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View Diary: Let's talk National Health Service (31 comments)

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  •  I think one big reason that we don't (or didn't) (2+ / 0-)
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    detroitmechworks, radarlady

    already have something like the NHS was the intense push-back from doctors in the 1950-90s.

    It worked great for them because they were quite successful in setting their own incomes.  So successful, in fact that eventually the insurance companies started flexing their reimbursement muscles (and around that time many insurance co.s went from non-profit to for-profit status when dividends, not health became their focus).  

    Then the relatively simple world of paying for medical care exploded in an avalanche of claims, paperwork, and coding minutia that required more and more time and back-office expenses for doctors - and daily second-guessing of their patient's care by the newly-intrusive insurance companies.  And so, finally, many physcians are seeing that there may just be a better way. (At least I hope so.) The AMA used to be a reliable (and fierce) antagonist to any expansion of public care. Don't know if they are still stuck in that position.

    Seems to me that more and more docs just want to take care of sick people, earn a good living, and leave the whole mess behind.

    OTOH, last year when my husband needed care in a Boston hospital, and had some complications, I happened to spend a lot of time waiting with his doctors for procedures and treatments to show effect. I used up my small store of small talk, and finally asked why they - all of them highly skilled cardiology specialists, and all Irish or from the UK, happened to fetch up in the US.  They weren't here on fellowships, as I imagined.  They were here because they could make two to three times as much money as they could from the NHS.  

    I think before something like the NHS can catch on here, though, the majority of US consumers are going to have to grapple with the reality that the we often get (and even demand) way more medical care than we need or is good for us (or for the source of funding of it).

    We have an overweening prepoccupation with health issues -anxiety about health is like a miasma. Our national obsession with it shows up in the popularity of info-tainment shows about health (Dr. Oz, The Doctors et al.) and countless online and print sources. It's a reliable way to get traffic to your site to offer some scintilla of health information.  And at the same time we are drowning in "health knowledge" more than half the population is overweight and in a non-specific to any particular disease, state of ill health. From mainstream care to clearly whack-adoodle theory we are adrift in a sea of medical worries.

    And then when you face a serious illness it is diificult to sort out from all the alternatives which treatment choices actually work, and why more care/ procedures/tests/medicines/ may not be the best course.  It's really, really tough to winkle out the best pathway.  It would be hard to make these kinds of decsions in a "normal" time, but when faced with life-threatening issues, it's darn near impossible to not get sucked into doing more.  

    Some people curse their health insurance companies for not approving every treatment anyone has dreamed up. Although not done with the patient's best interest in mind, some of this financial restraint may actually be beneficial. Not to say there aren't plenty of weasely insurance  companies out there whose business model is bait and switch and renege on paying for anything.

    But one side benefit of insurance restrictions may be the (entirely unintended) avoidance of over-care.  If we went to the NHS model, then it would become the focus of this anxiety, that the gov't was "rationing care", viz the absurd longevity of the Death Panel claim.

    But I'm all for the idea.  I think it would great to not have to worry about getting care if you become sick.  Think about how much that would free us up to just think about being well.


    •  All the things you point out... (2+ / 0-)
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      radarlady, glorificus

      are to me symptoms of the problem rather than roadblocks to the problem.

      IMHO, if we didn't have an entire industry dedicated to keeping people sick in order to make a profit, our costs would come down considerably.

      If you can't make a profit selling sickness due to established standards of care which show that over half the things people are "Asking their Doctor about" are bullshit dreamed up by folks looking to push legal drugs...

      Just my optimistic opinion of course, but I recall that every time I was actually SICK in the service, the health service I dealt with wanted me better.   Three days after getting shot, I was back on the line.  "Light Duty" but still, I was back at it.

      And end of life care needs to be addressed too.  I hate the term used by Rethugs and refuse to repeat it.  I prefer the concept of Death with Dignity, which flies in the face of our obsessed with extreme measures health care industry.

      But thanks for your points, and thanks for helping develop possible consequences and pitfalls to this idea.

      I think if we think about them more, the HUGE problems become considerably smaller.

      I don't blame Christians. I blame Stupid. Which sadly is a much more popular religion these days.

      by detroitmechworks on Mon Nov 26, 2012 at 11:17:52 PM PST

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      •  detroitmechworks - it's more likely that we (4+ / 0-)

        could move to a Canadian single payer model than a UK styled NHS model. In Canada the physicians and the facilities are privately owned, there is just a single payer. To try to move the US to a NHS model where the government owns nearly all the health facilities and the physicians are government employees is impossible at this time. Having the government buy all the hospitals and clinics would cost hundreds of billions and US physicians would aggressively resist becoming government employees.

        I think a plan that incorporates the private ownership of facilities and independence of the providers of the single payer Canadian system, but one that also allows physicians to have a private practice like the UK, is a model that has a chance in the US.

        "let's talk about that"

        by VClib on Tue Nov 27, 2012 at 12:47:50 AM PST

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        •  Also a great plan. (1+ / 0-)
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          But I'm sticking with the ideal of a NHS, just because it's much farther than I expect us to go.

          I am well aware that it is far more expensive and harder to achieve.

          The thing is, it's my OPENING position.  I'm fully willing to negotiate from that point.  I'm not willing to negotiate down from a "single payer" to a "Public option" to a "all options are on the table"...  You get the idea.

          Nope, I'm starting at completely insane and ultra left wing socialism.  Let em moderate me from there.

          I don't blame Christians. I blame Stupid. Which sadly is a much more popular religion these days.

          by detroitmechworks on Tue Nov 27, 2012 at 06:39:24 AM PST

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          •  The problem with that position (0+ / 0-)

            Is that it is easily dismissed because the acquisition of the facilities costs hundreds of billions that isn't allocated to the actual care of patients. Then rather than starting the conversation, it stops.

            "let's talk about that"

            by VClib on Tue Nov 27, 2012 at 07:22:00 AM PST

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            •  But we're discussing Single Payer now... (1+ / 0-)
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              And talking about a reasonable compromise.  IMHO, the discussion has gone exactly the way I wanted it to.  A discussion of a real solution closer to the left.

              I can always bring up National Health Service again, next time the discussion starts turning to "Public Option".  ;)

              I don't blame Christians. I blame Stupid. Which sadly is a much more popular religion these days.

              by detroitmechworks on Tue Nov 27, 2012 at 07:46:23 AM PST

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              •  You are correct, DMW. Always shoot (0+ / 0-)

                for Alpha Centauri at first, when the moon is really what you want.

                "I believe more women should carry guns. I believe armed women will make the world a better place. Women need to come to think of themselves not as victims but as dangerous." Anna Pigeon

                by glorificus on Tue Nov 27, 2012 at 08:02:26 AM PST

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            •  The American hospitals (1+ / 0-)
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              are building integrated care organizations.

              These integrated hospital-centric organizations could receive annual patient capitalization payments just like the very similar British NHS regional trusts.

              For example, Johns Hopkins pretty much runs the Baltimore area health care system.

              In Northern Virginia, I believe it's INOVA that runs most of the health care system.

              In Northern California, it's Sutter and Kaiser that run most of everything.

            •  In the metro Detroit area (0+ / 0-)
              Henry Ford Medical Centers, Henry Ford Macomb Health Centers and Henry Ford Wyandotte Health Centers offer the communities of southeastern Michigan a seamless array of care choices backed by excellence in research, education, and quality.

              Henry Ford Medical Centers each provide a wide range of medical services, from primary care and pediatrics to diagnostic tests as well as specialty medical services such as allergy or gastroenterology. Many Henry Ford Medical Centers offer pharmacies. The largest Medical Centers offer full-service care with Emergency Room services and select surgical services as well.

              Medical Centers

              Ann Arbor
              Bloomfield Hills
              Chicago Road
              Columbus (Novi)
              Detroit Northwest
              East Jefferson (St. Clair Shores)
              Fairlane (Dearborn)
              Farmington Road (West Bloomfield)
              Ford Road
              Harbortown (Detroit)
              Lakeside (Sterling Heights)
              New Center One (Detroit)
              Pierson (Grosse Pointe Farms)
              Royal Oak
              Sterling Heights
              Macomb Health Centers
              Wyandotte Health Centers
              Specialized Facilities

              The regional trust has basically already been assembled. Instead of millions of patient and insurer checks annually, 26 or 52 federal checks per year could finance it.
    •  araguato, you touched on the (1+ / 0-)
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      main reasons are costs are higher and they have nothing to do with insurance.

      Those doctors who came here because they could get paid 3 times as much.

      How are you going to get doctors here to reduce their own take to one third? We will never get to British health care costs if doctors here take three times as much from the system. The same with all the other aspects of care.

      The second major reason is over treatment which includes totally ineffective treatments or poor choice of alternatives — usually the most expensive alternatives. These are frequently harmful — as we see with the meningitis outbreak. Steroid shots for lower back pain are risky in best of circumstances and are not a cure. There are better and cheaper treatments. Yet none of the medical experts discussing the problems has dared to say these treatments were not appropriate. Too many docs who get a  lot of money for automatically giving a shot or three to patients who will be right back there in about 3 months. They would be furious.

      Yes the insurers have tried to limit poor treatments but they have been excoriated for it.

      People need to educate themselves and not accept everything your doctor tells you to do or take. Sometimes they don't even know what is best — and sometimes they don't care as long as it pays them.

      A great book by a great doctor, Otis Brawley is How We Do Harm: A Doctor Breaks Ranks About Being Sick in America

      Go to the page and read about  the book and the comments there. it is worth it. And if you can get the book you will enjoy it and learn a whole lot about our system.

      I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

      by samddobermann on Tue Nov 27, 2012 at 05:02:16 AM PST

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      •  doctor costs (1+ / 0-)
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        In my youth I went to a clinic that was open days and evenings and I believe early Saturday.

        This clinic was a business and not a government-funded entity.

        There were five or six doctors that had two people at a desk to serve all the doctors at work. They might have had three total office staff working 40 hour weeks and 60 hours of operation.

        This would be three staffers total for five or six doctors total, or a doctor to staff ratio of 5 to 3 or 6 to 3.

        A modern office might have a doctor to staff ratio of 1 to 2 or even 1 doctor to 3 staffers.

        The modern American sole practioner is now spending about four times and sometimes as much as six times as much on office staff salaries alone than the clinic doctors did in my youth.

        Going to the multi-practioner clinic system and doing away with the American solo-practioner system would enable doctors to work for lower fees and retain the same net incomes. The multi-practitioner clinic system would also enable doctors to provide care in the evenings.

        •  Another great suggestion! (0+ / 0-)

          See, this is exactly what I'm talking about.  You throw out the concept of "Our System is fine, just needs a few tweaks" and replace it with, "Nationalize it!" and suddenly there's a million good ideas for how we can change the system to really solve the real problems with it, instead of shuffling money around without really solving the problem.

          Which of course was my entire point in calling for a NHS.  It's the ideal, but even bringing up the ideal causes us to move in that direction.

          I don't blame Christians. I blame Stupid. Which sadly is a much more popular religion these days.

          by detroitmechworks on Tue Nov 27, 2012 at 08:21:02 AM PST

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