There is no doubt that US healthcare is the best in the world for those that can afford it - at the moment that includes the wealthy, most of the middle class and those covered by Medicare who don't have too many Rx and a low income. If you're poor (but not enough for Medicaid) or working class or middle class with a job with bad insurance your healthcare can be pitiful - or none. the reason we rank so low in the list of world countries is primarily because we don't have universal access or good prenatal/infant health coverage.

The "prescription coverage" passed by Congress is basically an indigent plan. What they need to do is pass a plan similar to New York State - which covers many middle class people with a sliding scale of payments depending on your income (not assets)- not just the super low income. With the current plan middle class people will need to become poor (by paying $7000 per year for RX for a couple) before they qualify for benefits - and after they've sold all their assets except their house.

To those who feel "Healthcare in any other country could not possibly be better than in the US" is wrong.
Now, if we burdened the other countries with similar gun laws, forcing their emergency rooms to deal with an equal number of gunshot wounds, and if we also burdened them with an equivalent percentage of single sub-teen mothers (with concomitant high infant mortality), how would things stack up?

I'm sure that I am not the only one who feels that the US healthcare system is the best in the world. The voters in the US would have changed it if the felt differently, wouldn't they?

As to whether voters would change it if they didn't like the current system? The "current" system has been in place for a few days. No vote since the change so that remains to be seen.

In the end, it will depend on the percentage of uninsured or underinsurd people who vote (at least for like-minded representation since voting on the issues themselves isn't going to happen - republic, not democracy and all that.) Just proves it's never wise not to vote. But until it becomes the overriding concern in choosing representation amongst the approx. 25%-30% of the population that actually still cares and votes, then yes it's probably indicative of general happiness with the healthcare system. Ahem... well, so say the statistics.

I had another patient who took an ambulance because he banged his elbow against the door of his car (the accident happened a month ago) Had been feeling fine for 3 weeks and 6 days. Today, woke up, had a twinge of pain in his elbow and called 911. Mind you the guy is 22 years old and healthy as a horse.
Of course didn't think to reach into his medicine cabinet for some Motrin. Got ticked off when I asked why he took an ambulance. ('Yo B****, my elbow hurts). Sent him home with a prescription for motrin and after which he asked me for car fare home. Cost to him $0.00 as he claims he has no money.
Cost to the taxpayer:
Ambulance ride: $600
ER charge: $300
Medication charge: $6.00
Car fare: $2.00 (because he refused to leave otherwise)
Exasperation: Priceless!
If you think this is an anomaly, think again. This is one small but perturbing example of why our healthcare expenses are so high. I am required by law to see and evaluate every single patient who decides to come to my ER, regardless of how baseless their complaint. Guess who pays? You and me.
Examples of why people take the ambulance:
-can't sleep
-had an argument with mom
-wants to get an MRI because he read about it in a newspaper and figured if he took an ambulance, he'd get it
-threw up once 2 weeks ago
-sometimes gets headaches (but doesn't have one now)
-runny nose for 1 day
-stubbed toe against sidewalk crack and on the recommendation of his lawyer to build a case against the city came to get xrays of said toe
Again, these costs just get passed on... to you know who.

I'm with erdoc on this one. Far too many cases of abuse.

Besides, Americans tend to OD on everything. 60% of Americans are overweight. I'll bet 60% are OD on drugs too.

Personally, I avoid drugs as much as possible. I'm over 60, take a Tylenol or two maybe once or twice a month and that's it.

Once when I was in a terrible auto accident, I was put on Tylenol with codeine for a couple of years. That medication always made me feel nauseous, so I was glad to be off it.

We don't need most of the drugs on the market today. However, the drug companies want us to keep buying and buying.

And if I get to a stage in old age when my doctor prescribes too many pills for me? I'm not going to take them and try to die as natural a death as possible.

As one angry young man has said: "Why should I pay for people with one foot in the grave?" Exactly, I don't want him to be paying for extending my life in my old age.

Our life expectancy is 120 years! Why would anyone want to extend their lives in an overdrugged, vegetative state for another 20 or 30 years?

Easytravelr

< we don't need most of the drugs on the market today>

Some one else agrees with you and you'll be surprised when you read the article , who it is!

http://news.independent.co.uk/low_re...=3&dir=505

Christina
>...What newspaper is this, out of curiosity, Ira? I read something in the Atlanta-Journal Constitution or something but it didn't look like a good newspaper from what I read, so I thought maybe that wasn't the main paper in town. I didn't see anything about Medigap in that article.<

It was the Sunday AJC, Christina. Somewhere around P7.

I'm sure that you didn't intend to offend, but the AJC is *the* daily paper in Georgia.

>As for the shifting from Medicaid to Medicare, I believe that is true as Medicare is primary carrier for those with dual coverage, although a state's Medicaid program may pay the premiums for someone to be in Medicare. I don't know how it will work if someone had better coverage under Medicaid for drugs, though--possibly it could pick up the difference...<

That seems to be one of the controversial changes. The new Medicare will limit the available drugs and the Feds will no longer cover the costs.

ira, you got my attention with this statementquot; The new Medicare will limit the available drugs"

How will they do this? Do you mean not pay for experimental drugs?

Hi Degas,

I'm not sure what the "limitation" will be, but I think that experimental drugs is part of it.

I think it's called a "formulary", a listing of drugs available to the beneficiary. It hasn't yet been made public, so let's just see what will NOT to be included!

Ira, my provincial health care plan offers a drug plan for seniors that requires they pay 1/3 of all drug costs up to a certain maximum, after which costs are covered unless the drug doesn't meet certain criteria. In addition, seniors above a certain minimum income must pay an annual premium to participate in the plan. I wonder how this would compare with the new American plan.

Erdoc, my province charges a flat rate for ambulance services unrelated to motor vehicle or work accidents. (It's about ten times the cost of a taxi.) For motor vehicle accidents, etc. the fee is much higher (about six times the flat rate) as those services are covered by private auto insurance or workman's compensation. So that's one solution to the problem of ambulance use abuse under a publicly funded scheme.

Meanwhile, I understand your ire, erdoc, but remember the public isn't always equipped to judge what is an emergency and what isn't. I only went to get my DVT treated at the ER after an alert pharmacist pointed out that what I had likely wasn't, as I thought, a mere pulled muscle. Had I waited until my GP could have seen me, it would have been way past 'too late.'

Hi Sue,

Do you know the maximum that must be paid?

We will have to pay about $450US per year for Rx, except for the very poor.

Ira

Direct comparisons are difficult, given the exchange rate and the differing restrictions applied to the two plans, but assuming the income of the person involved is above a certain amount, and assuming sufficient drugs are prescribed that the maximum co-pay per year is required, the amount seniors in my province will be paying will be about the same as their counterparts in the US(actually your seniors will be paying a little less given current exchange rates.)

I tend to agree with SMueller that direct subsidies of drugs, as is apparently done in France, isn't sustainable. Careful compromises are going to be needed between public and private sponsorship if the twin goals of both efficiency and sustainability are going to be met, and interestingly enough the US and Canada both seem headed in that direction. But given the nature of compromise, it also means that nobody is going to be happy.

Thanx, Sue

I didn't read the complete thread but I don't think we can say you pay for it one way or the other.

Pharmaceutical companies make differing amounts in different countries depending upon the laws.

For instance, in Canada the price of drugs is not determined as a result of government purchasing. It's determined as an average of, I believe, prices in six other countries (don't remember which).

Interestingly, some companies have decided to charge lesss than what is allowed. I'm not sure about the details as I don't live there and haven't been able to get somebody to explain it to me.

What you can be sure is that when something is run by the government it will be inefficient and when it is run by private enterprise they will make as much as they can.

We just have to decide which poison we want.

I almost tend to feel I would rather the government poison since it's much easier to keep your eye on one place. Also, if you don't like what you see you can vote them out next time.

If we have the best, why do I always hear references of sending people to specialists in Switzerland, France, Netherlands, etc. Aren't they ahead of us sometimes in medical advances, research and forward thinking ?

Ira

I have just been reading a nytimes.com article about your new plan. I misunderstood what you said. Clearly the total cost for the average US senior per year is going to be a lot more than US 450.

The example given in the nytimes article is someone whose present drug cost is US 6000 per year. Her premium would be US 420 per year (35 per month). A major goal of the plan is to exploit the ability of the private insurer to negotiate a better price - in the example quoted, 4800 per year instead of 6000. The insurance plan itself, after deductible, would pay 1500, for a total savings to the individual quoted of 2700.

But the total per year, for that individual at least, would be 3300, not 450. Granted, this is an isolated example, not an average, but still....there is something out of whack here. Either our taxpayers are paying a great deal more for our plan than I thought, or drug prices are vastly different (I know they're cheaper here, but that much?) or both.

Sorry about the ire, Sue. You are right, the public isn't always well equipped to decide what is or isn't an emergency. However, I see so many egregious examples on a daily basis; literally taxpayers dollars being flushed down the drain and it makes me very angry when I see very hard working people struggling to pay their taxes to fund these people. I don't suppose you've ever taken an ambulance to get a Tylenol have you? Literally not kidding. "I ran out of Tylenol at home, and it's $4 at the pharmacy" As for charging these people, they are what is nicely put as "judgement proof". Forget about sending them a bill, they're already living off the dole.

I am bemused by the automatic US response of "we have the best healthcare system in the world".My family's experience suggests otherwise.

My mother had the misfortune to trip over a loose paving stone on a trip to NY a couple of years ago. She broke her hip.

Fortunately, she had extensive travel insurance to cover the enormous medical bills incurred in carrying out the necessary hip replacement.

I naively expected that standard of care and treatment would exceed the care/treatment which she has received in (private ) hospitals in the UK where she has previously had knee replacements.

This was not the case. My mother was horrified by the cleanliness of the hospital (a familar concern in NHS hospitals here in the UK but less so in private hospitals) and the standard of nursing care. She was literally horrified by the fact that she could see armed guards taking gunshot patients to surgery. She was released far earlier than would be the case in the private sector (particularly tricky as she then faced a 7 hour flight home).