Great piece on 60 Minutes last night:
Be great if we could have a serious discussion about this, but as the freakout over death panels and mammogram guidelines show, good luck with that. One party finds it in their advantage to not be serious.
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Malron
I watched that. Good piece that the Rethuglicans will turn into another campaign to scare grandma.
Morbo
I watched that, too. I was blown away by the one line in there, something along the lines of “we wouldn’t have to ration if we handled end-of-life care more responsibly.”
Derelict
No, it is no longer possible to have a sane debate on this or almost any other topic. The Republicans have gone completely over the cliff, and the unfortunate fact is that the media still supports them.
What would REALLY be interesting would be for Democrats to begin actively pursuing some Republican policy goals. Say, for example, calling for elimination of the estate tax. Boehner’s head would explode since he couldn’t actually support anything that Democrats want. Yet, getting rid of the estate tax has been a GOP wet dream since St. Ronnie’s day.
Fun times!
dmsilev
God, there is nothing in the whole health care “debate” that pisses me off more than the whole ‘death panel’ thing. Blatant outright lying and fearmongering, all ginned up out of cold cynical political calculation.
In my darker moments, I wish that all of those responsible for that bit of trash spend the end of their days in an interminable twilight between life and death, supported in a semi-concious haze by a raft of machinery while various relatives and lawyers argue back and forth about what to do.
-dms
dan robinson
That’s because being a politician isn’t about solving public problems with well reasoned policy, it is about being in front of the cameras. This is about political theater where the goal is to stay in Act II for as long as possible.
If I remember correctly, the number of $50 billion a year in care for the last two months of life was bandied about. Is this correct?
BDeevDad
Somewhat related graphic: The Cost of Getting Sick
WereBear
@dmsilev: Lee Atwater kinda went that way.
Col. Klink
The GOP can get away with it because the media loves Death Panels since it is an easy hysterical sell to viewers and because insurance companies and Big Pharma account for about half of the commercial advertising revenue run during news slots.
Also. McCain, Graham, and Lieberman should be given lifetime chairs on Meet the Press.
Belafon (formerly anonevent)
Kay Bailey Hutchinson is running gubernatorial campaign ads touting how she’s willing to stay as senator in order to make sure that the government doesn’t take over health care.
4tehlulz
@Belafon (formerly anonevent):
wut?
Montysano (All Hail Marx & Lennon)
@dan robinson: Yes, $50B was the number. $100B is the number that is bandied about as the cost to insure everyone, so….
Joe Lieberman, Most Powerful Senator Evah, was on my radio this morning, concern trolling the public option by worrying about the PO’s deleterious effect on insurance company profits. Really, he said that.
Napoleon
By the way, here is Wall Street’s initial take on how average Joe friendly HCR developments over the weekend were:
techno
As my doctor once said to me, “since all these boomers think they deserve a $500,000 death, medicine is going to become even more expensive and less cost-effective.”
Brian J
Baby steps, baby steps. A lot of people were freaking out last week because of the changes in the recommendations for mammogram and other screenings, but once people (a) realized that these aren’t made because they want people to die but because they aren’t always worthwhile and (b) that nobody is preventing them from still getting the procedures if they want to pay out of pocket, a lot of people will calm down. I feel as if we’ve been conditioned to expect more is better for so long, we’re willing to do what amounts to burning money for no good cause.
Belafon (formerly anonevent)
Oh, and the one news item I saw on our local Fox News affiliate was about a Canadian woman losing her health insurance over some photos. I didn’t have the volume up to see what they were about, but be prepared to hear about every Canadian who lost insurance, ever Brit who had to wait two days for health care, and every French person who was told by their doctor not to eat croissants anymore.
Lex
Link is now to a segment from the morning show on injecting bourbon marinade into a turkey. Why would you want to do that to either a good bourbon or a good turkey?
Leelee for Obama
I didn’t watch this until this AM. I was trying to avoid it, as I’ve just been through it and thought it might be too much. It seems my cowardice was overcome this morning. It was a fine piece of journalism, as far as it went. They needed to go further, to call out the thugs on the Death Panel BS, to talk to more people, like me, who have seen this situation up close and personal, w/o any real assistance from the medical community in the beginning. I hate to say that all they think about in the money, because there have been many health professionals that truly were compassionate, even before the last emergency. But, the money that was spent by Medicare last year, when my Mom fell, was both exorbitant, and unnecessary. So little help in the eventual outcome, and so little understanding from BUSY docs and office staff about helping me cope with what was occurring. I’ve cried enough but a few more tears trickled today, for that lost month of August 2008, when I SHOULD have been encouraged to bring her home and try to make her last year as comfortable as possible. Hindsight is indeed, 20/20, but political hype and deliberate blindness is what will eventually destroy the health care system here.
woody
I’d only add that I’d want them to endure horrible, unending pain in the process and the knowledge that, like the soldier in “Johnny Got His Gun,” there was nothing they could do…
bago
They do right now. Life in a city is in fact an emergent condition built upon engineering. Too many people on K street are too insulated from reality by the engineers that do their job sans fellation.
Morbo
@Belafon (formerly anonevent): If that’s what they reported then they were blatantly lying. It seems she lost her disability benefits because the insurance company found pictures of her on Facebook looking happy. She was on leave for major depression. Ergo she’s no longer depressed, ready to work, no more benefits. That’s a Frist-like diagnosis right there, pricks.
Some Fox local affiliates actually have decent news programs…
Van
Theres two different issues in this story. One is the use of too many specialists for hospitalized patients, the other is the waste of resources on end of life care. As a dialysis nurse I see this all the time. We have people on dialysis who have terminal cancer, alzheimer’s, and people with multiple medical problems in their 80s or even 90s. Americans have an unrealistic understanding of what modern medicine can do. Doctors often talk with patients and their families about stopping treatment( except for comfort care), some are receptive but many are not. My parents are elderly, and I realize it’s a tricky issue but sometimes it’s so obvious that its hopeless, yet the family or patient insists that everything be done. The liberal blogosphere doesn’t always help this issue with their stories about the evil insurance companies denying care. While some cases thats true, other times it seems more likely that doctors want to stop treatment because things are hopeless.
Nicole
@Leelee for Obama: Leelee, thanks for sharing. I cried over the piece, too. I’ve lost two family members to breast cancer- my mom, in 1982, and my aunt (not related), last year. In both cases, Hospice was involved, and, while I wish there were things that were handled differently by the family in regards to me and my brother when my mom died (but we were little; I know they tried the best they could), I am aware, for the other family members, what a difference acknowledging the end and preparing for it, made for the people left behind, and, certainly for my aunt, in her last months. One of the Hospice workers who worked with my mom is still a family friend and came to my wedding, almost 25 years later.
We are all going to die, and it’s so upsetting that our absolute terror about it not only wastes so much money, but that that waste of money in attempts to squeeze a few more beats from a dying heart, I think also can also cause a lot of regret later- so much energy is spent on the assorted crises of the body, (when in fact it’s just the normal process of death), that not enough is spent on just being with the person who will be going. One of the last things my aunt said to me, laughingly, was how her Hospice worker teased her about all the people that were showing up to see my aunt one last time. “This is so unusual,” the worker said. “Most times they don’t all show up until after you’re gone.” The willingness to treat end of life as normal took away some of the fear, and reminded my aunt of how beloved she was by so many people. I hope we all are so lucky at the end of our time.
Sam Hutcheson
I think the most telling thing about this is that the first advertisement in the 60 Minutes story is for Viagra.
Ella in NM
I’m just starting my second career as a nurse in a long term acute care hospital, and we see lots of very expensive cases, some of which don’t make it. But part of why our hospital decides to work with them is that we decide from the start that they will live, and will benefit from our care, and will make it home in about 30 days. Some don’t, and they die, which may seem like a waste of time or money in hindsight, but the truth is there was hope for these cases. The care they received was reasonable, and were things in this country fixed, could have been far less expensive.
Yes, we do need to have a national discussion about issues such as end of life care and it’s costs–but not just to get people to pull the plug. It’s the discussion about why in God’s name we have decided that health care should be a free-market, corporate dominated capitalist commodity.
Every single machine, medicine, piece of tape or tubing I use for a patient had a cost to my hospital that included a gigantic profit markup. It foots the bill for 7 figure CEO compensation, luxury yacht parties, stockholder earnings. We pay it, and merely pass it on to the patients or the taxpayers. Every time you go to a doctor’s office and they check your urine or blood sugar or take your blood pressure, the markup on those supplies increases that doctor’s overhead costs and there for your bill. Even the fact that health care professionals must take out enormous student loan debt to finance their education contributes to your office visit fees. I myself HAVE to earn a certain amount over the next few years to pay off my debt, so that cost will be part of what I demand in salary from every place I work. And it goes on and on and on.
When we allowed health care to be just another part of the US free-market economy, we doomed ourselves to this nightmare that is the American health care system.
D-Chance.
Everyone wants to go to Heaven, but nobody wants to die.
D-Chance.
BTW, in the first minute of that embed… they actually aired a Viagra commercial with the obligatory attractive older white guy and his smiling older honey during a deathbed report?
You wanna know what’s wrong with health care?
At least, it wasn’t Smiling Bob and that incessant whistling…
Leelee for Obama
@Ella in NM: Ella, you are of course right about the costs being driven by salary, equipment and supplies. I understand that you will treat someone you think will survive. I think the issue has to become, what will that survival look like? What kind of care will it entail? Who is going to provide the care? How will it be paid for?
We need more tuition assistance, not loans, for health care professionals. We need education about how the last year or two is going to proceed. We need politicians, who are ultimately making the decisions about insurance, and Medicare and Medicaid, to stop making this issue of health care simply a zero-sum game of Dems lose when Repubs win, or vice-versa. These are lives, real peoples lives. The agony I went through for the month Mom spent in a hospital last year has damaged me profoundly. I will never be the same. It is no one’s fault, it is everyone’s fault. The only solution I was offered was rehabilitation, which was really short-term nursing home care, that Medicare would have paid for for a month, or three. I was told by one doc, she would die very quickly there and that was not an option for me. The sadness of watching her decide somewhere inside her head to lie down and start to die was compounded by the muddled memories she had of other people who had let her down. While I did not, I was the one who was there, and so I bore the brunt of the anger. If there had been other options I could have taken, I would have. But that didn’t happen.
Liz
I watched part of it, and believe it should be required watching for everyone facing these issues (ie,e a lot of us). I loved the part where the doctor said something to the effect that “we all die, and we just have to face it.” Bless him.
Ben
We should stop calling them the Republicans or the GOP and call them the Grand ole Archie Fucking Bunker Party… their outlook on things very closely mirrors the poor old ignorant sob Bunker.
Brachiator
@Van:
I only paid half attention to the 60 Minutes story (more interested in James Cameron and Avatar), but will come back to it.
What turned me off about the piece was that it too easily assumed that it is always a slam dunk to know when “life care” becomes “end of life care.” I found a program segment particularly uninformative when it mentioned a survey in which a majority of people said that they wanted to die at home. Just too many variables jammed into this question and response.
The other thing that bothers me is the (can’t help it) slippery slope leading to the idea that at some point, the elderly in particular have a duty to die so that aggregate health care dollars are not “wasted” because magically somehow everything that is spent on health care belongs to the general public.
This is not the same thing as the simplistic and noxious scare attempts about death panels. On the other hand, I don’t think the question of what is a meaningful life, especially one assisted by machinery and drugs, allows as easy a conclusion about “end of life care” as the 60 Minutes piece suggests, especially when the patients are still mentally alert.
Elie
Ella Esther and LeeLee
Both of you are of course correct about the costs of the equipment, services etc.
Our country allows people to make profits off of health care services and products. We have a country driven by the need to generate wealth — at least for a few. If the folks that are generating high incomes and wealth for themselves off of this were not doing it on this stuff, they would have to find another way to make those profits. Our healthcare is 17% of GNP because we support so many people generating incomes. Those people will have to find another way to do it. And that is the rub..
Americans have not been producing innovation and wealth from that innovation for a while now. Our financial products were our last effort and we see what happened there. As the costs of healthcare go down, there will have to be reigned in income and wealth generation in this sector. This explains the terror of the insurance and health care products sector…
Big changes ahead for this country. Big hard changes and a lot of unhappy people looking for work.
monkeyboy
One issue a TV program like this CAN NOT address is the problem of religious patients and families who believe in prayer and miracles.
When the family huddled around the sick bed praying for God to step in cure the patient , maybe the reason he hasn’t yet is because they have not prayed long enough for him to hear, and every extra minute of life is an opportunity for Holy intervention.
(While according to the Bible, God or Jesus can resurrect people from death, most families give up hope after the moment of death).
Brachiator
@Ella in NM:
So, here’s a hard-headed question (and I am in favor of health care reform). Are you against a reasonable profit, or against all profit at all? And under any system, private insurance, single payer, whatever, what amount would you permit for research and development, innovation, improvement of supplies and equipment? Or do we go with whatever we have now, and assume that it is adequate now and forever, and spend every dollar for patient care?
Are you saying that your education should be free? How about teachers, as well? How about anyone who goes into a public service job? If we subsidize your education, can we then also set your salary at a fixed level? Can we specify where you can work (e.g., under-served rural or inner city neighborhoods)?
kay
The way to start a discussion is to start one. We don’t need Republican’s permission to have a debate. They and their media parrots, have, once again, run from the room, screaming, but we can go on without them.
I’m pretty sure they’ve lost interest anyway, and are chasing Sarah Palin, so maybe we can get something going while they’re waiting for an autograph.
I’m really grateful that a lot of reasonable people, maybe even a majority, are willing to try.
Evinfuilt
The French yet again get it right.
They pay for the Doctors training, then pay the doctor to work at their hospital. The Doctor by working there for many years has paid off his/her “debt”.
No shortages of doctors, no doctors drowning in a mortgage sized debt from school.
Leelee for Obama
@Brachiator: In a world that allows such a thing as health, death or not dying to be a profit-center, then you are right Brachiator. The costs should cover all the expenses and the devil with folks who can’t afford it. Maybe a charity or government program will take care of them, maybe not. The market is working, and that’s what counts.
If you’re selling widgets, that’s fine. If your calling yourself a healer, a curer of ills, then it’s not. If we help people attend school, then, yes, we get to assign them for a few years. It’s not gonna be a tragic situation, and they might just learn something. If we’re going to allow the market, set up as it is now, to rule health care, then there will be far fewer Americans to complain about it in the future, cause they’ll be dead.
Leelee for Obama
@Evinfuilt:
This.
Nicole
@Brachiator: Worthwhile points to bring up, but to some extent, the questions have been answered already. My sister-in-law is a midwife- her tuition was paid for, in return she is working the first five years of her career in inner-city clinics for a very small salary. After 5 years, she can work where she pleases, but for now she is paying back her tuition via work in areas that need it. I think more programs like this could work, and make med school more affordable to people with limited means who would like to be doctors. It might be a way to help address the shortage of GPs. At the end of service periods, doctors could elect to stay gov’t employees, or take the risk and go out on their own as a private practitioner.
Much research and development, especially in crucial early stages is already gov’t funded (private companies tend to step in in later stages, when profits actually become possible) so I don’t see that being an issue. Seeing as how some of the biggest pharma companies are European, again, I don’t think reform here will affect development of new techniques and drugs.
I’m all for people making a living; I am not all for insurance moguls becoming super-wealthy over limiting access to a necessity. We’d never think of letting access to water or food or electricity be run like we do access to health care.
Elie
Brachiator:
You ask hard but very fair questions and questions that we will see answered one way or the other over the next x years…
Of course, our country is nowhere near having an intelligent conversation about it with our media into celebrity and reality shows about rich people and the lifestyles of the rich and famous. Our polarized electorate, half believing that Elvis is alive and Palin is our next President are singularly incapable of doing much beyond drooling and hiding their heads in confusion …
We have to slow and reorient the freight train of our former grandeur and try to focus on how to pull it back into reality with as little pain as possible ( pretty impossible)… Of course, we all behave as though this will effect someone else but not us…
Brachiator
@Leelee for Obama:
Funny. That’s not what I wrote at all. A lot of stuff that I read about the desire for universal health care assumes that almost all available dollars will be spent for patient care. There is also the weird American assumption that at some level medical equipment and supplies are Frankenstein like excessive devices. And one point in the past, dialysis machines were huge, cumbersome and so expensive that they were rationed. Pacemakers were a gleam in some inventor’s eye. I ask very simply how improvement and innovation should happen under any universal care system. This is a long way from consigning people to a charity ward.
Also, markets exist whether you want them are not because resources (health care to housing) are scarce and have to be allocated. A universal health care system does not magically become an endless cornucopia of delights.
Again, why stop at doctors? Why not teachers as well? And why not set their salaries for their entire professional careers? And why not make them work where we want them to work, not just for a few years, but for their entire lives?
I noted before that I am in favor of health care reform. But issues of cost, efficiency, innovation, research and development, don’t go away just because you adopt a universal care system. It has to be part of the debate.
The French indeed appear to have one of the best health care systems overall.
But the French also have to deal with the prospect of massive health care worker strikes. And the primary state insurer has been running a deficit since 1989, according to one recent story:
The French medical establishment reacted with criminal slowness to a 2003 heat wave that resulted in the deaths of over 12,000 mostly elderly people:
The French also appear to abuse their health care by over-indulging in second opinions and prescription drugs.
For a time some praised the Canadian system, others the UK NHS, and now the French system seems to be the most admired model. I think that all are probably superior to the private system that we now have, but none are so perfect that they should be slavishly followed.
gwangung
I don’t know why this is so hard for people to get (more so on the right than on the left, granted, but…). There are real world experiences. In many of them, they work out better than here. Why aren’t we adopting the ones that seem to work the best and adapt them–because what we have is demonstrably worse (I mean, jeez, folks–costs are going up in other systems…BUT OURS ARE GOING UP AT A HIGHER RATE!!! It aint even math, folks….)
Leelee for Obama
@Brachiator: Maybe I’m misunderstanding you. I readily admit that health care will never be cheap, nor do I think medical equipment is Frankenstein come to life. I’m trying to thread a needle between people making a living, and people, literally, making a killing. The machines were developed, very likely, with research money provided by taxes. Likewise, pharmaceuticals. Why are these things not factored into cost for Americans? Why does every other country, for the most part, negotiate? How many times must Americans pay something toward these costs? I don’t think any one country has the perfect answer, but a reasonable combination of what seems to work best makes all kinds of sense. I also think the idea of helping people go to school, in exchange for a few years of Public Service also makes some kind of sense. It would also begin to addrees the ridiculous personal debt ratios this country takes as a given.
This is what leads me to agree with Bruce Bartlett. Time for a VAT. He explains it somewhat in a Forbes article linked by someone here. A VAT would be indexed to address regressive problems, be more funded by folks with more money by dint of their buying more things, and can be handled in a way that doesn’t impose a protectionist label on the US.
We need to address this mess. I don’t even care about me anymore, if I ever did. I have Grandchildren that are in distress now, I can’t imagine what another 20 years of this head-in-the-sand BS will bring.
If I have misinterpreted you, I’m sorry. It seemed you were defending the status quo, and I’m, admittedly, a bit sensitive.
Brachiator
@Nicole:
This sounds very interesting and worthwhile. Does this program also apply to occupations such as physician-assistants? I’m all for programs that send medical people to needed areas in return for tuition assistance.
This is true, but I’m not sure how much goes into general medical equipment and supplies. By the way, I’m not entirely happy with how private firms make deals in which they benefit hugely from government funding, but this is too deep water for wading in here.
This is actually a potential problem, since it may remove these companies from US regulatory controls.
Uh, actually, I don’t think we have tight regulation of food markets. I agree with you about water and electricity, but here in Southern California, the Metropolitan Water District is trying to raise rates and boost salary and pension payouts to outrageous levels, while insisting on water rationing.
Elie — You ask hard but very fair questions and questions that we will see answered one way or the other over the next x years…
I certainly hope so. But I wish that more real discussion had taken place earlier. Maybe the Democratic health care plan would have been stronger, more defined, and less vulnerable to GOP sniping. Wishful thinking, perhaps.
Elie
Brachiator:
This
“I noted before that I am in favor of health care reform. But issues of cost, efficiency, innovation, research and development, don’t go away just because you adopt a universal care system. It has to be part of the debate.”
Could not have said it better.
We of course must retain our ideals. That said, we had better design with reality in mind and reality has costs and benefits. People’s lives will be shaped by these decisions and the decisions are not just the fate of those being treated, but livelihoods and impacts on our overall economic and political environment. If you are going to move from the location that you live now, it helps to know where you want to be at the end of the move, but you have to do all the steps in between from packing to buying and making a decision about the trade offs you can live with and without in your new place. You should still move though.
I am thrilled that we are traveling this road, but make no mistake, we had better be ready for all the challenges of it as well as the exhiliration of doing what is right and necessary for a long long time. Maybe this whole process will also help us to take on other difficult things — once we get used to doing that…
liberal
John Cole wrote,
Honestly, while I think Republicans are total scum, there ar many people who are crazy on these issues. Many, many people of all political persuasions actually believe that more tests are always better. And plenty of stupid/greedy doctors believe that, too. In some of the coverage of the mammogram freakout, prominent radiologists were quoted as coming down against the new breast cancer guidelines. (Jeez, I wonder why that would be?)
At a more general level, there are plenty of people—including my own blessed ilk, single-payor advocates—who think all decisions should be between a patient and her doctor. That’s just nuts; neither patients nor doctors are capable or have an interest in rational, evidence-based medicine.
Elie
Brachiator:
You said:
But I wish that more real discussion had taken place earlier. Maybe the Democratic health care plan would have been stronger, more defined, and less vulnerable to GOP sniping. Wishful thinking, perhaps.
My thoughts:
No way to do this. Old saying: Not all parts of the wheel hit the ground at the same time. Issues have their own evolution and speed to certain awareness…It is going to take some time for all the impacts to diffuse through the population and economy. Having that detail up front or the deeper debate would make it less likely to pass in my opinion, not more. Things this complex have to fit in their own time frame of evolving learning… Sometimes just going forward as fast and light as possible is the best you can do if you want to get it done…
liberal
@Van:
My favorite example of this is that experimental chemo treatment for certain breast cancers—IIRC it was to use bone marrow transplants (probably from the patient to herself post-chemo) after giving her a shit-ton of chemo.
Very expensive, often much more painful than conventional chemo.
Insurance companies didn’t want to pay for it because they said it was experimental.
Turns out that they were right; large studies showed no benefit over more conventional therapy. But some of the pr*ck doctors wanted to continue with it anyway.
liberal
@Ella in NM:
But that’s the problem. No matter how much you squeeze the fat out of things (which is what your comment went on to focus on), if you use vague measures like “hope,” then you’re going to end up spending all the nation’s economic resources.
Not that the excess costs shouldn’t be squeezed out.
liberal
@Brachiator:
Mostly agree.
The problem isn’t really “profit.” The problem is “[economic] rent.”
liberal
@Leelee for Obama:
But in terms of excess costs, the problem is that the “market” is NOT working—putting aside the problem of some people not getting enough medical care. The market will never work, actually. And by that I mean health care itself, not just insurance. You could have a single payor system, and providers (doctors et al.) would still have incentives—mostly financial, but also professional—to overtreat. AFAICT there’s no way to avoid massive market failure for this and many other reasons (mostly information problems).
If you’re a hammer, everything looks like a nail…
liberal
@Brachiator:
But the key here is to distinguish true scarcity from imposed scarcity. Latter gives way to rent collection. Cf the patent system for drugs and medical devices, and the physicians union (aka “the AMA”) which is hellbent on preserving the way doctors fit into the industrial organization of medicine. (IMHO, the physician system is pretty much a medieval guild system, and absurdly inefficient.)
Leelee for Obama
@liberal: I was being facetious, badly, apparently. My point is that there should be some things, like health, death and not dying, that are not handled in a free-market model. Not even addressing the fact that our markets are not free anyway, but rigged, for the most part in favor of the business, not the consumer. You cannot negotiate when you are sick, or in an emergency room. The government is prohibited from negotiating for prescription drugs for Medicare, you can’t really negotiate for your choice of physician with many insurance plans. I have to get my electricity from FPL, the gasoline I buy is the same price almost everywhere nearby, they gouge you at the pump near the airports, I can buy expensive produce almost anywhere near me-even though it likely grew in soil not far from where I live, and the local milk busunesses charge an extra dollar over what the store brand is, and who the hell knows where that comes from.
Free market my left ear.
BTW- what is AFAICT an acronym for?
Nicole
@Brachiator: I don’t know whether the program my SIL went through applies to physician-assistants. I see no reason why one couldn’t be developed, though. Especially with the extreme need for more GPs.
My point with food, water and electricity is that none of these industries are run under a system where you pay money to an entity that does not provide any of these services, regardless of whether you need them at that moment, and then, upon such time as you need them, said separate private entity decides whether they will cover the cost for them. The purpose of insurance is for a lot of people to pay a small amount of money regularly in order that, if something that is statistically not likely to happen, happens, one individual does not pay out a huge amount of money- all are protected against unlikely occurrences. Health care is a necessity. And the kinds of things emergency rooms are supposed to deal with- accidents, sudden heart attacks, etc., are the sort of things that would make the most sense to cover under insurance, since they aren’t as likely to happen. But they end up the only option for uninsured. And to cover general care, flu shots, checkups, etc. under a system that only profits if it tells you, “no” makes no sense.
Brachiator
@liberal:
RE: Are you against a reasonable profit, or against all profit at all? And under any system, private insurance, single payer, whatever, what amount would you permit for research and development, innovation, improvement of supplies and equipment?…
OK. I’ve seen you discuss this before. I hear where you’re coming from, but don’t quite see how considering this turns into a health care reform solution.
OK. My main point was that some people appear to think that a government plan, especially single payer would do away with all scarcity, which they see as almost purely a function of the existence of profit. But also I think that even after you deal with imposed scarcity, true scarcity is a bear to consider.
And again, how do you turn this into effective policy? For example, I agree with you that “the physician system is pretty much a medieval guild system, and absurdly inefficient,” but how would you get adequate numbers of qualified medical personnel into a system that you would like to see.
Leelee for Obama – My point is that there should be some things, like health, death and not dying, that are not handled in a free-market model.
I know that this is a kind of conventional wisdom of the left, but the problem is that just declaring that the free-market model should not be applied does not mean that a market will not emerge anyway. For example, Britain’s National Health System trains doctors, employs them and decides their salaries. You still end up with doctor (and especially dentist) shortages, grumblings and strikes over wages, and weird stuff (resulting from European Union rules over the hours that a doctor is allowed to work) that ends up with all kinds of problems and no increase in the quality of patient care.
I’m not defending the status quo, but I think that some proposed solutions may be as bad as the current system, or simply push the problem forward without really solving it (and by the way, I don’t see a VAT as any kind of solution to the health care issue).
Jager
Everyone should have a living will. My Mom lived long enough to see more than a few friends and family die on machines. She had a living will written and always emphasized no extraordinary care. She walked into the hospital on a Thursday evening and died the following Monday. The old girl gave us enough time to gather as a family. While she was drifting in and out, we all had a moment or two with her and we (and she) were spared the machines, the ICU and the dragging out of the inevitable. We were able to share our Mother’s last days and she was cognizant of our being with her…it was a good way for her to go and a good way for us to say goodbye.
gnomedad
@Leelee for Obama:
As Far As I Can Tell.
Leelee for Obama
@gnomedad: Thanks, gnomedad.