Another G-Damn socialized medicine thread

[VA Hopeful Dr]

One more question Miami.

Since you say that health and healthcare is essentially a commodity that conforms to normal rules of supply and demand....what monetary value would you place on your own life? The life of your parents? The life of your neighbor? The life of a complete stranger? If you can give me an exact amount, how did you arrive at that dollar figure? At what point would it not be worth saving your life or the life of your family from a purely monetary point of view?

Just curious.

I think the EM forum is a great place to ask this question. I can not give you an exact amount, but I do think there is a relative difference in the value of one person over another. My example is thus: who should we allocate more resources to save assuming identical, costly illnesses; the unemployed drug abusing, non-compliant diabetic, HIV+ person or the school teacher mother of 2?

Would it make me a horrible person to suggest we require some form of personal responsibility in exchange for treatment on the public ticket?

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[Hawk22]

I don't think any answer makes you a horrible person. The question is rhetorical and really doesn't have a right or wrong answer, but is designed to get people to think about the "demand" for health and healthcare and how different it is from demand for other goods and services. The "supply side" is complex as well, but for different reasons.

And I wanted to clarify something I said earlier. The regular economic principles of supply and demand can be applied to some healthcare economics, BUT the complexities of the situation make it impossible to apply many issues to these principles. Standard microeconomic theory works OK in certain areas of healthcare economics, but there are so many things where standard rules just can't be applied.

 

[deleted109597]

I think the EM forum is a great place to ask this question. I can not give you an exact amount, but I do think there is a relative difference in the value of one person over another. My example is thus: who should we allocate more resources to save assuming identical, costly illnesses; the unemployed drug abusing, non-compliant diabetic, HIV+ person or the school teacher mother of 2?

Would it make me a horrible person to suggest we require some form of personal responsibility in exchange for treatment on the public ticket?

You'll see resource utilization at the next open thoracotomy in the ED. Watch it, and you'll notice that ~95% of the staff will be in the room watching while someone who was inevitably a gangbanger or simple low life trauma gets cut open. Every other patient, regardless of socioeconomic status gets pushed aside for this maneuver. This will happen regardless of single payer (unless they change the rules and don't pay for those, then they won't get done).

 

[EctopicFetus]

One more question Miami.

Since you say that health and healthcare is essentially a commodity that conforms to normal rules of supply and demand....what monetary value would you place on your own life? The life of your parents? The life of your neighbor? The life of a complete stranger? If you can give me an exact amount, how did you arrive at that dollar figure? At what point would it not be worth saving your life or the life of your family from a purely monetary point of view?

Just curious.

You fully realize that the government does place a value on your life. It is roughly the cost to perform search and rescue. I believe it is around $2 mil, I would have to ask the Prof cause this is in her field.

I have spoken to med mal attys and in private they say from a cost point of view it is much better for a doc to kill the pt than it is to severely injure them.

There is a cost and it SHOULD matter if you contribute to society or if you are a leach on society. I know that WONT be a popular statement but thats how I feel.

 

[EctopicFetus]

You'll see resource utilization at the next open thoracotomy in the ED. Watch it, and you'll notice that ~95% of the staff will be in the room watching while someone who was inevitably a gangbanger or simple low life trauma gets cut open. Every other patient, regardless of socioeconomic status gets pushed aside for this maneuver. This will happen regardless of single payer (unless they change the rules and don't pay for those, then they won't get done).

I dont think I have ever seen a trauma or code run based on the ability of someone to pay. If an ED thoracotomy is needed it will get done regardless of pay.

 

[deleted109597]

I dont think I have ever seen a trauma or code run based on the ability of someone to pay. If an ED thoracotomy is needed it will get done regardless of pay.

Currently, yes. But in the future, with a single payer, there will probably be guidelines about trauma just as there will be about cancer, appys, etc. That is why people in Europe don't get mammograms at 40, because the cost outweighs the benefits.

At our ED, they don't get tox screens on patients, even ones that might need treated based on it, because insurance companies won't pay if the person was altered at the time of their trauma. At least that is the rationale given to me from higher ups.

 

[EctopicFetus]

Currently, yes. But in the future, with a single payer, there will probably be guidelines about trauma just as there will be about cancer, appys, etc. That is why people in Europe don't get mammograms at 40, because the cost outweighs the benefits.

At our ED, they don't get tox screens on patients, even ones that might need treated based on it, because insurance companies won't pay if the person was altered at the time of their trauma. At least that is the rationale given to me from higher ups.

Actually as Peer 7 just mentioned a tox screen is wasteful and rarely changes your mgmt of the pt.

Anyhow we wont have national HC anytime soon. Write that **** down..

Old farts vote and they would be the ones getting the biggest screw job.. so you can just forget about it.

 

[Miami_med]

No, these two things are completely different. The government is contracting for these guys to do their job in Iraq. JACHO doesn't receive its direction from the governmentn and makes their own regulations, even though the government may link funding for hospitals to accreditation. Not sure how to explain this any other way.....

We'll stop kicking this dead horse and agree to disagree.

 

[Miami_med]

One more question Miami.

Since you say that health and healthcare is essentially a commodity that conforms to normal rules of supply and demand....what monetary value would you place on your own life? The life of your parents? The life of your neighbor? The life of a complete stranger? If you can give me an exact amount, how did you arrive at that dollar figure? At what point would it not be worth saving your life or the life of your family from a purely monetary point of view?

Just curious.

The answer for this is going to vary from person to person. There are lots of things that get us all fuzzy inside that we wish we could give to everyone, but it just doesn't work that way. There is a price on everything from letting your kids have that nice backyard to having a shorter commute and more time with your family. If the goal was simply to maximize overall life expectancy, we should funnel all non-basic healthcare spending into economic development, as the number one indicator of longevity is socioeconomic status. I think healthcare is a profoundly individual association between doctor and patient, with the best result being the best balance of risk, benefit, and cost. I will not place a dollar value on anyone's life, because it is never that simple. There is never 100% chance of death or survival, and everyone is different.

I would spend everything I own to save my own life, as it is worth nothing to me if I am dead. I would do the same for my wife or child, as they are worth my life to me. I can't however, spend what I don't have. I would absolutely look for charity or other help if I was dying and couldn't afford treatment, but I would then be at the mercy of others. That is how it should be. When I spend money on healthcare that isn't mine, it is taken from someone else. The person that you want to treat with government money is effectively leaching off of those that earned it. Here in Miami, where the average house is ~$400k, and property tax rates are about 2.5%, a new purchaser of an average house would pay about $9k/year in taxes after some deductions in our system. To pay for one ICU stay that tops $100k, that is 11 peoples entire property tax payment that goes to pay for just that ICU stay. We love to talk about how we want to help people, but we conveniently ignore the 11 people getting screwed. You said that the market doesn't provide affordable healthcare to all, so the government should. I say that the fact that the market fails to provide it is an excellent reason as to why the government shouldn't. Our fundamental disagreement is that I don't believe the government's job is to try and spend our money better than we can. I trust my dollars in my hand more than in the hands of Bush, Clinton, or anyone else.

 

[deleted109597]

We'll stop kicking this dead horse and agree to disagree.

What, you didn't see my dead horse smiley on the last page?

 

[beaudubbs]

wow, i am away from a computer for a day and this thread explodes. there has been too much for me to even catch up/respond to it all. overall, i can certainly understand hesistation to allow the government to control our health care. i admit that i am not sure if this is the end answer to ensuring care for all. still, this doesn't matter as much to me as establishing universal coverage, something that i agree with hawk cannot occur under the forces of a free market.
i know many people don't like to idea of "forcing" society to bear the burden of its masses. this would include the truly needy as well as the horrible leeches that live among us (some closer than you think). however, i believe that access to health care is an exception. if there is a basic and effective treatment for an illness (difficult to define but doable), it cannot be exclusively available to the "privledged" members of our society. we would simply be failing one another. equal access is a fundamental human right (as i realize i have posted before). i think that future generations (assuming nothing bad happens) will look back with curiosity that we could perpetuate a primal "what's mine is all mine and i earned it" kind of mentality. the next level is to realize that you can have enough, and perhaps some of the rest should go into the pot (400,000 dollar homes is more than enough). still, of course i know that this is highly unpopular talk. will people abuse this. sure.

furthermore, talk about putting various values on life and health, and adjusting those when applied to different people is akin to playing god (or an overconfident economist). nobody can define someone else's value, especially because some people will even change who you thought they were/what they were worth to you(or society).

lastly, as we are all most familiar, mountains of uninsured in our country are working indeed. medicaid and medicare cover significant portions of the rest. thus, it doesn't make sense to me that those who lack health care access are simply not trying hard enough (or are in that position because they choose it). in fact, people who try the least are currently eligible for socialized medicine as we currently know it.

adding more red gasoline to the flames.

 

[Hawk22]

I will not place a dollar value on anyone's life, because it is never that simple. There is never 100% chance of death or survival, and everyone is different.

I would spend everything I own to save my own life, as it is worth nothing to me if I am dead. I would do the same for my wife or child, as they are worth my life to me. .

That sure doesn't sound like anything that conforms to normal economic principles of supply and demand to me......

You said that the market doesn't provide affordable healthcare to all, so the government should. I say that the fact that the market fails to provide it is an excellent reason as to why the government shouldn't. Our fundamental disagreement is that I don't believe the government's job is to try and spend our money better than we can. I trust my dollars in my hand more than in the hands of Bush, Clinton, or anyone else.

But what if you don't have the "dollars in your hand" like many of the working poor? You assume that everyone has the means to buy healthcare coverage or will be accepted for coverage if they apply for a private (i.e. non-emplyee sponsored) plan, which just isn't true. You did read the information posted here about how the majority of the uninsured have jobs and are working in jobs that don't provide benefits and can't afford private coverage, right?

 

[pushinepi2]

Admittedly, I am not the most informed person on this issue. Nor do I want to engage the fetus in a war of statistics. The purpose of my reply is merely to bring up some thinking points. We all throw around this "socialized medicine" buzzword as if it heralds the apocalypse. From my perspective, certain programs emblematic of socialized medicine are already in existence. I can think of no better forum than "Emergency Medicine" that should host a discussion like this. First, the ER is a virtual dumping ground. Anyone who works near or at an urban teaching hospital knows this for a fact. Many of my patients don't even know how to apply for medical assistance; others have medicaid, medicare, or are just plain working poor. Regardless of their insurance status, we diagnose, stabilize, treat, and refer them. As we all might agree, the current system is chock full of inefficiency and inadequacy. Even when we rescue a DKA'er from the depths of anaerobic metabolism, they might not be able to follow up with a primary care doc. The government's attempts to solve this problem haven't worked so far, and this leaves doctors and nurses baning their proverbial heads against the ED walls.
First of all, medicare, medicaid, and other programs are most definitely representative of a socialized form of medicine. We all pay taxes to shoulder the cost of providing health care for the poor and for those over 65 (or whatever age). EVERY patient on dialysis is funded out of the collective pocketbook. Socialized medicine represents a broad spectrum of government intervention, and I can't believe that any ED resident would deny that some rudimentary form of it is currently in existence. The more difficult question is not whether we have socialized medicine. Rather, it is how to make it work better. Unfortunately, the terms "universal HC" are often used to drive divides between the very people who provide such services on a daily basis. Though you may not like "single payer systems," I'd be willing to bet that the single largest contributor to our ER doc salaries is the federal government. Its most definitely NOT the HMO companies.

Also, EMTALA is NOT a program or a service. It is quite simply an unfunded mandate that requires EP's to perform a "medical screening examination" on people who "present" to the hospital. It is precisely because our health care system is so crippled by the fear of legal action that we screen everyone to the 9th degree. The expressed purpose of the EMTALA act is to prevent the dumping of uninsured patients. The intention of this act was to avoid 'dumping' poor patients off on county hospitals. Not even 30 years ago, it was common practice for private hospitals to refuse emergency care to the uninsured. The law, for example, DOES NOT require you to diagnose and treat every homeless / intoxicated patient that presents to the emergency department. We'd be well within the letter of EMTALA to determine that an emergency medical condition (EMC) does NOT exist and then refer urgent care type patients out to a primary care or fast track provider. Why is it that we must evaluate and treat everyone with dental pain? We DON'T HAVE TO!! It is our fear of legal retaliation that prevents doctors and hospitals from saying, "sorry, you don't have a medical emergency... you've been screened... please leave." It is also the lack of access. Though I loathe some shifts in our urgent care / dental pain center, I completely understand that some people have nowhere else to go. There's no freestanding dental clinic at our campus that will pull teeth for free or even dole out the motrin / percocet. Try walking into the student dental clinic... it's 35 bucks for an examination and about 100 bucks for an extraction. Our system is so fragmented and paradoxically funded that it cannot be fixed without acknowledging the SCOPE of the problem. To blame "socialized medicine" for this country's ills is to fall victim to short-sightedness.

For emergency departments to remain viable, there must be a continued source of funding. There must be adequate public health and support resources. Its been my experience, for example, that there's never enough ICU beds or primary care docs to go around. This makes emergency department care an extremely expensive and inefficient proposition. Part of the reason why state medical assistance and federal medicare programs are so out of control is that health care spending consumes WAAAAYY too much of the GNP! How can we ever fix the system when we're hemorrhaging dollars on a daily basis! It much better, for example, to PREVENT an asthma attack than to have one treated in the emergency department! Unfortunately, ER docs see a lot of people that rely on the ED for their monthly inhaler(s) or prednisone prescription. While I think Ectopic and others have made some fantastic points, I don't see how a solution to this expensive healthcare crises can be worked out without at least a modicum of federal intervention. We need to start thinking creatively, because not all hospitals have Dr. Peter Rosen, NIH funding, insurance carriers, and private foundations to help shoulder the massive burden of emergency health expenditures.

For another shining example of socialized medicine, I simply have to look out across the ED parking lot. Our Shock Trauma Center would not be possible without state dollars and the Maryland motor vehicle administration. The reason why everyone gets a free ride in a Maryland State Police helicopter is because the air rescue program is completely subsidized by the general public. Moral arguments about health care rights and privileges aside, there's little use in denying that at least some form of socialized medicine is here to stay. Heck, we Marylanders will gladly pay for unfortunate out-of-towners to take a ride in one of those Dauphins.


-Push

 

[Dr. Will]

So what's this thread about?

 

[Miami_med]

What, you didn't see my dead horse smiley on the last page?

I did. I was really just referring to that one post. What can I say? Please teach me the wisdom of the ninja

 

[Miami_med]

That sure doesn't sound like anything that conforms to normal economic principles of supply and demand to me......

Of course it does. Do you understand supply and demand? This is just an issue of determining the demand side of this equation. Whenever anyone takes a risk (The hallmark of a market system), they have to weigh potential costs and benefits of the decision. If I have leukemia, then I have to make choices. What are may chances of survival? How much am I willing to spend on my own survival? What are the chances that I will live if I do spend the money? What will my quality of life be if I survive? What are the odds that my survival will be long term? These are VERY difficult questions, but they the decisions made are economic nevertheless.

But what if you don't have the "dollars in your hand" like many of the working poor? You assume that everyone has the means to buy healthcare coverage or will be accepted for coverage if they apply for a private (i.e. non-emplyee sponsored) plan, which just isn't true. You did read the information posted here about how the majority of the uninsured have jobs and are working in jobs that don't provide benefits and can't afford private coverage, right?

I believe that it is your responsibility to find the dollars, not mine. We all make decisions, and I don't buy that the whole lot of the working poor are this mystical group that has no responsibility at all for where they are. We all make decisions. If Bob decides to work one job, drink beer on the weekends, never go to school, even play with his kids every night, that is a choice. When we compare him to the guy who works 80 hours a week and made smart decisions, it seems clear to me that the injustice would be taking the money from 80 hour a week guy who made so many other sacrifices in order to support Bob who did not. Now, I think it would be great if the other guy chose to help Bob, but taking his money by force is patently UNjust.

 

[Hawk22]

Miami, I really couldnt' disagree with you more. I have sent you my original comments, so check your private messages.

If anyone else would like to have a genuine discussion not driven by ideology, I'm more than open.

 

[docB]

If anyone else would like to have a genuine discussion not driven by ideology, I'm more than open.

How do you have a conversation about something like this that is not driven by ideology?

 

[GeneralVeers]

How do you have a conversation about something like this that is not driven by ideology?

Agreed. Either you're of the ideology that we should help everyone and pay for everything, or you are of the ideology that humans should fend for themselves. There are few facts to dispute, and most of the arguments depend upon the specifics of your ethical and moral belief system.

 

[Hawk22]

How do you have a conversation about something like this that is not driven by ideology?

I disagree.

People can have honest discussions about this type of topic and disagreements on things, but once you're wedded to a specific ideology that obviosuly makes you blind to any data or arguement against what you think .... than there is really no need to have a discussion. We all have a core belief system, but a completely closed mind never engenders any type of honest discussion or progress.

And "Either you're of the ideology that we should help everyone and pay for everything, or you are of the ideology that humans should fend for themselves" paints things in extremes that in my opinion isn't true. I really doubt that many fall on either extreme, but somehwere in the middle.

There is also plenty of data and published work out there for BOTH sides of the debate, it just isn't in the typical literature that emergency physicians read on a regular basis (although the NEJM typically has pretty good policy stuff).

All healthcare systems have positive and negative aspects and none are perfect. Socialized medicine isn't straight from the devil as some would have us believe, but it isn't a panacea for all of our problems either either. Same goes for our present system as well.

In the end, we have to make priorities as a country to determine what kind of healthcare we want to provide and how we want to provide it. However, to argue on pure ideological grounds (from either side) that ignore the realities of our cultural, poltical, and economic situation doesn't seem productive or useful to our common goals of improving the health and well-being of the nation.

 

[AmoryBlaine]

As much as I wish it could work, National Health care in the US would be a disaster. The way I see (grossly oversimplified) it one of two things will happen...

a) everyone will continue to get everything they "need" inc that TBI 22y/o vegetable soaking up 10k/day in the SICU. Expenses will skyrocket.

b) gov't will try to impose reasonable limits on care, expensive dx procedures etc. Americans (being what we are) will sue as soon as grandma dies b/c she had to wait a month for a her MRI. system will eventually move to option a).


The debate of national health care is stupid b/c it is carried out in isolation. If we really want to improve a broken system we could try getting serious about things like med mal. Some very disingenuous people have tried to tell me that there is "no evidence that 'defensive medicine' significantly raises the cost of health care."

There is also no serious discussion in the highest levels of gov't about the fact that Americans are less healthy than some of our socialized medicine friends because we eat like **** and watch alot of TV. If the gov't is going to be Big Brother enough to take over health care they should put their money where their mouths are and ban trans fats and tobacco.

I'm a pretty liberal person, but I think it is ludicrous to suggest that the 50 y/o morbidly obese woman with uncontrolled DM, HTN, CAD, etc etc etc whose idea of exercise is to change the channel twice in 15 seconds has the RIGHT to demand that her fellow citizens pay for her cath...

 

[Miami_med]

I disagree....

Your whole argument here IS an ideaology. Statistics are only important if your are trying to accomplish something. Determining what it is you are trying to accomplish requires an ideaology.

 

[Hawk22]

Your whole argument here IS an ideaology. Statistics are only important if your are trying to accomplish something. Determining what it is you are trying to accomplish requires an ideaology.

Until that ideology blinds you from reality and objectivity.

And for the record my arguements here are far from any specific ideology or political viewpoint, unless you consider trying to do what's best for patients an ideology (If so, I'm guilty). I'm trying to look at the issue from all sides, including evidence both in favor and against each type of healthcare system. I've provided some of that evidence here. I'm not trying to use (or misuse) anything to prove any one viewpoint, although I do have my opinions based on what I've learned so far just like anything else.

In the end the issue isn't to pick and choose your statistics and studies when "you are trying to accomplish something", but to evaluate everything that is out there from the begining on the way to finding the answer. If you start with your mind made up from an ideological point of view from the beginning, then it doesn't matter what your evidence and research finds because you won't believe it anyway and it will never change what you will do in the end.

 

[Hawk22]

b) gov't will try to impose reasonable limits on care, expensive dx procedures etc. Americans (being what we are) will sue as soon as grandma dies b/c she had to wait a month for a her MRI. system will eventually move to option a).

I think this is a great arguement why a single payer system is unlikely to ever be successful in the US. Everyone is fine with rationing and cost containment, until it is their health or their loved one's health involved (this goes back to the relative inelastiscity of demand for health I was talking about in an earlier post). An unfortunate reality of the US system is that many wants everything for themselves....and they want it right now. Now, its easier to allow insurance companies to assume the role of cost containment (which they haven't done very well for many reasons, not all of which are within their control) than to make the government make those decisions. Its easier to hate a faceless corporation (who oh by the way are making a profit) than a government that has to respond to the desires of it's electorate on at least some level, so I definitely understand why many in government positions are very hesitant to assume this role.

I'm just happy people are discussing important things like this and alleviating my pre-match day boredom.

 

[EctopicFetus]

b) gov't will try to impose reasonable limits on care, expensive dx procedures etc. Americans (being what we are) will sue as soon as grandma dies b/c she had to wait a month for a her MRI. system will eventually move to option a).

I think this is a great arguement why a single payer system is unlikely to ever be successful in the US. Everyone is fine with rationing and cost containment, until it is their health or their loved one's health involved (this goes back to the relative inelastiscity of demand for health I was talking about in an earlier post). An unfortunate reality of the US system is that many wants everything for themselves....and they want it right now. Now, its easier to allow insurance companies to assume the role of cost containment (which they haven't done very well for many reasons, not all of which are within their control) than to make the government make those decisions. Its easier to hate a faceless corporation (who oh by the way are making a profit) than a government that has to respond to the desires of it's electorate on at least some level, so I definitely understand why many in government positions are very hesitant to assume this role.

I'm just happy people are discussing important things like this and alleviating my pre-match day boredom.

Hawk I havent read all the back and forth cause well I had other things going on but I actually have a big disagreement with the above statement. If people had to bear the cost MRIs would be in less demand people wouldnt stay in vent farms for years etc. People dont care about cost cause it doesnt effect them. I realize that healthcare doesnt apply to the principles of a free market as there is no rational decision making due to a lack of knowledge and the emotional nature of healthcare. Some things like insulin are much more inelastic.

 

[Miami_med]

Until that ideology blinds you from reality and objectivity.

And for the record my arguements here are far from any specific ideology or political viewpoint, unless you consider trying to do what's best for patients an ideology (If so, I'm guilty). I'm trying to look at the issue from all sides, including evidence both in favor and against each type of healthcare system. I've provided some of that evidence here. I'm not trying to use (or misuse) anything to prove any one viewpoint, although I do have my opinions based on what I've learned so far just like anything else.

In the end the issue isn't to pick and choose your statistics and studies when "you are trying to accomplish something", but to evaluate everything that is out there from the begining on the way to finding the answer. If you start with your mind made up from an ideological point of view from the beginning, then it doesn't matter what your evidence and research finds because you won't believe it anyway and it will never change what you will do in the end.

Yes, wanting to do what's best for the patients is an ideaology. Your determination of what is best for the patients is also an ideaology. Your belief that taking money from someone who is not your patient in order to give it to your patient is a good thing is also an ideaology. I am not arguing with your objective statistics. I am not saying that the US secretly spends less than Germany on healthcare. What I am saying is that: #1: You are not taking into account all of the potential bias within the statistical methods, #2: You are pushing an ideaology that spending the least amount of money is the best thing, and that it is OK for the government to step in and control healthcare spending directly or indirectly in order to accomplish this. #2, which is your personal ideaology, is what I disagree with.

If I said that it would be cheaper to kill every sick person than provide any medical care, you would say that this is immoral. I agree with you. I believe that taking money from someone who has earned it in order to provide benefit to someone else against the earner's will is MORALLY WRONG. Even if you could prove to me that the governments do a great job, that wouldn't change the fact that I view this as morally wrong and won't support it, just like you wouldn't support genocide of sick people. In fact, the whole idea that healthcare should exist at all is an ideaology. Statistics only become important after the basic ideaological tenent of what we are trying to accomplish is determined. And on this, we disagree. You are trying to consider evidence from all sides. I have already considered it (for many years actually) and forumlated an opinion. You have not shown me any statistics that I did not see before I made my opinion, and I have no reason to change it.

 

[Hawk22]

Yes, wanting to do what's best for the patients is an ideaology. Your determination of what is best for the patients is also an ideaology. Your belief that taking money from someone who is not your patient in order to give it to your patient is a good thing is also an ideaology. I am not arguing with your objective statistics. I am not saying that the US secretly spends less than Germany on healthcare.

Ideology:

1. the body of doctrine, myth, belief, etc., that guides an individual, social movement, institution, class, or large group.

2. such a body of doctrine, myth, etc., with reference to some political and social plan, as that of fascism, along with the devices for putting it into operation.

3. Philosophy. a. the study of the nature and origin of ideas.
b. a system that derives ideas exclusively from sensation.

4. theorizing of a visionary or impractical nature.

http://dictionary.reference.com/browse/ideology

What I am saying is that: #1: You are not taking into account all of the potential bias within the statistical methods, #2: You are pushing an ideaology that spending the least amount of money is the best thing, and that it is OK for the government to step in and control healthcare spending directly or indirectly in order to accomplish this. #2, which is your personal ideaology, is what I disagree with.

#1. This is odd because I haven't given you a specific study for you to criticize it's methodology, and yet youv'e already decided that the results are biased without even reading the study. Sounds like you've already made up your mind and won't change your mind no matter what the study says.... which sounds real objective.

#2. Where have I ever said that its best to spend less? That may or may not be the case, depending on what we're talking about. Where have I said that government should control spending? I know its easier to disagree with someone when you put words in their mouth, but please let me speak for myself.

If I said that it would be cheaper to kill every sick person than provide any medical care, you would say that this is immoral. I agree with you. I believe that taking money from someone who has earned it in order to provide benefit to someone else against the earner's will is MORALLY WRONG. Even if you could prove to me that the governments do a great job, that wouldn't change the fact that I view this as morally wrong and won't support it, just like you wouldn't support genocide of sick people.

These two situations are not comparable and the fact that you have this here just demonstrates my point .

Statistics only become important after the basic ideaological tenent of what we are trying to accomplish is determined. And on this, we disagree. You are trying to consider evidence from all sides. I have already considered it (for many years actually) and forumlated an opinion. You have not shown me any statistics that I did not see before I made my opinion, and I have no reason to change it.

Statistics are important BEFORE you make up your mind only IF you actually are approaching the problem looking for real answers. After reading your blog and your other SDN posts on this, I have my doubts.

 

[Hawk22]

Hawk I havent read all the back and forth cause well I had other things going on but I actually have a big disagreement with the above statement. If people had to bear the cost MRIs would be in less demand people wouldnt stay in vent farms for years etc. People dont care about cost cause it doesnt effect them. I realize that healthcare doesnt apply to the principles of a free market as there is no rational decision making due to a lack of knowledge and the emotional nature of healthcare. Some things like insulin are much more inelastic.

For small things like insulin, I definitely think that standard supply/demand thinking can apply...I won't disagree with you there.

For other things, I think it depends on the situation. In general, I think people will get tests and procedures that doctors advise whenever possible. The more critical the situation (i.e. the closer to serious outcomes and death), the less that price affects the demand however and this is the definition of demand inelasticity.

 

[SolidGold]

Interesting discourse...

 

[Hawk22]

Interesting discourse...

Is that a nice way to say "complete train wreck?" lol

I just noticed that half of my last post reply to Ectopic was deleted. Let me finish it here.

In general, I think people will get tests and procedures that doctors advise whenever possible. The more critical the situation (i.e. the closer to serious outcomes and death), the less that price affects the demand however and this is the definition of demand inelasticity. Many think that pushing more of the cost burdon to patients will be a method to keep health costs down. In general, I'm a little skeptical because so many of the things that really drive healthcare costs and healthcare inflation are things that are pretty inelastic in their demand (emergency procedures, ICU stays, etc) and that will just put more burdon on the individual to pay more or go into debt. It will most certainly reduce costs for other less essential things which have more elastic demand and sensativity to price increases, but these things just don't seem to represent a significant percentage of healthcare spending. At this point, I'm open to anything that can potentially reduce costs for the system as a whole.

Many of the reforms recently proposed by Bush do just this sort of thing, so we'll see if anything will make it through Congress. Lots of insurance agencies are also now proposing similar measures in Consumer Driven Healthcare.... so we should see if these things are working to actually reduce costs and insurance premiums soon.

 

[Miami_med]

Ideology:

1. the body of doctrine, myth, belief, etc., that guides an individual, social movement, institution, class, or large group.

2. such a body of doctrine, myth, etc., with reference to some political and social plan, as that of fascism, along with the devices for putting it into operation.

3. Philosophy. a. the study of the nature and origin of ideas.
b. a system that derives ideas exclusively from sensation.

4. theorizing of a visionary or impractical nature.

http://dictionary.reference.com/browse/ideology

And so your belief that you want to help patients isn't part of a "doctrine, myth, belief, etc... that guides the individual?" Is your belief not a belief? Does your belief not guide you?

#1. This is odd because I haven't given you a specific study for you to criticize it's methodology, and yet youv'e already decided that the results are biased without even reading the study. Sounds like you've already made up your mind and won't change your mind no matter what the study says.... which sounds real objective.

I believe that this started with us talking about a study listed near the begining of this thread in which healthcare costs per person are shown. I have looked at this particular study extensively, both inside and outside of class. I actually had a class that disintigrated into an argument about which system was actually cheaper. We uncovered a number of biases, the least of which is not a big assumption that better healthcare always equals higher life expectancy.

#2. Where have I ever said that its best to spend less? That may or may not be the case, depending on what we're talking about. Where have I said that government should control spending? I know its easier to disagree with someone when you put words in their mouth, but please let me speak for myself.

The statistics of the study attempt to show that European healthcare costs less money than US healthcare for what you consider to be equal results. I think that it is much more convoluted, and I will happily send you other statistics if you would like them. The argument was that they got more for less. You can't have universal healthcare without the government in some way controlling spending or spending going out of control.

These two situations are not comparable and the fact that you have this here just demonstrates my point .

I used the extreme to make a point.

Statistics are important BEFORE you make up your mind only IF you actually are approaching the problem looking for real answers. After reading your blog and your other SDN posts on this, I have my doubts.

I am looking for real answers. You just don't seem to care for the solutions that I think will work. You are also not interested in any of the statistics that I have put forth on SDN. I've used the US itself as a statistics for pre-intervention healthcare spending. Statistics ARE important before you make up your mind, but they are not important BEFORE you determine an ideaology. I don't know how else to put this for you.

#1: Determine what you want to do (this is dependent on your ideaology) Do you want to help patients? Do you not want to help patients? Do you want to help patients if it doesn't involve stealing? Is it morally acceptable to not help patients? You have to determine all of these things before statistics mean anything, and this involves ideaology.

#2: Use statistics in order to determine the best way to implement what it is you are trying to do. I can show you a million statistics on the best way to build an airplane. If you don't want to build one, the statistics are irrelevant. You can show me a million statistics on how the government can control other people's money to contain costs. Even if I conceded that they were true, it would be irrelevant, because I don't want the government to control other people's money outside of its proper function. My determination of proper function is based on my ideaology, as is yours and anyone else's whether they like it or not.

#3: Implement the plan determined in number 2.

#4: Check your results.

If that didn't work for ya, I'll give up and accept that we're not speaking the same language.

 

[Hawk22]

If that didn't work for ya, I'll give up and accept that we're not speaking the same language.

Nope, we're not. I just hope you don't evaluate all published literature this way.....

If you discount a study based on your personal ideology from the beginning (as you clearly have), then you're never going to believe the results anyway. What's the point in even reading it? Why even ask the questions if you're not willing to accept the answers that might disagree with how you view the issue? You might as well be reading Cosmo.

I suggest we end this debate between us as we are obviously going to get nowhere. Let this thread continue without our disagreement because this is an important topic.

 

[briteyellowness]

i have some questions...

i've been browsing the posts and notice how people will want to help the single working mom but not the drug addict, but
a.) can we say maybe it was partly society's fault that the drug addict got to where she was? one patient at a methadone clinic told us she was just at the wrong corner hanging out with friends in the 70s and got hooked on pills, and i'm just wondering wow, really if i made some wrong friends, it wouldn't have taken me very long to not take pills. once you're hooked, it sounds very hard to stop without help, so why do we intend on punishing her and looking down on her when maybe she really doesn't want to be an addict?
b.) the perspective on drug addict worth seems to be seen differently by psychiatrists. i was wondering how they would feel about this talk about druggies who come into the ED to malinger and are deemed as worthless. how do we know that maybe if they can make it through kicking their addiction, they're actually normal beings who "contribute" to society.
c.) and while we're on that, should we even provide free methadone clinics? i mean they're meant just for druggies who just seem to come in for treatment and then when we ask some of them what they do for the rest of the day since they only need to go to the clinic for two hours, some just reply they do nothing (because ppl might not hire them b/c of their addiction, they can't get jobs b/c they still get "queasy", they might just be plain lazy).. and you're here thinking, you're so useless, why don't you contribute anything?!!... right?
so why do we even pay for it right?
d.) should we provide healthcare to prisoners? i mean, they don't contribute ANY good to society right?

i can see the argument of providing help for those who give something to the community, but can you say the addict is useless b/c everything about him was brought upon solely by himself? not really...

hope to hear responses, i'm still young i'm growing.

 

[GeneralVeers]

i have some questions...
a.) can we say maybe it was partly society's fault that the drug addict got to where she was? one patient at a methadone clinic told us she was just at the wrong corner hanging out with friends in the 70s and got hooked on pills, and i'm just wondering wow, really if i made some wrong friends, it wouldn't have taken me very long to not take pills. once you're hooked, it sounds very hard to stop without help, so why do we intend on punishing her and looking down on her when maybe she really doesn't want to be an addict?
c.) and while we're on that, should we even provide free methadone clinics? i mean they're meant just for druggies who just seem to come in for treatment and then when we ask some of them what they do for the rest of the day since they only need to go to the clinic for two hours, some just reply they do nothing (because ppl might not hire them b/c of their addiction, they can't get jobs b/c they still get "queasy", they might just be plain lazy).. and you're here thinking, you're so useless, why don't you contribute anything?!!... right?
so why do we even pay for it right?
d.) should we provide healthcare to prisoners? i mean, they don't contribute ANY good to society right?

Your questions are quite common. The druggie mom in a) is responsible for the choices she made in her life. Society didn't step in and get her addicted to drugs. She could just as easily refused to do drugs and become a productive member of society. She made a bad choice for herself. Should the rest of society have to bear the financial burden of her bad choice? I personally think that we shouldn't have to.

The prison system is based on the premise that people can have redemption and become productive members of soceity. I think the average prisoner should get basic medical care, because you can assume that eventually they will be out of prison, if they are healthy it is more likely that they can be productive. The prisoner on death row should get nothing.

 

[nocallaochicas]

Your questions are quite common. The druggie mom in a) is responsible for the choices she made in her life. Society didn't step in and get her addicted to drugs. She could just as easily refused to do drugs and become a productive member of society. She made a bad choice for herself. Should the rest of society have to bear the financial burden of her bad choice? I personally think that we shouldn't have to.

The prison system is based on the premise that people can have redemption and become productive members of soceity. I think the average prisoner should get basic medical care, because you can assume that eventually they will be out of prison, if they are healthy it is more likely that they can be productive. The prisoner on death row should get nothing.

Wow! Not even sure where to begin...

 

[docB]

i have some questions...

This also relates to the points Veers made and nocallaochicas taking issue with them. This is the EM board. Our view of junkies is based on our daily negative interactions with them and the results of their bad decisions. We don't get to see the few who have found redemption and become contributors. Consequently many of us have dismal views of them and we incorporate those negative experiences into out views about who should be denied when it comes to handing out the freebies.

One thing I will say is that under a socialized system society will presumably need to ration care. End of life care would be curtailed, diabetics over 70 ( or some other arbitrary age, depends on who is in office) would be denied CABGs and so on. In that situation it would be reasonable to withold care from addicts until they can show that they will not be a waste of resources. If you're going to continue your meth why should we pay for your dialysis? You can apply whatever addictions you want, smoking, trans fats, Rush Limbaugh, again it would just depend on who is in power at the time.

 

[EctopicFetus]

Wow! Not even sure where to begin...

How about with agreement?

 

[psychbender]

One thing I will say is that under a socialized system society will presumably need to ration care. End of life care would be curtailed, diabetics over 70 ( or some other arbitrary age, depends on who is in office) would be denied CABGs and so on. In that situation it would be reasonable to withold care from addicts until they can show that they will not be a waste of resources. If you're going to continue your meth why should we pay for your dialysis? You can apply whatever addictions you want, smoking, trans fats, Rush Limbaugh, again it would just depend on who is in power at the time.

Even in a semi-socialized system, such care should be rationed. That meth addict is likely a recipient of Medicaid, so should the government (read: us taxpayers) really pay for his continued dialysis in the face of his continued addiction? If such individuals want to have continued, quality care, or expensive procedures, they should be forced to pay for them themselves, rather than foist the cost on to others.

 

[Hawk22]

Most of the Medicaid patients I see aren't drug addicts and some of the worst drug addicts and alcohololics I've seen have insurance.

Can we try not to over-generalize medicaid and lower SES patients? They really are not a homogenous group, even though they may seem so given our daily interactions in the emergency department.

Psychblender's point about rationing is most likely true and any healthcare system (private, socialized, whatever...) will have to have some form of rationing because we just don't have the resources to give everyone everything.

 

[psychbender]

Most of the Medicaid patients I see aren't drug addicts and some of the worst drug addicts and alcohololics I've seen have insurance.

Can we try not to over-generalize medicaid and lower SES patients? They really are not a homogenous group, even though they may seem so given our daily interactions in the emergency department.

Ok, you have a point. All the drug addicts I've seen in my limited experience, though, are either college students or medicaid recipients. Never made any statements about the reverse (that those on medicaid are all drug addicts).

 

[qjj]

http://www.nytimes.com/2007/03/05/us/05uninsured.html?_r=1&hp&oref=slogin

 

[EctopicFetus]

So? Change jobs if people want insurance. If necessary then companies will pay for insurance. The problem is that these people dont put into the insurance system then things go bad and then.. whoops.. Well I pay insurance now and it is a losing proposition for me (and my employer) as I am healthly. What my insurance is for is if things hit the fan.

 

[Miami_med]

http://www.nytimes.com/2007/03/05/us/05uninsured.html?_r=1&hp&oref=slogin

$27k a year in order to be protected from cancer? That seems worth it to me. I'd sure as heck find a way to come up with it. I'm sure of course, that the purpose of this tear jerking story is to promote the idea that other middle class americans should give up their middle class lifestyles in the form of higher taxes in order to maintain this ladies middle class lifesyle because insurance is too expensive. If it weren't for healthcare, she'd be dead. Many people have worked hard perfecting techniques to save her life. Many more people went to school for many years and then worked many hours directly treating her. That is worth a lot. On top of that, what she has lost is the ability to cheaply be treated again. How many cancers in one person is society supposed to pay for? When does the economic burden stop being a social good?

Of course, as a real estate agent in New York, she sells many individuals on similar or much greater annual payments for shelter (a much bigger necessity than healthcare). Why is it okay for her to demand that someone pay $2k/month for a loft apartment and not for protection from cancer. Just like there is a scarcity of real estate in NY, there is a scarcity of healthcare, and that causes there to be an intrinsic cost. Someone has to pay for it.