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Should We Allow The Uninsured To Die?

What you're describing are the ObamaCare Death Panels that Governor Palin identified. There's nothing wrong with them other than so bureaucrat is deciding life and death issue by formula.

We have to have death panels. The issue comes down to how to implement them.

Here is P.J. O'Rourke paraphrasing Milton Friedman's insights on choices and behavior with regard to spending money:


"1. You spend your money on yourself. You're motivated to get the thing you want most at the best price. This is the way middle-aged men haggle with Porsche dealers.

2. You spend your money on other people. You still want a bargain, but you're less interested in pleasing the recipient of your largesse. This is why children get underwear at Christmas.

3. You spend other people's money on yourself. You get what you want but price no longer matters. The second wives who ride around with the middle-aged men in the Porsches do this kind of spending at Neiman Marcus.

4. You spend other people's money on other people. And in this case, who gives a sh*t?"​


As someone else has already noted, we spend a vast chunk of national wealth on medical spending for dying patient's last month of life. The reason we can do this is that the patient and the family can scream and shout and throw tantrums and the physicians simply don't need to be fiscally responsible because they're all playing with "other people's money." See point #4.

We need to revamp our elder care system so that it caps lifetime medical spending and allow for some portion of a residual to revert to the person's estate. All throughout history and across many cultures, old people chose to die when their survival meant impoverishing their families. Now old people are willing to spend hundred's of thousands of borrowed dollars that our kids will have to repay so that they can stay alive for a while longer.

Let the old person realize that if they want to fight for life to the very last possible moment that it will deplete their estate and leave their heirs nothing but that if they choose to die with dignity, on their own terms, that they will be strengthening their heirs by passing on some of their wealth.

Put the cost decisions regarding end of life care into the hands of patients and/or their designated guardians and let them make the decisions with respect to THEIR OWN MONEY.

Seriously, show me the "death panels" Palin was teferring to or lose all credibility with me. (Not that you care, I'm sure, but and you'll gain substantial credibility if you do.)
 
You know what? It is easy to let someone else's kid die. Look at how many die in Africa during famine. I'd be very surprised if 1 out of 200 lost even a moment's sleep after watching reports of such deaths.

Well yeah, exactly. You claim that if we were the ones being taxed, we wouldn't be in favor of raising taxes. I claim that if it was your kid who was dying and you couldn't afford to save them, you'd be in favor of universal health care.
 
Seriously, show me the "death panels" Palin was teferring to or lose all credibility with me. (Not that you care, I'm sure, but and you'll gain substantial credibility if you do.)

Well, there are none in Obamacare. That was just a myth. Such things do (sort of) exist, though. Basically, in a universal health care system, you can't pay for all the treatments everyone needs, so you've got to make some choices about who gets treated and who doesn't. They can still pay for it themselves if they want to, of course, and in most systems, they can also buy private insurance if they don't like the public.
 
Cheap procedures are so rare these days.

Not necessarily. An appendectomy is a cheap procedure, without which a person has a 100 percent fatality rate. That's the sort of thing that should always be available.
 
Well, there are none in Obamacare. That was just a myth. Such things do (sort of) exist, though. Basically, in a universal health care system, you can't pay for all the treatments everyone needs, so you've got to make some choices about who gets treated and who doesn't. They can still pay for it themselves if they want to, of course, and in most systems, they can also buy private insurance if they don't like the public.

We do that now already. Biological qualification is an aspect but so is financial qualification.
 
Well, there are none in Obamacare. That was just a myth. Such things do (sort of) exist, though. Basically, in a universal health care system, you can't pay for all the treatments everyone needs, so you've got to make some choices about who gets treated and who doesn't. They can still pay for it themselves if they want to, of course, and in most systems, they can also buy private insurance if they don't like the public.

Thanks! I knew that, but "death panel" is on my PR ****list. "Deadly Spin" by Wendell Potter (former health insurance industry PR exec) is an excellent dissection of the anti-healthcare PR campaign.

What the term was referring to was "end of life counseling". Blood Libel, anyone? Palin sucks.
 
By making insurance really insurance, and not a "catch all payment plan", the costs would go down as would premiums, making them more affordable to those who may not today, be able to purchase them. Such a move would also cut the exorbitant costs of hospital stays, procedures and treatments since the inflated costs are being addressed. By allowing people to get insurance from any state and not just within their own would also drive down costs. There are a few measures which would address this, but that's not where we as a country are right now unfortunately.

What about the people that WONT buy it at any price...thats my entire issue.....who pays for them...since the gop is against any mandates that forces individuals to buy insurance...
Last year 400,000 illegal immigrants ran over the border and gave us the privledge to pay for their child births...that includes all extended stays and issues...who pays for them.
They say 40,000,000 americans dont have insurance...10 to 20 % are out of work....millions more are under employed...walmart is the biggest employer in the country and most of their workers are partime....dont try and hand me that we can make it affordable because thats just not true...the same people that cant afford now wont afford it then...and the same people that wont buy it now ...wont buy it then...
 
I think "it" goes beyond a question like that.

Alright, that was a cheap shot. Seriously though, are you suggesting that rich people are inherently more valuable and more worth saving than poor people?
 
Seriously, show me the "death panels" Palin was teferring to or lose all credibility with me. (Not that you care, I'm sure, but and you'll gain substantial credibility if you do.)

Notorious Right Wing Propaganda Machine, THE NEW YORK TIMES:


When a proposal to encourage end-of-life planning touched off a political storm over “death panels,” Democrats dropped it from legislation to overhaul the health care system. But the Obama administration will achieve the same goal by regulation, starting Jan. 1. . . . .

The rule was issued by Dr. Donald M. Berwick, administrator of the Centers for Medicare and Medicaid Services and a longtime advocate for better end-of-life care.

“Using unwanted procedures in terminal illness is a form of assault,” Dr. Berwick has said. “In economic terms, it is waste. Several techniques, including advance directives and involvement of patients and families in decision-making, have been shown to reduce inappropriate care at the end of life, leading to both lower cost and more humane care.”​


More on Berwick:


Obama has doubled down on his unpopular Obamacare. The President ducked Senate confirmation and instead used a recess appointment to make Dr. Donald Berwick administrator for the Centers for Medicare and Medicaid Services (CMS). Berwick will be responsible for implementing portions of Obamacare. CMS has an annual budget of some $800 billion and is responsible for the heathcare of 100 million Americans.

Conservatives are angry that the President used his extraordinary power to avoid a public hearing, which would have generated testimony from Dr. Berwick and may have exposed him as being too extreme to run CMS.

Berwick’s public statements often raise eyebrows. Regarding end-of-life care, he told the Annals of Internal Medicine in 2002 that “most people who have serious pain do not need advanced methods, they just need the morphine and counseling that have been available for centuries.” This troubling statement doesn’t give much confidence to seniors that, as a bureaucrat, Berwick will care about costly end-of-life treatment when rationing Obamacare’s “benefits.”

The doctor also professed his love for Britain’s Socialist healthcare system and favors a single-payer government-run system for Americans. He wrote in 1996 that “I admit to my own devotion to a single-payer mechanism as the only sensible approach to healthcare finance that I can think of.” President Obama avoided a public hearing for Dr. Berwick when he used the special appointment power used by President Bush and objected to by Senate Democrats at the time.​


Background on QALY ("quality-adjusted-life-year") that Berwick is instrumental in popularizing in health policy circles:


If you are under the impression that it is impossible to calculate the value of a human life, you are obviously not a progressive policy expert or health care bureaucrat. This calculation, so elusive for philosophers and sages throughout the millennia, is child's play for such people. They have, in fact, already devised a formula for pricing out your life. It is called the "quality-adjusted-life-year" (QALY), and it assigns a numerical value to a year of life. A year of perfect health, for example, is given a value of 1.0 while a year of sub-optimum health is rated between 0 and 1. If you are confined to a wheelchair, a year of your life might be valued at half that of your ambulatory neighbor. If you are blind or deaf, you also score low. All that remains is to assign a specific dollar value to the QALY and, voilà, your life has a price tag.

And, lest you imagine that QALY is mere academic concept unlikely to be applied in the real world, it is already being used in countries burdened with socialized medicine. In Great Britain, for example, the National Institute for Health and Clinical Excellence (NICE) uses "cost per QALY" to determine if patients should receive expensive treatment or drugs. It was with this formula that NICE calculated the precise amount six months of an average Brit's life is worth. As the Wall Street Journal reports, "NICE currently holds that, except in unusual cases, Britain cannot afford to spend more than about $22,000 to extend a life by six months." In other words, patients whose country has guaranteed them "free" health care are in some cases refused treatment because the incremental cost per additional QALY is too high.


Death Panel type decisions have already started:


According to Sally Pipes, president of the Pacific Research Institute, the FDA’s decision is not based on the best outcome for patients but instead on the expense of Avastin, produced by Genentech, which can run as high as $90,000 per year for a single patient.

“The FDA claims its decision had nothing to do with Avastin's cost and was based solely on the drug's medical effectiveness,” Pipes said. “This isn't believable. Every year about 40,000 American women die from breast cancer. Avastin is the last hope for many not to meet that fate. While the drug is costly, it often provides immense benefits to patients.”

Avastin works by cutting off blood flow to tumors, and it has been used by thousands of women to treat late-stage breast cancer. Pipes points out clinical studies have shown improved survival rates for women who use the drug.

“By restricting blood flow to tumors, the medicine can decelerate cancer growth. In one clinical trial, 52 percent of women saw their tumors stop expanding or spreading. Some have gained years of extended life.

“Most major cancer groups think that's enough. Susan G. Komen and the Ovarian Cancer National Alliance urged the FDA to maintain approval of the drug, arguing that treatment choices should be left to patients and doctors—not a government agency,” Pipes added.​


As I noted above, I have no problem with the concept of rationing medical care, my problem is with the centralizing of that decision making authority. This is where I part company with conservatives who oppose ObamaCare - they pretend that we can continue to have a system characterized by no rationing. They're delusional if they actually believe that. My position is to put the rationing decision into the hands of the patient and/or immediate family.
 
Well yeah, exactly. You claim that if we were the ones being taxed, we wouldn't be in favor of raising taxes. I claim that if it was your kid who was dying and you couldn't afford to save them, you'd be in favor of universal health care.

If your daughter or wife is raped and murdered should you be allowed to sit as judge for the trail of the accused rapist/murderer?

Making policy decision based on personal circumstances is extremely unwise.
 
Alright, that was a cheap shot. Seriously though, are you suggesting that rich people are inherently more valuable and more worth saving than poor people?

In a social welfare state, **** YEAH. There's no debate when you use objective measures. In a non social welfare state the issue doesn't come up at all because no one but them is paying for their own care and in such a society everyone's life is worth the same.
 
If your daughter or wife is raped and murdered should you be allowed to sit as judge for the trail of the accused rapist/murderer?

Making policy decision based on personal circumstances is extremely unwise.

No, but you might suddenly find yourself in favor of the death penalty or looser gun laws.
 
Alright, that was a cheap shot. Seriously though, are you suggesting that rich people are inherently more valuable and more worth saving than poor people?

No absolutely not.

At the ripe old age of 44 I'm facing a heart transplant and I do not know how any family could not do this with out the help of Social Security. I collect benefits including Medicare.
 
In a social welfare state, **** YEAH. There's no debate when you use objective measures. In a non social welfare state the issue doesn't come up at all because no one but them is paying for their own care and in such a society everyone's life is worth the same.

You lost me.
 
You lost me.

A social welfare state needs money in order to operate, just like a body needs blood to keep all the organs functioning. A rich person provides a lot of money for the social welfare state to spend. A poor person provides no money, in fact, they are the recipient of money provided by the rich person. In a social welfare state the rich person is more valuable than the poor person. If you could conduct a Gedankenexperiment and vaporize the top 100,000 income earners in the US or the bottom 100,000 income earners in the US and then measure the effect of those vaporizations on the rest of society, you'd find that all of the wealth that the top 100,000 generated via their talents has been lost to society and that society is now measurably poorer for having lost those 100,000 top income earners. On the other hand, with the bottom 100,000 income earners vaporized you find that society is now measurably richer because the wealth that is extracted from the NET CONTRIBUTORS of taxes can now be allocated to a smaller base of NET RECIPIENTS, thus making all of the recipients that much better off.

In a non welfare state, that is in a society with no government mandated wealth redistribution, if you did the same Gedankenexperiment there would no spillover effects to the rest of society for governments don't redistribute wealth and because of this the wealth that disappeared would have no effect on the rest of society. In this society everyone's life is valued equally.
 
A social welfare state needs money in order to operate, just like a body needs blood to keep all the organs functioning. A rich person provides a lot of money for the social welfare state to spend. A poor person provides no money, in fact, they are the recipient of money provided by the rich person. In a social welfare state the rich person is more valuable than the poor person. If you could conduct a Gedankenexperiment and vaporize the top 100,000 income earners in the US or the bottom 100,000 income earners in the US and then measure the effect of those vaporizations on the rest of society, you'd find that all of the wealth that the top 100,000 generated via their talents has been lost to society and that society is now measurably poorer for having lost those 100,000 top income earners. On the other hand, with the bottom 100,000 income earners vaporized you find that society is now measurably richer because the wealth that is extracted from the NET CONTRIBUTORS of taxes can now be allocated to a smaller base of NET RECIPIENTS, thus making all of the recipients that much better off.

In a non welfare state, that is in a society with no government mandated wealth redistribution, if you did the same Gedankenexperiment there would no spillover effects to the rest of society for governments don't redistribute wealth and because of this the wealth that disappeared would have no effect on the rest of society. In this society everyone's life is valued equally.

Well, as long as we're being overly cynical, welfare states have death taxes, remember? So if a rich person were to die, the state would be able to unfairly claim even more of their wealth. Muahahahaha.

Back in reality, unless a procedure is prohibitively expensive, it's to the state's advantage to give it, because a sick or dead worker isn't gonna do much work. If it is prohibitively expensive, the rich person will be fine anyway, because they can afford it. Of course, that's under the assumption that the worker is employed, which is another thing socialism is good at.
 
Well, as long as we're being overly cynical, welfare states have death taxes, remember? So if a rich person were to die, the state would be able to unfairly claim even more of their wealth. Muahahahaha.

Your Kung-Fu is strong but my Kung Fu is stronger. Hah. Hah.

I have anticipated your response and that is why I referenced "income earners" instead of "wealthy people." The income earners are using their talents to create new wealth every year whereas the wealthy are riding into the future on the benefits that they've already earned in the past.

Back in reality, unless a procedure is prohibitively expensive, it's to the state's advantage to give it, because a sick or dead worker isn't gonna do much work. If it is prohibitively expensive, the rich person will be fine anyway, because they can afford it. Of course, that's under the assumption that the worker is employed, which is another thing socialism is good at.

This puts the state into the position of Death Paneling people. You note that it is in the "state's interest." That's the problem that people have with Death Panels.

I don't want the value of my life to be calculated by some bureaucrat who looks at what I contribute to the state versus what I cost the state. When people become dependent on government's money and good graces then they are also at the mercy of government. I'd rather know that I have a fixed amount of resources available to me with which I have to provide for my expensive medical care needs and know that when it comes time to ration those resources that I, or my loved ones, will be making the decisions and that if there is money to be saved that it be saved and allocated to help my family and that if they don't want the money then they can decide to blow the whole wad on keeping me alive hooked up to machines for another 4 months. Society really has no business involving itself in my end of life choices and journey.
 
Your Kung-Fu is strong but my Kung Fu is stronger. Hah. Hah.

I have anticipated your response and that is why I referenced "income earners" instead of "wealthy people." The income earners are using their talents to create new wealth every year whereas the wealthy are riding into the future on the benefits that they've already earned in the past.

Ah. But the working class are income earners, remember? More so than the wealthy living on their past success or their inheritance.

This puts the state into the position of Death Paneling people. You note that it is in the "state's interest." That's the problem that people have with Death Panels.

I don't want the value of my life to be calculated by some bureaucrat who looks at what I contribute to the state versus what I cost the state. When people become dependent on government's money and good graces then they are also at the mercy of government. I'd rather know that I have a fixed amount of resources available to me with which I have to provide for my expensive medical care needs and know that when it comes time to ration those resources that I, or my loved ones, will be making the decisions and that if there is money to be saved that it be saved and allocated to help my family and that if they don't want the money then they can decide to blow the whole wad on keeping me alive hooked up to machines for another 4 months. Society really has no business involving itself in my end of life choices and journey.

If people want additional care, they're free to buy it themselves. I'm sure someone would sell "extreme case" insurance for things that the government won't cover. Also, you say that you don't want society involved in your end of life choices. Well, that's basically what a "death panel" is: Society is removing itself from your medical care. It's not like the government is executing you itself or denying you care or something. They're just not paying for it anymore.
 
If people want additional care, they're free to buy it themselves.

You're undermining the whole case for UHC. Look at what's going on in Canada. It used to be the case, and I think it still might be in some provinces, that you couldn't buy additional care. They frame this debate as "two-tier" health care. One side wants to have a system where one can buy additional care or just leave the public system. The other side is adamantly opposed to this because it will privilege those with resources over those without the same level of resources. This latter group is actively working to restrict the system to a one-payer model.
 
Except that suggesting we raise taxes has been borderline political suicide since Reagan. Don't you hate it when reality disagrees with your position?

So now, instead of raising taxes, they just borrow obscene amounts of money and spend it anyhow. They're still spending beyond their means regardless of where the money comes from.
 
You're undermining the whole case for UHC. Look at what's going on in Canada. It used to be the case, and I think it still might be in some provinces, that you couldn't buy additional care. They frame this debate as "two-tier" health care. One side wants to have a system where one can buy additional care or just leave the public system. The other side is adamantly opposed to this because it will privilege those with resources over those without the same level of resources. This latter group is actively working to restrict the system to a one-payer model.

I don't support that. As I've said before, I don't care if some people have more as long as everyone has enough. "Enough" is hard to define in this situation, but I think you get my point.
 
I don't support that. As I've said before, I don't care if some people have more as long as everyone has enough. "Enough" is hard to define in this situation, but I think you get my point.

I don't, please define "enough" for the class. Is it catastrophic care? Is it preventative care? Is it anything that you can possibly have a doctor do, necessary or not? I guarantee you'll never get any agreement from everyone on what "enough" actually means.
 
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