Bounce a Check to save your life?
August 21, 2006 5:44 AM   Subscribe

Would YOU lie to save your life? The Doctor said that I needed a keyhole operation called a coronary angioplasty to clear the blockages, but the waiting list on the NHS was nine months. I couldn’t believe my ears. I knew that I would struggle to survive the next nine days, so nine months seemed an impossibility. What the doctor had just handed me was a virtual death sentence. He must have seen the look of horror. He said that if I paid for the operation, he could fit me in for the angioplasty within the week. The cost privately, he told me, would be around £8,500. I looked at him, my head a whirl as I tried to make sense of what he was telling me. As far as I could see, the choice was clear — if I paid I would live, if I didn’t I would probably die. I’m a pensioner living on £150 a week. And no bank would have given me a loan. But in that split second my survival instinct kicked in and I realised I had to convince the doctor that I had the money. ‘Well, you can’t take it with you,’ I said cheerily. ‘I’ll go private.’ The following morning, I gave the administrator the cheque before I was discharged from the hospital. Some people would say this was fraud, because I knew it would bounce. But there was nothing else I could do — I wanted to live.
posted by Izzmeister (163 comments total) 3 users marked this as a favorite
 
lol socialized healthcare
posted by thirteenkiller at 5:48 AM on August 21, 2006


Um, but actually, people in the US bounce checks to save their lives all the time. One of the main causes of bankruptcy here is catastrophic medical bills.
posted by thirteenkiller at 5:52 AM on August 21, 2006


An off-topic ideological diff here, thirteenkiller, but I'd argue that a lack of responsibility, as expressed by lack of healthcare insurance, causes bankruptcy when catastrophic medical bills arise. The bill didn't cause the bankruptcy, the person's failure to plan and prepare did.
posted by CodeBaloo at 5:57 AM on August 21, 2006


Much as I hate it when people just snark at a source's "credibility", this is the Daily Mail.
posted by Grangousier at 5:58 AM on August 21, 2006


"Furious that I had paid all my working life into a system that had promised to look after me if and when I needed medical help, and was now forcing me to lie just to get that help.

I did my National Service in the Fifties; I worked as a painter and decorator and only rarely had a day off sick.

I paid my taxes and National Insurance and made sure that my children grew up to be good, respectable citizens. In other words, I had trusted in the system and now the system was happily leaving me to die.
"

How can you not love the self-parodying Daily Mail?
posted by patricio at 6:04 AM on August 21, 2006


the person's failure to plan and prepare did

That may be true in some cases, CodeBaloo, but it's certainly not true in all. Stating that a lack of healthcare insurance is equivalent to a "lack of responsibility" is obnoxious, given the realities of poverty many people face. Not to mention those cute little "pre-existing condition" clauses that insurance companies use to deny coverage to people who might actually need it.
posted by mediareport at 6:04 AM on August 21, 2006


CodeBaloo: So the man who lives on 150 a week should be allowed to die becuase he didn't plan ahead to have 8500 saved up? Or that he couldn't afford to have private health insurance? And it is his own damn fault?

I don't view that as an ideological difference as much as a willingness to just let people die.
posted by killThisKid at 6:04 AM on August 21, 2006


Baloo, you did see that the fellow is living on 150 pounds a week? You can decree from on high that it's all his fault, but medical insurance for a 77 year old would probably eat at least half his total income, if he could even get it at all.

You're letting abstract principles replace, y'know, sense. He HAS health insurance, and has had no choice about paying for it all his life. Expecting him to pay even more for insurance that works, when he has almost nothing, is hardly reasonable.
posted by Malor at 6:05 AM on August 21, 2006


grangousier...

here are 171 more sources...google is a wonderful thing when you want to locate more information...

and, good for him... Allowing someone to die when care is actually available is tantamount to murder... a bit worse crime than bouncing a check.
posted by HuronBob at 6:08 AM on August 21, 2006


See, the genius of Canada's system is that this would never happen. The old man would be forced to wait and wouldn't be able to pay even if he wanted to!

Lately I'm starting to think that all large health-care system have major structural defects. There is no perfect system. That's barely even a good one.
posted by GuyZero at 6:10 AM on August 21, 2006


Bear in mind that 13% of the population of the UK has private health insurance. It's not a case of people not thinking about it, but assuming that you're covered by the NHS.

Not that I'm not suspicious of the angle taken in this report.

And what Malor said.
posted by edd at 6:11 AM on August 21, 2006


The bill didn't cause the bankruptcy, the person's failure to plan and prepare did.

Uh, whatever dude. Boner, bonér.
posted by thirteenkiller at 6:18 AM on August 21, 2006


I never quite understood the two tier health system in the UK and Ireland, and that's despite growing up there. My (American) wife once came down with a strep throat, so off we went to the local doctor. If we went on the NHS, we'd have to wait 2 days for an appointment - basically an invitation to head directly to the emergency room - but if we went private, and paid all of 30GBP, we could have an appointment immediately. Thankfully we had the 30 pounds, so we elected to go private. The private part of the practice was three feet away at the same reception desk.
posted by Sk4n at 6:22 AM on August 21, 2006


Good on him.
posted by Jimbob at 6:26 AM on August 21, 2006


If his fraudulent behavior gets him in any legal trouble that puts him in front of a judge (a magistrate? a barrister? Don't know how legal stuff works in the UK), I'd love it if he requested & got a jury trial. Talk about your extenuating circumstances!
posted by pax digita at 6:30 AM on August 21, 2006


Here's an interesting article from the New Yorker about public vs US-style company-provided private healthcare (among many other things) that might give some of the 'libertarians' something to think about, if they can be bothered to read it.
posted by A Thousand Baited Hooks at 6:31 AM on August 21, 2006


I was confused by the fact that he owns a house but apparently had no way to borrow money on it. Selling it was the only option?
posted by JanetLand at 6:40 AM on August 21, 2006


Basic human needs, such as health care and education, should be free and easy to get to. That people do not get this makes me livid.

This is not the way it is in the States. And people wonder why the fabric of human society is so fragile.
posted by geekhorde at 6:42 AM on August 21, 2006


Health care is easy, just train more doctors & nurses, and abolish pharmaceutical patents & pay for drug research directly (ala Swedish pirate party).
posted by jeffburdges at 6:44 AM on August 21, 2006


Geekhorde, healthcare in places where the government provides it, like the UK and Canada, is free but there are long wait times and some problems with quality. Healthcare in the US is expensive but easily accessed and generally very good.

How do you propose we improve each system?
posted by thirteenkiller at 6:46 AM on August 21, 2006


I would like to point people to Grangousier's comment.

This is the fucking Daily Mail. The toothless crazy guy that is convinced the CIA is reading his mind is a more reliable source for unbiased news than the Daily Mail.

Wiki on its editorial stance.
posted by slimepuppy at 6:46 AM on August 21, 2006


I considered my options — I couldn’t ask my two adult children for help: I did not want to be a burden to them...

I’m a pensioner living on £150 a week. My only asset is my house and I couldn’t have sold it in time, even if I’d wanted to. And no bank would have given me a loan.


As a homeowner he'd have got a loan in an, ahem, heartbeat. Lenders in the UK have been falling over themselves to give out cheap money; so much so that the Bank of Engoland has just hiked rates to try and slow things down.

When this chap says that he couldn't get hold of the money he's not telling the truth. Whether he should be asked to is another question. One that I'm inclined to disagree with.
posted by dmt at 6:50 AM on August 21, 2006


See, the genius of Canada's system is that this would never happen. The old man would be forced to wait and wouldn't be able to pay even if he wanted to!

Come on, you're not being fair. There's no waiting at all in the Canadian system. The man would have simply crossed the border to Buffalo and bounced his check there!
posted by loquax at 6:51 AM on August 21, 2006


lol socialized healthcare

First of all, remember that NHS is way undefended compared to other health systems in other countries. The British pay far less per dollar then do the Canadians, sweeds, and yes, Americans.

Secondly, at 77 years old, he would have qualified for Medicare in the US anyway, so he would have had "socialized" medicine here as well. It's only young and middle aged people in the US who go without medicine.

Thirdly, in the US you don't have to pay your medical bills until after the operation, so you don't actually have to bounce a check or whatever, you just go into bankruptcy. It's a rather stupid system.
posted by delmoi at 6:51 AM on August 21, 2006


Our (U S and A!) excellent healthcare system doesn't seem to make use healthier than folks in other developed countries, though.
posted by snofoam at 6:52 AM on August 21, 2006


I'm not entirely sure how much sympathy I have for the guy in this story. He had kids he wouldn't ask for help and a house he wouldn't sell. 'I had to commit fraud to save my life!' sounds all very noble and dramatic. 'I had to commit fraud to avoid getting a reverse mortgage on my house!' not so much.
posted by jacquilynne at 6:52 AM on August 21, 2006 [1 favorite]


For every story like this one, in which the NHS were slow to help, there are hundreds of others in which UK healthcare was free and timely. I've only been in hospital four or five times (including A&E visits) but each time the wait has been short, the procedure well explained and carried out, and I have had absolutely nothing but praise for the people looking after me. Same goes for friends and family, including one instance where admission to surgery came approximately 8 days after tentative diagnosis. Yes there are hitches (the NHS is something like the world's third largest employer - they can't all be brilliant!) and there are waiting list problems and there are sometimes issues with access to the latest drugs, but on the whole, the NHS is blooming marvellous. For some reason these daily successes and small miracles never make the Daily Mail.

I have to wonder how much of the blame here falls upon the consultant - far be it for me to suggest he decided to "big up" the waiting list estimate, but when scaring a patient into going private leads directly to money in your pocket, the temptation must be there.
posted by handee at 6:53 AM on August 21, 2006


Also, this guy went five weeks before going to the doctor?
posted by delmoi at 6:55 AM on August 21, 2006


The basic human needs are covered in the UK - they have a social safety net for healthcare, but the problem is, like with every system, it has its faults.

When I lived in Spain for a number of years I had a similar siuation as someone else here mentioned: I came down with a bad bout of bronchitis and was put into a two week waiting list (as it was flu season anyhow). Instead, I ponied up the ~USD$50 to see someone privately, got my drugs and headed straight back to bed because the "safety net" of social medicine....well...has its flaws.

See, everyone's basic needs are addressed in this system, its just that the system cannot address everyones' needs when they want or need it. This is where systems such as capitalism fill the void. There will always been those cases on the margin, that make for great headlines, I might add, that people will rally around, just like Ronald Reagan did with his infamous 'welfare queens' schtick.

This poor gentleman's case is probably at the margins - but it also highlights one of the faults of the social safety net healthcare system as it functions in the UK and in other parts of the world. My personal experiences in Spain weren't terribly great, nor were those of my then-girlfriend's dying father who had to wait six months for an MRI and another three to begin drug treatments because the doctors couldn't get him in.

No system is perfect.
posted by tgrundke at 6:57 AM on August 21, 2006


Sick and Broke (Washington Post Feb 9 2005):
As part of a research study at Harvard University, our researchers interviewed 1,771 Americans in bankruptcy courts across the country. To our surprise, half said that illness or medical bills drove them to bankruptcy. So each year, 2 million Americans -- those who file and their dependents -- face the double disaster of illness and bankruptcy.

But the bigger surprise was that three-quarters of the medically bankrupt had health insurance.
posted by ryanrs at 6:58 AM on August 21, 2006 [1 favorite]


The bill didn't cause the bankruptcy, the person's failure to plan and prepare did.

Just as bulletys don't kill people, peoples lack of foresight in not wearing a bullet-proof vest does.
posted by Artw at 7:01 AM on August 21, 2006


Also it's worth noting that the Daily Mail has some kind of weird vendetta against the NHS, and is probably not the most reliable source.
posted by Artw at 7:06 AM on August 21, 2006


This seems a little fishy to me. My experience of private hospitals is that they like to get assurance of funds up front - even for out patient visits: either a verified insurance reference number or edivence of sufficient credit.
posted by rongorongo at 7:08 AM on August 21, 2006


I'm trying very hard right now not to post nasty things at CodeBaloo.

My mother and step-father recently went through bankruptcy because of my sixteen year old sister's kidney disease. I forget the medical name for it, but three years ago, her kidneys began to eat themselves. The total costs, even with insurance, for the tests, the medicine, and the eventual transplant which just happened last month came to hundreds of thousands of dollars.

How does one, in middle america, in a lower-middle class income bracket, save hundreds of thousands of dollars in the case of a rare and unexpected disease?

I guess we can't all be fiscally prepared like Mr. Baloo.

(She's doing fine now, thanks to her dad's kidney, in case you were wondering. Also thanks to many kind individuals, and a grant from the hospital.)
posted by JeremyT at 7:10 AM on August 21, 2006


there are so many more forces at work here which (while i have not read ALL ofyour responses) most of you do not seem to understand. it's not just socialized or privatized healthcare which has limited the healthcare of our citizens, american, canadian, british or otherwise. medicine is becoming a business entity it was never supposed to. with the dawn of the healthcare systems, pharmaceutical corporations and rise in research in medical science, we have seen increased costs across the board. though, it is not just business which causes these massive costs we incur. the government is almost entirely at blame. limiting the funding of biomedical research ON TOP of eroding healthcare provisions has lead to a feedback loop of misery. privately paid costs of research, funded by corporations instead of the governement, has raised the price of research. that, in turn has raised the price of equipment and drugs that are required by doctors and the hospitals the work in. this, in turn has raised the price of services rendered - what once was a 5 dollar visit to the ER is now 50. as a result, people turn to healthcare to compensate for costs they incur. what most people don't realize is, insurance companies don't exist to help you. they exist to take your fucking money. they DON'T want to help you pay to take care of you ailments. they would much prefer to keep your money. most of us do not have the money to give and rely on government healthcare. the government healthcare system, as a result pays with little or no copay from their clients. as a result, the government does not have the funding to maintain a healthy healthcare system and cuts are made ...aaaaaand the viscious cycle begins anew.




....i fucking hate the capitalization of medicine. medicine is not a business. its a motherfucking calling. making medicine into a business is bloody criminal and i hate it. that is all.
posted by Doorstop at 7:10 AM on August 21, 2006 [1 favorite]


Doorstop,

I agree with most of your statement above. But keep in mind that throughout history "callings" have been perverted in the name of money and greed. The Catholic Church comes foremost to mind...
posted by tgrundke at 7:17 AM on August 21, 2006


Ok Doorstop, you first.
posted by knave at 7:18 AM on August 21, 2006


Medicine should not be a business - I agree. Too bad insurance IS a (lucrative) business. And that forces the hand of medicine to become a business.

I'm a healthy male who pays $1,200 a year all so I can get a monthly $95 prescription for $20-- after the $75 deductible. Do the math.

And good for that guy who bounced the check. I would have done the same- in a heartbeat.
posted by wfc123 at 7:20 AM on August 21, 2006


Thirteenkiller:

Yeah, I said free and easy to get. How do I propose to make 'socialized' healthcare easier to get? Well, I would argue that if your socialized healthcare system is not up to providing your needs, as a society, then you're not putting enough resources into it.

It's a matter of priorities, I suppose.

Oh yeah, you wrote: "Healthcare in the US is expensive but easily accessed and generally very good." I would disagree with this assessment. Anything that is expensive is not 'easily accessed' by those in poverty. So basically, what you're saying is that the American healthcare system is working, but only for the wealthy or generally well off.

I didn't have health insurance for about 10 years until I got a good job. Thank whatever gods there may be that I didn't have anything seriously wrong with me.

This is all academic in America. Once enough of the Baby Boomers are old enough to really NEED socialized medicine, and they will, you will see a large swing in the voting public and it will happen. Mark my words. It will probably take another ten to twenty years, but it will happen. Because there will really be no other option. They're too large a voting bloc and too many of them don't have insurance or don't have adequate insurance.
posted by geekhorde at 7:20 AM on August 21, 2006


Not to be snarky, but I have a question now: what did people do for the hundreds and hundreds of years before socialized medicine/medicare+medicaid, etc.?

Also - I like the argument that the public sector should pay for research and all. Of course, with our current crop of governing luddites in America, can you imagine the non-stop funding debates that would go on? Having said that, how much does private industry spend on medical research per annum? Does anyone have any figures?
posted by tgrundke at 7:24 AM on August 21, 2006


Um tgrundke, they got sick and died.

Life was nasty, brutish, short. And death was often painful and difficult.

It doesn't have to be like that.

Welcome to the 21st century.
posted by geekhorde at 7:27 AM on August 21, 2006


um, Couldn't he have faked a heart attack and entered into the emergency room, clutching his chest? I think that may have put him in the front of the line.
posted by Gungho at 7:29 AM on August 21, 2006


Geek - that highlights my point. So wouldn't you say that we're doing far better today than we were 100 or 200 years ago? Considering the sheer number of people involved in an industrialized society, while the system we have now clearly needs to be reformed, it's a monumental improvement over what we had at the end of the 19th and early 20th centuries.

I think we've established in this thread that (on a broad scale), the UK/social method has its flaws and the US/profit method clearly has its flaws.

Next step then is to answer two questions: what are your healthcare goals for the country, and how do we go about meeting them?
posted by tgrundke at 7:32 AM on August 21, 2006


Ok Doorstop, you first.

me "first" for what? all i'm saying is that its a perversion of what medicine is all about to begin with. i want to be a doctor. pretty badly too. my goal, however, is not to make hot stinkin piles of moolah. my plan is to join a group called doctors without borders for my first two years out of school. i want nothing more than to help those who need it the most. i just can't stand the idea that medicine is ruled by economics in our era. when i settle down and practice in the US, i plan on working in an underserved community. right now my only question is what speciality i want to choose. general practice, surgery, emergency medicine or neurology. (i know the last one isn't all about helping the needy, but really... i'm a neurogeek. it's what i do :) ).
posted by Doorstop at 7:41 AM on August 21, 2006


i'm not sure i would bother at the age of 77 ... just how long does he think he's going to live, anyway?
posted by pyramid termite at 7:48 AM on August 21, 2006


. The bill didn't cause the bankruptcy, the person's failure to plan and prepare did.
posted by CodeBaloo at 5:57 AM PST


Yea, because everyone can afford healthcare in the US of A. After rent, power bills, your student loans there is ALWAYS money left over for putting money aside for medical care.
posted by rough ashlar at 7:58 AM on August 21, 2006


Rule #1 Don't get sick

Rule #2 Don't get poor

Rule #3 If you're poor and sick, forget about rules.
posted by A189Nut at 7:59 AM on August 21, 2006 [1 favorite]


I've linked this before, but it's useful to remember that the "50% of bankruptcies are caused by health problems" claim is hardly settled fact.

And as one of the "libertarians" who read the Gladwell article, well, I can't say I learned much. In the face of wage controls, companies started to bundle health care with compensation, and the results have been disastrous. Thanks, FDR.
posted by Kwantsar at 8:00 AM on August 21, 2006


I'm torn.

On the one hand, if medical care is available for people, logic would dictate that they should get it.

However, dude is 77 years old. He's lived a long, full life. What's he going to do when the next thing goes wrong with his body? Bounce another check? At some point you need to stop being a burden on other people. It's not like hospitals can run for free, and what he's really doing by bouncing that check is depriving someone else of medical care.

I have a feeling that we're going to be seeing a lot more of this sort of thing right here in the US as the baby boom generations' bodies start to decrapitate and our top-heavy Social Security system begins to fail.
posted by Afroblanco at 8:01 AM on August 21, 2006 [1 favorite]


1st up confession - I haven't read the article - refuse to read the Daily Mail as it's a bigoted, racist, homophobic, xenophobic, lots-of-other-phobic rag.

But, I do remember this from when it 1st aired. I heard an interview he gave on BBC Radio, they also interviewed the hospital.

The hospital said, he didn't have a life threatening condition, his x month wait on the waiting list would not have affected his lifestyle. During the interview he came over as a sterotypical Daily Mail reader actually, kept using the Mail's stock phrase "they've come over here and get medical help straight away, whilst I've worked my finger's to the bone...etc etc"

From my experience with the NHS and Heart problems (father had the same procedure as this guy earlier this year), I can only say they're brilliant. Father was diagnosed, told there was a waiting list, but was back at the hospital every week for them to track the problem, when they realised it had got worse, he was immediatly rushed in and given the op.

Basically, I'd take anything I read in the Daily Mail with the realisation that they do not report in an unbiased manner

Rant over
posted by lloyder at 8:03 AM on August 21, 2006 [3 favorites]


i'm not sure i would bother at the age of 77 ... just how long does he think he's going to live, anyway?

Well, he got it free. Might as well.
posted by thirteenkiller at 8:11 AM on August 21, 2006


i'm not sure i would bother at the age of 77 ... just how long does he think he's going to live, anyway?

At some point you need to stop being a burden on other people.

These are healthy attitudes towards human life.
posted by Uther Bentrazor at 8:11 AM on August 21, 2006


He'd have got it "free" if he'd have waited, too.
posted by handee at 8:12 AM on August 21, 2006


The bill didn't cause the bankruptcy, the person's failure to plan and prepare did.

That's a mite cold.

The Big Idea in socialized medicine is to make sure everyone, even the less well educated, intelligent, or emotionally well-integrated among us, in effect plans and prepares.
posted by scheptech at 8:12 AM on August 21, 2006


"I couldn’t ask my two adult children for help: I did not want to be a burden to them"

That's an interesting attitude for him to take. He believes that he's "owed" an immediate, free operation funded by the state because he's worked and contributed, but at the same time he is unwilling to approach his adult children to help him out. I can't decide whether this says quite a lot about the reorganisation of how families view themselves (the change having happened in his lifetime) or is more about how older people perceive themselves in our society (it's the same reasoning that people don't take up benefits/pension credits - not wanting to be seen to be accepting charity)
posted by patricio at 8:17 AM on August 21, 2006


At some point you need to stop being a burden on other people.

These are healthy attitudes towards human life.


You probably wouldn't feel that way if you were denied medical care because of some check-bouncing codger.
posted by Afroblanco at 8:21 AM on August 21, 2006


The bill didn't cause the bankruptcy, the person's failure to plan and prepare did.
Just as bulletys don't kill people, peoples lack of foresight in not wearing a bullet-proof vest does.


Well retorted, Artw!

At some point you need to stop being a burden on other people.


Jesus. Yeah, let's go for the "put 'em on ice floes and push 'em out to sea" system. We'll see how long you stick to that attitude as you age. Or are you planning to die young and leave a beautiful corpse?
posted by languagehat at 8:27 AM on August 21, 2006


>medicine is becoming a business entity it was never supposed to

Is it fair to say that, in the US, litigious tendencies have also contributed the rising cost of healthcare?
posted by missbossy at 8:30 AM on August 21, 2006


A189nut: "Rule #1 Don't get sick
Rule #2 Don't get poor
Rule #3 If you're poor and sick, forget about rules."


No A1. The first rule is we don't talk about Fight Club.

*punches A1 in the stomach*
posted by ZachsMind at 8:33 AM on August 21, 2006


British people very often make stupid decisions about money. Most health care is private in France too; the state offers a flat reimbursement, doctors can charge more, but usually don't since customers start shopping around. Seems pretty frigging obvious why the French system works & the British one doesn't.
posted by jeffburdges at 8:33 AM on August 21, 2006


he would have qualified for Medicare in the US anyway, so he would have had "socialized" medicine here as well

Not really. My 60yo mom is on state disability and on Medicare in Fresno, CA. She has found it VERY difficult to find any doctor who will take her. What is odd is that the directory of choice she has, there is basically NO born-and-bred American doctors in the Medicare system. (She's kinda sensitive about this, for cultural, empathatic, and simple language-barrier issues that she has encountered in the past).

btw, I love seeing the sociopathic responses ^above. You know who you are.
posted by Heywood Mogroot at 8:34 AM on August 21, 2006


Is it fair to say that, in the US, litigious tendencies have also contributed the rising cost of healthcare?

Not compared to Big Insurance's losses in the stock market, no.
posted by Heywood Mogroot at 8:35 AM on August 21, 2006


Jesus. Yeah, let's go for the "put 'em on ice floes and push 'em out to sea" system. We'll see how long you stick to that attitude as you age. Or are you planning to die young and leave a beautiful corpse?

Ok, so I'm cold and callous. Whatever.

Do you think that the goal should be to keep people alive as long as possible, no matter what the cost?
posted by Afroblanco at 8:36 AM on August 21, 2006


It bears repetition one more time: it's the Daily Mail, the British paper that unapologetically supported Hitler.
posted by Hogshead at 8:36 AM on August 21, 2006


Do you think that the goal should be to keep people alive as long as possible, no matter what the cost?

Yes, to the extent that each doctor desires. I actually enjoy paying the part of my taxes that goes toward socialized medicine in this country. I consider it charity. The ~$9000 that goes to the DoD, not so much.
posted by Heywood Mogroot at 8:41 AM on August 21, 2006


Right, Kwantsar, it's all FDR's fault. Without him, there would never have been company health insurance, and health care would only be for the wealthy. What a utopia that would be.
posted by [expletive deleted] at 8:42 AM on August 21, 2006


One perspective that is conscipcuously absent from this article is that of the physician. I scanned the other Google links someone else posted and still couldn't find the other side of this story.

What we have is a scared guy with heart disease who believes he is going to have an imminent heart attack. He says "two of my four heart valves are completely blocked" -- that doesn't even make medical sense. In my practice, we have people with atherosclerotic coronary artery disease and angina all the time who for various reasons (poor operative candidate, fraility of health, inconvenient timing for operative recovery, or failure to attempt management with medications) go without bypass. Reading the Daily Mail we have no other perspective on this situation other than a scared 77 year old guy. I'm not saying he didn't need the operation but I doubt it would be quite the same scare story if more detailed medical facts were presented.

One of the recurring stories I hear in criticism of the Canadian system are things like "I had to wait 2 years for my knee replacement/gall bladder surgery/hysterectomy." That's because these things are elective and in a sane system, they should be postponed while people who really cannot wait are given a bigger piece of the resources.

And before people call me out for advocating rationing: don't think we don't have rationing here in the US. It's all rationed by money. If you have a job and insurance, you call walk into any ER and get your gallbladder out urgently if you look like you're in enough pain. If you're poor and you need an urgent bypass but the nearest cardiac surgeon that takes Medicaid is 300 miles away, what do you think is going to happen?

People are so naive about National Health policy. We have the same kind of tragic fuck ups in the US, we just get to pay 3-4 times as much for them.
posted by Slarty Bartfast at 8:46 AM on August 21, 2006 [1 favorite]


btw, here's the UK waiting list for cardio surgery (I think, I don't read UK bureaucratese very well). Odd that many hospitals don't have any waiting list at all. Mebbe they don't offer the services.
posted by Heywood Mogroot at 8:48 AM on August 21, 2006


Right, Kwantsar, it's all FDR's fault. Without him, there would never have been company health insurance, and health care would only be for the wealthy. What a utopia that would be.

That's about the stupidest retort that you could have written.
posted by Kwantsar at 8:55 AM on August 21, 2006


btw, here's the UK waiting list for cardio surgery (I think, I don't read UK bureaucratese very well). Odd that many hospitals don't have any waiting list at all. Mebbe they don't offer the services.

It's a massive step forward they can post this info to the web. You still don't really get a sense of what kind of cases they are putting on the waiting list.
posted by Slarty Bartfast at 8:56 AM on August 21, 2006


Slarty Bartfast, I don't think people are so much naive as they are either rich and content with the status quo, or poor and indoctrinated enough to hear the Soviet anthem any time someone mentions socialised medicine.
posted by [expletive deleted] at 8:58 AM on August 21, 2006 [1 favorite]


British people very often make stupid decisions about money.
posted by languagehat at 8:59 AM on August 21, 2006


PS Heywood Mogroot makes > 100K/yr!
posted by Kwantsar at 9:00 AM on August 21, 2006


You probably wouldn't feel that way if you were denied medical care because of some check-bouncing codger.

You are right. The problem isn't the system, it's old people living too long. My parents are in their 60's. Next I have dinner at their house, I will ask them if they've seriously considered the immense burden their existance is on younger healthier people.

These are good ideas. Let's continue to discuss who should live and die.
posted by Uther Bentrazor at 9:01 AM on August 21, 2006


PS Heywood Mogroot makes > 100K/yr!

Not necessarily. I could have been including the interest on the DOD debt.
posted by Heywood Mogroot at 9:02 AM on August 21, 2006


So what should I have written, what the hell was your point? If company health care came from FDR's price controls, then that would be probably the best thing to come from that policy, since it is generally considered a mistake.

What exactly are you blaming on FDR, if not lamenting that employers now feel obligated to provide pensions and health care? Are you championing a wholly public system, to allievate the burden on employers, or are you saying that firms shouldn't have to provide their employers with insurance? I'm guessing it's not the former.
posted by [expletive deleted] at 9:03 AM on August 21, 2006


Uther - see previous comment
posted by Afroblanco at 9:03 AM on August 21, 2006


Kwanstar ^ So? Some people like their cucumbers pickled.
posted by AllesKlar at 9:04 AM on August 21, 2006


And, loath as I am to defend Afroblanco, don't you (Heywood and Languagehat) think that a line must be drawn somewhere? If we have finite resources to spend on health care, then rationing must occur. If we accept that this is society's problem (I don't, but whatever), we then quibble about how much society should spend, and where the funding must come from, and eventually, where it should go.
posted by Kwantsar at 9:07 AM on August 21, 2006


Ok.

Do you think that the goal should be to keep people alive as long as possible, no matter what the cost?

You are right. This slope isn't slippery at all. These are good ideas.
posted by Uther Bentrazor at 9:09 AM on August 21, 2006


At some point you need to stop being a burden on other people.

These are healthy attitudes towards human life.
posted by Uther Bentrazor at 8:11 AM PST


Yes.
posted by rough ashlar at 9:09 AM on August 21, 2006


See, the genius of Canada's system is that this would never happen. The old man would be forced to wait and wouldn't be able to pay even if he wanted to!

You mean as opposed to cutting into line? How do we know that this man did not cause the death of a person who was ahead of him in that line? Maybe that little old lady who worked all her life as a waitress and now was dying of lung cancer from second-hand smoke? Let's hear her poignant story. Afroblanco's right--we're going to see a lot more of this.
posted by weapons-grade pandemonium at 9:10 AM on August 21, 2006



And, loath as I am to defend Afroblanco, don't you (Heywood and Languagehat) think that a line must be drawn somewhere? If we have finite resources to spend on health care, then rationing must occur. If we accept that this is society's problem (I don't, but whatever), we then quibble about how much society should spend, and where the funding must come from, and eventually, where it should go.


Or, instead of looking at the matter systematically and rationally, we could continue to assert that Amurka has the world's greatest health care and the market will take care of everyone in the most cost effective manner. If you don't like having 100s of profit-driven insurance companies fighting to deny payment for those lucky enough to afford their coverage, maybe you'd like to go get your heart transplant in Canada, comrade.
posted by Slarty Bartfast at 9:19 AM on August 21, 2006


we then quibble about how much society should spend, and where the funding must come from, and eventually, where it should go

As a left-libertarian I think we should reorder our society as much as necessary to mitigate these horrible rationing decisions.

It's not rocket science -- we need to break the doctors' & nursing guild, windfall-tax the sh*t out of Big Pharma, go single-payer, concentrate on preventative care, etc etc.

As for funding, I balance my general libertarianism with the proviso that as a rule goods & services that enable or maintain being a productive member of society should be equally affordable, and accessible, to all.
posted by Heywood Mogroot at 9:23 AM on August 21, 2006


He says "two of my four heart valves are completely blocked" -- that doesn't even make medical sense.

Yeah, hasn't anyone else noticed that a "coronary angioplasty" doesn't have anything to do with heart valves? Does he mean that his valves are stenotic, and that he needs a balloon valvuloplasty? The total lack of any reliable information about his medical condition makes the whole story bogus.

In any case, you want to live, don't you? What's it worth to you?
posted by Faze at 9:24 AM on August 21, 2006


lol socialized healthcare

In the U.S. right now we have all the disadvantages of "socialized medicine" without any of the advantages.

So in between all your lol-ing, please try to avoid getting sick or having any injuries.
posted by flug at 9:26 AM on August 21, 2006


What exactly are you blaming on FDR, if not lamenting that employers now feel obligated to provide pensions and health care? Are you championing a wholly public system, to allievate the burden on employers, or are you saying that firms shouldn't have to provide their employers with insurance? I'm guessing it's not the former.

I'm saying that it's patently stupid that the system exists the way it does, and every generation of regulators since WWII has perpetuated and entrenched the system as it stands. If you want to know why it's stupid, you can start here. Now, firms don't have to provide insurance for their employees, but many do-- and it makes sense, since firms get tax deductions and individuals don't. But this comes at the cost of curtailment of choice, lack of an incentive for a functioning market of healthcare to the enduser, and the double whammy of lose your job/ lose your coverage.

I for one would love to have the employer portion of my premiums, and the freedom to buy my own insurance. I'd save a ton of money, choose my own doctor, pay cash, and rely only on a catastrophic plan.
posted by Kwantsar at 9:37 AM on August 21, 2006


Ya for the record I'd piss on a spark plug or eat a large, gross bug to save my own skin. But can someone tell me what this means:

a keyhole operation

Is this common jargon for percutaneous transluminal coronary intervention in the UK?
posted by Mister_A at 9:39 AM on August 21, 2006


I can solve it in three: Mandatory death age. Problem solved!

[/sarcasm]

Seriously, if you are insured in the US, you're already paying for universal healthcare, you just don't get it. What's the aggregate figure now -- 16% of GDP on healthcare (and rising rapidly)? We still have 45M uninsured at any given time (many of them children) and 80M+ who go without insurance for some part of each year (due to job changes etc.) The stats paint a bad picture -- half of all bankruptcies (three quarters of whom had insurance when they got sick), fair to middling infant mortality rates and lifespan averages compared to other first-world nations, a quantifiable gap in the care recieved by the poor as compared to the well-to-do.

All the while, over 20% of healthcare costs are purely administrative -- paying to shuffle paper from here to there. That's 20 cents on every dollar that does nothing to provide medical care.

Don't kid yourself...you pay to care for the uninsured under the current system. When they get treatment, they are using emergency services for (what should be) preventative care, or GP type of care, and the bills never (and cannot) be paid. The costs of caring for the uninsured are passed onto payers, similar to uninsured drivers raise everybody's car insurance rates, or shoplifters cause stores to increase their prices.

In these discussions, the overblown talking point about the costs attributed to "frivolous lawsuits" always comes up (which assumes that all malpractice suits are frivolous.) I'd like to see a study of how much care for the uninsured raises hospital rates, (plus the costs assocaited with LACK of care) and tally up what THAT costs society. I'd bet it's a higher cost than lawsuits by a damn sight.

I'd also like to know the quantifiable benefits which would be derived for universal coverage -- a healthier, more productive workforce for example.
posted by edverb at 9:44 AM on August 21, 2006 [1 favorite]


keyhole surgery = laparoscopic surgery. Filtered through the Mail's reporting of the confused man's thoughts, Mister_A - yes, it would appear to be.
posted by altolinguistic at 9:45 AM on August 21, 2006


I'd save a ton of money, choose my own doctor, pay cash, and rely only on a catastrophic plan.

Assuming you're not particularly wealthy by the time you're, say, 60, what do you plan to do then?
posted by Armitage Shanks at 9:50 AM on August 21, 2006


Is it fair to say that, in the US, litigious tendencies have also contributed the rising cost of healthcare?
Discussed previously.

Also, see this.
posted by Kirth Gerson at 9:54 AM on August 21, 2006


These are healthy attitudes towards human life.

yes, because they're realistic and don't involve denial or wishful thinking

i'll give you a secret from the hermetic tradition and the old mystery schools -

"to live life to its fullest, one must die before one's death"
posted by pyramid termite at 9:56 AM on August 21, 2006


Thanks Alto. Laparoscopic surgery is not at all the same as PTCI, lending further credence to the idea that this article is a bunch of bunk. Or maybe the poor fella in the story considers any procedure done by poking a hole in you to be keyhole surgery, which may well be the case.

Edverb is dead on with regard to the misuse of emergency services in the US - the emergency dept. is the de facto primary care doc for most uninsured people in the US. It's horrifically expensive. And of course one must see any patient, no matter how trifling their affliction may seem.

I don't understand the resistance to giving coverage to the uninsured and allowing them to see a primary care doc in their neighborhood. Right now the congress and the people of the US are pretending that we are not pissing away many billions of dollars annually, because we are so terrified of another "entitlement" program. People are entitled to medical care, and they are getting it, at great cost; let's acknowledge this fact and cut the cost of this care (cover the uninsured) without getting our titties in a twist and yelling "Hillary Clinton!"
posted by Mister_A at 9:58 AM on August 21, 2006


Afroblanco, I wouldn't argue that all life must be preserved at all costs, but geez, do you actually know any old people whom you'd like to see have a couple more relatively good years? No namecalling here, but "Screw 'em, they weren't worth keeping around since they were fixin' to die anyway" sounds like the slippery slope [pdf link] that Germany was already on when they had a change of government in the 1930s. There's gotta be a happy medium between that and bankrupting nations trying to fix every hangnail.

That being said, without having read the FPP, I'm mighty suspcious of the author's and the Daily Mail's motivations in writing/publishing this -- it's the kind of slanted thing we see in the Reader's Digest over here.
posted by pax digita at 9:59 AM on August 21, 2006


So in between all your lol-ing, please try to avoid getting sick or having any injuries.

I've got insurance :) :)
posted by thirteenkiller at 9:59 AM on August 21, 2006


Assuming you're not particularly wealthy by the time you're, say, 60, what do you plan to do then?


Are you implying that I will have frittered away all of my savings?
posted by Kwantsar at 10:02 AM on August 21, 2006


I wish there would be some rational discussion on the fact that the British rag is exactly that, and has misstated the facts for the UK system (and the Canadian system by similarities)

Prioritization in the Canadian system is based on urgency. If someone in Canada is diagnosed with cancer, they immediately get put to the front of the line. People who can survive with a wait will wait. It may be uncomfortable, but they will be taken care of in short enough order (could be a year long wait, but if it's not critical, big whoop).

The idea is to make sure that everyone can get access to efficient service within as a low cost as possible and provide competent service and delivery.

I have no problem with this.

As for bouncing a cheque, well, good on him if it were truly a life or death situation.
posted by pezdacanuck at 10:05 AM on August 21, 2006


pax digita - yaaaaay! I'm glad somebody finally quit beating around the bush and actually went and said what was on their mind. I'm Hitler! Hear that guys, Hitler!

(cue the dancing girls)

la la la la la la la, Hitler!
Afroblanco is Hitler, Afroblanco is Hitler
la la la la la la la, Hitler!
h-i-t-l-e-r, Hitler!

(I come out wearing a Hitler moustache and Nazi unifrom, doing a bit of a kick-step, dancing girls on each side of me)

H-I-T-L-E-R, yeah!

Actually, I'm a Jewish guy who resents being compared to Hitler. And lest anybody misconstrue my rermarks, I am in favor of socialized health care in America. However, socialized or not, I don't think that it's reasonable to expect immmortatlity from your healthcare system. I also don't think its cold or callous to suggest that someone who tries to cheat the system is being selfish.

Oh yeah, and since pax digita was kind enough to Godwin all over us, does that mean this thread is over?
posted by Afroblanco at 10:07 AM on August 21, 2006 [1 favorite]


There does come a point where the cost of keeping someone alive is too great to expect society to bear. For example if the cost of keeping a man alive for an additional year was say 1 billion dollars that would be too much. If a person makes 50,000 dollars a year it would take him or her 20,000 years to make enough money to provide that level of treatment. That strikes me as a grossly unreasonable amount. Hell a million dollars would be 20 years of work. That's too much too.

Universal health care functions by coercing people into paying for each others health care. In order to have it requires parameters over what is an acceptable price for to pay for extending a stranger's life a certain amount. How many years out of your life are you individually willing to work towards extending the life of a stranger? How many years of unpaid labor are you willing to extract from strangers to extend your life one year? These numbers need to converge for socialized medicine to work.
posted by I Foody at 10:08 AM on August 21, 2006 [1 favorite]


This article has a little more on the cost/benefit of UK health spending. Apparently, they'll pay up to £30,000 if they think they can give you one year of life.
posted by biffa at 10:13 AM on August 21, 2006


CodeBaloo: the majority of people who go bankrupt in the US from catastrophic medial bills (which accounts for the majority of personal bankruptcies in the US) do indeed have health insurance. Their insurers, however, often choose not to cover certain things, or define some procedures as addressing pre-existing conditions. Even a 10% copayment on a $300,000 procedure can easily bankrupt many insureds.
posted by luriete at 10:16 AM on August 21, 2006


Actually, I'm a Jewish guy who resents being compared to Hitler.

How outrageous that you, as a person who advocates euthonasia, would get compared with Hitler! And you're jewish! GOSH WE'RE SO IMPRESSED!

Shut up and get over it, you nazi-copying fool.
posted by Artw at 10:22 AM on August 21, 2006 [1 favorite]


what most people don't realize is, insurance companies don't exist to help you. they exist to take your fucking money.

Uh-huh. I had insurance when I permanently damaged my elbow in an accident. My elbow cannot be fixed, it's massively scarred, doesn't function 100% correctly and is, all 'round, a major-league bummer. Insurance paid for most of what needed to be done (after a fight), but as soon as I won a lawsuit for the accident, guess who came calling? Yup. The insurance company can force you to pay them back for all the money they spent on you.

Never mind the crazy bastards rake in more premiums from my former company DAILY than they ever paid out on my behalf, never mind they fought me tooth and nail for my rehab bills... no, they can take even more money from me because -- gasp -- they actually had to pay out on a claim! You know, part of their whole business model...

What other business do you know that gets to charge shameless premiums, rarely spend them, earn massive interest on them while banked and, if by some chance they have to spend it on you, they can ask for it back?

Hey insurance companies? Screw you.
posted by bitter-girl.com at 10:28 AM on August 21, 2006



What is odd is that the directory of choice she has, there is basically NO born-and-bred American doctors in the Medicare system. (She's kinda sensitive about this, for cultural, empathatic, and simple language-barrier issues that she has encountered in the past).

posted by Heywood Mogroot at 8:34 AM PST on August 21 [+] [!]

This is a blatantly racist statement masquerading as justifiable reason. If a doctor said they would only treat english speaking patients they would be thrown out of the hospital. What if they said that they would only treat well-educated patients because the poor and poorly educated didnt follow their direction.

The reason that there are so many foreign born doctors is because the path to becoming a doctor is harrowing and expensive, and not nearly as lucrative as it once was. Therefore its less attractive to already affluent Americans that have alternative ways to make a good living. When you apply to medical school they say, "If you can imagine doing anything other than being a doctor, you should do it."

Be happy that someone went through that 7 to 10 year process and incurred $175,000 in debt (most medical schools offer no financial aid) and is willing to work 80 hours a week. We are all going to have to work harder to make good decisions about health care and will involve your mom talking to people who may have accents.

posted by ameliajayne at 10:31 AM on August 21, 2006


artw, you should take that sort of thing to email - my address is in my profile.

You should re-read my comments. Nowhere do I suggest that we euthanize old people. I'm just suggesting that what this guy did was wrong, and that we can't expect healthcare systems to keep us alive forever.
posted by Afroblanco at 10:32 AM on August 21, 2006


To everyone criticising Afroblanco,

How exactly do you propose to deal with the problem of limited resources? The elephant that Afroblanco mentioned is in the room, whether you like it or not. As medical science advances, there will be an ever increasing list of expensive interventions that can extend people's lives. The fact remains that people must die, and we can't expect that every possible intervention must be used for everyone at every opportunity. That's not euthanasia, that's life. Resources for health care are limited, and it is in the best interests of everyone that these resources are allocated in the most efficent way possible.
posted by [expletive deleted] at 10:40 AM on August 21, 2006 [1 favorite]


There does come a point where the cost of keeping someone alive is too great to expect society to bear.

Despite the understandable refusal of American politicians to discuss this, similar to the refusal of many participants in this thread, this is the real problem with the U.S. health system. Its not a matter of ideology, but an obvious medical fact; it becomes more difficult to extend life as individuals get older. In and of themselves, proposals like offering federal reinsurance to HMOs and offering "the same plan that Senators give themselves" to all Americans will not really solve the problem; they just shift money around. The problem is the exploding cost of healthcare, and the political difficulty of acknowledging that if we were to limit the amount of money spent on end-of-life care and redirect it to preventative care, life expectancies would increase.
posted by gsteff at 10:41 AM on August 21, 2006 [1 favorite]


[expletive deleted] - gsteff ... if we sue (god, the universe, reality) for violating our right to live as long as we want, we'll have enough money for 10 health care systems

someone should do this immediately, once they figure out what court the case should be tried in ...
posted by pyramid termite at 10:45 AM on August 21, 2006


Nowhere do I suggest that we euthanize old people.

Technically, that's true. What you do suggest is that old people euthanize themselves:

He's lived a long, full life. What's he going to do when the next thing goes wrong with his body? Bounce another check? At some point you need to stop being a burden on other people. [Emphasis added.]

I don't think you're Hitler. I do think you're young and foolish and can't imagine being 77 any more than you can imagine being a butterfly. Time changes everything.
posted by languagehat at 10:45 AM on August 21, 2006



"And as one of the "libertarians" who read the Gladwell article, well, I can't say I learned much. In the face of wage controls, companies started to bundle health care with compensation, and the results have been disastrous. Thanks, FDR."



You know what? You're goddamned right, "Thanks FDR."

I don't know how many douchebag libertarian capitalists and moneysuckers of various other stripes I've heard bitch about FDR and his "socialist policies" over the years, when they ought to be worshiping at his fucking feet.

Why?

Because the man near-singlehandedly SAVED American Capitalism.

FDR's recovery policies pulled the country back from the precipice of complete social chaos, economic collapse, and the concomitant "danger" of a large portion of the working class willing to give up on a capitalist system that had failed them.

Most of the fiscal conservative twits who criticise FDR today in doing so betray the shallowness of their historical education. They ought to have a goddamned statue of FDR in the NYSE.

Lets further not forget that the disastrous economic situation that caused the hoovervilles and soup lines of the Depression, was brought about by rampant corporatist corruption allowed by the laissez faire, anti-regulatory attitudes of the pre-FDR federal government, combined with disasterous human-caused environmental problems.

Sound like a familiar scenario?
posted by stenseng at 10:50 AM on August 21, 2006 [3 favorites]


Gsteff, you see, that would involve extending public health care expenditure to working age people, and that is tantamount to Communism. If public money was spent so a sick factory worker can go see his GP, what's next?

I'll tell you what. Revolution, madness! Cities will burn. The state will assume control of the economy. The leaders of business and industry will all be given show trials where they are denounced as parasites, and either killed or forced to toil on collective farms. People will starve in the streets. The state will spy on it's own people, and imprison them without trial, just like in the Soviet Union. Go jack off to pictures of Stalin, you murderous bastard.
posted by [expletive deleted] at 10:51 AM on August 21, 2006


I do think you're young and foolish and can't imagine being 77 any more than you can imagine being a butterfly.

i can't imagine being that condescending ...
posted by pyramid termite at 10:55 AM on August 21, 2006


There does come a point where the cost of keeping someone alive is too great to expect society to bear. For example if the cost of keeping a man alive for an additional year was say 1 billion dollars that would be too much. If a person makes 50,000 dollars a year it would take him or her 20,000 years to make enough money to provide that level of treatment. That strikes me as a grossly unreasonable amount. Hell a million dollars would be 20 years of work. That's too much too.

This is a reasonable argument with realistic parameters involved.

Some things just cost too much money and sometimes they are human lives. Sorry New Orleans.

I heard something on the news about a country called Iraq. I wonder how much we're spending on that. Probably not much.
posted by Uther Bentrazor at 10:55 AM on August 21, 2006


Stenseng, thanks for that. I felt alone when no one else challenged Kwantsar's ludicrous assertion that FDR is somehow to blame for the terrible state of health care in the US.

I can't possibly understand the perverse hatred for FDR libertarians in the US have. Hell, even the Economist summed up his presidency as "Saved the world." I guess even the sensible and pragmatic form of classical liberalism the Economist esposes is just dressed up communism in wacky libertarian land.
posted by [expletive deleted] at 10:59 AM on August 21, 2006


"i can't imagine being that condescending ..."



Not very imaginative, are we?
posted by stenseng at 11:00 AM on August 21, 2006


Saved America, Saved the World, got elected four times to the Presidency, and looked damned dapper doing it. All while cripped up in a chair.


No wonder the Ayn Rand sucking social darwinist self-interest monkeys don't like it. By god, they shoulda culled him from the herd at the first sign of weakness!
posted by stenseng at 11:04 AM on August 21, 2006


This discussion about age, cost+benefit analyses, etc. also highlight why a capitalist system of rationing is viewed by many as being more 'fair' than a socialized one. Under a socialized system this all becomes national debate - who lives and who dies. The capitalist system is more of a natural-law, almost Darwinian approach, where those who have the means to survive longer in the face of illness do, while the less strong die off.

I agree about changing the system and that doing so does little but to shift the money around. At the end of the day, someone has to pay. There are lots of points of failure in the US system and blame can fall on the insurance companies, the trial lawyers, the HMOs, the drop off in federal funding for research, etc.

But we can also place the blame on ourselves in a way - keeping people alive ain't cheap, and as the procedures get increasingly complicated to keep people alive, the costs will escalate as the risks (legal, economic, supply/demand) do as well. We also spend more on healthcare because our lifestlyles often lead to highened expenses (poor diet choices, a more sedentary lifestyle).

We have to tackle *all* of these points, plus accept the fact that there is a tradeoff no matter what we do. There ain't no such thing as a free lunch and if we wish to extend our lives then we as a society, or as individuals, must be willing to accept the greater cost of doing so. There will always be a great demand for medical services and the supply of doctors and medical supplies will be somewhat limited. No system will be perfect, and even if it were, no doubt we would still be hearing about stories such as the one in this post.

I'm not necessarily advocating one way over another, but there must be a rational discussion that can be had on the subject.
posted by tgrundke at 11:05 AM on August 21, 2006


What you do suggest is that old people euthanize themselves

No, not even.

I look at it this way - some day, I think that it will be possible to more-or-less indefinitely extend somebody's life. However, this will be fabulously expensive, and will become even more so as a person ages and more things break down. Who is going to pay for all of this? How much of our GNP are we willing to devote to keeping the oldest members of our society alive? I'm not saying that doing so is unimportant, but I do think that there are also other important problems that deserve attention and resources.

I don't think you're Hitler. I do think you're young and foolish and can't imagine being 77 any more than you can imagine being a butterfly.

Well, you are correct, I am not Hitler, I am young, and I don't even claim to understand what it's like to be 77. However, I don't think it's foolish to ask the question, "What would happen if all 77-year-olds wrote bad checks to obtain expedited medical care?"
posted by Afroblanco at 11:07 AM on August 21, 2006


I can solve it in three: Mandatory death age. Problem solved!

Lastday, Metafilter 29's. Year of the City: 2006. Carousel begins!
posted by zarah at 11:08 AM on August 21, 2006 [1 favorite]


These are good ideas. Let's continue to discuss who should live and die.
posted by Uther Bentrazor at 9:01 AM PST on August 21 [+] [!]


Um, precisely. That's exactly what this discussion is all about, despite your sarcastic tone. When the issue of healthcare is discussed as a topic one thing we are discussig is who should live and die no matter what your position. Knee jerk reactions to such a topic don't help the discussion.
posted by Stauf at 11:10 AM on August 21, 2006


One of the recurring stories I hear in criticism of the Canadian system are things like "I had to wait 2 years for my knee replacement/gall bladder surgery/hysterectomy." That's because these things are elective and in a sane system

My aunt needed knee surgery but had to wait 2+ years for it while her overall quality of life (simple stuff we take for granted, like being able to walk) declined. But Suzy.Who.Thinks.Her.Mammaries.Are.Too.Small convinces the government that they need to pay for her breast augmentation. Sane system indeed.
posted by squeak at 11:17 AM on August 21, 2006


Are you implying that I will have frittered away all of my savings?

Not at all. I am implying that no matter how clever you are, it's entirely possible that you will be unable to accurately predict how long you'll live, how sick you'll get, and how much inflation and future stock market events will eat into your relatively fixed savings.

Being a bleeding heart, I can imagine scenarios where you end up eating dog food and/or dying young for lack of afforable care even if you aren't the sort of wickedly irresponsible person that, you know, deserves to suffer.
posted by Armitage Shanks at 11:17 AM on August 21, 2006 [1 favorite]


Hi,

I'm just jumping in here and have only read parts of this thread but I wanted to add the following (about the Canadian healthcare system)

My father-in-law had a heart attack 2 weeks ago. He was of course admitted, and had the requisite tests within about 2 days (angiogram, CT scans etc) and it was determined that he need a quad bypass, and he was operated on 4 days later.

This happened even though he was over 80, failed kidneys so he's on dialysis, overweight.

So if the system is able to take care of him quickly, then i think it's in pretty good shape. The wait times you hear about in canada have to do mostly with elective surgeries like hip & knee replacements. My parents between them have 1 new hip and 2 new knees. yes the wait was up to a year, but I believe my parents feel they were fairly treated.

Recently, Canada's healthcare system has received more attention, specifically on wait times, which are being reduced.

I believe socialized medicine provides the best medicine at the lowest overall cost to the most people. A country which does not provide this is less civilized than one that does.

That's not to say that private industry has no role to play in health care, or that people should not be in some way accountable for poor lifestyle choices.
posted by Artful Codger at 11:24 AM on August 21, 2006


lol! The first responder totally boxed out when he attributed the problem to socialized health care.
posted by Mental Wimp at 11:35 AM on August 21, 2006


Uther Bentrazor:
I heard something on the news about a country called Iraq. I wonder how much we're spending on that. Probably not much.


Iraq is a huge misallocation of resources. I doubt cost benefit analysts supports the war in Iraq. If anything Iraq points to the dangers of using wishful thinking instead of reason as a policy making tool. Plus it is so not germane to the conversation.
posted by I Foody at 11:37 AM on August 21, 2006


There is no perfect medical system. The private way favours the wealthy. You generally get to live a longer, healthier life if you come into money, whether through hard work (or more likely) through inheriting Daddy's pot of gold, which was inherited from HIS Dad and so on.

The socialist way has good intentions, but humans are imperfect. There will always be some f***tard who abuses the system and sits on his fat arse expecting society to take care of him while he sucks the public teat. I'm not sure what it's like in the U.S. with your HMOs etc., but in Canada, socialized medicine attracts a disgusting amount of bureaucracy, more of the same appointed f***tards who sit in expensive offices and collect huge salaries to rubber-stamp procedural forms for the Ministry of Health.

I'm Canadian, my wife is a U.S. citizen. We had a long discussion about it, and we both agreed that neither system was clearly better than the other.

Having said that, I still prefer the socialist system. I don't like the idea of elderly people having to decide whether they should pay for their food instead of their medicine on a given day.
posted by illiad at 11:45 AM on August 21, 2006


From last year (it's probably gone up)

US per capita spending on healthcare $5,267

OECD average $2,193 per capita

As for those who blame lawsuits:
The average medical malpractice payment, which included both settlements and judgments, was $265,103 in the United States in 2001, compared with $309,417 in Canada and $411,171 in Britain.



If Canada or the UK spent as much as the US does per capita I don't imagine there would be nearly as much waiting. (these numbers are a little off because some stats include pharmacuticals and Canada doesn't pay for those)



If you have a subscription to "Health Affairs" you can read more
posted by Megafly at 12:01 PM on August 21, 2006


“I paid my taxes and National Insurance and made sure that my children grew up to be good, respectable citizens. In other words, I had trusted in the system and now the system was happily leaving me to die.”

You never thought to protect yourself with real friends. You think it's enough to be a citizen. All right, the police protects you, there are Courts of Law, and you found paradise, so you don't need a friend. But now you say you want justice. Take the justice from the judge, the bitter with the sweet. But if had you come to me in friendship, then the scum that ruined your healthcare would be suffering this very day. And if an honest man like yourself made enemies they would become my enemies, and then they would cure you...
posted by Smedleyman at 12:10 PM on August 21, 2006


THe most important driver of increasing healthcare costs in the US is not expensive last-ditch "Heroic measures" to preserve tenuous life, nor is it the proliferation of frivolous lawsuits in our litigious society. The biggest driver at this time is the exploding cost of prescription drugs.

American physicians and patients have been led to believe that the latest, most expensive drugs are an important part of a healthy lifestyle. New medical conditions have been manufactured (ED for instance). Menopause has been medicalized (it's a disease and needs treatment! Never mind that the treatment might give you cancer or a stroke.)

Huge numbers of patients are taking expensive drugs for relatively benign "conditions", regardless of whether medical science supports treating them with said drugs.

And then there's the really serious stuff, like statins being recommended for pretty much any American male over 55, regardless of a history of cardiovascular disease. The only population where statins have shown a mortality benefit is in higher-risk patients who have a history of cardiovascular disease, but it is now accepted practice to put people on statins with the stated goal of reducing their LDL. However, there is no evidence linking elevated LDL to a higher incidence of MI (heart attack) or death in patients age 60+ (see Framingham heart study). Thus, billions of dollars are spent annually to reduce LDL, a "surrogate marker" that doesn't even correlate to actual risk of cardiovascular events, and if you don't put some whiny patient on a statin when they demand it (because they saw an ad on TV), he/she will leave your practice and/or sue you for malpractice in the event that he/she does have an MI.

So that's part of the problem too. Drug companies push the most profitable drugs into heavy rotation, not the most effective or important drugs. You want to reduce your risk of heart attack? Exercise is, literally, infinitely better than a statin for most people.
posted by Mister_A at 12:23 PM on August 21, 2006


I have to say, although I disagree with Afroblanco's point, his Hitler dance is one of the funnier things I've seen here.
posted by JHarris at 12:35 PM on August 21, 2006


Gah. Now I remember why I'm trying to be scarcer around here.

You know what? You're goddamned right, "Thanks FDR."

I don't know how many douchebag libertarian capitalists and moneysuckers of various other stripes I've heard bitch about FDR and his "socialist policies" over the years, when they ought to be worshiping at his fucking feet.


All I pointed out was that the role of the employer in health care is in part attributable to FDR's wage caps, and the reaction of the employment market to said caps. In short, it is an unintentended consequence writ large.

Your comments (which go far above and beyond a response to my point) perhaps are not germane, but they nicely attest to the sensitivity of your nerve. I like the way you sort of called me a douchebag, too.

Because the man near-singlehandedly SAVED American Capitalism.

FDR's recovery policies pulled the country back from the precipice of complete social chaos, economic collapse, and the concomitant "danger" of a large portion of the working class willing to give up on a capitalist system that had failed them.

Most of the fiscal conservative twits who criticise FDR today in doing so betray the shallowness of their historical education. They ought to have a goddamned statue of FDR in the NYSE.


You know, I've bet I've read three thousand pages on the Great Depression, including the requisite books by Greenspan, and Friedman and Schwartz, where the writers persuasively argue that the third-grade Civics Class mantra of "FDR saved capitalism from itself" is wrong. Recent papers (By Cole and Ohanian, among others) suggest that FDR's New Deal policies worsened the Great Depression, rather than curing it.

Lets further not forget that the disastrous economic situation that caused the hoovervilles and soup lines of the Depression, was brought about by rampant corporatist corruption allowed by the laissez faire, anti-regulatory attitudes of the pre-FDR federal government, combined with disasterous human-caused environmental problems.

Sound like a familiar scenario?


Oh, yes. The "Hoover-as-capitalist" myth. Keep telling yourself that you're right, because it looks like you've spent a total of zero minutes wondering if you could be wrong. Maybe you should understand that not everyone who disagrees with you is ignorant.
posted by Kwantsar at 12:36 PM on August 21, 2006


Answer for Canada/US: get Dual Citzenship (if you can and if ya live near the border.)

When you need medical help, try the canadian side- if you get told "gotta wait a year", just come visit this side of the falls...

hmm?

oh, yeah, hitler- he was Evil. but then again, I'm Jewish, so i'm prejudiced, obviously.
posted by Izzmeister at 1:00 PM on August 21, 2006


Um, precisely. That's exactly what this discussion is all about, despite your sarcastic tone. When the issue of healthcare is discussed as a topic one thing we are discussig is who should live and die no matter what your position. Knee jerk reactions to such a topic don't help the discussion.

Oh. You are right. I forgot, who did I say should die? I hope it wasn't my parents.

I wish we were discussing ways to improve existing systems and reallocate available resources in a way more conducive to a healthy society instead of very preventable unrealistic black-and-white situations. That seems like more fun.
posted by Uther Bentrazor at 1:08 PM on August 21, 2006


Hey insurance companies? Screw you.

Wordy McWorderson. Here's the part that kills me -- Mary and Sherry both go into the hospital for an emergency, but uncomplicated, laparascopic gallbladder removal and the bill is roughly $29k for everything (hospital fees, lab fees, surgeons, anesthesia, etc.).

Mary has no health insurance, so she receives bills totaling $29k and is expected to find $15k to pay the hospital or declare bankruptcy when she can't.

Sherry belongs to a powerful local union and therefore has excellent health care coverage via the leading local PPO. After she pays her $100 hospital co-pay, the remaining $28,900 is billed to the PPO. But because they're the leading local insurer, they come back to the hospital and say "We're going to pay $15,600 and not a penny more but that's okay because in exchange for you taking 54 cents on the dollar you're going to remain in our system and will continue to be the primary hospital for people with our coverage... for whose care we will continue to pay you only part of what you've asked for, as a condition of sending you more people for whose care we will continue to pay you only part of what you've asked for, ad infinitum."

I know (on a personal level) a number of hardworking, hospital-based doctors. I also know a number of people who work in executive levels for insurance companies. I know which ones are living higher on the hog (cars, houses, clothes, etc.) and it isn't the group that knows how to open a person's body and fix it when it's broken. Insurance is a racket (in the -eteering sense of the word) and we're all suckers for buying into it instead of demanding changes that will benefit everybody, whether they're currently insured or not.
posted by Dreama at 1:31 PM on August 21, 2006


If Canada or the UK spent as much as the US does per capita I don't imagine there would be nearly as much waiting.

Throwing more money into the system isn't going to alter the simple facts like, the college of physicians and surgeons has a limit on the number of graduates who become doctors every year which is causing a shortage. Or how foreign trained doctors are set to (some would say) an unfair higher standard than those who are trained here in Canada and because of the policy can't practice medicine here. Or how the government throws money at adding new wards/buildings and then leaves them empty for years on end. Sure you could throw more money at the system but it would be like throwing a pencil down a mine shaft to plug the hole and doesn't fix the underlying problem(s). From where I sit I'm choking on the, more money mantra since I don't even have a GP.
posted by squeak at 1:39 PM on August 21, 2006


So - how much is it costing us to keep Dick Cheney alive? Speaking of burdens, and all.

Dreama - you are so right. The health-insurance industry is a giant leech sucking the care out of our healthcare system. We should poke it with an equally giant lit cigarette.
posted by Kirth Gerson at 1:51 PM on August 21, 2006


He didn't get the surgery for free. He's having to pay a substantial amount every month, for years. If he had just waited, he wouldn't have this debt.

Frankly, the problems of Britain's NHS is caused by the partial privatisation. You cannot run a two-teir system, without the private side sucking labour and resources from the public.

But it's still better than the private care I saw in the States.
posted by jb at 1:51 PM on August 21, 2006


There is no doubt Canada's healthcare system has some problems. The mistake is in blaming the requirement for public health care and not, say, inappropriate use of resources and over-management of facilities.

The health of the citizens of a nation is fundamental to the health of the nation. An ill nation can not be an economically prosperous nation. It can not be a happy nation.

The responsibility of a government is to help maximize both productivity and "happiness" of its citizens. So a universal health care system is pretty much a requirement.

I think Canada, despite its mistakes, is doing pretty well in that department. We need to cut overhead costs, not services.
posted by five fresh fish at 2:38 PM on August 21, 2006


My aunt needed knee surgery but had to wait 2+ years for it while her overall quality of life (simple stuff we take for granted, like being able to walk) declined. But Suzy.Who.Thinks.Her.Mammaries.Are.Too.Small convinces the government that they need to pay for her breast augmentation. Sane system indeed.
posted by squeak at 7:17 PM GMT on August 21 [+] [!]


I am sorry for your aunt - my mother in law actually has done studies on the waiting times for hip annd knee replacements, and is fully aware of the quality of life issues at stake. But the heart of the problem is that there are massive shortage of rheumatologists and orthopedic surgeons. They aren't popular or sexy specialities, and GP training in rheumatology is terrible.

Lobby your provincial government to give incentives for people to go into rheumatology and related disciplines. 1 in 10 Canadians has arthritis, and complications due to arthritis kill more Canadians than AIDs.

but in Canada, socialized medicine attracts a disgusting amount of bureaucracy, more of the same appointed f***tards who sit in expensive offices and collect huge salaries to rubber-stamp procedural forms for the Ministry of Health.

This is an example of a false stereotype. Research done at Harvard has shown that Canada's public system spends substantially less on adminstration than the American system. There is a powerful lobby trying to tell you otherwise, but the fact is that a single payer system is much more efficient than a privatised system.
posted by jb at 2:40 PM on August 21, 2006


(aside: the Cdn healthcare system is not helping my wife enough right now. It's taking over a g.d. year to get her in for sinus surgery. Effing hospital admin is utterly non-cooperative.)

jb: Not an entirely false stereotype. Just because we have substantially less overhead than the American system doesn't mean we don't have too much overhead.
posted by five fresh fish at 2:43 PM on August 21, 2006


Oh. You are right. I forgot, who did I say should die? I hope it wasn't my parents.

I wish we were discussing ways to improve existing systems and reallocate available resources in a way more conducive to a healthy society instead of very preventable unrealistic black-and-white situations. That seems like more fun.


You know, me too. But all you seem interested in is posting sarcastic snarks over and over again. It's getting old fast ("these are good ideas", "these are healthy attitudes toward life" get a new schtick please). I'm not exactly decided on the issue, but I do think some of the questions, such as the one posed by [expletive deleted] are serious ones which deserve serious answers, not sardonic "oh yeah, good idea" comments. This isn't a black and white issue, resources are limited, and death and illness are not easy issues to deal with.

p.s. I never said you said anyone should die; I just found your holier-than-thou comment incredibly off-putting. We are discussing the same damn thing, but instead of responding with a genuine argument you can't help but attempt to make yourself look oh-so-very moral and your opponents completely uncaring. And, seriously, your Iraq comment is completely off-topic.
posted by Stauf at 2:45 PM on August 21, 2006


But Suzy.Who.Thinks.Her.Mammaries.Are.Too.Small convinces the government that they need to pay for her breast augmentation. Sane system indeed.

Really? Can you give me a source on this?

I agree about changing the system and that doing so does little but to shift the money around. At the end of the day, someone has to pay. There are lots of points of failure in the US system and blame can fall on the insurance companies, the trial lawyers, the HMOs, the drop off in federal funding for research, etc.

But we can also place the blame on ourselves in a way - keeping people alive ain't cheap, and as the procedures get increasingly complicated to keep people alive, the costs will escalate as the risks (legal, economic, supply/demand) do as well. We also spend more on healthcare because our lifestlyles often lead to highened expenses (poor diet choices, a more sedentary lifestyle).

We have to tackle *all* of these points, plus accept the fact that there is a tradeoff no matter what we do. There ain't no such thing as a free lunch and if we wish to extend our lives then we as a society, or as individuals, must be willing to accept the greater cost of doing so. There will always be a great demand for medical services and the supply of doctors and medical supplies will be somewhat limited. No system will be perfect, and even if it were, no doubt we would still be hearing about stories such as the one in this post.

I'm not necessarily advocating one way over another, but there must be a rational discussion that can be had on the subject.
posted by tgrundke at 11:05 AM PST on August 21 [+] [!]


I just wanted to repost that, because it's probably the most reasonable starting point for the debate that needs to happen on this issue. And yet as a society we haven't been able to do this without resorting to calling each other "Commie!" or throwing out lies about how it works in other countries.
posted by Slarty Bartfast at 2:51 PM on August 21, 2006


"Oh, yes. The "Hoover-as-capitalist" myth. Keep telling yourself that you're right, because it looks like you've spent a total of zero minutes wondering if you could be wrong. Maybe you should understand that not everyone who disagrees with you is ignorant."


And maybe you should understand that name dropping a bunch of revisionist monetarists, hooverites, and other libertarian knuckle-draggers, whose axes can be heard grinding a mile away, doth not reality make.

Further, Friedman is certainly one to talk, considering that he couldn't get academic work during the depression and considered working for the New Deal "a lifesaver."
posted by stenseng at 2:54 PM on August 21, 2006


jb: Not an entirely false stereotype. Just because we have substantially less overhead than the American system doesn't mean we don't have too much overhead.

The previous poster was pointing out suposed high overheads in Canada as opposed to the US. The idea that public beurocracy is always larger and more wasteful than private is a pernicious lie which continues to be pushed by powerful lobbies. Public beurocracy has a hell of a lot more oversight than private.

And how much overhead is too much? How can you tell? In WW2, there were 12 men doing logistics and support for every fighting man on the Allied side. It was part of their strategy - and it was a sucessful one.

All I know is that Canada spends less on health care and has better overall health outcomes than the US, our nearest neigbour and the country with the most similar lifestyle to our own.
posted by jb at 3:01 PM on August 21, 2006


In my recent experience, what I have observed, personally and anecdotally, is that each healthy American should put about 10k into a reserve and open a HSA account. Simply plan to spend 5-7k a year on possible health care issues family wide and just pay out of pocket thru the HSA, which seems to bill at about 60% of the actual bill coming from the health care provider.

To reitterate, this might be adequate for HEALTHY americans.
posted by BrodieShadeTree at 3:11 PM on August 21, 2006


Agree w/you there, jb. Public systems can always be made to cost the consumer less than private systems: public systems need not show a profit. You can run a public system exactly the same as the most-efficient private system; and simply not take profit.

For those big systems that are required to ensure the health and happiness of the citizens, I prefer to see a public-run system. It needs to be done openly, with full accountability, and a citizens' interest group with a specific mandate of maximizing availability and minimizing costs in a socially-acceptable manner.

Everyone should have access to the basic necessities of life: food, shelter, safety; and everyone should have access to the basic mechanisms for improving one's lot in life: transportation, education, healthcare.
posted by five fresh fish at 3:15 PM on August 21, 2006


kwantsar, what do you imagine the U.S. healthcare system would look like today if the WWII wage controls had never existed? (fwiw, I think you're largely correct here, though I'd argue that the controls institutionalized a trend that was already well underway.)
posted by vetiver at 3:29 PM on August 21, 2006


jb, I won't argue that I might've offered an undeserved stereotype, but my own experience bears it out. Example: The Fraser Valley Health Authority fired its top guy five or six years ago for mismanagement of funds, and gave him a $5 million dollar handshake as they sent him packing.

WTF is that other than f***tards paying off one of their own?
posted by illiad at 3:31 PM on August 21, 2006


Really? Can you give me a source on this?

I tried finding a internet source (I like being able to back up what I say) but my googlefu is weak. It was mentioned in the media ... oh geez at least 5 years ago, maybe even farther back than that. What I recall of the story is, a teen in Ontario requested breast augmentation to help improve her self esteem (under the auspice of it being a mental health issue IIRC) and her wish was granted.
posted by squeak at 3:34 PM on August 21, 2006


/I really dig how folks in the U.K write the word “cheque” for checks. Much better mental mouth feel to the word and differentiates it from things you do in hockey, chess and on lists. Nifty.

“Hitler was evil”

...you know, I’m actually curious about the health care system in Nazi Germany now...
One of my favorite Simpson’s episodes is the one with Albert Brooks playing “Hank Scorpio” the sinister Bondesque supervillian. You kind of wonder why any bond villian has henchmen. Who would work for a madman trying to seize power? But then you see Scorpio who is so charismatic and offers great pay with excellent benefits as well as bonuses and ancillary benefits (for your life partner), you kind of see why. People tend not to kick so much about evil when they’re fat dumb and happy. I’ve seen a lot of people die, and it’s all pretty shitty. Whether it’s in a hospital or whatever, pretty much the end sucks. Is it possible we blind ourselves to this aspect of healthcare because we want the illusion? Similar to citizens of Nazi Germany saying they had no idea there were so many atrocities going on? Certainly the dramatic change in the German standard of living would have been a big distraction. But how much of that is wanting to be distracted? I dunno. I think though it’s a valid observation that this is such a contentious issue because of that emotional component. Where reason and study might otherwise have prevailed by now.
posted by Smedleyman at 3:37 PM on August 21, 2006


Old people vote. There are comparatively more of them every day. Maybe we will be seeing more of this type of discussion in the future?

Also Daily Mail suxx0rs!1! The NHS? Leave them alone you wierd driven faced fun-dispelling gits.
posted by asok at 3:41 PM on August 21, 2006


I'm not exactly decided on the issue, but I do think some of the questions, such as the one posed by [expletive deleted] are serious ones which deserve serious answers, not sardonic "oh yeah, good idea" comments. This isn't a black and white issue, resources are limited, and death and illness are not easy issues to deal with.

This will be a serious discussion when we aren't talking about "limited resources" and the concept of necessary, preventable deaths in the richest country in the world.

Until then, these are all very good ideas.
posted by Uther Bentrazor at 4:13 PM on August 21, 2006


Wow, Afroblanco, you're really something. Do you act like this in real life, too, or just on MeFi where nobody can actually see you? You're like a Woody Allen movie on acid or something....

I didn't call any names; I just pointed out that when you go to one extreme, you can find yourself on a slippery slope you'd rather not be on, and if you try to take things in the other direction, pretty quickly you can't afford to do anything much for anybody.

The only thing I'd change is my unthinking use of "happy medium"; actually, with compromises, you usually have to settle for making everybody more or less equally unhappy.

You're not Hitler. You're not, mmmmkay?

Whew...
posted by pax digita at 4:27 PM on August 21, 2006


...each healthy American should put about 10k into a reserve and open a HSA account...

To reitterate [sic], this might be adequate for HEALTHY WEALTHY americans [sic].

posted by Mental Wimp at 5:01 PM on August 21, 2006


five fresh fish wrote:

"Everyone should have access to the basic necessities of life: food, shelter, safety; and everyone should have access to the basic mechanisms for improving one's lot in life: transportation, education, healthcare."

I couldn't agree more. To me it's really about the Social Contract. Like I said before, it's really a matter of priorities, and right now, I think our society has its priorities very very screwed up. The idea that the very very poor (and the very old and very young) cannot afford adequate health care and that that is somehow an acceptable consequence of a capitalist society I find to be morally bankrupt, and especially hypocritical when it comes from people who pay lip service to the Gospel of Christ.

It's really a matter of philosophy. Some people believe that for some people to be 'haves' as it were, that other people must be 'have-nots'. Others, such as myself, believe that this is at the least an unthinking and irrational, and at worst, an evil and unethical way to structure a human society. Wealth requires scarcity. Continued wealth requires the artificial generation and continuation of scarcity and poverty.

Like I said (when I said it was a matter of priorities) spend more of the budget on health care, and more people will have access to said health care. This will require us to spend less of the budget on other things, like blowing things up and shooting people and stuff. Sound simplistic? Maybe it's really just simple.
posted by geekhorde at 6:51 PM on August 21, 2006


Smedleyman: walk on parts in a war / lead roles in a cage, much? Or even: better to rule hell than serve heaven?

More than a small amount of the problem with the american healthcare 'system' arise from confusion between two very different ideas of what the medical industry should provide: let us call one school the 'homeostasis' school, centered around returning the 'ill' to a state of 'normal' health, and the 'better living through chemistry' school, centered around improving one's comfort, enjoyment, and productivity, perhaps even to 'better than well' levels. For examples of the 'homeostasis' school think about medicine as typically thought of, for the 'better living through chemistry' think psychiatric medications, erectile dysfunction treatments, plastic surgery, lasik, etc.

Claims arising from the 'homeostasis' school are eminently insurable -- for healthy people catastrophic insurance coverage is all that is needed -- and most insurers would have little trouble meeting their obligations were their expected claims entirely restricted to this category. Claims arising from the 'better living through chemistry' school are very difficult to insure -- much more of the population wants the fruits of this school of medicine than needs the fruits of the 'homeostasis' school, and in contrast to the products of the 'homeostasis' school using the 'better living through chemistry' products in near-perpetuity is the norm, not the exception.

Some of the 'better living through chemistry' are not typically provided via health insurance -- lasik and most plastic surgery being the obvious examples -- but for the remainder there's a nearly-intractable set of interlocking problems: demand for 'better living through chemistry' is high and increasing (Americans more than any other nation have bought into this in their actions, if not in what they think of themselves as believing); 'better living through chemistry' is only legally available with a doctor's prescription and/or some additional steps to get the permission of a prescribing authority; for much of the population the doctor time to obtain the prescription and the subsequent expenses exceed what they are willing or able to pay directly, and so they must turn to insurers to cover the cost; ergo, insurers wind up with mounting long-term claims that are pretty much impossible to adequately insure, and have to make up the difference wherever possible.

No health insurance scheme -- nationalized or otherwise -- will ever run smoothly for the United States so long as too much of the population expects the insurance to provide not only medical care as-needed but also lipitor for life from age 40: either demand for insurers to cover those goods must decrease -- an unlikely prospect -- or the price of those sorts of products would have to decrease, and their availability increase, to the point that general demand could be met directly, without resorting to insurer coverage.

If one were to appoint me as a benevolent dictator tasked with saving something resembling the current American approach, I'd do all of the following:

* establish for pharmaceutical companies two tiers of fda approval -- one for products they wish to claim as medically beneficial, and one for products that can be demonstrated to do at worst only minimal amounts of harm under ordinary use. Products for sale under the latter category would have to have demonstrated that under recommended usage parameters no egregious harm comes to users, and once approved the manufacturers would be liable for outright fraud -- in the approval process -- or for manufacturing defects, but would not be liable for direct harm resulting from (proper and especially improper) usage of their product.

The first regime would be for products that have a demonstrable medical benefit, and whose manufacturers would like to see them covered primarily by insurers. It might also prove necessary to stipulate by law that any product in this regime cannot be turned down for coverage if a doctor has diagnosed a condition and conluded the product to be the best available treatment. Most 'homeostasis'-type products would ideally fall into this category.

The other regime would be designed for products from the 'better living through chemistry' school, and for products the manufacturers of which would not intend be covered by an insurance plan. For example, most psychiatric medications would potentially fall into this category, along with erectile dysfunction aids, stimulants, etc., and these would not require a prescription to purchase (although, presumably, most insurers would likely require a doctor's prescription at a minimum before covering a particular treatment in this category).

The aim of the dual regime is to decouple how products from the two schools of medicine are paid for -- and thus keep insurance for the insurable problems, while making the optional, life-enhancing (if not life-saving) products more available and thus more affordable. To avoid the risk of medical research abandoning the homeostasis route entirely it might be necessary to adjust the incentives slightly -- for example, reducng the strength and length of patent protection for products in the second regime, so that new products relased in that regime provide a surer profit but smaller upside than products released under the stricter regime -- but the general approach seems to me quite likely to accomplish its aims.

* double and then triple the number of doctors-in-education, phasing each increase over an eight year period; one could very easily admit twice as many medical students without an appreciable loss of quality in the final output, but it would take some time to build up the teaching infrastructure to adequately handle that many students.

In addition, make concomitant with licensure the publication of a profile where, online, prospective patients could read commentary from previous patients alongside a detailed history of complaints, outcomes, etc., and force the licensing boards to get serious about quality control: the former makes it much harder to allege malpractice -- after all, all the defendant will need to point out is that, as everyone knows, the patient could have found out what she was getting in to online -- and the latter will cut down on the 'bad apple' phenomenom; most doctors are average, but the (fairly few) bad doctors can do tremendous damage. The advantages of more (competent!) doctors should be apparent.

* establish a comprehensive series of standard grades of health insurance -- say, A through G -- with clearly-defined, legally obligated coverage patterns ranging from extremely bare-bones catastrophic insurance to just-about-everything, and then prevent insurers from offering plans that did not at a minimum provide one of those plans (for example, one could offer an 'enhanced E, covering all of E but also providing limited eye coverage', but not a plan that was not a superset of one of the standard plans).

Right around 1/3rd of the money spent on healthcare in the United States evaporates as deadweight loss spent on claims assistants, claims processors, etc., figuring out what is covered and to what extent; in general allowing the market to sort out what to offer is preferable to setting product types by fiat, but for the moment the interactions between healthcare providers and health insurers appears to be a solid example of where it is no longer reasonable to apply elementary microeconomics -- in particular, perfect information, zero information cost, zero cost of processing that information, and perfect rationality -- in predicting the outcome, and some measure of enforced standardization seems preferable to the current situation. If one standardized the basic types of health insurance -- and the range of types were sufficiently comprehensive -- while still permitting insurers to compete with add-ons and bonus coverages I suspect that much of the deadweight of tracking down coverages would be eliminated.

Those three changes -- all three fairly major, hence the 'dictator' requirement -- would be a last, best effort to salvage something resembling the American system. If you're a believer that the market is capable of fixing the American healthcare 'system' the first two are almost certainly what you'd want in place -- if not exactly those actions something similar -- and the third I also consider necessary to bring market forces to bear, because the complexity of plans makes it near impossible to make good choices in many cases, (let alone the increase in system efficiency by cutting down the overhead in determining what is covered). Something decoupling health coverage from particular employers would be even more advantageous but seems difficult to structure correctly without putting an even heavier hand on the insurance industry than this plan already would.

It's not clear to me, however, that such an approach would actually work -- unlike socialized medicine, which has been tried in several dozen countries, , mostly successfully, the above 'true(er) market approach' is entirely unproven. If I were tasked with fixing American healthcare without the requirement of maintaining a semblance to the existing system I'd simply import some Swedes and some Canadians and have them implement, wholesale, a single-regional-payer system (perhaps dividing the nation into 10-12 regions) modeled on their own systems.

So long as the system ran as well as, say, the Canadian system only a small minority would be worse off than they are now: for those who can afford to 'cut in line' the cost of airfare to private clinics in Thailand, India, or Mexico will be insubstantial (and if you think you could afford to 'cut in line' for any major surgery and yet blanch at the cost of an international flight you're deluding yourself about what things cost and your likely ability to pay); for the remainder they'd be trading getting seen right when they want (if their montonely decreasingly covering insurance covers it!) for being assured of being seen (if not always immediately!), which is in line with most people's risk preferences.

I'd also implement the two-tier pharmaceutical regime, to prevent the national health system from colllapsing under requests for lipitor and viagra, and its doctors from being overburdened by having to see patients just to grant the prescriptions.

A fundamental problem of healthcare economics is that, under most circumstances, the people paying for healthcare are not the people receiving the care (because the people receiving it are sick, to oversimplify a bit). The field of providing add-ons and enhancements to health is one area where the above characterization does not apply and thus market forces can be expected to work; for everything else, however, it's not at all clear that a market solution would ever work -- and, even if it were in principal capable of working, I have little tolerance for 'no true scotsman' arguments -- whereas, although perhaps not optimally efficient the socialized approach has been repeatedly shown to work well enough, and thus to be within human capacity to implement correctly. Whether it is within the political capacity of the United States to implement and then run successfully is an entirely separate question.
posted by little miss manners at 7:22 PM on August 21, 2006


pax digita : True, you did not directly compare me to Hitler - instead, you grossly mischaracterized my viewpoint, and then went about 85% the way there *cough* *cough* *strawman* *cough*. Then, a few equally hysterical people went the remaining distance.
posted by Afroblanco at 7:31 PM on August 21, 2006


Oh yes, and to answer your question, anybody who has met me can tell you that I am more or less exactly how I portray myself on MeFi.

Although, admittedly, I've never heard the Woody Allen on LSD thing - I've always been more of an Art Garfunkel on DMT.
posted by Afroblanco at 7:32 PM on August 21, 2006


Or, put more succinctly, no insurance scheme exists that can reasonably cover the kinds of things Americans typically and increasingly demand their insurer provide -- the life-enhancing products, as opposed to the life-saving products -- in the quantities they demand them, so for any insurance scheme to work either demand for such products must be diminished or insurance must no longer be (de facto) necessary for most to obtain them. If you further assume demand for those life-enhancing products is unlikely to diminish anytime soon, then regardless of the nature of your broader healthcare scheme you will require a liberalization of access to many of the semi-medical pharmaceutical-type products currently on offer -- making prozac, lipitor, viagra, etc., regulated and thereby available more after the fashion of herbal supplements and vitamin pills than currently the case, perhaps making physician oversight entirely optional.

Once you've liberalized access to many of the ongoing but largely nonessential treatments, you'll inevitably create a free market for much of the non-catastrophic medical goods, which should reduce the price and increase the availability for the nonessential medical care.

The remaining question is how to provide for illness, injury, catatrohpic accidents, cancer, and the like. Certainly increasing the amount and accountability of doctors will help regardless of the approach taken, but beyond that it becomes increasingly unclear that a market approach is optimal here: there is the practical evidence that there are no currently-existing successful healthcare systems on the completely-private model, and there is the theoretical argument that, in the general situation, the person receiving non-optional healthcare will never be the person paying for it, which makes it unclear how a direct market for this kind of healthcare will work. An indirect market -- in which one purchases health insurance from one of several different providers -- is more tractable, but in practice this can be seen to push tremendous costs onto customers and healthcare providers in the form of paperwork and incredibly complicated coverage schemes.

If one were to try to salvage the indirect-market-by-way-of-competing-insurance-plans a first step would be to reduce the deadweight cost the plan complexity imposes by creating standard grades of health insurance and disallowing plans that cannot be classified as meeting one of the grades, in the hopes that the increased standardization of what is covered and what needs to be insured increases system efficiency. This approach has not really ever been tried and might work, but at the moment the socialized approach to providing basic care has been demonstrated to work well enough in most places it has been tried that it seems foolish, to me, to favor a very dubious and untried approach over one definitively shown capable of being made to work.
posted by little miss manners at 7:43 PM on August 21, 2006 [1 favorite]


LMM GYOB TIA KK FTW
posted by scrump at 7:55 PM on August 21, 2006


Although, admittedly, I've never heard the Woody Allen on LSD thing - I've always been more of an Art Garfunkel on DMT.

Do what?
posted by dmt at 3:45 AM on August 22, 2006


“Smedleyman: walk on parts in a war / lead roles in a cage, much? Or even: better to rule hell than serve heaven?”

Just pure speculation.
posted by Smedleyman at 9:03 AM on August 25, 2006


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