tag:blogger.com,1999:blog-8429570072441023296.post5212149598779137790..comments2023-09-07T06:36:59.520-04:00Comments on The Virtual Philosophy Club: Health CareIra Glicksteinhttp://www.blogger.com/profile/10800080810596424897noreply@blogger.comBlogger12125tag:blogger.com,1999:blog-8429570072441023296.post-15944406590164083282009-08-23T13:29:09.491-04:002009-08-23T13:29:09.491-04:00I agree employers should offer choice in health ca...I agree employers should offer choice in health care plans as yours did, Joel. Perhaps active and retired employees should be allowed to purchase any qualified health insurance, with the employee picking up any premium amount in excess of the employer contribution. I also like Sen. McCain's idea that health insurance companies be allowed to compete nationwide, across state boundaries, to give the consumer the widest possible choices.<br /><br />Ira GlicksteinIra Glicksteinhttps://www.blogger.com/profile/10800080810596424897noreply@blogger.comtag:blogger.com,1999:blog-8429570072441023296.post-14880606944862196342009-08-23T12:40:45.063-04:002009-08-23T12:40:45.063-04:00My employer had three health care insurance option...My employer had three health care insurance options; Kaiser Permanente, Blue Cross and Straub Plan. This is an example of the proper place of government legislation and regulation. Perhaps, if an employer provides health insurance there must be choice. If you start with a goal of maximizing individual freedom for all rather than societal efficiency, you come up with a different set of solutions than the ones we are being offered by those who profit from Big Government. -Joeljoelhttps://www.blogger.com/profile/08770806025343971171noreply@blogger.comtag:blogger.com,1999:blog-8429570072441023296.post-17170552757692120242009-08-23T09:31:32.770-04:002009-08-23T09:31:32.770-04:00Well, Joel and John are in agreement that we do no...Well, Joel and John are in agreement that we do not need or want socialized medicine - and so am I!<br /><br />My health insurance was chosen for me by my employer, who pays part of the annual premium. My wife and I have only minor choices within their plan. We are both covered by Medicare. I assume you two are in a similar situation. Are you willing to give up your rights under your government and employer funded health plans? Of course not. You and I paid for that coverage. A private insurance plan with the same coverage would be prohibitively expensive.<br /><br />Therefore, whether it is the government or a big insurance company rule maker, it is a "WE" situation. WE have a claim against a bucket of government money and a bucket of insurance pool money. Both are limited resources that need to be spent wisely. <br /><br />"Outcome-based reimbursement" and "comparative effectiveness research" and "quality-adjusted life years" apply equally to public and private insurance pools. I think both public and private plans are spending too much money on we seniors. I look at the rapid advance of medical technology and the real possibility life may be extended indefinitely. That means costs for the chronically and terminally ill will grow as a percentage of total health care resources.<br /><br />Ira GlicksteinIra Glicksteinhttps://www.blogger.com/profile/10800080810596424897noreply@blogger.comtag:blogger.com,1999:blog-8429570072441023296.post-82007833634006084072009-08-23T08:57:44.911-04:002009-08-23T08:57:44.911-04:00Joel is correct Ira. You said “Good try, Joel! If...Joel is correct Ira. You said “Good try, Joel! If we had UNLIMITED public-funded health care resources, we'd give both of them replacement hips. With limited resources we need to make hard choices based on objective medical evidence that may result in one getting a hip and the other palliative care.” <br />Who is the WE? Yes, if we want socialized medicine then some WE will make the decisions and that concerns me greatly. Do we really need socialized medicine? Medicine controlled and administered by edict defined by Washington staffers or maybe under the supervision of a presidential appointed health czar. <br />Even though unfair in cases, a capitalistic system , with reasonable regulation, will prove better for the individual and the country. Let’s mend this system not place the entire health system under Washington’s blanket!JohnShttps://www.blogger.com/profile/05221749229032990533noreply@blogger.comtag:blogger.com,1999:blog-8429570072441023296.post-83822280124044310792009-08-22T23:31:15.242-04:002009-08-22T23:31:15.242-04:00Note the tiny word "free" (society) in t...Note the tiny word "free" (society) in the definition of Orwellian. Using the excuse of limited public funding, you are taking away the freedom of the individual and putting great power into the hands of bureaucrats. As I said in a previous post, all we need to do is to leave the power in the hands of the individual before you extract their earned money and make turn it into "public funds." Health insurance can be between an individual and a regulated insurance mutual. Like Term Insurance it can be for a fixed period. Like Whole Life, it can be for a fixed amount. Like fire insurance, it can be denied to those whose house is already burning when they finally make application. Like home insurance, it can be designed with various deductibles depending on your choice. <br /><br />Freedom is about having choices. Orwellian propaganda is about creating a crisis (like war with Oceana in 1984) so that security becomes more important than liberty in the mind of the individual. -Joeljoelhttps://www.blogger.com/profile/08770806025343971171noreply@blogger.comtag:blogger.com,1999:blog-8429570072441023296.post-70177389088748978682009-08-22T17:53:02.930-04:002009-08-22T17:53:02.930-04:00Good try, Joel! If we had UNLIMITED public-funded ...Good try, Joel! If we had UNLIMITED public-funded health care resources, we'd give both of them replacement hips. With limited resources we need to make hard choices based on <b>objective medical evidence</b> that may result in one getting a hip and the other palliative care. <br /><br />You seem to favor <b>subjective</b> criteria over <b>objective</b> ones? Kind of a popularity contest?<br /><br />Would you allocate a liver transplant to the obese drinker because he is popular with family and friends? Or to the athletic non-drinker who <i>may</i> be a wife-beater and drug dealer but has never been convicted of any crime? (Of course, IF he had been convicted of a serious crime I would put him at the end of the health care line.)<br /><br /><b><i>If you let all decisions on spending public money for health care to be made by the person whose life is in question and will benefit, then most of it will go to the most selfish among us.</i></b><br /><br />As for your suggestion that objective allocation of limited health care resources is "Orwellian" see <a href="http://en.wikipedia.org/wiki/Orwellian" rel="nofollow">Wikipedia</a><i>"The adjective Orwellian describes the situation, idea, or societal condition that George Orwell identified as being destructive to the welfare of a free society. It connotes an attitude and a policy of control by propaganda, surveillance, misinformation, denial of truth, and manipulation of the past,..."</i><br /><br />Ira GlicksteinIra Glicksteinhttps://www.blogger.com/profile/10800080810596424897noreply@blogger.comtag:blogger.com,1999:blog-8429570072441023296.post-23994278310105186942009-08-22T13:55:39.093-04:002009-08-22T13:55:39.093-04:00Ira wrote: For example, imagine two men of the sam...Ira wrote: For example, imagine two men of the same age. One is athletic and brok his hip skiing. The other is obese, a smoker and drinker with a bad heart and liver who broke his hip slipping on the stairs. etc. etc. <br /><br /><br /><br />Joel suggests: I think this is a horrible way to govern health care. Suppose the athletic guy beats his wife and children. He lives off the importation of drugs though he's never gone to jail for it. The obese guy is a physicist who has contributed to the exploration of subatomic particles. He has written several fiction works though he has a tendency to drink a bit much. He is beloved by his family and colleagues who would miss him terribly if he dies. Letting quality be judged by anyone but the person whose life is in question or their designate seems Orwellian to me. -Joeljoelhttps://www.blogger.com/profile/08770806025343971171noreply@blogger.comtag:blogger.com,1999:blog-8429570072441023296.post-37242537867824561382009-08-21T13:36:00.984-04:002009-08-21T13:36:00.984-04:00Itseems that we are in the same ball park although...Itseems that we are in the same ball park although I would like to have the patient more involved. Not just tell his family his desires and hope they follow through. I would also like to see someone explore further two ideas - greater nurse and nurse practitioner's ability to treat patients so doctor can concentrate on more serious medical problems and greater use of urgent care facilities to relieve the load on hospitals. Both, I think would recuce cost, relieve doctor shortages as well as adding incentive for people to enter nursing careers. Think of it this way a nurse has the equivilant of a BS degree qualifying her to perform certain patient treatments, a nurse practitioner has the equivilant of a Masters degree and can perform a greater range of treatment while a medical doctorate degree is the equivilient to a PHD His training can best be put to use treating more serious matters.JohnShttps://www.blogger.com/profile/05221749229032990533noreply@blogger.comtag:blogger.com,1999:blog-8429570072441023296.post-24276774471893671562009-08-21T12:30:58.806-04:002009-08-21T12:30:58.806-04:00I too agree with the general thrust of what John a...I too agree with the general thrust of what John and Howard say. Along with what Joel said in a different thread, I am concerned that some people, due to their desire for expensive "heroic" treatment to keep themselves or a family member alive, raise the costs the rest of us have to pay from our common medical resources.<br /><br />When my dad had a massive blood burst in his brain my brother and I took turns sleeping on a mat on the floor beside his hospital bed. When the doctor told me, based on a brain scan, our dad would not recover we quickly decided to have them remove everything, including IV and oxygen. The next night, a nurse came in and shoved a tube down his throat to suck fluid from his lungs and I told her to stop. My brother and I were with him when he passed away after a total of six days in the hospital. Had we not "pulled the plug" (which we knew he would have wanted) they could have kept him alive indefinitely at thousands of dollars a day in (mostly) public money. <br /><br />Many (perhaps most) share our attitude and do not want patients who are most likely not going to recover to be given expensive life-extending care. Unfortunately, some people, out of a guilt complex or misplaced ethics, insist the doctors "do everything possible". The medical establishment, fearful of lawsuits and profiting by keeping hospital beds and operating rooms fully occupied, go along. This raises the cost of end of life care paid by everyone.<br /><br />Advanced directives are a good approach, but what about those who do not or will not sign them? We need some general rule that limits futile care and protects doctors who withdraw artificial life support in qualifying cases.<br /><br />How about this as a general rule: If a patient cannot breathe on his or her own and take nutrition by mouth, and if, in the view of two doctors, further medical care will most likely not restore him or her to that condition, any artificial life support, including oxygen and IV-nutrition, should be removed. During this period pain relief (such as morphene) may be given even if it may shorten the patient's life.<br /><br />The "Judeo-Christian ethic" John refers to was established at a time when nutrition could only be given by mouth and there was no option for IV or oxygen or heart-lung machines, etc. Given the new technology, we have an ethical obligation to use it <b><i>TEMPORARILY</i>, WHILE DOING MEDICAL PROCEDURES</b>, WHEN THERE IS A GOOD CHANCE THE PATIENT WILL RECOVER AND BE ABLE TO BREATHE AND EAT ON HIS OR HER OWN. Absent that possibility, artificial life support should be removed.<br /><br />Ira GlicksteinIra Glicksteinhttps://www.blogger.com/profile/10800080810596424897noreply@blogger.comtag:blogger.com,1999:blog-8429570072441023296.post-10036412692035171292009-08-21T09:21:20.932-04:002009-08-21T09:21:20.932-04:00I agree with both of you, Ira and Howard. I was s...I agree with both of you, Ira and Howard. I was simply responding to the original blog. Ira, I cited several cases from my personal knowledge, if I were to say that one had extensive, costly care in his final year the lack of extensive care for the others mitigates the cost. However, let’s drop it.<br />I don’t have solutions but I have some thoughts. As Howard says, this is a culture-based “death denial” of mostly western technical societies that believe there is a rational or technical fix for every problem. I agree although I might extend the definition, it is also a Judeo-Christian ethic requiring us to make every effort to extend life regardless of the quality of life. Only God may make the final decision of when a person must die. <br />In Howard’s definition, time, discussion, education etc can possibly make western nations and others accept a more appropriate approach. In my definition, we are confronted by religious belief, which can be irrational and illogical although religious belief does change over time: as a populous becomes more educated, they tend to require religious leaders to rethink their positions. Abortion and heterosexual marriages are two examples.<br />The problem I see is that technology is changing so fast that our cultural and religious mores cannot keep up.<br />I abhor the thought that some national set of standards or guides will make life and death decisions although in a practical sense it appears necessary.<br />Another thought, could we give the patient a greater role in the decision-making? I emphasize the patient, not his doctor, not his family, not some ethics committee.<br />Suppose, each of us was permitted to prepare a statement of life retention conditions. (Observers would certify that the statement was made while sane and not under other duress.) That statement would have to be renewed or modified yearly. Let me use an example to illustrate the thought.<br /><br /><br /><br />I, John Doe, do not want my life extended under the conditions listed below. I authorize my doctor to take the necessary steps to terminate my life. I instruct my family not to contest these desires.<br />a. An incurable illness that requires me to be permanently bed ridden and under heavy medication for pain.<br />b. At my age, 85, I become permanently blind.<br />c. I am mentally incompetent. That is I am unable to carry on a rational dialog, know and understand my surroundings.<br />d. Any medical procedures that will require extensive (expensive) procedures whose sole purpose is to extend my life.<br />e. If the quality of my life deteriorates below a reasonable level as compared with others of my age.<br /><br /><br />Signed: John Doe <br />Witnessed:<br /><br />This idea will give every do gooder, probably every liberal a heart attack because they want to make the decisions for me, but to me something in this fashion is preferable to having life and death decisions based upon some statistical set of criteria. It also has the benefit of reducing expensive life extending therapies.<br /><br />Other thoughts:<br />Addressing tort litigation is necessary and can be done.<br />A means to share the cost of new drugs, therapies etc, although not reducing the cost of R&D, will reduce the cost of individual treatments.<br />More use of Urgent Care Centers to reduce the burden on Hospital emergency rooms.<br />Increase the authority of nurses and nurse practitioners to perform minor procedures normally restricted to doctors.<br />Encourage Doctors to share facilities to reduce the cost of overhead.JohnShttps://www.blogger.com/profile/05221749229032990533noreply@blogger.comtag:blogger.com,1999:blog-8429570072441023296.post-62195649863310731282009-08-20T21:08:07.756-04:002009-08-20T21:08:07.756-04:00The problem of staying alive (or keeping people al...The problem of staying alive (or keeping people alive) is not going to be solved by government regulations or by government funding. This is a culture-based “death denial” of mostly western technical societies that believe there is a rational or technical fix for every problem. <br /><br />Lifespan will continue to increase because of technology that is largely funded by government agencies. Most biomedical gerontologists believe that biomedical molecular engineering will eventually extend maximum lifespan and even bring about <b>rejuvenation</b> <a href="http://en.wikipedia.org/wiki/Maximum_life_span" rel="nofollow"><b>(see Wiki)</b></a>. <br /><br />The cost of these technologies continues to increase rapidly because of their complexity. The population age-distribution is shifting from productive youth towards the unproductive aged. Population growth by itself is ultimately the world’s greatest problem. Our present approach to medical care and technology is just making it worse.<br /><br />I don't have a solution. Anybody?Howard Patteehttps://www.blogger.com/profile/12181204289094297715noreply@blogger.comtag:blogger.com,1999:blog-8429570072441023296.post-57049546376413262622009-08-20T19:57:25.141-04:002009-08-20T19:57:25.141-04:00Thanks John for your thoughtful posting.
I have ...Thanks John for your thoughtful posting. <br /><br />I have not been able to find the source of President Obama's estimate of 80%. Here is the <a href="http://www.nytimes.com/2009/05/03/magazine/03Obama-t.html?pagewanted=5" rel="nofollow">link to the NY Times</a> where he says <i>"I mean, the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here."</i><br /><br />I'm amazed the press has not asked Obama or his press secretary for the source of the 80% estimate. Parsing bama's words, it appears he is not talking aout just the last year of life and not just about the aged, but also the chronically ill, which can occur at any age. Cronic illness can result in some people being institutionalized for a decade or more, at great cost in public health dollars. Also, Obama used the word "potentially" which means he is not saying 80% is the case now, but, projecting trends in advanced technology that will keep the chronically ill and aged alive indefinitely that, unless we take some action on end-of-life policy, it could grow to 80% at some point in the future.<br /><br />Your list of anecdotal evidence is good as far as it goes, but even those who spent only days in the hospital can run up bills of tens of thousands of dollars. <br /><br />My bottom line is that, given limited resources, it is better to spend it on those who are likely to be restored to vigorous health.<br /><br />For example, imagine two men of the same age. One is athletic and brok his hip skiing. The other is obese, a smoker and drinker with abad heart and liver who broke his hip slipping on the stairs. <br /><br />A hip replacement in the US costs around $100,000. If we give it to the athletic guy (100% quality of life), who has a good heart and liver and is otherwise very healthy with good habits, he will be up on his feet in weeks and back to work (at nearly 100% quality of life) in months and will use that hip for decades to come. He is likely to "pay back" that $100,000 in services to his family and his employer and taxes. The obese/smoker/drinker was at 50% quality of life before he broke his hip. If we give him a new hip, it will cost more because it will take him longer to get back on his feet. He is likely to keep with his bad habits. His heart and liver will still be bad and when they go we will be on the hook for more expensive treatments. He will never get back to a satisfactory quality of life and will be a drag on his family and society in general. I think he is what Obama means by "chronically ill".<br /><br />Ira GlicksteinIra Glicksteinhttps://www.blogger.com/profile/10800080810596424897noreply@blogger.com