A difficult dission. Please, kindly, proceed with caution.

[justamouse]

So, are you saying that these methods of intervention are NOT gifts from God and not there for our benefit?

 

And where does that idea fall within a person refusing treatment becuase they believe medicine is evil and God will heal them? (I know that fight personally, I watched the mother of my best friend chose no treatment for VERY treatable breast cancer and die (God was going to cure her), leaving her daughter and grandchildren scarred for life.)

 

The other side is that a person's life is worth no value anymore and so we should stop treating them.

 

My favourite one this week was the idea that Stephen Hawking would not have been considered worth treating under the NHS, whereas of course he actually lives in the UK and had extensive treatment for a chest infection this year.

 

Laura

 

 

Yep. Perfect example. Lets just tell him that he's not worth saving anymore. *eyeroll*

 

You fight until the family/person doesn't want to fight anymore.

 

These supposed death panels? Please.

 

My dad has diabetes. Not from being overweight-the other one. He, eventually WILL die from complications of the diabetes. And you know what? I want him counseled. And the every 5 years is an OPTION, not mandated, but there especially for people like him who will probably fight some big fight for his life every few years. I don't want my mother, or my brother and I doing something for him that he doesn't want done, and that horrible time is not the time to be making such decisions.

 

My FIL has Alzheimers, and my MIL needs the counseling, too.

 

It's a personal decision, all the way around. Me? If my brain were active, and my body failing and if they could make me into the bionic woman? Sign me up.

[MistyJ]

When my father was in his last few weeks of life and in the hospital, he was tortured by the constant blood draws and procedures. I had a hard time communicating to my brother, a dr., who was long distance, how terrible it was.

 

I won the argument, and was able to get my father onto Hospice and back home, where he had a peaceful death.

 

Have that discussion with the elderly?infirm? Of course! And anyone who's been there with a very sick loved one knows it has to happen. I get so upset when I hear this being politicized.

 

It wasn't even a matter of saving healthcare costs. It was a matter of knowing when to stop and allow someone a peaceful death.

 

BTW, I am a pro-life Roman Catholic.

[Lovedtodeath]

 

I think that people who are disgusted with the current health insurance issues should band together and pool THEIR resources to address those concerns. i might even decide to join.

You mean like all of us get together for group insurance? Or something else?

[nova147]

 

The whole health insurance thing makes me sick. Anyone who is against a public option should be forced to deal with buying insurance for their family on the open market.

 

 

I do deal with buying insurance on the open market. It's awful, no doubt. But I am firmly against a public option. It's just not a reasonable solution to the problems we face. The problems in the insurance industry? Difficulty getting coverage with pre-exisiting conditions (tell me about that one - I have bipolar disorder and am obese), medical malpractice lawsuits, and cancellation of coverage are the biggest issues (at least as far as I can tell - I'm no expert on these things!). A public insurance option doesn't directly address any of them. In fact, Obama has called for all insurance companies to be required to offer coverage to anyone, regardless of pre-exisiting conditions and for it to be illegal to cancel coverage because of new diagnoses. No one, however, seems to be talking about medical malpractice lawsuits, which are a major factor in the rising costs of health care. The government is already too involved in my day to day life for my taste; I'm just not too keen on giving them any more power over me.

[BalanceSeeker]

The issue for me rests in the fact that this "line" is different for everyone. It is human nature to want to prolong life as long as possible. To part with another soul(s) is the biggest thing anyone ever has to do, IMO.

 

It costs money, a LOT of money, in the hopes that it'll be worth it. In my nursing practice, though, I find more often than not that families and patients instinctively know when it's time to stop fighting, and there is a peace when they decide it's time to stop. I can't fathom the idea of a faceless, heartless entity making that ever-so-intimate decision for us.

[Peela]

I just know I want to be able to make the decision myself, as long as I am able, and then I would like my nearest and dearest to make whatever decisions are necessary. I don't want government policy to dictate me how long they keep trying.

 

It is however my understanding that generally speaking (here in Australia) there is a fairly common sense approach to such things. We do have a fairly decent public health system- in fact there are many treatments that the public system has access to that the private doesnt. I have only been treated well and respectfully in the public system, wheras I constantly feel ripped off in the private.

 

There is a case in my city at the moment of a quadraplegic man begging to be allowed to die, and euthanasia is not legal here, however he has been granted permission by the courts to refuse to be fed (through his tube) and so to starve to death. He is apparently rethinking whether he wants to die.

Not to turn it into a debate about euthanasia, but I do think we should be given basic rights to refuse medicine/food.

[Carol in Cal.]

The problems in the insurance industry? Difficulty getting coverage with pre-exisiting conditions (tell me about that one - I have bipolar disorder and am obese), medical malpractice lawsuits, and cancellation of coverage are the biggest issues (at least as far as I can tell - I'm no expert on these things!). A public insurance option doesn't directly address any of them.

 

A guarenteed issue public option does address these.

 

In fact, Obama has called for all insurance companies to be required to offer coverage to anyone, regardless of pre-exisiting conditions and for it to be illegal to cancel coverage because of new diagnoses.

 

I have heard of no proposal that involves true shared risk in individual or small group policies. That is the big problem! If someone avoids a diagnosis because they are afraid their insurance will become unaffordable, that isn't really much better than it being cancelled.

[Stacy in NJ]

I've told this story before, but I have a friend who worked on cancer policy for the British government. She researched the number of 'lines' of treatment offered by different health systems all over the world. The US offered by far the most, but she had to wonder at what cost. By the time you have already tried so many kinds of treatment which have failed, the likelihood of success is vanishingly small. Of course, that 'case' is a real person with real loved ones. But at what point does continued treatment become an abuse rather than a blessing.

 

My father died of cancer. He had had a couple of standard treatments, then was part of an experimental study when the initial treatments started to fail. He had previously survived another cancer and a heart bypass. When the experimental treatment didn't work any longer, he decided that the time had come to stop.

 

Laura

 

I'm just going to point out again, as I did previously, that the 5 year cancer survival rate is between 14 and 19% higher in the US vs. the UK. It's even higher for prostrate and breast cancer, the two most common types of cancer.

 

Patients can choose to write a living will, deciding what type of extreme measures they want undertaken.

 

Also, something Canadians, Europeans and Britons might like to consider is the negative effect of an American nationalized healthcare system might have on their own systems. Currently the US is responsible for the research and development of the lions share of new medical technology and pharma. Our current system subsidizes this r&d via higher costs for services and Rx's, this is one of the reasons we spend a larger percent of GPD on medical services.

 

After Canada and Europe began restricting profits on pharma the number of new drugs developed in those countries dried up completely. If he US begins restricting profitability on pharma and medical technology, where will the new innovations be developed? We subsidized new drug and medical technology for you. What will you do when we no longer do it? I guess we had all better pray the Chinese are willing.

[Lovedtodeath]

 

I guess we had all better pray the Chinese are willing.

The Chinese figured it out long ago, but most people refuse to use their methods. In China it is common to use accupuncture instead of anesthesia for surgery. I wish that would happen here along with many other Eastern health methods.

[Stacy in NJ]

The Chinese figured it out long ago, but most people refuse to use their methods. In China it is common to use accupuncture instead of anesthesia for surgery. I wish that would happen here along with many other Eastern health methods.

 

I happen to know that in the state of NY accupunture is a covered expense via state mandate.

 

:001_smile:

[Lovedtodeath]

 

I happen to know that in the state of NY accupunture is a covered expense via state mandate. :001_smile:

Well that is a start! Many accupuncturists can use the energy channels to "diagnose" and find remedies (homeopathic, nutritional, herbal) that will work as well. It sure helped me after 7 years of medical doctors and prescriptions making me worse. Of course, I didn't stick with it because of insurance, etc... now I am back again.

[Impish]

As a Canadian, and someone that worked in the health care system, I can honestly say that if a Dr says a treatment happens, it happens. Period. If a family demands a Dr refer to a cardiologist, etc then it happens...even in cases when it shouldn't, say, for the woman with Alzheimer's. Sorry, but if you're not able to tell tea from your elbow, I don't think life saving measures, prolonging measures are applicable...but if family wants it, family gets it.

 

We don't have euthanasia here any more than the States does. What we do have, in some thankful cases, are Drs who have the grace, empathy, and sense God gave a turnip, who will gently counsel a family as to what is the humane option.

 

And that's just it. Humane. We're more humane to our animals than to people. If an beloved pet has terminal cancer, we say, "We did the humane thing, and put him to sleep." But here in Canada, its not an option. Just like in the States, you'll suffer to your last if you're terminal, with drugs that don't touch the pain.

 

Wish I had the option the Vet gives :glare:

[Lovedtodeath]

Wish I had the option the Vet gives :glare:

 

:grouphug::grouphug: Oh Hon, I hope you don't mean now!:grouphug::grouphug:

[Jen+4dc]

These are decisions for the individual, their family, and their physician. As a society we have no right to interject ourselves into these personnal choices. This is why a government funded and managed national healthcare program is a non-starter for me.

 

:iagree::iagree::iagree:

[Dianne-TX]

I think when someone has a strong desire to live they should be offered that opportunity. Life is so precious. I think it should be up to the individual whether or not they want to battle through one more round of chemo for a mere 6 months. As long as someone wants to live and there is hope, I think it should be granted.

 

:iagree:

[Dianne-TX]

I think this is an easy question, honestly. Everybody's opinion will be different. There will never be a consenses; no chart to look up on, oh yes, according to row e, column 6, this old guy is past the point of worth saving. So....we leave it to the individual and the family and his doctors. What's so hard about that? No insurance company, no government agency, no panel of objective judges. I think EVERY life is precious and only an individual and his/ her loved ones have the right to have a say in weather or not it's "worth" it to continue supporting that life.

 

:iagree:

[Tree House Academy]

My husband had a beloved dog once. The dog lived to be 17 years old and was my dhs best friend in the world. Butch was there when my dh's dad died in his arms (massive heart attack at the age of 51) which is part of what made him so special to my husband.

 

As Butch got older, he became arthritic. He started to cost more money for dh to keep him up. He ate special food, had to take expensive medicines to keep him out of pain, and made more than just the one trip a year to the vet. Then, about a year before he died, he ate a piece of bone in the yard. Normally, Butch wouldn't have had any problems - but in his age, he did. He vomited, wouldn't eat, and finally became so lethargic that I rushed him to the vet (dh was at work). Dh met me at the vet. They told us it would cost $1300 for a week of IVs and even then, they didn't know if the dog would live or die. We happily gave them the credit card. Butch lived another year. He fully recovered from that episode. My husband knew the end was drawing near, but he wanted Butch to have some time here on our farm (we were living in GA at the time of the incident) and he wanted him to be buried here. About 8 months after Butch got sick, we moved back here to the farm - and we also gave birth to my ds6. For 4 months, Butch went out in the mornings and spent his days in the sun under the apple trees. In the evenings, just as if he was punching a time clock, he would come wandering back down our driveway. Butch passed peacefully in our home on my husband's 36th birthday.

 

I fully and truly believe that Butch's entire life was just a GOD thing. God knew he was going to call dh's dad home. God sent dh a dog. Then, when Butch had grown old, and his time was almost up, God gave dh a child.

 

That was a DOG. I can not imagine doing less for a human. I guess we can all look at it and say, "well, YOUR mom was sick and it was good that she died - she is in a better place now." But it would be d*mn hard for me to say, "MY mom...." And I can say, beyond a shadow of a doubt that I don't want you, Barack Obama, some doctor I hardly know, or anyone else allowing someone I love to die of something that could have been regulated with medication and prolonged their life. Every.single.day is a gift from God.

Edited August 16, 2009 by Tree House Academy

[LizzyBee]

The Chinese figured it out long ago, but most people refuse to use their methods. In China it is common to use accupuncture instead of anesthesia for surgery. I wish that would happen here along with many other Eastern health methods.

 

My sister is having acupuncture for osteoporosis, and it's covered by BC/BS of MD because there is evidence that it works. My endocrinologist has said that as long as my BMD is stable, I don't have to take meds for osteoporosis, but the minute I go through menopause, I do need to go on meds. But my sister did the research and refuses to take the meds; she's doing acupuncture instead. I have no idea if BC/BS of NC will cover acupuncture for osteoporosis, but I might find out in a few years. I'll keep you posted. :D

[Audrey]

I think the individual should decide, but should always be able to have access to ALL the information they desire.

 

Someone mentioned someone having surgery at 102. If you've ever had quite elderly loved ones faced with surgery, one of the first things the doctors will tell you is that the advanced age extremely increased the chance of death during the procedure. The elderly often don't do well under anesthesia and are more susceptible to die in surgery. That's a fact. They don't deny you the surgery, but there are doctors who will say, "I don't want you to do this because the risks are way too high for you." If it were me going under the knife, I'd want to know my chances in advance.

 

I wonder sometimes about really little kids who get so sick. An acquaintance of ours lost her pre-teen daughter to a brain tumour. From the time it was diagnosed, it was deemed inoperable because of the tissue involvement, but they went through every treatment they could find to fight it for her. She was so sick. So miserable. She often asked them to stop, but still they wanted her to get the treatment. She died after a long, rough year. I mean, as a parent, I think I understand that side. I think I'd want my kid to get any and every treatment possible, but on the other hand, I wonder sometimes if it's just torture for the child, and if the chances are so high that they're likely to die anyway, is it a good thing to make them go through all of that? I don't really have any answers to that. I just wonder about it, though.

[katemary63]

Will our society get to a point where most of our bodies are either being manipulated by medication or simply replaced with artificial parts? When is enough, enough?

 

BTW: Please don't put a negative spin on "artificial parts." The improvement in quality of life for those with artificial joints is unfathomable! I should know. I had a total hip joint replacement at the age of 39, when my youngest was only 1 year old. I had limped for 10 years. I couldn't put it off any longer. Although I was happy, I suffered greatly. Now.....I ride horses and run a farm. I would be cripled if it weren't for those wonderful, beautiful titanium joints and the genius doctors who put them it! Thank you God!!!

 

I picture myself long into the future, when other joints have given out, but my brain is sharp and my heart is stong. I'll take them all, hips, ankles, knees! What ever you can give me to give me a better life and keep me going so I can spend my time lovin' on my Grandkids! I plan to live to 112 (I want to see the tricentenial!) and I'm gonna need medical intervention to be able to do it, I'm sure. But I'm up for it!

[Lovedtodeath]

BTW: Please don't put a negative spin on "artificial parts." The improvement in quality of life for those with artificial joints is unfathomable! I should know. I had a total hip joint replacement at the age of 39, when my youngest was only 1 year old. I had limped for 10 years. I couldn't put it off any longer. Although I was happy, I suffered greatly. Now.....I ride horses and run a farm. I would be cripled if it weren't for those wonderful, beautiful titanium joints and the genius doctors who put them it! Thank you God!!!

 

I picture myself long into the future, when other joints have given out, but my brain is sharp and my heart is stong. I'll take them all, hips, ankles, knees! What ever you can give me to give me a better life and keep me going so I can spend my time lovin' on my Grandkids! I plan to live to 112 (I want to see the tricentenial!) and I'm gonna need medical intervention to be able to do it, I'm sure. But I'm up for it!

The artificial joints are not prolonging your life, but rather, improving the quality.

[Reya]

>A public example was the story of the 95 y.o. woman who was denied a pace maker, then was given one. Was she on other medication? If so, where those medications keeping her alive?

 

If so, SO WHAT? "Oh, I'm sorry, we need medicine to keep you alive, so you should die?" "Hey, all you asthmatics out there--you shouldn't be alive once you get too old!"

 

The real reason to be hesitant about surgery for a 95-y-o is that risks rise with age and frailty. What if the operation killed her?

 

Now, I believe in not causing pain to people when there is no possibility of recovery and when they are unable to understand what is being done to them. So if I had a baby who with birth defects that were (eventually to be) fatal requiring serious AND CONTINUING painful treatments or is in continuous pain because of his/her condition who would never understand what was being done to her and why, I would choose to not do treatments that would add to his/her pain, even if they were life-extending. Likewise, if my parents become seriously demented and require continuing painful treatments to live or are in continuing serious pain, I would choose to forgo any painful treatments. In both cases, if they are in serious continuing pain, I would seriously consider a DNR order.

 

If a person is able to choose whether they want any particular intervention, then they should choose.

 

Now, that said, first of all *I* would be making the decisions, not a board of "experts". And secondly, these decisions would be made when the harm of the procedure is greater than the benefit--that is, it amounts to the torture of someone unable to understand it or trapping a person near death in high levels of pain they are unable to understand.

 

Any time the decision to end a life is made "for the good of society," for "the wellbeing of the relatives," or any other consideration than the actual condition of the patient--and that is NOT to allow in sneaky little "well, who would want to live like that?" nonsense; we're talking about the Hippocratic oath here--it is made on the basis of evil, plain and simple.

 

The only VALID consideration when the wishes of the person can't be consulted or are invalid due to mental state is what would cause the least harm--direct, physical harm.

[Reya]

The language of the bill is quite clear that the purpose is to actively encourage patients to select less care. The requirement that doctors discuss palliative and hospice care but NO life-extending measures, provisions for changing the directive following any change in health, the provision that orders must follow a "program" outlined by a board of experts (and what if you want something else? is your order invalid?), and the explicit "cost-saving" goal of the program make very clear that it was set up to herd vulnerable member of our society in to choosing as little care as possible and would exploit feelings of being useless or depression--as there is NO requirement for psychiatric screening before a minimal treatment order is issued.

 

It is quite chilling, frankly. My grandparents were quite confused by the time they died. They could have been convinced to sign just about anything by anyone. A system like the one outlined in the bill is cynically designed to exploit any possible weakness, and the language of the bill is stomach-turning.

[Reya]

The form I had has a fairly high cure rate, but 50 years ago it was not unusual for people to die from the same form of cancer.

 

You're exactly right!

 

What if, 50 years ago, the decision to treat certain cancers was in the hands of bean-counters who looked at the numbers and said, "Look, only 5% of people with this condition live 5 years post-diagnosis. Therefore, they should be given palliative care and left to die"?

 

There would have been no advances. And today, everyone with the condition would still be condemned to die.

 

There is a reason that the cutting edge of medicine is in the US. Only here do we chase down hopeless cases--and maybe not save very many in the first 10 years, and just a few more in the next 10, but eventually develop therapies that ARE effective--sometimes amazingly so.

 

We must treat on the edge, beyond what can be economically defended, in order to develop therapies that ARE economically defensible.

 

Even bean-counters should understand that. :-/

[Reya]

If someone wants surgery at 102, I'm fine with that, but I don't think the govt should pay for it.

 

But the government should pay for you to reach 89?

 

What if you're fat?

 

What if you smoke? Drink heavily? Don't wear a seat belt and get in a crash?

 

Why are these more deserving of care than just being old?

[Reya]

I don't think for a minute that end of life counseling=a death panel making decisions for you.

 

Nor does anyone who has read the bill.

 

The "death panel" is in a very different section of the bill--that is, a government panel outlining which treatments are "effective" and under which conditions they should be done. These decisions will have NO appeal. Now, if you want care your insurance won't cover, you can almost always have the treatment and figure out how to pay for it later. Under the proposed system, on government care, you cannot get the treatment, period.

 

Oh, and the various methods for destroying private insurance are also in other sections of the bill.

 

The bill will also, absolutely, be GROSSLY underfunded. Can we say...shortages? Leading to even more rationing?

 

The result is a system under which you're guaranteed to have marriage counseling, ending smoking support, addiction treatment, social worker visits to teach you how to parent and take care of your baby--but grandma's hip replacement surgery could be denied because she's too old and it won't extend life, anyway, so she'd be better off taking pain pills and not having the surgery, as our beloved leader has said.

 

READ THE BILL! Every one here, I URGE you--read it!

[Reya]

This article talks about some of the misinformation. The Telegraph is a main stream, right wing (in UK terms) newspaper.

 

Laura

 

The corrections are more chilling, I believe.

 

"Oh, don't worry! We may have driven off so many oncologists that people used to die because they couldn't get in to see one, but we have LOTS more now! Way less people die waiting for care!"

 

"Oh, no, we'd never deny anyone care based on financial stuff, but we have to make sure that the government gets a bang for its buck."

 

You know, Bush got slammed because a government agency, during his term, reduced the "value" of an American life to about 100k per 6 months (based on average life expectancy). Something else to think about...

[Reya]

The Chinese figured it out long ago, but most people refuse to use their methods. In China it is common to use accupuncture instead of anesthesia for surgery. I wish that would happen here along with many other Eastern health methods.

 

It used to be common to use whiskey here instead of ether or nitrous. BECAUSE THAT' S ALL PEOPLE COULD GET.

 

Anyone telling you that there are people going into serious surgeries in China in droves and choosing acupuncture is lying.

 

And this even goes for all our relatives who are so backward they think that most illnesses are caused by and can be cured by food--wet/dry, hot/cold. Oh, or looking at the wrong thing. Yeah, my MIL, with her deep, ancient Chinese wisdom, thought my neighbor must have either eaten the wrong thing, gotten upset during pregnancy, or looked at the wrong thing to have her child born with Down syndrome. See, that's what Eastern medicine says could be the reasons. (She wondered if it was catching, too, and even knowing that it isn't strongly disapproves of our daughter playing with him because she believe that he can influence her. Through his messed up chi. Or something.)

 

Ancient wisdom of the East? Go for it. YOU choose a healthcare plan that pays for your yoga and acupuncture and, if you are incredibly internally inconsistent, your Eastern medicine and homeopathy. (Because embracing two philosophies that are mutually exclusive and diametrically opposite is ALWAYS the path to excellent care!) Meanwhile, I want the choice to not have any of those things in my plan--or drug rehab, or psychological services, or parental counseling, or marital counseling. But I do want to pay for very high lifetime benefits for the things that do matter to me.

 

Oh, and two of my DH's relatives would likely still be alive today if it weren't for the medical care they got in China, despite all the bribes that the relatives brought to the doctors.

[Reya]

Health insurance is *not* tied to a job. *Affordable* health insurance is tied to a job.

 

Actually, I can get catastrophic insurance for about $120 a month here, independently. COBRA is a joke, though. $800 per month?????

 

I think people buying their insurance independently should be given the same legal protections as those getting it from an employer. That they are not really annoys me.

[Reya]

I happen to know that in the state of NY accupunture is a covered expense via state mandate.

 

:001_smile:

 

Another instance of the government saving people health care costs!

[Danestress]

nm

Edited August 16, 2009 by Danestress

[Laura Corin]

And here it is:

 

"We don't put a limit on the amount the NHS can spend on an individual," said Andrew Dillon, the chief executive of the National Institute for Health and Clinical Excellence (Nice), the Government's drugs rationing body. "The basis of Nice's system of appraising drugs and other treatments is simple: something will be recommended for use if the benefits to patients are worth what the NHS is being asked to pay."

 

Who decides here whether the benefits are 'worth it'? The NICE drugs' rationing body. This is where the camel's nose is in the tent after all, IMV. This should be the decision of the patient with her doctor, not of some other entity that assesses 'worth'.

 

 

There's nothing to stop someone in the UK paying for extra treatment out of their own pocket or through extra insurance. Otherwise, the NHS, like any other insurance scheme, is limited.

 

Laura

[Laura Corin]

I'm just going to point out again, as I did previously, that the 5 year cancer survival rate is between 14 and 19% higher in the US vs. the UK. It's even higher for prostrate and breast cancer, the two most common types of cancer.

 

 

These are decisions that countries take, and debate about them is good. The US spends massively more of its GDP on health than does the UK. The difference in outcomes may be simply down to this: more money spent, rather than a different system.

 

Good luck working out what is best for your country.

 

Laura

[Catherine]

already been said elsewhere.

 

Just a few days ago, there was a good editorial in the New York Times that was written by some academic doctors, about effective alternatives to the currently proposed bill in Congress. It closely examined a study that looked at several regions around the country that do better than the average (across the country) at Medicare costs. Ten in particular, beat Medicare costs significantly. Some of the traits of these regions was the subject of the editorial.

 

One was that doctors, rather than being strictly in private, fee for service practice, are salaried. Mayo Clinic was one of the places. It's worth noting that the reductions in costs were relatively modest, yet tended to multiply over time, saving more.

 

One of the article's authors writes a regular column for the New Yorker magazine on medical issues, his name is Atul Gawande. He recently wrote an article that examined the other side of this study, localities that have the highest Medicare costs in the nation, and interviewed some cardiologists in one town there. Not surprisingly, this particular town has few large physician groups, few salaried doctors, and is heavily skewed toward specialist care, versus primary care. As an internist, I was alarmed to read their comments. One noted that a 40 year old woman with no cardiac risk factors and chest pain would not only see a cardiologist and have a stress test, but would also very likely get a cardiac catheterization!! It's a procedure with some risk involved. Yet the "culture" of that locale meant that recommending this procedure would be expected by a patient, and if she did NOT have it done, she might be convinced it was needed and see another local cardiologist to have it done.

 

The point being, so many factors come into play when ordering tests, local medical culture and patient's expectations included. In my own city, one hospital has a 39% C-section rate. Another, 9%. The lower rated hospital serves an inner city, higher risk population, has salaried docs, and the best maternal mortality\morbidity (death and illness) statistics locally, the other hospital serves a predominantly suburban, middle class, insured and low risk population. Oh, and is strictly fee for service. Numbers like this MUST mean that factors other than strict medical necessity are driving the rates of testing, procedures, and surgery. Finding a way to control those costs is what I think we an a nation must do.

[cathmom]

 

The point being, so many factors come into play when ordering tests, local medical culture and patient's expectations included. In my own city, one hospital has a 39% C-section rate. Another, 9%. The lower rated hospital serves an inner city, higher risk population, has salaried docs, and the best maternal mortality\morbidity (death and illness) statistics locally, the other hospital serves a predominantly suburban, middle class, insured and low risk population. Oh, and is strictly fee for service. Numbers like this MUST mean that factors other than strict medical necessity are driving the rates of testing, procedures, and surgery. Finding a way to control those costs is what I think we an a nation must do.

 

Addressing the c-section rate would go a long way to reducing costs and bettering our statistics!

[kdeno]

my issue is who gets to decide who gets care and lives and who is denied care and dies. We are all valuable, the elderly even more so.

[johnandtinagilbert]

 

BTW: Please don't put a negative spin on "artificial parts."

You read into my statement as negative? There was no negativity intended, nor did I think implied via language or use of negative words. It was a question stated.

[johnandtinagilbert]

already been said elsewhere.

 

Just a few days ago, there was a good editorial in the New York Times that was written by some academic doctors, about effective alternatives to the currently proposed bill in Congress. It closely examined a study that looked at several regions around the country that do better than the average (across the country) at Medicare costs. Ten in particular, beat Medicare costs significantly. Some of the traits of these regions was the subject of the editorial.

 

One was that doctors, rather than being strictly in private, fee for service practice, are salaried. Mayo Clinic was one of the places. It's worth noting that the reductions in costs were relatively modest, yet tended to multiply over time, saving more.

 

One of the article's authors writes a regular column for the New Yorker magazine on medical issues, his name is Atul Gawande. He recently wrote an article that examined the other side of this study, localities that have the highest Medicare costs in the nation, and interviewed some cardiologists in one town there. Not surprisingly, this particular town has few large physician groups, few salaried doctors, and is heavily skewed toward specialist care, versus primary care. As an internist, I was alarmed to read their comments. One noted that a 40 year old woman with no cardiac risk factors and chest pain would not only see a cardiologist and have a stress test, but would also very likely get a cardiac catheterization!! It's a procedure with some risk involved. Yet the "culture" of that locale meant that recommending this procedure would be expected by a patient, and if she did NOT have it done, she might be convinced it was needed and see another local cardiologist to have it done.

 

The point being, so many factors come into play when ordering tests, local medical culture and patient's expectations included. In my own city, one hospital has a 39% C-section rate. Another, 9%. The lower rated hospital serves an inner city, higher risk population, has salaried docs, and the best maternal mortality\morbidity (death and illness) statistics locally, the other hospital serves a predominantly suburban, middle class, insured and low risk population. Oh, and is strictly fee for service. Numbers like this MUST mean that factors other than strict medical necessity are driving the rates of testing, procedures, and surgery. Finding a way to control those costs is what I think we an a nation must do.

Thank you. This is an excellent post, with an interesting point of comparison.

 

I do want to add, though, that my children are on a gov't provided health insurance and they Require we go to specialist for everything. Our primary care provider sends us to a dermatologist for wart removal. We have to go to the primary to get a referral for eye glasses. Referrals, referrals, referrals. I have posted before it took me 6 or 7 (I forget now) doctor visits before I could officially be diagnosed with something I Knew I had.

 

Thanks again for the post.

[MomLovesClassics]

I have not read this whole thread. I can say that at one time I worked in a nursing home long ago. The quality of life that some had was unreal. Imagine being strapped to a bed with a feeding tube either in your mouth or your stomach and that was your only existance not being able to sit or stand. Imagine if no one came to visit you, give you hugs, no love, only medical life support. There was this elderly lady, reaching to pull out that tube from her throat, she pulled it out so many times, they took it out and put one in her stomach. She never said a word to anyone. I always had a habit of hugging all my patients, and kissing them on the forehead, I got attached to them all. One day that lady said to me "I love you, I want to die" if I were in her condition I would not want to live like that either. Yet most patients in that nursing home were in a similar condition. We all have different views about what we deem acceptable living conditions. I had to quit that job,it was so depressing to me. It was unacceptable to me to see all those people there and forgotten about. It was sad.

[Catherine]

for every little thing. It may be that the plan's administrators are trying to guard themselves against accusations of skimping on care for the poor. I don't agree that specialists are the best source of care in every situation. In fact, the drive toward specialization in medicine is one of the factors that increases costs.

[2squared]

I have enjoyed reading all the healthcare thread, and I delurked to ask this question.

 

Our government (us, the taxpayers) have a finite amount of money to fund our obligations. Obviously, our obligations includes healthcare. It seems to me that someone somewhere (I don't want to be that person) has to put parameters on healthcare options since we are running out of money as a country.

 

How do you wonderful ladies propose balancing the value of life and right to life against our finite financial resources?

 

Jennifer

7yo dd, 5yo ds, almost 3yo ds, 15mo dd

[Catherine]

a number of semi-effective means. The chief one is eliminating ill or potentially ill people from the rolls. Eventually, many of them are covered by government -funded plans like Medicare and Medicaid. In those cases, costs are limited by policy decision makers, as is proposed in the current bill before Congress.

 

But for people with insurance that is self-paid or employer-paid (costs borne by employees and consumers) decisions about coverage are made by insurance company employees, answerable to shareholders. There are mechanisms for appeal, which are rarely, by my observation, practical or useful to ordinary people. Appeal is time consuming to the extreme and often ineffective. State insurance commissioners may have ties to private insurers, and this corrupts the process. I once attempted to appeal my insurer's decision to not cover yearly mammography until I'm 50. My mother and her mother both had breast cancer. Neither had sisters. One was pre-menopausal. By medical definition, I am "high risk". Their policy explicitly states it covers yearly mammography from 35-50 for high risk patients. But despite hours of phone calls and 5 letters to different people in their company, they did not cover it or tell me why they won't. They simply...won't. So limitations on coverage in our current system are made by insurers, on a payroll and answerable to shareholders, and by government bodies.

 

In my experience, Medicare is less often perceived as unfair in its determinations of what is covered than private insurers. Particularly if you consider that the greatest cost-cutting in the private sector takes the form of simply limiting who is covered. *Those* decisions are 100% not appeal-able. I'm not certain that the current bill would be as broadly covering as Medicare, but if it is, I suspect beneficiaries would have less reason for grievance than some of us the benefit from employer-sponsored plans.

 

In recent years, the state of Oregon has used a plan ( I don't know if it is still in effect) that simply listed, in rank order, conditions that it would pay for. If a healthy person saw the doctor for a cold (no fever, clear runny nose, not allergies) it was not covered. Liver transplants were not covered. The place on the list where the line was drawn was different each year based on available funds. Rankings on the list were determined by the evidence supporting their usefulness to the most people. So mammograms were higher on the list than heart transplants. Of course everyone was free to purchase better coverage if they chose to and had the means. I personally believe this is the most just and rational system. It contains costs by setting the amount available based on available funds. Participants are always free to pursue better coverage or pay cash. There are no limitations on coverage based on prior health history.

[CAMom]

I haven't read all of the other replies yet but wanted to comment since this issue is very timely for me.

 

My 87 year old grandma passed away last night as my family and I sat by her bedside.

 

I always had a very close relationship with her and spent the past 10 years caring for her. She and I had frequent discussions about what her end of life wishes were. We talked about it naturally and intimately with one another.

 

So, during these past 8 weeks, when she got sick, was in the hospital, I had to choose a nursing facility and, finally, admit her to hospice and take her back home to her own house, I was very comfortable that I was doing exactly what she wanted.

 

Her final health issue was kidney failure. Originally she decided to do the dialysis they offered. She went through about 7 treatments and then decided that the quality of life it was offering her was not at all what she wanted. She valued quality over quantity. She reasoned that Medicare should not be paying for treatment in her particular case. She was very mindful of the cost even though she was not paying for it herself.

 

She lived 36 days after her last treatment and died very peacefully last night right after my husband read to her from a favorite Psalm and told her to "go...be with your Father."

 

I am fully supportive of talking openly about end of life plans and decisions. But, it should be done with family and with people that the person planning knows, respects and trusts. It should not be run by the government but run by families.

 

I am so very thankful that my grandma and I had the type of relationship where we could so openly discuss the issue as it gave me exactly what I needed to make the best decisions for her.

[stripe]

We all will die one day.

 

I believe in good healthcare that keeps that in mind. Sometimes, there simply is nothing to be done, except perhaps to control the pain. I think as Americans we live in denial of this very basic fact. That is why so much is spend in the last 6 months of life -- some of it, I daresay, frantically trying to put off the inevitable. (And I think that's why there's so much horror at the idea that a doctor might discuss end of life care with you -- how dare someone imply that you will die!)

 

That being said, I'm not in favor of killing people off or whatever other extremely ridiculous idea people float.

[johnandtinagilbert]

a number of semi-effective means. The chief one is eliminating ill or potentially ill people from the rolls. Eventually, many of them are covered by government -funded plans like Medicare and Medicaid. In those cases, costs are limited by policy decision makers, as is proposed in the current bill before Congress.

 

But for people with insurance that is self-paid or employer-paid (costs borne by employees and consumers) decisions about coverage are made by insurance company employees, answerable to shareholders. There are mechanisms for appeal, which are rarely, by my observation, practical or useful to ordinary people. Appeal is time consuming to the extreme and often ineffective. State insurance commissioners may have ties to private insurers, and this corrupts the process. I once attempted to appeal my insurer's decision to not cover yearly mammography until I'm 50. My mother and her mother both had breast cancer. Neither had sisters. One was pre-menopausal. By medical definition, I am "high risk". Their policy explicitly states it covers yearly mammography from 35-50 for high risk patients. But despite hours of phone calls and 5 letters to different people in their company, they did not cover it or tell me why they won't. They simply...won't. So limitations on coverage in our current system are made by insurers, on a payroll and answerable to shareholders, and by government bodies.

 

In my experience, Medicare is less often perceived as unfair in its determinations of what is covered than private insurers. Particularly if you consider that the greatest cost-cutting in the private sector takes the form of simply limiting who is covered. *Those* decisions are 100% not appeal-able. I'm not certain that the current bill would be as broadly covering as Medicare, but if it is, I suspect beneficiaries would have less reason for grievance than some of us the benefit from employer-sponsored plans.

 

In recent years, the state of Oregon has used a plan ( I don't know if it is still in effect) that simply listed, in rank order, conditions that it would pay for. If a healthy person saw the doctor for a cold (no fever, clear runny nose, not allergies) it was not covered. Liver transplants were not covered. The place on the list where the line was drawn was different each year based on available funds. Rankings on the list were determined by the evidence supporting their usefulness to the most people. So mammograms were higher on the list than heart transplants. Of course everyone was free to purchase better coverage if they chose to and had the means. I personally believe this is the most just and rational system. It contains costs by setting the amount available based on available funds. Participants are always free to pursue better coverage or pay cash. There are no limitations on coverage based on prior health history.

Thank you. I have considered an a la carte list often times when I have considered how health care could be managed. Then there could be a set price and individuals could choose what would be covered under their plan. Perhaps that is oversimplifying. I don't know. I am still very concerned with how our nation can afford these things. I don't believe the debt we currently have is in our best interest and I'm concerned that taking on more may lead to a collapse.

[EKS]

Actually, I can get catastrophic insurance for about $120 a month here, independently.

 

We can get catastrophic insurance here too for less, but it covers nothing ordinary, including prescriptions (which I understand is the point of catastrophic insurance). This is what we had for several years before my husband got his wonderfully-benefitted job at the local fire department. What scared me with that insurance wasn't a hospitalization, it was getting a condition that required lots of expensive drugs to manage over a long period of time.

[johnandtinagilbert]

I haven't read all of the other replies yet but wanted to comment since this issue is very timely for me.

 

My 87 year old grandma passed away last night as my family and I sat by her bedside.

 

I always had a very close relationship with her and spent the past 10 years caring for her. She and I had frequent discussions about what her end of life wishes were. We talked about it naturally and intimately with one another.

 

So, during these past 8 weeks, when she got sick, was in the hospital, I had to choose a nursing facility and, finally, admit her to hospice and take her back home to her own house, I was very comfortable that I was doing exactly what she wanted.

 

Her final health issue was kidney failure. Originally she decided to do the dialysis they offered. She went through about 7 treatments and then decided that the quality of life it was offering her was not at all what she wanted. She valued quality over quantity. She reasoned that Medicare should not be paying for treatment in her particular case. She was very mindful of the cost even though she was not paying for it herself.

 

She lived 36 days after her last treatment and died very peacefully last night right after my husband read to her from a favorite Psalm and told her to "go...be with your Father."

 

I am fully supportive of talking openly about end of life plans and decisions. But, it should be done with family and with people that the person planning knows, respects and trusts. It should not be run by the government but run by families.

 

I am so very thankful that my grandma and I had the type of relationship where we could so openly discuss the issue as it gave me exactly what I needed to make the best decisions for her.

:grouphug: and thank you for giving us an example of how a person can be reasonable and accepting of their lot in life. God bless your family during this time of loss.

[HRAAB]

Actually, I can get catastrophic insurance for about $120 a month here, independently. COBRA is a joke, though. $800 per month?????

 

I think people buying their insurance independently should be given the same legal protections as those getting it from an employer. That they are not really annoys me.

 

We are currently paying $186.00 for catastrophic health insurance for four children and myself. My dh is on COBRA paying $213.00 with the gov't picking up 65%. I was denied coverage by two companies; I've had one renewable prescription in my entire life - for Prevacid and a endoscopy early this year to find out if anything was causing my acid reflux. This put me into the high risk pool with premiums being in excess of $800.00 and up. When the COBRA runs out I'm not sure what dh will do as he takes cholesterol medication and has had several back procedures plus being a 51 year old male. Anyway, that's where we're at right now.

 

I was wondering what you meant by the above bolded statement - same legal protections as those insured through their employer?

 

Janet

[Renee in NC]

We can get catastrophic insurance here too for less, but it covers nothing ordinary, including prescriptions (which I understand is the point of catastrophic insurance). This is what we had for several years before my husband got his wonderfully-benefitted job at the local fire department. What scared me with that insurance wasn't a hospitalization, it was getting a condition that required lots of expensive drugs to manage over a long period of time.

 

Can you tell me which company? I haven't been able to find catastrophic coverage that inexpensive.

[Renee in NC]

We are currently paying $186.00 for catastrophic health insurance for four children and myself. My dh is on COBRA paying $213.00 with the gov't picking up 65%. I was denied coverage by two companies; I've had one renewable prescription in my entire life - for Prevacid and a endoscopy early this year to find out if anything was causing my acid reflux. This put me into the high risk pool with premiums being in excess of $800.00 and up. When the COBRA runs out I'm not sure what dh will do as he takes cholesterol medication and has had several back procedures plus being a 51 year old male. Anyway, that's where we're at right now.

 

I was wondering what you meant by the above bolded statement - same legal protections as those insured through their employer?

 

Janet

 

Janet, what company are you are your dc covered under?