folks feelin' tired

the milk has expired

Clinton all fired

pants suit attired

media wired

the public - uninspired

I've heard (perhaps urban legends) that doctors were getting out of OB/GYN due to very high insurance costs. Is there price gouging going on and/or lots of litigation?

My understanding, purely anecdotal, is that since one of the factors in determining litigation judgements is projected lost earnings, and juries can reasonably project 70+ years of earnings for a baby that suffers damage in delivery, and since a good lawyer could probably make the case that the baby would have been the CEO of a multinational corporation, the payouts tend to be huge. I think it's the OB part rather than the GYN part that is the problem.

Which they do, if they deem that you are insufficiently worthy (healthy) otherwise. You see part of the equation of socialized care, at least what it's morphed into is the nanny state that deems itself the sole arbiter of who is worthy to treat and who is not. And the list of those who are not, is getting progressively longer. If you smoke, if you drink, if you're overweight, if you give your kids junk food......you will find yourself slotted into marginal groups by the NHS which insists you are doing your part to be 'rewarded' with health care.

Now you can say in the cold calculus of cost it's worth it - why should you give bypass surgery to a 75 year old, they're old enough. But if you're the 75 year old and they take that decision away from you, it must be pretty depressing.

But if they're rationing care because it's unaffordable I suppose people can accept that. It's when they make a moral judgment on you and decide that you should be happy to die off for the better good and for the better people is where it gets dicey.

What good they are to you? That's when we should all start to practice mass euthanasia. Why not? It makes perfect sense.

ok, first, your stuff would be covered in any system. an MRI even with puffed up price is only a few hundred - no justification to not allow it. as would the spinal fusion operation (or whatever is required). you are a (relatively) young man with terrible pain. this is not a half-million dollar transplant operation on an eighty year old - yes, at seventy nine and a half i might very well thing differently. hell maybe everything can be done for everybody - people just say it's not possible.
what is important is finding a doctor who will talk to you for more than 10 minutes - actually listen - and most of all, if one test shows something wrong, another more precise test is then done. most doctors just listen to symptoms, treat them, and that's that, next, please!
Aycharaych it is online discussions or nothing for more than just you - and i have a loving family. but they get bored hearing the same old stuff and, worse, if THEY get upset, *I* get upset. HOWEVER if YOU (or some other unknown folks) get upset) umm, who really cares? (i think that's the reason we are so rude online - however it IS exhilarating, if sometimes hurtful)

What you're proposing is a strictly two tiered system. Economics would drive the providers to provide the services that compensate them the best. As soon as you have the relief valve of "Well if people want to pay for xxxxx then they can, on their own", that is EXACTLY where the services gravitate. And it's not always a bad choice. The problem with directed care is they have to treat you with the person they have. When I worked for a PPO we had providers under indictment for sexually molesting patients and we HAD to continue to refer patients to them because of the specialities they covered. Somehow when it's my wife's life on the line I'll figure out how to pay the private practice specialist out of network in lieu of a drug addict incompetent loser my PPO foists on me.

20 years ago when malpractice premiums accounted for no more than 7-10% of revenue doctors decided they had enough and all went out of the straight OBGYN business and instead became 'high risk pregnancy specialists' which cut their premiums enormously. Why? Because now every patient is high risk, and the probability that something will actually go wrong with everyone is quite low, and, if something does go wrong, it was to be expected.

The most expensive cases, as a group are not cancer or gerontology cases or AIDS or premature births (though preemies are way up there). The most expensive cases are generally long term neurological cases such as MS. The patient lingers with very expensive care for years, decades even. Millions of dollars is the normal lifetime cost for an MS case. And all you can ever do is make a quality of life improvement in what will always kill the patient, eventually.

same thing goin' on

days and weeks are long....

Our tort system doesn't work well at all for dealing with mistakes. When people are denied coverage for procedures, exams, tests etc under our current system they have very little recourse most places because, as Michael Moore demonstrated in "Sicko," a lot of insurance companies have explicit - to their employees not the customers - policies to reduce costs by denying coverage. A single payer plan would have to have some way for patients to challenge coverage decisions but it surely could be a lot simpler, quicker, and cheaper than our current non-system.

We have probably the most expensive health care in the world, but what often gets left out of these discussions is the reminder that we have the worst outcomes - death, infant mortality, disability etc etc - of every industrialized country except for Cuba. I think there are something like 34 or 35 countries ahead of us, and ahead of us not by a little bit either.

Here's a little experience my husband and I had with a single payer system. A few days before we traveled to France a few years ago my husband had a small cyst removed from his back and was given instructions about how to care for it. Less than two weeks later it was inflamed and painful. What to do? American friends who live in Paris suggested going to the nearest pharmacy to our hotel and asking someone there to look at it. Apparently this is standard procedure. The pharmacist looked at my husband's lesion, pronounced "pas jolie" (not pretty) and directed us to a small clinic in the next block. So at 3 in the afternoon we walked in, explained the problem and were sent upstairs to a clinic. We paid 20 euros and sat down to wait. In less than an hour my husband was seen by a brisk woman physician who wrote a prescription for an antibiotic and some cream or something. We went back to the pharmacy, made our purchase and were on our way. All this took no more than 2 hours and was within 3 blocks of our hotel.

Anybody know where you can get that kind of prompt inexpensive service away from home? As far as I know the French aren't clamoring for Aetna and Blue Cross and Cigna etc etc etc to come help them out.