Personally I think a non-profit, independent organization apart from the government would be more beneficial. They may receive funding from the government but the organization would be run by a team of medical experts who determine the costs and distribution of healthcare. Sort of like NASA really. It's a part o the executive branch but it's independent.

Something like a National Institute for Clinical Excellence, perhaps.

Not a bad idea, as it goes.

laklak wrote:Sure, a lot of old people in care homes need to go to the hospital on occasion, but not every single one, every 90-180 days.

On the first point - if the care was provided in the home, there would be no need for the majority of individuals to go into hospital in the first place. But, the residential care home is even more poorly funded than healthcare, so you wind up paying through the nose for people to go (and stay)in hospital.

And sure, they probably don't have to go into hospital every 90-180 days. That does sound incredibly wasteful but, exactly how much of that is incompetence of the system and simply a response to ineffective residential care, is a gordian knot we ain't going to undo here. To put it simply, it is too easy to place all the blame on Medicare for this arrangement when you have a lack of knowledge about the totality of provision across health and social care.

laklak wrote:And those that did not actually have a medical reason to go and were only discharged because of stupid, short sighted, useless Medicare regulations certainly do NOT need several tens of thousands of dollars worth of useless tests. Like OS said, Medicare is a money making machine.

How much money is it making?
Or is it simply a money "wasting" machine.

willhud9 wrote:Personally I think a non-profit, independent organization apart from the government would be more beneficial.

That is basically what the NHS is and more or less has been since the early 90s, with the Health & Social Care Act 2012, pushing its independence even further. Sure the neo-liberalism ventures of Thatcher and Blair tried to push the NHS into profit-making territory but, there are various curbs which limit the amount of profit making private practice it can do.

Then you have NICE (which I helped set up the early work programmes for into the mid-noughties) which is there to provide advice on the efficacy of medical interventions and best practice on care.

There is the independent regulator of health and adult social care, the Care Quality Commission (the latest iteration of system regulation, since regulation of healthcare was introduced circa 1999) which after a bumpy start, is now on v.2.0 and working well with NHSI (another independent body actually comprised of NHS-TDA and Monitor), in the regulation and improvement of care services. CQC is also taking on "use of resources" in its inspection and ratings methodologies, to help provide more clarity on which NHS providers are using their funding most efficiently. The anecdotal information is that good providers are also the best at living within their means, so in effect "good" care is less wasteful care.

HSIB is up and running providing independent investigations into patient safety incidents, with aspirations to turn it into a full blown NDPB in the future.

The NHS, as a provider independent from Government and independently held to account, is a thoroughly modern innovation that has been created over the last 18 years.

willhud9 wrote:Personally I think a non-profit, independent organization apart from the government would be more beneficial. They may receive funding from the government but the organization would be run by a team of medical experts who determine the costs and distribution of healthcare. Sort of like NASA really. It's a part o the executive branch but it's independent.

The majority of people at Ministry of Health and Long Term Care in Ontario are physicians and former clinicians. You don't need a seperate agency. I don't see what a seperate agency would do except allow the government to blame the agency when something fucks up.

http://www.health.gov.on.ca/en/common/m ... fault.aspx

It allows for the agency to hire competent workers instead of having the government appoint leadership and then have leadership hire friends.

I would not want the healthcare for everyone flip flopping every time a new president gets in office and elects a different head of the department.

willhud9 wrote:
I would not want the healthcare for everyone flip flopping every time a new president gets in office and elects a different head of the department.

This has been the blight of the NHS for a long time. The 2012 Act might lessen the effects and in many respects, Jeremy Hunt's tenure as the longest serving SofS Health has provided a period of stability for the NHS not seen before in my career.

willhud9 wrote:It allows for the agency to hire competent workers instead of having the government appoint leadership and then have leadership hire friends.

I would not want the healthcare for everyone flip flopping every time a new president gets in office and elects a different head of the department.

Regardless, the government holds the budget strings. Here most agency heads are appointed by the government anyway. I don't see how it would be qualitatively different, only a means of passing the buck.

FYI even the NASA administrators are nominated by the President and appointed by the President.

https://en.m.wikipedia.org/wiki/List_of ... rs_of_NASA

True but NASA has a lot of independence from the President and generally appointments to NASA are not politically motivated like say the director of the EPA

Hmmmm... not really

https://www.ft.com/content/1d5bc308-918 ... a243196c2c

Trump pick for Nasa chief would bring clarity to US space mission

According to this proposed legislation, government spending in space is primarily about national security. The US must secure its position “as the pre-eminent spacefaring nation” because the (unspecified) “enemies of the United States have identified space as a vulnerability”.

“We must be able to deter attacks, defend government and commercial assets, and defeat threats when necessary,” he wrote.

Commercial exploitation was best left to the private sector, with Nasa providing risk mitigation. Science barely received a mention. Mr Bridenstine has supported Nasa studying extreme weather, but has bridled at government spending on broader climate change science. It would be a tragic loss if US science research is now further defunded....

...Unlike his recent predecessors, Mr Bridenstine has no scientific credentials and little space experience, although he did serve as the executive director of the Tulsa Air and Space Museum and Planetarium from 2008-10. But he has been lobbying for the job for a while and is viewed by many in the space industry as a pragmatic choice.

The more Americans talk about the USA, the more like a third world country it seems....

Dude, go someplace else with your fucking axe to grind. And learn what third world means instead of making asinine comparisons. Or better yet actually go to a third world nation and see the destitution, poverty, and poor life conditions that those people face and how no matter how bad it's here in the US the majority of citizens have access to clean drinking water and shelter and are not subject to a variety of life threatening diseases but rather are at risk more from cardiovascular issues or cancer.

Your flippant attitude towards the plight of third world nations is rather fucking telling if you can call the USA third world.

I've been to both extensively and there are portions of the US that ARE third world level so stop white washing reality....your nation does NOT take care of its least fortunate citizens and there is no excuse....

The greed of the US medical and drug system over the general weal is totally unacceptable.

What portions of the USA are experiencing excruciating poverty en masse? What portions of the US has massive town wide hunger? What portions of one of he US are getting wiped out by west Nile? Yellow fever? Ebola?

I'm not white washing anything. Check your fucking privileges if you can seriously try and say the US is a third world nation.

Well Will try this:

Six Ways America Is Like a Third-World Country

Our society lags behind the rest of the developed world in education, health care, violence and more

Although the U.S. is one of the richest societies in history, it still lags behind other developed nations in many important indicators of human development – key factors like how we educate our children, how we treat our prisoners, how we take care of the sick and more. In some instances, the U.S.'s performance is downright abysmal, far below foreign countries that are snidely looked-down-upon as "third world." Here are six of the most egregious examples that show how far we still have to go:

More...

Scot Dutchy wrote:Well Will try this:

Six Ways America Is Like a Third-World Country

Our society lags behind the rest of the developed world in education, health care, violence and more

Although the U.S. is one of the richest societies in history, it still lags behind other developed nations in many important indicators of human development – key factors like how we educate our children, how we treat our prisoners, how we take care of the sick and more. In some instances, the U.S.'s performance is downright abysmal, far below foreign countries that are snidely looked-down-upon as "third world." Here are six of the most egregious examples that show how far we still have to go:

More...

And that rolling stone article needs to actually define what third world actually means. What standard are they using? What definition? America is not perfect, and I am not saying it's the best country, but to try and say third world has if living in the US is the equivalent of living in Sub-Saharan Africa where the poverty there is excruciatingly high to the point where the poverty rate is rising faster than the population is a injustice to the plights and struggles of those less developed nations. It makes light of the fact that they are struggling. A good majority of people living in these countries would love 7.25 USD as a minimum wage. They would love access to pediatric care for their kids and allowing their children to get the necessary immunizations that we take for granted. They would love to be able to get to a doctor (which may be hundreds of miles from their village) when an emergency happens and not have to worry about some warlord or criminal organization stealing what little food or money they saved up.

Like if third world simply means areas have poverty then almost all of the west could be labeled third world.

No Will.

US has regressed to developing nation status, MIT economist warns

Peter Temin says 80 per cent of the population is burdened with debt and anxious about job security

America is regressing to have the economic and political structure of a developing nation, an MIT economist has warned.

Peter Temin says the world's’ largest economy has roads and bridges that look more like those in Thailand and Venezuela than those in parts of Europe.

In his new book, “The Vanishing Middle Class", reviewed by the Institute for New Economic Thinking, Mr Temin says the fracture of US society is leading the middle class to disappear.

The economist describes a two-track economy with on the one hand 20 per cent of the population that is educated and enjoys good jobs and supportive social networks.

On the other hand, the remaining 80 per cent, he said, are part of the US’ low-wage sector, where the world of possibility has shrunk and people are burdened with debts and anxious about job security.

Mr Temin used a model, which was created by Nobel Prize winner Arthur Lewis and designed to understand developing nations, to describe how far inequalities have progressed in the US.

When applied to the US, Mr Temin said that “the Lewis model actually works”.

More...

The old chestnut about the poor of America are not poor compared to the rest of the world is easily demolished.

How Poor Are America’s Poor, Really?

willhud9 wrote:Dude, go someplace else with your fucking axe to grind. And learn what third world means instead of making asinine comparisons. Or better yet actually go to a third world nation and see the destitution, poverty, and poor life conditions that those people face and how no matter how bad it's here in the US the majority of citizens have access to clean drinking water and shelter and are not subject to a variety of life threatening diseases but rather are at risk more from cardiovascular issues or cancer.

Your flippant attitude towards the plight of third world nations is rather fucking telling if you can call the USA third world.

It's the Americans here who keep telling us about the corrupt kleptocracy, and how you can't do anything about it. That's one feature. Secondly, lack of clean drinking water in thousands of communities across the nation is a feature. The militarized police and two tiered justice system is another feature. Want me to keep going?

The only area I'm aware of that isn't third world is GDP, the only disqualifier for the USA. Looking at Kansas, they would be third world, if evaluated independently from the rest of the US.