[mycroft]

"You're nicked, mate" == "on the ground, now! Hands behind your back!"

But since they're a doctor, it will be a nice knock on the door in the morning rather than a SWAT team.

[Winstonm]

 kenberg, on 2013-December-04, 09:37, said:

And besides all this velocity stuff, it actually helps people. I have never wanted to give everything I have to the needy and live in a tent, but I think that most people are willing to give a helping hand. I think the problem of creating dependency is real, it's not just a fake issue created by Republicans, but it should not be an excuse for doing nothing.

You might like to see this: http://www.salon.com..._snap_is_wrong/

Quote

Hilary Hoynes is a University of California at Berkeley economist who wrote a particularly notable paper last year. Instead of increasing dependency, as conservative critics have repeatedly claimed, Hoyen’s paper showed that, for women at least, food stamp use during pregnancy and early childhood has exactly the opposite impact of what conservatives allege: It actually increases economic self-sufficiency when children grow up, in the next generation.

[FM75]

 Winstonm, on 2013-December-04, 10:01, said:

I am certainly not in favor of total socialism nor do I believe the premises of communism - but I can look at the data and see that when the US had higher tax brackets and less regressive taxation (payroll taxes) that GDP was higher and unemployment was lower - over decades. I really don't think that revising the tax codes so that the upper 5% pay a little more in taxes will cause much of a dependency class.

Calling you out on that crock.

Why do people assert nonsense as fact in support of their beliefs. Is it to disguise it as careful analysis? Is it because most of the people they talk to have the same beliefs and don't bother to check facts?

http://research.stlo...red2/series/GDP

[kenberg]

 PassedOut, on 2013-December-04, 09:58, said:

We like to travel, and so are interested in medical care abroad also. One of our family members required medical care in Paris and was quite impressed.

Here are a couple of pieces by others that convey the essence of what cousin Alicia told us: Travelogue Paris: Rendezvous at the American Hospital


The Saga of Paying My Paris Hospital Bill - Finally!

Whew. Broken arms, detached retinas. Sounds like a dangerous place.


I have no idea what happens if a foreign visitor needs unplanned for medical assistance in the U.S. but I am willing to bet that it is not good.

[PassedOut]

 kenberg, on 2013-December-04, 15:03, said:

Whew. Broken arms, detached retinas. Sounds like a dangerous place.

I have no idea what happens if a foreign visitor needs unplanned for medical assistance in the U.S. but I am willing to bet that it is not good.

But I'd expect that the billing process would be a quite efficient...

[Winstonm]

 FM75, on 2013-December-04, 14:51, said:

Calling you out on that crock.

Why do people assert nonsense as fact in support of their beliefs. Is it to disguise it as careful analysis? Is it because most of the people they talk to have the same beliefs and don't bother to check facts?

http://research.stlo...red2/series/GDP

http://elsa.berkeley...ity_nber_v2.pdf

[FM75]

"...but I can look at the data and see that when the US had higher tax brackets and less regressive taxation (payroll taxes) that GDP was higher and unemployment was lower - over decades. "

This is what you said, dude. Now tell us which years showed the higher GDPs and the higher tax brackets. Be specific to show your clear understanding (in your own words).

Or do what you did before. Post something unrelated, rather than simply admit your mistake.

[Winstonm]

 FM75, on 2013-December-04, 15:44, said:

"...but I can look at the data and see that when the US had higher tax brackets and less regressive taxation (payroll taxes) that GDP was higher and unemployment was lower - over decades. "

This is what you said, dude. Now tell us which years showed the higher GDPs and the higher tax brackets. Be specific to show your clear understanding (in your own words).

Or do what you did before. Post something unrelated, rather than simply admit your mistake.

I should have specified GDP growth rates.

[y66]

How many people die every year from preventable errors in U.S. hospitals?

Spoiler

Until very recently, health care experts believed that preventable hospital error caused some 98,000 deaths a year in the United States — a figure based on 1984 data. But a new report from the Journal of Patient Safety using updated data holds such error responsible for many more deaths — probably around some 440,000 per year. That’s one-sixth of all deaths nationally, making preventable hospital error the third leading cause of death in the United States. And 10 to 20 times that many people suffer nonlethal but serious harm as a result of hospital mistakes.

[kenberg]

From the cited article:

Quote

"All men make mistakes, but a good man yields when he knows his course is wrong, and repairs the evil. The only crime is pride."— Sophocles, Antigone"

Medical care in the United States is technically complex at the individual provider level, at the system level, and at the national level. The amount of new knowledge generated each year by clinical research that applies directly to patient care can easily overwhelm the individual physician trying to optimize the care of his patients.¹ Furthermore, the lack of a well-integrated and comprehensive continuing education system in the health professions is a major contributing factor to knowledge and performance deficiencies at the individual and system level.² Guidelines for physicians to optimize patient care are quickly out of date and can be biased by those who write the guidelines.^3–5 At the system level, hospitals struggle with staffing issues, making suitable technology available for patient care, and executing effective handoffs between shifts and also between inpatient and outpatient care.⁶ Increased production demands in cost-driven institutions may increase the risk of preventable adverse events (PAEs). The United States trails behind other developed nations in implementing electronic medical records for its citizens.⁷ Hence, the information a physician needs to optimize care of a patient is often unavailable.

This excerpt, definitely including the quote from Sophocles, is a fine presentation of my view of medicine and representative of my view of life in general. Being cautious and asking questions about medical treatment should not ever be seen as questioning a doctor's competence.Most doctors are well-educated and dedicated. But they are also human, and the patient must accept that it is his/her own life that is on the line.

I have known people who want to debate everything with a doctor, and I have known others who treat anything a doctor said as revealed truth, not to be questioned. In recent years I have seen enough to firmly reject either of these extremes. Mistakes happen. It is foolish to think otherwise, even if you are dealing with serious professionals.

[blackshoe]

 kenberg, on 2013-December-04, 09:37, said:

And besides all this velocity stuff, it actually helps people. I have never wanted to give everything I have to the needy and live in a tent, but I think that most people are willing to give a helping hand. I think the problem of creating dependency is real, it's not just a fake issue created by Republicans, but it should not be an excuse for doing nothing.

I'm willing to give a helping hand. I'm not willing to have politicians steal from me so they can give a helping hand.

[PassedOut]

One of the reasons that US healthcare costs are more than double what they should be is rampant corruption: An effective eye drug is available for $50. But many doctors choose a $2,000 alternative.

Quote

The two drugs have been declared equivalently miraculous. Tested side by side in six major trials, both prevent blindness in a common old-age affliction. Biologically, they are cousins. They’re even made by the same company.

But one holds a clear price advantage.

Avastin costs about $50 per injection.

Lucentis costs about $2,000 per injection.

Doctors choose the more expensive drug more than half a million times every year, a choice that costs the Medicare program, the largest single customer, an extra $1 billion or more annually.

Spending that much may make little sense for a country burdened by ever-rising health bills, but as is often the case in American health care, there is a certain economic logic: Doctors and drugmakers profit when more-costly treatments are adopted.

Of course not all US doctors are corrupt:

Quote

“Lucentis is Avastin — it’s the same damn molecule with a few cosmetic changes,” said J. Gregory Rosenthal, a Toledo ophthalmologist who, outraged by the price, co-founded a group called Physicians for Clinical Responsibility to protest its use. “Yet Americans are paying a billion dollars every year for no good reason — unless you count making Genentech rich.”

But the US congress has made it tough for honest doctors to fight greedy corporations:

Quote

Because so many doctors continue to use Lucentis, Genentech has rung up more than $1 billion in U.S. sales of the drug for four years running. Roughly 80 percent of U.S. sales are paid for by Medicare and its beneficiaries.

The rising cost of U.S. entitlement programs such as Medicare has prompted outrage in Congress, but it is Congress that has made it difficult in this case and others for Medicare to limit such expenses.

To begin with, the Medicare agency is blocked from seeking better drug prices by negotiating directly with the drug companies, as health agencies in other countries do. Authorities in Britain, for example, have negotiated a price of about $1,100 per dose of Lucentis, and in the Netherlands a dose sells for about $1,300.

Moreover, in cases in which two equivalent options are available, such as Lucentis and Avastin, Medicare is forbidden from restricting payment to the amount of the less costly alternative. After it sought to do so in 2009, a federal appeals court said it lacked that authority.

And Lucentis is just one example.

No one likes heavy regulation. I surely don't. But when businesses behave intolerably, congress is (eventually) forced to pass more regulations.

[Winstonm]

 PassedOut, on 2013-December-08, 09:39, said:

One of the reasons that US healthcare costs are more than double what they should be is rampant corruption: An effective eye drug is available for $50. But many doctors choose a $2,000 alternative.


Of course not all US doctors are corrupt:


But the US congress has made it tough for honest doctors to fight greedy corporations:


And Lucentis is just one example.

No one likes heavy regulation. I surely don't. But when businesses behave intolerably, congress is (eventually) forced to pass more regulations.

More regulation is not the answer - revised and improved legislation would help - enforcement of existing regulation would help - but the best answer lies in a total revamping of the physician reimbursement system so the higher pay goes to lowering costs without sacrificing care standards.

[PassedOut]

 Winstonm, on 2013-December-08, 10:02, said:

More regulation is not the answer - revised and improved legislation would help - enforcement of existing regulation would help - but the best answer lies in a total revamping of the physician reimbursement system so the higher pay goes to lowering costs without sacrificing care standards.

Government regulations control Medicare reimbursements.

[Trinidad]

 kenberg, on 2013-December-04, 15:03, said:

I have no idea what happens if a foreign visitor needs unplanned for medical assistance in the U.S. but I am willing to bet that it is not good.

We travel quite a bit, within Europe and to the USA (and Canada). Our health insurance pays for treatments up to the amount they would have paid if we had had the treatment at home. Among EU countries, this is handled in such a way that you do not incur large costs first and later get reimbursed.

We know that we will not be able to pay for health care if we would need it in the USA. Therefore, we have a separate travel insurance every time we travel to the USA. They pay for all medical cost in the USA or -if medically safe- for getting us back home to be treated at home.

I simply will not travel to the USA without a travel insurance to cover for medical expenses. I would estimate that 95% of European travelers to the USA follow the same reasoning. (After all, if you can afford the air fare, you can afford the travel insurance.) I think practically everybody who travels to the USA knows that it is a medically dangerous country.

Most other travelers will take travel insurance to insure against loss or theft of their smart phone or camera. I have never taken travel insurance for that reason: If they steal my camera, I will buy a new one. And the insurer will not be able to reimburse for the photographs that were on it anyway. I take it for possible medical expenses in the USA.

 PassedOut, on 2013-December-04, 15:13, said:

But I'd expect that the billing process [in the USA for a foreign traveler] would be a quite efficient...

I seriously doubt that. (Don't worry, I did note your emoticon.) That is another reason for the travel insurance: They will deal with the inefficient billing.

Rik

[Vampyr]

 Trinidad, on 2013-December-08, 10:31, said:

I simply will not travel to the USA without a travel insurance to cover for medical expenses. I would estimate that 95% of European travelers to the USA follow the same reasoning.

I am sure that this is true.

[kenberg]

I wonder if a treaty could be the answer to these visitor medical problems. I would think France is under no obvious obligation to treat a visitor in the generous manner described earlier. It would seem proper that we should reciprocate. Since we have different systems, the rules would have to be worked out through negotiation, but at the very least we should be able yo come to an agreement that would substantially lower the costs of a visitor, wheter for insurance or for an uninsured emergency.

I also do not insure against theft when traveling. In general I dopn't see the point of insuring against a loss that I can cover. Such insurance pools my risk with others who may be less careful than I am, and supports an insurance company. I see no reason to do that.

Another thing has occurred to me about the ACA, and a comparison to Medicare. When I turned 65, I was automatically enrolled in part A and given the option to enroll in the considerable more extensive part B. I and everyone I now enrolled in part B. The deal was this: You could not wait five yers, probably not even five months, and then enroll when you needed it. Well, you could, but you paid a much higher premium. If you wanted the advantages of part B, you signed up right away. Peopl,e did. No need for fines or any police action, most everyone signed up and if someone didn't it was his bad judgment that he could blame later. Foi some reason this approach was not applied to the co-called invincibles. Even a healthy 30 year old can understand that he will need medical care sometime. maybe not soon, but sometime. It seems to me that if signing up on the exchange is a long run good deal, then setting it up like Medcare part B would get people, including the young, in. As it stands, I am not all that confident of widespread compliance.

[Trinidad]

 kenberg, on 2013-December-08, 11:57, said:

I wonder if a treaty could be the answer to these visitor medical problems. I would think France is under no obvious obligation to treat a visitor in the generous manner described earlier. It would seem proper that we should reciprocate.

Of course, I applaud the idea and I find it sympathetic. But I can see a few problems.

A fundamental one is that the USA doesn't have jurisdiction. Treaties are signed between countries, in this case the USA and France (and others). France can deliver, but the USA can't. How can the USA -with the American free market ideals- order private companies (doctor's offices, hospitals) to treat visitors?

A second problem, of course, is that the USA already has a political problem to decide on comprehensive universal health care for its own citizens. Do you think that there will be more support among Tea Party Republicans to provide good health care to French tourists?

The third is that the US government in general does not reciprocate. People (You!) reciprocate. If one person is nice to another, the other person owes it to the first one to be nice too. If European countries are treating American citizens nicely, the US government doesn't think anything about it. Some government workers may get warm feelings, perhaps even a member of Congress, but that will not lead to working towards a treaty.

Rik

[kenberg]

The practical problems could be overcome. I am not so sure that the political problems are insurmountable either, although I may be an optimist It's a matter of attitudes catching up to reality.

Growing up in Minnesota, a big trip was from the Twin Cities to Northern Minnesota. I was never even in Canada, though Minnesota borders on Manitoba, until I was in my twenties. Europe was over there somewhere, I knew because we studied it in geography class. My family might plan a really big trip, say to Wisconsin or even to Chicago. It's a big country. That was then, now is different. My older daughter spent a college year in Madrid, she travels many places for her job, my granddaughter traveled in Spain with a high school group.. etc. And it's not just me and my family. By modern standards, I am still something of a stay at home. The extent of travel, especially foreign travel, is wholly different than it was when I was young. But old thought patterns die slowly.

The argument has to be a practical one. We have agreements protecting travelers. Agreements about healthcare could be part of this. The government could pick up the tab for an ill Frebchman, just as the French government picks up the tab for an ill American traveling in France. It probably would not really be a treaty, more like a trade agreement, but anyway it would be reasonable and I think that it could be presented in a way that would have fairly broad support.

Again, when I was young, anyone I knew who had been to Europe either had been in the war or, as in my father's case, came from there. This has completely changed, we simply haven't adjusted our heads to it yet.

.

[mike777]

Keep in mind tens of thousands of Canadians come to the USA for healthcare each year.

In any event our costs may stay 100% higher than europe as long as our entire health care system, docs and companies are deathly afraid of lawsuits. Over the years I have met docs who stopped see any patients because it was just too big a fear and hassle, even when they won. As I mentioned before I hear many stories from lawyers in my family on this issue.

I noticed in my one and only oversees lawsuit in Germany the loser(the other guy) had to pay my lawyer's fees.