3321

It’s already killed at least two that I’ve read about. Yay profit.

H.

3322

Please try to keep in mind that I am neither arguing for or against a particular healthcare system here, so try not to freak out at me.

Timex -if we had proper health coverage in this country this wouldn’t be an issue - PERIOD.

I believe that this kind of thing is always going to be an issue, in any system. There really isn’t any kind of healthcare coverage which can circumvent the fact that you have finite resources.

It’s really great that corporate America has said “screw terminally ill people, no matter how short a life you’ve had, you’re not worth it!”. And if it were up to Democrats… they would be covered.

Democrats can’t magically create resources. At some point, you have to draw the line and say, “This is not the most effective use of these resources.” Note that I am not suggesting that the line drawn in the case here is the correct line. I’m merely pointing out that you cannot get around drawing the line.

In the case cited (again, in a situation where the study conducted is correct, which I realize may not be the case here), if you have a procedure which costs hundreds of thousands of dollars, and yet has less than an 8% chance of even extending the patient’s life by six months, then that is probably not an effective use of those resources.

I realize that it is sad that the patient in question is being condemned to death. I’m not saying that it doesn’t matter, or that we shouldn’t care. I’m just saying that there’s a 92% chance that you’re going to spend that money, and the person is going to die anyway. And that money did not materialize out of the ether to pay for that operation. That money could have been used to save other patients.

The fact is, the choice to save that person has a real, tangible cost. Not merely in the form of abstract dollars, but in the form of concrete benefits to the lives of other people. By spending that money on one person, you are choosing not to spend it on those other people.

Timex, you don’t want to call it a death panel? What about the fact these people were in line for a new lease on life and now are not? What else would you call this? A life panel?

Do you realize that my avoidance of the term “death panel” is not a republican position? It’s actually the opposite. The term carries with it some dark quality, so it was used by republicans to frighten people away from government sponsored healthcare.

What it is, is simply a manifestation of the fact that any system that allocates a finite set of resources will be forced to make decisions about how to allocate those resources.

No system can avoid this problem. Single payer systems make the same types of choices. As hard as it is to face, someone will have to decide which patients merit the investment required to treat them. And the answer will never, ever, be all of them.

3323

Damn, all this hatred you feel for people who just dare to disagree with you on a public policy, makes discussing the issue with you at all pointless.

3324

Funny how pro-life people like Brewer are after the baby is born.

3325

You don’t ever actually discuss anything with anyone on this board anyway, so I don’t know why you think anyone would give a damn about your occasional “opinions” that you post here.

3326

Brett, you do a terrible disservice to all the kind and generous Republican, Libertarian, and Tea Party members of this forum.

So you claim I have hatred in my post? I don’t have hatred, I have disgust. I ask you, is watching people die unnecessarily supposed to not upset me? Watching a 12-year old kid who’s Mom & Dad work 4 jobs between them… FOUR JOBS, and are forced to rely on state sponsored medicine because none of the companies offer health insurance… while the people who run those companies make gobs of money. I’m supposed to sit back and be OK with that? Or even be neutral? American citizens who have done everything right?

You want to know how ridiculous this is? We’re spending $40 million on flying hummers, yet we question spending 1/10th of that - $4.5 million to save this program.

Among the discontinued procedures are lung transplants, liver transplants for hepatitis C patients and some bone marrow and pancreas transplants, which altogether would save the state about $4.5 million a year.

So Brett, you tell me why I should not be outraged that this country would rather put money into a stupid idea like making a truck fly vs. watching an innocent kid suffocate to death from an inherited disease… when he could live a beautiful life from receiving a new set of lungs.

Timex, you make a good argument, but the fact of the matter is there are countries that take much better care of their (non-wealthy) citizens, who did nothing wrong other than be born with an inherited disease, or getting cancer early in life. If any of these Arizonians lived in Scandinavia or Germany this wouldn’t be an issue. They would be eligible for a transplant.

3327

http://www.giftoflifemichigan.mobi/

Brett, please watch this.

3328

Actually in some cases you can have more ressources than you have asked for…

For those Germans who have already filled out advanced directives, however, the Bundestag decision means that now they can be sure they will receive only as much medical treatment as they want. Assisted suicide or euthanasia remains illegal.
http://www.dw-world.de/dw/article/0,,4406162,00.html
I have to pay 15.5% of my salary for mandatory health insurance. Minimum benefits for me and my family are:

[ul]
[li]Medical and dental treatment, with free choice of doctors and dentists[/li]> [li]Hospital treatment[/li]> [li]Drugs, dressings, complementary treatment, and aids such as hearing aids and wheelchairs[/li]> [li]Sickness benefit (Krankengeld): Normally, your employer will continue to pay your wage or salary for six weeks if you are unable to work. After that your health insurance would pay 70 per cent of your regular wage or salary before deductions for a maximum of 78 weeks[/li]> [li]Measures for the prevention and early detection of certain diseases[/li]> [li]Preventive dentistry and in particular individual and group prophylactic measures[/li]> [li]Preventive inoculations, excluding inoculations for non-work-related foreign travel[/li]> [li]Orthodontic treatment, normally only up to the age of 18.[/li]> [li]Medically necessary dentures and crowns[/li]> [li]Additional benefits for children[/li]> [/ul]

We have over 150 statutory medical insurance companies that compete with each other. As the amount you have to pay is always the same, the companies offer different additional benefits for their members.
My insurance company pays for acupuncture for example. You can also get money back if you perform special measures such as attending sport courses which are free of charge.

Of course you can get additional care if you want to pay for it. I would have to share my hospital room with two other patients. But I could opt for my own room for additional charge.

It isn´t a perfect system by all means, but I can sleep really well due to the knowledge that my family is covered if somebody gets ill. Even if I and my wife would loose our jobs.

That would be true if the health budget would be the only possibility for Arizona to get money.

3329

You do this bullshit in every thread. I don’t participate in P&R usually, but this is just about asinine enough to bring me in. How about you stop being a fucking sophist and talk instead about positions you ACTUALLY hold? Eh? Wouldn’t that be fun?

3330

Actually in some cases you can have more ressources than you have asked for…

Well, the case you cited there is dealing with people turning down medical treatment, in cases where they want to die. This doesn’t really imply “more resources than you have asked for”. Ultimately, the issue I’m describing is simply the situation where you have a system handing out resources which are coming from a finite pool.

This is universally the case. It’s the case in Germany, as well as any other country. You don’t have infinite money to spend on things.

For instance, in Germany, we have this story:

A leading German hospital has promised to review its procedures after being bitterly criticized for refusing a Turkish immigrant a heart transplant because she did not speak German.

The Heart and Diabetes Center of North-Rhine Westphalia originally put Fatma Eladi, 56, on the list of patients waiting for a transplant, but then wrote to her — in German — to say she had been taken off the list because of “lack of knowledge of the language.”

Eladi has has lived for 21 years in Germany, but is still a Turkish national. Some 2 million Turks live in Germany, and they are the nation’s largest non-German ethnic group.

And please, before anyone gets defensive, I’m not attacking Germany’s healthcare system. This is just an example of the kind of line that is drawn in ANY system. In Germany, they drew a line for who gets transplants and who doesn’t based on their ability to speak German. Because, obviously, a line needs to be drawn. They couldn’t just say, “Everyone who wants medical care, in any possible form, can get it here for free.” While actually speaking German seems weird, it’s not that far off from the idea of only providing medical care for actual citizens of the country, which I think many people would see as a non-horrific line.

Another example of a transplant being denied in Germany. A guy was denied a liver transplant to help him deal with Hep C (the same situation as one of the folks in AZ denied a transplant). In this case, he was denied the transplant because he smoked medical marijuana (with doctor approval, apparently).

So really, no matter what system you live under, someone’s going to be drawing lines and deciding who lives and who dies. It’s not pleasant, but it’s a decision that will need to be made.

You do this bullshit in every thread. I don’t participate in P&R usually, but this is just about asinine enough to bring me in. How about you stop being a fucking sophist and talk instead about positions you ACTUALLY hold? Eh? Wouldn’t that be fun?

Well, the position I hold is the one I’m describing… Namely, that in any system you’re going to have to make the kind of hard decisions we’re talking about here.

But this isn’t the same as a position of “Socialized healthcare is good/bad” or something like that. The nonsensically polarized positions that dominate the healthcare debate aren’t really super productive, especially when you are talking about it from a really high level.

Does that make sense? The caveat I issued at the beginning was an attempt to prevent people from assuming that I was presenting some kind of argument in defense of the American healthcare system, or attacking other systems. It wasn’t the introduction to a devil’s advocate argument, as you seem to be suggesting. Did you read the text that followed that paragraph?

3331

Of course every money source is finite. My example shows that you can have a pool which is great enough that it funds very expensive life-sustaining measures for terminal ill patients for years.

You should read your own links. The decision was wrong but the issue wasn´t her citizenship. What you didn´t quote from the article:

In taking Eladi off the transplant waiting list, the hospital said the death rate among transplant patients who did not speak German well was 50 percent — higher than for those who thoroughly understood the complex instructions for post-operative care.
to clarify:

The Heart and Diabetes Center of North Rhine-Westphalia, Bad Oeynhausen, Germany, denied 56-year-old heart patient, Fatma Elaldi, a heart transplant because her chances for successful follow-up treatment and long-term survival were poor. Eladi fulfilled the medical requirements for a transplant but was declared ineligible due to her inability to understand and carry out a doctor’s instructions, criteria set out in the German Medical Association’s guidelines for organ transplantation. These require transplant patients to be able to accurately understand and follow a physician’s instructions for effective long-term follow-up.

A patient who did not speak a word of German would not be able to cooperate in order for the transplant to be successful, Petra Mellwig, a hospital spokesperson told the AP. She cited the scarcity of donor organs as an obligation for hospitals to evoke stricter criteria for patients to be placed on a transplant list.
http://www.theheart.org/article/294681.do

from your own link:

It rejected the argument that Eladi’s daughter, who speaks perfect German, had offered to act as both caretaker and translator.
This is where the clinic took the wrong decision.

Again your own link:

She has a pacemaker and is now on the transplant waiting list at another German hospital.
So it wasn´t a money issue. Of course you have to decide who can live and who have to die if you have only so many hearts.

Again, you should read your own links, this happened in Seattle not Germany…
http://seattletimes.nwsource.com/html/localnews/2004387955_webmarijuanadeath02m.html

Don´t you see the difference between the availability of donor organs that you can´t increase and the availability of money which is a direct result of the healthcare-system you use?

3332

You should read your own links. The decision was wrong but the issue wasn´t her citizenship.

Ya, I actually said this. I said, “While not speaking German might seem a weird line to draw, it’s not far off from only providing free care for citizens”. I said this because, generally, I think that most people would agree that it’s reasonable for a country to only provide free care for citizens. It was merely an example of a line that could be drawn, which most people would agree was realistic and inoffensive.

The case of the woman being denied treatment due to her inability to speak German is actually very similar to the cases being denied treatment in AZ, at least as far as the rationale used to make the decision. As you point out, the reason non-german speaking people are denied coverage is simply because apparently there is a statistical correlation between speaking the native language and survival rates, due to the being able to understand the native language. They’re merely making a decision to best use their resources.

So it wasn´t a money issue. Of course you have to decide who can live and who have to die if you have only so many hearts.

Well, this is pretty much always the case though. In some of the AZ cases, for instance, the transplant organs weren’t just thrown away. They went to other patients.

Again, you should read your own links, this happened in Seattle not Germany…
http://seattletimes.nwsource.com/htm...adeath02m.html

Durr. Sorry.

Don´t you see the difference between the availability of donor organs that you can´t increase and the availability of money which is a direct result of the healthcare-system you use?

Consider for a moment that they are both resources. While you have more ability to shift where the line is when it’s drawn based on just funding, your ability to shift that line is still limited. You still have finite money.

Imagine the case, for instance, where you can treat a person with some rare disease, but it will cost a billion dollars, and there is only a 5% success rate with the operation. Is it responsible for the system to pay for that? That money could be used to improve the lives of a lot of other people.

Even in cases where you are reducing the tax burden on the population, this still constitutes improving peoples’ lives, because those people are able to use that money to live better. It will have an impact on the health of the economy, which translates into jobs, wages, etc. While economics and money are often seen as cold, they are directly related to the actual lives we lead, even when not dealing with things like paying for life saving operations.

No matter what, you’re always going to have to have some line drawn between covered and not covered stuff.

3333

Spock: …logic clearly dictates that the needs of the many outweigh the needs of the few.
Kirk: Or the one

Of course you can construct a rare case where there is no justification for further medical treatment. Nobody would dispute that.
But we don´t discuss a theoretical case.

To remind you of the facts:

to which you responded:

My point is that nobody should die because he cannot raise the sum of 200.000$ (and not your hypothetical billion) to pay his medical bills. At least not in one of the most developed countries on this planet.

3334

Two things Timex:

  1. The fact that healthcare policy comes down to the allocation of scarce resources isn’t particularly new or interesting. Welcome to, like, 80 pages ago.
  2. The argument is over how we allocate those resources. Do we do it based on personal wealth (FREE MARKET)? Or some other system? From what I can tell you’re kind of avoiding this question even though it’s the crux of the discussion. Care to share with the class what you think on this one?
  3. Your billion dollar 5% chance of working example is pretty much the definition of an attempt to derail the conversation into a ridiculous rathole.
3335

Short ones first:

  1. Ok, so no discussion needed there.
  2. My intent was not to derail the discussion, but rather to get at the underlying theoretical issues at play. We all seem to agree though, that regardless of the system in charge of allocating resources, that at some point a patient may be denied care because it is not cost-effective, despite the fact that putting it in such cold terms seems heartless.

The bigger issue:
2) My opinion is that both approaches have merit, and I believe some of the most successful systems tend to blend them to some degree. (Systems like Germany do this to some extent, right? Allow you to pay for services above and beyond those provided by the system?) But neither of these systems makes the problem we’re talking about here go away, right? Even in a socialized system, such as Germany, people are still denied care for some reasons (in the example cited, a low survival rate for a particular type of patient).

In the original topic, we’re actually talking about another socialized system, aren’t we? We’re talking about AZ’s medicaid program, which is a government provided healthcare system. So in that case, it’s still not a free market system where people are being denied coverage simply because they cannot pay. The government run system is refusing to pay for their treatment, for similar reasons that we see in the German case… very low survival rates for particular types of patients.

Doesn’t this shift the discussion away from the traditional free-market vs. socialized healthcare debate? In this case, we’re talking more about the failure of a particular socialized healthcare implementation, due to the socialized system drawing a line between covered and uncovered procedures.

3336

The point here is just how irrational and emotional the Republican argument is. Conservatives love to lecture Democrats on how, “we can’t pay for everything you know”, like Democrats are just a bunch of flakes who can’t balance their checkbooks (the irony is that usually this is the result of the conservative having very little understanding of how we pay more than other countries for worse health care). Meanwhile that same conservative is happy to carry on with scare tactics about death panels as though that’s the least bit consistent.

Personally I’m all for “death panels” (i.e. having conversations with people about their end of life wishes) and I certainly think it’s worth considering how much we’re willing to spend on any given patient. I’m not really incensed that a certain transplant wasn’t covered but I’m certainly amused by the cognitive dissonance of the right that’s in evidence here.

3337

That was one of the things I said originally. The term “Death Panels” was used, because it implied some kind of evil intent. The reality is that it’s just a necessary part of any system, including our existing private healthcare system. At the time, it was used as an emotional argument from conservatives in order to scare people, and the counter argument presented by some was that such a thing wouldn’t exist.

The reality is that such a system would exist, but it’s not bad. When private insurers deny coverage for some ailment, what’s doing the denying? A “Death Panel” of sorts. It’s just motivated by the private insurer’s desire for profit, which is arguably less desirable than having society make those decisions through a government organization elected by the people.

I think this is a more effective counter argument when the notion of “Death Panels” is brought up, because it removes the issue from the table completely, since they are present in both systems.

3338

To pick a nit, when would you be watching people die necessarily?

3339

His job is apparently helping people with medical issues. I don’t know if you are being facetious or not, but I’m going to assume that he is in contact with more people that die than the average american.

3340

You should listen to the podcast he did on the Sims. Yes, he’s seen a lot of this, more than any of us will ever see, I hope.

People die necessarily when there is nothing we can do to save them. If treatment is futile, jpinard isn’t suggesting we should offer it. He’s saying that a lot of people are dying of things that are treatable, if we are simply willing to pay the costs.