So what do people here think we should do with our current health care system in the US?
I work in health care and have a personal connection to this topic. But before I share my thoughts, I'd like to hear a few from everyone else.
What do you think put us in this mess? Is there a mess? Should we change the system? If yes, How? Does the constitution guarantee the right to health care? Should the government (state or federal) provide health care? What about medications? What about insurance? Should drug companies be more regulated? (BTW, medications in general are the most highly regulated industry in the country, can you say FDA).
I know this is a lot to chew on. Just trying to start a civil discussion. Lets bounce some ideas around.
Tullaan
Posted by Godric (Member # 4587) on :
Tullaan:
quote: I know this is a lot to chew on. Just trying to start a civil discussion. Lets bounce some ideas around.
The nerve of some newbies...
Posted by Tullaan (Member # 5515) on :
When I stumbled upon this forum I was suprised at the civility and thoughtfulness of most posts.
After seeing other forums that usually ended in name calling, it is a relief to see that there are some genuinly (sp) nice people out there. Even if you disagree with someone doesn't mean one has to personally attack and degrade.
Therefore I wanted to get some opinions on a major issue in our country.
Any way, thanks for listening to my muddled ramblings. (I'm working night shift, and I'm not sure if I even make sence.) Tullaan
Posted by ak (Member # 90) on :
Welcome, Tullaan! Yes, I agree it's seriously messed up. I don't even have the energy to tell about my experiences last year with my dad's illness and death, but the system is very badly broken, and the level of care people get is much much lower than it should be or could be. The price is also much much higher. I don't know how to fix it, though.
I am a major user of veterinary services for my cats and also have experience with our human medical care services from working in hospitals for many years as well as being a patient myself a fair bit lately, and the experience with my dad last year. I have to say that the veterinary services I have received are far superior for a tiny fraction of the price. I think that's a sad thing and shows that we could do much better than we do, but I don't know how to fix it.
[ August 12, 2003, 08:17 AM: Message edited by: ak ]
Posted by Tullaan (Member # 5515) on :
I agree that health care could be better. However, it's still the best in the world.
And as for vet's. I think it's because health care for pets is a "luxury". I say that carefully. I understand that some pet owners would call it necessity, not luxury.
Due to it being a luxury, competition starts to really come into play.
How many of us shop around for health care? When were sick, we just want to get better. We go to whomever or where ever is most convenient.
On the other hand competition can, in some cases lead to increased prices. How, you say?
Well let me tell you. (My theory)
Typical community served by two hospitals.
One purchases an MRI.
Since there is only ONE MRI machine in the city, where are people going to go?
In order for the other hospital to remain competitive, they must purchace thier own MRI machine. MRI machines cost money, say between 20 and 50 million dollars (I think).
Guess where that money comes from? Thats right, they increase the price of the various "services" they provide. The patients end up paying more for their care because of the price of technology. Competition forced both hospitals to purchase a machine that easily(?) could have handled the community. So instead of the community paying for one machine, they pay for two!
One solution, which happens often, is to have a limited partnership in certain services. In other words, the two hospitals share the cost and use of the MRI machine. But then you run into other problems like where will the machine be located? Is it good care to force patients from one hospital to travel another site for a diagnostic test? Wouldn't it be easier to just have the capability at your own facility?
Other governments that socialize medicine can force a set number of machines per community. But then you run the risk of decreasing the quality of health care.
It's really a trade off. Which leads to a moral question. When do you trade patient care for resources (money)? We cannot give unlimited care to everyone, we would deplete our resources, which leads to rationing. Who makes the decisions of rationing? Who wants rationing?
Lots of tough questions, I'm not sure I have the answers either. Tullaan
[ August 12, 2003, 08:43 AM: Message edited by: Tullaan ]
Posted by Cavalier (Member # 3918) on :
What do you think put us in this mess? A variety of things, but I'd say it is most likely the skyrocketing cost of technology and medicine. It raises the standard of living but absolutey kills the hospital budget
Is there a mess? Yep, and it revolves around insurance companies. They don't have enough doctors, they don't pay offer enough operations, they make insurance too expensive, not enough employers provide it, etc.
Does the constitution guarantee the right to health care?
In its current form? No. I actually want to hear where somebody would think this was enshrined in the Constitution. If you go on to say should it be in the Constitution, I'd say no again. It's a right that'd be far too easy to abuse with such general wording. (i.e. Mother wants to keep her brain dead 5 yr. old son on life support until he's 90 because he has a "right to healthcare".)
Should we change the system? If yes, How?/Should the government (state or federal) provide health care? What about medications? What about insurance?
Gov. definitely SHOULD NOT provide health care itself. Given how well are government is doing working on other tasks, the implications for health care are nightmarish. ( <--Me, annoyed at having to wait three hours to get into a governemnt clinic for substandard care and then being told I need another form before they'll sew my arm back on.)
The ideal thing would be to give tax credits/refunds to companies that provide a cerain level of insurance to its employees. I'd think the influx of new money into the healthcare system would help it open new hospitals and buy new equipment. More people shopping around for insurance would also encourage competition, thereby increasing efficiency.
Should drug companies be more regulated? (BTW, medications in general are the most highly regulated industry in the country, can you say FDA).
Good God NO! I have relatives that work in the drug industry and it's OBSCENE how long and how much effort it takes to get even the most minor drugs past the FDA. It can take 5 years just to add another use to an already approved drug sometimes. The lengthy process not only takes up time but hugely elevates the price of a drug. The FDA seems to be working reasonably well now, it doesn't need more red tape then it already has.
Posted by ClaudiaTherese (Member # 923) on :
quote:However, it's still the best in the world.
I'm interested, Tullaan -- why do you think so?
Posted by twinky (Member # 693) on :
^^^^^
CT beat me to it. But then, I'm Canadian.
Posted by slacker (Member # 2559) on :
Cav, don't you think that the pharmecutical companies spending most of their budgets on advertising and promotions has alot to do with pricing as well?
Posted by Cavalier (Member # 3918) on :
Slacker, Patially, but the point of that advertising is to try and recoup the loss of money caused by almost 10 years of years of R&D/Study/Pre- Production. Some heavy advertising is needed to make patients aware of the new treatment option before the drug loses its "Orphan Drug" staus (menaing it can be reverse-engineered and distributed by other companies as a generic drug).
Posted by sndrake (Member # 4941) on :
Cavalier:
quote:Some heavy advertising is needed to make patients aware of the new treatment option before the drug loses its "Orphan Drug" staus (menaing it can be reverse-engineered and distributed by other companies as a generic drug).
Before we go into the debate about drug companies, let's make sure we have our terminology straight. According to the FDA , that's not what "orphan drugs" are:
quote:Orphan Drugs. The term "orphan drug" refers to a product that treats a rare disease affecting fewer than 200,000 Americans.
I think you were probably referring to the length of time a company holds onto the exclusive patent for production of a drug.
Posted by BookWyrm (Member # 2192) on :
Here's another question about the pharmicos.....
Why is it that they charge 680 dollars for a scrip of one med here in the US yet they sell it to Canada and other countries for 68 dollars? They fought tooth and nail over congress's bill for the buy-back saying it will ruin them and other 'sky is falling' portents of doom. The very same drugs they are selling outside the US borders for substantially less than what they charge people here at home. I had a doc put me on a med that, had I had to pay for it would have cost me 3 grand per month. Yep thats a three with three zeros behind it. Who can afford that? I understand that they need to make a profit. I don't begrudge them that at all. But why is it they seem to want to make all that off the backs of their own people? Seems they could strike a happy medium there that would make it a little easier, particularly on our elderly on fixed incomes. No one should have to choose between an essential medicine and eating.
Posted by Dan_raven (Member # 3383) on :
What do you think put us in this mess? Health is the most personal area of the market, and the least responsible to rational thought or market forces. When you are sick, you want to get better, no matter what the cost.
Is there a mess? Yes.
Should we change the system? We will need to.
If yes, How? Take everyone's suggestion, find the faults in them, and come up with something totally new and different.
Does the constitution guarantee the right to health care? NO. However, after breathing and eating, it is the one thing everyone cares the most about, and will revolt if forced to do without it.
Should the government (state or federal) provide health care? Yes. What about medications? Yes What about insurance? If the Govt is providing the first two, then this is not neccesary. If the govt is providing Insurance, then it is providing the first two.
Should drug companies be more regulated? (BTW, medications in general are the most highly regulated industry in the country, can you say FDA). No. Food Additive companies like the ones marketing Efedra need to be regulated though.
There are many factors which go into our health care system. Most people are only worried about the two that the see everyday--Doctors and Insurance. However all parts of the market need to be incorporated:
1) Drug Companies, finding the new medicines that will make us all healthier, and making profits to encourage them to do so. 2) Hospitals. These are major income sources and distribution centers for the health products. 3) Doctors and the AMA. With have relied too heavilly on others for our own health. 4) Nurses and Technicians. These can either be the main faces of our healthcare, or minimum wage flunkies more worried about making rent payments than measuring correct dosages. 5) Insurance Companies--Ponzie schemes designed to take the bite out of medical costs. 6) THe Government--aiding those who can not pay. 7) Religious institutions--Also aiding those who can not pay, or building the hospitals where needed. 8) Us. We need to take responsibility for our own health. 9) Trial Lawyers--Making money off of the pain and suffering of others, while trying to keep the bad doctors and bad medicines away from the public.
Balancing all of these different special interest groups, while creating a win, win, win etc solution is almost impossible.
Posted by Cavalier (Member # 3918) on :
You're right sndrake, I got my terms confused, but it seems you knew what I was talking about anyway and the point still stands.
Posted by sndrake (Member # 4941) on :
quote:Should drug companies be more regulated?
Maybe it's my browser, but I couldn't really tell who voted "no" on this.
If we're talking regulation, I don't think a simple "yes" or "no" answer is really sufficient. There's actually been a frightening amount of deregulation when it comes to getting around rules for "informed consent" in experimental subjects.
During the Clinton years, the FDA rolled granted exceptions to getting consent for subjects in emergency room trials that were brought in unconscious. Not to put too fine a point on it, but this was actually a reversal of the Nuremburg Code. And, as a direct result of this exemption, people died. There were two companies in competition to the the first on the market with an artificial blood product. One of those companies got an exemption for the emergency room research. The experiment was called to a halt due to a higher than expected number of deaths.
During those years, we also saw several states (and countries across the world) make it easier to "enlist" experimental subjects - people with mental retardation, alzheimer's, etc. in research that would have no direct benefit to them.
For anyone interested, there are a couple of articles on those topics at:
Guinea Pigs Don't Get to Say "No." (one of the articles is actually something the editor of the magazine created by combining and editing some email I'd written on the subject.)
Now that we have a new administration, things don't look much better. The FDA just announced it was giving permission to Eli Lilly to market and distribute growth hormone to short children. Not children with a hormone deficiency - just those who are expected to be "short." It's obvious why Eli Lilly wants this. Genetic technology has enabled them to fill swimming pools with the stuff that used to be obtained by the drop from cadavers. They have a product in search of a market. And the FDA is helping them foist this "therapy" on healthy children.
Hmmm. Should I have given a "rant on" warning at the beginning of this post?
Posted by Sopwith (Member # 4640) on :
Just a thought on the MRI situation you laid out, Tullaan. My sister is an MRI tech and she works for a company that I think had a really good idea (beyond employing her that is...).
Basically, they have an MRI truck with a mobile unit that travels between five hospitals across four counties. They have a scheduled one day stop at each hospital for a full day, pretty much working around the clock if they need to. Their Saturday and Sunday stops are done on a rotating/need basis. Basically, each of the small hospitals has full access to MRI technologies, but without creating that competitive situation you described. Each can also have MRI without breaking their own individual budgets and hurting their other services.
Posted by Anna (Member # 2582) on :
Tullaan : Welcome ! Sorry to begin so hard, but...
quote: it's still the best in the world
Where exactly have you been in the world to say that ? I'm French, and maybe technically our medicine is worst that yours, but sociallly I assure it is the contrary ! We try - and most of the time we do - help everyone,even if the surgery or medication costs a lot, without consideration of money. I don't think it is the case in the USA.
[ August 13, 2003, 09:24 AM: Message edited by: Anna ]
Posted by Tullaan (Member # 5515) on :
Sorry everyone, I'm in the middle of vacation, so my response time and frequency will be less then I would like.
Where are most medical advancements made? I would say the US and europe second. Some would argue, but access is very high in the US. All you have to do is show up to an ER for care. Hospitals cannot refuse care because of lack of ability to pay. Most drug companies are in the US as well, europe again has their fair share (more advanced also, Hitler had alot to do with that).
The reason I don't consider Canada or France as better is the lack of choice. Why should I, if I can afford it, not get better health care? I earned the money and I'm returning the money to the economy. Why should I pay for the health care of the drunk down the street who refuses to take care of himself? Why should my tax dollars pay for the ill effects of smokers? In Canada the choice for faster or better service doesn't exist, unless you go to another country. Although you can get drugs cheaper.
I do feel something should be done about drug pricing. Currently, the reason drugs cost more here then elsewhere is because they CAN charge more. Drug companies are trying to make a profit after all. They do spend more in R&D then any other industry though.
I admire(limited) the British system. It believes there is a certain level of healthcare that should be provided by the government. If you want more, you can get it, you just have to pay for it yourself. Insurance still exists in Britain if you want to pay for it. You can still see your private doctor if you want too. You can have that cosmetic surgery if you want too (I don't).
I do consider Europe and Canada a very, very close second to the US. However, choice is more important to me then access. In the US, if you want health care, you can get it.
As for drug companies and regulation. Hmm, it's a mixed bag for me. Before the AIDS problem there was a drug in the seventies called thalidomide (some may remember). It was supposed to be a revolutionary new drug for morning sickness for pregnant women. The FDA refused to allow it in the country until it had been properly tested. People screamed and ranted and demanded the drug be allowed. Some went as far as going to europe and buying it themselves. The results were tragic. Children of mothers who took thalidomide were born with out arms and legs. They still had hands and feet, just no arms and legs.
Since the AIDs problem came into play we got a new process called orphan drugs. These are drugs that companies would never develop because they would never recoup there R&D costs due to small amounts of effected (affected?) people. Essentially the FDA allows less research (less cost) be done. The thought is at least were doing something rather then nothing. Lately some drugs have been put on the market prematurely because the recieved orphan drug status when they should not have. Several drugs have since been removed from the market because they caused deaths.
I do not agree that prescription drugs should be advertised to the lay public. The public isn't the "consumer", the prescriber is. Doctors should not be pressured by the patients for drugs they may not need. It's the doctor that decides if they need it or not. You can always go to another doctor if you don't feel your getting good care.
Alternative medicine companies should be regulated. At least for safety.
Artificial blood is a touchy subject and hindsight is 20/20. There is a huge blood shortage in our country. The potential good from artificial blood is huge. That probably had an effect on wether the artificial blood product trials were allowed in the manner they were. Probably it wasn't a good idea.
BTW, I am a clinical pharmacist. I do not sit at walmart and count pills. I work closely with physicians and nurses in a hospital to provide the best care to patients. In Washington state, where I live and work, pharmacist can have limited prescribing ability (under protocol with doctor and state approval), that allow me to take more mundane "treatment" from the doctor's, which allow them to "diagnose" which is thier primary job. I have a doctorate in pharmaceutical care (PharmD) and additional (optional) training in the form of a residency.
Thats enough for now. Dang, I talk to much. I'll get on a bit later if I can and post again. I enjoy having and hearing other opinions. Mine are not necissarily(I can't spell this word, I never could) right.
Tullaan
Posted by ClaudiaTherese (Member # 923) on :
Tullaan, I find the assessment of objective outcomes measures to be the most useful and appropriate way to assess the effectiveness of a system.
That is, I'd consider the most effective health care system to be one in which the patients are healthiest, measured by morbidity and mortality outcomes.
By the way, everyone has access to "emergency rooms" (or "casualty wards") in countries with national coverage. They just also have access to other care, too.
[And welcome to Hatrack! Thanks for the thoughtful explanation. You've happened to touch on one of my buttons, so I hope my responses don't come off as unfriendly. Just passionate about the topic. ]
[ August 14, 2003, 09:47 AM: Message edited by: ClaudiaTherese ]
Posted by twinky (Member # 693) on :
As a Canadian, I feel obligated to stick up for 1) my country's system, and 2) socialized health care in general.
Helps that I believe in it, too
>> Why should I, if I can afford it, not get better health care <<
Because this isn't fair to people who can't afford it. The best doctors would only cater to the rich, because the rich can pay more; the poor would get only altruistic doctors and doctors who can't get rich clients. You inevitably wind up with a healthy upper class and unhealthy, debt-ridden middle-to-lower classes.
Which is basically what you have in America right now, only taken to an extreme.
Look at the disaster that resulted from Australia trying a two-tiered system, for instance. Also, consider the Human Development Index, a general measure of quality of life developed by the UN. The Scanadanavian counries, as well as Canada (all of which have socialized medicine), have consistently placed higher on the HDI than the United States.
>> I earned the money and I'm returning the money to the economy. Why should I pay for the health care of the drunk down the street who refuses to take care of himself? Why should my tax dollars pay for the ill effects of smokers? <<
Say you're Canadian. The government will give you health care should you need it; the government also pays for your primary and secondary education; it also subsidizes your post-secondary education should you choose to pursue one. The government builds infrastructure, even in places where the population is very small. The government maintains an army.
The government creates an environment in which you can live. You pay for this privilege with your taxes. It wouldn't work if each person's tax dollars had to be allocated to something that helped that person directly. By creating an environment, a place where many people can live, the government allows you to have a livelihood.
By spending your tax dollars to help out that drunk down the street or that smoker who gets cancer, the government is pursuing this goal. If you think that you don't see a direct individual benefit from your tax money, perhaps you should consider living on a deserted island somewhere. Posted by Irami Osei-Frimpong (Member # 2229) on :
\I've been a financially independent adult for five years now, and before that, I lived school grants and part time work. The funny thing is that while I've always had a job and paid rent, I've only had health insurance for 5 months out of that time. I don't have it now. My job doesn't offer it unless you meet a set of qualifications that I will never meet. It's never been a problem because I'm indestructible(alright, I have a bad ankle), but I haven't seen a dentist since the early nineties. If ours is the best I wouldn't know in the world, I wouldn't know. I have friends who have tried to get insurance independent of their job and were turned down. One of these guys taught English in China and had excellent healthcare there, and now is in the middle of Guatamala with health care, but spent 3 years interim in the states working 55 hours a week at three jobs without healthcare. I rode my bike from Seattle to SF without insurance. I think it's common for people in their twenties to not have healthcare.
It's come to the point where I think it's silly. The only way I can get healthcare is work for six months full-time for some company I don't want to work for. If that's what it takes, I'd rather live without and enjoy my freedom.
[ August 14, 2003, 11:43 AM: Message edited by: Irami Osei-Frimpong ]
Posted by sndrake (Member # 4941) on :
quote:Artificial blood is a touchy subject and hindsight is 20/20. There is a huge blood shortage in our country. The potential good from artificial blood is huge. That probably had an effect on wether the artificial blood product trials were allowed in the manner they were. Probably it wasn't a good idea.
I must have been unclear - both in what I posted here and in the articles I referenced. The problem isn't with the specific study, but the policies that are allowing researchers to get exemptions to the "informed consent" requirement in medical research. The same year that the FDA passed the emergency room research exemption, their own report found widespread systemic problems with researchers complying with existing requirements.
It's easy to see how researchers and pharmaceutical companies (I'm being generous here) can honestly rationalize such waivers being in people's own interests. When you have professional or financial stakes in advancing such research, it's easy to minimize the personal risk of subjects and exaggerate the good to the greater public (not to mention your reputation or your pocketbook).
It's not just Germany that exploited vulnerable people for medical research - much of the hepatitis research in this country was done by intentionally exposing children with mental retardation to hepatitis virus.
And it's not just hindsight in operation when it comes to being alarmed over studies like the one with artificial blood - there were plenty of critics. It's just that none of them were as well-financed and connected as the industry reps and the bioethicists they had helping them lobby for policy changes.
Posted by ClaudiaTherese (Member # 923) on :
[Want to guess who has the most admirable morbidity and mortality outcomes for all major medical conditions? Hint: It isn't that Lone Ranger above. ]
[ August 17, 2003, 05:44 PM: Message edited by: ClaudiaTherese ]
Posted by Storm Saxon (Member # 3101) on :
When looking at who's the healthiest, don't forget that you can't blame it all on the health care system. For instance, correct me if I'm wrong, but America has the highest rate of obesity of any industrialized nation. Americans also work longer hours than any other industrialized country, if I'm not mistaken. These two factors alone could be reasons why we are 'more unhealthy' than other first world countries, and not because of our health care system.
Now, I'm not saying that America's health care system can't be improved upon. I'm just saying that health begins with the individual. The best doctors in the world aren't going to do much good if people don't live healthfully.
Posted by Icarus (Member # 3162) on :
quote: Food Additive companies like the ones marketing Efedra need to be regulated though.
Hear hear!
Irami, I too lived without any sort of medical coverage for much of my twenties. Many people have pointed out the potential for problems with socialized medicine, but certainly our own problems loom huge. Frankly, it's hard to imagine how socialized medicine could be any worse than HMOs.
I actually see a little of both, at least as they play out in the US. Cor and I have HMOs through our jobs, while our daughters receive Medicaid for having been wards of the state. The doctors that accept Medicaid tend to cater more to poor clients than to wealthy ones, and the Medicaid beaurocracy is labyrinthine . . . . it took more than 18 months after we moved to get a new primary care physician! And yet, in many ways, our daughters have much more comprehensive medical care than we do. There is virtually never a copayment, while for us copayments for an urgent care center or for an emergency room can be somewhat hefty.
Incidentally, I would not say that I have found Medicaid doctors to be any less competent than HMO doctors.
Not all poor people (and we are, admittedly not poor, but neither are we very rich) are poor because they are lazy drug addicts. Painting with that broad a brush makes the implication that they are a drain on our resources, and undeserving of good care. I don't think you're seeing the face of the uninsured in the US. The uninsured in the US are hardworking young people, or people who work hard but work with their hands, and so don't have enough income to afford good insurance. Or they are entrepeneurs. Or people like my father who worked hard for forty years, but has been forced into early retirement by disability. Unfortunately, though, his COBRA just ran out and he will not be eligible for Medicare for another 6 months or so. He has been skipping a dose of each medicine (he takes about a dozen, for diabetes and a bad heart) a day for the past six months in order to hoard them, to better make it through this uninsured period. Or they are hardworking people who work numerous part time jobs. In many service industries, companies refuse to give their employees more than thirty-odd hours a week, so they will not be eligible for benefits. They hire more employees for fewer hours and save money this way. Many hotel housekeepers, waitresses, etc., work 50 or 60 hours a week at two or three different jobs, in order to make enough to make ends meet, especially given their lack of benefits. Do most "white collar" workers work this hard? If your point is that poor people are undeserving because they don't work as hard as wealthy people, I would say this claim is, on the whole, false. If you mean to say that poor people are undeserving because they are not as gifted, and so they do not have the opportunity to take the higher-paying jobs, and that this makes them less deserving of quality health care, then that's a hell of a thing to say.
I'm not, however, opposed to wealthy people being able to choose to pay more for private health care. It gets a little scary when we go to the extreme of saying that fairness to the poor demands restrictions on the wealthy. I simply think, though, that there should be a certain minimum standard to which everyone is entitled. Everyone should be able to get competent routine medical care and prescription medicines. If someone is rich and wants to pay more for the privilege of a waiting room with leather couches, cable TV, and doctors who keep their appointment times, that's OK by me.
Posted by Alucard... (Member # 4924) on :
Tullaan
Be careful what you say:
quote: BTW, I am a clinical pharmacist. I do not sit at walmart and count pills. I work closely with physicians and nurses in a hospital to provide the best care to patients. In Washington state, where I live and work, pharmacist can have limited prescribing ability (under protocol with doctor and state approval), that allow me to take more mundane "treatment" from the doctor's, which allow them to "diagnose" which is thier primary job. I have a doctorate in pharmaceutical care (PharmD) and additional (optional) training in the form of a residency.
I too am a pharmacist, and I would challenge your PharmD degree as nothing more than an extra year of on-the-job training. Now since you practice clinically, you must somehow benefit by osmosis from the knowledge that spills forth from the ancillary staff that you mingle with.
I do not feel compelled to engage in your discussion because I generally agree with most of your points. But I would furthur challenge your credentials against a pharmacist who has 5 years practical experience, even if it is the traditional 5 year Bachelors Degree over a newly-graduated PharmD (6 year program).
Sorry to drag the rest of Hatrack into a debate over pharmacy education, but this is a sore subject with me. I will explain that the PharmD degree is a "Doctor of Pharmacy" degree that is a 6-year program, with the option to do 1 or 2 year residencies in a given field (Pediatrics, Oncology, Nephrology). Generally, clinical pharmacists are at the TOP of their esoteric game because they use their cognitive skills to better assist patient care in a hospital setting.
At one time, Pharmacy was a 5 year Bachelors Degree with a PharmD degree being a 1 year option. Those that did not feel the need to practice clinically (The rude Wal-Mart comment as presented above by Tullann) were then not locked into spending a year doing clinical rotations that did not generally augment their field of practice.
However, the field of pharmacy education changed and now all accredited pharmacy schools offer only the PharmD degree for students entering Pharmacy School. In fact, next year is the last year for students who actually had a choice between a BS and a PharmD degree. This I know because I have 2 interns that I mentor over who are both wonderful individuals. I advise them now and would advise them again, that if given the choice to bypass the PharmD degree, I would pass on the PharmD and stick with a BS as long as it fit my career path.
The PharmD is essential if you are doing clinical work, but largely a money-maker for pharmacy schools for the majority of students who enter community practice (retail pharmacy). At least I don't work at Wal-Mart, so I have someone to make fun of.
Again, I apologize to the rest of Hatrack, it is just that Retail and Hospital Pharmacists are at odds concerning many things. I do not mean a direct attack against you Tullaan, but your comment was very myopic to every community pharmacist on the planet, and for every egotistical clinical pharmacist, there is a retail pharmacist that can run rings around them any day of the week.
I also do not mean to imply any sort of seniority here at Hatrack. You are free to speak your mind here and it is a glorious place. Just tread more lightly here along the River as you never know whose toes you may be stepping on.
Posted by Ryan Hart (Member # 5513) on :
Who put is in this place? One of the people to blame (among insurance companies and medicare) is the hated Senator Spark.
Is there a mess? Yeah. That's why we are having this discussion.
Should we change the system? Medicare should be completely reformed. Doctors often do not prescribe certain medicines because they lose money every time they perscribe them. Medicare needs to be reformed so that Doctors get paid.
Does the Constitution gurantee health care? No.
Should drug companies be more regulated? No. If anything they should be given more freedom and flexibility with doctors.
My father is a doctor, so I'm very pro-doctor's rights at the moment.
Posted by pooka (Member # 5003) on :
In my lifetime, I think the half-formed managed care paradigm has been most damaging (that is, when HR Clinton was trying to bring on universal coverage but it never quite came together so we wound up with these really musclebound HMOs).
But before that, when I was a kid I remember someone complaining about hospitals becoming for-profit entities. It creates a real conflict because on the one hand, HMO's want costs controlled. But they want profits maximized. To me, this translates into unneccessary services at a reasonable price.
In my cynical moments I see America as this big consumerist machine, thirsty for whatever the media tells us is scarce. Our problem is our denial that we have a problem. And the problem. But the denial keeps us from solving it like a sane person.
Posted by ClaudiaTherese (Member # 923) on :
Ryan, how do you feel about the gifts and subsidy of travel and food, etc, given to physicians by pharmaceutical representatives?
[ August 16, 2003, 06:57 PM: Message edited by: ClaudiaTherese ]
Posted by Ryan Hart (Member # 5513) on :
I know a LOT of doctors. Growing up I knew even more. The doctors I knew were rarely swayed by the gifts of drug companies, it merely brought those companies to the doctor's attention. I do see how that could be misused, but the instances where it was abused were few and far between.
I did have a friend who's dad was a doctor, who had a Viagra clock in his room for several years.
Posted by pooka (Member # 5003) on :
I don't use ephedra and think it is dangerous. But the reason it isn't regulated is that it becomes a slippery slide where eventually McDonald's could be sued for the crap they sell as food. I mean, my in-laws are into vitamins and defy the government to stop them from taking 1000 times the RDA of Vitamin C. They get really agitated whenever talk of supplement regulation comes up. But McDonald's and Nabisco are the real ones who will keep it from happening.
Chocolate has killed way more people than ephedra, though perhaps not as dramatically and unexpectedly. Who here really wants the government to start regulating it?
Posted by ClaudiaTherese (Member # 923) on :
Ryan, I still worry about it, because influence can be so subtle. The research shows that physicians will prescribe more of those products with which they are most familiar -- not just by experience, but also merely by name recognition. In some ways this is good, because we would want changes in medical practice to move relatively slowly. But I'd rather see practicing decisions based on evidence-based guidelines instead of name recognition.
[That is, I guess I'd rather see the drug come to the physician's attention because of its effectiveness, not because of a perk for the physician. The former is more about taking care of the patient well, whereas the latter seems to take the focus off the best care for the patient.]
I'm glad your father and his colleagues have earned your respect. Have you considered medicine as a profession? Has your interest been caught by something else entirely?
[ August 16, 2003, 07:07 PM: Message edited by: ClaudiaTherese ]
Posted by Danzig (Member # 4704) on :
Well, most of you know my opinions on drugs of any sort, so I will say that I believe ephedra and similar supplements should be very lightly regulated (such as relevant warnings on the package and things like that) by the government. On to more interesting topics.
I do not believe that a country has a moral obligation to provide health care. However, I do feel that there is nothing morally wrong with it doing so. Legally, I think the argument could be made (for America) that the preamble to the Constitution requires it. (The preamble is considered part of it, right? I think so, but I could easily be mistaken.) It seems to me that health care is a fairly large part of promoting the general welfare.
I cannot believe I just wrote that. I become less and less of a libertarian/anarchist every day.
Posted by ClaudiaTherese (Member # 923) on :
Welcome to the dark side, Danzig. . . . . . . . . (where the groundhogs in the backyard look frickin HUGE!!!)
[ August 16, 2003, 07:20 PM: Message edited by: ClaudiaTherese ]
Posted by Icarus (Member # 3162) on :
quote:But the reason it isn't regulated is that it becomes a slippery slide where eventually McDonald's could be sued for the crap they sell as food.
I don't see why this is so. The difference between nutritional supplements and food seems clear to me: supplements are not consumed for sustenence, and they purport to cure maladies. McDonald's does not claim to do anything more than fill your stomach. The often fraudulent claims of the homeopathic crowd ought to be investigated.
I'm a big believer in the power of Vitamin C, and I take a lot of it. (And I have been incredibly healthy since I have!) But I don't feel threatened by government examination of homeopathic claims. "They" are not going to stop me from taking Vitamin C--talk about a straw man! All I want them to do is keep companies from being able to make claims about the efficacy of their supplements without boatloads of independent, thorough research to back it up.
This is serious stuff these days. A lot of people are abusing this stuff, being spurred on by increasingly ridiculous claims. I have personally seen it lead to tragedy. I think the packagers of homeopathic supplements are morally equivalent to snake oil salesmen.
Posted by filetted (Member # 5048) on :
Do folks think that the cost of healthcare is based on governmental bias or regulation?
(not a rhetorical question)
Posted by Alucard... (Member # 4924) on :
Ok Ok I cannot sit by idly and not get involved in this discussion because one of my colleuges offended me.
First of all, our healthcare system has too much wrong with it to simply change one aspect of healthcare and have everything fall into place into some Utopian healthcare system. That just is NOT going to happen.
What has saved our healthcare system is the core of wonderful individuals who have elevated themselves in the eyes of society to garner a level of trust between a patient and a physician. Most of the time, this level of trust is earned on both sides and patients are generally happy with the care they receive from their doctor.
But the biggest aspect that has changed healthcare is the popularity of HMOs. Initially seen as a way to reduce healthcare costs, HMOs have mutated into a forced avenue for most of us, as traditional indemnity insurance is usually cost-prohibitive.
But are you getting what you pay for? One small aspect of HMOs were the competitive, cut-throat tactics that took place during the late 90s. The theory was that HMO X would drastically reduce premiums to drive up enrollment, and HMO Y would have to do the same to stay competitive. Those that initiated these tactics expected a significant portion of HMOs to die off and go bankrupt. Well, this didn't happen. Most HMOs found a way to survive, so the actual losses that insurance companies took to entice enrollment has meant a drastic increase in premiums today.
Basically, someone of power rolled the dice, lost (as if he/she was worried) because we, the American public are footing the bill.
As far as drug companies are concerned, I believe they are a significant force in the US economy, if not THE most significant segment of the US economy. But then again, I am a homer, being in healthcare and all.
But as long as drug companies are spinning off versions of Prilosec as Nexium and Claritin as Clarinex, then I am concerned. At least some drug companies have the guts to tell you all they did was make their existing product into a sustained-release form, thank-you very much. The VERY SLIGHT modification of drugs to churn out products like Allegra and Strattera is almost enethical. But most of those with prescription benefits do not care so long as their copays are $10.00.
Do I want more regulation? No. Do I want more informed consumers? Yes. Do I want patients to have more choices? Yes.
Unfortunately, insurance companies, drug companies, and hospitals have drastically reduced your abilities to choose.
As I eluded to, this is just one small infection in the pandemic that is healthcare, and there is NO ONE ANSWER to solve all the problems.
I, however, enjoy the hospitals that are non-profit organizations. Any suprlus funds are redirected into the facility for new staffing, equipment, and/or facilities. I sometimes dream of a healthcare system where hospitals are non-profit, and drug-companies are not price-gouging the consumer, where there is a turkey in every pot and thre is a new car in every driveway. I have a dream, people, and it is everyone with a color TV with your choice of cable or dish.
This is not reality however. My Utopian system would disintegrate in a matter of months or years. Sure our current system is riddled with problems, but it is the professionals that drive the level of excellence in US healthcare that are to be thanked for our healthcare to be considered among the best in the world. Sure it can be argued that we are not the best in the world across the board, but why do foreigners come to the US to obtain top-level care among the best specialists in the world, and pay cash for their services?
I don't know either, but that sounds a lot like a system that is highly coveted, no matter where you call home. I honestly cannot see a significant number of Americans doing the opposite and leaving the US for their healthcare, so that aspect means a says a lot to me about the level of care we deliver.
Ok, now you can shred me!
[ August 17, 2003, 02:19 PM: Message edited by: Alucard... ]
Posted by twinky (Member # 693) on :
>> [Want to guess who has the top morbidity and mortality outcomes for all major medical conditions? Hint: It isn't that Lone Ranger above. [ ] ] <<
That doesn't surprise me. That "Lone Ranger" also happens to be the richest of the bunch.
[ August 17, 2003, 02:30 PM: Message edited by: twinky ]
Posted by Icarus (Member # 3162) on :
::scratches head::
What's your point, twink?
I'm wondering if you misunderstood CT . . .
Posted by twinky (Member # 693) on :
I found the sentence quite confusing, so it's certainly possible
I read it like this: The "Lone Ranger" (America) does not have the top mortality rates for medical procedures. I ascribe that to having lots of money, not to having a well-designed system
[ August 17, 2003, 02:56 PM: Message edited by: twinky ]
Posted by Icarus (Member # 3162) on :
I believe by "top" rates she meant "best," not "most deaths."
In other words, even as rich as we are, we still don't have the best health care, as she measures it.
Posted by twinky (Member # 693) on :
Ah, I see. I interpreted it the other way.
Posted by ClaudiaTherese (Member # 923) on :
Yep. Icarus, you are correct. Thanks for the clarification.
twinky, sorry it wasn't clear. I'll edit appropriately.
Stormie, it's really an excellent point. There is much, much more to the story than just healthcare; however, this troubles me nonetheless (or even more, actually), because:
1) This means, quite clearly, that the default position for Americans should be explaining why our healthcare system isn't as bad as it seems to be. Instead, the primacy is assumed, which begs the question in a most embarrassingly oblivious way.
2) Healthcare and other social constraints are markedly intertwined -- rather than just assuming that other social contexts may undermine health, we should also consider how health undermines other social contexts, as well.
This is the heart of critical analysis. This is the reason for a liberal arts education: learning to work within the complex and the gray; learning to analyze without clear right answers, but still in better (rather than worse) ways.
I am certain that this is also why people who trained in the hard sciences almost exclusively have difficulty in recognizing their initial assumptions are assumptions. We all must start with some axioms, but good analysis means that you understand what is assumed, and whether, given the context, that truly is a tenable position.
(It's the only way I can make sense of an evidence-based profession that is blinded to evidence regarding the most fundamental questions.
[ August 17, 2003, 05:38 PM: Message edited by: ClaudiaTherese ]
Posted by Icarus (Member # 3162) on :
Wow.
That was one of the most insightful things I have ever read. Anywhere.
Posted by ClaudiaTherese (Member # 923) on :
Hey, cool, Icarus.
I've spent a lot of my life trying to work through this topic, and I really appreciate the good word.
Thanks. Posted by Tullaan (Member # 5515) on :
Sorry about not being around much. We just got back from vacation and a 13 hour drive (with 3 kids).
I didn't state my "qualifications or credentials" to place my self above others. I do see how it could have been read that way, and I appologise. I stated them to show that I am intimatly involved with healthcare. I agree, the PharmD degree is silly. But, I was entering the work force and didn't have much choice. The RPh degree is not available anymore.
My father is a pharmacist (who works for one of the biggest drug companies as a scientist/liason) and I have two brothers-in-law that are MD's. My brother is in school trying to get in dental school. Needless to say we have a lot of discussions about healthcare and I see the problems from different view points.
HMO's were created to stop the disproportionate rise in cost in health care. They worked for a time. Now with HMO's, the prices are going up again. It's hard to cut costs more than HMO's already have. It will take some very creative thinking to solve this problem. Personally, I feel the government will eventually step in and take control. I hope not. I really, really don't want to be a government employee.
The drug companies are running a few scams. They were mentioned before. Prilosec is now nexium. Celexa is now lexapro. Prozac is serraphem(sp). There are a lot out there.
I applauded President Bush when he, sort of, fixed the patent problem with drug companies. When a drug is nearing the end of its patent life, drug companies often will file law suits to extend the term of the patent. It used to be that the drug remained on patent until the law suit was setteled. What Bush did was to allow the drug to go off patent, and if the suit was in favor of the drug company, the drug would be back on patent. Most drugs didn't get the extention on the patent, but it didn't matter, the lawsuit gave them an extension anyway. Now that "loop hole" has been fixed, drug companies are less likely to file suits.
Ultimatly, health care in this country is responsible by the individual. This country was founded on personal responsibility, which sadly has been diminished.
I believe the government has the ability to put pressures on certain sectors of health care to help control prices. As long as personal choice and accountability are not sacrificed, I may support certain ideas.
The constitution does not explicitly state that health care is the governments responsibility. It also does not state that clean water and electricity are government responsibilities, either. But there fingers prints are all over those industries. Eventually the majority of the public will expect government to care for their health care needs. At that point some sort of socialized medicine will be instituted. There will be a lot of discussion, a lot of screaming, yelling and blaming. Hopefully, our system will hash out an acceptable form of health care for the majority of the population.
![[Grumble]](graemlins/grumble.gif)
![[Wink]](wink.gif)
![[Sleep]](graemlins/sleep.gif)
![[Frown]](frown.gif)
![[Mad]](mad.gif)
<--Me, annoyed at having to wait three hours to get into a governemnt clinic for substandard care and then being told I need another form before they'll sew my arm back on.)![[Angst]](graemlins/angst.gif)
if you want too (I don't).![[Smile]](smile.gif)
Thanks for the thoughtful explanation. You've happened to touch on one of my buttons, so I hope my responses don't come off as unfriendly. Just passionate about the topic. ![[Big Grin]](biggrin.gif)
![[Razz]](tongue.gif)
![[Hail]](graemlins/hail.gif)
![[Cool]](cool.gif)