My concern is that the populism of this issue will push US into inexorably
favoring the politics of a Bentley for everyone: everyone deserves to have
access to all the care that anyone could conceivably ask for.  Granted,
this is hyperbole, but I don't think it is that far from the truth.  At
what point would a bureaucrat have the courage to withhold some very
expensive treatment that helps only small population but has political
influence.  The current healthcare legislation appoints about 2 dozen
people to mandate what insurances must cover.  That's an awfully small
number of people to have to influence.

For instance, what if the evidence shows that a "standard" HIV treatment is
able to get excellent results on 95% of the HIV population but highly
tailored HIV treatment is able to get 20% better results on up to 99% of
patients but would cost 10x as much?  Anyone want to bet that the more
expensive option will be mandated as part of insurance coverage?

John Lee

On Sun, Apr 7, 2013 at 6:29 AM, trzim29 <[log in to unmask]> wrote:

> Throughout my career I have worked in Florida and Illinois.
> I likely have seen about 5-10 Canadian patients per year, a few from
> Dubai, a few from the Netherlands, a few from other parts in the world.
> This is in no way scientific obviously by any means but every and I mean
> every foreign patient notes there healthcare in there country is no where
> near as good as the healthcare we provide.
> These are typically well to do patients as well.
> The Canadian patients are in shock universally how quickly they are seen
> and how "thorough" we are. Thorough is not just ordering tests.
> This is just a 15 year observation with a decent but still not huge of an
> "n".
> Rick your points were all excellent.
> TZ
> Sent from my Verizon Wireless 4G LTE Smartphone
> -------- Original message --------
> From: Doc Holiday <[log in to unmask]>
> Date: 04/07/2013  12:37 AM  (GMT-06:00)
> To: [log in to unmask]
> Subject: Our Future
> From: [log in to unmask]
> > And the US is an incredibly individual-focused nation. So each
> individual wants "everything done". Again, Bentley care.
> --> I must say that I find it unusual for "Bentley" to be used in such a
> context - I am more used to RR being the metaphor...
> ;-)
> > I wade into this debate with some trepidation.
> --> If we can't debate...
> I have been "debating" and doing lectures on this healthcare system
> comparison for quite a number of years, with associated reading this
> entails and my own exposure to the UK system as well as a few other systems
> and visits to the USA and many EDs there. A common representation I come
> across, which I find a teensy bit misleading, is the one which states that,
> while in the USA one can get up to any level of care for enough money (say
> "Bentley"), in the UK/NZ/etc. one can only get to whatever level the system
> rations. While this "ceiling" might apply in some countries, it is NOT at
> all a necessary part of the "nationalised" systems. In the UK, for example,
> where the NHS "ceiling" is set at what most experts seem to rate as at
> least 99% of Bentley, one can still buy a Bentley! That the NHS won't give
> you a free Bentley does not deprive you of your car-purchase rights, which
> are just as free as in the USA!
> Of course, it is sometimes pointed out to me,when I say this, that this is
> not as simple as buying a Bentley, as one has already been paying taxes
> into the NHS for years and then finds oneself having to pay for a Bentley
> if one requires something which is not in the 99.x%...
> This is true.
> But it is countered by another point - a medical Bentley often does not
> cost as much in the UK. For example, the NHS may offer a procedure but with
> too long a delay to satisfy, so, despite having paid taxes for years, the
> patient decides to "go Bentley" and pay out of pocket to have the procedure
> tomorrow. But the fact that the procedure DOES exist on the NHS has the
> effect of competing down the price of the Bentley in the market...
> In summary, simply because 99.x% of what a wealthy American can buy is
> available through a socialised NHS does NOT mean one cannot also buy the
> other <1% just like in the USA.
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