Except this is the misleading thing about "Death Panels" (as NICE has been referred to by various hyperbolics): insurance companies in the US will also cut off funding for certain drugs and treatments when there's no point any more, just like NICE will recommend to trusts.

konabunny – that point is so obvious that it shouldn't need pointing out…!

I suppose if the 'death panels' are insurance companies it must be ok.

How much is you wife's last 9 months worth to you? Your daughter's?

Hmmm an appeal to emotion is a strong indication that you don't actually have a particularly good argument. NICE have a difficult job to do and in general I'd say they do a good job. We have to accept either that NHS funds are limited and that situations like this are inevitable or we massively raise taxes to increase NHS spending.

…and even if we did massively increase taxes and NHS spending, you'll still have the same problem, since the amount of money available is not infinite. There'd always be something that was too expensive.

The US doesn't have a Health System, it has a Health Market, and there are strong vested interests in keeping it that way.

on a tangent re the unsympathetic 'mericans and mortgages…
They appeared to [genuinely] have no sympathy whatsoever for their plight
Seeing it as a problem they had brought on themselves

Things are slightly different in the States, you can hand back the keys to your house, to the bank or mortgage lender and walk away from any debt, so it's not unsurprising their view is different.

gonefishin – Member

How much is you wife's last 9 months worth to you? Your daughter's?

Hmmm an appeal to emotion is a strong indication that you don't actually have a particularly good argument.

No you're right, shouldn't get emotional about dying prematurely, particularly when there is no hope. After all, during that last nine months the person is sick. They contribute nothing to the national output, and in fact they prevent friends and family from working as hard and as long as they should, and cost the NHS money that would be better used for curing curable patients. Total wasteoids, all they do is add to the pain and suffering of both themselves and others. Should probably just let them die, and let everyone else get on with their lives.

Rational enough for you?
And on some level, it's a valid argument. If you're a ROBOT.
FFS.

Empathy is what makes us human. People who lack it are called psychopaths.

EDIT: And this is coming from an American whose belief in the market is unshakeable. I believe that a health market, like in the States is right. To allow you to pay the price on your wife's last 9 months, without being surprised about it.

I'm forking out for private insurance just like in the States, thank you very much

I doubt that you are paying hundreds a month, are you? Bupa is pretty cheap. In any case, we in the UK have the choice of private healthcare or state, and everyone has at least totally comprehensive cover; if you pay you just get even better cover still.

You can also just BUY the drugs you need, if you want, in the UK. So there's the price on your wife's 9 months of life – the cost of the drugs.

In the UK we have everything you have in the US PLUS a comprehensive coverage system for those who can't afford private cover, or don't want to pay. Our system does not STOP you doing anything. Seems good to me.

And if you can't afford it, get a job FFS.

So you have the barefaced cheek to bang on about empathy, when you come otu with lines like that?! You need a dictionary I think, or to seriously expand your understanding of human beings. Or both.

Oh, and the NHS funds a hell of a lot of care for people whose life is running out fast. NICE only doesn't fund drugs on the very edges of what's beneficial, which was the case with that cancer drug that was in the news IIRC. But in any case, is having your insurance company pull the plug any better?

You can also just BUY the drugs you need, if you want, in the UK. So there's the price on your wife's 9 months of life – the cost of the drugs.

Now this is bit is where the NHS goes wrong. As soon as you buy some drugs the NHS will no longer pay for any treatment for that 'episode of care'.

This is wrong, and needs changing ASAP.

This is wrong, and needs changing ASAP.

Agreed, tbh.

So you have the barefaced cheek to bang on about empathy, when you come otu with lines like that?! You need a dictionary I think, or to seriously expand your understanding of human beings. Or both.

It's ok – he's just explained himself….

…

this is coming from an American whose belief in the market is unshakeable

'nuff said

The drug referred to above that gives another nine months to die – not to live – costs £45 000 per year. Thats a lot of money for little benefit. ten hip replacement. one heat transplant. Waht are you going to disallow to allow that treatment? Thats the sort of decision NICE makes.

As for you forking out for health insurance. Its nothing like the USA – you are paying for a fairly useless top up on top of your NHS not instead of. Try using your BUPA when you crash your bike and break a bone. Try using it when you have a heart attack or acute asthma. try using it when you have chronic illness

Now this is bit is where the NHS goes wrong. As soon as you buy some drugs the NHS will no longer pay for any treatment for that 'episode of care'.

I thought that had been changed now?

It was certainly up for review with the consensus that it would change

theyEye your insurance company may also not fork out the money for a drug that prolongs the agony either . In fact there are far bigger problems getting medical insurance to pay out in curable cases in the USA never mind terminal ones . In the NHS system Nice way up the Medical advantages of a treatment against the cost and at the end of the day the available budget in the USA an insurance company ways up the medical advantages subject to policy terms as against the cost ensuring that cost takes into account available budget and share holder return . The Insurance company has a legal obligation to maximise profit and so ensures that any oportunity to avoid or deny treatment within the policy exclusions is taken .That's why the USA is the only first world country with third world health care for a significant chunk of it's population.

At the covered end of the scale is the unnecessary treatment and invaive treatment of patients. A patient with valid insurance and a covered condition is pay day to a private hospital who can mine the patients body for every billable procedure conceavable.

And i say this as a yorkshire man whose belief in the NHS is shakeable but held firm when ever i compare it to the US system.

theyEye

So you are content with yor view that the market works despite the fact that healthcare in the USA costs 50% more as a % of gdp than the NHS and still leaves many people without effective healthcare? Millions and millions have no healthcare cover

The fact that child mortality in the USA is similar to third world counties and much worse than Cuba for example?

It's fine TJ. The market has dictated that this is the correct child mortality rate for the States, and the market's never wrong 😉

I reckon I'm pretty right wing when it comes to most things, but even I look at the Anerican system of health care and don't know whether to laugh or cry.

There are a lot of ways the NHS could be improved, and there's a good argument to be made for looking at how Europe provides healthcare, but on the whole we're pretty well off here.

thyEYE

I did not say that one shouldn't be emotional about the fact that a loved one is dying, what I said was that using emotional blackmail when making strategic decisions, such as the ones that NICE make, illustrates a lack of a solid reasoned argument. Your decent into name calling and insults is further evidence of this.

I am further reminded of a conversation I had with an American doctor last year. He was of the opinion that, in general, Europeans have a far more mature attitude to dealing with illness and death. He characterised the American attiuted as being one of prolonging life for as long a possible no matter what the quality, whereas the European attitude was more geared towards the quality of life as well as an acceptance that sometimes people are going to die and there really isn't much you can about it.

As for your comment of

And this is coming from an American whose belief in the market is unshakeable.

Even Adam Smith didn't have that.

I believe that a health market, like in the States is right. To allow you to pay the price on your wife's last 9 months, without being surprised about it.

So you think healthcare should be for the rich not the poor, and you think that you have empathy for your fellow human beings? I think your definition of empathy is different to mine.

EDIT: And this is coming from an American whose belief in the market is unshakeable. I believe that a health market, like in the States is right. To allow you to pay the price on your wife's last 9 months, without being surprised about it.

You see the difference is that here its a debate about how best to share the available funds, in the states the health debate seems to be much more about how to take the patients available funds. Less of a market more of a bankruptcy sale from what I can see.

They appeared to [genuinely] have no sympathy whatsoever for their plight
Seeing it as a problem they had brought on themselves

I firmly believe that right wing ideologies go hand in hand with lack of empathy.

I'm surprised that the role of the Religious Right in all of this hasn't been mentioned. And yet their influence really shouldn't be underestimated – until just over a year ago, they had full political power in the US.

The Religious Right believe that "state charity" as they call it, is satanic. I read a very interesting article a while back, which I can't find now, that explains how state charity leaves people indebted to the state and in the belief that it is the state which provides everything.

When in fact only God provides, and it is to him which we should be indebted to. Therefore, state charity turns people away from God and is the work of Satan.

Although I can't find that article, here is something which was posted on a Christian forum :

"socialism is satan's substitute for Biblical Love, charity

since many people are wicked/selfish/lazy,,,,,,,
they can't be trusted to help us when we need help,
and the public knows this,
and this is bad advertisement for satan, (it proves the bible true, that we are wicked),

so, the satanists install socialism to help hide the selfishness and failure of the people to love, help,

and since the public doesn't want to pay for the govt charity programs,,,,,,they pay for it with borrowed money (deficit spending, national debt), or printing paper money out of thin air

in USA,
social security, medicare is socialism,,,,,,,and is loved by repubs and dems,,,,,who are socialists

socialism is satanic "

http://www.christian-forum.net/index.php?showtopic=34979

And in this website "Families Honoring Christ", it states :

"State charity as found in socialism and Marxism comes from a belief that people are entitled to material goods regardless of moral considerations."

Families Honoring Christ

So it would appear that God rewards morally superior people with material wealth. Whilst punishing sinners by leaving them in poverty. Presumably therefore, poor unemployed people who can't afford medical cover are wretched sinners (I bet Jesus Christ would be surprised) and clearly deserve no sympathy. Whilst Marxists who work for Satan, want to frustrate the will of God.

What genuinely perplexes me about the American right wing view is that 'their' solution costs waaaay more than the European model. I might have some sympathy/empathy for their view if the European model was vastly more inefficient/expensive but that doesn't appear to be the case.

At the end of the day, who cares whether you pay for your health coverage/service via taxes or through specific health insurance? It's still a deduction on your available income and, from what I understand, the amount most people pay in insurance premiums far outweighs any potential tax increases (unless you are ultra-rich!)

This seems to me idealogical dogma rather than anything else…

Ohohohoho!!!! 🙂

Now, where to start.
Empathy, without using a dictionary, is being able to put yourself in someone else's position, see things from their perspective. So I have:

— Fatal disease: Total desperation, there is no solution. Would then do anything and everything to fight off death as long as I possibly can, no matter how much it costs, or whether it bankrupts me. And for that possibilty, I have insurance.
— Can't afford health insurance: Get myself a decent job. No problem, anyone can do that. It's true, even though I know that most Europeans' (pretty pessimistic) opinion is that poor people are incapable of digging themselves out of their *relative* poverty, which is just BS.

Therefore I feel for those who are sick, but feel nothing for those who can't afford things. Empathy is NOT feeling sorry for everyone and everything.

Emotional blackmail. What? If talking from the perspective of individuals rather than usually meaningless generalities like 'society' is 'emotional blackmail', then we need more of it!
Listen, I don't know whether the decision to reject the drug in the BBC story was wrong or right, don't know much about it at all. Whatever cost-benefit equation is used to make these kinds of decisions I'm sure takes into account the human (ahem) impact on the family, and if it does, fine. They're trying to optimize the 'common good' (or whatever), and I can understand that philosophy. But frankly, I don't give a rat's ass about the common good, I care about my family, my friends and myself. AND YOU SHOULD TOO. If everyone did that, we would all be okay. And if it was my wife, I'd sell a kidney on the black market (thank god for the market!). It's all fine and good to talk about emotional blackmail and the 'common good' when you're sitting at your computer and talking generalities on a forum. But it's individuals that really matter, so I was just thinking about what if that individual is me.

What else…
Damn right the market works. Do you think there is some great conspiracy to inflate healthcare costs in the States? No, people there demand the best, doctors are afraid of giving anything but the best (lawsuits), and the best is expensive. My buddy works for a company that makes, among other devices, pacemakers. These things cost many tens of thousands, and the profitablity of that place isn't stellar. In fact, if drug/medical device companies couldn't charge market prices in the States, it would, I think have a great impact on innovation. As it is, Brits and the rest of the world benefit. Stuff made with an eye to making a profit in America eventually makes it over here. And it costs less, because someone already has taken the risk of research and development, by the time it makes it over here, the marginal cost of producing another pacemaker or whatever has dropped enough to make it reasonable for the NHS.

Now there are many things that are wrong with the American healthcare system, but the market is not one of them. Probably the biggest is the courts, and malpractice lawsuits, which makes doctors perscribe a million unnecessary tests and procedures 'to be on the safe side'. But that's a rant for another time.

so you think the millions without healthcare and the appalling child mortality rates are acceptable?

Edit – and for all the extra money spent on healthcare in the states outcomes are consistently poorer than in the UK. Your healthcare system is expensive – by far the most expensive in the world and only covers part of the population and has poorer outcomes than here.

Get myself a decent job. No problem, anyone can do that

HAHAHAHAHAHAHA! That's is prime f*cking bollocks! Did it ever occur to you that there might be more people than there are decent well paid jobs?* Are you seriously suggesting that people who are working low paid jobs just can't be bothered to make the effort to earn more? That's one of the most ludicrous assessments of the problems of social deprivation that I have EVER HEARD!

I don't give a rat's ass about the common good, I care about my family, my friends and myself. AND YOU SHOULD TOO

So, you value yourself over others? Ok. Well from where I am sitting, YOU are others. So [self-moderated removal of expletives]. If I can get ahead by beating you down, shall I? Would we all be happy?

How do you reconcile the fact that so many Americans have no healthcare? Do you really think it's their own fault?

(* btw the reason there are more people than well paid jobs is that market forces make employers pay as little as possible so their products can be the cheapst)

ah, the usual anti-American vitriol….

if I can summarize most Americans are against this legislation because it will eventually take the control away from the patient and doctor and places it in the hands of the government. Brits are quite used having many decisions made on their behalf, but Americans are accustomed to being able to choose their doctor, timing and course of treatment and are perfectly happy to pay for it.

Yes, there are many things wrong with the now old US system, but signing over decision making to the government does not sit well with most Americans nor does the increased cost which they will have to bare. This doesn't make them nethanderals or religious nuts, it just means most don't want someone else making decisions about medical issues for them.

It's true, even though I know that most Europeans' (pretty pessimistic) opinion is that poor people are incapable of digging themselves out of their *relative* poverty, which is just BS.

According to the CIA, and I refer to CIA Factbook because the CIA aren't noted for being particularly anti-American, 12% of Americans live in poverty. So you believe that one in eight of your countrymen live in poverty despite being perfectly capable of getting out of it ?

"But frankly, I don't give a rat's ass about the common good"

And I thought all Americans were deeply patriotic
……….you don't seem to care much about your fellow countrymen 😕

"talking from the perspective of individuals rather than usually meaningless generalities like 'society'"

We once had a Prime Minister who believed that there was no such thing as "society", only "individuals"………..in the end, her own Party sacked her.

"Damn right the market works"

And yet, even an arch neo-conservative President, had to rely on the socialist solution and carry out the wholesale nationalisation of American financial institutions due to the catastrophic failure of the market.

.

BTW, thanks for the patronising references to, "Brits", "Europeans", and "the rest of the world".

Infradig – from my understanding of the proposals it will not affect those that are insured at the moment at all – they will still be ablke to chose who what and when in the same way. To say otherwise is to swallow the anti propaganda.

All that will happen is that there will be provision made for those who don't have it at the moment and that teh cost will be shared out a bit.

You are content that you have millions of people with effectively no healthcare and that your child mortality rates are high?

Yes, I think that anyone who wants to make decent money, can. I truly believe that. People who are working low paid jobs may just have different priorities. For example I could make more money if I wanted to work harder for longer. But I don't because I can afford health insurance and a nice bike, and value my free time and am too lazy. And if you're making crap money and blaming it on the market, that's just a convenient excuse for your laziness.

You don't need to be rich to have decent health insurance.

So, you value yourself over others? Ok. Well from where I am sitting, YOU are others. So [self-moderated removal of expletives]. If I can get ahead by beating you down, shall I? Would we all be happy?

That's right, it's called competition. It's everywhere, and it's what makes the world efficient. And it doesn't have to be mean spirited or violent. Most of the time you get further ahead by being nice and sweet. But if it's the last 9 months of my wife's life on the line, I will beg, borrow, steal AND kill if it buys her more time, and I would expect you to do the same. That's life, and I'm quite comfortable with it.

Yes, I think that millions without healthcare is okay. It's up to them, an individual choice. It's not a choice that I would make for myself or my family, but it's okay. Affordability is not the issue in many of these cases, and if it is, refer to the first paragraph. I definitely shouldn't HAVE to work harder in order to buy subsidize my neighbour's health insurance. If I'm a bleeding heart, okay, I can donate to a charity that does the above on my behalf. But to be forced by the government? No thanks.

You're all such pessimists, reading some of this one might think that you think people are at the mercy of uncontrollable (market) forces and unable to help themselves. BS. You can do anything, and so can everyone else.

"Damn right the market works"

And yet, even an arch neo-conservative President, had to rely on the socialist solution and carry out the wholesale nationalisation of American financial institutions due to the catastrophic failure of the market.

Yeah, that was an unfortunate episode. I probably would have let the banks sink, although understand that it would have meant pretty lean times ahead, possibly for a long while. There were plenty that didn't take stupid risks and were solvent, and it makes me queasy that their competitors were rescued. Personal accounts would have been safe up to a hundred grand… Probably would have had to rescue the FDIC, who provides the insurance, but that wouldn't have been that bad.

Have you noticed yet that you've come across a libertarian extremist? 🙂

P.S. I know next to nothing about health care in particular, but it's the principles that are important, and that's what I'm defending.

Yes, I think that anyone who wants to make decent money, can. I truly believe that. People who are working low paid jobs may just have different priorities.

You're right. All those people in 3rd world countries are poor because basically they're mostly lazy.

clearly you know nest to nothing about healthcare! USA has a child mortality much higher than countries with free universal healthcare. 2- 3 times as high

http://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate

Life expectancy is lower

http://en.wikipedia.org/wiki/Life_Expectancy_by_Country.

You spend twice as much for a poorer service with poorer outcomes. In the UK if you become chronically ill you will get a decent standard of care – diabetes for example. In the US it varies from good to non existent.

Yeah, that was an unfortunate episode. I probably would have let the banks sink

What ? And then pretend that "the market" hadn't had a catastrophic failure ?

'Cause we knows, that it's "damn right" that the market works.

…………. good thinking Batman 8)

no TJ, I think it is a travesty that so many are not covered. There are many good things in the bill like eliminating pre-existing conditions exclusions, but the question is who pays for it all? I also think world poverty is terrible, but I don't think taxing the well off and distributing the money to the poor is the best solution to that problem.

In providing health cover to all Americans, many fear drops in quality standards and patient choice are inevitable. Like other Americans I'm very skeptical that moving towards socialized medicine is the best solution. I appreciate that many on this board would disagree, but that doesn't make me a wacko. I find this forum often descends to paint all Americans as ignorant, fat, right-wing, religious fanatics which is neither true or helpful for the debate.

btw, sorry if my use of "Brits" was deemed patronizing. not intended.

Ta infradig – that explains your position better. How else are you going to provide health care for the poor, the old, the chronically ill? You have to redistribute resources form rich to poor – there is no other way unless you continue to let them die

I don't mind "brits" – Its how I describe myself

but signing over decision making to the government does not sit well with most Americans

I didn't think that's what the current healthcare reform did?

That's right, it's called competition. It's everywhere, and it's what makes the world efficient

It's also what makes it unequal. I am not a communist, nor am I particularly hardline socialist in economic terms, but I firmly believe that being born less intelligent or capable in some way should not consign you do destitution.

Yes, I think that anyone who wants to make decent money, can

I honestly can't understand why an intelligent person would believe this! There are so many hard economic reasons why this cannot work, and they are because of the market economy that you talk about. Not every job is well paid, right? Ok. But everyone WANTS a liveable wage and a decent salary, so they all want the reasonably well paid jobs. Now there are not enough jobs like that, so no matter how good the people are there will always be some people who lose out. But they still need work, so they have to take other jobs that are not paid as well. Those jobs are low paid because more people have the ability to do them, because they are less demanding.

If everyone had a well paid job, who'd pick strawberries, or clean toilets? If picking strawberries paid well, then they'd cost loads in the supermarket and no-one'd buy them.

But if it's the last 9 months of my wife's life on the line, I will beg, borrow, steal AND kill if it buys her more time

I wouldn't. So you think extending a dying woman's life is worth ending some else's for? Mine? Woudl you like to come over here and tell me my entire existence, my wife and daughter's love are worth less than a few months of yours? Why? Because you are somehow better than me? How on earth can you not see how amazingly selfish that is?

Yes, I think that millions without healthcare is okay. It's up to them, an individual choice

Oh my goodness. Would you like me to put you in touch with my sister in law? She is pretty intelligent, a very decent girl indeed. She works extremely hard putting herself through university and working a full time job at a care home at the same time. She works amazingly hard, showing incredible dedication, and she has serious problems trying to get health cover. Really, I'd like to hear you tell her how lazy and worthless she is…

To be hoenst you are staggeringly compassionless and selfish.

I definitely shouldn't HAVE to work harder in order to buy subsidize my neighbour's health insurance

I think you should. You work for yourself, as I do, but a portion of what I earn goes towards helping others. And it's a good thing that it's mandatory, otherwise we'd go back to Victorian times. And chances are you're descended from working class folk, so if we were back in those days you'd be on the street scraping a living together with everyone else.

Astonishing, truly so.

You're all such pessimists

I'm not, although listening to you talk I am pessimistic about the future of the human race! Did you ever think you might be on the receiving end of someone else's f*ck you attitude some day? Why shouldn't I break into your house and steal all your stuff?

but the question is who pays for it all?

So the US is skint ?

Most of the rest of the Western World can afford to provide health care for it's citizens, but the US can't afford it ?

sorry if my use of "Brits" was deemed patronizing. not intended.

The term "Brit" isn't patronising. References to "most Europeans" talking BS about poverty, and how "Brits and the rest of the world" benefit from the American health care system is.

You're right, I know nothing about healthcare. But if I was really sick, I'd go back to the States. Maybe irrationally, but that's just a feeling that I have.

Anyway it seems to me that relying on indicators such as child mortality or life expectancy is fraught with danger. That's because for each of these, there are a million possible factors outside of the health system.

Life expectancy shorter? Long distances and cheap cars mean more teenagers on the road, and we all know they can't drive. Of course we all carry semi-automatics, and shoot at each other at every opportunity. Maybe Americans are particularly fond of cocaine. Even if the US had the world's best healthcare system (and I'm not saying it does), all of these millions other factors may not be offset by that fact. Mmmmmmm… Steak…

Child mortality? One of my friends turned seriously religous, and insisted on having all four of her kids in her bathtub at home, without any help. God will take care of it. And she is not considered weird (even though she should be). Perhaps Americans have their children when they are much older, due maybe to career commitments, and that leads to more complications than other countries.

The possibilites are endless.

Now it could be that the American healthcare market is really inferior, and these indicators really work. But having been to a random NHS hospital, in Barnet, and a random American hospital, in Syracuse NY, I have healthy doubts.

You're right. All those people in 3rd world countries are poor because basically they're mostly lazy.

You're right, it's harder in thirld world countries, I was generally thinking of developed and free economies. However some African countries have become quite successful since independence. And for individuals from societies that are broken? Europe is full of highly motivated African immigrants, a good chuck probably illegal. They have crossed deserts and seas, and now they're ticketing your car in Picadilly Circus. If you really want something, you can do it.

Really interesting to see how you in the UK perceive our healthcare and there are lots of interesting and both correct & incorrect perceptions. It really is a very convoluted, complex issue. I think a majority of people here think the system needed overhaul, it's just the way it has been done and the massive amount of debt incurred in doing so.
One thing they could have done that would have made a HUGE difference in medical costs here is to enact real tort reform to cut down on the frivolous lawsuits for malpractice. However, the Trial Lawyers have many in the Democratic party in their pockets and will spend any amount lobbying to avoid any realistic tort reform, since they make untold millions handling the frivolous lawsuits.
Another reason so many people were against it is that no-one, even most members of Congress still don't know exactly what is in the bill and what the under-the-table deals done to ensure votes (all adding billions to the debt). The president campaigned long and hard on making his administration transparent and proclaimed several times that any major legislation passed would be available for the public to review for 5 days before signing–then turned around and signed the bill in 36 hours when even many in Congress didn't know what it contained. Probably a big factor in his poll numbers dropping steadily to below 50% approval.

He characterised the American attiuted as being one of prolonging life for as long a possible no matter what the quality

Probably cos the Hospital makes more money by keeping the patient alive, regardless the quality of life.

Really good thread. I dont know whether to laugh or cry at some of the arguments used to defend the US "system".

But having been to a random NHS hospital, in Barnet, and a random American hospital, in Syracuse NY, I have healthy doubts

A study with sample size two is worthless.

You are completely ignorant and selfish, I'm afraid. I'm so glad me and my wife chose to live in the UK instead of the US!

Just out of interest, are you Christian?