Insightful and touching article into how our current healthcare system works....

[Jackie in NE]

http://articles.moneycentral.msn.com/Insurance/InsureYourHealth/lessons-of-a-618616-dollar-death.aspx

 

Comments?

 

:bigear:

[Catherine]

And I think her lack of a clear answer to the question "Why didn't we stop? Why couldn't we stop?" is so telling. How could anyone, given the situation, make those kinds of choices? It is very, very difficult for families. But I think the article raises the right questions for all of us. Can we continue in the current vein, health care wise?

[Mermaid Mama]

Sometimes I wonder if we're asking the right questions.

Should we do xyz to save someone....to add a few days, weeks, month, years to a person's life? What will the quality of life be?

 

I think we should ask WHY do we have these diseases at such increasing rates? What can be done to stop the cause of the disease? An ounce of prevention goes a long way and I for one blame toxic chemicals in our air, food, water, etc.....

 

We need to stop the greed of those who profit from our misery.

We need to teach our children how to read labels and make informed decisions regarding their diet. We need to boycott toxic toys, foods, buliding materials, etc... from countries that no longer even try to hide the fact that they are killing us slowly.

 

I can't answer the questions these people are faced with because I have never been in that position. I feel for them. What an awful place to be. I can only wonder how we can prevent it from happening to our children.

[Laura Corin]

This is so hard. A friend of mine worked on cancer policy for the UK NHS. She travelled to various countries to research how many lines of treatment were offered for cancer and what the outcomes were. Whatever you might have heard about the NHS, her brief was actually to try to weigh up outcomes vs. distress caused: how much distress as caused to the 98% of patients for whom drug x does no good, vs. the extra days given to the 2%.

 

My father was diagnosed with an unusually virulent form of prostate cancer in his mid-70s. He had been surviving polycythemia for over a decade (normal prognosis 15 to 20 years) had congenital high cholesterol leading to a triple heart bypass in his sixties. Nevertheless, at the time of the prostate diagnosis he was mentally and physically active, going for long walks and serving as a volunteer school governor, as well as lecturing part time in television studies.

 

He had a standard prostate cancer treatment, followed by an experimental one. The latter gave him time to do lots of things he wanted to - visiting me in China, renewing his relationship with an estranged grandson, watching my half sisters find partners and settle down. When the experimental drug stopped working it was clear that the cancer had invaded his bones. He decided that the time had come and accepted palliative care only from then on. He had months without much medical intervention to say goodbye to his family - a lot of good was done in that peaceful time.

 

I don't have any definitive answers for other families, but this is how 'letting go' can be good.

 

Laura

[Jackie in NE]

This is so hard. A friend of mine worked on cancer policy for the UK NHS. She travelled to various countries to research how many lines of treatment were offered for cancer and what the outcomes were. Whatever you might have heard about the NHS, her brief was actually to try to weigh up outcomes vs. distress caused: how much distress as caused to the 98% of patients for whom drug x does no good, vs. the extra days given to the 2%.

 

My father was diagnosed with an unusually virulent form of prostate cancer in his mid-70s. He had been surviving polycythemia for over a decade (normal prognosis 15 to 20 years) had congenital high cholesterol leading to a triple heart bypass in his sixties. Nevertheless, at the time of the prostate diagnosis he was mentally and physically active, going for long walks and serving as a volunteer school governor, as well as lecturing part time in television studies.

 

He had a standard prostate cancer treatment, followed by an experimental one. The latter gave him time to do lots of things he wanted to - visiting me in China, renewing his relationship with an estranged grandson, watching my half sisters find partners and settle down. When the experimental drug stopped working it was clear that the cancer had invaded his bones. He decided that the time had come and accepted palliative care only from then on. He had months without much medical intervention to say goodbye to his family - a lot of good was done in that peaceful time.

 

I don't have any definitive answers for other families, but this is how 'letting go' can be good.

 

Laura

 

Laura,

 

I really admire your father for the choice he made. I hope that if I ever have to make that type of decision, I can have the grace to let go when it's time.

 

One of the things I admired about the family in the article is how THEY LIVED. They went to Pompeii, they went to Spain. They made wonderful memories with their dc.

 

Aside from how they lived, the thing I found both troubling and interesting was the different prices charged by hospitals for the same medical procedure. How much could we "save" in medical care costs if the hospitals charged the same, or nearly the same prices. I am NOT an advocate of price controls. That never works. But I would think that the medical profession would be doing themselves a service by coming up with a more uniform method of pricing. If we were able to "shop" for health care; if the pricing were more transparent.... wouldn't we all be better off? I know that healthcare providers are often surprised when I ask for a price estimate. But I pay for almost everything out of pocket... so I really need to know.

 

Thanks for sharing your father's story. He was a good example, in my opinion.

 

Blessings, Jackie

[Jen500]

 

I think we should ask WHY do we have these diseases at such increasing rates?

 

Here is a link about cancer rates-

 

Annual Report to the Nation Finds Continued Declines in Overall Cancer Rates; Special Feature Highlights Current and Projected Trends in Colorectal Cancer

Rates of new diagnoses and rates of death from all cancers combined declined significantly in the most recent time period for men and women overall and for most racial and ethnic populations in the United States, according to a report from leading health and cancer organizations.

 

The drops are driven largely by declines in rates of new cases and rates of death for the three most common cancers in men (lung, prostate, and colorectal cancers) and for two of the three leading cancers in women (breast and colorectal cancer). New diagnoses for all types of cancer combined in the United States decreased, on average, almost 1 percent per year from 1999 to 2006. Cancer deaths decreased 1.6 percent per year from 2001 to 2006.

 

http://www.cancer.gov/newscenter/pressreleases/ReportNation2009Release

[laundrycrisis]

It would be very important to me in such a situation that the decisions around when to stop are left up to the patient and the patient's family, not a government entity, or an insurance company working as an agent for a government entity, along the lines of a program of spending limitations that have become law.

[stripe]

Those type of article are very moving. I know someone whose husband died after a long cancer battle; she swears she'll never take chemo.

 

I think most people are in denial that life ends (i.e. that all will die), and a lot of healthcare "treatment" is really trying to avoid dying, hence the disproportionate spending in the last 6 mo of life, rather than on prevention and even on (gasp!) people in all age and health brackets, instead of predominately the elderly/terminally ill.

[MeanestMomInMidwest]

It would be very important to me in such a situation that the decisions around when to stop are left up to the patient and the patient's family, not a government entity, or an insurance company working as an agent for a government entity, along the lines of a program of spending limitations that have become law.

 

I am not disagreeing with you. I do want to point out, though, that if one has insurance than the insurance is, in fact, making decisions. They force people out of treatment due to what is covered. They set up the hoops doctors must jump through as far as which test can be ordered when. Ditto for Medicare and Medicaid.

 

And when families are making the decision (i.e. do everything), they are often not aware or cannot grasp the significance of the prognosis with and without treatment. I often wonder how decisions would differ if families were actually (1) paying for or aware of the cost of certain treatments and (2) forced to watch their loved one undergo the severe pain some treatments cause. Now am I saying that all treatment decisions should be monetarily based? No. But I am saying that the cost/benefit should be fully understood in terms of human suffering, prognosis, quality of life, and economics.

 

From what I have seen, people select more humane treatment for the family pet than they do for grandma.

[Catherine]

And fully understanding the cost benefit, all aspects of it, is nigh impossible for patients and their families when they are enduring the stress of a critical or severe chronic illness. It's exactly what the author of the article is referring to.

[aude sapere]

I am not disagreeing with you. I do want to point out, though, that if one has insurance than the insurance is, in fact, making decisions. They force people out of treatment due to what is covered. They set up the hoops doctors must jump through as far as which test can be ordered when. Ditto for Medicare and Medicaid.

 

 

The insurance companies aren't, in fact, denying care. They, in specific instances, are declining to pay for the treatment. The patient is still free to change insurance companies or pay out of pocket.

[Jen500]

The patient is still free to change insurance companies or pay out of pocket.

 

This statement is just not a REALITY for many people.

[Audrey]

The insurance companies aren't, in fact, denying care. They, in specific instances, are declining to pay for the treatment. The patient is still free to change insurance companies or pay out of pocket.

 

This is an egregiously misleading statement. Changing insurance companies while having existing cancer is nigh to impossible. Almost none will accept you, and the very few that offer cancer coverage do so at exhorbitant rates, and they STILL can refuse to cover treatments, often unbeknownst to you when you sign the policy.

[Audrey]

 

From what I have seen, people select more humane treatment for the family pet than they do for grandma.

 

I would agree, but it is hard to let go. Human nature and all that. I understand the wanting to hang on and keep grandma around longer, but that's a selfish want. It isn't necessarily what is best or most desirable from grandma's point of view.

 

Part of me wanted my cancer ridden mother to be free from all the pain, but honestly? The second she was gone, I would have given my left arm to have just 5 more minutes with her.

 

It's a tough mix of emotions and sense.

[aude sapere]

This is an egregiously misleading statement. Changing insurance companies while having existing cancer is nigh to impossible. Almost none will accept you, and the very few that offer cancer coverage do so at exhorbitant rates, and they STILL can refuse to cover treatments, often unbeknownst to you when you sign the policy.

 

My statement was not misleading. In America you are free to change companies or pay out of pocket. I never said it would be easy, or the premium would be affordable. But it is the patient's choice.

[NoPlaceLikeHome]

The insurance companies aren't, in fact, denying care. They, in specific instances, are declining to pay for the treatment. The patient is still free to change insurance companies or pay out of pocket.

 

Yes but that is an impossibility for many patients due to being denied eligibility for new insurance due to pre-existing conditions or due to un-affordable costs. So yes, insurance companies often do deny care IMHO.

[G5052]

We have one of the federal plans that they say is a model for national healthcare, and we are still out-of-pocket a significant amount every year because of the sheer volume of doctor visits, medication, physical therapy, etc. required to keep one family member functioning. For some reason a lot of people think that we have a really sweet deal and are surprised that we struggle financially. Insurance helps immensely, but it doesn't mean that you aren't out of pocket.

 

We also pay 100% of some specialists and medications not on their lists, and of course that drags us down too. We choose to do that though.

[MeanestMomInMidwest]

And fully understanding the cost benefit, all aspects of it, is nigh impossible for patients and their families when they are enduring the stress of a critical or severe chronic illness. It's exactly what the author of the article is referring to.

True, true. Not only are they not in an emotional/mental state to understand, the billing is impossible to decipher. Ten people may be in the waiting room for the exact same procedure. None of them may get the same bill. It is kinda like buying a used car used to be. Almost impossible to find out ahead of time exactly what a procedure costs. Different costs for cash, Medicaid, Medicare, and various insurance plans.

[Jackie in NE]

True, true. Not only are they not in an emotional/mental state to understand, the billing is impossible to decipher. Ten people may be in the waiting room for the exact same procedure. None of them may get the same bill. It is kinda like buying a used car used to be. Almost impossible to find out ahead of time exactly what a procedure costs. Different costs for cash, Medicaid, Medicare, and various insurance plans.

 

 

This, to me, is the most frustrating and illogical part of our current health-care system. I understand collective bargaining, and that some insurance companies are able to get a "sweeter" deal than others...... But really!

 

An example: We have been in and out of coverage over the last 15 years, but more or less with the same pediatricians. When we are covered by insurance (extremely high deductibles, so still our cost) our pediatrician's office charges us FULL RATES. During those periods that we aren't covered, the rates are lower. I realize they are trying to help us, but I think that whole way of thinking is flawed. I still have to pay when they charge us up the kazoo, whether in higher premiums, or higher out-of-pocket to meet deductibles. When my husband or I work, the rate is "x dollars/hour". Why can't the medical profession work that way? It seems dishonest to me. It seems like a way to be paid higher rates (when the patient is "covered") because the consumer is not as discerning.

 

How do we change that?

[NoPlaceLikeHome]

This, to me, is the most frustrating and illogical part of our current health-care system. I understand collective bargaining, and that some insurance companies are able to get a "sweeter" deal than others...... But really!

 

An example: We have been in and out of coverage over the last 15 years, but more or less with the same pediatricians. When we are covered by insurance (extremely high deductibles, so still our cost) our pediatrician's office charges us FULL RATES. During those periods that we aren't covered, the rates are lower. I realize they are trying to help us, but I think that whole way of thinking is flawed. I still have to pay when they charge us up the kazoo, whether in higher premiums, or higher out-of-pocket to meet deductibles. When my husband or I work, the rate is "x dollars/hour". Why can't the medical profession work that way? It seems dishonest to me. It seems like a way to be paid higher rates (when the patient is "covered") because the consumer is not as discerning.

 

How do we change that?

 

You are fortunate that your doctor charged you a lower rate when not covered because from what I understand that is usually not the case. I have read numerous reports on how the uninsured have to endure higher charges for services than the insured whereas the insured only pay the lower contracted rates. This can be devastating when dealing with a hospitalization. I also have a high deductible, not by choice, and have only had to pay the significantly lower contracted insurance rate instead of the usual (uninsured) rate.

[MeanestMomInMidwest]

I would agree, but it is hard to let go. Human nature and all that. I understand the wanting to hang on and keep grandma around longer, but that's a selfish want. It isn't necessarily what is best or most desirable from grandma's point of view.

 

Part of me wanted my cancer ridden mother to be free from all the pain, but honestly? The second she was gone, I would have given my left arm to have just 5 more minutes with her.

 

It's a tough mix of emotions and sense.

 

True. this is why I advocate for living wills (which are not always honored). If the family can be assured that they are following their loved one's wishes at the end of life, well - it will still be unbearably hard, but there is some peace in knowing what your loved one would have wanted.

[Perry]

Sometimes I wonder if we're asking the right questions.

 

I think we should ask WHY do we have these diseases at such increasing rates? What can be done to stop the cause of the disease? An ounce of prevention goes a long way and I for one blame toxic chemicals in our air, food, water, etc.....

Lots of people are asking, and answering, those questions. Although as Jen pointed out, rates are decreasing, not increasing, for many diseases.

[mcconnellboys]

I think that the bureaucracy of this system, like a lot of systems we have in our country, is at the heart of the problem. I absolutely agree that we need to make changes. However, most of the systems that are too overgrown and bureaucratic in our country are government run. I simply can not believe that adding our health care system to the list of government run bureaucracies will help it to be better. In fact, I think it will be much, much worse than it is now....

[jld]

I think it's the greed of the health insurance industry that's at the heart of the problem.

[NoPlaceLikeHome]

I think that the bureaucracy of this system, like a lot of systems we have in our country, is at the heart of the problem. I absolutely agree that we need to make changes. However, most of the systems that are too overgrown and bureaucratic in our country are government run. I simply can not believe that adding our health care system to the list of government run bureaucracies will help it to be better. In fact, I think it will be much, much worse than it is now....

 

Yes, but most health insurance companies are humongous, inefficient bureaucracies themselves who take profit as the primary consideration for my health care:001_huh:. My insurance will process many claims in 3 separate departments who do not talk to each other.

[Jackie in NE]

I think that the bureaucracy of this system, like a lot of systems we have in our country, is at the heart of the problem. I absolutely agree that we need to make changes. However, most of the systems that are too overgrown and bureaucratic in our country are government run. I simply can not believe that adding our health care system to the list of government run bureaucracies will help it to be better. In fact, I think it will be much, much worse than it is now....

 

 

:iagree::iagree:

 

I have never seen the government do a better job than private enterprise. Yes, as others have stated, the insurance companies are out to make a profit. But there's nothing wrong with making a profit. It is not inherently evil. My dh and I try to make a profit every year! Those profits are then plowed back into growth, research, updating systems, employee raises, etc.

 

Maybe the appropriate question is: how do we make it profitable for insurance companies to insure the uninsurable without government involvement?

[NoPlaceLikeHome]

:iagree::iagree:

 

I have never seen the government do a better job than private enterprise. Yes, as others have stated, the insurance companies are out to make a profit. But there's nothing wrong with making a profit. It is not inherently evil. My dh and I try to make a profit every year! Those profits are then plowed back into growth, research, updating systems, employee raises, etc.

 

Maybe the appropriate question is: how do we make it profitable for insurance companies to insure the uninsurable without government involvement?

 

I do not see making a profit as inherently evil either. I do see companies that pay CEOs and top executives to the tune of millions and millions of dollars as immoral though. In the 1960s to 1980s, CEOs made about 42 times the pay of the average worker. Today, it is about 500 to 700 times the average worker and to me that is morally wrong. These top executives are like robber barons in my book and they are ripping off the tax paying, general public, their employees and stockholders IMHO. Then, on top of that, they are shipping many of our jobs overseas. There are plenty of of government workers who manage billions of dollars in budgets and have great responsibilities like the Secretary of Defense who earn less than $200,000 per year:001_huh:. Also, I do not think these CEOs are worth that much at all especially given the performance of many of these companies. I believe that there will be plenty of very qualified takers for these jobs for less money IMHO.

 

Don't get me wrong. I hope my family earns a fair amount of money, but we will never need 10's and 20's and 60's of millions of dollars at all. I think the tax code should be fair and tax these outrageous salaries appropriately. Then, maybe top executive salaries will become more fair and more realistic IMHO.

 

My 2 cents:)

Edited March 14, 2010 by priscilla
grammar

[Sarah CB]

That's very scary. My mom had stroke-like symptoms a couple of weeks ago and immediately underwent a series of tests and time in a stroke prevention clinic. She had an MRI, electrocardiogram, CAT scan, extensive blood work and I'm not even sure what else. She also had a Holter Monitor for 24 hours. Between all of her tests, the 10 hours she spent in emergency and the time she spent in the stroke clinic I imagine she would have racked up quite a medical bill.

 

Thankfully, we live in Canada and she didn't even have to consider the cost. The majority of her tests (including the MRI) were conducted on the day of her symptoms and the couple of days following the symptoms. There were no real waits.

[Mommyof4ks]

:iagree::iagree:

 

I have never seen the government do a better job than private enterprise. Yes, as others have stated, the insurance companies are out to make a profit. But there's nothing wrong with making a profit. It is not inherently evil. My dh and I try to make a profit every year! Those profits are then plowed back into growth, research, updating systems, employee raises, etc.

 

Maybe the appropriate question is: how do we make it profitable for insurance companies to insure the uninsurable without government involvement?

 

:iagree: Insurance companies, hospitals, drug companies need to make a profit or they will not last just like any other business. One of the very few things that I have heard that I like about some of the proposed health care changes is the ability to see what the hospitals are going to charge prior to performing a test or procedure and in general having more transparency in our health care system. It will make it more like other businesses in that respect. I would love to be able to walk in and get an honest opinion from doctors on the outcome. It is very hard to nail them down to an answer for fear of lawsuits.

 

I have watched my young son endure over 3 years of chemotherapy for leukemia (yep, very long treatment protocol), and he has a 94% chance of survival for 5 years based on the latest information given his risk factors. We fully expect him to be ok and move on. We have three friends who have children treated at our same local hospital who were given less than a 5% chance of survival, but here they are years later and doing well. These children endured transplants, relapses, and lots of harsh treatments to be here today, but no one knew if the next treatment would be the one that would save them. They were all success stories. We have lost friends who had a much better prognosis with standard treatments. All we can do is try and hope that this treatment saves them. If these children had been 70 year old adults they would not have survived all of the treatments and this would have been a non-issue. I don't know where to draw the line, but I have a hard time accepting that the government or insurance companies may decide who lives and who dies which may largely depend on statics. New treatments and cures will not be found if no one is allowed to survive to test them. The fact is that we need older people to test these treatments so that younger people (not kids, childhood cancer is a whole 'nother animal) can be cured one day.

[mommyrooch]

I do not see making a profit as inherently evil either. I do see companies that pay CEOs and top executives to the tune of millions and millions of dollars are immoral though. In the 1960s to 1980s, CEOs made about 42 times the pay of the average worker. Today, it is about 500 to 700 times the average worker and to me that is morally wrong. These top executives are like robber barons in my book and they are ripping off the tax paying, general public, their employees and stockholders IMHO. Then, on top of that, they are shipping many of our jobs overseas. There are plenty of of government workers who manage billions of dollars in budgets and have great responsibilities like the Secretary of Defense who earn less than $200,000 per year:001_huh:. Also, I do not think these CEOs are worth that much at all especially given the performance of many of these companies. I believe that there will be plenty of very qualified takers for these jobs for less money IMHO.

 

Don't get me wrong. I hope my family earns a fair amount of money, but we will never need 10's and 20's and 60's of millions of dollars at all. I think the tax code should be fair and tax these outrageous salaries appropriately. Then, maybe top executive salaries will become more fair and more realistic IMHO.

 

My 2 cents:)

 

 

:iagree::iagree::iagree:

 

You're my hero Priscilla!!! :hurray: I couldn't have said this better myself. ;)

[mcconnellboys]

I agree completely, and I've worked within the insurance world, so I've seen things from the inside of that arena, as well. I think that business should be completely reformed. But I think most of our government offices should also be completely reformed. I don't think any type of bureaucracy is ever efficient. The larger they are, the more inefficient they seem to be. Replacing one evil with another isn't a good solution in my opinion. Change is absolutely needed. I just don't think we're headed toward the right sort of change.

[mcconnellboys]

I agree that there is tremendous abuse of the profits and I'd like to see that corrected in some equitable way. However, I see the exact same sorts of abuse by large companies all across the spectrum of American business. Auto execs, bank execs, utilities execs, investment execs - greed is rampant everywhere you look, it's not limited to one industry. Why would we pick on just one industry and let execs in every other get away with the exact same stuff?

[Aggie]

I agree that there is tremendous abuse of the profits and I'd like to see that corrected in some equitable way. However, I see the exact same sorts of abuse by large companies all across the spectrum of American business. Auto execs, bank execs, utilities execs, investment execs - greed is rampant everywhere you look, it's not limited to one industry. Why would we pick on just one industry and let execs in every other get away with the exact same stuff?

 

And also in our government. We have some people in DC who don't have *our* best interests at heart anymore. :(

[jld]

Thank you, Priscilla, for speaking for many of us!

 

I don't see anything wrong with a truth commission on abuses in all sorts of industries. You have to start somewhere, and it seems Americans may be willing to start with health care insurance companies. And hopefully that will be just the beginning!

[NoPlaceLikeHome]

I agree that there is tremendous abuse of the profits and I'd like to see that corrected in some equitable way. However, I see the exact same sorts of abuse by large companies all across the spectrum of American business. Auto execs, bank execs, utilities execs, investment execs - greed is rampant everywhere you look, it's not limited to one industry. Why would we pick on just one industry and let execs in every other get away with the exact same stuff?

:iagree: I was referring to most top executives of many companies when I was referring to their robber baron like salaries:)

 

Of course, I do not think all top executives of private companies are like robber barons. I know of some honorable businessmen who did not feel a need to milk a company for all it is worth at the expense of everyone else. Of course, I strongly believe in capitalism, making a profit, and entrepreneurism:) I just do not condone robber baron like activity;)

Edited March 14, 2010 by priscilla
clarify

[aude sapere]

In reading through this thread, I am in awe of the passionate, insightful, reasoned responses. Priscilla, mcconnellboys, dwkilburn1 - you bring up excellent issues!

 

Perhaps you could lend your collective wisdom to the following question:

Is health care a right? Do I have a "right" to medicine, doctors, x-rays?

 

I believe in taking care of each other. I believe we should help those in need. But I'm not sure that health care is a right. And if it's not a "right," then how do we, as a society, provide that compassionate care? What mechanism do we use?

 

For example, let's say "Joe" lives in a town of 100 people. "Joe" has a right to health care, and breaks his leg. Since he has a right to health care, someone in that town must be a doctor. To set a broken leg, Joe needs x-rays. Someone must be a radiographer. If Joe needs pins placed, then someone needs to be a surgeon, an anesthesiologist, a surgical nurse, a post-op nurse. If Joe needs to stay in a hospital, then that hospital must be staffed - round-the-clock nursing care, food service, orderlies, nurses aides, etc.

 

Out of a town of 100 people, at least 30 are now engaged in health services to provide "Joe" his right.

 

I agree Joe needs care, but does it make sense to order 30 people in his town to provide it? What if those 30 people wanted to be lawyers, teachers, artists? How can it be a right, if it denies other people freedom?

[Laura Corin]

I agree Joe needs care, but does it make sense to order 30 people in his town to provide it? What if those 30 people wanted to be lawyers, teachers, artists? How can it be a right, if it denies other people freedom?

 

Our nearest town is much larger than your example but it still doesn't have a fully-fledged accident and emergency department. We need to drive half an hour to the nearest city for that.

 

Laura

[NoPlaceLikeHome]

 

 

I agree Joe needs care, but does it make sense to order 30 people in his town to provide it? What if those 30 people wanted to be lawyers, teachers, artists? How can it be a right, if it denies other people freedom?

 

As a nurse, I just do not see this happening. There will always be people who want to make a career of caring for others. I think it is human nature in many respects IMHO. People can always choose not to be healthcare provider as well. I do not see it as a freedom issue at all. I see healthcare for all as a moral imperative and I think it makes sense to pool our resources to see that happen IMO. I think if there are healthcare customers so to speak, then there will always be those willing to provide a service. Now obviously if there are conflicts of interest, a healthcare provider can always refer them to someone else.

[MeanestMomInMidwest]

In reading through this thread, I am in awe of the passionate, insightful, reasoned responses. Priscilla, mcconnellboys, dwkilburn1 - you bring up excellent issues!

 

Perhaps you could lend your collective wisdom to the following question:

Is health care a right? Do I have a "right" to medicine, doctors, x-rays?

 

I believe in taking care of each other. I believe we should help those in need. But I'm not sure that health care is a right. And if it's not a "right," then how do we, as a society, provide that compassionate care? What mechanism do we use?

 

For example, let's say "Joe" lives in a town of 100 people. "Joe" has a right to health care, and breaks his leg. Since he has a right to health care, someone in that town must be a doctor. To set a broken leg, Joe needs x-rays. Someone must be a radiographer. If Joe needs pins placed, then someone needs to be a surgeon, an anesthesiologist, a surgical nurse, a post-op nurse. If Joe needs to stay in a hospital, then that hospital must be staffed - round-the-clock nursing care, food service, orderlies, nurses aides, etc.

 

Out of a town of 100 people, at least 30 are now engaged in health services to provide "Joe" his right.

 

I agree Joe needs care, but does it make sense to order 30 people in his town to provide it? What if those 30 people wanted to be lawyers, teachers, artists? How can it be a right, if it denies other people freedom?

 

Well, I kinda think you don't want your example taken literally, but I'll go ahead and reply literally. I have actually lived in a town of 100 people. There was no healthcare in that small town. The nearest hospital was 45 minutes away. People who lived in or near that town knew and took that into account.

 

If you take any one item, you can theoretically point to numerous people who made that item available to another individual.

 

Also, this "right to healthcare" has been debated in the past, on these forums. As I recall, lines were formed, sides taken, no consensus reached.

[Catherine]

Health insurers and car manufacturers may both be large businesses, with overpaid CEOs, but there is a moral difference in the services\products that they provide that makes it more important when insurers "make a killing" than when Ford does. If Ford lays people off when it closes a plant, many of them will find other work, and the loss of availability of their product will not cause harm to anyone. When insurers drop sicker people from coverage, they may end up bankrupt, jobless, without housing, not to mention sick. Insurers can only do this because taxpayer dollars will pick up the cost of care for those people. But not until their lives have been devastated.

 

When coverage of a sick person's care goes against the bottom line, and you are a for-profit business with shareholders to answer to, it's not only advisable to drop that sick person from your rolls, it's illegal not to. And when your hospital profits from putting in more cardiac stents, won't there be some incentive to put them into people who (based on study data) will not benefit? There a case in my state right now of a private hospital having to answer in court and the legislature for greatly overusing cardiac stenting-*hundreds* of patients are involved! Think of, not only the cost, in terms of premiums, but the risks! Cardiac stenting is not a risk free procedure-some people might have even lost their lives in the process at this hospital.

 

Profit motive alone leads to too many abuses, higher costs, and tainted quality of care. It's not the best way to exclusively fund health care.

[NoPlaceLikeHome]

 

For example, let's say "Joe" lives in a town of 100 people. "Joe" has a right to health care, and breaks his leg. Since he has a right to health care, someone in that town must be a doctor. To set a broken leg, Joe needs x-rays. Someone must be a radiographer. If Joe needs pins placed, then someone needs to be a surgeon, an anesthesiologist, a surgical nurse, a post-op nurse. If Joe needs to stay in a hospital, then that hospital must be staffed - round-the-clock nursing care, food service, orderlies, nurses aides, etc.

 

Out of a town of 100 people, at least 30 are now engaged in health services to provide "Joe" his right.

 

I agree Joe needs care, but does it make sense to order 30 people in his town to provide it? What if those 30 people wanted to be lawyers, teachers, artists? How can it be a right, if it denies other people freedom?

 

I re-read your post and I do not see that services should be provided in every little town. I do not see any proponents advocating that since it would not be cost effective at all for health care services to be provided in every little town. I also can never imagine anyone, liberal or conservative, advocating forcing people into careers that they do not want:( People are free to choose where they will live. Many people already travel for health care services and choose to do so. Plus, there will always be guys and some gals who want to be paramedics and EMTs to transport you to the nearest healthcare facility;) (Ask me how I know:) Hooray for all of the first line-responders out there!!!) Why should that change? I know I will be re-locating and I will be choosing to live in area that has health care services:)

 

I see health care as a right in the sense that health insurance should be available to all regardless of pre-existing conditions or ability to pay IMHO.

Edited March 14, 2010 by priscilla

[NoPlaceLikeHome]

Health insurers and car manufacturers may both be large businesses, with overpaid CEOs, but there is a moral difference in the services\products that they provide that makes it more important when insurers "make a killing" than when Ford does. If Ford lays people off when it closes a plant, many of them will find other work, and the loss of availability of their product will not cause harm to anyone. When insurers drop sicker people from coverage, they may end up bankrupt, jobless, without housing, not to mention sick. Insurers can only do this because taxpayer dollars will pick up the cost of care for those people. But not until their lives have been devastated.

 

When coverage of a sick person's care goes against the bottom line, and you are a for-profit business with shareholders to answer to, it's not only advisable to drop that sick person from your rolls, it's illegal not to. And when your hospital profits from putting in more cardiac stents, won't there be some incentive to put them into people who (based on study data) will not benefit? There a case in my state right now of a private hospital having to answer in court and the legislature for greatly overusing cardiac stenting-*hundreds* of patients are involved! Think of, not only the cost, in terms of premiums, but the risks! Cardiac stenting is not a risk free procedure-some people might have even lost their lives in the process at this hospital.

 

Profit motive alone leads to too many abuses, higher costs, and tainted quality of care. It's not the best way to exclusively fund health care.

:iagree:

Thanks for the insightful post:)

[Slartibartfast]

My statement was not misleading. In America you are free to change companies or pay out of pocket. I never said it would be easy, or the premium would be affordable. But it is the patient's choice.

 

The insurance companies aren't, in fact, denying care. They, in specific instances, are declining to pay for the treatment. The patient is still free to change insurance companies or pay out of pocket.

 

My son is under two and will be uninsurable when he becomes too old for ours.

 

 

The solution you are presenting is not a humane one because it isn't possible for some. It is partly why people are demanding a solution.

Edited March 14, 2010 by Sis

[mcconnellboys]

I agree with your characterization of our current system of health care. Just a few of the many problems I foresee with a government run health care system is that it will be even more wasteful than our current system (simply due to the fact that it will be larger and more bureaucratic even than what we now have, as I mentioned before), will not have the money to provide the care promised to "all", and will thus be forced to look for ways to limit the care that is received. I believe such things have already been seen in other countries who adopted the same tact for health care.

 

And as someone else just mentioned regarding the dreaded "pre-existing condition" garbage - that sort of thing should absolutely be eliminated from the system. I would think most people would agree with that. If care is to be provided, then it should be provided. If the companies/agencies providing the care want to help do away with a large percentage of such "pre-existing conditions", then they need to get way, way more pro-active in the arena of promoting healthier lifestyles for their clients.

 

One arena I'm familiar with, for instance, is high-risk worker's comp trusts created by some states to help businesses get insured where they otherwise could not and would have to cease operation. Such companies generally run many, many different types of safety seminars, offer incentives, etc. to get their clients in a better state of affairs regarding their safety ratings.

 

Any type of insurance company could do way more to help encourage the health of their patients and concurrently help limit what would otherwise be an end-result of poor health for said clients somewhere down the road, sooner or later. There will still be unexpected problems, but those are not the bulk of the charges for the industry. Things like our growing obesity and diabetes rates are much, much more common problem sources, just to name a few......

 

And as our discerning friend mentioned regarding the potential of health care as a "right" - I think we all know that it's not a given "right" within our Constitution or Bill of Rights. Nor has it been deemed a "right", in general, by our court system in all cases (as yet, LOL)......

 

I think we can all agree that we think it "morally right, or correct" to provide health care across the board to all socioeconomic groups on a more equitable basis. We Americans have always had high hopes and ideals for our country. I would love to see us make such a thing happen, but how to do that best becomes the question.

 

Services must be paid for. Let's assume that we could effectively eliminate waste and most fraud so that people who work in health care are paid fairly for what they do and the costs of materials and supplies are covered as well. Where do we get the money for this?

 

In the current system proposed, many millions of people in addition to those already covered will be added to the insurance rolls of our country and covered. Even if we have enough people and supplies to serve them all, and have a way to assure proper payment, *where* does the money to do that come from?

 

If every person insured were paying some "fair share" of their portion of insurance, it might be possible. But that's not what's currently proposed, is it? Where are we going to get the money to pay for this? (I believe I know the answer to this, but it's very problematic.)

 

Will we get it from taxes? Less than half the people in this country currently pay income tax. Millions get a tax "refund" every year when they never even paid in anything.

 

The social security I paid into the system starting at age 11 is very nearly tapped out. It will certainly be gone before I am old enough to draw my paltry sum. Now there are rumblings of the government trying to take over 401K plans. If that happens, I do not expect anyone to ever be able to retire..... And when that money is tapped out, where will we turn to next for money for our insatiable machine?

 

Yes, I believe we have a right to work, and a right to purchase decent insurance to cover ourselves at a reasonable rate. I believe we have a right to receive appropriate levels of care when we need it. I believe that when we grow too old and tired or sick to work, we should be able to retire, at least in part relying on the money we laid aside for that very purpose. But *money* seems to have become an amorphous token that is pretty meaningless in terms of anything save bailing us out when we've overextended ourselves yet again, and again, and again....... We just print more, at will.

 

Our monetary system has not been based on a gold standard for decades. We can not continue to live on credit decade after decade, relying on our glory days and very little else to buy such credit from the world. The world will, at some point, pull out of U.S. interests and then where will we be? I'm afraid, if we continue at the same pace, that we will all be in the same boat.

 

The "right" we will have then, will be that we will all have the right to suffer together. I'd simply like to see us use some prudence to try to get ourselves back on a proper course NOW, before we pass a point of no return.

 

Thomas Sowell has written an interesting book about intellectuals within society. His studies demonstrate that during this last century, significantly more than at any time in past history, those with expertise in one area or other dabble into areas where they have absolutely no expertise whatsoever. And despite the fact that they are proven drastically wrong time and time again, they continue to do so. Despite the fact that their influence often results in complete catastrophe, they continue to do so. WHY do we allow this in matters that affect all of us? Why are we so taken up with fame, fortune, or expertise in any one thing that we cannot discern for ourselves when others are leading us down a wrong path? Why do we seem to have become lemmings?

[Barb_]

My statement was not misleading. In America you are free to change companies or pay out of pocket. I never said it would be easy, or the premium would be affordable. But it is the patient's choice.

 

After years of accepting premiums, denying covered treatment is unconscionable. Going without treatment because no other company will underwrite a policy for a cancer patient is no patient's choice.

 

Barb

[Catherine]

What I will say is that cost shifting in our current system moves the costs of the "uninsurable" onto medicare and medicaid, which we pay for. Administrative costs for these programs are reasonable. A large part of the current cost of medical care goes into administrative costs of private insurance, which are unreasonably high, partly because insurers have a virtual monopoly (more than 75% of the market share) in some parts of the United States.

 

Costs are driven up by inefficiency, poor communication, and defensive medicine. Maternity care is a great example of this. The American style of pregnancy and childbirth is very interventionalist, illness-model, and extremely expensive. The data on routine ultrasound during uncomplicated pregnancy? There is none that solidly supports this practice. Yet it's now "routine" in some OB practices to do 3 "routine" ultrasounds in every uncomplicated pregnancy! Plus the followup studies that are generated by this mountain of useless data. C-section rates widely differ at hospitals in the same city, with similar patient populations. Expenses like this come out of our pockets in the form of taxes and premiums. Changing this pattern won't be quick or easy, but don't imagine that we are not already paying for the uninsured. We are.

 

I don't even know that many details about current health care bills, but it was my understanding that part of the costs of insuring the uninsured will come from mandated payments for insurance coverage. The cost savings of this would be considerable, for taxpayers, because right now medicare and medicaid pay for care for young uninsured people who have medical disasters of one sort or another. Forcing people to carry insurance will save us all $$$.

[asta]

Thank you, Priscilla, for speaking for many of us!

 

I don't see anything wrong with a truth commission on abuses in all sorts of industries. You have to start somewhere, and it seems Americans may be willing to start with health care insurance companies. And hopefully that will be just the beginning!

 

China had truth commissions during the Cultural Revolution.

 

When coverage of a sick person's care goes against the bottom line, and you are a for-profit business with shareholders to answer to, it's not only advisable to drop that sick person from your rolls, it's illegal not to.

 

 

And, what ever happened to health insurance being, well insurance?

 

This was addressed in another thread awhile ago: Health insurance is a rather recent invention. It was designed to protect against catastrophic health problems that would completely bankrupt a person. It was never supposed to be something wherein a person paid a $10 copay to see their PCM for a strep test. Or even something to pay for a more extensive situation like having a baby (even a C-section!).

 

Health insurance has become "I'm going to pay you X dollars a year and I want Y amount of coverage in return. And if I don't get it, or if I use 100 times more than your average customer and you raise my rates, I'm going to sue you".

 

No wonder "the system" has failed. It was designed to do one thing, people expected it to do something completely different, and the smart money was on the financiers who figured out how to leverage the difference.

 

 

a

[Tea Time]

This was addressed in another thread awhile ago: Health insurance is a rather recent invention. It was designed to protect against catastrophic health problems that would completely bankrupt a person. It was never supposed to be something wherein a person paid a $10 copay to see their PCM for a strep test. Or even something to pay for a more extensive situation like having a baby (even a C-section!).

 

Health insurance has become "I'm going to pay you X dollars a year and I want Y amount of coverage in return. And if I don't get it, or if I use 100 times more than your average customer and you raise my rates, I'm going to sue you".

 

No wonder "the system" has failed. It was designed to do one thing, people expected it to do something completely different, and the smart money was on the financiers who figured out how to leverage the difference.

 

 

a

 

This is very true. As others have noted, this model seems to have taken place in several other areas as well such as the cost of college. As soon as money begins to flow into something from outside of the supply/demand system (regardless of what that outside system is, whether it be a private company or the government), then the whole thing inflates to proportions that no longer allow the "customer" to pay. Once the service provider and the customer are thus disconnected, the provider no longer answers to the customer who no longer pays him, then prices and services are also no longer directly connected.

 

Same thing when you look at car warranties. You almost can't have a car without one anymore for two reasons: 1) You can't pay the prices for repair work because they become so inflated, 2) You can't really be sure that said work needs to be done since you must take the shop's word that the problem actually exists. Of course much less is riding on those decisions (taking into consideration the accidental pun, that may not be true).

 

It is important to remember though that this huge money flow also makes possible things that might never have happened if the connection had remained direct and cheap. That is to say that research and development of new drugs and procedures might well have stagnated due to lack of funding. If there is not a huge payoff possible then huge risks will not be taken.

 

The result of all this reform may be that everyone will get their throat cultures, but there will be no more innovative cures for diseases. It is much like public education. Everyone has one available, but the overall quality has deteriorated over many years. You get "free schooling" but not a "free education." One thing is promised, but is it ever delivered? I am not sure that is a good trade off. I can see both sides though. It is good for some who would otherwise have nothing, but not so good for others who could have had better. A trade off.

 

Has anyone ever heard of a system that went in this direction that eventually was "reformed" to be more affordable again yet not lose quality?

[aude sapere]

After years of accepting premiums, denying covered treatment is unconscionable. Going without treatment because no other company will underwrite a policy for a cancer patient is no patient's choice.

 

Barb

 

In the article linked by the OP, the gentleman had insurance, and was not denied treatment. "Backed by robust medical insurance provided by a succession of my corporate employers, we were able to wage a fierce battle."

[spradlin02]

Also, this "right to healthcare" has been debated in the past, on these forums. As I recall, lines were formed, sides taken, no consensus reached.

 

It's hard to find consensus when the focus is on the area's of disagreement. With any debate, it seems to me that the opposing factions become so entrenched in the emotion of their perceived righteousness, that to allow ground to the "other side" would be the equivalent of defeat. Finding solutions is not about prevailing in the melee, but understanding the validity and contributions of the disparate beliefs. Unfortunately, that can be a very difficult thing to do.

 

As one wraps oneself in external identification, in this case political ideologies, there is incentive to defend and argue for the perceived correctness of that guise; if the integrity of the given facade deigned invalid, then one's identity itself is called into question.

 

Frankly, I don't feel that the fundamental values have been articulated all that well in this concern. I hear the discussion focusing around "big government" vs. "free-market", but that, in my opinion, complicates the discussions and wraps it in identity politics. Unfortunately, until this, or any discussion can be disentangled from political self-identification, there is very little ground that can be made toward civil discourse. IMHO. :ack2:

 

I will complement the tone of this discussion in that it does seem rather civil. I feel there is a lot more agreement in matters of health than is generally admitted to.

Edited March 15, 2010 by spradlin02