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
TallaDawg
June 28th, 2011
11:50 am
Profit, in and of itself, is not wrong or immoral. The real issue is reasonable profit, instead of an absolute maximization of profit.
Man Nurse
June 28th, 2011
11:50 am
USinUK @ 11:42
The profit margin is more important than the profits. Oddly enough, pharmaceutical companies have better margins than other industries (even the hated oil and gas companies), earning almost 20 cents for every dollar invested. I guess they have better lobbyists…
JKL2
June 28th, 2011
11:52 am
cluelessinUK- yeah. because medical costs have been declining for the last 30 years.
Two reasons: 1: Miracles cost money, and it’s hard to make the fattest laziest country in the world live longer.
2. There is NO COMPETITION to drive down prices. The insurance company (and now government) is going to pick up the tab so who cares what it costs. The poor sucker without insurance has to pay $70 for an office visit because the doctor knows the government is only going to pay him $4 for all the others he’s virtually forced to take.
oldguy
June 28th, 2011
11:52 am
To all you libs screaming about the Republicans wanting to “steal Medicare” conveniently overlook the fact that Obozocare steals 1/2 TRILLOIN dollars from Medicare to fund his new Medicaid voters!!
Paul Tietzen
June 28th, 2011
11:53 am
Regarding guilt and late stage prostate cancer, it is hard to blame those who failed to get checked for prostate cancer annually if they do not have the funds to pay for preventative medical care. In Canada, which has universal health care, albeit imperfect, men are encouraged to get their prostate checked at 50 years of age, and thereafter. My prostate cancer was caught “very early”, which allowed for treatment at one tenth of the cost of the late stage drugs cited. Until the lower and working class has free access to preventative care the problem will persist, much to the benefit of the drug companies as indicated.
The propaganda in the U.S. regarding the Canadian system fails to point out that it is a system with concerns about early detection and treatment, worker safety, etc. When in Palm Springs in the winter I cannot find a GP for an appointment, although I can see specialists at will. This is the result of a system which worships profit and not health.
Maybe the difficult decisions coming in the U.S.” Buy your Health” systems will set the scene for a decent public health program, however, I am not too hopeful, reflecting on the study at Stanford in the 1960’s, in which the Med students gave “to get rich” as their dominant (93%) reason for choosing that profession. This, before the era of greed! Edmonton, Alberta .
Bosch
June 28th, 2011
11:53 am
Normal,
If you are still around. I sympathize with your predicament, I’ve dealth with two deaths — very different — in the past year. My aunt-in-law was in the last stages of — well, she was just old — no other way to put it. The last year she was alive, she’d pretty much go comatose, we’d take her to the emergency room, they’d pump her full of fluids and she’d perk back up for a couple months — cycle continues. We finally talked to her doctor and decided to call in hospice. Hospice is really not at all like I thought — they basically take the approach of “let’s quit this cycle that is only avoiding the inevitable and let this person die with some dignity” — it took our aunt about four months to die, but it was very natural and very peaceful. So, if you haven’t already, I’d call in hospice. They are there for the family just as much as for the patient as well.
Also, many know my mom died very suddenly without warning last summer (almost a year) and while it sucked and the past year has been the hardest of my life, many days when I have some clarity about me I realize that is probably the best way to die. It was harder for my oldest sister because her and my mom had some issues, but me and my other sister, while it was very hard, it wasn’t as bad for us because we knew we had a good relationship with our mom and we don’t wonder with the “if” kind of questions.
You and your mom are all worked out. I know it’s tough but it will be all good.
Dave R.
June 28th, 2011
11:53 am
“Miracles cost money, and it’s hard to make the fattest laziest country in the world live longer.”
TESTIFY!
RB from Gwinnett
June 28th, 2011
11:54 am
“I’m not sure a mere six months of extended life is worth $500,00.00 dollars. ”
There are two problems with that thought (which I agree with BTW)…
The first is we have separated the consumer from the money involved with healthcare. You pay your premiums and your copays and all of the stuff going on betwee the doctor and the insurance company is foreign to most of us. We rarely know OR CARE what the cost of our procedure is. To us, it’s a $25 co-pay. Huge problem with that.
Second, we have a large segment of our society who honestly doesn’t care about that $500K for 6 months because it’s not their money anyway, they’re owed it by society, and they’ll opt for the 6 months because they can. Just like they’re more than happy to take all the other freebies they’re owed by society. The question is, are we as a society ever willing to say “no more” to these people?
Lynn
June 28th, 2011
11:55 am
The cost of US health care compared to that of other nations is distorted precisely because we do not “ration” care. Proponents of national health care won’t tell you that in other countries care is rationed to a high degree. Low cost, routine care is available, but if you need expensive treatment you will likely not receive it.
The US does develop most new drugs, technologies and techniques. Other countries do not invest in this process and piggyback off the US system.
As an international benefit consultant who has worked in numerous countries around the world, I have yet to find an individual who was happy with their national health care.
With that said, in the US we must start to limit care given for the small possible extension of life, over treatment of routine and minor conditions for the elderly in hospitals (treat in an outpatient setting). We also must stop paying for drugs that cost $5,000 or more a month to treat psoriasis. The drugs were developed to treat the serious condition of rheumatoid arthritis not the less serious skin condition. If you want the treatment, then pay for it don’t ask your employer, your fellow taxpayers or others to foot your bill.
USinUK
June 28th, 2011
11:55 am
jkl – since you would rather insult than actually, you know, pay ATTENTION to who is on what side, you’ll see that your narky little response would be better aimed at Common Sense who seems to think that competition will solve EVERYthing.
but thanks for playing.
Joe Mama
June 28th, 2011
11:56 am
Man Nurse — “Those profits go into research for other new drugs.”
What, none for the shareholders and executives? Surely you jest.
“I would put more faith in a joint group of physicians, nurses and patient care advocates devoid of government ties to make recommendations.”
And I would put more faith in a joint group of physicians, nurses and patient care advocates devoid of *corporate* ties and allegiances to make recommendations.
GT
June 28th, 2011
11:57 am
Private money, public money who knows the difference now days. Are the companies and banks the government bailed out considered government or private in statistics. Someone the other day was telling me that history shows when more private money is in the system the economy functions better. Is that a cause of an affect, and how do they define private. Also when they do save a company and it’s private pension fund is saved is that then government welfare or private money.
Dave R.
June 28th, 2011
11:57 am
Now, off to get some good old fashioned capitalism done for the rest of the day.
Adam
June 28th, 2011
11:58 am
I thought the death panels were pretty clearly defined in obamacare.
And you would be wrong there. The death panel thing is also 2009’s LIE OF THE YEAR.
josef
June 28th, 2011
11:58 am
Oh, good, Dave and getalife are at it again…life on the blog is back to normal…
Old guy…
From last p.m. Ain’t that prescription for red wine a good one…?
Disgusted
June 28th, 2011
11:59 am
“Who was the poster that said they worked for a health care insurance company?”
That’d be Thulsa Doom, who by sheer coincidence is unalterably opposed to the health care law. See, there’s not as much profit in it if everybody can afford health insurance.
USinUK
June 28th, 2011
12:00 pm
““Those profits go into research for other new drugs.””
no, they USED to go into research for other drugs … now they go into marketing …
or did you think that the proliferation of commercials you see during prime-time – not to mention the 2-page spreads you see in magazines – are free?
TRUTH
June 28th, 2011
12:00 pm
The costs alone will continue to kill Americans. The costs. The insurance industry still has the say on costs, and if it don’t make dollars, it don’t make sense. Again, costs.
Preventative healthcare will prevent major problems later in life. I agree, I agree, I agree. But with a large percentage of adults and young people out of work, healthcare is way to pricey for someone with 0 income.
So are we ready to address Nationalized Healthcare?? Eliminate the insurance companies, and the other money making vehicles that drain us?
oldguy
June 28th, 2011
12:00 pm
Dave,
Better enjoy that good old fashioned capitalism now, If Obozo has his way there won’t be any in a few years!!
WOODSTOCK MIKE
June 28th, 2011
12:00 pm
Funny that I’m not seeing any libs point out that Obama’s healthcare plan is in favor of big Pharma. Harry Reid played a vital role and has all kinds of connections with Big Pharma. Go ahead and look it up, you can find it very easily…
bhorsoft
June 28th, 2011
12:01 pm
As some have said earlier and I concur, drug companies are in it for profit. As a result, they focus on the treatment of an illness as opposed to a cure. Repeat business is much better for the bottom line.
This is also why we are are seeing increased use of “fast track” approval of drugs. If I can get my drug that costs $5000 a dose to market three to five years earlier, I can make a ton more of money – probably enough to cover any lawsuits and still leave a tidy profit.
Now I don’t deny anyone the right to make a profit. A little greed is good – it’s what makes us all want to try harder and do a bit better. However, a lot of greed is not so good – it tends to pervert free-enterprise a bit and upsets the balance between free-enterprise and social responsibility.
For a concrete example, I was on a drug that was $5000 per infusion per month. It was a fast-track drug and there were a couple of deaths related to it after the FDA approved it. It was withdrawn for a year while the company negotiated with the FDA. When it came back on the market it was supposed to be a drug of “last resort” – if all the other treatments weren’t working. The doctor I went to set up a new “infusion” room shortly after approval. During the couple of months I was on the drug, all 20 seats were full when I went in. From what I understand they were full every day. It took an hour for the infusion, so total monthly revenue for the infusion center was roughly (20 [people/hour] * 8 [hour/day] * 30 [days/month]) * $5000 [avg. charge/dose] which comes to a gross revenue of 24 million $ a month. Of course there are expenses (cost of the drug (vs retail price), labor, equipment, etc.) that would be deducted, so the doctor wasn’t making $24 mil a month, but that is what was coming out of insurance companies and individuals pockets. Again, this was for a treatment and not a cure.
This is just one isolated instance. Multiply this by a hundredfold for all kinds of different, new treatments (not cures) and you’ll see why health care costs have run amok in this country (and others). I don’t have a solution, but I can remember a day when the profit motive in medicine was not near as prominent and primary as it is now.
oldguy
June 28th, 2011
12:02 pm
OK Josef,
Still not a wine fan! Stout is much better for us Welchmen!
Adam
June 28th, 2011
12:03 pm
Thulsa Doom is also way crazier than Dave R. I am not sure how you managed to conflate the two.
oldguy
June 28th, 2011
12:03 pm
Had a lunch date……Later.
Adam
June 28th, 2011
12:04 pm
oldguy: Better enjoy that good old fashioned capitalism now, If Obozo has his way there won’t be any in a few years!!
I am disappointed in you, oldguy. Believing such nonsense even after it has been debunked multiple times.
Bosch
June 28th, 2011
12:05 pm
“Better enjoy that good old fashioned capitalism now, If Obozo has his way there won’t be any in a few years!”
“Obama’s healthcare plan is in favor of big Pharma.”
Can you wingnuts please get your memes straight? So Obama is gonna wipe out capitalism as we know it, by favoriting one of the biggest money making industries in our country?
Wingnuts and their logic…or rather, lack there of.
Joe Mama
June 28th, 2011
12:05 pm
Lynn — “We also must stop paying for drugs that cost $5,000 or more a month to treat psoriasis. The drugs were developed to treat the serious condition of rheumatoid arthritis not the less serious skin condition.”
Excuse me, madam, but you can go take a flying leap. There are plenty of *other* serious diseases those drugs treat — some MUCH more serious than RA — and I’ve *got* one of them.
“If you want the treatment, then pay for it don’t ask your employer, your fellow taxpayers or others to foot your bill.”
Here’s a thought. How about we cover the cost of the MABs for all patients with truly serious, life-threatening diseases, and let those with less-serious, non-life-threatening diseases — like RA — go pay for it themselves? How would that grab you?
RA is a painful and debilitating disease, to be sure, but to claim that because many of the MABs were developed to fight it — and therefore shouldn’t be used to treat other autoimmune conditions — is absolute lunacy IMO.
USinUK
June 28th, 2011
12:06 pm
woodstock mike – that’s because i’m still rooting for the single-payer system … the final version of the healthcare bill is the embodiment of the expression “a camel is a racehorse designed by committee”
getalife
June 28th, 2011
12:06 pm
We are learning today because people are sharing their experiences.
Make no mistake, everybody will get sick do this is great stuff.
Of course Uncle Jed is not here to call you liars so that helps.
I think it is up to the individual and their family to make this decision.
Not government or health care insurance companies.
How much is life worth?
If you are pro life, the answer is that is a stupid question.
Ragnar Danneskjöld
June 28th, 2011
12:08 pm
Good afternoon all. No moral or ethical issue here, as presented by our host. The death rate remains 100%.
“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?”
“We” have no right to decide anything – and the rational should be wary of those who would play “God” with the lives of others. The rational solution is the market solution. If Jay Bookman wants to take his last $50,000 to try to get another six months of life, who on earth has the right to tell him he should not be able to do so? If Jay elected to spend his $50,000 on a neat BMW instead, who on earth has the right to tell him he made a bad choice? And if Jay lived as Mother Teresa and never had two quarters to rub together, nobody has the right to condemn his virtuous, if slightly shorter than average, life.
josef
June 28th, 2011
12:08 pm
Yeah, Thulsa is all against government subsidized health care, but all for government subsidized insurance…that same mentality is what’s at work in this health care reform fiasco…nationalize the lot of them and be done with it…you can’t have it both ways…jmo…
Question
June 28th, 2011
12:08 pm
“… Is that an acceptable use of taxpayer money…” Please consider and carry this question over to the entitlement programs, in particular those “expected” by the generational government dependent baby factory, contribute nothing to society leeches!!!
USinUK
June 28th, 2011
12:08 pm
Adam (and Dave) –
talk about a back-handed compliment …
Bosch
June 28th, 2011
12:09 pm
Woodstock Mike,
I think you are under the delusion that we libs all are in favor of the HC Bill — I certainly am not because I am painfully aware of all the connections by all politicians from all sides who got their way.
I want single payer. Until then, no health care bill will have the Bosch stamp of approval.
M
June 28th, 2011
12:10 pm
I, for one, always comparison-shop whenever I call 911 for an ambulance.
Doggone/GA
June 28th, 2011
12:10 pm
“Funny that I’m not seeing any libs point out that Obama’s healthcare plan is in favor of big Pharma”
Maybe not today, yet, but if you haven’t seen that complaint you’re not paying atttention. It is THE biggest issue MOST of us have a problem with.
WOODSTOCK MIKE
June 28th, 2011
12:10 pm
Sen. Harry Reid Key Player In Big Pharma’s Control Over Washington
USinUK
June 28th, 2011
12:10 pm
Bosch – I hear ya! and am right there with ya.
Bosch
June 28th, 2011
12:10 pm
“in particular those “expected” by the generational government dependent baby factory, contribute nothing to society leeches!!
Question: are you pro-life?
Left wing management
June 28th, 2011
12:10 pm
I see our discussion has petered out here, having succumbed to CON CLOG.
Jefferson
June 28th, 2011
12:11 pm
If you know any doctors ask them about the perks, trips and kickback the drug dealers lay on them. Wonder why pills cost so much?
Bosch
June 28th, 2011
12:11 pm
Woodstock Mike,
Again, your point would be?
JKL2
June 28th, 2011
12:13 pm
USisUK-
If you want to be insulted talk to kamchak. It’s obama’s”new tone of civility” that seems to make every Demwit swell with hatred these days. I just said you were clueless as to why healthcare “cost so much”. I’ll stand by that.
Competition doesn’t “solve” everything, but without it you will never see the price of anything go down. It’s called a monopoly.
jt
June 28th, 2011
12:13 pm
There is no moral dilemma.Who owns yourself.?
.
If medicare,medicaid, the AMA, and the FDA was so effective……..then only PERSUASION would be necessary to participate.
.
Instead……….we have COERCION at the tip of a gun.
.
Let people opt out of your little corrupto-crat schemes..stand back……..and watch the medical miracles blossum….Let the frightened little R&D voters stay in their government managed health systems.Let the smarter ones go.
.
This will happen regardless………..as America marches centralized managed third-world economy.(by the way,Sir Ronald Reagan warned us about this 50 years ago).
.
Ron Paul 2012.
Tedmo
June 28th, 2011
12:14 pm
For me It would depend on if the six months were during Fooball season. LOL
getalife
June 28th, 2011
12:15 pm
There is a price tag attached to our pro life folks.
You can live but not if it is too costly.
That my friends is not pro life.
That is pro insurance company.
JKL2
June 28th, 2011
12:15 pm
Baby Mama said I need to eat healthy so I have a right to free hot wings. Why no Hooter’s amendment in obamacare? Free wings for everyone or the terrorists win.
Left wing management
June 28th, 2011
12:16 pm
Bosch: “Woodstock Mike, / Again, your point would be?”
It’s simple. To OBFUSCATE.
George Watson
June 28th, 2011
12:17 pm
What will undoubtedly be the moral dilemma of our time. Who gets how much benefit from public sponsored health and social services. I think all I know for certain is that I wouldn’t want the decision based on profitability. And for the same reason I don’t believe unfettered control of drug pricing by a few mega drug firms is an option either. And in case anyone’s wondering – they have that control because we give it to them in the form of almost unlimited patent protection. In many cases they did not invent the drugs that make them rich, but bought them and price them without competition. Nice work if you can get it.
Question
June 28th, 2011
12:18 pm
Bosch at 12:10 pm — Yes, with certain exceptions.
My recommendation for this segment of society is to prohibit or restrict (chemically or surgically) their ability to have children, i.e., upstream prevention instead of having to make the pro-life decision. Overall, we need to reverse the current way of thinking and instead — penalize failure and reward success!!
Ken
June 28th, 2011
12:18 pm
A major problem with insurance is this: When you go to get a regular check-up,all of the tests are covered by your deductable. But, if anything is found, then the whole bill goes toward treatment and you have to foot the bill plus more. This is just one thing that should be addressd in reform. I have no problem with a business making money, but shifting terms in this way should be regulated in order to keep Americans from getting those early tests.
Joe Mama
June 28th, 2011
12:21 pm
Question — “Overall, we need to reverse the current way of thinking and instead — penalize failure and reward success!!”
Huh?
Isn’t failure its own penalty? And isn’t success its own reward? Why would you need to *further incentivize* success?
Is this some sort of bizarre exhortation against taxing the wealthy?
Normal
June 28th, 2011
12:21 pm
Bosch
June 28th, 2011
11:53 am
Bosch,
Thank you for your words. I’m at a tough spot right now. My basic instinct is to run away as fast as I can until it’s all over. I don’t want to see her waste away. We were a military family and Dad was gone most of the time. She was it. She was our rock growing up. My Sister is dealing with the day to day stuff, but she is worn out. Our kids, grand kids and the rest of the families are looking to me to guide them through this, so there’s no running in my near future. I’m visiting her twice a week now and I know she’s enjoying that, but it’s really hard to be positive all the time. I guess I just have to accept it first, myself, and then I’ll deal with it and the others better. I can do it.
Doggone/GA
June 28th, 2011
12:24 pm
“I’m visiting her twice a week now and I know she’s enjoying that, but it’s really hard to be positive all the time.”
Normal – this is really hard for me, I’m tearing up as I type. Having watched my Mother die from a brain tumor, let me give you some advice that was given to me: let her see your grief. You don’t have to be upbeat ALL the time.
WOODSTOCK MIKE
June 28th, 2011
12:25 pm
@Bosch
“I think you are under the delusion that we libs all are in favor of the HC Bill — I certainly am not because I am painfully aware of all the connections by all politicians from all sides who got their way.”
Considering health care reform is widely viewed as Obama’s greatest accomplishment as president thus far, based on your comments above you must not be very happy with the POTUS??
Doggone/GA
June 28th, 2011
12:28 pm
“Considering health care reform is widely viewed as Obama’s greatest accomplishment as president thus far, based on your comments above you must not be very happy with the POTUS??”
“Widely viewe” doesn’t mean universally approved…but given how many times it’s been tried, yes, it was a great accomplishment to get ANYTHING approaching universal healthcare passed. Personally, I would have prefered Single Payer – but we weren’t going to get it at the time, so what we got is better than what we had. And it’s a foundation we can build on.
Joe Mama
June 28th, 2011
12:30 pm
Mike — “Considering health care reform is widely viewed as Obama’s greatest accomplishment as president thus far, based on your comments above you must not be very happy with the POTUS??”
In all seriousness, do you not read our comments? Many of us — possibly *most* of us — aren’t happy with him. But don’t think that that will translate into a wave of Democrats voting for Bachmann or Gingrich or Romney or Cain or whoever it is y’all end up nominating next year.
WOODSTOCK MIKE
June 28th, 2011
12:32 pm
@Joe Mama
Listen, I read your comments, and I see that we actually aren’t too different at all, you might not agree, but it’s true…
Paulo977
June 28th, 2011
12:33 pm
Bosch
“long as some people see healthcare as a privilege instead of a right associated with being a citizen of this country, things will not change — until, of course, a majority of people are not privileged enough”
We as a country do not empathise with our fellow humana beings unlike some other some other countries that do. Unfortunately for those of us who vehemently oppose any form of NHC, there is no guarantee that we will not someday join the ranks of those unable to meet the costs of HC!!!!!
The Leg Lamp is a "major award"......
June 28th, 2011
12:34 pm
Joe Mama
June 28th, 2011
12:30 pm
I don’t think a “wave of democrats” is needed. Just a small wave of independents.
WOODSTOCK MIKE
June 28th, 2011
12:35 pm
@Joe Mama
And Romney is certainly a threat so don’t overlook him… At this point, he will be nominated in my opinion and he is extremely sharp, the debates will be very interesting…
USinUK
June 28th, 2011
12:35 pm
JKL –
“Competition doesn’t “solve” everything, but without it you will never see the price of anything go down”
which is why the US spends more than TWICE what other countries who have a single-payer systems spend on healthcare.
and, seriously – blaming Obama for being rude and inaccurate? talk about lame.
Jezz A. Bell - The Phoenician SinSation
June 28th, 2011
12:37 pm
Aquagirl: 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.
For some reason Aquagirl you sound bitter. Mama James worked two Fast food jobs, was homeless, and had a hard time; her life wasn’t a “crystal stair” — nothing was handed to her. Her son had talent, he translated that talent into a profitable enterprise – that’s the American way. He may be a lame a-hole; but he’s a rich lame a-hole and he couldn’t be anymore lame than anyone else who worked for what they had and came up the hard way.
Why all the hate for someone who has done absolutely NOTHING to you nor affected your standard of living one little bit? You wouldn’t be from Cleveland would you? If so, that would explain a lot.
USinUK
June 28th, 2011
12:38 pm
Normal – what Doggone said – you don’t have to hold her up, you need to let her know how you are and that you’ll miss her. it doesn’t sound like it’ll help, but it’s all part of the letting go for both of you.
Thomas
June 28th, 2011
12:38 pm
Biggest Tax Avoiders Would Win on U.S. Tax Break
Here is your next one Jay- from Bloomberg.
Solution- set a system that is not based on world wide taxable income. Charge a repatriation “toll” of 5-10%.
Let’s get a Clinton type back in the House.
Joe Mama
June 28th, 2011
12:39 pm
Mike — “Listen, I read your comments, and I see that we actually aren’t too different at all, you might not agree, but it’s true…”
I certainly can’t speak for you, but if you see it, I can accept that. And I appreciate your polite reply.
My wife and I are both seriously disappointed in President Obama. But as she says, ‘better a halfa** friend than an outright enemy.’ The GOP won’t even consider some of the things on our agenda, and some of the things they want seem — from what I can tell — to run counter to the country’s best interest. Given that, I can’t vote GOP right now, and I don’t see it happening again for a long, long time — maybe not even again in my lifetime.
I’d say those are pretty strong words from someone who never voted for a Democrat until after he’d been voting for 20 years or so.
josef
June 28th, 2011
12:43 pm
Normal
St. Elsewhere…
Joe Mama
June 28th, 2011
12:43 pm
Mike — “And Romney is certainly a threat so don’t overlook him… At this point, he will be nominated in my opinion and he is extremely sharp, the debates will be very interesting…”
I don’t remember if we discussed this last week, but I made someone a bet — I said that I thought that if Romney got the nomination, he’d have to pick a running mate who was farther to the right. Someone like Palin or Bachmann, I think, and the fact that they’re women might be appealing to the GOP movers and shakers.
If someone like Bachmann or Cain gets the nomination, I think they’ll need to choose a more moderate running mate, and if Ron Paul gets the nomination, he will need to have his running mate custom-grown in a protein tank and then beamed down from the Mothership.
janet
June 28th, 2011
12:43 pm
I remember , as if it was yesterday, my mother telling me “if I had known it would be like this I wouldn’t have had the chemo”. She was in her mid 70’s and very healthy and then wham! Cancer of the spine and bones. The doctor gave her his best advice and she took it. She got 6 months extra but the cost to her quality of remaining life was horrible. She went from a “pain in her back” to being a limp rag who could barely move around.
So I think what you, Jay, are asking us is the question most Americans want to avoid. When and how are we going to die? Or better, when and how long are we going to live? Americans simply hate to face the fact that we are going to leave this Earth. In my family, from Spain originally, death and conversation about it was always around the dinner table. Not morose, sad, macabre= just a fact of life.
But we Americans who are accustomed to being able to accomplish almost everything we set out minds to can’t seem to overcome death and so we try to delay it by any means and at any cost.
WOODSTOCK MIKE
June 28th, 2011
12:44 pm
@Joe Mama
We are at a crossroads as a nation, I just hope we can pull through together and become an even stronger country…
It can’t be done if we are divided straight down the middle, we can’t let these boneheads in Washington divide us even more!!
DagnyT
June 28th, 2011
12:46 pm
This is why government should have nothing to do with health care at all (except for military and veterans). We need medical savings accounts, like IRAs where we save all of our lives for the last months or years of our lives and then we can choose how to spend that money, because it is our own money. Spend it and extend your life, or don’t spend it and pass it to the next generation. Yes, this creates haves and have nots.I for one am tired of paying into a system I never expect to get anything out of it. All of these “programs” were put in place before I was born, so I never got a say. How about this, your money, your choice. You can have minimum coverage or you can have a Cadillac plan… your money, your choice. When its taxpayer money, it’s no longer your choice.
I don’t think taxpayers should be on the hook for life extending drugs or enhancing drugs (viagra). Just mercy care and the rest is on you. Harsh, I understand, but health care is not a function of a federal government.
I appreciate your personal stories, but this problem will not be solved with personal stories. This is solved by a analytical look at how we’re spending money and on whom. At some point you have to ask is this a wise taxpayer investment. For these reasons, the government should be removed and this becomes a discussion of family resources and family investment. Would you give up your inheritance for your relative to have a few months more?Or should my child have to work 3 jobs as an adult to pay the taxes necessary for your relative to have a few months more? Unfortunate, yes, but that’s the point we’ve reached. It’s time for an honest, dispassionate conversation on this issue.
too little time
June 28th, 2011
12:46 pm
Finally, Jay. This article IS the crux of the health care problem. You didn’t go far enough, though. You noted end-of-life measures as the boogie man that it is. You failed to note obesity and its associated chronic and terminal conditions. These TWO situations are the very crux of the problem. ObamaCare does not address them. ObamaCare merely steals from the bottom 50% who use 5% of the healthcare dollars and gives it to the obese and the end-of-life patient. Until we can address these situations, ObamaCare will fail and Medicare will fail. I have paid enough into Medicare to fund myself and two other people in old age…IF they aren’t obese and IF they dont spend the last 6 months of their lives in a hospital. Why should I be told that now I have to take a voucher and pay more when, in fact, there is ample money in the system if we face the hard choices. NO, you 350lb person you cannot use up $1million in a heart failure unit if you refuse to be medically compliant, lose weight and take care of yourself. NO you frail 82 year old with pneumonia. We are not going to keep you on a ventilator in the hospital for 6 months while you waste away and die. Until we can make the harsh decisions as a country no amount of government spending will fix the healthcare dollar problem.
Lynn
June 28th, 2011
12:50 pm
@Joe Mama you clearly misunderstood my comments. Serious conditions should be treated up to point. If the cost of the drug is $500,000 for a 6 month life extension, then no I don’t believe the rest of us should foot the bill.
If you read my comments you will see that I also do not agree that we should pay for treatment of psoriasis with a drug that costs $5,000 or more a month. If you choose that treatment then pay the cost. Psoriasis is not a life threatening condition. Paying $5,000 a month will treat the cosmetic complications of the disease (which a family member has) but it not a cost that should be borne by the rest of society.
National health care will from financial necessity be forced to make these and much harder decisions.
JKL2
June 28th, 2011
12:50 pm
USinUK- which is why the US spends more than TWICE what other countries who have a single-payer systems spend on healthcare
England says, “What?” Is that why their healthcare system is the third largest employer in the world?
You want the government to pay for everything while my point is why does the US spend a single dime on it? Healthcare is as much a right as hot wings. If you want to make it affordable, get the government out of it.
AmVet
June 28th, 2011
12:51 pm
Normal, you hang tough, my brother.
Heartbreak is never easy to take, and all I can do is offer you my compassion.
And to janet’s point (and based on my own experiences), I have no regrets and am not at all worried about the “other side”. I’ve had one helluva great run and will try my damnedest to keep on running for as long as I can, but sooner or later, the race is gonna end.
Then my treasure trove of memories and family and friends will have to succor me.
There’s a life full of pain and a life full of glee
So you see that the rain doesn’t mean much to me
For I know that it pays making light
of living’s tragedies
Make your days be as bright
Take a few of these, the sweeter memories
http://www.youtube.com/watch?v=9-ctHzyVDFc
WOODSTOCK MIKE
June 28th, 2011
12:51 pm
The main issues with Healthcare cost is exactly what I’m seeing many people comment on…
New technologies, new drugs, new treatments are only making people live longer lives. This is going to continue, sometimes I wonder how long we will eventually be living…
The result is people that are kept alive will bankrupt the entire system so what’s the answer?
When you have a situation where the people costing the most are the people that have the least amount of money what is the answer??
getalife
June 28th, 2011
12:52 pm
Normal,
“I can do it.”
I have no doubt.
We got your back.
John Stewart
June 28th, 2011
12:52 pm
Where can I gat an application to be on Obama’s Medical Death Panel team? Bring back Amos and Andy!
Doggone/GA
June 28th, 2011
12:53 pm
“Healthcare is as much a right as hot wings”
Healthcare is in the process of becoming a right. We’ll get there. It IS “we the people” who decide what we want as rights and what we don’t. And more and more people are beginning to see that making a profit off someone else’s health is reprehensible – especially when making that profit mean denying them the care they need. The it’s despicable.
Jezz A. Bell - The Phoenician SinSation
June 28th, 2011
12:54 pm
For Aquagirl – please read below.
This whole LeBron discussion reminds me of what I once told my wife after my late night out with blood thinning beverages of choice: “Honey, we all suffer from varying degrees of imperfection.” LeBron James is not perfect. Like me that night, a little compassion would have been a good thing. When we found him short on humility, a better CQ, (cultural qualifier), balance among the thousands of our sports pundits would have produced a more balanced and objective analysis – and less over-the-top, year-long, jersey-burning, media-hyped rancor. If Jimmer Fredette, (BYU), was LeBron James and done the exact same things, would the media portrayal been the same? Hmmm.
Another good example is Michael Vick (dog fighting — served time) and Dany Heatley (Atlanta Thrashers) (killed friend while driving drunk — served no time, got probation).
M
June 28th, 2011
12:54 pm
It appears that deciding whose life is worth what is only considered a “death panel” if it’s part of Obama’s health care plan. Because, you know, it makes a cool bumper sticker.
mm
June 28th, 2011
12:55 pm
Jay,
Shame on you. You know righties can’t read charts. They only understand rightwing talking points. Leave the charts to smart folk, like Jethro Bodine.
Mr Charlie
June 28th, 2011
12:58 pm
I don’t think the majority of you guys realize what is about to happen to this country. Health care will be the least of our worries.
Don't Forget
June 28th, 2011
12:58 pm
The irony here (that non one seems to have picked up on) is that an elderly person with stage 4 cancer can get a $500,000 treatment to extend their life for 6 months with no guarantee that those months will have any quality of life but a working person who makes just above minimum wage with diabetes who supports 3 children will have a hard time getting the things they need to manage their diabetes. As a result, this person has a debilitating stroke or heart attack at age 64 say. They are left disabled and unable to care for themselves. But now they qualify for medicaid and will qualify for medicare when they hit 65 and they will get anything they need.
Ben Franklin said an ounce of prevention is worth a pound of cure. Sounds like a good deal for taxpayers.
Citizen of the World
June 28th, 2011
12:58 pm
Maybe the determination should be made on the basis of average life expectancy. Has the man reached this milestone year already? If so, no go on an expensive treatment (unless he wants to pay for it himself) that would only add months to his life.
This could be applied to any number of expensive treatments that would not offer a cure or a better quality of life, but just extend someone’s life by a matter or weeks or months.
If you’ve had a good, long life, you should count your blessings and accept that the inevitable is nigh. Father Time is undefeated.
USinUK
June 28th, 2011
12:59 pm
JKL – 12:50 – educate yourself:
UK per capita expenditure on healthcare: $2,992
US per capital expenditure on healthcare: $7290
http://en.wikipedia.org/wiki/Health_care_system#Cross-country_comparisons
Gator Joe
June 28th, 2011
1:00 pm
Jay,
Democrats have at least attempted to address the problems of healthcare and the uninsured, something the Repbublicans are unwilling to do. In my opinion, a large part the problem with healthcare legislation, is that the legislators aren’t actually affected by a unaffordable, or unavailable healthcare. Does anyone actually believe anyone in the House or Senate has to worry about coverage? When providing quality, affordable healthcare becomes a priority in the US, without regard to profit, then the situation will begin to improve. Drug manufacturers, big health insurers and their bought and paid for politicians (Republicans in particular) will stand in the way.
getalife
June 28th, 2011
1:02 pm
We found out pro life has a price tag.
My experience with dying family members is it is their choice to refuse treatment and we honor their choice.
My experience with those who want to continue to fight is promise your family members you will never give up.
Don't Forget
June 28th, 2011
1:03 pm
Citizen, age should NOT should not be the criteria. I’ve seen folks who were still mowing their lawn with a push mower in their nineties and I’ve seen people in their 60’s who rarely get out of bed. Functional status and comorbid conditions would be a much better paramter since it probably correlates with likelihood of success of the treatment as well as quality of life of the individual.
Adam
June 28th, 2011
1:05 pm
“Death Panels” have another name: “Health Insurance Companies.”
Repeal and Replace should be: Repeal ACA and replace with Single Payer, abolishing health insurance companies.
WOODSTOCK MIKE
June 28th, 2011
1:06 pm
@Gator Joe
Sorry, you need to do some research, Democrats as well are in bed with drug companies, it’s real simple, look it up and I think you might learn something… Start with Harry Reid…
Uncle Jed
June 28th, 2011
1:08 pm
Leave the charts to smart folk, like Jethro Bodine.
+++++++++++++++++++++++++++++++++++++++++++
Now leave the boy alone. He don’t know much, but he can cypher pert good and his maw is dang proud of that youngun. ELLIE MAE, turn loose of yuh cousin and come down outa dat tree.
Serious though, about the cost of them store bought preescripchuns and such; Granny can fix you a poltice for wahtever it is whats ailing ya. Just stay away from the jug.
getalife
June 28th, 2011
1:09 pm
Mike,
Your partisan rants do help anybody.
Your party bows down to insurance companies and you know it.
Give it a rest.
Joe Mama
June 28th, 2011
1:09 pm
Lynn — “Joe Mama you clearly misunderstood my comments.”
Okay, then by all means, clarify for me. Help me understand your point of view here.
“Serious conditions should be treated up to point. If the cost of the drug is $500,000 for a 6 month life extension, then no I don’t believe the rest of us should foot the bill.”
To be fair, I think that anything that costly is probably just out of clinical trials or has just been approved by the FDA, and I have to wonder if *any* insurance would cover a drug that costly. Can you cite any real-world examples of a drug that costly, please?
“If you read my comments you will see that I also do not agree that we should pay for treatment of psoriasis with a drug that costs $5,000 or more a month. If you choose that treatment then pay the cost. Psoriasis is not a life threatening condition.”
Well, for that matter, neither is rheumatoid arthritis, but you certainly seem to be advocating collective payment for treatments for *that.*
“Paying $5,000 a month will treat the cosmetic complications of the disease (which a family member has) but it not a cost that should be borne by the rest of society.”
But you’re saying that $5K a month to treat *arthritis* is okay. Am I understanding you correctly on that point?
“National health care will from financial necessity be forced to make these and much harder decisions.”
I don’t see the problem. For-profit health care systems are *already* making those decisions.
This is what you said earlier — “(w)e also must stop paying for drugs that cost $5,000 or more a month to treat psoriasis. The drugs were developed to treat the serious condition of rheumatoid arthritis not the less serious skin condition.”
I pointed out that there are FAR more serious conditions that can also be treated by the immunosuppressant drugs you refer to (I’m familiar with them as I’ve been treated with more than one), and that saying ‘we can only treat RA with these drugs’ seems to be an unsupportable position.
If your argument is “psioriasis isn’t worth $5K a month per patient,” then I have to ask how you can justify $5K a month per patient on *arthritis.* It’s true that psioriasis isn’t life-threatening, but neither is RA. There ARE, however, serious and life-threatening autoimmune diseases that can be treated with those same drugs (that are used to treat RA),
Left wing management
June 28th, 2011
1:10 pm
JKL2: “You want the government to pay for everything while my point is why does the US spend a single dime on it? Healthcare is as much a right as hot wings. If you want to make it affordable, get the government out of it.”
Then would you support abolishing the law forbidding emergency care from being refused to an indigent person or someone who can’t prove ability to pay out of pocket?
If not, then you’ll have to swallow your argument and join those of us who argue that health care is as much a right as a basic education.
Jefferson
June 28th, 2011
1:10 pm
Eliminate health insurance completely, let the health care industry charge what people can pay in cash or VISA. I’d bet prices would go down then, and there would be less sick people as they would not live as long.
Gator Joe
June 28th, 2011
1:11 pm
No doubt about it Mike, but I believe Democrats have done more to address the problems with healthcare and the uninsured than have Republicans.
Dan
June 28th, 2011
1:12 pm
I rarely agree with Jay but this is a great discussion, because this is the type of thing insurance or a government run safety net should be for, and it is a difficult decision with no right answer. Everyone puts a different value on 6 months of life. But one thing is certain, the perception of value changes when the beneficary is not the payer.
The main problem with the healthcare debate, is that the line has been blurred between insurance and healthcare, (see Gator Joe’s post) People perceive that their “insurance” should pay for basic health care. People also like to blame insurance and drug companies, because despite the fact that doctors fees are the primary cost, they don’t want to blame doctors. And remember when you are charged $10 for an aspirin at the hospital the drug companies are not getting that markup. People need to understand the real costs associated with healthcare, and not be duped into thiking their $25 copay is paying for their visit
Uncle Jed
June 28th, 2011
1:12 pm
Oh yeah, I forgot to mention; IT’S THE ECONOMY, STUPID!
It’s maws birthday and we are going for a nice drive and some Dawsonville Varsity. Yummm!
Is it 2012 yet
June 28th, 2011
1:13 pm
Anyone notice the riots in Greece?
This will be us in 2013 if we don’t face the situation now and stop our spending and start making our own cuts, rather than wait for China and Mexico to do it for us.
Wake up, forget the politics and get er done