matt weber <
[email protected]> wrote in message news:<
[email protected]>...
> On Mon, 24 May 2004 23:29:13 GMT, "Skeptic"
> <
[email protected]> wrote:
>
> >
> >"JonK" <
[email protected]> wrote in message
news:40B279EC.1CE94A02@the-
> >kaplansNOSPAM.com...
> >> Skeptic wrote:
> >>
> >> > > Pre-existing illnesses are being used to deny
> >> > > coverage.
> >> >
> >> > Yes. Will a singler payer change that?
> >> >
> >>
> >> With single payer, you've always had the coverage, so
> >> how can there be a
> pre-existing
> >> condition?
> >
> >Will all coverage be equal? Will there be levels of
> >coverage? Will there be coinsurance?
> >
> In most of the models in use today, the basic coverage
> will be equal, but you can buy better coverage (health
> funds in Australia, BUPA in the UK), That gets you
> usually is a shorter queue, if it something that is going
> to kill you in the immediate future, the basic system
> works quite well.
If you arrive at the A&E with an active coronary, you will
get a PTCA. If you are stabilized, you will get a
prescription for nitroglycerine.
If you show up at your GP with a lump in your breast, you
will gwet a referral to a specialist - in 3 months if you
are lucky.
> As for the nay sayers, I'd like to point a few things. By
> most measurments, the average health of US citizens is at
> best marginally better then the average Australian or
> European,
And health status is attributable directly to the level of
health care available?
> however we are probably spending 3 times as much for that
> marginal improvement,
In a recent study comparing Kaiser HMO (22 million
subscribers in a model that is cionsistently available in
the US) and the NHS, the costs were no different and the
access and outcomes of Kaiser patients more than just
marginally better. It was published in the BMJ. There were a
lot of NHS'ers extremely anxious about those results.
> and what you really see is a small portion in the USA who
> get really outstanding care, a large portion that get care
> that may be only slightly better then the average in the
> rest of industrialized world, and a large number who get
> essentially no care.
Lack of health insurance does not mean a lack of
health care.
> That component that gets nothing is missing in much of the
> rest of the industrialized world.
And that is why mandatory insurance is a solution, not
single payer.
> WE do lots of things in the USA that run up costs
> enormously with little benefit. One of the most
> interesting live demonstration of what altering the
> landscape will do is in Australia. The Australian
> Government says if you need an ACE inhibitor, these are
> the ones on the PBS scheme. If you want another one, you
> can have it, but the difference between the retail price
> and the PBS benefit, you are going to pay for out of your
> own pocket. It is truly amazing how few patients are
> willing to spend even an extra $2 a month. What should be
> equally obvious is that in general, the use of the lowest
> cost, therapeutically effectie drug saves a pile of money
> without degrading the quality of care.
And I would argue that you are wrong - and the reason is
quite simple. Therapeutic effect is quite ferquently
idiosyncratic. Therapeutic effect is variable in magnitude.
Effects are offset by side effects and these tend to be more
significant in the older technologies.
Case in point - antidepressants.
Tricyclics (of which there are a handful) are fairly
effective in some patients, but not all. Tricyclics have, in
many cases, rather significant side effects that impact on
patient willingness to continue therapy. Most notable are
the EPS effects and these can be non-reversible.
On the other hand, SSRIs, though generally thought to be
equally effective therapeutically, are free from EPS. This
was a tremendous step forward in antidepressant therapy.
> Because in the USA, someone other than the patient usually
> pays, and patient is almost entirely isolated from the
> cost issue, as is the physician, when a patient walks in
> and says my shoulder is bothering me, can you write me a
> prescription for Celebrex or Viox? The physician will
> happily do so.
Your observation that patients are isolated from medical
costs does not apply to pharmaceuticals in more cases than
not, in the US. Formulary systems use various cost
containment approaches to minimize program expenditures. One
such approach is cost sharing - either in terms of co-
insurance or in many cases, tiered copays.
> In most of the rest of the world, the likely reply will
> be, 'have you tried Asprin or Ibuprofen yet?' If you
> haven't, you will be encouraged to do so. If that doesn't
> work out, then the physician may well prescribe a COX2
> inhibitor. Vioxx and Celebrex probably are more effective
> than Asprin or Ibuprofen, the problem is that while they
> aren't a lot better, they are a lot more expenive!
And the side effect profile is different which could be
important to patients at risk for certain effects.
I don't agree with yiour anecdotal scenario. Have you ever
experience a GP visit first hand in the UK?
> There is no cost benefit analysis being made on the
> front end,
Please review the literature before you make statements like
these. YUse pub med and type in cost effectiveness and vioxx
and see what happens.
> we just demand that we go straight to latest/greates (and
> most expensive drug), even though the advantages it offers
> over drugs that are a fraction of the price are often
> surprisingly small. Take a good look at the ALHAT
> (spelling?)
Two LLs
>...trials about anti hypertensive drugs in the general
>population. It is an eye opening experience about cost
>versus benefit.
Had you read ALLHAT you would have seen that naive
hypertensives did well on monotherapy with HCTZ for about 6
months. By the end of the study, the overwhelming majority
of patients were on multiple drug therapy to control their
hypertension. All ALLHAT showed was what was already
generally well known - stepped therapy in hypertension is an
appropriate approach and the first step, with hctz is often,
but not always, medically appropriate.
js
