Health Care Procedural Machinations

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What if it probably cant be treated.(you know like i said in that last post.)

Same response (yes, I did read the original post).

As a health care provider, I would rather be treating someone who's in bad shape whom I'm likely to help than someone who's in bad shape that I'm unlikely to help.

If I were an ER patient after a massive traffic accident, I would rather the ER staff focus on the guy with the mere collapsed lung than on me with the belly full of blood from a ripped aorta, even if he doesn't have insurance and I do. If they got me into an OR within a few minutes there's a remote chance that I might make it - but if they focus on him, there's a very good chance that he'll not only make it but recover fairly well.

If I had pancreatic cancer, and there was a debate between treating me and treating a kid with leukemia, I would hope that they'd treat the kid b/c childhood leukemia is rarely fatal and pancreatic cancer almost always is. On the other hand, if I had breast cancer and the kid had a metastasizing brain cancer, I hope that they'd treat me.

We are all going to die. No matter what. No exceptions. In the long scheme of things, I would rather not flail ineffectually at that fact in a way that prevents others from getting the care that they need.

That is certainly my clinical approach. (Infectious disease, rather than oncology, but the same principles tend to apply--apply your skill and your art where it will do good rather than harm, and where it will do a greater good rather than a lesser good.)

Fortunately, I never have to consider the ability to pay. I never have to call an insurer to ask if a procedure is claimable. The only time I get involved in that kind of fiasco is if I suggest a therapeutic course that is experimental, or otherwise not clinically approved.

However, most of those matters are prescription drug issues rather than procedures, and fall outside the ambit of most public insurance in Canada, in any event. And my patients would face precisely the same coverage issue with a private insurer as with their provincial insurer, anyway.

I would rather be able to pay and be near the head of the line. It is good to be rich.

By the way, if you are delayed in treatment your condition will finally get so bad, you will be promoted to the head of the line. You will suffer for "social justice". But don't complain about your pain and suffering; remember it is for the Good of Society. I have some free advice for you --- don't get sick.

ruveyn

Not necessarily. As the American system currently stands, a rich old man can reserve the OR for a tummy tuck ahead of a poor person who needs an emergency coronary bypass.

Flab might get worse over time, but a tummy-tuck is not a life-saving procedure.

It is a theoretical possibility. How often does it happen.

ruveyn

On a much smaller scale, I'd say quite often. For example: My brother worked in England for a while, and wanted a wart frozen off of his hand. He was told that he'd have to wait ~3 months for an appointment. In the U.S., one can get in to see a GP or a PA within a week in most practices, if one has insurance.

He went to the pharmacy and bought some wart removal gel and got rid of the wart by himself.

Here's a somewhat more serious experience; it makes an interesting health-care travelogue, if nothing else.
http://www.salon.com/news/opinion/featu ... /08/22/nhs

And if you are born without the skills or the luck it takes to get rich? Or you've devoted your life to much needed professions that don't pay as much? Or you've had the missfortune to get so sick that years of hard earned savings are now exhausted? By no fault of your own, or for lack of effort, you can't buy your way up the line?

This whole healthcare issue, politics and methods set aside, is about how we share this amazing resource called health care. We have the ability to do so much, but the way it gets allocated and delivered is a mess, and many who are truly needy and would make good use of the care delivered to them go without. Is it ethical to limit access by ability to pay? True, emergency care will be delivered regardless, but that distorts the system and affects decisions as well, and often in ways that are negative for the community as a whole. So does the asset only go to the rich, or is it better for society to share it more equally? Economists are saying the later. We all bear the indirect costs of an asset not used as wisely as it could be.

Where costs run amuck is not in trying to care for those less fortunate. It is bending to the sense of entitlement that those with access seem to have. Entitlement to try every expensive drug and test, cost effective or not. Entitlement to extreme treatment in the last year of life. Entitlement to sue every time there is a less than perfect result, falsely believing that medicine is a simple equation with obvious right and wrong answers, instead of an art. Entitlement to choice, which results in much, much higher administrative overhead for each doctor's office. And so on.

The power of money is a social convention. Money has no value outside of society. Some people have decided that those with a good deal of power derived from the social convention of money should be privileged on even the very basics for maintaining life while others feel that the power that money grants is a social power and should be distributed to all members of a society for at least basic life maintenance. That is the gist of the argument.

Another email...

--------------------------------------------

“What’s next?” is a question I’m hearing a lot these days. Since the passage of the health care bill, many of my constituents are wondering not just what specific impact the law will have on their health care (see last week’s e-mail), but also what legislative or other legal steps might be taken now. I have received many calls to repeal the bill and to challenge its constitutionality in court.

First, I believe that the bill must not just be repealed; it must be replaced by better reform alternatives. While I believe there are many strengths in the traditional system, we must address its failings. We cannot simply return to our previous system with its escalating premiums, rising medical costs and denial of coverage. But we can fashion a better way to contain medical and insurance costs than by mandating government-approved health care coverage for Americans.

In the past, I have suggested a series of steps to improve our health care system, including allowing the purchase of insurance across state lines, creating state-wide insurance exchanges, creating small business risk pools, incentivizing maintaining high-risk subscriber pools to increase access without making coverage prohibitively expensive for patients with pre-existing health conditions, enacting tort reform and removing the anti-trust immunity that the health insurance industry has enjoyed for 45 years. You can read about some of the legislative options I have supported here. I believe that these proposals could be implemented in a bipartisan fashion to improve our health care system without turning one-sixth of our economy upside down, increasing taxes and ballooning our debt.

But before we can replace a terribly misguided law with something better, we must first un-do it. I am exploring not just legislative ways to repeal the law (which would need to be passed by the House and Senate and signed by the President or have enough support in the House and Senate to override the President’s veto) but also possible constitutional challenges to the legislation. I do not believe that the Congress has the constitutional authority to mandate that Americans buy health insurance. Other mandates – such as the auto insurance mandate – are conditioned on action first taken by an individual (i.e. buying a car) and are required and administered by the states, not the federal government. But the mandate to buy health insurance is all-encompassing without any action or choice by an individual: by being born, you are subject to the federal law which now dictates you must purchase health insurance and defines what qualifies as health insurance. I do not think that the Commerce Clause stretches so far as to cover this unprecedented mandate and it is my belief that a constitutional challenge by individuals and state attorney generals should be filed.

Repeal – and replace with workable reforms.

Sincerely,

Daniel E. Lungren
Member of Congress

The power of money is a social convention. Money has no value outside of society. Some people have decided that those with a good deal of power derived from the social convention of money should be privileged on even the very basics for maintaining life while others feel that the power that money grants is a social power and should be distributed to all members of a society for at least basic life maintenance. That is the gist of the argument.[/quote]

Money is not a primary substance. It is a trade good used to pay for labor and goods. One earns money through labor or one earns money through goods produced and sold. Money is not a common resources. Payments are made in conformity to contractual agreements written or verbal. Money, as a result, is not some common substance found in nature than can freely be distributed or redistributed. We all have air as a common resource. We don't have health care as a common resource because health care is labor performed by one party for the benefit of another. It is something received through a private arrangement or contract. I go to a doctor and I receive health care for which I pay. That is not a free service and I am not entitled to it. I am able to buy it by means of a consenting arrangement between me (the buyer) and the doctor/hospital (the seller).

ruveyn

Money is not a primary substance. It is a trade good used to pay for labor and goods. One earns money through labor or one earns money through goods produced and sold. Money is not a common resources. Payments are made in conformity to contractual agreements written or verbal. Money, as a result, is not some common substance found in nature than can freely be distributed or redistributed. We all have air as a common resource. We don't have health care as a common resource because health care is labor performed by one party for the benefit of another. It is something received through a private arrangement or contract. I go to a doctor and I receive health care for which I pay. That is not a free service and I am not entitled to it. I am able to buy it by means of a consenting arrangement between me (the buyer) and the doctor/hospital (the seller).

ruveyn[/quote]

Straighten out your quotes. I assume it's a mistake.

This is true. However, 'clean water' (as opposed to just plain 'water') can be put in the same category as 'money' by the description above. Should we end our socialized water purification programs, or can we admit that it is better for everyone, even the rich, if everyone, even the poor, has access to clean water?

Even the rich suffer when GDP decreases; poor health decreases GDP.

I think this is a difference between California and Massachusetts. In Massachusetts individual insurance is, or was, available and cannot be adjusted based on individual experience. In addition, the available insurance pooled through small business organizations was very attractive. Unfortunately, the new law bans that kind of pooling. That makes the situation in Massachusetts much worse for sole proprietorships, though California may be different.

If you do that where you work, you're very unusual. Hospitals in this area triage based on urgency, and I think that's the standard throughout the U.S. Granted more people with ability to pay means more money to be able to get to everyone faster.


And how much of that is because of Brits who have bought expensive add on insurance? Or who fly to India to get immediate treatment for things where there is a 6 month waiting line in the UK?

And what about the quality of life? My father in law, who immigrated from England, and one of his army buddies in the UK, got colon polyps at about the same time. My father in law got immediate treatment, and was as good as new. His Army buddy got triaged to low priority because his condition wasn't immediately life threatening. By the time they got around to him months later, the condition had progressed to the point where they had to remove his colon, and now he gets to wear a colostomy bag for the rest of his life. He's alive, but his quality of life just went down by a lot.


Indeed. Do you get your food from your health insurer? No? I guess the health care system is not the problem, then. Maybe the problem is the dietary recommendations from this same government that we're giving control of health care decisions to?


It's not like there's a single line. If someone pays extra for better coverage, that's more money that goes into the system, which in turn allows the system to deal with more patients at the same time.

I work at a mandated-care rural hospital, so we triage on need. Hospitals in big cities, though, have been known to dump indigent patients; in addition, docs in private practice (whether g.p. or specialist) can refuse to take on patients who cannot pay their fees. It's not only that the doc wouldn't be paid; often it's that the doc would lose money if they took on that patient. This means that someone might be admitted to the hospital when they need it, but they might not get any care more specialized than the hospitalist on-call. If they need a neurosurgeon, a vascular surgeon, whatever, they're likely s.o.l.



I strongly doubt that the percentage of Brits with special insurance is higher than the percentage of Americans with special insurance. I also doubt that medial care in India is better than medical care in the U.S. for those who have insurance.



That's an awful story, but I wonder how many Americans never got treatment at all because they couldn't afford a surgeon. Or never had a colonoscopy at all. This is from the weekly newsletter put out by my hospital:

In honor of March being National Colorectal Awareness Month, St. Joseph & Redwood Memorial Hospitals are partnering with the American Cancer Society and other local organizations to provide a drawing for 16 free colonoscopies for uninsured or underinsured members of our community. To enter, call the American Cancer Society at (707) 443-2241. The deadline to enter is March 31, 2010.

Please help us spread the word about the drawing by printing and posting this flyer in your department!



Brittish docs are paid extra when their patients' health improves. American docs are paid fee-for-service. In other words, A Brittish doc makes more money if he gets his patients to lose weight; an American doc makes more if he prescribes insulin and lots of lab tests. I sincerely doubt that this makes a conscious difference in 99.99% of docs' minds, but with millions of patients on a statistical level it will make a difference.



For some services, there *is* a single line.