BOIDS,

Just making sure - your (a) and (b) refer to the scenario where I have a sore throat or whatever right?

What are the options in the UK under the following scenarios?

- I've been vomiting on and off for 3 days and am unsure why
- I have a compound fracture
- I have heart palpitations and shortness of breath
- I have chronic knee pain that keeps getting worse
- I think i'm pregnant and need to have it confirmed (then what happens with the rest of my prenatal care)

Here you call 811 and they tell you what to do for all of those.

Except probably for the heart palpitations, in that case you should call 911, but of course they'd tell you that.

"That never was the case and if you are feeling bad enough most offices will try to squeeze you in. But most GP offices are overloaded with mundane medicine checks and other issues."

To some degree, this has been worsened by the fact that for a lot of common problems, the standard of care has evolved way beyond what a medical office can deal with.

I'm (just) old enough to remember when the treatment for a heart attack was bed rest, aspirin and hope. I'm easily old enough to remember calling a neurologist with an acute stroke patient and being told,"great, put him upstairs and I'll see him tomorrow"

Now you go to the cath lab/get CT/CTA/alteplase and an ICU bed. Which is for the best, by the way - but it's a hell of a lot more expensive.

Our healthcare system just hasn't caught up the the tech yet.

MM MD

"He's in Calgary. He probably makes in excess of 300k per year and doesn't even work full time. He just fills in for other docs when they need to take time off."

Just to be clear, that's locum work and it routinely pays a lot better than so called "full time" doctoring. One of my partners covered some dinky sized ER in Arizona for a three day holiday weeked at a cool $900 an hour. Thats a solid 300-400% bump over an "average" job in Arizona, from what I know.

MM MD

I know a lot about club sandwiches and sticking fingers in butholes but that doesn't make me a warlock.

"Also most medical research is done at universities and non profit hospitals."

Sort of. A LOT of it is funded by drug/gear companies, though. The stuff that isn't tends to be so called "basic" research, meaning that if anything concrete (meaning something you could actually use to treat sick people) is going to come out of it it's gonna be decades.

For an interesting read, I'd suggest a website called "In the Pipeline" by a guy named Derek Lowe (not the pitcher) - he's a Phd drug researcher. It's interesting and opens a door on an area that most people know nothing about - and he's a pretty good writer.

MM MD

An oldie but a goodie. Damn he was more spry just months ago. Dudes getting hit hard by the job.

I dunno but I will snap-pay for it.

Well I guess it's true that if you're well off or rich the U.S. system is 'better' in terms of being able to perhaps get quicker treatment or be more pampered while you're getting it. But of course if you're rich enough it doesn't really matter because you could probably just hire your own personal physician and keep him on call 24/7.

In terms of the point of the exercise though, which is mainly to get better when sick I'd say the two systems are pretty comparable. The exception being that in the USA you're getting charged 3x what the rest of the world is for the same thing.

first 3 = get to A&E, if i cant get there under my own steam then 999 -> ambulance

4th one i'd make a gp appointment

5th i dunno

He certainly is a master obstructionist. He has done literally nothing as a constructionist.

That’s a pretty good explanation for the dynamic shift I was trying to explain. Specialization and technology have really changed wha5 PCPs actually do with their patients.

5th was trick question. Get morning after pill is the answer.

GP will administer a pregnancy test if you want I'm pretty sure. All prenatal care is taken care of as far as I'm aware. National Insurance is 12% on any gross earnings between £157 and £866 a week and 2% on any earnings over £866 (nothing on your first £157 a week). Its supposed to only be for the nhs or unemoyment but obviously it all goes into the same big pot to be spent on bank bailouts etc.

A&E patients are generally seen in order of severity of condition so if you go in with something trivial that could be better dealt with by a GP you can expect a pretty long wait.

You might be right that attitude plays part. I'm off work today because I feel like absolute garbage but I'm not gonna go bothering the doctors just sleep, fluids and lemsip. The body sorts itself out pretty well.

What percent of new drug research is related to things like vaccines and "cures"? I get the sense that the holy grail of modern pharma research is long term treatments that patients may have to take for years (i.e., cash flow) and I wouldn't be surprised if financial considerations dictate a good deal of the research focus. Add to that efforts to "tweak" successful drugs bit so they remain on patent, and I suspect in house research isn't huge bang (in terms of improved health) for the buck. Not saying it's a conspiracy, but the economics of private research don't really incentive the optimal allocation of resources from a public health perspective.

"Not saying it's a conspiracy, but the economics of private research don't really incentive the optimal allocation of resources from a public health perspective."

All pretty much true - but exactly how you'd magically incentivize the public researchers to do something they have essentially never done is problematic. The number of actual drugs patented by Universities/Government outfits like the NIH or CDC is pretty close to zero, and has always been.

From what I can tell, the discovery-drug time frame is measured in decades - and the VAST majority of discoveries end up never producing drugs that can be used in patients.

Cures are few and far between, anyway (although god knows we could use some in the infectious disease area) - most of the big problems ( and big $$, for anyone who can figure it out ) lies in meds for stuff like Alzheimers - although a lot of me-too drugs have hit the market over the last 20 years, it seems that stategy is pretty played out - insurers aren't willing to pony up big $$ for meds that don't show actual benefit over previous drugs for the same condition (nor should they be, IMHO)

Note that I'm NOT in any way saying the the present state of affairs is optimal - and the Blog I referenced above is a great resource to begin to understand the issue - understanding that it is written by someone vested in the current system.

MM MD

This is all reasonable and my position is not firm--somewhat playing devil's advocate. I think private companies do plenty of good work that's likely helpful but may be, on balance, not much of a bargain.

And, as you suggest, many serious conditions are either genetic or not related to a specific vector, like Alzheimer's. In fact, I think the subject is so inherently complex that I only know a few things: 1) there are massive inefficiencies in the current system in the US, 2) the incentive structures are somewhat misaligned, 3) we do subsidize other countries' health systems with both our public and private R&D (which is fine, but may presage some adjustments if costs are brought down), 4) any advocate that fully favors either public or private research is probably uninformed about specifics and just pushing a broader ideological agenda. I'm tempted to review that blog, but it's not a core area of concern for me.

Jesus could not have said it better Himself.

Is anyone considering that the goals of McConnell and Senate GOPers in the inner circle might not be to pass the bill?

As I posted ITT earlier, it's definitely possible that they are hanging a threat like this over the American people since day 1 of Trump's term in order to use up everyone's resources fighting and protesting against this instead of eyeballing Russia or election cheating that was and will be done. Remember how long ago they knew.

Put it all in context with McConnell's reaction to Russian hacking last year. Rather than being shocked and going after Russia for it, he and others were more like *Oh ****, they are figuring it out. Better threaten Obama with a political firestorm if he breathes a word of this to the public.*

Everything that's happened Re: Russia since then hasn't done a thing to bolster my faith that this government is being at all consistent with their history. That includes going from being a "mastermind" to being an incompetent idiot overnight. Now maybe there's some other explanation like McConnell was great at obstructing and not constructing. But once again though, if you start off viewing both Trump & GOP through the lens of Russian blackmail or whatnot, everything makes so much more sense.

Inso means "we have black people", though I'm not sure how the health care homogeneity talking point coexists with the "dang Muslins are ruining Europe" talking point in the modern conservative mind.

And no, he can't explain why that matters.

Inso tried to use people of walmart dot com as an insult of OTHER PEOPLE lol

But that's my point, you can't actually do any of this in the Canadian system.


My breakdown is in terms of getting better when sick. Upper middle class and rich people will have better health outcomes in the US system than in the Canadian system. Money can be used to improve access and quality of care much more than in the Canadian system.

I have racist American relatives. I know exactly what he means. I'm pretty sure I've mentioned before that they have blatantly told me that Canadian healthcare is great but it wouldn't work in the US because of the freeloading black people and illegal immigrants.

They also never had a problem with me coming to work in the US. They're not as honest here, but they did let slip once that it was because I wasn't brown (Edit: I think it was actually that 'I spoke English') and lazy. For the record, I'm not brown but probably am lazier than most immigrants working in the US.

Reuters reports that Reps might consider bipartisan effort in health care.

Hope that the Dems tell them to **** off and die.

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