The Bitter Health Care Debate

Ptichka said:

I wish I could agree with that. However, the truth is that not all healthcare makes economic sense. Sure, it makes sense to cure pneumonia in a 30 y.o. man. However, what about cancer in a 60 y.o.? That person would probably retire in 5 years anyway, and not contribute much to society from that point on. I'm not saying we shouldn't have universal health coverage - just G-d forbid we'd start basing it even on the very long term economic sense.

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Ahh, you misunderstand me. By contribution, I wasn't even thinking of the financial. What about the 60 year old who babysits for a family, allowing parents to go to college? What about elders who mentor and volunteer? Contribution to society can come in many forms. There was a little boy in Maryland who died from an infection from an abscessed tooth. His family was poor and had Medicaid. Medicaid does not cover dental. Who knows what this boy might have become. Sure, he could have grown up to be a mass murderer, but maybe he would have been a genius. He had human potential, and in my book human potential should never be carelessly squandered. That is why I believe healthcare is a right, not a privilege. *stepping down from soap box*

And universal health care does not mean that everyone has access to the same levels of care with all diseases. If someone is in the advanced stages of Alzheimer's and has cancer- do you cure that? Most doctors would say no and that kind of healthcare rationing is occurring right now in the United States.

Wicked said:

... What about the 60 year old who babysits for a family, allowing parents to go to college? What about elders who mentor and volunteer? Contribution to society can come in many forms. There was a little boy in Maryland who died from an infection from an abscessed tooth. His family was poor and had Medicaid. ...

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The case of the boy - yes, it does make sense to spend public money on curing him; it's safe enough to assume that he will grow up to contribute to the society (genius and mass murderer are equally unlikely). As to your explanation on the elderly, if we're just talking economics then it becomes the following: is it cheaper to pay for that cancer treatment than it is to simply pay the parents for childcare while they go to college/ pay for a mentor/ etc. Unfortunately, in many cases the answer would be the latter.

As for rationing - I'm of two minds about it. I believe we do spend too much on end-of-life. Most people say they would like to die at home, in their own beds; very few actually do. By insisting on prolonging lives at any cost, we mar the already difficult time in the lives of the elderly and their families. OTOH, I look at my grandparents. Almost five years ago, my grandmother had surgery and chemo/radiation for a stage 3B cancer. Considering it's was her 3d cancer, I'm not sure that this treatment fit into the "rationing" philosophy. As it happened, my grandmother has recovered and is currently enjoying life, even helping me out with childcare on occasion. So I'm really not sure where that line should be between prolonging life and letting things take their course.

Ptichka said:

As for rationing - I'm of two minds about it. I believe we do spend too much on end-of-life.

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My mother died two years ago at age 93. For 92.5 of those years she was blessed with wonderful health. It cost more than $1,000,000 to keep her alive for six extra months.

MM, here is a question for you (please feel free to ignore it if it gets too personal). Even ignoring the cost issue - was it worth it? Too often, the end-of-life procedures end up causing more harm than good. In your mom's case - where those "good" 6 months? Or would it have been better for her to only get the help to alleviate pain and suffering? Once again, sorry if the questions are offensive. (btw, if you're wondering, yes, my opinions on the matter have been influenced by NPR special on the subject)

Also, the problem is that the doctors can't see future. In my grandmother's case, I really do think that most would agree to finance her treatment seeing how well (knock-on-wood) she's doing five years down the road. However, her prognosis was 2 years. Out of them, about 6 months were extremely difficult due to chemo/ radiation. So, the question should have been whether or not to spend a lot of money for probably something like one good year. The answer would've likely been "no" - and I wouldn't have anyone to come over and babysit my daughter tomorrow.

Ignoring the cost, it was worth it.

My father, on the other hand, suffered greatly from congestive heart failure. His life became nothing but constant trips back and forth to the hospital in an ambulance. Plus, it was killing my mother to take care of him. I am certain that he made a deal with his doctor to help him end his life.

Tonichelle said:

however I do believe the end times will be in my life time.

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..
Still, no one knoweth the day or the hour. In the meantime we do the best we can.

Anyway, I wanted to comment of this remark:

Tonichelle said:

fortunately I've always been a member of a church that DOES take care of its own. I think it's how it should be.

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I agree. We have a responsibility to take care of ourselves, to take care of our families, to take care of people in need in our immediate community. All those that we regard as our neighbors.

But then we can’t avoid the question, “Who is my neighbor?” Or the answer: “A certain man went down from Jerusalem to Jericho, and fell among thieves…”

So I'm really not sure where that line should be between prolonging life and letting things take their course.

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and don't think the government won't fight to have the right to make that decision FOR you.

Still, no one knoweth the day or the hour. In the meantime we do the best we can.

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very true, but we are to be ready and watching... and judging by the Book of Revelations... (I'm not saying it's going to happen tomorrow or in 2012 like hollywood/mayan calendar... just saying I have a feeling more and more that it's coming).


as I said I'm not against helping our neighbor. I have a severe problem with government becoming bigger than it already is and making medical decisions for me... it's not like they haven't already gone in that direction in other parts of life.

Tonichelle said:

as I said I'm not against helping our neighbor. I have a severe problem with government becoming bigger than it already is and making medical decisions for me... it's not like they haven't already gone in that direction in other parts of life.

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I don't know how US is going to change the system. But in Canada, the government doesn't make medical decisions for any one. It's between you and your doctors.

no age limits?

the unborn and the old/feeble/weak/sick don't get that much consideration in this country. if you aren't a benefit to your employer, and more importantly Uncle Sam, good luck...

unless you know how to milk the welfare system. you can make that your career if you're good with it (a lot of people in my hometown live better than those that work for their income... it really tears me up because those that actually COULD use the help are denied while others abuse the system)

Tonichelle said:

as I said I'm not against helping our neighbor. I have a severe problem with government becoming bigger than it already is and making medical decisions for me... it's not like they haven't already gone in that direction in other parts of life.

unless you know how to milk the welfare system. you can make that your career if you're good with it (a lot of people in my hometown live better than those that work for their income... it really tears me up because those that actually COULD use the help are denied while others abuse the system)

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I combined two of your posts.

I live in a country with a public health system, which is funded by a portion of one's salary/income and by government support. Anyone who wants to buy extra insurance can of course do that as well, and get medical care outside the system. Despite this, a lot of people stick with the regular system for most things.

My government does not make decisions for me or for other people. When my 80-year old grandfather was diagnosed with cancer, he got excellent treatment (and is now cancer free). When my father needed major surgery, he chose the doctors and the hospital, and his treatment was decided upon based on medical considerations, not number crunching. My father's and grandfather's premiums did not go up, they did not become uninsurable, they aren't denied treatment based on preexisting conditions.

We have no waiting period for urgent and life-saving treatment. It's true that some other procedures take longer to schedule, but those are free too. You can get good preventive care and if you need to see a doctor, you'll see one. I choose which physicians to go to and get all the tests I and procedures I need, either at no cost or for a few dollars. If I need a prescription, it's usually subsidized. My friend who had her first baby by c-section earlier this year did not pay thousands of dollars like Ptichka had to; she paid nothing. My friend who just had twins paid nothing, and nobody thinks she should return to work almost immediately, as American mothers are expected to. Her babies will have regular checkups and care at a clinic for mothers and babies.

It's not a perfect system, there are things that could be better, but overall, we get good medical care without the insane costs that Americans have to bear. I'm not familiar with what's being proposed for the US this time, but I really don't understand the distrust of the public sector that seems to be a major theme in the opposition to any sort of reform. Is what you're getting now in any way adequate? I've lived in the US; I don't understand how can a country that gets so many things right gets this so wrong.

Health care is a basic service that a country should provide to its citizens, like education. You shouldn't go bankrupt trying to stay healthy, and you shouldn't have to forgo preventive care and only see doctors if the situation is extreme. That's not fair, it's not right, and it's not good for any country to treat its citizens like that.

Does it really matter whether the Government runs the health care system or whether the capitalists run the system?

Both systems will raise the costs with the annual rise int the insurance premiums. At least ALL Americans will be covered. But then one might think, the poor don't deserve it.

The poor are already covered, through Medicaid.

The problem is the low pay workers with no employer based insurance, the self-employed, the young and healthy who think they are invincible and don't buy coverage, and people with prior existing conditions whom no insurance company will touch. I had cancer 10 years ago. It's a darn good thing that my ex employer covers some sort of insurance for me, or I'd have none.

I'm 62-and the cost of my insurance even through my employer (and yes the price can go up with age in employer supplied insurance) became so high that I had to choose the high deductible option. At that time, I checked for private insurance and found that even 10 years out from my cancer, I still can't get private coverage here in CT. So I am stuck with a bad plan that only covers in Network hospitals. When I'm in FL, the nearest hospital covered is 70 miles away and is a small hospital with limited services.

This winter I better not get sick. And in fact, I better not get sick until I qualify for Medicare in 3 years. (Which will be before prior existing conditions are no cause for refusing coverage in 2014)

However, there is actually some provision in the US health care bill for dental, if you know where to look for it. And a lot of stuff happened to the bill this last week. I wondered why Bernie Sanders (VT) switched to voting for it:

http://sanders.senate.gov/newsroom/news/?id=30b2a415-4ade-4367-af7d-4c3306e31b58

http://www.freeclinics.us/freeclinic.php

WASHINGTON, December 19 – A $10 billion investment in community health centers, expected to go to $14 billion when Congress completes work on health care reform legislation, was included in a final series of changes to the Senate bill unveiled today.

The provision, which would provide primary care for 25 million more Americans, was requested by Sen. Bernie Sanders (I-Vt.).

He said the additional resources will help bring about a revolution in primary health care in America and create new or expanded health centers in an additional 10,000 communities. The provision would also provide loan repayments and scholarships through the National Health Service Corps to create an additional 20,000 primary care doctors, dentists, nurse practitioners, physician assistants and mental health professionals.

Very importantly, Sanders also said the provision would save Medicaid tens of billions of dollars by keeping patients out of emergency rooms and hospitals by providing primary care when then needed it.

Sanders has worked with House Majority Whip James Clyburn (D-S.C.) to include $14 billion in the House version of the legislation.
Sanders is also working with Sen. Ron Wyden (D-Ore.) to improve language already in the bill to provide waivers for states that want to provide comprehensive, affordable health care and curb rapidly-rising costs for money-making private health insurance companies. The waivers could clear the way for a state-run, single-payer system.
For the health centers, the $14 billion in the bill that the House of Representatives approved on Nov. 7 would increase the number of centers from 20 million to 45 million over the next five years.
The investment would more than pay for itself by saving Medicaid $23 billion over five years on reduced emergency room use and hospital costs, according to a study conducted by George Washington University.

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These clinics include dental care. Despite the name, they are not free, because they base fees on ability to pay. However, they are open to anyone, and are reasonably priced.

Sadly, there are none in Alaska, Toni.

actually there ARE free/low cost good health centers in Anchorage... not sure about Fairbanks... and the university dental program allows the community to use them for the basic dental care (exams, cleaning, etc) for a VERY minimal fee... I don't go there simply because I know too many of them and it makes me uncomfortable, and I knew I had care that I wouldn't get there anyway.

the problem with Alaska is there are many more rural communities (don't worry big government is quickly killing them off with their stupid laws that shouldn't even be ALLOWED to go on, but that's another rant) they have to fly into the big cities to get it... which means most won't because of the high cost of living, and the fact that they're no longer allowed to live off the land because of an overlarge government saying they know how best to live up here (that and the government has never liked Native American's anyway, and even less teh Native Alaskans).

so yeah, big brother certainly watches out for everyone

dorispulaski said:

The poor are already covered, through Medicaid.

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The doctors who accept Medicaid, and many do not, are often inferior because Medicaid reimburses at a lower rate than other insurances. Doctors who take Medicaid agree to take the lower reimbursement. The better doctors choose to take insurance that reimburses at higher rates. I could tell you horror stories of taking clients to Medicaid accepting doctors.

It's interesting that people are so afraid of health care reform cutting down their choices. The choices in the US are already limited. The insurance you have determines which doctors you can see, which procedures are covered, which meds are covered, and so on.

The choices in the US are already limited. The insurance you have determines which doctors you can see, which procedures are covered, which meds are covered, and so on.

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one more reason I guess I'm not missing out. with deductables, and being "forced" to go with whomever they approve of, I'm still out an arm and a leg!

and you don't think that there aren't going to be Dr's that say "yeah the gov't thing ain't for me, I'll go where the money flows"? puh.

and I would hate to see it be forced upon the profession. that's like teachers being forced into the union up here. there's no freedom to choose how you will conduct your profession/business. which is unconstitutional.

Buttercup said:

Health care is a basic service that a country should provide to its citizens, like education.

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I agree.

The European countries have it. Canada has it. Japan and Singapore have it. China and South Korea have government assistant health care system through imployers and private firms. US is probably the only developed country which doesn't have an universal health care system. I have a feeling, sooner or later US is going to have it. It's like Obama was destined to be US president. No matter you like it or not.

What do you all think about the idea of the US forcing people to have healthcare? I heard something on the radio that this would never fly because it's unconstitutional.

Wicked said:

What do you all think about the idea of the US forcing people to have healthcare? I heard something on the radio that this would never fly because it's unconstitutional.

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It's just millions more customers forced to buy a crap product and the only beneficiary is the insurance companies who will reap the profits. The insurance lobby is strong no matter the party - they all work for the same corporate masters and all this rhetoric from the 2 sides is just kabuki to pit us against one another so we will buy this crap like we have a "socialist" in the WH, if he's a socialist, I'm Peter Pan. He works for the same corporations the last boss did. Or that the government will make our health care decisions and how disastrous that would be, the goverment could never employ the bureaucrats the insurance industry does to make your decisions for you - decisions based soley on profit, your health is the least of their considerations.

I would call it health "insurance" though, it's not health "care" - the model is designed to profit off denying care, if we got care they would not make money. Care is available to the very wealthy in the United States and the rest are a serious illness or accident away from bankruptcy regardless of their policy.

And many thanks to Buttercup for the very thoughtful post above. The American corporate media convinces Americans you hate your healthcare and it stinks when reality is, you don't but that would not serve their interests.

I work for a very large company and have probably a better plan than most Americans and I actually had to use it for the first time this year and ended up giving up on resolution - they never determined the reason for the bleeding in my stomach, but I haven't died and I simply could not afford any further diagnosis.

If the Capitalists continue runing the health care business, you can be assured the costs will rise up to satisfy big bonuses and profits for the insurance companies.

Wicked said:

What do you all think about the idea of the US forcing people to have healthcare? I heard something on the radio that this would never fly because it's unconstitutional.

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The proponents of this idea compare it to mandatory auto insurance. However, the rationale for mandatory no-fault and/or liability insurance is that if you cause an accident and injure someone else, then that person has a right to compensation for his/her injuries.

It is also similar to federal mandates on state and local governments and institutions. The federal government passes regulations that force the states to incur huge extra expenses, but does not offer any relief or advice about how the states are expected to pay for it.

I do not know what the Consitutional challenge would consist of. Perhaps depriving citizens of their property (money) without due process.

The argument in favor of mandatory insurance is that people recieve health care at government expense anyway. It is only right that they pay their fair share, not just sponge off the people who do have insurance and are paying higher rates because of the people who don't. Just like building a new highway.. Individuals are not given the option of agreeing not to drive on it and paying lower taxes proportionally.

I do not really see a unique Constitutional issue. Everything the government does is like this. The government decides what you need (a war in Afghanistan, for instance), then they send you the bill. I guess if you don't like it you can write to your congressman. :indiff:

well, congratulations... looks like you all will win in the long run...