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I am a minarchist libertarian, but I'm actually a believer in having a public health system, such as there is in Britain. Why? Because private health insurance does not work either.
Reforming the US health system is possible. The UK's National Health Service provides a decent alternative at a fraciton of the cost. Would this mean rationing care? Yes, unfortunately but that is probably workable method. Extreme medical measures will remain the possibility of only the extremely wealthy.
If a free market alternative is wished then at the very least the US needs to:
The concept is simple: Medicine is in a bubble.
The "pop" will be very bad, just like all the other bubbles. There will be no political courage to prepare or deal with this unavoidable eventuality. It will not be organized, so all of our great ideas to change the general outcome are essentially useless. The disorder will be dictated by the circumstances and any government interference will only worse things. Only the individual has a chance can try to prepare himself and possibly his circle of friends/family, but, again, there too many unforseen and unforeseeable outcomes. You will probably be significantly affected by the "pop" no matter your preparation. The individual (or in-duh-vidual as Dilbert says) is responsable to try, however. The government will attempt to punish you if you have prepared at all for this "pop of the bubble" through taxes, confiscation, ect. Government employees will do better than the average person.
I believe that I have stated some (not nearly all) common features of bubbles- and apply whatever I've left out to "medicine" and see if it fits. It will be ugly, especially for the tail end of the "boomers" like me, who will suck up all the resources. Certainly, there will be no good will for me when I get older, and this is understandable. I agree the boomers are a huge part of our problem, though I have tried to be counter-cultural to this boomer generation... sarcasm intended.
I am a doctor, who has gone 1/3 Galt, considering the full monte. I am far from perfect, but I decided 30 years ago that 50% OF EVERTHING I have been taught at all levels everywhere is wrong...and having been sorting this out over that time.
Personal profile IF anyone really cares- if you get offended suck it up.
1) recently converted to libertarian view point
2) 30 years ago became a born again christian and am still walking the way. (P.S.: all christians should study Bonhoeffers "Call to Discipleship" because you're going to need it. We are the Weimer.)
3) OBGYN- yes the most "liberal" and socialistic specialty of them all. I am self employed (small businessman) in a small town and i am just now finishing 48 hours of a busy "shift."
4) still married 25 years- for what ever that's worth, though this reflects more my wife's character than mine.
5) gun owner 40 years, since ten years old
6) recently converted "conceal carry", I don't know why that took so long. Same for "prepping"
7) I attend a rural baptist church-- don't ask-- little choice available. I am now getting the local culture to see the "woman"'s status as Jesus did.
8) So, Evangelical Christian OBGYN libertarian- if this were a political party, we could have our convention in an elevator. I've been called just about any foul term known. Whatever.
9) RON PAUL FOR PRESIDENT.
10) If the part of this post after "personal profile" makes you doubt the first part of this post, you should reasses your decision making process.
I won't likely get to respond for a day or 2 due to travel plans. Seriously, say what you want, I will read and consider everything, as is my habit. Most critics hold truths.
I am a doctor ... so the question put forward ..has been with me .. for all my professional life .
I can give You some fairly accurate answers .. i did so long time ago.. when I was Young and Naive .. but have stopped thinking about it .. not to say .. at all... talking about it. Because i discovered ... PEOPLE DONT WANT TO UNDERSTAND . People dont want to apprehend the TRUTH .. and get angry ..if You try and tell it . As if You wanted to steal something from them.( Just like people get angry when You try and tell them ..their property isnt worth what they think it is ) Politicians use HEALTHCARE .. as one of their TOOLS .. to extort from the people .. what they really want . So they come up with some phantastic examples where for ex a newborn ..ore may be a 102 year old ... from an absolutly impowerished background and who never put a penny in the system .. ..lets say ... gets a new heart .. EVERYTHING the system can provide . This is just a THE CARROT .. a SHOW-CASE ... Because there isnt MONEY in the system .. to give everyone who needs a new heart ... a new heart .. .The Political system knows this ... The reason is .. that the tax and other state fees which were paid by the " CUSTOMERS " went ..for other purposes ... its money long time spent. Healthcare in many countries is thus just a POLITICAL TOOL .. a BLACK-MAIL TOOL .. used by the political system .. to keep on extorting money from the people and keep a lot of UNPRODUCTIVE people in occupation .. the whole Health Care Administration employs armies of people who do ABSOLUTELY NOTTHING for the health of people .. they just get a SALARY .. in the US approx 25 % of the total Heatlh care Bill . .. FEW THINGS are perfect ... The best health care systems in place as of today are systems like in Germany and neighbouring countries .. in EUROPE ... .. who have a balanced mix of SOCIAL CONSIDERATION ..and ACTUAL LONG TERM FUNDING .. of a state of the art .. modern health care system ... but also here the systems implemented are under considerable strain due to demopgraphic reality .
HEALTHCARE COSTS MONEY .. not TOO MUCH .. BUT MORE THAN THE POLITICAL SYSTEM IS WILLING TO ALLOCATE BECAUSE THE NEED THE MONEY FOR OTHER PURPOSES !
May be in times to come... we will send old people to the Ancestry Cliff .. when they no longer have any value for society .
Thats allright.. if the same people had NOT for a life of labour ..paid to a system in trust of PROMISES by the system to provide security .. should it be needed.
The problems of HEALTHCARE FUNDING is just another example of THE FAILURE of THE POLITICAL SYSTEM of THE WESTERN WORLD !
This is not a difficult question. Simply set a maximum age for all complex medical solutions to old age issues. Call the age 80 for the moment. At age 80, any medical issues you have can only be treated with Pain Killers. Regardless how much money you have, you cannot buy any further treatment beyond Pain Killers. Fair for everybody.
If you are a Healthy 80 year old who took good care of himself with good nutritition and exercise, maybe you get to live into your 90s. Good for you if you think its worthwhile to live another 10 years from 80 to 90 rather than partying harder from 20 to 30 or whatever.
It is plain stupid and a waste of resources to keep 80+ folks going with complex med proceedures. If you are not healthy at age 80, give it up already and head for the Great Beyond.
Add to this Social Security Benefits should have a defined timeline from 65 to 80. If you are still walking the earth at age 80, either you can still work and do something people will pay you to do or you saved up enough money to make it therough another 10 years if you are healthy enough to live so long without medical treatment. This should make SS solvent for at least another decade or two.
I can only assume that you are being sardonic. The true SS fix will be means testing. That's right. Everyone will pay in but only those who need shall recieve. I understand that is a form of socialism. I also believe that society does indeed have minimal obligations and one of them is to ensure that the very old and or legitimately infirm do not starve or die of exposure. Ideally such a system would be augmented by family or community generosity/responsibility.
Then we really need to call it what it is -- WELFARE for the elderly. It's a crime that so many will not get anything close to what they paid in for decades.
Edna has the right to live. She does not have the right to live at the involuntary expense of any one else.
Edna's late husband fought for everyone else in WW2. It's not unlikely that he did so involuntarily via the draft. He could have been killed and he forwent a much larger paycheck in doing so. What's so different from everyone else getting his labor from him and his heirs getting their from everyone else?
If healthcare insurance was still for catastrophic events only instead of a routine checkup and everything in between, then this out of control cost wouldn't force us to make these decisions. When did this happen? Of course healthcare is expensive if every fucking person needs it to just see a doctor.
What do you think would be the cost of car insurance if you had to file when changing your oil? Or home insurance to change your HVAC filter? Normalcy bias reset button please.
Yes TN. But the problem is health insurance providers have a nasty tendency to fight large claims. They will gladly pay for you having a medical checkup so that you have the confidence to continue paying their insurance premiums. However, if you get a major disease you may find that they start trying to weasel their way out. You may well have to take them to court to have them pay. Unfortunately, by that time you may have died... which is precisely what they are counting on.
Healthcare is one fo the few places that government does have a role
Merry Christmas Bruce.
BTW, who is ranking which list is A or B or SHIT? I'm not invited to any A-list party in my hood but it is by design. Irrespective partisan hacks only incite vitriolic responses from me.
You should be commended for whatever soul-searching led you to being a pariah in your A-list hood. This country needs serious soul-searching and all we get is the typical Obama vs. Romney crap when both should be run out of Dodge.
Semi-boneless lamb roast is on the grill. Duck for New Year's is thawing (fresh duck is impossible here) although I'd prefer Taipei goose. We on the SHit-List don't need the A-list to party. Who wants to listen to their SHIT?
You keep blogging and I'll keep pimping your blog. Righting this ship before it sinks is not in the cards. So getting whoever onto the life rafts is the order of biz in 2012.
Merry Christmas Bruce! Speaking of "A" listers... I hope some cousin or in law reached across the table of Dimon or Blankfein today and smacked the fuckers with a sauce pan or a pot and said "you are a fucking prick" lol!
the audience need to see the spectacular method of them being killed off so that the illusion that they're going to a higher? plane/being reincarnated is preserved.
sciatic nerve pain
this is easy, you dont spend massive amounts of $$$ on the very old because they want to milk the system. Ok. No knees and hips or surgeries for the almost dead. want viagra at 91 years old? Fine, stroke out and end up on a respirator? Youve got 24 hours buddy unless the family wants to foot the bill. Dont want a colastamy bag? Fine, but you wouldnt be getting 12 freaking surgeries because you chose not to take 1, you would die, like your going to do anyway, at least do it with some self-respect eh? MANY parents abandoned their children after High School in America, is it any wonder that those that happened to want nothing to do with their aged parents? Suicide is always an option, and easy too.
Looks to me that you, and Bruce, and a lot of the comentators have missed what may be the main point here. This lady may be still be alive in spite of her medical treatment, not because of it. Doctors kill people left right and center in this country. The number seems to be somewhere between 100,000 (admitted by the docors) and 750,000 (see http://www.webdc.com/pdfs/deathbymedicine.pdf).
Medicine is a racket. No more, no less. I'd tell them to fuck off with their crap gastroscopy tubes too. Good on you Edna.
The exaggerated cost of healthcare in the US only serves to bring the "problem" of palliative care for the elderly into focus faster than elsewhere.
At the same time, the elderly will get a progressively higher share of the democratic vote; be assured that the parasitic insurance industry, big pharma and the medical sector will lobby their utmost to "speak for" those voters.
The biggest danger to America is a resulting generational disconnect and discord--along the same lines feminism and partisan politics have sown division in the society.
If healthcare cost can be brought down by outsourcing and medical "tourism" , at least a beginning can be made to dilute the poison of profiteering in the medical sector.
i have another example of how perverse the medical market is here in the usa. i have been flagged as a non compliant patient by my doctor because i have refused to take my meds. she is kinda mad at me because she prescribed some meds for my newly diagnosed diabetes 2 illness. i refused to take the meds for personal reasons. well since the insurance has found out i have refused to take the meds they have now increased my premiums for not contributing to the welfare of the medical industry even though i have a dnr so shouldn't cost them any end stage money except the ride to the hospital to be declared dead. since that diagnosis i have "cured" my diabetes using the usual exercise and diet regime but the insurance company still considers me a noncompliant patient and refuse to adjust premium to reflect my now symptom free body.
Go Paleo and get rid of your type ii diabetes, a disease caused by the food you eat.
I'm not up to speed on ancient Sparta.
A.T.Olmstead reports that the ancient persians had an abohorrence of bodies,
especially old ones. Customarily, when a person reached the age of 70,
they were put to death and then slow-cooked to make broth for the poor.
Only their bleached bones would be allowed a decent burial. Pre-dead bodies
were left out on the mountain for the vultures ... again only the bleached bones
That would take care of the social security shortfall rather handily.
We could start with the drug company and insurance company and hospital
CEO's, maybe a few bankers as well, and maybe it would catch on again as a tradition ....
Let's introduce the extreme case of "Edna" as a wedge to put "death panels" on the agenda and in the best light that such a potentailly ghoulish practice can be put in.
Well played, Bruce.
tradable lottery numbers picked annually for those over 80 is the answer. it is a brilliant plan. think about it. it is the only fair way.
The big lie in the “Everyone deserves health care” statement is its ridiculous over simplicity and the implicit assumption that everyone will get the same level and intensity of healthcare that Ted Kennedy got at his end if they ever need it for a similarly serious illness. There isn’t enough money in the world for that. The dark side of many advances in health care is that it vastly increases the probability that each of us will encounter such a need one day.
Ted Kennedy was an evil evil piece of shit murderer. I hope he is burning in hell.
The US has too many wars to fight and too many weapons to manufacture to "protect" us to be bothered with something mundane like humane and cost-effective healthcare...
Terrific Piece. Somewhat related to that: I was reading a MSM piece the other day about Doctors and Nurses and their own wishes regarding extension of life. It interesting because they are the one deciding and and acting on those decisions when a patient can't. As a group (non-scientific survey) all of them had DNRs (Do Not Resuscitate) and "NO CODE" in case of a Heart Attack or similar. The Epiphany happens when they are the ones breaking ribs when doing CPR compressions along with the Paddle "Clears" that don't work nearly as well as TV shows, Movies etc portray them,It's a violent intrusion of the body that none of these health care professionals would want to go through if they were the patient.
As far as sustained Health Care which is what your article centered on; They don't want it. Apparently seeing The tubes hanging out, the 14 pills a day , the pure anxiety of not knowing when the next flare up is going to come but still knowing that it will happen with most chronic killers, is enough for them to ask and answer: Are the extra months or years worth that much too me?
Nevertheless, other elements come into play. The family may want the person to stay alive even if it's uncomfortable or no one can make the decision to pull the plug unless the loved one has a wallet or purse card with a DNR on it while some where a medallion like a dog tag. Absent any direction from patient or patient's family, they must do everything in their power to preserve life. Solutions that probably won't work; Maybe a hard to enforce law where everyone has to have a implant with their will and living will. Even more scary is if the Doctors are not legally liable if they make the decision to end care. That's rough because that goes right to the heart of physician capabilities in making cost based decisions that have multiple parameters;
Unsaid but well understood in the health world is the physician competency level, greed and their belief system that might bias them one way or another or Many people have complained that when they get diagnosed with cancer their Oncologist turns into a salesperson for the pharma industry who have plenty of data available to help the physician show that this patients odds of winning the life or death lottery are higher than others.
I was in an Emergency room for an entire night after I fell off a ladder and hit hard cement after a 8 foot free-fall. I was still able to do a walk-in. The ER got hit with what seemed was a steady progression of heart attack victims along with gunshot victims. I heard "Clear" time and time again. When the ER Doc finally got to me, he said "well at least your still alive". I asked if any of the patients under the paddles I was hearing all night made it. Not one, not one patient, but plenty of them felt the pain of the resuscitation attempts, as they faded away.
Nothing will change until the Doctor is handed a DNR , probably by an Insurance company or the Govt after a series of lobbyist pushed laws. It will be a cat fight between just about everyone when it comes to patients that are well insured. I think consensus will happen around those who contributed the least in taxes or insurance premiums, which may or may not be a poor person. Plenty of schedule C filers out there with an AGI of -0- year after year.
We have a money dictated system. When profit is a primary goal in Health Care, like the defense industry who wants and lobbies for a perennial state of war, these people want to "save" lives, while the payers profit only when their are no claims. From the big Pharmas who drool over $100,000 Chemo treatments to device makers and to what seems like the large majority of specialists who all seem to carry a level of greed with them that far exceeds the net contribution they make.When surgeons are earning 3 Million a year with the majority of that income coming from Device makers, we can pretty well guess where that fight is going. Doctor, Hospital, Device Maker, Big and small Pharma stacked up against the insurance providers all in pursuit of the big pay-off.
That's why it's so interesting to see where Doctors and other Health Professionals are at, when it's their life on the line.
Great post and you're right on all accounts. Regarding the DNRs among doctors, nurses and paramedics, there is also an old joke in ERs that everyone says they'll get "NO CODE" tattoo'd on their chest because of exactly the problems that you cite. The same line is repeated in a more grim fashion down the hall or upstairs in the ICU where the survivors of the ER codes go until their ultimate demise, because so few of them actually "recover". And it can take a days to weeks for some of them to go, since artificial means can keep us in a living state for an extended period of time. You might remember from a high school biology class, the heart of a frog will go on beating for a long time after it has been removed from the body.
That being said, I don't think I know anyone who actually got the tattoo. Ultimately, everyone wants a chance if something happens, they just don't want to be kept alive on a ventilator and other machines in the ICU.
Decide what is acceptable to you in terms of how heroic you want efforts to be and then put it in writing as a living will. Choose someone you know who will respect your choices to have a health care power of attorney , guided be your Do Not Rescucitate order. It is your best protection against being stuck in a situation you would never choose for yourself if you're incapacitated and not able to participate in your own care. It's also good to look at if you need to have a talk with your parents.
bravo! excellent post Dburn, thankyou.
again, the time to make the decision, and do whatever prep necessary, is now.
One might consider that our high priced health system is not threaten by selfish seniors failing to die off or change habits. It is threatened by Austrian dog eat dog concentration of wealth. Other nations have better care for less cost.
Religions, countries, civilizations have been trying to recognize and implement the "social contract". Austrians refute the concept for an economic answer. For Austrians dislike the moans of the losers and favor hushing these voices.
The real issue is if taxpayer paid for bankers and CEOs should receive taxpayer bonuses, and better yet --taxpayer funded option grants exercised at most advantageous prices.
I know this is a 'hot potato' issue because none wants to deprive someone of his mansion in Newport or the Hamptons so I am going to withhold from making any judgments.
We love you Bruce. Don't feel bad. You can come to my office Christmas party. My Boss is splurging again this year and is sponsoring it for all employees and our families I could sneak you in as a distant cousin) and there will be lots to drink and eat---all free!
Day: December 27th
And don't be shy.
I'm in. What city was that?
What's an "A list?" is that like "we're the Anonymous people" list or something?
Once the attempt at corrupt central planning fails and Social Security, Medicare & all other exorbitant social programs meet their end, and a free market mechanism is somewhat restored, Edna will gladly take the bag in the face of the other stark choice she will face - a cold, cruel death.
In fact, I suspect that with the social chaos that is about to be unleashed on the US from the economic & financial collapse of the dolllar & with it, the loss of world reserve currency status, making imports prohibitively expensive and absoltely crushing the standard of living of 99% of "entitled" americans, that the ensuing death & detruction will serve to reduce the population (some refer it to as culling the herd) while at the same time creating a massive need for "clean-up" work...
so the unemployement problem may get better by "eliminating" part of the population & creating clean-up jobs for those who somehow manage to survive the collapse of society.
& on that happy note, hope you have a Merry Christmas.
A big portion of the trillions in unfunded liabilities for Pensions, Social Security, and Medicare disappears if the average life span drops.... Medicare is already collapsing with reductions in reimbursement rates and Docs refusing to accept new Medicare patients. Mrs. Thatcher was right - the problem with Socialism is eventually you run out of other people's money.
What Mrs. Thatcher left out was the Tories/Fascists also eventually run out of other people's money.
Maggie & her pal Ronnie, such a coincidence that they would both suffer from the same end-of-life maladies. . .
The problem is that Edna thinks she has the right to make expensive choices, but the expense isn't hers--always a formula that leads to catastrophic overspending.
bruce kasting and the rest of the zh reading team.
here's a nice xmas story. exceptional. i think it is true.
my local bar browsing in gramercy park nyc. met a nice young man, bright.
his uncle is a physician and was running a free clinic in south carolina. check out the stats - socio/economic for SC. 30% doesn't graduate high school in SC. so - of course he was prescribing things - but no health care, no money - what was the use. the uncle went and got his pharmaceutical license and basically opened a drug store at his clinic, apparently the cost savings was enough that at that point he could prescribe, and give it to the patients at next to nothing, and things worked out.
merry christmas - that is my most positive experience in the last year or so. and it is very positive
Scroll down to the sixth chart to see where we already stand.
I was disappointed with Obamacare Tax Bill which did notohing to incentivize people to lead healthier lives. Look at the obesity rates for America (and Australia)....above 83% if I remember. I am not sure society shold pay for patients who do not take care of themselves...it's a moral hazard, just like bailing out reckless banks.
while I understand your perspective, it should be noted that amrkns were taught from birth that their government created agencies to maintain high standards for the "products" sold them, health & safety, etc.
food pyramids, daily recommendations, etc. - meanwhile, this was all one big corporate fantasy, and food was engineered, people being the "testers" of these products, with copious amounts of pesticides, additives, GMO, etc. etc. being the end results.
so really, people are still coming to terms with the fact they've been lied to and used since birth, that Big Daddy Gov is using them as some kind of test tube or petri dish, while simultaneously extracting as much of their earnings as possible, be it through taxes or consuming product.
the "obesity epidemic" is partly the results of the experiment, as the medical procedures evolving from the "illness" illustrates perfectly. . . parasite, host. which is which?
USA is a facinating country, no problem with socialized killing, actually presidential candidates brag about it and let's add some socialized torture for a good measure.
But socialized medicine, which seems to be more cost effective according to the list in one of the posts here,
OOH NO, Soviet coming!
Maybe I have a pre existing condition that makes me think that taking care of elderly and weak is more important then CEO's making 145 mil a year.
Thank you ZH for a very educating site, even for a non financial moron like me.
Happy new year to you all, but I would not hold my breath.
puuhleeeze! the old are DEAD! the young are dead! nothing matters except for DEATH ! nothing matters ecxept for MY PROFIT MARGIN! I HAVE TO RETIRE! I HAVE KIDS!!! BRAICES! COLLEGE!
fucking confused assholes whinning all day! im sick of it!
GIMME MY MONEEEEEEE NOW! FUCKWADS!
FULL SPECTRUM DOMINANCE! SANCTIONS! DEATH! SHOCK & AWE!
for everrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr #winning! #FAIL
stay up man you have no choice
Would Edna make the same decisions if her family was left to bear the cost? That is the insidious nature of social welfare.... and it increases costs for everyone.
Impossible to even see what your healthcare providers are actually billing Medicare. These offices seldom if ever will give you any accounting data.
All expenses/Medicare payments should be posted in each office and each patient should be given a printout to APPROVE and SIGN for the services provided that day and fees charged to Medicare. Most Medicare patients have no idea what anything costs and it's nearly impossible to find out!
Comparative shopping on the internet should be encouraged. Google could provide an outstanding search engine just for medical care costs and Medicare costs by zip code/county/state/entire USA.
As a court appointed Guardian for years in multiple states I can say confidently and based upon facts:
1. All people regardless of age should receive the same usual and customary medical care (not "healthcare" which is a different type of "health" maintenance). Medicare does not allow the same medical tests or treatments for elders as a 25 year old would receive in the hospital or ER.
2. Old people's healthcare & medical care should not be legally managed by a family member or person that is also a beneficiary to their estate if they withhold usual and customary medical care. They may be motivated to withhold usual and customary care to speed their own inheritance. See this all the time.
3. People should have the right to not needlessly suffer and die quickly & comfortably if they chose.
4. Our current Medicare and it's physicians that must follow Medicare guidelines for elders systematically slowly euthanize elders by withholding usual and customary medical care. Many are simply needlessly degenerated (by withholding tests & treatments & drugs) into being bedridden and then starved to death while remaining medicated and unable to feed themselves. Google "haldol". The state of Kansas (Sebilius) has over 50 federal cases for illegally using haldol (haloperidol) on old people in nursing homes causing them to be bedridden, food & hydration withheld and ultimately die before their time and against their will. Don't tell me it's illegal....it is...but it is done daily all over the country and nobody talks about it. Family members go to the nursing home and see how much Grandmas has gone downhill and shake their head. Well hell, try giving Grandma water, food and basic nutrients to survive!! Medicare does not even allow comprehensive nutrient testing, so the poor or missing nutrition which kills is never medically validated. Convenient isn't it.
5. Family should take care of their own, but when they ignore the necessities of their elders and turn them over to government care don't expect the elders to last long. They could die in a fog of drugging while they are withheld food and water. It's done all the time. And many times family watches and does nothing, because they are beneficiaries waiting to get Grandma's home and estate.
6. Take care of your own and be mindful that the physician is probably not giving your elder usual and customary medical care for their conditions because Medicare guidelines dissallow many tests, treatments and drugs. You can research anything on the internet. Get proactive or you will be next.
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