Terry Schiavo and US Healthcare

Re: Terry Schiavo and US Healthcare

In my opinion the answer to this would be YES, and the only follow up and support I can offer for that is, why offer healthcare to one and not the other?




I thinkit would fit. How to get it to fit is a problem.
People would have to be willing to pay higher taxes for healthcare financing. ( or readjust the tax money that is already paid to fund this.. HA, that wont happen)
Drug companies need to be able to offer meds free of charge with out it throwing them into financial ruin. Same for doctors. They will need to be either REQUIRED to do a certain amout of work for free.. or be funded from possibly tax money, drug company profits.. ( ah who knows where it would come from) so that they could also offer thier services free of charge when needed.



I think that depends on where the funding for this public health care is coming from. But, my guess for a simple answer to this is
1) age...
2) income.




I would hope not. Because essentialy, what would be happening is -
Someone needs heart surgeory, and it is ABLE to be done, but they would be told it isnt going to happen for them.
If you are able to do something for someone, why wouldnt you? And how could you explain that ? How can anyone say " I can do this to save your life, but I wont"


I would say, this is where the Living Will should come in.
Maybe there should be a rule that if you are eligable for free services you HAVE to have a living will in place, A power of attorney assigned, and have more then one copy on file for easy referrance with the hospital/doctor of your choice.
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I hope that doesnt de-rail your thread. ;-)

Not at all, shewolf. Thanks for participating.

Re: Terry Schiavo and US Healthcare
Just a quick response based on first impressions.



There just have to be limits. There are only so many heart sergeons, with so many operating facilities. Again, I'll use the example of organ transplants to make the point. There are only five viable hearts available and there are twenty people whose lives depend on receiving them. There have to be limits, and someone has to make some decisions. Now, just as the supply of hearts is limited, so is the supply of money.

This is a sticky issue, but one that we have to deal with. There are finite resources in health care, as is the case everywhere else. But any politician how uses the word "rationing" may as well as retire, even though that's the reality. Maybe a kinder word is needed.

The saddest thing about the Schiavo case is that these questions aren't even entering into the debate. I can't imagine how much money has gone into keeping her maintained in her vegetative state. Somehow that's irrelevant amidst all the moral posturing going on.

Right, D'art, but if Terry Schiavo is truely in a vegetative state and unaware of her condition, we really back to the matter of resource allocation. I'm hoping we will hear from someone outside the US, and find how, or if, these resources are being allocated - that is, is there some income/need formula. Do the really wealthy pay into the system without taking out, or what. Ah, I'm sure FreeDuck will let us know if we get too far off topic.

No, you guys are doing a good job staying with the broadly defined topic.

One thing about the income criteria -- I understood shewolf's use of income as a criteria to mean ability to pay -- as in you get care if you can pay for it. I don't think income should at all be a consideration when determining what kind of care a person gets. But I am interested to know how well we can define such criteria and stay on the moral tightrope. For instance, if we had a socialized system, would Terry Shiavo's tube have been removed a long time ago to save those resources for someone who could better benefit from it? If so, would that be moral or no?

You've hit the nail on the head, FreeDuck, about what bothers me about the Schiavo case. How many low-income women could get prenatal care for the money being spent to keep Terry Schiavo alive?

That's just one question that could be asked. Why is this one life so much more important than many, many others?

So, boomerang mentioned the Oregon Health Plan as an example of the sort of thing we've been talking about (triage and prioritizing care). I found this article, which is very old, but speaks to the topic. I will look for something more recent.


http://www.findarticles.com/p/articles/mi_m1282/is_n13_v44/ai_12491105

Another interesting opinion:

http://alternativesmagazine.com/26/bayer.html

Hey! I got my pass into the debate room!

The reason I bring up the Oregon Health Plan is that it was really founded on the belief that we do have a moral obligation to provide health care for all of our citizens.

Briefly:

In the 80s Medicaide saw huge budget cuts. Most states were raising the eligibility requirements. Oregon wanted to expand coverage so instead of raising the requirements, they limited the services.

The services they offered were really good and they covered a lot of people. What they didn't cover were services that were extremely expensive, experimental and benefitted very few.

(The last big case I remember getting a "No" was for a girl who had some disease that caused her muscles and organs to become rigid. She needed a heart/lung/liver transplant. If she survived all of the transplants, the transplants would still be no cure for the disease.)

The fact is that most doctors were uncomfortable denying treaments not covered so the treatments were provided anyway.

We raised the cigarette tax to help pay for things.

Things clicked along pretty well until 2003 when the economy soured, voters rejected a tax that would help keep the OHP solevent (a tax, which, by the way, would have cost us about $107 per person) and serious cuts had to be made.

Here's an example of what happened:

We cut prescripton benefits. One guy, who needed $14 worth of medicine each day, had his benefits cut. He had a seizure and ended up in the hospital at over $7,000 a day.

Who ended up paying for his "treatment"?

Me and you!

Through our taxes and through increased premiums to our insurance companies.

John Kitzhauber, ex-governer of Oregon, recently wrote:

It is a policy that says we will not pay to manage hypertension in the community, but we will pay to care for the victim of a massive stroke in the hospital; that we will not pay to provide all pregnant women with good prenatal care, but we will pay to resuscitate their 500 gram infants in a neonatal intensive care unit. And this should not be acceptable to
any of us.

And it doesn’t have to be. But the only way to stop this madness is to adopt an explicit policy of universal coverage. In other words, we need to approach our health care system with the same eye to equity and sustainability with which we approach public education.

I really encourage you to read Kitzhauber's paper on health care reform: www.cciservices.com/webdocs/2005ConfKitzhaber.pdf

He says it much better than I ever could and he really address' all of the points in this thread's inital post.

I hope I haven't strayed to far afield!

You're right on target, boomer, and welcome!

Thank you!

I've tried posting that link two ways and still can't make it work from here. It's a great paper and well worth reading - maybe if you copy and paste it into your browser.....

One really great analogy that Kitzhaber makes is that when budget cuts force us to turn to education that we don't decide we will no longer send anyone over 16 to school - we make hard decisions about class size and courses offered and maybe shorten the school year - we ration education.

His point being that we should treat health care with the same careful rationing.

It works for me. Reading it now...

A kind of interesting anecdote from boomer's article:

It depends: The easy answer is: yes. But is this not really the hopeful answer to the question: Can we provide healthcare to all? (The term "citizen" excludes those who, presently, are not citizens and who are currently receiving such benefits via the welfare systems of the states.) However, the original question posed implies: "equal and efficacious treatment for all". The past and present practical application of socialized medical treatment has not met this standard. The main comparative instances are the Canadian and United Kingdom systems. In these we find those that can, obtaining their health care from outside the system. Indeed, the extreme case was the Soviet healthcare system which was scrupulously avoided by VIP's and such. A better example of a more "ideal" social health care institution we find in Scandinavia. However, this care is integrated into a very comprehensive "Cradle to Grave" socialism that demands massive taxes which would be simply unacceptable in the U.S. But in all these systems we find practical limits being imposed in an effort to keep the system solvent and fair. These practical concerns then lead us to FreeDuck's next question:






The premise of this question would seem to proscribe the very free market forces that we know and love so much in America. After all, if our society has an obligation to supply equal and effective health care to all, why would we need economic forces to decide anything? We must merely fulfill the obligation. But is this possible? FreeDuck's next question and roger's "There just have to be limits" is the answer, of course, but



This question, informed by the qualification of accepted "limits" would imply the relaxation of the former obligations. That is, no such obligation actually exists that all persons must be granted equal healthcare services. In fact, health care viewed as a service most properly falls under and must be subject to market forces for its proper rationing. But, higher quality (and quantity) of goods and services demand larger compensation and this does not depend on the source of payment. It is true that if the consumer (the state) of the service purchases large amounts it is possible to lower per capita costs, but this has its limits. After these limits have been reached further cuts in quality of the service can induce a corresponding decrease in costs, but, in a socialist setting, differences in quality invite the same claims of "unfairness" as does quantity differences. The only remedy seems a socialist system informed by realistic market forces. This would suggest a basic obligatory level of health care (socialistic) upon which could be voluntarily added levels (free market) of increasing health care at the individual's expense (higher premiums and/or higher deductibles).

These questions have employed the term obligation, but as noted, this is misapplied in assigning healthcare responsibility to the state. We always subject ourselves to disappointment regarding work product when shifting responsibility to others. Trying to gain something of value via legal plunder (taxes) and income redistribution (socialism) at little cost to ourselves is always a risky path. The obligation of health care certainly exists, but it resides with the individual and not the state. Indeed, it would seem more honest to ask directly for contributions to our own individual "tin cup" fund from others, rather then trying to covertly "get over" others by secretly raiding the public coffers.



Right to die? Right to life?

These are emotionally charged questions. Assuming the former is about one's "right" to commit suicide, the state's purpose is to insure and protect the individual's right of choice. But it is also the state's responsibility to protect the individual's life against those that might end it. Therefore state prosecution of those assisting human euthanasia can be rightly pursued by the state. This simply means that anyone so assisting can expect judicial and juridical review on a case by case basis. However, if the individual decides to end his life unassisted this is moot.

Right to life? This has been a term used by many to argue for a "Cradle to Grave" support for an individual's life. In the extremes (stem cells, Terri Schiavo) the argument tends to become fuzzy and fray. Indeed, the right to life argument that proscribes frozen embryos being thrown into the bio-medical waste bin rather than used for research exists purely to block entry onto the "slippery slope". That of preserving an already fully formed human life is less easily morally dismissed.

In regards to the main objective example in this thread, Terri Schiavo's right to be or not to be, it is no secret that all organized systems including the lives of human beings are subject to the second law of thermodynamics: Unless work and therefore energy is continually applied to their maintenance they will cease to exist. This work must be obtained at a cost and, even on an individual human level, this cost is substantial. As an individual becomes less and less able to take care of itself it reaches a point at which he/she can no longer supply the work or even energy so required. This is Terri's predicament presently. At this point a simple choice is to be made. The media, Congress, Terri's parents, President Bush, Theologists, and even those holding candlelight vigils tell us they choose life over death. But this is like stating one is for low unemployment, low crime rates, and healthy babies. I submit this choice is made almost automatically and in a knee-jerk manner. The real choice is lies in the question: Who supplies the energy or work to sustain Terri and for how long? More simply, who pays?

Terri's needed maintenance has, for the most part come from the state. That is, Terri's parents and her common law husband have been wrangling over life vs. quality of life issues while the taxpayers pay the bills. I have read where her father has used up his retirement to pay for legal bills/healthcare. This is admirable, but note the term "used up". Bill Schiavo has been portrayed as a cad by trying to move on with his life. Allegations of fund misuse by Mr. Schiavo, regarding the legal trust set up to pay for Terri's care has surfaced. Bill Schiavo says most went to lawyers and there is only about $60,000 left of the $1.3 million awarded in the medical malpractice judgment. The parents say they will be responsible for Terri's care given legal custody. Taking Terri's parents at their word that they have used up their financial resources, what does this mean for the taxpayers that have already shelled out the lion's share for Terri's battle with the second law of thermodynamics?

Altruism is noble but only when voluntary and utilizing one's own money. Additionally, when going hat in hand to ask for monetary assistance from strangers, one must be prepared for the likelihood of no kindness being displayed. The vilification of others that reply in the negative is possible but not without first recognizing their responsibility to their own families and personal priorities.

Given the tens of thousands of such cases that happen in this country every year why have Congressional Republicans, President Bush, and Gov. Jeb Bush fixated on this particular one? Additionally, why now and not years ago?

JM

Welcome back, James. I agree, but you express it so much better.

Well, very well-written response by JM. I have to say, though, that I read the entire article posted by boomer and it makes a lot of sense. Borrowing from the author's analogy, if we say that each individual is responsible for his or her own healthcare, shouldn't we also say that each individual is also responsible for his or her own education? But we don't because at some point we accepted the fact that a literate population is good for the country as a whole and that all children should be educated at a minimal level whether or not they can afford it. It seems obvious that a healthy population is also good for the country as a whole. Knowing how much medical care costs in this country, letting those costs fall directly on the shoulders of those requiring care will result in states (taxpayers) footing the bill anyway when they show up in the emergency room with acute conditions (having not been able to afford preventive care) and cannot pay. If the hospital eats the cost, then they get passed on to us in the form of higher prices and premiums. If they file bankruptcy, same thing.

The fact remains that if someone shows up in the hospital and needs medical attention, doctors must treat them. That's going to happen regardless of the system we have. We've agreed to pay for it (or maybe not agreed, but we are paying for it), so why not just accept that a basic level of care should be provided to all?

We, as taxpayers, are already paying taxes at a rate very close to if not equal to other countries who have such medical entitlements. The difference is, we're not getting much in return for it. As a nation, we are going to have to make decisions as to what our priorities are.

Just reading here - and was struck by this question.

In Oz, we ALL pay into the health care system - unless we are too poor (or too rich in some cases!) to pay tax.

There is a Medi-Care levy for all tax-payers.

All may use the free system - hospital care is free. Some doctors in the community charge only what medicare pays them - most charge more - and there is a varying "gap".

Emergency and critical care is provided immediately. You may have to wait a long time for non-critical procedures. Therefore, quite a few of us pay also into private health cover - so that we can have elective surgery done quickly. It also covers other things - like physiotherapy, dentistry etc.

Someone like Terri - hmmmm - she would be in a high-need nursing home type facility - (a normal one could not care for her) once she was out of the (free) hospital. If she had been kept alive. There she would pay - up to about 85% of what her social security benefit would pay (she would be on some sort of incapacity benefit.) The commonwealth government would subsidise the cost of her care - which would be hugely above her pension.

Hope this is useful?