massive tax breaks for the rich.

But hey yet another reason we should have a single payer system. These kinds of things wouldnt slip through the millions of cracks...

[inked]

IR,
"Christina M. Barnes, the pharmacy director at Galion Community Hospital in rural Galion, Ohio, said she was excited when her hospital qualified for the discount program earlier his year. But, she said, she was dismayed to learn that many drugs would be excluded.

“We were given an advantage with one hand, and it was taken away with the other hand,” Ms. Barnes said."

DEMOCRATS, IR, DEMOCRATS.

The Gaffer,
"Several years ago, Congress broadened the program to include children’s hospitals. But this year Congress, in revising the drug discount program as part of the new health care law, blocked these hospitals from continuing to receive price cuts on orphan drugs intended for treatment of diseases affecting fewer than 200,000 people in the United States."

Emphasis added, Gaffer, to identify the working definition of orphan drugs.

[Insidious Rex]

Originally Posted by inked

IR,
"Christina M. Barnes, the pharmacy director at Galion Community Hospital in rural Galion, Ohio, said she was excited when her hospital qualified for the discount program earlier his year. But, she said, she was dismayed to learn that many drugs would be excluded.

“We were given an advantage with one hand, and it was taken away with the other hand,” Ms. Barnes said."

DEMOCRATS, IR, DEMOCRATS.

You mean they were (finally) given an advantage with one hand and a DRAFTING MISTAKE with another. So do you support fixing this drafting mistake as the DEMOCRATIC legislature is trying to? And as I stated before who do you think is holding that up exactly?