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Humane or Cost-Effective?
My wife recently suffered a very serious stroke, She spent two weeks in the hospital and is now in a nursing home. I share this personal information as background for some observations on the current health care debate.
There is ongoing an intense artillery duel of words, claims, accusations, statistics and anecdotes from both sides of the debate over national health care. (Come on, you know that's what it's really about.) One side claims that care will be rationed, especially for the elderly. The other side vehemently denies this. This is in fact the case in the UK and, to a lesser extent, in Canada, an inevitable result as costs spiral upward and politicians and bureaucrats are caught between the rock-and-hard-place of confiscatory taxation versus service.
This rationing is quite subtle and not absolute. There is much debate, but expensive life-extending medical procedures for folks over 60 are frequently withheld or delayed. The testimonials from Britons happy with their health care are overwhelmingly from younger folks, as witnessed by the interviews in Michael Moore's movie Sicko.
I witnessed the crux of the problem during this past two weeks. The great majority of folks in beds that I saw were elderly. No question that our bodies deteriorate as we age--all of us. The assertion that most of the health care costs in the U.S. are incurred by old folks is, as far as I can see, completely valid. This is a major factor in the high cost of medical care and insurance. Other countries with nationalized health care employ--often subtly--policies that reduce these costs, hence the claim that "their" health care is less expensive. One structural problem is that doctors (in the U.K.) are salaried and work a normal work day with little incentive to put forth extra effort.
There is no magic formula regarding cost. Today's medical technology is expensive. The only way to substantially reduce the cost is to reduce expensive procedures like transplants. (No, the insurance companies are not staffed by robber barons! Their rates are based on payout statistics.) Some savings are achievable by eliminating duplication in facilities and drugs, which should be done--regrettably--via government intervention. I'm afraid that would result in fairly modest savings when compared to organ transplants and joint replacements.
Dr. Ezekial Emanuel, health policy advisor to President Obama, likely czar of any "government option" and brother of Chief of Staff Rahm Emanuel, has repeatedly and publicly advocated rationing of health care dollars based on fiscal principles. He has suggested restricting expensive health care procedures for the elderly and the very young! His reasoning is that society has not yet invested much in the young so not much is lost by their departure. Conversely, the elderly have little or nothing more to contribute to society, so they too are expendable. Best to invest scarce health care dollars in the lucky folks in the middle who are worth more to society, i.e. will provide a ROI (Return on Investment).
I'm sure Dr. Emanuel also opposes dripping water on the faces of terrorists to elicit information as constituting inhumane torture. (Liberals seem to have little difficulty with inconsistencies.)
The decision regarding national health care is straightforward, if not easy. Either ROI or humane; we really can't have it both ways. (By the way, "single-payer" Medicare already does this to some extent by tightly limiting rehabilitation coverage following a stroke. I know this first hand. Those pesky old folks again.) I guess it's our "Hobson's Choice."
Al - So good to see you back! Our best to Joan. We're here if you need anything! As a recent 'victim' of our great(?) medical care for the older patient, it will be interesting to hear and see through your eyes just where the deficiencies are.
Have a great week!
Al: Several chickens have clucked their relief at your return, no more sacrifices. I fear there is a long and arduous journey ahead for you and your family. Our prayers will continue. I wonder how much the decisions that you have seen are from the institutions involved rather than the Medicare system? Before my father passed on, he was given the greatest of rehabitation care in our home town. Close to six weeks in a rehab facility prior to being released, (Dad said they were the most frustrating weeks he had even spent, he wanted out but they had a set criteria he had to accomplish before he could be released) folowed by in home visits by a therapist, until he succumbed to a heart attack. Our family was very pleased with his care. Even my wife, who spent her entire working life in the medical field, (RN with a Master's) and is extremely critical of the care our family receives, found very little to criticize. I disagree with your contention that health care for the elderly in Canada is being rationed. I have a friend in BC, in his upper 70's, who in the past 12 months has had open heart surgery with 5 bypasses, both hips replaced and one eye lens replaced. To me that doesn't sound like there is any kind of rationing taking place. I do agree that it is difficult to have both ROI and humane care in a profit driven health insurance system. That system believes insurance is a privilege, instead of like most of the rest of the industrialized world, notable exception the US, believes insurance is a right.
My mother in her late 80s just had a hip replacement and pacemaker by medicare without incident and exellent care. Part of what may have happened in your case is an uncertain recovery prognoses ( I hope).
However I do take issue with this opinion,"One structural problem is that doctors (in the U.K.) are salaried and work 9 to 5 with no incentive to put forth extra effort." I'm sure the dedicated DR will put forth effort, where as the US med school grad is working a dogged schedule to pay back his education.Which to you makes a more attentive caretaker?
Not knowing anyone personally in a"socialized medicine" country I cannot give any example on their care, but something needs to be done to fix our broken system. I'm sure for every bad example you can give on the slowness of care there , there is a citizen of our country dying( maybe very slowly) from having no insurance and therefor no care at all.
"This is in fact the case in the UK and, to a lesser extent, in Canada"
If you insist on taking this position, then you must also claim that health care is rationed everywhere. After all, there's a finite amount of resources anywhere you go, therefore nobody can get more resources than whats available.
So why not just admit you're spreading a bunch of baloney.
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"expensive life-extending medical procedures for folks over 60 are frequently withheld or delayed."
Here you speak truth. In the US, this occurs frequently.
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"The testimonials from Britons happy with their health care are overwhelmingly from younger folks"
I would expect you to understand that the older people get sicker more often and sick people generally are less happy about ANY health related matters. What's your point?
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"I witnessed the crux of the problem during this past two weeks."
And your solution appears to be that you want me to keep paying for your wife's care, but you don't want 19 year olds to be covered at all. Yes, I'm sure you don't want that to change and you "see" that the problem is that coverage might be extended past "your kind".
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"The only way to substantially reduce the cost is to reduce expensive procedures like transplants."
No it isn't. That's very ignorant of you. I would imagine that you believe the only way to deliver packages quicker is to provide the pony express with faster ponies too. Ever here of Jets? Cell phones were once too expensive for individuals to own. Now there cheap. Heck, space flight is becoming cheap enough for individuals to go to space. Transplants can become cheaper too.
"I'm sure Dr. Emanuel also opposes dripping water on the faces of terrorists to elicit information as constituting inhumane torture. (Liberals seem to have little difficulty with inconsistencies.)"
I'm sure neanderthals like you love to torture. (Neocons have no problem acting inhumanely.)
“"advocated rationing of health care dollars based on fiscal principles."
That's exactly what republicans say too.
" He has suggested restricting expensive health care procedures for the elderly and the very young!"
The republicans say only for those with a job, but that excludes the elderly too, so there's no difference other than the elderly are already grandfathered in (no pun intended).
Guess I shouldn't have had that donor sticker put on my license.....The only way to substantially reduce the cost is to reduce expensive procedures like transplants. (No, the insurance companies are not staffed by robber barons! Their rates are based on payout statistics.) .. I guess that is the price Americans are to pay to ensure profitability for insurance companies??
Al -
So very sorry to hear about your wife. My thoughts are with you, her, and your family.
I have to say, though, that your perspective of our health care system is myopic. You and your wife are both eligible for Medicare, which I have to point out was fought tooth and nail by Republicans. As was Social Security. As was unemployment insurance. As were virtually every law that protects the health and safety of Americans.
If you did not have this nationalized health care system, which I have been paying into since it was established as law, do you know what this unfortunate (although not unpredictable) illness would be costing you, personally?
Please read my post on my conversations with British citizens about their national health care system. Nationalized health care is the only moral choice.
First, I am not really "back", although if I have a few spare moments I might write something. This post was a direct result of our experiences so far. Medicare will cut off coverage for rehabilitation therapy and nursing home care in as little as 10 days unless there is "significant progress," which is unlikely in our case.
I have edited the post slightly to clarify some of my comments. It seems to me that just about every national health care system is in financial difficulty and searching for ways to cut costs.
My point is that you can't achieve major cost reduction without cutting back on expensive medical procedures. Eliminating insurance company profitability will just drive them out of business. You can't cut corners on an organ transplant procedure and it's not going to happen through "efficiencies". Direct cost controls have never worked for anything.
The only way to accomplish significant savings is to withold expensive procedures from some people and that gets into a selection process. Call it what you will.
On the other hand, my wife was incompetently misdiagnosed in the ER, resulting in significantly greater impairment. So, I guess I'm not the greatest fan of our medical care system at this point. Talk about conflicted.
Al -
Get some rest. It's out of your hands.
Jeff, you are right. God bless.
Al - I believe that there is a new 'regulation' pertaining to Hospital errors. I'm sorry that I don't have the actual link to it, but if a Hospital makes a error that causes the patient to require more care, insurance will not pay for it. The Hospital will be required to pay the bill. Might be worth checking with medicare to see if this would also be the protocol for the nursing home. I think that Medicare was the one that initiated the new rule. It originated with staph infections. If you need me to do some more research on it, let me know and I'll be happy to see what I can come up with.
Let us know if you need anything! Joan is very lucky to have you by her side.
Al--I hope Joan not only improves but recovers fully. I'm sorry for you and your family.
Al...I'm so sorry to hear about your wife. My dad had a stoke at 78 and recovered quite well. It was a very serious stroke but he fought back to walk and talk again. It was amazing.
If I can help by sharing my fathers fight, please email me on the side. You know how to get a hold of me.
May God bless all of you.
Al -
How is your wife doing?
How are you?
Jeff: Not too well, I'm afraid. The damage was extensive. She can't communicate or walk. There has been slight progress--very slight. The worst is, I know she's in there.
I'm transferring her to a specialty hospital in Waterford in hopes of better results. Up to my *** in lawyer stuff, since she's legally incompetent. The system does not make it easy, but I've got a good lawyer. I'm O.K., just a little tired. Thanks for your concern.
Still thinking about both of you Al! When you get time, keep us updated so that we know what's up. And, don't be afraid to let any of us know if there's something that we can do for you.
Al: That's a 'ditto' from me as well.
Al, I sincerely hope all is going well and your wife is recovering well. And I'm sure that your argument has a lot of merit.
But, why not work towards something better with health care? something that has the potential to not ration health care at all? Where all people can get what they need when they need it?
Best wishes and regards.
djklein - I fear that in order for that to happen, we would have to get rid of most of the elected officials, insurance industry executives, lobbyists, ect. There are many 'layers' to our healthcare mess. It's taken a long time to get to this point. Until everyone decides to do the right thing, the arguements and posturing will continue.
In the end, it's really not the U.S. public that matters. We were forgotten long ago. They all just figure out ways to make money off of those of us that actually work, pay taxes and follow the rules.
Really fair, huh?
Have a great week!
Al: Any improvement at all? I hope that you have hired a real "shark" to pursue your concerns. While providing no consolation to your family, perhaps forcing accountability onto the hospital will prevent this happening to someone else.
Al,
Just checking in. When you get time, let us know how things are going and if there's anything that you need! Thinking of you!
Al: Any chance for a short update? We're all concerned and praying for you and your family.
Al: I'm sure the next few weeks will be extremely difficult for you and your family. Please take what comfort you can from the knowledge that there are a lot of people who think about you and lift your family in prayer daily. It may be tough to do but I'm certain you will be able to find something to be thankful for on Thanksgiving. I am thankful to have had the opportunity to converse with you through this site. We miss your calm lucid arguments. Happy Thanksgiving.
Tags: Society and Morals : Perceptions : National Issues
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