The Death Panel

Off Topic Politics & World Issues
61

[quote]Aragorn wrote:

[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]

In the interest of clarity, the drug might cost $8K per week for four weeks, then $10K per month. The Drug Company wants doctors to believe that it is lifelong therapy, but in fact, the literature indicates that after 12 weeks, therapy can be withheld and the patient can be observed for recurrence. So the total cost of treatment–to save a life–may be “as little as” $52K.

62

[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]

…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]

Uhhh…wrong again, James. You may want to look at your paystub or your W-2. You, and millions like you, are being taxed now to pay for MediCare now.

64

I anyone wanted to know why “Death Panels” all he really had to do is to read up on “Average Utilitarianism” and it would all be laid out.

If you build a state run or heavily state influenzed system, average utilitarianism is the way to go and to allocate resources where they do the most good is probably the most rational thing to do.

We have the same discussion each year when a new budget needs to be discussed, its the same in healthcare.

Cancer screenings vs keeping an 80 year old alive.

Do we pay to keep someone alive for a few weeks longer or do we invest in prenatal care?

What cancers are we going to screen for?

Either way, people will die.

Plus, the whole political bullshit and lobbying that is rampant in such a system.

See prostate vs breast cancer.

65

[quote]orion wrote:
I anyone wanted to know why “Death Panels” all he really had to do is to read up on “Average Utilitarianism” and it would all be laid out.

If you build a state run or heavily state influenzed system, average utilitarianism is the way to go and to allocate resources where they do the most good is probably the most rational thing to do.
…
[/quote]

Right…but we are not comparing polio vaccination in Pakistan to bone marrow transplants for amyloidosis in Minnesota. That choice is too easy. It is more like, is a coronary stent in an asymptomatic 50 year-old a better investment than radiotherapy for a node-positive 49 year old woman with breast cancer?

There is an inherent error in this thinking–which you call utilitarianism–one which you–of all people–should have recognized.

It presumes a state of perfect knowledge of values…that we “scientists” truly know the values and the statistics which would lead to such decisions. And further, that those who make the decisions are perfect engines to decide the value attached to lives and therapies.

We don’t and they don’t.

See, for example Kitzhaber in Oregon. Or more familiar to you, von Hayek, anywhere.

66

[quote]DrSkeptix wrote:

[quote]orion wrote:
I anyone wanted to know why “Death Panels” all he really had to do is to read up on “Average Utilitarianism” and it would all be laid out.

If you build a state run or heavily state influenzed system, average utilitarianism is the way to go and to allocate resources where they do the most good is probably the most rational thing to do.
…
[/quote]

Right…but we are not comparing polio vaccination in Pakistan to bone marrow transplants for amyloidosis in Minnesota. That choice is too easy. It is more like, is a coronary stent in an asymptomatic 50 year-old a better investment than radiotherapy for a node-positive 49 year old woman with breast cancer?

There is an inherent error in this thinking–which you call utilitarianism–one which you–of all people–should have recognized.

It presumes a state of perfect knowledge of values…that we “scientists” truly know the values and the statistics which would lead to such decisions. And further, that those who make the decisions are perfect engines to decide the value attached to lives and therapies.

We don’t and they don’t.

See, for example Kitzhaber in Oregon. Or more familiar to you, von Hayek, anywhere.[/quote]

I know that its bullshit, I just also know that it does follow a certain logic.

In order to make it as “fair” as possible they will assemble a team of “experts” and form some kind of “body” to institutionalize their operation.

Voila, Death Panels.

To assume that it wont happen is to assume unlimited resources.

Without going full out Goodwin, not only were the Nazis socialists, they were socialists that really meant it.

They actively killed mentally handicapped people because they refused to use any resources on them that would have kept them alive with stuff that would get supposedly get them more bang for the buck elsewhere.

Now I doubt that we would do it that way, we would just hang them on a feeding tube and watch them die.

Or pump them full off morphine, which has the added benefit that they will not curse their executioners with their dying breath.

67

[quote]Aragorn wrote:
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]

I absolutely agree that we should have really high goals. I’m just being pessimistic because I think there’s too much money involved in the whole industry to make any real changes. I mean changes that result in more people getting access to quality care.

james

68

[quote]DrSkeptix wrote:
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.
[/quote]

I mentioned earlier in response to a different post that I didn’t mean that to be an attack against you. I put that in there to illustrate the point that there’s very limited resources and there has to be some sort of control in place that says what the resources can and can’t be spent on. I certainly didn’t expect you to pay for the medicine because you see a myriad of patients and can’t do that for every one.

I apologize if you took that personally.

[quote]DrSkeptix wrote:
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.
[/quote]

Again, my point all along is that the decision on what to cover and what not to cover is already being made by the insurance companies and by CMS. The ACA hasn’t mandated any of this yet. And even when it does get fully enacted it’s only going to cover plans that fit under it’s umbrella. If you buy a plan from your local insurance privately then you’ll fall under a different set of rules. But you’re still only going to get covered for a finite amount of treatments.

[quote]DrSkeptix wrote:
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.

[/quote]

Bureaucracy sucks and it’s certainly not limited to the government. Good on you for fighting through that.

james

69

[quote]DrSkeptix wrote:

[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]

…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]

Uhhh…wrong again, James. You may want to look at your paystub or your W-2. You, and millions like you, are being taxed now to pay for MediCare now.[/quote]

I have seen my pay stub.

I wasn’t saying that there’s nobody to pay for it. I was saying that the pool of healthy, working people paying into it is smaller than it’s ever been. This is unlike traditional insurance where you’ve got a pool of people paying into something that they probably aren’t going to use. In this case the amount that we’re paying into it and the amount leaving it is reversing so now we’re paying out more than we’re taking in. That would never happen in a traditional model.

In fact this is the problem that I see with health care in general. We’re using the insurance model to cover maintenance and upkeep. I wouldn’t file a claim with my auto insurance company if I needed to get my oil changed or if I needed to get an O2 sensor replaced. Insurance should be for those really big things that need to get fixed.

james

70

Not sure how to put this… but I have actually been of a similar opinion as James on the “value of a life”.

Obviously to the family of an individual, their life is priceless. I feel this way about my family.

If we’re talking about health insurance though, your life is not priceless to that company. In fact your life probably has an exact actuarial value. There are people for example over the age of 80 with terminal illness(es) who are not going to be “worth saving” to an insurance company, and I cannot logically and objectively tell them that their decision is unjustified. How much longer will that person live? How much more can he contribute to society? What is his life worth to anyone besides the family?

Now you mentioned Jame’s wife and child. That is quite different. In fact a child should always be worth saving given that their potential value is practically incalculable even to those outside the family. That child could grow up to be the most brilliant physicist in the history of humanity for all anyone knows. Economically if you even tried to calculate their value based on the best data available that child is still worth millions to the economy and society even if he turns out to be very average.

72

[quote]csulli wrote:
Not sure how to put this… but I have actually been of a similar opinion as James on the “value of a life”.

Obviously to the family of an individual, their life is priceless. I feel this way about my family.

If we’re talking about health insurance though, your life is not priceless to that company. In fact your life probably has an exact actuarial value. There are people for example over the age of 80 with terminal illness(es) who are not going to be “worth saving” to an insurance company, and I cannot logically and objectively tell them that their decision is unjustified. How much longer will that person live? How much more can he contribute to society? What is his life worth to anyone besides the family?

Now you mentioned Jame’s wife and child. That is quite different. In fact a child should always be worth saving given that their potential value is practically incalculable even to those outside the family. That child could grow up to be the most brilliant physicist in the history of humanity for all anyone knows. Economically if you even tried to calculate their value based on the best data available that child is still worth millions to the economy and society even if he turns out to be very average.[/quote]

This would only make sense if you belonged to the insurancee company.

They do not try to get their best bang for the buck, they hopefully try to live up to their contractual obligation.

Now, if you had a system like Austria, or the UK then someone needs to decide what your life is worth, no way around it.

73

[quote]pushharder wrote:
We can certainly approach this with an abstract, philosophical, “let’s smoke a cigar and drink cognac and solve the problems of the world in 45 minutes,” casualness but when it comes right down to it we have no business empowering the government to assign dollar values to children OR 80 year old’s. It is super dangerous territory to tread.[/quote]
Hahah yeah you’re right. This is better solved witht he common sense approach than the academic philosophical one.

75

[quote]pushharder wrote:

[quote]csulli wrote:
Not sure how to put this… but I have actually been of a similar opinion as James on the “value of a life”.

Obviously to the family of an individual, their life is priceless. I feel this way about my family.

If we’re talking about health insurance though, your life is not priceless to that company. In fact your life probably has an exact actuarial value. There are people for example over the age of 80 with terminal illness(es) who are not going to be “worth saving” to an insurance company, and I cannot logically and objectively tell them that their decision is unjustified. How much longer will that person live? How much more can he contribute to society? What is his life worth to anyone besides the family?

Now you mentioned Jame’s wife and child. That is quite different. In fact a child should always be worth saving given that their potential value is practically incalculable even to those outside the family. That child could grow up to be the most brilliant physicist in the history of humanity for all anyone knows. Economically if you even tried to calculate their value based on the best data available that child is still worth millions to the economy and society even if he turns out to be very average.[/quote]

We can certainly approach this with an abstract, philosophical, “let’s smoke a cigar and drink cognac and solve the problems of the world in 45 minutes,” casualness but when it comes right down to it we have no business empowering the government to assign dollar values to children OR 80 year old’s. It is super dangerous territory to tread.[/quote]

Even that is not as clear cut.

How much should be spent to make highways safer?

I think the rule for Amtrak which faces similar problems, the cutoff point is 3 million a life.

76

[quote]orion wrote:
This would only make sense if you belonged to the insurancee company.

They do not try to get their best bang for the buck, they hopefully try to live up to their contractual obligation.

Now, if you had a system like Austria, or the UK then someone needs to decide what your life is worth, no way around it. [/quote]

It’s the same whether you’ve got private insurance or you get government healthcare. In Austria I would imagine that there’s a list of things that are approved for treatment and things that aren’t. Then if you want something that’s not on the approved list then you appeal it and a committee or individual approves or denies it. It works exactly the same way in the insurance companies.

And it’s not just over things that are life or death. Every treatment you get is on that list. I would invite everyone who has private insurance to review their documents and see the things that are and aren’t covered and what the appeal process looks like. You would be surprised at what’s not covered.

james

77

[quote]csulli wrote:
Not sure how to put this… but I have actually been of a similar opinion as James on the “value of a life”.

Obviously to the family of an individual, their life is priceless. I feel this way about my family.

If we’re talking about health insurance though, your life is not priceless to that company. In fact your life probably has an exact actuarial value. There are people for example over the age of 80 with terminal illness(es) who are not going to be “worth saving” to an insurance company, and I cannot logically and objectively tell them that their decision is unjustified. How much longer will that person live? How much more can he contribute to society? What is his life worth to anyone besides the family?

Now you mentioned Jame’s wife and child. That is quite different. In fact a child should always be worth saving given that their potential value is practically incalculable even to those outside the family. That child could grow up to be the most brilliant physicist in the history of humanity for all anyone knows. Economically if you even tried to calculate their value based on the best data available that child is still worth millions to the economy and society even if he turns out to be very average.[/quote]

That’s not exactly what I was saying. I’m saying that we’ve got limited resources by which to fix all of the sick people. Because of the finite nature of our resources we have to make decisions regarding what’s allowed for treatment and what’s not allowed. If you’re rich then your options are much wider than if you’re poor. But it’s still a finite figure (unless you’re Bill Gates).

james

78

[quote]DBCooper wrote:

But let’s face it, more humans means less for each human at some point.[/quote]
I disagree

It could play out that way, but I don’t see that as a given

Edit: talking about future and population growth, not saying “we” have unlimited $

79

[quote]squating_bear wrote:

[quote]DBCooper wrote:

But let’s face it, more humans means less for each human at some point.[/quote]
I disagree

It could play out that way, but I don’t see that as a given

[/quote]

In the current world we live in, yes, it is a given.

80

[quote]atypical1 wrote:

[quote]csulli wrote:
Not sure how to put this… but I have actually been of a similar opinion as James on the “value of a life”.

…[/quote]

That’s not exactly what I was saying. … we have to make decisions regarding what’s allowed for treatment and what’s not allowed. …
james
[/quote]

Who is this “we” you keep talking about?

I know I make decisions, and I am responsible for them. But who is this “we” that stands over me, or in my way, and takes no responsibility for the outcome?