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Old 07-22-2018   #41
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...................Elsewhere in the rich world, it isn't a party political issue either. Nationalized health care (I accept that some Americans use "socialized" as a synonym for "the work of the devil") is taken for granted by all but the far right. Why are Americans different? Are they in fact different? .....................
Roger: Sometimes the democratic process is easy to love. Sometimes, as in recent US history, our personal views differ so dramatically from the majority's that is becomes a challenge to be able to step back and realize we must support the democratic process in spite of our divergences from the majority. This has certainly been the case in the last 20 months in the US.

All we can do is work hard to change those majority views to be in line with our own. I actively do do.
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Old 07-22-2018   #42
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Roger: Sometimes the democratic process is easy to love. Sometimes, as in recent US history, our personal views differ so dramatically from the majority's that is becomes a challenge to be able to step back and realize we must support the democratic process in spite of our divergences from the majority. This has certainly been the case in the last 20 months in the US.

All we can do is work hard to change those majority views to be in line with our own. I actively do do.
Dear Bob,

There is a difference between representative democracy and populist democracy.

With the former, we try to elect people who are smart enough to run the country. With the latter, we either bypass them or elect people by whose intelligence we do not feel threatened.

In the unique American case, the popular vote can be overridden by the Electoral College.

Cheers,

R.
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Old 07-22-2018   #43
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Thank you Bob for that explanation of the situation.
I’m reminded of John Wilmot’s line that “Any experiment of interest in life must be carried out at ones own expense “ .
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Old 07-22-2018   #44
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Roger: different countries with their differing related political / social structures work for different people.

I am happy you found one that works for you.
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Old 07-22-2018   #45
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So this is kind of what I was getting at. Just wanted to make sure I wasn't making assumptions about the US healthcare system.

I don't mean any bad wishes towards Matt. I hope he makes a speedy recovery but personally I think that having some insurance coverage, even like the one that Bob mentions would be on my priority list.

I'm less than 30, I own a detatched house in Toronto, 2 cars, I have my life insurance set up to keep my family covered in case of an emergency, financial plan set up for retirement etc. I didn't come from a rich family and I worked for everything I have, I pay my bills and have no debt other than the house and a car loan. I like to think that I have my ducks in a row.

For someone roughly the same age as me living what seems like a similar life be faced with such a daunting financial hurdle doesn't make sense to me. Especially when it comes down insurance for something that could destroy everything you've worked for your entire life in the case of an emergency.

If he didn't have any notoriety or online presence he would be boned and I'm sure this situation is a common occurrence in the US. I can only try to sympathize because the financial toll is almost incomprehensible to me.
I, like most people, suffered from a misunderstanding of how things have shifted for many who might have done the right thing and thought they had all their ducks in a row. It is worth reading this and while this is based on US data it pretty much applies in CA/AU etc):
https://www.theatlantic.com/magazine...ocracy/559130/
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Old 07-23-2018   #46
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Roger: different countries with their differing related political / social structures work for different people . . .
Dear Bob,

Sure. I'm just curious as to why you have the US with one world-picture, and the rest of the rich world with another. Doesn't it strike you as odd too?

Cheers,

R.
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Old 07-23-2018   #47
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I find it very interesting how so many people here know the exact details of someone's financial well-being and what kind of situation he is currently in to be able to make such judgements about someone. Maybe his insurance wouldn't cover it because it required a specialist doctor or surgery that regular insurance wouldn't cover? There's an endless amount of reasons that they need help. The GoFundMe wasn't set up by Matt or his wife. It was set up by someone else with their family as the beneficiaries without them even knowing about it. I donated because Matt is a good friend, not because he's got a little bit of e-fame. I would have donated more if I could. Life gets hard sometimes and sometimes you're fortunate enough to have a community to help you out, even when you don't ask for it. To those of you saying things like, "He should have sold his stuff, he should have done this or that," you can **** right off. Ban me if you want.
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Old 07-23-2018   #48
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I find it very interesting how so many people here know the exact details of someone's financial well-being and what kind of situation he is currently in to be able to make such judgements about someone. Maybe his insurance wouldn't cover it because it required a specialist doctor or surgery that regular insurance wouldn't cover?
Fair point. But I wouldn't say many of us are making judgments. We can only make assumptions.
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Old 07-23-2018   #49
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Sure. I'm just curious as to why you have the US with one world-picture, and the rest of the rich world with another. Doesn't it strike you as odd too?
Roger, I have learned in life that I must clearly and unemotionally distinguish between what is and what one believes should be. I have been referring to reality or "what is" while I suspect you have been referring to what you think it should be.

Specific to your comment: I do not personally "have the US with one world-picture, and the rest of the rich world with another" as you imply. That is hard fact reality that I simply acknowledge. If one believes it should or should not be that way is an entirely different discussion.
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Old 07-23-2018   #50
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there are valid reasons to decide whether or not to give money to the fundraiser. medical crowdfunding contributes to inequitable disparities in health care, but it also supports care that falls through the cracks of a flawed health care system. we’re all good here.
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Old 07-23-2018   #51
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Roger, I have learned in life that I must clearly and unemotionally distinguish between what is and what one believes should be. I have been referring to reality or "what is" while I suspect you have been referring to what you think it should be.

Specific to your comment: I do not personally "have the US with one world-picture, and the rest of the rich world with another" as you imply. That is hard fact reality that I simply acknowledge. If one believes it should or should not be that way is an entirely different discussion.
Dear Bob,

No, I'm just wondering why. Don't you ever wonder why things are the way they are? Especially when one country does things one way, and everyone else does them another. There's not necessarily any "should" in it. But there's a lot of "wondering why". You seem exceptionally unwilling to address this.

Cheers,

R.
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Old 07-23-2018   #52
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Dear Bob,

No, I'm just wondering why. Don't you ever wonder why things are the way they are? Especially when one country does things one way, and everyone else does them another.
Dear Roger,

if I may answer?

IMHO, ultimately, it has to do with the theological concept of *justification*.

If the U.S.A. were predominantly Anglican, or Roman Catholic, or Lutheran, -- they would have a stable social insurance/social security system like basically all European countries.

But a predominantly Reformed/Calvinist [1] country doesn't need that; for the absolutely deprived some breadcrumbs -- mere welfare or assistence -- must be enough, I suppose.

[1] The Netherlands are a very special exception of that rule, of course.
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Old 07-23-2018   #53
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Dear Roger,

if I may answer?

IMHO, ultimately, it has to do with the theological concept of *justification*.

If the U.S.A. were predominantly Anglican, or Roman Catholic, or Lutheran, -- they would have a stable social insurance/social security system like basically all European countries.

But a predominantly Reformed/Calvinist [1] country doesn't need that; for the absolutely deprived some breadcrumbs -- mere welfare or assistence -- must be enough, I suppose.

[1] The Netherlands are a very special exception of that rule, of course.
Fascinating; I was more familiar with the cliché of salvation through works or through faith. Certainly, the substitution of faith for works explains a lot.

Cheers,

R.
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Old 07-23-2018   #54
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No, I'm just wondering why. Don't you ever wonder why things are the way they are? Especially when one country does things one way, and everyone else does them another. There's not necessarily any "should" in it. But there's a lot of "wondering why".
Roger, I do more than just "wonder why". I am politically involved by communicating with my elected representatives and supporting organizations who I believe will cause change to a more equitable structure.

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You seem exceptionally unwilling to address this.
Absolutely! I have learned years ago not to discuss or debate political views on the internet. I deal only in realities. You are one of the few posters who actually uses their real name and does not hide in the shadows. There are just too many people whose intelligence I question while they lash out anonymously. Mark Twain had some good quotes about getting into debates with the likes of them.
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Old 07-24-2018   #55
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WOW to this thread.

All I can add is that if I were to get sick like Matt, it would not be a good thing for me and my family. EVERY persons situation is different.

My wife and I both work and If I were to get ill, things could get tough QUICK for her. Do we have insurance, YES. Pretty good one at that.

Now you can blame us/me for not having a "Safety net" like obviously most people do but the reality is we don't. At least nothing that can cover us/her for a long term issue. MANY MANY factors come into play in people lives. Even selling off my gear and stuff wouldn't yield anything near or over $10k.

Even with that, neither of us would feel comfortable setting up a page to fund our situation. But I wont knock others since their case can be worse than most people think.

But if I were to get robbed, I mean come on. I cant see myself asking the public for help with that. I guess we all draw the line somewhere.

my 2 cents.
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Old 07-24-2018   #56
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Fascinating; I was more familiar with the cliché of salvation through works or through faith.
A common misconception... Faith (in God) and good works (for our fellow man) must go hand in hand.

“Salvation through works alone” is a misnomer. No one can “buy” their way to salvation by doing good works if the intent is just that — to buy their way to salvation, i.e., a celestial quid pro quo.

Rather, I would argue that a man of faith innately does good works because it is part of his very nature as a man of faith.

Wrt to “ salvation though faith alone,” the concept of ‘sola fides’ is incomplete because as I have stated above, a man of faith, by his very nature, does good works.

Sorry to get off topic.

-Keith
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Old 07-24-2018   #57
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I find it very interesting how so many people here know the exact details of someone's financial well-being and what kind of situation he is currently in to be able to make such judgements about someone. Maybe his insurance wouldn't cover it because it required a specialist doctor or surgery that regular insurance wouldn't cover? There's an endless amount of reasons that they need help. The GoFundMe wasn't set up by Matt or his wife. It was set up by someone else with their family as the beneficiaries without them even knowing about it. I donated because Matt is a good friend, not because he's got a little bit of e-fame. I would have donated more if I could. Life gets hard sometimes and sometimes you're fortunate enough to have a community to help you out, even when you don't ask for it. To those of you saying things like, "He should have sold his stuff, he should have done this or that," you can **** right off. Ban me if you want.
I agree 100%. I'm surprised and saddened that anyone should have had the reaction of "sell your stuff off". Insurance rarely covers every eventuality and small print exclusions are cited all too often as reasons for not paying out. What Matt and his family are going through sounds very challenging to put it mildly. He deserves and gets my support.
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Old 09-01-2018   #58
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Fortunately, Matt is doing better now. Have a look, he is talking to us and saying thank you to all who have helped him:

https://www.youtube.com/watch?v=9UEQSOSJH8A
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Old 09-01-2018   #59
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The real irony of it all is the system here in the US before was socialized medicine. Those of us that have insurance pay for those that don't. Those that get sick and don't have insurance go to their local emergency dept. They get treated and because it is an ED it is really expensive. And a lot of times they don't go until they are really sick. If they had insurance and went to a family practice or internal medicine physician it would cost a lot less. So the hospitals, which are usually running on very close margins, then raise their cost to cover those that don't have insurance thus causing those of us that have insurance rates to go up. So those that have are paying for those that don't. That is a redistribution of wealth no matter how you cut it. So it is a bit ironic that those that don't want insurance for all would call insurance for all socialized when that is exactly what it was and is returning to with so many loosing insurance. Thats not political it is just the way it is.
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Why we pay so much for healthcare in the US but our health comes lag behind
Old 09-02-2018   #60
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Why we pay so much for healthcare in the US but our health comes lag behind

I am late to this discussion, but would like to add a few thoughts. I am a physician who practiced in US in a highly technical field for 30 years. I took care of many thousands of very ill patients and performed around 14,000 procedures while in practice. I am now working for a large national healthcare system to try to help improve, the quality of care for our patients and tracking measurable outcomes (mortality, infection rates, heart attack and stroke rates, need for hospital readmission, quality of life, patient satisfaction, etc.j. It is not necessary for me to speculate about these numbers, we carefully gather them from multiple sources both internal and external. I have access to them from my computer. Here is what those numbers, as well as other verified research has to say.

Most Americans are under the misconception that the main issue with healthcare outcomes and costs is those that have insurance versus those that don’t. As long as I have “excellent” healthcare coverage through my job or Medicare, I will receive the excellent care the American healthcare system has to offer—the “envy of the world”. While it is certainly true that being uninsured or underinsured in America is a huge barrier to receiving healthcare, and can lead to personal financial ruin, the converse is not true. Having good insurance in no way guarantees good care.

The data show that for any given diagnosis or procedure there is a huge variation in outcomes depending upon where you live, who your doctor is, which hospital you go to, and what economic incentives or disincentives exist there. These variations cannot be simply explained by socioeconomic factors. I can compare the mortality rates for heart attack or heart failure patients (or whatever) across our >90 hospital system and find a wide variation in how patients do, and the poor outcomes may well be at one our gleaming, high tech suburban medical centers and the low mortality may be at an inner city “safety net hospital”. Also, the cost per equivalent severity case may be lower at the place with low mortality (that does fewer procedures and tests), and higher at the place with high mortality (that does a lot). For a description of this phenomenon I refer you to Atul Gawande’s article in The New Yorker on “The Cost Conundrum”. The data from our national healthcare system confirms those described in his article. https://www.newyorker.com/magazine/2...cost-conundrum

Why might this be? We Americans tend to have a bias towards aggressive highly technical solutions to our problems, and we demand that of our doctors (the “Moon Shot” mentality—“Just fix me, Doc!). These solutions often carry signicant short and long term risks and, when eventually rigorously tested against less agressive, more “conservative” options, prove to have no better and often worse results at hugely greater expense. This is also true of many drugs we use. We American doctors tend to also favor these types of treatments, we train many years in how to do them, and as they say “when you have a hammer everything looks like a nail”. We get to be heros like on TV. There is also still a strong profit motive here for doctors and hospitals, and if you happen to own a million dollar imaging machine or robot it tends to get used whether or not it has been proven to provide better outcomes. This may be conscious or unconscious, but the data have shown it over and over again (see Gawande article above).

There certainly are situations in which immediate, aggressive high tech approaches are absolutely life saving. These tend to be for emergencies like heart attack, stroke, trauma/gunshots, acute bleeding, appendicitis, and the like. I know, because I helped develop some of these techniques (met a lot of helicopters in my career) and they were proven to be better in large studies. But, outside of the emergency setting we spend nearly twice as much money as other countries but our patients frequently don’t do as well. We all, including me, pay for this either with our own health or our dollars, whether in premiums, tax dollars, out of pocket expense, or bankruptcy. This is not a liberal vs conservative issue—some very good work on this has come from conservatives. No matter who is in power, these facts will need to be addressed. Call it Romneycare, Obamacare, Trumpcare, whatever you want, the patient and financial data is there to see (except for the actual patients who have essentially no access to the information they need on quality or price). This is fixable. We need to insist that whenever possible, all patients receive the treatments that have been proven to work the best in clinical trials, every time, for every patient, in every place. We doctors all think that is what we do, but the data says otherwise. Facts are stubborn things, and they (still!) matter.

Last edited by stevierose : 09-02-2018 at 11:49. Reason: Fix typos
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Old 09-02-2018   #61
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Thanks for posting the link Skiff.
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Old 09-03-2018   #62
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I am late to this discussion, but would like to add a few thoughts. I am a physician who practiced in US in a highly technical field for 30 years. I took care of many thousands of very ill patients and performed around 14,000 procedures while in practice. I am now working for a large national healthcare system to try to help improve, the quality of care for our patients and tracking measurable outcomes (mortality, infection rates, heart attack and stroke rates, need for hospital readmission, quality of life, patient satisfaction, etc.j. It is not necessary for me to speculate about these numbers, we carefully gather them from multiple sources both internal and external. I have access to them from my computer. Here is what those numbers, as well as other verified research has to say.

Most Americans are under the misconception that the main issue with healthcare outcomes and costs is those that have insurance versus those that don’t. As long as I have “excellent” healthcare coverage through my job or Medicare, I will receive the excellent care the American healthcare system has to offer—the “envy of the world”. While it is certainly true that being uninsured or underinsured in America is a huge barrier to receiving healthcare, and can lead to personal financial ruin, the converse is not true. Having good insurance in no way guarantees good care.

The data show that for any given diagnosis or procedure there is a huge variation in outcomes depending upon where you live, who your doctor is, which hospital you go to, and what economic incentives or disincentives exist there. These variations cannot be simply explained by socioeconomic factors. I can compare the mortality rates for heart attack or heart failure patients (or whatever) across our >90 hospital system and find a wide variation in how patients do, and the poor outcomes may well be at one our gleaming, high tech suburban medical centers and the low mortality may be at an inner city “safety net hospital”. Also, the cost per equivalent severity case may be lower at the place with low mortality (that does fewer procedures and tests), and higher at the place with high mortality (that does a lot). For a description of this phenomenon I refer you to Atul Gawande’s article in The New Yorker on “The Cost Conundrum”. The data from our national healthcare system confirms those described in his article. https://www.newyorker.com/magazine/2...cost-conundrum

Why might this be? We Americans tend to have a bias towards aggressive highly technical solutions to our problems, and we demand that of our doctors (the “Moon Shot” mentality—“Just fix me, Doc!). These solutions often carry signicant short and long term risks and, when eventually rigorously tested against less agressive, more “conservative” options, prove to have no better and often worse results at hugely greater expense. This is also true of many drugs we use. We American doctors tend to also favor these types of treatments, we train many years in how to do them, and as they say “when you have a hammer everything looks like a nail”. We get to be heros like on TV. There is also still a strong profit motive here for doctors and hospitals, and if you happen to own a million dollar imaging machine or robot it tends to get used whether or not it has been proven to provide better outcomes. This may be conscious or unconscious, but the data have shown it over and over again (see Gawande article above).

There certainly are situations in which immediate, aggressive high tech approaches are absolutely life saving. These tend to be for emergencies like heart attack, stroke, trauma/gunshots, acute bleeding, appendicitis, and the like. I know, because I helped develop some of these techniques (met a lot of helicopters in my career) and they were proven to be better in large studies. But, outside of the emergency setting we spend nearly twice as much money as other countries but our patients frequently don’t do as well. We all, including me, pay for this either with our own health or our dollars, whether in premiums, tax dollars, out of pocket expense, or bankruptcy. This is not a liberal vs conservative issue—some very good work on this has come from conservatives. No matter who is in power, these facts will need to be addressed. Call it Romneycare, Obamacare, Trumpcare, whatever you want, the patient and financial data is there to see (except for the actual patients who have essentially no access to the information they need on quality or price). This is fixable. We need to insist that whenever possible, all patients receive the treatments that have been proven to work the best in clinical trials, every time, for every patient, in every place. We doctors all think that is what we do, but the data says otherwise. Facts are stubborn things, and they (still!) matter.
Dear Steve,

All very true, but unfortunately for many people ideologies (including what you call the Moon Shot Ideology) trump facts, logic and data. You are of course absolutely right about evidence-based medicine, but another problem is what Frances has always called the God Syndrome, which leads a distressing number of doctors to believe that they are omniscient, and that their personal prejudices and (possibly out-of-date) training and education set them above the common herd.

The "expensive toys" syndrome is also very dangerous. It turned out, unfortunately, that the local physiotherapist largely eschews hands-on massage in favour of the ripple massage bed, the "deep heat" collar and other bits of technology.

Fortunately we hope to be off to the baths at St. Thomas next week: 10€ ($11) each for an all-day visit, and a lot more use. Highly medicalized and (worse still) artificial spas tend to be very expensive and often useless, but a long soak in a proper spa -- essentially, a warm swimming pool fed by a thermal spring -- is another matter. We have visited them in France, Hungary, Germany, Romania, Greece...

Medical care is not a political issue. It's a public health issue. But again, ideology raises its head.

Cheers,

R.
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Old 09-03-2018   #63
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Answer is: NO, thanks to Obamacare (aka Mitt Romney’s health care reform in Massachusetts).
LOL! So do you believe that things were better before the ACA? Do you look back fondly on the days when 55 million Americans had no insurance coverage?

The ACA is far from perfect, but it has been an improvement. The only sensible alternative is to provide universal coverage, as almost every other developed nation has done.
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Old 09-03-2018   #64
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LOL! So do you believe that things were better before the ACA? Do you look back fondly on the days when 55 million Americans had no insurance coverage? . . .
Sure! Who cares if poor people die horribly, or from cheaply avoidable causes? They're just poor people.

What are you, some kinda commie?

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Old 09-05-2018   #65
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Dear Bob,

No, I'm just wondering why. Don't you ever wonder why things are the way they are? Especially when one country does things one way, and everyone else does them another. There's not necessarily any "should" in it. But there's a lot of "wondering why". You seem exceptionally unwilling to address this.

Cheers,

R.
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Old 09-05-2018   #66
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Originally Posted by FujiLove View Post
"You see, if only they didn't speak English in America, then we'd treat it as a foreign country–and probably understand it a lot better"

— Jon Sopel, from his book 'If only they didn't speak English'

I think he's onto something there.
Brilliant! Thanks!

Quite honestly, Frances and I have more in common with most of our Tibetan refugee friends than we do with some of our American and even English relatives. The Anglophone popular press and economic world picture can be pretty corrosive.

Cheers,

R.
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Old 09-05-2018   #67
ChipMcD
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ChipMcD is offline
Join Date: Oct 2010
Location: East Coast USA
Posts: 467
Quote:
Originally Posted by brennanphotoguy View Post
I find it very interesting how so many people here know the exact details of someone's financial well-being and what kind of situation he is currently in to be able to make such judgements about someone. Maybe his insurance wouldn't cover it because it required a specialist doctor or surgery that regular insurance wouldn't cover? There's an endless amount of reasons that they need help. The GoFundMe wasn't set up by Matt or his wife. It was set up by someone else with their family as the beneficiaries without them even knowing about it. I donated because Matt is a good friend, not because he's got a little bit of e-fame. I would have donated more if I could. Life gets hard sometimes and sometimes you're fortunate enough to have a community to help you out, even when you don't ask for it. To those of you saying things like, "He should have sold his stuff, he should have done this or that," you can **** right off. Ban me if you want.

These are good points. Recently Matt put up a YouTube video explaining that he contracted a very rare tick-borne illness in the course of his occupation of engraving gravestones in cemeteries. In this country, that type of business is typically a small business for which good medical insurance is very expensive because of the small number of employees constituting the risk pool. Matt explained that he suffered serious nerve damage in his arms, for which the rehabilitation period is lengthy. He cannot work during this time, and I believe that the Go Fund Me fund is partially to help out with the loss of income. Although he does not say so, given the nature of the nerve damage, it seems possible that he may not be able to continue in this line of work, and if he owns his own business, he may lose it.

If you watch the video (https://www.youtube.com/watch?v=9UEQSOSJH8A), you will see that he is extremely humble and grateful for the help he has received, which was orchestrated by a fellow photographer. I'm sure that there are abusive Go Fund Me campaigns, but it seems unlikely that this is one of them. It is disappointing that some posters here seem to jump to an adverse conclusion.
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