“And yeah, there are queues for elective surgery, and yeah i can’t choose my own surgeon, big deal.”

Yes it is a big deal. I’m not saying it is the only consideration, or that one parameter makes the US system better, but this does matter.

In the last couple of years both my daughter and I needed surgery where this mattered. I could have had surgery done locally but there was one surgeon in another city who did a procedure not performed by local surgeons. Among the benefits, besides being less invasive, was that I had minimal time off work compared to the other procedure, saving me thousands in lost income. He also performed it around my office schedule so I could further limit time off. As opposed to waiting for an elective surgery he scheduled the surgery for shortly after I saw him as the date was best for me. When my daughter needed surgery we wound up seeing a couple other surgeons before we found a specialist across the state who was one of the tops in his field nationally in the type of work.

It is certainly possible to envision a system without many of the faults we now have in the US, but I would definitely want to preserve the choice of surgeons.

Where do you get this information?

Lets now think about in the US once your born no-one gives a darn about your right to life. Children and elderly dying because they or thier parents can’t afford the treatments or medicine. Oh thats a real christian society. Then you will say “Well if you can’t afford them you shouldn’t have had them”.

The change that needs to come about is our sense of community. Why doesn’t anyone care about their neighbors? How can we deny health care to a sick child? How can we deny health care to the elderly? Why don’t we treat illness the same for everyone?

In the US, if you are one of the lucky ones who have good insurance (at a cost!), you can get excellent care, and often without waiting. Of course, if you have coin, you can do the same in the UK, and skip the waiting list. I have never had problems getting even surgery in the UK, but I’ve been lucky, and I know of plenty of horror stories.

The US system is a complete and utter administrative nightmare. It doesn’t feel like health care, rather then usual awful corporate disingenuousness that we’ve become accustomed to in the rest of our sphere or life. I don’t want a call to the health system to feel like I’m getting auto-insurance. And that’s when you have good insurance. I dread to think what the bad is like. By comparison, the UK system is a breeze, with all focus on your health and efficiency of the system.

Having more than half a century of European experience to draw on, can’t the US build a system that is the best of both worlds? It doesn’t have to have all the problems of the UK system.

Of course, one inescapable problem is that health treatment expenses are going up, everywhere. The same insurance doesn’t buy you the same medicine anymore — it has to be rationed. But surely giving money to insurance companies is a black hole, and the US would save a lot of money by universally providing minimal health services. In the sphere of prevention, for example, that would be invaluable, and save money for both health insurance and the productivity.

What I’d ask my US colleagues is this: Are US citizens ready to protect their health care system, given the heightened sense of entitlement that people have here? Will it work if people don’t feel ownership of the system? Certainly that is not the case with private insurers at the moment. In the UK, France, Germany, at least most people believe that the system is out to help them (even if not always succeeding), not to fleece them. Can that change in attitude be made in the US?

It’s like suggesting your British readers should get a balanced view of the US from Fox News.

The fact is that if i get ill, and i do occasionally, i get an appointment the same day or the day after, i get drugs prescribed that day or if its something serious, i get the treatment i need quickly. I suffered from a cancerous growth in my sinus back when i was in college (thats 17-18 year old education to you), i got access to the specialist within a week, i had my first op the next week, the whole thing was sorted (benign growth, they just yanked it out) within the month. And i paid not a penny, money simply doesn’t come into it. I never have to fill in paperwork for insurance, i don’t have to sign up to anything, i get ill, and they fix me.
And yeah, there are queues for elective surgery, and yeah i can’t choose my own surgeon, big deal, i’d take this system over yours any day.

So tax. I pay tax so that my government and council can make nice shiny raods for me to drive on, so that i have street lighting in my street and so that if i get sick, i get healed quickly. I don’t pay anything like 40%. And i’d happily pay more if it went to health and education. You call it socialism, putting money into a collective pot to help out the community, but really its a sensible idea. Better than getting gouged by private companies.

The US is already spending huge tax dollars on health, it’s just that (mostly) only the rich have the privilege of access to the results. If you are talking cancer, this is unequivocally true.

No, it is not hooey. You are demonstrating my point. I didn’t say that they don’t cover statins. I said they are using them suboptimally to save money. Simvastatin is a generic which they will cover, but they won’t cover the newer, more potent statins which many diabetics require. Are they getting your LDL under 70 with simvastatin? If they are, would they pay for a more expensive medication if your LDL did raise over 70?

Insulin is far less expensive than many other medications used for diabetes. Will pay for Actos, Januvia, or Byetta if one of these is better for you? Many people on insulin don’t even need insulin if treated with the newer medications. Others on insulin have their sugars much better controlled if combined with Actos to reduce insulin resistance. How tightly are they controlling your sugars. I’ve yet to see anyone from the VA whose diabetes was being treated properly. Of course patients are in no position to realize this, or to know that medications they are not receiving would do a better job.

Yes, this is largely because they can’t get a low enough cost, but people in other plans have access to many medication that people in the VA system do not.

The VA does do a good job in some areas, such as with MRSA. That is partially why some of the studies give them an exaggerated ranking. The problem is that they do a good job in some areas, but a terrible job in others that are not measured by the quality measures used in the study above.

However, it is not the VA’s complete fault with some drugs – the VA, unlike Medicare, can negotiate with drug companies for prices – and since they will purchase very large quantities – they should get good prices. Unfortunately, some drug companies refuse to negotiate and will provide these drugs only at regular market cost – which the VA will not do. So don’t blame the VA.

If you really need to blame someone – blame Congress – since the VA gets a single pot of money each year – they have to work within that budget. If it is short – then yes, cost-cutting does go into effect. And with all the lack of planning and preparation for the inevitable casualties of the GWOT, the system is currently strained in several areas.

I have received care at several VA hospitals, as well as private ones when I had insurance. I must say that I have had different levels of care in both. I have had bad care in a private hospital, and I have had bad care (many years ago) in a VA hospital.

Under Clinton, the entire VA system was overhauled, and clinical research studies have recently been done that show that the VA is substantially improved, and in fact does as well or better than most large famous private hospitals.

For instance, MRSA (Multiple Resistant Staphylococcus Aureus). The CDC’s recommended that all hospitals test patients when they are admitted and when they are discharged. Admitted to isolate carriers of this bad bug and prevent transmission to other patients, and on discharge to make sure that isolation has worked and patients not positive have not become positive.

The VA is the ONLY system in the country that has instituted this policy, and their new case rate of MRSA has dropped from 27% to less than 7%. I don’t know about you, but if I don’t have a bad bug when I go into the hospital, I sure would prefer not to have one when I come out!

In any case, whoever quotes waiting times, etc. in the U.S. without taking account of the fact that we have 47 million who (conveniently) remain uncounted, is a complete charlatan.

As is the case with so many matters which get politicized, the truth about the VA is somewhere between the attacks from the right and those on the left which cite it as a perfect example based upon some quality measures.

I’ve had patients experience a number of different VA hospitals and, not surprisingly, it does sound like there is variation from place to place.

One problem is that patients often do not realize whether they are getting good care or not. If you receive treatment at the VA you might not realize any deficiencies if they did exist.

My impression of the VA has fallen from a number of experiences. This includes their unwillingness to cover statins for patients with a history of diabetes and heart disease to lower their LDL under 100, but the standard of care is to lower the LDL to under 70 to achieve regression of atherosclerosis They are also reluctant to cover glitazones in diabetics who require them. When they do cover them they cover Avandia as opposed to Actos because the cost is lower, but Avandia appears to carry cardiac risks which Actos does not. They are also often unwilling to cover other medications which I have no problem getting for patients in private plans when indicated. Unfortunately patients do not realize when they are being denied the best drug for their problems in favor of a less expensive one.

Lots of good points made (not by the conservatives), but I feel I should comment on one particular thing. The argument about VA is misguided. If I hear one more person claim that the “Walter Reed” scandal proves ANYTHING about “VA” system, I will have to, I dunno, get mad or something. Walter Reed is NOT a “VA” hospital. It is an Army Medical Center. It is part of the Active Army medical system. The victims of the scandal were not “veterans”, they were still active duty soldiers, subject to Army control. They were being HOUSED in bad conditions and being treated badly in their medical holdover type unit, NOT receiving bad medical care itself. And as a vet myself, I can tell you that the Army is notorious for housing soldiers in sub-standard conditions with no qualms at all. So, the Walter Reed thing proves absolutely NOTHING.
That being said, I can also tell you that the VA itself, from personal experience only, was EXCELLENT. I had ZERO complaints. They treated me better than I’ve ever been treated by the private system. They gave me more treatment than I even thought that I was legitimately entitled to. I don’t use it much anymore, as I now have employer provided healthcare and don’t feel like I should use taxpayer provided healthcare when others could use it so much more than me, but if there are new problems popping up I can guarantee you it is simply that the idiots in power didn’t plan for this war properly and are being overwhelmed with the numbers of wounded vets. That is NO argument against the system itself.
I’ll end with this. One of my doctors at VA actually told me – and this guy was an old Navy doc, very military, probably Republican – that he preferred the system because he himself liked the idea that he could just treat patients without the interference of insurance companies. He also said, when I asked him why I was getting such good care, that as much as he hated to admit it, he gave the credit to Bill Clinton for pushing for better funding, etc.
Bottom line all of you conservatives: healthcare is a human right. Let capitalism decide what kind of car or toothpaste you get, that’s fine. But healthcare is a right.
Peace.

For people on Medicare we also have a strange system with regards to chemotherapy. Even before Medicare included prescriptions they would pay for IV medications, including chemotherapy. There were probably many people who received coverage for IV chemo but not tamoxifen. (Even before Medicare included prescriptions, which is done with a system of private insurance plans, many people had secondary insurance which may or may not have included prescription coverage. (Most people over 65 and as well as some who are disabled, are on Medicare.)

Link 

Maybe these problems don’t exist, but others do. Regardless, elimination of the current system isn’t going to be accepted politically, largely because the majority of people are happy with their coverage. Preexisting conditions is one problem, but this is dealt with by current proposals which still maintain the private insurance system.