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Mon Jul 2 22:45:15 BST 2007

In a message dated 7/2/2007 4:02:13 P.M. Central Daylight Time,  
tielserrath at yahoo.co.uk writes:

Can I  just ask one question, Dr Mattox; when you refer to how well equipped 
US  hospitals are, and the much more advanced levels of surgery, intervention 
and  all-round care compared with the UK, are you talking about care for the  
insured or the uninsured?

The answer is YES.   Actually, the uninsured in MOST of the US  major cities 
have relative good access to care and modern excellent  equipment.   At the 
county hospital in Houston, the Ben Taub General  Hospital, much of the 
equipment is equal or even better than some private  hospitals.    For many 
conditions, the uninsured and poor have  superior care to those with money and 
insurance.   It is an  interesting form of reverse discrimination that the best trauma 
centers in the  United States are the public county hospitals.  The results of 
the  treatment of infective valve endocarditis is among the best results in 
the  world.   

A few things I have read about the US health system in the last  couple of 
years...I've never worked in the US but I'd be interested to know if  they are 
true and what the long term plan is for solving these  problems?

It depends on who you talk to.   The American College of  Surgeons, the AMA, 
and others have suggestions which are not as politically  interesting, nor 
economically profitable to the HMOs and Insurance companies so  they oppose the 
doctors.    If you were impressed with FEMA's  response to Katrina, you are 
going to love a single payer government health  program in the United States.   

I  believe the major reason your neonatal mortality rates are significantly 
worse  than you'd expect is because they're dragged down by the millions who 
can't  afford insurance. How will this be tackled?

Every (EVERY) country keeps statistics differently.   They  do not include 
all risks adjusted people in the same pools for calculations of  various 
categories, therefore the infant mortality is  different.     We need a lowest common 
denominator and  common statistical system.  

There was an article in one of our broadsheets a few weeks back  about a 
child who was inexplicably taken off his chemotherapy when there was a  paperwork 
delay and his medicare cover lapsed. He died. He might have died  anyway, but 
his mother will never be certain of that. Apparently you have to  renew your 
paperwork every year, in some places every six months. Is that  essential or 
practical?
The regulatory industrial complex of the HMOs and Insurance companies, and  
governmental red tape make it impossible for doctors to practice good  
medicine.   The HMOs, Hospital administrators, Insurance companies,  and governments 
are practicing medicine without a license, but holding the  helpless and 
browbeat doctors hostage, while not paying them a fair payment for  services.    For 
most doctors in the United States to care for  Medicare patients they have to 
take a LOSS for every patient cared  for.   It cost the doctor in practice 
MORE MONEY per patient in  personnel, time, drugs, diagnoses, etc, than he/she 
will ever get reimbursed  from the government.   So. doctors are getting out of 
practice, or  refusing to accept Medicare patients.    

There are people in the US looking for jobs based on the health  insurance 
they will get. There are people being turned down for jobs because  they will 
blow the company insurance budget. what will happen to  them?
Unless their insurance is transferable, and they have NO pre-existing  
conditions, they end up with NO COVERAGE, because the purpose of insurance  
companies and HMOs is NOT to care for patients, but to make money for the  
stockholders of their "BUSINESS."

I think  there is less paperwork in countries with a 'free' system mainly 
because we  don't have to fill in insurance forms all the time, nor staff a whole 
system  dedicated to retrieving money from said companies and uninsured 
patients.  There is a fair amount of paperwork (though the most is in general 
practice,  not hospitals) but it's request forms, note-keeping and so on, which is 
not  exactly inappropriate. 

I did, however, enjoy the scene where he asks  the couple how much their baby 
'cost'. It had clearly been set up, yet you  could clearly see the bemusement 
of a British family at the concept. To a  right-winger the idea of paying for 
a delivery probably seems reasonable -  after all, you can choose not to have 
a baby. But this in fact is one of the  best arguments for a nationalized 
system; if you're lucky, and have a quick  straightforward delivery, it costs 
around the same as a luxury cruise. But if  you're unlucky and have 
pre-eclampsia, CPD, fetal distress, placenta accreta  ...then you can bankrupt yourself. 

I could not AFFORD the health care COSTS of the TAX in  the countries  where 
they think the health care is FREE.   NOTHING is  FREE.   

No  health system is free of problems, but at least no one is bankrupted in 
the UK  through paying for medical treatment.

I totally agree

k

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