There has never been any such thing as Universal Care

[CgDs]

[skyhook77sfg]

CG

an organization/corporation is an aggregation of indiviuals

it has no mind of its own nor hands with which to pick up a telephone

individuals make decisions, policies and rules.

individuals choose to obey orders or not.

individuals grant or deny care.


am not fond of the eichman defense.

[CgDs]

[skyhook77sfg]

sorry to do that

but can you think of a better examplar of the only following orders rationale?

if so will edit and replace.

awaiting your suggestion....

[lzzrdgrrl]

[Demon of Undoing]

[skyhook77sfg]

superbly appropriate post sir..

makes one laugh and cry....



reminds of that renegade psychiatrist Dr RD Laing who stated:

“Insanity - a perfectly rational adjustment to an insane world.”


he also witticized...

“Life is a sexually transmitted disease and the mortality rate is one hundred percent.”

[Tinker]

Hopefully more and more people will be following his example. It would be lovely to watch the 'tough on crime, pull yourself up by the bootstraps' folks heads explode as they try to reconcile prison time as a welfare entitlement.

If you are living alone, have no one in particular and are scrabbling to make ends meet, jail can't be all that bad as an alternative.

[whose care]

So, Perfect.

About these real debates you have out there in the big world of real men and real issues, those crucial conversations you have for which these here ninny squalls are kindergarten....

What are those real people out there telling you? Are they in agreement with your view that the reason a suture costs $3000 is that people didn't shop for their insurance?

[Demon of Undoing]

[Mr. Perfect]

[whose care]

[Mr. Perfect]

[Mr. Perfect]

OOOOOOOOOOOOOOOOOOOOOOOOOOOHHHHHHHHHHHHHHHHHHHH!!!!!!!!!!!!!!!!!!!!!!!!!!!

This might be Orpheus! How bout that.

[whose care]

[Mr. Perfect]

[Colonel Sun]

[CgDs]

[whose care]

[lzzrdgrrl]

[Tinker]

CgDs why do you even bother to type asinine shit like that comment about Obama and ATM machines. Why is stating the perfectly obvious stupid? Where do you get the idea that this is the first time ge ever considered the problem? Automation is putting people out of work. Obama says something uncontroversial and for some reason you feel the need to trash talk it. It is bizarre to say the least.

[skyhook77sfg]

CG posted some thoughtful observations forcing a rethink of what we are all debating

which in turn led to reading every post start to finish in this thread.....

conclusion?


CG is right saying what we have here is a failure to communicate....

not all of it unintentional. Take the title of this thread... already here

there is a directed vector that cannels discussion into a poltical cul de sac.


So suddenly repondering the special interests interested in the status quo of current industrialiized hippocratic paractices for profit

insurance companies, pharmaceutical companies, medical equipment companies, medical supply companies and of course the barbers and surgeons guild and members

and of course the political party functionaries...and the ominpresent government bureaurats...did I miss anyone? nurses union? EMT 's?

and then factoring in the many concerns reflected by just a handful of minds in this little corner of thinking folk courtesy one Tinker...


WE ARE TAKING ABOUT THE WRONG PROBLEM AT THE WRONG TIME

WE ARE AS A SOCIETY IN DENIAL REFUSING TO FACE THE FUNDAMENTAL DILEMNA

and when someone does bring it up they seem to disappear from further discussions.


Mr Perfect's first post is a good place to begin. His starting premise is correct. But it is a inversion of the more important premise....

there has always been rationing of health care. That is beyond discussion, The question is how to best do it.


And it leads to a rail more dangerous than the SS third rail of politics.....

the end of life and how to reconcile rationing with a free market

that must deal with the pricing of how much is one day or one week or one month of life worth.


It puzzles me no end that the self avowed most Christian people in the world who await the far better life beyond this one of the sinful flesh....

are so fearful of taking that journey to that glorious other side...that they will make every reasonable and unreasonable effort to avoid that step

when it is clealrly imminent no matter what the cost to them, their family, their society. Perhaps one of you can explain that to me.



But this oxymoronic symptom of that famed river in Egypt leads to the need to comprehend and integrate some basic data first from

http://www.nytimes.com/2009/07/19/magaz ... are-t.html" onclick="window.open(this.href);return false;" onclick="window.open(this.href);return false;


You have advanced kidney cancer. It will kill you, probably in the next year or two. A drug called Sutent slows the spread of the cancer and may give you an extra six months, but at a cost of $54,000. Is a few more months worth that much?

If you can afford it, you probably would pay that much, or more, to live longer, even if your quality of life wasn’t going to be good. But suppose it’s not you with the cancer but a stranger covered by your health-insurance fund. If the insurer provides this man — and everyone else like him — with Sutent, your premiums will increase. Do you still think the drug is a good value? Suppose the treatment cost a million dollars. Would it be worth it then? Ten million? Is there any limit to how much you would want your insurer to pay for a drug that adds six months to someone’s life?

If there is any point at which you say, “No, an extra six months isn’t worth that much,” then you think that health care should be rationed.

then from
http://www.usatoday.com/money/industrie ... osts_x.htm" onclick="window.open(this.href);return false;" onclick="window.open(this.href);return false;


Not so long ago, Americans were felled by a bad infection or an accident or a sudden illness, such as a heart attack. Advances in medicine mean more of us are living longer, but often with disabilities.

"Many more of us make it to older age, and so there's much more we can do (medically)," says geriatrician Lynn.

But, increasingly, ethicists, economists and patient advocates are questioning whether the spending mentality is best for elderly patients or the long-term financial future of programs such as Medicare.

"We are going to double the number of people who are sick, old and frail in about 15 years," says Lynn. "It would be a good thing to try on some ways of thinking about how to live that well ... and at a cost the community can sustain."

She and others say there's not enough money to give everyone a treatment with a one-in-a-million chance of success. "None of us wants to bankrupt our community on desperate, long-shot treatments," Lynn says. "The question is, how do we build a sustainable health system?"

Those questions about what care to give and when to quit are deeply personal. A USA TODAY/Kaiser/ABC poll of 1,201 Americans taken by telephone in September found the public divided on the answers.

When asked if it is better to keep a terminally ill person alive as long as possible, regardless of the expense, or to make a judgment as to whether it's worth the expense, 48% said it's better to weigh the costs, compared with 40% who said to keep the person alive as long as possible, regardless of the cost.

Among those 65 and older, 60% said expense should be considered, compared with 28% who said cost should not enter the decision. The nationally representative poll has a margin of error of plus or minus 3 percentage points.


then from

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1464043/" onclick="window.open(this.href);return false;" onclick="window.open(this.href);return false;

The elderly (65 years of age and older) have consumed more than 33 percent of health care spending (Waldo, Sonnefeld, and Arnett 1989). Their medical expenses are substantially higher in the last year of life (Scitovsky 1984; Riley et al. 1987; Scitovsky 1988; Gaumer and Stavins 1992; Temkin-Greener et al. 1992; Lubitz and Riley 1993; Scitovsky 1994; Barnato et al. 1999). While only 5 percent of elderly Medicare beneficiaries have died annually, the percentage of elderly Medicare expenditures spent on persons in the last year of life fluctuates between 27 percent and 31 percent (Lubitz and Riley 1993; Hogan et al. 2001). Mean annual Medicare expenditures for the last 12 months of life in the elderly rose from $1,924 in 1976 to about $23,000 in 1995, but the portion of Medicare expenditures spent on beneficiaries in the last year of life did not change during this time period (Lubitz and Riley 1993; Garber, MaCurdy, and McClellan 1999; Hogan et al 2001).

Medicare expenditures during the last 12 months of life decline with age at death (McCall 1984; Scitovsky 1984; Lubitz and Riley 1993). Reasons suggested for this include shorter intervals between illness and death and decreased use of acute care, hospitals, and other services with older age at death (Gaumer and Stavins 1992; Scitovsky 1994), as well as less desire among the oldest individuals or their health care providers to use advanced (and expensive) technological methods to prolong their lives (Kramer 1995). By contrast, end-of-life non-Medicare expenses are higher among those with older age at death. Three studies observed rising non-Medicare expenditures with older age at death during the last 90 days of life (Temkin-Greener et al. 1992), last year of life (Scitovsky 1984), and last two years of life (Spillman and Lubitz 2000).

Evaluating Medicare and non-Medicare expenditures among the elderly near the end of life remains important as the American population ages. But end-of-life non-Medicare and total elderly medical expenditures have not been studied or compared to non–end-of-life expenditures in a national sample.

SO HOW DO WE TALK ABOUT SOMETHING NOBODY SEEMS TO WANT TO EVEN LOOK AT MUCH LESS TALK ABOUT?

failure to communicate does not do this problem justice

perhaps we should stipulate a failure to think instead.

[CgDs]

[CgDs]

[whose care]