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The fighting Prince Harry
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I have no idea why people dashing around and snatching photos of them in a car would be so distressing to one of Diana's sons.
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A snatched photo of them in their car was posted online yesterday, there were lots of comments on how “miserable” they looked. Because we’d all look happy being photographed in our cars.
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Jeremy Clarkson has said some nasty things about Meghan Markle now. Seems a certain set of people are being triggered by her.
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So, Turning Point UK (ultra conservative group) have released a video of a black guy they refer to as "Londoner" who "busts Meghan Markle Oprah myths". This was shared by one of my Facebook friends who is anti-Brexit and anti-Trump but is a big fan of the Queen and supporting the military. She has previous for sharing Britain First posts about poppies, until I pointed out who BF were.
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An aside into general US healthcare whining.
My doctor just prescribed me a 14 day course of antibiotics. When I went to pick them up, the pharmacist apologized and said that she could only give me 10 days worth because my insurance company wouldn't allow her to give me the other 4, so I'd have to go back and get the rest later.
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Most people when they receive care get good care. This is anecdata. There have been huge patient safety issues and we could a deep dive and I could spam you wih stats. But all those links say that statistically the US lags on medical care outcomes.
I know you know, but for the audience, like...
Honestly, I’ve lost track of the point I was trying to make.
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Originally posted by Hot Pepsi View Post
But health, or even health care, is not the same as medical care.
The medical care - on an episode by episode basis - is often very good in the US. It just isn't cost-effective or easily available to all. My family has received plenty of good medical care. We have many of the leading hospitals and researchers in the world.
Doctors come from all over the world to work here and often make enormous sums of money. We also have the richest medtech and pharma industry and the US is the market they all want to be in even though the regulatory hurdles are the highest.
Because we splash out so much money on new drugs and gear.
For example, I just got off the phone with a doctor who researches cardiac resynchronization therapy for heart failure. He was pointing out how it's especially under-prescribed outside the US, even for people the professional guidelines say it is for.* It's very expensive and those people are probably only going to live a few more years, at most, either way. Is it worth it? Patients and plaintiff lawyers may have a different answer than insurance companies, politicians or taxpayers.
The US does well on some outcome metrics - like cancer survivorship and, apparently, hospital infections - but poorly in things like maternal care.
https://www.healthsystemtracker.org/...art-collection
Here's a more "pro doctor" angle on it. As it points out, we do a lot more knee surgeries than they do in the Netherlands, for example. That has pros and cons.
https://www.forbes.com/sites/physici...h=117f42fd1232
But outcomes are not the same as "quality of medical care." There are many things that influence one's health that have nothing to do with medical care. Ask any emergency or primary care doctor or nurse and they'll tell you how frustrated they are at how little they can actually do. The real world is far more like Scrubs than House MD.
* Although their are counter examples of that. Its way easier to get a CE mark than FDA approval, so sometimes doctors in Europe go apeshit with a new technology that hasn't been well-studied yet. That was true with drug-eluting stents and transcatheter aortic valves in their early days.
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Originally posted by Patrick Thistle View PostHot Pepsi The actual care delivered by the system isn't very good though, regardless of what it is working with. In terms of patient outcomes, the US system is the most expensive in the world and routinely delivers much poorer care outcomes. There is an entire industry of Healthcare Improvement (centred on the IHI in Boston, and also some health providers like Kaiser Permanente in Callifornia) dedicated to trying to resolve this problem. My point is that the gut notion that the USA gets better health outcomes is wrong. The document you posted is more up to date than the stuff I used to have to write about in the job I worked from 2010-2015, but it's saying the same things.
In my current healthcare niche, we don't look to the USA for leadership on clinical outcomes. We look to Holland, Germany and Sweden.
There are a lot of cultural and social aspects to why the US healthcare system costs so much and delivers so little. It's not a reflection on the staff involved.
The medical care - on an episode by episode basis - is often very good in the US. It just isn't cost-effective or easily available to all. My family has received plenty of good medical care. We have many of the leading hospitals and researchers in the world. Doctors come from all over the world to work here and often make enormous sums of money. We also have the richest medtech and pharma industry and the US is the market they all want to be in even though the regulatory hurdles are the highest.
Because we splash out so much money on new drugs and gear.
For example, I just got off the phone with a doctor who researches cardiac resynchronization therapy for heart failure. He was pointing out how it's especially under-prescribed outside the US, even for people the professional guidelines say it is for.* It's very expensive and those people are probably only going to live a few more years, at most, either way. Is it worth it? Patients and plaintiff lawyers may have a different answer than insurance companies, politicians or taxpayers.
The US does well on some outcome metrics - like cancer survivorship and, apparently, hospital infections - but poorly in things like maternal care.
https://www.healthsystemtracker.org/...art-collection
Here's a more "pro doctor" angle on it. As it points out, we do a lot more knee surgeries than they do in the Netherlands, for example. That has pros and cons.
https://www.forbes.com/sites/physici...h=117f42fd1232
But outcomes are not the same as "quality of medical care." There are many things that influence one's health that have nothing to do with medical care. Ask any emergency or primary care doctor or nurse and they'll tell you how frustrated they are at how little they can actually do. The real world is far more like Scrubs than House MD.
* Although their are counter examples of that. Its way easier to get a CE mark than FDA approval, so sometimes doctors in Europe go apeshit with a new technology that hasn't been well-studied yet. That was true with drug-eluting stents and transcatheter aortic valves in their early days.Last edited by Hot Pepsi; 12-03-2021, 20:41.
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And I should point out this is all taken from a Google Search. If you want me to go hunting for anything in particular then let me know.
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And for those who want it, here is a similar comparison focusing on the performance of the NHS against peer healthcare systems that was published in the BMJ in 2019 https://www.bmj.com/content/367/bmj.l6326
The NHS is better in some areas, lags behind in others, but spends less than anyone else.
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This is Forbes deconstructing a JAMA article in 2018 about the USA's poor performance on health outcomes https://www.forbes.com/sites/physici...h=711ebddb1232
Some of their points...
The higher healthcare costs are because higher value procedures are being done (although they rely on anecdata for that point)
The main costs are administrative (which is because it's all done through insurance)
The USA has a massive poverty problem
The USA is a big country and healthcare is harder for big countries (well, that's an opinion)
Fear or being sued means unnecessary scans, tests, procedures and medications are administered
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The Commonwealth Fund did it again in 2019 https://www.commonwealthfund.org/pub...rspective-2019
Here's a sample keyline statement:
Compared to peer nations, the U.S. has among the highest number of hospitalizations from preventable causes and the highest rate of avoidable deaths
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You don't have to read any further than the abstract
ABSTRACT
ISSUE: The United States health care system spends far more than other high-income countries, yet has previously documented gaps in the quality of care.
GOAL: This report compares health care system performance in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States.
METHODS: Seventy-two indicators were selected in five domains: Care Process, Access, Administrative Efficiency, Equity, and Health Care Outcomes. Data sources included Commonwealth Fund international surveys of patients and physicians and selected measures from OECD, WHO, and the European Observatory on Health Systems and Policies. We calculated performance scores for each domain, as well as an overall score for each country.
KEY FINDINGS: The U.S. ranked last on performance overall, and ranked last or near last on the Access, Administrative Efficiency, Equity, and Health Care Outcomes domains. The top-ranked countries overall were the U.K., Australia, and the Netherlands. Based on a broad range of indicators, the U.S. health system is an outlier, spending far more but falling short of the performance achieved by other high-income countries. The results suggest the U.S. health care system should look at other countries’ approaches if it wants to achieve an affordable highperforming health care system that serves all Americans.
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Hot Pepsi The actual care delivered by the system isn't very good though, regardless of what it is working with. In terms of patient outcomes, the US system is the most expensive in the world and routinely delivers much poorer care outcomes. There is an entire industry of Healthcare Improvement (centred on the IHI in Boston, and also some health providers like Kaiser Permanente in Callifornia) dedicated to trying to resolve this problem. My point is that the gut notion that the USA gets better health outcomes is wrong. The document you posted is more up to date than the stuff I used to have to write about in the job I worked from 2010-2015, but it's saying the same things.
In my current healthcare niche, we don't look to the USA for leadership on clinical outcomes. We look to Holland, Germany and Sweden.
There are a lot of cultural and social aspects to why the US healthcare system costs so much and delivers so little. It's not a reflection on the staff involved.
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It doesn't seem to answer TT's question which is whether the US's outcomes are good for people once they're in the system and getting fully treated.
My instincts are that TT is right. But firstly I've never seen data on it. And secondly I think the risk of over-treatment is much higher in the US. The number of people getting procedures and put on medications that are pointless or actively damaging is much higher here. The "First, do no harm" motto of most medical people definitely frays at the edges once the profit motive is in place for the providers, and when many of the costs are hidden in the insurance system
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Originally posted by Patrick Thistle View Post
That link disproves TT's gut feeling that the USA is good at health outcomes.
But, as I mentioned, the medical care system is not the only determinant of health outcomes. Our diets and lifestyles matter a lot too and the UK and US aren't particularly strong in those areas.
As my uncle, the prominent anesthesiologist told me once, "I've made a lot of money off of all these fancy surgeries, but the most important improvements in health have come from changes like not having shit running down the middle of the street." We don't have shit running down the middle of the street in the UK and US - at least not in most cities - but his point was that infrastructure and the so-called "social determinants of health" have a bigger impact on health overall than all the care that happens in the last 20 years of life.
Our diets are terrible - especially in the US. Our physical activity levels aren't ideal, collectively, but I've seen convincing evidence that our diet is having a much bigger impact.
Smoking is still at thing, although the US has made a lot of progress on that.
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Originally posted by Hot Pepsi View Post
The links I put above back that up.
Page 5 of this has a simple 1-11 ranking of the rich country's performances.
The UK does well in everything except actual outcomes, but of course health outcomes aren't just related to health. And Japan is not on the list. They often do really well on these kinds of league tables, but I can't recall the details.
https://www.commonwealthfund.org/sit...irror_2017.pdf
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Originally posted by TonTon View PostAnyway, back on topic - US healthcare / NHS waiting lists: my gut feeling based on very little is that there might be better outcomes for people in the US who get treated, but that the UK system is much better at treating people. Can someone dig out all the stats to back me up, please? Ta.
Often the best healthcare in terms of outcomes is Scandinavian.
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Originally posted by TonTon View PostAnyway, back on topic - US healthcare / NHS waiting lists: my gut feeling based on very little is that there might be better outcomes for people in the US who get treated, but that the UK system is much better at treating people. Can someone dig out all the stats to back me up, please? Ta.
Page 5 of this has a simple 1-11 ranking of the rich country's performances.
The UK does well in everything except actual outcomes, but of course health outcomes aren't just related to health. And Japan is not on the list. They often do really well on these kinds of league tables, but I can't recall the details.
https://www.commonwealthfund.org/sit...irror_2017.pdfLast edited by Hot Pepsi; 12-03-2021, 16:28.
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Originally posted by hobbes View Post
That's a political decision as much as anything. Under the last Labour govt. GP waiting times were pinned at 48 hours. The waiting time for elective surgery was a maximum of 18 weeks.
Since the Tories came in in 2010 it's all gone to shit. Because of course it has. The NHS is a constant reminder to them that people like nationalised institutions that can't be grifted off of. SO they try to break it, so they can say it's broken and sell it off as there's no alternative.
It's why they're doing their best to rot the BBC from outside and in.
Some statistics Here.
As a pragmatist, I'm never sure if this is an argument for or against massive nationalized institutions. On the one hand, they can be a very efficient way to serve all parts of society - but they're also easily susceptible to being broken by the forces of evil who win elections because they own the big newspapers/TV networks, politicians. And on the other other hand, I don't have a better idea.
It seems like the single-payer/multiple-provider idea works the best, but its complicated.
Last edited by Hot Pepsi; 12-03-2021, 16:26.
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