Semi-OT: Satisfied with your health care?

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"krw" wrote:

Back to smoking the good stuff?
Lew
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On Wed, 08 Jul 2009 00:42:27 GMT, "Lew Hodgett"

whether we like it or not.
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krw wrote:

warm salt water, assume the fetal position in a dark warm closet, wrap the blanket around you, and chant: "there is no hope and nothing will ever change". It's gonna be OK.
    erk,     j4
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No, you have that wrong. There's only hope that Obama 'll leave you with change.
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No, you have that wrong. There's only hope that Obama 'll leave you with change.
<end of original postings> Sorry to have not read the earlier posts on this topic, but just came across a very interesting article in the New Yorker: http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande Kerry
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Han wrote:

If The One gets his way, I (or anyone else for that matter) won't have to do that, the government will be making those choices for us. And no, that's not hyperbole -- take a critical look at the things that Daschle was promoting as far as evaluating "cost-effectiveness" of treatment, the comments The One made as related above, the fact that the only real way to bring medical costs down is to ration availability of care.
--
If you're going to be dumb, you better be tough

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If aspirin can do the same thing as Vioxx (kill the pain) then I would like the rule that cost plays a role. Not the only role, for sure, but that is where the if comes in.
--
Best regards
Han
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Do you really believe Vioxx and aspirin are equivalent?
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He didn't say one way or the other. But of course they are not equivalent. In many cases aspirin is safer and more effective. -- Doug
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On Tue, 07 Jul 2009 20:40:14 -0500, Douglas Johnson

He did.

In what case is asperin more effective?
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<snip>

Aspirin prevents heart attacks while Vioxx causes them?
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That indeed seems to be the case. Exactly why is not quite sure yet. Other NSAIDs may act in either way or not <Grin>.
This is the current explanation. Not everyone may believe all of it.
The protein involved in this all is called cyclo-oxygenase. There are 2 different forms of it. COX-1 and COX-2. Both convert arachidonic acid (AA, an n-3 or omega-3 fatty acid, which should be rather plentiful in your cell membranes) into a compound called PGH2 (prostaglandin endoperoxide). Depending on the tissue this occurs in (or near), this is converted then into several different compounds - prostaglandins, thromboxane, and prostacyclin. Thromboxane promotes thrombosis and other things, prostacyclin counteracts the tendency to thrombosis. PGH2, thomboxane and prostacyclin are inactivated in vivo in seconds ( aminute or 2 maximum). Therefore, in order to "work", they have to be formed over and over again (generally speaking).
COX-1 is really plentiful in blood platelets. Platelets do not (generally) make new proteins, what they are born with is what they carry. Aspirin reacts with an amino acid of COX near where the active site is, where AA is converted. The reaction effectively, very rapidly and irreversibly kills the enzyme activity. Since platelets live for about 10 days, a fairly low amount of aspirin once a day should keep platelets from making thromboxane from AA (via PGH2), and thereby prevent thrombosis.
COX-2 is more prevalent in inflammatory cells, but also in the cells lining the blood vessel that are an important part of the "machinery" that keeps blood fluid.
It was believed that perhaps the bad gastrointestinal effects of aspirin on at least some people could be avoided by targeting the inflammatory COX-2, with a drug that is specific for COX2. Vioxx was the second such drug. Their development was a great success story, at first. It is still being debated through what unintended consequences the inhibition of COX2, especially by Vioxx, resulted in it (Vioxx) "causing" an excess morbidity and mortality.
Sorry for the long lecture. It is a scientific subject of interest to me. I take a full aspirin tablet (325 mg) each day, because the baby aspirin doesn't seem to work sufficiently on my platelets, despite a huge body of research saying that 81 mg should suffice.
--
Best regards
Han
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Medical care has to be rationed like any non-free good, there is not enough for everyone to get everything they want. The choice is rationing based on ability to pay (US system), or medical necessity (Canadian system).

Our nasty socialist uncaring health care system offered knee replacement surgery to my 88-year old mother-in-law. She turned it down as she felt she was too old for that.
Luigi Just doing his bit to counter some of the lies about Canada's health care system.
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Luigi Zanasi wrote:

My mother just had a repair of a knee replacement done over 15 years ago, she is 84. For what it is worth, she has replacement hips and knees on both legs, all free.
--
Froz...

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Luigi Zanasi wrote:

You mom should have gotten on the list, even though she was probably correct in assuming she wouldn't live long enough to bubble to the top. Stranger things have happened.
I understand that abortions are free in Canada, but there's an eleven-month waiting list.
Is that so?
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On abortions, it's actually only 10 months, but only in the Catholic hospitals. :-)
My mother-in-law is not planning to die within the next 2-3 months (waiting time for knee surgery where she lives).
Luigi
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The question is not whether the US system needs rationing. It already has it. We ration it by who you happen to work for (corporate insurance), by age (Medicare), by poverty (Medicaid), and by wealth (private pay or individual insurance). Those that aren't in one of the privileged groups are out of luck.
Of course we need to ration health care. We need to ration any commodity where the demand exceeds the supply. In a pure capitalist system this is done by price. What we have now in health care is nothing close to a pure capitalist system nor do I necessarily think it should be.
Which finally brings me around to the real point. The question is not whether to ration health care, but how. Who gets what care and who decides? This is ugly. There will be winners and losers. Both sides are going to fight like hell. But rationing is the core issue. Anything else is smoke.
OK, I know there are inefficiencies that can be squeezed out. But that isn't going to get everyone all the health care they want. It won't even get everyone all the health care they need.
-- Doug
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Douglas Johnson wrote:

Just to dispel this notion -- this is not true. My wife had two elderly unmarried aunts who were never well off, to be blunt, they were poor their entire lives. When one was diagnosed with cancer, the state of Kansas paid not only for her treatment, but also for trips to and from the doctors. When her sister needed long-term care, she spent several years in a nursing home. The state got their home and anything left in savings after they passed away, but this was reasonable considering the care they received. Care is available to those who need it.

IMO, the system we have now is by far superior to as system run by the government. I don't want the same kind of people who run TSA, the Post Office, the Motor Vehicle Department, or the IRS deciding the kind, amount, or any other element of the kind of medical care I should receive.
--
If you're going to be dumb, you better be tough

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This sounds like it's Medicaid, which is a state run, federally funded welfare program. Like any such program, there is are a bunch of requirements, but the central one is poverty, or near poverty. If you have too many assets or too much income, you are out of luck. You also have to be old, disabled, on welfare, or a low income family with children -- at least in Texas. It is NOT available to everyone who needs it.
I included Medicaid in the list of privileged groups. It is a little odd to think of poor people as privileged, but when it comes to health care, they are.

Unless you are completely private pay, you do have such people making those decisions. They just work for the insurance company instead of the government. I think that is a distinction without a difference.
I'm heading towards Medicare at a rapid rate and will have government bureaucrats making those decisions for me. Keep your fingers crossed.
-- Doug
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Douglas Johnson wrote:

While this is somewhat true, there is a huge difference and distinction -- there are competing insurance companies that have to keep the majority of their clients satisfied or they lose business to other insurance companies. They are also subject to lawsuits and redress for grievances through the legal system. When the government takes over, no such mechanisms exist unless one is independently wealthy and can go private pay (if that will even be legal).
Further, once the government takes over, this gives a tremendous foothold in not just rationing health care, but using the fact that taxpayers are paying for it as an excuse to regulate every portion of one's life. Again, not hyperbole -- it's being done in Great Britain. Overweight? No hip replacement for you. Smoke? Forget about treatment for heart disease, you brought it upon yourself.
Think about the ramifications -- woodworking is a semi-dangerous hobby, it would not be far-fetched to see the government banning various hobbies because of the "burden" on the public health care system.

--
If you're going to be dumb, you better be tough

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