Health Care Policy

[frankj]

Interesting chart referenced by lisabob. And I am in debt to her for allowing me to debate based on "gut feelings," although I suspect that my gut feelings would be acceptable to her if they agreed with her opinions.

 

A couple of comments on the comparision. Most of the other countries cover "citizens and legal aliens," implying some limit on who is covered. The info on the US simply says 100% of people over 65 and, I think it was 82% of people under 65. How are illegal aliens to be handled under a universal system in this country, given that there are a lot of them?

 

A friend of our family, lives in England, is himself a doctor, had a heart problem that ran in his family -- in his late 40's this condition began to act up, seriously. The socialized system told him to wait his turn, fortunately for him and his family, he had the means to get the treatment he needed, privately and he is still alive.

 

So to you socialists and universalists out there, by all means, bring on universal health care, just make sure you squirrel away enough cash to take care of your own, or your families, emergencies.

[frankj]

Scrooge's words from the posting by lisabob: "...decrease the surplus population ..." And lisabob's closing comment: "I don't think anybody could get this much clearer than Charles Dickens did."

 

There IS someone who can get it much clearer -- and she has the power to institute controls on the surplus population, Nancy Pelosi. She believes more money thrown at abortion clinics will help the government cut costs. If this is what increased government involvement in health care is going to become, then we baby boomers better redouble our efforts to locate the Fountain of Youth, because the system will discover that the cost of an individual's health care really spikes in the last year of life, and then we will be in the crosshairs of Nurse Nancy's policy initiatives.

 

Soylent Green, anyone?

 

[OldGreyEagle]

Nancy Pelosis only wants to serve mankind, wasn't that a Twilight Zone episode, the book to serve mankind was actually a cookbook?

 

Anyway, humor aside, how ols is Nancy anyway? She may not have to worry about Medicare, but her family and friends will

[TheScout]

Great point!

 

Why are some only worried about the health of a person outside of the womb. A bit hypocritical for those who whine so about health care to also be an accomplice the killing of so many millions.

[Beavah]

Yah, apparently no better ideas from da scouter community than from da pols, and no less partisan bickering either!

 

Some aspects of medicine are like commercial markets, eh? Private pursuit increases innovation. Just look at cosmetic surgery . Some other aspects of medicine show da greedy downsides of markets. Just look at how big pharma as quashed small, innovative companies while producin' nothing themselves. A big piece of medicine are folks who are mission-driven, and supported by charitable and government grants. That's where most of da fundamental research happens, eh? I reckon the advocates of personal responsibility would be very upset if they were denied the new-fangled treatment that came out of NIH-funded research.

 

At da core, the problem is that medical care is a limited resource, eh? Whether by rationing or raw dollars, there's always goin' to be a resource allocation problem and some horror stories.

 

In terms of resource allocation, it occurs to me that Medicare subsidizes entirely the wrong group. Folks in retirement should have to pay for their own care, eh? They've had an entire life to plan for it, and subsidizin' their care is a drain on society, rather than an investment. Personal responsibility all da way. We waste a lot of dollars on folks my age who are "walking wounded."

 

Where we should be subsidizin' care is for kids. That's a good long-term societal investment, eh? Plus, as a Christian, I can't really see denying a child care because his parents were stupid, or drunk, or just poor. That's not encouragin' responsibility, it's just mean.

 

We'd never get it passed, though. Too many of us old folks are wedded to our entitlements or have become so irreligious that they're afraid of goin' home. We'd rather impoverish our grandkids in exchange for a few more years of bein' flogged by docs.

 

B

 

[scoutldr]

"Plus, as a Christian, I can't really see denying a child care because his parents were stupid, or drunk, or just poor."

 

I don't think anyone of either party has advocated denying care to children. Anyone can stroke a check to the charity or poor family of their choice. Why does the Govt need to be involved, involuntarily seizing the assets of some and giving it to others? If Christians want to be charitable, there's nothing stopping them. How about the Catholic Church, for example...they can set up group health insurance and clinics...heck my wife graduated from a Catholic hospital nursing school run by Nurse-Nuns, which has since closed its doors....why does it have to come from Washington or employers? Let's think outside the box here.

[TheScout]

Well the federal government should do it because they are always so good at doing stuff.

[vol_scouter]

Beavah,

 

I am sorry that you found no new ideas in my lengthy posts. The problem with the drug innovation has to do with the short time a drug can be sold prior to patents expiring. The democrats have tried to destroy small businesses in favor of large businesses which is much of the same issues for the drug companies that find that they must get bigger in the false market.

 

As I noted, the options for care should be limited by society and physicians. We need to decrease interference from the government making more rules that either produce the opposite effect or have an unpredicted negative effect. A more free market approach can start to bring in competition and will control prices.

 

Other things to decrease costs are to bring back wards of 20-30 beds each that provides more efficient nursing care with fewer nurses.

 

I agree that children deserve care. However, society needs to discuss how aggressive the care should be for severely retarded children who will likely be institutionalized for their entire adult life. I am not saying to with hold care but to with hold more invasive and aggressive care.

 

I think that the issue is that the answers are not what people want to hear. The government is the problem that I live daily and it is certainly not the answer.

[OldGreyEagle]

So Vol_scouter, when you say withhold more invasive and agressive treatment, you mean you want to determine who lives and dies, if not you, someone else, the state perhaps?

 

I really don't think so, but that could be interpretted as the direction your thought could lead us.

 

Wonder why that Catholic Hospital is out of business? All that free care and care to the indigent does eventually cost something. It's funny how Medicare and Medicaid and Insurance Companies can tell Hospitals what to accpet as payment for services, but those darn supply companies and employees need real money

[vol_scouter]

OldGreyEagle,

 

In a sense, that is what I am saying. It happens every day now. If you are too old and sick, you cannot have dialysis started because no one will pay (except for the very few wealthy enough to afford years of dialysis). Those patients die. IV drug abusers often get a condition called bacterial endocarditis on one (usually) or more heart valves. The infection can lead to the need for the replacement of the valve. They will have their valve. However, if the valve gets infected months to years later, the patient will typically not be offered a second valve. Those patients will eventually die though expensive antibiotics will keep them alive for sometimes a long time. There are now laws at least in my state that allow physicians with considerable review to declare treatment to be medically futile and withdraw treatment even if the family is opposed.

 

I have found that what I do to patients in not ultimately in their best interests but I am forced to provide care that is uncomfortable or worse to a patient whom I know will have a poor outcome. There are worse things than death. I do not want to play G_d but physicians already are placed in a role to make decisions about life and death. I recently cared for a 93 year demented patient whose family member wished her to be resuscitated even though I explained to her on several occasions that if that should occur, the patient would ultimately have a poor outcome. In my experience, this is not moral. It would also result in significant costs. Americans wish to have every intervention performed but to pay little or nothing for the care. Society with physician input needs to determine what is to be paid and then pay the actual costs with a reasonable profit. If the health care system is under the free market, the patients and their families will make most of these decisions. If we are socialized, the decision will be made by partisan bureaucrats who may have little experience.

[Beavah]

The problem with the drug innovation has to do with the short time a drug can be sold prior to patents expiring. The democrats have tried to destroy small businesses in favor of large businesses which is much of the same issues for the drug companies that find that they must get bigger in the false market.

 

Nah, gotta disagree here, knowin' some good folks in the business. Patent length is just fine, and we don't want to be givin' anybody a government-protected monopoly like that for too long, eh? It's the government's interference through the patent system which is da problem, not the solution, along with greed. Pick a big pharma company, and then identify one current drug they've made themselves. Yeh can't do it. All these guys do is buy out and destroy smaller firms who really are innovating, just in order to get the government-protected patent monopoly on individual drugs. Never to encourage more innovation. Lengthening patents would make it worse. Better to make patents non-transferable. Only the company that innovated gets monopoly protection to encourage further innovation. Otherwise it's a free market with no government interference in da form of patent protection triggerin' greed.

 

Agree with yeh on the other, though. The costs of flogging patients with poor prognoses just because their families can't deal with da loss is phenomenal. Emotionally painful for health care workers too, eh? There needs to be some mechanism to curtail that. I don't know if cost alone (like eliminatin' Medicare) would do it or not, since it's so emotional a decision. Don't want it entirely on da docs either. Should be some sort of combination in a way that limits physician/hospital liability exposure.

 

Just speculatin'.

 

Somethin' similar might be done for frequent abusers of emergency services.

 

B

 

[scoutldr]

One thing I think needs to be done is to ban pharmceutical advertising of prescription drugs, except to the medical profession. That would free up millions (if not billions) of dollars which could then go to reduced costs to the patient or more R&D. "Ask your Doctor if Levitra is right for you!" BS. Tell you Doc your problem, and let him prescribe. A lot of Docs will prescribe just to make the patient satisfied, whether medically indicated or not (sorry, vol). In Public Heath grad school we learned about a study about health beliefs...a patient's satisfaction after a Doctor visit directly correlates with the number of scrips they walk out with. Another, more recent study showed that not only do placebos make a pt feel better, but the more expensive the placebo, the better they feel. It's human psyche we're battling here. A relative of mine is a good example...she's terminal with advanced COPD, chronic diverticulitis, bronchitis, diabetes, O2 24/7, etc brought on by 60+ years of smoking. But she wants to live forever, no matter what it costs the taxpayers (currently about 10K per month from Medicare, plus 3-4 hospitalizations per year)...but when they charge her a co-pay for drugs she protests mightily how unfair it is, even though she never worked and never paid a dime into the system! She's ENTITLED!

[vol_scouter]

Beavah,

 

I am not certain that you assertion though the major pharmaceutical companies have developed no new drugs is correct. My understanding is different. However, you are entirely correct that major companies buy up smaller ones for a good product. I do not agree on the patent issue. If you and I patent a new gadget to sell we will patent it, do some safety testing, some marketing research, manufacture it, and then sell the gadget. So we will have a few years between development and selling the product. That gives us many years to re-coup our initial investment. The pharmaceutical industry has those same steps plus the clinical trials that are required by the FDA prior to selling the drug. The first trials can lead to further trials while the patent clock ticks. When finally OK'ed, they have a shortened period in which to re-coup their costs. Furthermore, drugs not uncommonly fail during clinical trials which leaves the company with enormous costs for each product actually brought to market. So if the total accumulated costs for the next product brought to market is X then those costs will typically be re-couped over the years on patent - Y or X/Y. Obviously, the cost to the consumer will be less if Y is larger rather than smaller. I am just suggesting to not assess the time in clinical trials (the time is largely controlled by the FDA) against the patent time. This would decrease the consumer cost.

 

I do not see the pharmaceutical companies as the 'good' guys but they do not deserve the demonization that they have endured. They all try to develop high paying drugs which means a large number of patients such as hypertension and diabetes. Antibiotics and drugs for uncommon diseases are low priority partly due to the patent issues noted above. They are companies trying to make a profit on what they do. Laws affect what they try to develop and market as well as the costs.

 

Some sort of protection to physicians and hospitals to make hard decisions would help to reduce costs. Changing medicare to an indemnity plan where the patient and family know how much they have to cover the surgery/ICU stay/procedure/medical equipment with the remainder to be paid by the patient. That accomplishes what you are discussing without going to the extreme of no coverage.

 

Physicians are spending tens if not hundreds of billions of dollars to show what that know in case of a lawsuit. This needs to be reformed while still protecting the ability of a patient injured from negligence to sue. An example, a patient presents with symptoms of a stroke. In the ER, a non-contrast CT of the head will be done. If there is no bleed, the patient has had an ischemic stroke. The patient will subsequently have an MRI to confirm the stroke. The MRI will only rarely change the management of the stroke but does prove that the stroke occurred. Each MRI is ~$1-2,000.00 so that the extra cost is to protect from concerned that a rare condition would be found that would change the diagnosis and/or treatment. The most likely finding that would change the diagnosis is a tumor in the brain which will cause subsequent problems. Often though not always, when the brain tumor is a metastasis from a primary elsewhere, the delay in diagnosis will not change the eventual outcome. Thus, we spend enormous amounts of money to look for conditions that may not be substantially effected by a delay in diagnosis. If a brain met is not found because it was not looked for will be hard to explain to a jury. Thus, physicians will not take that risk. There must be a happy medium.

[OldGreyEagle]

Sorry, somehow I missed you are a physician, which explains a lot.

 

Having physicians run healthcare is truly letting the inmates run the asylum (no specific offense intended, just in a general sense)

[vol_scouter]

scoutldr,

 

I absolutely agree that there is a bias toward doing something rather than not. A patient who presents with a viral upper respiratory will be unhappy to be told that it will run its' course. Most cannot understand that giving them antibiotics will not help them and can lead to more resistant organisms. So physicians will tend to satisfy their patients. That is not good but the level of science education in this country is abysmal at best but that is a whole thread of its own.

 

OGE,

 

I have not argued for physicians to run health care but often practicing physicians are not allowed input which is just as insane. As to my personal biases, please gather that I am leaving medicine (12 years early due to the increasing difficulty in caring for my patients - I have had a distinguished career in medicine) next month and will be only a consumer of medical services as are you. We all have bias and I did make mine clear early in the thread. However, the coming changes will not affect my daily life or income. Hopefully, I am somewhat objective but also informed in some ways that others are not. It is sad what is going to happen to the quality of our medical care.