[CRASH HARDDRIVE]

Originally Posted by SpaceMonkey 

Rationing: the limited distribution of scarce goods or services. How is what you are talking about different?

Because I'm talking about the free market, which operates based on supply and demand. Insurance schemes, government or private, seek to ignore real demand(high) by limiting supply(low). Thus, rationing. The free market welcomes high demand and seeks to meet it via increased supply and competition. Rationing has nothing to do with it. The belief that healthcare has to be scarce, and therefore rationed, is the result of artificial forces created by insurance companies and government. Government is also not the solution for eliminating it.

For an example- auto mechanics don't shun cars with 'pre existing conditions'- they welcome them. The more, the merrier. It's business for them. By the same token, people should wake up and realize that doctors operating in a free market system would never have any real incentive to shun people that actuall NEED healthcare! The insurance boondoggle system operates around shunning those most in need, and welcoming with open arms the perfectly healthy. It's backassackwards and completely foreign to a free market system.

If I paid for some comprehensive insurance plan and I decide, in the interests of conserving resources, to only use it for 'emergencies,' then that's a form of rationing.

What your missing is, you wouldn't need a 'comprehensive' insurance scam with market forces controlling access to routine healthcare. Do you have 'comprehensive' insurance that makes your car payments for you, as well as cover accidents? Do you have 'comprehensive' insurance that pays your rent?

But my point is that this mantra is already dominant with respect to health care, having won out in the market. Neither I nor my insurance company have a rational economic incentive to change our behavior (indeed, some insurers, in order to tap into the 'retail' market, have decided to start covering these clinics). You need some regulatory intervention to 'correct' what the market has wrought.

The market never created this mess, actually (once again) government did. The insurance scam took off during WWII when government stepped in and limited what corporations could pay in salaries. But they left a loophole with fringe benefits. So corporations began offering health insurance as incentives, rather than salary increases. It stuck, and people have just accepted it as a foregone conclusion ever since that they need heatlh insurance, either provided by an employer or a government. It simply doesn't cross enough people's minds that neither is really the best way to pay for health care.

I see you are continuing to be a jerk.

Grow up.

[ort888]

Originally Posted by CRASH HARDDRIVE 

For an example- auto mechanics don't shun cars with 'pre existing conditions'- they welcome them. The more, the merrier. It's business for them. By the same token, people should wake up and realize that doctors operating in a free market system would never have any real incentive to shun people that actuall NEED healthcare! The insurance boondoggle system operates around shunning those most in need, and welcoming with open arms the perfectly healthy. It's backassackwards and completely foreign to a free market system.

Auto-mechanics shun cars with pre-existing problems if the owners don't have any money. Just like the health care industry does.

[CRASH HARDDRIVE]

Originally Posted by ShortcutToMoncton 

I get the point you're making with this, but you keep using the example of "laser eye surgery clinics."

Well you'll notice, my point revolves around a free market system for the routine. Laser eye surgery isn't routine, and in fact it used to be extremely expensive. Competition and the free market have brought it into reach of just about anyone, and the number of clinics that now offer it have skyrocketed.

To be honest the two markets are so different that I really don't see how it's a good comparison. Laser eye surgery is an optional specialist procedure. Only an incredibly minute fraction of the population actually require it.

Lots of things are specialist procedures, be they optional, or critical. The point is, the free market has made this particular procedure less expensive and more available. Pick any non-optional procedure, requiring a level of skill and technical knowledge on par with laser eye surgery that you like in the insurance-driven market, and see if you can say the same thing: that it's consistently become more readily available, and cheaper, with the cost continuing to head downward.

In contrast, most people who use hospital services don't do it voluntarily. Most do against their wishes (in that, they'd rather be healthy and not using medical services). Many do it in an emergency. They don't have a choice.

How often have you been to the hospital in your life non-voluntarily?

Again, I'm talking the routine. Maybe you're on to something- perhaps we can categorize 'vollentary' (Gee, think I'll go see a doctor about this blotch on my skin...) vs. non-voluntary (wheeled in on a stretcher). The voluntary example shouldn't involve reaching for an insurance card, unless it turned into an emergency.

I don't know about you, but I've most often in my entire life been to see a doctor voluntarily, not carried in on a stretcher. I tend to go to the doctor for checkups, for tests, for exams, for 'what's going on with this?' etc.

Also, how many times do the majority of people, even when being seen for a serious illness really require treatment that goes far beyond the routine? IE: Exams, x-rays, scans, ultrasounds, drawing blood, tests/probes/injections, casts, braces, prescribing medicines, dental work (fillings, crowns, caps ) etc.

Are the overwhelming number of procedures required by most people more complicated, and require more skills and tech-prowess than laser eye surgery? Do most people check in, then get cut open and operated on shortly thereafter, or is there a lot of the routine first?

Emergencies where you're taken to a hospital against your will, gravely ill or bodily injury in need of some serious medical attention should be covered by insurance- IE: the ONLY thing you should need to have need insurance for. But be honest- how many times -in relation to your healthcare "coverage"- has this happened to you?

So yeah, I really think you need to come up with a better/more applicable example for this idea.

Well, as has been pointed to already, there are clinics that already operate on a fee-based business model. I think looking into expanding that (with the private sector, competition, etc.) to reach more people more affordably, is a good way to get the routine out of the way of the 'emergency'.

[CRASH HARDDRIVE]

Originally Posted by ort888 

Auto-mechanics shun cars with pre-existing problems if the owners don't have any money. Just like the health care industry does.

Right, because it's someone else's resonsiblity to pay for you to have a car. So once again, let's have nanny-care that assumes no one has any money to pay for anything important- and least important of all of course, your health.

Actually, after the government gets through with you to pay for their 'protection rackets', you probably won't have much left. But hey, you'll be 'covered'.

[Big Mac]

Originally Posted by CRASH HARDDRIVE 

For an example- auto mechanics don't shun cars with 'pre existing conditions'- they welcome them. The more, the merrier. It's business for them. By the same token, people should wake up and realize that doctors operating in a free market system would never have any real incentive to shun people that actuall NEED healthcare!

Hate to have to argue against you here, but auto mechanics are much more common, and much less expensive, than doctors. Medical doctor is a far higher stakes profession, with much higher cost and time barriers to entry. If a mechanic screws up your car, you can still buy another one, but if a doctor screws up your body you're dead. Mechanics don't have to go through many additional years of schooling, pass a rigorous examination and intern for a long time before they get to work on their own. That's why they make so much more money. Yes, direct payments (the free market) can work in non-life threatening situations where you can negotiate and even shop around for the best deal. When your life is at stake and you don't have any insurance to protect against that risk, the market doesn't work as well. It's similar to the legal profession. When you have a small legal need you can shop around and probably not break the bank over it. But if you're in major legal trouble you're usually screwed cost wise because lawyers too go through a lot of schooling and testing to get into an elite, highly paid, relatively low supply profession.

The market never created this mess, actually (once again) government did. The insurance scam took off during WWII when government stepped in and limited what corporations could pay in salaries. But they left a loophole with fringe benefits. So corporations began offering health insurance as incentives, rather than salary increases. It stuck, and people have just accepted it as a foregone conclusion ever since that they need heatlh insurance, either provided by an employer or a government.

Do you deny that health insurance is always a scheme and would never be necessary in a perfect market system? That assumes that the cost of medical services, aside from doctor compensation, would be very cheap no matter the procedure and that there would be enough doctors to bring the cost of their compensation to a low enough level as to be affordable for any services provided.

[CRASH HARDDRIVE]

Originally Posted by Big Mac 

Hate to have to argue against you here, but auto mechanics are much more common, and much less expensive, than doctors. Medical doctor is a far higher stakes profession, with much higher cost and time barriers to entry. If a mechanic screws up your car, you can still buy another one, but if a doctor screws up your body you're dead. Mechanics don't have to go through many additional years of schooling, pass a rigorous examination and intern for a long time before they get to work on their own. That's why they make so much more money.

It's simply an example of the free market, not a direct comparison of professions. Of course doctors need to be well trained and highly paid. (Actually the free market pays them better than insurance scams- and Medicare style scams in particular- ever will.)

When the demand is there, more people have incentive to go through the rigorous and expensive process needed to become medical professionals. Government dicking up health care will create less incentive for people to go into healthcare.

Yes, direct payments (the free market) can work in non-life threatening situations where you can negotiate and even shop around for the best deal.

Which is once again, what I'm talking about.

How many people here are all that often in need of medical care for a life-threatening situation? Really. Am I unsual in that I'm not constantly in fear of my life, and I'm not a hypochondriac, and that most often my healthcare needs are pretty damned minor, all things considered, not severe life threatening call the ambulance emergencies?

When your life is at stake and you don't have any insurance to protect against that risk, the market doesn't work as well.

When your life is at risk- sure, you have insurance. Again, how OFTEN IS THIS?

To use car insurance again as an analogy- how often are you just fixing things like minor body work, the tires, spark plugs, oil changes, etc. etc. vs BAM! you hit something and totaled your car?

It's similar to the legal profession. When you have a small legal need you can shop around and probably not break the bank over it. But if you're in major legal trouble you're usually screwed cost wise because lawyers too go through a lot of schooling and testing to get into an elite, highly paid, relatively low supply profession.

Wait Big Mac, you might be on to something here! We're ALL OF US just a lawsuit away from TOTAL RUIN! I think maybe we need legal insurance! I bet if we pushed hard enough, we could get the Democrats to whine for decades on end until half of the country was quaking in their boots over this grave threat! No more private lawyers- we need them all to be paid by the government out of our government insurance plan, and of course, it needs to be 'comprehensive' meaning not just covering being sued or charged with a crime, but for parking tickets too. Maybe we can start the movement!

Do you people realize- 300,000,000 Americans don't have legal coverage!

Do you deny that health insurance is always a scheme and would never be necessary in a perfect market system? That assumes that the cost of medical services, aside from doctor compensation, would be very cheap no matter the procedure and that there would be enough doctors to bring the cost of their compensation to a low enough level as to be affordable for any services provided.

Doctors used to make housecalls for pete's sake. Yes, even for poor people. Healthcare did use to be a lot cheaper than it is now. What's changed is the quality and the technology of course, but access used to actually be better than it is now.

Once more, I think I've said it many times- I'm not suggesting that the poor do without access- Medicare and other schemes could work if they just covered the truly needy. The thing that gets me about this whole subject, is that the socialized crowd really does believe they're getting something for free. So when ever the "what about those that can't afford it?" stuff comes up, you have to scratch your head. What, so you (not you Big Mac, but in general) really believe that if you have a job, and you actually earn any money, that you won't be paying for a government healthcare plan?

No matter what- this **** costs MONEY. You're going to pay for your health one way or another. I'm saying it's stupid to pay insurance for things that are routine and should be affordable and paid for ONLY when you need them. Then insurance can be significantly less to cover the things you hopefully (and again, I'm assuming here I'm unique in not being in constant need of emergency services and such) don't need all that often- IE: EMERGENCIES and critical illnesses.

If this is really about people paying less money for any of this stuff (and not the fantasy that it'll ever be free- it WON'T EVER BE FREE) then we've got to get out of this ridiculous fantasyland that believes the government model is free. It's NOT FREE. It'll just be another chunk of your paycheck that you'll NEVER SEE- each and every paycheck, not just when you're sick. Over the course of an average lifetime, that's a shitload of money to be paying to 'cover' yourself against friggen hangnails and the common cold along with the possibility of an emergency.

[Big Mac]

To make things clear, I don't believe in this government take over. I do believe some of the promised reforms are potentially a step forward, but you're completely right that in the end we'll most likely all be paying even more to government for less. It just sounds at times like you're arguing against all forms of health insurance, including catastrophic coverage (which I support strongly as a minimum).

Oh, and regarding house calls, medicine was a lot simpler back then, and doctors weren't as lazy in that way.

[ghporter]

House calls are a very inefficient use of the doctor's time. Since our system has evolved to make the physician the center of attention, his/her time is considered to be a crucial resource. Many doctors arrange their office schedules so that they use a putative "lunch time" to get from office to hospital to do rounds or perform surgeries, maximizing their available time in both locations. Characterizing physicians as "lazy" for being available to more patients because they don't do house calls is ingenuous at best. The majority of physicians bust their buns to treat patients.

Artificial time constraints that keep them from spending more than 10-15 minutes with each patient come from insurance and Medicare, not the doctors themselves. They don't get reimbursed according to how much quality time they have with patients, only for how many patients they see, and they need to get that reimbursement to be able to run their practices. There are darn few "simple" practices with just the doctor and maybe a nurse in an office-medical schools have mandatory business courses so that doctors can be prepared for the need to employ at least half a dozen people to run an office. The doctor can't afford to not see as many patients as possible because those half dozen people are depending on him/her for their livelihoods.

[SpaceMonkey]

Originally Posted by CRASH HARDDRIVE 

What your missing is, you wouldn't need a 'comprehensive' insurance scam with market forces controlling access to routine healthcare. Do you have 'comprehensive' insurance that makes your car payments for you, as well as cover accidents? Do you have 'comprehensive' insurance that pays your rent?

The market never created this mess, actually (once again) government did. The insurance scam took off during WWII when government stepped in and limited what corporations could pay in salaries. But they left a loophole with fringe benefits. So corporations began offering health insurance as incentives, rather than salary increases. It stuck, and people have just accepted it as a foregone conclusion ever since that they need heatlh insurance, either provided by an employer or a government. It simply doesn't cross enough people's minds that neither is really the best way to pay for health care.

Okay, but you're talking about your utopia (I never even said that I disagree with you) and I'm talking about how you get there. We're in a situation where "the market" is made up of health insurance oligopolies who like the present system very much. Unless there is some kind of mandate (read: regulation) for catastrophic coverage (and a clear definition for what that is, and some kind of public program of universal access to it) I don't think we're going to get there.

[Big Mac]

Yeah, you're right about my mischaracterization, Glenn. That was an unnecessary knock on the profession. I have actually seen doctors make house calls, once in a great while it still happens if you're friends with the doc.

[DBursey]

Posted by CRASH HARDDRIVE
The thing that gets me about this whole subject, is that the socialized crowd really does believe they're getting something for free.

Such a bed of straw. I'm reasonably sure even the most dim-witted and insular of your countrymen are aware, as are all Canadians, that the (more cost efficient) single payer insurance model is funded thru federal taxation.

[ghporter]

Originally Posted by Big Mac 

Yeah, you're right about my mischaracterization, Glenn. That was an unnecessary knock on the profession. I have actually seen doctors make house calls, once in a great while it still happens if you're friends with the doc.

The best family practice docs have offices near where people live, and work their schedules so that they can see people on a "non-urgent" basis. Unfortunately these docs are few and far between because of the costs of running such a practice.

Also unfortunately, the number of family practice docs coming out of med schools has been dropping like a rock because of the kind of hours and pay involved-much lower pay with much longer hours than most specialties. However dedicated a new doc may be, there's a ton of student loans to pay off when you finish 8 years of any kind of educational program...

[shifuimam]

Originally Posted by lpkmckenna 

Like I said, he should have put his name on a list years ago.

And again - what happens if he moves? Then what? He has to travel home for medical care until his two or three-year wait for a doctor in his area is up?

That's a good question. I don't know how long it takes to find a family doctor since I've had the same one since birth. A couple of months to a couple of years is a good guess. How long does it take to get a family doctor in the States?

Well, when I made my ex go to see someone about some long-standing medical complaints he had, we called a multi-doctor clinic in the area and got an appointment to see a nurse practicioner the same week.

I've had my family doctor since I was two years old (when we moved to Indianapolis). I don't really need to see him anymore, so I just call his office when I need prescriptions renewed. When I move out of Indiana, I'll find someone else.

And it won't take months or years of sitting on a waiting list.

In Canada, you can "go to the front of the line" whenever you want: go down to the States and pay cash up front. The rich do it all the time.

And this is a reasonable solution to you? Having to go to a different country (which now requires a passport, IIRC, even if you're just traveling in North America) to get medical care because the waiting lists in your own country are too long?

Don't quote me on this, but I believe that people do get priority rating on transplant lists depending on their age and the severity of their condition. Does the same happen in Canada?

What's sad is in the States, a company like Wal-Mart will hire two part-timers instead of one full-timers so they can avoid paying any health benefits. Then those part-timers get all their health care paid by the tax-payers via public hospitals and Medicaid. Tell me, is that fair?

No. But why do they not want to offer health insurance to part-timers? Because it's too expensive. Why is it too expensive? Because medical services have ballooned so much in cost that insurance providers can't afford to offer cheaper insurance with the same benefits.

It would be great if Wal-Mart offered a low-cost, extenuating-circumstances-only insurance plan.With HSAs becoming more popular, maybe they will. The point is, a federally-subsidized, single-payer system that rids us of private insurance options is not the only answer to the problem.

In the States, that unemployed single mom will get her insulin, via the tax-payer. Besides, there's no "waiting list" for insulin, silly.
Let's stay on topic, shall we?

My point remains the same. What about stuff you don't actually *need*, but want, like birth control, psychological therapy, or elective surgery - which can include things like hysterec(tomies, since many reasons for having one aren't considered life-threatening (like constant problems with ovarian cysts, the uterine muscles weakening and dropping the uterus down, etc.).

Why should I, as a gainfully employed, financially responsible professional with quality insurance, be punished and forced into a government-run health care program simply because a poor person wants the same elective medical services I can afford?

I just got Implanon a few months ago - it's a matchstick-sized piece of plastic in my upper arm that serves as birth control for three years. It costs nearly $1000 without insurance. I don't need it - I could have kept taking regular pills for $6 a month. I could have gone without birth control (although, in my case, I started on it because the cramping I got during periods was unbearable) entirely. But I could afford the Implanon with my insurance plan, so I got it. Does that mean that a broke-ass single mother is entitled to the same birth control options? HELL NO. She can get the pill dirt cheap from Planned Parenthood. It's just about as effective as Implanon and costs a hell of a lot less.

Should a morbidly obese fatass be granted cheap access to something like gastric bypass surgery, which costs tens of thousands of dollars? Of course not. There's too many examples of people weighing upwards of 400 and 500 lbs being able to shed the weight through diet, exercise, and this thing called self-discipline that most Americans have completely forgotten about.
There's huge difference between ensuring everyone has health insurance and "making everyone middle-class."

And all those people should have work-provided health insurance.

Sure, which is why I'm for options like HSAs, which cost employers far less than traditional insurance plans.

This is where CRASH HARDDRIVE's argument comes into play - why do we think everyone should be entitled to total, comprehensive health care? A trip to a normal GP costs maybe $80 without insurance. Out-of-patent drugs are butt cheap without insurance, seeing as places like Target, Wal-Mart, and CVS now offer such medications for only $4 per 30-day supply.

If you need to go to the ER, sure - insurance is super handy, when you're talking about a grand just for an ambulance ride (if it's a private ambulance). But how often do you actually have to go to the ER? If you're a healthy young adult, the answer is probably "never" or "I went once when I was a kid for a broken arm". Why should I be forced to pay into a comprehensive health insurance system that I'm not going to use? I'd much rather pay cash for the little things and only have the insurance for when I lose a limb or get diagnosed with cancer or have a similar catastrophic medical disaster in my life.

People "ignore it" because it's simply not true. The funny thing is I've heard criticisms of capitalism from loony-lefties who say the exact same thing: capitalism won't work in China because it's too big, capitalism won't work in Cuba because it's too small, free trade between Canada and the US won't work because the US is so big and Canada so small. All that "size matters" talk is completely phony. No research supports any of it.

Really? When I look at how many people are on welfare who shouldn't be, and how they can abuse the system in large metro areas because the offices and facilities are so understaffed, sure looks to me like the population is too big for the program.

Oh, and what about those millions of baby boomers who are going to retire soon and drain the Social Security reserve until it's bankrupt? Seems to me like too many people for a sustainable system.

I'll see what research I can find to back up my claim, but it seems pretty logical to me that the bigger the population, the easier the system is abused.

Think about a classroom - students in smaller classes tend to get a better education, because the teacher has fewer children to focus on. She's able to work with the problem students more closely. The same logic seems like it applies to something like this. When you have more people to keep track of, the likelihood of abuse goes up,

I love this lie. In fact, the pharma-industry spends more on advertising than on research. Ban direct pharma advertising like Canada. US pharma wastes tons of money on pretty bimbos visiting doctors and glitzy tv ads.

Could you provide some statistics and research to back up claim (that doesn't come from a political pundit or otherwise biased source)? Do you have numbers on how much of Lilly's budget was spent last year on advertising versus R&D?

I find it pretty hard to believe that the big pharma corps spend more on throwaway Bic Stics and Post-It pads than R&D for new drugs and medical technologies.

Originally Posted by ghporter 

Do not blame ADD on parents, nor blame ADD for people not making anything of themselves. Both are completely wrong.

I wouldn't go so far as to say completely wrong - not everyone who's diagnosed with ADD or ADHD has a clinical problem that can only be remedied by taking amphetamines at a young age. There are plenty of cases where a child is unruly, and mom and dad work full-time and don't want to discipline their child (spanking is so out of style now), so they plug the kid full of drugs and blame it on a disorder.

I don't think I can go so far as to unilaterally declare that all children diagnosed with ADD/ADHD are just undisciplined and need behavioral therapy more than speed, but in too many cases, that is the case. Not every five-year-old boy diagnosed with ADHD actually has a disorder. It's a grossly overdiagnosed disorder in the United States, and there's evidence out there from pediatric psychologists that drugs are not the only way to deal with a child who has attention issues.

Not that I want to get into a debate on the validity of an ADD diagnosis, but it's overdiagnosed enough that no, I don't want my tax dollars paying for some kid's Ritalin, unless we come up with a far more reliable way of diagnosing such a disorder.

I don't really think I want the government paying for my own antidepressants, which run about $130 sans insurance for a 30-day supply. Yes, I find it very difficult to function without them, but I won't die without them, and it's not someone else's fault that I'm mentally FUBAR due to my upbringing and my past.

Psychological and mental problems are a really big gray area in the world of medicine - I don't think that we have enough definitive methods of diagnosis to allow such things to be covered under a government health care program. It would be way too easy to work the system and get free or cheap drugs (which, in cases like amphetamines as ADD medication, can be used recreationally), since mental disorders can't, for the most part, be diagnosed with an irrefutable medical test.

[Laminar]

Originally Posted by shifuimam 

(although, in my case, I started on it because the cramping I got during periods was unbearable)

[SpaceMonkey]

Originally Posted by shifuimam 

Could you provide some statistics and research to back up claim (that doesn't come from a political pundit or otherwise biased source)? Do you have numbers on how much of Lilly's budget was spent last year on advertising versus R&D?

I find it pretty hard to believe that the big pharma corps spend more on throwaway Bic Stics and Post-It pads than R&D for new drugs and medical technologies.

It can be difficult to get clear numbers. To take one data point, Pfizer's 2008 annual report states they spent $14.5 billion on "Selling, Informational and administrative expenses," which includes "the cost of marketing, advertising, shipping and handling, information technology and non-manufacturing employee compensation." Specific "advertising" expenses totaled $2.6 billion, but I am willing to bet that number is the direct cost of the marketing campaigns themselves (i.e. what they paid for print or TV ads) and not "informational" expenses that might include advertising to the medical community. And certainly a lot of the other administrative overhead ("non-manufacturing employee compensation") is associated with marketing.

R&D expenses were $7.9 billion.

[DBursey]

Psychological and mental problems are a really big gray area in the world of medicine - I don't think that we have enough definitive methods of diagnosis to allow such things to be covered under a government health care program. It would be way too easy to work the system and get free or cheap drugs (which, in cases like amphetamines as ADD medication, can be used recreationally), since mental disorders can't, for the most part, be diagnosed with an irrefutable medical test.

To work the system you'd have to 'work' the doctor; he or she prescribes meds based on his or her diagnosis of the patient. I don't know of many medical practitioners who would entertain patients' efforts to self-diagnose or self-prescribe.

[ShortcutToMoncton]

Originally Posted by shifuimam 

And again - what happens if he moves? Then what? He has to travel home for medical care until his two or three-year wait for a doctor in his area is up?

Or... he could just go to a local clinic. Or he could just get a new family doctor.

I haven't seen my family doctor in, oh, probably 10 years. The couple times I've decided to see a doctor during that time I just walked into a clinic and sat and waited for an hour.

Well, when I made my ex go to see someone about some long-standing medical complaints he had, we called a multi-doctor clinic in the area and got an appointment to see a nurse practicioner the same week.

That... pretty much sounds like the same as Canada. Possibly with a shorter wait time here though.

I've had my family doctor since I was two years old (when we moved to Indianapolis). I don't really need to see him anymore, so I just call his office when I need prescriptions renewed. When I move out of Indiana, I'll find someone else.

And it won't take months or years of sitting on a waiting list.

See... it's pretty much the same here, too. But I still just think you don't really understand the system. People who are having problems getting a family doctor are doing so because there aren't enough doctors in their area. This isn't the system's fault. That's just because... doctors don't think it's worth working in that area. They'd make more money elsewhere, so they go elsewhere.

Make sense? It's probably similar to the US in that respect.

And this is a reasonable solution to you? Having to go to a different country (which now requires a passport, IIRC, even if you're just traveling in North America) to get medical care because the waiting lists in your own country are too long?

Isn't a reasonable solution, but it's usually for specialist procedures for which there are limited number of trained doctors and/or facilities. Not for GPs, which the rest of your complaint about. And it's usually the difference between "waiting for some period of time" and "getting it much quicker in the US and paying to do so." So I guess "too long" is relative. Although you're right; we need more/better funding in some areas.

It would be great if Wal-Mart offered a low-cost, extenuating-circumstances-only insurance plan.With HSAs becoming more popular, maybe they will. The point is, a federally-subsidized, single-payer system that rids us of private insurance options is not the only answer to the problem.

But it's one answer.

My point remains the same. What about stuff you don't actually *need*, but want, like birth control, psychological therapy, or elective surgery - which can include things like hysterec(tomies, since many reasons for having one aren't considered life-threatening (like constant problems with ovarian cysts, the uterine muscles weakening and dropping the uterus down, etc.).

Why should I, as a gainfully employed, financially responsible professional with quality insurance, be punished and forced into a government-run health care program simply because a poor person wants the same elective medical services I can afford?

I just got Implanon a few months ago - it's a matchstick-sized piece of plastic in my upper arm that serves as birth control for three years. It costs nearly $1000 without insurance. I don't need it - I could have kept taking regular pills for $6 a month. I could have gone without birth control (although, in my case, I started on it because the cramping I got during periods was unbearable) entirely. But I could afford the Implanon with my insurance plan, so I got it. Does that mean that a broke-ass single mother is entitled to the same birth control options? HELL NO. She can get the pill dirt cheap from Planned Parenthood. It's just about as effective as Implanon and costs a hell of a lot less.

You're still confused about how our system works. Canadian healthcare doesn't cover drugs that you only want, and don't need. (That might even be the same for drugs that you need, but I'm not sure about that. Something tells me that our system doesn't cover drugs at all. There might be some limited government subsidy just the same.) We pay for birth control just like everyone else. Or acne medication if you want it, or I suspect Implanon too. However, there is some limited government insurance coverage for specific groups, e.g. people on social assistance, native peoples, seniors, etc.

The Government of Canada, through various programs, provides prescription drug coverage for about one million Canadians who are members of eligible groups. These groups include First Nations and Inuit, members of the military, Veterans, members of the RCMP, and inmates in federal penitentiaries.

Each provincial and territorial government offers a drug benefit plan for eligible groups. Some are income-based universal programs. Most have specific programs for population groups that may require more enhanced coverage for high drug costs. These groups include seniors, recipients of social assistance, and individuals with diseases or conditions that are associated with high drug costs.

We get insurance to pay for drugs. Often through an employer, university, or whatever. I had to buy some antibiotic medication for an eye problem I had some years ago, and it cost me close to $200 because I had opted out of my university health insurance and hadn't realized that my parent's health insurance which I thought I was covered under expired when I turned 24 or something like that.

Should a morbidly obese fatass be granted cheap access to something like gastric bypass surgery, which costs tens of thousands of dollars? Of course not. There's too many examples of people weighing upwards of 400 and 500 lbs being able to shed the weight through diet, exercise, and this thing called self-discipline that most Americans have completely forgotten about.

There's huge difference between ensuring everyone has health insurance and "making everyone middle-class."

It's a good point, especially when you think of the thousands or millions of smokers who I'm sure have burdened Canada's national healthcare system as a result of smoking-related illness.

This is where CRASH HARDDRIVE's argument comes into play - why do we think everyone should be entitled to total, comprehensive health care? A trip to a normal GP costs maybe $80 without insurance. Out-of-patent drugs are butt cheap without insurance, seeing as places like Target, Wal-Mart, and CVS now offer such medications for only $4 per 30-day supply.

Again, the trip is free; the prescription isn't.

Think about a classroom - students in smaller classes tend to get a better education, because the teacher has fewer children to focus on. She's able to work with the problem students more closely. The same logic seems like it applies to something like this. When you have more people to keep track of, the likelihood of abuse goes up,

Your logic is incorrect because your example doesn't make any sense. You're confusing "abusing the system" with "overburdening the system."

What you mean to say is that 20 students in a classroom with a teacher get away with less bad behaviour than 40 students in a classroom with 2 teachers. Or that 20 students in a classroom with a teacher get a better education than 40 students in a classroom with 2 teachers.

Either way, I'm not sure that it's a good example in the first place.

I wouldn't go so far as to say completely wrong - not everyone who's diagnosed with ADD or ADHD has a clinical problem that can only be remedied by taking amphetamines at a young age. There are plenty of cases where a child is unruly, and mom and dad work full-time and don't want to discipline their child (spanking is so out of style now), so they plug the kid full of drugs and blame it on a disorder.

I'm not saying I disagree with you, but I will say that parenting lessons from a single young woman with no intention of having children is a hard sell.

(Sort of like marriage or womanly advice from the single Apostle Paul? )

Not that I want to get into a debate on the validity of an ADD diagnosis, but it's overdiagnosed enough that no, I don't want my tax dollars paying for some kid's Ritalin, unless we come up with a far more reliable way of diagnosing such a disorder.

Again: in Canada, the parents, or the parents' insurance, pays for the Ritalin AFAIK.

I don't really think I want the government paying for my own antidepressants, which run about $130 sans insurance for a 30-day supply. Yes, I find it very difficult to function without them, but I won't die without them, and it's not someone else's fault that I'm mentally FUBAR due to my upbringing and my past.

Taking personal responsibility for your own mental issues aside, in Canada you pay for your own antidepressants if you want them.

I dated a girl once who went on antidepressants. She paid for them herself, just before we broke up because she was a nutbar.

greg

[ort888]

I want to know more about the free child care in canada.

We're about to pay about $1,100 a month in daycare costs. I have a hard time even wrapping my head around that. We also want to have another child in a few years which will mean that there is a good chance we'll have two kids in day care at the same time.

How do people do it?

[shifuimam]

Originally Posted by SpaceMonkey 

It can be difficult to get clear numbers. To take one data point, Pfizer's 2008 annual report states they spent $14.5 billion on "Selling, Informational and administrative expenses," which includes "the cost of marketing, advertising, shipping and handling, information technology and non-manufacturing employee compensation." Specific "advertising" expenses totaled $2.6 billion, but I am willing to bet that number is the direct cost of the marketing campaigns themselves (i.e. what they paid for print or TV ads) and not "informational" expenses that might include advertising to the medical community. And certainly a lot of the other administrative overhead ("non-manufacturing employee compensation") is associated with marketing.

R&D expenses were $7.9 billion.

I didn't see the $14.5bil number anywhere in that document. Not to mention that you're talking about a lot of stuff other than advertising under that umbrella - like the entire Information Technology division of the corporation. I make $45k a year as a web dev, and that's a beginner position. You can expect people in the private sector to make a bit more, like $50-$55k starting, and upwards of $70-$100k for senior systems and software engineers. If you have even ten developers and ten admins, each averaging $50k a year, that's still $5mil right there. Then, on top of those people, you've got IT managers, IT project managers (my position doing that at a private multinational corp paid $53k plus an annual profit sharing bonus), HR reps, secretaries, and God knows who else for the IT department as a whole - and it starts adding up fast, when you also include employer contributions to retirement, employment taxes, and company-provided insurance plans.

Informational expenses is likely more than just advertising - it's also going to the 800 number you can call and the website you can visit when you have questions about a drug and its side effects, as well as the pamphlets your doctor gives you with information about different treatment options for some malady or illness or chronic problem. I suppose you can call that advertising, but how else are you going to know about your options? There are many different allergy medications out there - how will you know the differences between them or even know they exist if your doctor can't provide any materials on them?

Then you've got "non-manufacturing employee compensation" - which, if I'm interpreting that correctly, includes every manager, executive, and everyone in-between. That stuff adds up.

Yeah, I would imagine that the number is a bit more than $2.6bil for marketing and advertising as a whole, but I doubt that the number tops the R&D expenses of nearly $8bil (I'm still looking for that number in the financial report).

In the end, it's a bit far-reaching to claim that "the pharma-industry spends more on advertising than on research". This sounds like a claim made to vilify the pharmaceutical industry.

I find it so interesting how much people despise drug companies. I suppose life would be better without vaccines for diseases like polio and rubella? Or maybe when you are diagnosed with terminal cancer, you shouldn't try chemo and radiation? Perhaps we should also let bacterial infections go unchecked, and offer no treatment for chronic problems like eczema and Chron's Disease and Tourettes...

Originally Posted by DBursey 

To work the system you'd have to 'work' the doctor; he or she prescribes meds based on his or her diagnosis of the patient. I don't know of many medical practitioners who would entertain patients' efforts to self-diagnose or self-prescribe.

Not self-diagnosing - people can fake a mental disorder, depending on what it is. Certain diagnoses, like ADD/ADHD are heavily overused because the diagnostic criteria are so generalized. Same goes for a disorder like borderline personality disorder - there's a laundry list of traits that might indicate it, and you only have to display a handful in order to get a diagnosis of BPD.

It starts to get sketchy when the government is funding treatment for mental and psychological problems, because a disorder and its diagnosis and treatment are much less clear-cut than physiological medical problems.

[SpaceMonkey]

Originally Posted by shifuimam 

I didn't see the $14.5bil number anywhere in that document.

Page 19 of the PDF (page 17 as written in the document itself).

I completely agree with you that the SI&A category includes a lot of things other than what would broadly be called "marketing." I opened my post with exactly that point. We're all just guessing at this point. But speaking professionally, I'm fully aware of how hard organizations work from a public perception standpoint to mask their true "overhead" expenses in their audited reports, and I think that if their true "marketing costs" were actually as low as you think they are relative to R&D, Pfizer would be making a point to highlight that. As it stands, the only granular figure they give is the $2.6 billion for direct advertising costs for buying TV, radio and print space (page 55 of the PDF, page 53 of the document).

[lpkmckenna]

Originally Posted by shifuimam 

Not self-diagnosing - people can fake a mental disorder, depending on what it is. Certain diagnoses, like ADD/ADHD are heavily overused because the diagnostic criteria are so generalized. Same goes for a disorder like borderline personality disorder - there's a laundry list of traits that might indicate it, and you only have to display a handful in order to get a diagnosis of BPD.

It starts to get sketchy when the government is funding treatment for mental and psychological problems, because a disorder and its diagnosis and treatment are much less clear-cut than physiological medical problems.

Both ADHD and BPD are under-diagnosed. And any hesitancy for identifying BPD is very dangerous: borderlines have an extremely high rate of suicide. It's so sad because BPDs are often dismissed as mere "b!tches" or "drama queens" when they really need therapy and medication.

People like you are hostile to psychology and psychiatry because you believe it's a cop-out for bad behaviour, bad parenting, personal failings, etc. Please try to remember: a BPD teenager who is written off as a b!tch and a slut will usually grow up into a mother who abuses drugs and abuses her children. Early detection and treatment not only helps her, it helps her family even more.

[shifuimam]

Originally Posted by ShortcutToMoncton 

Or... he could just go to a local clinic. Or he could just get a new family doctor.

I haven't seen my family doctor in, oh, probably 10 years. The couple times I've decided to see a doctor during that time I just walked into a clinic and sat and waited for an hour.



That... pretty much sounds like the same as Canada. Possibly with a shorter wait time here though.

I was just going off the concept that you may wait a very long time (more than a year) to get with a family doctor. If it only takes a couple of weeks, great - I imagine it'll be about that long before I decide who I want for a gynecologist if I end up moving out-of-state soon.

I don't know how many options you have when it comes to a specialist like that, though - even in a relatively small town like Lafayette, there are several to choose from, and far more in a metro area like Indianapolis.

See... it's pretty much the same here, too. But I still just think you don't really understand the system. People who are having problems getting a family doctor are doing so because there aren't enough doctors in their area. This isn't the system's fault. That's just because... doctors don't think it's worth working in that area. They'd make more money elsewhere, so they go elsewhere.

Make sense? It's probably similar to the US in that respect.

Quite possibly, yes. I don't know how overburdened doctors are in less populated areas. Of course, in rural areas you generally have country folk, who are far more self-sufficient and less likely to see a medical professional for every ache and pain.

Isn't a reasonable solution, but it's usually for specialist procedures for which there are limited number of trained doctors and/or facilities. Not for GPs, which the rest of your complaint about. And it's usually the difference between "waiting for some period of time" and "getting it much quicker in the US and paying to do so." So I guess "too long" is relative. Although you're right; we need more/better funding in some areas.

Indeed. I have a problem with people who look to Canada's health care system as though it is the epitome of socialist health care, because of things like this. No system is perfect, and personally, I'd rather keep my private insurer if it means I can get access to elective (and maybe even necessary) health care faster.

Plus, what would all those rich Canadians do if we got rid of private insurance down here?

But it's one answer.

Yes, it is - it's by far the least desirable in my book (shocker). The problem is that I feel there is an underlying belief that a single-payer, all-socialized health insurance system is the only answer. This is just naive.

You're still confused about how our system works. Canadian healthcare doesn't cover drugs that you only want, and don't need. (That might even be the same for drugs that you need, but I'm not sure about that. Something tells me that our system doesn't cover drugs at all. There might be some limited government subsidy just the same.) We pay for birth control just like everyone else. Or acne medication if you want it, or I suspect Implanon too. However, there is some limited government insurance coverage for specific groups, e.g. people on social assistance, native peoples, seniors, etc.

That's a good thing, IMO. But does Canada's government negotiate lower prices with pharma corps, the way that Australia does? By forcing the price of medications down in other countries, pharma corps have to force prices up in the United States to make up the difference.

We get insurance to pay for drugs. Often through an employer, university, or whatever. I had to buy some antibiotic medication for an eye problem I had some years ago, and it cost me close to $200 because I had opted out of my university health insurance and hadn't realized that my parent's health insurance which I thought I was covered under expired when I turned 24 or something like that.

Again, this is a good thing - but I don't know how jazzed the Democrats down here in the US are going to be about such a concept. I mean, we are the country with the expensive drugs (a necessary evil, TBH) - if the government forces down drug prices in the US, it is undoubtedly going to significantly slow down the pace of R&D with the drugcos,

It's a good point, especially when you think of the thousands or millions of smokers who I'm sure have burdened Canada's national healthcare system as a result of smoking-related illness.

Yeah - and it's where the size thing comes into play. We're the fattest country on the planet. We have a lot of smokers and drug users and alcoholics. There are simply a lot of people who have medical problems as a result of their own selfishness, stupidity, and lack of self-control.

Fat people are a big one, because there's a huge range of medical problems (many chronic) that come as a result of being morbidly obese.

Your logic is incorrect because your example doesn't make any sense. You're confusing "abusing the system" with "overburdening the system."

What you mean to say is that 20 students in a classroom with a teacher get away with less bad behaviour than 40 students in a classroom with 2 teachers. Or that 20 students in a classroom with a teacher get a better education than 40 students in a classroom with 2 teachers.

Either way, I'm not sure that it's a good example in the first place.

I think the theory behind it stands - it's the same in any situation where something can be abused. The fewer security guards you have at an entertainment or sporting event, the more likely something bad is going to happen. It's just easier for people to slip by or fall through the cracks and loopholes in the system.

Not to mention flat-out numbers. Let's say you've got 200 people on a waiting list for a kidney transplant in Canada. Instead of 200, you end up with 2,000 people on a waiting list, making your chances of getting your kidney transplant before you die are looking much, much slimmer.

I think it's a pretty valid concern. Other social programs in the United States (welfare, medicare/medicaid, social security) have not fared well under the ever-increasing burden of the country's growing population, I don't expect a national health care program to be any different.

I'm not saying I disagree with you, but I will say that parenting lessons from a single young woman with no intention of having children is a hard sell.

(Sort of like marriage or womanly advice from the single Apostle Paul? )

True, but I've done some light research on the ADD epidemic in the United States, from a pediatric psychologist who specializes in behavior modification therapy as an alternative to drugs for children diagnosed with attention deficit disorders.

There is a lot about American culture that promotes the development of short attention spans in children. Passive entertainment (television, movies, many video games) is a major one, as is our general culture of immediate gratification. Many children are taught from a very young age that throwing a fit gets them what they want, and that being annoying gets them more time in front of the television because Mom doesn't want to interact with them (or she has a short fuse herself and simply doesn't want to deal with the whining). This doesn't account for all cases of ADD, but I'd say it accounts for a lot of them.

Again: in Canada, the parents, or the parents' insurance, pays for the Ritalin AFAIK.

Taking personal responsibility for your own mental issues aside, in Canada you pay for your own antidepressants if you want them.

I dated a girl once who went on antidepressants. She paid for them herself, just before we broke up because she was a nutbar.

greg

Yeah, but again - it seems to me that the American public wants more. They want a totally comprehensive plan that covers the cost of everything.

I'm down with coverage for basic, preventive care (vaccines, annual pediatric checkups, Pap smears, mammograms, colonoscopies, oral cleanings) - elective and noncritical care, however, is a whole other story. There are plenty of people who call up the doctor every single time their kid pukes or has a bruise or a sore throat. I don't, because I wasn't raised that way - but the millions who do are the ones who are the drag on the system in the first place. Making it government-paid isn't going to change that.

[shifuimam]

Originally Posted by lpkmckenna 

Both ADHD and BPD are under-diagnosed. And any hesitancy for identifying BPD is very dangerous: borderlines have an extremely high rate of suicide. It's so sad because BPDs are often dismissed as mere "b!tches" or "drama queens" when they really need therapy and medication.

People like you are hostile to psychology and psychiatry because you believe it's a cop-out for bad behaviour, bad parenting, personal failings, etc. Please try to remember: a BPD teenager who is written off as a b!tch and a slut will usually grow up into a mother who abuses drugs and abuses her children. Early detection and treatment not only helps her, it helps her family even more.

I'm dependent on an antidepressant at this point in my life. I see a clinical social worker/therapist once a week. All of my immediate family and most of my extended family suffers from some sort of chronic psychological problem.

I am no stranger to mental problems, nor am I hostile to psychology and psychiatry. Quite the contrary; I find it fascinating.

I also find it distressing that a small child who doesn't always pay attention is automatically diagnosed with a disorder. If medication were the only answer because the problem is physiological, why does behavioral therapy work? Why, in some cases, is the child's attention deficit only present when they're doing something they don't want to do?

Do you have any statistics backing up your claim that BPD is underdiagnosed?

And please do realize - my problem is not with the psychiatric industry. My problem is with the government paying for general psychiatric care, specifically because the criteria for diagnosis is generally far more vague than the criteria for the diagnosis of a medical condition.

Saying "you have this, this, and this symptom, so you're likely BPD" is not the same as saying "see this giant mass on your brain? yeah, that's a tumor and you're going to die in six months from it".

Allowing a government program to fund psychiatric care across the board would require the rules to be far too lax to sustain the program indefinitely - everyone and their brother suffers from some kind of mental problem, from winter blues to full-on dissociative identity disorder or schizophrenia. The cost of caring for all these, were it to be laid on a tax-funded system, would be utterly incomprehensible, particularly when you factor in the number of people in need of some kind of prolonged in-patient care.

....not to mention your own point about people's mental problems not being caught early enough, and they end up destroying their lives or committing suicide. You think it'd be a good thing for these people to be on a waiting list instead of immediately getting the care and diagnosis they need to stay sane? Either you're going to end up with doctors diagnosing and prescribing treatment without the proper time given to the patient in order to move through the long, long waiting list, or you're going to end up with an increase in the rate of suicides because of people sitting on waiting lists for ungodly quantities of time.

[ShortcutToMoncton]

Originally Posted by shifuimam 

I think the theory behind it stands - it's the same in any situation where something can be abused. The fewer security guards you have at an entertainment or sporting event, the more likely something bad is going to happen. It's just easier for people to slip by or fall through the cracks and loopholes in the system.

Not to mention flat-out numbers. Let's say you've got 200 people on a waiting list for a kidney transplant in Canada. Instead of 200, you end up with 2,000 people on a waiting list, making your chances of getting your kidney transplant before you die are looking much, much slimmer.

I think it's a pretty valid concern. Other social programs in the United States (welfare, medicare/medicaid, social security) have not fared well under the ever-increasing burden of the country's growing population, I don't expect a national health care program to be any different.

You didn't understand my criticism.

Your point was about "scaling up" the system to account for a larger population. But your examples here are only talking about "scaling up the population" and keeping the system at the same size.

It doesn't make any sense, at all. If you have 200 people on a kidney transplant list in Canada, you might have 2000 on a kidney transplant list in the US but you'd also have a far larger hospital system than Canada which would accomodate a greater load. That's what you have already.

The number of security guards at a concert has nothing to do with anything, unless you're suggesting that "we're only going to take Canada's 4 security guards used at their concert, and then allow ten times more fans in the stadium here in the US." And that's a ludicrous argument and I don't know how, why, or where you're making it.

greg

[Laminar]

Originally Posted by shifuimam 

Not to mention flat-out numbers. Let's say you've got 200 people on a waiting list for a kidney transplant in Canada. Instead of 200, you end up with 2,000 people on a waiting list, making your chances of getting your kidney transplant before you die are looking much, much slimmer.

But wouldn't you also have 10 times the kidney donors? Or are you saying that if all operations were completely covered by insurance, more people would opt to have the operation?

[ShortcutToMoncton]

She's just confused.

greg

[lpkmckenna]

Originally Posted by shifuimam 

I'm dependent on an antidepressant at this point in my life. I see a clinical social worker/therapist once a week. All of my immediate family and most of my extended family suffers from some sort of chronic psychological problem.

Me too. Mine is now under control, and I only see the shrink for a check-up and a new prescription.

I am no stranger to mental problems, nor am I hostile to psychology and psychiatry. Quite the contrary; I find it fascinating.

I also find it distressing that a small child who doesn't always pay attention is automatically diagnosed with a disorder.

It isn't "automatic." Parent take their kid to a doctor, and the doctor does his thing. Nothing automatic about it.

If medication were the only answer because the problem is physiological, why does behavioral therapy work?

Who says medication is the only answer? Most ADHD kids do both.

Why, in some cases, is the child's attention deficit only present when they're doing something they don't want to do?

Says who? I'm pretty sure the attention deficit is most apparent when the kid needs to concentrate. Most fun activities don't require much focus.

Do you have any statistics backing up your claim that BPD is underdiagnosed?

How about news reports?
http://www.digitaljournal.com/article/273398
http://www.medpagetoday.com/MeetingCoverage/APA/14335
http://ajp.psychiatryonline.org/cgi/...full/166/5/505

Originally Posted by from the third link

Borderline patients have long been to psychiatry what psychiatry has been to medicine—a subject of public health significance that is underrecognized, undertreated, underfunded and stigmatized by the larger discipline. As with psychiatry and medicine, this is changing. New knowledge, new attitudes, and new resources promise new hope for persons with borderline personality.

And please do realize - my problem is not with the psychiatric industry. My problem is with the government paying for general psychiatric care, specifically because the criteria for diagnosis is generally far more vague than the criteria for the diagnosis of a medical condition.

What seems "vague" to you is really a valuable guideline for doctors.

Saying "you have this, this, and this symptom, so you're likely BPD" is not the same as saying "see this giant mass on your brain? yeah, that's a tumor and you're going to die in six months from it".

So what? Some young woman is sexually impulsive, suicidal, cuts herself, and lives in terror of being abandoned by her parents and friends, but that's not good enough for you because it doesn't show up in a brain scan?

Allowing a government program to fund psychiatric care across the board would require the rules to be far too lax to sustain the program indefinitely - everyone and their brother suffers from some kind of mental problem, from winter blues to full-on dissociative identity disorder or schizophrenia. The cost of caring for all these, were it to be laid on a tax-funded system, would be utterly incomprehensible, particularly when you factor in the number of people in need of some kind of prolonged in-patient care.

You're right. It's cheaper to let them kill themselves. Too bad it's not cheaper to house them in prisons and homeless shelters. Does the phrase "preventative medicine" mean anything to you?

....not to mention your own point about people's mental problems not being caught early enough, and they end up destroying their lives or committing suicide. You think it'd be a good thing for these people to be on a waiting list instead of immediately getting the care and diagnosis they need to stay sane? Either you're going to end up with doctors diagnosing and prescribing treatment without the proper time given to the patient in order to move through the long, long waiting list, or you're going to end up with an increase in the rate of suicides because of people sitting on waiting lists for ungodly quantities of time.

Better to be on a waiting list than no list at all.

[ghporter]

Originally Posted by lpkmckenna 

Both ADHD and BPD are under-diagnosed. And any hesitancy for identifying BPD is very dangerous: borderlines have an extremely high rate of suicide. It's so sad because BPDs are often dismissed as mere "b!tches" or "drama queens" when they really need therapy and medication.

ADHD is both under and OVER diagnosed. Teacher finds Johnny doesn't pay attention and fidgets in his seat, teacher decides Johnny has ADHD and tells the parents. Parents go to doctor and demand medication for their child and far too often get it when a family practice physician is not at all in a position to properly diagnose ANY attention disorder. But when Suzie's mind wanders, teacher just figures she's slow because everybody knows only boys "get" ADHD, so Suzie doesn't get diagnosed and underperforms throughout school to everybody's detriment.

Diagnosing ADHD is done in accordance with the DSM IV TR, NOT in a physician's office on a 15 minute visit, and not at all by any lay individual. Medication is often very much diagnostic-something like Ritalin has a profound effect on a person with ADHD, but just tends to make someone who does not have it jittery. But diagnosis by medication is frowned upon, so a more in-depth, behavior analysis-based diagnostic procedure is warranted, as well as being much more accurate in assessing the degree of the problem and whether or not hyperactivity is actually involved. At the same time, there is no real screening for this or any other attention or behavioral disorder, especially in early grade levels, so not only is teacher the first person to notice Johnny's difficulties, teacher's observational skills and biases play a major role in determining whether or not Johnny or Suzie gets any attention at all for their difficulties.

Borderline Personality Disorder is one of the HARDEST personality disorders to accurately diagnose by its very nature. People with BPD, by the time they are older teens or adults, have years and years of experience manipulating people, either consciously or not, so when they eventually get to a psychologist's office, "it's really all just a misunderstanding, because Mom and Dad are having 'issues' with each other and they're projecting them onto me, while putting me in the middle of their problems..." It often takes YEARS to get an accurate personality disorder diagnosis, and BPD is generally one of the longest "undiagnosed" disorders.

[shifuimam]

Originally Posted by Laminar 

But wouldn't you also have 10 times the kidney donors? Or are you saying that if all operations were completely covered by insurance, more people would opt to have the operation?

That may very well be - in which case the wait may be no different...although I don't think it's a totally invalid concern.

@lpmckenna - you're still missing my point. Private insurance and care for mental patients is great. I don't want my tax dollars paying for millions of people with perceived disorders to get mental health care they may very well don't need. I realize that there are a lot of people with disorders and mental diseases who need medical care, therapy, and medication. The problem is, there are even more people who read about a disorder on Wikipedia, self-diagnose, and go to a doctor having already psyched themselves into believing they have some disorder, so it's a lot easier to allow the symptoms of such a disorder to manifest itself to an unwitting doctor or shrink.

The point is that when it comes to the realm of psychiatry and psychology, the lines are far fuzzier, and it would be extremely difficult to create a health insurance plan for mental health that provides necessary services to true sufferers while filtering out all the idiots who have convinced themselves they have mental problems. I can see the costs of a nationalized mental health plan quickly spiraling out of control for this reason, which is why I am extremely hesitant to agree that it's a good idea to nationalize/socialize mental health services.

[CRASH HARDDRIVE]

Originally Posted by Big Mac 

It just sounds at times like you're arguing against all forms of health insurance, including catastrophic coverage (which I support strongly as a minimum).

I honestly don't know where you got that idea, but I guess I wasn't clear. I believe we should have catastrophic coverage, and only that. I also believe in comprehensive insurance for the truly needy. (That is, the truly poor, people that have conditions from birth, etc. etc. Not a free-for-all welfare handout with a lot of perfectly healthy able-bodied people able to leech off of it. Granted, the government is terrible at running any such system, but so be it.)

For routine and non-emergency care, we should have an affordable healthcare market that's driven by market forces, not insurance or government boondoggles.

[Big Mac]

I agree with your position in large part. (I don't know if you're a proponent of HSAs but assume you are; I'm pretty sure you're against anything more comprehensive than catastrophic coverage. (I think that an insurance company in the free market should still be able to offer a normal PPO plan if it thinks it can do so in an affordable way, which you seem to be against.) However, the confusion on my part set in because you used the term insurance scheme a number of times (with scheme seemingly being in the pejorative sense), which made me assume that you think all insurance is unnecessary.

[DBursey]

You think it'd be a good thing for these people to be on a waiting list instead of immediately getting the care and diagnosis they need to stay sane

Where does the idea of these 'waiting lists' for routine visits & consultations come from anyway? If I want to see my doctor under normal (i.e. non-emergency) circumstances, I call and make an appointment - usually accommodated within the same day. If I don't want to call or if it's after hours I go see a doctor at a walk-in clinic. If I don't want to move a muscle I can call our free telehealth service to speak to a doctor or nurse.

IMO only fools and those with time to waste go to busy urban emergency rooms for routine medical consultation.

[stumblinmike]

Originally Posted by Big Mac 

However, the confusion on my part set in because you used the term insurance scheme a number of times (with scheme seemingly being in the pejorative sense), which made me assume that you think all insurance is unnecessary.

Psst... Mac... He's on to it!

[ghporter]

Originally Posted by shifuimam 

@lpmckenna - you're still missing my point. Private insurance and care for mental patients is great. I don't want my tax dollars paying for millions of people with perceived disorders to get mental health care they may very well don't need. I realize that there are a lot of people with disorders and mental diseases who need medical care, therapy, and medication. The problem is, there are even more people who read about a disorder on Wikipedia, self-diagnose, and go to a doctor having already psyched themselves into believing they have some disorder, so it's a lot easier to allow the symptoms of such a disorder to manifest itself to an unwitting doctor or shrink.

The point is that when it comes to the realm of psychiatry and psychology, the lines are far fuzzier, and it would be extremely difficult to create a health insurance plan for mental health that provides necessary services to true sufferers while filtering out all the idiots who have convinced themselves they have mental problems. I can see the costs of a nationalized mental health plan quickly spiraling out of control for this reason, which is why I am extremely hesitant to agree that it's a good idea to nationalize/socialize mental health services.

I think you're giving psychologists and psychiatrists a bum rap. They have a LOT of experience evaluating people for whatever it is that ails them, and there are very strong, very specific guidelines for a diagnosis to be rendered, all spelled out in the DSM IV TR (the "Diagnostic and Statistical Manual, 4th edition, Text Revision"-the latest and greatest). You're not going to walk in to a shrink's office and wind up with a diagnosis in your first visit, even if you're in real trouble. It takes a lot of time to examine, evaluate and monitor a person before you can even render a diagnosis of something as mild as mild depression.

The fact is that far more people go without any mental health diagnosis than should be, and very, very few get an incorrect diagnosis. I don't think there are enough cases of malingering by feinting a psychiatric disorder to even construct statistics on.

[besson3c]

shif: I just don't understand why you feel that what is unknown to you will magnify the occurrence of a generalization you have made to the point of the entire thing becoming a deal breaker. I mean this in a very general way. It just seems like a very fearful way of solving problems, trying very carefully not to make certain things worse, when most solutions come with a grab bag of strengths and weaknesses of their own.

[CRASH HARDDRIVE]

Originally Posted by Big Mac 

I agree with your position in large part. (I don't know if you're a proponent of HSAs but assume you are; I'm pretty sure you're against anything more comprehensive than catastrophic coverage. (I think that an insurance company in the free market should still be able to offer a normal PPO plan if it thinks it can do so in an affordable way, which you seem to be against.)

I should clarify I'm not against a truly free market offering whatever product or service a demand exists for. I'm not in favor of using government to dictate to the free market- merely, people willingly changing the way they view this particular part of the market.

I think most people recognize inherently that most of their needs are best provided by directly paying for them, not a complicated (and ultimately FAR more costly) insurance scheme. Therefore, if a business in the free market wanted to create some ridiculous 'food insurance' scheme, and there were people willing to buy into it, then fine. There's no need for any regulation or government intervention, because dumb ideas usually are seen as that, and fall by the wayside in a free market. So in a free market healthcare system, the insurance plans that truly make sense to consumers and meet an actual demand will thrive, and more power to them. The insurance companies that so many people seem to be whining about are evil bastards that rip everyone off- they should fall by the wayside. Let the market decide, let consumers decide.

What I'm against is the belief that people have that they NEED the insurance boondoggle we have, and worse, that they have a 'right' to now demand government pay for their fix as well. It wasn't normal market forces that created that belief in the first place, it was government dicking with the free market.

However, the confusion on my part set in because you used the term insurance scheme a number of times (with scheme seemingly being in the pejorative sense), which made me assume that you think all insurance is unnecessary.

Consider my every use of the term insurance scam to be short for 'comprehensive healthcare insurance' that covers the routine, and like any good ponzi scheme, requires more healthy people paying in than sick people receiving benefits. I realize any insurance plan operates this way, but there's one key difference. Insuring against the catastrophic actually makes economic sense- you'll likely pay in more than you'll take out, but because it's insurance against a relatively rare occurrence, the price can be reasonable. Insuring against the routine is in a sense being taxed continuously for merely living, and a much wider disconnect between the price and the actual value of the service occurs.

People say things like "I was covered by insurance for my doctor visit, yay!" but you rarely see people do the actual math and say things like "Gee, I had $5,000 taken out of my pay, to receive $2,000 worth of care." Which of course means you're actually the IDEAL customer for the insurance. Actually, I take that back- you're ideal if you're young and healthy and earning a decent living, so you can go YEARS of paying X amount into a system, while you receive virtually nil. About the time you actually need something yourself, you can safely be told to wait. Never made to wait to pay, mind you. That's always PRIORITY ONE.