American Health Care Reform Moves One Step Closer

Dr Galen

By the looks of it, the US has moving closer to pretty much completely reforming the way in which healthcare is provided to it's people. The House of Representatives voted 220 to 215 on Saturday there, to pass a version of a healthcare reform bill, the House of Representatives, is going to start debate on it's own version sometime this week I think. While it's going to be a close run thing, I think it might just squeeze through.

Has anyone else been following this at all? Even though it's been amended a fair bit, from Obama's and Clinton's original universal health care plans, it's still a sea change in policy and couild have far reaching effects across the country.

Dr Galen

final vote today by the looks of it. Should just about squeze through, but in what form no-one knows.

Some interesting news regarding how much it is going to save the US Government. Maybe its about time we had a similar debate here about root and branch reform of our healthcare services

imported_guy

this is far from the universal healthcare package we heard of... theres not much "reform" there all it says is you will have to buy private insurance. If you meet a certain poverty threshold you will get a government subsidy on a sliding scale.

If you refuse to purchase said policy expect a 750$ fine to the IRS.

Insurance companies will not be allowed to deny you due to a prexisting condition

You can stay on parents plan up to age 26.....

the pre-existing condition thing is pretty retarded, why am i not able to call a insurance company while my house is on fire and insure it then and there?, yet now i can call them up and insure myself if i ever get cancer. lol.

this is no way to fix the not-so-broken american healthcare system, the healthcare system in america is the best in the world (way better than universal healthcare, which will never work in america, nothing state-controlled ever does, look at social security/federal reserve/welfare/medicare/medicaid etc, all these government controlled systems are broken, the US govt just cant administer all this stuff), just like that its actully just that the "healthcare insurance system" is broken............ not the "healthcare system" and the only way to fix it is through a free market capitalist economy and by increasing the competition amongst the insurance companies, hope what i said makes sense

P.S this still covers the illegal aliens, and joe wilson was right, obama lied.

P.P.S this "forces" you to buy private insurance or pay a "fine".... im pretty sure that right there is illegal according to the U.S constitution.

GearMaven

This "health care reform" deal will be an absolute disaster for what was the best health care system in the world! Health care wasn't broken...there were some specific changes needed without throwing the "baby out with the bathwater."

Already today several major corporations that were convinced to support the health care bill are realizing. after the fine print was digested, that it will really cost them billions and result instead in layoffs and increased premiums to cover their pensioned employees' drug costs. Even the Internal Revenue Service now says it will need so many billion dollars for new staffers to deal with the increased tax issues.

America instead needed to enforce immigration laws and require reentry legally for all working immigrants. Current estimates are that over $10 million is spent annually in California ALONE on illegal immigrants' health care, education and related policing matters not even related to their illegal status. America should be addressing more urgently conditions in home countries and requiring those countries to step up to the plate with regards to their citizens. Richest man in the world lives in Mexico these days! Americans shouldn't be paying for the health care costs of foreign nationals!

Tort reform was needed so that malpractice insurance was affordable and that lawyers weren't filing unreasonable lawsuits and demanding outrageous settlements.

Citizens should have been allowed to purchase health insurance across state lines.

Americans are, if not the fattest people in the world, among the fattest...and a lot of responsibility for poor health and skyrocketing costs relates to the increases in diabetes and obesity-related health problems self-inflicted by poor eating and exercise choices. A necessary function of health care reform needed to be preventive health and personal responsibility.

Upgrades in health care should have come from individual state governments, NOT the federal government who daily is overstepping its Constitutional mandate.

The Center for Health Transformation is one organization creating partnerships to upgrade and transform American health care for the 21st Century and beyond. Shame Washington was only interested in taking control.

As I watch the top doctors one after another pull out of Irish public health systems and create boutique clinics and hospitals, I see the future for America. Where now my father with Medicare in California can see the best doctors, have lightening fast medical tests performed, is overseen by terrific "living and aging well" programs for serious medical conditions, I see his future as one similar to my aunt's...where she must wait in NUI Merlin Park clinic waiting rooms for 4-1/2 hours just to see a 2nd-year resident who doesn't even know what to ask to diagnose her continuing palsy issues until I intervene. Or he might someday be dealt with as my other aunt was when her Irish doctor said "Ahh, you've had a good life!" when she came to him with systems of extreme fatigue...actually related to heart problems but he in essence was writing her off as too old to worry about. Or he could be like my other aunt who ws misdiagnosed for 1-1/2 years with ailments that my father (Irish-trained but American practiced for 40 years) accurately identified in two minutes as a brain tumor.

This is not the way American health care should go...hope they fight it every step of the way!!

Capt'n Midnight

The hype I'm hearing is that it's moving health care from non-profit to commercial , seems like a great time to invest in private healthcare companies

or have I completely got it wrong ?

imported_guy

Capt'n Midnight wrote: »

The hype I'm hearing is that it's moving health care from non-profit to commercial , seems like a great time to invest in private healthcare companies

or have I completely got it wrong ?

its pretty much the opposite lol, how are companies going to make profit now that everyone who had cancer and got denied health insurance because its a pre existing condition will have coverage because the companies are being forced to cover them, its retarded, if thats the case i should be able to ring up a insurance company and demand to be covered when my house is on fire and not before its on fire.

HQvhs

imported_guy wrote: »

its pretty much the opposite lol, how are companies going to make profit now that everyone who had cancer and got denied health insurance because its a pre existing condition will have coverage because the companies are being forced to cover them, its retarded, if thats the case i should be able to ring up a insurance company and demand to be covered when my house is on fire and not before its on fire.

Jeez, heaven forbid someone with cancer should receive healthcare! Man, that is retarded! Thank the Lord we have the Republican Party looking out for the little guy, what would we do without them(!)

Seriously though, I think this has been way overblown by both sides. It's actually a rather conservative compromise and is a good building block to reform the US health system. I've no doubt that they have the best treatment in the world. But when a significant proportion of the population cannot access it either because they can't afford it, they were laid off or they were unlucky enough to have a pre-existing condition then no one can deny that there is a problem.

DrIndy

imported_guy wrote: »

its pretty much the opposite lol, how are companies going to make profit now that everyone who had cancer and got denied health insurance because its a pre existing condition will have coverage because the companies are being forced to cover them, its retarded, if thats the case i should be able to ring up a insurance company and demand to be covered when my house is on fire and not before its on fire.

Everything you are saying is so wrong on so many levels.

To give a breakdown on why the health care system in the USA is completely disfunctional before would take several essays of which many bloggers have already done.

Healthcare is a universal right. You don't take out health insurance BECAUSE you have cancer - you should NOT need to take out health insurance as you should have the universal right to a basic, but standard health care level.

Many americans who would be in the lower income brackets simply pray they will never ever get sick. They would lose everything - home, car, savings, family's savings and then become bankrupt.

In America - pharmaceutical companies are allowed to directly advertise to patients to ask their doctor on TV for the newest and most expensive drugs. Drug costs and therefore profit by pharma is much higher than in the EU. You may be getting the best in the world - but to get the second line drug where appropriate which is 80% effective but 20% the cost first to try out is out of order unlike UK/Ireland/Australia/NZ.

Cardiologists and neurologists run little clinics where they angiogram and MRI everyone - even though a stress test and a CT would probably be more appropriate, cost much less and only be slightly less effective. In america - its all about the annual colonoscopy (which you must have) - but in europe - you do faecal occult blood (which detects trace blood from cancer) and allows you to stratify people who really need colonoscopies versus people with a very low yield from colonoscopies.

This is at times safer - angiograms can tear heart vessels and need emergency surgery, like wise colonoscopies which if done unneccesarily result in a significant but low risk of bowel rupture.

Mandatory health insurance? This is common practise internationally actually - but if you are uninformed in posting here as you are imported_guy - you justly would be ignorant of this. Netherlands has mandatory health insurance by competitive insurance companies with government subsidy. In Australia - you are a higher income earner - you need to pay DOUBLE Medicare levy (which funds the health service) if you DO NOT have health insurance to make people make use of the private sector where appropriate.

Emergency Department access is free in the USA currently and runs at a loss - EMTLA requires all people presenting to be assessed by a doctor and the hospital must absorb the cost (which is unfair and will be corrected if all have health insurance) - meaning few
hospitals exist in areas of need. People don't go to GPs as they are too expensive and therefore their health suffers and preventable diseases caught early by a GP are non-existent meaning overall increased burden and OVERALL cost is dumped on the hospitals and costs vastly more in the end. Break a limb and the A&E puts on a temporary cast - people cannot afford a permanent cast or see an orthopaedic clinic - therefore the cast is not fitting right, the break slip, permanent disability and possible loss of job and income - also very expensive to the economy.

A friend of mine from the USA told me how his grandfather actively tried to die when in hospital (he knew he would be in a long time and so used to try to hide his medications and not use his inhalers) because he knew that every day he stayed alive, his family would be sued for untold more thousands by the debt collectors.

Tell me this is fair, tell me this is just, tell me that being refused health insurance is OK.

This may very well be the trigger for a root and branch review of system of profiteering on lives into a functional health service where pharma profits are appropriately curtailed, appropriate and not disproportionate imaging is done and appropriate with older, very functional drugs are used when needed rather than the most expensive - simply because they are new.

These boutique clinics simply exist to produce a profit - they are not primary care. They are not GPs and they are tailored towards high cost tertiary investigation and treatment rather than the cheaper model of primary prevention. As a doctor who is interested in treating people as people and not as profit margins - I can state that I could never work in the USA as it stood as it is the anathema to a proper health service.

I wish I had time and energy at 00:30 in Oz time - but the current USA model is ****ed and I wished I had time to post more.

Imported_guy - I respect an opposing debate and will gladly engage but please only post here again if you cannot deliver a credible opposing view - this is not After Hours. God forbid if you ever became unwell in the USA without health insurance.

imported_guy

DrIndy wrote: »

Tell me this is fair, tell me this is just, tell me that being refused health insurance is OK

you can hate on me all you want and call me illiterate all you want, i dont really care, bottom line is that this law is unconstitutional

and

where is my freedom of choice? i need to have a choice if i want to buy insurance or not, if im rich as hell i can just pay when i get sick i shouldnt be wasting money every day which i probably will never use, paying tax for medicare is fine, it helps people who are less well off (even though TAX itself is unconstitutional, IRS is just an organized crime gang run by the government i support helping others) but why are you FORCING me to buy health care or pay a penalty?

if you are unaware, check this out http://en.wikipedia.org/wiki/Tax_protester_constitutional_arguments

DrIndy

imported_guy wrote: »

you can hate on me all you want and call me illiterate all you want, i dont really care, bottom line is that this law is unconstitutional

and

where is my freedom of choice? i need to have a choice if i want to buy insurance or not, if im rich as hell i can just pay when i get sick i shouldnt be wasting money every day which i probably will never use, paying tax for medicare is fine, it helps people who are less well off (even though TAX itself is unconstitutional, IRS is just an organized crime gang run by the government i support helping others) but why are you FORCING me to buy health care or pay a penalty?

if you are unaware, check this out http://en.wikipedia.org/wiki/Tax_protester_constitutional_arguments

I don't hate you - but you're comments very often upset and irritate other users of this forum as they are factually inaccurate. If I receive any more complaints - your posting here will end. So I'll just ban you if you keep this up.

Not everyone can afford to pay on the spot and health insurance is just that - you pay when young to use when old. The government should provide a subsidy as the average level of healthcare has to be maintained at a minimum basic standard. If you want to stay in a 5 star hotel with doctors and one to one hand servants - pay more premium or pay $100,000 for your week or two there. Its a choice - but if you do like the wall street lads do and lose everything in your gambit for success - even they should be entitled to a basic minimum which they have lost since their employers collapsed and are now destitute AND UNINSURED.

DrIndy

imported_guy wrote: »

you can hate on me all you want and call me illiterate all you want, i dont really care, bottom line is that this law is unconstitutional

and

where is my freedom of choice? i need to have a choice if i want to buy insurance or not, if im rich as hell i can just pay when i get sick i shouldnt be wasting money every day which i probably will never use, paying tax for medicare is fine, it helps people who are less well off (even though TAX itself is unconstitutional, IRS is just an organized crime gang run by the government i support helping others) but why are you FORCING me to buy health care or pay a penalty?

if you are unaware, check this out http://en.wikipedia.org/wiki/Tax_protester_constitutional_arguments

I don't hate you - but you're comments very often upset and irritate other users of this forum as they are factually inaccurate. If I receive any more complaints - your posting here will end. So I'll just ban you if you keep this up.

Not everyone can afford to pay on the spot and health insurance is just that - you pay when young to use when old. The government should provide a subsidy as the average level of healthcare has to be maintained at a minimum basic standard. If you want to stay in a 5 star hotel with doctors and one to one hand servants - pay more premium or pay $100,000 for your week or two there. Its a choice - but if you do like the wall street lads do and lose everything in your gambit for success - even they should be entitled to a basic minimum which they have lost since their employers collapsed and are now destitute AND UNINSURED.

lonestargirl

Great post Dr. Indy. One small point to pick you up on. Emergency Departments are not free, yes they are obligated to treat you but you will receive a bill in the end for everything including the ambulance. However there is a whole population of the US who live under the radar, living paycheck to paycheck and the fact that $40k of accumaled hospital bills is affecting their credit rating has no impact on their lives.

My husband has jus finished a rotation in a county (public) ER. He had more than one patient come in with blood tests in hand saying 'I need my appendix out'. They had been diagnosed in another hospital and then told 'the bill will be $10k, if you can't afford if I suggest you go to XYZ', one hospital even gave the patient a Google Maps printout with the location of the hosiptal circled on it! These public hospitals treat everything that comes in the door and a huge proportion of their bills go unpaid so they are currently providing an essentially free sevice.

One of the big questions is 'will all hospitals take this new Obama insurance?', at the moment specialties are obligated to take Medicare (over 65s) and Medicaid (low earners) but primary healthcare providers are not. If the reimburment rates are unfavourable hospitals may just refuse to cover that insurance or else it encourages the use of un-necessary procedures in an effort to cover the costs.

tallaght01

DrIndy wrote: »

- but your comments very often upset and irritate other users of this forum as they are factually inaccurate.

Amen to that!

lonestargirl

Below is a link to a good summary of the healthcare reform bill

http://www.kff.org/healthreform/upload/finalhcr.pdf

metrovelvet

Dr Indy- the GP isnt your central point of referral in the US like it works here. You go stright to the specialist. You dont have the victorian caste system.

And someone tell me if illegal immigrants are getting state medical how are the low income income ones not getting it?

Also- every city has a "county" hospital which covers everyone.

HQvhs

metrovelvet wrote: »

Dr Indy- the GP isnt your central point of referral in the US like it works here. You go stright to the specialist. You dont have the victorian caste system.

Surely that is woefully inefficient?

metrovelvet

HQvhs wrote: »

Surely that is woefully inefficient?

Not at all. You'll get your gunecologists, ge, whatever appointment next week, rather than your gps appointment next week, which then refers you to the specialists, who then refers you to the radioloogist. Its far more direct. Why should I have to go to a GP to get a gynecoloigists appointment?

RobFowl

metrovelvet wrote: »

Not at all. You'll get your gunecologists, ge, whatever appointment next week, rather than your gps appointment next week, which then refers you to the specialists, who then refers you to the radioloogist. Its far more direct. Why should I have to go to a GP to get a gynecoloigists appointment?

Basically that means Gynaecologists tend to spend most of their time doing routine work like smears rather than the specialised work they are trained for. Also the is no one Doctor who takes responsability for the totality of your health care.
It's also much more expensive.
Regarding appointments GP's tend to offer same day appointments here while the waiting list for Gynae even privately can be up to 3/12 in this country.

metrovelvet

lonestargirl wrote: »

Great post Dr. Indy. One small point to pick you up on. Emergency Departments are not free, yes they are obligated to treat you but you will receive a bill in the end for everything including the ambulance. However there is a whole population of the US who live under the radar, living paycheck to paycheck and the fact that $40k of accumaled hospital bills is affecting their credit rating has no impact on their lives.

My husband has jus finished a rotation in a county (public) ER. He had more than one patient come in with blood tests in hand saying 'I need my appendix out'. They had been diagnosed in another hospital and then told 'the bill will be $10k, if you can't afford if I suggest you go to XYZ', one hospital even gave the patient a Google Maps printout with the location of the hosiptal circled on it! These public hospitals treat everything that comes in the door and a huge proportion of their bills go unpaid so they are currently providing an essentially free sevice.

One of the big questions is 'will all hospitals take this new Obama insurance?', at the moment specialties are obligated to take Medicare (over 65s) and Medicaid (low earners) but primary healthcare providers are not. If the reimburment rates are unfavourable hospitals may just refuse to cover that insurance or else it encourages the use of un-necessary procedures in an effort to cover the costs.

I dont know if anyone here knows how expensive medical school is in the US or how much insurance spend on malpractise insurance but the problem with medicaid is that often doctors in metroploises such as NYC have fees of over 200 for a visit and they will spend over an hour with you and are incredibly thorough. I have never ever received that kind of treatment in Ireland or in France where I have also been. Now if a doctor participates in medicaid, the governement reimbirses them something like $30 for a service which they would normally charge over 200 for. My car mechanic gets more than that.

I think its is abhorent that if someone cant pay for health insurance they owe the IRS. Which means they can get you for tax evasion, which means this is another tax, revenue project or the government.

sam34

metrovelvet wrote: »

Not at all. You'll get your gunecologists, ge, whatever appointment next week, rather than your gps appointment next week, which then refers you to the specialists, who then refers you to the radioloogist. Its far more direct. Why should I have to go to a GP to get a gynecoloigists appointment?

i think thats really inefficient

it assumes the patient knows which specialist they need to see, but very often they dont

if you have abdominal pain, you might need to see any or all of the following:

hepatologist
gastrointerologist
GI surgeon
endocrinologist
renal physician
cardiac surgeon
gynaecologist
psychiatrist

its a complete waste of the patients and doctors time, not to mind a delay in getting the right type of treatment, if the patient self-refers to the wrong specialist

thats the role of the GP, to direct the patient to the appropriate service

they can also gatekeep - there is no need for a gynaecologist to be carrying out smears, that sort of routine stuff can be done in primary care, thus freeing up the specialist services for those that really need them

metrovelvet

sam34 wrote: »

i think thats really inefficient

it assumes the patient knows which specialist they need to see, but very often they dont

if you have abdominal pain, you might need to see any or all of the following:

hepatologist
gastrointerologist
GI surgeon
endocrinologist
renal physician
cardiac surgeon
gynaecologist
psychiatrist

its a complete waste of the patients and doctors time, not to mind a delay in getting the right type of treatment, if the patient self-refers to the wrong specialist

thats the role of the GP, to direct the patient to the appropriate service

they can also gatekeep - there is no need for a gynaecologist to be carrying out smears, that sort of routine stuff can be done in primary care, thus freeing up the specialist services for those that really need them

I have yet to come across a GP here who does a breast exam and an internal along with your smear. The gyne gives you a full exam with your annual smear.

When I went to ER for a gastro issue, they told me to call a GI, and I didnt need a referral. I just called one.

sam34

metrovelvet wrote: »

I have yet to come across a GP here who does a breast exam and an internal along with your smear. The gyne gives you a full exam with your annual smear.

When I went to ER for a gastro issue, they told me to call a GI, and I didnt need a referral. I just called one.

you dont routinely need an annual internal exam

a smear is more important, as it would pick up cervical changes, which a manual internal examination wouldnt necessarily do

metrovelvet

sam34 wrote: »

you dont routinely need an annual internal exam

a smear is more important, as it would pick up cervical changes, which a manual internal examination wouldnt necessarily do

All of those are standard with your annual gyne exam in the US.

But there is no standard gyne exam that the GPS do here. They should at least give you a breast exam and a basic check up along with the smear.

sam34

metrovelvet wrote: »

All of those are standard with your annual gyne exam in the US.

But there is no standard gyne exam that the GPS do here. They should at least give you a breast exam and a basic check up along with the smear.

they may be standard in the US, but that does not mean they are necessary, or an efficient use of resources

metrovelvet

sam34 wrote: »

they may be standard in the US, but that does not mean they are necessary, or an efficient use of resources

A breast exam with your annual smear in inefficient? I would think late detection is by far more inefficient.

Sorry, but the system in NY is by far more efficient then what is happenning here with 100,000 referral letters not being openned and radiologists working till midnight.

I dont think anyone who is part of Irish healthcare can dare call anyone else's system inefficient these days.

RobFowl

metrovelvet wrote: »

All of those are standard with your annual gyne exam in the US.

But there is no standard gyne exam that the GPS do here. They should at least give you a breast exam and a basic check up along with the smear.

Current research suggests that regular selse examination is far better than annual reast exam. I'm a GP and at smear tests women are offered a breast exam and more importantly shown how to self examine.
Annual internal exams are unnessecary and next to useless as a screening tool.

Also the free cervical screening program pays GP's only for the actual smear.

metrovelvet

RobFowl wrote: »

Current research suggests that regular selse examination is far better than annual reast exam. I'm a GP and at smear tests women are offered a breast exam and more importantly shown how to self examine.
Annual internal exams are unnessecary and next to useless as a screening tool.

Ive had three GPs in this country and none of them do them.

I think I will continue practising my medical tourism.

sam34

metrovelvet wrote: »

A breast exam with your annual smear in inefficient? I would think late detection is by far more inefficient.

Sorry, but the system in NY is by far more efficient then what is happenning here with 100,000 referral letters not being openned and radiologists working till midnight.

I dont think anyone who is part of Irish healthcare can dare call anyone else's system inefficient these days.

i didnt say a breast exam was inefficient, i quoted your post which included the catch-all phrase "basic check-up" - this could be quite inefficient, depending what is included in a "basic check up"

plus, as rob has pointed out, a self-exam is equally if not more important.

the example of tallaght and the unopened letters is an example of one hospital, and is not reflective of teh whole system. it is as unreflective as the example of my service, where we see ALL new referrals within 8 working days - i dont pretend that i can generalise that to every other team in teh health service, anymore than the tallaght situation is.

finally, just because our situation is not perfect, that does not mean that we cannot recognise faluts in other services. in fact, observing what does and does not work elsewhere is a good way of getting ideas on how to improve your own service.

RobFowl

metrovelvet wrote: »

Ive had three GPs in this country and none of them do them.

I think I will continue practising my medical tourism.

Have a look at this Cochrane analysis.
It shows no evidence clinical examination is of use in terms of detecting breast cancer and limited evidence that self examination does.

http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD003373/frame.html

"Plain language summary

Regular self-examination or clinical examination for early detection of breast cancer.
Breast cancer is a common cause of cancer morbidity and mortality in women. Breast self-examination (examination of the breasts by the individual) or clinical breast examination (examination of the breasts by a doctor or a nurse) have been promoted for many years as screening methods to diagnose breast cancer at an early stage, in order to decrease the risk of dying from breast cancer. This review searched for well-designed trials that assessed these methods and found two large population-based studies involving 388,535 women who compared breast self-examination with no intervention. The review of data from these trials did not find a beneficial effect of screening in terms of improvement in breast cancer mortality. The trials showed that women who were randomised to breast self-examination were almost twice as likely to undergo a biopsy of the breast, with 3406 biopsies performed in the screening group compared to 1856 biopsies in the control group. The only large population-based trial of clinical breast examination combined with breast self-examination that was identified was discontinued. This was because of poor compliance with follow up and no conclusions can be drawn from the study.

Some women will continue with breast self-examination or will wish to be taught the technique. We suggest that the lack of supporting evidence from the two major studies should be discussed with these women to enable them to make an informed decision. Women should, however, be aware of any breast changes. It is possible that increased breast awareness may have contributed to the decrease in mortality from breast cancer that has been noted in some countries. Women should, therefore, be encouraged to seek medical advice if they detect any change in their breasts that may be breast cancer."

metrovelvet

sam34 wrote: »

i didnt say a breast exam was inefficient, i quoted your post which included the catch-all phrase "basic check-up" - this could be quite inefficient, depending what is included in a "basic check up"

plus, as rob has pointed out, a self-exam is equally if not more important.

the example of tallaght and the unopened letters is an example of one hospital, and is not reflective of teh whole system. it is as unreflective as the example of my service, where we see ALL new referrals within 8 working days - i dont pretend that i can generalise that to every other team in teh health service, anymore than the tallaght situation is.

finally, just because our situation is not perfect, that does not mean that we cannot recognise faluts in other services. in fact, observing what does and does not work elsewhere is a good way of getting ideas on how to improve your own service.

I think a big start would be if GPs could refer directly to radiologists.

Secondly as for breast exams, a lot of people dont do them and that is part of why you are paying your doctor. Its your doctor's job to do that. The doctor is the professional here.

Thirdly, patients should be listened to. I went into my GP with a letter saying my son must see a urologist and emphasised it must be a urologist and within four weeks. I was sent to a general surgeon 10 months later.

There is such widespread chaos in this country I suspect its going to collapse completely.

RobFowl

metrovelvet wrote: »

I think a big start would be if GPs could refer directly to radiologists.

Secondly as for breast exams, a lot of people dont do them and that is part of why you are paying your doctor. Its your doctor's job to do that. The doctor is the professional here.

Thirdly, patients should be listened to. I went into my GP with a letter saying my son must see a urologist and emphasised it must be a urologist and within four weeks. I was sent to a general surgeon 10 months later.

There is such widespread chaos in this country I suspect its going to collapse completely.

In Dublin we can and do refer directly to radiology.

If you want a breast exam and ask for one I'd be surprised if it were refused but read the link above and be aware that unless you have symptoms it's not of much value.

With regard to the problems with referrals thats unfortunate and I hope you're son has been sorted out.

I share some of your concerns re the Irish system but I would prefer the Canadian, Dutch or even the UK systems far more the US one.

sam34

metrovelvet wrote: »

I think a big start would be if GPs could refer directly to radiologists.

in every part of the country i've worked in, they can do so

metrovelvet wrote: »

Secondly as for breast exams, a lot of people dont do them and that is part of why you are paying your doctor. Its your doctor's job to do that. The doctor is the professional here.

Again, breast exams are of limited value when just done routinely.

metrovelvet wrote: »

Thirdly, patients should be listened to.

i'm not advocating that patients should not be listened to, but very often patients do not know what they need. they may think they need a particular test or treatment because their neighbour had it/they read an article about it/they googled it/whatever, but they are not necessarily right. its the GPs job to filter through the information and decide on the appropriate course of action.

lonestargirl

metrovelvet wrote: »

Dr Indy- the GP isnt your central point of referral in the US like it works here. You go stright to the specialist. You dont have the victorian caste system.

That's one of the things that's going to change with Obamacare. A lot of the focus is upon improving primary care access and services. Interestingly applications for primary care residency programs by medical students graduating this year increased a lot on previous years. Are they seeing the way healthcare is going?

metrovelvet wrote: »

And someone tell me if illegal immigrants are getting state medical how are the low income income ones not getting it?

Also- every city has a "county" hospital which covers everyone.

It's not that illegals get free care or even that care at 'county' is free. It’s just that county hospitals are obligated to treat everybody. They will send you a bill but if you are illegal what is the point is paying the bill? You will never be able to get a mortgage etc., the fact that this huge bill is affecting your credit rating will have no impact on your life.


I have experience of both healthcare systems, both professionally and as a patient. There are good and bad point to each.

Irish: It is chronically underfunded and understaffed. The GP -> consultant system is, in m opinion, the best method. One person has overall knowledge of your health. Current wait times for consultants are unacceptable though. The Irish system works well when something really bad happens the biggest problems are with access to colonoscopies etc. I’m in favour of greater separation of public and private facilities and also in favour of the centralisation of cancer services (people do better in dedicated cancer services).

USA: Any healthcare I have received in the US has been excellent, however I have excellent health insurance. The divide between the ‘haves and the ‘have nots’ in the US is nowhere more evident that in healthcare. The power of insurance companies over the market disturbs me somewhat, it encourages unnecessary tests and procedures. I thought I was just getting a routine CBC at my gynae (I have a tendency to be anaemic) and he ordered tests that cost my insurance $500. On the plus side I now know that I don’t carry the gene for CF!! I was at an academic conference today and a radiation oncologist old us a scary story. He was scheduled for what he thought was a ‘routine’ peer review of a case prior to treatment (required by insurance companies for 2 doctors to confirm the necessity of the expensive treatment). Upon making the conference call he was asked to swear an oath and then grilled by a team of 5+ doctors from the insurance company on the peer-reviewed data that supported the use of this treatment. They will look for any excuse not to pay out and there is no fall-back system for those who fall foul of the small print. I would be happy working for an academic hospital here but I could never work for private practice. Too mush pressure and I would find it ethically difficult.



Regarding the benefits (or not) of screening the whole of the current issue of the CA journal is dedicated to the current screening guidelines and practice. It is interesting to see the difference in screening rates between those who have health insurance and those who do not, stats are prevalence (SE).

Sigmoidoscopy/colonoscopy 52.6 (0.7) vs. 12.7 (2.5)
Mammogram 56.2 (0.7) vs. 26.0 (3.8)
Pap Test 81.0 (0.5) vs. 60.6 (2.4)
PSA 46.2 (1.0) vs. 9.1 (2.1)

Now I will say that there are probably some in the insured group who are over-screened (e.g. it’s only been a year since their last PSA test) but nobody can look at those stats and say that the US system is in any way fair.



I was at another conference recently in Ireland where a urologist presented some numbers for screening of prostate cancer. These are only rough numbers off the top of my head but I recall that 2000 men needed to be screened and 50 needed to be treated to prevent 1 death. Now prostate cancer treatment is not without morbidity and 49 people who have to be treated for a cancer they would never die from in order to save one life. The presenter was in favour of screening but only in a aged 50 – 70 population with at least 10 more years to live (prostate cancer generally being a slow progressing disease). In short, I think screening should only be carried out in situations where the guidelines deem it appropriate or in documented familial risk situations.

Capt'n Midnight

DrIndy wrote: »

God forbid if you ever became unwell in the USA without enough health insurance.

fyp

If you don't have enough health insurance, you may as well have none.
Nearly 2/3 of all personnel bankruptcies in 2007 were due to medical costs, 3/4 of those had health insurance.


Then again the US is probably the only country where people have seriously suggested reducing spending on education as a way to take 1c tax off gasoline.


Primary healthcare should be free at point of delivery, equally funded by everyone. The costs involved are minimal compared to the spending on stuff that isn't really needed.


The money is there to pay for basic health care.


Between them the US and UK spend more on "defence" than everyone else put together. Until 1940 it was thought that an atomic bomb would have to be delivered by ship. The biggest change in the last 70 years in launching a sneak attack with atomic bombs has been that you can put the bomb in a container so you aren't limited to a ship in a harbour, you can have the container stored on land. And having a big navy won't stop the sneak attack. Why does the US need a navy that is bigger than the next 13 biggest navies put together , especially when only two of those navies aren't allies ? Also war games carried out by the US navy back in 2002 showed that a determined enemy with explosive laden speedboats could take out a carrier task force in coastal waters.

So for 70 years it's been known that radar / missile defence / air force / satellites are of no use whatsoever in preventing such actions by "rogue states".


The US spends more than four times as much on 'defence' as China and Russia put together and no I can't see them uniting against the US. Everyone else in the top 15 military spend worldwide is an ally of the US

A but more is spent on Defence than on Healthcare
How many American lives have been saved by "star wars" / war on terrorism ?
How many more could have been saved if that spend had gone into better health, road improvements ? (up to 100,000 a year ??)
(Slightly off topic but you could ask how many American lives have been lost by CIA support of groups that later turned on the US.)

And remember Japan didn't become an economic superpower by sending on defence.

Anthony16

lonestargirl wrote: »

That's one of the things that's going to change with Obamacare. A lot of the focus is upon improving primary care access and services. Interestingly applications for primary care residency programs by medical students graduating this year increased a lot on previous years. Are they seeing the way healthcare is going?


Unless the pay for primary care physicians is going to double and more importantly the working conditions improve drastically,i cant see primary care becoming lucrative in the US again.cardiology is around 6-8 years after med school but the pay can triple what primary care docs earn