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So if you're statistically more likely to need X amount more health care per pack, charge for and include an insurance voucher for that amount in a little coupon that you turn in or otherwise register.
They used to give away coupons for valuable prizes in cigarettes, this would give them something
they really need.
Why should non-smokers have to pay for smoker's self inflicted health problems? You smoke a lot, you buy a lot of health insurance, you smoke a little you buy a little.
The insurance would be specific to smoking related health issues obviously.
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Annotation:
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The advantage over spending the revenue from a cigarette
tax on the pulmonology service at a municipal hospital, or a
subsidy for distributors of portable oxygen concentrators
would be that the consumer is assumed to be the best judge
of which are the best suppliers of such goods & services? |
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It's just supplemental health insurance for smoking related disease whose cost is based on your increased risk for buying that pack. |
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So if statistically you would require $100,000 more health care than a non-smoker after smoking a pack a day for 20 years, you would buy a $14 supplemental health insurance voucher with each pack. |
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If you go into the hospital and they ask for your insurance information, in addition to whatever else you have, you give them your H.A.C.S. card as well. "Healthcare Additional Coverage for Smokers". If it's a smoking related problem, your H.A.C.S. insurance will be billed. |
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//Punitive tax by fascists 4.00
I told you so tax 1.00// |
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In agreement on that one. |
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//supplemental health insurance for smoking related
disease whose cost is based on your increased risk for
buying that pack.//
Aha, that's a better justification than the one I tried to
supply. Supplemental health insurance for smoking
related disease is baked by insurance premium surcharges.
But supplemental insurance on a per-pack basis is a novel
idea, and insurance premiums can't do it, because people
would lie about their consumption. |
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But the marginal surplus health cost of a pack of cigarettes
will vary with the absolute number of packs consumed.
That is, if you've been smoking 5 packs a day for 5 years
and today, because it's your birthday, smoke 6 packs then
the increment, to your expected future health care costs
is smaller, from today's 6th pack than from the first 5, and
smaller still compared to the first one you smoked 5 years
ago. |
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So the vouchers shouldn't have a fixed value. If you
"spend" a stack of 10 vouchers, the first one should be
valued at 100%, the second at (say) 95%, the third at 90%,
and so on, with the last being counted at only 63% (say) of
face value. Something like that. |
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Sounds a little complicated, I tend toward simple is better. You have your H.A.C.S. account, you save your coupons and every once in a while scan them in to get credit. Or I suppose you could have your insurance card with you and scan them in at the grocery when you buy them. Stores already ask "Do you have a Tryandsave card?" They could just say "Do you have your insurance card?" They scan it, scan the cigs and you get the credit. |
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It might also make the black market a little tougher since each cigarette pack would registered. They could still sell non-hacs compliant black market cigarettes but consumers would know they're not legit when they tried to scan them into their account. I think most smokers would rather go to the store down the street than deal with Fat Tony selling boxes out of the back of a truck. |
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// Why should non-smokers have to pay for smoker's self inflicted health problems? // |
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Not a smoker and I generally agree, but that logic can
be a slippery slope. Why should exercisers pay for
non-exercisers? Why should people who eat
healthier pay for fast-food junkies? Why should
people with better genes pay for people with worse
genes? |
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Agreed, and of course I don't want to do anything that encourages the food/health/lifestyle police to further butt into people's lives. |
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But I don't think other things that effect people's health lend themselves as well to this thing. You could put it on booze, but a glass or two of red wine every day might actually be good for you. You can eat fast food and be in great health with low cholesterol, just don't eat it 3 times a day. You can also eat healthy fast food. |
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There's not as much controversy over cigarettes and their health effects and you wouldn't need any crazy cross referencing of fat content in restaurant food etc. 1 pack, 1 coupon. |
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But yea, I wouldn't want to see this on anything else. |
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But what if you don't want to spend money on health insurance? |
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//Sounds a little complicated, I tend toward simple is
better// In the real world, sure. But here? |
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//each cigarette pack would be registered// Ah, that's more
like it. |
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Well, maybe registered was the wrong word. Registered like a gift certificate from a store is registered. |
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As far as forcing people to buy health insurance, that's where I split with most philosophies on this. I think if somebody will never need to use health insurance, they shouldn't be forced to buy it. Problem is, everybody needs health insurance, and if they decide not to buy it and get sick, I don't want to be on the hook for their healthcare because they wanted to spend their health insurance money on something more fun. I'd rather spend my money on something more fun than their health care too. |
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If you're poor, ok, society should help you out, we don't want people dying in the streets, but if you've got any money at all, you should put the first few bucks from your paycheck into taking care of your well being. And putting some of that cigarette money into cigarette related illness health insurance might be a good thing to do to. |
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[doctorremulac3] Those who benefit should pay. But
there's a confusion about who benefits. Someone may
choose to go uninsured, and freely accept the
consequences of that decision, should he sicken. Society
may be squeamish about standing idly by while he suffers,
and may choose to protect itself against that, by providing
him with medical care, although he relinquished any claim
to it. But in that case, it's the others who benefit, and
they should be the ones who pay. |
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The problem is the moral hazard. Since it's well known
that society's too squeamish to let you die in the gutter,
your choice to go uninsured might be based on the
expectation that others will pay for your health care.
That's an argument for mandatory insurance, though not
one that will convince everybody. |
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// Society may be squeamish about standing idly by while he suffers // |
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So "society" is at fault, once again .. |
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// it's well known that society's too squeamish to let you die in the gutter// |
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// the expectation that others will pay for your health care. // |
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Somewhere, sometime, there's got to be an up-side to optimism. |
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// an argument for mandatory insurance, though not one that will convince everybody // |
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I'll admit I'm not super gung ho about mandatory anything. I think government's job should be to protect us from the barbarians without sticking their hands down our pants and x-raying our nuts. That and regulating the currency. That being said, we can see how well government's doing those comparitively simple tasks, so giving them a mandate to force us to buy insurance is something they'd probably screw up as well. |
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As for the nanny state, I don't have a problem with the government providing a safety net as long as it's not used as a hammock. |
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Ok, this is getting into politics, I'm bailing. |
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//I think government's job should be to protect us from the barbarians// But what if the government are the barbarians? Or (even more likely) we are the barbarians? |
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OK I was being naughty. If health insurance is compulsory for the moral hazard reasons outlined above, then how is this different to the NHS, where healthcare is funded out of general taxation, and is free at the point of delivery? And cigarettes are taxed extra, into general taxation revenues? Seems to me the only difference is feelgood nominal ringfencing, and more opportunities for private organisations to skim profits. |
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//self inflicted health problems?//
Everything kills you in the end. |
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I woulf think the libertarians in the group would be all for this. Or at least for pre-paid health care if not insurance (put a couple of bucks into an interest bearing escrow account, payable for tobaco related health care costs, payable complete if the purchaser lives to 100 without any problems). All this does is bring one of the externalities of cigarette sales directly into the product cost. |
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I'd also like to say that I'm not one of these anti
cigarette hysterics who thinks we'll all live forever
if
we ban second hand smoke. I also think cigarettes
can be used responsibly without damaging your
health if used in moderation, just like booze and
fast food. I knew somebody who smoked 1
cigarette a
day when they came home from work. Any
responsible doctor will tell you that's not going to
do
any real damage. |
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So this is just an idea, not an anti-smoking screed. |
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Aha, you forget about the third-hand smoke, the stuff that's on my clothes as I walk back into the house from smoking my cigarette outside. Yes, I have actually heard people talk about third hand smoke dangers. |
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UK smokers take up 25% of NHS income, but pay 33% of the revenue. Should be a "shake a smoker's hand day" otherwise you can wave goodbye to 1 in 12 of the health worker's salaries. I suggest April 11th. |
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* Before I start in on this rant, I would like to iterate that I am not against the idea, I am apposed to the entire healthcare system itself along with societies reliance on/requirement for all forms of insurance to include health insurance.* |
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Smoking is not conducive to good health. This however seems to me disproportionatley discriminated against in todays society. Let's view your idea implemented ad adsurdum... |
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All alcohol sales will include such coupons whose value coorelates to the damages cause by alcohol related incedences plus the healthcare costs due to alcoholism. Also all foods deemed unhealthy should require these coupons, whose value (of course) will defray the cost of obesity related healthcare (which dwarfs smokers burden). Factored also into the cookie coupons will be the copious amounts of extra fuel and resources required to maintain, clothe, transport and support the billions of unnecessary pounds of adipose tissue carried by the civilised. Purchase of hammers should, of course, include your coupons whose price defrays blunt force trauma to thumbs (and also the combined costs of apprehending, trying and jailing those who use hammers as weapons in illegal manners). |
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I smoke. I also run two miles in 13 minutes. I have been to a doctor less than ten times in my adult life, and I BUY my own health insurance. |
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Seems like you would really be fucking over the people who are pulling thier own weight by treating them like the people who aren't. |
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13 minutes? Wow, that's pretty fast Mike, the world
record is 9.5 minutes so I'd say if there were ever a
smoker's Olympics .... |
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Hmmmm. Sponsored by Marlboro.... |
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See idea post "Smoker's Olympics" |
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Or a lifetimes achievement, twice ever, to have run a 13 minute mile? |
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But yea Mike, like I said, I don't like the nattering
health nags telling us what's what. I saw an
interview where Michael Moore was talking about
how fat and sloppy Americans are. No comment
necessary. There's also that movie called "Super
Size Me" where the guy goes exclusively to Mac
Donald's and eats like 4,000 calories a day and
guess what? He got fat. I'd like to do the same
thing at some hippy health food store and declare
"See? Health food makes you fat!" |
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Man, I gotta drop off and get some work done
today. This website can be kind of addicting. |
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Where ethics separates patient from illness we must also separate, hoping that the patient will do the same. If we choose to disdain smoking we cannot do it because we hate the expense, we must do it because we morn the illness it has caused; to do this with clarity we must disdain illness itself. Most of treatments for illness are neither expensive in terms materials or require extraordinary skill on the part of the doctor. The price of medicine reflects the social value that health, unlike food, shelter and a basic education, is a luxury. If we focused on health and quality of life as maximally available to all regardless of our judgment about their habits we would be celebrating it as a social value. If we celebrated the notion of health as a social value then individuals would look on clearly unhealthy habits through that lens. Societal disregard for wellness is a major causal factor in individual disregard. |
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//Smoking is not conducive to good health//
Everyone knows lung cancer comes from eating green vegetables, it's a conspiracy I tell you...<sound of interns breaking out the straight-jacket (again)> |
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Anyway, tobacco is a vegetable and surely it counts towards my five a day? I'm ingesting it, after all. |
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//Sponsored by Marlboro.... See idea post "Smoker's Olympics" // |
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Those with the fastest 2-mile run time on the APFT, within any given unit strangely seems to be the smokers. |
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Well, I was hoping the inflammatory disposition and self-righteous indignatoryness of my previous annotation would result in an HB vs. MikeD flame war spilling over into other ideas and raging across the recent page for the next few weeks or so... But, as you have so gracefully acquiesced I find myself utterly disarmed and thoroughly humbled. I guess I am saying: I'm feeling a right tit (to use the parlance of you Britts). |
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I am getting shooed out of the office, [bigsleep]. But I will give you a well thought out response tomorrow. |
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Alrighty [SLEEP], here ya go: |
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//Can you give a quick straight answer as to why you don't believe in healthcare for all// |
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Because it is a natural tendancy for systems whose financial burden is carried by the people to be over-used by people whom either are taking advantage of the disperesed fiscal responsibility or over-used due to people set on getting thier "fair-share" of service. Obvioulsy, the more you use such a system, the more advantageous it is to you, but less advantageous to everyone else. Few people will show the slightest iota of concern for the ramifications of thier selfishness in such a system. |
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I think healthcare would be better served were it scaled back down to the local doctor whose skill set can nurse common illnesses and moderate trauma patients back to health, but forgetting those who desire another 3 miserable years before the inevitable. These services should also be paid for by the patient. Not insurance. |
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I would be happy to see all insurance programs abolished. |
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//I think a lot of people in Europe have a hard time dealing with the micro-blame climate in the US.// |
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I think alot of people in the U.S. have a hard time dealing with the micro-blame climate in the U.S. |
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Yes, but it happens to smokers more. |
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//I really don't get the attitude of "You got cancer. Haha!// |
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Provided you don't die from something else, cancer is ussually what gets everybody. Why are people so willing to waste so many resources just to live a couple more years of an agonizing existence? |
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Everybody dies, man. Modern medicine is not the magic, problem fixing, life saving wizard of Oz whomcan grant your every wish, which everyone seems to think it is. |
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Modern medicine can, at best facilitate the body in healing itself, and; more often than not, causes more problems than it solves. |
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That is entirely ridiculous. Everyone who doesn't die of something else dies of an infected paper cut too. Modern medicine, "at best" has protected us from pandemic illness, reduced infant mortality to a very low rate, provided many tools for preventing death from trauma and now provides quite real treatments for organ failure and cancer, all perfectly beneficial to the young not just those trying to survive for a few agonizing years. Largely speaking the whole field of Pharmacy, Epidemiology, and Surgery are "modern medicine". You have lived a very lucky life if you have never called on modern medicine, and even if you never used it yourself the fact that people around you didn't give you pertussis or measles was due to "modern medicine". You're calling for some pretty nasty weather. |
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[wcw], walk into any emergency department, take a good long look around and then tell me who is refferencing the majority. you or I? |
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Yes, those select few you mention will probably not fare so well, but life will be *on the whole* better, for everyone. (as far as I see it) |
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I have personally taken people, by ambulance to the ED for mild flus. An EMT cannot deny you a trip to the hospital, regardless of how asinign your medical problems are. Your "leave no one behind" attitude, coupled with your misplaced faith and over-dependance on modern medice leaves me thinking... nay, knowing you do not work therein. |
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Talk to an EMT, an RN, a CNA, an MD, somebody in the field. Then talk to a social worker. Then talk to some other civil service member. Keep doing this until your cheery disposition towards humanity is gone. Then I will enjoy talking with you [wcw]. |
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But if said person had medical insurance, they could get early treatment for the flu, instead of an ER visit. One of the reasons for the recent insurance mandate is specifically to avoid the free rider problem. |
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Regardless, where do you get the impression that cancer treatment is "just to live a couple more years of an agonizing existence?" Do a search for 20 year cancer survivor, 30 year cancer survivor. Complete remission, not continual treatment. Many cancer types have an over 90% 5 year survivor rate, healthy individuals. |
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Do I agree that there is a need for right to die, and some need for late life triage? Yes to the first, and a conditional yes to the second, but stating out-right that just because someone is sick they can't get better is ridiculous. |
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And as far as what modern medicine can or can't do. Have you had Measles, Mumps, Rubbella, Polio, Small Pox, Malaria? Seen 1/3 of the population wiped out in a Y. Pestis outbreak? Nope? Didn't think so. That's not helping the body heal itself, that's preventing the problem in the first place. And it works best when treatement is available to everyone. |
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Do you have fellow soldiers that are walking around on prosthetic limbs? Yes? Also not helping the body repair itself. |
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Organ transplants? The longest lived heart transplant patient lived 31 productive years after, and died of something completely unrelated. |
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"Those select few" are millions who now survive childhood without paralysis, crippling injury, or death. Thousands or millions of adults who are helped to maintain their lives and productivity. Please look at actual epidemic numbers and surgical outcomes before dismissing modern medicine. |
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MRSA? VRSA? Also, take a look at the side effects of most medications. Also realize most medications are just synthesized compounds found, and still available in nature. Yes, medicine helps. I am not saying it doesn't what I am saying is that is does more harm than good... HOLISTICALLY. Not just when compared to certain scenarios, or not just in the case of micro surgery, but the whole damn system. |
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It is just my own humble opinion, that life would be more enjoyable if technology was set back about two or three hundred years. |
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Yes, I realize life expectancy and infant mortality rates would worsen... Honestly I think there are too many people on this planet anyways. Disease is natures way of thinning our herds. We need to find an equilibrium with nature, because the more we push ourselves beyond that equilibrium, the more effort we must put, collectively, into doing so. And the more effort we put into it, the more taxed our society becomes. I opt for taking all of the safety stops off, and letting the cards fall as they may. Of course I am only a proponnent of such philosophy because it is a scenario that I would have a decisive advantage in. |
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And I understand you argue agaisnt it for the same reason. |
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MRSA is still an improvment over no antibiotics at all. |
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The only reason "it is a scenario that [you] would have a decisive advantage in" is because you've had the benefit of modern medicne to protect you from all the things that would have killed or weakened you already. |
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All these pandemics you refer to a) don't have a 100% mortality rate, so when my body fights off the disease I will be immune, and b) wouldn't spread like wild fire if people weren't living directly under other people's ass's. |
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Small pox killed most of the native americans because they were never exposed to it, yes. But if europeans weren't so crowded and congested, there wouldn't have been such a fertile breeding ground for disease. |
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Over-population leads to the evolution of disease. |
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You are bemoaning the effects and holding aloft our always-one-step-behind fixes as undenyable proof. |
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I am suggesting a preventative cure at the source. |
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Y. Pestis, the black plauge. 60% mortality rate. Spread quite happily by rats and fleas. Pretty much wiped out rural and small town Europe, not because they were living under peoples noses, the population density wasn't that high. |
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Malaria. Endemic to tropical areas. Not going to care how dense the population is, it's perfectly happy living in animals and mosquitos until it finds a human host. |
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Rabies. Same as malaria, except endemic to many sub-tropical areas as well. |
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Yes, high density unsanitary living conditions are breeding grounds for disease, but that's because there's a few very virulent diseases that require them to spread, not because most need them. Cholera loves those sorts of conditions, but... |
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When was the last time you heard of a major outbreak of Cholera in a first world nation? Modern New York City is still far more sanitary than any town 200-300 years ago. |
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I'll admit that you're more likely to get the flu living in NYC than on a ranch in Kansas, but not that much more likely. |
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AIDS = Mortality rate?, SARS, RSV, Looks like nothing you are referencing is really any different than it is now. How is modern medice making things any different in these cases? |
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Sickle cell has evolved as immunity to malaria, and rats are a side effect of human waste. When was the last time you saw a rat skittering through the woods? Through an inner-city back alley in and around dumpsters? |
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I'm sorry, Mech, but but you aren't going to persuade me from this view point by mentioning a few points. |
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When you present an overwhelming case that supercedes my own experiential wisdom then I might conscede the point. Until then I am firmly of the view-point that modern medicine's benifits have yet to justify it's cost. |
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AIDS, highest prevalance in the world is ~23%, about 1/2 to 1/3 of the infection rate for Y. Pestis. Highest percentage in a country with access to modern medicine, well below 1%. SARS, 916 confirmed deaths, not 9 million. RSV isn't new, it just wasn't recognized until recently, you'd still have it 200 years ago. Rats do quite well living in the woods, they just happen to be adaptable. The malaria vaccine doesn't kill half the people who get it, sickle cell does. |
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If you refuse to acknowledge a massive improvement in the standard of living as "justifying the cost" than I am afraid that you will never be persuaded. Of course, I could point to the number of artists, and scientists, and engineers that have survived disease only due to modern medicine, but given you want to roll tech back, that apparently won't do it either. I could point out that I like looking at attractive women, and small-pox scars just don't do it for me, but maybe that doesn't either. |
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Basically it comes down to the fact that you seem to believe that you would still be alive without modern medicine, and nothing else matters. Really don't think I can make a logical arguement that starts from that assumption. |
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Thanks for the understanding anno, [SLEEP]. |
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But, to continue my anti-humanity rant: |
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[MechE], again, I ask you: Walk into any ED. Let us set the % of people whom fit your modern medicine is capable of fixing/curing thier immediate illness as x%. It has been my copious first-hand experience that the % of people whom are there for illnesses and injuries that could be weathered at home to no ill end (if not better, because they haven't been exposed to all the other illnesses and resistant bugs at the hospital), will be greater than x%. The % of people whom are just seeking opiate medications is greater than x%. And of x%, if you subtract the amount of people whom would not need medical attention if they excersized regularly, maintained a constant state of hydration and didn't load thier bodies with a bunch of crap, then the this new x% (we will call x% subset 1) would be around x% of x%. |
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The majority of ED patrons will be paying x% subset 1 of the total cost of thier healthcare, whilst the rest of it is picked up by tax paying citizens. |
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And let's talk about medicine... |
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Let us talk of all the people who abuse medications. includeing cocain and herion which were at one time "modern-medicine". |
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And how many class action lawsuits are *currently* being tried involving medicine? |
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Go pick up Mosby's Drug Handbook and see how many medications have "suicide" listed as a side effect (in the anti-depressant section). |
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I am sure your vast wealth of health-care-system knowledge hails from personal experience working within the field, and not from popularized t.v. shows and second hand anecdotes. That is why I would never argue with you about the inner workings of the engineering world, because, although I too am a big fan of House P.E., I really wouldn't know what the hell I was talking about. |
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Nope. Mostly from my reasoned understanding of the field.
And discussions with my uncle and cousin and cousin in
law. All MDs. I'm not arguing there isn't abuse of the
system but that doesn't invalidate the system. |
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The one time I've been to the ER, it was for difficulty breathing. It turns out to have been for overexertion while having viral pneumonia. The total treatment was an inhaler to help keep things clear. Was this an abuse of the system because I could have "weathered it at home"? Or was it an abuse because I did it to myself (the overexertion bit)? I couldn't know that I could have weathered it at home, and I made a relatively minor misjudgement about how much I could undertake in that condition, when staying at home in bed was not a viable option if I wanted to graduate. I'd been to the doctor and been told, correctly, there was nothing they could do. I meet roughly two of your categories there, but I would say neither invalidates an ER visit. I didn't receive antibiotics or anything else, but that inhaler definitely helped. |
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Half the people who go to the emergency room uneccesarily go because they will recieve care, not neccesarily treatement, but someone will look at their problem and at least tell them what is wrong and what can be done. These same people would likely go to the doctor for this purpose if the doctor didn't cost them a week's salary for every visit. There is something broken when society will provide emergency care but not preventitive care, but it still doesn't invalidate modern medicine, and I think we disagree on which side of things is broken. |
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And who can modern medicine help in the ER? The people with bacterial infections, the people with traumatic injury, the people with cardiac difficulties, to a lesser extent the people with strokes or similar. |
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Who can't they help? The people with viral infections (except palliative care for critical symptoms), the people with phsychological problems. |
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And feel free to argue with me about engineering, just don't be surprised if I provide numbers to back up my claims. X% is not a number, it's a theory. |
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Every time I've been to the emergency room the majority of people there appeared to have a degree of illness that was in need of immediate evaluation. While under the best circumstances these people might not need emergency care I never noticed many people who did not have real visible symptoms of injuries and illnesses. I have seen people loose consciousness from alcohol overdose, bleeding profusely, blue from asthma, having seizures, going into labor. Your community emergency center may be full of not sick people, that would be the responsibility of triage to manage. They probably need to invest in a community clinic so people can get interventive care and not get so sick that they can get care at emergency. |
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Emergency medicine is a charitable feature of the community. Medical care dispensed without prejudice. Only a person of true privilege would feel comfortable saying "I wish they would keep the riff-raff out of here, really clogging this emergency room". If your relatives are whining about how they are forced to work in a triage community care setting then they should pursue another specialization. |
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Emergency room workers CAN provide care to: |
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People suffering from psychological crises. |
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People who have viruses with severe symptoms. |
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People who are not actually severely ill, but have symptoms that might indicate acute illness. |
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Victims of abuse and neglect. |
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People who have conditions that my worsen suddenly. |
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The elderly with minor but critical injuries that impair mobility. |
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People who are dying and wish to donate their organs. |
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Anyone who is found unconscious or unresponsive. |
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All conditions where immediate medical intervention would be effective in reducing illness or suffering and where that care cannot be provided by a GP. |
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//If your relatives are whining // |
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Make no mistake, [wcw], it is not my relatives. It is me. And yes, I do have that right. When I am loading one of our "frequent flyers" into the ambulance, with her only problem being that she wants more percocet, I can't help but despise her. Why? Because at that particular moment in time, our ambulance is dedicated to bull-shit. And if someone, somewhere were to really need us, they would be laying on the pavement, bleeding out for an extra five to ten minutes because little susie (not her real name) shit-bag wants to get high. |
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But I am done arguing with you two. Your position is based off of ideaology and the unrealistic assumption that human beings are, on a whole, good and decent people whom put societies needs above thier own. Mine, is based off of personal experience with mine own two friggin eye balls. |
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Your problem with public medical care is that a few people are going to try to abuse the system to try to get controlled substances. |
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And you claim to be a first responder. |
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Who currently works for an emergency dispatched medical service. |
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I'm guessing you don't actually dispense opiates without clear medical cause. |
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Nor will the physicians at the emergency room. |
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Most of the time they deal with people who have obvious and real illness and would be confused if you told them that their job was a waste of time and money. Ditto for the majority of paramedic calls. |
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Do you really think that your work (....) is a waste of public resources? Do you work for some sort of private, "we only dispatch to non-emergencies", med-trans company? (they are out there) |
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