Health Care Bill It's about Fire and Money

[Martha]

We are where we are on this list in part because of huge variability in quality in the US depending on where you are and who your are. McAllen Texas versus Rochester Minnesota. Insured versus uninsured.

Interestingly, I recently read that there is evidence that our elderly in the US have as good of outcomes on the average as elderly in other countries with national health care. Our elderly have national health care through medicare and the elderly poor are supplemented by medicaid.

I'm sorry, for the life of me I can't find the source of the statistic above.

 

[crazy connie]

One that gets me is the stat on cancer deaths in Canada. With all our air pollution and higher smoking rates, the Canadian Cancer death rate is 16% higher due to health care delay times and treatment limitations. Also think about Great Britain who denies breast cancer treatment for the women over age 60 I think it is.

 

[beowulf]

"Also think about Great Britain who denies breast cancer treatment for the women over age 60 I think it is."

Like I said, see the movie "Logan's Run." In England they also will not provide dialysis or other necessary life sustaining treatment once you reach a certain age (in some cases by putting you on a waiting list where you are expected to die before you will get treatment) . The tradeoff of health care for all, at least in that country, comes at the expense of the elderly ill. I'm not a fan of prolonging life at all costs, but I don't want the government making the decision for me. I had to pull the plug (literally by telling the Dr to turn off the respirator) on my mother after she had a major stroke at 89, but I knew she would not want to live that way - with no quality of life whatsoever.

 

[Martha]

One that gets me is the stat on cancer deaths in Canada. With all our air pollution and higher smoking rates, the Canadian Cancer death rate is 16% higher due to health care delay times and treatment limitations. Also think about Great Britain who denies breast cancer treatment for the women over age 60 I think it is.

I think your Canada number is misleading and likely incorrect.

Some research, now a few years old, indicates that Americans have the best chance of survival of five years for two of the five cancers that the researchers considered: breast cancer in women and prostate cancer. Cuba actually claims number 1 in breast cancer survival (but this is questioned by many), US number 2 and Canada number 3. Canada is not far behind the US. For prostate cancer, the US was number 1, Australia number 2 and Canada number 3.

The big problem is that US has huge variability which Canada does not have, for example white middle and upper class women do very well if they have breast cancer but poor black women do substantially worse. This is a big problem. It doesn't do much good to say to an uninsured person in the US that the US has the best breast cancer care in the US when it is not true for them. But yes, we do not want to slip either and given how much more money we spend on health care and the fact that leading edge drugs are often available here first, we do not need to slip in the treatment of these diseases. It isn't like we do everything bad.

My data is from an article in Lancet. I have also linked to an article that talks about survival rates and gives good grades to the US, as compared to Europe and Canada. Here I can link to more info: U.S. Cancer Care Is Number One - Brief Analysis #596

Some points from that article:

• For women, the average survival rate for all cancers is 61 percent in the United States, compared to 58 percent in Canada.
• For men, the average survival rate for all cancers is 57 percent in the United States, compared to 53 percent in Canada.

I do not look at the UK as a good model for health care delivery.

However, this stuff is really very muddy. Sometimes differences are due to how deaths are reported, is it postrate cancer or the heart attack that immediately caused the death? This wiki comparing Canada and the US gives a taste of how difficult it is to compare the outcomes on cancer: http://en.wikipedia.org/wiki/Canadian_and_American_health_care_systems_compared Note that some research shows better or as good outcomes for Canadians.

It is easier when countries have more dramatic differences.

 

[Martha]

Hey, I posted when I wasn't done and am forced to Galt once again.

More comparative information can be found on the Commonwealth Fund site:

Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care - The Commonwealth Fund

"Compared with five other nations—Australia, Canada, Germany, New Zealand, the United Kingdom—the U.S. health care system ranks last or next-to-last on five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives."

We need to see what we do right and well as what we do wrong and not lose what we do right in the process. Again, the data can be muddy but we nevertheless can learn from what others do right and wrong.

 

[JOHNNIE36]

Looking at the chart of life expectancies in all the countries got me to thinking (I know, that's dangerous). Everything has to be considered in life expectancies and I"ll bet that we have the highest death rate due to automobile accidents, murder and possibly suicide. That will skew the numbers Anyone out there willing to weigh in on stats? However, I also heard that we don't have a very good track record on infant mortality. Maybe I'm all wet.

 

[haha]

Some research, now a few years old, indicates that Americans have the best chance of survival of five years for two of the five cancers that the researchers considered: breast cancer in women and prostate cancer.

These 5 year survival rates can be misleading. Breast and prostate cancers are usually slow growing. The biggest influence on 5 year survival may have nothing to do with the ultimate survival rate, and much more with how young the tumor is when it is discovered. Imagine that something is going to kill you in 10 years. Your five year survival rate depends al ot of when that clock starts ticking. In America where we have vigorous screening for these two cancers especially, our 5 year survial rates might appear better than some country with less screening, while in actuality there is no difference as to length of life which is really what counts.

 

[Martha]

Right Ha, it is very hard to do an accurate comparison on cancer survival rates. When was it diagnosed? Was it diagnosed so early that odds of survival were high anyway? You have to compare all those things. I think that is the reason for the wide variability in statistics comparing the countries.

 

[crazy connie]

Looking at the chart of life expectancies in all the countries got me to thinking (I know, that's dangerous). Everything has to be considered in life expectancies and I"ll bet that we have the highest death rate due to automobile accidents, murder and possibly suicide. That will skew the numbers Anyone out there willing to weigh in on stats? However, I also heard that we don't have a very good track record on infant mortality. Maybe I'm all wet.

Johnnie,

On the infant mortality rate AFAIK other countries do not interceed near as much as we do with Mother Natures spontaneous abortions. We do our utmost with technology and medications to help mom's to deliver a live birth. That gives us the ultra-preemies which may or may not be a great thing. Here we put mom's to be on total bedrest and sometimes hospital care for weeks to deliver an ultra preemie weighing ounces that may spend months in a neo-natal unit costing several thousand dollars per day.

We are high on murder, but per mile driven our road deaths were in line when I saw a study a few years back. The suicide rate is higher in other places as well AFAIK.

 

[Martha]

Johnnie,

On the infant mortality rate AFAIK other countries do not interceed near as much as we do with Mother Natures spontaneous abortions. We do our utmost with technology and medications to help mom's to deliver a live birth. That gives us the ultra-preemies which may or may not be a great thing. Here we put mom's to be on total bedrest and sometimes hospital care for weeks to deliver an ultra preemie weighing ounces that may spend months in a neo-natal unit costing several thousand dollars per day.

We are high on murder, but per mile driven our road deaths were in line when I saw a study a few years back. The suicide rate is higher in other places as well AFAIK.

One thing that drives our infant mortality down is groups of people who are not getting proper care. But yes, it is another statistic that has to be looked at closely to make sure people are measuring the same thing. Your info on murder, highway accidents and suicide jibe with what I recall.

 

[Martha]

Homicide rates throughout the world: http://www.genevadeclaration.org/resources-armed-violence-report.html (Thank goodness I was not born Russian)

Here is an interesting stat on highway deaths: Report: Pedestrians and Cyclists Account for Almost Half of Traffic Deaths - washingtonpost.com

The US does pretty good, relatively, on highway fatalities:

I say relatively because:

[FONT=verdana,arial]The death toll on our highways makes driving the number one cause of death and injury for young people ages 5 to 27. Highway crashes cause 94 percent of all transportation fatalities and 99 percent of all transportation injuries, yet traffic safety programs receive only one percent of the funding of the U.S. DOT budget. The staggering loss of life and the incidence of life-threatening injuries occurring each year is best described as a public health crisis. According to a WHO report, "The Injury Pyramid," for every motor vehicle injury resulting in death in the US, 13 people sustain injuries severe enough to require hospitalization.[/FONT]

[FONT=verdana,arial]In the US DOT publication "The Economic Costs Of Motor Vehicle Crashes," [/FONT][FONT=Verdana,Arial] NHTSA[/FONT][FONT=verdana,arial] investigator Lawrence J. Blincoe reports that in 1994, motor vehicle crashes accounted for 40,676 fatalites, and 4,100,000 injuries (of which 533,000 or 13% were serious). The total lifetime cost to the US economy for automobile accidents that occured in 1994 was $150.5 billion. The 1996 [/FONT][FONT=Verdana,Arial] NHTSA[/FONT][FONT=verdana,arial] report "1996 Traffic Safety Facts" (pdf) came up with similar though somewhat improved statistics: 41,907 fatalities and 3,511,000 injuries, 456,430 of them serious. The 1997 [/FONT][FONT=Verdana,Arial] NHTSA[/FONT][FONT=verdana,arial] report "Traffic Safety Facts 1997" reports 41,967 fatalities and 3,399,000 injuries, 441,870 of them serious. The 1998 [/FONT][FONT=Verdana,Arial]NHTSA[/FONT][FONT=verdana,arial] report "Traffic Safety Facts 1998 Annual Report" reports 41,471 fatalities and 3,192,000 injuries, 414,960 of them serious.[/FONT]​

International Injury & Fatality Statistics



Kind of off the topic here, but it all has to do with public health. Hey, maybe we could save health care costs by reducing he speed limit to 55, banning cell phones and other distractions, and taking away all the guns!

Just riling up you libertarians.

 

[Gone4Good]

The biggest influence on 5 year survival may have nothing to do with the ultimate survival rate, and much more with how young the tumor is when it is discovered.

Whoops, thought you were saying something else. Never mind. Nothing to see here . . .

 

[Gone4Good]

I'm not a fan of prolonging life at all costs, but I don't want the government making the decision for me.

But part of the problem is NO ONE is making these decisions. We just spend for everything, the insurance company picks up the tab, and passes the cost along in ever increasing premiums. We're reaching the point where that is no longer affordable. As a result, the system is shedding coverage for millions of people in order to cope. So we end up with a system where an uninsured 20 year old doesn't get the cancer screening that could have provided him an extra 60 years of life but an insured 85 year old will get a pacemaker that might give him 5. It makes no sense.

"In defense of rationing" is a worthwhile read . . .
http://www.nytimes.com/2009/07/19/magazine/19healthcare-t.html?_r=1

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

If you can afford it, you probably would pay that much, or more, to live longer, even if your quality of life wasn’t going to be good. But suppose it’s not you with the cancer but a stranger covered by your health-insurance fund. If the insurer provides this man — and everyone else like him — with Sutent, your premiums will increase. Do you still think the drug is a good value? Suppose the treatment cost a million dollars. Would it be worth it then? Ten million? Is there any limit to how much you would want your insurer to pay for a drug that adds six months to someone’s life? If there is any point at which you say, “No, an extra six months isn’t worth that much,” then you think that health care should be rationed.

 

[beowulf]

"So we end up with a system where an uninsured 20 year old doesn't get the cancer screening that could have provided him an extra 60 years of life but an insured 85 year old will get a pacemaker that might give him 5. It makes no sense."

Sorry, but life isn't fair and everyone is not the same and does not get equal value out of life. What you are espousing is forced euthanasia - when the government makes a purposeful decision to deny care to people over a certain age to preserve money for those who are younger. In your model, an 80 year old Nobel prize winner who is still capable of great discoveries could be denied dialysis and left to die so a 20 year car thief who has been shot by the police can be saved. You're making it an age decision, not a quality of life or future value to society decision.

What about a 20 year old with Downes Syndrome with the emotional and intellectual level of a 5 year old? It it worth spending a lot of money to keep him alive when there is no productive future for society? It's not all black and white - there are thousands of shades of gray. It sounds real simple until you start looking at real people. Why allow children with debilating diseases or extremely poor prognosis for future good health, guaranteed to cost millions to keep alive, to even be born?

What incentive is there to do well and be successful if you know you can't get care when you need it, even if you can afford it? It seems to me that you are saying that everyone is equal in everything and that those with the longest to live, regardless of their potential, should get the greatest benefit. We have garbage men and we have nuclear physicists. They don't make the same contribution to society - should they get the same rewards?

Our current system needs lots and lots of work. Obamacare is not the answer.

BTW, the Peter Singer in the NYT article reference is not someone I would hang my hat on - here are some quotes from his works:

"sex with animals does not always involve cruelty" and that "mutually satisfying activities" of a sexual nature may sometimes occur between humans and animals"

"We may not want a child to start on life's uncertain voyage if the prospects are clouded. When this can be known at a very early stage in the voyage, we may still have a chance to make a fresh start. This means detaching ourselves from the infant who has been born, cutting ourselves free before the ties that have already begun to bind us to our child have become irresistible. Instead of going forward and putting all our effort into making the best of the situation, we can still say no, and start again from the beginning."

He also advocates that it's immoral for people in the US (and other Western countries) to live well when so many people elsewhere live poorly - so we should give up what we have to help them.

I have no idea what you call his philosophy, but he sure knows what's best for everyone (hint, hint - remind you of some others who believe the same thing?).

 

[crazy connie]

"BTW, the Peter Singer in the NYT article reference is not someone I would hang my hat on -

I just Googled and read up on this guy. It is amazing how low some of the elite schools can go to get faculty. Makes me glad I did not have the resources to send my kids to Princeton.

In my opinion his opinions do not count. I could get as good an education from the Dept of Corrections residents as anyone this arrogant. Highly educated people are frequently educated idiots. It's sad that the NY Times can not find better people to write for them.

 

[eridanus]

This thread has a lot of fear-mongering.

We pay more money and achieve the same or worse results than other "socialized" systems. There's money to be squeezed from the US health care system. "It's the prices, stupid."

 

[crazy connie]

This thread has a lot of fear-mongering."

I can agree with you on this point. We are following the lead of Potus and congress critters. The sky is gonna fall if we don't pass this today, this week, this month, this year, this term. Trust us you don't have time to read it let alone discuss or understand it! Just trust us/me so the sky doesn't fall and hit you on the head! After all there aren't any earmarks and I/we know what's best for you! It's only over 1,000 pages of crap I/we are telling you is great for you and your family and America and all the uninsured who need your money, healthcare, benefits more than you do.

I will believe and trust them only when they pay my bills. Since I know how to work and have saved that ain't gonna happen. So, they do not own me, my misplaced loyalty, or most important my vote. I will read, discuss and send my opinions in to them. They need to know what I want and do not want. If they screw this up badly, I will be a political activist getting my exercise by going door to door campaigning to get their removal. I will spend my monies to help candidates who oppose their foolish votes.

They don't read but they agreed, I made note and I will vote.

 

[eridanus]

I can agree with you on this point. We are following the lead of Potus and congress critters. The sky is gonna fall if we don't pass this today, this week, this month, this year, this term. Trust us you don't have time to read it let alone discuss or understand it! Just trust us/me so the sky doesn't fall and hit you on the head! After all there aren't any earmarks and I/we know what's best for you! It's only over 1,000 pages of crap I/we are telling you is great for you and your family and America and all the uninsured who need your money, healthcare, benefits more than you do.

Obama didn't have your vote anyway, right?

This isn't unusual. The Congresslings NEVER read large bills. You think they read all of the farm bill passed last year? No way. But you're right - they do need to spend more time. It's a complicated issue. Maybe that's what I'll write to my Congressman: Spend more time, get it right, and "I strongly favor universal access with no underwriting."

 

[crazy connie]

Obama didn't have your vote anyway, right?
"

My vote has always been secret and hopefully will remain that way!

I will admit that in the past it has been split on numerous occasions. By reviewing their records, stump and voting history I have tried to make informed decisions on the issues and the candidates. That is what my kids have been taught by me as well. Don't fall or vote for the cute candidate, promises, best ad campaign or single issue, if the values and history reflect otherwise. Needless to say my candidate does not win all the time at any level of government.

 

[Gone4Good]

What you are espousing is forced euthanasia -

Hardly. All I'm saying is that their should be some cost benefit analysis that goes into expenses that are collectively shared. Right now we've socialized the cost of medicine through private insurance. The exorbitant cost of providing heroic end of life care, no matter how dismal the odds, is currently paid for with other peoples money. If those people want to dig deep in their pockets and pay for that I could care less. But the way the system is set up right now, I'm forced to pay for these irrational decisions.

You're entire argument is based on the assumption that individuals are buying health care with their own money . . . in almost all cases, they aren't.

What about a 20 year old with Downes Syndrome with the emotional and intellectual level of a 5 year old?

Read the article.

What incentive is there to do well and be successful if you know you can't get care when you need it, even if you can afford it?

Who's saying anything about denying people the right to spend their own money however they see fit? If they can afford Michael Jackson's hyperbaric chamber so be it. But when you're spending other peoples money, those other people should have the right to say NO.

BTW, the Peter Singer in the NYT article reference is not someone I would hang my hat on - here are some quotes from his works: "sex with animals does not always involve cruelty"

Completely irrelevant to the strength or weakness of an argument that has nothing to do with sex with animals. By your logic Thomas Jefferson is not "someone we should hang our hats on" because he said things like this about African Americans . . .

"The improvement of the blacks in body and mind, in the first instance of their mixture with the whites, has been observed by every one, and proves that their inferiority is not the effect merely of their condition of life. "

 

[beowulf]

Hardly. All I'm saying is that their should be some cost benefit analysis that goes into expenses that are collectively shared. Right now we've socialized the cost of medicine through private insurance. The exorbitant cost of providing heroic end of life care, no matter how dismal the odds, is currently paid for with other peoples money. If those people want to dig deep in their pockets and pay for that I could care less. But the way the system is set up right now, I'm forced to pay for these irrational decisions."

Irrational until you or someone you love needs the care. And who defines what end of life care is heroic? For that matter, who decides when is the end of life? Some politicized bureaucratic body? For me, it's when there is no quality of life left and no hope for recovery. I had to authorize the removal of life support from my mother when she had a massive stroke at 89. I suppose they could have kept her alive for quite a while, but after 12 hours I could see that she would not want to live that way. I guarantee you won't want me making decisions for someone I'm not related to.

I did read the article, as well as his other works - he clearly favors termination of those who need more care than they are worth - in his humble opinion. By that standard, we would be no better than the Nazis getting rid of the mentally ill and handicapped.


"Completely irrelevant to the strength or weakness of an argument that has nothing to do with sex with animals. By your logic Thomas Jefferson is not "someone we should hang our hats on" because he said things like this about African Americans . . ."

TJ lived over 200 years ago and spoke in the vernacular of his time. This guy is speaking in 2009 and his views are bizarre - read some of his stuff - he makes NAMBLA look like the boy scouts.

I believe that most people in this country do not want the primary decision on their health care to be made by accountants. Does that mean it will cost more than it would otherwise - you betcha - the alternative is that you head down a slope where everything is counted - save the scientist - clearly far more valuable to society than the cabbie. Better hope you're at the top of the heap, not the bottom when you need care.

 

[Gone4Good]

Irrational until you or someone you love needs the care. And who defines what end of life care is heroic? For that matter, who decides when is the end of life? Some politicized bureaucratic body? For me, it's when there is no quality of life left and no hope for recovery.

Which is all well and good if you are personally paying for it. But that is not how our system works. If you're advocating moving to a system where people pay their own way for medical costs, fine. But I think you'll find an overwhelming number of people wouldn't support that because they simply can't afford the kind of care they get now. The alternative you seem to be arguing for is the right to spend unlimited amounts of other peoples money. I'm against that.

The other fact you overlook is that the "insurance bureaucrats" are making those choices now. What's the difference between an insurance company saying "we're not covering your hyperbaric chamber" and the government saying it?

TJ lived over 200 years ago and spoke in the vernacular of his time. This guy is speaking in 2009 and his views are bizarre - read some of his stuff - he makes NAMBLA look like the boy scouts.

Also irrelevant. My point was, and is, that you can't judge the merits of an argument by critiquing a completely different and unrelated argument - even when both are made by the same person.

I did read the article, as well as his other works - he clearly favors termination of those who need more care than they are worth - in his humble opinion. By that standard, we would be no better than the Nazis getting rid of the mentally ill and handicapped.

I sense we've come to the end of thoughtful discussion when the idea of applying a cost benefit analysis to medical spending is equated with Nazi extermination camps.

 

[beowulf]

"The other fact you overlook is that the "insurance bureaucrats" are making those choices now. What's the difference between an insurance company saying "we're not covering your hyperbaric chamber" and the government saying it?"

I'm not ignoring it, it's just a fact of life. What I don't want is for the situation to get worse, which it will with Obamacare and real rationing.

"Also irrelevant. My point was, and is, that you can't judge the merits of an argument by critiquing a completely different and unrelated argument - even when both are made by the same person."

Disagree completely - by your standard, it would be perfectly acceptable for me to quote Bernie Madoff for investment advice, as long as I could find a kernal of information I agreed with. When you do that, you render the entire arguement untenable.

"I sense we've come to the end of thoughtful discussion when the idea of applying a cost benefit analysis to medical spending is equated with Nazi extermination camps."

Not at all - my position, as well as many others, is that a society that ceases to care for it's most vulnerable citizens in the name of economics has lost its moral compass and has become unethical. Societies are judged by how well they care for those most in need. I'm not talking about racial, religious or other critieria, though they are just as important. You seem to think that using your money for anything you don't agree with is really terrible and must be stopped. Do you support public education if you send your kids to private school? Do you believe you should have to pay for public facilities you don't and never will use? If you oppose a particular military action, should you be exempt from taxes that fund it? The list goes on forever.

I won't engage you further, but I'll leave you with this paraphrased poem from Pastor Martin Neimoller (sorry, I can't figure out how to do an umlat over the o):

"In our country, they came first for those who were weakest, And I didn’t speak up because I wasn’t weak;

And then they came for the oldest, And I didn’t speak up because I wasn’t old;

And then they came for those were were sick, And I didn’t speak up because I wasn’t sick;

And then... they came for me... And by that time there was no one left to speak up."

Some day you may be in one of those groups you don't want to spend your money on now. Who will you go to then?

 

[Martha]

Restonham, I speak up for the weakest, who are screwed by our system. Or lack of a system. Are you going to speak up for them?

Using words like "Obamacare" doesn't make sense because there is no such thing. He is still negotiating with our representatives and senators.

So Restonham, what would you do? Do you think it is fine the way it is? Did you hear the Texas governor say let the states handle the problem and the feds should butt out? Interesting as his state can't handle the problem, with the highest percentage uninsured of any state at about 25%.

How would you address the problem of out of control costs? How would you address the problem that small employers are facing, having to cut health insurance because they can't afford it? Do you think that it is rationing to deny payment for certain unproven treatments? As Years said, that already occurs. You do realize that there is a fair amount of unnecessary care out there, don't you?

BTW, I am encouraged that there is some movement on medicare reform and how providers are compensated.

 

[Gone4Good]

Not at all - my position, as well as many others, is that a society that ceases to care for it's most vulnerable citizens in the name of economics has lost its moral compass and has become unethical.

So we're in agreement on the desirability of universal health care.

You seem to think that using your money for anything you don't agree with is really terrible and must be stopped.

Nope. Just that there are, and should be, limits. Even on the value of a human life.

Besides, we make these decisions every single day . . . and it's not a holocaust. You don't think automobile companies know precisely how much a human life is worth, either in terms of how much we, as consumers, are willing to pay for a safer automobile or how much the company is likely to lose in wrongful death lawsuits? You don't think automobiles are engineered to deliver precisely that level of safety and no more? Companies, and their government regulators, are fully aware that more people are going to be maimed and killed in automobile accidents than is absolutely necessary but they've made a cost benefit analysis and put a value on human life that we all live and die with every day.