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Doctors To Breathalyse Smokers Before Allowing Them NHS Surgery (bbc.com)
Smokers in Hertfordshire, a county in southern England, are to be breathalysed to ensure they have kicked the habit before they are referred for non-urgent surgery. From a report, shared by several readers: Smokers will be breath-tested before they are considered for non-urgent surgery, two clinical commissioning groups (CCGs) have decided. Patients in Hertfordshire must stop smoking at least eight weeks before surgery or it may be delayed. Obese patients have also been told they must lose weight in order to have non-urgent surgery. The Royal College of Surgeons (RCS) said the plan seemed to be "against the principles of the NHS (the publicly funded national healthcare system for England)." A joint committee of the Hertfordshire Valleys and the East and North Hertfordshire CCGs, which made the decisions, said they had to "make best use of the money and resources available." Patients with a body mass index (BMI) of over 40 must lose 15% of their weight and those with a BMI of over 30 must lose 10%, or reduce it to under a 40 BMI or a 30 BMI - whichever is the greater amount. The lifestyle changes to reduce weight must take place over nine months.
but this is a big step towards them.
"I don't know, therefore Aliens" Wafflebox1
A friend of mine was talking to a surgeon (a friend of his) about the risks of some surgery, and the doctor quoted his own success rates, so maybe he said "8% had a bad outcome" (I forget the number but it was in that range) but then he added, "but please realize every single one of those patients had serious complications such as being morbidly obese, usually with diabetes", etc. In those cases the risk of not doing the surgery was certain death, so the patient and doctor had little choice but to take the risk. However, I can see why a surgeon would want to avoid "non-urgent" surgery on a patient if they could significantly reduce the risk by losing some weight first.
"I have never let my schooling interfere with my education." - Mark Twain
Um, but isn't this exactly society forcing you to?
How long before we see this catch-22 in the Daily Mail:
Guy with bad knees can't walk. Gains weight. Needs knee replacement surgery. Ordered to loose weight before surgery can be approved. Told to get out and walk more to loose weight. "I can't walk!" Sorry, sucks to be you. BTW, I see you have a liver donor card...
Now the big question is will this result in the patients improving their health before surgery or will surgery just get deferred until it's urgent?
When someone says, "Any fool can see
It's not society's job to do it for you
Unless you have socialized medicine, then it is. At the same time, if "society" is footing the bill for your medical care, you shouldn't be surprised when "society" puts constraints on your behaviors.
Taking guns away from the 99% gives the 1% 100% of the power.
The UK doesn't have Single Payer. They have Socialized medicine - doctors are public employees, and the government runs the whole deal (supplemental care excepted)
Which wouldn't bother me if we had private-funded healthcare as a viable option. But since we don't, I guess it's up to Big Brother, since the moment a third party pays, it's no longer just about me and my doctor, right?
Funny, Canada has had single-payer for decades, and hasn't pulled this kind of nonsense.
Are Americans such sheep that they'd put up with it? I have my doubts.
I've calculated my velocity with such exquisite precision that I have no idea where I am.
It's not society's job to do it for you
Unless you have socialized medicine, then it is. At the same time, if "society" is footing the bill for your medical care, you shouldn't be surprised when "society" puts constraints on your behaviors.
Makes sense to me. Now tell us how you feel about drug tests for recipients of public assistance.
However, one does have to ask whether this is a wise choice based on the evidence.
Agree. A much better strategy would be to require a mandatory annual checkup.
During the checkup, the patient will be checked for all the normal stuff, And in addition they will be checked for "Hazards" --- for example, checks will be made to determine if they are Obese or a Smoker.
Patients will be assessed an annual Penalty or additional charge that will append to taxes owed; E.g. $1400 fine for failing to report for an annual checkup; $400 per year fine if found to be a smoker, and up to $700 fine per year if found to be obese scaled by the level of obesity down to $200 for somewhat obese and $0 for only slightly -- the fine will be reduced to zero if this is the first year they showed in a 'Hazard' category and make a marked improvement.
That way they help compensate the system/society for the additional costs AND promote change in all citizens, not just those that already need a surgery.
Which wouldn't bother me if we had private-funded healthcare as a viable option. But since we don't, I guess it's up to Big Brother, since the moment a third party pays, it's no longer just about me and my doctor, right?
That third-party being either the Government or private insurance - so how are they different? I private insurer can deny you coverage or payment for treatment and can have their own rules for access to care/procedures.
It must have been something you assimilated. . . .
In the UK? Yes, we have private-funded healthcare as an option - go take out any one of the dozens of private healthcare plans and check yourself into a Spire hospital for whatever you want cut off, adjusted, added or fondled.
The NHS isn't the only option in the UK.
But be warned - if you arrest on the private hospitals operating table, they are 100% going to be calling an NHS ambulance to deal with it.
Whats the Fucking Spaghetti Monster have to do with the price of rice in China?
Higher consumption of spaghetti would result in lower consumption of rice, resulting in lower demand and thus lower price.
http://spamdecoy.net - free throwaway anonymous email - avoid spam!
It's not society's job to do it for you
Unless you have socialized medicine, then it is. At the same time, if "society" is footing the bill for your medical care, you shouldn't be surprised when "society" puts constraints on your behaviors.
Makes sense to me. Now tell us how you feel about drug tests for recipients of public assistance.
TFS and TFA are about "non-urgent" surgery. If the the drug tests were limited to cases like this, I'm not sure I see a problem - as long as access to urgent surgery is unconstrained. I imagine this logic (critical vs. non-critical) could be expanded to handle general public assistance, if that was what you meant.
It must have been something you assimilated. . . .
What a wonderful world you live in. Before ACA, the insurance industry would charge you significantly more, if they would even cover you, for a litany of "pre-existing" conditions. If you go through some of those lists referenced, you'll see interesting things listed, like acid reflux. In fact, ACA came about because getting health insurance as a private citizen was basically impossible unless you were in the top 10%, and only then if you were "healthy" as defined by the insurance company. Single payer would be better for essential coverage because it would just cover everyone and knock out a large swath of basic care that's needed. Supplemental coverage (wow, does this ever sound like medicare...) could cover all those extras you'd want covered the government doesn't cover. So it's not the government deciding who lives/dies, they only cover certain basic functions. After that, it's you/your supplemental insurance that decides.
The cesspool just got a check and balance.
>"In the UK? Yes, we have private-funded healthcare as an option - go take out any one of the dozens of private healthcare plans "
And you can get back the money you "contributed" to the NHS?
No - you are voluntarily choosing not to use the NHS, thats your choice. The NHS will always be there to scrape you off the road after a car accident, to treat your cardiac arrest when you fall over in a shopping mall, to reset your broken leg when you fall down stairs after a boozy night out.
It will always give you treatment - just not on *your* terms alone. And thats perfectly fine.
I understand exactly how insurance is supposed to work for it to provide the type of service people want/need as healthcare. It's a general risk pool with people paying in. The thing ACA did was attempt to force everyone into the pool. It seems to have been somewhat successful at increasing the general pool. Single payer fixes it by having everyone in the pool. Your scenario would hold more water if there was a credit system for paying into the pool. But what happens with insurance is they're happy to take your money while you're healthy, but as soon as you develop something where they have to pay, they kick you out based on "pre-existing" conditions, because every year you need to sign up like you're a new person.
Now, if they couldn't kick you out, but you got a credit for every year you were in, the rate charged could be indexed to your credits. This would address the in/out scenario adequately in your scenario, and prevent exclusion for pre-existing conditions. If you stayed out during your 20s and 30s, you'd come in at a 5 or 10 fold higher rate in your 40s than someone who paid in the entire time. Now - everyone pays the same at 40, whether they were in or not. Pre ACA, you paid more at 40 than 20, unless/until you fell into the "pre-existing" condition loop hole, where you could be charged 10 times more or be kicked out entirely.
Finally, employment policies have nothing to do with personal policies at all. That's just a red-herring.
The cesspool just got a check and balance.
The doctor's trying to save your life, not deny you healthcare. Where's the controversy here? I don't see it.
The controversy is that everyone interprets the statements in their own world view, and generally comes to conclusions they don't like.
Taking the time to deeply understand the issues, even the hard parts, before forming the conclusions and jumping on the bandwagon with pitchforks and torches.
Certain things increase the risk factors. As you point out, when that happens and the risks of doing the surgery could be reduced by making some changes and doing the surgery later, then it makes sense to postpone it.
The article mentions it, but most of the opinions don't notice, that these are delays and are supposed to be time limited. The doctors are supposed to work with the patients for up to nine months, and at the end of the nine months the surgery proceeds anyway. I'm sure some physicians will work with the patient, help them with ways to change their lifestyle to reduce weight, or change lifestyle to remove help break the smoking addictions, but some of them won't work with the patient for those nine months.
The physicians who have brains in their head, or at least proper modern training, will know that both of these require major lifestyle changes and they are not easy. If it was easy to stop smoking there wouldn't be enormous industries built around it. If it was easy to change your overall body weight there wouldn't be industries around dieting and weight-loss. The extreme cases usually have many components. There are social components, psychological components, and other areas of life that need to be addressed in addition to the behavior. It can mean overcoming issues around immediate family, around friends, neighbors, co-workers, and even careers. A person with family who smoke, neighbors and co-workers who smoke, or are in an industry where all workplaces routinely have smoke breaks, simply hooking them up with a patch is not going to help them quit. Similarly with weight, when the entire family is overweight, when the community and friends have frequent dinner parties, when the business has trays of sweets that everyone eats and the business is constantly taking people to working lunches and business dinners, telling someone to count calories won't work.
Then the medical professionals are supposed to evaluate the risks of waiting versus the risk of proceeding, and to help make wise decisions on the patient's behalf. But the thing is people are human. Doctors make mistakes, nor do they have perfect information. Even when a doctor does everything by the book, there is still opportunity for things to go wrong. I've known people who were adamantly against mainstream medicine because a doctor made a judgement call that impacted a person's life; because one doctor once did something that harmed them or their loved one, they distrust that doctors have the patient's best interest in mind. I have a friend whose face is partially paralyzed because a numbing shot for a tooth cavity happened to have a rare complication, but that friend looked up stats and details afterword, and realized it was a rare side effect that could not have been predicted or avoided with today's technology. Even when everything looks like it should go right sometimes things go wrong during or after operations. Some people allow for it, some people take the exceptions and let them become conspiracies or treat them as incompetence of the profession.
But all of this is too much mental effort for most people. For many, they see the headline, make a bunch of assumptions, reach wrong conclusions, complain about how it is either completely fair or completely unfair, when in practice it is all somewhere in between, with rational humans making the best decisions they can along the way.
//TODO: Think of witty sig statement
What will gov funded health care look like globally? .
The number of emergency patients that can be cared for over 24 hours given the services needed in tax payer hospitals will be set.
What to do when too many patients need emergency services and gov funded hospitals cant accept any more patients at that time?
Wealthy governments will start to place their tax payer covered emergency patients in private hospitals removing services from the fully insured.
Such new costs will have to be covered more rationing in the public health sector.
Longer waits to see a specialist
Rationing of service to a few main city hospitals. Not in a city? A long wait to get to any services.
New standards about what level of care will be offered for any elective surgery. Rationing on an age scale. Medications and services just don't get offered to older people.
A set number of medications. Generic medications that have less of that "new" cost to the tax payer healthcare system. Fewer new drugs get added to the tax payer supported healthcare system so governments can keep funding under control.
Domestic spying is now "Benign Information Gathering"
the fine will be reduced to zero if this is the first year they showed in a 'Hazard' category and make a marked improvement.
So they get dinged the second year if they don't remove the "hazard" despite their best efforts, right? "This year you showed up as 'obese'. You got rid of half of that weight in a controlled, lasting manner, but this year are still obese. Pay up, sucker!" Or is it better to have people yo-yoing their diets, crashing to get under the "hazard limit" and then picking it all back up, plus some?
And, pray tell, what do you do with the people who have gained weight because of the medication you've put them on to keep them alive? I heard a fascinating lecture on weight loss 101 (search for the podcast "Darthmouth Hitchcock Medical Lectures") that reported a patient who was put on a certain medication that gained 30 pounds in one month with no other changes in lifestyle. "Woopsies, we gave you a drug with known weight gain issues and now you are obese. Pay us more!"
You know, people are all about health care being a basic human right and we must have single payer to make sure that happens, and then immediately start thinking of ways to keep people from getting healthcare that is their basic human right.
Bullcrap. It's just like public schools in the USA. In the name of equality, we replaced local control of school standards and funding with one size fits all -- And, for the last 100 years of this experiement in public education, average education performance has declined. Any parent who cares about his/her kids has to pay to private or homeschool. All the funds for public school are wasted and there are no refunds. The only thing you can be sure about with public educated kids is that they've been programmed to be obediant to authority, know enough math/science to be useful enough to get low wage jobs from major employers, and know absolutely nothing about history, economics, civics or anything practical...other than the fact that they have 'rights' and the government should provide a minimal living for all (self reliance not required).
Absolutely not surprised to hear about whats going on with the NHS....the public will be programmed to accept healthcare that is only minimally useful to those that meet the governments definition of a good citizen, anyone else can die off. I love the distinction made between urgent and non-urgent...and who determines what is urgent...the bureaucrats.
we have decades of overwhelming evidence now that diets don't work
No, we have decades of evidence that people do not stick to their diets. Diets do work. If you burn fuel faster than you take it in you will lose mass. There is no way around it.
The real problem is that "health insurance" isn't insurance, it's just a means for moving money around. Unless you wander off into a forest and die or fall into a volcano or a vat of molten lead, there is a 100% chance that you will require medical care. As for pre-existing condition clauses being required, imagine if Homeowner's insurance had "fire" as a pre-existing condition that followed you for the rest of your life. You have one grease fire in the kitchen and you can never get home insurance again. Unlike a house or a car, you can't yet replace a body. Once your roof is on fire, it's on fire forever. Except that with health "insurance" we expect insurance companies to keep replacing the roof as it burns and then watch the new roof burn too.
The REAL real problem is that modern top-of-the-line healthcare is incredibly expensive, and we're losing cheaper older technology that was generally "good enough", largely because of the enormous opportunity cost of manufacturing an older generic drug versus manufacturing a new patented drug. Good luck finding a doctor under 60 with the knowledge and mix to make a plain old plaster cast, because charging a % overhead on a $1000 fiberglass epoxy cast is way more profitable than on $5 worth of plaster of paris. Plain old insulin is another one that suffers from constant improvements - each slightly more expensive than the last.
Like "any" product? Are you sure about that? Someone is at the grocery store sitting there adjusting the charges as you browse because you pay more for the exact same apple because you're self-employed than if you worked for Ford? I'm sure you imagine that a Ford employee's apple must somehow be less nutritious or valuable than a self-employed person's apple, but I'm not seeing the difference from here. Generally employer-provided insurance is cheaper because they pay some portion of the premium for you (and get a tax deduction for doing so). That's why people get sticker shock when they leave the company and sign up for the COBRA extension: It's the exact same insurance but now they have to pay 100% of the premium themselves.
If I have been able to see further than others, it is because I bought a pair of binoculars.
It's elective surgery, not car crash surgery.
The reasoning is sound. The cost of the procedure goes way up if you're overweight, and since surgery is one of the most stressful things yor body will ever experience, you're more liskely t push an overwight body to failure when you're under the knife.
https://health.usnews.com/heal...
What art of "costs more, and is more likely to kill the pateint" don't you understand?
Smoking increases risk of complication, but not as extreme as weight.
https://www.ncbi.nlm.nih.gov/p...
Man is the animal that laughs.
And occasionally whores for Karma.
But in that case there is a fourth and fifth and sixth party you can elect for.
in theory. In America, most people get their insurance from their employer, and have no choice. .
Most do have a choice. People can choose to not get insurance at work, and instead get their own plan at an insurance company. Or at least, could a few years ago. Now with Obamacare, what was true may longer be the case.
If you think I voted for Trump because of this post, you're wrong. I voted for Dr. Jill Stein of the Green Party. Again.
It's not society's job to do it for you
Unless you have socialized medicine, then it is. At the same time, if "society" is footing the bill for your medical care, you shouldn't be surprised when "society" puts constraints on your behaviors.
Makes sense to me. Now tell us how you feel about drug tests for recipients of public assistance.
The idea behind drug testing for for recipients of public assistance is for States to save money by booting out drug users. It has been implemented in 7 U.S states and not only did they find that drug rates usage among recipients on all states was below estimated usage among the population at large (in most of them significantly below), all the states ending up loosing money to the testing programs due to the cost and low rates of drug usage. Not only do all of these States continue this ineffective program, it has been proposed in several more states as the true driver behind it is Conservative ideology that the poor are mostly lazy addicts. Something which ironically their own data disputes
I am not a surgeon, but I am a doctor who recently finished residency. Testing for recent smoking is a very good policy, and it will save lives and reduce complications, as smoking interferes with recovery from surgery like you wouldn't believe. Even if a patient can't stop smoking long term, they need to at least stop for a few weeks (preferably for at least a few weeks before and a few weeks after surgery).
Cigarettes are a vasoconstrictor, meaning they cause blood vessels to clamp down, reducing blood flow. It contains carbon monoxide, which reduces oxygen carrying capacity. It suppresses the immune system -- all this interferes with wound healing, and the post-surgical period is often a race between wound-healing and breakdown/infection. Patients literally can have poorly healing surgical sites split wide open or bits of themselves turn black and necrotic, because they couldn't stop smoking at least temporarily.
Smoking is pro-coagulant, increasing tendency of blood to clot -- this is not a good thing, as it tends to do so in all the wrong places at the wrong times, and a major potential complication with bed-bound patients and patients recovering from surgery can be abnormal blood clots in the veins and lungs. It paralyzes the respiratory cilia that clean your airways, and it reduces lung function, at a time when a patient is at elevated risk for pneumonia.
You want to keep smoking after you're all done healing up? Fine, we'll tut-tut at you about the long-term risks when you're following-up in the outpatient office later, but stopping around the time of surgery can literally be a matter of life or death.
Socialized medicine inverts the usual relationship and gives an effective monopoly to the consumer who can then dictate the terms, not least because they collectively (and with the help of surgeons, statisticians etc) know how much knee operations do and should cost.
Of course there are other reasons why the US spends twice as much as everyone else on healthcare, for instance the amounts each physician, insurance company, health scheme, hospital and drug company takes out in profit and spends on advertising, billing, lawyers and other extra administration.
The consumer of course pays the costs of this immense added complexity and if they're insured have the extra benefit of spending hours working out what's covered and worrying about how much they'll still have to pay (and then the insurers say no that's not covered).
There's also the human cost to those who can't afford the right healthcare or even the copay and have to wait till they're sick enough to qualify as an emergency.
This isn't the first time you've got something this wrong, not just ordinary wrong but completely backwards wrong.
I don't see why it is so important to win while young at the cost of losing while older, it's the lifetime win you're looking for
I have not seen the figures, but maybe it's the middle aged high earners that are paying most for healthcare compared to the benefits. After all, the young paid nothing at all until they started getting an income and assuming their income ramps up over time then maybe the biggest payment to sickness ratio doesn't come in until later in life. So if you take life in, say 25 year chunks, then 0-25 probably get as good a deal out of it as 50-75 year olds. Or at least I'll bet the numbers can be messed around with to make a similar case.
Of course it's the 75 to 100 year olds who would do best, but the young hope to be a member of that group one day and they'll get what's due to them then.
Nullius in verba
even inefficiency is only a minor player in what drives cost in the US.
in the US the primary reason care is so expensive is simply because: it can be.
ie, because they can get away with it.
because healthcare is not and never will be a truly free market situation.
-when you are dying you need care NOW, and aren't going to tell the ambulance driver "no, go to the other, farther away hospital, it's cheaper"
-when you need a specific high cost medication to NOT DIE, the majority of people are going so "ok", not "can we try something cheaper?"
because healthcare is a captive market.
and because private insurers lack the same ability to negotiate or even flat out control prices the way a government can.
and most insurers actually have little interest or compelling reason to lower costs to the degree as a single payer government system can; they know they have a captive consumer base.
The guy who said the election was rigged won the presidency with the second-most votes.
Makes sense to me. Now tell us how you feel about drug tests for recipients of public assistance.
I'm against both. Now tell us how you feel about bread lines.
Taking guns away from the 99% gives the 1% 100% of the power.