Quick question about the social health programs detailed in Sicko

[Squatch]

In those countries offering social health programs that were highlighted in Sicko, do those programs offer (and pay for) cutting-edge treatment or do they only offer the minimum acceptable treatment?

Say I have a bad cavity and am treated by an English dentist. Will I be given a color-matched porcelain filling or the standard silver amalgam filling?

I am tired of wearing glasses, will an optometrist recommend PKR or lasik or even contact lenses? Will the state-sponsored healthcare pay for those more expensive treatments?

Say I have a strange form of some disease that has been heretofore incurable. A new "wonder drug" that has not gained widespread acceptance but has shown promise is released to treat my ailment. Will the state healthcare pay for or even consider that drug?

[cassiepriam]

1. I think there is some rationing of health care which must happen with universal care.

If you are 100 years old and terminal, you
will not receive 2 million dollars worth of medical care
keeping you alive for 2 weeks
like we do here in the US.

Medical dollars are finite and some tough decisions will be made
if there is universal care. Right now we are letting the fat cat ceo's
make the choices of who lives and dies.

[Squatch]

2. So, if we're just talking a shift of that decision-making authority from

"fat cat CEOs" to government bureaucrats...is that really an improvement?

I think the issue is much deeper than just the question of fiscal-based decision making, although the cost of treatment plays a part in either form of health care.

[Greyhound]

11. Bureaucratic rules based on the opinions of the attending physician

are infinitely better at making these decisions that those made by for-profit corporations.

[China_cat]

16. My in-laws lived in one of those 'socialized'

medicine countries...the Netherlands. They are both gone now but the medical care they received was top-notch, including home visits from the doctor when they couldn't easily get out any more.

Rationed is mainly the elective procedures. You can get them done but you'll either have to wait or buy supplemental insurance to cover it with a doctor who has a private practice. The government does NOT tell the doctor what they can and can't do when it comes to treatment options that are not elective.

I wish we could have 1/2 the care my in-laws got.

[cassiepriam]

18. Currently health care is rationed by income. The wealthy get all they want.

The poor little to none. And the middle class allows their insurance company to decide what and if they will receive treatment.

And yes it remains to be seen whether there will be an improvement or not
with the govt making those decisions.

And even if the system is going to be a totally fair one, there will have to be some serious decision making.

Do we continue to spend a great deal of our health care money on the last couple of months of life like we do now?
Do we spend billions of dollars to help the aged live a few more months?

Do we spend billions of dollars to keep high risk preemies alive when other older children have no care at all?

I am not saying I have any answers, only questions.

[Squatch]

19. Me, too, brother. Me too.

"I am not saying I have any answers, only questions."

[cassiepriam]

20. If all Americans would start asking more questions it would be a better place,

instead of everyone having all the answers.

[northzax]

3. as a general rule, no

but then unless you have better than average private insurance in the US, you aren't getting it either.

many people, at least in the UK, have supplemental private insurance to cover these things. If you have gold plated insurance in the US, your experience will likely be better than under social medicine (at least under National Health, which is the one I am personally familiar with) yes, you will have to wait for non-essential operations that might be done faster in the US, but you will get them without private insurance, unlike in the US. I've had both NHS coverage (growing up in the UK, even as a US citizen, I still have a National Health card) and top line insurance in the US, and I certainly prefer the latter; but then I have also had less than super insurance in the US (and none at all, at times) and prefer NHS to that.

[Squatch]

6. I've got Tricare...pretty decent insurance for which I have to put my life

on the line to be qualified for...literally.

[BlooInBloo]

4. The only specific mention of the topic I recall was in the British segment....

... when the doc was detailing to MM about how he gets paid more when he provides more/better services. The doctor with a $1 million home in London (one of the 2 or 3 most expensive cities in the world).

[Squatch]

5. Didn't he get paid more if he had healthier clients?

I'm probably putting too fine a point on it.

[BlooInBloo]

7. I have no idea what you're talking about. I'm only talking about what was in the movie....

.... Because that's the extent of my familiarity with the subject.

[Squatch]

8. So am I. The doc said he got paid more if his clients

quit smoking, lost weight, and generally became "healthier".

I don't think he said he got paid more if he provided and performed more expensive procedures.

[BlooInBloo]

9. Nor did I say the doc said that.

[Squatch]

12. Maybe I misread what you wrote here:

"The only specific mention of the topic I recall was in the British segment....

... when the doc was detailing to MM about how he gets paid more when he provides more/better services"

Sorry.

[BlooInBloo]

13. Yup. The concept "expensive" is nowhere suggested in what I expressed.

[northzax]

15. a millon bucks won't buy much in London

that's 500,000 pounds. a pittance in the London market (as a comparison, my sister just bought a small 1.5 bedroom row house in a suburb 30 miles from London for 250,000 pounds) consider, as a general rule, that London costs the same, in pounds, that New York costs in dollars.

and NHS doctors make significantly less that US doctors. in 2003, for instance, the last straight data I could find on NHS salaries (http://www.nhscareers.nhs.uk/details/Default.aspx?Id=553) a starting doctor under contract to the system made 20,000 pounds, a doctor in her fifth year, with specialist training would make roughly 48,000 pounds.

Doctors in private practice in the UK make roughly what doctors in private practice in the US make, but then it's mostly a cash business, closer to the 100-120,000 pound range. in the US, for instance, a GP three years in practice made in 2004 roughly $156,000.

[BlooInBloo]

17. Maybe the doc was lying then. He said it was a 4 bedroom house....

... It looked nice enough in the movie. But maybe you're right.

EDIT: And he drove a late-model audi sedan. But maybe it was a kit car.

[northzax]

21. did he say he made all his money from his practice?

and there are always odd exceptions. How long has he owned the house? does he have family money? is his wife an investment banker?

and I just did a real estate search, and for 500,000 pounds, you can buy a two bedroom flat. but maybe he got a good deal?

[BlooInBloo]

22. Nope.

[northzax]

24. I was just asking

because I know people making $35,000 a year working for non-profits who live in million dollar houses because they have other sources of money (usually family)

[BlooInBloo]

25. Sure - all sorts of possibilities exist. His wife may work, for example...

... I simply don't recall those possibilities being addressed in the movie, which exhausts my knowledge of the topic.

[alarimer]

29. The doc in Sicko made close to 200k US

Now that's one guy but my guess is your figures may be outdated.

[northzax]

31. $200,000 US

is equivalent to about 98,000 pounds these days.

[originalpckelly]

10. I want to know what happens when the Republicans slink back into power.

[canetoad]

14. Australia was not mentioned

But I think we share similarities with the countries who were.

Medicare is the universal system. Cost is a 1.5% levy on taxable income. Private health fund exist that cover a variety of services, such as full dental, elective surgery, chiropractic etc.

Generally, your GP refers you for specialist care. Most of this is covered by medicare, for low income earners, all of it. The private health funds tout the choice of doctors and treatments, in practical terms, these can be varied, depending on your relationship with your GP. Such things as Lasik, cosmetic surgery, porcelain implants are not covered. (but then again I knew someone who did have a tooth implant under the system - convinced them that mental health suffering etc) but you will get glasses, dental care etc

[Cairycat]

23. Some treatments are rationed or not provided

I have macular degeneration that will probably become the type that can be treated with new drugs like Lucentis, Macugen, or Avastin. These are very effective but also very expensive - a course of treatment with Lucentis, for example, costs about $50K, but 95% of those treated can see as many or up to 3 more lines on an eye chart as before treatment.

Recently there has been quite an outcry in Britain over the National Health Service's decision to only give patients with macular degeneration (and vision loss) in both eyes Macugen or Lucentis (can't remember which). There are struggles with this issue in Canada and Australia also, IIRC.

Here in the US, if you don't have insurance and/or a lot of money, you would just have to go blind.

When I noticed distortion in my vision, we hurried and got on the insurance offered through my husband's place of employment. This meant a 20% cut in take-home pay, which is a huge chunk out of our lower middle class income. I am looking for a better paying job so we can afford it. We will have no coverage for a year and a half, and under Iowa law, there is the possibility that the insurance company will say, "Cairycat sought insurance after a reasonable person would have sought treatment for this, therefore we are permanently denying coverage." I think that isn't the case for me but have a feeling I might need to be ready to fight that. If I were denied coverage permanently, I guess I'd have to raid my retirement money, which would be better than permanent disability, but still. What gets me is the thought of what would happen to me if I didn't have these resources, Going by the way this disease blinded my father and sister, I would be legally blind by age 60 or so.

Oh, and in Iowa, we would have to be living at 33% of the Federal Poverty Level to get Medicaid coverage for us (not so for out kids). There are lots and lots of people who are not poor enough for government health care but not able to afford even employer-based coverage (forget about affording private insurance!!)

Macular degeneration affects about 30% of people by age 70, although the type and treatments I'm talking about are relevant to about 10% or so of that 30% - still a considerable number of people as Baby Boomers age. It will be a huge challenge to deal with this for the US and the rest of the world.

[Kazak]

26. No, but you will receive care, and...

base level care ought to be available to everyone.

[Spazito]

28. Adding to your comment....

You will receive care and you will not have to go in debt to pay for it, you won't have to choose between keeping your home and getting needed care, you won't have to choose between being able to feed your family or getting needed care.

[pitohui]

27. quick answers, those things are not covered by any american insurance NOW

cosmetic surgery is not covered by american insurance programs, they are cash on the barrelhead, and yes your fancy dental surgery and your LASIK are COSMETIC procedures


you want to stop people who are dying from, say, diabetes from being able to get care they can afford because you won't be able to get something from socialized medicine that you can't get NOW?

a lot of people need to get a clue and a conscience, do they really think we're this stupid?

[alarimer]

30. Lasik is not covered by most insurance now

Most people do not even have dental insurance, or at least most dental insurance is not very good. I work for the state of Texas and I have a dental plan that is basically a dental discount plan. I pay half price for most services. For some very expensive procedures, that is still very expensive. I was not aware that dentists still did silver fillings at all.

I have very limited vision coverage that does not cover glasses or contacts at all. Only the exams. Nothing else. Pretty shitty coverage I would say. My guess is universal health care would do a much better job of those things. We would have to make sure the legislation included it.

I think you are trying to slam universal health care for no reason. It is much better than what we have now since most people have crappy expensive plans that cover very little anyway.

[Rosemary2205]

32. I have CADILLAC insurance that covers NONE of those things.

My insurance is truly about the best money can buy. The cost to me is extremely minimal and we have never been denied any medically necessary treatment.

Only one medication was ever denied by our plan -- they asked me to switch from Nexium to Prevacid. No biggy. Also, they quit handling Precision extra diabetic testing strips and sent my husband a free new Accuchek monitor and 3 months worth of testing supplies to switch him over. There was also a problem with one newish and still quite expensive medication for RA and required only a call from his doctor to verify he had already tried the other cheaper alternatives. The medication was approved immediately.


Our only difficult waits for treatment was the surgery on my husband's neck. He was becoming paralyzed and it took 7 weeks from the first visit to the primary care for a referral to the actual surgery date. 5 days to get all the referrals for testing and specialist in the mail. (this problem is non-existant now due to the computerized systems). 9 days to get the earliest non-emergency appt. at Emory for the MRI. 4 days to get the films to the surgeon to determine if there was a surgical repair option. About 2 weeks to get into the surgeon for the first appt. 3 days to get the surgical pre-authorization from the insurance and several weeks to get a spot on the surgeon's OR schedule.

Obviously we are already "rationing" care when a big city like Atlanta has OR's and MRI machines booked up.