[quote]SkyzykS wrote:
You have way too much confidence in govt. bureaucracy if you think that any of them wouldn’t gladly usurp individual autonomy if it meant justifying its own continuing existence and position on a budget ledger.
No one single person means anything to a bureau or department, nor does an entire population, when you get right down to it. Once created, they exist ultimately to continue to exist regardless of their original intention.
Why the hell anybody would forfeit some of lifes biggest and most important decisions to the judgement of nameless faceless strangers is beyond me.
[/quote]
I don’t have confidence in govt, bureaucracy, etc and I never said that I did. What I said is that all the ACA does is add another layer of bureaucracy to an already overly bureaucratic system.
But you can’t say that it’s going to make things worse for everyone because not everyone is going to have healthcare through the exchanges/marketplace. There’s still going to be private insurance. There’s also going to be the option not to have healthcare and the option to pay for something on your own if you want to. There’s not going to be a panel that says “you live…and you die”. Those decisions are going to be made by you and your ability to pay for the care if what is needed is not covered.
On the positive note, while the bureaucracy sucks it’s better than the alternative of not having healthcare. So if opens the door to getting good care to more people then it’s not all bad.
Does it solve the problem of making healthcare more affordable? Hell no. Does it make it better at all? Hell no.
[quote]Chushin wrote:
Here in Japan it is definitely not true.
I’ve offered to pay myself a couple of times, and was told it was not allowed.[/quote]
Really? I would certainly be opposed to any system that didn’t allow you to pay for things yourself if need be. How do they handle treatments that aren’t covered?
james
[/quote]
Really? With all respect but you didn’t know that already happens routinely in govt healthcare systems? It’s been going on for years and is a big part–and indicator of–why i don’t trust govt more than i dont trust insurance corps. I keep saying recipe for disaster over and over and this is a reason why.
At what point does the cost outweigh the return? Honest question.
[/quote]
Thats easy. You take their current yearly income and increase it 2.2%/year, then calculate their federal tax debt per year multiplied by the number of years they have left as a viable entity in the workforce.
That is how much we are worth to our gov. When the cost of treatment meets or exceeds their value- Pull the plug.
The average person would last about 3 days in an ICU. Neonatal or cardiac units can just shut their doors right away. Nobody is going to last more than 10 min. in one of those.
[/quote]
I doubt we are worth that much to the gov.
In all seriousness, though, how do you figure out when the money runs dry? I have absolutely no idea, I am genuinely looking for an opinion that might spark a thought on this topic.
[quote]Aragorn wrote:
Really? With all respect but you didn’t know that already happens routinely in govt healthcare systems? It’s been going on for years and is a big part–and indicator of–why i don’t trust govt more than i dont trust insurance corps. I keep saying recipe for disaster over and over and this is a reason why.[/quote]
In the UK you can go not only to the DHS but also the private side. I don’t know anything about the Japanese system.
And the private side isn’t going away because of the ACA. I will continue to be insured through my employer using a group based plan not one that’s run through the marketplace / exchange. Individuals will still be able to purchase plans directly from the various health care providers. Additionally not every health insurance plan is going to be going through the marketplace / exchange.
Is the fear that this is putting us one step closer to the removal of private health care? If so then I don’t think those fears are ever going to come to fruition. There’s no way we’re going to turn health care totally public.
At what point does the cost outweigh the return? Honest question.
[/quote]
Thats easy. You take their current yearly income and increase it 2.2%/year, then calculate their federal tax debt per year multiplied by the number of years they have left as a viable entity in the workforce.
That is how much we are worth to our gov. When the cost of treatment meets or exceeds their value- Pull the plug.
The average person would last about 3 days in an ICU. Neonatal or cardiac units can just shut their doors right away. Nobody is going to last more than 10 min. in one of those.
[/quote]
I doubt we are worth that much to the gov.
In all seriousness, though, how do you figure out when the money runs dry? I have absolutely no idea, I am genuinely looking for an opinion that might spark a thought on this topic.[/quote]
It would probably be a little more complex, but that is essentially they type of formula already used when a spouse or someone injured wants to claim wrongful death or loss of income for a lifetime of earnings.
Using me for example- I’m a 41 year old welder and I make about 40-50K/year, 24 years left in the workforce.
If I get splattered by a big steel plate on monday, I might be worth about a million dollars before mitigating factors or negligence is factored in.
At what point does the cost outweigh the return? Honest question.
[/quote]
Thats easy. You take their current yearly income and increase it 2.2%/year, then calculate their federal tax debt per year multiplied by the number of years they have left as a viable entity in the workforce.
That is how much we are worth to our gov. When the cost of treatment meets or exceeds their value- Pull the plug.
The average person would last about 3 days in an ICU. Neonatal or cardiac units can just shut their doors right away. Nobody is going to last more than 10 min. in one of those.
[/quote]
I doubt we are worth that much to the gov.
In all seriousness, though, how do you figure out when the money runs dry? I have absolutely no idea, I am genuinely looking for an opinion that might spark a thought on this topic.[/quote]
This is where health economics come into play. They look at both the costs (or net savings…very rare but it happens) and the benefits of a certain treatment.
To quantify the benefits they use something called “Quality adjusted life years” (QUALY) which lets us take both gain of quality and gain of quantity of life into account. Obviously calculating these costs and QUALYs is very complicated and not always very objective (but then medicine is overcoming uncertainty). Afterwards the cost per QUALY is calculated. Where I’m from the norm for the compulsory state insurance (there’s basically no private insurance) is about 30.000 euros / QUALY (usually this level is near the GDP per capitum, so it varies between countries). If a treatment is more expensive than this they will not cover it.
Obviously other factors also play a role but I believe these calculations are used more and more, especially in the current economic climate. For example, Viagria (don’t quote me on this but I vaguely remember this only costs 3000 euros / QUALY) is not covered by insurance.
After 4 days of arguing and threats, the drug I had requested was given at 9.30 am yesterday. No side effects.
By 4 am today his platelet count had doubled.
Now, had the pharmacy followed my original order 4 days previously, instead of obstructing the order, he would have been spared:
–40 liters of plasma (that comes from 160 units of blood)
–4 platelet pharesis transfusions
–I don’t know how many transfusions of red cells.
–a thoracotomy (his second!) for bleeding
Recall that the drug cost the hospital $8000 and was denied (covertly) because of cost.
Now is someone going to tell me that rules made in Bethesda, MD, are going to be better able to contain costs than my judgment and the patient’s informed family?
After 4 days of arguing and threats, the drug I had requested was given at 9.30 am yesterday. No side effects.
By 4 am today his platelet count had doubled.
Now, had the pharmacy followed my original order 4 days previously, instead of obstructing the order, he would have been spared:
–40 liters of plasma (that comes from 160 units of blood)
–4 platelet pharesis transfusions
–I don’t know how many transfusions of red cells.
–a thoracotomy (his second!) for bleeding
Recall that the drug cost the hospital $8000 and was denied (covertly) because of cost.
Now is someone going to tell me that rules made in Bethesda, MD, are going to be better able to contain costs than my judgment and the patient’s informed family?
James?
Anyone?[/quote]
The idea in our current culture is that you cannot make such decisions because you will always decide for your patient.
Pharma companies have no problem with incentivicing doctors to prescribe more of their drugs, but if it ever came out that doctors had to make cost decsions that endanger a patients life, the would be a shitstorm of legendary proportions.
Somebody has to kill your patients for you, for you are a shaman and must stay that way.
After 4 days of arguing and threats, the drug I had requested was given at 9.30 am yesterday. No side effects.
By 4 am today his platelet count had doubled.
[/quote]
Like a boss. Nice work doc!
After 4 days of arguing and threats, the drug I had requested was given at 9.30 am yesterday. No side effects.
By 4 am today his platelet count had doubled.
Now, had the pharmacy followed my original order 4 days previously, instead of obstructing the order, he would have been spared:
–40 liters of plasma (that comes from 160 units of blood)
–4 platelet pharesis transfusions
–I don’t know how many transfusions of red cells.
–a thoracotomy (his second!) for bleeding
Recall that the drug cost the hospital $8000 and was denied (covertly) because of cost.
Now is someone going to tell me that rules made in Bethesda, MD, are going to be better able to contain costs than my judgment and the patient’s informed family?
James?
Anyone?[/quote]
That’s great news indeed and great work on your part.
I never once said that the way the system works now is great, optimal, or the best way to do it. I said what the current state is and that it’s the way that it is because of limited resources. Additionally there’s a lot of doctors / clinics / hospitals who would truly try to take advantage of the system if there weren’t controls in place.
All of this started because you mentioned death squads and how the ACA was going to create them. I said that’s how our current system works and that’s not the fault of the ACA. It’s the fault of us having an insurance driven health care system.
After 4 days of arguing and threats, the drug I had requested was given at 9.30 am yesterday. No side effects.
By 4 am today his platelet count had doubled.
Now, had the pharmacy followed my original order 4 days previously, instead of obstructing the order, he would have been spared:
–40 liters of plasma (that comes from 160 units of blood)
–4 platelet pharesis transfusions
–I don’t know how many transfusions of red cells.
–a thoracotomy (his second!) for bleeding
Recall that the drug cost the hospital $8000 and was denied (covertly) because of cost.
Now is someone going to tell me that rules made in Bethesda, MD, are going to be better able to contain costs than my judgment and the patient’s informed family?
James?
Anyone?[/quote]
The idea in our current culture is that you cannot make such decisions because you will always decide for your patient. [/quote]
Ah. The amphibolous construction. If you mean, by “for your patient,” that I would choose “in favor of my patient” over other considerations, yes.
If you meant “in the stead of your patient,” the answer is, sometimes, yes. (See the Nobel prize winning essays of an acquaintance of mine, Dr. Kenneth Arrow.) I am not given to paternalism; I have avoided absolute responsibility in situations where I am not given absolute authority. BUt every time, I will put the interest of the patient before that of the institution, whether that be the hosptial, the insurance company, and most definitely, the government or an undefinable “society at large.”
[quote]
Pharma companies have no problem with incentivicing doctors to prescribe more of their drugs, but if it ever came out that doctors had to make cost decsions that endanger a patients life, the would be a shitstorm of legendary proportions.
Somebody has to kill your patients for you, for you are a shaman and must stay that way. [/quote]
Well, the chief incentive for prescribing drugs is the litigious patient and his relations. Big Pharma does not send me cash bombs for my prescriptions, but I do depend on “benign self-interest” to make a living. Often just marginally. (For that 4 day struggle, I will earn something less than $30 per day.)
As for the declarations, “if it ever came out that doctors had to make cost decisions that endanger a patients life,” you are emphatically wrong. This is the case and the operational understanding in Canada, Britain, and largely through Europe. It is simply the case that people choose to misunderstand the truth, or to believe otherwise, in the mistaken belief that it is not happening to them or those close to them. No shitstorm.
As for shamanism…No, not entirely. I am most certainly not a magician, just very skilled at what I do: like a shaman I see the unseen. However, this is just the beginning phase of the War on Doctors, which must follow. As national central health planning fails everywhere, there must be someone to blame, and it will be doctors, as James has pointed out, “with 6-figure incomes and a nice house.”
After 4 days of arguing and threats, the drug I had requested was given at 9.30 am yesterday. No side effects.
By 4 am today his platelet count had doubled.
Now, had the pharmacy followed my original order 4 days previously, instead of obstructing the order, he would have been spared:
–40 liters of plasma (that comes from 160 units of blood)
–4 platelet pharesis transfusions
–I don’t know how many transfusions of red cells.
–a thoracotomy (his second!) for bleeding
Recall that the drug cost the hospital $8000 and was denied (covertly) because of cost.
Now is someone going to tell me that rules made in Bethesda, MD, are going to be better able to contain costs than my judgment and the patient’s informed family?
James?
Anyone?[/quote]
…I said that’s how our current system works and that’s not the fault of the ACA. It’s the fault of us having an insurance driven health care system.
james[/quote]
AH! The scales fall from his eyes!
Except it is indeed the fault of the ACA, which, contrary to any rational thought on the subject, simply turned over to insurance companies the money and power extracted from the public under the false promise of increasing the availability of health services.
After 4 days of arguing and threats, the drug I had requested was given at 9.30 am yesterday. No side effects.
By 4 am today his platelet count had doubled.
[/quote]
Like a boss. Nice work doc![/quote]
After 4 days of arguing and threats, the drug I had requested was given at 9.30 am yesterday. No side effects.
By 4 am today his platelet count had doubled.
[/quote]
Like a boss. Nice work doc![/quote]
The paths of glory lead but to the grave.[/quote]
But at least you shall go with your head held high.
[/quote]
After 4 days of arguing and threats, the drug I had requested was given at 9.30 am yesterday. No side effects.
By 4 am today his platelet count had doubled.
Now, had the pharmacy followed my original order 4 days previously, instead of obstructing the order, he would have been spared:
–40 liters of plasma (that comes from 160 units of blood)
–4 platelet pharesis transfusions
–I don’t know how many transfusions of red cells.
–a thoracotomy (his second!) for bleeding
Recall that the drug cost the hospital $8000 and was denied (covertly) because of cost.
Now is someone going to tell me that rules made in Bethesda, MD, are going to be better able to contain costs than my judgment and the patient’s informed family?
James?
Anyone?[/quote]
The idea in our current culture is that you cannot make such decisions because you will always decide for your patient. [/quote]
Ah. The amphibolous construction. If you mean, by “for your patient,” that I would choose “in favor of my patient” over other considerations, yes.
If you meant “in the stead of your patient,” the answer is, sometimes, yes. (See the Nobel prize winning essays of an acquaintance of mine, Dr. Kenneth Arrow.) I am not given to paternalism; I have avoided absolute responsibility in situations where I am not given absolute authority. BUt every time, I will put the interest of the patient before that of the institution, whether that be the hosptial, the insurance company, and most definitely, the government or an undefinable “society at large.”
Well, what they pay doctors in Austria is a bad joke.
A plumber working a bit on the side makes that.
That makes sense though, once you realize that people do not see your profession in a rational way.
They want to see doctors as someone with a calling beyond mere money.
You deal with people who are sick and helpless and who want to believe that you are on their side and that you have special knowledge that they dont.
That, for better or worse, makes you a Shaman.
You have a special connection to the spirit world and instead of dismissing it, I would embrace it.
They want it, in more than one way they NEED it, and while it may be a challenge to live uo to childlike trust, the alternative is a hopeless patient.
I think that as long as people can convince themeselves that doctors have forced decisions upon them by faceless bureaucrats that trust is not broken, but when doctors are seen to work for the nebulous “Man” there is a mighty big problem.
On the other hand, it makes doctors very vulnerable to allegations that they make too much, because every halfway decent negotiator should be reluctant to admitt
that his clients are in it for the money too, because that would mean squandering his biggest capital.
3 days after the drug, the patients’ platelets are normal, his coagulation parameters are normal and he is being weaned off continuous dialysis.
Now, recall that the average person–James, for example–wrote off the patient as dead. Age serves as a convenient shorthand for those who wish to contain costs; it is no barrier for futile therapy for the patient’s family.
Da Man wanted a solution–a universal solution–to the problem of finite resources colliding with infinite demand for medical resources. (I have my answer, but it is pointless to repeat it, here, again.) My current answer is, “Keep out of my way!” Had the hospital administration followed my legal order, instead of working to block it, it would have saved $50-100K.
[quote]DrSkeptix wrote:
Had the hospital administration followed my legal order, instead of working to block it, it would have saved $50-100K.
[/quote]
I guess working for a small business, I have no concept of the bureaucracy that must be involved here. I just wonder who you could have talked to and said “Listen, if you just do what I say this will save you like 100 grand.” And they would have probably said “Na.” Do you ever feel like you’re living in crazy town where people stop using common sense?