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What's the Biggest Problem in Healthcare? What would you do to solve it?

Discussion in 'Pre-Medical - MD' started by altaskier, Dec 18, 2001.

  1. altaskier

    altaskier Altaholics Anonymous 92'
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    Okay, this is a typical question asked during interviews. I was recently asked it and I responded, although not well (at least that's what I thought). I wanted to know what you guys thought about this topic. I said that the biggest problem is access of care for the underserved, just based upon my experiences. Now, there are a million ways to resolve this. What do you guys think?


    Just some food for thought
     
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  3. Ohiobuddhist

    Ohiobuddhist Member
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    Perhaps insurance companies' power to remove treatment options from the hands of trained medical professionals might be one to add to the list.
     
  4. Ohiobuddhist

    Ohiobuddhist Member
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    Oh wait, I forgot to solve it.
    - First, you get all the insurance schmucks in an isolated area of a non-extradition country...well, you can pretty much figure out the rest for yourselves. True, it may be short-term thinking, but it couldn't hurt.
     
  5. altaskier

    altaskier Altaholics Anonymous 92'
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    Okay, but how would you personally solve that one? You gotta say something that is probable to do, or else you'll be caught in a bind. Can't say something outrageous. So, how would you solve this problem you've posed?
     
  6. altaskier

    altaskier Altaholics Anonymous 92'
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    That'd go well in an interview: "Yeh, I've thought about a resolution and I'm leaning towards gathering the reps from all the insurance co's in one room and kicking the living crap out of them".

    LOL
     
  7. NE_Cornhusker1

    NE_Cornhusker1 12" Member
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    Random list of problems to talk about;
    HMO's-dont though because everyone does.

    Overprescription of Antibiotics-know your stuff or you can get burned easily.

    Overprescription of Ritalin/ Dx of ADD-pretty solid topic, esp. if you want to go into psychiatry.

    PKU Treatment/ Clinical Mgmt.-good for internal medicine.

    Obesity in children-good topic for pediatricians.

    Reaching out to underserved populations.

    Increased prescense of AED's in malls, airports, and homes-think abouthis if you're interested in CT surgery or cardiology.
     
  8. over use of the emergency room, basically seen by many patients as their primary care provider.

    Part of this is due to lack of insurance and the patients know the ER has to treat them.

    Part of this is due to the fact that some physicians that are members of HMOs are overworked and are hard to make appointments with in order to receive primary care.
     
  9. altaskier

    altaskier Altaholics Anonymous 92'
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    Once again, what do you propose to solve it?
     
  10. SMW

    SMW Grand Member
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    The huge number of uninsured people without access to decent health care is definitely the number 1 health care problem in the U.S. Either Medicaid needs to be expanded to cover everyone who doesn't have employer-provided health insurance, or the government has to mandate that all employees be covered (with provision made for coverage of the unemployed).
     
  11. altaskier

    altaskier Altaholics Anonymous 92'
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    I too agree with you SMW. But here are a few things to think about

    a) Where would the money come from if you were to expand medicaid so that it covers everyone?

    b) Also, a great portion of the underserved and uninsured don't work, so asking employers to cover employees wouldn't cover them. What would you do now?


    Sorry. I'm not tryin to sound like a smart ass. But your interviewer might turn around and say this to you in response. It's good to get some stimulating talk goin.


    "Sharpness is the key to life, as is an unlimited supply of beer"
     
  12. SMW

    SMW Grand Member
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    a) taxes -- it's shameful that all politicians want to do is cut taxes when there's such a crying need for healthcare
    b) Unemployed would have to be covered under Medicaid (or some other system set up for the purpose). But a large number of employed people are uninsured (the "working poor").
     
  13. altaskier

    altaskier Altaholics Anonymous 92'
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    So SMW, you'd recommend taxing people as a solution? That works. How about another approach. Lets say, requiring residents who want to graduate and docs that want to be re-"board certified" to spend X number of hours providing free service to the underserved. Resident could recieve credit for this and Docs who want to be re-certified can earn "hours" that they usually get from CME's. Just another option I guess. I guess my message is that instead of sitting in a hotel in Salt Lake City listening to a conference on X, they could be helping out in community clinics and recieving credit. Any other options you can think of?????


    Don't let this thread die!!!!!!!!!!! :)
     
  14. SMW

    SMW Grand Member
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    Residents are already grossly overworked and underpaid. I don't really think they have the spare time (or the desire). And I can't see requiring anyone to work for free. Lots of people do it out of the goodness of their hearts, but I don't see requiring it as viable. Besides, I want my doc to go to the conferences on X.

    Taxing people is the only way. Just like we tax now to pay for the basic services of water and sanitation that are responsible for most of the improvement in people's health in the past centry. I think we have to look at health care as a right as basic as clean running water and sewage systems.
     
  15. rightwing

    rightwing Junior Member
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    better hope the interviewer is a liberal (read east coast and CA) and not like me or suggestions of taxations would fire them up too....all of my interviews asked me the same question and I told them the threat of socialized health care was our biggest threat and backed it up...they seemed(aaahhh there's the rub) to agree.....


    Let liberalism implode under its own weight
     
  16. YBee

    YBee Member
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    I agree with "right wing". Once you start working and you see how many taxes you already pay, and once you see how screwed up the health care system is already, especially where the government is involved in the equation, you will realize what a terrible idea socialized medicine is (you can also look at Canada and Gt. Britain to see how badly it can go awry.)

    I believe that doctors are more likely to have a conservative viewpoint on the socialized medicine issue. By acting as an advocate of socialized med.., you will not only annoy your interviewer, you will come across as incredibly naive.
     
  17. Hey rightwing and YBee,

    Do you guys mind sharing your views on why socialized medicine is a treat or why it is bad in your opinion. I'd be interested in learning more about this topic.
     
  18. tentative at best

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    I'm pre pre-med, so take my opinion with a grain of salt, but the first thing that popped into my mind was frivolous lawsuits. You know the lawsuits that make the headlines and scare the bejezzus out of most docs. They in turn start over ordering tests, referrals, etc. This in turn drives up insurance costs, which often does one of two things. Employers may choose to go with a more affordable option than fee for services (HMOs, PPOs, etc.) or drop coverage altogether. HMOs are a story unto themselves and dropping coverage leaves thousands upon thousands without access.

    How to fix them? Ummm..... I'll have to get back to you on that one.

    Med errors also just popped into my mind. I could probably come up with an almost coherent answer for that one in an interview.
     
  19. altaskier

    altaskier Altaholics Anonymous 92'
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    Yeh, everyone's reluctant to pay taxes as it is. So what other solution to providing coverage to the underserved/economcially disadvantage is there? Can anyone think of a good solution??????
     
  20. Tweetie_bird

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    Yeap, I can. One of my first jobs was at an office that dealt with the Attorney General's office and docs that are sued. Having come from a different (read: third world) country, it's almost amusing to see how many people try to slap a law suit on a doc, asking for a ridiculous amount of money.

    The end result: docs in private clinics end up having to pay much more to cover their behinds, while docs in hospitals/academic med centers take a lower salary, albeit, they have a whole Risk Management office insuring them in case of a lawsuit. I seriously think there needs to be some sort of mandate on how much money each person can get from charging a doc with anything. It is true that docs are human, and they do make mistakes, but the amount of money being given out to people like charity, while our system is almost falling apart is hypocritical. I read something yesterday about how a mother was paid 16 million dollars b/c her daughter who had suffered a car accident and was DNR, was put on life support...when she came out of her coma, her brain was so damaged that she was living her life as a vegetable. This case is a very emotionally charged issue anyway, but 16 million or 16 billion dollars is probably MORE than compensation..don't you think? Perhaps I'd feel different if I was the mom.

    I propose having an upper limit on how much people can get through lawsuits, and use that money for "underserved clinics."

    Tweetie
     
  21. altaskier

    altaskier Altaholics Anonymous 92'
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    Well, I ran my idea of having docs volunteer their time with the underserved as a requirement for graduation or as a way to pick up CME hours by an attending and he really didn't agree with it. His main concern was that if doc or residents were gonna volunteer their time in underserved clinics to fulfill whatever requirment, who would pay for their insurance fees. Say a doc trying to help some poor guy ends up messing up some how and the poor guy sues. Then what!!


    Back to the Drawing Board!
     
  22. English Chick

    English Chick Senior Member
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    Another solution to the problem of covering more people without increasing taxes: Oregon currently has a system of prioritizing the care it provides to Medicaid recipients. Not all care is covered, just care that is perceived to be high priority. Oregon has used the extra funds made available by this prioritization to insure all its residents who live below the poverty line. (Before the new system, only a fraction of poor Oregonians recieved coverage.) One caveat though: I used this suggestion in my UCSF interview and my interviewer wanted to know what services I would consider "high priority." I was _not_ prepared for that curve ball. I kinda stuttered, suggested a couple of obvious things like childhood immunizations and family planning services and told her I'd get back to her in four years. *sheesh* Not smooth at all ...
     
  23. EpiII

    EpiII Senior Member
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  24. EpiII

    EpiII Senior Member
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  25. EpiII

    EpiII Senior Member
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  26. vinny11

    vinny11 Junior Member
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    I might be a little bit out of my league here, but what do you guys think about mandating health insurance. If you drive a car you are legally obligated to have car insurance, why shouldn't everyone over a certain age (21?) be required to have health insurance?
     
  27. altaskier

    altaskier Altaholics Anonymous 92'
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    Nice English Girl and Epi. The ideas are money. I was just thinking of another option to throw out there and have everyone either tear apart or love: How bout having certain programs that would pay for all your medical school tution, etc if you dedicate yourself to working in an underserved area. I know such a thing exists with the Armed Forces Scholarship, etc. But this program would actually not carry the heavy requirement that does. For example, with the Armed Forces Bailout, for every year you serve the underserved, they bail you out of one year of tution. But that might be a little too much for some docs (4 years of service to get rid of 4 years of med school loans). So maybe a new service can be started where you'd work less time and recieve a fair bailout. Just a thought to think about. I'll be on vacation till Dec 30th, but I'm looking forward to coming back and reading all the great ideas everyone has!


    See ya,
    Altaskier
     
  28. altaskier

    altaskier Altaholics Anonymous 92'
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    OH YEH,

    PLEASE DON'T LET THIS THREAD DIE!!! THIS IS AN IMPORTANT ISSUE THAT WILL AFFECT ALL OF US IN OUR PRACTICE OF MEDICINE IN THE FUTURE.

    KEEP IT ALIVE!!!!!!!!!!!!!!!!!!!!
     
  29. eagle26

    eagle26 Senior Member
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    I was asked in an interview what the biggest problem was, and I said HMOs doing what's best for their pockets rather than patients. I went on to say to my interviewer, "HMOs be damned! I'm treating patients with or without them, even if I have to subsidize care myself!" I'll be penniless, but who goes into medicine for the money?? Glares at people around on SDN with a sense of inquiry...
     
  30. UCMonkey

    UCMonkey Senior Member
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    OK, here's an idea on solving the access problem...

    What does the government do in a time of disaster? The call out the national guard. Along this same line, could we get the military to play some sort of role in providing care for those that don't have access? The way I figure it, they do humanitarian medical missions overseas, why not have them do some in our own country? This would also solve part of the funding issue, since, unless I'm way off base, the money would come out of the defense budget.

    Anyone like / dislike this idea?
     
  31. mpp

    mpp SDN Moderator
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  32. Zuleika

    Zuleika Member
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    Whatever people think is bad about Canadian and UK health care, I can think of one great thing that the Canadian system has over the US one:

    You will *never* be refused treatment because you don't have enough money!

    I know that the system here is certainly flawed (I don't know if *anyone's* found the perfect way to run everything), but to keep in the original context of this thread: I would say the largest problem with the US health care system is the fact that it's too business-like, and the biggest problem with the Canadian one is we just don't seem to have enough money!

    I'll probably have way more to say about this in a couple of months, because I'm taking a course on 'Health Care Systems of the World' next semester :) So if this thread is still active then, I'll post any new thoughts...
     
  33. mpp

    mpp SDN Moderator
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    Are people in the U.K. and Canada truly *never* denied treatment? Are there no cases when someone has been denied treatment?

    This does not mean the U.K. or Canadian systems are worse than the U.S. system as they may deny treatment to a far less a percentage than in the U.S. I would just like to know the true figures. I can't imagine that never has a single person been denied a treatment prescribed by a physician in the U.K. or Canada. But I've been wrong before...lots of times...
     
  34. English Chick

    English Chick Senior Member
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    You may never be denied treatment outright in the UK and Canada, but who wants to wait over a year for an MRI? Not me...
     
  35. Zuleika

    Zuleika Member
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    I can't 100% guarantee that it would never happen. I'm probably being idealistic, but that's sure what I think should happen! I'm totally with Joseph Reses in thinking that I'd rather pay out of my own pocket than see someone go untreated because of red tape. I suppose that generosity like that can only go so far though.. It's pretty sad that anyone would go without healthcare in the top countries of the world!
     
  36. YBee

    YBee Member
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  37. YBee

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  38. Tweetie_bird

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    I am SO glad Joseph actually said this out loud--I've been thinking and feeling the same sentiment. Yes, it is very naive to think that you can subsidize care yourself, but I do like to see that others out there think like me.

    Here's an idea, and I may sound very naive so tear it apart if you don't like it...tell me what you think about this--HMO's providing preventive care, like basic check ups for EVERYBODY at a very nominal cost (preventive medicine cheaper than curative). Those people that are "rich" like earn 150K plus a year, that may need extra care could take it out of their pocket. Those people that are "poor" could also take some out of their pocket for extra care, albeit they are aided by the government a little bit. This means, people below a certain pay bracket could have higher reimbursements, where as people above a certain pay bracket could get helped lesser. Basically, the amount of care you get from the government would be inversely related to your pay. I know that may sound like discrimiation, but we are discriminating against the poor right now by not providing care to them anyway, this discrimination could be for a good purpose....I can't think of a better idea.

    Nobody has yet mentioned anything about the idea to cap doc's salaries, and capping reimbursment payments to those that file lawsuits. Perhaps, make it MUCH MUCH harder for people to file a lawsuit...if the incentive is less, less money will be handed out in charity.

    Something I read a week ago got me thinking--it seems as though there are so many people on welfare and state provided funds, under the unemployment status..sometimes, these people get aided for five years on welfare. Does it really take five years to get a job? Whatever the reason it is to be on welfare, it seems hard to imagine that it would take five years to get one's feet off the ground. I say we should perhaps cut that to 2 years only, and take the money over to help those under a lower pay bracket. This way, they can have a job, and their care is subsidized by the gov.

    I end with a quote from yet another reading--"We all thought we needed reform; now we need a revoution." Think about it.....

    Tweetie
     
  39. Jessica

    Jessica Senior Member
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    I agree with SMW, and I would disagree about the "horrible" nature of socialized medicine. Granted there are problems with the Canadian and UK systems, but they still have some advantages over the currest US system (i.e. canadians see their primary care docs a lot more than people in the US, lower infant mortality, etc.) Did you know that the US has one of the highest percentage expenditures on health care administrative costs in the entire industrialized world? A big chunk of every health care dollar goes to administrative costs (somewhere around 25% if my memory serves me correctly, vs. 11% for the Canadian system), not to delivering much needed care to people who need it most (check out <a href="http://www.amsa.org" target="_blank">www.amsa.org</a> for more info.) The cost of expanding a program like medicare to the working poor and uninsured/unemployed might be partially covered by redicing administrative costs (stramline the system = more money for meeting the needs of the 44 million uninsured Americans (sure to go up with the recession setting in) + all of the underinsured people out there) Just my two cents... and whats the deal with tearing into poeple for being "naive"??? We're all just sharing out opinions, and NO ONE knows EVERYTHING about EVERYTHING, especially in regard to a complicated topic like health care reform.
     
  40. YBee

    YBee Member
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    Ahh-lighten up - I didn't "tear into" anyone. I stated my opinion, which was that an interviewer would find that comment naive. And I stand by that opinion. What's with tearing into people who give opinions you disagree with?
     
  41. Jessica

    Jessica Senior Member
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    I didn't mean to come off like I was tearing into YOU, and I don't disagree with your opinion (1. I see a LOT of flaws with a socialized system, and I am not all for helping others in exchange for living a penniless existance, 2. who in their right mind would want to wait an eternity to see a specialist or have an MRI? and 3. if you start spouting off ideas that you can't back up with some logic or demonstrate that you have made a well thought out decision you are bound to come off as naive, whether you are for socialized medicine or not.) I was just pointing out that this was an open, informative discussion... we should are all free to throw in our thoughts. Maybe in one interivewer's opinion a comment might be naive, while to another the idea would be altruistic and dedicated, its all relative. And I apoligize if it came off like I was tearing into you (what a hypocrite!!) I didn't mean to come off that way!
     
  42. Tweetie_bird

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    shhh, calm down guys. Obviously this is a very emotinonally charged issue, and combine that with a bad AMCAS year, holiday blues etc, we are all getting out of hand. :)

    I agree with Jessica completely. To a certain person, an "ideal" way of thinking may sound very naive....where as to another person, it may sound inspiring and dedicated. Personally, I would rather be called naive, and yet know I still have an ideal to work toward when I am out there practicing. Sure beats pessimism, in my opinion.

    Let's keep this forum going....obviously we are throwing out some great ideas, and I would like to read more input.

    Tweetie :p :D :p
     
  43. Deforciant

    Deforciant New Member

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    I can't comment much on providing universal health care because my knowledge about the intricacies of our health care system is limited. But I do believe that Medicaid should be expanded to cover everyone by increasing funding for it.

    I don't know how much this would exactly cost. I know that pretty much everyone hates to have their taxes raised. Does taxes even have to be raised at all to provide funding for Medicaid? I think that the efficiency of the our government in funding Medicaid is highly contingent on our government's efficiency to control spending on all other things.

    In fact, I think that our government has been very wasteful with taxpayers' money. Billions and billions of dollars have been wasted on things like the Department of Education, foreign policy ($7 billion sent to Russia - $5 billion of it LOST!!!), and lavish expenditures for government officials. Many other wasteful expenditures exist that are inconsequential individually do seem very significant when combined together (E.g. $400 luxurious toilet seats + many other things). Perhaps if the government would drastically reduce most of their ridiculously inefficient spending, it would have enough money to spend on more important things like expanding Medicaid. Taxes would probably not be raised (which is good because working people currently pay 40% of their income to the government in taxes).

    Gosh, after all that blabbering, can this question be answered shortly and swiftly? Maybe I would say that expanding Medicaid can be done without raising taxes. How can I be more specific about that if our government isn't nearly as forthright as it should be about what it does with our hard earned money?

    I guess the ultimate question is this: Does what I said make any logical sense? Can cutting down government spending inefficiencies (and there are TONS of them) yield enough money to provide universal health insurance?

    ** Maybe being altruistic (with naivety) is better than being very specific and bogged down with seemingly endless complexities that are overwhelming. Nobody can blame you for caring even if your solution is practically flawed.
     
  44. YBee

    YBee Member
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    thanks Jessica - it is hard to tell how people are saying things sometimes when we can't see facial expressions.

    You are right that different interviewers could look on it differently. I am just so used to hearing my friends who are in med. school and have helped with the admissions process tell me: they want to make sure you know what you're getting into,that you are not naive, being naive is the kiss of death (my words not theirs), etc.

    Regarding using the elimination of government inefficiencies to pay for increased health care: if only it could be done. The gov't wastes an unbeliveable amount of money, all those things previously mentioned, farm subsidies (if I want to be an artist but can't make a living, do you think the govt will pay for me to do that too?) and a bazillion! other things. Unfortunately the nature of a democracy in general is to be inefficient b/c of the "you scratch my back, I'll scratch yours" nature of getting things done. Add to that the huge area of our country and I think it is a hopeless cause.

    Even when a politician arises who would like to cut down on the waste, in order to get elected he must raise so much money and enter so many "gentleman's agreements" that he is automatically part of the problem before he's begun.

    I have often felt that if the newsmedia printed a weekly article on the uses to which taxpayer money is put (as riders to bills every week!), people would be outraged. The only time that I have ever seen this done tho' was during the line item veto argument back in Clinton's era - that info lasted all of one week. Of course the info in available on-line, but the avg. person isn't going to read it.

    If you really want to change the world (at least the political world) buy a newspaper.

    ok I'll stop here - sorry for the diatribe! :)

    Merry Christmas all.
     
  45. warpath

    warpath Officer Cadet
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  46. Original

    Original Ogori-Magongo Warrior
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    What kind of a name is Warpath anyway? Hey I think I read on another post that you grew up in Nigeria. Same here! Lagos kicks the sh!t out of...
     
  47. warpath

    warpath Officer Cadet
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  48. Original

    Original Ogori-Magongo Warrior
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    Hey I'm an FGC Ilorin class of 97 grad. You wouldn't happen to know a Bolaji Kukoyi (KC class of 96) would you? We go to school here together. The guy is a maniac.
     
  49. warpath

    warpath Officer Cadet
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  50. altaskier

    altaskier Altaholics Anonymous 92'
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    WOW this thread blew up while I was gone!

    :)
     
  51. WMN

    WMN Member
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    I grew up in Scotland with socialized medicine and neither I nor anyone in my family have ever been denied any kind of health care. My Grandmother had a stroke and was in a nursing home for almost a year and she did not have to "spend down" to qualify for it either, nor did she wait months for placement. My American husband stayed in Scotland with me for a year and he was not denied healthcare either and is now a firm believer in socialized medicine. It does have its problems but, to be honest, I do believe that it is a better system. Another thought, I have often wondered how Americans would handle access to health care if it became a lottery system instead of the way it is now - i.e. if you can afford it you get what you want. Ironically, when I was a student in USA, I could not afford to pay for an antibiotic for my son and fortunately a family member who was a physician gave me some samples.
     

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