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
Dave R.
June 28th, 2011
2:42 pm
Not so, Adam.
Tax rate INCREASES are off the table, and should be. Nothing could be worse for the “recovery” than to raise income tax rates.
However, the GOP is willing to look at removing subsidies and closing loopholes to clean up the tax code and provide more consistent revenues.
shawny
June 28th, 2011
2:42 pm
Should not be covered by medicare. Should be available for those that want to buy it out of pocket (not most of us).
JKL2
June 28th, 2011
2:44 pm
doggone- It is not, and never will be, a one-to-one issue
Social Security says, “What?”
Dave R.
June 28th, 2011
2:44 pm
Oh, and back to the topic at hand, if you don’t have a current Living Will, you’re doing yourself and your relatives a great disservice.
williebkind
June 28th, 2011
2:46 pm
Regardless of the dilemma government controlled healthcare is the worse solution.
Thulsa Doom
June 28th, 2011
2:46 pm
getalife,
Yes. Big pharma makes a pile and a healthy 20% or more profit margin. I don’t begrudge them their profits though. If you don’t like it don’t buy their drugs. Does it bother me that they recruit college cheerleaders to sell their drugs to docs? Or that they pay the docs for golfing trips, vacations, gifts, etc if they write a certain number of prescips for their drugs such as lipitor? yeah. I don’t like it because its seems like an unseemly alliance. But what are ya gonna do? Outlaw big pharma from selling drugs and from developing new drugs? Then we won’t have any new drugs.
RedEye
June 28th, 2011
2:47 pm
for those of you talking about price transparency for healthcare, here is an article discussing a state bill in Florida which will require urgent care clinics to display costs for procedures. however, the prices are for those who are paying in cash, and not for insured patients
http://www.tampabay.com/news/health/some-florida-urgent-care-clinics-will-be-required-to-post-prices-for/1177493
Adam
June 28th, 2011
2:47 pm
Dave R: Nothing could be worse for the “recovery” than to raise income tax rates.
Depends on who you raise them on. I have said before, a phased tax rate reset to Clinton levels from the top down should do the trick just fine (in addition to phased closing of loopholes, also targeted from the top down).
However, the GOP is willing to look at removing subsidies and closing loopholes to clean up the tax code and provide more consistent revenues.
Only when it comes to ethanol, apparently. They are against eliminating oil company subsidies, for instance.
Of course, we won’t REALLY know what they are will to do on the tax revenue side if they don’t even want to talk about it, either by leaving the discussion or remaining mum after the discussion takes place.
AmVet
June 28th, 2011
2:48 pm
“Regardless of the dilemma government controlled healthcare is the worse solution.”
Perhaps so, which is exactly why single payer is a great answer…
J. Wellington Wimpy
June 28th, 2011
2:48 pm
Government!! Keep your cotton picking hands off my
hamburgerMEDICARE!!!williebkind
June 28th, 2011
2:48 pm
living will
Function: noun
Date: 1972
: a document in which the signer requests to be allowed to die rather than be kept alive by artificial means if disabled beyond a reasonable expectation of recovery.
How can you call that a LIVING WILL?
Don't Forget
June 28th, 2011
2:49 pm
The irony is that if fewer people get these expensive treatments, the cost of the treatments will go up and research into these new treatments will drop as well due to a shrinking market.
Adam
June 28th, 2011
2:50 pm
RedEye: Your figures indicate that tax revenue has gone down and spending has gone up. This is true. My question, though, is how you can then reconcile that ONLY spending decreases must be talked about FIRST. I have no faith in the GOP “Tax Cut and Spend” agenda machine deciding that they will reverse tax cuts or implement any tax revenues AFTER they get their way on spending cuts. I say they put up or shut up, by implementing spending cuts AND tax revenue increases in the SAME legislation. Not one after the other, where they can renege on the deal any time.
Left wing management
June 28th, 2011
2:50 pm
RedEye: “as long as it is the most regulated industry by government any talk about using free market forces to lower prices in healthcare is just a waste of time”
Not sure quite how to respond to this ideological delusion. It’s similar to those who argued that the financial crash of ‘07-08 was the result not of too little regulation, but too much! Just sheer delusion, pure and simple.
The health system we currently have — a purely market driven one — is completely dysfunctional, and the ways in which it is dysfunctional are directly correlative to its free-market foundations.
Dave R.
June 28th, 2011
2:50 pm
“How can you call that a LIVING WILL?”
Because the wishes in that will are enforced while you are still alive, rather than post-death.
Adam
June 28th, 2011
2:51 pm
a document in which the signer requests to be allowed to die rather than be kept alive by artificial means if disabled beyond a reasonable expectation of recovery.
That’s not a living will. That’s a “Do Not Resuscitate”
Adam
June 28th, 2011
2:52 pm
nevermind, I misread the living will thing
Dave R.
June 28th, 2011
2:52 pm
“Depends on who you raise them on.”
No, it doesn’t. Bad idea in the middle of a supposed “recovery” for anybody.
AmVet
June 28th, 2011
2:53 pm
Outlaw BIG pharma?
No.
I’d be happy to just reign in their collusion, price fixing, vote buying/bribery and litany of criminal indictments…
getalife
June 28th, 2011
2:54 pm
“But what are ya gonna do?”
Sorry Doom.
Nationalize and put you out of a job.
When the costs are too high, they have to nationalize health care.
Dave R.
June 28th, 2011
2:54 pm
“I’d be happy to just reign in their collusion, price fixing, vote buying/bribery and litany of criminal indictments…”
Oh, so you’d just like to outlaw Congress . . .
Lynn
June 28th, 2011
2:54 pm
@Joe Mama, I am so glad you are doing better. I am sorry you have to deal with this condition. I wish you the best.
Your situation demonstrates exactly what these drugs and treatments are supposed to do. My comments come at it from a relative’s experience and what I see everyday in my work.
My 90 year old aunt with cancer and brain tumors does not need a week of hospitalization each time she feels shaky or has a urinary tract infection. Yet, that is exactly what happens. With any symptom she is convinced that life is over and wants all of modern medicine thrown at the treatment of the relatively minor condition she may have (UTI). Medicare and her private insurance as a whole can’t afford to continue this type of cost outlay. I am not speaking of just the cost of her care, but as it compares to all patients who receive this level of care. As I talk with her and her providers about more appropriate levels of care I am met with resistance.
This is what we have to overcome. Our culture doesn’t accept death when it is inevitable and is quite willing to “pay” the cost as long as someone else actually pays the bill.
Left wing management
June 28th, 2011
2:57 pm
Thulsa, AmVet: “Outlaw BIG pharma? / No. / I’d be happy to just reign in their collusion, price fixing, vote buying/bribery and litany of criminal indictments”
Yeah I wouldn’t either, at least not for now. Throw shackles around their ankles and lock them in the dungeon, use their waste to fertilize the garden.
You may have some good points on the areas of coverage, Thulsa. I’m not up on where the psychiatric, pregnancy, and other types of coverage fits into the pricing and cost schemes, but my sense is there is going to be a good deal of flexibility needed on these matters.
RedEye
June 28th, 2011
2:59 pm
LWM,
So Medicare, which is the largest payor and spender in healthcare in the US, which is controlled by CMS, a function of HHS, is a private entity? So you’re saying inpatient DRG reimbursements aren’t set by Medicare? (which drives private insurance rates)
I guess that does qualify as a “purely market driven” system. Except for the fact that it doesn’t.
Thulsa Doom
June 28th, 2011
2:59 pm
getalife,
Get a grip. Private health plans will always be with us. Public plans don’t work- just ask England which is moving in the exact opposite direction as us and is moving more towards privatized reforms. They’ve been there, done that, and it doesn’t work.
stands for decibels
June 28th, 2011
3:00 pm
he high prices of the drugs are necessary to support the drug companies’ television advertising budget. After all, we might not know we NEED expensive toxic chemicals if we don’t see the ads.
This is where I mention that, aside from New Zealand, I believe the USA is the only country on the planet that permits advertising for prescription medicine.
I’ve no idea how much of a factor it is in the prices we pay for drugs, but it’s got to play some role.
thomas
June 28th, 2011
3:01 pm
Adam
June 28th, 2011
2:23 pm
Starvation may not be that much of a factor but you must be smart enough to admit that the foods they put into their body certainly raises the cost of their health insurance.
So its simple, we should eliminate the ability of any company to make a profit if that companies product causes the cost of ones health insurance to become more expensive.
Starvation is not the only thing that comes from not being able to afford healthy food. Buying healthy food is actually not an opition for many people who do not make alot of money. Filler food is much cheaper and is what you see as the majority selcetion at most major grocery stores. There are some, very few, that carry truely healty no preservatives or additives types of foods, but they are very hard to find, and are even more expensive.
Seems the cost of health care would go way down if we could just eliminate people’s freedom to choose what to eat and what to do with their own body, as we Americans have shown our selves incappable of being able to make appropriate decisions, like budgeting for health care and such! Or planning ahead to ensure ourselves are marketable to the types of jobs which would include HC as part of the benefits package. Or simply deciding ahead of time, as in before someone gets sick or hurt, that health insurance may be more important than cable TV, or internet, or cell phones, or even a car.
Life’s about decisions, and sometimes people make the wrong one. i do not punish others when I make a bad choice, I should not be punished or responsible when others make bad choices either.
AmVet
June 28th, 2011
3:02 pm
The Kings of FarmaFraud are going mafia and moving in on the dirt-cheap weed market, so they can drive the price of that sky high (get it?)
(May 28, 2011) As DEA raids and IRS harassment continue on state-approved medical marijuana, Big Pharma eyes the profitability of cannabis and prepares to muscle in, using its lobbyists and government connections to ensure a monopoly on legal sales of the drug.
In early April of 2011, two drug manufacturing giants, G.W. Pharmaceuticals and Novartis, announced they had formed an alliance to license and market GW’s Sativex, a liquid cannabis drug. The drug is already available in Great Britain, as well as Canada and Spain. The licensing agreement with Novartis will enable sales to expand into markets in Africa, Asia and the Middle East. FDA Phase III trials are still being organized for Otsuka, GW’s partner for licensing Sativex for the US market.
Unlike other cannaboids produced for recreational or medicinal use, Sativex is not a synthetic but an actual extract of the cannabis plant. It therefore lacks the side-effects of the synthetic drugs which merely attempt to replicate cannabis.
Dave R.
June 28th, 2011
3:03 pm
“This is where I mention that, aside from New Zealand, I believe the USA is the only country on the planet that permits advertising for prescription medicine.”
Yeah, that whole pesky “Freedom of Speech” thing is such a downer, isn’t it?
getalife
June 28th, 2011
3:03 pm
Canada likes it and so will we.
stands for decibels
June 28th, 2011
3:04 pm
Private health plans will always be with us. Public plans don’t work- just ask England
None of the dozens, nay, hundreds I’ve heard speaking from the left side of the aisle in the USA on this topic, is proposing that we actually socialize the delivery system; rather, the insurance system.
I think you know that the UK’s NHS is not equal to Canada’s provincially-based Medicare systems.
And if you ask the English if they’d trade their system for ours, I think you’ll get very few takers.
Doggone/GA
June 28th, 2011
3:05 pm
“Yeah, that whole pesky “Freedom of Speech” thing is such a downer, isn’t it?”
Which, of course, explains why cigarette companies are no longer allowed to advertise on television. They’re being force to exercise their freedom to NOT advertise. Yep, that’s a real “freedome of speech” thing, no doubt.
stands for decibels
June 28th, 2011
3:07 pm
that whole pesky “Freedom of Speech” thing is such a downer
So you’re seriously suggesting that the reason we began permitting the direct advertising to consumers of prescription drugs, back in the 80s, was because we were just such a freedom lovin’ bunch we just hadda?
go on, pull the other one…
AmVet
June 28th, 2011
3:07 pm
I loved it back in the days when those pill pushers couldn’t have their idiotic “freedom of speech” ads on to sell counterproductive and useless “fixes” every fourth commercial.
They are the new tobacco industry. Mixed in with a lot of payola…
Thulsa Doom
June 28th, 2011
3:07 pm
Now if we could only disallow the lawyers from advertising. You know- the ambulance chasers that want you to call them everytime you have a fender bender or anytime you don’t feel good and you suspect it could be the medication you’re taking. Looks like the ambulance chasers have plenty of free speech.
Dave R.
June 28th, 2011
3:09 pm
While I disagree fundamentally with the ban of cigarette advertising, Doggone, I will admit a certain amount of justification exists in allowing advertising of something that is obviously harmful to the consumer.
That being said, if you’re too stupid to understand that inhaling the smoke of a toxic week is bad for you, you deserve to die sooner than those of us who do know that.
Dave R.
June 28th, 2011
3:10 pm
“So you’re seriously suggesting that the reason we began permitting the direct advertising to consumers of prescription drugs, back in the 80s, was because we were just such a freedom lovin’ bunch we just hadda?”
No, I’m saying that we have no Constitutional justification to prohibit said advertising.
Thulsa Doom
June 28th, 2011
3:10 pm
stands for decibels,
And if you ask the English if they’d trade their system for ours, I think you’ll get very few takers.
If that were true then why are the british moving towards a free market system with private reforms? And why do they have substantially lower cancer survival rates. BTW call some oncology practices in border cities like Detroit and Buffalo- I think you’ll be surprised at how many Canadian cancer patients they have.
stands for decibels
June 28th, 2011
3:10 pm
I don’t suppose it’d help to mention that our foolish tendency to allow more-or-less unregulated, unplanned residential development combined with a fossil fuel industry that literally writes legislation for us, plays a pretty significant role in America’s obesity rates, since Americans basically drive everywhere rather than walking or biking? And that if we addressed that as well, it’d probably drive down our healthcare costs?
thomas
June 28th, 2011
3:13 pm
AmVet
June 28th, 2011
3:07 pm
But you’re cool with a Fast Food commercial every 4th one, or a Soda company, or alcohol ads?
Seems there would be less of a need for the counterproductive and useless fixes if we didn’t treat our bodies like garbage disposals.
If the insurance companies should not have the freedom to make a profit, how can you argue that the causes of the need for as much insurance should be allowed to have the freedom to make a profit?
Dave R.
June 28th, 2011
3:14 pm
stands, your 3:10 doesn’t work in real life.
We planned out “live-play-work” communities with centralized retail and sidewalks and bike paths and nobody used them much more than non-planned communities.
stands for decibels
June 28th, 2011
3:14 pm
If that were true then why are the british moving towards a free market system with private reforms?
Talk to me when the NHS is actually dismantled. Last I’d checked David Cameron was getting shat upon for making some incremental moves in that direction.
and again, that’s an entire healthcare delivery system, not just the health insurance system.
Adam
June 28th, 2011
3:16 pm
Dave R: No, it doesn’t. Bad idea in the middle of a supposed “recovery” for anybody.
That’s only if you buy into the idea that people making over a certain amount of money and paying more income tax on that extra money is going to hurt the economy. Which it won’t. Those people aren’t exactly giving jobs away with the tax cuts they’ve already been given, so just roll them back. It won’t hurt them and the US will have a little more revenue. It certainly won’t statistically significantly hurt job creation.
Mighty Righty
June 28th, 2011
3:16 pm
Obamacare was rushed through in the middle of the night in secret without anyone knowing what was in it. Now we all know now, save for a few idealogues, that the bill is a disaster. It will have to be thrown out and redesigned from scratch. The risk will be congress may not be able to a agree on a new bill. In which case, we will be back to the starting grid which was the finest health care system in the history of the world. I guess we can live with that. In our old system, we didn’t have to worry about who deserved to live or die, now did we? That question, Who lives or who dies, tells us a lot about Obamacare.
Adam
June 28th, 2011
3:18 pm
Obamacare was rushed through in the middle of the night in secret without anyone knowing what was in it.
Not Intended to be a Factual Statement.
thomas
June 28th, 2011
3:18 pm
stands for decibels
June 28th, 2011
3:10 pm
thats all true, we are a very stagnant nation!
We should eliminate oil companies freedom to make a profit too.
Go look at the charts showing obesity rates and the WHO’s health system rankings.
Weird how the countries with high obesity ratings are usually in the lower rankings of the WHO, while those countries with very low obesity rates seem to also be at the top of the WHO’s rankings……
Weird!
Joe Mama
June 28th, 2011
3:18 pm
WhateverMan — “I have no problem with free speech nor someone else’s opinion. I do have a problem when their free speech and their opinion ends up taking from my pocket and yours.”
Well, that’s a shame. Freedom of speech protects even freedom that upsets you, and there’s not a lot you can do about it.
“And I agree, if your original agreement with a company said the retirement benefits were to be a certain way, then you have an argument to be upset with your company. However, if those benefits were dependent upon the success of the company being at a certain level and the company doesn’t achieve that or economic reasons cause it to be different, it is unrealistic to think they can live up to everything as promised.”
If the company doesn’t achieve that level of success, do you think that failure is the company’s or the individual employee’s? More to the point, if the company doesn’t think it can deliver on those benefit promises, then perhaps it shouldn’t be making them.
“It is actually remarkable that companies provide healthcare at all. In fact, it might be that the overall price would be lower just by having it up to individuals versus large company contracts.”
I doubt it; the pricing power of large or collective buyers far outstrips the pricing power of individuals. There’s a reason Costco is cheaper than Racetrac on potato chips and anything else they both happen to carry.
“And your argument about insurance regulation doesn’t make sense. I don’t care what government regulation it is (federal, state, local), it doesn’t change the fact that it is regulation that causes this increased expense.”
Given that the regulation you’re complaining about is a collection of 50 different sets of *state* regulations, maybe you could work on getting one state to drop theirs?
No?
Maybe they realize that dropping those regulations (while other states still have them) wouldn’t be in the best interest of their citizens.
Dave R.
June 28th, 2011
3:19 pm
And how many jobs have you created in your lifetime through direct investment of your profits in a particular company, Adam?
No need for an answer there.
AmVet
June 28th, 2011
3:20 pm
Yep, take those Ken Nugent scumbag ads back off the air.
“But you’re cool with a Fast Food commercial every 4th one, or a Soda company, or alcohol ads?”
Nope and fight back the best way I know how. I don’t buy that disgusting fast food crap, or that awful Unreal Thing (or any of it’s cola cousins) or drink pitiable cheap swill. And no matter how many times they try to convince me that “he can’t be a man ’cause he doesn’t smoke the same cigarettes as me.”, I’ve been wise to their Madison Avenue/Hollywood trash since I was a pup listening to the mid 60s Rolling Stones.
For gawdsakes, lots of folks sit around and watch the friggin’ commercials during the Super Bowl???!!!
You’ve got to be shiite-ing me. I walk out of the room.
I will not be manipulated.
thomas
June 28th, 2011
3:21 pm
Dave R.
June 28th, 2011
3:14 pm
Thats true too,
Maybe we should eliminate the freedom of any company that contributes to our sedentary lifestyle. There goes TV and internet coorporations!
stands for decibels
June 28th, 2011
3:22 pm
We planned out “live-play-work” communities with centralized retail and sidewalks and bike paths
good lord, this bit of revisionist history is even sillier than the notion that we flog boner-pills on teevee because we love that Freedom of Speech.
RedEye
June 28th, 2011
3:22 pm
“Obamacare was rushed through in the middle of the night in secret without anyone knowing what was in it.”
I can only agree with the last 7 words in that sentence
stands for decibels
June 28th, 2011
3:23 pm
Maybe we should eliminate the freedom of any company that contributes to our sedentary lifestyle.
I would be in favor of forced internment of people who consistently indulge in false dichotomies.
Jay
June 28th, 2011
3:23 pm
“Go look at the charts showing obesity rates and the WHO’s health system rankings.
Weird how the countries with high obesity ratings are usually in the lower rankings of the WHO, while those countries with very low obesity rates seem to also be at the top of the WHO’s rankings……
Weird!”
You know what’s weird, Thomas? When Michelle Obama makes that same point and tries to encourage people to exercise and eat smarter, she gets accused by conservatives of meddling and dictating and all kinds of other bad things.
THAT’S weird.
Fresh sheets upstairs.
thomas
June 28th, 2011
3:23 pm
AmVet
June 28th, 2011
3:20 pm
then why do you watch the drug company ones?
are you saying it is your responsibility to make your own choices and then…… deal with the consequences of those choices, like not eating fast food and drinking soda?
Or are the people who are fooled by those commercials just too dumb to make a good decision in your opinion?
Adam
June 28th, 2011
3:23 pm
thomas I disagree with your premise. Otherwise I would have responded to that post. I don’t think food intake, the choice of the food intake, or any aspect of it is the biggest reason for health care problems. I think lack of getting to a doctor for routine checkups and preventative care, or other simple stuff, is the problem. Doctors would be able to drive the message home to people doing bad things to themselves if only they were able to see the patient. At that point, it really is a choice rather than an uninformed habit.
Joe Mama
June 28th, 2011
3:24 pm
1811 — “You can get locked up for yelling “I’m gonna punch you in the nose” to your neighbor right here in Georgia”
Voice of experience?
AmVet
June 28th, 2011
3:24 pm
Continued form above…
Seems there would be less of a need for the counterproductive and useless fixes if we didn’t treat our bodies like garbage disposals.
Damn skinny, thomas. (LOL)
If the insurance companies should not have the freedom to make a profit, how can you argue that the causes of the need for as much insurance should be allowed to have the freedom to make a profit?
Perhaps, I’ve missed soemthing critical here, but who exactly has posited that they should NOT make a profit? I’m a capitalist. I just believe in ending their corproate shenanigans that cost people their lives and fortunes…
Dave R.
June 28th, 2011
3:25 pm
“good lord, this bit of revisionist history is even sillier than the notion that we flog boner-pills on teevee because we love that Freedom of Speech.”
Reading comprehension continues to be your weak suit, stands.
However, I have 4 years of government service and decades of planning training that pretty much backs up my statement.
You?
thomas
June 28th, 2011
3:27 pm
Jay
June 28th, 2011
3:23 pm
Painting with a real wide brush there Jay, and you know you are.
Those seem to be fringe groups, not too many elected officials making that argument. Theones who are doing so are simply doing it for political reasons. Which is not a good reason, but is one you have afforded our President on more than one occasion.
Weird how you are unable to do so when it is a member of the political party you disagree with!
especially after you started this entire piece with this…..
“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.”
My God man, is there any hypocritical ground you are not affraid to stomp on?
Mighty Righty
June 28th, 2011
3:27 pm
stands for decibels
June 28th, 2011
3:10 pm
“I don’t suppose it’d help to mention that our foolish tendency to allow more-or-less unregulated, unplanned residential development combined with a fossil fuel industry that literally writes legislation for us, plays a pretty significant role in America’s obesity rates, since Americans basically drive everywhere rather than walking or biking? And that if we addressed that as well, it’d probably drive down our healthcare costs?”
I would point out our forefathers walked everywhere and died in their 30’s. But you are right about one thing. Their health care costs were low. No Big Macs either. Clean air and plenty of exercise. I think I’ll take my bergers and pollution, thank you.
Adam
June 28th, 2011
3:27 pm
Dave R: And how many jobs have you created in your lifetime through direct investment of your profits in a particular company, Adam?
That doesn’t matter. Besides, have you? Even if you have, it still doesn’t matter. If you can clothe, feed, and shelter your entire family, and live well on top of all that, and THEN SOME, you’re not going to get hurt by a marginal tax rate increase. And statistics already show that when tax cuts are given along the same lines, jobs are not created. The money is simply kept. So I stand by my statement.
thomas
June 28th, 2011
3:28 pm
AmVet
June 28th, 2011
3:24 pm
Go back and read through the comments, it has been mentioned directly more than once, and indirectly more than twice…..
No need to call names you can read!
Left wing management
June 28th, 2011
3:29 pm
Ok, RedEye, you got me. I should have said the US is “primarily” a private market system.
Mighty Righty
June 28th, 2011
3:30 pm
Jay
June 28th, 2011
3:23 pm
“Go look at the charts showing obesity rates and the WHO’s health system rankings.
Weird how the countries with high obesity ratings are usually in the lower rankings of the WHO, while those countries with very low obesity rates seem to also be at the top of the WHO’s rankings……
Weird!”
You know what’s weird, Thomas? When Michelle Obama makes that same point and tries to encourage people to exercise and eat smarter, she gets accused by conservatives of meddling and dictating and all kinds of other bad things.
THAT’S weird.
I will tell you what is weird. She is about 30 pounds overweight telling me how to eat.
RedEye
June 28th, 2011
3:32 pm
I thought Michelle my bell was costing us 700K over in Africa and only eating french fries or something
Jay
June 28th, 2011
3:35 pm
I never said “all conservatives,” Thomas, or “most” or even “many.”
But when you get Limbaugh, Malkin, Palin, Beck and others, along with a good number of people on this blog making that claim, I’m satisfied as to the accuracy of my statement.
Joe Mama
June 28th, 2011
3:39 pm
Lynn — “Joe Mama, I am so glad you are doing better. I am sorry you have to deal with this condition. I wish you the best.”
I appreciate that very much.
When I woke up in recovery, I was still groggy from the sedation, but I was aware enough to tell my wife “it doesn’t hurt any more . . . I can’t feel it.” For the first time in two years, I didn’t feel like I was digesting two pounds of roofing nails.
I now have forward- and aft-firing b*ttholes, but the old one doesn’t really work any more.
If you can’t tell, my wife and I try to make a joke out of my situation, and the nurses over at Northside (i was hospitalized for UC several times before we actually did the surgery) all said that we had an incredibly positive attitude and outlook. I pointed out that I’m not yet 50, and what was I going to do — just stop living?
Here’s a joke we like about having an ileostomy — when it come to peeing, women sit and men stand, but only ostomates can crap standing up, ha, ha.
“My 90 year old aunt with cancer and brain tumors does not need a week of hospitalization each time she feels shaky or has a urinary tract infection. Yet, that is exactly what happens. With any symptom she is convinced that life is over and wants all of modern medicine thrown at the treatment of the relatively minor condition she may have (UTI).”
I think your aunt may simply be terrified of her situation. I don’t think that’s so unusual. We all have different responses to ill health, and when we die, we will approach the situation differently. Some will go quietly and peacefully, while others may struggle until the last moment. I hope I’m one of those who’s able to go peacefully, whether I’m conscious or not.
“Medicare and her private insurance as a whole can’t afford to continue this type of cost outlay. I am not speaking of just the cost of her care, but as it compares to all patients who receive this level of care. As I talk with her and her providers about more appropriate levels of care I am met with resistance.”
My mom’s retired, and while she’s not as old as your aunt, she’s on Medicare and BCBS. Fortunately, we haven’t needed to deal with any serious health conditions on her behalf. But I do worry that we will eventually have to bear that burden with her.
yuzeyurbrane
June 28th, 2011
3:55 pm
Health care is already rationed–by money. Would it be more equitable to ration it on the basis of need? This would mean taking profit out of the system. But even then, some drugs are more costly to produce than others and even socialized systems ration health care partially by cost.
Paulo977
June 28th, 2011
4:35 pm
stands for
decibels
“And if you ask the English if they’d trade their system for ours, I think you’ll get very few takers”
O YES , I know that for sure as I have a large family and friends there!!!
Paulo977
June 28th, 2011
4:40 pm
Mighty Righty
“will tell you what is weird. She is about 30 pounds overweight telling me how to eat”
Face it she is gorgeous ,articulate, brilliant and, oh yes, her husband is now the president!!!! Choke on it!
JKL2
June 28th, 2011
5:12 pm
Jay- tries to encourage people to exercise and eat smarter, she gets accused by conservatives of meddling and dictating and all kinds of other bad things.
Telling people what they should be eating is one thing. Passing laws to force restaurants to serve certain foods, or how to cook (like no salt in NY) is another. I think she has a good message, I just think it gets hijacked by all the left wingnuts out there (and then blame Bush/the right for the distortion they had nothing to do with).
Uncle Billy
June 28th, 2011
5:52 pm
The competitive market does not work well in medical care for several reasons:
1. The incidence of the need for it is very unpredictable for most of us. The exception is for those who have conditions which make it predictable that they will need a lot of it.
2. The fact that expenses can run very high means that you have to have an insurance policy if you can get one.
3. If you have a serious medical condition you may not be able to get one. You absolutely cannot get one if you go to the individual market.
4. Unlike most markets, you probably do not know enough to decide what you need so you have to rely on the physician who has the requisite expertise.
5. You do not deal with the physician or hospital about the costs. The insurance company does.
6. The physician has an obligation to act in your best interest and not in his/her own. They take an oath. That all do not always do this does not cancel the obligation. Storeowners are not under any such obligation. Nor do you expect them to be. Insurance companies have limited interest in your well being as do pharmaceutical manufacturers.
7. Our society decided, like most, that some level of medical care should be available to everyone just like some level of education. We are not prepared to let people suffer and die if they cannot afford medical treatment. That is why our governments already pay for almost half of all medical care delivered.
On Jay’s main question, we do not have the right to expect for others to pay for any and all medical care. If one wants some expensive treatments which will bring not very much benefit he/she ought to pay for them if they are able. As George Bernard Shaw said once, “Do not try to live forever. You will not succeed.”
oldguy
June 28th, 2011
5:56 pm
Uncle,
Who decides who is costworthy and who is not??
saywhat?
June 28th, 2011
5:58 pm
If Medicare tells the maker of Provenge, that yes, they will reimburse for the drug, but that they will only pay $500 ( or $1000, or more or less) per month for it, take it or leave it, what do you think the makers of Provenge would do? My bet is they would take the deal.
oldguy
June 28th, 2011
6:00 pm
currently Insurance companies can fight providing a service if they think it is not costeffective BUT they are well aware you can sue if they fight it so they are subject to changing their mind (and do).
YOU CANNOT sue the government….so when they say no….YOU ARE DEAD!!
oldguy
June 28th, 2011
6:08 pm
currently drug companies look at what is the potential return on their investment in research…..if the potential return is low (limited market application i.e. to few potential customers) they WILL NOT work on developing a drug…..What do you think they will do if you cut their return in half??
My daughter has a very rare form of cancer….Her Dr tells us that there is no current research going on in the field as there is no profit to be made on their return-on-investment. Do you think that will change with government-run healthcare??
Jimmy
June 28th, 2011
6:34 pm
With all the debate about PSA tests, what is a person to believe about early detection of Prostate Cancer. Mine was caught early, and I like to believe it was the right thing for me to undergo the testing, and then the 43 radiation treatments.
C. Dickens
June 28th, 2011
6:54 pm
“At what point, if any, do we decide that the marginal gain in lifespan is no longer worth the investment?”
If they’d rather die, then they had better do it and decrease the surplus population. E. Scrooge
Study: 5% account for almost 50% of medical costs | Sarasota Plastic Surgeon
June 28th, 2011
7:43 pm
[...] and is the driving force behind double-digit increases in insurance premiums, the National …The moral, financial dilemma at the heart of health careAtlanta Journal Constitution (blog)State Based Health Exchanges Are ImportantHuffington Post [...]
Uncle Billy
June 28th, 2011
7:50 pm
oldguy. You get to decide the care you get if you are willing to pay for it. If you are not or cannot somebody else gets to decide. Which will usually be the insurance company.
Uncle Billy
June 28th, 2011
7:56 pm
Folks, my last word on this subject. Life is full of decisions that need to be made about you and you do not get to make all of them. There is the old who/whom divide. Who does and to whom is it done.
Z
June 29th, 2011
2:39 pm
Until profit is taken out of Health-care in this country we will continue to go down hill. Universal Health-care for all.
The moral, financial dilemma at the heart of health care | Jay Bookman – Slinking Toward Retirement
June 29th, 2011
11:12 pm
[...] The moral, financial dilemma at the heart of health care | Jay Bookman. Share this:EmailFacebookRedditDiggPrint Posted in Health Care Reform, Opinion – Tagged 3 pennies, accident, course, decision, financial dilemma, half, health care dollar, health care management, health care spending, Jay Bookman, life, medicare, national institute for health, new drugs, Patient, percent, population accounts, profound questions, prostate, Technology SHARE THIS Twitter Facebook Delicious StumbleUpon E-mail « TSA Continues To Harass Tots and Seniors | The Barr Code No Comments Yet [...]
Vincent
July 2nd, 2011
12:18 pm
There was a comment that implied that “if you catch prostate cancer early, it will be cured.” I was treated early (in2003), but am now in stage 4 because I have the most aggressive form of cancer. I’ve had six month checkups consistently.
There was another comment about treatment being too expensive because all men eventually get prostate cancer. The truth is (per Johns Hopkins and Sloan Kettering) that 90 % of prostate cancer patients will die from something else. I just happen to be in the most aggressive 10%.
My father died of this disease in 1985. I have found out the cancer is an evil genius directing other parts of the body to do its bidding. All forms must be trying to be genetic. Otherwise, hw can they live forever. We are getting close to real beakthroughs. DNA, pathways, etc. are current terms that will lead to a much longer life.
I keep reading that big pharma are the richest companies in the world and are sitting on almost endless bundles of cash. I think they always see what the market will bear when a new drug comes out. Do a lot of arm wrestling. Eventually the price comes down. They do spend on research, but the amount they spend is exaggerated.
Anothe problem is that the companies do not want their drugs comared to others in a clinical trial. None of them want anyone to know which drug is more effective. They might lose sales. Competitive drugs will arrive before too, too long and (if there is no price fixing) prices should go down.
I don’t want to be shut off from a drug before prices go down. Don’t blah to me unless you are terminal yourself. Talk is cheap. The time limits that life gets extended are all medians. If one takes care of oneself (mostly diet), one can live longer on these drugs. If someone eats cheeseburgers and fries and drinks soda daily, he is asking for it.
I myself am also doing everything I can to extend my life. Diet, supplements, exercise, and meditation. LIke chicken soup. Can’t hurt. Michael Milken (junk bond king) was told he had a year to live when he got out of prison. I believe that was about 17 years ago. He credits a strict vegetarian diet and meditation. Hopefully, he does not have a secret medicine he is not telling us about. He went right back in the market,has a bundle of cash, and has set up a foundation to fight prostate cancer. I give him credit.
Live every day like it’s your last, even if you are not sick. That person drivng while on a cell may T bone you tomorrow. But, hopefully not. You never know.
Waffle House
July 3rd, 2011
4:21 pm
Is anyone on this blog subject to Obama’s tax increase plans? Will anyone on this blog in the running to make more than $250 000 after deductions?
Once, I was at Waffle House and there I heard 2 waitresses arguing against the inheritance tax saying it was so unfair! I asked if they were planning to leave a lot to their children. They said that they were barely making it at about $11 000 per year at Waffle House but they wanted to leave their homes to the children. How much were these homes? $33 000 and $41 000! .
Sounds like I am at Waffle House here….. Whose taxes are you asking to be lowered?