37th?

[Keroin]

Found this article while doing some work-related research today. Thought it was interesting enough to share.

"Why do we spend so much to get so little?"

Valid question.

 

[Netzach]

How are we in education? Valid answer.

 

[JMohegan]

Found this article while doing some work-related research today. Thought it was interesting enough to share.

"Why do we spend so much to get so little?"

Valid question.

Yes, it is a valid question.

One reason for the low U.S. ranking in that particular study should be obvious when looking at the 2nd and 3rd of the stated objectives: "improving health, reducing health disparities, protecting households from impoverishment due to medical expenses, and providing responsive services that respect the dignity of patients."

For those who can afford it, our health care system is second to none. Problem is, not everyone can afford it, with the result that we've got personal bankruptcies for many and no access to anything but emergency care for many more.

Another big reason relates to our political inability to rein in costs related to end-of-life care. Extensive discussion of the issue may be found here: The Cost of Dying. I find the excerpt below to be particularly compelling. [Note - Keroin, "Medicare" is the US government-administered health insurance program for people aged 65 and older.]



When it comes to expensive, hi-tech treatments with some potential to extend life, there are few limitations.

By law, Medicare cannot reject any treatment based upon cost. It will pay $55,000 for patients with advanced breast cancer to receive the chemotherapy drug Avastin, even though it extends life only an average of a month and a half; it will pay $40,000 for a 93-year-old man with terminal cancer to get a surgically implanted defibrillator if he happens to have heart problems too.

"I think you cannot make these decisions on a case-by-case basis," Byock said. "It would be much easier for us to say 'We simply do not put defibrillators into people in this condition.' Meaning your age, your functional status, the ability to make full benefit of the defibrillator. Now that's going to outrage a lot of people."

"But you think that should happen?" Kroft asked.

"I think at some point it has to happen," Byock said.

"Well, this is a version then of pulling Grandma off the machine?" Kroft asked.

"You know, I have to say, I think that's offensive. I spend my life in the service of affirming life. I really do. To say we're gonna pull Grandma off the machine by not offering her liver transplant or her fourth cardiac bypass surgery or something is really just scurrilous. And it's certainly scurrilous when we have 46 million Americans who are uninsured," Byock said.

"Every other major industrialized nation but the United States has a budget for how much taxpayer funds are allocated to health care, because they've all recognized that you could bankrupt your country without it," David Walker told Kroft.

Asked if he is talking about rationing, Walker said, "Listen, we ration now. We just don't ration rationally. There's no question that there's gonna have to be some form of rationing. Let me be clear: Individuals and employers ought to be able to spend as much money as they want to have things done. But when you're talking about taxpayer resources, there's a limit as to how much resources we have."

 

[Netzach]

Yes, it is a valid question.

One reason for the low U.S. ranking in that particular study should be obvious when looking at the 2nd and 3rd of the stated objectives: "improving health, reducing health disparities, protecting households from impoverishment due to medical expenses, and providing responsive services that respect the dignity of patients."

For those who can afford it, our health care system is second to none. Problem is, not everyone can afford it, with the result that we've got personal bankruptcies for many and no access to anything but emergency care for many more.

Another big reason relates to our political inability to rein in costs related to end-of-life care. Extensive discussion of the issue may be found here: The Cost of Dying. I find the excerpt below to be particularly compelling. [Note - Keroin, "Medicare" is the US government-administered health insurance program for people aged 65 and older.]



When it comes to expensive, hi-tech treatments with some potential to extend life, there are few limitations.

By law, Medicare cannot reject any treatment based upon cost. It will pay $55,000 for patients with advanced breast cancer to receive the chemotherapy drug Avastin, even though it extends life only an average of a month and a half; it will pay $40,000 for a 93-year-old man with terminal cancer to get a surgically implanted defibrillator if he happens to have heart problems too.

"I think you cannot make these decisions on a case-by-case basis," Byock said. "It would be much easier for us to say 'We simply do not put defibrillators into people in this condition.' Meaning your age, your functional status, the ability to make full benefit of the defibrillator. Now that's going to outrage a lot of people."

"But you think that should happen?" Kroft asked.

"I think at some point it has to happen," Byock said.

"Well, this is a version then of pulling Grandma off the machine?" Kroft asked.

"You know, I have to say, I think that's offensive. I spend my life in the service of affirming life. I really do. To say we're gonna pull Grandma off the machine by not offering her liver transplant or her fourth cardiac bypass surgery or something is really just scurrilous. And it's certainly scurrilous when we have 46 million Americans who are uninsured," Byock said.

"Every other major industrialized nation but the United States has a budget for how much taxpayer funds are allocated to health care, because they've all recognized that you could bankrupt your country without it," David Walker told Kroft.

Asked if he is talking about rationing, Walker said, "Listen, we ration now. We just don't ration rationally. There's no question that there's gonna have to be some form of rationing. Let me be clear: Individuals and employers ought to be able to spend as much money as they want to have things done. But when you're talking about taxpayer resources, there's a limit as to how much resources we have."

I *can* see why the disability community gets extremely skittish around this issue though. I desperately believe that better attention to the rights of the disabled and the things the disabled have to say about their OWN quality of life is needed.

However I think a defibrillator when you're terminal and 93 is just a form of torture. T says he had relatives who lived so long they just wandered in front of trains in the early half of the century. People need to be able to check in OR out under reliably voluntary circumstances, and I think we're too comfortable neglecting to suicide-counsel someone with a disability we aren't comfortable with ourselves.

As with other volatile things, I think un-coerced decision making is the only way to guard life. The ability to decide for oneself, truly for oneself is the opposite side of the coin of force.

 

[JMohegan]

I *can* see why the disability community gets extremely skittish around this issue though. I desperately believe that better attention to the rights of the disabled and the things the disabled have to say about their OWN quality of life is needed.

However I think a defibrillator when you're terminal and 93 is just a form of torture. T says he had relatives who lived so long they just wandered in front of trains in the early half of the century. People need to be able to check in OR out under reliably voluntary circumstances, and I think we're too comfortable neglecting to suicide-counsel someone with a disability we aren't comfortable with ourselves.

As with other volatile things, I think un-coerced decision making is the only way to guard life. The ability to decide for oneself, truly for oneself is the opposite side of the coin of force.

I can see that, too.

What I find most frustrating is the fact that we're not even having this conversation at the government level. A few tweets from the former half term governor of Alaska, and dialogue this summer centered around the ludicrous notion that funding *just to explain the current, legitimate end of life OPTIONS* amounted to pulling the plug on grandma.

But funding for such counseling is really the tiniest tip of the iceberg of what we need to do to deal with escalating costs. And just because the right wing assertion that Democrats are pushing end-of-life rationing constitutes a gross misrepresentation of facts and total paranoid delusion doesn't mean that end-of-life rationing itself is a bad idea. It's just politically impossible.

 

[MrMentor7]

I think much of the United States feels that people should "get what they pay for," even if there are cruel results.