US Doctors Call for Universal Healthcare: "Abolish the Insurance Companies"

Recent Forum Topics › Forums › The Public House › US Doctors Call for Universal Healthcare: "Abolish the Insurance Companies"

Viewing 30 posts - 1 through 30 (of 38 total)
1 2
  • Author
    Posts
  • May 31, 2016 at 12:57 am #45067
    zn
    Moderator

    US DOCTORS CALL FOR UNIVERSAL HEALTHCARE: “ABOLISH THE INSURANCE COMPANIES”

    THIS ARTICLE ORIGINALLY APPEARED IN THE GUARDIAN

    http://www.occupy.com/article/us-doctors-call-universal-healthcare-abolish-insurance-companies

    A group of more than 2,000 physicians is calling for the establishment of a universal government-run health system in the US, in a paper in the American Journal of Public Health.

    According to the proposal released Thursday, the Affordable Care Act did not go far enough in removing barriers to healthcare access. The physicians’ bold plan calls for implementing a single-payer system similar to Canada’s, called the National Health Program, that would guarantee all residents healthcare.

    The new single-payer system would be funded mostly by existing US government funding. The physicians point out that the US government already pays for two-thirds of all healthcare spending in the US, and a single-payer system would cut down on administrative costs, so a transition to a single-payer system would not require significant additional spending.

    “Our patients can’t afford care and don’t have access to the care they need, while the system is ever more wasteful, throwing away money on bureaucratic expenses and absurd prices from the drug companies,” said David Himmelstein, a professor in the CUNY School of Public Health at Hunter College and lecturer on medicine at Harvard Medical School.

    Himmelstein, one of the authors of the plan, said the proposal is meant as a rallying cry for physicians and other healthcare professionals around the cause of a single-payer model. According to the paper, even with the passage of the Affordable Care Act many patients “face rising co-payments and deductibles that compromise access to care and leave them vulnerable to ruinous medical bills”. Despite the current high healthcare spending levels in the US, healthcare outcomes are worse than in comparable well-funded countries.

    “There has been a conviction that we can approach this incrementally and get there in small steps and one of the advantages of having passed the ACA is that modest steps can’t do the job, and in a way make it easier to make arguments that we need more fundamental changes,” said Himmelstein.

    Under the proposal, all US residents would be able to see any physician of their choosing in the country and be treated at any hospital. With guaranteed coverage and no co-pays, deductibles and premiums, patients would not have financial barriers to seeking care, which would lead to greater utilization of the system and improved health outcomes, Himmelstein argues.

    The additional funds would be made up by modest tax increases in exchange for abolishing insurance premiums, deductibles and co-pays.

    “We would have to abolish the insurance companies, there is no way around that,” Himmelstein said. The employees at the private insurance companies would be retrained for other jobs, he explains, and receive job placement assistance. The insurance CEOs, who earn multimillion dollar salaries, would not get comparable job placement, Himmelstein said wryly.

    Fees for medication would be negotiated with pharmaceutical companies the same way other countries with single-payer systems already negotiate for lower cost medications. Currently, US drug prices are some of the highest in the world.

    While Himmelstein acknowledges that the physicians’ proposal would meet with political and business interest opposition, and he can’t say when such a system would realistically have the political backing needed to be implemented, he is hopeful that as more Americans view a single-payer system favorably, pressure will continue to mount on the government.

    Proposing a single-payer system in the US is not new. Vermont previously attempted to implement a single-payer system, which passed the legislature but was shut down by the once supportive governor when cost estimates increased beyond what the state was able to afford.

    Coloradans will vote this November on whether to institute a single payer system statewide. One of the leaders of the movement in Colorado is state senator Irene Aguilar, who is also a physician. The Colorado proposal would be financed by a payroll tax increase of 7% for employers and 3% for employees. For the self-employed, that would translate into a 10% tax increase.

    But Himmelstein said this type of reform can’t be done state by state. The physicians’ plan depends in part on cost containment through having a single payer with the power to negotiate drug pricing with pharmaceutical companies as well as eliminating many levels of bureaucracy in billing and insurance registration.

    The American Medical Association (AMA), which is the largest organization of physicians in the US, has opposed the idea of a single-payer model. When contacted, the AMA pointed to its policy regarding evaluating health reform proposals, which states in part that: “Unfair concentration of market power of payers is detrimental to patients and physicians, if patient freedom of choice or physician ability to select mode of practice is limited or denied. Single-payer systems clearly fall within such a definition and, consequently, should continue to be opposed by the AMA.”

    But Himmelstein sees change around the corner. “I think the AMA and its member organizations are slowly starting to come around and I am confident that they will eventually come around.” He points to the passing of resolutions by a few of the state medical associations that make up the AMA membership to study the impact of a single-payer system as indicators of change.

    For Himmelstein and the other writers of the editorial, the biggest indicator of change seems to be the talk of a single-payer system in the presidential primaries which has brought attention back to the issue.

    “Bernie Sanders showed you can do extraordinarily well campaigning on this issue,” said Himmelstein, who is confident that if enough American people demand a single-payer system, Congress will eventually have no choice but to change their minds and support it.

    May 31, 2016 at 5:55 am #45068
    PA Ram
    Participant

    The American Medical Association (AMA), which is the largest organization of physicians in the US, has opposed the idea of a single-payer model. When contacted, the AMA pointed to its policy regarding evaluating health reform proposals, which states in part that: “Unfair concentration of market power of payers is detrimental to patients and physicians, if patient freedom of choice or physician ability to select mode of practice is limited or denied. Single-payer systems clearly fall within such a definition and, consequently, should continue to be opposed by the AMA.”

    Another reason there is no single-payer plan. I don’t think it’s patient care they’re worried about–medicare works fine. Insurance companies routinely turn down claims and patients don’t get procedures done.

    They just happen to be trying to protect their own profits. If they aren’t getting paid what they want they have the power to just drop an insurance company. There is strength in numbers. If single-payer is the only game in town–that’s it. It would have the power to better control costs.

    I just don’t buy it.

    "Reality is that which, when you stop believing in it, doesn't go away. " Philip K. Dick

    May 31, 2016 at 8:04 am #45069
    nittany ram
    Moderator

    My wife is a physician and she has always been a proponent of the single payer method. Our current system is ridiculous with insurance companies acting as middle men needlessly driving up costs. They also drop doctors with high cost patients. A person’s health shouldn’t be at the mercy of some bean counter sitting behind a desk at Cigna.

    May 31, 2016 at 8:34 am #45071
    wv
    Participant
    PA Ram wrote:

    I don’t think it’s patient care they’re worried about–medicare works fine. Insurance companies routinely turn down claims and patients don’t get procedures done.

    They just happen to be trying to protect their own profits.

    —————–

    You know, Pa, one of the most dis-spiriting discussions I’ve ever had in my life, happened when i went to a dinner with a friend of mine, about seven years ago or so. My friend’s brother-in-law was in medical school. And this dinner was a get-together of Med-students. (all wealthy, white, privileged young people) — and somehow we got on the topic of single-payer. Every single med-student at the dinner (about eight or ten) was against single-payer — and several of them flat-out said things like “I did not take out all those loans so i could be poor.” It was all about the money. And they were adamant. And angry at the thought of not making a lot of money as doctors. That was their priority. It was painful to listen to. Not a word about poor people or what is happening to the poor. No understanding of what is happening to non-privileged Americans. Sigh. Ignorant, ignorant privileged med-students.

    w
    v
    “Our patients can’t afford care and don’t have access to the care they need, while the system is ever more wasteful, throwing away money on bureaucratic expenses and absurd prices from the drug companies,”

    May 31, 2016 at 8:56 am #45073
    bnw
    Blocked

    Yes physicians do not work for chickens or eggs any more in the US. Thats why we attract so many other physicians from other countries that can’t afford to lose them. The problem lies in both the insurance companies and the ridiculous artificial shortage of medical schools in our country that limits the supply of doctors thus maintaining higher pay and denying access to healthcare for too many people in many areas of the US.

    The upside to being a Rams fan is heartbreak.

    Sprinkles are for winners.

    May 31, 2016 at 9:40 am #45074
    nittany ram
    Moderator
    wv wrote:
    PA Ram wrote:

    I don’t think it’s patient care they’re worried about–medicare works fine. Insurance companies routinely turn down claims and patients don’t get procedures done.

    They just happen to be trying to protect their own profits.

    —————–

    You know, Pa, one of the most dis-spiriting discussions I’ve ever had in my life, happened when i went to a dinner with a friend of mine, about seven years ago or so. My friend’s brother-in-law was in medical school. And this dinner was a get-together of Med-students. (all wealthy, white, privileged young people) — and somehow we got on the topic of single-payer. Every single med-student at the dinner (about eight or ten) was against single-payer — and several of them flat-out said things like “I did not take out all those loans so i could be poor.” It was all about the money. And they were adamant. And angry at the thought of not making a lot of money as doctors. That was their priority. It was painful to listen to. Not a word about poor people or what is happening to the poor. No understanding of what is happening to non-privileged Americans. Sigh. Ignorant, ignorant privileged med-students.

    w
    v
    “Our patients can’t afford care and don’t have access to the care they need, while the system is ever more wasteful, throwing away money on bureaucratic expenses and absurd prices from the drug companies,”

    Well, those med students were worried about nothing. Canadian physicians under a single payer system get paid very well. They are not poor by any means. While they may earn less than their American counterparts, Canadian doctors also have fewer costs because of the single payer system.

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3110239/

    • This reply was modified 8 years, 4 months ago by nittany ram.
    • This reply was modified 8 years, 3 months ago by InvaderRam.
    May 31, 2016 at 10:14 am #45076
    PA Ram
    Participant

    I do want to be clear about something. I do not think that all doctors are evil or selfish or greedy. If they wanted to be that they could have become hedge fund managers. I’m glad and grateful that men and women are willing to devote their lives, the investment, the lost hours with family–to a noble profession.

    I was on a thread in Reddit this morning and someone posted an article about doctor’s salaries. In the comments sections there were all sorts of responses. This one caught my eye:

    Family medicine resident (MD) here. I see a lot of people saying they wish they were a doc here, and I’m assuming it’s because of the $$ listed. Let me first say that I hope this isn’t taken as complaining, because at the end of the day I know that I’m incredibly lucky to have a great job market, job security, and will make a good living doing something I love. That being said, a few points on why money is a terrible reason to go into medicine.
    Most docs don’t start making an attending salary until early 30s. At that point, you’ve accrued ~200k in debt, and with interest, will end up paying ~400k when all is said and done. Loan payments are approximately 2-3k/month once you’re out of residency. Most are paying off loans for 10-20years after starting.
    To get to that point, you have four years of undergraduate, four years of med school (two of which are clinical, in the hospital ~80hrs per week, unpaid- actually, you’re paying them) and a minimum of 3 years of residency. Right now as a resident, I make about $13/hour before taxes. This is with working an average of 80 hours/week (sometimes more, sometimes less). This is consistent across all residencies and specialties.
    if you want to work in any sort of an academic center, you’ll likely make less. For example, most attendings at my university make about $50k less per year than those in the private sector. They average about 65 hrs/week, depending on how efficient they are at charting.
    Opportunity cost to get to the point that you’re making those amounts is huge. Friends of mine don’t understand when I tell them that you essentially sign control of your life over to your residency for those years. I do not get to choose when I take vacation. I do not get holidays off. I do not choose whether I work days or nights. I often don’t get to choose when my days off are (these all apply to the med students working with us too!). I’ve stopped counting how many weddings/family gatherings/birthdays etc I’ve missed because I’ve had to be working. My family has taken to celebrating all of the major holidays on off days (a few days before or after) the real thing to accommodate, but I know a lot of colleagues who aren’t that lucky. This is in addition to all the things most life choices most docs in training choose to postpone because of how difficult it is to put time into anything outside of training – marriage, starting a family, etc. I’m easily 1-2 life stages behind most friends from college.
    I had several classmates who were pulling in six-figure salaries in business or banking right out of undergrad, who decided they wanted to do something more fulfilling. They all laughed at the idea of doing medicine to make a lot of money. From their perspective, if you’re smart enough to be a physician, you’re smart enough to go into something like what they did and you’d make much more money much more quickly.
    That being said, if given the chance, I wouldn’t change a thing. I love what I do. And I also recognize that everyone in a successful career has had to make big sacrifices to get where they are today. But if you want to make a lot of money, there are so many other professions better suited for doing that than medicine.
    I could go on for hours about this, but I’ll stop here. Happy to answer any questions if there are any.
    EDIT: wanted to clarify that I’m not complaining about the compensation in general- just clarifying some misconceptions about the hardship/sacrifice getting to that point.

    Other doctors chimed in and said that once they “made” it–so to speak the debt was not going to be a big issue.

    But the point is that–it takes a lot to be a doctor–financially, personally and so on. I get that. I am so grateful that anyone wants the job. I do nothing close to helping society like they do. I respect them.

    I would like to see this country make it easier for doctors to get established. Less burdens financially.

    But it is true that other countries have cheaper health care than we do–and ONE of those issues is certainly “for-profit” insurance. It’s by no means the only problem. But it’s a big one. To my understanding, medicare does not pay as much as a company like–Aetna for example. And if medicare was the only source of payment–doctors would probably be making less money. The AMA is a powerful lobbying group that would not like to see that happen. They may want to see more people insured(privately)and they may agree that hospital costs are too high–that the costs of an MRI, for example–is random and ridiculous. And frankly–I don’t know what the AMA thinks. But they are going to hold the line at some things.

    Since this professional group has a lot of clout–especially with democrats these days–their interests are going to matter. This is why trade agreements do not allow foreign doctors to open a practice without first doing a medical residency. They don’t want a flood of doctors coming in who may be willing to accept a single-payer type of system(this is all just me stating my thoughts–no proof of any of it). But the fact is that they have been protected while other jobs have not.

    I respect doctors. We NEED doctors.

    But health care in this country can’t continue as is–because having insurance won’t matter for millions of Americans. They still won’t be able to afford to see a doctor.

    "Reality is that which, when you stop believing in it, doesn't go away. " Philip K. Dick

    May 31, 2016 at 10:47 am #45078
    Billy_T
    Participant

    I think it’s disingenuous for an organization of doctors to call for Single Payer. They’re actually just as much a part of the problem as the insurance companies. They have every incentive in the world for a Single Payer system to come into place (they’ll make more money), and no doubt believe they could “capture” it via lobbying, as do Big Pharma, Hospitals and Medical Equipment folks, among others.

    Yes, we need Single Payer for the insurance side. We need non-profit health insurance for everyone. But in America, if we leave it at just that, the costs of medicine itself will not go down overall, and may well go up in many cases. As long as medical providers operate under capitalist laws of motion and incentives, those prices will continue to escalate. They, not just the insurance companies, keep raising their prices too on everything from simple 10-minute (almost symbolic) checkups, to surgery, to chemo — with cost pressures also coming from Big Pharma, etc.

    The cost of one chemo treatment, for instance, has literally doubled since I started on this journey. From roughly $15,000 to $30,000. And that’s for a single treatment, roughly 4-5 hours in a chair, with a single chemo drip bag and maybe two nurses in attendance (who also look after other patients). I’ve never had an insurance company turn down the chemo, though I have had them say no to a PET scan. Change it to a CT scan, and we’ll cover it, they said.

    To make a long story short: We need to make both insurance and delivery of health care a right, not a commodity. Decommidify all of it. Remove it from the capitalist laws of motion. End the profit incentives from both sides of the equation. If we do just the insurance side, we open ourselves up to a gold rush of abuse from medical providers, who will attack the new cash cow with armies of lobbyists and kill it, if they can’t control it.

    • This reply was modified 8 years, 4 months ago by Billy_T.
    May 31, 2016 at 10:59 am #45080
    Billy_T
    Participant

    Also, as much as it pisses me off to know that a huge amount of my premium dollars go to making insurance execs rich, it also pisses me off that medicine in America is so expensive — far more expensive than anywhere else on the planet — so that insurance companies have to keep raising their prices to keep up with the providers. And when I say “have to,” I don’t mean as the response to a moral dilemma. I mean as a response to the capitalist system itself, which is the real problem here.

    Another angle on this: Without insurance, I would have died in 2003. I couldn’t have afforded chemo treatment on my own. I had just purchased a house, so I didn’t have any equity in that to sell. Yeah, I could have afforded a few doctor’s visits. But not the full treatment schedule. That first year’s chemo regimen was in the neighborhood of 100K, which the insurance company covered. As mentioned above, it’s double that now. When I go through a year of this, it’s costing the insurance company itself roughly 200K, give or take.

    If every American has access to a new Single Payer system, and everyone goes to see their doctors, instead of choosing food or lodging instead, as they do now, something has to give. Some combination of non-profit medicine along with an huge increase in funding is going to have to kick in. We won’t just be able to wash our hands of this issue even if we get Single Payer — and we should. It’s going to be just part of the process toward sane, humane health care, and the best way to get there is separate it from the capitalist system itself.

    (I’d prefer seeing the end of capitalism altogether, but that’s a different story.)

    May 31, 2016 at 1:39 pm #45090
    PA Ram
    Participant

    The cost of one chemo treatment, for instance, has literally doubled since I started on this journey. From roughly $15,000 to $30,000. And that’s for a single treatment, roughly 4-5 hours in a chair, with a single chemo drip bag and maybe two nurses in attendance (who also look after other patients). I’ve never had an insurance company turn down the chemo, though I have had them say no to a PET scan. Change it to a CT scan, and we’ll cover it, they said.

    That’s incredible.

    I agree–there has to be some sort of overall plan when it comes to health care.

    I’m glad your experience with the insurance companies has been relatively good. I always felt if a doctor asks for something–your personal doctor–the one who physically sees you–they should pay for it. A bunch of doctors sitting in an office miles away looking at papers is in no position to make the call, IMO. This is where the “for profit” concerns come in and it’s slimy.

    Also–people have to pick up more and more of their share these days of the cost. Their cost in general–what they pay a week continues to rise–the procedure costs rise–and the co-pays and deductibles continue to rise. I myself have been told to have this or that done–looked at the cost and said: no thanks. I know others with more serious things who have done the same thing. Yes–they want this. They want you shopping around. Making these decisions about your own health. And yes–shopping around is a good thing. But all the pressure of costs are placed on the patient.

    More needs to be done from the other side.

    "Reality is that which, when you stop believing in it, doesn't go away. " Philip K. Dick

    May 31, 2016 at 2:56 pm #45094
    Ozoneranger
    Participant

    This is rather long, so I apologized in advance…

    I have experienced a single payer system. Italy. Two years ago, my wife was diagnosed with metastatic breast cancer after a five year remission (three mets so it was pretty advanced). This was ten days before a planed two week Med cruise. In a “fuck it all moment,” we decided to go ahead with the trip- Italy was was lifetime dream destination for my wife. She was symptomatic but seemingly healthy enough to travel. We kept our bad news from family (the plan was to tell them upon our return) and flew to Barcelona to embark on the ship.

    About half way through the cruise, my wife started deteriorating. Once I convinced her to see the ship’s doctor, her liver started to fail and we were fairly kicked off the ship in Venice and transported by ambulance (with full siren) to Ospidale del Angelo in Mestre, Venice. It was a clean, modern facility. Unfortunately, very few English speakers. I was unable to communicate to them what I knew of my wife’s condition. After tests, she was admitted to what I now know was a hospice ward. Due to her condition, her doctor would not allow her to fly on less than an air ambulance. I tried to arrange this through my insurance provider (Kaiser Permanente) and actually had an aircraft and medical staff on standby to get my wife home. However, after a conference call between the Italian docs and Kaiser docs in Sacramento, Ca. (Kaiser provided the translator), it was determined she would not survive the flight (this was a business jet and would take 16 hours and four refueling stops). “No hope.” That’s what her doctor told me in his limited English. My wife passed seven days after being admitted.

    Those seven days: I was trying to communicate with staff- only one nurse spoke passable English and he was either busy or off duty 16 out of 24 hours so I couldn’t get through to them to call my wife’s oncological team in CA so they could coordinate treatment. Actually, none of the staff even tried to talk to me, although I did attempt to use Google translate on an Ipad. One did loan me a power converter so I could keep my smart phones and Ipad charged up and was able to keep my family updated, not to mention communicating with Kaiser’s liaison. Thinking back now that I can think and remember more clearly, the only treatment they administered was a hydrating drip and vitamin K for the liver. As far as I can tell, they made no attempt to at the very least stabilize her for the trip back the states. I mentioned earlier that she was admitted to a hospice ward. I came to that conclusion due to watching five people die on that ward during the stay, the fifth being my wife. To this day, I am convinced she was “death paneled.” They did request a PET scan, which I refused as she had undergone one the day before we departed. They did a CT scan instead. I practically begged them to contact her oncologist in California, which was met with mute stares.I’m pretty sure the doctors and staff were not accustomed to a very involved care-giver husband. So for seven days treatment consisted of water administered by me, Vitamin K drip and in the end, morphine. No food to speak of -she stopped eating after day one, but they did feed me (lived in the hospital until my kids arrived, when I rented a B&B close by the hospital).

    I received the bill via registered mail after my return to the states. 4000 Euros. A bargain, I suppose, when compared to the $75000 bill for my wife’s prophylactic bi-lateral mastectomy back in 2010. I don’t know what her eight rounds of chemo and 25 rounds or radiotherapy was. My laundry bill in Venice was 30 euros, kindly arranged by the two Foreign Patient Liaison staffers assigned to us. They also found the B&B for me. They were very nice to me. Wish they could have had some medical training to help me communicate, though.

    So you must wonder what my opinion is via the single payer…nice if you have broken arm. But serious illness? I’m not so sure. And from what I know of the Canadian system, which is the system most Americans point to in this debate, the wait times for non-emergency appointments are astronomical. And it’s not “free” anywhere. I was in BC Canada a few years ago and paid a VAT tax of 14% on some gift items. In Ireland, there just last week, it’s 23% on taxable items. I know this to be true because I’m in the process of filling out the Irish paperwork to be reimbursed from the receipts I saved from the trip.

    I the US will adopt the single payer system. It’s inevitable, really. But I don’t think we’re going to like it very much and God help you if you find yourself in a dire medical predicament…there are no “heroic measures” in this system.

    • This reply was modified 8 years, 4 months ago by Ozoneranger.
    May 31, 2016 at 3:45 pm #45096
    bnw
    Blocked
    Ozoneranger wrote:

    This is rather long, so I apologized in advance…

    I have experienced a single payer system. Italy. Two years ago, my wife was diagnosed with metastatic breast cancer after a five year remission (three mets so it was pretty advanced). This was ten days before a planed two week Med cruise. In a “fuck it all moment,” we decided to go ahead with the trip- Italy was was lifetime dream destination for my wife. She was symptomatic but seemingly healthy enough to travel. We kept our bad news from family (the plan was to tell them upon our return) and flew to Barcelona to embark on the ship.

    About half way through the cruise, my wife started deteriorating. Once I convinced her to see the ship’s doctor, her liver started to fail and we were fairly kicked off the ship in Venice and transported by ambulance (with full siren) to Ospidale del Angelo in Mestre, Venice. It was a clean, modern facility. Unfortunately, very few English speakers. I was unable to communicate to them what I knew of my wife’s condition. After tests, she was admitted to what I now know was a hospice ward. Due to her condition, her doctor would not allow her to fly on less than an air ambulance. I tried to arrange this through my insurance provider (Kaiser Permanente) and actually had an aircraft and medical staff on standby to get my wife home. However, after a conference call between the Italian docs and Kaiser docs in Sacramento, Ca. (Kaiser provided the translator), it was determined she would not survive the flight (this was a business jet and would take 16 hours and four refueling stops). “No hope.” That’s what her doctor told me in his limited English. My wife passed seven days after being admitted.

    Those seven days: I was trying to communicate with staff- only one nurse spoke passable English and he was either busy or off duty 16 out of 24 hours so I couldn’t get through to them to call my wife’s oncological team in CA so they could coordinate treatment. Actually, none of the staff even tried to talk to me, although I did attempt to use Google translate on an Ipad. One did loan me a power converter so I could keep my smart phones and Ipad charged up and was able to keep my family updated, not to mention communicating with Kaiser’s liaison. Thinking back now that I can think and remember more clearly, the only treatment they administered was a hydrating drip and vitamin K for the liver. As far as I can tell, they made no attempt to at the very least stabilize her for the trip back the states. I mentioned earlier that she was admitted to a hospice ward. I came to that conclusion due to watching five people die on that ward during the stay, the fifth being my wife. To this day, I am convinced she was “death paneled.” They did request a PET scan, which I refused as she had undergone one the day before we departed. They did a CT scan instead. I practically begged them to contact her oncologist in California, which was met with mute stares.I’m pretty sure the doctors and staff were not accustomed to a very involved care-giver husband. So for seven days treatment consisted of water administered by me, Vitamin K drip and in the end, morphine. No food to speak of -she stopped eating after day one, but they did feed me (lived in the hospital until my kids arrived, when I rented a B&B close by the hospital).

    I received the bill via registered mail after my return to the states. 4000 Euros. A bargain, I suppose, when compared to the $75000 bill for my wife’s prophylactic bi-lateral mastectomy back in 2010. I don’t know what her eight rounds of chemo and 25 rounds or radiotherapy was. My laundry bill in Venice was 30 euros, kindly arranged by the two Foreign Patient Liaison staffers assigned to us. They also found the B&B for me. They were very nice to me. Wish they could have had some medical training to help me communicate, though.

    So you must wonder what my opinion is via the single payer…nice if you have broken arm. But serious illness? I’m not so sure. And from what I know of the Canadian system, which is the system most Americans point to in this debate, the wait times for non-emergency appointments are astronomical. And it’s not “free” anywhere. I was in BC Canada a few years ago and paid a VAT tax of 14% on some gift items. In Ireland, there just last week, it’s 23% on taxable items. I know this to be true because I’m in the process of filling out the Irish paperwork to be reimbursed from the receipts I saved from the trip.

    I the US will adopt the single payer system. It’s inevitable, really. But I don’t think we’re going to like it very much and God help you if you find yourself in a dire medical predicament…there are no “heroic measures” in this system.

    I’m sorry your wife had to pass away under those conditions. Did you call the US embassy or consular office for assistance? The US Diplomatic Mission has a large presence throughout Italy including Venice. I’m very sorry for your loss.

    • This reply was modified 8 years, 4 months ago by bnw.

    The upside to being a Rams fan is heartbreak.

    Sprinkles are for winners.

    May 31, 2016 at 3:59 pm #45098
    Ozoneranger
    Participant
    bnw wrote:
    Ozoneranger wrote:

    This is rather long, so I apologized in advance…

    I have experienced a single payer system. Italy. Two years ago, my wife was diagnosed with metastatic breast cancer after a five year remission (three mets so it was pretty advanced). This was ten days before a planed two week Med cruise. In a “fuck it all moment,” we decided to go ahead with the trip- Italy was was lifetime dream destination for my wife. She was symptomatic but seemingly healthy enough to travel. We kept our bad news from family (the plan was to tell them upon our return) and flew to Barcelona to embark on the ship.

    About half way through the cruise, my wife started deteriorating. Once I convinced her to see the ship’s doctor, her liver started to fail and we were fairly kicked off the ship in Venice and transported by ambulance (with full siren) to Ospidale del Angelo in Mestre, Venice. It was a clean, modern facility. Unfortunately, very few English speakers. I was unable to communicate to them what I knew of my wife’s condition. After tests, she was admitted to what I now know was a hospice ward. Due to her condition, her doctor would not allow her to fly on less than an air ambulance. I tried to arrange this through my insurance provider (Kaiser Permanente) and actually had an aircraft and medical staff on standby to get my wife home. However, after a conference call between the Italian docs and Kaiser docs in Sacramento, Ca. (Kaiser provided the translator), it was determined she would not survive the flight (this was a business jet and would take 16 hours and four refueling stops). “No hope.” That’s what her doctor told me in his limited English. My wife passed seven days after being admitted.

    Those seven days: I was trying to communicate with staff- only one nurse spoke passable English and he was either busy or off duty 16 out of 24 hours so I couldn’t get through to them to call my wife’s oncological team in CA so they could coordinate treatment. Actually, none of the staff even tried to talk to me, although I did attempt to use Google translate on an Ipad. One did loan me a power converter so I could keep my smart phones and Ipad charged up and was able to keep my family updated, not to mention communicating with Kaiser’s liaison. Thinking back now that I can think and remember more clearly, the only treatment they administered was a hydrating drip and vitamin K for the liver. As far as I can tell, they made no attempt to at the very least stabilize her for the trip back the states. I mentioned earlier that she was admitted to a hospice ward. I came to that conclusion due to watching five people die on that ward during the stay, the fifth being my wife. To this day, I am convinced she was “death paneled.” They did request a PET scan, which I refused as she had undergone one the day before we departed. They did a CT scan instead. I practically begged them to contact her oncologist in California, which was met with mute stares.I’m pretty sure the doctors and staff were not accustomed to a very involved care-giver husband. So for seven days treatment consisted of water administered by me, Vitamin K drip and in the end, morphine. No food to speak of -she stopped eating after day one, but they did feed me (lived in the hospital until my kids arrived, when I rented a B&B close by the hospital).

    I received the bill via registered mail after my return to the states. 4000 Euros. A bargain, I suppose, when compared to the $75000 bill for my wife’s prophylactic bi-lateral mastectomy back in 2010. I don’t know what her eight rounds of chemo and 25 rounds or radiotherapy was. My laundry bill in Venice was 30 euros, kindly arranged by the two Foreign Patient Liaison staffers assigned to us. They also found the B&B for me. They were very nice to me. Wish they could have had some medical training to help me communicate, though.

    So you must wonder what my opinion is via the single payer…nice if you have broken arm. But serious illness? I’m not so sure. And from what I know of the Canadian system, which is the system most Americans point to in this debate, the wait times for non-emergency appointments are astronomical. And it’s not “free” anywhere. I was in BC Canada a few years ago and paid a VAT tax of 14% on some gift items. In Ireland, there just last week, it’s 23% on taxable items. I know this to be true because I’m in the process of filling out the Irish paperwork to be reimbursed from the receipts I saved from the trip.

    I the US will adopt the single payer system. It’s inevitable, really. But I don’t think we’re going to like it very much and God help you if you find yourself in a dire medical predicament…there are no “heroic measures” in this system.

    I’m sorry your wife had to pass away under those conditions. Did you call the US embassy or consular office for assistance? The US Diplomatic Mission has a large presence throughout Italy including Venice. I’m very sorry for your loss.

    Yes, I was in contact with the consulate, who kept tabs on us. They helped where they could.

    May 31, 2016 at 4:08 pm #45099
    bnw
    Blocked

    The US consulate office in Venice couldn’t arrange a translator for you at the hospital?

    • This reply was modified 8 years, 4 months ago by bnw.

    The upside to being a Rams fan is heartbreak.

    Sprinkles are for winners.

    May 31, 2016 at 4:37 pm #45102
    zn
    Moderator

    Sorry to hear your story ozone.

    On Italy. Italy is not a single-payer public insurance system. The medical industry itself is part public, which is technically called socialized medicine (although in this case it is a mixed system). Socialized medicine and single-payer insurance systems are different. In contrast to Italy, for example, in the Canadian single-payer system, the medical industry is private and only the insurance is public.

    In Italy:

    …healthcare is provided to all citizens and residents by a mixed public-private system. The public part is the national health service, Sistema sanitario nazionale (SSN), which is organized under the Ministry of Health and is administered on a regional basis.

    Family doctors are entirely paid by the SSN, must offer visiting time at least five days a week and have a limit of 1500 patients. Patients can choose and change their GP, subjected to availability.

    On, however, single payer and wait times in Canada:

    http://theincidentaleconomist.com/wordpress/single-payer-does-not-equal-increased-wait-times/

    Now it’s possible that single payer systems can lead to increased wait times. In Canada, they keep spending far below what we put out. They do so partially by spacing out visits for elective procedures and such. That’s a conscious decision, and it leads to some people waiting for elective care. But that’s an outcome of their financial conservatism, not the single payer system. Other countries (think France) don’t have the same issues with elective procedures because they spend more money. Our single payer system (Medicare) has far fewer spending restraints, and does not suffer from the wait time problem

    That is, the decision to have longer wait times for elective procedures in Canada is a deliberate Canadian fiscally conservartive policy, not a direct result of a single-payer system.

    .

    May 31, 2016 at 4:51 pm #45104
    Ozoneranger
    Participant
    bnw wrote:

    The US consulate office in Venice couldn’t arrange a translator for you at the hospital?

    No, the first weekend was Labor Day. Office was closed. I didn’t really think about contacting them again until I had to arrange for a mortician. For this task, they were very helpful.

    • This reply was modified 8 years, 4 months ago by Ozoneranger.
    May 31, 2016 at 4:59 pm #45106
    wv
    Participant
    Ozoneranger wrote:

    … the US will adopt the single payer system. It’s inevitable, really. But I don’t think we’re going to like it very much and God help you if you find yourself in a dire medical predicament…there are no “heroic measures” in this system.

    ——————————–
    The Personal: Sounds like you did everything you possibly could to
    help your wife, O. It makes me smile to think how
    much you care/cared about her.

    The Political: As far as the politics goes, I agree a lot of folks wont like single-payer. But a lot of folks dont like the corporate-profit-system either.
    Big awkward systems are never fun to deal with, no matter what they are based on. But ask POOR PEOPLE how much they like this corporate system we got now.
    Again, the example from wv — in poverty-stricken McDowell County — average lifespan for males is 65. Six hours away, in wealthy Fairfax County Va — ave lifespan 84.

    Now… Can you imagine the “health care stories” in McDowell County WV ?
    Can you imagine the “health care stories” in Fairfax VA?
    Do you think the health-care stories would be different? I do.

    Single-payer helps the POOR. Thats why I’m for it. Its not perfect, though.
    But there should never be a 20 year difference in lifespans between the rich and poor in one country. That…is…wrong. Just my opinion, of course. One man’s opinion. 🙂

    w
    v

    May 31, 2016 at 5:04 pm #45110
    bnw
    Blocked
    Ozoneranger wrote:
    bnw wrote:

    The US consulate office in Venice couldn’t arrange a translator for you at the hospital?

    No, the first weekend was Labor Day. Office was closed. I didn’t really think about contacting them again until I had to arrange for a mortician. For this task, they were very helpful.

    To go through what you did at the hospital not able to communicate your wife’s medical condition to staff is horrible. Even the cruise company should have had their doctor talking with the hospital staff for you. Just horrible.

    The upside to being a Rams fan is heartbreak.

    Sprinkles are for winners.

    May 31, 2016 at 5:08 pm #45111
    Ozoneranger
    Participant
    Ozoneranger wrote:
    bnw wrote:

    The US consulate office in Venice couldn’t arrange a translator for you at the hospital?

    No, the first weekend was Labor Day. Office was closed. I didn’t really think about contacting them again until I had to arrange for a mortician. For this task, they were very helpful.

    On Italy- Obviously, I’m not a resident and they did not bill my insurance provider directly (Kaiser wanted a tax ID number for the hospital). I paid up and was reimbursed. So perhaps I’m not 100% fully informed about how my wife’s care, such as it was, fit into their system. I received a demand for payment via registered letter with no detailed bill for services provided.

    Canada- My sources are two Canadian widows from a couple of FB support groups. One elected to self-fund a boob job, of all things, due to quality of care concerns. The other is still recuperating from the auto accident that killed her husband. A third source is an instructor in a tech class I took last November. He cut one class short so he could make an appointment for chronic back pain- he stated that he HAD to go or wait several more months.

    So I’m providing anecdotal evidence on the Canadian system which is really all I have. As for Italy, thanks for firming that up.

    May 31, 2016 at 5:16 pm #45112
    Ozoneranger
    Participant
    zn wrote:

    Sorry to hear your story ozone.

    On Italy. Italy is not a single-payer public insurance system. The medical industry itself is part public, which is technically called socialized medicine (although in this case it is a mixed system). Socialized medicine and single-payer insurance systems are different. In contrast to Italy, for example, in the Canadian single-payer system, the medical industry is private and only the insurance is public.

    In Italy:

    …healthcare is provided to all citizens and residents by a mixed public-private system. The public part is the national health service, Sistema sanitario nazionale (SSN), which is organized under the Ministry of Health and is administered on a regional basis.

    Family doctors are entirely paid by the SSN, must offer visiting time at least five days a week and have a limit of 1500 patients. Patients can choose and change their GP, subjected to availability.

    On, however, single payer and wait times in Canada:

    http://theincidentaleconomist.com/wordpress/single-payer-does-not-equal-increased-wait-times/

    Now it’s possible that single payer systems can lead to increased wait times. In Canada, they keep spending far below what we put out. They do so partially by spacing out visits for elective procedures and such. That’s a conscious decision, and it leads to some people waiting for elective care. But that’s an outcome of their financial conservatism, not the single payer system. Other countries (think France) don’t have the same issues with elective procedures because they spend more money. Our single payer system (Medicare) has far fewer spending restraints, and does not suffer from the wait time problem

    That is, the decision to have longer wait times for elective procedures in Canada is a deliberate Canadian fiscally conservartive policy, not a direct result of a single-payer system.

    .

    On Italy- Obviously, I’m not a resident and they did not bill my insurance provider directly (Kaiser wanted a tax ID number for the hospital). I paid up and was reimbursed. So perhaps I’m not 100% fully informed about how my wife’s care, such as it was, fit into their system. I received a demand for payment via registered letter with no detailed bill for services provided.

    Canada- My sources are two Canadian widows from a couple of FB support groups. One elected to self-fund a boob job, of all things, due to quality of care concerns. The other is still recuperating from the auto accident that killed her husband. A third source is an instructor in a tech class I took last November. He cut one class short so he could make an appointment for chronic back pain- he stated that he HAD to go or wait several more months.

    So I’m providing anecdotal evidence on the Canadian system which is really all I have. As for Italy, thanks for firming that up.

    May 31, 2016 at 5:20 pm #45114
    Ozoneranger
    Participant
    Ozoneranger wrote:
    Ozoneranger wrote:
    bnw wrote:

    The US consulate office in Venice couldn’t arrange a translator for you at the hospital?

    No, the first weekend was Labor Day. Office was closed. I didn’t really think about contacting them again until I had to arrange for a mortician. For this task, they were very helpful.

    On Italy- Obviously, I’m not a resident and they did not bill my insurance provider directly (Kaiser wanted a tax ID number for the hospital). I paid up and was reimbursed. So perhaps I’m not 100% fully informed about how my wife’s care, such as it was, fit into their system. I received a demand for payment via registered letter with no detailed bill for services provided.

    Canada- My sources are two Canadian widows from a couple of FB support groups. One elected to self-fund a boob job, of all things, due to quality of care concerns. The other is still recuperating from the auto accident that killed her husband. A third source is an instructor in a tech class I took last November. He cut one class short so he could make an appointment for chronic back pain- he stated that he HAD to go or wait several more months.

    So I’m providing anecdotal evidence on the Canadian system which is really all I have. As for Italy, thanks for firming that up.

    Oops. I meant this for ZN…

    BNW, the ships doctor was South African. He just wrote some instructions for the staff at the hospital and handed them to the EMTS at the dock. The cruise line provided me with the number of some kind of “Port Advisor,” who was paid by the line to provide services to passengers who had to leave the ship. I guess for such things as transportation, hotels accomodations, etc. I was able to contact the guy but he was useless, too. Couldn’t speak English.

    May 31, 2016 at 5:33 pm #45115
    Ozoneranger
    Participant
    wv wrote:
    Ozoneranger wrote:

    … the US will adopt the single payer system. It’s inevitable, really. But I don’t think we’re going to like it very much and God help you if you find yourself in a dire medical predicament…there are no “heroic measures” in this system.

    ——————————–
    The Personal: Sounds like you did everything you possibly could to
    help your wife, O. It makes me smile to think how
    much you care/cared about her.

    The Political: As far as the politics goes, I agree a lot of folks wont like single-payer. But a lot of folks dont like the corporate-profit-system either.
    Big awkward systems are never fun to deal with, no matter what they are based on. But ask POOR PEOPLE how much they like this corporate system we got now.
    Again, the example from wv — in poverty-stricken McDowell County — average lifespan for males is 65. Six hours away, in wealthy Fairfax County Va — ave lifespan 84.

    Now… Can you imagine the “health care stories” in McDowell County WV ?
    Can you imagine the “health care stories” in Fairfax VA?
    Do you think the health-care stories would be different? I do.

    Single-payer helps the POOR. Thats why I’m for it. Its not perfect, though.
    But there should never be a 20 year difference in lifespans between the rich and poor in one country. That…is…wrong. Just my opinion, of course. One man’s opinion. 🙂

    w
    v

    Thanks for the words, WV, but I didn’t get her home. I failed her. Knowing what I know now, I would have done a lot of things differently. We were together since high school. Would have been 40 years since our first date on Oct. 10.

    I get what you’re saying about health care for the poor. Loud and clear. It’s just my opinion that to make such a system self-sustaining, something will have to be cut. And knowing 75% of health care costs can be attributed to last quarter of life care, for lack of a better term, something has to give. And that will be accross the board palliative care for the elderly. And the terminally ill. That’s what I believe happened to my wife. Set her aside and wait till the end. And they certainly did a good job at preparing for her death. I don’t remember a lot of things from that horrible week crystal clear, but I do remember that morning. The things they did.

    May 31, 2016 at 6:00 pm #45117
    zn
    Moderator
    Ozoneranger wrote:

    Canada- My sources are two Canadian widows from a couple of FB support groups.

    Well I am Canadian originally and have family there.

    The wait time thing is on elective procedures only, and that was a deliberate policy choice—keep costs down when it comes to elective procedures.

    Either way, here is one advantage of single-payer over private insurance: with private insurance, billions upon billions of dollars go to things like advertizing, executive salaries, lobbying (they are one of the biggest in spending on lobbying), and campaign donations. That doesn’t happen with public health insurance.

    There’s also administrative costs that have an effect on all health care costs. These are costs that exist solely because medical providers must deal with multiple insurance companies, while insurance companies must all pay clerks etc to handle all those transactions on their side. With public insurance this is all cut down on both sides to be much more efficient and much less costly.

    http://fortune.com/2014/10/20/health-insurance-future/

    In 1991, Steffie Woolhandler and David Himmelstein, two Harvard doctors with an interest in health policy, published a paper in The New England Journal of Medicine in which they estimated that health care administration constituted somewhere between 19% and 24% of total spending on health care, an amount that was 117% higher than what it was in Canada and much more than in the U.K.

    Their updated estimate, once again published in The New England Journal of Medicine, found that administration accounted for about 31% of health care spending and that more than 27% of all of the people employed in health care worked in administrative and clerical occupations.

    This large administrative expense is not surprising. It costs money for health care providers to deal with multiple insurers, each with its own protocols, forms, and requirements. And it costs money for insurers to be able to transact with multiple providers and to furnish the oversight—which many would consider more annoying than helpful—of health care delivery.

    May 31, 2016 at 7:12 pm #45125
    wv
    Participant
    Ozoneranger wrote:

    Thanks for the words, WV, but I didn’t get her home. I failed her. Knowing what I know now, I would have done a lot of things differently. We were together since high school. Would have been 40 years since our first date on Oct. 10.

    I get what you’re saying about health care for the poor…

    ———————

    Well, I’m sure somewhere in the deep-mystery of the Universe,
    your wife wants to kick your ass for thinking that you ‘failed her’. 🙂

    You did everything you could, given what you knew, and the circumstances.

    At any rate, she loved and married a human. Not a perfect, omniscient, all-powerful, being. A human.

    w
    v
    “And throughout all eternity, I forgive you, and you forgive me…” William Blake

    May 31, 2016 at 7:29 pm #45128
    Ozoneranger
    Participant
    zn wrote:
    Ozoneranger wrote:

    Canada- My sources are two Canadian widows from a couple of FB support groups.

    Well I am Canadian originally and have family there.

    The wait time thing is on elective procedures only, and that was a deliberate policy choice—keep costs down when it comes to elective procedures.

    Either way, here is one advantage of single-payer over private insurance: with private insurance, billions upon billions of dollars go to things like advertizing, executive salaries, lobbying (they are one of the biggest in spending on lobbying), and campaign donations. That doesn’t happen with public health insurance.

    There’s also administrative costs that have an effect on all health care costs. These are costs that exist solely because medical providers must deal with multiple insurance companies, while insurance companies must all pay clerks etc to handle all those transactions on their side. With public insurance this is all cut down on both sides to be much more efficient and much less costly.

    http://fortune.com/2014/10/20/health-insurance-future/

    In 1991, Steffie Woolhandler and David Himmelstein, two Harvard doctors with an interest in health policy, published a paper in The New England Journal of Medicine in which they estimated that health care administration constituted somewhere between 19% and 24% of total spending on health care, an amount that was 117% higher than what it was in Canada and much more than in the U.K.

    Their updated estimate, once again published in The New England Journal of Medicine, found that administration accounted for about 31% of health care spending and that more than 27% of all of the people employed in health care worked in administrative and clerical occupations.

    This large administrative expense is not surprising. It costs money for health care providers to deal with multiple insurers, each with its own protocols, forms, and requirements. And it costs money for insurers to be able to transact with multiple providers and to furnish the oversight—which many would consider more annoying than helpful—of health care delivery.

    Well, your just preaching the choir here. No disagreement.

    May 31, 2016 at 7:31 pm #45131
    bnw
    Blocked
    wv wrote:
    Ozoneranger wrote:

    Thanks for the words, WV, but I didn’t get her home. I failed her. Knowing what I know now, I would have done a lot of things differently. We were together since high school. Would have been 40 years since our first date on Oct. 10.

    I get what you’re saying about health care for the poor…

    ———————

    Well, I’m sure somewhere in the deep-mystery of the Universe,
    your wife wants to kick your ass for thinking that you ‘failed her’. 🙂

    You did everything you could, given what you knew, and the circumstances.

    w
    v

    Amen to that.

    The upside to being a Rams fan is heartbreak.

    Sprinkles are for winners.

    May 31, 2016 at 8:46 pm #45139
    Billy_T
    Participant

    Ozone,

    Am truly sorry to hear about your loss. There are no adequate words to express that. I’m just sorry.

    May 31, 2016 at 8:54 pm #45141
    zn
    Moderator
    wv wrote:

    Well, I’m sure somewhere in the deep-mystery of the Universe,
    your wife wants to kick your ass for thinking that you ‘failed her’.

    You did everything you could, given what you knew, and the circumstances.

    I have to echo that.

    Well said and true.

    I read that entire story, ozone, as a moving memorial and a testimony to your devotion, love, and care.

    My only inevitably inadequate response is that I am honored you posted that for us.

    May 31, 2016 at 8:56 pm #45142
    Billy_T
    Participant

    On the health care issue again. There is no reason for Single Payer to produce wait times. Those are almost entirely a result of the ratio of patients to doctors, and have next to nothing to do with the kind of insurance system in place. The real way to fix those wait times is to make sure there are plenty of doctors, hospitals and staff to support the needs of every community/region. And a great way to guarantee this is to make all public colleges and universities tuition free. This will also do away with the need for doctors to charge high enough rates to cover their student loans — which can set them back well over 150K.

    When it comes to rationing, that’s a different issue. In the capitalist system, “rationing” is done according to who can afford to pay for care. We have long had “death panels” for the poor, for the working poor, and for many a middle class person, even those with insurance. In my own case, I have to forego certain medical care suggested by my GP and oncologist, outside the scope of the seemingly urgent. Last year, this included treatment for Sleep Apnea. This year, other kinds of care. There are millions of Americans in worse shape than I am, too. “Rationing” is a part of our system, because of its profit motive and privatized nature, and most of it will vanish if we go to a truly non-profit, Single-Payer system. Most but not all. The rest would, if we decommodified all of it.

    Other issues will crop up, as mentioned before. But they won’t be “rationing” or “wait times.”

    May 31, 2016 at 9:04 pm #45143
    Billy_T
    Participant

    We were forced into a “bargain” of sorts, with the capitalist system. No one asked us for our accent. We were forced. But the basics are:

    Democracy is not allowed within the boundaries of capitalist commerce. It is not allowed in the workplace — if that business is still to be “capitalist.” It is not allowed inside the employer/employee relations, or they wouldn’t exist. Democracy has its own sphere, the public sphere. It doesn’t get to be in the private sphere, though it can sometimes act upon that private sphere from the outside.

    The reason why this is a major problem is because capitalism’s laws of motion force it to forever seek expansion into new markets. It must always grab up more, Grow or Die. It is the first truly imperialistic economic form in world history, and one of the results of this internal drive is the wiping out of the Commons, all over the world, including in America. Its internal desire is to commodify all things, make everything a sale, a private sector exchange for dollars. And that includes matters of life and death, as in, health care.

    We the people should fight back against this intrinsic, internal, perpetual drive and take back as many life spheres as we can — if not all of them. We the people should “democratize” and de-commodify as many aspects of life and death as we possibly can. That means grabbing hold of health care, from the payment and the delivery sides, and yanking it out of the private, for-profit sphere and placing it all, instead, in the Commons. Once in the Commons, we can radically reduce costs for care from the ground up. All of it. Not just from the payment side, and not just from the provider side.

    To me, if we don’t do this, we will continue to have “rationing,” “death panels” and long waits for a very large portion of society. Only the wealthy do fine, basically, in our current system. That, to me, is obscene.

    • This reply was modified 8 years, 4 months ago by Billy_T.
  • Author
    Posts
Viewing 30 posts - 1 through 30 (of 38 total)
1 2
  • You must be logged in to reply to this topic.

Comments are closed.