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Does it cost each time for multiple treatments of ESWT?

Posted by Shane on 3/22/02 at 15:10 (077237)

I was wondering if you pay each time that you have an ESWT treatment? Or do you get some type of 'package deal' for follow-up treatment? I imagine that if you pay for multiple treatments, it must be somewhat covered by your insurance carrier. Otherwise, that could get quite expensive! Any input?

Re: Does it cost each time for multiple treatments of ESWT?

DR Zuckerman on 3/22/02 at 17:21 (077247)

Our ESWT program is all additional treatment are includes. We are using the Dornier Epos machine. I have done hundreds of ESWT procedures ove the past two years with very effective results. If you would like additional information please don't hesitate to e-mail DR. Z (email removed)

Re: Does it cost each time for multiple treatments of ESWT?

Pauline on 3/23/02 at 10:19 (077290)

Dr.Z how can you say your using the Dornier, when it hasen't been delivered yet to your office. Isn't your answer a little misleading and premature to this poster and other readers?

Re: To Dr Z Does it cost each time for multiple treatments of ESWT?

Pauline on 3/23/02 at 10:45 (077291)

Your post would lead the reader to believe your two years of providing ESWT treatment has been while using the Dornier Espo. You know this has not been the case, and I think this post is somewhat misleading.

The new reader has a right to know your two years of experience in treating patients with ESWT has been while using a misbranded and adulterated device as the FDA described the Orbie in it's reply letter which was recently posted on this site. The new FDA approved Dornier Espo is just arriving in your office and your experience and results produced using this machine is just beginning.

Re: To Dr Z Does it cost each time for multiple treatments of ESWT?

John h on 3/23/02 at 11:17 (077293)

Pauline: You are sure feeling feisty this morning just like my wife. She just ran me out of her sewing room and told me to get lost so I think I will go to Home Depot and do some manly shopping.

As to cost in Canada I talked to Bayshore and had an email from them. It seems to me they would do 3 treatments to both of my feet for a total of $1100 U.S. and as posted the treatments were one day apart. This was a month or so ago and they were using the Dornier EPOS. They also advised me they were not using the Ossatron. The treatments would be every other day which would require a minimun of a 5 day visit. Gusess you could go watch the Blue Jays. I know my wife would be happy to send me on some 5 day excursion or even a 5 year excursion. The Sonocur was even less expensive and it seems there were 5 treatments involved on successive daysl

Dr. Z I cannot believe one would need any kind of shots with a low energy Epos. Having had the high energy Orby I thought that was no worse than getting your teeth cleaned so why whould one want shots for this. I do not think Allan uses any in Australia and Bayshore did not mention it to me. The EPOS has been in use for some time and I should think that all the providers should have somewhat a similar protocol by now as to number of treatments, time between treatments, and what to do after treatment. Certainly the most important thing is for the Doctor and operator to locate the energy to the correct location.

Re: Does it cost each time for multiple treatments of ESWT?

Dr. Zuckerman on 3/23/02 at 12:48 (077303)

No. But unless someone wants to have ESWT today at 5pm (EST) then they are going to have the dornier epos used to treat them.

Re: To Dr Z Does it cost each time for multiple treatments of ESWT?

Dr. Zuckerman on 3/23/02 at 12:52 (077304)

The FDA protocol is local posterior block then 3800 pulses from a medial side of the foot under ultrsasound guidance. The total joules for the one treatment is 1300 mj/mm2

Re: To Dr Z Does it cost each time for multiple treatments of ESWT?

Pauline on 3/23/02 at 14:07 (077312)

John,
We'll have to wait and see if Dr. Z's group will choose to raise their treatment cost. When he took the other machine on the road, the cost increased significantly when it went mobile. I don't think the increase in cost was related to the treatment cost, as much as it was to covering the cost of the new trailer unit which had to be paid for. One might call this the delivery system.

Now the new Dornier has to be paid for. To keep the cost the same either the original cost was inflated enough to cover the possibility of adding a new machine or the cost to the patient must reflect covering the cost of the new machine with an increase, or they must increase the number of treatments performed. Either way the patient will pay, or at least by having the doctor use an FDA approved devise their insurance company may cover some of the cost if not all of it. This would not have been possible with the old machine. It was strictly out of pocket until FDA approval came along.

Re: To Dr Z Does it cost each time for multiple treatments of ESWT?

Dr. Zuckerman on 3/23/02 at 14:38 (077317)

I am sending the bill for the dornier to the FDA. I believe that were some private insurance that paid for the old orbie machine

Re: To Dr Z Does it cost each time for multiple treatments of ESWT?

DR Zuckerman on 3/23/02 at 18:09 (077336)

Let's see how do I want to answer you.

The orbie was fda approved as a class one divice . To ignore this is misleading and false. Yes it did change but it was class one FDA approved when I started to use it.

I am one of if not the most experienced ESWT provider in the enire USA
To give the impression that I lack experince just because I am swithing to a new machinne is ridiculous. I haven't even turned the machine on and I am now a training center for Dornier. Why because of the over one thousand ESWT treatment I have done over the past two years. Let's not forget my 22 years of experience in treating heel pain. The results with the dornier will be at least what the FDA studies. I hope and so does Dornier hope that I can improve the results.

Pauline what are trying to prove That you are the protector of heelspur.com
IF you want to practice medicine go get a degree. If you want to help people learn to listen and be nice. If you are just a trouble maker go get a life.

IF you want to be research go do research but stop trying to slander me anymore. I am hear not to mis lead the people on this board but to try to help them What is you goal ?

Re: To Dr Z Does it cost each time for multiple treatments of ESWT?

nancy s. on 3/23/02 at 18:24 (077337)

well said, dr. z.
i think it's a shame that every so often you keep getting put in this position of having to defend yourself because of some fancy-sounding empty words on the part of one person. it's ridiculous.
most people on this board appreciate you tremendously, so i hope you don't let this hogwash get to you.
nancy

Re: To Dr Z Does it cost each time for multiple treatments of ESWT?

John h on 3/23/02 at 18:40 (077340)

Many of our high cost in the U.S. related to ESWT, medications and other devices is related to the high cost of putting these things through the high cost of FDA approval. Out litigious society in the U.S. drives up insurance cost unbelievable for the Doctors,Hospitals and anyone else associated with medical care. It boggles the mind to think that Allan in Australia can deliver a treatment with the Dornier Epos for $50.00 per treatment. Australia is not all outback and I would think they have a decent medical care delivery system with the same checks and balances we have in this country. I suspect but do not know that the same Dornier EPOS sells for significantly different prices in the U.S., Canada, and Australia. It is strange that Americans cross the border into Canada and Mexico to buy drugs for less than half what they cost in this country and are doing the same thing with ESWT. What we are good at in this country is paying for and discovering the new drugs,devices, and procedures. The drug companies and researchs have to recover the high cost of research and going through the FDA maze and we pay the cost. Why do the companies not pass that cost onto drugs shipped out of this country?

Re: To John

Pauline on 3/23/02 at 19:46 (077344)

John,
I for one do not want a Socalized Medical system. The medical systems of other countries always appear to look good, but we see the physicians and nurses coming across the border to take jobs here.

Most of the hospitals in Canada have closed and I'm not so sure you'd like to be treated in a Mexican hospital or even in Italy for that matter. Personal friend living there fly to the states for treatment. In Ireland your family provides the bed linens and your food and the hospitals are barebones.

I've have friends on waiting lists for surgeries only to be bumped at the last minute. Some have wait for months for tests like MRI and then have to travel to get one, not all hospitals have every piece of test equipment. Need a specialist better be prepared for a wait. Need a Vitrectomy come to the states.

Most countries with socialized medical care can hardly pay for the services they currently have, and they have cut back on available treatment but people don't hear those stories. It's wonderful for colds or if you don't get sick, but need a heart by-pass and you'd be on a list for quite a while. Your cancerous tumor could grow three times the size before your surgery turn comes up because your still on the waiting list to get the tests you need.

Anyone is free to move to these wonderful socialized medicine countries and begin using their health care, but I like mine just the way it is.

How about charging the countries we send drugs to higher prices say 50% higher and use the extra we collect to help poor Americans pay for their medicine. Let the other countries drug cost go up.

What about rich Americans stopping their Social Security Checks since they can live without the added income and let the money go to pay for medicine.

What about asking well off seniors to give up just one of their Senior trips and let that money go to pay for poor seniors medicine.

Trouble is we want it all here,and we want others to pay for what we want.

What about our Fat Cats in Washington? Did you ever look at what they weighed before going to Washington and how much they gained just by being there. Funny how they get their organ transplants, medical test and surgeries all within one weeks time and no one screams about it. We just accept it as business as usual.

Look at all the Government Waste, money that can't be accounted for, government charge cards used for personal goods and we allow it to happen and say nothing.

If we as Americans would demand more accountability from the men and women we send to Washington the money saved from the losses in these agencies could easily pay for poor people to have their medicine paid for, yet we allow it to continue.

I say before we turn to a socialized medicine plan that we cannot afford why not demand as voters accountability for every dime sent to Washington. Use the money that they thow away without any thought or concern to pay for poor people to have insurance coverage and medicine coverage. If we knew how much of our money is wasted or just isn't accounted for we'd be shocked.

What about limiting congressional campaigns to 2 months and a hundren thousand dollars. Let all the other money they raise go
go toward medical programs for the poor. I'd much rather see the money spent here than to see one more candidate's face on the TV telling lies.

I think there is a lot more that could be done, but we just don't demand
enough accountability. It's much easier to talk about it and climb on a political bandwagon than to requred accountability from every govermental agency and Representative or Senator in Washington.

Re: To Dr Z Does it cost each time for multiple treatments of ESWT?

DR Zuckerman on 3/23/02 at 19:46 (077345)

It won't get to me. and I appreciate your kind words. ESWT, heel pain is a pasion for me. I can't wait until the day when the sucess rate is 98%
It can be done. It was done with ESWL ( kidney) and it will be done wiht ESWT and I will do everything I can to make this happen.

Re: To John

John h on 3/23/02 at 22:20 (077356)

Pauline: I am the last person in the world who would want socialized medicine. I like choosing my own doctor. I was dead against Hillary Clinton and her health plan. I even fly all the way to N.J. to see a doctor of my choice. My only point was why on earth is their such a difference in price between the cost of ESWT in Australia ($50) and the thousands it will cost here. I cringe when I read so many of your post about having to wait to see a specialist or not seeing anyone you want when I can virtually go to any doctor in the U.S. and be covered. My mother was a nurse and her two sisters were nurses. My father was a dentist and my daughter is an x-ray technologist. My uncle is a Psychatrist. I am sort of wedded to our medical system.

Re: To John

Pauline on 3/23/02 at 22:46 (077360)

John,
Doesn't it may you wonder, why others want socialized medicine so bad. I think part of it is because they have only heard the good things, and have not traveled enough to see for themselves the conditions that exist in other countries.

I like the freedom of choosing my own doctors too. I hate when sitting in a physicians office when the receptionist yells out to a patient 'Do you have your referral, you know we can't see you if you don't have that'. Nothing is handled quietly for HMO patients. They scream at them like they are dirty people.

When this happens in my presence, I usually ask the receptionist if this is how they like being treated. At least it changes their attitude for a little while.

Re: To John and Pauline

Julie on 3/24/02 at 03:09 (077369)

I have no intention of getting into an argument about 'socialized' vs private medicine. Just answer one question. How do the (presumably many) Americans who cannot afford private health insurance manage? Where do they go for their medical care? What level of medical care do they get?

It's a genuine question. It's so long since I left the States that it's entirely possible things have changed radically, and the poor are now entitled to, and receive, equal treatment with the middle classes.

As you doubtless know, our National Health Service, which used to be the envy of the world, is creaking and groaning under the weight of the demands made on it (and bureaucracy). But it remains a magnificent, on the whole fair and inclusive system.

Re: To John

DR Zuckerman on 3/24/02 at 07:36 (077377)

Allen told me that the cost of the epos in Australia was the same as the USA 350,000 . I find that so hard to believe .

Re: To John and Pauline

John h on 3/24/02 at 09:04 (077386)

Julie I just knew you would weigh in on this one. I think helth care is available to amomst everyone on this country even those without any means though Medicad and many other programs. No hospital emergeny room in our country can turn away a patient because they have no money. The result of this is many of our poor use the emergency rooms for everyday care such as the common cold. We have a multitude of free screenings for just about anyone for such things such as mamograms, free vaccinations,etc. Much of our problems is making those people who are not under some sort of coverage aware of the various programs available to them. I doubt any nation in the world can match our medicare system other than it still does not cover prescription drugs. The media makes our health care system seem a lot worse than it really is. It took me all of 2 days last week to see the Podiatrist of my choice. It took me one 4 days to see the Dermatologist of my choice. Our drug companies are really bad mouthed but they are by far and away the leading research companies in the world and bring more new drugs to the market than anyone. Probably our biggest problem is not taking care of the poor but getting afordable medical care to some of the middle class who work for small companies who do not offer medical coverage. These people have to pay a big premium for their coverage. Our system has a lot of things that need improving but it is a work in progress and improves each year. I know nothing of your healthcare in the UK so cannot comment on it one way or the other. When I retired from the Military I did have medical coverage with choice but had a 20% copay so my secondary insurance was very expensive ($300 per month for me and my wife). Medicare has much the same coverage with choice but you need a secondary policy to avoid risk of a serious disease expense. Most Americans are very much for CHOICE of your physician and the Clinton Health Plan was resoundly defeated when it emerged after his election. We have a way to go in our country but our people are not as bad off as many would have you believe. I assume our Doctors and Healthcare professionals make more than any other such workers in the world but that is sort of the freemarket system this country has been built on. We have never been good a socializing anything in this nation.

Re: To John

John h on 3/24/02 at 09:11 (077387)

I am doing this in my head Dr. Z but if the Epos cost $350,000 and it was depreciated over 7 years at 10% the monthly payment would be around $8,333. Now add insurance,cost of doing business, profit and other overheads and it does not seem that $50 per treatment will reach. What does an MRI machine cost? $1 -$2 million. They keep those things going almost all day and night and the procedure is around $1000 - $1500. The cost of ESWT must eventually come down one way or the other in order to bring on Medicare and other large insurance companies or else it will alwyays be a fringe treatment for those who can scrape the necessary funds to get it done. Even in our countries with some form of social medicine it is not covered by national insurance.

Re: Thanks, John - I appreciate the explanation eom

Julie on 3/24/02 at 11:41 (077394)

.

Re: Thanks, John - I appreciate the explanation eom

John h on 3/24/02 at 12:58 (077401)

Julie: My explanation was probably a sorry one. As you and I know this is one of those issues we can all respectfully disagree on because I do not think threre is any one right answer. Many 3rd world nations could care less about picking your own doctor. They would be happy to see a nurse or you or me with some aspirin and bandaids. Many nations take different approaches and I guess a lot depends on what sortof care you have become accustomed to. What do they do in India with over 1 billion people? I suspect there are people there who never see a doctor. I know in Northern Thailand and in Laos healthcare is non existent. My feet hurt but I am not without food, clothing, and just the plain things that we in developed nations have come to expect and take for granted.

Re: Thanks, John - I appreciate the explanation eom

Julie on 3/24/02 at 16:01 (077417)

I didn't think it was at all sorry. It was very interesting, and I've learned from it that the health care situation has changed a good deal - not surprisingly! - since I left 40-odd years ago. Though I would say that a system under which the poor 'can't be turned away for lack of money' is a very different kettle of fish from a system under which everyone has equal right to treatment that is free. Overstretched and underfunded as it is, that's what our National Health Service offers to all, by right, and everyone knows it is their right, and there are no poor relations. Of course it's far from perfect: standards vary from area to area, and from hospital to hospital, waiting lists are long, and there is scarcely any emphasis on preventive medicine - but it is still a health SERVICE, from which no-one is excluded.

I'm glad you wrote this second message, and I know your concerns are much the same as mine. Yes, choice is great for those who can afford it, but it's important to hold the billions who have no choice,and little or no health care, in our minds.

Re: Re Yes, choice is Great, **for those who can afford it**

nancy s. on 3/24/02 at 17:01 (077423)

julie has mentioned the key words here.
in the u.s., you no longer have to be poor, uneducated, etc., to be unable to afford health care. my husband and i have been unable to afford health insurance since over three years ago, and even then it was a mighty struggle -- approaching the cost of another house mortgage.

we are self-employed, educated people who have worked hard all our lives and paid -- and continue to pay -- plenty to our government. the poor are well taken care of under the health care system as it stands. we are low to mid middle class, no account is taken of us, and there are millions of us out here. in addition, between the two of us, phil and i need to take three medications regularly. these three meds total well over $300 for one month! one is an older medication that we're being outright gouged on.

what choice do we have? go without meds we can't really afford but then be unable to work because we aren't taking them? and our choice is not which doctor to see, but whether to see ANY doctor. we skip just about all preventive care and see a doctor only when truly desperate. (there was a lot of that the past couple of years.) that's not easy to afford either, but it's better than paying the small fortune that we don't have to an insurance company.

it's very easy to talk about the glories of choice when you have a choice! the self-employed and people who work for small employers are out in the cold under our present system. i suspect we'll be here for a long time.
nancy

Re: To John and Pauline

Pauline on 3/24/02 at 17:55 (077435)

One of the problems I see is that Americans have never had to experience
the health care offered by others countries. They have never been put on surgical heart by-pass lists or bumped off of one. They have never traveled to a hospital 2hrs away in another city just to get an MRI done or been on a waiting list for over 3 months for that test.

They never have been turned away from a hospital while seeking care or waited months to get their tests results. They never have had to rely on family members to provide their food while hospitalized or told there isn't enough pain medication for everyone so it's being rationed.

What sounds so great, socialized medicine, would come as a huge shock to most Americans who currently experience the finest medical treatment in the World.

Most of our hospitals if not all of them treat who ever comes through the doors as John indicates. Sick children are treated in emergencies rooms daily because their parents do not have primary care physicians and no insurance. In our state the government pays for poor children to have health care.

The day American goes to a socialized medical system is the day you will begin to see medical care start to be rationed. It will become easier and easier to justify less care for older Americans because they've lived a good long life already, and treatment will go to younger people.

We cannot affort to provide for everyones want's and needs by taxing people to death. As Americans we need to demand accountability for every tax dime that is sent to Washington. The loss and waste of our money is irresponsible and can no longer be tolerated. That money could be used to help poor people with medical expenses.

One thing to remember is where ever there is a way for anyone to cheat the system to get double checks or make money whether rich or poor most people will do it. It's being done every day. A socialized medical system won't change that.

Re: Pauline

wendyn on 3/24/02 at 17:59 (077437)

Pauline - I know you and I have had some very interesting discussions (debates) on health care before.

I also know that you have got the $$ behind you to see the best doctors money can buy - and the idea of being unable to afford treatment is not something you've had to contend with.

Do you think that this gives you a different perspective on your health care system than someone like NancyS?

Re: Socialized health care

wendyn on 3/24/02 at 18:07 (077439)

I also think it's interesting that the two of us who live with socialized health care (Julie and myself) - don't seem to mind so much.

True - it has it's bad sides, but I still don't think I could sleep at night knowing that one care accident could bankrupt me for life.

That said - our premiums are going way up - because the system cannot be sustained the way it is.

We do have long waiting lists for many things - but you will wait for an MRI if you have a sore foot - not a brain tumor. Basis of need.

The city I live in has 3 hospitals as well as one of the best children's hospitals anywhere. Understaffed - yes. Overworked staff - yes.

Top of the line care - yes.

Would I trade it - No.

Re: Pauline

Pauline on 3/24/02 at 18:44 (077442)

Wendyn,
Certainly having $$ I am able to pay my own way, but I work with many social service agencies that help people get medical treatment. If one checks the numbers that are so often thrown around about the uninsured there are many people counted in these numbers that do not want health care. They can afford it, but just refuse to buy it. They are usually the younger people who think nothing is going to happen so why purchase and pay for a policy that isn't needed. You know the number games played by the government as well as I do.

In my state poor children get health care, it's provided by the state and anyone under a certain income can apply for that care. We have a law in the state that no one can be turned away for emergency treatment by any hospital.

I personally have seen physicians treat children for free. The Pediatrician I took my children too was an inner city doctor that provided hundreds of children treatment for free. He gave out medication and even made house calls. You don't find physicians like this too much anymore.
He wasn't in medicine for the money, he was in medicine because it gave him pleasure to make a sick child well. He made enough to live comfortably and that was enough for him. Today we pay sports figures more than a doctor that could safe a life and we complain that the doctor is still making too much money, not that the sports figure is over paid.

We can't have it all, but we could have it better if we as voters would demand more accountability on the money losses that are acceptable in Washington. I don't know about you, but I can account for all of our income, yet they throw away millions of dollars yearly in government agencies and it's just forgotten about.

If you think Enron was bad, just take a look at how our government cheats us out of in accounting for the tax dollars we send in. Look at the money squandered and wasted, the pet pork projects that are added onto bills, then ask yourself could we achieve better things with that money if we demanded more accountability and responsibility from those we send to Washington. The answer is yes.

It's convient, smart and easy for the government to pit the poor againt the rich on this because it draws the attention away from where the real solution lies. We have government agencies that don't even have a purpose any more yet they still continue to exist.

This is a subject that I'm sure you would agree could be debated for hours and is probably best turned over to the social board if it's continued.

Prospectives will always be different, but finding the best solution that will continue to provide choice and outstanding medical care isn't solved by adopting systems that are already showing failure for it citizens.

Re: Pauline

DR Zuckerman on 3/24/02 at 19:04 (077445)

This is a subject that is so real and we do nothing about it. Yes we can vote the country, state and federal govt people out but it is such a slow process. So what can we do. Taxation without representation works. Healthcare paid for by the wasted tax dollars in Washington. I would march on Washington. Anyone else . This could be the beginning

Re: Pauline

John h on 3/24/02 at 19:06 (077446)

It is amazing that we do in fact have many people who can afford insurance but do not buy it. I saw some numbers on that recently but would not try to repeat them. We do have more and more prevenative medicine available in this country particularly for the very young and seniors. We have an enormous number of retired people from the big unions whith unbelievable health care. Our civil service employees enjoy excellent benefits on the job and into retirement. As a miliary officer I of course had not choice but we all used the base hospitals. When they could not handle what ever was wrong with us we were sent into the civilian population. As Nancy writes the self employed really hurt because they are not part of a large group like a union who can used their purchasing power. I think we will finally get to where the self employed will have a better deal but probably not in time to help Nancy. All I can offer up to you Nancy is hurry and become a senior because Medicare is a very good program and by the time you arrive they should have prescription drug coverage. In the meantime just do not get sick.

Re: Pauline

wendyn on 3/24/02 at 20:20 (077455)

Well - it's nice (sort of?) to hear that you are as fed up with your government wasting money as we are with ours!!!!!

Re: Stop slandering and whining

Lori B. on 3/24/02 at 20:47 (077456)

Listen I can't stand that there is someone slanding doctor z on this site. Go get a life. do you know that this doctor took me when all else failed? When my hope of continuing in professional football was almost gone. Now i have hope and he will not give up on me, when every other doctor did, and said, 'another cortizone shot?' so I would appreciate that only serious people with serious pain respond to posts, everybody else please go away, because we have enough pain without you in our lives. Thank you.

Re: To John and Pauline

Donna SL on 3/24/02 at 21:02 (077457)

Pauline,

First of all it is not mandatory that you be treated under a socialized medical system in countries that offer it. You can pay for private insurance, or many employers provide it as a benefit just like they do here. I can only speak on experience with the UK, and several other European countries, because my husband is a British citizen, and all of his family, and most of his friends still reside in the UK, and in some other European countries. My husbands family has private insurance, but many of their friends choose to use the NHS system, and find it an adequate system. Nothing is stopping them from purchasing private insurance which is comparable with US prices if not a little cheaper, but they seem content with the NHS. Some of the most sophisticated, beautiful hospitals, clinics, treatments, etc., are in Europe, and are just as available to people in the NHS. There are some magnificent
health facilities in Mexico also. Have you ever seen some of the hospitals in Mexico City? I'm not even sure the have socialized medicine. I don't know where you get the idea that the rest of the world is so backwards with their medical care, and there is substandard health care facilities, and treatment if one is on a socialized medical plan. The NHS even has a web site to help you find the care you need.

http://www.nhsdirect.nhs.uk/index.asp

As a matter of fact even a vitrectomy is available all over the world that you stated one must come to the US for. I even found a web site for the
Agarwal Eye hospital in India as an example of an emerging world country doing sophisticated eye procedures including victretomies.
If you do a search on vitretomy you'll find it is available all over the world. The lack of your knowledge on this not being performed anywhere, but the US discredits a lot of facts that you seem to come up.

Socialized medicine allows people that don't have any other means, or choose not to pay additional cost for medical insurance to get decent
regular medical care in a normal setting. They can go to a regular doctors office, see a specialist, get necessary testing, etc. If a person needs routine medical care they can go to a regular doctors office to receive treatment. They don't have to go and wait 3 to 6 hours in an emergency room to get treatment for a simple cold, and an emergency room shouldn't be used for that purpose anyway.

Also, you can't just go into an 'any' emergency room in the US to be treated anyway. If you don't have insurance they will ship you off to the one crummy county hospital that treats indigents unless maybe you sign your life away that you will be responsible for all cost incurred. And that's a big maybe I had first hand experience with that when my husband first came to the US, when I was living in Philadelphia , and we went to an emergency room here, and he didn't have US insurance yet. You'll get the bare bone treatment in that crummy hospital too. Yet that would not happen if a foreigner walked into a UK hospital. You must live in a amazing state, because treatment in every emergency room is rare, especially for a routine condition.

We step over homeless people lying in the gutter, and maybe they will dragged off to an emergency room if they are unconscious, and once found
that they aren't nearly dead they are released. It's not like on TV where they treat everyone at every facility, and give two damns about their well being if they can't pay. There may be some horrible free clinics for people on welfare, here, and there, and some extra services for some fortunate select groups of children, but they are few and far between. In the UK even if a homeless person can't afford any insurance they will get the same care as someone here can with insurance.

Again people are not given regular care in emergency rooms, and surely not every hospital they walk into. When was the last time you tried to receive treatment in the hospital of your choice, or even for a child for that matter without medical insurance in an emergency room, well except in your state maybe?. My brother had insurance with a major carrier in Philadelphia, and needed to go to the emergency room here in CA, and when he went to the closest hospital they still stalled around for what seemed like forever until they verified his insurance. Otherwise they would have shipped him off to SF general . He still ended up being there close to 6 hours until he finally got the treatment he needed, and he was pretty sick. If it wasn't a Sunday, I would have dragged him to one of my doctors, and paid out of pocked, and hoped he got reimbursed. You would not want to have to go to an emergency room for routine care on a regular basis. To the non Americans on this board the US health system for people without insurance is not paved with gold.

As far as being treated poorly, and the socialized medical system only being good for colds, etc., and a serious condition not treated in timely manner is simply not true. Not to say it hasn't happened at times, but it occurs here too if someone happened to be in a particular HMO group. You're making like the rest of the world lets people suffer a slow death, and do not receive treatment until it is too late if they are in a socialized medical system, which is absolutely absurd. There were just several cases stated by some people on this board living in the US who's condition progressed to a worse state either because of not being treated in a timely manner, or a misdiagnoses of their condition with a paid HMO policy

Also, why do you say people have to travel to get diagnostic test like MRI's, etc. Do you think they are not readily available in many areas
in other countries just like they are here? The only reason someone would have to 'travel' to get diagnostic testing is if they lived out in the boonies somewhere, just like if they would in the US. Not every hospital has every bit of equipment here either. The UK for example is around the size of California, and the traveling time to a major center that has every bit of equipment is less there than someone living in California for example. If your not fortunate enough to live near LA, San Francisco, Stanford, etc. you will have to travel too.

I don't understand where you are getting your information from on these crazy facts you have stated occur as a routine basis. Have you personally
lived in the UK for example, and been under the care of the NHS, and had a personal experience with the system? Maybe you know some people that had a bad experience, but it is the exception ratter that the norm. At least in the UK, and most of Europe where socialized medicine exist. Even
if you came up with a couple of rare examples I could match each one with a horror story that occurred in the US with people under certain HMO's.
People in the US with HMO's are treated the same way, and require referrals, have had delays, etc. I have a PPO policy which allows me to go to any specialist I want on my own without a referral, but I pay very high premiums for that. Not everyone in the US can afford that type of policy. Again you can purchase the same type of policy outside of the US.

Some of the biggest medical breakthroughs have been discovered all over the world in countries other than the U.S such as the first heart transplant along with so many other life saving procedures, and drugs. Although not life saving don't forget ESWT was invented in Europe, The list is so long it's ridiculous to list them , but the point I'm making is some of the finest medical care in the World is available outside of the US in the very finest facilities with, or without private insurance. Yes on occasion for a more routine procedure you might have to wait a bit longer for certain conditions, but rarely if at all would diagnostics, or treatment be delayed if a serious illness was suspected.

Also, are you seriously saying that all countries with socialized medicine are rationalizing pain medicine, and people are being turned away for care? What countries are you talking about?

Donna

Re: Stop slandering and whining

DR Zuckerman on 3/24/02 at 21:10 (077459)

Thanks. Don't worry Pauline and DR. Z have a love/hate relationship

Re: To John and Pauline

DR Zuckerman on 3/24/02 at 21:16 (077460)

This is one hell of piece of writing. By the way you also win the academy award for the longest posting that I actually read from top to bottom every word of it and wasn't bored at the end. Very well written. Thanks now back to the academy awards

Re: Health care

Julie on 3/25/02 at 03:19 (077466)

Thanks, Pauline, Donna, Nancy, Wendy, John - all who have contributed to this discussion which I (not entirely unwittingly) began. Putting it all together, it seems that health care in America has not, after all, improved very much since I came to live in England in 1961.

I am happy to live in a country with 'socialized medicine'. When we need to see a doctor, we make an appointment with one of the five excellent GPs in our local group practice, and we go. It is free.

When I went to see one of the doctors with the lump in my breast eight years ago, he called our local Greenwich District Hospital and got me an immediate appointment with the consultant, who saw me at his first available clinic three days later. Mammogram, biopsy, and bone scan followed within two more days, diagnosis within another three days, and mastectomy a week later. My consultant was a prince, a brilliant doctor, and the hospital care excellent in every respect. I even had a private room with a shower - for nine days.

All free. The hospital was not exceptional: it was a very ordinary one, stretched to the limits, and with a so-so reputation. It has now closed, and been replaced by a huge, state-of-the-art hospital which I hope will be as good if we ever need hospital care again.

I am happy. Not just for myself, but because I know that everyone else who lives in this country is entitled to that same level of free treatment under the National Health Service. As I said before, there are no poor relations. So for me, there is simply no argument. However overburdened, underfunded and faulty our NHS is, there is no comparison between a system that treats all citizens as equal and one that doesn't.

We can afford private insurance, and we have it, principally to avoid having to wait for the less-than-urgent things we might have to have done. I had my torn medial meniscus operated on privately, and my husband had his two cataract operations privately. But everyone is aware that for serious conditions - cancer, heart attack, stroke, etc - you're better off with the NHS.

Nancy, maybe you and Phil should come and live in England!

PS. Now that we're over 60 we get all our medication free. No prescription charges. That sure helped with my six years of tamoxifen. And with my husband's glaucoma drops. And all sorts of other, less important things.

Re: Health care

Julie on 3/25/02 at 06:21 (077468)

I should say that of course our health care isn't really 'free'. We pay national insurance contributions, and of course I did that all during my 30-odd employed years. The unemployed, the disabled and the long-term sick, and the old (men over 65, women over 60) do not pay contributions. Whether you are paying in or not, you are entitled to all that the health service has to offer when you need it.

Yes, there is abuse of the system, as you might expect. But I was happy to have paid my contributions all those years, knowing that those less well-off would also benefit.

Re: To John and Pauline

Pauline on 3/25/02 at 08:13 (077473)

Donna,
Easily said, maybe easily done, and anyone in the states is free to move.
Our government doesn't hold anyone captive to the terrible conditions that exist here. We have open borders for those that would like to try another country and system. Why not suggest they try it first then choose where they want to reside. Some as you suggest may find your system wonderful and will want to stay there or select another country. You have to agree it really doesn't matter where they end up as long as they are more content than with living in the states. I have no problem with people choosing to live in another country based on your posting.

i think your right, they should find out for themselves and the best way is to live and work there for an extended period of time, then decide.

Re: To John and Pauline

john h on 3/25/02 at 09:43 (077481)

Donna: I do not disagree with most of what you say but I will tell you that in Little Rock, Arkansas you can walk into the Emergency Rooms of the four major hospitals in this city and if you are broke they are required to treat you. You are not shipped off to any other hospital. Our very best and largest hospital The Arkansas University Hospital For Medical Sciences treats by far the largest number of patients without coverage as does the Baptist Medical System. I do believe there are state or federal laws about not turning away patients seeking care. My daughter works in and out of the Emergency room. Perhaps there are some states or particular areas that operate in a different manner. Many of our hospitals are in a money crunch simply because of the large number of people they treat for free. There are occasions when an emergency room is overlaoded that ambulance services are directed to take patients to a different hospital but that applies to both the insured and uninsured.

Re: To John and Pauline

john h on 3/25/02 at 10:00 (077486)

One thing the majority of Americans clearly have demonstrated is that they are not ready for any form of socialized medicine. The Clinton Health Plan was soundly defeated by both Democrats and Republicans (they usually agree on nothing) after the election of Bill Clinton. This was a form of socialized medicine. There is a different culture in this country than in Europe and England and for better or worse there is a dislike of to much Government involvement. I think this began with our Declaration of Independance and our Constitution. More people still want to enter this nation than any other country in the world. People from all over the world come here for medical treatment so we must know how to do something right. I know we have a lot of flaws in our medical system but it seems that over the past 50 years we have come a long way and will continue to improve. There was a time in my life when I had no health coverage but I was young and healthy and did not even think about it. I personally do not want to copy anyones healthcare system as I think we will ultimately have one that pleases the majority of our people.

Re: To John and Pauline

Carole C in NOLA on 3/25/02 at 12:12 (077501)

I know I don't want socialized medicine. I could say more but it would just fan the flames. LOL

Carole C

Re: I meant

Carole C in NOLA on 3/25/02 at 12:20 (077503)

Well my last post sure sounded wrong. I didn't mean to imply that we are flaming each other. I meant that I respect each and every one of the opinions I read here on this topic, even though I may not agree with them. I think all of you have thought through this and have formed intelligent and valid opinions. I may disagree but I value each of you and your friendship on these boards I think the rest of you probably feel the same way.

Boy do I get in tangled up messes when I try to write! LOL

Carole C

Re: To John and Pauline

Donna SL on 3/25/02 at 14:38 (077516)

Pauline,

I think you are missing the point. I was not trying to convince anyone that we should have socialized medicine in the US, nor should anyone
emigrate to another country to experience it. Personally I couldn't care less, and fortunately I can afford private insurance here. It would be a nice system to have though for people that can't afford health care otherwise. I'm not sure if you are aware that I am native American currently living in US.

My purpose was to correct the mis-statements that were made by you in such a vengeful way about a system you obviously don't understand,
know little, or nothing about, and have not experienced personally. I agree that it would be a good idea if 'you' lived there, and got the correct facts before making untruthful off the cuff statements.

Donna

Re: To Dr. Z

Donna SL on 3/25/02 at 14:50 (077517)

Thanks Dr Z.

Hope you enjoyed the acadamy awards.

Donna

Re: Health care

John h on 3/25/02 at 18:16 (077535)

Julie you are correct that there is not much that is free anywhere. The government of any country only has what it gets from its citizens.

Re: To Donna

Pauline on 3/25/02 at 20:56 (077549)

Hi Donna,
Your points are well taken and havent been missed.
Here is how the health care system works in Mexico. Those beautiful hospitals you speak about are Private Facilities, many owned believe it or not by American Companies. An example, Texas-based Christus Health recently bought 51 percent of Hospital Muguerza--a privately-owned hospital in Northern Mexico.

Hospital Muguerza consists of a 178-bed hospital in Monterrey, Mexico and a smaller sister hospital in Saltillo. This facility and others like it
are aimed at serving the growing middle and upper classes that are interested in more services and better quality of care offered at privately owned hospitals. They pay for it.

IMSS is the National health care program in Mexico. It provides (3) three
levels of service in most major cities. Little to nothing in rural areas.

First level Small Clinics with a general practitioner to handle minor
illnesses and injures.

Second level Small hospitals with surgeons, internists and pediatricians.

Third level Large intensive care facilities which house specialist.

Anyone using IMSS does not have a choice of physicians and begin treatment
at these small clinics. Using a referral system some get to the second level, but the third level is restricted to the very ill when space is available. Many wait for space at home.

People who can afford to do so, use private clinics and hospitals when medical care is needed. They pay for it. The level of care is better because of higher quality staffing and quality physicians, with more medical equipment and treatments are available.

Poor people using IMSS go to the Social Security Hospitals where waiting is the norm. Long lines 6 to 8 hrs or more waiting time.

In healthcare institutions for uninsured populations, persons with AIDS as an example are provided with some medical attention, consultations, and medications for opportunistic infections, however, no antiretroviral drugs
drugs are provided them.

The following quote is directly taken from the Consular Information Sheet on Mexico dated October 19, 2001 speaking about Cancun probably the most Americanized Mexican City.

'Travelers should be aware that the standards of medical training, patient care and business practices vary graatly among the medical facilities in Cancun'.

One can deduce from this statement about Cancun that the same holds true
for most parts of Mexico.

We have dear friends citizens of Mexico who's homes are in Monterrey. I say homes because they have two. They would be considered higher income bracket. They also live in the states, however, they have two lovely daughters who chose to attend college in Monterrey. Recently, while we were enjoying dinner they received a phone call which told them one of their daughters, Grasella, had been in an auto accident. Immediately upon hanging up the cell phone, Roberto placed a call to his family to make sure his daughter was taken to a private hospital which he specifically named. I was told that night that they do not use certain medical facilities, the ISSM medical facilities, for the very reasons you and I would not want to use them. They flew home within hours to monitor her care. All turned out well and Grasella has finally returned to school.

The pretty hospitals you speak about are what is termed 'American Hospitals' by my friends, and just like other countries those that can afford to pay use them.

Many Canadians also carry and pay high premiums for private health care insurance that will provide medical care for them in the states. If they can afford it they purchase it. They seek treatment here for the quality and because they can get treatment faster.

The fact that many people in other countries which offer full medical coverage go the extra step and purchase private insurance says something about the availability and quality of care in that country. If it didn't people wouldn't feel the need to purchase it.

As for Vitrectomy being offered all over the world the real answer is while Vitrectomy itself is a surgery performed in many countries some still do not perform Vitrectomy for all Vitro/Retinal conditions. More Vitrectomies are preformed in the U.S. than any where else in the world and every condition is treated. Not all are successful, but they are treated.

Personally, I feel a successful approach to financing health care world wide is likely to be a combination of various things including new strategies and more conventional ones. These must respond to different levels of need and the availability of resources and must take into consideration the broader cultural, economic, political and historical content of each country.

I suggest if we want to continue discussing health care we should move this discussion to the Social Board. I think that's where this one belongs.

Re: To Donna

wendyn on 3/25/02 at 23:10 (077555)

Just for the record, I can't say it doesn't exist...but I have never heard of health care here that we could use for coverage in the US - unless you are referring to some type of travellers insurance during vacations?

Re: To Wendy

Donna SL on 3/26/02 at 00:38 (077570)

Wendy,

I'm don't understand your question. Are you referring to the current insurance I have?

Donna

Re: Health care

Julie on 3/26/02 at 02:37 (077573)

John, I think you missed my point, which was that a great many people in Britain who cannot and do not pay national insurance contributions because they are unwaged, disabled, or chronically sick, DO get FREE medical care at the same level as those who can afford to pay. No means test. No questions asked. No poor relations.

That is what the dreaded 'socialized medicine' means.

I call it civilized medicine.

Re: Health care - Wendy

Julie on 3/26/02 at 02:40 (077574)

It IS interesting that the two of us who live in countries that have socialized health care are pretty happy with it.

Perhaps it's also interesting that no-one has commented on my experience of socialized health care, posted yesterday.

Re: Funny

wendyn on 3/26/02 at 07:46 (077589)

What I find really funny Julie, is that I'm actually prompted to defend a system that I've often been very critical of myself.

I'm not really big on socialism of any kind, and I have seen the drawbacks of socialized medicine first hand.

Still, with Pauline (and Pauline knows it is not a personal thing between us) - her critcism (to me) seems often based on some extreme anti-social medicine propaganda. The system has it's faults for sure, but often she brings up problems that you and I simply don't experience. Therefore, I find myself in the weird position of defending something that I'm not terribly happy with!

I think it's important to do so though, if some of Pauline's (and others) conclusions are based on what sounds like exaggerated propaganda - I have real life 'first hand' experience of what these systems are about - and so do you.

Re: To Donna

wendyn on 3/26/02 at 07:49 (077590)

No Donna, I was referring to Pauline's suggestion that many Canadians also carry expensive coverage that gives them the ability to be treated in America if need be.

I cannot say I am 100% this is untrue, but I can say that I have never heard, or read about any such insurance - nor have I ever heard of anyone who has it. If such a thing exists, I can say that I am sure 'many' people do not have it - it must be rather elite and secretive.

The only time I know of where we buy additional insurance that covers us in the US, is when we purchase travellers insurance during for a vacation in your country.

Re: To Wendy

Donna SL on 3/26/02 at 11:40 (077600)

Wendy,

Now I see what you mean. I don't know what Pauline is talking about as far as purchasing insurance like that in Canada. I know with my insurance if I needed medical care outside of the states while traveling on vacation I would be covered under my plan. I would have to pay upfront though, and submit the claim for reimbursment when I got home.

What I DO see from that statement, and some other statements in that post is a very xenophobic attitude about receiving medical care anywhere but the US. I think it is a riduculous, ignorant assumption to make that the US is the only nation in the world to provide top quality medical care.

IMO it's an insulting statement. Wendy you would know better than anyone if 'many' Canadians feel they need to run to the US if they can afford it to get quality medical care that was implied is practically non-existent in Canada.

Donna

Re: To Wendy

john h on 3/26/02 at 12:54 (077608)

Our discussions have prompted me to read a lot more than I wanted to about the Canadian Health Care System. It is certainly not a simple system and not nearly as centralized as I had imagined. The Provinces seem to play a more important roll than the central government. I am not making any judgements just informing myself. In 1998 30,3% of healthcare cost was paid for by private citizens. Canada spends more of it;s gross national product on healthcare than nearly any nation at just over 10%. In some Provinces physicians are paid a salary and in others Doctors work for themselves but the fees they charge is set by the government. Canadians vist thier Doctors considerably more times than do Americans during each year. One of the bigger problems for the system is the long wait to see a specialist. To see a heart specialist may take 6 months (unless you have some life threating condition). To get an MRI may take 3 months unless it is some life threating condition. The number of hospital beds have greatly decreased and hospital stays are greatly reduced. Some hospitals are for profit and others are not. Most Canadians seem happy with their system but have a problem with the taxes to pay for it. The life expectancy in Canada and the U.S. are very similar. The Canadian model is still evolving as is the American health care system. I must have spent 3 hours reading about the Canadain system today and much of it was from the Administrators of the system. Apparently most of the population are happy with the system.Our discussion had caused me to become more informed.

I really think Americans are not good candidates for a true form of Social Medicine. The Clintons attempted to use the Canadian model and it went down in total flames because of the big public backlash. We do have forms of social medicne in Medicare and Medicaid and various other free medical care but I do not see us taking it much further in the forseeable future. We are much to independant in this country and some really bad words that politicans often use are 'Big Government'. Our system has it flaws but I still think we have the best medical care system in the world. We can do better.

Re: John h

wendyn on 3/26/02 at 14:28 (077619)

I cannot disagree with anything you have said in your post...if nothing else...we are all a little better educated through all this!

Re: To John

Pauline on 3/26/02 at 15:00 (077620)

John,
I think you put it all in prospective Here is a web site you may want to read. http://www.caledoninst.org/speaking/spkg04.htm

It's a study, called study # 4 'Costs,Closures & Confusion People in Ontario Talk about Health Care'.

The facts speak for themselves. One person's preceptive of 'Good Health Care' may not be the same for another. Do people get care in the UK and in Canada? Yes. Is it the same type of care provided in every country? No. Would I like it in the U.S.? No.

Should we call names and take the issue personally? I don't think so. Will it be a topic for discussion in the states again? Without a doubt.

Happy Easter!

Re: Wendy

Julie on 3/26/02 at 16:17 (077628)

Wendy, I know what you mean. I don't know anything about the health care system in Canada, but certainly our NHS has its faults, and of course one can point to bad experiences with it, and grave lapses, as one could with any system. That said, I've had nothing but acceptable and often very good experiences in the 40 years I've been here, contributing to and benefiting from the system and its services.

But more important, for me, is the principle that underlies the NHS, and the vision of its postwar founders. It is a profoundly satisfying one: that everyone in the community is entitled to whatever they need from the service, whether or not their personal and social circumstances allow them to contribute to it. Yes, it's pure, utopian socialism. And tattered though the health service here has become, it still abides by that principle and it still works, on the whole.

For me it is a social issue than a personal one; and, dare I breathe the dreaded word, a political one. I am thankful that the lonely old woman who lives up the road does not have to worry about her health care: that if she needs anything from the system, she has the right to it. Not as a handout to the indigent, but as a given right. That is important to me.

Re: Health care - Wendy

John h on 3/26/02 at 16:28 (077633)

Julie: I guess it all comes down to are you happy with your current health care no matter where you are? I am! You are! Wendy is! Would any of us like to switch health care systems with the other. Probably not! Are any of our system perfect or one size fits all? No! Are we all fortunate to live in modern industralized nations? You bet! Can any of us cure the needs of all the 3rd world nations? No! but we can help and we do. Bill Gates is currently involved in a program he has established in Africa to help with aids. His father heads up the program and Bill Gates has contributed $20 billion dollars and counting.

Re: To John

John h on 3/26/02 at 16:38 (077637)

Pauline: I have had the same family Doctor for 22 years. He is 5 minutes from my home. He and three other doctors have a small clinic. You do not make appointments you just walk in and wait your turn. The longest I have ever waited was 1 hour and the typical wait is 20 minutes. I can go Monday-Saturday from 9am to 6pm. He knows everything about me from A-Z. Although my insurance covers me his charges are reasonable. Would I ever want to give up this doctor and this service. No way Jose!

Re: Wendy

John h on 3/26/02 at 16:45 (077638)

The old and the poor have Medicare and Medicaid here. As Nancy says we have to solve the problem of the self employed and workers who work for small companies who do not have insurance. You can buy insurance but it is very expensive. There are some benefits for the self employed in that their health insurance premiums are tax deductable. This is not enough to pay for insurance but is a benefit. There are various plans being discussed in congress that would allow many of these people to pool their people and have the same advantage of large companies in buying insurance. I think I read that Canada has no provisions for Nursing Home Care or in home care. Does the UK offer any such services with your insurance Julie?

Re: Home care

wendyn on 3/26/02 at 20:11 (077664)

John - I don't know what you read about home care, but I do know that when my friend was dying of cancer - he was eligible for home care services that provided not only a nurse to visit, but also house cleaning services.

At the end of his disease he was visited regularly at home by a palliative care doctor, and he had a nurse present during his last day at home. She administered all the meds he needed and counselled the family. This may have actually been through hospice - I'm not sure.

All was covered financially anyway.

Same for my grandma - she has a home care nurse out - as well as an occupational and physio therapist - all covered under home care.

Re: Does it cost each time for multiple treatments of ESWT?

DR Zuckerman on 3/22/02 at 17:21 (077247)

Our ESWT program is all additional treatment are includes. We are using the Dornier Epos machine. I have done hundreds of ESWT procedures ove the past two years with very effective results. If you would like additional information please don't hesitate to e-mail DR. Z (email removed)

Re: Does it cost each time for multiple treatments of ESWT?

Pauline on 3/23/02 at 10:19 (077290)

Dr.Z how can you say your using the Dornier, when it hasen't been delivered yet to your office. Isn't your answer a little misleading and premature to this poster and other readers?

Re: To Dr Z Does it cost each time for multiple treatments of ESWT?

Pauline on 3/23/02 at 10:45 (077291)

Your post would lead the reader to believe your two years of providing ESWT treatment has been while using the Dornier Espo. You know this has not been the case, and I think this post is somewhat misleading.

The new reader has a right to know your two years of experience in treating patients with ESWT has been while using a misbranded and adulterated device as the FDA described the Orbie in it's reply letter which was recently posted on this site. The new FDA approved Dornier Espo is just arriving in your office and your experience and results produced using this machine is just beginning.

Re: To Dr Z Does it cost each time for multiple treatments of ESWT?

John h on 3/23/02 at 11:17 (077293)

Pauline: You are sure feeling feisty this morning just like my wife. She just ran me out of her sewing room and told me to get lost so I think I will go to Home Depot and do some manly shopping.

As to cost in Canada I talked to Bayshore and had an email from them. It seems to me they would do 3 treatments to both of my feet for a total of $1100 U.S. and as posted the treatments were one day apart. This was a month or so ago and they were using the Dornier EPOS. They also advised me they were not using the Ossatron. The treatments would be every other day which would require a minimun of a 5 day visit. Gusess you could go watch the Blue Jays. I know my wife would be happy to send me on some 5 day excursion or even a 5 year excursion. The Sonocur was even less expensive and it seems there were 5 treatments involved on successive daysl

Dr. Z I cannot believe one would need any kind of shots with a low energy Epos. Having had the high energy Orby I thought that was no worse than getting your teeth cleaned so why whould one want shots for this. I do not think Allan uses any in Australia and Bayshore did not mention it to me. The EPOS has been in use for some time and I should think that all the providers should have somewhat a similar protocol by now as to number of treatments, time between treatments, and what to do after treatment. Certainly the most important thing is for the Doctor and operator to locate the energy to the correct location.

Re: Does it cost each time for multiple treatments of ESWT?

Dr. Zuckerman on 3/23/02 at 12:48 (077303)

No. But unless someone wants to have ESWT today at 5pm (EST) then they are going to have the dornier epos used to treat them.

Re: To Dr Z Does it cost each time for multiple treatments of ESWT?

Dr. Zuckerman on 3/23/02 at 12:52 (077304)

The FDA protocol is local posterior block then 3800 pulses from a medial side of the foot under ultrsasound guidance. The total joules for the one treatment is 1300 mj/mm2

Re: To Dr Z Does it cost each time for multiple treatments of ESWT?

Pauline on 3/23/02 at 14:07 (077312)

John,
We'll have to wait and see if Dr. Z's group will choose to raise their treatment cost. When he took the other machine on the road, the cost increased significantly when it went mobile. I don't think the increase in cost was related to the treatment cost, as much as it was to covering the cost of the new trailer unit which had to be paid for. One might call this the delivery system.

Now the new Dornier has to be paid for. To keep the cost the same either the original cost was inflated enough to cover the possibility of adding a new machine or the cost to the patient must reflect covering the cost of the new machine with an increase, or they must increase the number of treatments performed. Either way the patient will pay, or at least by having the doctor use an FDA approved devise their insurance company may cover some of the cost if not all of it. This would not have been possible with the old machine. It was strictly out of pocket until FDA approval came along.

Re: To Dr Z Does it cost each time for multiple treatments of ESWT?

Dr. Zuckerman on 3/23/02 at 14:38 (077317)

I am sending the bill for the dornier to the FDA. I believe that were some private insurance that paid for the old orbie machine

Re: To Dr Z Does it cost each time for multiple treatments of ESWT?

DR Zuckerman on 3/23/02 at 18:09 (077336)

Let's see how do I want to answer you.

The orbie was fda approved as a class one divice . To ignore this is misleading and false. Yes it did change but it was class one FDA approved when I started to use it.

I am one of if not the most experienced ESWT provider in the enire USA
To give the impression that I lack experince just because I am swithing to a new machinne is ridiculous. I haven't even turned the machine on and I am now a training center for Dornier. Why because of the over one thousand ESWT treatment I have done over the past two years. Let's not forget my 22 years of experience in treating heel pain. The results with the dornier will be at least what the FDA studies. I hope and so does Dornier hope that I can improve the results.

Pauline what are trying to prove That you are the protector of heelspur.com
IF you want to practice medicine go get a degree. If you want to help people learn to listen and be nice. If you are just a trouble maker go get a life.

IF you want to be research go do research but stop trying to slander me anymore. I am hear not to mis lead the people on this board but to try to help them What is you goal ?

Re: To Dr Z Does it cost each time for multiple treatments of ESWT?

nancy s. on 3/23/02 at 18:24 (077337)

well said, dr. z.
i think it's a shame that every so often you keep getting put in this position of having to defend yourself because of some fancy-sounding empty words on the part of one person. it's ridiculous.
most people on this board appreciate you tremendously, so i hope you don't let this hogwash get to you.
nancy

Re: To Dr Z Does it cost each time for multiple treatments of ESWT?

John h on 3/23/02 at 18:40 (077340)

Many of our high cost in the U.S. related to ESWT, medications and other devices is related to the high cost of putting these things through the high cost of FDA approval. Out litigious society in the U.S. drives up insurance cost unbelievable for the Doctors,Hospitals and anyone else associated with medical care. It boggles the mind to think that Allan in Australia can deliver a treatment with the Dornier Epos for $50.00 per treatment. Australia is not all outback and I would think they have a decent medical care delivery system with the same checks and balances we have in this country. I suspect but do not know that the same Dornier EPOS sells for significantly different prices in the U.S., Canada, and Australia. It is strange that Americans cross the border into Canada and Mexico to buy drugs for less than half what they cost in this country and are doing the same thing with ESWT. What we are good at in this country is paying for and discovering the new drugs,devices, and procedures. The drug companies and researchs have to recover the high cost of research and going through the FDA maze and we pay the cost. Why do the companies not pass that cost onto drugs shipped out of this country?

Re: To John

Pauline on 3/23/02 at 19:46 (077344)

John,
I for one do not want a Socalized Medical system. The medical systems of other countries always appear to look good, but we see the physicians and nurses coming across the border to take jobs here.

Most of the hospitals in Canada have closed and I'm not so sure you'd like to be treated in a Mexican hospital or even in Italy for that matter. Personal friend living there fly to the states for treatment. In Ireland your family provides the bed linens and your food and the hospitals are barebones.

I've have friends on waiting lists for surgeries only to be bumped at the last minute. Some have wait for months for tests like MRI and then have to travel to get one, not all hospitals have every piece of test equipment. Need a specialist better be prepared for a wait. Need a Vitrectomy come to the states.

Most countries with socialized medical care can hardly pay for the services they currently have, and they have cut back on available treatment but people don't hear those stories. It's wonderful for colds or if you don't get sick, but need a heart by-pass and you'd be on a list for quite a while. Your cancerous tumor could grow three times the size before your surgery turn comes up because your still on the waiting list to get the tests you need.

Anyone is free to move to these wonderful socialized medicine countries and begin using their health care, but I like mine just the way it is.

How about charging the countries we send drugs to higher prices say 50% higher and use the extra we collect to help poor Americans pay for their medicine. Let the other countries drug cost go up.

What about rich Americans stopping their Social Security Checks since they can live without the added income and let the money go to pay for medicine.

What about asking well off seniors to give up just one of their Senior trips and let that money go to pay for poor seniors medicine.

Trouble is we want it all here,and we want others to pay for what we want.

What about our Fat Cats in Washington? Did you ever look at what they weighed before going to Washington and how much they gained just by being there. Funny how they get their organ transplants, medical test and surgeries all within one weeks time and no one screams about it. We just accept it as business as usual.

Look at all the Government Waste, money that can't be accounted for, government charge cards used for personal goods and we allow it to happen and say nothing.

If we as Americans would demand more accountability from the men and women we send to Washington the money saved from the losses in these agencies could easily pay for poor people to have their medicine paid for, yet we allow it to continue.

I say before we turn to a socialized medicine plan that we cannot afford why not demand as voters accountability for every dime sent to Washington. Use the money that they thow away without any thought or concern to pay for poor people to have insurance coverage and medicine coverage. If we knew how much of our money is wasted or just isn't accounted for we'd be shocked.

What about limiting congressional campaigns to 2 months and a hundren thousand dollars. Let all the other money they raise go
go toward medical programs for the poor. I'd much rather see the money spent here than to see one more candidate's face on the TV telling lies.

I think there is a lot more that could be done, but we just don't demand
enough accountability. It's much easier to talk about it and climb on a political bandwagon than to requred accountability from every govermental agency and Representative or Senator in Washington.

Re: To Dr Z Does it cost each time for multiple treatments of ESWT?

DR Zuckerman on 3/23/02 at 19:46 (077345)

It won't get to me. and I appreciate your kind words. ESWT, heel pain is a pasion for me. I can't wait until the day when the sucess rate is 98%
It can be done. It was done with ESWL ( kidney) and it will be done wiht ESWT and I will do everything I can to make this happen.

Re: To John

John h on 3/23/02 at 22:20 (077356)

Pauline: I am the last person in the world who would want socialized medicine. I like choosing my own doctor. I was dead against Hillary Clinton and her health plan. I even fly all the way to N.J. to see a doctor of my choice. My only point was why on earth is their such a difference in price between the cost of ESWT in Australia ($50) and the thousands it will cost here. I cringe when I read so many of your post about having to wait to see a specialist or not seeing anyone you want when I can virtually go to any doctor in the U.S. and be covered. My mother was a nurse and her two sisters were nurses. My father was a dentist and my daughter is an x-ray technologist. My uncle is a Psychatrist. I am sort of wedded to our medical system.

Re: To John

Pauline on 3/23/02 at 22:46 (077360)

John,
Doesn't it may you wonder, why others want socialized medicine so bad. I think part of it is because they have only heard the good things, and have not traveled enough to see for themselves the conditions that exist in other countries.

I like the freedom of choosing my own doctors too. I hate when sitting in a physicians office when the receptionist yells out to a patient 'Do you have your referral, you know we can't see you if you don't have that'. Nothing is handled quietly for HMO patients. They scream at them like they are dirty people.

When this happens in my presence, I usually ask the receptionist if this is how they like being treated. At least it changes their attitude for a little while.

Re: To John and Pauline

Julie on 3/24/02 at 03:09 (077369)

I have no intention of getting into an argument about 'socialized' vs private medicine. Just answer one question. How do the (presumably many) Americans who cannot afford private health insurance manage? Where do they go for their medical care? What level of medical care do they get?

It's a genuine question. It's so long since I left the States that it's entirely possible things have changed radically, and the poor are now entitled to, and receive, equal treatment with the middle classes.

As you doubtless know, our National Health Service, which used to be the envy of the world, is creaking and groaning under the weight of the demands made on it (and bureaucracy). But it remains a magnificent, on the whole fair and inclusive system.

Re: To John

DR Zuckerman on 3/24/02 at 07:36 (077377)

Allen told me that the cost of the epos in Australia was the same as the USA 350,000 . I find that so hard to believe .

Re: To John and Pauline

John h on 3/24/02 at 09:04 (077386)

Julie I just knew you would weigh in on this one. I think helth care is available to amomst everyone on this country even those without any means though Medicad and many other programs. No hospital emergeny room in our country can turn away a patient because they have no money. The result of this is many of our poor use the emergency rooms for everyday care such as the common cold. We have a multitude of free screenings for just about anyone for such things such as mamograms, free vaccinations,etc. Much of our problems is making those people who are not under some sort of coverage aware of the various programs available to them. I doubt any nation in the world can match our medicare system other than it still does not cover prescription drugs. The media makes our health care system seem a lot worse than it really is. It took me all of 2 days last week to see the Podiatrist of my choice. It took me one 4 days to see the Dermatologist of my choice. Our drug companies are really bad mouthed but they are by far and away the leading research companies in the world and bring more new drugs to the market than anyone. Probably our biggest problem is not taking care of the poor but getting afordable medical care to some of the middle class who work for small companies who do not offer medical coverage. These people have to pay a big premium for their coverage. Our system has a lot of things that need improving but it is a work in progress and improves each year. I know nothing of your healthcare in the UK so cannot comment on it one way or the other. When I retired from the Military I did have medical coverage with choice but had a 20% copay so my secondary insurance was very expensive ($300 per month for me and my wife). Medicare has much the same coverage with choice but you need a secondary policy to avoid risk of a serious disease expense. Most Americans are very much for CHOICE of your physician and the Clinton Health Plan was resoundly defeated when it emerged after his election. We have a way to go in our country but our people are not as bad off as many would have you believe. I assume our Doctors and Healthcare professionals make more than any other such workers in the world but that is sort of the freemarket system this country has been built on. We have never been good a socializing anything in this nation.

Re: To John

John h on 3/24/02 at 09:11 (077387)

I am doing this in my head Dr. Z but if the Epos cost $350,000 and it was depreciated over 7 years at 10% the monthly payment would be around $8,333. Now add insurance,cost of doing business, profit and other overheads and it does not seem that $50 per treatment will reach. What does an MRI machine cost? $1 -$2 million. They keep those things going almost all day and night and the procedure is around $1000 - $1500. The cost of ESWT must eventually come down one way or the other in order to bring on Medicare and other large insurance companies or else it will alwyays be a fringe treatment for those who can scrape the necessary funds to get it done. Even in our countries with some form of social medicine it is not covered by national insurance.

Re: Thanks, John - I appreciate the explanation eom

Julie on 3/24/02 at 11:41 (077394)

.

Re: Thanks, John - I appreciate the explanation eom

John h on 3/24/02 at 12:58 (077401)

Julie: My explanation was probably a sorry one. As you and I know this is one of those issues we can all respectfully disagree on because I do not think threre is any one right answer. Many 3rd world nations could care less about picking your own doctor. They would be happy to see a nurse or you or me with some aspirin and bandaids. Many nations take different approaches and I guess a lot depends on what sortof care you have become accustomed to. What do they do in India with over 1 billion people? I suspect there are people there who never see a doctor. I know in Northern Thailand and in Laos healthcare is non existent. My feet hurt but I am not without food, clothing, and just the plain things that we in developed nations have come to expect and take for granted.

Re: Thanks, John - I appreciate the explanation eom

Julie on 3/24/02 at 16:01 (077417)

I didn't think it was at all sorry. It was very interesting, and I've learned from it that the health care situation has changed a good deal - not surprisingly! - since I left 40-odd years ago. Though I would say that a system under which the poor 'can't be turned away for lack of money' is a very different kettle of fish from a system under which everyone has equal right to treatment that is free. Overstretched and underfunded as it is, that's what our National Health Service offers to all, by right, and everyone knows it is their right, and there are no poor relations. Of course it's far from perfect: standards vary from area to area, and from hospital to hospital, waiting lists are long, and there is scarcely any emphasis on preventive medicine - but it is still a health SERVICE, from which no-one is excluded.

I'm glad you wrote this second message, and I know your concerns are much the same as mine. Yes, choice is great for those who can afford it, but it's important to hold the billions who have no choice,and little or no health care, in our minds.

Re: Re Yes, choice is Great, **for those who can afford it**

nancy s. on 3/24/02 at 17:01 (077423)

julie has mentioned the key words here.
in the u.s., you no longer have to be poor, uneducated, etc., to be unable to afford health care. my husband and i have been unable to afford health insurance since over three years ago, and even then it was a mighty struggle -- approaching the cost of another house mortgage.

we are self-employed, educated people who have worked hard all our lives and paid -- and continue to pay -- plenty to our government. the poor are well taken care of under the health care system as it stands. we are low to mid middle class, no account is taken of us, and there are millions of us out here. in addition, between the two of us, phil and i need to take three medications regularly. these three meds total well over $300 for one month! one is an older medication that we're being outright gouged on.

what choice do we have? go without meds we can't really afford but then be unable to work because we aren't taking them? and our choice is not which doctor to see, but whether to see ANY doctor. we skip just about all preventive care and see a doctor only when truly desperate. (there was a lot of that the past couple of years.) that's not easy to afford either, but it's better than paying the small fortune that we don't have to an insurance company.

it's very easy to talk about the glories of choice when you have a choice! the self-employed and people who work for small employers are out in the cold under our present system. i suspect we'll be here for a long time.
nancy

Re: To John and Pauline

Pauline on 3/24/02 at 17:55 (077435)

One of the problems I see is that Americans have never had to experience
the health care offered by others countries. They have never been put on surgical heart by-pass lists or bumped off of one. They have never traveled to a hospital 2hrs away in another city just to get an MRI done or been on a waiting list for over 3 months for that test.

They never have been turned away from a hospital while seeking care or waited months to get their tests results. They never have had to rely on family members to provide their food while hospitalized or told there isn't enough pain medication for everyone so it's being rationed.

What sounds so great, socialized medicine, would come as a huge shock to most Americans who currently experience the finest medical treatment in the World.

Most of our hospitals if not all of them treat who ever comes through the doors as John indicates. Sick children are treated in emergencies rooms daily because their parents do not have primary care physicians and no insurance. In our state the government pays for poor children to have health care.

The day American goes to a socialized medical system is the day you will begin to see medical care start to be rationed. It will become easier and easier to justify less care for older Americans because they've lived a good long life already, and treatment will go to younger people.

We cannot affort to provide for everyones want's and needs by taxing people to death. As Americans we need to demand accountability for every tax dime that is sent to Washington. The loss and waste of our money is irresponsible and can no longer be tolerated. That money could be used to help poor people with medical expenses.

One thing to remember is where ever there is a way for anyone to cheat the system to get double checks or make money whether rich or poor most people will do it. It's being done every day. A socialized medical system won't change that.

Re: Pauline

wendyn on 3/24/02 at 17:59 (077437)

Pauline - I know you and I have had some very interesting discussions (debates) on health care before.

I also know that you have got the $$ behind you to see the best doctors money can buy - and the idea of being unable to afford treatment is not something you've had to contend with.

Do you think that this gives you a different perspective on your health care system than someone like NancyS?

Re: Socialized health care

wendyn on 3/24/02 at 18:07 (077439)

I also think it's interesting that the two of us who live with socialized health care (Julie and myself) - don't seem to mind so much.

True - it has it's bad sides, but I still don't think I could sleep at night knowing that one care accident could bankrupt me for life.

That said - our premiums are going way up - because the system cannot be sustained the way it is.

We do have long waiting lists for many things - but you will wait for an MRI if you have a sore foot - not a brain tumor. Basis of need.

The city I live in has 3 hospitals as well as one of the best children's hospitals anywhere. Understaffed - yes. Overworked staff - yes.

Top of the line care - yes.

Would I trade it - No.

Re: Pauline

Pauline on 3/24/02 at 18:44 (077442)

Wendyn,
Certainly having $$ I am able to pay my own way, but I work with many social service agencies that help people get medical treatment. If one checks the numbers that are so often thrown around about the uninsured there are many people counted in these numbers that do not want health care. They can afford it, but just refuse to buy it. They are usually the younger people who think nothing is going to happen so why purchase and pay for a policy that isn't needed. You know the number games played by the government as well as I do.

In my state poor children get health care, it's provided by the state and anyone under a certain income can apply for that care. We have a law in the state that no one can be turned away for emergency treatment by any hospital.

I personally have seen physicians treat children for free. The Pediatrician I took my children too was an inner city doctor that provided hundreds of children treatment for free. He gave out medication and even made house calls. You don't find physicians like this too much anymore.
He wasn't in medicine for the money, he was in medicine because it gave him pleasure to make a sick child well. He made enough to live comfortably and that was enough for him. Today we pay sports figures more than a doctor that could safe a life and we complain that the doctor is still making too much money, not that the sports figure is over paid.

We can't have it all, but we could have it better if we as voters would demand more accountability on the money losses that are acceptable in Washington. I don't know about you, but I can account for all of our income, yet they throw away millions of dollars yearly in government agencies and it's just forgotten about.

If you think Enron was bad, just take a look at how our government cheats us out of in accounting for the tax dollars we send in. Look at the money squandered and wasted, the pet pork projects that are added onto bills, then ask yourself could we achieve better things with that money if we demanded more accountability and responsibility from those we send to Washington. The answer is yes.

It's convient, smart and easy for the government to pit the poor againt the rich on this because it draws the attention away from where the real solution lies. We have government agencies that don't even have a purpose any more yet they still continue to exist.

This is a subject that I'm sure you would agree could be debated for hours and is probably best turned over to the social board if it's continued.

Prospectives will always be different, but finding the best solution that will continue to provide choice and outstanding medical care isn't solved by adopting systems that are already showing failure for it citizens.

Re: Pauline

DR Zuckerman on 3/24/02 at 19:04 (077445)

This is a subject that is so real and we do nothing about it. Yes we can vote the country, state and federal govt people out but it is such a slow process. So what can we do. Taxation without representation works. Healthcare paid for by the wasted tax dollars in Washington. I would march on Washington. Anyone else . This could be the beginning

Re: Pauline

John h on 3/24/02 at 19:06 (077446)

It is amazing that we do in fact have many people who can afford insurance but do not buy it. I saw some numbers on that recently but would not try to repeat them. We do have more and more prevenative medicine available in this country particularly for the very young and seniors. We have an enormous number of retired people from the big unions whith unbelievable health care. Our civil service employees enjoy excellent benefits on the job and into retirement. As a miliary officer I of course had not choice but we all used the base hospitals. When they could not handle what ever was wrong with us we were sent into the civilian population. As Nancy writes the self employed really hurt because they are not part of a large group like a union who can used their purchasing power. I think we will finally get to where the self employed will have a better deal but probably not in time to help Nancy. All I can offer up to you Nancy is hurry and become a senior because Medicare is a very good program and by the time you arrive they should have prescription drug coverage. In the meantime just do not get sick.

Re: Pauline

wendyn on 3/24/02 at 20:20 (077455)

Well - it's nice (sort of?) to hear that you are as fed up with your government wasting money as we are with ours!!!!!

Re: Stop slandering and whining

Lori B. on 3/24/02 at 20:47 (077456)

Listen I can't stand that there is someone slanding doctor z on this site. Go get a life. do you know that this doctor took me when all else failed? When my hope of continuing in professional football was almost gone. Now i have hope and he will not give up on me, when every other doctor did, and said, 'another cortizone shot?' so I would appreciate that only serious people with serious pain respond to posts, everybody else please go away, because we have enough pain without you in our lives. Thank you.

Re: To John and Pauline

Donna SL on 3/24/02 at 21:02 (077457)

Pauline,

First of all it is not mandatory that you be treated under a socialized medical system in countries that offer it. You can pay for private insurance, or many employers provide it as a benefit just like they do here. I can only speak on experience with the UK, and several other European countries, because my husband is a British citizen, and all of his family, and most of his friends still reside in the UK, and in some other European countries. My husbands family has private insurance, but many of their friends choose to use the NHS system, and find it an adequate system. Nothing is stopping them from purchasing private insurance which is comparable with US prices if not a little cheaper, but they seem content with the NHS. Some of the most sophisticated, beautiful hospitals, clinics, treatments, etc., are in Europe, and are just as available to people in the NHS. There are some magnificent
health facilities in Mexico also. Have you ever seen some of the hospitals in Mexico City? I'm not even sure the have socialized medicine. I don't know where you get the idea that the rest of the world is so backwards with their medical care, and there is substandard health care facilities, and treatment if one is on a socialized medical plan. The NHS even has a web site to help you find the care you need.

http://www.nhsdirect.nhs.uk/index.asp

As a matter of fact even a vitrectomy is available all over the world that you stated one must come to the US for. I even found a web site for the
Agarwal Eye hospital in India as an example of an emerging world country doing sophisticated eye procedures including victretomies.
If you do a search on vitretomy you'll find it is available all over the world. The lack of your knowledge on this not being performed anywhere, but the US discredits a lot of facts that you seem to come up.

Socialized medicine allows people that don't have any other means, or choose not to pay additional cost for medical insurance to get decent
regular medical care in a normal setting. They can go to a regular doctors office, see a specialist, get necessary testing, etc. If a person needs routine medical care they can go to a regular doctors office to receive treatment. They don't have to go and wait 3 to 6 hours in an emergency room to get treatment for a simple cold, and an emergency room shouldn't be used for that purpose anyway.

Also, you can't just go into an 'any' emergency room in the US to be treated anyway. If you don't have insurance they will ship you off to the one crummy county hospital that treats indigents unless maybe you sign your life away that you will be responsible for all cost incurred. And that's a big maybe I had first hand experience with that when my husband first came to the US, when I was living in Philadelphia , and we went to an emergency room here, and he didn't have US insurance yet. You'll get the bare bone treatment in that crummy hospital too. Yet that would not happen if a foreigner walked into a UK hospital. You must live in a amazing state, because treatment in every emergency room is rare, especially for a routine condition.

We step over homeless people lying in the gutter, and maybe they will dragged off to an emergency room if they are unconscious, and once found
that they aren't nearly dead they are released. It's not like on TV where they treat everyone at every facility, and give two damns about their well being if they can't pay. There may be some horrible free clinics for people on welfare, here, and there, and some extra services for some fortunate select groups of children, but they are few and far between. In the UK even if a homeless person can't afford any insurance they will get the same care as someone here can with insurance.

Again people are not given regular care in emergency rooms, and surely not every hospital they walk into. When was the last time you tried to receive treatment in the hospital of your choice, or even for a child for that matter without medical insurance in an emergency room, well except in your state maybe?. My brother had insurance with a major carrier in Philadelphia, and needed to go to the emergency room here in CA, and when he went to the closest hospital they still stalled around for what seemed like forever until they verified his insurance. Otherwise they would have shipped him off to SF general . He still ended up being there close to 6 hours until he finally got the treatment he needed, and he was pretty sick. If it wasn't a Sunday, I would have dragged him to one of my doctors, and paid out of pocked, and hoped he got reimbursed. You would not want to have to go to an emergency room for routine care on a regular basis. To the non Americans on this board the US health system for people without insurance is not paved with gold.

As far as being treated poorly, and the socialized medical system only being good for colds, etc., and a serious condition not treated in timely manner is simply not true. Not to say it hasn't happened at times, but it occurs here too if someone happened to be in a particular HMO group. You're making like the rest of the world lets people suffer a slow death, and do not receive treatment until it is too late if they are in a socialized medical system, which is absolutely absurd. There were just several cases stated by some people on this board living in the US who's condition progressed to a worse state either because of not being treated in a timely manner, or a misdiagnoses of their condition with a paid HMO policy

Also, why do you say people have to travel to get diagnostic test like MRI's, etc. Do you think they are not readily available in many areas
in other countries just like they are here? The only reason someone would have to 'travel' to get diagnostic testing is if they lived out in the boonies somewhere, just like if they would in the US. Not every hospital has every bit of equipment here either. The UK for example is around the size of California, and the traveling time to a major center that has every bit of equipment is less there than someone living in California for example. If your not fortunate enough to live near LA, San Francisco, Stanford, etc. you will have to travel too.

I don't understand where you are getting your information from on these crazy facts you have stated occur as a routine basis. Have you personally
lived in the UK for example, and been under the care of the NHS, and had a personal experience with the system? Maybe you know some people that had a bad experience, but it is the exception ratter that the norm. At least in the UK, and most of Europe where socialized medicine exist. Even
if you came up with a couple of rare examples I could match each one with a horror story that occurred in the US with people under certain HMO's.
People in the US with HMO's are treated the same way, and require referrals, have had delays, etc. I have a PPO policy which allows me to go to any specialist I want on my own without a referral, but I pay very high premiums for that. Not everyone in the US can afford that type of policy. Again you can purchase the same type of policy outside of the US.

Some of the biggest medical breakthroughs have been discovered all over the world in countries other than the U.S such as the first heart transplant along with so many other life saving procedures, and drugs. Although not life saving don't forget ESWT was invented in Europe, The list is so long it's ridiculous to list them , but the point I'm making is some of the finest medical care in the World is available outside of the US in the very finest facilities with, or without private insurance. Yes on occasion for a more routine procedure you might have to wait a bit longer for certain conditions, but rarely if at all would diagnostics, or treatment be delayed if a serious illness was suspected.

Also, are you seriously saying that all countries with socialized medicine are rationalizing pain medicine, and people are being turned away for care? What countries are you talking about?

Donna

Re: Stop slandering and whining

DR Zuckerman on 3/24/02 at 21:10 (077459)

Thanks. Don't worry Pauline and DR. Z have a love/hate relationship

Re: To John and Pauline

DR Zuckerman on 3/24/02 at 21:16 (077460)

This is one hell of piece of writing. By the way you also win the academy award for the longest posting that I actually read from top to bottom every word of it and wasn't bored at the end. Very well written. Thanks now back to the academy awards

Re: Health care

Julie on 3/25/02 at 03:19 (077466)

Thanks, Pauline, Donna, Nancy, Wendy, John - all who have contributed to this discussion which I (not entirely unwittingly) began. Putting it all together, it seems that health care in America has not, after all, improved very much since I came to live in England in 1961.

I am happy to live in a country with 'socialized medicine'. When we need to see a doctor, we make an appointment with one of the five excellent GPs in our local group practice, and we go. It is free.

When I went to see one of the doctors with the lump in my breast eight years ago, he called our local Greenwich District Hospital and got me an immediate appointment with the consultant, who saw me at his first available clinic three days later. Mammogram, biopsy, and bone scan followed within two more days, diagnosis within another three days, and mastectomy a week later. My consultant was a prince, a brilliant doctor, and the hospital care excellent in every respect. I even had a private room with a shower - for nine days.

All free. The hospital was not exceptional: it was a very ordinary one, stretched to the limits, and with a so-so reputation. It has now closed, and been replaced by a huge, state-of-the-art hospital which I hope will be as good if we ever need hospital care again.

I am happy. Not just for myself, but because I know that everyone else who lives in this country is entitled to that same level of free treatment under the National Health Service. As I said before, there are no poor relations. So for me, there is simply no argument. However overburdened, underfunded and faulty our NHS is, there is no comparison between a system that treats all citizens as equal and one that doesn't.

We can afford private insurance, and we have it, principally to avoid having to wait for the less-than-urgent things we might have to have done. I had my torn medial meniscus operated on privately, and my husband had his two cataract operations privately. But everyone is aware that for serious conditions - cancer, heart attack, stroke, etc - you're better off with the NHS.

Nancy, maybe you and Phil should come and live in England!

PS. Now that we're over 60 we get all our medication free. No prescription charges. That sure helped with my six years of tamoxifen. And with my husband's glaucoma drops. And all sorts of other, less important things.

Re: Health care

Julie on 3/25/02 at 06:21 (077468)

I should say that of course our health care isn't really 'free'. We pay national insurance contributions, and of course I did that all during my 30-odd employed years. The unemployed, the disabled and the long-term sick, and the old (men over 65, women over 60) do not pay contributions. Whether you are paying in or not, you are entitled to all that the health service has to offer when you need it.

Yes, there is abuse of the system, as you might expect. But I was happy to have paid my contributions all those years, knowing that those less well-off would also benefit.

Re: To John and Pauline

Pauline on 3/25/02 at 08:13 (077473)

Donna,
Easily said, maybe easily done, and anyone in the states is free to move.
Our government doesn't hold anyone captive to the terrible conditions that exist here. We have open borders for those that would like to try another country and system. Why not suggest they try it first then choose where they want to reside. Some as you suggest may find your system wonderful and will want to stay there or select another country. You have to agree it really doesn't matter where they end up as long as they are more content than with living in the states. I have no problem with people choosing to live in another country based on your posting.

i think your right, they should find out for themselves and the best way is to live and work there for an extended period of time, then decide.

Re: To John and Pauline

john h on 3/25/02 at 09:43 (077481)

Donna: I do not disagree with most of what you say but I will tell you that in Little Rock, Arkansas you can walk into the Emergency Rooms of the four major hospitals in this city and if you are broke they are required to treat you. You are not shipped off to any other hospital. Our very best and largest hospital The Arkansas University Hospital For Medical Sciences treats by far the largest number of patients without coverage as does the Baptist Medical System. I do believe there are state or federal laws about not turning away patients seeking care. My daughter works in and out of the Emergency room. Perhaps there are some states or particular areas that operate in a different manner. Many of our hospitals are in a money crunch simply because of the large number of people they treat for free. There are occasions when an emergency room is overlaoded that ambulance services are directed to take patients to a different hospital but that applies to both the insured and uninsured.

Re: To John and Pauline

john h on 3/25/02 at 10:00 (077486)

One thing the majority of Americans clearly have demonstrated is that they are not ready for any form of socialized medicine. The Clinton Health Plan was soundly defeated by both Democrats and Republicans (they usually agree on nothing) after the election of Bill Clinton. This was a form of socialized medicine. There is a different culture in this country than in Europe and England and for better or worse there is a dislike of to much Government involvement. I think this began with our Declaration of Independance and our Constitution. More people still want to enter this nation than any other country in the world. People from all over the world come here for medical treatment so we must know how to do something right. I know we have a lot of flaws in our medical system but it seems that over the past 50 years we have come a long way and will continue to improve. There was a time in my life when I had no health coverage but I was young and healthy and did not even think about it. I personally do not want to copy anyones healthcare system as I think we will ultimately have one that pleases the majority of our people.

Re: To John and Pauline

Carole C in NOLA on 3/25/02 at 12:12 (077501)

I know I don't want socialized medicine. I could say more but it would just fan the flames. LOL

Carole C

Re: I meant

Carole C in NOLA on 3/25/02 at 12:20 (077503)

Well my last post sure sounded wrong. I didn't mean to imply that we are flaming each other. I meant that I respect each and every one of the opinions I read here on this topic, even though I may not agree with them. I think all of you have thought through this and have formed intelligent and valid opinions. I may disagree but I value each of you and your friendship on these boards I think the rest of you probably feel the same way.

Boy do I get in tangled up messes when I try to write! LOL

Carole C

Re: To John and Pauline

Donna SL on 3/25/02 at 14:38 (077516)

Pauline,

I think you are missing the point. I was not trying to convince anyone that we should have socialized medicine in the US, nor should anyone
emigrate to another country to experience it. Personally I couldn't care less, and fortunately I can afford private insurance here. It would be a nice system to have though for people that can't afford health care otherwise. I'm not sure if you are aware that I am native American currently living in US.

My purpose was to correct the mis-statements that were made by you in such a vengeful way about a system you obviously don't understand,
know little, or nothing about, and have not experienced personally. I agree that it would be a good idea if 'you' lived there, and got the correct facts before making untruthful off the cuff statements.

Donna

Re: To Dr. Z

Donna SL on 3/25/02 at 14:50 (077517)

Thanks Dr Z.

Hope you enjoyed the acadamy awards.

Donna

Re: Health care

John h on 3/25/02 at 18:16 (077535)

Julie you are correct that there is not much that is free anywhere. The government of any country only has what it gets from its citizens.

Re: To Donna

Pauline on 3/25/02 at 20:56 (077549)

Hi Donna,
Your points are well taken and havent been missed.
Here is how the health care system works in Mexico. Those beautiful hospitals you speak about are Private Facilities, many owned believe it or not by American Companies. An example, Texas-based Christus Health recently bought 51 percent of Hospital Muguerza--a privately-owned hospital in Northern Mexico.

Hospital Muguerza consists of a 178-bed hospital in Monterrey, Mexico and a smaller sister hospital in Saltillo. This facility and others like it
are aimed at serving the growing middle and upper classes that are interested in more services and better quality of care offered at privately owned hospitals. They pay for it.

IMSS is the National health care program in Mexico. It provides (3) three
levels of service in most major cities. Little to nothing in rural areas.

First level Small Clinics with a general practitioner to handle minor
illnesses and injures.

Second level Small hospitals with surgeons, internists and pediatricians.

Third level Large intensive care facilities which house specialist.

Anyone using IMSS does not have a choice of physicians and begin treatment
at these small clinics. Using a referral system some get to the second level, but the third level is restricted to the very ill when space is available. Many wait for space at home.

People who can afford to do so, use private clinics and hospitals when medical care is needed. They pay for it. The level of care is better because of higher quality staffing and quality physicians, with more medical equipment and treatments are available.

Poor people using IMSS go to the Social Security Hospitals where waiting is the norm. Long lines 6 to 8 hrs or more waiting time.

In healthcare institutions for uninsured populations, persons with AIDS as an example are provided with some medical attention, consultations, and medications for opportunistic infections, however, no antiretroviral drugs
drugs are provided them.

The following quote is directly taken from the Consular Information Sheet on Mexico dated October 19, 2001 speaking about Cancun probably the most Americanized Mexican City.

'Travelers should be aware that the standards of medical training, patient care and business practices vary graatly among the medical facilities in Cancun'.

One can deduce from this statement about Cancun that the same holds true
for most parts of Mexico.

We have dear friends citizens of Mexico who's homes are in Monterrey. I say homes because they have two. They would be considered higher income bracket. They also live in the states, however, they have two lovely daughters who chose to attend college in Monterrey. Recently, while we were enjoying dinner they received a phone call which told them one of their daughters, Grasella, had been in an auto accident. Immediately upon hanging up the cell phone, Roberto placed a call to his family to make sure his daughter was taken to a private hospital which he specifically named. I was told that night that they do not use certain medical facilities, the ISSM medical facilities, for the very reasons you and I would not want to use them. They flew home within hours to monitor her care. All turned out well and Grasella has finally returned to school.

The pretty hospitals you speak about are what is termed 'American Hospitals' by my friends, and just like other countries those that can afford to pay use them.

Many Canadians also carry and pay high premiums for private health care insurance that will provide medical care for them in the states. If they can afford it they purchase it. They seek treatment here for the quality and because they can get treatment faster.

The fact that many people in other countries which offer full medical coverage go the extra step and purchase private insurance says something about the availability and quality of care in that country. If it didn't people wouldn't feel the need to purchase it.

As for Vitrectomy being offered all over the world the real answer is while Vitrectomy itself is a surgery performed in many countries some still do not perform Vitrectomy for all Vitro/Retinal conditions. More Vitrectomies are preformed in the U.S. than any where else in the world and every condition is treated. Not all are successful, but they are treated.

Personally, I feel a successful approach to financing health care world wide is likely to be a combination of various things including new strategies and more conventional ones. These must respond to different levels of need and the availability of resources and must take into consideration the broader cultural, economic, political and historical content of each country.

I suggest if we want to continue discussing health care we should move this discussion to the Social Board. I think that's where this one belongs.

Re: To Donna

wendyn on 3/25/02 at 23:10 (077555)

Just for the record, I can't say it doesn't exist...but I have never heard of health care here that we could use for coverage in the US - unless you are referring to some type of travellers insurance during vacations?

Re: To Wendy

Donna SL on 3/26/02 at 00:38 (077570)

Wendy,

I'm don't understand your question. Are you referring to the current insurance I have?

Donna

Re: Health care

Julie on 3/26/02 at 02:37 (077573)

John, I think you missed my point, which was that a great many people in Britain who cannot and do not pay national insurance contributions because they are unwaged, disabled, or chronically sick, DO get FREE medical care at the same level as those who can afford to pay. No means test. No questions asked. No poor relations.

That is what the dreaded 'socialized medicine' means.

I call it civilized medicine.

Re: Health care - Wendy

Julie on 3/26/02 at 02:40 (077574)

It IS interesting that the two of us who live in countries that have socialized health care are pretty happy with it.

Perhaps it's also interesting that no-one has commented on my experience of socialized health care, posted yesterday.

Re: Funny

wendyn on 3/26/02 at 07:46 (077589)

What I find really funny Julie, is that I'm actually prompted to defend a system that I've often been very critical of myself.

I'm not really big on socialism of any kind, and I have seen the drawbacks of socialized medicine first hand.

Still, with Pauline (and Pauline knows it is not a personal thing between us) - her critcism (to me) seems often based on some extreme anti-social medicine propaganda. The system has it's faults for sure, but often she brings up problems that you and I simply don't experience. Therefore, I find myself in the weird position of defending something that I'm not terribly happy with!

I think it's important to do so though, if some of Pauline's (and others) conclusions are based on what sounds like exaggerated propaganda - I have real life 'first hand' experience of what these systems are about - and so do you.

Re: To Donna

wendyn on 3/26/02 at 07:49 (077590)

No Donna, I was referring to Pauline's suggestion that many Canadians also carry expensive coverage that gives them the ability to be treated in America if need be.

I cannot say I am 100% this is untrue, but I can say that I have never heard, or read about any such insurance - nor have I ever heard of anyone who has it. If such a thing exists, I can say that I am sure 'many' people do not have it - it must be rather elite and secretive.

The only time I know of where we buy additional insurance that covers us in the US, is when we purchase travellers insurance during for a vacation in your country.

Re: To Wendy

Donna SL on 3/26/02 at 11:40 (077600)

Wendy,

Now I see what you mean. I don't know what Pauline is talking about as far as purchasing insurance like that in Canada. I know with my insurance if I needed medical care outside of the states while traveling on vacation I would be covered under my plan. I would have to pay upfront though, and submit the claim for reimbursment when I got home.

What I DO see from that statement, and some other statements in that post is a very xenophobic attitude about receiving medical care anywhere but the US. I think it is a riduculous, ignorant assumption to make that the US is the only nation in the world to provide top quality medical care.

IMO it's an insulting statement. Wendy you would know better than anyone if 'many' Canadians feel they need to run to the US if they can afford it to get quality medical care that was implied is practically non-existent in Canada.

Donna

Re: To Wendy

john h on 3/26/02 at 12:54 (077608)

Our discussions have prompted me to read a lot more than I wanted to about the Canadian Health Care System. It is certainly not a simple system and not nearly as centralized as I had imagined. The Provinces seem to play a more important roll than the central government. I am not making any judgements just informing myself. In 1998 30,3% of healthcare cost was paid for by private citizens. Canada spends more of it;s gross national product on healthcare than nearly any nation at just over 10%. In some Provinces physicians are paid a salary and in others Doctors work for themselves but the fees they charge is set by the government. Canadians vist thier Doctors considerably more times than do Americans during each year. One of the bigger problems for the system is the long wait to see a specialist. To see a heart specialist may take 6 months (unless you have some life threating condition). To get an MRI may take 3 months unless it is some life threating condition. The number of hospital beds have greatly decreased and hospital stays are greatly reduced. Some hospitals are for profit and others are not. Most Canadians seem happy with their system but have a problem with the taxes to pay for it. The life expectancy in Canada and the U.S. are very similar. The Canadian model is still evolving as is the American health care system. I must have spent 3 hours reading about the Canadain system today and much of it was from the Administrators of the system. Apparently most of the population are happy with the system.Our discussion had caused me to become more informed.

I really think Americans are not good candidates for a true form of Social Medicine. The Clintons attempted to use the Canadian model and it went down in total flames because of the big public backlash. We do have forms of social medicne in Medicare and Medicaid and various other free medical care but I do not see us taking it much further in the forseeable future. We are much to independant in this country and some really bad words that politicans often use are 'Big Government'. Our system has it flaws but I still think we have the best medical care system in the world. We can do better.

Re: John h

wendyn on 3/26/02 at 14:28 (077619)

I cannot disagree with anything you have said in your post...if nothing else...we are all a little better educated through all this!

Re: To John

Pauline on 3/26/02 at 15:00 (077620)

John,
I think you put it all in prospective Here is a web site you may want to read. http://www.caledoninst.org/speaking/spkg04.htm

It's a study, called study # 4 'Costs,Closures & Confusion People in Ontario Talk about Health Care'.

The facts speak for themselves. One person's preceptive of 'Good Health Care' may not be the same for another. Do people get care in the UK and in Canada? Yes. Is it the same type of care provided in every country? No. Would I like it in the U.S.? No.

Should we call names and take the issue personally? I don't think so. Will it be a topic for discussion in the states again? Without a doubt.

Happy Easter!

Re: Wendy

Julie on 3/26/02 at 16:17 (077628)

Wendy, I know what you mean. I don't know anything about the health care system in Canada, but certainly our NHS has its faults, and of course one can point to bad experiences with it, and grave lapses, as one could with any system. That said, I've had nothing but acceptable and often very good experiences in the 40 years I've been here, contributing to and benefiting from the system and its services.

But more important, for me, is the principle that underlies the NHS, and the vision of its postwar founders. It is a profoundly satisfying one: that everyone in the community is entitled to whatever they need from the service, whether or not their personal and social circumstances allow them to contribute to it. Yes, it's pure, utopian socialism. And tattered though the health service here has become, it still abides by that principle and it still works, on the whole.

For me it is a social issue than a personal one; and, dare I breathe the dreaded word, a political one. I am thankful that the lonely old woman who lives up the road does not have to worry about her health care: that if she needs anything from the system, she has the right to it. Not as a handout to the indigent, but as a given right. That is important to me.

Re: Health care - Wendy

John h on 3/26/02 at 16:28 (077633)

Julie: I guess it all comes down to are you happy with your current health care no matter where you are? I am! You are! Wendy is! Would any of us like to switch health care systems with the other. Probably not! Are any of our system perfect or one size fits all? No! Are we all fortunate to live in modern industralized nations? You bet! Can any of us cure the needs of all the 3rd world nations? No! but we can help and we do. Bill Gates is currently involved in a program he has established in Africa to help with aids. His father heads up the program and Bill Gates has contributed $20 billion dollars and counting.

Re: To John

John h on 3/26/02 at 16:38 (077637)

Pauline: I have had the same family Doctor for 22 years. He is 5 minutes from my home. He and three other doctors have a small clinic. You do not make appointments you just walk in and wait your turn. The longest I have ever waited was 1 hour and the typical wait is 20 minutes. I can go Monday-Saturday from 9am to 6pm. He knows everything about me from A-Z. Although my insurance covers me his charges are reasonable. Would I ever want to give up this doctor and this service. No way Jose!

Re: Wendy

John h on 3/26/02 at 16:45 (077638)

The old and the poor have Medicare and Medicaid here. As Nancy says we have to solve the problem of the self employed and workers who work for small companies who do not have insurance. You can buy insurance but it is very expensive. There are some benefits for the self employed in that their health insurance premiums are tax deductable. This is not enough to pay for insurance but is a benefit. There are various plans being discussed in congress that would allow many of these people to pool their people and have the same advantage of large companies in buying insurance. I think I read that Canada has no provisions for Nursing Home Care or in home care. Does the UK offer any such services with your insurance Julie?

Re: Home care

wendyn on 3/26/02 at 20:11 (077664)

John - I don't know what you read about home care, but I do know that when my friend was dying of cancer - he was eligible for home care services that provided not only a nurse to visit, but also house cleaning services.

At the end of his disease he was visited regularly at home by a palliative care doctor, and he had a nurse present during his last day at home. She administered all the meds he needed and counselled the family. This may have actually been through hospice - I'm not sure.

All was covered financially anyway.

Same for my grandma - she has a home care nurse out - as well as an occupational and physio therapist - all covered under home care.