The moral, financial dilemma at the heart of health care
If such a thing were possible, it would be useful to set aside partisan sentiments for a few minutes to discuss profound questions about life and death, the obligations that we have to each other as human beings and the morally difficult choices that technology increasingly forces upon us.
Let’s begin with a new report from the nonprofit National Institute for Health Care Management Foundation. It reports that Americans “spent nearly $2.5 trillion on health care in 2009, reaching an all-time high of $8,086 per person. This per-capita spending represents an almost two-fold increase since 1997.”
Those numbers, while startling in one sense, pretty much confirm what most of us already knew. But here’s where things get more sticky:
“Spending is highly concentrated among a relatively small portion of high-cost users, with just 5 percent of the population responsible for almost 50 percent of all (health care)spending. At the other end, half of the population accounts for just 3 percent of spending.”
The tricky part, of course, is how quickly and unexpectedly any one of us can jump from one category to another. You can go for decades as part of the 50 percent that consumes just 3 percent of spending, and with one diagnosis or accident suddenly become part of that 5 percent that consumes almost 50 percent of the health care dollar.
In fact, absent sudden death by accident or heart attack, most of us will at some point make that transition from the 50 percent to the 5 percent, as will our loved ones. It is the human condition.
I feel a chart coming on.
The healthiest 50 percent of Americans account for just 3 pennies of every health-care dollar spent, while the sickest 5 percent account for 50 cents of every dollar spent on health care.
———————————
Now let’s move from the statistical to the actual. The New York Times reports today on three new drugs developed to treat late-stage prostate cancer. The drugs do not cure the cancer, but they do prolong the lives of those afflicted.
Without the drugs, men with late-stage prostate cancer have a median life expectancy of a year and a half. With the new drugs, that can be extended by roughly six months, with a decent quality of life.
However, as the Times reports:
” … the price of these drugs has already stirred concerns about the costs of care among patients, providers and insurers. For example, Provenge costs $93,000 for a course of treatment, while Zytiga costs about $5,000 a month. Another of the new drugs, Sanofi’s Jevtana, costs about $8,000 every three weeks.
With other pricey drugs on the way, said Joel Sendek, an analyst at Lazard, “We could be talking easily $500,000 per patient or more over the course of therapy, which I don’t think the system can afford, especially since 80 percent of the patients are on Medicare.”
Medicare has been conducting a year-long review of Provenge, and is expected to announce on Thursday that it will cover the drug. Private insurers are expected to follow that lead. But as the Times reports, the fact that Medicare even decided to study the question became a point of controversy. “Medicare officials denied that price was the reason for the review,” the story reports. “But some patient advocates and politicians portrayed the review as a step toward rationing.”
So there’s the situation. Those men with sufficient financial resources can of course make their own decision about whether to spend $500,000 for another six months of life. But what about the rest of us? Is that an acceptable use of taxpayer money and health-insurance premiums?
And if it isn’t acceptable, what mechanism should we create to make such difficult decisions on our behalf?
I’m not looking for partisan rhetoric or bumper-sticker responses here. These are decisions that we as a society and a nation have to confront. At what point, if any, do we decide that the marginal gain in lifespan is no longer worth the investment?
Who makes that decision? And on what basis?
– Jay Bookman
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486 comments Add your comment
poison pen
June 28th, 2011
10:44 am
USinUK, I would think it was harder at 27.
ByteMe
June 28th, 2011
10:45 am
And Obama showed his cowardly ways
Did I just hear a gurgle, LWM?
Douglas
June 28th, 2011
10:46 am
Many are deriding the profit motive in health care. Why do you think most all of the new drugs and procedures are coming from the U.S.? I submit that it’s because of the profit motive. The countries with govt health care sit back and ride on the health care innovations/discoveries/drugs etc from the U.S. that are a direct result of the profit motive. Remove the profit motive and watch it all dry up.
Left wing management
June 28th, 2011
10:47 am
ByteMe, when I gurgle, my breath suddenly smells minty.
carlosgvv
June 28th, 2011
10:47 am
DEA
Maybe you can explain to all us “lefty fools” why drugs cost so much more in America than in other industrialized Western countries.
SOUTHERN ATL
June 28th, 2011
10:48 am
There is a difference in creating the laws (regulations) and owning the patent. I am sure that the pharmaceutical companies have their own concepts on how they price the drugs.
josef
June 28th, 2011
10:48 am
Not to be too sanguine here, but a good part of “the problem” has to do with the fact that our scientific advancement in the treating of “fatal” conditions has outpaced our social ability to adjust. What a scant generation ago would have been a death sentence diagnosis is today something that can be interdicted with a series of treatments and then brought under control through medications with an extension of both quality and quantity of life expectancy. Others not so much so.
As is the human condition, we look for a miracle. The medical and pharmaceutical professions have, to a great extent, replaced the priest and shaman in the miracle worker business, cheerfully adopting the term “miracle drug,” and, however much it may apply to this, that or the other treatment, to the popular ear it comes across that there is a miracle for whatever ails you and if there’s not, there soon will be. Just hang on.
Professional ethics and really good manners prohibit the care giver from being truthfully honest. They don’t want to say bluntly and forthrightly, “you’re on your way out, Pombo. It’s not going to be pretty and you’re going to suffer. There’s not a lot we can do. Get your paperwork together and enjoy what little time you’ve got left. And I’ll write you a perscription for…”
It helps if you have the medical professionals in the family or as close friends you can trust. When the boys’ mama was dying, I was privy to a few of her and Unmentionable’s conversations. Sure, they were both wanting a miracle, but there wasn’t one and it was up to him to tell her, point blank and no candy-covering. Later, when it was his brother, it was different. His own condition was such that there was some hope of prolonging the inevitable, to a degree “a miracle.” But in the end, he had to tell him, “time to go R. The best you can hope for is a few more weeks and it won’t be fun..here’s what you can expect…”
Keep Up the Good Fight!
June 28th, 2011
10:51 am
There are a lot of posters today with some difficult personal issues. To each of you I express my sorrow to read of your troubles and difficulties. Some I can relate to directly some only indirectly.
As for the comments of the those who cannot let go of their own personal need to attack with inane comments, their ignorance and in some cases, their inability to comprehend the human nature of compassion.
arnold
June 28th, 2011
10:51 am
I have been treated for prostate cancer. It was caught fairly early and it has been over five years since treatment. Should it return, I would opt out of any of the extra treatments. Especially when the cost is compared to the benefit.
Also, I’m not sure what the doctors are saying when they say the quality of life is acceptable. My younger sister recently passed away from colon cancer. The side effects from her treatment were not, in my opinion, acceptable.
I have every intention of refusing further treatment should my cancer reoccur. I will opt for paliative care.
Really
June 28th, 2011
10:51 am
Under Obozo Care it would be a bunch of bureaucrats making that decision for me, so far I don’t think the bureaucrats are capable of making a rational decision. Why would any sane person put their life’s decisions in the hands of our government?
RedEye
June 28th, 2011
10:52 am
carl,
you answer lies in Douglas’s 10:46 post
Southern ATL,
yes the pharm compaines own the patent, but the gov mandates they have one for 20 years (12 years in the HCR bill)..and yes the price their own drugs, but the gov is responible for creating this environment
but thats how it goes, doesn’t it? the gov creates a problem, and then gov creates a solution to that problem
AmVet
June 28th, 2011
10:54 am
For the most part, really good stuff. Then there was that third 10:06 and that 10:22.
Which were useless.
No easy answers on this one. And the rpersonal stories reflect jus 6thow difficult this scenario is in human terms.
For arguments sake we’re asked to believe the absolutist hypothetical that these treatments only extend life for six months. What if it really were 12 or 15 or….?
Would that change someone’s mind?
And admittedly, these drugs do not treat the cause, just the symptoms.
Which is why I find beyond barbaric that we still haven’t fully legalized and promoted marijuana.
Super cheap and very effective for lots of people in end of life conditions. Without the devastating side-effects of many of these legalized poisons.
Why? because BIG pharma gets away with bilking Uncle Sam while WAY too many of the right wing prohibitionists are still living some Reefer Madness movie…
Redneck Convert (R--and proud of it)
June 28th, 2011
10:57 am
Well, I’m all for getting as cheap as I can with the healthcare of other people. If they’re sick and it costs alot to treat, let them go make their Maker. If Heaven’s as nice as they say they ought to thank me for letting them get there faster.
Now if it’s me, the sky’s the limit. My life is worth alot more than anybody else’s. So let it all hang out. Bring in every Dr. and every expensive medicine you got.
That’s the Conservative point of view and it’s the right point of view. It’s why we hate Obamacare. Heck with everybody else. I might could say a prayer for them at church on Sunday, but stay out of my wallet. If they get sick it’s because they made Bad Choices and they need to take Personal Responsibility.
Have a good day everybody.
independent thinker
June 28th, 2011
10:57 am
How much money and how much increase in drug sales did Big Pharma make from Bush’s Medicare vote buying scheme where he gave away free drugs with no funding? Is that why we have all those insane and immorral advertisements on TV? Why is big Pharma not providing generics to Medicare at greatly reduced prices like the VA?? Our system is broken by all these unfunded vote buying schemes that make it look like politcians are concerned about health care when all they are doing is buying votes and helping Big Pharma and other profit making suppliers. We need to get a grip like the VA does on how to provide quality care within limits at a lower cost to as many as possible. If you are a veteran you can always go private care. Otherwise shut up and wait in line.
They provided hundreds of thousands of dollars in heart surgery and extended care care to my father before he died and the wait at times was terrrible but the care was excellent and he hardly paid a dime as a disabled WW II vet. Now there were limits on what they could oir would do in his final days.. Most Americans do not get those opportunities because the system is broken or they expect something extravagant at no cost when the government is paying and they sit on granny’s
dollars hoping they inherit it all.
USinUK
June 28th, 2011
10:58 am
“Instead he let the media attack Palin for him, and ridiculed her himself.”
BS – what he did was point out the hypocrisy of the same people who were leading the FearMongeringBrigade were the same people who were advocating for end-of-life counseling in a provision a couple of years earlier.
http://www.politico.com/news/stories/0809/26149.html
redneckbluedog
June 28th, 2011
10:58 am
It’s not about the health care…it’s about the socialism…Socialism is not as great as capitalism, but it’s a hell of a lot better than communism, oligarchy, facsicm, and/or other third-world dictatorships….When people realize this and what not raising the debt-ceiling would do this country. socialism looks like a freakin’ vacation…!!!!!
USinUK
June 28th, 2011
10:59 am
poison – no matter how you slice it, it’s never good.
finn mccool
June 28th, 2011
11:00 am
I have to agree with mountain man at 9:15. We need to get better at preventive maintenance – that will lower our costs. Require everyone to get an annual checkup and if you can’t show you did this when the cancer does surface, you don’t get to use public money for treatment.
USinUK
June 28th, 2011
11:00 am
““Maybe the government can work out a deal with whoever owns the patent!!””
good grief. I misread that as “whoever owns the patient”
then, I realized that’s just as accurate when talking about the question.
Aquagirl
June 28th, 2011
11:01 am
I’m amazed and dumbfounded all the time how people can have poutrage over something an ATHLETE has done, (mostly to himself) and shrug over what a SENATOR can do, ( to everyone).
Jezz, who is shrugging off a-hole Senators? Not I. This is not a zero-sum game.
FWIW, Mr. South Beach Talent is more a symptom than a cause. The Big Sports Machine is just as corrupt as Big Pharma and Big Agra and Big Government. I personally wouldn’t care if our society didn’t devote so many resources—both money and lives—to men handling balls. And other men obsessing about those men handling balls.
I think Leg did the best thing for his kid, picking a school with more emphasis on intellectual pursuits. Mama James pimped her baby out and now she has da houze, da joo-rey, and everything money can buy. But her son is a lame a-hole.
Maybe if we spent some of that time and money on stuff that matters, like hmmmm…CANCER TREATMENT, we could treat prostate cancer for less than $93,000. You can damn sure bet Lebron won’t be contributing in that area. Maybe Leg’s kid will, at the cost of not being able to sink a 3-pointer at the buzzer.
Logic
June 28th, 2011
11:01 am
Life is not fair.
We don’t all get the same genes.
Unfortunately, some of us get really poor genes and have health issues. Nevertheless, it is not my neighbor’s responsibility to pay for my health care. It is not the drug company’s responsibility to provide me with free or low cost drugs.
Life is tough and then we die.
USinUK
June 28th, 2011
11:01 am
damn, finneus … that’s hardcore.
The Leg Lamp is a "major award"......
June 28th, 2011
11:02 am
AmVet
June 28th, 2011
10:54 am
Were you a “Doobie Brothers” fan?
BlahBlahBlah
June 28th, 2011
11:02 am
Separate but similar question – is it EVER appropriate to give an 80 year old a knee replacement operation funded by Medicare? What has that significant expenditure achieved? Is that an efficient and effective use of scarce resources?
finn mccool
June 28th, 2011
11:03 am
The business community will not let the us default. Let’s see whose arm gets twisted to get the deal done.
USinUK
June 28th, 2011
11:03 am
Logic – 11:01 – you seem to be missing the point … your neighbor already IS paying for your health care. that’s how insurance works (by spreading out the risk), that’s how the single-payer system works, that’s how hospitals currently work, by overcharging you, hoping to recoup some of the money they WON’T get from the indigent.
Jack
June 28th, 2011
11:04 am
Good health is our only real asset. And it’s our personal responsibility to live a healthy life style that does not put undue stress and expense on our loved ones or the government. If I become incurably ill and have lived beyond the benefits I’ve paid for, then I’m ready to go. I’ve given my permission to pull the plug on more than one family member and it ain’t easy; but it has to be done. So, no extra money for six months.
Fletch
June 28th, 2011
11:04 am
The only drug I want is the one that kill the pain until the end finally comes.
USinUK
June 28th, 2011
11:05 am
blahblahblah – why wouldn’t it be? my dad is 85, calls bingo at the VFW, volunteered in Ringgold, helping people after the recent storms – not all octogenerians are ready for pasture.
AmVet
June 28th, 2011
11:08 am
Of course, Lamp!
Their early stuff was superb. And later there were still plenty of gems, like this one from the great Living on the Fault Line…
http://www.youtube.com/watch?v=RpaIfCY79gc
Adam
June 28th, 2011
11:08 am
Leg Lamp @ 10:06a: My point is basically that public education is NOT evil, and that you CAN get a good education out of it. You made that case yourself. Whether or not it was “best” is up to interpretation and priorities, both yours and the priorities of the educational institutions in question. But you did not choose between one evil and another, you chose between two GOOD options. That is my point.
RedEye
June 28th, 2011
11:09 am
USinUK,
with regard to your answer to blahblah, do 80 year olds get knee replacements in the publicly funded NHS in England?
BlahBlahBlah
June 28th, 2011
11:10 am
USinUK, why wouldn’t it be? Because we’re broke. Give his wrinkled behind a power scooter and a scrip for pain meds and save 80% of the cost.
Joe Mama
June 28th, 2011
11:10 am
Logic — “Unfortunately, some of us get really poor genes and have health issues. Nevertheless, it is not my neighbor’s responsibility to pay for my health care. It is not the drug company’s responsibility to provide me with free or low cost drugs.”
Do you have homeowners’ insurance? Do you have comprehensive auto insurance? Then you’re expecting your neighbor to pay for your house burning down or for your accident out on 285. Perhaps you should consider what it would mean for your life if you were to extend your Iron John mindset to *all* areas of your life, not just health insurance.
getalife
June 28th, 2011
11:10 am
Thanks for sharing Del.
I shared last night and Uncle Jed called me a liar.
I am thinking about Facebooking or Tweeting my next surgery in real time for my friends and family.
The first thing I do when I wake up every morning is celebrate that I have lived another day.
Our health care system is outstanding.
Our health care bills are out of control.
mmm, mmm, mmm, Barack the Liar Obama - BEND OVER, Here comes the CHANGE!
June 28th, 2011
11:11 am
How about this for moral/financial from the LIBERAL AOL.
First Lady Michelle Obama’s trip to South Africa and Botswana last week cost taxpayers well over half a million dollars, possibly in the range of $700,000 or $800,000, according to an analysis by White House Dossier.
jj
June 28th, 2011
11:11 am
One of my best friends passed away on Saturday after a year long struggle with cancer. Three weeks ago they said we can go again with raidation and Chemo but the prognosis was still death. He chose to go on his own terms, and thus saved the insurance company probably a hundred grand. We all know he made the right decision.
On a different note it is interesting that Jay is concerned about the consumption of heath care based on percentages, but you can use almost the identical numbers for who pays taxes and the liberals scream the rich are under taxed. (ie the top 3% pay around 40% of the total, while the bottom 50% pay no federal taxes)
GT
June 28th, 2011
11:12 am
Our economy works the same way. Only so much supply. If it is that important to a person let them who have the bread spend it. To prolong my life for 6 more months when I am over 60 is not worth taking away from my estate to my family. I not sure it would be worth it at 25 but I would be in more of a panic at that age. If the president needed it or someone of importance ,that six more months of life would benefit us all have at it. The problem is in this modern day some athlete or movie star would end up with it and the scientist inventing the energy solution would do without.
USinUK
June 28th, 2011
11:12 am
“with regard to your answer to blahblah, do 80 year olds get knee replacements in the publicly funded NHS in England?”
yep.
finn mccool
June 28th, 2011
11:14 am
Calls bingo at the vfw
Now that’s a civic duty!
I believe all they do at the buford vfw is drink…
USinUK
June 28th, 2011
11:14 am
“Give his wrinkled behind a power scooter and a scrip for pain meds and save 80% of the cost.”
which is going to be more expensive in the long-term than to just fix the flipping problem
like I said, you have a choice – treatment or CURE. given that my grandma lived to 102 and my dad is still going strong, you’d be talking about treatment for another 20-ish years.
penny-wise/pound-foolish
Left wing management
June 28th, 2011
11:15 am
Douglas: “Why do you think most all of the new drugs and procedures are coming from the U.S.? I submit that it’s because of the profit motive. The countries with govt health care sit back and ride on the health care innovations/discoveries/drugs etc from the U.S. that are a direct result of the profit motive. Remove the profit motive and watch it all dry up.”
Fair point, but note:
Jonathan Cohn, New Republic:
The single biggest source of medical research funding, not just in the United States but in the entire world, is the National Institutes of Health (NIH): Last year, it spent more than $28 billion on research, accounting for about one-third of the total dollars spent on medical research and development in this country (and half the money spent at universities). The majority of that money pays for the kind of basic research that might someday unlock cures for killer diseases like Alzheimer’s, aids, and cancer. No other country has an institution that matches the NIH in scale. And that is probably the primary explanation for why so many of the intellectual breakthroughs in medical science happen here.
There’s no reason why this has to change under universal health insurance. NIH has its own independent funding stream. And, during the late 1990s, thanks to bipartisan agreement between President Clinton and the Republican Congress, its funding actually increased substantially–giving a tremendous boost to research. With or without universal coverage, subsequent presidents and Congress could ramp up funding again–although, if they did so, they would be breaking with the present course. It so happens that, starting in 2003, President Bush and his congressional allies let NIH funding stagnate, even though the cost of medical research (like the cost of medicine overall) was increasing faster than inflation. The reason? They needed room in the budget for other priorities, like tax cuts for the wealthy. In this sense, the greatest threat to future medical breakthroughs may not be universal health care but the people who are trying so hard to fight it.
http://www.tnr.com/article/politics/creative-destruction
USinUK
June 28th, 2011
11:15 am
finn – the VFW in Marietta is great – they do fundraisers for local schools, all kinds of stuff.
mmm, mmm, mmm, Barack the Liar Obama - BEND OVER, Here comes the CHANGE!
June 28th, 2011
11:15 am
GT – I have stage IV colon cancer. Wait until you’re in those shoes before you decide.
The Leg Lamp is a "major award"......
June 28th, 2011
11:16 am
Adam
June 28th, 2011
11:08 am
Agreed.
AmVet
June 28th, 2011
11:16 am
Having survived (arguably a miracle) massive blood clots in my lungs, and also one that went through the hole in my heart (yikes!) and lodged in the main *artery* of my right arm, I can testify of two things.
Firstly, the awesome doctors, nurses, staff and volunteers at the Atlanta VAH not only saved my life, they did it in stunningly professional fashion. The best of the best. And I salute them every day of my life.
Secondly, though 50 years old I was in fantastic condition, as I had been training for the Georgia Senior Olympics.
I am absolutely convinced that had I been your average 50 year, woefully out of shape old couch potato, I would not have survived.
So for me, physical fitness is a lot more than just a hobby. It can mean the difference between life and death. And in my case, did.
So good peeps, get out there and get your soft buns fit! Yeah the process sucks sometimes (OK, a lot of the time!) but you’ll NEVER regret it!
Granny Godzilla
June 28th, 2011
11:17 am
Boy that trip got expensive…yesterday we were told it was $500,000
Now if you want to be a REAL reporter when you grow up compare that to the costs incurred by Laura and her girls trips to Budapest and to Paris and to Africa.
What’s the difference between Laura and Barbara and Jenna traveling
and Michelle, Sasha and Malia traveling?
What could it be I wonder?
Is
Dave R.
June 28th, 2011
11:18 am
I don’t care if you’re Mother Freakin’ Theresa, $50k or $500k for an extra 6 months isn’t worth it.
Take whatever drugs you need to manage the symptoms and enjoy what is left of your life with dignity. There is no dignity in forcing others (taxpayers or your family) to pay for your care when the results don’t warrant the cost.
Jay
June 28th, 2011
11:19 am
OK, Dave R, I agree.
Now.
How do you implement that on the policy level?
mmm, mmm, mmm, Barack the Liar Obama - BEND OVER, Here comes the CHANGE!
June 28th, 2011
11:19 am
Granny Godzil
Remeber the uproar with Nancy Reagan’s china? Hmmm……and by the way we are in FINANCIAL trouble, that’s the difference.
Clinton "Skink" Tyree
June 28th, 2011
11:19 am
If you want to just cut to the chase, healthcare costs are escalating at alarming rates and capitalism and the free market allow for these companies to make unconscionable profits which are spiraling out of control.
Apart from more tax breaks for the parmaceutical companies, does the Republican/Tea Party have a plan? So far all I’ve see is Republican’ts doing everything they can to protect this out of control industry.
Poor Boy from Alabama
June 28th, 2011
11:21 am
JB,
This is a complicated topic. You partially framed the argument, but missed some key points:
1. Life expectancies in the US rose by just over 20 years between 1929 (57.1 years) and 2003 (77.4 years) according to the CDC.
2. People over 55 accounted for 65.1% of health care spending according to the NIHCM study you cited.
3. The most costly illnesses to treat according to the NIHCM are heart disease, cancer, trauma, mental disorders, and pulmonary disorders.
4. The biggest drivers of health care costs according to the NIHCM are advances in medical technology, rising treatment prevalence for chronic diseases, and increased provider consolidation and pricing power. More than half of recent increases can be attributed to hospitals, doctors, and clinical services.
The first choice is how much are we willing to pay for extended life expectancies? Sixty-five percent of our costs are from people who would have been dead 80 years ago. I don’t think most of us would be willing to go back to an average life expectancy of 57 years so that leads us to a couple of other choices:
1. How much should society pay to extend life expectancies vs. how much of those costs should be born by individuals?
2. What kinds of incentives should we provide individuals who make diet and lifestyle choices that lower health care costs?
With most forms of insurance, consumers decide how much they’re willing to pay for a given set of deductibles and coverages. With our cars and homes, we know exactly what’s covered, at what level, and how much it will cost us. We make a choice and the chips fall where they may. Similar mechanisms apply with life insurance. We have a bit of a hybrid when it comes to disability insurance, with the government providing various forms of disability coverages as well.
Trying to calculate health care costs is more difficult, but I’m sure an actuary could come up with a figure for those who wanted the kinds of expensive prostate drugs you mentioned. As with life insurance, the costs would be increase with age. In other words, the longer you waited to pay for supplemental coverage, the higher your rates.
In our current system, we’ve effectively pushed our oldest, highest cost consumers into public health care and have done nothing to distinguish between those whose health care costs are moderate and those whose who have conditions that are extremely expensive to treat. Similarly, we don’t distinguish between those who make good diet and lifestyle choices and those who don’t.
Some folks won’t like this, but we should give people choices early on – pay more if you want high costs treatments or pay less and accept restrictions.
We should take the same approach to diet and lifestyle choices – we should give people incentives to make good choices. Those could take the form of tax credits, lower rates, higher coverage levels, etc. This would help contain costs as well since the NIHCM study also points out that chronic diseases, including many related to obesity, have also contributed to rising health care costs. Diet and lifestyle choice affect the prevalence of the most costly illnesses such as heart disease, cancers, and pulmonary disorders. We know from the American Cancer Society, for example, that one third of all cancers are caused by poor diet and lifestyle choices.
Rationing in this case is done by the consumer, not a bunch of bureaucrats. Pay more and/or make good diet and lifestyle choices if you want high cost treatments. Pay less and/or do what you want regarding diet and lifestyle if you’re willing ot accept treatment restrictions.
Jm
June 28th, 2011
11:22 am
Well either a government board will have to decide, subject to political meddling and influences. Or individuals will decide. Basically we have Medicare writing a blank check to senior currently, saddling untold future generations with huge debts for a short extension of their lives.
I vote end Medicare and let individuals sink or swim. Anything less is suboptimal.
Granny Godzilla
June 28th, 2011
11:22 am
MMMM MMM
The Bush ladies trip to Afica 2007
Recession begins 2007
Again what’s the difference?
mmm, mmm, mmm, Barack the Liar Obama - BEND OVER, Here comes the CHANGE!
June 28th, 2011
11:22 am
Clinton “Skink” Tyree
You’re wrong, not ALL Republicans or Tea Party members feel this way.
Personally, I don’t belive their should be ANY tax breaks. That includes individuals.
El Jefe
June 28th, 2011
11:23 am
Gee – it almost sounds like eugenics to me. Let’s wed out those that cost too much.
WOODSTOCK MIKE
June 28th, 2011
11:24 am
@Clinton “Skink” Tyree
Yeah, Republicans are making people live longer and it’s their fault that these new treatments are so expensive. You are a fool sir…
mmm, mmm, mmm, Barack the Liar Obama - BEND OVER, Here comes the CHANGE!
June 28th, 2011
11:25 am
Granny Godzilla
The difference is it wasn’t `14 TRILLION (with a “T”). Time for you to admit, gas price were $1.81 when NObama took office, the unemployment rate was close to 8% when he took office and is now at 10% and the deficit was nowhere near what it is now. He is a failure and ONE term president. How’s that “Change” and “Hope” working out?
WOODSTOCK MIKE
June 28th, 2011
11:25 am
Oh yeah, and how does taking tax breaks away from these companies make things cheaper?? Please answer that one…
Dave R.
June 28th, 2011
11:29 am
“OK, Dave R, I agree.”
Wow. mark the date!
“Now. How do you implement that on the policy level?”
I’m not sure that government is the solution here, except to honor and enforce any debt incurred.
First, hospitals must go after any and all assets of those who incur costs. If that means taking the inheritance of those who survive, then so be it. And letting the patient know IN ADVANCE what the consequences of their actions will be. “Oh, you want to incur $500k in costs for a treatment that will only give you another 6 months of life? Sign your house and liquid assets over to us right now.”
Stop enabling bad choices, as government tries to do in every walk of life, and you get better choices.
The Leg Lamp is a "major award"......
June 28th, 2011
11:30 am
AmVet
June 28th, 2011
11:08 am
I liked their earlier stuff better as well. Anything with Tom Johnston was better than the songs with Michael McDonald. Nothing wrong with McDonald, I liked a lot of his Doobie songs, but the original sound was better.
getalife
June 28th, 2011
11:31 am
Mike,
How does stealing Medicare make things cheaper?
Jefferson
June 28th, 2011
11:33 am
Why is it so hard to see who is getting all the money? Lot of these cost are because folks are making a lot of money, duh?
WOODSTOCK MIKE
June 28th, 2011
11:33 am
Just as Jay said, this is not a political debate, if people are living longer and longer and we know that it’s in their final months when the cost is so outragious taking away tax breaks means nothing. It is what it is, thousands of people are living much longer and when they have no money, guess who foots the bill, the taxpayer.
On the flip side let me mention my grandmother who became ill a few years ago. She had about a quarter million bucks that my father was going to inherit. She had a horrible case of alzheimers. So, with modern medicine she was kept alive for several years not even knowing her own children or what year we were in, she thought we were back in the 40’s. And because she had money she didn’t qualify for any govt assistance. Basically she drained her life savings to stay in a facility for the last few years of her life and didn’t even know it.
Maybe the answer is that we shouldn’t keep people alive for just the sake of keeping them alive but that opens up a whole other can of worms…
USinUK
June 28th, 2011
11:35 am
“Maybe the answer is that we shouldn’t keep people alive for just the sake of keeping them alive but that opens up a whole other can of worms…”
which is why Death with Dignity (or medically assisted suicide) should be legal
Common Sense
June 28th, 2011
11:35 am
Who makes the decision?
It should be my family and me based on what we can afford.
When the private sector pursues profits in a capitalist society, prices are driven down.
When government gets involved and sets the standards and payouts, prices are driven upward.
And before you say how much more medical care costs today, you are not comparing apples to apples.
Quality quantity, and types of medical treatments have increased exponentially since the 1960’s.
And if this was really insurance as it is being presented, then the insured in any given pool of those insured would collect enough in premiums to cover the costs.
WOODSTOCK MIKE
June 28th, 2011
11:35 am
@getalife
It’s about coming up with a new solution. Some form of Medicare will always be around. If we know that it’s unsustainable or there may be a better solution are you not open to looking into it?
getalife
June 28th, 2011
11:36 am
Dave,
Don’t you work for a health care insurance company?
Adam
June 28th, 2011
11:36 am
Dave R: And letting the patient know IN ADVANCE what the consequences of their actions will be.
THIS
ty webb
June 28th, 2011
11:36 am
UsinUK,
why stop there…all suicide should be legal.
Granny Godzilla
June 28th, 2011
11:37 am
mmm mmmm
what was that deficit that Bush left….11.7 TRILLION…..how many jobs
did the Bush administration end up netting the nation?
again what’s the difference?
and hope and change has worked out quite well for me.
thanks for asking.
getalife
June 28th, 2011
11:37 am
Mike,
Your party is trying to steal Medicare and SS.
Fact.
oldguy
June 28th, 2011
11:37 am
JJ exactically correct;
Jay,
One point you make but do not expand on is that there are 3 new prostate cancer drugs. If there were no profit in new drugs how many new drugs do you think there would be??
Some of your readers seem to think the drug companies are making huge profits on these new drugs OK prove it; what was their cost to develop, make and market the new drugs? what is the lifespan of the new products?
Take the profit out of developing new drugs and there will be no new drugs!!
Who develops the new drugs for treating illness (hint US drug companies make over 50% of all new drugs on the market)?
You can grandstand about what you would do if you were faced with deciding about impending life or death but facing the situation is another matter!
We are all going to die sometime, no one knows when , but is you want certainty just put a gun to your head now and we will all be happy!!
WOODSTOCK MIKE
June 28th, 2011
11:37 am
“When the private sector pursues profits in a capitalist society, prices are driven down.”
This is a great point that many seem to not understand. A capitalist system creates lower prices, not higher…
Dave R.
June 28th, 2011
11:38 am
This is another area where the GOP is dead wrong on their social agenda of protecting life.
Assisted suicide should be allowed across the whole country.
JKL2
June 28th, 2011
11:38 am
-Who makes that decision? And on what basis?
I thought the death panels were pretty clearly defined in obamacare. I guess you missed that part when you were reading about all the wonderful things inside the bill.
When can we move on to the bigger issue of starving children? Everyone has a right to free food. I can just feel the discrimination everytime I walk past Hooter’s…
Florida's Govenor
June 28th, 2011
11:39 am
How does stealing Medicare make things cheaper?
Ask Florida’s Govenor….
http://www.wusf.usf.edu/news/2010/06/18/whistleblowers_say_rick_scott_knew_about_medicare_fraud
USinUK
June 28th, 2011
11:40 am
ty – well, that too (although, it’s the ASSISTED part that’s the problem with medically assisted suicide … not the suicide part)
common sense – “When the private sector pursues profits in a capitalist society, prices are driven down.”
yeah. because medical costs have been declining for the last 30 years.
GT
June 28th, 2011
11:40 am
mmm, mmm, mmm, Barack the Liar Obama – BEND OVER, Here comes the CHANGE! I am very sorry about your cancer. I do speak for myself but I had a few of those problems myself, by the grace of God lived to tell about it. We live in a time of great depression in many people who especially after health problems do not care to live, so lead the way brother, the will to live is a very good thing. I got it just not eaten up with it for 6 months more.
Dave R.
June 28th, 2011
11:41 am
“Don’t you work for a health care insurance company?”
No, and why do you keep stalking me?
If you’d stop drinking so much during the day, you’d remember who does.
Left wing management
June 28th, 2011
11:42 am
Woodstock Mike: “When the private sector pursues profits in a capitalist society, prices are driven down”:
Wrong.
Did you not see my post above about how healthcare is an exception to this ‘free market efficiency’ hypothesis in almost every conceivable way? In healthcare private markets cause prices to spiral with a vengeance.
oldguy
June 28th, 2011
11:42 am
Maybe all you libs ought to go back and rent a cheesy 1970s movie called “Logans Run”. It makes a point. They solved their problem by exterminating everyone who reached the age of 30.
See, problem solved!!
USinUK
June 28th, 2011
11:42 am
Some of your readers seem to think the drug companies are making huge profits on these new drugs OK prove it;
http://money.cnn.com/magazines/fortune/global500/2007/industries/21/1.html
$11 billion profits for J&J.
Man Nurse
June 28th, 2011
11:43 am
There have been multiple posts lamenting the high cost of medications. People need to keep in mind it costs a pharmaceutical company around $800 million to bring a single drug to market. To come up with the price they charge, they figure out how many people the drug would be useful for and then charge enough to pay for the start up costs and earn a profit. Those profits go into research for other new drugs. I would guess that the US produces the most new medications. To answer Jay’s questions, I would put more faith in a joint group of physicians, nurses and patient care advocates devoid of government ties to make recommendations. Healthcare systems have been moving toward use of Evidence Based Practice which uses scientific studies to evaluate which treatments are best for the majority of the population. Let the science guide us. Allowing politicians to do so has gotten us into the position we are in.
poison pen
June 28th, 2011
11:43 am
Where is Dr Kevorkian when you need him.
Tychus Findlay
June 28th, 2011
11:44 am
Some of your readers seem to think the drug companies are making huge profits on these new drugs OK prove it;
http://money.cnn.com/magazines/fortune/global500/2007/industries/21/1.html
$11 billion profits for J&J.
I own stock in J&J
Uncle Billy
June 28th, 2011
11:44 am
Eight years ago my primary care physician, having diagnosed me with high blood pressure, prescribed a name brand medicine which cost about $80 per month (my co-pay was $15). It lowered my blood pressure but had the side effect of persisting serious coughing. He switched me to another brand name medicine which cost about the same and had no side effects but did not lower my blood pressure. I read a story in the AJC that reported a study in the Journal of the American Medical Association (JAMA) which compared the relative effectiveness of the various types of blood pressure reducers. It concluded the single most effective is the oldest, a diuretic. Wondering why my physician would prescribe less effective, more expensive medicines, I formed a theory. I called my brother, an MD retired, and asked whether pharmaceutical companies hire good looking young women in short skirts to visit physicians and try to convince them that company’s drugs. He laughed and said, “you bet they do, and plunging necklines.” When I went back to the physician I asked his assistant and the laughed and guessed that I had seen one sitting in the lobby. When the physician came in he denied that he was influenced by the tactics of the drug companies. He wrote me a prescription for a generic diuretic which cost me $4.25.
Many physicians get a lot of their information about drugs from the drug reps.
Thus endeth the lesson
Doggone/GA
June 28th, 2011
11:44 am
“So good peeps, get out there and get your soft buns fit! Yeah the process sucks sometimes (OK, a lot of the time!) but you’ll NEVER regret it”
But even then…it’s no guarantee, as your own experience shows. And I’ve said this before…Jim Fixx died of a heart attack.
poison pen
June 28th, 2011
11:45 am
Man Nurse, What you say is true, when Lipitor goes generic the fall they will lose 10 Billion a year in sales.
WOODSTOCK MIKE
June 28th, 2011
11:45 am
And all you hear about is big Pharma getting all these breaks, come on, we aren’t talking about taking prescription drugs here, we are talking about the expense of a heart surgery or chemo as Jay mentioned. Pharma companies have little effect on the cost of an open heart surgery…
USinUK
June 28th, 2011
11:46 am
Dave – he stalks because he loves …
getalife
June 28th, 2011
11:47 am
“If you’d stop drinking so much during the day, you’d remember who does.”
My bad.
I have short term memory loss and repeat things over and over.
You are the former Forsyth Country Commissioner that lost because of your people skills.
You are working on that problem but have a long way to go.
Who was the poster that said they worked for a health care insurance company?
Doggone/GA
June 28th, 2011
11:47 am
“Boy that trip got expensive…yesterday we were told it was $500,000″
No kidding! By tomorrow it’ll be 200 billion PER DAY!
Dave R.
June 28th, 2011
11:47 am
USinUK, I’d hardly consider J&J a pharmaceutical company alone.
Their consumer products (Bandaids, etc) may well generate much of that profit. That is the problem with statistics without proper background.
Joe Mama
June 28th, 2011
11:47 am
Dave — “Stop enabling bad choices, as government tries to do in every walk of life, and you get better choices.”
This is OT, but I would be interested in hearing Dave’s application of this aphorism to the War on Drugs.
USinUK
June 28th, 2011
11:48 am
Dave – look at the rest of the list – J&J was at the top, but they were by no means, alone.
Dave R.
June 28th, 2011
11:48 am
“Who was the poster that said they worked for a health care insurance company?”
Why do you care?
poison pen
June 28th, 2011
11:48 am
Uncle Billy, kinda like lobbyists in Washington selling out our country for a few bucks.
Dave R.
June 28th, 2011
11:49 am
I understand, USinUK, but I just found that choice problematic for making your point.
getalife
June 28th, 2011
11:50 am
Why do you care?
Answer the question grumpy?