Thread: Health Care in the USA

Originally Posted by jockeys

good questions. please see numbers above.

4. unhesitatingly yes. It's better to die on your feet than live on your knees. I am fully aware that most people are not so uncompromising. I'm fully aware that faced with such a choice, most people would choose their lives over their principles. I wouldn't.

So you'd rob them of the (even if it were remote) possibility to live free in the future?

I'd rather live in chains to fight another day.

Freedom is a mindset.

Originally Posted by LX_Emergency

I'd rather live in chains to fight another day.

Freedom is a mindset.

Agree to disagree.

Fair enough. We often do.

Originally Posted by jnich67

Yes, a gov. run system will check costs, but that will reduce provider participation and retard research.

I don't quite understand what you mean here.

Originally Posted by jnich67

Most of our health care dollars go to treat patients who have chronic conditions (diabetes, COPD, asthma, etc). I do think a certain amount of required participation in disease management programs for them would help. If they don't want to participate, they should have to pay more out of pocket.

Either you live your life the way the majority thinks is good for you or you get charged extra.

Originally Posted by jnich67

End of life decisions are another issue. I've seen a number of cases where say a 90 something year old person goes into a facility. They are on a ventilator, require dialysis, and have other comorbidities. In the jargon, they are referred to as "trainwrecks". They languish for months with no quality of life. Often they have nobody to make decisions for them. This "treatment" costs huge amounts of money for just one person. They slip through the cracks.

Funny thing about "quality of life" is that there are wide differences between people about what constitutes a good quality of life. Studies have shown that there is a wide gap between what a medical professional thinks is good quality and the people living that life. Consistently, the medical professional would rate the quality of life an ill person is having lower than that person or the family.

This kind of thinking is a first step down the path of having society (congress) determine how long someone will qualify for life sustaining treatment or how long someone can be thought of as living a quality life.

Originally Posted by jnich67

The fact is that the people reviewing cases are doctors and nurses who genuinly care about people - I've seen it myself. They are not bureaucrats, and they apply protocols decided on by the various specialty medical societies that represent the treating physicians. The protocols are based on emprical research.

1) I agree that the individuals that work in the insurance industry are good folks and, just like everyone else in health care, are trying to do the right thing by people.

2) Empiric research has it's limits. It doesn't account for a creative approach to unique circumstances. This is the concern whenever one thinks of a scripted approach (called cookbook medicine). Often a plan of care when tailored to an individual will include elements that have no research to support them, but makes sense in those particular circumstances.

Originally Posted by jockeys

2. minimum car insurance is not insuring your own car, it's insuring the cars of everyone else against damage you might do to it.

likewise minimum car insurance is insuring not your pocket, but the one of everyone else against damage you might do to it. as long as 'life' has enough value in our society that people are not asked to first pay then treated it seems pretty much the same to me.

Originally Posted by jockeys

3. Normality isn't necessarily a desirable thing. IMHO, normality is borderline despicable.

well again depends, most people are not serial killers either.

Originally Posted by jockeys

4. unhesitatingly yes.

for you i know, and of course your judgment could be affected by what you do for a living, or the later can be a reflection of the former.
in any case i don't think this is a desirable trait for most members of the society.

Originally Posted by jnich67

The big problem we have now - and I don't know that anyone is really focusing on it - is the increasing cost of care.

yes, indeed and at some point it will be unavoidable. from the little i've read on the current proposed legislation is that if enacted it is supposed to make cost control down the road easier.

Originally Posted by Pyment

I don't quite understand what you mean here.

For example, if we went to a single payer system (read further reduced provider fees), many more hospitals would close/consolidate. Many community providers would consolidate or close shop. Fewer services would be offered. This would happen over time of course. I'm not saying this would be bad, but I don't think people should think everything would be the same as it is now - except who's paying the bills. I also think we'd have a more glaring two-tier system than we do now. One for the wealthy and one for the rest of us.

Either you live your life the way the majority thinks is good for you or you get charged extra.

Not what the majority thinks, but you follow a course of treatment you develop with your doctor. You are using every one's money when your insurance pays for services. If you're not going to do your best to take care of your condition and keep yourself as well as possible, then you should have to kick in extra. This would be for specific conditions for which treatment courses are well established and have demonstrated improved outcomes.

Funny thing about "quality of life" is that there are wide differences between people about what constitutes a good quality of life. Studies have shown that there is a wide gap between what a medical professional thinks is good quality and the people living that life. Consistently, the medical professional would rate the quality of life an ill person is having lower than that person or the family.

This kind of thinking is a first step down the path of having society (congress) determine how long someone will qualify for life sustaining treatment or how long someone can be thought of as living a quality life.

I agree. I'm talking about extreme, clear cut cases. They are more common than one would think. My point is that we have to find a mechanism to address these issues - I don't think we have one now.

1) I agree that the individuals that work in the insurance industry are good folks and, just like everyone else in health care, are trying to do the right thing by people.

2) Empiric research has it's limits. It doesn't account for a creative approach to unique circumstances. This is the concern whenever one thinks of a scripted approach (called cookbook medicine). Often a plan of care when tailored to an individual will include elements that have no research to support them, but makes sense in those particular circumstances.

I agree. I made this point because many people are very flip about describing medical management folks at health plans as cold paper-pushers. In many instances, the treating physician can have a quick phone conversation with a medical director and have their approach approved for a unique case.

I'm certainly not saying I have all the answers - and the devil is always in the detail, but it seems like the debate centers around "the uninsured" or pre-existing conditions, etc. These are small parts of a very big, complex issue. I think they need to address the whole model we have here. I wish they would start by following the $$. Otherwise, we'll be doing this again in a few years.

Jordan

Originally Posted by gugi

1. likewise minimum car insurance is insuring not your pocket, but the one of everyone else against damage you might do to it. as long as 'life' has enough value in our society that people are not asked to first pay then treated it seems pretty much the same to me.


2. well again depends, most people are not serial killers either.


3. for you i know, and of course your judgment could be affected by what you do for a living, or the later can be a reflection of the former.
in any case i don't think this is a desirable trait for most members of the society.

1. ah, but I only have to use car insurance to pay for someone else if i am RESPONSIBLE for damaging their car. unless I am damaging other folk's health, it's apples and oranges. if I break a man's arm, I absolutely ought to have to pay his healthcare bills. if he breaks it on his own, it's his problem and his problem alone.
2. fair enough, but there will be extremes on both ends (good and bad). but taken as a whole, I find the average person contemptible.
3. with an attitude like that, we'd still be a British Colony.

Originally Posted by jockeys

3. with an attitude like that, we'd still be a British Colony.

And you'd have a national health system to boot!

I have to admit that, on occasion, I have referred to the "bean counters" of health care dollars. I am aware that these people are also good folks. Very few people in this business really want to harm folks or don't care about what happens as result of their decisions. We are all just doing the best we can.

I do find it laughable that people haven't figured out that the people with the experience of managing health care dollars whom will have to be employed for the new kinder gentler health care system are the same coldblooded paper pushers they currently deride.

I do want people to consider potential unintended consequences of the proposed "solution".

A lot of the issues that divide us are health care issues. Once health care becomes public, it will be used for "right thinking Americans" to manage the lives of other Americans they feel aren't quite as clear headed as they are.

Potential issues - family planning, abortion, and birth control, assisted suicide, tobacco, alcohol, obesity, high risk activities like scuba or hang gliding, vaccination, end-of-life, fast food, homeopathy, chiropractic, herbs, gun control, helmet laws, drug use etc

These can all be on the table as they are either directly part of health care or impact how much money the health care system is forced to spend on their consequences.

"I resent my money going to pay for X. I don't think I should have to pay for someone else's bad decision. We either need to make them pay extra or limit/ban that activity"

Originally Posted by jockeys

1. ah, but I only have to use car insurance to pay for someone else if i am RESPONSIBLE for damaging their car.

you have to buy the min insurance regardless if you damage anybody else's car or not. if you don't use it, which not having the numbers i suspect most drivers don't, they are essentially paying for the behavior of the more reckless ones. the same way you are currently paying for the minimum health care the uninsured receive for free, except that you can opt out of health insurance completely and potentially join their ranks if, through your fault or somebody else's you end up with a medical bill you cannot afford but somebody deemed that saving your life is more important than finding out if it's financially profitable for them to do so. I think it's fairly obvious that there are plenty of people who can cause you serious injury but have not the means of paying for your recovery. Yes you can put them in jail for life or even on the death row, but that is just punishing them, not helping you. a minimum insurance that everybody if forced to have is just spreading the risk of stuff like reckless behavior of the few to everybody else. It's not fair by some standards of fairness, but the way our society is structred most things are not.

Originally Posted by jockeys

3. with an attitude like that, we'd still be a British Colony.

So when is the Texas secession day scheduled for? As far as I know you are still enduring the tyrany of the federal government