Let's Talk About Health Care!

Off Topic Politics & World Issues
161

[quote]orion wrote:
DrSkeptix wrote:
Tiribulus wrote:
Not necessarily taking sides, but the environment for a true comparison doesn’t exist because we’ve never had a thoroughly market based medical industry.

What you’re asking him to do overlooks that fact. How can somebody explore their options without the FDA if the FDA has seen to it that no such options exist? The market has never had to handle what you’re talking about exactly because of the very FDA you’re now telling him to forgo in his research.

You’re assuming the truth of your assertion on the basis that it simply is, but that does not address what might have been in the marketplace in the absence of an FDA style agency.

What might have been in the marketplace in the absence of an FDA style agency?

Oh? OK. How another hypothetical that proves my contention?

Let’s say a woman is pregnant and has terrible nausea…a common event. In our mythical country, there is no FDA, but there is free access to new products. There is a product, which is advertized for the relief of the nausea of pregnancy. It works perfectly, and it is only a little sedating, so nightly use is possible. It has been in use in England and Europe for years, and is beating out the competition. In Canada, it is already in use and drug company representatives have started to drop off samples in doctors’ office.

So we have it all: no FDA-style agency to regulate a medicine, in use for years elsewhere, effective and beating the competition in a competitive free market. Pregnant women in the US deserve to be able to buy it as informed consumers.

…

Only this is not a hypothetical.

Thalidomide had been in use in Europe and England, it was there deemed safe and effective, and “detail men” had started sampling in Canada and the company wanted clearance in the United States. Studies in pregnant rabbits even confirmed safety.

Only one reviewer, a woman, at the US FDA stopped thalidomide. She said the information was inadequate, and she had just read some reports on a rare congenital abnormality, amelia, occurring in Europe. The drug company denied any connection.
She stopped Thalidomide from approval. (It turned out that metabolism in rabbits is different to that of humans.) The US avoided the epidemic of malformed babies.

So, there were places and times where market forces in the pharmaceutical industry were unrestrained, contrary to your assertion, and the risks of that market could not have been predicted by consumers.

I can tell you that drug companies, were they not thus contrained to perform studies and pass FDA, would be selling snake oil and thalidomide-equivalents to the unsuspecting public.
(And hence my homework assignment to orion, for which he seems to need more that 5 minutes on the internet to answer my subterfuge.)

Yes, that is their one big success story.

[/quote]
No. Actually, there are dozens of such success stories…you just have not heard of them. There are medicines, procedures and devices, all with some initial enthusiasm, or challenging scientific theory, or positive anecdote, which have proven useless and/or harmful in careful human studies, and denied approval.

I don’t know. Do you?
While you are at it, how many people were spared useless, harmful and expensive drugs?

A fair question. It is actually under review.
Incidentally, in such a situation, your death or experience would have to be recorded and analyzed by an agency like the FDA. Online chat rooms would not do at all.

But in the 1960s, that was also the case, but not to degree currently, because of the Thalidomide experience. If pregnant women can learn from the public experience, the FDA performed one of its jobs.
…
Now then, orion, if information in the age of the internet is so readily accessible, without government, and any rational economic unit can decide for himself the utility of a medicine, will you buy Tarceva for pancreas cancer?
Practice, not theory, please. Or praexis if you prefer; does your policy actually achieve the desired goals?

162

[quote]DrSkeptix wrote:
orion wrote:
DrSkeptix wrote:
Tiribulus wrote:
Not necessarily taking sides, but the environment for a true comparison doesn’t exist because we’ve never had a thoroughly market based medical industry.

What you’re asking him to do overlooks that fact. How can somebody explore their options without the FDA if the FDA has seen to it that no such options exist? The market has never had to handle what you’re talking about exactly because of the very FDA you’re now telling him to forgo in his research.

You’re assuming the truth of your assertion on the basis that it simply is, but that does not address what might have been in the marketplace in the absence of an FDA style agency.

What might have been in the marketplace in the absence of an FDA style agency?

Oh? OK. How another hypothetical that proves my contention?

Let’s say a woman is pregnant and has terrible nausea…a common event. In our mythical country, there is no FDA, but there is free access to new products. There is a product, which is advertized for the relief of the nausea of pregnancy. It works perfectly, and it is only a little sedating, so nightly use is possible. It has been in use in England and Europe for years, and is beating out the competition. In Canada, it is already in use and drug company representatives have started to drop off samples in doctors’ office.

So we have it all: no FDA-style agency to regulate a medicine, in use for years elsewhere, effective and beating the competition in a competitive free market. Pregnant women in the US deserve to be able to buy it as informed consumers.

…

Only this is not a hypothetical.

Thalidomide had been in use in Europe and England, it was there deemed safe and effective, and “detail men” had started sampling in Canada and the company wanted clearance in the United States. Studies in pregnant rabbits even confirmed safety.

Only one reviewer, a woman, at the US FDA stopped thalidomide. She said the information was inadequate, and she had just read some reports on a rare congenital abnormality, amelia, occurring in Europe. The drug company denied any connection.
She stopped Thalidomide from approval. (It turned out that metabolism in rabbits is different to that of humans.) The US avoided the epidemic of malformed babies.

So, there were places and times where market forces in the pharmaceutical industry were unrestrained, contrary to your assertion, and the risks of that market could not have been predicted by consumers.

I can tell you that drug companies, were they not thus contrained to perform studies and pass FDA, would be selling snake oil and thalidomide-equivalents to the unsuspecting public.
(And hence my homework assignment to orion, for which he seems to need more that 5 minutes on the internet to answer my subterfuge.)

Yes, that is their one big success story.

No. Actually, there are dozens of such success stories…you just have not heard of them. There are medicines, procedures and devices, all with some initial enthusiasm, or challenging scientific theory, or positive anecdote, which have proven useless and/or harmful in careful human studies, and denied approval.

It does raise two questions though.

First, how many people are dying unnecessarily each year or suffer without reason because the FDA plays it extra safe? How many diseases will never be cured because it costs a staggering 1 billion dollar to let a drug jump through all the hoops?

I don’t know. Do you?
While you are at it, how many people were spared useless, harmful and expensive drugs?

Second, why can�?�´t I not put into my body whatever I want if I have a serious illness? Yes, I might poison myself, but even then that might help the next person to suffer from the same thing. Especially if my life expectancy was limited, why could I not roll the dice and try to help me and others?

A fair question. It is actually under review.
Incidentally, in such a situation, your death or experience would have to be recorded and analyzed by an agency like the FDA. Online chat rooms would not do at all.

Why do people seem to owe it to the almighty collective to die a senseless death while the FDA tries to figure shit out?

Why can people not grasp for straws?

PS: As a PS I would like to point out that probably very few people would take something to treat morning sickness that was not thoroughly studied. Pregnant women tend to care what they put into their body.

But in the 1960s, that was also the case, but not to degree currently, because of the Thalidomide experience. If pregnant women can learn from the public experience, the FDA performed one of its jobs.
…
Now then, orion, if information in the age of the internet is so readily accessible, without government, and any rational economic unit can decide for himself the utility of a medicine, will you buy Tarceva for pancreas cancer?
Practice, not theory, please. Or praexis if you prefer; does your policy actually achieve the desired goals?[/quote]

I refer you to Tiribulus post.

It is highly unfair to demand to see the the private equivalent of the FDA after the FDA has crowded them out.

163

There is of course still the point that there are a plethora of relatively rare diseases that will never be cured as long as approving new drugs is so darn expensive.

We will have boner and fat loss pills though, because they sell.

164

[quote]PRCalDude wrote:
DrSkeptix wrote:

The benefits you cite–declining infant mortality, improved life expectancy, peripartum mortality–in large part was achieved through public health measures: chiefly, sewers. And some medical interventions like hand-washing.

And vaccinations, sterilization of medical instruments, etc. A lot of things were invented during wars (first aid).

People didn’t wake up one morning and say to themselves, “Gee, let’s build a sewer system and see what happens!” No, they were advised by the scientific community to do so.

My point remains valid: for the past several hundred years, medicine has gotten along fine by itself.

You will note that the construction of sewers is a “collectivist” notion.

Uh, no, I won’t.

Repeating myself: medical care is different than “preventive medicine.”

Really? Don’t you always hear doctors advising patients to lose weight and quit smoking? There is still very little doctors can do for you once you’ve screwed yourself up. They can delay the inevitable, but not avoid it altogether. Patient behavior still has to change drastically for outcomes to improve in a good number of illnesses, especially the illnesses that have a high prevalence and morbidity in this country like type II diabetes, heart disease, lung cancer, stroke. My wife is a dietitian and she sees patients all the time with things marked on their chart by doctors like, “Patient has every known risk factor.”

Some of us, having dealt with medical doctors, are far less optimistic about what they can actually do when you’re screwed up.

OK, then, abandoning dogma, practicalities: what will happen if, overnight, insurance and government stop paying?

–I can’t afford the purchases, my services stop. I can’t afford rent, salaries, all the overhead costs. I close shop with about 200,000 others.

You’d re-open later with a new business model if you wanted to keep eating.

–People who actually need medical services to live or recover–they are s-o-l, trying to barter their way to care. Deaths and morbidity climb. (If you doubt this, read up on how medical care changed after the fall of the Soviet Union. I guess private market medicine triumphed there, too.)

Are you honestly pointing to the USSfreakingR as a positive example? Russians are dropping like flies for several reasons. The fact is, Russia STILL HAS a system of socialized medicine - just an underfunded one (socialized medical systems, like government schools, are always “underfunded”).

Russians are using wire-hanger abortions as a form of birth control. That tends to lower population life expectancies, doesn’t it?

Russian men are drinking themselves to death. That affects life expectancy.

HIV is out of control there for the normal reasons HIV gets out of control. That affects life expectancy.

Russia is an ex-KGB run kleptocracy. Nothing has actually changed there since the end of the USSR, and the Russian medical system had already decayed to its current nadir PRIOR to the official collapse of the USSR (which is still very much in existence).
http://countrystudies.us/russia/53.htm

–You think that prices will fall, instantly and harmlessly? Wrong again. The facilities–xray departments, labs, surgicenters, hospitals, etc.–have all been capitalized based on anticipated earnings and costs. If the earnings are not there, the interest and principal payments are insecure, and the facilities close their doors, or go bankrupt. WIll modern drugs become cheap or scarce? I vote for scarce.

If we parse your sentence carefully, we uncover a huge part of the problem:
“have all been capitalized based on anticipated earnings and costs”

The “anticipated earnings” are based on bad assumptions and models altogether, much like the late credit default swap market that tanked the global economy. You guys “anticipate” earnings from Medicare, Medical, Medicaid, etc - earnings that shouldn’t be there in the first place due to their dependence on government meddling, robbery, and funny munny. The models upon which you base your capitalization schemes work on a “garbage in, garbage out” basis. Start capitalizing your business like everyone else and see if things don’t improve. You guys think you’re “too big to fail,” therefore you should never have to suffer the indignities of chapter 11 re-organizations like everyone else when you make bad business decisions. Now, we’re told we need even MORE government intervention to bail out the “failing medical system” - we’re going to socialize the whole damn thing. It’s the logical conclusion of your line of thinking. USSR, here we come!

The Soviet phase of the American “republic” is going to be a wild ride. I’m going to start stilling my vodka now.

[/quote]

You have missed my reasons for distinguishing “medical care” from “preventive medicine.” It is a policy question. They are different animals.
You have missed the obscure point I was making about the USSR. After the end of all that, doctors converted from taking bribes to taking barter. The resourceless sick suffered for years. Is this the practical outcome which you desire?

If I close my practice, I stop working and I finally get that gym time in. If doctors close their practices, who, in their right minds, would risk the capital to step in to the same office, and start over? If you are sure of the answer, just ask engelander if he would like to assume that risk with no viable business plan, no projected income, a barter and cash market. If orion thinks he knows the costs and rewards, he is welcome to come over here and start right away.

So, you did not answer my question. How many years would it take to set things right? And who suffers in the meantime.

I have made my points, perhaps poorly, but there is no need for me to discuss the dogma of the free market (“insurance is wrong on principal”), or abolishing the FDA, as if they were the only viable solutions.

165

Here is a good assessment against.

166

[quote]orion wrote:
DrSkeptix wrote:
orion wrote:
DrSkeptix wrote:
Tiribulus wrote:
Not necessarily taking sides, but the environment for a true comparison doesn’t exist because we’ve never had a thoroughly market based medical industry.

What you’re asking him to do overlooks that fact. How can somebody explore their options without the FDA if the FDA has seen to it that no such options exist? The market has never had to handle what you’re talking about exactly because of the very FDA you’re now telling him to forgo in his research.

You’re assuming the truth of your assertion on the basis that it simply is, but that does not address what might have been in the marketplace in the absence of an FDA style agency.

What might have been in the marketplace in the absence of an FDA style agency?

Oh? OK. How another hypothetical that proves my contention?

Let’s say a woman is pregnant and has terrible nausea…a common event. In our mythical country, there is no FDA, but there is free access to new products. There is a product, which is advertized for the relief of the nausea of pregnancy. It works perfectly, and it is only a little sedating, so nightly use is possible. It has been in use in England and Europe for years, and is beating out the competition. In Canada, it is already in use and drug company representatives have started to drop off samples in doctors’ office.

So we have it all: no FDA-style agency to regulate a medicine, in use for years elsewhere, effective and beating the competition in a competitive free market. Pregnant women in the US deserve to be able to buy it as informed consumers.

…

Only this is not a hypothetical.

Thalidomide had been in use in Europe and England, it was there deemed safe and effective, and “detail men” had started sampling in Canada and the company wanted clearance in the United States. Studies in pregnant rabbits even confirmed safety.

Only one reviewer, a woman, at the US FDA stopped thalidomide. She said the information was inadequate, and she had just read some reports on a rare congenital abnormality, amelia, occurring in Europe. The drug company denied any connection.
She stopped Thalidomide from approval. (It turned out that metabolism in rabbits is different to that of humans.) The US avoided the epidemic of malformed babies.

So, there were places and times where market forces in the pharmaceutical industry were unrestrained, contrary to your assertion, and the risks of that market could not have been predicted by consumers.

I can tell you that drug companies, were they not thus contrained to perform studies and pass FDA, would be selling snake oil and thalidomide-equivalents to the unsuspecting public.
(And hence my homework assignment to orion, for which he seems to need more that 5 minutes on the internet to answer my subterfuge.)

Yes, that is their one big success story.

No. Actually, there are dozens of such success stories…you just have not heard of them. There are medicines, procedures and devices, all with some initial enthusiasm, or challenging scientific theory, or positive anecdote, which have proven useless and/or harmful in careful human studies, and denied approval.

It does raise two questions though.

First, how many people are dying unnecessarily each year or suffer without reason because the FDA plays it extra safe? How many diseases will never be cured because it costs a staggering 1 billion dollar to let a drug jump through all the hoops?

I don’t know. Do you?
While you are at it, how many people were spared useless, harmful and expensive drugs?

Second, why can�??�?�´t I not put into my body whatever I want if I have a serious illness? Yes, I might poison myself, but even then that might help the next person to suffer from the same thing. Especially if my life expectancy was limited, why could I not roll the dice and try to help me and others?

A fair question. It is actually under review.
Incidentally, in such a situation, your death or experience would have to be recorded and analyzed by an agency like the FDA. Online chat rooms would not do at all.

Why do people seem to owe it to the almighty collective to die a senseless death while the FDA tries to figure shit out?

Why can people not grasp for straws?

PS: As a PS I would like to point out that probably very few people would take something to treat morning sickness that was not thoroughly studied. Pregnant women tend to care what they put into their body.

But in the 1960s, that was also the case, but not to degree currently, because of the Thalidomide experience. If pregnant women can learn from the public experience, the FDA performed one of its jobs.
…
Now then, orion, if information in the age of the internet is so readily accessible, without government, and any rational economic unit can decide for himself the utility of a medicine, will you buy Tarceva for pancreas cancer?
Practice, not theory, please. Or praexis if you prefer; does your policy actually achieve the desired goals?

I refer you to Tiribulus post.

It is highly unfair to demand to see the the private equivalent of the FDA after the FDA has crowded them out.

[/quote]

If you both would like to know what the market was like before the FDA, I would refer you to Upton Sinclair, The Jungle. It positively has me quivering with desire for the good old days of the free market.

You presume that the pharmaceutical industry and the public somehow would have a self-policing agencies to review their products.

Just like Armour Meatpacking had regard for the pigs.

167

[quote]DrSkeptix wrote:

You have missed my reasons for distinguishing “medical care” from “preventive medicine.” It is a policy question. They are different animals.

[/quote]
To you, they are. To everyone else who pays for things without government bailouts and screams of “To big to fail!” an ounce of prevention is worth a pound of cure.

Why were the sick “resourceless”? They were resourceless because they lived under a Communist system for 70 years that made everyone equally poor. You’re advocating the same thing for the health care industry because you believe your industry is “too big to fail.” Logically, there are many other industries that could make the same claim. People will starve to death without food. Why not allow the government to take over the means of food production and distribution?

[quote]
If I close my practice, I stop working and I finally get that gym time in.[/quote]
No, you won’t. YOu’ll be out on the street pounding pavement for a new job in another industry or else coming up with a viable business plan for the industry you’re in right now. Or you won’t eat.

The same people that make small business loans. Resourceful doctors will get loans and then get on Ebay to purchase equipment from stick-in-the-mud doctors who can’t seem to change with the times like everyone else. “I’m a doctor! I’ll be damned if I’m coming up with a business plan! Waaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaah!”

Every business in existence TODAY works in a “barter and cash market.” There are barter houses set up so that capital goods can be exchanged and inventories can be dealt with. Do you know a single thing about business? The reality is, doctors believe that there should be special rules for them, that they shouldn’t have to follow sound business practices, that everyone else should bail out their industry when they can’t run things right. In short, they’re like banksters. Doctors are a close-minded, insular group with a lot of hubris and a lot of influence over public policy. And for all intents and purposes, they are essentially ignorant of how businesses run for mere mortals.

I don’t know. But I do know one thing as a patient: I would greatly prefer a “cash and barter system” to the government taking over my care and rationing it as they see fit. I don’t want the same people who run the government running my health care.

I don’t actually have a problem with the FDA. I’m fine with regulatory bodies. I’m not fine with the inflationary pressure of government spending on the cost of health care. I’m not fine with people asking for government bailouts when they can’t make things work for a profit.

168

[quote]PRCalDude wrote:
DrSkeptix wrote:

… In short, they’re like banksters. Doctors are a close-minded, insular group with a lot of hubris and a lot of influence over public policy. And for all intents and purposes, they are essentially ignorant of how businesses run for mere mortals.

… [/quote]

…and conversely…

I don’t know, PRC. Such early promise, and so little understanding of the subject.

I find it strange that people yearn for the past, in the sense that they just know that if they could erase it, and put things in order according to some dogmatic ideology, things would be just perfect.

It isn’t so and it isn’t going to happen that way. We do the best we have with the tools we have, and I do not have a clock that runs backwards with an eraser attached.

What I do have is some practical, achievable suggestions–oh, and they do rely on some market principals–but if all I read is dogma in response, there is no purpose in posting them.

169

[quote]PRCalDude wrote:
DrSkeptix wrote:

…

I don’t actually have a problem with the FDA. I’m fine with regulatory bodies. I’m not fine with the inflationary pressure of government spending on the cost of health care. I’m not fine with people asking for government bailouts when they can’t make things work for a profit. [/quote]

But with these, I agree.

170

[quote]DrSkeptix wrote:
PRCalDude wrote:
DrSkeptix wrote:

… In short, they’re like banksters. Doctors are a close-minded, insular group with a lot of hubris and a lot of influence over public policy. And for all intents and purposes, they are essentially ignorant of how businesses run for mere mortals.

…

…and conversely…

I don’t know, PRC. Such early promise, and so little understanding of the subject.

I find it strange that people yearn for the past, in the sense that they just know that if they could erase it, and put things in order according to some dogmatic ideology, things would be just perfect.

It isn’t so and it isn’t going to happen that way. We do the best we have with the tools we have, and I do not have a clock that runs backwards with an eraser attached.

What I do have is some practical, achievable suggestions–oh, and they do rely on some market principals–but if all I read is dogma in response, there is no purpose in posting them.

[/quote]

I have little expectation that “things would be perfect” - far from it. I do think, that taken to their logical conclusion, ideas that most doctors espouse regarding how medical care ought to be financed will result only in socialized medicine. That is precisely what we’re seeing now in Obamacare. And every doctor I’ve talked to for the past 10 years smugly supports such a system. Well, they’re going to get it. And they will rue the day they did.

No one - I mean, no one - can keep their costs low enough to compete with the inflationary pressures of government spending in a certain field. The defense industry is a prime example - it’s basically a big planned economy and it takes decades and billions to get anything accomplished for no real benefit to the US consumer. Now we’re going to do it with medicine, and I’m frankly pretty scared. The Obamacare bill is basically a license for the government to own you. While I think a cash system would be far from perfect, I think it would be a million times better than Obamacare.

I also fail to see how if the government stops pouring money into medicine (again, it already pays for 2/3 of all medical expenses in this country), medical science will grind to a screeching halt and only the Bill Gateses amongst us will be seeing a doctor. It’s just not going to work out in the Doomsday fashion you think it will.

171

In case you were lacking something truly infuriating on your reading list:

[from the latest issue of the Journal of the NCI]

MEMO TO THE MEDIA

How much is life worth? The $440 Billion Question

The decision to use expensive cancer therapies that typically produce only a relatively short extension of survival is a serious ethical dilemma in the U.S. that needs to be addressed by the oncology community, according to a commentary published online June 29 in the Journal of the National Cancer Institute.
Tito Fojo, M.D., Ph.D., of the Medical Oncology Branch, Center of Cancer Research at the National Cancer Institute, in Bethesda, Md., and Christine Grady, Ph.D., of the Department of Bioethics, the Clinical Center at the National Institutes of Health, tackle the controversy concerning the life-extending benefits of certain cancer drugs and the extent to which their cost should factor in deliberations.

The authors illustrate cost-benefit relationships for several cancer drugs, including cetuximab for treatment of non-small cell lung cancer, touted as “practice changing” and new standards of care by professional societies, including the American Society of Clinical Oncology.

They ask, “Is an additional 1.7 months [the additional overall survival for colorectal cancer patients treated with cetuximab] a benefit regardless of costs and side effects?”

According to Fojo and Grady, in the U.S., 18 weeks of cetuximab treatment for non-small cell lung cancer, which was found to extend life by 1.2 months, costs an average of $80,000, which translates into an expenditure of $800,000 to prolong the life of one patient by 1 year. At this rate, it would cost $440 billion annually, an amount 100 times NCI’s budget, to extend the lives of 550,000 Americans who die of cancer annually by 1 year.

To address the issue, the commentators recommend that studies powered to detect a survival advantage of two months or less should test only interventions that can be marketed at a cost of less than $20,000 for a course of treatment.

Every life is of infinite value, the authors say, but spiraling costs of cancer care makes this dilemma inescapable.

“The current situation cannot continue. We cannot ignore the cumulative costs of the tests and treatments we recommend and prescribe. As the agents of change, professional societies, including their academic and practicing oncologist members, must lead the way,” the authors write. “The time to start is now.”

http://www.eurekalert.org/jrnls/jnci/Fojo.final.djp177.pdf

Uhh…the time to start was 15 years ago.

172

[quote]Tiribulus wrote:
DrSkeptix wrote:
<<<< This abstract speculation might be far from HeavyThrower’s intent, but it ain’t so abstract for me. We, as a society, are about to impose further rationing on all of us, in the cause of serving more of us.

However you might wish it, the egg will not be unscrambled: there will be no ideal free market in medical care. (Maybe, if we are lucky, there will be a competitive market in insurance services.) Some kind of jerry-rigged “plan” will pass, and I guarantee that it will not be rational, socially efficient, or transparent.
So, find your congressmen and e-mail them.

Maybe I’m dense or slow or both. Could you please tell us what you think is the best course of action today? I’m asking in all sincerity.

[/quote]
Bump, and re-direct:

Meanwhile, re: the Vet I tried to help
I made the diagnosis of Hodgkin’s Disease in 2 days, and I had him staged and ready to go in 4 days.
But…

…he needed to correct his insurance from TriCare Prime to TriCare Standard.
So he called them
They cancelled his insurance, and instead of transferring coverage, the expunged him from their computers.
Or so they say.
Now, 2 weeks later, he is without insurance, won’t be seen at the VA, and I have write emergency letters to try to get MediCaid for him.
(He could have been halfway to cure by now.)

What kind of “system” is that?
Am I supposed to entrust either the insurance industry, or the government, with health care management???

173

Seeing as how I was copying and pasting doc’s posts in another thread, I might as well bump this one.

174

[quote]heavythrower wrote:
fraggle wrote:
When you talk about dwindling resources, do you mean cash, or manpower.

…
problem is, in our system we get paid to treat diseases. without a diagnosed disease, we have no treatment(procedure/surgery/drugs) to prescribe, and then no reimbursement. so we test, test, test.

a 90 year old with a 3 pack a day smoking history for last 70 years comes in with a bad cough. a chest x-ray ($50) shows a spot. that leads to a CAT scan($1500), THAT LEADS TO AN mri($3000), AND possibly a PET scan($5000?). then chemo and or surgery and lengthy complicated hospital stay($$$$$$$$$$$$) all to provide 6 months to a couple of years of shitty quality of life to a very sick old person.

there is no way to test and prescribe quality of life or prevention, so no reimbursement, so no way. but under our system, we go ALL OUT on everybody, but we wait until a big disease is found and then its too late and too expensive.

here is a stat for you, did you know, that over 90% of the total money spent on your healthcare will be spent in the last few weeks of your life??? think about that one.[/quote]

For HT, if you are still out there.

This last “statistic,” that 90% of all money spent on health care didn’t seem quite right to me. Here are some published figures:[i]
–Nearly one third of terminally ill patients with insurance used up most or all of their savings to cover uninsured medical expenses such as home care.

–27 to 30 percent of Medicare payments cover the cost of care for people in the last year of life.

–4 percent of Medicare dollars cover care for people in the last month.

–12 percent of Medicare spending covers people who are in the last two months.

–10 percent of Medicare beneficiaries account for 70 percent of program spending.[/i]

We have seen wilder numbers thrown around–as high as 50% spent in the last year. Some of this is just silly. But, HT, for those readers who are not in “the business,” how can such an imbalance come to be?

Doctors do no know the appointed time of death. It is not just a matter of poor education or judgment or greed–although I have seen that–it is a matter of, well, the intersection of statistics and ethics.
Most diseases do not have a predictable outcome; i.e. 100% of people are dead at some time. For most diseases at various stages, there is skewed distribution, with a finite tail of survival extending for years. An example:
Let’s imagine a man (age 65 and not 90) who has lung cancer and a single metastasis, an “incurable” situation (i.e., there is a continuous risk of future relapse). Most doctors would consider this a lethal disease, with 100% mortality in 8 months. Not so. Let’s say, for illustration, that 50% are dead in one year, but 10% are alive beyond 2 years–with treatment. Who should I treat? I cannot know in advance with confidence, and so I cannot reliably separate the doomed from the saved. Half the people I treat will be treated futilely, but I do not know that in advance. And some number of men will be alive for years, either because of, or despite, my efforts.
But when you look at total expenditures, the aggregate figures look ridiculous. But taken as a series of individual decisions, undertaken with uncertainty, expenditures in the “last year” of life may not be so inexplicable, or categorically wasteful.

It would be so much easier to have a Panel of Experts determine that at age 65, a year of life is worth only $30,000 (as in Britain), and no expenditures should exceed that. But then, 10–or even 50–in 100 would be denied life-saving therapy arbitrarily.

The question then becomes, “Who decides, and by what right?”

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Great thread. Thank you, Dr. Skeptix.

176

I would also like to say, thank you Dr. Skeptix and HT for your views and I hope you continue posting on these subjects.

177

[quote]bignate wrote:
i for one feel that we are a country of paradoxes as i cant place the name of the author who wrote: America, a paradox or something along those lines,
but i feel we always demand more from our government which would mean we need to put more into the govt.

aka more taxes, but we would never agree to that, some countries such as the netherlands have a highest tax rate of almost 50% for the rich, but all of the money goes back to the people, they get paid vacations from the govt.

when they have children they are given monthly chewcks to cover that. We are afraid of thing labeled as socialism or communism ideals because of their names. We claim that they take away individualism.

Buy can you define yourself through what you make and your possessions? of course you can, and thats limited in these govts, but they do not limit who you are which people always seem to forget. I for one think that if we really want to push for better and nation healthcare we need to raise taxes or create some sort of revenue to expand the business[/quote]

You didn’t just say bigger government did you? No way did you just say that. I’d rather die than have a government without the support of special interest groups backing them tell me how to stay healthy.

Wait.

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[quote]heavythrower wrote:
As a health care professional for over 15 years, frankly i am more than a little tired of hearing various politicians, pundits, and frankly, people on this site who have no idea what is really going on today. instead of posting a long winded rant that would be far to long for anyone to read, i have started this thread as a question and answer type forum, in which i welcome any other members with experience in the health care field or insurance side of things to create a place to voice concerns or ask questions.

What troubles me as a practicing nurse in a very busy ED/regional trauma center is the increasing gap between what the public expects from the current health care system and the what it can deliver with the ever dwindling resources available.

I am not about to marginalize myself or this discussion to the simple prospect of socialized medicine vs private insurance, too many would take their sides and it would be a pissing match back and fourth drawn upon partisan/ideological lines that would produce the typical arguments and cliches.

Suffice it to say, the systems as it exists, is collapsing, and cannot continue much longer. take it from and "insider", all of us are about to have to face some very hard choices and get a serious reality check in the very near future. 

[/quote]

How do you feel about making it so hospitals do not have to see you?

as stated previously, having a waivor with your taxes stating the hospitals are not liable if you chose not to have insurance and do not have proof you can pay or do pay up front.

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As I was saying, on the coming shortage in medical professionals:

Dr. Pardes is being conservative in his estimates: he does not account for early retirement of trained and experienced doctors which will be precipitated by national health care and cost controls.

For example, even if there is no 20% reduction in MediCare payments in 2010, I nevertheless face a 6% reduction in compensation because of mandated cuts. Now, this would be unimportant, except that my costs for meds are already paid at less than replacement costs. If the compensation for services falls, and if I were driven by the profit motive only, I would stop seeing and caring fro MediCare patients.

Polltically, doctors are their own worst enemies in all of this.
Some reject the AMA’s crass capitulation to ObamaCare; and they still can’t project an idea at once conservative and attractive:

Note where Dr. Palmisano asserts that the MediCare enabling legislation prohibits the government to price-fix and to interfere in the business of government. And nevertheless, we have price-fixing and interference. The broader lesson, of course, is that whatever legislation is sold to Congress, something very different will evolve from the invisible hands of bureaucrats and regulators.

180

Well, then, for those of you who denied that Obamacare would bring rationing, how about a nice, convincing recess appointment to start off the gambit?

“Recent reports suggest that the recently passed health-care bill will be far more expensive than originally projected. As it becomes apparent that Obamacare is unsustainable, the calls for controlling its costs through rationing will grow louder. With Donald Berwick running the government’s health-care efforts, those voices have a ready ear” (dailycaller.com, May 27).

By then, Berwick will be involved in the government-controlled health of more than 100 million Americans and - notes Michael Tanner - “Maybe those worries about death panels weren’t so crazy after all.”

Keep in mind that already, in May, “the Congressional Budget Office updated its cost projections (of Obamacare). It found that the new health legislation would cost $115 billion more than estimated when it was enacted (“ObamaCare’s Ever-Rising Price Tag,” Wall Street Journal, June 3).”

http://www.cato.org/pub_display.php?pub_id=11880