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From: matt weber
Newsgroups: alt.cancer.support, alt.support.diabetes, fidonet.diabetes,
misc.health.diabetes, talk.politics.medicine
Subject: Re: Single Payer Universal Health Care
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Date: Mon, 24 May 2004 20:37:00 -0700
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On Mon, 24 May 2004 23:29:13 GMT, "Skeptic" wrote:
>
>"JonK" wrote in message
>news:40B279EC.1CE94A02@the-kaplansNOSPAM.com...
>> Skeptic wrote:
>>
>> > > Pre-existing illnesses are
>> > > being used to deny coverage.
>> >
>> > Yes. Will a singler payer change that?
>> >
>>
>> With single payer, you've always had the coverage, so how can there be a
>pre-existing
>> condition?
>
>Will all coverage be equal? Will there be levels of coverage? Will there
>be coinsurance?
>
In most of the models in use today, the basic coverage will be equal,
but you can buy better coverage (health funds in Australia, BUPA in
the UK), That gets you usually is a shorter queue, if it something
that is going to kill you in the immediate future, the basic system
works quite well.
As for the nay sayers, I'd like to point a few things. By most
measurments, the average health of US citizens is at best marginally
better then the average Australian or European, however we are
probably spending 3 times as much for that marginal improvement, and
what you really see is a small portion in the USA who get really
outstanding care, a large portion that get care that may be only
slightly better then the average in the rest of industrialized world,
and a large number who get essentially no care. That component that
gets nothing is missing in much of the rest of the industrialized
world.
WE do lots of things in the USA that run up costs enormously with
little benefit. One of the most interesting live demonstration of what
altering the landscape will do is in Australia. The Australian
Government says if you need an ACE inhibitor, these are the ones on
the PBS scheme. If you want another one, you can have it, but the
difference between the retail price and the PBS benefit, you are going
to pay for out of your own pocket. It is truly amazing how few
patients are willing to spend even an extra $2 a month. What should be
equally obvious is that in general, the use of the lowest cost,
therapeutically effectie drug saves a pile of money without degrading
the quality of care.
Because in the USA, someone other than the patient usually pays, and
patient is almost entirely isolated from the cost issue, as is the
physician, when a patient walks in and says my shoulder is bothering
me, can you write me a prescription for Celebrex or Viox? The
physician will happily do so.
In most of the rest of the world, the likely reply will be, 'have you
tried Asprin or Ibuprofen yet?' If you haven't, you will be
encouraged to do so. If that doesn't work out, then the physician may
well prescribe a COX2 inhibitor. Vioxx and Celebrex probably are more
effective than Asprin or Ibuprofen, the problem is that while they
aren't a lot better, they are a lot more expenive! There is no cost
benefit analysis being made on the front end, we just demand that we
go straight to latest/greates (and most expensive drug), even though
the advantages it offers over drugs that are a fraction of the price
are often surprisingly small. Take a good look at the ALHAT
(spelling?) trials about anti hypertensive drugs in the general
population. It is an eye opening experience about cost versus benefit.
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