Nhs

[R. Richard]

From The Telegraph, UK. Comment?

Patients forced to live in agony after NHS refuses to pay for painkilling injections

Tens of thousands with chronic back pain will be forced to live in agony after a decision to slash the number of painkilling injections issued on the NHS, doctors have warned.

Cuts to treatments would save the NHS £33 million. The Government's drug rationing watchdog says "therapeutic" injections of steroids, such as cortisone, which are used to reduce inflammation, should no longer be offered to patients suffering from persistent lower back pain when the cause is not known.

Instead the National Institute of Health and Clinical Excellence (NICE) is ordering doctors to offer patients remedies like acupuncture and osteopathy.

Specialists fear tens of thousands of people, mainly the elderly and frail, will be left to suffer excruciating levels of pain or pay as much as £500 each for private treatment.

The NHS currently issues more than 60,000 treatments of steroid injections every year. NICE said in its guidance it wants to cut this to just 3,000 treatments a year, a move which would save the NHS £33 million.

But the British Pain Society, which represents specialists in the field, has written to NICE calling for the guidelines to be withdrawn after its members warned that they would lead to many patients having to undergo unnecessary and high-risk spinal surgery.

Dr Christopher Wells, a leading specialist in pain relief medicine and the founder of the NHS' first specialist pain clinic, said it was "entirely unacceptable" that conventional treatments used by thousands of patients would be stopped.

"I don't mind whether some people want to try acupuncture, or osteopathy. What concerns me is that to pay for these treatments, specialist clinics which offer vital services are going to be forced to close, leaving patients in significant pain, with nowhere to go,"

The NICE guidelines admit that evidence was limited for many back pain treatments, including those it recommended. Where scientific proof was lacking, advice was instead taken from its expert group. But specialists are furious that while the group included practitioners of alternative therapies, there was no one with expertise in conventional pain relief medicine to argue against a decision to significantly restrict its use.

Dr Jonathan Richardson, a consultant pain specialist from Bradford Hospitals Trust, is among more than 50 medics who have written to NICE urging the body to reconsider its decision, which was taken in May.

He said: "The consequences of the NICE decision will be devastating for thousands of patients. It will mean more people on opiates, which are addictive, and kill 2,000 a year. It will mean more people having spinal surgery, which is incredibly risky, and has a 50 per cent failure rate."

One in three people are estimated to suffer from lower back pain every year, while one in 15 consult their GP about it. Specialists say therapeutic injections using steroids to reduce inflammation and other injections which can deaden nerve endings, can provide months or even years of respite from pain.

Experts said that if funding was stopped for the injections, many clinics would also struggle to offer other vital services, such as pain management programmes and psychotherapy which is used to manage chronic pain.

Anger among medics has reached such levels that Dr Paul Watson, a physiotherapist who helped draft the guidelines, was last week forced to resign as President of the British Pain Society.

Doctors said he had failed to represent their views when the guidelines were drawn up and refused to support the letter by more than 50 of the group's members which called for the guidelines to be withdrawn.

In response, NICE chairman Professor Sir Michael Rawlins expressed outrage over the vote that forced Dr Watson from his position, describing the actions of the society as "shameful". He accused pain specialists of refusing to accept that there was insufficient scientific evidence to support their practices.

A spokesman for NICE said its guidance did not recommend that injections were stopped for all patients, but only for those who had been in pain for less than a year, where the cause was not known.

Iris Watkins, 80 from Appleton, in Cheshire said her life had been "transformed" by the use of therapeutic injections every two years. The pensioner began to suffer back pain in her 70s. Four years ago, despite physiotherapy treatment and the use of medication, she had reached a stage where she could barely walk.

"It was horrendous, I was spending hours lying on the sofa, or in bed, I couldn't spend a whole evening out. I was referred to a specialist, who decided to give me a set of injections. The difference was tremendous",

Within days, she was able to return to her old life, gardening, caring for her husband Herbert, and enjoying social occasions.

"I just felt fabulous – almost immediately, there was not a twinge. I only had an injection every two years, but it really has transformed my life; if I couldn't have them I would be in despair".

 

[amicus]

Thank you R.Richard....Thas why I love the free press, a democracy and in specific, this forum.

Aside from the evidence, supported by your piece, that socialized medicine does not work, my opposition has always been ideolgical; I advocate a free market, not a controlled one.

Unfortunately, as I read DC, there will be some watered down form of socialized medicine passed into law and the administration will claim a victory and move on to other areas to infect with government madness and management.

Keep up the good fight, right will win out; you have to know that.


Amicus

edited to add: http://www.liberty-page.com/issues/healthcare/socialized.html

 

[manyeyedhydra]

I think this is one area where free markets may not be the most useful (and I'm also a free market advocate for most things).

There are too many perverse incentives that set a company's aim (maximise profits) at odds with the overall health care system's aim (maximise population's health/wellbeing).

For a free market solution to be the best it has to make sure that all the individual component company's aims are aligned with the overall aim of improved health care. I think this is a lot harder with healthcare than with, say making cars or TVs.

Say you are a phamaceutical company working on illness A. You have two research departments X and Y. X comes up with a one-shot cure for A. Y comes up with a drug that alleviates the symptons providing the patient takes it for the rest of their life. Which of these solution will best maximise your company's profits? (My guess is the one that gives you a captive market for life).

You are a pharmaceutical company with a limited budget for Research and Development. What is the more enticing project - drugs to help poor people survive tuberculosis or an anti-impotence drug you can market to rich old men?

You have an exclusive patent for the best drug X to deal with illness A. If a patient with A doesn't take X their standard of living is significantly imparied and they might die. For one patient X costs $15 to produce. 100% can and will pay $12 for X. 90% can and will pay $20 for X. 65% can and will pay $100 for X. What price do you sell X at to maximise your company's profits?

Unless you find a way to tackle these and examples like them, a completely free market healthcare system is probably going to be much less effective (in terms of overall health/wellbeing) than even a quite inefficient government/socialised system.

As an aside, it never fails to astound me when I go to the States and see so many adverts for healthcare products that seem little more than snake oil peddlers aimed at vulnerable people.

The British NHS has flaws (although not as bad as the current propaganda makes them out), but at least the overall aims are clearly aligned in the correct direction.

 

[amicus]

manyeyedhydra...it appears to many that the more difficult tasks of meeting the demand of people could certainly be addressed by an efficient, single producer, a.k., socialism, communism.

I perceive that the good intentions of many that a controlled system can provide all the needs, are blind to human nature and some of humanities more base urges of acquisition and domination, and that the self same human nature exists in the individuals that are responsible for any communal delivery of goods and services.

A free market cannot exist with the supporting legal structure that protects private property and individual rights and liberties and provides a legal framework for intellectual properties, like copyrights and exclusive rights.

No economic system is perfect and every system depends on the integrity of those who participate to do so within the letter and spirit of the laws that protect those rights.

Even with all its' potential flaws, the free market is the only system that both permits and encourages individual choice and responsibility.

For some reason beyond my comprehension, there are those that believe society would flourish if each and every need were met by a cradle to grave security free of fear and want. To me, and those authors who address the free market, it is the human necessity to compete, plan and overcome the adversities of life that define the nature of individual human rights and liberties.

Those who are granted their every wish appear to lose that very essence of humanity that elevates us above the animal kingdom. I really doubt anyone would prefer the life of a pampered pet or a caged bird.



Amicus

 

[R. Richard]

I think this is one area where free markets may not be the most useful (and I'm also a free market advocate for most things).

There are too many perverse incentives that set a company's aim (maximise profits) at odds with the overall health care system's aim (maximise population's health/wellbeing).

For a free market solution to be the best it has to make sure that all the individual component company's aims are aligned with the overall aim of improved health care. I think this is a lot harder with healthcare than with, say making cars or TVs.

Say you are a phamaceutical company working on illness A. You have two research departments X and Y. X comes up with a one-shot cure for A. Y comes up with a drug that alleviates the symptons providing the patient takes it for the rest of their life. Which of these solution will best maximise your company's profits? (My guess is the one that gives you a captive market for life).

WRONG! The best drug will maximize your company' profits. You see, in a free market economy, if you try to game the system, another company will come along and eat up your lunch. Neither company is operating out of compassion, but rather out of pursuit for money.

You are a pharmaceutical company with a limited budget for Research and Development. What is the more enticing project - drugs to help poor people survive tuberculosis or an anti-impotence drug you can market to rich old men?

One or more companies will work on the TB drug. Even if the poor people can't pay for the TB drug, the government will, to save money in the long run. One or more companies will work on the anti-impotence drug. It might surtprise you to learn that even poor old men sometimes have impotence problems.

You have an exclusive patent for the best drug X to deal with illness A. If a patient with A doesn't take X their standard of living is significantly imparied and they might die. For one patient X costs $15 to produce. 100% can and will pay $12 for X. 90% can and will pay $20 for X. 65% can and will pay $100 for X. What price do you sell X at to maximise your company's profits?

You sell it at a price that is in line with the industry markup for similar drugs. If you sell it for some other price, another company will see the big profits to be made and they'll come in, find something else that'll work and eat up your lunch.

Now, let's look at another health problem. You're a doctor, trying to help people as best you can, but mindful of the cost impact on their wallets. In 99% of all cases, one lab test is enough. However, in the remaining 1% some shyster will come in and sue the doctor for enough to begger the doctor. How many tests does the doctor call for? Does the current health care legislation address the shyster problem? Why not?

 

[manyeyedhydra]

Ami, you're preaching to the already converted on most of that stuff. It still doesn't address the core problem.

I am random person X from country Y and I want a healthcare system that provides the best ratio of my health/wellbeing to cost.

The possible solutions:

A. A socialised government system that is wasteful and inefficient, but aims to maximise health/wellbeing to cost.

B. A competing system of highly efficient individual companies that aim to maximise profits from providing healthcare to individuals.

I would argue that A is the best solution to this problem as the aims of the individual companies in B are too far removed from the overall aim because of the examples I gave above.

If the problem was instead, "I am random person X from country Y and I want the best value automobile to drive around in", then the solution would clearly be B as the aims of the individual companies are closely aligned to solving the problem.

Of course you could change the problem to, "I am rich person X from country Y and I want a healthcare system that provides the best ratio of my health/wellbeing to cost." and you get a different answer entirely. But this was not the problem as phrased as far as I am aware.

The danger with all idealogies is people see them solve one problem and then think that automatically means they should be applied to all problems. I'd rather use a spanner to undo bolts and a hammer to whack in nails personally.

But if you could get it so that the aims of the individual companies were more closely aligned with the overall solution to the problem (better ratio of healthcare/cost for random person X), now then we might be talking a better system...

 

[DeeZire]

From The Telegraph, UK. Comment?

Well... after reading the article, is appears as though the new guidelines are not going to fly. Was that your point, that even a government run program is accountable to the people it serves? Compare that to private run healthcare, which is only accountable to stockholders.

The USA spends considerably more on healthcare than any country in the world, yet the health of our citizens is rated below most industrialized nations. Your preference for American system begs the question: do you own stock in the healthcare field?

 

[TE999]

The NHS currently issues more than 60,000 treatments of steroid injections every year. NICE said in its guidance it wants to cut this to just 3,000 treatments a year, a move which would save the NHS £33 million.

A spokesman for NICE said its guidance did not recommend that injections were stopped for all patients, but only for those who had been in pain for less than a year, where the cause was not known.

Here's a taste of things to come. Saving money trumps an individuals discomfort...even if it's just those who've had pain less than one year and the cause is not known. How long will identifying the cause take? What if it's never identified but the pain's still there? Acupuncture? Sounds like rationing to me.

 

[R. Richard]

Well... after reading the article, is appears as though the new guidelines are not going to fly. Was that your point, that even a government run program is accountable to the people it serves? Compare that to private run healthcare, which is only accountable to stockholders.

A government run program is SOMEWHAT accountable to the people it's SUPPOSED to serve. I cite the 'War On Poverty.' The poor people, largely from the South, had to deal with 'furriners' from 'New Yoak Citeh.' The poor people and the city slickers literally couldn't understand what the other had to say. The program collapsed, after spending a great deal of taxpayer money.

The USA spends considerably more on healthcare than any country in the world, yet the health of our citizens is rated below most industrialized nations. Your preference for American system begs the question: do you own stock in the healthcare field?

I don't own stock in companies in the healthcare field or the drug industry, because I fear government intervention. Two of the biggest health care problems in the USA are fat slobs and smokers. The fat slob program could best be attacked by a mandatory physical education program. [I work out a minimum of an hour per day. If my daily workouts were forced on the GITMO inmates, charges of atrocities would follow.] I don't like smokers, for two main reasons. I don't like being forced to inhale tobacco smoke when a smoker lights up. I don't like to pay for hospital care for a smoker dying of emphesema or lung cancer. People come from all over the world for treatment in our USA hospitals. Very few USA citizens go to foreign countries for hospital care.

 

[manyeyedhydra]

WRONG! The best drug will maximize your company' profits. You see, in a free market economy, if you try to game the system, another company will come along and eat up your lunch. Neither company is operating out of compassion, but rather out of pursuit for money.

I disagree. If you can game the system you will game the system until someone forces you to do otherwise. Until someone else comes up with the one-shot cure it is better to run the captive market solution for as long as you can get away with it. Hence you sit on the better solution until someone else's actions forces you to go with it. How much time you can get away with this will depend on how complex the solution is and how competitive the market is.

One or more companies will work on the TB drug. Even if the poor people can't pay for the TB drug, the government will, to save money in the long run. One or more companies will work on the anti-impotence drug. It might surtprise you to learn that even poor old men sometimes have impotence problems.

What government? This is a free market solution I heard. You buy your own or not at all

I agree I should have phrased this problem better though. I was trying to point out the amount of money spent on illnesses is often disproportionate to the amount of people that are affected. A government might be motivated to provide drugs to treat TB whereas free market companies might come to the conclusion it isn't cost-effective to research in that area as the patients wouldn't be able to afford the cure in any case, and therefore concentrate funds in a more high-profile area that might be of less benefit to the populace as the whole.

You sell it at a price that is in line with the industry markup for similar drugs. If you sell it for some other price, another company will see the big profits to be made and they'll come in, find something else that'll work and eat up your lunch.

They can't because of the exclusive patent. They can try and look for an alternate solution that doesn't violate your patent, but in the meantime you can charge whatever the hell you think you can get away with. In the long term a competitor will appear and the prices will be forced down closer to cost, but in the short to medium term the first company will be quite happily maximising their profits while providing an inefficient solution to the maximise health/wellbeing to cost ratio. That's what I mean by the aims not being correctly aligned.

Now, let's look at another health problem. You're a doctor, trying to help people as best you can, but mindful of the cost impact on their wallets. In 99% of all cases, one lab test is enough. However, in the remaining 1% some shyster will come in and sue the doctor for enough to begger the doctor. How many tests does the doctor call for? Does the current health care legislation address the shyster problem? Why not?

I'm not sure how this fits in with the problem as stated.

In a free market situation you probably run as many tests as the 1% are silly enough to pay for, which hammers the cost part of the metric.

In a socialised system you take the risk that 1% slips through the crack and gets missed on the 1 test approach, which hammers the maximise health/wellbeing part of the metric.

Presumably one has a greater effect on the overall metric than the other. I wouldn't know which, but again there is an obvious incentive for a free market solution to offer as many tests as possible regardless of whether required as they can charge for them and maximise their profits that way. Whereas a socialised system has a strong incentive to make sure as few people die as possible (otherwise health secretaries start losing their jobs). This means the push is for them to not let the maximise health/wellbeing part fall too much while the free market system would quite like to push the cost portion of the metric as far as they can get away with.

 

[Liar]

WRONG! The best drug will maximize your company' profits. You see, in a free market economy, if you try to game the system, another company will come along and eat up your lunch. Neither company is operating out of compassion, but rather out of pursuit for money.

Except that in an unregulated market, there are many ways for a company that have achieved a dominant market position to cling to that position, in spite of having an inferior product.

A dominant company with a profitable but crappy product, can buy up threatening competitiors before their product gain traction and entern the distribution chains. A dominant company with a big economy can invest in control of retail and distribution venues and simply choose what competing product they are to not carry. A company with large margins can dump their prices at a temporary loss, until they've starved an upcoming competitior out of business. Or invest in marketing on a level a smaller company can't. Two companies can come to the conclusion that it's less profitable for them to compete head-to-head than to get together and divide the market between them.

That's why we have anti-trust laws, cartel regulations, and so on. Because free market and functional competition doesn't always go hand in hand, and the "better mouse trap" scenario is more than a little bit naive.

 

[DeeZire]

People come from all over the world for treatment in our USA hospitals. Very few USA citizens go to foreign countries for hospital care.

Obviously, those who can afford the best medical care in the world come to the USA to spend their money, (or get comparable care in India for twenty cents on the dollar.) But that's a small segment of the population. Looking at the country as a whole, you see a different picture.

A healthcare system that ignores the needs of the country in favor of the needs of the financially well off would seem to denigrate the quality of life in that particular country. Of course, if you're viewing the quality of life issue from the vantage point of the financially secure, you won't see a problem, you'll only see your own self interest being threatened by concern for the common good. That's understandable. It all comes back to the altruism gene.

I'm with you on the lifestyle issues. Even with the altruism gene, I have no sympathy for those who chose to run down their health - and run up health care costs for the rest of us.

 

[ishtat]

From The Telegraph, UK. Comment?



"therapeutic" injections of steroids, such as cortisone, which are used to reduce inflammation, should no longer be offered to patients suffering from persistent lower back pain when the cause is not known.

.

My Bolds.

Now RR I understand your political viewpoint but how can you fault the clinical sense of this strategy?

 

[R. Richard]

My Bolds.

Now RR I understand your political viewpoint but how can you fault the clinical sense of this strategy?

A person is suffering. The person has inflammation that tells the medical obvserver that there is indeed a problem, it's not psychosematic. However, until the NHS is satisfied that the cause is known, no treatment will be authorized. I can fault the NHS stategy very simply and so can you.

The NHS is a bureaucracy trying to make medical decisions. That's wrong, by definition.

 

[R. Richard]

Quote:
Originally Posted by R. Richard
WRONG! The best drug will maximize your company' profits. You see, in a free market economy, if you try to game the system, another company will come along and eat up your lunch. Neither company is operating out of compassion, but rather out of pursuit for money.

Manyeyedhydra:
I disagree. If you can game the system you will game the system until someone forces you to do otherwise. Until someone else comes up with the one-shot cure it is better to run the captive market solution for as long as you can get away with it. Hence you sit on the better solution until someone else's actions forces you to go with it. How much time you can get away with this will depend on how complex the solution is and how competitive the market is.

Your view of the situation is tactical. Yes, higher profits can be realized, for a time using a tactical point of view.

Now then, you have your short term profits from your tactical strategy and then one of your ex-employees publishes a tell all about how SuperDrugs is ripping off the consumer. SuperDrugs then spends many times the short term profit to regain customer confidence.

Your assumptions are based upon the supposition that a medical company is a closed, monolithic operation, run by very intelligent crooks. Medical professionals, in general don't fit your profile.

 

[manyeyedhydra]

Your assumptions are based upon the supposition that a medical company is a closed, monolithic operation, run by very intelligent crooks. Medical professionals, in general don't fit your profile.

No, my assumption is that an individual private company will behave in a manner that will maximise its own profits.

If you cannot align that with the overall objective then a free market solution can never be the most optimal.

 

[DeeZire]

...The NHS is a bureaucracy trying to make medical decisions. That's wrong, by definition.

If it's the bureaucracy of an HMO making medical decisions, is it also wrong? That's how HMOs work, BTW. The bureaucracy comes up with the guidelines and enforces them, and the doctors and patients must either follow those guidelines or go elsewhere.

Again, you make a good case for a single-payer system, where at least the guidelines are supposed to be in the interest of the patient, rather than in the interest of maximizing profit for shareholders. As your posted article shows, when those guidelines are not in the best interest of the patients, the bureaucracy hears about it, and public pressure forces them to do the right thing.

 

[TE999]

If it's the bureaucracy of an HMO making medical decisions, is it also wrong? That's how HMOs work, BTW. The bureaucracy comes up with the guidelines and enforces them, and the doctors and patients must either follow those guidelines or go elsewhere.

Once the US government assumes the burden of health care for the entire population (and that seems to be what most folks want)and there is no 'elsewhere', where will those who have complaints go to complain? Their senator or congressman? A committee? Take to the streets carrying signs and banners? Will it do any good?

When there is zero incentive (profit) to improve and no competition...you'll get what you're given and what's available. When funds run low and everyone who's still working for a living is taxed to death...you'll have rationing. Everyone who's young and strong and can work and pay taxes will be taken care of...the weak, the elderly, the handicapped, the insane, the addicts and substance/alcohol abusers will be a drain on the system and therefore expendable.

Idealize nationalized health care all you like...it's not what it seems or what you'll think it will be...you'll look back on what we had here one day and yearn for it...inequities and all.

 

[matriarch]

R Richard, I won't return the compliment by criticising your profit controlled health care system. I've seen both in operation, through my own life living here in UK, and NEVER having to worry about whether or not I'll be able to pay for ANY my healthcare (which, from a recovery point of view is enormous, people don't need the worry of medical bills if they're not well. Never underestimate the benefits of a worry free recovery, at least on repayment levels) or my children. My wife as an American, and my brother as a working resident of USA for the last 13 years and a cancer sufferer have given me experience, first hand, as 'customers' of the american healthcare system.

I know which I prefer, thank you very much. Of course the NHS is trying to save money, (so do your HMOs), not for profit, but so that the money available can be put to its best use.

I've probably put this clumsily, but people like you really tick me off. Come live here and experience it before you criticise it. Of course, if you really feel you get better treatment simply because you pull out your wallet, you're free to do that here as well.

 

[matriarch]

Once the US government assumes the burden of health care for the entire population (and that seems to be what most folks want)and there is no 'elsewhere', where will those who have complaints go to complain? Their senator or congressman? A committee? Take to the streets carrying signs and banners? Will it do any good?

When there is zero incentive (profit) to improve and no competition...you'll get what you're given and what's available. When funds run low and everyone who's still working for a living is taxed to death...you'll have rationing. Everyone who's young and strong and can work and pay taxes will be taken care of...the weak, the elderly, the handicapped, the insane, the addicts and substance/alcohol abusers will be a drain on the system and therefore expendable.

Idealize nationalized health care all you like...it's not what it seems or what you'll think it will be...you'll look back on what we had here one day and yearn for it...inequities and all.

I'm not even going to try and argue with someone so blinkered.

The NHS charter has a full complaints procedure.

http://http://www.nhs.uk/choiceintheNHS/Rightsandpledges/complaints/Pages/NHScomplaints.aspx

 

[Boxlicker101]

Quote:
Originally Posted by R. Richard
...The NHS is a bureaucracy trying to make medical decisions. That's wrong, by definition.

If it's the bureaucracy of an HMO making medical decisions, is it also wrong? That's how HMOs work, BTW. The bureaucracy comes up with the guidelines and enforces them, and the doctors and patients must either follow those guidelines or go elsewhere.

Again, you make a good case for a single-payer system, where at least the guidelines are supposed to be in the interest of the patient, rather than in the interest of maximizing profit for shareholders. As your posted article shows, when those guidelines are not in the best interest of the patients, the bureaucracy hears about it, and public pressure forces them to do the right thing.

Either bureaucracy is wrong, but there are some differences. The NHS is a monopoly, and if medical providers don't sign up with them, they are almost out of luck unless they can find some athletic organization who wants to hire them as a team doctor, or something like that. And, if the NHS wants to screw over their clients/patients/citizens, not much can be done about it.

If an HMO gets too greedy or too chickenshit, the professionals can leave and the clients/patients can go elsewhere. If the client is a corporation providing health care insurance for their employees, they can also go elsewhere.

That's how competition works. You try to maximize profits but, if you screw over people too much, your bottom line will eventually take a beating.

 

[TE999]

I'm not even going to try and argue with someone so blinkered.

The NHS charter has a full complaints procedure.

http://http://www.nhs.uk/choiceintheNHS/Rightsandpledges/complaints/Pages/NHScomplaints.aspx

I wasn't looking for an argument, Auntie. I'm sure the NHS works just fine for y'all. I'm not sure recreating it over here will be as satisfactory given what most of the people here are accustomed to, but I guess we'll see.

 

[DeeZire]

If an HMO gets too greedy or too chickenshit, the professionals can leave and the clients/patients can go elsewhere. If the client is a corporation providing health care insurance for their employees, they can also go elsewhere..

Box - where does the patient go if the patient gets their insurance from the corporation they work for but they're not happy with it? Oh, that's right, they either suck it up and take whatever the corporation decides to offer, or they quit their job.

What about self-employed people with pre-existing conditions? Where do they go when no one will sell them health insurance?

No system is perfect, but the system we're used to in the USA has got to be one of the worst in the industrialized world. If you want to dress up a pig and call it pretty, I suppose that's your right as an American, but it doesn't say much about your comprehension of the real world the other half of us live in.

On the issue of competition, the rich will always spur competition, regardless of what the fear mongers from the right wing spin machine tell you. Really Box, there's nothing to be afraid of. Just let go of the propaganda and embrace knowledge for a change

 

[ishtat]

A person is suffering. The person has inflammation that tells the medical obvserver that there is indeed a problem, it's not psychosematic. However, until the NHS is satisfied that the cause is known, no treatment will be authorized. I can fault the NHS stategy very simply and so can you.

The NHS is a bureaucracy trying to make medical decisions. That's wrong, by definition.

I happen to believe that the NHS system will not adapt to the US mainly because the medical professionals have a self interest in making sure it doesn't.

However, I again do not accept your point. The provision of painkillers merely because someone is in pain is not a sensible rationale. Pain has a purpose, to tell us that we are injured. if the fact of that injury is masked by inappropriate painkillers then further and greater injury can occur. In any event a system where lack of money makes the decision not to take the drug is no better than one governed by a bureaucratic decision.

Your objective is reasonable but I think your argument is full of holes.

 

[scheherazade_79]

If the NHS system is so crap, how come experts (and I'm not just talking about people who've read an article in a newspaper) from one of the richest, most advanced countries in the world are planning on setting up something similar over there?