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Old 07-22-2009, 10:49 AM   #21
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You can't control end of life care or efforts to save extreme preemies through lifetime caps. You would need to detail circumstances and allowed procedures.
I would think that a "gatekeeper" would have to determine the probability of a good outcome from the treatment.

Someone with a 20% chance of being "saved" with a $1 million price tag might be allowed treatment whereas someone with a 1% chance seeking a $500,000 treatment might not be.

And even in cases which are 100% terminal, when talking about treatments which could extend lives, you'd need to factor in at least three things: (a) the cost of the treatment, (b) the length of time we're talking about, and (c) the likely quality of that extra time.
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Old 07-22-2009, 11:05 AM   #22
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I would think that a "gatekeeper" would have to determine the probability of a good outcome from the treatment.

Someone with a 20% chance of being "saved" with a $1 million price tag might be allowed treatment whereas someone with a 1% chance seeking a $500,000 treatment might not be.

And even in cases which are 100% terminal, when talking about treatments which could extend lives, you'd need to factor in at least three things: (a) the cost of the treatment, (b) the length of time we're talking about, and (c) the likely quality of that extra time.
And even more interesting.......

If you could afford to private pay for disallowed treatments, should that be allowed or be considered illegal? That is, a multi-millionare mom pays $1 million to keep her preemie alive. Then, the feds find out and she, the doc and hospital officials all get the cuffs slapped on and sent to jail!
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Old 07-22-2009, 02:09 PM   #23
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Sounds a lot like a cross between Soylent Green and Logan's Run - with Jack Kevorkian as "The Decider"

Section 1233 of H.R. 3200. The section, titled “Advanced Care Planning Consultation” requires senior citizens to meet at least every 5 years with a doctor or nurse practititioner for End of Life counseling.

Seriously, do you really want bureaucrats deciding who should live and who should die based on economics? You know the rich will still get the care they need and the poor will die. That's the way it's always been and that's the way it will always be.

You can forget about being a centenarian, heck, you probably can forget about being an octogenarian. Watch Logan's Run if you want to see what really happens when health care is rationed.
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Old 07-22-2009, 02:18 PM   #24
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More scary words. The conversation is only interesting with substance. What is so wrong with having end of life counseling? So many are unprepared and leave their families unprepared.
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Old 07-22-2009, 02:19 PM   #25
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And even more interesting.......

If you could afford to private pay for disallowed treatments, should that be allowed or be considered illegal? That is, a multi-millionare mom pays $1 million to keep her preemie alive. Then, the feds find out and she, the doc and hospital officials all get the cuffs slapped on and sent to jail!
Why should it be illegal? Is there a good reason for it?
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Old 07-22-2009, 02:24 PM   #26
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Why should it be illegal? Is there a good reason for it?
Some people believe that health care is a basic human right and that all should receive it equally; that is, one shouldn't be able to "buy their way" into higher quality care or shorter waiting times. I think this is the concept behind the ban on individuals from seeking their own paid-out health care (and is one reason why some wealthy Canadians and Europeans come to the U.S. for treatment, as I understand it).

That's how I've heard it rationalized, anyway.
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Old 07-22-2009, 03:35 PM   #27
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There is nothing wrong with end of life counseling for people in a hospice or those that have terminal diseases. Under the current proposed legislation, the government will determine who gets counseling and when (as well as resultant healthcare). Our President has made it very clear that he doesn't see why people "linger" so long at great expense to the rest of us. The issue is whether the government should even be in that business.

Mandating equal health care for all is a very nice, socialistic dream. The only way it's possible is to ration what is available - so everyone is treated equally - poorly. I am not aware of any nation that has scoialized medicine that prevents (or criminalizes) people able to pay from seeking more care than they can get from the government.

The fact is that we are not all equal - or, as George Orwell said, "some are more equal than others." Even the communists had those of privilege. Only a naive and utterly clueless leadership could postulate otherwise.
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Old 07-22-2009, 04:00 PM   #28
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There is nothing wrong with end of life counseling for people in a hospice or those that have terminal diseases. Under the current proposed legislation, the government will determine who gets counseling and when (as well as resultant healthcare). Our President has made it very clear that he doesn't see why people "linger" so long at great expense to the rest of us. The issue is whether the government should even be in that business.

Mandating equal health care for all is a very nice, socialistic dream. The only way it's possible is to ration what is available - so everyone is treated equally - poorly. I am not aware of any nation that has scoialized medicine that prevents (or criminalizes) people able to pay from seeking more care than they can get from the government.

The fact is that we are not all equal - or, as George Orwell said, "some are more equal than others." Even the communists had those of privilege. Only a naive and utterly clueless leadership could postulate otherwise.
'

I am not a socialist. I don't want government to own the means of production. I wouldn't mind government acting as the payor for health care as the insurance model has not worked and the administration costs are way out of line. That isn't socialism. Medicare isn't socialism. But we aren't going to get medicare for all so we have to figure out a compromise. One thing we can do to improve the compromises being discussed is to work on improving medicare and the compensation system.

Our costs are higher than any other country. Many remain uninsured. Our system doesn't work. Costs are getting higher and higher, far outpacing inflation for years.

I see no reason to criminalize people for buying what they want to buy for health care and I seriously doubt any program will provide that. Heck, we will be lucky to get a federal option, much less a federal mandate.

As far as equally poor health care, what is your evidence for that? Ask people in other countries like Canada, France, Japan, Scandinavia, Australia, what they think of their system and whether they would trade it for ours. Look at Germany wait times, they are shorter than our wait times. Look at our emergency departments and compare them to other countries. They don't want our system.

We have rationing now. It is based on whether you are a have or a have not. I think that isn't right. What people are starting to realize is that they can slip into the have not category. Such as if they lose a job and can't buy insurance or their small employer drops health insurance.

I think we are equal enough in the US to be able to provide a mechanism to pay for health care for everyone. People shouldn't die because they can't pay. Now they do.

End of life counseling is appropriate. And not just if you are in a hospice. I have seen too many people and their families unprepared for what to do when things get hopeless. Requiring this as part of medicare is hardly pulling the plug or euthanizing people.
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Old 07-22-2009, 04:37 PM   #29
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We've got some current government-provided medical care in this country (the VA system and DoD health care). The stats on their performance are available, and some people hold up the VA as a model of efficiency. I wonder why proponents of a government system don't cite these programs more often as successes. I think I know the answer, but I'm not sure.

And we also have a huge example of a single-payer plan--Medicare. The system is there for anyone to see. Now, we'd have to imagine it with far fewer resources (since there'd be no cost-shifting of the approx 20% underpayments to privately insured patients once private insurance goes away.) If Medicare is the gold-standard of cost reduction and superior care, I wonder why the whole US isn't clamoring for care like that.

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'
Ask people in other countries like Canada, France, Japan, Scandinavia, Australia, what they think of their system and whether they would trade it for ours.
Can we assume that people in these countries really know about our system? They hear what the press (and Michael Moore) tell them. I imagine it does sound scary: "In the US you are responsible for providing your own medical care. You have to find a job that offers medical insurance or pay high rates as an individual. Only the poor and the old get care provided for them." That would be pretty scary for someone who believed health care was some sort of "right." Citizens of these countries probably can't imagine that most people here like the care they get. And just like the citizens in these countries, most Americans apparently don't want to swap the system they have for systems as they have in these other countries.

We definitely need to improve our system, but we should recognize that it will be very easy for us to us to end up with one that is more expensive and less effective than the one we have now. For example, the GAO says the current system dreamed up by Congress is much more expensive than the one we've got.

I think many citizens in countries with socialized medicine will like their plans a lot less if the US also adopts such a plan and the trickle-down of pharmaceutical/medical advances from the US ends.
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Old 07-22-2009, 05:27 PM   #30
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I'll support any health care reform package passed by Congress, no questions asked- if they and their families are included and bound by it. Under the provision to abolish alternate private plans, we should be able to quickly phase out the current Congressional health care plan- in favor of the new and improved version...
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Old 07-22-2009, 05:32 PM   #31
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I'll support any health care reform package passed by Congress, no questions asked- if they and their families are included and bound by it. Under the provision to abolish alternate private plans, we should be able to quickly phase out the current Congressional health care plan- in favor of the new and improved version...
I will put a bottle of bubbly to chill and we can all get together and pop the cork when that happens!
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Old 07-22-2009, 05:35 PM   #32
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I'll support any health care reform package passed by Congress, no questions asked- if they and their families are included and bound by it. Under the provision to abolish alternate private plans, we should be able to quickly phase out the current Congressional health care plan- in favor of the new and improved version...
Do you have a link to the congressional health care plan?
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Old 07-22-2009, 06:18 PM   #33
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I would think that a "gatekeeper" would have to determine the probability of a good outcome from the treatment.

Someone with a 20% chance of being "saved" with a $1 million price tag might be allowed treatment whereas someone with a 1% chance seeking a $500,000 treatment might not be.

And even in cases which are 100% terminal, when talking about treatments which could extend lives, you'd need to factor in at least three things: (a) the cost of the treatment, (b) the length of time we're talking about, and (c) the likely quality of that extra time.
You forgot one thing, and possibly the most important- is the patient a member of a politically favored group?

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Old 07-22-2009, 06:20 PM   #34
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Tonights address by the President should be very interesting. I heard on talk radio today that some of the very questions posed on this thread will likely be asked, like will congress and all government employes be included. If I like my current plan can I keep it as you promised or will it automatically be cancelled if the plan sponsor changes any terms, coverages or premiums? I can't wait to hear it. But then again, what you hear may not be what you get. I find the government telling more and more untruths. I'm quickly losing my faith in the honesty of this administration. One good question I heard today was why are we in such a rush to pass this bill when most of it won't take effect until 2013. Most of congress hasn't read the bill which is normal I suppose. One reason for the rush is the longer it hangs around the more people can shoot holes in the bill and they surely don't a lot of questions asked.
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Old 07-22-2009, 06:23 PM   #35
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Ask people in other countries like Canada, France, Japan, Scandinavia, Australia, what they think of their system and whether they would trade it for ours. Look at Germany wait times, they are shorter than our wait times. Look at our emergency departments and compare them to other countries. They don't want our system.

No matter how well their systems work, in a million years we will not get one. As a political process we seem to be uniquely snakebit when it comes to doing anything sensible.

PS: whatever the President, or Mrs Pelosi, or anyone else says, they lie.

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Old 07-22-2009, 06:52 PM   #36
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"Do you have a link to the congressional health care plan?"

Congress and all federal employees are covered by the Federal Employees Health Benefit Plan. Here is a link to it: OPM-Federal Employees Health Benefits Plan Home Page

It is, by far, one of the best available systems in the US and would be an excellent model for coverage. With one exception - it costs the employee and the government a heck of a lot of money. Blue Cross Blue Shield for a family runs the employee $350 a month and the government about another $1,000. The government pays 75% of most plan premiums, the employee 25%. Some of the plans cost more, some less - depends on what you consider important. There are several million people under the plan. The biggest complaint of people coming into the goverment from industry is "What?? You have to pay for your coverage?" The company I work for has cheaper and better coverage, BUT, you can't carry it into retirement.

It would be far more efficient to model the single payer plan on FEHB, except for the fact that it would bankrupt the US. That's the problem - FEHB is an employee benefit, not a freebie. If everyone were to have such coverage, then you would need to have rationing to keep costs down. And rationing of health care is, without question, socialized medicine. Single payer by itself is not - but once you have half the population not paying, you have a huge income redistribution and that's socialism. Half the people in the US don't pay any taxes now - let's give them free health care to boot - and have an ever diminishing middle and upper class pay the bill.

Why bother working or paying for insurance? If the government provides everything, may as well just sit home and collect. Oh, I forgot, sooner or later, you run out of rich people - and rich will be defined as anyone who actually is dumb enough to work.

Most people will gladly take something for nothing and then be very upset when you try to take that benefit away. Just human nature.
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Old 07-22-2009, 07:17 PM   #37
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You forgot one thing, and possibly the most important- is the patient a member of a politically favored group?

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Yes Ha, this is essential and for anyone who wonders what I refer to compare the stimulus awards over the red/blue state and county map.
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Old 07-22-2009, 07:22 PM   #38
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It would be far more efficient to model the single payer plan on FEHB, except for the fact that it would bankrupt the US. That's the problem - FEHB is an employee benefit, not a freebie. If everyone were to have such coverage, then you would need to have rationing to keep costs down. And rationing of health care is, without question, socialized medicine.
Deciding what the government will pay for, what you call rationing, is not socialism by any definition. It might be something you are concerned about, but it isn't socialism.
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Old 07-22-2009, 07:32 PM   #39
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Many of the following mailboxes are full. I did leave a message for Harry Reid. With the Cap & Trade costs estimated at $3100 annually per household (mine will be more due to sq footage of home) and more sudsidation of healthcare for able bodied lower wage workers I will have to sell my home. I can not afford this administrations grandiose plans for wealth re-distribution. Can you?
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Old 07-22-2009, 07:52 PM   #40
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Tonights address by the President should be very interesting. I heard on talk radio today that some of the very questions posed on this thread will likely be asked, like will congress and all government employes be included.
At 47 minutes after the hour, he said (in more words) NO.

He did say that the public plans are "more like the Federal Employees plan", but he did not say they would use the same plan.

I hope to find a transcript later...

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