[serenityseeker]

Originally Posted by Muncle

Okay, Canada's health system is sensational and we should all move to Alberta or Val d'Or except for the friggin' snow and low temps. It's been interesting to hear how much of the taxes go to health care. I don't know diddly about Canadian tax structure, if it is nearly as biased as the US, but if such a health system were imported into this country, we would end up with 50% of the population paying absolutely nothing --- they don't pay taxes, remember --- and the top 10% will end up with yet another mandate.

But regardless of the economic factors, why does it matter? Hancle's bible quote was nice, but has no bearing on reality. The Canadian program may have universal coverage, especially very supportive of the needy, but Canadians have no choice as to whether they wish to help those who didn't win life's lottery. Does that win any points on the Savior Scale?

But I reiterate my questions from a few days ago:


Does everyone have a "right" to all health care? Do all have the "right" to the same or equal health care? Is there a situation when especially expensive health procedures should be more readily available to those who have more resources to pay for them? Should "elective" procedures be available only to those with financial resources? When the time comes to prioritize certain procedures like organ replacement, should the patient's past or lifestyle be a determining factor (long-time smoker, high-pressure job, bad eating habits, drug use, homosexual promiscuity) and who should make these decisions? What about age? Any other social considerations?

Yes, there are major problems with our health care system, many/most of them financial. As far as I can see, everyone is to blame, i.e., medical professionals, insurance companies, blood sucking trial lawyers, drug companies, governments, both state and especially federal, and most importantly, we, the people. The health care system is a massive creature, ultra convoluted at best. There is no quick fix. All the players involved must make changes and the changes must be reasonable. Putting price caps on drugs would play well in the Daily Kos and on MSNBC, but unless it is done intelligently, it could spell the end of the development of new meds or at least severely hamper it. It's obvious that insurance companies and especially Medicare grossly underpay for many services. Doctors and hospitals have a legitimate complaint. If both were forced to increase these payments, remember that those costs will be passed to the members.

All in all, it is a real conundrum as to what can be done, and more critically, what should be done.





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Does everyone have a right to all healthcare? Obviously a philosophical question to a great degree. For those of us working frontline in healthcare everyday I think the majority might answer with a yes, certainly with some caveats.
Is there a situation when especially expensive health procedures should be more readily available to those who have more resources to pay for them.?[/B] Probably with regard to some elective procedures, otherwise no. Most developed countries of the world determined some time back that equitable delivery of healthcare is indeed a right to some degree. Does everyone get free boob jobs and face lifts? Nah, but the delivery of basic healthcare in todays world really should be a right, especially in developed countries that have the capability. Should only people with with greater financial means get the best/state of the art care for heart disease, stroke, cancer etc? The idea is aborrhent to those of us treating people with these and other tragic conditions.
Should "elective" procedures be available only to those with financial resources?[/ A loaded question that that requires some clarification. Certainly some elective procedures like cosmetic procedures done for more or less vanity purposes should be dependent on your financial ability to pay for them. An "elective" hip or knee replacement is a different story though. While not acutely fractured, the joint may be so degenerated as to cause pain and compromised function. Certainly this type of elective procedure falls in a different category. If your mother needed the joint replacement to have a better quality of life and relieve pain even though she could still "walk" would you deny her this procedure based on her finances? Would you deny it if she was obese and that contributed to the joint degeneration?
When the time comes to prioritize certain procedures like organ replacement, should the patient's past or lifestyle be a determining factor (long-time smoker, high-pressure job, bad eating habits, drug use, homosexual promiscuity) and who should make these decisions? What about age? Any other social considerations?[/COLOR] Certainly in some instances, as is already the case. Those with liver failure secondary to alcohlism have to show some period of abstinence before being considered for placement on the transplant list no matter the severity of it (I believe 6 mos. in some cases).High pressure job??? Not sure how that could ever be construed as a reason to ethically deny anyone parity of healthcare delivery, and would be wildly innapropriate. Eating habits?? Again unreasonable in today's world as it would preclude at least half of the population of our country, including children. Have you seen the obesity statistics? Homosexual promiscuity?? A completely innapropriate statement. Where was the inclusion of heterosexual promiscuity? And again, this would preclude massive numbers of people from receiving care for sexually transmitted diseases and HIV (I assume your point) leaving others without knowledge of that promiscuity at great risk and with no protection. Age? Yes, age limits much of the success in some major procedures and intervention. Social considerations? Would need some clarification but sounds morally reprehensible.
Lets look at the financial problems and realities of our system.We as Americans spent 16% of our GNP last year on healthcare. That is 16% of the total value of all goods and services from all of the industries in the United States, a staggering amount by any measure, and more per person than any country in the world. This is projected to increase to at least 20% of GNP by 2017-a projected 4.3 trillion dollars if we just continue things as they are. Even more shocking is that 5% of the population accounted for for more than half the costs in more than one study!
What are we getting for our dollars? We have higher infant mortality rates and lower adjusted life expectancy than mutiple other countries, ranking 41st and 46th respectively. Is this acceptable for a country spending more on healthcare than any other country on earth? These are just two of multiple areas where we rank intolerably low.
The U.S. is the only country in the developed world except South Africa that does not provide healthcare for all of its citizens as a matter of policy. Instead we do it in a horribly inefficient way with a hodge-podge system of private pay, private insurance, and multiple non-coordinated government programs burdened with beuracratic and administrative costs. Over 30% of healthcare costs are estimated to be administrative in the U.S. How utterly innefecient and wasteful.
Massive changes do have to be made and are way overdue, and a long slow "phasing in" is not a good solution. We have to be willing to make changes in liability reform, decreasing the massive beauracracy and the profits and incentives built in for certain individuals involved in perpetuating the mess. We have to be more realistic about what is reasonable to deliver and to whom. We need to look at reimbursments for doctors, nurses, therapists and more that are involved in delivering primary care, paradoxically the most difficult and time consuming care with the lowest reimbursement rates (see the rapidly dropping numbers entering primary care as our population ages). We need to make use of the massive amount of money so ineffeciently wasted, streamlining the process and disincentivizing waste and profits made of the backs of the sick. We need to make pateints accountable for self destructive habits like smoking and noncompliance with medications. Even more importantly we need the input and participation of real people working within the system and patients of the system, NOT more beuracrats and professional academicians with no real world experiences.
Bold and yes, some painful decisions and adjustments in expectations are in order. The system is already failed, and on the precipice of complete collapse.