How to make public healthcare sufficient?

[thyristor]

Quoting @More*of*Wenceslas from this thread:

 

Quote

It's hard to make a direct comparison between public and private healthcare as we don't really have a public healthcare system anymore. GPs have been put in charge of their own budgets - and budgets have become limited. Also, parts of the health service are now run by private companies. [...] (thoughts welcome if anyone has any)

Thought I'd make this into a new thread.

 

Yea, putting budget-pressure on public health care institutions is in fact making them act like privatized ones. Same thing in Sweden as for above described UK. And privatized or quasi-privatized methods include measuring to the minute how much time it takes for a caretaker to take an elder citizen to the toilet and putting restrictions on how many times a day you have the right to be taken to the tiolet. It means that caretakers soon enough could be replaced by robots, albeit increasing chances that you can use your robot for going to the toilet as much as you possibly want, still it will mean that social contact is more and more scarce, and the meaning of life is not going to the toilet, the meaning of life is social contact. ^^

 

 

[Whore*of*Mensa]

4 minutes ago, elisabeth_II said:

privatized or quasi-privatized methods include measuring to the minute how much time it takes for a caretaker to take an elder citizen to the toilet and putting restrictions on how many times a day you have the right to be taken to the tiolet

Oh we have that too. This is known as social care here, not funded by healthcare, and the criteria for funding  social care is 'risk of death or hospitalisation'. Carers are provided on the basis of how long you can sit in your own urine etc without getting a pressure sore - which would then cost more to treat. It's a cost/benefit analysis and it's utterly inhuman.  

 

But then I wonder what it's like in other countries, like the US (which maybe we'd compare more to a third world county now in terms of the differences between rich and poor and the lack of provisions for the poor?). Is there any concept at all of the right to go to the toilet, or are people literally left to die if they have no family to care for them?

[thyristor]

1 minute ago, More*of*Wenceslas said:

provided on the basis of how long you can sit in your own urine etc without getting a pressure sore - which would then cost more to treat.

🤬gaaaarrrhghghgh!!! 🥵🤬🤬😡☠️

[Guest]

9 minutes ago, More*of*Wenceslas said:

Oh we have that too. This is known as social care here, not funded by healthcare, and the criteria for funding  social care is 'risk of death or hospitalisation'. Carers are provided on the basis of how long you can sit in your own urine etc without getting a pressure sore - which would then cost more to treat. It's a cost/benefit analysis and it's utterly inhuman.  

 

But then I wonder what it's like in other countries, like the US (which maybe we'd compare more to a third world county now in terms of the differences between rich and poor and the lack of provisions for the poor?). Is there any concept at all of the right to go to the toilet, or are people literally left to die if they have no family to care for them?

People arent left to die. If you're 65 or older you can get Medicare. If you're disabled you can get Medicaid. And at home healthcare, or a stay in a facility. 

 

But if you're not old or disabled and cant afford healthcare... you are kind of stuck with emergency rooms. Hospitals cant turn you away. Though, they only have to cover "required" treatment so if your finger is cut off they have to stop the bleeding, but dont have to reattach it if you cant pay. And taxpayers pay off the hospital debt. So we actually do pay for all those uninsured people... a lot... some economists say more than covering them for preventative care would cost. A $60 bottle of antibiotics could stop a 10 day stay in the hospital as they are dying from an easily treatable infection that has gotten really bad. It's a silly system. Hospitals also bill you but you cant pay so it goes to your credit report that you're in major debt. 

 

Edit: Though the medical field leaves people in their own urine a lot. We had to fight to get nurses to change my grandmother, they would just let her sit in her own urine or feces for hours and hours. 

 

[Whore*of*Mensa]

4 minutes ago, Serran said:

But if you're not old or disabled and cant afford healthcare... you are kind of stuck with emergency rooms. Hospitals cant turn you away. Though, they only have to cover "required" treatment so if your finger is cut off they have to stop the bleeding, but dont have to reattach it if you cant pay. And taxpayers pay off the hospital debt. So we actually do pay for all those uninsured people... a lot... some economists say more than covering them for preventative care would cost. A $60 bottle of antibiotics could stop a 10 day stay in the hospital as they are dying from an easily treatable infection that has gotten really bad. It's a silly system. Hospitals also bill you but you cant pay so it goes to your credit report that you're in major debt. 

 

That sounds quite terrifying to me, actually. I'd be one of the people they wouldn't sew the finger back on for. I just cannot imagine how a medical professional could refuse a treatment like that..

 

The US system is the most expensive per head in the world, that's probably another reason why as hospital is very expensive. 

 

I wonder if this is why our whole system is geared toward preventing hospitalisation? 

 

So, in the UK, the whole thing now works on risk - ie, if you're a suicide risk you'll get mental health treatment, if you're at risk of pressure sores (as mentioned above) you'll get preventative treatment because they are very hard to treat once you have one, and need medical attention rather than unqualified carers. I know how the system works so I got counselling for my daughter by repeatedly turning up at the GP surgery informing them that I was not at work because I needed to look after her, and was at risk of losing my job if she didn't get help (this was true. But I also knew which buttons I needed to press) - that was another 'tick' on the cost/benefit analysis, as paying me benefits if I can't work is more expensive in the long-term than helping her so we can resume a more normal life. 

 

It's just so cynical. But I guess we have a little more prevention here, not sure how long for though. 

[thyristor]

5 minutes ago, Serran said:

cover "required" treatment so if your finger is cut off they have to stop the bleeding, but dont have to reattach it if you cant pay. And taxpayers pay off the hospital debt. So we actually do pay for all those uninsured people... a lot...

Reattaching the finger would mean you could go back to your ordinary job more easily and hence not cause any additional misery, like being put on the streets.

 

I'm glad that my employer pretty much embraces the philosophy that it is cheaper to pay for preventional care than to have emplyers that are long time sick.

 

But that, I guess, is also due to the enormous amount of benefits that the state guarantees you by forcing employers to pay high taxes. In Sweden, if your wage is, let's say 20000 Swedish kronor (roundabout 2000 Euro), you get about 16000 on your bank account, the rest is moslty incometax, AND your employer might originally have to pay as much as 30000, because 10000 goes to the state to cover a lot of social care and environmental stuff and whatnot. The employer wouldn't want to increase that amount by maltreating their staff to be more sick.

[Guest]

Yeah we dont offer the preventative care unless you're insured or can pay. Doctors just cant deny treatment due to the oath they take once its risking a patient. But... like... my grandmother's doctor ordered her stents in her heart to prevent the artery closing completely after she (with a history of 4 heart attacks) was in for chest pain and the blockage was getting to heart attack level. He deemed it needed to save her life. Medicare deemed it a luxury treatment and refused to cover it. They tried to bill her $40,000 for it since the government said they should have waited for her to have a heart attack to treat the blockage. Luckily the hospital agreed to eat the cost because she needed it according to every doctor they asked but... 

[thyristor]

4 minutes ago, Serran said:

Medicare deemed it a luxury treatment and refused to cover it.

Why ever do authorities interfere with professionals? A collegue of mine had a car accident and suffered som back injury, so she couldn't do her work as a train conductor. The doctor told her so, and, tbh, I'd think it didn't need a doctor to come to that conclusion. Anyways, our 'Medicare' (Försäkringskassan =  "insurancefond"), which has a bunch of overworked clerks dealing with numbers and forms rather than people, said right up in her face: "But a conductor doesn't do much all day, it's just walking up and down on the train?" Heck am I glad to have collegues that do more than walk up and down the train I drive...

[Whore*of*Mensa]

19 minutes ago, Serran said:

They tried to bill her $40,000 for it since the government said they should have waited for her to have a heart attack to treat the blockage. Luckily the hospital agreed to eat the cost because she needed it according to every doctor they asked but... 

😯

 

I'm glad she got the treatment...

 

This is why I do still think that medical care should be determined by qualified clinicians on the basis of health needs, not on the basis of cost...When you get finance people deciding whether or not people need medical treatment then the whole things becomes completely messed up, in my opinion. 

 

Edit: also, what is the cost of employing people to argue about whether or not a treatment is needed? How many wages does it cost to do that?

 

Here there's been a drive to cut the cost of disability benefits - and it has been found that the cost of contesting disability claims and the increased assessments for disability benefits (not to mention the court cases where the decisions have been found to be wrong) is way more than it would have cost just to keep paying the benefits. 

[Whore*of*Mensa]

2 minutes ago, elisabeth_II said:

Why ever do authorities interfere with professionals?

Exactly, we hear that often from teachers and nurses and doctors..

[the great acescape]

Quote

People arent left to die. If you're 65 or older you can get Medicare. If you're disabled you can get Medicaid. And at home healthcare, or a stay in a facility. 

I mean, "not left to die" is an interesting way of putting it, considering that exorbitant healthcare costs lead to higher mortality rates among uninsured or underinsured populations (45,000 deaths a year is a number most often cited, which arose from a Harvard Medical school study in 2009 published in the American Journal of Public Health, although it's just one of several observational and quasi-experimental studies in this vein). I get that you're trying to say that if you, for example, collapse on the sidewalk from a heart attack, an EMT won't not resuscitate you if you don't have insurance, but that belies that fact that uninsured patients are more likely to put off care and therefore have reduced health outcomes and a higher incidence of mortality for acute and chronic illnesses.

 

Medicare in its current iteration also doesn't pay for as much as you'd think, although it would be fixable if policymakers had the political will to do so. My mother is 65, has no monthly income, is disabled, and medicare will only pay the fraction of the cost of a hearing aid. She can't afford it,  so she goes without. This is, granted, one anecdotal example, but it's not at all uncommon.

 

Honestly there are literally dozens of ways to make public healthcare in the U.S. more palatable other than implementing full-scale socialized medicine (which I'd honestly love to have, even if it seems like such a pipe dream at this point. I salivate imagining the money I'd save on premiums and on my deductible). You could theoretically mandate that states expand medicaid by a certain percentage each year, for example, which imo is more politically feasible than people realize. Medicaid expansion in my state is a popular policy proposal across party lines, and it's shown consistently in polls, but over and over again state government refuses to do it. 

 

If you wanted to get especially creative you could, idk, regulate private insurers and at the very *least* institute a universal public option, but I think we can afford to dream bigger.

[daveb]

2 hours ago, the great acescape said:

Medicare in its current iteration also doesn't pay for as much as you'd think, although it would be fixable if policymakers had the political will to do so. My mother is 65, has no monthly income, is disabled, and medicare will only pay the fraction of the cost of a hearing aid. She can't afford it,  so she goes without. This is, granted, one anecdotal example, but it's not at all uncommon.

 

Honestly there are literally dozens of ways to make public healthcare in the U.S. more palatable other than implementing full-scale socialized medicine (which I'd honestly love to have, even if it seems like such a pipe dream at this point. I salivate imagining the money I'd save on premiums and on my deductible). You could theoretically mandate that states expand medicaid by a certain percentage each year, for example, which imo is more politically feasible than people realize. Medicaid expansion in my state is a popular policy proposal across party lines, and it's shown consistently in polls, but over and over again state government refuses to do it. 

 

If you wanted to get especially creative you could, idk, regulate private insurers and at the very *least* institute a universal public option, but I think we can afford to dream bigger.

Agreed

I was going to mention that about Medicare. People have to pay premiums (income-based?), deductibles, co-pays, extra private insurance for additional costs not covered by Medicare, etc. It's better than nothing, but not nearly as good as it could be if the political will was there (of course, the same politicians who won't make it better generally have much better healthcare plans for themselves).

[Guest]

1 hour ago, daveb said:

Agreed

I was going to mention that about Medicare. People have to pay premiums (income-based?), deductibles, co-pays, extra private insurance for additional costs not covered by Medicare, etc. It's better than nothing, but not nearly as good as it could be if the political will was there (of course, the same politicians who won't make it better generally have much better healthcare plans for themselves).

Income based premium, yeah. It comes out of my grandmother's SS check. But, she mostly doesn't have deductibles or co-pays with hers. They just don't pay for "elective" stuff. A hearing aid is considered elective, since you don't need to hear to survive. Her stents were considered elective, since she hadn't had a heart attack yet . Though, there are ways to trick the system and get some of that "elective" stuff if you really need it... my grandmother's doctors managed to get her a libre system for glucose checking which medicare didn't want to cover but somehow they convinced them to do so (that way she can check her glucose as often as she needs, without having to pay for strips herself, since medicare only covers checking it twice a day and her doctors want her checking it 7 times a day...)

[Nick2]

5 hours ago, Serran said:

People arent left to die. If you're 65 or older you can get Medicare. If you're disabled you can get Medicaid. And at home healthcare, or a stay in a facility. 

 

But if you're not old or disabled and cant afford healthcare... you are kind of stuck with emergency rooms. Hospitals cant turn you away. Though, they only have to cover "required" treatment so if your finger is cut off they have to stop the bleeding, but dont have to reattach it if you cant pay. And taxpayers pay off the hospital debt. So we actually do pay for all those uninsured people... a lot... some economists say more than covering them for preventative care would cost. A $60 bottle of antibiotics could stop a 10 day stay in the hospital as they are dying from an easily treatable infection that has gotten really bad. It's a silly system. Hospitals also bill you but you cant pay so it goes to your credit report that you're in major debt. 

 

Edit: Though the medical field leaves people in their own urine a lot. We had to fight to get nurses to change my grandmother, they would just let her sit in her own urine or feces for hours and hours. 

 

IN the USA we are tasked with begging for health care.  Lots of chili suppers and silent auctions are suppose to cover the cost of health care.

[Whore*of*Mensa]

Spoiler

 

7 hours ago, Serran said:

Edit: Though the medical field leaves people in their own urine a lot. We had to fight to get nurses to change my grandmother, they would just let her sit in her own urine or feces for hours and hours. 

Spoiler

It's 4 hours, max, before the skin begins to break down with the moisture. So, they will change people every 4 hours and no more. That's cost-effective health care for you. 

 

[Whore*of*Mensa]

1 hour ago, Nick2 said:

IN the USA we are tasked with begging for health care.  Lots of chili suppers and silent auctions are suppose to cover the cost of health care.

We're starting to see this here...Lots of Go Fund ME appeals. I work in an NHS hospital and I've been in my job 5 months and still don't have a desk or a computer..I have to search for a spare one every morning. We have a joke that I'll need to start an appeal for my own computer and phone line, so I can actually do my job. 

 

But the more serious aspect of this is that we have families here who are fund raising for treatments which may not actually help. They're clutching at straws of hope, because the NHS only funds treatments that actually are effective. There are so many unforeseen consequences when you privatise things and when clinicians make decisions based on anything other than clinical need. 

 

The whole of Breaking Bad was completely weird to us here - I mean, he'd have just got treatment on the NHS...

[thyristor]

6 minutes ago, More*of*Wenceslas said:

It's 4 hours, max, before the skin begins to break down with the moisture. So, they will change people every 4 hours and no more. That's cost-effective health care for you. 

Oh dear, maybe we should start covering these things in spoilers, they give me the creeps ^^^^^^^^^^

[Whore*of*Mensa]

Just now, elisabeth_II said:

Oh dear, maybe we should start covering these things in spoilers, they give me the creeps ^^^^^^^^^^

Sorry! And yes, me too, absolutely horrible to have to hear funders discussing this so coldly when they make the decisions about funding. 

[Guest]

1 hour ago, More*of*Wenceslas said:

We're starting to see this here...Lots of Go Fund ME appeals. I work in an NHS hospital and I've been in my job 5 months and still don't have a desk or a computer..I have to search for a spare one every morning. We have a joke that I'll need to start an appeal for my own computer and phone line, so I can actually do my job. 

 

But the more serious aspect of this is that we have families here who are fund raising for treatments which may not actually help. They're clutching at straws of hope, because the NHS only funds treatments that actually are effective. There are so many unforeseen consequences when you privatise things and when clinicians make decisions based on anything other than clinical need. 

 

The whole of Breaking Bad was completely weird to us here - I mean, he'd have just got treatment on the NHS...

Yeah... cancer is one of those things that is really bad to get here. My job actually offers cancer insurance, because our regular medical insurance coverage will not cover the cost of cancer treatment (even if you pay $400/mo for the family plan plus...). I remember once I was trying to help a lady find a home for two dogs because she had become homeless for seeking cancer treatment and her dogs were going to be put down by the shelter, so she had gotten them out and was desperate to find them a place to stay. 

[the great acescape]

Not sure if I really answered the question OP posed in my first post, so here's a brief synopsis of my views on the subject:

 

For public healthcare to be effective, it needs to be 1. properly funded, and 2. properly staffed, with extensively trained personnel and technical/support professionals. 1 and 2 are necessarily intertwined. Unfortunately, publicly funded healthcare systems always face a significant threat in the form of austerity. If you deprive public services of funds over a prolonged period of time, then the quality of care will necessarily suffer. Later on, this decline in care will be attributed to the fact that it's a publicly run service, and ergo to make things more efficient these services must be privatized (at this point I'd probably personally interject something along the lines of "by placing these services into the hands of sadistic private equity vampires", but that's not how I'd phrase it if i wanted to pose a particularly winning argument to somebody who was a neutral party). Collectively ensuring that austerity is not a threat to public services and their efficacy is probably one of the more important challenges we'll face as a society. 

 

Fin. 

 

@Serran forgive me if I missed this in your previous posts, but are you a healthcare professional? It sounds like you work closely in the field

[Guest]

11 hours ago, More*of*Wenceslas said:

So, in the UK, the whole thing now works on risk - ie, if you're a suicide risk you'll get mental health treatment

I loathe this. You have to have a phone interview with everything being scored 1-5, but you know a “wrong” answer or two leaves you on your own, or paying out the bum for private counselling. Given the headspace people are in when they want these services, surprisingly (I at least) don’t want to be discussing my life over the phone to a stranger just to qualify to actually speak to someone.

 

Saying that I’d rather have shit mental healthcare than have to remortgage for a serious accident or bout of cancer. That’s a life event on top of a life event.

[thyristor]

15 minutes ago, the great acescape said:

Not sure if I really answered the question OP posed

Haha, no one has yet.

 

15 minutes ago, the great acescape said:

Later on, this decline in care will be attributed to the fact that it's a publicly run service, and ergo to make things more efficient these services must be privatized

[...]

Collectively ensuring that austerity is not a threat to public services and their efficacy is probably one of the more important challenges we'll face as a society.

It's a difficult question really. In my dreams we first figure out what needs to be done and then we know how many people we need to employ to get it done, and even better, then we provide the funding to employ that amount of people. But in reality it always seems to run the other way round. And that's never the way it works for commercial projects, corporations always make the plan first and then fix the money in some way. Politicians always seem to have a fixed amount of money and then they have to resize the projects accordingly.

 

15 minutes ago, the great acescape said:

sadistic private equity vampires

☑️

 

[the great acescape]

13 minutes ago, elisabeth_II said:

It's a difficult question really. In my dreams we first figure out what needs to be done and then we know how many people we need to employ to get it done, and even better, then we provide the funding to employ that amount of people. But in reality it always seems to run the other way round. And that's never the way it works for commercial projects, corporations always make the plan first and then fix the money in some way. Politicians always seem to have a fixed amount of money and then they have to resize the projects accordingly.

This is why, among other things, I strongly believe that doctors, nurses, and healthcare professionals should (at least, in an ideal world) be at the forefront of shaping health policy. If anyone is going to know how much things cost, how much training is needed, and what areas of care are the most expensive, it will be the people working in clinics, hospitals, and nursing homes. 

 

I can't say I'd have any clue as to what that would look like, but while I'm dreaming it might look like a large scale meeting with health professionals, patient advocates, and last but not least, patients themselves. 

[thyristor]

I'll write more on this tomorrow, gotta take care of my health and sleep for a while now though....

[Guest]

59 minutes ago, the great acescape said:

 

 

Fin. 

 

@Serran forgive me if I missed this in your previous posts, but are you a healthcare professional? It sounds like you work closely in the field

No. My grandmother has been on medicare / medicaid my whole life though and frequently in the.hospital and to get her the care needed you have to fight with them. And I volunteered to help the lady with the dogs. And I learned about my own insurance because I needed to pick it... which includes cancer insurance as an option. 

[the great acescape]

17 hours ago, Serran said:

No. My grandmother has been on medicare / medicaid my whole life though and frequently in the.hospital and to get her the care needed you have to fight with them. And I volunteered to help the lady with the dogs. And I learned about my own insurance because I needed to pick it... which includes cancer insurance as an option. 

Oh, my mistake. From your description of your caretaking roles I had assumed it was part of your career. I'm a full-time caretaker for my parents on top of my job, and you definitely learn fast about these things as a result.

 

Is cancer insurance a medicare add-on? Not to get too off-topic but I'm curious.

[Guest]

10 minutes ago, the great acescape said:

Oh, my mistake. From your description of your caretaking roles I had assumed it was part of your career. I'm a full-time caretaker for my parents on top of my job, and you definitely learn fast about these things as a result.

 

Is cancer insurance a medicare add-on? Not to get too off-topic but I'm curious.

No. My job offers it as an add on to our insurance coverage through blue cross, because they dont cover cancer under the regular plan. I work for public schools, so we have ... adequate health care provided. The basic plan is given free, along with life insurance (10k) then add ons we choose cost money. Vision, dental, cancer, disability, etc. 

 

Medicare covers cancer treatment already. My grandmother has been treated for skin cancer. Heart disease, blood pressure, diabetes, dementia, seizures... so many health issues. Right now she's just finishing at home physical therapy so she can walk again after muscle atrophy got so bad from sitting too much due to pain from diabetic neuropathy and osteoporosis. And she just got medical marijuana prescribed but that isn't covered by medicare. 

[daveb]

Maybe a good start would be making politicians get the same healthcare they provide to their constituents, rather than the better healthcare they give themselves...  

That might motivate them to find real solutions that work.

[thyristor]

We're starting to see a lot of those jump-the-line-insurances. The wealthy can pay a bit more for their private insurance and magically can jump the line when they need special care that others have to wait for. The public health care system has a "three-months warranty" meaning that any inhabitant has the right for proper care within three months, which per se is a ridiculously large amount of time. Now imagine getting some hipster hoping in right before your nose. Politicians should forbid this kind of exclusive and discriminative forms of private business. Sure, have insurance companies collecting extra money by help of their good argumentative skills, but that money should go into public healthcare that is for everyone, much like an extra tax. If politicians can't debate well enough to get people to accept higher taxes, then let the companies do it, that's what they're good at. But don't cement or worse, widen the gaps in society...

[gisiebob]

I think there would have to be a big change in how we think about employment. right now we don't really have a way to think of these things other that "Distributing finite resources efficiently" which doesn't mesh well with "Everyone gets their health cared for" 

 

I wish I knew a better way