I'm still fascinated about this usage, probably because I'm not experiencing what I'm reading. Dictionary.com has something on it too, which basically agrees with everything else I've read. https://www.dictionary.com/e/word-fact-toward-vs-towards/
Unlike the others, they provided empirical data:
Looking at American English data from Google Books Ngram Viewer, towards appears to have been used more widely in American English texts up until about 1900, when it was overtaken by toward.
Ngram is case sensitive. Inserting forward and forwards will produce very different results.
Brit English n-grams will additionally be confounded by the fact that football doesn't have any centre towards ;)
AJ
Best head towards your medication...
If you hadn't heard, the UK has a crisis with its pharmaceutical supplies. I'm off my meds and feeling great, although I'm going to need a bigger patio for the bodies ...
AJ
If you hadn't heard, the UK has a crisis with its pharmaceutical supplies.
I'm sure it'll be blamed on Brexit (even if it doesn't happen...)
I'm sure it'll be blamed on Brexit (even if it doesn't happen...)
A few articles I've found are doing just that. That would be in a word, bullshit.
https://www.dcatvci.org/6056-the-eu-and-drug-shortages
Coincidence? Very unlikely.
https://www.politico.eu/article/europe-still-coming-up-short-on-drug-supplies/
Drug shortages in Europe are hitting all-time highs — and countries are looking to Brussels for an answer.
In July alone, cancer patients were unable to access treatment in Italy, shortages of neurological drugs reached an "unprecedented scale" in Poland and the total number of unavailable drugs in Belgium reached a new record.
Drug shortages are EU wide, and have been since before the Brexit vote. Why?
The answer isn't politically correct. In fact, in some parts of Europe, answering that question can get you arrested and or fined.
A few million refugees and asylum seekers, replete with third world medical issues, all receiving free drugs and medical care would pinch the supply line. Especially when big pharma starts farming out their production to higher paying customers that do not have socialist medicine fixed pricing. Not to mention production cuts where it's costing them more to produce than what they are being paid for it as a result of government mandates.
I'm sure that's going to piss some people off, but it is what it is.
The answer isn't politically correct. In fact, in some parts of Europe, answering that question can get you arrested and or fined.
The cause are multiples:
First the regulatory burden.
That burden put out of business small manufacturer, put it also put out smaller market drugs manufactured by big groups. When the burden requires 300man/hours producing production documentation for one drug and it is raised to 400man/hours by new regulation. There is a shortage of qualified bureaucrats to complete the task for every drug.
The regulatory burden on pharmaceutical producers worldwide and in Europe has risen steadily, to the point that it is unmanageable.
But there is a secondary problem: The lack of proper sourcing for base ingredients.
The market has globalized and more and more, big groups are no more vertically integrated and have terminated production of base ingredients for which they though they were no more competitive.
So they rely on unreliable Chinese suppliers with no correct management of production schedule.
You have to realize, that there are millions of ingredients, They are produced in batch with one production chain able to make dozen of them sequentially:
Typically:
- source ingredients
- test them
- Setup the production chain
- Manufacture a test batch
- test it
- Manufacture the whole world production for 6 month:(1-2Kg)
- Test it
Discover that you fucked up and shelve the problem for 6 month because you do not have enough base ingredients anymore, your production capacity and laboratory test equipment is needed for the next batch of the next product...
Next problem is that by rising the bar on certification, quality some of the ingredients manufacturer lost their licenses, that also lead to shortage which impact whole classes of drugs.
The problem is not really the government mandate or price, as the same drug is sold for a dime in India.
The problem is:
1 Paperwork
2 Poor production outsourcing decisions.
3 Production quality and reliability.
You have to realize that despite the price mandate, the margins are still highway robbery.
And even the most generic low cost drug like aspirine have a production cost of 1EUR/kg and a resale value: 400EUR/kg...
As if 0.5% of population increase would have any effect. The penury is specific on certain drugs for which big pharma fucked up the manufacturing outsourcing. Not on any drugs related to migrant population (Vacine / Antibiotics)
Your delusional misinformed racist bias is totally unfounded.
Your delusional misinformed racist bias is totally unfounded.
That accounts for about 40% of the U.S. adult population; tribalism has replaced reasoned discourse. Facts are judged by tribal origin; truth no longer matters.
Pharma prices are so high in the US only the wealthy can afford them; the 20% co-pay health insurance proviso is bankrupting families. Rising costs are threatening to bankrupt government health programs. Greed rules.
We've already had to refuse two medical prescriptions due to exorbitant costs. The drug that saved my daughter's life (stage 3 breast cancer) was $120,000/year seven years ago. How much higher today? A life-flight transport from a wreck scene to a trauma hospital now costs $50,000 or more. "Special" transport insurance is now almost mandatory.
What good is a fee-based health care system if greed and runaway costs price it out of reach? Maybe the NHS is inefficient and bureaucratic; but at least UK citizens have access to health care without facing personal financial disaster. Here in the US, being bankrupted and forced onto the street is hardly the more desirable option.
That accounts for about 40% of the U.S. adult population; tribalism has replaced reasoned discourse. Facts are judged by tribal origin; truth no longer matters.
Which 40% do you refer to? Whose truth, your own or your "tribe?"
Speaking of tribe, some still refer to us as tribes when we are, and always have been, nations. Of course that term is bandied about frequently among the 'hipster' group. On the rez we simply use nation, and tribe to account for the various subgroups, so maybe they are simply emulating us. Of course in PC speak, that would be cultural appropriation.
Then again, in PC speak, one could call the assumption that I am white racist itself. Especially when I was born to a 100% Cherokee father on the rez. Not the 1:1024th pretender plagiarizing french recipes and calling them Cherokee.
BTW; Where are you that a life flight cost 50k? I suggest you move if that's true.
BTW; Where are you that a life flight cost 50k?
A friend of mine was run over in a supermarket parking lot while loading his groceries into his trunk. The driver made a turn and hit his gas pedal instead of his brake. My friend was medivaced to a hospital (and this is the west valley part of the Phoenix metropolitan area so it's not a small rural town). I don't remember what he said it cost, but it was in the tens of thousands of dollars. It was paid for by the other guy's insurance.
Anything medical costs a fortune. Just look at the details on your hospital bill.
Anything medical costs a fortune. Just look at the details on your hospital bill.
Yes, I know. My mother's care for heart surgery was going to cost me 275k because the fucking insurance company said it wasn't a covered condition. Unfortunately she died from the condition before I could convince the hospital and doctors I was good for it. That was 2017 and it's still going in court. Apparently, if you're old, you're just shit out of luck.
And then there is the classic "the operation was a success, but the patient died." Once the operation is over there is a period when the patient is "in recovery" and then they get one of the difficult to treat infections usually a virus that is pretty much immune to any treatment the hospital has to give. There are special procedures involving washing hands of caregivers and colored gowns.
Just as the lady who was going to arrange for my wife to be moved to a nursing home for less expensive recovery arrived to discuss the change, my wife's condition worsened. It took about 3 weeks but she died anyway. No one at the hospital that treated her, and half a dozen different specialty doctors did, would sign the death certificate. They made her primary care physician, who had nothing to do with her treatment at the hospital, sign the document. A lot of copies were needed and boy were they expensive.
Nothing like the hospital bill, which I let the medical insurance handle. The copy I saw was in the hundreds of thousands, hey, four weeks in a hospital including the surgery? Sometimes you go to the hospital to get better, and sometimes you go there to die.
Apparently, if you're old, you're just shit out of luck.
Ditto the UK - the NHS is institutionally ageist. Oledr people get the cheap and nasty replacement joints, for example, and NHS doctors are still deliberately starving and dehydrating patients to death despite nominally giving up 'care pathways'.
AJ
BTW; Where are you that a life flight cost 50k? I suggest you move if that's true.
In the Pacific NW, not far from one of the major US cities where it's almost impossible for a working-class person to afford rent or to buy a home. Charges for medical transportation (whether ambulance or air) is in the tens of thousands. It's now very common to see advertising urging the necessity of "subscription plans" for Life Flight coverage.
A few years ago a good friend returned to Iran for a few months to have dental work done; it was 1/10th the US rate: $35K of work for $3500.
RV websites are now carrying regular columns about retired RV couples going to Mexico for medical treatment, again, at 1/10th (or less) the cost of US medicine. The only real hassle is getting back and forth across the border, thanks to gov't paranoia.
Before anybody shouts that the quality of care in Iran or Mexico is substandard compared to US standards, think again. All reports coming back on the website forums state that isn't the case.
As for superior US medical care, one might consider that we kill three times as many people per year with documented hospital errors as we do in traffic accidents: 90,000 to 30,000. So... its three times safer to drive the freeways than to be admitted to a US hospital. And auto insurance won't leave you bankrupt when the claim is settled.
In the Pacific NW, not far from one of the major US cities where it's almost impossible for a working-class person to afford rent or to buy a home.
I won't comment on Iranian health care as I've no experience with it.
Mexico is hit or miss depending on which state of Mexico you're in*. I've had health and dental work in Mexico. Burn treatment in Mexico city, dental work in Ensenada Baja Norte, and a knife wound in Michoacán. The former two were first class, the latter one not so much.
*The latter bears some minimal explanation. SEMA (oil and gas company out of Zamora) picked up the bill for Michoacán attack given I was contracted to them at the time and on their grounds. Unfortunately that was part of the problem. Some of the medical staff had an attitude about anyone working for them. Therefore I can't in fairness blame the system. I can blame the medical staff for the crap care I got.
Regarding dental work, I can't speak for the states for the last three decades, as that was the last time I had anything but a cleaning done. In the last fifteen years, the only place I've had work done is in the P.I. We usually schedule it (if needed) when we visit my wife's family. I'll be calling around this coming week to get an update on local cost.
As for the PNW, that's not a new problem. We lived in Lynnwood for while, and it was expensive as hell by comparison eighteen years ago.
No one should take any of my comments to mean I believe the health care system here is somehow better or cheaper. I had high hopes for the affordable health care act, but the entirety of Congress was apparently in the tank when it was written. That was self evident by the refusal to remove the interstate competition laws. Now the insurance companies have run roughshod over the entire industry. The only thing good to come of it was removal of preconditions clauses.
It doesn't really matter if you die because the insurance company refused to pay, or if it was because you had to wait a few more months than you had left to live before you got care. The dead certainly aren't around to do anything about it.
Edited for clarification
the entirety of Congress was apparently in the tank when it was written. That was self evident by the refusal to remove the interstate competition laws.
What are the interstate competition laws and how would their removal make things better?
What are the interstate competition laws and how would their removal make things better?
Insurance providers are licensed and regulated at the state level. If you live in state A, you can't buy insurance in neighboring state B. Many large insurers are licensed in many states, but differing regulatory requirements reduce economies of scale.
When the PPACA was enacted, Congress could have used commerce clause justifications to preempt state health insurance regulations, allowing large insurers to freely sell health insurance across state lines, increasing competition and putting downward pressure on premiums. But they didn't.
Insurance providers are licensed and regulated at the state level. If you live in state A, you can't buy insurance in neighboring state B. Many large insurers are licensed in many states, but differing regulatory requirements reduce economies of scale.
That also means each state has their own Department of Insurance, too, so there was a bit of pressure from states that this should NOT be free and open, as it's actually NOT interstate commerce. Insurance is an intangible item. It's not like a tomato farm in Indiana selling actually tangible items to consumers across state lines.
Insurance is an intangible item. It's not like a tomato farm in Indiana selling actually tangible items to consumers across state lines.
But it is a contract with considerations and obligations on both sides. The obligations may be provision of pre-paid or post-paid services.
Is providing telephone support across state lines a tangible good? It is certainly commerce as there is an exchange of things of value.
Is buying a software license across state lines a tangible good? It is certainly commerce, as there is an exchange of things of value.
Is, for example, paying WLPC for premier access to SOL across an international border a tangible good? It is certainly commerce as there is an exchange of things of value.
I understand what you're saying, but DS gave the correct description. It is interstate commerce the moment a payment is made across state lines. The words you're looking for are goods and services.
The subject has been hashed, and rehashed by SCOTUS repeatedly already. A good place to start research is the Sherman and Clayton antitrust acts. The latter in particular.
Commodities are not the only form of 'commerce' involved.
https://www.13newsnow.com/mobile/article/news/nation-now/47000-air-ambulance-bill-for-their-child-shocks-family-the-insurance-company-said-it-would-pay-5000/465-b351a5e0-d08c-4923-ab3f-01f1fe3b7c8a
Charged nearly double the normal rate. Around here, it's half that without insurance. That kind of charge is unconscionable.
at least UK citizens have access to health care
More and more don't have access to health professionals because of a dire shortage. Hence the Health Department telling people to go to their pharmacists to get eg complex heart conditions diagnosed.
AJ
More and more don't have access to health professionals because of a dire shortage. Hence the Health Department telling people to go to their pharmacists to get eg complex heart conditions diagnosed.
Never heard about the second part of that.
I groan when I hear candidates say Medicare for All is the answer. I'm on Medicare. My wife had a knee replacement 6 weeks ago. Guess what? It took forever to find a surgeon that accepted Medicare.
People think doctors won't have a choice but to accept Medicare when that's the only insurance. Think again. My primary care doctor doesn't take any insurance. I pay an annual fee and have to submit stuff to Medicare myself for some repayments.
I don't have dental insurance and asked my dentist for a break. He said my procedures cost me more than those people with insurance because the insurance companies negotiate a lower price. He said that if all his patients had insurance he'd go out of business.
Oh, Medicare isn't free. I pay a monthly premium. And it doesn't cover all. I have a private insurance plan to cover what it doesn't. With Medicare for All I lose that private insurance.
Congressmen have the best medical insurance in the world. I bet if Medicare for All goes into effect they don't give it up and switch to Medicare for All.
Your delusional misinformed racist bias is totally unfounded.
The racist card. Somehow I knew that one would be tossed. My comments had nothing to do with race. If you understood my background, you'd know just how ignorant your comment was.
Action A. Result B. No more, no less. That's all it was.
ETA: .5% is low btw. Try 1.2% in five years. Official numbers (.5%) only account for those legally accepted.
Oddly enough, Canada has very similar policies in this regards. Yet they are not experiencing the same wide spread shortages. One thing they stand out different in, is their cost. They left just enough meat on the bone to keep big pharmacy producing.
In the UK it's exacerbated by our medical authorities negotiating a cut-price for bulk contracts, then pharmacists selling drugs intended for the UK market to other countries that don't have such deals. Our Health Department has just banned the sale abroad of 27 types of pharmaceuticals.
AJ
If you hadn't heard, the UK has a crisis with its pharmaceutical supplies.
Haven't heard. All we hear lately from the candidates running for president in 2020 is that your healthcare system is to die for. (The pun is mine, not theirs.)
your healthcare system is to die for.
That's literally true. The UK is bottom of developed-world cancer survival tables.
The NHS is hideously inefficient and bureaucratic - whenever its bean counters find something that works well, they divide it into three processes, each with different teams that refuse to talk to each other :(
AJ
The UK is bottom of developed-world cancer survival tables.
I survived cancer two times. My father numerous times (maybe 5 or 6 times). However, they said my father died of old age. I believe the chemo weakened his body over the years so I believe cancer indirectly got him.
I don't mean to be insensitive (I've lost family to the disease) but I have to wonder whether 'cured' really means cured or whether there are just too few rogue cells to be detected still lingering in the body.
AJ
I don't mean to be insensitive (I've lost family to the disease) but I have to wonder whether 'cured' really means cured or whether there are just too few rogue cells to be detected still lingering in the body.
I suspect it depends on what kind it is. I'm one of the longest survivors of testicle cancer in the world. That was in 1983. In 1979, it had a 95% mortality rate - by 1983, when I was still considered an experimental patient - they figured they had the 5 year survival rate at 90%. Now it's considered a curable cancer, with an effective 99%+ survival rate if caught in time.
My wife is a 20 year survivor of lymphatic breast cancer. 20 years ago, it was about a 10% 5 year survival rate, and there really were no 20 year survivors, because it was tough to catch it all. She hates what she looks like, with all her scars, but I consider them her badges of pride, because she's alive and well. (Note that now it's between a 60 - 95% 5 year survival rate, depending upon how many lymph nodes were involved.)
Regarding costs - in 2017 I had to have a new aortic valve put in. The insurance company would pay for open heart, but not for a TAVR. (Trans-areterial heart valve). My surgeon's assistant spent three hours on the phone explaining to the insurance company why the TAVR was easier and would be far LESS expensive than open heart. There just hadn't been many of those done on someone my age. (Even today I'm not yet 60.) I was literally back to work 90 days after first hospitalization (due to FMLA running out), and only 2 months after my surgery. They let me come back on light duty until my rehab was done, which was another two months.
Total bill for was right at $200,000, my deductible was $6,000, and my stop loss was $5,000. So paying $11,000 instead of being DEAD - or in my mind, worse, by being totally disabled due to open heart surgery (because one of my cancer surgeries effectively WAS like open heart, so I've ALREADY had my chest cut in half, ribs spread open, and now held together with wires) - at 23, it took me almost a year to recover from that, I hate to think about how it would have affected me at 55.
