healthcare costs beyond our ability to finance.

[canoehead, BSN, RN]

With all the new advances in technology our healthcare costs are going to go up constantly unless some border is established.

Given a finite source of money is there a point that we say "no" to seriously ill that can be saved? What about if we crunched the numbers and found that the money spent saving one person could save 10 from another disease. Do we tell that one "no" even though the treatment is available, or let the theoretical 10 die and treat the one. (first come first served).

What if that one guy says- "OK I understand, but I have the money to pay for this myself" Then we've saved the ten that would die (and the one) but have established a two tiered system. If you don't have enough $ you die.

Or if we decided that this businessman (Bill Gates) is going to add $5 000 000 000 to the economy if allowed to live, and Joe Blow the welder will only add $20 000 for the rest of his life. Can we now afford to save Bill, but let Joe take his chances.

SO my question is with costs rising we can't cure everyone, how do we decide to spend it all? Assume taking over the billions of dollars in Saudi Arabia isn't an option.

[sanakruz, ADN]

Education,heatlh maintainence outreach and access to care for all.

Prevent the diabetic patient from reaching ESRD by helping her get her diabetes under control prior to her being in renal failure in your ER. 9 times out of 10 this person is uninsured.Sure "technology" is costly, But clearly she needed care prior to needing a kidney transplant.She just couldn't afford to pay out of pocket for a routine health screening.

[oramar]

If you draw the whole thing out to it's logical conclusion you would have to keep everyone alive forever. That is not possible is it. How to balance one person's life against another? I never do that. I just take care of everyone as if they are someone. Those big questions will have to be answered some otherway. I can't do it, ain't smart enough.

[sjoe]

You are clearly right that we need to do some serious rationing of our health care and of our health care dollars.

A number of systems have been proposed, but some combination of the following factors would probably work reasonably well: age, life years remaining, probable future productivity in dollars based on the person's history and training, financial cost to society of treatment's not being done (future financial/medical support for patient or family, etc.), cost of treatment and recovery.

IMHO.