How would a Romney/Ryan budget change the funding of dialysis in the US?

[Bill Peckham]

Granted the President doesn't write the budget he will sign but given what we know about Romney/Ryan preferred budget direction let's assume a budget comes to President Romney's desk that is broadly similar to the budgets the House has already voted on and passed.

One question about the Romney/Ryan proposal for CMS is the ESRD entitlement, would it exist if their budget passed into law? We can't be sure because the budget bills that the House voted on contained broad funding directions, the nitty gritty was left to work out and the provision of dialysis is definitely part of the nitty gritty. So it would depend how the legislative language is written but it would be consistent with the Romney/Ryan vision for the legislation to wind down the ESRD program by 2022 and have dialysis services covered/funded by the private health insurance their plan would fund. Would it be better if dialysis was funded in the same way as the rest of healthcare? Would it be better if there wasn't an ESRD entitlement?

The other consideration is that beyond the actual funding of dialysis, we should consider the other elements of CMS's ESRD program. For instance, there is the issue of the regulations that currently govern dialysis. In general the Romney/Ryan ticket is talking about unleashing healthcare by rolling back regulations. One of their complaints about CMS's involvement in healthcare is that CMS 'dictates' how care is provided and what constitutes a specific billable service. Would the provision of dialysis be improved if there were no Conditions of Coverage? Should the survey requirements and standards of care be up to each state?

On the reimbursement side I'm not sure. Changing to a system funded by private insurance would, I think, increase the resources available to providers. Maybe by a lot. And more money coming to the provision of dialysis could mean better care and better options for more people.

On the regulatory side I say no. I think the current system gives us the levers we need to improve care, we just have to develop policies that use them, something that takes time and a lot of work. In general I think that the process that has grown up around the ESRD entitlement to do the regulatory jobs that need to be done, for instance, setting reimbursement rules, Conditions for Coverage, contracting the Networks, is not a perfect way to do what needs to be done but it achieves better results than any known alternative, including turning the job over to the 50 States.

Knowing what you know about the provision of dialysis what do you think is the way forward to improve outcomes?

[Hemodoc]

Bill,

Conditions for coverage has NOT improved care with the perverse financial incentives of the current and recent systems.  There isn't anything in the 2008 CFCs that is incorrect at all, but they have added to the burden of care without improving the lives of dialysis patients.

Further regulations are not the answer, aligning financial incentives is as I believe we all agree.

[Bill Peckham]

Bill,

Conditions for coverage has NOT improved care with the perverse financial incentives of the current and recent systems.  There isn't anything in the 2008 CFCs that is incorrect at all, but they have added to the burden of care without improving the lives of dialysis patients.

Further regulations are not the answer, aligning financial incentives is as I believe we all agree.

Are the 2008 Conditions for Coverage worse than none at all? Given states wouldn't have the same payer leverage that CMS has, what would be a way for states to improve the situation?

There is stuff in the current CfC, around life safety codes and charting, that CMS has deemphasized tht one hopes will save wasted clinical time and effort but there is also a lot of good stuff in the CfC e.g. around patient rights, infection control, treatment options, water quality, case management, that is critical for safe, healthy dialysis, I can't see the states doing a better job with fewer tools at their disposal.

[Rerun]

When I started dialysis in 1987 they brought us hot lunch, there were more staff per person on dialysis, there was an ice machine there were classes on dialysis.

All that is gone now.  Do you think any of that will come back.  NO!

They are in this business to make money.  Patient care is kind of there because they have to.

[Hemodoc]

Bill,

Conditions for coverage has NOT improved care with the perverse financial incentives of the current and recent systems.  There isn't anything in the 2008 CFCs that is incorrect at all, but they have added to the burden of care without improving the lives of dialysis patients.

Further regulations are not the answer, aligning financial incentives is as I believe we all agree.

Are the 2008 Conditions for Coverage worse than none at all? Given states wouldn't have the same payer leverage that CMS has, what would be a way for states to improve the situation?

There is stuff in the current CfC, around life safety codes and charting, that CMS has deemphasized tht one hopes will save wasted clinical time and effort but there is also a lot of good stuff in the CfC e.g. around patient rights, infection control, treatment options, water quality, case management, that is critical for safe, healthy dialysis, I can't see the states doing a better job with fewer tools at their disposal.

Not what I was approaching Bill. Regulations, more or the lack thereof don't seem to matter as far as improving care. If they did matter, the massive 2008 CFC's would have shown improved care now 4 years later. As you and I know, they have added 40% more time to the inspections and reduced the efficiencies of the over sight groups but I have yet to see improved care.

We both agree that there needs to be an improvement in the financial incentives. Interestingly, the LDO's are pushing for an incentivized system as well. It works at the Kaiser/FMC facilities already. It is not an unknown development, but instead, there are many examples of how aligning financial incentives for improved care does actually improve care.

It was the misalignment of financial incentives in the 1973 ESRD program that drove people from a home hemodialysis setting into conventional in-center hemodialysis instead. I seriously doubt adding any more regulations will improve any health care outcomes. Instead, the massive burden of following all of these regulations subtracts from purely clinical care to the patients. Yes, there is a need of regulations, but the 2008 CFCs are construed throughout the industry as too burdensome and not any more effective improving outcomes.

You and I saw that with the Medicare conference we both participated with a few months back. Even CMS inspectors complain about the burdensome regulations. I believe that speaks loudly.

[Bill Peckham]

When I drilled into what was taking more time, a lot of it was the time it took to talk to actual patients. Which is time well spent IMO. The question I think you should ask is was the problem that they weren't spending enough time in 2008? The states don't like the surveying because it isn't funded by the feds but that was by design going back to the original legislation in 1963.


The regulatory problem with Romney/Ryan plan for Medicare is that it does not replace the current tools, it devolves the job to the states and their insurance commissioner, or whoever signs off on insurance plans. Personally I think Washington State would do a fine job under that approach but that's not good enough. I'd prefer that people in every zip code in the US have the same options I do. Doing away with Medicare's primary roll in ESRD would lead to worse care nationally but there would be pockets of excellence.

[Whamo]

My fear is that a global economic slowdown will squeeze dialysis out of the budget.  Romney/Ryan would certainly cut us out of the picture.  Even Obama may be forced to make deep cuts.

[jbeany]

Knowing what you know about the provision of dialysis what do you think is the way forward to improve outcomes?

Vote for Obama.

Okay, seriously, Romney and Ryan's - especially Ryan's - budget plans scare the stuffing out of me.  I already think the Ryan plan to balance the budget involves just letting people starve to death to get them off welfare.  There's a report out that estimates that in order to make up the food shortage caused by his planned cuts to food stamp programs, every single church in the country would need to provide $50,000 worth of food, every year, for the next 10 years.  EVERY church in America.  (If you attend one, do you think yours can afford that?) 
If that's his plan for healthy people who can't afford something as basic as food, I shudder to think what he would have planned for those of us sucking up both Social Security Disability funds as well as Medicare.

[PatDowns]

Vote for Obama.

Okay, seriously, Romney and Ryan's - especially Ryan's - budget plans scare the stuffing out of me.  I already think the Ryan plan to balance the budget involves just letting people starve to death to get them off welfare.  There's a report out that estimates that in order to make up the food shortage caused by his planned cuts to food stamp programs, every single church in the country would need to provide $50,000 worth of food, every year, for the next 10 years.  EVERY church in America.  (If you attend one, do you think yours can afford that?) 
If that's his plan for healthy people who can't afford something as basic as food, I shudder to think what he would have planned for those of us sucking up both Social Security Disability funds as well as Medicare.

First of all, Romney, as the president, will set the agenda, not Ryan.  Secondly, at least Ryan brought a starting point to the table.  As far as the Medicare program goes, no matter who is our next president, there will be no solutions - only trade-offs.

We already know the potential effect of the Patient Protection and Affordable Care Act (ObamaCare) on esrd patients.  It calls for the creation of the Independent Payment Advisory Board.  Its mission is to curb the growth of Medicare and find savings in the following areas: Medicare Advantage, Medicare Part D prescription drug program, skilled nursing facility, home health, dialysis, ambulance and ambulatory surgical center services, and durable medical equipment.

Gov. Romney, if elected, would like to repeal ObamaCare while assuring the future viability of the Medicare program.  We know for sure he would extend the current program to those over 55 and offer those 55 and under the option of either staying in traditional medicare or opting out for a voucher type system.   Further details would be worked out with congressional input - from both sides of the aisle - not by shoving something down our throats like Obama did.  Skeptical?  Well, Romney did it as governor of Mass. when his state house of representatives and senate was 87% democratic.

However, esrd patients shouldn't feel too bad.  Fresenius (#1),  Davita (#4), National Renal Administrators Assoc. (#50) and Dialysis Clinic, Inc.(#60) (yes, a "non-profit") have spent millions of dollars lobbying both sides of the aisle for "us."  How we hate them - how we need them. - http://www.opensecrets.org/lobby/indusclient.php?id=H03

As far as the food stamp program, you really need to check out the fraud, abuse and waste going on.  Those who are truly in need will continue to receive help.

[Ricksters]

All I can say is that I am more afraid of Obamacare than what Romney/Ryan will do.  I listen to my son-in-law, who is a nephrologist talkling about how he will have to stop taking new Medicare patients if the new cuts go into effect....Can't see how this farcse of a law is helping anyone.   IMHO, of course.

Ricki

[jbeany]

First of all, Romney, as the president, will set the agenda, not Ryan.  Secondly, at least Ryan brought a starting point to the table.  As far as the Medicare program goes, no matter who is our next president, there will be no solutions - only trade-offs.

Gov. Romney, if elected, would like to repeal ObamaCare while assuring the future viability of the Medicare program.  We know for sure he would extend the current program to those over 55 and offer those 55 and under the option of either staying in traditional medicare or opting out for a voucher type system.   Further details would be worked out with congressional input - from both sides of the aisle - not by shoving something down our throats like Obama did.  Skeptical?  Well, Romney did it as governor of Mass. when his state house of representatives and senate was 87% democratic.


As far as the food stamp program, you really need to check out the fraud, abuse and waste going on.  Those who are truly in need will continue to receive help.

Hmmm....Yes, in theory, it's Romney's budget.  It's also his choice for VP - a man who is perpetually one heart attack away from running the county.  I do not find this encouraging.

Romney's already disowned what he did with Massachussets health care - which is remarkably like Obamacare - so I have my doubts he'll do anything similar with the country.

I realize the food stamp program, like many welfare programs, has problems.  But Ryan's goal is to cut it drastically, not enforce the rules and kick out the cheats.  I have no confidence at all that those in need will still get sufficient help.  None.  The Nuns on the Bus aren't driving around because the Republican plan is going to help the poor work their way into the middle class.

IMHO, of course.

Ricki

Thought that was given on this board!     I don't ever expect to change anyone's mind on here - I just like to discuss the issues.  I'm usually so middle of the road on politics, I like to hear both sides.  The health care issue is so complex, I'm not sure I'm ever going to wrap my mind around all of it - but my overall impression of all the major issues this time leaves me pretty certain I'm going to be voting for all Democratic candidates next month.  This is not my usual voting procedure.  I tend to look across party lines and never do a straight party vote.

I had a conversation with one of my dearest, die-hard, extremely left-wing Democrat friends over the weekend.  We completely agree on candidates for once, but totally disagree on every single state proposal up for vote in Michigan this year.  I'd read through everything I could find about both sides of the proposals, and made up my mind a couple of weeks ago.  Yesterday, I read an article in the paper about where Michigan's current governor stands on all of them.  I'm voting the same way he's arguing for on all of them.  And he's Republican.  No wonder my friend was practically shouting at me when we were talking about the proposals.     Ah, the joys of having been both a business owner and a welfare recipient....

[Willis]

My fear is that a global economic slowdown will squeeze dialysis out of the budget.  Romney/Ryan would certainly cut us out of the picture.  Even Obama may be forced to make deep cuts.

We really have no way to know what Romney would do. So to say that he would do anything with certainty is mere speculation. We DO know (kind of) what's coming under the current admin via ObamaCare. (We can call it that since Obama himself blessed the term in the last debate.) And one element of that is the $600 billion that ObamaCare is taking out of Medicare--the President didn't even dispute that during the debate!

I believe our country needs to do something or rather than trying to defend Medicare we are going to be defending our homes and families. There is no money. Most of what the government spends is borrowed. It has become a giant Ponzi scheme and collapse is inevitable. If that happens you better be stocked up on ammunition, food, and water and be prepared to defend it.

Perhaps if painful cuts (actual cuts, not just reductions in proposed increases) were to occur ACROSS THE BOARD it may not be too late. Start with scaling back to 2007 budget numbers and then cut 10% per year. Keep taxes exactly where they are now (i.e., the Bush rates). No one gets singled out.

Maybe budget cuts or an economic collapse will cut off my dialysis and lead to a long and lingering death. But if nothing is done it's equally likely that I will die fighting off rioting marauders looking for food because the dollar has become worthless.

 

[Bill Peckham]

Willis how can you be against the sort of savings the ACA Obamacare captured but in favor of painful across the board cuts? If we can't scale back Part C overpayments (the largest source of ACA Obamacare savings) then what can we do to  make Medicare more efficient? Would you be in favor prescription drug formularies? I would be.

My fear is that a global economic slowdown will squeeze dialysis out of the budget.  Romney/Ryan would certainly cut us out of the picture.  Even Obama may be forced to make deep cuts.

Maybe budget cuts or an economic collapse will cut off my dialysis and lead to a long and lingering death. But if nothing is done it's equally likely that I will die fighting off rioting marauders looking for food because the dollar has become worthless.

 

I agree both scenarios are equally likely. And for a third, with a similar likelihood, I'd say DaVita going nonprofit.

[cariad]

Maybe budget cuts or an economic collapse will cut off my dialysis and lead to a long and lingering death. But if nothing is done it's equally likely that I will die fighting off rioting marauders looking for food because the dollar has become worthless.

 

I agree both scenarios are equally likely. And for a third, with a similar likelihood, I'd say DaVita going nonprofit.

Love this response, Bill. Genius!

[jbeany]

Maybe budget cuts or an economic collapse will cut off my dialysis and lead to a long and lingering death. But if nothing is done it's equally likely that I will die fighting off rioting marauders looking for food because the dollar has become worthless.

 

I agree both scenarios are equally likely. And for a third, with a similar likelihood, I'd say DaVita going nonprofit.

Love this response, Bill. Genius!

If we're going with those odds, Bill, I'm betting on the zombie apocalypse happening too....   

[MooseMom]

All I can say is that I am more afraid of Obamacare than what Romney/Ryan will do.  I listen to my son-in-law, who is a nephrologist talkling about how he will have to stop taking new Medicare patients if the new cuts go into effect....Can't see how this farcse of a law is helping anyone.   IMHO, of course.

Ricki

Why would your son-in-law HAVE to stop taking new Medicare patients when the ACA goes into effect?  Is someone holding a gun to his head or something?  I thought everyone wanted to put a break on the escalating costs of health care AND "reform Medicare".  Is your son-in-law's practice part of the problem?

[jbeany]

All I can say is that I am more afraid of Obamacare than what Romney/Ryan will do.  I listen to my son-in-law, who is a nephrologist talkling about how he will have to stop taking new Medicare patients if the new cuts go into effect....Can't see how this farcse of a law is helping anyone.   IMHO, of course.

Ricki

Why would your son-in-law HAVE to stop taking new Medicare patients when the ACA goes into effect?  Is someone holding a gun to his head or something?  I thought everyone wanted to put a break on the escalating costs of health care AND "reform Medicare".  Is your son-in-law's practice part of the problem?

Easy there, MM - no personal attacks allowed on here, remember?   *jbeany, speaking in her moderator/mom voice*   

Besides - it costs more to treat a Medicare patient than Medicare usually pays.  As a bottom line issue, all Medicare patients and not enough private payers means the doc no longer makes enough money to pay overhead.  While I'm sure many docs could afford to lower their salaries a bit - their student loans are not exactly cheap, and not many of their staff tend to be horrendously overpaid.  Plus, if he has partners or is part of a larger health care group, how much profit he's required to bring in may not be entirely up to him.

[Bill Peckham]

All I can say is that I am more afraid of Obamacare than what Romney/Ryan will do.  I listen to my son-in-law, who is a nephrologist talkling about how he will have to stop taking new Medicare patients if the new cuts go into effect....Can't see how this farcse of a law is helping anyone.   IMHO, of course.

Ricki

Why would your son-in-law HAVE to stop taking new Medicare patients when the ACA goes into effect?  Is someone holding a gun to his head or something?  I thought everyone wanted to put a break on the escalating costs of health care AND "reform Medicare".  Is your son-in-law's practice part of the problem?

Easy there, MM - no personal attacks allowed on here, remember?   *jbeany, speaking in her moderator/mom voice*   

Besides - it costs more to treat a Medicare patient than Medicare usually pays.  As a bottom line issue, all Medicare patients and not enough private payers means the doc no longer makes enough money to pay overhead.  While I'm sure many docs could afford to lower their salaries a bit - their student loans are not exactly cheap, and not many of their staff tend to be horrendously overpaid.  Plus, if he has partners or is part of a larger health care group, how much profit he's required to bring in may not be entirely up to him.

I wonder if you meant Medcaid reimbursement Ricki? I do think people relying on Medicaid will have fewer care options than those with Medicare or private health plans but it will still be more and better options than those with no insurance and no means to self-pay.

[cariad]

All I can say is that I am more afraid of Obamacare than what Romney/Ryan will do.  I listen to my son-in-law, who is a nephrologist talkling about how he will have to stop taking new Medicare patients if the new cuts go into effect....Can't see how this farcse of a law is helping anyone.   IMHO, of course.

Ricki

Why would your son-in-law HAVE to stop taking new Medicare patients when the ACA goes into effect?  Is someone holding a gun to his head or something?  I thought everyone wanted to put a break on the escalating costs of health care AND "reform Medicare".  Is your son-in-law's practice part of the problem?

Easy there, MM - no personal attacks allowed on here, remember?   *jbeany, speaking in her moderator/mom voice*   

Besides - it costs more to treat a Medicare patient than Medicare usually pays.  As a bottom line issue, all Medicare patients and not enough private payers means the doc no longer makes enough money to pay overhead.  While I'm sure many docs could afford to lower their salaries a bit - their student loans are not exactly cheap, and not many of their staff tend to be horrendously overpaid.  Plus, if he has partners or is part of a larger health care group, how much profit he's required to bring in may not be entirely up to him.

I wonder if you meant Medcaid reimbursement Ricki? I do think people relying on Medicaid will have fewer care options than those with Medicare or private health plans but it will still be more and better options than those with no insurance and no means to self-pay.

The doctors I've discussed the ACA with have said that Medicare almost always has one of the highest payouts. With respect, a nephrologist who doesn't want to deal with Medicare patients chose the wrong branch of medicine. My private insurance (UNITED HEALTHCARE) wrote into our policy that if Medicare paid more than they would have as primary, they pay nothing. That, incidentally, was always. Greed, greed, greed. So we were paying for us all to be on the policy but I was not getting any benefit from them. This strikes me as borderline illegal since they are not supposed to be allowed to single out specific individuals in a group policy and refuse to cover them as they cover everyone else.

Met a Brit who lived in Racine for 12 years today. She thinks, as most Brits do, that the American insurance practices are an abomination and that the lies told about the NHS are laughable. We give getting on the NHS as one of our primary reasons for wanting to return here.

I cannot be the only one who laughed uproariously when private insurance was given a choice to send everyone a check or lower future premiums. It did not even benefit us as Gwyn's premiums were set to be reduced the month that he gave notice, but I still remember it as a day when my heart sang with joy. Thanks, President Obama!

[PatDowns]

The doctors I've discussed the ACA with have said that Medicare almost always has one of the highest payouts. With respect, a nephrologist who doesn't want to deal with Medicare patients chose the wrong branch of medicine. My private insurance (UNITED HEALTHCARE) wrote into our policy that if Medicare paid more than they would have as primary, they pay nothing. That, incidentally, was always. Greed, greed, greed. So we were paying for us all to be on the policy but I was not getting any benefit from them. This strikes me as borderline illegal since they are not supposed to be allowed to single out specific individuals in a group policy and refuse to cover them as they cover everyone else.

Met a Brit who lived in Racine for 12 years today. She thinks, as most Brits do, that the American insurance practices are an abomination and that the lies told about the NHS are laughable. We give getting on the NHS as one of our primary reasons for wanting to return here.

I cannot be the only one who laughed uproariously when private insurance was given a choice to send everyone a check or lower future premiums. It did not even benefit us as Gwyn's premiums were set to be reduced the month that he gave notice, but I still remember it as a day when my heart sang with joy. Thanks, President Obama!

Please let us know when the NHS will be willing to provide health insurance coverage for 12,000,000+ illegal aliens.  OK?

Please let us know what your wait period will be if needing hip or knee replacement surgery.  OK?

Please let us know if 47% of all Brits pay NO FEDERAL INCOME TAXES.  OK?

"The current debacle over the Health and Social Care Bill mirrors the failure of
past attempts by governments to get Britain’s National Health Service (NHS)
to match the performance of health care systems in comparable developed
countries. The long waiting lists and poor standards of much NHS health care
have caused tens, if not hundreds of thousands, of Britons to die much earlier
than they should over the last fifty years, or suffer avoidable long term disability.
This has been very costly for the UK economy in terms of reduced GDP, lack of
international competitiveness and increased costs of welfare dependency."

   -- From: "Reforming the National Health Service - Reflections on four decades of NHS care"

http://www.adamsmith.org/sites/default/files/research/files/health-report.pdf

"Dialysis patients endure long wait for hospital transport, survey reveals"

http://www.guardian.co.uk/society/2009/jun/02/dialysis-patients-unacceptable-wait-hospital-transport

WAIT TIMES AND PROCEDURE FREQUENCY AT HOSPITALS IN THE NHS GRAMPIAN REGION.   In the US, these procedures are performed DAILY!

http://www.nhsgrampian.org/grampianfoi/files/064_Response_letter.doc

No country has the perfect solution for medical care.  As I stated above, no solutions only trade-offs.  I'll take the good ol' USA - imperfections and all.  However, I'm happy you and your family are where you feel more comfortable.

[MooseMom]

Why would your son-in-law HAVE to stop taking new Medicare patients when the ACA goes into effect?  Is someone holding a gun to his head or something?  I thought everyone wanted to put a break on the escalating costs of health care AND "reform Medicare".  Is your son-in-law's practice part of the problem?

Easy there, MM - no personal attacks allowed on here, remember?   *jbeany, speaking in her moderator/mom voice*   

Besides - it costs more to treat a Medicare patient than Medicare usually pays.  As a bottom line issue, all Medicare patients and not enough private payers means the doc no longer makes enough money to pay overhead.  While I'm sure many docs could afford to lower their salaries a bit - their student loans are not exactly cheap, and not many of their staff tend to be horrendously overpaid.  Plus, if he has partners or is part of a larger health care group, how much profit he's required to bring in may not be entirely up to him.

I have to admit that I am truly shocked that my question was taken as a "personal attack".  As a matter of fact, the explanation you gave was what I was looking for, but I would have preferred that it come from  the poster to whom I posed the question.  I wondered if perhaps the practice was not being run efficiently, that perhaps his son-in-law should be looking at the way he/his partners run their business to see if they could cut costs.  I know that whenever I go see my neph, there is a whole office filled with administrative staff, and I am left wondering where all the doctors are.

And it goes to my distaste of the idea of profit being made out of sick people to pay for student loans for college educations that we all know are costing more and more each year for reasons that no one can suss out.  It's all swings and roundabouts with the bottom line being that sick people are being treated according to their ability to pay, and that makes me uncomfortable.  We all gripe about how much Kent Thiry makes relative to the service that Davita's dialysis patients receive. 

And then we have to think about how we are supposed to "reform Medicare".  Who bears the brunt of these "reforms"?  Is that code for doctors being paid less, thus leaving said doctors to refuse service to YOU because you are eligible for Medicare, or is that code for fewer services across the board for those on Medicare?

Does it cost more to treat a Medicare patient than Medicare pays?  If so, why?  Is it because health care costs continue to rise faster than taxpayers can keep up with, or is it because maybe some practices allow inefficiencies to creep in?

Does anyone else find it disquieting that a doctor who is part of a practice that is supposed to ease illness and suffering is "required" to bring in a certain amount of profit?  If this question or any of my questions are, in anyone's opinion, evidence of a "personal attack", then color me astonished and please ban me now!

PS  If anyone feels personally attacked, I fervently apologize and promise that that was not my intention.  I regret if my post came across that way!

[cariad]

Please let us know when the NHS will be willing to provide health insurance coverage for 12,000,000+ illegal aliens.  OK?

Please let us know what your wait period will be if needing hip or knee replacement surgery.  OK?

Please let us know if 47% of all Brits pay NO FEDERAL INCOME TAXES.  OK?

"The current debacle over the Health and Social Care Bill mirrors the failure of
past attempts by governments to get Britain’s National Health Service (NHS)
to match the performance of health care systems in comparable developed
countries. The long waiting lists and poor standards of much NHS health care
have caused tens, if not hundreds of thousands, of Britons to die much earlier
than they should over the last fifty years, or suffer avoidable long term disability.
This has been very costly for the UK economy in terms of reduced GDP, lack of
international competitiveness and increased costs of welfare dependency."

   -- From: "Reforming the National Health Service - Reflections on four decades of NHS care"

http://www.adamsmith.org/sites/default/files/research/files/health-report.pdf

"Dialysis patients endure long wait for hospital transport, survey reveals"

http://www.guardian.co.uk/society/2009/jun/02/dialysis-patients-unacceptable-wait-hospital-transport

WAIT TIMES AND PROCEDURE FREQUENCY AT HOSPITALS IN THE NHS GRAMPIAN REGION.   In the US, these procedures are performed DAILY!

http://www.nhsgrampian.org/grampianfoi/files/064_Response_letter.doc

No country has the perfect solution for medical care.  As I stated above, no solutions only trade-offs.  I'll take the good ol' USA - imperfections and all.  However, I'm happy you and your family are where you feel more comfortable.

This is an absolutely superb example of what we were talking about yesterday! Congratulations! If you had only managed to work the words Freedom, Constitution and Jesus into your response I'd have given it a perfect 10.

[billybags]

Met a Brit who lived in Racine for 12 years today. She thinks, as most Brits do, that the American insurance practices are an abomination and that the lies told about the NHS are laughable. We give getting on the NHS as one of our primary reasons for wanting to return here.


Please let us know when the NHS will be willing to provide health insurance coverage for 12,000,000+ illegal aliens.  OK?

Please let us know what your wait period will be if needing hip or knee replacement surgery.  OK?

Please let us know if 47% of all Brits pay NO FEDERAL INCOME TAXES.

 


"/quote]

I am jumping in here. The discussions about the NHS. The quote about :
Please let us know when the NHS will be willing to provide health insurance coverage for 12,000,000+ illegal aliens.  OK?

We provide  health care for all. We have a tremendous  number of aliens, most illegal and they get free treatment as soon as they hit the country. Why do you think they want to be here?
 They get free dental as well as free prescriptions.
Our NHS and schools and Doctors are suffering from this.

The waiting times for hips, knees could be a tad quicker but it is better than it was, about 3 months depending on how bad the situation is and where you live. I would never call our NHS, may be some people would but we can not fault the care we have had over the last 4 years. We don't have to worry about having to pay doctors, hospital bills ext like you do in America..

Every one that works full time pays tax. People who work part time may have to pay a little. Why do you think our country is in such a mess. There are more people taking out than putting in.

People who are on Heamo can complain about hospital transport, my husband did experience this when he was on it. Do you get free hospital transport in America?

Hope I have answered a few of your questions.

[PatDowns]

I am jumping in here. The discussions about the NHS. The quote about :
Please let us know when the NHS will be willing to provide health insurance coverage for 12,000,000+ illegal aliens.  OK?

We provide  health care for all. We have a tremendous  number of aliens, most illegal and they get free treatment as soon as they hit the country. Why do you think they want to be here?
 They get free dental as well as free prescriptions.

Our NHS and schools and Doctors are suffering from this.

It is my understanding that anyone who doesn't ordinarily live in the UK – including tourists – is meant to pay for any NHS treatment they receive with exceptions being urgent care received in A&E departments or treatment for infectious and sexually transmitted diseases.  Refugees and asylum seekers are given free NHS treatment, but if their application to remain in the UK is turned down by the Home Office they lose the entitlement.   Is this incorrect?

BTW, the UK has a population about 1/5 of the US (60 million to 300 million).  Can you imagine the effect on your schools and healthcare system if the UK had the same proportion of illegal aliens - 2 million+?   Seems the problem with both of our countries is a failure to enforce lawas already on the books.

The waiting times for hips, knees could be a tad quicker but it is better than it was, about 3 months depending on how bad the situation is and where you live. I would never call our NHS, may be some people would but we can not fault the care we have had over the last 4 years. We don't have to worry about having to pay doctors, hospital bills ext like you do in America..

- You fail to mention that in many instances hip surgery will not be an option in the UK.  For older folks and those with certain co-morbidities, they will not be approved and told to stay on pain meds.  Yes, we "pay more" (as individuals, not the collective as in the UK) in the US, but wait times for surgery are usually dependent on when patients wish to go "under the knife," not availability of operating room time and physician availability.

Every one that works full time pays tax. People who work part time may have to pay a little. Why do you think our country is in such a mess. There are more people taking out than putting in.

- Your speaking to the choir!  Same problem in the US.

People who are on Heamo can complain about hospital transport, my husband did experience this when he was on it. Do you get free hospital transport in America?

- The truly disadvantged do receive free transport, especially in larger urban areas.  Why should those capable of paying get the same benefit?  However, it is not uncommon for those relying on transport services to experience long wait times. 

[MooseMom]

I certainly don't have any answers to any of these big and important questions, but it might help if we all remember that Medicare and Social Security are insurance policies that we have been paying for during our working lives.  These are NOT "entitlement programs" unless you think about it in terms of "I bought insurance so I am entitled to reimbursement should I have a claim."  If we allow ourselves to believe that these are truly "entitlement programs", then that becomes code for "money for lazy people who don't deserve anything."