Medicine has come up with more wonder drugs, procedures, technologies than ever before. All of it very expensive, too. It all comes at a big price. It's becoming more and more difficult to deliver it to everyone.
Have we gone as far as we really can practically manage, without going broke? More and more can be done, but will it end up bankrupting us? Obama is talking a lot on controlling Medicare costs before it goes bankrupt.
There's a lot of talk of how socialized medicine, universal coverage, is our salvation. But, is it really? I seriously doubt it.
How much does one MRI machine cost? Astronomical. Think of all the other expensive machinery in the hospital. And, at what cost is the regulatory burden? Then add in all the other costs. After that, figure in a bunch of heroic new surgeries and treatments. How about surgery on babies in the womb? Genetic manipulation, cloning body parts, new expensive treatments for AIDS patients with drug regimes totaling in the tens of thousands a year. Then add on all the new dialysis patients expected in the wake of our obesity/diabetes epidemic.
Without getting into the merits of hypothetical patients over 65 with serious coronary artery disease
This is a real live human man with serious coronary artery disease who was refused care in his country because he was over the age of 65. He could be put on a waiting list but each time a younger person went onto the waiting list he moved one place further back. The doctor said "you will not have open heart surgery in this country". This man has money, he came to NY and had his CABG, he had no complications and the doctor told him he was free to enjoy a good quality of life for another 20 years and he has no other health issues and the doctor placed him on no restrictions what-so-ever.
I'm not a fan of Jack Lalanne. He has summed up his philosophy as "If it feels good, stop doing it. If it tastes good, spit it out." What good is a long life if you can't enjoy it?
1) Teach people how to access levels of healthcare and penalize them for doing so inappropriately
Before that, someone needs to make sure that various levels of healthcare are available. Massachusetts, especially Boston, has a huge shortage of Primary Care Physicians (NPs and PAs can't be Primary Caregivers, though that may change soon). Until last year, the state had no walk-in "Mediquick"-type clinics. I volunteer in an ED, and a lot of patients come in with minor complaints because they don't have a PCP, or can't wait 3 weeks to see their PCP. We also get a lot of tourists.
My previous PCP left the state 2 years ago. It took 6 months to find an english-speaking PCP within 10 miles of home, and I don't live in the boondocks. I have great insurance, but I ended up going to the ER for a strep test.
So far, to the best of my knowledge, no country has a perfect system. They're expensive either directly (insurance premiums and fees) or indirectly (taxes), some people miss out, and demand grows exponentially. Interventions that were once extraordinary, like dialysis, are now an expected part of routine care.
However unpalatable it is, health resource rationing is a reality. No society can indefinitely afford to provide all its citizens with every available medical service and technology while still maintaining other services.
So we can either divert everything into health care (nd just delay the problem) or limit services. One way to do that is to deny some of the population even basic services (affordable medication, easy access to general practitioners) and provide those who can pay with whatever they or their insurers can afford. Another way is to provide everyone with basic services and limit some services based on cost, scarcity and qualifiers, including age and co-morbidities. Either way, someone misses out.
There isn't infinite money, and there aren't infinite resources. Advances in health care are why the system is more acute in every area - people who would've died from strokes, MIs and car accidents are now surviving. That's good, but it comes hand in hand with a new issue - as we intervene more and more, our population as a whole survives longer, increasing the incidence of other diseases.
Survive that stroke or MI, treat your type 2 diabetes that would have killed you in twenty years, and living an additional twenty years means you now have not only complications from the diabetes but also a raft of other conditions that now need treatment - and it all comes at a price.
Medicine has come up with more wonder drugs, procedures, technologies than ever before. All of it very expensive, too. It all comes at a big price. It's becoming more and more difficult to deliver it to everyone.
Have we gone as far as we really can practically manage, without going broke? More and more can be done, but will it end up bankrupting us? Obama is talking a lot on controlling Medicare costs before it goes bankrupt.
There's a lot of talk of how socialized medicine, universal coverage, is our salvation. But, is it really? I seriously doubt it.
How much does one MRI machine cost? Astronomical. Think of all the other expensive machinery in the hospital. And, at what cost is the regulatory burden? Then add in all the other costs. After that, figure in a bunch of heroic new surgeries and treatments. How about surgery on babies in the womb? Genetic manipulation, cloning body parts, new expensive treatments for AIDS patients with drug regimes totaling in the tens of thousands a year. Then add on all the new dialysis patients expected in the wake of our obesity/diabetes epidemic.
I don't think we can afford much more of this.
In other industries, advances are initially expensive, and then get cheaper over a few years. In computers, this has been dramatic. Anti-lock brakes, navigation systems, etc in autos are usually in the high priced cars first, then migrate to the ones that I drive. :wink2:
In health care much less so, although there are instances.
One of these is Lasik surgery, which has seen dramatic price declines. It's often a discretionary, uninsured procedure. Coincidence? I don't think so.
You confuse the political and the financial ramifications with the ability of humanity to create something new, or to improve upon previous technology.
Our layoffs yesterday were directly driven by state budget cuts. All 84 people in our SNF are Medicare. They are only private pay until their spouse is bankrupted. 60% of our ourpatients and all of our inpatients are Medicare, Medicaid, or the heavily-NYS-subsidized Family and Child Health Plus.
In other industries, advances are initially expensive, and then get cheaper over a few years. In computers, this has been dramatic. Anti-lock brakes, navigation systems, etc in autos are usually in the high priced cars first, then migrate to the ones that I drive. :wink2:
In health care much less so, although there are instances.
One of these is Lasik surgery, which has seen dramatic price declines. It's often a discretionary, uninsured procedure. Coincidence? I don't think so.
me either.....i worked in an ED, there was an RN who also did amateur photography. Did his own black and white developing.....said he could get a thermometer in his supply cat. that was as good as the one he used on patients, for WAY less money.....while working at a low end store, in the pet dept, got a call from the local hosp resp tech....wanted to know if i had the T junctions for the aerator...yup, said good i will be over to get some, they work on my tubing and are cheaper.....so there you go
new orleans - eighty-year-olds with clogged arteries or leaky heart valves used to be sent home with a pat on the arm from their doctors and pills to try to ease their symptoms. now more are getting open-heart surgery, with remarkable survival rates rivaling those of much younger people, new studies show.
years ago, physicians "were told we were pushing the envelope" to
operate on a 70-year-old, said dr. vincent bufalino, a cardiologist at loyola university in chicago. but today "we have elderly folks who are extremely viable, mentally quite sharp," who want to decide for themselves whether to take the risk, he said.
even 90-year-olds are having open-heart surgery, said dr. harlan krumholz, a yale university cardiologist who has researched older heart patients.
"age itself shouldn't be an automatic exclusion," he said. not every older person can undergo such a challenging operation, but the great results seen in the new studies show that doctors have gotten good at figuring out who can.
making you wait will either cure you or kill you. a close friend's mother died waiting for heart surgery (waiting lists are a function of budgets). desperate, my friend had offered to pay the cost. he would borrow the money, if necessary. operate today. "sorry. we have an available operating room, and work-hungry nurses and doctors. but we're not allowed to accept private money from canadians." socialized medicine killed a canadian mother.
last year, another friend took his closest buddy, with a heart attack, to four toronto hospitals. turned away at each (there were available operating rooms, etc., but no staff, because no budgets), the buddy died at the fifth.
highly-talented specialists have fled our socialized system in droves since the 1960s; that socialized medicine exerts a depressing effect on scientific research and technology; that currently the u.s., which has too many specialists, is successfully luring away legions of good g.p.s; that because canadian political (and medical) elites are too implicated to admit the gross failure of socialized medicine, we are going to be treated to another 30 years of compensatory policy adjustments and administrative band-aids designed not to make us healthier, but to keep us dumb, thankful, and most importantly - paying.
ok, i generally agree that we need some semblance of universal healthcare in this country. but be warned about what you are in for. you'll remember that, a couple days ago, i told you my dad had a minor stroke because he has 69% blockage in his carotid artery.
well, today he found out that they will not operate on him. he has to have 90% blockage in order to be considered.
if you want socialized medicine in this country, know what you are getting into. the decision about my dad was not made from a health perspective. if it was, he'd have been in the operating room already. it was made from a rationing perspective, and i am ****** off royally. it would not have happened here. you can talk all you want about the people who don't have healthcare in this country, and i definitely sympathize with that because my ex-partner's parents, who i love dearly, are ill and don't have insurance. but if you do have health insurance, and if your carotid artery is 69% blocked you'd get the operation here.
this is england:
london people have a "right" to health care. that is just not true. the british government says that, at any one time, there are about a million people waiting to get into hospitals. according to the fraser institute, almost 900,000 patients are on the waiting list at any point in time. and, according to the new zealand government, 90,000 people are on the waiting lists there. many of the people waiting are waiting in pain. many are risking their lives by waiting. and there is no market mechanism in these countries to get care first to people who need it first.
british doctors see 50 percent more patients than american doctors do, and, as a conse-
quence, they have less time to spend with each patient. in britain, the typical general
practitioner barely has time to take your temperature and write a prescription. and
even if they discover something wrong with you, they may not have the technology to
solve your problem. among people with chronic renal failure, only half as many canadians as americans get dialysis, and only a third as many britons.
the american rate of coronary bypass surgeries is three or four times what it is in canada, and five times what it is in britain.
britain is the country that invented the cat scanner, back in the 1970s. for a
while it exported more than half the cat scanners used in the world. yet they
bought very few for their own citizens. today, britain has half the number of cat
scanners per capita as we do in the united states. a similar problem exists in canada.
i'm especially interested in the elderly, because i find that--not only in britain and canada, but also in the united states--when people have to make decisions about who is going to get care and who is not, they choose the younger patient. surveys of the elderly breast cancer, only one fifth die in the united states, compared to one third in france and germany, and almost half in the united kingdom and new zealand.
among men who are diagnosed with prostate cancer, fewer than one fifth die in the united states, compared to one fourth in canada, almost half in france, and more than half in the united kingdom.
the percentage of the respondents in need coronary bypass who had been waiting for more than three months was 0% in u.s., 18.2% in sweden, 46.7% in canada, and 88.9% in the united kingdom. http://right-mind.us/blogs/blog_0/archive/2006/04/04/42753.aspx
ok, so this brings us back to the original question ... who pays for all this?? your citations state that these decisions are rationing based on budgets, which tells me that those systems cannot afford, for example, all the cabgs that are indicated.
i don't work for free ... neither do you ... the technology and drugs are not free ... in this country, every provider in the system takes their salary, fees and profits ... where is the money supposed to come from?
One of these is Lasik surgery, which has seen dramatic price declines. It's often a discretionary, uninsured procedure. Coincidence? I don't think so.
Discretionary = choice = only those who can afford it will have it done, those who can't won't. Those who provide this service don't have to deal with treating a bunch of people who may never pay off their bill. They simply say no to people who don't have the resources to pay the bill.
But how discretionary do we want angioplasty to be for an MI patient? Dialysis for renal failure patients? Or perhaps we let those with fewer resources use outdated technology that's less effective until the new technology becomes more affordable? I don't see any simple answers to the question of how to afford all of the wonderful medical advances that have been made.
How about my pt recently - a father of 3 in his early 40s - who is not going to receive the transplant he needs to live because he doesn't have the money to pay for his immunosuppressants? Care is rationed in the US as well, it's just based on finances rather than percentage of survival.
BroadwayRN, ASN, RN
164 Posts
This is a real live human man with serious coronary artery disease who was refused care in his country because he was over the age of 65. He could be put on a waiting list but each time a younger person went onto the waiting list he moved one place further back. The doctor said "you will not have open heart surgery in this country". This man has money, he came to NY and had his CABG, he had no complications and the doctor told him he was free to enjoy a good quality of life for another 20 years and he has no other health issues and the doctor placed him on no restrictions what-so-ever.
I don't make up hypothetical people.