Rationing Healthcare — Unconscionable or Inescapable?

[jaminkw]

Thanks Don. I will read the bill as soon as I have the time. I'm tired of listening to propaganda on both sides and will be happy to be more informed.

Judy in Key West

P.S. When I was a therapist, TRICARE paid me decent not slave wages like BCBS.

[recce101]

What a tough issue! More complex than capital punishment, abortion, euthanasia, or practically any other controversy I can think of. I'd really like to know more about the debates Canada, the UK, Sweden, etc. went through in setting up their own healthcare systems and how/why they settled on single-payer or whatever — if somebody knows of a good article on that, I'd love to read it.

Although everyone has made valid points, I find myself most aligned with Bud, RnR, and Don. I guess I have more confidence in government than some people do, especially in comparison to the insurance and pharmaceutical industries as a whole. This comes from what I've experienced and doesn't necessarily argue against someone else's opinion.

For the first 21 years of my adult life I was in the Air Force and our family benefitted from excellent care (on-base clinics or CHAMPUS). During the next 22 years, my wife and I were eligible for free care at a military clinic or hospital, but we found it more convenient to use the private health insurance offered by my commercial airline employers or bought myself during the time I was self-employed. During those years we needed a couple of major surgeries and several minor ones, but that was before costs started going out of sight, and my copays were quite small. Things got even better when I turned 65 and could go on Medicare, since Tricare for Life came into effect that same year for military retirees. Now, as long as I pay my $96 for Medicare Part B, Tricare picks up the entire 20% not paid by Medicare, meaning zero copays for me (except $3 for a month's supply of most prescriptions up to $9 a month for the most expensive such as Tarceva). When my wife turns 65 she'll have the same deal.

How close we can come to that standard of care for everyone, I don't know. I imagine some adjustments will be needed, but with good management we can probably come closer to it than many people assume. Without paying any more than we do right now, we should be able to provide good evidence-based care for everyone. As in other countries, I think there will always be doctors and institutions (if not insurance companies) ready to provide additional services for those able to pay.

Ned

[Nick C]

OK, I've been reading and taking notes on the bill.

Clearly it is not robust enough to understand every decision which will be made in every instance...but I would like to point out a few things.

No taxes on anyone but the rich right? That's what he promised. But here is where the money is supposed to come from per the bill:

(A) Existing sources of Federal Govern14

ment revenues for health care.

15 ( Increasing personal income taxes on

16 the top 5 percent income earners.

17 © Instituting a modest and progressive

18 excise tax on payroll and self-employment in19

come.

20 (D) Instituting a small tax on stock and

21 bond transactions.

I have news for you, C is EVERYONE a'la your social security and medicare type taxation is this type of tax and D affects everyone that owns any type of investment...so not everyone but also not just the wealthy....Oh by the way, A is like a tax too, because when the top 5% have less money in their pockets, that's when they spend less, they spend less the less of us that end up employed...just saying...it's a hidden "tax".

(2) CONVERSION OF INVESTOR-OWNED PRO18

VIDERS.—For-profit providers of care opting to par19

ticipate shall be required to convert to not-for-profit

20 status.

This bugs me...taken over Goverment Motors...threats of nationalizing banks...now convert doctor offices. Hmmm.

(3) PRIVATE DELIVERY OF CARE REQUIRE22

MENT.—For-profit providers of care that convert to

23 non-profit status shall remain privately owned and

24 operated entities.

This doesn't make sense. Legally. I run a non profit, I'm also a CPA and I have an MBA..."ownership" denotes rights to the net assets of an entity byt the owner. However, I do not OWN my non profit. I have no rights to the assets. So I don't understand how the doctor still "owns" his/her practice...but it is a non profit.

Look, I'm all for doing SOMETHING when improvements are needed. But this bill has a LOT of question marks in it...it is too broad and gives too much carte blanche to the gov't. The president took 9 months to pick a dog for his family, but for some reason wants the future of this country, it's debt load, it's tax system and its social system to get pushed through as soon as possible...why? So the questions don't get asked...because the public won't like the answers.

OK, I didn't shut up...Sorry.

[Bud Baker]

Yeah, that document is pretty vague, and I'm betting the first version of the working plan in practice won't be very good. But I still think we have to start somewhere. We've already waited far too long.

I got the impression that the non-profit statement referred to institutions, not individual doctors.

[Nick C]

But I still think we have to start somewhere.

Starting with something that is too far reaching, , takes away choice, puts our children into debt and has potential to ruin the best health care system on the plant is not the somewhere I want to start.

[RandyW]

I know UK you have very few choices of medical care. Many drugs are not offered to patients who are deemed as terminal by the system. 1.5 million doctors and health care professionals on the government payroll. Wait 2 weeks to see a doctor.......

[dahknee]

I've been reading this post since it appeared and have said nothing but, my employer has been gracious enough to carry me on insurance even though I've hardly been able to work in the last year. Now our insurance company is getting ready to cut and run because they can't compete financially with free government insurance that is being promised and my employer is going to be taxed more for already providing health care to all of his employees. Since Obama Binlyin was elected our unemployment statewide is almost doubled. I don't see one thing that he is doing for our country now except to create a deficit that our great grandchildren won't even be able to pay for. Yet people still seem to be saying he's doing a good job,, Where? for al queda, for communisim for Iran, North Korea? I just don't see any good coming out of all of these great plans at all. I am on the verge of losing my insurance that has so far paid for 95% of my care so that I can start paying for it all myself. He's full of sh

[gpawelski]

I've observed the insesent complaints on various cancer blogs and discussion boards about private insurers "denial of coverage" on the backs of injuried and diseased human beings during their fight with the great crab.

In one case, the patient was denied a CT scan. As the poster said, "because their private insurer is practicing medicine and deciding that such a thing is not medically necessary." Without the CT scan, there was no way for the doctor to definitively tell if a swollen leg is cancer related or a blood clot. The physician couldn't make a diagnosis based on the best avialable technique to make that diagnosis. A good case of a corporate bureaucrat coming between a patient and their doctor.

Another poster presented the case that their private insurer used to cover Pet Scans. Unfortunately, some study came out stating that Pet Scans aren't more effective than CT Sancs to find colon cancer. With that one study, the private insurer had decided not to cover the Pet Scan, even against the physician protest.

And one more described their situation while fighting prostate cancer that had metastasized to the hip bones and a clinical trial using hormone therapy and Helical Tomo Therapy was looking to be the best opportunity to fight the cancer. The studies showed that is was really helping people with bone cancer, it is very precise treatment that does much less damage to surrounding tissues. However, private insurer had denied covering the Helical Tomo Therapy treatment. They said it was just too expensive and the hormone therapy should be enough for the patient.

These are just a few of the numerous complaints happening across the United States. One poster goes on to say, "It would appear to me that we in the USA are rapidly closing in on having all of the drawbacks of socialized medicine, with none of the purported benefits. It is partly privately financed, but the controls are given over to remote corporate bureaucrats who determine who shall live and who just isn't worth it."

Most Americans are aware that what is good for the health care system as a whole often looks very different when it's their own health at stake or the health of someone in their family. Do we Americans view health care as a communal resource that should benefit everyone or do we view it mainly from the standpoint of "what's in it for me"? Do they view themselves as citizens working together for a "greater good," or as patients and consumers of health care, worried about retaining access to all that medicine has to offer? The longer we delay, the higher health care costs rise, while more and more Americans lose their health insurance.

The private insurance health care system controls costs by dropping coverage for many workers, a safety valve of uninsured to dump out of the system. If you can increase prices and have relatively inelastic demand (force people to drop out), you'll find enough people stay paying into the system so that the total amount paid in goes up.

In another five years, the $10,000 cost of family insurance will be $15,000 and more and more employers will have dumped people either into higher-deductible health plans or into the uninsured pool. The continued increases in health care costs will impact virtually everyone before it will create a constituency that will support universal health care.

In the meantime, you'll continue to have a corporate bureaucrat between you and your doctor.

http://krugman.blogs.nytimes.com/2009/0 ... ealthcare/

[Don]

That is a good link in what the Professor has to say. I agree with him, the system cannot work the way it is now and the only way to fix it is socialized medicine. So far the socialized medicine that I have with the military is fantastic. Just because I got cancer they don't drop me or charge me more. I have never been turned down for a PET, MRI or medicines like I here people talk about on this site. Had gamma knife at no cost to me. Even had a radio installed in back tooth (just kidding).

Please let's remember something else also. Obama has been in office for 7 months and it was the last eight years that has screwed us up. Let's see what he and ALL of the rest of the politicians can. I just read a story on my home page that new housing starts/buys shot straight up last month. Car sales will most likely get better also. If the govt wants to give me 4500.00 for my old 92 lincoln town car with 330,000 miles on it why the hell not. Use the system people.

If you have better ideas then do something about it not just be negative all the time. Things will get better because we have people that care in this country and they will find a way to help all of us.

Don

[Don]

I forgot to add

STAYING POSITIVE IS WHAT HELP ME BEAT SCLC.

[Bud Baker]

"Nick C"]

Starting with something that is too far reaching, , takes away choice, puts our children into debt and has potential to ruin the best health care system on the plant is not the somewhere I want to start.

I guess we'll agree to disagree on that. Last studies I checked had us rated 37th on health care, in spite of the fact that we spend more money on it than any other country.

[Nick C]

Bud,

Shoot me that study.

Yes, where I shake out may be different that you, and that's cool...but I do like to be educated.

[Bud Baker]

The last one I saw was the World Health Organization's rankings.

The frustrating thing is that here we are, with more than our share of the best medical schools, doctors, facilities, equipment, etc, yet we rate no better overall than 37th (just behind Costa Rica). It doesn't speak well of our system at all.

[ursol]

I'm with Nick on this issue.

What Obama wants to do scares the hell out of me and I pray that it does not move forward.

My husband is Portuguese and my family is Sicilian. We have dealt with hospitals oversea's. We actually hijacked my late father in law out of a hospital last year to get him back to the states where they would actually take care of him. In Sicily when you get to the emergency room you are put in the hallway until a bed opens. The doctors are not allowed to treat you until you are in a room. I know several people that died in hallways including my cousin from complications due to Rectal Cancer a few months ago. My mother in law waited 6 months in Portugal for an appointment to see a doctor because she couldn't walk well. My brother in law had a cyst or gash in his head and waited a month to see a doctor. These countries have National Health Care Systems. Yes, noone has to pay anything, everyone gets treated eventually but by the time some people will get treated it will be too late or they will have already been dead awhile. My cousins 9 year old daughter almost died this year drowning here in CT. She was clinically dead for several minutes but they brought her back to life and after incredible amount of work by the doctors at Hartford Hospital she fully recovered. My cousin in Sicily said to me while I was there "Thank God she was in America---they would never work that hard to keep someone alive here".

What really gets me about the debate on government deciding when end of life is is that for me when I was in the hospital and went into respiratory failure one middle of the night. A young resident looked at me and said "do you want me to intubate" I said "YES". The nurse next to him started arguing that I was a lung cancer patient and they shouldn't because it was pointless in not those exact words but I got the gist of what she was saying to him. What makes her GOD? If I want to live a long time, I'm going to and noone is going to stop me...I work my *ss off so I can have medical insurance to pay precisely to keep me alive for as long as I want to put up with the treatments. I have not quit working so I don't plan to die so easily. With that said Obama and the rest of the government can go pound sand if they think they are going to choose my end of life.

Sorry...my two cents.

Lilly

[Nick C]

Bud, thanks for throwing me the survey...I appreciate the opportunity to annalyze what is there. Did you see the component pieces of the survey? What makes up the rankings?

Responsiveness - guess which system is number one? US.

The survey then has a "financial fairness" criteria based on how much folks spend as a % of household income The US ranks # 54.5 out of 190 countries. But it is a ridiculous indicator. Columbia was #1 because their lowest income people spend $1 whereas higher earners spend $7.60 on healthcare...and as a reward they get a 94 responsiveness.

So actually this study makes my point as to why we are the best system in the world! out of 190 countries we aren't spending "the most" according to their indicator we are spending less than 70% of the other countries in the survey..and we still have the most responsive health system!!!

We have the BEST system in the world.

[gpawelski]

The private insurance health care system controls costs by dropping coverage for many workers, a safety valve of uninsured to dump out of the system. If you can increase prices and have relatively inelastic demand (force people to drop out), you'll find enough people stay paying into the system so that the total amount paid in goes up.

For those who still have health insurance and think you'll lose it with an "option" program, your premiums nearly doubled over the last eight years, and the health care system controlled costs by dropping coverage for many workers: a safety valve of uninsured to dump out of the system. If you can increase prices and have relatively inelastic demand (people forced to drop out), you'll find enough people stay paying into the system so that the total amount paid in goes up. Are you next?

If we don't get badly-needed health care reform now, in another five years, the $10,000 cost of family insurance will be $15,000 and more and more employers will have dumped people either into higher-deductible health plans or into the uninsured pool. The continued increases in health care costs will impact virtually everyone before it will create a constituency that will support universal health care, instead of the public option now.

In the meantime, you'll continue having a corporate bureaucrat between you and your doctor, who will become an employee of the local hospital.

The Best Care Anywhere

http://www.washingtonmonthly.com/featur ... tml#byline

[Bud Baker]

"Nick C"]

We have the BEST system in the world.

Being the quickest to overtreat makes us the best? I don't think so. We'll have to get a lot higher than 27th in life expectancy before I can consider agreeing with you.

Personally, I wasn't all that impressed with our system's responsiveness as my wife sat in an Arlington emergency room, waiting 10 hours to be seen by a doctor. It wasn't because all the other people's conditions were more serious than hers. It was because the emergency room was overfilled with uninsured people who couldn't get to see a doctor any other way. These people could receive better care at much less cost away from an emergency room, but that's where "the BEST system in the world" forces them.

In Congress, even those who don't like what's proposed don't even attempt to argue that the system doesn't need fixed. I had no clue that anyone did, but I see now that they do. It's insulting enough to me that I'll take my leave of this thread now.

[Nick C]

Life expectancy is not going to be improved by ANY healthcare system we come up with.

Life expectancy is an American lifestyle issue. Kids drinking soda, adults eating McDonalds at lunch everyday. School cafeterias deciding tater tots qualify as "the vegetable" portion of kids lunches.

And therefore, again, the "conclusion" of the study is skewed...mathematically they are drawing a direct correlation between life expectancy and healthcare system.

If you had said the US has an efficiency rating based on the study of 37th out of 190 I would say, OK...that makes sense> It's like saying the Yannkees are less efficient than Tampa Bay because they spend double but are only ahead of them by 3 games. I concede the US can be more efficient. Can't every system? To make us more efficient, you don't need to turn the system socialist.

Being the quickest to overtreat makes us the best?

What is the definition of overtreat? How many people here under this plan will fall into the "overtreated" category and therefore told the system doesn't accomodate you...it isn't in the budget.

[Nick C]

For the record I have thanked my counterpoint for information and said we'll disagree, and that's cool.

That is the one unfortunate thing about politics...somteimes it sounds snarky or heated, but I assure you, my typing is only my analysis of data and my logical flow of outcomes as a result of potential decisions...not an attack.

I used to be on a Star Wars message board (OK...I know I just invited the real abuse LOL) and we actually had a "Rancor Pit" where all political and religious discussion HAD to go. It was even password protected...so when you went in there, you KNEW what you were getting into. (The password was in the title of the board...like an enter at your own risk thing.)

Thanks Katie for always being on top of this stuff. If nothing else, I hope some people read all the stuff Bud posted, because it is informative and important, and I appreciate him giving folks the opportunity to read the actual information versus being fed 40 second incomplete info in the news.

[Nick C]

WSJ: page A17 Health Reform and Cancer ...please read.

[recce101]

This article seeks to clarify some of the issues that have been subject to misinformation and/or oversimplification by — dare I say — people on both sides of the controversy:

http://www.google.com/hostednews/ap/art ... gD99QQ2OG0

Ned

[gpawelski]

Comparative effectiveness research (CER) is not rationing health care. CER has the potential to tell us which drugs and treatments are safe, and which ones work. This is not information that the private sector will generate on its own, or that the "industry" wants to share. Companies want to control the data, how it is reviewed, evaluated, and whether the public and government find out about it and use it. Just about the way they are controlling data now.

CER is not something for patients to be afraid of. It can help doctors and patients, through research, studies and comparisons, undertand which drugs, therapies and treatments work and which don't. Nothing in the legislation will have the government monitoring treatments in order to guide your doctor's decisions. Doctors will still have the ultimate decision, along with the patient.

Yet as anyone with even a passing familiarity with the medical science and medical economics literature understands, comparisons are rarely black and white. Most medical technologies only help a fraction of patients. Most medical technologies have some risks associated with their use. Comparative cost-effectiveness analysis is an important tool for accurately evaluating those benefits and risks.

[Maryanne]

This was sent to me today. Scary stuff, especially for our seniors which includes me and probably most of us here, if not you then your parents.

http://fredthompsonshow.com/premiumstre ... N0U2l6ZT01

Maryanne

[gpawelski]

The venue at one of the lastest Institute of Medicine forums on assessing and improving value in cancer care, was the pharmaceutical and biotechnology industry's efforts to beat back efforts at cost control in cancer care, which is increasingly seen as the next big income generator for Big Pharma. No wonder the "industry" is worried.

They put together a coalition, the so-called Partnership to Improve Patient Care, which includes the lobbying arms of the drug, device and biotechnology industries as well as patient-advocacy groups, most of which accept pharmaceutical industry donations, and medical-professional societies, to lobbying Congress to give the "industry" a major say over how it will be run.

The drug and medical device industries mobilized to gut a provision in the stimulus bill that would spend money on research comparing medical treatments. The research funding would be doled out to the National Institutes of Health and other government bodies to focus on producing the best unbiased science possible.

Comparative effectiveness research has the potential to tell us which drugs and treatments are safe, and which ones work. This is not information that the private sector will generate on its own, or that the "industry" wants to share. Companies want to control the data, how it is reviewed, evaluated, and whether the public and government find out about it and use it. Just about the way they are controlling data now.

Do publicly traded companies have a seat on the governing board of the Securities and Exchange Commission? Should Boeing and Airbus be given the right to determine the scope of the National Transportation Safety Board's inquiry into airplane crashes? It is simply bad governance to give "industry" a seat at the table when officials decide what comparative effectiveness studies will get done.

Sometimes clinical practice guidelines are questioned on the basis of profit conflicts. Specialty medical societies work to insure their specialist members get reimbursement for common procedures/treatments, the drug industry works to produce evidence statements that promote use of their drugs, so some questions arise that do not seem comfortable that many trials are unobjective and balanced.

The entire premise upon which these societies base their evidence-based guidelines may be biased towards maintaining flow of their life blood-industry funded clinical trial dollars. Could it be that they focus on guidelines to both justify and feed the proposition that because cancer patients are probably going to die, then the FDA, CMS and taxpayers are supposed to pay for any combination of these wanna-be cancer drugs for any type of terminal cancer?

Evidence-based medicine has morphed into pharma-based medicine and HMO-based medicine. Evidence is based on data from medical journal articles, epidemiology and economics, which relies on randomized clinical trials, which doesn't even require a medical education. Nonphysicians trained in social science, science or even public policy analysis, have judgement over medicine. Where doctors defined the "standard of care," now payers and purchasers of medical services redefine the standards for appropriate medical care, encouraging doctors to act in ways to promote their financial interest when they make medical decisions.

The use of clinical trials to establish prescribing guidelines for evidence-based medicine is highly criticized because such trials have little relevance for the "individual" patient in the real world, the individuality and uniqueness of each patient. In cancer medicine, the best reform to the system is to totally remove the profit incentive from chemotherapy administration. Take physicians out of the retail pharmacy business and force them to be doctors again.

Conservatives have been misinforming the public about the health IT provisions of the stimulus package by falsely claiming that it would lead to the government telling the doctors what they can and cannot treat, and on whom they can and cannot treat. The Hudson Institute fellow, Betsy McCaughey, claims that legislation will have the government monitor treatments in order to guide your doctor's decisions (As Fred Thompson would sound in the background, "Tsk, Tsk, Tsk").

The language in the bill tasks the (already existing) National Coordinator of Health Information Technology (NCHIT) with providing appropriate information so that doctors can make better informed decisions. The NCHIT provides counsel to the Secretary of HHS and Departmental leadership for the development and nationwide implementation of health information technology.

Contrary to Ms. McCaughey's statements, the language does not establish authority to monitor treatments or restrict what your doctor is doing with regard to patient care. It addresses establishing an electronic records system so that doctors can have complete, accurate information about their patients. Converting an antiquated paper system to a computer system by making the health care system more efficient.

[recce101]

Please see this from Dr. West's cancergrace.org site:

http://cancergrace.org/general/2009/08/ ... interview/

Ned