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Old 03-10-2013, 08:12 AM   #241
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We watched this happen with my MIL. I don't think there was a test known to man they didn't decide they needed to run on her in the last 6 weeks of her life. She was 94. The amount of money and resources wasted was terrible. It's like a freight train that you can't stop.

My sister said that is normal with people on Medicare.... the docs know they will get paid and want to milk the patient as much as possible...

She works in a hospital, so she sees it all the time...


She also said that whenever a patient or family refuses to have them done, they do whatever to kick them out of the hospital... this happened to one of my other sisters....
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Old 03-10-2013, 08:31 AM   #242
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The answer to at least some of this is hospice care. It's not always appropriate or possible, but when everything lines up it is a wonderful option.

My FIL died this year after a struggle with cancer. He got good, appropriate, aggressive treatment as long as it was appropriate, but when the time for that ended he and my MIL agreed to hospice. After that, "Dad" only went to the hospital once for a short, acute incident, otherwise he stayed at home and got daily visits from the hospice nurse. My MIL had someone to call 24/7 about various issues, and they would come out any time she asked. The pain meds were made readily available, and he spent his time at home with her and his kids. He died there peacefully. It was much better and more humane for everyone than if he'd become a lab rat/profit center for medical practitioners.
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Old 03-10-2013, 08:44 AM   #243
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its obvious until it happens to you or a loved one.


it's not an easy dilemma
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Old 03-10-2013, 04:52 PM   #244
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We watched this happen with my MIL. I don't think there was a test known to man they didn't decide they needed to run on her in the last 6 weeks of her life. She was 94. The amount of money and resources wasted was terrible. It's like a freight train that you can't stop.
I had this happen with both my parents, who died within 10 months of one another. It totally changed how I feel about end-of-life issues, and I've had some very frank talks with our kids about what I consider to be quality of life. I think I'm going to make a video for them to show the doctor when they need to. I had POA, health care directive, etc., and I had to BATTLE those doctors to let them both die in peace. Heard about the woman in CA who died because they nurse wouldn't do CPR? I had just the opposite issue. I do not want my kids to be made to feel guilty because it's time for me to go, and the doctors won't let me until they suck every last dime out of whatever resources I have.
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Old 03-10-2013, 05:18 PM   #245
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The answer to at least some of this is hospice care. It's not always appropriate or possible, but when everything lines up it is a wonderful option.
My uncle just died at home in hospice care. It was a good option. He was 96 and had been active and in good mental health (even still driving) until close to the end. He apparently had severe blockages in several arteries and couldn't withstand surgery and his doctor was frank that nothing could be done and he was sent home to hospice care and died within a few weeks. I actually thought this was pretty good.

On the other hand talking to my mother I think that some of the family members were taken aback. One family member didn't like the person from hospice talking to my uncle and referring to "the little time you have left." I asked my mom what was wrong with that and she felt that he shouldn't be told that he only had a little time left. She also at first tended to feel that it just wasn't...proper to have him die at home. She felt that he should be in the hospital. I do think she was taken aback a bit in that she was told (by other family members so this might not be entirely accurate) that basically the doctor said that she could do nothing more for him and discharged him to hospice and basically refused to do anything more. While it probably wasn't as cold as it sounded, well, it did sound cold. I do believe in hospice, but I can see why some might be taken aback by it.

On the other hand, I reminded her of how miserable her sister (the uncle is question was her sister's widower) was in dying in the hospital at around age 90 and she agreed that her sister had been miserable and agreed that the uncle's death at home was far more comfortable for him.

Still, while she could see the logic of it, some part of her just feels that people should be in the hospital when they die.
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Old 03-10-2013, 05:57 PM   #246
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Perhaps we each understand risk differently. Some employers pay premiums, others don't, but there is no transfer of risk either way. The ACA establishes minimum coverage but allows insurance companies to charge for that. That's how insurance works.

Requiring hospitals to provide emergency care without regard to ability to pay is a good example. Hopefully, as more people get health care coverage, this will decline.
I think the confusion arises when we use the term " insurance " when speaking of access to health care. Insurance requires underwriting and its purpose is to cover unlikely events. The cost to cover likely events without underwriting would be astronomical. And it is.
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Old 03-11-2013, 04:18 AM   #247
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There is nothing within the word "insurance" that necessarily restricts use of the word to "unlikely" events. For example, there are a number of life insurance policies that are intended to always pay off. The word really encompasses all manner of arrangements where someone protects themselves from something, in this case, the cost of some service. The "active ingredient" in insurance, from the insured's perspective, is the way pooling risk helps guard keep the costs consistent without regard to then unforeseen.
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Old 03-11-2013, 08:45 AM   #248
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There is nothing within the word "insurance" that necessarily restricts use of the word to "unlikely" events. For example, there are a number of life insurance policies that are intended to always pay off. The word really encompasses all manner of arrangements where someone protects themselves from something, in this case, the cost of some service. The "active ingredient" in insurance, from the insured's perspective, is the way pooling risk helps guard keep the costs consistent without regard to then unforeseen.
Yes, but those life insurance policies have underwriting. And yes there can be any manner of arrangements. That was my original point. That the arrangement we want transfers risk for ordinary events. We should retain some of those risks to control costs. Does your auto insurance cover oil changes? Of course not.
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Old 03-11-2013, 09:00 AM   #249
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Originally Posted by SumDay View Post
I had this happen with both my parents, who died within 10 months of one another. It totally changed how I feel about end-of-life issues, and I've had some very frank talks with our kids about what I consider to be quality of life. I think I'm going to make a video for them to show the doctor when they need to. I had POA, health care directive, etc., and I had to BATTLE those doctors to let them both die in peace. Heard about the woman in CA who died because they nurse wouldn't do CPR? I had just the opposite issue. I do not want my kids to be made to feel guilty because it's time for me to go, and the doctors won't let me until they suck every last dime out of whatever resources I have.
First and foremost, I am sorry for the experience you went through, very sad.

My parents are adamant about 'no heroic measures' at end of life, and I hope I don't find myself in similar circumstances. They've both told my sister and I that they hope they pass in their sleep uneventfully, I assume that's an almost universal wish.

But even though I'm not a doctor or in any way part of the health care system, I'd like to think "the doctors won't let me until they suck every last dime out of whatever resources I have" is unfair to most doctors. I assume there's a lot factoring into their actions including:
  • doctors don't want to have to wonder did I do everything within reason to give the patient a reasonable chance at life
  • right or wrong, doctors have to have legal consequences in the back of their minds, and they're probably often reminded by insurers and hospital admins to err on the side of too much care for those reasons
  • doctors are left with vague or no instructions regarding the patients wishes too often - any end of life patient who does not provide any instructions is the most responsible party IMO
  • and even with patients instructions, I am sure there are family members pressuring doctors to disregard the patient
  • and hospital admins may be pushing doctors for reasons aside from money as well
  • just what comes easily to mind, I am sure there's more.
While I agree doctors and hospitals are clearly incentivized to over test, over prescribe, over spend in general where patients who are not at significant risk of dying - I'd like to think they're motivated by other factors when end of life circumstances are at hand.

I may be naive...

And discussion of end of life issues needs to be part of the debate without people using inflammatory 'death panel' tactics. As another member posted earlier, some end of life care is appropriate, some may not be. Some if not all other developed countries with much lower health care costs must have grappled with end of life issues, hopefully we can learn from their experiences. Though what little I found on Google indicated that the US end of life care outcomes are better than many developed countries (7th in the world) whereas our infant mortality, longevity outcomes are far lower in the rankings.
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Old 03-11-2013, 11:49 AM   #250
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Though what little I found on Google indicated that the US end of life care outcomes are better than many developed countries (7th in the world) whereas our infant mortality, longevity outcomes are far lower in the rankings.
The infant mortality statistics are >highly< suspect. The US gets "dinged" for the deaths of many infants that would never have been counted as live births in other countries.
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Old 03-11-2013, 02:26 PM   #251
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The infant mortality statistics are >highly< suspect. The US gets "dinged" for the deaths of many infants that would never have been counted as live births in other countries.
Good point. Coincidentally I just watched a pretty good CNN "Escape Fire" special on health care, and it mentioned that the US infant mortality stats included homicides of 1-4 year olds, that has nothing whatsover to do with our health care system. And they also noted that our lower longevity stats than other countries were driven in significant part by lifestyle/obesity choices, I don't doubt that either.

Our health care system challenges are complex and not from any one cause, if it were only that simple. And with lots of monied interests involved (just another of many causes), solutions will not come easily. But they'll have to come if the graphic shown in Escape Fire is true - "if other prices had risen at the same rate as health care costs since 1945, a dozen eggs would cost $45 and a gallon of milk would be $48."

HOLY COW!!!
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Old 03-11-2013, 02:32 PM   #252
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We should retain some of those risks to control costs.
Not in this case: You can live without a working car. You cannot live without health. The extent to which insurance is appropriate is related to how critical the aspect is. For example, for many things, there is no good justification for insurance. (This is often brought up in travel-related forums, where many folks contend that domestic trip interruption insurance falls into that category.) For other things, catastrophic insurance is what's best. For other things, comprehensive coverage, including preventive measures, is what's best.
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Old 03-11-2013, 04:35 PM   #253
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I agree with Gaterdoc50. I believe that our unhealthy lifestyle is the major force driving high healthcare costs. This might change if the healthcare system also emphasized preventation through lifestyle changes, instead of just treating disease.
I have a question regarding this: is there really someone who doesn't know that basically health is improved with the eating of more fruits and vegetables and less red meat, more exercise, avoiding smoking, etc.? Do we really need the "health care system" to tell us so? I'm unsure what is being proposed here. Please enlighten.

Second, I am unsure what "elective" surgery is, regarding the wait times in various developed nations. Certainly, cosmetic is elective, but the web says, "able to be scheduled in advance." Is cancer surgery considered elective? I really don't understand, quite.
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Old 03-11-2013, 09:07 PM   #254
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I agree with Gaterdoc50. I believe that our unhealthy lifestyle is the major force driving high healthcare costs. This might change if the healthcare system also emphasized preventation through lifestyle changes, instead of just treating disease.
It is interesting that many of the problems see in humans are also seen in cats, dogs and horses at least. Many pets will eat anything they can get access to and get obese also. This makes me suspect a large part of the problem is we have built and environment that we did not evolve to live in. By this I mean that until 140 or so years ago famine was a recurring problem. As a result the folks who ate when food was in good supply to overcome the short periods were better able to compete in the evolutionary cycle. Suddenly we find our selves in the inverse situation where there is more food (calories at least) than we need. The fact that this occurs in other mammals at least suggests a fundamental problem, and that obesity may also have genetic and epigenetic roots. some of us evolved to use scarce food more efficiently and store excess for the coming famine. Expecting a biological process to change over 3 generations is quite a stretch.
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Old 03-12-2013, 12:02 AM   #255
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Suddenly we find our selves in the inverse situation where there is more food (calories at least) than we need.
And I think two other complementary factors are at work to make us fat:
1) What tastes good to us. We like to each rich, fatty foods. To be "programmed" to prefer the taste of fats and other calorie-dense foods makes perfect sense when historically, starvation has been a major threat to human survival.
2) Most of us have no "drive" to exercise that counterbalances the "drive" to eat. Hunger and the enjoyment of food for its own sake make us want to consume calories, but there's no similar force making us want to expend them. This was not a problem when people needed to be much more physically active just to survive (get food, gather fuel for fires, travel long distances by foot, etc). Even our home heating systems today reduce required metabolic caloric expenditure--it takes food to keep a body warm in cold environments.
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Old 03-12-2013, 10:56 AM   #256
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You have to worry about unintended consequences. We all know that one of the problems with the current fee for service system is that if providers are paid for each procedure they do then they have an incentive to do a lot of procedures. And that has some pretty negative results.

On the other hand, when you have someone getting a set fee for you each month - whether they do anything for you or not - then you have a systems where providers make the most money by doing fewer procedures. On the surface that may sound good -- avoid overtreatment for example. And, that is good. The problem is that sometimes people actually do need treatment and may need a lot of it and/or may need treatment that is expensive.

.
The Mayo Clinic model of salaried physicians who have somewhat limited hours (that is, they cannot be abused by the organization demanding they work 19 hours a day for the same salary) seems to set such a great model. There is no motivation to under-treat nor to over-treat/do unnecessary procedures.
I also believe that at root most physicians went into to profession to care for people. When visiting one, it becomes pretty clear when s/he went into it for the money.
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