# Hey, you filthy smokers!  Time to punish you.



## Bill Mattocks (Feb 15, 2012)

I have said this before; and others have more-or-less agreed with the concept.  When a person buys their own insurance, they are rated based on many factors, and they pay more or less than others based on the risk pool to which they are assigned.  Smokers pay more for private health care insurance, in recognition of the fact that they represent a higher risk of incurring health care costs.  But at least in theory, people have a choice - they don't have to buy insurance.

Now as we move into the realm of state-controlled health insurance, if not actual nationalized or socialized medicine, we have a new situation.  When everybody pays, and it is mandatory that they both participate and pay, as one person on MT has pointed out, if it's my tax dollars, I should have a say in how they are spent.  And right they are.  When the state picks up the tab, it means the taxpayer is picking it up.  And that changes things.

Here we have a bill proposed in the state of Utah, proposing higher copays for smokers using Medicaid (a form of state-provided health care for a certain class of citizens).  The person proposing this law is a Republican - surprised?  The point is simple and logical; smokers cost the state more, so they should pay more.  And of course, there is the argument that the higher copays may encourage smokers to quit.

http://www.usatoday.com/news/health...harge-for-Utah-smokers-on-Medicaid/52893970/1

All true.  But this is precisely what I've been saying, and I'm often accused of 'slippery slope' arguments, that these things will never happen, that they don't happen now, so there is no reason to assume they will happen in the future.

Well guess what, folks.  We're not even fully into the new Obamacare regime (2014 for full implementation) and it's already starting.  If the taxpayers have to pay for your health care, they get a say in how it's provided and what's covered and so on.

That means, if you are a smoker, prepare to pay more; or be denied coverage.  Do not be shocked when it becomes law that you have to stop smoking.

And if you think that's fine and dandy because smoking is bad anyway, remember the factors that cost us the most in health care expenses.

Drunk driving.  Yes, DUI costs us a fortune.  Prepare to see alcohol drinkers pay more, and then see alcohol made illegal to drink.

Being fat.

Being out-of-shape.

Skydiving or engaging in extreme sports.

Do I need to go on?

Please tell me again how this will never happen in the USA.  I love to hear those, because I know that six months or a year later, I can shove them back in your face with the 'new reality' and you'll go all quiet and refuse to answer, because let's face it, I'm right, and you're wrong.

Dictatorship is coming to the USA.  And universal health care is the horse it rides.  In ten years, you'll think I was Nostra-fricken-damus.


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## Tez3 (Feb 15, 2012)

I have to say that here in our system smokers don't pay more. To be honest it's really not worth nor is there any point in people making comparisions between proposed American systems for 'national' healthcare and that of any other country. I know people do with some claiming that our system produces poor healthcare but as they have no knowledge of how ours work it's a pretty specious argument. What you have in America and what is proposed is unique, pertaining only to America. I don't know how your's will work out or if it will, there seems like this charging smokers more some odd things happening.


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## Bill Mattocks (Feb 15, 2012)

Tez3 said:


> I have to say that here in our system smokers don't pay more. To be honest it's really not worth nor is there any point in people making comparisions between proposed American systems for 'national' healthcare and that of any other country. I know people do with some claiming that our system produces poor healthcare but as they have no knowledge of how ours work it's a pretty specious argument. What you have in America and what is proposed is unique, pertaining only to America. I don't know how your's will work out or if it will, there seems like this charging smokers more some odd things happening.



This bill is being proposed for recipients of Medicaid, which is actually more like the UK system than the in-progress 'ObamaCare'.  Medicaid is for low-income people and people with certain disabilities.  It is a state-paid system, with no premiums charged (some states have a co-pay due at time of services being rendered, but no monthly premiums).  Together with Medicare (same type of program, but for elderly), this represents the closest thing we have in the USA to a nationalized health system similar to the UK.

http://en.wikipedia.org/wiki/Medicaid

Even in the UK, however, people are beginning to consider controlling costs.  It often takes a different form in the UK as I understand it.  Instead of charging a smoker more for coverage, the NHS might decide not to provide certain treatments for smokers (or heavy drinkers, etc).  But ultimately, controlling costs is controlling costs.  It can come at one end of the pony or the other, but it involves persuading people to change their habits so they cost the state less.

And in Canada, the trajectory is not dissimilar to the USA.

http://www.vancouversun.com/health/Smokers+more+health+care+minister+says/5480278/story.html



> VANCOUVER - B.C.&#8217;s smokers may be forced to pay higher MSP premiums because of the added burden they place on the health care system, Health Minister Mike de Jong said Thursday.
> 
> &#8220;Some people, in B.C. about 14 per cent of the population, continue to smoke and they&#8217;re going to cost more,&#8221; de Jong said in an interview. &#8220;Maybe they should contribute more.&#8221;



And remember, risk is risk.  Smokers add risk and cost to the system, that is undeniable.  Maybe you're not a smoker and you have no problem with this.  After all, if smokers cost us (taxpayers) more, they should pay more proportionately.

And so should people who do other things that cost us more.  Like those who engage in risky sexual activities, for example.

Somebody tell me that's different; I'd love to hear the argument.  Because it isn't different, it's the same.  Risk is risk.  Cost is cost.  If you control one behavior to control costs, you can control any behavior to control costs just as legitimately.


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## ballen0351 (Feb 15, 2012)

That's been my argument from the start of this.  If its MY responsibility to pay for your insurance then its your responsibility to not smoke, drink, have unprotected sex, use drug, or any other risky behavior that causes my responsibility to cost more.


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## Tez3 (Feb 15, 2012)

Bill Mattocks said:


> This bill is being proposed for recipients of Medicaid, which is actually more like the UK system than the in-progress 'ObamaCare'. Medicaid is for low-income people and people with certain disabilities. It is a state-paid system, with no premiums charged (some states have a co-pay due at time of services being rendered, but no monthly premiums). Together with Medicare (same type of program, but for elderly), this represents the closest thing we have in the USA to a nationalized health system similar to the UK.
> 
> http://en.wikipedia.org/wiki/Medicaid
> 
> ...



The NHS as such takes no decisions as to the medical treatment of smokers, drinkers or anyone else as such. Any decisions are made on medical grounds by medical staff. There's no overall policy about smokers, other than campaigns to get people to stop. Individual doctors may feel they can do little or nothing for someone who carries on doing something that endangers their recovery/health. *The decisions are medical not administrative*. If people aren't paying for their medical care then it's not like the British system at all, we pay for our healthcare with National Insurance. it is paid by everyone who works so isn't a 'free' service. We have a reciprocal agreement within the EU about paying for healthcare when in a EU country.


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## Bill Mattocks (Feb 15, 2012)

Tez3 said:


> The NHS as such takes no decisions as to the medical treatment of smokers, drinkers or anyone else as such. Any decisions are made on medical grounds by medical staff. There's no overall policy about smokers, other than campaigns to get people to stop. Individual doctors may feel they can do little or nothing for someone who carries on doing something that endangers their recovery/health. *The decisions are medical not administrative*. If people aren't paying for their medical care then it's not like the British system at all, we pay for our healthcare with National Insurance. it is paid by everyone who works so isn't a 'free' service. We have a reciprocal agreement within the EU about paying for healthcare when in a EU country.



Yes, that's correct if I understand it rightly.  However, as I said, the NHS controls costs, as they must.  In this case, instead of addressing individual behavior, they do it at the other end of the care spectrum; they limit care.  I could post the lists of medications that people in the UK are not allowed to have based on cost if you like.  I believe that is called 'rationing health care', is it not?

The point is, when taxpayers pay, taxpayers get a say.  You said that yourself.  And right you are.  The NHS has simply chosen to attack costs at the other end of the spectrum.

There are three ways to control medical costs.

1) Charge more.
2) Pay less (to doctors, hospitals, for drugs, etc).
3) Limit services.

In Utah (and apparently, Canada), they are talking about charging more.  In England, the NHS limits services.  It's the same thing; just the other side of the equation.


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## Tez3 (Feb 15, 2012)

Bill Mattocks said:


> Yes, that's correct if I understand it rightly. However, as I said, the NHS controls costs, as they must. In this case, instead of addressing individual behavior, they do it at the other end of the care spectrum; they limit care. I could post the lists of medications that people in the UK are not allowed to have based on cost if you like. I believe that is called 'rationing health care', is it not?
> 
> The point is, when taxpayers pay, taxpayers get a say. You said that yourself. And right you are. The NHS has simply chosen to attack costs at the other end of the spectrum.
> 
> ...



I don't know why people insist on comparing what happens in the UK ( pse it's the UK not England!), to what happens in the States ( perhaps I should say in California when I mean the whole of the USA?) yes some drugs aren't given out but not always because of cost, sometimes it's because they aren't approved of in the UK for not being tested enough, just because you use the drugs doesn't mean they are safe. Sometimes the drug doesn't give enough people enough life enhancing or saving benefits. It's not simply because they cost too much, if you insist you know better about our NHS I suggest you come and run it. It's ours, not yours, you don't live here and unless you visit and get taken ill or have an accident you will never experience it ( though if you do have an accident/get ill the treatment to you, a tourist will be entirely free) yes it's up to the tax payer ie me NOT you. I'm happy with it no reason for YOU to be another other than non interested frankly. The UK isn't America, bears no resemblence and if people are posting to say 'oh look how much better we are than you' well fine, we'll take it under advisement and then ignore it. We have to be realistic and affordable healthcare has to be realistic, no one who isn't a millionaire gets everything they want, and maybe not even them looking at the recent demise of Whitney Houston. the NHS with all it's faults is appreciated by the British people, if you don't appreciate it it doesn't mean a thing. Rake up all the problems you can find and it proves what? Every system had faults, every single one, more people publicise the faluts than do when they are satisfied with the results so it's always going to appear that the system is faulty. I could find pages of compalints about America, would that prove it was a bad place to live and the people horrible, no of course not, it proves the whingers are the loudest and those that are happy don't go to the media saying how happy they are. Finding stuff on the internet and the media saying how bad things are doesn't give anyone who doesn't live in a country a clear and honest impression of what that country is like.

I've had two children and three miscarriagesas well as a couple of other hosptial stays my brother was seriously ill for 6 years before he died ( no expense was spared on drugs for him btw they flwe stuff over from Sweden for him) both my parents have been in hospital at various times, my mother had three heart attacks before she died, my son has been in hospital and my daughter has had two riding accidents that needed hosptial care, I've spent a far amount of time in the care of or with people int he care of the NHS, I've obviously known even more people in the same situation. We've never had complaints about the way we were treated or had any problems with being refused drugs. I'm on two meds for life which I don't have to pay prescriptions for, I can give you impression of the NHS, I can't however tell you anything nor do I have an opinion on American healthcare. As it should be.Pointing out what you think are flaws in our system is a pointless exercise other than if you wish to pose as being superior. We the British taxpayers are satisfied with the NHS with the proviso that it should always strive to be better, the American taxpayer should care about the NHS? I don't think so.


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## Bill Mattocks (Feb 15, 2012)

Tez3 said:


> I don't know why people insist on comparing what happens in the UK ( pse it's the UK not England!), to what happens in the States ( perhaps I should say in California when I mean the whole of the USA?)



First, we compare it because it is natural to compare things.  Different countries do things differently, but in the USA, pre-Obama, back in the 1960s and 1970s, there was a huge progressive 'push' towards single-payer or nationalized health care.  So we've been here before in terms of debate.  Second, I used the term 'England' this time because I recognized that England and say Scotland have a different set of drugs that are controlled based on cost.  And I get real tired of that crap anyway. If I say "UK" I'm told no, it's England.  If I say "England," I get told no, it Great Britain.  I don't care.  Call it BoboLand for all I care.  Tea-drinking crumpet eaters, how's that work for ya?  



> yes some drugs aren't given out but not always because of cost, sometimes it's because they aren't approved of in the UK for not being tested enough, just because you use the drugs doesn't mean they are safe. Sometimes the drug doesn't give enough people enough life enhancing or saving benefits. It's not simply because they cost too much, if you insist you know better about our NHS I suggest you come and run it. It's ours, not yours, you don't live here and unless you visit and get taken ill or have an accident you will never experience it ( though if you do have an accident/get ill the treatment to you, a tourist will be entirely free) yes it's up to the tax payer ie me NOT you. I'm happy with it no reason for YOU to be another other than non interested frankly. The UK isn't America, bears no resemblence and if people are posting to say 'oh look how much better we are than you' well fine, we'll take it under advisement and then ignore it. We have to be realistic and affordable healthcare has to be realistic, no one who isn't a millionaire gets everything they want, and maybe not even them looking at the recent demise of Whitney Houston. the NHS with all it's faults is appreciated by the British people, if you don't appreciate it it doesn't mean a thing. Rake up all the problems you can find and it proves what? Every system had faults, every single one, more people publicise the faluts than do when they are satisfied with the results so it's always going to appear that the system is faulty. I could find pages of compalints about America, would that prove it was a bad place to live and the people horrible, no of course not, it proves the whingers are the loudest and those that are happy don't go to the media saying how happy they are. Finding stuff on the internet and the media saying how bad things are doesn't give anyone who doesn't live in a country a clear and honest impression of what that country is like.



Good God.  I'm not disagreeing with any of that.  My point was and is much simpler.  When taxpayers pay, cost-control is on the table.  And costs can be controlled in a variety of ways.  The UK  (or whatever the hell you call yourselves today) does it one way, we do it another; but costs still get controlled based on taxpayer's input among other things.  You actually don't seem to be disagreeing with me; it seems more you're agreeing but insisting that you LIKE the outcome.  Hey, that's fine!  Great!  And I'm sure people will LIKE the outcome when smokers have to pay more for health care in the USA, or are denied coverage.  And some might even like it when gay men are told they have to pay more if they are going to continue to engage in a risky behavior that costs the public a lot of money.  Whether you like it or not doesn't impact the truth of the issue; it just means you find it fine and dandy.



> I've had two children and three miscarriagesas well as a couple of other hosptial stays my brother was seriously ill for 6 years before he died ( no expense was spared on drugs for him btw they flwe stuff over from Sweden for him) both my parents have been in hospital at various times, my mother had three heart attacks before she died, my son has been in hospital and my daughter has had two riding accidents that needed hosptial care, I've spent a far amount of time in the care of or with people int he care of the NHS, I've obviously known even more people in the same situation. We've never had complaints about the way we were treated or had any problems with being refused drugs. I'm on two meds for life which I don't have to pay prescriptions for, I can give you impression of the NHS, I can't however tell you anything nor do I have an opinion on American healthcare. As it should be.Pointing out what you think are flaws in our system is a pointless exercise other than if you wish to pose as being superior. We the British taxpayers are satisfied with the NHS with the proviso that it should always strive to be better, the American taxpayer should care about the NHS? I don't think so.



I didn't call them flaws.  I said they were cost-control measures.  It's not an attack on you or your whatever-the-hell-name-it-is island.


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## billc (Feb 15, 2012)

Is this story accurate, a smoker in the U.K. refused treatment because he couldn't stop smoking...

http://www.dailymail.co.uk/news/article-481617/Doctors-refuse-fix-builders-broken-ankle-unless-quits-smoking.html




> A man with a broken ankle is facing a lifetime of pain because a Health Service hospital has refused to treat him unless he gives up smoking.
> 
> John Nuttall, 57, needs surgery to set the ankle which he broke in three places two years ago because it did not mend naturally with a plaster cast.
> 
> Doctors at the Royal Cornwall Hospital in Truro have refused to operate because they say his heavy smoking would reduce the chance of healing, and there is a risk of complications which could lead to amputation.






> They have told him they will treat him only if he gives up smoking. But the former builder has been unable to break his habit and is now resigned to coping with the injury as he cannot afford private treatment.
> 
> He is in constant pain from the grating of the broken bones against each other and has been prescribed daily doses of morphine.
> Mr Nuttall, of Newlyn, Cornwall, broke the ankle in a fall in 2005. Initially he refused surgery because he had caught MRSA at a different hospital four years earlier, and was terrified of history repeating itself.
> ...






Or is the refusal for treatment really based on the fact that he is 57 years old and the equation used to compute cost to benefit ratios is going against him?
​


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## MA-Caver (Feb 15, 2012)

Call me a filthy smoker and I'll just say "BITE ME!" .... no need to be insulting about it!


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## Bob Hubbard (Feb 15, 2012)

MA-Caver said:


> Call me a filthy smoker and I'll just say "BITE ME!" .... no need to be insulting about it!



Yeah. I met Caver and he didn't look filthy to me. I even saw him wash his hands once. 



I'm on the fence here.  While I've no problem with more fees, taxes, requirements for smokers (like forcing them to wear tight rubber suits and helmets that keep all that smoke in), I can see the creep and slide of control.  We're at a point where some smaller governments in the US are telling parents what they can and can't feed their kids, forcing lunch changes and sending the kids home with the bill for 'correcting' things. Next step is allowing higher premiums for those overweight, those with high blood pressure, those with acne, and so forth.  People say 'thats crazy talk. Itll never happen here. You exaggerate.'.  Then you wake up some day with a uniformed 'Health Enforcement Officer' banging on your door because you missed the mandated morning calisthenics and wonder where your freedom went.


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## Tez3 (Feb 15, 2012)

billcihak said:


> Is this story accurate, a smoker in the U.K. refused treatment because he couldn't stop smoking...
> 
> http://www.dailymail.co.uk/news/article-481617/Doctors-refuse-fix-builders-broken-ankle-unless-quits-smoking.html
> 
> ...




You see what I mean? Find a story that appears negative and use it to push how good your system is. The doctors would have taken that decision on medical grounds, 57 isn't old so that doesn't come into the equation. The guys refused surgery, his bones aren't mending probably due to that fact that very heavy smkoing causes the viens to narrow and often close, thats why often legs have to be amputated due to very heavy smoking. An operation involves general anaesthethics which if you are a heavy smkoer carries high risks due to your lungs being full of gunk from smoking. spin this how you like but it's nothing to do with money all to do with medical risks.

Bill, if you put England deliberately to wind people up don't be surprised when they are, the NHS is nationwide.


http://www.vascular.co.nz/intermittent_claudication.htm

http://www.ispub.com/journal/the-in...ld-stop-smoking-before-going-for-surgery.html

http://www.mja.com.au/public/issues/182_01_030105/letters_030105_fm-4.html

_"Desmond O&#8217;Brien_
_Emeritus Honorary Anaesthetist, The Prince of Wales Hospital, Randwick, NSW 2031. hdobrienATbigpond.com.au_


_To the Editor: Tonti-Filippini condemns denial of elective surgery to smokers as discriminatory.1 He disregards the fact that surgery requires anaesthesia, which may require serious consideration before undertaking non-urgent surgery, and in no way involves discrimination._
_He mistakenly regards denying elective surgery to those who continue to smoke as discrimination, in breach of the Hippocratic Oath, and the Australian Medical Association (AMA) Code of Ethics. In fact, to proceed with elective, especially cosmetic, surgery in a heavy smoker is more in breach of the Oath and the AMA Code than not proceeding, for the following reasons._
_Smokers are at a significantly greater risk under anaesthesia than non-smokers because, firstly, smoking reduces the capacity of the lungs to take up oxygen, thus increasing the risk of hypoxia and its consequences to heart and brain.2 It also causes coughing and breath-holding during anaesthesia,2,3 creating surgical difficulties, and the risk of error._
_Postoperative coughing causes additional pain (especially after thoracic and abdominal operations), and increases the risk of postoperative bleeding, infection, delayed healing and even wound breakdown.4,5_
_*Rather than being discriminatory, delaying elective and cosmetic surgery until he or she stops smoking is very much in the patient&#8217;s interests*."_


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## Bill Mattocks (Feb 15, 2012)

Bob Hubbard said:


> I'm on the fence here.  While I've no problem with more fees, taxes, requirements for smokers (like forcing them to wear tight rubber suits and helmets that keep all that smoke in), I can see the creep and slide of control.  We're at a point where some smaller governments in the US are telling parents what they can and can't feed their kids, forcing lunch changes and sending the kids home with the bill for 'correcting' things. Next step is allowing higher premiums for those overweight, those with high blood pressure, those with acne, and so forth.  People say 'thats crazy talk. Itll never happen here. You exaggerate.'.  Then you wake up some day with a uniformed 'Health Enforcement Officer' banging on your door because you missed the mandated morning calisthenics and wonder where your freedom went.



Yes, indeed.

Referring back to the original article I linked to:

http://www.usatoday.com/news/health...harge-for-Utah-smokers-on-Medicaid/52893970/1



> ST. GEORGE, Utah &#8211; If private health insurers can add a surcharge for smokers, why not Medicaid?
> That's the argument behind a bill Utah *Republican* Rep. Paul Ray has proposed that could become a first-in-the-nation state law imposing a higher co-payment for tobacco-using residents enrolled in Medicaid.
> 
> Although Medicaid recipients in Utah do not pay premiums, some are required to pay up to $5 co-payments for prescriptions or doctor visits.



And Utah is not really a state known for left-leaning politics, eh?



> The bill went before the Utah House Government Operations Committee on Thursday. It is being modified to include a wellness aspect with a smoking cessation program. Ray said he plans to bring it back before the committee next week. He said *he does not expect much opposition within the heavily Republican House and Senate*.
> 
> Ray said he would like to eventually extend the idea to an entire wellness program that would *include obesity and alcohol use*.



Bingo!



> "I'm not trying to do this to punish people," he said. "I'm doing this to *encourage people to be healthy*."



How very Orwellian of you, Representative Ray.  Encourage them with a stick.  The sign of a free society; when they're punished until they comply with instructions 'for their own good'.


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## Bill Mattocks (Feb 15, 2012)

Tez3 said:


> Bill, if you put England deliberately to wind people up don't be surprised when they are, the NHS is nationwide.



I wasn't trying to wind anyone up (until you clobbered me with that "UK" thing again). I said England because I *meant* England.  It's not NHS I was referring to, but NICE.

http://www.telegraph.co.uk/health/h...ied-arthritis-drug-available-in-Scotland.html



> The Government&#8217;s drugs rationing body, the National Institute for Health and Clinical Excellence (Nice), has provisionally said that it does not intend to recommend the use of the drug, called Tocilizumab, or Roactemra.
> 
> Nice claims that the £9,000 a year drug, for rheumatoid arthritis, has not proved that it is cost effective.
> 
> But patients in Scotland are to receive the treatment after it was recommended by the body which regulates drugs on the Scottish NHS, the Scottish Medicines Consortium (SMC).


Which, as I understand it, is England and not Scotland or Wales or Northern Ireland.


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## Carol (Feb 15, 2012)

I don't think this is a matter of buying your own insurance vs. state insurance, is it?  

There are databases kept on everyone "behind the scenes" that assess habits and risk factors (controllable and uncontrollable).  These series of codes are kept on patients and they affect insurance coverage and qualification for certain elective services.  This isn't conspiracy-theory stuff, they do exist....I've even been on a job interview with one Massachusetts-based company in the early 2000s that does this -- it was well before the days of Obama Care and Mass Health.  Perhaps there is an elegant name for the process, but not being in the healthcare or insurance field, I don't know what that name is.

One example -- I was in a bike accident this summer.  (Bike riding is supposed to be healthy, yes?)  I was out riding on a well-paved mountain trail, I hit a spot of trail that had taken some serious storm damage and couldn't clip out of my pedals in time to jump clear of the bike.  It was the last time I rode with clips, but that's a whole 'nother story    I'm falling to my right, so I put out my right forearm to break my fall and raise my neck and shoulders so I wouldn't smash my head on the ground.  Result:  I didn't smash my head on the ground....but I did become extremely dizzy, and my blood pressure took a nosedive. Standing was out of the question, let alone riding back down in to the valley.  A fellow cyclist called 911, a police officer with EMT training (bless you, whoever you were) was first to arrive and put me in a stabilization hold fearing neck issues.   Some strong paramedics came up mountain with collar and backboard and brought me down mountain to an ambulance where we rode to the hospital.  Throughout the entire ordeal I was asked -- was I wearing a helmet?  I kept saying I wasn't, but I didn't hit my head on the ground.  This was the truth.   I had hit my chin on my shoulder -- but not my head on the ground.   So all in all I was fine.  CT scan was negative.   The dizzyness and low BP were more of a vasovagal-type reaction and not because of any lasting trauma.  I was told I'd be sore for a few days but should heal within a week or two...and I did.

But now, I have no doubt that I'm in some database as engaging in risky behaviour because I was "caught" riding my bike without a helmet and getting in to an accident.  As far as I know that information is there, regardless of where the coverage is coming from.

Acutarial data mining is getting nastier and nastier -- and not just with health insurance.


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## Tez3 (Feb 15, 2012)

Bill Mattocks said:


> I wasn't trying to wind anyone up (until you clobbered me with that "UK" thing again). I said England because I *meant* England. It's not NHS I was referring to, but NICE.
> 
> http://www.telegraph.co.uk/health/h...ied-arthritis-drug-available-in-Scotland.html
> 
> ...




NICE is a national organisation. We have regional authorities for the NHS, what you can get in one regions may vary from another, it's to do with regions rather than countries. NICE makes recommendations, the individual health authorities decide what drugs to use. It's a matter of choice rather than the NHS or even NICe deciding who has what. Plenty of people have appealed to NICE for certain drugs and got them. Often NICE will reject a named drug from a famous drugs company in favour of a less known company and a cheaper alternative, that is just good house keeping is it not?
http://www.nice.org.uk/aboutnice/whatwedo/niceandthenhs/CostSaving.jsp
http://www.nice.org.uk/usingguidance/commissioningguides/bytopic.jsp

This is my local health authority. Socialism means having a say in our service as you can see here, you may think it means the opposite but as you can we have a big say in what goes on, many can't be bothered but the chance is there to have your say and to be involved. Do you have the chance to be so involved in healthcare with your insurance companies?
http://www.southtees.nhs.uk/live/


The NHS of course has a budget to work to it answers to the tax payers who are also the users and the employees in it's medical facitlities. It does the best it can one hopes with what it has. The pot of money isn't endless but neither is it when the healthcare is private, the insurance companies answer to it's share holders, the companies are there to make profits the NHS isn't. Over here we pay for our pets healthcare, we pay insurance and yet the insurance companies with cap what is available to spend on drugs and treatment. To have them pay out for treatment per,mission has to be sought for every procedure and there is a cap on the money they will spend. Now I know this is animal welfare but I really cannot see it being any different from human medical welfare when insurance companies are involved, can you relaly tell me that insurance companies won't cap what is spent on a single patient? If you need a transplant will they pay for everything or will they suggest looking a cheaper alternatives if possible? If you are chronically ill will they pay for everything you need including hospice and respite care on the same premium you paid before you became ill?

Comparing our system with yours is like comparing horses and snakes, two totally different beasts.


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## Bill Mattocks (Feb 15, 2012)

Tez3 said:


> NICE is a national organisation. We have regional authorities for the NHS, what you can get in one regions may vary from another, it's to do with regions rather than countries. NICE makes recommendations, the individual health authorities decide what drugs to use. It's a matter of choice rather than the NHS or even NICe deciding who has what. Plenty of people have appealed to NICE for certain drugs and got them. Often NICE will reject a named drug from a famous drugs company in favour of a less known company and a cheaper alternative, that is just good house keeping is it not?
> http://www.nice.org.uk/aboutnice/whatwedo/niceandthenhs/CostSaving.jsp
> http://www.nice.org.uk/usingguidance/commissioningguides/bytopic.jsp
> 
> ...



I find myself reading your long explanations of why I'm correct;  did you disagree with anything I said, or do you just object to the fact that I said it again?



> Comparing our system with yours is like comparing horses and snakes, two totally different beasts.



Health care is health care.  No matter what the means of paying for it happen to be, it has costs.  There are different ways of paying those costs, and different ways of controlling spiraling costs. Costs can be controlled in one or more of several ways.  Primarily as I noted, by raising costs to the individual, or by denying care to the individual.  We have the one, you have the other.  I can and do compare them; without judging yours to be better or worse than ours.  Sorry you object to me making the comparison, but I'm going to keep doing it.  You're spring-loaded where your island is concerned.  Chillax, eh?

So far, we seem to be in violent agreement.  I've never had so much contentious talk with someone who didn't disagree with anything I said, but took exception to things I did not say instead.


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## granfire (Feb 15, 2012)

Well, yes, smokers tend to incur higher medical bills. On average I suppose.
However, they do spend a lot of money one extra taxes, too.


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## Carol (Feb 15, 2012)

granfire said:


> Well, yes, smokers tend to incur higher medical bills. On average I suppose.
> However, they do spend a lot of money one extra taxes, too.



Do they?  

I have heard that over a lifetime, success with smoking cessation programs across a large block of people (such as a country) have resulted in increased healthcare costs overall due to citizens living longer.  I heard that at a talk at Harvard University when a band-mate was pursuing his MBA so...while the information seems credible, I don't really have a way of verifying it.  I do have to admit that I wonder if that has been proven true over the course of time.


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## granfire (Feb 15, 2012)

Carol said:


> Do they?
> 
> I have heard that over a lifetime, success with smoking cessation programs across a large block of people (such as a country) have resulted in increased healthcare costs overall due to citizens living longer.  I heard that at a talk at Harvard University when a band-mate was pursuing his MBA so...while the information seems credible, I don't really have a way of verifying it.  I do have to admit that I wonder if that has been proven true over the course of time.



At least that is the line fed to us. Smokers are not healthy. 


(and I think the majority of monies paid on smokes is taxes...)


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## Big Don (Feb 15, 2012)

How much money would the states and federal governments lose if every single smoker quit today?
TONS
Smokers typically die younger? Tell that to my Great aunt Stella, died at 99, smoked a pipe...
Even if smokers do die younger, isn't that a savings on SS payments, elder care, etc?
To paraphrase Andrew Dice Clay: It is a shame having same sex relationships is treated better than smoking tobacco...


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## Randy Strausbaugh (Feb 15, 2012)

Big Brother goes even further.  In Columbus, Ohio they are building a casino.  The casino has made it known that no employees will be allowed to use tobacco products or nicotine patches *even on their own time in their own homes.*  Employees will be subjected to random drug screens, and if nicotine shows up, *can city!*  I'm not a smoker myself, but this seems to be a case of an employer going too far.  What an employee does (legally) on his or her own time is none of the employer's business so long as said employee shows up for work on time and does his/her job.


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## Bill Mattocks (Feb 15, 2012)

Randy Strausbaugh said:


> Big Brother goes even further.  In Columbus, Ohio they are building a casino.  The casino has made it known that no employees will be allowed to use tobacco products or nicotine patches *even on their own time in their own homes.*  Employees will be subjected to random drug screens, and if nicotine shows up, *can city!*  I'm not a smoker myself, but this seems to be a case of an employer going too far.  What an employee does (legally) on his or her own time is none of the employer's business so long as said employee shows up for work on time and does his/her job.



This is common practice in Michigan and has been for a couple years now.  It's been tested all the way up to the state Supreme Court and it's perfectly legal.

However, one can always quit a job.  Try quitting paying taxes.  And that's the problem; when the state takes it over, they set the rules, and since you can't legally quit paying taxes, you have to do what they say or...


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## Sukerkin (Feb 15, 2012)

Have to agree with Don about the tax issue.  Over here in Britain (sticks out tongue at BillM ), smokers pay a shed-load of tax for their habit.  Trust me, I used to be a 40-60 a/day man so I know of what I speak.  The tax take from tobacco is huge and more than covers any drain smokers put on the NHS (I shall have to re-check those figures as I'm working from remembered ten year old data).

As to the funding and efficiency of the service, well, as I ever said in pragmatic defence of social systems of resource management, there are some things that central authority does better than the market and the statistics seem to bear out that health care is one of them (as are transport networks, water supply and power transmission).  The NHS proves a better standard of care for a lower cost than the American style system of personal insurance does - it consumes a lower proportion of our GDP for a higher per capita result (despite the manifest inefficiencies within the system).  Part of this is the notion of palliative rather than emergency care - the classic prevention rather than cure paradigm.

You (the American voter) don't want socialised medicine because your indoctrination tells you that Commies are bad?  Then that's up you to you.  I don't think you have the sense the non-existent Creator Deity gave a mouse in that case but it's no skin off my nose if you want to pay more for less (unless, as ever in the "Land of the Free" (irony quotes required), you happen to be very rich).


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## Big Don (Feb 15, 2012)

How much has petty crime increased since NYC's extreme tax hike on cigarettes?
How much has NJ's cigarette tax revenue increased? How much has NYC's declined?


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## ballen0351 (Feb 15, 2012)

Sukerkin said:


> You (the American voter) don't want socialised medicine because your indoctrination tells you that Commies are bad?  Then that's up you to you.  I don't think you have the sense the non-existent Creator Deity gave a mouse in that case but it's no skin off my nose if you want to pay more for less (unless, as ever in the "Land of the Free" (irony quotes required), you happen to be very rich).



Has nothing to do with being a Commie it has everything to do with our Constitution does not give that power to the Govt.  If Obama and the dems want it then they need to do it right and amend the Constitution.  However they know they would never get the support for that since most Americans already have health care coverage and dont want it messed with.  

As for the smokers Im ok with a company making rules about its workers smoking or drinking on duty but Smoking is legal and I dont think they or the Govt has the right to say you cant do it in your own home.


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## Sukerkin (Feb 15, 2012)

I get you on the Constitutional aspect, Ballen :nods:.  I am actually not sure that anyone has made that point in previous visits to similar topics (I might just have missed it), so thanks for bringing that to the fore. 

That helps me understand better just why there have been some very strong objections to the idea of a differently administered, decent, health service for everyone - it's not really made true sense to me before why any rational person would kick up such a loud fuss about it.


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## Big Don (Feb 15, 2012)

At Qualcomm stadium, where the San Diego Chargers play, there is no smoking allowed in the stands, which are open to the sky. Smoking is allowed in the corridor, which, becomes cramped and crowded with smokers each time there is a break in play. I'm not opposed to people banning smoking in doors, banning it out of doors is a bit idiotic...


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## ballen0351 (Feb 15, 2012)

Big Don said:


> At Qualcomm stadium, where the San Diego Chargers play, there is no smoking allowed in the stands, which are open to the sky. Smoking is allowed in the corridor, which, becomes cramped and crowded with smokers each time there is a break in play. I'm not opposed to people banning smoking in doors, banning it out of doors is a bit idiotic...



In MD they have banned smoking at all state parks.  SO outisde in the woods all alone and you still cant smoke.  I am pretty sure there is no smoking at M&T Bank stadium where Ravens play anywhere in the stadium. No smoking in Bars either you have to go outside to smoke.


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## ballen0351 (Feb 15, 2012)

Big Don said:


> How much has petty crime increased since NYC's extreme tax hike on cigarettes?
> How much has NJ's cigarette tax revenue increased? How much has NYC's declined?



A ton of former Drug smugglers have stopped running drugs and now go to SC and NC and buy 1000's of cartons of Cigarettes and bring them back to NY and they now make more money selling black market Cigarettes then they did selling drugs with none of the risk.


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## Big Don (Feb 15, 2012)

ballen0351 said:


> A ton of former Drug smugglers have stopped running drugs and now go to SC and NC and buy 1000's of cartons of Cigarettes and bring them back to NY and they now make more money selling black market Cigarettes then they did selling drugs with none of the risk.



Wow, a policy that caused a demonstrable increase in crime. Have NY'ers quit smoking? Or do they buy black market smokes?


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## Bill Mattocks (Feb 15, 2012)

Bottom line, my point isn't really about the goodness or badness of nationalized, socialized, or single-payer health insurance.

It's about a simple fact.  Private coverage means choices; if a person wishes to be made to pay more based on their lifestyle choices, they can.  If they choose not to, they can refrain.  If they wish to modify their behavior, they can.  If they wish not to, they can refrain.  The consequences can be severe for making a poor choice in lifestyle or health care coverage; but they are one's own to make.

In a single-payer system where by necessity, everyone must take part, that choice is removed, forever and permanently.

Such systems may tread lightly on one's choices and lifestyle, or harshly.  But whichever they do, the choice of it happening is no longer the individual's to make.

That's all.


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## Tez3 (Feb 16, 2012)

Why can't you opt out here then? If you are unemployed, you don't pay your NI, you can also pay more and have private healthcare if you wish. I think the thing to remember here is that the government doesn't have the power, the NHS belongs to us, the people, it's ours not the governments. The government is trying to 'reform' it at the moment, it won't succeed as the people don't want the changes, it may even bring the government down and we'll have an election. the thing about nationalisation is not that the government owns things it's that the people do. We chose to vote in the party that pledged to bring in the NHS, thus it was our choice to join together to have our healthcare the way it is, people don't want it any different even now. As I said if a government starts messing around with it and we don't like it the government will be defeated. Governments here don't have the powers that your President has, that your government has, we have checks and balances to stop the abuse you fear. We want our healthcare this way, we chose it, we will keep it. 

http://news.bbc.co.uk/1/hi/events/nhs_at_50/special_report/123511.stm


Bill you may think I'm agreeing with you, if that's how you read it fine but trust me I'm not.


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## Bill Mattocks (Feb 16, 2012)

Tez3 said:


> Bill you may think I'm agreeing with you, if that's how you read it fine but trust me I'm not.



Yes, you are agreeing with me.  The reason I say you are agreeing with me is that you see every comment I make about your NHS as an attack, and you think I don't like it.  I haven't disagreed about your statements about the NHS, and I am not attacking it.  

ME: I like cheese the way it is and I don't want it to become government cheese.
YOU: The UK cheese is great.
ME: That's fine, I'm talking about the difference between private cheese and government cheese.
YOU: In the UK, the people control the cheese, not the government.
ME: If you like it, that's great.  I'm just saying I like private cheese.
YOU: The UK is GREAT!  I love the cheese here!  I am disagreeing with you!

Like that.  The reason you're not disagreeing with me is that you are disagreeing with things I haven't said.


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## Tez3 (Feb 16, 2012)

Bill Mattocks said:


> Yes, you are agreeing with me. The reason I say you are agreeing with me is that you see every comment I make about your NHS as an attack, and you think I don't like it. I haven't disagreed about your statements about the NHS, and I am not attacking it.
> 
> ME: I like cheese the way it is and I don't want it to become government cheese.
> YOU: The UK cheese is great.
> ...




So your acid remarks about us not having any choice is my agreeing with you?


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## Bill Mattocks (Feb 16, 2012)

Tez3 said:


> So your acid remarks about us not having any choice is my agreeing with you?



You only appeared to disagree, you actually agreed.

ME: When the government provides health care, all taxpayers have to pay into it.  Taxpayers have the right to control costs.  When payment is compulsory, the individual no longer has a choice in the matter.
YOU: The NHS is the citizens.  The government doesn't control it.
ME: (Unsaid, because that's just silly) The government of course *is* the people, and government agencies *are* the people, that's true.  So what?  You're just arguing it's not true by redefining what the government is.

In any case, every point I've brought up, you've abandoned and found a new point to argue against; hence, you agree with me.  And most of your arguments...they're playing silly buggers with words, not argument.

If I say England has a government-controlled health care system, you say it's not England, it's the UK.  Yeah, so what?  Not really the point.
If I say England has NICE and Scotland and Wales have something else, therefore I was talking about England and not the UK, you say NICE is part of the NHS so it's still the UK.  Yeah, so what?  Not the point.
If I say England controls costs by limiting drugs, for example, you argue that some drugs are not safe yet.  Yeah, but again, who cares?  Do they or do they not limit drugs as a cost-control measure?  Not answering the question is admitting I'm right.  Again, being distracting is not arguing.

All of your 'points' so far have been to point out that you like the UK system of health care.  Yay you.  I've not said it's bad.  I've said it is a government-run system that all taxpayers have to pay into; they cannot opt out of it (yes, tedious trifle pouncer, they can buy their own care, but they still can't opt-out of the national health care system).  You're not arguing with me, you're niggling at side points because that's all you've got.

So yes, you agree with me.  You just don't like it, so you keep trying to get to argue about tedious trifles and insist your health care system is wonderful.  Fine, it's wonderful.  Not. The. Point.


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## Tez3 (Feb 16, 2012)

Bill Mattocks said:


> You only appeared to disagree, you actually agreed.
> 
> ME: When the government provides health care, all taxpayers have to pay into it. Taxpayers have the right to control costs. When payment is compulsory, the individual no longer has a choice in the matter.
> YOU: The NHS is the citizens. The government doesn't control it.
> ...




As Sukerkin said on another thread the right wing Americans are always right, they cannot be wrong and we should be grateful they even deign to acknowledge we exist. So I'll bow out, leaving you to your illusions. You miss my points totally, perhaps I didn't explain well enough or perhaps you have to actually know what it's like here and have a couple of thousands of years history binding you as a people to understand.


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## Big Don (Feb 16, 2012)

Get a room


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## Tez3 (Feb 16, 2012)

Amusing...not. I don't particularly like being patronised and it's all 'you agree with me' not one 'I agree with you'. anyway  I'm off to work. Troops are off to Afghan this year so are making the most of any off time they have which means life is hectic. Have fun guys


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## seasoned (Feb 16, 2012)

He said then she said, then she said then he said................


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## Tez3 (Feb 17, 2012)

seasoned said:


> He said then she said, then she said then he said................




Well I could agree with him but them we'd both be wrong. I've never figured out why people argue as if they were right about a country they don't actually live in, I wouldn't correct any of you if we were talking about America but everyone an expert on the UK it seems.

You have guns, and regard being armed as your right because of your history and culture, we have the NHS because of our history and culture and also regard it as our right.


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