January 04, 2006

• This entire story is nothing but a troll. An attempt to distract and confuse those who are compassionate enough to be concerned about such things. As horrible an example of the depths of human behaviour as this is, it pales so in comparison to the other tragedies that occur daily in America that it should not absorb a disproportionate amount of our energy. This tragic woman had some last few days, weeks of life snatched from her, but every day Americans lose years, decades, dying because they could not pay the toll to have their very curable diseases addressed. Children born into poverty and poor social conditions lose entire lifetimes because there is no one to address their basic needs of stability and education. This was a tragedy and worthy reminder of the truths of America's 'health' system, but as a news story it merely serves as a distraction from the larger concerns.
• By technical definitions it may be a troll. However, it also accurately represents the contemporary face of "compassionate conservatism". Unfortunately, most people I know who consider themselves "compassionate conservatives" have no concept of with whom exactly they make alignments.
• Let me clarify that I'm not accusing the MoFi post of being a troll, but rather the existence of this case as a news story.
• I too am jumping on Nal's clarification bandwagon.
• The whole article is totally off base from a medical perspective. I care for patients who have cancer and patients on ventilators on a daily basis, and the reality is that the measures we use, often quite futilely, to keep people's hearts beating amount to nothing other than prolonged torture. Being on a ventilator and conscious is not fun. That's why most people in respiratory failure require nearly around the clock sedation while intubated. Oh also, late-stage metastatic cancer -- not exactly pleasant. To write articles like this, with no real experience or frame of reference on the matter, particular spinning the subject for political ends, is disgusting, and I call bullshit. And if you want to complain that they were trying to save a buck (which I'm quite sure the people that ultimately had to make this decision did not), then you have absolutely no idea how costly our healthcare system is, how much a day in an ICU costs, and how incredibly misappropriated our healthcare dollars already are. Being judicious about futile care isn't just about saving a buck. It's a moral imperative.
• If somebody asked her whether she wanted to stay on the ventilator, and she said No, maybe I could see the argument that 15 minutes suffocating is a mercy. But I can't forget that George Bush signed the law allowing the indigent to be pulled off life support and later went apeshit about Terry Schiavo and the sanctity of life. A little consistency would be nice. We're so concerned about what the family of the brain-dead girl wants but we don't give a crap about what the conscious terminally ill cancer patient wants. Euthanasia please. I'd rather a good dose of morphine than a nice 15 minutes struggling to take a breath after my lungs no longer work right. Oh right, sanctity of life, no morphine for me. I'll have to make my own arrangements, and they'll be messier for my loved ones. Thanks compassionate conservatives. The guy who wrote the slate editorial missed the boat. He's presenting a false dichotomy, milk or ventilator support, when the real issue is when people should be allowed to die and how. I have no problem with money being a factor in triage. The state doesn't have unlimited resources for life support, and neither does my insurer or me. But $5 worth of morphine or $1000 plane ticket for Mom are trivial expenses for places that bring in $200 for an asprin and another $600 for somebody to watch you take it.
• I don't understand Nal's comment at all. How can a news story be a "troll"? I think it is an important story, at least to me. It certainly points out some ugly facts about how healthcare works in Texas. And there is also the question raised by KOS, as to why those who raised such a stink about Terry are so silent about Tirhas. It may be that the story we've heard so far isn't entirely factual, or doesn't properly report the hospital's side. Maybe we'll hear more details come up in subsequent articles. But I don't see how it can be considered a troll from a news perspective.
• I took Nal's comment to be referring to the front page link; frankly, I thought it was borderline trollish to post it (sorry guys) but I couldn't find anything better. Thanks for not going off on me. I posted the story because I think it helps to illuminate the gulf between the concocted Schiavo controversy, and the fact that this stuff goes on all the time. With conscious, cognizant patients, against their will.
• And if you want to complain that they were trying to save a buck ... then you have absolutely no idea how costly our healthcare system is Damn! I wish there were some sort of solution to this problem.. TPCQ: "Don't worry, Marge! The US health care system is second only to Canada.. Japan.. France.. Well, all of Europe. But you can thank your lucky stars we don't live in Paraguay!"
• Here are 2 news articles (via Google News search) CBS11 (Dallas) and WFAA (DFW). Not much detail. It does sound like there is a disagreement between the family and the hospital regarding how the hospital treated the family. Still have to wonder where the Terry supporters are.
• "it should not absorb a disproportionate amount of our energy" I'm not sure what would constitute a "sisproportionate amount of our energy", Nal, explain that. Should we just talk about it a little, talk about it but not write about it, forget about it, pretend it didn't happen? You got me on that, could you clarify please, how much SHOULD I care about this event? Or was that just an absurd statement in the first place? this country just sucks..... I'm gonna go see Narnia and forget about this...that ok with you, Nal?
• shit... "disproprotinate" although "sisproportionate" works for me too.
• Can someone explain the arguments against socialised medicine in the US? I read stuff here, and hear stories from my friends in the US, about how the lack of it cripples them. But assuming, please, that the ideas against socialised medicine are for the good, what's the reasoning? Why does the country burden itself like that?
• Rich people want the best healthcare, and socialized medicine would reduce their access to it. If I understand that particular argument correctly.
• That doesn't sound right to me. I think it's more a matter of not wanting to pay for someone else's healthcare, isn't it? That's ... that's ... communism!
• I think you might be simplifying the argument at its cost, petebest. Ultimately, rich people will be able to afford superior healthcare regardless of whether the US begins a Canadian or UK-style socialized medicine system or not. Though they would undoubtedly bear additional taxes in contributing to that system. Hence, their opposition. But it is not merely the rich who are against socialized medicine in the US -- the most powerful demographic segments in American society are generally against socialized medicine. A very large number of vocal and politically active seniors (the middle class-and up in the AARP-crowd) are dead-set against it (including my parents, who are lifelong left-of-center Democrats), and their opposition can be entirely summed up in two words: wait lists. Should my mother's knee finally give out, she considers eighteen week waits, twenty-four week waits, and longer, for assessment by a specialist and specialized treatment or surgery. Since these are generally "elective" surgeries, the socialized medicine systems in Canada and UK simply have longer waits for such treatments than for those fully insured in the US. Many old-school Union members are against socialized medicine for similar reasons. In the US, even to the present day, in some labor Unions (which are extremely politically powerful in their own right), the workers pay as little as $60/month for full insurance, where non-union members in the same company are paying $300 and more for the same coverage. There is also the "Bush Republican" effect and polity to consider in these matters. There is a significant group of people who vote ultimately against their long-term self-interest due to their ideology. Those people seem to believe that becoming rich is their birthright, and oppose socialized medicine for nebulous "tax" reasons. Small-government types oppose it also for tax reasons. Consider that in places like Canada and the UK, and in many parts of Europe, between the VAT and Income tax, it is not uncommon that the portion of a person's income subject to taxation exceeds 50%. Regardless of the additional services that may buy, Americans balk seriously when that magic number pops into their minds. Finally, a very large number of people who think about socialized medicine think it will be run like the DMV. While these arguments may or may not be correct or well-supported in the facts outside the US, these are some of the real reasons the public is generally opposed to socialized medicine, and socialized medicine proponents ignore or dismiss these concerns at their peril.
• Far as I understand it, the idea behind socialized medicine is that (theoretically speaking) it is the profit motive that drives innovation. Hence, pharmaceutical companies invent new drugs based upon the idea that they wioll profit from them, and thereby invest their billions in research. No potential for profit, no research, no new drugs. Same with other medical products, new techniques, people becoming doctors and excelling within their fields, specialization, &c. BUT with that, you also get profit maximization strategies; the insurance industry pays the freight (and keep in mind that health insurance companies are, overwhelmingly, the *least* profitable segments of the insurance industry), and so they demand control over costs and subsequent treatment. Thus, situations like this one. It is a flawed system, without a doubt. Changing to a socialized system will, I think, solve the lack of coverage issue - but would it have saved this person? I don't know. My understanding is that there are some significant limits to treatment under European systems (Europeans feel free to chime in, as I have no idea), so it seems like someone in a similar situation as Schiavo would never have gotten to this point under a socialized system, as the sort of care that got her to an artificially supported vegetative state would have been stopped long ago (true?). Anyway, that's the rub of it: eliminating the profit motive would decrease innovation and reduce continued advances in medicine. However, one cannot discount the benefits of universal coverage. To be honest, I have no idea what to do with the US health care system. There's a lot of suffering here that could be ameliorated, as well as emergency care that could be forestalled, by a socialized system. But then? there are huge costs (although, admittedly, there are now, too). I guess, to my mind, the equation is: are we willing to reduce innovation and assume costs to assure universal coverage? While I am generally of the opinion that less government is better government, I personally think that, overall, the benefits of universal coverage outweigh the detractions.
• I should also add that the very people who would most benefit from socialized medicine in the US are generally low-voter turnout types: The young and uninsured, the very poor and uninsured, and the very old, unhealthy, and uninsured all have very low turnout rates.
• re arguments against socialized medicine, there are multiple segments of the private sector built around "private" medicine in the u.s. turning medical care over to the government would remove the need for some of these organizations and push the burden of administration onto the state (federality). there is a healthcare business lobby that will fight against any moves toward universal healthcare. some interesting studies i read a long time ago (15 years), compared "total cost of healthcare" in the u.s. and canada, finding the latter to be more efficient mainly due to administration and liability insurance costs in the u.s. i've not read any recent studies so the relative efficiency may have changed.
• That's one aspect I forget: if the gov't controls healthcare, what recourse do you have when someone fungoes your appendectomy? I'm not saying that the answer is "none," but it's definitely something that'll need to be addressed.

• No potential for profit, no research, no new drugs. Same with other medical products, new techniques, people becoming doctors and excelling within their fields, specialization, &c.

  socialized medicine or universal healthcare do not necessarily imply a negation/reduction of the profit motive. patent legislation ensures that pharmaceutical companies will earn back the investments they make in research. doctors make a good living through western europe (and, i believe, in canada); excellence in one's field is something that is not driven only by the opportunity to profit. on preview: yes, there's an issue with responsibility if your medical procedure goes badly. however, part of the spiralling costs in the u.s. is to cover medical liability insurance. there's a compromise that has to be found here, i think.
• I think the supply-side "stifling of innovation" argument is a bit less compelling, Fes, for a couple reasons. Firstly, many major Pharmaceutical companies are headquartered or have very large research facilities in Europe, and the profit-motive is not only tolerated, but encouraged in a European-style medicine system. In the US, pharmaceutical prices are artificially high (for non-generics), and the FDA's "safe and effective" system also contributes to this problem: pharmaceutical companies are not required to prove that a new drug is MORE effective than a previous medication for the same illness... as a matter of fact, they are not even required to prove that they are EQUALLY effective. Just that they are safe and "effective," meaning quantitatively superior to placebo. I think the "stifling innovation" argument, though valid, is probably a bit less of a concern to the public than the issues I raised above. If the fully-insured could be convinced that they would see no degradation of their service, the tax-hawks could see a limited tax growth offset by measurable tax relief in such things as subsidies for Emergency care, more people will be pro-socialized medicine.
• I'll concede the point. Like I say, I am (guardedly) pro-socialized medicine. Like defense, it seems like one of the rather short list of hugely important things that the government ought to be involved in. The collaboration between govt and private enterprise has proved both costly and ineffective, so...? It comes back, once again, to concentrating the power in 535 easily bribable, arguably opportunistic neo-aristocrats. When vested interest can target sweet money at the exact right people, and the citizenry are relagated to the rather pallid and generalized power of the vote? Calculus not required to figure out who comes out on top.
• I don't think malpractice liability has anything to do with socialized medicine. Doctors in Canada are personally liable for their blunders, and carry considerable malpractice insurance as a result. In a socialized system, the government is not the health care provider, it is the health insurance carrier. Profit is still a factor, and I just need to drive by my doctor's house as evidence of that.
• The way Americans scream about taxation, though, I doubt seriously this'll happen anytime soon.
• excellence in one's field is something that is not driven only by the opportunity to profit. You uh . . . you ain't from aroun' here, are ya boy? *sput* *adjusts enormous belt buckle*
• I also lean toward supporting socialized medicine. However, the thing that I would worry about in a socialized healthcare atmosphere in the US would be that whenever a certain proceedure becomes politically inexpedient or unpopular it would become nearly impossible to get. If the government would be the insurance provider, they could choose not to cover anything they find to be "immoral," thus leaving many without access(1). I understand that there will be private clinics and private insurance, but I would think that the majority of docs would work in a state-funded facility and would be trained to perform the most common proceedures(2). I guess I just worry that this system would be put into place to cover everyone, including the poor, and that the poor would continue to lack access to certain proceedures just because some politicians want to look good to their voters -- I worry that this could make the system more vulnerable to politics, maybe. (1)I am thinking of abortion or the availability of birth control, here, but hopefully my comment won't derail the thread into a discussion of just those, and I think this can be extended into many different proceedures or drugs. (2) Again, this is already happening -- most general practitioner and OB/GYN docs do not learn how to perform abortions; some because of their own value systems, but most because that training is simply not available at their medical school (probably because of the value systems of the head of that school or because the school doesn't want to be open to the political debate). Yeah. Footnotes. I am *such* a frickin' dork.
• MCT: I don't think Americans are so stinkified about taxes per se as they are about the rather ostentatious waste of their tax dollars by Congress. I think that if people were assured that their taxes were going toward paying for healthcare/defense/justice/other important, worthwhile items, you'd find a lot less strident anti-tax predisposition. But instead, we get things like bridges to nowhere, &c. And while we are a bit fatigued as to what to do about it, those porky lessons are not wasted on the American public. For every dollar of waste, not only is there a dollar NOT going to something important, but there's another uncounted number of dollars that people are withholding (legally and illegally) from their taxes, on the assumption that it'll just get wasted too.
• > I don't think malpractice liability has anything to do with socialized medicine. Doctors in Canada are personally liable for their blunders, and carry considerable malpractice insurance as a result. i don't know about the rest of canada, but the bmj indicates that in ontario the state pays 70% of insurance premiums and the cmpa pays the rest through member contributions. the article is five years old, however.
• I'm skeptical about the loss of innovation, considering that a great deal of research is not done by pharmaceutical companies, but by university researchers, who do not do it for money (prestige among colleagues, maybe, but not money). I used to know someone who invented a new form of fake cartilage when she was a graduate student; she saw no profit from it (and actually had to leave that particular field of research due to her own arthritis). Pharmaceutical companies do give funding to this research, but so do the universities, and in the US, the government gives a great deal (many biologist grad students I know are on government funding). However, the pharmaceutical companies receive the vast majority of the profit from this non-profit research. It's a subsidy to them. As for costs and quality of care: right now, the US is spending (private and public) about twice as much as Canada per person for health care. The health outcomes, however, are not as good. Infant mortality is higher and life expectency is shorter. A large minority of the population is not insured, but an even larger minority are inadequately insured (covered for emergencies, but not for preventative care). And this is in a country which isn't as rural as Canada (higher costs of provision for distance), and which has a lower percentage of recent immigrants. Having been on Canadian public health care, and on a good American health care plan (university with teaching hospital), I am equally skeptical of the "loss of quality" arguments for insured people. A few specific proceedures like hip and knee replacements aside*, the American care I have received was no better than the Canadian (and for a couple of friends, actually worse). *These are a problem the Canadian health care system is very well aware of. I used to work at a research unit (funded by the Ontario Min of Health) which studied hip and knee replacement and wait times. About the link: this is a frightening trend. I understand the balance needed between heroic measures and costs, but it does seem to suggest that the meaning of life in the US is determined by your wealth.
• I wouldn't say taxation is a bad thing (less is better, obviously), but rather the stupid, useless crap that it gets spent on. Umpteen billion to eradicate WMDs in Iraq which is suddenly re-purposed into fighting terra and defending democracy? A coupla billion here and there to build weapon platforms named after a 70's sci-fi movie? It would be nice if we could vote with our tax dollars. Perhaps a fixed percentage goes to some defense and other basic stuff, then the rest could be allocated as voter's choice. You can bet I'd be dumping my dollars to providing medical care and space travel. We need a way of providing a level of basic medical care across the board. The rich can have their uber-expensive botox treatments, some of us just want to survive.
• Waiting for healthcare seems like a much better option than not getting it at all.
• MCT: I don't think Americans are so stinkified about taxes per se as they are about the rather ostentatious waste of their tax dollars by Congress. What I've seen is a good mix of both. For instance, Mrs. Tool and I briefly lived in Nashville, TN, which has no state income tax. There was a budget crisis that led to the discussion of instituting one and simultaneously lowering sales and other taxes. Even though study after study revealed that low-to-mid-income families would pay roughly the same amount or less, there were loud (and nearly violent) demonstrations outside the capitol for weeks. Most of those who demonstrated were blue-collar, because their perception was that this was yet another tax to stick it to the little guy. I've seen numerous examples of the same here in Arkansas, which historically has ranked 49th or 50th in terms of average per capita tax burden (tax revenue is literally the only reason hard liquor sales were legalized here, because FDR threatened to pull federal funds if the state didn't raise taxes). In principle, people say they'd be willing to pay taxes if they knew the money was going to a good cause, but if you start talking 20% sales taxes to pay for national healthcare, even many of those who would be coming out financially ahead on the deal would start screaming about bloated government, "tax and spend," etc.
• people say they'd be willing to pay taxes if they knew the money was going to a good cause Part of the problem is that "the good cause" definition is pretty self-centered, ie., why should my money buy healthcare for some stinking drunk in some state where I wasn't aware that people actually lived? As a general rule, we're pretty selfish, ya' know?
• Can someone explain the arguments against socialised medicine in the US? It's not difficult. Most people in the US have very good health insurance, and some of them are afraid that they'd have less care or lower-quality care under a socialized regime. That doesn't mean that they're right, of course. I think they're wrong.
• Also note use of the word "socialized." Which to a certain contingent in the US means "bunch of goddamn Commies."
• Well, back to the article that spawned this whole debate. How did the doctor who pulled the plug in this particularl situation rationalize his behaviour in light of his Hippocratic Oath? You know, the one the includes the phrase "I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone."
• I'd also slightly alter Xeny's comment from Most people in the US have very good health insurance to Everyone with money and political influence down through the middle class in the US has very good health insurance
• Well I can add that living in a society with socialized healthcare it ain't so great. Many people need beds that aren't getting them. People wait for treatment that could save the if they didn't have to wait 9 months to get it. If you go to the emergency room you could wait up to 8 hours. People catch the superbug, MRSA, from our HOSPITALS. Yeah, they go in to get something done and come out with a whole new problem. On the other hand going to the Hospital doesn't cost you a thing. I am going to buy private healthcare so if I get sick I can go to the private rich people hospitals. However, as I understand it our shit healthcare state is do to bad management. As I understand it the French have kick ass social healthcare.
• At least traditionally, sales taxes in the US are levied by state and local governments. There a big difference among states as to what they're levied on. In California, there are no taxes on edible grocery store items or take-out food, though you'll pay if you eat at a table in a restaurant. When I was last in New Jersey, there was no tax on clothing purchases (it sucked those New Yorkers right in to the designer clothing outlets located just across the river.) The federal government is pretty much limited to taxes on income and interstate commerce. Property taxes are also at the state/local level. In California, they were originally the source of funds for the school system, and we had what may bave been the best in the nation when I was growing up - you could make your way though school, including university, at little to no cost and relly learn. When I attended Berkeley in the late 50s/early 60s, I paid $300 per semester in fees. Then, Proposition 13 passed in the early 1970s. It stemmed from the burden placed on property owners with fixed incomes, and mandated that properties would not be re-assessed until they were sold. Over the next several years, our school systems became one of the worst in the nation, especially in rural communities. Even though the lottery was voted in to help make up the difference, most k-through-12 schools in my county repeatedly fail to meet minimal standards set by the state. And, can anyone tell me what Berkeley is now charging per semester - I'm pretty sure it's in the 5 figures, even for California residents? So, what did Prop-13 accomplish? Well, my mother has benefitted. The house she and my father bought in about 1958 for $12K, and made a few improvements to over the years, is still taxed at about $400 per year. She also owns several rentals bought in the 1960s, for which property taxes have stayed flat. And the schools churn out students who can't compete, and the streets are full of pot holes, and, and, and... Oops, sorry that was way off topic, but MCT suckered me in.
• Yeah, those darn waiting times that the US doesn't have. There's a long series of posts on US healthcare over here (this is the first one, see the LHS menu for links to the rest) and this study compares patient experiences over six different countries. The big problem with health insurance is adverse selection, which means private companies spend a lot of time and energy trying not to insure people. Bottom line: the US pays a lot more to get worse outcomes.
• > As I understand it the French have kick ass social healthcare. it's good, though perhaps not as good as sweden or finland. there is generally a ceiling on treatment costs paid for by the state, so a lot of companies offer employee medical insurance to "top up". the french health service does cost a lot - along with other welfare services - but it's a tax that i'm happy to pay for a decent service (unlike in ireland, where i felt i was paying quite a lot for very little in return). an impression i have (no data to back it up) is that france produces more doctors than britain or ireland, making access to qualified personnel easier and cheaper, even if performed privately. in recent years, a sort of "treatment tourism" has emerged with people traveling from britain to france to pay for procedures for which they would otherwise have to wait a long time. in some cases, the british national health service picks up the tab. i've seen this referred to as a "bruise cruise". all that said, nursing staff in france are neither treated nor paid very well.