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So we have Obamacare!

  1. General Discussions Senior Member The Studio Senior Member Boardwars Senior Member  #101
    Beware of Zombified Terrorists Langy's Avatar
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    Well, yeah, Paladin. I never said that the co-pay shouldn't be based upon the person's income/ability to pay. I'm fine with it being graduated like that.

    No-cost doctor visits for everyone is a bad idea all-around, since it dramatically increases the cost of doctor's visits by making people go in when they don't need it and making the doctor's order tests that they really shouldn't, etc.

    In any case, your problem with catastrophic coverage boils basically down to 'that's how it already works!' - the poor already skip on going to the doctor and wait until problems are serious enough to go to the emergency room, and the emergency room is required to take you in. Also, catastrophic situations are the ones that are the most significant cost, and can be pretty likely to completely bankrupt a family - thus, not providing catastrophic coverage means we'll wind up with more medical bankruptcies, etc.

    And note I never said anything about there not being a deductible or co-pay with the catastrophic coverage. If that deductible is something like $1000, it's pretty high, which means people are going to want to go to the (much cheaper) doctor in order to get preventative care, while it's low enough that it won't bankrupt almost anyone.

  2. #102
    Forum Farseer Akranadas's Avatar
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    No-cost doctor visits for everyone is a bad idea all-around, since it dramatically increases the cost of doctor's visits by making people go in when they don't need it and making the doctor's order tests that they really shouldn't, etc
    You can go to a no-cost GP doctor in Australia, but generally the wait times are quite long. Rather, we have lots of private doctors and medical centers that have the option to bulk-bill the health care system or take an after examination fee - it depends on your doctor really. Mine for instance takes a fee after the examination but at the same time, his wait times are considerably lower, in the end the option is for the individual doctor or medical center to establish.

    I do suppose its quite hard to imagine a system where you can get cared for by your governments health scheme when you've been living without one since.... forever.

  3. #103
    Langy: The problem with catastrophic only, and yes, this is a major problem with our current system, isn't the bankruptcies that are caused when people end up in a catastrophic situation, it's that the treatment itself is orders or magnitude more costly, objectively, not in terms of what the patient pays, but in terms of actual resources expended in their treatment, than years of regular checkups would have been. A serious condition that's caught early saves the whole system untold amounts of money. Vastly less resources need be expended to treat a condition that's just beginning to develop than to deal with one that's nearing the end of its progression.

    And yes, in the current system the emergency room is required to take you in, and the government will reimburse them for trauma care if the patient could not pay, but that happens after they bill the patient, send it to collections, and the patient goes bankrupt. All of which, as you noted cost loads of money, and in my terms are an unnecessary and avoidable expenditure of finite resources. But again, even ignoring that, the resource cost of not having the poor come in for regular checkups and waiting too long to have symptoms treated is far greater than the resource expenditure involved in simply treating them regularly.

    You're worrying about people going in for every little sniffle, but ultimately that costs the system less than having everyone not go in, and having some of them turn out to have strep that ultimately requires hospitalization because they didn't go in to have it checked out.

    So I'm simply not in favor of this catastrophic only coverage. I don't think that's what we should be extending to the poor, and I don't think that anyone should be allowed to choose such an option, as it encourages behavior that is ultimately not in the interest of the collective as a whole, and is a wasteful and inefficient use of resources.

    I think a reasonable copay for routine treatment makes sense, but again I think that if you implement that policy, there's an income threshold below which that copay should be waived entirely, and the fee should scale up indefinitely. If the rich don't have to make the same proportional expenditure as the less wealthy, how is that fair? After all, what you end up with there is the poor avoid going in for every little thing because the transportation costs alone are a deterrent for them, the middle classes where the copay starts to appear and runs up to the $20 or whatever you have in mind for a reasonable ceiling have the copay as a deterring factor, but the very wealthy are free to visit the doctor for every little thing because $20 is literally meaningless to them.

    Hell, the truly, truly wealthy in this country already have care that outstrips anything the rest of us get by outrageous amounts, with personal doctors on retainer who will come to them whenever they feel a little cold coming on.

    That's simply not equitable or acceptable.
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  4. General Discussions Senior Member The Studio Senior Member Boardwars Senior Member  #104
    Beware of Zombified Terrorists Langy's Avatar
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    I'm failing to see why you have an issue with people who have money being able to buy nicer things than people who are poor.

    Anyways, I think you may need to re-read what I said. I was talking about catastrophic coverage being the minimum, not the only coverage ever. Sure, give the poor better coverage, and the dirt-poor can get free coverage - they pay enough just getting to the doctors that they aren't going to go in for every sniffle. Also, a co-pay or deductible on the catastrophic coverage would ensure that people would still go visit their doctors for the little things rather than wait until it's serious. An actual doctor's visit doesn't cost more than $50 or so; if they think they'll make money in the long run by 'gaming the system' to give them the catastrophic coverage, they're idiots. As I said, make the deductible something like $1000 - that's 20 doctor's visits right there.

    Also: Making it so the copays have no limit is ridiculous. They should definitely have a limit that's simply equal to the cost of going to the doctor without insurance. They shouldn't pay more than the doctor is charging. That's just ridiculous.

    EDIT: Oh, and prescription medication needs to be seriously overhauled; I think that's one of if not the major cost associated with 'routine' medical care. Allow a national healthcare plan to collectively bargain for lower medication costs, similar to how other national healthcare plans handle it.

  5. #105
    I have an issue with there being a rich class in the first place, but even assuming that I'm ok with that, the argument that they should be able to buy nicer things is a straw man, as we're not talking about nic nacs for the house here, we're talking about basic human services.

  6. General Discussions Senior Member The Studio Senior Member Boardwars Senior Member  #106
    Beware of Zombified Terrorists Langy's Avatar
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    ...I'm still failing to understand why that's an issue. If you can afford to hire someone to attend to go out of their way to make them comfortable/go to their home/etc, then good for them. There's no reason to deny them these things just because they're richer than you. And insisting that everyone get that same level of service is ridiculous, because it would mean nobody got that level of service - there aren't enough doctors in the world to service every patient like that.

  7. #107
    Is watching TheDeadlyShoe's Avatar
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    Also: Making it so the copays have no limit is ridiculous. They should definitely have a limit that's simply equal to the cost of going to the doctor without insurance. They shouldn't pay more than the doctor is charging. That's just ridiculous.
    If the goal of copays is to control behavior then they have to be financially relevant. If the goal of copays is not to control behavior than what's the point?

    This has always been the problem with civil fines and fee-based controls of all sort. they hit the poor way harder than the middle class and are meaningless to the wealthy. Even before you factor in the time factor.

    Or is this a thing where wealth entitles you to way better health care? Why should it do so? What moral or ethical or any justification is there for that? You're framing it as a matter of resource allocation at the end. There is nothing natural or inevitable about allocating resources based on wealth. It's a choice.

    Not that I - or most anyone else - really cares, as long as there is some basic fairness in the system. People are entitled to spend their money on whatever. But for God's sake, not having some basic level of care - in a 21st century western nation - is insane.

    **EDIT**

    Romney, who championed the Massachusetts health care mandate, but is an opponent of the federal mandate passed by President Barack Obama, marveled at how little Israel spends on health care relative to the United States.

    “When our health care costs are completely out of control. Do you realize what health care spending is as a percentage of the GDP in Israel? 8 percent. You spend 8 percent of GDP on health care. And you’re a pretty healthy nation,” Romney told donors at a fundraiser at the King David Hotel in Jerusalem, speaking of a health care system that is compulsory for Israelis and funded by the government. “We spend 18 percent of our GDP on health care. 10 percentage points more. That gap, that 10 percent cost, let me compare that with the size of our military. Our military budget is 4 percent. Our gap with Israel is 10 points of GDP. We have to find ways, not just to provide health care to more people, but to find ways to finally manage our health care costs.”
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  8. General Discussions Senior Member The Studio Senior Member Boardwars Senior Member  #108
    Beware of Zombified Terrorists Langy's Avatar
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    Or is this a thing where wealth entitles you to way better health care? Why should it do so? What moral or ethical or any justification is there for that? You're framing it as a matter of resource allocation at the end. There is nothing natural or inevitable about allocating resources based on wealth. It's a choice.
    Resource allocation based on wealth is natural from the simple matter of 'wealth is defined by resource allocation'. It's a tautology, not choice.

    As for why wealth entitles you to better health care - health care is expensive. People who have resources to spend on it get better healthcare because they can pay for it, and paying for that same level of care for everyone would immediately bankrupt the nation, making it so nobody can get even minimal healthcare unless they can personally afford it.

    By rationing healthcare, you are able to help more people in the long run than if you tried to give everyone the top level of care. Since rich people have the resources that we don't have, they can afford to spend those resources doing what they like.

    And co-pays are not intended as fines. They're intended to deal with behavior, yes, but only because people would go to the doctor for every little thing, wasting money. However, if the rich people are willing and able to pay for everything themselves, then they are no longer wasting money - they're putting it into the system. There is no reason, however, to make a rich person spend a million dollars on a $50 doctors visit just because they're a billionaire. That's ludicrous, and will just get those rich people to go to doctors that aren't part of the national healthcare system, whether that's by hiring them privately or going out-of-country.

  9. #109
    Actually I'm not opposed--beyond my standard objection to allowing anyone to get that rich in the first place--to allowing the very rich to do whatever the fuck they want with private care, but they should have copays that provide a proportional deterrent to using the public system. That way we maintain the principle on which the system would be founded: The rich funding health care for the poor.

  10. Child's Play Donor  #110
    senile member Mac_Bug's Avatar
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    We don't have copay in Canada, we just have copay on drugs. I don't understand what you mean by people going to the doctor wasting money Langy, because if they have a problem then they will be referred for additional tests, if they don't then they just walk out of the GP's office with nothing and that GP works the same hours regardless of who shows up at the door.

  11. General Discussions Senior Member The Studio Senior Member Boardwars Senior Member  #111
    Beware of Zombified Terrorists Langy's Avatar
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    If you have more people trying to use a limited resource, that resource gets used up. This causes higher wait times, among other things.

    In other words, even in a 'free' healthcare system, a doctor's time is still worth something. More importantly, it's those tests that you mention that are so costly. They eat up time and money, and, in the US at least, doctors order many more tests than are absolutely required in order to protect themselves from lawsuits - and because they typically cost the patient nothing or near-nothing.

    Paladin: I see no reason that doctors who see patients under the national healthcare system should be prevented from seeing patients outside that system or vice-versa.

  12. General Discussions Senior Member  #112
    Senior Member roflmao's Avatar
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    Premium care is definitely a contributing factor to high healthcare costs in the US. Just in the past 30 years healthcare spending in the U.S. has doubled from 8% of GDP to 16% of GDP. How did this happen? It clearly isn't "market inefficiency" as 30 years ago the US healthcare system was even more private based than today. As much as the FDA adds to the costs of healthcare, spending on drugs doesn't account for a large percentage of healthcare spending and therefore can't be the story behind a 200% increase in spending.

    The answer is, well, more healthcare. more tests, more specialists. The problem is that you hit into a problem of diminishing returns very quickly. 2 MRIs a year per capita is certainly better than 1. That doesn't mean 150 MRIs a year per capita are better than 60. It might even be worse. More is not necessarily better.

    This is probably one of the best anecdotes when it comes to accurately summarizing the ridiculous excesses of healthcare in the US.

    And this book so concisely illustrates how much more "premium" healthcare in the US is today than it was in the 1970's. It's chock-full of awesome statistics that drive the point hard. A few examples:

    Percentage increase in number of physicians by specialty 1975-2002:
    General practice: 55%
    Pulmonary Diseases: 472%
    Diagnostic Radiology: 704%

    Growth of CT and MRI scans in the United States 1980-2003 (number of scans, millions):
    1980: 3.6 CT
    1990: 13.3 CT, 1.6 MRI.
    2003: 50.1 CT, 24.2 MRI.

    You're talking about a 376% increase in the number of CT scans in just 13 years! Nothing is free.

  13. General Discussions Senior Member  #113
    terrible, terrible damage Starfisher's Avatar
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    When I was 24, I crashed my bike and had chest pain. I went to the ER figuring I had broken some ribs. They took an EKG, which was slightly abnormal, which resulted in me getting an x-ray, a CT scan with that weird dye and an overnight stay in the hospital, followed up later with an echocardiogram.

    I was fine.

    So here's the problem - there's an non-zero chance I had some sort of actual injury to my heart, or that I had some sort of congenital disease that was manifesting itself. If those things were true, this "excessive care" would have saved my life. But none of those things were true. I was just a bruised and needed to eat some pain killers for a few days. I got charged a few thousand dollars for the experience after insurance (total bill was above $10k before insurance magic). Aggregate this behavior over an entire population, and you get some lives saved while at the same time massively inflating medical costs.

    Very few people are ever willing to make the tradeoff between potentially saving a life and potentially wasting money. In fact, if I'm remembering my studies correctly, virtually everyone, given the choice in isolation, will choose the course of action that potentially saves a life regardless of cost. To do otherwise requires you to put a price on human life, something we're trained from birth either to associate with evil, or to avoid thinking about entirely. But aggregate that over society, and eventually you can't pay for it.

    Paladin's point about preventative care is a good one as well. Catching cancer early can radically reduce the eventual cost, same with most serious illnesses. I don't think the problem here comes from people going to the doctor for "sniffles", but more from people going to the doctor for severe chest pain, and the doctor feeling obligated to assume the worst. Or from the doctor fooling themselves into thinking they're doing a good thing by prescribing the latest and greatest medication... or from a specialist getting a bit too enthusiastic about trying to make their particular hammer a good fit for every nail they come across. Or from a doctor being so narrowminded as to ignore the fact that a patient with a chronic illness is doing fine without medication and must continue on regardless just in case (happened to me, switched doctors, saved three years worth of medical expenses so far). Or hell, just from a doctor needing to make the boat payment on time.

    There's such a broad spectrum of things going on here that I think we might be facing a fundamental problem with how American culture approaches medicine - as an opportunity to profit, as a cure-all, as an abdication of responsibility to "experts" and a chance to engage in some delightful party politics. How we fix this, I don't know, but I don't think any technocratic solution is going to work. It might help a bit on the margins, but until we fix some fundamental beliefs in American I don't think the issue is going to go away.

  14. #114
    _ A _ _ _ _ LoCo's Avatar
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    http://en.wikipedia.org/wiki/Health_care_in_New_Zealand

    In 2005, New Zealand spent 8.9% of GDP on health care, or US$2,403 per capita. Of that, approximately 77% was government expenditure.[2] In a 2010 study, New Zealand came last in a study for the level of medications use in 14 developed countries (i.e. used least medicines overall), and also spent the lowest amount on healthcare amongst the same list of countries, with US$2510 ($3460) per capita, compared to the United States at US$7290.
    I'm strangely happy with that.

    People here don't go to the doctor for every sniffle. In fact most just suck it up, go in every 2-3 years for a general checkup once they start getting older (The young don't go to the doctor at all unless they can help it) or if they are in real trouble.

    Can anyone point to anything that's wrong with the NZ system?
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  15. #115
    If you have more people trying to use a limited resource, that resource gets used up. This causes higher wait times, among other things.

    In other words, even in a 'free' healthcare system, a doctor's time is still worth something. More importantly, it's those tests that you mention that are so costly. They eat up time and money, and, in the US at least, doctors order many more tests than are absolutely required in order to protect themselves from lawsuits - and because they typically cost the patient nothing or near-nothing.
    The problem here is that you're factoring a completely extraneous problem (A shortage of doctors) into your evaluation of no-charge healthcare. We have a doctor shortage. That's due to any number of other factors, and needs to be addressed separately. If we didn't have a shortfall with respect to the number of physicians, the limited resource would not feel quite so limited.

    There are several factors involved in the shortage. First is barrier to entry. We place a much more onerous burden on prospective doctors here than anywhere else. Even just comparing us to the rest of the first world, we require much longer schooling, much greater costs, and far more obnoxious apprenticeship periods (Call it internship, whatever, it's still an apprenticeship).

    Then there's the financial reality that unless you end up practicing in a private clinic in an affluent area, you're really not making much more money per hour than any number of other white collar jobs that would have been orders of magnitude easier to get into. If you end up working as a non-specialist in a hospital in a less affluent area, you might as well be working for McDonalds. And you spent 10 years of school, internship, blood, sweat, tears, abuse, and a small fortune for that?

    I and any number of high IQ friends and acquaintances who could easily have become doctors had they so chosen, all agree that we would never have even considered it. The investment/reward ratio is just awful.

    These problems can be addressed by reducing our ridiculous requirements for an MD to be comparable to the rest of the world (And address RN and NP requirements while we're at it), and by ensuring that being a doctor is fiscally rewarding, in proportion to the high investment required of the individual, and the fact that it's honestly a dirty, unpleasant job in many ways.

    A central public health service that acts as a baseline employer and a baseline for benefits, and is designed with rational analysis of cost and value, could in fact make it much more attractive for a given individual to choose medicine as a career, since there is now a (Hopefully lucrative) minimum standard of salary they can expect to receive, even if they're working in Hicktown, Farmstate, or Ghettoville, Urbania.

    That means more people will find the payout worth the investment, and we end up with many more doctors, which means less wait time, even though the citizens of Skid Row can now visit the doctor whenever their sniffles seem bad enough to justify bus fare, or taking a Saturday off for once.

    Paladin: I see no reason that doctors who see patients under the national healthcare system should be prevented from seeing patients outside that system or vice-versa.
    It depends. If you're talking about a publicly owned facility, then I disagree... If you're talking about a private facility that receives payment from a central public coverage system, I never indicated there was a problem. I'm simply talking about the copay on collective-supplied benefits. If they don't need them, there's no reason they should be using them after all. That'd be like making a big deal of bankrolling a soup kitchen, and then eating there every night


    @roflmao, Starfisher: I obviously can agree that there need to be rational limits on what treatments we provide for which problems, however, it's a bit difficult to quantify objectively, which is why we have GPs to make informed judgement calls. That said, I had the opposite of Starfisher's experience. Since I was a small child I had chronic sinus and respiratory infections. Generally several times a year. Now, part of that has turned out to have been my mother cleaning everything with bleach, and thus aggravating my asthma (Which I miraculously "outgrew" when I moved out, go figure...), but I genuinely did have chronic sinus infections which of course can develop into respiratory infections due to drip. I spent years being written off as a hypochondriac because of the frequency of my visits to the doctor, bouncing from GP to GP, witnessing the massive difference in competency between different doctors.

    If you've ever had a chronic condition you'll know the feeling of being through the looking glass because you end up knowing more about your particular problem than most of the doctors you see. If you have chronic infections, you generally get to where you can diagnose yourself with near 100% accuracy, because there's a very noticeable difference in symptoms between a cold/flu and an infection, when you've had enough experience of them to tell the difference. I saw some doctors who could identify an infection, and others who didn't seem to have clue 1. And I'm not just talking about disagreeing with me on a specific instance of diagnosis, but actually spouting blatantly incorrect information at me ("Oh no, if you had a sinus infection your tonsils would be swollen and leaking mucous"). I was constantly given antibiotic courses that I knew from experience would be insufficient (Partially due to having built up a tolerance to antibiotics due to the frequency I was having to take them, partially because of what the problem turned out to be...).

    Now, you could dismiss me as a hypochondriac, except that when I finally managed to get someone to refer me to an ear, nose, and throat specialist, he took one look into my nose, said, "Yep, you've got an infection" (Despite the doctor having told me I had no such thing just a few days prior), gave me a CT scan, discovered cysts in my sinuses and evidence of a long term pattern thereof, decided that I had an infection that had become antibiotic resistant and was simply cysting up and biding its time until I got any little cold or even a severe hay fever episode, and bursting out to re-infect my sinuses again.

    He put me on Clindamycin for about a month and a half. I have not had chronic sinus problems since.

    So the problem is that there really are unusual problems that GPs just aren't trained to deal with, and sometimes can't identify. And while there obviously has to be a point at which you draw the line before you're giving full-body scans for the common cold, it's not easy to figure out where that should be...

  16. General Discussions Senior Member  #116
    Senior Member roflmao's Avatar
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    @Starfisher:
    Exactly. The thing is that the incentive structure in the U.S. leads to overdiagnosing on a regular basis. The doctor has a strong incentive not to get sued, and has no incentive to control costs as those are covered by the insurance company or government. The patient also has no direct interest in keeping costs down and doesn't really know what tests are necessary and which aren't, and therefore just trusts what the doctor orders.

    And that's how you get a system where someone with an eye infection is sent to 8 or so different specialists for a problem that can, in 98% of cases (madeup statistic by my part), be covered with an antibiotic. I'm just going to quote the book since it concisely parrots what you said (in relationship to the insane anecdote I quoted):

    Quote Originally Posted by Book
    My guess is that 30 years ago, a patient with similar symptoms would have been treated "empirically," a term doctors use to describe a situation for which they do not have a precise diagnosis and treatment, so that instead they must use guesswork. A layman's synonym for treated empirically would be "trial and error." In this case, the patient might have been sent home with an antibiotic and perhaps a prescription for Prednisone, a steroid used to reduce inflammation. There would have been nothing else to do. In 1975, computerized medical imaging technology was new and exotic, with limited applications.

    In contrast, in 2005, over the course of a few days Quixote was given a computed tomography (CT) scan, referred to a specialist, sent to a different hospital, referred to a specialty clinic, seen by a batter of specialists there, and given yet another CT scan. Ultimately, however, she was sent home, as she might have been 30 years ago, with an antibiotic, Pednisone, and no firm diagnosis.

    The CT scans and specialist consultations could have turned out differently. They might have been critically important, depending on her actual condition. Under some circumstances, treating Quixote empirically with an antibiotic and Prednisone could have been a mistake, perhaps costing some or all of her sight in one eye.

    Such is the modern medicine in the United States. Doctors are able to take extra precautions. They can use more specialized knowledge and better technology to try to pin down the diagnosis. They can perform tests to rule out improbable but dangerous conditions. But only in a minority of cases does the outcome deviate from what would have been the case 30 years ago.

    @Paladin:
    I don't really disagree with what you said, you're exactly on the money. There isn't a specific empirical measurement that can be used to define how much examination is the "right amount."

    As utterly heartless as it sounds, the problem ultimately boils down to a cost benefit analysis. At what level of $$$ cost to society is it acceptable to let people die instead, because all of that $$$ is money that could have been spent on some other social cause that would lend more benefit in a utilitarian sense.

  17. #117
    Member Carl's Avatar
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    @Roflamo: The problem with starfishers example is that it's just silly. A "proper" doctor would have checked for the obvious first. They'd only have moved onto something like that if they had good reason to suspect something like that, or if it continued for a time beyond what would be expected of the first diagnosis. They might have done an X-Ray here in the UK to check for nothing broken. But they wouldn't have gone straight for the EKG and the like without a good reason, (i for example have a history of heart problems on both sides of the family so I’m high risk, so they'd be more likely to routinely check something like that).

    I hate to say it but it sounds like an excuse to do more in the name of doing good just to gouge money.

    Preventative care and that kind of over testing are worlds apart. The core of preventative measures is getting people to check anything that is either A) out of the norm and not explainable by obvious bumps and scrapes and common colds, or B) has those symptoms but is Essexville strong in it's symptoms. Both are signs of something potentially far more serious. Being able (like here in the UK), to just go to the doctor and get those sorted out without worrying about an immediate financial burden, makes eventual treatment of potential problems vastly easier, and cheaper, plus of course it does sometimes save lives.

    To use an actual example from IRL I’ve encountered a couple of days ago with someone I know:

    You've been out in some really strong sun and because you weren’t expecting it to be sunny you got a bit sunburned. Not badly but a littlie. The next day your chin which was one of the burned area's turns really red and a starts to weep a littlie.

    Would you normally go to the doctors with something like that?


    @paladin: that’s not unique to the US I’m afraid. When my mum was pregnant with me we both nearly died to a bad diagnosis, and my cousin nearly died a couple of years back with again bad diagnosis issues.
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  18. General Discussions Senior Member  #118
    terrible, terrible damage Starfisher's Avatar
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    Carl: Both my grandfathers died of heart attacks in their 50s, I was complaining of chest pain, and I had a mildly abnormal EKG after a pretty significant blunt impact (fell off a bike going 20 mph). They were following their established diagnostic charts to make sure they covered everything. Bizarrely enough, a friend of mine growing up discovered that he had a congenital heart defect around that age, so it does happen. I assure you it wasn't "silly".

    The question is how many people with congenital heart defects or rare impact induced heart injuries do you want to save. You will kill people at the margins with your decision, unless it's "save everyone", at which point you'll eventually bankrupt yourself.

    Paladin: I have Crohn's. I spent years taking 4+ grams of medication a day (2 pills 4 times a day, fun) in order to "maintain remission" after the initial course of steroids knocked it down a bit. Then one day I discovered some reasons to believe I might be able to maintain remission with diet and after a bit of dieting decided to go off the pills. When I told my original gastroenterologist she blew a gasket and told me that dietary intervention was impossible and that I had to stay on my pills to avoid relapse. I dumped her and went to a new guy, who floored me with the revelation that the pills I had been on hadn't actually proven to be effective in Crohn's anyway, so I might as well try. Three years later, no Crohn's and three years of expensive prescriptions saved.

    So I can sympathize with the inversion of the expert relationship a bit, just in the opposite direction: I finally stopped trusting my doc and got better on my own rather than finally finding a doc who wasn't cutting me short.

  19. General Discussions Senior Member The Studio Senior Member Boardwars Senior Member  #119
    Beware of Zombified Terrorists Langy's Avatar
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    Quote Originally Posted by Carl View Post
    @Roflamo: The problem with starfishers example is that it's just silly. A "proper" doctor would have checked for the obvious first. They'd only have moved onto something like that if they had good reason to suspect something like that, or if it continued for a time beyond what would be expected of the first diagnosis. They might have done an X-Ray here in the UK to check for nothing broken. But they wouldn't have gone straight for the EKG and the like without a good reason, (i for example have a history of heart problems on both sides of the family so I’m high risk, so they'd be more likely to routinely check something like that).
    An EKG is dirt-cheap; the expense came from that CT scan and overnight in the hospital.

    Starfisher is right about needing to put a price on life. This whole discussion is mostly niggling about what that price should be and who should pay it.

    Also: What do you mean about the chin weeping? Do you mean bleeding? If my chin was bleeding due to a sunburn you bet your ass I'd go to the hospital; that's not supposed to happen.

  20. #120
    Starfisher: If you had a family history and your EKG read oddly after that impact, I'd say that the tests were fairly justified. It's not like that would come up often enough to cause massive overspending. Its going to be fairly rare for an EKG to come back looking abnormal and turn out to be nothing. That's why we use them as a first line triage sort of test.

    I think it's probably fair enough if we treat potential cardiac symptoms with diligence and care, because the warning signs of impending death can be very subtle when it comes to heart problems. It doesn't bother me that when I've been waiting in Urgent Care for an hour or whatever and someone comes in with any sort of chest pain complaint he gets whisked directly in and hooked up to an EKG. It's obvious that that guy should be checked immediately and my sinus infection or whatever can wait a little longer. Same sort of deal, you just don't mess around with cardiac symptoms.

  21. #121
    Member Carl's Avatar
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    @Starfisher: That’s a very different thing. Like I said my family on both sides has had heart trouble. My mum, all her sisters, her dad, and all her dads brother have all been diagnosed with heart or circulatory issues before they where 40. Several of my granddads brothers died before they where 40 due to heart attacks. I've had an EKG at a similar age because of severe chest pains one time. So i understand fully there are good reasons for doing it. I just didn't know that was true in your case.

    As paladin points out since it came up abnormal there where sound reasons for doing more tests, (for some reason i missed the abnormal result part last night, sorry). But under normal circumstances, (like my case), where the EKG turned up normal they didn't do anything else. Paladins also correct, that shouldn't come up anywhere near often enough to be an issue. EKG's being abnormal is pretty odd, and a genuine cause for concern.

    EDIT:

    @Langly: I mean as in weeping. You know you touch it and it feels a bit wet.

  22. General Discussions Senior Member The Studio Senior Member Boardwars Senior Member  #122
    Beware of Zombified Terrorists Langy's Avatar
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    'Weeping' does not mean 'wet', Carl. It means 'crying', and chins can not physically cry. Maybe you mean 'sweating'? Going to the doctor's just because you're sweating doesn't seem reasonable. Same with your chin being red; a sunburn makes the burned areas red, after all. If it was something truly off-the-wall weird, then sure, go to the doctor's to get checked out - but don't go just because normal body functions are happening.

  23. #123
    _ A _ _ _ _ LoCo's Avatar
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    Langy: I think when your chin is sweating after getting a sunburn that constitutes 'truly off-the-wall weird'. It may be an indication that the chin was burned rather badly or that there is a bad reaction to the cream or something that was put on after. It's hard to tell without more info. But your chin sweating? That's just weird. I have a beard and my chin doesn't sweat. Ever. So even discounting the sunburn, chin sweat is not normal.

  24. #124
    Member Carl's Avatar
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    It's hard to explain langly, (weeping is the term we use in the UK BTW). The most common time you see it (at least for me), is if you graze yourself but not deep enough to draw blood. The damaged area of skin will often "weep" a clear water like liquid for a bit till it forms a cover. But it can happen with all sorts of things. In this case it was weeping constantly

    Guess it will be easier to tell the story. Basically a young lady i know via my work travels had suburnt her chin over the weekend, a couple of days later when i ran into her going for a fast food trip after work it was still weeping and looked a pretty angry red. Wasn't yellow or anything, and burns do (at least for me), rarely do that for a bit, but it was concerning so when it wasn't any better after another day she went to get it checked out. I found out via her work mates on Monday that she's now on mandatory sick leave because it turned out the weeping was the result of a very infectious skin disease which takes advantage of things like burns, (I can’t remember the proper name, was something impossible for me to pronounce), that’s very easily spread. For health and safety reasons she therefore can't work because she'd almost certainly infect anyone she served if she touched something after touching her chin.

    By getting it detected and sorted promptly she’s minimized or possibly prevented anyone else becoming infected. Had she just dismissed it as harmless the result would have been a lot more people infected, (who if they dismissed it could have spread it to others and so on). It could of course have just been an unusual type of burn, they're rare but they happen. But as that case shows it's a lot better for a bunch of people to get a harmless burn, (or other skin injury that’s behaving a littlie unusually), checked than miss the one person with an infectious form of skin infection that then infects and bunch more people, (and so on and so forth), since the later ends up costing a lot more to treat than a bunch of checkups. Not to mention the number of cases will produce more checkups in the end anyway.

  25. #125
    Forum Farseer Akranadas's Avatar
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    Wounds can weep fluid Langy, and if a wound, sore or scratch is indeed weeping fluid, it is something to go get looked at.

    Think of weeping in this context as oozing, but not as much.

  26. General Discussions Senior Member The Studio Senior Member Boardwars Senior Member  #126
    Beware of Zombified Terrorists Langy's Avatar
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    Ah. Yeah, it's not at all normal for any sunburn to ooze puss. The original description didn't sound at all all that abnormal, but now that it's been explained a bit, yeah, it does.

  27. #127
    Member Carl's Avatar
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    Ah. Yeah, it's not at all normal for any sunburn to ooze puss. The original description didn't sound at all all that abnormal, but now that it's been explained a bit, yeah, it does.
    I wasn't talking about pus, like I said it just looks like water, (but it's visibly different from sweat, different movement and no smell ). It’s hard to describe if you’ve never seen it.

  28. General Discussions Senior Member The Studio Senior Member Boardwars Senior Member  #128
    Beware of Zombified Terrorists Langy's Avatar
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    Quote Originally Posted by Carl View Post
    I wasn't talking about pus, like I said it just looks like water, (but it's visibly different from sweat, different movement and no smell ). It’s hard to describe if you’ve never seen it.
    Sorry, from your description of what happened it sounded like pus - junk that gets caught up in an infected wound, which is what she had. I did a little research and I guess it's blood plasma? *shrug*

  29. #129
    Member Carl's Avatar
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    Sorry, from your description of what happened it sounded like pus - junk that gets caught up in an infected wound, which is what she had. I did a little research and I guess it's blood plasma? *shrug*
    No problem, if you've never encountered it personally then i can't blame you for being confused, must sound odd if you’ve never heard of it. I've had fungal skin infections that weeped a mucky version of the same liquid, plus I get the clear version with all sorts of cuts and scrapes so i'm familiar with it. Also interesting if it is blood plasma.

  30. #130
    It is blood plasma, when there's a breach that's too small for your red blood cells to fit through blood pressure still forces the liquid they're suspended in through it. You end up with a clear slightly yellowish liquid coming out instead of red blood.

  31. Child's Play Donor Technical Help Senior Member General Discussions Senior Member Homeworld Senior Member Forum Subscriber  #131

  32. Child's Play Donor Technical Help Senior Member General Discussions Senior Member Company of Heroes Senior Member Forum Subscriber  #132
    Hydra's Super Marshal GeoffS's Avatar
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    A lot of the arguments being given here against Obamacare seem to be more to do with the cost of health care in the US than the principle of having some form of universal health care system. Here is an interesting article about the inequities in treatment in the US due to costs. It seems to me that attacking the problem of the high cost of health care first would make the introduction of universal health care a whole lot easier.


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    heralds new discoveries, is not 'Eureka!' but 'That's funny...'
    Isaac Asimov

  33. General Discussions Senior Member The Studio Senior Member Boardwars Senior Member  #133
    Beware of Zombified Terrorists Langy's Avatar
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    The problem with that, GeoffS, is that nobody seems to be able to agree on what can be done in order to reduce the cost of health care in the US.

  34. #134
    Member TDATL's Avatar
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    Universal health care is different than government mandated health insurance. I would far rather we had the former than the latter.
    You must be the change you want to see in the world.
    -Mahatma Gandhi

  35. Gamers Lounge Senior Member Boardwars Senior Member  #135
    Moe~ money, moe~ problems Mokino's Avatar
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    That's what Obama originally pushed for. America ended up with the latter due to the Republican dominated congress.

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