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The Inaugural Medical Debate: Would you rather be ill in America or the UK? Watch

  • View Poll Results: Would you rather be ill in America or the UK?
    America
    2
    9.52%
    UK
    19
    90.48%

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    (Original post by digitalis)
    is it fair that a taxpayer should pay for a serial boozer/IVDU/obese bla bla bla patient?
    yes becuase there is no way of ever drawing the line of what a person ios resonsible for (e.g. should you then pay if you didn't use suncream and got skin cancer, or chose to go skiing and broke a leg)

    I did however like the suggestion of some docotr/policitican (can't remember who said it), that instead of the fines which have been proposed for people admitted for A&E for alcohol (which IMO would be impossible for doctors to impose), that people who are admitted because they drank too much should be made to go on a alcohol awareness course.
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    (Original post by *tink*)
    I did however like the suggestion of some docotr/policitican (can't remember who said it), that instead of the fines which have been proposed for people admitted for A&E for alcohol (which IMO would be impossible for doctors to impose), that people who are admitted because they drank too much should be made to go on a alcohol awareness course.
    Surely that has completely the opposite to a fine though, because then the taxpayer is effectively paying twice - once for the treatment and once for the course.
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    depends on who you are. If you prefer not to spend money or aren't that well off then the UK for obvious reasons. However if you don't mind spending money for the very best treatment plan then the US. The NHS is under pressure to buy medicine which are cost-effective. For example, if a drug company creates a pill which extends the life of a cystic fibrosis sufferer on average by 1 week compared to current treatment plans, but the pill is very expensive, hospitals most likely won't be giving it to patients.
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    (Original post by *tink*)
    yes becuase there is no way of ever drawing the line of what a person ios resonsible for (e.g. should you then pay if you didn't use suncream and got skin cancer, or chose to go skiing and broke a leg)
    Aha, but this is exactly the point I was making. Surely the person who went skiing and broke a leg, or went out in the sun without sunblock should pay for their own health problems, rather than making others pay for it?

    The elderly gentleman who has lead a healthy life and has never been to a doctor in his life (unlikely, but theoretically possible) will resent paying a large part of his tax bill on behalf of the care of others.

    The American (essentially market driven system) is popular because each person accepts that their health is their own business, and many are happy to pay for private insurance/treatment because it is payment for "their" illness, not others. It also allows choice in your healthcare: you don't like the service provided by one doctor? You (and others) leave him for a competitor (driving down his fees). You want to see an eminent cardiologist for your high blood pressure? You can have it!
    You are not forced to take the cheapest option that is currently present in the NHS.

    It also allows people to put a price on their own health. Considering the fact that there is state provided Medicare for the elderly and medicaid for the destitute (establishing a baseline level of care), any insurance taken out over this signifies a price on their perception of their health/ill health. (see "The Undercover Economist by Tim Harford) The reason why insurance premiums are so high in the US is that there is an uneven skew in insurance uptake.

    For example, young people don't think they are going to get ill (and statistically, they are less likely to) so they don't take out insurance, opting for "pay as you go" treatment. The middle aged and elderly know they are going to get ill so take out insurance, and of course they claim more, driving insurance premiums up as the sector of the market who own lot of the insurance is the high-claiming, middle to elderly population!

    Don't be fooled by the fact that you don't outright pay for health in the UK-the 120,000,000,000,000 that is spent on health in the UK has to come from somewhere!

    Much better is the Singapore health system...should be adopted worldwide!

    1.) There are mandatory health savings accounts: “Individuals pre-save for medical expenses through mandatory deductions from their paychecks and employer contributions… Only approved categories of medical treatment can be paid for by deducting one’s Medisave account, for oneself, grandparents, parents, spouse or children: consultations with private practitioners for minor ailments must be paid from out-of-pocket cash…”

    2.) “The private healthcare system competes with the public healthcare, which helps contain prices in both directions. Private medical insurance is also available.”

    3.) Private healthcare providers are required to publish price lists to encourage comparison shopping.

    4.) The government pays for “basic healthcare services… subject to tight expenditure control.” Bottom line: The government pays 80% of “basic public healthcare services.”

    5.) Government plays a big role with contagious disease, and adds some paternalism on top: “Preventing diseases such as HIV/AIDS, malaria, and tobacco-related illnesses by ensuring good health conditions takes a high priority.”

    6.)The government provides optional low-cost catatrophic health insurance, plus a safety net “subject to stringent means-testing.”

    7.)Almost all care is subject to significant co-pays.
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    (Original post by digitalis)
    Aha, but this is exactly the point I was making. Surely the person who went skiing and broke a leg, or went out in the sun without sunblock should pay for their own health problems, rather than making others pay for it?
    but the point is where do you draw the line? e.g someone who smoked 10 years when they were in their 20s and has a heart attack aged 50 - is that their fault? Or what about the person who has never smoked, is not overweight but has never done any exercise? A man who gets lung cancer, has never smoked, yet their wife has? An obese child who was fed junk food by their parents and then develops type II DM at 17years old?

    and how are you going to find out if people are telling the truth? "No doctor I have never smoked" yet they have nicotene stained fingers... "yes doctor I used sun cream and have never used a sunbed"

    Also its very often lower social classes who make the wrong health-related decisions. We would be further creating a split between classes
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    (Original post by *tink*)
    but the point is where do you draw the line? e.g someone who smoked 10 years when they were in their 20s and has a heart attack aged 50 - is that their fault? Or what about the person who has never smoked, is not overweight but has never done any exercise? A man who gets lung cancer, has never smoked, yet their wife has? An obese child who was fed junk food by their parents and then develops type II DM at 17years old?

    Cause or line drawing has nothing to do with it. The principle is "you have it, you pay for it". If you discount the ethical debates surrounding it, it is quite a sound principle and hence why it is popular in a population who's day to day existence has been shaped by a free market. It goes back to the whole freedom/independence mentality: you have something, it's your business.

    The problem (which Obama is trying to solve with the public option-compulsory insurance for everyone, either public or private) is what I outlined above. Basically the only people paying for good quality insurance are the people most likely to claim, which of course is going to raise premiums and exclude cover.



    and how are you going to find out if people are telling the truth? "No doctor I have never smoked" yet they have nicotene stained fingers... "yes doctor I used sun cream and have never used a sunbed"
    Well this is a question of imperfect information (again, paraphrasing from the excellent book I quoted above. Of course people have far more information about their own health when filling out insurance questionnaires and the insurance companies have tricks to gain a more even footing: e.g. for smoking, carbon monoxide levels.

    There is an even stronger incentive not to lie on your form: if you get caught, they won't pay and your premiums will have gone to waste.


    Also its very often lower social classes who make the wrong health-related decisions. We would be further creating a split between classes This is America, remember. They vast majority have no interest in socialist ways of thinking.
    ..
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    Just realised I've never posted my views on here.

    The idea of a national health service is something that I truly adore. The NHS does have it's failings, and they are numerous - but it always has, and it probably always will. But it will always be just good enough to carry on. It will, for the most part, get care to those who need it, when they need it.

    In contrast, the American system is very much a market driven system. As some people have said, research will progress faster there because of this. But I don't see why this is such a big deal as some people make out - very often the origin of research will have little effect on how quickly that technology comes into practice in a location. But these markets come at a cost. In some ways, the treatment afforded to those who live in the richest country in the world is barely third world standard. This is appalling, that a civilised country can be happy for those who fall out of society to not be treated to medical care they need.

    I guess it comes down to whether you would rather be seen as a patient or a price tag. And I for one know that when I have to call an ambulance for someone I want their first question to be what is wrong with the person, not the type of insurance they have.
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    (Original post by digitalis)
    ..
    sorry, I took the wrong approach through not reading it all through properly - i.e. charging people in an nhs based system for conditions caused through health decisions rather than the american insurance system the whole thread is about :o:
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    (Original post by digitalis)
    What about the flipside to that...is it fair that a taxpayer should pay for a serial boozer/IVDU/obese bla bla bla patient? The proponents of the American healthcare system that equity is delivered when each person pays for their own issues and doesn't prop up anyone else.

    (Just a catalyst for debate ps )
    You could say that, but then you are getting into a whole other ballpark of morals and stuff.

    Though also, you could also say that when people are sick when they are young, curing them is good for the economy because they are generating wealth for the country by working etc., and when people are old their healthcare is a repayment to their contribution to society and the economy ?
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    (Original post by miranda-ae)
    You could say that, but then you are getting into a whole other ballpark of morals and stuff.

    Though also, you could also say that when people are sick when they are young, curing them is good for the economy because they are generating wealth for the country by working etc., and when people are old their healthcare is a repayment to their contribution to society and the economy ?
    An interesting theory! :teeth:

    But in my post take haze, I see two flaws:

    1.) Where do the people who have a negative effect on the economy fit in? (The professionally unemployed, the student of cirrhosis etc)
    2.) Surely providing healthcare by your model is inefficient as it provides rewards twice for the same thing? (Healthcare for contributing and healthcare again for rewarding)
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    In the UK you can currently have healthcare without being worried about the costs.
    Until the USA socialises healthcare, I'm sticking with the UK.
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    has anyone seen the movie by the fat american guy on the american healthcare system? its quite good, i think the guy is called michael something

    america will never give up the capitalist way, so the poor people will lose out >(
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    (Original post by Onychophagia)
    Possibly, yeah.

    Do you not think that, in the NHS, doctors may possibly be under more pressure to prescribe a less effective treatment because it's cheaper or may not be the best treatment in terms of benefit to the society as opposed to benefit to the individual?
    Its a bit of both in practice to my understanding, while most embarrassingly I can't find the study one of our lecturers in first year spoke at length about how the US practice of CT scanning all children who have been knocked out can be shown to do more harm than good, yet continues as its a good money spinner.

    If remember the study name later I'll try and dig it out.
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    (Original post by terpineol)
    Its a bit of both in practice to my understanding, while most embarrassingly I can't find the study one of our lecturers in first year spoke at length about how the US practice of CT scanning all children who have been knocked out can be shown to do more harm than good, yet continues as its a good money spinner.

    If remember the study name later I'll try and dig it out.
    There seem to be numerous cases of this sort of thing.

    The example I'm most familiar with is PSA over-testing in the states. The FDA approved the PSA test for annual screening of prostate cancer in men of age 50 and older. While an elevated PSA reading may indicate a life-threatening cancer, it may also detect much slower moving tumors that would never cause death: most men would be dead of something else before the cancer progressed. Because the test doesn't offer any way of telling how aggressive the cancer is, treatments are often ordered that can impair men's quality of life. On top of this, The test has a notoriously high rate of false positives.

    One NEJM study, which followed almost 80,000 American men for seven years, found no reduction in prostate cancer deaths among those who had regular PSA tests, compared to men who made no special attempt to have such tests.

    This is treatment for treatments sake if ever I've seen it. DRE FTW.
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    (Original post by digitalis)
    An interesting theory! :teeth:

    But in my post take haze, I see two flaws:

    1.) Where do the people who have a negative effect on the economy fit in? (The professionally unemployed, the student of cirrhosis etc)
    2.) Surely providing healthcare by your model is inefficient as it provides rewards twice for the same thing? (Healthcare for contributing and healthcare again for rewarding)
    Well, I know its not perfect, but basically it would be hard (and probably just as expensive as treating them) to work out who to exclude.
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    (Original post by digitalis)
    An interesting theory!

    But in my post take haze, I see two flaws:

    1.) Where do the people who have a negative effect on the economy fit in? (The professionally unemployed, the student of cirrhosis etc)
    2.) Surely providing healthcare by your model is inefficient as it provides rewards twice for the same thing? (Healthcare for contributing and healthcare again for rewarding)
    In the current climate it dosn't take much for anyone to become dans le merd...
 
 
 
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