Impact of US government spending impasse

[cdev]

There have to be positive avenues for everybody to focus on in their lives, hobbies and learning are good ones but one needs to have at least a bit of money, and time to pursue that.

Hard drugs - any abuse of drugs seems to me to often be a trap that people fall into when they have some huge pain they think they cant resolve.

I suspect that the system (at least here in the US) has really failed a lot of people and they feel there is no future for them. Society should not be just about profit at any cost.
 
In the world thats being promoted, there is no room for most of our people, as they and their so called 'unrealistic expectations' (to have a decent job and live a decent life) don't fit the profit hungry agenda's plans well. It doesn't mesh well with the global value chains approach where every penny must be shaved off costs. In that world, basically the entire US workforce earns too much, wants too much. There is not any intelligence in a system that destroys the middlc class to make a few more pennies selling products to - who- There goes the customers.

The Asian countries that do not already have a sizable middle class (percentage wise, not by numbers) are unlikely to develop one, and suddenly start paying their workers more.

They are so hierarchical and rigid that smart people from those countries leave, they will tell us about how rigged their systems are. And that any expectation on our parts that they will grow into huge markets is a delusion.

So to export the jobs that the less-skilled can do, in order to placate a few oligarchs, is a bad idea. It makes more sense to automate them, keep them here, and promote free lifetime learning for people when they are not working. Trying to adjust may be as simple as changing our working model to a more flexible one that gives people more time to have a life. We have earned it.

And our own bought and sold and paid for politicians really need to realize that whats most profitable is often really a bad choice when the entire picture is considered.

If we solved these structural problems, I suspect that all despair-related problems like drug addiction would resolve. What is really horrible is that there are so few paths that people can follow which lead to good places, we need to make more of them. Otherwise we're totally failing the country and those responsible should be replaced.

"Vote of no confidence" and a complete restoration of democracy in its original form. One person, one vote. No human rights for corporations, no more corporate personhood. Thats where we really went wrong..   

[Zero999]

There have to be positive avenues for everybody to focus on in their lives, hobbies and learning are good ones but one needs to have at least a bit of money, and time to pursue that.

Hard drugs - any abuse of drugs seems to me to often be a trap that people fall into when they have some huge pain they think they cant resolve.

I think most people that get into drugs do through natural curiosity and because they're easily accessible. For example, I tried cannabis purely because it interested me. Nothing to do with any mental health condition or lack of focus in my life. I was at a music festival, my peers were using it, so I thought I'd give it a go. I didn't become addicted because I didn't like it. Had I liked it, things might of been difference. No doubt if I tried a more addictive drug it could be worse.

I don't buy into the idea that most addicts resort to drugs to cope with personal problems.

I'd take it one step further. There are plenty of people who are prescribed painkillers and have no issues coming "off" them. However, some people have an "addictive" personality. I believe they are genetically predisposed to becoming addicted to a substance, whether it be illicit drugs, prescription drugs, alcohol, food, etc.

No doubt that's true, but some drugs are more addictive, than others.

[cdev]

The cause of drug addiction is loss of hope and despair. Young people are running into a economic wall thats preventing them from ever having a life like they are constantly told they need to have. A family, etc. A stable life. But the system is now eating its own. Its not going to give them that good life, its skimming off the riches and they are losing hope.

We need to stand up for them more. We need to have a future for this country. People need to be able to get a decent education, even if jobs wont be there for them. So it needs to be free, but GATS blocks that. It also blocks us from fixing our health care system. And it sets us up for a future economic disaster which will leave millions of people homeless, other people likely living in their homes, or maybe them sitting empty, some foreign oligarchs investment. Their 'escape hatch'.

It’s not just the young suffering. It’s every age group (except perhaps for young kids). In economically depressed areas, many middle age people lost their jobs and have no hope of recovering, nor of having anything resembling a retirement. So while the opioid crisis is affecting young adults a lot, it is by no means avoiding older groups. On the contrary, they’re using at higher rates than one might otherwise predict, historically speaking.

Over the last few decades they have done a lot of research on drug addiction and found that the same systems are involved in the neurobiology of reward in the brain as are modulated by many drugs of abuse as well as behaviors like sex and gambling that can often become problem addictions.

That could lead off into an entire thread of its own about the need for people to be able to have things that appropriately reward when they had earned a reward, which wasn't some phony thing. (like the Internet)

But the point I am trying to make is that writing off more and more of society - especially now as they propose, most of it because it fails to fit into some economic box of profitability for a very few, isn't a failure of that society so much as its a failure of a model that proposes to do that which is not working as it needs to for the planet any more.

[Mr. Scram]

I'd take it one step further. There are plenty of people who are prescribed painkillers and have no issues coming "off" them. However, some people have an "addictive" personality. I believe they are genetically predisposed to becoming addicted to a substance, whether it be illicit drugs, prescription drugs, alcohol, food, etc.

Speculating about medical or biological mechanisms involved is a bit risky. Currently we're not aware of reliable indicators which predict addiction.

[cdev]

If the medical profession was willing to return to curing health problems, which would require more time, (differential diagnosis) and getting to the root of what was causing things like 'pain' which has a purpose, telling us some problem needs attention, that would be very helpful.

Its my understanding that doctors are now under so much time pressure from HMOs to work faster that they basically only get a few minutes with each patient.

That has led to them basically being forced to give up even trying to find, say what is causing pain.

Plus they are forced to sign agreements (physician gag clauses and their ilk) to not discuss tests or treatments - even ones that they know would be necessary or helpful unless the insurer has approved that discussion in advance to be within the scope of the plan that the customer's or their employer's plan pays for.. (group plans get a lot more lattitude to cover less because of a law, ERISA that allows insurers to as long as it meets a locally different 'standard of care' for that geographical area. Sort of an lowest common denominator. As long as the insurer's reductions in care are not faster than the reductions applied to that standard of care, they cant be sued for failure to treat a problem. As long as its a plan thats part of an employee benefit, not an individual plan. At least thats how I remember it as being when last I read about this, decades ago but I doubt greatly if it has changed. ERISA Section 514)

SO what is required as far as treatment is heavily influenced by geographic area, it varies from the new bare minimum thats always lower than it was before to "modern medicine" (only a few areas of the US get consistently high standards of care applied in their most expensive health care plans) Where you live and how much you pay determines what the medico-legal "standard of care" level is in the US. Its often a lot less care than people from elsewhere are used to. Even when they are supposedly getting the best "Cadillac plan" care that US healthcare has to offer, Europeans with sick family members that depend on some important treatment sometimes come here to take 'dream jobs' and end up going right back home, turning down the dream job, because the "best available" healthcare a family member was getting here, literally from the best, most advanced hospitals and doctors was inferior enough in some crucial aspect to prompt a decision to pass on the dream job, even after making the move with a family, because it was somehow 'wrong'.

One thing thats increasingly absent in the HMOs is differential diagnosis.

With a lot of illnesses, determining what is causing the problem is a process of elimination. A doctor is trained to try to eliminate the most likely diagnoses systematically until they find the cause of the problem, then treat it. But the HMOs are forcing them to just give up and attempt to make a guess as to what it is if its very likely to be that, otherwise, just treat symptoms. If a symptom is pain, I dont know what they do. I doubt if its try to find the cause of the pain, unless it literally falls into their laps. That kind of patient would be well advised to leave the US to get healthcare somewhere else that could get to the root of the problem and fix it, because nobody should live in pain, and pain killers are not a solution either, fixing whatever is causing the pain is.

Sometimes they could make very big mistakes, doing it like that. Rather than fix the system, they are constantly under pressure from HMOs to do less and less and any doctor who doesn't like that has to draw the line and with most kinds of insurance, those two lines don't meet.

Now the US is trying to force other countries into becoming more like us.
We should realize that the system we're pushing is a crime and that denying people care they need is not just hurting, its unnecessarily killing people.

[Zero999]

I'd take it one step further. There are plenty of people who are prescribed painkillers and have no issues coming "off" them. However, some people have an "addictive" personality. I believe they are genetically predisposed to becoming addicted to a substance, whether it be illicit drugs, prescription drugs, alcohol, food, etc.

Speculating about medical or biological mechanisms involved is a bit risky. Currently we're not aware of reliable indicators which predict addiction.

Yes, no one really knows. I think it's likely there's a strong genetic predisposition to addiction. If we look at pre-existing mental health conditions, then I should be alcoholic by now. I've had problems with depression, social anxiety and an eating disorder. I used to use alcohol to deal with social anxiety and as a weight loss tool. I'd drink so much it would make me sick and so hungover I couldn't eat for most of the following day. I did get help and am OK now, but didn't have any trouble with stopping drinking, when I got put on antidepressants, which I also had no problem with being weaned off. Quitting the eating disorder as much more difficult than the alcohol. I don't drink now because on reflection I didn't like it doing so would bring back bad memories and I feel better for it.

No doubt there are others who have pre-existing mental health conditions before they suffered from addiction and it was worsened by the drugs, but I think too much is often made of it. I look at others who have become addicted to drugs and many of them were happy before. Then there are those who were fine until they were prescribed painkillers.

If the medical profession was willing to return to curing health problems, which would require more time, (differential diagnosis) and getting to the root of what was causing them, that would be very helpful. Its my understanding that doctors are now under so much time pressure from HMOs that they basically only get a few minutes with each patient. That has led to them basically being forced to give up even trying to find, say what is causing pain. Plus they are forced to sign agreemenst to not discuss treatments that they know would be helpful unless the insurer has approved that discussion in advance to be within what the customer's plan pays for.. Also what is required as far as treatment is heavily influenced by geographic area, it varies from the bere minimum to "modern medicine" (only a few areas of the US get consistently high standards of care applied in their most expensive health care plans) Where you live and how much you pay determines what the medico-legal "standard of care" level is.

With a lot of illnesses, determining what is causing the problem is a process of elimination. A doctor is trained to try to eliminate the most likely diagnoses systematically until they find the cause of the problem, then treat it. But the HMOs are forcing them to just give up and attempt to make a guess as to what it is if its very likely to be that, otherwise, just treat symptoms. Sometimes they could make very big mistakes, doing it like that. They have to be given more time to handle that situation, but instead they keep giving them less and less time.

What ware HMOs? I'm not familiar with that term. A Google search gives me Houses of Multiple Occupation.

I gather the US has more of a problem with addiction to painkillers than other countries, but it occurs in the UK too. The problem is doctors will often not have time to treat the cause, so prescribe painkillers to mask the symptoms. I think the same happens with antidepressants as well. In my case I did get help from the doctors but it took a long time and my recovery was more down to having a supportive family and taking a long time away from work to get better.

[Mr. Scram]

If the medical profession was willing to return to curing health problems, which would require more time, (differential diagnosis) and getting to the root of what was causing them, that would be very helpful. Its my understanding that doctors are now under so much time pressure from HMOs that they basically only get a few minutes with each patient. That has led to them basically being forced to give up even trying to find, say what is causing pain. Plus they are forced to sign agreemenst to not discuss treatments that they know would be helpful unless the insurer has approved that discussion in advance to be within what the customer's plan pays for.. Also what is required as far as treatment is heavily influenced by geographic area, it varies from the bere minimum to "modern medicine" (only a few areas of the US get consistently high standards of care applied in their most expensive health care plans) Where you live and how much you pay determines what the medico-legal "standard of care" level is.

With a lot of illnesses, determining what is causing the problem is a process of elimination. A doctor is trained to try to eliminate the most likely diagnoses systematically until they find the cause of the problem, then treat it. But the HMOs are forcing them to just give up and attempt to make a guess as to what it is if its very likely to be that, otherwise, just treat symptoms. Sometimes they could make very big mistakes, doing it like that. They have to be given more time to handle that situation, but instead they keep giving them less and less time.

I'm well familiar with health care and health care professionals and this is blatantly untrue. There will always be challenges trying to maximise the effectiveness of inherently limited resources, but suggesting medicine is reduced to palliative care is just offensive. You're shortchanging an entire sector of hardworking professionals. Can we please get through this thread without alarmist conspiracies being thrown around?

[cdev]

If we look at the numbers of patients whose illnesses and outcomes were amenable to improved access to health care or improved health care or simply health care, (who did not get any health care that they needed, when they needed it) we must come to a very scary conclusion. That large numbers of Americans are dying who would not be dying in the civilized countries. Even ones who pay for what is represented to them as health insurance. 

For example, in San Jose, CA. a teenage girl, Sarah Broughton, died not long ago of a sinus infection, because she could not afford medical care, did not have health insurance, and didn't get the hospital care until it became an emergency and she deteriorated rapidly after that.

Afterward her family was swamped with bills and many made donations but last I heard they were still strugglling to pay off the bill for her emergency room care, and funeral.  They have a web page on Go Fund Me. << Link- currently they are at around $11,000 out of $20,000

This story is extremely common here in the US.

Not a day goes by when I don't hear of some person who has some curable but expensive illness who needs donations.

People put up web pages on GoFundMe. People who need specialist care are often told no, insurance wont pay for that.

Or the deductibles are so high they need to spend huge amounts of money they don't have before the insurance kicks in. (And they keep getting higher) Also, if somebody has presented needing care and received it, they then get sicgned up for insurance they cant afford, automatically, even if they have no way of paying that money, and then has been billed but has been late in paying that bill, they often cannot get more care until they pay it. It keeps building up. So this results in huge numbers of people having money paid on their behalf by the taxpayers who still cannot get health care because the system which claims they have enough to pay the premiums but in reality they don't have enough for the deductibles or maybe they are embarrassed they could not afford to fill the prescriptions their doctor wrote for them on the last visit. Maybe they had to buy food for a child or pay rent.

Anyway, someday there will be trials, like the ones at Nuremberg.

Because its rigged. The US is not some backwards, poor country. Its a country that should not lie to its people, either. Telling them its simply a matter of votes in Congress when what has actually happened is the policy space to do the things we need to do has been traded away, in the WTO.

So, its a fraud and one with staggering medical implications. An avoidable crime against humanity. An medical experiment on a whole country we already knew would fail, without informed consent. That's one of the most serious crimes there is.

The magnitude of people who are dying here who would not die even in poor countries - where they would get minimal care but at least it would be some care, is huge. No other country spends as much so a direct comparison cant be made of value. But when we compare outcomes here to the best other developed countries the number of excess deaths amenable to... is astronomical no matter which figures you use or how you slice the data.

Its likely hundreds of unnecessary preventable deaths occur in the US each day that would not occur in the other countries we should be comparing ourselves to.

By all accounts, the US is the worst country to have a chronic illness in in the world now. Even if you are middle income. Huge numbers of people are bankrupted each year by medical bills and if they have intention of ever fixing this, they havent illustrated that, instead it seems we're constantly being treated to more aggressive attempts to avoid any accountability or improvement. There is no adult supervision, just elites trying to pretend they are doing something they are not. They are making it worse. Trying to lock it in in ways voting can't address. They want to globalize health care in order to suck the other countries in to this madness.

This is all easy to prove, its not subjective, its fact. The motive is money, and its enslaving people to debt.

[TheNewLab]

What ware HMOs? I'm not familiar with that term. A Google search gives me Houses of Multiple Occupation.

I gather the US has more of a problem with addiction to painkillers than other countries, but it occurs in the UK too. The problem is doctors will often not have time to treat the cause, so prescribe painkillers to mask the symptoms. I think the same happens with antidepressants as well. In my case I did get help from the doctors but it took a long time and my recovery was more down to having a supportive family and taking a long time away from work to get better.

HMO Healthcare Management Org.
Kaiser Healthcare is an example.
However I like the term Houses of multiple occupation! So to live there you need to have multiple jobs in different occupations,right?
LOL

[vtwin@cox.net]

Speculating about medical or biological mechanisms involved is a bit risky. Currently we're not aware of reliable indicators which predict addiction.

True at the moment.

But to draw a parallel, some have claimed they are genetically predisposed to being homosexual (e.g. "I was born this way"), so there's no reason not to think addiction may have a genetic component as well.

Scientific America had an article a while back which indicated there was a genetic link to having a "sweet tooth".... in a sense, "addicted" to sugar.

[cdev]

Another big problem is that they are bringing back some practices which they had attempted to get rid of in a law, the Affordable Care Act, one of them is medical underwriting, reserving health insurance coverage to new conditions only and rejecting people with pre-existing conditions, in some cases retroactively, if it turns out they lied to get coverage (or pay less for coverage) by misrepresenting or omitting some 'material fact'. What the insurance companies do is they flag it when a patient is diagnosed with a serious medical condition and if somebody gets an expensive condition that costs a lot of money they have a team that tries to find a reason they can use to dump them as well as claw back the money going back to the beginning. If they dump an expensive patient they give the employee a bonus. The return of medical underwriting for common medical conditions almost certainly means this is going to return. Imagine having cancer, literally struggling for your life and then suddenly getting a letter, along with dozens of bills from healthcare providers going back to when you first got the insurance policy, all telling you that your insurance payments had been retroactively cancelled and you now had to pay the full bill, not the discounted rate they offer the insured. (which is often a fraction as much)

At the same time, you're likely to be hit with innumerable other problems related to your sudden change.

This is why I think going cashless is so bad. Imagine being sick and on top of that suddenly having your care end, becoming so indebted that you would basically be immobilized, because your entire income and savings, was not enough to pay this, could not pay for anything.  They deliberately make people fill out 30 page forms so later if people get sick, they can retroactively look for any mistake sick people made. This is just one link to a huge body of hearings in 2009 on health insurance rescissions.



The LA Times did a series on the problem, if you're interested in health care read those articles.

Also see the web site kaiserpapers.org - the issues that occur with various kinds of mangled care are not unique to any one flavor of for profit health insurance.

Ive been lucky, I've never had to deal with anything like this. But I see that the scary and dishonest way this system is being forced on Americans (via services FTAs) and others behind the countries backs, is a crime.

[TheNewLab]

[
Scientific America had an article a while back which indicated there was a genetic link to having a "sweet tooth".... in a sense, "addicted" to sugar.

Genetic??
I am so screwed! No winder why I.....Uh Oh here it comes..
I need to run ya'all I need a Malted Moo' Shake TIllamook ice cream fix!

I do not want to make lite the issue of poor healthcare in the US and the loss of Sarah's and the other tragic lives lost because of it, but This issue is way too complicated to be discussed off-topic on this thread. How about creating it's own subject? better yet,  anyone game to a live Skype conference on the subject?

Another thought, create a website, using google's sites web page ?

Look, this is a huge important issue. And, if the US continues to have the influence it has had around the world, then what happens here may influence other parts of the world.

I AM, going out to get some ice cream! Period!
If anyone messages me personally asking. Then I will set up a google sites webpage myself about this!

In the meantime may we please return to "impact of US govt spending impasse, affecting NIST?
my short and flippant answer is NIST is putting pressure on the Admin. just like many other US govt depts are. Many of the calling in sick, of TSA agents are simply finding work elsewhere. they need to eat. and yes, most Americans have not been able to set aside moeny for any crisis for ages now/

I am serious about the offer to set up a website if ya'all are serious. just let me get my ice cream first please

[nctnico]

With a lot of illnesses, determining what is causing the problem is a process of elimination. A doctor is trained to try to eliminate the most likely diagnoses systematically until they find the cause of the problem, then treat it. But the HMOs are forcing them to just give up and attempt to make a guess as to what it is if its very likely to be that, otherwise, just treat symptoms. Sometimes they could make very big mistakes, doing it like that. They have to be given more time to handle that situation, but instead they keep giving them less and less time.

I'm well familiar with health care and health care professionals and this is blatantly untrue. There will always be challenges trying to maximise the effectiveness of inherently limited resources, but suggesting medicine is reduced to palliative care is just offensive. You're shortchanging an entire sector of hardworking professionals. Can we please get through this thread without alarmist conspiracies being thrown around?

Actually there is a sense of truth in Cdev's text. Treatment protocols are often setup to maximise profit for the hospital and not offer the best care for the patient. I had kind of an odd problem with my wrist that couldn't be diagnosed quickly. Instead of getting an MRI I bounced back & forth between two departments for months. At some point I had enough and had a doctor prescribe an MRI and I had the scan done a few days later (at a third party specialising in MRI scans). Ofcourse I asked to get the scan data myself. Two weeks later I told the doctor how he should fix my wrist. The MRI was cheaper then all the other consults + tests and if I had the MRI earlier I wouldn't have lost so much money because I couldn't work as much as I could have otherwise.

In a country where sick people are just milking cows without a maximum on the tarifs I expect this to be much worse. My health insurance covers health expenses world wide except for the US.

@TheNewLab: you lost me after the word 'ice cream'. My kids stole the last bit of Ben & Jerry's. 

[cdev]

Mr. Scram,

You should read up on what goes into physician contracts with HMOs. What they have to agree to to be 'in network' doctors. There is a reason so many doctors are only taking cash from patients or retiring. Those contracts are it. 

Many US patients are leaving the US to get more comprehensive care at a lower price and outside of the US insurance companies grip, they often get tests or imaging they cant get here, tests that cost a tiny fraction in other countries (often from the same companies) as they do here. An MRI that costs $3000 here might cost $50 in another country.

Then they come back and have this information and thats become an issue the insurers are upset about.

Health care for sick people where every day counts should never have become this  "innocent until proven guilty" situation where insurers try to prevent care.

Patients should get care in the way doctors are taught to deliver it, doctors are not irresponsible. They don't prescribe unnecessary tests. But if the question is: Is the for profit insurance system is sometimes treating people's lives like they are just there to pay money, and deliberately delaying care? Is this business now a game some of these corporations seem to think they 'win' by denying patients they likely know are in fact seriously sick, care as long as they can. It has become that system, and its not getting fixed, as far as I know.

This is a horribly broken system. The US system is horribly broken. Its the poster child for these problems globally. Thats a matter of fact. Its easy to illustrate in dozens of ways. We pay more than anybody and we seem to have to get the least care, because the WTO rules require ever more 'progressive liberalization' which means ever more deregulation, meaning they always get to do more of what they want and restrictions on the things they do have to always be the "least burdensome necessary (to them) to ensure the quality of the service".

That means that the people will always get the short end of the stick and that politics cant work on the peoples behalf as it used to to arrive at a compromise, instead any change always has to be in the same direction, towards the most minimal government involvement. If a penny of subsidy is involved, that means means testing, limits on who is helped, and limits on quality so it would never be good enough to be acceptable unless one pays the most, otherwise, why buy the Cadillac Platinum Plan when the aluminum foil paper plan is adequate? See the problem? Look up 'trade distorting' and minimally trade restrictive. Thats what we got for entering the WTO.

I'm well familiar with health care and health care professionals and this is blatantly untrue. There will always be challenges trying to maximise the effectiveness of inherently limited resources, but suggesting medicine is reduced to palliative care is just offensive. You're shortchanging an entire sector of hardworking professionals. Can we please get through this thread without alarmist conspiracies being thrown around?

[Mr. Scram]

Mr. Scram,

You should read up on what goes into physician contracts with HMOs. What they have to agree to to be 'in network' doctors. There is a reason so many doctors are only taking cash from patients or retiring. Those contracts are it. 

Many US patients are leaving the US to get more comprehensive care at a lower price and outside of the US insurance companies grip, they often get tests or imaging they cant get here, tests that cost a tiny fraction in other countries (often from the same companies) as they do here. An MRI that costs $3000 here might cost $50 in another country.

Then they come back and have this information and thats become an issue the insurers are upset about.

Health care for sick people where every day counts should never have become this  "innocent until proven guilty" situation where insurers try to prevent care.

Patients should get care in the way doctors are taught to deliver it, doctors are not irresponsible. They don't prescribe unnecessary tests. But if the question is: Is the for profit insurance system is sometimes treating people's lives like they are just there to pay money, and deliberately delaying care? Is this business now a game some of these corporations seem to think they 'win' by denying patients they likely know are in fact seriously sick, care as long as they can. It has become that system, and its not getting fixed, as far as I know.

This is a horribly broken system. The US system is horribly broken. Its the poster child for these problems globally. Thats a matter of fact. Its easy to illustrate in dozens of ways. We pay more than anybody and we seem to have to get the least care, because the WTO rules require ever more 'progressive liberalization' which means ever more deregulation, meaning they always get to do more of what they want and restrictions on the things they do have to always be the "least burdensome necessary (to them) to ensure the quality of the service".

That means that the people will always get the short end of the stick and that politics cant work on the peoples behalf as it used to to arrive at a compromise, instead any change always has to be in the same direction, towards the most minimal government involvement. If a penny of subsidy is involved, that means means testing, limits on who is helped, and limits on quality so it would never be good enough to be acceptable unless one pays the most, otherwise, why buy the Cadillac Platinum Plan when the aluminum foil paper plan is adequate? See the problem? Look up 'trade distorting' and minimally trade restrictive. Thats what we got for entering the WTO.

No. I'm not interested in all the nonsense you spout. Why do you have to ruin many interesting threads this endless spamming of your personal agenda and trade organisation fever dreams? This obsession isn't healthy. Get some help.

[Mr. Scram]

True at the moment.

But to draw a parallel, some have claimed they are genetically predisposed to being homosexual (e.g. "I was born this way"), so there's no reason not to think addiction may have a genetic component as well.

Scientific America had an article a while back which indicated there was a genetic link to having a "sweet tooth".... in a sense, "addicted" to sugar.

Being born a certain way doesn't automatically mean it's a genetic matter. But again these kinds of assessments shouldn't be made by people not qualified to do so, based on cursory information. Biology and genetics are wildly complicated subjects.

[Mr. Scram]

Actually there is a sense of truth in Cdev's text. Treatment protocols are often setup to maximise profit for the hospital and not offer the best care for the patient. I had kind of an odd problem with my wrist that couldn't be diagnosed quickly. Instead of getting an MRI I bounced back & forth between two departments for months. At some point I had enough and had a doctor prescribe an MRI and I had the scan done a few days later (at a third party specialising in MRI scans). Ofcourse I asked to get the scan data myself. Two weeks later I told the doctor how he should fix my wrist. The MRI was cheaper then all the other consults + tests and if I had the MRI earlier I wouldn't have lost so much money because I couldn't work as much as I could have otherwise.

In a country where sick people are just milking cows without a maximum on the tarifs I expect this to be much worse. My health insurance covers health expenses world wide except for the US.

@TheNewLab: you lost me after the word 'ice cream'. My kids stole the last bit of Ben & Jerry's. 

Treatment protocols aren't set up to maximise profits. I can't guarantee that's never the case, but it's certainly not the standard. I'm sorry you had a bad experience, but not being able to effectively diagnose your problem doesn't demonstrate this is done for profit. Health care in developed parts of the world is facing challenges with risings costs due to ever more sophisticated treatment and therefore struggles with effectively treating as many people as possible with limited resources. There is no endless pile of cash, so choices and optimising are required and it's not going to be perfect all the time. It's a rather complicated problem with an insane amount of constantly moving parts.

[vtwin@cox.net]

An MRI that costs $3000 here might cost $50 in another country.

Had an MRI on my spine about 6 years ago prior to having a percutaneous discectomy.

MRI facility billed insurance company $2,700.

Insurance company paid $625.


Now, we know the MRI facility at a minimum "broke even" on their expenses at $625 (if not, they'd go out of business)

If I didn't have insurance, I would have to pay $2,700.

To me, that is criminal.

I can understand some level of 'discount' to a provider, due to streamlined billing, etc... but a 75% discount?

[james_s]

Speculating about medical or biological mechanisms involved is a bit risky. Currently we're not aware of reliable indicators which predict addiction.

True at the moment.

But to draw a parallel, some have claimed they are genetically predisposed to being homosexual (e.g. "I was born this way"), so there's no reason not to think addiction may have a genetic component as well.

Scientific America had an article a while back which indicated there was a genetic link to having a "sweet tooth".... in a sense, "addicted" to sugar.

I think it's apparent that some people are genetically far more prone to addiction than others. It still in most cases takes a conscious decision to shoot up or smoke something. Especially substances that are known to be especially addictive and/or have a high mortality rate. I've known social drinkers and social tobacco or pot smokers but I've never known a moderate heroin user. The few people I knew who used that went downhill real fast becoming hardcore addicts.

[cdev]

By the way, vtwin, a cheap and effective approach exists which could probably save many people from needing "pain killers" for back and joint pain of various kinds. It might have also helped you with your back.

The problem for US for profit medicine, is, it is cheap and available and its made from a common invasive plant.

Of which there is an oversupply in the US. Japanese knotweed.
Where is the profit in that? Good health is its own "profit".

You can read about it yourself, its a subject of intense research, all around the world.

https://www.ncbi.nlm.nih.gov/pubmed/?term=resveratrol+disc

It actually seems to repair the underlying vertebral injury. 

Curing the underlying problem certainly may be useful in addressing vertebral disc pain.

"Resveratrol" also might be useful in preventing bone loss in microgravity during long space voyages.

As well as dozens of other things.

[maginnovision]

An MRI that costs $3000 here might cost $50 in another country.

Had an MRI on my spine about 6 years ago prior to having a percutaneous discectomy.

MRI facility billed insurance company $2,700.

Insurance company paid $625.


Now, we know the MRI facility at a minimum "broke even" on their expenses at $625 (if not, they'd go out of business)

If I didn't have insurance, I would have to pay $2,700.

To me, that is criminal.

I can understand some level of 'discount' to a provider, due to streamlined billing, etc... but a 75% discount?

Actually I've always negotiated as a cash patient because using my insurance costs MORE. CT scan for instance was $1400, As a cash patient I got it done for $300.

[beanflying]

Among all the Drug speculation and the USA nonhealth system and OT all I saw was Ice Cream which is never really off topic

Seems the FCC has gone to sleep as has chunks of the FDA. https://www.cnet.com/news/government-shutdown-delays-launch-of-new-tech-products/

[cdev]

Many countries have highly regulated prices on essential procedures like imaging. For this reason an MRI in Japan a few years ago cost around $99

The US is strongly against the spread of government regulation which it views as sort of akin to a contagion. Like an illness. Which is why we and the EU and a few other nations created the WTO which has largely halted the spread of public health care by creating new entitlements that blocked expansion of public services by defining "public services' so very narrowly that almost none qualify. If they don't then they are subjected to all sorts of Byzantine rules.

An MRI that costs $3000 here might cost $50 in another country.

Had an MRI on my spine about 6 years ago prior to having a percutaneous discectomy.

MRI facility billed insurance company $2,700.

Insurance company paid $625.


Now, we know the MRI facility at a minimum "broke even" on their expenses at $625 (if not, they'd go out of business)

If I didn't have insurance, I would have to pay $2,700.

To me, that is criminal.

I can understand some level of 'discount' to a provider, due to streamlined billing, etc... but a 75% discount?

Actually I've always negotiated as a cash patient because using my insurance costs MORE. CT scan for instance was $1400, As a cash patient I got it done for $300.

[raptor1956]

If the medical profession was willing to return to curing health problems, which would require more time, (differential diagnosis) and getting to the root of what was causing things like 'pain' which has a purpose, telling us some problem needs attention, that would be very helpful.

Its my understanding that doctors are now under so much time pressure from HMOs to work faster that they basically only get a few minutes with each patient.

That has led to them basically being forced to give up even trying to find, say what is causing pain.

Plus they are forced to sign agreements (physician gag clauses and their ilk) to not discuss tests or treatments - even ones that they know would be necessary or helpful unless the insurer has approved that discussion in advance to be within the scope of the plan that the customer's or their employer's plan pays for.. (group plans get a lot more lattitude to cover less because of a law, ERISA that allows insurers to as long as it meets a locally different 'standard of care' for that geographical area. Sort of an lowest common denominator. As long as the insurer's reductions in care are not faster than the reductions applied to that standard of care, they cant be sued for failure to treat a problem. As long as its a plan thats part of an employee benefit, not an individual plan. At least thats how I remember it as being when last I read about this, decades ago but I doubt greatly if it has changed. ERISA Section 514)

SO what is required as far as treatment is heavily influenced by geographic area, it varies from the new bare minimum thats always lower than it was before to "modern medicine" (only a few areas of the US get consistently high standards of care applied in their most expensive health care plans) Where you live and how much you pay determines what the medico-legal "standard of care" level is in the US. Its often a lot less care than people from elsewhere are used to. Even when they are supposedly getting the best "Cadillac plan" care that US healthcare has to offer, Europeans with sick family members that depend on some important treatment sometimes come here to take 'dream jobs' and end up going right back home, turning down the dream job, because the "best available" healthcare a family member was getting here, literally from the best, most advanced hospitals and doctors was inferior enough in some crucial aspect to prompt a decision to pass on the dream job, even after making the move with a family, because it was somehow 'wrong'.

One thing thats increasingly absent in the HMOs is differential diagnosis.

With a lot of illnesses, determining what is causing the problem is a process of elimination. A doctor is trained to try to eliminate the most likely diagnoses systematically until they find the cause of the problem, then treat it. But the HMOs are forcing them to just give up and attempt to make a guess as to what it is if its very likely to be that, otherwise, just treat symptoms. If a symptom is pain, I dont know what they do. I doubt if its try to find the cause of the pain, unless it literally falls into their laps. That kind of patient would be well advised to leave the US to get healthcare somewhere else that could get to the root of the problem and fix it, because nobody should live in pain, and pain killers are not a solution either, fixing whatever is causing the pain is.

Sometimes they could make very big mistakes, doing it like that. Rather than fix the system, they are constantly under pressure from HMOs to do less and less and any doctor who doesn't like that has to draw the line and with most kinds of insurance, those two lines don't meet.

Now the US is trying to force other countries into becoming more like us.
We should realize that the system we're pushing is a crime and that denying people care they need is not just hurting, its unnecessarily killing people.

The Pharmaceutical industry has moved away from developing drugs that cure to those the treat problems and it make sense that they have.  Why spend a lot of money to develop a drug that, in a matter of weeks or months, cures a problem and ends the payments when you can develop drugs that treat the problem but don't cure it.  With the second approach you customer provides a constant cash flow for the rest of there lives.

One of the big problems we face is the fact that more and more of our antibiotics no longer work as they have in the past as the bugs adapt.  Several large pharmaceuticals began a development program to address this but they canceled the program because, well, why develop a cure when you can hook your customer for life treating the problem instead.

Speaks volumes about how the unrestrained capitalist approach works, and doesn't work.


Brian

[cdev]

Which reminds me..

Solutions to those multidrug resistant bugs are out there. They just lie in the world of plants. And would require we recognize the fact that Nature was/is the source of most medicine. Not man. The drug industry just hates things it can't monopolize. They would rather people remain sick than get better without paying them. We cant let them do that.

A drug company exec (an oasis of sanity in that industry) once told me exactly what you just said, informed by figures, startling figures about how little most Rx drugs cost to make.

Biotech /medicine/drugs should be more like electronics where the benefits of mass production and the economies of scale are passed on more. Instead people are being milked for every last dollar now, at least here in the US. Its just insane. I have heard so many really horrible stories - you start to burn out and not even register any more. So many people are dying because they don't get treatment which should be so very cheap, but they cant afford it. Even generic drugs that literally cost pennies long off  patent cost hundreds of dollars if you don't have health insurance which costs hundreds or thousands of dollars a month.

Which adds absolutely no value. All it does is insulate the politicians from responsibility. And ensure that nobody besides the wealthiest people get modern health care in countries that adhere to its core tenets.. a rigid ideology.