The poor and the disabled have a social safety net called Medicaid. This is the taxpayer-funded program that was put in place to give basic medical care to citizens who cannot work. After all, who of us wants to see a man with no legs die of tuberculosis on the street corner? No one.
So, who should fall under the umbrella of Medicaid? What services should Medicaid offer? Let's save the first question for another discussion, and look at the latter. Medicaid is funded partly by the state, and partly by the feds. The Great Recession has seen many states floundering on the verge of financial collapse, and those people who rely on the government for their health care are facing the effects.
Huffpo is running a story about Medicaid cutbacks in several states, and highlights the case of a man who was denied a liver transplant. The man died. The transplant would have cost taxpayers $500,000. Horrific, right? While the article does explain that the man was suffering from Hepatitis C, it doesn't share what that means for his prognosis, with or without a transplant. Within days of a transplant, the virus attacks the new liver, and the patient becomes even sicker than he was before. However, there is a chance that the hepatitis can be controlled with drug therapies, and that it won't destroy the new liver. Medical breakthroughs are fast and furious. Transplant, or don't transplant?
Does Medicaid's decision not to pay for the transplant constitute a "death panel"?
The Huffpo story also wrings its hands over Medicaid recipients being forced to have teeth pulled, rather than undergo an expensive root canal. Most of the people I know (non-military) who have any kind of dental insurance face a hefty deductible, and then the policy only pays for 40-50% of the dental work. Choosing to have a tooth pulled rather than a root canal is a financial fact for many working-class insured people. Should Medicaid provide better coverage for its recipients than the taxpayers who fund it?
We have many issues to tackle in our country, and some very tough decisions to make. We must be able to discuss the problems in a calm, intelligent, and thoughtful way. We must be able to look at a problem from ALL sides, and apply even standards to our decision making. We must look beyond what kind of civilization we have become, and weigh the answer to this question: What kind of civilization do we want to build for our children and our grandchildren, our nieces and our nephews?
Our ill-chosen "representatives" in Washington are incapable of making decisions for the good of the country as a whole. They are so utterly corrupt that there is nothing left of their brains and their hearts but sawdust and wrinkled dollar bills. It falls to all of us, the citizens and tax-payers, to design a framework for the way forward. We have the most powerful document on earth to guide us; with the United States Constitution spread across every kitchen table in the land, we can salvage this mess. Can't we?
Too long-winded? Probably. :D
ReplyDelete"Death Panel" or centralized bureaucratic Fiscal Restraint(s) equals the same thing. All you have to do is look at VA Health Care and the changes between 1970 and today. VA went from "universal veteran coverage to only selected veteran coverage plus the NGO Tri-Care for some. The 2007 change (now income based) in premiums for Medicare Part B also comes to mind. They significantly increase if you continue working after age 1965 and elect Part B ... if you fail to elect Part B, when you get around to it later the premiums will be Plus 10% ...a penalty for your dalliance.
ReplyDeleteDown the road expect the premiums for Part B to both increase and the eligibility for Part B to be re-defined ala' VA system. It now has both a income eligibility criteria along with the revised source of malaise criteria ... e.g. Purple Heart recipients with 30% or higher disability only need apply for all extents and purposes. Same thing will happen, MUST happen to a centralized health care mandate system (insurers are not free to innovate).
Example: I pay about $96 per month for Part B plus $110 per month for the supplement...it's going up next year, even though there's no COLA again. Apparently insurance inflates while COL doesn't, eh? Anywho...A previous co-worker (3 grades lower) of mine now pays $500+/- per month, including the $140+/- per month for her FEHBP supplement (her elected plan is higher cost than mine...e.g., the government pays the same amount for both, employee pays the difference). Her mistake? She went back to work as a part time annuitant employee for 2008 and 2009 and part of 2010 and her income for Part B purposes is the sum of wages plus pension. No, a federal annuitant is not "double dipping" ... the pension does not regenerate, nor do you accumulate benefits otherwise... that's why is it called "annuitant employment...cheaper for the government than a new FTE. She is covered for Part A without added premium because Feds all pay Medicare payroll taxes, even the older CSRS system types, who did not pay FICA portion. FEM system types (last 20+ years) all pay FICA and Medicare payroll taxes....have significantly reduced pension but draw social security.
Lady Red # 1 ...nope, not enough actually. It is v-e-r-y hard to actually get a grasp on what is coming.
ReplyDeleteOne part is very simple: whenever the cost of the "universal system" (a gross misnomer) exceeds what Congress appropriates for it, there MUST be reductive changes to both income and eligibility criteria. A.K.A "Death Panel" by default at times.
Enjoy.
[It'd be nice is Sarah gurl (of "death panel" fame) could grasp even that much of the how and why of it instead of spouting specious rants. But you can't get much more than that from stupid. She'd better wind down before 2012 or we're all in trouble.]
Aridog, every time I try to get a grasp of the pickle we've gotten ourselves into, my head implodes. There's just SO much information, and it's so very complicated.
ReplyDeleteSimplification of our system must be incorporated into any changes we make, IMHO. How can we fix what we don't understand? If ordinary people can't comprehend the ins and outs, what chance do the idiots we elect to go to Washington have? Zilch.
At this point, what little national discourse we have is an ear-shattering cacophony of media-fed noise. The answers won't come from Washington.
Starting over might be easier (quicker and cheaper, too)than fixing the existing monstrosity.
It's funny that you bring up the root canal thing - I just got a double, with the second part today (I go in in two weeks for the final crown).
ReplyDeleteAnd the worst part of it all is that the issue that led to me needing a root canal had it's genesis in shitty dental care; a tooth that didn't really need a filling which was drilled too deeply and filled badly resulting in a real cavity starting and then an infection.
Sheesh. Anyway, even with good dental, AF Family is out 1600$ on my tooth (and the filling for the tooth next to it, which didn't need the filling Dentist #1 insisted it needed and then did a shit job filling, either).
The dentist who did the really awful job on my teeth was the ONLY one who took the military dental insurance (and, not surprisingly, medicaid dental) in the town we lived in at the time. My new dentist, who is truly awesome, takes "real" insurance. The difference is absolutely night and day.
I didn't get dinged for fillings I don't need (I've had ONE tooth that really needed filling in my life, the previous dentist drilled three additional teeth), she was quite impressed with my tooth strength and told me that the one tooth I do have with "pits" will be fine if I'm careful to get extra calcium and use an enamel strengthening toothpaste.
I'm absolutely convinced that she didn't try to fill every other tooth in my mouth because the practice doesn't take medicaid patients. They make enough money on procedures without needing to "pad" what they do.
I've had the same experiences with doctors - which is a big part of the reason why we chose to have 3 of our 4 kids at home with a midwife and no one who is making medical decisions with a fiscal basis.
Kanani Fong at The Kitchen Dispatch is a surgeon's wife. Her discussions on government health care are eye opening - particularly the amounts that go to insurance companies to start with.
"Does Medicaid's decision not to pay for the transplant constitute a "death panel"? "
ReplyDeleteIn a way it does, and shows therefore, exactly what will be the case for everyone if the Federal Gov't takes over all health care. Surelt no-one outside of La-La Land actually thinks that the goc't will both reduce costs (or even keep them as they are now) and provide expensive care for all?
As for myself, I am the 'proud' owner of three gaps in my smile, from teeth that were filled more than 25 years ago, and are now breaking. Twenty-five years ago I had excellent (State of Alaska) dental insurance, now I have none, so instead of capping these teeth, the economic reality means having them pulled.
One of them is still healing (I hope) even as I type this.
The liver transplant case is an interesting test, because there are some stringent requirements to even get on the list for a new organ.
ReplyDeleteI have one friend whose brother in law got a liver last year. I have another friend whose husband got a heart this year.
If the liver recipient had been drinking - forget it. If the heart recipient had tested positive for nicotine - forget it. No heart for you.
There is a kind of "goldilocks" zone to get an organ - you have to be desperate, but not otherwise so ill or substance-abusing that the organ will be deemed 'wasted'.
So. The liver patient in the HuffPo piece - did he really qualify to even be on the list? Is it the case that Medicare will deny you an organ that the transplant doctors would otherwise offer you?
If so - then f*** yeah, it's a death panel.
Once upon a time we resolved as a society (I'm told - I wasn't consulted personally) not to let people die for want of treatment.
This is not a bad impulse, for a society. That the problematic aspects of leaving the fulfillment of this aspiration to the State weren't anticipated fully can also be understood.
But the reality is that back in the day, medicine could do relatively little for relatively few people, and what it could do, didn't cost all that much. So we were not called to pay much for our benevolent ideal, and that part which was genuine compassion was allowed to commingle with that part which was naive vanity, without the need to distinguish.
Now medicine can do much more, for many more, for a lot more. And the trend is really just getting started.
In fifty years, medical science might well eradicate many common scourges and extend one's life - dramatically, and for nearly everyone. At prices which are utterly bankrupting.
Some of this cost might be due to genuine scarcity of inputs and the capital intensive requirements of treatments - complex formulations and expensive apparatus. Some will inevitably be due to a scarcity of talent - the best and the brightest are never cheap. And some will be due to the nature of the market: what's perfect health and vitality into old age worth to folks, anyway? What rewards are deserved by the talented and persistent practitioners who can deliver such a precious good?
On a fifty year horizon I would offer a stark and humbling dilemma: we can remain free, or we can remain recognizably human. I say this because I fear that any country which prevents its citizens from partaking in the truly revolutionary advancements in medicine will no longer in any sense be a "free" country. And any population which does partake of those delicious fruits will no longer be recognizably "human".
Mere "policy" is unlikely to be competent to unravel this conundrum.
Health care has always been an object of money. Even in Madison's day, those with money had better health care than those without.
ReplyDeleteDespite the current guidelines, I suspect that if you have enough benjamins, you can get a transplant even if you're an alcoholic or a chain smoker. Those pesky little guidelines are created to ration product (in this case, transplantable organs) to the rest of us.
Must we choose between humanity and freedom? I don't acquaint humanity with emptying my bank account every time a neighbor needs critical health care. Humanity comes from caring for my neighbor and his family in their time of need. In this way, my neighbor and I both retain our humanity and our freedom. We might die a little sooner than a rich person who can afford the best medicine has to offer, but at least we die free and at peace with God. Does that make sense? Or am I too old-fashioned?
lady red, I yield to no-one in my cynicism toward the institutions who govern us, but at least in the case of the United States, no, I don't think the alcoholics or chain smokers fair too well with the organ transplant people. They guard their prerogative quite jealously, it seems.
ReplyDeleteThere are ways to game the system around the margin - e.g. move to the right county in the right state at the right time of year. My friend's brother in law did this to get his liver - perfectly legal, but you have to know the system, and have the money to move for a bit.
Now in Asia, things are probably different, and likely to remain so. This is where the drinkers and smokers (and those desiring cut-rate sex change operations) go to "shop".
Must we chose between freedom and humanity? My point is simply this: to the extent that we might die a little sooner than the rich, then yes, you are correct - but my view is that the future affords the possibility that the poor will die a lot sooner than the rich - or more properly, the rich will live a lot longer. And with better hearing, vision, mobility, skin, sex, everything. And they will pay for this.
This will not be affordable for everyone, or even most. Many, many will be left to die for want of treatments which a few rich folks can afford. And the graph of wealth to life expectancy and quality of life will become much, much more correlated.
Freedom has always entailed a certain freedom to pursue one's health, commensurate with means, as you observe. Even extreme wealth could not purchase extreme or miraculous outcomes. This will change.
And when it does, I would suggest that society will have to chose just what it will let money purchase.
Society makes these choices all the time. Today, you cannot buy slaves, or concubines, which could in days past be traded the way commodities are traded today.
With the advent of organ transplants came the question of an organ market. Today, you cannot buy organs. (Again, I'm a cynic, but no, I don't think there is an organ black market in this country). I've read reasoned and impassioned arguments that organs should be allowed to be traded for money by the likes of Viginia Postrel and Ilya Somin. They may be wrong, but they aren't crazy. At a minimum, they convince me that restriction in trade of organs is a restriction of liberty in some sense - the state has decided that there is no reasonable possibility that such a transaction is entered into without compulsion, by consent of competent actors. There are plenty of people who feel otherwise; perhaps for the sake of the vulnerable, the activities of the truly competent have to be curtailed. But it is a trade off.
In the future, society will have to circumscribe what money may and may not purchase to an unprecedented degree, as money will buy more and more products and services which are today unimaginably miraculous. "God-like", if you will.
And so society will become progressively less free, or else, humans will become less recognizable to their predecessors.
I think we're at a critical inflection point with state provision for organ transplants. The issue will only become more critical from here. Whole countries will take different paths.
I'd guess that in Europe, the entire scope of human activity will become a kind of "white list". Everything off the list - every food, medicine, technology, and practice - will be forbidden. They will remain themselves - or rather, a kind of zoo, populated by Homo Europa circa 2000 (not their best vintage, frankly).
I'd guess that in Asia is where we'll see a braver and crazier future evolve, with Korean doctors, Japanese roboticists, and Chinese militarists eventually cooking a mutually agreeable stew of hedonism and power unimaginably compelling and repellent at the same time. They will agree that Europe is a zoo, and maintain it as a kind of petting zoo.
And what will become of us?
lewy - I agree and disagree with you. Because I do that.
ReplyDeleteI do see what you mean in the huge leaps in medicine, and yet I don't think that the horizon is what you are projecting.
For one thing, I look at the medical treatments at Bethesda (where I volunteer) for wounded service-members. I see AMAZING stuff that has been done for these guys. Our KIA rate is (and this is not to disparage a single death, because they are all tragedies) amazingly low for a conflict that has gone on for 9 years. Our wounded casualty rate, however... I don't think people have any idea. I really don't. I could tell you, if you want.
It is advances in medicine that has given these service-members the tools to be able to survive, but it is the will of these service-members and their determination to live "normal" lives that has actually caused their survival.
What I see in many civilians I know with chronic problems and access to unlimited health care is not a gratitude for life and the drive to create a better life for themselves, it is the non-stop step from one chronic condition to another. In some cases the cures causing more problems than the original disease! It's as though the access to certain sorts of treatments creates a dependency on medical care that those with good preventative health care (but not of an invasive health care bent)don't experience.
My great-grandparents lived into their late nineties (or past 100). My grandparents followed suit. These were people who worked hard, spent long days in the sun farming, and were successful enough that they never went hungry. They had tremendously full lives - inside and out - in a way that people have forgotten now.
I think that there is more in that lifestyle than in medical age advancements. Not that I want medicine to stop advancing, just that I don't think medicine is as much of a cure-all as it is often made out to be.
Also - I can't say I blame the organ donation lists for being strict about their very scarce resources. A transplant is in effect the gift of life. It is a gift, not a right. Someone has to die for someone to live.
ReplyDeleteAnd I don't think that it is asking too much for them to require the recipient to appreciate that gift enough follow the strict rules.
The rules aren't hidden - the choice is up to the prospective recipient.
Also - please don't read this with my voice sounding all bitchy and preachy. As I re-read what I wrote, I realized it could totally come off that way, and it really wasn't my intention.
ReplyDeleteJust discussing...
afw - no worries - that was some f****d up stuff I wrote. Specifically, it was highly speculative, and my "voice" carried a level of conviction which I don't actually possess. But it flowed, so I went with it. Think of it as a thumbnail sketch of a science fiction novel.
ReplyDeleteA few points:
- I think you should talk about the wounded rate. I'm given to understand it is pretty high.
- I also agree completely with the strict rules for organ transplants - my point was to highlight the potential for disparity between the organ transplant rules and the insurance rules. If a person qualifies for a transplant, that implies they are in some sense both "deserving" and "desperate" from a purely medical point of view - and so if they are then denied for financial reasons, then yeah, that body which denied them is arguably deserving of the "death panel" sobriquet. Who wields that authority, well, that's a matter for policy and politics, but it will be difficult to deny that rationing is occurring.
- lastly - current medical research indicates that the primary factor in living past 100 is genetic. For this level of health, "healthy lifestyle" isn't sufficient, and in some cases isn't even necessary - you have to have the right genes. My great grandfather and my grandfather (and his two brothers) lived a similar lifestyle and lived into their 90s. My father on the other hand had diabetes and, absent the miracle of insulin and a desk job, would have died much younger, with no deficit in the "zest for life" department. Brain chemistry too is an attribute not entirely determined by attitude and will; some folks have a harder time than others, as with everything.
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So while I hold the scenario I outlined rather lightly, I don't discount it either. I do believe that the fruit of the tree of knowledge has the capacity to change who we are to the point of revulsion - and yet any attempt by Mankind to return to the Garden might only be accomplished by a kind of totalitarian regime that would have to be viewed as a kind of prison.
What's the point of this kind of speculation? I'm a follower of Gretzkism - don't skate to where the puck is, skate to where the puck is going. I see the puck of knowledge moving very quickly, and we're not on a rink, but a pond, without clear boundaries, and potentially some very thin ice. Cheers.
lady red, what thought-provoking writing. I am so discourared by what has happened recently with the omnibus bill (which I understand has some major funding for Obamacare included in it) and other legislation that Reid and others are attempting to push through the lame duck session.
ReplyDeleteI don't have any answers except that I think we need to start SLOWLY instead of with this huge health care package whose impact and efficacy is unknown. We could start by seriously pursuing those who defraud Medicare and Medicaid.
Your last paragraph says exactly what I feel:
Our ill-chosen "representatives" in Washington are incapable of making decisions for the good of the country as a whole. They are so utterly corrupt that there is nothing left of their brains and their hearts but sawdust and wrinkled dollar bills. It falls to all of us, the citizens and tax-payers, to design a framework for the way forward. We have the most powerful document on earth to guide us; with the United States Constitution spread across every kitchen table in the land, we can salvage this mess. Can't we?