Fiscal Cliff

@georgeob1,

Quote:

Then they could go on to nationalizing the Pubs.

Our pubs were nationalised years ago George. Landlords are public servants in all but name.

Government operated cafeterias represent a difficult question due to the way we organise our breeding hutches. But using barracks, like the one in the Algerian desert, they have an undoubted usefulness. Or in aircraft carriers.

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@georgeob1,

The only comparison that can be made about food and health care is that they are both necessary for survival. Immunization for certain disease are as important as food for survival. How each is utilized is as varied as there are good and bad food and medical care. I doubt that will ever change except in their improvement as we learn more.

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@georgeob1,

No confusion. Canada does not accept drugs for use until independent testing is complete. It is generally a longer and more involved testing process than that required by the FDA. Canadians have been sneaking over the border for many decades to pick up drugs available in the U.S. before they become available in Canada.

The one that comes to mind most quickly is naproxen. Available in the U.S. by prescription for many years before it was available in Canada. Available over the counter in the U.S. for more than a decade before it was non-prescription in Canada.

We do not have a "Public Health Service" - health care is provincially managed. There is no national purchase of drugs. Several of the smaller provinces are currently discussing the possibility of group purchasing for drugs provided through their specific plans.

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@JPB,

JPB wrote:

I'm not sure about the approval process in Canada but, you're right, even on the diagnostic side (which runs parallel to the pharmaceutical side) we'd always submitted for Canadian approval after we were on market in the US. The regulatory burden in Europe and Japan was much less than in the US. Then, the ICH guidelines were supposed to standardize clinical trial guidelines so that a single set of trials could satisfy all regulatory agencies. For some reason the FDA is wary of accepting data generated outside of the US resulting in multiple additional evaluations. That may have improved since I left the biz.

Another problem is the delay in getting generics on-market. Plavix is a prime example of what I believe to be classic crony capitalism between big pharma and the feds.

Interesting. I suspect different local forms of bureaucratic sclerosis are a near universal problem in these areas. Ours are every bit as good at that as anywhere else. It generally isn't hard to motivate bureaucrats to be more authoritarian and obstructionist than they usually are, and if you've got a lucrative patent monopoly to protect, it is well worth the effort.

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@ehBeth,

ehBeth wrote:

No confusion. Canada does not accept drugs for use until independent testing is complete. It is generally a longer and more involved testing process than that required by the FDA. Canadians have been sneaking over the border for many decades to pick up drugs available in the U.S. before they become available in Canada.

We do not have a "Public Health Service" - health care is provincially managed. There is no national purchase of drugs. Several of the smaller provinces are currently discussing the possibility of group purchasing for drugs provided through their specific plans.

Thanks for the reply. Forgive my error about PHS - I knew better, but forgot. However, I do understand that in most provinces, the formulary for medicines is centrally controlled and managed, and that is why drug costs are typically lower than here. Am I wrong in this?

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@georgeob1,

georgeob1 wrote:

that is why drug costs are typically lower than here. Am I wrong in this?

I think the big difference is that the allowable mark-up is provincially mandated.

this is the Ontario example for exceptional access drugs

Quote:

Until further notice, for all other products reimbursed under the EAP, pharmacists will continue to be reimbursed their acquisition cost plus the applicable markup (currently 8%).

http://www.health.gov.on.ca/en/pro/programs/drugs/odbf/odbf_except_access.aspx

Private insurers also tend to severely limit the dispensing costs allowed. Consumers can choose to pay more - but it's with the knowledge that neither the provincial nor most private plans will fully reimburse them.

Most Ontarians are responsible for their own drug purchases, and people tend to go with the purchase option that costs them the least. There's pretty significant downward cost competition given the tiny size of the market.

http://www.health.gov.on.ca/english/providers/program/drugs/funded_drug/funded_drug.html

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@JPB,

JPB wrote:

For some reason the FDA is wary of accepting data generated outside of the US resulting in multiple additional evaluations.

it goes both ways. I'm not familiar with any country that accepts FDA results.

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@ehBeth,

Peripherally on topic with the direction of the current discussion/off-topic with the thread title - just heard interviews with these fellows on the news

http://www.cbc.ca/news/health/story/2013/01/18/drug-safety-boxes.html

Quote:

Woloshin said most people assume if a doctor prescribes a drug, it will work. When he and Schwartz did a survey, 40 per cent of Americans believed only extremely effective and extremely safe drugs are approved.

Medications with only a marginal effect or even dangerous side-effects sometimes get approved by Health Canada or the U.S. Food and Drug Administration.

"Some of the reviewers may have actually voted against drug approval, but in fact the drug is being approved anyway," Schwartz said. "Or the FDA had important concerns about safety and had recommended studies after marketing to monitor for those harms and those things are not routinely highlighted in the label."

the interview had to do with the contents of the inserts prepared by pharmaceutical companies. harsh.

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@georgeob1,

George, there is still a question to which you have not responded at:

http://able2know.org/topic/201479-55#post-5231193

The response is important, because you had been citing the fact that services were not available (or very, very hard to obtain) for you in San Francisco as a negative in the safety net Medicare.

I hope you have time to consider my question...and to respond to it.

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@joefromchicago,

joefromchicago wrote:

You realize that insurance isn't like a bank account, don't you? You don't get to take a dollar in benefits for every dollar you pay in premiums -- that's not how any insurance system works. If you're like most people, I imagine that you've had a similar experience with your home and auto insurance policies -- you've paid more in premiums than you've received in benefits. Does that mean that home and auto insurance are rip-offs too?

There's a difference between, evaluating the odds and making an individual choice to buy insurance of any kind, and being involuntarily taxed for it and being unable to opt out.

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@Frank Apisa,

Frank Apisa wrote:

George, there is still a question to which you have not responded at:

http://able2know.org/topic/201479-55#post-5231193

The response is important, because you had been citing the fact that services were not available (or very, very hard to obtain) for you in San Francisco as a negative in the safety net Medicare.

I hope you have time to consider my question...and to respond to it.

Here is my original statement on the matter;

Quote:

One simply can't easily find a medical praticioner here in the San Francisco Area who will accept a Medicare patient.

I later indicated I discovered this while searching for a replacement for my regular internist who had retired, and generally described the typical Q&A with the Doctor's adminstrative staff. I might add that this is rather common knowledge in this area and I have a number of doctor friends who readily confirm it.

A while later in response to your repeatedly expressed incredulity I suggested you

Quote:

you get out your phone book and start calling a few local internists, presenting yourself as a candidate new patient. Note the questions they ask about your insurance coverage and the responses if you say medicare only. Then I suspect you will have a better idea of the reality.

I take it you haven't chosen to try this. OK by me. The inredulity is your problem, not mine.

You appear to be in an odd search of some "gotcha" moment, rather than the answewr to your repeated queries - why I don't know. I'l just repeat that I discovered this, quite without intention, in a rather ordinary search for a regular doctor.

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@georgeob1,

georgeob1 wrote:

There's a difference between, evaluating the odds and making an individual choice to buy insurance of any kind, and being involuntarily taxed for it and being unable to opt out.

Well, your decisions to buy home and auto insurance are only semi-voluntary if your bank requires you to carry homeowners insurance as a condition of your mortgage and your state requires you to carry auto insurance as a condition for driving. But then your complaint was that you got less back from Medicare than you put in, not that you didn't want to put any in. The former, however, is common in insurance schemes, whether funded through premiums or taxes. The latter complaint, in contrast, is common among people who whine about having to pay for things that government provides to somebody else.

I'll just add that, for most people, the largest amount of medical services they receive is in the last twelve-to-eighteen months of life. So, if you haven't needed Medicare yet, don't worry -- you will.

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@georgeob1,

George...this is the first time I've ever encountered this kind of nonsense from you...so I am a bit surprised.

You certainly left the impression that you were unable to find a physician to replace the one who previously cared for you but had retired...simply because you were a Medicare patient. You even said something about having to use Medicare as a back up...rather than as a primary insurance.

Now you playing some kind of word game about what was or was not said.

Here on this coast, if you have Medicare and a reasonable supplementary back up...damn near every doctor will take you on as a patient...and Medicare will be the Primary provider with the supplementary insurer being the supplementary insurer.

I suspect it is the same way out on the West Coast...I suspect there is no real difference. But you wanted to pretend it is otherwise to bolster whatever conservative point you were trying to make.

Now you suggest that I try getting a doctor to accept me as a patient without any further coverage besides Medicare.

Why not suggest I go out and see if I can get a physician to take me on as a patient on a gratis basis...with no payment whatsoever?

C'mon...stop the nonsense.

If your point was that Medicare alone is not going to do the job...fine. It won't...any more than Social Security is going to meet all expenses. But that was not the impression you left...and playing this silly con is underhanded.

But I guess when arguing the conservative take on safety net programs, you folk have to resort to tricks like this or you end up with almost no argument at all.

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@joefromchicago,

I think you're quibbling. Insurance on a home as a condition of borrowing money, getting a mortgage on it, is a voluntary action, and a reasonable one too in that the lender has a right to demand the protection of the equity on which the loan is based.. Your point is more meaningful with resprct to automobile liability insurance - in most states it is precondition for getting a license to operate on public roads. Even there the state's interest there is reasonable.

There could lots of private health insurance available out there for nearly everyone. Government itself has foolishly fragmented the industry with a host of state specific requirements and a priori policy restrictions, often with unintended side effects. There are real issues out there with respect to responsible access to health care to be sure. However their resolution does not necessarily require the heavy hand of government to take over the whole system and subject everyone to the workings of a top down authoritarian system.

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@Frank Apisa,

Finding a new Dr can be a problem for anyone of any age. Many Drs don't take new patients, not because of Medicare but simply because they are full up with the current patients they have.

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@parados,

That's also true with my doctor; she was given more administrative responsibilities.

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@cicerone imposter,

ci, parados...that may be correct. But the thing I was discussing with George was his implication that he could not find a doctor because physicians were not accepting Medicare patients...and that he had to use Medicare as his secondary insurance.

I think that is nonsense...and I asked, politely, for more information so we could discuss it.

I can tell you this: Here in New Jersey, if you have Medicare and any of many supplemental healthcare programs...the doctors will take you on as patients with no problem.

Anyway, this is going nowhere. My guess is if George has Medicare and a supplemental healthcare program...he would have no problem at all in finding a physician.

Medicare is a fine safety net program...and I think it should be expanded. George seems to find anything in the safety net area to be suspect.

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@Frank Apisa,

Okay, find me a family physician in Farmington, NM that accepts new patients with Medicare only. My doctor continues to accept Medicare when existing patients move to medicare, and I'll tell you, I worry almost as much about his health as my own.

Oh yeah, the hospital's urgent care operation does take it. Not quite the same, though.

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@roger,

roger wrote:

Okay, find me a family physician in Farmington, NM that accepts new patients with Medicare only.

Four are listed here.

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@Frank Apisa,

The only con going on here is the one you are playing. I reviewed my posts on the subject and my words were quite clear, your after-the-fact, self-serving revisionist interpretations notwithstanding. Your concluding slam on "conservatives" and the safety net was both stupid and dishonest, and your rather tortured pretense of surprise and piety is transparently false.

I never wrote or implied that I couldn't find a physician, rather that I noted (to my surprise) that many practicioners here weren't taking Medicare patients - i.e. that one couldn't "easily find" one who did.

I made no assertions whatever on whether Medicasre was or was not advertised as the only solution or whether or not it should be comnsidered as such by anyone. If anything I was suggesting the futility of government attempts to control the price and quality of services or products of any kind.

You have offered no evidence or experience other than "what you have heard" and, despite that, you appear to be quite sure of facts, out here, which are demonstrably not the case. Now you are trying to alter the question to include supplementary or other insurance in the balance. That was never the issue in the points I made. You are, in effect, on a search for something to argue about. I don't play that game.

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