The Death Panel

[quote]pat wrote:

[quote]DBCooper wrote:
I was thinking earlier today about all this climate change shit and I finally just gave in and have decided that none of it really matters. Whether or not we can prevent/slow down/ reverse any of it is immaterial in my mind now.

PEOPLE are the problem, not what we actually do to the environment. All this bullshit about trying to save lives and all that really just isn’t that great for the planet at all. I say have at it with all the booze and cigarettes and fatty foods and all of that shit. Flu shots? Fuck 'em. Speed limits? Who needs those? Safety features in cars? Why make the companies put that much more money into their products?

It’s occurred to me that it is completely hypocritical or ignorant or short-sighted for all these liberals to push the environmental shit down our throats and then turn around and tout some healthcare program that will allegedly save lives or increase our life spans. Increasing our life span is the LAST thing this planet needs. I HOPE that Obamacare has some sort of death panel. It would be good for the whole planet to start knocking off a bunch of people left and right. [/quote]

I love a good post full of facts.
How prey-tell, does obamacare save lives or increase anybody’s life span? [/quote]

Look up the word “allegedly”, along with the context it is properly used in. After that, look up the word “bullshit” and it’s proper contextual use.
How, pray tell, did you miss the meaning of what I said when I used the phrases “save lives” and “increase our life spans”?

[quote]Testy1 wrote:

[quote]pushharder wrote:

[quote]Testy1 wrote:

how do you feel about the many thousands who are not poor enough to receive medicaid yet don’t have good enough jobs to have health insurance? If they don’t have insurance fuck em right?

[/quote]

The James’ of the world are willing to fuck 'em, not me. Read his post. In context.
[/quote]

I did read his post. In context. My take on what he said is that we can’t have unlimited benefits, that someone is going to have to make the hard choices on if it is the best application of limited resources. Are those against Obamacare(not you specifically) suggesting that there be unlimited benefits but only if you are insured? That is how it comes across to me.

It did read to me in the OP that the guy was terminal and on deaths door regardless. Could just be reading failure on my part.

While we are talking about one admittedly sad case, many times that will die because they have no health insurance. All I hear about is how bad Obama care is, but I don’t hear of any alternatives. I’m not saying it is all or even mostly good, but lets try to come up with solutions.[/quote]

A couple things here come to mind:

First, there have always been death panels. Always. What changes is who, what is in charge and how they operate. It doesn’t matter what era of medicine we are talking about there is a death panel somewhere, from ancient times to civil war to 20th century and pre-insurance to post insurance to post insurance reform measures to Obamacare. Always.

What I have a HUUUUUGE problem with is the upcoming–and if we are to weight Docs post highly then already emerging–incarnation of said death panels. There is no entity I trust on earth less than gov’t bureaucrats and senators and lobbyists. And I only trust insurance companies slightly more (all you have to is look at stories–true stories mind you–like those John Grisham writes about with insurance companies as well as the history they have in the past 50+ years).

But yes, i do trust insurance companies more than what I see coming down the pipe, if for no other reason than market pressures can eventually force them to change–not to mention lawsuits-- whereas a gov’t run bureaucracy is nearly immutable and immune to the pressures that would otherwise force change. Theoretically this is not so–we elect representatives to further our priorities–but practically speaking this has not worked regarding “agencies” or bureacratic entities for over 60 years. I would argue even further.

Nobody except the patient, his family, and the doctors we train and trust to know the in’s and out’s of medical care and triage should have the permission to make those “death panel” decisions. Doc said it better than myself already, but if you give the gov’t the power to decide what treatments are acceptable in a situation such as this you have already given away the inalienable right to Life, Liberty, and the pursuit (not attainment) of happiness. And it will never come back. Insurance companies can become by and large only a slight degree better than scum IMO–I hope I have made my disapproval clear–but they are still more accountable to pressures than the above.

Second, and again I hope my opinion is clear that I do not consider the present situation with regard to cost or role of insurance to be anything less than completely FUBAR, there is no such thing as unlimited benefits for ANYBODY rich or poor unless you have unlimited money. There is always a cut-off point for some reason, so anybody suggesting things should be otherwise is perhaps a good hearted soul but clearly living in a dream world that will never exist, gov’t healthcare or not. It never has and it never will.

Third, I would respectfully suggest that if you have heard anybody offer solutions other than Obamacare you are not listening. There exist a number of solutions that are easier to implement, less costly to the country and us as taxpayers, and carry much less risk from a liberty and choice standpoint. Given that the current problems are complex and wide-reaching I am not suggesting that any complete problem exists. However, and this is a clear and immutable part of all analytical problem solving particularly in the sciences (including diagnosis and medicine), if a problem is overly complex, or so multi-factorial that you cannot analyze the situation, you begin not by throwing the kitchen sink at all variables involved but by addressing one aspect at a time to simplify the variables involved. It makes subsequent analysis easier and less error prone, and it tell you how things are affected by your actions: ie in many cases it gives predictive power and in others explanatory power.

What I am saying is that people have been trying to advocate alternative solutions to cheapen cost DIRECTLY for years now but nobody wants to listen. The same can be said for other issues involved in the healthcare debate. Cost is one of the very fundamental issues is it not? Well if cost goes down more people can afford care. Force insurance companies to compete across state lines: It doesn’t fix the whole problem but it is faster to effect and it allows a stepping stone for other issues to be solved. This does two things: give PATIENTS more choices thus re-inforcing liberty, forces lower costs via competition.

You could have passed a bill like that in what…30 pages? Maybe 60? It wouldn’t have alienated political capital either. And it would have made subsequent problem solving attempts easier to predict because one of the variables has been partially tacked down. It would also have kept lobbyist pork to a minimum because people can read a 30 page bill and call out lawmakers for that shit. 3000 pages? Fuck that. A serial approach to issues on tort reform, insurance competition and others would have helped literally millions of people AND ALSO would have clarified more of the problem (or "diagnosis"if you will) making subsequent measures easier to analyze and predict.

There is no perfect system. There never has been, and there never will be. but you don’t conduct a trial, experiment, or drug treatment/diagnosis by changing every fucking variable. You change one at a time, test, measure, then move on to the next variable.

The OP read to me that he is on deaths door (which he most certainly is), but is saveable. read “cure” and “life saving” not “palliative treatment”, so I definitely picked up on Docs post without a problem. Not a dig at you personally, just how I read it.

[quote]atypical1 wrote:

[quote]Testy1 wrote:
Are those against Obamacare(not you specifically) suggesting that there be unlimited benefits but only if you are insured? [/quote]

Let’s be clear, if you’re insured you do not have unlimited benefits. You have the benefits according to the contract you sign and that you pay for. In this case the gentlemen’s insurance did not cover the meds that the Doctor wanted to give him. He wasn’t going to get the drugs with or without the ACA.

Want to change healthcare for the better and really make it affordable? Bring it to the people. Nothing wrong with buses or vans going out to the places that the poor live to provide service in a low overhead, low cost setting. Why does all of our services require an expensive hospital or clinic? Why can’t more services be on a cash basis with total visibility into what everything costs? [/quote]

Exactly. Far more succinct than my post. The more bureacracy we put down the more we obscure the connection and visibility between cost of service and price. This is a fundamental rule: the more middlemen there are–and gov’t agencies damn sure count that way with the money involved–the more price goes up or stays volatile because every entity wants its money some way or other, “non” profit gov’t or not.

[quote]
I notice that the six figure making doctor living in the nice home in the nice neighborhood didn’t offer to pay for this gentlemen’s medicines. Did you set up a charity to pay for his meds? Did you tap into the family? His church?

james[/quote]

That’s a low blow thinly disguised ad hominem AND red herring and you know it. Not classy and that’s the second time you’ve done something like that in this thread. And you should have crunched numbers beforehand anyway because 8000/week medication costs 416,000 buck a year. That is not even in the realm of possibility for a good-samaritan doctor to think of picking up without bankruptcy. Don’t bring that up again please, keep to the issue.

[quote]Aragorn wrote:
That’s a low blow thinly disguised ad hominem AND red herring and you know it. Not classy and that’s the second time you’ve done something like that in this thread. And you should have crunched numbers beforehand anyway because 8000/week medication costs 416,000 buck a year. That is not even in the realm of possibility for a good-samaritan doctor to think of picking up without bankruptcy. Don’t bring that up again please, keep to the issue.[/quote]

Second? It wasn’t meant to be a personal attack by any means and you hit on the point that I was trying to make exactly. The doctor sees a lot of patients and he can’t cover the costs of every patient who can’t afford the medicines. If you extrapolate that out to society then you get the problem that we are currently in. There’s more sick people than there are resources available.

james

[quote]DBCooper wrote:

[quote]pushharder wrote:

[quote]atypical1 wrote:

…his life really isn’t worth saving…

[/quote]

You wanna know something, James? I really don’t say this very often if ever, but friend, you’re an asshole.

A bona fide asshole. The kind that smells from a mile away.

And those who feel like you do are as well. Whether you’re name is Bert…or Smith or Jones…or Goebbels.

Let’s see how you feel when we pose a similar hypothetical about your 5 year old son. Asshole.[/quote]

Hey, don’t lump me into that crowd! I was simply pointing out a logical catch-22 of sorts when it comes to death-prevention measures. I was obviously speaking tongue-in-cheek when I said I hoped Obamacare had death panels. Have I really conveyed that sort of image to you, Push? That I’m so wholly lacking in compassion that I would actively root for a program that picks and chooses who gets to live and die?

My point is that you can’t logically sit there and try to legislate what is best for humanity as a whole (and I’m sure most liberal supporters of Obamacare, or any other healthcare program that seeks to make healthcare affordable to the lowest rungs of society, claim that this program is ultimately aiming to do) and then turn around and try to beat those 100 to 1 odds when someone is on the verge of death.

I’m not saying that we SHOULD just say fuck it and embrace wholesale euthanasia, only that the catch-22 involved in making the country a better place for everyone to live in necessarily entails less people here to begin with. The Chinese have already shown that birth limits doesn’t really do shit. I don’t think that we should legislate some sort of population control, no matter how good for the rest of society it may be in the long run, for many reasons, not the least of which is that it is immoral and it becomes extremely problematic anytime you choose who lives and dies. That’s complete insanity that belongs in 1930’s Russia.

But let’s face it, more humans means less for each human at some point. When we value consumerism and materialism as much as this country does, that becomes problematic as more and more people end up here. I think perhaps what is best is some sort of paradigm shift in which people learn to accept that we cannot live forever and that there is some value in accepting death with dignity at some point. I know that a lot of doctors don’t seek the same last-ditch efforts when the writing is on THEIR wall because they see the negative effects of trying to stave off the inevitable for a few more months or years all the time. I simply think that sometimes it is selfish to try and extract a few more months or whatever out of the end of your life (this is not a mindset I would apply to children AT ALL) at what amounts to a huge cost to the system and your family. But that is simply how humans are, and as selfish as it may be, there really isn’t anything wrong in humans acting…well, like humans.[/quote]

You might want to make your sarcasm or satire a touch more obvious then please, because I read your post several times and I couldn’t tell if you were being serious or not, but it sounded to me like you were actually serious.

Also I would point out from your first post that what makes humans so different from animals is our desire and ABILITY to beat those odds in all fields of endeavor including medicine. That led to all the best developments of humankind throughout history. We are self-aware in a way that animals cannot hope to be and therefore I would not apply animal standards of behavior to us in the same way. Our ability as humans is adaptability and creativity, not to mention our ability to subjugate our animal instincts to higher ends (even when we don’t)

[quote]atypical1 wrote:

[quote]Aragorn wrote:
That’s a low blow thinly disguised ad hominem AND red herring and you know it. Not classy and that’s the second time you’ve done something like that in this thread. And you should have crunched numbers beforehand anyway because 8000/week medication costs 416,000 buck a year. That is not even in the realm of possibility for a good-samaritan doctor to think of picking up without bankruptcy. Don’t bring that up again please, keep to the issue.[/quote]

Second? It wasn’t meant to be a personal attack by any means and you hit on the point that I was trying to make exactly. The doctor sees a lot of patients and he can’t cover the costs of every patient who can’t afford the medicines. If you extrapolate that out to society then you get the problem that we are currently in. There’s more sick people than there are resources available.

james
[/quote]

If that was your point then I would respectfully submit that you need to rephrase that point and others in the future, because that came out not as satire or sarcasm but a full blown insult and I read it that way. Otherwise I would simply say that you are right, but it has always been more sick people than resources from time immemorial.

[quote]Aragorn wrote:
But yes, i do trust insurance companies more than what I see coming down the pipe, if for no other reason than market pressures can eventually force them to change–not to mention lawsuits-- whereas a gov’t run bureaucracy is nearly immutable and immune to the pressures that would otherwise force change. Theoretically this is not so–we elect representatives to further our priorities–but practically speaking this has not worked regarding “agencies” or bureacratic entities for over 60 years. I would argue even further.[/quote]

You will still be able to buy private insurance from the insurance companies. And don’t forget that the government isn’t going to be administering the policies or delivering care. It’s going to be private health care insurance companies running it. The government is going to set up regulations and paying some of the dues.

james

[quote]Aragorn wrote:
If that was your point then I would respectfully submit that you need to rephrase that point and others in the future, because that came out not as satire or sarcasm but a full blown insult and I read it that way. Otherwise I would simply say that you are right, but it has always been more sick people than resources from time immemorial.[/quote]

Fair enough, it’s tough having a conversation on a forum because rhetorical questions don’t really come off that way. I really didn’t expect the doctor to pay for the medicine but was trying to make a point.

Agree on more sick people than resources but I think that we have an unrealistic expectation that we can fix and/or save everyone. We can’t and our attempts to do so are incredibly expensive. Medicare is an especially odd situation because the system is trying to pay for the care of some of the most expensive patients and there’s no “healthy pool” of people that necessarily cover the costs of the sick like you would in a typical insurance situation. Couple that with a HUGE aged population that’s getting bigger and that spells trouble.

james

[quote]pushharder wrote:

[quote]atypical1 wrote:

It’s going to be private health care insurance companies running it.

james[/quote]

LOL, if you say so.[/quote]

No, it’s something that I know for fact.

james

[quote]pushharder wrote:
Hey James, I thought we were going to have the pleasure of discussing hypotheticals about those close to you.

Why did you run from that?

I’m pretty sure you’re married so let’s talk about your wife. Let’s give her the exact same situation as Doc’s patient. You gonna talk the big talk when we’re talking about her? Should we put her down?[/quote]

I didn’t answer because I figured that was a rhetorical question.

In answer to your question, if it wasn’t covered by insurance then I would take out debt to pay for the treatment. I mean what other option would I have? I don’t get your point. We all have that option available to us. Well, not everyone. If I was poor I wouldn’t and she would probably die. But that’s the same under the current situation with insurance companies.

james

[quote]atypical1 wrote:

[quote]Aragorn wrote:
If that was your point then I would respectfully submit that you need to rephrase that point and others in the future, because that came out not as satire or sarcasm but a full blown insult and I read it that way. Otherwise I would simply say that you are right, but it has always been more sick people than resources from time immemorial.[/quote]

Fair enough, it’s tough having a conversation on a forum because rhetorical questions don’t really come off that way. I really didn’t expect the doctor to pay for the medicine but was trying to make a point.

Agree on more sick people than resources but I think that we have an unrealistic expectation that we can fix and/or save everyone. We can’t and our attempts to do so are incredibly expensive. Medicare is an especially odd situation because the system is trying to pay for the care of some of the most expensive patients and there’s no “healthy pool” of people that necessarily cover the costs of the sick like you would in a typical insurance situation. Couple that with a HUGE aged population that’s getting bigger and that spells trouble.

james
[/quote]

Understood, I agree.

I think that yes it is unrealistic, but I believe also…in general… that trying to achieve the impossible will most likely lead to infinitely greater rewards and achievements than just accepting that it is not feasible in the first place. I do not apply this to gov’t entities or bureacracies–I do however apply this to human interaction in general and individual choice/action. You might never squat 1000 lbs, but if you put that as a goal I guarantee you are going to be infinitely stronger than if you just thought to accept it. Similarly you might never be a genius but if you go all-out to learn as much as you can you’re going to be infinitely smarter and well-rounded than otherwise would have EVER been possible without the attitude to attempt it.

And occasionally, the impossible happens: flight, da vinci, calculus and Newton’s laws, relativity, the Pyramids, Notre Dame, atomic bomb ( the ethical considerations aside). So way better to try and fail with the impossible as a goal.

[quote]atypical1 wrote:

[quote]Testy1 wrote:
Are those against Obamacare(not you specifically) suggesting that there be unlimited benefits but only if you are insured? [/quote]

Let’s be clear, if you’re insured you do not have unlimited benefits. You have the benefits according to the contract you sign and that you pay for. In this case the gentlemen’s insurance did not cover the meds that the Doctor wanted to give him. He wasn’t going to get the drugs with or without the ACA.

Want to change healthcare for the better and really make it affordable? Bring it to the people. Nothing wrong with buses or vans going out to the places that the poor live to provide service in a low overhead, low cost setting. Why does all of our services require an expensive hospital or clinic? Why can’t more services be on a cash basis with total visibility into what everything costs?

You read my post right. There’s a very limited amount of resources available to us. We simply cannot afford to pay for everything so choices get made. But they get made now and typically it means that the rich stay healthy and the poor stay sick. But the ACA is not the cause for that and the ACA isn’t going to ruin American healthcare.

I notice that the six figure making doctor living in the nice home in the nice neighborhood didn’t offer to pay for this gentlemen’s medicines. Did you set up a charity to pay for his meds? Did you tap into the family? His church?

james[/quote]

One risk that the ignorant might make in an ad hominem remark is just that: he is ignorant of the hominis of which he speaks. So, in a paralipsis, I will not point out the tens of thousands of dollars of medications which I have written off, out of charity to the dead and his widow and family, willingly, or somewhat less willingly when cheated by insurance, scammers, bankruptcies, or MediCare.
James, in ignorance, you do not know that I cannot donate to the costs of this patient’s care, and neither can the drug companies, by MediCare law.
Further, in your ignorance, you do not know that even if his Church or a charity came up with $8000, the hospital would not allow me to buy the medicine for him–MediCare and hospital rules prevent this.
Also in your ignorance, you should know that his family is contributing to his care, paying the co-pay for his lengthy hospitalization.

Don’t be offended, James, ignorance is no shame. Obstinacy in the face of information is.

At risk of repeating myself, the problem here is an occult and–in my opinion–unlawful policy that deprived a viable elderly man of a medicine which may reverse a potentially lethal disease. His life was to be wasted, not by the careful consideration of costs and benefits and risks, but by bureaucrat indifference and intentional misunderstanding of rules.

This is not about an abstraction, "limited resources " and “unlimited demands.” I can say that because the machinery of the hospital is wasting tens of thousands of dollars a day on treatment which does not work, instead of following my informed and legal treatment decision.

This is about who decides and by what right.


In its latest chapter, after 3 days of arguing, the administration allowed me to order the medicine yesterday afternoon. Imagine my surprise and anger when my order was not followed, because some guardian pharmacist decided, “you need to get more authorizations.” I informed her my next phone call would not be to her superior but to the newspapers.
Well, somehow, more paperwork was faxed to me within the hour, I filled it out…and then was informed that because it was after 2 pm, the medicine could not be delivered before Tuesday (5+ days from today).
I will not need to tell you what I did next, but let’s just say he is getting his medicine tomorrow. If he lives.


You seem determined not to see how this affects you, us, the young, in the ACA. I am telling you again, that this is the way that costs will be contained, useful treatments will be denied: by bureaucratic indifference, and not through rational decisions.