Should Health Care Be Rationed?
Princeton bioethics prof Peter Singer writes in New York Times Magazine that health care must be rationed:
You have advanced kidney cancer. It will kill you, probably in the next year or two. A drug called Sutent slows the spread of the cancer and may give you an extra six months, but at a cost of $54,000. Is a few more months worth that much?If you can afford it, you probably would pay that much, or more, to live longer, even if your quality of life wasn't going to be good. But suppose it's not you with the cancer but a stranger covered by your health-insurance fund. If the insurer provides this man -- and everyone else like him -- with Sutent, your premiums will increase. Do you still think the drug is a good value? Suppose the treatment cost a million dollars. Would it be worth it then? Ten million? Is there any limit to how much you would want your insurer to pay for a drug that adds six months to someone's life? If there is any point at which you say, "No, an extra six months isn't worth that much," then you think that health care should be rationed.
...Remember the joke about the man who asks a woman if she would have sex with him for a million dollars? She reflects for a few moments and then answers that she would. "So," he says, "would you have sex with me for $50?" Indignantly, she exclaims, "What kind of a woman do you think I am?" He replies: "We've already established that. Now we're just haggling about the price." The man's response implies that if a woman will sell herself at any price, she is a prostitute. The way we regard rationing in health care seems to rest on a similar assumption, that it's immoral to apply monetary considerations to saving lives -- but is that stance tenable?
Where do we draw the line? Who gets to draw the line?
@Kate Coe Tweeted:
Why (not) ration health care by how popular a patient is? More FB, Twitter pals, better medicine for you.
Why not ration by how much money you have?
No, seriously, why not?
Crid [CridComment@gmail] at July 19, 2009 1:10 AM
OK, I apologize for the snotty question, it's addressed plainly in the piece... But half-heartedly. The article is smoke-screeny. It's full of how-can-you-justify-this-when-you-don't-justify-that passages, but never seems to consider the essential motivating factor in health care: People provide it because they get paid.
Crid [CridComment@gmail] at July 19, 2009 2:07 AM
Private health care: your policy should contain the terms of care, including the limits. If you want more, pay more.
Public health care for the uninsured: restrict to basic, life-saving stuff, with a very strict cost limit. No ultrasounds of your baby, no narcotics for "pain", etc, etc.
bradley13 at July 19, 2009 2:11 AM
> no narcotics for "pain"
Um... Dude... What if someone, y'know, hurts? Someone in a hospital I mean. Or someone who's sick?
Crid [CridComment@gmail] at July 19, 2009 2:48 AM
If we follow Peter Singer's ideas, then any kid who falls ill before age five should be euthanized.
Peter Singer is piece of shit. I love how he tries to make sure you believe you already agree with him, and it's just a matter of how radical you're willing to be.
People like him are why the government can never be allowed to make decisions like this.
brian at July 19, 2009 4:39 AM
Obviously the people who get to draw the line are me (Ezra Klein) and my friends.
Or if you prefer: people like me who went to Ivy League schools and need to feel important without actually having to take any risks.
Ezra Klein (not really) at July 19, 2009 4:41 AM
Huh. The health care system is broken. By whom? I'm with Bradley13...BTW, he indicated pain as "pain", tongue-in-cheek. Consider people who shop for pharmaceuticals at all the local ER's. All the Rush Limbaughs, Michael Jacksons, and suburban junkies who think if it's a prescription medication, it's not as embarrassing as cocaine addiction.
I had to take my youngest to the hospital two weeks ago. We were out of town and ended up in a little podunk town of 10,000 in the middle of BFE. This podunk town's hospital is EXPANDING.
Huh? How? Because they're in the middle of cow country where everyone works their asses off and their bills too. This hospital is actually in the black, and they're drawing insured patients from the surrounding areas who've heard about the excellent care. The hospital can work this way since they haven't been force fed patients who refuse to pay. Big city uninsured patients won't drive waaaaaay out there for the ER.
Juliana at July 19, 2009 5:30 AM
If there's a drug that will extend life for 6 months, that's 6 more months to find a kidney donor, so there's always the possibility that this drug SAVES your life. Then how much is it worth?
Also, if there is such a drug, researchers are that much closer to a drug that will extend life even longer: A year, or two, or ten? Who knows? Not the guy trying to trick us into believing we all live in the closed circle of his scenario. But if the drug that provides modest gains will never be prescribed, because guys like him can't see the use, what's the incentive to develop and shepherd any modestly successful drug through the costly and time-consuming approval process? Which in turn renders it far less likely that the next drug, perhaps providing important gains, will ever be developed because such gains are so often made in incremental steps.
To ignore the possible usefulness of a drug that provides even slight benefits is to present a dishonest scenario.
Robin at July 19, 2009 5:39 AM
Robin -
You state the point while missing it, I think.
The point of health care rationing, and ending/limiting new drug research (which is a serious idea that Daschle floated, and the whole "comparative effectiveness research" thing is supposed to lead to) is simple:
To eliminate the people who don't think, like Peter Singer, that the human race is a cancer on the planet.
People like Algore, Singer, Ehrlich and Holdren are misanthropes, first and foremost. Sure, they like the human race, just not all of it.
Or as P.J. O'Rourke titled his chapter on population in "All the Trouble in the World": "Just enough of me, way too much of you."
brian at July 19, 2009 6:11 AM
The same "bioethicist" Peter Singer who advocates the weeding out of less than desirable (according to his standards) infants within 30 days after birth.
In the hands of government bureaucrats and eugenicists like Singer, treatment becomes a pure cost-benefit analysis. If someone is deemed "non-productive" to the purposes of the State, such as the elderly, the chronically infirm, or the mentally disabled, these are expendible. No matter whether they show ability to pay or not. This is evidenced by the provision in the proposed legislation to grandfather *everyone* into the government plan.
It is a small additional step to include in the "undesirables" those who are deemed to be a net drain on the planet's resources. That would be most of us. I hope all those who would be affected, and their loved ones, can be alerted to this before this POS legislation can be rammed through.
cpabroker at July 19, 2009 6:51 AM
To add to Robin's point: The gains are not simply six months for one patient; they are six months for each of perhaps tens of thousands of patients each year; hundreds of thousands each decade; millions soon enough. And, of course, six months might be the low guess; it might give some a year, so over only a short time you're enriching the lives of millions of people for many, many years. By reducing it to the six months for the one solitary patient, he obscures the enormous collective benefit such a drug provides.
I agree with Brian: people like this are misanthropes.
kishke at July 19, 2009 7:31 AM
Amy Alkon
http://www.advicegoddess.com/archives/2009/07/19/should_health_c.html#comment-1659028">comment from kishkeAre you willing to pay $100 more a month to keep people alive for an extra six months then? Just wondering.
Amy Alkon at July 19, 2009 7:54 AM
Yes. It's what I and all of us do now anyhow with our current insurance payments.
kishke at July 19, 2009 8:04 AM
In the old USSR, contraceptives were unavailable, so abortion was the main form of family planning. The operation was free, but if you wanted pain relief, you had to pay the doctor black market rates under the table.
How may medical breakthroughs came from that system? Treating polio in the 1940's was very costly. The research to make a vaccine was costly. The vaccine you receive is cheap and prevents lost productivity in those spared paralysis.
Ruth at July 19, 2009 8:06 AM
All this is controversy because of a reluctance to approach the truth.
Life is a competition, a combat, now camouflaged in the USA by the abundance provided by industry.
The truth is plural. One of them is that there are too few doctors to deal with any pandemic or great disaster, such as California's Next Great Earthquake, one nuke in a US city, the Yellowstone supervolcano.
Another is that it is completely possible to vote yourself out of the ability to do things. Look at California, again. No matter what you do, you cannot legislate perfect health for everyone.
And so, rationing of a public service is mandatory. It already applies to dozens of public services - and have you noticed that the term, "rationing" implies that the public sector can actually do everything for everyone? It cannot. The term is subtly misused, in that it really applies to the process of determining what can be treated with the available medicine.
I hate that it has become a code word for "some elitist is deciding if I am important". It's not about you.
The only way to see that you, yourself, get quality health care is to pay for it yourself. That is actually most fair: the risks you take bear on you alone. Rewarded, you curiously fail to share with others unless forced; maybe that should work the other way, too.
Now, there is just one more thing to remember and pass along: Obamacare, like Hillarycare before it, will forbid you from paying for your own care. No, you may NOT use your own doctor or drugs. Yes, you WILL go to jail or be fined for doing other than what government tells you to do. If there is no form to fill out for your condition, too bad. If there is a line, you will wait. You are sick? So what? The clerk is not sick. Fill out this form.
Radwaste at July 19, 2009 8:42 AM
"Why not ration health care by how popular a patient is?"
"Why not ration by how much money you have?"
Health care actually tends to be rationed by how much power you have. In Czechoslovakia there were entire hospitals set aside for the exclusive use of Communist Party officials & their families. Ordinary citizens in ordinary hospitals, on the other hand, had to bring their own clean sheets, toilet paper, & light bulbs with them if they wanted any such conveniences during their stay. If you had enough money to bribe a nurse, she might change your bed pan for you. But even if you bribed away your entire life savings, you could not get a bed in the Party hospital. Heaven only knows how many millions of rubles were spent giving Leonid Brezhnev a few more days of life.
Martin at July 19, 2009 9:13 AM
Brian: I got it. I just didn't state it as clearly as you did.
I agree with kishke. We are already paying a version of that $100 to keep someone alive for 6 months. The whole system is set up that way, and I think it works pretty well. Not perfectly. We just won't realize how much we were getting for our $100 until Obama's new eugenicist science czar hooks up with Singer to stifle any further research that might benefit pestilent humanity.
Robin at July 19, 2009 9:14 AM
And it's the market that draws the line. I prefer that to a government bureaucracy, which I believe is the realistic other choice.
Robin at July 19, 2009 9:19 AM
Anyone who's ever had to fight an insurance company to get medical treatment covered, knows full well that we already have rationing of health care. (In our case, it was getting coverage for extended physical therapy for a child with cerebral palsy.)
deja pseu at July 19, 2009 9:31 AM
Why not ration by how much money you have?
Exactly. I'm guessing the reason he was pussy-footing around this is that people have a tendency to respond emotionally to a statement like this and never think it through. He was trying to sneak past the emotional radar. It's not my style and I don't think it will work on too many people in this case, but who knows?
It didn't work here. Note that brian went immediately to a straw man and ad hominem rather than actually addressing the point - not unusual for him, though. cpabroker also went to the ad hom. Robin dodged the original question by pretending to answer it, but actually constructing a completely different, more complex scenario and throwing in a little ad hom for good measure. Only kiske gave a straight-forward answer, but even that drew an obviously false equivalence between private, voluntary insurance with different price points and levels of service and a universal, mandatory plan.
People just don't like to think about this stuff. It doesn't help that most are economically ignorant.
Frankly, I don't like the way that Singer makes the argument above. He seems to be saying, "I'll bet you don't support rationing, but look at this extreme situation. I bet you'll support it in this situation and that means it's not a question of whether you support it, but when you support it."
I don't think rationing is something you can support or not support any more than gravity. It's inevitable. We have unlimited desires and limited resources. We always have and we always will. The question isn't whether some desires will go unfulfilled, but who chooses and how.
Shawn at July 19, 2009 9:51 AM
Hey ever'buddy! Brian has feelings to share about insurance!
> Ordinary citizens in ordinary hospitals
You mean Canadian ones?
––
Anyone else around here deserve to be scolded? Eh:
> over only a short time you're
> enriching the lives of millions
For "enrichment", we look to government?
Crid [CridComment@gmail] at July 19, 2009 9:55 AM
For "enrichment", we look to government?
No way! I'm arguing in favor of our current system, in which our insurance premiums pay for the treatment Singer decries.
(Not that govt. doesn't meddle in private insurance, to our detriment mostly, but there's not much hope of rolling the clock back on that; we're lucky if we get to keep what we have. And I say that as someone who pays an awful lot for family insurance, and is likely to benefit financially, at least in the short run, from govt. administered, universal health care.)
kishke at July 19, 2009 10:21 AM
"We have unlimited desires and limited resources. We always have and we always will. The question isn't whether some desires will go unfulfilled, but who chooses and how." Shawn.
Why so difficult?
I would rather make the choice, then to have the govt. impose Lowest Common Denominator on me. By nature the govt. MUST do that, because we are all paying in.
SwissArmyD at July 19, 2009 10:45 AM
Radwaste said - "The only way to see that you, yourself, get quality health care is to pay for it yourself. "
My brother was in accident a year and a half ago that screwed up his left leg. He needs knee replacement surgery and I'm not sure what else. He does not have health insurance but does have the money to pay for it, and none of the doctors will do it.
William (wbhicks@hotmail.com) at July 19, 2009 11:06 AM
Amy Alkon
http://www.advicegoddess.com/archives/2009/07/19/should_health_c.html#comment-1659058">comment from William (wbhicks@hotmail.com)More information is needed here, William, about your brother who needs knee replacement surgery. You say he has the money to pay for it, but none of the doctors will do it.
No doctor anywhere? None of the two doctors he's asked?
And if they won't do it, is that because he has X number of dollars, but if there's a complication, the hospital will end up paying for it in the long run because he lacks insurance? A simply operation can go terribly awry.
Amy Alkon at July 19, 2009 11:10 AM
> Peter Singer is piece of shit.
Have you been canoodling with Joe Pesci again?
> BTW, he indicated pain as "pain",
> tongue-in-cheek.
He doesn't have to be perfectly sincere to be wrong. Sure, people shouldn't abuse the health care system to get stoned. But a generalized effort to tone down pain relief as a way to save money is a spectacularly bad idea.
> The only way to see that you,
> yourself, get quality health
> care is to pay for it yourself.
> That is actually most fair: the
> risks you take bear on you alone.
I appreciate Raddy's clean thinking. When you buy what you want for yourself, everyone's motives remain clear.
Singer is not a "piece of shit" and he's not a "eugenicist": But he has a typical NY Times columnist's disinterest in the power of capitalism. Such people have a weird idea that insurance creates wealth. And they have an unspoken presumption that nobody should ever be denied access to health care, and that we'll all agree with this.
But we want people to work for it. We don't want them to suffer, we want them to work for it.
Crid [CridComment@gmail] at July 19, 2009 11:33 AM
> More information is needed here,
> William, about your brother
Exactly exactly exactly. If Ballmer or Trump came in with a bum knee and a satchel of cash, they'd be treated. So what's the deal?
Crid [CridComment@gmail] at July 19, 2009 11:36 AM
I don't care for this article.
So Sutent costs $54,000. We now have to consider the possibility of rationing as an alternative.
(You know what, I HATE articles like this).
Sutent, and other pharmaceuticals like it cost so much because of the government's intervention. Particularly, in this case, the passing of the Kefauver Amendment (1962).
A new drug must not only be proven safe, but ALSO "effective". Proving drugs are safe is not difficult or costly. Proving them "effective" is a completely different animal altogether.
To prove a drug effective takes $800M, 40,000 pages of documentation and about twelve years of research and studies. And this is for only one drug.
Do i need to know a drug is effective before I take it? No, fuck no. I only care that it is safe. My doctor, and/or I are responsible for determining it’s effectiveness.
Pushing for the repeal of this amendment should be first on the list of solutions to healthcare cost management. We don't need to be discussing rationing. We need to be holding the government accountable for the inflated costs of healthcare NOW.
Feebie at July 19, 2009 11:58 AM
Shawn:
Bullshit. He wasn't pussyfooting around anything. This is the man who advocated (and to my knowledge still advocates) for infanticide for "defective" infants on the basis that a new born pig is more functional than a new born human, and so there ought not be a moral dilemma.
Singer was going right to the point - defective people are a drain on the system and ought to be euthanized.
Yeah, fuck you too, buddy. It's only ad hominem if it's being used to discredit the man unfairly. His extremist views are what make him a piece of shit, and you know it.
Crid:
Make sure you never comment on another thread about marriage, because you are clearly not qualified to talk about it. And I will call you on it every single time. Just to be a dick, of course.
brian at July 19, 2009 12:03 PM
>> Make sure you never comment on another thread about marriage...
"I'll take inappropriate for $500, Alex!"
Feebie at July 19, 2009 12:16 PM
No, Feebie, it's not. Every time I have something to say about health care, Crid trots out the old "chickenhawk" argument, explicitly stating that I have no right to an opinion because I've not paid into the system.
Fuck him. Fuck him with sixteen feet of curare-tipped wrought iron, and no lubricant.
And that goes double this time, because he appears to be trying to link me to something someone else said.
brian at July 19, 2009 12:25 PM
Amy Alkon
http://www.advicegoddess.com/archives/2009/07/19/should_health_c.html#comment-1659074">comment from FeebieDo i need to know a drug is effective before I take it? No, fuck no. I only care that it is safe.
Drugs have side-effects. Taking a drug is taking a risk. Long-term studies sometimes show that drugs cause harm. For example, I take 5,000 iu of vitamin D. I'm going to get tested in a few months to see if that maintains an adequate level in my body. An epidemiologist I'm friends with cautioned that in 20 years, they could find that it causes sarcoma, that there aren't tests on the longterm effects of D. He takes a conservative view in general, but it seems clear to me that with vitamins, at least, much of what we do is a crap shoot. I also take calcium. Is it enough? Too much? Bioavailable? I take gel caps, etc, and do what I can to try to be prudent, but who really knows without any sort of longterm testing. And even that, as my friend cautions me from time to time, is on populations, and individuals vary. (I experienced this myself with my extreme reaction to "conscious sedation" -- losing some cognitive ability for a few weeks and experiencing some memory loss for a little longer.)
Amy Alkon at July 19, 2009 12:32 PM
@crid:
I put this idea forward in a comment on a previous posting on health care rationing. All resources are rationed by the market.
The market provides a morally neutral mechanism for rationing goods and services. A subsequent commenter said that this was amoral, probably without understanding the difference between amoralism and moral neutrality.
Tyler at July 19, 2009 12:51 PM
Singer's example is not rationing.
What he's describing is a closed market for health care that excludes drugs based on utility estimates that incorporate price and longevity.
Rationing concerns the allocation of scarce goods a/o services within a market. If Sutent is not available to anyone, within the monopoly insurance system that he describes, then it can't be rationed by that system.
For instance, drugs that don't meet FDA standards aren't 'rationed' in the US. They're prohibited. And it doesn't make sense to claim that the FDA selection is a form of rationing, because the FDA is not restricted in the number of drugs that it can approve.
Similarly Singer's insurance monopoly is prohibiting market access, but it's not exchanging anything to perform this function, so its selection of market entrants is not a form of rationing.
Jack at July 19, 2009 12:57 PM
Amy, truly, I see your point.
But as you said, it can be a crap shoot. And the Kefauver Amendment is the primary bottleneck of medicinal progress.
It creates an huge delays (years) in getting new drugs on the market. New drugs which could have been saving countless lives in the interim (not to mention, the ones that hault progression of some conditions into more expensive and life threatening ones down the line). Personally, I think medical professionals and private enterprise would keep things as check as much as it is possible with these things.
The Amendment creates so many expenses and regulatory disincentives that many promising drugs are never developed at all.
If it was maybe even revised or reamended with just cutting the current FDA requirements in half (another option, perhaps) then maybe that would be a solution worth looking at.
I don't know, there are pleanty of these that need to be revisted. This was an amendment made in 1962 when our research and knowledge was not as advanced as it is now... I have a difficult time believing that what it took in 1962 to prove a drug effective, would still be the same time and effort as it would with today's technology.
Just sayin'.
Feebie at July 19, 2009 12:59 PM
Brian.
I don't know what side of the bed you woke up on this morning...but I am hoping from what I am seeing right now, that it was the bad side.
Check yourself.
Feebie at July 19, 2009 1:05 PM
I think Feebie's making a great point. Sure, there should be some testing for effectiveness, to weed out the quacks. But based on what I've read over the years, the FDA has gone way overboard on this. Another place where governmental meddling brings drug prices up is patents. If the govt. wouldn't so severely limit the patent-protection period for new drugs, I bet we'd see prices come down. The combination of the two is a double-whammy: all the extra testing costs a huge fortune, and there's only so little time to make it back.
kishke at July 19, 2009 1:05 PM
> I have no right to an opinion
> because I've not paid into the
> system.
You can hold whatever opinion you want, but those who hear it should know the risk you've been imposing on others, expecting providers to have trust that "they'll eventually get their money." Speaks to moral seriousness, y'know?
> he appears to be trying to link
> me to something someone else said.
Sorry! I thought you said, "at July 19, 2009 4:39 AM", that "Peter Singer is piece of shit."
There was a indisputable Scorcese vibe, yet it felt like you, too.
> The market provides a morally
> neutral mechanism for rationing
> goods and services
I'm sincerely pleased that so many people in this thread get this.
Crid [CridComment@gmail] at July 19, 2009 1:07 PM
It's only ad hominem if it's being used to discredit the man unfairly.
Um, no. I sort of forgot that not knowing the meaning of words, but thinking that you do, is yet another example of your quality of thought.
Here's a definition of ad hominem. What makes an argument ad hominem is that it's against the person presenting an idea rather than the idea itself.
His extremist views are what make him a piece of shit, and you know it.
He may be a piece of shit, but I don't know it and I don't much care. IIRC, this is the first time I've ever seen him quoted and it may be the last. What interested me was the only the idea that Amy quoted. I have the ability to understand that the idea can be evaluated on its own merit.
Why so difficult? I would rather make the choice, then to have the govt. impose...
For me it is just that simple. There are a lot of arguments for single payer and you have to address them as they are presented. Most involve a certain amount of complexity, because , well, you need a lot of smoke and mirrors to make people ignore an elephant in the room.
Shawn at July 19, 2009 1:20 PM
> But based on what I've read over
> the years, the FDA has gone way
> overboard on this.
I dunno about. (Of course I have no idea what you've read, I mean the other thing.)
No one seems to doubt that a tremendous source of the cost of bringing drugs to market is shielding the providers from liability, and I'd assume Fed certification of testing is a big part of that... Presumably, when Sally Jo Smalltown sues Lilly for poisoning her 89-year old husband with a pain reliever, the first thing the defense lawyers will say is "Hey, yer honor, the FDA signed off on this...."
This is not the kind of science that can be rushed. I remember how disappointed the Act Up types were about ten years ago... They insisted that the usual protocols for AIDS drugs be streamlined and rushed, and the resulting drugs were marginally effective and had horrible side effects, besides.
And not only the that, the scientific method itself hasn't undergone a whole lot of serious improvement in recent generations. There are a lot of more effective procedures, but these will often seem like the very bureaucracy you mean to decry. The nature of a meaningful data point hasn't changed... And neither, of course, has the avarice of a drugmaker who needs to goose his share price.
Crid [CridComment@gmail] at July 19, 2009 1:26 PM
Feebie:
No. The side of me you are seeing is the side that is sick of the bullshit moral posturing of a self-satisfied schmuck. I'm tired of his relentless attacks on my character, his insinuations (and sometimes outright accusations) that I am a thief, liar and swindler. I don't live according to HIS moral code, and therefore my position and opinion is irrelevant and subject to bullshit attack? Fuck no.
Shawn - By the strictest definition, sure, it's ad hominem. But the common usage involves an attempt to discredit someone's VALID position by attacking their character. I did not do that. I asserted that his position is abhorrent, and that furthermore he is also a piece of shit. Not ad hom really, just a simple statement of fact.
Shawn:
The idea, evaluated on its own merit, is abhorrent. As someone else said upthread, it isn't rationing. It is deciding whether or not advancing the state of the art is worth the cost based upon who benefits.
Let me put his argument into different terms. A drug that cures leukemia in adolescents and gives them 30-40 years? He might be for it, because those people can still be sucked dry. But curing lung cancer for 60 year olds that are about to retire? They're a burden. The money is better spent elsewhere.
Peter Singer wants to reduce life to simple calculus of projected total life value. If he doesn't think that your life is worth living, you shouldn't be allowed to live it.
You would do well to research this piece of shit and see just what it is that people like he, Ehrlich, and Holdren (who is our new Science Czar) advocate.
You might find out that you are next in line for the human sacrifice.
brian at July 19, 2009 2:29 PM
Crid:
Nope. The courts have already determined in the Vioxx case, and (if memory serves) long before, that an FDA ruling of "safe and effective" does not confer immunity of any kind.
Basically, the drug companies have to dance through hoops to get a drug tested and evaluated, they spend millions on testing and trials and documentation to get approval. And then when they get sued because someone overdoses on it, the FDA says "you're on your own pal!"
I'm guessing they get sued infrequently enough that this is an acceptable risk.
brian at July 19, 2009 2:33 PM
Government certs will have no meaning to a jury? Good to know!
Crid [CridComment@gmail] at July 19, 2009 3:54 PM
"He needs knee replacement surgery and I'm not sure what else. He does not have health insurance but does have the money to pay for it, and none of the doctors will do it."
$19,000 to $33,000 for the replacement itself (depending on where you live), plus hospitalization, drugs, post-surgical rehab...you're talking 50-60,000 dollars.
There are a few risk factors that contraindicate a knee replacement, regardless of insurance/money issues. He has no other problems?
crella at July 19, 2009 4:18 PM
In the past, I've repeated the letter I sent my Senators proposing a change to the health-care setup. I've been inspired by driving through Jacksonville and looking at the office buildings full of medical insurance workers who see no patients whatsoever.
Rather than repeat it every time Amy puts up a health-care post, I'll just link to it.
One way or another, you'll pay for medical work on you. I'm worried that you might begin to think it is the duty of others to pay for your bad luck and bad choices. I think we can keep the innovation going without miring everyone in a mudbath of Federal forms. And clearly, there should be a way for you to get the treatment you need, so long as you recognize there are indeed limits.
I'm sure you think no one can understand your pain when you are ill or broken. It is clear that you cannot expect a government clerk to have that understanding. You must also realize that you cannot command others to spend recklessly on your behalf in the hope that something finally works.
Please note that there is still a medical issue to be faced: medical proficiency. Some doctors perform in anonymity with respect to their record of successes and failures of treatment.
Radwaste at July 19, 2009 4:33 PM
Singer is an asshole. Nothing ad hominem about fact.
As for Brian's bad day-he should stop posting on insurance, and us divorcees should stop posting on marriage, and the childless should stop on raising kids. Right?
momof4 at July 19, 2009 6:01 PM
No, he should make it clear that his doesn't take paying for his health care seriously, since:
• providers will (or may) "eventually get their money"
• "payment on credit is acceptable" (even when his providers aren't told they're working on credit),
• and perhaps that his bills need not be paid, since "they get enough people to pay on terms that it's worth the hassle", therefore his own debts should be ignored.
His clearest & dearest views of this are those of a child. It offends me that he should speak of it like a grown man.
Have you been at Amy's blog for awhile? It'd be like a Canadian who pretends to be American while discussing our politics... Or like a loving parent who thinks it's OK when other people's babies don't have mommies or daddies.
I often think Amy's a fool for her simplistic denigration of religious people... But she never tells them how to pray.
Crid [CridComment@gmail] at July 19, 2009 6:22 PM
You're too easily offended. Especially about things that are ultimately none of your business.
Would it surprise you to learn that even if the hospital won't take American Express, I can get a cash advance to pay the hospital until I've secured long-term financing?
Did that thought ever cross your tiny little mind?
Or do you think that hospitals only take insurance company checks?
Do you think the hospital is financing this shit themselves? Fool. See, there's these things called "Banks", and if you're creditworthy, they loan you money, and you pay it back.
It has always stunned me that people have no problem going $50,000 in debt to buy a Lexus, but can't countenance the idea of doing the same to set a broken leg. No, they expect to pay into some magical slush fund and let the payments become someone else's problem.
I'm glad you took the bait and made an even larger fool of yourself thinking you were making a fool of me.
Yes, I still view most health insurance as a major scam. But I've always had my options covered. You just happen to think that by not giving some insurance company my money to hold I've been irresponsible. You'd be wrong.
As I said, unless I end up in a PVS, there's no way I end up getting the taxpayers to cover a fucking thing. See, when you're responsible with your finances, it gives you options.
And unless that jug-eared douchebag and his cast of idiots in DC get their way, I'll finally get my wish and be able to buy actual INSURANCE, instead of the opportunity to pay into an organized slush fund to subsidize other people's bad lifestyles.
So I'd say it's a win-win all around. Except for you of course, because you don't get to feel all superior and shit. But I'm sure you'll get over it.
brian at July 19, 2009 6:54 PM
Riiiiiiiiiiiiiiiiiiiiiiiiiiight.
Crid [CridComment@gmail] at July 19, 2009 7:32 PM
I think we have solved the problem right here. Should we we inform the major newspapers or Obama Administration of our profound thoughts? I am sure they would respect our guidance.
But if we do get national health insurance, and rich people end up subsidizing it, you know what? Life is not fair. Boo-hoo. Get on with life. There are advantages enough in the world for those with lots of money.
Hey Andrew Carnegie, titan of the capitalists, thought no inherited wealth was the way to go. Zero. Each person makes it in the world on their own steam, without the enfeebling advantage of inherited wealth.
Okay, so who really, really believes in the free market?
i-holier-than-thou at July 19, 2009 7:59 PM
i-holier - Just for you.
http://query.nytimes.com/mem/archive-free/pdf?_r=1&res=9F02E2DA1138E033A25751C0A9679C94649FD7CF
Socialist.
Feebie at July 19, 2009 8:42 PM
"rich people end up subsidizing it, you know what? Life is not fair."
It's been widely recognized already the rich can't pay for it all. Which means everyone down to the pay-no-tax level will subsidize it for the rest. Personally, we don't make much, esp for a family of 6. But we have health insurance, and we pay our bills and do ok. This will end once I am asked to kick in to cover other people's lives (more than I already do via current taxes and insurance). Plus our personal level of care will go way down. Gee, what a deal for us!!
momof4 at July 20, 2009 5:27 AM
After all the shouting, Momof4 is getting to the endpoint faster than others: When the government tells people "NFW!" to their demands for more, more, more health care, that will cause problems. But if the government does not say "NFW!", that will cause even worse problems. Because even if you take every last nickel of income and capital of the rich, the demand for health care services will remain unsatisfied.
In the end, the government is going to have to tell people that, "no, we are not going to pay for that." That bad guy role is currently played by an insurance company who will go out of business if it doesn't say that. (The government has similar excuses but no one realizes that.)
Spartee at July 20, 2009 6:01 AM
"Big city uninsured patients won't drive waaaaaay out there for the ER. "
Interesting. In a California cow country ER at 3:00 a.m. it was packed to the gills with Mexicans who don't speak English.
I came in with a medical insurance card and the shock from the admitting nurse was palpable.
I wonder how much we'd save if we'd send the uninsured illegal aliens home.
Gog_Magog_Carpet_Reclaimers at July 20, 2009 3:38 PM
But back on topic - rationing health care.
Time for news from the UK, where a young binge-drinker was denied a liver transplant and subsequently died:
http://news.bbc.co.uk/2/hi/uk_news/england/london/8159813.stm
Gog_Magog_Carpet_Reclaimers at July 20, 2009 4:36 PM
Without reading the link (no time at the moment) I'd have to say good for the UK! Refusing to change your cars oil will invalidate the warranty and cause you to have to pay out of pocket. Why should refusal to take at least a modicum of care with your body be different?
momof4 at July 20, 2009 6:11 PM
Several years ago, we were "self-insured." I had a baby that was delivered by a surprise c-section. We paid the doctor up front, in cash, and the hospital, before leaving, in cash. Three months later I had to have an emergency appendectomy. Again, we paid the hospital before leaving, in cash.
We got a 20% discount, too.
Want the name of the hospital and the surgeon, both of whom never blinked when told we didn't have insurance? Email me. I believe they are not unusual.
Karen at July 20, 2009 6:14 PM
Mom of 4, are you serious????
How about if Obamacare decides that having more than two children is a "refusal to take at least a modicum of care with your body"?
Karen at July 20, 2009 6:19 PM
I pay for private insurance. They cover maternity. All of it. It's their right (or, should be) to NOT offer that service if they don't find it profitable. It's my right (or SHOULD be) to find and buy with the company that provides the services I want.
The suckers in the UK don't GET to choose what they cover and for who in what circumstance. They're all paying for everything. And paying out the arse.
Anyway, I am in better shape and physical condition that over 90% of the US. I gave birth 8 weeks ago, and 3 weeks ago qualified for the super-premium discounted life insurance because I was in such good shape. Pregnancy and breastfeeding also bestow any number of health benefits-lower risk of breast cancer, lower risk of uterine and ovarian cancers, some benefits to your heart health, the list goes on. So really, those NOT giving birth are more likely to cost the Obamatrons money.
Anyway, livers are a very, very scarce commodity. It's stupid and in my opinion immoral to give it to someone who's proven they will not only not care for it, but will actively destroy it.
momof4 at July 20, 2009 7:21 PM
Don't bother wondering. Obamacare explicitly covers them.
We. Are. So. Fucked.
brian at July 20, 2009 9:15 PM
Hey Brian! Speak for yourself!
Crid [CridComment@gmail] at July 20, 2009 11:25 PM
Or: Speak. For. Yourself. !.
Crid [CridComment@gmail] at July 20, 2009 11:31 PM
Yeah, maybe I should renounce my citizenship and become an illegal alien. I'd have more rights than I do now.
You just don't give up, do you? Do you harp on people like this in meatspace? How many dental surgeries have you had as a result?
brian at July 21, 2009 5:07 AM
Only the deserving. In real life, people don't say silly things.
Crid [CridComment@gmail] at July 21, 2009 6:17 AM
An example came to mind! Just before receiving services, no one would ever tell a doctor "You'll get your money eventually." They wouldn't say that to an auto mechanic, or even a short-order cook.
Besides, why is it supposed to be cool with the rest of your vendors if you blow your financial brains out on health care? If, after a crisis, you're in the process of 'eventually getting the money' to your doctor, how cool is the plumber supposed to be about waiting for payment?
Crid [CridComment@gmail] at July 21, 2009 6:57 AM
And then in the commute, I was thinking about it again... You really shouldn't say nasty things about our President.
You, Mr. Uninsured American, are a datum in his spreadsheet. (You don't have insurance... because it's too expensive!) Well, our President looks at the devastation caused to individuals who (ahem) can't afford insurance, and the rippling effects throughout our communities, and he says: 'I'm here to help! I have an idea!'
The actual conduct of your affairs speaks much more clearly to the President of the United States than does any blog commentary. He uses you as a tool to push his agenda forward and believes, with good reason, that you should be grateful to him.
Crid [CridComment@gmail] at July 21, 2009 8:03 AM
Crid,
I've concluded that you are just too stupid to understand. Hospitals take payment on credit because they can. If you don't like it, too bad.
Oh, and I just had a customer change my terms to Net 60 from Net 30. What am I supposed to do? I suppose I could stop servicing them, but then they'd go somewhere else. By your lights, I should cry for a government bailout? No, it's just business.
Again, with the concentrated, industrial-strength stupid. I don't have insurance because until recently nobody sold it
No, he doesn't. He sees socialized medicine as a means to control the most intimate details of every American's private life.
No, it does not. If he thinks of people like me at all, it is as his enemy, to be subdued and brought to heel.
He doesn't see me as a tool to push his agenda forward because I'm not crying about how I can't get health care.
There's only one thing I'll be grateful for. When Barack Obama stands up and says "I have failed the people of America, and I humbly submit my resignation, effective immediately."
brian at July 21, 2009 8:29 AM
> I don't have insurance because
> until recently nobody sold it
Insurance has been available throughout the United States for centuries. I think you mean nobody sold it at a price that allowed for motorcycle payments, too.
> his enemy, to be subdued and
> brought to heel.
Yeah, Brian... He quivers in fear.
> He doesn't see me as a tool
> to push his agenda forward
> because I'm not crying about
> how I can't get health care.
You're uninsured! He thanks your for your service to the Democratic party. Ta-da!
Crid [CridComment@gmail] at July 21, 2009 8:40 AM
I love this. I love it. Don't tell me to stop, it's too fun!
You say insurance wasn't even available to you, Brian! Barack Obama wants to help! He's compassionate!
Crid [CridComment@gmail] at July 21, 2009 8:44 AM
Well, I guess it depends upon your definition of "insurance", I suppose. If by "insurance" you mean providing of financial protection from low-probability, high-cost occurrences, then no, such a thing was not available in Connecticut until recently. If however, you mean the providing of an organized system for hiding the true cost of care from the consumer while transferring the costs of maintenance incurred by the least healthy to the most healthy, then yeah, that was available.
And given that I still, at least theoretically, live in a free nation, I can choose not to blindly finance that kind of foolishness to the tune of hundreds of dollars per month.
I hope to Christ you don't believe that. Because if you do, then you really are stupid.
Barack Obama does not want to help anyone but Barack Obama. He's not compassionate, he's a fucking fascist. Healthcare nationalization is just one more step along the path to dictating the terms by which all people will ultimately live.
If agreeing with Barack Obama is your idea of fun, then you either drink too much, or you don't drink enough.
brian at July 21, 2009 8:55 AM
> Well, I guess it depends upon your
> definition of "insurance"
That's very Clinton of you! Obama appreciates the way you muddy the waters as he advances his initiatives!
> I still, at least theoretically,
> live in a free nation
Well, not entirely "free": Eventually, they'll get their money... You promised!
Crid [CridComment@gmail] at July 21, 2009 9:02 AM
Leave a comment