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Health Care Reform
Posted: 29 June 2011 08:19 AM   [ Ignore ]
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http://www.foreignaffairs.com/articles/67918/peter-r-orszag/how-health-care-can-save-or-sink-america

This article is an interesting and fairly objective report on health care and how to fund it in the US.

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Posted: 01 July 2011 03:51 AM   [ Ignore ]   [ # 1 ]
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garythehuman - 29 June 2011 08:19 AM

http://www.foreignaffairs.com/articles/67918/peter-r-orszag/how-health-care-can-save-or-sink-america

This article is an interesting and fairly objective report on health care and how to fund it in the US.

Why is it so impossible to adopt a program that has a proven track record in other countries. Are they just healthier and use less medical services than we? Or are we so egocentric that we cannot acknowledge that someone could possibly know better?

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Posted: 01 July 2011 07:32 AM   [ Ignore ]   [ # 2 ]
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Write4U - 01 July 2011 03:51 AM
garythehuman - 29 June 2011 08:19 AM

http://www.foreignaffairs.com/articles/67918/peter-r-orszag/how-health-care-can-save-or-sink-america

This article is an interesting and fairly objective report on health care and how to fund it in the US.

Why is it so impossible to adopt a program that has a proven track record in other countries. Are they just healthier and use less medical services than we? Or are we so egocentric that we cannot acknowledge that someone could possibly know better?

When someone is making huge profits from something, it is very difficult to change that something.

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Posted: 03 July 2011 10:36 AM   [ Ignore ]   [ # 3 ]
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Or are we so egocentric that we cannot acknowledge that someone could possibly know better?

The “Not Invented Here” syndrome is alive and well in the USA. It doesn’t help that a lot of the general public has been scared silly of anything that even so much as smells like socialism that all some partisan hack needs to do is throw out the term as a buzzword to generate instant opposition.

In the events leading up to the passage of the so-called “Obamacare” package, I predicted the following;

a) It’s supporters would play up it’s virtues whether they existed or not and ignore it’s faults.
b) It’s opponants would play up it’s faults whether they existed or not and ignore it’s virtues.
c) The people who had taken the trouble to read the proposals and who understood it’s actual strengths and shortcomings would either be ignored or shouted down by both sides.

As it turns out, that’s exactly what happened!

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Posted: 03 July 2011 06:51 PM   [ Ignore ]   [ # 4 ]
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The health care debate is doomed IMO. Rising health care costs are the result of our population becoming older and obese from the ultra convienient lifestyle we have. Even if we had national health care, most Americans would run it into the ground with their lard asses. The problem with health care needs to be fixed at the bottom up, the people have to make the nessesary changes in their own lives,then maybe the national health idea might be more workable.

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Posted: 03 July 2011 11:25 PM   [ Ignore ]   [ # 5 ]
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mid atlantic - 03 July 2011 06:51 PM

The health care debate is doomed IMO. Rising health care costs are the result of our population becoming older and obese from the ultra convienient lifestyle we have. Even if we had national health care, most Americans would run it into the ground with their lard asses. The problem with health care needs to be fixed at the bottom up, the people have to make the nessesary changes in their own lives,then maybe the national health idea might be more workable.

I agree with a lot you said, but there are solutions to those type of problems. As I said before, other countries are faced with the same problems, yet they manage to make it work reasonably well. How do they do that?

A few ideas,
The expenses can be addressed in several ways, all of them geared to savings in health care but insuring a thriving economy in health related businesses, just with a little lower profits to serve a larger number of clientele.

a) Take the profit out of it, by having a non-profit corporation run the administrative functions. It will save literally billions of dollars. Employees get their salaries, management get their salaries, but no one gets vulgar bonuses and the system itself will be geared toward providing services , not profit. Medicare is such a system and could easily be expanded to include all legally entitled residents of the US. You become legally entitled if you contribute into the system from your paycheck or other regular monthly payments based on income.

b) We can have a system where the patient contributes out-of-pocket expenses for actual delivered services as we have now in Medicare as well as private health insurance.  And here we can have incentives. If a person can spend a lot of money on bad habits they can afford to pay more out-of-pocket. On the other hand a person who shows that their personal health is important to them they will be rewarded with lower out-of-pocket contributions when they do become sick.
We can have free yearly mandatory check-ups where doctors can and do diagnose self abusive behavior by blood tests, which can reveal a lot about their eating habits and self health maintenance. i.e. alcoholism will show up in tests, drug abuse will show up in tests, obesity from eating too much sugar will show up in tests. I am not advocating that doctors break their confidentiality obligations, but a rating system can be developed where the doctors have ability to recommend a lowering of out-of-pocket liability. i.e. a bill of clean health lowers your out-of-pocket obligations, not your contribution.
If a person is healthy and remains relatively healthy from self-care, their out-of-pocket expenses will be lower when they do get sick. It is reward system which still allows the personal freedom of choice and doctor/patient confidentiality, but if you take care of yourself, you will in fact be rewarded financially when you do get sick. (kinda like lower car insuarance premiums for good drivers).

c) Drug companies and docters can participate in the system if they are willing to accept a discount on their Public health services. This may sound socialist, but the lower profits are offset by a larger clientele and it still allows them to deal with rich people with Cadillac Insurances on their own terms.

d) An individual can opt out if you can prove that you have your own preferred health insurance, but then you must provide evidence of such coverage every year or be required to contribute into the system. If you cannot afford to contribute (job loss, physical disabilities, etc) you may get an exemption, paid out of a general contingency fund.

These are just a few ideas which occurred to me. I am sure there are arguments that can be made for and against, but the main point is that Health Care services need not be as expensive as they are now, not by a long shot.

IMO the only reason why we have not adopted a combination of the best practices in other countries are the shrill voices from for profit companies or public officials screaming “Socialism”, while they happily accept their socialist perks (paid for by tax payers).

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Posted: 04 July 2011 12:02 AM   [ Ignore ]   [ # 6 ]
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Write4U - 03 July 2011 11:25 PM
mid atlantic - 03 July 2011 06:51 PM

The health care debate is doomed IMO. Rising health care costs are the result of our population becoming older and obese from the ultra convienient lifestyle we have. Even if we had national health care, most Americans would run it into the ground with their lard asses. The problem with health care needs to be fixed at the bottom up, the people have to make the nessesary changes in their own lives,then maybe the national health idea might be more workable.

I agree with a lot you said, but there are solutions to those type of problems. As I said before, other countries are faced with the same problems, yet they manage to make it work reasonably well. How do they do that?

A few ideas,
The expenses can be addressed in several ways, all of them geared to savings in health care but insuring a thriving economy in health related businesses, just with a little lower profits to serve a larger number of clientele.

a) Take the profit out of it, by having a non-profit corporation run the administrative functions. It will save literally billions of dollars. Employees get their salaries, management get their salaries, but no one gets vulgar bonuses and the system itself will be geared toward providing services , not profit. Medicare is such a system and could easily be expanded to include all legally entitled residents of the US. You become legally entitled if you contribute into the system from your paycheck or other regular monthly payments based on income.

b) We can have a system where the patient contributes out-of-pocket expenses for actual delivered services as we have now in Medicare as well as private health insurance.  And here we can have incentives. If a person can spend a lot of money on bad habits they can afford to pay more out-of-pocket. On the other hand a person who shows that their personal health is important to them they will be rewarded with lower out-of-pocket contributions when they do become sick.
We can have free yearly mandatory check-ups where doctors can and do diagnose self abusive behavior by blood tests, which can reveal a lot about their eating habits and self health maintenance. i.e. alcoholism will show up in tests, drug abuse will show up in tests, obesity from eating too much sugar will show up in tests. I am not advocating that doctors break their confidentiality obligations, but a rating system can be developed where the doctors have ability to recommend a lowering of out-of-pocket liability. i.e. a bill of clean health lowers your out-of-pocket obligations, not your contribution.
If a person is healthy and remains relatively healthy from self-care, their out-of-pocket expenses will be lower when they do get sick. It is reward system which still allows the personal freedom of choice and doctor/patient confidentiality, but if you take care of yourself, you will in fact be rewarded financially when you do get sick. (kinda like lower car insuarance premiums for good drivers).

c) Drug companies and docters can participate in the system if they are willing to accept a discount on their Public health services. This may sound socialist, but the lower profits are offset by a larger clientele and it still allows them to deal with rich people with Cadillac Insurances on their own terms.

d) An individual can opt out if you can prove that you have your own preferred health insurance, but then you must provide evidence of such coverage every year or be required to contribute into the system. If you cannot afford to contribute (job loss, physical disabilities, etc) you may get an exemption, paid out of a general contingency fund.

These are just a few ideas which occurred to me. I am sure there are arguments that can be made for and against, but the main point is that Health Care services need not be as expensive as they are now, not by a long shot.

IMO the only reason why we have not adopted a combination of the best practices in other countries are the shrill voices from for profit companies or public officials screaming “Socialism”, while they happily accept their socialist perks (paid for by tax payers).

True enough, they do seem happy to take the money confused

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Posted: 13 September 2012 05:00 PM   [ Ignore ]   [ # 7 ]
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I hope Obama still wins this election. Obama Care health plan will surely still be continued. Would be such a waste though if this will get cancelled.click here for the best solution.

[ Edited: 01 October 2012 11:45 AM by raindrps61 ]
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Posted: 13 September 2012 05:45 PM   [ Ignore ]   [ # 8 ]
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Over the last 18 months I have, unfortunately become familar with the US health care system.  The first reform needed is to have the different care providers talk to each other.  The current system is basically the blind NOT leading the blind.

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Posted: 14 September 2012 03:49 AM   [ Ignore ]   [ # 9 ]
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I spoke with my sister the other day who’s a nurse practitioner at the V.A.  hospital.  If I understood her properly, she received a rebate on her health insurance because the company made more than 30% profit.  Apparently the 30% limit is part of the new health legislation?  Does it seem odd to anyone else, that an individual working for a well functioning, (by her account), not for profit health care provider has to buy insurance from a company that can makes a 29% profit on the service they provide?  As usual, I’m confused.

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Posted: 14 September 2012 04:18 AM   [ Ignore ]   [ # 10 ]
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Jeciron - 14 September 2012 03:49 AM

I spoke with my sister the other day who’s a nurse practitioner at the V.A.  hospital.  If I understood her properly, she received a rebate on her health insurance because the company made more than 30% profit.  Apparently the 30% limit is part of the new health legislation?  Does it seem odd to anyone else, that an individual working for a well functioning, (by her account), not for profit health care provider has to buy insurance from a company that can makes a 29% profit on the service they provide?  As usual, I’m confused.

Unfortunately for-profit insurance companies are too powerful and well-entrenched to be allowed significant non-profit or governmental competition. IIRC several such plans were on the table and eventually rejected due to lobbying.

As I understand it, on the present system, though, there is a maximum percentage that an insurance company can make in profit. I think I remember hearing it was 15%. So if your insurance company makes more than that, it must return the surplus.

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Posted: 14 September 2012 07:51 AM   [ Ignore ]   [ # 11 ]
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Write, a lot of the ideas you suggest are good ones and many of them are included in the ACA as well as the plans of other countries. There is one big item you have left out however. It seems to be the third rail in this discussion but its an item without which no plan can succeed. Its the intelligent rationing of care. I mean it when i say that there is absolutely no way for any health care system to succeed long term unless this issue is addressed.

Much is said about exorbitant profits being the driver of spiraling health costs and that may be a part of it in some areas of the system but overuse of services has become a major factor in the rise of premiums. What i mean by overuse is the use of services that do not alter the outcome or improve care. This happens for a number of reasons.

1) Its profitable -  Medicare and insurance companies pay much more for procedures and tests than they do for thinking services. If I spend an hour talking to a patient and educating them about good health practices I may get paid $90, but if I were to do a holter monitor which takes a few minutes to set up and a few more to read i get paid $180. A cardiologist can spend an hour doing an exam and get $100 but if he does a stress test on you he may get $500 and if he does a cardiac catheterization he may get $5,000. How in the world does that make any sense at all? Incentivize bad care and overuse and that is exactly what you will get. That is what this country has done.

2) Patient expectations - Many patients seem to be of the opinion that more care is better care. Much of this has been pounded into their head by the media. The media often gives people unrealistic expectations of what modern medicine can do or scares them into thinking they all need the latest most expensive test to diagnose the simplest problem. People really need to be educated to “dial it down”. More is not better. more is just more and sometimes more care is worse care. The USPSTF has been doing a good job in the area of making logical recommendations for screening tests based on clinical evidence rather than gut feelings. Unfortunately the public and the press have interpreted this as an attempt to take away valuable medical care instead of seeing it as a logical step to reducing useless and potentially harmful medical care ( ie. PSA’s, Mammograms in women under 50 etc.)

3) Law suits - You cant address the cost of medical care without addressing this. A very significant portion of the testing that is done every day could be done away with if doctors didn’t feel like they faced professional and financial ruin every time they stepped in a room with a patient. Combine this fear with the unrealistic patient expectations mentioned above and you have a recipe for fear and CYA medicine that leads to rampant over testing. I like to think that I am a little better than the average doctor and that I do my best to use years of clinical experience and education rather than testing to diagnose most things but I know every time I do that I am putting myself and my family’s economic future at risk. It shouldn’t be that way.

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Posted: 16 September 2012 06:42 AM   [ Ignore ]   [ # 12 ]
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I still think the bottom-up approach is the best one.  Nationalized health care invites a whole host of other problems, and doesn’t adequately solve the ones we have.

I heard a report about two years ago about a company which had a double-tiered health plan.  The lower-priced tier was available to those who:

1) If they were smokers, went on a plan to quit smoking.
2) Visited the company gym a certain number of times a week.
3) If they were overweight, set and accomplished targeted goals through sponsored weight-loss plans, etc.
4) And other stuff which I can’t remember off the top of my head.

Anyway, their plan enrollment went up *and their costs went down dramatically*.  What can we learn from this?  That if preventive care and healthy lifestyles are properly incentivized, we’ll see our nation’s health care costs decrease dramatically.

Now, part of the reason Obamacare was proposed in the first place was because of the law under Reagan that those who go to the emergency room *must* receive treatment, regardless of ability to pay.  But now we’ve turned the emergency room into a ridiculously overpriced, one-stop shop for everything from a broken bone to a mild sore throat, in addition to all of the other care that emergency rooms legitimately need to handle.  The idea to provide some safety net for those unable to afford health care is an admirable one, but imho it should be handled at the state or local level.

Now, I don’t believe the free market will necessarily come up with the best ideas, but what we seem to be doing is creating a path towards greater and greater health care costs…and the health insurance companies, etc., are getting rich at our expense.  Probably the best thing we can do is interview a consortium of doctors to come up with ideas, generate public input, and establish practices that work well at a state and local level.  Preventive care and free health education should be at the top of that list.

By health education, I mean the general common sense stuff that a lot of people don’t seem to have learned in school:

1) Learn what kinds of ingredients make you fat, people.  High fructose corn syrup, refined sugar, heavily processed foods, etc.  Avoid them, even if it costs more or if your favorite cereal with the fourteen different colors and shapes inside, happens to have said ingredients in abundance.  Also, if the food you eat doesn’t have enough nutrition content in it, you’ll be more prone to getting sick!
2) What are the common tricks you can use to avoid getting sick in the first place?  For instance, regulate the temperature in your house properly!  Don’t keep it too hot or too cold, because you’ll be more prone to getting sick if you do.
3) If you do get sick, how do you take care of yourself and avoid getting other people around you sick?  Stay the f*ck home and get enough rest, people.  Eat smart for whatever you have.  If you’ve got the flu and you’re having a pop tart for breakfast, you’re an idiot.
4) Attitude and emotions have a lot to do with your physical health.  If you’re down all the time, you’ll be more likely to get sick.

Note that other than the flu, which I had for about a day two winters ago (and only because I was overdoing it and not getting enough sleep for about a week before that, combined with really cold weather and insufficient insulation in the place I had at the time), I’ve not been sick in about ten years.  And I got over the flu that quickly using a homeopathic remedy called Oscillococcinum that you can get at your local drug store.

Damon

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Posted: 16 September 2012 08:05 AM   [ Ignore ]   [ # 13 ]
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Damon I am al for preventative health care and spend a good deal of my time educating my patients about it. I think its important to develop and support measures that encourage people to eat healthier, exercise more, smoke less, practice safe sex and receive health care screening measures that have proven benefits. This alone will not solve the rising cost of health care though. At most it will reduce costs in the single digit range. Partly because we all get sick eventually, partly because we already have programs in place to work on this, and partly because no campaign no matter how well intentioned or designed is ever going to be completely successful in eradicating bad behavior.

You state that “Nationalized health care invites a whole host of other problems, and doesn’t adequately solve the ones we have.” No system is perfect and without flaws but in the majority of the industrialized world they have better health care than us at half the cost. Universal health care is not the complete solution but its a far site better than what we have and it would be a good start.

Your argument that Obamacare (The correct term is the Affordable Care Act ( ACA) rather than Obamacare which is used by those who refer to it in derisive terms) as you call it was proposed because of a law requiring that ER’s treat all people is just not correct. It was proposed because there are many flaws with the existing system including most importantly cost and access. The fact is that ER’s don’t and won’t will turn away people who show up there for care because it is morally wrong to do so if they have no alternative pace to get care. The ACA certainly will address that issue by allowing more people to afford coverage and thereby giving them access to primary care in other locations but the ACA is meant as a first step in addressing the many other problems with the system, not just access for acute care.

I would like to point out a couple of things about this statement while we are at it.

“Note that other than the flu, which I had for about a day two winters ago (and only because I was overdoing it and not getting enough sleep for about a week before that, combined with really cold weather and insufficient insulation in the place I had at the time), I’ve not been sick in about ten years.  And I got over the flu that quickly using a homeopathic remedy called Oscillococcinum that you can get at your local drug store.”

Exposure to cold has absolutely nothing to do with catching colds or the flu. This has been proven time and again but its one of those wives tales that won’t die so for the record please scratch that idea.

You say you got over the flu quickly using a homeopathic remedy. First of all you may not have even had the flu. People use that term loosely to describe all manner of symptoms which can be caused by any of a hundred viruses and often what they have is nothing more than a cold virus but even if it were the flu all you can say is you got over it quickly. Whether the homeopathic remedy had anything to do with it or not is an unsupportable conclusion. Most people do get over “the flu” on their own. The length of time it takes depends on many factors including the particular virus involved and the health of the person infected. In all likelihood you would have gotten over this virus in the same period of time whether you took this concoction or not but the point is there is no good scientific evidence to support the use of Oscillococcinum for treating influenza.

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Posted: 16 September 2012 08:36 AM   [ Ignore ]   [ # 14 ]
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macgyver - 16 September 2012 08:05 AM

Damon I am al for preventative health care and spend a good deal of my time educating my patients about it. I think its important to develop and support measures that encourage people to eat healthier, exercise more, smoke less, practice safe sex and receive health care screening measures that have proven benefits. This alone will not solve the rising cost of health care though. At most it will reduce costs in the single digit range. Partly because we all get sick eventually, partly because we already have programs in place to work on this, and partly because no campaign no matter how well intentioned or designed is ever going to be completely successful in eradicating bad behavior.

I don’t believe health care should be as politicized or as controlled as it is, either.  And the idea isn’t to eradicate bad behavior, but to incentivize good behavior so we can help keep costs down.

macgyver - 16 September 2012 08:05 AM

You state that “Nationalized health care invites a whole host of other problems, and doesn’t adequately solve the ones we have.” No system is perfect and without flaws but in the majority of the industrialized world they have better health care than us at half the cost. Universal health care is not the complete solution but its a far site better than what we have and it would be a good start.

I disagree.  I think it locks us into a one-size-fits-all mentality, and I don’t want that.  I *especially* don’t want to subsidize someone else’s bad health choices, when I’m a damn sight healthier than the average person, and that’s what the health mandate is all about, unfortunately.  Its modus operandi is to get everyone on the rolls so that the people who are healthier can subsidize those who are less healthy, and those who can’t afford health insurance at the going rates.

macgyver - 16 September 2012 08:05 AM

Your argument that Obamacare (The correct term is the Affordable Care Act ( ACA) rather than Obamacare which is used by those who refer to it in derisive terms) as you call it was proposed because of a law requiring that ER’s treat all people is just not correct. It was proposed because there are many flaws with the existing system including most importantly cost and access. The fact is that ER’s don’t and won’t will turn away people who show up there for care because it is morally wrong to do so if they have no alternative pace to get care. The ACA certainly will address that issue by allowing more people to afford coverage and thereby giving them access to primary care in other locations but the ACA is meant as a first step in addressing the many other problems with the system, not just access for acute care.

Well, I didn’t mean to imply that the ACA was *only* implemented because of Reagan’s law, but it’s certainly a natural progression from it.

macgyver - 16 September 2012 08:05 AM

I would like to point out a couple of things about this statement while we are at it.

“Note that other than the flu, which I had for about a day two winters ago (and only because I was overdoing it and not getting enough sleep for about a week before that, combined with really cold weather and insufficient insulation in the place I had at the time), I’ve not been sick in about ten years.  And I got over the flu that quickly using a homeopathic remedy called Oscillococcinum that you can get at your local drug store.”

Exposure to cold has absolutely nothing to do with catching colds or the flu. This has been proven time and again but its one of those wives tales that won’t die so for the record please scratch that idea.

I vehemently disagree.  Having the ambient temperature either too hot or too cold can lead to people getting sick, whether it’s with the flu or whatever other germs or virii our bodies are exposed to all the time.

macgyver - 16 September 2012 08:05 AM

You say you got over the flu quickly using a homeopathic remedy. First of all you may not have even had the flu. People use that term loosely to describe all manner of symptoms which can be caused by any of a hundred viruses and often what they have is nothing more than a cold virus but even if it were the flu all you can say is you got over it quickly. Whether the homeopathic remedy had anything to do with it or not is an unsupportable conclusion. Most people do get over “the flu” on their own. The length of time it takes depends on many factors including the particular virus involved and the health of the person infected. In all likelihood you would have gotten over this virus in the same period of time whether you took this concoction or not but the point is there is no good scientific evidence to support the use of Oscillococcinum for treating influenza.

I had a fever and chills, then, and I had vomited a couple of times.  By the time I realized what it was, I was already a day into the symptoms and I was bedridden at that point, not able to get up and having to sleep most of the time.  Within one hour of taking Oscillococcinum, my flu symptoms were entirely gone, and all I had left was a mild cold that I got rid of in a couple of days.

Now, I happen to believe in mind over matter, so I believe that my refusal to *stay* sick probably played a large part in why I got better so quickly.  I doubt that my personal experience is of any scientific value as far as being a general predictor of how to stay healthy, basically.  Even so, I don’t want to subsidize other people’s health issues, so I would rather pay for my health issues as I go and just get emergency coverage when I’m able to afford it.

Damon

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Posted: 16 September 2012 03:25 PM   [ Ignore ]   [ # 15 ]
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damoncasale - 16 September 2012 08:36 AM

I had a fever and chills, then, and I had vomited a couple of times.  By the time I realized what it was, I was already a day into the symptoms and I was bedridden at that point, not able to get up and having to sleep most of the time.  Within one hour of taking Oscillococcinum, my flu symptoms were entirely gone, and all I had left was a mild cold that I got rid of in a couple of days.
Damon

...and of course you are absolutely positively certain that your symptoms would NOT have subsided if you hadn’t taken a medication proved to have absolutely NO active ingredients. Anecdote doth not evidence make. Thou shalt have a double blinded study and method of action beforeth thou shalt claim truth. smile

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