Great quotes by politicains, Lyndon B Johnson, Winston Churchill, etc.

quote:

Originally posted by fatcat:
They don’t get any better than this.

Please tell me this was the wazzock at No. 10

John

quote:

Originally posted by David Scott?:
Gary,

I have no doubt American healthcare is exemplary for those whose insurance is adequate to their needs.

This is probably less to do with the inadequacies of public funding than with cultural traditions. I expect well heeled Italians in the private wards were paying good money for their enemas and going home happy.

David

David,

My point is that people who don't have insurance also get access to the same quality of care are those who are insured. I won't deny that there are horror stories and it is usually those who were denied care by their insurance companies.

If the govt takes over there will be many more denials for care due to costs and limitations placed just as we see in Europe and in several states out west in the US.

As far as Italy was concerned, this was not a cultural issue with the care my wife received, this was completely due to underfunding of resources, medications, etc... due to their govt funded system.

quote:

Originally posted by gary1 (US):

quote:

Originally posted by fred simon:


One of my favorite quotes from anyone, let alone a politician, is by the late US senator Paul Wellstone:

Politics is not about power. Politics is not about money. Politics is not about winning for the sake of winning. Politics is about the improvement of people's lives. It's about advancing the cause of peace and justice in our country and in our world. Politics is about doing well for people.

Best,
Fred

That's a great quote if only it were true. First of all politics is first and foremost about getting re-elected. Everything else is secondary.

Read Robert Caro's trilogy on LBJ or his best book about Robert Moses "The Power Broker" for a real look at what politics really is.

What Wellstone said is true. It was true for him, and it's true for many politicians as well. That some politicians don't live up to it doesn't make it not true.

Best,
Fred

quote:

Originally posted by gary1 (US):

What the supporters of UHC do not ever tell you is that of the $47 million who are uninsured the overwhelming majority are people in the 18-30 age group who are employed and who have CHOSEN not to buy insurance because they'd rather spend their money on alchol, electronics, cigarettes etc...

I'm sorry, that's anecdotal mythology ... I'm gonna need to see some verifiable, nonpartisan documentation of that claim. "The overwhelming majority"? Not true.

Of course there are some who fit that description, but their actual numbers are very few. This is akin to the ages old mythology of the welfare queens, having babies by the dozens, collecting government checks, and not unable to work but too lazy to do so. Again, of course there are some who fit this description, but not anywhere as many as the right-wing would have us believe ... most people on welfare truly need the assistance, just as most people who file for bankruptcy due to their inability to pay huge medical bills have no other choice.

Gary, it seems you're between a rock and a hard place ... on the one hand, you echo the right-wing mantras decrying the "lazy and shiftless" who would rather buy cigarettes and alcohol than health insurance, and saying the bankruptcy laws are too lax, and disparaging the idea of government regulated UHC.

On the other hand, you correctly condemn lack of governmental regulation of the voraciously greedy insurance companies who drive up health care costs to the astronomical point at which people are forced to declare bankruptcy.

You can't have it both ways. Human nature is greedy, and unregulated market-driven health care is far too susceptible to greed. Thus, government regulation is needed, as it always has been in any industry in which the dollar supersedes justice.

Best,
Fred

I'm not sure how it's possible to argue in one sentence that most people who are without health insurance have voluntarily chosen to forego it and spend their money on cigarettes, alcohol, etc (and I'm not sure where the evidence supporting this claim comes from) and in the next paragraph point to a 300% increase in one's own cost of health care (premiums, deductibles, etc) over a 10 year period. If costs are going up at that rate, is it not likely that there will be many people who will be unable to afford them (since the overwhelming majority of people will not have seen their incomes increasing by the same amount)?

And what about those who are unable to obtain coverage because of issues like pre-existing conditions or whose lifetime coverage limits have been exceeded because of major illnesses? Surely, there is a role for government to intervene on their behalf in some way? In their cases, coverage will be unavailable no matter how much they might be willing to pay for it.

Having lived in both Canada and the UK, I am fully aware of the weaknesses of the various flavours of universal health care but I do have to say that it should be possible for the US to introduce some type of universal guarantee while retaining most of the advantages of their current system.

Some Blair gems:

"We are not the masters. The people are the masters. We are the servants of the people. . . What the electorate gives, the electorate can take away" (1997)

"This is not a time for soundbites. We've left them at home. I feel the hand of history upon our shoulders" (1998)

"I've listened, and I've learned. . . I, we, the Government are going to focus now relentlessly on the priorities the people have set for us." (2005)

http://www.askoxford.com/worldofwords/quotations/quotefrom/tonyblair/

Gary,

I think you would be very surprised were you to see the quality of care available in the UK nowadays. It is definately true that under the last Conservative Government the National Health Service had declined to the point where anyone who could afford it probably chose to pay privately and lets face it Thatcher in particular only cared about those who could afford to exercise choice. However, since Labour came to power (and poured billions of pounds in) it is my belief that the NHS now offers a superb standard of care across the board to the rich and the poor. The hospitals are clean, modern, well equipped, you're seen pretty quickly, offered state of the art treatment, there are 24 hour helplines (free), drop in centres open at weekends. In short it's now world class and the best bit is that unlike in the USA this high standard is not denied to anyone based upon income, nationality, colour or class. I for one am rather proud of that and I have no involvement in the NHS other than as a satisfied citizen and taxpayer who has paid for it and I'm glad I did.

Re: quotes my favourite of all is from one of the greatest politicians and orators of the 20th and 21st century - Labour MP and Lord Anthony Wedgwood Benn - Five questions Benn insists should be asked of any powerful person:

"What power have you got? Where did you get it from? In whose interests do you use it? To whom are you accountable? How do we get rid of you?""

Could anyone say it better - for more see:

http://www.bennites.com/ISSUESLABOURSOCIALISM.html

The best Prime Minister we never had. Without him there's be no Concorde.

Jonathan

"Liberty is not merely a privilege to be conferred; it is a habit to be acquired."

David Lloyd George

Jonathan,

What you guys are not hearing or reading is that in the US healthcare is not denied based upon ability to pay, race or any other factor. Everybody can get the same level of care. Why do you think everyone the world over gets on a plane and comes over here and shows up in an emergency room in the US, or cross the border illegally to go to a US hospital, or comes from Canada to a US hopsital, or for many other reasons, it's because the get the care they want and unfortunately we US taxpayors wind up paying the tab for all of this. If it was so easy and great elsewhere that's where they'd go.

BTW my example of what the British ex-pats said was only about 18 months ago. Furthermore there is a reason why so many Brits opt for the private system, because there is better access to care. Why would someone want to pay for something if the NHS was so wonderful.

You can tell me whatever you want, but I have heard and continue to hear about what goes on in Europe and Canada with even getting routine screening is difficult. I have friends who currently live in these countries and friends who have done their medical training as well. My wife's experience was less than 1 year ago.

In Canada they recently rescinded the physician income cap because the drs would work until reaching the cap and take the rest of the year off.

quote:

Why do you think everyone the world over gets on a plane and comes over here and shows up in an emergency room in the US

I would not do this, in any circumstance, so not quite everyone ...

ATB from George

Jonathan

You have not heard about the situation in Mid STaffs - over 400 extra peope died due to excessive chasing of goverment targets.

Even now going into a NHS hospital for any length of time is is a MRSA and or C-Dif risk

In the adjacent 6 or 7 house in my neighbourhood I am aware of 6 people going into hospitals for significant operations in the last 4 years.

3 out of the 4 who went NHS got infected and their stay in hospital was significantly extended due to the infection. Two of the people who went private did not get any infection

THe UK health service is a lottery you may be lucky, you may not be lucky, you may get the drugs, you may not depending on where you live.

If you in your late 60s or older - then abandon all hope if you need care.

quote:

Originally posted by Derek Wright:

If you in your late 60s or older - then abandon all hope if you need care.

Sorry, but that's just scaremongering nonsense. Having worked extensively with healthcare systems and funding of same in UK, the Americas, Germany, Italy and the Middle East the one thing that can be said is that in the UK you get particularly more "care." The difficulty, as with any system working under a budget, is effective triage.

There is no universal solution to the funding of healthcare as no one seems to be able to balance the efficient delivery of a service within the context of successful outcomes and reasonable bureaucracy. This applies to both governmental bodies and the tax- / insurance premium payers themselves. Universal healthcare is essentially a social issue where those that have are supposed to subsidise those who have not. This ends up being a snake that eats its own tail, "my healthcare should be free," "why should I be subsidising fat, smoking, alcoholic unemployed layabouts...," "where's my performance related bonus?"

In the context of the US it is neither greedy insurers or physicians that create the most significant problems. It is the litigious society that drives malpractice premiums to such a level that medical students elect to avoid high risk specialties such as Ob/Gyn work, creating a real lack of skills across the board, particularly in those facilities servicing the indigent communities.

Not that statistics tell us anything, but infant mortality in the US (6.3 per thousand) is consistently higher than either the EU average or Canada by between 1 and 2 per thousand. This is in spite of there being more neonatal physicians and beds per capita available than in these countries. Depending on the survey, the rate in the US for those of African American origin is as much as double the US rate as a whole. Nevertheless these are all better than the world average of ca. 48 per thousand.

Huwge,

I agree with many of the points you make:

The stastics with respect to infant mortailty are true, but what people don't report,nor any of the studies, is that this occurs because of the behavior and lifestyles of those individuals. They don't get healthcare and just show up in an ER in Labor. This has nothing to do with the cost of healthcare, they don't go and get prenatal care and wouldn't even if it were "free." BTW there are free clinics everywhere for these people and they still don't go. UHS would not change this fact.

The malpractice issue is more complex. Yes, our population wants to blame someone else for evrything, but the system is set up poorly and is designed to favor plaintiffs since there are no repercussions for them if they lose and juries award outrageous amonts of money. In fact, if someone gets injured at work and has the same outcome as some who's end result is the same , but it is determined that that end result was due to negligence the award to that individual's award is typically a minimum of 30x greater than what a worker gets under the legal system of Workers' compensation.

Why do have som many more lawsuits?

1. Lottery mentality
2. No personal responsibility
3. Managed Care
Has destroyed the dr./patient relationship since physicians are paid so little for their services that in order to earn a living everything is volume based. This means short, curt office visits, unsatisfied patients who don't get the time they need and therefore do not consider the physician as a caring friend, and are more likely to litigate if there is any problem.

I do not agree with your comment about insurance companies since your premium dollars are not going to Drs., but to executives and shareholders.

Why are fewer drs. going into high risk specialties? Yes, the risks of lawsuits are higher, but the real factor is based upon two deciding factors: income, as individuals do not see the risk/reward, and the fact that under managed care you increased costs of doing business cannot be shifted to your patients (raising your charges does not mean more income in managed care). Every other industry always shifts cost increases to consumers, but physicians cannot do this (we are the only "capitalists" who cannot do this)anymore, but our costs of doing business increase evry year and real incomes have dropped by almost 21% during the last 8 years. Many physicians have retired because their cost increases have completely eroded their bottom line. Who would choose this?

This situation will only worsen under any UHS as income will certainly decrease, but I doubt the govt will bear the cost of malpractice.

Physicians definitely do order more tests now than previous to practice defensive medicine since if there is a lawsuit your only defense is you medical record (paper trail). Any attorney will always find an expert to claim that since a particular test wasn't ordered that was the reason for the poor outcome.


I'll break this into 2 posts.

Costs:

Yesterday it was reported that it will cost $1.5 trillion for UHS in the US. Given that govt estimates are always way off it will probably be more like $5 trillion. There already looking at ways to cut costs.

There are only 2: rationing of services and less reimbursement for services.

Medicare has already started this. The way medicare works is that a set amount of dollars are allocated to provide all services (physicians, hospitals etc...) As more people have hit "medicare age", there has been no increase to the allocated dollars. What happens? costs need to be reduced. How?

1. Decrease reimbursement for physicians/hospitals (not drug companies, device makers, medical supply companies)

2. Medicare has already rolled out a list of certain complications that if they occur in the hospital setting they will not pay for. This effects the hospital, I'm not sure how it effects the drs who have to provide the service.

3. Hospital re-admissions for the same problem within a specified time course are not paid for by medicare. I'm sure the privates will follow suit to increase their profits in due course.

4. Reimbursement will be linked to "performance", so if your physician does an appendectomy and you are in the hospital for 7 days, your dr. will get paid less than someone who has you in for 3 days. It's based on an average of all physicians for the same procedure. It doesn't take into account your medical condition when this occurred-- are your healthy or do you have diabetes, high blood pressure, obesity, etc...and therefore more likely to require a longer hospital stay. It doesn't take into account if you presented with a ruptured appendix and more likely to require a longer stay or develop an intra-abominal abscess requiring further intervention ( a likely scenario). I'm sure they'll also develop criteria to determine if you delayed treatment which allowed the appendix time to rupture. Never mind that the hospital didn't have an OR available for you to perform the procedure when your patient arrived. It will also take more time and cost more money to determine which level of payment you will receive. Hospital records will need to be reviewed to look at the performance criteria and there will be a delay in payment to the physician which will affect their cash flow and ability to stay in business (yes medicine is a business). These increased costs will also require further cuts. A never ending cycle.

5. Decrease reimbursement to outpatient facilities- eg surgicenters. These are the low cost providers which are now being pinched even further. Ultimately these facilites will be put out of business, some are starting to fail, and thus more services will be shifted back to hospitals which costs far more than the outpatient facilities.

There are ways to overhaul the system, make it work, and cost less, none of these options is being evaluated and none of them have anything to do with UHS or govt control of healthcare.

BTW, almost forgot. There are hospital and privately owned mutli-specialty groups which are essentially HMOs.

Physician performance is tightly controlled due to economic factors such as capitated payments for HMO patients, low reimbursement for PPO patients, overhead etc...

Physicians are required to see a certain number of patients per day and it is broken down to per hour to maximize revenues. Someone knocks on the door if your taking too long.

As reimbursements decrease and will do so quicker under any govt controlled UHS what do you think is going to happen.

In the US we already have Nurse Practitioners and midwives petitioning to function as full fledged physicians. The govt and insurance companies like it because they pay less per visit than for the doctor.

Wait until the malpractice suits start hitting. The money saved will pale in comparison to the payout by malpractice carriers and since NPs and midwives are underinsured to begin with wait and see what happens.

quote:

Originally posted by gary1 (US):
In the US we already have Nurse Practitioners and midwives petitioning to function as full fledged physicians. The govt and insurance companies like it because they pay less per visit than for the doctor.

Wait until the malpractice suits start hitting. The money saved will pale in comparison to the payout by malpractice carriers and since NPs and midwives are underinsured to begin with wait and see what happens.

Mmm. Presumably you mean they want to be recognised as clinicians, rather than doctors per se.

In the UK such folk as physiotherapists, nurses, radiographers etc. have become registered under the Heath Professions Council, and under the umbrella of their professional colleges can work as autonomous healthcare professionals. Their status is protected by law, and anyone who seeks to practice in their disciplines and is unregistered is committing a criminal offence.

This system works very well in the UK, and it means patients can be referred directly to the various specialist practitioners without going through time-consuming and convoluted processes.

As far as malpractice litigation goes, the clinicians in question all have to carry substantial insurance (they'd be mad not to!) and despite the scaremongering by doctors before this system came about, in practice such cases have been almost non-existent. The important factor is that clinicians are trained to refer cases which fall outside their area of expertise.

Tonym,

I'm not about scaremongering. I make my comments based upon what I witness in my profession.

Any physician who agrees to serve as the"umbrella" for these people so that they can practice independently and autonomously is out of their minds. You, the physician are ultimately responsible for any of their decisions whether you agree, or even know what they've done. The physician would be the "deep pocket" and the one the attorneys will go after. Remember in the US, litigation is far more prevalent than in the UK.

In the US, NPs midwives carry little insurance with very small premiums at this point.

One example,one local hospital employs a mid-wife group. They must be "covered" by an OB/GYN. The hospital does not want to pay for their own OB/GYN group who would then supervise the midwives. So, the hospital has contracted with the private physicians to cover the midwives, yet the hospital won't provide malpractice insurance for the physicians when they are covering the midwives. Furthermore, the midwives do not practice the standard of care in the community. End result, no contract has lasted more than 6 months before the physicians have terminated their relationship.

I'm not knocking these health care providers such as NPs, midwives etc..., but they are Ancillary providers, not physicians, that's why they are callied Allied Health Professionals.

Why would anyone think that someone who has gone to medical school for 4 years and then completed anywhere from 3-8 years of post-graduate training is the equivalent of someone with a bachelors degree and typically 2 years of training?

If that were the case I wasted many years when I could have been practicing. My wife who is an OB/GYN and has had to work with NPs and midwives has only found a rare few that she feels have knowledge, experience, and good decision making skills. As she has said many times the problem is that they do not have the knowledge and therefore do not know when they do not know.

They have only gained in popularity because they are cheaper labor. Smart physicians employ NPs or PAs because they can double their output of patients seen at a cheaper cost than hiring another physician and thus increasing their income even if the reimbursement is slightly less than if the service was provided by the physician.

As you said patients see these people so they "do not have to go through the time-consuming and convoluted process." Thank you for proving my point. This is the nature of socialized medicine. Less access to the physician, so we find a cheaper alternative to use as a "work around."

You also must remember that the volume of patients seen in the US dwarfs that in the UK by huge numbers.

The thing is Tony, I don't know how I'd feel if I was raised in the UK and dealt with your system. Maybe I'd think it was fine because I had never experienced the alternative. However, I am both a provider and a consumer of healthcare. Unless you can see both sides of the equation, you don't really know what goes on. No disrespect intended.

I do know that I have experienced both systems and unfortunatly the European system experience was not for some minor problem such as a sprained ankle or a cold or even an elective condition, but was with a potentially life threatening emergency and all I can tell you that as a physician, not just as a husband, I had to stand by watching incompetence, not being able to do anything about the situation I was witnessing, not being allowed to even put an IV in my wife's arm ,which the first responders did not know how to do, seeing the time response in the system (or lack of) in an emergency situation and I was terrified and shaking. The Brits who we were staying with saw me pacing the halls watching and couldn't believe not only what they were witnessing, but were wondering how I didn't completely freak out and and just push them out of the way.

Ok, this from someone who has during my training been chief resident at one of the busiest trauma centers in New York, spent months as head of the Surgical Intensive Care Unit, and dealt with life-threatening situations almost daily on that Trauma service.

Personally I would not be against UHS if the system worked, there was no rationing of care and the physicians were compensated appropriately. Unless all 3 conditions are met I'm against it. I already know what the end result will be.

quote:

Originally posted by gary1 (US):
Any physician who agrees to serve as the"umbrella" for these people so that they can practice independently and autonomously is out of their minds........Why would anyone think that someone who has gone to medical school for 4 years and then completed anywhere from 3-8 years of post-graduate training is the equivalent of someone with a bachelors degree and typically 2 years of training?

Although it's often the case that doctors of certain specialties will provide medical input as part of a dedicated rehabilitation team in the UK, and have overall responsibility for treatment, there are areas where Allied Health professionals can act autonomously, are trained to do so, and are insured accordingly.

The length of said training is commensurate with their area of expertise and is often far longer than just a minor degree and a couple of year's worth of post-grad training for those at the highest levels.

This just illustrates how different both heathcare systems are, and in terms of value for money I would argue the UK system is excellent.

quote:

The thing is Tony, I don't know how I'd feel if I was raised in the UK and dealt with your system. Maybe I'd think it was fine because I had never experienced the alternative. However, I am both a provider and a consumer of healthcare. Unless you can see both sides of the equation, you don't really know what goes on. No disrespect intended.

Could you be a bit more condescending Gary? you see I'm not very good with subtlety.

You know nothing about me or where I was raised and I'm certainly not going to enter into a weeing-up-the-wall contest. Suffice to say that for the last forty-odd years I've been a heathcare provider and recently retired from an independent heathcare provider which I set up in the eighties and grew into the second largest such company in the world.

Tony,

I apologize. Congratualtions on your success. Nice to be able to be rewarded for your expertise and entrepreneurship.

I agree with your comment about the rehabilitation services. This is defintiely an area where allied professionals can and do function independently with overall supervision by a physiatrist.That is very different than NPs and midwives opening thier own practices and providing healthcare as physicians.

Yes, the UK and the US are very different for a multitude of reasons. My point has always been that just because NHS works in the UK, doesn't mean it will work elsewhere and on a much larger scale. I do see there has been a shift of healthcare from NHS to the Independent sector with the privates now contracting with NHS to provide care for an increasing number of NHS patients for better access to services, decreasing waiting times etc... Your opinion is that the system as it now stands provides good care and VFM. Many others feel differently.

Just look at Medicare in the US which is our "retirement" insurance. Fees are below the cost of providing the services. Hospitals and Drs. already lose money on a real cost analysis for providing services to these individuals and need private patients and workers compensation patients to survive and profit. Many physicians limit their appointment slots to these individuals or have withdrawn from the system altogether.

Look at the Veterans Hospital System for military personnel. Paid for and run by the govt. An untold and little known disaster. Beaurocracy, limited access, and overall not great standard of care. A fore-runner of any NHS system in the US.

This will only worsen under any type of NHS system. There is no question that our system is not perfect, none are. Scaremongering is being used to convince the public that an NHS type of system is needed when it is not. Americans have the services they now enjoy almost entirely due to the private sector.

As far as VFM, costs and statistics are evaluated. Great, they can be manipulated to make any position depending on your viewpoint. They also only look at the "medical costs" of the system. No one looks at what the US gets in overall economics terms in return for our large private heath sector: millions of jobs, benefits, retirment accounts, community vitality, etc... The majority of the money paid to physicians doesn't even make it into their paycheck but drives a huge economic engine of primary, secondary, and tertiary services.

Game tony.


So no politician quotes then.
Perhaps if one started a "Discussion of health care politics" thread,we would get some in that?

Actually BigH47, I wouldn't say "game Tony" by any stretch of the imagination.

The fact that I didn't know Tony was in the healthcare field does not change the overall argument or discussion.

Interesting that we are now seeing many UK residents now coming to the US and paying out of pocket for our healthcare services. They are shocked that they can just call a primary care or specialists office and make an appointment in a timely manner, get seen, get sophisticated tests, diagnosis, and treatment within a few days. For the "same access and care" they were told by NHS that the waiting time to see a primary NHS care physician was anywhere from 4 months to over 1 year and longer in some instances.

The province of Quebec has 8 MRI machines servicing the entire province. There are more than 8 MRI machines within 5 miles of my home.

"many UK residents now coming to the US and paying out of pocket for our healthcare services"

and how much

you can do the same in the UK if you are happy to pay for it and also avoid the DVT risk.

quote:

Originally posted by gary1 (US):

I do see there has been a shift of healthcare from NHS to the Independent sector with the privates now contracting with NHS to provide care for an increasing number of NHS patients for better access to services, decreasing waiting times etc... Your opinion is that the system as it now stands provides good care and VFM. Many others feel differently.

The model of involving independent providers to provide services to NHS patients is a very good one IMO, and it's interesting to note both sides of the political divide support the concept.

The NHS is a wonderful institution and I stand by what I stated regarding its value for money. This doesn't mean it's adequately funded, or the service is faultless any more than it is in the USA. Nevertheless if I suffered an acute illness I know where I'd rather be...

It's pretty pointless to trot out examples of bad practice, rather better to look at how a high-quality, cost-efficient service can be delivered to the largest numbers of people, and again IMO the NHS, working with the independent sector in competition, has the greatest chance of achieving this.

As always we'll just have to agree to disagree. I don't think that there is any government agency that can adequate provide for anything, in the US at least. As I said we are two very different countries and the mindset of the population is very different in what we are willing and not willing to accept.

I do not believe that the total cost of the healthcare services provided represents the total value or importance of the entire healthcare industry to the success of our economy. In the US physicians in the private healthcare industry contribute directly or indirectly more in economic terms than in any other nation as I've mentioned before. None of this will be looked at when decisions are made going forward whether we ever get to a NHS system a two-tiered system, etc...

We all agree that there are problems in the current UK system, none are perfect, take the size of your healthcare system and multiply it by a huge factor to account for an equal size of the population and I cannot see in any way shape or form that the US govt. will be able to deliver any type of quality, cost efficient healthcare. Even with the current Medicare system so much of the running of the system is farmed out to the privates insurance carriers who are paid huge sums of money to do what the govt can't and how much waste in that aspect alone there already exists.

There are ways to actually overhaul our system, but you also have to eliminate the fraud and abuse from so many who are costing us billions in healthcare dollars that the govt allows to continue. Not to mention our liberal policies that allow illegal immigrants to come here and recieve top quality care for free when the rest of us are paying significant premiums to have.

The biggest joke in the whole system is that the joke is on us who actually pay have less access to care than those folks above as those who are on the public system or free loading get the same care for nothing. HMOs already limit access to appropritate care if your in the plan. I see this everyday. Wait until it's rationed by the govt.

quote:

I don't think that there is any government agency that can adequate provide for anything, in the US at least.

Dear Gary [US],

That is probably what we Europeans were really being too kind to point out.

Of course no governement [or in fact any other large] organisation is flawless, but there is a long and noble tradition of well run state provision in Europe, and perhaps what is surprising is not that there are failings, but that these failing a relatively few and far between. Thus they make front page news.

Of course there are well healed Europeans who can afford better than what the National Health services provide, but at least in the UK, Norway, and some other European countries, I would definately think not only the poorest in scoiety, but in fact the majority of society would be not only well catered for at home but quite possibly better catered for than they could afford to be in the US.

I wish you good health Gary. Certainly failing health can be devastatingly expensive in the US.

ATB from George