Is Healthcare a "right" and should it have limits on how much is consumed and by whom?

[Lyndon]

So Republicans are less developed than Neanderthals, that makes sense!!

 

[ManSinha]

Regarding your OP, my opinion was clearly stated. Everyone should have totally FREE basic healthcare coverage. Everyone should have it for as long as they need it. It may not be a constitutional right, but it is certainly an obligation of the government. Many other countries can afford it, so why not us. Because of the Trillions of dollars wasted on regime-change wars to profit the industrial war complex. Because of the high salaries that doctors command for their services. Because of the high cost of insurance premium. And because of the unnecessary high cost of drugs, levied by the drug industry. We can also increase the taxes of those making more that $200,000. Once we address these things, having universal health care for all will never again be a topic of discussion. Anyway, these are my 2 cents.

Go Tulsi.

I have no reservations at all about the basics of care and even advanced treatments that are pushing the known frontiers once they are acknowledged to be useful and not just another expensive approach that has the same results as a known more economical one.

Given my skewed experience in this (Ex ICU doc) my question was more centered about those families that insist on keeping existing individuals like after advanced dementia and stroke - when every neurological / neuropsychiatric test has shown that the person is no longer mentating anymore. My use of the word existing rather than living is very deliberate.

Now I know that there are people who insist that all life is sacred and worth preserving but that goes back to the anecdote that happened with me personally a long time ago and is described in the OP -

Will we have stringent opposition (and is that justified) to setting limits on how much can be spent on a single individual when they are not able to decide for themselves or when there is general consensus based on years of direct observation and study that recovery is well nigh impossible?

 

[tas8831]

I love not being subjected to the whims of do-gooders who try to get the government to do their dirty work.

Buddhistic Panenthetic Jesusonian

I'm guessing the above is ironic?

 

[BSM1]

Buddhistic Panenthetic Jesusonian

I'm guessing the above is ironic?

Your beliefs should not preclude you being a door mat...

 

[Lyndon]

Your beliefs should not preclude you being a door mat...

Your beliefs are not as compassionate as the Neanderthals!!

 

[BSM1]

Your beliefs are not as compassionate as the Neanderthals!!

I wish you as much joy and happiness as I have found in my life.

 

[Milton Platt]

What he's talking about, is Medicare negotiates a lower payment for services (they don't pay list price for doctors, meds, or hospital tests etc), just like the insurance companies do, not greater cost to the consumer.

For medical services, yes...they set a price they will pay, (not to be confused with negotiation) which may or may not be what it costs to actually provide the service, which is why many physicians do not accept Medicare patients.

My understanding is that currently only Medicare Part B negotiates prices on prescription drugs, basic medicare coverage for this is not negotiated. I would assume that other medicare supplements provided by private companies also negotiate these costs. However, the Trump administration has recently moved to allow negotiation of drug prices by Medicare. We'll see how the legislation shakes out.

 

[ManSinha]

For medical services, yes...they set a price they will pay, (not to be confused with negotiation) which may or may not be what it costs to actually provide the service, which is why many physicians do not accept Medicare patients.

My understanding is that currently only Medicare Part B negotiates prices on prescription drugs, basic medicare coverage for this is not negotiated. I would assume that other medicare supplements provided by private companies also negotiate these costs. However, the Trump administration has recently moved to allow negotiation of drug prices by Medicare. We'll see how the legislation shakes out.

Small correction - the part associated with drug coverage is Medicare D - and per my understanding they were not allowed to negotiate drug prices until recently

 

[Lyndon]

Actually most doctors and hospitals accept Medicare, it Medcaid that many won't accept, they pay less. Medicare pays pretty well, which is why Medicare for all would be incredibly expensive unless things changed.

For medical services, yes...they set a price they will pay, (not to be confused with negotiation) which may or may not be what it costs to actually provide the service, which is why many physicians do not accept Medicare patients.

My understanding is that currently only Medicare Part B negotiates prices on prescription drugs, basic medicare coverage for this is not negotiated. I would assume that other medicare supplements provided by private companies also negotiate these costs. However, the Trump administration has recently moved to allow negotiation of drug prices by Medicare. We'll see how the legislation shakes out.

 

[Milton Platt]

Actually most doctors and hospitals accept Medicare, it Medcaid that many won't accept, they pay less. Medicare pays pretty well, which is why Medicare for all would be incredibly expensive unless things changed.

That may well be, Lyndon. I was going off of memory.
I think that Medicare for all doesn't have to be "incredibly expensive". Everyone is taking an "all or nothing" approach to it. I see no reason why it can't cover basic well being visits to the doctor, as well as things like vaccines, and perhaps some other basic needs. There could also be an income cap at which it phases out. The catastrophic illnesses could be covered by private insurance, which should be cheaper. Haven't given a lot of thought to the subject, just saying it would be good to have an objective look at the subject and to realize it is a sliding scale.

 

[Milton Platt]

Small correction - the part associated with drug coverage is Medicare D - and per my understanding they were not allowed to negotiate drug prices until recently

Yes, drug is part D. Drug prices are not negotiated at this time. But Medicare part B(which includes some drugs),, which is the first step above the basic Medicare plan is allowed to negotiate pricing, I think. I read up a little, but it gets confusing.

 

[sealchan]

The debate over the provision of healthcare in the US has raged for years and seems to be ramping up. I have had a very narrow view of those who consume it but I am reminded of an incident from my past:

Very unfortunate pregnant young lady with little pre natal care was brought to us in late stages of pregnancy with very very high blood pressures. They delivered the child (since that is the only thing that will allow the patient's pressure to be controlled effectively) but she had a major brain bleed and became a person who exists rather than lives.

No brain activity after several days and the family agonized about what to do. The father wanted the plug pulled and the husband did not. Finally he asked for their pastor. I requested to sit in the conversation as a mute observer. I shall take with me to my grave what the pastor kindly said to the husband: "If God wanted us to live on a breathing machine; He would have sent us all with one. The soul has left; the person you knew as your wife is no longer; it is time to let the body go"

On the flip side I see families of people who have very advanced diseases sometimes like dementia, demand that everything be done to keep them going. What are various religious view points if any?

For my own - if I am not mentating (meaning my brain is irreparably damaged), I am happy to be let go.

I think these are two separate questions...we do not want to get too much involved in mandating what is enough medical care for someone via our attitudes towards access to healthcare. This would unnecessarily complicate things. It is like focusing on abortion without addressing all of the surrounding issues that promote such considerations to become practical realities.

I think that whatsoever humans determine should be a right is how a right is made. If a society can achieve something as a human right then it should implement that.

Actually that is already the case, the debate is simply a matter of how to pay for it.

DNR instructions are ideal in that they reflect the wishes of the individual when they are unable to speak for themselves.

 

[Truly Enlightened]

I have no reservations at all about the basics of care and even advanced treatments that are pushing the known frontiers once they are acknowledged to be useful and not just another expensive approach that has the same results as a known more economical one.

Given my skewed experience in this (Ex ICU doc) my question was more centered about those families that insist on keeping existing individuals like after advanced dementia and stroke - when every neurological / neuropsychiatric test has shown that the person is no longer mentating anymore. My use of the word existing rather than living is very deliberate.

Now I know that there are people who insist that all life is sacred and worth preserving but that goes back to the anecdote that happened with me personally a long time ago and is described in the OP -

Will we have stringent opposition (and is that justified) to setting limits on how much can be spent on a single individual when they are not able to decide for themselves or when there is general consensus based on years of direct observation and study that recovery is well nigh impossible?

There are 5 corporate industries that control everything you hear, see, or read. This includes the control of NBC, MSNBC, ABC, CNN, Fox News, and their affiliates. These are the military industrial complex, the fossil fuel industries, the tobacco industries, the pharmaceutical industries, and wall street's special interest lobbyists industries. If the media repeated that s**t was now good to eat, guess what would be new on the menu, and the next talking point? Why is it that 96% of the global insulin market is controlled by only three originator companies? Not much room for any realistic challenge, or competition? If you believe that there is not enough money to provide basic healthcare, or protect our environment, or provide affordable housing, or have access to free education, then you are just another corporate talking head, and simply believe what you're being told(divisiveness) We are not talking about if you will ever own a Jaguar XJR-15. We are talking about something that every single person will need at some time in their future. Production costs and potential prices for biosimilars of human insulin and insulin analogues

Corporations are only interested in their bottom line, not in the suffering of people. How much suffering did the tobacco and alcohol industries cause? In spite of all this suffering, did their prices go up or down? Stop spending trillion of dollars on the wars that we create, to increase the wealth of the few. Why not use the war dividends to support programs that are of interest for the many?

This is a non-issue, and a no-brainer. Unless your longevity is based only on how long you have left on a clock("In Time"), you will be treated for many age related conditions and diseases before you die. Barring accidents or acts of criminality, this is a certainty.

Are you really comparing taking away the decision-making rights of women about their own body, with the decision to pull the plug on a brain-dead patient? Let me rephrase, I support comprehensive free healthcare for all those that are not the living dead. Since, from their perspective care does not exist, I think we should focus only on the vast majority of people where care certainly does exist, but inaccessible. Using corpse's on life support, is an extreme example to attach a use-by date on healthcare for the living.

Unless you are God, then you should not terminate life, without a court-order to remove life-support. This is done by the patient's spouse, relatives, family, or partner. Or, if the patient is a DNR, or if the decision is made by someone who has the power of attorney. The last thing we need is doctors deciding who's life they should terminate. It is precisely because of your direct observation and study, that disqualifies you from making the decision. Maybe we should only allow generals to decide whether we should go to war or not? Your knowledge is limited TO the patient, not OF the patient. I believe that all life has dignity and value to someone. And, only those who know this value and dignity(and not just a dead body on organ support) , should make the decision to pull the plug.

 

[ManSinha]

Unless you are God, then you should not terminate life, without a court-order to remove life-support. This is done by the patient's spouse, relatives, family, or partner. Or, if the patient is a DNR, or if the decision is made by someone who has the power of attorney. The last thing we need is doctors deciding who's life they should terminate. It is precisely because of your direct observation and study, that disqualifies you from making the decision.

Actually - you bring up a great point - that would be "who decides"

In my world - physicians are excluded from such decision making. The group would comprise perhaps ethicists, community members, religious leaders, family members lawyers and perhaps an uninvolved physician who would be there only to answer general medical questions that might arise but absolutely the treatment team would be sitting this discussion out completely.