Health Care Reform

[vison]

When ideology trumps reason, who is surprised at disaster?

[nerdanel]

And a subsidized system in a capitalist society will be taken advantage of by the industry being paid. Unless price caps are placed on proceedures and supplies ($8.00 for two tablets of ibuprofin being a prime example), do you really think the medical industry is going to charge less and reduce the strain on taxpayer funds?

I'm far from an expert on this issue, but my understanding is that the government does place price caps on medical goods and services when it ventures into the mix, as with Medicare. (Googling "Medicare price ceiling" leads to numerous online articles and discussions of this.) The ACA apparently will impose additional price ceilings on Medicare providers.

Ironically, this causes some people another concern: whether the quality of medical services provided will decrease in response to state-mandated price controls. However, that does not seem to be your concern.

[Folca]

[quote Ironically, this causes some people another concern: whether the quality of medical services provided will decrease in response to state-mandated price controls.[/quote]

I am counting on it. It doesn't matter if it is a concern of mine or not.

"I get the idea that you think doctors and nurses and other medical professionals should "take less" for the public good? Would you, in your job?"

Vision- Yes I would. But I don't have children or a signifigant other, which I believe would make me the exception to the rule. However, most agencies in my state pay less than mine, which means most individuals who are in my career have made that choice. Had I not been hired by the agency of my choice, I would have selected another to apply for until I landed my career choice. Having said that, only by working as much overtime as possible and having a room mate am I able to socialize or go on camping trips, hunt and fish (all of which I do as cheaply as possible).

The "hypocritic oath" (written that way on purpose) medical professionals take is a sick joke to me, as the greatest cause of bankrupcy in the US is due to medical care cost, even with insurance. So, they will save you, but lower the standard of living for you and your family in the process. How does that equate to "do no harm?"

"When ideology trumps reason, who is surprised at disaster?"

That statement cuts both ways. You find your ideology reasonable, and act on it. I do not find your ideology reasonable and object. You do not find my ideology reasonable, and object. Disasters have been visited upon mankind based on a variety of ideologies, and most likely opposition existed for each of the ideologies responsible for the disaster.

Prim- Anyone who wants to strike out on their own can do so. The risks are known, and if they want to go ahead, they can. Personally I think life would be just dandy if I could live close to a high alpine lake, full of fish, far from people, where I could stride through wood and glen, walking staff in hand, picking berries, drying meat, laying up stores for the winter, and then writing stories of adventure and drama to my heart's content during the winter by the light of my fire. But I was not born into the wealth or resources to make that happen. So I work at a job I love, count my life experience as well earned, and will write when I have the time, and really write when I have retired. My reality dictated my necessity, which set me on a planned path to adapt as best I could to that reality and necessity.

River- I have already agreed people get sick. It isn't a point of contention. This legislation isn't going to prevent people from getting sick either. And yes, I am aware money I pay into insurance goes to others, others who are all paying into the same money pool because they are working for it, because they have made a choice to act for their own behalf instead of waiting for someone else to help them along.

Demetia runs in my family too. Not really looking forward to it. However, the typical law enforcement officer dies 3 - 7 years after retirement, so I very likely will be dead before I get dementia. And, since I will be dead earlier than most, perhaps I am doing you all a favor by not using up extra medical care funds in my twilight years!

[vison]

"Health care"? No, what we are talking about is "sick care". Two entirely different things.

If you, Folca, or anyone else, earns or has "too much" money, you can always give it away. I don't understand your ideas about what people "should" earn, and I certainly don't share your opinion of medical professionals. The people caring for me might want to be rich (and if they do, I couldn't care less) but they also are brilliant and dedicated and I admire them greatly.

Ideology trumps Reason: What did they say when they cut down the last tree on Easter Island?

Here's another one: the world's population growth is unsustainable and yet one of the most powerful institutions on earth continues to oppose birth control.

Enuff said, AFAIC.

[Voronwë the Faithful]

The "hypocritic oath" (written that way on purpose) medical professionals take is a sick joke to me, as the greatest cause of bankrupcy in the US is due to medical care cost, even with insurance. So, they will save you, but lower the standard of living for you and your family in the process. How does that equate to "do no harm?"

Folca, that is not due to medical professionals "earning too much" it is due to our broken system based on greedy insurance companies. You are actually arguing for true socialized medicine here, whether you know it or not. Even well payed doctors make a pittance compared to high level financial institution executive, who provide no valuable goods or services. If you want to look to a group of people to direct your ire at, that's a good place to start, not people who, for all their faults (being human) are clearly helping individuals and society.

[Frelga]

Prim- Anyone who wants to strike out on their own can do so. The risks are known, and if they want to go ahead, they can. Personally I think life would be just dandy if I could live close to a high alpine lake, full of fish, far from people, where I could stride through wood and glen, walking staff in hand, picking berries, drying meat, laying up stores for the winter, and then writing stories of adventure and drama to my heart's content during the winter by the light of my fire. But I was not born into the wealth or resources to make that happen.

I'm not sure if you are aware that Prim published three SF novels. If she was born into wealth, she hides it well.

The issue is not living the life of perfect leisure. The issue is working your tail off at something you are really good at, thereby contributing to the society to your full potential, as opposed to clinging to an office job so your kid gets treatment for asthma.

[axordil]

it is due to our broken system based on greedy insurance companies

It has often occurred to me, as I work with health insurance companies, that their use of the phrase "moral hazard" should be enshrined in the Bitter Irony Hall of Fame.

However, they're not the only problem. There are a lot of unintended consequences at play too: the creation of Medicare, for example, meant that suddenly there was someone who would pay for treatment near the end of life, because health insurance companies predictably dumped people when they got old. Is it a coincidence that the explosion of treatment options--and costs--for what usually ends up being the last six months of life dates from after Medicare's creation?

[vison]

I think we should begin an "end of life" thread, actually.

As far as I know - from my personal experiences - few Canadians are subjected to, or have to endure, the sorts of drastic end of life interventions that some Americans do - simply because it CAN be done and "insurance will pay for it".

"Death panels"? No. Common sense. Reason, in other words.

[Primula Baggins]

Drastic end-of-life interventions are available and some people want them, either for themselves or for their loved one who can't choose. The rest of us pay for this.

I don't know how things work in other states, but in Oregon, if the hospital doesn't have a document on file for the patient, they ask them or their surrogate to complete and sign one on day 1. Oregon goes beyond that in that there is also a document you can fill out for after you leave that spells out in detail what interventions you do and don't want—if you're found without a pulse, if you can no longer breathe on your own, if you can't or won't eat.

Your decisions are stored in a database that medical facilities can access statewide. This helps prevent the common situation where the patient is unconscious and the family or friend available doesn't know the patient's wishes or wants to supersede them. Usually people choose much less intervention for themselves than others would choose for them. This system helps those decisions be respected (whatever they are—in all cases one option is "Do everything possible to save me").

Frelga, thanks.

[River]

A quick thought about doctor's pay, 'cuz my mom's a MD and she drives a 10 year-old VW Bug when she's not out her bicycle. How much docs get paid depends on their specialty, seniority, and the terms of employment. A number of docs, even the ones working out of hospitals, are actually running their own practices and have to deal with everything that comes with running a business. Others, like my mom, are direct employees of the hospital they work in. But, to put things in perspective, my mother, a very senior pathologist at a non-profit hospital, is bringing in ~$200K while the top administrator at her hospital brings in seven figures. Why an administrator is worth so much is a question for the ages. Also, there's a huge salary range across specialties. Plastic surgeons do very well. General practitioners, not so much. If you see a GP driving a Porsche, you can bet that every disposable cent they've got is going towards making the payments on that thing. Or they have a wealthy family or partner backing them up.

[axordil]

Or they own the lab they send you to for tests.

[River]

Yeah, but I pick doctors and nurses who're conservative about poking me and then refuse half the time they try (my midwife is having a field day with me, lemme tell ya). And I'm discovering that that squeamishness about needles and anything else invasive extends to lovedones and pets. I've refused draws on my cats and I flipped my lid when S had to get a HIV test and all his shots AGAIN for his green card and when the Rivulet is born I'll probably be the kind of mom who takes a swing at the doctors whenever they pull out a syringe. Maybe I'll just delegate the doctor's appointments to S. He gets lost in the jargon but he can handle the needles.

[Folca]

Frelga, I am aware of Prim's success, and admire it. I didn't mean to imply that my ideal existence would be a life of liesure, as it certainly wouldn't be. There would be lots of effort involved before the snows flew. As it is, between regular shifts, overtime, housekeeping, and a little bit of socializing, there isn't alot of time left over to immerse myself in writing. And, I am the type of person who needs to be able to utilize large blocks of time to get anywhere with writing. The reference to wealth is that it would be required in order to purchase land and pay a lifetime of taxes on that land, especially on the shores of an alpine lake!

[River]

My state is on fire. As idyllic as the mountains are, I do not recommend alpine property at this time. Unless you buy in an area that's already burned.

[Frelga]

Folca, fair enough. I wasn't sure when your peregrinations brought you here. And yes, the irony of rustic life being too expensive. *sigh*

River, you may recall we had a bad wildfire here, some 20+ years ago. Many homes lost, but most people rebuilt in the same place, gorgeous expensive houses. But of course the scale can't be compared to Colorado fires.

[River]

Some 20+ years ago I was a grade-schooler and wasn't paying much attention to the national news.

It's a funny thing. I've been living in this state nine years. To a certain extent, I've grown numb to the fires. This year is just that bad. I've fantasized about living in the mountains above the city since I arrived here, but, in light of the fires we've seen in the mountains this year, the big fire we had right outside Boulder in 2010, and the general state of the forests, I wouldn't do it. Not unless the house I bought was made of stone or stucco or brick and had a metal roof (and I have yet to see a house in the mountains that met those criteria...everyone builds their fantasy log cabin; no one pauses to consider how wood might, you know, burn) and I could afford additional fire mitigation to the property. But this is off-topic. We're talking about health care, not building for the environment you live in.

[Folca]

Well, Colorado is too gorgeous of a state for it all to burn. Hopefully they can contain the fires soon.

[vison]

A very interesting program on CNN right now about health care. I don't know the guy (Fareed Something?) but I can tell you the facts he presents are pretty much irrefutable: every modern nation beats the US in life expectancy, infant mortality, and cost of insurance.

[Primula Baggins]

Yes, vison, but it's all okay because free market. I mean, what's your priority here? Human life? Tcheh.

[Cenedril_Gildinaur]

What free market? The US Healthcare System hasn't been a free market in decades. It is one of the most regulated sectors of the economy.

Another of the most regulated sectors is finance. Health Insurance (which is what the whole Healthcare debate is actually about, coverage and not care) is at the overlap and thus is very regulated.

Free market? Where?