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  #1  
Old 06-22-2007, 03:48 PM
tmont tmont is offline
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" Nobody in the United States seriously proposes recreating the British or Canadian systems here — in part because, as critics charge and Moore ignores, they really do have waiting lines. A closer model for the United States would be France, which doesn't have that problem and which — thankfully — also merits considerable screen time in Moore's movie. As Paul Dutton explains in a new book called "Differential Diagnoses," the French prize individual liberty, so they created an insurance system that, today, allows free choice of doctor and offers highly advanced medical care to those who need it. One of this system's most appealing features, which Moore showcases, is the availability of 24-hour house-call service via a company called SOS Médecins. (Moore travels along with one of the company's doctors as he rides around Paris one night, taking dispatch calls like a taxi driver and then administering at-home medical care to a young man with some kind of stomach problem.)

All of this does cost money, naturally, and Moore acknowledges what many assume is the French system's big drawback: its high taxes. But Moore also provides the same answer that any good policy wonk (including yours truly) would: They pay more in taxes but less in private insurance. In fact, the French system, like every other one in the rest of the developed world, costs less than ours overall.

The French like their system a lot — more than the citizens of any other country, including the United States, if you believe the opinion polls. The World Health Organization likes it a lot, too: It has ranked France's system tops in the world. But that isn't stopping critics from attacking it. In a pre-buttal of "Sicko" that appeared in the New York Post, the Cato Institute's Michael Tanner warned last week that Moore missed the real problem in France: its shortage of high-tech care.

This was news to me. I spent a lot of time researching France when I wrote my book, and I never heard anything about shortages of high-tech care. I asked Victor Rodwin of New York University, this country's leading expert on the French health care system, if he had ever heard of such shortages. He hadn't, either.

In the interest of fairness, I decided I would ask Tanner himself: What was his evidence? He said the French government was starting to tighten access to specialists. Well, sure — but it's still a far cry from what managed care has done in this country for years. He also said that France has fewer MRIs and CT scanners than the United States, which is very true and very irrelevant. Most experts think we have far more than we need here. If there were real shortages in France, there would be long queues to use them, and there's no evidence of this, either.

Tanner's op-ed was a good reminder of the proper context for considering "Sicko" — the fact that opponents of universal health care have been spewing half-truths and outright falsehoods for decades. If anything, the proponents of universal health care have probably been too honest, getting so caught up in nuance and policy accuracy that they undermine the very real moral power of their own argument. As another great health care debate begins, it's worth remembering that the fundamental challenge isn't technical. We have plenty of good ideas for achieving universal coverage. The challenge is political. Our side needs some passion and, yes, perhaps a little simplicity, too."


I can only acknowledge these comments as accurate and appreciate, for once, an open mind regarding this system I've lived in and 'used' for the past 18 years. As a mother of three and a spine patient, it has been largely adequate and our family does not regret a cent spent in taxes required to support such a system. As far as the supposed lack of 'high' technology and/or MRI and CAT scan facilities, it is simply untrue (at least in this region). I have never waited more than 2 weeks for an MRI, and when I was in serious pain I was taken immediately. What kills me are the critics who have absolutely no idea of how this system works, but who criticize it because 'even a crappy US system is better than any foreign one'. And no , that attitude is not uncommon...

I will say it once again: I sincerely hope that all Americans can one day enjoy the kind of healthcare we have here in France (and I hope the French will wake up and realize how good they've got it, and do all they can to protect this system rather than drain it dry). But for that, people are going to have to first admit other systems are better, then get very vocal about it. Any activists out there: let me know if I can help in any way to get the message across to more people back home. I would be happy to outline my experiences with some vivid examples.

You can read the rest of the article here:

http://www.cbsnews.com/stories/2007/...24_page2.shtml
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  #2  
Old 06-22-2007, 09:14 PM
Ouch! Ouch! is offline
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Wow, thanks for some new insite.

I have been away for awhile & I am still catching up on all the new information & posts.

Insurance companies in the US have us all hostage. They now dictate what doctors can & can't do and for how much money. I remember that 25-30 years ago, doctors could call many of the shots. If the doctor said you needed a week in the hospital for a proceedure then that was what happened; now the insurance companies tell doctors how long a patient can stay in the hospital. Period. It doesn't matter about the patient's condition, age or any other factors.

I was afraid of insurance "fall out" from the Medicare decision. I don't care what they said about studies in "older" patients, the bottom line was the money. They just don't want to spend it. My insurance is Tri-Care, the military option to pay for civilian health care. I have dealt with the ups & downs of this system for many years. There is always a yearly struggle to keep insurance benefits. Many benefits have been reduced, or eliminated, and co-payments have been raised. Many doctors will not accept this insurance. A woman I know was told by her doctor that Tri-Care is worse than welfare & people on welfare have better coverage. Her husband is active duty, so the doctor has really given a slap in the face to a family whose husband & father is off serving our country. But, I digress.

Medicare for the elderly has many problems too. They actually have to pay to have this coverage. Plus, they usually have to have a costly supplement to really have adequate coverage. (My parents had to pay about $800+ per month for their supplement in addition to what they had to pay for their Medicare enrollment.)

A note about government health care in Germany. Our friends in Germany tell us that because of rising health care costs their government insurance has eliminated coverage for many “elective” procedures. They also must wait for availability & approvals. They told us that they must pay for private insurance if they want to have adequate coverage for health costs.

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  #3  
Old 06-23-2007, 10:41 AM
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Trace, thanks for this and the CBS article. It's interesting to read the comments on the story too: http://www.cbsnews.com/stories/2007/...ge2.shtml#ccmm

I have lots to say about this topic, and I confess I've been holding back a bit for many reasons.

For those of you that don't know about me, I live in Taxachusetts. We've seen some dramatic new insurance changes because of the consummate politician's efforts (that would be "Mitt"). The new compulsory insurance for this state will cost us BILLIONS of extra dollars. The figure of $1.7 billion was quoted; but we heard that with the Big Dig, which is nearing a $20,000,000,000 expense. This insurance bill may break the bank, even if all the other poorly-planned programs don’t. Fiscal responsibility? Huh?

I love the idea of ensuring that everyone has insurance. But I am also a realist (OK, cynic) and have little faith that state or federal agencies (in this country) have the efficiencies and leadership necessary to implement anything helpful to 300,000,000 citizens (er, I mean people) living here. Recall a quote from Steve Case: “A vision without the ability to execute is a hallucination.”

Therefore, case in point (pun intended), let’s look at the insurance providers in Taxachusetts that are part of the Commonwealth Choice Program:

- Blue Cross Blue Shield (Blue Corpse Blue Sled)
- Fallon Community Health Plan
- Harvard Pilgrim
- Health New England
- Neighborhood Health Plan
- Tufts Health Plan

Guess how many of these plans give us a “choice” of ADR? Zero. Zippo. Nada. Well, you can get ADR – they just won’t pay for it!

So, my fear is that any monumental changes in our national health care policies that strive to insure any/everyone will succeed in one thing – excelling to great degrees of mediocrity! Taxes will go up, and we are stuck debating these issues until the cows come home. But I hope they do come home…we’ll be starving and could use the beef n butter…

Finally, I believe we simply need to “nudge” the real market-makers -- that is the private HMO execs -- into a new reality. How do we do this?

We’ll see in the coming months…
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  #4  
Old 06-24-2007, 08:32 AM
tmont tmont is offline
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Quote:
Finally, I believe we simply need to “nudge” the real market-makers -- that is the private HMO execs -- into a new reality. How do we do this?

We’ll see in the coming months…
Well, that'll be interesting to watch but I don't see how this can be done in the 'culture of greed' that reigns in the US regarding healthcare. We(or I should say 'you' since I'm outside the system) won't be able to get anywhere at all until caps are put on the prices and profit margins for health services rendered RIGHT ACROSS THE BOARD (and how we do that is beyond me--sometimes I wonder if anything short of mass rioting will make our lawmakers concretely react).

The first step is a broad change in mentality ('ha ha, she's cute'..) to that which is already written in the French Code of Medical Deontology: 'medicine must not be practiced as a commerce' (gee, how many docs/organizations need to read and absorb that one, d'ya think?? ). And no, it's not because you're brilliant and went to medical school and might be up to your eyeballs in debt that you deserve to make money hand over fist at the expense of the people you treat. Yes, you're wonderful and we need you. But why did you go to med school initially? What drives you, the Hippocratic or Hypocritic (al) Oath?

For starters, there should be no ads for meds in magazines and on TV, as prices for drugs should be fixed: treatment should not be based on pharmaceutical warfare, putting the patient in a position to 'ask his doctor' about meds solely based on advertisements rather than medical knowledge!

Secondly, if you pay insurance premiums there should be NO DISCUSSION about any non-cosmetic and FDA-approved procedure being covered. None at all. They take your check every month or trimester, then they should be covering your butt when you need it, period.

I could go on and on ('oh please don't Trace') but the US is supposedly the richest and most technologically advanced nation on the planet and yet prime--hell, skip 'prime' and replace with ' basic and decent'-- medical care seems to be largely reserved for those who can pay for it themselves. It really hurts to watch people struggle to pay for care that includes immorally high profit margins for those who provide treatment, as well as every single element involved in the production/distribution of that treatment.

I'm from 'Taxachussetts' as well but have been outside the country for so long that I will not even pretend to understand HOW what's going on is actually possible (the 'Big Dig' still ain't finished??? Last time I drove through in 2003 there were leaks everywhere; added 3 hours to my total travel time ).

I will say that over the years, on each visit home, I have been struck by--and at times shocked by-- cultural changes insidiously creeping in over time, among them the rampant ads for drugs which use a cheezy, emotionally manipulative approach: 'oh we love you so freaking much; buy our product or ask your doc about it'.

Right. I doubt the makers of that famous pain-killer hit the ground running every morning and go into work thinking 'OOh, I am gonna put SO MUCH LOVE into every pill today'...puh-leeze....

I read comments in the newspapers, and would really love to have the chance to reply directly to the author(s) who criticize this French system about which they know little, yet have decided to cherry-pick data on (probably off the Net), such as the comment above: 'France is starting to restrict access to specialists'.

Uh...not exactly. You can choose to go to a specialist without a referral from your GP, but if you do, at times you pay out-of-pocket. Admitted. But that would be, I believe, something like 25 bucks roughly converted in most cases. "25 bucks??" Oops. Kinda left that cherry on the tree, didn't he??

I am not trying to say that our system here in France is a perfect one, nor that it is THE solution for the US. I don't have enough systemic knowledge of either country to be able to determine if what works in the Hexagon can be applied to a country as large and diverse as the US. However, there are examples to be taken note of, and above all the awareness that what is happening Stateside is neither normal nor acceptable.

People, we need to react all together, on local, state, and national levels, before we've got a chance of really being heard. No government alone can push through the reforms needed without the full weight of a determined and fed-up population behind it.
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  #5  
Old 06-24-2007, 08:50 AM
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I don't have much to add, other than some humor born of anger. I hope Harrison does not delete this, as it's from the heart.

MEDICAL INSURANCE EXPLAINED

Q. What does HMO stand for?

A. This is actually a variation of the phrase, "HEY MOE." Its roots go back to a concept pioneered by Moe of the Three Stooges, who discovered that a patient could be made to forget the pain in his foot if he was poked hard
enough in the eye.

Q. I just joined an HMO. How difficult will it be to choose the doctor want?

A. Just slightly more difficult than choosing your parents. Your insurer will provide you with a book listing all the doctors in the plan. The doctors basically fall into two categories: those who are no longer accepting new patients, and those who will see you but are no longer participating in the plan. But don't worry, the remaining doctor who is still in the plan and accepting new patients has an office just a half-day's drive away and a diploma from a third world country.

Q. Do all diagnostic procedures require pre-certification?

A. No. Only those you need.

Q. Can I get coverage for my pre-existing conditions?

A. Certainly, as long as they don't require any treatment.

Q. What happens if I want to try alternative forms of medicine?

A. You'll need to find alternative forms of payment.

Q. My pharmacy plan only covers generic drugs, but I need the name brand. I tried the generic medication, but it gave me a stomachache. What should I do?

A. Poke yourself in the eye.

Q. What if I'm away from home and I get sick?

A. You really shouldn't do that.

Q. I think I need to see a specialist, but my doctor insists he can handle my problem. Can a general practitioner really perform a heart transplant right in his/her office?

A. Hard to say, but considering that all you're risking is the $20 co-payment, there's no harm in giving it a shot.

Q. Will health care be different in the next decade?

A. No, but if you call right now, you might get an appointment by then.
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Old 06-24-2007, 09:15 AM
chasswen chasswen is offline
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ROFL
man thats so true its not even funny.
chuck
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Old 06-24-2007, 10:33 AM
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You can't get anything done in Washington without bucks. I think H. Clinton gave up after her battle in the 90s. Hard to step in those doors and come out morally unscathed.

E.g. http://www.freep.com/apps/pbcs.dll/a...706240521/1035
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  #8  
Old 06-24-2007, 10:58 AM
tmont tmont is offline
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Yeah...and while you can theoretically pay someone to fix your bodily scrapes, moral ones tend to linger and fester

Thought this was the most pertinent part of the article, Ans:

"We started thinking about a different kind of film from one where we would bust into a corporate boardroom or try to make a company accountable. After 'Fahrenheit 9/11,' I started asking myself, 'How do I communicate better with the people who have different political beliefs than I do? What can we do to bring people together instead of widening that divide?'

"I didn't make this film as an indictment, even though there is no shortage of corporate and political greed in this mess. So we didn't focus on the people who don't have health insurance. We focused on those who do, and still can't get care."

There's the whole issue right there <sigh>.
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Old 06-24-2007, 04:10 PM
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Allan, Trace, thanks for the interesting info and ideas. Let me try to build some reasonably squishy syllogistic reasoning here.

One can be like Sisyphus and forever struggle uphill with the weight of the earth. That is, by way of example, making the Hillary mistake and attempting to make a wholesale change in the insurance system. An idealistic adventure, this is, given the constraints I suggested earlier. So, instead of moving mountains – lets ALL agree on the problem(s):

1. Americans pay a lot of money for healthcare, through premiums and taxes;
2. We have lots of complaints about our health care -- but the issue being debated here is the coverage of artificial disc replacement;
3. Though artificial disc replacement is approved by the FDA (both the Charite’ and Prodisc), most insurance companies will not pay for the procedure. This leaves thousands of paid subscribers in unnecessary short & long term pain and debt.

So, let's develop the specific problem statement, the solution, and take that to the media and Capitol Hill. And we’ve done a lot of this already! As I plan my trips for D.C. in mid July (hot much..phew), I’d like your candid thoughts as to the crisp words that may actually become a bill in congress. Note: I am not talking about one of those dumb, "earmarky" thingies. Besides, these are no longer trendy. If you don't get this, read the paper or watch C SPAN once in a while...

So, I believe most of us agree with 1-3. So, the theme of a future bill before congress (not the bill title) could be:

1. “all surgical spine procedures approved by the FDA must be paid for by insurance…”

as compared to:

2. “all surgical spinal procedures with their associated implanted devices approved by the FDA must be paid for by insurance…”

Option #2 is a problem, as it will invite device companies to potentially abuse the provision (this is America, y’all), so there must be a cost containment benchmark associated with this condition (tricky, actuarial stuff here).

OK, I’m sure I am leading us down a narrow path here folks, but stay with me as we get dangerously constructive. I know there are some great thinkers/writers/analysts on this forum, so let’s do some wordsmithing here. If we work together, Mr. Harrison goes to Washington with a constructive recommendation that may help thousands and thousands of people!

Is that exciting and worthwhile or what?! Get involved!
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  #10  
Old 06-24-2007, 04:46 PM
LBP LBP is offline
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just look at the FEHB policy for guidance. http://www.charitedisc.com/charitedev/domestic/patients...sement/fedappeal.pdf
This policy gives you backgroud/purpose and policy.

Basically, If any drug, medical device, or biological product is FDA approved it can no longer be deemed "investigational" and/or "experimental" and should (must) be covered by one's health insurance plan if (1) it is being used for it's intended purpose and (2) it is deemed medically necessary and appropriate for the patient as determined by their treating medical professionals.

Using the FEHB standard...keeps the law and coverage consistent for federal and private employees and should included Medicare recipients too.
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