Grover-
I suppose things could get worse - worse than spending 18% on GDP and having the worst outcomes and shortest lifespan in the developed world.
Or we could keep things as they are, with costs rising at … what, 10% per year?
I don’t think doing nothing is an option. Or - did you present an option I didn’t see?
Again, I’ve seen national healthcare work. It requires death panels, but it works.
The core reason why it works is competition. With basic medical care for free for everyone at the lower end, the for-profit hospitals figure out they can’t be rapacious jerks because people will have a choice. So they have to compete with each other on cost and quality.
Insurance companies can’t charge too much either - competition sees to that. Worst comes to worst, you can go without insurance because you can always fall back to the (proposed) public system which will keep you alive, but may not provide the newest drugs, or the fanciest equipment.
Right now, we’re locked into the must-have-insurance most-expensive-care-possible system, because we don’t have a choice.
Death panels are the answer. Death panels enable low cost, basic medical care for everyone.
Dave,
I didn’t provide a solution. I really don’t see any “solution” being politically viable - including yours. The big boyz have toooooooooooo much money at stake and toooooooooo many connections in congress/media/etc. By the way, who regulates the death panels? If you were told that you didn’t meet the panel’s criteria, would you glibly accept it and invest in a coffin? Of course, high net worth customers can buy their own health care. That makes it death panels only for the unwashed. Is that the new definition of universal? Where have you seen national health care work?
We got to this point because of all the “great” ideas foisted upon us in the past. The programs may have started as small, humane measures but have grown bit by bit due to spaghetti code law that benefits the patrons of lobbying groups. Every US federal government program has these. Because the system is so corrupted, nobody can fix it. It will only get more corrupted and more convoluted. Eventually, there won’t be enough energy available to feed all the complexity and the system will collapse. The problem will fix itself.
Grover
The problems will fix themselves.
The death panel was a term used by the for-profit medical industry to scare people out of voting for national healthcare. Sarah Palin popularized it. https://en.wikipedia.org/wiki/Death_panel
Concept is simple. Who determines the standard of care? That’s also known as a death panel. But unlike Palin who was just carrying the water for the sickcare cartel, I’m embracing the concept because it will serve to keep costs down.
Do you get one nurse to deliver a baby? Or do you get an entire medical team? Death panel decides. And if I were on the panel, you’d end up getting just the one nurse.
I think “free healthcare” should be basic - so it can be affordable for the state to give to everyone. It shouldn’t be throwing literally everything we have at every person who walks through the door. We can’t afford that.
So - expensive procedures - the state won’t do them. If you want an expensive procedure (organ transplant!) you pay for it. If you want a common procedure done (baby delivered, broken arm fixed, inflamed appendix removed, gunshot wound fixed), the state will do it for free. If you want the $100,000/pill drug treatment - sorry. State won’t pay.
Of course, high net worth customers can buy their own health care. That makes it death panels only for the unwashed. Is that the new definition of universal? Where have you seen national health care work?Of course the great unwashed get death panels. Free stuff has to be rationed. That's just common sense. And of course rich people get better stuff. They get better wine, better food, better cars, better seats on the plane, and - yes, better medical care. Private rooms, a flock of nurses on hand to attend to their every complaint. It is just how things go. Pretending otherwise is just silly. And I didn't say "universal" (somehow implying that everyone gets the same first-class seat on the healthcare plane), I said "national." And basic. Basic, national healthcare. As to where national healthcare works - that would be Thailand. They give everyone care for 4.3% of GDP. You'd think if a relatively corrupt emerging market nation (which has a military coup every few years, seemingly just to keep the weaker souls from traveling there) can provide national healthcare, the US should be able to figure out a way to make it happen. Nothing is perfect (people go to hospital when they have a cold) but - they cover literally everyone, for 4.3% of GDP. But its basic. That's how they can make it happen. https://en.wikipedia.org/wiki/Health_in_Thailand And their death panels said: if you are having a baby, you get one nurse. And I suspect they don't have any $80,000 pills either. If you were in the lower 50%, and your job didn't provide you healthcare, I bet you'd vote to get my "basic national healthcare" program over the expensive and life-shortening system we have now. Poverty chops 7 years off your life - and the single leading cause of bankruptcy is an unexpected healthcare event. By that poverty-inducing mechanism, our cartel-controlled rapacious rentier people-harvesting sickcare system is killing people - via poverty - each and every year, just so the small gang at the top can get even richer. As for you saying "it can't happen", I agree to a point. I believe with our current mind set and cast of characters in place, it won't happen, but I'm preparing for a future for when that mind-set (and cast of characters) changes. In that future, I am envisioning what program I'd like to put in place. First step to creating a new world is envisioning what you want it to look like. I want to move beyond complaining, throwing-up-the-hands, and saying "it is impossible to change." And I don't think we need to await Gotterdammerung for such a thing to come to pass.
I just want to clarify the terminology re: standard of care. It is a legal term:
Medical Definition of Standard of care - MedicineNet
A nurse who delivers babies would therefore could be held to a different standard than an MD with subspecialty credentials. Death panels related to end of life decisions are a very particular process.
I think rationing is a necessity in the delivery of any needed service where supply cannot meet demand just wondering who should decide that issue. Agreed basic health care on a national level works in other countries like Thailand and would be a very good thing here.
Heh. Pardon my misuse of the terms of art in your industry. I just enjoyed hijacking the term “death panels” for my own purposes and got carried away.
There would have to be some method for establishing the level of service that would be provided. I suggest we toss out whatever current “standard of care” happens to be - its probably overkill. The essence of my point is that the system I envision should not be handicapped by the usual American desire to use heroic measures at every turn, and provide everything to everybody. “We spared no expense” is our usual motto, as if we had infinite money and resources, but as we slide down the other side of peak oil, its probably a luxury-mindset we can no longer afford.
Basic care should be basic care. Generic drugs unless there is a truly compelling difference. Use nurses instead of doctors if possible. No heroic measures if not warranted, no “defensive medicine” - in fact, no malpractice-for-money if you work for the state. The system should target 95% of most people’s basic medical needs using a reasonable but perhaps somewhat spartan level of effort.
If you have an “interesting case”, the state system probably can’t deal with you.
And the healthcare workers get their medical school loans paid if they work for the state system for 7 years.
That’s my vision.
I mean, if Thailand can do it…surely we can too. Then again, they are fairly pragmatic about life because they are constrained to live a generally lower energy-input lifestyle.
But basic state-provided care is possible, and it doesn’t need to cost all that much. In exchange, we just have to be ok with basic care as the (free) baseline.
Can we get used to that approach as a country? I think we have no choice.
Thought that might be interesting click-bait. Just wanted to toss this topic out as it seems to come up from time to time with end of life options. One more potential bridge to cross or slippery slope, IMO.
The Netherlands appears to be going the way of nearby Belgium, with that 0.2 percent statistic climbing rapidly. In 2009, 12 patients with dementia were euthanized. In 2016, there 141 cases reported. And for those with psychiatric illness, there were no cases in 2009 but 60 in 2016. Boudewijn Chabot, a psychogeriatrician and prominent euthanasia supporter, said in June that things are “getting out of hand.” He continued, “[L]ook at the rapid increase … The financial gutting of the healthcare sector has particularly harmed the quality of life of these types of patients. It’s logical to conclude that euthanasia is going to skyrocket.” In North America, Alex Schadenberg warns, “People need to recognize that euthanasia or assisted-suicide laws will be abused. Will assisted death be your choice or will it be imposed on you?” https://www.lifesitenews.com/news/dutch-euthanasia-getting-so-out-of-han...And this, from 1973:
Soylent Green is a 1973 American science fiction thriller film ... it combines both police procedural and science fiction genres; the investigation into the murder of a wealthy businessman and a dystopian future of dying oceans and year-round humidity due to the greenhouse effect, resulting in suffering from pollution, poverty, overpopulation, euthanasia and depleted resources https://en.wikipedia.org/wiki/Soylent_GreenBut I digress. Who would'a thunk?
Yes we agree about the midwives and prenatal care. That’s the kind of basic care I am talking about. Things everyone needs to live their normal lives.
Kaiser seems to do a decent job (from observation - I’m a long-time member) about the preventative side of things, since they see it as a way to lower their costs long term. They certainly do rationing too.
However, we don’t agree on the “actual medical need” part. There may be an actual medical need for a $100,000 pill for a given patient; in that case, I would lean towards saying no to the patient, but under the “actual medical need” paradigm, you might say yes.
Some things are just really expensive because the government is willing to write a check for it. Once the government stops writing the checks, I’m guessing the price will drop. If the basic system only provides generics, I suspect prices of a whole lot of things would suddenly fall through the floor.
That, along with getting rid of the fake patent lifetime extensions alongside some criminal prosecutions for price-fixing (which supposedly is in progress right now) and we could get costs down to below 10% of GDP faster than you can shake a stick.
The Netherlands appears to be going the way of nearby Belgium, with that 0.2 percent statistic climbing rapidly. In 2009, 12 patients with dementia were euthanized. In 2016, there 141 cases reported. And for those with psychiatric illness, there were no cases in 2009 but 60 in 2016.My grandmother had dementia. She knew what was happening to her. I was her favorite grandson (or so she liked to tell everyone - I was also her only grandson), and I was driving her from a home she was living in to visit our family, and she grabbed my arm and looked into my eyes and said, "you have to promise me, when it gets bad, just kill me." Heaven help me, I promised her that I would. Ît definitely got bad. Of course I couldn't kill her. She was my grandmother. So ... euthanasia. I can definitely see where that could be a blessing. And a slippery slope. But sliding down the other side of peak resources...we might not have the luxury to warehouse people for years...
I’m in the “when it gets really bad just kill me” camp as well. At least with respect to advanced dementia. I have told my wife, kids and siblings this and have WRITTEN IT DOWN so that there is universal understanding of my intention. (Even one family member who want to “prolong life at all costs” can make it nearly impossible for the other family members to make that call unless the patient has put their wishes in writing.)
Comfort Care Only is a recognized medical treatment strategy for the end of life and is recommended for those with dementia and end-stage, unsolvable, health conditions.
- no antibiotics
- no IV fluids
- no surgeries
- no ICU
- do not take me to the emergency room when I have problems, call the hospice nurse.
- no invasive lines or tubes of any kind
- do not feed me after I am unable to eat
- do not give me water after I no longer feel thirst and am unwilling to drink water.
- Give me comfort medications when needed (such as pain and nausea)
- Keep me clean and dry (change my diapers and sheets)
- Put my Teddy Bear in bed with me, hold my hand, talk to me so I can hear your voice.
The $100,000 pill is probably a fiction, but in universal health care countries the gov’t negotiates with pharmaceutical companies to lower the cost of medications. In our country (US) the legislature and executive have seen fit to deny gov’t the right to negotiate drug costs. Hence, the $750 pill that cost about $13 before Martin Shkreli bought the company.
https://www.cnbc.com/2015/09/21/drug-goes-from-1350-a-tablet-to-750-over…
That wouldn’t have happened in Canada.
As I understand it, big pharma is the most powerful lobby in Congress.
Here’s a discussion of the topic put out by Kaiser. Of course Kaiser has a big dog in this hunt and its analysis may be suspect. Nowhere in the discussion is the alternative of universal health care mentioned. Until that becomes a real possibility, honest discourse on the subject will be at a premium.
https://www.kff.org/medicare/issue-brief/searching-for-savings-in-medica…
Of course euthanasia is common in the US as well as just about everywhere else. My mother and mother-in-law chose to OD on hospital administered drugs rather than spend much the rest of their lives in a hospital bed. If you or those close to you haven’t been involved in this kind of decision yet, you’re probably pretty young.
Dave,
Your idea sounds great! Now, how do we get it to survive intact through the legislative process? Remember that the big boyz aren’t concerned about the well being of the little people. They are only concerned with amassing more tokens in the game. The winner is the one with the most tokens ($.)
My point is that any idea that hurts them won’t see the light of day. Your idea will be interpreted as a big hit to a lot of bottom lines. That’s the bugaboo that will kill any and all reforms. I hate the current system! I honestly believe that nothing (literally) would be better. They interpret my last sentence to read that I’m completely happy with the current system because nothing would be better.
Greed knows no bounds. That is what got us to this point. However, the earth has definite finite limits. When energy (or other resource limits) constraints impact the economy, lots of these “great” ideas will be too expensive to maintain.
Grover-
I’m in full agreement that as things stand right now, with the insurance and drug cartels exercising their chokehold over government, no plan other than “funneling even larger profits for the cartels” has a chance of passing.
(We might see “picking a different set of winners” - insurance vs drug companies, etc, but that’s about it).
I also believe that a crisis will open the door towards a fix for these problems. Perhaps when healthcare is 25% of GDP, or 30%, or 50% (with premiums at 50% of our incomes), we will finally ignore “statues” and “nazis” and all the rest of the distractions and call them to account.
When that happens, I’d like to be mentally (and energetically) prepared.
Can’t happen? 4 years ago did you imagine Trump could possibly win? I thought it was a joke when he announced. I think most people did. And yet, here we are.
Anything really can happen. And fast, if the right things align - when the tipping point is reached.
Ultimately, even in a world of substantially less, we can still afford (as a society) a basic national healthcare plan. If Thailand can do it, so can we. Their per capita energy budget is about 1/4 of ours. And if we keep it basic, we’ll have a much broader coalition that supports it.
No doubt the kind-hearted (Yoxa!) and the drug companies will join forces to beg for more money because that (metaphorical) $80,000 pill will save all those suffering children (and the suffering drug company executives, and shareholders) but if we’re firm and stick to the basics, we should be fine. Its all very affordable.
There really is an $80,000 pill. I just can’t locate it. It was a new thing - “personalized medicine.”
A fine, revolutionary product for the top 0.1%. Meanwhile, you can read about:
http://www.compoundingpharma.net/most-expensive-prescription-medications-sovaldi-cost/
Change can happen rapidly.
This time is not different.
-Snydeman
PS- Over the weekend we ordered about $500 of dehydrated and long-term storage foods, purchased about $200 worth of canned goods to stock our pantry back up to full, and ordered two crossbows as well as other tools and books. Better a year early than a day late, and I sense the tipping point isn’t here, it was there. points back about a year
I just read that new data released by the pentagon put the daily expenditures for war at $250 million per day for the last 16 years.
Why do we argue over the leftovers like there isn’t any money to take care of the people’s needs ?
Tim.