Universal Health Care - Post 4 - A Time to Die.

[Silverhair]

In my previous three installments, I talked about how the free market is failing us in delivering health care, and why. I also talked about why insurance wasn’t working either, and about the tremendous amount of waste in using insurance. In those posts I was pretty much preaching to the choir, but I wanted to establish reasons that a conservative could accept for overhauling our health care system. Most liberal reasons for redoing it are based on compassion. The conservative will point out that unlimited compassion, without some hardheaded bean counting, is just too expensive and doesn’t work.

If we are going to have a good universal health care system, we will have to limit some of the expenses. Some of that limiting is going to call for some “tough love.” We are going to have to look at the huge amount of money that is spent on most people in the last year of life. According to this link, 22% of ALL medical care is spent in the last year of a person’s life. Here is a link for that stat: http://www.ahcpr.gov/research/apr03/0403RA25.htm Most of this is already covered under Medicare, (Most people are have Medicare in their last year of life.) but I am assuming that a universal health care system will replace Medicare. By saving much of that 22% we can gain considerable total savings. Not all of that 22% of course, and I don’t have enough data to make a guess at how much would be saved, but I think it would be significant.

As an insurance agent, I have had clients run up huge bills trying vainly to cling to life. I have seen others accept that it was time to die and refuse the last battle and instead opt for comfort care, at home if possible. My own father refused the surgeries, had a few days to say his goodbyes, and departed with dignity. Same with several other family members.

I remember a study, from years ago, that compared survival rates between groups of patients with similar health states, who chose comfort care instead of aggressive care. The comfort care group actually had longer survival times. The body didn’t have to try to heal from the insults of surgery and fight the disease at the same time.

Doctors who participated in the system would have to understand that they would be required to shift a patient to comfort care if it was determined that the patient’s condition was terminal. Doctor’s would be monitored for excessive end of life costs.

Pleasant? Definitely NOT. But there is a difference between restoring to health, and stretching out and torturing the dying.

I believe the public is way ahead of the politicians on this one, and would understand and accept it. Look at the popularity of living wills.

Thoughts & comments, please.

[liberalhistorian]

1. "Doctors would be monitored for excessive

end-of-life costs?" NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO!

And NO again! Who are they to decide who should receive the best end-of-life care and who should just "accept their fate" and die already thus getting out of everyone's hair?

I thought the whole point of universal health care was to avoid these kinds of situations, where one person's life takes precedence over another's simply due to race, age, gender, socioeconomic status, whether they're a community bigshot, etc., etc., etc.? This is just more of the same shit, those who have, get, those who don't, tough luck, you and your suffering and your family's suffering aren't important enough, anyway.

If my mother is sick, I don't need some goddamn ice-for-blood bean counter looking over her doctor's shoulder at every little thing, a bean counter who usually doesn't have to worry about his own care of that of his family, I get that now with the fucking HMO's and insurance companies anyway.

What you are suggesting is positively Orwellian, and not at all in the spirit of universal health care.

[papau]

4. I agree - the cost savings of 15% on paper, and another 15% removing

profit for no risk from system and 30 m CEO salaries is enough to cover cost of universal care.

Indeed, paper costs are increasing so fast that insurance companies are beginning to have a hard time making the ROE on the required "reserve" assets the States make them put away before they do any insurance business, so that I suspect Insurance company converting their Health operation into a admin services only operation would be something the companies would want to do.

Indeed when we have universal health with the former insurance companies contracted to do the paperwork, we will have to forbid the moving of the jobs to India - since that will be the only way they could really improve their profit quickly on such contracts.

[BeFree]

5. This is about being economical and affordable

The money would be better spent on the health and well being of the youngsters.

People need to accept that when it's time to go, it's time to go, and if they have the $$ to keep them alive for a few more hours, that's fine, spend it. Don't ask for my contribution though, I'll need the money for myself over the next 20 years.

[papau]

6. I agree that money can be saved by end of life truth telling, rather

than ordering up procedures meant to comfort the relatives that all that could be done was done.

But that is an AMA discussion.

It need not and should not be part of the universal single payer health discussion

[outinforce]

10. "Money Better Spent"

"The money would be better spent on the health and well being of the youngsters"

Better spent?

By whose standards?

Who, exactly, gets to decide which is a "better" way to sepnd money?

The young and the healthy?

The old and infirm?

How about allowing each person to decide for himself/herself?

You'll excuse me for saying so, but your suggestion sound like something sure to scare seniors -- many of whom sacrificed so that you could enjoy the life-style you now enjoy.

[BeFree]

18. Ya'll reminded me of this quote

"The operation was a great success, however, the patient died"
Ed Abbey

[outinforce]

19. Perhaps Because it is Monday...

Perhaps because it is Monday (or maybe it is my advancing age), but I don't get your comment.

Could you explain it a bit more to me?

[BeFree]

24. Explanation

Ya'll reminded me of that quote because ya'll seem to think that operating on someone who is damn near dead is the better place to expend limited health care dollars.

While the operation to replace the heart of a 70 year old person might be doable, the patient will soon enough be dead anyway and there ain't damn thing that can stop that from happening.

[outinforce]

31. What Difference Do the Patients Age Make

"While the operation to replace the heart of a 70 year old person might be doable, the patient will soon enough be dead anyway and there ain't damn thing that can stop that from happening."

What difference does it make if a heart-transplant patient is 70 years old or 30 years old?

Are you suggesting that we should cease organ transplants, regardless of age, into high-risk folks, because they "will sone enough be dead anyway and there ain't a damn thing that can stop that from happening"?

Are you suggesting, for instance, that all NICUs (Neo-Natal Intensive Care Units) be disbanded, because so many of the little patients i n them are very high-risk, and most of the patients in them will all be dead anyway, and their ain't a damn thing that can stop that from happening?

Or are you suggesting that we just limit the patients in the various ICU's and intensive coronory care units to people under the age of 45? Or would you prefer to limit to patients under the age of 30? 25?

[liberalhistorian]

37. Yeah, and a 20 or 30-year-old

could die the very next day as well. Matter of fact, a child could die the very next day, or get hit by a bus a few months down the road, etc., etc. And I'm sorry you don't think people's lives are worthy after they reach a certain age. Like I said before, why don't we just outlaw seniors altogether, never mind that their hard work and sacrifices enable us to enjoy our lives today, and make mandatory suicide at, say, 65 or 70 the law?

[Silverhair]

43. You are being silly and absurd.

Classic straw man style arguement. You seem to think that medical resources are unlimited, but they aren't. Everything for everybody would quickly bankrupt any medical system.

[BeFree]

47. Thanks Silverhair, it is silly and absurd. n/t

[liberalhistorian]

13. Bullshit!

Such a system would be the same as the mess we have now, what's the difference? And what if it were YOUR family member, would you tell them that they just needed to buck up and accept that it was "time to go?"

The point of universal health care is to provide necessary care for EVERYONE, regardless of their age, race, social status, socioeconomic status, and the size of their wallets. And, as another poster pointed out, the savings from all of the waste elimination and elimination of the expensive for-profit middle layer, billing and paper expenses, and massive HMO salaries, would more than cover all necessary care for everyone.

[BeFree]

17. My Dear Grandmother

When she was placed in her last nursing home, pleaded with me to bring her something to 'End' it now. Of course, I did nothing. Why did I refuse her? Because it would have broken the law.

Another 8 years, at $3,000 a month, in a 'Lovely' nursing home, was the sentence forced upon her only because there is no other recourse for people like her to do anything else.

And you, by virtue of your harsh stance, would place many others in the same circumstance. Please, rethink your position. If not for yourself, do so for others.

[outinforce]

21. Other than Being Old....

Other than being old and apparently unable to care for herself, what medical condition did your dear grandmother have?

Did she have COPD? Terminal Cancer? A Kidney or Liver Condition that was inoperable?

Did she so fear life in a nursing home that she was willing to ask her dear grandchild for something to end it all because she also lacked love and compassion from those nearest to her?

Was there some reason that prevented your grandmother, old unable to care for herself as she was, to move in with one of her family member, instead of having to resort to life in a nursing home, which can be, because of the lack of loving family member visits that some residents receive, be a very lonely place?

[BeFree]

30. I'll leave it to you

To imagine the consequences leading to the internment of my Granmother.

Suffice to say that she had no other option. And that option being one that she had no legal recourse to alter, she was senteneced, by people who have a mindset such as yours, to the hell she endured. I know you wouldn't have wanted it to come out the way it did for her, but it did.

Until the mindset of 'Keep 'em alive at all costs' is reputed, many others will suffer the same fate.

[outinforce]

35. From Your Comments, I would take it that your grandmother

was simply old.

I have asked you if your grandmother had a medical condition that was terminal, and you have quite deftly avoided answering my question.

So, let me ask you one more time: Did Your Grandmother suffer from a medical condition that was terminal?

Or was she merely old?

If she did suffer from a terminal medical condition, did your family explore the possibility of hospice care for her?

Hospice care does NOT take the approach -- which you incorrectly seem to think I have -- of "keep 'em alive at all costs" . Rather, it honros the dignity of the individual and provides comfort in a person's final days on this earth.

It looks to me as though your family may have decided that it was just too inconvenient to provide care in their homes for granny, and decided to warehouse her instead.

I'm sorry if that sounds insulting to you, but you really have provided me with no information to lead me to any other conclusion here.

[BeFree]

45. She died at 102

With no major surgery except that for a broken hip.

My point, the one you are dancing around, is that she, as an individual, had no legal right to live, or not live, as she wanted too.

Some of you ask.." Who shall make the decision?" The answer is that the state makes the decision for everyone. And that decision is "Keep 'em alive at all costs. Do not allow them the personal dignity to decide whether they shall be "Homed-up", or not, they shall be, in one place or another, or we will press charges."

As for how Granny ended up where she did, I told you, it is because of the mindset of "Keep 'em alive" which you are so unwilling to re-examine.

[outinforce]

51. You Are Incorrect

First of all, my sympathy for the loss of your grandmother. It sounds to me as though she was someone very special in your life.

But you are just incorrect when you say that the state makes the decision for everyone. (As an aside, what do you think the situation would be under a single-payer system in which the single-payer would be the United States Government?)

The state does not require that people be kept alive at all costs. No state requires that.

Every state that I know of allows any patient the right to refuse medical care, or to stop care once it has started. If you have cancer, every state will allow you to begin medical treatment to fight and defeat that cancer. But every state also recognizes that there may come a time when you, as a patient, understand that continuing to fight the cancer is hopeless. In those situations, the state does NOT require you to continue to receive medical treatment. The state allows you to end treatment, and even to enter hospice care.

Moreover, as far as I know, no state requires patients who are simply old and unable to care for themselves to enter a nursing home. One option that is always available is for an old person, unable to provide basic care for him/herself, to move into the house of a family member or other loved one who will provide basic care (feeding, getting dressed, etc) for the elderly family member. It is only when the family decides that caring for their older family member is not (for one reason or another) an option that the state simply requires that some sort of care be provided.

You are quite correct about one thing. All states (except, I think, Oregon) prohibit suicide. And all states (again, excepting Oregon, I think) forbid doctors from actively assisting in suicide. And, as fall as I know, all states (including Oregon) call taking the life of another person nurder or manslaughter. Even when done to end "terminal pain or suffering". And I think that even in Oregon, doctors would be prosecuted for assisitng in the suicide of a patient simply because she was old.

[BeFree]

84. Watch it, bub

But you are just incorrect when you say that the state makes the decision for everyone.

Then you go on to say that there are options that the state gives one. All but the one option of deciding for yourself when and how you can die.

In my personal case, I was glad to see Granny finally be let out of the prison in which we put her. She knew, better than anybody else, what was going down. She asked the only person she thought she could trust to help her in her decision. The law left NO option but for the one that transpired. 8 years of hell, in her case.

It -- the choice of living or dieing -- should be left up to each individual. In your words, you might say there need be more options handed out by the state. Fine, whatever.

You want to spend thousands and thousands of dollars keeping alive someone who wants to die, that's fine. Don't ask me to contribute to that.

This is what this whole thread is about. Asking for everyone to pay into a system that is not well concieved or thought out, is a crock.

Nothing you have written has brought any new info into the debate. Meanwhile, the health system, as it now stands, is going broke even as you try defend it's way's.

Thanks, but no thanks, a revolution in the system is the only way to proceed.

[outinforce]

97. From "bub" -- a suggestion

It's been sometime since someone called me "bub".

But, it seems to me, BeFree, that unless you consider simply being old to be a medical condition, you are mixing medical care (and the condition of the medical care system in this country) with the care we provide to otherwise healthy old people in this country.

They are not the same system.

A person who is terminally ill is not the same as a person who is simply old and unable to care for her/himself owing only to the frailities of old age.

You have mentioned no medical condition that your grandmother had that would have caused her to die. In that case, she is not the type of person I have been discussing here. What I have been discussing here, for the most part, are people who have serious, life-threatening, and usually life-ending diseases. And I have been discussing the way our medical system allows or does not allow them to make decisions concerning the medical care they receive in order to treat, or not treat, such illnesses when it appears that such treatment would be futile.

It sounds to me as though your grandmother had the misfortune to be "healthy" (as in free of disease) until her death at age 102. I cannot and will not guess why she felt that the last eight years of her life were "hell".

I do know this, though. Often times, nursing homes are little more than warehouses for old people whose families and loved ones simply do not wish to be bothered with them anymore. What is more gratifying to note is the nursing home residents who continue to enjoy thier lives because they are frequently visited by those who love them, and whose loved ones take the time to intervene on their behalf with nursing home staff. Nursing homes, in other words, do NOT have to be prisons, and often are the only places where disease-free older folks can receive the specialized care they need in order to enjoy their final years with us.

And that, I think, is the model we should strive for. I truly worry about a society which wouldgive its consent to assisted suicide. I worry that the old muight feel an obligation to commit suicide and thereby spare their families and society from "spending thousands and thousands of dollars keeping alive" who society says is worthless.

If we are lucky, we are all going to be old sometime.

Ask yourself what sort of society you would want to find yourself in: a society that values you just as much as it values a good-looking 20-year-old. or a society that reminds you of how much it is costing your family and society as a whole to keep you alive and in which the option of taking your own life is awlays "available".

[Silverhair]

101. Good thoughtful post. n/t

[BeFree]

102. Ya gotta be kidding...

Have you ever seen the folks in a low-priced nursing home? Or a Vet hospital?

You can blather on all ya want, but it doesn't change the fact that the present day system is failing. Failing to meet real needs and failing to provide any other option than vegetate in a home at the end of a life.

You say there was no medical condition as a cause of Grannie's death? Damn... Why then did she die? She had no reason, according to you...

Have you ever seen a loved one pass on? I doubt it. I pity you the day you come face to face with death. You can deny it now, but just you wait. It'll come.

[outinforce]

107. A Reply

"Have you ever seen the folks in a low-priced nursing home? Or a Vet hospital?"

As a matter of fact, I have.

Several years ago, a very good friend of mine developed a serious brain condition as a result of being infect with HIV. He was only 32, but the condition was such that he became progressively bi-polar (or manic-depressive). At one point, during one of his "depressions", he became alomst cataonic. His family, in Kentucky, had issues with him,kk revolving around his homosexuality, and so wanted nothing really to do with him. It fell to me and two other friends to deal with his medical care.

We put him into the VA hospital here in DC. In the psych ward.

Having put him there, we made a point of visiting him every single day. At least one of us, and more often two or three of us would visit him. He was cataonic -- he did not communicate or talk at all -- he just sat there, staring ito space, with an occasional babble. I broke our hearts to visit him, and it was certainly a pianful experience for us, not just because we saw our friend in the psych ward of the VA hospital in Washington, DC, but also because we saw so many other men who were on the psych ward, and who were, in many ways, in even worse shape than our friend.

Eventually, our friend recovered -- only temporarily -- from his depression and was released from the VA hospital in DC.

When he was released, I'll never forget what one of the nurses told me. She told me that our visits made all the difference in getting our friend healthy again. She said that most of the patients on that psych ward had no one -- no one at all -- who ever visited them. No one to show any compassion or love. It convinced me then, and still convinces me, that simple acts of love from loved ones and friends can make all the difference in the worst hospital situations.

"Have you ever seen a loved one pass on? I doubt it. I pity you the day you come face to face with death."

Have I ever seen a loved one pass on? I watched my father die of COPD. He did not want to die in a hospital, connected to tubes. SO we brought him home, and provided his care, along with hospice hurses. My mother, brothers and sisters and I kept (in a rotation) 24/7 vigil with him. And finally, when it came time for him to die, we all gathered to be with him.

Futhermore, because of my experience with my friend and with my father, I volunteer at a local hospital. My volunteer work consists of many things, including being with family members when they decide to end life support for a loved one, and being with them as their loved one dies. I have been asked by nurses to simply come into an ICU room and be with a patient whose family has gone home while the patient dies -- and so that the patient does not die alone.

Do you have any more questions you would like to pose?

[BeFree]

110. Good for you. Seriously.

It didn't seem as if you had faced the facts. So... what is it about the system that you would change? It seems as if you think the system is a-ok and there need not be a way to opt out of the system.

Can you counter the fact that the system is going broke?

Do you have a medical reason yet for the death of my Grandmother?

You write real swell.... but you haven't told me anything new. Can you?

[liberalhistorian]

131. Excuse me, but I

witnessed my grandfather's final months in a nursing home, and I and the rest of my family wouldn't have traded one single day of that, or wanted him to just "let go". He was in a good home, with activities and caring people and good care. We wouldn't have had it otherwise. He had seven children and 14 grandchildren, so he almost always had visitors, even when he was so far gone that he couldn't recognize any of us anymore. His life was extremely valuable to us, and I resent people like you saying that we should have just wanted him to "let go" because he was old and "in the way."

[Kanary]

121. I notice you concentrate on families

What about those of us without families? We are usually forgotten in all the equations.

Those of us who *DON"T* have someone as "watchdog" have a lot to fear. Yes, a lot of us would rather be gone that withstand the abuse that is so often prevalent in these situations.

Kanary

[outinforce]

143. Re-Read My "A Reply" Post

I certainly agree that it is an all too uncommon, and an all too unfortunate, situation where people (even some with large families) are simply warehoused in hospitals and nursing homes.

But, given the lack of compassion and loving care that already exists within the nursing home system, I hardly think that the "solution" is to allow old people confronting life in nursing homes to kill themselves.

If we were to do that, what would be the incentive for nursing homes to improve their care, and to make their care more compassionate and more loving -- especially towards those without families?

I happen to be gay, and I know quite a few gay folks who either have no family or who, like my friend who was hospitalized in the DC VA Hospital's psych ward, have become totally estranged from their own families. So I understand this problem very well.

For me, the answer lies in changing perceptions about nursing care. For instance, when President Clinton established the Americorps Volunteer Program, I wonder how many volunteers were selected (or who themselves opted) to visit and advocate for people in nursing homes. I don't know, but I would guess it was probably not very many.

How many of us regularly visit people we don't even know in nursing homes -- either by ourselves or as part of an organized group of people committed to compassionate loving care of older people who are alone and whom society may have just decided to abandon in a warehouse until they die?

It is no wonder that so many people fear nursing home care, given our society's view of people who are simply old. We fear gettingold, and we do not want to be around people who are old.

I would rather change that perception and let older people know that if they go into a nursing home, someone who genuinely cares for them will regularly visit them and will advocate on their behalf, rather than simply change the law to permit those old folks to kill themselves -- confirming in their own minds that society just doesn't want them around any more.

[Kanary]

154. I hear you

I understand what you're saying. Yes, things need to change.

However, that isn't likely to happen anytime soon.

Actually, what is happening is it's going in the other direction, and rather rapidly. I don't see people getting *more* compassionate, especially towards those they don't know.

While waiting for this glorious change, I have no intention of suffering more in order to be some poster child for increased caring, and positive changes in nursing homes. I, personally, have had about all I can handle, and it's in nobody's best interest, and certainly not mine, to be pushed by abuse to "lose my cool" and be drugged into unconsiousness. That's no life, and it's to no purpose.

I agree with your goals, and admire your push to achieve it. But, until that day comes that you are able to enlist enough people to meet those goals, I stick by what *I* desire for me. And, I'm willing to bet there are many who feel the same way. Maybe many who wouldn't be so foolish as to state it publicly on a forum where they are vulnerable to being shot down for stating their fears.

Kanary

[outinforce]

158. My Best Wishes for You

I understand that when disucssing an issue such as this, sometimes things can be said that can rub tender wounds.

If I did that, I'm truly sorry.

I wish I could come and visit you right now, because it sounds as though you are not in a good place.

My best wishes for you as you confront the situaton life has placed you in.

And I do not think you foolish at all. I think you are most courageous to share yourself here the way you have done.

Anyone here who would shoot you down is someone I would call a fool.

[Kanary]

163. Thanks so much for your understanding!

I also wish that it were possible for us to visit. If I had been "heard" and cared about many years ago, it's likely my situation wouldn't have deteriorated to this point. But, people are so full of their own opinions so much of the time, and so unwilling to just listen to each other that years of being brusquely brushed aside have taken their toll.

I very much appreciate your willingness to listen to what I had to say. I really believe that so much of the problem is just that.... people mostly don't hear each other. There is so much "shoulding" going on.

Actually, you got me to thinking that this is much like the abortion debate..... nobody feels good about it, but oftentimes the alternatives aren't good, either. If there were more effort towards ameliorating the need for such drastic measures, such as you are suggesting and attempting, the need will go down, at least for some. Just telling people to suck it up and "deal with it" (suffer through it) is NOT the way to achieve that.

People of good will can hear each other, learn from each other, and come to reasonable ideas, just as we did.

And, yes, I've been "shot down" on this forum, and that has definitely led me to a sense of hopelessness and futility. There are many who simply cannot hear, and won't listen, and I found that out. When that happens among "progressive" people, it leads one to the sense of futility.

Thanks for listening. It is much appreciated.

Kanary

[liberalhistorian]

23. And my own grandmother would have

fought, and she did fight, with every ounce of her being, and I would have been, and was, right there with her. This is a very individual decision that cannot have a cookie-cutter one-size-fits-all template. People have the right to make their own decisions in this matter, whether they want to let go or stay alive and frankly, seniors have worked hard and sacrificed all their lives, they deserve the right to that decision in peace. EVERYONE deserves that.

My "position" would only be "harsh" as you call it, if everyone were forced to adopt a one-size-fits-all template and were forced to give up after a certain age.

[BeFree]

28. People do NOT have the right

That is my point, and was my Grandmothers point. She had to ask ME! Not her paid doctors, not the nurses, ME! She had no choice, no Right, no nothing, but to lay there and witther away for 8 years as she knew she would have too.

Re-examine your position, if you can, LH. You speak with forked tongue.

[Cato1]

20. This is a pipedream

"The point of universal health care is to provide necessary care for EVERYONE, regardless of their age, race, social status, socioeconomic status, and the size of their wallets."

It doesn't work like this in any universal health care systems I'm aware of. For example, priorization is key cost control factor in the Scandinavian public health care systems. In one anecdote I know from Finland, an elderly man was accepted for bypass surgegy due to the fact that he had girlfriend. Without this condition he would have been forced to pay for the operation himself in the private market.

[Silverhair]

34. In a world of finite resourse, choices have to be made.

One of my pet peeves with much of the left (I am only a little left of center.) is that they just don't accept the brutal reality that resources are limited, and that means choices about resourse allocaiton.

One company that I was an agent for spent over one million dollars keeping a policyholder in ICU on the machines for eight months before he died. I don't feel one bit sorry for the insurance company, BUT IT WAS STILL A WASTE OF RESOURCES.

[outinforce]

38. If the Insurance Company

contract to provide such services, then why should you feel that it was a waste of resources?

The insurance company appears to have offered a contract which included the possiblity of covering expenses of over a million dollars for patients who might find themselves in an ICU on life-support for 8 months. Someone bought such a policy, and apparently found him/herself in exactly that situation.

There were corporate executives who thought that money could be made by offereing such a policy. I would wonder how well that insurance company did as a whole during the year in which it paid out benefits to the patient who spent 8 months on life support in an ICU. My guess is that the insurance company did not go out of business because of the ebenfits paid to this patient. I might also speculate that the company most likely showed a profit.

So who exactly are you to say that resources were "wasted"?

[Silverhair]

42. Insurance compainies don't print money in the basement.

Ultimately, the funds come from the overall economy. So, ultimately, it was everybody's money that kept the machines going for eight months.

Face it. We live in a universe of LIMITS. That means choices have to be made. It just isn't possible to give everything to everybody. Not in this life.

[outinforce]

55. Of Course.

Of course insurance companies don't print money in the basement.

But insurance companies issue policies.

And it was a specific insurance company that issued a specific policy to a specific customer that ended in the insurance company taking money from other policy-purchases and transferring those funds to make good on its promise to the person who had purchased that policy. (Isn't that what insurance is all about abyway? Pooling resources to share the risk?)

It seems to me that your real beef here is with the insurance comany that tok a business decision to offer a policy that was, in effect, a contract which said, "As long as you pay the premiums, we will, should you require life support in an ICU -- even if it is for as long as 8monthjs and even if the cost is over $1 million -- cover those costs).

And again, I bet the insurance company, having made such a business decision, and having "lost" the bet it made when it offered such a policy, did not go out of business, did not raise its premiums a lot, and most likely showed a profit for the year in which in made those payments.

But that is just a guess.

[Silverhair]

57. One raindrop is not a flood, but it is part of a flood. n/t

[liberalhistorian]

39. I don't equate the worth of people's

lives with how much money is available or how much money they have, and I find it absolutely sickening, disgusting, and beyond belief that anyone on THIS site, of all places, would do so.

Eliminate the waste and the for-profit middleman and the obscene billing and paperwork costs and the obscene and outrageous management salaries of the fucking HMO's and insurance companies, and you'll have more than enough of what is needed.

[Silverhair]

46. Eliminate all of those wastes and you STILL live in a universe of

LIMITS. Resources are not infinite. Any workable plan has to face the fact that some real tough choices have to be made. You seem to deny that is a fact.

[Jose Diablo]

61. I agree LH

Before ayone commits to allow euthanasia, this site will provide background about the end result once we go down this road.

"Present day death proponents of the "right-to-die" movement disavow any analogy between what they are selling and what happened in Nazi Germany in the 1930's. And, if one does not examine the facts too closely, there appears to be none. After all, Hitler was bent on exterminating the Jews, even though he destroyed a few thousand others before he found his focus. His was a dictatorship, not a democratic nation. His agenda was political, not moral. He fed on hate, not compassion. And one could add to the list.

However, if we look back to German society of the twenties and thirties, we find a civilized culture not so unlike our own. As a nation, Germany took pride in its art, its culture, and its science. People engaged in business, went shopping, enjoyed their families, followed the news. Genocide did not seem a likely development. But the seeds had already sprouted, though few foresaw into what kind of twisting vines they would soon grow."

http://www.pregnantpause.org/euth/nazieuth.htm

[Silverhair]

64. Is everybody that disagrees with you a Nazi???

That word is greatly overused around here.

Would you kindly tell me how, in a world of finite resources, you are going to have an everything for everybody system?

[Jose Diablo]

81. Nobody called anybody a Nazi

The article draws parallels between the modern 'right to die' movement and the previous euthanasia movement in Germany. "Me think thou protestest too much".

As for the parallels, it seems to me the very same arguments for euthanasia in germany, are being made today. That is what the article in about.

As for limits on resources, I presume you speak of my response further into the thread.

[liberalhistorian]

65. I know, these kinds of

attitudes really frighten me, and you are correct that it is similar to Germany in the 20's and, especially, the 30's. If we're hearing this kind of thinking on DU, of all places, then we're really in trouble!

[outinforce]

67. I'm Not Sure That Anyone Here Has Suggested Euthanasia

I'm not sure anyone here has actually suggested euthanasia, which I understand to be the active ending of human life.

I think the suggestion has been made that there ought to be some mechanism for letting someone decide when "enough is enough", and ending medical treatment.

The question is "Who gets to decide" when treatment ends and when "hospice" or "comfort" care begins?

That is quite different from saying "Let's, as a society, decide that some lives are not worth living, and then go out and kill off those folks".

[Silverhair]

29. It is impossible to provide everything for everybody.

Somewhere, limits have to be set. This is one of them.

I, personally have only a few years left. I hope to go with dignity and grace, and not with a lot of expense.

[outinforce]

2. "Excessive" End of Life Costs

"As an insurance agent, I have had clients run up huge bills trying vainly to cling to life. I have seen others accept that it was time to die and refuse the last battle and instead opt for comfort care, at home if possible. My own father refused the surgeries, had a few days to say his goodbyes, and departed with dignity. Same with several other family members.

I remember a study, from years ago, that compared survival rates between groups of patients with similar health states, who chose comfort care instead of aggressive care. The comfort care group actually had longer survival times. The body didn’t have to try to heal from the insults of surgery and fight the disease at the same time.

Doctors who participated in the system would have to understand that they would be required to shift a patient to comfort care if it was determined that the patient’s condition was terminal. Doctor’s would be monitored for excessive end of life costs."

"Excessive" end-of-life costs?

Who gets to decide what is "excessive"? The patients invovled? Their families? The doctors? Nurses? Government Officials who have never met the patient involved? Or perhaps some caring/compassionate administrator of a big medical health-care program?

I have had two members of my family who have received diagnoses of terminal illnesses. In both cases, the decision concerning when and if they entered hospice care was up to them.

And that, in my view, is just how it should be. We should honor the individual enough to permit him or her to make his or her own end-of-life decisions. Based upon his or her own sense of worth -- his or her own sense of the quality of his/her life.

We criticize -- and rightly so, in my view -- the notion that insurance or HMO administrators can make meidcal decisions tha tuse to be made by doctors caring for their patients.

If I understand your suggestion rightly, what you are suggesting is that the decision concerning when a patient decides that he or she is "sick and tire of being sick and tired" and decides to stop fighting a given disease be taken away from the patient, his or her family, and even the doctor, and be given over to a bureaucrat whose eye is not on the patient, but rather on the bottom line.

No, thanks very much.

[liberalhistorian]

3. EXACTLY!

Well-said, outinforce.

[YNGW]

9. Single-Payer

>If I understand your suggestion rightly, what you are suggesting is that the decision concerning when a patient decides that he or she is "sick and tire(d)(sic) of being sick and tired" and decides to stop fighting a given disease be taken away from the patient, his or her family, and even the doctor, and be given over to a bureaucrat whose eye is not on the patient, but rather on the bottom line.

That's why many fear single-payer coverage. If the government is the one paying the bills, they're eventually going to want full control. That's what governments do.

One of my concerns of government paid health care is turning over these things to a bureaucracy. I have no doubt that the USA would eventually have a medical data-base that includes every Americans personal medical records, including any "private" conversations, that can be retreived at the touch of a button. It seems strange to me than in a country where so many are concerned about the intrusiveness of "Big Brother", so many would freely turn over their health care to "Big Brother". Anyone trying to convince me that the government can be kept from knowing private doctor/client information will not get far. If the government is paying the bill, they're going to want to know what they're paying for, and what they're getting for their money. Yes, eventually medical services will be rationed out.

No doubt we need to do something, I'm just not convinced what that something should be.

[Nederland]

11. The bottom line

Much as you would like to believe that you can remove the question of cost from end of life decisions, you can't. The fact is that no matter how you design a single payer or univeral coverage system, there will be a limited number of dollars allocated to said system. Therefore, every dollar spent on end of life care is a dollar not spent on preventive care for younger people. You question the right of doctors and nurses to define how much money gets spent on an end of life patient. I might as well turn the question around: what gives dying patients the right to define how many dollars are spent on younger people?

[outinforce]

12. Perhaps it Is Because

Perhaps it is because I myself am now over 50 years of age, but my view is that the Democratic Party is, and really always has been, the party within our society that favors the weak over the strong.

And, given the choice between funding health care for healthy young 20-somethings and ill and infirm 70 and 80-somethings (if such a choice is truly required), I would like to think that our party would come down in favor of the older, retired, less-able to pay for increasingly exopensive health care. And to so so in such a way that does not make older people feel as though they have an obligation to simply get out of the way and die already.

I happen to think also, by the way, that part of the solution to this whole problem is to find a means to control health care costs. And I also happen to think that that involves at least looking into the tort system within our country.

[Nederland]

16. Question

Do you have children?

[outinforce]

22. Much as I hate to Answer a Question

Much as I hate to answer a question with another question, let me ask you this:

What difference would it make if I had any children or not?

[Nederland]

25. Here's Why

I think its reasonable to assume that a person's personal situation influences their opinions. For example, I have a child and I know perfectly well that it biases the way I think about the issue.

[outinforce]

41. OK, thanks for your repely. Here's Mine

You asked if I had any children.

I have no children of my own.

But I have ten nieces and nephews that I love very dearly.

Now, can you explain the way this personal situation of mine biases the way I think about this issue?

[Silverhair]

49. I will address the tort problem in another post, with a radical

solution that works in other countries. We are the only country in the world that doesn't use it. I bet that post, when I do it will step on a lot of toes, as this one seems to have.

[liberalhistorian]

14. UNBELIEVABLE!

I just cannot believe I'm reading that from a DU member, that some lives are more worthy than others simply due to age and status. Here's a newsflash for you: seniors have worked hard and sacrificed all of their lives, and they deserve to be treated with dignity and respect and to have their lives affirmed as important and to decide when and how they want to live the end of their lives.

Why don't we just require that everyone commit suicide once they reach the age of, say, 68 or 70, unless they're a wealthy bigshot and in that case far more worthy than the average human piffle.

I simply cannot believe the Orwellian comments on this thread, I might as well be on Freak Republic.

[Nederland]

15. Question

I just cannot believe I'm reading that from a DU member, that some lives are more worthy than others simply due to age and status.

Then why would you support an arrangement where older people are considered more valuable than younger people?

[liberalhistorian]

26. I AM DOING NO SUCH THING!

YOU are the one claiming that, not me, by your insistence that only lives of a certain age have value and are worthy. I thank people like you weren't in charge when my grandparents were alive, because I then would have missed the pleasure of experiencing my relationship with them while growing up. YOU are the one putting some lives over others simply by virtue of age. That is one of the most offensive things I can think of. And let me tell you this: seniors have WORKED HARD AND SACRIFICED ALL OF THEIR LIVES, and they deserve to be treated with dignity and respect and to have their lives valued as well.

[Silverhair]

50. Your are making exactly that claim.

You are denying that resourses are limited. The brutal fact is that resources are finite, and that FORCES choices to be made.

[Nederland]

56. Another question

It is a fact that there are 10 times as many people that need organs as there are availible organs. If you found yourself in a situation where you had one donor kidney and two people that were both compatible, how would you determine who gets it? If one of those people was an 80 year old man and the other a 12 year old child, would that influence your decision?

The fact of the matter is that health care resources are limited and will always be limited--even with a universal care system. It is naive to think that you can set up a system where people can get whatever they ask for without having to pay for it. It cannot be done. As with the above example, sometimes the limiting factor has nothing to do with money. You may not like the fact that not everybody can get what they want, but its just a fact of life. You cannot please everyone and any health care system you set up will involve hard choices having to be made.

I think the original poster is brave enough to acknowledge what many universal care advocates refuse to acknowledge: no matter how you set up a system, you will have to ration care. Its not an option, its a necessity created by the reality of limited resources. I commend him/her on taking the issue head on.

[Silverhair]

59. Thank you for the compliment.

And you have made me realize something that I will work up into a non-medical post. Progressives often seem to not realize that there are limits which force choices to be made in all areas of life. That's why I am a centrist - I know that you can't have everything just by wishing for it.

[DemExpat]

89. Good luck with addressing this issue here, Silverhair.....

I live in a country that has tried the state's universal, cradle to the grave care, and now the results are coming in proving this approach is unsustainable.

Now the very unpopular but necessary steps are being taken to turn back the richly generous welfare system to one having to make a lot of cut-backs and provide more limited services and benefits.

I absolutely agree that resources are limited, costs are rising, and tough choices are having to be made.

Sustainable services -one of the crucial problems now in Europe's Social Democracies and welfare systems....

DemEx

[Silverhair]

40. Excellent. n/t

[Gulf Coast J]

27. We get to decide what is excessive

Society simply can't throw all of its resources into providing everybody with unlimited amounts of health cares. Just because a completely free market does a socially inadequate job of rationing health care, that doesn't mean that we simply abandon any attempt to ration. What happens if we start spending half our GDP on health care? 75%? How much care to provide at end of life is very debatable, but we can't hold on to the notion that no expense should be spared to prolong life.

[outinforce]

44. "WE"? Who, exactly, is that?

Who is this "we" that you are speaking of?

The electorate? The electorate that votes?

Because if that is the "we" you are speaking of, I have some news for you -- that "we" contains many more older folks than it does younger folks. (Notice I said the electorate that actually votes).

Does that make you feel secure?

What, by the way, was your position on the recently-enacted prescription drugs for all seniors bill that passed both houses of Congress and was signed into law by the President?

Did you feel, like AARP, that the law provided just the right amount of funding for all seniors, given the political realities? Or did you feel, like Sen. Kennedy and others, that the law was way too stingy?

[Gulf Coast J]

53. Certainly political pressures will be at work

The AARP contingent will prevent any 'Children of the Corn' type culling from taking place.

I disliked the prescription bill drug because it prevented re-importation from Canada and seemed to have too many corporate handouts. The same level of coverage could have been provided for at a much smaller cost. But the reality is that some coverage is better than no coverage, and complete coverage is probably not possible when we pretend to care that budget deficits matter - even if we go back to the Clinton tax code.

[Mr.Green93]

7. A Time to Die."

maybe we should end all health care at a certain age, say 65 or 72?

[Silverhair]

52. Straw man arguement. Invalid. n/t

[liberalhistorian]

62. And just why is that?

It appears to be exactly what almost everyone on here is advocating anyway. If you're beyond a certain age, unless you're a wealthy bigshot whose life is, therefore, more worthy, then the hell with you and why should we waste any resources on you? THAT is the "brutal reality" that YOU are not facing!

Thank God I just turned only 39 and not 59 or 60. With attitudes like these, I sure as hell am NOT looking forward to being older than 50! Maybe my son, who'll be grown by then, can hide me in his basement after my 50th birthday. If I'm lucky, he'll be or marry a doctor who'll understand that my life is worth more than the sum of my age and the size of my wallet.

[Jose Diablo]

68. You got that right LH

This thread is like some neo-con argument about the unproductively of keeping 'unprofitable' old people alive. And of course, the old 'chestnut' about living in a world of limited resources where we must ration resources in the most worthy (read profitable) way. Kinda like we are investing in a horse, huh?

Just think, if that old guy in ICU for 8 months hadn't 'wasted' over a million dollars, the insurance company could have invested it in Enron. Or MAYBE paid more to its agents..hmmm......I wonder..is it possible?

[liberalhistorian]

79. There would be more than enough

reesources if money was distributed where it should be. Look at all the waste in military spending, billions of dollars, and billions wasted on corporate welfare. It's not the lack of resources that's the problem, it's the WAY it's allocated and distributed.

[Silverhair]

73. Straw man arguements are always invalid.

He accuses me of positions that I do not take, and then attacks those positions, instead of what I actually have advocated. I do not need to defend positions that I have not taken.

[Jose Diablo]

85. What position did you take then?

Silver hair said,

"You are denying that resources are limited. The brutal fact is that resources are finite, and that FORCES choices to be made."

What choice will be FORCED. The choice of who lives and who dies based on some allocation of some hypothetical resource?

You have stated and I quote, "Doctors who participated in the system would have to understand that they would be required to shift a patient to comfort care if it was determined that the patient’s condition was terminal. Doctor’s would be monitored for excessive end of life costs."

Are you saying doctors would be required to stop treatment if the costs go above some amount. Sounds like it to me.

As for the limited resource, would the resources be limited if the profit was removed from the equation. No profit for the insurance companies (they would be out of the picture both for medical and malpractice insurance policies), the hospitols (hey they get their start-up money from the public anyway (remember at the public feeding place like many corporations), don't forget the drug companies (after all much of the research is done from money from the NIH).

I think there is plenty of money there to provide good medical care for everyone and pay the Doctors a lot too. It is the others I have a problem with supporting with my medical dollar.

[Silverhair]

93. Here is a quote from your first post:

You stated: maybe we should end all health care at a certain age, say 65 or 72?


Now where did I advocate that position? I didn't, and you know it too.

I have addressed the problem of the insurance companies in previous posts. I will not repeat myself. Basically I advocated getting rid of them. Look at those posts. Do you need the links?

And yes, resources are ALWAYS limited. Fact of life, not hypothetical at all. And when resources are limited, then choices have to be made. As long as we deny that tough choices have to be made, then we will continue to lose the issue.

[Jose Diablo]

95. Actually, that is not a quote from me

I am Jellybean1. The quote you are reffering to is from the honorable Mr.Green93.

When the resources are unknown, for example how much is taken from the center of the cash flow (by insurance comanies for medical insurance) and from the end of the cash flow (malpractice insurance), how can anybody speak about limits on a resource when what is really needed is unknown.

Well, you will excuse me if I become confused when you speak about withholding care, when nobody knows how much is being extracted to supply the current care being delivered.

Did I address your strawman defense, you DID speak about withholding care when the costs became excessive. Did you not?

[Silverhair]

96. I don't think you are understanding at all.

I don't have a link because I am working from memory on this from an article that I read years ago about the results of a study.

They patients were burn victims, all burned to such a state that no one had ever survived such extensive burns. Each patient was offered a choice of comfort care or agressive treatment. Only a few selected the agressive treatment. ALL DIED. None survived longer than the norm for the type of injury.

There are many other situations in which the doctors know, from medical experience, that a person has reached their end, and THAT AGRESSIVE TREATMENT IS FUTILE. At that point - treatment should switch to comfort care.

This can occur at any age, although for the obvious reasons, it will happen mostly with older people.

I personally do not expect to be on this earth more than a few remaining years. As my time draws near, I hope to meet it with dignity and a lack of unneeded expense.

[Jose Diablo]

105. Actually, I do understand

And you said at the end of your post,

"I personally do not expect to be on this earth more than a few remaining years. As my time draws near, I hope to meet it with dignity and a lack of unneeded expense."

I myself also draw near the end, as did my father. I feel the same way you do and I will not prolong the inevitable.

But that does not address the point of our difference. The point of our difference, and I think the LiberalHistorian will agree with me on this point, IT IS MY DECISION. Not some doctor or administrator, nor some politicians decision when to stop health care. It is my decision and mine alone. It is me (actually God) that decides when I leave. Not you or any other person.

I have paid taxes, and health care insurance also, for many many years. What I have recieved back doesn't even come close to what I have prepaid.

I exercise the decision to not recieve care with the existence of a living will if not conscience and will leave the hospital if aware.

Now compare this to what you said in your original post.

"Doctors who participated in the system would have to understand that they would be required to shift a patient to comfort care if it was determined that the patient’s condition was terminal. Doctor’s would be monitored for excessive end of life costs."

What you and many other imply here is the decision to stop treatment will belong to someone other than myself and there will be a need to allocate resources. When the need for allocation has NOT been demonstrated.

This is what I object to, others having a life and death decision making capability on me based on some hypothetical shortage that may or may not exist.

[Silverhair]

108. But I don't want somebody else sticking me with the bill.

If someone wants to fight death to the last with lots of expensive treatment, even though they have been told it is futile - don't expect me, via taxation, to pay. Via taxes I will willingly make available comfort care. I will even throw in coming death counseling, and a few legals visits to make sure everything is in order. But I don't want to pay for futile treatment. And with a gov't paid plan, that's what we are talking about.

If we have a gov't plan, we will have to count the beans. There is no way around that.

[outinforce]

111. There are Many Bills We all Get Stuck With

I have no kids. I will never have any kids.

And yet I pay my taxes which support schools.

When I travel to Florida or to New York, I pay taxes (in the form of sale taxes and other taxes) to those jurisdictions.

I live in Virginia, but work in DC. When I am in DC, I usually get my lunch and sometimes my breakfast at local eateries. I pay a 10% restaurant tax for the privilege of enjoying a meal in DC.

DC uses its tax dollars (including, I think, money it collects in restaurant taxes) in some ways I happen to find quite offensive.

Part of living in a society as complex as ours is that we are often asked to "pay the bill" -- even when there is no apparent benefit to ourselves.

Until we as a society decide that patients themselves should not have the right to make, in concert with their physicians, their family and friends, and their God, whether to continue treatment at the end of their lives -- even in the face of medical evidence that suggests that such treatment is "futile" -- it is, I think incumbent upon all of us to pay the bill for those who -- for whatever reason -- decide that medical care is still an option -- for them.

[Silverhair]

113. In what way does society at large benefit from futile care? n/t

[Jose Diablo]

114. Who can say what is futile? n/t

[Silverhair]

123. That's is part of making hard choices.

If liberals are unable to make hard choices, the conservatives won't hesitate to make them. Trying to deny that hard choices are necessary is a guarantee of losing any attempt to get universal health care, and will also lose elections.

[Jose Diablo]

116. It is called altruism

As a specie we have a high survival rate because we care about others and help each other.

Forming a society to benefit all members, even the weak, has allowed us to prosper.

Think about it.

[Silverhair]

124. That sounds wonderful, but ignores reality.

There isn't enough money to give everything to everybody. Choices have to be made.

[liberalhistorian]

133. Once again, there would be

more than enough money if the waste caused by the for-profit medical system were eliminated, including the insurance middleman, billing and paperwork and collection costs, obscene HMO salaries, etc., etc., and eliminating waste and overcharges in military and corporate welfare spending, etc., etc. Again, it's not the LACK of money that's the problem, it's HOW THE MONEY IS DISTRIBUTED.

[outinforce]

119. By Honoring Individual Choice

This is just my own view.

But since you ask, it seems to me that society at large benefits when everyone understands his or her own worth and dignity as an individual.

Because when that situation exists, people tend to understand that no one is "superior" to them. No one else can make life or death decsions for them.

When people become accustomed to a situation in society where some people have life-or-death decision making power over them -- absent any input from the person whose life is at stake, and absent any appeal process, then, I think we ALL -- every single one of us -- become a little less -- no, a LOT less -- free.

And this is especially so when the issue is life and death -- an issue fraught with spiritual issues.

When the cost-efficiency experts are given the power to decide who receives treatment and who does not -- then, truly, those experts become like God.

Do I think the current system is good? No.

Do I think the current system could use some repair? Most definitely?

Do I have any specific answers as to how, exactly, I would modify the current system? No. But this thread has surely given me a lot of food for thought (One of the things I find most useful about DU is that it is a forum where people can exchange ideas in what is -- we hope -- a "safe" environment).

But I will say this -- the starting point of any medical system, in my own view, has to be that it is a system where the individual -- whether that individual is some well-educated productive and rich member of society or is some poor, barely literate cast off of our society -- has the basic right to decide when "enough is enough" - free from pressure from anyone with an interest in shutting things off.

[Jose Diablo]

120. Yes, yes, yes

It is all about the individual. Well said.

[Silverhair]

126. How do you pay for an everything for everybody system? n/t

[outinforce]

141. You Are, I Think, Missing My Point

My point is simply this:

In devising any change to our current health system, never forget that it is individuals who receive health care. And never forget that it must --must -- be individuals who are, to the maximum extent possible, given the choice of whether to accept or decline medical care.

If someone other than the individual with the illness has the power to determine that "enough care is enough", then, I'm afraid, we surrender -- as individuals -- far too much autonomy to someone else.

To me, finding a new and improved system which begins at a place which posits that certain "experts" in cost-efficiency should have the power to monitor doctors in order to dertmine whether medical decisons those doctors have made for patients who desire continuing care near the end of their lives is "excessive" or not is just n ot the way to go.

I would prefer to start at a place which acknowledges the basic human right (at least, I think it is a basic human right) to determine whether or not one wants to receive medical care. And to be quite clear that we do not advocate a change to a system in which that power is ever removed from the individual.

How many of us objected to those situations in which well-intentioned family members forced end-of-life care on a person who had made his/her desires known in advance, and who had said that it was their explicit desire that no extraordinary means be taken to prolong his/her life? What was it, exactly, that we were objecting to? I know that my objection was that family members (including, sometimes, significant others) were forcing medical care onto someone who had said that he/she did not want it. Denying the choice that the individual had made regarding end-of-life care.

To do the same thing -- but to deny someone care that he/she feels he/she wants, and has taken the necessary steps to provide financial coverage for -- seems to me as perhaps aas well-intentioned, but in the end just as mean-spirited, as those who force care onto someone who does not want it.

[Silverhair]

145. Where does the money come from?

Those words sound really great and wonderful, until you run up against the realities of a limited world. Recourses are finite, and that means THAT THERE WILL BE SOME FORM OF RATIONING. Current the rationing takes place by price and wealth. I am proposing that we look at take some measure of efficiency into account, by eliminating FUTILE CARE and replacing it with comfort care.

I believe that you are in denial if you think there is no such thing as futile care. If there was no such thing as futile care, then the machines would NEVER be turned off.

[outinforce]

150. Thanks for your observation

I do, in fact, believe that some medical care is absolutely futile. Be assured of that. My experience as a volunteer in hospital has allowed me to see too many situations of true denial -- like a "full code" 25-year-old patient who suffered serious brain damage when he was 19. For six long, agonzing years, his mother refused any suggestion that she simply "let God or nature" take its course. Her notion of God was that God somehow "owed" her her son's life back as His payment for her work in the church.

And so her son was in nursing homes and hospitals where doctors and other medical staff had to do full codes to revive his failing heart and his failing lungs -- both of which, since they were so young, took six years before they finally gave out and could not be revived. In the end, this young man's flesh around his abdomen had simply rotted away -- because of his constant bed-ridden status.

I know denial. And I know I don't have it.

But I think I also recognize the beginnings of totalitarianism when I see it.

And that begins, I think, with denying individuals the right to make basic decisions in the name of "efficiency". Basic decisions over their own individuality -- like whether or no to continue or cease medical care.

I happen to be pro-life, but I would never advocate, in the name of cost efficiency, forbidding all abortions. THAT would save a whole lot of money, wouldn't it? But would the cost in terms of personal choice truly be worth it?

[Silverhair]

152. Then how do you deal with the limited resources problem?

Do you deny that there is a limit to resourses? Do you really think that we can have an "everything for everybody" system?

[Jose Diablo]

112. Nobody likes to pay taxes

This is not the issue we originally disagreed. I cannot speak for another when it is time to go, nor can you.

[Silverhair]

115. That sound very compassionate, but it flunks the reality test.

Life/death decisions are daily & routinely made for others all the time. The main difference is that those decisons are usually impersonal.

[Jose Diablo]

118. Specific examples please

[Silverhair]

127. Sure.

What diseases get the research dollars?
What communities get increased police presence?
Where do the bridge improvements get made?
Which air trafic contol center gets the new computer?
Where does the new hospital get built?
What will the speed limit be along a certain stretch of road?

Every one of those means somebody lives and somebody dies. You just never think about it. The only difference is that in the obove examples you can't put specific names to the dead and specific names to those whose lives were saved. They are just numbers in a statistical study. But in shifting someone to comfort care from agressive care - there is a person for a sob story. But they aren't really victims, because they are going to die anyway, and at about the same time.

[liberalhistorian]

134. Most of those

are POLITICAL decisions, particularly which diseases will get research funding (especially under the Boy King Impostor currently occupying the WH).

[Silverhair]

142. So? They are still decisions that change, for some people

whether they live or die. Decisions that are life changing are being made routinely for us, some more critical and direct than others.

[outinforce]

147. May I Interject?

The specific examples you cite (police protection, bridge-building, air traffic control computers) do not involve decisions that individuals usually make for themselves.

However, a decision to continue or to cease medical care is, currently, a very personal decision that individuals make.

THAT to me is the biggest difference between the types of "life-or-death" situations you cite and the life-or-death situation a sick person -- a sick individual -- confronts.

[Silverhair]

151. Let me ask the question a bit differently?

You are approaching this as a question of individual rights.

So let us say that Mr. Jones has been diagnosed and confirmed with a condition that will lead to his death within a year. So far, no one in medical history that has reached his point has survived. There are two opions.

1. There are surgeries that can be tried, but they have not worked on anybody else before, and they are expensive.

2. There is comfort care. He can be kept at a greatly reduced level of pain, and moderately lucid, up until the end. The gov't will also make available counselors and legal aid.

Now Mr. Jones is terrified of dying, (Naturally, not many of us want to do that.)and he wants the very expensive first option.

Does he have the right to stick the taxpayers with the bill because he is a coward? (Remember, under either option - he is dead in a few months.)

[outinforce]

157. Looks Like Mr. Jones is Really Sick

The first question I would pose, given the gravity of Mr. Jones' illness, is this "what are the chances of his surviving the surgery". My experience is that typically very ill people do not survive major surgery -- the surgery itself is too great a strain on the system.

But let's say that Mr. Jones' condition is such that he will be able to (1) make a rational decision if provided all the relevant facts, (2) survive an extremely risky surgery (so risky, in fact, that it has killed every other patient who has had the procedure performed on him/her), and (3) will, regardless of the surgery, die within six months.

If I were his physician, I would acknowledge Mr. Jones' fear of dying and try to suggest to Mr. Jones that he allow some spiritual guie (either a minister, chaplain, priest, or other spiritual or religious figure to deal with the issues underlying his fear of death).

Then I would remind Mr. Jones that the surgery is very, very risky, and that he could die on the operating table, connected to tubes and away from those he loves.

Or that he could forego the surgery and continue the treatment regimin he is currently on until such time as he feels comfortable enough to say "enough". At which time, we will provide as much palliative care as we can.

And I think I might be inclined to discuss with Mr. Jones the difference in dying on an operating table, surronded by beeping machines and medical personnel and dying in a room surrounded by no machines and by loving family members and/or friends instead.

And then I would leave the decision up to Mr. Jones.

And I would certainly NEVER call him a coward -- It would, I think, take a fair amount of courage to consent to an operation that no one else had survived.

[Silverhair]

161. Now one further question.

Mr. Jones will not have to pay the bill. You personally will. I know in the real world that your share would be so minuscule that you would not be aware of it directly. But for the sake of the discussion, to establish principle - you personally are going to have to pay, out of your own pocket - THE ENTIRE BILL. (Never mind why you are paying the bill as it is just for the discussion that you have the responsibility. We shall assume that it is not the result of some sort of fault of yours for which you might be found legally liable or anything like that.)

Now please address the question. It is your money that Mr. Jones is about to spend. Do you get to participate in the decision? How much participation?

[outinforce]

166. I Tried to Respond Yesterday

But it must have been during one of those "downtimes".

Anyway, here is the gist of what I had to say regarding the situation you pose:

It is impossible for me to say how much I get to participate in the decision that Mr. JOnes is about to make without knowing why it is, exactly, that I am going to be paying the bill.

You suggest that I "never mind" about that issue, but for me, it is the very crux of the issue.

If Mr. Jones and I are fellow-citizens of a country in which we have both paid into a social system in which part of the "contract" or understanding is that citizens who are desperately (in the precise sense of that word) ill will get to elect to have one other citizen pay the costs of their medical expenses, and if Mr. Jones, under that system, has elected me as the person to pay his bill, then no, I have no voice in Mr. Jones' decision. It seems to me that my only concern that I could legitimately voice is that of assuring that the procedure is performed at the lowest possible cost necessary to acomplish the results for which the procedures is being performed.

If, on the other hand, Mr. Jones and I are in some sort of business arrangement in which Mr. Jones and I agree mutually that if either one of us becomes desperately ill, the other will pay the entire medical expenses of the person who is sick, as long as the person paying the expenses believes that the expenditure is somehow "justified", then, under that sort of scenario, I think I would have some voice in Mr. Jones' decision.

But absent any knowledge of what understanding Mr. Jones and I have as to why it is, exactly, that I am going to personally pay for this procedure, I'm afraid I cannot give you a terribly precise response.

[Kanary]

159. I don't think it's clear, first, that we actually have those choices now

You are bringing up some very important questions, and because of the limitations on a forum such as this, I doubt that it's very possible to actually come to some consensus. Just being willing to listen to different opinions is of high value.

So far in all your health care posts you have done admirably at maintaining civility, even under attack. However, I would respectfully suggest that calling people names and using derogatory adjectives to describe people isn't very conducive to civil debate, and getting your point across. As in:

"Does he have the right to stick the taxpayers with the bill because he is a coward?"

No need to use the term "coward", and it isn't helping your case. A person may be fearful, and that is understandable. Except for those who think it's wrong to have *any* emotions, "fearful" doesn't carry negative baggage.

Kanary

[Silverhair]

160. Yeah, you're right. I let my own emotional control slip some.

Thanks for the compliment.

[liberalhistorian]

132. My, how generous of you.

Will you even throw in a couple of burgers at the hospital cafeteria, too? Most of us pay an awful lot in taxes and insurance premiums, and we deserve to have our lives valued and to be given the choice of what we want to do.

And I wonder how you'd feel if it was YOUR family member.

[Silverhair]

144. If you will reread my original post, I have discussed my own

family and MYSELF. Remember please that I am talking about the difference between FUTILE CARE vs comfort care.

[outinforce]

8. Another Thought

I really do not know how many people truly understand the legal obligations of hospitals.

I do volunteer work at a local hospital, and on more than a few occasions, I have been present when a patient has been brought to the Emergency Room because a member of his or her family called "911". Often, such a patient is without a living will, but the family member who called 911 tells the medical staff that the patient's wishes are that s/he not be hooked up to a bunch of tubes and that no extrordinary measure be taken to prolong his /her life.

But hospitals -- especially emergency rooms -- are precisely places where patients go to have extraordinary measures taken in order to preserve life. And I think I am correct in saying that hospitals and doctors have a legal obligation to do all they can in order to preserve life.

Right now, the only option someone has, if they see a loved one having a heart attack or gaspiong for breath, is to call 911 -- thus triggering an entire medical team who is legally obliged to do all they can in order to keep the patient alive -- even if it means tubes and other extraordinary medical measures.

However, if the general population had another number they couild call that would trigger a response team whose job it would be to provide palliative end-of-life care -- to ease the pain and suffering, but no necessary prolong life -- I wonder how many call to 911 might not be made.

[sam sarrha]

33. the Dalai Lama was asked what the purpose life was ..he replied,

"To learn how to die well...." The Tibetans Believe that your state of mind at the time of is very important, Dieing involves ritual and practice. It is a very important aspect of life and rebirth. My Tibetan friend when asked if he feared death actually smiled and laughed.. then said "NO!,..it means that I will have a new young body and another chance to achieve Liberation."

actually messing with people when they are dieing can only create problems with their rebirth. People say their goodbye's when the person is still healthy if passable, crying and expressing grief around a dieing person can create grasping, attachment and regret which are negative emotions and can mess up a good rebirth. The worst thing that can happen to a Tibetan is a Bad Rebirth... that can take a very long time and a lot of suffering to rectify.

My father knew he had terminal cancer and never sought treatment because he knew it would bankrupt 2 families and do no good. he suffered horribly. He died in my arms at home.

[Silverhair]

54. Unworkable. Requires a non medical person to make

life/death decisions. However, you are correct in what you say about the ER. The problem lies in current law, which needs to be changed.

[outinforce]

63. Unworkable? Why?

What I suggested was an addition to the current 911 system.

If you have ever been around someone who is having a heart attack or who is suffering from not being able to breathe because of COPD or other respiratory illnesses, then you know that in many (I might argue most) cases, the person who is witnessing another person in such obvious distress wants to do something to ease the victim's suffering and distress.

Currently, the only option such a person has is to call 911. But calling 911 triggers a whole army of people whose job igt is -- and who are legally obvliged to -- keep the person alive.

On the other hand, what I am suggesting is a system in which people who did not want to be kept alive if they had a heart attack or suffered from some other type of serious medical condition could wear some sort of braclet that indicated that it was their desire that 911 NOT be called. And, in such a system, people who witnessed folks with such an express desire not to have their lives artificially prolonged having a heart attack or a breathing episode could call another emergency number -- a number which would dispatch people to provide palliative care to the person having the heart attack and any sort of spiritual or emotional care to the person who had just witnesses such a horrifying incident.

I think such a system would respect the right of individuals to make their own end-of-life decisions (without, of course, resorting to suicide), while at the same time acknowledging the desire of most people to assist others who are having serious medical episodes. And, I would venture to guess, it would cut down on the number of visits to the ER's of our country -- visits in which the doctors, medical staff, and hospitals are legally obliged to do all they can to keep the person alive, until and unless the patient (or someone authorized on his/her behalf) changes his/her mind.

[Silverhair]

72. Here is why.

Let's say my wife starts to have trouble. I am not competent to make a diagnosis on whether I should call 911 or the other number. That is why it won't work.

Rather the ER should make the determination as to what kind of care to give, and the law amended to support the ER.

[outinforce]

77. Simple Solution

"Let's say my wife starts to have trouble. I am not competent to make a diagnosis on whether I should call 911 or the other number. That is why it won't work."

If you see you see your wife having, say, a heart attack, and you call the "compassionate care emergency number", the first question I would hope you would be asked is "Does the person having the medical emergency have a "compassionate care" bracelet?" If you respond that your wife does not have such a bracelet, you would, under the system I am suggesting, be directed to call 911, and be sympathetically told that the "compassionate care" number is to be used only when the person having the medical emergency has stated that s/he does not want the services of the 911 team.

"Rather the ER should make the determination as to what kind of care to give, and the law amended to support the ER."

Using what sort of criteria? Age of patient? Insurance plan the patient happens to have coverage under? Would you propose that the patient him/herself (or the patient's family -- including gay significant other) have any say in the coverage s/he recieves, or would it be left soley to the discretion of physicians who are being monitored by cost-conscious bureaucrats who want to ensure that medical costs for end-of-life patients are not, as you say, "excessive"?

[Silverhair]

80. How do I know it is a heart attack? They don't always give

the classic symptoms that one sees on TV. I AM NOT COMPETENT TO MAKE THAT DETERMINATION. Only a trained medical person can determine if the cause of the distress would be in one category or another.

The second paragraph of you post would have to be part of a great debate on what health care we provide. WE DO NOT HAVE THE RESOURCES TO GIVE EVERYTHING TO EVERYBODY. That means some hard choices have to be made that will be painful to make.

[cryofan]

32. put defense, space, corp welfare money into healthcare

Here is where are those billions would:

1. develop agreements with 3rd world countries to build medical schools there. A large fraction of the graduates would be sent to the USA to practice medicine. Just put the law of supply and demand to work for us right off the bat. And if the doctors unions complain.....well....FUCK THEM, fuck them and the Porsches they rode in on, and fuck the mini mansions they sleep in.

2. Build hospitals, more hospitals and more hospitals.

3. Build nursing schools.

4. Fund tax free development of high tech medical equipment.

This aint rocket science, people. Just bust up the cartels that monopolize and rig prices and constrain supply. It's easy. You just need honest politicians, and lots of 'em.


And repeat this process for dentistry.....

[SOS]

36. The US spends 14.9% of GDP

on health "care". That is nearly double what most western nations spend. As Kucinich pointed out in a debate, we are already paying for universal health care, it just isn't being delivered. In Europe, Japan, Australia, New Zealand (etc) health care is delivered to every citizen (old and young) at a much lower cost as % GDP. We need not sacrifice the elderly or the young or anyone else. Just kick out the parasitic insurance companies and we could have UHC tomorrow. But, sadly, the people suffering in this awful, broken sytem don't have an army of lawyers and lobbyists bribing the Congress on their behalf.

[outinforce]

58. I'm Not So Sure about that "Army of Lawyers"

While I think I understand your point, I would also point to the case of the survivors and families of people killed in the attacks on the US on 9/11/01.

The Governmentr offered -- rather like a "single-payer" -- a cash settlement to anyone who had a family member who died in the attacks on 9/11/01.

Most took the government's offer (or at least applied for it).

But a few -- prodded, I think, by lawyers -- sought to sue the airline companies, the manufacturers of the airplanes, the owners of the WTC, and any other "deep pocket" they could find.

The problem, at least as I understand it, is that some of the survivors felt that the government was not being generous enough with its resources.

I would imagine that in countries such as New Zealand, Australia, and Japan, there are frequently people who are upset with wghat they perceive as their government's lack of compassion and generosity when it comes to health care.

But, those countires certainly do "manage" to spend a lot less on health care than we do. I wonder what the costs and trade-offs are, though.

[gbwarming]

70. 9/11 suits are because the gov't isn't being forthcoming enough

not because the offer was too small.

edit spelling

[outinforce]

78. In Some, but not all, of the cases

WHat you say is true in some of the cases.

But not all of them.

What the failure of some to take the government's offer demonstrates to me is that some folks apparently think that there is more money to be obtained in some distant future than there is right now.

It is exactly that sort of thought that would always cause some of us Americans (with our love of the lawsuit) to attempt to sue the government (or to use political pressures) to get the government to pay what we think we deserve in a single payer situation, rather than what the government has determined is best in order to fairly ration the scarce medical care dollars of our society.

[SOS]

155. The lawyers and lobbyists

represent the interests of pharmaceutical and insurance companies, doctors (AMA) and hospital corporations. They "donate" tens of millions to politicians in our pay-to-play system.
Although no other country on earth comes close to 14.9% of GDP for medical services, the US does have one distinction:
According to the 2003 CIA World Factbook the US ranks 48th (!)
in life expectancy at birth.

USA: #1 in spending, #48 in life expectancy.

http://www.photius.com/rankings/life_expectancy_at_birth_0.html

[outinforce]

162. You seem to suggest that

You seem to suggest (and please do correct me if I have read too much into your post) that the life expectance at birth of people born in the USA is somehow a function of either lawyers and lobbyists or doctors, or hosptial corporations or politicians or 14.8% of GDP.

I'm really not quite sure what point you are, in fact, making here.

But I would suggest that in perhaps no other country in the world do we, as a culture, honor individual choice.

Even the choice or unhealthy, ultimately destructive life choices.

Those choices we honor, of course, have consequences. Sometimes those consequences mean fore-shortened lives.

One way to ensure longer lives for all Americans would be to enforce healthy diets.

But, aside from a view nutrition facsists, I don't tnink anyone is seriously suggesting that.

[Kanary]

164. Actually, in some instances there is more "choice" elsewhere

Your post got me to thinking about "choice" of either healthy or unhealthy. Since I don't smoke and never have, I don't think of this often, but it is interesting to note that in almost all other countries, more people smoke than in the US. Given that, it's very curious that the US life expectancy rate is lower, eh? That certainly says something about the level of health care here.

Kanary

[Bridget Burke]

48. Freedom of choice is the way to go.

Whatever the patient's age, doctors must present the patient & family with all information concerning their condition & the treatment options available. Realistic discussion of these matters can be difficult for medical professionals and patients but must happen. The Living Will, Durable Power of Attorney & DNR status are all tools that can help people deal with the end of life. Many will choose the more graceful exit. But some choose to fight, even with no hope of long-term survival.

If the patient wants hospice care & must receive it in an inpatient setting, will they go to a dedicated hospice that offers non-medical support as well as palliation of symptoms? Or will they be warehoused in a hospital ward because that's what their coverage offers?

I notice you emphasize that "old" patients are the problem. Some relatively young people have diseases that cause them to face these issues. Some old patients may need expensive medical care that will give them a few more good years. Are these decisions to be made based on age alone?

The problem is not that limited health benefits are being "taken away" from the young to benefit the old. I believe it has to do with the current regime's priorities. The money that's being spent in foreign adventures should be spent on decent health care for everybody. Of course, those foreign adventures are keeping increasing numbers of young people from becoming old people--another way to cut health care costs?

And the absolute last people who need to make these decisions are the insurance company bean-counters.

[Silverhair]

60. The person who pays will ALWAYS want to be part of the decision.

Usually the major part. (When my daughter wanted to go to Liberty college - Jerry Falwell's place - I got to say, "No" because I was writing the checks. BTW - Now she is glad she didn't go there.) The point is that the person who want the agressive end of life care is wanting me, via taxes, to foot the bill. Therefore, I get to be part of the decision, via my elected representatives.

[Bridget Burke]

74. And your role is "tax payer"?

Somehow, I got the impression that you're an insurance agent.

The need for insurance companies to have a big profit margin is one of the main reasons that health care costs so much. Oh, we must keep government "bureaucracies" out of these decisions. So we leave them to the private bureaucracies. And there's so little left for patient care that we must decide whose life is worth more.

But the recent "tort reform" has caused malpractice insurance to go down in Texas, hasn't it? Well, no.

[Silverhair]

76. Was an insurance agent. I got sick of it and left.

I stated that in my first post on the subject.

I am a Private Investigator, and Poker Professional now.

[outinforce]

66. Here's Yet Another Question For You.....

re-reading your original message, I am struck by the notion that there are some meidcal decisions that must be made in the cold, hard light of economic realities. We just don't have enough money to fix everyone's medical problems, and so we should limit medical care to those the someone (and it is unclear just who that someone is) decides could best benefit from additional expenditures of our scarce medical care dollars.

I think I am conveying the thought behind your original message here, but if not, please do correct me.

Some of us here have responded to what such a proposal would mean in terms of older people -- those who are well-advanced in years, and who, as some have pointed out, will most likely die in a very short period of time, with or without more medical procedures.

But my questio;n is this: What about life that is just beginning?

To be more precise: What would your proposal suggest in terms to whether to allow a mother to give birth to a child that is shown, while still in utero, to have serious medical conditions, such as Downs Syndrome or spina bifida? Would your proposal require the mother to have an abortion? Or, if not, would your proposal deny medical coverage to the new-born infant, on the theory that, as a rule, such babies, even with the best medical care, normally do not survive beyond one year?

Would doctors who provide ob/gyn services to women with "high risk" pregnancies be monitored in order to assured that the number of high risk pregnancies were terminated at a rate the person doing the monitoring found acceptable?

And would physicians who provided medical care to infants having serious birth defects also be monitored to ensure that the costs devoted to keeping such young lives living would not be "excessive"?

[Silverhair]

69. Excellent questions, and you slightly misunderstand me.

I didn't say that we don't have enough money to treat everybody's medical problems. I said that some treatment if futile, and therefore a waste.

Certainly some of the cases that you cite are also cases of expensive and futile treatment. I have no idea how much money is being used on those type cases, and on what percentage of the national medical bill it represents.

Extensive care for an infant that is going to die in less than a year would seem to me to be last-year-of-life care, and should switch to comfort care.

But 22% on last year of life care is huge, and certainly needs to be looked at.

[Mr.Green93]

71. some treatment if futile,

AIDs patients?

[Silverhair]

75. You are implying a position that I do not take.

I am not saying "No Treatment", I am saying comfort care in untreatable situations.

Certainly continue research to find cures if possible. And if a treatment actually works to realistically prolong the life, then we aren't talking about last-year-of-life are we?

[outinforce]

82. But Mr.Green93 DOES Raise an Interesting Point

The current state of the medical technology is such that people who have become infected with the HIV virus can live productive lives for many many years.

But, when HIV first was discovered in people, it was a death sentence -- and a death that occurred, in most cases, rather quickly. Most treatments were completely ineffective.

Under the system you propose, silverhair, what would your system have done in the early 1980's with people who were known to be infected with what was then called "the AIDS virus"?

Would you have simply put them all into hospices -- denying them medical treatment on the theory (which was a fact back then) that treatment was absolutely futile, and people infected with HIV were simply going to die -- and die quite soon anyway? Would you have argued that the compassionate thing for society to do with such poor, unfortunate folks would be to simply provide them with palliative care, instead of "wasting" our society's scarce resources on "futiel" treatments for these poor souls?

And, what do you think might have been the reaction to a system that actaully conducted research -- again, "draining" scarce resources -- to find a cure for a disease, especially when we were providing such kind, and compassionate -- and most of all, cost-efficient -- care to those unfortunate enough to have become infected with the HIV virus?

[Silverhair]

83. You are distorting my position.

I suppose that you simply want to have "everything for everybody" regardless of any costs. Sounds very compassionate - except for the problem that there simply isn't enough money. If we are going to have an effective health care system, then it means that there is going to have to be some hard headed bean counting, or the system goes bankrupt.

Now let's address your example. I NEVER SAID THAT RESEARCH SHOULD NOT CONTINUE. In fact I did say that research SHOULD continue. Please get my positions correct if you are going to debate me. I will not defend positions that are not mine - I don't need to - they aren't mine. So there is no problem with continued research into medical problems. And often times research on one disease may accidently discover a treatment for a different disease, or a general treatment that will cover a range of diseases.

So let's pretend that we are in the early 1980's with an AIDS patient. Unless that individual is part of a research program, then he would be given comfort care, because nothing else that could work was available. Now, of course, there are other options.

Now will you address the problem of limited funds? Or do you think that resources are unlimited and everybody can have everything?

[Mr.Green93]

86. the problem of limited funds?

at what age would you cut off kidney dialysis?

[Silverhair]

88. Obviously you want "everything for everybody".

Exactly when a treatment would and would not be given would be a matter of debate. What is undebatable is that you simply can't have everything for everybody.

And I am sure, that no matter what limits were drawn, you quickly go with a camera to somebody that was being given comfort care and produce a real tear jerker of a film. But if you try to have everything for everybody, the system goes bankrupt and nobody is helped.

[liberalhistorian]

91. Instead of answering

a very good question, you once again respond with "we cannot have everything for everybody." Fine. Whatever. You want to play God, whatever. But you are still not answering the questions.

At just what age WOULD you cut off something like kidney dialysis? For the 20-year-old who has no chance in hell of ever recovering, or the 70-year-old who's in good health and with said treatment will live many more fairly productive years? You're not answering these questions, you're simply chanting "can't have everything for everybody", like a mantra, and that's a cop-out.

[Jose Diablo]

125. I think we can have everything for everyone

But not with the system we have now. We are used to shortages and high prices for health care because of the system as it exists today, not because it is impossible to supply the demand needed.

Our expectations are low because we have been trained by the health care industry to expect less.

[Kanary]

98. Can't have everything for everybody. Agreed.

And, that is specifically what is happening now, and I don't see a lot of evidence that the incensed folks here have put a lot of energy into changing that fact. Lots of us don't get the medical care we need, and sure don't have a lot of people in our corner.

I don't know where this fits into your thesis, Silverhair, but I've also done a lot of thinking about, given the limits, the fact that people who have abused their bodies all their lives get all sorts of heroic care if they have $$$, but those o f us who have put our health first and have really worked at maintaining health still lose out if we don't have the $$$. Something doesn't seem quite right about that.

Although I suspect it won't be heard by those here who are really angry, I will say that I do wish everyone could have whatever care is necessary. However, that already isn't happening, and I don't see that changing any time in the near (or even far) future. While I do wish that everyone could receive good care, it truly burns me up to see people who've gone out of their way to mess up their health get care while others have watched their nutrition, gotten exercise and all the other things only to end up suffering without care.

Kanary

[Silverhair]

99. Yes, a proper health care system would need to push

prevention, but I don't know how. I will bring that up in a future post.

People who have money will always have choices that the rest of us don't have. That's OK. We need for there to be a reason to have money so people will have motives to be productive and get rich. I am a capitalist.

But there needs to be a floor of excellent health care that available to all. I can make that arguement from liberal compassion, or from conservative national security/defense/productivity as needed.

But resources are always going to be limited, and hard choices have to be made. One of those choices needs to be realizing when there is no hope of recovery and switching from agressive to comfort care.

[Kanary]

122. When I heard you say "hard choices" before, I figured I'd be gone

You brought this up in your previous "episode" of healthcare, and I thought, "here it comes, I'll be told to get out of the way". Those of us on disability are so used to being targeted and told we have no use and therefore no rights that I was fully expecting that. It didn't get to me too badly, because I'm already to the point where I've heard it so much that it's hard to care much anymore.

It's very interesting because the last several days I've thought of former Colorado governor Dick Lamm's famous ( or infamous) words that got so badly misused: "Duty to die". He was trying to say much the same thing, and it's very unfortunate that he so badly chose the wrong words that the dialog never took place... it just stalled over anger at how he said it. All these years later, and the discussion still hasn't taken place.

So, I agree with you about limitations... that will always be there, and it's time to talk about it rationally and reasonably. (Although if we can ever get smart enough to end all war, there will certainly be alot more resources!)

I also disagree with you about "motivation", and disagree strongly, but that is a topic for another thread.

Kanary

[Silverhair]

128. I'm not saying, "Die and get out of the way."

Most people here are misunderstanding what I am saying.

There are conditions which are terminal and for which there is no treatment. All of us will have one of those conditions someday. I am opposed to spending taxpayer dollars on agressive treatment that will not help. If somebody wants to spend their own money - fine.

If treatment is helping a disabled person, then it isn't futile care.

We are spending 22% of a national health care (Including private insurance, but mostly Medicare.)on the last year of life. That means a LOT of the treatments are futile treatments that do nothing but enrich the hospitals & doctors - while torturing the patient in the process.

[Kanary]

138. I know. People didn't get that with Dick Lamm, either

So, here it is, all these years later, and we still have yet to really discuss this issue. Glad you brought it up again.

I hope you will keep advocating for care and treatment for disabled people, as that is soon to be going away.

Kanary

[liberalhistorian]

136. Being productive has NEVER

been synonymous with being rich. There are millions of productive people who work very hard, much harder than a lot of people with money, for that matter, and receive very little in return and still get looked down on. I've known more than enough of them, and I'm one myself.

Unless, by productive, you mean screwing people and climbing all over them to get your money, or being a member of a family with great wealth, and therefore, being born into it, which, in this society, automatically makes you far more worthy than the person who works 12 hours a day 6 days a week and barely takes home enough to feed himself and/or his family.

The problem I have is not with money, it's with the fact that, in this society, your worth and the value of your life is determined solely by how much money you have regardless of how you have it, whether you were born into it, or screwed others, or got it off the back of those who actually earned it for you.

[liberalhistorian]

135. That's because they have

MONEY, and frankly that's all that seems to count in this society. You can be the worst person in the world, but if you have money, well then, hey, you're the toast of society! So what if your liver is shot because you did drugs and alcohol for thirty years, you've got money and a name, so you get the organ donation, and the hell with the thirty-year-old who's taken care of himself, but who's suffering from a congenital disease, or something similar, because he's a nobody from nowhere.

Our lives are valued and our worth determined by how much fucking MONEY we have, and NOTHING ELSE, ESPECIALLY when it comes to health care. And that's simply disgusting and despicable.

And as far as working to change things, I belong to and work with TWO national groups working for total health care reform and a universal, national health program.

[Silverhair]

148. That has always been true and always will be true.

Money is power, and power is status. Even in the animal world, the boss ape is the one the females prefer. I suggest you read, "The Selfish Gene" and "Nonzero, The Logic of Human Destiny". They show how greatly our biology controls us in ways that we aren't even aware of.

Even racism has a sociobiological basis. That doesn't make it right, not at all. But understanding why there is that "program" in us, helps fight it.

Lots of other behaviors can be understood by understanding sociobiology too.

[outinforce]

103. Since You Asked.

First of all, let me apologize for mis-representing your position. I absolutely HATE it when people do that to me.

But what I hate even more is when people do not give me to opportunity to clarify my own position.

Here is what I understand your position to be regarding AIDS patients in the early 1980's:

Since, in almost every case of HIV infection in the early 1980's, medical treatment was absolutely futile, and patients who became infect with HIV died in a very short period of time, society should have not provided any medical care to those patients. Rather, a compassionate and cost-efficient-concerned society would have provided competant compassionate (or hospice) care which would have provided palliative care (including drugs designed to ease pain and suffering).

Moreover, society should have allocated dollars to fund research into the causes and possible cures and treatments for people infect with HIV.

I hope I have correctly state your position here. If not, do let me know, since I never want to intentionally (or even unintentionally) mis-represent what another person's position is, especially on an issue as sensitive as this one.

Since you asked me to address the problem of limited funds, I will. And I will do so by asking you a question that many folks asked in the early 1980's concerning research into the cause and treatment of AIDS.

The question is this: We know that in most cases, AIDS is spread through contacts which can easily be avoided (unprotected sex, sharing of needles are the two largest means of transmission of this disease.) That being the case, why does it make any sense at all to devote scarce medical research dollars to finding the cause and potential cure for AIDS, especially when there are many more illnesses, such as cancer and heart disease, which claim many more people every year? Wouldn't it make more sense, from a cost-efficiency point of view, simply to quaranteen anyone found to have the HIV virus?

[Silverhair]

106. In the early stages, Yes. Now - impossible.

I know it sounds like a brutal violation of a person human rights, but isolation WORKS. Vietnam stopped SARS by doing exactly that. In the early stages there were few enough AIDS people that agressive action could have stopped it, but at a high cost as some civil right would have been trashed. Once gone they would have been hard to get back.

Aside from the obvious homosexual politics involved, AIDS was extremely important to have been researched because it was a new disease and unknown. In the early 80's there was serious speculation that AIDS might wipe out humanity, or pretty close to it.

Even now it looks like it may depopulate Subsharan Africa.

[outinforce]

109. Thanks for your honesty.

I think it took real courage to say what you said about quarantining people with AIDS -- especially here on DU, and especially to someone who (and I'm not sure I have made this clear) is gay.

I will not condemn you for what you said about quarantining people with AIDS/HIV infection.

And I appreciate your comments concerning research into the HIV virus. The thought that was often expressed by many during the 1980's and even into the 1990's was that we were spending far too much money research AIDS, since it really affected a rather small portion of our population, and since it was easily controlled through behavior modification.

And this, for me, points out the danger in having our entire medical policy set by the government. If the government controls -- even through our elected representatives, all of the medical dollars, then it seems to me that a disease that only affects a small portion of the population may be left un-researched while the relatively few people unfortunate enough to contract the disease are simply provided quality palliative care.

The profit motive may be terrible in some cases, but my guess is that medical companies who see the potential profits in discovering cures or treatments for things like AIDS do a much better job at allocating scarce medical research dollars than the government ever would have -- especially the government of Ronald Reagan and George Bush I.

[kiahzero]

87. Kill the sick! We'll save tons of money!

This is the most ridiculous thing I've heard in a long, long time.

You're actually suggesting that the right thing to do in our society is abandon the elderly after a certain point, for cost-benefit reasons? How much extension are you willing to put on this principle?

Take me, for instance - I have Crohn's Disease, which is an autoimmune intestinal disorder. I have to have $8,000 treatments every 8 weeks, not to mention 2 prescriptions every night, a few surgeries, etc.

So far, just on the $8,000 infusions, my insurance company has spent roughly a quarter of a million dollars. Why not just take out my colon and give me a colostomy bag? After all, it'd be cheaper, and you'd be able to allocate that money to someone much more worthy than I.

Excuse me if I sound skeptical of your grand idea.

[Silverhair]

90. Do you deny that hard choices have to be made?

Do you actually think that we can have a system that has everything for everybody? Do you think that there are no limits to the resources available?

As to the specific question of your specific disease, I will not address that. I am attempting to speak in general terms. Sadly, we have to accept that there simply isn't enough money for everybody to get everything. That means some hard choices have to be made.

One of the problems of liberalism, is that it won't attempt to make the hard choices, but tries to give everything to everybody. When that fails, as it must, then the conservatives are able to take over. The only way we can have progressive programs is to also realise when there are limits, and be willing to make the hard choices.

[kiahzero]

92. I deny merely that we are limited to the options you have presented

Do you actually think that we can have a system that has everything for everybody? Do you think that there are no limits to the resources available?
No, but I fail to see how performing "cost-benefit" analysis on people is a realistic idea.

As to the specific question of your specific disease, I will not address that. I am attempting to speak in general terms. Sadly, we have to accept that there simply isn't enough money for everybody to get everything. That means some hard choices have to be made.

One of the problems of liberalism, is that it won't attempt to make the hard choices, but tries to give everything to everybody. When that fails, as it must, then the conservatives are able to take over. The only way we can have progressive programs is to also realize when there are limits, and be willing to make the hard choices.

Your problem is that you've created a false dichotomy - you assume that costs must necessarily be high to keep the elderly alive, and then go on to logically deduce that the money could be better spent.

What dictates that costs be high? The chemicals that go into your average prescription drug are not that expensive, nor is the procedure that difficult. With any sort of technological device, there is more fixed cost, but how much of the price is profit? Once you've designed the first silicon chip, the rest of them are very cheap to make.

You've created a system where your answer is correct, but the problem is that your system doesn't allow for some of the real-world variables involved.

On another note, that I neglected to mention - How can any progressive feel comfortable giving the government that much power? We've seen what the government can do with the relatively limited power it has now (Bush Administration)... if I read you correctly, it would ultimately be in the hands of the government (via the government health-care plan) to decide whether it is worth the investment to keep a person alive.

[Silverhair]

94. You misinterpreted, and then argued against your mininterpretation

instead of against what I actually said. I recommend that you read what I actually said, and respond to it. I am talking about futile treatment vs. comfort care. The last year of life can come at any age. Usually, in our society, it comes in old age.

I am talking about realizing when a condition has reached the stage that agressive treatment is futile and care should be switched to comfort care.

Respond to my actual positions, instead of your strawmen.

Regarding the gov't having that power. I don't really like it, but right now I don't like have the huge number of uninsured that we have now, nor do I like the huge waste that is caused by the inurance system. No system will be perfect. That is beyond human ability.

[Kanary]

100. Who has the power now?

Right now, decisions about care are being made by "bean counters" who have no interest in people, only in profits.

While having a government make the decisions doesn't sound enticing, having someone who is actually trained for that post to take into account actual human beings could be a whole lot better than some emotionally dead profiteer.

Kanary

[rman]

130. last year of my life won't be your hard choice to make

nor the choice of any government or corporation. not if it's up to me.

[Kanary]

139. Do you really think you have the choice now??

[Cleita]

104. This is why we have living wills to determine when

it's time for us to die, or if we can't because of dementia, others can follow our wishes set out in the living will. However now that the first steps have been taken to privatize Medicare by forcing us into health plans in order to get prescription drugs, the time for universal health care has become more urgent and timely.

How about pointing out the the fact that the cost of health care is twice as much with private plans as under a single payer government system and the extra cost per person leaves about a third of the population without any coverage at all, whereas the single payer plan covers everyone for less per person.

[Kanary]

117. Living wills are for those with family to enforce it.

It still depends on whether your relatives will actually enforce your desires, when push come to shove.

And those of us without family are out of luck.

Kanary

[liberalhistorian]

137. That's not true.

If you have a living will, its provisions MUST be enforced, regardless of what the hospital and/or doctor thinks about it or wants to do. I'm a paralegal who does a lot of those for my boss, and many people we do it for don't have any family. It still has to be enforced.

[Kanary]

140. Then it's strange

That people are always warned about having their family in agreement, because it can be overturned. Everyone I know who has gone through the process has been warned about that, and it has happened.

Kanary

[rman]

129. hm yes another cost cut for corporations. very good

-

[bloom]

146. I don't want my death drawn out...

But one could not make assumptions based on age.

[Silverhair]

149. No assuptions, based on age were made.

A person can develop a fatal condition at any age. However, as a simple reality, for most people that happens in old age. I am talking about FUTILE CARE vs comfort care. Futile care is agressive care that has no chance of working.

[outinforce]

153. Let's Define Terms

Since you use the term "futile care" quite a lot, it might be useful to get a little specific here in our definitions.

You say, "Futile care is agressive care that has no chance of working."

Suppose a woman is diagnosed with stage four breast cancer. Would an operation be futile? How about radiation treatment? Chemo? What factors would you suggest be used to determine whether this specific woman, with stage four breast cancer be allowed to receive treatment?

Suppose an infant is born with Downs Syndrome. Part of the infant's condition is that he has trouble gaining weight, and his heart is not correctly formed. His heart could be opeerated upon to correct this malformation, but it would be a very risky procedure, with no guarantee of success. And the procedure could only be performed if the parents agreed to a very agressive plan involving force-feeding, via a feeding tube down the nose of the infant, until such time (probalby around one year of age) when the heart surgery could be performed. Very expensive, with no certainty, and a very high risk of failure. Would providing this sort of expensive care for a Downs Sydrome Kid who, in all likelihood, even if the heart surgery is successful, will not be able to gain basic language skills by age 16, br futile or not? What factors would you want the overseers of the doctors (the ones monitoring the costs) to look at here? And, if you think that the care in this case would be futile, would you be willing to tell the parents that their child's life is just not worth it, or would that task fall to someone else?

[Silverhair]

156. I am not a doctor. In these posts, I paint with broad brush strokes.

I don't even know what the different stages of breast cancer are. I would need a doctor to tell me, in each case what the probabilities were.

But 22% of our health care dollars are being spend in the last year of life. That strongly implies that a huge hunk of resources are being committed to futile care. (Remember that the last year of life can come at any year.)

I made a response post upthread, titled: "Let me rephase the question". I posed it in detail there. Please take a look at it. I would use the same question for the rest of this response.

[Silverhair]

165. The sick Mr. Jones.

The thread branch was getting pretty crowded so I have dropped this down here as I think we were getting somewhere and the discussion is worth persuing.

I Posted:

You are approaching this as a question of individual rights.

So let us say that Mr. Jones has been diagnosed and confirmed with a condition that will lead to his death within a year. So far, no one in medical history that has reached his point has survived. There are two opions.

1. There are surgeries that can be tried, but they have not worked on anybody else before, and they are expensive.

2. There is comfort care. He can be kept at a greatly reduced level of pain, and moderately lucid, up until the end. The gov't will also make available counselors and legal aid.

Now Mr. Jones is terrified of dying, (Naturally, not many of us want to do that.)and he wants the very expensive first option.

Does he have the right to stick the taxpayers with the bill because he is a coward? (Remember, under either option - he is dead in a few months.)

On revision, I regret having used the word coward. Sometimes I get frustrated in these threads and let my own emotional control slip.

A DUer responed:

The first question I would pose, given the gravity of Mr. Jones' illness, is this "what are the chances of his surviving the surgery". My experience is that typically very ill people do not survive major surgery -- the surgery itself is too great a strain on the system.

But let's say that Mr. Jones' condition is such that he will be able to (1) make a rational decision if provided all the relevant facts, (2) survive an extremely risky surgery (so risky, in fact, that it has killed every other patient who has had the procedure performed on him/her), and (3) will, regardless of the surgery, die within six months.

If I were his physician, I would acknowledge Mr. Jones' fear of dying and try to suggest to Mr. Jones that he allow some spiritual guie (either a minister, chaplain, priest, or other spiritual or religious figure to deal with the issues underlying his fear of death).

Then I would remind Mr. Jones that the surgery is very, very risky, and that he could die on the operating table, connected to tubes and away from those he loves.

Or that he could forego the surgery and continue the treatment regimin he is currently on until such time as he feels comfortable enough to say "enough". At which time, we will provide as much palliative care as we can.

And I think I might be inclined to discuss with Mr. Jones the difference in dying on an operating table, surronded by beeping machines and medical personnel and dying in a room surrounded by no machines and by loving family members and/or friends instead.

And then I would leave the decision up to Mr. Jones.

And I would certainly NEVER call him a coward -- It would, I think, take a fair amount of courage to consent to an operation that no one else had survived.

----------
So we have essential agreement that what we are treating is NOT Mr. Jones illness, but his emotional problems as he faces death.

The expensive surgeries will only humor him, at huge expense to the taxpayer. Does he have the right to demand to be humored?

You are the administrator of the medical fund for you area. You have a fixed budget of X, and can't get any more. If you spend the money humoring Mr. Jones - then you can't spend those same dollars somewhere else. What do you do?