Health Care...Should this really be regulated by the Government?

[dearon]

You may want to read the Newsweek article available on line. "Let Granny Die"  http://www.newsweek.com/id/215291?GT1=43002. 
I found it quite disturbing that our government is trying to rationalize limiting medicare due to the rising costs.  Does anyone else feel the same?

[Mike Raburn]

I am REALLY curious if ANYONE here has been denied treatment, besides for elective services, in an emergency situation or other quality of life situation?
Hospital or private physician.

Of course we have to pay "something", but has anyone been told NO and turned away?

I didn't read the article.

[mirjo]

The truth is medicare reimbursements to hospitals, doctors, and nursing homes have always been 'limited' and as far as I know have likely decreased in the 12 years since I became a nurse, it is not a new concept. As an LPN I first worked in a nursing home/rehab facility and although my job wasn't about billing people, I did learn that medicare paid x dollars per day for a room and the room actually cost xx, so those places lose money it seems on long term patients (which may explain the chronic understaffing). I don't know if there is different pay structure for rehab?? Like I said, billing people is not what I did.

As an RN I worked in the hospital and know that they also received limited Medicare reimbursement. That's how medicare is. The article pointed out an important point that I have witnessed personally over and over: family members who are struggling with the reality of mom or dad dying and want "heroic" measures. I can empathize with how difficult it is to see your loved one lying there, but in the patient advocate roll, which was my job it was difficult to see an 88 y/o whose organs are shutting down, because he's old and they're tired. He clearly just wants to die--he's ready, but his family can't deal with the thought of it. I always pray that when I am in those shoes that I will be able to put my emotions aside and allow things to be as they should. Dying is a fact of life. We're dying from the moment we're born. We just spend the entire time in denial of that fact.

I am not an advocate of rationing health care by any means, but a little common sense goes a long way, something that often seems to lack in politics. And in heated debates among otherwise sane individuals!

The Newsweek article made another important point: the Mass General program cut costs by 5 percent while providing the elderly what they want and need most: caring human contact. The elderly and especially those  in a health care setting want more than anything to have some kind of meaningful human contact. What I found most patients appreciated more than anything was having a nurse who was able to take a few minutes to talk with them. Something that is sorely missing in health care today! In fact the last place I worked, I was  expected to deliver the prescribed meds and exit the room w/o  much else consideration. I was even asked by the  director of nursing if the patients (clients) were keeping me in the room longer than I should be and wanting me to "do stuff." I left soon after that.


President Obama spoke airily about reducing inefficiency, but he slid past the hard choices that will have to be made to stop health care from devouring ever-larger slices of the economy and tax dollar.

I didn't hear the presidents speech, but I have heard him say things since. I think this statement is crap. I think he is right when he says that historically (if you bother to look back) every time healthcare  reform is brought up it gets shot down in flames for one reason or other. It happens because special interest groups fuel the flames that create all the controversy that stops it dead in its tracks. EVERY DAMN TIME!! This is not a new issue. This goes back many many years. The most recent in memory is probably the Clinton Admin! But health care has long been an issue. The problem is no one realizes it because all the news we get is Hollywood fluff stuff! Not what we really need to know.

I think one of the best things that peole can do for themselves is be aware and be their own advocates. So often I see people (not to discriminate, but it's a generation thing) mostly those of my mother's era, who don't question their doctor. There is a patient bill of rights, you have the right to refuse any treatment you don't want to have. I do think if doctors didn't have to carry such high amounts of insurance it would make  some difference, I also think that peole need to be educated and use some common sense...including doctors! Every sniffle or cough is not  from a bacteria and does not require an antibiotic! Viruses cannot be cured with a pill, only time. Bugs like MRSA exist because of anibiotic overuse and not using all of a prescribed dose when you do need one! Also all the anti bacterial cleaners etc haven't helped any either. It's a great marketing ploy by large companies to feed the fears of already paranoid consumers and it has only helped to create the superbug problem! Regular soap & water and friction will get rid of the germs on your hands/counter. it's the friction that does it really.

Any disinfecting that needs to be done can be done with a solution of bleach and water! the hand sanitizers are good to have when you don't have soap & water available to wash your hands, but this needs to be rubbed in until it's dry! This is kind of off the track.

I know people are even more panicky about children, but most of the time parents haul their kids off to the doc when it's not needed. What I see happening is the insurance companies making tons of $ with premiums coming in and setting high deductibles so they aren't paying out unlless something major happens and mostly that doesn't happen. I also see someone  some fations stirring the pot getting people riled about healthcare, about killing grany about socialsim about god knows whatelse and to what end? To derail the entire process. So who continues to reap benefits? The insurance companies. Who continues to suffer? The American people. I think this president is really trying to do something, trying being the operative word.

We forget that we have it better in Vermont than other states, because we HAVE a public health option! I obviously don't have any answers, just a long winded opinion! don't

[Loctavious]

You make some valid points mirjo. 

A few points that rise caution in me:

"I can empathize with how difficult it is to see your loved one lying there, but in the patient advocate roll, which was my job it was difficult to see an 88 y/o whose organs are shutting down, because he's old and they're tired. He clearly just wants to die--he's ready, but his family can't deal with the thought of it. I always pray that when I am in those shoes that I will be able to put my emotions aside and allow things to be as they should. Dying is a fact of life. We're dying from the moment we're born. We just spend the entire time in denial of that fact."

    For one thing - that example you used is a Black and White one.  My fear is that when doctors start makign decisions on their own based on 'what's most cost effective'  if your loved one CAN live even for e few months more and wants to - then they should be able to.  If we can't help people die ( euthanasia ) than we certainly shoudln't withhold treatments/procedures/operations because they won't 'cure' them.

My father's body was in declien back in '97.  He knew it, his doctors knew it, we felt it.  He had a needed surgery in May of that year that WAS NOT meant to be a life-extender -but rather a quality of life improver for his last few months.  I'm grateful for the extra tiem i had with him - which was not in a hospital.

So will we withhold quality of life procedures because we've assigned a value to durations/increments of life now?   It's a really gray area that attempting to quanitfy or navigate will see humans face some real ethical and moral issues. 

 On another note - Death is a powerful topic.  There's no way ever that there will be an expectation of humans of how they should correctly handle it.  Just because death is a fact of life DOES NOT mean it's anywhere near as easy to accept as any other fact of life:

Gravity - fact of life - negative impact - injuries that heal
Heartbreak/disappointment - fact of life - negative impact -depression, sadness  - but you  still live
Economics - fact of life - negative impact - poor understandinf of which and lack of moitvation lead to bad ecnomics - you still are living

Death being the very end of your being in this realm is a HIGHLY emotional issue - you can only try to mitigate it - removing it would deny compassion, empathy and anf humanity.

[mirjo]

If I implied callousness regarding death, I certainly didn't intend to, I have witnessed it on different levels. I can't imagine being in someone's shoes facing the impending death of their parent, regardless of age. I just know that my day is coming at some point, as it is for most of us. My parents are still fairly young and healthy, but it's ahead. I was referring to a situation that I recalled vividly with an elderly man who really just wanted to die, it was painfully clear and his family wasn't able to accept that. I don't think most families can. I was saying that I hope that if faced with a similar circumstance I can find a way to put my emotions aside and let go. I don't work in health care anymore, I can't deal with it on many, many levels--this being one of them.

I am curious--where is all of this talk of rationing coverage or whatever coming from? Has that been said explicitly? Was it stated somewhere by someone that this is what is going to have to happen to make a health care plan work, OR is it a lot of hyperbole and scare tactics and BS that is being generated in the media that people are latching onto?

This is what I have personally heard about healthcare reform with my own ears: Those who have plans with their employer  that they like and want to keep can continue with what they have, those that want to change will have that option, those that don't have access to insurance will have a public option. There are to be regulations against discriminating certain people due to previous illness and such. My understanding is the concept is meant to generate a more competetive environment so insurance companies can't do what they are currently doing--charging maximum premiums and paying squat.
The  health care industry doesn't seem to be well regulated, so maybe that's where some investigating should happen!

[mirjo]

cont from previous post...

For example, I have had MRI's in the past (necessary), but what I noticed on the bills that came from the insurance co., was that the radiologist charged a huge amount of money to read the scan and the specialist (my doc) also charged a huge amount to read the scan! I don't know what's reasonable, but I don't think paying out over $1000 for two docs to read an MRI should be allowed personally. I don't know if it was unquestioned because it's considered an acceptable charge?? This was several years ago, but still it's ridiculous.

Perhaps there are two evils at hand, not just the insurance co, but the healthcare industry and the insurance company together. When did healthcare become an 'industry?' Maybe that's part of the problem? It's not supposed to be--the concept of industry is a commercial enterprise named after its principle product--in this case I guess that's healthcare.

Who is paying and who is reaping the profits in this particular industry? Has anyone ever questioned why we have to have insurance in the first place? Who came up with this concept? Because the Healthcare Industry charges so much for its services we need another industry to pay the bills for us. We are all terrified that we will be financially ruined if we have a health problem and that is quite possibly so, because pharmaceuticals cost so much, tests cost so much, and a visit to the ER costs a fortune.  I've never seen anything about these costs and why it is so expensive.

 Has anyone else? I think  a lot needs to be looked at here and I think  everyone everywhere would be better served if all the flaming   crap just stopped and congress   just worked on something  sensible and answered  the important questions. It would help if the media didn't create more problems than already exist! I think the scare tactics of healthcare to the elderly being rationed will not come to pass because those who are vigilant won't allow it and I really doubt that is something that would happen. But there is yet to be a plan drafted that everyone can agree on so...

[dearon]

I just know that when I'm on medicare, if I am fortunate to live that long, I don't want anyone but my family or myself making my healthcare decisions.  I have a healthcare directive and certainly don't want it interpreted that I choose to die!.  Health care decision are best made by yourself and a close relative if you cannot speak for yourself, not some bureaucrat dictating what I can or cannot have or if I'm worth saving.

[vtoutdoorguymb]

I have to agree with mirjo...


In my profession as an x-ray technologist I can't tell you how many times I have seen terminally ill or patients on "delaying death" machines poked, prodded, treated, xrayed, medicated etc. when the only reason that it is done is because as mirjo said, the family wants it done and pushed the Dr to keep trying to "do something."   I am sorry, but until you have seen the condition of some of these poor people when they are on deaths door you can not pass judgement on when is the right time to keep the person comfortable and let them go... Does anyone really think that a person who is 83 years old, has primary brain cancer, has metastases throughout their whole body, and whose only thread of life is an IV bag and feeding tube would really want their blood drawn or their xrays taken every day to document their death picture by picture? I think many families do not understand that none of that stuff is going to help...their loved one is terminally ill, and they are going to pass on...finding out if their cholesterol is high or if they have a small bowel obstruction is not going to cure their family member or even help them... it would be great if doctors didn't have to order unnecessary exams and treatments because of a fear of getting sued....

 Of course there are extremes in both situations, politicians should not be deciding who dies and who lives, but let me tell you that just because you have private healthcare now does not mean its any different...  Sure, a "doctor" that works for your insurance company oversees all approvals and payouts...let me assure you that time and again I have seen that his biggest concern is not whether your back pain is treated, or your ACL repaired, or your artery is opened back up...his concern is how to approve enough to not get sued, while still keeping your insurance company in a healthy profit margin...   At the very least, if healthcare becomes government regulated and overseen, there won't be elderly couples choosing to get sick over facing more medical bills...there won't be single mothers letting their childrens cold turn for the worse because she can't afford rent...and there won't be young couples (I know one) that are going bankrupt trying to pay for cancer treatment...

Politics, b-s, and bickering aside...is there really anything in our current system that is working so great it couldn't be changed? Us fortunate enough to have insurance find it easy to see no flaws with what we have...the family choosing between diabetes medication for their baby and food for their table might disagree...

[mirjo]

Exactly, vtoutdoorguymb. I think a lot of the problem/fear surrounding this  issue is that people fear what they have that is good will change. As I have questioned in my several long winded posts, I don't know where these ideas are coming from about the government controlling who lives and dies or who gets what for treatment?

In Vermont, we are actually far better off than most states. For years we've had laws against penalizing for pre-existing conditions, had programs like Dr. Dynasaur and healthcare coverage for kids. In recent years there has been coverage for those who are uninsured. This is a "public option" and so far as I know, no unsuspecting patient has been denied services to save money--at least it hasn't been reported. The one caveat of this program which is interesting, while the state didn't allow other insurance companies to penalize for pre-existing conditions, it did with its Catamount Health.

Comments I made earlier rearding death were taken the wrong way by Loctavious and I want to explain further that good health goes a long way, but can only go so far as difficult as it is to accept, death is a part of life. It's a hard concept to grasp and my intention is not to be callous or flip about it, however there is no denying that at some point the body is going to fail.

I am a firm believer in holistic care and people being a true partners in their own healthcare team. I agree with what dearon said about her family making decisions. That's how it should be. We all need to take control of our own health--doctors aren't always the answer. But for those who don't have the insurance coverage they need that they really do need and are giving up important meds or treatment it's not good.

I also firmly stand by Death with Dignity when someone has reached the end in a terminal illness I think that person has every right to make the choice to end his life. Anyone who takes the time to read about the law tht Oregon passed about  a dozen years ago now will realize that it it not  about doctors going out and randomly killing people  as the scare police have led folks to believe, but it's bout giving people a choice and a follow up and the law showed that some who chose to get the medication from their doctor chose not to use it, but felt better having the option. Who are we, the living to tell the dying how they feel?  That they should fight, hold on etc? I don't think so. Religion always seems to  play a part in these things and it shouldn't--it's a personal thing. A person has to reconcile with their own god so its up to him or her to make that decision.

You're right when you say there isn't so much that is great about our current system that couldn't stand a change! What I have seen happen to many people in the past year or so, is the health plans they had changed from having  a co-pay for a visit to the doc to having a $2500 deductible that had to be met before the insurance kicks in. With the average visit costing about $125 someone would have to go to the doctor about twice a month before the insurance would pay any thing! Since the average healthy person or even the the average chronically ill person only sees their doctor once maybe twice in a year, all those premiums about $5000 per person or more are just getting collected, but not paid out.

I have said tons more on this subject tahn I ever intended and still I could probably go on.... but won't

[7F24]

lisa and vtoutdoorguymb,
     

    Great posts.  It amazes me that companies that make a profit by not paying for treatment are being looked at as the good guys.  If you pay the loud mouth radio guys  enough to keep telling lies, people will believe them.

[Loctavious]

I didn't take your comments the wrong way mirjo - i commented on the vagueness your comments left about what should be done then about people who don't accept the terminal situation of their loved ones.  Your presentation of information - lead me to that point.  I took care to not assume or accuse you of anything Mirjo - just the vagueness around " if loved ones don't accept the situation, and continue to order and expect additional treatment when it's not going to help' statement - to make sure it wasn't be suggested that the decision-making fall somewhere other than the person receiving treatment. 

As for health care in general, i didn't comment on that really - except to say that if we're allowed the extreme of elongating a person life of a person who's dieing painfully or not even conscious, thus putting them in more suffering and pain, then the other extreme should be allowed as well.  I don't think it's anyone else's right to take a moral high ground and tell someone that they HAVE TO ENDURE extreme pain and suffering until they're body just turns off.  Just as it's nobody else's right to refuse treatment to any patient based on their assessment of their quality of life or how long the treatment may let them live.

I'm encouraged that you feel the same way Mirjo. We're looking at the same issues - just from different angles.